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1.
Int J Mol Sci ; 22(6)2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33810180

RESUMO

Status epilepticus (SE) is a frequent medical emergency that can lead to a variety of neurological disorders, including cognitive impairment and abnormal neurogenesis. The aim of the presented study was the in vitro evaluation of potential neuroprotective properties of a new pyrrolidine-2,5-dione derivatives compound C11, as well as the in vivo assessment of the impact on the neurogenesis and cognitive functions of C11 and levetiracetam (LEV) after pilocarpine (PILO)-induced SE in mice. The in vitro results indicated a protective effect of C11 (500, 1000, and 2500 ng/mL) on astrocytes under trophic stress conditions in the MTT (3-[4,5-dimethylthiazole-2-yl]-2,5-diphenyltetrazolium bromide) test. The results obtained from the in vivo studies, where mice 72 h after PILO SE were treated with C11 (20 mg/kg) and LEV (10 mg/kg), indicated markedly beneficial effects of C11 on the improvement of the neurogenesis compared to the PILO control and PILO LEV mice. Moreover, this beneficial effect was reflected in the Morris Water Maze test evaluating the cognitive functions in mice. The in vitro confirmed protective effect of C11 on astrocytes, as well as the in vivo demonstrated beneficial impact on neurogenesis and cognitive functions, strongly indicate the need for further advanced molecular research on this compound to determine the exact neuroprotective mechanism of action of C11.


Assuntos
Anticonvulsivantes/farmacologia , Cognição/efeitos dos fármacos , Neurogênese/efeitos dos fármacos , Pilocarpina/efeitos adversos , Estado Epiléptico/etiologia , Animais , Anticonvulsivantes/administração & dosagem , Astrócitos/efeitos dos fármacos , Astrócitos/metabolismo , Biomarcadores , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Masculino , Camundongos , Fármacos Neuroprotetores/farmacologia , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico
4.
Epilepsy Behav ; 118: 107887, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33743344

RESUMO

PURPOSE: In March 2020, the World Health Organization declared the SARS-CoV-2 infection-related coronavirus Disease (COVID-19) a pandemic. During the first and second waves of the pandemic spread, there have been several reports of COVID-19-associated neurological manifestations, including acute seizures and status epilepticus (SE). In this systematic review, we summarized the available data on clinical features, diagnosis, and therapy of COVID-19-related SE. METHODS: We performed a systematic search of the literature to identify data on demographics, clinical, neurophysiological, and neuroradiological data of patients with COVID-19-related SE. We used regression models (linear or logistic) with a stepwise forward method to identify features associated with mortality or severity of SE. RESULTS: Thirty-nine articles were included with a total of 47 cases of SE associated with COVID-19. Age, time between the acute respiratory phase of SARS-CoV-2 infection and SE onset, and hospitalization correlated with a higher SE severity as assessed by quantitative validated scales. CONCLUSIONS: SE can be a neurological manifestation of SARS-CoV-2 infection. Although a possible association between SE and COVID-19 has been reported, the exact mechanisms are still not fully understood. Systemic inflammatory syndrome due to cytokine release could play a role in COVID-19-related SE.


Assuntos
Estado Epiléptico , Humanos , Pandemias , Convulsões , Estado Epiléptico/diagnóstico , Estado Epiléptico/epidemiologia , Estado Epiléptico/etiologia
5.
No Shinkei Geka ; 49(2): 335-341, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762454

RESUMO

Both diffusion-weighted MRI(DWI)modalities and continuous electroencephalography(cEEG)are useful for diagnosing status epilepticus. In case 1, DWI showed hyperintense regions in the right-sided parieto-occipital cortex during peri-ictal status. Intensity of the regions normalized after left hemiparesis improved. In status epilepticus , DWI usually depicts some hyperintense regions, such as the cerebral cortex, hippocampus, and thalamic pulvinar, where ictal brain activity and its propagation are likely occur the seizure. In case 2, cEEG led to an accurate diagnosis of non-convulsive status epilepticus due to right-sided temporal contusion. Intravenous application of levetiracetam and lacosamide alleviated the clinical symptoms and electrographic seizures. Abnormal cEEG findings during status epilepticus vary from rhythmic delta activity and epileptiform and generalized periodic discharges to ictal discharges. Accurate diagnosis of status epilepticus using MRI and cEEG can offer earlier intervention, such as prompt administration of benzodiazepines, midazolam, lorazepam, ultimately resulting in a good recovery.


Assuntos
Estado Epiléptico , Imagem de Difusão por Ressonância Magnética , Eletroencefalografia , Humanos , Imagem por Ressonância Magnética , Convulsões , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico
6.
Epilepsy Behav ; 117: 107847, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33636529

RESUMO

PURPOSE: The aim of this study was to characterize clinically, etiologically, and electroencephalographically focal Nonconvulsive Status Epilepticus (NCSE) in children. Moreover, we tried to identify focal NCSE features distinguishing between different ages, NCSE etiologies, and cases of de novo onset. METHODS: We retrospectively identified patients (aged 1 month to 18 years) who had EEG-documented focal NCSE between January 2001 and December 2019. We analyzed the clinical features, etiology, and EEG features of each event. RESULTS: Thirty-eight patients were included in this study. NCSE had a de novo onset in 26 patients and was the first manifestation of previously undiagnosed epilepsy in 12 patients. NCSE etiology was acute symptomatic in 13 patients. Acute symptomatic NCSE events were mainly observed in hospitalized children, were usually longer, and had a significantly higher frequency of repetitive EEG patterns than other etiologies. In patients with epilepsy, the etiology of NCSE was remote symptomatic in 14, progressive in 6, and cryptogenic in 5; a definite or suspected genetic disorder was observed in 11. EEG localization was frequent in posterior regions (18 children). Eleven patients had refractory NCSE and 4 required admission to the intensive care unit. CONCLUSION: Focal NCSE in children is more frequent in the first years of life, mainly involves posterior regions, and often has de novo onset. In the case of de novo focal NCSE both acute symptomatic NCSE and new-onset epilepsy must be considered and investigated. A higher frequency of repetitive EEG patterns and an inpatient setting are significantly associated with acute symptomatic NCSE.


Assuntos
Epilepsia , Estado Epiléptico , Criança , Eletroencefalografia , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos , Estado Epiléptico/diagnóstico , Estado Epiléptico/epidemiologia , Estado Epiléptico/etiologia
7.
Epilepsy Behav ; 115: 107679, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33360401

RESUMO

BACKGROUND AND OBJECTIVE: Patients with psychogenic nonepileptic attacks (PNEA) sometimes receive aggressive treatment leading to intubation. This study aimed to identify patient characteristics that can help differentiate PNEA from status epilepticus (SE). METHODS: We retrospectively identified patients with a final diagnosis of PNEA or SE, who were intubated for emergent convulsive symptoms and underwent continuous electroencephalography (cEEG) between 2012 and 2017. Patients who had acute brain injury or progressive brain disease as the cause of SE were excluded. We compared clinical features and laboratory values between the two groups, and identified risk factors for PNEA-related convulsive activity. RESULTS: Over a six-year period, 24 of 148 consecutive patients (16%) intubated for convulsive activity had a final diagnosis of PNEA rather than SE. Compared to patients intubated for SE, intubated PNEA patients more likely were <50 years of age, female, white, had a history of a psychiatric disorder, had no history of an intracranial abnormality, and had a maximum systolic blood pressure <140 mm Hg (all P < 0.001). Patients with 0-2 of these six risk factors had a 0% (0/88) likelihood of having PNEA, those with 3-4 had a 15% (6/39) chance of having PNEA, and those with 5-6 had an 86% (18/21) chance of having PNEA. Sensitivity for PNEA among those with 5-6 risk factors was 75% (95% CI: 53-89%) and specificity was 98% (95% CI: 93-99%). CONCLUSIONS: In the absence of a clear precipitating brain injury, approximately one in six patients intubated for emergent convulsive symptoms had PNEA rather than SE. Although PNEA cannot be diagnosed only by the presence of these risk factors, these simple characteristics could raise clinical suspicion for PNEA in the appropriate setting. Urgent neurological consultation may prevent unnecessary intubation of this at-risk patient population.


Assuntos
Epilepsia , Estado Epiléptico , Eletroencefalografia , Feminino , Humanos , Estudos Retrospectivos , Convulsões , Estado Epiléptico/diagnóstico , Estado Epiléptico/terapia
11.
Seizure ; 81: 198-200, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32861152

RESUMO

PURPOSE: Neurological manifestations of COVID-19 infection include impaired consciousness, strokes, and seizures. Limited reports describing EEG abnormalities in patients with COVID-19 have been published. These articles reported nonspecific encephalopathic patterns, epileptiform discharges, and rarely seizures. Our primary aim was to assess EEG abnormalities in patients with COVID-19 and evaluate for epileptiform activity or seizures. METHODS: We identified five critically ill adult patients with COVID-19 who underwent EEG monitoring. All patients had Ceribell™ rapid response EEG initially and two continued with conventional long-term video EEG. RESULTS: All 5 patients had encephalopathy and 3 also had seizure-like movements, thus prompting EEG monitoring. EEGs all showed nonspecific markers of encephalopathy including diffuse slowing and generalized rhythmic delta activity. Two also had epileptiform discharges reaching 2-3 Hz at times, with one patient in nonconvulsive status epilepticus and the other developing clinical status epilepticus with myoclonic movements. EEG and clinical symptoms improved with anti-seizure medications. CONCLUSION: Status epilepticus was present in 2 out of our cohort of 5 critically ill patients who underwent EEG monitoring. These findings highlight the importance of EEG monitoring in high-risk patients with COVID-19 and encephalopathy. EEG recordings in such patients can identify pathological patterns that will benefit from treatment with anti-seizure medications.


Assuntos
Encefalopatias/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Convulsões/fisiopatologia , Estado Epiléptico/fisiopatologia , Adulto , Betacoronavirus , Encefalopatias/diagnóstico , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Convulsões/diagnóstico , Estado Epiléptico/diagnóstico
12.
Epilepsia ; 61(7): 1386-1396, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32683696

RESUMO

OBJECTIVE: Describe hospital readmission for status epilepticus (SE) in the United States, and study potential risk factors for readmission. METHODS: This is a retrospective observational study using the Healthcare Cost and Utilization Project's 2016 Nationwide Readmissions Database. We studied patients of all ages admitted to the hospital due to SE. RESULTS: We included 32 327  patients admitted for SE in 2016. 8.4% of these patients were readmitted for SE at least one more time within 2016 (cross-sectional analysis). The incidence rate was 18 readmissions for SE per 1000 patient-months. Among the survivors of the index admission for SE who had at least 6 months of follow-up within this database (16 043  patients), the cumulative probability of having a readmission for SE at 1, 3, and 6 months from the index admission was approximately 3.5%, 7.5%, and 11%, respectively (time-to-event analysis). Patients with refractory epilepsy were more likely to have a readmission for SE compared to patients without refractory epilepsy (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.23-1.82, adjusted P =.0006), and pediatric patients were more likely to have a readmission for SE compared to adult patients (HR 1.53, 95% CI 1.26-1.87, adjusted P = .0003) during 6-month follow-up. SIGNIFICANCE: Hospital readmissions for SE in the United States are frequent. Independent factors associated with readmission in this database were refractory epilepsy and pediatric age.


Assuntos
Bases de Dados Factuais/tendências , Readmissão do Paciente/tendências , Estado Epiléptico/diagnóstico , Estado Epiléptico/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
16.
Ann Clin Transl Neurol ; 7(7): 1240-1244, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32407609

RESUMO

Neurological complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. We present a single-center retrospective case series reporting the EEG and outcome of de novo status epilepticus (SE) in two African-American women with laboratory-confirmed SARS-CoV-2 virus. SE was the initial presentation in one asymptomatic individual. Patient 2 had COVID-19 pneumonia, and fluctuating mental status that raised the suspicion of subclinical SE. The patient with older age and higher comorbidities failed to recover from the viral illness that has no definitive treatment.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Estado Epiléptico/etiologia , Afro-Americanos , Idoso , Anticonvulsivantes/uso terapêutico , Betacoronavirus , Eletroencefalografia , Feminino , Humanos , Levetiracetam/uso terapêutico , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico
17.
Seizure ; 78: 109-112, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32344366

RESUMO

SARS-CoV-2, a novel zoonotic coronavirus, is currently spreading all over the world, causing a pandemic disease defined coronavirus disease 2019 (COVID-19). The spectrum of COVID-19 ranges from asymptomatic or mild infection to rapidly progressive, acute respiratory distress syndrome and death [1].To the best of our knowledge, status epilepticus has never been described as initial presentation of COVID-19. We report a patient affected by COVID-19 whose primary presentation was a focal status epilepticus.


Assuntos
Infecções por Coronavirus/diagnóstico , Epilepsias Parciais/diagnóstico , Pneumonia Viral/diagnóstico , Estado Epiléptico/diagnóstico , Idoso , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Humanos , Imagem por Ressonância Magnética , Pandemias
18.
J Clin Neurosci ; 75: 128-133, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32178991

RESUMO

To date, hospital length of stay (LOS) determinants for convulsive status epilepticus's (CSE) acute-phase treatment have not been sufficiently investigated, as opposed to those for status epilepticus's (SE) outcome predictors, such as status epilepticus severity score (STESS). Here, we aimed at assessing the significance of STESS in the LOS in patients with CSE. We retrospectively reviewed consecutive adult patients with CSE who were transported to the emergency department of our urban tertiary care hospital in Tokyo, Japan. The study period was from August 2010 to September 2015. The primary endpoint was the LOS of patients with CSE who were directly discharged after acute-phase treatment, and survival analysis for LOS until discharge was conducted. As a result, among 132 eligible patients with CSE admitted to our hospital, 96 (72.7%) were directly discharged with a median LOS of 10 days (IQR: 4-19 days). CSE patients with severe seizures, represented by higher STESS (≥3), had a significantly longer LOS after adjustments with multiple covariates (p = 0.016, in restricted mean survival time analysis). Additionally, prediction for the binomial longer/shorter LOS achieved better performance when STESS was incorporated into the prediction model. Our findings indicate that STESS can also be used as a rough predictor of longer LOS at index admission of patients with CSE.


Assuntos
Tempo de Internação , Índice de Gravidade de Doença , Estado Epiléptico/diagnóstico , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Prognóstico , Estudos Retrospectivos , Convulsões , Estado Epiléptico/mortalidade , Análise de Sobrevida
19.
Epilepsia ; 61(3): 498-508, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32077099

RESUMO

OBJECTIVE: Electroencephalographic seizures (ESs) are common in encephalopathic critically ill children, but ES identification with continuous electroencephalography (EEG) monitoring (CEEG) is resource-intense. We aimed to develop an ES prediction model that would enable clinicians to stratify patients by ES risk and optimally target limited CEEG resources. We aimed to determine whether incorporating data from a screening EEG yielded better performance characteristics than models using clinical variables alone. METHODS: We performed a prospective observational study of 719 consecutive critically ill children with acute encephalopathy undergoing CEEG in the pediatric intensive care unit of a quaternary care institution between April 2017 and February 2019. We identified clinical and EEG risk factors for ES. We evaluated model performance with area under the receiver-operating characteristic (ROC) curve (AUC), validated the optimal model with the highest AUC using a fivefold cross-validation, and calculated test characteristics emphasizing high sensitivity. We applied the optimal operating slope strategy to identify the optimal cutoff to define whether a patient should undergo CEEG. RESULTS: The incidence of ES was 26%. Variables associated with increased ES risk included age, acute encephalopathy category, clinical seizures prior to CEEG initiation, EEG background, and epileptiform discharges. Combining clinical and EEG variables yielded better model performance (AUC 0.80) than clinical variables alone (AUC 0.69; P < .01). At a 0.10 cutoff selected to emphasize sensitivity, the optimal model had a sensitivity of 92%, specificity of 37%, positive predictive value of 34%, and negative predictive value of 93%. If applied, the model would limit 29% of patients from undergoing CEEG while failing to identify 8% of patients with ES. SIGNIFICANCE: A model employing readily available clinical and EEG variables could target limited CEEG resources to critically ill children at highest risk for ES, making CEEG-guided management a more viable neuroprotective strategy.


Assuntos
Encefalopatias/fisiopatologia , Epilepsia/fisiopatologia , Convulsões/diagnóstico , Estado Epiléptico/diagnóstico , Encefalopatias/complicações , Pré-Escolar , Estado Terminal , Eletroencefalografia , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Estudos Prospectivos , Medição de Risco , Convulsões/etiologia , Estado Epiléptico/etiologia
20.
BMC Neurol ; 20(1): 51, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046682

RESUMO

BACKGROUND: Nonconvulsive status epilepticus (NCSE) is a state of ongoing seizure activity without convulsions. The heterogeneous and subtle clinical features of NCSE make diagnosis and treatment challenging. Here, we report a patient with NCSE who showed a main presenting symptom of acute visual impairment, which is a rare and atypical clinical symptom of NCSE. CASE PRESENTATION: A 62-year-old man was admitted to the neurology department after complaining of an inability to see in the right eye for 2 days and progressive headache. He had a history of poststroke epilepsy and vascular dementia. Physical examination revealed right visual field hemianopia, visual neglect and cognitive impairment. T2 and diffusion-weighted magnetic resonance imaging showed high signal intensity in the left temporal, parietal and occipital lobes. Electroencephalography monitoring was performed, which found continuous sharp wave discharges, especially in the regions of the left temporal, parietal and occipital lobes. These findings were most consistent with the diagnosis of NCSE. Thus, a treatment of intravenous pumping of diazepam and an oral antiepileptic drug was added immediately. After that, the visual loss in the patient recovered quickly, and electroencephalography did not find epileptiform waves. On day 11, a follow-up MRI was performed, which showed that the abnormal signals of the left temporal, parietal and occipital lobes were markedly attenuated, and the patient returned to his premorbid state with a modified Rankin Scale score of 3. CONCLUSIONS: Acute visual impairment can be seen in NCSE, and it can be reversed by administering effective antiepileptic treatment. Meanwhile, transient peri-ictal MRI abnormalities can be observed in NCSE.


Assuntos
Anticonvulsivantes/uso terapêutico , Hemianopsia/etiologia , Estado Epiléptico/diagnóstico , Disfunção Cognitiva/diagnóstico , Demência Vascular/patologia , Diazepam/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Eletroencefalografia , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Epiléptico/complicações , Estado Epiléptico/tratamento farmacológico , Resultado do Tratamento
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