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Biomedical subjects

R Rovira

Publications and source records attributed to R Rovira.

15 recordsLinked to original sources
PubMed2004

Maternal soluble tumour necrosis factor receptor type 2 (sTNFR2) and adiponectin are both related to blood pressure during gestation and infant's birthweight.

OBJECTIVE: Tumour necrosis factor alpha (TNF-alpha) and adiponectin are strongly related to insulin sensitivity; insulin resistance of pregnancy is a major determinant of infant's birthweight. We aimed to study the contributions of maternal serum concentrations of soluble TNF-alpha receptors (sTNFR1 and sTNFR2) and adiponectin to infant's birthweight. DESIGN: Cross-sectional, hospital-based study of insulin sensitivity during gestation. PATIENTS: Fifty-one healthy women with uncomplicated pregnancy and delivery (except for elective Caesarian section) and their healthy newborn infants. measurements Maternal blood levels of glucose, insulin, glycosylated haemaglobin (HbA1c), sTNFR1, sTNFR2 and adiponectin at delivery; cord-blood levels of sTNFR1, sTNFR2 and adiponectin. RESULTS: At delivery, maternal sTNFR2 correlated with systolic blood pressure (SBP; r = 0.38, P = 0.005). In multiple regression analyses, SBP and HbA1c were independent predictors of sTNFR2, explaining 18 and 7% of its variance, respectively; insulin resistance index (HOMA-IR), body mass index at delivery and SBP were independent predictors of adiponectin, explaining 15, 8 and 7% of its variance, respectively. Both maternal sTNFR2 and SBP were negatively correlated with infant's birthweight (r = -0.28, P = 0.04 and r = -0.36, P = 0.01 respectively, adjusted for sex and gestational age). In multivariate regression analyses, infant's sex and either maternal sTNFR2 or adiponectin were independent predictors of infant's birthweight, each explaining between 6 and 9% of birthweight variance. Further addition of maternal SBP to these models revealed that this variable was the main predictor of infant's birthweight, explaining 13% of its variance. CONCLUSIONS: Maternal sTNFR2 and adiponectin are independently related to both maternal blood pressure and infant's birthweight in uncomplicated pregnancy. The contributions of the TNF-alpha system and adiponectin to hypertensive disorders of pregnancy and fetal growth merit further studies.

Adiponectin↗
PubMed2002

Gabapentin in late-onset poststroke seizures.

Stroke is a frequent cause of epileptic seizures (ES) in adults. The authors evaluated the long-term efficacy and tolerability of gabapentin (900 to 1,800 mg/day) in 71 patients with a first poststroke late ES during a mean follow-up time of 30 months. ES recurred in 18.3% of the patients and side effects were noted in 27 cases (38%), but only two (2.8%) required discontinuation or early withdrawal. Gabapentin monotherapy was useful and safe for late poststroke ES.

Acetates↗
PubMed1998

[Diagnosis of seizures originating in the amygdala and the hippocampus].

INTRODUCTION: Lesions in the hippocampus of some epileptic patients were first described one hundred and seventy years ago. Since then our knowledge of the relationship between epileptic seizures and temporal lobe lesions has greatly improved. DEVELOPMENT: The aim of this paper is to systematize the symptomatology of the hippocampus and amygdala seizures. These seizures may have a great number of different clinical features: special 'loss' or 'impairment of consciousness', epileptic automatisms and autonomic changes. Moreover, at the beginning of seizures some patients have reported experiences having subjective qualities similar to those experienced in everyday life. P Gloor named them 'experiential phenomena' and subdivided them into affective (eg: fear), perceptual (eg: visual hallucinations) and mnemonic (eg: 'déjà vu' illusion). CONCLUSION: It is very important to know the contribution of the hippocampus and the amygdala to the symptomatology of temporal lobe seizures due to the progress of MRI diagnostic possibilities that are improving the surgical outcome.

Amygdala↗
PubMed1998

[Usefulness of the EEG recording in the diagnosis of cyclosporin A-induced encephalopathy].

INTRODUCTION: Cyclosporine A is one of the immunosuppressors most frequently used to prevent transplant rejection. Neurotoxicity is one of the complications often associated with it. These complications include acute encephalopathy, lethargy, confusion state, tremor, headache, motor disorders, visual changes and epileptic crises amongst others, even when blood levels are at what are considered to be 'therapeutic' levels. CLINICAL CASES: We present the EEG anomalies found in 3 transplant patients (two liver transplants and on double lung transplant) to whom cyclosporin A had been given and who presented with status epilepticus. The EEG recordings showed paroxystic discharges of focal onset in the temporo-occipital areas. They were mainly correlated with the clinical findings of oculomotor and eyelid disorders. CONCLUSION: The topography of the neurophysiological findings supports--as do the other clinico-radiological findings--localization preferably to the posterior areas of cerebral dysfunction associated with cyclosporin A. Although the physiopathological origin of the encephalopathy of patients treated with cyclosporin A seems to correspond to multiple factors, we wish to point out the diagnostic usefulness of the identification of EEG changes localized to the temporo-occipital areas in the recognition of the neurotoxic syndrome in these patients.

Acute Disease↗
PubMed1997

[Treatment of status epilepticus].

The management of status epilepticus (SE) is very complex due to the variability of its clinical features. This paper aims to achieve an schematic basis for a consensus in the treatment of these patients. Thus we need the clinical forms of SE grouped according to the differences in treatment. We also need to divided the development of every type of SE into stages in order to adjust the correct application of general measures and antiepileptic drugs. In patients prone to suffering recurrent seizures it is important to prevent risk factors. We can sometimes identify a premonitory phase during which the clinical deterioration presages SE; in these cases immediate treatment at home can prevent the evolution into true SE. Once SE has developed up to stage of early SE or stablished SE, the treatment must be carried out in emergency department. If seizures have not responded, the stage of refractory SE is reached and Intensive Care Unit facilities are mandatory. We devote special attention to conic-clonic SE but the other clinical forms of SE are categorized according to the differences in treatment.

Anticonvulsants↗
PubMedDate not supplied

[Monotherapy with gabapentin ++].

INTRODUCTION AND OBJECTIVE: Gabapentin is an anti-epileptic drug approved in the USA in December 1993 as an additional treatment for patients with crises of partial onset. Recently it has been approved for use as monotherapy. We review the characteristics of this molecule as an anti-epileptic drug and the clinical trials which have permitted approval of the current indications. DEVELOPMENT: We review the particular difficulties of designing trials using monotherapy, both for ethical reasons (problems with the use of a placebo) and for technical reasons and those of interpretation (problems comparing two drugs with equivalent results) and analyze the trials in which attempts were made to overcome these difficulties. A trial designed to replace polytherapy in drug-resistant patients by monotherapy did not show conclusive results, although they were suggestive. A trial of patients admitted for pre-surgical studies permitted verification of the efficacy and safety of higher doses (3,600 mg/day) than those previously used (800-2,400 mg/day). Another trial, this time of newly diagnosed patients, permitted verification of the efficacy and safety of gabapentin used in different dosages. CONCLUSIONS: Gabapentin is effective when used as monotherapy. The dose recommended for the initial treatment of newly-diagnosed patients is 900 mg/day. It has a better safety profile than carbamazepine and is indicated in simple and complex partial crises with or without secondary generalization.

Acetates↗
PubMedDate not supplied

[Withdrawal of antiepileptic treatment in adults].

INTRODUCTION: The withdrawal of antiepileptic treatment is a major challenge for the epileptologist who has to make a decision involving two risks, namely long term maintenance of drug treatment and recurrence of the seizures. OBJECTIVE: In our review we wish to systematize the process of decision-making and calculation of the possibilities of recurrence. DEVELOPMENT: First we review the factors to be considered when making a decision. This is complex since epileptics are a very heterogeneous group of patients. We emphasize the respect due to the patient who, in the end, is the one who assumes the risk involved. Then we consider the factors to be taken into account when calculating the individual's possibilities of having a recurrence and describe a theoretical outline of non-recurrence. Finally, we give details of the practical aspects of withdrawal of treatment. CONCLUSIONS: We emphasize that the current challenge in this field is to design a method of measuring risks to permit the prediction of probabilities of recurrence in individual patients. We quote examples of the classification and measurement of risks, and suggest that only by institutional measures--perhaps by organizations such as LECE--can further essential epidemiological studies, of great scientific interest in the long term, be carried out.

Adult↗
PubMedDate not supplied

[Advances in the treatment of epilepsy: status epilepticus].

OBJECTIVE: The complexity of the treatment of status epilepticus (SE) is due to the wide variety of forms of clinical presentation. In this review we wish to emphasize that satisfactory management of SE requires a system which takes account of the successive phases of the gravity of the electroclinical course of SE and the different types of SE according to the electroclinical semiology of the seizure. DEVELOPMENT: The concepts and classifications which, in current epileptology, are used in SE are mainly based on criteria developed at three international symposia: in Marseilles in 1962 and Santa Monica, California, in 1979 and 1997. Current knowledge permits distinction of different therapeutic periods depending on the chronology of each SE and to classify the SE according to the type of seizures, age of the patient and underlying pathology. CONCLUSIONS: The classifications described permit the standardization of treatment: preventive measure in high-risk patients; immediate and in situ treatment during the prodromal phase; three parallel lines of action--differential diagnosis, general measures and antiepileptic treatment--during the initial phase; measures in hospital emergencies and in the Intensive Care Unit when the SE is at a fully established phase; special measures, including induction of anaesthesia in the refractory phase; transition to long-term treatment, recovery of autonomy by the patient and long-term management in the phases following remission of the SE. The standardization proposed may perhaps serve as a basis for the future development of guidelines.

Diagnosis, Differential↗
PubMedDate not supplied

[Gabapentin and women].

OBJECTIVE: In the management of epilepsy, as a chronic disorder, one should remember the factors which differentiate the patients so that they may be classified into groups with common characteristics. Using gender as a differentiating criterion, we tried to systematize the factors which should be considered when studying and treating a female patient with epilepsy. DEVELOPMENT: The factors to be taken into account are biological such as the sex hormones or of psychosocial type such those related to the stigma, which may have special characteristics depending on gender. Once these factors had been systematized, we reviewed the clinical use of gabapentin from the point of view of the group considered. CONCLUSIONS: We suggest that special guidelines should be used according to the patient s gender. This review considers the female gender. The rational use of gabapentin, as monotherapy or polytherapy plays an important part in fulfilling the requirements described.

Acetates↗
PubMedDate not supplied

[Prognostic factor for medical control for seizures in patients with radiologic evidence for mesial temporal lobe sclerosis].

INTRODUCTION: Patients with mesial temporal lobe sclerosis (MTS) usually have suffered a brain insult during early childhood, a febrile convulsion in most cases. Complex partial seizures start after a seizure free period of variable duration. These complex partial seizures have an stereotypic semiology. Often, these seizure are not controlled with medical therapy, previous studies shows a rate of control not superior of 30%. AIM. To know the prognosis for medical control of patients with MTS and to find related factors. PATIENTS AND METHODS: The clinical characteristics of 51 patients with temporal lobe epilepsy and radiologic evidence of MTS (hippocampus atrophy or increased signal on T2 or Flair magnetic resonance sequences). RESULTS: 51 patients, of them 17 (34%) were men. 17 (34%) presented right MTS, 30 (60%) left MTS and 2 (4.3%) bilateral MTS. 16 patients (34.8%) referred autonomic aura, 14 (27.5%) psychic aura, 4 (7.8%) dysphasia and 13 (25.5%) no aura, in 2 (3.9%) aura were mixed: autonomic psychic. The aura was associated to the lesion laterality (p= 0.023) and to the reference of some antecedent of cerebral aggression during early childhood (p= 0.011). Concerning to the seizure control, 15 patients (29.2%) were seizure free in the last 6 month and 36 (70.6%) remaining uncontrolled. The associated factors to the medical control were the age of onset (p= 0.024) and the duration of the epilepsy (p= 0.018). CONCLUSIONS: Around 29% of patients with MTS can be controlled with medical therapy. Seizure control is related with later age of onset and short duration of the epilepsy

Adult↗
PubMedDate not supplied

[Idiopathic generalised epilepsy. The value of semiology and EEG scanning in its classification].

INTRODUCTION: The different syndromes included in the idiopathic generalized epilepsies present an important overlapping of their electroclinical characteristics. AIM: To compare the two actual classifications (International classification of epileptic syndromes: ILAE of 1989 and of 2001) in a sample of patients with idiopathic generalised epilepsy (IGE) and to evaluate which electro-clinical factors were more useful in order to classify a patient into a syndrome. PATIENTS AND METHODS: 70 patients (44 women/26 men). Neurological examination and neuro-radiological examination were normal in all cases. The EEG (standard or sleep deprived) showed generalised epileptiform discharges in all patients. Clinical findings included a median age of onset 12.3 years. Most frequent first type of seizure was tonic-clonic (71%). Seizures during awakening were the most frequent (37%) and lack of sleep was the most important precipitating factor (44.7%). Generalized epileptiform discharges were present in 62.9% of the basal sleep deprived EEG, on the other hand, only 22.3% of the basal standard EEG showed epileptiform discharges, p = 0.048. 28% of patients were unclassifiable according to the 1989 ILAE classification, 7% were unclassifiable according to the 2001 ILAE classification. EEG during intermittent photic stimulation (p = 0.007), at awakening (p = 0.015) and the timetable of the seizures (seizures generalised at awakening) (p = 0.053) differentiated between idiopathic generalised syndromes of adolescence. CONCLUSION: The 2001 ILAE classification is more useful in order to classify patients with IGE because includes patients previously considered unclassifiable in the syndrome of generalised epilepsy with different phenotypes.

Adult↗