Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

About 30 years ago, an autoimmune reaction was hypothesised in animal models of epilepsy and for the genesis of the 'mirror focus' in some patients with refractory epilepsy. However, this hypothesis did not attract attention among clinicians. During the 1950s, cortisone and corticotropin appeared to be efficacious in some epileptic syndromes, but the link with the immune system was not made. Furthermore, controlled studies were not rigorously planned and the best dosage and schedule still remain unknown. Later, immune deficits were described in patients with epilepsy, but the origin (disease-related or treatment-related) of these deficits is still open. An immunogenetic predisposition was also described in these patients, but results were often contradictory. During the 1980s, the successful use of intravenous immunoglobulin (IVIg) in childhood epilepsies again suggested a possible autoimmune process in some patients. During the last few years, specific autoantibodies have been found in Rasmussen disease and other epileptic syndromes. Immunomodulatory treatments (IVIg, plasmapheresis) have been used with significant success in refractory epilepsies, and IVIg is considered by most epileptologists as the first-choice treatment in Rasmussen syndrome. Recent work has shown that autoantibodies directed against some brain components might interact with ion-gated channels or neurotransmitters and therefore affect the stability of neuronal membranes. Autoimmune mechanisms are considered possible in the process of epileptogenesis. Taking this hypothesis further, immunomodulatory treatment at the time of brain injury (such as by trauma, prolonged seizures or stroke) could offer a preventive approach against epileptogenesis and therefore prevent recurrent seizures.
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PMID:Immunological mechanisms in the aetiology of epilepsy: implications for treatment. 1803 Nov 69

Peri-insular hemispherotomy is a disconnective procedure that enables functional isolation of single or multiple epileptogenic regions largely involving one hemisphere. This report is based on a consecutive series of 13 pediatric patients affected by refractory hemispheric epilepsy studied and operated on at the Neurological Institute "C. Besta" of Milan. In all patients seizures were focal with polymorphic features and daily frequency. Preoperative electro-clinical and MRI data were suggestive of Rasmussen's encephalitis in 6 cases, hemimegalencephaly in 2, hemispheric cortical malformation in 3, perinatal stroke in 2 cases. Mean age at surgery was 7.3 years. The postoperative course was good for all patients. Mean follow-up period was 4.5 years (range 2-7 years). After hemispherotomy, 8 patients were Engel Class I and five continued to have seizures and were classified as Engel Class II (1 case) III (3 cases) or IV (1 case). The outcome results varied according to the etiology; the best results were achieved in patients with Rasmussen encephalitis and perinatal vascular strokes with 75% classified in Engel Class I. Three patients underwent a second surgery because of persistent seizures and evidence of incomplete disconnection; two out of three patients had hemimegalencephaly, and did not improve; the third patient with perinatal stroke resulted seizure free. We conclude that hemispherotomy can be performed successfully to treat medically intractable hemispheric epilepsy, providing remarkable results in terms of seizure outcome and quality of life.
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PMID:Hemispherotomy and functional hemispherectomy: indications and outcome. 1988 95

Magnetic stimulation has called the attention of neuroscientists and the public due to the possibility to stimulate and "control" the nervous system in a non-invasive way. It has helped to make more accurate diagnosis, and apply more effective treatments and rehabilitation protocols in several diseases that affect the nervous system. Likewise, this novel tool has increased our knowledge about complex neural behavior, its connections as well as its plastic modulation. Magnetic stimulation applied in simple or paired-pulse protocols is a useful alternative in the diagnosis of diseases such as multiple sclerosis, Parkinson disease, epilepsy, dystonia, amyotrophic lateral sclerosis, cerebrovascular disease, and sleep disorders. From the therapeutic perspective, magnetic stimulation applied repetitively has been found useful, with different degrees of efficacy, in treating resistant depression, tinnitus, psychogenic dysphonia, Alzheimer disease, autism, Parkinson disease, dystonia, stroke, epilepsy, generalized anxiety as well as post traumatic stress disorder, auditory hallucinations, chronic pain, aphasias, obsessive-compulsive disorders, L-dopa induced dyskynesia, mania and Rasmussen syndrome, among others. The potential of magnetic stimulation in neurorehabilitation is outstanding, with excellent range of safety and, in practical terms, without side effects.
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PMID:[Present and future of the transcranial magnetic stimulation]. 2378 15

Epilepsia partialis contina (EPC) in a narrow definition is a variant of simple focal motor status epilepticus in which frequent repetitive muscle jerks, usually arrhythmic, continue over prolonged periods of time. In a broader definition (used in this review) it also includes non-motor manifestations otherwise known as aura continua. EPC may occur as a single episode, repetitive episodes, it may be chronic progressive or non-progressive. It appears as an unusual manifestation of epilepsy in which more typical paroxysmal events are partly or entirely replaced by the sustained repetition of seizure fragments in rapid succession. The minimum duration is defined as one hour but EPC may continue for up to many years. There are multiple possible etiologies which can be local or systemic, including two disease entities, Rasmussen encephalitis and Russian tick-borne spring-summer encephalitis. Among systemic brain disorders, mitochondrial diseases and non-ketotic hyperglycemia are particularly likely to cause EPC whereas stroke is a frequent cause of acute EPC. The symptoms of motor EPC have been interpreted as cortical reflex myocloni but the pathophysiology is probably not uniform for all cases. In pathophysiological terms, EPC seems to represent an oscillation of excitation and inhibition in a feedback loop whose mechanisms are still poorly understood. However, EPC only seems to occur rarely in an otherwise healthy brain. Treatment has to take account of the etiology but, in general, EPC tends to be drug-resistant. Epilepsy surgery is often indicated in Rasmussen encephalitis.
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PMID:Epilepsia partialis continua: A review. 2802 52