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1.
Rev. neurol. (Ed. impr.) ; 71(10): 365-372, 16 nov., 2020. tab
Artículo en Español | IBECS | ID: ibc-198071

RESUMEN

INTRODUCCIÓN: El estado epiléptico representa la emergencia neurológica más frecuente en pediatría. Las convulsiones febriles prolongadas representan la etiología más frecuente. Nuestro objetivo es actualizar su epidemiología y analizar sus consecuencias evolutivas. PACIENTES Y MÉTODOS: Estudio observacional analítico de cohortes retrospectivas de niños atendidos en urgencias con estado epiléptico entre enero de 2014 y diciembre de 2018. Se recogieron las variables demográficas, los antecedentes personales, las características clínicas, las pruebas complementarias y la etiología de los estados epilépticos seguidos en nuestro hospital. Se analizaron las consecuencias evolutivas en cuanto a neurodesarrollo y epilepsia ulterior. RESULTADOS: De un total de 525.000 urgencias atendidas durante el estudio, los casos de estado epiléptico fueron 79 en 68 pacientes (16 casos/100.000 niños/año). La etiología sintomática fue la más frecuente (35,4%). El 20,6% de los pacientes presentaba antecedente de prematuridad; el 30,8%, un déficit del neurodesarrollo previo, más frecuente en caso de etiología sintomática, y el 44% estaba diagnosticado de epilepsia. La duración mediana de las crisis fue de 50 minutos. En siete pacientes se identificó un desencadenante cerebral agudo. El déficit del neurodesarrollo ulterior achacable al estado epiléptico fue del 9,1%, y se relacionó con la etiología sintomática o antecedentes de prematuridad. El desarrollo de epilepsia ocurrió en el 10,7%. CONCLUSIONES: La alteración del neurodesarrollo achacable al estado epiléptico afecta a uno de cada 11 casos. La prematuridad fue un factor de riesgo por sí misma. La epilepsia posterior a un estado epiléptico se desarrolló en uno de cada 10 casos


INTRODUCTION: Epileptic status represents the most frequent neurological emergency in pediatrics. Prolonged febrile seizures represent the most common etiology. Our objective is to update its epidemiology and analyze its evolutionary consequences. PATIENTS AND METHODS: Observational analytical study of retrospective cohorts of children seen in the emergency department with epileptic status between January-2014 and December-2018. Demographic variables, personal history, clinical characteristics, complementary tests and the etiology of the epileptic status followed in our hospital were collected. The evolutionary consequences in terms of neurodevelopment and subsequent epilepsy were analyzed. RESULTS: Of a total of 525,000 emergencies attended during the study, epileptic status cases were 79 in 68 patients (16 cases/100,000 children/year). The symptomatic etiology was the most frequent (35.4%). 20.6% of the patients had a history of prematurity, 30.8% had a deficit of previous neurodevelopment, this being more frequent in case of symptomatic etiology, and 44% were diagnosed with epilepsy. The median duration of seizures was 50 minutes. An acute brain trigger was identified in seven patients. The subsequent neurodevelopmental deficit attributable to epileptic status was 9.1% of patients related to symptomatic etiology and/or a history of prematurity. The development of epilepsy occurred in 10.7%. CONCLUSIONS: The neurodevelopmental disorder attributable to epileptic status affects one in 11 cases. Prematurity was a risk factor per se. Post-epileptic status epilepsy developed in one in 10 cases


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Estado Epiléptico/epidemiología , Estado Epiléptico/fisiopatología , Convulsiones Febriles/epidemiología , Convulsiones Febriles/fisiopatología , Estado Epiléptico/etiología , Trastornos del Neurodesarrollo/fisiopatología , Trastornos del Neurodesarrollo/epidemiología , Estudios Retrospectivos , Pronóstico , Factores de Riesgo , España/epidemiología
2.
BMJ Case Rep ; 13(10)2020 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-33012721

RESUMEN

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Asunto(s)
Antipsicóticos/efectos adversos , Betacoronavirus , Clozapina/efectos adversos , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Trastornos Psicóticos/tratamiento farmacológico , Estado Epiléptico/etiología , Clozapina/uso terapéutico , Diagnóstico Diferencial , Electroencefalografía/métodos , Femenino , Humanos , Persona de Mediana Edad , Pandemias , Estado Epiléptico/fisiopatología
4.
Clin Neurol Neurosurg ; 197: 106173, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32877769

RESUMEN

People with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, COVID-19, can have neurological problems including headache, anosmia, dysgeusia, altered mental status (AMS), ischemic stroke with or without large vessel occlusion, and Guillen-Barre Syndrome. Louisiana was one of the states hit hardest by the pandemic with just over 57,000 laboratory-confirmed cases of COVID-19 by the end of June 2020. We reviewed the electronic medical records (EMR) of patients hospitalized during the peak of the pandemic, March 1st through March 31st, to document the type and frequency of neurological problems seen in patients with COVID-19 at presentation to the emergency room. Secondary aims were to determine: 1) the frequency of neurological complaints during the hospital stay; 2) whether the presence of any neurological complaint at presentation or any of the individual types of neurological complaints at admission predicted three separate outcomes: death, length of hospital stay, or the need for intubation; and 3) if the presence of any neurological complaint or any of the individual types of neurological complaints developed during hospital stay predicted the previous three outcomes. A large proportion of our sample (80 %) was African American and had hypertension (79 %). Out of 250 patients, 56 (22 %) patients died, and 72 (29 %) patients required intubation. Thirty-four (14 %) had a neurological chief complaint at presentation; the most common neurological chief complaints in the entire sample were altered mental status (AMS) (8 %), headache (2 %), and syncope (2 %). We used a competing risk model to determine whether neurological symptoms at presentation or during hospital stay were predictors of prolonged hospital stay and death. To establish whether neurological symptoms were associated with higher odds of intubation, we used logistic regression. Age was the only significant demographic predictor of death and hospital stay. The HR (95 %CI) for remaining in the hospital for a ten-year increase in age was 1.2, (1.1, 1.3, p < 0.0001), and for death was 1.3, (1.1, 1.5, p < 0.01). There were no demographic characteristics, including age or comorbidities predictive of intubation. Adjusting for age, patients who at presentation had neurological issues as their chief complaint were at significantly increased risk for remaining in the hospital, HR = 1.7, (1.1,2.5, p = 0.0001), and dying, HR = 2.1(1.1,3.8, p = 0.02), compared to patients without any neurological complaint. Of the individual admission complaints, AMS was associated with a significantly prolonged hospital stay, HR = 1.8, (1.0-3.3, p = 0.05). Patients that required dialysis or intubation or had AMS during hospitalization had more extended hospital stays. After adjusting for age, dialysis, and intubation, patients with AMS during hospital stay had a HR of 1.6, (1.1, 2.5, p = 0.01) for remaining in the hospital. Patients who had statistically significant higher odds of requiring intubation were those who presented with any neurological chief complaint, OR = 2.8 (1.3,5.8, p = 0.01), or with headaches OR = 13.3 (2.1,257.0, p = 0.008). Patients with AMS during the hospital stay, as well as those who had seizures, were more likely to need intubation. In the multivariate model, dialysis, OR = 4.9 (2.6,9.4, p < 0.0001), and AMS, OR = 8.8 (3.9,21.2, p < 0.0001), were the only independent predictors of intubation. Neurological complaints at presentation and during the hospital stay are associated with a higher risk of death, prolonged hospital stay, and intubation. More work is needed to determine whether the cause of the neurological complaints was direct CNS involvement by the virus or the other systemic complications of the virus.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Intubación Intratraqueal/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Enfermedades del Sistema Nervioso/fisiopatología , Neumonía Viral/fisiopatología , Adulto , Afroamericanos/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital , Grupo de Ascendencia Continental Europea , Femenino , Cefalea/etiología , Cefalea/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Enfermedades del Sistema Nervioso/etiología , Nueva Orleans , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Pronóstico , Modelos de Riesgos Proporcionales , Respiración Artificial , Convulsiones/etiología , Convulsiones/fisiopatología , Estado Epiléptico/etiología , Estado Epiléptico/fisiopatología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Síncope/etiología , Síncope/fisiopatología
6.
J Ayub Med Coll Abbottabad ; 32(2): 280-282, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32584012

RESUMEN

Fahr's disease is a rare disease in which there is symmetrical bilateral intracranial calcification. We are presenting a 50-year-old female patient who presented with status epilepticus. She had history of generalized tonic clonic fits for the last fifteen years. Her CT scan revealed widespread bilateral and symmetrical intracranial calcification in cerebellum, thalamus, basal ganglia and in white matter of the cerebral hemisphere Most of the secondary causes were ruled out to make the clinical diagnosis of Fahr's disease.


Asunto(s)
Enfermedades de los Ganglios Basales , Calcinosis , Enfermedades Neurodegenerativas , Estado Epiléptico/etiología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
11.
Ann Clin Transl Neurol ; 7(7): 1240-1244, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32407609

RESUMEN

Neurological complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. We present a single-center retrospective case series reporting the EEG and outcome of de novo status epilepticus (SE) in two African-American women with laboratory-confirmed SARS-CoV-2 virus. SE was the initial presentation in one asymptomatic individual. Patient 2 had COVID-19 pneumonia, and fluctuating mental status that raised the suspicion of subclinical SE. The patient with older age and higher comorbidities failed to recover from the viral illness that has no definitive treatment.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Estado Epiléptico/etiología , Afroamericanos , Anciano , Anticonvulsivantes/uso terapéutico , Betacoronavirus , Electroencefalografía , Femenino , Humanos , Levetiracetam/uso terapéutico , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamiento farmacológico
13.
Med Clin North Am ; 104(3): 525-538, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32312413

RESUMEN

Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.


Asunto(s)
Urgencias Médicas/epidemiología , Cuidados Paliativos al Final de la Vida/normas , Planificación de Atención al Paciente/normas , Cuidado Terminal/métodos , Anciano , Anciano de 80 o más Años , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/uso terapéutico , Diagnóstico Diferencial , Hemorragia/etiología , Hemorragia/terapia , Humanos , Hipercalcemia/etiología , Persona de Mediana Edad , Neoplasias/complicaciones , Cuidados Paliativos/normas , Cuidados Paliativos/estadística & datos numéricos , Planificación de Atención al Paciente/tendencias , Pronóstico , Factores de Riesgo , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/terapia , Estado Epiléptico/tratamiento farmacológico , Estado Epiléptico/etiología , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/terapia
18.
Epilepsia ; 61(3): 498-508, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32077099

RESUMEN

OBJECTIVE: Electroencephalographic seizures (ESs) are common in encephalopathic critically ill children, but ES identification with continuous electroencephalography (EEG) monitoring (CEEG) is resource-intense. We aimed to develop an ES prediction model that would enable clinicians to stratify patients by ES risk and optimally target limited CEEG resources. We aimed to determine whether incorporating data from a screening EEG yielded better performance characteristics than models using clinical variables alone. METHODS: We performed a prospective observational study of 719 consecutive critically ill children with acute encephalopathy undergoing CEEG in the pediatric intensive care unit of a quaternary care institution between April 2017 and February 2019. We identified clinical and EEG risk factors for ES. We evaluated model performance with area under the receiver-operating characteristic (ROC) curve (AUC), validated the optimal model with the highest AUC using a fivefold cross-validation, and calculated test characteristics emphasizing high sensitivity. We applied the optimal operating slope strategy to identify the optimal cutoff to define whether a patient should undergo CEEG. RESULTS: The incidence of ES was 26%. Variables associated with increased ES risk included age, acute encephalopathy category, clinical seizures prior to CEEG initiation, EEG background, and epileptiform discharges. Combining clinical and EEG variables yielded better model performance (AUC 0.80) than clinical variables alone (AUC 0.69; P < .01). At a 0.10 cutoff selected to emphasize sensitivity, the optimal model had a sensitivity of 92%, specificity of 37%, positive predictive value of 34%, and negative predictive value of 93%. If applied, the model would limit 29% of patients from undergoing CEEG while failing to identify 8% of patients with ES. SIGNIFICANCE: A model employing readily available clinical and EEG variables could target limited CEEG resources to critically ill children at highest risk for ES, making CEEG-guided management a more viable neuroprotective strategy.


Asunto(s)
Encefalopatías/fisiopatología , Epilepsia/fisiopatología , Convulsiones/diagnóstico , Estado Epiléptico/diagnóstico , Encefalopatías/complicaciones , Preescolar , Enfermedad Crítica , Electroencefalografía , Femenino , Humanos , Lactante , Modelos Logísticos , Masculino , Estudios Prospectivos , Medición de Riesgo , Convulsiones/etiología , Estado Epiléptico/etiología
20.
AJR Am J Roentgenol ; 214(4): 907, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32045303

RESUMEN

OBJECTIVE. Myelography is a commonly used procedure to evaluate the spinal canal. However, the procedure is not without risk, chiefly risk of seizure after intrathecal administration of iodinated contrast material. CONCLUSION. The risk of seizure remains an important concern for radiologists, who should strongly consider practice parameter guidelines that address this risk.


Asunto(s)
Medios de Contraste/efectos adversos , Mielografía/efectos adversos , Estado Epiléptico/etiología , Estado Epiléptico/mortalidad , Humanos , Factores de Riesgo
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