Unusual side effects of levetiracetam

2021 ◽  
Vol 14 (4) ◽  
pp. e242496
Author(s):  
Samih Badarny ◽  
yazid Badarny ◽  
Fatima Mihilia
Keyword(s):  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
Side Effects ◽  
Normal Pressure Hydrocephalus ◽  
Clinical Condition ◽  
Marked Improvement ◽  
Normal Pressure ◽  
Cognitive Status ◽  
Walking Balance ◽  
Cognition Impairment

We present a 75-year-old man who was admitted to our hospital due to 4 months of general deterioration, gait disturbance and cognition impairment which appeared very close to the start of levetiracetam (LEV) as a new antiepileptic drug. Brain CT shows central and less peripheral atrophy of brain, and diagnosis of normal pressure hydrocephalus was raised; however, removal of 30 cc of cerebrospinal fluid (CSF) by lumbar puncture in order to amend walking did not lead to gait improvement. After excluding metabolic, vascular, infection, inflammatory and other reasons explaining his status. Thinking that may be any correlation between LEV added in the last months and his clinical condition, we stopped LEV. Several days after that, there is marked improvement in his general sensation, alertness and cognitive status and there is marked improvement in walking balance to the point of being able to walk without the use of walker or cane or help from other person. Certain cognitive impairment and gait difficulties are not known as side effects of LEV treatment.

scholarly journals Idiopathic normal pressure hydrocephalus. Retrospective review of pathogenesis and modern theories

2020 ◽  
pp. 146-155
Author(s):  
Г.В. Гаврилов ◽  
А.В. Станишевский ◽  
Б.В. Гайдар ◽  
Д.В. Свистов
Keyword(s):  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
Normal Pressure Hydrocephalus ◽  
Retrospective Review ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Ventricular Enlargement ◽  
Csf Pressure ◽  
Morphological Studies ◽  
Disease Mechanisms

Идиопатическая нормотензивная гидроцефалия - хроническое прогрессирующее дегенеративное заболевание головного мозга, характеризующееся изменением конфигурации боковых желудочков и других ликворсодержащих пространств головного мозга на фоне нормального давления ликвора, проявляющееся клинически триадой симптомов: нарушением походки, развитием деменции и нарушением мочеиспускания. Патофизиология и патоморфогенез этого заболевания до конца не ясны. С появлением термина и описания клинической картины нормотензивной гидроцефалии в 1964 г. S. Hakim выполнено множество экспериментальных, морфологических и клинических исследований, направленных на выяснение ключевых звеньев патогенеза заболевания. В представленной работе приведена ретроспектива взглядов на закономерности патогенеза идиопатической нормотензивной гидроцефалии, анализируются современные исследования, посвящённые данной проблеме, а также обобщены и сформулированы основные теории, касающиеся ключевых звеньев патологического процесса. Idiopathic normal pressure hydrocephalus is a chronic, progressive degenerative brain disease characterized by ventricular enlargement disproportionate to other cerebrospinal fluid (CSF) spaces with normal CSF pressure. This disease presents with gait disturbance, cognitive impairment, and incontinence. The pathophysiology and morphogenesis of this condition are not well studied. Since the first description by S. Hakim in 1964, a number of experimental and morphological studies have focused on investigation of the disease mechanisms. This review retrospectively analyzed and summarized principal ideas about the pathogenesis of idiopathic normal pressure hydrocephalus.

scholarly journals Normal-Pressure Hydrocephalus: Is There a Genetic Predisposition?

2011 ◽  
Vol 38 (2) ◽  
pp. 274-281 ◽  
Author(s):  
M. D. Cusimano ◽  
D. Rewilak ◽  
D. T. Stuss ◽  
J. C. Barrera-Martinez ◽  
F. Salehi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Urinary Incontinence ◽  
Cognitive Impairment ◽  
Environmental Factors ◽  
Natural History ◽  
Normal Pressure Hydrocephalus ◽  
Genetic Predisposition ◽  
Fluid Pressure ◽  
Cerebral Atrophy ◽  
Normal Pressure

Background:Normal-pressure hydrocephalus (NPH) is characterized by gait disturbance, cognitive impairment, with or without urinary incontinence, enlarged ventricles with or without cerebral atrophy and normal cerebrospinal fluid pressure.Methods:We report two sisters with NPH who lived together their entire lives and whose natural history might provide insights into genetic and environmental mechanisms underlying this disorder. Both patients were in their early seventies, single, had similar daily habits and hypertension. No other family members had NPH.Results:They both underwent shunt placement and showed improvement documented by history and neuropsychological assessment. Both showed a delayed deterioration due to vasculopathy. Both patients were homozygous for the apolipoprotein E (ApoE) e3 allele on chromosome 19. No environmental factors that might have influenced the development of NPH were identified.Conclusion:Our report of two sisters with NPH may indicate the presence of genetic predisposition and further studies involving genetics and environmental factors are necessary to elucidate their role in the pathogenesis of NPH.

Alzheimer’s Disease Biomarkers in Idiopathic Normal Pressure Hydrocephalus: Linking Functional Connectivity and Clinical Outcome

2021 ◽  
Vol 83 (4) ◽  
pp. 1717-1728 ◽  
Author(s):  
Giulia Bommarito ◽  
Dimitri Van De Ville ◽  
Giovanni B. Frisoni ◽  
Valentina Garibotto ◽  
Federica Ribaldi ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cerebrospinal Fluid ◽  
Functional Connectivity ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Cognitive Status ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Response To Treatment ◽  
Timed Up And Go

Background: Alzheimer’s disease (AD) pathology impacts the response to treatment in patients with idiopathic normal pressure hydrocephalus (iNPH), possibly through changes in resting-state functional connectivity (rs-FC). Objective: To explore the relationship between cerebrospinal fluid biomarkers of AD and the default mode network (DMN)/hippocampal rs-FC in iNPH patients, based on their outcome after cerebrospinal fluid tap test (CSFTT), and in patients with AD. Methods: Twenty-six iNPH patients (mean age: 79.9±5.9 years; 12 females) underwent MRI and clinical assessment before and after CSFTT and were classified as responders (Resp) or not (NResp), based on the improvement at the timed up and go test and walking speed. Eleven AD patients (mean age: 70.91±5.2 years; 5 females), matched to iNPH for cognitive status, were also included. DMN and hippocampal rs-FC was related to amyloid-β42 and phosphorylated tau (pTau) levels. Results: Lower amyloid-β42 levels were associated with reduced inter- and intra-network rs-FC in NResp, and the interaction between amyloid-β42 and rs-FC was a predictor of outcome after CSFTT. The rs-FC between DMN and salience networks positively correlated to amyloid-β42 levels in both NResp and AD patients. The increase in the inter-network rs-FC after CSFTT was associated with higher pTau and lower amyloid-β42 levels in NResp, and to lower pTau levels in Resp. Conclusion: Amyloid-β42 and pTau impact on rs-FC and its changes after CSFTT in iNPH patients. The interaction between AD biomarkers and rs-FC might explain the responder status in iNPH.

Idiopathic normal pressure hydrocephalus and Alzheimer's disease in clinical practice: comorbidity and differentiation

2020 ◽  
pp. 36-43
Author(s):  
V. Yu. Lobzin ◽  
M. R.o. Alizade ◽  
A. V. Lapina ◽  
S. V. Lobzin ◽  
K. A. Kolmakova ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Brain Parenchyma ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Protein Biomarkers ◽  
Brain Functions

The idiopathic normal pressure hydrocephalus (Hakim – Adams syndrome) is characterized by the expansion of cerebrospinal cavities, which is clinically manifested by triad symptoms: cognitive impairment, impaired gait and urination. In this research the severity and modality of cognitive impairment, the pattern of gait changes and the levels of protein biomarkers of amyloidosis and neurodegeneration and neuroimaging changes was evaluated for idiopathic normal pressure hydrocephalus, Alzheimer's disease and their combination. It has been established that for patients with idiopathic normal pressure hydrocephalus the most characteristic is the dysregulatory type of disorders of higher brain functions, while for patients with a combination of Alzheimer's disease and idiopathic normal pressure hydrocephalus, mnemonic disorders are also detected. The specific changes of cerebrospinal fluid in patients with idiopathic normal pressure hydrocephalus are higher levels of amyloid beta, a decrease concentration of tau and phosphorylated tau-protein compared to patients with Alzheimer's disease. In the case of a combination of diseases (comorbidity), it was characterized by intermediate results by cerebrospinal fluid biomarkers. We also revealed patterns of transformation of moderate cognitive impairment into dementia (according to the ratio of tau/Aβ‑42 and ftau /Aβ‑42). The value of evaluating the results of magnetic resonance imaging using special techniques that evaluate both the expansion of the ventricular system and atrophy of the brain parenchyma. Comorbid patients are characterized by a combination of these processes based on the results of neuroimaging. That is why it is necessary to use complex visually analog neuroimaging scales for differential diagnosis and establishing diagnosis. Also, in the course of this work, an algorithm is proposed for mandatory clinical-neuropsychological and laboratory-instrumental examination of patients with cognitive impairment in idiopathic normal pressure hydrocephalus, Alzheimer's disease and their combination.

Recent Advances in Rational Diagnosis and Treatment of Normal Pressure Hydrocephalus: A Critical Appraisal on Novel Diagnostic, Therapy Monitoring and Treatment Modalities

2019 ◽  
Vol 20 (10) ◽  
pp. 1041-1057 ◽  
Author(s):  
Lei Zhang ◽  
Zahid Hussain ◽  
Zhuanqin Ren
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Critical Appraisal ◽  
Therapy Monitoring ◽  
Normal Pressure ◽  
Treatment Modalities ◽  
Pharmacological Agents ◽  
Recent Advances ◽  
Rational Diagnosis ◽  
Neuroimaging Techniques

Background:Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess Cerebrospinal Fluid (CSF) is accumulated in the brain’s ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH.Objective:The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised.Results:Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications.Conclusion:Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.

scholarly journals ELEVATION OF MATRIX METALLOPROTEINASES 3 AND 9 IN CEREBROSPINAL FLUID AND BLOOD IN PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. 702-708 ◽  
Author(s):  
Mark Grossetete ◽  
Jeremy Phelps ◽  
Leopold Arko ◽  
Howard Yonas ◽  
Gary A. Rosenberg
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Brain Injury ◽  
Matrix Metalloproteinases ◽  
Blood Brain Barrier ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Brain Barrier ◽  
Western Immunoblot ◽  
Blood Brain

Abstract OBJECTIVE Traumatic brain injury (TBI) causes an increase in matrix metalloproteinases (MMPs), which are associated with neuroinflammation, blood-brain barrier disruption, hemorrhage, and cell death. We hypothesized that patients with TBI have an increase in MMPs in ventricular cerebrospinal fluid (CSF) and plasma. METHODS Patients with TBI and a ventricular catheter were entered into the study. Samples of CSF and plasma were collected at the time of catheter placement and at 24 and 72 hours after admission. Seven TBI patients were entered into the study, with 6 having complete data for analysis. Only patients who had a known time of insult that fell within a 6-hour window from initial insult to ventriculostomy were accepted into the study. Control CSF came from ventricular fluid in patients undergoing shunt placement for normal pressure hydrocephalus. Both MMP-2 and MMP-9 were measured with gelatin zymography and MMP-3 with Western immunoblot. RESULTS We found a significant elevation in the levels of the latent form of MMP-9 (92-kD) in the CSF obtained at the time of arrival (P < 0.05). Elevated levels of MMP-2 were detected in plasma at 72 hours, but not in the CSF. Using albumin from both CSF and blood, we calculated the MMP-9 index, which was significantly increased in the CSF, indicating endogenous MMP production. Western immunoblot showed elevated levels of MMP-3 in CSF at all times measured, whereas MMP-3 was not detected in the CSF of normal pressure hydrocephalus. CONCLUSION We show that MMPs are increased in the CSF of TBI patients. Although the number of patients was small, the results were robust and clearly demonstrated increases in MMP-3 and MMP-9 in ventricular CSF in TBI patients compared with controls. Although these preliminary results will need to be replicated, we propose that MMPs may be important in blood-brain barrier opening and hemorrhage secondary to brain injury in patients.

scholarly journals Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Johanna Rydja ◽  
Andreas Eleftheriou ◽  
Fredrik Lundin
Keyword(s):  
Cerebrospinal Fluid ◽  
Scale Score ◽  
Normal Pressure Hydrocephalus ◽  
Postoperative Outcome ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Urinary Continence ◽  
Predictive Values ◽  
Tap Test ◽  
Total Scale Score

Abstract Background The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. Methods One hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated. Results In the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively. Conclusions The CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive.

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