Short-term efficacy of ultramicronized palmitoylethanolamide in peripheral neuropathic pain.

Introduction. This study evaluates the efficacy of palmitoylethanolamide ultramicronized (PEA-um) as an add-on treatment in patients with diabetic or traumatic neuropathic pain (NP). Methods. 30 patients with chronic NP were assessed with Visual Analogue Scale (VAS), NP Symptom Inventory (NPSI), and Health Questionnaire Five Dimensions (EQ-5D), both at baseline and after 10 and 40 days of treatment with 1200 mg/die of PEA-um. All other therapies were maintained stable during the follow-up period. Results. VAS mean score significantly improved within the first 10 days, ranging from 8.20 ± 1.53 to 6.40 ± 1.83 (P<0.002), with a further decrease to 5.80 ± 2.04 (P<0.001) after 40 days of PEA-um administration. Moreover, NPSI total score improved from 5.2 ± 1.5 to 3.8 ± 2.1 (P: 0.025) and EQ-5D ranged from −0.30 ± 0.65 to 0.5 ± 0.34 (P<0.001) between T0 and T2. Conclusions. This study reports the prospective short-term efficacy data of oral PEA-um in patients with diabetic or traumatic NP. A significant improvement was observed both in VAS and NPSI scores and in quality of life scales after 40 days of treatment, although some limitations should be considered, including the short followup and the open-label study design

A rare case of intracranial malignant triton tumor arising in the middle cranial fossa: A case report and review of the literature

We describe a rare case of intracranial malignant triton tumor (MTT) arising in the middle cranial fossa in a 74-year-old female patient who had previously been exposed to radiation in the Chernobyl disaster. The patient underwent a surgical subtotal removal of the mass and radiation therapy, but the progression-free survival was only 2.5 months and death occurred four months after the onset of symptoms. MTTs are rare aggressive tumors arising from the nerve sheath showing rhabdomyosarcomatous differentiation and associated with a poor prognosis. The intracranial location is very rare, and only 10 cases, including the present report, have been described so far. Among intracranial MTTs, the cerebellopontine angle is the most common location. Neurofibromatosis type 1 (NF-1) and radiation exposure are risk factors as for MTTs located in other sites. The gold standard therapy is surgical excision followed by radiation therapy, but the prognosis is usually very poor

Analysis of shared common genetic risk between amyotrophic lateral sclerosis and epilepsy

Because hyper-excitability has been shown to be a shared pathophysiological mechanism, we used the latest and largest genome-wide studies in amyotrophic lateral sclerosis (n = 36,052) and epilepsy (n = 38,349) to determine genetic overlap between these conditions. First, we showed no significant genetic correlation, also when binned on minor allele frequency. Second, we confirmed the absence of polygenic overlap using genomic risk score analysis. Finally, we did not identify pleiotropic variants in meta-analyses of the 2 diseases. Our findings indicate that amyotrophic lateral sclerosis and epilepsy do not share common genetic risk, showing that hyper-excitability in both disorders has distinct origins

Emergent EEG: Indications and diagnostic yield

In a recent article, Varelas et al. 1 reviewed the indications and diagnostic yield of emergent EEG (EmEEG) and concluded that although EmEEG was ordered to rule out status epilepticus (SE) in 60.2% of cases, this diagnosis was performed in only 10.7% of patients. Their study was based on about 90% of cases of EmEEG requested in intensive care units, neurology, and neurosurgery services. We recently evaluated the role of EmEEG in a general hospital population. In the 1-year period (January\u2013December 2002), 434 of the 2453 EEG performed in our service (17.7%) could be identified as EmEEG. Of those, 105 were performed in 53 adult inpatients (mean age 71.1 \ub1 14.9 years) of internal medicine and surgery departments (several patients had more than one EEG record). We reviewed the reasons for EmEEG requests and the impact of EmEEG in the management of these patients according to a slightly modified version of the guidelines proposed by Hillen and Sage. 2 The most frequent causes of EmEEG request were acute confusional states (38 cases) and unexplained brief loss of consciousness (13 cases). Many patients had more than one etiologic factor. Major metabolic derangements including diabetes and electrolyte imbalance, liver or renal impairment were present in 23 cases (43.3%). Nine patients (16.9%) had cardiac or pulmonary disease; 15 patients (28.3%) had cancer with toxic encephalopathies or metastatic complications; and 5 patients (9.4%) had postsurgical complications. The EmEEG showed abnormalities in 50 patients (94.3%) and was deemed useful in 45 (84.9%). EEG findings and clinical data suggested generalized nonconvulsive status epilepticus (NCSE) in 9 patients with acute confusional state and showed focal epileptiform discharges in 3 patients. In internal medicine and surgery departments, the symptom most frequently resulting in requests for EmEEG was a sudden onset of altered mental status. EmEEG were useful in the management of hospitalized patients in about 85% of cases, and epileptiform abnormalities were found in 22.6% of the 53 patients. NCSE is a condition frequently underdiagnosed and confounded by coexisting disorders, and EEG patterns are suggestive but not pathognomonic. 3 In contrast with a recent report, 4 we believe that there are no unique clinical features of NCSE and only prolonged and serial EEG may help the diagnosis\u2014an integration of clinical data and EEG findings. 5 Despite the obvious importance of both neuroimaging and EmEEG, neither investigation can replace the neurologic consultation

Nonconvulsive status epilepticus during cephalosporin therapy

Cephalosporins may induce nonconvulsive status epilepticus (NCSE), a potentially reversible condition. Despite the wide use of these antibiotics, there are only few reported cases, because this condition is probably underestimated. We report two new cases of NCSE occurring during treatment with cefepime and ceftazidime, and emphasize the utility of emergent electroencephalogram in patients with an acute altered state of consciousness while receiving treatment with cephalosporins, particularly when there is evidence of impaired renal function