Epilepsy—Work-Up and Management in Children

2020 ◽  
Vol 40 (06) ◽  
pp. 638-646
Author(s):  
Jeffrey R. Tenney
Keyword(s):  
Treatment Guidelines ◽  
Treatment Decisions ◽  
Pediatric Epilepsy ◽  
Prognostic Information ◽  
Specific Diagnosis ◽  
Age Related ◽  
Epilepsy Diagnosis ◽  
Variable Condition ◽  
Work Up ◽  
Diagnosis Classification

AbstractPediatric epilepsy is a highly variable condition due to age-related expression of syndromes that require specific diagnosis, evaluations, and treatments. Children with epilepsy differ from their adult counterparts in many important ways, mostly related to the age-related expression of specific epilepsy syndromes. This results in many important considerations related to the epilepsy diagnosis, classification, evaluations to determine an etiology, as well as treatment guidelines. A good understanding of these factors will help to establish an accurate epilepsy diagnosis, which in turn will guide appropriate testing and treatment decisions. In this way, patients will have improved seizure outcomes, and families will be educated appropriately and provided with the most accurate prognostic information available. The purpose of this article is to review the diagnosis, work-up, and management of pediatric epilepsy.

scholarly journals The Applications of Artificial Intelligence in Chest Imaging of COVID-19 Patients: A Literature Review

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1317
Author(s):  
Maria Elena Laino ◽  
Angela Ammirabile ◽  
Alessandro Posa ◽  
Pierandrea Cancian ◽  
Sherif Shalaby ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Literature Review ◽  
Diagnostic Imaging ◽  
Clinical Work ◽  
Rapid Expansion ◽  
Chest Imaging ◽  
Imaging Data ◽  
Prognostic Information ◽  
Quantitative Ct ◽  
Work Up

Diagnostic imaging is regarded as fundamental in the clinical work-up of patients with a suspected or confirmed COVID-19 infection. Recent progress has been made in diagnostic imaging with the integration of artificial intelligence (AI) and machine learning (ML) algorisms leading to an increase in the accuracy of exam interpretation and to the extraction of prognostic information useful in the decision-making process. Considering the ever expanding imaging data generated amid this pandemic, COVID-19 has catalyzed the rapid expansion in the application of AI to combat disease. In this context, many recent studies have explored the role of AI in each of the presumed applications for COVID-19 infection chest imaging, suggesting that implementing AI applications for chest imaging can be a great asset for fast and precise disease screening, identification and characterization. However, various biases should be overcome in the development of further ML-based algorithms to give them sufficient robustness and reproducibility for their integration into clinical practice. As a result, in this literature review, we will focus on the application of AI in chest imaging, in particular, deep learning, radiomics and advanced imaging as quantitative CT.

scholarly journals Age-related aspects of differential diagnosis of acute cough in children and adults

2018 ◽  
Vol 28 (4) ◽  
pp. 461-468
Author(s):  
I. V. Leshchenko ◽  
S. A. Tsar’kova ◽  
A. D. Zherebtsov
Keyword(s):  
Differential Diagnosis ◽  
Anatomical Location ◽  
Pathological Changes ◽  
Review Of Literature ◽  
Acute Cough ◽  
Age Related ◽  
Common Causes ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Cough is one of the most common causes of seeking the primary medical care, especially during the autumn and the spring. This article is a review of literature  aimed at differential diagnosis of possible causes of acute cough in children and  adults. Given a vast majority of diseases associated with cough, differential diagnosis  have to consider several issues. The key issue is cough duration and possible  anatomical location of the pathological changes. An algorithm of differential diagnosis  of acute cough in children and adults and description of most common diseases  associated with acute cough are given in the review. Further diagnostic work-up  should be driven by the duration of cough as soon as the acute cough could be first  manifestation of a chronic disease.

scholarly journals ORCA study: real-world versus reading centre assessment of disease activity of neovascular age-related macular degeneration (nAMD)

2020 ◽  
pp. bjophthalmol-2019-315717 ◽  
Author(s):  
Sandra Liakopoulos ◽  
Georg Spital ◽  
Christian K Brinkmann ◽  
Tina Schick ◽  
Focke Ziemssen ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Image Interpretation ◽  
Subretinal Fluid ◽  
Treatment Decisions ◽  
Age Related Macular Degeneration ◽  
Correct Identification ◽  
Age Related ◽  
Ocean Study ◽  
The Impact ◽  
Sd Oct

Background/aimsThe prospective, non-interventional ORCA module of the OCEAN study (Observation of Treatment Patterns with Lucentis in Approved Indications) evaluated the qualiy of spectral domain-optical coherence tomography (SD-OCT) image interpretation and treatment decisions by clinicians in Germany and the impact on visual outcomes over 24 months in patients with neovascular age-related macular degeneration (nAMD).Methods2286 SD-OCT scans of 205 eyes were independently evaluated by clinicians and reading centres (RCs) regarding signs of choroidal neovascularisation (CNV) activity, including presence of intraretinal fluid, subretinal fluid, and/or increase in pigment epithelial detachments. Agreement between clinicians and RCs was calculated. Treatment decisions by clinicians and the impact on treatment outcomes were evaluated.ResultsCNV activity was detected by RCs on 1578 scans (69.0%) and by clinicians on 1392 scans (60.9%), with agreement in 74.9% of cases. Of the 1578 scans with RC detected CNV activity, anti-vascular endothelial growth factor injections were performed by clinicians in only 35.5% (560/1578). In 19.7% of cases (311/1578), lack of treatment was justified by patients request, termination criteria or chronic cystoid spaces without other signs for CNV activity. In 44.8% of cases (707/1578) with RC detected CNV activity, clinicians claimed no treatment was necessary despite having correctly detected CNV activity in about 2/3 of these cases. In 34% of cases with presumed undertreatment, visual acuity declined in the following visit.ConclusionAlthough broad agreement on CNV activity parameters was observed between clinicians and RCs, correct identification of CNV activity did not always lead to the initiation of (re-)treatment. To preserve vision over time, correct interpretation of SD-OCT scans and careful retreatment decisions are required.Trial registration numberNCT02194803.

Use of Lamotrigine in Lennox-Gastaut and Related Epilepsy Syndromes

1997 ◽  
Vol 12 (1_suppl) ◽  
pp. S23-S28 ◽  
Author(s):  
Olivier Dulac ◽  
Anna Kaminska
Keyword(s):  
Drug Therapy ◽  
Pediatric Epilepsy ◽  
Mental Deterioration ◽  
Clinical Observations ◽  
Generalized Seizures ◽  
Antiepileptic Medication ◽  
Generalized Epilepsy ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Lennox-Gastaut syndrome, a combination of various generalized seizures including atypical absences and tonic seizures with generalized slow spike waves and mental deterioration, is often difficult to distinguish from a subgroup of myoclonic-astatic epilepsy, other generalized epilepsy syndromes, and various symptomatic generalized epilepsies. Conventional antiepileptic medication is poorly effective in this condition, particularly because various types of seizures respond differently to each given drug. Lamotrigine is effective in the various types of generalized seizures and efficacy has been demonstrated in Lennox-Gastaut syndrome. Given the potential of major mental deterioration within a matter of months in this condition, and the need of slow dose escalation in order to prevent skin rash, lamotrigine should be administered as soon as the diagnosis of Lennox-Gastaut syndrome is suspected. In addition, there is growing evidence that lamotrigine is also most useful in the subgroup of myoclonic-astatic epilepsy beginning in childhood, and that these patients should benefit from the drug like those affected by Lennox-Gastaut syndrome, as soon as the diagnosis is suspected. However, this drug may worsen other cases of myoclonic-astatic epilepsy beginning in infancy. These clinical observations add to the evidence for the need of clear diagnostic work-up before appropriate drug therapy is decided in pediatric epilepsy. (J Child Neurol 1997;12(Suppl 1):S23-S28).

Upper reference limits for cerebrospinal fluid total protein and albumin quotient based on a large cohort of control patients: implications for increased clinical specificity

2016 ◽  
Vol 54 (2) ◽  
Author(s):  
Harald Hegen ◽  
Michael Auer ◽  
Achim Zeileis ◽  
Florian Deisenhammer
Keyword(s):  
Cerebrospinal Fluid ◽  
Total Protein ◽  
Neurological Disease ◽  
Large Cohort ◽  
Barrier Dysfunction ◽  
Serum Samples ◽  
Age Related ◽  
Reference Limits ◽  
Future Revision ◽  
Work Up

AbstractDetermination of cerebrospinal fluid (CSF) total protein (TP) as well as of CSF/serum albumin quotient (Qalb) is part of the routine CSF work-up. However, currently used upper reference limits (URL) are not well validated leading to over-reporting of blood-CSF barrier dysfunction in approximately 15% of patients without neurological disease. The objective of this study was to determine age-related URL for CSF TP and Qalb in a cohort of control patients.A total of 332 paired CSF and serum samples of patients without objective clinical and paraclinical findings of a neurological disease were analyzed for CSF TP and Qalb. CSF TP was measured by spectrophotometry and albumin in CSF and serum by nephelometry.CSF TP concentration and Qalb significantly correlated with age. In subjects at the age of 18–70 years, median CSF TP ranged from 320 to 460 mg/L and URL defined as the 95th percentile were 530–690 mg/L. Median Qalb ranged from 4.1 to 6.1 and URL from 8.7 up to 11.0. For URL of Qalb we calculated the following formula: age/25+8.Age-dependent URL for CSF TP and Qalb are presented here in a large cohort of control patients. They are higher than those currently recommended and this probably explains why isolated blood-CSF barrier dysfunction has been apparently over-reported. These new URL might be considered in a future revision of CSF guidelines.

scholarly journals Juvenile myoclonic epilepsy: Under-diagnosed syndrome

2011 ◽  
Vol 64 (7-8) ◽  
pp. 381-385
Author(s):  
Ksenija Bozic ◽  
Ksenija Gebauer-Bukurov ◽  
Petar Slankamenac ◽  
Marija Knezevic-Pogancev ◽  
Slobodan Sekulic
Keyword(s):  
Clinical Manifestations ◽  
Juvenile Myoclonic Epilepsy ◽  
Good Prognosis ◽  
Clinical Syndrome ◽  
Myoclonic Epilepsy ◽  
Clinical Criteria ◽  
Age Related ◽  
Increased Risk ◽  
Epilepsy Diagnosis ◽  
Atypical Presentations

Introduction. Juvenile myoclonic epilepsy is an idiopathic, hereditary form of epilepsy. Although juvenile myoclonic epilepsy is a well defined clinical syndrome, attempts at diagnosing it commonly fail. Etiopathogenesis. The exact cause of juvenile myoclonic epilepsy remains unknown. Clinical, morphological and metabolic data suggest a preferential role for frontal regions in this syndrome. Several major genes for juvenile myoclonic epilepsy have been identified, but these genes account for only a small proportions of juvenile myoclonic epilepsy cases, suggesting multifactorial or complex inheritance in most. Clinical Manifestations. Juvenile myoclonic epilepsy is characterized by the triad of myoclonic jerks on awakening (all patients), generalized tonic-clonic seizures (>90% of patients) and typical absences (about one third of patients). Seizures have an age-related onset, circadian distribution and are frequently precipitated by sleep deprivation, fatigue and alcohol intake. Intelligence is normal. Diagnosis. Juvenile myoclonic epilepsy diagnosis is based upon clinical criteria and typical electroencephalographic findings (generalized pattern of spikes and/or polyspikes and waves). All other tests are normal. Treatment and Prognosis. Both medical treatment and counselling are important in the management of juvenile myoclonic epilepsy. Mono-therapy with valproate is the preferred treatment. Some of the newer antiepileptic drugs have been suggested as possible alternatives. Juvenile myoclonic epilepsy has a good prognosis. Lifelong treatment is usually considered necessary in vast majority of patients due to the increased risk of relapse if treatment is discontinued. Conclusion. Juvenile myoclonic epilepsy is a common, although under-diagnosed epileptic syndrome. The clinician should study the occurrence of myoclonic jerks and should consider atypical presentations.

scholarly journals HIV as a Cause of Immune Activation and Immunosenescence

2017 ◽  
Vol 2017 ◽  
pp. 1-16 ◽  
Author(s):  
T. Sokoya ◽  
H. C. Steel ◽  
M. Nieuwoudt ◽  
T. M. Rossouw
Keyword(s):  
Immune Activation ◽  
Large Scale ◽  
Antiretroviral Treatment ◽  
Treatment Guidelines ◽  
Hiv Treatment ◽  
Therapeutic Interventions ◽  
Adjunctive Treatment ◽  
Systemic Immune Activation ◽  
Proinflammatory Mediators ◽  
Age Related

Systemic immune activation has emerged as an essential component of the immunopathogenesis of HIV. It not only leads to faster disease progression, but also to accelerated decline of overall immune competence. HIV-associated immune activation is characterized by an increase in proinflammatory mediators, dysfunctional T regulatory cells, and a pattern of T-cell-senescent phenotypes similar to those seen in the elderly. These changes predispose HIV-infected persons to comorbid conditions that have been linked to immunosenescence and inflamm-ageing, such as atherosclerosis and cardiovascular disease, neurodegeneration, and cancer. In the antiretroviral treatment era, development of such non-AIDS-defining, age-related comorbidities is a major cause of morbidity and mortality. Treatment strategies aimed at curtailing persistent immune activation and inflammation may help prevent the development of these conditions. At present, the most effective strategy appears to be early antiretroviral treatment initiation. No other treatment interventions have been found effective in large-scale clinical trials, and no adjunctive treatment is currently recommended in international HIV treatment guidelines. This article reviews the role of systemic immune activation in the immunopathogenesis of HIV infection, its causes and the clinical implications linked to immunosenescence in adults, and the therapeutic interventions that have been investigated.

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