Objectives
Lacosamide is an antiepileptic drug (AED), which has proven to be effective to control seizures, including acute conditions such as status epilepticus. The aim of this study is to describe ...the clinical experience with lacosamide in neuro‐oncological patients.
Materials and methods
Multicenter retrospective study in patients with cancer‐related seizures, who received lacosamide as an add‐on therapy.
Results
Forty‐eight patients with benign and malignant tumors, including primary brain tumors, lymphomas, systemic cancer with central nervous system involvement, or paraneoplastic encephalitis, were included. Lacosamide was effective in the control of chronic seizures in patients with either benign or malignant tumors. The success rate was greater in malignant tumors, and drug‐resistant epilepsies were more likely associated with benign tumors. Adverse events occurred in nearly 70% of patients, particularly in acute conditions and associated with the concomitant use of radio‐/chemotherapy. Lacosamide‐related adverse events were more likely somnolence and dizziness, which usually resolved after dose adjustment. After starting lacosamide, nearly half of the patients discontinued one of the baseline AEDs and decreased or discontinued dexamethasone. Fifteen patients with status epilepticus were treated with intravenous lacosamide, and 73% of them had their condition resolved without serious drug‐related adverse events.
Conclusion
Lacosamide is an AED to consider in cases of cancer‐related seizures. Lacosamide pharmacodynamics and pharmacokinetics allow the achievement of responder rates over 50% with no serious adverse effects, amelioration of side effects from other AEDs or radio‐/chemotherapy, and no significant drug interactions. Furthermore, the intravenous formulation shows clear benefits in acute conditions such as status epilepticus.
We present an uncommon case of isolated basal ganglia mucormycosis in a patient without any known cause of immunosuppression, but with a history of drug injection. The patient presented a good ...clinical and radiological response to antifungal treatment without aggressive surgical debridement (liposomal amphotericin B combined with isavuconazole for 4 weeks followed by isavuconazole as maintenance therapy for 10 months).
INTRODUCTIONMild traumatic brain injury (mTBI) has traditionally been considered to cause no significant brain damage since symptoms spontaneously remit after a few days. However, this idea is facing ...increasing scrutiny. The purpose of this study is to demonstrate the presence of early cognitive alterations in a series of patients with mTBI and to link these findings to different markers of brain damage. METHODSWe conducted a prospective study of a consecutive series of patients with mTBI who were evaluated over a 12-month period. Forty-one (3.7%) of the 1144 included patients had experienced a concussion. Patients underwent a routine clinical evaluation and a brain computed tomography (CT) scan, and were also administered a standardised test for post-concussion symptoms within the first 24hours of mTBI and also 1 to 2 weeks later. The second assessment also included a neuropsychological test battery. The results of these studies were compared to those of a control group of 28 healthy volunteers with similar characteristics. Twenty patients underwent an MRI scan. RESULTSVerbal memory and learning were the cognitive functions most affected by mTBI. Seven out of the 20 patients with normal CT findings displayed structural alterations on MR images, which were compatible with diffuse axonal injury in 2 cases. CONCLUSIONSResults from this pilot study suggest that early cognitive alterations and structural brain lesions affect a considerable percentage of patients with post-concussion syndrome following mTBI.
Resumen Introducción Los traumatismos craneoencefálicos leves (TCE-L) han sido tradicionalmente considerados acontecimientos sin repercusiones cerebrales significativas, cuya sintomatología remite ...espontáneamente en unos días. Sin embargo, estos hechos son cada vez más cuestionados. Este estudio pretende objetivar la existencia de alteraciones cognitivas precoces en una serie de pacientes con TCE-L y relacionar los hallazgos con distintos marcadores de lesión cerebral. Métodos Estudio prospectivo de una cohorte de pacientes con un TCE-L valorados de forma consecutiva durante 12 meses. De un total de 1.144 pacientes, se seleccionó a 41 (3,7%) que habían presentado una conmoción cerebral. Además de la valoración clínica habitual y de la práctica de una tomografía computarizada (TC) cerebral, los pacientes fueron estudiados mediante un test estandarizado para síntomas posconmocionales en las primeras 24 h después del TCE-L y al cabo de 1-2 semanas y, coincidiendo con la segunda valoración, mediante una batería neuropsicológica. Los resultados se compararon con los de un grupo de 28 voluntarios sanos de características parecidas. En 20 pacientes se practicó una resonancia magnética (RM) craneal. Resultados En este análisis exploratorio, la memoria y el aprendizaje verbal fueron las funciones cognitivas más afectadas después del TCE-L. Siete de los 20 pacientes con TC cerebral normal presentaron alteraciones estructurales visibles por RM, que en 2 casos fueron compatibles con la presencia de lesión axonal difusa. Conclusiones Los resultados de este estudio piloto sugieren la presencia de alteraciones cognitivas precoces y lesiones cerebrales estructurales en un porcentaje no despreciable de pacientes que han presentado una conmoción cerebral recuperada después de un TCE-L.
Pupil assessment is a fundamental part of the neurological examination. Size and reactivity to light of each pupil should be recorded periodically since changes in these parameters may represent the ...only detectable sign of neurological deterioration in some patients. However, there is great intraobserver and interobserver variability in pupil examination due to the influence of many factors, such as the difference in ambient lighting, the visual acuity and experience of the examiner, the intensity of the luminous stimulus, and the method used to direct this stimulus. In recent years, digital cameras have incorporated infrared devices allowing the development of user-friendly portable devices that permit repeated, non-invasive examinations of pupil size and its reactivity to light with an objective, accessible and inexpensive method.
The purpose of this review is to describe the fundamentals of infrared pupillometry and discuss potential applications in the monitoring of neurocritical patients. We also present some recommendations in the routine assessment of pupils in neurocritical patients.
The possibility of evaluating the changes in pupil reactivity in an early, objective and almost continuous way provides a new non-invasive monitoring method. This method could improve the predictive factor of neurological deterioration and the bedside monitoring of the neurological state of the patient, avoiding unnecessary examinations and enabling early therapeutic intervention.
Mild traumatic brain injury brain injury (mTBI) has traditionally been considered to cause no significant brain damage since symptoms spontaneously remit after a few days. However, this idea is ...facing increasing scrutiny. The purpose of this study is to demonstrate the presence of early cognitive alterations in a series of patients with mTBI and to link these findings to different markers of brain damage.
We conducted a prospective study of a consecutive series of patients with mTBI who were evaluated over a 12-month period. Forty-one (3.7%) of the 1144 included patients had experienced a concussion. Patients underwent a routine clinical evaluation and a brain computed tomography (CT) scan and were also administered a standardised test for post-concussion symptoms within the first 24h of mTBI and also 1-2 weeks later. The second assessment also included a neuropsychological test battery. The results of these studies were compared to those of a control group of 28 healthy volunteers with similar characteristics. Twenty patients underwent a magnetic resonance imaging (MRI) scan.
Verbal memory and learning were the cognitive functions most affected by mTBI. Seven out of the 20 patients with normal CT findings displayed structural alterations on MR images, which were compatible with diffuse axonal injury in two cases.
Results from this pilot study suggest that early cognitive alterations and structural brain lesions affect a considerable percentage of patients with post-concussion syndrome following mTBI.
Los traumatismos craneoencefálicos leves (TCE-L) han sido tradicionalmente considerados acontecimientos sin repercusiones cerebrales significativas, cuya sintomatología remite espontáneamente en unos días. Sin embargo, estos hechos son cada vez más cuestionados. Este estudio pretende objetivar la existencia de alteraciones cognitivas precoces en una serie de pacientes con TCE-L y relacionar los hallazgos con distintos marcadores de lesión cerebral.
Estudio prospectivo de una cohorte de pacientes con un TCE-L valorados de forma consecutiva durante 12 meses. De un total de 1.144 pacientes, se seleccionó a 41 (3,7%) que habían presentado una conmoción cerebral. Además de la valoración clínica habitual y de la práctica de una tomografía computarizada (TC) cerebral, los pacientes fueron estudiados mediante un test estandarizado para síntomas posconmocionales en las primeras 24h después del TCE-L y al cabo de 1-2 semanas y, coincidiendo con la segunda valoración, mediante una batería neuropsicológica. Los resultados se compararon con los de un grupo de 28 voluntarios sanos de características parecidas. En 20 pacientes se practicó una resonancia magnética (RM) craneal.
En este análisis exploratorio, la memoria y el aprendizaje verbal fueron las funciones cognitivas más afectadas después del TCE-L. Siete de los 20 pacientes con TC cerebral normal presentaron alteraciones estructurales visibles por RM, que en dos casos fueron compatibles con la presencia de lesión axonal difusa.
Los resultados de este estudio piloto sugieren la presencia de alteraciones cognitivas precoces y lesiones cerebrales estructurales en un porcentaje no despreciable de pacientes que han presentado una conmoción cerebral recuperada después de un TCE-L.
PDF
