207 research outputs found
Carotid artery stenting with filter protection in high-risk patients showing severe electroencephalographic alterations during carotid endarterectomy
Purpose: To describe the results and efficacy of stent treatment in patients with carotid
stenosis who had aborted carotid endarterectomy procedures due to the appearance of
severe electroencephalographic (EEG) alterations.
Methods: A retrospective study was conducted of 18 patients (11 men; mean age 72 years,
range 62–84) with symptomatic high-grade carotid artery stenoses ( 70%) who experienced
severe EEG alterations during carotid endarterectomy, causing the procedure to be
aborted. Twelve patients had shown no hemodynamic alterations during preoperative
transcranial Doppler evaluation after external compression of the common carotid artery;
the remaining 6 could not be evaluated. The patients were referred for carotid artery stenting
(CAS); 7 had contralateral internal carotid artery stenosis and 5 had contralateral occlusion.
Endovascular intervention was carried out using standard techniques under filter
protection. Follow-up was scheduled at 3, 6, and 12 months.
Results: All patients were successfully treated without immediate complications. The EEG
did not display any significant alterations during the endovascular procedure. Mean followup
was 43 months. Magnetic resonance imaging at 6 months showed no signs of cerebral
ischemia. Color Doppler ultrasound imaging documented normal stent patency in all patients.
Conclusion: Patients with symptomatic severe carotid stenosis ( 70%) who are considered
at risk due to the appearance of severe EEG alterations during surgical treatment may
benefit from CAS with respect to both major and minor complications. Larger studies are
needed to confirm these findings.
J Endovasc Ther 2006;13:451–456
Key words: carotid endarterectomy, carotid artery, stenosis, electroencephalography, cerebral
ischemia, carotid angioplasty, sten
Increased cortical excitability after selective REM sleep deprivation in healthy humans: a transcranial magnetic stimulation study
REM sleep has antiepileptogenic properties whereas, its loss is known to have a proconvulsive role. However, the mechanisms underlying the proepileptogenic effects of REM sleep deprivation are yet not fully understood. The aim of our study was to evaluate the effects of selective REM sleep deprivation (SRD) on cortical excitability in healthy subjects by means of transcranial magnetic stimulation (TMS)
Is autonomic nervous system involved in restless legs syndrome during wakefulness?
OBJECTIVE: To investigate cardiovascular autonomic function in patients with restless leg syndrome (RLS) by means of cardiovascular reflexes and heart rate variability (HRV) during wakefulness.METHODS: Twelve RLS patients and 14 controls underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. HRV analysis was performed in the frequency domain using both autoregressive (AR) and fast Fourier transform algorithms in rest supine condition and during HUTT.RESULTS: There was a significant increase in systolic blood pressure values in supine rest condition and a trend toward a lower Valsalva ratio in RLS patients with respect to controls. The significant and physiological changes of HRV at HUTT detected in healthy subjects were not found in RLS patients. CONCLUSION: RLS patients exhibit a tendency toward hypertension, reduced amplitude of both sympathetic and parasympathetic responses at HUTT, as well as blunted parasympathetic drive to blood pressure changes. These findings, if confirmed by more controlled studies, might support the hypothesis of auonomic nervous system involvement during wakefulness and consequently an enhanced cardiovascular risk in RLS
Symptomatic nonconvulsive status epilepticus erroneously suggestive of sporadic Creutzfeldt-Jakob disease
Nonconvulsive status epilepticus (NCSE) may have heterogeneous presentations and differential diagnosis may be particularly difficult because clinical signs coupled with periodic EEG pattern are most often subtle or non-specific. Moreover, few cases of NCSE have been previously described as the presenting symptom of sporadic Creutzfeldt–Jakob disease (sCJD) [1,4,5,7]. We describe a patient with a NCSE strongly, but erroneously, suggestive of a probable sCJD
The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy
Glutamate is the brain’s main excitatory neurotransmitter. Glutamatergic neurons primarily compose basic neuronal networks, especially in the cortex. An imbalance of excitatory and inhibitory activities may result in epilepsy or other neurological and psychiatric conditions. Among glutamate receptors, AMPA receptors are the predominant mediator of glutamate-induced excitatory neurotransmission and dictate synaptic efficiency and plasticity by their numbers and/or properties. Therefore, they appear to be a major drug target for modulating several brain functions. Perampanel (PER) is a highly selective, noncompetitive AMPA antagonist approved in several countries worldwide for treating different types of seizures in various epileptic conditions. However, recent data show that PER can potentially address many other conditions within epilepsy and beyond. From this perspective, this review aims to examine the new preclinical and clinical studies—especially those produced from 2017 onwards—on AMPA antagonism and PER in conditions such as mesial temporal lobe epilepsy, idiopathic and genetic generalized epilepsy, brain tumor-related epilepsy, status epilepticus, rare epileptic syndromes, stroke, sleep, epilepsy-related migraine, cognitive impairment, autism, dementia, and other neurodegenerative diseases, as well as provide suggestions on future research agenda aimed at probing the possibility of treating these conditions with PER and/or other AMPA receptor antagonists
Zonisamide in the management of epilepsy in the elderly
Zonisamide (ZNS), a second-generation antiepileptic drug, indicated as add-on treatment of focal epilepsy, has been recently approved as monotherapy for the treatment of partial seizures in adults affected by newly diagnosed epilepsy in Europe. Evidence on the efficacy and tolerability of antiepileptic drugs in the elderly is still lacking as these patients are frequently excluded from clinical trials. Here, a comprehensive overview of available data regarding the use of ZNS in the treatment of epilepsy in elderly people is provided. In a pooled analysis conducted in patients aged 6565 years, no new/unexpected safety findings have emerged. Few data from uncontrolled investigations suggest that ZNS may be effective and well tolerated when administered as monotherapy or adjunctive antiepileptic treatment in the elderly. However, evidence from these observational studies is less than satisfactory, and randomized controlled trials focused on these patients are still needed
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Dreaming Characteristics in Non-Rapid Eye Movement Parasomnia and Idiopathic Rapid Eye Movement Sleep Behaviour Disorder: Similarities and Differences
Background: Speech graph analysis (SGA) of dreams has recently shown promise as an objective and language-invariant diagnostic tool that can aid neuropsychiatric diagnosis. Whilst the notion that dreaming mentations reflect distinct physiologic processes is not new, such studies in patients with sleep disorders remain exceptionally scarce. Here, using SGA and other dream content analyses, we set to investigate structural and thematic differences in morning dream recalls of patients diagnosed with Non-Rapid Eye Movement Parasomnia (NREMP) and Idiopathic REM Sleep Behavior Disorder (iRBD). Methods: A retrospective cross-sectional study of morning dream recalls of iRBD and NREMP patients was undertaken. Traditional dream content analyses, such as Orlinsky and Hall and Van de Castle analyses, were initially conducted. Subsequently, SGA was performed in order to objectively quantify structural speech differences between the dream recalls of the two patient groups. Results: Comparable rate of morning recall of dreams in the sleep laboratory was recorded; 25% of iRBD and 18.35% of NREMP patients. Aggression in dreams was recorded by 28.57% iRBD versus 20.00% in NREMP group. iRBD patients were more likely to recall dreams (iRBD vs NREMP; P = 0.007), but they also had more white dreams, ie having a feeling of having dreamt, but with no memory of it. Visual and quantitative graph speech analyses of iRBD dreams suggested stable sequential structure, reflecting the linearity of the chronological narrative. Conversely, NREMP dream reports displayed more recursive, less stable systems, with significantly higher scores of graph connectivity measures. Conclusion: The findings of our exploratory study suggest that iRBD and NREMP patients may not only differ on what is recalled in their dreams but also, perhaps more strikingly, on how dreams are recalled. It is hoped that future SGA-led dream investigations of larger groups of patients will help discern distinct mechanistic underpinnings and any associated clinical implications
Factors Influencing Generation Z Bachelor of Nursing Students’ Decision to Choose Nursing as a Career: A Pilot Study
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