Estado de mal não convulsivo em unidade de terapia intensiva neurológica: [revisão] / Nonconvulsive status epilepticus in neurological intensive care unit: [review]

Os tumores e cirurgias cerebrais são causas de convulsões e epilepsia. No estado de mal não-convulsivo as alterações eletroencefalográficas consistentes com atividade epileptiforme estão associadas ao coma e obnubilação com mínima ou nenhuma manifestação motora. Essa é responsável por aproximadamente 20% de todos os estados de mal e está cada vez mais sendo reconhecida em pacientes comatosos. Nessa revisão os autores chamam a atenção para o diagnóstico precoce e tratamento dessa entidade até então negligenciada no passado.

Surgical treatment of myelomeningocele carried out at 'time zero' immediately after birth.

BACKGROUND/AIMS: To present a protocol of immediate surgical repair of myelomeningocele (MMC) after birth ('time zero') and compare this surgical outcome with the surgery performed after the newborn's admission to the nursery before the operation. METHODS: Data from the medical files of 31 patients with MMC that underwent surgery after birth and after admission at the nursery (group I) were compared with a group of 23 patients with MMC admitted and prospectively followed, who underwent surgery immediately after birth--'at time zero' (group II). RESULTS: The preoperative rupture of the MMC occurred more frequently in group I (67 vs. 39%, p < 0.05). The need for ventriculoperitoneal shunt was 84% in group I and 65% in group II and 4 of them were performed during the same anesthetic time as the immediate MMC repair, with no statistically significant difference. Group I had a higher incidence of small dehiscences when compared to group II (29 vs. 13%, p < 0.05); however, there was no statistically significant difference regarding infections. After 1 year of follow-up, 61% of group I showed neurodevelopmental delay, whereas only 35% of group II showed it. CONCLUSIONS: The surgical intervention carried out immediately after the birth showed benefits regarding a lower incidence of preoperative rupture of the MMC, postoperative dehiscences and lower incidence of neurodevelopmental delay 1 year after birth.