RESUMEN
BACKGROUND: There is still limited knowledge regarding the role of impaired brain glucose metabolism in the generation of aggression during diabetes. Additionally, there are rapidly replicating piece of evidence suggesting that topiramate may exert significant mood stabilizing effect. In this respect, we aimed to evaluate the neurometabolic correlates of the therapeutic effect of topiramate in a patient with diabetes and Intermittent explosive disorder (IED). METHODS: We measured regional cerebral glucose metabolism using 2-[18F]-fluoro-2-deoxy-D-glucose and positron emission tomography (FDG-PET) in a diabetic patient with aggressive outbursts before and after treatment with topiramate. In order to reveal a defined information underlying the improvement of the aggressive symptoms we also combined the PET with Modified Overt Aggression Scale. RESULTS: We have found that topiramate leads to the improvement in Modified Overt Aggression Scale that was well correlated with the increase in cortical brain metabolism. DISCUSSION: The therapeutic role of topiramate may not only suggest secondary deficits due to diminished functions of the cortical part of emotional circuits but also indicate that diabetic individuals may be vulnerable to lower cerebral glucose metabolism in cortical regions. Further clinical trials that include well-conducted randomized controlled trials and cohort studies by using other methods (i.e., magnetic resonance spectroscopy and quantitative EEG analysis) are necessary to confirm our preliminary findings.
Asunto(s)
Agresión/efectos de los fármacos , Encéfalo/diagnóstico por imagen , Diabetes Mellitus/diagnóstico por imagen , Diabetes Mellitus/tratamiento farmacológico , Fructosa/análogos & derivados , Tomografía de Emisión de Positrones , Adulto , Agresión/fisiología , Animales , Encéfalo/metabolismo , Diabetes Mellitus/sangre , Fructosa/farmacología , Fructosa/uso terapéutico , Humanos , Masculino , Tomografía de Emisión de Positrones/métodos , TopiramatoAsunto(s)
Anticonvulsivantes/efectos adversos , Epilepsia/tratamiento farmacológico , Músculos Faciales/efectos de los fármacos , Fructosa/análogos & derivados , Mioclonía/inducido químicamente , Adulto , Anticonvulsivantes/uso terapéutico , Electroencefalografía/estadística & datos numéricos , Músculos Faciales/fisiopatología , Femenino , Fructosa/efectos adversos , Fructosa/uso terapéutico , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Mioclonía/diagnóstico , Mioclonía/fisiopatología , TopiramatoRESUMEN
Pure alexia is a rare disorder usually caused by an ischemic or hemorrhagic stroke. We describe a case of pure alexia due to nonconvulsive status epilepticus (NCSE). This 57-year-old man presented in a hyperosmolar, nonketotic state with fluctuations in mental status and an inability to read. His EEG was diagnostic of NCSE originating from the left temporo-occipital region. MRI of the brain revealed increased FLAIR signal over the left occipitotemporal region. Following initiation of antiepileptic treatment, his neurological examination normalized concomitantly with resolution of the NCSE. A follow-up MRI scan of the brain obtained 1 month later was normal. NCSE can have unusual clinical manifestations, and a high index of suspicion is necessary to correctly diagnose these patients.
Asunto(s)
Dislexia/psicología , Estado Epiléptico/psicología , Glucemia/metabolismo , Dislexia/etiología , Dislexia/fisiopatología , Electroencefalografía , Epilepsias Parciales/complicaciones , Epilepsias Parciales/fisiopatología , Epilepsias Parciales/psicología , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Lectura , Estado Epiléptico/complicaciones , Estado Epiléptico/fisiopatologíaRESUMEN
OBJECTIVE: To find out whether there is a relationship between the headache characteristics and polysomnographic findings in patients with prediagnosis of the sleep apnea syndrome (SAS) and, if there is, to search for its possible cause. BACKGROUND: Chronic morning headache is considered by many to be an important part of the SAS. Some reports support this relationship, and some do not. METHODS: We questioned 75 patients with SAS about headache. Headaches were classified according to the International Headache Society (IHS-88) system. We evaluated the relationship between headache and polysomnographic findings. RESULTS: There was no statistically significant relationship between headache and apnea hypopnea index (AHI) or minimal oxygen saturation (P >.05). CONCLUSIONS: We could not demonstrate a statistically significant relationship between headache, AHI, and minimal oxygen saturation in our patients with SAS.