Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Status epilepticus is a condition in which multiple epileptic seizures occur without complete recovery from the physiological effects of one seizure before another seizure occurs. There are as many types of SE as there are kinds of epileptic seizures. Generalized convulsive status epilepticus initially presents with repeated generalized convulsions without full recovery of consciousness between seizures. If untreated or undertreated, the convulsive activity becomes progressively subtle and is accompanied by a predictable series of progressive EEG changes. Non-convulsive SE refers to complex partial SE or absence SE, both of which exhibit an epileptic twilight state of altered contact with the environment. In simple partial SE there is no impairment of consciousness, and the behavioural changes reflect focal ictal discharges confined to one area of the cortex. There are between 65,000 and 150,000 cases of the SE in the US each year. Both acute and remote cerebral insults can cause SE, as can severe systemic disease that causes SE secondary to a toxic-metabolic encephalopathy. Mortality is high, but is largely a reflection of underlying aetiology when SE is treated appropriately and aggressively. Treatment is focused on terminating ongoing seizure activity as quickly as possible, both because the longer SE persists the more likely permanent neuronal damage will ensure and also because of strong evidence that the longer SE persists the more refractory to treatment it will be. Currently the most commonly accepted treatment protocol involves rapid initiation of therapy with intravenous lorazepam (0.1 mg/kg), followed, if necessary, by 20 mg/kg of phenytoin, followed, if necessary, by 20 mg/kg of phenobarbital. However, some neurologists still use intravenous diazepam (because of its more rapid antistatus effect) followed by phenytoin. New experimental data in the rat suggest that phenytoin followed by diazepam may be more effective, but this order of administration still has to tested in properly designed clinical trials.
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PMID:Status epilepticus. 906 83

Between 1984 and 1993, monoclonal antibodies (MAbs) radiolabelled with (131)I were administered into the CSF of 52 patients with neoplastic meningitis (meningosis) with progressive disease despite active conventional therapy. Selection of MAbs was based on immunoreactivity with patients' tumour and lack of binding to normal central nervous system (CNS) tissue. Following full clinical assessment and neuro-imaging which included isotope flow study of CSF pathways, (131)I-MAb was administered via a ventricular access device, lumbar catheter or both. Radioisotope activity varied from 25 mCi to 160 mCi in adults. Dose escalation was carried out and some patients received multiple doses. Distribution of (131)I-MAb and clearance kinetics were derived from serial scintigraphy and CSF/blood sampling. Evidence of localisation to tumour was frequently observed. Toxicity was minimal and easily treated, although one death occurred, possibly due to a seizure. The best results were obtained in primitive neuroectodermal tumour (n=22), where 53% of evaluable cases had responses and 11% had stable disease, adults responding better than children. Three exceptional survivals have been recorded; one patient leads a normal life at 10 years 11 months, one case is alive and normal at 3 years, 2 months. A third case survived in good condition for 8 years. The mean survival of responders was 39 months and non-responders 4 months. In the total series, 50% of patients survived for at least one year with 2 long term survivors. CSF therapy with (131)I-MAb appears to be valuable as a single agent or when used in combination with other modalities. Results of treating leukaemia and carcinoma cases suggest that re-seeding into the CSF compartment from active systemic disease may account for early relapse in the CNS. One carcinoma case with no apparent systemic disease made a remarkable response and survival for 4 years following a single treatment. Neoplastic meningitis generally carries a dismal prognosis. The results obtained in this initial trial are sufficiently encouraging to stimulate further attempts at CSF therapy with (131)I-MAbs.
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PMID:Treatment of neoplastic meningitis by targeted radiation using (131)I-radiolabelled monoclonal antibodies. Results of responses and long term follow-up in 40 patients. 969 76

Burkitt's lymphoma, the most common childhood non-Hodgkin's lymphoma, usually presents with abdominal tumors. Central nervous system (CNS) involvement in Burkitt's lymphoma is mostly secondary to advanced systemic disease, rarely with brain parenchymal lesions, and was previously recalcitrant to treatment. We report an unusual case of CNS Burkitt's lymphoma with minimal extraneural disease. This 10-year-old immunocompetent boy presented with increased intracranial pressure and seizures and was found to have multifocal intracerebral lesions on brain imaging studies. Cerebrospinal fluid studies confirmed the presence of Burkitt's lymphoma cells. Abdominal computed tomography showed bilateral nephromegaly with left intrarenal lesions that disappeared after three doses of intravenous dexamethasone. The patient was treated for 6.5 months according to the LMB 89 group C protocol of the French Pediatric Oncology Society. The response was brisk and complete. The patient has been disease free for more than 4 years, and is believed to be cured.
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PMID:Successfully treated central nervous system Burkitt's lymphoma with minimal extraneural disease in a child. 1006 77

A 5-year-old boy with generalized absence seizures was treated with valproate (VPA), 30 mg/kg/day. One month after VPA introduction, routine examination showed moderate reduction in fibrinogen and prolonged partial thromboplastin time (PTT). The search for lupus anticoagulant (LAC) was negative. After 10 months of VPA treatment, seizures persisted, and lamotrigine (LTG), 2 mg/kg/day, was progressively given with VPA. Seizures disappeared, but PTT was more prolonged than before LTG introduction. The search for LAC was positive, and enzyme-linked immunosorbent assays (ELISAs) for immunoglobulin G (IgG) anticardiolipid antibodies were positive. Serum autoantibody screen and rheumatoid factor were negative; serum complement was normal. LAC eventually disappeared with VPA discontinuation. We believe that LTG may have exacerbated an initially mild immune response induced by VPA without clinical evidence of systemic disease. We therefore suggest that careful surveillance for LAC and systemic disease should be instituted when VPA is used with LTG.
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PMID:Lupus anticoagulant induced by the combination of valproate and lamotrigine. 1056 97

Seizures are extremely common in the elderly, with an annual incidence reaching 100 per 100000 people aged over 60 years. Most are precipitated by acute symptomatic illnesses such as stroke or systemic disease. Chronic neurological diseases such as Alzheimer's disease may also cause seizures. The aetiology of seizures in many patients is unknown. Seizures may be situational and subside quickly, but the prevalence of chronic seizures--epilepsy--is as high as 1% in the elderly. The majority of seizures are of partial onset, especially complex partial. Complex partial seizures at this age may be very subtle and hard to diagnose. Generalised-onset seizures also occur, perhaps as a result of diffuse changes with aging or degenerative disease or to a combination of genetic and environmental factors. The prognosis for complete seizure control in this population is relatively favourable. Physiological and disease-related changes with aging result in complex pharmacokinetics. Most changes lead to a need for gentler drug treatment with cautious initiation of drugs at lower dosages. Consideration must be given to renal and hepatic function, protein binding and drug interactions. Determinations of free (unbound) drug concentrations are helpful for highly protein bound drugs. The dosages of newer drugs excreted renally must be adjusted based on creatinine clearance. The dosage of most drugs is determined empirically by careful observation of seizure control and adverse effects. Carbamazepine, valproic acid (sodium valproate), gabapentin and lamotrigine have certain theoretical advantages, but comparative trials of anticonvulsants in the elderly are needed. The ideal drug for older patients would be effective, without neurological toxicity, with low protein binding, a nonparticipant in drug interactions and amenable to once daily administration.
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PMID:Epidemiology and drug treatment of epilepsy in elderly people. 1058 73

objective To identify the frequency of single small enhancing CT lesion cases (SSECTL) in a provincial hospital in Thailand and verify a set of clinico-radiological criteria for the diagnosis of benign SSECTL. methods All patients who fulfilled the following criteria were recruited: acute symptomatic focal seizures with or without secondary generalization; minimal or no neurological deficit; no evidence of raised intracranial pressure; no evidence of systemic disease; CT scan showing SSECTL of < 20 mm diameter. After recruitment, patients received antiepileptic drugs and other symptomatic treatment. A CT scan of the brain was repeated every 2 weeks until the lesion had significantly resolved, which was defined as a 50% decrease in size. A CT scan was then taken every 4 weeks until the lesion had completely disappeared or turned into a calcified spot. The data from all other patients presenting with seizures and solitary enhancing lesion on the CT scan who did not fulfil the inclusion criteria were also reviewed. results 972 patients with seizure disorder were recruited. 110 patients (11.3%) presented with seizure and solitary enhancing lesion on the CT scan, 22 of whom (20%) fulfilled the inclusion criteria. 20 of the 22 patients had SSECTL with a spontaneous resolution: 14 (70%) within 4 weeks and 18 (90%) within 8 weeks. Two patients had a progressive course. One patient with a solitary enhancing CT lesion > 20 mm had spontaneous resolution. 87 patients had another diagnoses. The diagnostic criteria for benign SSECTL were 95.23% sensitive, 97.75% specific, had a positive predictive value of 90.91% and a negative predictive value of 98.86%. conclusion SSECTL is not uncommon in our provincial hospital. The clinico-radiological criteria proposed by Rajshekhar (1991) are valid and reliable in predicting a benign outcome. CT follow-up within the first 4 weeks is critical.
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PMID:Single small enhancing CT lesion in thai patients with acute symptomatic seizures: a clinico-radiological study 1081 18

Refractory epileptic state (RES) is defined by severe seizures that are resistant to antiepileptic drug treatment. Diagnostic errors such as pseudo-seizures and encephalopathies with triphasic waves must be distinguished at an early stage from cases of RES. The latter are symptomatic of a focal brain lesion or severe systemic disease, most frequently metabolic in origin. The treatment of such conditions is aimed at correction of the underlying cause. A nosographic issue that is still a subject of discussion and which requires further study, i.e., PLEDS, will also be discussed in this article.
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PMID:[Drug resistant status epilepticus]. 1091 20

Among three recognised clinical phenotypes, type 3a Gaucher's disease is characterised by mild to severe systemic disease, neurological manifestations and myoclonic seizures. We report the long term clinical and electrophysiological follow-up of a 27-year old man with a diagnosis of type 3a Gaucher's disease, which was confirmed by bone marrow biopsy examination and leukocyte glucocerebrosidase level measurement. His neurological examination was normal throughout the follow-up period. EEG examination, recorded five days after the first seizure, revealed generalised nonrhythmic paroxysmal rapid spikes with occipital predominance increased by photic stimulation and normal background activity. The frequency of seizures increased from 3-4/year to 1-2/month within a follow-up period of 12 years and a repeat EEG examination on the eight year of diagnosis revealed additional background slowing. A giant potential was obtained in somatosensory evoked potential (SEP) examination. EEG findings of this case demonstrate a specific pattern with rapid spike activity, photosensitivity, eye closure sensitivity and gradual background slowing.
Seizure 2000 Oct
PMID:Longterm follow-up of electroencephalographic and clinical findings of a case with Gaucher's disease type 3a. 1103 70

The treatment of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) can be difficult and complex owing to the variety of nervous system manifestations that can occur, which include peripheral nerve disease, headaches, seizures, cerebrovascular disease, chorea, transverse myelitis, and psychiatric and cognitive disorders. Many of these manifestations can result from metabolic abnormalities or infection or as side effects of medications. Thus, in any patient with suspected NPSLE, it is crucial to exclude secondary causes of the presenting symptoms before assuming that they are due to NPSLE. It is especially important to exclude infection because this is a common cause of both morbidity and mortality in patients with systemic lupus erythematosus (SLE). Symptoms such as anxiety and depression may or may not be related to disease activity. Treatment decisions are based on accurate diagnosis of the specific NPSLE manifestation, which is usually made using tools such as brain imaging, electroencephalography, cerebrospinal fluid analysis, nerve conduction studies, or special serologic tests (eg, determination of antiphospholipid or antiribosomal P antibody levels). It is also important to assess the degree of other SLE- mediated systemic disease activity in a patient with neurologic manifestations to determine if activation of systemic disease activity is also occurring. This is done by measuring complement levels, anti-double-stranded DNA levels, complete blood count, and urinalysis. For some NPSLE manifestations (eg, infrequent seizures, headaches, depression, anxiety, or peripheral neuropathy) that appear without activation of systemic disease, symptomatic treatment is appropriate. For others (eg, psychosis, delirium, or transverse myelopathy without other obvious cause), treatment with high-dose glucocorticoids with or without cyclophosphamide is appropriate whether there is evidence of other systemic disease activity or not. In general, the activity and severity of the leading organ manifestations dictate pharmacologic treatment.
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PMID:Neuropsychiatric Systemic Lupus Erythematosus. 1109 72

A 12 year old male had a secondarily generalized epileptic seizure and a subsequent right hemiparesis with fasciobrachial predominance after a closed head injury. His seizures responded to antiepileptic drug therapy immediately. Computerized tomographic scanning and magnetic resonance imaging showed an acute infarct of the head of the left caudate nucleus, indicating the isolated occlusion of the left recurrent artery of Heubner and lateral lenticulostriate arteries. Pathologies leading to vasculitis and embolism were also looked for, but no finding of associated systemic disease could be disclosed. We present this case since posttraumatic infarction in the territory of the deep perforators such as recurrent artery of Heubner and lateral lenticulostriate arteries are exceptionally rare conditions especially in this age group.
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PMID:Posttraumatic isolated infarction in the territory of Heubner's and lenticulostriate arteries: case report. 1172 72


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