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1.
Pan Afr Med J ; 33: 114, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489092

RESUMO

Introduction: Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. Methods: We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. Results: Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. Conclusion: Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.


Assuntos
Arritmias Cardíacas/diagnóstico , Atletas , Cardiopatias/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Arritmias Cardíacas/epidemiologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/epidemiologia , Morte Súbita/prevenção & controle , Ecocardiografia , Eletrocardiografia/métodos , Feminino , Cardiopatias/epidemiologia , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Estudos Retrospectivos , Esportes , Inquéritos e Questionários , Adulto Jovem
2.
J Athl Train ; 54(4): 361-373, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31017807

RESUMO

CONTEXT: Implementation of health and safety best practices for the leading causes of sudden death and catastrophic injury has been shown to mitigate risk. However, to our knowledge, no authors have examined progress toward health and safety policy implementation at the state level. OBJECTIVE: To investigate the progress made by state secondary school leaders in developing and implementing health and safety policies (ie, exertional heat stroke, sudden cardiac arrest, concussion, emergency action plans) and to explore perceived barriers to and strategies for implementation. DESIGN: Mixed-methods study. SETTING: State high school athletics associations and sports medicine advisory committees. PATIENTS OR OTHER PARTICIPANTS: Collaborative Solutions for Safety in Sport meeting attendees participated in this study. Thirty-five state leaders (current role experience = 8 ± 6 years) completed the survey. Ten of the 35 participated in follow-up interviews. DATA COLLECTION AND ANALYSIS: A survey assessing progress on health and safety policy implementation was administered. Respondents indicated whether their state had implemented a policy, made progress without implementation, or made no progress. We conducted follow-up telephone interviews so they could expand on the survey responses. The data were analyzed using descriptive statistics and the general inductive approach. RESULTS: A total of 89% of respondents reported their states made progress on or implemented health and safety policies during the 2015-2016 academic year. Barriers to policy implementation included cost, a lack of understanding regarding policies versus recommendations, the content and value of policy change, and a false sense of security. Strategies for implementation included varying approaches to change, education of all constituents, and collaborative relationships among key stakeholders. CONCLUSIONS: Although a majority of respondents reported progress in implementing health and safety policies in their states, perceived barriers pointed to the need for the continued education of state leaders in charge of developing and implementing health and safety policies. Despite these barriers, collaboration among key stakeholders is crucial to successful implementation of best-practice policies in secondary school athletics.


Assuntos
Traumatismos em Atletas/prevenção & controle , Morte Súbita/prevenção & controle , Implementação de Plano de Saúde/métodos , Liderança , Serviços de Saúde Escolar/normas , Medicina Esportiva/organização & administração , Esportes/normas , Adolescente , Traumatismos em Atletas/epidemiologia , Criança , Pré-Escolar , Feminino , Política de Saúde , Humanos , Incidência , Masculino , Estudos Retrospectivos , Instituições Acadêmicas , Medicina Esportiva/normas , Estados Unidos/epidemiologia
3.
Medicine (Baltimore) ; 98(8): e14697, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813218

RESUMO

BACKGROUND: Fulminant myocarditis (FM) is a sub-category myocarditis. Its primary characteristic is a rapidly progressive clinical course that necessitates hemodynamic support. FM can be difficult to predict at the onset of myocarditis. The aim of this meta-analysis was to identify the early characteristics in FM compared to those of non-fulminant myocarditis (NFM). METHODS: We searched the databases of MEDLINE, EMBASE, CENTRAL, for studies comparing FM with acute NFM from January 1, 2000 to June 1, 2018. The baseline variables were compared in each study. Mean differences (MD) and relative ratios (RR) were calculated. RESULTS: Seven studies (158 FM patients and 388 NFM patients) were included in the analysis. The FM group had significantly lower systolic blood pressure (SBP), higher creatine kinase (CK), wider QRS duration, lower left ventricular ejection fraction (LVEF), thicker left ventricular posterior wall diameter (LVPWd), higher incidence of ST depression, ventricular tachycardia/ventricular fibrillation (Vt/Vf) and syncope, less incidence of chest pain than the NFM groups. There was no difference in terms of heart rate (HR), c-reactive protein (CRP), fever, dyspnea, white blood cells (WBC), atrioventricular block (AVB), Q waves, ST elevation, interventricular septum diameter (IVSd), or end-diastolic left ventricular diameter (LVEDd) between FM and NFM. CONCLUSION: We found that the lower SBP, higher CK, wider QRS duration, lower LVEF, thicker LVPWd, higher incidence of ST depression, Vt/Vf and syncope as well as lower incidence of chest pain were early characteristics of FM.


Assuntos
Morte Súbita , Diagnóstico Precoce , Miocardite/diagnóstico , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Intervenção Médica Precoce , Testes de Função Cardíaca/métodos , Hemodinâmica , Humanos , Miocardite/complicações , Miocardite/fisiopatologia , Avaliação de Sintomas/métodos
4.
Trends Neurosci ; 42(4): 242-250, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30905388

RESUMO

Premature, sudden death is devastating. Certain patient populations are at greater risk to succumb to sudden death. For instance, infants under 1year of age are at risk for sudden infant death syndrome (SIDS), and patients with epilepsy are at risk for sudden unexpected death in epilepsy (SUDEP). Deaths are attributed to these syndromic entities in these select populations when other diagnoses have been excluded. There are a number of similarities between these syndromes, and the commonalities suggest that the two syndromes may share certain etiological features. One such feature may be deficiency of arousal to CO2. Under normal conditions, CO2 is a potent arousal stimulus. Circumstances surrounding SIDS and SUDEP deaths often facilitate CO2 elevation, and faulty CO2 arousal mechanisms could, at least in part, contribute to death.


Assuntos
Nível de Alerta/fisiologia , Dióxido de Carbono/metabolismo , Morte Súbita/etiologia , Animais , Morte Súbita/prevenção & controle , Epilepsia Resistente a Medicamentos/metabolismo , Humanos , Lactente , Morte do Lactente/etiologia , Morte do Lactente/prevenção & controle , Sono/fisiologia
5.
Arch Cardiovasc Dis ; 112(4): 270-277, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30670362

RESUMO

BACKGROUND: Left ventricular ejection fraction lacks accuracy in predicting sudden cardiac death, resulting in unnecessary implantation of cardioverter defibrillators for the primary prevention of sudden cardiac death. Baroreflex sensitivity could help to stratify patients at risk of ventricular arrhythmia. AIM: To assess the association between cardiac baroreflex sensitivity and ventricular arrhythmias in patients implanted with an implantable cardioverter defibrillator for the primary prevention of sudden cardiac death after myocardial infarction. METHODS: This case-control single-centre study took place between 2015 and 2016. Cases (n=10) had experienced ventricular arrhythmias treated by the implantable cardioverter defibrillator in the previous 3 years; controls (n=22) had no arrhythmia during the same period. Baroreflex sensitivity was assessed using the temporal sequence method (mean slope) and cross-spectral analysis (low-frequency gain and high-frequency gain). RESULTS: The mean age was 65 years; 94% of the patients were men. 24-hour Holter electrocardiogram autonomous nervous system variables, left ventricular ejection fraction and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration did not differ between cases and controls. The mean slope was lower in cases than in controls (8 vs. 15ms/mmHg [P=0.009] in the supine position; 7 vs. 12ms/mmHg [P=0.038] in the standing position). The mean slope in the supine position was still significantly different between groups after adjustment for age, left ventricular ejection fraction and NT-proBNP (P=0.03). By comparison, low-frequency gain and high-frequency gain did not differ between groups in either the supine or the standing position. CONCLUSION: Patients with ventricular arrhythmias had a lower mean slope compared with those who were free of arrhythmia. A prospective study is needed to confirm this association.


Assuntos
Arritmias Cardíacas/prevenção & controle , Barorreflexo , Morte Súbita/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Infarto do Miocárdio/complicações , Prevenção Primária/instrumentação , Idoso , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Biomarcadores/sangue , Tomada de Decisão Clínica , Estudos Transversais , Morte Súbita/etiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Seleção de Pacientes , Fragmentos de Peptídeos/sangue , Projetos Piloto , Pletismografia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
6.
Arch Dis Child ; 104(2): 189-192, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30266875

RESUMO

The relationship between sleep and seizure disorders is a particularly vicious cycle. Nocturnal seizures can interrupt sleep while a number of factors, including antiepileptics and sleep disorders that cause sleep fragmentation, can worsen seizures. Understanding and managing seizures and related sleep disturbance is therefore an important and treatable intervention target that could potentially improve children's sleep, but also their learning, mood, behaviour, seizures and parental quality of life.


Assuntos
Epilepsia/complicações , Privação do Sono/complicações , Transtornos do Sono-Vigília/complicações , Anticonvulsivantes/efeitos adversos , Criança , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Dieta Cetogênica , Epilepsia/terapia , Humanos , Qualidade de Vida , Estimulação do Nervo Vago
7.
Epilepsy Behav ; 90: 99-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30522060

RESUMO

BACKGROUND: Sudden Unexpected Death in Epilepsy (SUDEP) is a significant cause of death in childhood epilepsy, and causes considerable concern to patients and their families. Despite this, the condition remains poorly understood. This systematic review investigates the risk factors, pathophysiology, and circumstances associated with childhood SUDEP. It aimed to explore the etiology of SUDEP and inform clinicians approaching SUDEP risk disclosure. METHODS: A structured electronic database search of MEDLINE, CENTRAL, EMBASE, and ISI web of science was conducted. Studies were included if they described clinical details of one or more patients, aged 18 years of age and below, who had SUDEP. Two reviewers independently reviewed each article for data extraction and quality assessment. RESULTS: Information on 108 cases of pediatric SUDEP was extracted from 22 included studies. These comprised five cohort studies, four retrospective case control studies, seven case series, and five case reports. Factors that appeared to be linked to pediatric SUDEP included those associated with severe epilepsy (early age of onset, high seizure frequency, intellectual impairment and developmental delay, multiple antiepileptic drug therapy, and structural abnormalities). The majority of included studies was noncomparative and had significant risk of bias. CONCLUSIONS: There is currently insufficient evidence to determine the etiology of pediatric SUDEP. Current best practice to prevent pediatric SUDEP is to optimize the management of epilepsy. A national SUDEP registry would provide invaluable high-quality data and insights into modifiable risk factors, genetic predispositions, and novel prevention strategies.


Assuntos
Morte Súbita/epidemiologia , Morte Súbita/prevenção & controle , Epilepsia/epidemiologia , Epilepsia/terapia , Adolescente , Anticonvulsivantes/uso terapêutico , Estudos de Casos e Controles , Criança , Estudos de Coortes , Morte Súbita/etiologia , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/terapia , Epilepsia/complicações , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco
8.
BMJ ; 363: k5094, 2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30545967

RESUMO

OBJECTIVE: To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft. DESIGN: Randomized controlled trial. SETTING: Private or commercial aircraft between September 2017 and August 2018. PARTICIPANTS: 92 aircraft passengers aged 18 and over were screened for participation. 23 agreed to be enrolled and were randomized. INTERVENTION: Jumping from an aircraft (airplane or helicopter) with a parachute versus an empty backpack (unblinded). MAIN OUTCOME MEASURES: Composite of death or major traumatic injury (defined by an Injury Severity Score over 15) upon impact with the ground measured immediately after landing. RESULTS: Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001). CONCLUSIONS: Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.


Assuntos
Medicina Aeroespacial/métodos , Morte Súbita/prevenção & controle , Equipamentos de Proteção , Ferimentos e Lesões/prevenção & controle , Acidentes Aeronáuticos/prevenção & controle , Adulto , Aeronaves , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Senso de Humor e Humor como Assunto
9.
Rev Med Chil ; 146(8): 902-908, 2018 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-30534869

RESUMO

The risk of sudden unexpected death in patients with epilepsy (SUDEP), is 20 to 25 times greater than in the general population. This increased risk is seen specially in refractory epilepsy, with an incidence of 9:1,000 patients-years. Risk factors have been established based on retrospective studies, finding that the frequency of seizures, specially generalized tonic clonic seizures, is the most important one. The physiopathological mechanism of SUDEP is not yet fully understood. Autonomic system abnormalities, as well as cardiac and respiratory changes have been found. The finding of new molecular biomarkers to identify patients with increased risk should be a priority. Treatment is based in the management of risk factors, although clear recommendations are hard to establish given the low level of evidence.


Assuntos
Morte Súbita/etiologia , Epilepsia/complicações , Epilepsia/mortalidade , Biomarcadores , Chile/epidemiologia , Morte Súbita/epidemiologia , Morte Súbita/prevenção & controle , Feminino , Humanos , Incidência , Fatores de Risco
10.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(4): 173-175, out.-dez. 2018. ilus
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-999266

RESUMO

Relato de caso de uma paciente do sexo feminino, com 16 anos de idade à ocasião de sua admissão no Instituto de Cardiologia. A mesma foi encaminhada por serviço de saúde externo devido a síncopes durante atividade física e foi submetida à investigação, com diagnóstico final de taquicardia ventricular catecolaminérgica. Após a definição diagnóstica, foi realizado tratamento medicamentoso com betabloqueador, sendo necessário o implante de marcapasso definitivo por conta da incompetência cronotrópica secundária ao tratamento farmacológico instituído. Posteriormente, por persistência das arritmias ventriculares mesmo com o uso de terapia otimizada, optou-se por realizar um implante de CDI


Case report of a 16-year-old female patient at the time of her admission to the Institute of Cardiology. She was referred by an external healthcare service due to syncope during physical activity and was submitted to the investigation with a final diagnosis of catecholaminergic ventricular tachycardia. Once the diagnosis was established, the patient was administered a beta-blocker and definitive pacemaker implant was required due to chronotropic incompetence secondary to drug therapy. Subsequently, due to the persistence of ventricular arrhythmias despite the use of optimized therapy, we decided to implant an ICD


Assuntos
Humanos , Feminino , Adolescente , Taquicardia Ventricular , Desfibriladores Implantáveis , Marca-Passo Artificial , Síncope , Nadolol/uso terapêutico , Técnicas Eletrofisiológicas Cardíacas/métodos , Morte Súbita/prevenção & controle , Tratamento Farmacológico/métodos , Doenças Genéticas Inatas/diagnóstico
11.
J Athl Train ; 53(8): 756-767, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30212234

RESUMO

CONTEXT: : Implementation of best-practice health and safety policies has been shown to be effective at reducing the risk of sudden death in sport; however, little is known about the extent to which these policies are required within secondary school athletics. OBJECTIVE: : To examine best-practice health and safety policies pertaining to the leading causes of sudden death and to concussion management in sport mandated at the state level for secondary school athletics. DESIGN: : Descriptive observational study. SETTING: : State high school athletic associations (SHSAAs), state departments of education, and enacted legislation. PATIENTS OR OTHER PARTICIPANTS: : United States (including the District of Columbia) SHSAAs. MAIN OUTCOME MEASURE(S): : A review of SHSAA health and safety policies for the 2016-2017 academic year, state department of education policies, and enacted legislation was undertaken to assess the polices related to the leading causes of sudden death and concussion management in sport. Current best-practice recommendations used to assess health and safety policies were specific to emergency action plans, automated external defibrillators, heat acclimatization, environmental monitoring and modification, and concussion management. The total number of best-practice recommendations required for each SHSAA's member schools for the aforementioned areas was quantified and presented as total number and percentage of recommendations required. RESULTS: : Four of 51 SHSAA member schools were required to follow best practices for emergency action plans, 7 of 51 for access to automated external defibrillators, 8 of 51 for heat acclimatization, and 3 of 51 for management of concussion. CONCLUSIONS: : At the time of this study, SHSAA member schools were not required to follow all best-practice recommendations for preventing the leading causes of sudden death and for concussion management in sport. Continued advocacy for the development and implementation of best practices at the state level to be required of all secondary schools is needed to appropriately serve the health and well-being of our young student-athletes.


Assuntos
Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/terapia , Morte Súbita/prevenção & controle , Medicina Esportiva/normas , Adolescente , Atletas , Benchmarking , Concussão Encefálica/prevenção & controle , Morte Súbita/etiologia , Medicina Baseada em Evidências , Humanos , Políticas , Instituições Acadêmicas , Estudantes , Estados Unidos , Esportes Juvenis
12.
Int. j. cardiovasc. sci. (Impr.) ; 31(5)set.-out. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-914765

RESUMO

Background: To reduce mortality of acute myocardial infarction, medical care must be provided within the first hours of the event. Objective: To identify the "front door" to medical care of acute coronary patients and the time elapsed between patients'admission and performance of myocardial reperfusion in the public health system of the city of Joinville, Brazil. Methods: The study was a retrospective analysis of the medical records of 112 consecutive patients diagnosed with acute myocardial infarction by coronary angiography. We identified the place of the first medical contact and calculated the time between admission to this place and admission to the referral hospital, as well as the time until coronary angiography, with or without percutaneous transluminal angioplasty. A descriptive analysis of data was made using mean and standard deviation, and a p < 0.05 was set as statistically significant. Results: Only 16 (14.3%) patients were admitted through the cardiology referral unit. Door-to-angiography time was shorter than 90 minutes in 50 (44.2%) patients and longer than 270 minutes in 39 (34.5%) patients. No statistically significant difference was observed in door-to-angiography time between patients transported directly to the referral hospital and those transferred from other health units (p < 0.240). Considering the time between pain onset and angiography, only 3 (2.9%) patients may have benefited from myocardial reperfusion performed within less than 240 minutes. Conclusion: Management of patients with acute myocardial infarction is not in conformity with current guidelines for the treatment of this condition. The structure of the healthcare system should be urgently modified so that users in need of emergency services receive adequate care in accordance with local conditions


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Assistência à Saúde/métodos , Falha da Terapia de Resgate , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Terapêutica/métodos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Angioplastia/métodos , Angiografia Coronária/métodos , Procedimentos Clínicos/tendências , Morte Súbita/prevenção & controle , Diagnóstico por Imagem/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência/métodos , Assistência Hospitalar/métodos , Reperfusão Miocárdica/métodos , Estudos Retrospectivos , Análise Estatística , Terapia Trombolítica/métodos , Sistema Único de Saúde
13.
Neuroimage Clin ; 20: 205-215, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30094170

RESUMO

Objective: Generalized tonic-clonic seizures are accompanied by cardiovascular and respiratory sequelae that threaten survival. The frequency of these seizures is a major risk factor for sudden unexpected death in epilepsy (SUDEP), a leading cause of untimely death in epilepsy. The circumstances accompanying such fatal events suggest a cardiovascular or respiratory failure induced by unknown neural processes rather than an inherent cardiac or lung deficiency. Certain cortical regions, especially the insular, cingulate, and orbitofrontal cortices, are key structures that integrate sensory input and influence diencephalic and brainstem regions regulating blood pressure, cardiac rhythm, and respiration; output from those cortical regions compromised by epilepsy-associated injury may lead to cardiorespiratory dysregulation. The aim here was to assess changes in cortical integrity, reflected as cortical thickness, relative to healthy controls. Cortical alterations in areas that influence cardiorespiratory action could contribute to SUDEP mechanisms. Methods: High-resolution T1-weighted images were collected with a 3.0-Tesla MRI scanner from 53 patients with generalized tonic-clonic seizures (Mean age ±â€¯SD: 37.1 ±â€¯12.6 years, 22 male) at Case Western Reserve University, University College London, and the University of California at Los Angeles. Control data included 530 healthy individuals (37.1 ±â€¯12.6 years; 220 male) from UCLA and two open access databases (OASIS and IXI). Cortical thickness group differences were assessed at all non-cerebellar brain surface locations (P < 0.05 corrected). Results: Increased cortical thickness appeared in post-central gyri, insula, and subgenual, anterior, posterior, and isthmus cingulate cortices. Post-central gyri increases were greater in females, while males showed more extensive cingulate increases. Frontal and temporal cortex, lateral orbitofrontal, frontal pole, and lateral parietal and occipital cortices showed thinning. The extents of thickness changes were sex- and hemisphere-dependent, with only males exhibiting right-sided and posterior cingulate thickening, while females showed only left lateral orbitofrontal thinning. Regional cortical thickness showed modest correlations with seizure frequency, but not epilepsy duration. Significance: Cortical thickening and thinning occur in patients with generalized tonic-clonic seizures, in cardiovascular and somatosensory areas, with extent of changes sex- and hemisphere-dependent. The data show injury in key autonomic and respiratory cortical areas, which may contribute to dysfunctional cardiorespiratory patterns during seizures, as well as to longer-term SUDEP risk.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/fisiopatologia , Imagem por Ressonância Magnética/métodos , Convulsões/diagnóstico por imagem , Convulsões/fisiopatologia , Adolescente , Adulto , Morte Súbita/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Adulto Jovem
14.
Epilepsy Behav ; 86: 200-203, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30007785

RESUMO

BACKGROUND: Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death among people with chronic epilepsy. People with intellectual disability (ID) are overrepresented in this population. The SUDEP and Seizure Safety Checklist ("Checklist") is a tool to discuss risk factors influencing seizures and the risk of SUDEP. It includes questions about the availability of nocturnal monitoring. In Cornwall UK, people with epilepsy and ID and their relatives and carers are routinely advised to consider nocturnal surveillance to reduce harm from potential nocturnal seizures. We assessed the retention of advice provided on nocturnal monitoring and if there were differences between those in residential care and those living with their families. METHODS: A postal questionnaire was sent to carers of all people with epilepsy and ID in Cornwall followed by the adult specialist ID epilepsy service. All those who were contacted had received the same advice on SUDEP and nocturnal monitoring at least once in the past year. Each person was categorized into living in a residential setting or with their family group. Intergroup differences were compared using Fisher's exact test. RESULTS: Carers for 170 people were contacted and 121 responded (71%). The family group had statistically more nocturnal seizures than the residential group. While there was no difference in the awareness of SUDEP, the groups differed in their recollection of the person-centered discussion of risk with carers in residential setting being less aware. Where nocturnal monitoring advice was given, it was followed, and previously unknown seizures were identified in 75%. CONCLUSIONS: Carers in residential settings are less likely to recall specific person-centered discussion of risks to the individual they support as compared with those living with families although general awareness of SUDEP and implementing advice such as nocturnal monitoring is present equally in both groups. In improving detection of nocturnal seizures, audio monitoring may be a useful strategy to reduce risk of harm for people with ID.


Assuntos
Cuidadores/normas , Lista de Checagem/normas , Comunicação , Morte Súbita/epidemiologia , Convulsões/mortalidade , Adulto , Cuidadores/psicologia , Lista de Checagem/métodos , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Feminino , Seguimentos , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/mortalidade , Deficiência Intelectual/terapia , Masculino , Fatores de Risco , Convulsões/complicações , Convulsões/terapia , Inquéritos e Questionários , Reino Unido/epidemiologia
15.
Lancet ; 392(10145): 387-399, 2018 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-30017552

RESUMO

BACKGROUND: A one-dose-fits-all approach to use of aspirin has yielded only modest benefits in long-term prevention of cardiovascular events, possibly due to underdosing in patients of large body size and excess dosing in patients of small body size, which might also affect other outcomes. METHODS: Using individual patient data, we analysed the modifying effects of bodyweight (10 kg bands) and height (10 cm bands) on the effects of low doses (≤100 mg) and higher doses (300-325 mg or ≥500 mg) of aspirin in randomised trials of aspirin in primary prevention of cardiovascular events. We stratified the findings by age, sex, and vascular risk factors, and validated them in trials of aspirin in secondary prevention of stroke. Additionally, we assessed whether any weight or height dependence was evident for the effect of aspirin on 20-year risk of colorectal cancer or any in-trial cancer. RESULTS: Among ten eligible trials of aspirin in primary prevention (including 117 279 participants), bodyweight varied four-fold and trial median weight ranged from 60·0 kg to 81·2 kg (p<0·0001). The ability of 75-100 mg aspirin to reduce cardiovascular events decreased with increasing weight (pinteraction=0·0072), with benefit seen in people weighing 50-69 kg (hazard ratio [HR] 0·75 [95% CI 0·65-0·85]) but not in those weighing 70 kg or more (0·95 [0·86-1·04]; 1·09 [0·93-1·29] for vascular death). Furthermore, the case fatality of a first cardiovascular event was increased by low-dose aspirin in people weighing 70 kg or more (odds ratio 1·33 [95% CI 1·08-1·64], p=0·0082). Higher doses of aspirin (≥325 mg) had the opposite interaction with bodyweight (difference pinteraction=0·0013), reducing cardiovascular events only at higher weight (pinteraction=0·017). Findings were similar in men and women, in people with diabetes, in trials of aspirin in secondary prevention, and in relation to height (pinteraction=0·0025 for cardiovascular events). Aspirin-mediated reductions in long-term risk of colorectal cancer were also weight dependent (pinteraction=0·038). Stratification by body size also revealed harms due to excess dosing: risk of sudden death was increased by aspirin in people at low weight for dose (pinteraction=0·0018) and risk of all-cause death was increased in people weighing less than 50 kg who were receiving 75-100 mg aspirin (HR 1·52 [95% CI 1·04-2·21], p=0·031). In participants aged 70 years or older, the 3-year risk of cancer was also increased by aspirin (1·20 [1·03-1·47], p=0·02), particularly in those weighing less than 70 kg (1·31 [1·07-1·61], p=0·009) and consequently in women (1·44 [1·11-1·87], p=0·0069). INTERPRETATION: Low doses of aspirin (75-100 mg) were only effective in preventing vascular events in patients weighing less than 70 kg, and had no benefit in the 80% of men and nearly 50% of all women weighing 70 kg or more. By contrast, higher doses of aspirin were only effective in patients weighing 70 kg or more. Given that aspirin's effects on other outcomes, including cancer, also showed interactions with body size, a one-dose-fits-all approach to aspirin is unlikely to be optimal, and a more tailored strategy is required. FUNDING: Wellcome Trust and National Institute for Health Research Oxford Biomedical Research Centre.


Assuntos
Aspirina/uso terapêutico , Peso Corporal , Doenças Cardiovasculares/prevenção & controle , Neoplasias Colorretais/epidemiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Fatores Etários , Idoso , Aspirina/administração & dosagem , Estatura , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Neoplasias Colorretais/prevenção & controle , Morte Súbita/epidemiologia , Morte Súbita/prevenção & controle , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Modelos de Riscos Proporcionais , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/prevenção & controle
16.
Epilepsy Behav ; 86: 193-199, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30017838

RESUMO

OBJECTIVE: The aim of the study was to summarize the pooled incidence rate of sudden unexpected death in epilepsy (SUDEP) in patients. Meta-regression analysis was applied to identify factors influencing the incidence rate. DESIGN: The study was a systematic review and critical appraisal with a meta-analysis of cohort studies, both prospective and retrospective. MATERIAL AND METHOD: In a literature search, a total of 45 cohort studies were identified. A random effect model was used to synthesize the results. Heterogeneity between studies was examined by subgroup and meta-regression analysis. The small-study effect was evaluated and not corrected for by the "trim and fill" method because of great heterogeneity. RESULTS: A substantial heterogeneity was present. The pooled estimated incidence rate for SUDEP was 1.4/1000 patient years. A meta-regression pinpointed a negative association between the incidence rate of SUDEP and the mean follow-up time and a positive association with the mean age of the patient. The definition of epilepsy showed statistical significance, with a higher incidence rate of SUDEP in studies where the definition of epilepsy was described and clear (p = 0.019) compared with studies having an inadequate or failing epilepsy definition. CONCLUSION: Evidence from this study suggests a high incidence rate of sudden death in epilepsy. Its incidence rate was 23 times the incidence rate of sudden death in the total population of the same age. There was heterogeneity and variability of incidence rate depending on the quality of the study and on the definition of epilepsy and the mean age of the patients.


Assuntos
Morte Súbita/epidemiologia , Epilepsia/diagnóstico , Epilepsia/mortalidade , Adolescente , Adulto , Estudos de Coortes , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Epilepsia/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
Epilepsia ; 59 Suppl 1: 61-66, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29873831

RESUMO

Sudden unexpected death in epilepsy (SUDEP) is most often associated with the occurrence of generalized tonic-clonic seizures (GTCS), a seizure type that can now be detected with high sensitivity and specificity by wearable or bed devices. The recent development in such devices and their performance offer multiple opportunities to tackle SUDEP and its prevention. Reliable GTCS detection might help physicians optimize antiepileptic treatment, which could in turn reduce the risk of SUDEP. GTCS-triggered alarms can lead to immediate intervention by caregivers that are also likely to decrease the odd of SUDEP. The biosignals used to detect GTCS might provide novel SUDEP biomarkers, in particular, by informing on several important characteristics of the ictal and postictal periods (type of GTCS, duration of tonic phase, rotation in the prone position, presence and duration of postictal immobility and bradycardia, rise in electrodermal activity). Other biosensors not yet used for detecting GTCS might provide complementary information, such as the presence and intensity of ictal/postictal hypoxemia. The above biomarkers, if strongly predictive, could help identify patients at very high risk of SUDEP, enabling better assessment of individual risk, as well as selection of appropriate patients for clinical studies aiming at preventing SUDEP. The same biosignals could also be used as ancillary biomarkers to test the impact of various interventions before moving to highly challenging randomized controlled trials with SUDEP as a primary outcome.


Assuntos
Morte Súbita/prevenção & controle , Epilepsia/fisiopatologia , Dispositivos Eletrônicos Vestíveis , Anticonvulsivantes/uso terapêutico , Morte Súbita/epidemiologia , Epilepsia/epidemiologia , Epilepsia/terapia , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Humanos
20.
Epilepsia ; 59 Suppl 1: 53-60, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29638008

RESUMO

People with epilepsy need assistance and are at risk of sudden death when having convulsive seizures (CS). Automated real-time seizure detection systems can help alert caregivers, but wearable sensors are not always tolerated. We determined algorithm settings and investigated detection performance of a video algorithm to detect CS in a residential care setting. The algorithm calculates power in the 2-6 Hz range relative to 0.5-12.5 Hz range in group velocity signals derived from video-sequence optical flow. A detection threshold was found using a training set consisting of video-electroencephalogaphy (EEG) recordings of 72 CS. A test set consisting of 24 full nights of 12 new subjects in residential care and additional recordings of 50 CS selected randomly was used to estimate performance. All data were analyzed retrospectively. The start and end of CS (generalized clonic and tonic-clonic seizures) and other seizures considered desirable to detect (long generalized tonic, hyperkinetic, and other major seizures) were annotated. The detection threshold was set to the value that obtained 97% sensitivity in the training set. Sensitivity, latency, and false detection rate (FDR) per night were calculated in the test set. A seizure was detected when the algorithm output exceeded the threshold continuously for 2 seconds. With the detection threshold determined in the training set, all CS were detected in the test set (100% sensitivity). Latency was ≤10 seconds in 78% of detections. Three/five hyperkinetic and 6/9 other major seizures were detected. Median FDR was 0.78 per night and no false detections occurred in 9/24 nights. Our algorithm could improve safety unobtrusively by automated real-time detection of CS in video registrations, with an acceptable latency and FDR. The algorithm can also detect some other motor seizures requiring assistance.


Assuntos
Sistemas de Computação , Convulsões/diagnóstico , Convulsões/fisiopatologia , Gravação em Vídeo , Algoritmos , Cuidadores/psicologia , Morte Súbita/prevenção & controle , Eletroencefalografia , Feminino , Humanos , Masculino , Estudos Retrospectivos
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