RESUMEN
Although vaccines are generally safe in persons with epilepsy (PWE), seizures can be associated with vaccination, including COVID-19. This study assessed the occurrence of COVID-19 vaccination-related seizure exacerbations in PWE. Adult PWE who had received a COVID-19 vaccine were consecutively recruited at a tertiary epilepsy clinic between June 2021 and April 2022. Patient demographics, including epilepsy history, vaccination details, and reported adverse effects were recorded. Seizure exacerbation, defined as occurring within one week of vaccination, was assessed. Five hundred and thirty PWE received the COVID-19 vaccine. 75 % received the Comirnaty (Pfizer) vaccine as their initial dose. Most patients (72 %) were taking ≥ 2 antiseizure medications (ASM) and had focal epilepsy (73 %). One-third were 12 months seizure free at their first vaccination. 13 patients (2.5 %) reported a seizure exacerbation following their first vaccination, three of whom required admission. None were seizure-free at baseline. Six of these patients (46 %) had a further exacerbation of seizures with their second vaccine. An additional four patients reported increased seizures only with the second vaccine dose. Seizure exacerbations are infrequently associated with COVID-19 vaccination, mainly in patients with ongoing seizures. The likelihood of COVID-19 infection complications in PWE outweighs the risk of vaccination-related seizure exacerbations.
Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Epilepsia , Adulto , Humanos , COVID-19/complicaciones , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Epilepsia/epidemiología , Convulsiones/inducido químicamente , Convulsiones/tratamiento farmacológico , Vacunación/efectos adversosRESUMEN
OBJECTIVES: The risk of recurrence following a first-ever seizure is 40-50%, warranting driving restriction during the early period of highest risk. This restriction must be balanced against the occupational, educational and social limitations that result from patients being ineligible to drive. The recommended duration of non-driving after a first seizure varies widely between jurisdictions, influenced by various factors including the community perception of an acceptable relative level of risk for an accident (the accident risk ratio; ARR). Driving restrictions may be based on individualised risk assessments or across-the-board guidelines, but these approaches both require accurate data on the risk of seizure recurrence. METHODS: 1386 patients with first-ever seizure were prospectively analysed. Seizure recurrence was evaluated using survival analysis. The duration of non-driving required for a range of risks of seizure recurrence and ARRs was calculated. Additionally, the actual occurrence of seizures while driving was prospectively determined during follow-up. RESULTS: For a risk of seizure recurrence to fall to 2.5% per month, corresponding to a monthly risk of a seizure while driving of 1.04 per thousand and an ARR of 2.6, non-driving periods of 8â months are required for unprovoked first-ever seizure, and 5â months for provoked first-ever seizure. Of patients with a seizure recurrence, 14 (2%) occurred while driving, with the monthly risk falling to less than 1/1000 after 6â months. CONCLUSIONS: Our data provide a quantitative approach to decisions regarding a return to driving in patients with first-ever provoked or unprovoked seizure.
Asunto(s)
Conducción de Automóvil/psicología , Conducción de Automóvil/estadística & datos numéricos , Convulsiones/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Medición de Riesgo , Análisis de Supervivencia , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Increased calf muscle stiffness is a common impairment following acquired brain injury. This study examined the immediate effects of cyclic ankle stretching at two stretch velocities on calf stiffness in individuals with hemiparesis (n=17) and control subjects (n=10). METHODS: Cyclic ankle stretching was applied for 3min at velocities of 5 degrees s(-1) and 25 degrees s(-1) using a purpose-built dynamometer. Surface electromyography was employed to ensure stretches were passive. Peak plantarflexor resistive torque was derived from torque-angle curves. Comparisons were made between groups, velocities, and between limbs for hemiparetic subjects. FINDINGS: At baseline, mean peak plantarflexor resistive torque was greater in the affected limbs of hemiparetic subjects than their contralateral limbs (P<0.001), however there was no significant difference between groups. Plantarflexor resistive torque was reduced in all limbs following cyclic stretching regardless of stretch velocity (P<0.005). Two distinct patterns of response were observed in hemiparetic subjects. In nine cases the affected limb responses did not differ from the contralateral limb or control data. In the remaining eight cases mean peak plantarflexor resistive torque in the affected limb was greater than the contralateral limb and control values. In this subgroup, peak plantarflexor resistive torque was significantly affected by stretch velocity and showed the greatest reduction following cyclic stretching. INTERPRETATION: Cyclic stretching has been shown to produce a short term reduction in calf stiffness in a subgroup of individuals with hemiplegia. Further investigation is required to elaborate the characteristics of those most likely to respond optimally to this intervention.
Asunto(s)
Articulación del Tobillo/fisiopatología , Lesiones Encefálicas/fisiopatología , Contracción Muscular , Hipertonía Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Adulto , Anciano , Lesiones Encefálicas/complicaciones , Módulo de Elasticidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hipertonía Muscular/etiología , Estrés Mecánico , Torque , Adulto JovenRESUMEN
PURPOSE: To examine the effect of intramuscular injection of botulinum toxin type A [Dysport] to reduce relative overactivity of the vastus lateralis [VL] muscle, in conjunction with re-training of vastus medialis [VM] muscle as an adjunct to rehabilitation for chronic anterior knee pain. METHOD: Eight females with chronic (>6 months) history of anterior knee pain, who had failed conservative management, were studied in this open label pilot study. Intramuscular Dysport injection [300 - 500 units] to the distal third of VL muscle was followed by a 12-week customized home exercise programme to improve recruitment of VM muscle and functional knee control. VL and VM muscle cross sectional area from a standardized spiral CT sequence, isometric quadriceps strength (dynamometry), timed stair task, self-reported pain and disability were assessed. RESULTS: Subjects reported reduced knee pain and brace dependency and increased participation in sporting and daily living activities. Isometric quadriceps muscle strength was maintained or improved despite significant atrophy, evident on CT, of the distal component of VL in the treated limb. Time taken to ascend and descend a flight of stairs improved in all subjects. Subjective and objective improvements were maintained at 24-week follow-up. CONCLUSIONS: These pilot data provide preliminary support for the role of Dysport as an adjunct to non-surgical management of individuals with chronic anterior knee pain. Larger double blind, randomized, placebo-injection controlled studies of this novel approach to improving patellofemoral mechanics are needed to establish the efficacy of this intervention.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Fármacos Neuromusculares/uso terapéutico , Síndrome de Dolor Patelofemoral/rehabilitación , Músculo Cuádriceps/fisiopatología , Adolescente , Adulto , Fenómenos Biomecánicos , Terapia por Ejercicio , Femenino , Humanos , Inyecciones Intramusculares , Dimensión del Dolor , Síndrome de Dolor Patelofemoral/tratamiento farmacológico , Proyectos Piloto , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: The purpose of this study was to document the outcome of non-surgical management of equinovarus ankle contracture in a cohort of patients with acquired brain injury admitted to a specialist Neurosurgical Rehabilitation Unit. METHODS: This prospective descriptive study examined all patients with a new diagnosis of moderate to severe acquired brain injury (Glasgow Coma Scale score =12) admitted for rehabilitation over a 1 year period. Ankle dorsiflexion range and plantarflexor/invertor muscle activity were evaluated weekly during the period of hospitalization. Contracture was defined as maximal passive range of motion = 0 degrees dorsiflexion, with the knee extended, on a minimum of two measurement occasions. Patients were retrospectively allocated to one of four treatment outcome categories according to ankle dorsiflexion range, type of intervention required and response to treatment. RESULTS: Ankle contracture was identified in 40 of the 105 patients studied. Contracture resolved with a standard physiotherapy treatment programme, including prolonged weight-bearing stretches and motor re-education, in 23 patients. Contracture persisted or worsened in 17 of 40 cases, all of whom exhibited dystonic muscle overactivity producing sustained equinovarus posturing. Ten of 17 cases required serial plaster casting (+/- injection of botulinum toxin type A) in order to achieve a functional range of ankle motion. Remediation of ankle contracture was not considered a priority in the remaining seven patients due to the severity of their overall disability. CONCLUSION: The incidence of ankle contracture identified in this population was considerably less than previously reported. Reduced dorsiflexion range was remediated with standard physiotherapy treatment in over half of the cases. Additional treatment with serial casting +/- botulinum toxin type-A injection was required to correct persistent or worsening contracture in one quarter of cases. Dystonic extensor muscle overactivity was a major contributor to persistent or progressive ankle contracture.
Asunto(s)
Lesiones Encefálicas/complicaciones , Contractura/etiología , Contractura/rehabilitación , Deformidades Adquiridas del Pie/rehabilitación , Modalidades de Fisioterapia/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Tobillo , Lesiones Encefálicas/diagnóstico , Moldes Quirúrgicos , Estudios de Cohortes , Contractura/diagnóstico , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/diagnóstico , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Aparatos Ortopédicos , Estudios Prospectivos , Rango del Movimiento Articular/fisiología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: This study sought to determine whether factors other than stretch reflex excitability contribute to velocity dependent passive plantarflexor resistive torque following brain injury. BACKGROUND: In patients with acquired brain injury increased resistance to passive muscle lengthening commonly results from abnormal muscle contraction, secondary to disinhibition of descending motor pathways, in addition to rheologic changes within the musculo-tendinous unit. Hyper-excitable tonic stretch reflex responses (spasticity) have traditionally been considered to be the main factor influencing resistance that is velocity dependent. METHODS: Ten adults with brain injury and eighteen age matched controls were studied. A computer controlled torque measurement system was utilised to evaluate resistance to dorsiflexion stretches at two velocities (5 degrees and 25 degrees s(-1)). Only stretches which did not evoke muscle contraction were included in the data analysis. The mean difference and 95% confidence limits in passive plantarflexor resistive torque at two stretch velocities, measured over a defined portion of the test movement, were compared between subject groups. RESULTS: A velocity dependent increase in passive plantarflexor resistive torque was evident when the ankle was dorsiflexed past the neutral position in both subjects with brain injury and controls. However, the mean difference was approximately 10 times greater in neurologically impaired limbs compared with control values. CONCLUSIONS: These data indicate that an important component of velocity dependent resistance to passive muscle lengthening in adults with brain injury can be mechanical, and unrelated to stretch induced reflex muscle contraction. RELEVANCE: Increased resistive torque during rapid muscle lengthening may represent a compensatory adaptation for reduced distal motor control following brain injury. A velocity dependent increase in passive plantarflexor resistive torque has the potential to improve stability during gait and provide mechanical resistance to sudden external perturbations.
Asunto(s)
Articulación del Tobillo/fisiopatología , Lesiones Encefálicas/fisiopatología , Hipertonía Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Adulto , Lesiones Encefálicas/complicaciones , Elasticidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hipertonía Muscular/etiología , Reflejo de Estiramiento , Reproducibilidad de los Resultados , Rotación , Sensibilidad y Especificidad , Estrés Mecánico , TorqueAsunto(s)
Contracción Isométrica/fisiología , Rigidez Muscular/fisiopatología , Espasticidad Muscular/fisiopatología , Rango del Movimiento Articular/fisiología , Reflejo de Estiramiento/fisiología , Aceleración , Articulación del Codo/fisiopatología , Humanos , Accidente Cerebrovascular/fisiopatología , TorqueRESUMEN
The purpose of this open study was to find out whether botulinum toxin A (BTX-A) relieves the signs and symptoms of chronic limb spasticity. The study comprised 40 patients, aged 12-82 years, with moderate to severe spasticity of the upper (13) or lower limbs (27) refractory to conventional physical and medical treatments. Outcome measures were clinical and blinded videotape assessments of spasticity and motor function. Electromyography guided BTX-A injections were given in one or two sessions at total doses averaging 175 U in the upper limb (range 70-270 U) and 221 U in the lower limb (range 100-500 U). Thirty four patients (85%) derived worthwhile benefit, with improved limb posture and increased range of passive motion in 31, pain reduction in 28 of 31 with pain, and improved function in 16. Side effects were limited to local and usually mild discomfort from the injections (19), symptomatic local weakness (one), and local infection (one). Preliminary experience indicates that BTX-A is a promising adjunctive treatment for selected patients with spasticity.
Asunto(s)
Toxinas Botulínicas/uso terapéutico , Espasticidad Muscular/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Enfermedad Crónica , Extremidades/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/fisiopatologíaAsunto(s)
Catatonia/diagnóstico , Estado Epiléptico/diagnóstico , Anciano , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
OBJECTIVES: To determine the clinical features, response to treatment and outcome of petrol sniffers presenting to Perth's teaching hospitals. DESIGN: Retrospective study of all admissions to Perth's tertiary referral hospitals that were related to petrol sniffing from 1 January 1984 to 31 December 1991. RESULTS: Twenty-five patients (22 male and 3 female) were admitted with a diagnosis of intentional petrol sniffing. Five presented with acute petrol intoxication as the result of an isolated action. The remaining 20 patients were "chronic petrol sniffers". The mean age was 17.7 years (range, 5-27 years). Twenty patients were Australian Aborigines, including 18 of 20 chronic petrol sniffers and the three females. In the chronic petrol sniffers, a high prevalence of seizures and an alarmingly high case fatality ratio (8 of 20), usually by sudden death, were found. An altered mental state was universal, manifesting as drowsiness, delirium or stupor. Generalised tonic-clonic seizures occurred in 14, three with status epilepticus. Myoclonus (9), chorea (8) and cerebellar ataxia (appendicular and truncal) (13) were common. High blood lead levels on presentation were associated with a poor prognosis (survivors v. deaths, P = 0.002). Eighteen of the 20 patients were treated with specific agents to reduce the lead load, but the results were extremely disappointing. CONCLUSION: Petrol sniffing is an important cause of sickness and death in young people from some rural Aboriginal communities. It can cause sudden death or irreversible encephalopathy. Those severely affected have a poor prognosis, despite treatment. Effective strategies for prevention are needed.
Asunto(s)
Encefalopatías/inducido químicamente , Gasolina , Trastornos Relacionados con Sustancias/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Australia , Encefalopatías/tratamiento farmacológico , Niño , Preescolar , Enfermedad Crónica , Femenino , Humanos , Intoxicación por Plomo/tratamiento farmacológico , Intoxicación por Plomo/etiología , Masculino , Nativos de Hawái y Otras Islas del Pacífico , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/mortalidadRESUMEN
Phenelzine associated sensorimotor peripheral neuropathy is reported in two patients. Symptoms were predominantly sensory, and improvement occurred after withdrawal of phenelzine. Electrophysiologic findings were consistent with an axonal process.