1,720,989 research outputs found
Late-onset seizures and risk of subsequent stroke: A systematic review
No full textOtherwise unexplained late-onset seizures, conventionally defined as epileptic seizures occurring in subjects older than 60years and in the absence of disorders known to increase the risk of developing epilepsy, have been assumed to be, in most cases, of cerebrovascular origin. We systematically searched the literature to identify the evidence supporting the association between otherwise unexplained late-onset seizures/epilepsy and the risk of subsequent stroke. Most data from the literature indicate that cerebrovascular disease often underlies otherwise unexplained late-onset seizures/epilepsy. Patients presenting with seizures occurring for the very first time in late life and without clinically overt cerebrovascular disease should be considered as at increased risk of stroke. Consequently, these patients should be screened for the presence of vascular risk factors and treated accordingly. Such measures may greatly contribute to prevent strokes in these patients
Parkinson's desease and lower limb somatosensory evoked potentials: apomorphine-induced reliefe of the akineic-rigid syndrome and vertex P37-N50 potentials
No full textWe evaluated brainstem P30, vertex-central P37-N50 and contralateral frontal N37 somatosensory evoked potentials (SEPs) from the tibial nerve in 14 patients affected by Parkinson's disease (PD) with akinetic-rigid syndrome. In seven patients SEPs were recorded after administration of apomorphine. The cortical P37-N50 complex was either absent (five patients, eight tested sides) or significantly smaller in patients as compared to the control group (n = 18). There was a relationship between abnormalities of early vertex potentials and degree of motor impairment. Administration of apomorphine was followed by an increase in amplitude of P37-N50 response, which was maximal after 15-30 min and then progressively returned to basal values in parallel with clinical improvement. Amplitude of brainstem P30 and frontal N37 responses was within normal values and did not vary following drug administration. These results suggest that the P37-N50 complex arises from independent cortical generators, probably located in the pre-rolandic cortex, which may be selectively affected by basal ganglia dysfunction. Amplitude decrease of the P37-50 complex may reflect an abnormal processing of somatosensory inputs within the pre-central cortex due to defective modulation exerted by basal ganglia circuitry on cortical excitability. SEP potentiation following apomorphine, besides indicating that this dysfunction is partly reversible, might suggest objective method to measure therapeutic efficacy
When one plus one makes three: the quest for rational antiepileptic polytherapy with supraadditive anticonvulsant efficacy.
No full textThe experimental and clinical evidence in support of “rational polytherapy” is sparse, and to date, no clear evidence-based indications can be made to help physicians in their choice of a specific drug combination against specific forms of epilepsy. This article briefly reviews the data available in the literature and obtained from studies conducted in humans to evaluate which main AED combinations might possess supraadditive, synergistic effects in terms of efficacy, with infraadditive toxicity. By far, the most documented association resulting in supraadditive anticonvulsant effects against focal seizures is that of VPA and LTG. There are some indications that combinations of drugs with different primary mechanisms of action may be more effective than combining drugs with the same mechanisms of action. However, further animal and human research studies that focus both on toxicity and anticonvulsant effects of various combinations of AEDs are required
Seizure heralding tuberculous meningitis.
No full textSeizures may frequently occur during tuberculous meningitis. We describe a patient with an apparent generalised tonic-clonic seizure, initially not associated with any magnetic resonance imaging (MRI) abnormality, which was the presenting symptom of tuberculous meningitis. Follow-up MRI, performed after gadolinium administration, showed signs of meningeal involvement. Seizures may be the presenting symptoms of tuberculous meningitis even in the absence of evident intracerebral lesions on MRI. Therefore, contrast-enhanced brain MRI should be performed in the diagnostic workup for each first seizure, especially in patients with a clinical suspicion of CNS infectious disease. The term “heraldic seizure”, indicating a subset of acute symptomatic seizures presenting at the onset of a brain/systemic injury or preceding the full clinical manifestation of a cerebral insult, may be helpful to classify these seizures retrospectively, based initially on unknown aetiology
Demyelinating polyradiculoneuritis following Coxiella burnetti infection (Q fever)
No full textNeurological complications of Coxiella burnetii infection (Q fever) are rare, although the occurrence of headache, paresthesias, and transient focal deficits has been reported. We report the case of a patient with a relapsing demyelinating polyradiculoneuritis as an aftermath of C. burnetti endocarditis and pneumonia
Tongue biting in epileptic seizures and psychogenic events: An evidence-based perspective.
No full textTongue biting (TB) may occur both in seizures and in psychogenic non-epileptic events (PNEEs). We undertook a systematic review to determine sensitivity, specificity, and likelihood ratios (LR) of TB. Five studies (222 epilepsy patients and 181 subjects with PNEEs) were included. There was a statistically significant higher prevalence of TB (both without further specifications on site of lesions and lateral TB) in patients with seizures. Pooled accuracy measures of TB (no further specifications) were sensitivity 38%, specificity 75%, pLR 1.479 (95% CI 1.117–1.957), and nLR 0.837 (95% CI 0.736–0.951). Pooled measures of lateral TB were sensitivity 22%, specificity 100%, pLR 21.386 (95% CI 1.325–345.169), and nLR 0.785 (95% CI 0.705–0.875). Only a pooled analysis of data demonstrated a statistically significant pLR for lateral TB. Lateral TB but not ‘any’ TB has diagnostic significance in distinguishing seizures from PNEEs, supporting the diagnosis of seizures. Tongue biting without further specifications has, therefore, no value in the differential diagnosis between seizures and PNEEs
Transcranial magnetic stimulation and sleep disorders: pathophysiologic insights.
No full textThe neural mechanisms underlying the development of the most common intrinsic sleep disorders are not completely known. Therefore, there is a great need for noninvasive tools which can be used to better understand the pathophysiology of these diseases. Transcranial magnetic stimulation (TMS) offers a method to noninvasively investigate the functional integrity of the motor cortex and its corticospinal projections in neurologic and psychiatric diseases. To date, TMS studies have revealed cortical and corticospinal dysfunction in several sleep disorders, with cortical hyperexcitability being a characteristic feature in some disorders (i.e., the restless legs syndrome) and cortical hypoexcitability being a well-established finding in others (i.e., obstructive sleep apnea syndrome narcolepsy). Several research groups also have applied TMS to evaluate the effects of pharmacologic agents, such as dopaminergic agent or wake-promoting substances. Our review will focus on the mechanisms underlying the generation of abnormal TMS measures in the different types of sleep disorders, the contribution of TMS in enhancing the understanding of their pathophysiology, and the potential diagnostic utility of TMS techniques. We also briefly discussed the possible future implications for improving therapeutic approaches
Non-invasive brain stimulation in the functional evaluation of alcohol effects and in the treatment of alcohol craving: a review.
No full textAcute and chronic consumption of alcohol have direct effects on central nervous system by altering predominantly gamma-aminobutyric acidergic and glutamatergic neurotransmission. Abnormalities in these neurotransmitter systems can be demonstrated by changes in cortical excitability parameters assessed with transcranial magnetic stimulation (TMS). Furthermore, integrated approaches utilizing TMS combined with electroencephalography (EEG) enable the evaluation of the focal effects of alcohol on the human cortex, providing useful information, different from that obtained using other functional brain imaging modalities. Alcohol was found to modulate EEG responses evoked by motor-cortex TMS, predominantly at the right prefrontal cortex, indicating that ethanol alters the functional connectivity between motor and prefrontal areas. Alcohol decreases amplitudes of EEG responses of anterior parts of the cortex after left prefrontal TMS, suggesting a decrease of prefrontal cortical excitability. High-frequency repetitive TMS (rTMS) revealed significant changes in short-term plasticity of the primary motor cortex after acute ethanol intake and in patients with chronic alcohol abuse. TMS findings also support the recently emerged theory that abnormal function of glutamate receptors plays a relevant role in the development of alcohol dependence and manifestation of the alcohol withdrawal syndrome. Finally, initial studies provide evidence that non-invasive brain stimulation techniques (rTMS and transcranial direct current stimulation) might represent a potential therapeutic tool to reduce alcohol craving. Future studies with larger sample size evaluating the clinical effects of these neuromodulatory approaches are required to confirm and extend the preliminary findings
Why do people Google epilepsy?: an infodemiological study of online behavior for epilepsy-related search terms.
No full textMillions of people worldwide use the Internet daily as a source of health information. Google is the most popular search engine and is used by patients and physicians to search for online health-related information. This study aimed to evaluate changes in web search behavior occurring in English-speaking countries over time for terms related to epilepsy and epileptic seizures. Using Google Trends, data on global search queries for the terms "epilepsy", "seizure", and "seizures" between January 2004 and September 2013 were analyzed. The reduction over time in search queries for the term "epilepsy" (and, to a lesser extent, "seizures") was counterbalanced by an increased trend in searches for the term "seizure". Most terms associated with the search queries were related to symptoms of seizures, especially tonic-clonic seizures, and to seizures occurring in children. Three peaks in search volume over the period studied corresponded to news of celebrities having seizures. The volume of searches for the term "epilepsy SUDEP" was found to be enormously increased over time. Most people appear to use search engines to look for terms related to epilepsy to obtain information on seizure symptoms, possibly to aid initial self-diagnosis. Fears and worries about epileptic seizures and news on celebrities with epilepsy seem to be major factors that influence online search behavior
- …
