Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
29
result(s) for
"Kothare, Sanjeev V"
Sort by:
The difficulties in treating children with rare epileptic encephalopathies
[...]the results of a meta-analysis suggested superior efficacy of corticosteroids over benzodiazepines in cognitive outcomes on the basis of retrospective data.6 No head-to-head comparison of these two drugs has been done, but this knowledge gap is now filled by the long-awaited publication, by Marleen van Arnhem and colleagues in The Lancet Neurology, of the results of the RESCUE-ESES trial.7 RESCUE-ESES was a randomised non-blinded comparison of treatment with corticosteroids (either continuous treatment with 1–2 mg/kg per day of prednisolone orally or pulse treatment with 20 mg/kg per day of methylprednisolone intravenously for 3 days every 4 weeks) or clobazam (0·5–1·2 mg/kg per day orally) for 6 months. The difference in IQ responder rate was no longer apparent at the 18-month reanalysis, but there were significant confounders (including attrition), and treatments administered by the treating physicians differed, which might have had an effect. Selective reduction of synaptic connections occurs overnight during slow-wave sleep (recuperative synaptic downscaling).8 Synaptic homoeostasis is closely correlated with slow-wave activity.9 However, the study by van Arnhem and colleagues7 did not show a significant correlation between cognitive scores and spike-wave index.
Journal Article
Risk Factors Associated with Death in In-Hospital Pediatric Convulsive Status Epilepticus
To evaluate in-patient mortality and predictors of death associated with convulsive status epilepticus (SE) in a large, multi-center, pediatric cohort.
We identified our cohort from the KID Inpatient Database for the years 1997, 2000, 2003 and 2006. We queried the database for convulsive SE, associated diagnoses, and for inpatient death. Univariate logistic testing was used to screen for potential risk factors. These risk factors were then entered into a stepwise backwards conditional multivariable logistic regression procedure. P-values less than 0.05 were taken as significant.
We identified 12,365 (5,541 female) patients with convulsive SE aged 0-20 years (mean age 6.2 years, standard deviation 5.5 years, median 5 years) among 14,965,571 pediatric inpatients (0.08%). Of these, 117 died while in the hospital (0.9%). The most frequent additional admission ICD-9 code diagnoses in addition to SE were cerebral palsy, pneumonia, and respiratory failure. Independent risk factors for death in patients with SE, assessed by multivariate calculation, included near drowning (Odds ratio [OR] 43.2; Confidence Interval [CI] 4.4-426.8), hemorrhagic shock (OR 17.83; CI 6.5-49.1), sepsis (OR 10.14; CI 4.0-25.6), massive aspiration (OR 9.1; CI 1.8-47), mechanical ventilation >96 hours (OR9; 5.6-14.6), transfusion (OR 8.25; CI 4.3-15.8), structural brain lesion (OR7.0; CI 3.1-16), hypoglycemia (OR5.8; CI 1.75-19.2), sepsis with liver failure (OR 14.4; CI 5-41.9), and admission in December (OR3.4; CI 1.6-4.1). African American ethnicity (OR 0.4; CI 0.2-0.8) was associated with a decreased risk of death in SE.
Pediatric convulsive SE occurs in up to 0.08% of pediatric inpatient admissions with a mortality of up to 1%. There appear to be several risk factors that can predict mortality. These may warrant additional monitoring and aggressive management.
Journal Article
Sleep Disorders in Adolescents
This clinical casebook presents a comprehensive review of common sleep problems in adolescents in a concise, easy-to-read format. Each chapter thoroughly addresses a unique sleep disorder in teenagers through illustrative cases, reviews of relevant literature, and pearls of wisdom for both the practicing sleep specialist and other practitioners involved in the care of adolescents. Early chapters address various sleep disorders in detail: parasomnias, narcolepsy, obstructive sleep apnea, and delayed sleep-wake phase disorder, providing clear treatment considerations. Later chapters address sleep when complicated by issues of major depression, PTSD, epilepsy, and Traumatic Brain Injury. In-depth discussions and differential diagnosis engage the reader, and offer a multitude of research-based and clinically guided recommendations for the evaluation and treatment of sleep disorders in the adolescent.An ideal, practical resource for clinicians at all levels, Sleep Disorders In Adolescents provides a valuable contribution to adolescent care.
eBook
Sudden Unexpected Death in Epilepsy: A Narrative Review of Mechanism, Risks, and Prevention
Sudden unexpected death in epilepsy (SUDEP) is sudden, unexpected, witnessed or unwitnessed, nontraumatic, non-drowning death that occurs in a person with epilepsy. SUDEP is the leading cause of epilepsy-related death in adults with epilepsy, with an incidence of about 1.2 per 1000 person-years in the general epilepsy population. Recent studies have shown similar prevalence in the pediatric population too. Although the precise mechanism remains unclear, well-documented cases of SUDEP suggest that a generalized tonic clonic seizure-induced, centrally mediated change in cardiorespiratory function leads to terminal apnea and cardiac arrest. Risk factors include generalized tonic clonic seizure frequency, duration of epilepsy, nocturnal seizure, and certain genetic syndromes. Orexin, adenosine, and serotonin neurotransmission have been explored as novel drug targets to mitigate SUDEP risk. Neurostimulation and resective epilepsy surgery have been reported to have beneficial effects on long-term SUDEP risk as well. Future studies may aim to clarify the role of sleep and other comorbidities in SUDEP pathophysiology.
Journal Article
A Role for Electroconvulsive Therapy in the Management of New Onset Refractory Status Epilepticus (NORSE) in a Young Child
New-onset refractory status epilepticus (NORSE) describes prolonged or recurring new onset seizures which fail to respond to antiseizure medications. NORSE poses a challenge in diagnosis and treatment, and limited high-quality evidence exists to guide management. The efficacy of Electroconvulsive therapy (ECT) in aborting refractory status epilepticus has been described in case reports, but its application remains uncommon, particularly in young children. We describe a case of NORSE in a 3-year old child in which ECT played an important role in aborting status epilepticus, facilitating the diagnosis and surgical excision of an underlying focal cortical dysplasia. Although further research is needed, our case suggests that ECT can be a valuable tool in the treatment of refractory status epilepticus in children.
Journal Article
Behaviorally-determined sleep phenotypes are robustly associated with adaptive functioning in individuals with low functioning autism
Despite sleep disturbance being a common complaint in individuals with autism, specific sleep phenotypes and their relationship to adaptive functioning have yet to be identified. This study used cluster analysis to find distinct sleep patterns and relate them to independent measures of adaptive functioning in individuals with autism. Approximately 50,000 nights of care-giver sleep/wake logs were collected on school-days for 106 individuals with low functioning autism (87 boys, 14.77 ± 3.11 years) for 0.5–6 years (2.2 ± 1.5 years) from two residential schools. Using hierarchical cluster analysis, performed on summary statistics of each individual across their recording duration, two clusters of individuals with clearly distinguishable sleep phenotypes were found. The groups were summarized as ‘unstable’ sleepers (cluster 1,
n
= 41) and ‘stable’ sleepers (cluster 2,
n
= 65), with the former exhibiting reduced sleep duration, earlier sleep offset, and less stability in sleep timing. The sleep clusters displayed significant differences in properties that were not used for clustering, such as intellectual functioning, communication, and socialization, demonstrating that sleep phenotypes are associated with symptom severity in individuals with autism. This study provides foundational evidence for profiling and targeting sleep as a standard part of therapeutic intervention in individuals with autism.
Journal Article
Central sleep apnea and complex sleep apnea in patients with epilepsy
Purpose
We sought to examine the prevalence of central sleep apnea (CSA) and complex sleep apnea (CompSA) in patients with epilepsy and to examine their clinical profile, with respect to epilepsy type, etiology, medication use, and EEG abnormalities.
Methods
We undertook a retrospective analysis of 719 consecutive patients with epilepsy who underwent polysomnography (PSG) at our institution between 2004 and 2011. Of the 458 patients with complete data, we excluded 42 patients with congestive heart failure or left ventricular ejection fraction <40 %. Comparison of clinical and PSG variables between the three groups were conducted with Fisher exact test and analysis of variance.
Results
Out of 416 patients tested, 315 (75 %) had obstructive sleep apnea (OSA), 16 (3.7 %) had CSA, 33 (7.9 %) had CompSA. There were more males in the CSA and CompSA groups than in the OSA group (81.2, 81.8, and 59.6 %, respectively,
p
= 0.04). Focal seizures were more prevalent in patients with CSA than in patients OSA or CompSA (62.5, 265, and 21.1 %, respectively,
p
= 0.02).
Conclusion
About 11 % of epilepsy patients have sleep-breathing disorders with central apneas, which is not higher than that in a general population. These data should be expanded with future research investigating the role of interictal, ictal, and postictal central apneas in epileptogenesis and epilepsy.
Journal Article