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Biomedical subjects

Joseph I Sirven

Publications and source records attributed to Joseph I Sirven.

18 recordsLinked to original sources
PubMed2006

Protracted ictal confusion in elderly patients.

BACKGROUND: Ictal confusion, particularly if protracted, often presents a diagnostic challenge. OBJECTIVES: To define protracted ictal confusion in elderly patients and to characterize its features and outcome. DESIGN: Case series. SETTING: Neurology outpatient and emergency departments at 2 tertiary care centers. PATIENTS: Consecutive series of 22 ambulatory patients with acute ictal confusion. MAIN OUTCOME MEASURES: Duration of ictal confusion was correlated with age and lesions noted on cerebral images and videoelectroencephalographic studies. RESULTS: The ictal basis underlying confusion was not recognized for up to 5 days in 22 patients (mean +/- SD age, 70 +/- 8.5 years). Twenty patients had partial complex status epilepticus, and 2 patients had newly diagnosed primary generalized status epilepticus. Motor movements were not present in either group, although reduced mood states and ictal neglect were noted in some patients. Fifteen patients had previous episodes (2-10) of protracted ictal confusion. Once identified, treatment reversed confusion, and eventually patients were discharged to home, although a few patients sustained persistent reduction in baseline cognition. CONCLUSIONS: Protracted ictal confusion is often not considered in the ambulatory elderly patient, with resulting delay in diagnosis. Electroencephalographic and videoelectroencephalographic studies performed while the patient is experiencing symptoms are crucial to early diagnosis and timely management.

Age Factors↗
PubMed2006

Evaluation of stigmatizing language and medical errors in neurology coverage by US newspapers.

OBJECTIVES: To analyze US newspaper coverage of neurologic diseases to determine whether stigmatizing language is used in describing patients and examine its sources where found and to examine stories for medical errors. METHODS: A content analysis of newspaper articles was performed for 2003 using the Lexis-Nexis database. Keyword searches for 11 common neurologic conditions were performed for The New York Times and 8 regional newspapers with circulation greater than 200,000. RESULTS: A total of 1203 stories focusing on 11 neurologic conditions were recovered. Newspaper coverage did not reflect disease prevalence (rank correlation, p=-0.009; P=.98). The topics most covered were Alzheimer disease and other dementias (400 stories, 33% of total), which were eventually combined Into 1 category for purposes of data analysis. Conditions with the highest prevalence were among the least covered topics, including migraine (34 stories, 3% of total) and head trauma (19 stories, 2% of total). Stigmatizing language was found in 15% of all stories. Excluding wire stories, the average among locally produced newspaper stories was higher (21%). Stories on epilepsy (30%) and migraine (29%) contained the highest frequency of stigmatizing language. Sources of stigma within a story included reporters (55%), patients (26%), family (17%), and physicians (16%). In an accuracy analysis, 20% of sampled stories contained medical errors or exaggerations, with half of these concerning neurodegenerative conditions. CONCLUSION: A total of 21% of all stories (excluding wire stories) contained language judged stigmatizing, with reporters as the most common source of the stigmatizing language. A total of 20% of analyzed stories had medical errors or exaggerations, the latter most often overstating treatment effectiveness.

Attitude to Health↗
PubMed2005

Liver transplant in a patient with a ventriculoperitoneal shunt.

There are no published accounts of patients with ventriculoperitoneal shunts undergoing liver transplantation in the literature. Because patients with ventriculoperitoneal shunts are prone to infections, this may be a theoretical contraindication to transplantation. We present a case of a patient with cirrhosis who had a ventriculoperitoneal shunt placed many years prior to transplantation. The patient had no neurological complications and the shunt was intact and functioning. Prior to transplantation, the patient underwent a ventriculoperitoneal to ventriculopleural shunt conversion that was reversed posttransplantation. Apart from some minor complications, the patient has done remarkably well from a graft and neurological perspective. In conclusion, patients who have ventriculoperitoneal shunts may be considered for liver transplantation as the risk of infectious and neurological complications is low and there are no deleterious effects on graft survival.

Adult↗
PubMed2005

Qué es la Epilepsia? Attitudes and knowledge of epilepsy by Spanish-speaking adults in the United States.

BACKGROUND: Spanish-speaking adults are the largest minority population group in the United States and are disproportionately afflicted by epilepsy. METHODS: A unique 78-item survey instrument conducted entirely in Spanish and devoted to the topic of epilepsy was administered to 760 Spanish-speaking adults in seven large U.S. Hispanic metropolitan areas representing a cross section of the U.S. Hispanic community. The answers were compared with those of 272 non-Hispanic controls administered the same survey in English in June 2004. RESULTS: The Hispanic sample correlated well with U.S. Census data. Spanish-speaking adults are mostly unaware about epilepsy, with 21% reporting no familiarity with the condition (P=0.0001). The vast majority of Hispanics use the term convulsiones or ataque to describe a seizure. Thirteen percent of Hispanics with less than high school education believe that epilepsy is contagious (P=0.0001); 8% see "sins" as a cause of seizures (P=0.0001); and 10% agree that "exorcism" would be a good remedy (P=0.002). CONCLUSIONS: There is considerable misinformation about epilepsy in the U.S. Hispanic community. Neurologists must be made aware of U.S. Hispanic attitudes and beliefs regarding epilepsy to provide culturally competent care.

Adolescent↗
PubMed2005

Diagnosing epilepsy in older adults: what does it mean for the primary care physician?

Acute and chronic seizures (epilepsy) occur frequently in older adults. However, despite their high prevalence, the condition is often overlooked or misdiagnosed because seizures mimic other common spells in the aged. The causes of seizures in older adults are often the sequelae of highly prevalent conditions that occur in this age group, eg, stroke, dementia, and head trauma. Recognizing and correctly diagnosing seizures can lead to a number of effective treatments. This article reviews the causes and presentation of seizures in older adults and offers an approach for diagnosis.

Adolescent↗
PubMed2004

Seizure prophylaxis in patients with brain tumors: a meta-analysis.

OBJECTIVE: To assess whether antiepileptic drugs (AEDs) should be prescribed to patients with brain tumors who have no history of seizures. METHODS: We performed a meta-analysis of randomized controlled trials (1966-2004) that evaluated the efficacy of AED prophylaxis vs no treatment or placebo to prevent seizures in patients with brain tumors who had no history of epilepsy. Summary odds ratios (ORs) were calculated using a random-effects model. Three subanalyses were performed to assess pooled ORs of seizures in patients with primary glial tumors, cerebral metastases, and meningiomas. RESULTS: Of 474 articles found in the initial search, 17 were identified as primary studies. Five trials met inclusion criteria: patients with a neoplasm (primary glial tumors, cerebral metastases, and meningiomas) but no history of epilepsy who were randomized to either an AED or placebo. The 3 AEDs studied were phenobarbital, phenytoin, and valproic acid. Of the 5 trials, 4 showed no statistical benefit of seizure prophylaxis with an AED. Meta-analysis confirmed the lack of AED benefit at 1 week (OR, 0.91; 95% confidence interval [CI], 0.45-1.83) and at 6 months (OR, 1.01; 95% CI, 0.51-1.98) of follow-up. The AEDs had no effect on seizure prevention for specific tumor pathology, including primary glial tumors (OR, 3.46; 95% CI, 0.32-37.47), cerebral metastases (OR, 2.50; 95% CI, 0.25-24.72), and meningiomas (OR, 0.62; 95% CI, 0.10-3.85). CONCLUSIONS: No evidence supports AED prophylaxis with phenobarbital, phenytoin, or valproic acid in patients with brain tumors and no history of seizures, regardless of neoplastic type. Subspecialists who treat patients with brain tumors need more education on this issue. Future randomized controlled trials should address whether any of the newer AEDs are useful for seizure prophylaxis.

Anticonvulsants↗
PubMed2003

Management of status epilepticus.

Status epilepticus is an increasingly recognized public health problem in the United States. Status epilepticus is associated with a high mortality rate that is largely contingent on the duration of the condition before initial treatment, the etiology of the condition, and the age of the patient. Treatment is evolving as new medications become available. Three new preparations--fosphenytoin, rectal diazepam, and parenteral valproate--have implications for the management of status epilepticus. However, randomized controlled trials show that benzodiazepines (in particular, diazepam and lorazepam) should be the initial drug therapy in patients with status epilepticus. Despite the paucity of clinical trials comparing medication regimens for acute seizures, there is broad consensus that immediate diagnosis and treatment are necessary to reduce the morbidity and mortality of this condition. Moreover, investigators have reported that status epilepticus often is not considered in patients with altered consciousness in the intensive care setting. In patients with persistent alteration of consciousness for which there is no clear etiology, physicians should be more quickly prepared to obtain electroencephalography to identify status epilepticus. Physicians should rely on a standardized protocol for management of status epilepticus to improve care for this neurologic emergency.

Anticonvulsants↗
PubMed2003

The current treatment of epilepsy: a challenge of choices.

There are now several distinct choices for seizure and epilepsy treatment. These include 16 antiepileptic medications, surgery, vagus nerve stimulation, and ketogenic diet. However, not every option is appropriate for all individuals with epilepsy. This article reviews the commonly employed treatments for chronic seizures, with the goal of trying to assess when certain treatments should be considered. An approach to seizure management is presented to help navigate the challenge of epilepsy treatment choices.

Animals↗
PubMed2003

Questions for the consultant: seizures and epilepsy.

Issues regarding management of acute and chronic seizures constitute one of the more frequent consultations that all neurologists encounter. With a significant medical and surgical therapeutic armamentarium now available, many clinicians are perplexed about how to approach the most basic of seizure consultation questions. In this article, four of the most commonly asked seizure consultation questions are reviewed: when antiepileptic drug (AED) treatment should be initiated; how to choose an AED; when to refer a patient for surgery; and when to withdraw AEDs in a seizure-free patient. By utilizing frequently encountered clinical scenarios, the decision-making process to best illustrate application of existing clinical evidence to the individual patient is explored.

Adult↗
PubMed2003

An overview of surgery for chronic seizures.

Intracranial surgical intervention offers the potential to reduce or eliminate seizures in a substantial number of patients with medically intractable epilepsy. Although some patients with epilepsy have a pathologic condition that can be imaged radiographically, this is not a requirement for the patient to be considered a surgical candidate. Evaluation in a comprehensive epilepsy center includes defining the characteristics of the seizures; integrating medical criteria, psychosocial factors, imaging findings, and surgical risks; and weighing these factors against the risks of continued, uncontrolled epilepsy. Several neurosurgical procedures are available to help these patients, including frontal and temporal lobectomy, lesionectomy, subpial transection, and callosotomy.

Chronic Disease↗
PubMed2003

Paroxysmal sleep as a presenting symptom of bilateral paramedian thalamic infarctions.

Bilateral paramedian thalamic infarctions may result in hypersomnolence, supranuclear palsy, and an amnestic syndrome. We describe an 82-year-old man who presented with recurrent, transient episodes of unresponsiveness secondary to bilateral paramedian thalamic infarctions. Electroencephalography was performed during one of these paroxysmal events and showed an abrupt transition to a stage 2 sleep pattern with spindle formation.

Aged↗
PubMed2003

Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months.

OBJECTIVE: To evaluate whether changing the seizure-free interval in Arizona from 12 months to 3 months affected the number of seizure-related motor vehicle crashes. METHODS: We performed a time trend study with analysis of motor vehicle crash reports in the state of Arizona 3 years before (1991-1993) and 3 years after (1994-1996) the seizure-free interval was decreased from 12 to 3 months. The number of motor vehicle crashes related to seizures, other medical conditions, and other nonmedical crashes was compared before and after the law changed. Other population trends, including population growth, registered vehicles, and registered drivers, are also reported. RESULTS: Seizure-related crashes increased from 125 to 136 for the 3 years before and 3 years after the law changed, respectively. The total rate of seizure-related crashes did not increase on the basis of an incidence rate difference of -0.03/10(9) miles (95% confidence interval [CI], -0.30 to 0.24) and a relative risk of 0.98 (95% CI, 0.77 to 1.24). Over the same time interval, crashes related to other medical conditions increased from 288 to 310, respectively, for an incidence rate difference of -0.09/10(9) miles (95% CI, -0.51 to 033) and a relative risk of 0.97 (95% CI, 0.82 to 1.13). Fatalities due to seizure-related crashes decreased during the same period, whereas the number of multiple vehicle crashes increased. CONCLUSION: The rate of seizure-related crashes did not significantly increase in the state of Arizona after the seizure-free interval was reduced from 12 to 3 months.

Accidents, Traffic↗
PubMed2002

Classifying seizures and epilepsy: a synopsis.

Seizures can have a number of clinical presentations. Epilepsy, the condition of recurrent unprovoked seizure, can also be categorized in a variety of ways and is associated with several conditions. Seizures and the epilepsies are classified most commonly by a system devised by the International League Against Epilepsy (ILAE) that employs clinical, electroencephalographic, and imaging data. The system has two broad divisions: focal and generalized for seizures and localization related and generalized for the epilepsies. This article surveys all seizure and epilepsy types according to the ILAE scheme. Limitations of the current categorization are discussed, and a recent new proposal for classifying seizures and epilepsy is demonstrated.

Epilepsy↗
PubMed2002

Neurocysticercosis: nursing perspectives.

Management of neurocysticercosis (NCC) is mostly by means of prevention and antihelminthic medications. We reviewed the role of medical and surgical intervention in patients with NCC lesions. We also identified two patients with isolated NCC lesions to determine whether they might be rendered seizure free through surgical removal of the lesion. The two patients, one male and one female, ages 21 and 43 years, respectively, presented with generalized seizures. Electroencephalograms showed focal slowing consistent with the site of the lesion and had failed antiepileptic drug therapy. Magnetic resonance imaging scans showed a distinct single-ring-enhanced lesion in each patient consistent with late-stage NCC. The patients underwent surgery with ultrasonagraphic guidance to remove the cysts. Surgery involved resection of the suspected calcified neurocystic lesion. Both patients have been seizure free since surgery. Patients with a single calcified neurocystic lesion may benefit from surgery for control of seizures. Prospective evaluations are needed to assess the timing of surgery in relation to the stage of the disease. Nurses play a significant role in the primary prevention of this disease and care throughout treatment.

Adult↗
PubMed2002

Antiepileptic drug therapy for adults: when to initiate and how to choose.

Although antiepileptic drugs (AEDs) are commonly used to control and prevent seizures, their long-term use carries a considerable risk of morbidity. The decision to start AEDs is made once the risks of further seizures outweigh the risks of treatment. Despite a large body of literature on the subject, this common clinical issue perplexes many practitioners because of its neurologic, psychological, and, at times, legal implications. Adding to the confusion is the recent approval of several new AEDs. This article summarizes the current evidence to support individual clinical decisions regarding initiation of AEDs in adults and considers the use of AEDs as seizure prophylaxis. Recently approved AEDs are discussed to help the practitioner understand when to initiate and how to choose the appropriate AED for the patient with seizures.

Acetates↗