SUMMARYPurpose: The identification of the epileptic zone in patients with mesial temporal lobe epilepsy sometimes requires intracranial recordings, for example, with foramen ovale electrodes (FOE). This paper reviews and analyzes the resulting complications in a series of patients studied with bilateral FOE for presurgical evaluation. Prior to performing surgery for refractory mesial temporal lobe epilepsy (MTLE), the epileptogenic zone must be correctly identified (Lüders and Awad, 1991;Engel et al., 1997;Sola, 1997). While noninvasive tests are usually adequate, invasive video-EEG monitoring methods are sometimes required (Boon and Williamson, 1989;Wieser and Williamson, 1993). These can include the use of foramen
The term neurophobia was defined by Jozefowicz as "a fear of the neural sciences and clinical neurology that is due to the students' inability to apply their knowledge of basic sciences to clinical situations, leading to a paralysis of thought or action". In this paper we review what we see as the key aspects of neurophobia. What gives rise to it? Notable among multiple causes are how basic and clinical neurosciences are taught, the peculiarities of neurological patient history, examination and differential diagnosis in the field, and how neurology and neurologists are seen from outside the field. We will also review the extent of the issue, for in view of its prevalence, many students will reject a specialty in increasing demand (as the incidence of neurological disorders will not cease to grow), along with its consequences: more patient referrals to neurology (owing to neurophobia or defensive medicine), or overprescription of ancillary tests for diagnosis. Finally we will look at the solutions proposed, especially those aiming to bring about changes in the form and content of teaching, how the teaching of neurological examination and of new technologies is to be approached, and the use of those technologies as teaching aids. DefinitionThe term neurophobia was first used by Poser in 1959(Poser, 1959, though we owe its durable definition to Jozefowicz: "a fear of the neural sciences and clinical neurology that is due to the students' inability to apply their knowledge of basic sciences to clinical situations, leading to a paralysis of thought or action" (Jozefowicz, 1994). Neuroscience truly does engender anxiety in medical students, and this continues when on starting their clinical activity they are faced with neurological patients; if doctors are not trained in neurology, neurological examination and its interpretation will remain a real mystery.Hernando-Requejo V MedEdPublish https://doi. CausesIn this section we will consider what give rise to neurophobia. Notable among its multiple causes are how basic and clinical neurosciences are taught, the peculiarities of neurological patient history, examination and differential diagnosis in the specialty, and how neurology and neurologists are perceived from outside the field. Basic neuroscienceA common denominator in studies is to regard the separation of clinical and basic disciplines as the chief cause of neurophobia, especially if the latter are separated into neuroanatomy, neurophysiology, neuropathology and neuropharmacology (Fantaneanu et al., 2014;Pakpoor et al., 2014), for these subjects are normally taught by different specialists not linked to each other or to clinical practice. Moreover a lack of knowledge of basic neuroscience is one of the main reasons why medical students would reject a neurology residency (Gupta et al., 2013). In his 1994 paper, Jozefowicz asserts that for students, separating the (basic) "science" and the (clinical) "art" makes the former irrelevant and the latter mystical (Jozefowicz, 1994).A 2018 study by Tarolli et al. with a sa...
Background. Wernicke's encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency. It is mainly related to alcohol abuse but it can be associated with other conditions such as gastrointestinal disorders. This vitamin deficiency can also present with cardiovascular symptoms, called “wet beriberi.” Association with folate deficit worsens the clinical picture. Subject. A 70-year-old man with gastric phytobezoar presented with gait instability, dyspnoea, chest pain associated with right heart failure and pericarditis, and folate deficiency. Furosemide was administered and cardiac symptoms improved but he soon developed vertiginous syndrome, nystagmus, diplopia, dysmetria, and sensitive and motor deficit in all four limbs with areflexia. Results. A cerebral magnetic resonance imaging (MRI) showed typical findings of WE. He was immediately treated with thiamine. Neurological symptoms improved in a few days and abnormal signals disappeared in a follow-up MRI two weeks later. Conclusion. Patients with malabsorption due to gastrointestinal disorders have an increased risk of thiamine deficiency, and folate deficiency can make this vitamin malabsorption worse. An established deficiency mainly shows neurological symptoms, WE, or rarely cardiovascular symptoms, wet beriberi. Early vitamin treatment in symptomatic patients improves prognosis. We recommend administration of prophylactic multivitamins supplements in patients at risk as routine clinical practice.
Introduction. Recently, we have published the results of a first surgical series of patients with temporal lobe epilepsy (TLE). We describe a posterior series of patients intervened of TLE, we compare the functional results with the previous series and we finally analyze the causes of changes. Patients and methods. We studied the first 22 consecutive patients surgically intervened of TLE with a minimum post-surgery follow-up of 2 years. Patients showing I and II Engel's grade were used as gold standard for evaluation of pre-surgical complementary studies. Results. We have obtained better functional results: 91% patients showing Engel's grade I, 9% showing grade II and neither III nor IV grades were obtained. Pre-surgical studies changed in comparison with the previous report. The most improving change was observed in video-EEG with foramen-ovale electrodes (FOE) (37%), scalp EEG (26.6%), interictal SPECT (11.7%) and MRI (11.7%). Video-EEG with FOE was the study than showed greater concordance with epileptic focus (95.5%), followed by EEG (86.4%). In 35% of cases, MRI was normal or without valid data for correct localization of focus. Conclusions. Video-EEG with FOE and TLE surgery are safety methods, which results improve with the experience. Normal or not informative MRI do not should a priori reject those patients with drug-resistant TLE from surgery.
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