Background This study aimed to determine the characteristics of computed tomography perfusion (CTP) patterns and their utility in predicting antiseizure medication (ASM) resistance in patients with nonconvulsive status epilepticus (NCSE).
Methods We retrospectively reviewed patients diagnosed with NCSE at Inje University Haeundae Paik Hospital Epilepsy Center between March 2015 and March 2022. CTP patterns were analyzed for those patients. A hyperperfusion pattern (HPP) in CTP was defined as a region of both increased cerebral blood flow and cerebral blood volume that did not necessarily follow the vascular territories. The primary endpoint was the responses to ASMs according to CTP patterns.
Results Fourteen (74%) of the 19 included patients met the criteria for definite NCSE, with the remaining 26% showing nonepileptiform activities with fluctuating quasirhythmic delta activities at >0.5 Hz on electroencephalogram. Three of the four patients who had HPPs with thalamic involvement were refractory to ASMs, whereas all eight patients who had HPPs without thalamic involvement were responsive to ASMs (p = 0.018). Although HPPs themselves were not associated with ASM responses, HPPs with thalamic involvement were associated with resistance to ASMs.
Conclusions HPP with thalamic involvement in CTP might be associated with ASM resistance. Therefore, CTP may be useful for predicting ASM resistance in NCSE patients.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy with heterogeneous features. Appropriate treatment will produce a favorable outcome, but a poor treatment response and severe disability have also been reported. The roles of the clinical phenotypes and electrophysiological features of CIDP as well as of autoantibodies against nodal and paranodal proteins have been highlighted previously due to their association with the treatment response and long-term prognosis. This review addresses the diverse factors associated with the prognosis of CIDP.
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Tendon-Sparing Extraocular Muscle Enlargement Associated With Chronic Inflammatory Demyelinating Polyradiculoneuropathy Antonios D. Dimopoulos, Anne Barmettler Ophthalmic Plastic & Reconstructive Surgery.2024; 40(2): e38. CrossRef
Electrodiagnostic tests (EDX) is essential for the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). EDX could provide information about demyelinating pathology in the peripheral nerves. According to phenotypes, CIDP could be classified several phenotypes, which has different clinical manifestations, EDX could present a different distribution pattern of demyelinating lesions. In addition, EDX could be useful markers for predicting treatment response of prognosis of CIDP.
Background Postural tachycardia syndrome (POTS) refers to the presence of orthostatic
intolerance symptoms associated with a heart rate increment of greater than 30 beats/min,
usually up to 120 beats/min, on head-up tilt test. Symptoms related to POTS are usually lightheadedness, palpitations and tremor, but syncope can also occur. The pathophysiology of POTS is heterogeneous and its prognosis is uncertain.
Methods We prospectively evaluated patients who met the criteria for POTS, at baseline and follow-up, using composite autonomic symptom scores and autonomic tests to assess the autonomic function. We compared the clinical and autonomic test results between baseline and follow-up.
Results Sixty-eight patients met the inclusion criteria for POTS and forty-five patients were ultimately followed up for at least 1 year after baseline. The patients were predominantly young females (84%), with a mean age of 21 years. Most patients showed improved orthostatic symptoms and more than a quarter of patients had no longer met the criteria for POTS at follow-up.
Conclusions Most patients had a benign outcome in that they could resume their daily activities without great limitations. Our results demonstrated a relatively favorable prognosis in most patients with POTS.
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Long‐Term POTS Outcomes Survey: Diagnosis, Therapy, and Clinical Outcomes Jeffrey R. Boris, Edward C. Shadiack, Elizabeth M. McCormick, Laura MacMullen, Ibrahim George‐Sankoh, Marni J. Falk Journal of the American Heart Association.2024;[Epub] CrossRef
Background: Diffusion-weighted image (DWI) might be useful to predict the prognosis of acute hypoxic encephalopathy. The aim of our study was to test whether the early change and extent of DWI abnormalities can be an indicator of the clinical outcome of hypoxic encephalopathy. Methods: Forty-four patients who were diagnosed as hypoxic encephalopathy due to the cardiorespiratory arrest were retrospectively identified. Clinical variables were determined, and the DWI abnormalities were counted by four areas: cortex, subcortical white matter, cerebellum and deep grey matter, and were divided into three groups by the extent of lesions. Prognosis was classified as 'poor' (Glasgow coma scale (GSC) at 30 days after arrest <9 or death) and 'good' (GSC at 30 days after arrest ≥9). Results: GCS at day 3 (p<0.001), presence of seizure (p=0.01), and presence of lesion (p<0.001) were significantly different in prognosis, but statistically there is no association with the extent of lesions and prognosis (p=0.26). Conclusions: Presence of early DWI changes could predict the clinical outcome of hypoxic encephalopathy after cardiorespiratory arrest.
Background Benign paroxysmal positional vertigo (BPPV) is a relatively common disorder, and is characterized by episodic vertigo and nystagmus which was provoked by head motion. However, little is known about the short and long-term outcome and the prognostic factors for recurrence of BPPV. In this pilot study, we tried to identify the prognostic factors of BPPV for short-term outcome.
Methods We analyzed clinical features of 32 patients (men=21, mean age=60.4�±12.6y) with BPPV that was diagnosed by typical nystagmus induced by positioning maneuver. The induced nystagmus was recorded using video-oculography (VOG). According to the semicircular canal involved, BPPV patients were classified into horizontal, posterior, or anterior canal type. Univariate analysis for age, sex, and history of vertigo, and Kaplan-Meier analysis for each canal type were performed.
Results Horizontal (n=21, 65.6%) semicircular canal type BPPV was more common than the posterior one (n=11, 34.4%). Median follow-up period was 113 day (from 34 to 216 days). Four patients with horizontal canal type BPPV had recurrent attacks. Age, history of vertigo, and days prior to diagnosis were not different between canal type. Overall recurrence rate of horizontal canal type BPPV by Kaplan-Meier estimation was 19% at 60 days (p=0.13).
Conclusions Horizontal canal type BPPV was more common and recurred more frequently than posterior canal type in the present study. However, we did not find prognostic factors for recurrence of BPPV.
Electroencephalogram (EEG) is a representative diagnostic tool in epilepsy. However, there are several points of debate on the role of EEG in diagnosis and management of epilepsy. We suggest that EEG has some limitations for differential diagnosis from nonepileptic episodic diseases, classification of epilepsy, prediction of recurrence, and evaluation of treatment response. Interictal EEG cannot diagnose or exclude epilepsy because interictal epileptic discharge (IED) is frequently absent in epilepsy and can appear in nonepileptic conditions. Although EEG is helpful in classification of epilepsy, focal spikes in generalized epilepsy and secondary bilateral synchrony in localization related epilepsy cause interrater disagreement. It is controversial whether EEG predicts recurrence after the first seizure in adults. The predictive value of EEG in antiepileptic drug (AED) withdrawal is not absolute. The prognosis after AED withdrawal depends on epilepsy syndrome. Many studies could not confirm the value of EEG in assessing the treatment response. After all, epilepsy is clinically diagnosed and assessed. Interictal EEG alone does not provide decisive information and routine follow-up of EEG is not recommended.
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