Convulsive Episodes Research Articles

The Role of Human Herpesvirus Type-6 (HHV-6) in Convulsions Seen in Children at Korle-Bu Teaching Hospital, Accra

Background: Since the isolation of HHV-6 in 1986, extensive investigation has revealed it to be ubiquitous and responsible for the majority of cases of a common febrile rash illness of infants known as roseola. Other clinical associations including seizure disorders, encephalitis and meningitis have also been stated in various publications. Objective: The aim of the study is to find out if there is any association between HHV-6 infection and the convulsions prevailing at the Child Health Department of the Korle-Bu Teaching Hospital, Accra-Ghana. Methods and Results: Children admitted into the Department of Child Health with episode of convulsions were recruited after informed consent had been sought from subjects. Cerebrospinal fluid (CSF) and Plasma were obtained from patients. PCR directed at the detection of the large tegument protein (LTP) gene in the SIE strain of the HHV-6 in Plasma and CSF from patients was done. The mean age of study subjects was 37.44 months with 53 (64.6%) being males. There was a significant relationship between the convulsions and fever (P

Clinical Profile of Status epilepticus (SE) in Children in a Tertiary Care Hospital in Bihar.

Status epilepticus (SE) is a common, life threatening neurologic disorder that is essentially an acute, prolonged epileptic crisis. SE can represent an exacerbation of a pre-existing seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder. To study the aetiology, clinical profile, and outcome of SE in pediatric age group. Setting and study design: Prospective study at a tertiary care medical college hospital in Bihar, India. Study was carried out for a period of one year (from April 2008 to March 2009). Seventy patients of SE in the age group of six month to 12 years were included in the study. Clinical history, general and systemic examination and relevant investigations along with pretested questionnaire were used to categorise different variables. Independent t-test was used for continuous variables and chi-square test for categorical variables. Mean age for the study population was found to be 5.94 years (SD=3.152). Preponderance of male (60%) over female (40%) was observed. Aetiology included Idiopathic (27.14%), remote symptomatic (20%), acute symptomatic (47.14%), febrile (2.86%) and progressive encephalopathy (2.86%) groups. Generalised tonic clonic convulsion (GTC) convulsion was observed in 91.4% of SE patients while 8.6% had partial SE. Eighteen patients (25.7%) had prior history of convulsion whereas 52 patients (74.3%) presented with SE as first episode of convulsion. In our study, mortality rate was found to be 31.4% and acute symptomatic causes were responsible for most of the deaths. SE is a severe life threatening emergency with substantial morbidity and mortality. Patients with younger age and male sex are slightly more vulnerable to develop SE. Longer duration of SE and acute symptomatic aetiologies are independent predictors for poor outcome.

Predictors of acute bacterial meningitis among children with a first episode of febrile convulsion from Northern India: A prospective study

A person’s state of health is a key resource for living a fulfilling and rewarding life. The term ‘health’ encompasses a person’s physical, mental, and social capabilities. Regardless of age, a person’s health depends on his or her ability to maintain homeostasis, adapt to adverse situations, and maintain relationships. However, many Americans define their own […]

Identification of a novel mutation in a patient with pseudohypoparathyroidism type Ia.

Pseudohypoparathyroidism type Ia (PHP Ia) is a disorder characterized by multiform hormonal resistance including parathyroid hormone (PTH) resistance and Albright hereditary osteodystrophy (AHO). It is caused by heterozygous inactivating mutations within the Gs alpha-encoding GNAS exons. A 9-year-old boy presented with clinical and laboratory abnormalities including hypocalcemia, hyperphosphatemia, PTH resistance, multihormone resistance and AHO (round face, short stature, obesity, brachydactyly and osteoma cutis) which were typical of PHP Ia. He had a history of repeated convulsive episodes that started from the age of 2 months. A cranial computed tomography scan showed bilateral calcifications in the basal ganglia and his intelligence quotient testing indicated mild mental retardation. Family history revealed that the patient's maternal relatives, including his grandmother and 2 of his mother's siblings, had features suggestive of AHO. Sequencing of the GNAS gene of the patient identified a heterozygous nonsense mutation within exon 11 (c.637 C>T). The C>T transversion results in an amino acid substitution from Gln to stop codon at codon 213 (p.Gln213*). To our knowledge, this is a novel mutation in GNAS.

Acute pancreatitis and elevated liver transaminases after rapid titration of oral levetiracetam

We report a 25-year-old woman with new onset convulsive episodes. The patient initially failed to respond to phenytoin and was switched to levetiracetam (LEV) which was rapidly titrated to 3000mg daily over 1week. At initiation of LEV therapy, she developed mild nausea and decrease in appetite. This was rapidly followed by severe digestive symptoms consistent with acute pancreatitis. She was also found to have elevated liver transaminases. An extensive work-up failed to reveal an organic cause for her symptoms, suggesting a direct relationship to LEV. Clinical symptoms and laboratory abnormalities normalized after LEV discontinuation, along with supportive therapy.

Malignant hypertension and interferon-beta: a case report

On 23 May 2012, a 41-year-old patient was admitted to hospital following a convulsive episode and severe hypertension. She had been treated for multiple sclerosis by interferon-beta since 2002. Her usual blood pressure (BP) values were unknown. She did not have any other cardiovascular risk factors. On admission to the emergency unit her BP was 220/140 mm Hg, and she was in a convulsive state. On initial evaluation, there was hemolysis, low serum potassium (3.2 mmol l−1), secondary hyperaldosteronism, and an elevation of cardiac, hepatic and pancreatic enzymes (Table 1). The electrocardiogram and the echocardiography were normal. There was no evidence of renal artery stenosis on Doppler echography, and adrenals, liver and pancreas were normal on computed tomography scan. Magnetic resonance imaging (MRI) of the brain showed ‘posterior regressive encephalopathy syndrome’ (PRES), and on fundal examination there was grade III hypertensive retinopathy. The patient was admitted to the intensive care unit and required intubatation and ventilation. Interferon-beta was stopped and she was given nicardipine IV to control BP, but the hemolysis persisted with worsening renal function. After extubation on 26 May she was started on bisoprolol. After the acute phase, the patient was transferred to the kidney unit on 05/06/2012. Blockers of the renin–angiotensin aldosterone system were titrated (progressive introduction of ramipril up to 10 mg per day followed by irbesartan up to 300 mg per day along with atenolol 100 mg per day). Amlodipine 10 mg was then administered reducing the BP below 140/90 mm Hg; all biologic parameters were normalized in 4 weeks (Table 1).

Operative strategy for large brain abscess resulting from immune reconstitution inflammatory syndrome in an AIDS patient in Swaziland

The objective of our study was to report a rare case with a large brain abscess related to central nervous system immune reconstitution inflammatory syndrome (IRIS) and to discuss the operative strategy for it. Brain abscess with HIV co-infection is considered to be a critical infectious condition that requires neurosurgical intervention. The presentation of IRIS may worsen the patient’s condition after the initiation of antiretroviral therapy, especially in IRIS of the central nervous system. Only a few cases of IRIS-related brain abscess have been reported in the current literature, with discussion of the operative strategy. A 30-year-old man was diagnosed with HIV infection in 2007 and he developed right-sided convulsion episodes in 2008. His first brain computed tomography (CT) scan revealed two intracranial cysts, and his symptoms were well controlled by anticonvulsant treatment. He also initiated antiretroviral therapy in the same year. However, his neurological conditions gradually worsened with sensory loss, weakness, visual impairment on the right side, as well as motor aphasia. A CT scan in 2011 revealed a well-encapsulated, hypodense 8 cm × 9 cm intracranial lesion in the left frontal parietal lobe with a 3-cm midline shift. Surgery was performed with a combination of direct suction and quick-suturing of the incision. The abscess capsule was enucleated completely. After surgical removal, he recovered well and remains functional at work in the following year with only minor neurological sequelae. In conclusion, this case illustrates well the clinical course of brain abscess resulting from IRIS in Swaziland, where the prevalence rate of HIV infection is relatively high and delay in diagnosis and treatment is common. The use of a modified excision method for HIV co-infection brain abscess may be considered the operative strategy, with a probable good outcome in such a resource-limited area as Swaziland.

A population-based study of risk factors for severe hypoglycaemia in a contemporary cohort of childhood-onset type 1 diabetes

Severe hypoglycaemia is a major barrier to optimising glycaemic control. Recent changes in therapy, however, may have altered the epidemiology of severe hypoglycaemia and its associated risk factors. The aim of this study was to examine the incidence rates and risk factors associated with severe hypoglycaemia in a contemporary cohort of children and adolescents with type 1 diabetes. Subjects were identified from a population-based register containing data on >99% of patients (<16 years of age) who were being treated for type 1 diabetes in Western Australia. Patients attend the clinic approximately every 3 months, where data pertaining to diabetes management, demographics and complications including hypoglycaemia are prospectively recorded. A severe hypoglycaemic event was defined as an episode of coma or convulsion associated with hypoglycaemia. Risk factors assessed included age, duration of diabetes, glycaemic control, sex, insulin therapy, socioeconomic status and calendar year. Clinical visit data from 1,770 patients, providing 8,214 patient-years of data between 2000 and 2011 were analysed. During follow-up, 841 episodes of severe hypoglycaemia were observed. No difference in risk of severe hypoglycaemia was observed between age groups. Good glycaemic control (HbA1c <7% [53 mmol/mol]) compared with the cohort average (HbA1c 8-9% [64-75 mmol/mol]) was not associated with an increased risk of severe hypoglycaemia. When compared with patients on injection regimens, subjects aged 12-18 years on pump therapy were at reduced risk of severe hypoglycaemia (incidence risk ratio 0.6; 95% CI 0.4, 0.9). In this population-based sample of children and adolescents with type 1 diabetes, contemporary therapy is associated with a changed pattern and incidence of severe hypoglycaemia.

A forensic autopsy case of death in a patient with pseudoxanthoma elasticum – Dermatopathologic findings as a clue of the cause of death

Pseudoxanthoma elasticum (PXE) is an autosomal recessive disorder, characterized by papular skin lesions and cutaneous laxity caused by fragmentation and mineralization of elastic fibers. Although vascular and retinal aspects of this disease and their associated complications are well characterized, few authors have focused on the increased incidence of epilepsy in patients with PXE. A 28-year-old Korean male was found dead in his work place with bloody-foamy discharge from his mouth and nostrils. He reportedly had a convulsive episode 5 days prior to his death in the work place. The skin showed generalized laxity and many creases with maculopapular pigmentations. A histopathologic examination of the skin revealed Pseudoxanthoma elasticum. Based on the histopathological findings and medical history, death was postulated to be due to ‘an internal cause, possibly related to a seizure attack’. Our findings suggest that histopathologic examinations of any lesions found during the forensic autopsy should be encouraged.

Closed Lip Schizencephaly: A Case Report

Schizencephaly, has been defined as an almost symmetrical bilateral cleft along the cerebral hemisphere. Clinical findings in patients with schizencephaly depends on the type of clefts (on of off type) and the amount of malformed parenchyma. Incidence of schizencephaly is unclear, while a population-based study performed in the United States reported its incidence as 1.54:100000. These types of cortical developmental malformations had variable clinical signs depending on the function of the affected area which range widely from mental-motor retardation and epilepsy to focal neurological disorders. We also presented a very rare case with bilateral cleft palate aged 4 years who was referred with recurrent afebrile convulsive episodes and diagnosed as schizencephaly, subependimal heterotopia and temporal lobe epilepsy by cranial MRI

Demanda asistencial para atender a población pediátrica en un servicio de emergencias prehospitalario

To quantify and to describe the characteristics of use of an Emergency Medical Service by children in Bilbao City (Spain).An observational and retrospective study was performed taking patients younger than 15 years old who were served by Basic Life Support Units from an Emergency Medical Service for 4 consecutive years (2008-2011).525 interventions were registered (anual range 102-155 interventions), which represented 2.25% of total services. 54.5% (p<0,001) of patients were male. The mean age was 7.6 years old (95% CI 6.8 to 7.5). The causes of action were associated to accidental causes in 49.1% of cases and disease in 50.9% (p=0,44), with a predominance of injuries in the 5 to 9 years (p<0,001) and disease among children under 5 years (p<0,001). The main disorders observed were injuries (41.9%), convulsive episodes (17.1%) and respiratory symptoms (10.3%). 78.9% need to transfer to health care center.The volume of pediatric care carried out between 2008 and 2011 has not changed annually. The main visits were due to traumas and convulsions. Most emergency situations are not resolved on the spot, being necessary to transfer to hospital.

English

INTRODUCTION: Injuries are very common after a convulsive episode of seizure . The patient can sustain soft tissues injuries in the form of tongue bite, and cuts or abrasions over skin. But more problematic are bony injuries like dislocation and fracture1. These injuries can be primarily due to epileptic fit or secondary to the accidental fall , which the patient sustain after the seizure 1. We describe a young male who had bilateral posterior dislocation of shoulder in the first episode of seizure.

Use of postictal respiratory pattern to discriminate between convulsive psychogenic nonepileptic seizures and generalized tonic-clonic seizures

Distinguishing between generalized tonic-clonic seizures (GTCSs) and convulsive psychogenic nonepileptic seizures (PNESs) can be difficult at the bedside, and this distinction has important implications for patient care. This study used a fully blinded method to examine postictal breathing parameters to identify features distinguishing between generalized tonic-clonic seizures (GTCSs) and convulsive psychogenic nonepileptic seizures (PNESs). Three blinded readers examined edited video recordings of the postictal phase of 72 convulsive seizure episodes recorded from 56 patients. There were 59 GTCS episodes and 13 PNES episodes. Postictal breathing after a PNES episode was more rapid than after a GTCS episode and, thereafter, normalized more rapidly. Postictal breathing after a GTCS episode was more likely to be characterized by stertorous respirations. Postictal breathing after a PNES episode was very unlikely to be characterized by stertorous respirations. Postictal respiratory pattern can assist in discriminating between GTCS and convulsive PNES.

吃逆を契機に失神を繰り返した1症例

A 66-year-old man visited our hospital with a chief complaint of a sore throat. On examination, the pharyngeal and laryngeal mucosa was reddish and localized mucosal erosion was present on the left side. Based on an initial diagnosis of acute pharyngitis caused by bacteriological infection or mycotic infection, treatment with antibacterial and antimycotic agents was initiated. However, the patient's sore throat gradually worsened and he developed intractable hiccups. Intravenous steroids were given for the treatment of the severe sore throat, and this symptom was gradually alleviated. However, the intractable hiccups persisted. In addition, the patient began to have convulsive syncope episodes and was subsequently admitted to our hospital. Further examination revealed that the syncope episodes were linked to the hiccups. To treat the hiccups, baclofen and Chinese medicine were prescribed, and the convulsive syncope episodes disappeared immediately. The patient's hiccups also improved and disappeared six days thereafter. Based on this clinical evidence, we concluded that the hiccups were caused by pharyngitis, resulting in the stimulation of the glossopharyngeal nerve, while the convulsive syncope episodes were a type of situational syncope related to hiccups.

A case of glucose-sensitive insulinoma accompanied by slightly elevated serum insulin levels and persisting convulsions after the surgically removed neuroendocrine tumor

Insul(in)oma is a usually solitary or, in some cases, multifocal tumor of pancreatic beta cells. It may be a component of multiple endocrine neoplasia type 1. or von Hippel-Lindau syndrome. In typical forms the diagnosis - based on the Whipple triad - is simple, however, it may be difficult to recognize in cases with near normal or only slightly elevated serum insulin levels, as well as in patients with known convulsive episodes. With the case presentation of an 81-year-old woman the authors draw attention to the pitfalls of the correct diagnosis. A special feature of the presented case is that convulsions persisted after surgical removal of the pancreatic neuroendocrine tumor verified with functional and imaging methods. Recurrent or residual tumor was not found, and morphological damage of the brain was absent. In the background of the continuing convulsions cerebrovascular alterations as well as the cytotoxic effect of the hypoglycemia-induced excessive glutamate production can be postulated.

A Case of Cerebral Sinus Venous Thrombosis Resulting in Mortality in Severe Preeclamptic Pregnant Woman

Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality.

Simultaneous posterior fracture dislocation of the shoulder following epileptic convulsion.

Shoulder dislocations with fractures are a possible complication of an epileptic seizure and are often missed on the first sight. The incidence of sustaining an avascular humeral head necrosis (AVN) is high, and primary prosthetic replacement is the choice of treatment. In this paper, we describe such a rare case: a 48-year-old male patient sustained simultaneous bilateral posterior shoulder dislocation with fractures of both humeral heads following the first episode of an epileptic convulsion. On the left side, open reduction and internal fixation were performed with angle stable plate osteosynthesis. In the same operation, a hemi-prosthesis was implanted on the right side. One and a half years postoperatively, function on the right side is unsatisfying and AVN is seen on the left side and secondary prosthetic replacement had to be performed. In case of a shoulder dislocation with a complex fracture after an epileptic seizure, prosthetic replacement is the choice of treatment.

Primary Headaches in Children: Clinical Findings and the Association with other Conditions

The aim of the present study is to report on the frequency of some comorbidities in primary headaches in childhood. Two hundred and eighty children (175 males and 105 females; ratio 1.7:1), aged 4 to 14 years, affected by primary headaches were consecutively enrolled in this study. In direct interviews, parents and children gave information about the association of their headaches with different conditions including asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight, affections some time associated in the literature to headache as comorbidities . In addition, anxiety and depression, attention deficit/hyperactivity disorder, tics, learning disabilities and obsessive-compulsive disorders, using psycho-diagnostic scales were evaluated. Two hundred and eighty children matched for age, sex, race and socio-economic status, were used as controls. No significant association of primary headaches was found with asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight. Overall behavioral disorders were more common in children who experienced headache than in controls. A significant association of primary headache was found with anxiety and depression (p value &#60; 0.001), but not with the other psychiatric disorders. Primary headaches in children are not associated with most of the psychiatric and systemic conditions herein investigated. On the contrary, there was a significant association with anxiety and depression, as frequently reported in adults.

Spinal Anesthesia for Lower Segment Cesarean Section in Patients With Stable Eclampsia

Abstract Study Objective To report the use of spinal anesthesia in eclamptic patients. Design Prospective case series. Setting Emergency operating room of a metropolitan hospital. Patients 12 stable eclamptic parturients. Interventions Subarachnoid block was instituted with hyperbaric 0.5% bupivacaine 1.7 mL with fentanyl 25 μg. Measurements Intraoperative maternal hypotension, episodes of convulsion, the need to convert to general anesthesia, and Apgar scores at 1 and 5 minutes were recorded. Main Results Only one of the 12 parturients had an episode of hypotension (treated by intravenous ephedrine), while no patient had a convulsion over the 48 hours after delivery. The sensory level achieved was T 5 -T 6 and none of the cases was converted to general anesthesia. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively. Conclusion Spinal anesthesia avoided the known risks of general anesthesia and was not associated with any major complications.

Disseminated tuberculosis: How early can it present?

Abstract/ Summary A four-month-old female presented with persistent fever & cough since three months of age and one episode of convulsion at four months of age. She was diagnosed as disseminated tuberculosis with miliary spread and neurotuberculosis. We report this rare early presentation of disseminated tuberculosis which was acquired postnatally (the contact being an adult relative with open pulmonary tuberculosis with hemoptysis).