20 research outputs found
Bruising following natalizumab infusion for relapsing-remitting multiple sclerosis: a case report
<p>Abstract</p> <p>Introduction</p> <p>Natalizumab is a new treatment for relapsing-remitting multiple sclerosis. Because of limited experience of this treatment, medical professionals must be alert to possible side effects.</p> <p>Case presentation</p> <p>We present a 34-year-old Caucasian woman with relapsing-remitting multiple sclerosis. She developed bruises on her legs after the first and second administrations of the new monoclonal antibody, natalizumab. Clinical and laboratory investigations revealed no hematological abnormalities. At the time of writing, she has remained on natalizumab treatment without any further side effects.</p> <p>Conclusion</p> <p>In our patient, bruises on the lower extremities may be a benign side effect of natalizumab. This is the first documented incidence of this side effect, and the patient did not require discontinuation of natalizumab treatment.</p
The prognostic value of electroencephalography in epilepsy: a long-term follow-up study
Predicting the evolution of epilepsy is of obvious importance for patients and their families. Value of electroencephalography (EEG) is extensively used in the diagnosis of epilepsy yet its role as a prognostication method remains unclear. The aim of the present retrospective study is to investigate the relationship between serial EEG recordings and long-term clinical and social outcomes in a cohort of patients with epilepsy. Thirty-nine epileptic patients were monitored clinically and with repeat EEG recordings for more than 15 years. All patients who initially had epileptiform discharges ended up with poor or moderate seizure control whereas more than half of the patients with normal initial recordings had good clinical outcomes and satisfactory social adjustment. Deterioration of the recordings over time was associated with unfavourable results in a significant proportion of patients (90 %), while stable or improved EEG findings predicted a favourable outcome. It is concluded that serial EEG recordings can be used in the prognostic evaluation of epilepsy
Depression and anxiety in epilepsy: the association with demographic and seizure-related variables
<p>Abstract</p> <p>Background</p> <p>Depression and anxiety are common psychiatric symptoms in patients with epilepsy, exerting a profound negative effect on health-related quality of life. Several issues, however, pertaining to their association with psychosocial, seizure-related and medication factors, remain controversial. Accordingly, the present study was designed to investigate the association of interictal mood disorders with various demographic and seizure-related variables in patients with newly-diagnosed and chronic epilepsy.</p> <p>Methods</p> <p>We investigated 201 patients with epilepsy (51.2% males, mean age 33.2 ± 10.0 years, range 16–60) with a mean disease duration of 13.9 ± 9.5 years. Depression and anxiety were assessed in the interictal state with the Beck Depression Inventory, 21-item version (BDI-21) and the state and trait subscales of the State-Trait Anxiety Inventory (STAI-S and STAI-T), respectively. The association of mood disorders with various variables was investigated with simple and multiple linear regression analyses.</p> <p>Results</p> <p>High seizure frequency and symptomatic focal epilepsy (SFE) were independent determinants of depression, together accounting for 12.4% of the variation of the BDI-21. The STAI-S index was significantly associated with the type of epilepsy syndrome (SFE). Finally, high seizure frequency, SFE and female gender were independent determinants of trait anxiety accounting for 14.7% of the variation of the STAI-T.</p> <p>Conclusion</p> <p>Our results confirm the prevailing view that depression and anxiety are common psychological disorders in epileptics. It is additionally concluded that female gender, high seizure frequency and a symptomatic epilepsy syndrome are independent risk factors for the development of anxiety and/or depression.</p
The surgical treatment of drug - resistant epilepsy of mesial temporal lobe
Objective. To evaluate the efficacy and safety of surgical treatment in medically intractable mesial temporal epilepsy, according to the protocol and procedures of Epilepsy Surgery Unit of the Athens University Medical School. Methods-Materials. We evaluated 60 patients suffering from drug resistant mesial temporal lobe epilepsy. Forty five patients underwent surgical resection. The candidates for surgical treatment were selected on the basis of clinical features, imaging findings, non invasive and invasive ictal recordings and the results of psychiatric and neuropsycological examination. They complete a two-year follow up following a complete presurgical evaluation. Results. Thirty two patients (71.1%) had become seizure free at their last follow-up visit. Thirty four (75.5%) needed a decreased number of antiepileptic medication and six patients (13.3%) were off antiepileptic drugs whereas twenty one patients (46.7%) showed substantial improvement in neurocognitive tasks as early as 12 months after surgery. Seventeen patients underwent anterior temporal lobectomy and 28 patients selective amygdalohippocampectomy. There was no mortality. The most frequent side effect was homonymous quadrantanopsia in thirty patients (67%) and the most serious hemiparesis was in one patient (2%).We found no correlation of age at onset of epilepsy, duration of epilepsy, febrile spasms, infection of the central nervous system and type of surgery with seizure outcome. Unexpectedly, the side of mesial temporal sclerosis and surgery-related seizure control postoperatively showed statistically significant difference in favor of the left mesial temporal sclerosis.None of the patients who were candidates for epilepsy surgery and refused the idea of surgical treatment is seizure free at the last follow-up visit. Furthermore, one of these patients died because of status epilepticus. Conclusion. Mesial temporal lobe epilepsy surgery is an effective and safe treatment procedure for patients with intractable mesial temporal lobe epilepsy. This result is similar to our conclusions that we have with the protocol used in our survey. Patients who denied epilepsy surgery continue to experience uncontrolled seizures and they have a negative impact on many aspects of their lives.Σκοπός. Ο σκοπός της παρούσας μελέτης είναι η παρουσίαση του προεγχειρητικού ελέγχου και των αποτελεσμάτων της χειρουργικής θεραπείας σε ασθενείς με ανθεκτική στα φάρμακα επιληψία του έσω κροταφικού λοβού.Μέθοδος - Υλικό. Μελετήθηκαν 60 ασθενείς, οι οποίοι υποβλήθηκαν σε προεγχειρητικό έλεγχο, σύμφωνα με το διαμορφωμένο πρωτόκολλο της Μονάδας της Χειρουργικής Θεραπείας της Επιληψίας και κρίθηκαν κατάλληλοι υποψήφιοι για χειρουργική θεραπεία της επιληψίας του έσω κροταφικού λοβού. Σαράντα πέντε ασθενείς υπεβλήθησαν σε χειρουργική θεραπεία. Εξ αυτών 38 ασθενείς εμφάνιζαν σκλήρυνση ιπποκάμπου και 7 ασθενείς κρίσεις από τον έσω κροταφικό λοβό οφειλόμενες σε αίτια πλην της ιπποκάμπιας σκλήρυνσης. Παράλληλα, συσχετίσθηκαν τα κλινικά, ηλεκτροφυσιολογικά, νευροαπεικονιστικά και νευροψυχολογικά δεδομένα και ο τύπος της χειρουργικής προσπέλασης με τη μετεγχειρητική πορεία των ασθενών. Δεκαπέντε ασθενείς κρίθηκαν κατάλληλοι υποψήφιοι μετά την ολοκλήρωση του προεγχειρητικού ελέγχου, αλλά δε χειρουργήθηκαν κυρίως λόγω άρνησής τους.Όλοι οι ασθενείς συμπλήρωσαν 2 έτη παρακολούθησης.ΑποτελέσματαΤριάντα δύο ασθενείς (71.1%) ήταν ελεύθεροι κρίσεων το δεύτερο μετεγχειρητικό έτος. Σε 34 ασθενείς (75.5%) μειώθηκε ο αριθμός των αντιεπιληπτικών φαρμάκων και έξι ασθενείς δε λαμβάνουν πλέον αντιεπιληπτική αγωγή.Η ηλικία έναρξης των κρίσεων, η διάρκεια της νόσου, η ηλικία των ασθενών όταν χειρουργήθηκαν, τα περιγεννητικά συμβάματα, οι λοιμώξεις του κεντρικού νευρικού συστήματος, οι πυρετικοί σπασμοί και η χειρουργική τεχνική δεν αποτελούν μεταβλητές που σχετίζονται με τη συχνότητα των κρίσεων μετεγχειρητικά ή τις επιπλοκές.Η πλευρά της βλάβης σχετιζόμενη με τον έλεγχο των κρίσεων μετεγχειρητικά ανέδειξε σημαντικά στατιστική διαφορά υπέρ της έσω κροταφικής σκλήρυνσης αριστερά (p<0,05).Πραγματοποιήθηκαν συνολικά 55 επεμβάσεις. Σε 7 ασθενείς απαιτήθηκε ενδοκράνια καταγραφή λόγω αντιφατικών ή ανεπαρκών δεδομένων από τον προεγχειρητικό έλεγχο. Δεκαεπτά ασθενείς υποβλήθηκαν σε πρόσθια κροταφική λοβεκτομή και 28 ασθενείς σε εκλεκτική αμυγδαλοϊπποκαμπεκτομή. Ο νευροψυχολογικός έλεγχος διενεργήθηκε σε 29 ασθενείς προεγχειρητικά και σε 22 μετεγχειρητικά. Σε 21 ασθενείς παρατηρήθηκε βελτίωση που αφορούσε κυρίως την ενεργό μνήμη. Στην ομάδα των ασθενών με ιπποκάμπια σκλήρυνση παρατηρήθηκε ήπια επιδείνωση στη μνημονική αναγνώριση προσώπων.Δύο ασθενείς με ενεργή ψυχωσική συμπτωματολογία προεγχειρητικά παρέμειναν ελεύθερες κρίσεων μετεγχειρητικά και παράλληλα διαπιστώθηκε πλήρης ύφεση των ψυχωσικών συμπτωμάτων.Η πιο συχνή επιπλοκή ήταν η ασυμπτωματική άνω τεταρτοκυκλική ημιανοψία που παρατηρήθηκε σε 30 ασθενείς (67%). Αριστερή ημιπληγία εμφάνισε μετεγχειρητικά ένας ασθενής (2%) παραμένοντας παράλληλα ελεύθερος κρίσεων.Στην ομάδα των ασθενών που δεν υποβλήθηκαν σε χειρουργική θεραπεία της επιληψίας, κανένας ασθενής δεν είναι ελεύθερος κρίσεων, ενώ υπήρξε και ένας θάνατος λόγω status epilepticus. Συμπέρασμα. Η χειρουργική θεραπεία της επιληψίας σύμφωνα με το πρωτόκολλο που εφαρμόζεται στην Μονάδα Χειρουργικής Θεραπείας της Ν/Χ Κλινικής του ΕΚΠΑ στο Νοσοκομείο «Ευαγγελισμός» είναι μία αποτελεσματική και ασφαλής θεραπεία για τους ασθενείς που πάσχουν από ανθεκτική στα φάρμακα επιληψία του έσω κροταφικού λοβού
Extensive Bilateral Intracranial Calcifications: A Case of Iatrogenic Hypoparathyroidism
This is a case of a 69-year-old male patient with long-standing iatrogenic hypoparathyroidism after total thyroidectomy. The clinical evaluation revealed mild neurological symptoms and excessive brain calcinosis. Intracranial calcification that affects structures other than the basal ganglia and the cerebellum is a rare manifestation of postoperative hypoparathyroidism. Detection of brain calcinosis in patients who had total thyroidectomy can motivate clinicians in further investigation of possible hypoparathyroidism with measurement of calcium and phosphorus serum levels
Oromandibular dystonia: a case report of the lateral pterygoid muscle involvement and treatment with botulinum toxin A
The objective of the present case report is to punctuate the importance of individualized therapy procedures and the accurate diagnosis of the muscles involved in oromandibular dystonia and underline the role of electromyography (EMG). We report a woman who presented sustained jaw movement towards the left, severe difficulty in jaw opening and jaw protrusion. The patient was treated with injections of botulinum A toxin in lateral pterygoid, masseter, platysma, sternoclidomastoid, temporalis muscles with EMG guidance. She experienced an 80% reduction of her symptoms after the first injection. In jaw deviation dystonia symptoms impressively respond to botulinum toxin treatment of the pterygoid muscle. Individualized therapy procedures are necessitated
Vertebrobasilar dolichoectasia induced hydrocephalus: the water-hammer effect
Vertebrobasilar dolichoectasia is a clinical entity associated rarely with obstructive hydrocephalus. We present a 48-year old male with a profound dilatation of the ventricular system due to a dolichoectatic basilar artery, as appeared in imaging studies. The patient suffered from longstanding hydrocephalus and presenile dementia. The underlying mechanism for obstructive hydrocephalus due to vertebrobasilar dolichoectasia is considered to be both a water-hammer effect and a direct compression of adjacent structures. We suggest prompt surgical intervention upon diagnosis as a first choice treatment in order to avoid further complications
Epidemiology of first epileptic seizures in the northern Aegean island of Lesvos, Greece
We aimed at establishing the epidemiologic profile of first epileptic
seizures (FES) in the Greek island of Lesvos. During a 1year period
(01/06/2010 to 31/05/2011), cases of FES admitted to the Lesvos General
Hospital/addressed by general practitioners/private neurologists were
prospectively identified. A total of 45 cases (30 males and 15 females;
mean age +/- SD of 59.4 +/- 28.4 and 58.9 +/- 26.8 years, respectively),
were collected. The FES incidence rate was 52.1 (95% CI 37-67) per 105
persons. Provoked and unprovoked FES had an incidence of, 16.2 and 35.9
cases per 105 persons, respectively. Following age-adjustment to the
2000 US census population, incidence rates of FES (all types combined)
were, 40.5 (95% CI 28-56) per 10(5) persons. Cerebrovascular disease
(CVD) was the most prevalent etiologic factor. The present findings
indicate a low-ranking incidence of FES in the studied population and
highlight CVD as a leading causative factor
Remission of drug-resistant epileptic psychosis following left selective amygdalohippocampectomy
We describe two female patients with drug-resistant mesial temporal lobe
epilepsy and chronic drug-resistant psychosis. In both patients, MRI
scans revealed left mesial temporal sclerosis. After clinical
assessment, ictal video/EEG monitoring, and a neuropsychological
evaluation including Wada testing, the patients underwent selective left
amygdalohippocampectomy. Since the operation, the two patients have
remained free of seizures for 17 and 15 months. During the same period,
both patients have sustained a full remission of the psychosis. (C) 2008
Elsevier Inc. All rights reserved