Hyponatremia is a typical side effect of antiseizure drugs from the dibenzazepine family. The study investigated the prevalence of hyponatremia in patients with epilepsy who were treated with eslicarbazepine. We aimed to determine the prevalence of hyponatremia, reveal the factors leading to the discontinuation of treatment, and identify possible risk factors for the development of hyponatremia including the dose dependency. The medical records of 164 patients with epilepsy taking eslicarbazepine in our center were analyzed. The overall prevalence of hyponatremia was 30.5%. The prevalence of mild hyponatremia, seen in 14%-20% of patients, was not dose dependent. The prevalence of moderate and severe hyponatremia was significantly dose dependent. The severity of hyponatremia was significantly dose dependent. Severe hyponatremia was found in 6.1% of patients. Hyponatremia was asymptomatic in the majority of cases, and in 48% did not require any management. Hyponatremia was the reason for discontinuation in 6.2% of patients. The major risk factor for developing hyponatremia was older age. The study shows that eslicarbazepine-induced hyponatremia is usually mild and asymptomatic. It usually does not require any management and seldom leads to treatment discontinuation. Hyponatremia is dose dependent. Another major risk for developing hyponatremia (besides dose) is older age.
Objective.The proportion of patients becoming seizure-free after epilepsy surgery has stagnated. Large multi-center stereo-electroencephalography (SEEG) datasets can allow comparing new patients to past similar cases and making clinical decisions with the knowledge of how cases were treated in the past. However, the complexity of these evaluations makes the manual search for similar patients impractical. We aim to develop an automated system that electrographically and anatomically matches seizures to those in a database. Additionally, since features that define seizure similarity are unknown, we evaluate the agreement and features among experts in classifying similarity.Approach.We utilized 320 SEEG seizures from 95 consecutive patients who underwent epilepsy surgery. Eight international experts evaluated seizure-pair similarity using a four-level similarity score. As our primary outcome, we developed and validated an automated seizure matching system by employing patient data marked by independent experts. Secondary outcomes included the inter-rater agreement (IRA) and features for classifying seizure similarity.Main results.The seizure matching system achieved a median area-under-the-curve of 0.76 (interquartile range, 0.1), indicating its feasibility. Six distinct seizure similarity features were identified and proved effective: onset region, onset pattern, propagation region, duration, extent of spread, and propagation speed. Among these features, the onset region showed the strongest correlation with expert scores (Spearman's rho = 0.75,p< 0.001). Additionally, the moderate IRA confirmed the practicality of our approach with an agreement of 73.9% (7%), and Gwet's kappa of 0.45 (0.16). Further, the interoperability of the system was validated on seizures from five centers.Significance.We demonstrated the feasibility and validity of a SEEG seizure matching system across patients, effectively mirroring the expertise of epileptologists. This novel system can identify patients with seizures similar to that of a patient being evaluated, thus optimizing the treatment plan by considering the results of treating similar patients in the past, potentially improving surgery outcome.
- MeSH
- dítě MeSH
- dospělí MeSH
- elektroencefalografie * metody MeSH
- epilepsie * chirurgie diagnóza patofyziologie MeSH
- klinické rozhodování * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- reprodukovatelnost výsledků MeSH
- stereotaktické techniky MeSH
- záchvaty diagnóza chirurgie patofyziologie 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
- práce podpořená grantem MeSH
INTRODUCTION: Epilepsy surgery is the only curative treatment for patients with drug-resistant focal epilepsy. Stereoelectroencephalography (SEEG) is the gold standard to delineate the seizure-onset zone (SOZ). However, up to 40% of patients are subsequently not operated as no focal non-eloquent SOZ can be identified. The 5-SENSE Score is a 5-point score to predict whether a focal SOZ is likely to be identified by SEEG. This study aims to validate the 5-SENSE Score, improve score performance by incorporating auxiliary diagnostic methods and evaluate its concordance with expert decisions. METHODS AND ANALYSIS: Non-interventional, observational, multicentre, prospective study including 200 patients with drug-resistant epilepsy aged ≥15 years undergoing SEEG for identification of a focal SOZ and 200 controls at 22 epilepsy surgery centres worldwide. The primary objective is to assess the diagnostic accuracy and generalisability of the 5-SENSE in predicting focality in SEEG in a prospective cohort. Secondary objectives are to optimise score performance by incorporating auxiliary diagnostic methods and to analyse concordance of the 5-SENSE Score with the expert decisions made in the multidisciplinary team discussion. ETHICS AND DISSEMINATION: Prospective multicentre validation of the 5-SENSE score may lead to its implementation into clinical practice to assist clinicians in the difficult decision of whether to proceed with implantation. This study will be conducted in accordance with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (2014). We plan to publish the study results in a peer-reviewed full-length original article and present its findings at scientific conferences. TRIAL REGISTRATION NUMBER: NCT06138808.
- Publikační typ
- časopisecké články MeSH
Konvulzivní status epilepticus je tonicko-klonický záchvat trvající déle než 5 minut, nebo opakované tonicko-klonické záchvaty v tomto časovém období, mezi nimiž nedochází k návratu vědomí. Iniciálně je léčen benzodiazepiny - diazepamem i. v., midazolamem i. m. nebo podaným bukálně, nebo diazepamem podaným rektálně. V případě selhání terapie benzodiazepiny je indikováno intravenózní podání protizáchvatových léků - levetiracetamu v dávce 60 mg/kg (maximálně 4 500 mg), valproátu v dávce 40 mg/kg (maximálně 3 000 mg), nebo fenytoinu v dávce 20 mg/kg (maximálně 1 500 mg). V článku uvádíme udržovací dávky léků a věnujeme se jejich významným farmakologickým vlastnostem i možným nežádoucím účinkům. Závěrem zmiňujeme další léky potenciálně využitelné při léčbě konvulzivního status epilepticus, které jsou dostupné ve formě pro intravenózní podání - lakosamid a brivaracetam.
Convulsive status epilepticus is the form of a tonic-clonic seizure lasting longer than 5 minutes, or in the case of repeated tonic-clonic seizures within this time period. Initially is treated with benzodiazepines - diazepam i. v., midazolam i. m. or buccal, or diazepam administered rectally. If benzodiazepine therapy fails, intravenous administration of anti-seizure drugs is indicated - levetiracetam at 60 mg/kg (maximum 4500 mg), valproate at 40 mg/kg (maximum 3000 mg), or phenytoin at 20 mg/kg (maximum 1500 mg). In this article, we present maintenance doses of the drugs and discuss their important pharmacological properties and possible adverse effects. Finally, we mention other drugs potentially useful in the treatment of convulsive status epilepticus that are available in a form for intravenous administration - lacosamide and brivaracetam.
Dravetové syndrom (DS) je ve většině případů podmíněn mutací podjednotky sodíkového kanálu (SCN1A), začíná v dětském věku, nicméně se jedná o onemocnění celoživotní. V rámci článku se soustředíme na charakteristiky pacientů s DS v dospělosti. Z hlediska epileptologie je pro nás zásadní výskyt epileptických záchvatů. V dospělosti se jedná především o konvulzivní záchvaty (generalizované tonicko‐klonické, tonické nebo fokální záchvaty s přechodem do bilaterálně tonicko‐klonických záchvatů), které mohou být provokovány zvýšením tělesné teploty nebo emocemi. Nicméně rodiče/pečující o pacienty s DS uvádějí často další projevy onemocnění jako velmi významné, mnohdy více omezující než vlastní epileptické záchvaty. Jedná se především o kognitivní obtíže, poruchy učení, poruchy chování, motorické problémy (crouch gait, parkinsonismus, ataxii, abnormální postury při stoji a chůzi), poruchy spánku a kardiální abnormity. U DS je rovněž vysoké riziko náhlého neočekávaného úmrtí (SUDEP, sudden unexpected death in epilepsy). V druhé části článku se věnujeme terapii. V současnosti existují doporučení pro pacienty s DS. První linii terapie představuje valproát a klobazam. V druhé linii se uplatňují specifické léky indikované pro tento syndrom, konkrétně se jedná o stiripentol (Diacomit), fenfluramin (Fintepla) a vysoce čištěný kanabidiol (CBD, v České republice dostupný jako Epidyolex).
Dravet syndrome (DS) is predominantly caused by a mutation in the sodium channel subunit (SCN1A). It begins in childhood but is a lifelong condition. In this article, we focus on the characteristics of adult patients with DS. From an epileptological perspective, the occurrence of epileptic seizures is crucial. In adulthood, there are mainly clonic seizures (generalized tonic-clonic seizures, tonic seizures or focal seizures to bilateral tonic-clonic seizures). They can be provoked by increased body temperature or by emotions. However, parents/caregivers of patients with DS often report other manifestations of the disease as very significant, often more limiting than the seizures themselves. These primarily include cognitive difficulties, learning disorders, behavioral issues, motor problems (crouch gait, parkinsonism, ataxia, abnormal postures while standing and walking), sleep disorders, and cardiac abnormalities. There is also a high risk of sudden unexpected death in epilepsy (SUDEP) in DS. The second part of the article is dedicated to therapy. Currently, there are recommendations for patients with DS. The first line of therapy includes valproate and clobazam. The second line involves specific drugs indicated for this syndrome, specifically stiripentol (Diacomit), fenfluramine (Fintepla), and cannabidiol (CBD, available in the Czech Republic as Epidyolex).
- MeSH
- antikonvulziva aplikace a dávkování MeSH
- dospělí * MeSH
- epilepsie myoklonické * farmakoterapie patologie MeSH
- fenfluramin aplikace a dávkování ekonomika MeSH
- kanabidiol aplikace a dávkování farmakologie MeSH
- klinická studie jako téma MeSH
- lékové předpisy MeSH
- lidé MeSH
- motorické poruchy etiologie patologie MeSH
- Check Tag
- dospělí * MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Insulinomas are rare gastrointestinal tumors with an incidence of 1-3 per million inhabitants annually. These tumors result in excessive insulin production, culminating in hypoglycemia. Such hypoglycemia triggers various central nervous system (CNS) manifestations, including headache, confusion, abnormal behavior, and epileptic seizures, which can lead to misdiagnosis as epilepsy. This case report documents a 46-year-old male who presented seizure-like episodes. Episodes occurred mainly during the night, lasting several minutes to hours. Initial seizures were characterized by bizarre behavior and altered responsiveness. Over time, seizure frequency, complexity, and severity escalated. We managed to record two episodes during long-term EEG and report, as the first ones, the detailed quantitative EEG analysis of these hypoglycemia-related events. EEG changes preceded the development of clear-cut pathological motor activity in tens of minutes and were present in all investigated frequency bands. The development of profound motor activity was associated with other increases in EEG power spectra in all frequencies except for delta. The most pronounced changes were found over the left temporal region, which can be the most susceptible to hypoglycemia. In our patient, the seizure-like episodes completely disappeared after the insulinoma removal, which demonstrates their relationship to hypoglycemia.
- Publikační typ
- kazuistiky MeSH
Susac syndrome is a rare and enigmatic complex neurological disorder primarily affecting small blood vessels in the brain, retina, and inner ear. Diagnosing Susac syndrome may be extremely challenging not only due to its rarity, but also due to the variability of its clinical presentation. This paper describes two vastly different cases-one with mild symptoms and good response to therapy, the other with severe, complicated course, relapses and long-term sequelae despite multiple therapeutic interventions. Building upon the available guidelines, we highlight the utility of black blood MRI in this disease and provide a comprehensive review of available clinical experience in clinical presentation, diagnosis and therapy of this disease. Despite its rarity, the awareness of Susac syndrome may be of uttermost importance since it ultimately is a treatable condition. If diagnosed in a timely manner, early intervention can substantially improve the outcomes of our patients.
- Publikační typ
- kazuistiky MeSH
