ABSTRACT
PURPOSE: To investigate the relationship between self-reported sleep quality and cognitive function in patients with epilepsy (PWE), as well as anxiety and depressive symptoms and patient quality of life (QoL). METHODS: This multicenter cross-sectional study included PWE aged ≥12â¯years who were receiving ≥1 anti-seizure medication (ASM) and had not been diagnosed with a sleep disorder. Patients completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Montreal Cognitive Assessment test (MoCA), the Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory-10 (QOLIE-10). RESULTS: The study enrolled 150 patients aged 16-83â¯years, mean age (standard deviation [SD]) 40.6 (15.2) years; 58.7% were female and 75.3% had focal epilepsy. Mean (SD) PSQI score was 4.71 (3.08), 44.4% of patients had impaired sleep quality (PSQI score ≥5), 19.9% had pathologic excessive daytime sleepiness (ESS score >12), and 32.7% had mild cognitive impairment (MoCA score <26). Within the PSQI, sleep disturbance (Pâ¯=â¯0.036) and use of sleep medication (Pâ¯=â¯0.006) scores were significantly higher in patients with mild cognitive impairment. Multiple regression analysis showed older age (regression coefficient [B], -0.086; 95% confidence interval [CI], -0.127, -0.045; Pâ¯<â¯0.001) and the use of sleep medication component of the PSQI [B, -1.157; 95% CI, -2.064, -0.220; Pâ¯=â¯0.013) were independently associated with lower MoCA score. Poor sleep quality was associated with probable anxiety and depression symptoms, and directly correlated with reduced QoL. CONCLUSIONS: In PWE, sleep quality was not significantly independently associated with mild cognitive impairment, although poor sleep quality had a negative effect on mood and QoL.
Subject(s)
Epilepsy , Quality of Life , Adult , Aged , Cognition , Cross-Sectional Studies , Epilepsy/complications , Epilepsy/drug therapy , Female , Humans , SleepABSTRACT
Eslicarbazepine acetate (ESL, Aptiom™) is a once-daily anticonvulsant, approved as adjunctive treatment of partial-onset seizures (POS). Historical-controlled trials investigating the use of ESL as monotherapy have demonstrated a favorable efficacy and tolerability profile in patients with POS. This prospective, non-interventional study recruited POS patients in 17 hospitals in Spain. After a 3-month baseline period, ESL therapy was initiated as 400mg QD and up-titrated to an optimal maintenance dose based on clinical response and tolerance. The incidence of seizures was assessed via seizure calendars and the nature and severity of adverse events (AEs) were also recorded. A total of 117 patients (aged 9-87years) enrolled in the study and were treated with ESL at either 400mg/day (3.4% patients), 800mg/day (61% patients), 1200mg/day (27.1% patients) or 1600mg/day (8.5% patients). At 3months, 82.0% (n=72) of patients achieved a ≥50% reduction in seizure frequency, compared to 79.7% (n=67) of patients at 6months and 83.0% (n=49) at 12months. Patients who suffered secondary generalized tonic-clonic (SGTC) seizures had seizure-free rates of 71% (n=27), 69.6% (n=29), and 72.7% (n=16) at 3, 6, and 12months, respectively. Overall, 18 patients (15.3%) reported AEs of instability and dizziness (n=9), somnolence (n=3), mild hyponatremia (n=3), headache (n=1), hypertriglyceridemia (n=1), and allergic reaction (n=1), which caused ESL discontinuation of ESL treatment. ESL is effective and well tolerated as monotherapy for patients with POS, which supports previous findings. Early use is supported by its frequent use as monotherapy in this study and lack of severe side effects.
Subject(s)
Anticonvulsants/therapeutic use , Dibenzazepines/therapeutic use , Seizures/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Anticonvulsants/adverse effects , Child , Depression/chemically induced , Dibenzazepines/adverse effects , Dizziness/chemically induced , Female , Headache/chemically induced , Humans , Male , Middle Aged , Prospective Studies , Spain , Treatment Outcome , Young AdultABSTRACT
The brainstem consists of the midbrain, pons, and medulla. The cerebellum is attached to the dorsal surface of the pons and upper medulla. The brainstem contains 9 of the 12 cranial nerves and is crossed by ascending, descending, and cerebellar pathways and their nuclei as well as the reticular formation. Numerous and rare crossed brainstem syndromes have been described in recent years, many of them without clinical significance. The aim of this article is to provide a brief clinical description of some conditions affecting the brainstem.
Subject(s)
Brain Stem Infarctions/diagnosis , Brain Stem Neoplasms/diagnosis , Brain Stem/pathology , Brain Mapping/methods , Cranial Nerve Diseases/diagnosis , Cranial Nerves/pathology , Humans , Magnetic Resonance Imaging/methodsSubject(s)
Lysosomal Membrane Proteins/genetics , Mutation/genetics , Myoclonic Epilepsies, Progressive/genetics , Myoclonus/genetics , Receptors, Scavenger/genetics , Renal Insufficiency/complications , Adult , Ataxia/genetics , Female , Humans , Myoclonus/diagnosis , Renal Insufficiency/genetics , Sequence Analysis, DNA/methodsABSTRACT
Most partial epilepsy crises originate in the temporal lobe. Two main syndromes have been described in temporal lobe epilepsy (TLE): mesial temporal epilepsy and neocortical temporal epilepsy. In recent years, the number and types of drugs used to control the crises have significantly increased, but almost 30% of patients do not have complete control of their epilepsy. In those cases, surgery is an efficient therapeutic option, especially in the case of mesial temporal sclerosis. Before surgery, wide and complex neurophysiological studies are needed to precisely delineate the epileptogenic area. The clinical and neurophysiological aspects of TLE that may be useful for understanding this pathologic entity are reviewed.
Subject(s)
Brain Mapping/methods , Brain/physiopathology , Electroencephalography/methods , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/physiopathology , Epilepsy, Temporal Lobe/therapy , HumansSubject(s)
Arthritis, Infectious/microbiology , Knee Joint/microbiology , Postoperative Complications/microbiology , Streptococcal Infections/microbiology , Streptococcus/isolation & purification , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/surgery , Combined Modality Therapy , Debridement , Diabetes Mellitus, Type 2/complications , Escherichia coli Infections/complications , Escherichia coli Infections/drug therapy , Humans , Lumbar Vertebrae/injuries , Lumbar Vertebrae/surgery , Male , Postoperative Complications/drug therapy , Postoperative Complications/surgery , Spinal Cord Compression/etiology , Spinal Fractures/surgery , Streptococcal Infections/complications , Streptococcal Infections/drug therapy , Streptococcal Infections/surgery , Streptococcus/classification , Surgical Wound Infection/complications , Surgical Wound Infection/drug therapyABSTRACT
Se obtuvieron algunos derivados del aureol y se evaluó la capacidad de éstos de competir con el estradiol por enlazarse con el receptor de estradiol de útero de rata. Se comprobó que al igual que el aureol, todos los compuestos desplazan al estradiol; el dibromo aureol es el que presenta mayor afinidad por el receptor y se compara su afinidad con la del antiestrógeno tamoxifén
Subject(s)
Rats , Animals , Estradiol/therapeutic use , Plicamycin/therapeutic use , Uterine NeoplasmsABSTRACT
Se obtuvieron algunos derivados del aureol y se evaluó la capacidad de éstos de competir con el estradiol por enlazarse con el receptor de estradiol de útero de rata. Se comprobó que al igual que el aureol, todos los compuestos desplazan al estradiol; el dibromo aureol es el que presenta mayor afinidad por el receptor y se compara su afinidad con la del antiestrógeno tamoxifén
Subject(s)
Rats , Animals , Estradiol/therapeutic use , Plicamycin/therapeutic use , Uterine NeoplasmsABSTRACT
La hormonodependencia en el cáncer mamario resulta de gran utilidad para guiar la terapéutica y el pronóstico del paciente. Sin embargo, los métodos para su determinación, hasta la fecha, resultan prohibitivos para centros asistenciales de escasos recursos financieros. Por este motivo, desde el inicio de la dosificación de los receptores hormonales los investigadores se dieron a la tarea de relacionarlos con variables clínicas y anatomopatológicas con el fin de predecirlo. Sin embargo la mayoría de los estudios no han dado resultados relevantes. En nuestro caso, utilizando un medio de regresión múltiple en una "muestra de aprendizaje" de 64 pacientes, se obtuvo una función que logró determinar la hormonodependencia en 70 pacientes de una muestra de 100. Considerado este primer resultado como alentador, se continúa perfeccionando el método con el fin de mejorar sus índices de clasificación
Subject(s)
Humans , Female , Neoplasms, Hormone-Dependent , Breast Neoplasms , Receptors, Estrogen/analysis , Receptors, Progesterone/analysisABSTRACT
La hormonodependencia en el cáncer mamario resulta de gran utilidad para guiar la terapéutica y el pronóstico del paciente. Sin embargo, los métodos para su determinación, hasta la fecha, resultan prohibitivos para centros asistenciales de escasos recursos financieros. Por este motivo, desde el inicio de la dosificación de los receptores hormonales los investigadores se dieron a la tarea de relacionarlos con variables clínicas y anatomopatológicas con el fin de predecirlo. Sin embargo la mayoría de los estudios no han dado resultados relevantes. En nuestro caso, utilizando un medio de regresión múltiple en una "muestra de aprendizaje" de 64 pacientes, se obtuvo una función que logró determinar la hormonodependencia en 70 pacientes de una muestra de 100. Considerado este primer resultado como alentador, se continúa perfeccionando el método con el fin de mejorar sus índices de clasificación
Subject(s)
Humans , Female , Breast Neoplasms , Neoplasms, Hormone-Dependent , Receptors, Estrogen/analysis , Receptors, Progesterone/analysisABSTRACT
Se estudiaron 200 pacientes con carcinoma diseminado, en diferentes estadios clínicos antes del fallecimiento com consecuencia de sus metástasis, las que fueron seguidas durante toda su evolución. Se determinaron las formas clínicas de presentación en la primera metástasis y en las subsiguientes, así como el sitio anatómico afectado, se establece la relación entre el sitio de la primera y seguda metástasis
Subject(s)
Humans , Female , Breast Neoplasms , Neoplasm Metastasis , CarcinomaABSTRACT
Se estudiaron 200 pacientes con carcinoma diseminado, en diferentes estadios clínicos antes del fallecimiento com consecuencia de sus metástasis, las que fueron seguidas durante toda su evolución. Se determinaron las formas clínicas de presentación en la primera metástasis y en las subsiguientes, así como el sitio anatómico afectado, se establece la relación entre el sitio de la primera y seguda metástasis