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Seizure protocol

Samuel Lapalme-Remis, Gregory D Cascino
PURPOSE OF REVIEW: This article discusses structural and functional neuroimaging findings in patients with seizures and epilepsy. The indications for neuroimaging in these patients and the potential diagnostic utility of these studies are presented. RECENT FINDINGS: Patients presenting with new seizures typically require urgent imaging to rule out a critical underlying cause. MRI is the structural neuroimaging procedure of choice in individuals with epilepsy. Specific epilepsy protocols should be considered to increase the diagnostic yield of neuroimaging in patients with structural lesions associated with focal or generalized seizures...
October 2016: Continuum: Lifelong Learning in Neurology
Jens Henrichs, Viki Verfaille, Laura Viester, Myrte Westerneng, Bert Molewijk, Arie Franx, Henriette van der Horst, Judith E Bosmans, Ank de Jonge, Petra Jellema
BACKGROUND: Intrauterine growth retardation (IUGR) is a major risk factor for perinatal mortality and morbidity. Thus, there is a compelling need to introduce sensitive measures to detect IUGR fetuses. Routine third trimester ultrasonography is increasingly used to detect IUGR. However, we lack evidence for its clinical effectiveness and cost-effectiveness and information on ethical considerations of additional third trimester ultrasonography. This nationwide stepped wedge cluster-randomized trial examines the (cost-)effectiveness of routine third trimester ultrasonography in reducing severe adverse perinatal outcome through subsequent protocolized management...
October 13, 2016: BMC Pregnancy and Childbirth
Sarah E Bigby, Jennifer E Carter, Sébastien Bauquier, Thierry Beths
Anesthesia protocols for patients with intracranial lesions need to provide hemodynamic stability, preserve cerebrovascular autoregulation, avoid increases in intracranial pressure, and facilitate a rapid recovery. Propofol total intravenous anesthesia (TIVA) maintains cerebral blood flow autoregulation and is considered superior to inhalant agents as an anesthetic protocol for patients with intracranial lesions. A propofol-based TIVA subsequent to premedication with medetomidine and diazepam was used in a king penguin ( Aptenodytes patagonicus ) undergoing magnetic resonance imaging of the brain after a new onset of seizures...
September 2016: Journal of Avian Medicine and Surgery
Jiwon Lee, Eu Gene Park, Munhyang Lee, Jeehun Lee
BACKGROUND AND PURPOSE: Antiepileptic drug (AED)-associated cutaneous adverse drug reactions can lead to the discontinuation of medications. The aim of this study was to determine the long-term efficacy and safety of performing desensitization to oxcarbazepine. METHODS: This study involved 20 patients who exhibited cutaneous adverse drug reactions associated with oxcarbazepine use between July 2009 and March 2016 at Samsung Medical Center. All of the participants had to discontinue oxcarbazepine despite presenting initially positive responses...
October 7, 2016: Journal of Clinical Neurology
Srinivasa P Kommajosyula, Marcus E Randall, Srinivasan Tupal, Carl L Faingold
Patients with epilepsy are at risk of sudden unexpected death in epilepsy (SUDEP). The most common series of events in witnessed cases of SUDEP is a generalized convulsive seizure followed by terminal apnea. Risk factors for SUDEP include prolonged postictal depression (PID), as well as alcohol abuse. The present study examined these issues in a genetic epilepsy model that exhibits generalized convulsive audiogenic seizures (AGSz) but rarely exhibits seizure-induced death, the genetically epilepsy-prone rats (GEPR-9s)...
October 7, 2016: Epilepsy & Behavior: E&B
M Baulac, W Byrnes, P Williams, S Borghs, E Webster, M De Backer, P Dedeken
OBJECTIVE: To assess prospectively the effectiveness of lacosamide (LCM) added to levetiracetam (LEV) after down-titration of a concomitant sodium channel blocker (SCB) among patients with focal epilepsy not adequately controlled on LEV and SCB. METHODS: In this open-label trial, LCM was initiated at 100 mg/day and up-titrated to 200-600 mg/day over 9 weeks; SCB down-titration started when LCM dose reached 200 mg/day. Patients remained on stable LCM/LEV doses for 12 weeks' maintenance (21-week treatment period)...
October 6, 2016: Acta Neurologica Scandinavica
Daniel San-Juan, Dulce Anabel Espinoza López, Rafael Vázquez Gregorio, Carlos Trenado, Maricarmen Fernández-González Aragón, León Morales-Quezada, Axel Hernandez Ruiz, Flavio Hernandez-González, Alejandro Alcaraz-Guzmán, David J Anschel, Felipe Fregni
BACKGROUND: Transcranial direct current stimulation (tDCS) has been evaluated in medication refractory epilepsy patients. The results have been inconclusive and protocols have varied between studies. OBJECTIVE: To evaluate the safety and efficacy of two protocols of tDCS in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). METHODS: This is a randomized placebo-controlled, double-blinded clinical trial, with 3 arms, 3 sessions, 5 sessions and placebo stimulation...
August 31, 2016: Brain Stimulation
Vinod G Ugale, Sanjay B Bari
Anticonvulsants effective against multiple seizures are of wide interest as antiepileptic drugs, especially if active against pharmaco-resistant seizures. Herein, we synthesized 16 different, rationally designed 2-((6,7-dimethoxy-4-oxo-2-phenylquinazolin-3(4H)-yl)amino)-N-(substituted phenyl)acetamides and screened for anticonvulsant activities through in vivo experiments. Compound 4d emerged as prototype with excellent anti-seizure action in mice against electroshock, chemically induced and pharmaco-resistant 6-Hz seizure models with no symptoms of neurotoxicity and hepatotoxicity (ED50  = 23...
September 28, 2016: Archiv der Pharmazie
Puneet Gandhi, Richa Khare, Kavita Niraj, Nitin Garg, Sandeep K Sorte, Hanni Gulwani
Mixed gliomas, primarily oligoastrocytomas, account for about 5%-10% of all gliomas. Distinguishing oligoastrocytoma based on histological features alone has limitations in predicting the exact biological behavior, necessitating ancillary markers for greater specificity. In this case report, human telomerase reverse transcriptase (hTERT) and high mobility group-A1 (HMGA1); markers of proliferation and stemness, have been quantitatively analyzed in formalin-fixed paraffin-embedded tissue samples of a 34 years old patient with oligoastrocytoma...
September 16, 2016: World Journal of Clinical Cases
Kyra Doumlele, Erin Conway, Julie Hedlund, Patricia Tolete, Orrin Devinsky
West Syndrome is characterized by infantile spasms, a hypsarrhythmic electroencephalogram (EEG) pattern, and a poor neurodevelopmental prognosis. First-line treatments include adrenocorticotrophic hormone (ACTH) and vigabatrin, but adverse effects often limit their use. CPP-115 is a high-affinity vigabatrin analogue developed to increase therapeutic potency and to limit retinal toxicity. Here, we present a child treated with CPP-115 through an investigational new drug protocol who experienced a marked reduction of seizures with no evidence of retinal dysfunction...
2016: Epilepsy & Behavior Case Reports
Lisa J Rosenthal, Brandon A Francis, Jennifer L Beaumont, David Cella, Michael D Berman, Matthew B Maas, Eric M Liotta, Robert Askew, Andrew M Naidech
BACKGROUND: Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium and found worse outcomes in health-related quality of life (HRQoL) in the domain of cognitive function. OBJECTIVE: We tested the hypothesis that agitation would have additional prognostic significance on later cognitive function HRQoL. METHODS: Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium, with a standardized protocol and measures...
August 5, 2016: Psychosomatics
Silvia L Cruz, Marcia Y Gauthereau-Torres, María Teresa Rivera-García
Several organic solvents have anticonvulsant or convulsant actions depending on the dose and exposure time. To study if there is a structure-activity relationship for organic solvents as anticonvulsant agents we subjected independent groups of mice to a single 30-min exposure session to inhale n-hexane, cyclohexane, benzene (8000ppm each), toluene (500-6000ppm), m-xylene (1000-6000ppm), ethylbenzene (500-4000ppm) or propylbenzene (500-4000ppm). Immediately after, animals were injected i.p. with 90mg/kg pentylenetetrazol (PTZ) and re-exposed to the same solvent for another 30min...
September 20, 2016: Neurotoxicology
Francesca Camia, Livia Pisciotta, Giovanni Morana, Maria Cristina Schiaffino, Salvatore Renna, Paola Carrera, Maurizio Ferrari, Maria Giuseppina Baglietto, Edvige Veneselli, Laura Siri, Maria Margherita Mancardi
INTRODUCTION: Variants in the CACNA1A gene on chromosome 19p13 result in a spectrum of neurological phenotypes ranging from familial or sporadic hemiplegic migraine to congenital or progressive encephalopathies. Patients with CACNA1A variants often show acute attacks with ataxia or hemiplegia till coma, sometimes related to unilateral brain oedema. No guidelines for the medical management of these attacks are available since treatment is empiric, and many cases do not respond to common antimigraine drugs...
September 19, 2016: Cephalalgia: An International Journal of Headache
Rani Ameena Bashir, Liza Espinoza, Sakeer Vayalthrikkovil, Jeffrey Buchhalter, Leigh Irvine, Luis Bello-Espinosa, Khorshid Mohammad
BACKGROUND: We report the impact of implementing continuous video electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy via a protocol in the context of neonatal neuro-critical care program. METHODS: Neonates with hypoxic-ischemic encephalopathy were studied retrospectively two years before and after implementing continuous video electroencephalography for 72 hours as a care protocol. Before continuous video electroencephalography, a 60-minute routine electroencephalography was performed at the discretion of the provider...
August 3, 2016: Pediatric Neurology
Torsten Fregin, Ulf Bickmeyer
OBJECTIVES: In search for methods of anesthesia of crustaceans, an implanted electrode into lobster and crayfish CNS enabled us to monitor signal propagation in the nerve system of animals undergoing different protocols. RESULTS: Cooling (tap water 0°C, sea water -1,8°C) and anesthesia with MgCl2 (10%) were both discarded as anesthetic procedures because responses to external stimuli were still detectable under treatment. Contrarily, bubbling the aquarium water with CO2 can be considered a "partially successful" anesthesia, because signal propagation is inhibited but before that the animals show discomfort...
2016: PloS One
Katherine Remick, Christopher Redgate, Daniel Ostermayer, Amy H Kaji, Marianne Gausche-Hill
OBJECTIVE: Many Emergency Medicine Services (EMS) protocols require point-of-care blood glucose testing (BGT) for any pediatric patient who presents with seizure or altered level of conscious. Few data describe the diagnostic yield of BGT when performed on all pediatric seizures regardless of presenting mental status. We analyzed a large single center dataset of pediatric patients presenting with prehospital seizures to determine the prevalence of hypoglycemic seizures and the utility of repeat BGT in the emergency department (ED)...
September 16, 2016: Prehospital Emergency Care
Fatima Zahra Taoufiqi, Jamal Mounach, Amal Satte, Hamid Ouhabi, Aboubaker El Hessni
Objective. This study aims to evaluate the incidence of pathological cerebral activity responses to intermittent rhythmic photic stimulation (IPS) after a single epileptic seizure. Patients and Methods. One hundred and thirty-seven EEGs were performed at the Neurophysiology Department of Mohamed V Teaching Military Hospital in Rabat. Clinical and EEG data was collected. Results. 9.5% of our patients had photoparoxysmal discharges (PPD). Incidence was higher in males than in females, but p value was not significant (p = 0...
2016: Neuroscience Journal
Masaki Iwasaki, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga
Epilepsy surgery is aimed to remove the brain tissues that are indispensable for generating patient's epileptic seizures. There are two purposes in the pre-operative evaluation: localization of the epileptogenic zone and localization of function. Surgery is planned to remove possible epileptogenic zone while preserving functional area. Since no single diagnostic modality is superior to others in identifying and localizing the epileptogenic zone, multiple non-invasive evaluations are performed to estimate the location of the epileptogenic zone after concordance between evaluations...
October 15, 2016: Neurologia Medico-chirurgica
L Fisch, A M Lascano, N Vernaz Hegi, F Girardin, V Kapina, L Heydrich, O Rutschmann, F Sarasin, M I Vargas, F Picard, S Vulliémoz, A C Héritier-Barras, M Seeck
A first seizure is a life-changing event with physical and psychological consequences. We aimed to assess the role of early comprehensive patient care after a first unprovoked seizure to improve diagnostic accuracy and follow-up adherence. From April 2011 to March 2012, patients presenting a first unprovoked epileptic seizure received standard patient care (SPC), i.e., a consultation in the ED, an EEG and a CT scan. The patients were notified of the follow-ups. We compared this protocol to subsequently acquired "early comprehensive patient care" (ECPC), which included a consultation by an epileptologist in the emergency department (ED), a routine or long-term monitoring electroencephalogram (LTM-EEG), magnetic resonance imaging and three follow-up consultations (3 weeks, 3 months, 12 months)...
September 7, 2016: Journal of Neurology
Anine H Stam, Parul H Kothari, Aisha Shaikh, Andreas Gschwendter, Joanna C Jen, Suzanne Hodgkinson, Todd A Hardy, Michael Hayes, Peter A Kempster, Katya E Kotschet, Ingeborg M Bajema, Sjoerd G van Duinen, Marion L C Maat-Schieman, Paulus T V M de Jong, Marc D de Smet, Didi de Wolff-Rouendaal, Greet Dijkman, Nadine Pelzer, Grant R Kolar, Robert E Schmidt, JoAnne Lacey, Daniel Joseph, David R Fintak, M Gilbert Grand, Elizabeth M Brunt, Helen Liapis, Rula A Hajj-Ali, Mark C Kruit, Mark A van Buchem, Martin Dichgans, Rune R Frants, Arn M J M van den Maagdenberg, Joost Haan, Robert W Baloh, John P Atkinson, Gisela M Terwindt, Michel D Ferrari
Cerebroretinal vasculopathy, hereditary vascular retinopathy, and hereditary endotheliopathy, retinopathy, nephropathy and stroke are neurovascular syndromes initially described as distinct entities. Recently they were shown to be one disease caused by C-terminal frame-shift mutations in TREX1, which was termed 'retinal vasculopathy with cerebral leukodystrophy'. Here we defined the genetic and clinicopathologic spectrum of this clinically and pathophysiologically poorly characterized and frequently misdiagnosed fatal neurovascular disorder...
September 6, 2016: Brain: a Journal of Neurology
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