Melatonin versus chloral hydrate as the sedating agent in performing electroencephalogram in paediatric patients

AbstractElectroencephalography (EEG) is a valuable tool in the diagnosis of epilepsy. The attainment of a high quality EEG requires patient's co-operation which is particularly difficult in children. Chloral hydrate has been used as a sedating agent in EEGs but it has potential serious adverse effects and anti-epileptic activity. Melatonin is used increasingly in different investigations as a safe alternative. Our study is to compare their effectiveness as sedating agents in performing EEGs and the detection rate of abnormal EEGs. This is a retrospective study performed in a regional hospital in Hong Kong. One hundred and ninety two EEG studies were included from December 2010 to July 2014. One hundred and two children were given chloral hydrate (50 mg/Kg) in the first half of the period and 90 children were given melatonin (3 mg for =< 5 years or 6 mg for >= 5 year) in the later half. The two groups are compared with Pearson's Chi-squared test with Yates’ continuity correction. The successful rate in sedation was similar between the two groups while the pick up rate of abnormal EEGs was 52.56% in the melatonin group and 21.57% in the chloral hydrate group (p < 0.05). Subgroup analysis among patients with epilepsy or mental retardation and intellectual disability shared same findings with higher detection rate of abnormal EEGs in the melatonin group. No side effect was documented in the study. Compare with chloral hydrate, melatonin is a safe and effective alternative and probably has less interference with the electrographic activity.

Download Full-text

The use of progesterone during pregnancy in women with epilepsy as an alternative to the correction of doses of anticonvulsants

GYNECOLOGY ◽

10.26442/20795696.2019.6.190708 ◽

2020 ◽

Vol 21 (6) ◽

pp. 12-15

Author(s):

Elena V. Tsallagova ◽

Vasily O. Generalov ◽

Timur R. Sadykov

Keyword(s):

Clinical Remission ◽

Epileptic Seizures ◽

Progesterone Concentration ◽

Teratogenic Effects ◽

Safe Alternative ◽

Patients With Epilepsy

Pregnancy is the most dangerous period in terms of interruption of even persistent and long-term remission. At the same time increasing the dose of anticonvulsant increases the risk of teratogenic effects. Aim. to assess the possibility of using progesterone to prevent relapse of epileptic seizures during pregnancy. Materials and methods. 38 pregnant patients with epilepsy with clinical remission before pregnancy, with relapse of epileptic seizures in I trimester of pregnancy, age 31.81.4 years. Dydrogesterone in a dose of 10 to 60 mg/day was prescribed after the relapse of remission. Anticonvulsant dosage was not changed. The blood progesterone concentration and EEG control was carried out. Results. During pregnancy, the level of progesterone in the blood gradually increased from 77.8 nmol/l at 78 weeks of pregnancy to 521.1 nmol/l at 3637 weeks of pregnancy, without exceeding the limits. EEG results did not deteriorate. None of the patients had seizures during pregnancy. Conclusion. Progesterone therapy is an adequate and safe alternative to increasing the dose of anticonvulsants in case of recurrent seizures during pregnancy.

Download Full-text

Everolimus in adult tuberous sclerosis complex patients with epilepsy: Too late for success? A retrospective study

Epilepsia ◽

10.1111/epi.16829 ◽

2021 ◽

Vol 62 (3) ◽

pp. 785-794

Author(s):

Jakob Stockinger ◽

Adam Strzelczyk ◽

Andrea Nemecek ◽

Michal Cicanic ◽

Frank Bösebeck ◽

...

Keyword(s):

Retrospective Study ◽

Tuberous Sclerosis ◽

Tuberous Sclerosis Complex ◽

Complex Patients ◽

Patients With Epilepsy

Download Full-text

A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

Ear Nose & Throat Journal ◽

10.1177/01455613211025744 ◽

2021 ◽

pp. 014556132110257

Author(s):

Dongho Shin ◽

Andrew Ma ◽

Yvonne Chan

Keyword(s):

Retrospective Study ◽

Teaching Hospital ◽

Intraoperative Complications ◽

Percutaneous Tracheostomy ◽

Hospital Setting ◽

Complication Rates ◽

Safe Alternative ◽

Neck Extension ◽

Intraoperative Complication ◽

Community Teaching

Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Conclusion: Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

Download Full-text

MRI-directed biopsy for primary detection of prostate cancer in a population of 223 men: MRI In-Bore vs MRI-transrectal ultrasound fusion-targeted techniques

British Journal of Radiology ◽

10.1259/bjr.20210528 ◽

2021 ◽

Author(s):

Maurizio Del Monte ◽

Stefano Cipollari ◽

Francesco Del Giudice ◽

Martina Pecoraro ◽

Marco Bicchetti ◽

...

Keyword(s):

Prostate Cancer ◽

Detection Rate ◽

Transrectal Ultrasound ◽

Focal Therapy ◽

Malignant Cells ◽

Median Percentage ◽

Detection Rates ◽

Biopsy Core ◽

Significant Difference ◽

Chi Squared

Objectives: To compare the detection rates of overall prostate cancer (PCa) and clinically significant PCa (csPCa) and the median percentage of cancer per biopsy core between MRI-guided In-bore and MRI-TRUS fusion-targeted biopsy (TBx). Methods: In this retrospective study, 223 patients who underwent prostate multiparametric MRI (mpMRI) and subsequent MR-directed biopsy were included. For PCa and csPCa detection rate (DR), contingency tables were tested via the Pearson’s chi-squared to explore the variance of the outcome distribution. The percentage of cancer per biopsy core was tested with a two-tailed Mann-Withney test. Results: One hundred and seventeen and 106 patients underwent MRI-TRUS fusion or MRI In-bore TBx, respectively. 402 MRI biopsy targets were identified, of which 206 (51.2%) were biopsied with the MRI-TRUS TBx and 196 (48.8%) with the MRI In-bore TBx technique. Per-patient PCa and csPCa detection rates were 140/223 (62.8%) and 97/223 (43.5%), respectively. PCa-DR was 73/117 (62.4%) and 67/106 (63.2%) for MRI-TRUS and MRI In-Bore TBx (p = 0.9), while csPCa detection rate reached 50/117 (42.7%) and 47/106 (44.3%), respectively (p = 0.81). The median per-patient percentage of malignant tissue within biopsy cores was 50% (IQR: 27–65%) for PCa and 60% (IQR: 35–68%) for csPCa, with a statistically significant difference between the techniques. Conclusion No statistically significant difference in the detection rate of MRI In-bore and MRI-TRUS fusion TBx was found. MRI In-bore TBx showed higher per-core percentage of malignant cells. Advances in knowledge MRI In-bore biopsy might impact risk stratification and patient management considering the higher per-core percentage of malignant cells, especially for patients eligible for active surveillance or focal therapy.

Download Full-text

Early outcome of orchiopexy and analysis of predictive factors: A retrospective study from 2001 to 2010 in a Norwegian regional hospital

Scandinavian Journal of Urology ◽

10.3109/21681805.2014.905631 ◽

2014 ◽

Vol 48 (5) ◽

pp. 474-481 ◽

Cited By ~ 4

Author(s):

Rasmus Nilsson ◽

Harald Omland ◽

Alv A. Dahl ◽

Truls E. Bjerklund Johansen

Keyword(s):

Retrospective Study ◽

Predictive Factors ◽

Regional Hospital ◽

Early Outcome

Download Full-text

How to Handle Lymphadenectomy Specimens to Identify Metastasis More Accurately in Gynecologic Pathology

International Journal of Surgical Pathology ◽

10.1177/1066896918802032 ◽

2018 ◽

Vol 27 (3) ◽

pp. 244-250

Author(s):

Gunsu Kimyon Comert ◽

Nazmiye Dincer ◽

Alp Usubutun

Keyword(s):

Retrospective Study ◽

Lymph Nodes ◽

Detection Rate ◽

Gynecologic Cancer ◽

Processing Technique ◽

Cancer Surgery ◽

Test Results ◽

Single Section

Aim. To identify the value of processing multiple sections to detect metastasis in lymph nodes (LNs) dissected during gynecologic cancer surgery, and to evaluate the sizes of metastatic LNs in each region to compare with the largest one. Materials and Methods. This retrospective study included 362 patients who had gynecologic cancer with at least one metastatic LN. Slides of 627 metastatic LN specimens were categorized according to the processing technique into single and more than one section (MOS) groups. In the MOS group, the LNs were cut into 2 or 3 parallel slices because their greatest dimensions exceeded 0.5 cm. Sizes of LN metastatic foci (MF) were measured and defined as follows: MF ⩽2 mm as micrometastasis and MF >2 mm as macrometastasis. The largest LN diameters among the metastatic LNs and the largest LNs in those regions were measured. Groups were compared using the Kruskal-Wallis test. Results. Sixty-five (10.3%) of the metastatic LNs included in this study had micrometastases and 40 (6.3%) of them had MF ⩽1 mm. The rate of micrometastasis was higher in the MOS group than in the single-section group (11.8% vs 8.5%, respectively). Twenty-eight percent (n = 175) of metastatic LNs were not the largest, and 55.5% of those were less than 1 cm in diameter. Conclusion. Methods of LN processing and macroscopic evaluation are not standardized, and processing single sections from LNs may overlook micrometastases. The detection rate of micrometastases can be improved by processing multiple sections from LNs.

Download Full-text

Application of the APE2-CHN and RITE2-CHN scores for autoimmune epilepsy in Chinese patients: a retrospective study

10.21203/rs.3.rs-18039/v1 ◽

2020 ◽

Author(s):

Wei-ping Liu ◽

Mian Wang ◽

Chen Zhang ◽

Charlie Weige Zhao ◽

Bo Xiao ◽

...

Keyword(s):

Retrospective Study ◽

Sensitivity And Specificity ◽

Chinese Patients ◽

Unknown Etiology ◽

Thyroid Peroxidase ◽

Seizure Outcome ◽

Receptor Antibody ◽

Autoimmune Epilepsy ◽

Patients With Epilepsy ◽

New Onset

Abstract Background : Autoimmune epilepsy is recognized as a distinct entity of epilepsy with underestimated incidence. Our previous study reported that prompt diagnosis and early-initiated immunotherapy led to better outcome. We proposed to assess the feasibility and reasonability of the Antibody Prevalence in Chinese Patients with Epilepsy and Encephalopathy (APE 2 -CHN) and Response to Immunotherapy in Chinese Patients with Epilepsy and Encephalopathy (RITE 2 -CHN) scores in predicting Chinese patients with autoimmune epilepsy. Methods : We conducted a retrospective study of consecutive patients from Xiangya Hospital, Central South University (01/01/2017-02/28/2019) whose serum and/or cerebrospinal fluid (CSF) samples were examined for autoimmune encephalitis antibodies. Of these, patients with new-onset epilepsy or established epilepsy of unknown etiology were selected in our study. An APE 2 -CHN score was assigned to each patient and a RITE 2 -CHN score was calculated for each patient who received immunotherapy. Results : 191 patients meeting the diagnostic criteria for epilepsy were enrolled in our study. 36 were subsequently identified with specific etiologies. The rest of the 155 patients had an unknown etiology. Central nervous system-specific antibodies were detected in 76 (49.0%) of them, after excluding solely thyroid peroxidase antibody or glutamic acid decarboxylase antibody. N-methyl-D-aspartate receptor antibody (48.7%, 37/76) was the most common antibody specificity, followed by γ-aminobutyric acid type B receptor antibody (14.5%, 11/76). Certain clinical features such as new-onset epilepsy, autonomic dysfunction, viral prodrome, facio-brachial dystonic seizures/oral dyskinesia, inflammatory CSF profile, and mesial temporal magnetic resonance imaging abnormalities correlated with positive antibody results. Sensitivity and specificity of an APE 2 -CHN score ≥ 5 to predict the presence of specific neural auto-antibodies in our study were 85.5% and 58.9%, respectively. In the subset of patients who received immunotherapy (n = 112), sensitivity and specificity of a RITE 2 -CHN score ≥ 8 to predict favorable seizure outcome were 98.6% and 63.2% respectively. Conclusion : The APE 2 -CHN and RITE 2 -CHN scores were preferable tools in predicting positive serologic findings and prognosis of autoimmune epilepsy in Chinese patients with epilepsy.

Download Full-text

097 Associations between cognitive and memory problems, employment and quality of life: a survey of epilepsy patients in australia

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.85 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A31.2-A32

Author(s):

Jeremy M Welton ◽

Christine Walker ◽

Kate Riney ◽

Alvin Ng ◽

Lisa M Todd ◽

...

Keyword(s):

Quality Of Life ◽

Employment Status ◽

List Type ◽

Cross Sectional ◽

Memory Problems ◽

Online Pharmacy ◽

Chi Squared ◽

Level Of Concern ◽

Patients With Epilepsy

IntroductionThis analysis explored relationships between memory/cognitive issues, quality of life (QoL), and employment among patients with epilepsy (PwE) in Australia.MethodsCross-sectional surveys were completed by PwE, or caregiver proxies, recruited via the online pharmacy application MedAdvisor and Australian PwE Facebook groups from May–August 2018. Data were collected on adverse events from antiepileptic drugs (AEDs), comorbidities, epilepsy severity and management, QoL (using QOLIE-10-P total score)1 and demographics. Descriptive statistics were stratified by employment status: employed; not looking for work (NLW); looking for work (LW); or unable to work (UW), and differences in means or distributions were analysed using chi-squared, Mann-Whitney U or Kruskal-Wallis H tests. Regression models were constructed to explore associations between memory/cognition-related variables and QOLIE-10-P within each employment group.Results950 eligible responses reporting current AED use were included (71% via MedAdvisor, 29% via Facebook; 55% seizure-free for >1 year). Mean QOLIE-10-P score was significantly different across employment groups (p<0.001): 49.61 in employed PwE (n=493), 48.87 in NLW (n=227), 32.75 in LW (n=52), and 25.97 in UW (n=178). After controlling for possible confounders, presence of memory problems from AEDs was associated with a -7.50 decrease in QOLIE-10-P only among employed PwE (p=0.002). The extent that PwE felt bothered by memory difficulties, however, was significantly associated with QOLIE-10-P in all employment groups; generally, as level of concern about memory difficulties increased, estimated QOLIE-10-P decreased.ConclusionsSelf-reported memory problems are prevalent among PwE in Australia and may impact QoL differentially depending on employment status. UCB Pharma-sponsored.ReferencesCramer JA, Perrine K, Devinsky O, Meador K. A brief questionnaire to screen for quality of life in epilepsy: The QOLIE-10. Epilepsia 1996;37:577–582.

Download Full-text