Cases reported "Seizures"

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1/23. phenytoin/isradipine interaction causing severe neurologic toxicity.

    OBJECTIVE: To report a young man on phenytoin who developed acute neurologic symptoms after isradipine was introduced to his treatment regimen and discuss the possible causes of this drug interaction. CASE SUMMARY: A 21-year-old white man, with propionic acidemia and seizures treated with phenytoin and carbamazepine, was started on isradipine for essential hypertension. Soon thereafter, he developed acute and severe lethargy, ataxia, dysarthria, and weakness that resolved once isradipine was withheld. phenytoin concentrations were within normal limits or elevated, despite sequential reductions of phenytoin dosage, during concomitant isradipine administration. DISCUSSION: isradipine is a known inhibitor of the CYP450 isoenzyme family. Although the daily dose of phenytoin was decreased significantly, phenytoin blood concentrations remained high, suggesting a pharmacokinetic interaction. Previously, the patient had never had neurologic symptoms associated with increased phenytoin concentrations. This also indicates a likely pharmacodynamic interaction between phenytoin and the calcium-channel blocker. Both phenytoin and isradipine have been shown to bind to calcium channels and to inhibit calcium entry into the cells. Binding of isradipine to the brain has been described in humans and animals, and calcium-channel blockers have been shown to cause potentiation of anticonvulsant action of phenytoin. CONCLUSIONS: Acute pharmacokinetic and pharmacodynamic interactions between phenytoin and isradipine were probably responsible for the lethargy, dysarthria, ataxia, and weakness our patient developed. The combination of phenytoin and calcium-channel blockers should be used with caution.
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ranking = 1
keywords = animal
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2/23. pancytopenia induced by hypothermia.

    hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. Her recurrent cytopenias could not be explained by any etiology except chronic hypothermia. The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.
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ranking = 1
keywords = animal
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3/23. Seizure exacerbation associated with inhibition of progesterone metabolism.

    The reduced progesterone metabolite tetrahydroprogesterone is a potent positive modulator of GABA(A) chloride conductance that exerts powerful neuroinhibitiory and anti-seizure effects in animal models. Cyclic natural progesterone use may lessen seizure frequency in women with catamenial seizure exacerbation. We report a case in which efficacy was eliminated during concomitant treatment with a reductase inhibitor. The observation suggests that a reduced metabolite, rather than progesterone itself, was responsible for improved seizure control.
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ranking = 1
keywords = animal
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4/23. The effect of vagus nerve stimulation on migraines.

    vagus nerve stimulation (VNS) inhibits nociceptive behavior in animals. VNS might reduce pain in patients with VNS device implanted for intractable seizures. One case report described possible benefits on migraines. We contacted all patients who received VNS therapy for intractable epilepsy between 1993 and 1999 at Southern illinois University, Springfield, illinois. patients who had concomitant chronic pain were subsequently interviewed. Pain intensity before and after VNS implantation was rated by the patient as average, worst, and least and on numeric rating scale from 1 to 10. Current pain measurements were compared to preimplantation by using Global Pain Relief Rating Scale. Of 62 patients who received VNS, 27 patients were interviewed; 4 patients had common migraine, and no other chronic pain syndromes were identified. All patients with migraine reported reductions in headache frequency and numeric rating scale score for average and least headache intensity. One patient reported complete relief of headaches. Improvement was reported to start 1 to 3 months after initiation of therapy. On Global Pain Relief Rating Scale, 1 patient reported complete pain relief, 2 reported a lot of pain relief, and 1 reported slight pain relief. Concomitant antiepileptic drugs were decreased in 3 patients and slightly increased in 1. VNS might be beneficial for prophylactic therapy of migraine.
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ranking = 1
keywords = animal
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5/23. Carboxyatractyloside poisoning in humans.

    OBJECTIVE: Cocklebur (xanthium strumarium) is an herbaceous annual plant with worldwide distribution. The seeds contain the glycoside carboxyatractyloside, which is highly toxic to animals. We describe nine cases of carboxyatractyloside poisoning in humans which, to our knowledge, has not previously been reported. The clinical, laboratory and histopathological findings and our therapeutic approach are also discussed. SUBJECTS AND methods: The patients presented with acute onset abdominal pain, nausea and vomiting, drowsiness, palpitations, sweating and dyspnoea. Three of them developed convulsions followed by loss of consciousness and death. RESULTS: Laboratory findings showed raised liver enzymes, indicating severe hepatocellular damage. BUN and creatinine levels were raised, especially in the fatal cases who also displayed findings of consumption coagulopathy. CPK-MB values indicative of myocardial injury were also raised, especially in the fatal cases. Three of the patients died within 48 hours of ingesting carboxyatractyloside. Post-mortem histopathology of the liver confirmed centrilobular hepatic necrosis and renal proximal tubular necrosis, secondary changes owing to increased permeability and microvascular haemorrhage in the cerebrum and cerebellum, and leucocytic infiltrates in the muscles and various organs including pancreas, lungs and myocardium. CONCLUSIONS: Carboxyatractyloside poisoning causes multiple organ dysfunction and can be fatal. Coagulation abnormalities, hyponatraemia, marked hypoglycaemia, icterus and hepatic and renal failure are signs of a poor prognosis. No antidote is available and supportive therapy is the mainstay of treatment.
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ranking = 1
keywords = animal
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6/23. Circadian activity rhythms in selectively bred ethanol-preferring and nonpreferring rats.

    Chronic alcohol intake is associated with dramatic disruptions in sleep and other circadian biological rhythms in both humans and experimental animals. In human alcoholics, these disruptions persist during extended abstinence and appear to promote relapse to drinking. Whereas chronic ethanol intake alters fundamental properties of the circadian pacemaker in unselected rats, nothing is known concerning circadian pacemaker function in selectively bred ethanol-preferring and nonpreferring rats, which are the most widely accepted animal models of genetic predisposition to alcoholism. The present experiments were designed to characterize free-running circadian activity (wheel-running) rhythms under both constant darkness and constant light in selectively bred ethanol-preferring (P, HAD2) and nonpreferring (NP, LAD2) rats. Differences in circadian organization between ethanol-preferring and nonpreferring animals were seen for both pairs of selected lines (P vs. NP; HAD2 vs. LAD2), but these differences were not identical in the two line pairs. For example, although P rats showed shorter free-running periods than NP rats only in constant light, HAD2 rats showed shorter free-running periods than LAD2 rats only in constant darkness. In addition, ethanol-preferring HAD2 rats showed a high rate of rhythm "splitting" that was not seen in any of the other three lines. Taken together, these results suggest that the circadian pacemakers of P and NP rats differ mainly in light sensitivity, whereas those of HAD2 and LAD2 rats differ in their intrinsic period.
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ranking = 3
keywords = animal
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7/23. Levetiracetam reduces frequency and duration of epileptic activity in patients with refractory primary generalized epilepsy.

    PURPOSE: Levetiracetam (LEV) is a new antiepileptic drug highly effective as add-on treatment in refractory partial epilepsies. In animal models, LEV is effective against absence seizures. A limited number of case reports and series indicate that LEV reduces seizure frequency in patients with generalized epilepsies. METHOD: We evaluated with continuous EEG eight adult patients with idiopathic generalized epilepsy (IGE). All patients were refractory to the conventional therapy for IGE. Four patients received LEV as add-on therapy, and in four, a conversion to LEV monotherapy was undergone. Epileptic activity was analyzed in order to determine spike-wave density as well as median and maximal duration of spike-wave discharges. Each patient underwent a 24h EEG baseline monitoring before starting LEV therapy. A second 24h EEG examination was performed after a mean follow-up period of 136 days. RESULTS: Spike-wave density (spikes/h) was reduced by 78% after LEV administration. Median spike-wave duration decreased by 72% (p < 0.05). Maximal spike-wave duration was 6s before, and 1.5s after LEV with a percentage change of 81% (p < 0.05). The four patients on LEV monotherapy evidenced also a considerably improvement after conversion. CONCLUSIONS: This study showed that LEV produces a consistent long-term reduction of interictal epileptic activity in patients with refractory IGE. The reduction in the spike-wave activity additionally correlated with a clinically relevant antiepileptic effect. Our results support the concept that LEV could be an alternative therapy in primary generalized epilepsies.
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ranking = 1
keywords = animal
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8/23. Animal illness and human emotion. Neurologic problems.

    Clients' decisions are based on the veterinarian's ability to familiarize them with nervous system disease. Unfortunately, the nervous system does not lend itself to complete examination without advanced neurodiagnostic tests. These tests usually require general anesthesia, may be invasive, and often require advanced training. Therefore, a logical and orderly approach to animals with neurologic disease should be mastered. Problems can be avoided by educating the client about the extent of neurologic disease, the working diagnosis, pros and cons of diagnostic and therapeutic options, and a plan of action should unanticipated problems arise.
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ranking = 1
keywords = animal
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9/23. Cat scratch encephalopathy.

    Cat scratch disease is usually benign, self-limited and without sequelae. Margileth has established four clinical criteria, three of which must be satisfied to make the diagnosis: 1) a history of animal exposure, usually kitten, with primary skin or ocular lesions; 2) regional chronic adenopathy without other apparent cause; 3) a positive cat scratch disease antigen skin test; and 4) lymph node biopsy demonstrating noncaseating granulomas and germinal center hyperplasia. central nervous system involvement in cat scratch disease has been previously reported, although it is extremely uncommon. In a several-month period, we encountered two cases of cat scratch disease complicated by encephalopathy. The intents of this paper are twofold: 1) to briefly review the current literature on cat scratch disease, 2) to demonstrate that cat scratch disease complicated by encephalopathy presents acutely with seizures, posturing and coma and resolves rapidly with supportive care.
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ranking = 1
keywords = animal
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10/23. Controversies concerning neonatal seizures.

    Five issues are discussed with respect to the diagnosis, etiology, treatment, prognosis, and pathogenesis of neonatal seizures. The presentation of a newborn with seizures represents a true emergency and frequently indicates significant neurologic dysfunction or damage to the immature nervous system. Despite the urgency to establish a diagnosis, several unique aspects of neonatal seizures impede prompt recognition. In addition, several etiologic possibilities may be associated with seizures. The efficacy of antiepileptic drugs and the prediction of outcome of patients with neonatal seizures are controversial. Experimental research in developing animals suggests both a selective vulnerability and resistance of the brains of immature animals subjected to neonatal seizures.
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ranking = 2
keywords = animal
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