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1.
BMJ ; 366: l4485, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31383632

RESUMO

Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as "essential tremor plus." Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.


Assuntos
Tremor Essencial/complicações , Tremor Essencial/terapia , Antagonistas Adrenérgicos beta/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antipsicóticos/uso terapêutico , Estimulação Encefálica Profunda , Tremor Essencial/diagnóstico , Tremor Essencial/epidemiologia , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Bloqueio Nervoso
3.
Chem Pharm Bull (Tokyo) ; 67(7): 699-706, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257325

RESUMO

In our search for novel orally active α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonists, we found that conversion of an allyl group in the lead compound 2-[allyl(4-methylphenyl)amino]-4H-pyrido[3,2-e][1,3]thiazin-4-one (4) to a 2-cyanoethyl group significantly increased inhibitory activity against AMPA receptor-mediated kainate-induced toxicity in rat hippocampal cultures. Here, we synthesized 10 analogs bearing a 2-cyanoethyl group and administered them to mice to evaluate their anticonvulsant activity in maximal electroshock (MES)- and pentylenetetrazol (PTZ)-induced seizure tests, and their effects on motor coordination in a rotarod test. 3-{(4-Oxo-4H-pyrido[3,2-e][1,3]thiazin-2-yl)[4-(trifluoromethoxy)phenyl]amino}propanenitrile (25) and 3-[(2,2-difluoro-2H-1,3-benzodioxol-5-yl)(4-oxo-4H-pyrido[3,2-e][1,3]thiazin-2-yl)amino]propanenitrile (27) exhibited potent anticonvulsant activity in both seizure tests and induced minor motor disturbances as indicated in the rotarod test. The protective index values of 25 and 27 for MES-induced seizures (10.7 and 12.0, respectively) and PTZ-induced seizures (6.0 and 5.6, respectively) were considerably higher compared with those of YM928 (5) and talampanel (1).


Assuntos
Anticonvulsivantes/síntese química , Nitrilos/química , Receptores de AMPA/antagonistas & inibidores , Administração Oral , Animais , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Hipocampo/citologia , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Locomoção/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos ICR , Microssomos Hepáticos/metabolismo , Nitrilos/farmacologia , Nitrilos/uso terapêutico , Pentilenotetrazol/toxicidade , Ratos , Ratos Wistar , Receptores de AMPA/metabolismo , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Convulsões/veterinária , Relação Estrutura-Atividade
4.
Fortschr Neurol Psychiatr ; 87(6): 357-363, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31261415

RESUMO

Since 2004 several reports on the treatment of status epilepticus with levetiracetam have been published. In this review, the results of a PubMed-based search of publications December 12, 2011 - July 6, 2018 are summarized and compared to those of earlier publications. In total, 28 treatment episodes in case reports, each on one or two cases of treatment episodes, and 412 treatment episodes in case series and prospective studies were analyzed. Case series and prospective studies reported an average success rate for termination of status probably of 55,0 %-59,4 %. Since preclinical data suggest a delayed effect of levetiracetam, its use in the treatment of generalized convulsive status epilepticus appears still questionable. A loading dose of 30 mg / kg seems to be reasonable.


Assuntos
Levetiracetam/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Humanos , Estudos Prospectivos , Projetos de Pesquisa
5.
Brain Nerve ; 71(8): 901-910, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31346147

RESUMO

We evaluated the efficacy and safety of lorazepam (LZP) 4 mg for adults (age, 16 years old or older) or 0.05mg/kg for children (age, 3 months to less than 16 years) as a slow intravenous injection in 26 Japanese patients with status epilepticus or repetitive seizures. The proportion of patients whose initial seizure stopped within 10 minutes and who continued seizure-free for at least 30 minutes after the completion of initial dose as the primary endpoint was 48.0% (12/25, 95%CI: 27.8%-68.7%). However, the proportion of patients whose seizures stopped within 10 minutes and who continued seizure-free for at least 30 minutes after the completion of either initial or second dose (in 10 to 30 minutes from the initial dose) was 64.0% (16/25, 95%CI: 42.5%-82.0%) in total, and 77.8% and 56.3% in adults and children, respectively. The most common adverse events (AEs) were somnolence (7.7%) and insomnia (7.7%), and almost all AEs were mild or moderate in severity. No patient experienced serious or severe LZP-related AEs. No one discontinued the study due to AEs.


Assuntos
Anticonvulsivantes/uso terapêutico , Lorazepam/uso terapêutico , Convulsões/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Criança , Pré-Escolar , Humanos , Injeções Intravenosas , Lorazepam/efeitos adversos
6.
Medicine (Baltimore) ; 98(27): e16156, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277117

RESUMO

The occurrence of seizures during pregnancy is really a challenging situation which risks the health of both mothers and fetuses. However, new onset epilepsy is unpredictable in pregnancy, and its clinic feature is barely known. This study aimed to explore the clinical characteristics and pregnancy outcomes of new onset epilepsy during pregnancy.We screened consecutive women with epilepsy and reproductive history from June 2013 to November 2018 from 3 hospitals in West China. Detailed demographics, clinical features, neurological status, related tests, managements, seizure and pregnancy outcomes were recorded and followed-up. Within them, patients with first seizure during pregnancy and spontaneous recurrent seizures after delivery or abortion were defined as new onset epilepsy during pregnancy.We screened a total of 1041 consecutive women with epilepsy and reproductive history. Twenty-two of them (2.1%) had new onset epilepsy during pregnancy. The average age at seizure onset was 22.7 ± 3.0 years. All their first seizures occurred in pregnancy period, including 4 (18.2%) in the first trimester, ten (45.4%) in the second trimester and eight (36.4%) in the third trimester. Most patients delivered healthy babies, except one patient had to choose induced abortion because of the disappearance of fetal heart rate, one child was diagnosed with mild harelip and one was diagnosed with trisomy 21 syndrome, tetralogy of Fallot and congenital duodenal atresia. All 3 complications happened in patients with their first seizures in first trimester.Although the risk of new onset epilepsy during pregnancy was relatively low, accurate diagnosis and appropriate treatment were required to reduce the damage to both mothers and fetuses. New onset epilepsy during pregnancy mostly began in middle and late pregnancy. However, seizures occurred from early pregnancy had bad effects on the embryo or fetus.


Assuntos
Epilepsia/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Feminino , Humanos , Gravidez , Adulto Jovem
8.
Brain Nerve ; 71(6): 611-616, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31171758

RESUMO

Everolimus is a mammalian target of rapamycin (mTOR) inhibitor that has cytoreductive effects on subependymal giant cell astrocytoma and renal angiomyolipoma in tuberous sclerosis complex (TSC). Recent studies have also shown its efficacy against refractory seizures in TSC. We investigated the efficacy of everolimus in nine patients with TSC, who were admitted to the TSC clinic in Seirei Hamamatsu General Hospital and who suffered from refractory seizures. At the start of treatment, patients ranged from 1 month to 23 years of age, and were refractory to a mean of 5.4 antiepileptic agents. Main seizures were focal in six patients and generalized in three patients. After 0.5 to 4.0 years (mean=2.4 years), three patients (33%) were seizure-free and two patients (22%) experienced >90% reduction in seizures. Everolimus may therefore be effective in the treatment of refractory seizures in TSC. (Received February 20, 2019; Accepted April 2, 2019; Published June 1, 2019).


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Everolimo/uso terapêutico , Convulsões/tratamento farmacológico , Esclerose Tuberosa/tratamento farmacológico , Adolescente , Animais , Criança , Pré-Escolar , Humanos , Lactente , Adulto Jovem
9.
Br J Anaesth ; 123(2): e385-e396, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31208761

RESUMO

BACKGROUND: Trigeminal neuralgia (TN) can have a significant impact on wellbeing and quality of life. Limited data exist for treatments that improve TN pain acutely, within 24 h of administration. This systematic review aims to identify effective treatments that acutely relieve TN exacerbations. METHODS: We searched Medline and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant English language publications. The reference list for all articles was searched for other relevant publications. All studies that satisfied the following PICO criteria were included: (i) Population-adults with acute exacerbation of primary TN symptoms; (ii) Intervention-any medication or intervention with the primary goal of pain relief within 24 h; (iii) Comparator-usual medical care, placebo, sham or active treatment; (iv) Outcome-more than 50% reduction in pain intensity within 24 h of administration. RESULTS: Of 431 studies, 17 studies were identified that reported immediate results of acute treatment in TN. The evidence suggests that the following interventions may be beneficial: local anaesthetic, mainly lidocaine (ophthalmic, nasal or oral mucosa, trigger point injection, i.v. infusion, nerve block); anticonvulsant, phenytoin or fosphenytoin (i.v. infusion); serotonin agonist, sumatriptan (s.c. injection, nasal). Other referenced interventions with very limited evidence include N-methyl-d-aspartate receptor antagonist (magnesium sulphate infusion) and botulinum toxin (trigger point injection). CONCLUSIONS: Several treatment options exist that may provide fast and safe relief of TN. Future studies should report on outcomes within 24 h to improve knowledge of the acute analgesic TN treatments.


Assuntos
Analgesia/métodos , Analgésicos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Neurotoxinas/uso terapêutico , Neuralgia do Trigêmeo/tratamento farmacológico , Doença Aguda , Toxinas Botulínicas/uso terapêutico , Humanos , Sulfato de Magnésio/uso terapêutico
10.
BMC Neurol ; 19(1): 114, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164100

RESUMO

BACKGROUND: Epigenetics underlying refractory epilepsy is poorly understood. DNA methylation may affect gene expression in epilepsy patients without affecting DNA sequences. Herein, we investigated the association between Carbamazepine-resistant (CBZ-resistant) epilepsy and EPHX1 methylation in a northern Han Chinese population, and conducted an analysis of clinical risk factors for CBZ-resistant epilepsy. METHODS: Seventy-five northern Han Chinese patients participated in this research. 25 cases were CBZ-resistant epilepsy, 25 cases were CBZ-sensitive epilepsy and the remaining 25 cases were controls. Using a CpG searcher was to make a prediction of CpG islands; bisulfite sequencing PCR (BSP) was applied to test the methylation of EPHX1. We then did statistical analysis between clinical parameters and EPHX1 methylation. RESULTS: There was no difference between CBZ-resistant patients, CBZ-sensitive patients and healthy controls in matched age and gender. However, a significant difference of methylation levels located in NC_000001.11 (225,806,929.....225807108) of the EPHX1 promoter was found in CBZ-resistant patients, which was much higher than CBZ-sensitive and controls. Additionally, there was a significant positive correlation between seizure frequency, disease course and EPHX1 methylation in CBZ-resistant group. CONCLUSION: Methylation levels in EPHX1 promoter associated with CBZ-resistant epilepsy significantly. EPHX1 methylation may be the potential marker for CBZ resistance prior to the CBZ therapy and potential target for treatments.


Assuntos
Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Resistência a Medicamentos/genética , Epilepsia Resistente a Medicamentos/genética , Epóxido Hidrolases/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Metilação de DNA , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia/tratamento farmacológico , Epilepsia/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Regiões Promotoras Genéticas , Adulto Jovem
11.
Vet J ; 249: 53-57, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31239165

RESUMO

The aim of this study was to evaluate changes in epileptic seizures (ES) frequency and semiology in antiepileptic-medication (AEM)-naïve dogs with idiopathic epilepsy (DIE) after initiation of imepitoin (IMP) or phenobarbital (PB) monotherapy. In this observational prospective cohort study, inclusion criteria were as follows: diagnosis of idiopathic epilepsy (based on clinical, laboratory and magnetic resonance imaging investigations) in AEM-naïve dogs and presence of a detailed ES-diary. Exclusion criteria were: occurrence of cluster seizures (CS) or status epilepticus (SE) prior to treatment initiation and concurrent disease and/or treatments. Thirty-one DIE commenced IMP at 10-20mg/kg/12h and 30 dogs commenced PB at 2.50-3.30mg/kg/12h. AEM dosage was increased over time (up to IMP 30mg/kg/12h and PB 5.20mg/kg/12h). All dogs experienced generalised-tonic-clonic ES. In the IMP-group, pre-treatment median ES-frequency was 1.50ES/month (range, 1-4ES/month); post-treatment median ES-frequency was 0.95ES/m (range, 1ES/6m-3ES/m); n=21/31 (67.70%) dogs developed CS 1-18 months after initiation of treatment; n=7/31 (22.60%) dogs experienced unacceptable adverse events in the first month of treatment which required switching to an alternative AEM; and n=3/31(9.70%) dogs did not develop CS with a 3year follow-up. In the PB-group, pre-treatment median ES-frequency was 2.46ES/month (range, 1-7ES/month); post-treatment median ES-frequency was 0.36ES/month (range, 0ES/3years-1ES/month); n=11/30 (36.70%) dogs developed CS between 12-25 months after initiation of treatment. Nineteen of 30 (63.30%) dogs did not develop CS with a 3-year follow-up; three of these 19 dogs were ES free. In this study, AEM-naïve DIE receiving imepitoin-monotherapy developed CS significantly more frequently and earlier in the course of the disease, and developed aggression and required earlier discontinuation of monotherapy than AEM-naïve DIE receiving phenobarbital-monotherapy.


Assuntos
Anticonvulsivantes/uso terapêutico , Doenças do Cão/tratamento farmacológico , Epilepsia/veterinária , Imidazóis/uso terapêutico , Fenobarbital/uso terapêutico , Animais , Estudos de Coortes , Cães , Epilepsia/tratamento farmacológico , Imidazóis/administração & dosagem , Fenobarbital/administração & dosagem , Estudos Prospectivos , Convulsões/veterinária , Resultado do Tratamento
12.
Med Klin Intensivmed Notfmed ; 114(5): 475-484, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31053866

RESUMO

Both convulsive and nonconvulsive status epilepticus are associated with a high risk of morbidity and mortality. To limit brain damage, emergency investigation of etiology and treatment must be done synchronously. This review presents the general rules for treatment. The steps of pharmacologic escalation with benzodiazepines, antiepileptics, and anesthetics are discussed together with their advantages and disadvantages.


Assuntos
Anticonvulsivantes/uso terapêutico , Unidades de Terapia Intensiva , Estado Epiléptico , Benzodiazepinas , Eletroencefalografia , Humanos , Estado Epiléptico/diagnóstico , Estado Epiléptico/terapia
13.
Infect Dis Poverty ; 8(1): 30, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31036087

RESUMO

BACKGROUND: In 2012, the Ugandan Government declared an epidemic of Nodding Syndrome (NS) in the Northern districts of Gulu, Kitgum, Lamwo and Pader. Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation. However, a wide gap remained between the pre-defined care standards and the quality of routine care provided to those affected. This study is to qualitatively assess adherence to accepted clinical care standards for NS; identify gaps in the care of affected children and offer Clinical Support Supervision (CSS) to Primary Health Care (PHC) staff at the treatment centres; and identify psychosocial challenges faced by affected children and their caregivers. METHODS: This case study was carried out in the districts of Gulu, Kitgum, Lamwo and Pader in Uganda from September to December in 2015. Employing the 5-stage approach of Clinical Audit, data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities, as well as with caregivers and political leaders. The qualitative data was analysed using Seidel model of data processing. RESULTS: Clinical Audit and CSS revealed poor adherence to treatment guidelines. Many affected children had sub-optimal NS management resulting in poor seizure control and complications including severe burns. Root causes of these outcomes were frequent antiepileptic drugs stock outs, migration of health workers from their work stations and psychosocial issues. There was hardly any specialized multidisciplinary team (MDT) to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed, leading to loss of skills learnt. Reported psychosocial and psychosexual issues associated with NS included early pregnancies, public display of sexual behaviours and child abuse. CONCLUSIONS: Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines, multidisciplinary care was not implemented in practice. There is urgent need to review the NS clinical guidelines. Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities. Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Síndrome do Cabeceio/terapia , Adolescente , Anticonvulsivantes/uso terapêutico , Criança , Pré-Escolar , Auditoria Clínica , Epilepsia , Humanos , Lactente , Entrevistas como Assunto , Síndrome do Cabeceio/tratamento farmacológico , Síndrome do Cabeceio/epidemiologia , Pesquisa Qualitativa , Resultado do Tratamento , Uganda
14.
Medicine (Baltimore) ; 98(20): e15726, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096528

RESUMO

RATIONALE: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most frequent autoimmune encephalitis in children, and its presentation is various. The disease can be triggered by various infections. PATIENT CONCERNS: Case 1 was a 7-year-old female with the presentation of seizure, repeated fever, language disorder, and decreased muscle strength of the right limbs; Case 2 was a 7-year-old male with the manifestation of repeated emesis, headache, involuntary movement, altered personality, seizures, and cognitive impairment; Case 3 was a 2-year-old female with repeated fever, emesis, seizures, coma, and decreased muscle strength of limbs. Anti-NMDAR antibody was identified in cerebrospinal fluid (CSF) in the 3 cases, confirming the diagnosis of anti-NMDAR encephalitis. Pathogenic examinations revealed positive serum Epstein-Barr virus (EBV)-nuclear antigen and EBV-capsid antigen (CA)-IgG antibodies in the 3 cases, as well as positive EBV-early antigen (EA)-IgG antibody in CSF. Case 1 also had positive EBV-CA-IgA antibody; Case 3 also had positive EBV-CA-IgA and EBV-CA-IgG antibodies. DIAGNOSES: Anti-NMDAR antibody and EBV-EA-IgG antibody in CSF were tested positive in the 3 cases. Thus, they were diagnosed as anti-NMDAR encephalitis associated with reactivated EBV infection. INTERVENTIONS: All of the 3 cases received immunoglobulin, corticosteroid, and ganciclovir treatment. Cases 2 and 3 also received antiepileptic drugs due to repeated seizures. In addition, Case 3 also received assistant respiration, plasma exchange, and rituximab. OUTCOMES: The 3 cases were substantially recovered after treatment. Repeat CSF analysis showed decreased titer of the anti-NMDAR antibody. LESSONS: Reactivated EBV infection may trigger anti-NMDAR encephalitis in children, which has not been reported previously. Related possible virology tests should be completed while diagnosing the disease.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Encefalite Antirreceptor de N-Metil-D-Aspartato/virologia , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Convulsões/tratamento farmacológico , Corticosteroides/uso terapêutico , Encefalite Antirreceptor de N-Metil-D-Aspartato/líquido cefalorraquidiano , Anticonvulsivantes/uso terapêutico , Autoanticorpos/líquido cefalorraquidiano , Proteínas do Capsídeo/imunologia , Criança , Pré-Escolar , Infecções por Vírus Epstein-Barr/líquido cefalorraquidiano , Infecções por Vírus Epstein-Barr/complicações , Antígenos Nucleares do Vírus Epstein-Barr/imunologia , Feminino , Ganciclovir/uso terapêutico , Humanos , Imunoglobulinas/uso terapêutico , Masculino , Convulsões/líquido cefalorraquidiano , Convulsões/etiologia , Resultado do Tratamento
15.
Neurologist ; 24(3): 93-108, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045720

RESUMO

BACKGROUND: Tourette syndrome (TS) and other chronic tic disorders are clinically heterogenous and cause physical discomfort, social difficulties, and emotional distress. In addition to tics, TS patients have a variety of behavioral comorbidities, including obsessive-compulsive disorders and attention-deficit hyperactivity disorders. TS treatment is multidisciplinary, involving behavioral therapy, oral medications, and botulinum toxin injections. METHODS: Relevant studies on pharmacological and surgical treatment options for TS and other chronic tic disorders, their limitations and current recommendations were reviewed using the PubMed search till April 2, 2018. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies. This review aims to discuss the progress in pharmacological and surgical treatment options for TS and other chronic tic disorders. RESULTS AND CONCLUSIONS: Both typical and atypical antipsychotic agents are mainstays of pharmacological treatment of TS and other chronic tic disorder patients; however, their use is limited by serious side effects considering their potential of dopamine blockade. Because of the phenotypic variability, no medication has proven effective for all persons with TS and other chronic tic disorders. Botulinum toxin has emerged as a good therapeutic option, especially for focal and dystonic tics. But, their uses are limited by lack of sufficient evidence and high cost. Surgical treatment is considered in medically refractory and severely disabled tics patients. Deep brain stimulation has replaced lesional surgeries; however, there is uncertainty regarding the selection of patients and target of stimulation.


Assuntos
Transtornos de Tique/tratamento farmacológico , Transtornos de Tique/cirurgia , Síndrome de Tourette/tratamento farmacológico , Síndrome de Tourette/cirurgia , Anticonvulsivantes/uso terapêutico , Antipsicóticos/uso terapêutico , Humanos , Procedimentos Neurocirúrgicos/métodos , Parassimpatolíticos/uso terapêutico , Resultado do Tratamento
16.
Environ Health Prev Med ; 24(1): 31, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31084599

RESUMO

In Japan, because the most common site of drowning among patients with epilepsy is the bathtub, showering is generally recommended as an alternative to bathing. We herein report a case involving a female patient with epilepsy who drowned while showering. She had been diagnosed with epilepsy approximately 25 years previously, and her condition had progressed to refractory epilepsy. Carbamazepine, levetiracetam, lamotrigine, clobazam, and perampanel were prescribed daily. One day while showering, the patient was found lying with her face immersed in water that had accumulated on the floor of the bathtub. A forensic autopsy revealed water in the stomach, trachea, and proximal regions of both lung bronchi as well as white and red foam on the pharynx and larynx. A total of 1.9 µg/mL of lamotrigine, 0.14 µg/mL of carbamazepine, and 0.069 µg/mL of perampanel were detected in the patient's blood. The patient's cause of death was determined to be drowning due to an epileptic seizure. Although the patient was prescribed five types of antiepileptic medication, only three were detected in her blood. The current case demonstrates that drowning can occur while showering, suggesting that it is unsafe for patients with medication nonadherence. To prevent unintentional deaths in the bathroom, we recommend that patients with epilepsy maintain high adherence to all prescriptions and are supervised by a family member, even when showering. The current case is the first autopsy report of a patient with epilepsy who drowned while showering.


Assuntos
Afogamento/etiologia , Afogamento/patologia , Epilepsia Resistente a Medicamentos/patologia , Adulto , Anticonvulsivantes/sangue , Anticonvulsivantes/uso terapêutico , Autopsia , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Feminino , Humanos , Japão , Adesão à Medicação
17.
J Ayub Med Coll Abbottabad ; 31(2): 237-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094124

RESUMO

BACKGROUND: The use of anti-epileptic drugs for prophylaxis of early post-traumatic seizures after traumatic brain injury has been very promising. The objective of this study was to determine the outcome of phenytoin in prevention of early post-traumatic seizures in moderate to severe traumatic brain injuries and to compare the frequency of seizures in moderate to severe traumatic brain injury, with phenytoin started within 12 hours and after 12 hours of injury. METHODS: This cross-sectional study was conducted at Department of Neurosurgery, Ayub Medical Institute, Abbottabad from April to October, 2015. All the patients with moderate to severe head injury presenting within 48 hours of injury were included in this study in consecutive manner. Patients were started on phenytoin and observed for early post-traumatic seizures. RESULTS: A total of 163 patients were included in this study with a mean age of 24.69±10.186 years. One hundred and twenty-two (74.8%) were males and rest of 41 (25.2%) were females. A total of 26 (16%) patients had early post-traumatic seizures. 9.89% patients in whom phenytoin was started within 12 hours had seizures, while 23.11% patients in whom phenytoin was started after 12 hours of injury had seizures, the difference being statistically significant (p-value .018).. CONCLUSIONS: Frequency of early post-traumatic seizures is high in patients with moderate to severe head injured patients. Anti-epileptics like phenytoin should be started within 12 hours for seizure prophylaxis.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia Pós-Traumática , Fenitoína/uso terapêutico , Adolescente , Adulto , Estudos Transversais , Epilepsia Pós-Traumática/tratamento farmacológico , Epilepsia Pós-Traumática/prevenção & controle , Feminino , Humanos , Masculino , Paquistão , Adulto Jovem
18.
Expert Opin Pharmacother ; 20(10): 1289-1297, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31063406

RESUMO

INTRODUCTION: Epilepsy is a prominent feature of myoclonic epilepsy with ragged-red fibers (MERRF)-syndrome. The most frequent seizure type is myoclonic seizures, of which the treatment is challenging and empiric. AREAS COVERED: Herein, the author summarises and discusses previous and recent findings of antiepileptic drug (AED) treatment in MERRF-syndrome. EXPERT OPINION: MERRF-syndrome is a predominantly maternally inherited, multisystem mitochondrial disorder caused by pathogenic variants predominantly of the mitochondrial DNA (mtDNA). Canonical clinical features of MERRF include myoclonus, epilepsy, ataxia, and myopathy. Additionally, other manifestations in the CNS, peripheral nerves, eyes, ears, heart, gastrointestinal tract, and endocrine organs may occur (MERRF-plus). Today, MERRF is considered rather as myoclonic ataxia than as myoclonic epilepsy. Genotypically, MERRF is due to mutations in 13 mtDNA-located genes and 1 nDNA-located gene. According to the modified Smith-score, the strongest gene-disease relationship exists for MT-TK, MT-TL1, and POLG1. Epilepsy is the second most frequent phenotypic feature of MERRF. Seizure-types associated with MERRF include focal myoclonic, focal clonic, and focal atonic seizures, generalized myoclonic, tonic-clonic, atonic, and myoclonic-atonic seizures, or typical absences. Treatment of myoclonic epilepsy relies on expert judgments recommending levetiracetam, together with clonazepam, or topiramate, zonisamide, or piracetam in monotherapy as the first line AEDs.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Síndrome MERRF/tratamento farmacológico , Humanos , Mutação , Convulsões/tratamento farmacológico
19.
Acta Neurobiol Exp (Wars) ; 79(1): 86-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038487

RESUMO

Epilepsy is a life­threatening disorder that is marked by recurrent seizures. Febrile seizure is a common neurological disorder observed in neonates. In many cases, reducing body temperature can prevent febrile seizure. Transient receptor potential cation channel subfamily M member 8 (TRPM8) is a cation channel that is involved in body thermoregulation. It was reported that M8­B, a TRPM8 antagonist, can reduce body temperature. Thus, we aimed to investigate the effect of M8­B on different experimental seizure models. Eight­day­old male Wistar rat pups were used for induction of febrile seizure. M8­B and diazepam were injected intraperitoneally. The rat pups were then transferred to a heated plexiglas chamber and the latency to the first febrile seizure was measured. In addition, different groups of mice were pretreated with M8­B and received a convulsant dose of pentylenetetrazol (PTZ). Latencies to stages 2 and 4 and duration of stage 5 seizure episodes were measured. Furthermore, the effect of M8­B on electroshock­induced seizures was also investigated and hindlimb extension time was measured. The results showed that M8­B decreased the body temperature of rat pups and increased the latency to the first febrile seizure, implying a significant protective effect. It also induced a significant anticonvulsant effect in PTZ ­ but not electroshock­induced convulsions. M8­B showed anticonvulsant effects in both febrile­ and PTZ­induced seizures. M8­B had a hypothermic effect with significant protective effects on febrile­ and PTZ­induced seizures; however, it did not produce similarly protective effects on seizures induced by electroshock.


Assuntos
Anticonvulsivantes/uso terapêutico , Convulsivantes/toxicidade , Pentilenotetrazol/toxicidade , Convulsões Febris/tratamento farmacológico , Convulsões/induzido quimicamente , Convulsões/prevenção & controle , Tiofenos/uso terapêutico , Animais , Animais Recém-Nascidos , Temperatura Corporal/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Masculino , Ratos , Ratos Wistar , Canais de Cátion TRPM/antagonistas & inibidores , Canais de Cátion TRPM/metabolismo , Fatores de Tempo
20.
BMC Public Health ; 19(1): 595, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101093

RESUMO

BACKGROUND: Childhood epilepsy can adversely affect education and employment in addition to health. Previous studies are small or highly selective producing conflicting results. This retrospective cohort study aims to compare educational and health outcomes of children receiving antiepileptic medication versus peers. METHODS: Record linkage of Scotland-wide databases covering dispensed prescriptions, acute and psychiatric hospitalisations, maternity records, deaths, annual pupil census, school absences/exclusions, special educational needs, school examinations, and (un)employment provided data on 766,244 children attending Scottish schools between 2009 and 2013. Outcomes were adjusted for sociodemographic and maternity confounders and comorbid conditions. RESULTS: Compared with peers, children on antiepileptic medication were more likely to experience school absence (Incidence Rate Ratio [IRR] 1.43, 95% CI: 1.38, 1.48), special educational needs (Odds ratio [OR] 9.60, 95% CI: 9.02, 10.23), achieve the lowest level of attainment (OR 3.43, 95% CI: 2.74, 4.29) be unemployed (OR 1.82, 95% CI: 1.60, 2.07), be admitted to hospital (Hazard Ratio [HR] 3.56, 95% CI: 3.42, 3.70), and die (HR 22.02, 95% CI: 17.00, 28.53). Absenteeism partly explained poorer attainment and higher unemployment. Girls and younger children on antiepileptic medication had higher risk of poor outcomes. CONCLUSIONS: Children on antiepileptic medication fare worse than peers across educational and health outcomes. In order to reduce school absenteeism and mitigate its effects, children with epilepsy should receive integrated care from a multidisciplinary team that spans education and healthcare.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/epidemiologia , Hospitalização/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Absenteísmo , Adolescente , Adulto , Criança , Bases de Dados Factuais , Prescrições de Medicamentos/estatística & dados numéricos , Escolaridade , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Registro Médico Coordenado , Razão de Chances , Gravidez , Estudos Retrospectivos , Escócia/epidemiologia , Adulto Jovem
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