Corey E. Goldsmith

Clinical experience with generic levetiracetam in people with epilepsy

Purpose:  To describe the clinical outcomes of a compulsory switch from branded to generic levetiracetam (LEV) among people with epilepsy (PWE) in an outpatient setting.

Longitudinal feasibility of MINDSET: a clinic decision aid for epilepsy self-management.

The purpose of this paper is to report on the development and feasibility of the longitudinal version of MINDSET, a clinical tool to assist patients and health-care providers in epilepsy self-management. A previous study described the feasibility of using MINDSET to identify and prioritize self-management issues during a clinic visit. This paper describes the development of the longitudinal version of MINDSET and feasibility test over multiple visits with a printed action plan for goal setting and the capacity for monitoring changes in self-management. Feasibility was assessed based on 1) postvisit patient and provider interviews addressing ease of use and usefulness, patient/provider communication, and shared decision-making and 2) the capacity of the tool to monitor epilepsy characteristics and self-management over time. Results indicate MINDSET feasibility for 1) identifying and facilitating discussion of self-management issues during clinic visits, 2) providing a printable list of prioritized issues and tailored self-management goals, and 3) tracking changes in epilepsy characteristics and self-management over time.

Central nervous system vasculitis secondary to systemic sclerosis.

Systemic sclerosis (SSc) or scleroderma is a connective tissue disease with a diverse array of clinical manifestations secondary to underlying fibrosis and autoimmunity. Central nervous system (CNS) impairment is uncommon in SSc. Here we report the fourth known patient with CNS vasculitis caused by SSc. In each previous report, the patient was a middle-aged to elderly female. Our patient was 24 years old at the time of presentation, significantly younger than the other reported patients. Importantly, our patients rapidly progressive clinical course and poor response to immunosuppression have not been reported in patients with CNS vasculitis secondary to scleroderma. Although CNS vasculitis is extremely rare in SSc, our report suggests that clinicians should consider this diagnosis in the differential of SSc patients with neurologic impairment.

Clinical and radiologic spectrum of corpus callosum infarctions: clues to the etiology.

Infarctions of the corpus callosum are rare. The clinical picture varies from an acute onset to slow evolving symptoms, frequently with poor localizing signs; however, the location of the infarct in the callosum often correlates with a specific etiology. We describe three patients with varying degrees of callosal infarction, each corresponding to a particular etiology.

Osmotic demyelination syndrome: variable clinical and radiologic response to intravenous immunoglobulin therapy.

The term ‘‘osmotic demyelination syndrome’’ (ODS) encompasses central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM), which often results from rapid correction of an osmolar abnormality [1]. Currently, there is no established treatment for ODS, and supportive care is the mainstay of therapy. In recent times, few case reports have highlighted the efficacy of intravenous immunoglobulin (IVIg) in the management of ODS, but the long-term prognosis remains unknown. We report three cases of ODS with favorable response to IVIg.

Churg-Strauss Syndrome: An Uncommon Cause of Intracerebral Hemorrhage

A58-year-oldmanwithasthma, chronic sinusitis, andnasal polyposis presented with a 1-day history of headache, blurry vision, and vomiting. His blood pressure was 170/88mmHg. Neurological examinationwas significant for right homonymous hemianopsia. Initial laboratory resultswere remarkable for peripheral bloodeosinophilia (25%; normal, 0%-8.5%). A computed tomographic scan of theheadshowedan intracranialhemorrhage in the leftoccipital lobe (Figure1A).Emergentevacuationof the intracranialhemorrhagewas performed, and brain tissue was sent for routine biopsy. On postoperativeday2, hedevelopedcoughand shortness of breath.Oxygen saturation was 90%. A general examination revealed coarse crackles bilaterally on chest auscultation. Diffuse alveolar hemorrhage was noted on a computed tomographic scan of the chest (Figure 1B).Hewas intubated for respiratory failure. Furtherworkup revealed an elevated myeloperoxidase–antineutrophil cytoplasmic antibody (>1000EU; normal, 0-21 EU). Brain tissue pathologic study results showed an intense eosinophilic vasculitis (Figure 2A andB).AdiagnosisofChurg-StraussSyndrome(CSS)wasmade.The patientreceivedpulsecyclophosphamide infusionanda5-daycourse of pulse intravenous methylprednisone (1000 mg/d). His respiratory parameters improved, and he was weaned off the ventilator. Hewasdischargedandprescribedoral prednisoneandmonthly cyclophosphamide infusions. Brain magnetic resonance imaging (Figure 2C) obtained 6weeks later showed a small residual left occipital hematoma,withnoevidenceof chronic ischemic sequelaeor microhemorrhages. At the 3-month follow-up, the patient’s neuro-

A case of severe chronic progressive axonal polyradiculoneuropathy temporally associated with anti-CV2/CRMP5 antibodies.

Objectives: The involvement of the peripheral nervous system by anti-CV2/CRMP5 paraneoplastic antibodies is typically encountered as a mixed sensorimotor polyneuropathy. We report a fatal case of severe chronic progressive axonal polyradiculoneuropathy in association with this antibody. Methods: Review of the patients chart, nerve conduction/electromyographic studies, and nerve biopsy. Results: A 51-year-old man presented with a progressive quadriparesis over a 4-month period. Extensive evaluation for potential etiologies was significant only for positive anti-CV2/CRMP5 antibodies without detection of an underlying neoplasm. Despite multiple immunomodulatory therapies, the patient progressed and demonstrated electrodiagnostic evidence for a chronic axonal polyradiculoneuropathy with ongoing denervation. The patient eventually died of respiratory failure. Conclusions: This case adds to the clinical spectrum of the peripheral nervous system involvement in patients with paraneoplastic anti-CV2/CRMP5 antibodies.