bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical experience of abrupt discontinuation of perampanel: a case series
Authors: Blickhan Marko , Intravooth Tassanai , Staack Anke. M. , Kornmeier Reinhold , Mahn Patricia , Schneider Matthias , Stockinger Jakob , Bacher Matthias , Kurth Christoph , Steinhoff Bernhard J. 
Published: March 2021

AbstractWith an elimination half‐life of 105 hours, perampanel (PER) allows a once‐daily dosing regimen. In pivotal trials, when PER was tapered, it was therefore usually discontinued abruptly. Thus, in our hospital we have always practiced abrupt cessation. In this case series, we investigated how long PER serum concentrations still remain measurable after abrupt discontinuation of PER and whether withdrawal symptoms, such as an increase in seizures or status epilepticus, occur. PER serum levels and the clinical course of 15 adult in‐patients were monitored for three weeks based on a retrospective study design following abrupt discontinuation of PER. After one week, PER was still detected in 13 of 15 patients, after two weeks in 10, and after three weeks in three. Neither a severe increase in seizure frequency nor status epilepticus occurred. However, modifications of the concomitant antiseizure drugs were necessary. The abrupt discontinuation of PER leads to a slow decrease in plasma concentration, thus resembling self‐evident gradual discontinuation of PER. In some cases, PER may still be measurable and thus clinically active even weeks after its discontinuation. Efficacy and safety of other antiseizure drugs can be estimated appropriately only thereafter.
Developmental and epileptic encephalopathies: recognition and approaches to care
Authors: Raga Sharika , Specchio Nicola , Rheims Sylvain , Wilmshurst Jo M. 
Published: March 2021

AbstractThe term “developmental and epileptic encephalopathy” (DEE) refers to when cognitive functions are influenced by both seizure and interictal epileptiform activity and the neurobiological process behind the epilepsy. Many DEEs are related to gene variants and the onset is typically during early childhood. In this setting, neurocognition, whilst not improved by seizure control, may benefit from some precision therapies. In patients with non‐progressive diseases with cognitive impairment and co‐existing epilepsy, in whom the epileptiform activity does not affect or has minimal effect on function, the term “developmental encephalopathy” (DE) can be used. In contrast, for those patients with direct impact on cognition due to epileptic or epileptiform activity, the term “epileptic encephalopathy” (EE) is preferred, as most can revert to their normal or near normal baseline cognitive state with appropriate intervention. These children need aggressive treatment. Clinicians must tailor care towards individual needs and realistic expectations for each affected person; those with DE are unlikely to gain from aggressive antiseizure medication whilst those with EE will gain. Patients with DEE might benefit from a precision medicine approach in order to reduce the overall burden of epilepsy.
Measurable outcomes for pediatric epileptic encephalopathy: a single‐center experience with corticosteroid therapy
Authors: Gofshteyn Jacqueline S. , Gurcharran Kevin , Marquis Belinda O. , Lamothe Jacqueline , Gourley Dena , Grinspan Zachary , Nangia Srishti 
Published: March 2021

AbstractObjective: Corticosteroids are commonly used to treat refractory epilepsy in children, but the heterogeneity of the population and lack of standardized outcome measures have limited understanding of their effectiveness. We conducted a single‐center study of corticosteroids for epileptic encephalopathy to (a) identify domains for measurement and estimate potential effect sizes, (b) characterize heterogeneity, and (c) identify outcomes that may need better tools for measurement.Methods: In this retrospective single‐center cohort study, children with epileptic encephalopathy (excluding infantile spasms) were treated with a standardized course of oral dexamethasone or IV methylprednisolone. Long‐term video electroencephalography (EEG) was assessed via novel ordinal scales for five features: seizure semiology/burden, epileptiform activity, slowing, organization, and sleep architecture. We abstracted parental assessment of functional domains (i.e., cognition) from the medical records. Pre‐treatment and post‐treatment EEG features, functional domains, and treatment regimens were compared.Results: Thirty‐five children with refractory epilepsy were included. Overall, 16/35 (46%) of individuals had a >50% reduction in seizure frequency from the pre‐treatment EEG to the initial post‐treatment EEG. In particular, tonic seizures (in a subset of 23 children) were reduced (24‐hour tonic seizure count pre‐treatment was 8 [4‐13] and 3 [1‐5] post‐treatment EEG#1, p=0.04). For follow‐up post‐treatment EEGs, there was: (1) better formation of sleep spindles (37% normal pre‐treatment to 63% normal post‐treatment; p=0.04); and (2) improvement in parental reported cognition (in 43%). Improved cognition was the only outcome that differed between the dexamethasone and methylprednisolone treated groups (58% for dexamethasone [n=11/19] vs. 25% for methylprednisolone [n=4/16]; p=0.03).Significance: Large studies should be powered to detect reductions in seizures (particularly tonic as we identified a 2.6‐fold reduction), improved EEG organization, and improved sleep architecture (21 percentage points). Cognitive improvements following steroid treatment, reported by parents, should be quantified and fully characterized in future work.
Cognitive tasks as provocation methods in routine EEG: a multicentre field study
Authors: Braga Patricia , Mameniskiené Rüta , Guaranha Mirian , Zeissig Eleonora Vega , Samaitienė Rüta , Özcelik Emel Ur , Bogacz Alicia , Lin Katia , Gardella Elena , Yacubian Elza Márcia , Baykan Betül , Legnani Mariana , Beniczky Sándor , Navickiene Eglè , Jasionis Arminas , Lunardi Mariana , Falco Graciela , Wolf Peter 
Published: March 2021

AbstractObjective: This study aimed to analyse the effect of neuropsychological activation methods on interictal epileptiform discharges, compared to standard activation methods, for both focal and generalized epilepsies.Methods: This was a multicentre, prospective study including 429 consecutive EEG recordings of individuals with confirmed or suspected diagnosis of epilepsy. Neuropsychological activation included reading aloud in foreign and native language, praxis and a letter cancelation task (each with a duration of three minutes). After counting interictal discharges in three‐minute time windows, activation and inhibition were assessed for each procedure, accounting for spontaneous fluctuations (95% CI) and compared to the baseline condition with eyes closed. Differences between generalized and focal epilepsies were explored.Results: Interictal epileptiform discharges were present in 59.4% of the recordings. Activation was seen during hyperventilation in 31%, in at least one neuropsychological activation method in 15.4%), during intermittent photic simulation in 13.1% and in the resting condition with eyes open in 9.9%. The most frequent single cognitive task eliciting activation was praxis (10.3%). Lasting activation responses were found in 18–25%. Significant inhibition was found in 88/98 patients with baseline interictal epileptiform discharges, and was not task‐specific.Significance: Adding a brief neuropsychological activation protocol to the standard EEG slightly increased its sensitivity in patients with either focal or generalized epilepsy. However, in unselected epilepsy patients, this effect seems only exceptionally to result in ultimate diagnostic gain, compared to standard procedures. From a diagnostic perspective, cognitive tasks should be reserved for patients with a suspicion of cognitive reflex epilepsy/seizures and probably require longer exposure times. Further research is needed to explore potential therapeutic applications of the observed inhibition of interictal epileptiform discharges by cognitive tasks in some patients.
Clinical management of voice and breathing problems in two patients with vagus nerve stimulation therapy
Authors: Alantie Sonja , Makkonen Tanja , Hietala Satu , Peltola Jukka 
Published: March 2021

AbstractWe report two cases highlighting the diversity of vagal nerve stimulation (VNS)‐related effects on voice and breathing in patients with refractory epilepsy. The patients had both implantation and stimulation‐related side effects, which lasted for several months, impacting on their quality of life. The adverse effects appear to be due to recurrent laryngeal nerve paralysis‐related vocal cord hypofunction and stimulation‐related vocal fold spasms, however, their inter‐relationship is complex. In one of the patients, we were able to utilize the novel programming capabilities of the VNS device to reduce the laryngeal side effects without compromising therapeutic efficacy. [Published with video sequences].
Surgery for drug‐resistant tuberous sclerosis complex‐associated epilepsy: who, when, and what
Authors: Specchio Nicola , Pepi Chiara , de Palma Luca , Moavero Romina , De Benedictis Alessandro , Marras Carlo Efisio , Vigevano Federico , Curatolo Paolo 
Published: March 2021

AbstractObjective: Tuberous sclerosis complex (TSC) is a multisystem genetic disorder associated with refractory early‐onset epilepsy. Current evidence supports surgery as the intervention most likely to achieve long‐term seizure freedom, but no specific guidelines are available on TSC pre‐surgical workup. This critical review assesses which TSC patients are suitable for surgical treatment, when pre‐surgical evaluation should start, and what degree of surgical resection is optimal for postsurgical outcome.Methods: We searched for publications from 2000 to 2020 in Pubmed and Embase using the terms “tuberous sclerosis,” “epilepsy,” and “epilepsy surgery”. To evaluate postsurgical seizure outcome, we selected only studies with at least one year of follow‐up.Results: Overall, we collected data on 1,026 patients from 34 studies. Age at surgery ranged from one month to 54 years. Mean age at surgery was 8.41 years. Of the diagnostic non‐invasive pre‐surgical tools, MRI and video‐EEG were considered most appropriate. Promising data for epileptogenic tuber detection is provided from invasive SEEG studies. Data on surgery and related outcome were available for 769 patients. Seizure freedom was seen in 64.4% of patients who underwent tuberectomy, 68.9% treated with lobectomy and 65.1% with multilobar resection. The most effective surgical approach was lobectomy, even though more recently tuberectomy associated with the resection of the perituberal area seems to be the best approach to reach seizure freedom. Published postsurgical seizure freedom rates in patients with TSC were between 65% and 75%, but reduced to 48%‐57% over longer follow‐up periods. Early surgery might positively affect neurodevelopmental trajectory in some patients, even though data on cognitive outcome are still to be confirmed with longitudinal studies.Significance: Considering the strong correlation between epilepsy duration and neurocognitive outcome, all patients with TSC ought to be referred early to a dedicated epilepsy centre for individually tailored pre‐surgical evaluation by a multi‐disciplinary epilepsy surgery team.
The aetiologies of epilepsy
Authors: Balestrini Simona , Arzimanoglou Alexis , Blümcke Ingmar , Scheffer Ingrid E. , Wiebe Samuel , Zelano Johan , Walker Matthew C. 
Published: March 2021

AbstractThe identification of the aetiology of a patient's epilepsy is instrumental in the diagnosis, prognostic counselling and management of the epilepsies. Indeed, the aetiology can be important for determining the recurrence risk of single seizures and so for making a diagnosis of epilepsy. Here, we divide the aetiologies into six categories: structural, genetic, infectious, metabolic, immune (all of which are part of the International League Against Epilepsy [ILAE] classification system) and neurodegenerative (which we have considered separately because of its growing importance in epilepsy). These are not mutually exclusive categories and many aetiologies fall into more than one category. Indeed, genetic factors probably play a role, to varying degrees, in the risk of seizures in all people with epilepsy. In each of the categories, we discuss what we regard as the most important aetiologies; importance being determined not only by prevalence but also by clinical significance. The introduction contains information suitable for level 1 competency (entry level), whilst the subsequent sections contain information aimed at level 2 competency (proficiency level) as part of the new ILAE competency‐based curriculum. As we move towards precision medicine and targeted therapies, so aetiologies will play an even greater role in the management of epilepsy.
Síntomas emocionales y compras por pánico durante la pandemia de COVID-19: Un análisis de trayectoria
Authors: Orellana Carlos I. , Orellana Ligia M. 
Published: March 2021

Objetivo: Examinar las manifestaciones y los vínculos entre síntomas emocionales y las compras por pánico durante la aplicación de medidas de cuarentena domiciliar debido a la pandemia de COVID-19.
Método: Una muestra no probabilística de 339 residentes en El Salvador, mayores de 18 años, respondió un cuestionario en línea. El instrumento constaba de datos sociodemográficos, ítems sobre percepciones sobre la pandemia, una escala sobre compras por pánico y la escala abreviada de Depresión, Ansiedad y Estrés (DASS-21). Se realizaron análisis bivariados y multivariados, incluyendo un análisis de trayectoria o path analysis.
Resultados: Casi 40% de la muestra incurrió en compras por pánico. Las compras por pánico se asocian con depresión, ansiedad y estrés, y con el interés en la pandemia y la percepción de alteración de rutinas. El análisis de trayectoria comprueba que, indirectamente, la depresión desincentiva la compra por pánico y la ansiedad la incentiva. El estrés ejerce un efecto positivo indirecto a través del interés en el tema y la alteración de rutinas, y un efecto directo sobre las compras por pánico.
Conclusión: La depresión, ansiedad y estrés se relacionan de manera diferencial con percepciones y comportamientos asociados al afrontamiento de la pandemia. El estrés constituye una respuesta adaptativa a la demanda de la situación y las compras por pánico una forma de paliar las emociones negativas suscitadas por la crisis. El interés en estos patrones de compra debe contemplar el contexto consumista en el que ocurren y las formas de afrontamiento en función del poder adquisitivo.
Bone Remodeling Markers in Assessing of Sternal Reparative Regeneration in Patients With Carbohydrate Metabolism Disorders After Coronary Bypass Surgery
Authors: Gusakova A. M. , Nasrashvili G. G. , Trubacheva O. A. , Saushkin V. V. , Gorchakova M. B. , Kozlov B. N. , Suslova T. E. 
Published: March 2021

Aim To study time-related changes in bone remodeling markers in patients with ischemic heart disease (IHD) associated with type 2 diabetes mellitus (DM) and disorders of carbohydrate metabolism (CM). Also, a possibility was studied of using these markers for evaluation of breast bone reparative regeneration in early and late postoperative periods following coronary bypass (CB).Materials and methods This study included 28 patients with IHD and functional class II-III exertional angina after CB. Patients were divided into 2 groups based on the presence (group 1) and absence (group 2) of CM disorders. Contents of osteocalcin (OC), C-terminal telopeptide (CTTP) of type 1 collagen, deoxypyridinoline (DPD), and alkaline phosphatase bone isoenzyme (ALPBI) were measured by enzyme immunoassay on admission (Т1) and at early (Т2) and late (Т3) postoperative stages. Sternal scintigraphy with a radiopharmaceutical (RP) was performed at stage 3 following sternotomy.Results The content of OC and CTTP was reduced in group 1 compared to the values in the group without CM disorders (р<0.005) at stages Т1 and Т2. There were no significant intergroup differences in concentrations of ALPBI and DPD throughout the study. Time-related changes in OC, CTTP, and DPD had some intergroup differences: the increase in biomarkers was observed in group 1 considerably later, at stage Т3 (р<0.005), while in group 2, it was observed at stage T2 after sternotomy. Scintigraphy revealed significant intergroup differences in the intensity of RP accumulation in sternal tissue.Conclusion The intergroup differences in the content of biomarkers evidenced a disbalance among processes of formation and resorption of bone tissue and delayed remodeling processes in patients with IHD associated with type 2 DM and CM disorders. The study confirmed significance of comprehensive evaluation of time-related changes in markers for bone tissue metabolism and sternal scintigraphy for diagnosis and evaluation of sternal reparative regeneration following sternotomy in patients with IHD associated with type 2 DM and disorders of CM metabolism.
Combined femoral and sciatic nerve blocks for lower limb surgeries
Authors: Wani Sadia Ali , Nahida Qazi , Wani Sadaf Ali , Kakroo Shafia , Farooq Sabahat 
Published: March 2021

The peripheral nerve blocks can be used to interrupt the nerve pathways at multiple locations without undue sedation or loss of consciousness. Low incidence of pre and postoperative complications, good postoperative analgesia and increased operating room efficiency, all have accounted for the resurgence of interest in these techniques. The main aim of this study was to assess the suitability of this simple and safe technique for various unilateral lower limb surgeries and to assess the hemodynamic stability of the patients after this procedure.This prospective randomized study involved 50 patients, in the age group of 20-80 years, scheduled to undergo elective and emergency lower limb surgeries under combined femoral and sciatic nerve blocks. A sciatic nerve block was given by the posterior approach of Labat, and a femoral (3 in 1) block was given by Winnie's inguinal perivascular approach using a mixture of lidocaine, ropivicaine, and saline. Complete block was achieved in 92% of the patients. None of the patients had any complications and there was no significant difference between the pre-operative and post- operative vitals (pulse and blood pressure). 84% of the patients preferred to undergo the same anesthetic technique, if required in the future. Combined femoral(3-in-1) and sciatic nerve block is a simple, safe, and efficient technique with very low incidence of sideeffects and a negligible failure rate.
A comparative study between cuffed oropharyngeal airway and laryngeal mask airway in spontaneously breathing anaesthetized patients for short surgical procedures
Authors: Madhusoodanan Vishnu , Gautam Archana , Dhulkhed Vithal K 
Published: March 2021

The art of endotracheal intubation has a long-chequered history being accepted as the gold standard of the airway. This study was done to compare LMA and COPA in spontaneously breathing anaesthetized patients for short surgical elective procedures. To compare Cuffed Oropharyngeal Airway (COPA) with Laryngeal Mask Airway (LMA) in terms of Placement success rate, Requirement of airway interventions and Intraoperative and postoperative complications. A prospective Randomized Controlled clinical study was conducted among 60 patients undergoing elective surgical procedure under Department of Anaesthesia in Krishna Institute of Medical Sciences and Hospital, Karad. Randomization was done and patients were divided into two Groups- A and B. Chi-Square test was used for analysis.Male preponderance was seen in the study. Mean age in group A & B were 34.86 ±10.64 & 35.53 ±11.36 years respectively. First time successful insertion rate was higher in LMA group (93.33%) than COPA group (83.33%). No manoeuvres were required for clear, unobstructed airway in group A while in 40% of patients of COPA group required manoeuvres for clear, unobstructed airway. Coughing & gagging were observed in both the groups. But no intraoperative major complications are observed.Considering technical aspects of airway management, LMA is better than COPA with respect to higher first-time success rate of LMA.
Tramadol-paracetamol combination for postoperative pain relief in elective single level lumbar microdiscectomy surgery: A comparison of two different doses of tramadol
Authors: Sharma Sunita , Aishwarya  , Gupta Priyamvada 
Published: March 2021

Pain is a suffering and every individual has the right to be pain free. Moreover, pain in the post -operative period may lead to sense of being unwell as well as many complications like nausea, vomiting, hypertension, tachycardia, restricted mobility, breathlessness etc. Thus, it is essential to obtain sufficient pain relief in the perioperative period. The objective of our study was to compare the postoperative pain scores in patients receiving two different doses of tramadol, 1mg/kg and 1.5mg/kg in combination with paracetamol 1gm for elective single-level microdiscectomy. Patients were randomly divided into two groups of thirty each. Group A received injection tramadol 1mg/kg intravenously and group B received injection tramadol 1.5mg/kg intravenously. In addition, both groups received injection paracetamol 1gm intravenous infusion. Pain intensity (VAS score) recorded at 1 minute, 30 minutes, 1 hour, 2, 3 and 4 hours in both the groups. Side effects like nausea, vomiting, sedation was also noted. Injection fentanyl 1 mcg/kg intravenously was used as rescue analgesic. Total dose of fentanyl used was also noted. Data was analyzed using appropriate statistical tests. On the basis of the present study, paracetamol(1g) and tramadol (1mg/kg or 1.5mg/kg) intravenously were found to be safe and effective in post-operative pain relief in elective single-level microdiscectomy surgery.
Assessment and Prognostic significance of renal dysfunction in acute stroke patients
Authors: Jain Pallav , Sardana Vijay 
Published: March 2021

During hospitalization due to stroke, patients can have acute kidney injury (AKI) as a possible complication which is frequently overlooked and underestimated in clinical trials. To assess the prevalence of renal dysfunction in acute stroke patients and to assess its prognostic significance A total of 100 patients were recruited for this study with diagnosis of stroke. Renal dysfunction was evaluated in the form of Acute kidney injury and unrecognized renal dysfunction (Baseline Normal serum Creatnine&#60;1.2 mg/dl with EGFR&#60; 60 ml/min on admission). The primary functional outcome was measured using the modified Rankin Scale at the time of discharge, 1 month after stroke onset. Analysis of data was done using SPSS-17.Independent t-test and chi-square test were used to calculate difference between two groups Our study shows prevalence of acute kidney injury in patients of stroke is 15%. Moreover, the study showed that AKI after stroke was associated with higher in-hospital mortality and poorer functional outcome at 1 month. Acute kidney injury appears to be a common complication after stroke and is related to increased mortality and disability in stroke.AKI is common complication after stroke and frequent cause of poor functional outcome.