The document summarizes a study investigating clinical and electroencephalography (EEG) features of patients with nonconvulsive status epilepticus (NCSE). The study reviewed 45 patients over 5 years. The most common etiologies were acute symptomatic (58%) and cerebrovascular disease (49%). EEG patterns were classified using the Salzburg Consensus Criteria, with 25 definite, 30 possible, and 6 no NCSE. In-hospital mortality was high at 33%. Prognostic factors associated with mortality included potentially fatal etiology, refractory NCSE, use of anesthetics, multiple EEG patterns, and nonreactive EEGs. The criteria had high diagnostic accuracy but did not affect prognosis.
This document discusses various techniques for monitoring patients in the intensive care unit (ICU), including electroencephalography (EEG), somatosensory evoked potentials (SSEPs), brain oxygen monitoring, intracranial pressure (ICP) monitoring, and cerebral blood flow monitoring using transcranial Doppler ultrasound. It provides examples of how these monitoring techniques can be used to detect seizures, brain injury, vasospasm, and other conditions in ICU patients.
Clinical and eeg features of patients with eeg wicket rhythms misdiagnosed wi...Olusola Adeyemi
Patients with EEG wicket rhythms are sometimes misdiagnosed with epilepsy when these normal EEG patterns are mistaken for epileptogenic activity. This study compared clinical features of 25 patients with wicket rhythms but no epilepsy to 25 age- and sex-matched epilepsy patients. Key differences included: 1) Wicket patients developed episodes in mid-life (mean 38 years) versus late teens/early adulthood for epilepsy patients (mean 20 years). 2) Wicket episodes lasted much longer (mean 156 minutes) than epilepsy seizures (mean 2 minutes). 3) Wicket rhythms had longer duration (mean 0.66 seconds) than epileptogenic patterns (mean 0.11 seconds). The presence of confusion during episodes strongly
ORIGINAL ARTICLENeuromuscular complications after hematopo.docxalfred4lewis58146
ORIGINAL ARTICLE
Neuromuscular complications after hematopoietic stem
cell transplantation
Susanne Koeppen & Abhiyrahmi Thirugnanasambanthan &
Michael Koldehoff
Received: 19 December 2013 /Accepted: 20 March 2014 /Published online: 29 March 2014
# Springer-Verlag Berlin Heidelberg 2014
Abstract
Purpose The aim of this study was to analyze the occurrence
of neuromuscular symptoms in recipients of allogeneic hema-
topoietic stem cell transplantation (HSCT) for treatment of
malignant hematopoietic disease.
Methods Among 247 outpatients after allogeneic HSCT, we
conducted a prospective non-interventional study between
July 2011 and August 2013. During follow-up visits, clinical
and electrophysiological findings were correlated to the pres-
ence of autoantibodies/alloantibodies and to frequencies of
lymphocyte subpopulations in peripheral blood.
Results Resulting in an incidence of 8.1 %, 20 patients were
diagnosed with neuromuscular complications at a median
onset of 12 months post-transplant. Five patients (25 %) were
identified with polyneuropathy (PNP), ten patients (50 %)
with combined PNP and myopathy, four patients (20 %) with
myopathy or polymyositis (PM), and one patient (5 %) with
myasthenia gravis (MG). Immune-mediated sensorimotor
PNP after HSCT is characterized by a predominantly axonal
lesion and can be overlapping with neurotoxic side effects.
The latency between HSCT and development of PM varied
between 60 days and 72 months. In general, PM occurs
parallel to graft-versus-host disease (GvHD) after tapering of
immunosuppressive medication. Typical clinical features are
proximal bilateral limb weakness with muscle atrophy. Auto-
antibodies (Ab) were detected in 12 patients, myositis-specific
Ab only in one patient. In patients with progressive
neurological symptoms, a decrease in the CD4/CD8 T cell
ratio was observed.
Conclusions GvHD-related myositis appeared similar to idi-
opathic myositis regarding clinical and electromyographical
findings. As outcome measure, sequential analysis of lympho-
cyte subpopulations in peripheral blood seems to be more
suitable than Ab measurements. Whereas peripheral neuropa-
thies are commonly observed shortly after HSCT, MG is a rare
complication in the late post-HSCT phase.
Keywords Allogeneic hematopoietic stem cell
transplantation . Graft-versus-host disease . Polyneuropathy .
Polymyositis . Myasthenia gravis
Abbreviations
AChR Ab Acetylcholine receptor antibody
AL Acute leukemia
ALL Acute lymphocytic leukemia
ANA Antinuclear antibodies
AML Acute myeloid leukemia
Ab Autoantibodies
CK-MB Creatine kinase-MB
CLL Chronic lymphocytic leukemia
CML Chronic myeloid leukemia
GvHD Graft-versus-host disease
HSCT Hematopoietic stem cell transplantation
ND Not done
MCL Mantle cell lymphoma
MG Myasthenia gravis
MM Multiple myeloma
MPN Myeloproliferative neoplasm
OMF Osteomyelofibrosis
PM Polymyositis
PNP Polyneuropathy
S. Koeppen (*): A. Thirugnanasambanthan
Department of Neurology, Medical School, Un.
1. A 27-year-old female presented with sudden loss of language over 2 days. She had a history of left parietal lobe trauma and hematoma requiring craniectomy at age 19. CT showed a new left parietal lobe lesion.
2. The diagnosis is aphasic status epilepticus, likely caused by the new left parietal lobe lesion seen on CT.
3. Status epilepticus is a medical emergency requiring prompt treatment to stop seizures and prevent complications. The goals of management are to maintain vital functions, stop seizures, identify and treat the underlying cause, and manage any sequelae.
Mini-mental state examination in patients with hepatic encephalopathy and liv...Enrique Moreno Gonzalez
Mini-Mental State Examination (MMSE) is one of the most commonly used methods in the assessment of cognitive mental status. MMSE has been used in hepatology but its usefulness in the evaluation of hepatic encephalopathy (HE) has never been properly assessed. The aim of the study was to investigate the value of MMSE in detection of HE in atients with cirrhosis.
idiopathic normal pressure hydrocephalus, the comorbidities, differential diagnoses, clinical presentations, and pathology of iNPH imaging studies and clinical procedures used for the diagnosis of iNPH. The treatment modality, outcomes, and prognosis
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
Presentation given by Dr Catherine Poots from Craigavon Area Hospital at the 2014 Northern Ireland Intensive Care Society annual Coppel Prize on Wednesday November 26th
This document discusses various techniques for monitoring patients in the intensive care unit (ICU), including electroencephalography (EEG), somatosensory evoked potentials (SSEPs), brain oxygen monitoring, intracranial pressure (ICP) monitoring, and cerebral blood flow monitoring using transcranial Doppler ultrasound. It provides examples of how these monitoring techniques can be used to detect seizures, brain injury, vasospasm, and other conditions in ICU patients.
Clinical and eeg features of patients with eeg wicket rhythms misdiagnosed wi...Olusola Adeyemi
Patients with EEG wicket rhythms are sometimes misdiagnosed with epilepsy when these normal EEG patterns are mistaken for epileptogenic activity. This study compared clinical features of 25 patients with wicket rhythms but no epilepsy to 25 age- and sex-matched epilepsy patients. Key differences included: 1) Wicket patients developed episodes in mid-life (mean 38 years) versus late teens/early adulthood for epilepsy patients (mean 20 years). 2) Wicket episodes lasted much longer (mean 156 minutes) than epilepsy seizures (mean 2 minutes). 3) Wicket rhythms had longer duration (mean 0.66 seconds) than epileptogenic patterns (mean 0.11 seconds). The presence of confusion during episodes strongly
ORIGINAL ARTICLENeuromuscular complications after hematopo.docxalfred4lewis58146
ORIGINAL ARTICLE
Neuromuscular complications after hematopoietic stem
cell transplantation
Susanne Koeppen & Abhiyrahmi Thirugnanasambanthan &
Michael Koldehoff
Received: 19 December 2013 /Accepted: 20 March 2014 /Published online: 29 March 2014
# Springer-Verlag Berlin Heidelberg 2014
Abstract
Purpose The aim of this study was to analyze the occurrence
of neuromuscular symptoms in recipients of allogeneic hema-
topoietic stem cell transplantation (HSCT) for treatment of
malignant hematopoietic disease.
Methods Among 247 outpatients after allogeneic HSCT, we
conducted a prospective non-interventional study between
July 2011 and August 2013. During follow-up visits, clinical
and electrophysiological findings were correlated to the pres-
ence of autoantibodies/alloantibodies and to frequencies of
lymphocyte subpopulations in peripheral blood.
Results Resulting in an incidence of 8.1 %, 20 patients were
diagnosed with neuromuscular complications at a median
onset of 12 months post-transplant. Five patients (25 %) were
identified with polyneuropathy (PNP), ten patients (50 %)
with combined PNP and myopathy, four patients (20 %) with
myopathy or polymyositis (PM), and one patient (5 %) with
myasthenia gravis (MG). Immune-mediated sensorimotor
PNP after HSCT is characterized by a predominantly axonal
lesion and can be overlapping with neurotoxic side effects.
The latency between HSCT and development of PM varied
between 60 days and 72 months. In general, PM occurs
parallel to graft-versus-host disease (GvHD) after tapering of
immunosuppressive medication. Typical clinical features are
proximal bilateral limb weakness with muscle atrophy. Auto-
antibodies (Ab) were detected in 12 patients, myositis-specific
Ab only in one patient. In patients with progressive
neurological symptoms, a decrease in the CD4/CD8 T cell
ratio was observed.
Conclusions GvHD-related myositis appeared similar to idi-
opathic myositis regarding clinical and electromyographical
findings. As outcome measure, sequential analysis of lympho-
cyte subpopulations in peripheral blood seems to be more
suitable than Ab measurements. Whereas peripheral neuropa-
thies are commonly observed shortly after HSCT, MG is a rare
complication in the late post-HSCT phase.
Keywords Allogeneic hematopoietic stem cell
transplantation . Graft-versus-host disease . Polyneuropathy .
Polymyositis . Myasthenia gravis
Abbreviations
AChR Ab Acetylcholine receptor antibody
AL Acute leukemia
ALL Acute lymphocytic leukemia
ANA Antinuclear antibodies
AML Acute myeloid leukemia
Ab Autoantibodies
CK-MB Creatine kinase-MB
CLL Chronic lymphocytic leukemia
CML Chronic myeloid leukemia
GvHD Graft-versus-host disease
HSCT Hematopoietic stem cell transplantation
ND Not done
MCL Mantle cell lymphoma
MG Myasthenia gravis
MM Multiple myeloma
MPN Myeloproliferative neoplasm
OMF Osteomyelofibrosis
PM Polymyositis
PNP Polyneuropathy
S. Koeppen (*): A. Thirugnanasambanthan
Department of Neurology, Medical School, Un.
1. A 27-year-old female presented with sudden loss of language over 2 days. She had a history of left parietal lobe trauma and hematoma requiring craniectomy at age 19. CT showed a new left parietal lobe lesion.
2. The diagnosis is aphasic status epilepticus, likely caused by the new left parietal lobe lesion seen on CT.
3. Status epilepticus is a medical emergency requiring prompt treatment to stop seizures and prevent complications. The goals of management are to maintain vital functions, stop seizures, identify and treat the underlying cause, and manage any sequelae.
Mini-mental state examination in patients with hepatic encephalopathy and liv...Enrique Moreno Gonzalez
Mini-Mental State Examination (MMSE) is one of the most commonly used methods in the assessment of cognitive mental status. MMSE has been used in hepatology but its usefulness in the evaluation of hepatic encephalopathy (HE) has never been properly assessed. The aim of the study was to investigate the value of MMSE in detection of HE in atients with cirrhosis.
idiopathic normal pressure hydrocephalus, the comorbidities, differential diagnoses, clinical presentations, and pathology of iNPH imaging studies and clinical procedures used for the diagnosis of iNPH. The treatment modality, outcomes, and prognosis
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
Presentation given by Dr Catherine Poots from Craigavon Area Hospital at the 2014 Northern Ireland Intensive Care Society annual Coppel Prize on Wednesday November 26th
The document summarizes the process of presurgical evaluation for epilepsy patients. It discusses how modern imaging techniques like video EEG monitoring, high-resolution MRI, fMRI, PET and SPECT are used to localize the epileptogenic zone noninvasively in most patients. When noninvasive methods are insufficient, invasive EEG monitoring using subdural or depth electrodes may be used. The goal is to precisely identify the brain area responsible for seizure generation to allow its surgical resection, while avoiding damage to critical functions. A classical example where surgery is often curative is mesial temporal lobe epilepsy.
This study evaluated the efficacy of levetiracetam and sodium valproate treatments for 195 patients with benign childhood epilepsy with centrotemporal spikes (BECTS) over 2 years. The study found that monotherapy, particularly with levetiracetam, was associated with normalization of EEG patterns and prevention of cognitive decline. Polytherapy, especially those including sodium valproate, was linked to poorer cognition. Early treatment to control electrical status epilepticus in sleep may help reduce cognitive issues in BECTS patients.
This document discusses the history and importance of neurocritical care units (NICUs). It notes that NICUs were established in the 1960s-1970s due to advances in neurosurgery and monitoring. The document outlines common conditions treated in NICUs such as stroke, hemorrhage, and brain injury. It emphasizes the role of NICUs in effectively treating these conditions and improving outcomes through specialized care and multidisciplinary teams. The document also discusses the development of neurocritical care societies and training to standardize care and education in the field.
Vns Therapy™ System For Weikong For Printcalaf0618
The document discusses VNS Therapy, a treatment for epilepsy patients who have difficulty controlling seizures through medications alone. It provides information on:
- How VNS Therapy works by electrically stimulating the vagus nerve to impact brain regions involved in seizure activity.
- Clinical evidence that VNS Therapy can significantly reduce seizure frequency in refractory epilepsy patients and improve quality of life factors like mood and alertness.
- Safety data showing the risks of VNS Therapy are low, with most side effects being mild and transient.
- High patient and clinician satisfaction rates with VNS Therapy as an effective alternative or addition to medications for difficult-to-treat epilepsy.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
This study assessed the association between calcified neurocysticercosis lesions (CNLs) and antiepileptic drug-resistant epilepsy through a prospective analysis of 45 patients in South India with CNLs. The study divided patients into three groups: CNL alone (n=17), CNL with unilateral hippocampal sclerosis (HS) (n=18), and CNLs as incidental findings (n=10). Patients with CNL alone or CNL with HS who underwent resective surgery had good seizure outcomes, with 4 of 5 and 9 of 11 patients respectively becoming seizure-free. The study suggests CNLs can cause drug-resistant epilepsy and resective surgery may be an effective treatment for select patients
EEG in convulsive and non convulsive seizures in the intensive care unitPramod Krishnan
Case based discussion regarding the utility of EEG in the management of convulsive and non convulsive seizures, including status epilepticus in the intensive care unit
Disorder of reversible subcortical vasogenic brain oedema in patients with acute neurological symptoms (eg, seizures, encephalopathy, headache, and visual disturbances) in the setting of renal failure, blood pressure fluctuations, cytotoxic drugs, autoimmune disorders, and pre-eclampsia or eclampsia.
Also called as:
Reversible posterior cerebral edema syndrome
Posterior leukoencephalopathy syndrome
Hyperperfusion encephalopathy
Brain capillary leak syndrome
PRES is caused by endothelial injury related to abrupt blood pressure changes or direct effects of cytokines on the endothelium, which leads to breakdown of the blood– brain barrier and subsequent brain edema.
PRES is generally reversible, both radio graphically and clinically, and has a favourable prognosis.
Cerebral blood flow can be regulated by four major mechanisms:
Myogenic,
Neurogenic,
Metabolic, or
Endothelial.
These mechanisms ensure that cerebral blood flow (CBF) is maintained within a relatively normal range. NO—nitric oxide, ET1—endothelin 1
Dr. sarah weckhuysen kcnq2 Cure summit parent track learn more at kcnq2cure.orgscottyandjim
This document discusses KCNQ2 gene mutations which can cause different epilepsy phenotypes from benign familial neonatal seizures (BFNS) to more severe early-onset epileptic encephalopathy. It describes the discovery of KCNQ2 mutations in BFNS in 1998 and more recent findings of de novo missense mutations in 10% of patients with treatment-resistant neonatal epileptic encephalopathy. These mutations have a dominant-negative effect on channel function and cause neuronal hyperexcitability. The document also reviews other ion channel mutations associated with epilepsy phenotypes along a spectrum, such as SCN1A mutations which can cause GEFS+ or more severe Dravet syndrome.
Electrical status beyond convulsive status epilepticusTeik Beng Khoo
Non-convulsive status epilepticus (NCSE) refers to ongoing seizures without convulsions lasting more than 30 minutes. Studies have found NCSE occurs in 11-21% of pediatric intensive care unit patients based on EEG findings. Risk factors for NCSE include prior seizures, acute brain injury, and abnormal brain imaging. Left untreated, NCSE can lead to worse outcomes including increased mortality and neurological impairment. Prompt treatment of NCSE is important to mitigate negative effects.
This document contains summaries of multiple poster presentations from the III Latin American Congress of Epilepsy in Mexico City, Mexico in 2004. The posters covered topics such as:
- The association between multiple sclerosis and epilepsy based on 24-hour EEG monitoring.
- Studies on the prevalence and causes of epilepsy in Venezuela and potential solutions.
- Whether epilepsy predisposes patients to psychosis based on a study in Tabasco, Mexico.
- Application of the 2001 ILAE diagnostic scheme for epileptic seizures and epilepsy types to a population in Havana, Cuba.
- Clinical and electroencephalographic characteristics of astatic epileptic seizures from a polygraphic study.
A case report of posterior reversible encephalopathy syndrome in a patient di...bijnnjournal
Posterior reversible encephalopathy syndrome (PRES), a clinical radiological syndrome, is characterized by the
abrupt development of neurological symptoms such as headaches, convulsions, altered sensorium, and visual
problems. PRES has been linked to a number of risk factors or etiologies, including the use of immunosuppressants
or cytotoxins, hypertensive encephalopathy, eclampsia, preeclampsia, and underlying autoimmune diseases.
A 41-year-old female was admitted with acute necrotizing emphysematous pancreatitis complicated by posterior
reversible encephalopathy syndrome
This document discusses status epilepticus (SE), including:
- Definitions and types of SE such as convulsive SE, nonconvulsive SE, and acute repetitive seizures.
- Characteristics of generalized convulsive SE.
- Incidence and mortality rates of SE which increase with age.
- Main causes of SE such as low antiepileptic drug levels, cerebrovascular accidents, anoxia/hypoxia, and metabolic disturbances.
- Guidelines for the management of SE including initiating treatment with benzodiazepines like lorazepam or diazepam, followed by antiepileptic drugs like fosphenytoin, phenytoin,
1) Status epilepticus refers to prolonged or continuous seizure activity lasting more than 5 minutes. It is a medical emergency that can cause neuronal damage the longer it persists.
2) Treatment involves controlling airway and vital signs, administering glucose and thiamine, performing diagnostic tests, and starting anticonvulsant drug therapy.
3) First line drug therapy includes lorazepam or diazepam followed by phenytoin or fosphenytoin. If seizures continue, additional doses of these drugs or alternative drugs like phenobarbital are given.
Dr. john millichap kcnq2 Cure summit professional track learn more at kcnq2cu...scottyandjim
Dr. John Millichap speaking at 2014 Denver KCNQ2 Cure summit professionals track at Children's Hospital of Colorado. More information at www.kcnq2cure.org
Post-traumatic epilepsy (PTE) is defined as recurrent seizures occurring after traumatic brain injury (TBI). TBI accounts for 10-20% of epilepsy cases. Risk factors for early PTE include GCS <10, intracranial hematoma, and seizures within 24 hours of injury. Risk factors for late PTE include penetrating injury, intracranial hematoma, early PTE, and age over 35. Temporal lobes are the most common localization. Standard anticonvulsants are used to treat established PTE but prophylaxis is ineffective at preventing late PTE. Surgery may be considered for refractory late PTE if the seizure focus is well-localized.
1. Status epilepticus (SE) is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. SE can be convulsive or non-convulsive.
2. The annual incidence of SE is estimated to be between 9,000-14,000 new cases per year in the UK. Mortality is about 20-30% and is higher in the elderly.
3. SE is initially treated with benzodiazepines like lorazepam or diazepam. If seizures continue, second line drugs like fosphenytoin or phenytoin are used. For refractory SE, anesthetic drugs under ICU care may be required
Neurological Pupil Index as an Indicator of Irreversible Cerebral Edema: A Ca...NeurOptics, Inc.
Assessing the pupillary light reflex (PLR) is acore component of neurological assessments. Changes in pupil size and reactivity can provide early recognition of neurological decline and facilitate lifesaving interventions.
The Prevalence and Prognostic Value of Neuroimaging Abnormalities in the Acut...CrimsonPublishersTNN
The Prevalence and Prognostic Value of Neuroimaging Abnormalities in the Acute Phase of Sepsis-Associated Encephalopathy by Keenan A Walker in Techniques in Neurosurgery & Neurology
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
The document summarizes the process of presurgical evaluation for epilepsy patients. It discusses how modern imaging techniques like video EEG monitoring, high-resolution MRI, fMRI, PET and SPECT are used to localize the epileptogenic zone noninvasively in most patients. When noninvasive methods are insufficient, invasive EEG monitoring using subdural or depth electrodes may be used. The goal is to precisely identify the brain area responsible for seizure generation to allow its surgical resection, while avoiding damage to critical functions. A classical example where surgery is often curative is mesial temporal lobe epilepsy.
This study evaluated the efficacy of levetiracetam and sodium valproate treatments for 195 patients with benign childhood epilepsy with centrotemporal spikes (BECTS) over 2 years. The study found that monotherapy, particularly with levetiracetam, was associated with normalization of EEG patterns and prevention of cognitive decline. Polytherapy, especially those including sodium valproate, was linked to poorer cognition. Early treatment to control electrical status epilepticus in sleep may help reduce cognitive issues in BECTS patients.
This document discusses the history and importance of neurocritical care units (NICUs). It notes that NICUs were established in the 1960s-1970s due to advances in neurosurgery and monitoring. The document outlines common conditions treated in NICUs such as stroke, hemorrhage, and brain injury. It emphasizes the role of NICUs in effectively treating these conditions and improving outcomes through specialized care and multidisciplinary teams. The document also discusses the development of neurocritical care societies and training to standardize care and education in the field.
Vns Therapy™ System For Weikong For Printcalaf0618
The document discusses VNS Therapy, a treatment for epilepsy patients who have difficulty controlling seizures through medications alone. It provides information on:
- How VNS Therapy works by electrically stimulating the vagus nerve to impact brain regions involved in seizure activity.
- Clinical evidence that VNS Therapy can significantly reduce seizure frequency in refractory epilepsy patients and improve quality of life factors like mood and alertness.
- Safety data showing the risks of VNS Therapy are low, with most side effects being mild and transient.
- High patient and clinician satisfaction rates with VNS Therapy as an effective alternative or addition to medications for difficult-to-treat epilepsy.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
This study assessed the association between calcified neurocysticercosis lesions (CNLs) and antiepileptic drug-resistant epilepsy through a prospective analysis of 45 patients in South India with CNLs. The study divided patients into three groups: CNL alone (n=17), CNL with unilateral hippocampal sclerosis (HS) (n=18), and CNLs as incidental findings (n=10). Patients with CNL alone or CNL with HS who underwent resective surgery had good seizure outcomes, with 4 of 5 and 9 of 11 patients respectively becoming seizure-free. The study suggests CNLs can cause drug-resistant epilepsy and resective surgery may be an effective treatment for select patients
EEG in convulsive and non convulsive seizures in the intensive care unitPramod Krishnan
Case based discussion regarding the utility of EEG in the management of convulsive and non convulsive seizures, including status epilepticus in the intensive care unit
Disorder of reversible subcortical vasogenic brain oedema in patients with acute neurological symptoms (eg, seizures, encephalopathy, headache, and visual disturbances) in the setting of renal failure, blood pressure fluctuations, cytotoxic drugs, autoimmune disorders, and pre-eclampsia or eclampsia.
Also called as:
Reversible posterior cerebral edema syndrome
Posterior leukoencephalopathy syndrome
Hyperperfusion encephalopathy
Brain capillary leak syndrome
PRES is caused by endothelial injury related to abrupt blood pressure changes or direct effects of cytokines on the endothelium, which leads to breakdown of the blood– brain barrier and subsequent brain edema.
PRES is generally reversible, both radio graphically and clinically, and has a favourable prognosis.
Cerebral blood flow can be regulated by four major mechanisms:
Myogenic,
Neurogenic,
Metabolic, or
Endothelial.
These mechanisms ensure that cerebral blood flow (CBF) is maintained within a relatively normal range. NO—nitric oxide, ET1—endothelin 1
Dr. sarah weckhuysen kcnq2 Cure summit parent track learn more at kcnq2cure.orgscottyandjim
This document discusses KCNQ2 gene mutations which can cause different epilepsy phenotypes from benign familial neonatal seizures (BFNS) to more severe early-onset epileptic encephalopathy. It describes the discovery of KCNQ2 mutations in BFNS in 1998 and more recent findings of de novo missense mutations in 10% of patients with treatment-resistant neonatal epileptic encephalopathy. These mutations have a dominant-negative effect on channel function and cause neuronal hyperexcitability. The document also reviews other ion channel mutations associated with epilepsy phenotypes along a spectrum, such as SCN1A mutations which can cause GEFS+ or more severe Dravet syndrome.
Electrical status beyond convulsive status epilepticusTeik Beng Khoo
Non-convulsive status epilepticus (NCSE) refers to ongoing seizures without convulsions lasting more than 30 minutes. Studies have found NCSE occurs in 11-21% of pediatric intensive care unit patients based on EEG findings. Risk factors for NCSE include prior seizures, acute brain injury, and abnormal brain imaging. Left untreated, NCSE can lead to worse outcomes including increased mortality and neurological impairment. Prompt treatment of NCSE is important to mitigate negative effects.
This document contains summaries of multiple poster presentations from the III Latin American Congress of Epilepsy in Mexico City, Mexico in 2004. The posters covered topics such as:
- The association between multiple sclerosis and epilepsy based on 24-hour EEG monitoring.
- Studies on the prevalence and causes of epilepsy in Venezuela and potential solutions.
- Whether epilepsy predisposes patients to psychosis based on a study in Tabasco, Mexico.
- Application of the 2001 ILAE diagnostic scheme for epileptic seizures and epilepsy types to a population in Havana, Cuba.
- Clinical and electroencephalographic characteristics of astatic epileptic seizures from a polygraphic study.
A case report of posterior reversible encephalopathy syndrome in a patient di...bijnnjournal
Posterior reversible encephalopathy syndrome (PRES), a clinical radiological syndrome, is characterized by the
abrupt development of neurological symptoms such as headaches, convulsions, altered sensorium, and visual
problems. PRES has been linked to a number of risk factors or etiologies, including the use of immunosuppressants
or cytotoxins, hypertensive encephalopathy, eclampsia, preeclampsia, and underlying autoimmune diseases.
A 41-year-old female was admitted with acute necrotizing emphysematous pancreatitis complicated by posterior
reversible encephalopathy syndrome
This document discusses status epilepticus (SE), including:
- Definitions and types of SE such as convulsive SE, nonconvulsive SE, and acute repetitive seizures.
- Characteristics of generalized convulsive SE.
- Incidence and mortality rates of SE which increase with age.
- Main causes of SE such as low antiepileptic drug levels, cerebrovascular accidents, anoxia/hypoxia, and metabolic disturbances.
- Guidelines for the management of SE including initiating treatment with benzodiazepines like lorazepam or diazepam, followed by antiepileptic drugs like fosphenytoin, phenytoin,
1) Status epilepticus refers to prolonged or continuous seizure activity lasting more than 5 minutes. It is a medical emergency that can cause neuronal damage the longer it persists.
2) Treatment involves controlling airway and vital signs, administering glucose and thiamine, performing diagnostic tests, and starting anticonvulsant drug therapy.
3) First line drug therapy includes lorazepam or diazepam followed by phenytoin or fosphenytoin. If seizures continue, additional doses of these drugs or alternative drugs like phenobarbital are given.
Dr. john millichap kcnq2 Cure summit professional track learn more at kcnq2cu...scottyandjim
Dr. John Millichap speaking at 2014 Denver KCNQ2 Cure summit professionals track at Children's Hospital of Colorado. More information at www.kcnq2cure.org
Post-traumatic epilepsy (PTE) is defined as recurrent seizures occurring after traumatic brain injury (TBI). TBI accounts for 10-20% of epilepsy cases. Risk factors for early PTE include GCS <10, intracranial hematoma, and seizures within 24 hours of injury. Risk factors for late PTE include penetrating injury, intracranial hematoma, early PTE, and age over 35. Temporal lobes are the most common localization. Standard anticonvulsants are used to treat established PTE but prophylaxis is ineffective at preventing late PTE. Surgery may be considered for refractory late PTE if the seizure focus is well-localized.
1. Status epilepticus (SE) is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. SE can be convulsive or non-convulsive.
2. The annual incidence of SE is estimated to be between 9,000-14,000 new cases per year in the UK. Mortality is about 20-30% and is higher in the elderly.
3. SE is initially treated with benzodiazepines like lorazepam or diazepam. If seizures continue, second line drugs like fosphenytoin or phenytoin are used. For refractory SE, anesthetic drugs under ICU care may be required
Neurological Pupil Index as an Indicator of Irreversible Cerebral Edema: A Ca...NeurOptics, Inc.
Assessing the pupillary light reflex (PLR) is acore component of neurological assessments. Changes in pupil size and reactivity can provide early recognition of neurological decline and facilitate lifesaving interventions.
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Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
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4. Select Research Methodology and Tools
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8. Sampling Strategy
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1. ELECTROCLINICAL PATTERNS IN PATIENTS WITH
NONCONVULSIVE STATUS EPILEPTICUS :
ETIOLOGY, TREATMENT, AND OUTCOME
Presented by:
dr. Banu Eko Susanto
Supervised by:
dr. Diah Kurnia Mirawati, dr, Sp. S (K)
1
4. ABSTRACT
Introduction: This study investigated the clinical and electroencephalography (EEG)
features and prognostic factors of patients with nonconvulsive status epilepticus (NCSE).
Materials and methods: retrospectively reviewed the clinical files and EEG data of 45
consecutive patients with NCSE over a five-year period.
Results: The most common etiology for NCSE was acute symptomatic etiologies (57.8%)
and cerebrovascular disease (48.9%). Twenty-five status patterns on the EEGs were
classified as definite, 30 as possible, and six as no NCSE according to the SCC (Salzburg
Consensus Criteria). The in-hospital mortality rate was high (33.3%)
Conclusions: The SCC for NCSE have high diagnostic accuracy but do not affect
prognosis.
4
6. INTRODUCTION
Nonconvulsive status epilepticus (NCSE) is an important cause of reduced or
altered levels of consciousness, which may worsen the prognosis of
neurologic outcomes.
Electroencephalography (EEG) plays an essential role in identifying the
diagnosis of this condition.
NCSE is a treatable disorder in most cases and probably underdiagnosed,
especially in critically ill patients.
This research systematically assessed the demographic features, etiologies,
treatments, ictal EEG patterns, and prognostic findings in our patients
diagnosed as having NCSE
6
8. PATIENTS POPULATION AND DATA
COLLECTION
Researcher retrospectively reviewed the clinical files and video-EEG recordings of all
consecutive adult and adolescent patients aged over 15 years who were diagnosed and
treated for NCSE at the Department of Neurology of the Trakya University Hospital
between January 2015 and July 2020.
NCSE was defined as the occurrence of seizures without marked motor manifestations
lasting more than 10 minutes, which was confirmed through EEG recordings in all
patients
The etiology of NCSE was grouped as stated in the International League Against
Epilepsy (ILAE) classification as acute, remote or progressive symptomatic
8
9. DIAGNOSIS OF NCSE
Diagnosis of NCSE was made by a certified epileptologist with more than ten years’
experience for the patients who were referred to the EEG department with clinical
suspicion of NCSE.
All patients referred to the EEG department had either altered consciousness without
major motor symptoms or persistence of altered consciousness after a motor seizure.
Twenty-one channel EEG recordings with additional anterior temporal electrodes (FT9
and FT10) according to the international 10–20 system for at least a 30-minute duration
were recorded from each patient.
Continuous EEG monitoring was not available for patients with SE, but routine EEGs
were repeated at different days in patients who were not responsive to antiseizure
treatments.
Reevaluation of EEGs according to the SCC was performed by a certified clinical
neurophysiologist (LBK) who was trained on theSCC for NCSE.
9
10. DIAGNOSIS OF NCSE
Status patterns in the EEGs were classified as ‘definite NCSE,’ ‘possible NCSE,’ or ‘no
NCSE’ according to the SCC
10
11. STATISTICAL ANALYSIS
For categorical variables, Chi-square tests or Fischer’s exact test was used.
Continuous variables were analyzed using independent Student t-tests or the Mann–
Whitney U test after testing for normal distribution of the data.
The level of significance was set as p < 0.05. Statistical analysis was performed using
commercially available statistical software (IBM SPSS 22.0).
11
14. PATIENT DEMOGRAPHICS
45 patients [28 females, 17 males, mean age 54 ± 22.5 (range, 15–89) years
The reasons for requesting an EEG:
altered state of consciousness or behavioral abnormalities: 21 (48.9%) patients
prolonged impairment of consciousness after convulsive seizures: 14 (31.1%),
confusional states with minor motor manifestations in 10 (22.2%) patients.
14
15. ETIOLOGIES
An acute symptomatic etiology was present in 26 (57.8%) patients.
Cerebrovascular disease in 22 (48.9%) patients
Multiple etiologies in 15 (33.3%) patients.
Acute post-anoxic in 1 patient
Potentially fatal etiologies were determined in 17 (37.8%) patients.
15
16. ETIOLOGIES
Brain magnetic resonance imaging (MRI) was performed in 41 patients; the other four
patients had only brain computed tomography (CT).
Bilateral tonic-clonic seizures evolved into NCSE in 14 (31.1%) patients, preceded by
NCSE in six (13.3%) patients.
16
18. EEG FINDINGS
Fig. 1. An example of multiple status pattern. The patient was a 56-year-old female with a diagnosis of primary central nervous
system lymphoma. She presented with altered consciousness and minor motor movements in the left arm. The EEG shows
lateralized periodic discharges over the right temporal region with a frequency of 0.4–0.9 Hz, and rhythmic theta frequency
discharges over the left temporal region with fluctuation. The patient was treated with I.V. diazepam, phenytoin, levetiracetam, and
anesthetics, and died during her follow-up in the ICU unit
18
19. EEG FINDINGS
Fig. 2. a-b: An example of false-negative diagnosis according to the SCC for NCSE. The patient was a 70-year-old female who was
admitted with fluctuating consciousness and irritability. She was diagnosed as having meningioma in the left parietal region. The
EEG shows lateralized periodic discharges over the left parietal region with a frequency of 0.9–1.2 Hz; there was no fluctuation or
evolution and no significant change after I.V. diazepam administration. The patient regained consciousness after treatment with I.V.
phenytoin. The EEG six days later shows notable improvement with mild slowing on the left parietal region
19
20. EEG FINDINGS
Fig. 2. a-b: An example of false-negative diagnosis according to the SCC for NCSE. The patient was a 70-year-old female who was
admitted with fluctuating consciousness and irritability. She was diagnosed as having meningioma in the left parietal region. The
EEG shows lateralized periodic discharges over the left parietal region with a frequency of 0.9–1.2 Hz; there was no fluctuation or
evolution and no significant change after I.V. diazepam administration. The patient regained consciousness after treatment with I.V.
phenytoin. The EEG six days later shows notable improvement with mild slowing on the left parietal region
20
21. TREATMENT
NCSE was treated most frequently with I.V. diazepam and/or second-line AEDs including
phenytoin, valproic acid, and levetiracetam in 29 (64.4%) patients.
Twelve (26.7%) patients were treated with additional I.V. continuous anesthetics as third-
line treatment in the ICU.
One patient with a history of hepatic encephalopathy, who was not treated with AEDs,
was transferred to the ICU due to coma and died.
In one patient, treatment was unknown
21
22. OUTCOME
Fifteen (33.3%) patients died during hospital follow-up. The leading etiologies of SE
among the deceased patients were cerebrovascular disease (35.8%), tumors (28.6%),
and systemic infections (21.4%).
Only potentially fatal etiology, refractory SE, treatment with continuous I.V.
anesthetics, nonreactive EEGs, and multiple status patterns in the EEGs revealed
significant association with mortality.
Classification of status patterns according to the SCC as definite or possible NCSE had
no impact on outcome (p > 0.05)
The mean follow-up time of the patients who were discharged from hospital was 1.7 ±
1.7 (range, 0–5) years.
22
25. DISCUSSION
The overall prognosis of our patients was poor, with a 33.3% in-hospital mortality rate.
Presumed fatal etiology, refractory SE, use of continuous I.V. anesthetics, multiple status
patterns in the EEGs, and nonreactivity in EEGs were related to mortality.
NCSE is a heterogeneous group of disorders, provoked most commonly by acute
symptomatic etiologies (57.8%) and cerebrovascular disease (48.9%). In 33.3% of the
patients, the etiology was multifactorial, with metabolic or infectious abnormalities
triggering SE in an already injured brain.
Only one patient with a previous history of epilepsy died during follow-up, suggesting
that epileptic activity had little impact on mortality
The diagnosis of NCSE is challenging due to rhythmic and periodic patterns in EEG that
fall on the ictal-interictal continuum, rather than electrographic seizures, which results
in inter-rater discordance
25
26. DISCUSSION
The SCC had no impact on prognosis. The primary purpose of the SCC was not to
interpret outcomes.
Multiple status patterns in EEGs were independently associated with mortality, which
has not been reported before.
Previous studies showed that critically ill patients with LPDs in the EEGs had higher
mortality, whereas patients with lateralized rhythmic activity had superior functional
outcome
Limitation:
retrospective collection of clinical data
relatively small sample size
did not use continuous EEG
Classified by one neurophysiologist who was blinded to clinical and outcome data.
26
28. CONCLUSION
This study confirms the importance of etiology, the morphology of status patterns
and the reactivity in EEGs, and clinical factors for the prognosis of NCSE.
The SCC are highly concordant for NCSE diagnosis but have no impact on
prognosis.
EEG should be mandatory, especially for older patients with alterations of mental
status and acute symptomatic etiologies with comorbidities or after motor seizures
in the event of prolonged alterations of consciousness
28