Epilepsia
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Case Reports Comparative Study
Seizures lead to elevation of intracranial pressure in children undergoing invasive EEG monitoring.
To study the effects of intracranial subdural grid electrode placement and seizures on intracranial pressure (ICP) in children undergoing invasive EEG monitoring. ⋯ Seizures in general and generalized tonic-clonic seizures, in particular, increase ICP temporarily in patients who are undergoing invasive EEG monitoring with subdural grids.
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Comparative Study
Diagnostic inaccuracy in children referred with "first seizure": role for a first seizure clinic.
To determine (a) the range of diagnoses, and (b) the prevalence of previous seizures in children presenting to a first seizure clinic. ⋯ Diagnostic inaccuracy is common in first seizure. One quarter of children were incorrectly diagnosed as having a seizure while the diagnosis of epilepsy was missed in over one-third of children.
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Comparative Study
Association between HLA-B*1502 allele and antiepileptic drug-induced cutaneous reactions in Han Chinese.
A previous study conducted in Taiwan found a 100% association between HLA-B*1502 allele and carbamazepine-induced Stevens-Johnson syndrome (SJS) in Han Chinese subjects, with an extremely high odds ratio compared with carbamazepine-tolerant subjects (odds ratio = 2,504). We examined this association in 24 Hong Kong Han Chinese subjects who had cutaneous adverse reactions induced by different antiepileptic drugs (AEDs). ⋯ Further studies in larger samples of ethnically matched subjects should be conducted to confirm the findings. Identification of genetic polymorphisms predisposing to development of AED-induced SCR offers the possibility of avoiding these high-risk drugs in genetically susceptible individuals.
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Case Reports
Propofol-associated fatal myocardial failure and rhabdomyolysis in an adult with status epilepticus.
Propofol is increasingly used for the treatment of status epilepticus due to the ease of use and tolerability, even if safety data from randomized clinical trials are lacking. An association of high infusion rates of propofol (>5 mg/kg/h) for more than 48 h and constellation of acidosis, rhabdomyolysis, and cardiovascular collapse has been reported in children, but has only been described in a few adult cases. We report a case and autopsy findings of an adult who developed rhabdomyolysis and cardiac failure after receiving propofol for status epilepticus. ⋯ Preexisting antiepileptic medication may have exacerbated acidosis. Propofol infusion for the treatment of status epilepticus should be carefully weighted against its real risk to develop propofol infusion syndrome, and alternative agents such as benzodiazepines or barbiturates should be considered for first line therapy. If necessary, prolonged propofol infusion at high doses for the treatment of status epilepticus should be used with caution, and in all cases careful monitoring for rhabdomyolysis and acidosis must be performed.
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Comparative Study
Nonconvulsive status epilepticus in a neurological intensive care unit: profile in a developing country.
Nonconvulsive status epilepticus (NCSE) is an under-recognized cause of altered mental status. There are hardly any reported data on NCSE in developing countries. ⋯ The frequency of NCSE in the current study was comparable with those in prior reports from developed countries. CNS infections accounted for about a fifth of the etiology. Outcome was excellent in patients with nonacute symptomatic NCSE. Initial 60-min EmEEG may be performed in establishing the diagnosis of NCSE, but almost half of patients with NCSE will be missed with this approach.