Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith / Apesar do desapontamento com a morte súbita cardíaca nas epilepsias, os epileptologistas mantêm a fé

ABSTRACT Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP.

RESUMO A morte súbita nas epilepsias (SUDEP) é a causa mais comum de morte em indivíduos com epilepsia refratária. Provavelmente, o controle das crises epilépticas irá evitar algumas dessas mortes. Resumidamente, nós descrevemos nesse artigo alguns dados sobre a epidemiologia, fatores de risco, etiologia e medidas preventivas na SUDEP.

Crises epilépticas no período neonatal: análise descritiva de uma população hospitalar / Neonatal epileptic seizures: descriptive analysis in a hospital population

OBJETIVO: Investigar a incidência e a letalidade de crises epilépticas neonatais e as condições associadas à sua presença. MÉTODOS: Estudo retrospectivo observacional de base hospitalar com crianças nascidas de janeiro de 1995 a dezembro de 2004 acompanhadas por quatro semanas após o parto. Analisaram-se os dados referentes aos períodos pré-natal, intraparto e neonatal. RESULTADOS: Foram identificados 6.600 nascidos vivos de 6.483 partos, encontrando-se 61 casos incidentes de crises epilépticas neonatais (0,9 por cento). A primeira crise ocorreu até 12 horas após o parto em 45,3 por cento dos neonatos. Das mães analisadas, 32,8 por cento apresentaram síndromes hipertensivas. Entre os 61 pacientes, 91,8 por cento eram conceptos únicos e 4,9 por cento eram primeiro e segundo gemelares. O peso foi menor que 2500g em 50,8 por cento e a restrição do crescimento intrauterino ocorreu em 25,9 por cento das gestações analisadas. Obervaram-se: hipoglicemia neonatal (56,5 por cento), icterícia neonatal (52,1 por cento) e asfixia perinatal (70,7 por cento). Desenvolveram sepse bacteriana 32 crianças e 17 apresentaram síndrome de aspiração meconial ao nascer. O desequilíbrio ácido-básico ocorreu em 68,1 por cento ao longo de 28 dias pós-parto. A letalidade foi de 47,4 por cento, sendo mais frequente no sexo masculino (65,6 por cento) e em filhos de mães afro-descendentes (67,2 por cento). CONCLUSÕES: A incidência de crises epilépticas no período neonatal identificada neste estudo foi três a quatro vezes superior à incidência relatada em hospitais de países desenvolvidos, embora as características dos casos fossem semelhantes. A letalidade foi de 47,4 por cento e a asfixia grave foi a condição patológica intraparto mais frequente.

OBJECTIVE:To investigate their incidence and lethality of neonatal epileptic seizures and their associated conditions. METHODS: A retrospective observational hospital-based study was carried out in infants born between January 1995 and December 2004. The infants were followed up for four weeks after birth. Data on the prenatal, intrapartum and neonatal periods were analyzed. RESULTS: Among 6,483 deliveries resulting in 6,600 liveborn infants, 61 cases of neonatal epileptic seizures were identified (0.92 percent). The first seizure occurred within 12 hours after birth in 45.3 percent of the newborn infants. Hypertensive syndromes were present in 32.8 percent of mothers and intrauterine growth restriction occurred in 25.9 percent of the pregnancies. Of the 61 newborn infants, 91.8 percent were single births and 4.9 percent were first or second twins. In 50.8 percent of the infants, birthweight was below 2500g. Associated conditions were: hypoglycemia in 56.5 percent, jaundice in 52.1 percent and perinatal asphyxia in 70.7 percent. Thirty-two infants developed bacterial sepsis and 17 had meconium aspiration syndrome. Acid-base imbalance occurred in 68.1 percent during the neonatal period. Lethality was 47.4 percent and occurred more often among boys (65.6 percent) and in neonates of Afro-descendent mothers (67.2 percent). CONCLUSIONS: The incidence of neonatal epileptic seizures identified here was three to four times higher than the incidence found in hospitals of developed countries, although the cases characteristics were similar. Lethality rate was 47.4 percent and severe asphyxia was the most common pathological condition during delivery.

Seizures after stroke : a prospective clinical study.

Stroke is one of the most common causes of epilepsy in elderly. However, there have been very few prospective studies to define the incidence, pattern and outcome of seizures in stroke. Most studies are based on retrospective analysis of hospital records. Hence, we planned this prospective study to see the clinical, radiological and electroencephalographic characteristics of seizures in stroke and their outcome, from a north Indian tertiary care centre. Over a span of approximately 6 years, 269 consecutive patients with stroke were studied and followed up. Thirty-five (13%) of these developed seizures, primarily related to stroke, during mean follow up period of 15.9 months. Twenty of these had infarctions while 15 had haemorrhages. Involvement of the cortical region was seen in most of the patients with seizures. In these patients, 86% of the lesions involved cortical areas exclusively or in addition to subcortical areas on CT scan of the brain. Twenty-seven (77%) developed early seizures, two third of them had immediate post-stroke seizures. None of the patients with early onset seizures developed recurrent seizures or epilepsy, while 50% of late onset seizures developed epilepsy. No specific EEG pattern was found in those who later developed epilepsy. In the present study, early onset seizures after stroke were rather common and did not affect outcome and did not recur even when not treated with anti-epileptics. Late onset seizures were less common but were associated with recurrent seizures.