Causes and prognosis of adults experiencing a first seizure in adulthood: A pilot cohort study conducted in five countries in Latin America.

There are limited data on first seizure (FS) among adults in low and middle-income countries. We describe findings from a prospective cohort study involving 180 adults presenting with seizures in emergency departments in five Latin American countries. Overall, 102 participants (56.7%) had acute symptomatic seizures (ASyS) while 78 (43.3%) had unprovoked seizures (UPS). Among patients with ASyS, 55 (53.9%) had structural causes, with stroke (n = 24, 23.5%), tumor (n = 10, 9.8%), and trauma (n = 3, 3%) being the most frequent. Nineteen patients (18.6%) had infectious causes, including four (4%) with meningoencephalitis, three (3%) neurocysticercosis, and two (2%) bacterial meningoencephalitis. Twenty patients (19.6%) had metabolic/toxic evidence, including four (4%) with uremic encephalopathy, two (2%) hyponatremia, and three (3%) acute alcohol intoxication. Immune dysfunction was present in seven (7%) patients and neurodegenerative in two (2%). Among participants with UPS, 45 (57.7%) had unknown etiology, 24 (30.7%) had evidence of structural disorders (remote symptomatic), four (5%) were related to infectious etiology (>7 days before the seizure), and five (6.4%) had genetic causes. During the 3- and 6-month follow-up, 29.8% and 14% of patients with UPS, respectively, experienced seizure recurrence, while 23.9% and 24.5% of patients with ASyS had seizure recurrence. Longer follow-up is necessary to assess seizure recurrence for patients with ASyS after the acute cause is resolved and to determine the 10-year risk of recurrence, which is part of the definition of epilepsy. PLAIN LANGUAGE SUMMARY: We monitored 180 adults who presented with their first seizure in emergency departments across five Latin American countries. Among these patients, 57% had acute symptomatic seizures, with structural causes such as stroke (23%), infection (17%), or tumor (10%) being more prevalent. Among the 43% with unprovoked seizures, 58% showed no identifiable acute cause, while 6.4% were due to genetics. Within 3 months after their initial seizure, 26.6% of individuals experienced a second seizure, with 11.9% continuing to have seizures in Months 3-6. Between Months 3 and 6, an additional 20% of patients encountered a second seizure. Research is needed to better understand the cause and prognosis of these patients to improve outcomes.

Demencia rápidamente progresiva y parkinsonismo asociados a múltiples fístulas arteriovenosas durales / Rapidly progressive dementia and parkinsonism associated to multiple dural arteriovenous fistulas

Introducción. Las demencias rápidamente progresivas son un grupo poco frecuente de enfermedades caracterizadas por un deterioro cognitivo y otras alteraciones neurológicas que evolucionan en el transcurso de semanas a meses. Su etiología es diversa e incluye un gran número de condiciones neurodegenerativas, tóxicas, metabólicas, autoinmunes, infecciosas y vasculares. Caso clínico. Varón de 69 años, que ingresó por demencia rápidamente progresiva y parkinsonismo causado por múltiples fístulas arteriovenosas durales tratadas exitosamente mediante terapia endovascular. Conclusión. Las fístulas arteriovenosas durales son conexiones anómalas entre las arterias durales y los senos venosos o venas corticales que constituyen una causa inusual de demencia rápidamente progresiva, pero que debe considerarse, dada la disponibilidad de un tratamiento específico con reversión de los síntomas (AU)

Introduction. Rapidly progressive dementias are an infrequent group of diseases characterised by cognitive deterioration and other neurological disorders that develop over a period ranging from weeks to months. Their causation is varied and includes a large number of neurodegenerative, toxic, metabolic, autoimmune, infectious and vascular conditions. Case report. We report the case of a 69-year-old male who was admitted to hospital due to a rapidly progressive dementia and parkinsonism caused by multiple dural arteriovenous fistulas, which were successfully treated by means of endovascular therapy. Conclusion. Dural arteriovenous fistulas are anomalous connections between the dural arteries and the venous sinuses or cortical veins that are an unusual cause of rapidly progressive dementia. They must, however, be taken into account, given the availability of a specific treatment with reversal of the symptoms (AU)

Validity of a PCR assay in CSF for the diagnosis of neurocysticercosis.

OBJECTIVE: To prospectively evaluate the validity of a PCR assay in CSF for the diagnosis of neurocysticercosis (NC). METHODS: We conducted a multicenter, prospective case-control study, recruiting participants from 5 hospitals in Cuenca, Ecuador, from January 2015 to February 2016. Cases fulfilled validated diagnostic criteria for NC. For each case, a neurosurgical patient who did not fulfill the diagnostic criteria for NC was selected as a control. CT and MRI, as well as a CSF sample, were collected from both cases and controls. The diagnostic criteria to identify cases were used as a reference standard. RESULTS: Overall, 36 case and 36 control participants were enrolled. PCR had a sensitivity of 72.2% (95% confidence interval [CI] 54.8%-85.8%) and a specificity of 100.0% (95% CI 90.3%-100.0%). For parenchymal NC, PCR had a sensitivity of 42.9% (95% CI 17.7%-71.1%), and for extraparenchymal NC, PCR had a sensitivity of 90.9% (95% CI 70.8%-98.9%). CONCLUSIONS: This study demonstrated the usefulness of this PCR assay in CSF for the diagnosis of NC. PCR may be particularly helpful for diagnosing extraparenchymal NC when neuroimaging techniques have failed. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that CSF PCR can accurately identify patients with extraparenchymal NC.