Seizure : the journal of the British Epilepsy Association
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Review Case Reports
Seizure as the presenting sign for massive pulmonary embolism: case report and review of the literature.
A 50-year-old male with sudden syncope and witnessed seizure activity was discovered to have pulmonary emboli. Although he denied shortness of breath, d-dimer testing was positive and a ventilation-perfusion scan was positive for bilateral pulmonary emboli; cardiac ECHO also confirmed elevated right ventricular pressures. The literature on this unusual presentation for seizures as the initial manifestation of pulmonary embolism is reviewed. Clinicians need to be more aware that pulmonary embolism is important to consider within the differential diagnosis for unexplained new onset of seizure activity.
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Anterior thalamus (AN) has been shown to mediate seizures in both focal and generalized models. Specific regional increase in AN serotonergic activity was observed following AN-DBS in our pentylenetetrazol (PTZ) rodent model of acute seizures, and this increase may inhibit seizures and contribute to the mechanism of anticonvulsant DBS. ⋯ Increased serotonergic activity in AN raised PTZ seizure threshold, similar to DBS, but without preventing cortical bursting. 5-Carboxamidotryptamine, a 5-HT(7) agonist, demonstrated dose-dependent seizure inhibition. Methysergide proved to have an inverse, dose-dependent agonist property, antagonizing the action of AN-DBS at the highest dose. Anticonvulsant AN-DBS may in part act to selectively alter serotonin neurotransmission to raise seizure threshold.
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Propofol is associated with abnormal motor events resembling seizures, the exact nature of these events remains to be elucidated. We describe here a case of seizure-like activity after propofol-induced conscious sedation accompanied by a prolactin rise, together suggesting that the event was ictal.
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Meta Analysis
Central nervous system adverse effects of new antiepileptic drugs. A meta-analysis of placebo-controlled studies.
Systematic review and meta-analysis of the most frequent treatment-emergent central nervous system adverse events (CNS AEs) of new antiepileptic drugs (AEDs) from double-blind, add-on, placebo-controlled studies conducted in adult epileptic patients and identification of dose-adverse effect relationships. ⋯ No comparison between drugs was possible. One CNS AE was significantly more frequent for levetiracetam, two for zonisamide and gabapentin, three for lamotrigine and four for pregabalin and topiramate.
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Case Reports
Acute hepatic injury in four children with Dravet syndrome: valproic acid, topiramate or acetaminophen?
We describe four children with Dravet syndrome treated with the combination of valproic acid (VPA) and topiramate (TPM) who developed transient liver toxicity. The time-interval between fever, administration of acetaminophen, epileptic status and liver enzyme disturbances in our four cases suggests that accumulation of toxic acetaminophen-metabolites is possibly responsible for liver toxicity. If acetaminophen and its metabolites cause those liver problems in children treated with the combination of VPA and TPM, the advice to use acetaminophen for treating fever in children using this combination, should be changed. Only future clinical observations and research can solve this clinical dilemma.