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Biomedical subjects

V Mateos

Publications and source records attributed to V Mateos.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Epidemiology and etiology of status epilepticus].

Establishing the incidence and frequency of status epilepticus (SE) is difficult because of differences in definition, problems of diagnosing nonconvulsive SE and, above all, the diversity of study populations. There are differences involved in studying the frequency of SE in a population of epileptics, in a sample of all patients seen at a single hospital or by a specific department, or in the general population. It is estimated that SE is suffered annually by 50 out of 100,000 inhabitants in the general population, 0.2% of hospital patients, 3.5% of patients admitted to an intensive care unit, and from 2 to 10% of epileptic patients. These figures increase if only children are considered. Age and history of epilepsy must be taken into account in order to determine the cause of SE. SE often appears in a context of no known prior history of epilepsy, particularly in the elderly. The cause remains undetected in approximately one third of SE cases. Among the most common symptomatic causes in the adult are cerebral vascular disease and toxic-metabolic disorders.

Adolescent↗
PubMed1996

[Status epilepticus].

Prolonged or repeated seizures--or status epilepticus (SE)--presents diagnostic and therapeutic problems and is one of the most common neurologic emergencies. SE is defined as seizure lasting longer then 30 minutes or the repetition of at least two seizures within a short period of time, independently of the patient's state of consciousness or the type of seizure. At least 10% of epileptic patients suffer an SE during the course of their disease. Fifty percent of SEs appear in patients with no known history of epilepsy. SE is more frequent in symptomatic epilepsies, particularly those arising from trauma, tumor or infection. Most are found in epilepsies involving the frontal lobe. SE is present in nearly all epileptic syndromes, even idiopathic ones, although it is more frequent in cryptogenic and symptomatic forms. Tonic-clonic SE is the best known type and its diagnosis is simple. Partial SE, above complex partial SE, presents a diagnostic challenge. Particularly difficult is the differential diagnosis of complex partial SE and absence SE, above all the form termed late-onset de novo absence SE, which presents as confusional syndrome in the elderly. The treatment of SE, which is always a medical emergency, is based on intravenous benzodiazepines along with phenytoin, barbiturates or both. We discuss the utility of other drugs, such as lidocaine and valproic acid i.v., as well as the possibility of drugs like phosphenytoin becoming available in the near future.

Adolescent↗
PubMed1994

[Janz's juvenile myoclonic epilepsy: a little-known frequent syndrome. A study of 85 patients].

BACKGROUND: Juvenile myoclonic epilepsy (JME) constitutes 10% of all epilepsies. Despite this syndrome being well defined, its diagnosis is usually delayed. The aim of this study was to analyze the clinical and electroencephalographic characteristics to facilitate guidelines to contribute to its recognition. METHODS: From January 1986 to July 1993 the clinical and EEG data of 85 patients with JME were prospectively studied. In 68 cases (80%) the polygraphic study of sleep was also analyzed during a nap period. RESULTS: The series included 44 males and 41 females of a mean age of 28 years (range: 13-63). Fifty-six percent of the cases showed family history of epilepsy and/or febrile convulsions. All the patients had myoclonic crisis with the age of 15 being the mean age of initiation (range: 8-27). Eighty-seven percent also had generalized tonic-clonic crisis and 18% typical absences. Myoclonias were presented daily up the administration of adequate treatment in 60% of the cases with 21% having myoclonic status. The mean interval from the initiation of the myoclonic crisis to diagnosis of JME was of 10.6 years. On monotherapy with valproic acid and following a mean follow up period of 23.8 months, 86% of the patients remained free of crisis. Nonetheless, the rate of recurrence was 100% in the 19 patients who discontinued the treatment. Surveillance EEG was normal on some occasion in 88% of the cases. The most characteristic paroxysms were the following: wave-point at 4-5 Hz and generalized rapid wave-polypoint. Light stimulation provoked a paroxysmal response in one third of the cases. Sleep EEG was abnormal in all the patients. An activation of the paroxysms during non-REM sleep in 78% of the cases and on waking up in 25%. CONCLUSIONS: Juvenile myoclonic epilepsy is a well defined syndrome. Its diagnosis is based on directed anamnesis allowing myoclonic jerks to be collected which often remain unperceived, and EEG exploration with sleep tracing in which the characteristic outbreaks of wave-point or generalized rapid wave-polypoints may be discovered.

Adolescent↗
PubMed1993

[Liposome amphotericin in the treatment of deep mycoses in patients not severely immunosuppressed. An efficient alternative with low toxicity].

Amphotericin is a powerful antifungal agent of high toxicity. Encapsulation in liposomes has led to new perspectives although clinical experience is still slight. Four patients, who were neither carriers of antibodies against the human immunodeficiency virus nor neutropenic, diagnosed of meningeal cryptococcosis, pleural aspergillosis, cerebral aspergillosis and ophthalmic candidiasis, respectively and treated with liposomal amphotericin are reported. The treatment was effective and well tolerated. Clinical improvement was observed in the patient with cerebral aspergillosis but magnetic resonance demonstrated persistence of the lesions. Only slight deterioration in renal function was observed in one case and in the other two renal failure improved upon substitution of conventional amphotericin by liposomal amphotericin. The slight systemic toxicity and the absence of local intolerance allowed the administration of high doses and shortening of the therapeutic schedule.

Adult↗
PubMed1993

Hyperammonaemic encephalopathy as the presenting feature of IgD multiple myeloma.

We observed a case of hyperammonaemic encephalopathy in a patient without liver dysfunction which revealed meningeal involvement of IgD multiple myeloma. We have reviewed briefly the hyperammonaemic syndrome and we believe that this diagnosis has to be considered in differential diagnosis of encephalopathies in patients with multiple myeloma.

Aged↗
PubMed1993

[Drug-resistant focal epilepsy with normal cranial CT. Electroclinical correlation and magnetic resonance in 45 patients].

Forty-five patients between 15 and 60 years of age with pharmacoresistant focal epilepsy of more than 4 years duration with normal cranial CT were analyzed. Magnetic resonance and sleep EEG were performed. In 82% of the patients epilepsy had initiated prior to 20 years of age with 89% having partial complex crises and 75% also having secondary generalized crises. EEG demonstrated abnormalities in the temporal lobe in 78% of the cases. Activation of the abnormalities was observed during REM sleep in 24% of the patients. MR was pathologic in 38%, with the most frequent finding corresponding to a sole hyperintense T2 signal (76%). A good correlation was observed between the electroclinical findings and MR in 72% of the cases with pathologic MR. Most of these patients should, thus, be considered as candidates for surgical evaluation of their epilepsy.

Adolescent↗
PubMed1992

[Acute meningoencephalitis caused by Coxiella burnetii with periodic EEG complexes].

Q fever is a zoonosis found worldwide and is produced by Coxiella burnetii. It may be acute or chronic with neurological manifestations being infrequent. Several cases of acute encephalitis or meningoencephalitis have been described, generally with an evolution towards cure regardless of the use of selective antibiotic treatment. Recently the authors had the opportunity to study a 33 year old male presenting acute meningoencephalitis in which the clinical manifestations, CSF findings (increase in cellularity with lymphocytic predominance and excess proteins ) and neurophysiological findings (appearance of periodic bilateral complexes in the EEG) suggested the diagnosis of herpetic meningoencephalitis. Treatment with acyclovir was initiated. However, serologic studies demonstrated, a posteriori, that the germ responsible had been Coxiella burnetii. The patient evolved satisfactorily with no specific treatment and the EEG anomalies disappeared within a few days. The authors insist on the need to include Q Fever in the diagnostic differential of acute meningoencephalitis and emphasize the possibility that germs of a non viral nature may produce periodic EEG complexes in all that similar to those found in herpetic encephalitis.

Acute Disease↗
PubMed1992

[Ischemic ictus in a young woman with fibromuscular dysplasia of the basilar artery].

Fibromuscular dysplasia (FMD) is a vasculopathy of unknown etiology generally presented in young women and preferentially found in the renal arteries. The second site of frequency of appearance corresponds to the cervical-cephalic arteries with cases of the intracranial vessels being exceptional. We recently had the opportunity to study a female patient of 29 years of age admitted following an acute progressive cerebrovascular event. Cranial computerized tomography (CT) demonstrated multiple ischemic lesions bilaterally affecting the basilar-vertebral territory. Angiographic study established the diagnosis of FMD upon observing "pearl-like" lesions located in the distal part of the basilar artery. Anticoagulant treatment was initiated and the patient evolved satisfactorily although some neurologic deficits persisted. The authors insist on the need to consider FMD as a cause of ictus in young, specially female, patients.

Adult↗
PubMedDate not supplied

[Almotriptan in the treatment of migraine attacks in clinical practice: results of the TEA 2000 observational study].

BACKGROUND: Almotriptan, the most recent drug of the triptan family, has shown good efficacy and tolerability profile in clinical trials. OBJECTIVE: To assess almotriptan's tolerability and effectiveness in the setting of routine clinical practice. PATIENTS AND METHODS: 1,643 patients diagnosed of migraine according to IHS criteria were recruited by 317 neurologists in the TEA 2000 study. Patients were instructed to report data on migraine attacks in a diary for a three months follow-up period. Data from 4,253 migraine attacks were obtained. RESULTS: The incidence of adverse events was 0.02 per migraine attack (3,9 % of patients). Subjective clinical improvement after 30 minutes (33.2 y 37.1 %), pain improvement after 2 hours (65.5 % and 70.2 %), pain free response after 2 hours (26.6 % and 29.2 %), recurrence between 2 and 24 hours (21.2 % and 17 %) and a complete response by 24 hours (18.6 % and 22.9 %) were found. These results were obtained in both "intention to treat" and "per protocol" analyses, being even much better when only low pain intensity attacks were considered. CONCLUSIONS: The TEA 2000 study results demonstrate good effectiveness and excellent tolerability profile of almotriptan 12.5 mg in the daily clinical neurological practice. The results of this study confirm those obtained in clinical trials carried out before almotriptan was introduced into the market and that it is a good therapeutic choice for the symptomatic treatment for migraine attacks.

Adult↗
PubMedDate not supplied

[Nuclear syndrome of the oculomotor nerve caused by a mesencephalic infarction confirmed by MRI].

The nuclear syndrome of the third nerve was first described in 1981. It has the very characteristic disturbance of an ophthalmoplegia with complete ipsilateral third nerve palsy associated with paresis of elevation in contralateral eye. This particularly presentation is due to the innervation of the superior rectus which comes mainly from the contralateral oculomotor nucleus. As associated signs were described contralateral cerebellar and or pyramidal syndromes, uni or bilateral parasympathetic disfunction and sometimes gaze disorders. The etiology es usually a vascular damage (ischemic most frequently) located in mesencephalon. We report on a case of a 60 years old man who developed acute nuclear ophthalmoplegia of the third right nerve accompanied with cerebellar and pyramidal syndrome and focal asterixis in left extremities. MRI showed an ischemic lesion in right paramedial mesencephalic territory with extension to the ipsilateral thalamic region. Pyramidal and cerebellar syndromes and asterixis disappeared in a few weeks, while ophthalmoplegia remained unchanged. Semiologic characteristics and anatomic basis of the nuclear oculomotor syndrome which allow to make the differential diagnosis between this syndrome and intra-axial fascicular disturbances of the third nerve (Weber, Claude and Benedikt syndromes) are discuss.

Cerebral Infarction↗
PubMedDate not supplied

[Therapeutic strategies used by neurologists and primary care physicians in the symptomatic treatment of migraine. Findings from Strategia-I and Strategia-II opinion studies].

INTRODUCTION: Few studies have been carried out on the subject of stratification of medical care for migraines, and even fewer have been conducted with the aim of determining the attitudes adopted by physicians towards their patients when dealing with this issue. Strategia-I and II studies were designed for this purpose. SUBJECTS AND METHODS: The sample consisted of 162 neurologists and 3,168 Primary Care physicians (PCP). Participants in the studies filled out an opinion survey that was produced ad hoc and included the different possible strategies, namely a) Stepped care between attacks (the patient takes medication during several attacks and, if it is not effective, it is replaced by another in successive attacks); b) Stepped care within attacks (the patient treats his or her seizures with medication and, if it does not work, another is used as rescue medication); and c) Stratified care (the physician classifies the patient according to the degree of disability produced by the migraine and recommends the most appropriate drug at the start). RESULTS: Most participants in the study (90.7% of neurologists, 85.2% of PCP) reported using a single strategy. Stratified care was found to be the preferred choice by both collectives (67.6% of neurologists, 43.8% of PCP; p < 0.0001). Only 16% of the respondents admitted using some disability scale. Nonsteroidal antiinflammatory drugs are the medication chosen if disability is mild-moderate, while triptans are preferred if it is moderate-severe (92.9% of neurologists, 78.8% of PCP; p < 0.001). CONCLUSIONS: The strategy based on stratified care is the most widely used in visits to Neurology and Primary Care in Spain, although there are significant differences between the two collectives. Triptans are perceived as being the ideal medication in situations involving moderate-severe disability.

Clinical Protocols↗
PubMedDate not supplied

[Nodular subependymal heterotopia and epilepsy].

Neuronal migration disorders may manifest as epilepsy alone and this is usually the case in nodular subependymal heterotopia, of which we present 5 cases. We consider this entity to be a well-defined epileptic syndrome because it is found nearly exclusively in women and is characterized by nearly constant seizures which start in the second or third decade of life, familial aggregation of cases, a clinical and EEG profile that suggests a temporal focus and the absence of associated cognitive or motor deficits. Seizures are usually controllable with medication.

Adult↗