ABSTRACT
Acute disseminated encephalomyelitis is a monophasic, immune-mediated disorder that produces multifocal demyelinating lesions within the central nervous system. It is characterized clinically by the acute onset of neurologic abnormalities, including varying degrees of mental state changes ranging from drowsiness to coma. It is unusual for the illness to present as an isolated acute psychosis. The case of a 14-year-old female with biopsy-confirmed acute disseminated encephalomyelitis, who was initially diagnosed with an acute psychiatric disorder, is presented, and published reports on this unusual manifestation are reviewed. A Medline database search was performed from 1965 to 1999, using the terms acute disseminated encephalomyelitis, postvaccinal encephalomyelitis, postinfectious encephalomyelitis, and measles encephalomyelitis, combined with the terms psychosis, psychiatric disorder, and behavioral disorder. Selected cross-referenced reports were also reviewed. Nine patients were identified who presented with acute psychosis. We conclude that, although rare, acute disseminated encephalomyelitis can present as an acute psychosis. This immune-mediated condition should be included in the differential diagnosis of neurologic disorders presenting as a psychiatric illness.
Subject(s)
Encephalomyelitis, Acute Disseminated/diagnosis , Psychotic Disorders/diagnosis , Adolescent , Diagnosis, Differential , Encephalomyelitis, Acute Disseminated/epidemiology , Encephalomyelitis, Acute Disseminated/psychology , Female , Humans , Incidence , Magnetic Resonance ImagingABSTRACT
This review highlights our understanding of episodic phenomena in children and adolescents that resemble epileptic seizures. Although the initial focus is on psychogenically determined nonepileptic seizures (NES; pseudoseizures), other forms of conversion symptoms are also discussed. We subsequently examine the diverse nonpsychogenic, nonepileptic paroxysmal disorders that may be encountered in this age group.
Subject(s)
Brain Diseases/diagnosis , Seizures/diagnosis , Adolescent , Child , HumansABSTRACT
We report two patients with intractable partial seizures who developed generalized nonconvulsive status epilepticus (NCSE) after receiving tiagabine (TGB). Neither had a history of absence seizures or generalized epileptic discharges on prior EEG monitoring. Clinicians need to be aware of a possible association between TGB and NCSE.
Subject(s)
Anticonvulsants/adverse effects , Epilepsies, Partial/drug therapy , Nipecotic Acids/adverse effects , Status Epilepticus/chemically induced , Adult , Anticonvulsants/therapeutic use , Electroencephalography/statistics & numerical data , Female , Humans , Male , Nipecotic Acids/therapeutic use , TiagabineABSTRACT
PURPOSE: We assessed rates of symptoms of anxiety and depression among pediatric patients with epilepsy. METHODS: We administered the Revised Child Manifest Anxiety Scale (RCMAS), and Child Depression Inventory (CDI) to 44 epilepsy patients aged 7-18 years (mean age 12.4 years). Demographic, socioeconomic, and epilepsy-related information was examined in relation to depression and anxiety scores. RESULTS: No patients had been previously identified to have depression or anxiety. However, 26% had significantly increased depression scores and 16% met criteria for significant anxiety symptomatology. CONCLUSIONS: Symptoms of depression and anxiety are common among pediatric patients with epilepsy and appear to be overlooked by care providers.
Subject(s)
Anxiety Disorders/epidemiology , Depressive Disorder/epidemiology , Epilepsy/epidemiology , Adolescent , Age Factors , Anxiety Disorders/diagnosis , Chi-Square Distribution , Child , Comorbidity , Depressive Disorder/diagnosis , Female , Humans , Male , New York/epidemiology , Personality Inventory/statistics & numerical data , Prevalence , Psychiatric Status Rating Scales/statistics & numerical data , Severity of Illness Index , Sex FactorsABSTRACT
We prospectively investigated drug-induced headaches (HA) among 60 epileptic patients receiving felbamate (FBM). Twenty patients (33%) experienced HA. HA was pounding in 11 (55%), steady in 9 (45%), moderate or severe in 19 (95%), occurred at least once a week in all patients, and was relieved by nonnarcotic analgesics in 14 (70%). Mean duration on FBM before HA onset was 19 days. HA occurred with higher FBM doses and was relieved in 8 of 13 patients (62%) with FBM dose reduction. FBM was discontinued in most cases because of risks of anemia or hepatitis; not because of HA. Other side effects included insomnia (25%), gastrointestinal symptoms (27%), and agitation or restlessness (23%). HA is a common dose-related complication of FBM, occurs early after initiation of FBM treatment, and is relieved by dose reduction.
Subject(s)
Anticonvulsants/adverse effects , Epilepsy/drug therapy , Headache/chemically induced , Propylene Glycols/adverse effects , Adolescent , Adult , Aged , Analgesics, Non-Narcotic/therapeutic use , Dose-Response Relationship, Drug , Drug Therapy, Combination , Felbamate , Female , Headache/drug therapy , Humans , Male , Middle Aged , Phenylcarbamates , Prospective StudiesABSTRACT
We report the case of an 18-month-old child with infantile spasms and a hypsarrhythmic electroencephalogram (EEG) pattern associated with a porencephalic cyst. Surgical removal of the cyst and its surrounding tissue was performed following failure of medical therapy. Postoperatively, the patient has been free of infantile spasms for 12 months and the EEG has normalized. He has been maintained on the same preoperative antiepileptic medications. This case suggests that surgical treatment is helpful in selected patients with infantile spasms and focal CNS lesions.
Subject(s)
Spasms, Infantile/surgery , Brain/physiopathology , Brain Diseases/complications , Brain Diseases/surgery , Cysts/complications , Cysts/surgery , Electroencephalography , Follow-Up Studies , Humans , Infant , Magnetic Resonance Imaging , Male , Spasms, Infantile/diagnosis , Spasms, Infantile/etiologySubject(s)
Electroencephalography , Nervous System Diseases/diagnosis , Adolescent , Adult , Aged , Cerebral Cortex/physiology , Cerebral Cortex/physiopathology , Child , Child, Preschool , Epilepsy/diagnosis , Humans , Infant , Infant, Newborn , Middle Aged , Monitoring, Physiologic , Nervous System Diseases/physiopathologyABSTRACT
Analysis of computed tomograms of patients with adrenoleukodystrophy in the early disease phase reveals a dinstinct CT apperance. It is suggested that brain or adrenal biopsy may not be necessary for diagnosis of adrenoleukodystrophy when these particular CT features are correlated with the clinical course and other laboratory parameters.
