-
Mymensingh Medical Journal : MMJ Jan 2014Patients with epilepsy experience recurrent, unprovoked seizures. In most of the cases seizure occurs spontaneously, but there may be association with various triggers....
Patients with epilepsy experience recurrent, unprovoked seizures. In most of the cases seizure occurs spontaneously, but there may be association with various triggers. These triggers may act as seizure precipitating factors (SPFs). This study was done to find out the most common SPFs and their relationship to different types epileptic patients attending a tertiary care hospital in Bangladesh. This cross sectional study was carried out in specialized epilepsy weekly outdoor clinic and Medicine outpatient department (OPD) of Dhaka Medical College Hospital from January 2008 to July 2011, which included 1168 epilepsy patients. All patients attending the clinic were included in the study. Epilepsy syndromes were broadly classified into four categories using the classification system of international league against epilepsy (ILAE) namely, generalized epilepsy (GE), localization related epilepsy (LRE), symptomatic and unclassified. Each patient was evaluated and classified by consultant neurologist. All participants were interviewed through a predesigned close ended questionnaire that included a long list of 30 precipitating factors. Among all the patients 71.5% were male, with most common age group 11-20 years (36.8%). About 62% could indentify at least one precipitator. Excitation (25.2%) was the most common SPF reported by patients followed by emotional stress in 17.7%. Fever precipitated seizure in 16.4% of the subjects. A good number of them (15.5%) noticed that whenever there was sleep deprivation, they had an attack of epilepsy. However, drug withdrawal, playing outside and head trauma were also common among the patients, about 11.7%, 11.3% and 8.4% respectively. Most of the patients can identify their seizure precipitant and clustering of many SPFs suggests a common patho-physiologic mechanism for these triggers. Excitation, sleep deprivation, fever, watching television and head trauma showed a strong association with generalized epilepsy. Patients with seizure disorder should be evaluated for presence of SPFs, because identification of these might help in proper management of epilepsy.
Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Epilepsy; Female; Humans; Male; Middle Aged; Precipitating Factors; Seizures; Surveys and Questionnaires; Tertiary Healthcare
PubMed: 24584374
DOI: No ID Found -
Multiple Sclerosis and Related Disorders Nov 2020
Topics: Crotonates; Glomerulosclerosis, Focal Segmental; Humans; Hydroxybutyrates; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Nitriles; Precipitating Factors; Renal Insufficiency; Toluidines
PubMed: 32979731
DOI: 10.1016/j.msard.2020.102506 -
Tierarztliche Praxis. Ausgabe K,... Jun 2019
Topics: Animals; Dogs; Epilepsy; Precipitating Factors; Seizures
PubMed: 31212354
DOI: 10.1055/a-0902-0769 -
International Journal of Cardiology Oct 2023Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant... (Review)
Review
BACKGROUND
Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant factor (PF). Large-scale studies with precise PF documentation and temporal-outcome variation remain limited.
METHODS
We reviewed prospectively collected 2412 consecutive patient-level records from a multicenter Japanese registry of hospitalized patients with HF (West Tokyo Heart Failure2 Registry: 2018-2020). Patients were categorized based on PFs: behavioral (i.e., poor adherence to physical activity, medicine, or diet regimen), treatment-required (i.e., anemia, arrhythmia, ischemia, infection, thyroid dysfunction or other conditions as suggested exacerbating factors), and no-PF. The composite outcomes of HF rehospitalization and death within 1 year after discharge and HF rehospitalization were individually assessed.
RESULTS
Median patient age was 78 years (interquartile range: 68-85 years), and 1468 (61%) patients had documented PFs, of which 356 (15%) were considered behavioral. The behavioral PF group were younger, more male and had past HF hospitalization history compared to those in the other groups (all p < 0.05). Although risk of in-hospital death was lower in the behavioral PF group, their risk of composite outcome was not significantly different from the treatment-required group (hazard ratio [HR] 1.19 [95% confidence interval {CI} 0.93-1.51]) and the no-PF group (HR 1.28 [95%CI 1.00-1.64]). Furthermore, the risk of HF rehospitalization was higher in the behavioral PF group than in the other two groups (HR 1.40 [95%CI 1.07-1.83] and HR 1.39 [95%CI 1.06-1.83], respectively).
CONCLUSION
Despite a better in-hospital prognosis, patients with behavioral PFs were at significantly higher risk of HF rehospitalization.
Topics: Humans; Male; Aged; Aged, 80 and over; Hospital Mortality; Precipitating Factors; Hospitalization; Prognosis; Hospitals; Heart Failure; Registries; Multicenter Studies as Topic
PubMed: 37437664
DOI: 10.1016/j.ijcard.2023.131161 -
Journal of Thrombosis and Haemostasis :... May 2023The prevention of catastrophic antiphospholipid syndrome (CAPS), a rare complication of antiphospholipid syndrome (APS), is a major goal.
BACKGROUND
The prevention of catastrophic antiphospholipid syndrome (CAPS), a rare complication of antiphospholipid syndrome (APS), is a major goal.
OBJECTIVES
We analyzed its precipitating factors, focusing on anticoagulation immediately before CAPS episodes.
METHODS
We retrospectively analyzed patients in the French multicenter APS/systemic lupus erythematosus database with at least 1 CAPS episode. Then we compared each patient with known APS before CAPS with 2 patients with non-CAPS APS matched for age, sex, center, and APS phenotype.
RESULTS
We included 112 patients with CAPS (70% women; mean age, 43 ± 15 years). At least 1 standard precipitating factor of CAPS was observed for 67 patients (64%), which were mainly infections (n = 28, 27%), pregnancy (n = 23, 22%), and surgery (n = 16, 15%). Before the CAPS episode, 67 (60%) patients already had a diagnosis of APS. Of the 61 treated with anticoagulants, 32 (48%) received vitamin K antagonists (VKAs), 23 (34%) heparin, and 2 (3%) a direct oral anticoagulant. They were less likely than their matched patients with APS without CAPS to receive VKA (48% vs 66%, p = .001). Among those treated with VKA, 72% had a subtherapeutic international normalized ratio (ie, <2) versus 28% in patients with APS without CAPS (p < .001). Finally, excluding pregnant patients (n = 14) for whom we could not differentiate the effect of treatment from that of pregnancy, we were left with 47 cases, 32 (68%) of whom had recently begun a direct oral anticoagulant, planned bridging therapy, or had VKA treatment with international normalized ratio <2.
CONCLUSION
These results strongly suggest that suboptimal anticoagulation management can trigger CAPS in patients with thrombotic APS.
Topics: Pregnancy; Female; Male; Humans; Antiphospholipid Syndrome; Anticoagulants; Precipitating Factors; Retrospective Studies; Lupus Erythematosus, Systemic
PubMed: 36792010
DOI: 10.1016/j.jtha.2023.02.007 -
Acta Clinica Croatica Apr 2023The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender...
The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender and severity of diabetic ketoacidosis. Medical records from January 1, 2017 until December 31, 2019 were reviewed and patients diagnosed with diabetic ketoacidosis were selected. The study included 52 patients, median age 34 (interquartile range 21-56) years. There was no statistically significant difference between male and female gender. The severity of diabetic ketoacidosis was moderate in the majority of cases (65.4%; p=0.005). The most common precipitating factor was infection (61.7%). In patients with moderate diabetic ketoacidosis, respiratory infections were more common, while gastrointestinal infections were more common in severe diabetic ketoacidosis (33% and 25%, respectively; p=0.03). Nausea (median age 32 years; p=0.004) and vomiting (median age 31 years; p=0.01) were more common in younger age groups, while altered mental status was more common in the older age group (median age 61 years; p=0.001). Infection was the most common precipitating factor. The most common symptoms in younger age groups were nausea and vomiting, and altered mental status in the older age group.
Topics: Humans; Male; Female; Aged; Young Adult; Adult; Middle Aged; Diabetic Ketoacidosis; Diabetes Mellitus, Type 1; Precipitating Factors; Vomiting; Nausea
PubMed: 38304369
DOI: 10.20471/acc.2023.62.01.08 -
Journal of Affective Disorders Sep 2015Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the... (Comparative Study)
Comparative Study Review
OBJECTIVES
Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap.
METHOD
Narrative review based on a literature search of PubMed and Google Scholar.
RESULTS
Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures.
CONCLUSIONS
The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.
Topics: Antidepressive Agents; Bipolar Disorder; Epilepsy; Female; Health Status; Humans; Male; Mental Fatigue; Precipitating Factors; Risk Factors; Seizures; Sleep Deprivation; Stress, Psychological
PubMed: 26001664
DOI: 10.1016/j.jad.2015.04.057 -
Emergencias : Revista de La Sociedad... Jun 2017Acute heart failure (AHF) has become a public health problem of the first magnitude: it is the main cause of emergencies and hospitalization in patients over the age of... (Review)
Review
Acute heart failure (AHF) has become a public health problem of the first magnitude: it is the main cause of emergencies and hospitalization in patients over the age of 65. Various guidelines for managing AHF have been drafted in recent years, yet we continue to see high readmission and mortality rates. The emergency department is where patients with AHF should be diagnosed and stabilized, and their clinical picture established. A next step would be to identify the factors that may have led to the acute event so that it can be managed optimally. Few studies have analyzed precipitating factors in AHF and their role in prognosis. This review analyzes the prevalence of precipitating factors and their relation to readmission and mortality.
Topics: Acute Disease; Aged; Aged, 80 and over; Anemia; Cardiovascular Diseases; Heart Failure; Hospital Mortality; Humans; Hypertension; Infections; Patient Compliance; Precipitating Factors; Prognosis; Research Design
PubMed: 28825240
DOI: No ID Found -
Journal of Atherosclerosis and... Jun 2021
Topics: Age Factors; Aged; Cardiovascular Diseases; Cross-Sectional Studies; Glucosephosphate Dehydrogenase Deficiency; Heart Disease Risk Factors; Humans; Nitric Oxide; Odds Ratio; Oxidative Stress; Patient Acuity; Precipitating Factors
PubMed: 33361648
DOI: 10.5551/jat.ED152 -
Intraoperative hypovolemia as a possible precipitating factor for pituitary apoplexy: a case report.Journal of Medical Case Reports Feb 2023Pituitary apoplexy is acute infarction with or without hemorrhage of the pituitary gland. It is a rare but potentially life-threatening emergency that most commonly...
BACKGROUND
Pituitary apoplexy is acute infarction with or without hemorrhage of the pituitary gland. It is a rare but potentially life-threatening emergency that most commonly occurs in the setting of pituitary adenoma. The mechanisms underlying pituitary apoplexy are not well understood, but are proposed to include factors of both hemodynamic supply and adenoma demand. In the case of patients with known pituitary macroadenomas undergoing major surgery for other indications, there is a theoretically increased risk of apoplexy in the setting of "surgical stress." However, risk stratification of patients with nonfunctioning pituitary adenomas prior to major surgery is challenging because the precipitating factors for pituitary apoplexy are not completely understood. Here we present a case in which intraoperative hypovolemia is a possible mechanistic precipitating factor for pituitary apoplexy.
CASE PRESENTATION
A 76-year-old patient with a known hypofunctioning pituitary macroadenoma underwent nephrectomy for renal cell carcinoma, during which there was significant intraoperative blood loss. He became symptomatic with ophthalmoplegia on the second postoperative day, and was diagnosed with pituitary apoplexy. He was managed conservatively with cortisol replacement therapy, and underwent therapeutic anticoagulation 2 months after pituitary apoplexy for deep vein thrombosis. His ophthalmoplegia slowly resolved over months of follow-up. Pituitary apoplexy did not recur with therapeutic anticoagulation.
CONCLUSIONS
When considering the risk of surgery in patients with a known pituitary macroadenoma, an operation with possible high-volume intraoperative blood loss may have increased risk of pituitary apoplexy because intraoperative hypovolemia may precipitate ischemia, infarction, and subsequent hemorrhage. This may be particularly relevant in the cases of elective surgery. Additionally, we found that we were able to therapeutically anticoagulate a patient 2 months after pituitary apoplexy for the management of deep vein thrombosis without recurrence of pituitary apoplexy.
Topics: Male; Humans; Aged; Precipitating Factors; Pituitary Apoplexy; Blood Loss, Surgical; Hypovolemia; Adenoma; Pituitary Neoplasms; Infarction; Venous Thrombosis; Anticoagulants
PubMed: 36759850
DOI: 10.1186/s13256-022-03738-4