scholarly journals Long-Term Undiagnosed Nonconvulsive Status Epilepticus Identified by Urgent Electroencephalography with Hyperventilation Activation

2020 ◽  
Vol 12 (2) ◽  
pp. 153-159
Author(s):  
Go Taniguchi ◽  
Katsura Masaki ◽  
Shinsuke Kondo ◽  
Masato Yumoto ◽  
Kiyoto Kasai
Keyword(s):  
Status Epilepticus ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
Relevant Literature ◽  
Nonconvulsive Status Epilepticus ◽  
Seizure Type ◽  
Continuous Electroencephalography ◽  
Clinically Significant ◽  
Patients With Epilepsy

Nonconvulsive status epilepticus (NCSE) might be underdiagnosed in cases where clinical symptoms are ambiguous. If a patient exhibits ictal psychiatric symptoms such as NCSE presentation and is misdiagnosed as having a psychiatric disorder, the patient may be treated in psychiatry settings, where continuous electroencephalography (cEEG), the gold standard for NCSE diagnosis, is typically not used. Herein, we report our experience with a patient having NCSE who exhibited psychiatric symptoms and remained misdiagnosed for many years. We also included a brief review of the relevant literature. Our experience with this patient presents two clinically significant points: (1) clinicians should consider NCSE in the differential diagnosis of interictal psychosis when patients with epilepsy, in whom the seizure type is unknown, repeatedly present transient psychiatric symptoms, and (2) urgent EEG with hyperventilation activation during acute periods may help diagnose patients with suspected NCSE.

New possibilities in the treatment of uterine body myomas – HIFU-technology

2017 ◽  
pp. 47-51
Author(s):  
T.M. Kozarenko ◽  
◽  
I.Yu. Karacharova ◽  
V.N. Goncharenko ◽  
A.N. Klyusov ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
The Body ◽  
Uterine Myoma ◽  
Long Term Results ◽  
Clinical Material ◽  
General Effect ◽  
Non Invasive ◽  
Ultrasound Ablation ◽  
Clinically Significant

The technology of HIFU-ablation has a number of advantages in comparison with other methods of treatment of patients with uterine myoma, since it is non-invasive, organ-preserving, has no clinically significant general effect on the body, is not accompanied by a long period of rehabilitation and temporary disability. The objective: was to increase the effectiveness of treatment of women with uterine myoma by optimizing the protocols of ultrasound ablation. Patients and methods. The clinical material consisted of 90 remote ultrasound ablations for women diagnosed with «symptomatic myoma of the uterus body», which were performed at KMECC, the Center for Nuclear Medicine. The procedure was carried out on a JC apparatus (manufactured by: Chongqing Haifu (HIFU) Technology Co., Ltd., China). Results. The power during treatment was 350±70 W, the total energy was 282 487±47 650 J, the average time of insonation was 765±137 s. With dynamic observation, the regression of the volume of myoma nodes on average averaged 25±14.6% after 1 month, 33±12.9% after 3 months, and 61±17.8% after 6 months. But 4 (9,7%) patients had an unsatisfactory effect after the procedure, and the treatment was continued. All patients recorded a decrease in clinical symptoms already in the first month after the procedure. When the procedure was performed, 5 (12.2%) patients had a first-degree skin burn, 14 (34.1%) women had a short-term increase in body temperature to 37.6°C on the day of the procedure, which stabilized independently in for 3 days, in 1 (2.4%) – cystitis. The conclusion. The method is selective, does not damage surrounding tissues, thereby being safe for the endometrium, which is important for maintaining fertility. The area of fibrosis, which is formed after treatment and the regression process of the myoma node, is safe for further gestation. For the clinical evaluation of this method, its impact on the quality of life, immediate and long-term results, further accumulation and analysis of the clinical material is necessary. Key words: uterine myoma, local adenomyosis, ultrasonic ablation, HIFU-technology, treatment.

The Evolution of Subclinical Seizures in Children With Tuberous Sclerosis Complex

2019 ◽  
Vol 34 (12) ◽  
pp. 770-777 ◽  
Author(s):  
Anne-Elise C. de Groen ◽  
Jeffrey Bolton ◽  
Ann Marie Bergin ◽  
Mustafa Sahin ◽  
Jurriaan M. Peters
Keyword(s):  
Status Epilepticus ◽  
Tuberous Sclerosis ◽  
Tuberous Sclerosis Complex ◽  
Clinical Symptoms ◽  
Seizure Type ◽  
Epileptic Spasms ◽  
Clinical Seizure ◽  
Eeg Data ◽  
Electrographic Seizures ◽  
Region Match

Background:Subclinical seizures are electrographic seizures that present without subjective or objective clinical symptoms. In tuberous sclerosis complex, it is not known whether subclinical seizures occur alone, forewarn, or coexist with clinical seizures. To address this knowledge gap, we studied the prevalence and evolution of subclinical seizures in tuberous sclerosis complex.Methods:We retrospectively reviewed electroencephalography (EEG) data from our tuberous sclerosis complex clinic with subclinical seizures and clinical seizures in a blinded fashion. Based on EEG location and ictal pattern, subclinical seizures were classified as having a clinical counterpart from the same epileptogenic region (match) or not (no match).Results:Of 208 children with tuberous sclerosis complex, 138 had epilepsy and available EEG data. Subclinical seizures were detected in 26 of 138 (19%) children. Twenty-four children had both subclinical seizures and clinical seizures captured on EEG. In 13 of 24, subclinical seizures were detected as a novel, not previously recorded seizure type. In these children, subclinical seizures preceded matching clinical seizures in 4 (31%) within a median time of 4.5 months (range 2-14), whereas 9 (69%) never had any matching clinical seizure. In 11 of 24 children, subclinical seizures were not novel and could be matched to a previously recorded clinical seizure. Matching seizure types were focal (n = 10, 67%), tonic (n = 2), epileptic spasms (n = 2), and status epilepticus (n = 1).Conclusions:Subclinical seizures occur in one-fifth of children with tuberous sclerosis complex and epilepsy, and match with clinical seizures in a small majority. In a third of patients presenting with a novel subclinical seizure, matching clinical seizures follow.

Long-term behavioral and morphological consequences of nonconvulsive status epilepticus in rats

2004 ◽  
Vol 5 (2) ◽  
pp. 180-191 ◽  
Author(s):  
Pavel Kršek ◽  
Anna Mikulecká ◽  
Rastislav Druga ◽  
Hana Kubová ◽  
Zdeněk Hliňák ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Nonconvulsive Status Epilepticus

scholarly journals New Insights of Phospholipase A2 Associated Neurodegeneration Phenotype Based on the Long-Term Follow-Up of a Large Hungarian Family

2021 ◽  
Vol 12 ◽  
Author(s):  
Renata Toth-Bencsik ◽  
Peter Balicza ◽  
Edina Timea Varga ◽  
Andras Lengyel ◽  
Gabor Rudas ◽  
...  
Keyword(s):  
Phospholipase A2 ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
Cerebellar Atrophy ◽  
Neuroaxonal Dystrophy ◽  
Presenting Symptoms ◽  
Age Related ◽  
The Family

IntroductionPhospholipase A2-associated Neurodegeneration (PLAN) is a group of neurodegenerative diseases associated with the alterations of PLA2G6. Some phenotype-genotype association are well known but there is no clear explanation why some cases can be classified into distinct subgroups, while others follow a continuous clinical spectrum.MethodsLong-term neurological, and psychiatric follow-up, neuropathological, radiological, and genetic examinations, were performed in three affected girls and their family.ResultsTwo 24-years old twins and their 22-years old sister harbored the p.P622S, and p.R600W mutation in PLA2G6. The age of onset and the most prominent presenting symptoms (gaze palsy, ataxia, dystonia, psychomotor regression indicated atypical neuroaxonal dystrophy (ANAD), however, optic atrophy, severe tetraparesis would fit into infantile neuroaxonal dystrophy (INAD). All siblings had hyperintensity in the globi pallidi and substantiae nigrae which is reported in ANAD, whereas it is considered a later neuroradiological marker in INAD. The slow progression, rigidity, bradykinesis, and the prominent psychiatric symptoms indicate PLA2G6-related dystonia-parkinsonism. Abnormal mitochondria, lipid accumulation and axonal spheroids were observed in the muscle and nerve tissue. Brain deposition appeared 6 years following the initial cerebellar atrophy. Mild MRI alterations were detected in the asymptomatic carrier parents.ConclusionThe colorful clinical symptoms, the slightly discordant phenotype, and the neuroimaging data in the family supports the view that despite the distinct definition of age-related phenotypes in PLAN, these are not strict disease categories, but rather a continuous phenotypic spectrum. The mild MRI alterations of the parents and the family history suggest that even heterozygous pathogenic variants might be associated with clinical symptoms, although systematic study is needed to prove this.

scholarly journals The antidepressant standoff: why it continues and how to resolve it

2019 ◽  
Vol 50 (2) ◽  
pp. 177-186 ◽  
Author(s):  
Johan Ormel ◽  
Philip Spinhoven ◽  
Ymkje Anna de Vries ◽  
Angélique O. J. Cramer ◽  
Greg J. Siegle ◽  
...  
Keyword(s):  
Acute Phase ◽  
Relevant Literature ◽  
Number Needed To Treat ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Psychological Treatments ◽  
Analysis And Synthesis ◽  
Health Significance ◽  
Clinically Significant

AbstractBackgroundAntidepressant medications (ADMs) are widely used and long-term use is increasing. Given this extensive use and recommendation of ADMs in guidelines, one would expect ADMs to be universally considered effective. Surprisingly, that is not the case; fierce debate on their benefits and harms continues. This editorial seeks to understand why the controversy continues and how consensus can be achieved.Methods‘Position’ paper. Critical analysis and synthesis of relevant literature.ResultsAdvocates point at ADMs impressive effect size (number needed to treat, NNT = 6–8) in acute phase treatment and continuation/maintenance ADM treatment prevention relapse/recurrence in acute phase ADM responders (NNT = 3–4). Critics point at the limited clinically significant surplus value of ADMs relative to placebo and argue that effectiveness is overstated. We identified multiple factors that fuel the controversy: certainty of evidence is low to moderate; modest efficacy on top of strong placebo effects allows critics to focus on small net efficacy and advocates on large gross efficacy; ADM withdrawal symptoms masquerade as relapse/recurrence; lack of association between ADM treatment and long-term outcome in observational databases. Similar problems affect psychological treatments as well, but less so. We recommend four approaches to resolve the controversy: (1) placebo-controlled trials with relevant long-term outcome assessments, (2) inventive analyses of observational databases, (3) patient cohort studies including effect moderators to improve personalized treatment, and (4) psychological treatments as universal first-line treatment step.ConclusionsGiven the public health significance of depression and increased long-term ADM usage, new approaches are needed to resolve the controversy.

scholarly journals Case Report: Hypopituitarism Presenting With Nonconvulsive Status Epilepticus

2021 ◽  
Vol 12 ◽  
Author(s):  
Huimin Li ◽  
Lina Xu ◽  
Fengbing Yang ◽  
Longbin Jia ◽  
Hongjiang Cheng ◽  
...  
Keyword(s):  
Case Report ◽  
Status Epilepticus ◽  
Female Patient ◽  
Clinical Symptoms ◽  
Hormone Replacement ◽  
Nonconvulsive Status Epilepticus ◽  
Pituitary Hormone ◽  
Initial Symptom ◽  
Epileptic Discharges ◽  
Magnetic Resonance Imaging Mri

Introduction: Hypopituitarism is defined as one or more partial or complete pituitary hormone deficiencies. Nonconvulsive status epilepticus (NCSE) refers to a state of continuous or repetitive seizures without convulsions. In this paper, we review a case of an old female patient with hypopituitarism who presented with NCSE, which is rare in the clinic.Case Report: This paper describes a 67-year-old female patient with hypopituitarism who presented as NCSE. She had surgical resection of pituitary tumor half a year before the seizures and did not get regular hormone replacement therapy. She presented general convulsive status epilepsy as the initial symptom and got sedation and antiepileptic drug in the emergency room. The seizure was terminated but the patient fell in coma in the following days. The patient had magnetic resonance imaging (MRI) and other inspects, and EEG showed epileptic discharges. Combining these clinical symptoms and examinations, we made the diagnosis of NCSE. Finally, she regained consciousness after the treatment with diazepam.Conclusion: This case report and literature review investigated the possible mechanism of hypopituitarism presenting with NCSE.

Hashimoto encephalopathy

2013 ◽  
Vol 154 (33) ◽  
pp. 1312-1316 ◽  
Author(s):  
Gábor Pocsay ◽  
Andrea Gazdag ◽  
József Engelhardt ◽  
István Szaniszló ◽  
Zoltán Szolnoki ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Immunosuppressive Treatment ◽  
Unknown Origin ◽  
Corticosteroid Treatment ◽  
Thyroid Peroxidase ◽  
Thyroid Autoantibodies ◽  
Thyroglobulin Antibodies ◽  
Hashimoto Encephalopathy ◽  
Generalized Seizures

The authors present a case report and review the literature on Hashimoto encephalopathy. The onset of the disease may be marked by focal and then progressively generalized seizures or other neurological symptoms, but a cognitive decline or various psychiatric symptoms may also emerge. High levels of anti-thyroid peroxidase antibodies and/or anti-thyroglobulin antibodies are present in the serum. Corticosteroid treatment usually results in an improvement of symptoms. The syndrome is frequently overlooked and, therefore, the authors strongly recommend testing serum thyroid autoantibodies in cases with encephalopathy of unknown origin independently on the presence of thyroid disease in the patient or family history. The importance of long-term immunosuppressive treatment should also be stressed. Orv. Hetil., 2013, 154, 1312–1316.

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