Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

OBJECTIVE: To investigate neurologic outcome of patients with cardiac arrest with refractory status epilepticus (RSE) treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics compared to patients with other EEG patterns. METHODS: In the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 independent EEG patterns (benign, RSE, generalized periodic discharges [GPDs], malignant nonepileptiform) and multimodal prognostic indicators. Primary outcomes were survival and cerebral performance category (CPC) at 6 months. RESULTS: RSE occurred in 36 patients (21.7%) and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. RSE started after 3 \ub1 2.3 days after cardiac arrest and lasted 4.7 \ub1 4.3 days. A benign EEG pattern was recorded in 76 patients (45.8%); a periodic pattern (GPDs) was seen in 13 patients (7.8%); and a malignant nonepileptiform EEG pattern was recorded in 41 patients (24.7%). The 4 EEG patterns were highly associated with different prognostic indicators (low-flow time, clinical motor seizures, N20 responses, neuron-specific enolase, neuroimaging). Survival and good neurologic outcome (CPC 1 or 2) at 6 months were 72.4% and 71.1% for benign EEG pattern, 54.3% and 44.4% for RSE, 15.4% and 0% for GPDs, and 2.4% and 0% for malignant nonepileptiform EEG pattern, respectively. CONCLUSIONS: Aggressive and prolonged treatment of RSE may be justified in patients with cardiac arrest with favorable multimodal prognostic indicators

Epidemiology of childhood Guillan-Barre syndrome in the north west of Iran

<p>Abstract</p> <p>Background and aims</p> <p>This study was carried out to investigate the incidence, annual time trend and some epidemiological and clinical features of Guillain-Barre syndrome in children in the north west of Iran.</p> <p>Materials and methods</p> <p>In this population-based cross sectional research, epidemiological and clinical features of 143 cases with Guillain-Barre syndrome between 2001 and 2006 were studied. The setting of the study was Tabriz Children Medical Centre, the major University-Hospital located in Tabriz city of the East Azarbaijan province covering whole region. Data collected included age, gender, chronological information, preceding events, functional grade of motor deficit.</p> <p>Results</p> <p>The mean age (standard deviation) of subjects was 5.4 (3.6) years. The male/female ratio was 1.3. The average annual incidence rate was 2.27 per 100 000 population of 15 years children (CI95%: 1.9–2.6). The majority of cases occurred in March, July and November and the highest proportion of the syndrome was observed in winter (29 percent, P > 0.10).</p> <p>Conclusion</p> <p>The results indicated that an unexpected high incidence of Guillain-Barre syndrome has occurred in 2003 in the region. We concluded that a monitoring and surveillance system for Guillain-Barre syndrome is essential to set up in this region.</p

Guillain-Barré Syndrome and Preceding Infection with Campylobacter, Influenza and Epstein-Barr Virus in the General Practice Research Database

BACKGROUND: A number of infectious agents have previously been suggested as risk factors for the development of Guillain-Barré syndrome (GBS), but robust epidemiologic evidence for these associations is lacking. METHODS AND FINDINGS: We conducted a nested case-control study using data from the United Kingdom General Practice Research Database between 1991 and 2001. Controls were matched to cases on general practice clinic, sex, year of birth and date of outcome diagnosis in their matched case. We found positive associations between GBS and infection with Campylobacter, Epstein-Barr virus and influenza-like illness in the previous two months, as well as evidence of a protective effect of influenza vaccination. After correction for under-ascertainment of Campylobacter infection, the excess risk of GBS following Campylobacter enteritis was 60-fold and 20% of GBS cases were attributable to this pathogen. CONCLUSIONS: Our findings indicate a far greater excess risk of GBS among Campylobacter enteritis patients than previously reported by retrospective serological studies. In addition, they confirm previously suggested associations between infection due to Epstein-Barr virus infection and influenza-like illness and GBS. Finally, we report evidence of a protective effect of influenza vaccination on GBS risk, which may be mediated through protection against influenza disease, or result from a lower likelihood of vaccination among those with recent infection. Cohort studies of GBS incidence in this population would help to clarify the burden of GBS due to influenza, and any potential protective effect of influenza vaccination

PROGNOSTIC SIGNIFICANCE OF SYNDROMIC CLASSIFICATION IN NEWLY DIAGNOSED EPILEPSY PATIENTS

Purpose: To assess the frequency, timing, patterns and prognostic significance of change of the syndromic diagnosis in a cohort of newly diagnosed adults with epilepsy.Method: 180 newly diagnosed adults from an epilepsy centre were included and followed for 852.4 person years. For each patient, the syndromic diagnosis was made at entry according to simplified categories. Changes of the diagnostic categories were then recorded retrospectively during follow-up. A change of the syndromic diagnosis was made and dated, based on new data on seizure types and/or EEG findings and/or neuroimaging results. Using survival analysis, the cumulative time-dependent probability of change of syndromic category and of 2-year remission was measured. Differences were tested with the logrank test. A multivariate analysis was performed using Cox\u2019s proportional hazard function. Results: The sample included 104 men and 80women aged 15 through 84 years. At entry, 61 patients (33.9%) had partial epilepsies, 42 (23.3%) had generalised epilepsies, 19 (10.6%) had undetermined epilepsies, and 58 (32.2%) had isolated seizures. The syndromic diagnosis was changed during follow-up in 54 cases (30%). The cumulative probability of change was 10% at six months, 16%, 19%, and 25% at 12, 24, and 36 months. 83% of changes were in patients with isolated seizures who relapsed (45 cases). A total of 105 patients (58.3%) achieved 2-year remission. The cumulative probability of remission was similar when comparing patients with and without change of the syndromic diagnosis (log-rank 0.11; p = ns), after excluding those with isolated seizures at entry, and when adjusting for age, sex, disease duration at entry, and treatment in the multivariate analysis model. Conclusion: Except for isolated seizures, the syndromic diagnosis at entry changed infrequently (mostly during the first year) in adults and did not affect the chance of long-term remission of epilepsy

PROGNOSTIC SIGNIFICANCE OF SYNDROMIC CLASSIFICATION IN NEWLY DIAGNOSED EPILEPSY PATIENTS

Purpose: To assess the frequency, timing, patterns and prognostic significance of change of the syndromic diagnosis in a cohort of newly diagnosed adults with epilepsy.Method: 180 newly diagnosed adults from an epilepsy centre were included and followed for 852.4 person years. For each patient, the syndromic diagnosis was made at entry according to simplified categories. Changes of the diagnostic categories were then recorded retrospectively during follow-up. A change of the syndromic diagnosis was made and dated, based on new data on seizure types and/or EEG findings and/or neuroimaging results. Using survival analysis, the cumulative time-dependent probability of change of syndromic category and of 2-year remission was measured. Differences were tested with the logrank test. A multivariate analysis was performed using Cox\u2019s proportional hazard function. Results: The sample included 104 men and 80women aged 15 through 84 years. At entry, 61 patients (33.9%) had partial epilepsies, 42 (23.3%) had generalised epilepsies, 19 (10.6%) had undetermined epilepsies, and 58 (32.2%) had isolated seizures. The syndromic diagnosis was changed during follow-up in 54 cases (30%). The cumulative probability of change was 10% at six months, 16%, 19%, and 25% at 12, 24, and 36 months. 83% of changes were in patients with isolated seizures who relapsed (45 cases). A total of 105 patients (58.3%) achieved 2-year remission. The cumulative probability of remission was similar when comparing patients with and without change of the syndromic diagnosis (log-rank 0.11; p = ns), after excluding those with isolated seizures at entry, and when adjusting for age, sex, disease duration at entry, and treatment in the multivariate analysis model. Conclusion: Except for isolated seizures, the syndromic diagnosis at entry changed infrequently (mostly during the first year) in adults and did not affect the chance of long-term remission of epilepsy