Michael W Mann | PubMed Health

PubMed2005

[Management of a first epileptic seizure in adults].

Management of a first seizure is a frequent challenge in the emergency room. Definite diagnosis is mandatory before treatment, identification of the epileptic syndrome is recommended. The overall recurrence rate of a first unprovoked seizure is about 50%, but varies considerably depending on several risk factors (neurological deficit in particular, a congenital one, Todd's paralysis, significant psychiatric disorders, epilepsy in siblings, symptomatic seizures (MRI is the standard procedure now to detect a structural lesion, except in case of a idiopathic generalised epilepsy and epilepsy with centro-temporal spikes) and epileptiform abnormalities on EEG which should be obtained within 24 hours after a seizure. Each treatment decision has to be taken individually after discussion with the patient. Early treatment reduces the 2 years recurrence rate but doesn't alter the long term prognosis.

Adult↗

PubMed1991

Central pain and thalamic hyperactivity: a single photon emission computerized tomographic study.

Five patients with central post-stroke pain (CPSP) accepted to be studied according to the following paradigm: a single photon emission computerized tomography (SPECT) using [123I]N-isopropyl-iodoamphetamine (IMP) was made in each patient 20 min following i.v. injection of IMP; during this time, the patients were stimulated in order to reproduce their spontaneous pain. Of the five patients, two had CPSP with hyperpathia following a stroke (with a lesion on CT scan involving the thalamo-cortical pathway in one and involving the thalamus in the other); two had CPSP following a stroke in the middle cerebral artery area, without hyperpathia; and the last patient suffered pain from algodystrophia following a fracture of the wrist. In the two cases with hyperpathia, SPECT demonstrated a contralateral relative hyperactivity in a central region corresponding to the thalamic area. This was not observed in the three other patients. In the two patients with hyperpathia, a second SPECT scan with stimulation of the contralateral pain-free arm did not demonstrate any hyperactivity in the thalamic area. These results suggest that a thalamic neuronal hyperactivity may characterize some hyperpathic syndromes and, in accordance with our previous results obtained in the rat, that the loss of inhibition on medial thalamic neurons may be a main feature of hyperpathia following certain cerebral stroke syndromes.

Aged↗