Diagnostic value of lumbar puncture in afebrile infants with suspected new-onset seizures.

No established guidelines address the need for lumbar puncture in fever-free infants younger than 6 months of age with a first seizure. We analyzed cerebrospinal fluid results in infants and found that lumbar puncture adds little diagnostic value to the evaluation of young, well-appearing infants presenting with possible new-onset seizures.

Ketogenic diet fed rats have low levels of S100B in cerebrospinal fluid.

Ketogenic diets have been used to treat seizure disorders of children resistant to conventional anti-epileptic drug treatment. The mechanism of action of this diet, however, is unknown. Gliosis is a very common characteristic in tissues associated with epileptogenesis and glial cytokines may be involved in the pathology of seizure disorders. We investigate herein, whether ketogenic diet fed rats demonstrate changes in the immunocontent of S100B, an astrocyte-derived cytokine elevated in the temporal lobe of refractory epilepsy. Lower levels of S100B were observed in cerebrospinal fluid with no significant changes in S100B and GFAP content in brain tissue. Ketogenic fed rats presented a lower seizure severity induced by pentylenetetrazole and no change in cerebrospinal fluid S100B after pentylenetetrazole administration. These results support the concept that the ketogenic diet is neuroprotective in seizure disorders. Since S100B has an extracellular activity in neuronal excitability and synaptic plasticity, it would be reasonable to conceive that a decrease in the S100B could be involved in the mechanism of action of the ketogenic diet. However, it is not possible to establish a direct link between reduced CSF S100B and decreased severity of PTZ-induced attacks at present moment. Regardless of this, CSF S100B could be proposed as an index of efficacy of ketogenic diet for seizure disorders.

The value of CSF analysis for the differential diagnosis of HTLV-I associated myelopathy and multiple sclerosis.

Cerebrospinal fluid (CSF) and serum of 17 patients with HAM/TSP (HTLV-I associated myelopathy/tropical spastic paraparesis), six with multiple sclerosis and six with idiopathic epilepsy (non inflammatory control) from Brazil were analysed for the presence of intrathecal synthesis of virus-specific antibodies against measles, rubella, varicella zoster virus and herpes simplex virus by enzyme-linked immunosorbent assay (ELISA). All HAM/TSP and multiple sclerosis cases had an intrathecal immune response (oligoclonal IgG). In HAM/TSP, only 1/17 case showed a polyspecific intrathecal immune response against measles and rubella virus. In multiple sclerosis, specific antibodies against measles and rubella (MRZ response) were observed in all patients but not in the control with idiopathic epilepsy. The diagnostic and theoretical relevance of mono- and polyspecific immune responses is discussed for these chronic neurological diseases.

The value of csf analysis for the differential diagnosis of HTLV-I associated myelopathy and multiple sclerosis

Amostras do líquido cefalorraquidiano (LCR) e soro de 17 pacientes brasileiros com HAM/TSP, seis com esclerose múltipla e seis com epilepsia idiopática (controle nao-inflamatório) foram analisadas para a presença de anticorpos para o vírus de sarampo, rubéola, varicela zoster e herpes simples pelo método de ELISA. Todos os casos de HAM/TSP e esclerose múltipla tinham resposta imune poliespecífica intratecal para sarampo e rubéola. Anticorpos específicos para sarampo e rubéola (resposta MRZ) foram observados em todos os pacientes com esclerose múltipla, mas nao nos controles com epilepsia idiopática. A relevância das respostas poliespecífica e monoespecífica é discutida para essas doenças neurológicas crônicas.

[Clinical study of catamenial epilepsy: significance of the presence of a previous cerebral lesion]. / Estudo clínico da epilepsia catamenial: significado da presença de lesão cerebral prévia.

Four hundred thirty one epileptic patients, aged 10 years or more old, have been studied in the neurology clinic of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da U.S.P., from February to July, 1981. The authors selected 119 patients aged between 13 to 45 years, that presented periodic menstrual bleeding and at least, one epileptic seizure a month. The patients were divided in two groups, the first constituted of 36 patients with catamenial seizures and the second one with 83 patients showing non catamenial seizures. The authors compare the number of pictures suggestive of "organic lesions" found in both groups. The statistical analysis shows that there are no differences between the two groups. The authors registered the EEG findings of these patients.

[Epilepsy and chronic Chagas disease]. / Epilepsia e donença de Chagas crônica.

The epileptic syndrome in chronic Chagas' disease is rarely reported in neurological literature. At the present time many papers have demonstrated that histopathological basis of Chagas' disease is a neuronal destruction. The authors studied 167 epileptic patients; 44 out of them had a chronic form of the disease. It was made a comparison of semiologic data between the two groups, and also the evaluation of the therapeutic results with anticonvulsant drugs. The chagasic patients had the onset of epileptic seizures later than the control group, with great predominance of partial seizures of autonomic type. The neurologic examination and cerebrospinal fluid test revealed moderate rates of disturbances, but not sufficient to characterize a neurologic syndrome. The EEG study was performed in 15 of the 44 cases and revealed a suggestive pattern of a diffuse cerebral damage in half of patients. Anticonvulsant therapy based on use of phenylhydantoin, barbituric acid derivates, primidone and benzodiazepines, showed that control of epileptic seizures in Chagas' diseases is more difficult and requires greater quantities of drugs than in the control group.

[Possible role of acetylcholine-acetylcolinesterase in the etiopathogenesis of epilepsy]. / Posible papel del sistema acetilcolina-acetilcolinesterasa en la etiopatogenia de la epilepsia.

Of the results obtained by numerous investigators in the study of the acetylcholine-acetylcholinesterase system, it is quite clear that it is altered significantly in the convulsive state. In the present work, a study of the acetylcholinesterase activity (AChE) in serum was made in 53 patients with different type of epilepsy during the intercritical period. A significantly high increase in the enzymatic activity (p less than 0.001) was found, compared with that of the controls, unrelated with the probable etiology of the process nor with some symptoms. We observed, nevertheless, a tendency towards diminished enzymatic activity with an increase of the severity of the electroencephalographic picture, and we interpreted this as a compensating effect. The AChE activity in serum and cerebrospinal fluid of a group of epileptic patients subjected to stereotaxic operations was studied before and after surgery, observing a significantly diminished activity of AChE in serum (p less than 0.001) after surgery. This asserts the hypothesis of the compensating increase of the AChE activity in serum, which tends to normalize once some of the factors producing the decompensation are eliminated.