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Seminars in Neurology Feb 2017Seizures are a common occurrence following cardiac arrest and may occur both during targeted temperature management and after rewarming. Postanoxic seizures may be... (Review)
Review
Seizures are a common occurrence following cardiac arrest and may occur both during targeted temperature management and after rewarming. Postanoxic seizures may be nonconvulsive and very difficult to diagnose without electroencephalography (EEG) or associated with prominent myoclonus. Importantly, to date no randomized controlled trials are available to guide the management of seizures in patients with cardiac arrest. Seizure prophylaxis is not recommended, and when seizures are diagnosed they are typically treated the same as seizures in other patients with acute brain injury. Electroencephalographic abnormalities that are highly epileptiform, but do not fulfill classic seizure criteria, also known as the ictal-interictal continuum, occur frequently and there is no consensus on how to treat these. Several EEG patterns have been associated with poor outcome in retrospective studies. Increasing evidence has emerged that patients may have a favorable outcome, even with status myoclonus and malignant EEG patterns, if aggressive management is pursued.
Topics: Electroencephalography; Heart Arrest; Humans; Retrospective Studies; Seizures; Status Epilepticus
PubMed: 28147416
DOI: 10.1055/s-0036-1593862 -
Seizure Jul 2018Tap seizure is a type of reflex myoclonic epilepsy in which seizures are evoked mainly by unexpected tactile stimuli and which is classified among the electroclinical... (Review)
Review
Tap seizure is a type of reflex myoclonic epilepsy in which seizures are evoked mainly by unexpected tactile stimuli and which is classified among the electroclinical syndromes of infancy. This condition, whose onset is in the first two years of life, is characterized by excellent prognosis and is extremely rare. We reviewed all published articles and case reports on Reflex Myoclonic Epilepsies focusing on touch-induced seizures in order to clarify clinical and electroencephalographic findings. Our aim is to increase knowledge about this specific disorder in order to help pediatricians avoid extensive investigations when making their diagnosis and reassure parents regarding absence of long-term complications.
Topics: Brain; Epilepsy, Reflex; Humans; Infant; Myoclonic Epilepsy, Juvenile; Seizures; Touch
PubMed: 29727740
DOI: 10.1016/j.seizure.2018.04.013 -
Frontiers in Immunology 2023An analysis of the clinical features of autoimmune encephalitis accompanied by anti-amphiphysin antibodies.
OBJECTIVE
An analysis of the clinical features of autoimmune encephalitis accompanied by anti-amphiphysin antibodies.
METHODS
The data of encephalitis patients with anti-amphiphysin antibodies were retrospectively evaluated, including demographics, neurological and laboratory findings, imaging, treatment, and prognostic predictions.
RESULTS
Ten patients aged between 29 and 78 years (median age 52 years) were included. The male: female ratio was 4:6. Limbic encephalitis was found in nine patients while epileptic seizures were present in seven patients. All patients showed anti-amphiphysin antibody positivity in sera while one ninth was positive for CSF antibody. The EEG findings were abnormal, including reductions in background activity, and the presence of diffuse slow waves, sharp waves, and spikes and waves. Five patients showed signs of increased T2 signals in the medial temporal lobe on MRI while PET showed either hyper- or hypo-metabolic changes in several brain regions, including the temporal lobe, hippocampus, basal ganglia, frontal and parietal cortices. Nine of ten patients were treated with immunotherapy, with improvements of varying degrees. There was a significant reduction in seizure frequency, and all patients were seizure-free at last follow-up.
CONCLUSION
Autoimmune encephalitis with anti-amphiphysin antibodies has a variety of clinical manifestations. The most common symptom is limbic encephalitis. Although relief from seizures can be achieved relatively easily, many patients suffer psychiatric, cognitive, and sleep sequelae. The disease was found to be associated with a lower incidence of cancer than has been previously reported for paraneoplastic neurologic syndromes.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Limbic Encephalitis; Retrospective Studies; Encephalitis; Seizures; Autoimmune Diseases of the Nervous System
PubMed: 37090693
DOI: 10.3389/fimmu.2023.1084883 -
Indian Journal of Pediatrics Sep 2014Neonatal seizures are the most important indicators of underlying brain injury. Seizures in a neonate are different from seizures in older children in many aspects... (Review)
Review
Neonatal seizures are the most important indicators of underlying brain injury. Seizures in a neonate are different from seizures in older children in many aspects including clinical presentation and etiology. The neonatal brain is immature and tends to have a decreased seizure threshold. Neonatal seizures are classified, based on their presentation as, clinical seizures, electroclinical seizures and electroencephalographic seizures; based on the pathophysiology as epileptic and nonepileptic seizures; and also on the basis of the etiology. Hypoxic ischemic encephalopathy is the leading cause of neonatal seizures, followed by intracranial hemorrhage, metabolic causes such as hypoglycemia and hypocalcemia, intracranial infections and strokes. Neonatal epilepsy syndromes are rare. Electroencephalography (EEG) is the gold standard for diagnosis. Amplitude integrated EEG (aEEG) is also used for continuous monitoring. The approach to management consists of initial stabilization of the neonate followed by treatment of potentially correctable injurious processes such as hypocalcemia, hypoglycemia and electrolyte disturbances, etiology specific therapies and antiepileptic drug (AED) therapy. Phenobarbital remains the first line AED therapy. Pharmacokinetic data on newer drugs is limited. Prognosis depends on the etiology, seizure type, neurological examination at discharge and EEG. Long term neurodevelopmental follow up is essential for babies with neonatal seizures.
Topics: Algorithms; Electroencephalography; Humans; Infant, Newborn; Seizures
PubMed: 25124329
DOI: 10.1007/s12098-014-1540-2 -
Journal of Clinical Neurophysiology :... Mar 2021Recording of interictal epileptiform discharges to classify the epilepsy syndrome is one of the most common indications for ambulatory EEG. Ambulatory EEG has superior... (Review)
Review
Recording of interictal epileptiform discharges to classify the epilepsy syndrome is one of the most common indications for ambulatory EEG. Ambulatory EEG has superior sampling compared with standard EEG recordings and advantages in terms of cost-effectiveness and convenience compared with a prolonged inpatient EEG study. Ambulatory EEG allows for EEG recording in all sleep stages and transitional states, which can be very helpful in capturing interictal epileptiform discharges. In the absence of interictal epileptiform discharges or in patients with atypical events, the characterization of an epilepsy syndrome may require recording of the habitual events. Diagnostic ambulatory EEG can be a useful alternative to inpatient video-EEG monitoring in a selected number of patients with frequent events who do not require medication taper or seizure testing for surgical localization.
Topics: Adult; Cost-Benefit Analysis; Electroencephalography; Epileptic Syndromes; Female; Humans; Male; Monitoring, Ambulatory; Seizures; Sleep Stages
PubMed: 33661784
DOI: 10.1097/WNP.0000000000000678 -
Epilepsia Open May 2023Evidence showing that the immature brain is vulnerable to seizure-induced damage has been accumulating for decades. Clinical data have always suggested that some... (Review)
Review
Evidence showing that the immature brain is vulnerable to seizure-induced damage has been accumulating for decades. Clinical data have always suggested that some early-life seizures are associated with negative sequelae, but clinical observations are frequently obscured by multiple uncontrolled contributing factors and can rarely establish causality. Determining with certainty that seizures, per se, can cause neuronal death and can irreversibly disrupt critical developmental processes, required the development of suitable model systems. Several experimental seizure models clearly show that the immature brain can sustain neuronal injury as a result of uncontrolled seizure activity and that even in the absence of observable neuronal death, the developing brain is selectively vulnerable to interruptions of required growth programs. Severe early-life seizures inhibit DNA, RNA, and protein synthesis, and they can reduce the accumulation of myelin and synaptic markers in the developing nervous system, leading to functional delays in development. Depending on the seizure pathway involved, and the developmental period under study, classic neurodegeneration, excitotoxicity, and apoptosis can result in permanent damage to critical neural networks in the temporal lobe and in many other brain regions. This conclusion is further supported by recent clinical studies showing that prolonged febrile status epilepticus can lead to hippocampal injury, which evolves into hippocampal atrophy and hippocampal sclerosis. A growing body of experimental data demonstrates that the metabolic compromise and cellular loss produced by seizures during critical phases of brain development negatively affect later hippocampal physiology including learning and memory functions in maturity.
Topics: Animals; Status Epilepticus; Seizures; Seizures, Febrile; Brain; Disease Models, Animal
PubMed: 35434910
DOI: 10.1002/epi4.12601 -
Brain : a Journal of Neurology Oct 2023While anti-seizure medications are effective for many patients, nearly one-third of individuals have seizures that are refractory to pharmacotherapy. Prior studies using...
While anti-seizure medications are effective for many patients, nearly one-third of individuals have seizures that are refractory to pharmacotherapy. Prior studies using evoked preclinical seizure models have shown that pharmacological activation or excitatory optogenetic stimulation of the deep and intermediate layers of the superior colliculus (DLSC) display multi-potent anti-seizure effects. Here we monitored and modulated DLSC activity to suppress spontaneous seizures in the WAG/Rij genetic model of absence epilepsy. Female and male WAG/Rij adult rats were employed as study subjects. For electrophysiology studies, we recorded single unit activity from microwire arrays placed within the DLSC. For optogenetic experiments, animals were injected with virus coding for channelrhodopsin-2 or a control vector, and we compared the efficacy of continuous neuromodulation to that of closed-loop neuromodulation paradigms. For each, we compared three stimulation frequencies on a within-subject basis (5, 20, 100 Hz). For closed-loop stimulation, we detected seizures in real time based on the EEG power within the characteristic frequency band of spike-and-wave discharges (SWDs). We quantified the number and duration of each SWD during each 2 h-observation period. Following completion of the experiment, virus expression and fibre-optic placement was confirmed. We found that single-unit activity within the DLSC decreased seconds prior to SWD onset and increased during and after seizures. Nearly 40% of neurons displayed suppression of firing in response to the start of SWDs. Continuous optogenetic stimulation of the DLSC (at each of the three frequencies) resulted in a significant reduction of SWDs in males and was without effect in females. In contrast, closed-loop neuromodulation was effective in both females and males at all three frequencies. These data demonstrate that activity within the DLSC is suppressed prior to SWD onset, increases at SWD onset, and that excitatory optogenetic stimulation of the DLSC exerts anti-seizure effects against absence seizures. The striking difference between open- and closed-loop neuromodulation approaches underscores the importance of the stimulation paradigm in determining therapeutic effects.
Topics: Rats; Male; Humans; Animals; Female; Epilepsy, Absence; Superior Colliculi; Optogenetics; Seizures; Electroencephalography; Disease Models, Animal
PubMed: 37192344
DOI: 10.1093/brain/awad166 -
European Journal of Paediatric... Sep 2016Benign convulsions with mild gastroenteritis (CwG) is a clinical condition characterized by convulsions occurring in otherwise healthy children, usually in the absence... (Review)
Review
BACKGROUND
Benign convulsions with mild gastroenteritis (CwG) is a clinical condition characterized by convulsions occurring in otherwise healthy children, usually in the absence of fever and in the presence of mild acute gastroenteritis. Until now, CwG had not been fully recognized as an epileptic syndrome, and several aspects of this condition are not clearly defined, especially its pathogenesis.
METHODS
The main aim of this paper is to discuss after the review of the literature what is known about CwG to facilitate its recognition and treatment.
RESULTS
CwG is a benign condition that has several clinical and prognostic similarities with febrile seizures. The disease occurs in infants and in children who are 1 month to 3 years old, during the winter and early spring when rotavirus and norovirus are circulating. In most cases, seizures follow gastrointestinal symptoms. In a minority of patients, the seizures and gastrointestinal symptoms occur before or simultaneously with the development of diarrhoea. Even if convulsions are mostly described as generalized tonic-clonic, the ictal recordings have always demonstrated a focal origin. Electroencephalography, lumbar punctures, and radiological examinations are not useful because they are normal in these patients; and when alterations are present, they disappear in a relatively short time. Only prolonged seizures, which are usually not common, require antiepileptic treatments in the acute phase.
CONCLUSION
Knowledge of CwG characteristics is essential for paediatricians to avoid useless hospitalization, examinations and, above all, drug administration, as the drugs have potential side effects.
Topics: Child; Child, Preschool; Electroencephalography; Female; Gastroenteritis; Humans; Infant; Male; Seizures
PubMed: 27292317
DOI: 10.1016/j.ejpn.2016.05.014 -
Journal of the American Psychiatric... 2023Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high... (Review)
Review
BACKGROUND
Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices.
AIM
To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES.
METHODS
An integrative review guided by the Whittemore and Knafl approach.
RESULTS
The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies).
CONCLUSIONS
Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.
Topics: Humans; Quality of Life; Psychogenic Nonepileptic Seizures; Seizures; Psychotherapy; Cognitive Behavioral Therapy
PubMed: 35801259
DOI: 10.1177/10783903221107637 -
Epilepsy & Behavior : E&B Nov 2023The continuously expanding research and development of wearable devices for automated seizure detection in epilepsy uses mostly non-invasive technology. Real-time... (Review)
Review
INTRODUCTION AND PURPOSE
The continuously expanding research and development of wearable devices for automated seizure detection in epilepsy uses mostly non-invasive technology. Real-time alarms, triggered by seizure detection devices, are needed for safety and prevention to decrease seizure-related morbidity and mortality, as well as objective quantification of seizure frequency and severity. Our review strives to provide a state-of-the-art on automated seizure detection using non-invasive wearable devices in an ambulatory (home) environment and to highlight the prospects for future research.
METHODS
A joint working group of the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology (IFCN) recently published a clinical practice guideline on automated seizure detection using wearable devices. We updated the systematic literature search for the period since the last search by the joint working group. We selected studies qualifying minimally as phase-2 clinical validation trials, in accordance with standards for testing and validation of seizure detection devices.
RESULTS
High-level evidence (phases 3 and 4) is available only for the detection of tonic-clonic seizures and major motor seizures when using wearable devices based on accelerometry, surface electromyography (EMG), or a multimodal device combining accelerometry and heart rate. The reported sensitivity of these devices is 79.4-96%, with a false alarm rate of 0.20-1.92 per 24 hours (0-0.03 per night). A single phase-3 study validated the detection of absence seizures using a single-channel wearable EEG device. Two phase-4 studies showed overall user satisfaction with wearable seizure detection devices, which helped decrease injuries related to tonic-clonic seizures. Overall satisfaction, perceived sensitivity, and improvement in quality-of-life were significantly higher for validated devices.
CONCLUSIONS
Among the vast number of studies published on seizure detection devices, most are strongly affected by potential bias, providing a too-optimistic perspective. By applying the standards for clinical validation studies, potential bias can be reduced, and the quality of a continuously growing number of studies in this field can be assessed and compared. The ILAE-IFCN clinical practice guideline on automated seizure detection using wearable devices recommends using clinically validated wearable devices for automated detection of tonic-clonic seizures when significant safety concerns exist. The studies published after the guideline was issued only provide incremental knowledge and would not change the current recommendations.
Topics: Humans; Seizures; Epilepsy, Tonic-Clonic; Epilepsy, Absence; Electroencephalography; Wearable Electronic Devices
PubMed: 37857030
DOI: 10.1016/j.yebeh.2023.109486