Publications by authors named "A B Guekht"

129 Publications

Differential diagnosis between epileptic and psychogenic nonepileptic seizures through conversational analysis: A blinded prospective study in the Russian language.

Epilepsy Behav 2021 Nov 24;125:108441. Epub 2021 Nov 24.

University of Milano Bicocca, GSD Research, Milan, Italy.

The current study examined the validity of conversational analysis (CA) in Russian patients with seizures, using a scoring table for the Simplified Linguistic Evaluation (SLE). The study sample was composed of 12 adult participants suffering either from epilepsy (ES) or psychogenic nonepileptic seizures (PNES) recruited in the Moscow Research and Clinical Center for Neuropsychiatry. Definitive diagnosis was established only after a habitual event was captured onvEEG. All participants with PNES or ES and at least one mental disorder underwent a 20-minute-long interview recorded on video. The interview then was evaluated by the external blinded physician already experienced in CA. Finally, that physician filled the SLE, consisting of 5 items analyzing the main characteristics of patient narrations. A score of ≥12 suggested a diagnosis of ES, while a score of <12 suggested a diagnosis of PNES. The blinded evaluator correctly identified 11 out of 12 cases. The concordance between the vEEG diagnosis and the CA diagnostic hypothesis was 91.67%. The sensitivity of the scoring table was 100%, while the specificity was 80%. The positive and the negative predictive values were, respectively, 87.5% and 100%. Our results suggested that the differences in seizure descriptions between patients with PNES and patients with ES are similar across Indo-European language family and are independent of psychiatric comorbidity.
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http://dx.doi.org/10.1016/j.yebeh.2021.108441DOI Listing
November 2021

Epilepsy and COVID-19: Management of Patients and Optimization of Antiepileptic Treatment in the Pandemic.

Neurosci Behav Physiol 2021 Nov 5:1-7. Epub 2021 Nov 5.

Scientific and Applied Psychoneurological Center, Moscow Health Department, Moscow, Russia.

There are as yet no data pointing to any increase in the incidence of the novel coronavirus infection (COVID-19) or a more severe course of illness in patients with epilepsy. However, considering the high prevalence of epilepsy in patients over 60 years of age, the high comorbidity of epilepsy and a whole series of somatic diseases, and the need to maintain the opportunity for constant access to antiepileptic medications and follow-up of epilepsy patients, we can expect a whole set of difficulties in the management of these patients in the conditions imposed by the COVID-19 pandemic. This article addresses the main principles of the management of epilepsy patients in the conditions of the COVID-19 pandemic: the need to follow regimes; preservation of regular and continuous taking of antiepileptic drugs, including consideration of interdrug interactions; and switching patients to i.v. forms of antiepileptic drugs where necessary.
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http://dx.doi.org/10.1007/s11055-021-01142-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8569090PMC
November 2021

Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions.

J Neurol 2021 Oct 21. Epub 2021 Oct 21.

Department of Neurology, Centre for Global Health, Technical University of Munich, Munich, Germany.

Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified.
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http://dx.doi.org/10.1007/s00415-021-10848-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528941PMC
October 2021

Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis.

Neurology 2021 Oct 11. Epub 2021 Oct 11.

Rajendra Institute of Medical Sciences, Ranchi-834009, Jharkhand, India

Background And Objectives: One year since the onset of the COVID-19 pandemic, we aimed to summarize the frequency of neurological manifestations reported in COVID-19 patients and investigate the association of these manifestations with disease severity and mortality.

Methods: We searched PubMed, Medline, Cochrane library, clinicaltrials.gov and EMBASE from 31 December 2019 to 15 December 2020 for studies enrolling consecutive COVID-19 patients presenting with neurological manifestations. Risk of bias was examined using Joanna Briggs Institute (JBI) scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% Confidence Intervals (CI) were calculated for neurological manifestations. Odds ratio (OR) and 95%CI were calculated to determine the association of neurological manifestations with disease severity and mortality. Presence of heterogeneity was assessed using I-square, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.

Results: Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 COVID-19 patients, 89% of whom were hospitalized. Forty-one neurological manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurological symptoms included: fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%) and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurological diagnosis (pooled prevalence- 2%). In COVID-19 patients aged ≥60, the pooled prevalence of acute confusion/delirium was 34% and the presence of any neurological manifestations in this age group was associated with mortality (OR 1.80; 95%CI 1.11 to 2.91).

Discussion: Up to one-third of COVID-19 patients analysed in this review experienced at least one neurological manifestation. One in 50 patients experienced stroke. In those over 60, more than one-third had acute confusion/delirium; the presence of neurological manifestations in this group was associated with near doubling of mortality. Results must be interpreted keeping in view the limitations of observational studies and associated bias.
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http://dx.doi.org/10.1212/WNL.0000000000012930DOI Listing
October 2021

Stress load and neurodegeneration after gastrostomy tube placement in amyotrophic lateral sclerosis patients.

Metab Brain Dis 2021 Dec 24;36(8):2473-2482. Epub 2021 Sep 24.

Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia.

Dysphagia and progressive swallowing problems due to motoneuron death is one of amyotrophic lateral sclerosis (ALS) symptoms. Malnutrition and body weight loss result in immunological disturbances, fatigability and increase risk of secondary complications in ALS patients, percutaneous endoscopic gastrostomy tube (PEG) placement representing a well-recognized method for malnutrition correction and potentially increasing life expectancy. However, despite nutritional correction, occasional rapid neurological deterioration may develop after PEG placement. We have hypothesized that this decline can be a result of exteroceptive stress during PEG placement and promote neurodegeneration in ALS patients. Intravenous sedation may decrease stress during invasive procedures and it is safe during PEG placement in ALS patients. The aim of the study was comparing different PEG placement protocols of anesthesia (local anesthesia or local anesthesia plus intravenous sedation) in ALS from perspectives of stress load and neurological deterioration profile. During 1.5 years 94 ALS patients were admitted; gastrostomy was performed in 79 patients. After screening according to inclusion and exclusion criteria, 30 patients were included in the prospective consecutive study. All patients were divided in two groups, with local anesthesia and with combination of local anesthesia and intravenous sedation. Routine biochemical indices, neurodegeneration and stress markers were measured. The age of ALS patients was 61 ± 10 years; 20 patients were included at stage 4A and 10 at stage 4B (King's College staging). PEG was placed at average14 months after the diagnosis and 2.2 years after first symptoms. Mean ALS Functional Rating Scale-Revised was 27.8, mean forced vital capacity of lung 46.3% (19-91%). After one year of observation only 8 patients survived. Mean life duration after PEG was 5 months (5 days-20 months). Comparison of two PEG placement protocols did not reveal differences in survival time, stress load and inflammation level. Higher saliva cortisol levels, serum cortisol, glucose, C-reactive protein and interleukin-6 were detected after PEG placement, confirming considerable stress response. PEG is a stressful factor for ALS patients, PEG placement representing a natural model of exteroceptive stress. Stress response was detected as increased cortisol, C-reactive protein, interleukin-6, and glucose levels. Intravenous sedation did not increase the risk of PEG placement procedure, however, sedation protocol did not affect stress load.
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http://dx.doi.org/10.1007/s11011-021-00837-xDOI Listing
December 2021
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