Convulsions Research Articles

The effect of estradiol on sevoflurane-induced epileptiform cortical EEG waves in neonatal rats

Objective To investigate the effect of estradiol on sevoflurane-induced epileptiform cortical EEG waves in neonatal rats. Methods Forty neonatal rats, aged 4-6 days, weighting 8-15 g, were divided into 5 groups according to random number table: normal saline control group (group C), estradiol group (group E), ICI182780 (group I), Formestane group (group O) and estradiol + ICI182780 (group EI). After establishing the monitoring model of cortical electroencephalogram in neonatal rats, EEG was recorded continuously for 30 minutes, then different treatment drugs were given according to different groups. After 30 minutes of continuous recording of EEG, anesthesia induction was started with inhalation of 6% sevoflurane for 3 minutes, followed by inhalation of 2.1% sevoflurane to maintain anesthesia. Sevoflurane anesthesia lasted for 1 hour.The righting reflex disappearance time was recorded after sevoflurane anesthesia.The total duration, single duration and frequency of EEG convulsion waves were recorded.Spike frequencies were recorded at different periods.Animal respiratory rate was recorded after sevoflurane induction. Results One rat in group I and one rat in group EI showed convulsion wave before treatment, which were excluded from the study.The righting reflex disappearance time of group S, group E, group I, group O and group EI were (24.4±2.5)s, (16.4±4.2)s, (31.8±5.2)s, (29.8±1.8)s, (24.8±2.7)s respectively, and there were statistically significant differences among the 5 groups (F=16.693, P 0.05). Compared with group S, the total duration, single duration and frequency of convulsion wave were significantly increased in group E during anesthesia, and the differences were statistically significant (P<0.05). Compared with group E and group S, the total duration, single duration and frequency of convulsion wave during anesthesia were significantly reduced in group I, group O and group EI, and the differences were statistically significant (P<0.05). Compared with group S, the spike frequency of group E increased significantly in each period, and the differences were statistically significant (P<0.05). The frequency of spike wave in group I, group O and group EI at 65-70 min and 90-95 min were lower than that in group S, and the differences were statistically significant (P<0.05). The frequency of spike wave between group O and group EI during 115-120 min was statistically different with group S and group E(P<0.05). Conclusion The mechanism of epileptiform EEG wave induced by sevoflurane anesthesia may be related with neuroactive steroidal estradiol. Key words: Sevoflurane; Neonatal rats; Epileptiform electroencephalography; Estradiol

Emergency Medical Services Protocols in California for Status Epilepticus Lag Behind Guidelines

The American Epilepsy Society released guidelines in 2016 updating the recommendations for treatment of generalized convulsive status epilepticus

Clinical and imaging features of cerebral infarction in children

To summarize and analyze the etiology, clinical manifestations and imaging features of children with cerebral infarction. A retrospective analysis was performed for the clinical data of 54 children with cerebral infarction, including etiology, clinical manifestations, distribution of infarcts, type of infarcts and clinical outcome. Of the 54 children, 93% had a clear cause, among whom 46% had the coexistence of multiple factors, and the top three causes were infection (54%), vascular disease (40%) and trauma (26%). Major clinical manifestations included limb paralysis (85%), pyrexia (20%), disturbance of consciousness (19%) and convulsion (17%). As for the location of infarcts, 80% of the infarcts were located in the cerebral cortex and 52% in the basal ganglia. Major types of infarcts were small-area infarcts (74%) and multifocal infarcts (56%). Viral encephalitis was the most common cause of cerebral infarction caused by infection, with the cerebral cortex as the most common location of infarcts (21/23, 91%) and multiple infarcts as the most common type of infarcts (13/23, 57%). Among the 12 children with cerebral infarction caused by nonspecific endarteritis, 10 (83%) had infarcts located in the basal ganglia and only one child had multiple infarcts. Among the five children with cerebral infarction caused by moyamoya disease, four children (80%) had infarcts located in the cerebral cortex, and large-area infarction (4/5, 80%) and multifocal infarction (4/5, 80%) were the major types of infarcts. Among the children with traumatic cerebral infarcts, 92% had infarcts located in the basal ganglia, and small-area infarcts (92%) and single infarcts (85%) were the major types of infarcts. Among the 46 children with limb paralysis, 34 (74%) had infarcts located in the basal ganglia; 50% of the children with disturbance of consciousness had infarcts located in the basal ganglia. Subcortical infarcts were observed in all six children with epilepsy. Seventy-five percent of the infarcts located in the cerebral cortex and 87% of the infarcts located in the basal ganglia had a good prognosis. Among the two children with cerebral infarcts located in the brainstem, one had the sequela of hemiplegia and the other had the sequela of cognitive impairment. Eighty-eight percent of the children with cerebral infarction caused by infection and 82% of the children with traumatic cerebral infarction tended to have a good prognosis, and 83% of the children with cerebral infarction caused by nonspecific endarteritis had good prognosis. Recurrence was observed in all three children with cerebral infarction caused by vascular malformations. Of the five children with cerebral infarction caused by moyamoya disease, one child died and four children survived with the sequela of localized brain atrophy, among whom one child also had the sequela of epilepsy. Infection, vascular disease and trauma are the most common causes of cerebral infarction in children, and limb paralysis is the most common clinical manifestation. Cerebral cortex is the most common infarct site, and small-area infarcts and multifocal infarcts are the most common types of infarcts, which tend to have a better prognosis.

Clinical analysis of 19 deaths from severe influenza among children in Shenzhen

Objective To explore the characteristics and causes of death of severe influenza cases, in order to attract the attention of pediatricians. Methods The data of 19 cases with influenza-associated deaths admitted to Shenzhen Children′s Hospital from September 2009 to November 2018 were retrospectively analyzed. Results There were 11 males and 8 females, aged from 4 months to 12 years old, of whom 5 cases were over 5 years old.Five deaths occurred during the 2009 influenza A (H1N1) pandemic, followed by 1 case in 2014, 6 cases in 2016, 3 cases in 2017 and 4 cases in 2018.Four of the 19 deaths were due to underlying diseases.The time from onset to death was 0.5-36.0 days, and the most common clinical manifestations were high fever, convulsions, coma and dyspnea.Among them, 11 cases died of influenza-associated encephalopathy, 4 cases died of severe pneumonia, acute respiratory distress syndrome(ARDS) and respiratory failure, 3 cases died of sepsis caused by secondary streptococcus pneumoniae infection, and 1 case died of secondary fungal pyothorax and fungal meningitis. Conclusions Children under 5 years of age, even if they were previously healthy, may still be at high risk of dying from influenza. Neurological complications were high and the leading causes of death were influenza-associated encephalopathy, severe pneumonia, ARDS and secondary severe bacterial infection. Key words: Child; Influenza A (H1N1); Death

Turns and Revolutions: On the Convulsive Present

Turns and Revolutions: On the Convulsive Present

Clinical analysis of 18 cases of pseudohypoparathyroidism

Objective To analyze the clinical characteristics of pseudohypoparathyroidism (PHP) inpatients in our hospital from January 2008 to December 2017 and to gain a better understanding of this disorder. Methods 18 inpatients diagnosed as sporadic PHP in our hospital were analyzed retrospectively, as regarding the clinical manifestation, laboratory examination and imaging data. Results 18 inpatients were diagnosed sporadic PHP consisting of 12 males and 6 females, with 13 adults and 5 child participants respectively. The medium age of onset was 14 (6-57), and the average age at diagnosis was (24.9±14.7) years old. Initial onset of symptoms reported were: 12 patients complained of tetany, 3 reported convulsions, 1 reported numbness, 1 reported dysnoesia, and 1 were asymptomatic. Among them: 3 patients were found to have short distal phalanx, 7 displayed a round face, and 3 out of 15 adults were less than 155 cm in height. 12 patients had a positive Trousseau sign, 1 had an ectopic calcification. 11 were found to have intercranial massive calcifications by head computed tomography. Serum calcium was reported at (1.58±0.11) mmol/L and parathyroid hormone was (359.5±146.6) pg/ml. 3 patients were discovered to have hypothyroidism, 2 had been misdiagnosed with epilepsy, and 1 with encephalitis. Conclusions Tetany and intracranial calcifications were the most common signs of PHP patients. A number of the PHP cases in this study lacked typical Albright′s Hereditary Osteodystrophy (AHO) appearance. The age of onset and duration of the disease varied somewhat in the different patient populations. The heterogeneity nature of the clinical manifestations of PHP makes it difficult to diagnose. It is therefore important to make accurate differential diagnosis of PHP to avoid misdiagnosis. (Chin J Endocrinol Metab, 2018, 34: 920-925) Key words: Pseudohypoparathyroidism; Hypocalcemia; Hypoparathyroidism

Gobierno y Administración de los Erarios de la Monarquía Hispana en las Indias, siglo XVIII

El estudio sobre los erarios regios en América durante la dinastía borbónica ha tendido a focalizarse en sus dimensiones estrictamente fiscales y de gasto: la recaudación, la introducción de impuestos y nuevos estancos, los egresos, han concitado la atención de buena parte de la historiografía. Entre tanto, el arco cronológico tendió a centrarse en los años que corren a partir de 1780, cuando el proceso de reformas en la órbita fiscal se condensa y ofrece un parámetro para el análisis de su crisis definitiva, una vez atravesados los umbrales revolucionarios en torno a la década de 1820. El presente Dossier reabre los interrogantes sobre la periodización de aquellas transformaciones, así como sobre la cambiante concepción del gobierno de la Hacienda en Indias y las implicancias que ello tuvo en la circulación de recursos fiscales, intentando ofrecer un panorama sobre los modos en que la política habitaba la Real Hacienda durante un siglo de convulsiones definitorias.&#x0D;

Emergency treatment of convulsion in children

Convulsion is one of the most common pediatric emergencies.It can be caused by many factors, and the most common one is febrile convulsion.A severe or prolonged seizure can cause neurological damage, so it is nece-ssary for timely and standardized treatment.The first step in emergency treatment is to keep the airway unobstructed, and control convulsion as soon as possible.The second step is to look for the cause of the disease, and to follow up the drug treatment for the cause of the disease.Children should be admitted to hospital for further diagnosis and treatment when necessary. Key words: Child; Convulsion; Emergency treatment

Clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion in children with mycoplasmmapneumonia infection

Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children with mycoplasmmapneumonia infection. Methods The clinical data of 15 children with MERS diagnosed in our hospital were analyzed retrospectively. Results Among the 15 cases, there were 5 males and 10 females. The onset age ranged from 2 years old to 11 years old. All the 15 cases were onset of acute infection. 8 cases were onset of vomiting, diarrhea and other gastrointestinal symptoms. 2 cases were onset of respiratory tract infection such as cough. 8 cases were accompanied by fever. 15 cases were accompanied by convulsions. 2 cases were onset of consciousness disturbance. All 15 children underwent lumbar puncture and routine cerebrospinal fluid tests were in normal range. Electroencephalogram examination was abnormal in 13 children, showing slow activity in each lead. The cranial MRI examination of the onset of 4-6 d suggested that the lesions of the corpus callosum were characterized by high signal intensity of DWI sequence. Etiological examination of 15 children showed mycoplasma pneumoniae (MP) -IgM or -Ab positive. In 10 children, the MRI of the corpus callosum was completely restored to normal after 7-12 d. 15 children were treated with anti-infection and azithromycin orally, but not with propofol or hormone. They were discharged after 4-14 days of hospitalization. All 10 children were reexamined with MRI at 7-12 days intervals. Conclusions Minor encephalitis/encephalopathy associated with reversible corpus callosum pressure in children with mycoplasma pneumoniae infection is characterized by mild encephalitis or encephalopathy. The imaging of the corpus callosum is reversible and has a good prognosis. Key words: Pneumonia, mycoplasma; Brain edema; Corpus callosum; Encephalitis; Diagnostic imaging; Child

Clinical characteristics of acute necrotizing encephalopathy in childhood

Objective To summary the clinical characteristics of acute necrotizing encephalopathy in childhood so as to estimate the prognosis and guide the therapy. Methods We collected and analyzed retrospectively the data of 10 acute necrotizing encephalopathy cases hospitalized in the pediatric department of our hospital from January 2014 to April 2018.The clinical manifestations, laboratory examinations and imaging features were retrospectively analyzed. Results A total of 10 cases all had fever and convulsions (100%). There was no specific clinical manifestation in the early stage, always showing the symptoms of acute respiratory infection or acute gastroenteritis.Mental malaise, lethargy, restlessness and frequent convulsions occured when the conditions aggravated.Nine patients had different degrees of consciousness disorder.It could be complicated by multiple organ dysfunction syndrome, hemophagocytic syndrome and so on.Eight patients underwent MRI.In acute phase, homogeneously prolonged T1 and T2 relaxation time of the brain lesions on MRI were found in most patients, and diffusion-weighted imaging (DWI) and FLAIR showed high signal intensity.Six cases underwent head CT examination, hypodensities were seen on 4 cases.Cerebrospinal fluid (CSF) was detected in all patients, and the protein levels in CSF increased to varying degrees, while white blood cells did not increase.Of the 10 patients, 3 died, 1 was discharged normally, 1 had hemophagocytic syndrome, transferred to pediatric hematology department, and 5 patients were transferred to rehabilitation department. Conclusion Acute necrotizing encephalopathy in children always make progress rapidly, has high mortality, many survivors have severe neurological sequelae, which is worthy of being attention. Key words: Acute necrotizing encephalopathy; Children; Clinical characteristics

A case report: Simultaneous bilateral posterior shoulder and unilateral central acetabular fracture dislocations secondary to epileptic seizure

Fracture dislocations of extremities are a possible complication following epileptic seizures. Management mainly depends on the severity of the injury and the current medical status of the patient. We describe a rare case of bilateral posterior shoulder and unilateral central acetabular fracture dislocations without direct trauma after a convulsive seizure related to lung cancer with brain metastases. Two weeks after the seizure, we performed an open reduction and internal fixation (ORIF) with locking plate to treat bilateral posterior shoulder fracture dislocations when the patient’s neurological condition became more stable. However, nonoperative treatment was selected for the acetabular fracture dislocation because of the patient’s advanced-stage cancer. Since the patient was responding well to the newest target therapy for his lung cancer, and his life span is beyond our estimate, we, therefore, performed a total hip replacement 6 months later because of traumatic osteoarthritis development. The clinical outcome was satisfactory at the 6-month follow-up. Due to medical progress in non-small cell lung cancer treatment, we consider aggressive treatment may be necessary even in such advanced stage patients.

Nipah virus: an update

On May first Nipah Virus NiV outbreak was reported from Kozhikode district of Kerala and Mallapuram district of South India There is high risk of NiV outbreak to individual as well as community NiV is classed across the world as a bio safety level BSL hazards Emerging zoonotic risk grade RG Hendra and Nipah viruses cause severe and often lethal respiratory illness encephalitis particularly in sows boars and human and have public impact on human health fever aches tiredness chills amp nervous signs twitching trembling muscle fasciculation spasms muscle weak spot convulsions and death Zoonotic diseases transfer to human being from animals NiV can infect a huge variety of species Transmission of NiV from human being to human being has been observed They are associated with high risk group of life threatening disease in human and or animals Treatment is restrained to supportive care Because NiV encephalitis can be transmitted from one person to another person standard infection control practices and proper barrier nursing techniques are important to prevent nosocomial transmission infections For handling RG Nipah virus there is a requirement for a laboratory with extensive BSL high level containment that includes practices BSL plus controlled access safety equipment rsquo s Biological Safety Cabinet full body air supplied positive pressure and personnel suit and facilities BSL plus dedicated air and exhaust decontamination procedures for exit separate building Biological safety cabinets use high efficiency particulate air HEPA filters in their exhaust and or supply systems A Power Air Purifying Respirator PAPR or tight fitting goggles and N respirator should be worn for high risk aerosol generating procedures The therapeutic use of a neutralizing human monoclonal antibody targeting the Nipah G glycoprotein has experimentally been evaluated in the post exposure therapy in the ferret model and found to be of benefit Additional efforts focused on surveillance and awareness will assist save future outbreaks

A COMPARISON OF PROPOFOL AND PROPOFOL-KETAMINE EFFECTS ON HEMODYNAMIC RESPONSES DURING ELECTROCONVULSIVE THERAPY (ECT)

Objective : Electroconvulsive Therapy (ECT) is the most effective treatments in curing the major depression and psychiatric disease. Since propofol and ketofol (Propofol-Ketamine) are common medicines in ECT, this study aims to compare the effect of these medicines on seizure duration and hemodynamic responses. Methods: This study was a clinical trials with a sample volume of 25 patients (50 patients meeting), classified based on ASA 1 and 2, 20-58 years old, who were candidate for ECT at Ebn Sina hospital in Bandar Abbas during 2014-2015. All of the patients and their first degree relatives were satisfied to participate in the study. Patients with high blood pressure history, diabetes, renal failure, neuro-vascular and heart disease were excluded from the study. Initial systolic and diastolic blood pressure and heart rate of all participants were recorded. In the first session, they randomly received propofol (2 mg/kg), atropine (0.5 mg), Esculin (0.5 – 1.0 mg) and in the next session ketamine (0.8 mg/kg), propofol (2 mg/kg), Esculin (0.5 – 1.0 mg), atropine (0.5 mg) and ECT with 10 -15 joule. Hemodynamic parameters of all participants again measured and registered at 1, 3 and 5 minutes after convulsion. Data was analyzed with SPSS software using descriptive statistical tests and independent T-test. Results: The average duration of convulsive anesthesia was 32.76 and 32.72 seconds for propofol and ketofol, respectively, which was statistically no significant difference (P = 0.99). Hemodynamic variations in patients were higher for propofol compared to ketofol and these variations were statistically meaningful in 3rd minute for SBP, 1st and 5th minute for DBP and 3rd minute for heart rate. (P<0.05) Discussion: Based on effect of propofol and ketofol(Propofol-Ketamine) on hemodynamic parameters and convulsive duration, ketofol is more recommended for anesthesia in ECT.

Diagnosis and treatment of ruptured intracranial aneurysms in infants

Objective To investigate the epidemiological characteristics, clinical manifestations and treatment of intracranial aneurysms in infants. Methods From January 2010 to December 2016, 6 256 cases of intracranial aneurysms were consecutively admitted to Neurosurgery Department of West China Hospital of Sichuan University, 6 (0.1‰) of whom were less than 1 years old. Among them, the youngest was 2 months old and the oldest was 11 months old. We retrospectively analyzed medical records of the 6 patients with ruptured intracranial aneurysms. In those 6 cases, 5 patients were female, and 1 was male. The time of diagnosis in 6 cases was from 8 to 144 hours, and the primary symptom was vomiting in 4 cases. Convulsions were reported in 3 cases. All 6 cases had single aneurysms with mean diameter of 0.4-1.5 cm and included 1 with vertebrobasilar fusiform aneurysms (untreated) and 5 cases with cystic aneurysms from middle cerebral artery (MCA). Those 5 patients included 2 cases of pseudoaneurysms and all underwent craniotomy for aneurysm clipping. Results All aneurysms were successfully clipped in 5 cases with MCA aneurysms. None of them had complications such as cerebral vasospasm, cerebral infarction, hydrocephalus, intracranial infarction or cerebrospinal fluid leakage. The postoperative follow-up lasted for 7-68 months and no residual or recurrent aneurysm was found in CTA examination. Their intellectual development was normal and the muscle strength in the limbs recovered obviously in 5 patients, of which 1 was grade Ⅳ and 4 were grade Ⅴ. The Glasgow outcome scale was used to assess the outcome which revealed Ⅳ-Ⅴ in the 5 patients. Conclusions The incidence of infantile intracranial aneurysms is very low which mostly occurs in MCA. Due to lack of specific demonstrations, delayed diagnosis might be common for ruptured intracranial aneurysms in infants. In addition, infants with ruptured intracranial aneurysms might have good outcomes following surgical treatment. Key words: Intracranial aneurysm; Aneurysm, ruptured; Infant; Diagnosis; Microsurgery

Differentiating Between Syncope and Convulsive Seizures

One of the most common yet difficult management problems in medicine is that of patients who presents with a paroxysmal loss of consciousness. One

Clinical analysis of 2 siblings with late-onset meningitis caused by group B streptococcus which were homogenous to the colonization bacteria of their mother

Objective To raise awareness of the late-onset meningitis caused by group B streptococcus (GBS) which was homogenous to the maternal colonization. Methods The clinical data of late-onset GBS meningitis in neonates twins whose pathogens were homogenous to their maternal colonization were collected from Department of Neonatology, Guangzhou Women and Children′s Medical Center.The general conditions, clinical symptoms, laboratory tests and drug treatment of the twins and their mother were retrospectively analyzed, and the GBS homology during inpatient care was tested.And the progress of the twins′ condition was investigated by telephone follow-up. Results The mother had two pregnancies without prenatal GBS screening or intrapartum antimicrobial intervention for GBS, everything was normal during pregnancy and delivery.Twins were born through cesarean section.The elder sister was discharged with Linezolid taken orally after 167 days in hospital without convulsions, shaking or other discomfort.The elder sister was followed up for every 2 weeks, and in the last time of follow-up, cerebrospinal fluid white blood cell counts were 45×106/L, protein level was 1.52 g/L and Linezolid was withdrawn.The younger brother was discharged after 58 days in hospital with follow-up for every 2 weeks, and in the last time of follow-up, cerebrospinal fluid white blood cell counts were 30×106/L, protein level was 0.66 g/L.During the hospitalization and follow-up without convulsions and irritation, and the cranial magnetic resonance imaging of the twin brother was normal.Test results showed that the GBS bacteria strain for twins and their mother were all serotype Ⅲ.The possibility of the GBS homology was more than 90%. Conclusions The toxicity of serotype Ⅲ GBS strain was strong.More proactive precautions should be considered to apply for the mother whose first birth already had GBS infection.Early identification and intervention of infection risk factors would help optimize the anti-infection treatment program and reduce nerve system damage and other adverse outcomes caused by invasive GBS infection. Key words: Group B streptococcus; Infant, newborn; Meningitis

La organización territorial de España. Una reflexión sobre el estado de la cuestión y claves para la reforma constitucional

La organización territorial de España. Una reflexión sobre el estado de la cuestión y claves para la reforma constitucional

Progress of the prevention of febrile seizures with a intermittent short-range treatment between diazepam and levetiracetam

Febrile seizures is one of the most common neurological diseases in childhood and the most common reason of convulsions.Although most of the convulsions have a good prognosis, prolonged febrile seizures can lead to hypoxic ischemic brain injury and influence the long-term intellectual development if the convulsions are repeated.It will lead to cognitive abilities, learning and memory decline, and even become the pathophysiological etiology of intractable epilepsy.Therefore, it has been became a great concern due to its serious impact on the quality of the child′s life.How to safely and effectively prevent the onset of febrile seizures has been an important task in pediatric clinical work.At present, there are some variously preventive treatment guidelines or specifications, but it still left a debate about its effect.This article reviewed the progress of the studies on the preventive treatment of febrile seizures, so as to improve the understanding and the level of clinical preventive treatment of febrile seizures of the pediatricians. Key words: Febrile seizures; Diazepam; Levetiracetam; Prophylactic treatment

Cerebral palsy due to kernicterus - can we do more for our patients?

Kernicterus is still a health concern in the pediatric age group. Has a high morbidity and mortality rate? This report highlights a case study of a child with kernicterus. The patient is a 1 year two-month-old male, with history of prematurity, asthma, and HEI currently on septrin and seronegative, presented with a two-day history of convulsive episodes with fever, choreoathetosis head movements and delayed milestones.

Quercetin Exerts Anti-convulsant Effects in Animal Model of Grand Mal Epilepsy: Modulation of GABA and Glycinergic Pathways

Quercetin is low molecular weight flavonoid having multiple neuropharmacological actions. Recently, its anticonvulsant effect was reported in rats using electrical kindling models. However, earlier cell culture studies have documented antagonistic action of quercetin on GABAA, GABAC and Glycine channels, which is contrary to recent findings. Hence, the present study aimed at characterizing the effects of quercetin administration in various experimental models of epilepsy. Dose-dependent effects of quercetin on maximal-electroshock seizure (MES) were determined. Further, the effective dose was tested in pentylenetetrazol-induced seizures (PTZ), and strychnine-induced seizures to study the involvement of GABA and Glycinergic receptors. The results revealed a potent anticonvulsant effect of quercetin in MES induced seizures at a dose of 5 and 10 mg/kg. This effect was found to be retained in case of PTZ-induced convulsions and strychnine-induced convulsions (quercetin 10 mg/kg). The present finding warrants further substantiation along with their correlation to molecular mechanism of action.