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Epilepsy Behav. Hesdorffer DC, Tomson T. Sudden unexpected death in epilepsy: potential role of antiepileptic drugs.
CNS Drugs. Devinsky O. Sudden, unexpected death in epilepsy. N Engl J Med. Population-based study of the incidence of sudden unexplained death in epilepsy. Sudden unexplained death in epilepsy: the role of the heart.
Cleve Clin J Med.
Sudden unexpected death in epilepsy: risk factors and potential pathomechanisms. Nat Rev Neurol. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol. Sudden unexpected death in epilepsy: a search for risk factors.
Sudden unexpected death in epilepsy: From the lab to the clinic setting.
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Nei M, Hays R. Sudden unexpected death in epilepsy. Curr Neurol Neurosci Rep. Sudden death in epilepsy: of mice and men. J Clin Invest.
So EL. The other side of the coin: Beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy. Devinsky O, Friedman D. Sudden unexpected death in epilepsy: continuing the global conversation. Report of the American Epilepsy Society and the Epilepsy Foundation joint task force on sudden unexplained death in epilepsy. J Neurol Neurosurg Psychiatry. Pros and Cons. Surges R, Sander JW. Sudden unexpected death in epilepsy: mechanisms, prevalence, and prevention.
Curr Opin Neurol.
Attitudes of Brazilian epileptologists to discuss about SUDEP with their patients: truth may hurt but deceit hurts more. Dear Editor, Patients usually have bilateral asymmetrical involvement. Atonic pupils with distorted margins and occasionally ocular hypertension were described by Tugal-Tutkun et al. Acute depigmentation of the iris may be more common than expected in many countries, including Brazil. Therefore, it is important to detect and correctly diagnose it. Below, we describe three recent cases of acute depigmentation of the iris.
THMZ, a year-old white female with diabetes and hypothyroidism, presented with photophobia for 15 days. Her eyes were examined twice in the previous 2 years and found normal. Anterior biomicroscopy showed positive iris transillumination in both eyes and a heavily pigmented anterior chamber angle. No anterior chamber reaction or signs of inflammation were noted.
The lens was clear OU. The fundoscopic findings were unremarkable. The patient had been prescribed a day course of systemic moxifloxacin AvaloxH for pneumonia 3 months before the onset of symptoms. TF, a year-old white female complained of low visual acuity and photophobia in the left eye for 10 weeks and the right eye for 8 weeks. Biomicroscopy showed bilateral positive iris transillumination, dense atrophy, and dyschoria.
No signs of active ocular inflammation were noted. The patient had been extensively examined for uveitis and pigmentary glaucoma, with negative results. She had been prescribed systemic moxifloxacin AvaloxH for pneumonia 2 months before the onset of symptoms.
RMP, a year-old male, also had a previous history of systemic moxifloxacin use for upper respiratory infection 3 months before the onset of symptoms. Biomicroscopy showed a normal right eye, positive transillumination and dyschoria in the left eye, and a moderate anterior chamber reaction. No keratic precipitates were noted, and the condition was resolved with a short course of mild steroids. Quinolones were first introduced in , and their excellent oral absorption, good tissue distribution in tissue, and urinary concentrations, which exceed the minimum inhibitory concentration for many common pathogens, popularized their use in routine clinical practice.
Structural modifications of quinolones resulted in improved pharmacokinetics, with a longer elimination half-life, which permitted once-daily dosing and improved tissue penetration. For this reason and many others, fourth generation compounds, such as moxifloxacin, are increasingly being prescribed 1,2.
Moxifloxacin is licensed to treat acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, community acquired pneumonia, complicated and uncomplicated skin and skin structure infections, and complicated intraabdominal infections. In , moxifloxacin ranked th among the top drugs prescribed in the United States, and it has proven to be a blockbuster drug, generating billions of dollars in revenue.
In ophthalmology, moxifloxacin is widely prescribed as eye drops to treat infectious keratitis and as a postoperative prophylactic regimen during cataract surgery. It is also injected intraocularly to prevent and treat intraocular infections 3. Acute depigmentation of the iris is a new clinical condition that is characterized by an acute onset of pigment dispersion in the anterior chamber, depigmentation and discoloration of the iris stroma, pigment deposition in the anterior chamber angle, and positive transillumination 4.
Systemic moxifloxacin treatment has been associated with this condition 5. Several types of iris changes, such as positive transillumination, dyschoria, and depigmentation, have been reported; anterior chamber reaction and anterior uveitislike syndrome have also been observed in some cases. Email: helomn gmail. No potential conflict of interest was reported.
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DOI: Positive iris transillumination. Figure 2 - Bilateral iris depigmentation and dyschoria. This explanation might be the reason why only systemic and not topical moxifloxacin causes this condition 9. All physicians, not just ophthalmologists, should be aware of this entity. The potential associations should be better understood because it is still unclear whether this disease represents an adverse effect of fluoroquinolone use or the sequelae of a systemic infectious disease.
Our cases indicated that these Brazilian patients had unilateral or bilateral asymmetrical involvement, transillumination defects, and dyschoria.
Photophobia was the main complaint. The first two patients were examined after complaining of photophobia.
We presume that iris transillumination was already present, although we do not know whether the patients had prior inflammation signs. The third patient was observed earlier in the course of the disease, and signs of mild inflammation were observed. All patients were treated with mild topical steroids, and their symptoms improved, although the clinical signs remained stable.
The differential diagnosis involves inflammatory and non-inflammatory entities; in most cases, the etiology and physiopathology mechanisms leading to the iris changes are unclear. Herpetic iridocyclitis without associated keratitis is a distinct entity that is characterized by unilateral recurrences in the same eye, sectoral or patchy atrophy of the iris, and an acute IOP increase 4.
Sectoral iris atrophy is rarely observed in immunocompetent patients with CMV anterior uveitis. Sectoral atrophy resulting from ischemic necrosis of the iris and loss of function of the sphincter muscle may cause pupillary distortion, which is sometimes associated with iris spiraling.
Transillumination caused by the loss of iris pigment epithelium may be observed in the absence of apparent iris stromal atrophy. One of the early diagnostic features is iris stromal smoothing, with loss of the normal corrugated texture. The pharmacokinetics of moxifloxacin demonstrate that the aqueous concentration is higher than the vitreous concentration upon topical administration.
However, the aqueous concentration is similar to that in the vitreous when moxifloxacin is taken orally. Knape et al. Sousa JM wrote the manuscript.
Campos M collected and revised the data. Belfort Jr collected the data and revised the final draft. J Med Pharm Chem.
Retrieved 21 July Safety of prophylactic intracameral moxifloxacin use in cataract surgery. J Ocul Pharmacol Ther. Bilateral Acute Depigmentation of the Iris. Bilateral Acute Iris Transillumination.
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Arch Ophthalmol. Acute and bilateral uveitis secondary to moxifloxacin. Arch Soc Esp Oftalmol. Uveitis-like syndrome and iris transillumination after the use of oral moxifloxacin.
Eye Lond. Ocul Immunol Inflamm. Moxifloxacin and bilateral acute iris transillumination. J Ophthalmic Inflamm Infect. METHOD: An observational study was performed including 56 volunteers, consisting of 30 eumenorrheic women who were non-users of oral contraceptives and 26 users of oral contraceptives.Belfort Jr collected the data and revised the final draft.
The interaction between E2 and glutamate receptors increases the excitability of the hippocampus by opening sodium channels and increasing the Statistical Analysis The sample size was calculated previously based on the standard deviation data obtained from a pilot study.
Classic Reader may not have as many titles as some other sites, with just under 4, at the time of writing. The fundoscopic findings were unremarkable. Herpetic iridocyclitis without associated keratitis is a distinct entity that is characterized by unilateral recurrences in the same eye, sectoral or patchy atrophy of the iris, and an acute IOP increase 4.
His findings revealed lower thresholds during the premenstrual phase compared to the other phases. However, when the participants were pregnant, the threshold was increased due to the high levels of progesterone P4 and endogenous opioids present.
Samsung Galaxy Tab S2 8. Sectoral atrophy resulting from ischemic necrosis of the iris and loss of function of the sphincter muscle may cause pupillary distortion, which is sometimes associated with iris spiraling.
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