scholarly journals Serial case report of high seizure threshold patients that responded to the lengthening of pulse width in ECT

2021 ◽  
Author(s):  
Hiroshi Katagai ◽  
Norio Yasui‐Furukori ◽  
Hirotsugu Kawashima ◽  
Taro Suwa ◽  
Chieko Tsushima ◽  
...  
Keyword(s):  
Case Report ◽  
Pulse Width ◽  
Seizure Threshold

Use of ultrabrief pulse width electroconvulsive therapy to induce therapeutic seizures in an elderly patient with a high seizure threshold: a case report

2019 ◽  
Vol 28 (3) ◽  
pp. 291-296
Author(s):  
David Plevin ◽  
Susan Waite
Keyword(s):  
Case Report ◽  
Electroconvulsive Therapy ◽  
Pulse Width ◽  
Depressive Illness ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Augmentation Strategies ◽  
Seizure Quality ◽  
Unipolar Major Depression

Objective: This case report describes a 73-year-old man suffering from unipolar major depression with melancholic features, in whom treatment with electroconvulsive therapy (ECT) proved difficult due to inadequate seizure generation. Methods: A number of augmentation strategies were trialled in an attempt to improve seizure quality. Pre-ECT and Post-ECT measurement of symptoms, quality of life and cognition were undertaken with a variety of validated scales. Results: The single most efficacious strategy to elicit therapeutic seizures was the use of right unilateral (RUL) electrode placement with an ultrabrief pulse width. The patient subsequently had a resolution of his depressive illness, with a concomitant improvement in cognitive functioning. Conclusion: This case demonstrates that a number of ECT augmentation strategies can be used in routine clinical practice for patients with high seizure thresholds. It highlights that UB pulse width may be considered earlier in the treatment course for patients in whom conventional brief pulse ECT fails to generate effective seizures.

scholarly journals New Onset Focal Seizure Following COVID-19 Vaccination: Case Report

2021 ◽  
Author(s):  
Chun Seng Phua ◽  
Shalini Bhaskar ◽  
Azman Ali Raymond
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Focal Seizure ◽  
Seizure Threshold ◽  
Hippocampal Atrophy ◽  
Case Presentation ◽  
Mri Brain ◽  
Focal Seizures ◽  
Patient’S History ◽  
New Onset

Abstract IntroductionAs more novel COVID-19 vaccines are being rolled out in a frantic pace globally, any complication that might be related to COVID-19 vaccines should be highlighted, especially since COVID-19 vaccines are relatively new, and side effects may yet to be fully elucidated. We report a case of a healthy 18-year-old male who presented with new onset focal seizures 5 days after receiving 1st dose of Oxford/AstraZeneca COVID-19 vaccine. Case PresentationThe patient was treated with intravenous phenytoin and oral levetiracetam 250mg twice daily with no further events. There was no documented fever. CT venogram and EEG were unremarkable. MRI brain revealed generalised atrophy including mild bilateral hippocampal atrophy with no evidence of sclerosis. There was no predilection for seizures identified from the patient’s history. The patient was discharged the following day on levetiracetam and advised to proceed with the 2nd dose of Oxford/AstraZeneca COVID-19 vaccination in 3 months’ time.ConclusionSeizures following COVID-19 vaccination have only been reported in a handful of cases. COVID-19 vaccination could lower seizure threshold, or unmask an underlying predisposition for epilepsy. As most COVID-19 vaccines worldwide are given in 2 doses, clinicians should consider maintaining patients on anti-seizure drugs if vaccination was thought to be a provoking factor.

Phenytoin-Induced Paradoxical Seizures and Blood Dyscrasias in a Patient Receiving Rapid Intravenous Infusion: A Case Report

2019 ◽  
pp. 089719001989486
Author(s):  
Pooja Sudarsan ◽  
Resia Varghese ◽  
Aneena Suresh ◽  
Arun Radhakrishnan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Normal Saline ◽  
Intravenous Infusion ◽  
Hematological Parameters ◽  
Serum Levels ◽  
Blood Parameters ◽  
Seizure Threshold ◽  
Dose Titration

Paradoxical seizure is an unusual reaction of seizure aggravation or change in its pattern due to antiepileptics. Decrease in seizure threshold with phenytoin is bound to occur with an increase in serum levels. We herein report a 51-year-old female, who was brought to the intensive care unit with complaints of episodic seizures and frothing. She is a known case of tonic–clonic epilepsy on oral phenytoin 100 mg for past 6 months. Rapid intravenous infusion of 700 mg phenytoin in 100 mL normal saline over a rate of 15 minutes was initiated on admission. This was followed by a sudden abnormality of her baseline blood parameters and an occurrence of paradoxical seizure. The dose of phenytoin was tapered which reversed her condition. The patient was followed up regularly and monitored for fluctuations in her hematological parameters. The mainstay treatment for phenytoin-induced paradoxical seizure and blood dyscrasias is to monitor the patient and dose titration. Dosing of phenytoin remains a challenge for all clinicians which increase the need for such reports.

Lowering the seizure threshold in electroconvulsive therapy using transcranial magnetic stimulation: A case report

2019 ◽  
Vol 12 (3) ◽  
pp. 781-784 ◽  
Author(s):  
J. Albrecht ◽  
J. Buday ◽  
T. Mareš ◽  
L. Kališová ◽  
J. Raboch ◽  
...  
Keyword(s):  
Case Report ◽  
Transcranial Magnetic Stimulation ◽  
Electroconvulsive Therapy ◽  
Magnetic Stimulation ◽  
Seizure Threshold

scholarly journals Speed of response in ultrabrief and brief pulse width right unilateral ECT

2013 ◽  
Vol 16 (4) ◽  
pp. 755-761 ◽  
Author(s):  
Colleen K. Loo ◽  
Joshua B. B. Garfield ◽  
Natalie Katalinic ◽  
Isaac Schweitzer ◽  
Dusan Hadzi-Pavlovic
Keyword(s):  
Pulse Width ◽  
Cox Regression ◽  
Similar Efficacy ◽  
Seizure Threshold ◽  
Speed Of Response ◽  
Two Samples ◽  
Blinded Study ◽  
Remission Rates ◽  
Univariate Analyses ◽  
Cognitive Side Effects

Abstract Ultrabrief pulse width stimulation electroconvulsive therapy (ECT) results in less cognitive side-effects than brief pulse ECT, but recent work suggests that more treatment sessions may be required to achieve similar efficacy. In this retrospective analysis of subjects pooled from three research studies, time to improvement was analysed in 150 depressed subjects who received right unilateral ECT with a brief pulse width (at five times seizure threshold) or ultrabrief pulse width (at six times seizure threshold). Multivariate Cox regression analyses compared the number of treatments required for 50% reduction in depression scores (i.e. speed of response) in these two samples. The analyses controlled for clinical, demographic and treatment variables that differed between the samples or that were found to be significant predictors of speed of response in univariate analyses. In the multivariate analysis, older age predicted faster speed of response. There was a non-significant trend for faster time to 50% improvement with brief pulse ECT (p = 0.067). Remission rates were higher after brief pulse ECT than ultrabrief pulse ECT (p = 0.007) but response rates were similar. This study, the largest of its kind reported to date, suggests that fewer treatments may be needed to attain response with brief than ultrabrief pulse ECT and that remission rates are higher with brief pulse ECT. Further research with a larger randomized and blinded study is recommended.

scholarly journals Mastication Muscle Suppression by the Mandibular Branch of Trigeminal Nerve Catheter-Based, Ultrasound-Guided Block: A Case Report

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Fardin Yousefshahi ◽  
Juan Francisco Asenjo ◽  
Hossein Majedi
Keyword(s):  
Case Report ◽  
Nerve Block ◽  
Mandibular Nerve ◽  
Seizure Threshold ◽  
Partial Seizures ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Seizure Focus ◽  
Out Of Plane ◽  
Continuous Block

Introduction: Ultrasound-guided nerve blocks have enhanced our abilities to selectively and effectively suppress certain nerves to accomplish specific goals, including blockade a localized seizure muscle movement without affecting the seizure threshold or level of the consciousness. Case Presentation: This is a case report of the blockade of the movement of a chewing muscle by the continuous (catheter-based) mandibular nerve block in a 27 years old man with high-frequency partial seizures in facial muscles who was a candidate for seizure focus ablation. An out-of-plane approach was used to insert a catheter near the mandibular nerve to provide intermittent or continuous peripheral nerve block. This report demonstrated that a continuous block of the mandibular nerve could effectively facilitate the seizure focus mapping and ablation. Conclusions: We can selectively suppress the contractures of a certain muscle in partial seizures by a continuous block of the responsible nerve. This blockade can facilitate seizure focus mapping and ablation.

scholarly journals Non-epileptic seizure caused by selective serotonin reuptake inhibitors (SSRI) - case report

2021 ◽  
Author(s):  
André Douglas Marinho da Silva ◽  
Ana Caroline Fonseca Silva ◽  
Lucas Pablo Almendro ◽  
Pedro da Cunha Dantas
Keyword(s):  
Case Report ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Medication Management ◽  
Antidepressant Drugs ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Seizure Threshold ◽  
Seizure Event ◽  
Patient Reported

Context: Seizures are the most frequent clinical emergency neurological manifestation, corresponding to 1-5% of the visits, except for trauma. Several conditions have the potential to reduce the seizure threshold, and the use of antidepressant drugs as selective serotonin reuptake inhibitors is one of those reported. The seizure triggering risk related to SSRIs use is low, being 0.1%, perceptibly lower than that of tricyclic antidepressants, with a 1% rate. Case report: Male patient, previously healthy, 23-year-old, was seen at the Emergency Room in Rio Branco after a generalized seizure lasting 3 minutes. Complementary exams, including computed tomography, were all normal. Magnetic resonance imaging of the skull without atypical findings and electroencephalogram showed dysrhythmia by waves and discrete spicules. Patient reported using escitalopram (esc) 20mg for 3 months after 10mg progression dose, in use for 1 year, without clinical improvement. Due to the seizure event, medication management was switched for sertraline 50mg intake. After 2 months, the patient had a new generalized seizure, preceded by prolonged depersonalization. Complementary exams were normal, 10mg of esc was reestablished and the patient ceased with the seizures. Conclusions: The diagnostic hypothesis: patient’s seizure threshold is low, and seizures are triggered by SSRI higher doses adverse effect. Due to case rarity and SSRI efficacy and tolerance, it is suggested to encourage the discussion about administration safety of these drugs.

scholarly journals Initial Seizure Threshold in Ultra-Brief Pulse Width Right Unilateral Electroconvulsive Therapy

2020 ◽  
Vol 59 (4) ◽  
pp. 311
Author(s):  
Hyo Seob Kim ◽  
Sam Yi Shin ◽  
Seong Hoon Jeong ◽  
Yeni Kim ◽  
Tak Youn ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Pulse Width ◽  
Seizure Threshold

Misophonia: An Evidence-Based Case Report

2020 ◽  
Vol 29 (4) ◽  
pp. 685-690
Author(s):  
C. S. Vanaja ◽  
Miriam Soni Abigail
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Case History ◽  
Pure Tone ◽  
Physiological Responses ◽  
Evidence Based ◽  
Management Option ◽  
Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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