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PubMed1976

[Analysis of the structure of the components of the convulsive action of corazole following administration of sulazepam and its metabolites to mice].

A study was made of the interrelationship between the minimal effective doses of pseudoclonic and clonico-tonic convulsions, and also tonic extension caused by the intravenous injection of corazol to mice and the effect of anticonvulsive action of sulazepam and its metabolites (diazepam, desmethyldiazepam and oxadiazepam) on this process. It was shown that all the compounds under study increased the values of the minimal effective doses by the recorded indices of the convulsive seizure, whereas the maximum of the anticonvulsive activity was reached 15 minutes after the sulazepam and oxazepam, and 5 to 30 min after diazepam administration. There proved to be a distinct correlation between the minimal effective doses values of the recorded indices of the confulsive seizure in the control animals which also persisted after the administration of the agents under study. It is supposed that sulazepam and its metabolites increased the minimal effective doses of corazol for the recorded effects, but failed to alter the general picture of the convulsive attack and did not influence the dispersion corazol dose-effect dependence.

Animals↗
PubMed2000

[Non-convulsive status epilepticus--confusion and cognitive failure during seizures].

BACKGROUND: Non-convulsive status epilepticus is characterized by confusion and impaired consciousness, lasting at least half an hour. Seizure activity in the EEG confirms the diagnosis, but ictal discharges can be heterogeneous and difficult to classify. There is controversy regarding evidence of morbidity in humans. MATERIAL AND METHODS: We report three patients with non-convulsive status epilepticus. RESULTS: In two patients, the clinical findings during seizures were subtle cognitive impairment. One patient was confused during seizures. Localisation of seizure activity in the EEG was mainly frontal in two patients, and generalised with focal predominance in one. There were no sign of neurologic sequelae after the seizures were terminated. INTERPRETATION: Complex partial status epilepticus of frontal origin is common, but differentiation between complex partial and generalised non-convulsive status can be difficult. The clinical symptoms may overlap, and generalised EEG seizure activity does not exclude initial focal ictal discharges. Presumably the reported sequelae after this condition are in most cases a consequence of underlying cerebral illness. Treatment response to diazepam can be variable, with high recurrence risk. Effective prophylactic treatment is most important.

Adult↗
PubMed2000

[Two cases of cranial pachymeningitis presenting only severe continuous headache or convulsion].

In cranial pachymeningitis, headache, cranial nerve palsies, and ataxia were the most common clinical manifestations. We reported two rare cases presenting only headache or convulsion as a main symptom. A 66-year-old man was suffering from severe continuous headache for years with no other clinical symptoms. Laboratory data revealed positive RA test and elevated RAPA. With oral steroid therapy, his headache was subsided. A 39-year-old woman visited us with convulsive attacks as only symptom. Biopsy of the thickened dura revealed granulated epithelioid cells without central necrosis. With antituberculosis therapy, hypertrophy of dura, as well as the symptom, was disappeared. It is difficult to diagnose pachymeningitis when patients manifest only headache or convulsion. We suggest to carry out Gd-enhanced MR scan in these cases.

Adult↗
PubMedDate not supplied

[Non-convulsive status epilepticus secondary to adjusted cefepime doses in patients with chronic renal failure].

Fever is one of the most frequent causes of hospital admission in patients with end-stage renal disease. Lack of an identified source of infection and/or lack of clinical response to the first empirical antibiotic treatment favour the use of broader spectrum antibiotics. The availability of fourth-generation cephalosporins (e.g. cefepime) and the increasing incidence of bacterial resistances to classical antibiotics has increased their use in the clinical practice. We present two cases of non-convulsive status epilepticus in patients with advanced chronic renal failure who received cefepime at doses corrected for the degree of renal function according to the manufacturer's instrument as. The clinical symptoms included shouthough, processes, disorientation, loss of attention, and the later appearance of myoclonus. In both cases the electroencephalogram (EEG) was compatible with non-convulsive epileptic status. After cefepime withdrawal there was a clinical remission of symptoms and normalization of the EEG. It is concluded that cefepime treatment can induce a non-convulsive epileptic status in patients with advanced chronic renal failure. Pharmacokinetic studies are urgently needed to clearly define the appropriate dose of cefepime in patients with advanced chronic renal failure.

Aged↗
PubMed2000

Lumbar puncture refusal in febrile convulsion.

A descriptive study was carried out on patients admitted for febrile convulsion over a two-year period to determine rate of lumbar puncture (LP) refusal, factors associated with LP refusal and outcome of such patients. From 77 patients indicated and requested for LP, 19 (25%) patients refused the procedure. Refusal of LP was significantly more common among the Malay ethnic group (p = 0.01) but not significantly associated with age,gender or whether the patient was admitted for a first or recurrent febrile convulsion. Half of the patients who refused LP had to be started empirically on antibiotics for meningitis. Patients who refused LP were also 8.5 times more likely to discharge themselves "at own risk" (AOR), compared to other patients with febrile convulsion (p = 0.004). In conclusion, LP refusal is a common problem in the local setting and is a hindrance to the proper management of patients with fever and seizure. Appropriate measures must be carried out to educate the public, particularly those from the Malay ethnic group on the safety and usefulness of the procedure. Reasons for patients discharging AOR following LP refusal also need to be addressed and problems rectified.

Culture↗
PubMed1975

[The influence of ethrane on the electro- and pentylenetetrazol-convulsions in mice (author's transl)].

The influence of Ethrane upon electro shock and pentylenetetrazol-induced convulsions was studied in mice. Similar to other inhalation anaesthetics and to barbiturates Ethrane exerts a powerful anticonvulsive activity. There is a dose response relationship between the rate of electro shock (20 mA/0.2 sec) induced convulsions and inspiratory Ethrane concentration, convulsions being completely prevented by 1.5 vol.-percent of Ethrane. The LD(50) of pentylentetrazol increases five fold under a 2 vol.-percent Ethrane anaesthesia.

Anesthesia, Inhalation↗
PubMed2001

Convulsive syncope in young adults: think of a cardiac cause.

Convulsive syncope is often misdiagnosed as epilepsy because of its similarity in clinical presentation. We present the case of a patient who had several such episodes before a definitive diagnosis was made. The diagnosis of prolonged sinus arrest was finally made with the valuable assistance of cardiac monitoring during a witnessed episode of convulsive syncope. Appropriate therapy was promptly introduced, i.e. temporary then permanent cardiac pacing. It is possible that any further delay in reaching the correct diagnosis and delivering appropriate treatment might have carried a significant risk of morbidity and mortality. Continuous electrocardiographic monitoring performed at an early stage is therefore crucial in the initial assessment of a young adult presenting with convulsive syncope, as a significant proportion may have a cardiovascular aetiology, particularly arrhythmias, for their syncopal episodes.

Adult↗
PubMed1988

Convulsive Therapy and the Course of Bipolar Illness, 1940-1949.

A total of 93 bipolar patients admitted in the 1940s were divided into those who received convulsive therapy and those who did not. Clinically, the two groups were similar. Those who received convulsive therapy were discharged back home more frequently, indicating the efficacy of the treatment. Those who received convulsive therapy showed more episodes, both manias and depressions, in the course of their illnesses. The reason for this difference in course of illness is not known, but deserves further exploration. The explanation may involve either biological factors or social circumstances related to a successful treatment outcome.

Journal Article↗
PubMed2002

Simple febrile convulsions in children: explain and reassure the parents.

(1) Simple febrile convulsions (brief and generalised) in children carry a high risk of recurrence during new febrile episodes (30-50%), especially while the child is under the age of 3 years. These relapses are rarely severe and only occur during a minority of febrile episodes. Later onset of epilepsy is rare. (2) Long term treatment with phenobarbital and valproic acid reduce the risk of relapse but carry a risk of bothersome or severe adverse effects. These treatments are rarely warranted in this setting. (3) Oral diazepam administration to a febrile child has moderate preventive efficacy, which is further limited by the difficulty of timing the treatment correctly. Oral diazepam has frequent but generally mild adverse effects. (4) Antipyretics are not very effective at preventing febrile convulsions but can make the child more comfortable. (5) Parents are often upset when they first see their child have a febrile convulsion. It is important to take the time to reassure them.

Analgesics, Non-Narcotic↗
PubMed2002

Ropivacaine-induced convulsion immediately after epidural administration--a case report.

Ropivacaine is a new long-acting amide-type local anesthetic with less toxic effects compared with bupivacaine. Here, we report a case who sustained convulsion immediately after administration of epidural ropivacaine. A 75-year-old woman was scheduled for total knee replacement. Epidural catheter was inserted smoothly. After aspiration test and injection of a test dose of 3 ml of 2% lidocaine containing 15 micrograms epinephrine, 160 mg ropivacaine was administered epidurally. Unfortunately, a generalized tonic-clonic convulsion of sudden onset occurred right after ropivacaine injection. After he was given 100% oxygen and intravenous thiopental 150 mg, the patient recovered uneventfully. During the episode of convulsion sinus tachycardia at a rate of 120 beats/min without the interposal of other form of cardiac arrhythmia was noted, and respiration remained intact. This suggests that ropivacaine offers a good cardiovascular stability. This example serves as another evidence to remind us that even with a negative aspiration following epidural catheter placement and an uneventful test dose injection, inadvertent intravascular injection may still happen, particularly in the elderly.

Aged↗
PubMed1975

Monosodium L-glutamate-induced convulsions: temporary alteration in blood-brain barrier permeability to plasma proteins.

Monosodium L-glutamate (MSG), a commonly used food additive, induces convulsive disorders in rats. A reversible change in the cerebrovascular permeability of plasma proteins occurs during convulsions induced by the intraperitoneal administration of 4.0 g/kg of MSG to the neonatal rat. During MSG-induced seizures, but not before or after, trypan blue dye enters into the brain tissues, whereas no dye penetration occurs in control rats receiving saline. The frequency of the incidence of MSG-induced convulsions is inversely proportional to the age of the animal. It decreases with the age of the rat. By 42 days of age no substantial seizure activity of dye penetration into the brain tissue occurs in MSG-treated rats. Histological examination indicates that seizure activity is not correlated with characteristic periventricular-arcuate area lesions known to be induced in neonates by parenteral MSG administration. No hypothalamic damage was observed in MSG-treated rats older than 10 days of age.

Age Factors↗
PubMedDate not supplied

[Methylmalonic aciduria associated with myoclonic convulsions, psychomotor retardation and hypsarrhythmia].

INTRODUCTION: Organic acidurias have long been known to cause neurological problems, such as convulsions, stupor, coma, and psychomotor and mental retardation. The organic acidurias include propionic aciduria, methylmalonic aciduria (MMA), isovaleric acidemia, lactic acidemia and glutaric acidemia type I. However, the association of MMA with electrical activity of the brain characterised by a hypsarrhythmic pattern, refractory convulsions and psychomotor retardation is very rare. CASE REPORTS: Two patients, one male and one female, were seen to have psychomotor retardation, erratic attacks of myoclonic convulsions, hypsarrhythmic encephalographic pattern and an increase in the urinary excretion of methylmalonic acid, as shown by gas chromatography and mass spectrometry, all of which supported a diagnosis of MMA in both cases. In one patient, the brain MRI with gadolinium showed lesions compatible with brain atrophy. Protein restrictions, the administration of vitamin B12 and l carnitine re established the normal neurological state and reduced the urinary excretion of methylmalonic acid in one of them. CONCLUSIONS: To the best of our knowledge these are the first cases of MMA that have been seen accompanied by hypsarrhythmia. The rareness of this clinical presentation with the characteristics described above make us suspect that we are dealing with a new clinical syndrome.

Brain↗
PubMedDate not supplied

[Convulsive status epilepticus. Physiopathologic and clinical features].

Convulsive status epilepticus (CSE) is a medical emergency with a prognosis associated to its duration, aetiology and patient age. On account of the absence of a satisfactory definition and of its clinical and electroencephalographical dynamic temporal evolution, recognition of this entity is a major clinical problem. Only the early recognition of CSE allows an urgent treatment, the reason why it should be adopted the following practical definition: 5 min or more of continuous seizures or two or more seizures without regain of consciousness between them. The treatment should be immediately initiated whenever a patient has a convulsion that persists more than 5 min, has a second seizure in the posictal period, or experience a generalized tonic-clonic convulsion at the time of arrival in the emergency department. The typical temporal evolution of CSE affects its prognosis since subtil SE is more refractory to treatment than evident SE. The monitoring of any kind of treatment protocol should have not only a careful clinical observation but also an EEG continuous record.

Child↗
PubMed1976

The role of cerebral 5-hydroxytryptamine for convulsive threshold and anticonvulsant effect of acetazolamide in rats.

The effect of various substances modifying the activity of serotoninergic system on convulsive threshold and anticonvulsant effect of acetazolamide (ACA) in rats was studied using the electric test. The obtained results are suggestive of 5-hydroxytryptamine (5-HT) playing a significant role for convulsive threshold. On the other hand, the changes in the potency of anticonvulsant effect of ACA resulting from administration of substances altering the level of cerebral 5-HT seems to be secondary to the effect of these substances on convulsive threshold. Additionally, the ACA doses being effective as anticonvulsant were found to increase the cerebral level of 5-hydroxyindoleacetic acid (5-HIAA) and to accelerate the 5-HT turnover.

5,6-Dihydroxytryptamine↗
PubMed1992

[The threshold lowering effects of chronic treatment with haloperidol on beta-carboline derivative-induced tonic convulsion].

To clarify a relationship between dopamine neuron and purine, GABA or benzodiazepine system, we have studied the changes in the threshold of tonic convulsion induced by each antagonist after chronic treatment with haloperidol in mice. Mice were given haloperidol (1 mg/kg, sc) once a day for 19 d and challenged with caffeine (an adenosine receptor antagonist), beta-DMCM (beta-carboline derivative: as a benzodiazepine receptor antagonist), picrotoxin (a Cl- channel blocker) or bicuculline (a GABAa receptor antagonist) 30 min, 24 h and 48 h after the last injection of haloperidol. Only the threshold of beta-DMCM-induced tonic convulsion was lowered and it was reversed 7 d after the last injection. The beta-DMCM-induced convulsions on 2 d withdrawal were reversed by diazepam (2.5 mg/kg, ip; a benzodiazepine receptor agonist), Ro15-1788 (5.0 mg/kg, ip; as like a benzodiazepine receptor partial agonist), muscimol (2.0 mg/kg, ip; a GABAa receptor agonist) or apomorphine (0.25 and 2.0 mg/kg, ip; a dopamine receptor agonist). These results suggest that the lowering effect of chronic haloperidol on seizure threshold may be involved in the development of tolerance to haloperidol. It may implicate in direct interactions between benzodiazepine and dopamine or GABA systems but may not between dopamine and GABA neurons in development of lowering seizure threshold following chronic haloperidol treatment.

Animals↗
PubMed2003

Management of febrile convulsion: scene in a regional hospital.

OBJECTIVE: To determine whether practice parameters are applied to the management of children with febrile convulsion. DESIGN: Retrospective study. SETTING: Paediatric department of a public hospital, Hong Kong. METHODS: Practice parameters of the American Academy of Pediatrics and audit measures recommended by the Joint Working Group of the Research Unit of the Royal College of Physicians and the British Paediatric Association were employed as standards. Records between January and April 2000 with the diagnostic coding of febrile convulsion, convulsion, status epilepticus, or meningitis/encephalitis/encephalopathy were reviewed. Areas assessed were appropriate documentation of hospital records and unit statistics (adverse outcomes, inappropriate investigations and treatment). RESULTS: Ninety-four consecutive records were evaluated. In the documentation of hospital notes, accurate description of seizure was observed in 92%, incorrect diagnosis or coding in 12%, and presence/absence of signs of meningitis and parental counselling documented in 64% and 85%, respectively. Regarding unit statistics, investigations performed included a complete blood count, blood glucose, serum calcium, serum electrolytes, renal function tests, liver function tests, chest X-ray, and urinalysis. The mean number of routine investigations was seven. The average length of stay was 2 days. There were no cases of delay in the diagnosis of central nervous system infection. Inappropriate investigations and treatment were as follows: electroencephalography 11%, computed tomography brain scan 2%, and maintenance anticonvulsants 2%. All patients were discharged home with panadol regardless of clinical state. CONCLUSIONS: The present study showed that the use of unnecessary investigations was common. Investigations, though resulting in significant expense, proved to be of little diagnostic value. Diagnostic procedures should be performed only when specifically called for by the patient's condition or medical history.

Child, Preschool↗
PubMedDate not supplied

["De novo" non-convulsive status epilepticus in adults and in the elderly].

There is a growing number of publications in the recent literature reporting the incidence of non-convulsive status epilepticus in the elderly, including both absence epilepsy and partial epileptic seizures. Absence status epilepticus creates a diagnostic problem because of its clinical features: confusion ranging from slight disorientation to stupor. Duration of such states may vary from one hour to a few weeks, with fluctuations and epileptic features in EEG recording (a typical pattern of spikes-slow waves, 3 Hz frequency, symmetrical and synchronical) that disappear after an intravenous injection of benzodiazepines. Absence status epilepticus can be evoked by toxic, metabolic or pharmacological factors as well as by convulsive epileptic seizures. Besides absence epileptic states of middle-cerebral origin there is a rising concern about absence status resulting from simple or complex partial seizures. Generalized non-convulsive status epilepticus following either simple partial or simple complex seizures is characterized by the presence of various focal signs associated with confusion, stupor or coma. The latter may be masking the clinical picture of an underlying cerebral pathology (e.g. brain tumor, hemorrhage, etc.), and epileptic changes can be seen in EEG recording only. Absence status epilepticus can occur in various forms of brain pathology, including stroke, brain tumors, traumatic lesions and other conditions, as well as in systemic diseases affecting the central nervous system function. Therefore, the authors emphasize the importance of electroencephalography in severely ill and unconscious patients, as well as the role of proper anti-epileptic treatment, as this may improve the outcome.

Adult↗
PubMed1992

Per rectal diazepam therapy in convulsive disorders.

One hundred and twenty children with persistent convulsions (lasting > or = 10 min) were treated with per rectal diazepam (dosage: 0.2 to 0.7 mg/kg/dose). Another group of 100 age matched children with convulsions, along with those who did not respond to rectal therapy were given intravenous diazepam in a dosage of 0.2 to 0.3 mg/kg/dose. Rectal treatment was effective in 80.83% cases while intravenous diazepam was effective in 90% cases which is statistically just significant (p < 0.05). No significant difference was observed in the efficacy of two routes of administration in controlling convulsions of different clinical types and various etiological groups (p < 0.05), except for primary generalized type where intravenous route was more effective than the rectal one (p < 0.05). No significant side-effect was observed with rectal therapy. Among the 23 (19.17%) children in whom rectal therapy failed, 12 (10%) responded to intravenous diazepam while the remaining 11 (9.17%) cases were resistant to both routes of administration.

Administration, Rectal↗