We describe 13 patients with neurological signs and symptoms associated with Mycoplasma pneumoniae infection. M. pneumoniae was isolated from the cerebrospinal fluid (CSF) of 9 patients: 5 with meningoencephalitis, 2 with meningitis, and 1 with cerebrovascular infarction. One patient had headache and difficulties with concentration and thinking for 1 month after the acute infection. M. pneumoniae was detected, by means of PCR, in the CSF of 4 patients with negative culture results. Two had epileptic seizures, 1 had blurred vision as a consequence of edema of the optic disk, and 1 had peripheral nerve neuropathy.
Summary:Purpose: To investigate the risk of illnesses in a cohort of patients with epilepsy and in matched nonepilepsy controls, by type and complications.Methods: A total of 951 children and adults with idiopathic, cryptogenic, or remote symptomatic epilepsy and 904 matched controls seen in secondary and tertiary centers in eight European countries (England, Estonia, Germany, Italy, the Netherlands, Portugal, Russia, Slovenia) were followed prospectively for 17,484 and 17,206 person-months and asked to report any spontaneous complaint requiring medical attention (illness), its type and complications (hospitalization, absence from work or school, medical action). Risk assessment was done by actuarial methods, relative risks (RR), and 95% confidence intervals (CIs).Results: During the study period 644 patients (68%) and 504 controls (56%) reported an illness (p < 0.0001); 30% were seizure related. The cumulative probability of illness at 12 and 24 months was 49 and 86% in the cases and 39 and 75% in the controls (p < 0.0001). The largest differences regarded disorders affecting the nervous system (NS) (RR, 3.3; 95% CI, 2.3-4.2) and ear, nose, and throat (ENT) (RR, 1.3; 95% CI, 1.0-1.6). In patients with epilepsy, an NS illness was more likely to be followed by hospital admission, work absence, or medical intervention. All risks were significantly reduced after excluding seizure-related events.Conclusions: Patients with epilepsy are at higher risk of NS and ENT illnesses and complications than the general population. However, the risk of illness is significantly reduced when seizure-related events are excluded. Key Words: EpilepsyMorbidity-Illnesses.Patients with epilepsy have been thought to have a higher risk of illness than the general population, but comorbidity in epilepsy has been investigated in few population-based prevalence or analytic studies. Other clinical conditions and disabilities were reported by 47% of adults with epilepsy in Sweden, with psychiatric, cardiovascular, pulmonary, systemic, and renal diseases in decreasing order (1). Lifetime mental and gastric disorders were reported by 7 and 3% of adults with childhoodonset epilepsy in the Czech Republic (2). In Finland, somatic comorbidity was found in 84-95% of patients with childhood-onset epilepsy and 67-74% of controls (3). In a multicenter European cohort study of children and adults with idiopathic, cryptogenic, or remote symptomatic epilepsy, we found one or more illnesses at entry in 30% of cases compared with 17% of age-and sex-matched controls (4).These contrasting results may be explained by differences in the study populations and in the study design and methods. In addition, the morbidity risk attributable Accepted September 14, 2003. Address correspondence and reprint requests to Dr. E. Beghi at Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea 62, 20157 Milano, Italy. E-mail: beghi@marionegri.it to the disease cannot be explored in studies on the prevalence of other clinical conditions in epilepsy. For these reasons, i...
Episodic cluster headache is a well-recognized entity usually starting in the second decade of life. Uncommonly, the first typical symptoms may present in the first decade of life, but are rarely recognized as such during childhood. We report a 12-year-old girl who presented with a 1-year history of bouts of right-sided hemicrania with ipsilateral, clearly demarcated, redness and itching of the skin of the face, lasting from 15 minutes to 2 hours per day. The episodes recurred up to several times daily for a few days and were followed by remissions lasting up to 2 months. Thorough investigations failed to prove any definite cause. Antihistamine prophylaxis, first with astemizole and then with Ioratadine, proved to be very effective. During the follow-up period of more than 3 years, such a prophylactic regimen provided excellent relief, with only two relapses due to noncompliance. We suggest that in a sequential treatment trial for cluster headache during childhood, antihestamines should have their place, especially in those cases where clinical evidence may suggest histamine involvement.Key words: cluster headache, childhood, Ioratadine prophylaxis, urinary methylhistamine (Headache 1997;37:296-298) Episodic cluster headache is defined as a severe unilateral head or facial pain, which lasts from 15 minutes to 3 hours and is commonly associated with conjunctival injection, lacrimation, and nostril blockage on the same side. Attacks can occur once or several times daily for a period of weeks or months. 1 Attacks with the same characteristics but of briefer duration and recurring more frequently (up to 30 times) during the day were named chronic paroxysmal hemicrania (CPH) by Sjaastad and Dale in 19762 and were reported to respond well to indomethacin. Also an episodic form was recognized with very frequent daily attacks lasting for a few weeks followed by a long symptom-free period with relapses only after months or even years. 3 To avoid different terminology for all these forms, the term "cluster headache syndrome" was proposed. 4 The pathophysiology of cluster headache is still unclear. Histamine-induced attacks in susceptible individuals were recognized in 1941 by Horton 5 whose name is sometimes used as an eponym for this type of headache. Some authors have detected high levels of histamine in blood during the attacks, 6,7 but treatment with antihistamine drugs was usually described as useless in such cases. 8 CASE HISTORYA 12-year-old girl was referred to our outpatient department with possible trigeminal neuralgia. Detailed history revealed that she had been suffering for more than a year from occasional paroxysmal attacks of right-sided hemicrania associated with ipsilateral itching of facial skin and clearly demarcated areas of purple-redness. These attacks usually lasted for 15 minutes, but were occasionally prolonged up to 2 hours and resolved spontaneously. Up to four attacks could occur in a day in a cluster manner. Remissions between the attacks were of variable duration, not exceeding 3 months. N...
The lack of unified procedures pertaining to the evaluation and therapy of epilepsy is reflected by marked differences in access to treatment modalities for patients from CEEU countries.
One hundred and fifty children with febrile convulsions (FC) were followed up for 3–10 years. They were divided into two groups: group A consisted of 120 children whose disorder was under control, and group B 30 patients in whom the disorder was not under control. Risk factors for uncontrolled FC and later development of epilepsy were looked into. In group A, 8 patients (6.6%) developed epilepsy, while another 3 (2.5%) had a single afebrile seizure. In group B, 10 (33.3%) children developed epilepsy, while 1 (3.3%) had a single afebrile seizure. The difference in the later occurrence of epilepsy between the two groups was statistically significant.
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