Construction of an epileptic seizure prediction model using a semi-supervised method of generative adversarial and long short term memory network combined with Stockwell transform / 南方医科大学学报

OBJECTIVE@#To propose a semi-supervised epileptic seizure prediction model (ST-WGAN-GP-Bi-LSTM) to enhance the prediction performance by improving time-frequency analysis of electroencephalogram (EEG) signals, enhancing the stability of the unsupervised feature learning model and improving the design of back-end classifier.@*METHODS@#Stockwell transform (ST) of the epileptic EEG signals was performed to locate the time-frequency information by adaptive adjustment of the resolution and retaining the absolute phase to obtain the time-frequency inputs. When there was no overlap between the generated data distribution and the real EEG data distribution, to avoid failure of feature learning due to a constant JS divergence, Wasserstein GAN was used as a feature learning model, and the cost function based on EM distance and gradient penalty strategy was adopted to constrain the unsupervised training process to allow the generation of a high-order feature extractor. A temporal prediction model was finally constructed based on a bi-directional long short term memory network (Bi-LSTM), and the classification performance was improved by obtaining the temporal correlation between high-order time-frequency features. The CHB-MIT scalp EEG dataset was used to validate the proposed patient-specific seizure prediction method.@*RESULTS@#The AUC, sensitivity, and specificity of the proposed method reached 90.40%, 83.62%, and 86.69%, respectively. Compared with the existing semi-supervised methods, the propose method improved the original performance by 17.77%, 15.41%, and 53.66%. The performance of this method was comparable to that of a supervised prediction model based on CNN.@*CONCLUSION@#The utilization of ST, WGAN-GP, and Bi-LSTM effectively improves the prediction performance of the semi-supervised deep learning model, which can be used for optimization of unsupervised feature extraction in epileptic seizure prediction.

Epilepsy detection and analysis method for specific patient based on data augmentation and deep learning / 生物医学工程学杂志

In recent years, epileptic seizure detection based on electroencephalogram (EEG) has attracted the widespread attention of the academic. However, it is difficult to collect data from epileptic seizure, and it is easy to cause over fitting phenomenon under the condition of few training data. In order to solve this problem, this paper took the CHB-MIT epilepsy EEG dataset from Boston Children's Hospital as the research object, and applied wavelet transform for data augmentation by setting different wavelet transform scale factors. In addition, by combining deep learning, ensemble learning, transfer learning and other methods, an epilepsy detection method with high accuracy for specific epilepsy patients was proposed under the condition of insufficient learning samples. In test, the wavelet transform scale factors 2, 4 and 8 were set for experimental comparison and verification. When the wavelet scale factor was 8, the average accuracy, average sensitivity and average specificity was 95.47%, 93.89% and 96.48%, respectively. Through comparative experiments with recent relevant literatures, the advantages of the proposed method were verified. Our results might provide reference for the clinical application of epilepsy detection.

The evaluation of psychogenic non-epileptic seizures (PNES) cases with saline injection method in video-EEG monitorization unit / Avaliação de casos de crises não epilépticas psicogênicas (CNEPs) pelo método de injeção de solução salina em unidade de monitoramento por vídeo-EEG

ABSTRACT Background: It has been reported that 10 to 30% of patients sent to epilepsy centers with a diagnosis of refractory epilepsy are diagnosed with psychogenic non-epileptic seizure (PNES). A wide variety of provocative methods are used to assist PNES diagnosis. Objective: To investigate the effect of seizure induction on the diagnosis and prognosis of PNES. Methods: We retrospectively examined 91 patients with PNES complaints in our video-EEG laboratory. Intravenous saline was administered to all patients for induction of seizures. Results: Saline injection was performed in 91 patients referred to our EEG lab with PNES initial diagnosis, 57 of whom were female and 34 male. Saline injection triggered an attack in 82 patients (90%). Conclusions: In this study we have concluded that provocative methods are practical, cheap and, most of all, effective for patient diagnosis. In clinical practice, explaining the diagnosis is the first and most important step of the treatment, and careful patient-doctor communication has a positive impact on patient prognosis.

RESUMO Antecedentes: Há relatos de que 10 a 30% dos pacientes com epilepsia refratária enviados a centros de epilepsia são diagnosticados com crise não epiléptica psicogênica (CNEP). Uma ampla variedade de métodos provocativos é usada para auxiliar no diagnóstico de CNEP. Objetivo: Investigar o efeito da indução de convulsões no diagnóstico e no prognóstico de CNEP. Métodos: Examinamos 91 pacientes com queixas de CNEP em nosso laboratório de vídeo-EEG. Foi administrada solução salina intravenosa a todos os pacientes para indução de convulsões. Resultados: A injeção de solução salina foi realizada em 91 pacientes com diagnóstico inicial de CNEP encaminhados ao nosso laboratório de EEG, 57 dos quais eram mulheres e 34 homens. A injeção de solução salina desencadeou um ataque em 82 pacientes (90%). Conclusões: Neste estudo, concluímos que os métodos provocativos são práticos, baratos e, acima de tudo, eficazes para o diagnóstico de pacientes. Na prática clínica, a explicação do diagnóstico é a primeira e mais importante etapa do tratamento, e a comunicação cuidadosa entre médicos e pacientes tem um impacto positivo em seu prognóstico.

Research progress of epileptic seizure predictions based on electroencephalogram signals / 生物医学工程学杂志

As a common disease in nervous system, epilepsy is possessed of characteristics of high incidence, suddenness and recurrent seizures. Timely prediction with corresponding rescues and treatments can be regarded as effective countermeasure to epilepsy emergencies, while most accidental injuries can thus be avoided. Currently, how to use electroencephalogram (EEG) signals to predict seizure is becoming a highlight topic in epilepsy researches. In spite of significant progress that made, more efforts are still to be made before clinical applications. This paper reviews past epilepsy studies, including research records and critical technologies. Contributions of machine learning (ML) and deep learning (DL) on seizure predictions have been emphasized. Since feature selection and model generalization limit prediction ratings of conventional ML measures, DL based seizure predictions predominate future epilepsy studies. Consequently, more exploration may be vitally important for promoting clinical applications of epileptic seizure prediction.

Automatic epileptic seizure detection algorithm based on dual density dual tree complex wavelet transform / 生物医学工程学杂志

It is very important for epilepsy treatment to distinguish epileptic seizure and non-seizure. In this study, an automatic seizure detection algorithm based on dual density dual tree complex wavelet transform (DD-DT CWT) for intracranial electroencephalogram (iEEG) was proposed. The experimental data were collected from 15 719 competition data set up by the National Institutes of Health (NINDS) in Kaggle. The processed database consisted of 55 023 seizure epochs and 501 990 non-seizure epochs. Each epoch was 1 second long and contained 174 sampling points. Firstly, the signal was resampled. Then, DD-DT CWT was used for EEG signal processing. Four kinds of features include wavelet entropy, variance, energy and mean value were extracted from the signal. Finally, these features were sent to least squares-support vector machine (LS-SVM) for learning and classification. The appropriate decomposition level was selected by comparing the experimental results under different wavelet decomposition levels. The experimental results showed that the features selected in this paper were different between seizure and non-seizure. Among the eight patients, the average accuracy of three-level decomposition classification was 91.98%, the sensitivity was 90.15%, and the specificity was 93.81%. The work of this paper shows that our algorithm has excellent performance in the two classification of EEG signals of epileptic patients, and can detect the seizure period automatically and efficiently.

Amplitude-integrated electroencephalography for neonatal seizure detection. An electrophysiological point of view / Electroencefalograma integrado por amplitud para la detección de convulsiones neonatales. Un punto de vista electrofisiológico

ABSTRACT Seizures in the newborn are associated with high morbidity and mortality, making their detection and treatment critical. Seizure activity in neonates is often clinically obscured, such that detection of seizures is particularly challenging. Amplitude-integrated EEG is a technique for simplified EEG monitoring that has found an increasing clinical application in neonatal intensive care. Its main value lies in the relative simplicity of interpretation, allowing nonspecialist members of the care team to engage in real-time detection of electrographic seizures. Nevertheless, to avoiding misdiagnosing rhythmic artifacts as seizures, it is necessary to recognize the electrophysiological ictal pattern in the conventional EEG trace available in current devices. The aim of this paper is to discuss the electrophysiological basis of the differentiation of epileptic seizures and extracranial artifacts to avoid misdiagnosis with amplitude-integrated EEG devices.

RESUMO Las convulsiones neonatales están asociadas a una alta morbi-mortalidad por lo que su correcto diagnóstico y tratamiento es fundamental. Las convulsiones en los recién nacidos son frecuentemente subclínicas lo que hace que su detección sea dificultosa. La electroencefalografía integrada por amplitud es una técnica de monitoreo electroencefalográfico simplificado que ha encontrado una creciente aplicación clínica en las unidades de terapia intensiva neonatales. Su principal ventaja es la relativa simplicidad de su interpretación lo que permite a personal no especializado del equipo neonatal diagnosticar convulsiones electrográficas en tiempo real. Sin embargo, para evitar diagnosticar erróneamente artefactos rítmicos como crisis epilépticas es necesario reconocer los patrones electrofisiológicos ictales en el EEG convencional disponible en los dispositivos actuales. El objetivo de este artículo es describir las bases electrofisiológicas para la diferenciación de convulsiones neonatales y artefactos extracraneanos para evitar errores diagnósticos con el uso de EEG integrado por amplitud.

Trastornos paroxísticos no epilépticos en el lactante / Non-paroxysmal disorder in infant

Los trastornos paroxísticos no epilépticos (TPNE) se definen como episodios que se repiten periódicamente y que remedan una crisis epiléptica. Su aparición es generalmente brusca y de breve duración, originados por una disfunción cerebral de origen diverso y que no obedecen a una descarga neuronal excesiva (a diferencia de una crisis epiléptica). Su incidencia es diez veces más elevada que la epilepsia y pueden aparecer a cualquier edad, pero son más frecuentes en los primeros años de vida. La inmadurez del sistema nervioso en la infancia hace que en este período las manifestaciones sean muy diversas y diferentes a otras edades. El primer paso para un diagnóstico correcto es un buen interrogatorio y establecer si el episodio puede corresponder a una crisis epiléptica o a un TPNE. El diagnóstico diferencial es muy amplio, especialmente en las primeras edades. Aparte del examen neurológico completo, en caso de duda se debe ampliar el estudio con exámenes complementarios que en la mayoría de las ocasiones serán normales/ negativos. En algunos casos se ha demostrado una base genética. Las opciones terapéuticas son escasas y la mayoría de los TPNE, especialmente en el lactante, desaparecen con la edad sin dejar secuelas.

Non-epileptic paroxysmal disorders (PNED) are defined as events that mimic epileptic seizures. Its onset is usually sudden and short-lived, caused by brain dysfunction of various origins, but not due to excessive neuronal firing. Its incidence is higher than the epilepsy (10:1). They can occur at any age but are most common in children, especially in the first year of life. The immature nervous system in childhood causes in this period, paroxysmal manifestations that are very diverse and different from other ages. Normal and common paroxysmal disorders in children can mimic epileptic seizures. The first step is to establish a correct diagnosis, if the clinical paroxysmal episode is a seizure or PNED. Differential diagnosis is very broad, especially in the first ages. It's necessary a complete neurological examination in case of doubt and the study should be extended with complementary exams, investigations that in most cases will be normal/negative. In some of them, a genetic basis has been shown. Treatment options are limited and most PNED untreated have a favorable outcome.

Trastornos paroxísticos no epilépticos neonatales / Non-epileptic paroxysmal disorder in neonates

Los trastornos paroxísticos no epilépticos son eventos frecuentes en el neonato, generalmente transitorios. Sin embargo, por su intensidad pueden ser confundidos como verdaderas crisis epilépticas. El objetivo de esta revisión es actualizar los conceptos en relación a los temblores, mioclonías neonatales benignas del sueño (MNBS) e hiperecplexia. Los temblores son muy frecuentes, una vez identificados debe determinarse si pertenecen a un síndrome de hiperexcitabilidad relacionado con factores maternos o perinatales, en casos idiopáticos se espera buen pronóstico. Las MNBS con frecuencia se confunden con crisis epilépticas, se caracterizan porque las mioclonías son breves y solo se presentan en el sueño, los niños son normales y el EEG también es normal. La hiperecplexia es un trastorno raro, genéticamente determinado, caracterizado por hipertonía y reacciones de sobresalto exagerado ante un estímulo banal, que pueden mejorar con clonazepam.

Non-epileptic paroxysmal disorders are frequent events in the neonate, generally transient. However, due to their intensity they can be confused as true epileptic seizures. The objective of this review is to update the concepts in relation to tremors, neonatal benign sleep myoclonus (MNBS) and hyperekplexia. The tremors are very frequent, once identified it must be determined if they belong to a hyperexcitability syndrome related to maternal or perinatal factors, in idiopathic cases a good prognosis is expected. MNBS are often confused with epileptic seizures. They are characterized by the fact that myoclonus is brief and occurs only in sleep, children are normal, and the EEG is also normal. Hyperekplexia is a rare, genetically determined disorder characterized by hypertonia and exaggerated startle reactions to a banal stimulus, which can be improved with clonazepam.

Tratamiento de las convulsiones neonatales / Treatment of neonatal seizures

Las convulsiones neonatales están entre las manifestaciones más dramáticas de enfermedad neurológica y deben ser consideradas una emergencia. La incidencia es 3.5 por cada 100 nacidos a término y en prematuros asciende a 58 por cada 100 nacidos vivos. Las convulsiones neonatales son una manifestación clínica de disfunción cortical no específica que puede dar lugar a daño permanente del cerebro. La etiología es multifactorial y requiere una evaluación cuidadosa de cada escenario clínico. El diagnóstico es más complejo por el hecho de que la mayoría de convulsiones son sub-clínicas o sutiles y a veces no tienen correlación con el electroencefalograma. Aunque la identificación temprana y el tratamiento son críticos, el diagnóstico se complica por algunos factores como la variedad de presentaciones clínicas, diferentes etiologías y varias alternativas de tratamiento. De todas maneras, los estudios de investigación y la evidencia clínica disponible han demostrado que el tratamiento precoz con fármacos anticonvulsivantes puede mejorar el pronóstico.

Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysfunction. The incidence is much higher in very low weight neonates than in full term infants (~58 and 3.5 per 100 live births, respectively). Neonatal seizures represent the clinical manifestation of a non-specific cortical cerebral dysfunction which can lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment for each clinical scenario. The diagnosis is further complicated by the fact that most neonatal seizures are subclinical, that is, may display very subtle or no clinical changes and the diagnosis may just be based on EEG findings. The treatment depends on the etiology, but an early and opportune intervention prevents further brain damage, thus improving prognosis. Although early identification and treatment are critical, the diagnosis of neonatal seizures is complicated by several factors such as different clinical presentations, possible etiologies and several treatment options. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.

Convulsiones neonatales: Diagnóstico clínico y electroencefalográfico / Neonatal seizures. Clinical and electroencephalographic diagnosis

Las convulsiones neonatales son una expresión común de lesiones cerebrales agudas durante el periodo perinatal y podrían incrementar el daño neuronal. La mayoría son electroencefalográficas y las clínicas pueden ser sutiles y difíciles de identificar por el personal médico. Las convulsiones neonatales son usualmente cortas pero frecuentes al inicio y tienden a desaparecer en un periodo corto. El video-EEG continuo es el test ideal para detectar estas convulsiones, pero el EEG de amplitud es útil cuando el EEG convencional no está disponible. El monitoreo con EEG no solo es necesario para evaluar la frecuencia y duración de estas convulsiones, también puede proporcionar información pronóstica importante.

Neonatal seizures are common expression of acute brain injury in the perinatal period and could potentiate the degree of neuronal injury. The majority of events are electroencephalographic and the clinical seizures can be subtle and difficult to identify by medical personnel. Neonatal seizures are usually short and frequent at onset and have a tendency to subside after a short period. Continuous video-EEG monitoring is the gold standard to detect seizures, but amplitude integrated EEG is a useful tool when conventional EEG is not available. EEG monitoring is important not only to monitor frequency and duration of seizures but to provide important prognostic information.

Estado de mal epiléptico / Status epilepticus

El estado de mal epiléptico (EME) es la emergencia más frecuente en la neuropediatría. Es el resultado de un fallo en los mecanismos responsables de terminar la convulsión o de la iniciación de mecanismos que provocan una convulsión anormalmente prolongada. Esta definición se relaciona con el momento de iniciar el tratamiento. En general, el primer punto de tiempo o t1, es el momento cuando el tratamiento debería comenzarse, que es a los 5 minutos para las convulsiones tónico-clónicas generalizadas y a los 10 minutos para las focales con o sin compromiso de la conciencia. El segundo punto de tiempo o t2 marca el momento en el cual el daño neuronal o de las redes neuronales puede comenzar e indica que el EME debería ser controlado, que para los casos de mal tónico-clónico generalizados debe ser de 30 minutos. Todos los protocolos de tratamiento diferencian estadios en donde se utilizan diferentes fármacos: temprano o 1, establecido o 2, refractario o 3, súper-refractario o 4; y enfatizan el rápido reconocimiento y tratamiento de la actividad epiléptica persistente en cada estadio con el objetivo de reducir la morbimortalidad y las secuelas a largo plazo (después de t2).

Status epilepticus (SE) is one of the most common neurologic emergencies in pediatrics. It is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which leads to abnormally, prolonged seizures. This definition provides a good guidance, when emergency treatment must be considered. In general, time point t1 is the time when treatment should be started, which is at 5 minutes for generalized tonic-clonic seizures, and at 10 min for focal seizures with or without impairment of consciousness. Time-point t2 marks the time at which neuronal damage or self-perpetuating alteration of neuronal networks may begin and indicates that SE should be controlled latest by that time; 30 min in case of generalized tonic-clonic seizures. All treatment protocols recognize a staged approach to treatment with different drugs used in early (stage I), established (stage II), refractory (stage III) and super-refractory SE (stage IV); and emphasize prompt recognition and treatment of persisting seizure activity at each stage aiming to reduce morbidity, mortality, and long-term consequences of status epilepticus (beyond t2).

Prevalencia y características clínicas de episodios paroxísticos no epilépticos y epilepsias en el Servicio de Pediatría del Hospital Británico en el período junio 2013 a junio 2015 / PREVALENCE AND CLINICAL CHARACTERISTICS OF PAROXYSMAL EPISODES NONEPILEPTIC EVENTS AND EPILEPSIES IN THE PEDIATRIC SERVICE OF THE BRITISH HOSPITAL FROM BUENOS AIRES, BETWEEN THE PERIOD JUNE 2013 THROUGH JUNE 2015

Introducción: El diagnóstico temprano de los Episodios Paroxísticos No Epilépticos (EPNE) y la clara diferenciación con crisis epilépticas es esencial para su manejo y evitar tratamientos innecesarios. Conocer la frecuencia y características clínicas permite mejorar las estrategias diagnósticas, disminuyendo la cantidad de estudios complementarios solicitados y los días de internación, mejorando la calidad de atención. Materiales y Métodos: estudio descriptivo y retrospectivo de revisión de historias clínicas de pacientes de un mes a 16 años de edad internados por convulsión en el Hospital Británico durante el periodo de junio 2013 a junio 2015. Resultados: Se obtuvo una muestra de 71 pacientes: 25.4% tuvieron como diagnóstico EPNE, 74.6% tuvieron otros diagnósticos. Se compararon ambos grupos. La edad de presentación de los EPNE fue en la mayoría de los casos antes de los 2 años de edad con hipotonía como presentación clínica más frecuente. En el resto de la población analizada, la edad de presentación fue a los 3.5 años y prevalecieron los movimientos tónicos clónicos generalizado. Los EEG realizados fueron normales en el 100% de los EPNE mientras que en los trastornos convulsivos resultó patológico en el 56.5% Conclusiones: Se observaron diferencias significativas entre los pacientes con EPNE en comparación con el resto de la población analizada. Los EPNE presentan crisis de menos de 1 minuto de duración, suelen no tener episodio post-ictal, presentan una mayor incidencia de hipotonía y el EEG es normal. Los pacientes con EPNE no requirieron medidas de cuidados intensivos lo que habla de la benignidad de estos eventos.

Introduction: Paroxysmal nonepileptic disorders can cause diagnostic confusion,and it is important to differentiate them from epileptic disorders, so that a correct management and treatment can be established. In order to settle a correct diagnostic strategy it is essential to know the incidence and the clinical presentation of this pathology. With an accurate diagnosis, the number of complementary studies and the length of the hospital stay will diminish. Methodology: A retrospective descriptive study of clinical histories from pediatric patients, aged 1 month to 16 years, admitted at the British Hospital of Buenos Aires with seizure diagnosis during the lapse of time between June 2013 and June 2015, was undertaken. Results: A total of 71 patients were analyzed. 25.4% had non-epileptic paroxysmal events, 74.5% had other diagnosis. Both groups were compared. Patients with non-epileptic paroxysmal events presented symptoms before the 2 years of age, hypotonia was the most common clinical presentation and these patients had a normal electroencephalogram (EEG). The other group presented symptoms at 3.5 years of age, tonic-clonic movement was the most frequent symptom and 56, 5% had abnormal EEG. Conclusion: Significant differences were found between patients with nonepileptic paroxysmal events and the rest of the patients analyzed. Patients with non- epileptic paroxysmal disorder present events of less than one minute of duration with no postictal state, hypotinia is the most frequent symptom seen and the EEG results normal. Patients with nonepileptic paroxysmal disorder did not require admission to intensive care unit; this reflects the benign condition of the pathology

Primera crisis epiléptica en pediatría: evaluación clínica y manejo / First epileptic crisis in pediatrics: clinical evaluation and management

Las crisis epilépticas en Pediatría son un importante motivo de consulta. En este artículo se revisará la importancia de la primera crisis epiléptica, cómo enfrentarse a esta situación desde los antecedentes y el examen físico, diagnósticos diferenciales y además se revisará el manejo de la crisis en urgencia y su posterior estudio.

Pediatric seizures are a major complaint. In this article the importance of the first seizure is reviewed, how to deal with this situation from the history and physical examination, and further management and study will be reviewed.

Neuropsychiatric Lupus in clinical practice / Lúpus neuropsiquiátrico na prática clínica

ABSTRACT Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organs, characterized by the production of autoantibodies and the development of tissue injury. The etiology of SLE is partially known, involving multiple genetic and environmental factors. As many as 50% of patients with SLE have neurological involvement during the course of their disease. Neurological manifestations are associated with impaired quality of life, and high morbidity and mortality rates. Nineteen neuropsychiatric syndromes have been identified associated with SLE, and can be divided into central and peripheral manifestations. This article reviews major neuropsychiatric manifestations in patients with SLE and discusses their clinical features, radiological findings and treatment options.

RESUMO Lúpus eritematoso sistêmico (LES) é uma doença autoimune crônica que envolve múltiplos órgãos e sistemas, caracterizada pela produção de auto anticorpos e lesão tecidual. A etiologia do LES é parcialmente conhecida e envolve interação entre fatores genéticos e ambientais. Até 50% dos pacientes com LES apresentam envolvimento neurológico no decorrer da doença. Manifestações neurológicas estão associadas a prejuízo na qualidade de vida e altas taxas de mortalidade e morbidade. Foram identificadas 19 síndromes neuropsiquiátricas em pacientes com LES, divididas entre manifestações do sistema nervoso central e periférico. O objetivo deste artigo é revisar as manifestações neuropsiquiátricas mais importantes. Serão abordadas as características clínicas, os aspectos radiológicos e opções de tratamento dos eventos neuropsiquiátricos.

Convulsiones por isoniazida: una causa toxicológica a considerar / Isoniazid seizures: A toxicological cause to consider

La neurotoxicidad de la isoniazida (INH) frecuentemente no es tenida en cuenta por el pediatra ante un paciente con un cuadro convulsivo agudo. La INH es uno de los fármacos más indicados en el tratamiento y quimioprofilaxis de la tuberculosis. Habitualmente se la indica al grupo familiar, debido a las características epidemiológicas de esta enfermedad, lo cual permite una amplia disponibilidad en los hogares, pudiendo originar intoxicaciones accidentales o intencionales. La intoxicación severa se caracteriza por un cuadro neurotóxico agudo, expresado en un síndrome convulsivo o coma, que no cede con el tratamiento habitual. Se presenta un caso clínico de una paciente intoxicada grave con isoniazida, habiendo sido la anamnesis dirigida ampliada junto con un diagnóstico precoz y el tratamiento específico con el antídoto, la base fundamental para la evolución favorable de la paciente.

Pediatricians do not usually considered isoniazid (INH) neurotoxicity in cases of patients with severe seizure disorders. INH is one of the most suitable drugs in the treatment and chemoprophylaxis of tuberculosis. It is usually indicated to the family group, due to the epidemiological characteristics of this disease, allowing a wide availability in homes and being able to cause accidental or intentional poisoning. An acute neurotoxic picture, expressed as a convulsive syndrome or coma, which does not improve with the usual treatments, characterized severe intoxication. A case of a patient with severe intoxication with isoniazid is presented. The extended anamnesis, along with an early diagnosis and the specific antidote treatment, set the fundamental basis for the favorable evolution of the patient.

People with psychogenic non-epileptic seizures: a South African perspective

Background: Psychogenic non-epileptic seizures (PNES) is a disabling disorder which has a negative effect on the quality of life of individuals with PNES. A clear understanding of the disorder is necessary; however, to date, research about PNES in South Africa is limited. Objectives: The aims of this study were to explore the demographic variables of individuals with PNES in South Africa, to review the available body of research on PNES, and to compare it with our results. Method: Twenty-two people with PNES, with confirmed video EEG, were recruited by means of convenience sampling from two hospitals. Descriptive statistics were used to describe the demographic variables of the participants. Results: Internationally comparable results revealed misdiagnoses and low treatment delivery amongst a primarily female population.Conclusion: This study provided greater insight into individuals with PNES in South Africa, highlighting the need for more information, support, effective treatment and accurate diagnosis of PNES

Clinical Features of Seizures in Patients with Human Immunodeficiency Virus Infection

Patients with human immunodeficiency virus (HIV) infection have a higher burden of seizures, but few studies have examined seizures in HIV-infected individuals in Korea. A retrospective study was conducted to determine the epidemiology and clinical characteristics of seizures in patients with HIV infection. Among a total of 1,141 patients, 34 (3%) had seizures or epilepsy; 4 of these individuals had epilepsy before HIV infection, and the others showed new-onset seizures. Most patients exhibited moderate (200 to 500, n = 13) or low (below 200, n = 16) CD4 counts. The most common seizure etiology was progressive multifocal leukoencephalopathy (n = 14), followed by other HIV-associated central nervous system (CNS) complications (n = 6). Imaging studies revealed brain lesions in 21 patients. A total of 9 patients experienced only one seizure during the follow-up period, and 25 patients experienced multiple seizures or status epilepticus (n = 2). Multiple seizures were more common in patients with brain etiologies (P = 0.019) or epileptiform discharges on EEG (P = 0.032). Most seizures were controlled without anticonvulsants (n = 12) or with a single anticonvulsant (n = 12). Among patients with HIV infection, seizures are significantly more prevalent than in the general population. Most seizures, with the exception of status epilepticus, have a benign clinical course and few complications.

Psychogenic non-epileptic seizures and psychoanalytical treatment: results / Crises não epilépticas psicogênicas e tratamento psicanalítico: resultados.

Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes. .

Introdução: estima-se que o número de casos de pacientes com crises não epilépticas psicogênicas (CNEP) seja de 2 a 33 por 100 mil habitantes. O índice de CNEP corresponde ainda a, aproximadamente, 19% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como portadores de epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivo: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP de forma a avaliar a evolução do quadro clínico de CNEP e verificar sua associação com gênero, tempo de crise, prejuízos sociais, afetivos e profissionais, bem como término do tratamento. Métodos: a casuística foi composta por 37 pacientes com diagnóstico de CNEP feito por meio da monitoração por vídeo-EEG. Foram realizadas sessões de tratamento psicanalítico: atendimento clínico individual com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n = 11) de cessação/cura dos sintomas e 51,4% (n = 19) de redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e gênero (p<0,01), religião (p<0,01) e término do tratamento (p<0,01). Conclusão: este estudo apontou eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises. .

Fisiopatología, diagnóstico diferencial y tratamiento de la apnea emotiva grave: A propósito de un caso clínico / Pathophysiology, differential diagnosis and treatment of severe emotional apnea: based on report case

Introduction: Emotional apneas (EA) are non-epileptic paroxysmal events affecting 5% of healthy children. The diagnosis is based on a stereotyped sequence of clinical events that start with tears caused by emotional stimulus, resulting in an autonomic nervous system alteration with transient color change, pale or cyanotic. 15% of the cases are associated with loss of consciousness, changes in tone or tonic-clonic movements secondary to hypoxia. Objective: To report a case of severe EA and to review the differential diagnosis and preventive treatments. Case report: A 15-month old infant with cyanotic emotional apnea since 8 months of age, triggered by pain, disgust or fear, increasing in frequency (3-4 per day) and intensity with altered consciousness and hypotonia. At 12 months, the patient also presented generalized tonic-clonic seizures of 3 minutes long, reason why the infant was admitted to the emergency service. Normal psychomotor development as well as normal physical, neurological and laboratory test results (without anemia) were found. Electroencephalography and brain MRI presented no abnormalities. Preventive therapy using Piracetam was performed in order to reduce crisis, which occurred in the first month of treatment. Conclusions: In most cases, a timely information delivery to parents is enough due to the benign nature and natural history of EA. However, when the frequency and severity of EA impact the child and family, to rule out heart disease or epilepsy and to seek preventive treatment options are required.

Introducción: Las apneas emotivas (AE) son eventos paroxísticos no epilépticos que afectan al 5% de niños sanos. El diagnóstico se basa en una secuencia estereotipada de eventos clínicos iniciado con llanto provocado por un estimulo emocional que desencadena una alteración refleja del sistema nervioso autonómico con cambio de color, pálido o cianótico. En el 15% se asocia a pérdida de conciencia, cambios del tono o movimientos tónico-clónicos secundarios a hipoxia. Objetivo: Presentar un caso clínico de AE grave, revisar el diagnóstico diferencial y tratamientos preventivos. Caso clínico: Lactante de 15 meses con cianóticas a partir de los 8 meses de edad, desencadenados por dolor, disgusto o miedo que aumentaron en frecuencia (3-4 por día) e intensidad con alteración de conciencia e hipotonía. A los 12 meses, se agregó además una crisis tónico clónica de 3 min de duración, por la cual ingresó a Servicio de Urgencia. Se constató un desarrollo psicomotor normal, examen físico, neurológico y parámetros de laboratorio normales (sin anemia), al igual que la electroencefalografía y resonancia magnética cerebral. Se inició terapia preventiva con piracetam con el propósito de disminuir las crisis, lo que se produjo desde el primer mes de tratamiento. Conclusiones: En la mayoría de los casos, la naturaleza benigna e historia natural de las AE permiten que una entrega de información oportuna a los padres sea suficiente. Sin embargo, cuando la frecuencia y severidad de las AE impactan al niño y su familia, se requiere descartar patología cardíaca o epilepsia y buscar opciones de tratamiento preventivo.

Hallazgo por neuroimaginología de microangiopatía cerebral retiniana con calcificaciones y quistes / Neuroimaging findings in cerebroretinal microangiopathy with calcifications and cysts

La microangiopatía cerebral retiniana con calcificaciones y quistes es una enfermedad poco frecuente, caracterizada por alteraciones cerebrales, retinianas y óseas, así como por predisposición al sangrado gastrointestinal. Existen pocos reportes de casos de esta condición, especialmente en adultos, en quienes la incidencia es baja. Los hallazgos por medio de neuroimágenes son característicos, con calcificaciones bilaterales y múltiples formaciones quísticas. El propósito de este artículo fue hacer una revisión bibliográfica e ilustrar dos casos cuyo diagnóstico fue posible con la ayuda de neuroimágenes.

Cerebroretinal microangiopathy with calcifications and cysts is a rare condition characterized by brain, retinal and bone anomalies, as well as a predisposition to gastrointestinal bleeding. There are few reported cases of this condition in adults, among whom the incidence is low. Neuroimaging findings are characteristic, with bilateral calcifications, leukoencephalopathy and intracranial cysts. The purpose of this article was to do a literature survey and illustrate two cases diagnosed with the aid of neuroimaging.