ABSTRACT
PURPOSE: Status Epilepticus can be a serious life threatening event in epileptic patients. The definition of refractory or super-refractory Status Epilepticus was based on the therapeutic response to anti-epileptic and anesthetic drugs. Vagal Nerve Stimulation showed efficacy in treating drug-resistant epilepsy but there are only few reports on emergentplacement of Vagal Nerve Stimulator for refractory or super-refractory Status Epilepticus. METHODS: Among 49 children implanted at our Institution with Vagal Nerve Stimulation for drug-resistant epilepsy, the authors retrospectively identified those implanted for refractory or super-refractory Status Epilepticus, according with the current definitions. RESULTS: 4 patients were operated upon at ages ranging 7 to 17 months and reached the programmed output current of 1 mA over a time ranging from 24 to 36 h (fast ramping-up). In 3 out of 4 patient we observed the abrupt of Status Epilepticus; one patient was refractory both to drugs and Vagal Nerve Stimulation and later died, without recovering from SE. At follow up, ranging from 24 to 45 months, the remaining 3 patients showed a decrease of the seizures frequency >80% without relapse of Status Epilepticus; in all the patients, output current and/or Duty Cycle were increased later. CONCLUSION: VNS can be effective in treating refractory or super-refractory Status Epilepticus.
Subject(s)
Drug Resistant Epilepsy/therapy , Electrodes, Implanted , Status Epilepticus/therapy , Vagus Nerve Stimulation/methods , Adolescent , Anticonvulsants/therapeutic use , Brain Waves/drug effects , Brain Waves/radiation effects , Child , Child, Preschool , Electroencephalography , Female , Follow-Up Studies , Humans , Infant , Male , Retrospective Studies , Treatment OutcomeSubject(s)
Brain/surgery , Cerebral Hemorrhage/surgery , Neuroendoscopy , Neurosurgical Procedures , Adult , Aged , Brain/pathology , Female , Humans , Male , Middle Aged , Neuroendoscopy/adverse effects , Treatment OutcomeABSTRACT
OBJECTIVE: We investigated the osteoblast and adipocyte differentiation of mesenchymal stem cells (MSCs) from young and aged rats cultured on Ti. MATERIAL AND METHODS: Bone marrow MSCs derived from 1-month and 21-month rats were cultured on Ti discs under osteogenic conditions for periods of up to 21 days and osteoblast and adipocyte markers were evaluated. RESULTS: Cell proliferation, alkaline phosphatase (ALP) activity, extracellular matrix mineralization and gene expression of RUNX2, osterix, ALP, bone sialoprotein, osteopontin, and osteocalcin were reduced in cultures of 21-month rats compared with 1-month rats grown on Ti. Gene expression of PPAR-γ , adipocyte protein 2, and resistin and lipid accumulation were increased in cultures of 21-month rats compared with 1-month rats grown on the same conditions. CONCLUSIONS: These results indicate that the lower osteogenic potential of MSCs derived from aged rats compared with young rats goes along with the higher adipogenic potential in cultures grown on Ti surface. This unbalance between osteoblast and adipocyte differentiation should be considered in dental implant therapy to the elderly population.
Subject(s)
Adipogenesis/physiology , Aging/physiology , Dental Implants , Mesenchymal Stem Cells/physiology , Osteoblasts/physiology , Titanium/chemistry , Age Factors , Alkaline Phosphatase/analysis , Animals , Cell Proliferation/physiology , Cells, Cultured , Female , Gene Expression , Lipids/analysis , Osteogenesis/physiology , Rats , Real-Time Polymerase Chain Reaction , Surface PropertiesABSTRACT
ABSTRACT Aging negatively affects bone/titanium implant interactions. Our hypothesis is that the unbalance between osteogenesis and adipogenesis induced by aging may be involved in this phenomenon. Objective We investigated the osteoblast and adipocyte differentiation of mesenchymal stem cells (MSCs) from young and aged rats cultured on Ti. Material and Methods Bone marrow MSCs derived from 1-month and 21-month rats were cultured on Ti discs under osteogenic conditions for periods of up to 21 days and osteoblast and adipocyte markers were evaluated. Results Cell proliferation, alkaline phosphatase (ALP) activity, extracellular matrix mineralization and gene expression of RUNX2, osterix, ALP, bone sialoprotein, osteopontin, and osteocalcin were reduced in cultures of 21-month rats compared with 1-month rats grown on Ti. Gene expression of PPAR-γ , adipocyte protein 2, and resistin and lipid accumulation were increased in cultures of 21-month rats compared with 1-month rats grown on the same conditions. Conclusions These results indicate that the lower osteogenic potential of MSCs derived from aged rats compared with young rats goes along with the higher adipogenic potential in cultures grown on Ti surface. This unbalance between osteoblast and adipocyte differentiation should be considered in dental implant therapy to the elderly population.
Subject(s)
Animals , Female , Rats , Osteoblasts/physiology , Titanium/chemistry , Aging/physiology , Dental Implants , Adipogenesis/physiology , Mesenchymal Stem Cells/physiology , Osteogenesis/physiology , Surface Properties , Gene Expression , Cells, Cultured , Age Factors , Cell Proliferation/physiology , Alkaline Phosphatase/analysis , Real-Time Polymerase Chain Reaction , Lipids/analysisABSTRACT
Patients affected by inborn errors of metabolism can develop catastrophic epilepsies ineligible for resective surgery. Few reports concerning vagal nerve stimulation in patients with epileptic encephalopathy in the context of metabolic diseases have been published in the literature. Drug-resistant epilepsies in metabolic disease could be a specific target for vagal nerve stimulation, although the efficacy of this technique in these patients still needs to be proved. The authors report our experience in treating refractory epilepsy with vagal nerve stimulation in 2 patients affected by inborn errors of metabolism. The first patient is a 23-year-old patient affected by glutaric aciduria type II, the other one is a 16-month-old child with nonketotic hyperglycinemia. Vagal nerve stimulation reduced seizures up to 50% in the first case and up to 90% in the second one.
Subject(s)
Carbapenems/pharmacology , Cerebral Ventricles/microbiology , Cross Infection/cerebrospinal fluid , Cross Infection/drug therapy , Klebsiella Infections/cerebrospinal fluid , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/drug effects , Adult , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Drug Resistance, Bacterial , Endoscopy , Female , Humans , Hydrocephalus/therapy , Klebsiella pneumoniae/isolation & purificationABSTRACT
BACKGROUND: The cavum veli interpositi (CVI) usually is a small CSF-containing abnormality of septum pellucidum, asymptomatic and rare after the age of 3 years. When symptomatic, it is large and can be related to psychiatric disorders, syndromic association of mental retardation and seizures or to hydrocephalus. METHODS: This is the first reported case of an otherwise healthy pediatric patient with a large CVI experiencing episodes of hypertonic loss of consciousness unrelated to epileptic, cardiologic or psychiatric causes without signs of chronic increase in intracranial pressure (ICP). RESULTS: Supposing a CSF compartmentalization in the CVI as the cause of acute poussés of ICP due to block of CSF pathways and considering the severity of the symptoms, an endoscopic fenestration was performed with a reduction of cyst dimensions. CONCLUSION: We suggest considering the fenestration of large CVI even in otherwise asymptomatic patients to avoid the risk of CSF compartmentalization with ICP poussés.
