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Metoclopramide-induced Acute Dystonia Misdiagnosed as an Epileptic Seizure in a Lupus Patient. 甲氧氯丙胺引起的急性肌张力障碍误诊为狼疮患者癫痫发作。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21025
Airenakho Emorinken, Oluwaseun Remi Agbadaola

Acute dystonic reactions are the most prevalent extrapyramidal adverse effects associated with metoclopramide. It could be mistaken for a variety of other conditions, such as seizures, tetanus, and encephalitis, to name a few possibilities. We present a case of a 26-year-old female misdiagnosed as having an epileptic seizure who was rushed to the emergency unit with an involuntary bilateral upward deviation of the eyes, spasm, stiffness, lateral deviation of the neck, and protrusion of the tongue. Symptoms occurred 36 hours after the commencement of metoclopramide, used to treat nausea and vomiting in the referring hospital. All the laboratory work was normal. The drug was discontinued and 5 mg of intravenous biperiden was administered. The symptoms subsided in about 10 minutes with no recurrence. Metoclopramide-induced acute dystonia not only creates an anxious environment for patients but may also be life-threatening. Due to the high probability of misdiagnosis, detailed drug history and a high index of suspicion are critical in making the correct diagnosis.

急性张力障碍反应是与甲氧氯普胺相关的最常见的锥体外系不良反应。它可能被误认为各种其他疾病,如癫痫、破伤风和脑炎,仅举几个可能性。我们提出一个病例26岁的女性被误诊为癫痫发作谁是匆忙到急诊室与不自主的双侧上偏的眼睛,痉挛,僵硬,颈部外侧偏,和舌头突出。症状发生在转介医院用于治疗恶心和呕吐的甲氧氯普胺开始使用36小时后。所有的实验室工作都很正常。停用该药,静脉注射双哌啶5毫克。症状约10分钟消退,无复发。甲氧氯丙胺引起的急性肌张力障碍不仅给患者造成焦虑的环境,而且可能危及生命。由于误诊的可能性高,详细的用药史和高怀疑指数是做出正确诊断的关键。
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引用次数: 1
Parameters of Oxidative Stress and Behavior in Animals Treated with Dexametasone and Submitted to Pentylenetetrazol Kindling. 地塞米松处理和戊四氮点燃动物的氧化应激参数和行为。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21017
Edson Fernando Muller Guzzo, Gabriel de Lima Rosa, Rafael Padilha Bremm, Caroline Paula Meska, Carmen Regla Vargas, Adriana Simon Coitinho

Background and purpose: Oxidative stress (OS) is defined as an excessive production of reactive oxygen species that cannot be neutralized by the action of antioxidants, but also as an alteration of the cellular redox balance. The relationship between OS and epilepsy is not yet fully understood. The objective of this study was to evaluate the effect of dexamethasone on OS levels and memory in the kindling model induced by pentylenetetrazole.

Methods: The animals were divided in six groups: control group that received no treatment, vehicle group treated with vehicle, diazepam group, and groups treated with dexamethasone (1, 2 and 4 mg/kg). Treated animals received pentylenetetrazole in alternated days for 15 days. Inhibitory avoidance test was conducted in 2 hours and OS was evaluated after animal sacrifice.

Results: Regarding the treatment with dexamethasone, there was no significant difference when compared to the control groups in relation to the inhibitory avoidance test. On OS levels, there was a decrease in catalase activity levels in the hippocampus and an increase in thiobarbituric acid reactive substances and glutathione peroxidase levels in the hippocampus.

Conclusions: The anticonvulsant effect of dexametasone remains uncertain. Immunological mechanisms, with the release of cytokines and inflammatory mediators, seem to be the key to this process. The mechanisms that generate OS are probably related to the anticonvulsant effects found.

背景和目的:氧化应激(OS)被定义为活性氧的过量产生,不能被抗氧化剂的作用中和,也可以作为细胞氧化还原平衡的改变。OS和癫痫之间的关系尚不完全清楚。本研究的目的是评价地塞米松对戊四唑点燃模型大鼠OS水平和记忆的影响。方法:将大鼠分为6组:不给药对照组、给药组、地西泮组、地塞米松组(1、2、4 mg/kg)。治疗动物隔天服用戊四唑,共15天。2 h后进行抑制回避试验,动物祭祀后评价OS。结果:在地塞米松治疗方面,与对照组相比,在抑制性回避测试方面无显著差异。在OS水平下,海马中过氧化氢酶活性水平降低,海马中硫代巴比妥酸活性物质和谷胱甘肽过氧化物酶水平升高。结论:地塞米松的抗惊厥作用尚不确定。随着细胞因子和炎症介质的释放,免疫机制似乎是这一过程的关键。产生OS的机制可能与所发现的抗惊厥作用有关。
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引用次数: 1
A Rare Case of 3:1 Alpha Variant. 3:1 α变体的罕见案例。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21024
Seolah Lee, Sang Kun Lee

Since the first documentation of slow alpha variants in Goodwin et al., there has been a single case report with an actual electroencephalography (EEG). However, any further case has not been reported since then, and neurologists are still unfamiliar with its presence due to its scarcity. Here, we present a rare case of 3:1 subharmonic alpha variant in a hope to acquaint EEG interpretations and speculate upon its benign nature.

自Goodwin等人首次记录慢α变异以来,只有一例实际脑电图(EEG)报告。然而,从那时起,任何进一步的病例都没有报道,神经学家仍然不熟悉它的存在,因为它的稀缺性。在这里,我们提出了一个罕见的3:1次谐波α变异的情况下,希望熟悉脑电图的解释和推测其良性性质。
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引用次数: 0
Predictors of Seizure Recurrence in Solitary Calcified Neurocysticercosis in Relation to Computed Tomography Scan: Prospective Observational Study. 孤立钙化神经囊虫病癫痫复发的预测因素与计算机断层扫描的关系:前瞻性观察研究。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21018
Shinu Singla, Ravindra K Garg, Rajesh Verma, Hardeep S Malhotra, Imran Rizvi, Neeraj Kumar, Ravi Uniyal, Shweta Pandey, Anit Parihar, Praveen Sharma

Background and purpose: Solitary calcified neurocysticercosis (NCC) on the computed tomography (CT) scan of brain in patients of epilepsy is common finding in endemic regions. Factors causing seizures in such cases are debatable. Immature calcification may be the causative factor for seizure recurrence. Thus, we aimed to study predictors of seizure recurrence specific to morphological characteristics on CT scan.

Methods: Patients with solitary calcified NCC on CT scan brain and active seizures were prospectively included. The protocol included clinical evaluation, contrast-enhanced CT scan of the brain, and electroencephalogram (EEG) at baseline and 9th month of 1-year follow-up in all patients. Seizure recurrence after 1 week of enrolment was recorded.

Results: One hundred twenty patients with a mean age of 23.33±12.81 years were included with a final follow-up of 109 patients and 35 patients had seizure recurrence. On univariate analysis, seizure frequency of more than 1 episode/month (45.7% vs. 25.7%, p=0.037; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.05-5.68), perilesional edema on CT head (45% vs. 10.8%, p<0.001; OR, 6.95; 95% CI, 2.58-18.7), lower density (HU) of lesion on CT head (139.85±76.54 vs. 204.67±135.9 HU p=0.009) and abnormal EEG at presentation (p<0.001; OR, 18.25; 95% CI, 2.15-155.13) were significantly associated with seizure recurrence. On multivariate analysis, presence of perilesional edema on CT head (p=0.001; OR, 6.854; 95% CI, 2.26-20.77), density of lesion on CT (HU) (p=0.036; OR, 0.995; 95% CI, 0.99-1) and abnormal EEG (p=0.029; OR, 12.125; 95% CI, 1.29-113.74) were independently associated with seizure recurrence.

Conclusions: The presence of perilesional edema, HU of calcification on CT brain, and abnormal EEG suggest an increased risk of seizure recurrence in patients of epilepsy with solitary calcified NCC.

背景与目的:癫痫患者的CT扫描显示孤立性钙化神经囊虫病(NCC)在流行地区很常见。在这种情况下引起癫痫发作的因素是有争议的。未成熟的钙化可能是癫痫复发的原因。因此,我们的目的是研究癫痫发作复发的预测因素,具体到CT扫描的形态学特征。方法:前瞻性纳入CT扫描的单发钙化NCC伴活动性癫痫发作患者。该方案包括所有患者的临床评估、脑CT增强扫描和基线和1年随访第9个月的脑电图(EEG)。记录入组1周后癫痫复发情况。结果:纳入120例患者,平均年龄23.33±12.81岁,最终随访109例,癫痫复发35例。单因素分析中,癫痫发作频率大于1次/月(45.7% vs. 25.7%, p=0.037;优势比[OR], 2.06;95%可信区间[CI], 1.05-5.68)、CT头部病灶周围水肿(45% vs. 10.8%, pp=0.009)和首发时脑电图异常(pp=0.001;或者,6.854;95% CI, 2.26-20.77), CT上病变密度(HU) (p=0.036;或者,0.995;95% CI, 0.99-1)和脑电图异常(p=0.029;或者,12.125;95% CI, 1.29-113.74)与癫痫复发独立相关。结论:病灶周围水肿、CT脑钙化HU、脑电图异常提示孤立性钙化NCC患者癫痫复发风险增加。
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引用次数: 0
Pulse Methylprednisolone with Oral Prednisolone versus Adrenocorticotropic Hormone in Children with West Syndrome: a Randomized Controlled Trial. 脉冲甲泼尼龙与口服泼尼松龙对比促肾上腺皮质激素治疗韦斯特综合征患儿:随机对照试验。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21020
Kanij Fatema, Mizanur Rahman, Mohammad Monir Hossain, Shaheen Akhter, Dewan Afsana Shomee, Sohela Akhter, Mazharul Mannan

Background and purpose: West syndrome is an epileptic encephalopathy of infancy. According to guidelines, adrenocorticotrophic hormone (ACTH) is probably effective for the short-term management of infantile spasm, but there is little uniformity in treatment due to variable response. This study has been done to evaluate the efficacy of pulse methylprednisolone as compared to ACTH in children with West syndrome.

Methods: Children between 3 months to 24 months with the diagnosis of West syndrome were included and ACTH and pulse methyl prednisolone followed by oral prednisolone were given after randomization. Total duration of treatment was 6 weeks in both groups.

Results: Total 87 children were enrolled; 12 patients lost in follow up. Finally, 43 received ACTH and 32 received pulse methylprednisolone. In pulse methylprednisolone group, 28.13% showed 50-80% response, 28.13% showed 80-99% response and 21.87% patients showed 100% response. In ACTH group, 41.86% showed 50-80% response, 25.58% showed 80-99% response and only 3 (6.97%) patients showed 100% response. Methylprednisolone treatment regimen did not cause significant or persistent adverse effects.

Conclusions: Pulse methylprednisolone followed by oral prednisolone for 6 weeks is as effective as ACTH. Thus, methylprednisolone therapy can be an important alternative to ACTH.

背景和目的:韦斯特综合征是一种婴儿期癫痫性脑病。根据指南,肾上腺皮质激素(ACTH)可能对婴儿痉挛症的短期治疗有效,但由于反应不一,治疗方法几乎没有统一性。本研究旨在评估脉冲甲基强的松龙与促肾上腺皮质激素相比对韦斯特综合征患儿的疗效:方法:纳入 3 个月至 24 个月的诊断为韦斯特综合征的儿童,在随机分配后给予促肾上腺皮质激素和脉冲甲基强的松龙,然后口服强的松龙。两组的总治疗时间均为 6 周:结果:共有 87 名儿童入组;12 名患者失去了随访机会。最后,43 名儿童接受了促肾上腺皮质激素治疗,32 名儿童接受了脉冲甲基强的松龙治疗。在脉冲甲基强的松龙组中,28.13%的患者有50%-80%的反应,28.13%的患者有80%-99%的反应,21.87%的患者有100%的反应。在促肾上腺皮质激素组中,41.86%的患者有 50-80% 的反应,25.58% 的患者有 80-99% 的反应,只有 3 名(6.97%)患者有 100% 的反应。甲基强的松龙治疗方案没有引起明显或持续的不良反应:脉冲甲基强的松龙后口服强的松龙 6 周的疗效与促肾上腺皮质激素相同。因此,甲基强的松龙疗法可以作为促肾上腺皮质激素的重要替代疗法。
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引用次数: 0
Early Combination Therapy of Ketamine and Midazolam in Patients with Refractory Status Epilepticus in Hemodynamic Unstable State. 氯胺酮与咪达唑仑早期联合治疗血液动力学不稳定的难治性癫痫持续状态。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21023
Jung-Won Choi, Jung-Won Shin

The use of anesthetics is inevitable to suppress seizure activity in refractory status epilepticus (RSE). Hypotension, which is a critical side effect observed when treating RSE using a higher dosage of anesthetics that enhance γ-aminobutyric acid (GABA) activity, often requires vasopressor agents. Concomitant treatment with N-methyl-D-aspartate (NMDA) receptor antagonists, such as ketamine, could be effective in prolonged refractory SE, while maintaining stable blood pressure owing to the blockage of catecholamine reuptake in the systemic circulation. We report two cases of patients who had RSE with hemodynamic instability treated promptly with an early combination of ketamine and low-dose midazolam. The combination treatment effectively suppressed epileptic discharge with less hemodynamic side effects; moreover, a low dose of midazolam was required when combined with ketamine therapy. The initial combination of a third-line therapy that blocks NMDA receptors with enhanced GABAergic activity could be useful in RSE. Further studies are necessary in many variable etiologies of SE.

在难治性癫痫持续状态(RSE)中,使用麻醉剂抑制癫痫发作是不可避免的。低血压是使用高剂量增强γ-氨基丁酸(GABA)活性的麻醉剂治疗RSE时观察到的一个关键副作用,通常需要血管加压剂。与n -甲基- d -天冬氨酸(NMDA)受体拮抗剂(如氯胺酮)联合治疗可有效治疗长期难治性SE,同时由于儿茶酚胺在体循环中的再摄取受阻而维持稳定的血压。我们报告了两例伴有血流动力学不稳定的RSE患者,早期及时联合氯胺酮和低剂量咪达唑仑治疗。联合用药能有效抑制癫痫放电,血流动力学副作用小;此外,当与氯胺酮联合治疗时,需要低剂量的咪达唑仑。阻断NMDA受体和增强gaba能活性的三线治疗的初始联合可能对RSE有用。SE的多种病因需要进一步研究。
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引用次数: 3
The Role of Focal Epilepsy Features in Defining SCN1A Mutation-positive Dravet Syndrome as Generalized and Focal Epilepsy. 局灶性癫痫特征在定义SCN1A突变阳性Dravet综合征为全身性癫痫和局灶性癫痫中的作用
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21019
Young Jun Ko, Il Han Yoo, Jiwon Lee, Jeehun Lee, Mi-Sun Yum, Tae-Sung Ko, Hunmin Kim, Hee Hwang, Soo Yeon Kim, Jong-Hee Chae, Ji-Eun Choi, Ki Joong Kim, Byung Chan Lim

Background and purpose: This study was aimed to describe focal epilepsy features of SCN1A mutation-positive Dravet syndrome patients.

Methods: A total of 82 SCN1A mutation-positive patients were reviewed retrospectively (39 boys and 43 girls). Seizure type and electroencephalography (EEG) findings were investigated according to the stage, disease onset, and steady state (after age 2 years). Long-term video EEG data were used to classify the seizure type.

Results: Focal seizures at onset and the steady state were found in 54.9% (45/82) and 90% (63/70) of patients, respectively. Afebrile focal seizures were an initial seizure in about one fourth of the patients (22/82, 26.8%). Of 48 seizures captured during long-term video EEG monitoring of 30 patients, 19 seizures were classified as focal onset (39.6%). Of the 19 focal seizures, 12 were either focal motor or focal non-motor seizures, and seven were focal onset bilateral tonic-clonic seizure. Focal epileptiform discharges were more frequent than generalized epileptiform discharges at seizure onset and during the clinical course on conventional EEG (3.7% vs. 0%, 52.9% vs. 32.9%, respectively).

Conclusions: Our study provides a comprehensive description of focal epilepsy features of SCN1A mutation-positive Dravet syndrome patients. Recognizing these features as defining the clinical spectrum of Dravet syndrome may lead to earlier genetic diagnosis and tailored management.

背景与目的:本研究旨在描述SCN1A突变阳性Dravet综合征患者局灶性癫痫的特征。方法:回顾性分析82例SCN1A突变阳性患者(男39例,女43例)。根据阶段、发病和稳定状态(2岁以后)调查癫痫发作类型和脑电图(EEG)结果。采用长期视频脑电图数据对癫痫发作类型进行分类。结果:54.9%(45/82)的患者出现局灶性发作,90%(63/70)的患者出现稳态局灶性发作。约1 / 4的患者(22/82,26.8%)以发热性局灶性癫痫为首发。30例患者长期视频脑电图监测48次发作,其中局灶性发作19次(39.6%)。在19例局灶性癫痫发作中,12例为局灶性运动性或局灶性非运动性癫痫发作,7例为局灶性双侧强直阵挛性癫痫发作。癫痫发作时局灶性癫痫样放电比全局性癫痫样放电更频繁(分别为3.7%对0%,52.9%对32.9%)。结论:我们的研究提供了SCN1A突变阳性Dravet综合征患者局灶性癫痫特征的全面描述。认识到这些特征可以定义Dravet综合征的临床谱,可能会导致早期的遗传诊断和量身定制的管理。
{"title":"The Role of Focal Epilepsy Features in Defining <i>SCN1A</i> Mutation-positive Dravet Syndrome as Generalized and Focal Epilepsy.","authors":"Young Jun Ko,&nbsp;Il Han Yoo,&nbsp;Jiwon Lee,&nbsp;Jeehun Lee,&nbsp;Mi-Sun Yum,&nbsp;Tae-Sung Ko,&nbsp;Hunmin Kim,&nbsp;Hee Hwang,&nbsp;Soo Yeon Kim,&nbsp;Jong-Hee Chae,&nbsp;Ji-Eun Choi,&nbsp;Ki Joong Kim,&nbsp;Byung Chan Lim","doi":"10.14581/jer.21019","DOIUrl":"https://doi.org/10.14581/jer.21019","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study was aimed to describe focal epilepsy features of <i>SCN1A</i> mutation-positive Dravet syndrome patients.</p><p><strong>Methods: </strong>A total of 82 <i>SCN1A</i> mutation-positive patients were reviewed retrospectively (39 boys and 43 girls). Seizure type and electroencephalography (EEG) findings were investigated according to the stage, disease onset, and steady state (after age 2 years). Long-term video EEG data were used to classify the seizure type.</p><p><strong>Results: </strong>Focal seizures at onset and the steady state were found in 54.9% (45/82) and 90% (63/70) of patients, respectively. Afebrile focal seizures were an initial seizure in about one fourth of the patients (22/82, 26.8%). Of 48 seizures captured during long-term video EEG monitoring of 30 patients, 19 seizures were classified as focal onset (39.6%). Of the 19 focal seizures, 12 were either focal motor or focal non-motor seizures, and seven were focal onset bilateral tonic-clonic seizure. Focal epileptiform discharges were more frequent than generalized epileptiform discharges at seizure onset and during the clinical course on conventional EEG (3.7% vs. 0%, 52.9% vs. 32.9%, respectively).</p><p><strong>Conclusions: </strong>Our study provides a comprehensive description of focal epilepsy features of <i>SCN1A</i> mutation-positive Dravet syndrome patients. Recognizing these features as defining the clinical spectrum of Dravet syndrome may lead to earlier genetic diagnosis and tailored management.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"11 2","pages":"127-135"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/07/jer-21019.PMC8767227.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Therapeutic Challenge in a Case of Recent Onset Refractory Cluster Seizures. 一例新近发作的难治性丛集性癫痫的治疗挑战。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21022
Sachin Sureshbabu, Muralikrishnan Veleri Padmanabhan, Jacob Alappat, Smilu Mohanlal, Sujith Janardhanan, Sellam Karunanidhi, Lakshminarayan Kannan, Dinesh Nayak, Biju Shekhar

A dilemma exists in context to the timing of surgery in a case presenting with explosive onset seizures secondary to a focal cortical dysplasia (FCD). This case report highlights the challenges faced in the management of a 4-year-old child with recent onset cluster seizures refractory to anti-epileptic drugs. A 4-year-old girl presented with an acute onset of cluster seizures (up to 32 in a day), semiologically characterized by tonic upper limb extension and laughter lasting for few seconds with no response to multiple anti-epileptic drugs. The clinical, electrographic, neuroimaging and interictal positron emission tomography data were concordant and consistent with a left middle frontal gyrus dysplasia which was successfully resected under electrocorticographic guidance. Patient is seizure free at 2 months of follow up. (Engel Class 1). Surgical resection is feasible and potentially more effective in the early phase of clinical presentation of FCD.

一个进退两难的情况下,手术的时机存在的情况下,表现为继发于局灶性皮质发育不良(FCD)的爆炸性发作癫痫发作。本病例报告强调了在管理一名4岁儿童与最近发作的丛集性癫痫难抗抗癫痫药物所面临的挑战。1例4岁女孩急性发作集束性癫痫发作(一天多达32次),符号学特征为强直性上肢伸展和持续数秒的笑声,对多种抗癫痫药物无反应。临床,电图,神经影像学和间期正电子发射断层扫描数据与左额叶中回发育不良一致,并在皮质电图引导下成功切除。随访2个月,患者无癫痫发作。手术切除在FCD临床表现的早期阶段是可行的,并且可能更有效。
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引用次数: 0
Cell-based Therapy Approach for Drug-resistant Epilepsy. 耐药性癫痫的细胞治疗方法。
Pub Date : 2021-12-31 eCollection Date: 2021-12-01 DOI: 10.14581/jer.21021
Pradeep V Mahajan, Swetha Subramanian, Siddhesh C Parab, Sanskruti Mahajan

Drug-resistant epilepsy (DRE) is a global public health problem. This category includes patients who continue to experience seizures despite long-term anti-epileptic medications. DRE can lead to severe disability and morbidity in older children and adults and is associated with increased risk of mortality than the general population. This report describes the case of a 15-year-old male patient with DRE successfully managed with autologous cell-based and hyperbaric oxygen therapy. The patient underwent two sessions of cell-based therapy consisting of cells derived from the bone marrow, adipose tissue, and peripheral blood followed by neuro-physiotherapy and oxygen therapy. Post-treatment, the patient experienced decrease in the frequency of seizures and reduction in the dosage of anti-epileptic medications. Electroencephalogram taken one year after the therapy revealed improvement in seizure activity. The outcomes in this case may be considered a preliminary finding in formulating more robust treatment strategies using cell-based therapy for DRE.

耐药癫痫是一个全球性的公共卫生问题。这一类别包括尽管长期服用抗癫痫药物,但仍有癫痫发作的患者。DRE可导致年龄较大的儿童和成人严重残疾和发病,其死亡风险高于一般人群。本报告描述了一例15岁的男性DRE患者,通过自体细胞和高压氧治疗成功治疗。患者接受了两个疗程的细胞治疗,包括来自骨髓、脂肪组织和外周血的细胞,然后是神经物理治疗和氧气治疗。治疗后,患者癫痫发作频率降低,抗癫痫药物剂量减少。治疗一年后的脑电图显示癫痫发作活动有所改善。在这种情况下的结果可能被认为是制定更强大的治疗策略,使用细胞为基础的治疗DRE的初步发现。
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引用次数: 0
Electroencephalogram versus Magnetic Resonance Imaging Brain as the Initial Investigation of Choice in Neurologically Normal Children with First Afebrile Seizure in India. 在印度,脑电图与脑磁共振成像是神经正常儿童首次非发热性癫痫发作的首选初步检查方法。
Pub Date : 2021-06-30 eCollection Date: 2021-06-01 DOI: 10.14581/jer.21008
Jyoti Bagla, Harpreet Kaur, Anu Singhal, Devendra Mishra, Sweta Kumari, Anand Prakash Dubey, Sandhya Soneja

Background and purpose: To compare the rates of clinically relevant information provided by electroencephalogram (EEG) and magnetic resonance imaging (MRI) brain in first afebrile seizure (FAS) in children.

Methods: In this prospective randomized controlled trial, neurologically normal children between the age of 2 and 14 years, presenting with first episode of unprovoked, afebrile generalized or partial seizures, were included. Enrolled patients were randomized into two groups. After stabilization, initial workup and management, group I-patients underwent an EEG followed by MRI, whereas group II-patients underwent an initial MRI brain followed by an EEG. The patients were followed up after results of both the investigations and then every 3 months for seizure recurrence. The primary outcome was the proportion of investigations, providing clinically relevant information. The secondary outcomes were to determine the etiological diagnosis of FAS and record adverse events associated with EEG and MRI.

Results: Out of 170 enrolled patients, 52 patients (61.2%) in initial EEG group and 53 patients (70.6%) in initial MRI group had abnormal results on first investigation. An etiological diagnosis could not be made in any patient in initial EEG group. Neuroimaging revealed an etiological diagnosis in 53 patients (70.6%) in initial MRI group. Inflammatory granuloma was found to be the most common cause of FAS, followed by idiopathic epilepsy.

Conclusions: The results of our study done in neurologically normal children with FAS showed a high diagnostic yield with an initial MRI. We recommend MRI brain to be considered as the initial investigation for evaluation of FAS in children.

背景和目的:比较脑电图(EEG)和磁共振成像(MRI)在儿童首次癫痫发作(FAS)中提供的临床相关信息的比率:在这项前瞻性随机对照试验中,纳入了神经系统正常的 2 至 14 岁儿童,这些儿童首次出现无诱因的发热性全身或部分性癫痫发作。入组患者被随机分为两组。在病情稳定、初步检查和治疗后,I 组患者先进行脑电图检查,然后再进行核磁共振成像检查;II 组患者先进行脑部核磁共振成像检查,然后再进行脑电图检查。在两项检查结果出来后,每 3 个月对患者进行一次随访,以了解癫痫是否复发。主要结果是提供临床相关信息的检查比例。次要结果是确定 FAS 的病因诊断,并记录与脑电图和磁共振成像相关的不良事件:在 170 名登记患者中,首次脑电图检查组的 52 名患者(61.2%)和首次核磁共振成像检查组的 53 名患者(70.6%)首次检查结果异常。首次脑电图检查组的所有患者均无法做出病因诊断。神经影像学检查显示,初次核磁共振成像检查组的 53 名患者(70.6%)确诊了病因。炎性肉芽肿是 FAS 最常见的病因,其次是特发性癫痫:我们对神经系统正常的 FAS 患儿进行的研究结果表明,初次核磁共振成像的诊断率很高。我们建议将脑部核磁共振成像作为评估儿童 FAS 的初步检查方法。
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引用次数: 0
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Journal of epilepsy research
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