RESUMEN
People with focal epilepsies are known to under-document their seizures, but there is no data on self-documentation in adults with genetic (idiopathic) generalized epilepsy (GGE/IGE). We assessed the accuracy of self-evaluation of typical absences (TA) or myoclonic seizures (MS) in adults with IGE based on home video-EEG telemetry (HVET). Patients' own estimates were compared to the objective count of definite TA and MS, performed visually. We considered definite TA as generalized spike-wave discharges (GSWD) that met any of the following criteria: 1) coinciding with clear behavioural arrest on video, 2) followed after a few seconds by positive indication that an absence occurred, or 3) in the absence of video, consistently coinciding with clear motor arrest, as evidenced by interruption of continuous muscle activity. For each patient, we also classified probable TA as GSWDs that were longer than those corresponding to the shortest definite TA on HVET or based on the most recent sleep-deprived EEG (SDEEG). From the first 300 consecutive adults who had HVET, 24 had IGE with TA and / or MS; 23 were women. Only one patient had newly diagnosed IGE. Erroneous self-assessment of TA and MS was noted in 16/24 patients (66.7%). Seizures were overestimated in nine (37.5%) and underestimated in seven (29.2%). Only one patient (4.2%) documented all her TA and MS without false-positive estimates. Overestimation (but not underestimation) of TA on HVET could be predicted when patients reported daily or multiple weekly TA and a recent SDEEG was either normal or contained only subclinical GSWD (p=0.0095). Under- and over-self-documentation of TA and MS occurred in two thirds of adults with GGE/IGE, with substantial impact on their outpatient management and treatment. Diagnostic HVET is a useful tool for the detection of erroneous self-evaluation in these patients.
Asunto(s)
Epilepsia Generalizada , Adulto , Autoevaluación Diagnóstica , Electroencefalografía , Epilepsias Mioclónicas/diagnóstico , Epilepsias Mioclónicas/genética , Epilepsia Tipo Ausencia , Epilepsia Generalizada/diagnóstico , Femenino , Humanos , Inmunoglobulina E , Masculino , Convulsiones/diagnóstico , Autoevaluación (Psicología) , TelemetríaRESUMEN
OBJECTIVE: Encephalopathy is a major neurological complication of severe Coronavirus Disease 2019 (COVID-19), but has not been fully defined yet. Further, it remains unclear whether neurological manifestations are primarily due to neurotropism of the virus, or indirect effects, like cerebral hypoxia. METHODS: We analysed the electroencephalograms (EEGs) of 19 consecutive patients with laboratory-confirmed COVID-19, performed at peak disease severity as part of their clinical management. Disease severity, respiratory failure, immune and metabolic dysfunction, sedation status, and neurological examination on the day of the EEG were noted. RESULTS: Severe encephalopathy was confirmed in 13 patients, all with severe COVID-19; 10 remained comatose off sedation, and five of them had alpha coma (AC). Disease severity, sedation, immune and metabolic dysfunction were not different between those with AC and those without. CONCLUSIONS: Severe COVID-19 encephalopathy is a principal cause of persisting coma after sedation withdrawal. The relatively high incidence of the rare AC pattern may reflect direct SARS-CoV-2 neurotropism with a predilection for the brainstem ascending reticular system. SIGNIFICANCE: Systematic early EEG detection of encephalopathy related to severe COVID-19 is important for the acute care and the management of long-term neurological and cognitive sequelae, and may help our better understanding of its pathophysiology.
Asunto(s)
Encefalopatías/fisiopatología , Encéfalo/fisiopatología , COVID-19/fisiopatología , Coma/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Encefalopatías/etiología , COVID-19/complicaciones , Coma/etiología , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Neuropsychiatric symptoms are well recognized in systemic lupus erythematosus (SLE), with depression and anxiety often reported. The authors' clinical observations suggested emotional lability might also be a noteworthy symptom. In a consecutive series of systemic lupus erythematosus clinic attendees the authors therefore measured depression, anxiety, and emotional lability. Additionally, based on reports linking emotional reactivity and transient mood changes to alterations in early attentional processes, the authors investigated event-related potential indices of preattentive and early orienting responses to auditory stimuli (N1, MMN, P3a and P3b). The authors observed that 15 of 32 participants with systemic lupus erythematosus had high lability scores and, comparing event-related potential measures between the high and low lability subgroups, noted that those with greater emotional lability demonstrated reduced response latencies in N1 and MMN paradigms.
Asunto(s)
Síntomas Afectivos/etiología , Variación Contingente Negativa/fisiología , Emociones/fisiología , Potenciales Evocados Auditivos/fisiología , Lupus Eritematoso Sistémico/complicaciones , Estimulación Acústica/métodos , Adulto , Análisis de Varianza , Electroencefalografía/métodos , Femenino , Humanos , Lupus Eritematoso Sistémico/psicología , Masculino , Persona de Mediana Edad , Tiempo de ReacciónRESUMEN
The aim of this study was to investigate whether a physiological measure of impaired use of context could be obtained in people with Asperger's Syndrome (AS). The experimental paradigm employed was the use of electroencephalography to measure the detection of semantic incongruity within written sentences, as indexed by an N400 event-related potential. Whilst the seven controls appropriately demonstrated N400 potentials only to semantically incongruent stimuli, the seven participants with AS inappropriately demonstrated N400 potentials to congruent stimuli. These results are compatible with the possibility that the participants with AS did not use the context within sentences to predict the final word of the sentences.