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Biomedical subjects

Allan Krumholz

Publications and source records attributed to Allan Krumholz.

6 recordsLinked to original sources
PubMed2006

Psychogenic (nonepileptic) seizures.

Psychogenic (nonepileptic) seizures are among the most common and serious of all psychogenic neurological disorders. They account for approximately 20% of all intractable seizure disorders referred to comprehensive epilepsy centers and present with a reported annual incidence of approximately 4% that of true epilepsy. These events are serious and disabling. Indeed, compared with patients with true epilepsy, patients with psychogenic seizures exhibit more frequent, severe, and disabling seizures as well as a poorer quality of life. The diagnosis and management of psychogenic seizures remain challenging, although advances in video electroencephalographic (EEG) monitoring have improved the ability of physicians to identify these disorders accurately. The prognosis of these patients is still relatively poor, and a good outcome seems dependent on a young age at diagnosis, early diagnosis, less severe psychological comorbidities, and continued follow-up and management by the diagnosing neurologist or clinician. Additional psychological or psychiatric assessment may be beneficial, particularly in elucidating the etiology of the disorder as well as identifying comorbid disorders, and may help in the long-term management of these patients. This review presents the history, epidemiology, differential diagnosis, and management of psychogenic seizures, with particular attention to the use of diagnostic testing, including video EEG monitoring.

Adult↗
PubMed2005

Factors at diagnosis predict subsequent occurrence of seizures in systemic lupus erythematosus.

OBJECTIVE: To determine the factors associated with seizures in systemic lupus erythematosus (SLE). METHODS: One hundred ninety-five patients with SLE were followed at the University of Maryland Lupus Clinics from January 1992 until June 2004. Neuropsychiatric (NP) manifestations were defined according to the American College of Rheumatology nomenclature and case definitions for NP-SLE syndromes, and seizures were defined using the International Classification of Epileptic Seizures. At the end of the study period, 28 of the 195 (14%) patients with SLE had seizures (21 generalized convulsive, 7 partial) during their course of disease. Recurrent seizures or epilepsy occurred in 12 of 28 patients (43%). The baseline features of those patients with seizures and those without them were compared to determine their contribution to the occurrence of isolated seizures and epilepsy. RESULTS: Isolated seizures in SLE are common; epilepsy is less frequent but nonetheless important. Certain clinical features at baseline were independent predictors of seizures including disease activity, in particular psychosis, moderate- to high-titer serum anti-cardiolipin and anti-Smith antibodies, and damage accrual. Higher disease activity at baseline, concurrent multiple NP-SLE manifestations, prior strokes, and male gender were predictive of epilepsy. CONCLUSION: The risk of seizure and epilepsy in systemic lupus erythematosus (SLE) is increased in those patients with higher disease activity at baseline, prior neuropsychiatric SLE disease, and anti-cardiolipin and anti-Smith antibodies.

Adult↗
PubMed2004

Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy.

OBJECTIVES: To estimate the risk to public safety posed by drivers with epilepsy, the authors compared annual totals and disease-specific risk for fatal crashes associated with seizures and other medical conditions. They compared individual risks for fatal crashes due to seizures and other causes of mortality in patients with epilepsy. METHODS: The authors analyzed Multiple-Cause of Mortality data files from death certificates provided by the National Center for Health Statistics (NCHS) for the years 1995-97. They analyzed International Classification of Diseases-9 codes for underlying causes of death and other major conditions and determined disease-specific rates of fatal crashes associated with seizures and other medical conditions. RESULTS: An average of 44,027 US drivers died annually as a result of motor vehicle crashes during 1995-97; however, only 86 (0.2%, range 82 to 97) of these deaths were associated with seizures in mortality reports. The incidence rate of fatal crashes for patients with seizures was 2.3 times the rate for patients with cardiovascular and hypertensive diseases and 4.6 times the rate for patients with diabetes. The proportionate mortality ratio for motor vehicle crashes in patients with seizures was low (0.2); most patients with epilepsy died of common cardiovascular and systemic disorders. CONCLUSION: Fatal driver crashes due to seizures are uncommon. This finding supports the current public policy of permitting patients whose seizures are controlled to drive.

Accidents, Traffic↗