scholarly journals The evaluation of psychogenic non-epileptic seizures (PNES) cases with saline injection method in video-EEG monitorization unit

2021 ◽  
Vol 79 (11) ◽  
pp. 957-962
Author(s):  
İbrahim Bora ◽  
Aylin Bican Demir ◽  
Dursun Ceylan
Keyword(s):  
Refractory Epilepsy ◽  
Positive Impact ◽  
Epileptic Seizures ◽  
Saline Injection ◽  
Diagnosis And Prognosis ◽  
Patient Diagnosis ◽  
Intravenous Saline ◽  
Patient Prognosis ◽  
Doctor Communication ◽  
Video Eeg

ABSTRACT Background: It has been reported that 10 to 30% of patients sent to epilepsy centers with a diagnosis of refractory epilepsy are diagnosed with psychogenic non-epileptic seizure (PNES). A wide variety of provocative methods are used to assist PNES diagnosis. Objective: To investigate the effect of seizure induction on the diagnosis and prognosis of PNES. Methods: We retrospectively examined 91 patients with PNES complaints in our video-EEG laboratory. Intravenous saline was administered to all patients for induction of seizures. Results: Saline injection was performed in 91 patients referred to our EEG lab with PNES initial diagnosis, 57 of whom were female and 34 male. Saline injection triggered an attack in 82 patients (90%). Conclusions: In this study we have concluded that provocative methods are practical, cheap and, most of all, effective for patient diagnosis. In clinical practice, explaining the diagnosis is the first and most important step of the treatment, and careful patient-doctor communication has a positive impact on patient prognosis.

Exercise Capacity in Chronic Heart Failure

2012 ◽  
Vol 9 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Gina G Mentzer ◽  
Alex J Auseon
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Exercise Capacity ◽  
Positive Impact ◽  
Pharmacologic Therapy ◽  
The Past ◽  
Diagnosis And Prognosis ◽  
Future Therapy

Heart failure (HF) affects more than 5 million people and has an increasing incidence and cost burden. Patients note symptoms of dyspnea and fatigue that result in a decreased quality of life, which has not drastically improved over the past decades despite advances in therapies. The assessment of exercise capacity can provide information regarding patient diagnosis and prognosis, while doubling as a potential future therapy. clinically, there is acceptance that exercise is safe in hf and can have a positive impact on morbidity and quality of life, although evidence for improvement in mortality is still lacking. specific prescriptions for exercise training have not been developed because many variables and confounding factors have prevented research trials from demonstrating an ideal regimen. Physicians are becoming more aware of the indices and goals for hf patients in exercise testing and therapy to provide comprehensive cardiac care. it is further postulated that a combination of exercise training and pharmacologic therapy may eventually provide the most benefits to those suffering from hf.

scholarly journals Screening the genome for HCC-specific CpG methylation signatures as biomarkers for diagnosis and prognosis evaluation

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Rui-kun Zhang ◽  
Jia-lin Liu
Keyword(s):  
Cox Regression ◽  
Malignant Tumors ◽  
Gene Expression Omnibus ◽  
The Cancer Genome Atlas ◽  
Survival Prediction ◽  
Training Set ◽  
Cpg Sites ◽  
Diagnosis And Prognosis ◽  
Patient Prognosis ◽  
Prognosis Evaluation

Abstract Background Hepatocellular carcinoma (HCC) is one of the most common and invasive malignant tumors in the world. The change in DNA methylation is a key event in HCC. Methods Methylation datasets for HCC and 17 other types of cancer were downloaded from The Cancer Genome Atlas (TCGA). The CpG sites with large differences in methylation between tumor tissues and paracancerous tissues were identified. We used the HCC methylation dataset downloaded from the TCGA as the training set and removed the overlapping sites among all cancer datasets to ensure that only CpG sites specific to HCC remained. Logistic regression analysis was performed to select specific biomarkers that can be used to diagnose HCC, and two datasets—GSE157341 and GSE54503—downloaded from GEO as validation sets were used to validate our model. We also used a Cox regression model to select CpG sites related to patient prognosis. Results We identified 6 HCC-specific methylated CpG sites as biomarkers for HCC diagnosis. In the training set, the area under the receiver operating characteristic (ROC) curve (AUC) for the model containing all these sites was 0.971. The AUCs were 0.8802 and 0.9711 for the two validation sets from the GEO database. In addition, 3 other CpG sites were analyzed and used to create a risk scoring model for patient prognosis and survival prediction. Conclusions Through the analysis of HCC methylation datasets from the TCGA and Gene Expression Omnibus (GEO) databases, potential biomarkers for HCC diagnosis and prognosis evaluation were ascertained.

scholarly journals Neuromodulation in refractory epilepsy: Brazilian specialists consensus

2016 ◽  
Vol 74 (12) ◽  
pp. 1031-1034
Author(s):  
Vera Cristina Terra ◽  
Isabella D’Andrea-Meira ◽  
Ricardo Amorim ◽  
Francisco Arruda ◽  
Andrea Julião de Oliveira ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Epileptic Seizures ◽  
Palliative Surgery ◽  
Therapeutic Approaches ◽  
Brain Disorder ◽  
Medically Refractory Epilepsy ◽  
Deep Brain

ABSTRACT Epilepsy is a potentially devastating brain disorder characterized by a predisposition to spontaneous epileptic seizures. In patients with medically refractory epilepsy, new non-pharmacological therapeutic approaches may be considered. In this scenario, palliative surgery such as vagus nerve stimulation (VNS) or deep brain stimulation (DBS) may be indicated in a subset of patients. In this paper we make recommendations for the use of VNS and DBS in patients in Brazil with refractory epilepsy.

scholarly journals Movement-induced heart rate changes in epileptic and non-epileptic seizures

2009 ◽  
Vol 67 (3b) ◽  
pp. 789-791 ◽  
Author(s):  
Gisele R. de Oliveira ◽  
Francisco de A.A. Gondim ◽  
Edward R. Hogan ◽  
Francisco H. Rola
Keyword(s):  
Heart Rate ◽  
Motor Activity ◽  
Rate Increase ◽  
Epileptic Seizures ◽  
Baseline Heart Rate ◽  
Heart Rate Increase ◽  
Event Duration ◽  
Rate Analysis ◽  
Heart Rate Analysis ◽  
Video Eeg

Heart rate changes are common in epileptic and non-epileptic seizures. Previous studies have not adequately assessed the contribution of motor activity on these changes nor have evaluated them during prolonged monitoring. We retrospectively evaluated 143 seizures and auras from 76 patients admitted for video EEG monitoring. The events were classified according to the degree of ictal motor activity (severe, moderate and mild/absent) in: severe epileptic (SE, N=17), severe non-epileptic (SNE, N=6), moderate epileptic (ME, N=28), moderate non-epileptic (MNE, N=11), mild epileptic (mE, N=35), mild non-epileptic (mNE, N=33) and mild aura (aura, N=13). Heart rate increased in the ictal period in severe epileptic, severe non-epileptic, moderate epileptic and mild epileptic events (p<0.05). Heart rate returned to baseline levels during the post ictal phase in severe non-epileptic seizures but not in severe epileptic patients. Aura events had a higher baseline heart rate. A cut-off of 20% heart rate increase may distinguish moderate epileptic and mild epileptic events lasting more than 30 seconds. In epileptic seizures with mild/absent motor activity, the magnitude of heart rate increase is proportional to the event duration. Heart rate analysis in seizures with different degrees of movement during the ictal phase can help to distinguish epileptic from non-epileptic events.

scholarly journals Ictal ECG changes in temporal lobe epilepsy

1995 ◽  
Vol 53 (3b) ◽  
pp. 619-624 ◽  
Author(s):  
L.M. Li ◽  
J. Roche ◽  
J.W.A.S. Sander
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Sinus Bradycardia ◽  
Cardiac Pacemaker ◽  
Epileptic Seizures ◽  
Ecg Changes ◽  
Unexpected Death ◽  
Complex Partial Seizures ◽  
The Mean ◽  
Video Eeg

Changes in cardiac rhythm may occur during epileptic seizures and this has been suggested as a possible mechanism for sudden unexpected death amongst patients with chronic epilepsy (SUDEP). We have studied ECG changes during 61 complex partial seizures of temporal lobe origin in 20 patients. Tachycardia was observed in 24/61 (39%) and bradycardia in 3/61 (5%). The mean and median tachycardia rate was 139 and 140 beats/min (range 120-180). The longest R-R interval observed was 9 seconds. No difference was found in regard to the lateralisation of seizures and cardiac arrhytmia. One of the patients with bradycardia was fitted with a demand cardiac pacemaker, which appeared to decrease the number of his falls. In conclusion, ictal cardiac changes which may be seen in temporal lobe epilepsy (TLE) are sinus tachycardia and occasionally sinus bradycardia. Patients presenting vague complains suggestive of either TLE or cardiac dysrhythmia, simultaneous monitoring with EEG/ECG is required, and if the episodes are frequent, video-EEG should be considered. Further studies on this subject are warranted as this may shed some light on possible mechanisms for SUDEP.

Cardiogenic syncope diagnosed as epileptic seizures: the importance of ECG during video-EEG recording

2015 ◽  
Vol 17 (2) ◽  
pp. 198-203 ◽  
Author(s):  
Luis C Mayor ◽  
Hernan N Lemus ◽  
Jorge Burneo ◽  
Ana Cristina Palacio ◽  
Sergio Linares
Keyword(s):  
Epileptic Seizures ◽  
Cardiogenic Syncope ◽  
Video Eeg

Neurologist, 13 years’ experience, Australia

2020 ◽  
pp. 204-206
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Emergency Department ◽  
Behavioral Therapy ◽  
Epileptic Seizures ◽  
Clinical Psychologist ◽  
Eeg Monitoring ◽  
Patient Reported ◽  
History Of ◽  
Convulsive Seizures ◽  
One Year ◽  
Video Eeg

This chapter discusses the experience of a Neurologist with a patient who presented with a history of three bilateral convulsive seizures over a period of several months. The Neurologist started him on an adjunct antiepileptic therapy and he became seizure free. However, the situation changed dramatically after a stable period of twelve months. He started having seizures again and his mother was able to recognize that these seizures were different from those he had had one year earlier. Prolonged video-EEG monitoring confirmed the diagnosis of Non-Epileptic Seizures (NES). The Neurologist then referred the patient to a Clinical Psychologist, who used Cognitive Behavioral Therapy and taught him some techniques to cope with the condition. Eventually, the patient and his family were able to manage the NES better with the help of the psychologist. The patient reported a significant improvement clinically with less frequent NES and they learned how to manage the situation without visiting the Emergency Department.

Psychologist, 2 years’ experience, USA; Psychologist, 5 years’ experience, USA

2020 ◽  
pp. 122-125
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Epileptic Seizures ◽  
Holistic Approach ◽  
Well Being ◽  
Definitive Diagnosis ◽  
Adolescent And Young Adult ◽  
Frontal Lobe Epilepsy ◽  
Compelling Evidence ◽  
Caucasian Female ◽  
Video Eeg

This chapter presents a case with compelling evidence for frontal lobe epilepsy (FLE) and Psychogenic Non-Epileptic Seizures (PNES) to address the difficulties providers encounter in helping families receive a definitive diagnosis and eventual path forward. The patient in question was a teenage Caucasian female seeking a third opinion for paroxysmal events. Her father had requested an evaluation to rule out epilepsy after having been told twice before that his daughter’s episodes were likely to be psychogenic in nature. Evidence subsequently obtained over the course of her three-day video-EEG hospitalization provided support for both epilepsy and PNES. The chapter then argues that every adolescent and young adult with epilepsy would benefit from a holistic approach to seizure management, one that takes into account the patient’s quality of life, psychosocial well-being, and relationship with school, family, and friends.

scholarly journals 006 Can seizure-related heart rate differentiate epileptic seizures from psychogenic non-epileptic seizures?

2019 ◽  
Vol 90 (e7) ◽  
pp. A2.3-A3
Author(s):  
Hue Mun Au Yong ◽  
Erica Minato ◽  
Eldho Paul ◽  
Udaya Seneviratne
Keyword(s):  
Heart Rate ◽  
Area Under The Curve ◽  
Epileptic Seizures ◽  
Roc Curve Analysis ◽  
Predictive Values ◽  
Minute Post ◽  
Poor Differentiation ◽  
Good Differentiation ◽  
Sensitivity Specificity ◽  
Video Eeg

IntroductionThis study aims to (i)evaluate the diagnostic sensitivity, specificity and predictive values of seizure-related heart rate (HR) in differentiating epileptic seizures(ES) from psychogenic non-epileptic seizures(PNES), (ii)define the most useful point of HR measurement: pre-ictal, ictal-onset, maximal-ictal or post-ictal, and (iii)define the HR cut-off points to differentiate ES from PNES.MethodsAll video EEG(VEEG) at Monash Health from May 2009 to November 2015 were retrospectively reviewed. Baseline(during wakefulness), one-minute pre-ictal, ictal-onset, maximal-ictal and one-minute post-ictal HR were measured for each ES and PNES event. Events less than ten seconds or with uninterpretable ECG due to artefacts were excluded. ROC curve analysis was performed to study the diagnostic accuracy reflected by area under the curve(AUC). The AUC was interpreted as follows; ≤0.5, differentiation of PNES from ES no better than chance; 0.80–0.89, good differentiation; and 0.9–1, excellent differentiation.ResultsVEEG of 341 ES and 265 PNES from 130 patients were analysed. The AUC for pre-ictal, ictal-onset, maximal-ictal and post-ictal HR were found to have poor differentiation between ES and PNES. Comparing PNES and bilateral tonic-clonic ES, AUC for absolute maximal-ictal HR was 0.84(CI 0.73–0.95) and for absolute post-ictal HR was 0.90(CI 0.81–1.00). Using Youden’s index, to diagnose tonic-clonic ES, the optimal cut-off point for absolute maximal-ictal HR was 114bpm (sensitivity 84%;specificity 82%;PPV 26.7%,NPV 98.5%) and for absolute post-ictal HR was 90bpm(sensitivity 91%;specificity 82%;PPV 30.3%;NPV 99.1%).ConclusionsThese findings suggest that seizure-related HR increase is useful in differentiating bilateral tonic-clonic ES from PNES. Based on the AUC, the best diagnostic measureme.

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