•Prospective observational open study of treatment with cannabidiol for 6 months.•Efficacy: 86% responders, 11% non-responders, and 2% worsening.•Dose: The responding patients ended with a mean of ...329 mg/day.•Adverse events: 34% of patients reported mild adverse events and no patient reported severe adverse effects.•Most patients have a significant improvement in their quality of life.
Cannabidiol oil (CBD) has been approved as an anti-seizure medication for the treatment of uncommon types of epilepsy, occurring in children: Dravet syndrome, Lennox-Gastaut syndrome, and Tuberous Sclerosis Complex. There are few publications in relation to use the CBD in adult patients with focal drug-resistant epilepsy. The objective of this study was to evaluate the efficacy, tolerability, safety, and quality of life, of adjuvant treatment with CBD, in adult patients with drug-resistant focal epilepsy for at least 6 months.
An open, observational, prospective cohort study was conducted using a before-after design (time series) in adult patients undergoing outpatient follow-up in a public hospital in Buenos Aires, Argentina.
From a total of 44 patients, 5% of patients were seizure-free, 32% of patients reduced more than 80% of their seizures and 87% of patients reduced 50% of their monthly seizures. Eleven percent presented a decrease of less than 50% in seizure frequency.
The average final dose was 335 mg/d orally administered. Thirty-four percent of patients reported mild adverse events and no patient reported severe adverse effects. At the end of the study, we found in most patients a significant improvement in the quality of life, in all the items evaluated.
Adjuvant treatment with CBD in adult patients with drug-resistant focal epilepsy was effective, safe, well tolerated, and associated with a significant improvement in their quality of life.
Temporal lobe epilepsy can disturb eloquent areas, affecting language. We applied a visually-mediated task to measure lateralization of language recognition in drug-resistant temporal lobe epilepsy.
...Patients with left (
= 26), right (
= 28) temporal lobe epilepsy and controls (
= 30) were administered the translingual lexical decision task. We performed repeated measures analyses of variance, with the visual half-field as an intrasubject factor and the group as an intersubject factor.
A main effect of visual half-field was found, showing the right visual field (left hemisphere) advantage for both accuracy and response time. A main effect of the group was found in accuracy, showing that both epilepsy groups performed less accurately than controls, and left temporal lobe epilepsy performed less accurately than right temporal lobe epilepsy. Also, the group-by-visual half-field interaction was significant. Post hoc t tests indicated the controls and right temporal lobe epilepsy performed better in the right visual field than in the left visual field, whereas no visual half-field effect was found in left temporal lobe epilepsy. For response times, the interaction was also significant. Post hoc t tests showed a significant right visual-field advantage for controls (two-tailed) and for the right temporal lobe epilepsy (one-tailed). Right visual-field advantage was absent in left temporal lobe epilepsy.
The translingual lexical decision task can efficiently distinguish between left and right temporal lobe epilepsy. Compared to right temporal lobe epilepsy and controls, language lateralization is diminished in left temporal lobe epilepsy. The potential use of the translingual lexical decision task as an effective noninvasive presurgical language lateralization screening tool is highlighted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Dancing epilepsy: A stereo encephalography case report Cámpora, Nuria; Nasimbera, Alejandro; Daza, Anilu ...
Epileptic disorders,
February 2024, 2024-Feb, 2024-02-00, 20240201, Letnik:
26, Številka:
1
Journal Article
Recenzirano
Ictal semiology is essential to identify the epileptogenic zone (EZ), especially in drug‐resistant focal epilepsy (DRE), as its accurate identification determines the surgical prognosis. Dancing is ...highly unusual ictal semiology, and its underlying neural networks remain somehow unclear since both temporal and frontal lobe (FL) have been implicated in its generation. We present a 21‐year‐old male with DRE characterized by dancing seizures. Homemade videos were obtained. Through a non‐invasive pre‐surgical evaluation, the epileptogenic zone was localized within a gross lesion in the left FL. Using stereo electroencephalography (SEEG), we successfully identified the ictal‐onset zone in the mesial middle, inferior, and orbito‐frontal cortex, with rapid propagation of ictal activity extending backward and laterally to the precentral regions. Subsequently, a left frontal middle and inferior gyrectomy was performed, resulting in seizure freedom for the patient. Pathology results revealed a mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE). Atypical seizure semiology, such as dancing, provides an interesting starting point for the analysis of the areas involved in the EZ. Further intracranial recordings are required to fully comprehend the underlying networks and interactions of cerebral areas during dancing seizures.
Purpose: To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules.
Materials and methods: Institutional review board ...approval was obtained, and patients' consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated.
Results: No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was −67 ± 19% vs. −57 ± 21% (p < 0.001) − 70 ± 19% vs. −62 ± 22% (p = 0.001) in LA group and in RFA group, respectively. Nodules with volume >30 mL had significantly higher percentage volume reduction at 6 and 12 months (−69 ± 19 vs. −50 ± 21, p = 0.001) and (−73 ± 18 vs. −54 ± 23 8, p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator's skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116)
Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator's skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Introduction Depression is the most frequent psychiatric co-morbidity in patients with epilepsy. Lifetime prevalence of depression is reported more frequently in temporal lobe epilepsy and ...is estimated at 35%. This co-morbidity appears to be related with various mechanisms. The aim of this study was to determine the quality of life (QoL) of patients with pharmacoresistant epilepsy with and without co-morbid depression in an Argentinean population. Methods Patients admitted to the video-EEG monitoring unit during the period 2010–2013 went through a standardized psychiatric assessment using SCID-I (Structured Clinical Interview for Axis I diagnoses of DSM-IV), BDI II (Beck Depression Inventory) GAF (Global assessment of functioning), and Q LES Q-SF (for quality of life). Patients were divided in two groups: with and without depression (according to DSM-IV). Sociodemographic data, BDI II scores, GAF, and quality of life (QoL) were compared between the two groups. Comparisons were made using Student's t- test and Mann–Whitney U test. Frequency distributions were compared by Chi-square test. Spearman correlation coefficients were determined. Results Seventy-seven patients with pharmacoresistant epilepsy were eligible for this study, 41 patients were included in the group with depression (mean BDI II 15.93), and 36 in the group without depression (mean BDI II 3.36) (p = 0.001). The overall QoL was significantly lower in the group with depression compared to the group without depression (p < 0.01). The most affected areas were: physical health (p = 0.013), mood (p = 0.006), course activities (referring to school as well as to hobbies or classes outside of school) (p = 0.003), leisure time activities (p = 0.011), social activities (p = 0.047), general activities (p = 0.042), and medication (p = 0.022). Severity of depression according to BDI II had a negative correlation with overall QoL (r - 0.339, p < 0.01). No correlations were found between seizure frequency, QoL and BDI II. Conclusion Patients with pharmacoresistant epilepsy and co-morbid depression reported worst QoL. Depression disrupts daily functioning (leisure, social functioning) and is a negative influence for subjective perception of health and medication. Interdisciplinary treatment should be considered (neurology–psychiatry–psychotherapy).
The association between the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is rare and has never been treated with an ...arginine vasopressin receptor antagonist. We report a unique case of SIADH associated with ibuprofen use and successfully treated with tolvaptan. A 76-year-old man came to our observation because of lumbar pain and epigastric discomfort. He was taking ibuprofen orally 400 mg bid as an analgesic treatment. Laboratory tests showed low levels of sodium (116 mmol/L) and chloride; a diagnosis of SIADH was formulated and ibuprofen was stopped immediately. Imaging tests allowed to rule out the presence of malignancies or cerebral and lung diseases. Slightly hypertonic saline infusion was administered for 3 days without significant sodium improvement; therefore, tolvaptan was started at the initial dose of 7.5 mg daily, doubled after 5 days. After 8 days of treatment the patient showed progressive increase of sodium levels up to normal values. In the following weeks tolvaptan was prescribed at progressively titrated dosage to full suspension; afterwards the sodium levels remained normal without any type of treatment.
•Impulsivity is a behavioral trait related to epilepsy and risky behavior.•Impulsivity was measured one year after surgery.•Higher impulsivity after surgery was associated with a worse epilepsy ...seizure outcome.
Psychiatric comorbidities in patients with drug-resistant epilepsy (DRE) are frequently observed before and after epilepsy surgery. Impulsivity, defined as behaviors that are poorly conceived, are also frequent among patients with epilepsy. The aim of this study was to determine the presence of comorbid impulsivity in patients with DRE after one year of epilepsy surgery.
Patients who underwent epilepsy surgery for DRE and completed the postsurgical assessment protocol one year after surgery were included. All patients underwent a presurgical protocol comprising of neurological, psychiatric, neuropsychological, video-EEG and MRI assessments. The psychiatric evaluation was performed before and one year after surgery using SCID-I, SCID-II, GAF scale of DSM IV, and Beck Depression Inventory II. One year after surgery, Barratt Impulsiveness Scale 11, and Engel classification of seizures, were administered.
A total of 38 patients were included in this study, 21 women (55.3%) and 17 men (44.7%), mean age 36 years (SD = 9.4). Higher impulsivity was associated with a worse epilepsy seizure outcome (p < 0.05), one year after surgery. According to the multiple linear regression analysis, a worse epilepsy seizure outcome was associated with higher levels of nonplanning impulsivity (p < 0.05) (p < 0.05, β −0.5, r2 0.25). The GAF score was negatively associated with motor score (p < 0.05, β −0.584, r2 0.42) and with the total BIS-11 score (p < 0.05, β −0.557, r2 0.39).
Impulsivity has been associated with a worse post-surgical seizure outcome. Larger studies about impulsivity might confirm these preliminary findings.
Purpose. The goal of this study was to assess the cognitive function status in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (TLE
+
HS) to determine their cognitive function ...profile and to correlate material-specific memory deficits with HS laterality diagnosed by MRI.
Methods. Seventy-one patients were assessed with a neuropsychological protocol that includes IQ, attention, handedness, verbal memory, visual memory, language, and the executive function.
χ
2 and correlation tests were used.
Results. Memory impairment was found in 46 patients (66%): patients without any memory deficit (
n=25), patients with verbal memory deficit (
n=21), patients with visual memory deficit (
n=17), patients with deficit for both types of memory (
n=8). Correlation between MRI lesion and memory was 66%. Language was impaired in 33 patients (46%). Eighteen patients (25%) had a deficit of the executive function.
Conclusions. Patients with TLE
+
HS presented with a deficit in material-specific episodic memory correlating in large proportion with HS lateralization. We also found language and executive function impairments.
•Invalidating environment was analyzed in different seizure disorders.•Maternal negative response identified a group of patients with functional disorders.•Chaotic families predicted a specific ...drug-resistant epilepsy patients population.•Stress coping strategies were also analyzed in different seizure disorders.•The analysis of stress coping succeeded in identifying various seizure disorders.
We investigated perceived invalidating environment during childhood and stress-coping strategies in patients with; functional dissociative seizures (FDS, n=26), drug-resistant epilepsy patients with no psychiatric comorbidity (DREnc, n=23), and drug-resistant epilepsy patients with psychiatric comorbidity (DREpc, n=34).
We performed a cross-sectional study. Patients underwent Video Electroencephalography to confirm the diagnosis and completed a psychiatric assessment supported by clinical instruments. Invalidating environment and stress coping were studied through the ICES and CAE questionaries, respectively. A series of multinomial logistic regression analyses were performed with the explored variables.
The maternal negative response model predicted a higher probability of FDS condition. A chaotic family type increased the likelihood of DREpc instead of FDS. DREpc and FDS patients displayed many different behaviors to cope with stress other than trying to solve the problem, the most used strategy in the DREnc group. Parental invalidation was higher in DREpc than in FDS.
Our results deepen the data provided by previous studies indicating that multiple variables of biosocial origin have significant effects on these groups of patients. The presence of an invalidating environment may predict FDS but also the presence of psychiatric disorders among DRE. Psychotherapeutic strategies to enhance these variables might be necessary for this population.
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