1
|
Fogarasi A, Fazzi E, Smorenburg ARP, Mazurkiewicz-Beldzinska M, Dinopoulos A, Pobiecka A, Schröder-van den Nieuwendijk D, Kraus J, Tekgül H, Kraus J, Dinopoulos A, Koutsaki M, Fogarasi A, Baranello G, Bertoli S, Caramaschi E, Cordelli DM, De Amicis R, Fazzi E, Forchielli ML, Guerra A, Lividini A, Marchiò M, Rossi A, Nieuwendijk DSVD, Fliciński J, Gurda B, Lemska A, Matheisel A, Mazurkiewicz-Beldzinska M, Niwinska Z, Pawłowicz M, Sawicka A, Steinborn B, Szmuda M, Winczewska-Wiktor A, Zawadzka M, Pobiecka A, Arhan E, Aydin K, Bayram E, Carman KB, Edem P, Ertem D, Goktas ÖA, Gungor S, Haliloglu G, Kansu A, Kömür M, Mutlu A, Kırsaçlıoğlu CT, Okuyaz Ç, Özgör B, Ozturk Y, Sager SG, Sarıgeçili E, Selimoglu MA, Serin HMÖ, Teber ST, Tekgül H, Thomas G, Turkdogan D, Volkan B, Yarar C, Yilmaz SK. The PURPLE N study: objective and perceived nutritional status in children and adolescents with cerebral palsy. Disabil Rehabil 2022; 44:6668-6675. [PMID: 34473588 DOI: 10.1080/09638288.2021.1970255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To obtain information on characteristics, management, current objective nutritional status and perception of nutritional status of children with cerebral palsy (CP) from healthcare professionals (HCPs) and caregivers. MATERIALS AND METHODS A detailed survey of several items on eight main topics (general characteristics, motor function, comorbidities, therapies, anthropometry, feeding mode and problems and perceived nutritional status) was developed and tested for the study. Correlation between nutritional status and Gross Motor Function Classification System (GMFCS) levels was assessed using continuous variables (Z-scores for weight-for-age, height-for-age, weight-for-height, and body mass index-for-age), and categorical variables (being malnourished, stunted, or wasted). HCP and caregiver perceptions of the child's nutritional status as well as agreement between perceived and objective nutritional status and agreement between perceived nutritional status and concerns about the nutritional status were analyzed. RESULTS Data were available for 497 participants from eight European countries. Poorer nutritional status was associated with higher (more severe) GMFCS levels. There was minimal agreement between perceived and objective nutritional status, both for HCPs and caregivers. Agreement between HCP and caregiver perceptions of the child's nutritional status was weak (weighted kappa 0.56). However, the concerns about the nutritional status of the child were in line with the perceived nutritional status. CONCLUSIONS The risk of poor nutritional status is associated with more severe disability in children and adolescents with CP. There is a mismatch between HCP and caregiver perceptions of participants' nutritional status as well as between subjective and objective nutritional status. Our data warrant the use of a simple and objective screening tool in daily practice to determine nutritional status in children and adolescents with CP. Clinical trial registration: ClinicalTrials.gov Identifier: NCT03499288 (https://clinicaltrials.gov/ct2/show/NCT03499288). IMPLICATIONS FOR REHABILITATIONUse of the ESPGHAN recommendations and simple screening tools in daily practice is needed to improve nutritional care for individuals with CP.Attention should be paid to the differences in the perception of nutritional status of individuals with CP between professionals and caregivers to improve appropriate referral for nutritional support.Objective measures rather than the professional's perception need to be used to define the nutritional status of individuals with CP.
Collapse
Affiliation(s)
- Andras Fogarasi
- Child Neurology Department, Bethesda Children's Hospital, Budapest, Hungary
| | - Elisa Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ana R P Smorenburg
- Department of Specialized Nutrition, Danone Nutricia Research, Utrecht, The Netherlands
| | | | - Argirios Dinopoulos
- 3rd Department of Pediatrics, Attikon General Hospital, University of Athens, Athens, Greece
| | - Alena Pobiecka
- Department of Pediatrics, University Hospital Trnava, Slovakia
| | | | - Josef Kraus
- Department of Child Neurology, University Hospital Motol, Czech Republic
| | - Hasan Tekgül
- Ege University School of Medicine, Pediatric Neurology, Izmir, Turkey
| | | | | | - Josef Kraus
- Department of Child Neurology, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | | | - Argirios Dinopoulos
- Pediatric Neurology Unit, 3rd Department of Pediatrics, University of Athens, Attikon General Hospital, Athens
| | - Maria Koutsaki
- Pediatric Neurology Unit, 3rd Department of Pediatrics, University of Athens, Attikon General Hospital, Athens
| | | | | | | | | | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan
| | - Elisa Caramaschi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena
| | - Duccio Maria Cordelli
- Child Neurology and Psychiatry Unit, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan
| | - Elisa Fazzi
- ASST Spedali Civili, Brescia, and University of Brescia, Brescia, Italy
| | - Maria Luisa Forchielli
- Pediatric Gastroenterology and Nutrition Clinic, AO Sant'Orsola - Malpighi, University of Bologna
| | - Azzurra Guerra
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Althea Lividini
- Child Neurology and Psychiatry Unit, S. Orsola Hospital, University of Bologna
| | - Maddalena Marchiò
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Andrea Rossi
- Child and Adolescent Neurology and Psychiatry Unit, Children Hospital, ASST Spedali Civili - Brescia
| | | | | | | | - Jędrzej Fliciński
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Barbara Gurda
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Anna Lemska
- Department of Developmental Neurology, Medical University of Gdańsk
| | | | | | - Zuzanna Niwinska
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Małgorzata Pawłowicz
- Department of Developmental Neurology, Medical University of Gdańsk.,(current affiliations: Department of Pediatric Neurology.,Provincial Specialist Children's Hospital in Olsztyn, Olsztyn.,Department of Pathophysiology, Faculty of Medicine, Warmia and Mazury University in Olsztyn, Olsztyn, Poland)
| | | | - Barbara Steinborn
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk
| | | | - Marta Zawadzka
- Department of Developmental Neurology, Medical University of Gdańsk
| | | | - Alena Pobiecka
- Department of Pediatrics, University Hospital Trnava, Slovakia
| | | | - Ebru Arhan
- Gazi University School of Medicine/Neurology, Gazi
| | - Kursad Aydin
- Gazi University, School of Medicine, Pediatric Neurology, Ankara
| | - Erhan Bayram
- Dokuz Eylul University School of Medicine, Pediatric Neurology, Izmir
| | - Kursat Bora Carman
- Division of Pediatric Intensive Care Unit, Eskişehir Osmangazi University Medical Faculty
| | - Pinar Edem
- Dokuz Eylul University School of Medicine, Pediatric Neurology, Izmir
| | - Deniz Ertem
- Marmara University School of Medicine/Gastroenterology, Istanbul
| | | | - Serdal Gungor
- Inonu University School of Medicine/Neurology, Malatya
| | - Goknur Haliloglu
- Hacettepe University Faculty of Medicine, Department of Pediatric Neurology, Ankara
| | - Aydan Kansu
- Ankara University School of Medicine/Gastroenterology, Ankara
| | | | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation/Developmental and Early Physiotherapy Unit, Ankara
| | | | - Çetin Okuyaz
- Division of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin
| | - Bilge Özgör
- Inonu University School of Medicine, Malatya
| | - Yesim Ozturk
- Dokuzeylul University School of Medicine/Gastroenterology, Izmir
| | | | | | | | | | - Serap Tıraş Teber
- University of Ankara Faculty of Medicine, Department of Child Neurology, Ankara
| | - Hasan Tekgül
- Ege University School of Medicine, Pediatric Neurology, Izmir
| | - Gülten Thomas
- Marmara University School of Medicine/Gastroenterology, Istanbul
| | | | - Burcu Volkan
- Marmara University School of Medicine/Gastroenterology, Istanbul
| | - Coşkun Yarar
- Department of Pediatric Neurology, Eskişehir Osmangazi University School of Medicine, Eskişehir
| | | |
Collapse
|
2
|
Zawadzka M, Anuszkiewicz K, Szmuda M, Błaszczyk W, Knurowska A, Stogowski P, Sokolewicz EM, Waszak P, Mazurkiewicz-Bełdzińska M. Epilepsy awareness among school-aged students in Poland. Epilepsy Behav 2022; 128:108603. [PMID: 35151191 DOI: 10.1016/j.yebeh.2022.108603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Epilepsy can be a well-controlled condition with only a slight impact on patients' life. Lack of knowledge within society contributes to children with epilepsy experiencing discrimination and hostility. The aim of this study was to evaluate the awareness of epilepsy and general views on people struggling with this disease among school-aged children. METHODS The study was conducted on a random sample of Polish school students, in total 472 participants. Participants' knowledge was assessed by a self-completed survey. RESULTS Students are unaware of the wide range of symptoms occurring during seizures. More than half claimed that people experiencing epilepsy should not perform sports activities. Alarmingly, 30% of participants believe that those patients should not leave the house and they should be excluded from many jobs. Almost all participants would help a person experiencing seizures and remember proper head protection; shockingly, 20% of children would try to put something in the person's mouth. Older students seem to be better educated on epilepsy, but the percentage of incorrect personal beliefs and myths is similar for each age group. SIGNIFICANCE School-aged students have insufficient knowledge of epilepsy. More emphasis should be put on first aid during seizures and on the spectrum of epilepsy symptoms. Educating society is important for life quality of people experiencing epilepsy.
Collapse
Affiliation(s)
- Marta Zawadzka
- Department of Developmental Neurology, Medical University of Gdańsk, Dębinki 7 Street, 80-952 Gdańsk, Poland.
| | - Karolina Anuszkiewicz
- Department of Developmental Neurology, Medical University of Gdańsk, Dębinki 7 Street, 80-952 Gdańsk, Poland
| | - Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk, Dębinki 7 Street, 80-952 Gdańsk, Poland
| | - Weronika Błaszczyk
- Department of Developmental Neurology, Medical University of Gdańsk, Dębinki 7 Street, 80-952 Gdańsk, Poland
| | - Agata Knurowska
- Department of Developmental Neurology, Medical University of Gdańsk, Dębinki 7 Street, 80-952 Gdańsk, Poland
| | - Piotr Stogowski
- Department of Developmental Neurology, Medical University of Gdańsk, Dębinki 7 Street, 80-952 Gdańsk, Poland
| | - Ewa Maria Sokolewicz
- Department of Developmental Neurology, Medical University of Gdańsk, Dębinki 7 Street, 80-952 Gdańsk, Poland
| | - Przemysław Waszak
- Department of Hygiene and Epidemiology, Department of Developmental Psychiatry, Psychotic and Geriatric Disorders, Dębinki 7 Street, 80-952 Gdańsk, Poland
| | | |
Collapse
|
3
|
Zawadzka M, Pilarska E, Konieczna S, Szmuda M, Matheisel A, Lemska A, Modrzejewska S, Mazurkiewicz-Bełdzińska M. Peri-ictal headaches in the paediatric population - prospective study. Cephalalgia 2020; 41:690-700. [PMID: 33297744 DOI: 10.1177/0333102420977856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The co-occurrence of headache and epilepsy is well-documented in the adult population. The aim of the prospective study was to analyse in the paediatric population the correlations between the types of peri-ictal headaches and types of seizures. Furthermore, an attempt was made to find trends in characteristic features of peri-ictal headaches.Material: A total of 57 children with peri-ictal headache were enrolled in the study. The participants' guardians were asked to keep a diary of the seizure and peri-ictal headache episodes during a 180-day period. During follow-up visits, systematic history regarding peri-ictal headaches was taken. RESULTS A total of 913 seizure and 325 peri-ictal headache episodes were noted during the study. Post-ictal headaches were most common, occurring in < 1 h after the seizure, lasting minutes to hours and more likely to occur after generalised seizures, whereas pre-ictal headaches occurred 30-240 min before the seizure. In the analysed group, peri-ictal headaches were most often moderate in intensity. Only 30% of patients took analgesic medication, usually to treat post-ictal headaches. CONCLUSION Peri-ictal headaches are a significant health problem for patients with epilepsy. The most common type are post-ictal headaches, and they are most likely to appear after a generalised seizure.
Collapse
Affiliation(s)
- Marta Zawadzka
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Pilarska
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Seweryna Konieczna
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Agnieszka Matheisel
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Lemska
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Sandra Modrzejewska
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | | |
Collapse
|
4
|
Zawadzka M, Mazurkiewicz-Bełdzińska M, Szmuda M, Pilarska E. Re: Field testing of ICHD-3 beta criteria of periictal headache in patients with focal epilepsy – a prospective diary study. Cephalalgia 2018; 38:2085. [DOI: 10.1177/0333102418776469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marta Zawadzka
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Pilarska
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
5
|
Jędrzejczak J, Mazurkiewicz-Bełdzińska M, Szmuda M, Majkowska-Zwolińska B, Steinborn B, Ryglewicz D, Owczuk R, Bartkowska-Śniatkowska A, Widera E, Rejdak K, Siemiński M, Nagańska E. Convulsive status epilepticus management in adults and children: Report of the Working Group of the Polish Society of Epileptology. Neurol Neurochir Pol 2018; 52:419-426. [PMID: 29937151 DOI: 10.1016/j.pjnns.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/11/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The Working Group was established at the initiative of the General Board of the Polish Society of Epileptology (PSE) to develop an expert position on the treatment of convulsive status epilepticus (SE) in adults and children in Poland. Generalized convulsive SE is the most common form and also represents the greatest threat to life, highlighting the importance of the choice of appropriate therapeutic treatment. AIM OF GUIDELINE We present the therapeutic options separately for treatment during the early preclinical (>5-30min), established (30-60min), and refractory (>60min) SE phases. This division is based on time and response to AEDs, and indicates a practical approach based on pathophysiological data. RESULTS Benzodiazepines (BZD) are the first-line drugs. In cases of ineffective first-line treatment and persistence of the seizure, the use of second-line treatment: phenytoin, valproic acid or phenobarbital is required. SE that persists after the administration of benzodiazepines and phenytoin or another second-line AED at appropriate doses is defined as refractory and drug resistant and requires treatment in the intensive care unit (ICU). EEG monitoring is essential during therapy at this stage. Anesthesia is typically continued for an initial period of 24h followed by a slow reversal and is re-established if seizures recur. Anesthesia is usually administered either to the level of the "burst suppression pattern" or to obtain the "EEG suppression" pattern. CONCLUSIONS Experts agree that close and early cooperation with a neurologist and anesthetist aiming to reduce the risk of pharmacoresistant cases is an extremely important factor in the treatment of patients with SE. This report has educational, practical and organizational aspects, outlining a standard plan for SE management in Poland that will improve therapeutic efficacy.
Collapse
Affiliation(s)
- J Jędrzejczak
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - M Szmuda
- Department of Developmental Neurology, Chair of Neurology, Medical University of Gdańsk, Poland
| | - B Majkowska-Zwolińska
- Centre for Epilepsy Diagnosis and Treatment, Foundation of Epileptology, Warsaw, Poland
| | - B Steinborn
- Department of Developmental Neurology, Poznan Univerity of Medical Sciences, Poznań, Poland
| | - D Ryglewicz
- 1st Neurological Department, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - R Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Poland
| | - A Bartkowska-Śniatkowska
- Department of Paediatric Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznań, Poland
| | - E Widera
- Clinic of Pediatrics and Neurology of Developmental Age, Medical University of Silesia, Katowice, Poland
| | - K Rejdak
- Department of Neurology, Medical University of Lublin, Poland
| | - M Siemiński
- Department of Emeregency Medicine, Medical University of Gdansk, Poland
| | - E Nagańska
- Department of Experimental and Clinical Neuropathology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
| |
Collapse
|
6
|
Zawadzka M, Szmuda M, Mazurkiewicz-Bełdzińska M. Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć. ACTA ACUST UNITED AC 2017; 49:227-234. [DOI: 10.5603/ait.2017.0042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
|
7
|
Szmuda T, Rogowska M, Słoniewski P, Abuhaimed A, Szmuda M, Springer J, Sabisz A, Dzierżanowski J, Starzyńska A, Przewoźny T. Frontal aslant tract projections to the inferior frontal gyrus. Folia Morphol (Warsz) 2017; 76:574-581. [PMID: 28553860 DOI: 10.5603/fm.a2017.0039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/11/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Frontal aslant tract (FAT) is a white matter bundle connecting the pre-supplementary motor area (pre-SMA) and the supplementary motor area (SMA) with the inferior frontal gyrus (IFG). The purpose of the present study was to evaluate the anatomical variability of FAT. MATERIALS AND METHODS Total number of fibres and the lateralisation index (LI) were calculated. We attempted to find factors contributing to the diversity of FAT regarding IFG terminations to the pars opercularis (IFG-Op) and to the pars triangularis (IFG-Tr). Magnetic resonance imaging of adult patients with diffusion tensor imaging (DTI) with total number of 98 hemispheres composed a cohort. V-shaped operculum was the most common (60.5%). RESULTS Total number of FAT fibres had widespread and unimodal distribution (6 to 1765; median: 160). Left lateralisation was noted in 64.3% of cases and was positively correlated with total number of FAT fibres and the bundle projecting to IFG-Op (p < 0.01). LI correlated with total number of FAT fibres (r = 0.43, p < 0.01). FAT projected predominantly to IFG-Op (88.9%; 88 of 99). Only in 3 (3.1%) cases more fibres terminated in IFG-Tr than in IFG-Op. Total number of FAT fibres and number of fibres terminating at IFG-Op did not correlate with the ratio of fibre numbers: FAT/IFG-Op, FAT/IFG-Tr and IFG-Op/IFG-Tr (p > 0.05). The greater total number of fibres to IFG-Tr was, the higher were the ratios of IFG-Tr/ /FAT (r = 0.57, p < 0.01) and IFG-Tr/IFG-Op (r = 0.32, p = 0.04). CONCLUSIONS Among the IFG, the major termination of FAT is IFG-Op. Whereas the IFG-Tr projection seems to be related to the expansion of the entire FAT bundle regardless of side, domination and handedness. Nevertheless, FAT features a significant anatomical variability which cannot be explained in terms of DTI findings.
Collapse
Affiliation(s)
- T Szmuda
- Neurosurgery Department, Medical University of Gdansk, Poland..
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Szmuda M, Szmuda T, Springer J, Rogowska M, Sabisz A, Dubaniewicz M, Mazurkiewicz-Bełdzińska M. Diffusion tensor tractography imaging in pediatric epilepsy - A systematic review. Neurol Neurochir Pol 2015; 50:1-6. [PMID: 26851683 DOI: 10.1016/j.pjnns.2015.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent years brought several experimental and clinical reports applying diffusion tensor tractography imaging (DTI) of the brain in epilepsy. This study was aimed to evaluate current evidence for adding the DTI sequence to the standard diagnostic magnetic resonance imaging (MRI) protocol in pediatric epilepsy. MATERIAL AND METHODS Rapid and qualitative systematic review (RAE, Rapid Evidence Assessment), aggregating relevant studies from the recent 7 years. The PubMed database was hand searched for records containing terms "tractography AND epilepsy." Only studies referring to children were included; studies were rated using "final quality of evidence." RESULTS Out of 144 screened records, relevant 101 were aggregated and reviewed. The synthesis was based on 73 studies. Case-control clinical studies were the majority of the material and comprised 43.8% of the material. Low 'confirmability' and low 'applicability' referred to 18 and 17 articles (29.5% and 27.9%), respectively. The sufficient quality of evidence supported performing DTI in temporal lobe epilepsy, malformations of cortical development and prior to a neurosurgery of epilepsy. CONCLUSIONS The qualitative RAE provides an interim estimate of the clinical relevance of quickly developing diagnostic methods. Based on the critical appraisal of current knowledge, adding the DTI sequence to the standard MRI protocol may be clinically beneficial in selected patient groups with childhood temporal lobe epilepsy or as a part of planning for an epilepsy surgery.
Collapse
Affiliation(s)
- Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland.
| | - Tomasz Szmuda
- Department of Neurosurgery, Medical University of Gdańsk, Gdańsk, Poland.
| | - Janusz Springer
- Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland.
| | - Marianna Rogowska
- Department of Neurosurgery, Medical University of Gdańsk, Gdańsk, Poland.
| | - Agnieszka Sabisz
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland.
| | | | | |
Collapse
|
9
|
Mazurkiewicz-Bełdzińska M, Szmuda M, Zawadzka M, Matheisel A. Current treatment of convulsive status epilepticus - a therapeutic protocol and review. Anaesthesiol Intensive Ther 2015; 46:293-300. [PMID: 25293482 DOI: 10.5603/ait.2014.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022] Open
Abstract
The management of status epilepticus (SE) has changed in recent years. Substantial differences exist regarding the definition and time frame of a seizure, which has been operationally defined as lasting for 5 min. Not only have many new intravenous drugs, such as levetiracetam and lacosamide been introduced but other routes of administration, such as intranasal or buccal administration for midazolam, are also being developed. Optimal and successful therapy initiated at the appropriate moment, adequately tailored to the clinical state of the patient, determines the first step in the normalisation of vital functions and leads to the restoration of the physiological homeostatic mechanisms of the organism. The aim of this review is to present the current treatment options for the management of convulsive status epilepticus (CSE) that have been widely confirmed as the most effective in clinical trials and approved by the international neurology authorities as the actual therapeutic standards. We also intend to indicate distinct and unequivocal differentiation and therapeutic indications for each phase of CSE, including the precise doses of the related medications, to present practical guidelines for clinicians. The treatment of patients with CSE requires emergency physicians, neurologists and specialists in intensive care to work together to provide optimal care that should be initiated as soon as possible and conducted as a unified procedure to improve neurocritical care in patients who are transferred from the ambulance service, through the emergency department and finally to the neurology department or ICU. Appropriate treatment also involves avoiding mistakes associated with inadequate doses of medications, overdosing a patient or choosing an inappropriate medication.
Collapse
|
10
|
Mazurkiewicz-Bełdzińska M, Szmuda M, Zawadzka M. Internuclear opthalmoplegia as a symptom of ischemic stroke in a girl with patent foramen ovale. Pediatr Neurol 2015; 52:466-7. [PMID: 25682482 DOI: 10.1016/j.pediatrneurol.2014.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | - Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Zawadzka
- Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
11
|
Szmuda T, Sloniewski P, Waszak PM, Springer J, Szmuda M. Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review. J Neurointerv Surg 2015; 8:488-94. [PMID: 25792038 DOI: 10.1136/neurintsurg-2015-011665] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/02/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Owing to their peculiar features and rare occurrence, ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery are challenging by both surgical and endovascular approaches and their proper management is uncertain. We therefore aimed to define the currently optimal treatment of ruptured BBAs in terms of mortality, outcome, rebleeding, and recurrence. METHOD An in-depth search of electronic databases, gray literature and internet resources for ruptured BBAs was performed and complemented by data retrieval during neurosurgical congresses. Clinical and radiological characteristics, intervention details, outcomes, and the impact factor of the source journal were pooled. RESULTS The pooled cohort comprised 311 patients. Neither surgical nor endovascular methods had an impact on clinical outcome, aneurysm regrowth, remote bleeding, or complication rate. By contrast, aneurysm clipping was a predictor of intraoperative bleeding (OR 6.5; 95% CI 1.2 to 34.3), and stent-assisted coiling increased the likelihood of a second treatment (OR 4.1; 95% CI 1.3 to 13.1), its conversion to another modality (OR 4.7; 95% CI 1.4 to 16.0), and incomplete aneurysm obliteration (OR 2.6; 95% CI 1.0 to 6.6). Higher impact journals were more likely to publish papers on endovascular techniques, particularly flow-diverter stents. CONCLUSIONS None of the methods is unequivocally superior. Considering its inefficiency, stent-assisted coiling should be undertaken with caution. A time-delimited systematic review is needed to establish the most accurate treatment for ruptured BBAs.
Collapse
Affiliation(s)
- Tomasz Szmuda
- Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland
| | - Pawel Sloniewski
- Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland
| | - Przemyslaw M Waszak
- Students Scientific Association at Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland
| | - Janusz Springer
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
| | - Marta Szmuda
- Developmental Neurology, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
12
|
Szmuda T, Sloniewski P, Szmuda M, Springer J, Waszak P. Letter to the Editor: Internal carotid artery anterior wall aneurysms. J Neurosurg 2014; 121:221-3. [DOI: 10.3171/2014.1.jns132871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
13
|
Szmuda T, Słoniewski P, Szmuda M, Waszak PM, Starzyńska A. Quantification of white matter fibre pathways disruption in frontal transcortical approach to the lateral ventricle or the interventricular foramen in diffusion tensor tractography. Folia Morphol (Warsz) 2014; 73:129-38. [DOI: 10.5603/fm.2013.0063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/27/2013] [Accepted: 08/31/2013] [Indexed: 11/25/2022]
|
14
|
Mazurkiewicz-Bełdzińska M, Szmuda M, Matheisel A. Long-term efficacy of valproate versus lamotrigine in treatment of idiopathic generalized epilepsies in children and adolescents. Seizure 2010; 19:195-7. [PMID: 20167512 DOI: 10.1016/j.seizure.2010.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 01/19/2010] [Accepted: 01/22/2010] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In order to estimate and compare the long-term effectiveness of lamotrigine (LTG) versus valproate (VPA) monotherapy in treatment of newly diagnosed idiopathic generalized epilepsies (IGE) the following study was performed. METHODS Medical records of 214 children and adolescents suffering from IGE were analyzed. 132 of them were on VPA monotherapy, 82 on LTG. The majority of patients had juvenile myoclonic epilepsy - 98, the rest: juvenile absence epilepsy - 32, childhood absence epilepsy - 53 and epilepsy with a tonic-clonic seizures on awakening - 12, others - 19. Mean age of the patients was 8.9 years (range 4-16 years). The mean time of treatment was 28 months, time of observation 40 months. In order to estimate retention rates and factors predicting successful treatment with LTG and VPA we used Kapplan-Meyer analysis and Gehan tests. RESULTS Data analysis showed significantly longer retention rates with VPA versus LTG treatment in overall rates as well in all syndromes subgroups. After 12 months of therapy 69% stayed on LTG therapy versus 89% on VPA, after 24 months 57% versus 83% respectively. VPA showed comparable efficacy in all IGE syndromes where LTG showed better efficacy in childhood and juvenile absence epilepsy than in juvenile myoclonic epilepsy. The shorter duration of treatment with LTG was due to lack of efficacy. CONCLUSIONS Our results show the superiority of VPA versus LTG treatment in idiopathic generalized epilepsy syndromes.
Collapse
|
15
|
|
16
|
Lemka M, Pilarska E, Szmuda M, Pienczk-Recławowicz K. [Sporadic hemiplegic migraine in a 14-year-old boy--a case report]. Neurol Neurochir Pol 2009; 43:579-583. [PMID: 20054761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hemiplegic migraine is a specific form of migraine with aura including hemiparesis. It is a rare condition of unclear aetiology. The authors present a case of a 14-year-old boy with persistent foramen ovale, suffering from sporadic hemiplegic migraine. The authors broadly describe the symptoms and types of hemiplegic migraine as well as underlining diagnostic and therapeutic difficulties of the attacks. The patient suffered from recurrent severe headaches, vomiting and co-existing focal neurological symptoms, including alternant hemiparesis. On the basis of the history, thorough clinical observation and numerous accessory investigations a diagnosis of sporadic hemiplegic migraine was established. However, the last attack, with prolonged neurological deficits, was treated as a complication of migraine and defined as persistent aura without infarction. The authors also broadly discuss a differential diagnosis, including other stroke-like incidents, vascular diseases, immunological and mitochondrial disorders that mimic the symptoms and clinical course of sporadic hemiplegic migraine.
Collapse
Affiliation(s)
- Małgorzata Lemka
- Klinika Neurologii Rozwojowej, Gdański Uniwersytet Medyczny, ul. Debinki 7, 80-952 Gdańsk.
| | | | | | | |
Collapse
|
17
|
Mazurkiewicz-Bełdzińska M, Szmuda M, Matheisel A. Correlation of neuroradiological, electroencephalographic and clinical findings in cortical dysplasias in children. Folia Neuropathol 2006; 44:314-8. [PMID: 17183458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Cortical dysplasias (CD) are defined as malformations of cortical development. They result from impairment of neuronal proliferation, migration and differentiation. CD are common pathological substrates in patients with early-onset childhood epilepsy and/or developmental delay as well as neurological signs. Recognition of the importance of cortical dysplasias has been shown in many studies when introducing structural MRI. The following study was performed in order to correlate the neuroimaging findings with the electroencephalographic and clinical picture of children with cortical dysplasias. MATERIALS AND METHODS 46 patients with the presence of CD features in MRI were identified. There were 18 female and 28 male patients. The age ranged from 3 months to 12 years (mean age = 6.2, median age = 3.1). The objectives of the study were explained to the parents or legal representatives of children when possible and also informed consent was obtained. Multiple EEG recordings as well as detailed clinical analysis of all patients were performed. Statistical analysis was conducted in order to correlate the type of CD with clinical outcome and electrophysiological findings. RESULTS There were 31 patients with focal dysplasias, 6 with schizencephaly, 4 with heterotopias, 3 lissencephaly and 2 with band heterotopia. 80% presented epilepsy (60% of them drug-resistant). Additionally, we tried to elucidate the clinical characteristics of epilepsy. In 75% of epilepsy patients the electroencephalographic changes correlated with anatomical localization of CD. 74% of patients were mentally retarded and 30% had focal neurological deficits. CONCLUSIONS There were no correlations between the type of CD and the severity of the clinical picture, especially the level of mental retardation and presence of drug-resistant epilepsy. Different age at epilepsy onset and various responsiveness to antiepileptic drugs in the majority of patients may reflect different dynamics in epileptogenicity of the underlying CD.
Collapse
Affiliation(s)
- Maria Mazurkiewicz-Bełdzińska
- Department of Developmental Neurology, Chair of Neurology, Medical University of Gdansk, ul. Debinki 7, 80-952 Gdansk, Poland.
| | | | | |
Collapse
|