scholarly journals Misdiagnosis of prolonged psychogenic non-epileptic seizures as status epilepticus: epidemiology and associated risks

2021 ◽  
pp. jnnp-2021-326443
Author(s):  
Johannes Jungilligens ◽  
Rosa Michaelis ◽  
Stoyan Popkirov
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Individual Patient Data ◽  
Clinical Course ◽  
Epileptic Seizures ◽  
Patient Characteristics ◽  
Final Diagnosis ◽  
Treatment Trial ◽  
Anticonvulsant Medication ◽  
Treatment Escalation

ObjectiveTo determine the epidemiology of prolonged psychogenic non-epileptic seizures (pPNES) misdiagnosed as status epilepticus, as well as the risks associated with non-indicated treatment.MethodsWe performed an individual patient data analysis from the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) and the Established Status Epilepticus Treatment Trial (ESETT) to assess incidence, patient characteristics and clinical course of misdiagnosed pPNES.ResultsAmong 980 patients aged 8 years or older diagnosed and treated for status epilepticus in RAMPART and ESETT, 79 (8.1%) were discharged with a final diagnosis of pPNES. The relative incidence was highest in adolescents and young adults (20.1%). The typical female preponderance seen in that age bracket was not evident in children and older adults. Adverse effects, including respiratory depression and intubation, were documented in 26% of patients with pPNES receiving benzodiazepines in RAMPART and 33% of patients receiving additional second-line medication in ESETT. In ESETT, patients who were treated with benzodiazepines before hospital admission had higher rates of unresponsiveness and severe adverse effects than those treated after admission, suggesting cumulative effects of accelerated treatment momentum. Across trials, one in five patients with pPNES were admitted to an intensive care unit.ConclusionsMisdiagnosis and treatment of pPNES as status epilepticus are a common and widespread problem with deleterious consequences. Mitigating it will require training of emergency staff in semiological diagnosis. Status epilepticus response protocols should incorporate appropriate diagnostic re-evaluations at each step of treatment escalation, especially in clinical trials.

scholarly journals Incidence, characteristics, determinants and prognostic impact of recurrent syncope

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Zimmermann ◽  
J Du Fay De Lavallaz ◽  
T Nestelberger ◽  
D Gualandro ◽  
P Badertscher ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Coronary Intervention ◽  
Final Diagnosis ◽  
Major Adverse Cardiovascular Events ◽  
Unknown Etiology ◽  
Funding Source ◽  
Prognostic Impact ◽  
Lasso Regression ◽  
Recurrence Rates ◽  
Increased Risk

Abstract Background The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians. Methods We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism. Results Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures. Conclusion Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

scholarly journals Clinical Presentation of Epileptic Seizures in a Child with a Final Diagnosis of Atrial Fibrillation: A Pediatric Case Report

2016 ◽  
Vol 38 (3) ◽  
pp. 125-126
Author(s):  
Ayse Kacar Bayram ◽  
Ozge Pamukcu ◽  
Sefer Kumandas ◽  
Zubeyde Gunduz ◽  
Mehmet Canpolat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Clinical Presentation ◽  
Epileptic Seizures ◽  
Final Diagnosis ◽  
Pediatric Case

scholarly journals Intravascular lymphomatosis of central nervious system - case report

2003 ◽  
Vol 131 (7-8) ◽  
pp. 325-328 ◽  
Author(s):  
Jasmina Jovic ◽  
Marko Ercegovac ◽  
Branko Dozic ◽  
Dubravka Cvetkovic ◽  
Miroslava Zivkovic ◽  
...  
Keyword(s):  
Clinical Course ◽  
Vascular Occlusion ◽  
Epileptic Seizures ◽  
Signs And Symptoms ◽  
Lymphoid Cells ◽  
Cognitive Changes ◽  
Small Vessels ◽  
Intravascular Lymphomatosis ◽  
Systemic Manifestations ◽  
The Brain

Intravascular lymphomatosis is an uncommon lymphoproliferative disorder characterised by intravascular distribution of neoplastic lymphoid cells (B- or T- lymphocites), what leads to occlusion of small vessels and causes signs and simptoms of disorder. Its initial predilection sites are the brain or the skin, and hematopoetic organs are usually spared. The signs and symptoms of the disorder are attributed to vascular occlusion. Clinical course is fatal, besides therapy. In our case disorder has started with partial epileptic seizures with secondary generalisation, and after that with motor aphasia, right hemi paresis, urinary incontinence and cognitive changes. She was hospitalized for several times, completely investigated, but with no conclusion. Seven months after appearance of symptoms, she died. And diagnosis was determined at autopsy. A myriad of neurological and systemic manifestations are putting us in an unequal position with this fatal disease. Early diagnosis can increase survival and decrease intensity of symptoms. So every new case is important as warning that we must not forget about this disease.

Chest pain in achalasia: Patient characteristics and clinical course☆, ☆☆

1999 ◽  
Vol 116 (6) ◽  
pp. 1300-1304 ◽  
Author(s):  
V ECKARDT ◽  
B STAUF ◽  
G BERNHARD
Keyword(s):  
Chest Pain ◽  
Clinical Course ◽  
Patient Characteristics

Neurologist, 26 years’ experience, Turkey

2020 ◽  
pp. 269-271
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Status Epilepticus ◽  
Behavioral Problems ◽  
Psychiatric Treatment ◽  
Past History ◽  
Epileptic Seizures ◽  
Teenage Girl ◽  
The Third ◽  
Physical Injuries ◽  
Serious Infection ◽  
Different Types

This chapter explores the experience of a Neurologist who has seen many different types of Non-Epileptic Seizures, from very hyperactive and even aggressive movements to dissociative-like symptoms. It specifically considers the stories of three patients at different ages with different manifestations. The first patient was an older lady whose seizures seemed to be aggravated after menopause. Her past history revealed a serious infection during her first pregnancy, which had resulted in the loss of her baby. During her visit with the Neurologist, she had a seizure in which she was not able to speak, her eyes were deviated upward with eye blinking, and her face looked pale. The second patient was a teenage girl who had started to have seizures diagnosed as status epilepticus after she had been involved in an accident. Later, the Neurologist found out that she had not suffered any serious physical injuries in her head associated with the accident and that she was undergoing psychiatric treatment because of her behavioral problems. The third patient was in her twenties and had had seizures for several years, which always happened at night during sleep. The seizures were described as involving excessive movement and were happening three to four times a month.

Clinical Psychologist, 3 years’ experience, UK

2020 ◽  
pp. 89-90
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Epileptic Seizures ◽  
Final Diagnosis ◽  
Clinical Psychologist ◽  
Not Given ◽  
Perceived Injustice ◽  
The People ◽  
High Incidence ◽  
Universal Truth ◽  
And Training ◽  
Conscious Control

This chapter assesses the idea that patients with Non-Epileptic Seizures (NES) are “difficult.” Anger is an emotion that people feel in the context of perceived injustice: if something is taken from someone, if someone is treated differently, or if someone is not given what he or she deserves. Often, individuals with NES have been treated badly by the people who should have shown them care. This is not a universal truth by any stretch, but research has shown there to be a high incidence of trauma within NES populations. Experiencing symptoms affecting movement and awareness that are outside of conscious control often means that people with NES miss out on opportunities and lose their jobs and driving licenses as well as their independence. Unfortunately, for someone who experiences NES, the journey to a final diagnosis could take years. As such, patients’ anger is not simply attributable to an interaction with one professional or to an explanation that people with NES are inherently difficult. Instead, it is important to look beyond the clinic room to acknowledge that the system as a whole is not meeting the needs of people who experience NES and that this is not fair. One way to make a difference, then, is to provide access to information and training for healthcare professionals.

scholarly journals Delayed antibiotic prescribing for respiratory tract infections: protocol of an individual patient data meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e026925 ◽  
Author(s):  
Beth Stuart ◽  
Hilda Hounkpatin ◽  
Taeko Becque ◽  
Guiqing Yao ◽  
Shihua Zhu ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Patient Data ◽  
Published Data ◽  
Controlled Trials ◽  
Antibiotic Prescribing ◽  
Cochrane Central Register ◽  
Life Years ◽  
Tract Infections

IntroductionDelayed prescribing can be a useful strategy to reduce antibiotic prescribing, but it is not clear for whom delayed prescribing might be effective. This protocol outlines an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) and observational cohort studies to explore the overall effect of delayed prescribing and identify key patient characteristics that are associated with efficacy of delayed prescribing.Methods and analysisA systematic search of the databases Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Plus and Web of Science was conducted to identify relevant studies from inception to October 2017. Outcomes of interest include duration of illness, severity of illness, complication, reconsultation and patient satisfaction. Study authors of eligible papers will be contacted and invited to contribute raw IPD data. IPD data will be checked against published data, harmonised and aggregated to create one large IPD database. Multilevel regression will be performed to explore interaction effects between treatment allocation and patient characteristics. The economic evaluation will be conducted based on IPD from the combined trial and observational studies to estimate the differences in costs and effectiveness for delayed prescribing compared with normal practice. A decision model will be developed to assess potential savings and cost-effectiveness in terms of reduced antibiotic usage of delayed prescribing and quality-adjusted life years.Ethics and disseminationEthical approval was obtained from the University of Southampton Faculty of Medicine Research Ethics Committee (Reference number: 30068). Findings of this study will be published in peer-reviewed academic journals as well as General Practice trade journals and will be presented at national and international conferences. The results will have important public health implications, shaping the way in which antibiotics are prescribed in the future and to whom delayed prescriptions are issued.PROSPERO registration numberCRD42018079400.

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