Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension.

While the typical patient with idiopathic intracranial hypertension (IIH) is an obese female of childbearing age, there are unique patient populations, such as non-obese females, that have not been well studied. Characterizing this subpopulation may increase awareness our of it, which may prevent underdiagnosis and improve our understanding of IIH's underlying pathophysiology. We retrospectively reviewed electronic medical records and compared the clinical and radiological characteristics of non-obese (BMI < 30) and obese (BMI > 30) female patients with IIH. Two hundred and forty-six patients (age 32.3 ± 10) met our inclusion criteria. The non-obese patients (n = 59, 24%) were significantly younger than the obese patients (29.4 ± 9.9 vs. 33.2 ± 10.2, p = 0.004) and had higher rates of severe papilledema (Friesen 4-5; 25.4% vs. 11.8%, p = 0.019), scleral flattening (62.7% vs. 36.9%, p = 0.008), and optic nerve dural ectasia (78.0% vs. 55.6%, p = 0.044). Non-obese patients also had a tendency to have a higher lumbar puncture opening pressure (368 ± 92.7 vs. 344 ± 76.4, p = 0.062). Non-obese patients were three times more likely to present with a combination of scleral flattening and optic nerve dural ectasia (OR = 3.00, CI: 1.57-5.72, χ2 = 11.63, α < 0.001). Overall, non-obese females with IIH were found to have a more fulminant presentation, typified by higher rates of severe papilledema and radiological findings typical for IIH.

Drug Resistance in Late-onset Epilepsy.

BACKGROUND: The annual incidence of epilepsy increases with age, from nearly 28 per 100,000 by the age of 50 years to 139 per 100,000 by the age of 75 years. Late-onset epilepsy differs from epilepsy at a young age in the prevalence of structural-related epilepsy, types of seizures, duration of seizures, and presentation with status epilepticus. OBJECTIVES: To check the response to treatment in patients with epilepsy with age of onset of 50 years and older. METHODS: We conducted a retrospective study. The cohort included all patients referred to the Rambam epilepsy clinic between 1 November 2016 and 31 January 2018 with epilepsy onset at age 50 years or older and at least one year of follow-up at the recruitment time point and epilepsy not caused by a rapidly progressive disease. RESULTS: At recruitment, most patients were being treated with a single antiseizure medication (ASM); 9 of 57 patients (15.7%) met the criteria for drug-resistant epilepsy (DRE). The mean duration of follow-up was 2.8 ± 1.3 years. In an intention-to-treat analysis, 7 of 57 patients (12.2%) had DRE at the last follow-up. CONCLUSIONS: Late-onset epilepsy, which is defined as a first diagnosis in patients older than 50 years of age, is easy to control with monotherapy. The percentage of DRE in this group of patients is relatively low and stable over time.

Knowledge and emotional attitudes of health care practitioners regarding patients with psychogenic nonepileptic seizures.

BACKGROUND: Psychogenic nonepileptic seizures (PNESs) are paroxysmal events that resemble epileptic seizures without concomitant changes in electroencephalograms (EEGs) or any other physiological cause. These seizures are one of the most common and dramatic conversion disorders. First responders treat many PNES patients with unnecessary emergency abortive medication and sometimes even intubate them. Several of our PNES patients have complained they have experienced harsh attitudes from health care practitioners (HCPs), especially during their stay in the emergency room (ER). OBJECTIVE: To assess the emotional attitude of HCPs toward PNES patients. METHODS: We handed a questionnaire containing 23 questions regarding PNES patients to HCPs from emergency medicine, internal medicine, and neurology disciplines. The questions dealt with three categories: diagnosis, management, and emotional attitudes. RESULTS: Overall, 47 HCPs participated in this study: 11 ER, 18 internal medicine, and 18 neurology practitioners. The HCP from those disciplines showed high knowledge and good management practice of PNES patients. On the other hand, the HCPs agreed with most emotional attitude statements regarding PNES patients, reflecting a high percentage of negative emotional attitudes toward this group of patients. We did not find any correlation between negative emotional attitude and HCP department, profession, or seniority. CONCLUSIONS: Although HCPs in our center perform good management practice regarding PNES patients, most reported a negative emotional attitude. This finding implies that what PNES patients feel regarding the harsh attitudes is also reflected by HCP views. Emotional attitudes towards PNES patients may not depend solely on the level of knowledge of the HCPs.

ANTECEDENTES: Crises não epilépticas psicogênicas (CNEPs) são eventos paroxísticos que se assemelham a crises epilépticas sem alterações concomitantes nos eletroencefalogramas (EEGs) ou não causadas por qualquer outra causa fisiológica. Essas convulsões são um dos distúrbios de conversão mais comuns e dramáticos. Os socorristas tratam muitos pacientes com CNEP com medicamentos abortivos de emergência desnecessariamente e às vezes até os entubam. Vários de nossos pacientes com CNEP queixaram-se de atitudes duras dos profissionais de saúde (HCPs), especialmente durante a permanência na sala de emergência (SE). OBJETIVO: Avaliar a atitude emocional dos profissionais de saúde em relação aos pacientes com CNEP. MéTODOS: Entregamos um questionário contendo 23 perguntas sobre pacientes com CNEP aos profissionais de saúde das disciplinas de medicina de emergência, medicina interna e neurologia. As questões tratavam de três categorias: diagnóstico, manejo e atitudes emocionais. RESULTADOS: No geral, 47 profissionais de saúde participaram deste estudo: 11 ER, 18 medicina interna e 18 profissionais de neurologia. Os profissionais de saúde dessas disciplinas apresentaram alto conhecimento e boa prática de manejo dos pacientes da CNEP. Por outro lado, os profissionais de saúde concordaram com as afirmações da maioria das atitudes emocionais em relação aos pacientes da CNEP, refletindo um alto percentual de atitudes emocionais negativas em relação a esse grupo de pacientes. Não encontramos nenhuma correlação entre atitude emocional negativa e departamento de HCP, profissão ou antiguidade. CONCLUSõES: Embora os profissionais de saúde de nosso centro tenham uma boa prática profissional de manejo em relação aos pacientes com CNEP, a maioria relatou uma atitude emocional negativa. Esse achado implica que o que os pacientes da PNES sentem em relação às atitudes duras também se reflete na visão do HCP. Atitudes emocionais em relação aos pacientes da CNEP podem não depender apenas do nível de conhecimento dos profissionais de saúde.

Knowledge and emotional attitudes of health care practitioners regarding patients with psychogenic nonepileptic seizures / Conhecimento e atitudes emocionais dos profissionais de saúde acerca de pacientes com convulsão psicogênica não epiléptica

Abstract Background Psychogenic nonepileptic seizures (PNESs) are paroxysmal events that resemble epileptic seizures without concomitant changes in electroencephalograms (EEGs) or any other physiological cause. These seizures are one of the most common and dramatic conversion disorders. First responders treat many PNES patients with unnecessary emergency abortive medication and sometimes even intubate them. Several of our PNES patients have complained they have experienced harsh attitudes from health care practitioners (HCPs), especially during their stay in the emergency room (ER). Objective To assess the emotional attitude of HCPs toward PNES patients. Methods We handed a questionnaire containing 23 questions regarding PNES patients to HCPs from emergency medicine, internal medicine, and neurology disciplines. The questions dealt with three categories: diagnosis, management, and emotional attitudes. Results Overall, 47 HCPs participated in this study: 11 ER, 18 internal medicine, and 18 neurology practitioners. The HCP from those disciplines showed high knowledge and good management practice of PNES patients. On the other hand, the HCPs agreed with most emotional attitude statements regarding PNES patients, reflecting a high percentage of negative emotional attitudes toward this group of patients. We did not find any correlation between negative emotional attitude and HCP department, profession, or seniority. Conclusions Although HCPs in our center perform good management practice regarding PNES patients, most reported a negative emotional attitude. This finding implies that what PNES patients feel regarding the harsh attitudes is also reflected by HCP views. Emotional attitudes towards PNES patients may not depend solely on the level of knowledge of the HCPs.

Resumo Antecedentes Crises não epilépticas psicogênicas (CNEPs) são eventos paroxísticos que se assemelham a crises epilépticas sem alterações concomitantes nos eletroencefalogramas (EEGs) ou não causadas por qualquer outra causa fisiológica. Essas convulsões são um dos distúrbios de conversão mais comuns e dramáticos. Os socorristas tratam muitos pacientes com CNEP com medicamentos abortivos de emergência desnecessariamente e às vezes até os entubam. Vários de nossos pacientes com CNEP queixaram-se de atitudes duras dos profissionais de saúde (HCPs), especialmente durante a permanência na sala de emergência (SE). Objetivo Avaliar a atitude emocional dos profissionais de saúde em relação aos pacientes com CNEP. Métodos Entregamos um questionário contendo 23 perguntas sobre pacientes com CNEP aos profissionais de saúde das disciplinas de medicina de emergência, medicina interna e neurologia. As questões tratavam de três categorias: diagnóstico, manejo e atitudes emocionais. Resultados No geral, 47 profissionais de saúde participaram deste estudo: 11 ER, 18 medicina interna e 18 profissionais de neurologia. Os profissionais de saúde dessas disciplinas apresentaram alto conhecimento e boa prática de manejo dos pacientes da CNEP. Por outro lado, os profissionais de saúde concordaram com as afirmações da maioria das atitudes emocionais em relação aos pacientes da CNEP, refletindo um alto percentual de atitudes emocionais negativas em relação a esse grupo de pacientes. Não encontramos nenhuma correlação entre atitude emocional negativa e departamento de HCP, profissão ou antiguidade. Conclusões Embora os profissionais de saúde de nosso centro tenham uma boa prática profissional de manejo em relação aos pacientes com CNEP, a maioria relatou uma atitude emocional negativa. Esse achado implica que o que os pacientes da PNES sentem em relação às atitudes duras também se reflete na visão do HCP. Atitudes emocionais em relação aos pacientes da CNEP podem não depender apenas do nível de conhecimento dos profissionais de saúde.