RESUMO
It has been established that 20-30% of epilepsies are not controlled by antiepileptic drugs. Drug resistance is associated with several major problems, including prognosis, cognitive function, behavior, mortality, cost and quality of life. Apart from classic risk factors for drug resistance, such as neurological, psychiatric, imaging, EEG abnormalities, a high frequency of seizures before medical therapy and complex febrile convulsions, the potential role of multidrug transporters as well as their genetic control and the altered sensitivity of neuronal drug receptors has gained growing attention. In the future, pharmaceutical engineering may bypass these factors. To a certain extent, drug resistance may develop progressively in a neurobiological process and the control of this process could limit its development.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Anticonvulsivantes/farmacologia , Resistência a Medicamentos , Epilepsia/genética , Humanos , Farmacogenética , Receptores de Droga/efeitos dos fármacos , Receptores de Droga/genéticaRESUMO
A patient suffering from juvenile myoclonic epilepsy experienced myoclonic jerks, fairly regularly, while playing chess. The myoclonus appeared particularly when he had to plan his strategy, to choose between two solutions or while raising the arm to move a chess figure. Video-EEG-polygraphy was performed, with back averaging of the myoclonus registered during a chess match and during neuropsychological testing with Kohs cubes. The EEG spike wave complexes were localised in the fronto-central region. [Published with video sequences].
Assuntos
Eletroencefalografia , Epilepsias Mioclônicas/diagnóstico , Epilepsia Reflexa/diagnóstico , Jogos e Brinquedos , Processamento de Sinais Assistido por Computador , Gravação em Vídeo , Adulto , Anticonvulsivantes/uso terapêutico , Atenção/efeitos dos fármacos , Atenção/fisiologia , Eletroencefalografia/efeitos dos fármacos , Eletromiografia/efeitos dos fármacos , Epilepsias Mioclônicas/tratamento farmacológico , Epilepsias Mioclônicas/fisiopatologia , Epilepsia Reflexa/tratamento farmacológico , Epilepsia Reflexa/fisiopatologia , Potenciais Evocados/efeitos dos fármacos , Potenciais Evocados/fisiologia , Lobo Frontal/efeitos dos fármacos , Lobo Frontal/fisiopatologia , Jogos Experimentais , Humanos , Masculino , Testes Neuropsicológicos , Resolução de Problemas/efeitos dos fármacos , Resolução de Problemas/fisiologia , Desempenho Psicomotor/efeitos dos fármacos , Desempenho Psicomotor/fisiologia , Ácido Valproico/uso terapêuticoRESUMO
Two cases of Wernicke's encephalopathy with severe hypothermia as a major presenting sign are reported. The outcome was favorable with thiamine treatment. The clinical features, frequency, prognostic value and clinico-pathological correlations of hypothermia in this condition are reviewed.
