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1.
Tohoku J Exp Med ; 246(4): 245-249, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30555128

RESUMO

During a daily neonatology practice, seizures are a continuous challenge as a common neurological disease with a wide range of underlying etiologies, and considerable risks of morbidity and mortality. This study aimed to clarify the rate, etiological factors and outcomes of neonatal seizures, and a possible foresight of neonatal death in Iraq. A prospective cohort study was conducted in neonates with seizures admitted to 3 major neonatology centers in Baghdad, Iraq, from 1st of December 2017 till the end of May 2018. Both term and preterm neonates affected by seizures were recruited with a total number of 203 patients. Perinatal asphyxia (n = 81; 39.90%), infection (n = 77; 37.93%), and metabolic abnormalities (n = 52; 25.62%) were most common causes for seizures. Death occurred in 66 neonates (32.51%), with higher mortality rates found in preterm neonates. Six adverse prognostic indicators were shown to be significant: positive pressure resuscitation, mechanical ventilation, perinatal asphyxia, infection, gestational age (preterm babies), and low birth weight (< 2,500 g). Neonatal seizures may be the first manifestation of neurological insults, and they are most commonly caused by perinatal asphyxia, followed by infection, and metabolic disturbances. Prevention of neonatal seizures is much more important than the treatment of them for the reduction of neonatal mortality. The effective strategies should therefore be proper medical care and management for mothers and neonates before, during and after delivery to prevent neonatal infections, perinatal asphyxia, low birth weight, prematurity, metabolic abnormalities, and other risk factors of neonatal seizures.


Assuntos
Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/terapia , Convulsões/etiologia , Convulsões/terapia , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Iraque/epidemiologia , Masculino , Convulsões/mortalidade , Resultado do Tratamento
2.
Med Sci Monit ; 24: 9292-9299, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30573725

RESUMO

BACKGROUND Drug-resistant epilepsy is a common neurological disease in adults and children. This study aimed to undertake a systematic review of the literature with meta-analysis of the data from published studies to assess the effectiveness of magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) in treatment-resistant epilepsy. MATERIAL AND METHODS The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, MEDLINE, and EMBASE databases were systematically searched for indexed publications in the English language up to May 2018. Data on the prevalence, outcome using the Engel Epilepsy Surgery Outcome Scale (Class I to IV), and postoperative complications were analyzed with 95% confidence intervals (CIs). The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the risk of bias in the included studies. RESULTS Sixteen published studies that included a total of 269 patients with treatment resistant epilepsy were identified. The prevalence of Engel Class I, II, III and IV were 61% (95% CI, 0.54-0.68; I²=14.5%; P=0.302), 12% (95% CI, 0.07-0.16; I²=86.8%; P=0.000), 16% (95% CI, 0.10-0.22; I²=3.0%; P=0.397), and 15% (95% CI, 0.08-0.22; I²=13.2%; P=0.330), respectively. The prevalence of postoperative complications was 24% (95% CI, 0.16-0.32; I2=0%; P=0.629). CONCLUSIONS Meta-analysis of data from 16 studies that included 269 patients with treatment-resistant epilepsy showed that MRI-guided LITT significantly reduced the frequency of seizures and reduced postoperative complications, supporting the safety and effectiveness of MRI-guided LITT in the treatment of drug-resistant epilepsy.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/terapia , Terapia a Laser/métodos , Adolescente , Adulto , Criança , Epilepsia/diagnóstico por imagem , Epilepsia/terapia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Período Pós-Operatório , Convulsões/diagnóstico por imagem , Convulsões/terapia , Resultado do Tratamento
3.
Continuum (Minneap Minn) ; 24(6): 1683-1707, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30516601

RESUMO

PURPOSE OF REVIEW: Status epilepticus, refractory status epilepticus, and super-refractory status epilepticus can be life-threatening conditions. This article presents an overview of the three conditions and discusses their management and outcomes. RECENT FINDINGS: Status epilepticus was previously defined as lasting for 30 minutes or longer but now is more often defined as lasting 5 minutes or longer. A variety of potential causes exist for status epilepticus, refractory status epilepticus, and super-refractory status epilepticus, but all three ultimately involve changes at the cellular and molecular level. Management of patients with status epilepticus generally requires several studies, with EEG of utmost importance given the pathophysiologic changes that can occur during the course of status epilepticus. Status epilepticus is treated with benzodiazepines as first-line antiepileptic drugs, followed by phenytoin, valproic acid, or levetiracetam. If status epilepticus does not resolve, these are followed by an IV anesthetic and then alternative therapies based on limited data/evidence, such as repetitive transcranial magnetic stimulation, therapeutic hypothermia, immunomodulatory agents, and the ketogenic diet. Scores have been developed to help predict the outcome of status epilepticus. Neurologic injury and outcome seem to worsen as the duration of status epilepticus increases, with outcomes generally worse in super-refractory status epilepticus compared to status epilepticus and sometimes also to refractory status epilepticus. SUMMARY: Status epilepticus can be a life-threatening condition associated with multiple complications, including death, and can progress to refractory status epilepticus and super-refractory status epilepticus. More studies are needed to delineate the best management of these three entities.


Assuntos
Gerenciamento Clínico , Epilepsia Resistente a Medicamentos , Estado Epiléptico , Anticonvulsivantes/uso terapêutico , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Estado Epiléptico/diagnóstico por imagem , Estado Epiléptico/epidemiologia , Estado Epiléptico/etiologia , Estado Epiléptico/terapia , Resultado do Tratamento , Adulto Jovem
5.
J Neurosurg Pediatr ; 23(3): 274-284, 2018 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-30544364

RESUMO

OBJECTIVE Drug-resistant epilepsy (DRE) presents a therapeutic challenge in children, necessitating the consideration of multiple treatment options. Although deep brain stimulation (DBS) has been studied in adults with DRE, little evidence is available to guide clinicians regarding the application of this potentially valuable tool in children. Here, the authors present the first systematic review aimed at understanding the safety and efficacy of DBS for DRE in pediatric populations, emphasizing patient selection, device placement and programming, and seizure outcomes. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. Relevant articles were identified from 3 electronic databases (MEDLINE, Embase, and Cochrane CENTRAL) from their inception to November 17, 2017. Inclusion criteria of individual studies were 1) diagnosis of DRE; 2) treatment with DBS; 3) inclusion of at least 1 pediatric patient (age ≤ 18 years); and 4) patient-specific data. Exclusion criteria for the systematic review included 1) missing data for age, DBS target, or seizure freedom; 2) nonhuman subjects; and 3) editorials, abstracts, review articles, and dissertations. RESULTS This review identified 21 studies and 40 unique pediatric patients (ages 4­18 years) who received DBS treatment for epilepsy. There were 18 patients with electrodes placed in the bilateral or unilateral centromedian nucleus of the thalamus (CM) electrodes, 8 patients with bilateral anterior thalamic nucleus (ATN) electrodes, 5 patients with bilateral and unilateral hippocampal electrodes, 3 patients with bilateral subthalamic nucleus (STN) and 1 patient with unilateral STN electrodes, 2 patients with bilateral posteromedial hypothalamus electrodes, 2 patients with unilateral mammillothalamic tract electrodes, and 1 patient with caudal zona incerta electrode placement. Overall, 5 of the 40 (12.5%) patients had an International League Against Epilepsy class I (i.e., seizure-free) outcome, and 34 of the 40 (85%) patients had seizure reduction with DBS stimulation. CONCLUSIONS DBS is an alternative or adjuvant treatment for children with DRE. Prospective registries and future clinical trials are needed to identify the optimal DBS target, although favorable outcomes are reported with both CM and ATN in children. ABBREVIATIONS ATN = anterior thalamic nucleus; CM = centromedian nucleus of the thalamus; DBS = deep brain stimulation; DRE = drug-resistant epilepsy; RNS = responsive neurostimulation; STN = subthalamic nucleus; VNS = vagus nerve stimulation.


Assuntos
Estimulação Encefálica Profunda/métodos , Epilepsia Resistente a Medicamentos/terapia , Adolescente , Criança , Pré-Escolar , Estimulação Encefálica Profunda/efeitos adversos , Epilepsia Resistente a Medicamentos/diagnóstico , Eletrodos Implantados , Feminino , Hipocampo , Humanos , Masculino , Núcleo Subtalâmico , Tálamo , Resultado do Tratamento
6.
Medicine (Baltimore) ; 97(50): e13626, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558048

RESUMO

RATIONALE: Sodium valproate is a widely used antiepileptic drug and also used to prevent postoperative seizures in neurosurgery. Anemia caused by sodium valproate is occasionally reported and most are from pediatric patients. PATIENT CONCERNS: We present the case of a 79-year-old man who developed anemia in the setting of a short-term sodium valproate therapy for the prevention of postoperative seizures. DIAGNOSIS: By testing complete blood count we found anemia and hepatic enzyme elevations arising after 3-week standard dose sodium valproate therapy for preventing postoperative seizures. Our investigations ruled out most of the known causes of anemia including infection, uncontrolled bleeding, underlying systemic disease, malnutrition, immune hemolytic anemia, and neoplasia. On the drug's discontinuation as diagnostic therapy the patient's hemoglobin began to rise spontaneously and liver function returned to normal. Thus anemia secondary to sodium valproate was considered as the most likely diagnosis. INTERVENTIONS: Sodium valproate was suspended and the patient was transfused with concentrated red blood cells. OUTCOMES: The hemoglobin recovered obviously on the drug's discontinuation. LESSONS: Hematologic toxicity of sodium valproate can occur quickly. Regular complete blood count test helps to make prompt diagnosis and drug discontinuation leads to the recovery.


Assuntos
Anemia , Transfusão de Eritrócitos/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Convulsões , Ácido Valproico , Suspensão de Tratamento , Idoso , Anemia/induzido quimicamente , Anemia/diagnóstico , Anemia/terapia , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Humanos , Testes de Função Hepática/métodos , Masculino , Convulsões/etiologia , Convulsões/prevenção & controle , Resultado do Tratamento , Ácido Valproico/administração & dosagem , Ácido Valproico/efeitos adversos
7.
Medicine (Baltimore) ; 97(48): e13247, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30508910

RESUMO

BACKGROUND: Early and/or late onset in patients with brain injury (BI) is associated with a poorer prognosis, and phenytoin (PHT) is standard of care to prevent seizures. Levetiracetam (LEV), an alternative antiepileptic drug, is associated with less cognitive disruption. The purpose of this study was to evaluate the safety and efficacy of LEV in the prevention of brain traumatic seizures with the standard drug PHT. METHODS: Search the publications on comparison the safety and efficacy of LEV against the standard agent PHT in prevention of traumatic seizures in BI to January 2018. After rigorous reviewing on quality, the data were extracted from eligible trials. All trials analyzed the summary hazard ratios of the endpoints of interest. RESULTS: LEV was found not more effective than PHT in terms of overall seizure (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.51-1.05; P = .09), and late seizure (OR = 0.64; 95% CI = 0.34-1.19; P = .16) occurrence. However, there is significant difference in terms of early seizure (OR = 0.63; 95% CI = 0.40-0.99; P = .04). Moreover, there were no significant differences in terms of mortality (OR = 0.67; 95% CI = 0.43-1.05; P = .08), or side effects (OR = 1.31; 95% CI = 0.80-2.15; P = .29) between groups. CONCLUSION: The meta-analysis showed that LEV prevention of seizures was associated with early seizure rates that were lower than the PHT-prolonged course of treatment. There is no statistically significant difference in the efficacy and safety profile of PHT and LEV in cases of traumatic BI.


Assuntos
Anticonvulsivantes/uso terapêutico , Lesões Encefálicas/complicações , Levetiracetam/uso terapêutico , Fenitoína/uso terapêutico , Convulsões/etiologia , Convulsões/prevenção & controle , Anticonvulsivantes/efeitos adversos , Lesões Encefálicas/tratamento farmacológico , Humanos , Levetiracetam/efeitos adversos , Fenitoína/efeitos adversos
8.
Epileptic Disord ; 20(6): 535-540, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30563804

RESUMO

A challenge in treating epilepsy is the accurate documentation of seizure frequency, which is needed in order to assess the benefits of ongoing treatment. We present a 17-year-old girl who underwent video-based monitoring in order to establish an accurate seizure count before and after the implantation of a vagus nerve stimulator to treat refractory epilepsy. The results show a reduction in disabling seizure types after vagus nerve stimulator implantation and highlight the inconsistencies between the reported and actual seizure count in this patient. Our case adds to the recognised issue of inaccurate seizure documentation. [Published with video sequence on www.epilepticdisorders.com].


Assuntos
Convulsões/diagnóstico , Estimulação do Nervo Vago/métodos , Gravação em Vídeo , Adolescente , Eletroencefalografia , Feminino , Humanos , Convulsões/terapia , Resultado do Tratamento
9.
Curr Sports Med Rep ; 17(12): 425-432, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30531459

RESUMO

Children with chronic medical conditions face many challenges when considering sport participation. Compared with their healthy counterparts, they are often discouraged from physical activity or sports participation because of real or perceived limitations imposed by their condition. Prescribed exercise should be based on the demands of the sport, the effect of the disease on performance, and the potential for exercise-induced acute or chronic worsening of the illness or disability. This article will focus on several examples of chronic medical conditions and the clinician's role in providing advice about sport participation.


Assuntos
Doença Crônica/terapia , Pessoas com Deficiência , Exercício Físico , Promoção da Saúde/métodos , Artrite Juvenil/fisiopatologia , Artrite Juvenil/terapia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/fisiopatologia , Transtorno do Espectro Autista/terapia , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/terapia , Criança , Fibrose Cística/fisiopatologia , Fibrose Cística/terapia , Epilepsia/fisiopatologia , Epilepsia/terapia , Hemofilia A/fisiopatologia , Hemofilia A/terapia , Humanos , Doenças Neuromusculares/fisiopatologia , Doenças Neuromusculares/terapia , Traço Falciforme/fisiopatologia , Traço Falciforme/terapia , Medicina Esportiva
11.
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
12.
Curr Biol ; 28(24): 3893-3902.e4, 2018 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30503621

RESUMO

Mood disorders cause significant morbidity and mortality, and existing therapies fail 20%-30% of patients. Deep brain stimulation (DBS) is an emerging treatment for refractory mood disorders, but its success depends critically on target selection. DBS focused on known targets within mood-related frontostriatal and limbic circuits has been variably efficacious. Here, we examine the effects of stimulation in orbitofrontal cortex (OFC), a key hub for mood-related circuitry that has not been well characterized as a stimulation target. We studied 25 subjects with epilepsy who were implanted with intracranial electrodes for seizure localization. Baseline depression traits ranged from mild to severe. We serially assayed mood state over several days using a validated questionnaire. Continuous electrocorticography enabled investigation of neurophysiological correlates of mood-state changes. We used implanted electrodes to stimulate OFC and other brain regions while collecting verbal mood reports and questionnaire scores. We found that unilateral stimulation of the lateral OFC produced acute, dose-dependent mood-state improvement in subjects with moderate-to-severe baseline depression. Stimulation suppressed low-frequency power in OFC, mirroring neurophysiological features that were associated with positive mood states during natural mood fluctuation. Stimulation potentiated single-pulse-evoked responses in OFC and modulated activity within distributed structures implicated in mood regulation. Behavioral responses to stimulation did not include hypomania and indicated an acute restoration to non-depressed mood state. Together, these findings indicate that lateral OFC stimulation broadly modulates mood-related circuitry to improve mood state in depressed patients, revealing lateral OFC as a promising new target for therapeutic brain stimulation in mood disorders.


Assuntos
Afeto , Estimulação Encefálica Profunda , Depressão/prevenção & controle , Estimulação Elétrica , Adulto , Depressão/psicologia , Eletrodos Implantados , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Infect Dis Poverty ; 7(1): 114, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30501640

RESUMO

BACKGROUND: A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon, including Bilomo and Kelleng. We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin (CDTI). METHODS: Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018. Epilepsy was diagnosed using a 2-step approach: administration of a standardized 5-item questionnaire followed by confirmation by a neurologist. Previously published diagnostic criteria for onchocerciasis-associated epilepsy (OAE) were used. Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission. Findings were compared with previous data from these two villages. RESULTS: A total of 1525 individuals (1321 in Bilomo and 204 in Kelleng) in 233 households were surveyed in both villages. The crude prevalence of epilepsy was 4.6% in Bilomo (2017) and 7.8% in Kelleng (2018), including 12 (15.6% of cases) persons with epilepsy (PWE) with nodding seizures. The age and sex-standardized prevalence in Kelleng decreased from 13.5% in 2004 to 9.3% in 2018 (P < 0.001). The median age of PWE shifted from 17 (IQR: 12-22) years to 24 (IQR: 20-30) years in Bilomo (P < 0.001); and slightly from 24 (IQR: 14-34) years to 28 (IQR: 21.25-36.75) years in Kelleng (P = 0.112). Furthermore, 47.6% of all tested children between 7 and 10 years had Ov16 antibodies. CONCLUSIONS: There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages. The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents. Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures. Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs.


Assuntos
Epilepsia/etiologia , Ivermectina/uso terapêutico , Oncocercose/complicações , Rios , Adolescente , Adulto , Antiparasitários/uso terapêutico , Camarões/epidemiologia , Criança , Pré-Escolar , Epilepsia/epidemiologia , Epilepsia/prevenção & controle , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Oncocercose/epidemiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
15.
Epilepsy Behav ; 88S: 25-32, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30558717

RESUMO

Epilepsy is often associated with comorbid psychiatric illnesses that can significantly impact its long-term course. The most frequent of these psychiatric comorbidities is major depressive disorder, which affects an estimated 40% of patients with epilepsy. Many patients are underdiagnosed or undertreated, yet managing their mood symptoms is critical to improving their outcomes. When conventional psychiatric treatments fail in the management of depression, neuromodulation techniques may offer promise, including electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), and repetitive transcranial magnetic stimulation (rTMS), as discussed in this review. "This article is part of the Supplement issue Neurostimulation for Epilepsy."


Assuntos
Transtorno Depressivo Maior/terapia , Epilepsia Resistente a Medicamentos/terapia , Eletroconvulsoterapia/métodos , Neuroestimuladores Implantáveis , Ensaios Clínicos como Assunto/métodos , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia Resistente a Medicamentos/psicologia , Eletroconvulsoterapia/instrumentação , Humanos , Psicoterapia/instrumentação , Psicoterapia/métodos , Estimulação Magnética Transcraniana/instrumentação , Estimulação Magnética Transcraniana/métodos , Estimulação do Nervo Vago/instrumentação , Estimulação do Nervo Vago/métodos
16.
Farm. hosp ; 42(6): 251-260, nov.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174853

RESUMO

Objetivo: El objetivo del presente trabajo es resumir el tratamiento inmunológico de las enfermedades neurológicas, describiendo la situación actual y los retos y oportunidades que se presentan en un futuro próximo. Método: Se realiza un análisis bibliográfico para, tras clasificar topográficamente las patologías neurológicas autoinmunes, presentar las más relevantes según las opciones inmunoterapéuticas disponibles. Asimismo, se exponen otras enfermedades neurológicas que serán nuevas candidatas a terapia inmunológica en el futuro. Resultados: Existen múltiples patologías neurológicas con base autoinmune, aunque su fisiopatología, a veces, solo sea parcialmente conocida. Sin embargo, pocos son los ensayos clínicos aleatorizados y controlados que soportan la evidencia de los tratamientos inmunológicos con los que las tratamos. Esta situación está cambiando rápidamente en enfermedades como la esclerosis múltiple, donde ensayos clínicos con un nivel de evidencia grado 1 son la norma. La enfermedad de Alzheimer y la migraña son algunas de las más prevalentes que se están incorporando al grupo de candidatas a inmunoterapia. Conclusiones: Con un número rápidamente creciente de terapias inmunológicas y de enfermedades neurológicas potencialmente tratables por esta vía, será necesaria una adecuada evaluación del impacto sociosanitario que van a conllevar para llegar a compromisos y consensos por parte de todos los actores implicados en su manejo


Objective: The objective of this work is to summarize the immunological treatment of neurological diseases, describing the present situation and the challenges and opportunities the future will present. Method: After topographically classifying the autoimmune neurological pathologies, a bibliographic analysis is made to present the most relevant ones regarding the available immunotherapeutic options. Likewise, new neurological entities that will be future candidates for immunotherapy are discussed. Results: There is a large number of neurological diseases with an autoimmune basis, even though their pathophysiology is, sometimes, only partially understood. Only a few randomized controlled clinical trials support the evidence of the immunotherapies with which we treat some of these diseases. This situation is rapidly changing among entities like multiple sclerosis where level 1 of evidence clinical studies are today's standard. Alzheimer's disease and migraine are two of the most prevalent conditions that are being incorporated to the group of diseases candidates for immunotherapy. Conclusions: Taking into account the rapidly growing number of immunological therapies and of neurological diseases potentially receiving them, an adequate evaluation of the impact these treatments will have on social and healthcare system grounds is necessary to reach compromises and consensus among all the professionals involved in the management of these pathologies


Assuntos
Humanos , Doenças do Sistema Nervoso/terapia , Imunoterapia/métodos , Doenças Autoimunes/terapia , Doenças do Sistema Nervoso/imunologia , Imunoterapia/tendências , Esclerose Múltipla/terapia , Neuromielite Óptica/terapia , Doença de Alzheimer/terapia , Transtornos de Enxaqueca/terapia , Transtornos dos Movimentos/terapia , Epilepsia/terapia , Encefalopatias/terapia , Doenças do Sistema Nervoso Periférico/terapia
17.
Seizure ; 63: 1-6, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30391660

RESUMO

PURPOSE: Epileptic seizures are a common manifestation of autoimmune encephalitis, but the role of neural antibodies in long-term epilepsy remains unclear. The aim of this study was to assess the prevalence of neural-surface antibodies (NSAbs) and antibodies against glutamic acid decarboxylase (GAD) in patients with chronic temporal lobe epilepsy (TLE). METHOD: Patients with an electro-clinical diagnosis of TLE and a disease duration longer than one year were included. NSAbs (LGI1, CASPR2, AMPAR1/2, NMDAR, GABABR) and antibodies against GAD were detected. Only patients with significant antibody levels in serum, and/or positivity in CSF (according to antibody subtype), were enrolled in the seropositive group. Cohorts of seropositive and seronegative patients were compared regarding clinical and imaging data. RESULTS: Significant serum levels of antibodies were detected in eight out of 163 (5%) TLE patients (CASPR2 n = 2, GAD n = 3, LGI1 n = 2, and GABABR n = 1). In four of them, antibodies were detected in the CSF as well (CASPR2 in one, GAD in three). Five seropositive patients had uni- or bilateral temporal lobe lesions on MRI and three patients were non-lesional. All seropositive patients had TLE of unknown cause. Seropositive patients had higher age at epilepsy onset and autoimmune comorbidity, but did not differ in other clinical, EEG or neuroimaging characteristics. Response to immunotherapy (seizure reduction >50%) was observed in three of the six patients treated. CONCLUSIONS: Besides older age at epilepsy onset and autoimmune comorbidity, seropositive patients cannot be distinguished from seronegative patients on the basis of clinical, EEG or neuroimaging data.


Assuntos
Autoanticorpos/sangue , Epilepsia do Lobo Temporal/epidemiologia , Epilepsia do Lobo Temporal/fisiopatologia , Glutamato Descarboxilase/imunologia , Proteínas do Tecido Nervoso/imunologia , Adulto , Idade de Início , Idoso , Doenças Autoimunes/complicações , Doenças Autoimunes/epidemiologia , Doença Crônica , Comorbidade , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/terapia , Feminino , Humanos , Imunoterapia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos
18.
J Laryngol Otol ; 132(11): 1036-1038, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30394239

RESUMO

BACKGROUND: The benefit of mandibular advancement devices in patients with sleep-disordered breathing and as a potential option for obstructive sleep apnoea syndrome is well recognised. Their use in the setting of epilepsy or other seizure disorders is typically contraindicated.Case reportA 48-year-old patient with a history of poorly controlled epilepsy and obstructive sleep apnoea syndrome was referred for ENT review for possible tracheostomy. The patient was wheelchair-bound with 24-hour continuous positive airway pressure, but sleep studies demonstrated persistent, severe episodes of apnoea and notable sleep disturbance. Sleep nasendoscopy demonstrated marked improvement on capnography with the laryngeal mask airway in situ, and this was maintained with mandibular advancement using jaw thrust following removal of the laryngeal mask airway. A mandibular advancement device was subsequently trialled; this had no subjective benefit for the patient, but the seizures resolved and control of apnoea was achieved with the combination of a mandibular advancement device and continuous positive airway pressure. CONCLUSION: This paper highlights a novel application of mandibular advancement devices, used in combination with continuous positive airway pressure, which resulted in complete resolution of sleep deprivation and apnoea-induced epileptic events.


Assuntos
Epilepsia/terapia , Avanço Mandibular/instrumentação , Apneia Obstrutiva do Sono/terapia , Terapia Combinada , Pressão Positiva Contínua nas Vias Aéreas , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Epilepsy Res ; 148: 90-95, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30396007

RESUMO

OBJECTIVE: We report the frequency of seizure, its possible mechanisms and effect of seizure on the outcome of tuberculous meningitis (TBM). METHODS: Seventy-nine patients with TBM admitted during 2014-2017 were evaluated. The seizures were categorized as per International League Against Epilepsy as well as into early (within 1 month of meningitis) and late (>1 month) seizure. The possible association of seizures was recorded and the outcome was assessed using modified Rankin Scale (mRS ≤ 2 as good, and mRS > 2 as poor). RESULTS: The median age was 27 (18-76) years and 43 (54.4%) of whom were females. Tuberculous meningitis was definite in 31 (39.2%) and highly probable in the remaining. Seizures occurred in 27 (34.2%): early onset in 8 (29.6%) and late in 19 (70.4%) patients. The seizures were focal in 11(13.9%), focal to bilateral in 9 (11.4%), generalised tonic clonic in 7 (8.9%) and status epilepticus in 6 (7.6%) patients. Early seizures were associated with meningeal irritation and late seizures with tuberculoma, infarction and hyponatremia (P = 0.01). Seizure did not affect the mortality but were associated with worse six months outcome (P = 0.03). CONCLUSION: Seizures occurred in 34% patients with TBM and were associated with poor outcome at six months.


Assuntos
Convulsões/epidemiologia , Tuberculose Meníngea/epidemiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia , Resultado do Tratamento , Tuberculose Meníngea/fisiopatologia , Tuberculose Meníngea/terapia , Adulto Jovem
20.
Seizure ; 63: 40-47, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30399460

RESUMO

PURPOSE: To report the leadership role and change activities of epilepsy specialist nurses (ESNs) in Ireland; findings from the SENsE study. METHOD: A mixed methods study design was used, involving 12 epilepsy specialist nurses working in five units in Ireland, 24multidisciplinary team members working with them, and 35 people with epilepsy and their family members. Data were collected using individual and focus group interviews, observation and documentary analysis. RESULTS: Five key areas in which ESNs demonstrated leading on the change agenda were identified. These included: Initiating new clinical practice developments; Building capability within the multidisciplinary team; Developing education programmes and resources for people with epilepsy, family and the public; Exerting influence through membership of committees and lobbying; and Advancing the ESN role. CONCLUSION: Though the epilepsy specialist nurse role was first established in the UK in 1988, much of the literature that discusses or describes the ESN role is founded on anecdotal evidence, or focusses on their clinical expertise. Findings from this study provide empirical evidence that the ESNs were involved as key players in leading changes within the services, in the education of others, and the continuous advancement of epilepsy care.


Assuntos
Epilepsia/terapia , Enfermeiras Especialistas , Melhoria de Qualidade , Família , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Irlanda , Liderança , Manobras Políticas , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto
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