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1.
Artículo en Ruso | MEDLINE | ID: mdl-33834715

RESUMEN

OBJECTIVE: To evaluate the efficacy and tolerability of extended release carbamazepine (finlepsin-retard and tegretol CR) in adult patients with new-onset focal epilepsy (FE) with the assessment of epileptiform activity index (EAI). MATERIAL AND METHODS: The study included 62 patients (38 (61.3%) men and 24 (38.7%) women) with new-onset FE aged ≥18 years (mean age 42.9±18.4 years). All patients underwent video-ECG-monitoring with EAI assessment at each visit. Treatment efficacy was assessed using the criteria of seizure absence (medically induced remission), seizure rate decrease by >50% (responders), seizure rate decrease by <50% - insufficient efficacy, retention on treatment and seizure rate increase compared to baseline and/or development of new type of seizures (aggravation). Overall study period was 12 months. RESULTS: By the end of the 12-month follow-up period, there was a 4.3-fold decrease of the total EAI compared to baseline (p<0.001). Retention on carbamazepine treatment during 12 months was achieved in 61.3% (n=38) patients; medically induced remission - in 40.3% (n=25); seizure rate decrease by >50% - in 21.0% (n=13). In 29.1% (n=18) of patients, treatment change was performed; double-drug therapy, including carbamazepine, was prescribed in 9.6% (n=6) of patients. Incidence of adverse events was 29.1% (n=18). CONCLUSIONS: Carbamazepine is an effective and promising drug for initial monotherapy of FE. Its use in the treatment of FE results in a 4.3-fold decrease of EAI (p<0.001), which reflects the efficacy of treatment. EAI is an additional objective measure of treatment efficacy.


Asunto(s)
Epilepsias Parciales , Epilepsia Generalizada , Epilepsia , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Carbamazepina/uso terapéutico , Epilepsias Parciales/tratamiento farmacológico , Epilepsia/tratamiento farmacológico , Epilepsia Generalizada/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
2.
Artículo en Ruso | MEDLINE | ID: mdl-33834730

RESUMEN

OBJECTIVE: To study the possibility of using the polypeptide drug cortexin for the treatment of cognitive, emotional and behavioral disorders in children and adolescents with epilepsy and to assess the efficacy and safety of the drug in this group of patients. MATERIALS AND METHODS: Eighty-six patients (41 girls and 45 boys) were examined at the age of 3 to 17 y.o. Cortexin was used along with antiepileptic drugs. Clinical and pathopsychological methods were administered. RESULTS: Children and teenagers with epilepsy have average IQ (91-110) in 72% of cases, 24% had mental deficiency of various intensity, these were children with pharmacoresistant epilepsy, including 2% with IQ 154 and 2% with IQ 71-80. CONCLUSION: Clinical, neurophysiological and psychological study of children and adolescents with epilepsy reveal the improvement of electrophysiological parameters, there are no aggravation of seizures in 95% cases. The improvement of cognitive functions is observed in 65% of patients.


Asunto(s)
Epilepsia , Péptidos y Proteínas de Señalización Intercelular , Adolescente , Anticonvulsivantes/uso terapéutico , Niño , Cognición , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Masculino
3.
Arq Neuropsiquiatr ; 79(1): 22-29, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33656108

RESUMEN

BACKGROUND: Data on prescribing patterns of antiepileptic drugs (AEDs) to older adult inpatients are limited. OBJECTIVE: To assess changes in prescribing patterns of AEDs to older adult inpatients with late-onset epilepsy between 2009-2010 and 2015-2019, and to interpret any unexpected patterns over the 2015-2019 period. METHODS: Patients aged ≥60 years with late-onset epilepsy from a tertiary center were selected. Demographic data, seizure characteristics and etiology, comorbidities, and comedications were analyzed, in addition to prescription regimens of inpatients taking AEDs to treat epilepsy. AED regimens were categorized into two groups: group 1 included appropriate AEDs (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazam, lamotrigine, levetiracetam, topiramate, and lacosamide); and group 2 comprised suboptimal AEDs (phenytoin and phenobarbital). Multivariate logistic regression analysis was performed to identify risk factors for prescription of suboptimal AEDs. RESULTS: 134 patients were included in the study (mean age: 77.2±9.6 years). A significant reduction in the prescription of suboptimal AEDs (from 73.3 to 51.5%; p<0.001) was found; however, phenytoin remained the most commonly prescribed AED to older adult inpatients. We also found an increase in the prescription of lamotrigine (from 5.5 to 33.6%) and levetiracetam (from 0 to 29.1%) over time. Convulsive status epilepticus (SE) and acute symptomatic seizures associated with remote and progressive etiologies were risk factors for the prescription of suboptimal AEDs. CONCLUSIONS: Phenytoin was the main suboptimal AED prescribed in our population, and convulsive SE and acute symptomatic seizures associated with some etiologies were independent risk factors for phenytoin prescription. These results suggest ongoing commitment to reducing the prescription of suboptimal AEDs, particularly phenytoin in Brazilian emergence rooms.


Asunto(s)
Anticonvulsivantes , Pacientes Internos , Anciano , Anciano de 80 o más Años , Anticonvulsivantes/uso terapéutico , Brasil , Humanos , Levetiracetam , Fenitoína/uso terapéutico
4.
Medicine (Baltimore) ; 100(12): e25171, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761695

RESUMEN

RATIONALE: Acute necrotizing encephalopathy (ANE) is a specific type of encephalopathy usually followed by febrile infection. It has an aggressive clinical course; however, it usually does not recur after recovery in cases of spontaneous ANE. Nevertheless, there are several studies reporting recurrences in familial ANE with RAN-binding protein 2 (RANBP2) mutation. There are few cases of familial ANE with RANBP2 mutation in Asian populations. PATIENTS CONCERNS: A 21-month-old Korean boy who was previously healthy, presented with seizure following parainfluenza - a virus and bocavirus infection, followed by 2 recurrent seizure episodes and encephalitis after febrile respiratory illnesses. Meanwhile, his 3-year-old sister had focal brain lesions on neuroimaging studies when evaluated for head trauma. The siblings also had an older brother who presented status epilepticus after febrile respiratory illness at the age of 10 months old. DIAGNOSIS: Brain magnetic resonance imaging was performed to evaluate the seizure and neurologic symptoms. Imaging findings showed variable spectrum - from non-specific diffuse white matter injury pattern to typical "tricolor pattern" of the ANE on diffusion-weighted images. The other 2 siblings showed focal lesions in both external capsules and severe diffuse brain edema. Genetic tests identified a heterozygous missense mutation in the RANBP2 [c.1754C>T (p.Thr585Met)] in 2 siblings and their mother. INTERVENTIONS: Patients were treated conservatively with anticonvulsive agents, intravascular immunoglobulin, and steroids. OUTCOMES: Among the 3 siblings, 2 male siblings died from familial ANE, whereas the female sibling was asymptomatic. LESSONS: These cases highlight the radiological aspects of familial ANE with incomplete penetrance of the RANBP2 gene in 3 family members, showing variable involvements of the brain and natural history on magnetic resonance images. Radiologists should be aware of the typical and atypical imaging findings of familial ANE for prompt management of affected patients.


Asunto(s)
Grupo de Ascendencia Continental Asiática/genética , Leucoencefalitis Hemorrágica Aguda/diagnóstico por imagen , Leucoencefalitis Hemorrágica Aguda/genética , Chaperonas Moleculares/genética , Mutación Missense , Proteínas de Complejo Poro Nuclear/genética , Corticoesteroides/uso terapéutico , Anticonvulsivantes/uso terapéutico , Preescolar , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Lactante , Leucoencefalitis Hemorrágica Aguda/complicaciones , Leucoencefalitis Hemorrágica Aguda/tratamiento farmacológico , Masculino , Penetrancia , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Sustancia Blanca/diagnóstico por imagen , Adulto Joven
5.
BMJ Case Rep ; 14(3)2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33762283

RESUMEN

COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.


Asunto(s)
Encefalopatías/etiología , Convulsiones/etiología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Adulto , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antivirales/uso terapéutico , Encefalopatías/diagnóstico , Encefalopatías/terapia , /terapia , Confusión/complicaciones , Humanos , Inmunización Pasiva/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Reacción en Cadena de la Polimerasa , Radiografía/métodos , Convulsiones/terapia , Resultado del Tratamiento
6.
Medicine (Baltimore) ; 100(10): e23571, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725809

RESUMEN

ABSTRACT: This study investigated the epidemiological status of depression and its influencing factors among caregivers of children with epilepsy in southwestern China.This was a cross-sectional study. Caregivers of children with epilepsy were recruited from February to June 2018 at the Pediatric Neurology Department of the West China Second Hospital. Depression status was assessed using the Zung Self-Rating Depression Scale. Multiple linear regression analysis was used to assess correlations between depression status and its influencing factors.A total of 319 participants were included. The mean Zung Self-Rating Depression Scale score was 36.37 ±â€Š10.178 and 5.3% (17/319) of participants were classified as depressed. Regression analysis showed that place of residence (B = 0.114; standard error = 0.643; P = .039), attitude towards seizures (B = -0.121; standard error = 1.215; P = .029), medical expenses payment (B = -0.111; standard error = 2.002; P = .044), and children's medication adherence (B = -0.124; standard error = 0.393; P = .025) were related to depression.Some caregivers of children with epilepsy in southwestern China experience depression. Health care providers should pay particular attention to caregivers who live in rural areas, who fear seizures, who experience difficulty paying medical expenses, and whose children show low medication adherence.


Asunto(s)
Cuidadores/estadística & datos numéricos , Depresión/epidemiología , Epilepsia/terapia , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Cuidadores/psicología , Niño , China/epidemiología , Estudios Transversales , Depresión/diagnóstico , Depresión/psicología , Epilepsia/psicología , Miedo/psicología , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Población Rural/estadística & datos numéricos , Autoinforme/estadística & datos numéricos
7.
Int J Mol Sci ; 22(5)2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33668718

RESUMEN

BACKGROUND: Status epilepticus (SE) is a neurological disorder characterized by a prolonged epileptic activity followed by subsequent epileptogenic processes. The aim of the present study was to evaluate the early effects of topiramate (TPM) and lacosamide (LCM) treatment on oxidative stress and inflammatory damage in a model of pilocarpine-induced SE. METHODS: Male Wistar rats were randomly divided into six groups and the two antiepileptic drugs (AEDs), TPM (40 and 80 mg/kg, i.p.) and LCM (10 and 30 mg/kg, i.p.), were injected three times repeatedly after pilocarpine administration. Rats were sacrificed 24 h post-SE and several parameters of oxidative stress and inflammatory response have been explored in the hippocampus. RESULTS: The two drugs TPM and LCM, in both doses used, succeeded in attenuating the number of motor seizures compared to the SE-veh group 30 min after administration. Pilocarpine-induced SE decreased the superoxide dismutase (SOD) activity and reduced glutathione (GSH) levels while increasing the catalase (CAT) activity, malondialdehyde (MDA), and IL-1ß levels compared to the control group. Groups with SE did not affect the TNF-α levels. The treatment with a higher dose of 30 mg/kg LCM restored to control level the SOD activity in the SE group. The two AEDs, in both doses applied, also normalized the CAT activity and MDA levels to control values. In conclusion, we suggest that the antioxidant effect of TPM and LCM might contribute to their anticonvulsant effect against pilocarpine-induced SE, whereas their weak anti-inflammatory effect in the hippocampus is a consequence of reduced SE severity.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Inflamación/patología , Lacosamida/uso terapéutico , Especies Reactivas de Oxígeno/metabolismo , Estado Epiléptico/inducido químicamente , Estado Epiléptico/tratamiento farmacológico , Topiramato/uso terapéutico , Animales , Anticonvulsivantes/farmacología , Biomarcadores/metabolismo , Hipocampo/efectos de los fármacos , Hipocampo/patología , Hipocampo/fisiopatología , Interleucina-1beta/metabolismo , Lacosamida/farmacología , Masculino , Actividad Motora/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Pilocarpina , Ratas Wistar , Convulsiones/fisiopatología , Estado Epiléptico/fisiopatología , Topiramato/farmacología , Factor de Necrosis Tumoral alfa/metabolismo
10.
Int J Mol Sci ; 22(4)2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33671463

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to coronavirus disease 2019 (COVID-19) which, in turn, may be associated with multiple organ dysfunction. In this review, we present advantages and disadvantages of cannabidiol (CBD), a non-intoxicating phytocannabinoid from the cannabis plant, as a potential agent for the treatment of COVID-19. CBD has been shown to downregulate proteins responsible for viral entry and to inhibit SARS-CoV-2 replication. Preclinical studies have demonstrated its effectiveness against diseases of the respiratory system as well as its cardioprotective, nephroprotective, hepatoprotective, neuroprotective and anti-convulsant properties, that is, effects that may be beneficial for COVID-19. Only the latter two properties have been demonstrated in clinical studies, which also revealed anxiolytic and antinociceptive effects of CBD (given alone or together with Δ9-tetrahydrocannabinol), which may be important for an adjuvant treatment to improve the quality of life in patients with COVID-19 and to limit post-traumatic stress symptoms. However, one should be aware of side effects of CBD (which are rarely serious), drug interactions (also extending to drugs acting against COVID-19) and the proper route of its administration (vaping may be dangerous). Clearly, further clinical studies are necessary to prove the suitability of CBD for the treatment of COVID-19.


Asunto(s)
Analgésicos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antivirales/uso terapéutico , Cannabidiol/uso terapéutico , Analgésicos/efectos adversos , Analgésicos/farmacología , Animales , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/farmacología , Antivirales/efectos adversos , Antivirales/farmacología , Cannabidiol/efectos adversos , Cannabidiol/farmacología , Dronabinol/efectos adversos , Dronabinol/farmacología , Dronabinol/uso terapéutico , Humanos , /fisiología , Internalización del Virus/efectos de los fármacos
13.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547116

RESUMEN

A 10-year-old girl presented with a month long history of episodic limb movements. She had a normal neurological examination and after thorough investigation, she was thought to have possible tics. Anxiety was reported as being a trigger. Unusually, these 'tics' were not directly witnessed during hospital visits. Eighteen months after the initial presentation, the clinician observed dystonic posturing after the child stood up from having been seated during a consultation. Paroxysmal kinesigenic dyskinesia (PKD) was then suspected and confirmed on genetic testing. She was successfully treated with carbamazepine. In hindsight, it became apparent that her anxiety was related to a fear of uncontrolled movements, rather than it being a trigger. The abnormal involuntary movements in PKD are precipitated by sudden voluntary movement. Lack of recognition of this typical feature, normal examination and/or features such as coexisting anxiety can lead to misdiagnosis or delayed diagnosis of this easily treatable condition.


Asunto(s)
Distonía/diagnóstico , Anticonvulsivantes/uso terapéutico , Carbamazepina/uso terapéutico , Niño , Diagnóstico Diferencial , Distonía/tratamiento farmacológico , Distonía/genética , Distonía/psicología , Femenino , Humanos
14.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541949

RESUMEN

We report the case of a 70-year-old diabetic woman who presented to the emergency department with multiple seizure episodes and coma, prompting the need for sedation and mechanical ventilation. She was transferred to our institution for neurosurgical evaluation as the initial CT scan identified hyperdense lesions in the left basal ganglia, interpreted as acute intracranial haemorrhage. On admission, laboratory tests were mostly normal except for blood glucose of 413 mg/dL. Medical records revealed a history of poorly controlled diabetes mellitus and non-adherence to therapy. After seizure control and lifting sedation, right-sided ataxia/involuntary movements were observed. Considering the patient's history and these findings, the CT scan was reviewed and the striatal region hyperdensities interpreted as lesions typical of non-ketotic hemichorea-hemiballismus. MRI was latter performed and confirmed the diagnosis, even though the unusual presentation. Levetiracetam initiation and glycaemic control optimisation led to great neurological improvement without seizure recurrence.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Diagnóstico Diferencial , Discinesias/diagnóstico , Hiperglucemia/diagnóstico , Cumplimiento de la Medicación , Anciano , Anticonvulsivantes/uso terapéutico , Ganglios Basales/diagnóstico por imagen , Glucemia/análisis , Coma/etiología , Femenino , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Levetiracetam/uso terapéutico , Imagen por Resonancia Magnética , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Tomografía Computarizada por Rayos X
15.
Am Fam Physician ; 103(4): 227-239, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33587568

RESUMEN

Bipolar disorders are common, recurrent mental health conditions of variable severity that are difficult to diagnose. Affected individuals have higher rates of other mental health disorders, substance use disorders, and comorbid chronic medical illnesses. New diagnostic criteria and specifiers with attention on mixed features and anxious distress aid the physician in recognizing episode severity and prognosis. Physicians should consider bipolar disorder in any patient presenting with depression. Pharmacotherapy with mood stabilizers, such as lithium, anticonvulsants, and antipsychotics, is a first-line treatment that should be continued indefinitely because of the risk of patient relapse. Active lifestyle approaches include good nutrition, exercise, sleep hygiene, and proper weight management. Monotherapy with antidepressants is contraindicated during episodes with mixed features, manic episodes, and in bipolar I disorder. Ongoing management involves monitoring for suicidal ideation, substance use disorders, treatment adherence, and recognizing medical complications of pharmacotherapy. Psychotherapy is a useful adjunct to pharmacotherapy. Patients and their support systems should be educated about the chronic nature of this illness, possible relapse, suicidality, environmental triggers (e.g., seasonal light changes, shift work, other circadian disruption), and the effectiveness of early intervention to reduce complications.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Psicoterapia/normas , Adulto , Anciano , Anciano de 80 o más Años , Curriculum , Educación Médica Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
Cochrane Database Syst Rev ; 1: CD003032, 2021 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-33475151

RESUMEN

BACKGROUND: This is an updated version of the Cochrane Review previously published in 2019. Absence seizures (AS) are brief epileptic seizures which present in childhood and adolescence. Depending on clinical features and electroencephalogram (EEG) findings they are divided into typical, atypical absences, and absences with special features. Typical absences are characterised by sudden loss of awareness and an EEG typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently used to treat absence seizures. This review aims to determine the best choice of antiepileptic drug for children and adolescents with AS. OBJECTIVES: To review the evidence for the effects of ethosuximide, valproate and lamotrigine as treatments for children and adolescents with absence seizures (AS), when compared with placebo or each other. SEARCH METHODS: For the latest update we searched the Cochrane Register of Studies (CRS Web, 22 September 2020) and MEDLINE (Ovid, 1946 to September 21, 2020). CRS Web includes randomised or quasi-randomised, controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialized Registers of Cochrane Review Groups including Epilepsy. No language restrictions were imposed. In addition, we contacted Sanofi Winthrop, Glaxo Wellcome (now GlaxoSmithKline) and Parke Davis (now Pfizer), manufacturers of sodium valproate, lamotrigine and ethosuximide respectively. SELECTION CRITERIA: Randomised parallel group monotherapy or add-on trials which include a comparison of any of the following in children or adolescents with AS: ethosuximide, sodium valproate, lamotrigine, or placebo. DATA COLLECTION AND ANALYSIS: Outcome measures were: 1. proportion of individuals seizure free at one, three, six, 12 and 18 months post randomisation; 2. individuals with a 50% or greater reduction in seizure frequency; 3. normalisation of EEG and/or negative hyperventilation test; and 4. adverse effects. Data were independently extracted by two review authors. Results are presented as risk ratios (RR) with 95% confidence intervals (95% CIs). We used GRADE quality assessment criteria to evaluate the certainty of evidence for the outcomes derived from all included studies. MAIN RESULTS: On the basis of our selection criteria, we included no new studies in the present review. Eight small trials (total number of participants: 691) were included from the earlier review. Six of them were of poor methodological quality (unclear or high risk of bias) and seven recruited less than 50 participants. There are no placebo-controlled trials for ethosuximide or valproate, and hence, no evidence from randomised controlled trials (RCTs) to support a specific effect on AS for either of these two drugs. Due to the differing methodologies used in the trials comparing ethosuximide, lamotrigine and valproate, we thought it inappropriate to undertake a meta-analysis. One large randomised, parallel double-blind controlled trial comparing ethosuximide, lamotrigine and sodium valproate in 453 children with newly diagnosed childhood absence epilepsy found that at 12 months, seizure freedom was higher in patients taking ethosuximide (70/154, 45%) than in patients taking lamotrigine (31/146, 21%; P < 0.001), with no difference between valproate (64/146, 44%) and ethosuximide (70/154, 45%; P > 0.05). In this study, the frequency of treatment failures due to intolerable adverse events was significantly different among the treatment groups, with the largest proportion of adverse events in the valproic acid group (48/146, 33%) compared to the ethosuximide (38/154, 25%) and the lamotrigine (29/146, 20%) groups (P < 0.037). Overall, this large study demonstrates the superior effectiveness of ethosuximide and valproic acid compared to lamotrigine as initial monotherapy aimed to control seizures without intolerable adverse effects in children with childhood absence epilepsy. This study provided high certainty of the evidence for outcomes for which data were available. However, the certainty of the evidence provided by the other included studies was low, primarily due to risk of bias and imprecise results because of the small sample sizes. Hence, conclusions regarding the efficacy of ethosuximide, valproic acid and lamotrigine derive mostly from this single study. AUTHORS' CONCLUSIONS: Since the last version of this review was published, we have found no new studies. Hence, the conclusions remain the same as the previous update. With regards to both efficacy and tolerability, ethosuximide represents the optimal initial empirical monotherapy for children and adolescents with AS. However, if absence and generalised tonic-clonic seizures coexist, valproate should be preferred, as ethosuximide is probably inefficacious on tonic-clonic seizures.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Epilepsia Tipo Ausencia/tratamiento farmacológico , Etosuximida/uso terapéutico , Lamotrigina/uso terapéutico , Ácido Valproico/uso terapéutico , Adolescente , Anticonvulsivantes/efectos adversos , Niño , Epilepsia Tipo Ausencia/prevención & control , Etosuximida/efectos adversos , Femenino , Humanos , Lamotrigina/efectos adversos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Convulsiones/prevención & control , Insuficiencia del Tratamiento , Ácido Valproico/efectos adversos
17.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431543

RESUMEN

We report a case of a prolonged postictal hemianopsia occurring after a focal extraoccipital seizure. A 55-year-old man with a history of neurosyphilis, treated with penicillin, presented to our epilepsy monitoring unit (EMU) for diagnostic evaluation of his spells occurring for 2 years. The spell semiology was stereotypical, described as oral and manual automatisms, speech difficulty and unresponsiveness. During the EMU stay, after his typical seizure was recorded, he experienced right hemianopsia lasting for 2 hours. Electrographically, the ictal pattern was prominent over the left temporal derivation and propagated to the left occipital derivation as the seizure progressed. Interictal epileptiform activity was over the left temporal derivations. We support the view that postictal phenomenon may represent merely a seizure termination zone and not be necessarily localising to the seizure onset zone. Furthermore, prolonged isolated postictal symptom of hemianopsia could also be noted in rare situations.


Asunto(s)
Hemianopsia/etiología , Convulsiones/complicaciones , Convulsiones/diagnóstico , Anticonvulsivantes/uso terapéutico , Electroencefalografía , Humanos , Masculino , Persona de Mediana Edad , Convulsiones/tratamiento farmacológico , Factores de Tiempo
18.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-33504534

RESUMEN

A 47-year-old woman with history of seizure disorder (semiology of seizure unknown), not well controlled with antiepileptic drugs since last 30 years presented with 1-year history of intermittent throbbing headache. On the day prior to admission, she experienced worst headache, followed by loss of consciousness. On regaining consciousness, she had neck pain without any focal neurological deficit, but examination was marked by positive meningeal signs. She had history of oral ulceration, photosensitivity and small joints pain for which no medical consultancy was sought until. Following relevant investigations, this case came out to be moyamoya angiopathy secondary to underlying systemic lupus erythematosus. She was put on immunosuppressive and immunomodulator as per recommendations. Among neurological symptoms, headache improved dramatically without any further seizure recurrence till the 6 months of follow-up.


Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Lupus Eritematoso Sistémico/diagnóstico , Enfermedad de Moyamoya/diagnóstico por imagen , Albuminuria , Angiografía de Substracción Digital , Anticuerpos Antinucleares/inmunología , Anticonvulsivantes/uso terapéutico , Antirreumáticos/uso terapéutico , Angiografía Cerebral , Hemorragia Cerebral/etiología , Epilepsia/complicaciones , Epilepsia/tratamiento farmacológico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/inmunología , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Enfermedad de Moyamoya/complicaciones , Tomografía Computarizada por Rayos X
19.
Neurology ; 96(10): e1443-e1452, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33495377

RESUMEN

OBJECTIVE: To develop a diagnostic test that stratifies epileptic seizures (ES) from psychogenic nonepileptic seizures (PNES) by developing a multimodal algorithm that integrates plasma concentrations of selected immune response-associated proteins and patient clinical risk factors for seizure. METHODS: Daily blood samples were collected from patients evaluated in the epilepsy monitoring unit within 24 hours after EEG confirmed ES or PNES and plasma was isolated. Levels of 51 candidate plasma proteins were quantified using an automated, multiplexed, sandwich ELISA and then integrated and analyzed using our diagnostic algorithm. RESULTS: A 51-protein multiplexed ELISA panel was used to determine the plasma concentrations of patients with ES, patients with PNES, and healthy controls. A combination of protein concentrations, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), intercellular adhesion molecule 1 (ICAM-1), monocyte chemoattractant protein-2 (MCP-2), and tumor necrosis factor-receptor 1 (TNF-R1) indicated a probability that a patient recently experienced a seizure, with TRAIL and ICAM-1 levels higher in PNES than ES and MCP-2 and TNF-R1 levels higher in ES than PNES. The diagnostic algorithm yielded an area under the receiver operating characteristic curve (AUC) of 0.94 ± 0.07, sensitivity of 82.6% (95% confidence interval [CI] 62.9-93.0), and specificity of 91.6% (95% CI 74.2-97.7). Expanding the diagnostic algorithm to include previously identified PNES risk factors enhanced diagnostic performance, with AUC of 0.97 ± 0.05, sensitivity of 91.3% (95% CI 73.2-97.6), and specificity of 95.8% (95% CI 79.8-99.3). CONCLUSIONS: These 4 plasma proteins could provide a rapid, cost-effective, and accurate blood-based diagnostic test to confirm recent ES or PNES. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that variable levels of 4 plasma proteins, when analyzed by a diagnostic algorithm, can distinguish PNES from ES with sensitivity of 82.6% and specificity of 91.6%.


Asunto(s)
Proteínas Sanguíneas/análisis , Encefalitis/sangre , Encefalitis/complicaciones , Epilepsia/etiología , Convulsiones/etiología , Adolescente , Adulto , Algoritmos , Anticonvulsivantes/uso terapéutico , Área Bajo la Curva , Diagnóstico Diferencial , Electroencefalografía , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Masculino , Trastornos Mentales/etiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Convulsiones/tratamiento farmacológico , Adulto Joven
20.
Cochrane Database Syst Rev ; 1: CD001415, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33434292

RESUMEN

BACKGROUND: This is an updated version of the Cochrane Review previously published in 2018. Epilepsy is a common neurological disorder characterised by recurrent seizures. Most people with epilepsy have a good prognosis and their seizures are well controlled by a single antiepileptic drug, but up to 30% develop drug-resistant epilepsy, especially people with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RCTs) of gabapentin, when used as an add-on treatment for drug-resistant focal epilepsy. OBJECTIVES: To evaluate the efficacy and tolerability of gabapentin when used as an add-on treatment for people with drug-resistant focal epilepsy. SEARCH METHODS: For the latest update, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid) on 11 August 2020. CRS Web includes randomised or quasi-randomised, controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialised Registers of Cochrane Review Groups including Epilepsy. We imposed no language restrictions. SELECTION CRITERIA: Randomised, placebo-controlled, double-blind, add-on trials of gabapentin in people with drug-resistant focal epilepsy. We also included trials using an active drug control group or comparing different doses of gabapentin. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion and extracted the relevant data. We assessed the following outcomes: seizure frequency, seizure freedom, treatment withdrawal (any reason) and adverse effects. Primary analyses were intention-to-treat. We also undertook sensitivity best-case and worst-case analyses. We estimated summary risk ratios (RR) for each outcome and evaluated dose-response in regression models. MAIN RESULTS: We identified no new studies for this update, therefore, the results and conclusions are unchanged. In the previous update of this review, we combined data from six trials in meta-analyses of 1206 randomised participants. The overall risk ratio (RR) for reduction in seizure frequency of 50% or more compared to placebo was 1.89 (95% confidence interval (CI) 1.40 to 2.55; 6 studies, 1206 participants; moderate-certainty evidence). Dose regression analysis (for trials in adults) showed increasing efficacy with increasing dose, with 25.3% (95% CI 19.3 to 32.3) of people responding to gabapentin 1800 mg compared to 9.7% on placebo, a 15.5% increase in response rate (95% CI 8.5 to 22.5). The RR for treatment withdrawal compared to placebo was 1.05 (95% CI 0.74 to 1.49; 6 trials, 1206 participants; moderate-certainty evidence). Adverse effects were significantly associated with gabapentin compared to placebo. RRs were as follows: ataxia 2.01 (99% CI 0.98 to 4.11; 3 studies, 787 participants; low-certainty evidence), dizziness 2.43 (99% CI 1.44 to 4.12; 6 studies, 1206 participants; moderate-certainty evidence), fatigue 1.95 (99% CI 0.99 to 3.82; 5 studies, 1161 participants; low-certainty evidence) and somnolence 1.93 (99% CI 1.22 to 3.06; 6 studies, 1206 participants; moderate-certainty evidence). There was no evidence of a difference for the adverse effects of headache (RR 0.79, 99% CI 0.46 to 1.35; 6 studies, 1206 participants; moderate-certainty evidence) or nausea (RR 0.95, 99% CI 0.52 to 1.73; 4 trials, 1034 participants; moderate-certainty evidence). Overall, the studies were at low to unclear risk of bias due to information on each risk of bias domain not being available. We judged the overall certainty of the evidence (using the GRADE approach) as low to moderate due to potential attrition bias resulting from missing outcome data and imprecise results with wide CIs. AUTHORS' CONCLUSIONS: Gabapentin has efficacy as an add-on treatment in people with drug-resistant focal epilepsy, and seems to be fairly well-tolerated. However, the trials reviewed were of relatively short duration and provide no evidence for the long-term efficacy of gabapentin beyond a three-month period. The results cannot be extrapolated to monotherapy or to people with other epilepsy types. Further trials are needed to assess the long-term effects of gabapentin, and to compare gabapentin with other add-on drugs.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Epilepsia Refractaria/tratamiento farmacológico , Epilepsias Parciales/tratamiento farmacológico , Gabapentina/uso terapéutico , Ácido gamma-Aminobutírico/uso terapéutico , Adulto , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/efectos adversos , Niño , Quimioterapia Combinada/métodos , Gabapentina/administración & dosificación , Gabapentina/efectos adversos , Humanos , Análisis de Intención de Tratar , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto
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