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1.
São Paulo; s.n; 2023. 186 p.
Thesis in Portuguese | LILACS | ID: biblio-1510002

ABSTRACT

Objetivos: artigo 1: Descrever a prevalência das nas mulheres gestantes com epilepsia (MGCE), perfil sociodemográfico e desfechos obstétricos e analisar associação dessas variáveis com a doença. Artigo 2: Descrever o perfil de MAC (medicação anticrise) e tipos de crises e analisar a associação desses perfis com a incidência de complicações maternas e fetais nas MGCE. Artigo 3: Descrever a prevalência, perfil sociodemográfico e clínico, perfil de MAC, tipos de crises e analisar a associação da incidência de complicações maternas e fetais com essas variáveis nas MGCE. Métodos: Artigos 1 e 2: coortes retrospectivas com 234 MGCE e 492 MGSE. Artigo 3 coorte prospectiva coletou dados de 95 MGCE e 380 sem epilepsia (MGSE). Ambas as coortes com idade 40 anos em prontuários e entrevistas em 4 maternidades de alto risco em Alagoas no período de 2008 a 2021 na coorte retrospectiva e 2021 e 2022 na prospectiva. Resultados: A prevalência de MGCE nas coortes retrospectiva e prospectiva foi de 0,49% (n = 224/44917) e 0,53% (n = 105/19.624) com médias de idade (24,94 ± 6,25 e 23,98 ± 6,89); (24,42 ± 5,64 e 24,42 ± 5,62) anos. MGCE procederam da zona rural (58,2%; 64,2%), eram de cor parda (88,6%;98%), (7%; 3,2%) analfabetas e com ensino fundamental (40%; 52,1%), solteiras (47,3%; 49,5%) e (76,9%; 78,9%) donas de casa, respectivamente. Em relação a partos, a maioria (60,3%; 54,8%) eram multíparas, (74,6%; 70,8%) tiveram parto cesáreo, respectivamente. Na coorte prospectiva 15,8% sem renda, 54,7% com menos de 1 salário mínimo, 44,2% eram de religião católica e 87.4% não planejou a gravidez. A análise dos desfechos obstétricos e neonatais mostrou um risco maior nas MGCE para hipertensão relacionada à gravidez (HRG) (OR =6.29; 95% CI =3.50-11.30), pré-eclâmpsia (OR=8.04; 95% CI=2.22-29.10) na coorte retrospectiva, e em ambas coortes um risco de sangramento vaginal (OR=2.54; 95% CI=1.15-5.59);(OR=4.13; 95% CI=1.45-9.11), aborto espontâneo (OR=1.75; 95% CI=1.16-2.63); (OR=1.50; 95% CI=1.00-2.22) e natimorto (OR=11,16; 95% CI=2.22-29.10); (OR=5.27; 95% CI=2.29-10.30). Nas coortes retrospectiva e prospectiva (14%; 14,7%) não usaram MAC, (50,2%; 85,3%) monoterapia (35,8%; 12,6%) politerapia, respectivamente. O fenobarbital foi o MAC mais prescrito seguido pela carbamazepina em ambas coortes. Na prospectiva MGCE que usaram MAC e em politerapia tiveram maior risco de hemorragia vaginal, admissão em UTI materna e natimorto. Analisando os tipos de epilepsia a maioria 40% tinha o tipo generalizada. A respeito do tipo de crise, a maioria 53,3% apresentou crise focal na coorte retrospectiva, enquanto na prospectiva a maioria delas 48,4% teve CTCG e 19% estado de mal epiléptico associados a desfechos obstétricos e neonatais adversos. Conclusão: Ambos os estudos relatam um perfil sociodemográfico da MGCE de alta vulnerabilidade social e alto risco de desfechos obstétricos e neonatais adversos, provavelmente devido à procedência de uma região pobre do Brasil. Foi constatado algumas limitações na distribuição de MACs apropriados para essa população.


Objectives: article 1: To describe the prevalence of epilepsy in pregnant women, sociodemographic profile and obstetric outcomes and analyze the association of these variables with a disease. Article 2: Describe the profile of ASM (anti-crisis medication) and types of seizures and analyze the association of these profiles with the incidence of maternal and fetal complications in pregnat women with epilepsy (PWWE). Article 3: Describe the prevalence, sociodemographic and clinical profile, types of ASM used and seizures and analyze the association of the incidence of maternal and fetal complications with these variables in PWWE. Methods: Articles 1 and 2: retrospective cohorts with 234 PWWE and 492 pregnant women without epilepsy (PWNE). Article 3 prospective cohort collected data from 95 PWWE and 380 PWNE. Both cohorts aged 40 years in medical records and interviews from four high-risk maternity hospitals in Alagoas. The period from 2008 to 2021 in the cohort retrospective and 2021 and 2022 in the prospective. Results of the articles: The prevalence of PWWE in the retrospective and prospective cohorts were 0.49% (n = 224/44917) and 0.53% (n = 105/19,624) with mean ages (24.94 ± 6.25 and 23 .98 ± 6.89); (24.42 ± 5.64 and 24.42 ± 5.62) years, respectively. PWWE came from the countryside (58.2%; 64.2%), had brown skin (88.6%; 98%), illiterate (7%; 3.2%) and had primary education (40%; 52 .1%), single (47.3%; 49.5%) and (76.9%; 78.9%) homemakers, respectively. Regarding deliveries, the most of them (60.3%; 54.8%) were multiparous, (74.6%; 70.8%) had cesarean delivery, respectively. In the prospective cohort, 15.8% had no income, 54.7% earned less than 1 minimum wage, 44.2% were Catholic religious and 87.4% had not planned the pregnancy. Analysis of obstetric and neonatal outcomes showed a higher risk in PWWE for pregnancy-related hypertension (PrH) (OR=6.29; 95% CI=3.50-11.30), preeclampsia OR=8.04; 95% CI=2.22-29.10) in the retrospective cohort, and in the retrospective and prospective cohorts a risk of vaginal bleeding (OR=2.54; 95% CI=1.15-5.59);(OR=4.13; 95% CI=1.45-9.11), miscarriage (OR=1.75; 95% CI=1.16-2.63); (OR=1.50; 95% CI=1.00-2.22) and stillbirth (OR=11.16; 95% CI=2.22-29.10); (OR=5.27; 95% CI=2.29-10.30), respectively. In both cohorts (14%; 14.7%) they did not use MAC, (50.2%; 85.3%) monotherapy (35.8%; 12.6%) polytherapy, respectively. Phenobarbital was the most prescribed ASM followed by carbamazepine in both cohorts. In prospective PWWE who used ASM and polytherapy had a higher risk of vaginal bleeding, maternal ICU admission and stillbirth. Analyzing the types of epilepsy, most of them 40% had the generalized type. Regarding the type of seizure, most 53.3% had focal seizures in the retrospective cohort, while in the prospective cohort, most of them 48.4% had GTCS (tonic-clonic generalized) and 19% had status epilepticus, associated with adverse obstetric and neonatal outcomes. Conclusion: Both studies report a sociodemographic profile of PWWE with high social vulnerability and higher risk of adverse obstetric and neonatal outcomes, probably due to the origin of a poor region of Brazil. Some limitations were found in the distribution of appropriate ASM for this population


Subject(s)
Humans , Female , Pregnancy , Pregnancy , Epilepsy, Tonic-Clonic/drug therapy , Epilepsy
2.
Rev. med. interna Guatem ; 19(3): [3], sept.-dic. 2015. ilus
Article in Spanish | LILACS | ID: biblio-996551

ABSTRACT

Se presenta el caso de paciente masculino de 15 años de edad que es llevado a sala de urgencia s del Hospital Roosevelt por convulsiones tónico clónico generalizadas de 2 minutos de duración, con período postictal, con antecedentes familiares de convulsiones mostradas en el árbol genealógico (grafico 2 ). Además presenta antecedente de síndrome convulsivo desarrollado a los tres años de edad, tratado con múltiples anticonvulsivantes sin llegar a un dia gnóstico. Paciente al examen físico se presenta normocéfalo, cabello adecuada implantación, alerta, orientado en tiempo, espacio y persona, escleras y mucosas normales, con lesiones angiofibromatosas de distribución en alas de mariposa en región de puente nasal, alas nasales, mejillas y frente , frecuencia respiratoria de 14 por minuto, con ruidos respiratorios conservados, frecuencia cardíaca 70 por minuto, presión arteria l 100/60 mmHg, ritmo cardíaco normal, sincrónico con el pulso, abdomen sin alteraciones, extremidades y evaluación de sistema nervioso central sin presentar alteraciones...(AU)


We present the case of a 15-year-old male patient who is taken to the emergency room s Roosevelt Hospital for generalized 2-minute clonic tonic convulsions, with a period postictal, with family history of seizures shown in the pedigree (chart 2). It also presents a history of convulsive syndrome developed at three years of age, treated with multiple anticonvulsants without reaching a Gnostic day. Patient to the physical examination presents normocephalus, adequate hair implantation, alert, oriented in time, space and person, normal scleras and mucous membranes, with angiofibromatosis lesions of distribution in butterfly wings in nasal bridge region, nasal wings, cheeks and forehead, frequency respiratory rate of 14 per minute, with preserved respiratory sounds, heart rate 70 per minute, artery pressure l 100/60 mmHg, normal heart rate, synchronous with the pulse, abdomen without alterations, extremities and evaluation of the central nervous system without presenting alterations. . (AU)


Subject(s)
Humans , Male , Adolescent , Seizures/drug therapy , Tuberous Sclerosis/diagnosis , Tuberous Sclerosis/prevention & control , Anticonvulsants/therapeutic use , Physical Examination , Epilepsy, Tonic-Clonic/drug therapy , Medical History Taking
3.
Cent Nerv Syst Agents Med Chem ; 13(2): 122-31, 2013 Jun.
Article in English | MEDLINE | ID: mdl-24195634

ABSTRACT

Polyamines are compounds that interact with ionotropic receptors, mainly modulating the NMDA receptor, which is strictly related to many neurologic diseases such as epilepsy. Consequently, polyamines rise as potential neuropharmacological tools in the prospection of new therapeutic drugs. In this paper, we report on the biological activity of synthetic polyamine Mygalin, which was tested as an anticonvulsant in model of chemically induced seizures. Male Wistar rats were injected with vehicle, diazepam, MK-801 or Mygalin at different doses followed by Pentylenetetrazole or N-Methyl-D-Aspartate administration. Mygalin presented protection against seizures induced by both NMDA injections and PTZ administration by 83.3% and 16.6%, respectively. Moreover, it prolonged the onset of tonic-clonic seizures induced by PTZ. Furthermore, it was tested in neuroethological schedule evaluating possible side-effects and it presented mild changes in Open Field, Rotarod and Morris Water Maze tests when compared to available anticonvulsant drugs. The mechanism underlying the anticonvulsant effect of Mygalin is noteworthy of further investigation, nevertheless, based on these findings, we hypothesize that it may be wholly or in part due to a possible NMDA receptor antagonism. Altogether, the results demonstrate that Mygalin has an anticonvulsant activity that may be an important tool in the study of prospection of therapeutics in epilepsy neuropharmacology.


Subject(s)
Anticonvulsants/therapeutic use , Epilepsy, Tonic-Clonic/drug therapy , Spermidine/analogs & derivatives , Acute Disease , Animals , Anticonvulsants/pharmacology , Anticonvulsants/toxicity , Cognition/drug effects , Diazepam/therapeutic use , Dizocilpine Maleate/therapeutic use , Drug Evaluation, Preclinical , Epilepsy, Tonic-Clonic/chemically induced , Excitatory Amino Acid Antagonists/pharmacology , Excitatory Amino Acid Antagonists/therapeutic use , Excitatory Amino Acid Antagonists/toxicity , Exploratory Behavior/drug effects , Locomotion/drug effects , Male , Maze Learning/drug effects , N-Methylaspartate/toxicity , Pentylenetetrazole/toxicity , Rats , Rats, Wistar , Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors , Rotarod Performance Test , Spermidine/pharmacology , Spermidine/therapeutic use , Spermidine/toxicity
5.
Pediatr Diabetes ; 11(7): 505-8, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20042013

ABSTRACT

Congenital hyperinsulinism of infancy (CHI) is the most common cause of hypoglycemia in newborns and infants. Several molecular mechanisms are involved in the development of CHI, but the most common genetic defects are inactivating mutations of the ABCC8 or KCNJ11 genes. The classical treatment for CHI has been pancreatectomy that eventually leads to diabetes. More recently, conservative treatment has been attempted in some cases, with encouraging results. Whether or not the patients with heterozygous ABCC8 mutations submitted to conservative treatment may spontaneously develop type 2 diabetes in the long run, is a controversial issue. Here, we report a family carrying the dominant heterozygous germ line E1506K mutation in ABCC8 associated with persistent hypoglycemia in the newborn period and diabetes in adulthood. The mutation occurred as a de novo germ line mutation in the mother of the index patient. Her hypoglycemic symptoms as a child occurred after the fourth year of life and were very mild, but she developed glucose metabolism impairment in adulthood. On the other hand, in her daughter, the clinical manifestations of the disease occurred in the neonatal period and were more severe, leading to episodes of tonic-clonic seizures that were well controlled with octreotide or diazoxide. Our data corroborate the hypothesis that the dominant E1506K ABCC8 mutation, responsible for CHI, predisposes to the development of glucose intolerance and diabetes later in life.


Subject(s)
ATP-Binding Cassette Transporters/genetics , Congenital Hyperinsulinism/complications , Diabetes Mellitus/genetics , Diabetes, Gestational/genetics , Epilepsy, Tonic-Clonic/etiology , Potassium Channels, Inwardly Rectifying/genetics , Receptors, Drug/genetics , Adult , Child , Congenital Hyperinsulinism/genetics , Diazoxide/therapeutic use , Epilepsy, Tonic-Clonic/drug therapy , Epilepsy, Tonic-Clonic/genetics , Female , Humans , Hypoglycemia/complications , Hypoglycemia/genetics , Infant, Newborn , Octreotide/therapeutic use , Pregnancy , Sulfonylurea Receptors
6.
Epilepsy Behav ; 8(3): 575-80, 2006 May.
Article in English | MEDLINE | ID: mdl-16530016

ABSTRACT

The interaction between thalamus and cortex appears to be critical to the pathophysiology of idiopathic generalized epilepsies (IGEs). The objective of this study was to investigate thalamic volumes of a group of patients with IGEs using high-resolution MRI. Thalamic segmentation was performed by the same rater, who was unaware of the diagnosis. Thalamic volumes were divided into anterior half and posterior half. One hundred forty-seven patients were scanned (71 with juvenile myoclonic epilepsy, 49 with generalized tonic-clonic seizures only, and 27 with absence epilepsy). Subgroup analyses with corrections for multiple comparisons showed that, when compared with those of controls, anterior thalamic volumes were increased in patients with absence epilepsy and juvenile myoclonic epilepsy with absence seizures, but not in patients with generalized tonic-clonic seizures only and juvenile myoclonic epilepsy without absence seizures. Our results demonstrated that the anterior thalamus is structurally different in patients with IGEs and absence seizures as compared with patients with IGEs without absence seizures.


Subject(s)
Epilepsy, Absence/pathology , Epilepsy, Tonic-Clonic/pathology , Magnetic Resonance Imaging , Myoclonic Epilepsy, Juvenile/pathology , Thalamus/pathology , Adult , Anticonvulsants/therapeutic use , Electroencephalography , Epilepsy, Absence/drug therapy , Epilepsy, Tonic-Clonic/drug therapy , Female , Humans , Male , Middle Aged , Myoclonic Epilepsy, Juvenile/drug therapy
7.
Arq Neuropsiquiatr ; 63(3B): 733-7, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16258645

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerability of topiramate (TPM) in juvenile myoclonic epilepsy (JME). METHOD: We assessed seizure control and adverse effects of TPM in 22 patients (18 females) aged 13 to 53 years. Target TPM dosage was up to 200 mg/day. The patients were subdivided into 3 groups: those treated with seizure control plus side effects (n=4); treated with non-controlled seizures (n=15) and with JME newly diagnosed (n=3). RESULTS: Sixteen patients completed the first year of the follow-up. Generalized tonic-clonic seizures were completely controlled in 10 (62.5%); more than 50% of reduction in 4 (25.0%) and less than 50% in 2 (12.5%). Myoclonia were controlled in 11 (68.8%) and persisted in 5 (31.2%) patients. Absence seizures were present in 5 (22.7%) of whom 2 (9.0%) showed more than 50% of seizure reduction while 3 (13.6%) presented worsening. Discontinuations were due to inadequate seizure control and adverse events (N=4), low compliance and loss of follow-up (N=2) and subject choice (N=1). CONCLUSION: TPM showed to be an effective and well-tolerated drug in the treatment of JME. Although frequently observed, TPM side effects were tolerable and the drug could be maintained in the majority of patients.


Subject(s)
Anticonvulsants/therapeutic use , Fructose/analogs & derivatives , Myoclonic Epilepsy, Juvenile/drug therapy , Adolescent , Adult , Anticonvulsants/adverse effects , Diagnostic and Statistical Manual of Mental Disorders , Epilepsy, Absence/drug therapy , Epilepsy, Tonic-Clonic/drug therapy , Female , Follow-Up Studies , Fructose/adverse effects , Fructose/therapeutic use , Humans , Male , Middle Aged , Prospective Studies , Topiramate , Treatment Outcome
8.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;63(3B): 733-737, set. 2005. graf, ilus
Article in English | LILACS | ID: lil-445157

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerability of topiramate (TPM) in juvenile myoclonic epilepsy (JME). METHOD: We assessed seizure control and adverse effects of TPM in 22 patients (18 females) aged 13 to 53 years. Target TPM dosage was up to 200 mg/day. The patients were subdivided into 3 groups: those treated with seizure control plus side effects (n=4); treated with non-controlled seizures (n=15) and with JME newly diagnosed (n=3). RESULTS: Sixteen patients completed the first year of the follow-up. Generalized tonic-clonic seizures were completely controlled in 10 (62.5%); more than 50% of reduction in 4 (25.0%) and less than 50% in 2 (12.5%). Myoclonia were controlled in 11 (68.8%) and persisted in 5 (31.2%) patients. Absence seizures were present in 5 (22.7%) of whom 2 (9.0%) showed more than 50% of seizure reduction while 3 (13.6%) presented worsening. Discontinuations were due to inadequate seizure control and adverse events (N=4), low compliance and loss of follow-up (N=2) and subject choice (N=1). CONCLUSION: TPM showed to be an effective and well-tolerated drug in the treatment of JME. Although frequently observed, TPM side effects were tolerable and the drug could be maintained in the majority of patients.


OBJETIVO: Avaliar a eficácia e tolerabilidade do topiramato (TPM) na epilepsia mioclônica juvenil (EMJ). MÉTODO: Avaliamos a resposta terapêutica e efeitos colaterais do TPM em 22 pacientes (18 mulheres) com idades entre 13 e 53 anos. A dose alvo utilizada foi até 200 mg/dia. Os pacientes foram divididos em 3 grupos no início do tratamento: aqueles com controle das crises mas que apresentavam efeitos colaterais (n=4); com crises não controladas (n=15) e com EMJ recém diagnosticada (n=3). RESULTADOS: Dezesseis pacientes completaram o primeiro ano de acompanhamento. Crises tônico-clonicas generalizadas foram completamente controladas em 10 (62,5%), tiveram redução maior de 50% em 4 (25,0%) e menor de 50% em 2 (12,5%). Mioclonias foram controladas em 11 (68,8%) e persistiram em 5 (31.2%) pacientes. As crises de ausências, presentes em 5 (22,7%) pacientes, tiveram redução maior do que 50% em 2 (9,0%) e agravamento em 3 (13,6%). A retirada do estudo foi devida principalmente ao controle inadequado das crises e efeitos colaterais indesejáveis (n=4), pouca adesão e perda do seguimento (n=2) e escolha do paciente (n=1). CONCLUSÃO: TPM foi considerada droga eficaz e bem tolerada no tratamento da EMJ. Apesar de freqüentemente observados, os efeitos colaterais do TPM foram toleráveis e a medicação pode ser mantida na maioria dos pacientes.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Anticonvulsants/therapeutic use , Myoclonic Epilepsy, Juvenile/drug therapy , Fructose/analogs & derivatives , Anticonvulsants/adverse effects , Diagnostic and Statistical Manual of Mental Disorders , Epilepsy, Absence/drug therapy , Epilepsy, Tonic-Clonic/drug therapy , Follow-Up Studies , Fructose/adverse effects , Fructose/therapeutic use , Prospective Studies , Treatment Outcome
9.
Neuropharmacology ; 49(3): 367-75, 2005 Sep.
Article in English | MEDLINE | ID: mdl-15993434

ABSTRACT

The effects of two serotonergic (5-HT1A) receptor agonists (8-OH-DPAT; 0.01, 0.1, 0.3, 1 mg/kg, s.c., and Indorenate; 1, 3, 10 mg/kg, i.p.) were evaluated in three type of seizures in male Wistar rats: clonic-tonic convulsions induced by pentylenetetrazol (PTZ, 60 mg/kg, i.p.), status epilepticus (SE) of limbic seizures produced by kainic acid (KA, 10 mg/kg, i.p.) and tonic-clonic seizures by amygdala kindling. 8-OH-DPAT decreased the incidence of tonic seizures and the mortality rate induced by PTZ. Indorenate increased the latency to the PTZ-induced seizures and decreased the percentage of rats showing tonic extension and death. Concerning KA, 8-OH-DPAT augmented the latency and reduced the frequency of wet-dog shake (WDS) and generalized seizure (GS). At high doses it diminished the occurrence and delayed the establishment of SE. Indorenate augmented the latency to WDS, GS and SE, and diminished the number of GS. 8-OH-DPAT and Indorenate did not alter the expression of kindled seizures. However, Indorenate enhanced the refractoriness to subsequent seizures during the postictal depression. Some effects induced by 8-OH-DPAT and Indorenate on seizures evaluated and postictal depression were fully or partially blocked by WAY100635. These results suggest that 5-HT1A receptor agonists modify epileptic activity depending on the type of seizure.


Subject(s)
Anticonvulsants , Receptor, Serotonin, 5-HT1A/drug effects , Seizures/drug therapy , Serotonin Receptor Agonists/pharmacology , 5-Methoxytryptamine/analogs & derivatives , 5-Methoxytryptamine/pharmacology , 8-Hydroxy-2-(di-n-propylamino)tetralin/pharmacology , Amygdala , Animals , Convulsants , Dose-Response Relationship, Drug , Epilepsy, Complex Partial/prevention & control , Epilepsy, Generalized/drug therapy , Epilepsy, Generalized/physiopathology , Epilepsy, Tonic-Clonic/drug therapy , Epilepsy, Tonic-Clonic/physiopathology , Excitatory Amino Acid Agonists , Kainic Acid , Kindling, Neurologic , Male , Pentylenetetrazole , Rats , Rats, Wistar , Status Epilepticus/chemically induced , Status Epilepticus/prevention & control
10.
Arq Neuropsiquiatr ; 61(3A): 566-73, 2003 Sep.
Article in English | MEDLINE | ID: mdl-14513159

ABSTRACT

OBJECTIVE: To investigate the value of leaving seizure-free patients on low-dose medication. METHOD: This was an exploratory prospective randomized study conducted at our University Hospital. We evaluated the frequency of seizure recurrence and its risk factors following complete or partial antiepileptic drug (AED) withdrawal in seizure free patients for at least two years with focal, secondarily generalized and undetermined generalized epilepsies. For this reason, patients were divided into two groups: Group 1 (complete AED withdrawal), and Group 2 (partial AED withdrawal). Partial AED withdrawal was established as a reduction of 50% of the initial dose. Medication was tapered off slowly on both groups. Follow-up period was 24 months. RESULTS: Ninety-four patients were followed up: 45 were assigned to complete (Group 1) AED withdrawal and 49 to partial (Group 2) AED withdrawal. Seizure recurrence frequency after two years follow-up were 34.04% in group 1 and 32.69% in Group 2. Survival analysis showed that the probability of remaining seizure free at 6, 12, 18 and 24 months after randomization did not differ between the two groups (p = 0.8). Group 1: 0.89, 0.80, 0.71 and 0.69; group 2: 0.86, 0.82, 0.75 and 0.71. The analysis of risk factors for seizure recurrence showed that more than 10 seizures prior to seizure control was a significant predictive factor for recurrence after AED withdrawal (hazard ratio = 2.73). CONCLUSION: Leaving seizure free patients on low AED dose did not reduce the risk for seizure recurrence. That is, once the decision of AED withdrawal has been established, it should be complete.


Subject(s)
Anticonvulsants/administration & dosage , Epilepsies, Partial/drug therapy , Epilepsy, Tonic-Clonic/drug therapy , Adolescent , Adult , Aged , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pilot Projects , Prognosis , Prospective Studies , Recurrence , Regression Analysis , Risk Assessment , Seizures/prevention & control , Time Factors
11.
Seizure ; 12(5): 312-5, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12810345

ABSTRACT

OBJECTIVES: To perform MRI cerebellum volumetry in patients exposed to phenytoin and to identify factors associated with cerebellar atrophy (CA). METHODS: From 100 consecutive epilepsy patients we selected those with phenytoin use for more than 2 months and with MRI scan available for volumetric studies. We obtained cerebellar volumes corrected for total intracranial volume. Volumes below 2 standard deviations from the mean of control group were considered abnormal. RESULTS: We studied 56 patients (33 women). Mean age was 33.6 years and mean duration of epilepsy was 17.6 years. Mean daily dose of phenytoin was 301 mg. CA was detected in 20 (35.7%) patients. CA was not associated with frequent generalised seizures. CA correlated with duration of epilepsy (r=-0.34; P=0.01) and years of treatment with phenytoin (r=-0.48; P=0.001), but not with age and mean daily dosage of phenytoin (P>0.05). However, a multiple correlation analysis as well as a backward stepwise multiple regression analysis including all variables showed that only duration of treatment was significantly associated with CA (P=0.001). CONCLUSIONS: CA is frequently associated with long-term use of phenytoin. Although duration of epilepsy may have an influence in the CA, this is clearly less important than the time of exposure to phenytoin.


Subject(s)
Anticonvulsants/adverse effects , Cerebellum/drug effects , Epilepsy/drug therapy , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Mathematical Computing , Phenytoin/adverse effects , Adolescent , Adult , Aged , Anticonvulsants/administration & dosage , Anticonvulsants/pharmacokinetics , Cerebellum/pathology , Child , Child, Preschool , Dose-Response Relationship, Drug , Epilepsies, Partial/blood , Epilepsies, Partial/diagnosis , Epilepsies, Partial/drug therapy , Epilepsy/blood , Epilepsy/diagnosis , Epilepsy, Generalized/blood , Epilepsy, Generalized/diagnosis , Epilepsy, Generalized/drug therapy , Epilepsy, Temporal Lobe/blood , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/drug therapy , Epilepsy, Tonic-Clonic/blood , Epilepsy, Tonic-Clonic/diagnosis , Epilepsy, Tonic-Clonic/drug therapy , Female , Humans , Long-Term Care , Male , Middle Aged , Phenytoin/administration & dosage , Phenytoin/pharmacokinetics , Reference Values , Regression Analysis , Risk Factors
12.
J Neurol Sci ; 177(1): 1-17, 2000 Aug 01.
Article in English | MEDLINE | ID: mdl-10967177

ABSTRACT

The pathophysiology of convulsive and non-convulsive epilepsies is discussed in its primary generalised forms. Focal, clinical and experimental epilepsies, with emphasis placed on the temporal lobe epilepsies (TLE) and their pathophysiologies are also reviewed. Neurotransmitters and neuromodulators and between them, the second messenger systems are considered in the generation, maintenance or inhibition of the epileptic discharge. Action mechanisms of the more classic antiepileptic drugs are briefly summarized along with the therapeutic strategies that might achieve the final control of abnormal discharges, including genetic control as a promising alternative in the current state of research. We emphasized the study of all type of glutamate and GABA receptors and their relation with mRNA editing in the brain. Some of the genetic studies which have been so fruitful during the last ten years and which have brought new insights regarding the understanding of epileptic syndromes are summarized in this article.


Subject(s)
Epilepsy, Generalized/physiopathology , Epilepsy, Temporal Lobe/physiopathology , Receptors, GABA/physiology , Signal Transduction/physiology , Animals , Anticonvulsants/pharmacology , Anticonvulsants/therapeutic use , Epilepsy, Generalized/drug therapy , Epilepsy, Generalized/genetics , Epilepsy, Temporal Lobe/drug therapy , Epilepsy, Temporal Lobe/genetics , Epilepsy, Tonic-Clonic/drug therapy , Epilepsy, Tonic-Clonic/genetics , Epilepsy, Tonic-Clonic/physiopathology , Humans , Membrane Potentials/drug effects , Membrane Potentials/physiology , Receptors, GABA/drug effects , Signal Transduction/drug effects
13.
Rev Neurol ; 30(1): 41-4, 2000.
Article in Spanish | MEDLINE | ID: mdl-10742994

ABSTRACT

INTRODUCTION: The Sturge-Weber syndrome is characterized by facial cutaneous angioma associated with leptomeningeal and cerebral angioma, typically ipsilateral to the facial lesion, which is accompanied by convulsions, mental retardation, contralateral hemiparesia, hemiatrophy, homonymous hemianopsia and glaucoma. Most of the patients with radiographic evidence of intracranial angioma develop convulsive crises, but only half have severe mental retardation. The image of calcification on cranial tomography often leads to confusion in diagnosis, especially with neurocysticercosis, particularly in places where this is endemic and the patients present with minimal skin lesions or these are at atypical sites. CLINICAL CASE: We present the case of a 13 year-old boy hospitalized with status epilepticus who, since the age of 1 year and 3 months, had had convulsive seizures which were of generalized tonic-clonic type and partially complex with secondary generalization, treated with carbamazepine at a dose of 400 mg per day. Neurocysticercosis was diagnosed on a tomogram showing calcification of the left parieto-occipital gyrus. Following physical examination and complementary tests the diagnosis of Sturge-Weber syndrome was made. CONCLUSION: We emphasize the importance of the diagnosis of Sturge-Weber syndrome, its clinical picture and treatment.


Subject(s)
Neurocysticercosis/diagnosis , Sturge-Weber Syndrome/diagnosis , Adolescent , Anticonvulsants/therapeutic use , Brain Diseases/diagnostic imaging , Calcinosis/diagnostic imaging , Carbamazepine/therapeutic use , Diagnosis, Differential , Epilepsy, Tonic-Clonic/drug therapy , Epilepsy, Tonic-Clonic/etiology , Humans , Male , Occipital Lobe/diagnostic imaging , Parietal Lobe/diagnostic imaging , Tomography, X-Ray Computed
15.
Pesqui. méd. (Porto Alegre) ; 32(1): 6-11, 1998. tab, graf
Article in Portuguese | LILACS | ID: lil-224999

ABSTRACT

O trabalho visa comparar a eficácia anticonvulsivante da oxcarbazepina e da carbamazepina e a relaçao dose-efeito das mesmas. Foram utilizados 64 ratos albinos Wistar divididos em sete grupos, que receberam doses de OCBZ e CBZ em diferentes concentraçöes, sendo submetidos 30 minutos depois a eletrochoque transcorneal de 100V po 0,2 segundos, sendo observado o período de latência e de início das crises convulsivas tônico-clônicas...


Subject(s)
Animals , Rats , Anticonvulsants/administration & dosage , Anticonvulsants/pharmacology , Anticonvulsants/therapeutic use , Carbamazepine , Electroshock , Epilepsy, Tonic-Clonic/drug therapy
16.
Rev Neurol ; 25(147): 1681-4, 1997 Nov.
Article in Spanish | MEDLINE | ID: mdl-9484517

ABSTRACT

INTRODUCTION AND MATERIAL: We studied 54 patients younger than 17 years of age with neurocysticercosis to determine the clinical manifestations, neuroimaging findings, and prognostic factors of this condition. RESULTS: Seizures were present in 48 patients, representing the most common clinical manifestation. Forty-eight patients had a normal neurological examination, and only 3 patients had clinical evidence of increased intracranial pressure. CT scan of the brain revealed parenchymal brain cysticerci in 52 patients; one patient had a pure subarachnoid form of the disease and the remaining patient had a mixed (subarachnoid and parenchymal) form. The most common CT finding in patients with parenchymal neurocysticercosis was a single colloidal cyst (19 cases). All patients with seizures were treated with anti-epileptic drugs with an excellent rate of seizure-control. In addition, 23 patients received albendazole that caused resolution of cystic lesions in 19 cases. Anti-epileptic drugs were withdrawn in 13 patients who remained free of seizures during two years. However, 9 (69%) of these patients had recurrent seizures. CONCLUSION: This evidence is in contrast with the reported benign course of neurocysticercosis in children, since most patients had seizure relapses despite therapy.


Subject(s)
Brain Diseases/diagnostic imaging , Brain Diseases/parasitology , Brain/diagnostic imaging , Cysticercosis/diagnostic imaging , Tomography, X-Ray Computed/methods , Adolescent , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Anticonvulsants/therapeutic use , Brain Diseases/complications , Brain Diseases/drug therapy , Carbamazepine/therapeutic use , Child , Child, Preschool , Cysticercosis/complications , Cysticercosis/drug therapy , Epilepsy, Tonic-Clonic/diagnosis , Epilepsy, Tonic-Clonic/drug therapy , Epilepsy, Tonic-Clonic/etiology , Female , Humans , Male , Phenytoin/therapeutic use , Prognosis
18.
Rev Invest Clin ; 44(1): 109-13, 1992.
Article in Spanish | MEDLINE | ID: mdl-1381840

ABSTRACT

Hyperthyroidism in childhood has a relative incidence of 5%. The presence of epilepsy secondary to thyrotoxicosis is very unusual. We report the case of a four-year old boy with thyrotoxicosis due to Graves' disease. This patient developed a generalized tonic-clonic seizure followed by left sided partial motor status epilepticus. The EEG was markedly abnormal. The EEG was normal after five months of the ablative therapy. At the present time the patient is seizure-free without any antiepileptic medication and receiving replacement therapy with thyroxin due to post-ablation hypothyroidism. We conclude that this is the first reported case with this association in our country. We discuss the possible pathophysiological mechanism involved in the development of seizures in this patient.


Subject(s)
Epilepsy, Tonic-Clonic/etiology , Graves Disease/complications , Anticonvulsants/therapeutic use , Antithyroid Agents/therapeutic use , Child, Preschool , Combined Modality Therapy , Epilepsy, Tonic-Clonic/drug therapy , Graves Disease/drug therapy , Graves Disease/radiotherapy , Humans , Iodine Radioisotopes/therapeutic use , Male
20.
Arq Neuropsiquiatr ; 38(3): 269-77, 1980 Sep.
Article in Portuguese | MEDLINE | ID: mdl-6110418

ABSTRACT

Twenty nine patients were treated with barbexaclone for 6-41 months. Eighteen of these patients suffered from grand-mal epilepsy and complete control of the crises was achieved in 16 of them. No alterations were noted in the hemogram, liver or renal function tests. Side effects were minimal and didn't necessitate discontinuing the drug. 25% of the patients also showed a psychological improvement on the medication.


Subject(s)
Epilepsy, Tonic-Clonic/drug therapy , Phenobarbital/analogs & derivatives , Adolescent , Adult , Child , Clinical Trials as Topic , Epilepsy, Temporal Lobe/drug therapy , Female , Humans , Kidney Function Tests , Liver Function Tests , Male , Middle Aged , Phenobarbital/therapeutic use , Propylamines/analogs & derivatives , Propylamines/therapeutic use
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