Diffusion tensor tractography imaging in pediatric epilepsy – A systematic review

Purpose Recent years brought several experimental and clinical reports applying diffusion tensor tractography imaging (DTI) of the brain in epilepsy. This study was aimed to evaluate current evidence for adding the DTI sequence to the standard diagnostic magnetic resonance imaging (MRI) protocol in pediatric epilepsy. Material and methods Rapid and qualitative systematic review (RAE, Rapid Evidence Assessment), aggregating relevant studies from the recent 7 years. The PubMed database was hand searched for records containing terms “tractography AND epilepsy.” Only studies referring to children were included; studies were rated using “final quality of evidence.” Results Out of 144 screened records, relevant 101 were aggregated and reviewed. The synthesis was based on 73 studies. Case-control clinical studies were the majority of the material and comprised 43.8% of the material. Low ‘confirmability’ and low ‘applicability’ referred to 18 and 17 articles (29.5% and 27.9%), respectively. The sufficient quality of evidence supported performing DTI in temporal lobe epilepsy, malformations of cortical development and prior to a neurosurgery of epilepsy. Conclusions The qualitative RAE provides an interim estimate of the clinical relevance of quickly developing diagnostic methods. Based on the critical appraisal of current knowledge, adding the DTI sequence to the standard MRI protocol may be clinically beneficial in selected patient groups with childhood temporal lobe epilepsy or as a part of planning for an epilepsy surgery

Spinal Cord Stimulation in Failed Back Surgery Syndrome: Review of Clinical Use, Quality of Life and Cost-Effectiveness

Failed back surgery syndrome (FBSS) is complex and recurrent chronic pain after spinal surgery. Several important patient and surgery related risk factors play roles in development of FBSS. Inadequate selection of the candidates for the spinal surgeries is one of the most crucial causes. The guidelines suggest that conservative management featuring pharmacologic approaches and rehabilitation should be introduced first. For therapy-refractory FBSS, spinal cord stimulation (SCS) is recommended in selected patients. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS. Cost-effectiveness of SCS still remains unclear. However evidence for SCS role in FBSS is controversial, SCS can be beneficial for carefully classified patients

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

  Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment. The aim of this review is to present the current treatment options for the management of central fever and to analyze recent recommendations for the treatment of hyperthermia, including the use of hypothermia. The recommendations of American and European associations are inconsistent, mainly due to the lack of randomized clinical trials confirming the effectiveness of such treatment. The diagnosis of central fever is still made by the exclusion of other causes. The authors of the review intended to present the characteristic features of central fever, differentiating this state from infectious fever and also analyze the presence of central fever in particular neurological diseases. It seems particularly important to establish diagnostic criteria for central fever or to find diagnostic markers. It is also necessary to conduct further randomized clinical trials evaluating the indications for treatment of hyperthermia.    Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment. The aim of this review is to present the current treatment options for the management of central fever and to analyze recent recommendations for the treatment of hyperthermia, including the use of hypothermia. The recommendations of American and European associations are inconsistent, mainly due to the lack of randomized clinical trials confirming the effectiveness of such treatment. The diagnosis of central fever is still made by the exclusion of other causes. The authors of the review intended to present the characteristic features of central fever, differentiating this state from infectious fever and also analyze the presence of central fever in particular neurological diseases. It seems particularly important to establish diagnostic criteria for central fever or to find diagnostic markers. It is also necessary to conduct further randomized clinical trials evaluating the indications for treatment of hyperthermia.

Współczesne leczenie drgawkowego stanu padaczkowego — algorytm leczenia i przegląd piśmiennictwa

The management of status epilepticus (SE) has changed in recent years. Substantial differences exist regarding the definition and time frame of a seizure, which has been operationally defined as lasting for 5 min. Not only have many new intravenous drugs, such as levetiracetam and lacosamide been introduced but other routes of administration, such as intranasal or buccal administration for midazolam, are also being developed. Optimal and successful therapy initiated at the appropriate moment, adequately tailored to the clinical state of the patient, determines the first step in the normalisation of vital functions and leads to the restoration of the physiological homeostatic mechanisms of the organism. The aim of this review is to present the current treatment options for the management of convulsive status epilepticus (CSE) that have been widely confirmed as the most effective in clinical trials and approved by the international neurology authorities as the actual therapeutic standards. We also intend to indicate distinct and unequivocal differentiation and therapeutic indications for each phase of CSE, including the precise doses of the related medications, to present practical guidelines for clinicians. The treatment of patients with CSE requires emergency physicians, neurologists and specialists in intensive care to work together to provide optimal care that should be initiated as soon as possible and conducted as a unified procedure to improve neurocritical care in patients who are transferred from the ambulance service, through the emergency department and finally to the neurology department or ICU. Appropriate treatment also involves avoiding mistakes associated with inadequate doses of medications, overdosing a patient or choosing an inappropriate medication.The management of status epilepticus (SE) has changed in recent years. Substantial differences exist regarding the definition and time frame of a seizure, which has been operationally defined as lasting for 5 minutes. Not only have many new intravenous drugs, such as levetiracetam and lacosamide been introduced but other routes of administration, such as intranasal or buccal administration for midazolam, are also being developed. Optimal and successful therapy initiated at the appropriate moment, adequately tailored to the clinical state of the patient, determines the first step in the normalisation of vital functions and leads to the restoration of the physiological homeostatic mechanisms of the organism. The aim of this review is to present the current treatment options for the management of convulsive status epilepticus (CSE) that have been widely confirmed as the most effective in clinical trials and approved by the international neurology authorities as the actual therapeutic standards. We also intend to indicate distinct and unequivocal differentiation and therapeutic indications for each phase of CSE, including the precise doses of the related medications, to present practical guidelines for clinicians. The treatment of patients with CSE requires emergency physicians, neurologists and specialists in intensive care to work together to provide optimal care that should be initiated as soon as possible and conducted as a unified procedure to improve neurocritical care in patients who are transferred from the ambulance service, through the emergency department and finally to the neurology department or ICU. Appropriate treatment also involves avoiding mistakes associated with inadequate doses of medications, overdosing a patient or choosing an inappropriate medication

Napadowe zwężenie źrenic – rzadka symptomatologia napadów ogniskowych.

Epileptic seizures, manifested by pupils’ size alteration without impairment of consciousness, may remain unnoticed or be mistaken with other nonepileptic events. There is a lack of comprehensive descriptions and evidence in the literature regarding seizures with pupillary autonomic manifestation as the isolated phenomena. This fact indicates the need of reporting the cases of focal autonomic seizures, clinically manifesting with pupillary changes, which should be discussed in order to remain aware of this rare seizure symptomatology and asses their actual frequency in a longer perspective. Therefore, we present clinical and diagnostic implications regarding a 3,5-year-old boy, diagnosed with focal seizures with autonomic component. There were no pregnancy and delivery complications and the psychomotor development was also normal. Interictal EEG revealed sharp waves in occipital and parieto- occipital regions, pronounced over the right hemisphere. MRI of the brain was normal. Hospital observation and video recording confirmed focal seizures with autonomic manifestation. He was successfully treated with carbamazepine and remains seizure free. Our findings provide the evidence that focal epileptic seizures are elusive and difficult to recognize. Capturing the seizures on video monitoring isessential to the diagnosis. Careful observation, proper diagnosis and early implementation of antiepileptic therapy may provide satisfactory and long-lasting improvement in managing the seizures.Napady padaczkowe, manifestujące się pod postacią zmiany szerokości źrenic, bez zaburzeń świadomości, mogą pozostać niezauważone lub niewłaściwie rozpoznane jako incydenty niepadaczkowe. W piśmiennictwie niewiele jest prac dotyczących napadów manifestujących się w postaci izolowanych zaburzeń autonomicznych, w tym napadowych zmian szerokości źrenic. Fakt ten wskazuje na utrzymującą się potrzebę dyskusji i uzupełniania literatury o doniesienia na temat napadów ogniskowych z objawami autonomicznymi, manifestujących się w postaci napadowych zmian szerokości źrenic, celem oszacowania rzeczywistej częstości występowania tego typu napadów. Mając na uwadze powyższe, przedstawiamy obraz kliniczny oraz implikacje diagnostyczne, dotyczące przypadku 3,5-letniego chłopca, bez obciążeń w wywiadzie ciążowo-okołoporodowym, rozwijającego się prawidłowo, z rozpoznaną padaczką z napadami ogniskowymi, manifestującymi się w postaci zaburzeń autonomicznych. W międzynapadowym zapisie EEG u chłopca stwierdzono fale ostre w okolicach ciemieniowo-potylicznych oraz potylicznych, głównie znad prawej półkuli mózgu. MRI mózgowia był prawidłowy. Obserwacja kliniczna oraz nagrania video potwierdziły występowanie napadów ogniskowych z objawami autonomicznymi, bez zaburzeń świadomości. Włączono terapię karbamazepiną, uzyskując ustąpienie napadów padaczkowych. Przedstawione przez nas dane kliniczne oraz wyniki badań ukazują, że semiologia występujących u chłopca ogniskowych napadów z komponentą autonomiczną możne stanowić duże wyzwanie diagnostyczne/budzić duże trudności diagnostyczne. Nagranie na video napadów o tej rzadkiej manifestacji klinicznej może stanowić podstawę ich rozpoznania i zaklasyfikowania. Uważna obserwacja kliniczna oraz właściwa diagnoza pozwala na szybkie rozpoczęcie właściwej i skutecznej terapii przeciwpadaczkowej