1/119. Psychoneuroendocrine aspects of temporolimbic epilepsy. Part III: case reports.Many reproductive steroids have neuroactive effects that can modulate neuronal excitability and influence emotions. Emotional disorders may result when 1) abnormal endocrine states interact with normal brain, 2) normal endocrine states interact with abnormal brain, and 3) abnormal endocrine states interact with abnormal brain. An understanding of these pathogenetic relationships and the potential therapeutic role of reproductive hormones should lead to a more effective and comprehensive management of women and men with anxiety and mood disorders.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/119. Legal aspects of epilepsy.This article discusses issues of concern for physicians who treat patients with epilepsy. It particularly focuses on driving laws and employment of people with epilepsy. physicians are often asked to provide certification to state driving authorities regarding whether their patients are fit to drive; sometimes, they are required to report patients who experience seizures to the state. Potential liability areas for physicians are also discussed in this article. In addition, this article addresses the increasing importance of the physician's role in determining whether a person who has seizures can perform certain jobs safely, and discusses approaches the physician can take to assist employers in providing reasonable accommodations for people with epilepsy.- - - - - - - - - - ranking = 0.66666666666667keywords = state (Clic here for more details about this article) |
3/119. Attempted child-stealing: post-ictal psychosis and psychological distress.Baby-stealing is probably one of the more taboo crimes in our society. Its connection with psychological distress, while generally acknowledged, is not always well understood. In this paper we present an unusual and complex case of a woman who attempted to steal young babies while in a state of extreme psychological distress following epileptic seizures. While the post-epileptic state was characterized as 'psychotic' there were clear psychological antecedents to explain the form in which the postical psychosis was expressed. Treatment strategies included modification of medication regime and use of cognitive therapy to ameliorate the impact of postictal confusion.- - - - - - - - - - ranking = 2.4110013503915keywords = confusion, state (Clic here for more details about this article) |
4/119. Rectal diazepam: pitfalls of excessive use in refractory epilepsy.INTRODUCTION: The rectal administration of diazepam (DZP) has provided a safer existence to many epilepsy patients and their carers, when prolonged or serial seizures are present. However, in patients with frequent seizures, chronic, intermittent over-administration may occur, particularly in the presence of multihandicaps. methods: Six patients who experienced untoward effects from excessive rectal DZP are reported. In two patients, serial plasma levels of DZP and its active metabolites were monitored. RESULTS: Three patients exhibited a pattern of cyclic reappearance of seizures, interrupted by rectal DZP, followed by sedation and gradual awakening. The intervals were approximately 4 days. The three other patients had variable and complex symptoms with serial seizures and alternating states of tension, apathy, and sleepiness. The plasma levels of DZP and desmethyl-DZP showed rapid fluctuations. CONCLUSION: When rectal DZP is prescribed, chronic and excessive administration should be avoided. Fluctuating plasma-levels may probably support a cyclic reappearance of seizures in some patients. The combination of high bolus doses and a rapid drug clearance due to enzyme inducing co-medication may probably increase the risk for rebound reactions. Toxic, withdrawal, and epileptic symptoms may be intermingled and difficult to manage. A replacement strategy in the form of a prophylactic, oral, low dose benzodiaepine regimen may facilitate the discontinuation of this prescription pattern. Adequate counselling and medically appropriate, written directions for the use of rectal DZP is mandatory.- - - - - - - - - - ranking = 0.33333333333333keywords = state (Clic here for more details about this article) |
5/119. Paradoxical seizures in phenytoin toxicity.phenytoin toxicity is an uncommon problem seen in clinical practice. The predisposing factors for toxicity are hypoalbuminemia, chronic renal failure, hepatic dysfunction and drugs which interfere with phenytoin metabolism. Common manifestations of toxicity, like confusion and ataxia, are well known. A less well known phenomenon is paradoxical seizures. In this condition, seizures develop as the serum phenytoin level rises and decrease in frequency as levels drop. It may or may not be accompanied by other features of toxicity. We present three patients with paradoxical seizures; their serum phenytoin levels were 43.5 mcg/mL, 46.5 mcg/mL and 38.3 mcg/mL. In all cases, seizures were controlled by withdrawal of phenytoin and reduction of drug levels.- - - - - - - - - - ranking = 1.7443346837248keywords = confusion (Clic here for more details about this article) |
6/119. Noninvasive continuous monitoring of cerebral oxygenation periictally using near-infrared spectroscopy: a preliminary report.PURPOSE: To report on the use of near-infrared spectroscopy (NIRS) to examine the changes in cerebral oxygenation in the periictal period in patients with seizures. methods: Cerebral hemoglobin oxygen availability was monitored continuously and noninvasively with NIRS in three patients (one in the pediatric intensive care unit (ICU) and two in epilepsy-monitoring units) in conjunction with continuous EEG monitoring. Ictal events were recorded and compared with the pre-, intra-, and postictal periods for cerebral oxygen availability, as defined by oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (Hb), and the redox state of cytochrome oxidase (cytox). RESULTS: Several important preliminary observations were made by using this technology. First, a preictal increase in cerebral oxygenation began between 1 and 2 h and >10 h before the ictal event. Second, despite adequate perfusion, based on an observed increased HbO2, reduction in cytox indicates a perfusion-metabolism mismatch during seizure activity. Third, continued seizure activity and even isolated ictal events were associated with decreased cerebral oxygen availability. Fourth, differences in cerebral oxygen availability were noted between different types of seizures (e.g., electrographic seizures were accompanied by rapid reductions in HbO2 and cerebral blood volume without reduction of cytox, whereas electroclinical seizures were characterized by marked increases in HbO2 with or without reduction of cytox). CONCLUSIONS: In this preliminary report on the use of NIRS for patients with seizures, we believe that NIRS allows continuous and noninvasive monitoring of changes in cerebral oxygenation periictally, thereby permitting investigations into the pathophysiology of seizures and the exploration of the potential of cerebral oximetry as a tool for seizure localization.- - - - - - - - - - ranking = 0.33333333333333keywords = state (Clic here for more details about this article) |
7/119. Comparison of auras and triggering factors in epilepsy.case reports of five patients are presented, each with a specific aura at the onset of the seizures. All of these patients' had seizures during the waking state. Their auras were carefully replicated and presented to the patients under various conditions. The presentation of the auras evoked neither clinical nor EEG evidence of seizures. A sixth patient had seizures only when asleep which were preceded by vivid nightmares. Since the seizures occurred only when the patient was asleep, we considered that the seizures could be reflex in nature and evoked by a dream. Replication of the dream, however, did not evoke clinical or EEG evidence of epilepsy. The dreams, therefore, were auras or a part of the seizure complex.- - - - - - - - - - ranking = 0.33333333333333keywords = state (Clic here for more details about this article) |
8/119. Transient seizure disappearance due to bilateral striatal necrosis in a patient with intractable epilepsy.An 8-year-old girl had suffered from intractable epilepsy due to cortical dysplasia. She developed mycoplasma pneumonia with massive pleural effusion. fever continued for 3 weeks. Four weeks after the onset of this infection, she suddenly developed horizontal nystagmus, ataxia, choreoathetotic movements and confusion. CT disclosed swelling and low density of the heads of the caudate nuclei and putamina bilaterally. MRI revealed areas of symmetrical high intensity in the striatum on T2-weighted imaging. These lesions were thought to comprise bilateral striatal necrosis (BSN) mediated by the mycoplasma infection or wernicke encephalopathy. Six months later, she had completely recovered clinically. During the 6 months after BSN, she did not have any epileptic seizures. Her epileptic seizures reappeared thereafter at a lower frequency. The striatum may be involved in the propagation pathway for epileptic seizure activity in this patient.- - - - - - - - - - ranking = 1.7443346837248keywords = confusion (Clic here for more details about this article) |
9/119. Left temporal rhythmic electrical activity: a correlate for psychosis? A case report.It is well recognized that epileptic patients are at higher risk for acute or chronic psychotic states than non-epileptic subjects. Here we present intracranial depth electrode recordings during a psychotic episode in a 20-year-old woman who was referred for presurgical evaluation. Unrelated to her seizures, she presented acoustic hallucinations and delusions and became agitated for a duration of 18-24 hours. During this period, a new unusual pattern of sharp slow waves was seen semi-rhythmically every 2-3 sec from left anterior neocortical temporal areas. Her condition responded well to a treatment with haloperidol, but not with benzodiazepines. Ictal and interictal scalp- and depth-EEG recordings outside the psychotic episode as well as MRI-based volumetry, PET, SPECT and neuropsychological testing gave evidence of bilateral temporal and frontal dysfunction. This case report suggests that psychosis in epileptic patients may be based on a bilateral cerebral dysfunction linked together in a pathological network, but with a focal (here: left temporal) driving mechanism.- - - - - - - - - - ranking = 0.33333333333333keywords = state (Clic here for more details about this article) |
10/119. Three children with a syndrome of obesity and overgrowth, atypical psychosis, and seizures: a problem in neuropsychopharmacology.Three children presented with a complex syndrome of atypical psychotic and extremely immature behavior, obesity and overgrowth, borderline retardation, and seizures (prominent in two). Weight overgrowth exceeded height overgrowth and was stratospheric (up to 8 SD above mean). obesity seemed related to lack of satiety. The cases fit no known condition: hypothalamic damage, Sotos' syndrome, and prader-willi syndrome were excluded. Empirical treatment with anticonvulsants (carbamazepine and acetazolamide) together with psychotropic agents (selective serotonin reuptake inhibitors and risperidone) controlled seizures, improved behavior, and stopped weight gain in each patient. We have not found this syndrome previously described. The etiology is unknown: perinatal encephalopathy could be a factor in the two patients with prominent seizures; in the third, familial major affective disorder is implicated. Medication responses suggest a low-serotonin state underlying the lack of satiety, an imbalance of serotonin and noradrenergic modulation in the hypothalamus, and epileptogenic disorders (or affective disorder responsive to anticonvulsants in one case) involving these same systems.- - - - - - - - - - ranking = 0.33333333333333keywords = state (Clic here for more details about this article) |
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