RESUMO
Limbic encephalitis (LE) associated with positive potassium channel complex antibodies often manifests with faciobrachial dystonic seizures (FBDS). We retrospectively analyze two cases, admitted to our video-EEG unit between 2006 and 2014. Both patients were males, aged 66 and 76 years respectively, presenting with brief, but very frequent uni/bilateral dystonic brachial movements, hand posturing and ipsilateral facial grimacing. Severe hyponatremia was found in both patients who went on to develop cognitive impairment. Immunosuppressive therapy improved both seizures and cognitive dysfunction. Serology testing confirmed anti VGKC antibody presence. FBDS are often the first manifestation of LE associated to positive anti VGKC antibodies, and are refractory to treatment with antiepileptic drugs. Early diagnosis and treatment of FBDS with immunosuppressive therapy is important, not only because of seizure suppression, but also because it may help limit the extent of the cognitive damage.
Assuntos
Neuropatias do Plexo Braquial/etiologia , Distúrbios Distônicos/etiologia , Encefalite Límbica/complicações , Convulsões/etiologia , Idoso , Autoanticorpos/sangue , Neuropatias do Plexo Braquial/sangue , Distúrbios Distônicos/sangue , Eletroencefalografia , Humanos , Hiponatremia/sangue , Terapia de Imunossupressão , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: This study aimed to present 2 patients with simple partial refractory status epilepticus (RSE) treated with a single oral lacosamide (LCM) dose and to review the literature on this topic. METHOD: A retrospective description of 2 patients with simple partial RSE treated with 300 mg of LCM per os (p.o.) and a literature review were done. RESULTS: Both patients responded to single-dose oral LCM treatment with seizure cessation after 30 minutes. CONCLUSIONS: This is the first report on successful treatment of simple partial RSE with a single-dose of LCM p.o.. Oral LCM might represent an option for treatment of patients presenting with simple partial RSE.
Assuntos
Acetamidas/uso terapêutico , Anticonvulsivantes/uso terapêutico , Bloqueadores dos Canais de Sódio/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Acetamidas/administração & dosagem , Administração Oral , Adulto , Idoso , Anticonvulsivantes/administração & dosagem , Resistência a Medicamentos , Feminino , Humanos , Lacosamida , Bloqueadores dos Canais de Sódio/administração & dosagem , Resultado do TratamentoRESUMO
Atonic seizures are epileptic attacks characterised by a sudden loss or diminution of muscle tone. Structures corresponding to inhibitory cortical areas, such as the primary negative motor area or the supplementary negative motor area, could be responsible. We present findings observed in a patient with atonic seizures due to focal epilepsy, who underwent intracranial video-EEG monitoring and epilepsy surgery, and discuss possible underlying mechanisms. [Published with video sequences].
Assuntos
Eletroencefalografia/métodos , Epilepsias Parciais/fisiopatologia , Convulsões/fisiopatologia , Adulto , Epilepsias Parciais/cirurgia , Feminino , Humanos , Convulsões/cirurgia , Resultado do TratamentoRESUMO
RATIONALE: Epilepsy surgery procedures started in Argentina more than 50 years ago. This is the first comprehensive and systematic survey of epilepsy surgery long-term outcome from our country. METHODS: A descriptive cohort study was conducted between 1998 and 2008 for drug-resistant epilepsy surgery with a minimum of 12 months follow-up (n=110). In 84 cases (76.36%) resective surgery was performed, and outcome periodically assessed using the Engel score. Patients were stratified into groups: 12, 13-36, 37-60 and over than 60 months of follow-up. Video-EEG with and without intracranial electrode implants, intraoperative electrocorticograms, Wada tests, pathology reports, use of antiepileptic drugs (AEDs), and surgical complication rates were evaluated. RESULTS: Surgical techniques included: 69 lobectomies (62.7%), 15 lesionectomies (13.6%), 6 callosotomies (5.4%), 6 multiple subpial transection (5.4%), 11 vagus nerve stimulations (10%), 3 hemispherectomies (2.7%). Male: female ratio: 1/1.44. Mean age at time of surgery: 26.2 years. Mean duration of epilepsy: 14 years. Age at seizure onset: 11.5 years. Mean follow-up: 46 months. Pathology findings: mesial temporal sclerosis 32 (35.1%); dual pathology 17 (18.7%); cortical dysplasia 15 (16.4%); non-specific inflammatory changes 11 (12.1%); tumors 7 (7.7%); other 6 (6.8%). Engel scores at 12 months follow-up: 72.6% (61) class I, 16.6% (14) class II and 15.5% (13) class III-IV; 13-36 months after surgery: 68.1% of cases were class I, 15.9% class II and 15.5% class III-IV. After 37-60 months, 74% class I, 14% class II, 14% class III-IV. Over 60 months (n=45) 78% class I, 13.5% class II and 8.1% class III-IV. CONCLUSION: Conducting a successful epilepsy surgery program in a developing country is challenging. These results should encourage specialists in these countries. Long-term outcome results comparable to centres in developed countries can be achieved.