Towards a better understanding of idiopathic epilepsy through metabolic fingerprinting of cerebrospinal fluid in dogs.

Cerebrospinal fluid metabolomics is a promising research technology in the elucidation of nervous system disorders. Therefore, in this work, a cerebrospinal fluid (CSF) metabolomics method using liquid chromatography coupled to mass spectrometry was optimized and validated to cover a wide range of metabolites. An acceptable coefficient of variance regarding instrumental, within-lab and intra-assay precision was found for 95, 70 and 96 of 102 targeted metabolites, together with 1256, 676 and 976 untargeted compounds, respectively. Moreover, approximately 75% of targeted metabolites and 50% of untargeted compounds displayed good linearity across different dilution ranges. Consequently, metabolic alterations in CSF of dogs with idiopathic epilepsy (IE) were studied by comparing CSF of dogs diagnosed with IE (Tier II) to dogs with non-brain related disease. Targeted metabolome analysis revealed higher levels of cortisol, creatinine, glucose, hippuric acid, mannose, pantothenol, and 2-phenylethylamine (P values < 0.05) in CSF of dogs with IE, whereas CSF of dogs with IE showed lower levels of spermidine (P value = 0.02). Untargeted CSF metabolic fingerprints discriminated dogs with IE from dogs with non-brain related disease using Orthogonal Partial Least Squares Discriminant Analysis (R2(Y) = 0.997, Q2(Y) = 0.828), from which norepinephrine was putatively identified as an important discriminative metabolite.

The value of csf analysis for the differential diagnosis of HTLV-I associated myelopathy and multiple sclerosis

Amostras do líquido cefalorraquidiano (LCR) e soro de 17 pacientes brasileiros com HAM/TSP, seis com esclerose múltipla e seis com epilepsia idiopática (controle nao-inflamatório) foram analisadas para a presença de anticorpos para o vírus de sarampo, rubéola, varicela zoster e herpes simples pelo método de ELISA. Todos os casos de HAM/TSP e esclerose múltipla tinham resposta imune poliespecífica intratecal para sarampo e rubéola. Anticorpos específicos para sarampo e rubéola (resposta MRZ) foram observados em todos os pacientes com esclerose múltipla, mas nao nos controles com epilepsia idiopática. A relevância das respostas poliespecífica e monoespecífica é discutida para essas doenças neurológicas crônicas.

Evaluación de la epilepsia farmacorresistente / Evaluation of drug-resistant epilepsy

Objective. Drug-resistant epilepsy makes up between 10 and 30% of all epilepsies, and is an important cause of morbidity and mortality. In this article we review the guidelines and techniques used when assessing a patient with drug-resistant epilepsy. Development. Evaluation of a patient with drug-resistant epilepsy requires three steps: first a careful, detailed clinical history to establish the semiological data of the seizure, determine the factors predisposing to drug-resistance (partial epilepsy, history of severe head injury etc.) and to evaluate the antiepileptic treatment given previously and whether the patient actually took the drugs prescribed. Second, a prolonged video-EEG recording is made to determine the type and site of the seizure and decide whether surgical treatment would be suitable. Thirdly, whether structural imaging investigations (magnetic resonance) or functional imaging (sole photon emission computerized tomography or positron emission tomography) should be done. It is also useful to make neuropsychological and psychiatric studies to detect possible associated defects and preexisting psychiatric pathology –which is very common in this population– in order to establish a rehabilitation programme according to the needs of each patient. Conclusion. Careful evaluation of each patient with drug-resistant crises leads to the correct diagnosis of epilepsy with the possibility of its correct classification and localization and may permit improvement or change of the treatment received (AU)

Objetivo. Las epilepsias farmacorresistentes constituyen entre el 10 y el 30% de todas las epilepsias y son causa de importante morbimortalidad. En el presente artículo se revisan las pautas y técnicas a seguir para evaluar a un paciente con epilepsia farmacorresistente. Desarrollo. La evaluación de un paciente resistente a los fármacos supone la consecución de tres pasos: primero, realizar una anamnesis detenida y exhaustiva para fundamentar los datos semiológicos de las crisis, determinar los factores predisponentes a la farmacorresistencia (epilepsias parciales, historia de trauma craneal grave, etc.) y para valorar el tratamiento antiepiléptico realizado con anterioridad y el cumplimiento del paciente del tratamiento prescrito. Segundo, realizar un registro prolongado vídeo-EEG para determinar el tipo de crisis, su localización y definir la posibilidad de cirugía de epilepsia. Tercero,realizar pruebas de imagen estructural (resonancia magnética) o funcional (tomografía de emisión de fotón único o tomografía de emisión de positrones). Además, es conveniente llevar a cabo un estudio neuropsicológico y psiquiátrico para definir los posibles déficit asociados y la patología psiquiátrica preexistente –muy frecuente en esta población– con el fin de establecer un programa de rehabilitación ajustado a cada paciente. Conclusión. La evaluación detenida del paciente con crisis farmacorresistentes lleva a un diagnóstico de certeza de la epilepsia, ofrece la posibilidad de una correcta clasificación y localización de la misma y puede conducir a una mejora o un cambio en el tratamiento establecido (AU)