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1.
PLoS One ; 12(9): e0184050, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28886073

RESUMO

INTRODUCTION: Nonconvulsive seizures (NCS) are frequent in hospitalized patients and may further aggravate injury in the already damaged brain, potentially worsening outcomes in encephalopathic patients. Therefore, both early seizure recognition and treatment have been advocated to prevent further neurological damage. OBJECTIVE: Evaluate the main EEG patterns seen in patients with impaired consciousness and address the effect of treatment with antiepileptic drugs (AEDs), continuous intravenous anesthetic drugs (IVADs), or the combination of both, on outcomes. METHODS: This was a single center retrospective cohort study conducted in a private, tertiary care hospital. Consecutive adult patients with altered consciousness submitted to a routine EEG between January 2008 and February 2011 were included in this study. Based on EEG pattern, patients were assigned to one of three groups: Group Interictal Patterns (IP; EEG showing only interictal epileptiform discharges or triphasic waves), Group Rhythmic and Periodic Patterns (RPP; at least one EEG with rhythmic or periodic patterns), and Group Ictal (Ictal; at least one EEG showing ictal pattern). Groups were compared in terms of administered antiepileptic treatment and frequency of unfavorable outcomes (modified Rankin scale ≥3 and in-hospital mortality). RESULTS: Two hundred and six patients (475 EEGs) were included in this analysis. Interictal pattern was observed in 35.4% (73/206) of patients, RPP in 53.4% (110/206) and ictal in 11.2% (23/206) of patients. Treatment with AEDs, IVADs or a combination of both was administered in half of the patients. While all Ictal group patients received treatment (AEDs or IVADs), only 24/73 (32.9%) IP group patients and 55/108 (50.9%) RPP group patients were treated (p<0.001). Hospital length of stay (LOS) and frequency of unfavorable outcomes did not differ among the groups. In-hospital mortality was higher in IVADs treated RPP patients compared to AEDs treated RPP patients [11/19 (57.9%) vs. 11/36 (30.6%) patients, respectively, p = 0.049]. Hospital LOS, in-hospital mortality and frequency of unfavorable outcomes did not differ between Ictal patients treated exclusively with AEDs or IVADs. CONCLUSION: In patients with acute altered consciousness and abnormal routine EEG, antiepileptic treatment did not improve outcomes regardless of the presence of periodic, rhythmic or ictal EEG patterns.


Assuntos
Transtornos da Consciência/diagnóstico , Transtornos da Consciência/psicologia , Estado de Consciência , Eletroencefalografia , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Lesões Encefálicas Traumáticas/complicações , Comorbidade , Estado de Consciência/efeitos dos fármacos , Transtornos da Consciência/tratamento farmacológico , Transtornos da Consciência/etiologia , Diagnóstico por Imagem , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Fluxo de Trabalho
2.
Seizure ; 22(9): 752-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23838088

RESUMO

PURPOSE: The aim of the study was to report the seizure outcome, motor skills and adaptive motor functions in a series of children and adolescents who underwent hemispheric surgery, analysing the risk-benefits of surgery. METHODS: The clinical course, seizure and motor function outcomes of 15 patients who underwent hemispheric surgery were reviewed. RESULTS: The mean age at surgery was 9.5, with 1-9 years follow-up. The underlying pathologies were Rasmussen encephalitis, vascular disorders, and hemimegalencephaly. All the patients presented with severe epilepsy and different degrees of hemiparesis, although motor functionality was preserved in 80% of the patients. At last follow-up, 67% were seizure free, and 20% rarely experienced seizures. Antiepileptic drugs were reduced in 60%, and complete withdrawal from such drugs was successful in 20% of the patients. The motor outcome following the surgery varied between the patients. Despite the motor deficit after surgery, the post-operative motor function showed unchanged for gross motor function in most (60%), while 27% improved. Similar results were obtained for the ability to handle objects in daily life activities. Sixty percent of the children were capable of handling objects, with somewhat reduced coordination and/or motor speed. CONCLUSION: Pre-surgical motor function continues to play a role in the pre-surgical evaluation process in order to provide a baseline for outcome. Hemispheric surgery, once regarded as a radical intervention and last treatment resource, may become routinely indicated for refractory hemispheric epilepsy in children and adolescents, with oftentime favourable motor outcomes.


Assuntos
Adaptação Psicológica/fisiologia , Epilepsia , Hemisferectomia/métodos , Transtornos das Habilidades Motoras/etiologia , Adolescente , Criança , Eletroencefalografia , Epilepsia/complicações , Epilepsia/psicologia , Epilepsia/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Testes Neuropsicológicos , Pais/psicologia , Resultado do Tratamento
3.
Neurology ; 79(22): e189, 2012 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-23183285

RESUMO

A 10-year-old boy presented to our hospital with a 3-year history of fall attacks triggered by laughing, leading to a generalized loss of muscle tone without loss of consciousness (video). One year later, motor delayed skills started. Examination showed ataxia, moderate cognitive impairment, and vertical gaze palsy. EEG revealed diffuse slowing and disorganization of background rhythms. Molecular analysis disclosed heterozygosis p.P1007A and p.A1035V mutations, diagnostic of Niemann-Pick disease type C (NPC).


Assuntos
Cataplexia/diagnóstico , Cataplexia/etiologia , Doença de Niemann-Pick Tipo C/complicações , Doença de Niemann-Pick Tipo C/diagnóstico , Cataplexia/genética , Criança , Humanos , Riso , Masculino , Doença de Niemann-Pick Tipo C/genética , Gravação de Videoteipe/métodos
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