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1.
Handb Exp Pharmacol ; 271: 379-400, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33712941

RESUMO

Temporal lobe epilepsy is considered to be one of the most common and severe forms of focal epilepsies. Patients frequently develop cognitive deficits and emotional blunting along progression of the disease. The high incidence of refractoriness to antiepileptic drugs and a frequent lack of admissibility to surgery pose an unmet medical challenge. In the urgent quest for novel treatment strategies, neuropeptides and their receptors are interesting candidates. However, their therapeutic potential has not yet been fully exploited. This chapter focuses on the functional role of the dynorphins (Dyns) and the kappa opioid receptor (KOR) system in temporal lobe epilepsy and the hippocampus.Genetic polymorphisms in the prepro-dynorphin (pDyn) gene causing lower levels of Dyns in humans and pDyn gene knockout in mice increase the risk to develop epilepsy. This suggests a role of Dyns and KOR as modulators of neuronal excitability. Indeed, KOR agonists induce inhibition of presynaptic neurotransmitter release, as well as postsynaptic hyperpolarization in glutamatergic neurons, both producing anticonvulsant effects.The development of new approaches to modulate the complex KOR signalling cascade (e.g. biased agonism and gene therapy) opens up new exciting therapeutic opportunities with regard to seizure control and epilepsy. Potential adverse side effects of KOR agonists may be minimized through functional selectivity or locally restricted treatment. Preclinical data suggest a high potential of such approaches to control seizures.


Assuntos
Epilepsia do Lobo Temporal , Epilepsia , Animais , Dinorfinas , Epilepsia do Lobo Temporal/tratamento farmacológico , Hipocampo , Humanos , Camundongos , Receptores Opioides kappa
2.
Neurosurg Clin N Am ; 33(1): 113-134, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34801136

RESUMO

This review describes the clinical presentations and treatment options for commonly recognized epilepsy syndromes in the pediatric age group, based on the 2017 International League Against Epilepsy classification. Structural epilepsies that are amenable to surgical intervention are discussed. Lastly, emerging technologies are reviewed that are expanding our knowledge of underlying epilepsy pathologies and will guide future syndromic classification systems including genetic testing and tissue repositories.


Assuntos
Epilepsia , Síndromes Epilépticas , Criança , Epilepsia/diagnóstico , Epilepsia/terapia , Humanos
3.
Clin EEG Neurosci ; 53(1): 45-53, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34558322

RESUMO

Introduction and aim: A proportion of patients diagnosed with genetic generalized epilepsy (GGE) experience eye-closure sensitivity (ECS), the underlying pathogenesis of which is unknown. In this study, we compare magnetic resonance spectroscopy (MRS) findings of healthy volunteers with patients diagnosed with GGE, with and without ECS, to detect possible explanatory differences between groups. Materials and methods: A total of 33 patients diagnosed with GGE: 17 with ECS and 16 without, and 12 healthy volunteers are included. MRS measurements of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were made of bilateral occipital lobes and thalamus, and values of patients with GGE were compared with those of normal controls, and within subgroups with different clinical variables, using appropriate statistical tests. Results: Left occipital NAA and NAA/Cr levels were found to be significantly higher in the ECS group than in the control group. In the ECS epilepsy group, a significant moderate positive correlation was noted between left thalamic Cr and duration of drug therapy (r = .539, P = .047) and left thalamic Cr and age at epilepsy onset (r = .564, P = .036). Additionally, left thalamic NAA and NAA/Cr levels were observed to be lower in GGE patients compared to healthy subjects, although not to a statistically significant degree. Conclusion:The differences in MRS-measurable metabolites in the left occipital lobe in those with ECS epilepsy suggest an association between the ECS mechanism and the left occipital lobe. Our results also support the multifocal thalamocortical pathway disorder in the pathophysiology of GGE based on the observation of cellular dysfunction in the thalamus.


Assuntos
Eletroencefalografia , Epilepsia Generalizada , Creatina , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética
4.
Clin EEG Neurosci ; 53(1): 54-60, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33356510

RESUMO

OBJECTIVE: We aimed to research the effect of cognitive tasks on interictal electroencephalographic (EEG) recordings in patients with epilepsy who had reported cognitive functions as a seizure trigger. We investigated the usefulness of cognitive function tasks as a method of activation in standard-awake EEG in daily practice. METHODS: Standard-awake EEG with cognitive activation tasks consisting of verbal and arithmetic tasks was administered to 35 (11.7%) of 299 patients with epilepsy who reported cognitive functions as a reflex seizure stimulus. During the background EEG, patients were divided into 2 groups: group 1 (17 patients) with interictal epileptiform discharges (IEDs), and group 2 (18 patients) without IEDs. RESULTS: IEDs were activated by a verbal task in 11.4% of patients and by an arithmetic task in 5.7%. All activated patients were in the genetic/idiopathic generalized epilepsy (IGE) group. In group 1, IEDs were activated in 17.6% of patients by a verbal task and in 5.9% by an arithmetic task. Both verbal and arithmetic tasks showed provocative effect in one patient in group 2. Hyperventilation was the most effective activation method, followed by cognitive activation tasks and photic stimulation. The provocative effects of verbal and arithmetic tasks were comparable to those of photic stimulation. CONCLUSION: Cognitive tasks might activate the IEDs in patients reporting cognitive functions as a seizure trigger, particularly in IGE. Brief and standardized cognitive activation tasks should be developed and applied as a method of activation during standard-awake EEG recordings to increase the diagnostic yield of EEG.


Assuntos
Eletroencefalografia , Epilepsia Generalizada , Cognição , Humanos , Reflexo , Convulsões/diagnóstico
5.
Clin EEG Neurosci ; 53(1): 74-78, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33881950

RESUMO

Objectives. There is emerging evidence that network/computer analysis of epileptiform discharge free electroencephalograms (EEGs) can be used to detect epilepsy, improve diagnosis and resource use. Such methods are automated and can be performed on shorter recordings of EEG. We assess the evidence and its strength in the area of seizure detection from network/computer analysis of epileptiform discharge free EEG. Methods. A scoping review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance was conducted with a literature search of Embase, Medline and PsychINFO. Predesigned inclusion/exclusion criteria were applied to selected articles. Results. The initial search found 3398 articles. After duplicate removal and screening, 591 abstracts were reviewed, 64 articles were selected and read leading to 20 articles meeting the requisite inclusion/exclusion criteria. These were 9 reports and 2 cross-sectional studies using network analysis to compare and/or classify EEG. One review of 17 reports and 10 cross-sectional studies only aimed to classify the EEGs. One cross-sectional study discussed EEG abnormalities associated with autism. Conclusions. Epileptiform discharge free EEG features derived from network/computer analysis differ significantly between people with and without epilepsy. Diagnostic algorithms report high accuracies and could be clinically useful. There is a lack of such research within the intellectual disability (ID) and/or autism populations, where epilepsy is more prevalent and there are additional diagnostic challenges.


Assuntos
Eletroencefalografia , Epilepsia , Estudos Transversais , Epilepsia/diagnóstico , Humanos , Convulsões
6.
Int. j. med. surg. sci. (Print) ; 8(4): 1-8, dic. 2021.
Artigo em Espanhol | LILACS | ID: biblio-1348217

RESUMO

La epilepsia engloba un conjunto de trastornos convulsivos heterogéneos, con diversas características clínicas que excluyen un mecanismo etiológico singular. Individuos con epilepsia presentan una tasa significativamente mayor de condiciones psiquiátricas y neurológicas asociadas. Niños con epilepsia tienen dos a tres veces más riesgo de desarrollar trastornos por déficit de atención e hiperactividad (TDAH) cuando son comparados con individuos sanos, mientras que uno de cada cinco adultos epilépticos presentan síntomas de TDAH. En los niños con epilepsia, la gravedad y frecuencia de las crisis y una edad más temprana de inicio de las crisis son factores de riesgo comunes para padecer TDAH. Se realizó una revisión narrativa de la literatura y se seleccionaron artículos publicados en el periodo entre el año 2003 y 2021 en bases digitales del área de la salud (LILACS, Medline, Web of Science, SciELO y PubMed). La revisión evidenció que la epilepsia puede aumentar el riesgo de desarrollar TDAH en los niños, y que la epilepsia rolándica benigna es el tipo más diagnosticado en estos niños, que incluso tiene alta tasa de trastornos neuroconductuales con síntomas de TDAH asociados. El diagnóstico temprano y un manejo apropiado, llevan a mejor pronóstico en este grupo de pacientes


Epilepsy encompasses a set of heterogeneous seizure disorders, with various clinical characteristics that exclude a unique etiological mechanism. Individuals with this disease have a significantly higher rate for the development of psychiatric and neurological conditions. Children with epilepsy have two to three times increased risk of developing ADHD when compared to healthy individuals, while one in five epileptic adults have ADHD symptoms. In children with epilepsy, the severity and frequency of seizures and an earlier age at the onset of seizures are common risk factors for ADHD. A narrative review of the literature was carried out and articles published in the period between 2003 and 2021 in digital databases of the health area (LILACS, Medline, Web of Science, SciELO and PubMed) were selected. The review showed that epilepsy can increase the risk of developing ADHD in children, and that benign rolandic epilepsy is the most diagnosed type in these children, which even has a high rate of neurobehavioral disorders with associated ADHD symptoms. Early diagnosis and appropriate management lead to a better prognosis in this group of patients.


Assuntos
Humanos , Criança , Transtorno do Deficit de Atenção com Hiperatividade , Epilepsia
8.
Orphanet J Rare Dis ; 16(1): 461, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34727962

RESUMO

BACKGROUND: Epilepsy is a neurological disorder characterized by the potential to induce seizure and accompanied by cognitive, psychological, and social consequences. CACNA1A gene is a voltage-gated P/Q-type Cav2.1 channel that is broadly expressed in the central nervous system, and the pathogenic variants within this gene may be associated with the epileptic phenotype. In the present study, we collected clinical and molecular data related to epileptic patients with CACNA1A pathogenic variants and investigated possible meaningful relationship between age at onset, neurodevelopmental disorders, type of seizures, brain imaging abnormalities, genotype, and protein domains. RESULTS: In our retrospective literature studies, from among 890 articles reviewed, a total of 90 individuals were related to epilepsy phenotype. Our findings showed that about 90 percent of patients have shown the first symptoms in childhood and teenage years and different types of neurodevelopmental disorders, such as intellectual disability, developmental arrest, and behavioral disorders, have been common findings for these patients. Further, a wide range of abnormalities have been observed in their brain imaging, and generalized seizures have been the most type of seizures in these patients. However, our data showed no specific genotype-phenotype correlation in epileptic patients with CACNA1A pathogenic alterations. CONCLUSIONS: Our study focused on epileptic phenotype in patients with CACNA1A pathogenic variants and showed a wide range of clinical and molecular heterogeneity with no specific genotype-phenotype correlation. It seems that incomplete penetrance, de-novo variants, and modifier genes are obstacles in predicting the clinical outcome.


Assuntos
Canais de Cálcio Tipo Q , Canais de Cálcio/genética , Epilepsia , Adolescente , Canais de Cálcio Tipo N/genética , Epilepsia/genética , Humanos , Estudos Retrospectivos
9.
Rev Neurol ; 73(11): 390-393, 2021 12 01.
Artigo em Espanhol | MEDLINE | ID: mdl-34826332

RESUMO

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.

10.
Medicina (Kaunas) ; 57(11)2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34833354

RESUMO

Background and Objectives. Juvenile myoclonic epilepsy (JME) is an idiopathic generalized epileptic syndrome, with a genetic basis clinically identified by myoclonic jerks of the upper limbs upon awaking, generalized tonic-clonic seizures and less frequent absences. Although the brain magnetic resonance imaging (MRI) is by definition normal, computer-based Voxel-Based morphometry studies have shown a number of volumetric changes in patients with juvenile myoclonic epilepsy. Thus, the aim of the present Voxel-Wise Meta-Analysis was to determine the most consistent regional differences of gray matter volume between JME patients and healthy controls. Materials and Methods. The initial search returned 31 studies. After excluding reviews and studies without control groups or without detailed peak coordinates, 12 studies were finally included in the present meta-analysis. The total number of JME patients was 325, and that of healthy controls was 357. Results. Our study showed a statistically significant increase of the gray matter in the left median cingulate/paracingulate gyri, the right superior frontal gyrus, the left precentral gyrus, the right supplementary motor area and left supplementary motor area. It also showed a decrease in the gray matter volume in the left thalamus, and in the left insula. Conclusions. Our findings could be related to the functional deficits and changes described by previous studies in juvenile myoclonic epilepsy. In this way, the volumetric changes found in the present study could be related to the impaired frontal lobe functions, the emotional dysfunction and impaired pain empathy, and to the disrupted functional connectivity of supplementary motor areas described in JME. It additionally shows changes in the volume of the left thalamus, supporting the theory of thalamocortical pathways being involved in the pathogenesis of juvenile myoclonic epilepsy.


Assuntos
Epilepsia Mioclônica Juvenil , Encéfalo/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Epilepsia Mioclônica Juvenil/diagnóstico por imagem
11.
Medicina (Kaunas) ; 57(11)2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34833494

RESUMO

We report an unprecedented case of a young patient with epilepsy coexisting with acute zonal occult outer retinopathy (AZOOR), a rare white dot syndrome of unknown etiology, associated with damage to the large zones of the outer retina. Recently, it has been established that epileptic episodes contribute to an inflammatory response both in the brain and the retina. A 13-year-old male patient with epilepsy was referred by a neurologist for an ophthalmologic consultation due to a sudden deterioration of visual acuity in the left eye. The examination, with a key role of multimodal imaging including color fundus photography, fluorescein angiography, indocyanine green angiography (ICGA), fundus autofluorescence (FAF), swept-source optical coherence tomography (SS-OCT) with visual field assessment, and electroretinography indicated AZOOR as the underlying entity. Findings at the first admission included enlargement of the blind spot in visual field examination along a typical trizonal pattern, which was revealed by FAF, ICGA, and SS-OCT in the left eye. The right eye exhibited no abnormalities. Seminal follow-up revealed no changes in best corrected visual acuity, and multimodal imaging findings remain unaltered. Thus, no medical intervention is required. Our case and recent laboratory findings suggest a causative link between epilepsy and retinal disorders, although this issue requires further research.


Assuntos
Epilepsia , Síndrome dos Pontos Brancos , Adolescente , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Seguimentos , Humanos , Masculino , Escotoma/diagnóstico , Escotoma/etiologia , Tomografia de Coerência Óptica
12.
Sensors (Basel) ; 21(22)2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34833780

RESUMO

Epilepsy is a brain disorder disease that affects people's quality of life. Electroencephalography (EEG) signals are used to diagnose epileptic seizures. This paper provides a computer-aided diagnosis system (CADS) for the automatic diagnosis of epileptic seizures in EEG signals. The proposed method consists of three steps, including preprocessing, feature extraction, and classification. In order to perform the simulations, the Bonn and Freiburg datasets are used. Firstly, we used a band-pass filter with 0.5-40 Hz cut-off frequency for removal artifacts of the EEG datasets. Tunable-Q Wavelet Transform (TQWT) is used for EEG signal decomposition. In the second step, various linear and nonlinear features are extracted from TQWT sub-bands. In this step, various statistical, frequency, and nonlinear features are extracted from the sub-bands. The nonlinear features used are based on fractal dimensions (FDs) and entropy theories. In the classification step, different approaches based on conventional machine learning (ML) and deep learning (DL) are discussed. In this step, a CNN-RNN-based DL method with the number of layers proposed is applied. The extracted features have been fed to the input of the proposed CNN-RNN model, and satisfactory results have been reported. In the classification step, the K-fold cross-validation with k = 10 is employed to demonstrate the effectiveness of the proposed CNN-RNN classification procedure. The results revealed that the proposed CNN-RNN method for Bonn and Freiburg datasets achieved an accuracy of 99.71% and 99.13%, respectively.


Assuntos
Aprendizado Profundo , Epilepsia , Algoritmos , Eletroencefalografia , Epilepsia/diagnóstico , Humanos , Qualidade de Vida , Convulsões , Processamento de Sinais Assistido por Computador
13.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 38(12): 1228-1232, 2021 Dec 10.
Artigo em Chinês | MEDLINE | ID: mdl-34839513

RESUMO

OBJECTIVE: To study the genetic variants of a child with Autism Spectrum Disorder (ASD) combined with epilepsy, and explore its possible pathogenic mechanism. METHODS: Clinical data of the child were collected and evaluated, whole-exome sequencing (WES) technology was used to explore the genetic variants sites of the child and his parents and candidate genes were filtered out. Sanger sequencing were performed to verify the variants identified by WES and PolyPhen2 was utilized to predict the function of these variants. qPCR was carry out to determine the expression of the variant gene. RESULTS: The proband carried a compound heterozygous mutation in the SIK3 gene (Chr11 q23.3, NM_025164.6), which contains a missense mutation c.1295A>G (p.N432S) inherited from the father and a deletion [c.2389_2391del(p.797del)] inherited from the mother. Both mutation sites are highly conservative, and PolyPhen2 predicted (c.1295A>G [p.N432S]) to be harmful. Compared to the mother, expression of SIK3in mRNA level in the peripheral blood of the proband and his father were both significantly decreased; compared to normal child, SIK3 expression in the peripheral blood of the proband and two other children with ASD were all decreased significantly too. In addition, studies on mice found that Sik3 gene has a marked higher level of expression in the brain. CONCLUSION: The SIK3 gene variants may probably be associated with ASD. The detailed mechanism needs to be studied further, which may involve lipid metabolism dysfunction in the brain.


Assuntos
Transtorno do Espectro Autista , Epilepsia , Animais , Transtorno do Espectro Autista/genética , Epilepsia/genética , Camundongos , Mutação , Mutação de Sentido Incorreto , Proteínas Serina-Treonina Quinases/genética , Sequenciamento Completo do Exoma
14.
Acta Neurol Taiwan ; 30(4): 151-154, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34841500

RESUMO

A 35 year-old woman had a two-year history of recurrent headache with clinical presentations of visual aura in her left visual field followed by right-sided throbbing headache. The patient suffered from a similar attack but her visual aura-like symptoms persisted for over 48 hours. The concurrent electroencephalogram demonstrated focal non-epileptiform rhythmic slow waves in the right occipital region. The magnetic resonance images showed prominent parenchymal edema in the right occipital area. The cerebral angiographic study proved a small cerebral arteriovenous malformation. This illustrated case showed that cerebral arteriovenous malformation produces headaches mimicking migraine with visual aura. The acute vascular flow change and the parenchymal edema trigger a prolonged visual aura with coinstantaneous evidence of cortical depression shown on the electroencephalogram. Keywords: Symptomatic migraine; Prolonged visual aura; Unruptured arteriovenous malformation.


Assuntos
Epilepsia , Malformações Arteriovenosas Intracranianas , Transtornos de Enxaqueca , Enxaqueca com Aura , Adulto , Angiografia Cerebral , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Lobo Occipital/diagnóstico por imagem
15.
J Healthc Eng ; 2021: 1834123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34745491

RESUMO

The bottleneck associated with the validation of the parameters of the entropy model has limited the application of this model to modern functional imaging technologies such as the resting-state functional magnetic resonance imaging (rfMRI). In this study, an optimization algorithm that could choose the parameters of the multiscale entropy (MSE) model was developed, while the optimized effectiveness for localizing the epileptogenic hemisphere was validated through the classification rate with a supervised machine learning method. The rfMRI data of 20 mesial temporal lobe epilepsy patients with positive indicators (the indicators of epileptogenic hemisphere in clinic) in the hippocampal formation on either left or right hemisphere (equally divided into two groups) on the structural MRI were collected and preprocessed. Then, three parameters in the MSE model were statistically optimized by both receiver operating characteristic (ROC) curve and the area under the ROC curve value in the sensitivity analysis, and the intergroup significance of optimized entropy values was utilized to confirm the biomarked brain areas sensitive to the epileptogenic hemisphere. Finally, the optimized entropy values of these biomarked brain areas were regarded as the feature vectors input for a support vector machine to classify the epileptogenic hemisphere, and the classification effectiveness was cross-validated. Nine biomarked brain areas were confirmed by the optimized entropy values, including medial superior frontal gyrus and superior parietal gyrus (p < .01). The mean classification accuracy was greater than 90%. It can be concluded that combination of the optimized MSE model with the machine learning model can accurately confirm the epileptogenic hemisphere by rfMRI. With the powerful information interaction capabilities of 5G communication, the epilepsy side-fixing algorithm that requires computing power can be integrated into a cloud platform. The demand side only needs to upload patient data to the service platform to realize the preoperative assessment of epilepsy.


Assuntos
Epilepsia do Lobo Temporal , Encéfalo , Entropia , Epilepsia do Lobo Temporal/diagnóstico por imagem , Lateralidade Funcional , Humanos , Aprendizado de Máquina , Imageamento por Ressonância Magnética
17.
BMJ Case Rep ; 14(11)2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772678

RESUMO

A 51-year-old woman known for sickle cell disease presented with 2 weeks of headache and bilateral lower limb pain. During admission, she suffered from multiple generalised tonic-clonic seizures but had an unremarkable CT of the brain. Incidentally, she had worsening baseline renal function. She was admitted to the intensive care unit with an acute confusional state. A bedside electroencephalogram showed triphasic waves and diffuse slow activity suggestive of encephalopathy with no epileptiform discharges. She remained obtunded despite appropriate medical therapy of hydration, antiepileptic and pain control. Lumbar puncture failed to identify an infectious cause. An urgent MRI of the brain was done and revealed features compatible with fat embolism syndrome (FES). Her haemoglobin S was 84.2%. Urgent red cell exchange transfusion was done, and within 3 days she fully regained her orientation and motor function. This represents the first case of such profound obtundation due to FES with a complete response to exchange transfusion.


Assuntos
Anemia Falciforme , Embolia Gordurosa , Anemia Falciforme/complicações , Coma , Embolia Gordurosa/etiologia , Embolia Gordurosa/terapia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Convulsões/etiologia
18.
Trials ; 22(1): 821, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34801061

RESUMO

BACKGROUND: Many people living with epilepsy (PLWE) reside in rural communities, and epilepsy self-management may help address some of the gaps in epilepsy care for these communities. A prior randomized control trial of a remotely delivered, Web-based group format 12-week self-management program (SMART) conducted in Northeast Ohio, a primarily urban and suburban community, demonstrated improved outcomes in negative health events such as depression symptoms and quality of life. However, there is a paucity of research addressing the needs of PLWE in rural settings. METHODS: The present study leverages collaboration between investigators from 2 mid-western US states (Ohio and Iowa) to replicate testing of the SMART intervention and prioritize delivery to PLWE in rural and semi-rural communities. In phase 1, investigators will refine the SMART program using input from community stakeholders. A Community Advisory Board will then be convened to help identify barriers to trial implementation and strategies to overcome barriers. In phase 2, the investigators will conduct a 6-month prospective randomized control trial of the SMART program compared to 6-month waitlist controls, with the primary outcome being changes in negative health events defined as seizure, self-harm attempt, emergency department visit, or hospitalization. Additional outcomes of interest include quality of life and physical and mental health functioning. The study will also assess process measures of program adopters and system end-users to inform future outreach, education, and self-management strategies for PLWE. DISCUSSION: The method of this study employs lived experience of PLWE and those who provide care for PLWE in rural and underserved populations to refine a remotely delivered Web-based self-management program, to improve recruitment and retention, and to deliver the intervention. Pragmatic outcomes important to PLWE, payers, and policymakers will be assessed. This study will provide valuable insights on implementing future successful self-management programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04705441 . Registered on January 12, 2021.


Assuntos
Epilepsia , Autogestão , Epilepsia/diagnóstico , Epilepsia/terapia , Humanos , Estudos Prospectivos , Qualidade de Vida , População Rural
19.
Zhonghua Yi Xue Za Zhi ; 101(41): 3361-3364, 2021 Nov 09.
Artigo em Chinês | MEDLINE | ID: mdl-34758538

RESUMO

Epilepsy is a common neurological disease that seriously affects the health of the human population. The treatment of epilepsy has always been an important direction in the field of neurosurgery. New epilepsy theories and surgical treatment techniques contribute new direction of epilepsy surgical treatment in the future. This article aims to review the therapeutic advances in the treatment of epilepsy, including project of the brain networks, epileptic networks, the construction of epilepsy brain networks, and to explore the new branch of epilepsy surgery (brain-networks oriented epilepsy surgery), thereby providing a new precision treatment method for epileptic patients.


Assuntos
Epilepsia , Neurocirurgia , Encéfalo , Epilepsia/cirurgia , Humanos , Procedimentos Neurocirúrgicos
20.
Zhonghua Yi Xue Za Zhi ; 101(41): 3380-3385, 2021 Nov 09.
Artigo em Chinês | MEDLINE | ID: mdl-34758540

RESUMO

Objective: To explore the clinical characteristics, treatment strategies and prognosis of rolandic and perirolandic drug-resistant epilepsies (DREs). Methods: The clinical data of 53 patients diagnosed with rolandic or perirolandic DRE who were admitted to Epilepsy Center, Sanbo Brain Hospital of Capital Medical University from January 2008 to January 2019 were retrospectively analyzed. The patients were divided into resective therapy group and non-resective therapy group [bipolar electrocoagulation on cortex, stereotactic electroencephalography (SEEG)-guided radiofrequency thermocoagulation, and vagus nerve stimulation]. The outcomes of epilepsy and post-surgical limb function were compared and analyzed. Results: A total of 53 patients were included, aged from 3 to 45 years old [(19±11) years], with 33 males and 20 females. Thirty patients received resective therapy and 23 patients received non-resective therapy. The curative effect of the resective therapy group was significantly better than that of the non-resective therapy group. The rate of Engel Ⅰ in resective therapy group was higher than that of non-resective group [83.3% (25/30) vs 39.1% (9/23), P=0.011). Compared with the non-resective group, the incidence of muscle strength decline in the resective group was higher both at 1 week [73.3% (22/30) vs 21.7% (5/23), P=0.006] and 3 months [30% (9/30) vs 0, P=0.016] after surgery. Conclusions: During the diagnosis and treatment, the multimodal method is conducive to the qualitative and localized diagnosis of the rolandic or perirolandic epilepsy, while SEEG has important value in the diagnosis, functional localization and treatment of the disease. Resective therapy is still the most effective method to terminate epilepsy, but it has a higher risk of post-surgical dysfunction.


Assuntos
Epilepsias Parciais , Epilepsia , Preparações Farmacêuticas , Adolescente , Adulto , Criança , Pré-Escolar , Eletroencefalografia , Epilepsias Parciais/cirurgia , Epilepsia/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Técnicas Estereotáxicas , Resultado do Tratamento , Adulto Jovem
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