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Epilepsy & Behavior : E&B Oct 2020Seizure disorders are associated with multisystem complications. Cardiovascular complications account for a significant proportion of morbidity and mortality in these... (Review)
Review
Seizure disorders are associated with multisystem complications. Cardiovascular complications account for a significant proportion of morbidity and mortality in these patients. As such, particular attention must be paid to the incidence of cardiovascular complications especially in populations at increased risk. The background for cardiac dysfunction lies in the interplay of genetic/molecular, autonomic, and iatrogenic factors that contribute to its onset. The purpose of this review was to summarize the state of literature in the last decade with regard to cardiac complications of epileptic seizures in order to increase awareness of short- and long-term debilitating cardiac complications as well as facilitate informed clinical decision-making. Taken together, the evidence provided in this review suggests that cardiac dysfunction following seizures should not be viewed as a separate entity but as an important complication of epileptic seizures. Appropriate cardiac therapy should be instituted in the postictal medical management of epileptic seizures. In acute states, postictal cardiac troponinemia (elevated cTn) should be worked up. Longer-term, monitoring for the development of cardiac structural and functional abnormalities is prudent.
Topics: Cardiovascular Diseases; Clinical Decision-Making; Humans; Seizures
PubMed: 32554232
DOI: 10.1016/j.yebeh.2020.107185 -
Cleveland Clinic Journal of Medicine May 2022Psychogenic nonepileptic seizure (PNES) is often misdiagnosed as epilepsy, leading to unnecessary treatments and procedures, as well as failure to engage patients in... (Review)
Review
Psychogenic nonepileptic seizure (PNES) is often misdiagnosed as epilepsy, leading to unnecessary treatments and procedures, as well as failure to engage patients in needed mental health care. To establish an accurate diagnosis, video electroencephalography (EEG) in the context of and simultaneous with a comprehensive neurologic and psychosocial evaluation is recommended for any patient with seizures that are not responding to treatment. Delivering the diagnosis with empathy and respect is a crucial component of care that helps patients establish trust with caregivers and follow treatment recommendations. Effective treatment is available, highlighting the importance of early diagnosis to avoid unnecessary and potentially harmful treatment. But there are many barriers to care, including provider misperceptions, lack of acceptance of the diagnosis, poor patient engagement with treatment, and lack of access to care.
Topics: Diagnosis, Differential; Electroencephalography; Epilepsy; Humans; Psychogenic Nonepileptic Seizures; Seizures
PubMed: 35500924
DOI: 10.3949/ccjm.89a.21109 -
Seminars in Pediatric Neurology Apr 2022Psychogenic nonepileptic seizures (PNES) are a common condition seen in children and adolescents. The diagnosis is clinical, based on a description of events, and can be... (Review)
Review
Psychogenic nonepileptic seizures (PNES) are a common condition seen in children and adolescents. The diagnosis is clinical, based on a description of events, and can be supported using video electroencephalography recording. Children and adolescents with PNES often have comorbid psychiatric conditions and psychosocial stressors, although this is not a requisite for diagnosis. The pathophysiology is not fully understood but may be related to emotional processing and underlying aberrant functional connectivity. Communication of the diagnosis to patients and families in a compassionate way that leads to understanding is of paramount importance and the key first step to treatment. Psychotherapy that utilizes principles of cognitive behavioral therapy is the current standard for therapy. Symptoms can improve and many with PNES do experience remission of events with treatment, although not all. There is still much to be elucidated regarding underlying mechanisms and best treatments to help patients with this condition. In this article I review current knowledge about PNES in children and adolescents as well as share practical advice gleaned from clinical experience at Nationwide Children's Hospital's PNES Clinic.
Topics: Adolescent; Child; Cognitive Behavioral Therapy; Electroencephalography; Humans; Psychogenic Nonepileptic Seizures; Seizures; Video Recording
PubMed: 35450667
DOI: 10.1016/j.spen.2021.100949 -
Epilepsy & Behavior : E&B Sep 2023Idiopathic generalized epilepsy (IGE) is a common epilepsy syndrome with early age onset and generally good seizure outcomes. This study aims to determine the incidence... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Idiopathic generalized epilepsy (IGE) is a common epilepsy syndrome with early age onset and generally good seizure outcomes. This study aims to determine the incidence and predictive risk factors for drug-resistant IGE.
METHODS
We systematically searched three databases (PubMed, Embase, and Cochrane Library) in November 2022 and included 12 eligible studies which reported long-term outcomes (mean = 14.05) after antiseizure medications (ASMs) from 2001 to 2020. We defined drug resistance as the persistence of any seizure despite ASMs treatment (whether as monotherapies or in combination) given the criteria of drug resistance varied in original studies. A random-effects model was used to evaluate the prevalence of refractory IGE. Studies reporting potential poor prognostic factors were included for subsequent subgroup meta-analysis.
RESULTS
The pooled prevalence of drug resistance in IGE cohorts was 27% (95% CI: 0.19-0.36). Subgroup analysis of the risk factors revealed that the psychiatric comorbidities (odds ratio (OR): 4.87, 95% confidence interval (CI): 2.97-7.98), combined three seizure types (absences, myoclonic jerks, and generalized tonic-clonic seizures) (OR: 5.37, 95% CI: 3.16-9.13), the presence of absence seizure (OR: 4.38, 95% CI: 2.64-7.28), generalized polyspike trains (GPT) (OR: 4.83, 95% CI: 2.42-9.64), sex/catamenial epilepsy (OR: 3.25, 95% CI: 1.97-5.37), and status epilepticus (OR: 5.94, 95% CI: 2.23-15.85) increased the risk of poor prognosis. Other factors, including age onset, family history, and side effects of ASMs, were insignificantly associated with a higher incidence of refractory IGE.
CONCLUSION
Drug resistance is a severe complication of IGE. Further standardized research about clinical and electroencephalography factors is warranted.
Topics: Humans; Anticonvulsants; Prevalence; Epilepsy, Generalized; Seizures; Drug Resistant Epilepsy; Risk Factors; Immunoglobulin E
PubMed: 37523796
DOI: 10.1016/j.yebeh.2023.109364 -
Seminars in Pediatric Neurology Jul 2022The risk of seizure is increased in premature neonates compared to full term infants, with a distinct profile of etiologies, timing and character. Despite improvements... (Review)
Review
The risk of seizure is increased in premature neonates compared to full term infants, with a distinct profile of etiologies, timing and character. Despite improvements in neonatal care, preterm infants with seizure continue to have higher risk of abnormal neurodevelopmental outcomes when compared to preterm infants without seizures, or to full term infants with seizures. Very limited evidence guides the care of this challenging population, therefore, management of the preterm neonate with seizure is largely extrapolated from the care of full-term neonates. A critical need exists for well-designed clinical trials investigating and validating the safety, efficacy, and outcomes of seizure management in this vulnerable population.
Topics: Humans; Infant; Infant, Newborn; Infant, Premature; Seizures
PubMed: 35868735
DOI: 10.1016/j.spen.2022.100971 -
Epilepsy & Behavior : E&B Dec 2019Mapping the circuits underlying the generation and propagation of seizures is critically important for understanding their pathophysiology. We review evidence to suggest... (Review)
Review
Mapping the circuits underlying the generation and propagation of seizures is critically important for understanding their pathophysiology. We review evidence to suggest that circuits engaged in secondarily generalized seizures are likely to be more complex than those currently proposed. Focal seizures have been proposed to engage canonical thalamocortical circuits that mediate primarily generalized absence seizures, leading to secondarily generalized tonic-clonic seizures. In addition to traveling through the canonical thalamocortical circuits, secondarily generalized seizures could also travel through the striatum, globus pallidus, substantia nigra reticulata, and corpus callosum to the contralateral hemisphere. Recruitment of principal neurons in superficial layers 2/3 of the cortex can play a critical role in corticocortical seizure spread. Understanding the neuronal structures engaged in generating secondarily generalized seizures could provide novel targets for neuromodulation for the treatment of seizures. Furthermore, these sites may be loci of neuronal plasticity facilitating epileptogenesis. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
Topics: Animals; Epilepsy, Generalized; Humans; Nerve Net; Seizures
PubMed: 31431400
DOI: 10.1016/j.yebeh.2019.106474 -
American Family Physician May 2022Seizures are transient signs and symptoms of abnormal, excessive, or synchronous neuronal activity in the brain. Up to 10% of adults have a seizure during their...
Seizures are transient signs and symptoms of abnormal, excessive, or synchronous neuronal activity in the brain. Up to 10% of adults have a seizure during their lifetime, with increasing incidence in people older than 55 years. One-third of people have a recurrent seizure within one year of an initial unprovoked seizure. Acute symptomatic (provoked) seizures recur less often, especially when provoking factors are addressed. After confirming a probable seizure, evaluation focuses on identifying provoking factors such as tumor, metabolic derangement, infectious disease, stroke, traumatic brain injury, medications, or substance misuse. Magnetic resonance imaging with an epilepsy protocol and electroencephalography should be performed as soon as practical. Lumbar puncture is useful if intracranial infection is suspected. Immediate initiation of anti-seizure medication reduces seizure recurrence by 35% within the first two years. Recurrence rates between three and five years are similar between patients who start anti-seizure medication immediately after the first seizure and those who do not. Restoration of driving privileges varies by state. After a seizure, safety concerns should be addressed, such as the need for a safety companion when bathing or swimming and the risks of ladders and other hazards.
Topics: Adult; Anticonvulsants; Brain; Electroencephalography; Epilepsy; Humans; Recurrence; Seizures
PubMed: 35559631
DOI: No ID Found -
Neonatal Network : NN Nov 2021Seizures are the abnormal, excessive, synchronous discharge of cortical neurons that results in injury to the brain. Seizures presenting in the neonatal period may be...
Seizures are the abnormal, excessive, synchronous discharge of cortical neurons that results in injury to the brain. Seizures presenting in the neonatal period may be the first and only clue to underlying neurological pathology. Despite advances in care, the mortality rate for infants experiencing neonatal seizures is still as high as 20 percent, with up to 65 percent of infants with seizures demonstrating significant morbidity. Early identification and treatment of the seizure or modifiable underlying etiology greatly reduces the extent of morbidity associated with neonatal seizures. Literature, including journal articles and relevant textbooks, was reviewed and condensed into a practical guide to neonatal seizures which includes the pathophysiology of injury associated with neonatal seizures, clinical manifestations, methods of diagnosis, and various options available for treatment.
Topics: Brain; Electroencephalography; Humans; Hypoxia-Ischemia, Brain; Infant; Infant, Newborn; Infant, Newborn, Diseases; Seizures
PubMed: 34845086
DOI: 10.1891/11-T-695 -
Pediatric Neurology Mar 2022
Topics: Epilepsy; Humans; Infant, Newborn; Infant, Newborn, Diseases; Seizures
PubMed: 34991933
DOI: 10.1016/j.pediatrneurol.2021.11.014 -
JAMA Network Open Nov 2023Neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) frequently experience seizures, which are associated with adverse outcomes.... (Observational Study)
Observational Study
IMPORTANCE
Neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) frequently experience seizures, which are associated with adverse outcomes. Efforts to rapidly identify seizures and reduce seizure burden may positively change neurologic and neurodevelopmental outcomes.
OBJECTIVE
To describe the onset, treatment, and evolution of seizures in a large cohort of newborns with HIE during TH assisted by a telehealth model and remote neuromonitoring approach.
DESIGN, SETTING, AND PARTICIPANTS
This was a prospective, observational, multicenter cohort study performed between July 2017 and December 2021 in 32 hospitals in Brazil. Participants were newborns with HIE meeting eligibility criteria and receiving TH. Data were analyzed from November 2022 to April 2023.
EXPOSURE
Infants with HIE receiving TH were remotely monitored with 3-channel amplitude-integrated electroencephalography (aEEG) including raw tracing and video imaging, and bedside clinicians received assistance from trained neonatologists and neurologists.
MAIN OUTCOMES AND MEASURES
Data on modified Sarnat examination, presence, timing and seizure type, aEEG background activity, sleep-wake cycling, and antiepileptic drugs used were collected. Descriptive statistical analysis was used with independent t test, χ2, Mann-Whitney test, and post hoc analyses applied for associations.
RESULTS
A total of 872 cooled newborns were enrolled; the median (IQR) gestational age was 39 (38-40) weeks, 518 (59.4%) were male, and 59 (6.8%) were classified as having mild encephalopathy by modified Sarnat examination, 504 (57.8%) as moderate, and 180 (20.6%) as severe. Electrographic seizures were identified in 296 newborns (33.9%), being only electrographic in 213 (71.9%) and clinical followed by electroclinical uncoupling in 50 (16.9%). Early abnormal background activity had a significant association with seizures. Infants with flat trace had the highest rate of seizures (58 infants [68.2%]) and the greatest association with the incidence of seizures (odds ratio [OR], 12.90; 95% CI, 7.57-22.22) compared with continuous normal voltage. The absence of sleep-wake cycling was also associated with a higher occurrence of seizures (OR, 2.22; 95% CI, 1.67-2.96). Seizure onset was most frequent between 6 and 24 hours of life (181 infants [61.1%]); however, seizure occurred in 34 infants (11.5%) during rewarming. A single antiepileptic drug controlled seizures in 192 infants (64.9%). The first line antiepileptic drug was phenobarbital in 294 (99.3%).
CONCLUSIONS AND RELEVANCE
In this cohort study of newborns with HIE treated with TH, electrographic seizure activity occurred in 296 infants (33.9%) and was predominantly electrographic. Seizure control was obtained with a single antiepileptic drug in 192 infants (64.9%). These findings suggest neonatal neurocritical care can be delivered at remote limited resource hospitals due to innovations in technology and telehealth.
Topics: Infant, Newborn; Infant; Male; Humans; Female; Anticonvulsants; Cohort Studies; Hypoxia-Ischemia, Brain; Prospective Studies; Seizures; Hypothermia, Induced
PubMed: 37966836
DOI: 10.1001/jamanetworkopen.2023.43429