Electrographic Seizures in the Critically Ill
Identifying and treating critically ill patients with seizures can be challenging. In this article, the authors review the available data on patient populations at risk, seizure prognostication with tools such as 2HELPS2B, electrographic seizures and the various ictal-interictal continuum patterns with their latest definitions and associated risks, ancillary testing such as imaging studies, serum biomarkers, and invasive multimodal monitoring. They also illustrate 5 different patient scenarios, their treatment and outcomes, and propose recommendations for targeted treatment of electrographic seizures in critically ill pati...
Source: Neurologic Clinics - September 28, 2022 Category: Neurology Authors: Smitha K. Holla, Parimala Velpula Krishnamurthy, Thanujaa Subramaniam, Monica B. Dhakar, Aaron F. Struck Source Type: research
Rescue Treatments for Seizure Clusters
Treatment of seizure clusters endeavors to prevent additional seizures and avoid progression to conditions such as prolonged seizures and status epilepticus. Rescue therapies are key components of seizure action plans (SAPs) for individuals with seizure clusters. Three rescue therapies are approved in the United States for the treatment of seizure clusters: diazepam rectal gel, midazolam nasal spray, and diazepam nasal spray. Diazepam rectal gel is an effective rescue therapy for seizure clusters, though adults and adolescents may have social reservations regarding its administration. Intranasal delivery of midazolam or di...
Source: Neurologic Clinics - September 28, 2022 Category: Neurology Authors: Robert J. Kotloski, Barry E. Gidal Source Type: research
Evaluation and Treatment of Psychogenic Nonepileptic Seizures
Patients with psychogenic nonepileptic seizures (PNES) represent a distinct, challenging group among those with functional neurologic symptom (conversion) disorders and involve a complex set of symptoms and comorbidities, best evaluated and treated by a multidisciplinary team of clinicians. Multidisciplinary, collaborative care is becoming more common, using evidence-based treatment. Outpatient neurology clinics at sites not currently treating these patients hold potential for providing such a model of care, with coordination of services. Best practice care should encourage the integration of neurology and mental health pr...
Source: Neurologic Clinics - September 28, 2022 Category: Neurology Authors: Nicholas J. Beimer, William Curt LaFrance Source Type: research
Update on Sudden Unexpected Death in Epilepsy
Persons with epilepsy (PWE) have an up to 34-fold increased risk of dying suddenly and unexpectedly compared with the general population. Despite being potentially preventable by optimal care, sudden unexpected death in epilepsy (SUDEP) is one of the most frequent causes of death in PWE, especially in children and younger adults. The incidence of SUDEP in the general epilepsy population is rather consistent at 1.2 to 1.3 per 1000 person-year across series. Several risk factors for SUDEP have been identified, but with focal-to-bilateral or generalized tonic-clonic seizures and sleeping alone as the most significant. Thereby...
Source: Neurologic Clinics - September 28, 2022 Category: Neurology Authors: Marius Kl øvgaard, Anne Sabers, Philippe Ryvlin Source Type: research
Evaluation of Cerebellar Ataxic Patients
Cerebellar ataxia results from damage to the cerebellum and presents as movement incoordination and variability, gait impairment, and slurred speech. Patients with cerebellar ataxia can also have cognitive and mood changes. Although the identification of causes for cerebellar ataxia can be complex, age of presentation, chronicity, family history, and associated movement disorders may provide diagnostic clues. There are many genetic causes for cerebellar ataxia, and the common autosomal dominant and recessive ataxia are due to genetic repeat expansions. Step-by-step approach will lead to the identification of the causes. Sy...
Source: Neurologic Clinics - August 30, 2022 Category: Neurology Authors: Sara Radmard, Theresa A. Zesiewicz, Sheng-Han Kuo Source Type: research
Imaging of Headache Attributed to Vascular Disorders
This article will focus on imaging pearls and pitfalls of vascular causes of headaches. These include aneurysms, vasculitides, vascular malformations, and cerebral venous thrombosis. (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 22, 2022 Category: Neurology Authors: Lily L. Wang, Abdelkader Mahammedi, Achala S. Vagal Source Type: research
Imaging of Headache
NEUROLOGIC CLINICS (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 22, 2022 Category: Neurology Authors: Sangam Kanekar Source Type: research
Copyright
ELSEVIER (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 22, 2022 Category: Neurology Source Type: research
Contributors
RANDOLPH W. EVANS, MD (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 22, 2022 Category: Neurology Source Type: research
Contents
Sangam Kanekar (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 22, 2022 Category: Neurology Source Type: research
Forthcoming Issues
Epilepsy (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 22, 2022 Category: Neurology Source Type: research
Neuroimaging of Headache
Headache is a common presenting symptom in the ambulatory setting that often prompts imaging. The increased use and associated health care money spent in the setting of headache have raised questions about the cost-effectiveness of neuroimaging in this setting. Neuroimaging for headache in most cases is unlikely to reveal significant abnormality or impact patient management. In this article, reasons behind an observed increase in neuroimaging and its impact on health care expenditures are discussed. The typical imaging modalities available and various imaging guidelines for common clinical headache scenarios are presented,...
Source: Neurologic Clinics - June 28, 2022 Category: Neurology Authors: Shadi Asadollahi, David M. Yousem, Rohini Nadgir Source Type: research
Imaging Appearance of Migraine and Tension Type Headache
Headache disorders rank third among the worldwide causes of disability, measured in years of life lost to disability.1 Primary headaches, such as migraine-type headache (MTH) and tension-type headache (TTH), are the most prevalent type of headache disorders. According to the Global Burden of Disease Study 2010 (GBD2010), TTH and migraine were reported as the second (20.1%) and third (14.7%) most prevalent disorders in the world, respectively, (after dental caries first).2 The global prevalence of TTH is 40% and migraine 10%. (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2022 Category: Neurology Authors: Abdelkader Mahammedi, Lily L. Wang, Achala Vagal Source Type: research
Posttraumatic Headaches and Postcraniotomy Syndromes
Headaches following head trauma or craniotomy have multiple causes, each of which has characteristic imaging features. Posttraumatic headaches may relate to intracranial hemorrhage, fracture, shear injury, mass effect, or vascular injury. Various complications of craniotomy and craniectomy may manifest with headache. CT and MRI of the brain play important roles in diagnosing these causes of headache. (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2022 Category: Neurology Authors: Allison Weyer Source Type: research
Headache Attributed to Non-vascular Intracranial Disorder
Evaluation of headaches warrants a careful history and neurologic assessment to determine the need for further workup and imaging. Identifying patients who are at risk for underlying pathology is important and this includes individuals with known or suspected malignancy and those who are immunocompromised and at increased risk for intracranial infection. While CT is helpful in the acute setting and to screen for intracranial hypertension, MRI is the modality of choice for the evaluation of underlying pathologies. Imaging in substance abuse may show injury related to direct toxicity or secondary to vascular complications. (...
Source: Neurologic Clinics - June 28, 2022 Category: Neurology Authors: Kassie McCullagh, Mauricio Castillo, Carlos Zamora Source Type: research
