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1.
Eur J Paediatr Neurol ; 27: 30-36, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32473849

RESUMEN

AIM: Little is known about acute febrile status epilepticus-induced injury of extrahippocampal structures. To clarify the presence and clinical significance of acute extrahippocampal injuries, we performed diffusion-weighted imaging (DWI) in children immediately after prolonged febrile seizure (PFS). METHOD: We performed a retrospective cohort study in children younger than 6 years old who visited one of two hospitals due to PFSs between January 2013 and October 2018. PFS was defined as a febrile seizure that persisted for 15 min or longer. We collected brain DWI data within 6 h of the end of PFS. When the initial DWI detected an abnormality, a follow-up DWI was performed a few days later. RESULTS: The study population consisted of 101 patients with PFSs. DWI was performed within 6 h in 51 patients, while the remaining 50 patients did not undergo imaging because of good recovery of consciousness. Restricted cortical diffusion was evident in 9 (18%) patients on initial DWI. All of them underwent DWI within 100 min after PFS. Restricted cortical diffusion was associated with male sex, asymmetrical PFS symptoms, and a shorter duration between the end of the seizure and DWI, but was not associated with seizure duration. All cortical abnormalities had resolved on follow-up DWI of these patients within 72 h after the initial imaging, but ipsilateral hippocampal hyperintensity appeared in one patient. All 9 patients with restricted cortical diffusion were finally diagnosed with PFS and discharged without sequelae. CONCLUSIONS: Some children with PFSs exhibit transient restricted diffusion in the regional cortex on DWI performed immediately after the end of PFS. These transient diffusion changes were not associated with unfavorable epileptic sequelae or neuroimaging in the short-term.


Asunto(s)
Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/fisiopatología , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/fisiopatología , Preescolar , Estudios de Cohortes , Imagen de Difusión por Resonancia Magnética/métodos , Femenino , Humanos , Lactante , Masculino , Neuroimagen/métodos , Estudios Retrospectivos
2.
J Stroke Cerebrovasc Dis ; 29(3): 104600, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31917092

RESUMEN

Dyke-Davidoff-Masson syndrome (DDMS) was first described in 1933 as a clinical condition characterized by hemiatrophy, hyperpneumatization of paranasal sinuses, contralateral hemiparesis, facial asymmetry, seizures, and mental retardation.1 DDMS can be of 2 types: congenital and acquired. The congenital type can be caused by various conditions experienced during fetal or early childhood development, including ischemia, infarction, trauma, infections, and hemorrhage. The acquired type is mostly associated with hemorrhage, trauma, and infections experienced after 1 month of age. DDMS can manifest alone or can be accompanied by crossed cerebellar atrophy (CCA) which is a newly discovered radiological marker characterized by prominent cortical sulci and loss of cerebellar parenchyma. The congenital type of DDMS is known to be accompanied by ipsilateral cerebellar atrophy and the acquired type is known to be accompanied by contralateral cerebellar atrophy.2,3 Supratentorial events may lead to destruction in the cortico-ponto-cerebellar pathways, mostly in the contralateral side of the body (80%) due to decussation.4 In this report, we present 2 cases of DDMS accompanied by CCA to emphasize the possibility that the DDMS cases with severe intrauterine hemorrhage can be accompanied by contralateral CCA and migratory abnormalities rather than ipsilateral CCA and clinical survey.


Asunto(s)
Enfermedades Cerebelosas/complicaciones , Epilepsia Generalizada/complicaciones , Hemorragias Intracraneales/etiología , Convulsiones Febriles/complicaciones , Adolescente , Anticonvulsivantes/uso terapéutico , Atrofia , Enfermedades Cerebelosas/congénito , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/tratamiento farmacológico , Epilepsia Generalizada/congénito , Epilepsia Generalizada/diagnóstico por imagen , Epilepsia Generalizada/tratamiento farmacológico , Femenino , Humanos , Lactante , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/tratamiento farmacológico , Imagen por Resonancia Magnética , Factores de Riesgo , Convulsiones Febriles/congénito , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/tratamiento farmacológico , Esteroides/uso terapéutico , Síndrome , Resultado del Tratamiento
3.
Epilepsia ; 60(7): 1306-1316, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31166617

RESUMEN

OBJECTIVE: To assess hippocampal signal changes on diffusion-weighted imaging (DWI) during the acute period after febrile status epilepticus (FSE) and to examine the relationship between DWI and subsequent epilepsy. METHODS: A prospective, multicenter study of children with a first episode of FSE was performed. The patients underwent magnetic resonance imaging (MRI) within 3 days of FSE, and signal intensity was evaluated on DWI. Electroencephalography studies within 3 days of FSE were also assessed. Nine to 13 years after FSE, information on subsequent epilepsy was obtained. RESULTS: Twenty-two children with FSE were evaluated. DWI showed unilateral hippocampal hyperintensity in six patients (27%). Three of six patients with hippocampal hyperintensity had ipsilateral thalamic hyperintensity. On EEG within 3 days of FSE, five of six patients with hippocampal hyperintensity had ipsilateral focal slowing, spikes, or attenuation. Nine to 13 years later, the outcomes could be determined in five patients with hippocampal hyperintensity and in 10 without. All 5 patients with hippocampal hyperintensity had hippocampal atrophy and developed focal epilepsy, whereas only 1 of 10 patients without hippocampal hyperintensity developed epilepsy (P = 0.002). Ictal semiology was concordant with temporal lobe seizures in all patients. Ipsilateral temporal epileptiform abnormalities were seen on EEG in four of five at last follow-up. SIGNIFICANCE: Acute DWI hippocampal hyperintensity was seen in 27% of patients with FSE. Acute DWI hyperintensity suggests cytotoxic edema caused by prolonged seizure activity. Hippocampal DWI hyperintensity is related to mesial temporal lobe epilepsy and can be a target of neuroprotective treatments to prevent the onset of epilepsy.


Asunto(s)
Epilepsia/patología , Hipocampo/patología , Convulsiones Febriles/patología , Estado Epiléptico/patología , Preescolar , Imagen de Difusión por Resonancia Magnética , Electroencefalografía , Epilepsia/diagnóstico por imagen , Femenino , Hipocampo/diagnóstico por imagen , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Estudios Prospectivos , Convulsiones Febriles/diagnóstico por imagen , Estado Epiléptico/diagnóstico por imagen
4.
Seizure ; 69: 228-234, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31112829

RESUMEN

PURPOSE: To summarize the clinical features and neuroimaging changes of epilepsy associated with TBC1D24 mutations. METHODS: Genetic testing was conducted in all epilepsy patients without acquired risk factors for epilepsy. Epilepsy patients identified with TBC1D24 compound heterozygous mutations by next-generation sequencing (NGS) epilepsy panel or whole exome sequencing (WES) were enrolled. The enrolled patients were followed up to summarize the clinical features. RESULTS: Nineteen patients were identified with TBC1D24 compound heterozygous mutations. Nine patients carried the same pathogenic variant c.241_252del. The seizure onset age ranged from 1 day to 8 months of age (median age 75 days). The most prominent features were multifocal myoclonus and epilepsia partialis continua (EPC). Myoclonus could be triggered by fever or infection in 15 patients, and could be terminated by sleep or sedation drugs. Psychomotor developmental delay was presented in 11 patients. Six patients exhibited hearing loss. Brain MRIs were abnormal in eight patients. Twelve patients were diagnosed with epilepsy syndromes including one patient who was diagnosed with Dravet syndrome. Two patients died due to status epilepticus at 4 months and 19 months of age, respectively. CONCLUSION: TBC1D24 mutation related epilepsy was drug-resistant. Multifocal myoclonus, EPC, and fever-induced seizures were common clinical features. Most patients presented psychomotor developmental delay. The neuroimaging abnormality and hearing loss could exacerbate during follow-up.


Asunto(s)
Epilepsia/genética , Proteínas Activadoras de GTPasa/genética , Mutación , Mioclonía/genética , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Discapacidades del Desarrollo/diagnóstico por imagen , Discapacidades del Desarrollo/genética , Discapacidades del Desarrollo/fisiopatología , Discapacidades del Desarrollo/terapia , Epilepsia Parcial Continua/diagnóstico por imagen , Epilepsia Parcial Continua/genética , Epilepsia Parcial Continua/fisiopatología , Epilepsia Parcial Continua/terapia , Epilepsia/diagnóstico por imagen , Epilepsia/fisiopatología , Epilepsia/terapia , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Pérdida Auditiva/diagnóstico por imagen , Pérdida Auditiva/genética , Pérdida Auditiva/fisiopatología , Pérdida Auditiva/terapia , Humanos , Lactante , Recién Nacido , Masculino , Mioclonía/diagnóstico por imagen , Mioclonía/fisiopatología , Mioclonía/terapia , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/genética , Convulsiones Febriles/fisiopatología , Convulsiones Febriles/terapia
6.
Epilepsia ; 60(4): 585-592, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30854647

RESUMEN

Febrile infection-related epilepsy syndrome (FIRES) is a rare severe epileptic syndrome occurring in previously healthy children and characterized by refractory status epilepticus (SE) following a febrile illness. Brain imaging findings in affected patients have been reported in few case series and some case reports. This article is a comprehensive review of the magnetic resonance imaging (MRI) characteristics in all reported patients with a diagnosis of FIRES, describing the findings in the acute and chronic phases of the disease, and discussing possible pathogenesis and radiologic differential diagnoses. Most of the patients had normal brain scans in the acute phase (61%) and about 25% of the patients reported in literature had abnormalities in the temporal lobes. Changes in the basal ganglia and rarely in thalami or brainstem have also been described, as well as diffuse cerebral edema in a minority of patients during the acute phase. The chronic phase of the disease was characterized by atrophic changes and evidence of mesiotemporal sclerosis. An understanding of these MRI abnormalities is necessary to support the diagnosis of FIRES and exclude mimics.


Asunto(s)
Epilepsia Refractaria/diagnóstico por imagen , Síndromes Epilépticos/diagnóstico por imagen , Neuroimagen/métodos , Convulsiones Febriles/diagnóstico por imagen , Estado Epiléptico/diagnóstico por imagen , Niño , Preescolar , Epilepsia Refractaria/etiología , Epilepsia Refractaria/patología , Síndromes Epilépticos/etiología , Síndromes Epilépticos/patología , Femenino , Humanos , Infecciones/complicaciones , Masculino , Convulsiones Febriles/patología , Estado Epiléptico/etiología , Estado Epiléptico/patología
7.
Magn Reson Med ; 81(5): 2915-2923, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30697813

RESUMEN

PURPOSE: To investigate the effects of frequency drift on chemical exchange saturation transfer (CEST) imaging at 3T, and to propose a new sequence for correcting artifacts attributed to B0 drift in real time. THEORY AND METHODS: A frequency-stabilized CEST (FS-CEST) imaging sequence was proposed by adding a frequency stabilization module to the conventional non-frequency-stabilized CEST (NFS-CEST) sequence, which consisted of a small tip angle radiofrequency excitation pulse and readout of three non-phase-encoded k-space lines. Experiments were performed on an egg white phantom and 26 human subjects on a heavy-duty clinical scanner, in order to compare the difference of FS-CEST and NFS-CEST sequences for generating the z-spectrum, magnetization transfer ratio asymmetry (MTRasym ) spectrum, and amide proton transfer weighted (APTw) image. RESULTS: The B0 drift in CEST imaging, if not corrected, would cause APTw images and MTRasym spectra from both the phantom and volunteers to be either significantly higher or lower than the true values, depending on the status of the scanner. The FS-CEST sequence generated substantially more stable MTRasym spectra and APTw images than the conventional NFS-CEST sequence. Quantitatively, the compartmental-average APTw signals (mean ± standard deviation) from frontal white matter regions of all 26 human subjects were -0.32% ± 2.32% for the NFS-CEST sequence and -0.14% ± 0.37% for the FS-CEST sequence. CONCLUSIONS: The proposed FS-CEST sequence provides an effective approach for B0 drift correction without additional scan time and should be adopted on heavy-duty MRI scanners.


Asunto(s)
Clara de Huevo/química , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética , Convulsiones Febriles/diagnóstico por imagen , Algoritmos , Animales , Artefactos , Pollos , Niño , Preescolar , Mareo/diagnóstico por imagen , Femenino , Cefalea/diagnóstico por imagen , Humanos , Masculino , Fantasmas de Imagen , Ondas de Radio
8.
Clin Neurol Neurosurg ; 175: 61-67, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30384118

RESUMEN

OBJECTIVE: The objective of this feasibility study was to investigate whether myelin water fraction (MWF) patterns can differentiate children presenting with febrile seizures who will go on to develop nonfebrile epilepsy from those who will not. PATIENTS AND METHODS: As part of a prospective study of myelination patterns in pediatric epilepsy, seven subjects with febrile seizures underwent magnetic resonance imaging (MRI) including the following standard sequences-T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR)-and an additional experimental sequence, multicomponent-derived equilibrium single-pulse observation of T1 and T2 (mcDESPOT) to quantify MWF. For each of these subjects, MWF maps were derived and compared with an age-matched population-averaged MWF atlas. RESULTS: All seven subjects (<5 years old) initially presented with febrile seizures. Of the seven, four had complex seizures and three had simple seizures. All of the children with simple febrile seizures had higher MWF compared with model-derived controls and did not develop epilepsy. All of the children with complex febrile seizures had lower MWF than their model-derived control, and two of these subjects later developed epilepsy. CONCLUSION: This is the first study in which MWF maps were used to study children with febrile *seizures. This data suggests that relatively higher or stable MWF compared with normative data indicates a lower risk of nonfebrile epilepsy while relatively lower MWF may indicate a pathological condition that could lead to nonfebrile epilepsy.


Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Vaina de Mielina/metabolismo , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/metabolismo , Agua/metabolismo , Preescolar , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Vaina de Mielina/patología , Estudios Prospectivos
9.
Ital J Pediatr ; 44(1): 70, 2018 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-29907116

RESUMEN

BACKGROUND: In previous study, we have found intermittent oral levetiracetam (LEV) can effectively prevent recurrence of febrile seizure (FS). This study aimed to analyze the effects of the preventive on the patients with frequent FS accompanied with epileptiform discharge. METHODS: Patients with frequent FS were assigned to undergo Electroencephalogram (EEG). At the onset of fever, the patients who presented epileptiform discharge were orally administered with LEV with a dose of 15-30 mg/kg per day twice daily for 1 week, thereafter, the dosage was gradually reduced until totally discontinued in the second week. The seizure frequency associated with febrile events and FS recurrence rate during a 48-week follow-up were analyzed. RESULTS: among the 19 patients presented epileptiform discharge on EEG, 31.58% (6 of 19) had complex FS, 68.42% (13 of 19) had simple FS. Up to 57.89% (11 of 19) had a family history of seizure disorder and 36.84% (7 of 19) had a family history of FS in first-degree relatives. 42.11% (8 of 19) happened the first FS episode at the age < 18 months. 36.84% (7/19) presented generalized spikes, 63.16% (12/19) showed focal spikes. During the 48-week follow-up period, the patients experienced 26 febrile episodes, none of them presented seizure recurrence. CONCLUSION: Intermittent oral LEV can prevent the seizure recurrence of FS accompanied with epileptiform discharge in 48-week. However, further randomized controlled trials should be conducted. TRIAL REGISTRATION: ChiCTR-IPR-15007241 ; Registered 1 January 2014 - Retrospectively registered.


Asunto(s)
Electroencefalografía/métodos , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Piracetam/análogos & derivados , Convulsiones Febriles/tratamiento farmacológico , Convulsiones Febriles/epidemiología , Administración Oral , Atención Ambulatoria , Anticonvulsivantes/administración & dosificación , Preescolar , Estudios de Cohortes , Comorbilidad , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Epilepsia/diagnóstico por imagen , Femenino , Humanos , Lactante , Levetiracetam , Masculino , Proyectos Piloto , Piracetam/administración & dosificación , Pronóstico , Recurrencia , Estudios Retrospectivos , Convulsiones Febriles/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
10.
J Child Neurol ; 33(6): 417-421, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29618277

RESUMEN

In this study, the authors assessed cerebrospinal fluid cytokine levels and single-photon emission computed tomography (SPECT) findings in complex febrile seizures. This study included 23 Japanese patients with complex febrile seizures. Twenty patients underwent SPECT and 12 underwent analysis of cerebrospinal fluid cytokine levels (interleukin [IL]-6, interleukin-10, interleukin-17, interleukin-1ß, tumor necrosis factor-α, and interferon-γ); 9 patients underwent both studies. Cerebrospinal fluid cytokine levels were compared between the current complex febrile seizure patients and 30 patients with acute encephalopathy. In 17 of 20 patients, SPECT findings revealed areas of hypoperfusion, including the frontal (5), occipital (4), and lobular (4) regions, overlapping with other areas. Relative to patients with acute encephalopathy, those with complex febrile seizures exhibited significantly lower cerebrospinal fluid interleukin-6, interleukin-1ß, tumor necrosis factor-α, and interleukin-10 levels and significantly higher interleukin-17 levels. As patients with complex febrile seizures frequently exhibit abnormal SPECT findings, cerebrospinal fluid interleukin-17 levels might provide a valid biomarker to discriminate complex febrile seizures and acute encephalopathy, regardless of SPECT findings.


Asunto(s)
Encéfalo/diagnóstico por imagen , Citocinas/líquido cefalorraquídeo , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/metabolismo , Tomografía Computarizada de Emisión de Fotón Único , Biomarcadores/metabolismo , Encéfalo/metabolismo , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino
11.
Epilepsia ; 58 Suppl 3: 11-19, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28675560

RESUMEN

Epilepsy can be a devastating disorder. In addition to debilitating seizures, epilepsy can cause cognitive and emotional problems with reduced quality of life. Therefore, the major aim is to prevent the disorder in the first place: identify, detect, and reverse the processes responsible for its onset, and monitor and treat its progression. Epilepsy often occurs following a latent period of months to years (epileptogenesis) as a consequence of a brain insult, such as head trauma, stroke, or status epilepticus. Although this latent period clearly represents a therapeutic window, we are not able to stratify patients at risk for long-term epilepsy, which is prerequisite for preventative clinical trials. Moreover, because of the length of the latent period, an early biomarker for treatment response would be of high value. Finally, mechanistic biomarkers of epileptogenesis may provide more profound insight in the process of disease development.


Asunto(s)
Biomarcadores/análisis , Epilepsia/inmunología , Inflamación Neurogénica/inmunología , Animales , Astrocitos/fisiología , Encéfalo/diagnóstico por imagen , Encéfalo/inmunología , Encéfalo/fisiopatología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/inmunología , Lesiones Encefálicas/fisiopatología , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Electroencefalografía , Epilepsia/diagnóstico por imagen , Epilepsia/fisiopatología , Epilepsia/prevención & control , Humanos , Aumento de la Imagen , Imagen por Resonancia Magnética , Inflamación Neurogénica/diagnóstico por imagen , Inflamación Neurogénica/fisiopatología , Inflamación Neurogénica/prevención & control , Espectroscopía de Protones por Resonancia Magnética , Ratas , Factores de Riesgo , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/fisiopatología , Estado Epiléptico/complicaciones , Estado Epiléptico/diagnóstico por imagen , Estado Epiléptico/inmunología , Estado Epiléptico/fisiopatología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/inmunología , Accidente Cerebrovascular/fisiopatología , Molécula 1 de Adhesión Celular Vascular/análisis , Grabación en Video
13.
Epilepsia ; 58(6): 1102-1111, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28448686

RESUMEN

OBJECTIVE: Our aim was to explore the association between plasma cytokines and febrile status epilepticus (FSE) in children, as well as their potential as biomarkers of acute hippocampal injury. METHODS: Analysis was performed on residual samples of children with FSE (n = 33) as part of the Consequences of Prolonged Febrile Seizures in Childhood study (FEBSTAT) and compared to children with fever (n = 17). Magnetic resonance imaging (MRI) was obtained as part of FEBSTAT within 72 h of FSE. Cytokine levels and ratios of antiinflammatory versus proinflammatory cytokines in children with and without hippocampal T2 hyperintensity were assessed as biomarkers of acute hippocampal injury after FSE. RESULTS: Levels of interleukin (IL)-8 and epidermal growth factor (EGF) were significantly elevated after FSE in comparison to controls. IL-1ß levels trended higher and IL-1RA trended lower following FSE, but did not reach statistical significance. Children with FSE were found to have significantly lower ratios of IL-1RA/IL-1ß and IL-1RA/IL-8. Specific levels of any one individual cytokine were not associated with FSE. However, lower ratios of IL-1RA/IL-1ß, IL-1RA/1L-6, and IL-1RA/ IL-8 were all associated with FSE. IL-6 and IL-8 levels were significantly higher and ratios of IL-1RA/IL-6 and IL-1RA/IL-8 were significantly lower in children with T2 hippocampal hyperintensity on MRI after FSE in comparison to those without hippocampal signal abnormalities. Neither individual cytokine levels nor ratios of IL-1RA/IL-1ß or IL-1RA/IL-8 were predictive of MRI changes. However, a lower ratio of IL-1RA/IL-6 was strongly predictive (odds ratio [OR] 21.5, 95% confidence interval [CI] 1.17-393) of hippocampal T2 hyperintensity after FSE. SIGNIFICANCE: Our data support involvement of the IL-1 cytokine system, IL-6, and IL-8 in FSE in children. The identification of the IL-1RA/IL-6 ratio as a potential biomarker of acute hippocampal injury following FSE is the most significant finding. If replicated in another study, the IL-1RA/IL-6 ratio could represent a serologic biomarker that offers rapid identification of patients at risk for ultimately developing mesial temporal lobe epilepsy (MTLE).


Asunto(s)
Biomarcadores/sangre , Daño Encefálico Crónico/sangre , Citocinas/sangre , Hipocampo/diagnóstico por imagen , Hipocampo/fisiopatología , Convulsiones Febriles/sangre , Estado Epiléptico/sangre , Daño Encefálico Crónico/diagnóstico por imagen , Niño , Preescolar , Epilepsia del Lóbulo Temporal/sangre , Femenino , Humanos , Lactante , Recién Nacido , Proteína Antagonista del Receptor de Interleucina 1/sangre , Interleucina-1beta/sangre , Interleucina-6/sangre , Interleucina-8/sangre , Masculino , Factores de Riesgo , Convulsiones Febriles/diagnóstico por imagen , Estado Epiléptico/diagnóstico por imagen
14.
Brain Dev ; 39(1): 84-88, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27459916

RESUMEN

A 1-year-old boy was admitted because of febrile status epilepticus (FSE). A secondary cluster of seizures was seen on day 5 after onset, and the patient eventually displayed developmental delay. Conventional magnetic resonance imaging (MRI) showed no abnormal findings on day 1 after onset, but showed reduced diffusion in the subcortical regions of bilateral frontal lobes on day 5 after onset. Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) was diagnosed. Arterial spin labeling (ASL) revealed reduced cerebral blood flow (CBF) in bilateral frontal lobes on day 1 after onset and showed increased CBF in the corresponding region in the subacute phase. Outcomes after prolonged febrile seizures are usually good, but mental deficit and/or epilepsy often remain in AESD. Discriminating between these syndromes is difficult, because no useful biomarkers have been identified. Reduced CBF in bilateral frontal lobes was observed on ASL on day 1 of FSE in the present case, and this finding may be predictive of developing AESD.


Asunto(s)
Encefalopatía Aguda Febril/diagnóstico por imagen , Circulación Cerebrovascular , Lóbulo Frontal/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Convulsiones Febriles/diagnóstico por imagen , Encefalopatía Aguda Febril/fisiopatología , Circulación Cerebrovascular/fisiología , Discapacidades del Desarrollo/diagnóstico por imagen , Discapacidades del Desarrollo/etiología , Diagnóstico Diferencial , Progresión de la Enfermedad , Estudios de Seguimiento , Lóbulo Frontal/fisiopatología , Humanos , Lactante , Masculino , Convulsiones Febriles/fisiopatología
15.
Seizure ; 43: 26-31, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27821269

RESUMEN

PURPOSE: To evaluate the role of neuro-imaging in children presenting with the first afebrile seizure and determine factors that influence the outcome of imaging in a large paediatric emergency centre. METHOD: This is a retrospective review of the medical records of all patients presenting with the first non-febrile seizure to a large paediatric emergency centre in the state of Qatar. Seizure classification followed the current ILAE classification system. Imaging was undertaken in our tertiary hospital and all images were reviewed by experienced neuro-radiologists. Student t test was used for statistical analysis. RESULTS: Ninety-six children underwent neuro-imaging following the first afebrile seizure. Of them, thirty-two patients (33%) were reported to have abnormalities. Children below the age of two demonstrated a significantly higher percentage of abnormal imaging (59%); (p=0.002). Children presenting with prolonged seizures showed a high percentage of imaging abnormalities (58%); (p=0.003). Children with focal seizures demonstrated a higher percentage of imaging abnormality compared to those presenting with generalized seizures (35% vs 31%). This difference did not reach statistical significance. CONCLUSION: Children below the age of two demonstrated significantly higher percentages of abnormal imaging (59%), as did children presenting with status epilepticus (58%). Neuro-imaging should be considered in infants and those with focal or prolonged seizures. Neuro-imaging informed decision making in 6-8% of children.


Asunto(s)
Encéfalo/diagnóstico por imagen , Neuroimagen , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/patología , Adolescente , Niño , Preescolar , Electroencefalografía , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
16.
Epilepsy Behav ; 64(Pt A): 283-288, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27794237

RESUMEN

OBJECTIVE: The objective of this study was to determine early developmental and cognitive outcomes of children with febrile status epilepticus (FSE) one month and one year after FSE. METHODS: One hundred ninety four children with FSE were evaluated on measures of cognition, receptive language, and memory as part of the FEBSTAT study and compared with 100 controls with simple febrile seizures (FSs). RESULTS: Children with FSE did not differ dramatically on tasks compared with FS controls at one month after FSE but demonstrated slightly weaker motor development (p=0.035) and receptive language (p=0.034) at one year after FSE. Performances were generally within the low average to average range. Within the FSE cohort, non-White children performed weaker on many of the tasks compared with Caucasian children. At the one-year visit, acute hippocampal T2 findings on MRI were associated with weaker receptive language skills (p=0.0009), and human herpes virus 6 or 7 (HHV6/7) viremia was associated with better memory performances (p=0.047). CONCLUSION: Febrile status epilepticus does not appear to be associated with significant cognitive impairment on early developmental measures, although there is a trend for possible receptive language and motor delay one year after FSE. Further follow-up, which is in progress, is necessary to track long-term cognitive functioning.


Asunto(s)
Cognición/fisiología , Lenguaje , Memoria/fisiología , Convulsiones Febriles/psicología , Estado Epiléptico/psicología , Preescolar , Femenino , Hipocampo/diagnóstico por imagen , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Pruebas Neuropsicológicas , Convulsiones Febriles/complicaciones , Convulsiones Febriles/diagnóstico por imagen , Estado Epiléptico/complicaciones , Estado Epiléptico/diagnóstico por imagen
17.
Brain Dev ; 38(10): 943-946, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27595174

RESUMEN

We report a 13-month-old girl who developed acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) with transient reduced diffusion in the hippocampus and anterior commissure on diffusion-weighted imaging (DWI), which was performed on the first day after febrile status epilepticus (FSE) as the initial neurological symptom of AESD. DWI just after late seizures showed high signal intensity lesions in both left hippocampus and anterior commissure, and left extratemporal and occipital subcortical white matter. HHV-6 DNA was positive in both blood and cerebrospinal fluid samples. DWI at two months after onset showed atrophy in the left mesial temporal lobe and extratemporal and occipital lobe without the signal abnormalities. Although it has been reported that magnetic resonance images tend to show no acute abnormality during the first two days in typical AESD, transient reduced diffusion could be found on the DWI performed on the first day of AESD.


Asunto(s)
Imagen de Difusión por Resonancia Magnética , Hipocampo/diagnóstico por imagen , Infecciones por Roseolovirus/diagnóstico por imagen , Convulsiones Febriles/diagnóstico por imagen , Estado Epiléptico/diagnóstico por imagen , Enfermedad Aguda , ADN Viral/sangre , ADN Viral/líquido cefalorraquídeo , Femenino , Herpesvirus Humano 6/genética , Herpesvirus Humano 6/aislamiento & purificación , Hipocampo/fisiopatología , Humanos , Lactante , Infecciones por Roseolovirus/fisiopatología , Convulsiones Febriles/fisiopatología , Estado Epiléptico/fisiopatología , Factores de Tiempo
18.
Brain Dev ; 38(8): 772-6, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26906012

RESUMEN

Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is characterized by prolonged severe seizures and a high-grade fever. We experienced a boy with severe AERRPS with frequent partial seizures that exhibited right-side predominance. The patient required the continuous intravenous administration of many antiepileptic drugs and respirator management for several months. Methylprednisolone pulse therapy and intravenous immunoglobulin administration were only temporarily effective. The MRI and EEG showed the abnormality in the left occipital lobe. Although occipital lobectomy was performed, his seizures continued. His cerebrospinal fluid exhibited elevated protein and proinflammatory cytokine levels, and was positive for anti-glutamate receptor ε2 antibodies. Pathological examination showed infiltration of many neutrophilic leukocytes, T cells, and microglia in the area exhibiting severe spongiosis. We thought that the exaggerated microglia and T-cell responses were related to the pathogenesis of the patient's seizures, and we therefore initiated treatment with tacrolimus. As a result, many of the daily seizure clusters were ameliorated, and the patient was discharged. We attempted to discontinue the tacrolimus twice, but the patient's seizure clusters recurred each time. This is the first case report of the pathological findings of AERRPS and showing an effective therapeutic approach using tacrolimus. Tacrolimus may be an effective immunosuppressant, especially for patients with severe AERRPS.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Epilepsia Refractaria/tratamiento farmacológico , Encefalitis/tratamiento farmacológico , Epilepsias Parciales/tratamiento farmacológico , Convulsiones Febriles/tratamiento farmacológico , Tacrolimus/uso terapéutico , Enfermedad Aguda , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Encéfalo/fisiopatología , Niño , Epilepsia Refractaria/diagnóstico por imagen , Epilepsia Refractaria/patología , Epilepsia Refractaria/fisiopatología , Electroencefalografía , Encefalitis/diagnóstico por imagen , Encefalitis/patología , Encefalitis/fisiopatología , Epilepsias Parciales/diagnóstico por imagen , Epilepsias Parciales/patología , Epilepsias Parciales/fisiopatología , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/patología , Convulsiones Febriles/fisiopatología
19.
Pediatr Emerg Care ; 29(4): 430-4, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23528503

RESUMEN

BACKGROUND: Complex febrile seizures (CFSs) are a common diagnosis in the pediatric emergency department (PED). Although multiple studies have shown a low likelihood of intracranial infections and abnormal neuroimaging findings among those who present with CFS, the absence of a consensus recommendation and the diversity of CFS presentations (ie, multiple seizures, prolonged seizure, focal seizure) often drive physicians to do a more extensive workup than needed. Few studies examine the factors that influence providers to pursue invasive testing and emergent neuroimaging. OBJECTIVE: The objective of this study was to determine the clinical factors associated with a more extensive workup in a cohort of patients who present to the PED with CFSs. METHODS: Patient visits to a tertiary care PED with an International Classification of Diseases, Ninth Revision, diagnosis of CFS were reviewed from April 2009 to November 2011. Patients included were 6 months to 6 years of age. Complex febrile seizures were defined as febrile seizures lasting 15 minutes or longer, more than 1 seizure in 24 hours, and/or a focal seizure. Charts were reviewed for demographics, clinical parameters (duration of fever, history of febrile seizure, focality of seizure, antibiotic use before PED, and immunization status), PED management (antiepileptic drugs given in the PED or by Emergency Medical Services, empiric antibiotics given in the PED, laboratory testing, lumbar puncture, or computed tomography [CT] scan), and results (cultures, laboratories, or imaging). A logistic regression model was created to determine which clinical parameters were associated with diagnostic testing. RESULTS: One hundred ninety patients were diagnosed with CFS and met study criteria. Clinical management in the PED included a lumbar puncture in 37%, blood cultures in 88%, urine cultures in 47%, and a head CT scan in 28%. There were no positive cerebral spinal fluid or blood cultures in this cohort. Of the 90 patients, 4 (4.4%) with urine cultures had a urinary tract infection. Of the 53 patients who had head CT imaging, there were no significant findings that guided therapy. The only factor associated with having a lumbar puncture performed was whether empiric antibiotics were used (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.28-6.8). History of a febrile seizure was associated with lower odds of a lumbar puncture (OR, 0.29; 95% CI, 0.12-0.69). In addition, higher age category was also associated with lower odds of a lumbar puncture (OR, 0.53; 95% CI, 0.31-0.91). Those who received an antiepileptic drug had a higher odds of getting a head CT (OR, 3.5; 95% CI, 1.5-8.6). Furthermore, patients presenting with a focal seizure also had higher odds of getting a head CT (OR, 4.89; 95% CI, 1.41-16.9). CONCLUSIONS: Despite the low utility of associated findings, there are important clinical parameters that are associated with obtaining a lumbar puncture or a head CT as part of the diagnostic workup. National practice parameters to guide evaluation for CFSs in the acute setting are warranted to reduce the amount of invasive testing and imaging.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Neuroimagen/métodos , Convulsiones Febriles/diagnóstico , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Factores de Riesgo , Convulsiones Febriles/diagnóstico por imagen , Punción Espinal , Tomografía Computarizada por Rayos X
20.
J Child Neurol ; 25(1): 61-6, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19482839

RESUMEN

The aim of this study is to assess any cerebral dysfunction in young children, who experienced febrile seizures, by means of magnetoencephalography. Our study population included 15 children (9 boys, 6 girls) within the age range of 2 to 7 years. The magnetoencephalography data were recorded with a 122-channel biomagnetometer. Equivalent current dipoles were calculated for epileptic spikes on magnetoencephalography recordings according to the single dipole model. Of 15 children, 8 showed equivalent current dipoles that located at the left-temporal, right-temporal, occipital, and frontal lobe, as active regions responsible for febrile seizures. We assumed that the interictal epileptiform discharges are a consequence of febrile seizures. Of course, further study in a larger number of patients is needed to evaluate the exact role of the equivalent current dipoles, in young children, who experienced febrile seizures.


Asunto(s)
Encéfalo/fisiopatología , Magnetoencefalografía/métodos , Convulsiones Febriles/fisiopatología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Mapeo Encefálico/instrumentación , Mapeo Encefálico/métodos , Niño , Preescolar , Electroencefalografía , Epilepsia Tónico-Clónica/diagnóstico por imagen , Epilepsia Tónico-Clónica/patología , Epilepsia Tónico-Clónica/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Magnetoencefalografía/instrumentación , Masculino , Proyectos Piloto , Cuero Cabelludo/fisiopatología , Convulsiones Febriles/diagnóstico por imagen , Convulsiones Febriles/patología , Tomografía Computarizada por Rayos X
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