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Biomedical subjects

P Jallon

Publications and source records attributed to P Jallon.

At least 19 recordsLinked to original sources
PubMed2001

Newly diagnosed unprovoked epileptic seizures: presentation at diagnosis in CAROLE study. Coordination Active du Réseau Observatoire Longitudinal de l' Epilepsie.

PURPOSE: We describe first unprovoked seizures and newly diagnosed epilepsies at initial presentation, with a special emphasis on epilepsy syndromes, in a large cohort recruited in the mid-1990s in France. METHODS: The French Foundation for Research on Epilepsy set up a network to conduct a prospective study of patients with newly diagnosed unprovoked seizures. Information was provided by 243 child or adult neurologists. Four neurologists classified each case according to the International League Against Epilepsy (ILAE) criteria. First-seizure patients and patients with previously undiagnosed seizures were compared. RESULTS: Between May 1, 1995, and June 30, 1996, 1,942 patients aged from 1 month to 95 years were identified: 926 (47.7%) with a single seizure and 1,016 (52.3%) with newly diagnosed epilepsy. All but 17 patients had EEGs. In the first-seizure and newly-diagnosed-epilepsy groups, neuroimaging studies were performed in 78.2 and 68.3% of patients, and medication prescribed in 54.1 and 89.6%, respectively. There were significant differences between the two groups with respect to age at onset and diagnosis, sex, etiology, several specific syndromes, as well as the type and presentation of initial seizure. In patients for whom the first seizure was convulsive, only sex, multiple seizures in a day or status epilepticus, and cryptogenic localization-related syndrome differed between the two groups. CONCLUSIONS: Approximately half of patients who first came to attention for an unprovoked seizure already met epidemiologic criteria for epilepsy. There were significant differences between the types of patients with a first seizure and those with newly diagnosed epilepsy. One or several seizures at diagnosis did not influence the diagnostic assessment of the patients but had a strong influence on the initiation of treatment.

Adolescent↗
PubMed2001

Symptomatic postictal cardiac asystole in a young patient with partial seizures.

This report describes a patient with complex partial seizures arising from the right temporal lobe who developed symptomatic sinus arrest following the end of his seizure activity. A ventricular pacemaker was implanted and was documented to function appropriately, preventing development of bradycardia associated symptoms during subsequent seizures. Possibly relevant cerebral structures are briefly discussed.

Adult↗
PubMed2001

SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus?

Periodic lateralized epileptiform discharges (PLEDs) are a well defined electroencephalographic entity but whether PLEDs represent an ictal condition or not remains debated. Much work has been done using electroencephalography (EEG) but new approaches using cerebral perfusion imaging may give more information about this question. We aimed to evaluate if PLEDs were associated with high regional cerebral blood flow (rCBF). We studied 18 patients with PLEDs and different pathologies, and performed brain single-photon-emission computed tomography (SPECT) during and, for three cases, after the disappearance of PLEDs. Qualitative variations and locations of rCBF were compared with PLEDs. Association with seizures and type of seizures were also assessed. SPECT showed high rCBF in 18/18 patients (100%). The location of PLEDs and high rCBF matched in 17/18 cases (94%). In the three cases where SPECT was performed after PLEDs disappeared, the high rCBF had cleared (100%). Eighteen cases (100%) presented seizures before recording of PLEDs, mainly motor (partial motor or generalized tonic-clonic). Where there was a decreased rCBF (related to a lesion) there was little relationship to PLEDs and all patients with decreased rCBF had an adjacent increased rCBF. These results confirm preliminary case reports. Hyperperfusion adds further to the argument that PLEDs may be related to a form of partial status epilepticus.

Aged↗
PubMed2000

Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR).

BACKGROUND: To determine the incidence, risk factors, and case fatality rate of status epilepticus (SE) in the French-speaking part of Switzerland. METHODS: Between October 1, 1997 and September 30, 1998 all cases of SE referred to all the hospitals in the six cantons of the French-speaking part of Switzerland were identified by physicians working in emergency rooms, intensive care units, and electroencephalography departments; neurologists; and pediatricians from all hospitals in the area. Each case was validated and classified according to seizure type and etiology. RESULTS: Over 1 year, 172 cases were identified, of whom 74 had a history of epilepsy (42.4%). The crude and standardized annual incidence rate were 9.9/100,000 (95% CI, 8.4 to 11.4) and 10.3/100,000 (95% CI, 8.7 to 11.9). The incidence rate was higher among children < 1 year of age and adults > 65 years, and among men than women. There were 108 cases of acute symptomatic SE (incidence: 6.2 per 1000), 49 cases of remote symptomatic SE, and 15 cases of unknown etiology. Case fatality rate was 7.6%. CONCLUSIONS: The standardized incidence rate of SE in the French-speaking part of Switzerland was lower than that reported in Rochester, MN (18.3/100,000) and in the white population of Richmond, VA (20/100,000). The discrepancy may stem from the lack of a homogeneous, rigorous, and pragmatic definition of SE and the efficient management of acute repetitive seizures in this area.

Adolescent↗
PubMed2000

[Drug resistant status epilepticus].

Refractory epileptic state (RES) is defined by severe seizures that are resistant to antiepileptic drug treatment. Diagnostic errors such as pseudo-seizures and encephalopathies with triphasic waves must be distinguished at an early stage from cases of RES. The latter are symptomatic of a focal brain lesion or severe systemic disease, most frequently metabolic in origin. The treatment of such conditions is aimed at correction of the underlying cause. A nosographic issue that is still a subject of discussion and which requires further study, i.e., PLEDS, will also be discussed in this article.

Anticonvulsants↗
PubMed2000

[The difficulty of defining and classifying status epilepticus].

Status epilepticus (SE) can theoretically be described using a simple definition based on physiopathological mechanisms: any seizure of epileptic nature, partial or generalized, convulsive or non-convulsive, lasting over a period of more than 30 minutes; or repeated seizures lasting for a period of over 30 minutes without recovery of consciousness. In the context of a historical review of various definitions, the validity of this definition is assessed and questioned. The heterogeneous nature of this condition is evidenced in daily clinical practice and by the results of epidemiologic studies. In the present study, the authors propose a more pragmatic and heuristic classification, taking into account not only clinical but also electroencephalographic data, as well as the particular nature of the epileptic syndrome when this is known.

Humans↗
PubMed2000

Severe but reversible encephalopathy associated with cefepime.

In this study, a report has been made of 19 cases of severe encephalopathy in patients with renal impairment who were treated during the last three years for various infections with cefepime, a new parenteral cephalosporin antibiotic. All patients (aged 57 to 91 years) presented a prolonged confusional state associated with diffuse rhythmic non-reactive triphasic sharp waves on the EEG. All the electroclinical symptomatology disappeared within 24-48 hours after discontinuation of drug administration. A clear relation was found between encephalopathy and cefepime intake. These observations underline the fact that the cefepime dosage should be reduced in renally impaired patients.

Aged↗
PubMed2000

Clinical correlates and prognosis in early spindle coma.

OBJECTIVE: To determine the prognostic significance of spindle coma (SC) according to etiology and EEG reactivity. METHODS: We reviewed 15 patients with SC due to various causes within 8 days of coma to determine the prognostic significance of this EEG pattern. RESULTS: The outcome among survivors was favorable: among 13 survivors, 9 were independent in all activities of daily living (ADLs) at 6 months; 3 were dependent in all ADLs; and one remained in coma. EEG reactivity to noxious stimuli best predicted outcome: All patients (whatever the coma etiology) with EEG reactivity survived; conversely, not all patients without EEG reactivity died. CONCLUSION: In our patients, EEG reactivity independent of etiology predicted survival, neurological examination did not predict outcome. Most SC survivors had a meaningful recovery achieving all ADLs. From the literature, the cause of SC was predictive of outcome: encephalopathy, seizures and trauma had the best prognosis while hypoxia, CRA and structural lesions carried the worst. Literature review revealed that 23% of patients [56/242] died or remained in a persistent vegetative state (PVS). Best outcomes occurred when SC was due to drugs, encephalopathy or seizures: (0/14 died or were in a PVS). With trauma 15% [25/169] died or were in a PVS). Intermediate outcomes occurred with hypoxia and cardio-respiratory arrest (CRA): 33% [7/21] died or were in a PVS. The gravest outcomes occurred with brain-stem and cerebral infarctions, and tumors: 73% [22/30] died or were in a PVS.

Activities of Daily Living↗
PubMed2000

The contributing factors to medical cost of epilepsy: an estimation based on a French prospective cohort study of patients with newly diagnosed epileptic seizures (the CAROLE study). Active Coordination of the Longitudinal Observational Network in Epilepsy.

Epilepsy is a common neurological condition with significant resource implications. An estimation was performed in France of the direct medical cost of patients presented with newly diagnosed seizures and followed during the first two years after diagnosis. This estimation was based on the service utilization data collected from French prospective cohort study (CAROLE: 1942 patients enrolled). Costs were estimated in a societal perspective in 1998 value. The impact on the costs of different factors like age, aetiologic categorization and severity of seizures (type and number of seizures), and treatment by anti-epileptic drugs (AEDs) was analysed. The mean annual direct epilepsy-related costs per patient were estimated to be 14 305 F and 3766 F for the first and the second year of follow-up respectively, 68% and 40% of the costs were devoted to inpatient care. Costs during the first year were highly sensitive to aetiologic categorization of seizures at inclusion and to other clinical parameters. Second-year costs had a much lower variance and were sensitive to frequency of seizures and the fact of being treated or not by AEDs. Our data emphasize the importance of seizure control as means of reducing the costs of epilepsy especially during the first year of follow-up.

Adolescent↗
PubMed2000

Distinct behavioral and EEG topographic correlates of loss of consciousness in absences.

PURPOSE: To describe the behavioral and EEG topographic correlates of absences with 3-Hz generalized spike-waves and partitioned impairment of consciousness. METHODS: Two adult women had so-called "phantom" absences, characterized by brief and mild impairments of consciousness that were previously inconspicuous to both patient and physician. Neuropsychological examination was performed under video-EEG monitoring during absence status. EEG topographic mapping of spike-wave discharges was obtained in the two cases. RESULTS: Only mild attentional and executive disturbances were observed during absence status despite prolonged discharges. Spike-wave bursts were associated with selective impairment in the initiation of response and self-generated action, whereas short-term storage of external information during discharges was fully preserved. This is consistent with a predominant involvement of frontomesial cortex demonstrated by topographic mapping of spike-wave discharges in the two cases. By contrast, in two other patients with typical absences and a complete lack of retention for information given during the discharges, topographic mapping found a more lateral frontal involvement by spike-wave activity. CONCLUSIONS: Different types of absence seizures may impair distinct components of conscious behavior. A predominant involvement of frontomesial thalamocortical circuitry may underlie an "inconspicuous" disorder of consciousness as seen in phantom absences with selective loss of initiation and goal-oriented behavior, whereas involvement of more lateral frontal areas in typical absences may additionally disrupt working memory processes.

Adult↗
PubMed2000

Encephalopathy with epileptic spasms resolved with corticoids in a 69 year-old patient.

A 69 year-old man with a history of recent temporal lobe seizures, presented with progressive coma and frequent epileptic spasms. Ictal EEG, PET and SPECT alterations were strikingly similar to those described in infantile spasms. Conventional antiepileptic drugs were ineffective but the introduction of corticoids induced a dramatic improvement with disappearance of the spasms. The etiology remains unknown. Epileptic spasms may occur in the elderly. If conventional antiepileptic drugs are ineffective, corticoids should be tried immediately.

Aged↗
PubMed1999

[Sudden death of epileptic patients].

DEFINITION: Sudden unexpected death in an epileptic patient which no likely cause--head trauma, drowning, grand mal, bronchial aspiration, suffocation--and no anatomic or toxicologic condition which could clearly explain the death. A seizure reported by witnesses or suspected from clinical signs observed prior to death and compatible with the definition raises the problematic of the relationship with sudden death. INCIDENCE AND RISK FACTORS: Sudden death is estimated to occur in 1 out of 450 to 2000 epileptic patients, giving an annual incidence of 0.55 to 9.3 per 1000 patients. Such a wide incidence range can be explained by the difficulties in providing a rigorous definition of sudden death and more importantly by the heterogeneous nature of the population at risk. The risk of sudden death is clearly related to the severity of the epilepsy. It is observed in young adults with symptomatic, often difficult to treat epilepsy. Death is frequently observed during sleep. PATHOPHYSIOLOGICAL HYPOTHESES: The circumstances of sudden death in the epileptic patient illustrate the complex relationships existing between seizures and irreversible cardiorespiratory dysfunction. Neurogenic lung edema is frequently observed at autopsy and has been confirmed by experimental data. Experimental work and clinical observations would suggest that central apnea, associated with cardiac dysrhythmia could be involved. Other risk factors, including sleep, compliance to treatment, arrhythmogenic effect of certain antiepileptics and the consequences of repeated seizures on the myocardium may also play a role.

Adult↗
PubMed1999

Left temporal rhythmic electrical activity: a correlate for psychosis? A case report.

It is well recognized that epileptic patients are at higher risk for acute or chronic psychotic states than non-epileptic subjects. Here we present intracranial depth electrode recordings during a psychotic episode in a 20-year-old woman who was referred for presurgical evaluation. Unrelated to her seizures, she presented acoustic hallucinations and delusions and became agitated for a duration of 18-24 hours. During this period, a new unusual pattern of sharp slow waves was seen semi-rhythmically every 2-3 sec from left anterior neocortical temporal areas. Her condition responded well to a treatment with Haloperidol, but not with Benzodiazepines. Ictal and interictal scalp- and depth-EEG recordings outside the psychotic episode as well as MRI-based volumetry, PET, SPECT and neuropsychological testing gave evidence of bilateral temporal and frontal dysfunction. This case report suggests that psychosis in epileptic patients may be based on a bilateral cerebral dysfunction linked together in a pathological network, but with a focal (here: left temporal) driving mechanism.

Adult↗
PubMed1999

Semantically-triggered reading epilepsy: an experimental case study.

Primary reading epilepsy (PRE) is a rare syndrome in which epileptic seizures are electively provoked by reading. Cognitive neuropsychology has demonstrated the existence of at least two pathways for reading, the sublexical pathway involved in converting graphemes to phonemes, and the lexical pathway used when meaning is conveyed. Which of these specific pathways is relevant in triggering epileptic discharges remains largely unknown. We report the case of a patient suffering from PRE in which the two routes were distinguished on the basis of the reading material employed. Significantly less epileptic discharges were observed when the patient read non-words than words. In view of our findings, we tentatively contrast a lexical form of PRE, triggered by the activation of semantic knowledge structures, with a sublexical form, triggered by non-word reading. Evidence from the literature suggests that the former is characterized by bilateral EEG activating patterns, whereas the latter involves preferentially the left hemisphere.

Electroencephalography↗