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1.
An Pediatr (Engl Ed) ; 96(6): 511-522, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35650008

RESUMO

AIM: Ketogenic dietary therapies (KDT) produce anticonvulsant and neuroprotective effects, reduce seizures and improve the cognitive state in patients with epilepsy. Our purpose was to evaluate the effects of KDT in children with refractory epilepsy (effectiveness, side effects, impact on nutritional status and growth). METHODS: A retrospective and prospective observational descriptive study was conducted in a Spanish tertiary hospital (January 2000 to December 2018). One hundred sixty pediatric patients with epilepsy were treated with KDT (82 males; mean age 5 years 9 months). Seizures, anti-epileptic drugs, anthropometric measures, side effects, and laboratory assessment were monitored baseline and at 3, 6, 12 and 24 months after the onset of KDT. RESULTS: In these time intervals, the seizure-free patients were: 13.7, 12.5, 14.4 and 10.6%, respectively, and a reduction of seizures ≥ 50% was achieved in 41.9, 37.5, 28.7 and 16.2%. Side effects were frequent, especially digestive disorders, hypercalciuria, hypoglycemia, hepatic dysfunction and dyslipidemia. Prealbumin, retinol binding protein, vitamin A and magnesium decreased significantly. Height was affected, especially in children below 2 years. CONCLUSIONS: KDT are effective for refractory epilepsy in children. However, adverse effects are frequent, and it may affect nutritional status and growth.


Assuntos
Dieta Cetogênica , Epilepsia Resistente a Medicamentos , Epilepsia , Criança , Pré-Escolar , Dieta Cetogênica/efeitos adversos , Humanos , Masculino , Estudos Retrospectivos , Convulsões
3.
Brain Stimul ; 15(3): 814-821, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35643390

RESUMO

BACKGROUND: While vagus nerve stimulation (VNS) has been in use for over two decades, little professional guidance exists to describe dosing and titration of therapy which is the consequence of a limited amount of evidence developed during the pre-market phase of therapy development. Post-market surveillance of dosing practice has revealed significant deviations from dosing and titration guidance offered by professional societies as well as the manufacturer. OBJECTIVE: This analysis aims to identify a target dose for VNS Therapy in Epilepsy. METHODS: Herein, VNS clinical outcomes are linked to the patient-specific dosing parameters for each study visit (n = 1178 patients). A generalized linear mixed model was built to ascertain the relationship between key stimulation parameters (i.e., Output Current, Pulse Width, Signal Frequency, and Duty Cycle) and clinical response, defined as a 50% or greater reduction in seizure frequency from baseline. Other demographic parameters of interest, such as duration of epilepsy and age at implant, were also explored. RESULTS: A population level target output current and duty cycle for VNS therapy for epilepsy was identified as 1.61 mA and 17.1% duty cycle. Patients with shorter duration of epilepsy were identified to have a higher likelihood to respond to VNS therapy (p < 0.001). While patients who were on the therapy longer were more likely to respond to the therapy, the effect did not interact with the dosing settings - suggesting that patients who have been chronically underdosed may still benefit from achieving the target dose. CONCLUSION: An opportunity exists to improve upon VNS outcomes by aligning clinical practice around this evidence-based target dose.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Estimulação do Nervo Vago , Epilepsia Resistente a Medicamentos/terapia , Epilepsia/terapia , Frequência Cardíaca , Humanos , Convulsões/terapia , Fatores de Tempo , Resultado do Tratamento
4.
Brain Nerve ; 74(6): 753-757, 2022 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-35676207

RESUMO

Many cases of healthcare transition were referred to the Department of Neurology in our local core hospital with an emergency and critical care center, owing to the relocation of a nearby children's medical center. Most patients presented epilepsy with difficulty in controlling seizures or were children with severe mental and physical disabilities requiring medical care. During the transition, multidisciplinary collaboration centered on the medical consultation office was conducted. After the transition, many patients were transported to emergency rooms for seizures, pneumonia, and other infectious diseases. Education, advanced care planning, and regional collaboration were some of the issues in the process.


Assuntos
Epilepsia , Neurologia , Transição para Assistência do Adulto , Instituições de Assistência Ambulatorial , Criança , Epilepsia/terapia , Humanos , Convulsões
5.
Brain Nerve ; 74(6): 777-782, 2022 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-35676211

RESUMO

When treatment for childhood-onset epilepsy is introduced in the transitional period, neurologists must classify the epilepsy syndrome according to the age of onset and etiology. When a patient with refractory epilepsy consults a neurologist during the transition, it is essential to review the antiepileptic medication and reaffirm the treatment goal. In cases where pre-existing disease or comorbidities are present, a neurologist should treat their patients in consultation with general physicians or home-visit doctors.


Assuntos
Epilepsia , Neurologia , Médicos , Anticonvulsivantes/uso terapêutico , Criança , Epilepsia/tratamento farmacológico , Humanos , Neurologistas
6.
BMC Genomics ; 23(1): 430, 2022 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-35676651

RESUMO

BACKGROUND: Seizures are a common symptom in glioma patients, and they can cause brain dysfunction. However, the mechanism by which glioma-related epilepsy (GRE) causes alterations in brain networks remains elusive. OBJECTIVE: To investigate the potential pathogenic mechanism of GRE by analyzing the dynamic expression profiles of microRNA/ mRNA/ lncRNA in brain tissues of glioma patients. METHODS: Brain tissues of 16 patients with GRE and 9 patients with glioma without epilepsy (GNE) were collected. The total RNA was dephosphorylated, labeled, and hybridized to the Agilent Human miRNA Microarray, Release 19.0, 8 × 60 K. The cDNA was labeled and hybridized to the Agilent LncRNA + mRNA Human Gene Expression Microarray V3.0, 4 × 180 K. The raw data was extracted from hybridized images using Agilent Feature Extraction, and quantile normalization was performed using the Agilent GeneSpring. P-value < 0.05 and absolute fold change > 2 were considered the threshold of differential expression data. Data analyses were performed using R and Bioconductor. RESULTS: We found that 3 differentially expressed miRNAs (miR-10a-5p, miR-10b-5p, miR-629-3p), 6 differentially expressed lncRNAs (TTN-AS1, LINC00641, SNHG14, LINC00894, SNHG1, OIP5-AS1), and 49 differentially expressed mRNAs play a vitally critical role in developing GRE. The expression of GABARAPL1, GRAMD1B, and IQSEC3 were validated more than twofold higher in the GRE group than in the GNE group in the validation cohort. Pathways including ECM receptor interaction and long-term potentiation (LTP) may contribute to the disease's progression. Meanwhile, We built a lncRNA-microRNA-Gene regulatory network with structural and functional significance. CONCLUSION: These findings can offer a fresh perspective on GRE-induced brain network changes.


Assuntos
Epilepsia , Glioma , MicroRNAs , RNA Longo não Codificante , Redes Reguladoras de Genes , Glioma/complicações , Glioma/genética , Glioma/metabolismo , Humanos , Potenciação de Longa Duração , MicroRNAs/genética , MicroRNAs/metabolismo , RNA Longo não Codificante/genética , RNA Mensageiro/genética
7.
Sci Rep ; 12(1): 10932, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35768501

RESUMO

The study proposes a novel method to empower healthcare professionals to interact and leverage AI decision support in an intuitive manner using auditory senses. The method's suitability is assessed through acoustic detection of the presence of neonatal seizures in electroencephalography (EEG). Neurophysiologists use EEG recordings to identify seizures visually. However, neurophysiological expertise is expensive and not available 24/7, even in tertiary hospitals. Other neonatal and pediatric medical professionals (nurses, doctors, etc.) can make erroneous interpretations of highly complex EEG signals. While artificial intelligence (AI) has been widely used to provide objective decision support for EEG analysis, AI decisions are not always explainable. This work developed a solution to combine AI algorithms with a human-centric intuitive EEG interpretation method. Specifically, EEG is converted to sound using an AI-driven attention mechanism. The perceptual characteristics of seizure events can be heard using this method, and an hour of EEG can be analysed in five seconds. A survey that has been conducted among targeted end-users on a publicly available dataset has demonstrated that not only does it drastically reduce the burden of reviewing the EEG data, but also the obtained accuracy is on par with experienced neurophysiologists trained to interpret neonatal EEG. It is also shown that the proposed communion of a medical professional and AI outperforms AI alone by empowering the human with little or no experience to leverage AI attention mechanisms to enhance the perceptual characteristics of seizure events.


Assuntos
Inteligência Artificial , Epilepsia , Algoritmos , Criança , Eletroencefalografia/métodos , Epilepsia/diagnóstico , Humanos , Recém-Nascido , Convulsões/diagnóstico
8.
Elife ; 112022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35642783

RESUMO

Neuronal KCNQ channels mediate the M-current, a key regulator of membrane excitability in the central and peripheral nervous systems. Mutations in KCNQ2 channels cause severe neurodevelopmental disorders, including epileptic encephalopathies. However, the impact that different mutations have on channel function remains poorly defined, largely because of our limited understanding of the voltage-sensing mechanisms that trigger channel gating. Here, we define the parameters of voltage sensor movements in wt-KCNQ2 and channels bearing epilepsy-associated mutations using cysteine accessibility and voltage clamp fluorometry (VCF). Cysteine modification reveals that a stretch of eight to nine amino acids in the S4 becomes exposed upon voltage sensing domain activation of KCNQ2 channels. VCF shows that the voltage dependence and the time course of S4 movement and channel opening/closing closely correlate. VCF reveals different mechanisms by which different epilepsy-associated mutations affect KCNQ2 channel voltage-dependent gating. This study provides insight into KCNQ2 channel function, which will aid in uncovering the mechanisms underlying channelopathies.


Assuntos
Epilepsia , Canal de Potássio KCNQ2 , Transtornos do Neurodesenvolvimento , Cisteína/genética , Epilepsia/genética , Humanos , Canal de Potássio KCNQ2/genética , Canal de Potássio KCNQ2/metabolismo , Mutação , Transtornos do Neurodesenvolvimento/genética
9.
Epileptic Disord ; 24(3): 567-571, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35653098

RESUMO

17p13.1-2 microdeletion syndrome is a congenital anomaly syndrome with characteristic facial features and multiple malformations. The prevalence of epilepsy with 17p13.1-2 microdeletion is low, with only one case reported for late-onset spasms. Late-onset spasms is one of the rare epilepsy syndromes and one of the developmental epileptic encephalopathies requiring urgent treatment. We experienced two cases of 17p13.1-2 microdeletion syndrome, one of which presented with epileptic spasms in cluster at 18 months of age. EEG showed symmetrical hypsarrhythmia during interictal periods and a paroxysmal fast wave superimposed on widespread slow waves during seizures, leading to the diagnosis of late-onset spasms. Another case had no epilepsy. Comparing the extent of deletion in the two cases with that of previous reports, the involvement of the USP6 gene was suspected. However, the accumulation of additional case reports is needed to confirm the genetic involvement in late-onset spasms.


Assuntos
Anormalidades Múltiplas , Epilepsia , Espasmos Infantis , Deleção Cromossômica , Eletroencefalografia , Epilepsia/complicações , Humanos , Convulsões/complicações , Espasmo , Espasmos Infantis/diagnóstico , Espasmos Infantis/genética , Ubiquitina Tiolesterase
10.
Sci Rep ; 12(1): 10065, 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710825

RESUMO

Epileptic seizures are due to excessive and synchronous neural activity. Extensive modelling of seizures has been done on the neuronal level, but it remains a challenge to scale these models up to whole brain models. Measurements of the brain's activity over several spatiotemporal scales follow a power-law distribution in terms of frequency. During normal brain activity, the power-law exponent is often found to be around 2 for frequencies between a few Hz and up to 150 Hz, but is higher during seizures and for higher frequencies. The Bidomain model has been used with success in modelling the electrical activity of the heart, but has been explored far less in the context of the brain. This study extends previous models of epileptic seizures on the neuronal level to the whole brain using the Bidomain model. Our approach is evaluated in terms of power-law distributions. The electric potentials were simulated in 7 idealized two-dimensional models and 3 three-dimensional patient-specific models derived from magnetic resonance images (MRI). Computed electric potentials were found to follow power-law distributions with slopes ranging from 2 to 5 for frequencies greater than 10-30 Hz.


Assuntos
Epilepsia , Convulsões , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Epilepsia/diagnóstico , Humanos , Neurônios/fisiologia , Convulsões/diagnóstico
11.
Rev Neurol ; 74(12): 383-391, 2022 06 16.
Artigo em Espanhol | MEDLINE | ID: mdl-35698433

RESUMO

INTRODUCTION: Neurocysticercosis (NCC) is the most frequent parasitic disease in the central nervous system of humans. OBJECTIVE: to establish the correlation between clinical and tomographic variables in patients with neurocysticercosis in the neurology consultation of Hospital San Vicente de Paul and Hospital IESS Ibarra, during the year 2020. PATIENTS AND METHODS: descriptive, correlational and cross-sectional research. POPULATION AND SAMPLE: 93 patients. The information was collected in the neurology consultation. Clinical and imaging criteria were used for diagnosis. Odds Ratio (OR; 95% CI) was calculated. For multivariate analysis, binary logistic regression models were used. Statistical significance was considered when the value of p <0.05. SYMPTOMS: headache (77.4%), epilepsy (41.9%). Tomographic findings: size < 1 cm (67.7%), single lesion (54.8%), supratentorial (93.5%). There were several clinical / tomographic correlations in the bivariate analysis, the presence of epilepsy was associated with lesions of size >1 cm (OR: 9.65; 95% CI: 3.48-26.7), the vesicular + ventricular colloidal stage + nodular (OR: 3.90; 95% CI: 1.64-9.28) and parenchymal topography (OR: 5.03; 95% CI: 2.03-12.4) (p < 0.05). In the multivariate analysis, epilepsy was not associated with tomographic aspects such as the size, stage and topography of the cysticerci (p < 0.05). Headache and reduced muscle strength were associated with parenchymal topography and stage of lesions respectively (p < 0.05). CONCLUSIONS: Despite having a wide clinical spectrum, the presence of epilepsy, headache, and reduced muscle strength seem to be the most representative manifestations, so their inclusion in the development of prognostic scores should be evaluated, which allow evaluating the approach diagnostic and evolutionary in subsequent research.


TITLE: Correlación entre variables clínicas y tomográficas en pacientes con neurocisticercosis. Estudio en una cohorte de pacientes de la Sierra Norte ecuatoriana entre 2019 y 2020.Introducción. La neurocisticercosis es la enfermedad parasitaria más frecuente en el sistema nervioso central de los humanos. Objetivo. Establecer la correlación entre variables clínicas y tomográficas en pacientes con neurocisticercosis en la consulta de neurología del Hospital San Vicente de Paúl y el Hospital Instituto Ecuatoriano de Seguridad Social de Ibarra durante 2020. Pacientes y métodos. Investigación descriptiva, correlacional y transversal. Población y muestra: 93 pacientes. La información se recolectó en la consulta de neurología. Para el diagnóstico se utilizaron criterios clínicos e imagenológicos. Se calculó la odds ratio (OR) ­intervalo de confianza al 95% (IC 95%)­. Para el análisis multivariado, se utilizaron modelos de regresión logística binaria. Se consideró significación estadística cuando p menor de 0,05. Resultados. Síntomas: cefalea (77,4%) y crisis epilépticas (41,9%). Hallazgos tomográficos: tamaño menor de 1 cm (67,7%), lesión única (54,8%) y lesión supratentorial (93,5%). Hubo varias correlaciones clinicotomográficas en el análisis bivariado: la presencia de crisis epilépticas se asoció con lesiones de tamaño > 1 cm (OR: 9,65; IC 95%: 3,48-26,7), el estadio vesicular + ventricular coloidal + nodular (OR: 3,9; IC 95%: 1,64-9,28) y la topografía parenquimatosa (OR: 5,03; IC 95%: 2,03-12,4) (p menor de 0,05). La cefalea y la reducción de la fuerza muscular se asociaron con topografía parenquimatosa y estadio de las lesiones, respectivamente (p menor de 0,05). Conclusiones. A pesar de cursar con un amplio espectro clínico, la presencia de crisis epilépticas, cefalea y reducción de la fuerza muscular parece ser la manifestación más representativa, por lo que debería evaluarse su inclusión en el desarrollo de puntuaciones pronósticas que permitan evaluar el enfoque diagnóstico y evolutivo por estudio de imagen en investigaciones posteriores.


Assuntos
Epilepsia , Neurocisticercose , Estudos Transversais , Equador/epidemiologia , Epilepsia/diagnóstico por imagem , Epilepsia/epidemiologia , Epilepsia/etiologia , Cefaleia/complicações , Humanos , Neurocisticercose/complicações , Neurocisticercose/diagnóstico por imagem , Neurocisticercose/epidemiologia
12.
Harefuah ; 161(6): 349-354, 2022 Jun.
Artigo em Hebraico | MEDLINE | ID: mdl-35734790

RESUMO

INTRODUCTION: About one percent (over 81,000 patients) of the Israeli population suffer from epilepsy. The main treatment for this condition is medication, but about a third of the patients suffer from drug-resistant epilepsy (DRE). Each year about 5,000 new patients are diagnosed with epilepsy, of whom 3,000 are children. For these patients, an evaluation in designated centers is required in order to diagnose possible foci and propose neurosurgical treatment alternatives. BACKGROUND: A model for diagnosis and treatment of the epileptic network in a minimally invasive approach is presented through the description of a case study. Phase I: includes diagnosis of the semiology, neuropsychological assessment, video EEG recording and performing a PET-MRI-FMRI-EEG synchronized examination. Phase II: involves stereo-electroencephalography (SEEG) minimally invasive diagnosis to target the epileptic area and accurately map adjacent functional areas and assessment of cortical redundancy. Phase III: includes radiofrequency ablation of the foci without any further surgery. This procedure is performed under clinical monitoring (the patient is awake during treatment) and continuous EEG monitoring. CONCLUSIONS: This case study demonstrates the multi-dimensional model performed by a multidisciplinary team, combining innovative technologies. This model is essential for the precision of the diagnosis and treatment methods of focal epilepsy and allows preservation of function based, among other factors, on the identification of cortical redundancy. DISCUSSION: The preoperative assessment identified focal epilepsy adjacent to the motor area dominating the right hand. A combined PET-FMRI-MRI-EEG examination enabled detecting redundancy of motor functions beyond the epileptic focus. Based on this information, a targeted implantation of depth electrodes (SEEG) was performed, the epileptic foci were identified and targeted ablations were performed during clinical monitoring and continuous EEG. This resulted in the cessation of seizures in parallel with the disappearance of the pathological signal in the EEG, all while preserving the patient's hand function.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsias Parciais , Epilepsia , Criança , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia , Epilepsias Parciais/diagnóstico , Epilepsia/diagnóstico , Epilepsia/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Convulsões
13.
Artigo em Inglês | MEDLINE | ID: mdl-35742766

RESUMO

OBJECTIVE: This study assessed the differentiation of treatment costs with newer and older antiepileptic drugs (AEDs) through its correlation with treatment effectiveness and an adverse event (AE) in pediatric patients with epilepsy (PPE). METHODS: PPE on monotherapy of AEDs for the last 6 months were screened for this study. Seizure frequency during the study was compared with that within 6 months before the study. The following parameters were also assessed: quality of life in epilepsy, Pittsburgh Sleep Quality Index, and Liverpool AEs Profile. An incremental cost-effectiveness ratio (ICER) analysis based on the costs of pharmacotherapy was also performed. RESULTS: Out of 80 PPE, 67 completed the study, and 13 PPE were lost after failing to meet the inclusion criteria. A total of 56.71% of PPE were on newer AEDs, and 43.28% were on older AEDs. Newer and older AEDs did not differ significantly in seizure frequency reduction and quality of life parameters, although these were improved significantly during the study period. As per ICER, newer AEDs need an additional EUR 36.82 per unit reduction in seizure frequency. CONCLUSION: Newer AEDs have comparatively better efficacy, although not significantly better than older AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in pediatric epilepsy treatment.


Assuntos
Anticonvulsivantes , Epilepsia , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Criança , Farmacoeconomia , Epilepsia/induzido quimicamente , Epilepsia/tratamento farmacológico , Humanos , Qualidade de Vida , Convulsões/induzido quimicamente
14.
Int J Mol Sci ; 23(12)2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35742817

RESUMO

Glutamate excitotoxicity induces neuronal cell death during epileptic seizures. Death-associated protein kinase 1 (DAPK1) expression is highly increased in the brains of epilepsy patients; however, the underlying mechanisms by which DAPK1 influences neuronal injury and its therapeutic effect on glutamate excitotoxicity have not been determined. We assessed multiple electroencephalograms and seizure grades and performed biochemical and cell death analyses with cellular and animal models. We applied small molecules and peptides and knocked out and mutated genes to evaluate the therapeutic efficacy of kainic acid (KA), an analog of glutamate-induced neuronal damage. KA administration increased DAPK1 activity by promoting its phosphorylation by activated extracellular signal-regulated kinase (ERK). DAPK1 activation increased seizure severity and neuronal cell death in mice. Selective ERK antagonist treatment, DAPK1 gene ablation, and uncoupling of DAPK1 and ERK peptides led to potent anti-seizure and anti-apoptotic effects in vitro and in vivo. Moreover, a DAPK1 phosphorylation-deficient mutant alleviated glutamate-induced neuronal apoptosis. These results provide novel insight into the pathogenesis of epilepsy and indicate that targeting DAPK1 may be a potential therapeutic strategy for treating epilepsy.


Assuntos
Epilepsia , Ácido Glutâmico , Animais , Proteínas Quinases Associadas com Morte Celular/metabolismo , Epilepsia/genética , MAP Quinases Reguladas por Sinal Extracelular , Ácido Glutâmico/metabolismo , Ácido Glutâmico/toxicidade , Humanos , Ácido Caínico/toxicidade , Camundongos , Convulsões/induzido quimicamente
15.
Int J Mol Sci ; 23(12)2022 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-35742889

RESUMO

Epilepsy is a common chronic neurological disorder in modern society. One of the major unmet challenges is that current antiseizure medications are basically not disease-modifying. Among the multifaceted etiologies of epilepsy, the role of the immune system has attracted considerable attention in recent years. It is known that both innate and adaptive immunity can be activated in response to insults to the central nervous system, leading to seizures. Moreover, the interaction between ion channels, which have a well-established role in epileptogenesis and epilepsy, and the immune system is complex and is being actively investigated. Some examples, including the interaction between ion channels and mTOR pathways, will be discussed in this paper. Furthermore, there has been substantial progress in our understanding of the pathophysiology of epilepsy associated with autoimmune encephalitis, and numerous neural-specific autoantibodies have been found and documented. Early recognition of immune-mediated epilepsy is important, especially in cases of pharmacoresistant epilepsy and in the presence of signs of autoimmune encephalitis, as early intervention with immunotherapy shows promise.


Assuntos
Encefalite , Epilepsia , Doença de Hashimoto , Encefalite/complicações , Epilepsia/diagnóstico , Epilepsia/etiologia , Epilepsia/terapia , Humanos , Canais Iônicos
16.
Molecules ; 27(12)2022 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-35744955

RESUMO

Epilepsy is a chronic neurological disorder that lacks a cure. The use of plant-derived antioxidant molecules such as those contained in turmeric powder and resveratrol may produce short-term anticonvulsant effects. A total of 42 three-month-old male Wistar rats were divided into six groups (n = 7 in each group): Vehicle (purified water), turmeric (150 and 300 mg/kg, respectively), and resveratrol (30 and 60 mg/kg, respectively), administered per os (p.o.) every 24 h for 35 days. Carbamazepine (300 mg/kg/5 days) was used as a pharmacological control for anticonvulsant activity. At the end of the treatment, status epilepticus was induced using the lithium-pilocarpine model [3 mEq/kg, intraperitoneally (i.p.) and 30 mg/kg subcutaneously (s.c.), respectively]. Seizures were evaluated using the Racine scale. The 300 mg/kg of turmeric and 60 mg/kg of resveratrol groups had an increased latency to the first generalized seizure. The groups treated with 150 and 300 mg/kg of turmeric and 60 mg/kg of resveratrol also had an increased latency to status epilepticus and a decreased number of generalized seizures compared to the vehicle group. The chronic administration of turmeric and resveratrol exerts anticonvulsant effects without producing kidney or liver damage. This suggests that both of these natural products of plant origin could work as adjuvants in the treatment of epilepsy.


Assuntos
Epilepsia , Estado Epiléptico , Animais , Anticonvulsivantes/efeitos adversos , Curcuma , Modelos Animais de Doenças , Epilepsia/tratamento farmacológico , Lítio , Masculino , Pilocarpina/toxicidade , Ratos , Ratos Wistar , Resveratrol/farmacologia , Resveratrol/uso terapêutico , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Estado Epiléptico/induzido quimicamente , Estado Epiléptico/tratamento farmacológico
17.
Curr Protoc ; 2(6): e447, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35671160

RESUMO

Traumatic brain injury (TBI) is a leading cause of epilepsy in military persons and civilians. Spontaneous recurrent seizures (SRSs) occur in the months or years following the injury, which is commonly referred to as post-traumatic epilepsy (PTE). Currently, there is no effective treatment or cure for PTE; therefore, there is a critical need to develop animal models to help further understand and assess mechanisms and interventions related to TBI-induced epilepsy. Despite many attempts to induce PTE in animals, success has been limited due to a lack of consistent SRSs after TBI. We present a comprehensive protocol to induce PTE after contusion brain injury in mice, which exhibit robust SRSs along with neurodegeneration and neuroinflammation. This article provides a complete set of protocols for injury, outcomes, troubleshooting, and data analysis. Our broad profiling of a TBI mouse reveals features of progressive, long-lasting epileptic activity, hippocampal sclerosis, and comorbid mood and memory deficits. Overall, the PTE mouse shows striking consistency in recapitulating major hallmark features of human PTE. This mouse model will be helpful in assessing mechanisms of and interventions for TBI-induced epileptogenesis, epilepsy, and neuropsychiatric dysfunction. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Inducing controlled cortical impact injuries Support Protocol: Creating the custom domed camp Basic Protocol 2: Recording long-term video-EEG signals Basic Protocol 3: Analyzing video-EEG recordings.


Assuntos
Lesões Encefálicas Traumáticas , Epilepsia Generalizada , Epilepsia Pós-Traumática , Epilepsia , Animais , Dano Encefálico Crônico/complicações , Lesões Encefálicas Traumáticas/complicações , Modelos Animais de Doenças , Epilepsia/etiologia , Epilepsia Generalizada/complicações , Epilepsia Pós-Traumática/etiologia , Camundongos , Convulsões/etiologia
18.
Neurologia (Engl Ed) ; 37(5): 317-324, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35672118

RESUMO

OBJECTIVE: We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. MATERIAL AND METHODS: We performed a retrospective cohort study including patients aged 0--16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. RESULTS: We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26--143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). CONCLUSIONS: The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.


Assuntos
Epilepsia , Convulsões Febris , Criança , Serviço Hospitalar de Emergência , Epilepsia/complicações , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Humanos , Estudos Retrospectivos , Convulsões Febris/diagnóstico , Convulsões Febris/epidemiologia , Convulsões Febris/etiologia , Punção Espinal/efeitos adversos
19.
Neurologia (Engl Ed) ; 37(5): 325-333, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35672119

RESUMO

INTRODUCTION: Neurofibromatosis type 1 (NF1) is a progressive multisystem disorder following an autosomal dominant inheritance pattern that presents with multiple neurological manifestations. METHODS: We reviewed medical histories of patients with NF1 followed up at our hospital's paediatric neurology department from May 1990 to 31 December 2018. We collected data on neurological symptoms. RESULTS: A total of 128 patients with NF1 were identified. Mean age (SD) at NF1 diagnosis was 4.43 (3.38) years (range, 0.5-14.5 years). There was a slight female predominance (53.1%). Macrocephaly (head circumference over 2 SDs above average for age) was present in 37.5% of cases. Attention-deficit/hyperactivity disorder was recorded in 28.9% of patients (37): combined type in 20 patients, predominantly inattentive in 15, and predominantly impulsive/hyperactive in 2. Other manifestations included headache (18.6%), cognitive impairment (7.8%), motor deficit (6.2%), and epilepsy (4.68%). Brain MRI was performed in 85 patients, revealing T2-weighted hyperintensities in the basal ganglia and/or cerebellum in 60 patients (70.5%), Chiari malformation type 1 in 4 cases, and arachnoid cysts in 3. Optic nerve gliomas were identified by MRI in 22 patients (25.8%). Other MRI findings included plexiform neurofibromas (9.3%) and central nervous system gliomas (3.1%). CONCLUSIONS: The neurological manifestations identified in our sample are consistent with those reported in the literature. Effective transfer strategies from paediatric neurology departments and subsequent clinical follow-up by adult neurology departments are needed to prevent loss to follow-up in adulthood.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Epilepsia , Neurofibromatose 1 , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Cefaleia , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Neurofibromatose 1/complicações
20.
Neurologia (Engl Ed) ; 37(5): 334-345, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35672120

RESUMO

OBJECTIVE: Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS: In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS: The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION: SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsias Parciais , Epilepsia , Adolescente , Adulto , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Eletroencefalografia/métodos , Epilepsias Parciais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas Estereotáxicas , Adulto Jovem
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