Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.367
Filtrar
1.
BMC Infect Dis ; 20(1): 574, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758161

RESUMO

BACKGROUND: Despite widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive disorder (HAND) and HIV-associated myelopathy (HAM) are not showing significant reduction in there occurrence. The HAM is a progressive myelopathy that often occur synchronously with severe form of the HAND in patients' having advanced immunosuppression. However, co-existence of less severe form of the HAND and HAM in patient with relatively preserved CD4 cells is rarely reported clinical entity in post cART era. CASE PRESENTATION: We report a 16-year old male, acquired HIV infection vertically, was on second line regimen because of virological failure since 3 years. His current CD4 lymphocyte count is 835 cells/uL with viral RNA level of 33,008 copies/mL. Currently presented with progressive forgetfulness, gait imbalance, and a frequent staring episodes without loss of postural tone. Neurological examination was pertinent for cognitive dysfunction with score of 6 on International HIV Dementia Scale (motor speed = 3, psychomotor speed = 2, and memory recall = 1). Lower limbs power is 4-/5, increased deep tendon reflexes, and unsteady gait. Brain MRI revealed diffuse both cortical and white matter T2 and FLAIR hyperintense lesions. Thoracic MRI showed abnormal T2 signal prolongation spanning from mid thoracic cord to conus. Electroencephalography study showed severe generalized slowing with evidence of focal dysrhythmia in bilateral frontotemporal regions. Unremarkable serum vitamin B 12 level (286 ng/mL). Virological failure with the HAND, HAM and seizure was considered. Dolutegravir +3TC + ATV/r regimen and valproate for seizure disorder was started. On 6 months follow up evaluation, he is clinically stable with significant improvement of his symptoms related to seizure disorders and modest improvement of his cognitive dysfunction, as he is now attending his school regularly. However, less improvement was observed reading his gait abnormality. CONCLUSION: This case supports the current understanding regarding the persistent occurrence of HIV-associated neurocognitive disorder and HIV-associated myelopathy even decades after introduction of cART. Therefore, it's important to screen HIV+ patients for the HAND and HAM even if they have relatively preserved immunity. Because patient can be easily shifted to ART drugs with better CNS penetrating potential to achieve acceptable virological suppression level, to observe sound clinical improvement.


Assuntos
Complexo AIDS Demência/complicações , Complexo AIDS Demência/diagnóstico , Linfócitos T CD4-Positivos , Convulsões/complicações , Convulsões/diagnóstico , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Carga Viral , Complexo AIDS Demência/tratamento farmacológico , Complexo AIDS Demência/imunologia , Adolescente , Contagem de Linfócito CD4 , Disfunção Cognitiva/diagnóstico , Seguimentos , Inibidores de Integrase de HIV/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Masculino , RNA Viral/sangue , Convulsões/tratamento farmacológico , Doenças da Medula Espinal/tratamento farmacológico , Resultado do Tratamento
2.
Rinsho Shinkeigaku ; 60(9): 627-630, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779601

RESUMO

A 17-year-old woman presented with transient consciousness impairment attack and convulsion after bathing and prolonged standing since age 12. EEG showed WHAM ( wake, high amplitude, anterior, male) type of phantom spikes that usually carry the high risk of epilepsy at age 13. At age 17, EEG wise generalized spike and wave complex was recorded once, and head-up tilt test was positive. She was carefully observed without antiepileptic drugs since convulsive syncope due to neurally mediated syncope was most likely. During the follow-up period, she had eventually unprovoked generalized tonic-clonic seizures (convulsive seizure) twice and thus she was started with antiepileptic drug with success. Although both convulsive syncope and convulsive seizure differ in nature and effects on quality of life, in this patient, the latter occurred later and both occurs together. It is important to distinguish them by means of the degree of convulsion and EEG finding.


Assuntos
Convulsões/complicações , Convulsões/diagnóstico , Síncope/complicações , Síncope/diagnóstico , Anticonvulsivantes/uso terapêutico , Criança , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Humanos , Qualidade de Vida , Recidiva , Convulsões/tratamento farmacológico , Síncope/tratamento farmacológico , Teste da Mesa Inclinada , Resultado do Tratamento
3.
J Neurovirol ; 26(5): 619-630, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32839951

RESUMO

The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Encéfalo/metabolismo , Infecções por Coronavirus/genética , Interações Hospedeiro-Patógeno/genética , Proteínas do Tecido Nervoso/genética , Pneumonia Viral/genética , Proteínas Virais/genética , Encéfalo/patologia , Encéfalo/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Depressão , Tontura/complicações , Tontura/genética , Tontura/patologia , Tontura/virologia , Encefalite/complicações , Encefalite/genética , Encefalite/patologia , Encefalite/virologia , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/genética , Síndrome de Guillain-Barré/patologia , Síndrome de Guillain-Barré/virologia , Cefaleia/complicações , Cefaleia/genética , Cefaleia/patologia , Cefaleia/virologia , Humanos , Proteínas do Tecido Nervoso/classificação , Proteínas do Tecido Nervoso/metabolismo , Transtornos do Olfato/complicações , Transtornos do Olfato/genética , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Mapeamento de Interação de Proteínas , Convulsões/complicações , Convulsões/genética , Convulsões/patologia , Convulsões/virologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/virologia , Proteínas Virais/metabolismo
5.
PLoS One ; 15(6): e0234082, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479533

RESUMO

OBJECTIVES: To investigate whether cerebrospinal fluid levels of neuron-specific enolase (CSF-NSE) during the first 72 hours correlate with other tools used to assess ongoing brain damage, including clinical grading of hypoxic-ischemic encephalopathy (HIE), abnormal patterns in amplitude integrated electroencephalography (aEEG), and magnetic resonance imaging (MRI), as well as with the neurodevelopmental outcomes at two years of age. MATERIAL AND METHODS: Prospective observational study performed in two hospitals between 2009 and 2011. Forty-three infants diagnosed with HIE within 6 hours of life were included. HIE was severe in 20 infants, moderate in 12, and mild in 11. Infants with moderate-to-severe HIE received whole-body cooling. Both the HIE cohort and a control group of 59 infants with suspected infection underwent measurement of CSF-NSE concentrations at between 12 and 72 hours after birth. aEEG monitoring was started at admission and brain MRI was performed within the first 2 weeks. Neurodevelopment was assessed at 24 months. RESULTS: The HIE group showed higher levels of CSF-NSE than the control group: median 70 ng/ml (29; 205) vs 10.6 ng/ml (7.7; 12.9); p <0.001. Median levels of CSF-NSE in infants with severe, moderate, and mild HIE were 220.5 ng/ml (120.5; 368.8), 45.5 ng/ml (26, 75.3), and 26 ng/ml (18, 33), respectively. CSF-NSE levels correlated were significantly higher in infants with seizures, abnormal aEEG, or abnormal MRI, compared to those without abnormalities. Infants with an adverse outcome showed higher CSF-NSE levels than those with normal findings (p<0.001), and the most accurate CSF-NSE cutoff level for predicting adverse outcome in the whole cohort was 108 ng/ml and 50ng/ml in surviving infants. CONCLUSIONS: In the era of hypothermia, CSF-NSE concentrations provides valuable information as a clinical surrogate of the severity of hypoxic-ischemic brain damage, and this information may be predictive of abnormal outcome at two years of age.


Assuntos
Lesões Encefálicas/patologia , Hipotermia Induzida/efeitos adversos , Hipóxia-Isquemia Encefálica/diagnóstico , Fosfopiruvato Hidratase/líquido cefalorraquidiano , Lesões Encefálicas/etiologia , Estudos de Casos e Controles , Eletroencefalografia , Feminino , Idade Gestacional , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/terapia , Recém-Nascido , Listeria monocytogenes/patogenicidade , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Convulsões/complicações , Convulsões/diagnóstico , Índice de Gravidade de Doença
6.
J Med Virol ; 92(7): 699-702, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-96729

RESUMO

Neurologic sequelae can be devastating complications of respiratory viral infections. We report the presence of virus in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem examination from a patient infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our observations of virus in neural tissue, in conjunction with clinical correlates of worsening neurologic symptoms, pave the way to a closer understanding of the pathogenic mechanisms underlying central nervous system involvement by SARS-CoV-2.


Assuntos
Ageusia/diagnóstico , Ataxia/diagnóstico , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Transtornos do Olfato/diagnóstico , Pneumonia Viral/diagnóstico , Convulsões/diagnóstico , Idoso , Ageusia/complicações , Ageusia/fisiopatologia , Ageusia/virologia , Ataxia/complicações , Ataxia/fisiopatologia , Ataxia/virologia , Betacoronavirus/genética , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Células Endoteliais/patologia , Células Endoteliais/virologia , Evolução Fatal , Lobo Frontal/irrigação sanguínea , Lobo Frontal/patologia , Lobo Frontal/virologia , Hospitalização , Humanos , Pulmão/irrigação sanguínea , Pulmão/patologia , Pulmão/virologia , Masculino , Neurônios/patologia , Neurônios/virologia , Transtornos do Olfato/complicações , Transtornos do Olfato/fisiopatologia , Transtornos do Olfato/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Convulsões/complicações , Convulsões/fisiopatologia , Convulsões/virologia
7.
Artigo em Russo | MEDLINE | ID: mdl-32323939

RESUMO

OBJECTIVE: To study a cohort of adult patients with various forms of epilepsy to determine various clinical patterns of remission with subsequent relapse of seizures. MATERIALS AND METHODS: The study included 1384 patients. Two hundred and forty-nine patients with one or more remissions in the history resulted in relapse. Patients were stratified into 6 groups by clinical features of the disease. For each group, a long-term outcome of the disease was evaluated. RESULTS AND CONCLUSIONS: Return to a basic therapy after a relapse due to dose reduction or AED discontinuation does not guarantee the remission. One or more «honeymoons¼ in medical history are predictors of the low probability of achieving remission. Patients with focal epilepsies often have one or more long-term remissions that may not correspond with AED treatment. In these patients, the relapse often happen in the second decade of life with the following development of intractable epilepsy.


Assuntos
Epilepsia , Recidiva , Adulto , Anticonvulsivantes/uso terapêutico , Estudos de Coortes , Epilepsias Parciais/complicações , Epilepsias Parciais/tratamento farmacológico , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Humanos , Convulsões/complicações , Convulsões/tratamento farmacológico
8.
J Med Virol ; 92(7): 699-702, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32314810

RESUMO

Neurologic sequelae can be devastating complications of respiratory viral infections. We report the presence of virus in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem examination from a patient infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our observations of virus in neural tissue, in conjunction with clinical correlates of worsening neurologic symptoms, pave the way to a closer understanding of the pathogenic mechanisms underlying central nervous system involvement by SARS-CoV-2.


Assuntos
Ageusia/diagnóstico , Ataxia/diagnóstico , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Transtornos do Olfato/diagnóstico , Pneumonia Viral/diagnóstico , Convulsões/diagnóstico , Idoso , Ageusia/complicações , Ageusia/fisiopatologia , Ageusia/virologia , Ataxia/complicações , Ataxia/fisiopatologia , Ataxia/virologia , Betacoronavirus/genética , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Células Endoteliais/patologia , Células Endoteliais/virologia , Evolução Fatal , Lobo Frontal/irrigação sanguínea , Lobo Frontal/patologia , Lobo Frontal/virologia , Hospitalização , Humanos , Pulmão/irrigação sanguínea , Pulmão/patologia , Pulmão/virologia , Masculino , Neurônios/patologia , Neurônios/virologia , Transtornos do Olfato/complicações , Transtornos do Olfato/fisiopatologia , Transtornos do Olfato/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Convulsões/complicações , Convulsões/fisiopatologia , Convulsões/virologia
9.
BMC Med Genet ; 21(1): 47, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131761

RESUMO

BACKGROUND: Choreoacanthocytosis (ChAc), is a rare neurodegenerative disease, characterized by movement disorders and acanthocytosis in the peripheral blood smears, and various neurological, neuropsychiatric and neuromuscular signs. It is caused by mutations in VPS13A gene with autosomal recessive pattern of inheritance. CASE PRESENTATION: Here we report two patients belonging to a consanguineous Moroccan family who present with movement disorder pathology. They were suspected to have choreoacanthocytosis according to biological, clinical and radiological finding. Thus, whole-exome sequencing was performed for precise diagnosis and identified a homozygous novel nonsense mutation c.337C > T (p.Gln113*) in exon 5 of VPS13A in the two affected siblings. CONCLUSION: Here, we report a novel nonsense p.Gln113* mutation in VPS13A identified by whole-exome sequencing, which caused ChAc in a Moroccan family. This is the first description of ChAc in Morocco with genetic confirmation, that expands the mutation diversity of VPS13A and provide clinical, neuroimaging and deep brain stimulation findings.


Assuntos
Neuroacantocitose/genética , Polimorfismo de Nucleotídeo Único , Proteínas de Transporte Vesicular/genética , Adulto , Códon sem Sentido , Consanguinidade , Feminino , Humanos , Marrocos , Neuroacantocitose/patologia , Linhagem , Convulsões/complicações , Convulsões/genética , Irmãos , Espasmo/complicações , Espasmo/genética
10.
Epilepsia ; 61(4): 798-809, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32201948

RESUMO

OBJECTIVE: To determine electrical changes in the heart in a chronic, nonstatus model of epilepsy. METHODS: Electrocorticography (ECoG) and electrocardiography (ECG) of nine animals (five made epileptic by intrahippocampal injection of tetanus neurotoxin (TeNT) and four controls), are monitored continuously by radiotelemetry for up to 7 weeks. RESULTS: Epileptic animals develop a median of 168 seizures, with postictal tachycardias reaching a mean of 487 beats/min and lasting a mean of 661 seconds. Ictal changes in heart rate include tachycardia and in the case of convulsive seizures, bradyarrhythmias resembling Mobitz type 1 second-degree atrioventricular block; notably the P-R interval increased before block. Postictally, the amplitude of T wave increases. Interictally, QT dependence on RR is modest and conventional QT corrections prove ineffective. Interictal QT intervals, measured at a heart rate of 400 bpm, increased from 65 to 75 ms, an increase dependent on seizure incidence over the preceding 10-14 days. SIGNIFICANCE: Repeated seizures induce a sustained tachycardia and increase in QT interval of the ECG and evoke arrhythmias including periods of atrioventricular block during Racine type 4 and 5 seizures. These changes in cardiac function may predispose to development in fatal arrhythmias and sudden death in humans with epilepsy.


Assuntos
Bradicardia/etiologia , Convulsões/complicações , Taquicardia/etiologia , Animais , Eletrocardiografia , Eletrocorticografia , Masculino , Neurotoxinas/toxicidade , Ratos , Ratos Wistar , Convulsões/induzido quimicamente , Convulsões/fisiopatologia , Morte Súbita Inesperada na Epilepsia/etiologia , Toxina Tetânica/toxicidade
11.
Med Sci Monit ; 26: e920751, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32134903

RESUMO

Todd's paralysis, a neurological abnormality characterized by temporary limb weakness or hemiplegia, typically occurs following a seizure, without enduring consequences. Since limb weakness or hemiplegia can also be a common symptom of an acute ischemic stroke, it is often difficult to diagnose Todd's paralysis in individuals experiencing an acute ischemic stroke if they do not have a pre-existing history of epilepsy. Given that there is a limited understanding of Todd's paralysis, this review discusses the history, prevalence, clinical manifestations, duration, etiology, and diagnosis of Todd's paralysis. A few factors that may help clinicians distinguish Todd's paralysis from other clinical indications are as follows: (1) Todd's paralysis is commonly observed after partial seizures or generalized tonic-clonic seizures. (2) The incidence of Todd's paralysis is greater if the epilepsy is associated with old age or stroke history. (3) The duration of Todd's paralysis can range from minutes to days, depending on the type of seizure or whether the patient has experienced cortical structural damage. (4) The etiology of Todd's paralysis is associated with cerebral perfusion abnormality after seizures. Further research is needed to explore factors that distinguish Todd's paralysis from other indications that may lead to limb weakness in order to improve the diagnosis of Todd's paralysis.


Assuntos
Paralisia/fisiopatologia , Convulsões/complicações , Epilepsia/complicações , Humanos , Paralisia/etiologia , Acidente Vascular Cerebral/complicações
12.
World Neurosurg ; 138: 153-157, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147553

RESUMO

BACKGROUND: Pituitary apoplexy is an acute clinical syndrome caused by infarction and/or hemorrhage of pituitary adenoma, which typically presents with severe headache, visual deterioration, and endocrine abnormalities. However, temporal lobe seizure (and temporal lobe epilepsy) has not been viewed as a symptom of pituitary apoplexy in the literature. CASE DESCRIPTION: To elucidate further such a rare complication of temporal lobe seizure, we describe here the rare clinical manifestations of a 55-year-old previously healthy man with pituitary apoplexy harboring headache, combined palsies involving cranial nerves III to VI, endocrinologic disturbances, and temporal lobe seizure. In addition, we discuss the temporal lobe seizure (and temporal lobe epilepsy) associated with pituitary adenoma based on the literature. CONCLUSIONS: Although further accumulation of clinical data is needed, we would like to emphasize the importance of recognition of temporal lobe seizure caused by pituitary apoplexy, and to suggest that early surgery could be considered as an option in patients displaying such a rare complication.


Assuntos
Epilepsia do Lobo Temporal/complicações , Apoplexia Hipofisária/complicações , Convulsões/complicações , Adenoma/complicações , Epilepsia do Lobo Temporal/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/etiologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/complicações , Convulsões/diagnóstico por imagem , Convulsões/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Doenças do Nervo Troclear/etiologia
13.
BMC Pediatr ; 20(1): 36, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992265

RESUMO

BACKGROUND: Neonatal seizures are difficult to diagnose and, when they are, tradition dictates first line treatment is phenobarbital. There is little data on how consultants diagnose neonatal seizures, choose when to treat or how they choose aetiological investigations or drug treatments. The purpose of this study was to assess the variation across the UK in the management of neonatal seizures and explore paediatricians' views on their diagnosis and treatment. METHODS: An explanatory sequential mixed methods approach was used (QUAN→QUAL) with equal waiting between stages. We collected quantitative data from neonatology staff and paediatric neurologists using a questionnaire sent to neonatal units and via emails from the British Paediatric Neurology Association. We asked for copies of neonatal unit guidelines on the management of seizures. The data from questionnaires was used to identify16 consultants using semi-structured interviews. Thematic analysis was used to interpret qualitative data, which was triangulated with quantitative questionnaire data. RESULTS: One hundred questionnaires were returned: 47.7% thought levetiracetam was as, or equally, effective as phenobarbital; 9.2% thought it was less effective. 79.6% of clinicians had seen no side effects in neonates with levetiracetam. 97.8% of unit guidelines recommended phenobarbital first line, with wide variation in subsequent drug choice, aetiological investigations, and advice on when to start treatment. Thematic analysis revealed three themes: 'Managing uncertainty with neonatal seizures', 'Moving practice forward' and 'Multidisciplinary team working'. Consultants noted collecting evidence on anti-convulsant drugs in neonates is problematic, and recommended a number of solutions, including collaboration to reach consensus guidelines, to reduce diagnostic and management uncertainty. CONCLUSIONS: There is wide variation in the management of neonatal seizures and clinicians face many uncertainties. Our data has helped reveal some of the reasons for current practice and decision making. Suggestions to improve certainty include: educational initiatives to improve the ability of neonatal staff to describe suspicious events, greater use of video, closer working between neonatologists and neurologists, further research, and a national discussion to reach a consensus on a standardised approach to managing neonatal epileptic seizures.


Assuntos
Anticonvulsivantes/uso terapêutico , Padrões de Prática Médica , Convulsões/terapia , Anticonvulsivantes/efeitos adversos , Atitude do Pessoal de Saúde , Técnicas e Procedimentos Diagnósticos , Eletroencefalografia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Entrevistas como Assunto , Levetiracetam/efeitos adversos , Levetiracetam/uso terapêutico , Neonatologistas , Equipe de Assistência ao Paciente , Pediatras , Fenobarbital/uso terapêutico , Convulsões/complicações , Convulsões/diagnóstico , Inquéritos e Questionários , Reino Unido
14.
PLoS One ; 15(1): e0227854, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31971965

RESUMO

BACKGROUND: Common mental illness has a substantial impact on seizure control and negatively affects the overall quality of life among individuals with epilepsy. However, there is a dearth of studies that examined the associated factors of common mental illness among epilepsy patients in Ethiopia, particularly in the study area. This study aimed to assess the magnitude and factors associated with common mental disorders in epilepsy patients who attended government health institutions in Bahir Dar city, Ethiopia. METHOD: Health institution based cross-sectional study was conducted using a systematic sampling technique among people living with epilepsy in Bahir Dar City Administration. Common mental illness was assessed using a self-reporting questionnaire and a semi-structured questionnaire was employed to collect data on socio-demographic and clinical related characteristics. Data were analyzed using descriptive statistics, univariate logistic regression, and multivariable logistic regression. RESULTS: The magnitude of comorbid common mental illness among people living with epilepsy was found 35.4%. High magnitude of common mental illness was reported among females (39.9%) when compared to males (32.3%). The most prevalent common mental disorders symptoms include being worried, unhappy feeling, trouble thinking clearly, and difficult to enjoy daily activities. Family history of epilepsy, frequent seizures attacks, side effects of antiepileptic drugs, lack of social support and not adherent to antiepileptic drugs were factors associated with common mental illness. CONCLUSIONS: Common mental illness was found to be prevalent among people living with epilepsy. Therefore, it is recommended that great attention should be given to mental illness besides controlling seizure attacks.


Assuntos
Epilepsia/epidemiologia , Transtornos Mentais/epidemiologia , Convulsões/epidemiologia , Adulto , Anticonvulsivantes/efeitos adversos , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Epilepsia/patologia , Etiópia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/patologia , Pessoa de Meia-Idade , Qualidade de Vida , Convulsões/complicações , Convulsões/tratamento farmacológico , Convulsões/patologia , Caracteres Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
15.
Epilepsia ; 61(2): 259-266, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31912492

RESUMO

OBJECTIVE: To determine the incidence of hyperlipidemia after first anticonvulsant treatment for seizures, using a large US administrative claims database. METHODS: We obtained data from the MarketScan Commercial and Medicare databases for 2005-2009 for all adult patients newly treated with an anticonvulsant for seizures who had no previous history of hyperlipidemia or treatment with a lipid-lowering agent. We divided the population based upon whether they were treated with an enzyme-inducing anticonvulsant (phenytoin, carbamazepine, phenobarbital, primidone) or a noninducing anticonvulsant (all others). The primary outcome measure was a new diagnosis of hyperlipidemia during subsequent follow-up. We accounted for a large number of demographic and clinical covariates. RESULTS: Of 11 374 subjects, 8778 (77%) were prescribed noninducers and 2596 (23%) were prescribed inducers. New hyperlipidemia diagnoses were seen in 14.6% of the patients started on inducing anticonvulsants and 10.7% of the patients started on noninducing anticonvulsants (P < .001). Both hyperlipidemia and the use of inducers were significantly associated with older age and male gender. After accounting for covariates, inducer prescription was still associated with 23% higher odds of a subsequent diagnosis of hyperlipidemia (odds ratio = 1.225, 95% confidence interval = 1.066-1.408, P < .001). SIGNIFICANCE: The use of enzyme-inducing anticonvulsants in patients with newly diagnosed epilepsy was associated with a significant increase in subsequent diagnoses of hyperlipidemia, suggesting that the lipid-elevating properties of these agents are of genuine clinical importance. This adds to the body of data demonstrating that these agents are likely associated with additional hassle, cost, and morbidity.


Assuntos
Anticonvulsivantes/efeitos adversos , Hiperlipidemias/induzido quimicamente , Hiperlipidemias/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Bases de Dados Factuais , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Feminino , Humanos , Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Incidência , Masculino , Medicare , Pessoa de Meia-Idade , População , Convulsões/complicações , Convulsões/tratamento farmacológico , Fatores Sexuais , Fatores Socioeconômicos , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
16.
Epilepsia ; 61(2): e13-e16, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31944280

RESUMO

The mechanism(s) for sudden death in epilepsy (SUDEP) remain(s) unknown, but seizure spread to brainstem areas serving autonomic and respiratory function is critical. In a rat model, we established a mechanism for SUDEP that involves seizure-induced laryngospasm and obstructive apnea lasting until respiratory arrest. We hypothesized that DBA/2J mice, which display lethal audiogenic seizures, would be protected from death by implanting a tracheal T-tube as a surrogate airway. In a 2 × 2 design, mice were implanted with either open or closed tracheal T-tubes and treated with either low-dose ketamine/xylazine to moderate thoracic spasm during the tonic seizure phase or no drug. Animals receiving both treatments had the highest survival rate, followed by animals receiving the open tube without ketamine/xylazine. The odds ratio for survival was >20 higher with an open T-tube (odds ratio = 24.14). The impact of open tracheal tubes indicates that the mechanism of death in DBA/2J mice involves seizure-induced upper airway obstruction until respiratory arrest. These results, our rat work, and our demonstration of inspiratory effort-based electromyographic signals and electrocardiographic abnormalities in rats and humans suggest that seizure-induced laryngospasm and obstructive apnea directly link seizure activity to respiratory arrest in these sudden death examples.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Epilepsia Reflexa/genética , Próteses e Implantes , Convulsões/complicações , Convulsões/terapia , Traqueia , Obstrução das Vias Respiratórias/cirurgia , Animais , Morte Súbita/etiologia , Eletrocardiografia , Desenho de Equipamento , Parada Cardíaca , Laringismo/etiologia , Camundongos , Camundongos Endogâmicos DBA , Morte Súbita Inesperada na Epilepsia
17.
Ann Neurol ; 87(3): 339-346, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31943325

RESUMO

OBJECTIVE: SCN8A encephalopathy is a developmental and epileptic encephalopathy (DEE) caused by de novo gain-of-function mutations of sodium channel Nav 1.6 that result in neuronal hyperactivity. Affected individuals exhibit early onset drug-resistant seizures, developmental delay, and cognitive impairment. This study was carried out to determine whether reducing the abundance of the Scn8a transcript with an antisense oligonucleotide (ASO) would delay seizure onset and prolong survival in a mouse model of SCN8A encephalopathy. METHODS: ASO treatment was tested in a conditional mouse model with Cre-dependent expression of the pathogenic patient SCN8A mutation p.Arg1872Trp (R1872W). This model exhibits early onset of seizures, rapid progression, and 100% penetrance. An Scn1a +/- haploinsufficient mouse model of Dravet syndrome was also treated. ASO was administered by intracerebroventricular injection at postnatal day 2, followed in some cases by stereotactic injection at postnatal day 30. RESULTS: We observed a dose-dependent increase in length of survival from 15 to 65 days in the Scn8a-R1872W/+ mice treated with ASO. Electroencephalographic recordings were normal prior to seizure onset. Weight gain and activity in an open field were unaffected, but treated mice were less active in a wheel running assay. A single treatment with Scn8a ASO extended survival of Dravet syndrome mice from 3 weeks to >5 months. INTERPRETATION: Reduction of Scn8a transcript by 25 to 50% delayed seizure onset and lethality in mouse models of SCN8A encephalopathy and Dravet syndrome. Reduction of SCN8A transcript is a promising approach to treatment of intractable childhood epilepsies. Ann Neurol 2020;87:339-346.


Assuntos
Encefalopatias/prevenção & controle , Epilepsias Mioclônicas/prevenção & controle , Canal de Sódio Disparado por Voltagem NAV1.6/efeitos dos fármacos , Animais , Encefalopatias/complicações , Encefalopatias/mortalidade , Relação Dose-Resposta a Droga , Epilepsias Mioclônicas/complicações , Epilepsias Mioclônicas/mortalidade , Feminino , Infusões Intraventriculares , Masculino , Camundongos , Camundongos Transgênicos , Mutação , Canal de Sódio Disparado por Voltagem NAV1.6/administração & dosagem , Oligonucleotídeos Antissenso/farmacologia , Convulsões/complicações , Convulsões/prevenção & controle
18.
Adv Exp Med Biol ; 1251: 49-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31792808

RESUMO

The aim of the study was to determine the course and outcome of bacterial meningitis (BM) in patients with cancer. We retrospectively reviewed files of patients with community-acquired BM, hospitalized in a single neuroinfection center between January 2010 and December 2017. There were 209 patients included in the analysis: 28 had cancer (9 women, 19 men; median age 76, IQR 67-80 years) and 181 were cancer-free (76 women, 105 men; median age 52, IQR 33-65 years) and constituted the control group. Cancer patients, compared with controls, were more likely to present with seizures (25% vs. 8%, p = 0.019), scored higher on the Sequential Organ Failure Assessment, and had a higher mortality rate (32% vs. 13%, p = 0.025). Further, cancer patients were less likely (64% vs. 83%, p = 0.033) to present with two or more out of four clinical manifestations of BM (pyrexia, neck stiffness, altered mental status, and headache) and had a lower white blood cell (WBC) count than non-cancer controls. In multiple regression analysis, the presence of bacterial meningitis in cancer patients was independently associated only with older age (p = 0.001) and lower WBC count (p = 0.007), while mortality was associated with lower Glasgow Coma Score (p = 0.003). In conclusion, bacterial meningitis in cancer patients is characterized by atypical symptoms and high mortality, which requires physicians' vigilance and a prompt investigation of cerebrospinal fluid in suspected cases. However, multiple regression analysis suggests that differences in clinical presentation and outcomes of bacterial meningitis between cancer and cancer-free patients may also be attributable to other factors, such as age differences.


Assuntos
Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/tratamento farmacológico , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Neoplasias/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Febre/complicações , Cefaleia/complicações , Humanos , Masculino , Estudos Retrospectivos , Convulsões/complicações , Resultado do Tratamento
19.
Eur J Paediatr Neurol ; 24: 43-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31879224

RESUMO

Traditionally treatment of epileptic seizures has been symptomatic, namely medication has been targeted at raising the threshold to the occurrence of epileptic seizures. This has had little impact on the rate of drug resistance over time, or impact on comorbidities such as learning and behaviour particularly in the early onset epilepsies. The advent of advanced neuroimaging and genomics has revealed the cause of the epilepsy in a much higher percentage, and advanced our knowledge as to the underlying pathophysiology. This has given us the opportunity to turn to the possibility of interventional treatment, targeting the underlying cause, and consequently the possibility of changing the natural history of disease. Here we review the options open to us, and the evidence to date.


Assuntos
Deficiências do Desenvolvimento/tratamento farmacológico , Gerenciamento Clínico , Terapia Genética/métodos , Terapia de Alvo Molecular/métodos , Convulsões/tratamento farmacológico , Deficiências do Desenvolvimento/complicações , Humanos , Convulsões/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA