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Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
When dealing with neonatal seizures, a number of considerations may make early management decisions difficult. Although the initial management of neonates with seizures is based upon the usual principles of general medical management and cardiovascular-respiratory stabilisation, transposition of acquired knowledge from epilepsy treatment of older children and adults is not always possible. This is due to several specific factors that influence treatment choices for paroxysmal events observed in neonates: The difficulty to recognise and interpret motor phenomena and autonomic signs in the newborn.Classification of seizure type and epilepsy syndrome in newborns is less straightforward than in older children and adults.The role and impact of electrical discharges without clinical manifestations.Difficulties related to the determination of aetiology and pathophysiology of paroxysmal events.Limited knowledge on the effect that true epileptic seizures and/or antiepileptic drugs (AEDs) may have on the developing brain.Lack of controlled studies in newborns on the use of new AEDs.
Epilepsy
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Donald C. Barr, Andres M. Kanner
The diagnostic evaluation of paroxysmal episodes requires an answer to these questions addressed in the following order: Is this paroxysmal event an epileptic seizure or a nonepileptic event that imitates an epileptic seizure?If this is not an epileptic seizure, what type of event is it?If this is an epileptic seizure, what seizure type is it (Figures 5.1 and 5.2)?Given the type of seizure, what type of epilepsy is it (Figure 5.1)?Given the available clinical, imaging, electrophysiologic data available, can we establish what type of epileptic syndrome is it (Figure 5.1)?
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
A 40-year-old man is referred to your clinic with hypertension, headaches, palpitations and sweating. How will you investigate him?This sounds like it could be a phaemochromocytoma.I would take a history, looking for other specific symptoms (headaches, visual problems, dizziness) and ask about a family history. The symptoms are classically paroxysmal. Direct trauma and stress can precipitate symptoms.Phaeochromocytoma is seen with MEN 2A and 2B syndromes, neurofibromatosis, von Hippel−Lindau syndrome (cerebellar haemangiomas and renal tumours) and SDH mutations.I would perform a full examination and then confirm the diagnosis with blood and urinalysis.
The role of left atrial peak systolic strain in atrial fibrillation recurrence after catheter ablation. A systematic review and meta-analysis
Published in Acta Cardiologica, 2022
Ioannis Anagnostopoulos, Maria Kousta, Charalampos Kossyvakis, Eleni Lakka, Nikolaos Taxiarchis Paraskevaidis, Nikolaos Schizas, Spyridon Deftereos, Georgios Giannopoulos
All articles that were obtained after the initial search, were screened by two independent reviewers (I.A. and M.K.) based on title and abstract. Subsequently, potentially eligible studies were further reviewed for inclusion in the final analysis based on the full text. Any disagreements were resolved after consensus with an expert (G.G.). Eligibility criteria for inclusion were: (a) prospective or retrospective studies including patients with paroxysmal or/and persistent AF, (b) endocardial pulmonary venous isolation (PVI) with radiofrequency catheter ablation (RFCA) or cryoballoon ablation, (c) pre-procedural quantification of LA-PLSsys (LA strain during reservoir phase), averaged in at least two segments, using 2DSTE (d) a follow-up of at least 6 months for post-ablation AF recurrence.
Contextualizing ovarian pain in the late 19th century—Part 1: Women with “hysteria” and “hystero-epilepsy”
Published in Journal of the History of the Neurosciences, 2021
John Jarrell, Frank W. Stahnisch
The first consideration that the ovaries might be involved in what was then identified as hysteria was made by William Cullen (1710–1790) in Scotland (Cullen 1796). Cullen was a physician, chemist, agriculturalist, and a professor in the Edinburgh Medical School. He was the author of the important medical oeuvre First Lines of the Practice of Physic (1796). In its third tome, Cullen described the typical “fit” associated with hysteria this way: The disease attacks in paroxysms or fits. These commonly begin by some pain and fullness felt in the left side of the belly. … The patient is affected with a stupor and insensibility, while at the same time the body is agitated with various convulsions. … The trunk of the body is wreathed to and fro. … More or less suddenly, and frequently with repeated sighing and sobbing … the patient returns to the exercise of sense and motion but generally without any recollection of the several circumstances that had taken place during the fit. (Cullen 1796, 161)
Current challenges in the pathophysiology, diagnosis, and treatment of paroxysmal movement disorders
Published in Expert Review of Neurotherapeutics, 2021
Cécile Delorme, Camille Giron, David Bendetowicz, Aurélie Méneret, Louise-Laure Mariani, Emmanuel Roze
Diagnosis of PMD secondary to an insulinoma is often challenging with a median delay reported to be as long as 2 to 3 years [130,131]. The wide phenotypic expression of neuroglycopenia and its potential variability in a single subject (as also observed in GLUT1-deficiency syndrome) may largely account for this delay. Characteristics of the paroxysmal episodes may provide good clues to the diagnosis i) episodes sometimes occur during the second part of the night or early morning or are triggered by prolonged exercise ii) paroxysmal symptoms tend to increase and decrease within an episode in a gradual manner iii) mixed hyperkinetic movements could vary from one day to another, lasting minutes to hours iv) motor manifestations are combined with behavioral disturbances, such as aggressiveness/disinhibition or psychomotor slowing v) drowsiness/dreaminess are frequently observed vi) neurovegetative features can also be present, such as sweating. One diagnosis pitfall is that hyperkinetic abnormal movements may sometimes combine genuine movement disorders and awkward pseudo-voluntary movements accompanying the behavioral problems [132–134]. The key diagnostic investigation is the measurement of ictal glycemia, which is very low (0.2 to 0.4 g/L in reported cases) [132–134]. Frequent misdiagnosis occurs for psychiatric conditions, epilepsy, or functional movement disorder [132,133]. Ictal glycemia should thus be largely assessed in patients with PMD without a definite diagnosis. Treatment mostly consists in the resection of the insulinoma.