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

Myocarditis with complete atrioventricular block is a very unusual complication of the herpex simplex infection. We report a 10-year-old boy infected very likely by the herpes simplex virus and who presented with high fever, erythema multiforme, complete atrioventricular block, and Adams-Stokes seizures. Emergent temporary pacemaker was performed for bradycardia. A sixteen-fold rise in herpes simplex antibody titer by a complement fixation method occurred within two weeks. Normal cardiac rhythm recovered 11 days later with a sequela of complete right bundle branch block after 2 years follow-up.
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PMID:Myocarditis with complete atrioventricular block associated with herpes simplex virus infection: report of one case. 940 Nov 83

Trifascicular block, which consists of impaired conduction in the three main fascicles of the ventricular conduction system, may progress to high-grade or complete atrioventricular block. It rarely occurs in children with a structurally normal heart. We report a case of trifascicular block in a previously healthy 9-year-old girl. The patient presented with repetitive seizures. The electrocardiogram showed a complete right bundle branch block, left axis deviation, PR interval prolongation, and intermittent high-degree and complete atrioventricular block. She was successfully treated with a temporary pacemaker and her electrocardiogram returned to a normal sinus rhythm in 3 days. She has remained well over a 4-year follow-up. Although her cardiac enzyme levels were normal, the clinical course and electrocardiography findings suggested myocarditis. We emphasize the diagnosis of trifascicular block using electrocardiography; clinical outcome is good, if the patient is managed properly.
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PMID:Trifascicular block with intermittent complete atrioventricular block in a child. 940 28

Acute viral myocarditis is an uncommon but potentially fatal illness in children. Patients with myocarditis may present with nonspecific symptoms or atypical findings that make diagnosis in the emergency department difficult. We describe a previously healthy 14-month-old child with difficulty breathing and a tonic-clonic seizure who was subsequently found to have ECG changes and cardiac marker elevation consistent with acute myocardial infarction. The patient was immediately transferred from our community hospital ED to our tertiary care children's hospital. Shortly after admission, the patient developed intractable nonperfusing ventricular arrhythmias necessitating extracorporeal membrane oxygenation. Cardiac function did not recover, and the patient required heart transplantation before cessation of bypass. Serology and anatomic pathology confirmed coxsackievirus B myocarditis. This case illustrates (1) the nonspecific presentation of myocarditis as dyspnea and seizure, (2) the manner in which myocarditis can mimic myocardial infarction, and (3) the importance of early diagnosis in the ED and transfer to a tertiary care facility.
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PMID:Viral myocarditis presenting with seizure and electrocardiographic findings of acute myocardial infarction in a 14-month-old child. 1082 77

From 1983 to 1997, we have studied ten children with complete atrioventricular block likely due to myocarditis in order to assess its prognosis and to define a therapeutic strategy. Their age ranged from 6 days to 16 years (median: 4.1 years). All were admitted for sudden complete block, with symptoms in seven: syncope or fainting, seizures, collapse. Three had an asymptomatic bradycardia which was detected on routine auscultation in children with fever or already hospitalized; fever was present in 5. The disease was related to infection on biological data in 4 cases (1 listeriosis and 3 seroconversions for Epstein Barr or cytomegalic or Coxsackie B viruses), on a myocardial biposy in 1 case and on scintigraphic data in 1 case. In the remaining 4, indirect arguments were considered such as infectious context, normal recent ECG, favourable outcome. Five children were given intravenous isoprenalin with ventricular tachycardia in 3. Five were treated with steroids and 3 with specific antiviral agents. Seven patients were paced temporarily. One child died, 6 recovered totally and 3 have a permanent block with a definitive pacemaker implanted in 2. In conclusion, sudden acquired complete atrioventricular blocks are often ill-tolerated in children and have to be treated with transient pacing. Recovery occurs as a rule but some of these blocks may be definitive. Infective myocarditis is likely to be the cause of the disease even if the pathogen agent cannot always be identified.
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PMID:[Therapy and prognosis of infectious complete atrioventricular block in children]. 1085 52

The etiologies of complete heart block in thirty-one children (mean age 5.5 +/- 5.2 years, range 0-14 years) diagnosed at King Chulalongkorn Memorial Hospital between 1990-2001 were reviewed. Three main groups of patients were identified: 1) patients who presented in utero or in the newborn period (congenital heart block, n = 6), 2) patients who had complete heart block after cardiac surgery (postoperative heart block, n = 10), and 3) children outside the newborn period with a new diagnosis of complete heart block unrelated to cardiac surgery (unknown etiology, n = 15). Among 15 patients in the last group, 5 were asymptomatic (or minimally symptomatic) with complete heart block unexpectedly found. These patients probably had previously undetected congenital heart block. Two patients had complete heart block associated with mild viral illness, but no bradycardia-related symptom. The etiology for heart block in these 2 patients was unknown. Eight patients probably had recent onset heart block because of new bradycardia-related symptoms, or a previously documented normal heart rate. All patients in this group were female (mean age 4.3 +/- 4.3 years, median 3.5 years). All were diagnosed between August and January, and the majority (75%) had a history of non-specific viral illness in the preceding 2 weeks. Seven patients (87.5%) were acutely symptomatic. Syncope and/or seizure were the most common presenting symptoms. Left ventricular systolic dysfunction was found in only one patient. The etiology of complete heart block in these patients probably was an acute viral myocarditis that preferentially affected the conduction system. Two of these eight patients had complete recovery of the atrioventricular conduction. The rest had no improvement or had only partial recovery and subsequently underwent permanent cardiac pacemaker insertion.
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PMID:Complete heart block in children at King Chulalongkorn Memorial Hospital. 1152 22

Symptomatic second- or third-degree atrioventricular (AV) block at any anatomical level is a class I indication for permanent pacemaker implantation. We describe a 44-year-old male with acute viral myocarditis who suffered from syncope followed by a seizure attack associated with AV conduction disturbance. His initial electrocardiogram in our emergency room revealed sinus tachycardia with 2:1 AV conduction and a right bundle branch block QRS morphology with a ventricular rate of 60 beats/min. Because of episodic slowing of the heart rate below 40 beats/min, he received 1 mg atropine intravenously which increased the atrial rate but further worsened the AV conduction, resulting in ventricular asystole for more than 30 seconds associated with loss of consciousness and seizure-like activity. He was immediately paced transcutaneously and transferred to the catheterization laboratory to receive temporary transvenous cardiac pacing. The cardiac catheterization study showed a normal coronary angiogram and very mild diffuse hypokinesis. Electrophysiological studies revealed advanced infra-Hisian AV block. The infra-Hisian AV block, however, resolved rapidly in 2 days. The patient did not receive a permanent pacemaker and remained asymptomatic with normal electrocardiogram over 1 year of follow-up. We suggest that symptomatic infra-Hisian AV block due to viral myocarditis can be reversible, and implantation of a permanent pacemaker may not be necessary.
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PMID:Reversible infra-Hisian atrioventricular block in acute myocarditis. 1177 Nov 89

Enteroviruses are common causes of viral encephalitis in childhood and the most common cause of myocarditis. The prognosis is good with exception of the immunocompromised children who are at higher risk with increased mortality. A case of a 7-year-old boy with acute lymphoblastic leukemia and coxsackievirus B5-associated encephalitis and myocarditis is described. The boy was in complete remission and coxsackievirus B5 infection occurred 22 months after the beginning of chemotherapy. The clinical manifestations were fever, seizures, and altered consciousness. He underwent only supportive treatment. He had an excellent outcome; 2 years later he is still in complete remission with normal electroencephalogram and normal cardiac function.
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PMID:Encephalitis and myocarditis in a child with acute lymphoblastic leukemia: role of coxsackievirus B5? 1193 34

Complete atrioventricular block (CAVB) can be either congenital or acquired in children. Acquired CAVB is occasionally seen in myocarditis patients. To determine the etiology, natural history, and outcome of children with acquired nonsurgical CAVB, we retrospectively reviewed nine children who had suffered CAVB caused by suspected infectious myocarditis. All of them had CAVB with a wide QRS escape ventricular rhythm on admission. Three of them had ventricular tachycardia in addition to CAVB. Seven of them had a preceding upper respiratory tract infection. All of them had congestive heart failure. Five of them had Stokes-Adams seizures. Three etiologies were identified in four of the children. All patients received inotropic agents and emergency temporary pacing. In all except one case, the cardiac rhythm returned to sinus rhythm within 10 days. During a follow-up period of 9 to 96 months, all were asymptomatic and drug-free. Electrocardiograms showed that four patients were completely normal, there was complete RBBB in four and left anterior fascicular block in one patient. We conclude that although CAVB associated with myocarditis can be life-threatening, the long-term prognosis is good if patients are diagnosed early and proper management is employed.
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PMID:Complete atrioventricular block following myocarditis in children. 1218 8

Clozapine was one of the major advances in the treatment of schizophrenia since the introduction of the classic antipsychotic agent chlorpromazine in the 1950s. Over the past 10 years, clozapine has become the reference compound for the development of new antipsychotics, and new drugs have been developed which have also claimed atypical status. The indications of clozapine were recently extended to Psychosis in Parkinson's disease and harmonized in the European Union. This provides the opportunity to update the data on clozapine in the treatment of schizophrenia. In this article we review current clinical evidence in schizophrenia to address the following issues: 1) Efficacy in refractory/positive symptoms: a systematic and critical analysis of 14 double-blind clinical trials in comparison with both standard and novel antipsychotics show consistent findings in favour of clozapine, with all but three of the reports demonstrating superiority. The review of studies allow us to say little about the predictors of treatment response, time to clozapine response and about the impact of clozapine on the quality of patients'life and longer-term outcome. Treatment options for clozapine non-responders are reviewed. 2) Risk of EPS: clozapine is considered to have a minimal risk of EPS and in all studies where a valid methodology was used, a clear superiority over the other neuroleptics is demonstrated. It is pointed out that, if the prevalence and incidence of EPS with clozapine is low, it is not zero. All the studies assessing clozapine treatment for TD have major methodological limitations, so no final conclusion can be drawn. 3) Efficacy for primary and secondary negative symptoms and neurocognitive effects: the data of clinical studies where negative symptoms scales were used favour clozapine in terms of improvement. However most of the studies were carried out in populations with predominantly positive symptoms. With regard to the need to distinguish primary and secondary symptoms, data are conflicting regarding the benefit of clozapine. Due to the lack of studies with a valid methodology, no definitive conclusion can be drawn about the efficacy on clozapine on the deficit syndrome and on neurocognitive disorders. 4) Impact on suicide risk: 4 out of 6 retrospective studies provide evidence for the ability of clozapine therapy to reduce suicidal behaviour. The results of a recent randomized, parallel-group study designed to compare clozapine versus olanzapine in preventing suicide attempts seems to confirm this hypothesis. We also address the tolerability and safety data, especially haematologic, comitial, cardiovascular and metabolic side-effects. The effectiveness of blood monitoring for the management of neutropenia and agranulocytosis demands that the recommendations are strictly followed. The use of clozapine at doses higher than 600 mg daily should follow published recommendations, in order to minimize the risk of seizures; these include anticonvulsant regimens based on blood levels. With regard to the cardiovascular mortality, if clozapine therapy has negligible effects on QT interval, its association with potential fatal myocarditis cannot be excluded in young patients who should be investigated if they develop cardiac symptoms in the first weeks of treatment. Available data support the notion that the frequency of bodyweight gain is high with several new antipsychotics, including clozapine. Potential long term effects of bodyweight gain on mortality and morbidity have to be taken into consideration. The pharmacological mechanisms underlying the "unique clozapine profile" is discussed. Clozapine remains the only antipsychotic with efficacy at relatively low D2 receptor occupancy. The pharmacogenetic and pharmacokinetic aspects are also reviewed. Finally, the place of clozapine in the current treatment of schizophrenia is highlighted to inform the development of guidelines for clinical management.
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PMID:[Leponex, 10 years after -- a clinical review]. 1562 52

Clozapine is a distinctive antipsychotic agent, having a unique clinical profile and an idiosyncratic safety profile. More so than with other agents, the weighting of its adverse event profile is critical, in order to counterbalance its clear clinical advantages. The safety issues with clozapine are in a number of areas, some of which are considered medical emergencies and potentially life-threatening. These include haematological (neutropenia and agranulocytosis), CNS (seizures), cardiovascular (myocarditis and cardiomyopathy), metabolic (diabetes), gastrointestinal and neuromuscular. Understanding the safety profile of clozapine allows an informed use of the agent that can maximise its clear clinical benefit and minimise the known risks.
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PMID:A review of clozapine safety. 1601 51


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