scholarly journals Pharmacoresistant Atypical Benign Partial Epilepsy of Childhood: Early Introduction of Specific Therapies to Prevent Cognitive Decline

2019 ◽  
Vol 09 (01) ◽  
pp. 007-012
Author(s):  
Aiko Nishikawa ◽  
Yui Otani ◽  
Susumu Ito ◽  
Satoru Nagata ◽  
Hirokazu Oguni
Keyword(s):  
Focal Epilepsy ◽  
Treatment Options ◽  
Case Series ◽  
Epileptic Encephalopathy ◽  
Partial Epilepsy ◽  
Oral Steroid ◽  
Early Introduction ◽  
Excellent Response ◽  
Acth Therapy ◽  
Atypical Absence

AbstractAtypical benign partial epilepsy (ABPE) of childhood is a special type of epileptic syndrome characterized by the combination of epileptic negative myoclonus, atypical absence seizures, focal motor seizures, and a continuous spike–wave during slow sleep (CSWS). Although the seizures are resistant to antiseizure drugs (ASDs) effective for focal epilepsy, they are markedly responsive to ethosuximide (ESM). An incorrect ASD choice may aggravate the seizures and CSWS, resulting in a pseudo-catastrophic state or nonconvulsive status epilepticus. In this study, we retrospectively investigated the effectiveness of steroid and ketogenic diet (KD) therapies for children with ABPE resistant to ASDs, including ESM. Adrenocorticotropic hormone (ACTH) therapy (n = 4), KD therapy (n = 4), and an oral steroid (n = 2) were tried for eight patients (two patients tried two therapies). An excellent response (seizure-free period > 1 year) was achieved by four out of four patients undergoing ACTH therapy, two out of four undergoing KD therapy, and one out of two receiving oral steroid therapy. In conclusion, steroid and KD therapies are reasonable treatment options early in the course of treatment of children with pharmacoresistant ABPE to prevent a decline in cognitive function due to the persistence of epileptic encephalopathy. The majority of patients in our case series had an excellent response, though further studies are warranted to confirm their efficacy and safety.

In-block lateralization as a new technique for mobilization of the inferior alveolar nerve: a technique case series

2020 ◽  
Author(s):  
Marcos Augusto Tomazi ◽  
Alexandre da Silveira Gerzson ◽  
Angelo Menuci Neto ◽  
André Luciano Pasinato da Costa
Keyword(s):  
Treatment Options ◽  
Inferior Alveolar Nerve ◽  
Case Series ◽  
New Technique ◽  
Autogenous Bone ◽  
Minimal Risk ◽  
Short Implants ◽  
Bone Atrophy ◽  
A New Technique ◽  
Number Of Treatment

The edentulous atrophic posterior mandible is often a great challenge for implant rehabilitation. Although a number of treatment options have been proposed, including the use of short implants and surgical grafting techniques, in cases of severe bone atrophy, techniques for mobilization of the inferior alveolar nerve (IAN) have been shown to be efficient, with good results. Four female patients underwent IAN lateralization for prosthetic rehabilitation of the posterior mandible from 2013 to 2019, with 1 year to 5 years and 4 months of follow-up. This case series describes a new technique for mobilization of the IAN, named in-block lateralization, to facilitate access to the IAN and to reduce nerve manipulation. The implant is immediately installed (allowing nerve lateralization in unitary spaces) and the original mandibular anatomy is restored with autogenous bone from the original bed during the same surgical procedure. When well indicated and well performed, this new approach provides better and easier visualization of the IAN as well as safer manipulation aiming to achieve good results for implant stability and minimal risk of neurosensory disturbances, allowing rehabilitation even in unitary spaces.

scholarly journals Association of early-onset epileptic encephalopathy with involuntary movements – Case series and literature review

2020 ◽  
pp. 100417
Author(s):  
Atsuko Arisaka ◽  
Mitsuko Nakashima ◽  
Satoko Kumada ◽  
Kenji Inoue ◽  
Hiroya Nishida ◽  
...  
Keyword(s):  
Literature Review ◽  
Early Onset ◽  
Case Series ◽  
Epileptic Encephalopathy ◽  
Involuntary Movements

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

2019 ◽  
Vol 41 (2) ◽  
pp. 187-192
Author(s):  
Ricardo E. Colberg ◽  
Monte Ketchum ◽  
Avani Javer ◽  
Monika Drogosz ◽  
Melissa Gomez ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Plantar Fasciitis ◽  
Case Series ◽  
Successful Outcome ◽  
Oral Steroid ◽  
Tarsal Tunnel ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Sclerosing Mesenteritis: Diverse clinical presentations and dissimilar treatment options. A case series and review of the literature

2011 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Konstantinos Vlachos ◽  
Fotis Archontovasilis ◽  
Evangelos Falidas ◽  
Stavros Mathioulakis ◽  
Stefanos Konstandoudakis ◽  
...  
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Sclerosing Mesenteritis ◽  
Review Of The Literature ◽  
Clinical Presentations

Midcarpal instability

2015 ◽  
Vol 41 (1) ◽  
pp. 86-93 ◽  
Author(s):  
D. G. Hargreaves
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Case Series ◽  
Definite Diagnosis ◽  
Stress Tests ◽  
Functional Instability ◽  
Painful Wrist ◽  
Relative Rarity ◽  
Passive Stress

Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

scholarly journals A Brief Review of Severe Asthma

2021 ◽  
Vol 6 (2) ◽  
pp. 4-12
Author(s):  
Muhammad Amin Ibrahim ◽  
Ahmad Izuanuddin Ismail ◽  
Mohammed Fauzi Abdul Rani
Keyword(s):  
Severe Asthma ◽  
Treatment Options ◽  
Oral Steroid ◽  
Inhaler Technique ◽  
Inhaled Corticosteroid ◽  
Asthma Care ◽  
Asthmatic Patients ◽  
Appropriate Treatment ◽  
Considerable Morbidity ◽  
The Cost

Severe asthma describes an asthma condition that requires a substantial amount of inhaled corticosteroid and bronchodilators to keep it under control including the frequent additional need for oral steroid to avoid exacerbations. The incidence of severe asthma in Malaysia is unknown but data elsewhere shows that it is around 5 to 10 % of asthmatics. This category of asthmatic patients has considerable morbidity, is disproportionate cost-wise to the number of sufferers and requires specialised and focused care. The management of severe asthma should be undertaken at a severe asthma clinic led by a physician with a special interest in its management. The diagnosis needs confirmation, comorbidities identified and triggering factors addressed. Inhaler technique and compliance are major contributing issues and must be addressed at all consultation opportunities. Once the diagnosis of severe asthma is confirmed, the disease needs phenotyping to plan for the most appropriate treatment, termed as a personalised approach to severe asthma care. The advances in biologics have changed the landscape of treatment of this disease but in Malaysia especially, there are many limitations namely the cost. This article briefly explores the current understanding of severe asthma, the assessment including phenotyping and possible treatment options.

scholarly journals Use of valproate and carbamazepine in the therapy of epilepsy (guidelines for the practitioner)

2018 ◽  
Vol 10 (4) ◽  
pp. 129-138 ◽  
Author(s):  
P. N. Vlasov
Keyword(s):  
Metabolic Diseases ◽  
Chromosomal Abnormalities ◽  
Focal Epilepsy ◽  
Retention Rate ◽  
Clinical Situation ◽  
Epileptic Encephalopathy ◽  
Childbearing Age ◽  
Good Tolerability ◽  
First Choice ◽  
Different Types

The paper gives comparative data on the efficacy and tolerability of valproic acid (VA, valproate) and carbamazepine (CBZ) for different types of epilepsy and seizures in different age and clinical groups. The results of studies suggest that despite a more than 50-year history of their effective use, the extended-release formulations of VA and CBZ remain the drugs of first choice for many types of epilepsy.CBZ is effective for focal epilepsy and isolated generalized tonic-clonic seizures. However, its use is substantially limited by properties, such as cytochrome P450 induction and autoinduction, high drug-drug interactions, the aggravation of absences, negative myoclonus, myoclonic and atonic seizures, an effect on the profile of steroid sex hormones, elevated concentrations of atherogenic lipids and cholesterol, myocardial conduction disorders, and hyponatremia.Due to the multiple mechanism of action, VA is prescribed for almost all types of epilepsy and seizures in patients of different ages. VA should not be used (if the clinical situation allows) in women of childbearing age, in some infantile epileptic encephalopathy, inherited metabolic diseases, and chromosomal abnormalities. Effectiveness against different types of seizures and epilepsy, good tolerability, minimal aggravation risk, high retention rate of monotherapy, the presence of a variety of dosage forms, and favorable pharmacokinetic and pharmacodynamic profiles still make VA essential in many clinical situations.

scholarly journals PAROTID SWELLING IN CHILDREN

2009 ◽  
Vol 16 (01) ◽  
pp. 38-43
Author(s):  
ABID HAMEED SHEIKH ◽  
EHSAN UL HAQ ◽  
MUHAMMAD ZULFIQAR ANJUM ◽  
Gulzar Ahmad
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Cystic Hygroma ◽  
Vascular Lesions ◽  
Paediatric Surgery ◽  
Malignant Tumours ◽  
Parotid Region ◽  
Case Series Study ◽  
Parotid Swelling ◽  
Benign Tumours

Objective: To describe the clinical and pathological presentation as well as treatment options of parotid swelling inchildren. D e s i g n : Descriptive case series study. S e t t i n g : Department of Paediatric Surgery Bahawal Victoria Hospital Bahawalpur. Period:From Nov2005 to Jul2007. Material a n d m e t h o d : All patients of either sex below the age of 13 years presenting with parotid swelling wereincluded in the study. Clinical presentations, preoperative investigations, operative procedures, histopathology reports, postoperativecomplications and further management (radiotherapy &chemotherapy) were recorded. Results: Twelve patients presented with parotidswelling. Commonest presentation was a lump over the parotid region (100%) & pain (25%). Majority of tumours were benign (50%).Vascular lesions outnumbered solid tumours. 4 patients (33.33%) had haemangioma 1 patient (8.33%) had cystic hygroma, one patienteach of pleomorphic adenoma, mucoepidermoid carcinoma and Adenocarcinoma. C o n c l u s i o n : Salivary gland lesions are most likelyinflammatory in origin. Vascular tumours are common benign tumours than epithelial tumours in children. Superficial parotidectomy is theoperation for benign tumours and total conservative parotidectomy for malignant tumours.

scholarly journals Human umbilical cord-derived mesenchymal stem cells treatment for refractory uveitis: a case series

2021 ◽  
Vol 14 (11) ◽  
pp. 1784-1790
Author(s):  
Jing Yang ◽  
◽  
Xi-Teng Chen ◽  
Yuan-Feng Jiang ◽  
Zhi-Bo Han ◽  
...  
Keyword(s):  
Stem Cells ◽  
Visual Acuity ◽  
Mesenchymal Stem Cells ◽  
Umbilical Cord ◽  
Immunosuppressive Agents ◽  
Case Series ◽  
Oral Steroid ◽  
Human Umbilical Cord ◽  
Therapeutic Outcomes ◽  
Snellen Chart

AIM: To evaluate therapeutic outcomes of human umbilical cord-derived mesenchymal stem cells (HUC-MSCs) treatment in patients with refractory uveitis. METHODS: A retrospective and noncomparative review was performed on four patients with refractory uveitis from December 2013 to December 2017. HUC-MSCs were administered intravenously at a dose of 1×106 cells/kg. Clinical response, relapse rate, change of visual acuity, and other metrics were evaluated. RESULTS: All four patients presented with responses to HUC-MSCs treatment, with three males and one female. The numbers of uveitis attacks per year after the HUC-MSCs treatment (0, 2, 0, 0 respectively) all decreased compared with the numbers before the treatment (3, 6, 4, 4 respectively). The oral steroid and immunosuppressive agents were tapered in all patients without recrudescence of ocular inflammation, and three patients discontinued their oral medicine at the last visit. The best corrected visual acuity (BCVA) of 3 patients was improved to varying degrees, and the BCVA of 1 patient remained at 20/20 (Snellen chart) from the first to the last consultation. CONCLUSION: The study provides an effective therapy of HUC-MSCs in maintaining remission in patients affected by uveitis refractory to previous immunosuppressant treatments.

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