Polyneuropathy: A Rare and Challenging Presentation of Essential Mixed Cryoglobulinemia.

A 49-year-old male presented with acute chronic sensory motor bilateral lower extremity polyneuropathy. Electromyography showed bilateral acute sensory motor axonal polyneuropathy. Lumbar spine magnetic resonance imaging showed diffuse bone marrow replacement and bilateral ankylosing spondylitis. Laboratory workup revealed elevated inflammatory markers and low G6PD (glucose-6-phosphate dehydrogenase) level. Due to elevated acute phase reactants, inflammatory polyneuropathy was suspected; patient was treated accordingly with resolution of neuropathy. Three months later, he relapsed and presented with disabling polyneuropathy and renal impairment, which prompted renal biopsy. Renal histopathology revealed the, otherwise mysterious, etiology, essential mixed cryoglobulinemia. Essential mixed cryoglobulinemia was not considered initially due to the absence of classic systemic manifestations of autoimmune disorders.

Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile.

Subtypes of psychogenic nonepileptic seizures (PNES) have emerged via classification of seizure semiology, psychological variables, or both. PNES subtypes that differ with respect to etiology may be amenable to targeted treatment strategies. The aim of the present study was to investigate the relationship between semiology type and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profile among patients with PNES. We did so by modifying a classification scheme proposed by Selwa et al. Our main hypothesis was that there would be significant associations of semiology-based subtypes with psychological profiles among patients with PNES. We found significant differences in mean scores on MMPI-2 clinical scales 1 (Hypochondriasis) and 3 (Hysteria) and Harris-Lingoes subscales D5 (Brooding) and Sc5 (Lack of Ego Mastery, Defective Inhibition) across PNES subtypes (catatonic, minor motor, major motor). The results of the present study enhance understanding of the nosology of PNES by identifying psychopathological correlates of semiology-based subtypes of PNES. Our study also may inform the methodology of future investigations of psychopathology among patients with PNES by providing support for content-based interpretation of the MMPI.

Levetiracetam use in critically ill patients.

INTRODUCTION: Levetiracetam (LEV) is used in the setting of acute brain injury for seizure treatment or prophylaxis but its safety and efficacy in this setting is unknown. METHOD: We retrospectively analyzed the patterns of use and safety/efficacy of LEV in 379 patients treated in the neuroscience intensive care unit (NSICU). We extracted from the charts clinical data including diagnosis, AED therapy before and during stay in the NSICU, complications of treatment, length of stay, and clinical outcomes (improvement, Glasgow Coma Scale, and death). We analyzed the data using binary and ordered (multi-category) logistic regression. RESULTS: Overall, our findings are that phenytoin used prior to the NSICU admission was frequently replaced with LEV monotherapy (P < 0.001). Patients treated with LEV monotherapy when compared to other AEDs had lower complication rates and shorter NSICU stays. Older patients and patients with brain tumors or strokes were preferentially treated with LEV for prevention and/or management of seizures (all P < or = 0.014). DISCUSSION: The results of this study suggest that LEV is a frequently used AED in the setting of acute brain injury and that it may be a desirable alternative to phenytoin. Prospective studies evaluating the long-term safety, efficacy and outcomes of LEV in this setting are indicated.

Quality of life in medication-resistant epilepsy: the effects of patient's age, age at seizure onset, and disease duration.

OBJECTIVE: The goal of this study was to examine the effects of age, age at seizure onset, and duration of epilepsy on health-related quality of life (HRQOL) in patients with medication-resistant epilepsy. METHODS: We analyzed data for a sample of 99 patients with medication-resistant epilepsy drawn from admissions to the Epilepsy Monitoring Unit. Patients had completed the Quality of Life in Epilepsy-89 (QOLIE-89), Profile of Mood States (POMS), and Adverse Events Profile. Number of comorbidities and number of antiepileptic drugs were abstracted from the chart. The dependent variable was QOLIE-89 overall score. The data were analyzed using ordinary least-squares regression. RESULTS: The simple regression results showed no significant effect of patient's age on QOLIE-89 (P=0.354), whereas age at onset and duration had significant effects (P=0.004 and P=0.012, respectively); the higher the age at onset and the shorter the disease duration, the lower the HRQOL. After adding POMS Depression/Dejection, Adverse Events Profile, comorbidities, and antiepileptic drugs, the effects of age at onset and duration were no longer significant (P=0.084 and P=0.207). CONCLUSIONS: Adult-onset epilepsy can disrupt one's established social, economic, and psychological life, while better coping mechanisms and social support may improve HRQOL as the duration of epilepsy increases. The modest association of age at onset and disease duration with HRQOL is explained away by mood states and adverse events, which are much stronger predictors of HRQOL. Interventions to improve HRQOL in patients with medication-resistant epilepsy should, therefore, focus on treating mood disturbances and minimizing medication side effects.