This report presents a fatal case of a young female Type I diabetic patient who developed convulsions and loss of consciousness after taking methamphetamine and spending some time in a dance club. During the convulsions, she was given sugar and when no response occurred, her boyfriend who was not experienced in the use of insulin administered a dose of insulin to her. The woman lost consciousness and died despite the efforts of the emergency service. A biochemical analysis revealed a high level of insulin (196.67 mU/L) and low levels of glucose (2.96 mmol/L) and C-peptide (26 pmol/L). Toxicological analysis revealed a methamphetamine concentration of 389 ng/mL and an amphetamine concentration of 19 ng/mL. The forensic perspective of the difficult determination of the contribution of each of the factors to the death, i.e., the pre-existing medical condition (Type I diabetes), the use of methamphetamine, the physical exertion at the dance club, and, finally, the non-indicated administration of insulin, is discussed. The ruling of the court is also reported.
- MeSH
- bezvědomí chemicky indukované MeSH
- C-peptid krev MeSH
- diabetes mellitus 1. typu * MeSH
- dospělí MeSH
- fatální výsledek MeSH
- hypoglykemika škodlivé účinky MeSH
- inzulin * aplikace a dávkování MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- methamfetamin * škodlivé účinky MeSH
- poruchy spojené s užíváním amfetaminu komplikace MeSH
- stimulanty centrálního nervového systému * škodlivé účinky MeSH
- tanec MeSH
- tělesná námaha MeSH
- záchvaty MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Úvod: Febrilné kŕče (FK) postihujú približne 2-5% detí. Podľa väčšiny guidelines je indikáciou k hospitalizácii a diagnostike podskupina komplikovaných resp. rekurentných simplexných FK. V prípade stabilného stavu u dieťaťa (nad 18 mesiacov) po simplexných FK nie je dôvod hospitalizovať ani rozširovať diagnostiku, u detí do 18 mesiacov sa odporúča observácia do vylúčenia neuroinfekcie. Cieľom bolo porovnať publikované odporúčania s realitou praxe. Materiál a metódy: Súbor tvorilo 66 detí s FK hospitalizovaných počas 12 mesiacov na Klinike detí a dorastu UPJŠ LF a DFN Košice. Pacienti boli rozdelení podľa klinického stavu a priebehu. Manažment bol porovnaný s medzinárodnými odporúčaniami s cieľom preveriť opodstatnenosť vyšetrení (elektroencefalografia, EEG) a samotnej hospitalizácie. Výsledky: V 14 prípadoch bola dôvodom prijatia opodstatnená neurologická indikácia (komplikované FK n = 5 resp. recidivujúce simplexné kŕče n = 9). V prípadoch prvovýskytu simplexného charakteru bolo v 11 prípadoch (16% z celého súboru) hospitalizované aj stabilné dieťa s nízkym rizikom komplikácií. Počas hospitalizácie bolo EEG realizované až u 75% detí (n = 39) zo skupiny prvého výskytu simplexných FK, pričom žiadne nemalo abnormálny nález. Záver: Štúdia konštatuje nadužívanie EEG vyšetrenia, ktoré v prípade jednoduchých FK nemá opodstatnenie. EEG a neuropediatrické vyšetrenie sa odporúča realizovať len v prípadoch komplikovaných a rekurentných jednoduchých FK. Dáta potvrdzujú benígny charakter FK a podčiarkujú význam nasledovania medicínskych postupov založených na dôkazoch s cieľom racionalizácie a optimalizácie zdravotnej starostlivosti. Hospitalizácia detí s nekomplikovanými FK je opodstatnená len v prípade potreby diagnostiky a liečby pridruženej komorbidity (signifikantná dehydratácia apod.), alebo ak neuroinfekciu nie je možné klinicky vylúčiť z dôvodu nízkeho veku.
Introduction: Febrile seizures (FS) cumulatively affect approximately 2-5% of children. According to most guidelines, complicated and recurrent simplex FS are indicated for hospitalization and further diagnostic workup. In the case of a stable condition in a child (over 18 months) after simple FK, there is no reason to hospitalize or extend the diagnosis, in children under 18 months observation is recommended until neuroinfection is ruled out. The aim was to compare published recommendations with the reality of practice. Material and methods: Studied sample consisted of 66 children with FS hospitalized over 12 months at the Department of Paediatrics and Adolescent Medicine of P. J. Safarik University and Children Teaching Hospital in Košice. Patients were divided according to clinical status and course. The management was compared with international recommendations in order to verify the validity of examinations (electroencephalography, EEG) and hospitalization itself. Results: In 14 cases, the reason for admission was a justified neurological indication (complicated FS n=5 or recurrent simplex convulsions n=9). In cases of first simple FS 11 cases were identified (16% of the entire set) where a stable child with a low risk of complications was also hospitalized. During hospitalization, EEG was carried out in up to 75% of children (n=39) from the subgroup of first simple FS. None of them had abnormal EEG findings. Conclusions: The study shows the overuse of the EEG examination, which is not justified in the case of simple FS. Electroencephalographic and neuropediatric examination is recommended only in cases of complicated and recurrent simple FS. The data confirm the benign nature of FS and underline the importance of following evidence-based medical practices to rationalize and optimize health care. Hospitalization of children with uncomplicated FS is justified only if diagnosis and treatment of associated comorbidity is necessary (significant dehydration, etc.) or if neuroinfection cannot be clinically excluded due to young age.
- MeSH
- benzodiazepiny farmakologie terapeutické užití MeSH
- diferenciální diagnóza MeSH
- elektroencefalografie metody MeSH
- febrilní křeče * diagnóza etiologie klasifikace komplikace MeSH
- infekce centrálního nervového systému diagnóza komplikace MeSH
- kojenec MeSH
- lidé MeSH
- nemoci nervového systému diagnóza klasifikace MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- předškolní dítě MeSH
- Geografické názvy
- Slovenská republika MeSH
OBJECTIVE: The pre-surgical evaluation of epilepsy relies on the electrophysiological recordings of spontaneous seizures. During this period drug dose decreases increase the likelihood of seizures transitioning the brain from a low to high seizure likelihood state, so-called pro-ictal state. This study aimed to identify the dynamic brain changes characteristic of this transition from 386 ten-minute segments of intracranial EEG recordings of 29 patients with drug-refractory temporal lobe epilepsy. METHODS: We studied brain dynamics through mean phase locking value and relative power in gamma band, and autocorrelation function width. We further explored interactions with pro-ictal factors, such as rate of interictal spikes and high frequency oscillations, circadian and multi-day cycles, and clinical outcomes. RESULTS: We observed significant increases in gamma power in the epileptogenic zone, and critical slowing in both the epileptogenic zone and presumably healthy cortex. These changes were linked with increases in spike and high frequency oscillations rate. CONCLUSIONS: Brain dynamics changed on the slow time scale - from the beginning to the end of the multi-day interval - but did not change in the short-term during the pre-ictal interval, thus could reflect pro-ictal changes. SIGNIFICANCE: We highlight gamma power and critical slowing indices as markers of pro-ictal brain states, as well as their potential to track the seizure-related brain mechanisms during the presurgical evaluation of epilepsy patients.
- MeSH
- dospělí MeSH
- elektroencefalografie metody MeSH
- elektrokortikografie metody MeSH
- epilepsie temporálního laloku * patofyziologie diagnóza MeSH
- gama rytmus EEG * fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mozek * patofyziologie MeSH
- refrakterní epilepsie * patofyziologie MeSH
- záchvaty * patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
In drug-resistant focal epilepsy, planning surgical resection can involve presurgical intracranial EEG (iEEG) recordings to detect seizures and other iEEG patterns to improve postsurgical seizure outcome. We hypothesized that resection of tissue generating interictal high-frequency oscillations (HFOs, 80-500 Hz) in the iEEG predicts surgical outcome. In eight international epilepsy centres, iEEG was recorded during the presurgical evaluation of patients. The patients were of all ages, had epilepsy of all types, and underwent surgical resection of a single focus aiming at seizure freedom. In a prospective analysis, we applied a fully automated definition of HFO that was independent of the dataset. Using an observational cohort design that was blinded to postsurgical seizure outcome, we analysed HFO rates during non-rapid-eye-movement sleep. If channels had consistently high rates over multiple epochs, they were labelled the 'HFO area'. After HFO analysis, centres provided the electrode contacts located in the resected volume and the seizure outcome at follow-up ≥24 months after surgery. The study was registered at www.clinicaltrials.gov (NCT05332990). We received 160 iEEG datasets. In 146 datasets (91%), the HFO area could be defined. The patients with a completely resected HFO area were more likely to achieve seizure freedom in comparison to those without [odds ratio 2.61, 95% confidence interval (CI) 1.15-5.91, P = 0.02]. Among seizure-free patients, the HFO area was completely resected in 31 and not completely resected in 43. Among patients with recurrent seizures, the HFO area was completely resected in 14 and not completely resected in 58. When predicting seizure freedom, the negative predictive value of the HFO area (68%, CI 52-81) was higher than that for the resected volume as a predictor by itself (51%, CI 42-59, P = 4 × 10-5). The sensitivity and specificity for complete HFO area resection were 0.88 (CI 0.72-0.98) and 0.39 (CI 0.25-0.54), respectively, and the area under the curve was 0.83 (CI 0.58-0.97), indicating good predictive performance. In a blinded cohort study from independent epilepsy centres, applying a previously validated algorithm for HFO marking without the need for adjusting to new datasets allowed us to validate the clinical relevance of HFOs to plan the surgical resection.
- MeSH
- dítě MeSH
- dospělí MeSH
- elektroencefalografie metody MeSH
- elektrokortikografie * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- prospektivní studie MeSH
- refrakterní epilepsie * chirurgie patofyziologie MeSH
- výsledek terapie MeSH
- záchvaty * chirurgie patofyziologie diagnóza MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Epilepsy is a neurological disease characterized by epileptic seizures, which commonly manifest with pronounced frequency and amplitude changes in the EEG signal. In the case of focal seizures, initially localized pathological activity spreads from a so-called "onset zone" to a wider network of brain areas. Chimeras, defined as states of simultaneously occurring coherent and incoherent dynamics in symmetrically coupled networks are increasingly invoked for characterization of seizures. In particular, chimera-like states have been observed during the transition from a normal (asynchronous) to a seizure (synchronous) network state. However, chimeras in epilepsy have only been investigated with respect to the varying phases of oscillators. We propose a novel method to capture the characteristic pronounced changes in the recorded EEG amplitude during seizures by estimating chimera-like states directly from the signals in a frequency- and time-resolved manner. We test the method on a publicly available intracranial EEG dataset of 16 patients with focal epilepsy. We show that the proposed measure, titled Amplitude Entropy, is sensitive to the altered brain dynamics during seizure, demonstrating its significant increases during seizure as compared to before and after seizure. This finding is robust across patients, their seizures, and different frequency bands. In the future, Amplitude Entropy could serve not only as a feature for seizure detection, but also help in characterizing amplitude chimeras in other networked systems with characteristic amplitude dynamics.
The distribution and morphology of neuronal degeneration were observed and analyzed in each sector of the zona incerta in a lithium‐pilocarpine (LiCl) Wistar rat model of status epilepticus in 12, 15, 18, 21, and 25‐day‐old rats and survival intervals of 4, 8, 12, 24, and 48 hours. Status epilepticus was induced via intraperitoneal (IP) injection of LiCl (3 mmol/kg) 24 hours before an injection of pilocarpine (40 mg/kg, IP). Motor seizures were suppressed by paraldehyde (0.3‐0.6 ml/kg, IP) two hours after status epilepticus onset. Animals were anesthetized using urethane and perfused with phosphate‐buffered saline followed by 4% paraformaldehyde. Brains were sectioned and Nissl stained for map guidance, with fluoro‐Jade B fluorescence used to detect degenerated neurons. Fluoro‐jade B‐positive neurons were plotted to a standard stereotaxic atlas, their distribution was quantified, and their long‐axis diameter was measured. Fluoro‐jade B‐positive neurons were found in pups aged 15 days and older 24 hours after status epilepticus, in which their numbers increased, and their perikaryon size decreased with advancing age. Thus, neuronal damage severity was dependent on age and survival interval. Neuronal damage was only found in the rostral sector of the zona incerta, a region that exhibits a small number of inhibitory neurons and is reciprocally connected to the limbic cortex. This system of hyperactivity, coupled with inhibitory neurons, may be the underlying cause of the neuronal degeneration and explain why it was confined to the rostral sector of the zona incerta.
- MeSH
- chlorid lithný toxicita MeSH
- degenerace nervu * patologie etiologie MeSH
- fluoresceiny MeSH
- krysa rodu rattus MeSH
- modely nemocí na zvířatech MeSH
- neurony * patologie MeSH
- novorozená zvířata MeSH
- pilokarpin toxicita MeSH
- potkani Wistar MeSH
- status epilepticus * patologie chemicky indukované komplikace MeSH
- věkové faktory MeSH
- zona incerta * patologie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Epileptické záchvaty jsou nejčastější urgentní událostí v dětském věku, a to zejména v prvním roce života. u čtyř procent dětí se vyskytnou febrilní křeče, 1 % dětí trpí chronickou epilepsií, 1 % prodělá ojedinělý epileptický záchvat a přibližně 2 % dětí mají různé formy křečí či poruch vědomí připomínající či imitující záchvaty epileptické. obvykle se jako první se záchvatem setká pediatr, který dle předpokládané diagnózy rozhoduje o dalším postupu. ne vždy a všude je dostupné vyšetření dětským neurologem, proto je základní znalost sémiologie epileptických záchvatů a syndromů pro pediatry užitečná. následné krátké komentované kazuistiky si kladou za cíl upozornit na možná diferenciálně diagnostická úskalí záchvatů a věkově vázaných syndromů v jednotlivých vývojových etapách.
Epileptic seizures are the most common urgent events in childhood, particularly during the first year of life. less than 1% of children suffer from chronic epilepsy, 1% experience a single epileptic seizure, 4% have febrile seizures, and approximately 2% of children exhibit various forms of convulsions or consciousness disorders resembling or mimicking epileptic seizures. pediatricians are usually the first to encounter a seizure and must decide on further steps based on the presumed diagnosis. since access to pediatric neurologists is not always available, a basic understanding of the semiology of epileptic seizures and syndromes can be beneficial for pediatricians. the following brief case studies aim to highlight potential differential diagnostic challenges of seizures and age-related syndromes at various developmental stages.
- MeSH
- antikonvulziva farmakologie terapeutické užití MeSH
- diferenciální diagnóza * MeSH
- dítě MeSH
- epilepsie diagnóza MeSH
- epileptické syndromy diagnóza MeSH
- lidé MeSH
- záchvaty * diagnóza etiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
This study investigated the striatopallidal complex's involvement in status epilepticus (SE) caused by morphological neurodegenerative changes in a post-natal immature developing brain in a lithium-pilocarpine male Wistar albino rat model of mesial temporal lobe epilepsy. One hundred experimental pups were grouped by age as follows: 12, 15, 18, 21, and 25 days. SE was induced by lithium-pilocarpine. Brain sections were microscopically examined by Fluoro-Jade B fluorescence stain at intervals of 4, 12, 24, and 48 h and 1 week after SE. Each interval was composed of four induced SE pups and a control. Fluoro-Jade B positive neurons in the dorsal striatum (DS) were screened and plotted on stereotaxic rat brain maps. The DS showed consistent neuronal damage in pups aged 18, 21, and 25 days. The peak of the detected damage was observed in pups aged 18 days, and the start of the morphological sequela was observed 12 h post SE. The neuronal damage in the DS was distributed around its periphery, extending medially. The damaged neurons showed intense Fluoro-Jade B staining at the intervals of 12 and 24 h post SE. SE neuronal damage was evidenced in the post-natal developing brain selectively in the DS and was age-dependent with differing morphological sequela.
- MeSH
- corpus striatum * patologie metabolismus MeSH
- epilepsie temporálního laloku * patologie chemicky indukované MeSH
- krysa rodu rattus MeSH
- modely nemocí na zvířatech MeSH
- neurony patologie metabolismus MeSH
- pilokarpin MeSH
- potkani Wistar MeSH
- status epilepticus * patologie chemicky indukované MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
18letý chlapec s epilepsií a multifokální motorickou neuropatií po očkování proti chřipce byl přijat k hospitalizaci pro respirační infekci a stav po epileptickém paroxysmu. Při přijetí byl klinický nález až na chabou paraparézu dolních končetin jako reziduum multifokální neuropatie a faryngitidu chudý, laboratorně byla trombopenie a elevace zánětlivých markerů. Za 36 hodin od přijetí se rozvíjí kvalitativní porucha vědomí charakteru deliria s halucinacemi, bludy, poruchou paměti, výrazným motorickým neklidem a spánkovou inverzí. Chlapec byl následně přeložen na jednotku intenzivní péče. Bylo provedeno toxikologické a neurologické vyšetření s lumbální punkcí, MR i CT mozku, vše s negativním nálezem, psychiatrické vyšetření se závěrem organické delirium. Chlapec byl i přes vysoké dávky midazolamu, chlorpromazinu a risperidonu stále delirantní. Až po opakovaných rozhovorech chlapec přiznává abúzus alkoholu, zejména absintu, to potvrzuje i vysoká hladina CDT. Po nasazení klomethiazolu příznaky deliria rychle ustoupily.
An 18-year-old boy with epilepsy and multifocal motor neuropathy after influenza vaccination was admitted for respiratory infection and after an epileptic seizure. On admission, clinical findings were poor except for peripheral paraparesis as residual multifocal neuropathy and pharyngitis, with thrombopenia and elevation of inflammatory markers in the admission laboratory. Within 36 hours, he developed a qualitative disruption of consciousness in the nature of delirium with hallucinations, delusions, memory impairment, marked motor restlessness, and sleep inversion. The boy was subsequently transferred to the intensive care unit. Toxicological and neurological examination with lumbar puncture, MRI and CT of the brain were performed, all with negative findings, and psychiatric examination concluded organic delirium. The boy was still delirious despite high doses of midazolam, chlorpromazine and risperidone. Only after repeated interviews did the boy admit to alcohol abuse, especially absinthe, as confirmed by a high CDT level. After the administration of clomethiazole, the symptoms of delirium quickly subsided.
- MeSH
- alkoholové delirium * etiologie komplikace MeSH
- chlorpromazin farmakologie terapeutické užití MeSH
- epilepsie farmakoterapie MeSH
- infekce dýchací soustavy farmakoterapie MeSH
- karbohydrátdehydrogenasy analýza MeSH
- lidé MeSH
- midazolam farmakologie terapeutické užití MeSH
- mladiství * MeSH
- polyneuropatie etiologie MeSH
- poruchy vědomí etiologie MeSH
- risperidon farmakologie terapeutické užití MeSH
- záchvaty * etiologie MeSH
- Check Tag
- lidé MeSH
- mladiství * MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Childhood epilepsy is frequently associated with neurobehavioral comorbidities such as depression, anxiety, cognitive impairments, and social dysfunction, as revealed by both clinical and experimental studies. Despite extensive neurophysiological research, behavioral studies in developing animals remain limited and underreported. Here, we review the behavioral impact of early-life seizures (ELSs) in commonly used rat models in developmental studies. We outline suitable tests and provide guidance on how traditional tests should be adapted and interpreted in this context. Finally, we examine factors influencing behavioral analysis in developmental studies, exploring confounding variables and offering strategies to minimize their impact.
