Registro de epilepsias na gravidez, complicações obstétricas e fetais e o uso de drogas antiepilépticas em Alagoas-BR / Registry of epilepsy during pregnancy, obstetric and fetal complications and the use of antiepileptic drugs in Alagoas-BR

Objetivos: artigo 1: Descrever a prevalência das nas mulheres gestantes com epilepsia (MGCE), perfil sociodemográfico e desfechos obstétricos e analisar associação dessas variáveis com a doença. Artigo 2: Descrever o perfil de MAC (medicação anticrise) e tipos de crises e analisar a associação desses perfis com a incidência de complicações maternas e fetais nas MGCE. Artigo 3: Descrever a prevalência, perfil sociodemográfico e clínico, perfil de MAC, tipos de crises e analisar a associação da incidência de complicações maternas e fetais com essas variáveis nas MGCE. Métodos: Artigos 1 e 2: coortes retrospectivas com 234 MGCE e 492 MGSE. Artigo 3 coorte prospectiva coletou dados de 95 MGCE e 380 sem epilepsia (MGSE). Ambas as coortes com idade 40 anos em prontuários e entrevistas em 4 maternidades de alto risco em Alagoas no período de 2008 a 2021 na coorte retrospectiva e 2021 e 2022 na prospectiva. Resultados: A prevalência de MGCE nas coortes retrospectiva e prospectiva foi de 0,49% (n = 224/44917) e 0,53% (n = 105/19.624) com médias de idade (24,94 ± 6,25 e 23,98 ± 6,89); (24,42 ± 5,64 e 24,42 ± 5,62) anos. MGCE procederam da zona rural (58,2%; 64,2%), eram de cor parda (88,6%;98%), (7%; 3,2%) analfabetas e com ensino fundamental (40%; 52,1%), solteiras (47,3%; 49,5%) e (76,9%; 78,9%) donas de casa, respectivamente. Em relação a partos, a maioria (60,3%; 54,8%) eram multíparas, (74,6%; 70,8%) tiveram parto cesáreo, respectivamente. Na coorte prospectiva 15,8% sem renda, 54,7% com menos de 1 salário mínimo, 44,2% eram de religião católica e 87.4% não planejou a gravidez. A análise dos desfechos obstétricos e neonatais mostrou um risco maior nas MGCE para hipertensão relacionada à gravidez (HRG) (OR =6.29; 95% CI =3.50-11.30), pré-eclâmpsia (OR=8.04; 95% CI=2.22-29.10) na coorte retrospectiva, e em ambas coortes um risco de sangramento vaginal (OR=2.54; 95% CI=1.15-5.59);(OR=4.13; 95% CI=1.45-9.11), aborto espontâneo (OR=1.75; 95% CI=1.16-2.63); (OR=1.50; 95% CI=1.00-2.22) e natimorto (OR=11,16; 95% CI=2.22-29.10); (OR=5.27; 95% CI=2.29-10.30). Nas coortes retrospectiva e prospectiva (14%; 14,7%) não usaram MAC, (50,2%; 85,3%) monoterapia (35,8%; 12,6%) politerapia, respectivamente. O fenobarbital foi o MAC mais prescrito seguido pela carbamazepina em ambas coortes. Na prospectiva MGCE que usaram MAC e em politerapia tiveram maior risco de hemorragia vaginal, admissão em UTI materna e natimorto. Analisando os tipos de epilepsia a maioria 40% tinha o tipo generalizada. A respeito do tipo de crise, a maioria 53,3% apresentou crise focal na coorte retrospectiva, enquanto na prospectiva a maioria delas 48,4% teve CTCG e 19% estado de mal epiléptico associados a desfechos obstétricos e neonatais adversos. Conclusão: Ambos os estudos relatam um perfil sociodemográfico da MGCE de alta vulnerabilidade social e alto risco de desfechos obstétricos e neonatais adversos, provavelmente devido à procedência de uma região pobre do Brasil. Foi constatado algumas limitações na distribuição de MACs apropriados para essa população.

Objectives: article 1: To describe the prevalence of epilepsy in pregnant women, sociodemographic profile and obstetric outcomes and analyze the association of these variables with a disease. Article 2: Describe the profile of ASM (anti-crisis medication) and types of seizures and analyze the association of these profiles with the incidence of maternal and fetal complications in pregnat women with epilepsy (PWWE). Article 3: Describe the prevalence, sociodemographic and clinical profile, types of ASM used and seizures and analyze the association of the incidence of maternal and fetal complications with these variables in PWWE. Methods: Articles 1 and 2: retrospective cohorts with 234 PWWE and 492 pregnant women without epilepsy (PWNE). Article 3 prospective cohort collected data from 95 PWWE and 380 PWNE. Both cohorts aged 40 years in medical records and interviews from four high-risk maternity hospitals in Alagoas. The period from 2008 to 2021 in the cohort retrospective and 2021 and 2022 in the prospective. Results of the articles: The prevalence of PWWE in the retrospective and prospective cohorts were 0.49% (n = 224/44917) and 0.53% (n = 105/19,624) with mean ages (24.94 ± 6.25 and 23 .98 ± 6.89); (24.42 ± 5.64 and 24.42 ± 5.62) years, respectively. PWWE came from the countryside (58.2%; 64.2%), had brown skin (88.6%; 98%), illiterate (7%; 3.2%) and had primary education (40%; 52 .1%), single (47.3%; 49.5%) and (76.9%; 78.9%) homemakers, respectively. Regarding deliveries, the most of them (60.3%; 54.8%) were multiparous, (74.6%; 70.8%) had cesarean delivery, respectively. In the prospective cohort, 15.8% had no income, 54.7% earned less than 1 minimum wage, 44.2% were Catholic religious and 87.4% had not planned the pregnancy. Analysis of obstetric and neonatal outcomes showed a higher risk in PWWE for pregnancy-related hypertension (PrH) (OR=6.29; 95% CI=3.50-11.30), preeclampsia OR=8.04; 95% CI=2.22-29.10) in the retrospective cohort, and in the retrospective and prospective cohorts a risk of vaginal bleeding (OR=2.54; 95% CI=1.15-5.59);(OR=4.13; 95% CI=1.45-9.11), miscarriage (OR=1.75; 95% CI=1.16-2.63); (OR=1.50; 95% CI=1.00-2.22) and stillbirth (OR=11.16; 95% CI=2.22-29.10); (OR=5.27; 95% CI=2.29-10.30), respectively. In both cohorts (14%; 14.7%) they did not use MAC, (50.2%; 85.3%) monotherapy (35.8%; 12.6%) polytherapy, respectively. Phenobarbital was the most prescribed ASM followed by carbamazepine in both cohorts. In prospective PWWE who used ASM and polytherapy had a higher risk of vaginal bleeding, maternal ICU admission and stillbirth. Analyzing the types of epilepsy, most of them 40% had the generalized type. Regarding the type of seizure, most 53.3% had focal seizures in the retrospective cohort, while in the prospective cohort, most of them 48.4% had GTCS (tonic-clonic generalized) and 19% had status epilepticus, associated with adverse obstetric and neonatal outcomes. Conclusion: Both studies report a sociodemographic profile of PWWE with high social vulnerability and higher risk of adverse obstetric and neonatal outcomes, probably due to the origin of a poor region of Brazil. Some limitations were found in the distribution of appropriate ASM for this population

Bilateral fracture of the shoulders following epileptic seizures: a case report / Fratura bilateral de ombros após convulsões epilépticas: relato de caso

Convulsive seizures caused by hyponatremia occur when this condition is severe and develops quickly, resulting in a brain's adaptive inability to contain brain swelling. Seizures are rarely the cause of shoulder fractures. This is a case report of bilateral humerus fracture following a single epileptic seizure caused by drug hyponatremia, an unconventional event in medical practice. A 69-year-old woman was admitted to the emergency room after a single tonic-clonic seizure with spontaneously ceased sphincter relaxation, showing Glasgow 6. No falls or restraint were reported by observers. When alert, the patient reported pain and difficulty moving both arms. During examination, the movement was li- mited to the right and left. Anteroposterior radiographs revealed bilateral fracture at the neck of humerus. To complement inves- tigation for further lesions, a computed tomography confirmed bilateral fracture-dislocation with impaction of the humeral head with the glenoid. Atraumatic bilateral fracture-dislocation of the humerus after epileptic seizure is a very rare event. It is believed that some of these diagnoses have been neglected due to the difficulty of characterizing the patient's pain in a postictal state. The importance of a detailed physical examination shall be emphasized in risk groups such as the polymedicated elderly.

Convulsive seizures caused by hyponatremia occur when this condition is severe and develops quickly, resulting in a brain's adaptive inability to contain brain swelling. Seizures are rarely the cause of shoulder fractures. This is a case report of bilateral humerus fracture following a single epileptic seizure caused by drug hyponatremia, an unconventional event in medical practice. A 69-year-old woman was admitted to the emergency room after a single tonic-clonic seizure with spontaneously ceased sphincter relaxation, showing Glasgow 6. No falls or restraint were reported by observers. When alert, the patient reported pain and difficulty moving both arms. During examination, the movement was li- mited to the right and left. Anteroposterior radiographs revealed bilateral fracture at the neck of humerus. To complement inves- tigation for further lesions, a computed tomography confirmed bilateral fracture-dislocation with impaction of the humeral head with the glenoid. Atraumatic bilateral fracture-dislocation of the humerus after epileptic seizure is a very rare event. It is believed that some of these diagnoses have been neglected due to the difficulty of characterizing the patient's pain in a postictal state. The importance of a detailed physical examination shall be emphasized in risk groups such as the polymedicated elderly.

Photosensitive tonic-clonic seizures:a continuum between focal and generalized seizures / 北京大学学报(医学版)

OBJECTIVE@#To investigate whether the tonic-clonic seizure (TCS) induced by intermittent photic stimulation (IPS)was generalized tonic-clonic seizure (GTCS)or partial secondarily tonic-clonic seizure (PGTCS),and to analyze the relationship between them.@*METHODS@#Video-electroencephalogram (VEEG)database of Peking University First Hospital from March 2010 to October 2018 were reviewed. Fifteen cases with idiopathic epilepsy who had TCS induced by IPS were included in this study, and their clinical and electroencephalogram (EEG)characteristics were retrospectively analyzed.@*RESULTS@#In this study, 4 of the 15 cases were boys and 11 were girls. The age of seizure onset ranged from 1 to 13 years. According to the medical records: 12 cases were considered as GTCS,while the remaining 3 cases were considered as PGTCS. The age at VEEG monitoring ranged from 2.5 to 16.0 years. All backgrounds of the VEEG were normal. Interictal discharges:generalized discharges in 11 cases, of which 4 cases coexisted with posterior discharges, 2 cases coexisted with Rolandic discharges, the other 5 cases merely had generalized discharges; merely focal discharges in two cases, one in the Rolandic area and the other in the posterior area; no interictal discharge in the remaining 2 cases. IPS induced photoparoxysmal response (PPR)results: 2 cases without PPR,the remaining 13 cases with PPR of generalized discharges, and 6 of the 13 cases coexisted with posterior discharges. IPS induced photoconvulsive response (PCR)results: GTCS in one case (contradictory to medical history),PGTCS in 11 cases (consistent with medical history),and GTCS and PGTCS hardly to distinguish in the remaining 3 cases. Of the three conditions above, there were generalized myoclonic seizures induced by IPS before TCS in 7 cases.@*CONCLUSION@#The medical history was unreliable in determining whether TCS was generalized or focal. Myoclonic seizures can coexist with PGTCS, and sometimes GTCS was indistinguishable from PGTCS, indicating that the dichotomy of seizure types need to be improved. Photosensitive TCS should be regarded as a continuum between focal and generalized seizures.

Seizure due to multiple drugs intoxication: a case report / Convulsão por causa de intoxicação por múltiplas drogas: relato de caso

Abstract The mechanism of the antidepressant effect of bupropion is not fully understood. Besides, using it in the treatment of depression, it is found to be effective in reducing withdrawal symptoms due to smoking cessation. A 28-year-old female patient with a history of depression was admitted to emergency department an hour after ingestion of bupropion, quetiapine, and levothyroxine in high doses to commit suicide. While accepting her into the Intensive Care Unit, she was awake, alert, disoriented and agitated. After 2 h, the patient had a generalized tonic-clonic seizure. The necessary treatment was given and 9 h later with hemodynamic improvement, the patients’ mental status improved. Bupropion may cause unusual behaviors such as delusions, paranoia, hallucinations, or confusion. The risk of seizure is strongly dose-dependent. We want to emphasize the importance of early gastric lavage and administration of activated charcoal.

Resumo O mecanismo do efeito antidepressivo de bupropiona ainda não está bem esclarecido. Contudo, seu uso no tratamento de depressão revelou ser eficaz para reduzir os sintomas de abstinência relacionados à cessação do tabagismo. Uma paciente do sexo feminino, 28 anos, com história de depressão, deu entrada no setor de emergência uma hora após a ingestão de bupropiona, quetiapina e levotiroxina em doses elevadas para cometer suicídio. Ao ser internada em unidade de terapia intensiva, estava acordada, alerta, desorientada e agitada. Após duas horas, apresentou uma crise tônico-clônica generalizada. O tratamento necessário foi administrado e nove horas mais tarde, com a estabilização hemodinâmica, o estado mental da paciente melhorou. Bupropiona pode causar comportamentos incomuns, incluindo delírios, paranoia, alucinações ou confusão mental. O risco de convulsão é altamente dependente da dose. Queremos enfatizar a importância da lavagem gástrica precoce e da administração de carvão ativado.

Infección por VIH/SIDA y múltiples enfermedades oportunistas simultáneas / HIV/AIDS Infection and multiple simultaneous opportunistic diseases

La infección por Virus de Inmunodeficiencia Humana y el Síndrome de Inmunodeficiencia Adquirida en fase avanzada de la infección, propician condiciones de vulnerabilidad para las infecciones oportunistas. Caso Clínico: Paciente femenina de 21 años, sin antecedentes conocidos, se presentó a emergencia con historia de convulsión tónico-clónica de dos minutos de duración, acompañada de oculogiros, sin relajación de esfínteres; pérdida ponderal de ocho meses de evolución, acompañada de astenia, adinamia, hiporexia y tos seca. En el examen físico de tórax: a la inspección de piel se observó costra serohematica impetiginizada en hemitórax izquierdo, sin cruzar la línea media, acompañado de dolor y seguía el trayecto dermatomérico; a la auscultación, crépitos escasos en lóbulo medio de pulmón derecho. Durante la evaluación de ingreso presentó dos episodios convulsivos similares. Se practicó radiografía de tórax posteroanterior, se observó masa circular en lóbulo medio de pulmón derecho; hematología demostró falla renal aguda, anemia normocitica-normocromica y sospecha de inmunosupresión. Se diagnosticó Infección por Virus de Inmunodeficiencia Humana/Síndrome Inmunodeficiencia Adquirida mediante serología y conteo de linfocitos CD4, histoplasmosis sistémica, herpes zóster y tuberculosis pulmonar; se instauró tratamiento. Al finalizar terapia y la evolución clínica se decide su egreso, para control ambulatorio. Conclusión: la intervención temprana y la terapia adecuada son esenciales para la evolución y desenlace clínico; la paciente tuvo evolución satisfactoria posterior al inicio de una terapia antifimica profiláctica, se egresó y se dio control en consulta externa de Infectología del Hospital Escuela Universitario...(AU)

Esclerosis tuberosa / Tuberous sclerosis

Se presenta el caso de paciente masculino de 15 años de edad que es llevado a sala de urgencia s del Hospital Roosevelt por convulsiones tónico clónico generalizadas de 2 minutos de duración, con período postictal, con antecedentes familiares de convulsiones mostradas en el árbol genealógico (grafico 2 ). Además presenta antecedente de síndrome convulsivo desarrollado a los tres años de edad, tratado con múltiples anticonvulsivantes sin llegar a un dia gnóstico. Paciente al examen físico se presenta normocéfalo, cabello adecuada implantación, alerta, orientado en tiempo, espacio y persona, escleras y mucosas normales, con lesiones angiofibromatosas de distribución en alas de mariposa en región de puente nasal, alas nasales, mejillas y frente , frecuencia respiratoria de 14 por minuto, con ruidos respiratorios conservados, frecuencia cardíaca 70 por minuto, presión arteria l 100/60 mmHg, ritmo cardíaco normal, sincrónico con el pulso, abdomen sin alteraciones, extremidades y evaluación de sistema nervioso central sin presentar alteraciones...(AU)

We present the case of a 15-year-old male patient who is taken to the emergency room s Roosevelt Hospital for generalized 2-minute clonic tonic convulsions, with a period postictal, with family history of seizures shown in the pedigree (chart 2). It also presents a history of convulsive syndrome developed at three years of age, treated with multiple anticonvulsants without reaching a Gnostic day. Patient to the physical examination presents normocephalus, adequate hair implantation, alert, oriented in time, space and person, normal scleras and mucous membranes, with angiofibromatosis lesions of distribution in butterfly wings in nasal bridge region, nasal wings, cheeks and forehead, frequency respiratory rate of 14 per minute, with preserved respiratory sounds, heart rate 70 per minute, artery pressure l 100/60 mmHg, normal heart rate, synchronous with the pulse, abdomen without alterations, extremities and evaluation of the central nervous system without presenting alterations. . (AU)

Status Epilepticus: an intractable case with a successful outcome

A thirty-two-year-old male patient with a history of fever presented with generalized tonic-clonic convulsions and a low Glasgow Coma Score [GCS]; an endotracheal tube was inserted to secure his airway. The patient had malignant generalized tonic-clonic convulsions for six weeks, he was diagnosed as status epilepticus [SE] on the electroencephalogram [EEG]. Achieving control was very difficult even with various antiepileptic medications. More than six antiepileptic drugs were used in addition to continuous infusion of anesthetic medications to control the convulsions. After four-months in the ICU, the patient became fully conscious with no residual neurological deficit and good control of convulsions but with generalized muscle weakness. The patient was eventually transferred to the regular ward and was discharged after few days

Psychiatric Symptoms in Temporal Lobe Epilepsy with Left Mesial Hippocampal Sclerosis

A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients.

Sindrome de sandifer: a propósito de la enfermedad por reflujo gastroesofágico en niños / Sandifer syndrome and gastroesophageal reflux in childre

El Síndrome de Sandifer es un trastorno neuroconductual con movimientos de hiperextensión de cuello, cabeza y tronco, con rotación de cabeza, que generalmente se presentan durante o inmediatamente después de la ingesta de alimentos y cesa durante el sueño, secundario a enfermedad por reflujo gastroesofágico. Se caracteriza por esofagitis, anemia por deficiencia de hierro y son confundidos con frecuencia como crisis de origen epiléptico. Lactante masculino de 5 meses referido por movimientos de tónico-clónicos generalizados, de segundos de duración, con una frecuencia de 30 episodios al día, que no ceden con el uso de 3 anticonvulsivantes. Disfagia a alimentos pastosos. Hospitalización al mes de vida por episodio de amenazante de la vida. Estudios neurológicos normales. Paraclínica: anemia microcítica e hipocrómica. Videodeglutoscopia: Disfagia de fase oral leve, disfagia fase esofágica a estudiar (Regurgitación), reflujo faringolaringeo según escala de Belafsky y Larigomalacia grado I; pHmetría de 24 horas con impedancia, puntación de Boix-Ochoa de 26%, durante la colocación de la sonda se observo posición anómala de la cabeza e hiperextensión del dorso. Estudio contrastado de esófago, estómago y duodeno sin anormalidad anatómica. Endoscopia digestiva superior: Esofagitis no erosiva, Hernia hiatal. El Síndrome de Sandifer es una de las presentaciones atípicas de RGE en lactantes. Amerita la evaluación de un equipo multidisciplinario para establecer el diagnóstico. El manejo medico incluyó medidas antireflujo, esomeprazol y técnica de alimentación adecuada con evolución satisfactoria. La diversidad de enfermedades relacionadas con RGE exige el uso de variadas técnicas para lograr diagnósticos más asertivos

Sandifer's syndrome is a neurobehavioral disorder with hyperextension movements of neck, head and trunk, head rotation, which usually occur during or immediately after food intake and ceases during sleep, secondary to gastroesophageal reflux disease. It is characterized by esophagitis, anemia and iron deficiency are often confused as a crisis of epileptic origin. A male infant of 5 months reported by tonic-clonic movements of widespread, lasting seconds, with a frequency of 30 episodes per day, which do not yield with the use of 3 anticonvulsants. Pasty food dysphagia. Hospitalization month of life-threatening episode of life. Normal neurological studies. Paraclinical: hypochromic microcytic anemia. Videodeglutoscopia: mild oral phase dysphagia, esophageal dysphagia to study phase (regurgitation), pharyngolaryngeal reflux as Belafsky and Larigomalacia scale grade I, ph-metry of 24 hours with impedance, Boix-Ochoa score of 26% during the placement of probe was observed abnormal head position and hyperextension of the back. Contrast study of esophagus, stomach and duodenum without anatomical abnormality. Upper gastrointestinal endoscopy: nonerosive esophagitis, hiatal hernia. Sandifer Syndrome is one of the atypical presentations of GER in infants. Warrants evaluation by a multidisciplinary team to establish the diagnosis. The medical management included antireflux measures, esomeprazole and proper feeding technique with satisfactory outcome. The diversity of diseases associated with GER requires the use of various diagnostic techniques to get more assertive

Epilepsia em cães: 66 casos (2005-2010) / Epilepsy in dogs: 66 cases (2005-2010)

O objetivo deste estudo foi identificar cães com epilepsia e obter informações a respeito da raça, do sexo, da idade, da classificação da epilepsia e da crise convulsiva, dos estágios e do período de ocorrência das crises convulsivas. Em 66,7% (44/66) dos cães a epilepsia foi primária, em 21,2% (14/66) sintomática e em 12,1% (8/66) provavelmente sintomática. Os cães sem raça definida (27%) foram os mais acometidos e a faixa etária predominou entre um e cinco anos de idade. A crise convulsiva generalizada tônico-clônica (66,7%) foi a mais observada, a procura pelo dono (72,7%) no período pré-ictal e o andar compulsivo (60,5%) no período pós-ictal foram os sinais mais encontrados e a ocorrência das crises convulsivas foi maior no período noturno (79,2%).

The objective of this study was to identify dogs with epilepsy and to obtain information about breed, sex, age, classification of the epilepsy and the seizures, as well as the stage and time of occurrence of the seizures. Epilepsy was primary in 66.7% (44/66) of dogs, symptomatic in 21.2% (14/66), and probably symptomatic in 12.1% (8/66). Crossbred dogs (27%) were the most affected and the predominant age group ranged from one to five years; the generalized tonic-clonic seizures (66.7%) was the most frequent presentation. The search for the owner (72.7%) during the preictal period and the compulsive walking (60.5%) in post-ictal period were the more frequent signs observed in the affected dogs, and the occurrence of seizures was higher at night (79.2%).

(1)H-magnetic resonance spectroscopy on bilateral thalamus of patients with secondarily generalized tonic-clonic seizures / 中南大学学报(医学版)

OBJECTIVE@#To examine the changes of metabolites in the bilateral thalamus of patients with secondarily generalized tonic-clonic seizure (SGTCS) and to explore the mechanism of SGTCS.@*METHODS@#Thirty patients with SGTCS (epilepsy group) and 30 matched healthy controls (control group) were examined by 1H-magnetic resonance spectroscopy (1H-MRS). The levels of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine phosphocreatine (Cr-PCr), and myo-inositol (mI) of the bilateral thalamus were measured in both the epilepsy group and the control group. The ratios of NAA/Cr-PCr, NAA/(Cr-PCr+Cho), Cho/Cr-PCr and mI/Cr-PCr were compared and analyzed in the 2 groups.@*RESULTS@#The ratios of NAA/Cr-PCr, and NAA/(Cr-PCr+Cho)(1.7074 ± 0.2214; 0.9333 ± 0.2173) in the left thalamus in the epilepsy group were significantly lower than those in the control group(1.8834 ±0.2093; 1.1243 ±0.2447)(P0.05).@*CONCLUSION@#There is neuronal dysfunction in the bilateral thalamus in the epilepsy group. Abnormal changes of the bilateral thalamus are involved in the mechanism of SGTCS.

Clinical and electroencephalographic characteristics of Jeavons syndrome / 中华儿科杂志

<p><b>OBJECTIVE</b>The study was designed to examine the clinical and electroencephalographic characteristics of children with Jeavons syndrome.</p><p><b>METHOD</b>Video-electroencephalography (VEEG) monitoring was carried out in 9 patients with Jeavons syndrome. The clinical and electroencephalographic characteristics, treatment and prognoses were analyzed.</p><p><b>RESULT</b>Of the 9 patients, 8 were female, and 1 was male. The onset age of children with eyelid myoclonia (EM) was from 3 to 9 years old. It was obtained through the chief complaint, prosecution or VEEG monitoring. Three cases were misdiagnosed and 2 cases were overlooked initially. Seven out of 9 patients had generalized tonic clonic seizures (GTCS) during the course of disease, of whom 5 experienced only one episode. GTCS was the cause for the first visits to hospital in 5 patients. Since the clinical manifestations of EM with or without absence were often slight, VEEG monitoring with eye closure and intermittent photic stimulation tests helped to induce discharges and seizures. Eye closure was more potent than intermittent photic stimulation as a triggering factor. Ictal EEG showed 3 - 6 Hz generalized spike and waves and polyspikes burst. The main treatment option was valproate monotherapy (6 cases) or combined with other antiepileptic drugs (1 case). Levetiracetam, lamotrigine and topiramate were also used in patients and effective to some degree. Two patients lost follow up. The age of 7 patients at follow-up ranged from 9 y to 15 y. Seizures were controlled in 1 case, suspiciously controlled in 1 case, decreased in frequency in 4 cases and were still frequent in 1 case. During follow-up, normal intelligence was found in the former 2 cases, difficult learning in 2 cases, and slightly intellectual impairment in 2 cases.</p><p><b>CONCLUSION</b>Jeavons syndrome is one of the idiopathic generalized epilepsies characterized by EM with or without absence. The age of seizure onset might be difficult to be exactly established, as EM was often misinterpreted and overlooked initially. Clinical history combined with VEEG monitoring with eye closure and intermittent photic stimulation tests could diagnose this disease. Valproate and other new antiepileptic drugs were effective for this disease. Jeavons syndrome is a lifelong disorder. Seizures sometimes could be well controlled. When seizures were resistant to treatment, cognitive and intellectual impairment might occur.</p>

Diagnóstico e tratamento de convulsões / Diagnosis and treatment of convulsions

As características, as causas, os cursos e os tratamentos dos vários tipos de convulsões serão aqui apresentados. Os tipos mais comuns de desordens convulsivas são: 1. grande mal, às vezes chamada tônico-clônica generalizada; 2. ausência ou pequeno mal; 3. psicomotora ou complexa parcial; 4. mioclônica ou espasmo convulsivo; e 5. febril, em crianças pequenas. Os tipos de convulsões mais raras são: status epilepticus; atônica; parcial; jacksoniana; e espasmo infantil.

The characteristics, causes, treatment and courses of various types of convulsive disorders are presented here. The most common types of convulsive disorders are: 1. great evil, sometimes called generalized tonic-clonic; 2. absence or petit mal; 3. psychomotor or complex partial; 4. myoclonic or convulsive spasm; and 5. febrile, illness in young children. The types of convulsions are rare: status epilepticus; atonic; partial; jacksonian; and infantile spasms.

Visual contrast sensitivity in tonic-clonic epileptic patients

We measured the effects of epilepsy on visual contrast sensitivity to linear and vertical sine-wave gratings. Sixteen female adults, aged 21 to 50 years, comprised the sample in this study, including eight adults with generalized tonic-clonic seizure-type epilepsy and eight age-matched controls without epilepsy. Contrast threshold was measured using a temporal two-alternative forced-choice binocular psychophysical method at a distance of 150 cm from the stimuli, with a mean luminance of 40.1 cd/m². A one-way analysis of variance (ANOVA) applied to the linear contrast threshold showed significant differences between groups (F[3,188] = 14.829; p < .05). Adults with epilepsy had higher contrast thresholds (1.45, 1.04, and 1.18 times for frequencies of 0.25, 2.0, and 8.0 cycles per degree of visual angle, respectively). The Tukey Honestly Significant Difference post hoc test showed significant differences (p < .05) for all of the tested spatial frequencies. The largest difference between groups was in the lowest spatial frequency. Therefore, epilepsy may cause more damage to the neural pathways that process low spatial frequencies. However, epilepsy probably alters both the magnocellular visual pathway, which processes low spatial frequencies, and the parvocellular visual pathway, which processes high spatial frequencies. The experimental group had lower visual contrast sensitivity to all tested spatial frequencies.

Clinical analysis in viral encephalitis patients accompanying generalized tonic clonic seizure / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To summarize the value of clinical features, CSF, imaging and EEG in diagnosing viral encephalitis accompanying generalized tonic clonic seizure (GTCS).</p><p><b>METHODS</b>The clinical, imaging and EEG characteristic of 30 patients with viral encephalitis accompanying GTCS were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 30 cases with viral encephalitis, 21 cases GTCS attacked (70%) within 14 days, 9 cases had GTCS (30%) in 15-28 days. 27 cases CSF were abnormal with the pressure, cell number, protein. The incidence of positive pathogenicity was 12/16; 19 cases MRI had abnormal signal. All the patients had abnormal EEG during the disease.</p><p><b>CONCLUSION</b>The clinical features, CSF, imaging and EEG were all important in diagnosing and estimate of viral encephalitis accompanying GTCS.</p>

Proteus syndrome: a case report

Proteus Syndrome is an extremely rare, sporadic and progressive disorder. We describe a four-month-old male baby with central nervous system manifestations in this article. A four-month-old boy was admitted into our hospital with three tonic- clonic generalized seizure attacks which started from the day before admission. Each seizure attack lasted less than 10 minutes and the baby was well between attacks. No fever was detected. On physical examination, abnormal facial features, macrocrania, a wide nasal bridge, overgrowth of the right lower limb, macrodactyly in the third left toe, epidermal nevus on the left side of the abdomen and skin vascular abnormalities were detected. His developmental status was normal. Brain Magnetic Resonance Imaging [MRI] revealed left sided hemihypertrophy, ventricle enlargement and macrocrania on the same side

Edema pulmonar neurogénico secundario a crisis epiléptica: presentación de un caso y revisión de la literatura / Neurogenic pulmonary edema secondary to epileptic seizures: report of a case and a short review

The acute neurogenic pulmonary edema (NPE) is a kind of pulmonary edema that occurs as a result of a variety of injuries of the central nervous system. Usually it is underdiagnosed. It has been reported in many diseases and direct injuries of the central nervous system. We present the clinical case of a middle age women with a neurogenic pulmonary edema secondary to a epileptic seizure. We made a review of the literature with special emphasis on clinical implications and treatment.

El edema pulmonar agudo neurogénico (EPN) es un tipo de edema pulmonar que ocurre como consecuencia de una variada gama de lesiones del sistema nervioso central. Generalmente es subdiagnosticado. Se ha reportado en múltiples patologías y lesiones directas del sistema nervioso central. Presentamos el caso clínico de una mujer de mediana edad, con edema pulmonar agudo secundario a una crisis convulsiva epiléptica. Se realiza una revisión de la literatura con especial énfasis en las implicancias clínicas y tratamiento.

Simultaneous fracture of both femoral necks secondary to a hypocalcemic seizure

We report a rare case of simultaneous fracture of both femoral necks caused by hypocalcemic fit secondary to chronic renal failure. The case was successfully treated by bilateral bipolar arthroplasties