Convulsive Crisis Research Articles

Brain Tumor in Differential Diagnosis of Seizures in Puerperium: Case Report

Convulsive crisis is a transient disturbance of cerebral function, and the etiology of which may be manifold. Its clarification is essential for establishing adequate therapy and seizure control. In the pregnancy-puerperal cycle, eclampsia is the most common cause of it, but brain tumor, epilepsy and other disorders are part of the differential diagnosis. We report a case of seizure triggered by tumor in a primigest, 22 years old, at 38 weeks’ gestation with premature rupture of membranes. Cesarean section was performed due to non-reassuring fetal condition. On the second day of puerperium, she presented recurrent episodes of generalized tonic-clonic seizures and elevated blood pressure. She received magnesium sulfate for 24 hours and persisted with severe headache. Magnetic resonance imaging of the brain showed an expansive lesion in the left frontoparietal region. The patient underwent intracranial microsurgery on the eighth day after cesarean section, with complete resection of the lesion and anatomopathological diagnosis of schwannoma. She went through good postoperative evolution, without neurological deficits, and stayed on phenobarbital, with no seizures until 6 months of follow-up. From the case we conclude that although the first diagnosis in pregnant or puerperal women with seizures should be eclampsia, there are other causes, such as brain tumor and Posterior Reversible Encephalopathy Syndrome (PRES). Careful evaluation is required, especially in refractory cases and not responding to usual treatment.

Sustained elevation of cerebrospinal fluid glucose and lactate after a single seizure does not parallel with mitochondria energy production

Generalized seizures trigger excessive neuronal firing that imposes large demands on the brain glucose/lactate availability and utilization, which synchronization requires an integral mitochondrial oxidative capability. We investigated whether a single convulsive crisis affects brain glucose/lactate availability and mitochondrial energy production. Adult male Wistar rats received a single injection of pentylentetrazol (PTZ, 60 mg/kg, i.p.) or saline. The cerebrospinal fluid (CSF) levels of glucose and lactate, mitochondrial respirometry, [14C]-2-deoxy-D-glucose uptake, glycogen content and cell viability in hippocampus were measured. CSF levels of glucose and lactate (mean ± SD) in control animals were 68.08 ± 11.62 mg/dL and 1.17 ± 0.32 mmol/L, respectively. Tonic-clonic seizures increased glucose levels at 10 min (96.25 ± 13.19) peaking at 60 min (113.03 ± 16.34) returning to control levels at 24 h (50.12 ± 12.81), while lactate increased at 10 min (3.23 ± 1.57) but returned to control levels at 360 min after seizures (1.58 ± 0.21). The hippocampal [14C]-2-deoxy-D-glucose uptake, glycogen content, and cell viability decreased up to 60 min after the seizures onset. Also, an uncoupling between mitochondrial oxygen consumption and ATP synthesis via FoF1-ATP synthase was observed at 10 min, 60 min and 24 h after seizures. In summary, after a convulsive seizure glucose and lactate levels immediately rise within the brain, however, considering the acute impact of this metabolic crisis, mitochondria are not able to increase energy production thereby affecting cell viability.

Corrigendum: Potential Clinical Benefits of CBD-Rich Cannabis Extracts Over Purified CBD in Treatment-Resistant Epilepsy: Observational Data Meta-analysis.

[This corrects the article DOI: 10.3389/fneur.2018.00759.].

Potential clinical benefits of CBD-rich Cannabis extracts over purified CBD in treatment-resistant epilepsy: observational data meta-analysis

This meta-analysis paper describes the analysis of observational clinical studies on the treatment of refractory epilepsy with (CBD)-based products. Beyond attempting to establish the safety and efficacy of such products, we also investigated if there is enough evidence to assume any difference in efficacy between CBD-rich extracts compared to purified CBD products. The systematic search took place in February/2017 and updated in December/2017 using the keywords “epilepsy” or “Dravet” or “Lennox-Gastaut” or “CDKL5” combined with Cannabis, cannabinoid, cannabidiol or “CBD” resulting in 199 papers. The qualitative assessment resulted in 11 valid references, with an average impact factor of 8.1 (ranging from 1.4 to 47.8). The categorical data of a total of 670 patients were analyzed by Fischer test. The average daily dose ranged between 1 and 50 mg/kg, with treatment length from 3 to 12 months (mean 6.2 months). Two thirds of patients reported improvement in the frequency of convulsive crisis (399/622, 64%). There were more reports of improvement from patients treated with CBD-rich extracts (318/447, 71%) than patients treated with purified CBD (81/223, 36%), with statistical significance (p<0.0001). Nevertheless, when the standard clinical threshold of a “50% reduction or more in the frequency of convulsive crisis” was applied, only 39% of the individuals were considered “responders”, and there was no difference (p=0.56) between treatments with CBD-rich extracts (97/255, 38%) and purified CBD (94/223, 42%). Patients treated with CBD-rich extracts reported lower average dose (6.1 mg/kg/day) than those using purified CBD (27.1 mg/kg/day). The reports of mild (109/285 vs 291/346, p<0.0001) and severe (23/285 vs 77/346, p<0.0001) adverse effects were more frequent in products containing purified CBD than in CBD-rich extracts. CBD-rich extracts seem to present a better therapeutic profile than purified CBD, at least in this population of patients with refractory epilepsy. The roots of this difference is likely due to synergistic effects of CBD with other phytocompounds (aka Entourage effect), but this remains to be confirmed in controlled clinical studies.

Recurrent decrease level of consciousness as first manifestation of high grade glioma

Objective and method: Paroxysmal and recurrent alteration of the level of consciousness is a diagnostic given by multiple causes, being sometimes the first sign of a systemic or central nervous system disease. We report a case of a 9-year-old patient with a recurrent decrease in the level of consciousness. Results: He was admitted at PICU with acute fever, vomiting, headache and decreased of the level of consciousness. Analysis, urine toxics and CT, normals. CSF showed 10 cells without germ. Eeg slowed activity. Acute meningoencephalitis was suspected and treated with cefotaxime and acyclovir. Excellent improvement, recovery of the level of consciousness in the first 24 h and discharged at home at 7 day. That day reentered by similar episode with agitation psychomotor, aggressiveness requiring intubation. Another craneal CT normal and CFS showed 13 cells and hyperproteinorraquia. Two craneal NMR and another CT were normal. Autoimmune encephalitis was suspected and initiating Methylprednisolone. NMDA antibodies in CSF, oligoclonal bands, GADs, lactic, ammonium, and PCR herpes were negatives. Extubated on the 3rd day with normal level of consciousness, discharged at 11 days, persisting bradypsychia. Readmited to the 14 days by similar episode and convulsive crisis and papillary effacement. We measured the pressure of the CSF. We treated of HTC, with sharp decreases in the level of consciousness with response to SSH3%. ICP monitoring showed 60 cm H2O placing VDVP. Clinical improvement being discharged, restless legs and ataxia. Cranio-medullary MRI showed germinoma hypothalamic-pineal disease with leptomeningeal carcinomatosis. Moved to Childhood Oncology Unit, being death on a month Conclusions: A systematic and oriented study of recurrent alteration of the level of consciousness, without forgetting that the normality of tests not discard our suspicion. In our case the late syndrome of restless legs, was the key. The request for pathological anatomy in CSF could help before.

Posterior Reversible Encephalopathy Syndrome in Systemic Lupus Erythematosus: Case Report of a Young Female Patient

Posterior Reversible Encephalopathy Syndrome is a rare manifestation of lupus erythematosus, in which there is altered mental function, headache, convulsions, visual impairment and posterior and transient changes on neurologic imagistics [1,2], occurring in a few hours and presenting with rapidly progressive neurologic symptoms [3]. It was first described in 1996. It is more frequent in patients with acute kidney injury or chronic kidney disease, and is associated with hypertension, autoimmune diseases, immunosuppressive therapies- especially antibody-based immunosuppressive therapy, and organ transplantation. It is clinically reversible within one week and imagistically reversible within 2-4 weeks. It is treatable and has a good prognosis. We present the case of a young woman of 27 years diagnosed with systemic erythematous lupus who developed convulsive crisis, headache, visual impairment, being under immunosuppressive therapy with azathiorpine. She had class IV lupus nephritis on the kidney biopsy and partial remission of the nephrotic syndrome. Other lupic manifestations were cutaneous, immunological, articular and hematological. She had a good short-term prognosis at 30 days.

Consideraciones prácticas sobre epilepsia y manejo anestésico

Epilepsia, enfermedad caracterizada por la alteración de la actividad eléctrica cerebral. Las crisis epilépticas se clasifican en: parciales, generalizadas y desconocidas. El diagnóstico se establece mediante la correlación clínica y electroencefalografía. El tratamiento de mantenimiento depende del tipo específico de crisis. El estatus constituye la persistencia de crisis convulsiva por más de cinco minutos (para efectos clínicos) que requiere un manejo farmacológico intensivo con benzodiacepinas, fenitoína, fenobarbital y otros medicamentos. El manejo anestésico del paciente con epilepsia, requiere una adecuada valoración preoperatoria para indagar la existencia de comorbilidades, características de las crisis, farmacoterapia que recibe y sus interacciones con determinados agentes anestésicos. En pacientes epilépticos se debe evitar la administración de aquellos anestésicos proconvulsivantes (etomidato, ketamina, enflurano, sevoflurano, fentanil, alfentanil, remifentanil, meperidina, entre otros). Considerándose como agentes anestésicos seguros: benzodiacepina, tiopental, propofol (a pesar de su efecto proconvulsivante en algunos casos), isofurano, halotano, desflurano, entre otros.

Aproximación a la legislación protectora del deudor hipotecario

En el presente trabajo pretendemos hacer un análisis descriptivo y crítico de las distintas reformas legislativas adoptadas en los últimos años, de grave crisis económica en España, encaminadas a deparar al deudor hipotecario la necesaria protección, partiendo de la primera iniciativa representada por el Real Decreto-Ley 8/2011, de 1 de Julio, hasta culminar con las más recientes disposiciones en el momento de escribir estas páginas: el RDL 1/2015 de 27 de febrero y la Ley 25/2015, de 28 de julio. Estimamos que resulta indispensable un examen exhaustivo de todas ellas para alcanzar a dilucidar si, fundamentalmente a lo largo de la última legislatura en España (2012-2015), se ha ultimado o no el objetivo de conferir al deudor hipotecario la protección adecuada en estos tiempos de crisis extremadamente convulsos y complejos, que han tenido una especial incidencia precisamente en el ámbito del mercado inmobiliario y el sobreendeudamiento de particulares.

Ganglioglioma intraventricular y psicosis en la adolescencia

Se presenta el caso clínico de un adolescente de 17 años de edad sin antecedentes psiquiátricos previos y con buen nivel funcional académico y social. De manera brusca comienza a presentar alteraciones de la conducta, clínica psicótica positiva, sintomatología que impresiona de negativa y una escasa conciencia de enfermedad. Durante el ingreso hospitalario y a través de las pruebas de imagen aparece el hallazgo de una neoplasia cerebral, gangliogliomaintraventricular derecho. A pesar del tratamiento neuroléptico y corticoideo la evolución del paciente fue negativa, manteniéndose la clínica productiva y presentando alteraciones de la memoria, estados confusionales y crisis convulsivas durante los ingresos posteriores. Tras meses de evolución se decide llevar a cabo la resección total del tumor, transcurriendo la intervención y postoperatorio sin complicaciones. El curso posterior de la patología permaneció inalterable, con aumento de la clínica anteriormente descrita a la que se suma un agravamiento de los comportamientos de aislamiento y abandono de actividades vitales. Durante este progreso se ensayaron varios neurolépticos hasta llegar al tratamiento con clozapina.

Epidemiological and Clinical Characteristics and Outcomes of Scorpion Envenomation in Hospitalized Children in Adiyaman, Turkey.

Epidemiological and Clinical Characteristics and Outcomes of Scorpion Envenomation in Hospitalized Children in Adiyaman, Turkey.

Bilateral Anterior Dislocation of the Shoulder after an Epileptic Seizure during the Sleep: A Case Report and Review of Literature

Bilateral dislocation of the shoulder is rare and still very rare when it arises during the sleep due to an epileptic seizure. We report in this work the case of a young 24-year-old patient not known epileptic before and who never has a convulsive crisis. We discuss the mechanism of this uncommon variety of shoulder dislocation and modalities of treatment.

Liver transplantation for classical maple syrup urine disease: long-term follow-up.

The aim of the study was to evaluate indications, results, and clinical and neurological evolution in children who have undergone liver transplantation for classical maple syrup urine disease (MSUD). Descriptive study of liver transplantation for MSUD between 1991 and 2012. Eight patients were transplanted. Indications for transplant were poor metabolic control expressed as significant psychomotor disabilities (4 had psychomotor delays, 5 had spasticity, and 5 had epilepsy) and poor quality of life (mean number of acute metabolic decompensations and mean number of total hospitalizations before transplantation 5 and 12, respectively). Four required nasogastric tube, with a maximum 4 g/day protein-restricted diet in all of them. Seven sustained significant alterations in brain magnetic resonance imaging. Mean leucine and alloisoleucine levels were 608 (standard deviation [SD] 516) and 218 μmol/L (SD 216), respectively. All of the patients received transplants with deceased-donor livers, with ages between 1.5 and 2.5 years (mean 1.78 years). Mean posttransplantation follow-up period was 12.2 years (range 5-21 years). Final patient and graft survival was 87.5% and 75%, respectively. Following transplantation, none required hospitalization in the last 3 years nor did any have new acute metabolic decompensations following a normal diet. Five followed normal schooling, 2 had motor disabilities, and 2 had convulsive crises. Brain magnetic resonance imaging was taken in 4 patients, showing neuroimage improvement in 3 of them. Mean leucine levels were <350 μmol/L from the immediate posttransplantation period (mean 225 μmol/L, SD 78), with a maximum alloisoleucine level of 20 μmol/L. Liver transplantation is an effective treatment for classical MSUD that arrests brain damage, although it does not reverse the process.

Superficial Necrolytic Dermatitis in a Dog With an Insulin-Producing Pancreatic Islet Cell Carcinoma

A 10-year-old dog presented with convulsive crisis and symmetrical hyperkeratotic cutaneous lesions affecting the abdomen, inguinal area, eyelids, muzzles, both pinnae, and all the paw pads. Hypoglycemia and hyperinsulinemia were the main biochemical findings. A mass 2cm in diameter was detected within the left pancreatic lobe by ultrasonography. It was surgically removed and histologically and immunohistochemically diagnosed as an insulin-producing pancreatic islet cell carcinoma. The animal was eventually euthanized due to lack of clinical improvement. At necropsy, metastatic nodules were observed in the pancreatic lymph nodes and liver. Histopathological findings of cutaneous lesions were highly suggestive of superficial necrolytic dermatitis and were interpreted as a paraneoplastic syndrome derived from the islet cell carcinoma. To the authors' knowledge, this is the first report of superficial necrolytic dermatitis associated with an insulin-producing pancreatic neuroendocrine carcinoma in dogs.

Lymphoma outbreak in a GASH:Sal hamster colony

We have detected a high incidence of lymphomas in a colony of GASH:Sal Syrian golden hamsters (Mesocricetus auratus). This strain is characterised by its ability to present convulsive crises of audiogenic origin. Almost 16 % (90 males and 60 females) of the 975 animals were affected during a 5-year period by the development of a progressing lymphoid tumour and exhibited similar clinical profiles characterised by lethargy, anorexia, evident abdominal distension, and a rapid disease progression resulting in mortality within 1 to 2 weeks. A TaqMan® probe-based real-time PCR analysis of genomic DNA from different tissue samples of the affected animals revealed the presence of a DNA sequence encoding the hamster polyomavirus (HaPyV) VP1 capsid protein. Additionally, immunohistochemical analysis using HaPyV-VP1-specific monoclonal antibodies confirmed the presence of viral proteins in all hamster tumour tissues analysed within the colony. An indirect ELISA and western blot analysis confirmed the presence of antibodies against the VP1 capsid protein in sera, not only from affected and non-affected GASH:Sal hamsters but also from control hamsters from the same breeding area. The HaPyV genome that accumulated in tumour tissues typically contained deletions affecting the noncoding regulatory region and adjacent sequences coding for the N-terminal part of the capsid protein VP2.

Creation of a Solid Organ Transplant Program in an Underdeveloped Country: Mexico's General Hospital Transplantation Program

BackgroundWith a population of >112 million persons, all Mexicans are entitled to receive medical care by the state and more than half have limited access to healthcare. From January 1985 to March 2009, 40 renal transplants were performed from living donors with a high percentage of complications. In April 2009, a new Solid Organ Transplantation Program was started; herein, we present this enterprise to the international community and briefly present a perspective on the Mexican transplant situation. Materials and MethodsWe performed a retrospective chart review of kidney and liver transplant recipients from April 2009 to November 2011, including demographic features, immunosuppression, complications as well as initial and 1 month function. ResultsWe performed 68 kidney (59 living and 9 deceased donors) and 5 liver transplants (cadaveric donors). The kidney transplant recipients were 73.5% males and showed an overall mean age of 29.77 years (range, 18–60). The donor mean age was 34.08 years. Mean recipient creatinine pretransplant was 13.32 mg/dL, while at day 5 it was 2.33 and at month one, 1.32 mg/dL. Five grafts were lost (7.3%): 4 due to death with a functioning graft and 1 due to acute pyelonephritis. Five patients experienced delayed graft function Basiliximab induction was required in all but one who received thymoglobulin owing to a high panel reactive antibody. Maintenance therapy included a calcineurin inhibitor, mycophenolate mofetil (MMF), and prednisone. Liver transplant recipients were 83.6% women. The etiologies were alcoholic cirrhosis (n = 2), primary billiary cirrhosis (n = 1) and hepatitis C virus infection (n = 2). Complications included: reperfusion syndrome (n = 1), convulsive crisis (medication; n = 1), acute respiratory distress syndrome (n = 1), and death (n = 1). Their Model for End-Stage Liver Disease scopes were 10–21. After basiliximab induction, they had maintenance therapy with tacrolimus, MMF, and steroids. The donor mean age was 26.2 years. All survivors show normal liver function tests currently. ConclusionsFrom 1985 to 2009, 40 kidney transplants were performed, with multiple complications including donor deaths. Our current results were comparable to international standards, with <15% complication rate.

Cirugía de epilepsia refractaria en niños y adolescentes. Serie de casos

Our objective is to present a series of 20 cases of children under 15 years operated on of intractable epilepsy in the last 12 years in Sanatorio Allende of Córdoba, based on medical records and follow up. Were included 8 patients with cortical dysplasias, 6 with tumors, 2 with Rasmüssen syndrome, 1 with mesial gliosis, 1 with porencephalic cyst, 1 with gliosis due to traumatic brain injury, and 1 with encephalitis history. Localization was temporal in 9 cases and extra-temporal in 11 cases (4 were frontal, 4 occipital, and 3 parietal). There was no surgical mortality. Patients with brain tumors present a satisfactory control over convulsive crises after tumor resection (Engel IA in 100%). Good results were also achieved in nontumor pathologies: 8 cases Engel IA, 1 Engel I B; 3 cases Engel III A, one IV A and other IV C.

Surgery of intractable epilepsy in infants and adolescents. Case report

Our objective is to present a series of 20 cases of children under 15 years operated on of intractable epilepsy in the last 12 years in Sanatorio Allende of Cordoba, based on medical records and follow up. Were included 8 patients with cortical dysplasias, 6 with tumors, 2 with Rasmussen syndrome, 1 with mesial gliosis, 1 with porencephalic cyst, 1 with gliosis due to traumatic brain injury, and 1 with encephalitis history. Localization was temporal in 9 cases and extra-temporal in 11 cases (4 were frontal, 4 occipital, and 3 parietal). There was no surgical mortality. Patients with brain tumors present a satisfactory control over convulsive crises after tumor resection (Engel IA in 100%). Good results were also achieved in nontumor pathologies: 8 cases Engel IA, 1 Engel I B; 3 cases Engel III A, one IV A and other IV C.

PP166. HELLP syndrome: Challenges for establishing diagnostic criteria

Preeclampsia is a public health problem which may manifest as pre-eclampsia (hypertension, proteinuria and/or edema) and eclampsia (convulsive crises and rarely coma in pregnant women with previous pre-eclampsia). But the pathology of hypertensive disease of pregnancy can present different clinical forms. Within that spectrum is HELLP syndrome: hemolysis (H), elevated liver enzymes (EL) and thrombocytopenia (LP). To assess the diagnostic criteria in the literature adopted for HELLP syndrome. A literature review on the Virtual Health Library with the keywords "HELLP syndrome" and "diagnosis" found 674 citations. Six hundred and thirty-four dismissed for failing to engage with the proposed question, and 43 articles remained. Twenty seven articles were excluded because of the language, unable in Latin America, letters, case report and articles published prior to 1999. Sixteen original articles were included. Eleven reviews, one prospective study, two cohorts, one retrospective cohort study and a cross. Studies were classified according to degree of recommendation and level of evidence. The term clinical and laboratory markers were varied and their cut-off levels differ among the authors. The appearance of eclampsia, pain in the upper abdomen, nausea and significant proteinuria and other maternal morbidities were more frequent in patients with HELLP syndrome. The levels of lactic dehydrogenase, AST, and uric acid were further elevated in women with HELLP syndrome guarding correlation with the prognosis of the case. There is no consensus for the interpretation of laboratory values that may represent the most widespread occurrence of parameters: hemolytic anemia, elevated liver enzymes and thrombocytopenia. Other morbidities may have clinical signs, symptoms and laboratory abnormalities that mimic the syndrome. There are many questions to establish standard diagnostic criteria for all patients with HELLP syndrome, necessitating studies consistent with significant population numbers to establish the main signs and symptoms and try to reach consensus on the best markers for the diagnosis and its proper indexes cutting.

Time for an optimistic Englishness

N ational communities tend to be imagined or re-imagined at times of convulsive change and crisis. Yet though such change social, economic, technological and constitutional is currently undermining the political status quo, the English political conversation continues to be avoided. My argument here is that this avoidance is becoming increasingly unsustainable and that a serious conversation on the issue is now overdue.

Giant Intracranial Pial Arteriovenous Fistula Treated by Endovascular Intervention

Arteriovenous fistulas (AVF) are rare vascular lesions of the brain that differ from arteriovenous malformations as they present a direct connection between artery and vein, without interposition of the nidus. They are fed by one or more arterial branches, with a single draining vein. Clinically they can be revealed through cerebral hemorrhage, convulsive crisis, neurological deficit, heart failure in neonates and infants, headache, bruit, or intracranial hypertension symptoms. A 30-year-old patient was found unconscious on a public street, presenting a generalized tonic-clonic convulsive crisis. At admission, she presented with ocular proptosis, conjunctival hyperemia and bilateral jugular turgescence. The cranial computed tomography showed diffuse subarachnoid hemorrhage, and the cerebral angiography evidenced a giant intracranial pial AVF with high flow supplied by 2 branches of the left anterior cerebral artery.The patient underwent endovascular treatment in 2 sessions, using a mixture of histoacryl and lipiodol for complete occlusion of the lesion. She was discharged after a month, alert, devoid of motor deficit, and the ocular proptosis and the conjunctival hyperemia had decreased. AVFs are rare vascular lesions that require prompt treatment. The endovascular treatment must be considered, especially when the lesions are deep and the risks of neurological deficit associated with the surgery are high. Endoscopic intervention represents an effective and safe option for the treatment of this type of lesion.