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1.
Eur Child Adolesc Psychiatry ; 28(5): 615-624, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30218395

RESUMO

Routine electroencephalograms (EEG) are not recommended as a screen for epileptic discharges (EDs) in current practice guidelines for children with autism spectrum disorder (ASD). However, a review of the research from the last three decades suggests that this practice should be reevaluated. The significant comorbidity between epilepsy and ASD, its shared biological pathways, risk for developmental regression, and cognitive challenges demand increased clinical investigation requiring a proactive approach. This review highlights and explains the need for screening EEGs for children with ASD. EEG would assist in differentiating EDs from core features of ASD and could be included in a comprehensive assessment. EEG also meets the demand for evidence-based precision medicine and focused care for the individual, especially when overlapping processes of development are present.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Eletroencefalografia/métodos , Medicina Baseada em Evidências/métodos , Transtorno do Espectro Autista/patologia , Criança , Epilepsia/diagnóstico , Epilepsia/patologia , Feminino , Humanos , Masculino , Programas de Rastreamento
2.
J Clin Neurophysiol ; 34(3): 230-235, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27893495

RESUMO

INTRODUCTION: Data from an EEG is not commonly used by psychiatrists to plan treatment and medication. However, EEG abnormalities such as isolated epileptiform discharges are found to be more prevalent in psychiatric patients, particularly those diagnosed with autism spectrum disorder (ASD). Most medications prescribed for ASD lower seizure threshold and increase side effects. Therefore, it may be prudent to order an EEG for ASD cases, especially those categorized as refractory. METHODS: The data set was obtained from a multidisciplinary practice that treats a wide variety of neuroatypical children and adolescent refractory patients. This study investigated 140 nonepileptic subjects diagnosed with ASD, aged 4 to 25 years. Visual inspection of the EEG was performed to search for paroxysmal, focal, or lateralizing patterns. RESULTS: Of the 140 subjects, the EEG data identified 36% with isolated epileptiform discharges. The χ analysis found no significant difference between genders among the three age groups. Findings indicated a high prevalence of isolated epileptiform discharges among individuals with ASD. CONCLUSIONS: Our results find that compared with the healthy population, a large number of patients with ASD have isolated epileptiform discharges despite never having a seizure. Our findings support the use of EEG in children, adolescents, and young adults with ASD, regardless of gender or age. This is particularly true for those who exhibit aggressive behaviors or those who have failed previous medication attempts with stimulants, antidepressants, and/or antipsychotics.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Eletroencefalografia/métodos , Epilepsia/diagnóstico , Medicina de Precisão/métodos , Psiquiatria/métodos , Adolescente , Adulto , Transtorno do Espectro Autista/tratamento farmacológico , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Comorbidade , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Adulto Jovem
3.
Clin EEG Neurosci ; 48(5): 322-326, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28771044

RESUMO

Many antiepileptic drugs (AEDs) have been tested on nonepileptic patients with a variety of diagnoses. The Food and Drug Administration has only approved certain AEDs for a small number of psychiatric conditions. There are few studies of nonepileptic patients that recommend an empirical trial of AEDs when isolated epileptiform discharges (IEDs) are identified in the electroencephalogram (EEG). However, no trials have been published. The purpose of this study is to evaluate the outcome of treating nonepileptic patients with AEDs when IEDs are present. Refractory cases were reviewed from a multidisciplinary practice whose EEG readings contained IEDs and were subsequently medicated with anticonvulsants by the clinic's psychiatrist. The psychiatrist's progress notes were assessed to determine the impact of adding anticonvulsants based on parent reports, teacher reports, and clinical observation. The final sample was composed of 76 refractory cases. Of the 76 patients treated with anticonvulsants, the majority were found to be improved in follow-up progress notes: 65 improved (85.53%), 6 unchanged (7.89%), and 5 more severe (6.58%). These observational findings suggest that further studies will be needed to show that IEDs may predict positive treatment outcome to anticonvulsant medication and act as a step toward an evidence-based treatment. Also, EEG screening may prove to be useful for refractory cases regardless of age, gender, or diagnosis.


Assuntos
Anticonvulsivantes/uso terapêutico , Eletroencefalografia/efeitos dos fármacos , Transtornos Mentais/tratamento farmacológico , Adulto , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
Child Adolesc Psychiatr Clin N Am ; 14(1): 163-76, viii, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15564057

RESUMO

With electroencephalographic (EEG) biofeedback (or neurofeedback), it is possible to train the brain to de-emphasize rhythms that lead to generation and propagation of seizure and emphasize rhythms that make seizures less likely to occur. With recent improvements in quantitative EEG measurement and improved neurofeedback protocols, it has become possible in clinical practice to eliminate seizures or reduce the amount of medication required to control them. In this article, the history of neurofeedback for epilepsy is presented followed by discussions of the relevant neurophysiology of epilepsy. A model of how neurofeedback might raise the seizure threshold is then presented. Clinical experience using a quantitative EEG-guided approach is described, including a representative case study.


Assuntos
Biorretroalimentação Psicológica/métodos , Eletroencefalografia , Epilepsia/terapia , Epilepsia/fisiopatologia , Humanos , Modelos Neurológicos , Terminologia como Assunto , Resultado do Tratamento
5.
Clin EEG Neurosci ; 46(3): 192-6, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25420624

RESUMO

Pharmaco-electroencephalography (Pharmaco-EEG) studies using clinical EEG and quantitative EEG (qEEG) technologies have existed for more than 4 decades. This is a promising area that could improve psychotropic intervention using neurological data. One of the objectives in our clinical practice has been to collect EEG and quantitative EEG (qEEG) data. In the past 5 years, we have identified a subset of refractory cases (n = 386) found to contain commonalities of a small number of electrophysiological features in the following diagnostic categories: mood, anxiety, autistic spectrum, and attention deficit disorders, Four abnormalities were noted in the majority of medication failure cases and these abnormalities did not appear to significantly align with their diagnoses. Those were the following: encephalopathy, focal slowing, beta spindles, and transient discharges. To analyze the relationship noted, they were tested for association with the assigned diagnoses. Fisher's exact test and binary logistics regression found very little (6%) association between particular EEG/qEEG abnormalities and diagnoses. Findings from studies of this type suggest that EEG/qEEG provides individualized understanding of pharmacotherapy failures and has the potential to improve medication selection.


Assuntos
Monitoramento de Medicamentos/métodos , Eletroencefalografia/efeitos dos fármacos , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Medicina de Precisão/métodos , Psicotrópicos/administração & dosagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Eletroencefalografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto Jovem
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