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OBJECTIVE: This study was undertaken by the Epilepsy Subcommittee of the Japanese Society of General Hospital Psychiatry (JSGHP) to explore the challenges faced by psychiatrists in treating epilepsy and the difficulties encountered during the transition of patients with epilepsy (PWE) from pediatric to adult care. METHODS: An online survey targeting 1,980 JSGHP-affiliated psychiatrists was conducted from May to July 2022. The participants were asked to complete a questionnaire on epilepsy care. We analyzed the factors associated with participant hesitancy to treat epilepsy and their professional characteristics. RESULTS: Responses were obtained from 545 of the 1,980 solicited psychiatrists (response rate: 27.5 %). The mean number of years of clinical experience in psychiatry was 20.9 ± 10.3 years. A majority of the psychiatrists were hesitant toward treating epilepsy (89.2 %) and managing the transition of PWE from pediatric services to adult care (83.3 %). Logistic regression analysis showed that the absence of hesitation toward epilepsy treatment was significantly associated with years of clinical experience in psychiatry (OR: 1.05, p = 0.002), being a board-certified epileptologist (OR: 4.36, p = 0.037), having colleagues who are specialists in epilepsy care that may be consulted in the workplace (OR: 2.12, p = 0.027), and general confidence in managing PWE transition from pediatric to adult care (OR 3.54, p < 0.001). Confidence in managing the transition was positively correlated with being a board-certified psychiatrist of the Japanese Society of Psychiatry and Neurology (OR: 4.55, p = 0.048), being a board-certified psychiatrist of the JSGHP (OR: 1.75, p = 0.034), treating six or more PWE per month (OR: 3.54; 95 % CI, p < 0.001), and overall confidence in treating epilepsy (OR: 3.38, p < 0.001). CONCLUSIONS: Alleviation of reluctance to providing epilepsy care and managing the process of transition are correlated; however, the factors influencing each are distinct. To reduce resistance to epilepsy treatment, enhancing the knowledge of epilepsy and creating an environment conducive to consultations are essential. Improving transition-related outcomes, having substantial psychiatric expertise, and increasing opportunities to treat PWE are of great significance. The integration of these approaches may enable psychiatrists to alleviate hesitancy towards epilepsy care and enhance both treatment and transitional care modalities.
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BACKGROUND: Epilepsy causes substantial psychological distress and anxiety, primarily due to seizures. However, the impact of stress responses and changes in arousal and their association with anxiety patterns in patients with epilepsy (PWE) remains unclear. This study aimed to investigate the relationships among seizures, stress and arousal characteristics, and trait and state anxiety characteristics in PWE. METHODS: Our sample consisted of 159 outpatients with epilepsy recruited from five institutions in Japan in 2020. Participants completed the State-Trait Anxiety Inventory-Form JYZ (STAI) and the Japanese-Stress Arousal Check List (J-SACL). We analyzed the correlations between inventory scores and clinical information. Using principal component analysis (PCA), we derived epilepsy-specific stress/arousal characteristics, which accounted for high arousal and low-stress levels, termed epilepsy-specific stress or arousal response (ESAR), from the J-SACL scores. We conducted a mediation analysis to assess the mediating role of ESAR in the relationship between traits and state anxiety. RESULTS: We found significant correlations between J-SACL stress and arousal factors (r = -0.845, p < 0.001), ESAR and seizure frequency (r = -0.29, p < 0.001), ESAR and trait anxiety scores on the STAI (r = -0.77, p < 0.0001), and ESAR and state anxiety scores on the STAI (r = -0.60, p < 0.0001). Mediation analysis supported by the Monte Carlo method revealed that ESAR significantly mediated the association between trait and state anxiety. CONCLUSIONS: These findings elucidate the epilepsy-specific stress and arousal characteristics and their roles in mediating traits and state anxiety. These results may reflect the long-term clinical course and unique emotion recognition tendencies in epilepsy.
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Transient epileptic amnesia (TEA) is a special type of temporal lobe epilepsy, the main symptom of which is recurrent amnesia attacks. In the late 1990s, Zeman et al. developed the following diagnostic criteria for TEA: (i) recurrent, witnessed episodes of amnesia; (ii) other cognitive functions remain intact during attacks; and (iii) evidence of epilepsy. It was subsequently reported that patients with TEA almost always demonstrate two other types of memory symptoms: accelerated long-term forgetting (ALF) and autobiographical amnesia (AbA). As a result, it has been recognised that TEA causes at least three characteristic types of amnesia, that is, amnesia attacks, ALF, and AbA. In this report, we present two clinical cases, in which the patients showed symptoms of ALF and/or AbA without suffering any type of epileptic seizure, including amnesia attacks, for a long time. We discuss a syndrome associated with TEA, particularly the relationship between TEA and ALF/AbA, based on our two cases and a review of the literature. In addition, we propose a new clinical entity, which we named 'transient epileptic amnesia complex syndrome (TEACS)' and will help to ensure that physicians recognise the existence of such cases and do not overlook this condition. Furthermore, the following diagnostic criteria for TEACS are proposed. (i) The patient is middle-aged to elderly at onset and has no history of epilepsy. (ii) ALF and/or AbA have been definitively diagnosed. (iii) The ALF and/or AbA precede TEA attacks and/or other epileptic seizures. (iv) Except for the ALF/AbA, the patient's cognitive functions are confirmed to be intact via clinical examinations. (v) There is evidence for a diagnosis of epilepsy. Such evidence can include: (i) wake or sleep electroencephalography; or (ii) a clear response to anti-epileptic drugs. Furthermore, we describe our hypotheses regarding the pathogenesis of ALF/AbA and discuss the relationships between TEACS and other epileptic amnesia-related syndromes.
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Amnésia , Epilepsia , Idoso , Amnésia/diagnóstico , Epilepsia/complicações , Epilepsia/diagnóstico , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Convulsões , SíndromeRESUMO
OBJECTIVE: To evaluate efficacy and safety of lacosamide (up to 12 mg/kg/day or 400 mg/day) as adjunctive treatment for uncontrolled primary generalised tonic-clonic seizures (PGTCS) in patients (≥4 years) with idiopathic generalised epilepsy (IGE). METHODS: Phase 3, double-blind, randomised, placebo-controlled trial (SP0982; NCT02408523) in patients with IGE and PGTCS taking 1-3 concomitant antiepileptic drugs. Primary outcome was time to second PGTCS during 24-week treatment. RESULTS: 242 patients were randomised and received ≥1 dose of trial medication (lacosamide/placebo: n=121/n=121). Patients (mean age: 27.7 years; 58.7% female) had a history of generalised-onset seizures (tonic-clonic 99.6%; myoclonic 38.8%; absence 37.2%). Median treatment duration with lacosamide/placebo was 143/65 days. Risk of developing a second PGTCS during 24-week treatment was significantly lower with lacosamide than placebo (Kaplan-Meier survival estimates 55.27%/33.37%; HR 0.540, 95% CI 0.377 to 0.774; p<0.001; n=118/n=121). Median time to second PGTCS could not be estimated for lacosamide (>50% of patients did not experience a second PGTCS) and was 77.0 days for placebo. Kaplan-Meier estimated freedom from PGTCS at end of the 24-week treatment period (day 166) for lacosamide/placebo was 31.3%/17.2% (difference 14.1%; p=0.011). More patients on lacosamide than placebo had ≥50% (68.1%/46.3%) or ≥75% (57.1%/36.4%) reduction from baseline in PGTCS frequency/28 days, or observed freedom from PGTCS during treatment (27.5%/13.2%) (n=119/n=121). 96/121 (79.3%) patients on lacosamide had treatment-emergent adverse events (placebo 79/121 (65.3%)), most commonly dizziness (23.1%), somnolence (16.5%), headache (14.0%). No patients died during the trial. CONCLUSIONS: Lacosamide was efficacious and generally safe as adjunctive treatment for uncontrolled PGTCS in patients with IGE.
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Anticonvulsivantes/uso terapêutico , Epilepsia Generalizada/tratamento farmacológico , Lacosamida/uso terapêutico , Adolescente , Adulto , Idoso , Tontura/induzido quimicamente , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Cefaleia/induzido quimicamente , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Convulsões/tratamento farmacológico , Sonolência , Resultado do Tratamento , Adulto JovemRESUMO
The mental health of patients with epilepsy represents a substantial public health concern in Japan. For instance, the Japanese term for epilepsy, "tenkan", has the negative meaning of "mad" and "a violent temperament that is apt to be infatuated". Although epilepsy is now understood as a disease caused by abnormal neuronal activity in the brain, discrimination and stigma against people with epilepsy remain deeply rooted in Japanese culture. Understandably, this stigma can have a serious impact on the psychology and behavior of individuals with epilepsy. To our knowledge, no studies have clarified the formation process or examined the treatment of self-stigma in patients with epilepsy in Japan. Characterizing coping strategies and examining methods for reducing self-stigma will increase our understanding of the experiences of patients and facilitate effective psychiatric rehabilitation. Accordingly, the purpose of our study was to investigate the quality and degree of cognition regarding self-stigma and to examine coping strategies in patients with epilepsy living in the community. The participants were psychiatric outpatients aged 20-65â¯years who had been diagnosed with epilepsy and visited our psychiatric outpatient clinic between October 1 and December 31, 2016. We conducted semi-structured interviews with 20 patients who consented to participate. For data analysis, we used the content analysis method proposed. Our study revealed details of self-stigma in patients with epilepsy. Patients and their families are often aware of the presence of this self-stigma, and many do not know how to address it. In this study, we qualitatively examined self-stigma in patients with epilepsy on the basis of patient narratives. Per our findings, we would like to examine intervention methods for reducing self-stigma in patients with epilepsy.
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Epilepsia/epidemiologia , Epilepsia/psicologia , Entrevista Psicológica/normas , Pesquisa Qualitativa , Autoimagem , Estigma Social , Adaptação Psicológica/fisiologia , Adulto , Conscientização/fisiologia , Centros Comunitários de Saúde Mental/normas , Epilepsia/terapia , Feminino , Humanos , Entrevista Psicológica/métodos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Adulto JovemRESUMO
BACKGROUND: Chronic hypersensitivity pneumonitis (CHP) is characterized by lymphocytic inflammation and progressive fibrosis of the lung caused by a variety of inhaled antigens. Due to the difficulty of accurately diagnosing CHP, and the poor prognosis associated with the condition, a novel clinical biomarker is urgently needed. OBJECTIVE: To investigate the usefulness of C-C motif chemokine ligand 15 (CCL15), which had been demonstrated to highly express in the lungs of CHP patients, as a clinical biomarker for CHP. METHOD: Immunohistochemical investigations were performed on lung tissue from CHP patients, and CCL15 levels in serum and bronchoalveolar lavage fluid (BALF) were measured via the enzyme-linked immunosorbent assay. RESULTS: Immunohistochemistry investigations revealed high CCL15 expression in the lungs of CHP patients. Serum CCL15 levels in CHP patients (29.1 ± 2.1 µg/mL) were significantly higher than those of idiopathic pulmonary fibrosis patients (19.7 ± 1.3 µg/mL, p = 0.01) and healthy subjects (19.5 ± 1.7 µg/mL, p = 0.003). When BALF CCL15 level was divided by BALF albumin (Alb) level (BALF CCL15/Alb), it was significantly inversely correlated with forced vital capacity (ß = -0.47, p = 0.0006), percentage of predicted carbon monoxide diffusion capacity of the lung (ß = -0.41, p = 0.0048), and BALF lymphocyte count (ß = -0.34, p = 0.01) in CHP patients. Multivariate Cox proportional hazards analysis revealed that high BALF CCL15/Alb and poor prognosis were statistically significantly independently correlated in CHP patients (HR 1.1, 95% CI 1.03-1.18, p = 0.004). CONCLUSION: The results of the current study suggest that CCL15 may be a useful prognostic biomarker for CHP. CCL15 was highly expressed in the lung tissue of CHP patients, and BALF CCL15/Alb was significantly associated with CHP prognosis.
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Alveolite Alérgica Extrínseca/metabolismo , Quimiocinas CC/metabolismo , Fibrose Pulmonar Idiopática/metabolismo , Pulmão/metabolismo , Proteínas Inflamatórias de Macrófagos/metabolismo , Idoso , Albuminas/metabolismo , Alveolite Alérgica Extrínseca/fisiopatologia , Biópsia , Líquido da Lavagem Broncoalveolar/química , Estudos de Casos e Controles , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imuno-Histoquímica , Macrófagos Alveolares/metabolismo , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Plasmócitos/metabolismo , Prognóstico , Modelos de Riscos Proporcionais , Capacidade de Difusão Pulmonar , Índice de Gravidade de Doença , Capacidade VitalRESUMO
BACKGROUND: Periostin and squamous cell carcinoma antigen (SCCA) are involved in the pathogenesis of asthma. Acute bronchitis due to respiratory syncytial virus (RSV) infection during infancy exhibits an asthma-like pathogenesis, suggesting that it may be associated with the subsequent development of asthma. However, the mechanism by which RSV infection leads to development of asthma has not yet been fully elucidated. METHODS: Infants younger than 36 months were enrolled and classified into three groups. Group I included patients hospitalized with RSV-induced bronchitis. These patients were further stratified into two sub-groups according to whether the criteria for the modified Asthma Predictive Index (mAPI) had been met: Group I consisted of mAPI (+) and mAPI (-) patients; Group II included patients with food allergy as a positive control group; and Group III included children with no allergy as a negative control group. Serum periostin and SCCA levels were measured in the groups. This study was registered as a clinical trial (UMIN000012339). RESULTS: We enrolled 14 subjects in Group I mAPI (+), 22 in Group I mAPI (-), 18 in Group II, and 18 in Group III. In Group I, the serum periostin and SCCA levels were significantly higher during the acute phase compared with the recovery phase. However, no significant differences were found between Group I mAPI (+) and mAPI (-). CONCLUSIONS: The serum periostin and SCCA levels increased during acute RSV bronchitis. Both periostin and SCCA may play a role in the pathogenesis of acute bronchitis due to RSV.
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Antígenos de Neoplasias/sangue , Bronquite/sangue , Bronquite/virologia , Moléculas de Adesão Celular/sangue , Infecções por Vírus Respiratório Sincicial/sangue , Serpinas/sangue , Asma/sangue , Asma/virologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Infecções por Vírus Respiratório Sincicial/complicações , Regulação para CimaRESUMO
BACKGROUNDS: With Japan's globalization, maternal-child health care for foreign mothers is highly necessary. We examined postpartum depressive symptoms in foreign mothers in Japan and the factors associated with such symptoms, particularly social support. METHOD: A cross-sectional study was conducted for Japanese and foreign mothers at 3 to 4 months postpartum. The Edinburgh Postnatal Depression Scale was used to evaluate postpartum depression symptom, and social support was evaluated by support type and provider. Multiple regression analyses was used. RESULTS: Data from 97 Japanese mothers and 68 foreign mothers were analyzed. The average score of Edinburgh Postnatal Depression Scale for foreign mothers was 7.5, significantly higher than that for Japanese mothers (4.2). Financial circumstances, spouse-partners' emotional support, and families' informational support were significantly related to foreign mothers' postpartum depressive symptoms. CONCLUSION: Postpartum depression symptoms were more common among foreign mothers than among Japanese mothers. Medical personnel should encourage such mothers to obtain more social support from their spouse-partners and family.
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Depressão Pós-Parto/psicologia , Emigrantes e Imigrantes , Apoio Social , Adulto , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Mães/psicologiaRESUMO
Epilepsy with the main symptom of amnesia is known as transient epileptic amnesia (TEA). Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia. The concept that Lewy body disease includes Parkinson's disease with dementia and dementia with Lewy bodies was proposed in the 2005 revision of the Clinical Diagnostic Criteria. Here, we describe a woman with cognitive impairment, olfactory dysfunction, and reduced 123 I-meta-iodobenzylguanidine uptake on myocardial scintigraphy. The patient and her family and friends were unaware of parkinsonism, visual hallucinations, or epilepsy for a long period. After syncope occurred twice within a short interval, electroencephalography revealed sharp waves from the bilateral frontal to parietal lobes, indicating a diagnosis of TEA. The present case prompted us to compare the symptoms of TEA with the clinical diagnostic criteria for dementia with Lewy bodies, revealing their similarities. We also discuss whether Lewy body disease may cause TEA rather than having an incidental association with it.
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Amnésia/diagnóstico , Doença por Corpos de Lewy/diagnóstico , Convulsões/diagnóstico , 3-Iodobenzilguanidina/metabolismo , Idoso , Amnésia/complicações , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Transtornos Cognitivos/etiologia , Eletroencefalografia , Feminino , Alucinações/complicações , Humanos , Levetiracetam , Doença por Corpos de Lewy/tratamento farmacológico , Imagem de Perfusão do Miocárdio , Transtornos Parkinsonianos/complicações , Piracetam/administração & dosagem , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Convulsões/complicações , Convulsões/tratamento farmacológico , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
BACKGROUND: There are some biomarkers for asthma diagnosis but they are often difficult in clinical use, particularly in pediatric cases. Periostin is an extracellular matrix protein, upregulated in response to IL-4 or IL-13. Serum periostin is expected to be used as a non-invasive biomarker for asthma diagnosis and management. METHODS: Twenty-eight children with asthma (BA) and 27 children without asthma (patients with pectus excavatum, etc. as control group) aged 6-16 years were included. Bronchial asthma was diagnosed according to International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Fractional exhaled nitric oxide (FeNO), lung function, blood eosinophil counts, total immunoglobulin E (IgE) levels, and serum periostin levels were assessed. Results were compared between BA and controls. Asthma diagnostic accuracies were calculated using receiver operating characteristics (ROC) curve analyses. RESULTS: Serum periostin levels in the BA group were significantly higher than those in the control group [medians (with interquartile ranges), 134.0 (116.3-166.3) vs. 112.0 (97.0-132.0) ng/ml; p = 0.012]. The area under the ROC curve (AUC) for periostin, FeNO, and eosinophil counts were 0.70, 0.72, and 0.84, respectively. After the exclusion of controls with pectus excavatum, AUC for periostin, forced expiratory volume in 1 s (FEV1 ), and maximum mid-expiratory flow rate (MMF) were 0.75, 0.74, and 0.80, respectively. CONCLUSION: Serum periostin levels were significantly higher in children with asthma. ROC AUC values for periostin were equivalent to conventional biomarkers, including FeNO levels and lung function testing, indicating the utility of serum periostin levels in diagnosing asthma in children.
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Asma/diagnóstico , Biomarcadores/sangue , Moléculas de Adesão Celular/sangue , Adolescente , Antígenos de Neoplasias/sangue , Biomarcadores/metabolismo , Criança , Eosinófilos/citologia , Feminino , Humanos , Imunoglobulina E/sangue , Interleucina-13/sangue , Interleucina-4/sangue , Contagem de Leucócitos , Masculino , Óxido Nítrico/metabolismo , Serpinas/sangue , EspirometriaRESUMO
Graph theory is an emerging method to investigate brain networks. Altered cerebral blood flow (CBF) has frequently been reported in temporal lobe epilepsy (TLE), but graph theoretical findings of CBF are poorly understood. Here, we explored graph theoretical networks of CBF in TLE using arterial spin labeling imaging. We recruited patients with TLE and unilateral hippocampal sclerosis (HS) (19 patients with left TLE, and 21 with right TLE) and 20 gender- and age-matched healthy control subjects. We obtained all participants' CBF maps using pseudo-continuous arterial spin labeling and analyzed them using the Graph Analysis Toolbox (GAT) software program. As a result, compared to the controls, the patients with left TLE showed a significantly low clustering coefficient (p=0.024), local efficiency (p=0.001), global efficiency (p=0.010), and high transitivity (p=0.015), whereas the patients with right TLE showed significantly high assortativity (p=0.046) and transitivity (p=0.011). The group with right TLE also had high characteristic path length values (p=0.085), low global efficiency (p=0.078), and low resilience to targeted attack (p=0.101) at a trend level. Lower normalized clustering coefficient (p=0.081) in the left TLE and higher normalized characteristic path length (p=0.089) in the right TLE were found also at a trend level. Both the patients with left and right TLE showed significantly decreased clustering in similar areas, i.e., the cingulate gyri, precuneus, and occipital lobe. Our findings revealed differing left-right network metrics in which an inefficient CBF network in left TLE and vulnerability to irritation in right TLE are suggested. The left-right common finding of regional decreased clustering might reflect impaired default-mode networks in TLE.
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Circulação Cerebrovascular/fisiologia , Epilepsia do Lobo Temporal/fisiopatologia , Hipocampo/patologia , Lobo Temporal/patologia , Adulto , Mapeamento Encefálico/métodos , Epilepsia do Lobo Temporal/patologia , Feminino , Hipocampo/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose/patologia , Esclerose/fisiopatologia , Software , Lobo Temporal/fisiopatologiaRESUMO
The International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new-onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of any difficulties identified. By canvassing the breadth and depth of scope of neuropsychological assessment, this report demonstrates the pivotal role played by this noninvasive and minimally resource intensive investigation in the care of people with epilepsy.
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Comitês Consultivos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Epilepsia , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Neuropsicologia , Comitês Consultivos/organização & administração , Comitês Consultivos/normas , Comitês Consultivos/tendências , Epilepsia/complicações , Epilepsia/psicologia , Epilepsia/terapia , Humanos , Cooperação Internacional , Testes Neuropsicológicos , Reprodutibilidade dos TestesRESUMO
Women with epilepsy are exposed to social stigma, and they have anxiety and lose self-confidence in their social role as a woman. Psychiatrists, especially female psychiatrists, are able to support them. Important considerations are: 1) Pre-pregnant counseling; Physicians give appropriate advice and guidance. We need to provide the latest information on the teratogenicity of AEDs, and replace them with a safer combination of AEDs BEFORE pregnancy. Folate supplementation is also recommended. 2) Management during pregnancy: Patients are advised to adhere to taking AEDs as instructed, which prevents not only seizures during pregnancy but also reduces the risk of miscarriage and premature delivery. Doses of AED are to be increased after the second trimester. 3) Collaborating with obstetricians at delivery: Obstetricians are also nervous when faced with women with epilepsy. Basically, patients can deliver spontaneously, and the correct way to deal with unexpected seizures during labor should be fully understood. 4) Parental care: women with epilepsy can breastfeed. Physicians advise other family members on how to bottle feed at night to help mothers avoid a lack of sleep due to breastfeeding. Childcare is one of the most precious experiences in life. Patients with epilepsy, especially women, have a lower self-esteem; however, once they experience delivery, they act positively and become even-tempered. Physicians should be aware that childcare fosters a profound insight into their lives, allowing them to mature as a person.
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Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Epilepsia , Transtornos Mentais/induzido quimicamente , Complicações na Gravidez , Cuidado Pré-Natal , Apoio Social , Adulto , Criança , Educação Infantil , Pré-Escolar , Anticoncepcionais Orais , Interações Medicamentosas , Epilepsia/tratamento farmacológico , Epilepsia/genética , Epilepsia/psicologia , Feminino , Monitorização Fetal , Ácido Fólico/administração & dosagem , Aconselhamento Genético , Humanos , Lactente , Recém-Nascido , Transtornos Mentais/epidemiologia , Transtornos Mentais/prevenção & controle , Medicina de Precisão , Gravidez , Resultado da Gravidez , Efeitos Tardios da Exposição Pré-Natal , RiscoRESUMO
Epilepsy was defined conceptually in 2005 as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. This definition is usually practically applied as having two unprovoked seizures >24 h apart. The International League Against Epilepsy (ILAE) accepted recommendations of a task force altering the practical definition for special circumstances that do not meet the two unprovoked seizures criteria. The task force proposed that epilepsy be considered to be a disease of the brain defined by any of the following conditions: (1) At least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Epilepsy is considered to be resolved for individuals who either had an age-dependent epilepsy syndrome but are now past the applicable age or who have remained seizure-free for the last 10 years and off antiseizure medicines for at least the last 5 years. "Resolved" is not necessarily identical to the conventional view of "remission or "cure." Different practical definitions may be formed and used for various specific purposes. This revised definition of epilepsy brings the term in concordance with common use. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Comitês Consultivos , Epilepsia/classificação , Epilepsia/diagnóstico , Relatório de Pesquisa , Sociedades Médicas , Adulto , Comitês Consultivos/tendências , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Criança , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Relatório de Pesquisa/tendências , Convulsões/classificação , Convulsões/diagnóstico , Convulsões/fisiopatologia , Sociedades Médicas/tendências , Adulto JovemRESUMO
Periodic lateralised epileptiform discharges (PLEDs) are uncommon transient electroencephalographic findings accompanied by acute brain lesions. A small proportion of PLEDs persist for more than three months and are called "chronic" PLEDs, the pathophysiology of which is still debated. Herein, we report a man with right hemispheric PLEDs which lasted for more than 14 months and mild left hemispatial neglect after he experienced status epilepticus. Although MRI was normal, positron emission tomography revealed right temporo-parieto-occipital hypometabolism, which coincided with the source area of PLEDs estimated by magnetoencephalography. In addition, levels of anti-N-methyl-D-aspartate (NMDA) receptor antibodies and granzyme B were found to be high in the cerebrospinal fluid. Following two courses of steroid pulse therapy, the patient's left spatial neglect improved and the PLEDs were partially resolved. These findings suggest that the chronic PLEDs present in this case were an interictal phenomenon and that their pathophysiology involved autoimmune processes.
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Autoanticorpos/imunologia , Epilepsia/imunologia , Epilepsia/fisiopatologia , Receptores de N-Metil-D-Aspartato/imunologia , Anti-Inflamatórios/uso terapêutico , Anticonvulsivantes/uso terapêutico , Autoanticorpos/líquido cefalorraquidiano , Epilepsia/líquido cefalorraquidiano , Lateralidade Funcional/fisiologia , Granzimas/imunologia , Humanos , Imageamento por Ressonância Magnética , Magnetoencefalografia , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Tomografia por Emissão de PósitronsRESUMO
The common problems faced by adult patients with epilepsy are different from those facing pediatric patients. When adults with epilepsy work, marry, and give birth, they must deal with problems that they never experienced in childhood, such as gaining drivers licenses and accessing various medical and welfare services, in addition to the potential complications involved with their disease. Therefore, medical transitions from pediatric to adult care of epilepsy are crucial to ensuring that patients have a high quality of life. To solve the underlying problems that can block efficient transitions, we propose cooperation not only between pediatric neurologists and adult neurologists but between these practitioners and those from other disciplines, such as psychiatrists. We also argue that collaboration among relevant societies and national education programs is necessary.
Assuntos
Epilepsia , Transição para Assistência do Adulto , Adolescente , Adulto , Comportamento Cooperativo , Feminino , Educação em Saúde , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Neurologia , Pediatria , Médicos , Psiquiatria , Qualidade de Vida , Apoio Social , Adulto JovemRESUMO
The role of ferroptosis in steatohepatitis development is largely unknown. We investigated (1) whether hepatocyte ferroptosis occurs in a gene-modified steatohepatitis model without modifying dietary components, (2) whether ferroptosis occurs at an early stage of steatohepatitis, and (3) whether apomorphine, recently reported as a ferroptosis inhibitor, can ameliorate steatohepatitis. Hepatocyte-specific PTEN KO mice were used. Huh 7 and primary cultured hepatocytes isolated from the mice were used in this study. The number of dead cells increased in 10-week-old PTEN KO mice. This cell death was suppressed by the administration of ferroptosis inhibitor ferrostatin-1 for 2 weeks. Apomorphine also ameliorated the severity of steatohepatitis. Treatment with ferroptosis inhibitors, including apomorphine, decreases the level of lipid peroxidase. Apomorphine suppressed cell death induced by RSL-3 (a ferroptosis inducer), which was not suppressed by apoptosis or necroptosis inhibitors. Apomorphine showed a radical trapping capacity with much more potent activity than ferrostatin-1 and Trolox, a soluble form of vitamin E. In addition, apomorphine activated nrf2 and its downstream genes, including HO-1 and xCT. In conclusion, ferroptosis occurs in steatohepatitis from an early stage in PTEN KO mice. In addition, apomorphine ameliorates the severity of steatohepatitis by inhibiting ferroptosis.
RESUMO
Experiential auditory hallucinations have been reported in patients with epilepsy. We report the case of a 46-year-old woman with a history of more than three years of experiential auditory hallucinations caused by chronic epileptic discharges, which developed after radiotherapy for an oligoastrocytoma in the left temporal lobe. Electroencephalography revealed frequent spikes in the left temporal lobe. In response to clonazepam, but not antipsychotics, her auditory hallucinations almost completely disappeared and spikes were reduced. Her auditory hallucinations exhibited the characteristics of first-rank symptoms of schizophrenia, however, the content of experiential auditory hallucinations endured by our patient suggested an epileptic origin. We believe that the persistent subictal discharges, in combination with hyperexcitability of the temporal neocortex near radiation-induced necrotic lesions, were the cause of the auditory hallucinations.