Psychogenic non-epileptic and epileptic seizures: clues for a differential diagnosis. Findings from a Colombian study. / Crisis psicogenas no epilepticas y crisis epilepticas: pistas para un diagnostico diferencial. Hallazgos de un estudio colombiano.

INTRODUCTION: Psychogenic non-epileptic seizures (PNES) are paroxysmal changes in behavior that resemble epileptic seizures, although they have no electrophysiological correlation or clinical evidence of epilepsy. AIM: To compare clinical and sociodemographic characteristics of patients diagnosed with PNES-alone and PNES-and-epilepsy. PATIENTS AND METHODS: A cross-sectional study of consecutive patients diagnosed with PNES in a 20-month period was carried out. A video-EEG was performed in all patients. Socio-demographical, clinical and semiological characteristics were compared between those patients with and without concomitant epilepsy. RESULTS: Sixty-five patients were included, 35 (53.9%) had PNES-alone and 30 (46.1%) had PNES-and-epilepsy. The proportion of women in the study was 70.8%. The median age at seizure onset was 16 years. A late start was recorded in PNES-alone group (23 years) compared to PNES-and-epilepsy group (11 years), however, it was not significant. There was a lower frequency of antiepileptic drugs use in the PNES-alone group compared with the PNES-and-epilepsy group. The most frequent semiological features were the gradual onset of events (69.2%) and the duration longer than two minutes (63.1%). CONCLUSION: The waxing and waning pattern during paroxysmal events suggest a non-epileptic origin. However, it is not uncommon to find patients with concomitant epileptic seizures.

TITLE: Crisis psicogenas no epilepticas y crisis epilepticas: pistas para un diagnostico diferencial. Hallazgos de un estudio colombiano.Introduccion. Las crisis psicogenas no epilepticas (CPNE) son cambios paroxisticos en el comportamiento que se asemejan a las crisis epilepticas, aunque no tienen correlacion electrofisiologica ni evidencia clinica de epilepsia. Objetivo. Comparar las caracteristicas clinicas y sociodemograficas entre pacientes diagnosticados con CPNE, con y sin epilepsia concomitante. Pacientes y metodos. Estudio transversal de pacientes consecutivamente diagnosticados de CPNE durante un periodo de 20 meses. A todos los participantes se les realizo un videoelectroencefalograma (video-EEG). Se compararon las caracteristicas sociodemograficas, clinicas y semiologicas entre los que presentaban y los que no presentaban epilepsia concomitante. Resultados. Se incluyo a 65 pacientes, 35 con CPNE (53,9%), y 30 con CPNE y epilepsia (46,1%). La edad mediana en el inicio del video-EEG fue de 33 años, y un 70,8% eran mujeres. La edad mediana de inicio de las crisis fue de 16 años. En el grupo de CPNE hubo un inicio mas tardio (23 años) en comparacion con el grupo de CNPE y epilepsia (11 años), pero la diferencia no fue significativa. La proporcion de pacientes en terapia con farmacos antiepilepticos fue significativamente mayor en el grupo con CPNE y epilepsia comparado con el grupo con CPNE. Las caracteristicas semiologicas mas frecuentemente encontradas fueron el inicio gradual de las crisis (69,2%) y una duracion de mas de dos minutos (63,1%). Conclusion. La variabilidad en los sintomas sugiere un origen no epileptico de los eventos paroxisticos, los cuales se presentan frecuentemente en pacientes con epilepsia.

Respiratory sinus arrhythmia in growth restricted fetuses with normal Doppler hemodynamic indices.

BACKGROUND: The autonomic behavior of growth-restricted fetuses at different evolving hemodynamic stages has not been fully elicited. AIM: To analyze the respiratory sinus arrhythmia (RSA) of growth-restricted fetuses that despite this severe condition show normal Doppler hemodynamics. SUBJECTS: 10 growth-restricted fetuses (FGR group) with normal arterial pulsatility indices (umbilical, uterine, middle cerebral, ductus venosus and aortic isthmus), and 10 healthy fetuses (Control group), 32-37weeks of gestation. METHOD: B-mode ultrasound images for visualizing fetal breathing movements (FBM) or breathing akinesis (FBA), and the simultaneous RR-interval time series from maternal abdominal ECG recordings were obtained. The root-mean-square of successive differences of RR-intervals (RMSSD) was considered as a RSA-related parameter among the instantaneous amplitude of the high-frequency component (AMPHF) and its corresponding instantaneous frequency (IFHF), both computed by using empirical mode decomposition. Mean fetal heart-periods and RSA-related parameters were assessed during episodes of FBM and FBA in 30s length windows. RESULTS: FGR and Control groups presented RSA-related fluctuations during FBM and FBA. Also, both groups showed significant higher (p<0.001) values for the mean heart-period, RMSSD and AMPHF during FBM. No-significant differences (p>0.05) were found for the IFHF regardless of breathing activity (FBM vs. FBA). CONCLUSION: Growth-restricted fetuses without evident hemodynamic compromise exhibit a preserved autonomic cardiovascular regulation, characterized by higher values of RSA and mean heart-period in the presence of FBM. This physiological response reflects a compensatory strategy that may contribute to preserve blood flow redistribution to vital organs.

[Systematic examination of the uterine cavity after parturition]. / Revisión sistematizada de cavidad uterina post alumbramiento.

The revision of uterine cavity afterbirth should be a process preventing complications immediate or late during puerperium, due to the retention of ovular remains that are not diagnosed in opportunely, avoiding so the risk that implies for the patients who show bleeding that leads them to complications of hemorrhaging in the interest of puerperal infection, with consequences so serious such as mutilation or death, otherwise undergoing surgery under poor conditions, in addition to the extra administrative costs, that imply surgery and those costs, derived from hospitalization; 1,205 patients were studied. On 1,155 the revision of the uterine cavity was performed; only one of them developed complications irrelevant to the process, consisting in fever, uterine subinvolution, more than normal hemorrhaging. On fifty patients the uterine cavity afterbirth was not found, fourteen patients experienced greater than normal hemorrhaging and hypothermia two to five days after being released, caused by the presence of ovarian remains, requiring posterior hospitalization. One patient experienced inflammation of the peritoneo due to the presence of placental remains.

Effects of fetal respiratory movements on the short-term fractal properties of heart rate variability.

We evaluated the effect of fetal respiratory movements (RM) on the heart rate (HR) fractal dynamics.Abdominal ECG recordings were collected from low-middle-risk pregnant woman at rest. Mean gestational age was 34.8 ± 3.7 weeks. Ultrasound images were simultaneously acquired determining if RM were exhibited by fetuses. 13 pairs of HR series were compared. Each pair included 5 min of data from the same fetus either during the manifestation of RM or when there was no persistent indication of them. Detrended fluctuation analysis was applied to these series for obtaining the scaling exponent α1. HR series were also assessed using the conventional parameters RMSSD and HF power.The main findings of this contribution were the lack of significant changes in the scaling exponent α1 of fetal HR fluctuations as a result of RM. By contrast, HF power and RMSSD did show significant changes associated with the manifestation of fetal RM (p < 0.001 and p < 0.05, respectively). Yet the scaling exponent was the only parameter showing a significant relationship with the particular frequency of fetal RM (r s  = 0.6, p < 0.03). Given the invariability of α1 regarding the manifestation of fetal RM, we consider that the HR short-term fractal properties are convenient for assessing the cardiovascular prenatal regulation.

Characterization of EHG contractions at term labor by nonlinear analysis.

Uterine electromyogram on the abdomen of pregnant women (electrohysterogram, EHG) plays an interesting role to evaluate possible risks to the binomial mother-fetus. In this sense, the present study explored the characterization of contractions by EHG during active phase of labor at term in a population at low risk. The goal was to investigate the differences in the contractions generated by women that evolve labor to a vaginal delivery (group 1) to those associated with caesarean section (group 2). Abdominal signals were acquired using Ag-AgCl electrodes in a bipolar configuration and the EHG was obtained by band-pass filtering in the range of 0.3 to 4 Hz. Sample entropy (SampEn) was used to calculate the irregularity of manually selected contractions of the EHG time series. The results showed that it is plausible to discriminate contractions from both groups as the average SampEn was 2.1359 with a standard deviation of 0.0583 for group 1 (N=8), while for group 2 (N=8) was 2.0352 with standard deviation of 0.0946; it was found significant statistical difference between groups as p was 0.046. Consequently, the nonlinear analysis via SampEn of EHG could provide an index to evaluate the quality of the active phase labor at term.

Short-term heart rate dynamics of pregnant women.

Aiming to detect the stage of gestation where dynamical changes of the RR fluctuations may occur, we assessed short-term fluctuations of low risk pregnant women. Ninety six, 10min ECG recordings were collected along gestation (7 to 39 weeks). Corresponding RR fluctuations series were analysed to obtain the RMSSD, α(1), α(1(mag)) and α(1(sign)) parameters. Four groups covering first, second and last trimesters of gestation were conformed. No significant changes in α(1), which was close to unit, and α(1(sign)) among gestational groups were identified. But, in accordance with previous findings, we did find a significant reduction of RMSSD along gestation, and significant short-term changes that indicate a higher degree of nonlinearity after about 26 weeks of gestation (α(1(mag))>0.5)). These results suggest that the short-term heart rate dynamics of low risk pregnant women do not become compromised during gestation, despite the increased haemodynamic demands and other ongoing adaptations. Yet the complexity of the mechanisms involved in the cardiac regulation of pregnant women does seem to increase from mid-pregnancy, possibly owing to new short-term control influences or to modifications regardless the strength of the regulatory interactions.

Prenatal RR fluctuations dynamics: detecting fetal short-range fractal correlations.

OBJECTIVE: Several studies have suggested that the analysis of heart rate variability (HRV) during gestation provides indications of the development or maturation of fetal cardiovascular regulatory mechanisms. In this study, we evaluate the existence of short-range fractal-like correlations in fetal RR fluctuations data from the second half of human gestation. METHODS: Fifty-six short-term abdominal ECG recordings were obtained from low-middle-risk pregnant women. Gestational age varied from estimated 21 weeks to term. For comparison, RR-interval data of 51 healthy adults were also analysed. RESULTS: Principal findings along the gestational period explored were the existence of fractal RR dynamics in prenatal fetal data as revealed by the short-range scaling exponent alpha(1). No significant differences of alpha(1) (p = 0.4770) were found between fetal (median 1.2879) and adult data (median 1.3214), either between the fetal cases before or after 24 weeks (p = 0.6116) despite observing more variation at early stages. However, fetal RR data did involve lower magnitude in comparison with adults as we found significant differences in pNN20 and SDNN values. CONCLUSION: The fetal short-range fractal behaviour of RR data could then be linked to the functional development of the parasympathetic activity, which appears to become manifested before 21 weeks of gestation.