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1.
Medicine (Baltimore) ; 98(51): e18075, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860957

RESUMO

RATIONALE: Dyke-Davidoff-Masson syndrome (DDMS) is a rare syndrome commonly occurring in children and characterized by cerebral hemiatrophy, hypertrophy of the skull, epilepsy, and mental retardation. However, few have been reported in China, especially in teenagers. This case investigated its possible cause and explored a relative effective solution. PATIENT CONCERNS: A 24-year-old female came to department having experienced recurrent seizures for 12 years. DIAGNOSIS: DDMS was diagnosed from its manifestations, biochemistry indexes, and imaging (computed tomography angiography, magnetic resonance venography, and so on). INTERVENTIONS: Several drugs are used to treat the disease, including valproate, carbamazepine, topiramate, and ginkgo biloba extract. OUTCOMES: Under the medicine treatment of magnesium valproate with carbamazepine, the patient experienced partial seizures approximately once per month that lasted 30 to 60 seconds each without any complications observed during a follow-up period of 24 months. CONCLUSION: The imaging and clinical features of DDMS in this teenager were similar to those in classic infantile-onset cases. A potential cause of the disease could be brain trauma, which impaired the middle cerebral artery and reduced cerebral blood supply, leading to epilepsy and hemiatrophy. LESSONS: It was concluded early diagnosis and pharmacotherapy are the keys to preventing intellectual decline in DDMS patients. Moreover, the combination of magnesium valproate and carbamazepine could significantly reduce the frequency and duration of seizures, despite not eliminating them completely.


Assuntos
Encefalopatias/diagnóstico por imagem , Deficiência Intelectual/diagnóstico , Imagem por Ressonância Magnética/métodos , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Encefalopatias/tratamento farmacológico , Carbamazepina/uso terapêutico , China , Doença Crônica , Feminino , Humanos , Deficiência Intelectual/tratamento farmacológico , Prognóstico , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Síndrome , Tomografia Computadorizada por Raios X/métodos , Ácido Valproico , Adulto Jovem
2.
Nervenarzt ; 90(12): 1221-1231, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31673723

RESUMO

Wearables are receiving much attention from both epilepsy patients and treating physicians, for monitoring of seizure frequency and warning of seizures. They are also of interest for the detection of seizure-associated risks of patients, for differential diagnosis of rare seizure types and prediction of seizure-prone periods. Accelerometry, electromyography (EMG), heart rate and further autonomic parameters are recorded to capture clinical seizure manifestations. Currently, a clinical use to document nocturnal motor seizures is feasible. In this review the available devices, data on the performance in the documentation of seizures, current options for clinical use and developments in data analysis are presented and critically discussed.


Assuntos
Epilepsia , Monitorização Ambulatorial , Acelerometria/instrumentação , Sistema Nervoso Autônomo , Eletroencefalografia/instrumentação , Epilepsia/diagnóstico , Frequência Cardíaca , Humanos , Monitorização Ambulatorial/instrumentação , Convulsões/diagnóstico
3.
N Engl J Med ; 381(17): 1644-1652, 2019 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-31597037

RESUMO

Genome sequencing is often pivotal in the diagnosis of rare diseases, but many of these conditions lack specific treatments. We describe how molecular diagnosis of a rare, fatal neurodegenerative condition led to the rational design, testing, and manufacture of milasen, a splice-modulating antisense oligonucleotide drug tailored to a particular patient. Proof-of-concept experiments in cell lines from the patient served as the basis for launching an "N-of-1" study of milasen within 1 year after first contact with the patient. There were no serious adverse events, and treatment was associated with objective reduction in seizures (determined by electroencephalography and parental reporting). This study offers a possible template for the rapid development of patient-customized treatments. (Funded by Mila's Miracle Foundation and others.).


Assuntos
Proteínas de Membrana Transportadoras/genética , Mutagênese Insercional , Lipofuscinoses Ceroides Neuronais/tratamento farmacológico , Lipofuscinoses Ceroides Neuronais/genética , Oligonucleotídeos Antissenso/uso terapêutico , Medicina de Precisão , Doenças Raras/tratamento farmacológico , Biópsia , Criança , Desenvolvimento Infantil , Descoberta de Drogas , Drogas em Investigação/uso terapêutico , Eletroencefalografia , Feminino , Humanos , Testes Neuropsicológicos , RNA Mensageiro , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Pele/patologia , Sequenciamento Completo do Genoma
4.
East Asian Arch Psychiatry ; 29(3): 97-98, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31566187

RESUMO

We report a case of pulmonary embolism in a patient who presented with repeated anxiety attacks and psychotic symptoms and was misdiagnosed as having withdrawal seizure or anxiety disorder not otherwise specified. This case highlighted the nonspecific clinical features of pulmonary embolism and the principles in making psychiatric diagnosis. Careful history taking, thorough physical examination, appropriate investigation, and a high index of suspicion led to the correct diagnosis. The principle of hierarchy of psychiatric diagnosis (ie, organic over non-organic) and the possibility of comorbidities should always apply.


Assuntos
Ansiedade/complicações , Dispneia/complicações , Embolia Pulmonar/complicações , Transtornos de Ansiedade/diagnóstico , Erros de Diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/diagnóstico , Síndrome de Abstinência a Substâncias/diagnóstico
5.
J Stroke Cerebrovasc Dis ; 28(11): 104344, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488375

RESUMO

INTRODUCTION: Despite the close relationship between stroke and seizures, little is known about stroke trends and inpatient mortality among patients with seizures. MATERIALS AND METHODS: The National Inpatient Sample was used to analyze the prevalence and trends of stroke among patients discharged with a primary diagnosis of seizures between 2006 and 2014. International Classification of Diseases, Ninth Revision, Clinical Modification was used to identify patients discharged with a primary diagnosis of seizures and those with a secondary diagnosis of stroke. Multivariable logistic regression was used to examine the association between inpatient hospital mortality and stroke. Adjusted prediction of mortality post estimates of logistic regression was used to analyze mortality by stroke status overtime. FINDINGS: A total of 400,391 (weighted 1,980,707) patients with seizures were identified between 2006 and 2014, including 61,039 weighted (3%) with a secondary diagnosis of stroke patients. Among patients with a primary diagnosis of seizures, having a secondary diagnosis of stroke doubled the odds of in-hospital death (odds ratio = 2.02; 95% confidence interval: 1.74-2.34; P < .001). Overall, between 2006 and 2014, the prevalence of stroke among patients discharged with a primary diagnosis of seizures remained stable at 3% amid fluctuations across years. Among patients with a primary discharge diagnosis of seizures who had stroke, in-hospital mortality increased from 2.3% in 2006 to 3.6% in 2014 but decreased from .8% in 2006 to .7% in 2014 in those without stroke. CONCLUSIONS: Stroke is prevalent and is associated with increased mortality among patients who are discharged with a primary diagnosis of seizure, with a stable prevalence but suggested increased mortality across time.


Assuntos
Pacientes Internados , Admissão do Paciente , Convulsões/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Convulsões/diagnóstico , Convulsões/mortalidade , Convulsões/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
6.
J Clin Neurophysiol ; 36(5): 358-364, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31491786

RESUMO

PURPOSE: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. METHODS: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. RESULTS: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79-5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58-170.19; P = 0.02). CONCLUSIONS: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.


Assuntos
Eletroencefalografia/tendências , Unidades de Terapia Intensiva/tendências , Monitorização Fisiológica/tendências , Admissão do Paciente/tendências , Convulsões/fisiopatologia , Estado Epiléptico/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Eletroencefalografia/métodos , Feminino , Escala de Coma de Glasgow , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Convulsões/diagnóstico , Estado Epiléptico/diagnóstico , Taxa de Sobrevida/tendências , Adulto Jovem
7.
Epileptic Disord ; 21(4): 337-346, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31371275

RESUMO

Differentiation between syncope secondary to epileptic seizures and cardiac disease in patients displaying transient loss of consciousness associated with convulsive movements is a diagnostic challenge both for neurologists and cardiologists. In such patients, prolonged video-EEG monitoring not only helps in identifying asystole as the cause of syncope, but also in categorizing asystole as primarily cardiac in origin (cardiac asystole) and secondary to epileptic seizures (ictal asystole). We carried out this study to ascertain the prevalence of asystole in an epilepsy monitoring unit, and to contrast the clinical and electrophysiological characteristics between ictal asystole and cardiac asystole. Through a retrospective search, we identified patients who were shown to have had asystole using a database of patients who underwent prolonged video-EEG monitoring during a 68-month period. We compared the data of 18 consecutive patients; five with ictal asystole and 13 with cardiac asystole, with 121 and 64 events recorded from them, respectively. Of the 10,096 patients who underwent prolonged video-EEG monitoring during the study period, we identified 18 (0.17%) patients with asystole. Cardiac asystole was 2.6 times more frequent than ictal asystole. Older age at onset, heralding symptoms of presyncope, occurrence during wakefulness, and brief duration of the events supported the diagnosis of cardiac asystole. Ictal asystole events were more protracted, and prolonged asystole more frequently occurred in patients with extratemporal seizures compared to temporal lobe seizures. Asystole occurred in only half of the recorded seizures. The accurate categorization of asystole as seizure-related or heart disease-related has huge implications for management strategy and outcome. The necessity of permanent pacemaker implantation is more frequent and urgent in patients with cardiac asystole because of the greater risk of sudden death. Hence, in patients with an ominous diagnosis of cardiac asystole, a thorough cardiac evaluation should surpass neurological evaluation.


Assuntos
Eletroencefalografia , Fenômenos Eletrofisiológicos/fisiologia , Parada Cardíaca/etiologia , Monitorização Fisiológica , Idoso , Eletrocardiografia/métodos , Eletroencefalografia/métodos , Epilepsia/complicações , Feminino , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/diagnóstico , Convulsões/fisiopatologia
8.
Neurology ; 93(12): e1212-e1226, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31462582

RESUMO

OBJECTIVE: To evaluate efficacy and tolerability of adjunctive lacosamide in children and adolescents with uncontrolled focal (partial-onset) seizures. METHODS: In this double-blind trial (SP0969; NCT01921205), patients (age ≥4-<17 years) with uncontrolled focal seizures were randomized (1:1) to adjunctive lacosamide/placebo. After a 6-week titration, patients who reached the target dose range for their weight (<30 kg: 8-12 mg/kg/d oral solution; ≥30-<50 kg: 6-8 mg/kg/d oral solution; ≥50 kg: 300-400 mg/d tablets) entered a 10-week maintenance period. The primary outcome was change in focal seizure frequency per 28 days from baseline to maintenance. RESULTS: Three hundred forty-three patients were randomized; 306 (lacosamide 152 of 171 [88.9%]; placebo 154 of 172 [89.5%]) completed treatment (titration and maintenance). Adverse events (AEs) were the most common reasons for discontinuation during treatment (lacosamide 4.1%; placebo 5.8%). From baseline to maintenance, percent reduction in focal seizure frequency per 28 days for lacosamide (n = 170) vs placebo (n = 168) was 31.7% (p = 0.0003). During maintenance, median percent reduction in focal seizure frequency per 28 days was 51.7% for lacosamide and 21.7% for placebo. Fifty percent responder rates (≥50% reduction) were 52.9% and 33.3% (odds ratio 2.17, p = 0.0006). During treatment, treatment-emergent AEs were reported by 67.8% lacosamide-treated patients (placebo 58.1%), most commonly (≥10%) somnolence (14.0%, placebo 5.2%) and dizziness (10.5%, placebo 3.5%). CONCLUSIONS: Adjunctive lacosamide was efficacious in reducing seizure frequency and generally well tolerated in patients (age ≥4-<17 years) with focal seizures. CLINICALTRIALSGOV IDENTIFIER: NCT01921205. CLASSIFICATION OF EVIDENCE: This trial provides Class I evidence that for children and adolescents with uncontrolled focal seizures, adjunctive lacosamide reduces seizure frequency.


Assuntos
Anticonvulsivantes/administração & dosagem , Lacosamida/administração & dosagem , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Adolescente , Anticonvulsivantes/sangue , Criança , Pré-Escolar , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Lacosamida/sangue , Masculino , Estudos Prospectivos , Convulsões/sangue , Resultado do Tratamento
9.
Epileptic Disord ; 21(4): 366-369, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31366451

RESUMO

Recently, decanoic acid (C10), a medium-chain fatty acid, was shown to be a direct inhibitor of the AMPA receptor. Accordingly, C10 has been suggested as a potential anticonvulsant factor in the ketogenic diet (KD) or the medium-chain triglyceride KD. Here, we tested whether C10 serum levels correlate with the response to KD in five children (1.5 ± 0.6 years of age) with epilepsy. The serum levels of C10 were measured before and after KD initiation (n=2 at one month, n=3 at three months, and n=1 at six months after initiation) by gas chromatography-mass spectrometry. After three months on KD, two patients were found to be responders. The mean serum level before KD initiation was 63.2 µM. Only one patient, who was a non-responder, showed an increase (5%) in C10 serum level after a month of KD. The remaining four patients (two responders) showed a decrease in the C10 level from -5.3% to -75.5%. Our preliminary data show that KD does not lead to an increase in C10 serum levels, suggesting that increased concentration of C10 might not be directly involved in the anticonvulsant effects of classic KD.


Assuntos
Ácidos Decanoicos/sangue , Dieta Cetogênica , Epilepsia/sangue , Convulsões/sangue , Adolescente , Anticonvulsivantes/uso terapêutico , Criança , Dieta Cetogênica/métodos , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Convulsões/diagnóstico , Convulsões/tratamento farmacológico
11.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326904

RESUMO

Bilateral independent periodic lateralised epileptiform discharges (BIPLEDs) in electroencephalograms (EEGs) are commonly caused by anoxic encephalopathy and central nervous system infections. They are associated with coma and high mortality and are thus markers of poor prognosis. We present a case of encephalitis who presented with BIPLEDs in EEG. Though the clinical, EEG and MRI features closely resembled herpes simplex encephalitis, further investigations proved it to be Epstein-Barr virus (EBV) encephalitis. Despite the presence of BIPLEDs in the EEG, the patient had a rapid clinical response to therapy with acyclovir. We emphasise that BIPLEDs may not always indicate poor prognosis especially in the setting of EBV encephalitis.


Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Encefalite Viral/virologia , Herpesvirus Humano 4/isolamento & purificação , Convulsões/virologia , Adulto , Diagnóstico Diferencial , Eletroencefalografia , Encefalite Viral/diagnóstico , Encefalite Viral/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética , Masculino , Convulsões/diagnóstico , Convulsões/tratamento farmacológico
12.
Handb Clin Neurol ; 162: 363-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324321

RESUMO

Seizures are more common in the neonatal period than at any other time of life, partly due to the relative hyperexcitability of the neonatal brain. Brain monitoring of sick neonates in the NICU using either conventional electroencephalography or amplitude integrated EEG is essential to accurately detect seizures. Treatment of seizures is important, as evidence increasingly indicates that seizures damage the brain in addition to that caused by the underlying etiology. Prompt treatment has been shown to reduce seizure burden with the potential to ameliorate seizure-mediated damage. Neonatal encephalopathy most commonly caused by a hypoxia-ischemia results in an alteration of mental status and problems such as seizures, hypotonia, apnea, and feeding difficulties. Confirmation of encephalopathy with EEG monitoring can act as an important adjunct to other investigations and the clinical examination, particularly when considering treatment strategies such as therapeutic hypothermia. Brain monitoring also provides useful early prognostic indicators to clinicians. Recent use of machine learning in algorithms to continuously monitor the neonatal EEG, detect seizures, and grade encephalopathy offers the exciting prospect of real-time decision support in the NICU in the very near future.


Assuntos
Encefalopatias/congênito , Encefalopatias/diagnóstico , Eletroencefalografia/métodos , Convulsões/congênito , Convulsões/diagnóstico , Adulto , Feminino , Humanos , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/terapia , Recém-Nascido , Gravidez
13.
Orv Hetil ; 160(29): 1143-1145, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31303014

RESUMO

A 52-year-old woman is presented with repetitive transient loss of consciousness. Implantable loop recorder (ILR) recorded muscle artifacts during the generalized tonic-clonic seizures. Seizure was diagnosed and antiepileptic drug was started. The patient has been asymptomatic for 9 months. Orv Hetil. 2019; 160(29): 1143-1145.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Epilepsia Tônico-Clônica/diagnóstico , Próteses e Implantes , Convulsões/diagnóstico , Síncope/etiologia , Anticonvulsivantes , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Convulsões/complicações
14.
BMJ Case Rep ; 12(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31320374

RESUMO

A 30-year-old Caucasian woman with no prior medical history presented with pedal oedema, arthralgias and abdominal pain with diarrhoea, following a respiratory infection. She had mild abdominal tenderness along with a purpuric rash on the extremities and was anaemic. Following initial workup for anaemia and rash, her condition deteriorated with renal impairment, respiratory failure and seizures necessitating ventilatory support, dialysis and steroids. Serologies were negative, and skin biopsy showed leucocytoclastic vasculitis without vascular IgA deposition, and renal biopsy showed subendothelial, mesangial deposits of IgA with C3 indicative of Henoch-Schonlein purpura (HSP). She was treated with steroids, haemodialysis and on 6-month follow-up recovered renal function. We present the case to illustrate that HSP, though rare in adults, can present with multiorgan failure, with renal, pulmonary and central nervous system involvement, and the need for early diagnosis and prompt treatment for rapid clinical recovery.


Assuntos
Lesão Renal Aguda/etiologia , Glomerulonefrite/etiologia , Púrpura de Schoenlein-Henoch/complicações , Síndrome do Desconforto Respiratório do Adulto/etiologia , Convulsões/etiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/patologia , Lesão Renal Aguda/terapia , Corticosteroides/uso terapêutico , Adulto , Anticonvulsivantes/uso terapêutico , Biópsia , Eletroencefalografia , Feminino , Glomerulonefrite/patologia , Glomerulonefrite/terapia , Humanos , Imagem por Ressonância Magnética , Púrpura de Schoenlein-Henoch/diagnóstico , Púrpura de Schoenlein-Henoch/patologia , Púrpura de Schoenlein-Henoch/terapia , Diálise Renal , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/terapia , Convulsões/diagnóstico , Convulsões/tratamento farmacológico
15.
EBioMedicine ; 45: 422-431, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31300348

RESUMO

BACKGROUND: The inability to reliably assess seizure risk is a major burden for epilepsy patients and prevents developing better treatments. Recent advances have paved the way for increasingly accurate seizure preictal state detection algorithms, primarily using electrocorticography (ECoG). To develop seizure forecasting for broad clinical and ambulatory use, however, less complex and invasive modalities are needed. Algorithms using scalp electroencephalography (EEG) and electrocardiography (EKG) have also achieved better than chance performance. But it remains unknown how much preictal information is in ECoG versus modalities amenable to everyday use - such as EKG and single channel EEG - and how to optimally extract that preictal information for seizure prediction. METHODS: We apply deep learning - a powerful method to extract information from complex data - on a large epilepsy data set containing multi-day, simultaneous recordings of EKG, ECoG, and EEG, using a variety of feature sets. We use the relative performance of our algorithms to compare the preictal information contained in each modality. RESULTS: We find that single-channel EKG contains a comparable amount of preictal information as scalp EEG with up to 21 channels and that preictal information is best extracted not with standard heart rate measures, but from the power spectral density. We report that preictal information is not preferentially contained in EEG or ECoG channels within the seizure onset zone. CONCLUSION: Collectively, these insights may help to devise future prospective, minimally invasive long-term epilepsy monitoring trials with single-channel EKG as a particularly promising modality.


Assuntos
Aprendizado Profundo/estatística & dados numéricos , Eletrocorticografia/métodos , Epilepsia/diagnóstico , Convulsões/diagnóstico , Eletrocardiografia/estatística & dados numéricos , Eletrocorticografia/estatística & dados numéricos , Eletroencefalografia/estatística & dados numéricos , Epilepsia/fisiopatologia , Epilepsia/terapia , Feminino , Humanos , Masculino , Medicina de Precisão/métodos , Medicina de Precisão/estatística & dados numéricos , Convulsões/fisiopatologia , Convulsões/terapia
16.
PLoS Negl Trop Dis ; 13(7): e0007300, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31314757

RESUMO

BACKGROUND: High epilepsy prevalence and incidence were observed in onchocerciasis-endemic villages in the Democratic Republic of Congo (DRC). We investigated the clinical characteristics of onchocerciasis-associated epilepsy (OAE), and the relationship between seizure severity and microfilarial density. METHODS: In October 2017, ivermectin-naive persons with epilepsy (PWE) were recruited from onchocerciasis-endemic areas in the Logo health zone in the DRC. Additional PWE were enrolled in the Aketi health zone, where ivermectin had been distributed annually for 14 years. Past medical history, clinical characteristics and skin snips for Onchocerca volvulus detection were obtained from participants. Bivariate and multivariable analyses were used to investigate associations with microfilarial density. RESULTS: Of the 420 PWE in the Logo health zone, 392 were skin snipped (36.5% positive). Generalized motor seizures were most frequent (392 PWE, 93.3%), and nodding seizures were reported in 32 (7.6%) participants. Twelve PWE (3.1%) presented Nakalanga features. Sixty-three (44.1%) skin snip-positive PWE had a family history of epilepsy, compared to only 82 (32.9%) skin snip-negative PWE (p = 0.027). Eighty-one onchocerciasis-infected PWE were recruited in the Aketi health zone. Positive correlations between seizure frequency and microfilarial density were observed in Logo (Spearman-rho = 0.175; p<0.001) and Aketi (Spearman-rho = 0.249; p = 0.029). In the multivariable model adjusted for age, gender, and previous treatment, high seizure frequency was associated with increasing microfilarial density in Aketi (p = 0.025) but not in Logo (p = 0.148). CONCLUSION: In onchocerciasis-endemic regions in the DRC, a wide spectrum of seizures was observed. The occurrence of Nodding seizures and Nakalanga features, as well as an association between seizure severity and O. volvulus microfilarial density suggest a high OAE prevalence in the study villages. TRIAL REGISTRATION: ClinicalTrials.gov NCT03052998.


Assuntos
Epilepsia/parasitologia , Microfilárias/isolamento & purificação , Oncocercose/complicações , Oncocercose/epidemiologia , Convulsões/epidemiologia , Adolescente , Adulto , Idoso , Animais , Antiparasitários/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , República Democrática do Congo/epidemiologia , Doenças Endêmicas , Feminino , Humanos , Lactente , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Onchocerca volvulus/efeitos dos fármacos , Oncocercose/diagnóstico , Oncocercose/tratamento farmacológico , Prevalência , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Convulsões/classificação , Convulsões/diagnóstico , Convulsões/parasitologia , Índice de Gravidade de Doença , Adulto Jovem
17.
Handb Clin Neurol ; 161: 103-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307594

RESUMO

Acute symptomatic seizures have been known to occur in critically ill patients for many years. It was not until the widespread use of continuous EEG (cEEG) in the critically ill did we appreciate the incidence of electrographic seizures and status epilepticus in the ICU (Newey and Kinzy, 2018). Many of the seizures that occur are without any apparent clinical signs at the time of the recording. The patients often have convulsive seizures at onset then over the next few hours they lose the ability to have a generalized tonic clonic convulsion. They may then have subtle clinical signs (ictal nystagmus, facial twitching, etc.) or lose any apparent motor response. The end result is that many of the patients lose any clinical signs for their seizures by the time they are in the ICU and their seizures are termed "nonconvulsive." The recognition of seizures in the ICU is important for the effects the seizures have on outcome, particularly in morbidity and mortality and the risk of developing epilepsy after the acute symptomatic event. The use of cEEG in the ICU population has not only highlighted the high incidence of seizure activity but has also been used to assess overall cerebral function with applications in ischemia monitoring and prognostication, and to assess the degree of encephalopathy. This chapter will illustrate the core principles of cEEG monitoring in the critical care population including the incidence of seizures, determining who is at highest risk for seizures, how long patients should be monitored and ICU EEG seizure.


Assuntos
Cuidados Críticos/métodos , Eletroencefalografia/métodos , Monitorização Neurofisiológica/métodos , Convulsões/diagnóstico , Convulsões/epidemiologia , Humanos , Incidência , Unidades de Terapia Intensiva
18.
Seizure ; 70: 59-62, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280099

RESUMO

PURPOSE: To evaluate the accuracy of expert estimations of achieving seizure freedom after epilepsy surgery in the context of presurgical patient counseling. METHOD: The retrospective study comprised a random sample of 200 patients who underwent any type of resective epilepsy surgery at the University of Bonn Epilepsy Center and the routine 1-year postoperative control visit in the years from 2008-2016. The prediction by a team of epileptologists and the actual seizure outcome were extracted from the pre- and postsurgical medical files, respectively. A deviation of >10% was a priori defined as a relevant discrepancy. RESULTS: Estimated chances of achieving seizure freedom ranged from 30 to 90% (mean: 67%). The actual seizure freedom rate was 66% (Engel Ia/ ILAE 1a). Nine of 12 estimation categories showed a tolerable deviation of ≤10%, none of these with a worse than expected outcome. Two estimation categories (40-50%, and 80%) showed a worse actual seizure outcome with deviations of -40% (n = 3); and -17% (n = 30), respectively. All in all, for 83% of the patients a correct prediction was provided. CONCLUSIONS: For the vast majority of surgical patients, the expert prediction of postsurgical seizure freedom at the 1-year follow-up was accurate despite the heterogeneity of patients and surgical procedures.


Assuntos
Epilepsia/diagnóstico , Epilepsia/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Convulsões/diagnóstico , Convulsões/cirurgia , Adulto Jovem
19.
Epileptic Disord ; 21(S1): 15-21, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262717

RESUMO

Encephalopathy with continuous spike-waves during slow-wave sleep (CSWS) evolves over time, and three stages can be recognized: before the onset of CSWS, during CSWS, and after the CSWS period. Clinical seizures tend to remit spontaneously around puberty. This pattern is independent of the etiological lesion. The CSWS also disappears in all cases. Focal abnormalities instead, may persist for some time after the disappearance of CSWS. The disappearance of the clinical seizures and CSWS may be simultaneous or seizures may disappear before or after disappearance of the CSWS pattern on the EEG. Electroclinical parameters in the pre-CSWS period that have been proposed to predict a poor outcome are early-onset seizures, appearance of new seizures, and a significant increase in seizure frequency. From the electrical point of view, an increase in the frequency of the interictal EEG paroxysms while awake and during sleep and bilateral spike-and-wave paroxysms may also be predictive of a poor evolution in CSWS. When CSWS disappears, neurocognitive and behavioral status improve, but in most patients, residual moderate to severe neurocognitive impairments remain. In non-lesional epilepsy, cognitive recovery after cessation of the CSWS depends on the severity and duration of the initial regression. The duration of the CSWS seems to be the most important predictor of cognitive outcome. Early recognition and effective therapy to reduce the seizures and resolve the CSWS may be crucial to improve long-term prognosis. Cognitive recovery is observed in patients who respond well to AED treatment and outcome depends on the etiology.


Assuntos
Transtornos Cognitivos/psicologia , Epilepsia/psicologia , Convulsões/fisiopatologia , Sono/fisiologia , Encefalopatias/fisiopatologia , Transtornos Cognitivos/diagnóstico , Eletroencefalografia/métodos , Humanos , Estudos Longitudinais , Prognóstico , Convulsões/diagnóstico , Sono de Ondas Lentas
20.
World Neurosurg ; 130: 240-243, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295622

RESUMO

BACKGROUND: Herniation of the brain through an osseodural defect has been well described in small children as an uncommon occurrence after closed head injury. Pressure from the growing brain has been implicated in progressive enlargement and reshaping of the fracture line. An analogous phenomenon in adults has been observed in the described cases where neurosurgical intervention led to a persistent dural defect. Transcalvarial herniation of the brain through the dural defect resulted in characteristic neurologic and imaging findings producing symptoms disproportionately greater than expected from the extent of the affected brain, accompanied by enlargement of the underlying ventricle and elevation of the bone flap. Disruption of the axonal conduction due to distortion of the axons in the herniated brain is probably responsible for these observations. CASE DESCRIPTION: A series of 3 cases is described. In all cases, the dural reconstitution at the conclusion of surgery was incomplete. Brain herniation was evident in the postoperative scan. The transcalvarial herniation of the brain was precipitated by either a seizure and resultant brain swelling or persistently raised intracranial tension from a tumor residual. In 2 cases, surgical reexploration resulted in improvement in the neurologic symptoms. CONCLUSIONS: In symptomatic patients with transcalvarial herniation of the brain, identified on imaging, the neurologic syndrome is quite characteristic. Recognition of this condition and prompt treatment lead to lasting neurologic improvement.


Assuntos
Encéfalo/cirurgia , Craniotomia , Encefalocele/cirurgia , Hérnia/terapia , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encefalopatias/diagnóstico , Encefalopatias/cirurgia , Craniotomia/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Hérnia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Convulsões/diagnóstico , Convulsões/cirurgia
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