Littérature scientifique sur le sujet « Convulsive event »

Convulsive status epilepticus is a relatively frequent event that requires a quick picture of the situation and an early and appropriate treatment with subsequent levels of intervention. It is important that the pediatrician, as well as the emergency room physician or the resuscitator are well aware of the early stages of crisis management, both at the local and hospital level. The final outcome of the event will depend above all on the timeliness and appropriateness of the decisions taken, without forgetting that, sometimes, status epilepticus can originate from acute events that, if present, must also be identified and treated appropriately.

Ischemic and traumatic brain injuries often induce non-convulsive seizures (NCSs), which likely contribute to the worsening of neurological outcomes. Here, we evaluated the effect of glycyl-l-methylprolyl-l-glutamic acid (NNZ-2566) to lessen the severity of NCSs caused by permanent middle cerebral artery occlusion (pMCAo). Continuous electroencephalographic recordings were performed in rats during pMCAo. Glycyl-l-methylprolyl-l-glutamic acid (3, 10, or 100 mg/kg bolus followed by an infusion of a fixed dose of 3 mg/kg per hour for 12 h) was delivered at 20 mins after pMCAo (before the first NCS event) or delayed until immediately after the first NCS event occurred. Control rats received pMCAo and saline treatment. The results revealed that 91% of the saline-treated animals had NCSs (23 episodes per rat and 1238 secs per rat) with an onset latency of 35 mins after injury. When NNZ-2566 was administered before the NCS events, it dose-dependently reduced the NCS incidence to 36%–80%, decreased NCS frequency to 5–16 episodes per rat, and shortened the total duration of NCS to 251–706 secs per rat. The two high doses significantly reduced the infarct volume by 28%–30%. Delayed treatment also attenuated NCS duration but had no effect on the infarct volume. Results indicate that NNZ-2566 possesses a unique therapeutic potential as a safe prophylactic agent that synergistically provides neuroprotection and reduces injury-induced seizures.

Objetivo: Los antipsicóticos son medicamentos que pueden disminuir el umbral convulsivo. La clozapina es un antipsicótico atípico usado en el tratamiento de la esquizofrenia resistente a los antipsicóticos convencionales y está asociado a convulsiones como efecto adverso. Caso clínico: Varón de 28 años con diagnóstico de esquizofrenia paranoide que ingresó a un servicio de psiquiatría de un hospital general por síntomas psicóticos de difícil manejo. Por la persistencia de los síntomas psicóticos a pesar del uso de medicación antipsicótica, y la ideación suicida, se decidió el inicio de clozapina. Presentó dos crisis convulsivas, la primera con 700 mg/d de clozapina y la segunda con 600 mg/d, que remitieron tras la suspensión de este antipsicótico. Debido a este evento adverso, no se reinició la clozapina y se inició la terapia electroconvulsiva, con una respuesta clínica favorable. Resultados: La clozapina es uno de los antipsicóticos que más se asocia a la disminución del umbral convulsivo y que no contraindica su uso. Conclusiones: Si bien en el caso presentado se suspendió la clozapina por la aparición de dos eventos convulsivos, y se decidió el uso de la terapia electroconvulsiva con una respuesta clínica favorable, existen otras estrategias que pueden utilizarse para el manejo de este efecto adverso.

Of the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP), higher frequency of seizures is a very consistent issue. Following this reasoning, it has been established that hemodialysis-associated seizure is a complication of dialysis procedure. Based on these facts, this study investigated a possible association between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program. For that, a retrospective medical history of 209 patients was reviewed to investigate the occurrence of convulsive seizures and EKG abnormalities during dialytic program. Three patients presented generalized tonic-clonic seizures, one had partial seizure with secondary generalization, and one presented unclassified seizure. Any EKG abnormalities and SUDEP event were found in all patients evaluated. In conclusion, the present findings demonstrated uncommon the occurrence of seizures and also SUDEP. Probably, the main justification to not allow us to demonstrated a direct relation between SUDEP and cardiovascular diseases in hemodialysis are the reduced number of cases examined.

No abstract available. Article truncated after 150 words. History of Present Illness A 35-year-old African-American man with a history of alcohol abuse presented to Emergency Department after he was found down. He was seen by a passerby on the street who witnessed the patient fall with a possible convulsive event. He was brought in by ambulance and was unconscious and unresponsive. PMH, SH, and FH The patient had a history of prior ICU admission in Yuma with septic shock secondary to a dental procedure requiring a tracheostomy in 2018. He also had a history of alcohol intoxication requiring an ED visit about 10 years ago and history of sickle cell trait. Per chart review, the patient took no home medications. Further history was unable to be obtained due to the patient's condition. Physical Examination On arrival the patient had a core temperature of 41°C, systolic blood pressure in the 70s-80s, heart rate of 185, respiratory rate of 19 …

La radio-telemetria è una tecnologia di segnali radio che permette mediante radio-trasmittenti cronicamente impiantati di registrare parametri fisiologici da animali liberi di muoversi. Il video è una metodologia innovativa che permette mediante software dedicati (l'es. EthoVision XT), una misura quantitativa e qualitativa delle attività comportamentali. Lo scopo di questa attività di ricerca è di evidenziare i vantaggi dell’applicazione di un modello video, telemetrico nel ratto. 34 ratti (Sprague-Dawley) maschi sono stati impiantati con una sonda telemetricica (TL10M3-F50-EEE); gli elettrodi furono messi sulla dura madre per registrare l’EEG corticale (EEGc), nel giro dentato per la registrazione dell’EEG ippocampale (EEGhipp) e sul muscolo cervicoauricolare (muscolo del collo) per la registrazione muscolare (EMG). Questa ricerca aveva tre obiettivi principali: - Analizzare la relazione tra la condizione ambientale (arricchimento o non, gli stimoli olfattori o non) e parametric fisiologici quali sonno e attivita’ theta. In bibliografia molti studi hanno mostrato cambiamenti significativi su animali di laboratorio messi in condizioni ambientali diverse a livello morfologico e comportamentale, ma solamente pochi e non recenti lavori hanno valutato effetti di queste condizioni su modello di sonno. Inoltre, alcuni dati suggerirono una correlazione tra attività elettriche cortical, ippocampale ed olfatto. 8 ratti furono messi in gabbie sperimentali (PhenoTyper) per l'acclimatamento e 4 animali su 8 hanno ricevuto l'arricchimento ambientale. I segnali EMG, EEGc ed EEGhipp tramite la telemetria e le attività locomotorie tramite video furono registrate continuamente per 24h immediatamente dopo l’introduzione dell’arricchimento (la Fase 1), dopo 3 giorni di permanenza dell'animale nella gabbia arricchita (la Fase 2). Tre giorni dopo questa ultima registrazione, tutti gli animali hanno ricevuto uno stimolo olfattorio (2 goccie di bergamotto e 2 gocce di limone) ogni mattina pe 4 giorni ed e’ stata effettuata una registrazione telemetrica (EMG,EEGc e EEGhipp) e video il primo e il quarto giorno dall’introduzione dello stimolo. Tutti i video furono analizzati tramite Ethovision e sui tracciati elettroencefalografici furono fatti l’analisi del sonno e dell’attivita’ theta. L’analisi video mostro’ un aumento dell’attivita’ motoria solo il primo giorno dall’introduzione dell’arricchimento. Questo puo’ essere spiegato dal fatto che gli animali aumentano l’attivita’ motoria esplorando maggiormente la gabbia dopo l’introduzione dell’arricchimento. Nessuna differenza e’ stata riscontrata dopo l’introduzione dello stimolo olfattivo. Nell’ analisi dell’attivita’ theta e’ stata considerata la differenza tra le fasi in cui gli animali hanno ricevuto lo stimolo nuovo e le fasi in cui gli animali si sono gia’ abituati allo stimolo. In dettaglio gli animali che non avevano ricevuto l’arricchimento ambientale mostrarono un aumento dell’attivita’ theta tre volte maggiore rispetto a quelli che l’avevanno ricevuto. Questo risultato puo’ indicare che un solo stimolo puo’ aumentare l’attivita’ theta piu’ che stimuli associate. Tutti questi risultati suggeriscono come sia importante controllare e valutare sempre le procedure usate in laboratorio per garantire l’attendibilita’ dei dati. - Analizzare il rapporto tra crisi e convulsioni (tracce EEG versus osservazioni comportamentali); Uno dei modelli più frequentemente utilizzati per valutare l’attivita’ pro-convulsante e anticonvulsionante dei farmaci e’ il modello di convulsione indotto dal pentiletetrazolo (PTZ). 6 animali sono stati somministrati con veicolo (saline) e, il giorno successivo, con PTZ per via intraperitoneale a 40 mg / kg. Due settimane prima del trattamento PTZ e il giorno di trattamento, i segnali di telemetria (EMG, EEGc e tracce EEGhipp) e i video sono stati registrati contemporaneamente e continuamente, a partire da 1 ora prima del trattamento fino a 23 ore dopo il trattamento. Su ogni condizione sperimentale (basale, veicolo e PTZ) l'attività motoria spontanea è stata analizzata con il software Ethovision XT. I tracciati di telemetria sono stati poi analizzati con Neuroscore Software 1 ora prima del trattamento fino a 4 ore dopo il trattamento. Eventi parossistici sono stati classificati come convulsioni quando almeno 4 picchi erano rilevabili in una registrazione EEGc (≥ 3 sec; intervalli di 1 sec minimo), caratterizzato da un incremento di ampiezza 1,5 volte quello basale. Alterazioni EEGc, meno di 3 secondi, sono stati classificati come treni di spike. Il gruppo somministrato con PTZ ha mostrato un aumento significativo dei parametri motori rispetto al basale e al gruppo di veicolo. Dal momento che le tracce EEGc e EEGhipp presentato caratteristiche simili, abbiamo focalizzato la nostra attenzione sulla traccia di EEG corticale. Dobbiamo notare che, indipendentemente dalla manifestazione della convulsione, tutti gli animali hanno mostrato alterazioni elettriche. Un solo animale non ha mostrato un evento comportamentale tonico clonico ma ha evidenziato un numero molto più elevato di treni di spike e di seizure elettriche, confermando l'estrema importanza di questa prima finestra, che è assolutamente trascurato in una semplice osservazione del comportamento. Abbiamo riscontrato due sottopopolazioni in base alla latenza di convulsione: gli animali caratterizzati da minore latenza hanno sviluppato una più grave crisi epilettica post-convulsivi. Possiamo quindi ipotizzare che la predisposizione singolare PTZ è predittivo della gravità della patologia. Questo lavoro di ricerca dimostra l'importanza di eseguire radio-telemetria EEG combinato con il monitoraggio video sincronizzato, nel modello acuto indotto da PTZ. In particolare il modello video-tEEG distingue anomalie nei modelli di EEG, in assenza di segni comportamentali, tenendo anche conto della variabilità inter-individuale. - Valutare la fattibilità dell'integrazione di un sistema video telemetrico ed elettroencefalografico con un sistema per il prelievo di sangue sequenziale. L'inserimento di un catetere nella vena femorale è un metodo ampiamente usato in studi pre-clinici per consentire la raccolta di campioni di sangue a tempi stabiliti per ottenere un profilo farmacocinetico (PK-PD). 6 animali telemetrici sono stati sottoposti ad un secondo intervento chirurgico per la cannulazione cronica della vena femorale. Il catetere è stato esteriorizzato nella regione interscapolare e il ratto è stato dotato di una giacca per consentire la protezione del catetere e la sua connessione con la molla di protezione del catetere. Dopo un recupero post-intervento chirurgico di 5-6 giorni tutti gli animali sono stati messi nelle gabbie gabbie PhenoTyper . Il catetere è stato inserito in una molla metallica lunga 45 cm collegato ad un braccio che è stato fissato direttamente alla parete della gabbia. Al fine di mantenere la pervietà del catetere femorale durante tutta la procedura sperimentale, si è continuamente infuso con pompa una soluzione fisiologica eparinizzata (25UI/mL eparina a 0,2 mL / h ). Al fine di ottenere le concentrazioni plasmatiche esattamente quando un evento comportamentale di convulsione veniva osservato, tutti i ratti sono stati trattati con un composto di prova noti per indurre convulsioni comportamentali; video e segnali di telemetria (EMG, EEGc e tracce EEGhipp) sono stati registrati contemporaneamente e continuamente , a partire da 1 ora prima del trattamento fino a 4 ore post-dose. I campioni di sangue (300 microlitri di sangue / tempo) prelevati dal catetere sono stati raccolti manualmente nel pre-dose, a tre punti di tempo stabiliti dopo la somministrazione e ad ogni occasione, quando un episodio comportamentale si osserava. Tutti i campioni di sangue richiesti sono state raccolti con successo anche in occasione di eventi convulsivi comportamentali. I video sono stati analizzati con il software Ethovision XT e il software è stato in grado di monitorare gli animali anche in presenza di ulteriori attrezzature necessarie per il prelievo, a conferma che questo set up non ha compromesso in alcun modo l'analisi dell’ attività motoria spontanea. L’integrazione del sistema video e telemetrico con un sistema per il prelievo di sangue a tempi stabiliti può essere utilizzato in indagini pre-clinici per meglio definire il profilo farmacocinetico e farmacodinamicodi un farmaco che induce convulsioni o crisi epilettiche, consentendo di rendere più sicuri e prevedibili gli studi in fase clinica.
The radio-telemetry is a technology of radio-signals recording from chronically implanted radio-transmitters to investigate less invasively physiological parameters from freely moving animals. The video image is an innovative methodology which allows capturing the behavioural patterns and dedicated software-hardware systems (es. EthoVision XT), using video tracking technologies, allow the quantitative and qualitative measure of the behavioural activities. The aim of present research activities is the application of a new Video-Telemetry EEG (Video-tEEG) Model in the Rat. Thirty-four male Sprague-Dawley rats were intraperitoneally implanted with a telemetric transmitter (type TL10M3-F50-EEE); EEG leads were placed on the dura mather for cortical EEG (EEGc) recording and deep to the dentate gyrus for the hippocampal EEG (EEGhipp) recording; the third couple of leads was secured to the musculus cervicoauricolaris (neck muscle) for the EMG recording. This research had three principal objectives: 1- Analyze the relation between environmental condition (enrichment or not, olfactory stimuli or not), behavioural/sleep pattern and theta activity; Following differential experiences provided by enriched environmental conditions, several studies have shown significant changes in laboratory animals at morphological and behavioural levels, but only few and not recent works evaluated effects of these conditions on sleep pattern. Besides, some data suggested the correlations between cortex, hippocampal electrical activities and olfaction. 8 rats were placed into the experimental PhenoTyper® cages for habituation. 4 of 8 animals received novel environmental enrichment. From these rats EMG, EEGc and EEGhipp signals by telemetry and the general activity information by video were recorded continuously for 24h immediately after this enrichment change (Phase 1) then continuously for 24h after 3 days of permanence of the animal into the enriched cage (Phase 2). Three days after this last registration, all 8 animals received olfactory stimuli (2 drops of bergamot and 2 of lemon essential oil) every morning for 4 days. From these rats 24h telemetric signals (EEGc, EEGhipp and EMG) and videos were recorded immediately after the first olfactory stimuli (Phase 3) and on the 4th day of olfactory stimulation (Phase 4). From the whole 24h period videos, spontaneous motor activity was analysed by automated video-tracking with Ethovision XT software. Sleep analysis by EEGc and EMG traces and theta activity by EEGhipp were performed in all recorded 24h telemetric traces. The video-tracking analysis showed that the novel environmental enrichment induces in rats an increase of motor activity which is not observed after 2 days by novel objects introduction. The novel enrichment takes animals to enhance cage’s exploration and so to increase their motor activity, but this effect is not observed after some days by novelty, likely due to animals to become accustomed to the enrichment presence. Instead, after introduction of novel olfactory stimuli (Phase 3) and after 4 daily reinforced olfactory stimuli (Phase 4), no differences were found between enriched and not enriched environmental groups of the same phase in any considered motor parameters. The theta activity analysis showed that there is a light difference between time of theta activity during the first day by introduction of enrichment or olfactory stimuli in all animals with or without environmental enrichment. Otherwise the interesting result is the value of delta considering the differences between olfactory phase (Phase 4) and enrichment phase (Phase 2) and so focus on the stimuli after “habituation”. In details, the animals which didn’t receive enrichment showed an increase of theta activity almost three times than animals with environmental enrichment. This result should indicate that a single stimulus (olfactory stimuli) induces an increase of theta activity bigger than more stimuli associated together. All these results suggest how it is important to check any possible influence of test conditions and also the routine laboratory procedures like cleaning, in order to ensure the reliability and daily repeatability of experimental data. 2- Analyze the relation between seizures and convulsions (EEGs traces versus behavioural observations); One of the most frequently used model for assessing pro-convulsant/anticonvulsant drugs activity and to identify pharmaceuticals that may alter seizure susceptibility is the pentylentetrazol (PTZ)-induced convulsion model. Six telemetric animals were injected with vehicle (saline) and, the following day, with PTZ freshly dissolved in the vehicle and administered intraperitoneally at 40 mg/kg dose. Two weeks before PTZ treatment and the day of treatment, telemetric signals (EMG, EEGc and EEGhipp traces) and videos were recorded simultaneously and continuously, starting 1 hour before treatment until 23 hours after treatment. On each experimental condition (baseline, vehicle- and PTZ-injection) from 23h period videos, spontaneous motor activity was analysed by automated video-tracking with Ethovision XT software. Telemetry traces were then analysed with Neuroscore Software starting 1 hour before treatment until 4 hours after treatment. Paroxysmal events were categorized as seizures when at least 4 peaks were detectable in an EEGc recording (≥ 3 sec; 1 sec minimal interval), characterized by a 1.5 fold amplitude increment than baseline. EEGc alterations, shorter than 3 sec, were categorized as spike trains. PTZ-injection group showed a significant increase in motor parameters compared with baseline and vehicle-injection groups. Since EEGc and EEGhipp traces presented similar features, we focus our attention and quantitative analysis on cortical EEG trace. We should note that, independently to convulsion-latency, four animals up to five showed electrical EEG seizures alterations. The animal showing no seizure before tonic-clonic convulsive state was however characterized by a much higher number of spike trains, confirming the extreme importance of this first window, which is absolutely neglected in a mere behavioural observation. Considering the two subpopulations based on the latency of convulsions, we can observe that animals characterized by shorter latency will develop more severe post-convulsive seizure activity, with an augmented seizure frequency. We can thus postulate that the singular susceptibility to PTZ is predictive of the severity of the pathology. This research work demonstrates the importance of performing EEG radio-telemetry combined with synchronised video monitoring, in the acute PTZ-induced convulsion model. In particular the video-tEEG model distinguishes abnormalities in EEG patterns, in the absence of behavioural signs, also taking into account the inter-individual variability in seizure activity and behavioural manifestation. 3- Assess the technical feasibility for the integration of a Video-telemetry Electroencephalography (video-tEEG) system with a set up for sequential blood bleeding. The chronic femoral vein cannulation is a method widely used in pre-clinical studies to allow collection of blood samples at established time-points and to obtain a Pharmacokinetic-Pharmacodinamic (PK-PD) profile. Six telemetric animals were submitted to a second surgical procedure for the chronic cannulation of the femoral vein. The catheter was exteriorized in the interscapular region and rat was equipped with a jacket to allow for protection of the catheter and its connection with the tether. After a post-surgery recovery of 5-6 days all animals were placed in PhenoTyper® cages. The catheter was inserted into a 45 cm long metallic tether connected with a balanced harm which was directly fixed to the PhenoTyper® cage’s wall. In order to maintain patency of femoral catheter during whole experimental procedure, it was continuously infused saline with heparin 25UI/mL at 0.2 mL/h by infusion pump. In order to obtain time-right plasma concentrations exactly when a motor behavioural convulsion event was observed, all rats were treated with a test compound known to induce behavioural convulsions; videos and telemetric signals (EMG, EEGc and EEGhipp traces) were recorded simultaneously and continuously, starting 1 hour before treatment until 4 hours post-dose. Blood samples (300 µL blood/time point) from the catheter were collected manually at pre-dose, at three established post-dose time points, and at each occasion when a motor behavioral convulsive episode was observable. All blood samples required were collected successfully including on the occasion of motor behavioral convulsion events. The videos were analysed by the Ethovision XT software and the software was able to track animals also in presence of the additional equipment required for the bleeding (i.e., jacket, tether and balance harm), confirming that this set up did not compromise in any way the spontaneous motor activity analysis made by this software. In addition no interferences with the telemetric recordings due to the bleeding equipment were noted. The combined video-tEEG Model and the blood bleeding systems can be used in pre-clinical investigations to better define the PK/PD profile of drug-induced convulsions or seizures, allowing for safer investigations in the clinical phase.

Generalized convulsive status epilepticus (GCSE) is a serious neurologic illness causing unresponsiveness, major physiologic disturbances, risk of injury and, if prolonged enough, neuronal damage. Causes are many, and the outcome often depends as much on the etiology as on the epileptic seizure itself. Several anti-seizure medications are used in treatment of GCSE, but some cases continue electrographically when clinical convulsions cease (nonconvulsive SE), and EEG is essential in their diagnosis. About 20% of cases become refractory to initial treatment, and the EEG becomes even more crucial in diagnosis and management. This chapter also covers other forms of SE with significant motor manifestations including: focal motor status (including epilepsia partialis continua); myoclonic status, which includes some relatively benign forms as well as some with a very poor prognosis; and clonic and tonic status. It reviews the many different EEG findings in those forms of status, and the use of EEG in their treatment and management, especially in prolonged cases.

The clinical presentation and encephalographic (EEG) findings of nonconvulsive status epilepticus (NCSE) can be complicated, making diagnosis difficult. There are generalized (e.g., absence status) and focal (e.g., aphasic status, complex partial status) forms. Some patients are responsive but have cognitive or other neurologic deficits; others are less responsive or even comatose. Increasingly, the diagnosis of NCSE is considered in intensive care unit patients. Here, without clinical signs of seizures such as convulsions, EEG is critical in diagnosis, but there is uncertainty about which EEG patterns represent seizures and which clinical situations and EEG patterns warrant aggressive treatment. Antiseizure medications are tailored to the NCSE type and the clinical condition. Treatment is often easier for NCSE, and the outcome better, than for convulsive SE, but this is not always true for critically ill patients with NCSE in the ICU, for whom continuous EEG monitoring is often crucial for diagnosis and management.

This is the first history of the psychiatric illness called catatonia, virtually forgotten by medicine yet often present in severely ill patients. The main symptoms of catatonia affect movement and thought, including staring, stupor, mutism, food refusal, negativism, and even psychosis. These symptoms are age-old, but they were brought together in the single term “catatonia” by German psychiatrist Karl Kahlbaum in 1874. Yet, 30 years later, catatonia disappeared from view as an independent illness, turned into a “subtype” of dementia praecox (schizophrenia). There, catatonia remained submerged from view for almost a century, rediscovered again as a disease of its own in the 1990s. Today, catatonic symptoms are seen in around one in ten admissions to a psychiatric emergency department. Untreated, catatonia may have a fatal outcome. Interest today has been increasing because of the discovery that, unlike schizophrenia, catatonia responds readily to therapy, with the symptoms vanishing without a trace. The authors argue that catatonia may be a response to fear and alarm triggered by trauma; during a stupor, patients often experience terrifying images and thoughts. Edward Shorter is a medical historian who has written widely about psychiatry. Max Fink is a clinician whose writings on melancholia, catatonia, and convulsive therapy have been internationally recognized.

The Trials of Allegiance examines the law of treason during the American Revolution—a convulsive, violent civil war in which nearly everyone could be considered a traitor, either to Great Britain or to America. Drawing from extensive archival research in Pennsylvania—one of the main centers of the revolution—Carlton Larson provides the most comprehensive analysis yet of the treason prosecutions brought by Americans against British adherents—through committees of safety, military tribunals, and ordinary criminal trials. Although popular rhetoric against traitors was pervasive in Pennsylvania, jurors consistently viewed treason defendants not as incorrigibly evil, but as fellow Americans who had made a political mistake. This book explains the repeated—and violently controversial—pattern of acquittals. Juries were carefully selected in ways that benefited the defendants, and jurors refused to accept the death penalty as an appropriate punishment for treason. The American Revolution, unlike many others, would not be enforced with the gallows. More broadly, Larson explores how the Revolution’s treason trials shaped American national identity and perceptions of national allegiance. He concludes with the adoption of the Treason Clause of the United States Constitution, which was immediately put to use in the early 1790s in response to the Whiskey Rebellion and Fries’s Rebellion. In taking a fresh look at these formative events, The Trials of Allegiance will reframe how we think about treason in American history—up to and including the present.

This chapter provides an overview of the book’s historical, political, and literary material. It is broken into three sections. The first section situates “enthusiasm” in relationship to the modern critique of revolution and leveling democracy, specifically the American and French Revolution, through discussions of Edmund Burke and William Blake. The second section argues for enthusiasm’s importance to transnational studies of American literature, histories of American protest and American religion, affect theory, and philosophies of emancipation (or “the event”). The third section defines what the author calls “literatures of enthusiasm” as a convulsive writing of political crisis encouraging acts of dissent and liberation, using Frederick Douglass and Walt Whitman as examples.

Thee for my recitative, Thee in the driving storm even as now, the snow, the winter-day declining, Thee in thy panoply, thy measur’d dual throbbing and thy beat convulsive, Thy black cylindric body, golden brass and silvery steel, Thy ponderous side-bars, parallel and connecting rods,...

In the second half of the nineteenth century, European neuropsychiatrists had identified three mental illnesses that dominated the clinical scene: neurosyphilis (described as dementia paralytica), dementia praecox (schizophrenia today), and manic-depressive insanity (now known as the two disorders of major depression and bipolar disorder). These diseases were devastating, often fatal, and no effective treatments were known. Caretakers of the mentally ill commonly resorted to chains, restraining chairs, cold and hot baths, and seclusion to control aggressive behavior. Morphine and other sedative chemicals kept patients asleep but did little to heal their illnesses. The mentally ill who were dangerous to themselves or to others were housed in large state-supported hospitals managed by hospital superintendents with full authority to treat the inmates. Lacking effective remedies, they permitted many experimental and unsafe interventions. Prolonged sleep was an experimental treatment that seemed to relieve severe depressive and agitated states. Agitated patients were kept in a stupor for days with continuing high doses of barbiturates, with periods of alertness for feeding and toileting. While some died of pneumonia, the few who recovered their senses encouraged these trials. Body infections were once thought to cause mental disorders, so to cure mental disease, the teeth, tonsils, gallbladder, and large sections of the colon were often removed even though there was no credible evidence to justify the procedures. Many patients died. The patients suffered further humiliation when hospitals did not provide false teeth to help them chew their food. Surgical removal of sexual organs was another “treatment.” Eugenicists argued for sterilization of the mentally ill, especially those who had become burdens on society. It is estimated that more than 18,000 people in psychiatric institutions were surgically sterilized during the first half of the twentieth century. The discovery of bacteria as the cause of infectious febrile illnesses was a great accomplishment of medical research in the nineteenth century. The French chemist Louis Pasteur’s demonstration that high temperatures would destroy bacteria, an observation that led to the pasteurization of foods, also suggested that fevers could have a therapeutic benefit in bodily infections. This theory was supported by improvement of psychosis in patients who survived infections with smallpox or typhoid fever.

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting longer than 5 minutes or recurrent seizure activity without return to baseline between events. Several classifications exist. The Neurocritical Care Society recommends a simplified classification in which SE is dichotomized as convulsive or nonconvulsive, with nonconvulsive status epilepticus further stratified as focal or generalized.

Cerebral Palsy (CP) is a limiting deficiency, characterized by a permanent neuromotor disorder which affects movements, resulting in non-progressive lesions of the immature brain during the neuro psychomotor stages. Epidemiological studies of premature births correlated with the presence of high levels of inflammation in the umbilical cord, amniotic fluid, and fetal blood, being that one of the most relevant underlying physiopathological mechanisms includes inflammation and intra-amniotic infection, with inflammatory response and damage to the developing brain. Recently attributed to the excessive production of cytokines, CP inflammation is mostly modulated through diet restriction, intestinal dysfunction, and drug intake. The high prevalence of convulsive crises in individuals with CP (77%) on its own does not bring about post inflammatory and post convulsive cytokine synthesis, treated with antiepileptic medication. In these individuals, there is high incidence of intestinal constipation (47%), besides oral dysbiosis, gingival bleeding and even greater increase in chronic inflammation. The dysbiosis causes an increase in mucous permeability (leaky-gut) of the gut-brain axis, and increase in seric endotoxin, demonstrating a persistent inflammatory state, and supporting the emergence of new side effects, which can become the object of future research.

This chapter highlights how Psychogenic Non-Epileptic Seizures (PNES) are frequent and difficult situations that should be distinguished from epileptic seizures. When misdiagnosed as epilepsy, patients with PNES are faced with serious and multidimensional difficulties, such as delayed appropriate treatment, adverse effects of long-term antiepileptic drugs (AED), and the financial burden they have to face. Moreover, PNES may be misdiagnosed with status epilepticus (SE), leading to interventions with potentially serious consequences, such as an admission to the intensive care unit (ICU) and intubation. The importance of continuous EEG monitoring for such episodes and evaluation by a clinical neurophysiologist is stressed. In cases such as PNES attacks triggered by convulsive syncope, multidimensional evaluation is necessary. Factors such as life events and psychological traumas should also be taken into consideration.

ntrodução: A morte materna é considerada um grande problema de saúde pública, chegando a ser evitável em 90% dos casos e constituindo uma preocupante violação dos direitos reprodutivos — por consequência, dos direitos humanos. No Brasil, a hipertensão arterial na gravidez constitui a primeira causa de mortalidade materna, representando 25% dos óbitos maternos investigados. A eclâmpsia é a manifestação convulsiva ou comatosa da pré-eclâmpsia, sendo uma intercorrência emergencial, com complicações obstétricas importantes e incidência crescente, apesar das tentativas e modificações estabelecidas para seu controle. Objetivo: Avaliar a mortalidade por eclâmpsia no Brasil. Métodos: Trata-se de um estudo ecológico com dados referentes à morte materna obtidos das Informações de Saúde do Departamento de Informática do Sistema Único de Saúde (TABNET/DATASUS) entre os anos de 2010 a 2019. Resultados e conclusão: Os óbitos maternos no período em estudo totalizaram 16.697. A eclâmpsia foi a causa mais frequente em todos os anos, sendo responsável por 1.576 mortes (9,4%). A menor taxa de óbito materno por eclâmpsia foi em 2014, com 8,0%, enquanto as maiores taxas foram em 2013 (10,4%) e 2019 (10,1%). Observou-se uma diferença de sua frequência de acordo com as regiões do Brasil. Ela foi responsável por 14,0% dos óbitos maternos na Região Norte, por 11,4% na Região Nordeste, 8,6% na Centro-Oeste, 6,9% na Sudeste e 6,5% na Sul. Detalhando a mortalidade materna por idade, identificamos as seguintes faixas etárias: de 10 a 19 anos (18,3%), de 20 a 29 anos (36,6%), de 30 a 39 anos (37,5%) e de 40 a 49 anos (7,3%). Em relação à cor/raça, 56,8% eram pardas, 25,6% eram brancas e 10,6% pretas. Sobre o grau de escolaridade, observaram-se as seguintes frequências: nenhum grau (3,1%), de um a três anos (10,4%), de quatro a sete anos (26,4%), de oito a 11 anos (34,1%) e de 12 anos para mais (8,4%). Acerca do momento de ocorrência do óbito, constatamos que 55,3% ocorreram no decurso do puerpério e 29,0% durante a gravidez. Dessa forma, a eclâmpsia foi a principal causa de morte materna e foi mais prevalente nas pacientes com faixa etária de 20 a 39 anos, pardas, com escolaridade de 8 a 11 anos, e com grande ocorrência do evento no puerpério. Em síntese, a prevenção da eclâmpsia poderá ser alcançada mediante uma efetiva assistência pré-natal na atenção primária, complementada pela atenção secundária aos grupos de risco, para assim se chegar a um ciclo grávido-puerperal seguro para as mulheres.

In 1980, Hall et all described a syndrome characterized by “hamartoblastoma”, hypopituitarism, unperfurated anus, polydactyly postaxial and numerous visceral anomalies, today known as Pallister-Hall Syndrome. On the study, Hall et all reported six cases of children with that malformation syndrome - lethal on neonatal period. None of the newborns had anterior hypophysis and the hypothalamic tumor was apparent in the inferior part of the brain, going from the optic chiasm to the interpeduncular fossa. Besides, other anomalies were found, such as: laryngeal split, abnormal pulmonary lobation, renal agenesis or dysplasia, shorts fourth metacarpals, nail dysplasia, multiple mouth frenulum, hypoadrenalism, congenital cardiomyopathy and intrauterine growth retardation. Every case was sporadic, the chromosome were apparently normal, without consaguinity relations. Several similar, milder and even asymptomatic cases were described later on. Kletter and Biesecker (1992), Topf et all (1993) and Penman Splitt et all (1994), define the disease as dominant autosomal inheritance. Kettler and Biesecker (1992) stated that most cases as sporadic as a result of a gene mutation with variable expressiveness. According to Biesecker et al (1996), an international workshop determined diagnostic criteria to the Syndrome: Hypothalamic Hamartroma and Central Polydactyly; First degree relative with hypothalamic hamartroma and polydactyly; Dominant autosomal parrent inheritance or in a consistent form with germaine mosaicism. The radiological changes are important for differential diagnosis between Pallister-Hall Syndrome and other hamartroma-present diseases. The hypothalamic hamartroma isolated has phenotypical features and causes hormonal disorders such as early puberty. On the MRI (Magnetic resonance imaging) it shows hyperintese sign on attenuated fluid. On the other hand, the Pallister-Hall Syndrome the hamartroma shows itself as a isointense signs along with other deformities as polydactyly, for example. According to Kuo et al (1999), on MRI, the classic hypothalamic hamartroma isn’t calcified, is homogenous and isointense to the grey matter on weight images in T1, and isointense and often hyperintense on weight images in T2. Those findings are pretty distinctive and help distinguish the hypothalamic hamartroma from ordinary lesions, as craniopharyngioma and hypothalamic/opticalchiasmic glioma, observed in children. Case report: The patient ALDV, male, born in 30/12/1995, was referred to evaluation on the Medical Genetic Service from HCPA. At the time, aged one year and 8 months, he was the only son of a young, healthy couple with no consanguinity. The family history of similar cases or other genetic pathologies are unknown. The prenatal happened with no intercurrences, unless the smoking mother. It was a natural birth; Birth Weight: 2kg; High: 42cm; PC: 32cm. APGAR 9. At 8 months, starts an investigation for precocious puberty, and a karyotype was performed in her hometown: 46, XY (normal). He presents convulsive crises since one year old. DNPM: cephalic support when he had 8 months, sat without support at the age of one. Physical examination: Head circumference in the 97th percentile, length above the 97th percentile. Good general condition, dysmorphic, facies with fusion of eyebrows (sinofre), epicanthus, small nose, dysplastic ears with a broad shield, three café-au-lait spots on the body. Presence of pubic hair. Increase in length and diameter of the penis, as well as of the testicles, in relation to chronological age. In the hands, significant brachydactyly with bitateral hexadactyly. In the feet, bilateral hexadactyly. Proximal cutaneous syndactyly between the 2nd and 3rd bilateral arthroids, mainly on the right. Additional exams: Rx of hands and wrists for bone age: 7 years; Chronological Age: 1 year and 10 months. Normal abdominal ultrasound; Computed Tomography of Skull/Magnetic Resonance of Skull: hypothalamic expansive lesion (3 cm), compatible with hamartoma; triventricular hydrocephalus; Cavum septum pellucidum. Endocrinological Evaluation: compatible with precocious puberty of central cause. High resolution karyotype: 46, XY (normal). Computed tomography of the brain: Examination for neurological control, performed on 10/12/2014, 18-year-old patient. It was observed solid nodular formation in the hypothalamic region, hypodense, with well-defined limits, in close contact with the mesencephalon, without impregnation by contrast medium administered intravenously, measuring about 2.9 X 2.4 X 3.0 cm, in the respective laterolateral, anteroposterior and craniocaudal planes, which in correlation with the patient’s clinical history may be related to hypothalamic Hamartoma.