Are epilepsy classifications based on epileptic syndromes and seizure types outdated?
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Epilepsy↗
Biomedical subjects
M Carreño
Publications and source records attributed to M Carreño.
Complex motor behaviors in temporal lobe epilepsy.
Complex motor behaviors differing from typical automatisms were found in 12 of 502 patients with temporal lobe epilepsy. Movements involved proximal limb segments (6) or body axis (6) and were often preceded by auras and followed by automatisms. Seven of 12 patients are seizure free after surgery. The other 5 patients declined surgery.
Adolescent↗
A semiological classification of status epilepticus.
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Humans↗
Epilepsy, antiepileptic drugs (AEDs) and cognition.
People with epilepsy are at increased risk of cognitive deficits as a result of various factors: the effect of seizures themselves, psychosocial factors and adverse effects of AEDs. It is crucial that, following early diagnosis of the correct epileptic syndrome, patients are treated with the appropriate drugs, as incorrect AEDs can exacerbate symptoms. By discussing various epileptic syndromes and performing a broad review of the available evidence, it is possible to make recommendations concerning prescription of AEDs with respect to cognition. An interesting advance in this area is the increasing use of AEDs such as valproate (in some countries divalproex is indicated), carbamazepine or lamotrigine (lamotrigine has been filed for approval in this indication) for bipolar disorders. Children and the elderly are especially vulnerable to adverse effects on cognition. This review highlights advantages of valproate in these populations; it is well tolerated and produces few cognitive side effects.
Adolescent↗
Intractable epilepsy in vascular congenital hemiparesis: clinical features and surgical options.
Forty-one patients with vascular congenital hemiplegia and intractable epilepsy were reviewed. Most had severe hemiparesis, mental retardation, porencephaly, and focal epilepsy. Thirty-three were considered surgical candidates and 25 underwent surgery. Seizure freedom and significant seizure reduction were achieved in 12 of 13 patients after functional hemispherectomy, 4 of 6 after temporal lobectomy, 2 of 2 with extratemporal focal resections, 1 of 3 with corpus callosotomy, and 1 with porencephalic cyst drainage.
Adolescent↗
Seizure outcome after functional hemispherectomy for malformations of cortical development.
MRI features were correlated with postsurgical seizure outcome in patients with hemispheric malformations of cortical development (MCD). After functional hemispherectomy, 5 of 6 patients (83%) with hemimegalencephaly had persistent, although markedly improved, seizures; 5 of 6 patients (83%) with relative preservation of part of one lobe or atrophy were seizure free. Hemimegalencephaly and other types of hemispheric MCD appear to differ in prognosis for freedom from seizures after functional hemispherectomy.
Brain↗
Time-related configuration change in benign focal epileptiform discharges of childhood: from a dipole to a negative monopole in a patient with generalized epilepsy.
The case of a 6-year-old child with generalized epilepsy and benign focal epileptiform discharges (BFEDs) of childhood is presented. During his first EEG, performed when he was 6 years old, the patient had three staring episodes accompanied by bursts of 3-Hz spike-and-wave complexes. Interictally, frequent BFEDs were seen, configured as dipoles with a right temporal negativity and a right frontal positivity. The patient was administered ethosuximide and the staring spells disappeared. On follow-up EEG performed 2 years later, no generalized discharges were seen. However, the EEG again showed frequent spikes with a characteristic morphology of BFEDs. This time they were not configured as dipoles, but as monopoles with a maximum negativity over the right frontal region. The change in the generator's orientation over time (from a horizontal to a vertical dipole) is discussed, as well as the prognostic implications of the morphology and configuration of focal spikes. In addition, the authors review the coexistence of BFEDs and 3-Hz spike-and-wave complexes in their patient database.
Child↗
Amplification of herpes simplex virus type 1 DNA in human geniculate ganglia from formalin-fixed, nonembedded temporal bones.
Polymerase chain reaction (PCR) has provided new insights in molecular biology. Recently, some studies have been focused on temporal bone pathology, with amplification of DNA from fixed sections of celloidin-embedded bones. The purpose of our study was to elucidate the utility of PCR in detection of minor concentrations of DNA from nonoptimal stored samples. We obtained geniculate ganglia from 30 temporal bones preserved in formalin for a long time, without any process of embedding. By performing a nested PCR assay, we detected herpes simplex virus type 1 DNA in 13 of 30 ganglia (43%). We conclude therefore that study of temporal bones stored under poor conditions by PCR is possible, although there are some limitations when compared with fresh or optimally archived samples.
Adult↗
Hemangiopericytoma of the parapharyngeal space.
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Adult↗
Vestibular schwannoma: unusual recurrence presenting as an external auditory canal mass.
Vestibular schwannomas (VS) commonly are limited to the internal auditory canal (IAC) and cerebellopontine angle. Extension to labyrinth is less frequent, and involvement of the middle ear or external acoustic canal (EAC) is very rare. In this report we present the case of a 41-year-old woman with a VS, which recurred after a previous surgical removal 4 years before. The tumor involved the IAC, cochlea, vestibule, semicircular canals, cavum tympani, mastoid cells, and EAC. Total removal of the tumor was achieved by a transotic approach, without neurological sequela.
Case Reports↗
[Thyroid cancer with extension to the upper respiratory-digestive tract: therapeutic approach].
Thyroid carcinomas usually have a good prognosis, particularly well-differentiated tumors confined to the gland. An analysis was made of the treatment and prognosis of thyroid neoplasms with invasion of the upper respiratory and digestive tract. Of 211 patients treated at our institution from 1975 to 1994, only 18 had invasion of the upper respiratory and digestive system. All patients were treated surgically. The procedures included total thyroidectomy, laryngectomy, partial esophagectomy, and tracheal resection. The neoplasm recurred locally after complete resection in 33%. Cervical lymph node metastases occurred in 17% and distant metastases in 33%. The 5-year survival rate was 46% for well-differentiated carcinomas. Invasion of the respiratory and digestive tract had negative prognostic significance in the statistical analysis. Locally advanced thyroid neoplasms had a poorer prognosis than those limited to the thyroid gland. However, complete surgical resection of the malignancy was achieved in most patients without functionally mutilating procedures and with satisfactory survival results.
Aged↗
[Use of double PCR in an experimental mode of HSV-1 infection of the facial nerve].
Recent studies suggested herpes simplex virus type 1 as a major etiologic factor in Bell's palsy. To analyze different aspects of facial nene infections, Swiss mice were inoculated with HSV-l in tongue (41 animals) and auricle (44). Nineteen mice developed unequivocal signs of nevous infection, but only in 1 mouse was evident a facial palsy. Mice were sacrificed at different intervals from inoculation, and facial nerves, Gasser ganglia and brain stem were obtained to test the presence of HSV-1 by nested PCR and viral culture. Virus was detected in the 3 types of samples, but identification was more frequent in animals injected in tongue and sacrificed during the acute infection. Nested PCR was far more sensitive than culture, particularly during viral latency. According with our results, HSV-1 could origin facial palsy, but is possible that lesions are immunomediated and localized at brain stem.
Acute Disease↗
Detection of herpes simplex virus-1 by nested PCR. An experimental model.
Nested polymerase chain reaction (nested PCR) was performed using a reaction mix batch-prepared and kept frozen in single reaction tubes at -20 degrees C until use. Twenty-one New Zealand white rabbits were infected with herpes simplex virus type 1 (HSV-1). Eleven animals were killed on day seven and the other ten were sacrificed on day 21. Viral culture and nested PCR was used to determine the presence of HSV-1 in samples from the tongue, HSV-1 was detected in 90.47% of the animals; in 84.21% by nested PCR and in 52.63% by culture. Nested PCR assay had greater sensitivity than culture in animals sacrificed on day seven with significative difference (p < 0.05). Higher sensitivity and faster results were obtained with this method, so we found it reliable and useful in the setting of a clinical laboratory dealing with diagnosis of herpes virus infections.
Animals↗
[Epidermoid carcinoma of the nasal septum].
Squamous-cell carcinoma of the nasal septum occurs infrequently and only a few cases have been reported. Because of the small number of cases, comparisons between treatment groups have been inadequate. Five patients with this type of tumor are presented. All of them underwent surgery (4 as primary treatment and 1 for recurrence after radiation therapy). One patient had a local recurrence, 2 had cervical metastases, and 2 (40%) died as a consequence of the tumor. In the squamous cell carcinoma of the nasal septum our study supports surgical resection with wide margins combined with postoperative irradiation as the preferred treatment with prophylactic neck dissection for tumors over 2 cm or extended to adjacent areas.
Aged↗
Organ donation among Hispanics: a single-center experience.
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Cadaver↗
[Usefulness of RET proto-oncogene in the diagnosis of hereditary-type medullary carcinoma of the thyroid. Correlation with surgical findings].
In about 25% of cases medullary thyroid carcinoma (MTC) is hereditary. In this group is possible to detect germline point mutations of the RET proto-oncogene in about 95% of the studied cases. The purpose of the present paper is to confirm the value of the RET in the screening of the hereditary MTC. We studied 43 subjects at risk for a Multiple Endocrine Neoplasia Type 2A Syndrome. RET analysis was positive for MEN 2A in 22 subjects. Fifteen of the 22 have undergone a total thyroidectomy at our facility. Histopathological study of the surgical specimens confirmed the presence of a MTC in all the cases. According with our experience. RET analysis is a 100% sensitive and specific method of hereditary MTC screening, and we think it has obvious advantages over the calcitonin tests in technical, economic and ethic aspects.
Adolescent↗
[Neuronal migration disorders: a cause of curable medication resistant epilepsy].
INTRODUCTION: Focal cortical dysplasia is a neuronal migration disorder that appears with bouts of epileptic seizures that are usually medication resistant. The improvements introduced into neuroimaging techniques in recent years have made it possible to diagnose and offer surgical treatment to certain patients who have been under polytherapy for many years with poor control over their seizures. CASE REPORT: We report the case of a 22-year-old male with epileptic fits since the age of 18 months, who was refractory to multiple combinations of oral antiepileptic drugs (AEDs) with electroencephalograms that displayed frontal, fast spike-wave discharges, with greater expression on the left side and findings from neuroimaging techniques that were repeatedly normal. After being readmitted to hospital because his seizures had got worse, the neuroimaging study was repeated and left frontal focal cortical dysplasia was observed, which led us to start considering neurosurgery. At present, six months after the intervention, the patient has had no further convulsive fits and therapy with oral AEDs is being reduced. CONCLUSIONS: Neuroimaging studies must be repeated in patients that have already been examined because in this way it may be possible to save a group of patients (who would otherwise have to resign to poor control over their seizures as well as the side effects of many AEDs) from becoming medication resistant.
Adult↗
[Fatigue and functional system involvement in multiple sclerosis].
Fatigue is a frequent complaint in multiple sclerosis (MS) patients. Its pathogenesis is unknown and the question of whether or not there is a specific type of fatigue in MS is controversial. The aim of this work was to determine the link between fatigue in MS and physical and psychological involvement. We studied 50 patients diagnosed of MS category la by Poser's criteria. They were examined using the Kurtzke and Hamilton scales for depression and anxiety. We also applied an original scale for assessing the spontaneity, clinical characteristics, severity and frequency of fatigue. Asthenia, a tendency to feel tired and a worsening of other symptoms were identified as clinical traits. Using statistical tests for non parametric distribution of data (Spearman's R and Kruskal-Wallis's H coefficients), we found a positive correlation between the characteristics of and severity of fatigue and functional system involvement, anxiety and depression. Thirty-one (62%) patients suffered fatigue, 22 of them spontaneously. Fatigue was the main symptom in 3. and was proportional to pyramidal involvement (r = 0.41; p < 0.01) and intelligence quotient (r = 0.30; p < 0.03). Depression and anxiety were not related to fatigue (p > 0.05). Patients in the progressive phase of disease had higher fatigue scores than did patients who were stable or in remission. Disease duration was not proportional to fatigue. Our results point to a high rate of fatigue in MS patients. The severity of fatigue is proportional to pyramidal involvement and mental decline and is linked to phases of disease progression.
Adolescent↗