engleski

Rational diagnosis of epileptic syndrome in hospitalized patients

Epileptic seizures are a relatively common cause of hospita-lization, either in patients with previously diagnosed epilepsy or in those experiencing an initial epileptic seizure. The curren-tly available possibilities of neuroimaging require precise dia-gnosis of the cause of seizure to allow appropriate etiologic treatment for metabolic or other disbalance, or radical treat-ment for possible macrofactors. Difficulties may arise from a relatively limited approach to the diagnosis (computed tomo-graphy, angiography or magnetic resonance), emphasizing the otherwise needed previous examinations in cases which can be solved in a simpler way This was especially pronounced at the Osijek University Hospital during the war period. All patients with the diagnosis of epileptic syndrome, ad-mitted to the Department during a 3-year period (1993-1995) were analyzed according to the diagnosed cause and type of epilepsy, and according to the diagnostic methods used, with due consideration of the situation in the besieged town, with a large number of the wounded soldiers and civilians. In total, 139 such patients were admitted, which made 5.75% of all admissions to the Department during the mentioned period of time. Careful analysis of history and cliniconeurolo-gic data, EEG recordings, ultrasound diagnosis and brain scin-tigraphy helped in relieving the pressure on CT and angio-graphy, with the optimal use of biochemistry laboratory and other consultant possibilities, and provided accurate diagno-sis for the introduction of appropriate therapeutic regimen in many a case. Structural pathology was demonstrated in 107, congenital malformations in three, arteriovenous malforma-tions in three, stroke in 49, sequelae of craniocerebral trauma in ten, primary neoplasms in 11, mefiastatic neoplasms in six, brain atrophy in six, chronic alcoholism in 18 patients and CNS infection in one patient. The cause of epileptic syndrome was determined in four patients, i.e. hypertensive crisis, sarcoido-sis, multiple sclerosis and lithium therapy in one case each, the latter relating to a psychiatric patient. The diagnosis of idiopa-thic epilepsy was made in seven patients. In 21 patients, the causative diagnosis of epilepsy was not made, whereas in some patients there was suspicion of inadequate compliance with the treatment or temporary shortage of AED.

rational diagnosis; epileptic syndrome

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