ABSTRACT
BACKGROUND: Strokes are the leading cause of epileptic seizures in adults and account for 50% of seizures in those over the age of 65 years. The use of antiepileptic drugs to prevent recurrent poststroke seizures is recommended. METHODS: One hundred and twenty-eight patients with poststroke seizures were randomly allocated to treatment with either levetiracetam (LEV) or sustained-release carbamazepine (CBZ) in a multicenter randomized open-label study. After a titration study phase (2 weeks), the optimal individual dose of trial medication was determined and treatment was continued for another 52 weeks. The primary endpoint was defined as the proportion of seizure-free patients; the secondary endpoints were: evaluation of time recurrence to the first seizure, EEG tracings, cognitive functions and side effects. RESULTS: Of 128 patients, 22 discontinued the trial prematurely; thus a total of 106 patients (52 treated with LEV and 54 treated with CBZ) were included in the analysis. The results of the study were as follows: no significant difference in number of seizure-free patients between LEV and CBZ (p = 0.08); time to the first recurrence tended to be longer among patients on LEV; there was no correlation between the therapeutic effect and the EEG findings in either treatment group; LEV caused significantly fewer (p = 0.02) side effects than CBZ; attention deficit, frontal executive functions and functional scales (Activities of Daily Living and Instrumental Activities of Daily Living indices) were significantly worse in the CBZ group. CONCLUSIONS: This trial suggests that LEV may be a valid alternative to CBZ in poststroke seizures, particularly in terms of efficacy and safety. In addition, our results show that LEV has significant advantages over CBZ on cognitive functions. This trial also indicates that LEV in monotherapy is a safe and effective therapeutic option in elderly patients who have suffered epileptic seizures following a stroke.
Subject(s)
Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Piracetam/analogs & derivatives , Seizures/drug therapy , Stroke/complications , Activities of Daily Living , Aged , Aged, 80 and over , Anticonvulsants/adverse effects , Carbamazepine/adverse effects , Female , Humans , Levetiracetam , Male , Middle Aged , Piracetam/adverse effects , Piracetam/therapeutic use , Prospective Studies , Seizures/etiology , Treatment OutcomeABSTRACT
The "Stiff person syndrome"(SPS) is a rare dysimmune chronic neurological disorder, sometimes paraneoplastic, characterized by progressive stiffness, painful persistent or spasmodic muscle contractions, mostly involving spine and lower extremities. In 60 to 90 percent of cases, non-paraneoplastic forms are associated to the presence of anti-glutamic acid decarboxylase (anti-GAD) antibodies in the cerebrospinal fluid and in the serum, while anti-amphiphysin antibodies are frequently associated to paraneoplastic types. The relevant treatment consists of three basic approaches: increase in the inhibitory processes in charge of muscle activity control, re-modulation of the immune response, removal of any associated neoplasia. Indications regarding the efficacy of high-dose intravenous immunoglobulin (IVIG) also in this dysimmune pathology are on the increase. We described an unusual case of autoimmune SPS associated with an exclusively motor left peroneal nerve neuropathy, with conduction block, treated with high-dose intravenous immunoglobulin (IVIG), oral cyclosporine, sodium valproate, baclofen and diazepam.
Subject(s)
Neural Conduction , Peroneal Neuropathies/complications , Stiff-Person Syndrome/complications , Female , Humans , Middle Aged , Peroneal Neuropathies/drug therapy , Peroneal Neuropathies/physiopathology , Stiff-Person Syndrome/physiopathologyABSTRACT
The corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (the so-called "Hashimoto's Encephalopathy") is a rare disorder with multiple symptomatology, breaking out with an acute or subacute onset and having a relapsing course, not correlated to thyroid hormone levels, with autoimmune pathogenesis, and usually associated with Hashimoto's thyroiditis. In this paper, we report on a case study regarding a 46 year-old woman showing a subacute course cerebellar syndrome, associated with Hashimoto's thyroiditis, diagnosed as "Hashimoto's encephalopathy". The possible pathogenesis and the major aspects of the differential diagnostic sector are discussed with particular reference to an ataxic syndrome caused by a progressive non-familial adult onset cerebellar degeneration (PNACD), associated with the thyroid disease itself.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Brain Diseases/complications , Cerebellar Diseases/drug therapy , Cerebellar Diseases/etiology , Hashimoto Disease/complications , Brain Diseases/diagnosis , Brain Diseases/drug therapy , Cerebellar Diseases/diagnosis , Female , Hashimoto Disease/diagnosis , Hashimoto Disease/drug therapy , Humans , Middle Aged , Treatment OutcomeABSTRACT
The authors report a case of neurocysticercosis treated with Albendazole (methyl-5-propyl-thio-2-benzimidazilcarbamate). Computerized tomography (CT) and magnetic resonance imaging (MRI) of the brain presented various small bilateral parenchymal calcifications in the white matter and two inflammatory granulomatous formations localized respectively in the left and right posterior parietal lobe. After the serological diagnosis (Elisa-test) of cysticercosis, the patient was treated with albendazole (Zentel) with oral doses of 15 mg/kg/die for 20 days, and successively with a lower dose for another 40 days. Repeated CT and MRI showed a gradual reduction in the granulomas in comparison with the ones previously found, until the complete disappearance of the neuroradiological evidence of them. No side-effects were recorded during the treatment nor symptoms or neurological consequences in the period up until two years after the initial observation.
