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

We reviewed the videotapes of 49 consecutive patients with a history of medically refractory temporal lobe epilepsy for the presence and laterality of unilateral hand posturing (UHP), unilateral hand automatism (UHA), non-forced head turning (HT), and post-ictal dysphasia (PID). All of these patients underwent temporal resections with follow-up for more than 2 years after the surgery. We examined the correlation of consistency, frequency, and laterality of each of these signs on the postsurgical outcomes. The distribution of these signs was not significantly different between patients with Engel class 1 versus Engel class 2-4. The consistency and laterality of these signs do not correlate with postsurgical outcomes.
Seizure 2003 Jul
PMID:Lateralising value of ictal features in partial seizures: effect on postsurgical outcome. 1281 Mar 37

For the treatment of patients with chronic refractory epilepsies, information about the long-term efficacy and safety profile of any new antiepileptic drug is crucial. Topiramate has been proven to be effective in patients with refractory chronic partial epilepsies in short-term controlled clinical trials, but the long-term retention, long-term efficacy, and long-term side-effect profile have not been sufficiently investigated. We analyzed all patients who had been treated with topiramate in the Epilepsy Centre Kempenhaeghe from the introduction of the drug in the spring of 1993 up to a final assessment point in mid-2002. In total, 470 patients were identified. The data show that the clinical dose achieved was about 200mg/day, reached after approximately 6 months of treatment. Further dose escalation in the survivors was slow, with a mean dose of about 300 mg/day after 24 months of treatment. Mean titration dose is 25mg/week, but titration strategy is mostly individual and responds to patient complaints. With respect to seizure frequency, 10-15% of the patients were seizure-free at the 6-month evaluation; 4 patients achieved a 2-year remission. Retention rate was 53% after 1 year, 45% after 2 years, 38% after 3 years, and 30% after 4 years. At 4 years, almost 70% of the patients had discontinued topiramate. The main reason was adverse events, which accounted for about 65% of the discontinuations. Behavioral side effects were dominant, with mental slowing (27.6%), dysphasia (16.0%), and mood problems (agitation: 11.9%) being the most frequently reported side effects. In about 10% of the patients side effects led to discontinuation despite the obvious favorable effects on seizure frequency. Comparisons between the patients who discontinued topiramate treatment and those who continued topiramate showed that discontinuation was associated with comedication (vigabatrin and lamotrigine). Our conclusion is that TPM is associated with a high incidence of side effects in clinical practice, affecting long-term retention. Meaningful prognostic factors that may help us in clinical decision making, i.e., to prevent the side effects or to help us identify those at risk, have not been found.
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PMID:Topiramate in clinical practice: long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center. 1514 8

Cerebral venous and sinus thrombosis is an infrequent condition which presents with a wide spectrum of signs and a variable mode of onset. Sinus thrombosis may cause isolated intracranial hypertension but also may cause cerebral venous infarcts, which are frequently hemorrhagic. Treatment with antithrombotic agents is controversial because there is only one randomised controlled trial with unfractionated heparin. We report a 46- years-old man complaining of progressive headache, paraparesis and dysphasia. After admission, his neurological status worsened and he developed tetraparesis, depressed level of consciousness and seizures. A cranial computarized tomography (CT) scan showed multiple hyperdensities suggestive of hemorrhagic infarcts. Magnetic resonance imaging (MRI) study confirmed extensive cerebral venous thrombosis. Unfractionated heparin was administered for two weeks followed by acenocumarol. Within a few days his neurological status improved, and five weeks after admission the patient only hadd slight neurological deficit. After 11 years of follow-up, he has had a complete recovery. The G20210A mutation in the prothrombin gene was detected as a likely risk factor for venous thrombosis. Therapeutical and diagnosis aspects are discussed. We review the previous literature on the topic.
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PMID:[Anticoagulant treatment in hemorrhagic brains infarts due to large sinus venous thrombosis]. 1556 76

A 62-year-old woman developed dysphasia, signs of intracranial hypertension and seizures. An MRI scan evidenced extra-axial contrast enhancement in the absence of mass lesions. CSF analysis was negative for malignant cytology and viral or bacterial microbiology. In the absence of other evidence, considering the acute clinical onset and MRI picture, a viral encephalitis was suspected and antiviral therapy was started, however, with no effect. Death occurred three weeks after presentation because of acute brain swelling. Autopsy revealed leptomeningeal gliomatosis and diffuse parenchymal infiltration at the cerebellar and left temporal lobe. Primary leptomeningeal gliomatosis (PLMG) is a rare event. The reported case and the reviewed literature evidence that clinical signs at presentation are non-specific, CSF negative findings are common, the diagnosis is always delayed and the prognosis dismal.
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PMID:Primary leptomeningeal gliomatosis: case report and review of the literature. 1599 30

We report the long-term follow-up of an elderly patient who developed a permanent sensorimotor dysphasia after status epilepticus. Magnetic resonance imaging of the brain and magnetic resonance angiography failed to demonstrate structural cerebral damage; however, a fluorodeoxyglucose positron emission tomography scan revealed marked hypometabolism involving a large area in the left hemisphere and contralateral cerebellar cortex. Our case illustrates that permanent language dysfunction may occur after recurrent complex partial and secondarily generalized seizures.
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PMID:Permanent dysphasia after status epilepticus: long-term follow-up in an elderly patient. 1649 57

Two adult patients with a background history of astrocytomas treated with resection and cranial irradiation, 18 and 16 years previously, presented with acute onset of headache associated with prolonged neurological deficits, including dysphasia and right hemiparesis. The first patient also developed seizures while in hospital. In both patients, magnetic resonance imaging brain scans failed to show evidence of acute ischaemia or tumour recurrence and symptoms reversed completely after 1 month and 7 days, respectively. A single photon emission computed tomography scan, performed on the first patient at day 8 post-admission, showed hyperperfusion in the left parieto-occipital region (in the same region as his previous tumour). The clinical histories and outcomes are consistent with the diagnosis of post-cranial irradiation syndrome with migraine-like headaches and prolonged and reversible neurological deficits. Recognition of this disorder is useful in providing reassurance of a favourable prognosis and may also help avoid invasive investigations.
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PMID:Post-cranial irradiation syndrome with migraine-like headaches, prolonged and reversible neurological deficits and seizures. 1654 41

In this retrospective study, the authors evaluated confounding risk factors, which are allegedly influential in causing unprovoked posttraumatic epilepsy, in 489 patients from the frontlines of the Iran-Iraq War. Four hundred eighty-nine patients were followed for 6 to154 months (mean 39.4 months, median 23 months), and important factors precipitating posttraumatic epilepsy were evaluated using uni- and multivariate regression analysis. One hundred fifty-seven (32%) of 489 patients became epileptic during the study period. The results of univariate analysis indicated a significant relationship between epilepsy and Glasgow Outcome Scale (GOS) score (X2 = 76.49, p < 0.0001, df = 2), Glasgow Coma Scale score at admission (X2 = 19.48, p < 0.0001, df = 3), motor deficit (X2 = 11.79, p < 0.001, df = 1), mode of injury (X2 = 10.731, p < 0.05), transventricular injury (X2 = 6.9, p < 0.008, df = 1), dysphasia (X2 = 5.3, p < 0.02), central nervous system infections (X2 = 5.3, p < 0.02), and early-onset seizures (X2 = 4.1, p < 0.04, df = 1). The results of multivariate analysis, on the other hand, indicated that the GOS score and motor deficit were of greater statistical importance (X2 = 35.24, p < 0.0001; and X2 = 7.1, p < 0.07, respectively). Factors that did have much statistically significant bearing on posttraumatic epilepsy were the projectile type, site of injury on the skull, patient age, number of affected lobes, related hemorrhagic complications, and retained metallic or bone fragments. Glasgow Outcome Scale score and focal motor neurological deficit are of particular importance in predicting posttraumatic epilepsy after missile head injury.
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PMID:Prognostic factors in the occurrence of posttraumatic epilepsy after penetrating head injury suffered during military service. 1690 97

Seizures and focal neurologic deficits may be the complications of neurosyphilis, but status epilepticus as a presenting picture of neurosyphilis is rare. We describe a 41-year-old man with an acute onset of expressive dysphasia, followed by persistent seizure state and severe complications of systemic medical problems. An extensive laboratory evaluation confirmed the diagnosis of neurosyphilis and diabetes mellitus. Brain magnetic resonance imaging showed edematous change in the left cingulate gyrus, left temporal lobe, and peri-Rolandic area, which suggested an inflammatory process. Due to varied clinical manifestations of neurosyphilis, we underscore the importance of considering neurosyphilis among the possible causes of status epilepticus and any central nervous system diseases.
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PMID:Status epilepticus as an initial manifestation of neurosyphilis: a case report. 1691 23

Schistosomiasis is a parasitic disease caused by blood flukes of the genus Schistosoma. Currently more than 200 million people worldwide are affected. Neuroschistosomiasis constitutes a severe presentation of the disease. Neurological symptoms result from the inflammatory response of the host to egg deposition in the brain and spinal cord. Neurological complications of cerebral schistosomiasis include delirium, loss of consciousness, seizures, dysphasia, visual field impairment, focal motor deficits and ataxia. Cerebral and cerebellar tumour-like neuroschistosomiasis can present with increased intracranial pressure, headache, nausea and vomiting, and seizures. Myelopathy (acute transverse myelitis and subacute myeloradiculopathy) is the most common neurological complication of Schistosoma mansoni infection. Schistosomal myelopathy tends to occur early after infection and is more likely to be symptomatic than cerebral schistosomiasis. The conus medullaris and cauda equina are the most common sites of involvement. Severe schistosomal myelopathy can provoke a complete flaccid paraplegia with areflexia, sphincter dysfunction and sensory disturbances. Schistosomicidal drugs, steroids and surgery are the currently available treatments for neuroschistosomiasis. Rehabilitation and multidisciplinary team care are needed in severely disabled patients.
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PMID:Neurological complications of Schistosoma infection. 1790 71

Cerebrovascular Moyamoya disease (MMD) is a clinical entity characterized by stenotic or occlusive lesions around the terminal portions of the internal carotid arteries (ICA) and the formation of abnormal vascular networks at the base or convexity. This condition is sporadic, and there are no pathological explanations for this cause. A case with unilateral juvenile MMD is reported. A 13-year-old girl with sudden episode of left limbs weakness, accompanied by transient dysphasia and seizures attack, was admitted to our hospital for further investigation. Computed tomography scanning showed an area of localized brain swelling in the right capsular-thalamic region. Angiographic findings demonstra-ted unilateral involvement. Cerebral panangiography reve-aled a high grade stenosis of the right supraclinoid ICA and a peculiar network (moyamoya phenomenon) formed by dilated basal collateral perforating arteries and produced a cloudy image resembling "a puff of smoke". Left carotid angiogram showed a collateral circulation through the anterior communicant artery and apportioned to the right cerebral hemisphere. The vertebrobasilar system was normal. An ultrasoud Doppler study demonstrated a severely decreased blood flow gradient (0.1 l/min) through the right hypoplastic ICA, while the left common and the left ICA showed remarkable increased blood flow, partly due to abondant collateral vessels. Acquired, non-progressive vitiligo with areas of complete pigment loss appeared on flexor wrists, extensor distal extremities, superior eyelids and especially on joints regions (elbow, knee and small joints of the hands and fret). This association has not been reported previosly.
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PMID:[Unilateral moyamoya disease associated with acrofacial vitiligo in a 13-year-old patient--case report]. 1797 97


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