Dialysis encephalopathy: a review

Dialysis encephalopathy (DE) is a distinct neuropsychiatric syndrome typically occurring in patients undergoing longterm hemodialysis. It is characterized by electroencephalographic abnormalities in association with disturbances of speech, cognition, movement, affect, or behavior. Previously thought to be relentlessly progressive, recent evidence linking the illness to aluminum overload has led to advances in prevention and treatment. Early diagnosis aids in the reversal or amelioration of the syndrome and can be of immense value to the patient, the family and involved health personnel. The general features of the syndrome, etiologic considerations, differential diagnosis and treatment are discussed. Three case studies are included to illustrate salient features of the syndrome.     

Seasonal panic disorder: a possible variant of seasonal affective disorder.

The present communication concerns a 30 year-old female patient with panic disorder in whom panic attacks appeared to be seasonally-related. Characteristically, attacks were more frequent and severe during the months of October to May with spontaneous remissions during the months of June to September. Since 70% of patients with seasonal affective disorder (SAD), a variant of affective illness characterized by recurrent winter depressions with remissions in summer, suffer from anxiety disorders, we propose that seasonal panic disorder may be a variant of SAD. Since SAD is associated with phase delay of circadian rhythms, some forms of panic disorder may be related to phase instability of circadian rhythms. Moreover, since administration of artificial bright light therapy is currently the most effective treatment for SAD, it is suggested that patients with panic disorder should be questioned as to whether their symptoms are seasonally related. If a positive association is established, these patients should be offered treatment with light therapy prior to or coincident with the institution of pharmacotherapy.     

Stereotaxic treatment of seizure disorder.

Individuals with intractable epilepsy have a murky existence, fraught with medical helplessness, social rejection and personal despair. Drugs control many, but unfortunately not all, cases of epilepsy. An attempt to elucidate on the indications, selections and rationale for the stereotaxic interruption is made. Three cases of intractable epilepsy treated by stereotaxic Fields of Forel Interruptions are reported with special emphasis on pre and postoperative evaluations. Based on the data so far available, it appears that a significant number of patients with medically intractable epilepsy who are not candidates for "standard" neurosurgical interventions, can be helped further by stereotaxic interruptions with minimal morbidity.     

Kainic acid-induced thalamic seizure in cats--a possible model of petit mal seizure.

Bipolar depth electrodes were implanted stereotaxically in the thalamus, hippocampus and midbrain reticular formation of cats. Cortical screw electrodes were placed over the bilateral sensorimotor cortex. A guide cannula with an inner injection cannula was inserted unilaterally into the posterolateral ventral nuclei (VPL) of the thalamus. Eight days after the procedures, kainic acid (2.0 micrograms) was injected unilaterally into the VPL via the injection cannula in freely moving animals and electro-clinical observations were made. About 1 h after the kainic acid injection, multiple spikes were observed in the VPL (injection site), which propagated to the subcortical structures. These seizures finally propagated bilaterally to the cortex about 2 h after the injection. About 3-4 h after the injection, small spike and wave complexes repeatedly appeared for a short period of time in cortical leads and cats exhibited behavioral arrest with unresponsiveness during the seizures. About 24 h after the injection, generalized small spike and wave complexes were observed intermittently in cortical and subcortical structures. They persisted for 4-5 s and were associated with behavioral arrest and staring. The results demonstrate that a unilateral microinjection of kainic acid into VPL induced petit mal-like seizure, and suggest that VPL plays an important role in the generation or transfer of spike and wave complexes.     

Hashimoto's encephalopathy: documentation of mesial temporal seizure origin by ictal EEG.

Hashimoto's encephalopathy is a chronic relapsing and remitting encephalopathy associated with antithyroid antibodies. Seizures are a frequent manifestation, but are not well characterized in the literature with respect to their onset. We describe a 48-year-old patient with recurrent encephalopathy and seizures, and elevated antithyroid antibodies. One seizure was documented with video-EEG monitoring using scalp and sphenoidal electrodes. The ictal discharge originated in the left mesial-basal temporal region. MRI showed an increased T2 signal in the white matter of the centrum semiovale, but no temporal pathology. Symptoms resolved after treatment with prednisone and azathioprine. Hashimoto's encephalopathy should be considered in patients with unexplained encephalopathy and seizures, including those originating in the temporal lobe.     

Cerebral toxocariasis: a possible cause of epileptic seizure in children

Introduction Toxocariasis is a worldwide human helminthiasis, which is mostly asymptomatic and caused by toxocara canis, a roundworm in dogs. These can cause visceral larva migrans syndrome in humans who ingest contaminated soil. CNS manifestation with a focal mass lesion is very rare, seizures often being the first symptom.Case report We describe an 11-year-old girl presenting with a generalized epileptic seizure and eosinophilia in blood. Under antibiotic therapy under the assumption of toxoplasmosis the lesion did not decrease and surgical resection was considered. We used computer-assisted surgery (CAS) for careful tissue resection. Postoperatively the diagnosis of toxocariasis was confirmed and albendozole medication was administered for 7 days. The patient developed well without neurological deficits or seizures.Conclusion We conclude that although neurological involvement is rare in toxocariasis, a cerebral infection in a child with epileptic seizures and eosinophilia should be considered.     

Three patients with concomitant panic attacks and seizure disorder: possible clues to the neurology of anxiety

The authors present the cases of three patients in whom panic attacks and epilepsy appeared together. These cases illustrate various possible relationships between panic attacks and epilepsy. These relationships include panic attacks representing the aura of a complex partial seizure, panic attacks representing a manifestation of interictal behavior change, and panic attacks and seizure coexisting independently. The authors conclude that exploration of the mechanisms operating in unusual cases like these may provide a vehicle for clarifying the neurobiological basis of anxiety.     

Syncope as a first sign of seizure disorder

We studied the long-term follow-up of patients with the diagnosis of "syncope of unknown origin," and their progression to epilepsy to gain a better understanding of the relationship between syncope and epilepsy, and to determine whether findings of the first syncopal attack have prognostic significance in relationship to the onset of epilepsy or not. Eighteen patients with the diagnosis of syncope of unknown origin were evaluated for the possibility of becoming epileptic during a 4-year period, and four patients showed characteristic seizure disorder. There were no clinical or laboratory features that differentiated them from the nonepileptic group, except that they were all girls. The interval between the first syncopal attack and the typical epileptic seizure ranged between 7 and 19 months. Syncope of unknown origin could be the first sign of an epileptic disorder, especially in girls. Long-term follow-up extending up to 1 year is necessary to disclose the risk of becoming epileptic.     

Closed head injury resulting in paradoxical improvement of a seizure disorder.

People with epilepsy are prone to head injuries and these traumas are usually considered adverse events. We report the case of a 31-year-old woman who sustained a closed head injury as a result of a seizure. This accidental trauma resulted in a 1-year remission of her previously intractable complex partial seizures. The paradoxical improvement of a seizure disorder can occur as a result of a closed head injury. We postulate it simulated ablative epilepsy surgery.     

Desipramine: a possible treatment for depersonalization disorder

Primary depersonalization disorder is believed to be resistant to treatment. However, we report the successful treatment of a case with desipramine and suggest that, because there is a link between depersonalization and anxiety disorders, tricyclic antidepressants may prove effective for depersonalization.     

Destructive encephalopathy in incontinentia pigmenti: a primary disorder?

A 3-day-old infant with incontinentia pigmenti presented with acute encephalopathy associated with neuroradiographic findings of hemorrhagic necrosis and brain edema. No specific infectious, inflammatory, vascular, or metabolic abnormality was identified. We speculate that there is a variably expressed mutant protein in incontinentia pigmenti that could cause either developmental brain malformations or a destructive process.     

Hepatic encephalopathy: a neuropsychiatric disorder involving multiple neurotransmitter systems

Evidence from both biochemical measurements and from noninvasive techniques continues to suggest that neurotransmission failure rather than primary energy failure is the major cause of hepatic encephalopathy. Major neurotransmitter systems in which abnormalities have been identified include the glutamatergic, monoaminergic and opioid systems. Further elucidation of these neurotransmitter changes could provide novel pharmacological approaches in the treatment of hepatic encephalopathy.     

Iron status: a possible risk factor for the first febrile seizure

PURPOSE: We conducted a controlled study to investigate the relation of iron status and first febrile seizure (FFS). METHODS: Measures of iron sufficiency including hemoglobin concentration (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and plasma ferritin (PF) were prospectively measured in 75 children with FFS and compared with 75 controls matched for age and sex with febrile illnesses without convulsions. RESULTS: Mean ferritin level was significantly lower in cases with FFS (29.5 +/- 21.3 microg/L) than in controls (53.3 +/- 37.6 microg/L) with p = 0.0001. The proportion of subjects with a PF level 相似文献