Search

Objective: To assess the effectiveness and tolerability of eslicarbazepine acetate (ESL) monotherapy in routine clinical practice for the treatment of focal-onset seizures., Methods: Multicenter, retrospective, observational study conducted in patients older than 16 years treated with ESL as first-line monotherapy or converted to ESL monotherapy from polytherapy or other monotherapy. Outcomes included 1-year retention rate, seizure-free rates after 6 and 12 months of monotherapy treatment, and safety/tolerability issues., Results: A total of 256 patients were included (106 first-line and 150 conversion to monotherapy; 56 patients aged >65 years). Overall, the 1-year retention rate was 79% (72.7% in the ≥65 years subgroup) and seizure-free rates at 6 and 12 months were 59.3% and 55.3% (72.2% and 67.3% in the ≥65 years subgroup), without significant differences when comparing first-line vs conversion-to-ESL monotherapy groups (P = .979). However, the conversion group was heterogeneous and included 43 (29.1%) patients that were seizure free the year prior ESL introduction. A substantially higher proportion of patients remained seizure free for the entire follow-up among those who initiated ESL due to tolerability problems compared with those treated due to inadequate seizure control (71.4% vs 37.3%). Overall, 62 of 256 (24.2%) patients reported AEs (39.3% in >65 years subgroup) and led to discontinuation in 20/256 (7.8%) patients (12.5% in >65 years subgroup). Commonly reported AEs were somnolence (6.6%), dizziness (6.3%), and headache (4.3%). Hyponatremia was recorded in five patients, the majority (4/5) of whom were older than 65 years., Conclusions: Eslicarbazepine acetate was effective and well-tolerated as first-line or conversion to monotherapy in a clinical setting in adult and elderly patients with focal-onset seizures., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A case of severe miastenia beginning with dyspnea, secondary to a bilateral larynx paralysis in aduction is presented. During the evolution of the severe miastenia the affectation of the larynx musculature does not result infrequent, but however, after having realized a bibliographic revision, the infrequency resulting in this disease of the beginning through a bilateral larynx paralysis in aduction was verified. A wide exposition of the clinic case, methods of exploration to obtain the diagnosis of severe miastenia, and the different treatment options actually in use to control these disease, are realized.

We present a 28-year-old woman with encephalomyelitis and concomitant central nervous system infection by Epstein-Barr virus. Progression took place in 2 phases, with myelitis at the beginning and encephalitis developing later. Despite great functional impairment, recovery was good and the patient was left suffering only from urinary retention that was presumably caused by spinal lesions. The etiology of the case is unusual, particularly in adults.

A severe adverse drug effect secondary to allopurinol ingestion has been described, characterized by fever, eosinophilia, cutaneous rash, hepatic lesion and renal failure, with a high mortality (21-26%) and unknown ethiopathogenicity. In many cases patients had a previous disorder on their renal function (53%) and more than half received allopurinol due to asymptomatic hyperuricemia. We present two new cases and review other 18 patients diagnosed in the last nine years, analyzing the ethiopathogenicity, epidemiological, clinical, therapeutical and preventive aspects.

Background: Cerebrovascular disease has particular features in young adults (15-45 years). In this context, non-traumatic intracranial hematoma (NTICH) has received little attention. Therefore, its analysis has been attempted focusing on etiology, localization and short term prognosis., Methods: 42 patients aged 15-45 years who were admitted because of NTICH were evaluated. 41 variables were analyzed with chi-square method and Fischer's exact test., Results: The localization of hematoma was as follows: basal ganglia/thalamus in 59%, lobar in 19%, posterior fossa in 12%, pure intraventricular in 2 cases and multiple in one case. The most common etiology was hypertension (HT) (32%), followed by arteriovenous malformations (12%), oral anticoagulants (10%), chronic alcohol abuse (10%), coagulation disorders and one central nervous system arteriopathy; 12 cases were idiopathic. On the basis of etiology two groups were distinguished: 15-30 years (no case with hypertension) and 30-45 years (HT as the leading cause). Survival was 89%., Conclusions: NTICH in young adults has a heterogeneous etiology. On the basis of the most common cause two groups can be considered: from 15 to 30 years (arteriovenous malformation) and from 30 to 45 years (HT). High blood pressure at the time of stroke is correlated with previous HT. The short term life prognosis is better than that of NTICH in general series. Deterioration of consciousness in the acute phase and oral anticoagulation are poor prognostic factors.

Two patients with a dural carotid-cavernous sinus fistula presented with unilateral oculomotor nerve palsies without signs of ocular congestion or proptosis. According to this, dural carotid-cavernous sinus fistula should be included in the differential diagnosis of any case of painful ophthalmoplegia, even in the absence of other ocular signs.

Two cases of benign intracraneal hypertension or pseudotumor cerebri, associated with non specific infective illness, in infants are reported. Presenting symptoms were vomiting, irritability and bulging anterior fontanelle. Both infants had rapid resolution of their symptoms after lumbar puncture, although the second case had recurrences with further febrile diseases. We suggest that a non specific infective illness can interfere transiently with cerebrospinal fluid dynamics.