Absceso cerebral por Actinomyces sp: una infección infrecuente en niños: a propósito de un casot / Actinomyces sp. brain abscess: a rare infection in children: a case repor

A pesar de los avances en las técnicas de diagnóstico y tratamiento, las infecciones intracraneanas son aún enfermedades graves con una incidencia estimada entre 0,3 y 1,3 casos por cada 100 000 habitantes. Se presenta un paciente previamente sano con un absceso cerebral de diagnóstico intraoperatorio en quien, si bien el cultivo evidenció desarrollo polimicrobiano, se identificó presuntivamente Actinomyces sp. en la anatomía patológica. Dado este hallazgo, se realizó antibioticoterapia combinada prolongada con buena evolución. La presentación de este proceso supurado fue inespecífica y la contribución de la anatomía patológica en el diagnóstico etiológico fue relevante. La identificación de un microorganismo inhabitual definió la necesidad de profundizar en la determinación de factores predisponentes

Despite advances in diagnostic and treatment techniques, intracranial infections remain serious diseases with an estimated incidence of between 0.3 and 1.3 cases/100,000 inhabitants. We present a previously healthy patient with an intraoperative diagnostic of brain abscess, in whom although the culture showed polymicrobial development, Actinomyces sp was presumptively identified in the pathological anatomy. Given this finding, prolonged combined antibiotic therapy was performed with good evolution The presentation of this suppurative process was nonspecific and the contribution of the anatomopathology in the etiological diagnosis was relevant. The identification of an unusual microorganism defined the need to deepen the identification of predisposing factors.

A clinical study of new onset seizures in children aged 3-12 years

Background: Seizures are common in pediatric age group and less than 1/3rd of seizures in children are caused by epilepsy. Aim of present study was to analyze the etiological factors and clinical profile of new onset seizures in children aged 3-12 years.Methods: This was a prospective study done at a tertiary care center of south India. Authors analyzed 98 children aged 3-12 years presenting with new onset seizures. Proper history and investigations including EEG, and CT brain were done to confirm the etiology.Results: Out of 98 children 51 were 3-5 yrs of age and 47 were 6-12 years. 66.3% had generalized seizure and 33.6% had partial seizure. Partial seizure were more common in 5-12 years of age. Intracranial infections were the leading cause (73/98) which included neurotuberculosis (26/73), NCC (20), bacterial meningitis (12), cerebral malaria (8) and viral encephalitis (7). Intracranial infections' were the' leading cause in both age groups. Space occupying lesions were more common in 6-12 years (46.8%) as compared to 3-5 years (19.6%). NCC and Tuberculoma were the leading CT findings in both age groups. There was significantly high incidence of focal EEG changes in partial seizure group compared to generalized seizure group.Conclusions: Intracranial infections were leading cause of new onset seizures especially GTCS. Good clinical evaluation and judicious use of investigations should be ensured. CT brain and EEG are more likely to be informative in partial seizures than in generalized seizures.

A review of the drug pregabalin.

Pregabalin (PGB) is a well-established anticonvulsant and analgesic agent. The stydy reviewed the mechanism of action, pharmacokinetics, adverse drug reactions, contraindications, and various uses of PGB. Literature search was done to identify the relevant studies. PGB is an antagonist of voltage-gated calcium channels and specifically binds to α2-δ subunit to produce antiepileptic and analgesic activity. It has less protein binding activity and lacks hepatic metabolism. It is unlikely to cause pharmacokinetic drug-drug interactions. It has a wide safety margin and does not require serum drug monitoring. The above-mentioned favorable pharmacological benefits of PGB makes it a first-line or adjunctive therapy in various conditions like diabetic peripheral neuropathy, post-herpetic neuralgia, in partial seizures and generalized anxiety disorders.

Recurrent Complex Partial Seizures in a Patient with Progressive Multifocal Leukoencephalopathy / 대한간질학회지

Seizures are less frequent in progressive multifocal leukoencephalopathy (PML), because it is considered to be restricted to the white matter. In addition, types of seizures in patients with PML are mostly convulsive, and seizures are usually present at the time of diagnosis or early in the course of disease. We report a case of chronic PML with recurrent complex partial seizures in the absence of motor component.

Recurrent Complex Partial Seizures in a Patient with Progressive Multifocal Leukoencephalopathy

Seizures are less frequent in progressive multifocal leukoencephalopathy (PML), because it is considered to be restricted to the white matter. In addition, types of seizures in patients with PML are mostly convulsive, and seizures are usually present at the time of diagnosis or early in the course of disease. We report a case of chronic PML with recurrent complex partial seizures in the absence of motor component.

Progress of the syndrome of malignant migrating partial seizures in infancy / 国际儿科学杂志

The syndrome of malignant migrating partial seizures in infancy (MMPSI) is one of the most severe epileptic encephalopathies of infancy onset.It has been firstly reported by Coppola in 1995.There have been approximately 80 cases reported worldwide by now,but there is no case reported in our country.The etiology for MMPSI is still unknown,the diagnosis is difficult,and conventional antiepileptic drugs have little efficacy.This paper reviews the possible causes,clinical characteristics,diagnosis and treatment of MMPSI.

Efficacy, Safety and Tolerability of Trioptal®d: (Oxcarbazepine) in Children and Adolescents with Newly Diagnosed Partial Seizures or Generalized Tonic-Clonic Seizures: Results of a 6 Months, Prospective, Open-Label, Multicentre, Non-Comparative, Observational Post-Marketing Surveillance Study.

Objective: The current study was designed to analyze the extended efficacy and safety of Trioptal® (Oxcarbazepine) in treatment of children and adolescents with newly diagnosed partial seizures or generalized tonicclonic seizures in Indian population. Methods: This was an open-label non-randomized multi-centric observational prospective study (PMS study) across 54 centers in India. Treatment with Trioptal® (Oxcarbazepine) was initiated with a clinically effective dose (8-10 mg/kg/day in children) given in two divided doses as per the prescribing information. The dose was increased depending on the clinical response of the patient. In children, if clinically indicated, the dose was increased by a maximum of 10 mg/kg/day increments at approximately weekly intervals from the starting dose, to a maximum daily dose of 60 mg/kg/day. The efficacy of Trioptal® was assessed primarily by the percentage of seizure-free patients at 24 weeks. Secondary efficacy of the treatment was assessed through: reduction in seizure frequency at 24 weeks and the Global assessment of efficacy by the investigator at 24 weeks. Results: A total of 485 subjects were enrolled in the study. Majority of the subjects (52%) were stabilized at 8-15 mg/kg/day dose of Trioptal® and mean effective dose was 16.1 mg/kg/day (± 7.02). Approximately 70 % of the subjects were seizures free after 24 weeks of Trioptal® treatment and around 88% of the subjects reported the reduction in seizure of more than 50 %. The mean reduction in seizure frequency after 24 weeks of treatment was 82.3%. The overall efficacy with the Trioptal® treatment for 24 weeks was ‘good’ to ‘excellent’ in more than 97% of the subjects as per the assessment by the physician. A total of 59 adverse events were observed in 43 (8.9%) subjects. Headache was the most common adverse event being recorded in 8 subjects, followed by somnolence, nausea, vomiting, skin rash and weight gain. The overall tolerability of Trioptal® as per assessment by the patients was ‘good’ to ‘excellent’ in more than 98% of the subjects. Conclusion: Trioptal® (Oxcarbazepine) treatment is effective, safe and well tolerable in children and adolescents with newly diagnosed partial seizures or generalized tonic-clonic seizures.

Role of Magnectic Resonance Imaging of Brain in Paediatric Patients with Partial Seizures.

The study was carried out for one year to find out the role of magnetic resonance imaging brain in pediatric patients with partial seizures. Children from age 28 days to 18 years who presented with partial seizures were included and the information obtained from the history, clinical examination and investigations particularly MRI brain were noted down and analyzed.Maximum numbers of patients were in the age group of 5-10 years (48.84%).27.91% had simple seizures and the rest 72.09%had complex partial seizures with none having secondary generalization. The risk factor for seizures were present in 54.19% of cases. Most of the lesions involved parietal region (44.19%) followed by temporal lobe involvement in 13.95%. 55.81% had findings of neurocysticercosis (NCC), 29.91% showed tuberculoma, 8.30% had normal MRI findings and 6.98% had findings suggestive of cerebritis, sturge weber syndrome and porencephalic cyst. 89.74% lesions showed contrast enhancement on MRI. Contrast enhancement MR altered the radiological diagnosis in many patients with partial seizures. It helped to diagnose infections like tuberculoma and NCC in various stages of evolution and also helped to rule out other structural lesions, thus helping in planning modalities of treatment.

Benign Partial Seizures of Adolescence.

Benign partial seizures of adolescence (BPSA) presents as partial seizures with or without secondary generalization occurring isolated or in a cluster in the first 24 to 48 hours after onset in adolescents. Correct recognition of this entity can avoid use of antiepileptic drugs and associated risks. We conducted retrospective review of charts to identify seven cases of BPSA between 11-15 years at presentation who did not have generalized epilepsy, benign rolandic epilepsy, benign occipital epilepsy, an epileptogenic lesion on neuroimaging, or unprovoked recurrent tonic-clonic seizures. All of them had partial seizures, normal neuroimaging and electroencephalogram with no recurrence of seizures despite no treatment.

Economic Evaluation of Add-on Levetiracetam for the Treatment of Refractory Partial Epilepsy in Korea

OBJECTIVE: This study estimated the expected cost-effectiveness ratio expressed as the incremental cost per seizure-free day (SFD) gained and the incremental cost per quality adjusted life year (QALY) gained when using levetiracetam (LEV) as add-on therapy from a third-party payer perspective. METHODS: A 1-year dose-escalation decision-tree model comparing LEV plus standard therapy (ST) with ST alone was designed to combine transition probabilities, costs and outcomes. The short-term outcomes and probabilities were derived from a prospective, open-label clinical trial with 100 Korean adults with refractory partial epilepsy. All data for the direct medical costs were derived from Korean cost data extracted from reports published by the National Health Insurance Corporation. RESULTS: The average gain in SFDs attributed to LEV add-on was 18.3 days per patient per year and the incremental cost-effectiveness ratios (ICERs) for LEV add-on were US$ 44 per SFD per patient and US$ 11,084 per QALY gained. All sensitivity analyses showed that the model was robust to the assumptions made. CONCLUSION: The economic evaluation indicates that, given a wide range of assumptions, the increased cost of treating patients having refractory partial epilepsy with LEV may be partially offset by a reduction in other direct medical costs. This reduction is a consequence of an increase in the number of SFDs and improved quality of life.

Efficacy and Safety of Levetiracetam as Adjunctive Treatment in a Multicenter Open-Label Single-Arm Trial in Korean Patients with Refractory Partial Epilepsy: Over 1-Year Follow-Up / 대한간질학회지

PURPOSE: This prospective, open-label study evaluated the efficacy and safety of adjunctive levetiracetam (LEV) in Korean adults with uncontrolled partial epilepsy. METHODS: A total of 100 patients whose partial seizures were inadequately controlled on their current antiepileptic drugs were enrolled and received LEV (1000-3000 mg/day). Seizure count and adverse events (AEs) were recorded by patients. Global evaluation scale (GES) and quality of life (QOLIE-31) were also evaluated. Additionally effectiveness over 1-year follow-up was investigated. RESULTS: Ninety-two patients completed the short-term 16-week trial. The median percent reduction in weekly seizure frequency over the treatment period was 43.2%. The > or =50% and > or =75% responder rates were 45.4% and 36.1%, respectively. Seizure freedom was observed in 17 patients throughout the initial 16-week treatment period. On investigator's GES, 81 patients were considered improved, with 41 patients showing marked improvement. Most QOLIE-31 scales improved significantly. At the end of the trial, 79 chose to continue follow-up treatment with LEV. At the follow-up visit (ranging 60 to 81 weeks), 64 patients were still taking LEV; during the last 16 weeks, 65.6% of patients had > or =50% reduction, 50.0% had > or =75% reduction, and 35.9% had a 100% reduction. Seven patients showed continuous seizure freedom from the initiation of LEV treatment. During the entire treatment period, LEV was withdrawn in 36 patients; due to lack of efficacy in 22, AEs in six, both in three, other reasons in five. CONCLUSION: Adjunctive LEV therapy in patients with refractory partial epilepsy was effective and well-tolerated, as evidenced by the high seizure freedom and retention rates in both the short-term trial and the long-term follow-up.

A Case of Idiopathic Localized Hypertrophic Pachymeningitis Presented with Partial Seizures / 대한간질학회지

Idiopathic hypertrophic pachymeningitis is a clinical disorder caused by a localized or diffuse thickening of the dura mater, with an associated chronic inflammation. This can be diagnosed when there is no evidence of other etiologies such as trauma, infection, tumors, and Wegener's disease. Clinical manifestations are chronic headache with or without neurological manifestations such as cranial nerve palsies, cerebellar ataxia, neuro-ophthalmologic complications, and rarely clinical seizures. We described a patient with simple partial seizures with focal sensory and motor symptoms in the right hand as an initial and the only clinical manifestation, accompanied by a tumor-like lesion in the left parietal convexity on brain MRI. The patient underwent a lesionectomy, and the seizures have been well controlled so far without immunosuppressant treatment.

Clinical Significance of Interictal Serum Prolactin Level in Male Patients with Complex Partial Seizures Involving Temporal Lobe

BACKGROUND: To investigate the clinical significance of interictal serum prolactin level (ISPL), especially in the medical intractability, in patients with complex partial seizure involving the temporal lobe. METHODS: Forty-one male patients older than 16 years, who had motionless staring, were selected. The patients were divided into paired groups according to medical intractability, secondary generalization, duration of disease, seizure frequency, number of antiepileptic drugs, hippocampal sclerosis in MRI, and interictal epileptiform discharge. Serum was sampled in the morning before breakfast, and ISPL was measured. RESULTS: ISPL of the medically intractable patients (11.43 +/- 1.25 ng/ml, n=23) was relatively higher than the treatable patients (9.67 +/- 1.52, n=18), but it was not statistically significant (p>0.05). ISPL of the patients with secondary generalization was significantly higher (11.58 +/- 1.10, n=33) than that of the patients without secondary generalization (6.84 +/- 1.39, n=8; p=0.049). The other factors did not make significant changes in ISPL (p>0.05). CONCLUSIONS: The medical intractability of epilepsy with clinically determined complex partial seizures involving temporal lobe did not change the ISPL. Therefore, ISPL may not be useful as a biochemical marker of the medical intractability of complex partial seizures involving the temporal lobe. However, there was the evidence suggesting that the secondary generalization of complex partial seizures may be an important factor to increase ISPL, which implies that more widespread robust activation of limbic structures may be needed to elevate ISPL.

Study on the efficacy tolerability of topiramate in transferring monotherapy for the patients with partial seizures / 临床神经病学杂志

Objective To observe the possibility and efficacy tolerability of topiramate(TPM) in transferring monotherapy for the patients with partial seizures with or without secondary general seizure,as well as to find out the optimum way of the transferring.Methods After TPM add on therapy 64 patients with seizures reduced ≥50%, it reduced about 1/4 of AEDs or one drug each time according to every two weeks until gradually to stop fully and transferring monotherapy.Results 18 patients were successful with TPM monotherapy (28.13%), 35 patients were half success(54.69%), 11 cases for failure (17.19%). The less AEDs combined, the higher possibility of transferring monotherapy would be. The rate of success for cabamazepine seemed higher than valproate.Conclusion It was possible to transfer monotherapy by TPM. The rate of success was 28.13%. It was easier to reduce cabamazepine than valproate. In the transferring monotherapy it was better to reduce one after another, in principle the one of the little dose was reduced first,and then the hepatic enzyme inducing agents was reduced. Even if the transferring was half success,the kinds of concomitant AEDs could be reduced at least, it was in line with the policy of medicine application.