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Seizure Aug 2019We aimed to identify clinical characteristics of patients with shoulder dislocations caused by an epileptic seizure. (Review)
Review
PURPOSE
We aimed to identify clinical characteristics of patients with shoulder dislocations caused by an epileptic seizure.
METHODS
In our retrospective analysis, we identified 15 patients, recorded over an 8-year period, who were diagnosed with shoulder dislocations in the setting of a bilateral tonic-clonic seizure.
RESULTS
Patients were almost exclusively male (13/15) and drug-naïve patients suffering their first or second seizure (14/15). Epilepsy was diagnosed in five of these 14 patients after further diagnostic tests, four patients were diagnosed with a provoked or acute symptomatic seizure and five patients with an unprovoked seizure. Treatment with anticonvulsant drugs (AED) was initiated in 10/15 patients after the first seizure, without recommendation for tapering, although long-term treatment was retrospectively judged to be appropriate for only four of those cases. Posterior dislocations - usually rare - were seen in 12/15 patients and often required complex orthopedic interventions.
CONCLUSIONS
We conclude that in particular posterior shoulder dislocations are often caused by a first seizure and should always raise the suspicion of an epileptic seizure even in the absence of a clear history. AED treatment likely has a protective effect against this type of injury, even if seizure-freedom is not achieved.
Topics: Adult; Aged; Aged, 80 and over; Anticonvulsants; Comorbidity; Epilepsy; Female; Humans; Male; Middle Aged; Retrospective Studies; Seizures; Shoulder Dislocation; Young Adult
PubMed: 31252362
DOI: 10.1016/j.seizure.2019.06.025 -
Epilepsy & Behavior : E&B Dec 2011Over the last decade, the search for a method able to reliably predict seizures hours in advance has been largely replaced by the more realistic goal of very early... (Review)
Review
Over the last decade, the search for a method able to reliably predict seizures hours in advance has been largely replaced by the more realistic goal of very early detection of seizure onset, which would allow therapeutic or warning devices to be triggered prior to the onset of disabling clinical symptoms. We explore in this article the steps along the pathway from data acquisition to closed-loop applications that can and should be considered to design the most efficient early seizure detection. Microelectrodes, high-frequency oscillations, high sampling rate, high-density arrays, and modern analysis techniques are all elements of the recording and detection process that in combination with modeling studies can provide new insights into the dynamics of seizure onsets. Each of these steps needs to be considered if detection devices that will favorably impact the quality of life of patients are to be implemented. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.
Topics: Brain Mapping; Brain Waves; Computer Simulation; Early Diagnosis; Electroencephalography; Humans; Microelectrodes; Seizures; Time Factors
PubMed: 22078518
DOI: 10.1016/j.yebeh.2011.08.029 -
Neuro-oncology Jul 2015There is growing evidence that antitumor treatment contributes to better seizure control in low-grade glioma patients. We performed a systematic review of the current... (Review)
Review
There is growing evidence that antitumor treatment contributes to better seizure control in low-grade glioma patients. We performed a systematic review of the current literature on seizure outcome after radiotherapy and chemotherapy and evaluated the association between seizure outcome and radiological response. Twenty-four studies were available, of which 10 described seizure outcome after radiotherapy and 14 after chemotherapy. All studies demonstrated improvements in seizure outcome after antitumor treatment. Eight studies reporting on imaging response in relation to seizure outcome showed a seizure reduction in a substantial part of patients with stable disease on MRI. Seizure reduction may therefore be the only noticeable effect of antitumor treatment. Our findings demonstrate the clinical relevance of monitoring seizure outcome after radiotherapy and chemotherapy, as well as the potential role of seizure reduction as a complementary marker of tumor response in low-grade glioma patients.
Topics: Brain Neoplasms; Glioma; Humans; Seizures; Treatment Outcome
PubMed: 25813469
DOI: 10.1093/neuonc/nov032 -
Seizure Jul 2017The primary goal of neuroimaging in a first, unprovoked seizure is to identify a lesion that can explain the seizure. Secondarily, neuroimaging may be used to predict... (Review)
Review
The primary goal of neuroimaging in a first, unprovoked seizure is to identify a lesion that can explain the seizure. Secondarily, neuroimaging may be used to predict seizure recurrence and assist with the diagnosis of epilepsy. However, the events leading from a first seizure to epilepsy, with or without an identifiable epileptogenic lesion, are not well understood, and it is not always clear which lesions are epileptogenic as opposed to incidental. Much neuroimaging research to date has focused on findings in chronic epilepsy, rather than first seizure. Dedicated epilepsy imaging with high quality MRI protocols maximizes the likelihood of a diagnosis. However, a significant proportion of patients are MRI-negative, prompting researchers in the field to continue the search for better imaging strategies. Here we describe the role of neuroimaging in the assessment of a first seizure, the current state of the art and possible future directions.
Topics: Brain; Humans; Magnetic Resonance Imaging; Neuroimaging; Seizures; Tomography, X-Ray Computed
PubMed: 27324840
DOI: 10.1016/j.seizure.2016.05.015 -
ELife Jul 2020Seizures are a disruption of normal brain activity present across a vast range of species and conditions. We introduce an organizing principle that leads to the first...
Seizures are a disruption of normal brain activity present across a vast range of species and conditions. We introduce an organizing principle that leads to the first objective Taxonomy of Seizure Dynamics (TSD) based on bifurcation theory. The 'dynamotype' of a seizure is the dynamic composition that defines its observable characteristics, including how it starts, evolves and ends. Analyzing over 2000 focal-onset seizures from multiple centers, we find evidence of all 16 dynamotypes predicted in TSD. We demonstrate that patients' dynamotypes evolve during their lifetime and display complex but systematic variations including hierarchy (certain types are more common), non-bijectivity (a patient may display multiple types) and pairing preference (multiple types may occur during one seizure). TSD provides a way to stratify patients in complement to present clinical classifications, a language to describe the most critical features of seizure dynamics, and a framework to guide future research focused on dynamical properties.
Topics: Epilepsy; Genetic Variation; Genotype; Humans; Seizures; Terminology as Topic
PubMed: 32691734
DOI: 10.7554/eLife.55632 -
Seizure Mar 2021To determine long-term seizure outcome, use of antiseizure medication (ASM) and seizure recurrence risk after its withdrawal in patients with autoimmune encephalitis...
PURPOSE
To determine long-term seizure outcome, use of antiseizure medication (ASM) and seizure recurrence risk after its withdrawal in patients with autoimmune encephalitis (AE) due to neuronal surface and GAD antibodies.
METHODS
In patients from a specialized AE outpatient clinic, we assessed seizure manifestation, ASM and immunotherapy at onset of AE as well as seizure occurrence, development of autoimmune-associated epilepsy (AAE) and use of ASM in the long-term. Data were collected from patients via telephone interviews and medical records.
RESULTS
Out of 94 AE patients, 75 were analyzed; 47 patients had NMDAR, 17 LGI1, 7 GAD, 3 CASPR2 and 1 mGluR5 antibodies. Fifty-three of the 75 patients (71 %) experienced seizures, all of which for the first time occurred at AE onset. After a median follow-up of 6 years (range, 1-15), 47 of the 53 AE patients had 1-year terminal seizure remission, median duration of terminal seizure freedom was 5 years. Rate of 1-year terminal seizure remission was significantly higher in patients with neuronal surface antibodies (NMDAR 97 %, LGI1 93 %, CASPR2 100 %) compared to patients with GAD antibodies (20 %, p < 0.001). In seizure-free patients, ASM was withdrawn after 13 months (median) without any relapse seizures.
CONCLUSIONS
Seizures are common in most forms of AE manifesting at disease onset in all cases. However, the development of AAE is rare and typically occurs in patients with GAD antibodies. Thus, in most AE cases with neuronal surface antibodies, ASM can be withdrawn after the acute phase of AE with low risk of seizure relapse.
Topics: Encephalitis; Epilepsy; Hashimoto Disease; Humans; Seizures
PubMed: 33618141
DOI: 10.1016/j.seizure.2021.02.010 -
Seizure Jul 2017A first seizure can result in significant uncertainty, fear and apprehension. One of the key roles of the clinician in the setting of first seizure is to provide... (Review)
Review
PURPOSE
A first seizure can result in significant uncertainty, fear and apprehension. One of the key roles of the clinician in the setting of first seizure is to provide accurate, timely information and counselling.
METHOD
We review the numerous components to be considered when counselling an adult patient after a first seizure.
RESULTS
We provide a framework and manner to provide that counselling. We focus on an individualized approach and provide recommendations and information on issues of diagnosis, etiology, prognosis, the role and importance of medical testing, lifestyle considerations, driving, medication and other key counselling considerations.
CONCLUSION
Accurate, timely counselling can allay fears and anxieties, remove misconceptions and reduce the risk for injury in seizure recurrence.
Topics: Adult; Anticonvulsants; Automobile Driving; Counseling; Electroencephalography; Humans; Life Style; Neuroimaging; Patient Education as Topic; Prognosis; Seizures
PubMed: 27720347
DOI: 10.1016/j.seizure.2016.09.012 -
International Journal of Molecular... Apr 2021Epilepsy, one of the most common neurological disorders worldwide, is characterized by recurrent seizures and subsequent brain damage. Despite strong evidence supporting... (Review)
Review
Epilepsy, one of the most common neurological disorders worldwide, is characterized by recurrent seizures and subsequent brain damage. Despite strong evidence supporting a deleterious impact on seizure occurrence and outcome severity, stress is an overlooked component in people with epilepsy. With regard to stressor duration and timing, acute stress can be protective in epileptogenesis, while chronic stress often promotes seizure occurrence in epilepsy patients. Preclinical research suggests that chronic stress promotes neuroinflammation and leads to a depressive state. Depression is the most common psychiatric comorbidity in people with epilepsy, resulting in a poor quality of life. Here, we summarize studies investigating acute and chronic stress as a seizure trigger and an important factor that worsens epilepsy outcomes and psychiatric comorbidities. Mechanistic insight into the impact of stress on epilepsy may create a window of opportunity for future interventions targeting neuroinflammation-related disorders.
Topics: Comorbidity; Epilepsy; Humans; Inflammation; Male; Quality of Life; Seizures
PubMed: 33920037
DOI: 10.3390/ijms22084061 -
Epilepsy & Behavior : E&B Jan 2014Recent advances have been made in the network mechanisms underlying impairment of consciousness during seizures. However, less is known about patient awareness of their... (Review)
Review
Recent advances have been made in the network mechanisms underlying impairment of consciousness during seizures. However, less is known about patient awareness of their own seizures. Studying patient reports or documentation of their seizures is currently the most commonly utilized mechanism to scientifically measure patient awareness of seizures. The purpose of this review is to summarize the available evidence regarding the accuracy of patient seizure counts and identify the variables that may influence unreliable seizure reporting. Several groups looking at patient documentation of seizures during continuous EEG monitoring show that patients do not report as many as 50% of their seizures. These studies also suggest that seizures accompanied by loss of consciousness, arising from the left hemisphere or the temporal lobe, or occurring during sleep are associated with significantly reduced reporting. Baseline memory performance does not appear to have a major influence on the accuracy of seizure report. Further prospective studies using validated ictal behavioral testing as well as using correlation with newer electrophysiological and neuroimaging techniques for seizure localization are needed to more fully understand the mechanisms of underreporting of seizures. Better methods to alert caregivers about unrecognized seizures and to improve seizure documentation are under investigation.
Topics: Consciousness; Consciousness Disorders; Humans; Seizures
PubMed: 24126026
DOI: 10.1016/j.yebeh.2013.09.018 -
Postgraduate Medical Journal Sep 2006Post-stroke seizure and post-stroke epilepsy are common causes of hospital admissions, either as a presenting feature or as a complication after a stroke. They require... (Review)
Review
Post-stroke seizure and post-stroke epilepsy are common causes of hospital admissions, either as a presenting feature or as a complication after a stroke. They require appropriate management and support in long term. With an increasingly ageing population, and age itself being an independent risk factor for stroke, the incidence and prevalence of post-stroke seizure and post-stroke epilepsy is likely to increase. This article examines aetiology, clinical presentation, and presents a management outline of these conditions with particular focus on adults. The aim of this review article is to provide the clinicians with background information and recommendations.
Topics: Diagnosis, Differential; Electrocardiography; Epilepsy; Humans; Incidence; Magnetic Resonance Imaging; Patient Care Team; Prevalence; Seizures; Stroke; Tomography, X-Ray Computed
PubMed: 16954451
DOI: 10.1136/pgmj.2005.041426