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The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation

The primary purpose of the current study was to determine the value of the shunt surgery and/or prophylactic antiepileptic therapy, in patients after mild traumatic brain injury (mTBI) with ventricular dilatation (VD) and incipient cognitive impairment, in the prevention of cognitive deterioration a...

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Autores principales: Faropoulos, Konstantinos, Fotakopoulou, Ourania, Fotakopoulos, George
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9236681/
https://www.ncbi.nlm.nih.gov/pubmed/35774699
http://dx.doi.org/10.7759/cureus.25423
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author Faropoulos, Konstantinos
Fotakopoulou, Ourania
Fotakopoulos, George
author_facet Faropoulos, Konstantinos
Fotakopoulou, Ourania
Fotakopoulos, George
author_sort Faropoulos, Konstantinos
collection PubMed
description The primary purpose of the current study was to determine the value of the shunt surgery and/or prophylactic antiepileptic therapy, in patients after mild traumatic brain injury (mTBI) with ventricular dilatation (VD) and incipient cognitive impairment, in the prevention of cognitive deterioration and probably in the development of dementia. Based on the following criteria: a) mTBI b) VD detected in CT scan during admission, and c) the presence of one of the following: i) dizziness, ii) headache, and iii) seizures, admitted to the Emergency Department between January 2010 and January 2020, we enrolled 127 of 947 eligible subjects. The subjects were divided into five groups: Group A (control group): only VD illustration in CT scan, Group B: incipient dementia, who had a more insidious onset presenting with cognitive dysfunctions at indefinite ages, Group C: shunt system (SH)/antiepileptic drugs (AEDs) presenting with cognitive dysfunction and urinary incontinence or gait disturbances or both, that were treated as idiopathic normal-pressure hydrocephalus (iNPH) with the surgical placement of an SH and AED therapy (standard AED phenytoin (1000 mg loading dose followed by 300 mg) daily), and Group D: AED, presenting with cognitive dysfunctions at indefinite ages and one or two episodes of seizures in the past, treated with AED from the very first moment of initiation with a standard AED phenytoin (1000 mg loading dose followed by 300 mg) daily. Overall, improvement in daily activities was achieved in 14.1% (18 of 127 patients), recording a significantly higher performance in group D (5.5%) rather than in groups A (1.5%), B (3.1%), and C (3.9%), (p < 0.05). We concluded that changes in VD (ΔVD) were associated with improvement in mRS (ΔmRS ≥ 1) - daily activities and mental status. ΔVD was also independently associated with reduced daily activities during the long-term follow-up. Interestingly, therapeutic shunting and AED in patients with a history of epilepsies may have a positive impact on the development of mental status impairment. This is a novel observation that has to be confirmed by more extensive multicenter studies in the future.
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spelling pubmed-92366812022-06-29 The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation Faropoulos, Konstantinos Fotakopoulou, Ourania Fotakopoulos, George Cureus Neurology The primary purpose of the current study was to determine the value of the shunt surgery and/or prophylactic antiepileptic therapy, in patients after mild traumatic brain injury (mTBI) with ventricular dilatation (VD) and incipient cognitive impairment, in the prevention of cognitive deterioration and probably in the development of dementia. Based on the following criteria: a) mTBI b) VD detected in CT scan during admission, and c) the presence of one of the following: i) dizziness, ii) headache, and iii) seizures, admitted to the Emergency Department between January 2010 and January 2020, we enrolled 127 of 947 eligible subjects. The subjects were divided into five groups: Group A (control group): only VD illustration in CT scan, Group B: incipient dementia, who had a more insidious onset presenting with cognitive dysfunctions at indefinite ages, Group C: shunt system (SH)/antiepileptic drugs (AEDs) presenting with cognitive dysfunction and urinary incontinence or gait disturbances or both, that were treated as idiopathic normal-pressure hydrocephalus (iNPH) with the surgical placement of an SH and AED therapy (standard AED phenytoin (1000 mg loading dose followed by 300 mg) daily), and Group D: AED, presenting with cognitive dysfunctions at indefinite ages and one or two episodes of seizures in the past, treated with AED from the very first moment of initiation with a standard AED phenytoin (1000 mg loading dose followed by 300 mg) daily. Overall, improvement in daily activities was achieved in 14.1% (18 of 127 patients), recording a significantly higher performance in group D (5.5%) rather than in groups A (1.5%), B (3.1%), and C (3.9%), (p < 0.05). We concluded that changes in VD (ΔVD) were associated with improvement in mRS (ΔmRS ≥ 1) - daily activities and mental status. ΔVD was also independently associated with reduced daily activities during the long-term follow-up. Interestingly, therapeutic shunting and AED in patients with a history of epilepsies may have a positive impact on the development of mental status impairment. This is a novel observation that has to be confirmed by more extensive multicenter studies in the future. Cureus 2022-05-28 /pmc/articles/PMC9236681/ /pubmed/35774699 http://dx.doi.org/10.7759/cureus.25423 Text en Copyright © 2022, Faropoulos et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurology
Faropoulos, Konstantinos
Fotakopoulou, Ourania
Fotakopoulos, George
The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation
title The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation
title_full The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation
title_fullStr The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation
title_full_unstemmed The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation
title_short The Value of Shunt Surgery or Prophylactic Antiepileptic Therapy or Both in the Development of Dementia at Early Stages in Patients With Ventricular Dilatation
title_sort value of shunt surgery or prophylactic antiepileptic therapy or both in the development of dementia at early stages in patients with ventricular dilatation
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9236681/
https://www.ncbi.nlm.nih.gov/pubmed/35774699
http://dx.doi.org/10.7759/cureus.25423
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