RESUMO
PURPOSE: The Status Epilepticus Severity Score (STESS) is one of the most well-known clinical scoring systems to predict mortality in status epilepticus (SE). The objective of this study was to validate STESS in a Colombian population. METHOD: We evaluated historical data of adult patients (age ≥16 years) with a clinical or electroencephalographic diagnosis of SE admitted between 2014 and 2017. Prospectively, we included patients admitted from January to June of 2018. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC)-analysis, determination of best cutoff values, sensitivity, specificity, and positive and negative likelihood ratios were performed. RESULTS: The sample was 395 patients, with in-hospital mortality of 16.8 %. The area under the ROC curve for STESS was 0.84. A cutoff point of ≥3 produced the highest sensitivity of 84.9 % (95 % CI 73.9 %-92.5 %) and a specificity of 65.7 % (95 % CI 60.2 %-70.8 %), with a positive likelihood ratio of 2.5 and a negative likelihood ratio of 0.2. CONCLUSIONS: STESS is a useful tool to predict mortality in patients with SE. In Medellin, Colombia, a STESS < 3 allows the identification of the patients who survive reliably. Those patients with a score <3 may have a better prognosis, and treatment with fewer side effects than anaesthetics could be suggested, always remembering the importance of the treating physician's clinical judgement.
Assuntos
Estado Epiléptico , Adolescente , Adulto , Colômbia , Mortalidade Hospitalar , Hospitais , Humanos , Prognóstico , Curva ROC , Índice de Gravidade de Doença , Estado Epiléptico/diagnósticoRESUMO
OBJECTIVE: Forced normalization (FN) is an intriguing phenomenon characterized by the emergence of psychiatric disturbances following the establishment of seizure control or reduction in the epileptic activity in a patient with previous uncontrolled epilepsy. We aim to describe the clinical characteristics of the condition. METHODS: We conducted a systematic review on MEDLINE, EMBASE, Cochrane, and Scielo from January 1953 to January 2018. Clinical, electrographic, and imaging data were gathered. We considered all outcomes in children and adults. We performed no meta-analyses due to the limited available data. RESULTS: Of 2606 abstracts identified, 36 fulfilled the FN diagnostic criteria; 193 FN episodes were evaluated and 77 of them were analyzed extensively. Sixty percent of cases were female. Mean age ± standard deviation (SD) was 28.3 ± 14.2 years. The majority of patients had focal (80%) symptomatic (44%) epilepsy. Most patients reported a high ictal frequency (58%) and were on polytherapy (51%). Patients presented psychosis (86.4%), mood disorders (25.8%), and dissociation (4.5%) as the main manifestations. In the psychosis group, persecutory (52.6%) and reference (47.3%) delusions were frequent. FN was provoked by an antiepileptic drug (AED) (48.5%) mainly levetiracetam, epilepsy surgery (31.8%), or vagus nerve stimulation (13.6%). Treatment was homogeneous including anticonvulsant withdrawal (47%) or taper (25%); antipsychotics were initiated in the majority of cases (73%). Psychiatric symptoms were partially controlled in 35%, with complete resolution of symptoms in the remaining 65% of cases. The majority of patients (87%) with AED trigger and withdrawal presented complete resolution of symptoms in comparison to 28.5% of patients triggered by surgery. SIGNIFICANCE: Forced normalization is an entity whose pathophysiology remains uncertain. Antipsychotic drug use does not predict complete resolution of psychiatric symptoms in comparison with AED withdrawal. Although there is a positive response to treatment in patients with FN triggered by drugs, the prognosis is obscure in patients with surgery triggered FN.
Assuntos
Epilepsia/tratamento farmacológico , Transtornos Psicóticos/etiologia , Anticonvulsivantes/uso terapêutico , Epilepsia/complicações , Humanos , Transtornos Psicóticos/fisiopatologia , Indução de RemissãoRESUMO
People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of ß-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.
Assuntos
Epilepsia/psicologia , Exercício Físico/psicologia , Qualidade de Vida/psicologia , Esportes , Consenso , Humanos , Convulsões/complicaçõesRESUMO
Epilepsy has afflicted humanity during most of the extent of documented history. The Aztecs believed that illnesses were punishments that were sent from a furious goddess. In particular, epilepsy was considered in Aztec culture as a "sacred disease", and convulsions were traditionally associated with a deified woman who had died at childbirth. As the goddess Shiva and Apasmâra in ancient India and Saint Valentine in Germany, Tlazolteotl was considered able to bring about and send away epilepsy. We performed a comprehensive review to identify Tlazolteotl depictions and its historical context related with epilepsy. Tlazolteotl is one of the most endearing and complex goddesses of the Mesoamericans. She was the deity of the black fertile and fecund earth that gains its energy from death and in turn feeds life. Associated with purification, expiation, and regeneration, she embodied fertility and turned all garbage, physical and metaphysical, into rich life. This article reviews the most relevant artistic works related with Tlazolteotl. We also present a modern depiction of the Aztec goddess of epilepsy from the Mexican artist Eduardo Urbano Merino, displaying the supernatural view of epilepsy in America.
Assuntos
Epilepsia/história , Religião e Medicina , Convulsões , Feminino , História Antiga , História Medieval , Humanos , GravidezRESUMO
The coexistence of focal and generalized epilepsy is rare. We report on a 17-year-old male with drug-resistant focal epilepsy and idiopathic generalized epilepsy (IGE). He began to experience generalized tonic-clonic seizures (GTCS) at the age of 3 years, with a good response to phenobarbital. At the age of 14 years, he began to experience complex partial seizures (CPS). Video-electroencephalography (video-EEG) telemetry showed the coexistence of right temporal spikes and bursts of generalized spike-wave (GSW). The ictal EEG showed a unique EEG pattern characterized by a 4- to 5-second burst of GSW followed by rhythmic delta activity over the right temporal region. A magnetic resonance image (MRI) showed right hippocampal sclerosis. The patient underwent a right temporal lobectomy that significantly improved his seizure control. He was rendered seizure free of the complex partial seizures and improvement of the GTCS. This case illustrates a very uncommon ictal EEG pattern, and shows that the decision for surgery in patients with focal drug-resistant epilepsy should not be affected by coexistent generalized epilepsy.
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Eletroencefalografia/métodos , Epilepsias Parciais/diagnóstico , Epilepsias Parciais/fisiopatologia , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/fisiopatologia , Lobo Temporal/fisiopatologia , Adolescente , Diagnóstico , Diagnóstico Diferencial , Epilepsias Parciais/cirurgia , Epilepsia Generalizada/cirurgia , Humanos , Masculino , Lobo Temporal/cirurgia , Resultado do TratamentoRESUMO
The impact of health and disease has led many artists to depict these themes for thousands of years. Specifically, epilepsy has been the subject of many famous works, likely because of the dramatic and misunderstood nature of the clinical presentation. It often evokes religious and even mythical processes. Epilepsy surgical treatment has revolutionized the care of selected patients and is a relatively recent advance. Epilepsy surgery has been depicted in very few artistic works. The first portrait showing a potential surgical treatment for patients with epilepsy was painted in the 12th century. During the Renaissance, Bosch famously provided artistic commentary on traditional beliefs in "The stone of madness". Several of these works demonstrate a surgeon extracting a stone from a patient's head, at one time believed to be the source of all "folly", including epileptic seizures, psychosis, intellectual disability, depression, and a variety of other illnesses. There are some contemporary art pieces including themes around epilepsy surgery, all of them depicting ancient Inca Empire procedures such as trepanning. This article reviews the most relevant artistic works related with epilepsy surgery and also its historical context at the time the work was produced. We also present a painting from the Mexican artist Eduardo Urbano Merino that represents the patient's journey through refractory epilepsy, investigations, and ultimately recovery. Through this work, the artist intends to communicate hope and reassurance to patients going through this difficult process.
Assuntos
Arte , Epilepsia/cirurgia , Neurocirurgia/história , Arte/história , Epilepsia/história , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Medieval , Humanos , Neurocirurgia/métodosRESUMO
Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.
Assuntos
Meningite/etiologia , Neurossífilis/complicações , Trombose/etiologia , Vasculite/etiologia , Insuficiência Vertebrobasilar/etiologia , Alcoolismo/complicações , Antibacterianos/uso terapêutico , Terapia Combinada , Disartria/etiologia , Emergências , Procedimentos Endovasculares , Soronegatividade para HIV , Humanos , Hipertensão/complicações , Imageamento por Ressonância Magnética , Masculino , Meningite/tratamento farmacológico , Pessoa de Meia-Idade , Neurossífilis/tratamento farmacológico , Paresia/etiologia , Penicilina G/uso terapêutico , Stents , Trombectomia , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/cirurgia , Tomografia Computadorizada por Raios X , Vasculite/tratamento farmacológico , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgiaRESUMO
INTRODUCTION: Ulegyria is a cortical lesion affecting neighbouring vascular zones, which gives the convolutions a mushroom-like appearance. It is an important cause of occipital epilepsy. AIM. To correlate patients diagnosed clinically, electrically and morphometrically with ulegyria and epilepsy by comparing the thickness of the cortex in the zones affected by ulegyria with the normal cortical thickness reported in the literature and the average cortical thickness of healthy subjects. PATIENTS AND METHODS: Ten patients with ulegyria confirmed by magnetic resonance imaging were included in the study; all of them were submitted to a clinical interview, an electroencephalographic study and cortical morphometric analysis based on volumetric T1 sequences. RESULTS: Findings included a predominance in males, neurodevelopmental retardation and epilepsy. Ulegyria was mainly parietooccipital, frequently bilateral, with statistically significant thinning of the cortical thickness in the site of the lesion and an increase in the thickness of the cortex in the areas surrounding the lesion. CONCLUSIONS: We report on a series of patients with ulegyria with characteristics similar to those existing in the literature and by means of morphometry we detected an increase in the thickness of the cortex around the areas affected by ulegyria. These findings could point to the presence of adaptive neuroplasticity in the neurons that surround the scar tissue or they may be the result of mechanical changes of normal tissue in response to the loss of volume of the ulegyria-affected area, although these data need to be replicated in a study with a greater number of patients.
Assuntos
Córtex Cerebral/anormalidades , Córtex Cerebral/patologia , Eletroencefalografia , Epilepsia/diagnóstico , Imageamento por Ressonância Magnética , Adolescente , Adulto , Criança , Pré-Escolar , Epilepsia/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Se presenta el caso clínico de un paciente de 54 años, negativo para VIH, con enfermedad cerebrovascular por trombosis de la arteria basilar, secundaria a neurosífilis meningovascular. La neurosífilis es el compromiso del sistema nervioso central por Treponema pallidum subespecie pallidum en cualquier estadio de la entidad e incluye las formas asintomáticas y sintomáticas de la infección; sus formas de presentación son diversas y dependen de la localización y la extensión de las lesiones. La recomendación actual es el tratamiento con 4 millones de unidades de penicilina cristalina cada 4 horas por 14 días.
Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.