Can J Neurol Sci
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Invasive monitoring for the investigation of medically intractable epilepsy may be associated with undesirable morbidity. We performed a review of our recent experience to determine the incidence of major complications. ⋯ In comparison with previously published literature on the topic, the major complication rate in this group of patients appears to be low.
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Non-invasive mechanical ventilation (BiPAP) has been introduced for use in neuromuscular respiratory disease such as amyotrophic lateral sclerosis and myasthenia gravis. There is no experience in Guillain-Barré syndrome. ⋯ Until more experience is available, we strongly warn against using BiPAP in deteriorating patients with GBS.
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Spontaneous supratentorial intracerebral hemorrhage is a vexing clinical problem. Without established guidelines, clinicians are often forced to make case-by-case decisions, based on their own interpretation of relevant studies and experience. A number of randomized studies and several meta-analyses have been unable to provide a clear indication for surgery for this condition. ⋯ The timing of any surgery may also be important with theoretical advantages associated with early and thorough clot evacuation. Future surgical advances will require techniques or adjuvant medical treatment to reduce the occurrence of clot expansion and rebleeding, that have been identified as a source of early deteration and post-operative condition. We review the randomized clinical trials, experimental evidence and management options related to surgical treatment of spontaneous supratentorial intracerebral hemorrhage.
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The epileptic encephalopathies comprise a group of devastating seizure syndromes which begin in infancy and early childhood and usually result in intractable epilepsy. While some syndromes are relatively easily diagnosed early in their course, others take time to evolve, hampering an early, confident diagnosis. ⋯ In these "idiopathic" cases, recurrent subtle seizures, frequent epileptiform discharge and non-convulsive status epilepticus probably all play a role in deterioration of cognitive function and evolution of behavior disorders. This paper will review the most common epileptic encephalopathy syndromes, discuss the cognitive and behavioral co-morbidities and review current therapeutic options.