RESUMEN
BACKGROUND: Epilepsy is a common medical condition for which physicians perform driver fitness assessments. The Canadian Medical association (CMA) and the Canadian Council of Motor transportation administrators (CCMTA) publish documents to guide Canadian physicians' driver fitness assessments. OBJECTIVES: We aimed to measure the consistency of driver fitness counseling among epileptologists in Canada, and to determine whether inconsistencies between national guidelines are associated with greater variability in counseling instructions. METHODS: We surveyed 35 epileptologists in Canada (response rate 71%) using a questionnaire that explored physicians' philosophies about driver fitness assessments and counseling practices of seizure patients in common clinical scenarios. Of the nine scenarios, CCMTA and CMA recommendations were concordant for only two. Cumulative agreement for all scenarios was calculated using Kappa statistic. Agreement for concordant (two) vs. discordant (seven) scenarios were split at the median and analyzed using the Wilcoxon signed rank sum test. RESULTS: Overall the agreement between respondents for the clinical scenarios was not acceptable (Kappa=0.28). For the two scenarios where CMa and CCMta guidelines were concordant, specialists had high levels of agreement with recommendations (89% each). A majority of specialists disagreed with CMa recommendations in three of seven discordant scenarios. The lack of consistency in respondents' agreement attained statistical significance (p<0.001). CONCLUSIONS: Canadian epileptologists have variable counseling practices about driving, and this may be attributable to inconsistencies between CMa and CCMta medical fitness guidelines. This study highlights the need to harmonize driving recommendations in order to prevent physician and patient confusion about driving fitness in Canada.
Asunto(s)
Actitud del Personal de Salud , Conducción de Automóvil/normas , Epilepsia/terapia , Educación del Paciente como Asunto/normas , Médicos/normas , Guías de Práctica Clínica como Asunto/normas , Canadá/epidemiología , Epilepsia/diagnóstico , Epilepsia/epidemiología , Humanos , Educación del Paciente como Asunto/métodos , Relaciones Médico-Paciente , Encuestas y CuestionariosRESUMEN
Multicenter, retrospective analysis of 70 subjects with TSC following surgery for relief of epilepsy revealed significant associations between younger age at seizure onset, present/prior history of infantile spasms, interictal focality (bilateral versus unilateral), and absence of residual postoperative predominant tuber, and poorer postoperative outcome (p < 0.01). Ictal multifocality, mental retardation, and discordant EEG and MRI data showed a negative trend toward outcome, but were not significant.
Asunto(s)
Esclerosis Tuberosa/cirugía , Edad de Inicio , Mapeo Encefálico , Corteza Cerebral/patología , Corteza Cerebral/fisiopatología , Corteza Cerebral/cirugía , Niño , Preescolar , Electroencefalografía/estadística & datos numéricos , Epilepsias Parciales/patología , Epilepsias Parciales/fisiopatología , Epilepsias Parciales/cirugía , Epilepsia/patología , Epilepsia/fisiopatología , Epilepsia/cirugía , Femenino , Lateralidad Funcional/fisiología , Humanos , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias , Cuidados Preoperatorios , Estudios Retrospectivos , Resultado del Tratamiento , Esclerosis Tuberosa/patología , Esclerosis Tuberosa/fisiopatologíaRESUMEN
Yawning has been rarely described in association with seizures and not previously documented by video-EEG. We present a 48-year-old woman with a long history of non-dominant for speech hemisphere seizures and post-ictal yawning. Yawning was irresistible, forceful and often repetitive. We reviewed the few similar epileptic cases described in the literature and discussed the possible mechanisms. [Published with video sequences].
Asunto(s)
Epilepsia/fisiopatología , Convulsiones/fisiopatología , Bostezo , Electroencefalografía/métodos , Femenino , Humanos , Persona de Mediana Edad , Grabación en VideoRESUMEN
PURPOSE: The association between headache (HA) and epilepsy is well known. However, few previous studies characterized HA types and head sensations (HSens) in large populations of individuals with well-defined forms of epilepsy. METHODS: To analyze the incidence of HA in such a group, we compare HA and non-HA patients to identify special predictive factors for HAs or migraine. We also investigate the pathologically verified group for possible correlations with HAs or migraine. One hundred consecutive patients undergoing presurgical evaluation for pharmacologically intractable partial epilepsy were interviewed. For each HA type, we inquired about lateralization, localization, quality of HA, and results of treatment. RESULTS: Periictal HAs were reported by 47 patients. Of those, 11 had preictal HA (PIHA), and 44 had postictal HA (PostHA). Eight patients had both PIHA and PostHA. Interictal HAs (InterHAs) were reported by 31 patients. Twenty-nine (62%) of 47 patients had frontotemporal HAs. Twenty-five patients had migraine-like HA without aura: 18 (60%) of 30 patients with temporal lobe epilepsy (TLE) and seven (41%) of 17 with extratemporal epilepsy (ETE). No correlation between pathology and presence of HA was found in 59 pathologically verified patients, except in four who had arteriovenous malformations (AVMs): three had and one did not have HAs. Eighteen patients had, in addition, poorly localized and ill-described HSens other than HAs. CONCLUSIONS: We confirm an association between focal epilepsy and HAs, including migraine without aura. This is true for both TLE and ETE. PIHA and even prodromal HA may be related to the epileptic discharge and may have lateralizing value. This association is not recognized by the current International Headache Society (IHS) classification. The presence of HA and migraine is not related to the underlying epileptogenic pathology except in patients with AVMs.
Asunto(s)
Epilepsias Parciales/diagnóstico , Cefalea/diagnóstico , Adolescente , Adulto , Encéfalo/patología , Encefalopatías/diagnóstico , Encefalopatías/epidemiología , Encefalopatías/patología , Niño , Comorbilidad , Epilepsias Parciales/epidemiología , Epilepsias Parciales/patología , Epilepsia del Lóbulo Temporal/diagnóstico , Epilepsia del Lóbulo Temporal/epidemiología , Epilepsia del Lóbulo Temporal/patología , Femenino , Lateralidad Funcional/fisiología , Cefalea/epidemiología , Cefalea/patología , Humanos , Incidencia , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Malformaciones Arteriovenosas Intracraneales/epidemiología , Malformaciones Arteriovenosas Intracraneales/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/patología , Cuidados PreoperatoriosRESUMEN
Post-ictal rage and aggression have been mentioned in the literature but have rarely been documented by video-EEG recording. We studied a patient with dramatic, episodic, seizure-related rage and violence. This mentally retarded man had a lifelong history of seizures. He developed increasing episodic rage and aggression. Caregivers were afraid of him, although there was no record of directed violence. In one of these episodes he fractured his tibia and fibula. Interictal discharges arose from both temporal areas independently. He had focal seizures with secondary generalization. Immediately after cessation of the ictal discharge he became greatly agitated, with undirected aggression, loud screaming, kicking and fighting against the restraints. A video sequence illustrates the behavior. Imaging studies showed bilateral, periventricular, nodular heterotopia in the lateral aspect of both temporal horns and the trigones. Increasingly frequent, severe bursts of rage and aggression were proven to be post-ictal. Documented attacks occurred while he was restrained and this may have been a factor in their severity. Such attacks however, have been described while he was not restrained and these increased in severity and frequency over time. Developmental abnormalities with periventricular, nodular heterotopia in the region of the trigones and inferomesial temporal areas are considered to be causally related to his retardation and epilepsy. [Published with video sequences].