Seizure-Induced Spinal Fractures: A Systematic Review.

BACKGROUND: Patients with epilepsy have a higher risk of skeletal injuries, and some of these fractures occur in the spine during a seizure. Seizure-induced spinal fractures (SISF) are unusual injuries that typically occur in the thoracolumbar spine. Because these skeletal injuries are not well described in the literature, this article aims to analyze the characteristics of this uncommon clinical entity. METHODS: A PubMed and Scopus search adhering to preferred reporting items for systematic reviews and meta-analyses guidelines was performed to include studies reporting patients with SISF. The data gathered from this review were analyzed to characterize this condition. RESULTS: The search yielded 34 articles with a total of 38 patients with SISF. All studies were case reports (level 5 evidence). Most fractures occurred in the thoracic and lumbar spine, and the most common injuries were type A1 and A4 fractures according to the AO spine classification system. Different characteristics of SISF are described including demographics, clinical findings, imaging, and treatment. CONCLUSIONS: SISF should be ruled out in patients who have a recent history of seizures and who report persistent dorsolumbar pain or neurological deficit. SISF usually occurs in the thoracolumbar spine and less frequently in the cervical spine. This review shows that different patterns of neurological deficits, some of them severe, may occur in approximately a quarter of patients with SISF. CLINICAL RELEVANCE: This study provides awareness of an uncommon spine condition. Physicians should suspect SISF in patients with persistent dorsolumbar pain after a seizure.

Crisis sintomáticas agudas y epilepsia en niños y adolescentes en época de COVID-19 / Acute symptomatic crisis and epilepsy in children and adolescents in times of COVID-19

Objetivo: Describir los aspectos de mayor relevancia en niños y adolescentes con crisis sintomáticas agudas o diagnóstico de epilepsia, en tiempo de pandemia de la COVID-19. Métodos: La información se obtuvo de las bases de datos PubMed/Medline, Scielo, y Clinical Key utilizando palabras clave incluidas en el Descriptor de Ciencias de la Salud en idioma inglés o español, sin límite de tiempo, y todo tipo de publicación; se seleccionaron los artículos relacionados con epilepsia, crisis epilépticas, y COVID-19. Resultados: En la literatura se justifica la ocurrencia de crisis epilépticas por varias causas en enfermos con la COVID-19 y se insiste en la conducta terapéutica y la necesidad de vigilancia de las interacciones farmacológicas entre los medicamentos indicados para la prevención de recurrencia de las crisis epilépticas y los específicos para esta nueva enfermedad. Basado en estos criterios, presentamos una propuesta para la conducta a seguir en cada situación. Consideraciones finales: Esta comprobada la posibilidad de que ocurran complicaciones neurológicas en pacientes con la COVID-19 y específicamente en las crisis epilépticas y la epilepsia. El uso de interferón y lopinavir/ritonavir, en caso de estar indicado en los protocolos de actuación, y el mantenimiento del tratamiento previo con los medicamentos para prevenir la recurrencia de crisis en los epilépticos, considerando las posibles interacciones y la vigilancia requerida en cada caso, parece ser la mejor opción en la mayoría de los niños y adolescentes con COVID-19(AU)

Objective: To describe the most outstanding aspects in children and adolescents with acute symptomatic crisis or diagnosis of epilepsy in times of the COVID-19 pandemic. Methods: The information was collected in PubMed/Medline, Scielo and Clinical Key databases using the keywords included in the Descriptor of Health Sciences in English or Spanish language, with not time limit, and looking for all kind of publications. There were selected articles related to epilepsy, epileptic seizures and COVID-19. Results: In the consulted literature, it was justified the occurrence of epileptic seizures due to different causes in patients with COVID-19 and it is highlighted the therapeutic behaviour and the need of surveillance of the pharmacologic interactions among the drugs indicated for the prevention of epileptic seizures and the specific of this new disease. Based in these precepts, we present a final proposal for the behaviour to follow in each situation. Final considerations: It is proved the possibility of neurologic complications in patients with COVID-19 and specifically in the epileptic seizures and epilepsy. The use of interferon and lopinavir/ritonavir, in case of being indicated in the action protocols, and to keep the previous treatment with the drugs to prevent the recurrence of crisis in epileptic patients considering the possible interactions and the required surveillance in each case, seems to be the best option in most of the children and adolescents with COVID-19(AU)

Encefalopatía Posterior Reversible asociada a Exacerbación de Enfermedad Pulmonar Obstructiva Crónica / Reversible Posterior Encephalopathy associated with Exacerbation of Chronic Obstructive Pulmonary Disease

Resumen El Síndrome de Encefalopatía Reversible Posterior (PRES) es una entidad clínica y radiológica reversible. Existen varias entidades clínicas que se asocian con PRES. La enfermedad pulmonar obstructiva crónica (EPOC) es un factor predisponente poco frecuente para el desarrollo de esta patología. Se presenta el caso de una mujer de 71 años de edad que estaba siendo tratada por una exacerbación aguda de EPOC y desarrolló alteración del sensorio y crisis convulsivas. Los hallazgos de imágenes características, los síntomas clínicos asociados y su historial médico llevaron a un diagnóstico de PRES en nuestro paciente. A pesar de que la asociación de PRES y EPOC es una entidad poco común, el diagnóstico de PRES debe ser un diferencial en caso de que un paciente desarrolle encefalopatía o convulsiones en la exacerbación de EPOC.

Abstract Posterior Reversible Encephalopathy Syndrome (PRES) is a reversible clinical and radiological entity. There are several entities that are associated with PRES. Chronic obstructive pulmonary disease (COPD) is a rare factor for the development of this condition. We present the case of a 71-years-old woman who was being treated for an acute exacerbation of COPD and developed sensory impairment and seizures. The findings of characteristic images, associated clinical symptoms and their medical history led to a diagnosis of PRES in our patient. Although the association of PRES and COPD is a rare entity, the diagnosis of PRES should be a differential if a patient develops encephalopathy or seizures in the exacerbation of COPD.

Caracterización de encefalitis por Zika y atención de enfermería: caso clínico / Characterization of encephalitis by Zika and nursing attention: clinical case

Introducción:La encefalitis es un proceso inflamatorio del parénquima cerebral de forma aguda aumentando la morbilidad y mortalidad. Se ha relacionado con una rápida propagación de enfermedades transmitidas por mosquitos: virus del Nilo Occidental, dengue, encefalitis japonesa y Zika, principales amenazas para la salud pública. Está asociado a complicaciones con microcefalia en fetos, y síndrome de Guillian-Barré en adultos.Objetivo:Caracterizar los síntomas biológicos frecuentes en pacientes afectados por Zika, que permita la individualización de la acción enfermera durante el tratamiento en periodo de hospitalización.Descripcióndel caso:Paciente de 34 años de edad, 8 días de evolución, cuadro clínico típico de Zika con alza térmica, rash cutáneo, cefalea holocraneana, alteración del estado de la conciencia, ideas delirantes, lenguaje incoherente, conducta exhibicionista. Además, cuadro de agresividad, finalmente presenta convulsiones tónico clónico generalizado. Resultado de laboratorio positivo para Zika,EEG muestra ondas agudas sobre una base enlentecida con predominio bitemporal. Imagenología igual enlas Encefalitis Herpéticas con compromiso temporal bilateral con predominio en un hemisferio.Conclusiones:La encefalitis por virus Zikase caracterizó por presentar cuadro clínico característico de la enfermedad, signos y síntomas neurológicos, PCR en sangre y orina positivos, con alta probabilidad clínica epidemiológica de ser un caso de Encefalitis por Zika. La acción de Enfermería se centró: seguridad del paciente, control y valoración de signos vitales, control de estado de conciencia, cumplimiento de prescripciones farmacológicas médica, toma de muestras, preparación para exámenes especiales, manejo de líquidos.

Introduction:Encephalitis, cerebral parenchymal inflammatory process, is acute and there is important morbidity and mortality, it has been related to a rapid spread of diseases transmitted by mosquitoes: West Nile virus, dengue, Japanese encephalitis and Zika, main threats to the public health. Zika, associated with complications with microcephaly in fetuses, and Guillian-Barré syndrome in adults.Objetive:To characterize the frequent biological symptoms in patients affected by Zika, which allows the individualization of the nursing action during the treatment during the hospitalization period.Case description:Patient of 34 years of age, 8 days of evolution, typical Zika clinical picture with thermal boost, skin rash, holocranial headache, altered state of consciousness, delusional ideas, incoherent language, exhibitionist behavior. in addition, aggressiveness picture, finally presents generalized clonic tonic seizures. Positive laboratory for Zika, EEG shows sharp waves on a slow basis with bitemporal predominance. Imaging equal to Herpetic Encephalitis with bilateral temporal involvement predominantly in one hemisphere.Conclusions:Zikavirus encephalitis was characterized by a characteristic clinical picture of the disease, neurological signs and symptoms, positive blood and urine PCR, with a high clinical and epidemiological probability of being a case of Zika encephalitis. The nursingaction was focused: patient safety, control and evaluation of vital signs, control of state of consciousness, compliance with medical pharmacological prescriptions, taking of samples, preparation for special examinations, liquid handling.

Síndrome de Turcot / Turcotꞌs syndrome

RESUMEN Se presenta a una paciente de 27 años de edad, con varios ingresos en el Hospital Provincial Clínico Quirúrgico Docente “José Ramón López Tabrane”, de Matanzas. Por presentar clínica compatible con pólipos de colon, corroborados por videocolonoscopia, diagnosticados en marzo de 2015. Posteriormente reingresa a los 14 meses por convulsiones, al inicio generalizado y luego limitado al hemicuerpo derecho, cefalea universal y vómitos. Falleció a los 23 días de su ingreso, en los antecedentes patológicos familiares destaca madre fallecida a los 52 años por cáncer de colon y hermana a los 21 años por neoplasia maligna colorectal (AU).

ABSTRACT The case of a female patient, aged 27 years is presented. She was in-patient in the Teaching Clinical Surgical Provincial Hospital “José Ramón López Tabrane”, of Matanzas for several times presenting clinical characteristics compatible polyps in the colon, corroborated by video colonoscopy, and diagnosed in March 2015. She was readmitted 14 months later because of convulsions, generalized firstly and lately limited to the right side of the body, universal headache and vomits. She died 23 days after the admittance. The family history shows that her mother died when she was 52, due to colon cancer and her sister died at twenty one due to colorectal malignant neoplasia (AU).

Psychopharmacological effects and safety of styryl-2-pyrones and dihydrostyryl-2-pyrones-rich fraction from Polygala sabulosa: absence of withdrawal syndrome and tolerance to anxiolytic-like and anticonvulsant effects.

OBJECTIVES: To investigate whether mice develop tolerance to the anxiolytic-like and anticonvulsant effects of subchronic treatment with EA (the styryl-2-pyrones and dihydrostyryl-2-pyrones-rich fraction of Polygala sabulosa), as well as any withdrawal symptoms after abrupt discontinuation; to compare the effects of EA with those of diazepam (DZP) on withdrawal-induced anxiety; and to evaluate the toxicity of EA according to OECD guidelines. METHODS: Male or female mice were acutely or subchronically treated with EA or DZP, and their tolerance to anxiolytic (evaluated in the elevated plus maze, EPM) and anticonvulsant effects (measured against pentylenetetrazole (PTZ)-induced convulsions) were investigated. Other groups received EA or DZP for 28 days followed by withdrawal, being the anxiety-like behaviour evaluated in the EPM. KEY FINDINGS: Both acute and subchronic treatments with EA induced an anxiolytic effect in the EPM. The anticonvulsant activity of DZP, but not EA, was reduced by protracted treatment. EA withdrawal retained the anxiolytic profile, while DZP withdrawal induced anxiogenesis. EA counteracted the anxiogenic-like actions of DZP withdrawal. EA has low toxicity as it did not cause any changes in the biochemical, haematological and histopathological markers. CONCLUSIONS: EA avoids the development of tolerance to its anxiolytic-like and anticonvulsant actions, and does not promote withdrawal syndrome. EA does not cause relevant toxic effects in rodents.

Poisoning by Brunfelsia uniflora in sheep and donkeys.

Farmers in the State of Piauí in northeastern Brazil reported nervous signs in ruminants and donkeys after ingestion of Brunfelsia uniflora at the start of the rainy season when the plant is flowering. Leaves of the plant, collected at the start or at the end of the rainy season, were administered in single doses of 5-20 g/kg body weight to 8 sheep and 3 donkeys. Two sheep and 1 donkey that ingested 10 g/kg of the plant in November at the start of the rainy season, when the plant was flowering, developed severe convulsions and diarrhea. One sheep was euthanized and autopsied, and no significant lesions were found. The other sheep and the donkey recovered. Four sheep and one donkey that ingested 10 or 20 g/kg of leaves collected in April, at the end of the rainy season, did not show clinical signs. One donkey that ingested 5 g/kg of leaves collected in November developed diarrhea and recovered. These results demonstrate the toxicity of B. uniflora for livestock and suggest that the plant is toxic at these doses only during the start of the rainy season.

Otite bacteriana por Klebsiella sp. como causa de encefalite em um gato / Bacterial otitis by Klebsiella sp. as a cause of encephalitis in a cat

Background: Meningoencephalitis in cats is usually related to infectious diseases but may also be caused by the extension of bacterial infections originated in the middle or inner ear. This paper seeks to report on a case of encephalitis due to an infection in the middle/inner ear in a 15-year-old cat. The diagnosis was made through brain CT scan and culture and antibiogram of material collected during a ventral osteotomy of the tympanic bulla and reported grave intravascular haemolysis associated to the treatment with antimicrobial imipenem with cilastatin sodium that has already been described in humans but not in small animals in the researched literature.Case: A 15-year-old, male, castrated, Siamese cat was brought to the Veterinary Clinical Hospital of the UFRGS. The animal presented pyrexia and hyporexia, tested negative in the immunoenzymatic test to detect antigens of the FeLV and antibodies of the FIV. The animal had a history of three episodes of tonic convulsion within two days and otitis that had gone untreated for 10 months prior to the consultation, with apparent spontaneous remission. After blood tests, serum biochemistry profile, abdominal ultrasound scan, chest x-rays and CT scan was requested. It revealed middle and inner otitis in the right ear. It was performed a ventral osteotomy of the right tympanic bulla. Material was collected for culture and antibiogram. It was confirmed that the animal had an inner otitis of bacterial origin by multi-resistant Klebsiella spp. that was sensitive only to antimicrobial imipenem with cilastatin sodium. Fifteen days into the treatment with this antibacterial combination, grave haemolysis was observed, probably associated to the use of the medicine. The patient died on the 17th day of the treatment which was not interrupted as per its owners decision. At necropsy, both in the tympanic bulla and liver were found mucous content and whitish lumps.[...](AU)

Otite bacteriana por Klebsiella sp. como causa de encefalite em um gato / Bacterial otitis by Klebsiella sp. as a cause of encephalitis in a cat

Background: Meningoencephalitis in cats is usually related to infectious diseases but may also be caused by the extension of bacterial infections originated in the middle or inner ear. This paper seeks to report on a case of encephalitis due to an infection in the middle/inner ear in a 15-year-old cat. The diagnosis was made through brain CT scan and culture and antibiogram of material collected during a ventral osteotomy of the tympanic bulla and reported grave intravascular haemolysis associated to the treatment with antimicrobial imipenem with cilastatin sodium that has already been described in humans but not in small animals in the researched literature.Case: A 15-year-old, male, castrated, Siamese cat was brought to the Veterinary Clinical Hospital of the UFRGS. The animal presented pyrexia and hyporexia, tested negative in the immunoenzymatic test to detect antigens of the FeLV and antibodies of the FIV. The animal had a history of three episodes of tonic convulsion within two days and otitis that had gone untreated for 10 months prior to the consultation, with apparent spontaneous remission. After blood tests, serum biochemistry profile, abdominal ultrasound scan, chest x-rays and CT scan was requested. It revealed middle and inner otitis in the right ear. It was performed a ventral osteotomy of the right tympanic bulla. Material was collected for culture and antibiogram. It was confirmed that the animal had an inner otitis of bacterial origin by multi-resistant Klebsiella spp. that was sensitive only to antimicrobial imipenem with cilastatin sodium. Fifteen days into the treatment with this antibacterial combination, grave haemolysis was observed, probably associated to the use of the medicine. The patient died on the 17th day of the treatment which was not interrupted as per its owner’s decision. At necropsy, both in the tympanic bulla and liver were found mucous content and whitish lumps.[...]

Intracerebroventricular administration of the (1→6)-ß-d-glucan (lasiodiplodan) in male rats prevents d-penicillamine-induced behavioral alterations and lipoperoxidation in the cortex.

CONTEXT: Lasiodiplodan, an exocellular (1→6)-ß-d-glucan of molecular weight >1.4 × 106 Da produced by MMPI strain of Lasiodiplodia theobromae (Pat.) Griffon & Maubl. (Brotyosphaeriaceae) is known to exhibit anti-proliferative activity on breast cancer cells (MCF-7), anticoagulant activity when sulfonylated, and reduction in transaminase activity when administered in rats. OBJECTIVE: The effect of intracerebroventricular (I.C.V) injection of lasiodiplodan on neurotoxicity and behavioural changes induced by d-penicillamine was investigated. MATERIALS AND METHODS: Twenty-four male Wistar rats were initially separated in groups of six and treated with 0.15 µmol/µL of NaCl (Groups Ct and d-Pen) and 0.01 µg/µL of lasiodiplodan (Groups Las and Las + d-Pen). After 15 min, they received 6 µmol/µL of NaCl (Groups Ct and Las) and 2 µmol/µL of d-penicillamine (Groups d-Pen and Las + d-Pen). The animal behavior was observed in an open-field test for 60 min. Twenty-four h later, the animals were sacrificed and histopathological analysis and Thiobarbituric acid reactive substances (TBARS) production measurements were performed. RESULTS: Lasiodiplodan prevented neurotoxicity induced by d-penicillamine significantly reducing the production of TBARS (308%; p < 0.05), and behavioural signs; convulsive and pre-convulsive. No histopathological alterations in the cerebral cortex were observed. DISCUSSION AND CONCLUSION: The reduction of TBARS production and convulsive episodes suggests that the protector effect provided by lasiodiplodan passes thought an antioxidant path, possibly interfering in a cascade of neurochemical events, triggering cell death and convulsive episodes. These results demonstrated that lasiodiplodan can be effective in treating neurotoxicity, and reducing damage triggered by convulsions in neuropathies related to GABAergic system.

Pentylenetetrazole-induced seizures in developing rats prenatally exposed to valproic acid.

BACKGROUND: Epidemiological evidence indicates epilepsy is more common in patients with autism spectrum disorders (ASD) (20-25%) than in the general population. The aim of this project was to analyze seizure susceptibility in developing rats prenatally exposed to valproic acid (VPA) as autism model. METHODS: Pregnant females were injected with VPA during the twelfth embryonic day. Seizures were induced in fourteen-days-old rat pups using two models of convulsions: pentylenetetrazole (PTZ) and lithium-pilocarpine (Li-Pilo). RESULTS: Two subgroups with different PTZ-induced seizure susceptibility in rats exposed to VPA were found: a high susceptibility (VPA+) (28/42, seizure severity 5) and a low susceptibility (VPA-) (14/42, seizure severity 2). The VPA+ subgroup exhibited an increased duration of the generalized tonic-clonic seizure (GTCS; 45 ± 2.7 min), a higher number of rats showed several GTCS (14/28) and developed status epilepticus (SE) after PTZ injection (19/27) compared with control animals (36.6 ± 1.9 min; 10/39; 15/39, respectively). No differences in seizure severity, latency or duration of SE induced by Li-Pilo were detected between VPA and control animals. DISCUSSION: Prenatal VPA modifies the susceptibility to PTZ-induced seizures in developing rats, which may be linked to an alteration in the GABAergic transmission. These findings contribute to a better understanding of the comorbidity between autism and epilepsy.

Anticonvulsant mechanism of saponins fraction from adventitious roots of Ficus religiosa: possible modulation of GABAergic, calcium and sodium channel functions

ABSTRACT In our previous studies, quantified saponins-rich fraction from adventitious root extract of Ficus religiosa L., Moraceae, showed anticonvulsant effect in acute, as well as chronic mice models of epilepsy. The present study was designed to reveal putative anticonvulsant mechanism of quantified saponins-rich fraction using target specific animal models. The anticonvulsant effect of quantified saponins-rich fraction was initially studied in maximal electroshock and pentylenetetrazol test at 1, 2 and 4 mg/kg; i.p. doses. Based on the results of initial anticonvulsant testing, different groups of mice were injected with vehicle or quantified saponins-rich fraction (4 mg/kg; i.p.), 30 min prior to an injection of N-methyl-D-aspartic acid (100 mg/kg; s.c.), bicuculline (5 mg/kg; i.p.), strychnine hydrochloride (2 mg/kg; i.p.), BAY k-8644 (37.5 µg; i.c.v.), veratridine (500 µg/kg; i.p.) and the convulsive episodes were studied. Treatment with the extract (1, 2 and 4 mg/kg) showed significant protection in maximal electroshock and pentylenetetrazol-induced convulsion tests, in a dose-dependent manner. Moreover, quantified saponins-rich fraction at 4 mg/kg dose showed significant increase in latency to clonic convulsions, decrease in seizure severity and increase in average wave amplitude in bicuculline, BAY k-8644 and veratridine tests, respectively, as compared to vehicle control. However, SRF treatment failed to abolish N-methyl-D-aspartic acid and strychnine-induced convulsions, indicated by insignificant change in the appearance of turning behavior and onset of tonic extension, respectively, as compared to vehicle control. From the results of present study, it is concluded that quantified saponins-rich fraction suppress maximal electroshock, pentylenetetrazol, bicuculline, BAY k-8644 and veratridine-induced convulsions, indicating its GABAergic, Na+ and Ca2+ channel modulatory effects. Further it can be correlated that quantified saponins-rich fraction causes deactivation of voltage-gated Na+ and Ca2+ channels, without effecting ligand-gated Na+ and Ca2+ channels. More studies are required at molecular levels using in vitro techniques to understand the exact molecular interactions of quantified saponins-rich fraction with these pathways.

Avaliação de tratamento homeopático em cães epilépticos / Evaluation of homeopathic treatment in epileptic dogs / Evaluación del tratamiento homeopático en perros epilépticos

O objetivo foi de avaliar a evolução de animais da espécie canina epilépticos tratados homeopaticamente. Foram avaliados 172 consultas de 30 animais da espécie canina que convulsionavam com tratamento alopático. Os medicamentos utilizados: Cuprum met., Arsenicum album, Causticum, Belladonna, Lycopodium, Nux vomica, Pulsatilla nig, Hyosciamus, Calcarea carbonica, Stramonium, Sulphur, Ignatia, Kali carbonicum, Phosphorus e Silicea. A intensidade do processo era muito elevada quando se iniciou o tratamento homeopático e ocorreu melhora entre 45 a 60 dias após o tratamento. O processo epiléptico estabilizou entre cinco a seis meses e se mantive por 9 a 12 meses. A utilização da medicação homeopática é uma alternativa viável e importante nos casos de epilepsia idiopática.

The objective was to assess the evolution of animals of the canine species epileptics treated homeopathically. 172 queries were assessed 30 animals of the canine species which convulsed with allopathic treatment. Medications used: Cuprum met., Arsenicum album, Causticum, Belladonna, Lycopodium, Nux vomica, Pulsatilla nig, Hyosciamus, Calcarea carbonica, Stramonium, Sulphur, Ignatia, Kali carbonicum, Phosphorus and Silicea. The strength was very high when the process is started homeopathic treatment and improvement occurred between 45 and 60 days after treatment. The process epileptic stabilized between five to six months and kept for 9 to 12 months. The use of homeopathic medicine is a viable and important in cases of idiopathic epilepsy.

El objetivo fue evaluar la evolución de los animales de la especie canina epilépticos tratados homeopáticamente. 172 consultas se evaluaron 30 animales de la especie canina que convulsionaron con tratamiento alopático. Medicamentos utilizados: Cuprum met., Arsenicum album, Causticum, Belladonna, Lycopodium, Nux vomica, Pulsatilla nig, Hyosciamus, Calcarea carbonica, Stramonium, Sulphur, Ignatia, Kali carbonicum, Phosphorus y Silicea. La intensidad era muy alta cuando se inicia el tratamiento homeopático y la mejora se produjo entre 45 y 60 días después del tratamiento. La epilepsia se fue estabilizada entre cinco y seis meses y se mantuvo durante 9 a 12 meses. El uso de la medicina homeopática es una alternativa viable e importante en los casos de epilepsia idiopática.

Avaliação de tratamento homeopático em cães epilépticos / Evaluation of homeopathic treatment in epileptic dogs / Evaluación del tratamiento homeopático en perros epilépticos

O objetivo foi de avaliar a evolução de animais da espécie canina epilépticos tratados homeopaticamente. Foram avaliados 172 consultas de 30 animais da espécie canina que convulsionavam com tratamento alopático. Os medicamentos utilizados: Cuprum met., Arsenicum album, Causticum, Belladonna, Lycopodium, Nux vomica, Pulsatilla nig, Hyosciamus, Calcarea carbonica, Stramonium, Sulphur, Ignatia, Kali carbonicum, Phosphorus e Silicea. A intensidade do processo era muito elevada quando se iniciou o tratamento homeopático e ocorreu melhora entre 45 a 60 dias após o tratamento. O processo epiléptico estabilizou entre cinco a seis meses e se mantive por 9 a 12 meses. A utilização da medicação homeopática é uma alternativa viável e importante nos casos de epilepsia idiopática.(AU)

The objective was to assess the evolution of animals of the canine species epileptics treated homeopathically. 172 queries were assessed 30 animals of the canine species which convulsed with allopathic treatment. Medications used: Cuprum met., Arsenicum album, Causticum, Belladonna, Lycopodium, Nux vomica, Pulsatilla nig, Hyosciamus, Calcarea carbonica, Stramonium, Sulphur, Ignatia, Kali carbonicum, Phosphorus and Silicea. The strength was very high when the process is started homeopathic treatment and improvement occurred between 45 and 60 days after treatment. The process epileptic stabilized between five to six months and kept for 9 to 12 months. The use of homeopathic medicine is a viable and important in cases of idiopathic epilepsy.(AU)

El objetivo fue evaluar la evolución de los animales de la especie canina epilépticos tratados homeopáticamente. 172 consultas se evaluaron 30 animales de la especie canina que convulsionaron con tratamiento alopático. Medicamentos utilizados: Cuprum met., Arsenicum album, Causticum, Belladonna, Lycopodium, Nux vomica, Pulsatilla nig, Hyosciamus, Calcarea carbonica, Stramonium, Sulphur, Ignatia, Kali carbonicum, Phosphorus y Silicea. La intensidad era muy alta cuando se inicia el tratamiento homeopático y la mejora se produjo entre 45 y 60 días después del tratamiento. La epilepsia se fue estabilizada entre cinco y seis meses y se mantuvo durante 9 a 12 meses. El uso de la medicina homeopática es una alternativa viable e importante en los casos de epilepsia idiopática.(AU)

Interleucina-1ß, crisis convulsivas y muerte neuronal / Interleukin-1ß, seizures and neuronal cell death

La epilepsia es un trastorno neurológico que afecta aproximadamente al 1% de la población mundial. Estudios realizados en humanos y animales de experimentación sugieren que mediadores de inflamación, como las citocinas, participan en la fisiopatología de la epilepsia; entre ellos, la interleucina-1beta (IL-1ß) podría participar en la susceptibilidad para generar crisis convulsivas así como en la muerte neuronal causada por las convulsiones, aunque algunos hallazgos son contradictorios. En este documento se revisa el conocimiento actual que establece una relación entre la IL-1ß, las crisis convulsivas y la muerte neuronal.

Epilepsy is a neurological disorder affecting almost 1% of the world population. Experimental human and animal studies suggest that inflammation mediators, like cytokines, participate in the physiopathology of epilepsy. Interleukin-1beta (IL-1ß) could influence susceptibility for seizures, as well as neuronal death caused by seizures, although some findings are contradictory. This document reviews the current knowledge establishing a connection between IL-1ß, seizures and neuronal death.

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.

Meningoencefalite causada pelo vírus vacinal da febre amarela transmitido pelo leite materno / Infant meningoencephalitis caused by yellow fever vaccine virus transmitted via breastmilk

OBJETIVO: Relatar um caso de meningoencefalite, provavelmente causada pelo vírus vacinal da febre amarela transmitido pelo leite materno. DESCRIÇÃO: Paciente de 38 dias de idade, internado em 23/05/09 para investigação de febre. No dia 25/05/09 iniciaram-se as crises convulsivas. O exame do líquido cefalorraquidiano (LCR) foi sugestivo de meningoencefalite. A mãe havia recebido dose da vacina contra febre amarela e o bebê estava em aleitamento materno exclusivo. Recebeu alta com controle das crises convulsivas. Foi detectado anticorpo IgM específico para febre amarela no soro e no LCR. COMENTÁRIOS: Em 2009, ocorreu o primeiro caso confirmado de meningoencefalite pelo vírus vacinal da febre amarela transmitido pelo leite materno. Descrevemos o segundo caso, em que, possivelmente, o vírus vacinal tenha sido o agente etiológico da meningoencefalite. O Ministério da Saúde do Brasil recomenda adiar a vacinação de nutrizes até a criança completar 6 meses ou orientar alternativas para evitar o risco de transmissão do vírus vacinal pelo leite materno.

OBJECTIVES: To describe a case of infant meningoencephalitis that was probably caused by yellow fever vaccine virus transmitted via breastmilk. DESCRIPTIONS: A 38-day old patient was admitted to hospital on May 23, 2009, with fever. On May 25, 2009, convulsive crises began. Cerebrospinal fluid (CSF) test results were suggestive of meningoencephalitis. The mother had been given a dose of yellow fever vaccine and the baby was on exclusive breastfeeding. The baby was discharged after the convulsive crises were controlled. Tests identified IgM antibodies specific for yellow fever in both serum and CSF. COMMENTS: In 2009, the first case was confirmed of meningoencephalitis caused by the yellow fever vaccine virus transmitted via breastmilk. We describe a second case in which the vaccine virus was possibly the etiologic agent of meningoencephalitis. The Brazilian Ministry of Health now recommends delaying vaccination of nursing mothers until their children reach 6 months or providing them with guidance on alternative options to avoid the risk of transmission of the vaccine virus via breastmilk.

Epileptic seizures in a descendant of Dom Pedro I / Crises epilépticas em uma descendente de Dom Pedro I

Intrauterine seizure is a rare event. Genetic predisposition and trauma are possible risk factors. OBJECTIVE: To review and comment on the historical description of intrauterine events of a bastard daughter of Dom Pedro I (Maria Isabel Alcântara Brasileira - 1830-1896). METHOD: Review of historical facts about the health of Dom Pedro I's daughter according to primary and secondary historical data. RESULTS: According to historical accounts, Dom Pedro I's daughter suffered trauma during the intrauterine period that provoked intrauterine seizures. At the age of eight years, she developed self-limited and benign generalized epilepsy. Like her father, she had mood problems and also learning difficulties. CONCLUSION: Dona Maria Isabel's own report does not shown sufficient evidence to support the diagnosis of post-traumatic intrauterine seizures. Nevertheless, her family history suggests a genetic basis for her epilepsy.

A convulsão intra-uterina é evento raro, sendo possíveis fatores de risco a genética e o traumatismo. OBJETIVO: Rever e comentar a descrição histórica de eventos intra-uterinas de uma filha bastarda de D. Pedro I (Maria Isabel Alcântara Brasileira - 1830-1896). MÉTODO: Revisão dos fatos históricos sobre a saúde da filha do D. Pedro I, de acordo com dados históricos primários e secundários. RESULTADOS: A filha de Dom Pedro I, de acordo com relatos históricos teria sofrido um traumatismo durante o período intra-uterino, o que provocou convulsões intra-uterinas. Na idade de oito anos a menina desenvolveu uma epilepsia generalizada limitada e benigna. Como seu pai, teve problemas do humor e, também, dificuldades de aprendizagem. CONCLUSÃO: O relato de Dona Maria Isabel não gera prova suficiente para sustentar o diagnóstico de convulsões intra-uterinas de origem traumática. Não obstante, seus antecedentes familiares sugerem uma base genética para sua epilepsia.

Enfermedad de Creutzfeldt-Jakob en un paciente interpretado como encefalitis por herpes simple / Creutzfeldt-Jakob disease in a patient with possible herpes simplex encephalitis

Se presentó un paciente con una enfermedad de Creutzfeldt-Jakob, al cual se le realizó un diagnóstico presuntivo inicial de encefalitis por herpes simple, que comenzó con trastornos conductuales, agresividad, alucinaciones visuales y pérdida progresiva de la visión, empeoró de forma paulatina, aparecieron movimientos involuntarios inespecíficos y estado de postración, convulsiones técnico-clínicas del hemicuerpo izquierdo, paresia homolateral, poca respuesta al dolor con empobrecimiento de la mímica facial e imposibilidad para localizar el estímulo nociceptivo y discreta rigidez nucal. Se le realizaron estudios microbiológicos para pesquisaje virológico incluido herpes virus, bacterias y hongos, así como análisis citoquímico del líquido cefalorraquídeo y resultaron normales, en el electroencefalograma aparecieron alteraciones que señalaron actividad paroxística asimétrica. El paciente evolucionó tórpidamente y falleció, se presenta el resultado de los estudios anatomopatológicos de la microscopia óptica

This is the case of a patient presenting with Creutzfeldt-Jakob disease with an initial presumptive diagnosis of herpes-simplex encephalitis started with behavioral disorders, aggression, visual hallucinations and a progressive loss of vision, worsening in a gradual way, non-specific unintentional movements and prostration status, left hemi-body tonic-clonic convulsions, homolateral paresis, a low response to pain with a poor facial expression and inability to locate the nociceptive stimulus and a light nuchal stiffness. Microbiologic studies were conducted for a virology screening including herpesvirus, bacteria and fungi, as well as, cytochemistry of cerebrospinal fluid with normal results, in electroencephalogram appeared alterations related to an asymmetric paroxysmal activity. Patient evolved with torpidity and died. Anatomic-pathologic studies result of optical microscopy is showed

Frecuencia de crisis epilépticas en pacientes pediátricos de la consulta externa de un hospital general / Seizures rate in pediatric outpatients at a general hospital in México City

Introducción. Las crisis epilépticas son la segunda enfermedad neurológica más común. Se identificó la proporción de crisis epilépticas y su distribución por tipo en pacientes pediátricos de la consulta externa de un hospital general. Métodos. Se registraron los pacientes con diagnóstico clínico de crisis epilépticas, realizado por el pediatra, atendidos en la consulta externa pediátrica durante un mes. Se determinó la proporción que representaba en el período y se calcularon intervalos de confianza (IC) del 95%. Se identificó la distribución por tipo de crisis convulsiva y se comparó la edad en los distintos tipos. Resultados. La proporción encontrada fue 11.5% (n =382, IC95% 8.31-14-69) a expensas principalmente de crisis tónico-clónico generalizadas 5.5% (47% de todas las crisis, n =44), la frecuencia de crisis epilépticas no difirió significativamente entre los diferentes grupos de edad (P =0.483). Las crisis febriles representaron sólo 0.8% (6.8% de todas las crisis, n =44). Conclusiones. La proporción encontrada fue alta; la proporción de crisis febriles fue menor a la reportada.

Introduction. Seizures are the second most common neurological disease. Objective: To identify the rate and type of seizures in pediatric outpatients of a general hospital. Methods. Patients with a clinical diagnosis of seizures attend-ing the outpatients Pediatrics clinic were enrolled in this one-month study. Rate ratios and 95% confidence intervals (CI) were calculated. Distributions of seizure type according to gender and age were calculated. Results. The rate ratio found was 11.5% (n =382, 95% CI 8.31-14.69); the most common seizure type was generalized tonic-clonic seizure 5.5% (47% of total seizures, n =44); seizure frequency did not show any statistical difference among age-group (P =0.483). Febrile seizures represented only 0.8% (6.8% of total seizures, n =44). Conclusions. The seizure rate observed was higher than the expected rate. The febrile seizure rate was lower than those reported in previous works.