Purpose: Troponin is a very sensitive marker of cardiac injury. Conflicting data regarding elevat... more Purpose: Troponin is a very sensitive marker of cardiac injury. Conflicting data regarding elevation of troponin level following generalized tonic clonic seizures (GTCs) have been reported. In this study we hypothesized that troponin elevation after GTCs occurs more frequently in patients with cardiovascular risk factors. Method: Consecutive patients who presented to ER over a one year period with a GTC and whose work up included troponin T level were included. Patients with cardiac symptoms at the time of admission or renal insufficiency were excluded. The frequency and risk factors for elevated troponin levels in this cohort were analyzed. Result: Fourteen patients (mean age: 54 years; range: 19–87) were included. Four patients (28.6%) had an elevated troponin level (Mean = 0.06, range: 0.035–0.076). Those four patients were significantly older than those with normal levels (77.5 vs. 45.5 years, P = 0.035). EKGs in these patients were normal. Of the eight patients 60 years or olde...
Rhythmic midtemporal discharge (RMTD) is one of the benign epileptiform variants, typically consi... more Rhythmic midtemporal discharge (RMTD) is one of the benign epileptiform variants, typically consisting of runs of 4-Hz to 7-Hz activity, lasting up to 10 seconds and maximal over the midtemporal area. We report a child who, during an admission for diagnostic closed-circuit television (CCTV) and electroencephalographic (EEG) monitoring, was found to have prolonged rhythmic monomorphic discharges, alternating over both midtemporal areas, with one of the discharges lasting up to 82 minutes. An analysis of the dominant frequency, during the longest discharge, showed that it was monomorphic throughout. On the basis of various features of these discharges, we concluded that they represented RMTD of unusual duration.
Background: Levetiracetam is a broad spectrum antiepileptic drug (AED) with proven efficacy when ... more Background: Levetiracetam is a broad spectrum antiepileptic drug (AED) with proven efficacy when used as adjunctive therapy against myoclonic seizures. We report two patients suffering from epilepsy with myoclonic-astatic epilepsy (MAE) who experienced a paradoxical worsening of seizures after initiation of treatment with LEV, a finding not previously described. Case presentation: Patients included were enrolled in an ongoing large prospective study evaluating children and adults with new onset epilepsy in Lebanon conducted at the American University of Beirut Medical Center in association with the Lebanese Chapter of the International League against Epilepsy. Based on an extensive evaluation, these patients were stratified into idiopathic partial, idiopathic generalized, symptomatic partial or symptomatic generalized epilepsies. Whenever possible the electroclinical syndrome was identified according to the ILAE classification of epilepsy syndromes. Patients were subsequently followed up on regular intervals and were assessed for adverse events, and seizure recurrence. MAE was diagnosed in five (1.6%) out of 307 consecutive children enrolled in this study. LEV was used as adjunctive therapy in four of those children with two experiencing a substantial and dose related worsening in the frequency of their myoclonic and atonic seizures. Conclusion: LEV should be used with caution in children with MAE and an exacerbation of seizure frequency temporally related to the introduction of LEV should alert the clinician to the possibility of a paradoxical seizure exacerbation.
... 3. Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, et al. ... Corresponding autho... more ... 3. Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, et al. ... Corresponding author:Bassem Yamout, MD, Multiple Sclerosis Clinic and Research Center, Doctors' Center, 3rd Floor, Cairo Street, Near AUH, Hamra, Beirut, Lebanon Email: [email protected] 644 ...
Background: Extracranial venous stenosis (EVS) has recently been implicated as the primary cause ... more Background: Extracranial venous stenosis (EVS) has recently been implicated as the primary cause of multiple sclerosis (MS). Objective: The aim of this study was to determine the presence of EVS in MS patients. Methods: We performed selective extracranial venography on 42 patients with early MS (EMS): clinically isolated syndrome (CIS) or relapsing—remitting MS (RRMS) of less than 5 years duration, and late MS (LMS): RRMS of more than 10 years duration. Magnetic resonance imaging (MRI) and clinical relapse data were reviewed for all patients with EVS. Results: EVS was present in 7/29 patients with EMS and 12/13 patients with LMS, a highly significant statistical difference ( p< 0.001). Only 3/42 patients (all in the LMS group) had two vessel stenoses, while the rest had only one vessel involved. EVS was seen in 1/11 patients with CIS compared with 6/18 RRMS patients of less than 5 years duration. Disease duration was greater in patients with EVS overall ( p < 0.005). LMS remai...
Purpose: Troponin is a very sensitive marker of cardiac injury. Conflicting data regarding elevat... more Purpose: Troponin is a very sensitive marker of cardiac injury. Conflicting data regarding elevation of troponin level following generalized tonic clonic seizures (GTCs) have been reported. In this study we hypothesized that troponin elevation after GTCs occurs more frequently in patients with cardiovascular risk factors. Method: Consecutive patients who presented to ER over a one year period with a GTC and whose work up included troponin T level were included. Patients with cardiac symptoms at the time of admission or renal insufficiency were excluded. The frequency and risk factors for elevated troponin levels in this cohort were analyzed. Result: Fourteen patients (mean age: 54 years; range: 19–87) were included. Four patients (28.6%) had an elevated troponin level (Mean = 0.06, range: 0.035–0.076). Those four patients were significantly older than those with normal levels (77.5 vs. 45.5 years, P = 0.035). EKGs in these patients were normal. Of the eight patients 60 years or olde...
Rhythmic midtemporal discharge (RMTD) is one of the benign epileptiform variants, typically consi... more Rhythmic midtemporal discharge (RMTD) is one of the benign epileptiform variants, typically consisting of runs of 4-Hz to 7-Hz activity, lasting up to 10 seconds and maximal over the midtemporal area. We report a child who, during an admission for diagnostic closed-circuit television (CCTV) and electroencephalographic (EEG) monitoring, was found to have prolonged rhythmic monomorphic discharges, alternating over both midtemporal areas, with one of the discharges lasting up to 82 minutes. An analysis of the dominant frequency, during the longest discharge, showed that it was monomorphic throughout. On the basis of various features of these discharges, we concluded that they represented RMTD of unusual duration.
Background: Levetiracetam is a broad spectrum antiepileptic drug (AED) with proven efficacy when ... more Background: Levetiracetam is a broad spectrum antiepileptic drug (AED) with proven efficacy when used as adjunctive therapy against myoclonic seizures. We report two patients suffering from epilepsy with myoclonic-astatic epilepsy (MAE) who experienced a paradoxical worsening of seizures after initiation of treatment with LEV, a finding not previously described. Case presentation: Patients included were enrolled in an ongoing large prospective study evaluating children and adults with new onset epilepsy in Lebanon conducted at the American University of Beirut Medical Center in association with the Lebanese Chapter of the International League against Epilepsy. Based on an extensive evaluation, these patients were stratified into idiopathic partial, idiopathic generalized, symptomatic partial or symptomatic generalized epilepsies. Whenever possible the electroclinical syndrome was identified according to the ILAE classification of epilepsy syndromes. Patients were subsequently followed up on regular intervals and were assessed for adverse events, and seizure recurrence. MAE was diagnosed in five (1.6%) out of 307 consecutive children enrolled in this study. LEV was used as adjunctive therapy in four of those children with two experiencing a substantial and dose related worsening in the frequency of their myoclonic and atonic seizures. Conclusion: LEV should be used with caution in children with MAE and an exacerbation of seizure frequency temporally related to the introduction of LEV should alert the clinician to the possibility of a paradoxical seizure exacerbation.
... 3. Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, et al. ... Corresponding autho... more ... 3. Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, et al. ... Corresponding author:Bassem Yamout, MD, Multiple Sclerosis Clinic and Research Center, Doctors&#x27; Center, 3rd Floor, Cairo Street, Near AUH, Hamra, Beirut, Lebanon Email: [email protected] 644 ...
Background: Extracranial venous stenosis (EVS) has recently been implicated as the primary cause ... more Background: Extracranial venous stenosis (EVS) has recently been implicated as the primary cause of multiple sclerosis (MS). Objective: The aim of this study was to determine the presence of EVS in MS patients. Methods: We performed selective extracranial venography on 42 patients with early MS (EMS): clinically isolated syndrome (CIS) or relapsing—remitting MS (RRMS) of less than 5 years duration, and late MS (LMS): RRMS of more than 10 years duration. Magnetic resonance imaging (MRI) and clinical relapse data were reviewed for all patients with EVS. Results: EVS was present in 7/29 patients with EMS and 12/13 patients with LMS, a highly significant statistical difference ( p< 0.001). Only 3/42 patients (all in the LMS group) had two vessel stenoses, while the rest had only one vessel involved. EVS was seen in 1/11 patients with CIS compared with 6/18 RRMS patients of less than 5 years duration. Disease duration was greater in patients with EVS overall ( p < 0.005). LMS remai...
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