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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 73-year-old patient with hyperglycemia and rheumatoid arthritis presented with attacks of involuntary lingual movements that were associated with pain at the base of the tongue, often followed by aversion of head and eyes to the left with clonic contractions of the left corner of the mouth. Seizures could be induced by a combination of specific movement and somesthetic stimuli. Ictal EEG recording revealed a focal epileptiform discharge in the right centrofrontal area, thus confirming that the patient had lingual seizures, an extremely unusual manifestation.
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PMID:Lingual seizures. 333 20

The s.c. administration of morphine (2.5-80 mg/kg) produced a dose-dependent hyperglycemia, whereas morphine (12.5-50 micrograms) given i.t. in the lumbar region caused a dose-dependent hypoglycemia in unanesthetized mice. Both effects on blood glucose were antagonized by s.c. naloxone, although inhibition of i.t. morphine required a higher naloxone dose. Naloxone pretreatment with 2 mg/kg, but not 1 mg/kg s.c., potentiated a hyperglycemic response to i.t. saline. High i.t. doses of morphine caused an early (within 2 min) scratching behavior that was not inhibited by naloxone or glucose loading and a later (greater than 20 min) tonic convulsive behavior (opisthotonus). Lethality was partially inhibited by glucose loading which delayed, but did not prevent, the hypoglycemic effect of i.t. morphine. The hypoglycemic effect of i.t. morphine was also delayed in streptozotocin-diabetic ICR mice and diabetic (db/db) C57BL/KsJ mice, but the latter were more sensitive to lethality, which occurred without hypoglycemia or seizures. All these effects of i.t. morphine were completely blocked by acute spinal transection of T10-T11, but the nociceptive, hypoglycemic and opisthotonic effects were not mimicked by i.c.v. morphine (6.25-50 micrograms) in ICR mice, which showed a bell-shaped hyperglycemic dose-response relationship and a brief explosive motor behavior at the higher doses (25-50 micrograms). It is concluded that the effects of morphine on blood glucose and on behavior are dependent upon the route of administration, and that the convulsive effect of i.t. morphine may be facilitated by the production of a profound hypoglycemia, which involves a spinal, rather than supraspinal or systemic, action of morphine.
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PMID:Differential effects of subcutaneous and intrathecal morphine administration on blood glucose in mice: comparison with intracerebroventricular administration. 336 41

To examine the hypothesis that hypoglycemia has an adverse effect on brain energy state during seizure, neonatal dogs were subjected to bicuculline-induced seizure while hyperglycemic, normoglycemic, or hypoglycemic. Cerebral blood flow increased and remained elevated in all animals subjected to seizure, regardless of blood or brain glucose concentration. In vivo 31P nuclear magnetic resonance spectroscopy disclosed a small (10-20%) decrease in adenosine triphosphate levels and a greater (20-40%) decline in phosphocreatine levels in animals experiencing seizure, irrespective of whether they were hyper-, normo-, or hypoglycemic. In vitro analysis of brain extracts with 1H nuclear magnetic resonance spectroscopy disclosed a significant elevation of lactate in all seizing animals. There were differences in brain alanine, glycine, and beta-hydroxybutyrate levels between the hyperglycemia-seizure and hypoglycemia-seizure groups. Alternate substrates such as lactate, fatty acids, or amino acids may be used when neonatal seizure is complicated by hypoglycemia, thereby preventing further deterioration of brain metabolic state.
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PMID:In vivo 31P and in vitro 1H nuclear magnetic resonance study of hypoglycemia during neonatal seizure. 342 68

A total of 46 patients with aplastic anemia (34 severe; 12 moderate) were treated with antihuman thymocyte globulin (ATG), high-dose methylprednisolone, and oxymetholone. Early symptoms of ATG toxicity included fever, rash, and bronchospasm. Signs of serum sickness also developed in 23 patients. Complications associated with high doses of steroids were hyperglycemia, hypertension, fluid retention, gastrointestinal hemorrhage, and aseptic necrosis of the hip. Other morbidity possible associated with steroid administration included seizures, arrhythmias, and headache with papilledema. Studies of elevated liver function necessitated discontinuation of androgen therapy in eight patients. A complete or partial hematological response was noted in 19 patients (41%). Of these, three have had recurrent cytopenias, of whom one has developed a myelodysplastic syndrome. There are currently 34 patients surviving, and 12 who have died. Actuarial survival at three years is 65%. These response and survival data are comparable to those of previous trials using ATG and androgens without high-dose steroids. A prospective, randomized trial is needed to determine whether the addition of high-dose corticosteroids to ATG does significantly increase the rate and frequency of response in order to justify the toxicity of this additional immunosuppressive therapy in the treatment of aplastic anemia.
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PMID:Treatment of aplastic anemia with antithymocyte globulin, high-dose corticosteroids, and androgens. 349 72

Previous investigations have shown that preischemic hyperglycemia worsens cerebral outcome. This study sought to delineate the temporal relations between postischemic brain edema and the development of spontaneous epileptic activity. Fasted rats were subjected to 10 minutes of forebrain ischemia. One-half of the animals were made hyperglycemic by glucose infusion prior to ischemia. At serial recirculation intervals regional specific gravity and cortical electrolytes were measured. Normoglycemic animals showed a biphasic increase in brain water content that was fully resolved by 96 hours and had no convulsive activities. Hyperglycemic brains, although displaying a slower resolution from an initial transient decrease in specific gravity, also developed an interval with normal water content that persisted at 18 hours postischemia. At 24 hours, an increase in water content recurred and was soon followed by the onset of seizure activity. Cortical electrolyte changes were unremarkable until seizures occurred. Significant increases in total Na+, Cl-, and Ca2+ and a decrease in K+ were then seen. We conclude that while the normoglycemic brain is capable of resolving postischemic edema in this model, the hyperglycemic brain develops a delayed secondary increase in water content followed by the onset of seizure activity accompanied by a deterioration of ionic homeostasis.
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PMID:Ischemia in normo- and hyperglycemic rats: effects on brain water and electrolytes. 356 5

The significance of megamitochondria in the alcoholic liver injury of humans was investigated as part of a large Veterans Administration cooperative study of the natural history of alcoholic hepatitis. Two hundred twenty patients were clinically stratified into the following three groups according to disease severity using serum bilirubin and prothrombin time as indicators: Group 1 (mild disease), serum bilirubin levels less than 5 mg/dl and prothrombin time prolonged for less than 4 s; group 2 (moderate disease), serum bilirubin levels greater than 5 mg/dl but prothrombin time prolonged for less than 4 s; and group 3 (severe disease), serum bilirubin levels greater than 5 mg/dl and prothrombin time prolonged for greater than 4 s. Megamitochondria were observed in 20% of the patients (45 of 220). Of these, 43 patients were in groups 1 and 2 of severity and only 1 patient belonged in group 3. The association of megamitochondria with cirrhosis was infrequent (33%, 15 of 45 patients). The differences in severity correlated with the differences in mortality: in patients with megamitochondria, only 1 had died at 6 mo compared with 40 deaths in patients without megamitochondria. By 12 mo, there were two deaths in patients with megamitochondria versus 51 deaths in those patients without. No complications were present in 72% of patients with megamitochondria versus 39% for those without. Infection, gastrointestinal bleeding, pancreatitis, hyperglycemia, azotemia, delirium tremens, seizures, and hepatic encephalopathy were all more common in patients without megamitochondria. The patients with megamitochondria appear to represent a subcategory of alcoholic hepatitis with a milder degree of clinical severity, lower incidence of cirrhosis, fewer complications, and good long-term survival.
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PMID:Significance of megamitochondria in alcoholic liver disease. 369 4

Systemic administration of kainic acid (KA), 11 mg/kg body weight, to hyperglycemic rats induced lethal seizures in all animals, while 40% of normoglycemic rats survived the KA treatment and all hypoglycemic rats survived. An inverse correlation (P less than 0.01) between the plasma glucose level and survival during KA-induced seizures was demonstrated (Chi-square-test). Histopathological observations on the surviving rats clearly divided them into a group with severe hippocampal CA-1 damage and a group with mild hippocampal CA-1 damage. Hippocampal pyramidal cells and CA-1 interneurons were counted 3 weeks after the insult. The pyramidal cell loss in the CA-1 region was significant within mildly, as well as severely, affected rats with normo- and with hypoglycemia. CA-1 interneurons and CA-4 interneurons were only lost in the severely affected group. Hypoglycemia seemed to protect those CA-1 interneurons situated close to the alveus and within the stratum radiatum in these animals. The increased mortality in the hyperglycemic rats could be due to increased brain lactate accumulation, but extra-cerebral damage of hyperglycemia in association with KA is also a possibility. The study indicated a correlation between loss of interneurons and pronounced CA-1 pyramidal cell death and furthermore that hypoglycemia possibly protected some interneurons against KA.
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PMID:Influence of the plasma glucose level on brain damage after systemic kainic acid injection in the rat. 377 74

The study describes a reproducible model of complete brain ischemia in rats. Rats with different plasma glucose concentrations were exposed to 10 min of complete cerebral ischemia achieved by compression of neck vessels by a pneumatic cuff. All 30 rats, except one, in which pre-ischemic plasma glucose level were lower than 22 mM (range 1.6-22) survived 10 min complete ischemia and made a similar recovery. Ten rats with pre-ischemic plasma glucose levels above 22 mM (range 22-47.2) died from seizures in the post-ischemic period. Post-ischemic treatment of seizures and hyperglycemia in the hyperglycemic rats significantly improved recovery. In conclusion, pre-ischemic hyperglycemia above 22 mM impairs recovery after complete ischemia by inducing seizures, post-ischemic hyperglycemia and lactic acidosis.
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PMID:The effect of glucose upon restitution after transient cerebral ischemia: a summary. 389 8

Sustained convulsive seizures were induced with bicuculline in newborn rabbits and marmoset monkeys. In both species, seizures were predominantly tonic, with generalized polyspikes on the EEG. Brain glucose concentration fell dramatically during seizures in both species, and in many normoglycemic animals reached levels usually associated with severe hypoglycemia, suggesting that glucose transport from blood to brain could not keep pace with glucose utilization. Glucose loads given to rabbits induced hyperglycemia and during seizures maintained brain glucose well above concentrations needed to saturate hexokinase so that glycolytic rates were probably never limited by substrate availability. Blood and brain lactate concentrations rose during seizures but never reached levels considered cytotoxic. These data suggest that epileptic seizures can deplete brain glucose in normoglycemic neonates of several species, including subhuman primates.
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PMID:Neonatal seizures in monkeys and rabbits: brain glucose depletion in the face of normoglycemia, prevention by glucose loads. 393 54

In many institutions it is the "standard of care" to obtain serum chemistries and anticonvulsant levels as part of the emergency department evaluation of seizure patients. To determine the efficacy of such a workup in the ED, 163 seizure patients presenting to an inner-city teaching hospital were studied in a standardized, prospective manner. After the clinical examination all patients had CBC, serum electrolyte, BUN, creatinine, glucose, calcium, magnesium, and if indicated, anticonvulsant drug level determinations performed. Any patient presenting with a first-time seizure (in patients greater than 6 years old), recent head trauma, focal neurologic deficit, or focal seizure activity had cranial computerized tomography (CCT). After obtaining historical and physical examination and before receiving laboratory results, as many as five likely etiologies were listed and assigned probability ratings. After review of the laboratory data (and CCT scan, if obtained), final etiologies again were listed and assigned percentages of likelihood. Significant abnormalities (ie, those that changed diagnosis, management, or disposition) were found in 104 patients; 96 had subtherapeutic anticonvulsant levels, five had abnormal CCT scans, two had hypoglycemia, and one had hyperglycemia as the cause of seizure. The clinical examination successfully predicted those abnormalities in all but two cases (one each of hyperglycemia and subdural hematoma). We contend tha routine serum chemistries in patients presenting to the ED are of extremely low yield, and that the clinical examination can predict accurately the need to obtain these studies. CCT scanning is useful in selected patients, and was found to be abnormal in five of 19 (25%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy of a "standard" seizure workup in the emergency department. 394 54


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