Sample records for generalized seizure leading

  1. Dissociation of spontaneous seizures and brainstem seizure thresholds in mice exposed to eight flurothyl-induced generalized seizures. (United States)

    Kadiyala, Sridhar B; Ferland, Russell J


    C57BL/6J mice exposed to eight flurothyl-induced generalized clonic seizures exhibit a change in seizure phenotype following a 28-day incubation period and subsequent flurothyl rechallenge. Mice now develop a complex seizure semiology originating in the forebrain and propagating into the brainstem seizure network (a forebrain→brainstem seizure). In contrast, this phenotype change does not occur in seizure-sensitive DBA/2J mice. The underlying mechanism(s) was the focus of these studies. DBA2/J mice were exposed to eight flurothyl-induced seizures (1/day) followed by 24-hour video-electroencephalographic recordings for 28-days. Forebrain and brainstem seizure thresholds were determined in C57BL/6J and DBA/2J mice following one or eight flurothyl-induced seizures, or after eight flurothyl-induced seizures, a 28-day incubation period, and final flurothyl rechallenge. Similar to C57BL/6J mice, DBA2/J mice expressed spontaneous seizures. However, unlike C57BL/6J mice, DBA2/J mice continued to have spontaneous seizures without remission. Because DBA2/J mice do not express forebrain→brainstem seizures following flurothyl rechallenge after a 28-day incubation period, this indicated that spontaneous seizures were not sufficient for the evolution of forebrain→brainstem seizures. Therefore, we determined whether brainstem seizure thresholds were changing during this repeated-flurothyl model and whether this could account for the expression of forebrain→brainstem seizures. Brainstem seizure thresholds were not different between C57BL/6J and DBA/2J mice on day one or on the last induction seizure trial (day eight). However, brainstem seizure thresholds did differ significantly on flurothyl rechallenge (day 28) with DBA/2J mice showing no lowering of their brainstem seizure thresholds. These results demonstrated that DBA/2J mice exposed to the repeated-flurothyl model develop spontaneous seizures without evidence of seizure remission and provide a new model of

  2. Vagus nerve stimulation for generalized epilepsy with febrile seizures plus (GEFS+ accompanying seizures with impaired consciousness

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    Ryosuke Hanaya


    Full Text Available Generalized epilepsy with febrile seizures plus (GEFS+ is characterized by childhood-onset epilepsy syndrome. It involves febrile seizures and a variety of afebrile epileptic seizure types within the same pedigree with autosomal-dominant inheritance. Approximately 10% of individuals with GEFS+ harbor SCN1A, a gene mutation in one of the voltage-gated sodium channel subunits. Considerably less common are focal epilepsies including focal seizures with impaired consciousness. We report vagus nerve stimulation (VNS in a 6-year-old girl with GEFS+ who exhibited drug-resistant generalized tonic-clonic seizures and focal seizures with impaired consciousness.

  3. [Simple febrile seizure, complex seizure, generalized epilepsy with febrile seizure plus, FIRES and new syndromes]. (United States)

    Moreno de Flagge, Noris


    Febrile seizures are the most common seizures in childhood. They have been observed in 2-5% of children before the age of 5, but in some populations this figure may increase to 15%. It is a common cause of pediatric hospital admissions and cause of anxiety for parents. Febrile seizures could be the first manifestation of epilepsy. About 13% of epileptic patients have a history of febrile seizure, and 30% have had recurrent febrile seizures. Their phenotypic characteristics allow, in the majority of cases, a classification of the seizure, an elaboration of a prognosis and to assume a specific therapeutic attitude. It is possible to describe a spectrum according to their severity, from the benign simple seizure to the more complex, febrile seizure plus, Dravet'syndrome, and FIRES. During the past decade, molecular genetic studies have contributed to the identification of genetic factors involved in febrile seizure and related disorders, making the necessity of a careful follow up of these patients in order to detect risk factors earlier. We have reviewed the medical literature to update current knowledge of febrile seizures, their prognosis and their relation to new epileptic syndromes.

  4. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy (United States)

    Krauss, Gregory L.; Wechsler, Robert T.; Wang, Xue-Feng; DiVentura, Bree; Brandt, Christian; Trinka, Eugen; O'Brien, Terence J.; Laurenza, Antonio; Patten, Anna; Bibbiani, Francesco


    Objective: To assess efficacy and safety of adjunctive perampanel in patients with drug-resistant, primary generalized tonic-clonic (PGTC) seizures in idiopathic generalized epilepsy (IGE). Methods: In this multicenter, double-blind study ( identifier: NCT01393743; funded by Eisai Inc.), patients 12 years or older with PGTC seizures and IGE were randomized to placebo or perampanel during a 4-week titration period (perampanel uptitrated from 2 to 8 mg/d, or highest tolerated dose) and 13-week maintenance period. The primary endpoint was percent change in PGTC seizure frequency per 28 days (titration plus maintenance vs baseline). The key secondary endpoint (primary endpoint for European Union registration) was 50% PGTC seizure responder rate (patients achieving ≥50% reduction in PGTC seizure frequency; maintenance vs baseline). Treatment-emergent adverse events were monitored. Results: Of 164 randomized patients, 162 comprised the full analysis set (placebo, 81; perampanel, 81). Compared with placebo, perampanel conferred a greater median percent change in PGTC seizure frequency per 28 days (−38.4% vs −76.5%; p seizure responder rate (39.5% vs 64.2%; p = 0.0019). During maintenance, 12.3% of placebo-treated patients and 30.9% of perampanel-treated patients achieved PGTC seizure freedom. For the safety analysis (placebo, 82; perampanel, 81), the most frequent treatment-emergent adverse events with perampanel were dizziness (32.1%) and fatigue (14.8%). Conclusions: Adjunctive perampanel was well tolerated and improved control of drug-resistant PGTC seizures in patients with IGE. Classification of evidence: This study provides Class I evidence that adjunctive perampanel reduces PGTC seizure frequency, compared with placebo, in patients with drug-resistant PGTC seizures in IGE. PMID:26296511

  5. Stationarity and Redundancy of Multichannel EEG Data Recorded During Generalized Tonic-Clonic Seizures

    CERN Document Server

    Zöldi, S M; Greenside, H S; Zoldi, Scott M.; Krystal, Andrew; Greenside, Henry S.


    A prerequisite for applying some signal analysis methods to electroencephalographic (EEG) data is that the data be statistically stationary. We have investigated the stationarity of 21-electrode multivariate EEG data recorded from ten patients during generalized tonic-clonic (GTC) seizures elicited by electroconvulsive therapy (ECT). Stationarity was examined by calculating probability density functions (pdfs) and power spectra over small equal-length non-overlapping time windows and then by studying visually and quantitatively the evolution of these quantities over the duration of the seizures. Our analysis shows that most of the seizures had time intervals of at least a few seconds that were statistically stationary by several criteria and simultaneously for different electrodes, and that some leads were delayed in manifesting the statistical changes associated with seizure onset evident in other leads. The stationarity across electrodes was further examined by studying redundancy of the EEG leads and how t...

  6. [Neurophysiological markers of generalized and focal epileptic seizures]. (United States)

    Kravtsova, E Yu; Shulakova, K V

    To identify neurophysiological markers of focal and generalized epileptic seizures in the inter-epileptic period. Sixty-four patients, including 36 with isolated generalized tonic-clonic seizures and 28 with focal seizures, were examined. The control group consisted of 27 healthy people. EEG-video monitoring and bioelectric activity analysis of the brain during wakefulness and day sleep, spectral EEG analysis, quantitative and quality indicators of sleep were used. In generalized epileptic seizures, alpha rhythm is predominantly recorded in the left hemisphere. In wakefulness, the focal epileptiform activity develops during the first two stages of day sleep. In focal epileptic seizures, delta and beta-2 rhythms were recorded in the left hemisphere, regional epileptiform changes are aggravated during the 1st and 2nd stages of slow sleep initiated in the frontal regions. A focal component of the epileptiform activity in the inter-epileptic period in patients with different types of seizures should be taken into account in examination and treatment planning of patients who had difficulties with the diagnosis of epilepsy type.

  7. Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration (United States)

    Kennedy, Jeffrey D.; Hardin, Kimberly A.; Parikh, Palak; Li, Chin-Shang; Seyal, Masud


    Purpose Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. Methods Chest X-Rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. Results Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p=0.002) in GTCS with abnormal CXR (259.7 sec) versus GTCS with normal CXR (101.2 sec). Odds-ratio for CXR abnormality was 20.46 (p=0.006) with seizure duration greater than 100 sec versus less than 100 sec. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p=0.015). Conclusions Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP. PMID:25844030

  8. Blood lead level and seizure: a narrative review

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    Ahmad Shah Farhat


    Full Text Available Environmental pollution is one of the most serious and fast-growing problems in the world of today. Lead poisoning is a threatening environmental situation with the potential of causing irreversible health issues and serious negative consequences in adults and children. Lead proves to have almost no clear biological function. However, once it enters the body, it is known to cause severe health effects, which might be irreversible. In this article, we aimed to review the related literature to find evidence concerning the effect of lead toxicity on CNS, particularly its role in febrile convulsion. In this review, PubMed database was searched using MeSH terms. One hundred and fifty seven articles were retrieved, most of which were irrelevant to the topic. After a thorough search in PubMed and Google Scholar, seizure was shown to be one of the consequences of lead toxicity, but there was no evidence of epilepsy or febrile convulsion, induced by this metal contamination.

  9. Mapping brain activity on the verge of a photically induced generalized tonic-clonic seizure

    DEFF Research Database (Denmark)

    Moeller, Friederike; Siebner, Hartwig R; Wolff, Stephan


    In a photosensitive patient intermittent photic stimulation (IPS) accidentally provoked a generalized tonic-clonic seizure during simultaneous recordings of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Before seizure onset, IPS consistently induced generalized ph...

  10. Functional Network Connectivity Patterns between Idiopathic Generalized Epilepsy with Myoclonic and Absence Seizures

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    Qifu Li


    Full Text Available The extensive cerebral cortex and subcortical structures are considered as the major regions related to the generalized epileptiform discharges in idiopathic generalized epilepsy. However, various clinical syndromes and electroencephalogram (EEG signs exist across generalized seizures, such as the loss of consciousness during absence seizures (AS and the jerk of limbs during myoclonic seizures (MS. It is presumed that various functional systems affected by discharges lead to the difference in syndromes of these seizures. Twenty epileptic patients with MS, 21 patients with AS, and 21 healthy controls were recruited in this study. The functional network connectivity was analyzed based on the resting-state functional magnetic resonance imaging scans. The statistical analysis was performed in three groups to assess the difference in the functional brain networks in two types of generalized seizures. Twelve resting-state networks were identified in three groups. Both patient groups showed common abnormalities, including decreased functional connectivity in salience network (SN, cerebellum network, and primary perceptional networks and decreased connection between SN and visual network, compared with healthy controls. Interestingly, the frontal part of high-level cognitive resting-state networks showed increased functional connectivity (FC in patients with MS, but decreased FC in patients with AS. Moreover, patients with MS showed decreased negative connections between high-level cognitive networks and primary system. The common alteration in both patient groups, including SN, might reflect a similar mechanism associated with the loss of consciousness during generalized seizures. This study provided the evidence of brain network in generalized epilepsy to understand the difference between MS and AS.

  11. The adolescent or adult with generalized tonic-clonic seizures

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    Roop Gursahani


    Full Text Available Primary and secondary generalized tonic-clonic seizures (GTCs together constitute up to 50% of adolescent and adult patients with epilepsy as diagnosed by history and EEG. Syncope and psychogenic nonepileptic seizures are major differential diagnoses and must be carefully excluded in therapy-resistant cases. Individual episodes can have up to seven phases in secondarily generalized GTCs. The distinction between primary and secondary GTCs depends mainly on history and EEG, and yield can be improved with sleep deprivation or overnight recording. Epilepsies with primary or unclassified GTCs can respond to any one of the five broad-spectrum antiepileptic drugs (AEDs: valproate, lamotrigine, levetiracetam, topiramate and zonisamide. Unless a focal onset is clearly confirmed, a sodium-channel blocking AED should not be used in the initial treatment of these conditions.

  12. Generalized seizure: A rare etiology of intraperitoneal rupture of the urinary bladder

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    Bipin C Pal


    Full Text Available Seizures can lead to different types of injuries which can be as simple as minor lacerations and at times as serious as fractures and head injuries. We are reporting a case wherein a female patient presented with a history of abdominal pain and not passing urine for 24h following an attack of seizure. After catheterization the urine drained was blood-stained. On clinical suspicion a cystogram was done which showed intraperitoneal rupture of the bladder. At laparotomy an isolated rent in the dome of the bladder was found which was repaired in three layers. Postoperative period was uneventful. To our knowledge this is the second case of its kind reported in the literature. Our case illustrates that a thorough abdominal examination is desirable while examining a patient following an episode of generalized seizure.

  13. Patterns of muscle activation during generalized tonic and tonic–clonic epileptic seizures

    DEFF Research Database (Denmark)

    Conradsen, Isa; Wolf, Peter; Sams, Thomas


    was recorded from the deltoid muscles, on both sides, during 63 seizures from 20 patients with epilepsy (10 with generalized tonic and 10 with tonic–clonic seizures). Twenty age‐ and gender‐matched normal controls simulated 100 generalized tonic seizures. To characterize the signal properties we calculated...... the root mean square (RMS) of the amplitudes, the median frequency (MF), and the coherence. Based on the spectrograms of both epileptic and simulated seizures, we chose to determine the relative spectral power (RP) in the higher (100–500 Hz) frequency domain. Key Findings: During the tonic seizures...

  14. Epileptic seizure in a patient with an implantable cardioverter-defibrillator: Quo vadis right ventricular lead? (United States)

    Wedekind, Horst; Rozhnev, Andrey; Kleine-Katthöfer, Peter; Kranig, Wolfgang


    The case of a 77-year-old man admitted for suspected epileptic seizure is reported. Patient history showed implantation of a single-chamber implantable cardioverter-defibrillator (ICD) after cardiac arrest in 2007 with replacement in 2012 due to battery depletion; the patient reported no previous syncope, unconsciousness or seizures. Interrogation records of the ICD showed five ventricular tachyarrhythmia episodes that corresponded to the "seizure". Further examination revealed incorrect position of the RV-lead. Diagnosis was a provoked epileptic seizure due to undersensing of ventricular tachycardia because of improper ICD lead implantation in the coronary sinus. Treatment consisted of implantation of a new device with an additional ICD lead into the right ventricle.

  15. Seizures (United States)

    ... have warning symptoms before the attack, such as: Fear or anxiety Nausea Vertigo (feeling as if you are spinning or moving) Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes) Causes Seizures of all types are caused by disorganized and sudden electrical activity ...

  16. Rufinamide for generalized seizures associated with Lennox-Gastaut syndrome. (United States)

    Glauser, T; Kluger, G; Sachdeo, R; Krauss, G; Perdomo, C; Arroyo, S


    Lennox-Gastaut syndrome is a catastrophic pediatric epilepsy syndrome characterized by multiple types of treatment-resistant seizures and high rates of seizure-related injury. Current available treatments are inadequate, leaving patients with few treatment options and opportunities. We conducted a double-blind, randomized, placebo-controlled trial of the antiepileptic drug rufinamide in patients with Lennox-Gastaut syndrome. Eligible patients between 4 and 30 years of age had multiple types of seizures (including tonic-atonic and atypical absence seizures) with a minimum of 90 seizures in the month before baseline and a recent history of a slow spike-and-wave pattern on EEG. After a 28-day baseline period, 139 eligible patients were randomized; 138 patients received either rufinamide (n = 74) or placebo (n = 64) in addition to their other antiepileptic drugs. The median percentage reduction in total seizure frequency was greater in the rufinamide therapy group than in the placebo group (32.7% vs 11.7%, p = 0.0015). There was a difference (p or=10% of patients receiving rufinamide) were somnolence (24.3% with rufinamide vs 12.5% with placebo) and vomiting (21.6% vs 6.3%). Rufinamide was an effective and well-tolerated treatment for seizures associated with Lennox-Gastaut syndrome.

  17. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy A randomized trial. (United States)

    French, Jacqueline A; Krauss, Gregory L; Wechsler, Robert T; Wang, Xue-Feng; DiVentura, Bree; Brandt, Christian; Trinka, Eugen; O'Brien, Terence J; Laurenza, Antonio; Patten, Anna; Bibbiani, Francesco


    To assess efficacy and safety of adjunctive perampanel in patients with drug-resistant, primary generalized tonic-clonic (PGTC) seizures in idiopathic generalized epilepsy (IGE). In this multicenter, double-blind study ( identifier: NCT01393743; funded by Eisai Inc.), patients 12 years or older with PGTC seizures and IGE were randomized to placebo or perampanel during a 4-week titration period (perampanel up titrated from 2 to 8 mg/d, or highest tolerated dose) and 13-week maintenance period. The primary endpoint was percent change in PGTC seizure frequency per 28 days (titration plus maintenance vs baseline). The key secondary endpoint (primary endpoint for European Union registration) was 50% PGTC seizure responder rate (patients achieving $50% reduction in PGTC seizure frequency; maintenance vs baseline). Treatment-emergent adverse events were monitored. Of 164 randomized patients, 162 comprised the full analysis set (placebo, 81; perampanel, 81). Compared with placebo, perampanel conferred a greater median percent change in PGTC seizure frequency per 28 days (238.4%vs 276.5%; p , 0.0001) and greater 50%PGTC seizure responder rate (39.5% vs 64.2%; p 5 0.0019). During maintenance, 12.3% of placebo treated patients and 30.9%of perampanel-treated patients achieved PGTC seizure freedom. For the safety analysis (placebo, 82; perampanel, 81), the most frequent treatment-emergent adverse events with perampanel were dizziness (32.1%) and fatigue (14.8%). Adjunctive perampanel was well tolerated and improved control of drug-resistant PGTC seizures in patients with IGE. This study provides Class I evidence that adjunctive perampanel reduces PGTC seizure frequency, compared with placebo, in patients with drug-resistant PGTC seizures in IGE.

  18. Dravet syndrome or genetic (generalized) epilepsy with febrile seizures plus?

    NARCIS (Netherlands)

    Scheffer, Ingrid E.; Zhang, Yue-Hua; Jansen, Floor E.; Dibbens, Leanne


    Dravet syndrome and genetic epilepsy with febrile seizures plus (GEFS+) can both arise due 10 mutations of SCN1A. the gene encoding the alpha 1 pore-forming subunit of the sodium channel. GEFS+ refers to a familial epilepsy syndrome where at least two family members have phenotypes that fit within t

  19. Dravet syndrome or genetic (generalized) epilepsy with febrile seizures plus?

    NARCIS (Netherlands)

    Scheffer, Ingrid E.; Zhang, Yue-Hua; Jansen, Floor E.; Dibbens, Leanne

    Dravet syndrome and genetic epilepsy with febrile seizures plus (GEFS+) can both arise due 10 mutations of SCN1A. the gene encoding the alpha 1 pore-forming subunit of the sodium channel. GEFS+ refers to a familial epilepsy syndrome where at least two family members have phenotypes that fit within

  20. EEG features of absence seizures in idiopathic generalized epilepsy: Impact of syndrome, age, and state

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    Sadleir, L.G.; Scheffer, I.E.; Smith, S.


    Purpose: Factors influencing the electroencephalography (EEG) features of absence seizures in newly presenting children with idiopathic generalized epilepsy (IGE) have not been rigorously studied. We examined how specific factors such as state, provocation, age, and epilepsy syndrome affect the E...

  1. Can hyper-synchrony in meditation lead to seizures? Similarities in meditative and epileptic brain states. (United States)

    Lindsay, Shane


    Meditation is used worldwide by millions of people for relaxation and stress relief. Given sufficient practice, meditators may also experience a variety of altered states of consciousness. These states can lead to a variety of unusual experiences, including physical, emotional and psychic disturbances. This paper highlights the correspondences between brain states associated with these experiences and the symptoms and neurophysiology of epileptic simple partial seizures. Seizures, like meditation practice, can result in both positive and negative experiences. The neurophysiology and chemistry underlying simple partial seizures are characterised by a high degree of excitability and high levels of neuronal synchrony in gamma-band brain activity. Following a survey of the literature that shows that meditation practice is also linked to high power gamma activity, an account of how meditation could cause such activity is provided. This paper discusses the diagnostic challenges for the claim that meditation practices lead to brain states similar to those found in epileptic seizures, and seeks to develop our understanding of the range of pathological and non-pathological states that result from a hyper-excited and hyper-synchronous brain.

  2. Common variants associated with general and MMR vaccine-related febrile seizures (United States)

    Feenstra, Bjarke; Pasternak, Björn; Geller, Frank; Carstensen, Lisbeth; Wang, Tongfei; Huang, Fen; Eitson, Jennifer L.; Hollegaard, Mads V.; Svanström, Henrik; Vestergaard, Mogens; Hougaard, David M.; Schoggins, John W.; Jan, Lily Yeh; Melbye, Mads; Hviid, Anders


    Febrile seizures represent a recognized serious adverse event following measles, mumps, and rubella (MMR) vaccination. We conducted a series of genome-wide association scans comparing children with MMR-related febrile seizures, children with febrile seizures unrelated to vaccination, and controls with no history of febrile seizures. Two loci were distinctly associated with MMR-related febrile seizures, harboring the interferon-stimulated gene IFI44L (rs273259; P = 5.9×10−12 vs. controls; P =1.2×10−9 vs. MMR-unrelated febrile seizures) and the measles virus receptor CD46 (rs1318653; P = 9.6×10−11 vs. controls; P = 1.6×10−9 vs. MMR-unrelated febrile seizures). Furthermore, four loci were associated with febrile seizures in general implicating the sodium channel genes SCN1A (rs6432860; P = 2.2×10−16) and SCN2A (rs3769955; P = 3.1×10−10), a TMEM16 family gene (TMEM16C; rs114444506; P = 3.7×10−20), and a region associated with magnesium levels (12q21.33; rs11105468; P = 3.4×10−11). Finally, functional relevance of TMEM16C was demonstrated with electrophysiological experiments in wild-type and knockout rats. PMID:25344690

  3. Searching for hidden information with Gabor Transform in generalized tonic-clonic seizures. (United States)

    Quian Quiroga, R; Blanco, S; Rosso, O A; Garcia, H; Rabinowicz, A


    The analysis of generalized tonic clonic seizures is usually difficult with scalp EEG due to muscle artifact. We applied Gabor Transform to evaluate 20 seizures from 8 consecutive patients admitted for video-EEG monitoring. We studied the relative intensity ratios of alpha, theta and delta bands over time. In 14/20 events we found a significant decremental activity in the delta band at the onset of the seizure indicating that this is dominated by theta and alpha bands. We conclude that GT is a useful auxiliary tool in the analysis of ictal activity that sheds light on the underlying pathophysiological mechanisms.

  4. Generalized seizures and transient contralateral hemiparesis following retrobulbar anesthesia: a case report. (United States)

    Dettoraki, Maria; Dimitropoulou, Chrisafoula; Nomikarios, Nikolaos; Moschos, Marilita M; Brοuzas, Dimitrios


    Retrobulbar block is a local anesthetic technique widely used for intraocular surgery. Although retrobulbar anesthesia is considered to be relatively safe, a number of serious adverse events have been reported. To our knowledge, immediate onset of generalized seizures with contralateral hemiparesis after retrobulbar anesthesia has not been reported. A 62-year-old Caucasian healthy male with a right eye retinal detachment was admitted for pars plana vitrectomy. During retrobulbar anesthesia with ropivacaine and before needle withdrawal, the patient developed twitching of the face which rapidly progressed to generalized tonic-clonic seizures. Arterial oxygen saturation decreased to 75 %. Chin lift was performed and 100 % oxygen was administrated via face mask, which increased saturation to 99 %. Midazolam 2 mg was administrated intravenously to control seizures. After cessation of seizures, left-sided hemiparesis was evident. Brain computed tomography and electroencephalogram were normal 3 h later. The patient underwent pars plana vitrectomy under general anesthesia 4 days later. Serious complications of local anesthesia for ophthalmic surgery are uncommon. We present a case in which generalized tonic-clonic seizures developed during retrobulbar anesthesia, followed by transient contralateral hemiparesis. The early onset of seizures indicated intra-arterial injection of the anesthetic. Our case suggested the need for close monitoring during the performance of retrobulbar anesthesia and the presence of well-trained personnel for early recognition and immediate management of the complications.

  5. Loss of MeCP2 From Forebrain Excitatory Neurons Leads to Cortical Hyperexcitation and Seizures (United States)

    Zhang, Wen; Peterson, Matthew; Beyer, Barbara; Frankel, Wayne N.


    Mutations of MECP2 cause Rett syndrome (RTT), a neurodevelopmental disorder leading to loss of motor and cognitive functions, impaired social interactions, and seizure at young ages. Defects of neuronal circuit development and function are thought to be responsible for the symptoms of RTT. The majority of RTT patients show recurrent seizures, indicating that neuronal hyperexcitation is a common feature of RTT. However, mechanisms underlying hyperexcitation in RTT are poorly understood. Here we show that deletion of Mecp2 from cortical excitatory neurons but not forebrain inhibitory neurons in the mouse leads to spontaneous seizures. Selective deletion of Mecp2 from excitatory but not inhibitory neurons in the forebrain reduces GABAergic transmission in layer 5 pyramidal neurons in the prefrontal and somatosensory cortices. Loss of MeCP2 from cortical excitatory neurons reduces the number of GABAergic synapses in the cortex, and enhances the excitability of layer 5 pyramidal neurons. Using single-cell deletion of Mecp2 in layer 2/3 pyramidal neurons, we show that GABAergic transmission is reduced in neurons without MeCP2, but is normal in neighboring neurons with MeCP2. Together, these results suggest that MeCP2 in cortical excitatory neurons plays a critical role in the regulation of GABAergic transmission and cortical excitability. PMID:24523563

  6. A tautology in the classification of generalized non-convulsive epileptic seizures. (United States)

    Seino, M; Fujiwara, T; Miyakoshi, M; Yagi, K


    Five patients with the Lennox-Gastaut syndrome who have shown generalized nonconvulsive seizures were presented. The seizure manifestations which occurred spontaneously were documented by simultaneous recording and analyzed in terms of clinical and electroencephalographic correlates. According to the diagnostic criteria of the International Classification, it was possible, on the one hand, to regard them as "atypical complex absences" in which the impairment of consciousness is accompanied by other symptoms, which tend to dominate the clinical picture. They were: hypotonic, hypertonic, myoclonic and akinetic components, respectively. On the other hand, if we give a special weight to the accompanying symptoms, it is entirely possible that they are at the same time diagnosed atonic, axial tonic, bilateral myoclonic and akinetic seizures. The initial impairment of consciousness is common to all the seizure manifestations, and the ictal and interictal EEG expressions are not of diagnostic significance. A question arises as to whether two different nomenclatures were arbitrarily given to a unique ictal manifestation or not as far as the generalized non-convulsive seizures were concerned.

  7. Detection of generalized tonic-clonic seizures by a wireless wrist accelerometer

    DEFF Research Database (Denmark)

    Beniczky, S.; Hjalgrim, Helle; Polster, T.


    Our objective was to assess the clinical reliability of a wrist-worn, wireless accelerometer sensor for detecting generalized tonic-clonic seizures (GTCS). Seventy-three consecutive patients (age 6-68 years; median 37 years) at risk of having GTCS and who were admitted to the long-term video-elec...

  8. Early Seizure Detection Using Neuronal Potential Similarity: A Generalized Low-Complexity and Robust Measure. (United States)

    Bandarabadi, Mojtaba; Rasekhi, Jalil; Teixeira, Cesar A; Netoff, Theoden I; Parhi, Keshab K; Dourado, Antonio


    A novel approach using neuronal potential similarity (NPS) of two intracranial electroencephalogram (iEEG) electrodes placed over the foci is proposed for automated early seizure detection in patients with refractory partial epilepsy. The NPS measure is obtained from the spectral analysis of space-differential iEEG signals. Ratio between the NPS values obtained from two specific frequency bands is then investigated as a robust generalized measure, and reveals invaluable information about seizure initiation trends. A threshold-based classifier is subsequently applied on the proposed measure to generate alarms. The performance of the method was evaluated using cross-validation on a large clinical dataset, involving 183 seizure onsets in 1785 h of long-term continuous iEEG recordings of 11 patients. On average, the results show a high sensitivity of 86.9% (159 out of 183), a very low false detection rate of 1.4 per day, and a mean detection latency of 13.1 s from electrographic seizure onsets, while in average preceding clinical onsets by 6.3 s. These high performance results, specifically the short detection latency, coupled with the very low computational cost of the proposed method make it adequate for using in implantable closed-loop seizure suppression systems.

  9. Effects of conventional anticonvulsant drugs on generalized tonic-clonic seizures in Noda epileptic rats. (United States)

    Inoue, Maki; Yamamoto, Ayaka; Kaneko, Yuka; Noda, Atsushi; Naito, Hiroyuki


    Noda epileptic rats (NERs) present with clinico-pathological manifestations reminiscent of human generalized tonic-clonic epilepsy. Thus, this strain of rat has been a model of primary, generalized, tonic-clonic epilepsy. However, the infrequency of seizures in these rats makes the assessment of antiepileptic drugs (AEDs) difficult. Therefore, traditional AEDs have only been tested in NERs against audiogenic seizures evoked by weekly acoustic priming from 3 to 22 weeks of age or by using the kindling procedure in adult animals. Adult NERs are susceptible to changes in their environment, such as bedding replacement or unpleasant sensory stimuli. In the present study, traditional AEDs-phenobarbital (PB) and sodium valproate (VPA)-were evaluated against seizures evoked by strong environmental stimuli in mature NERs that had not been previously primed. The number of animals presenting with seizures decreased in a dose-dependent manner following administration of either PB (dose range 1.0-5.0mg/kg) or VPA (50 and 100mg/kg). Consequently, the utility of NERs as a model of generalized tonic-clonic epilepsy was confirmed. This type of protocol can be used to further evaluate AEDs and test effects of chronic administration of AEDs. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. CHD2 mutations are a rare cause of generalized epilepsy with myoclonic-atonic seizures. (United States)

    Trivisano, Marina; Striano, Pasquale; Sartorelli, Jacopo; Giordano, Lucio; Traverso, Monica; Accorsi, Patrizia; Cappelletti, Simona; Claps, Dianela Judith; Vigevano, Federico; Zara, Federico; Specchio, Nicola


    Chromodomain helicase DNA-binding protein 2 (CHD2) gene mutations have been reported in patients with myoclonic-atonic epilepsy (MAE), as well as in patients with Lennox-Gastaut, Dravet, and Jeavons syndromes and other epileptic encephalopathies featuring generalized epilepsy and intellectual disability. The aim of this study was to assess the impact of CHD2 mutations in a series of patients with MAE. Twenty patients affected by MAE were included in the study. We analyzed antecedents, age at onset, seizure semiology and frequency, EEG, treatment, and neuropsychological outcome. We sequenced the CHD2 gene with Sanger technology. We identified a CHD2 frameshift mutation in one patient (c.4256del19). He was a 17-year-old boy with no familial history for epilepsy and normal development before epilepsy onset. Epilepsy onset was at 3years and 5months: he presented with myoclonic-atonic seizures, head drops, myoclonic jerks, and absences. Interictal EEGs revealed slow background activity associated with generalized epileptiform abnormalities and photoparoxysmal response. His seizures were highly responsive to valproic acid, and an attempt to withdraw it led to seizure recurrence. Neuropsychological evaluation revealed moderate intellectual disability. Chromodomain-helicase-DNA-binding protein 2 is not the major gene associated with MAE. Conversely, CHD2 could be responsible for a proper phenotype characterized by infantile-onset generalized epilepsy, intellectual disability, and photosensitivity, which might overlap with MAE, Lennox-Gastaut, Dravet, and Jeavons syndromes.

  11. Seizure ending signs in patients with dyscognitive focal seizures. (United States)

    Gavvala, Jay R; Gerard, Elizabeth E; Macken, Mícheál; Schuele, Stephan U


    Signs indicating the end of a focal seizure with loss of awareness and/or responsiveness but without progression to focal or generalized motor symptoms are poorly defined and can be difficult to determine. Not recognizing the transition from ictal to postictal behaviour can affect seizure reporting accuracy by family members and may lead to delayed or a lack of examination during EEG monitoring, erroneous seizure localization and inadequate medical intervention for prolonged seizure duration. Our epilepsy monitoring unit database was searched for focal seizures without secondary generalization for the period from 2007 to 2011. The first focal seizure in a patient with loss of awareness and/or responsiveness and/or behavioural arrest, with or without automatisms, was included. Seizures without objective symptoms or inadequate video-EEG quality were excluded. A total of 67 patients were included, with an average age of 41.7 years. Thirty-six of the patients had seizures from the left hemisphere and 29 from the right. All patients showed an abrupt change in motor activity and resumed contact with the environment as a sign of clinical seizure ending. Specific ending signs (nose wiping, coughing, sighing, throat clearing, or laughter) were seen in 23 of 47 of temporal lobe seizures and 7 of 20 extra-temporal seizures. Seizure ending signs are often subtle and the most common finding is a sudden change in motor activity and resumption of contact with the environment. More distinct signs, such as nose wiping, coughing or throat clearing, are not specific to temporal lobe onset. A higher proportion of seizures during sleep went unexamined, compared to those during wakefulness. This demonstrates that seizure semiology can be very subtle and arousals from sleep during monitoring should alert staff. Patient accounts of seizure frequency appear to be unreliable and witness reports need to be taken into account. [Published with video sequences].

  12. MR imaging findings of generalized tonic clonic seizure induced brain changes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Ah; Chung, Jin Il; Yonn, Pyeong Ho; Kim, Dong Ik; Chung, Tae Sub; Kim, Joo Hee [College of Medicine, Yonsei Unversity, Seoul (Korea, Republic of)


    To evaluate MRI signal changes in the brain induced by generalized tonic clonic seizure. Six patients who underwent MRI within three days of generalized tonic clonic seizure were retrospectively reviewed. Diffusion -weighted images were added in three patients during initial examination, and in six, the follow-up MRI was performed nine days to five months after the onset of seizure. We evaluated the patterns of signal change, location of the lesion and degree of contrast enhancement, and the signal change seen on diffusion weighted images. We also compared the signal changes seen on initial and follow-up MRI. In all six patients, MR images showed focally increased T2 signal intensity, and swelling and increased volume of the involved cortical gyrus. In five, the lesion was mainly located in the cortical gray matter and subcortical white matter; namely, in the bilateral cingulate gyri, and the bilateral parieto-occipital, left parietal, left frontoparietal, and left temporal lobe. In the remaining patient, the lesion was located in the right hippocampus. Two patients showed bilateral lesions and one showed multiple lesions. In four patients, T1-weighted images revealed decreased signal intensity of the same location, and in one, gyral contrast enhancement was noted. On diffusion-weighted images, three patients showed increased signal intensity. Follow-up MRI demonstrated complete resolution of the abnormal signal change (n=3D5), or a decrease (n=3D1). A transient increase in MR signal intensity with increased volume was noted in cortical and subcortical white matter after generalized tonic clonic seizure. This finding reflects the vasogenic and cytotoxic edema induced by seizure and can help exclude etiologic lesions such as tumors, inflammation and demyelinating disease that induce epilepsy. (author)

  13. Clinical efficacy of perampanel for partial-onset and primary generalized tonic-clonic seizures

    Directory of Open Access Journals (Sweden)

    Besag FM


    Full Text Available Frank MC Besag,1–3 Philip N Patsalos4,51East London Foundation NHS Trust, 2Institute of Psychiatry, Psychology and Neuroscience, 3UCL School of Pharmacy, 4Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, 5Epilepsy Society, Chalfont Centre for Epilepsy, Chalfont St Peter, UKBackground and purpose: Perampanel, a selective noncompetitive antagonist at the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA receptor, is highly effective in a wide range of experimental models. Although initially licensed as adjunctive therapy for partial seizures with or without secondary generalization in patients aged 12 years or older, the US Food and Drug Administration has recently approved its use in the treatment of primary generalized tonic–clonic seizures (PGTCS. This paper reviews the pharmacokinetics, efficacy, and tolerability of perampanel as an antiepileptic drug.Results: After oral ingestion, perampanel is rapidly absorbed (Tmax, 0.5–2.5 hours, has a bioavailability of ~100%, and is highly protein bound (~95% in plasma. It undergoes extensive (>90% hepatic metabolism, primarily via cytochrome P450 3A4 (CYP3A4, with a half-life of 48 hours. Carbamazepine and other antiepileptic drugs can enhance its metabolism via induction of CYP3A4. Efficacy of perampanel in focal seizures has been extensively evaluated in Phase II and randomized, placebo-controlled Phase III trials. The efficacy in PGTCS has been reported in one class I study. In the treatment of focal seizures, perampanel showed significant dose-dependent median seizure reductions: 4 mg/d, 23%; 8 mg/d, 26%–31%; 12 mg/d, 18%–35%; and placebo, 10%–21%. The 50% responder rates were 15%–26%, 29%, 33%–38%, and 34%–36% for placebo, 4 mg/d, 8 mg/d, and 12 mg/d perampanel, respectively. Freedom from seizures was recorded in 0%–1.7% of the placebo group, 1.9% of the 2

  14. The electroclinical-semiology of generalized tonic-clonic seizures among different epilepsies. (United States)

    Pan, S P; Wang, F; Zhang, Y; Wang, J


    The study reported here discusses the duration of the generalized tonic-clonic seizures (GTCS) among frontal lobe epilepsy (FLE), medial temporal lobe epilepsy (MTLE) and idiopathic generalized epilepsy (IGE). The study was done by analyzing the data from patients who had undergone video-EEG in 2009 and had GTCS during the monitoring. The patients were selected for the frontal lobe epilepsy (FLE), medial temporal lobe epilepsy (MTLE), and idiopathic generalized epilepsy (IGE). Once they met the criteria, the durations of all the phases were measured, then discussed if there were any difference in duration for different epilepsies. On comparison of the total duration of various types of seizures it was found that the duration of FLE (177 ± 212.6 sec.) was significantly different from the duration of MTLE (104.6 ± 51.8 sec.) and IGE (63.9 ± 28.2 sec.). It can be found in the comparison of GTCS that the duration of phase 6,7 of FLE (63.5 ± 30.9 sec.) was statistically significant compared with MTLE (37.3 ± 13.8 sec.) and IGE (46.4 ± 30.1 sec.). The duration of various types of epilepsy in the generalized tonic-clonic period was not statistically significant. Through this study, we found the differences of the duration of different types of epilepsies that provide the clinical basis for further studies of seizure mechanism and neural network conduction.

  15. Febrile seizures and genetic epilepsy with febrile seizures plus (GEFS+). (United States)

    Camfield, Peter; Camfield, Carol


    To review the literature about febrile seizures and GEFS plus with special emphasis on management and outcome. Selected literature review. Febrile seizures are the most common convulsive event in humans, occurring in 2-6% of the population. The aetiology is complex with strong evidence for a heterogeneous genetic predisposition interacting with fever of any cause, with certain viral infections having a greater effect. A large amount of literature has established that febrile seizures have no long-term consequences on cognition or behaviour. Unfortunately, about 40% of children with a first febrile seizure will have a recurrence. The strongest predictor of recurrence is age febrile seizure. Epilepsy follows febrile seizures in ∼3% cases, with the concepts of simple and complex febrile seizures providing relatively weak prediction. Very prolonged febrile seizures may lead to mesial temporal sclerosis and temporal lobe epilepsy although the degree of risk remains uncertain. Investigations beyond establishing the cause of the provoking fever are nearly always unnecessary. Treatment is mainly reassurance and there is some evidence that parents eventually "come to grips" with the fear that their children are dying during a febrile seizure. Antipyretic medications are remarkably ineffective to prevent recurrences. Daily and intermittent prophylactic medications are ineffective or have unacceptable side effects or risks. "Rescue" benzodiazepines may prevent prolonged recurrences for selected patients with a first prolonged febrile seizure although this has not been proven. Genetic epilepsy with febrile seizures plus (GEFS+) is a complex autosomal dominant disorder usually caused by mutations in SCN1A (a voltage-gated sodium channel). One third of patients have febrile seizures only; two thirds have a variety of epilepsy syndromes, both focal and generalized. Febrile seizures may distress parents but rarely have any long-term consequences. Reassurance is the only

  16. A microdeletion of the GABRB3 locus on 15q in a child with generalized seizures

    Energy Technology Data Exchange (ETDEWEB)

    Hirsch, B.; Krueger, L.; Nook, J. [Univ. of Minnesota School of Medicine, Minneapolis, MN (United States)] [and others


    A 13-month-old female presented with a history of infrequent febrile tonic-clonic seizures and recent onset of daily absence and clusters of myoclonic seizures. She had minimal developmental delays, slight frontal bossing, a wide nasal bridge and macrostomia. Initial EEG was normal as were multiple metabolic and biochemical determinations. Subsequent EEGs demonstrated normal back ground activity with frequent bursts of generalized, irregular spikes and polyspikes. The child responded favorably to a course of parenteral ACTH and at 17 months, she was maintained on valproic acid, was seizure-free and had a normal EEG. Examination was notable for prominent, socially appropriate smiling, age-appropriate speech, and significant ataxia and tremor. High resolution G-banded chromosome analysis revealed a suspected deletion of 15q11.2 and part of 15q12. FISH was performed with ONCOR probes to the D15S11, SNRPN, D15S10 and GABRB3 loci. A total of 30 metaphase cells (from two separate blood samples) were examined and revealed positive hybridization on both chromosome 15 homologues for D15S11, SNRPN, and D15S10. However, the GABRB3 probe revealed positive hybridization to only one chromosome 15 homologue, thus supporting the interpretation of a deletion of this region. FISH analyses of the patient`s parents are in progress as are methylation studies. To our knowledge, these findings represent the first report of a deletion of GAMRB3 which does not extend proximally to include all of D15S10 in a patient presenting with generalizied seizures. Careful comparison of this patient`s phenotype to that of Angelman syndrome will therefore be most informative for furthering genotype-phenotype correlations within this critical region of 15q.

  17. Maternal grand mal seizure leads to a surprising diagnosis of Dandy-Walker variant. (United States)

    Mendelson, Sherri G


    Pregnant women may present with abnormal symptoms that are assumed to be related to the pregnancy. The purpose of this case study is to examine an obstetric case that provides a wider view of a grand mal seizure in a perinatal patient with previously undiagnosed Dandy-Walker Variant. When a pregnant or newly postpartum woman has seizures, eclampsia may be the most the most likely diagnosis, but it may not be accurate.

  18. Peripheral viral challenge elevates extracellular glutamate in the hippocampus leading to seizure hypersusceptibility. (United States)

    Hunsberger, Holly C; Konat, Gregory W; Reed, Miranda N


    Peripheral viral infections increase seizure propensity and intensity in susceptible individuals. We have modeled this comorbidity by demonstrating that the acute phase response instigated by an intraperitoneal (i.p.) injection of a viral mimetic, polyinosinic-polycytidylic acid (PIC), induces protracted hypersusceptibility to kainic acid-induced seizures. We have further demonstrated that PIC challenge robustly increases the level of tonic extracellular glutamate and neuronal excitability in the hippocampus. This study was undertaken to determine a relationship between tonic glutamate and seizure susceptibility following PIC challenge. Briefly, glutamate-sensing microelectrodes were permanently implanted into the CA1 of 8-week-old female C57BL/6 mice. Following a 3-day recovery, acute phase response was induced by i.p. injection of 12 mg/kg of PIC, while saline-injected mice served as controls. Tonic glutamate was measured at 1, 2, 3 and 4 days after PIC challenge. PIC challenge induced an approximately fourfold increase in tonic glutamate levels measured after 24 h. The levels gradually declined to the baseline values within 4 days. Twenty-four hours after PIC challenge, the mice featured an approximately threefold increase in cumulative seizure scores and twofold increase in the duration of status epilepticus induced by subcutaneous injection of 12 mg/kg of kainic acid. Seizure scores positively correlated with pre-seizure tonic glutamate. Moreover, seizures resulted in a profound (76%) elevation of extracellular glutamate in the CA1 of PIC-challenged but not saline-injected mice. Our results implicate the increase in extracellular glutamate as a mediator of seizure hypersusceptibility induced by peripheral viral challenge.

  19. Does Education Lead to Higher Generalized Trust?

    DEFF Research Database (Denmark)

    Charron, Nicholas; Rothstein, Bo


    Generalized trust has become a prominent concept at the nexus of several disciplines, and the wide differences in trust between different societies continue to puzzle the social sciences. In this study, we explore the effects of micro and macro level factors in explaining an individual's propensity...... to ‘trust others'. We hypothesize that higher levels of education will lead to higher social trust in individuals, given that the context (country or regions within countries) in which they reside has a sufficiently impartial and non-corrupt institutional setting. However, the positive effect of education...

  20. Dopey's seizure. (United States)

    Dan, B; Christiaens, F


    Angelman syndrome is a neurogenetic condition namely characterized by developmental delay, virtual absence of expressive verbal language, peculiar organization of movement, seizures and happy demeanor. This syndrome has been recognized since 1965, but it seems that Walt Disney presented an original depiction of it in his first full-length animated film, including myoclonic jerks and an apparently generalized tonic-clonic seizure.

  1. Risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure. (United States)

    Boulloche, J; Leloup, P; Mallet, E; Parain, D; Tron, P


    A cohort of 119 two- to 16-year-old patients was followed to assess the risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure. Only children with a normal neurological examination and intellectual development, and an EEG showing no focal abnormality, were studied. The risk of recurrence at six months was 22 per cent, at one year 28.5 per cent, at three years 32.6 per cent and at eight years 37.7 per cent. 58 per cent of recurrences occurred within the first six months and 87 per cent within the first two years. Initial EEGs showing generalized, unprovoked spikes and waves, generalized paroxysmal discharges precipitated by intermittent photic stimulation, or isolated slowing, were associated with risks of recurrence at two years of 40, 50 and 26 per cent, respectively. These results do not differ significantly from those obtained when the initial EEG was normal (29 per cent). Age, seizure duration and history of epilepsy in the family were not associated with a significantly higher risk of recurrence. The risk of recurrence was similar for treated and untreated patients.

  2. Automated Algorithm for Generalized Tonic–Clonic Epileptic Seizure Onset Detection Based on sEMG Zero-Crossing Rate

    DEFF Research Database (Denmark)

    Conradsen, Isa; Beniczky, Sándor; Hoppe, Karsten


    Patients are not able to call for help during a generalized tonic–clonic epileptic seizure. Our objective was to develop a robust generic algorithm for automatic detection of tonic–clonic seizures, based on surface electromyography (sEMG) signals suitable for a portable device. Twenty-two seizure......% with a mean detection latency of 13.7 s, while the rate of false detection was limited to 1 false alarm per 24 h. The overall performance of the presented generic algorithm is adequate for clinical implementation.......Patients are not able to call for help during a generalized tonic–clonic epileptic seizure. Our objective was to develop a robust generic algorithm for automatic detection of tonic–clonic seizures, based on surface electromyography (sEMG) signals suitable for a portable device. Twenty-two seizures...... were analyzed from 11 consecutive patients. Our method is based on a high-pass filtering with a cutoff at 150 Hz, and monitoring a count of zero crossings with a hysteresis of $\\pm 50\\,\\mu \\hbox{V}$ . Based on data from one sEMG electrode (on the deltoid muscle), we achieved a sensitivity of 100...

  3. Loss of SYNJ1 dual phosphatase activity leads to early onset refractory seizures and progressive neurological decline

    DEFF Research Database (Denmark)

    Hardies, Katia; Cai, Yiying; Jardel, Claude


    SYNJ1 encodes a polyphosphoinositide phosphatase, synaptojanin 1, which contains two consecutive phosphatase domains and plays a prominent role in synaptic vesicle dynamics. Autosomal recessive inherited variants in SYNJ1 have previously been associated with two different neurological diseases: a...... with severe epilepsy, and emphasize the importance of this biological pathway in seizure pathophysiology....... with intractable epilepsy and tau pathology. We performed whole exome or genome sequencing in three independent sib pairs with early onset refractory seizures and progressive neurological decline, and identified novel segregating recessive SYNJ1 defects. A homozygous missense variant resulting in an amino acid...... in a large cohort of 543 patients with a wide phenotypical range of epilepsies and intellectual disability revealed no additional pathogenic variants, showing that SYNJ1 deficiency is rare and probably linked to a specific phenotype. While variants leading to early onset parkinsonism selectively abolish Sac1...

  4. The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures.

    LENUS (Irish Health Repository)

    O'Sullivan, S S


    OBJECTIVE: The purpose of this work was to assess the opinion of general practitioners (GPs) regarding the diagnosis of psychogenic nonepileptic seizures (PNES) and the role they feel they should play in the management of the disorder. METHODS: Patients with PNES were identified from hospital records. Seizure and patient characteristics were recorded. Their GPs were surveyed regarding their understanding of the diagnosis and ongoing management of PNES. RESULTS: Twenty-three patients were identified over a 3-year period as having been diagnosed with PNES. Sixty-five percent of GPs agreed with the diagnosis, and when asked to grade their understanding of the diagnosis (poor = 1, excellent = 10), the mean score was 5.7 (+\\/-SD 2.3). Thirty-five percent of GPs felt psychological input was of benefit to their patients. Fifty-two percent of GPs felt comfortable following up these patients, either with or without neurology outpatient services. CONCLUSIONS: PNES remains a difficult disease to manage. There is a high level of uncertainty regarding the optimum management of PNES among primary care physicians, for which further education is needed.

  5. Spectral Analysis of Acceleration Data for Detection of Generalized Tonic-Clonic Seizures (United States)

    Joo, Hyo Sung; Han, Su-Hyun; Lee, Jongshill; Jang, Dong Pyo; Kang, Joong Koo; Woo, Jihwan


    Generalized tonic-clonic seizures (GTCSs) can be underestimated and can also increase mortality rates. The monitoring devices used to detect GTCS events in daily life are very helpful for early intervention and precise estimation of seizure events. Several studies have introduced methods for GTCS detection using an accelerometer (ACM), electromyography, or electroencephalography. However, these studies need to be improved with respect to accuracy and user convenience. This study proposes the use of an ACM banded to the wrist and spectral analysis of ACM data to detect GTCS in daily life. The spectral weight function dependent on GTCS was used to compute a GTCS-correlated score that can effectively discriminate between GTCS and normal movement. Compared to the performance of the previous temporal method, which used a standard deviation method, the spectral analysis method resulted in better sensitivity and fewer false positive alerts. Finally, the spectral analysis method can be implemented in a GTCS monitoring device using an ACM and can provide early alerts to caregivers to prevent risks associated with GTCS. PMID:28264522

  6. Generalized epilepsy with febrile seizures plus (GEFS+) spectrum: clinical manifestations and SCN1A mutations in Indonesian patients. (United States)

    Herini, Elisabeth Siti; Gunadi; Harahap, Indra Sari Kusuma; Yusoff, Surini; Morikawa, Satoru; Patria, Suryono Yudha; Nishimura, Noriyuki; Sunartini; Sutaryo; Takada, Satoshi; Matsuo, Masafumi; Nishio, Hisahide


    Generalized epilepsy with febrile seizures plus (GEFS+) is a childhood genetic epilepsy syndrome. GEFS+ includes a wide spectrum of clinical manifestations, and SCN1A mutations have frequently been reported among the GEFS+-related gene abnormalities. In this study, to clarify the distributions of the clinical subtypes, we analyzed 34 families with GEFS+ in Indonesia using the hospital records of the patients and questionnaires for the family members. The number of patients with febrile seizures plus (FS+), FS+ and afebrile generalized/partial seizures, borderline severe myoclonic epilepsy in infancy (SMEB) and severe myoclonic epilepsy in infancy (SMEI) were 9, 11, 7, and 7, respectively. Most patients had a family history of febrile seizures. Next, we performed molecular analyses to clarify the contributions of SCN1A mutations to the development of the GEFS+ subtypes. Only 3 of 34 probands showed SCN1A mutations. These mutations were two missense mutations, p.V1612I and p.C1756G, in two patients with SMEI and SMEB, and one silent mutation, p.G1762G, in a patient with FS+ and afebrile partial seizures. In conclusion, the majority of GEFS+ patients in Indonesia were not associated with SCN1A mutations. To detect the GEFS+-causing mutations, we must search and analyze other genes in these patients. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  7. Deep Recurrent Neural Networks for seizure detection and early seizure detection systems

    Energy Technology Data Exchange (ETDEWEB)

    Talathi, S. S. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)


    Epilepsy is common neurological diseases, affecting about 0.6-0.8 % of world population. Epileptic patients suffer from chronic unprovoked seizures, which can result in broad spectrum of debilitating medical and social consequences. Since seizures, in general, occur infrequently and are unpredictable, automated seizure detection systems are recommended to screen for seizures during long-term electroencephalogram (EEG) recordings. In addition, systems for early seizure detection can lead to the development of new types of intervention systems that are designed to control or shorten the duration of seizure events. In this article, we investigate the utility of recurrent neural networks (RNNs) in designing seizure detection and early seizure detection systems. We propose a deep learning framework via the use of Gated Recurrent Unit (GRU) RNNs for seizure detection. We use publicly available data in order to evaluate our method and demonstrate very promising evaluation results with overall accuracy close to 100 %. We also systematically investigate the application of our method for early seizure warning systems. Our method can detect about 98% of seizure events within the first 5 seconds of the overall epileptic seizure duration.

  8. An integrative view of mechanisms underlying generalized spike-and-wave epileptic seizures and its implication on optimal therapeutic treatments.

    Directory of Open Access Journals (Sweden)

    Boyuan Yan

    Full Text Available Many types of epileptic seizures are characterized by generalized spike-and-wave discharges. In the past, notable effort has been devoted to understanding seizure dynamics and various hypotheses have been proposed to explain the underlying mechanisms. In this paper, by taking an integrative view of the underlying mechanisms, we demonstrate that epileptic seizures can be generated by many different combinations of synaptic strengths and intrinsic membrane properties. This integrative view has important medical implications: the specific state of a patient characterized by a set of biophysical characteristics ultimately determines the optimal therapeutic treatment. Through the same view, we further demonstrate the potentiation effect of rational polypharmacy in the treatment of epilepsy and provide a new angle to resolve the debate on polypharmacy. Our results underscore the need for personalized medicine and demonstrate that computer modeling and simulation may play an important role in assisting the clinicians in selecting the optimal treatment on an individual basis.

  9. Screening of SCN1A gene mutation in 10 families with generalized epilepsy accompanied by febrile seizure

    Directory of Open Access Journals (Sweden)

    Guang-sheng WU


    Full Text Available Objective To analyze the phenotypes and to identify SCN1A gene mutation in families with generalized epilepsy accompanied by febrile seizures (GEFS+. Methods The clinical data were collected, and genomic DNA was extracted from peripheral blood lymphocytes of the proband and available members in the GEFS+ families. The phenotypes of the related members were analyzed. The coding regions and flanking intronic regions of the SCN1A gene were screened for mutations using PCR and direct DNA sequencing. Results Thirty-three related members from 10 GEFS+ families, ranged from 2 to 7 members in each family received the examination. Their phenotypes included febrile seizures (FS in 11 persons (33.3%, febrile seizures plus (Fs+ in 11 (33.3%, FS with partial seizures in 1 (3.0%, afebrile generalized tonic-clonic seizures (AGTCS in 3 (9.1%, Dravet syndrome in 1 (3.0%, childhood absence epilepsy in 1 (3.0%, and unclassified seizures in 5 members (15.2%. SCN1A mutations were found in 3 families, including one family with missense mutation (glu1444-lys, and silent mutation: synonymous mutation existed in exon 15 (c.2592G>A, with synonymous mutation in exon 9 (c.1212 G>A and exon 26 (c.5385 G>A in two families. Conclusions A new missense mutation and three synonymous mutation have been found in the coding regions of SCN1A gene in three families. One of the families has synonymous mutation in two exons. Genetic mechanism is complicated in GEFS+ families. DOI: 10.11855/j.issn.0577-7402.2014.10.09

  10. Cerebellum abnormalities in idiopathic generalized epilepsy with generalized tonic-clonic seizures revealed by diffusion tensor imaging.

    Directory of Open Access Journals (Sweden)

    Yonghui Li

    Full Text Available Although there is increasing evidence suggesting that there may be subtle abnormalities in idiopathic generalized epilepsy (IGE patients using modern neuroimaging techniques, most of these previous studies focused on the brain grey matter, leaving the underlying white matter abnormalities in IGE largely unknown, which baffles the treatment as well as the understanding of IGE. In this work, we adopted multiple methods from different levels based on diffusion tensor imaging (DTI to analyze the white matter abnormalities in 14 young male IGE patients with generalized tonic-clonic seizures (GTCS only, comparing with 29 age-matched male healthy controls. First, we performed a voxel-based analysis (VBA of the fractional anisotropy (FA images derived from DTI. Second, we used a tract-based spatial statistics (TBSS method to explore the alterations within the white matter skeleton of the patients. Third, we adopted region-of-interest (ROI analyses based on the findings of VBA and TBSS to further confirm abnormal brain regions in the patients. At last, considering the convergent evidences we found by VBA, TBSS and ROI analyses, a subsequent probabilistic fiber tractography study was performed to investigate the abnormal white matter connectivity in the patients. Significantly decreased FA values were consistently observed in the cerebellum of patients, providing fresh evidence and new clues for the important role of cerebellum in IGE with GTCS.

  11. Seizure types and frequency in patients who "fail" temporal lobectomy for intractable epilepsy. (United States)

    Englot, Dario J; Lee, Anthony T; Tsai, Catherine; Halabi, Cathra; Barbaro, Nicholas M; Auguste, Kurtis I; Garcia, Paul A; Chang, Edward F


    Temporal lobectomy can lead to favorable seizure outcomes in medically-refractory temporal lobe epilepsy (TLE). Although most studies focus on seizure freedom after temporal lobectomy, less is known about seizure semiology in patients who "fail" surgery. Morbidity differs between seizure types that impair or spare consciousness. Among TLE patients with seizures after surgery, how does temporal lobectomy influence seizure type and frequency? To characterize seizure types and frequencies before and after temporal lobectomy for TLE, including consciousness-sparing or consciousness-impairing seizures. We performed a retrospective longitudinal cohort study examining patients undergoing temporal lobectomy for epilepsy at our institution from January 1995 to August 2010. Among 241 TLE patients who received temporal lobectomy, 174 (72.2%) patients achieved Engel class I outcome (free of disabling seizures), including 141 (58.5%) with complete seizure freedom. Overall seizure frequency in patients with persistent postoperative seizures decreased by 70% (P seizures. While the number of patients experiencing consciousness-sparing simple partial seizures decreased by only 19% after surgery, the number of individuals having consciousness-impairing complex partial seizures and generalized tonic-clonic seizures diminished by 70% and 68%, respectively (P seizure was the predominant seizure type in 19.1% vs 37.0% of patients preoperatively and postoperatively, respectively (P seizure outcome was predicted by a lack of generalized seizures preoperatively (odds ratio 1.74, 95% confidence interval 1.06-2.86, P seizures with or without impairment of consciousness, seizure type and frequency remain important considerations in epilepsy surgery.

  12. Absence Seizure (Petit Mal Seizure) (United States)

    ... seizures are more common in girls. History of febrile seizures. Infants and children who have seizures brought on by fever are at greater risk of absence seizures. Family members who have seizures. Nearly half of ...

  13. Long-lasting remission of type 1 diabetes following treatment with topiramate for generalized seizures. (United States)

    Davalli, Alberto M; Perego, Carla; Folli, Franco B; Bosi, Emanuele


    We report a case of unusually long-lasting remission of type 1 diabetes (T1D). The patient, a Caucasian man, at the age of 43 years developed a ketotic diabetes, classified as type 1 based on clinical presentation and positivity for islet autoantibodies. Shortly after diabetes onset, oral topiramate was added to preexisting valproic acid for generalized seizures and maintained thereafter. Initial intensive insulin treatment was rapidly reduced to low doses (3 Units/day) maintained for a long time and then discontinued at month 55; fasting glucose and glycosylated hemoglobin were basically normalized at 58 months. An oral glucose tolerance test performed at month 53 showed an impaired fasting glucose (6.0 mmol/l) and a value slightly above the threshold for the diagnosis of diabetes at 2 h (11.2 mmol/l). We hypothesize that this unusually prolonged preservation of β-cell function might be ascribed to the concomitant therapy with topiramate, an antiepileptic agent with demonstrated efficacy as antidiabetic in type 2 diabetes (T2D). Topiramate should be further investigated as candidate agent for the preservation of β-cell function also in T1D.

  14. Controlling Seizures (United States)

    Henderson, Nancy


    This article describes how an implantable device could greatly improve the quality of life for people with epilepsy. Gabe Anderson was diagnosed with bilateral heterotopia, a congenital condition that can lead to the onset of complex partial seizures stemming from both hemispheres of the brain. In early 2004, Gabe became one of the first 35…

  15. Repeated 6-Hz Corneal Stimulation Progressively Increases FosB/ΔFosB Levels in the Lateral Amygdala and Induces Seizure Generalization to the Hippocampus. (United States)

    Giordano, Carmela; Vinet, Jonathan; Curia, Giulia; Biagini, Giuseppe


    Exposure to repetitive seizures is known to promote convulsions which depend on specific patterns of network activity. We aimed at evaluating the changes in seizure phenotype and neuronal network activation caused by a modified 6-Hz corneal stimulation model of psychomotor seizures. Mice received up to 4 sessions of 6-Hz corneal stimulation with fixed current amplitude of 32 mA and inter-stimulation interval of 72 h. Video-electroencephalography showed that evoked seizures were characterized by a motor component and a non-motor component. Seizures always appeared in frontal cortex, but only at the fourth stimulation they involved the hippocampus, suggesting the establishment of an epileptogenic process. Duration of seizure non-motor component progressively decreased after the second session, whereas convulsive seizures remained unchanged. In addition, a more severe seizure phenotype, consisting of tonic-clonic generalized convulsions, was predominant after the second session. Immunohistochemistry and double immunofluorescence experiments revealed a significant increase in neuronal activity occurring in the lateral amygdala after the fourth session, most likely due to activity of principal cells. These findings indicate a predominant role of amygdala in promoting progressively more severe convulsions as well as the late recruitment of the hippocampus in the seizure spread. We propose that the repeated 6-Hz corneal stimulation model may be used to investigate some mechanisms of epileptogenesis and to test putative antiepileptogenic drugs.

  16. Repeated 6-Hz Corneal Stimulation Progressively Increases FosB/ΔFosB Levels in the Lateral Amygdala and Induces Seizure Generalization to the Hippocampus.

    Directory of Open Access Journals (Sweden)

    Carmela Giordano

    Full Text Available Exposure to repetitive seizures is known to promote convulsions which depend on specific patterns of network activity. We aimed at evaluating the changes in seizure phenotype and neuronal network activation caused by a modified 6-Hz corneal stimulation model of psychomotor seizures. Mice received up to 4 sessions of 6-Hz corneal stimulation with fixed current amplitude of 32 mA and inter-stimulation interval of 72 h. Video-electroencephalography showed that evoked seizures were characterized by a motor component and a non-motor component. Seizures always appeared in frontal cortex, but only at the fourth stimulation they involved the hippocampus, suggesting the establishment of an epileptogenic process. Duration of seizure non-motor component progressively decreased after the second session, whereas convulsive seizures remained unchanged. In addition, a more severe seizure phenotype, consisting of tonic-clonic generalized convulsions, was predominant after the second session. Immunohistochemistry and double immunofluorescence experiments revealed a significant increase in neuronal activity occurring in the lateral amygdala after the fourth session, most likely due to activity of principal cells. These findings indicate a predominant role of amygdala in promoting progressively more severe convulsions as well as the late recruitment of the hippocampus in the seizure spread. We propose that the repeated 6-Hz corneal stimulation model may be used to investigate some mechanisms of epileptogenesis and to test putative antiepileptogenic drugs.

  17. Vertebral Artery Dissection Associated with Generalized Convulsive Seizures: A Case Report

    Directory of Open Access Journals (Sweden)

    Faisal Mohammad Amin


    Full Text Available A 46-year-old male with juvenile myoclonic epilepsy was admitted to the neurological department for convulsive seizures just after lamotrigine was discontinued. On admission he was awake but had a right-sided hemiparesis with Babinski sign and ataxic finger-nose test on the left side. An MR scan showed a left-sided pontine infarction, an infarct in the left cerebellar hemisphere and a right vertebral artery dissection (VAD. The patient was treated with heparin and an oral anticoagulant for 6 months. Recovery of neurologic function was excellent. In patients with symptoms of disturbances of posterior circulation after epileptic seizures, VAD should be considered.

  18. Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures

    Energy Technology Data Exchange (ETDEWEB)

    Mennel, Emilie A. [University of Texas Southwestern Medical School, Dallas, Texas (United States); John, Susan D. [Department of Radiology, University of Texas-Houston Medical School, 6431 Fannin-MSB2.100, Houston, TX 77030 (United States)


    We report the case of a 23-month-old male with hypotonia, developmental delay, and complex seizures. Radiographs revealed profound sclerosis of the metaphyses and epiphyses of the long and short bones in the extremities, with a unique pattern of distribution. Sclerosis also involved the anterior ribs, iliac crests, talus, and calcaneus. The skull and vertebral bodies appeared unaffected. Blood lead levels were normal. We believe that this constellation of clinical and radiographic abnormalities closely resembles osteosclerotic metaphyseal dysplasia (OMD) due to an autosomal recessive defect. Characteristic skeletal findings were instrumental in determining the diagnosis. OMD is a very rare sclerosing bone disorder, first described in 1993. The syndrome is characterized clinically by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase, and late-onset spastic paraplegia. We encountered a young child with these neurologic symptoms who displayed sclerotic metaphyseal changes on hand radiographs obtained to determine the bone age. Lead poisoning, a known cause of metaphyseal sclerosis, was initially suspected. Careful analysis of the metaphyseal bone changes helped to distinguish this bone dysplasia from lead poisoning and other causes of metaphyseal sclerosis. (orig.)

  19. The effect of generalized absence seizures on the progression of kindling in the rat

    NARCIS (Netherlands)

    Onat, F.Y.; Aker, R.G.; Gurbanova, A.A.; Ates, N.; Luijtelaar, E.L.J.M. van


    The involvement of the thalamus in limbic epileptogenesis has recently drawn attention to the connectivity between the nuclei of the thalamus and limbic structures. Thalamo-limbic circuits are thought to regulate limbic seizure activity whereas thalamocortical circuits are involved in the expression

  20. Treatment of drug-induced seizures. (United States)

    Chen, Hsien-Yi; Albertson, Timothy E; Olson, Kent R


    Seizures are a common complication of drug intoxication, and up to 9% of status epilepticus cases are caused by a drug or poison. While the specific drugs associated with drug-induced seizures may vary by geography and change over time, common reported causes include antidepressants, stimulants and antihistamines. Seizures occur generally as a result of inadequate inhibitory influences (e.g., gamma aminobutyric acid, GABA) or excessive excitatory stimulation (e.g. glutamate) although many other neurotransmitters play a role. Most drug-induced seizures are self-limited. However, status epilepticus occurs in up to 10% of cases. Prolonged or recurrent seizures can lead to serious complications and require vigorous supportive care and anticonvulsant drugs. Benzodiazepines are generally accepted as the first line anticonvulsant therapy for drug-induced seizures. If benzodiazepines fail to halt seizures promptly, second line drugs include barbiturates and propofol. If isoniazid poisoning is a possibility, pyridoxine is given. Continuous infusion of one or more anticonvulsants may be required in refractory status epilepticus. There is no role for phenytoin in the treatment of drug-induced seizures. The potential role of ketamine and levetiracetam is promising but not established.

  1. Low glycemic index treatment for seizure control in Angelman syndrome: A case series from the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital. (United States)

    Grocott, Olivia R; Herrington, Katherine S; Pfeifer, Heidi H; Thiele, Elizabeth A; Thibert, Ronald L


    The low glycemic index treatment, a dietary therapy that focuses on glycemic index and reduced carbohydrate intake, has been successful in reducing seizure frequency in the general epilepsy population. Epilepsy is a common feature of Angelman syndrome and seizures are often refractory to multiple medications, especially in those with maternal deletions. Dietary therapy has become a more frequently used option for treating epilepsy, often in combination with other antiepileptic drugs, due to its efficacy and favorable side effect profile. This study aimed to assess the effectiveness of the low glycemic index treatment for seizure control in Angelman syndrome. Through a retrospective medical record review of 23 subjects who utilized the low glycemic index treatment at the Clinic and Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital, we found that the high level of seizure control and favorable side effect profile make the low glycemic index treatment a viable treatment for seizures in Angelman syndrome. The majority of subjects in our cohort experienced some level of seizure reduction after initiating the diet, 5 (22%) maintained complete seizure freedom, 10 (43%) maintained seizure freedom except in the setting of illness or non-convulsive status epilepticus, 7 (30%) had a decrease in seizure frequency, and only 1 (4%) did not have enough information to determine seizure control post-initiation. The low glycemic index treatment monotherapy was successful for some subjects in our cohort but most subjects used an antiepileptic drug concurrently. Some subjects were able to maintain the same level of seizure control on a liberalized version of the low glycemic index treatment which included a larger amount of low glycemic carbohydrates. No correlation between the level of carbohydrate restriction and level of seizure control was found. Few subjects experienced side effects and those that did found them to be mild and easily treated. The

  2. Thalamic lesion and epilepsy with generalized seizures, ESES and spike-wave paroxysms--report of three cases. (United States)

    Kelemen, Anna; Barsi, Péter; Gyorsok, Zsuzsanna; Sarac, Judit; Szucs, Anna; Halász, Péter


    We report three patients, who have thalamic lesion and secondary generalized epilepsy with generalized spike wave pattern. The first two patients have unilateral perinatal lesion, one with generalized tonic-clonic seizures on awakening the other with Landau-Kleffner-like syndrome. During the course of the disease both children developed electrical status epilepticus in slow wave sleep (ESES). The third patient has a dominantly unilateral thalamic tumor and epilepsy that mimics juvenile myoclonic epilepsy. All the patients have a lesion located in the inferior-medial-posterior part of the thalamus. The role of some thalamic and subthalamic nuclei in the generalized spike-wave electrical pattern patophysiology is discussed, with emphasis on the possible role of the inhibitory system from the zona incerta.

  3. Service-Learning General Chemistry: Lead Paint Analyses (United States)

    Kesner, Laya; Eyring, Edward M.


    Houses painted with lead-based paints are ubiquitous in the United States because the houses and the paint have not worn out two decades after federal regulations prohibited inclusion of lead in paint. Remodeling older homes thus poses a health threat for infants and small children living in those homes. In a service-learning general chemistry class, students disseminate information about this health threat in an older neighborhood. At some of the homes they collect paint samples that they analyze for lead both qualitatively and quantitatively. This service-learning experience generates enthusiasm for general chemistry through the process of working on a "real" problem. Sample collection familiarizes the students with the concept of "representative" sampling. The sample preparation for atomic absorption spectroscopic (AAS) analysis enhances their laboratory skills. The focus of this paper is on the mechanics of integrating this particular service project into the first-term of the normal general chemistry course.

  4. Hypocalcemia-Induced Seizure

    Directory of Open Access Journals (Sweden)

    Pengcheng Han


    Full Text Available Calcium is essential for both neurotransmitter release and muscle contraction. Given these important physiological processes, it seems reasonable to assume that hypocalcemia may lead to reduced neuromuscular excitability. Counterintuitively, however, clinical observation has frequently documented hypocalcemia’s role in induction of seizures and general excitability processes such as tetany, Chvostek’s sign, and bronchospasm. The mechanism of this calcium paradox remains elusive, and very few pathophysiological studies have addressed this conundrum. Nevertheless, several studies primarily addressing other biophysical issues have provided some clues. In this review, we analyze the data of these studies and propose an integrative model to explain this hypocalcemic paradox.

  5. Adjunctive levetiracetam in children, adolescents, and adults with primary generalized seizures: Open-label, noncomparative, multicenter, long-term follow-up study.

    LENUS (Irish Health Repository)

    Delanty, Norman


    Purpose: To evaluate the long-term efficacy and tolerability of adjunctive levetiracetam (LEV) in patients with uncontrolled idiopathic generalized epilepsy (IGE). Methods: This phase III, open-label, long-term, follow-up study (N167; NCT00150748) enrolled patients (4 to <65 years) with primary generalized seizures (tonic-clonic, myoclonic, absence). Patients received adjunctive LEV at individualized doses (1,000-4,000 mg\\/day; 20-80 mg\\/kg\\/day for children\\/adolescents weighing <50 kg). Efficacy results are reported for all seizure types [intention-to-treat (ITT) population, N = 217] and subpopulations with tonic-clonic (n = 152), myoclonic (n = 121), and\\/or absence (n = 70) seizures at baseline. Key Findings: One hundred twenty-five (57.6%) of 217 patients were still receiving treatment at the end of the study. Mean (standard deviation, SD) LEV dose was 2,917.5 (562.9) mg\\/day. Median (Q1-Q3) exposure to LEV was 2.1 (1.5-2.8) years, and the maximum duration was 4.6 years. Most patients were taking one (124\\/217, 57.1%) or >\\/=2 (92\\/217, 42.4%) concomitant antiepileptic drugs (AEDs). Seizure freedom of >\\/=6 months (all seizure types; primary efficacy end point) was achieved by 122 (56.2%) of 217 patients, and 49 (22.6%) of 217 patients had complete seizure freedom. Seizure freedom of >\\/=6 months from tonic-clonic, myoclonic, and absence seizures was achieved by 95 (62.5%) of 152, 75 (62.0%) of 121, and 44 (62.9%) of 70 patients, respectively. Mean (SD) maximum seizure freedom duration was 371.7 (352.4) days. At least one treatment-emergent adverse event (TEAE) was reported by 165 (76%) of 217 patients; most TEAEs were mild\\/moderate in severity, with no indication of an increased incidence over time. Seventeen (7.8%) of 217 patients discontinued medication because of TEAEs. The most common psychiatric TEAEs were depression (16\\/217, 7.4%), insomnia (9\\/217, 4.1%), nervousness (8\\/217, 3.7%), and anxiety (7\\/217, 3.2%). Significance: Adjunctive

  6. Pyridoxine-Dependent Seizures: A Family Phenotype that Leads to Severe Cognitive Deficits, Regardless of Treatment Regime (United States)

    Rankin, Peter M; Harrison, Sue; Chong, W. K.; Boyd, Stewart; Aylett, Sarah E.


    The neuropsychological and clinical histories of three male siblings affected by pyridoxine-dependent seizures with known homozygous antiquitin mutations are presented. Neuropsychological evaluation is reported from when the siblings were 11, 9, and 7 years of age. Two of the siblings had received early pyridoxine treatment (antenatal, 2-4 wks…

  7. Seizure semiology and aging. (United States)

    Silveira, Diosely C; Jehi, Lara; Chapin, Jessica; Krishnaiengar, Suparna; Novak, Eric; Foldvary-Schaefer, Nancy; Najm, Imad


    The incidence of epilepsy is high in older individuals. However, epilepsy in the elderly may be underdiagnosed and undertreated because of diagnostic difficulties. The main goal of this study was to determine whether seizure semiology differs between older and younger adults with epilepsy in the outpatient setting. Fifty patients with focal epilepsy aged 55 years and older and 50 patients aged between 18 and 45 years were included. Review of medical records contained detailed seizure description. There were no differences in seizure semiology between groups, except that subtle perceptions of transient confusion were seen in older patients but not in younger patients (P=0.0028). Older patients had less generalized motor seizures, but the differences between groups did not reach significance (P=0.01). Older patients may present with subtle symptoms of seizures characterized by brief periods of confusion, which may contribute to greater difficulty diagnosing seizures in the elderly. Copyright © 2010 Elsevier Inc. All rights reserved.

  8. Fever, febrile seizures and epilepsy. (United States)

    Dubé, Céline M; Brewster, Amy L; Richichi, Cristina; Zha, Qinqin; Baram, Tallie Z


    Seizures induced by fever (febrile seizures) are the most common type of pathological brain activity in infants and children. These febrile seizures and their potential contribution to the mechanisms of limbic (temporal lobe) epilepsy have been a topic of major clinical and scientific interest. Key questions include the mechanisms by which fever generates seizures, the effects of long febrile seizures on neuronal function and the potential contribution of these seizures to epilepsy. This review builds on recent advances derived from animal models and summarizes our current knowledge of the mechanisms underlying febrile seizures and of changes in neuronal gene expression and function that facilitate the enduring effects of prolonged febrile seizures on neuronal and network excitability. The review also discusses the relevance of these findings to the general mechanisms of epileptogenesis during development and points out gaps in our knowledge, including the relationship of animal models to human febrile seizures and epilepsy.

  9. Brain mechanisms of altered conscious states during epileptic seizures. (United States)

    Cavanna, Andrea Eugenio; Monaco, Francesco


    Impaired consciousness has long been considered the hallmark of epileptic seizures. Both generalized seizures and complex partial seizures are characterized by a multifaceted spectrum of altered conscious states, in terms of the general level of awareness and the subjective contents of consciousness. Complete loss of consciousness occurs when epileptic activity involves both cortical and subcortical structures, as in tonic-clonic seizures and absence seizures. Medial temporal lobe discharges can selectively impair experience in complex partial seizures (with affected responsiveness) and certain simple partial seizures (with unaffected responsiveness). Electrical stimulation of temporal lobe structures has been shown to evoke similar subjective experiences. Findings from neurophysiological and brain-imaging studies in epilepsy have now demonstrated that involvement of the bilateral thalamus and upper brainstem leads to selective impairment of frontoparietal association cortices and midline 'default mode' networks, which results in ictal loss of consciousness. The spread of epileptic discharges from the medial temporal lobe to the same subcortical structures can ultimately cause impairment in the level of consciousness in the late ictal and immediate postictal phase of complex partial seizures. This paper reviews novel insights into the brain mechanisms that underlie alterations of consciousness during epileptic seizures and the implications for clinical practice in terms of diagnosis and management.

  10. Loss of zebrafish lgi1b leads to hydrocephalus and sensitization to pentylenetetrazol induced seizure-like behavior.

    Directory of Open Access Journals (Sweden)

    Yong Teng

    Full Text Available Mutations in the LGI1 gene predispose to a hereditary epilepsy syndrome and is the first gene associated with this disease which does not encode an ion channel protein. In zebrafish, there are two paralogs of the LGI1 gene, lgi1a and lgi1b. Knockdown of lgi1a results in a seizure-like hyperactivity phenotype with associated developmental abnormalities characterized by cellular loss in the eyes and brain. We have now generated knockdown morphants for the lgi1b gene which also show developmental abnormalities but do not show a seizure-like behavior. Instead, the most striking phenotype involves significant enlargement of the ventricles (hydrocephalus. As shown for the lgi1a morphants, however, lgi1b morphants are also sensitized to PTZ-induced hyperactivity. The different phenotypes between the two lgi1 morphants support a subfunctionalization model for the two paralogs.

  11. Generalized Master Equations Leading to Completely Positive Dynamics (United States)

    Vacchini, Bassano


    We provide a general construction of quantum generalized master equations with a memory kernel leading to well-defined, that is, completely positive and trace-preserving, time evolutions. The approach builds on an operator generalization of memory kernels appearing in the description of non-Markovian classical processes and puts into evidence the nonuniqueness of the relationship arising due to the typical quantum issue of operator ordering. The approach provides a physical interpretation of the structure of the kernels, and its connection with the classical viewpoint allows for a trajectory description of the dynamics. Previous apparently unrelated results are now connected in a unified framework, which further allows us to phenomenologically construct a large class of non-Markovian evolutions taking as the starting point collections of time-dependent maps and instantaneous transformations describing the microscopic interaction dynamics.

  12. Impairments of cingulated cortex in the generalized tonic-clonic seizure epilepsy by combining morphological and functional connectivity magnetic resonance imaging. (United States)

    Ke, Ming; Jin, Bixia; Liu, Guangyao; Yang, Xiaoping


    Previous studies suggested that the patients with generalized tonic-clonic seizure had structural abnormalities in the thalamus, cingulated cortex and some other specific brain regions. Concurrently, the abnormality in thalamocortical network and basal ganglia network has been found in idiopathic generalized epilepsy. The cingulated cortex, a nexus of information processing and regulation in human brain, is implicated in the propagation of generalized spike in IGE and the previous studies have suggested that the structural features and functional connectivity of the cingulated cortex have been changed. The aim of this study was to demonstrate the alterations in the cingulated cortex in generalized tonic-clonic seizure by combining morphological and functional connectivity magnetic resonance imaging. 19 patients with generalized tonic-clonic seizure and 19 age-and gender-matched healthy controls were involved in the study. The three-dimensional high-resolution T1-weighted magnetic resonance imaging data were acquired for voxel-based morphometry analysis, two-sample t-test run on the T1-weighted structural images revealed clusters exhibiting significant decreases in grey-matter volume in the generalized tonic-clonic seizure group, located within the cingulated cortex, thalamus, frontal lobe, temporal lobe, and cerebellum. The decreased gray matter volume in the cingulated cortex indicating that the cingulated cortex has structural impairments in generalized tonic-clonic seizure patients. The bilateral cingulated cortex, as detected with decreased gray matter volume in patients with generalized tonic-clonic seizure through voxel-based morphometry analysis, was selected as seed regions for functional connectivity analysis. Compared with controls, we found decreased functional connectivity to left anterior cingulated cortex (ROI1) in the cuneus, frontal lobe and precentral gyrus. There was no significant result when seeding at the right anterior cingulum gyrus (ROI2

  13. Febrile and other occasional seizures. (United States)

    Bast, T; Carmant, L


    Seizures with fever that result from encephalitis or meningitis usually occur late in the course of febrile illness, and are focal and prolonged. Febrile seizures are by far the most common affecting 5% of the population, followed by posttraumatic seizures and those observed in the setting of a toxic, infectious, or metabolic encephalopathy. This chapter reviews the clinical presentation of the three most common forms, due to fever, trauma, and intoxication. Febrile seizures carry no cognitive or mortality risk. Recurrence risk is increased by young age, namely before 1 year of age. Febrile seizures that persist after the age of 6 years are usually part of the syndrome of Generalized epilepsy febrile seizures plus. These febrile seizures have a strong link with epilepsy since non-febrile seizures may occur later in the same patient and in other members of the same family with an autosomal dominant transmission. Complex febrile seizures, i.e., with focal or prolonged manifestations or followed by focal defect, are related to later mesial temporal epilepsy with hippocampal sclerosis; risk factors are seizure duration and brain malformation. Prophylactic treatment is usually not required in febrile seizures. Early onset of complex seizures is the main indication for AED prophylaxis. Early posttraumatic seizures, i.e., within the first week, are often focal and indicate brain trauma: contusion, hematoma, 24 hours amnesia, and depressed skull fracture are major factors of posttraumatic epilepsy. Prophylaxis with antiepileptic drugs is not effective. Various psychotropic drugs, including antiepileptics, may cause seizures.

  14. [Ecstatic seizures]. (United States)

    Likhachev, S A; Astapenko, A V; Osos, E L; Zmachynskaya, O L; Gvishch, T G


    Ecstatic seizures is a rare manifestation of epilepsy. They were described for the first time by F.M. Dostoevsky. Currently, the description of ecstatic seizures is possible to find in the scientific literature. The description of the own observation of a patient with emotional-affective seizures is presented. A role of the anterior insular cortex in the ecstatic seizures origin is discussed. The similarities between the feelings reported during ecstatic seizures and the feelings experienced under the effect of stimulant addictive drugs are described. The possible reasons of the low frequency of emotional-affective seizures are considered.

  15. Can cortical silent period and motor threshold be practical parameters in the comparison of patients with generalized epilepsy and patients with psychogenic non-epileptic seizures?. (United States)

    İpekdal, İlker H; Karadaş, Ömer; Ulaş, Ümit H; Vural, Okay


    This study aimed to compare the cortical excitability of patients with generalized tonic-clonic seizures (GTCSs) and that of patients with psychogenic non-epileptic seizures (PNESs). Patients were classified into groups according to their electroencephalogram (EEG) findings and seizure types: group 1 = GTCS with an abnormal EEG, group 2 = GTCS with a normal EEG and group 3 = PNES with a normal EEG. The control group included healthy volunteers with normal EEGs. Cortical silent period (CSP) and motor threshold (MT) were measured for all groups and the results were compared. CSPs were significantly prolonged in groups 1 and 2 when compared with group 3 and the control group. No differences were found between the MT measurements of all groups. The prolongation of CSP may demonstrate the differences between the pathophysiological mechanisms of GTCS and those of PNES. Copyright © 2012 S. Karger AG, Basel.

  16. Classification of seizures and epilepsy. (United States)

    Riviello, James J


    The management of seizures and epilepsy begins with forming a differential diagnosis, making the diagnosis, and then classifying seizure type and epileptic syndrome. Classification guides treatment, including ancillary testing, management, prognosis, and if needed, selection of the appropriate antiepileptic drug (AED). Many AEDs are available, and certain seizure types or epilepsy syndromes respond to specific AEDs. The identification of the genetics, molecular basis, and pathophysiologic mechanisms of epilepsy has resulted from classification of specific epileptic syndromes. The classification system used by the International League Against Epilepsy is periodically revised. The proposed revision changes the classification emphasis from the anatomic origin of seizures (focal vs generalized) to seizure semiology (ie, the signs or clinical manifestations). Modified systems have been developed for specific circumstances (eg, neonatal seizures, infantile seizures, status epilepticus, and epilepsy surgery). This article reviews seizure and epilepsy classification, emphasizing new data.

  17. [A case of a pediatric patient with tuberous sclerosis (Bourneville-Pringle disease) and frequent epileptic seizure for intensive dental treatment under general anesthesia]. (United States)

    Mimura, Shinichiro; Kikura, Mutsuhito; Itagaki, Taiga; Inokuma, Mie; Iwamoto, Tatsuaki; Kawakubo, Atsushi; Hirano, Kazuhiro; Sato, Shigehito


    Tuberous sclerosis (Bourneville-Pringle disease) is a rare disease with a triad of mental retardation, epilepsy, and facial spot. Management of the patients with tuberous sclerosis under general anesthesia has been previously reported. However, there are few case reports about management under general anesthesia of a pediatric patient with tuberous sclerosis with frequent epileptic seizure. Here, we report a case of a pediatric patient with tuberous sclerosis and frequent epileptic seizure who underwent intensive dental treatment under general anesthesia with careful management of epilepsy. The patient was discharged on the day of surgery without any complications. In this case report, we discussed the appropriate assessment of the complications of tuberous sclerosis; such as, of central nervous, circulatory, respiratory, endocrine, and urinary systems including the management of general anesthesia.

  18. Evaluation of safety and efficacy of zonisamide in adult patients with partial, generalized, and combined seizures: an open labeled, noncomparative, observational Indian study

    Directory of Open Access Journals (Sweden)

    Dash A


    Full Text Available Amitabh Dash,1 Sangeeta Ravat,2 Avathvadi Venkatesan Srinivasan,3 Ashutosh Shetty,4 Vivek Kumar,5 Renu Achtani,6 Vivek Narain Mathur,7 Boby Varkey Maramattom,8 Veeresh Bajpai,9 Nanjappa C Manjunath,10 Randhi Venkata Narayana,11 Suyog Mehta12 1Eisai Co. Ltd., 2Department of Neurology, Seth GS Medical College & KEM Hospital, Mumbai, 3Department of Neurology, Trinity Acute Care Hospital, Chennai, 4Department of Neurology, Criticare Multispeciality Hospital & Research Centre, Mumbai, 5Department of Neurology, Metro Multispeciality Hospital, Noida, 6Department of Neurology, Mata Chanan Devi Hospital, New Delhi, 7Department of Neurology, Vivekananda Hospital, Hyderabad, 8Department of Neurology, Lourdes Hospital, Kochi, 9Department of Neurology, Sai Neurology Clinic, Lucknow, 10Department of Neurology, Brain and Nerve Care, Bangalore, 11Department of Neurology, Seven Hills Hospital, Visakhapatnam, 12Department of Pharmacology & Therapeutics,Government Medical College, Solapur, India Abstract: A prospective, multicentric, noncomparative open-label observational study was conducted to evaluate the safety and efficacy zonisamide in Indian adult patients for the treatment of partial, generalized, or combined seizures. A total of 655 adult patients with partial, generalized, or combined seizures from 30 centers across India were recruited after initial screening. Patients received 100 mg zonisamide as initiating dose as monotherapy/adjunctive therapy for 24 weeks, with titration of 100 mg every 2 weeks if required. Adverse events, responder rates, and seizure freedom were observed every 4 weeks. Efficacy and safety were also assessed using Clinicians Global Assessment of Response to Therapy and Patients Global Assessment of Tolerability to Therapy, respectively. Follow-up was conducted for a period of 24 weeks after treatment initiation. A total of 655 patients were enrolled and received the treatment and 563 completed the evaluation phase. A total of 20

  19. Seizures due to high dose camphor ingestion. (United States)

    Tekin, Hande Gazeteci; Gökben, Sarenur; Serdaroğlu, Gül


    Camphor is a cyclic ketone of the hydro aromatic terpene group. Today it is frequently used as a prescription or non-prescription topical antitussive, analgesic, anesthetic and antipruritic agent. Camphor which is considered an innocent drug by parents and physicians is a common household item which can lead to severe poisoning in children even when taken in small amounts. Neurotoxicity in the form of seizures can ocur soon after ingestion. A two-year old female patient who presented with a complaint of generalized tonic-clonic seizures after oral ingestion of camphor is presented.

  20. Impaired resting-state functional integrations within default mode network of generalized tonic-clonic seizures epilepsy.

    Directory of Open Access Journals (Sweden)

    Ming Song

    Full Text Available Generalized tonic-clonic seizures (GTCS are characterized by unresponsiveness and convulsions, which cause complete loss of consciousness. Many recent studies have found that the ictal alterations in brain activity of the GTCS epilepsy patients are focally involved in some brain regions, including thalamus, upper brainstem, medial prefrontal cortex, posterior midbrain regions, and lateral parietal cortex. Notably, many of these affected brain regions are the same and overlap considerably with the components of the so-called default mode network (DMN. Here, we hypothesize that the brain activity of the DMN of the GTCS epilepsy patients are different from normal controls, even in the resting state. To test this hypothesis, we compared the DMN of the GTCS epilepsy patients and the controls using the resting state functional magnetic resonance imaging. Thirteen brain areas in the DMN were extracted, and a complete undirected weighted graph was used to model the DMN for each participant. When directly comparing the edges of the graph, we found significant decreased functional connectivities within the DMN of the GTCS epilepsy patients comparing to the controls. As for the nodes of the graph, we found that the degree of some brain areas within the DMN was significantly reduced in the GTCS epilepsy patients, including the anterior medial prefrontal cortex, the bilateral superior frontal cortex, and the posterior cingulate cortex. Then we investigated into possible mechanisms of how GTCS epilepsy could cause the reduction of the functional integrations of DMN. We suggested the damaged functional integrations of the DMN in the GTCS epilepsy patients even during the resting state, which could help to understand the neural correlations of the impaired consciousness of GTCS epilepsy patients.

  1. 19 CFR 162.22 - Seizure of conveyances. (United States)


    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Seizure of conveyances. 162.22 Section 162.22... TREASURY (CONTINUED) INSPECTION, SEARCH, AND SEIZURE Seizures § 162.22 Seizure of conveyances. (a) General applicability. If it shall appear to any officer authorized to board conveyances and make seizures that there...

  2. Update on the Neurobiology of Alcohol Withdrawal Seizures



    Abrupt cessation of alcohol intake after prolonged heavy drinking may trigger alcohol withdrawal seizures. Generalized tonic–clonic seizures are the most characteristic and severe type of seizure that occur in this setting. Generalized seizures also occur in rodent models of alcohol withdrawal. In these models, the withdrawal seizures are triggered by neuronal networks in the brainstem, including the inferior colliculus; similar brainstem mechanisms may contribute to alcohol withdrawal seizur...

  3. [The general practitioner is not in the lead on ADHD]. (United States)

    Damoiseaux, Roger A M J


    The diagnosis of and therapy for ADHD is complex and should be done by experts in this field. In the Netherlands, a new guideline on ADHD for general practitioners has recently been issued. Although there is some room for general practitioners to start medication for this disorder, the main message is to exercise caution in starting medication in general practice. Many children with ADHD have psychiatric comorbidity and proper diagnosis by a specialist is recommended. The main task of the general practitioner is making the right choice concerning when to refer for further diagnosis. Children sometimes show behaviour which, although it is not always what adults want, does not necessarily require psychiatric intervention and this is what a general practitioner can determine.

  4. Psychogenic seizures--why women? (United States)

    Rosenbaum, M


    The only consistent finding in studies of psychogenic seizures is the approximately threefold higher incidence in women. Therefore, why women? Charcot and Freud emphasized the sexual aspects of the seizure as has the current interest in childhood sexual abuse. From case studies and review of the literature the author believes that psychogenic seizures in women express rage, fear, and helplessness against the dominant and abusive male rather than sexual conflicts. Emphasizing the aggressive component of seizures does not minimize the traumatic effects of sexual abuse but rather includes it as leading to rage and helplessness.

  5. Seizures Induced by Music

    Directory of Open Access Journals (Sweden)

    A. O. Ogunyemi


    Full Text Available Musicogenic epilepsy is a rare disorder. Much remains to be learned about the electroclinical features. This report describes a patient who has been followed at our institution for 17 years, and was investigated with long-term telemetered simultaneous video-EEG recordings. She began to have seizures at the age of 10 years. She experienced complex partial seizures, often preceded by elementary auditory hallucination and complex auditory illusion. The seizures occurred in relation to singing, listening to music or thinking about music. She also had occasional generalized tonic clonic seizures during sleep. There was no significant antecedent history. The family history was negative for epilepsy. The physical examination was unremarkable. CT and MRI scans of the brain were normal. During long-term simultaneous video-EEG recordings, clinical and electrographic seizure activities were recorded in association with singing and listening to music. Mathematical calculation, copying or viewing geometric patterns and playing the game of chess failed to evoke seizures.

  6. Fibromyalgia and seizures. (United States)

    Tatum, William O; Langston, Michael E; Acton, Emily K


    The purpose of this case-matched study was to determine how frequently fibromyalgia is associated with different paroxysmal neurological disorders and explore the utility of fibromyalgia as a predictor for the diagnosis of psychogenic non-epileptic seizures. The billing diagnosis codes of 1,730 new, non-selected patient encounters were reviewed over a three-year period for an epileptologist in a neurology clinic to identify all patients with historical diagnoses of fibromyalgia. The frequency with which epileptic seizures, psychogenic non-epileptic seizures, and physiological non-epileptic events were comorbid with fibromyalgia was assessed. Age and gender case-matched controls were used for a between-group comparison. Wilcoxon tests were used to analyse interval data, and Chi-square was used to analyse categorical data (pFibromyalgia was retrospectively identified in 95/1,730 (5.5%) patients in this cohort. Females represented 95% of the fibromyalgia sample (age: 53 years; 95% CI: 57, 51). Forty-three percent of those with fibromyalgia had a non-paroxysmal, neurological primary clinical diagnosis, most commonly chronic pain. Paroxysmal events were present in 57% of fibromyalgia patients and 54% of case-matched controls. Among patients with fibromyalgia and paroxysmal disorders, 11% had epileptic seizures, 74% had psychogenic non-epileptic seizures, and 15% had physiological non-epileptic events, compared to case-matched controls with 37% epileptic seizures, 51% psychogenic non-epileptic events, and 12% physiological non-epileptic events (p = 0.009). Fibromyalgia was shown to be a predictor for the diagnosis of psychogenic non-epileptic seizures in patients with undifferentiated paroxysmal spells. However, our results suggest that the specificity and sensitivity of fibromyalgia as a marker for psychogenic non-epileptic seizures in a mixed general neurological population of patients is less than previously described.

  7. Varying seizure semiology according to age. (United States)

    Nordli, Douglas R


    The clinical manifestations of seizures change in a predictable fashion with advancing age. For focal seizures these changes can be summarized into domains similar to those used in developmental models. These include fine motor, communication, and gross motor manifestations. Instead of socialization the fourth domain for seizure semiology concerns synchronization. Focal seizures in the very young tend to be simpler with fewer fine motor manifestations. Auras are uncommon, even in young children with some linguistic skill and it is often difficult to discern alteration of consciousness. Infantile focal seizures can present with spasms or even diffuse tonic seizures. In terms of synchronization, orderly secondary generalization is rarely seen so that primary generalized clonic seizures are rarely recorded in infants. Amongst so-called "generalized" seizures spasms are most often seen in the first year of life. Absence seizures, myoclonic-astatic and generalized tonic-clonic seizures are all usually not seen until after age 2 years. A full description of the clinical details of seizures is probably the most important part of the epilepsy history. A detailed knowledge of seizure semiology can make the history more effective and also in the identification of the correct seizure classification. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. [Quality of life and perceived general health state related to seizure type and frequency, electroencephalographic findings, cognitive impairment, therapeutic response and secondary effects in persons with epilepsy]. (United States)

    Rossinol, Antoni; Molina, Irene; Rossinol, Tomeu; Garcia-Mas, Alexandre


    INTRODUCTION. The perceived quality of life (QoL) in persons with epilepsy has demonstrated to be a relevant factor for the continuity of treatment and for the patients' own general health perception. Currently, the positive concept of QoL is used to assess the psychosocial factors of the epilepsy, replacing the concept of stigma. AIM. To analyze the relationship between QoL and general health perception, with several relevant clinical parameters in a sample of persons with epilepsy, in order to draw conclusions that help to suggest a more global approach to the disease. PATIENTS AND METHODS. We applied the Spanish versions of the QOLIE-10, the GHQ-12, and MMSE, and registered the clinical parameters (diagnostic, years of illness, electroencephalographic patterns, seizure type and frequency, response to medication, and side effects) in a sample of 29 persons with epilepsy. RESULTS. QoL and perceived general health are two unrelated factors respect to the clinical features. QoL is closely related to the frequency and type of crisis, whilst the years of illness and the level of neurocognitive impairment are not related with QoL. CONCLUSIONS. From the clinical point of view, it must be taken into account the relationship between the persons with epilepsy perceived QoL with factors such as the seizure frequency, side effects of the medication, and the general health perception, in order to obtain the best response and treatment adherence.

  9. Fluoxetine Overdose-Induced Seizure


    Suchard, Jeffrey R


    A 37-year-old woman experienced a witnessed generalized seizure in the Emergency Department three hours after ingesting approximately 1400 mg of fluoxetine in a suicide attempt. Although the majority of fluoxetine ingestions are benign, seizures may occur after large intentional overdoses. [WestJEM. 2008;9:154-156


    Directory of Open Access Journals (Sweden)

    M. B. Mironov


    Full Text Available Despite the considerable advances of epileptology drug-resistant epilepsies consist about 30% among all forms of epilepsy. A case of successful using of a new antiepileptic drug lacosamide (vimpat in the treatment of 31 years old patient with the resistant form of cryptogenic focal epilepsy with focal automotor and secondarily generalized seizures is presented. Authors represent the review of the literature devoted to efficacy and tolerability of lacosamide in the treatment of drug-resistant epilepsy.

  11. Seizure outcomes after resective surgery for extra-temporal lobe epilepsy in pediatric patients. (United States)

    Englot, Dario J; Breshears, Jonathan D; Sun, Peter P; Chang, Edward F; Auguste, Kurtis I


    While temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults, seizures in children are more often extratemporal in origin. Extra-temporal lobe epilepsy (ETLE) in pediatric patients is often medically refractory, leading to significantly diminished quality of life. Seizure outcomes after resective surgery for pediatric ETLE vary tremendously in the literature, given diverse patient and epilepsy characteristics and small sample sizes. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after resective surgery for ETLE, excluding hemispherectomy. Thirty-six studies were examined. These 36 studies included 1259 pediatric patients who underwent resective surgery for ETLE. Seizure freedom (Engel Class I outcome) was achieved in 704 (56%) of these 1259 patients postoperatively, and 555 patients (44%) continued to have seizures (Engel Class II-IV outcome). Shorter epilepsy duration (≤ 7 years, the median value in this study) was more predictive of seizure freedom than longer (> 7 years) seizure history (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.07-2.14), suggesting that earlier intervention may be beneficial. Also, lesional epilepsy was associated with better seizure outcomes than nonlesional epilepsy (OR 1.34, 95% CI 1.19-1.49). Other predictors of seizure freedom included an absence of generalized seizures (OR 1.61, 95% CI 1.18-2.35) and localizing ictal electroencephalographic findings (OR 1.55, 95% CI 1.24-1.93). In conclusion, seizure outcomes after resective surgery for pediatric ETLE are less favorable than those associated with temporal lobectomy, but seizure freedom may be more common with earlier intervention and lesional epilepsy etiology. Children with continued debilitating seizures despite failure of multiple medication trials should be referred to a comprehensive pediatric epilepsy center

  12. [Pyridoxine dependent seizures]. (United States)

    Hansen, K N; Ostergaard, J R; Møller, S M


    Pyridoxine dependent seizures is a rare autosomal recessive disorder. Its manifestations are intractable epilepsy leading to death in status epilepticus. Treatment with pyridoxine prevents the seizures and normalizes the EEG. Early diagnosis is important for the intellectual outcome. In Denmark, the disease has occurred in a child of healthy Tamil immigrants, who are first cousins. The child's case story is described and points to awareness of increased occurrence of rare autosomal recessive disorders in immigrants from cultures with traditional consanguinity. We suggest giving a pyridoxine test dosis to all cases of severe epilepsy and status epilepticus in infants younger than 18 months.

  13. Seizures Complicating Bacterial Meningitis

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available The clinical data of 116 patients, 1 month to <5 years of age, admitted for bacterial meningitis, and grouped according to those with and without seizures during hospitalization, were compared in a study at Buddhist Dalin Tzu Chi General Hospital, Chang Gung Memorial Hospital and other centers in Taiwan.

  14. Recurrent seizures after lidocaine ingestion. (United States)

    Aminiahidashti, Hamed; Laali, Abolghasem; Nosrati, Nazanin; Jahani, Fatemeh


    Lidocaine has a concentration-dependent effect on seizures. Concentrations above 15 μg/mL frequently result in seizures in laboratory animals and human. We report a case of central nervous system (CNS) lidocaine toxicity and recurrent seizure after erroneous ingestion of lidocaine solution. A 4-year-old boy presented to the Emergency Department of Imam Hospital of Sari in December 2013 due to tonic-clonic generalized seizures approximately 30 min ago. 3 h before seizure, his mother gave him 2 spoons (amount 20-25 cc) lidocaine hydrochloride 2% solution instead of pediatric gripe by mistake. Seizure with generalized tonic-clonic occurred 3 times in home. Neurological examination was essentially unremarkable except for the depressed level of consciousness. Personal and medical history was unremarkable. There was no evidence of intracranial ischemic or hemorrhagic lesions in computed tomography scan. There were no further seizures, the condition of the patient remained stable, and he was discharged 2 days after admission. The use of viscous lidocaine may result in cardiovascular and CNS toxicity, particularly in children. Conservative management is the best option for treatment of lidocaine induced seizure.

  15. Recurrent seizures after lidocaine ingestion

    Directory of Open Access Journals (Sweden)

    Hamed Aminiahidashti


    Full Text Available Lidocaine has a concentration-dependent effect on seizures. Concentrations above 15 μg/mL frequently result in seizures in laboratory animals and human. We report a case of central nervous system (CNS lidocaine toxicity and recurrent seizure after erroneous ingestion of lidocaine solution. A 4-year-old boy presented to the Emergency Department of Imam Hospital of Sari in December 2013 due to tonic-clonic generalized seizures approximately 30 min ago. 3 h before seizure, his mother gave him 2 spoons (amount 20-25 cc lidocaine hydrochloride 2% solution instead of pediatric gripe by mistake. Seizure with generalized tonic-clonic occurred 3 times in home. Neurological examination was essentially unremarkable except for the depressed level of consciousness. Personal and medical history was unremarkable. There was no evidence of intracranial ischemic or hemorrhagic lesions in computed tomography scan. There were no further seizures, the condition of the patient remained stable, and he was discharged 2 days after admission. The use of viscous lidocaine may result in cardiovascular and CNS toxicity, particularly in children. Conservative management is the best option for treatment of lidocaine induced seizure.

  16. Localization of pediatric seizure semiology. (United States)

    Vendrame, Martina; Zarowski, Marcin; Alexopoulos, Andreas V; Wyllie, Elaine; Kothare, Sanjeev V; Loddenkemper, Tobias


    The aim of this study was to evaluate the relationship between semiology of seizures in children and adolescents to the corresponding EEG localization. Charts of 225 consecutive pediatric epilepsy patients undergoing Video-EEG monitoring (VEM) over 2 years were reviewed. Seizure semiology recorded during VEM was classified according to ILAE seizure semiology terminology and EEG localization, and analyzed based on onset as defined by the EEG data (generalized, frontal, temporal, parietal, occipital or multilobar). A total of 1008 seizures were analyzed in 225 children (mean age 8.5 years, range 0-20), with 50% boys. Auras and seizures with automatisms arose predominantly from the temporal lobes (psemiologies relate to specific brain regions, with overlap between focal and generalized semiological seizure types, as identified electrographically. Semiology of seizures can provide important information for epilepsy localization, and should not be overlooked, especially in patients undergoing pre-surgical evaluation. Separation of clinical seizure description and EEG findings may be useful, in particular when only incomplete information is available. i.e. during the first office visit. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Predictors of seizures during pregnancy in women with epilepsy. (United States)

    Thomas, Sanjeev V; Syam, Unnikrishnan; Devi, J Sucharitha


    We aimed to characterize the seizure pattern during pregnancy in a large cohort of women with epilepsy (WWE) and identify possible predictors of seizure relapse during pregnancy. We recorded the antiepileptic drug (AED) use and seizure frequency for WWE during the prepregnancy month and pregnancy. The seizure profile was correlated with the clinical details and seizure type as abstracted from the clinical records maintained in the registry. Of the 1,297 pregnancies in WWE with complete seizure data, 47.8% were seizure-free during pregnancy. Seizure relapse was highest during the three peripartum days. Women with partial seizures-had higher risk of relapse (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0) than those with generalized seizures. They had two peaks of seizure relapse (second to third month and sixth month). Those with generalized seizures had one peak at first trimester. Those who were on polytherapy had increased risk of seizures (OR 2.98, 95% CI 2.3-3.9) when compared to those on monotherapy. Those who had seizures in the prepregnancy month had higher risk (OR 15, 95% CI 9-25.1) of seizures during pregnancy when compared to those who were seizure-free during that period. On multiple logistic regression, prepregnancy seizure was the most important predictor of seizures during pregnancy.

  18. Absence seizure control by a brain computer interface

    NARCIS (Netherlands)

    Maksimenko, V.A.; Heukelum, S. van; Makarov, V.V.; Kelderhuis, J.; Lüttjohann, A.; Koronovskii, A.A.; Hramov, A.E.; Luijtelaar, E.L.J.M. van


    The ultimate goal of epileptology is the complete abolishment of epileptic seizures. This might be achieved by a system that predicts seizure onset combined with a system that interferes with the process that leads to the onset of a seizure. Seizure prediction remains, as of yet, unresolved in

  19. In silico validation and structure activity relationship study of a series of pyridine-3-carbohydrazide derivatives as potential anticonvulsants in generalized and partial seizures. (United States)

    Sinha, Reema; Sara, Udai Vir Singh; Khosa, Ratan Lal; Stables, James; Jain, Jainendra


    A series of twelve compounds (Compounds RNH1-RNH12) of acid hydrazones of pyridine-3-carbohydrazide or nicotinic acid hydrazide was synthesized and evaluated for anticonvulsant activity by MES, scPTZ, minimal clonic seizure and corneal kindling seizure test. Neurotoxicity was also determined for these compounds by rotarod test. Results showed that halogen substitution at meta and para position of phenyl ring exhibited better protection than ortho substitution. Compounds RNH4 and RNH12, were found to be the active analogs displaying 6Hz ED50 of 75.4 and 14.77 mg/kg while the corresponding MES ED50 values were 113.4 and 29.3 mg/kg respectively. In addition, compound RNH12 also showed scPTZ ED50 of 54.2 mg/kg. In the series, compound RNH12 with trifluoromethoxy substituted phenyl ring was the most potent analog exhibiting protection in all four animal models of epilepsy. Molecular docking study has also shown significant binding interactions of these two compounds with 1OHV, 2A1H and 1PBQ receptors. Thus, N-[(meta or para halogen substituted) benzylidene] pyridine-3-carbohydrazides could be used as lead compounds in anticonvulsant drug design and discovery.

  20. Propofol Anesthesia-Induced Seizures


    J Gordon Millichap


    A case of a healthy young man who developed seizures and generalized paroxysmal fast activity in the EEG following use of propofol for anesthesia in minor surgery is reported from the Department of Neurology, University of South Alabama, Mobile, AL.

  1. Febrile Seizures (United States)

    ... medical facility for diagnosis and treatment. Call an ambulance if the seizure is less than 5 minutes but the child does not seem to be recovering quickly. Gradually place the child on a protected surface such as the floor or ground to prevent accidental injury. Do not restrain or ...

  2. Clinical characteristics of children with febrile seizure. (United States)

    Shrestha, D; Dhakal, A K; Shakya, H; Shakya, A; Shah, S C; Mehata, S


    Febrile seizure is common in children below five years of age. This study was conducted to evaluate the clinical profile of children presenting with febrile seizure in a teaching hospital. This was a descriptive retrospective study among children presenting with febrile seizure in a teaching hospital from July 2009 to June 2013. Children between six months to six years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient's demographic and clinical data were collected from the in-patients records and analyzed. This study included 103 children with febrile seizure. Out of which 67% were male. Simple febrile seizure and complex febrile seizure were observed in 76.7% and 23.3% of patients respectively. Majority of children (71.8%)had generalized tonic clonic seizure followed by tonic seizures. Most of children (72.8%) who developed first episode of seizure were below 24 months of age with the mean age of 20.7 (±12.1) months. Overall 33% of patients developed recurrence of febrile seizure and first episode of febrile seizure at age one year or below was associated with the seizure recurrence. Upper respiratory tract infections were the commonest cause of fever in these children. Febrile seizure was observed predominantly in children below age of two years and simple febrile seizure was the ommonest variety. Recurrence of febrile seizure was common and significantly associated with the first episode of febrile seizure at the age of one year or below.

  3. The effect of leptin, ghrelin, and neuropeptide-Y on serum Tnf-Α, Il-1β, Il-6, Fgf-2, galanin levels and oxidative stress in an experimental generalized convulsive seizure model. (United States)

    Oztas, Berrin; Sahin, Deniz; Kir, Hale; Eraldemir, Fatma Ceyla; Musul, Mert; Kuskay, Sevinç; Ates, Nurbay


    The objective of this study is to examine the effects of the endogenous ligands leptin, ghrelin, and neuropeptide Y (NPY) on seizure generation, the oxidant/antioxidant balance, and cytokine levels, which are a result of immune response in a convulsive seizure model. With this goal, Wistar rats were divided into 5 groups-Group 1: Saline, Group 2: Saline+PTZ (65mg/kg), Group 3: leptin (4mg/kg)+PTZ, Group 4: ghrelin (80μg/kg)+PTZ, and Group 5: NPY (60μg/kg)+PTZ. All injections were delivered intraperitoneally, and simultaneous electroencephalography (EEG) records were obtained. Seizure activity was scored by observing seizure behavior, and the onset time, latency, and seizure duration were determined according to the EEG records. At the end of the experiments, blood samples were obtained in all groups to assess the serum TNF-α, IL-1β, IL-6, FGF-2, galanin, nitric oxide (NOֹ), malondialdehyde (MDA), and glutathione (GSH) levels. The electrophysiological and biochemical findings (pleptin, ghrelin, and NPY shows that these peptides may have anti-inflammatory effects in epileptic seizures. Also, leptin significantly increases the serum levels of the endogenous anticonvulsive agent galanin. The fact that each one of these endogenous peptides reduces the levels of MDA and increases the serum levels of GSH leads to the belief that they may have protective effects against oxidative damage that is thought to play a role in the pathogenesis of epilepsy. Our study contributes to the clarification of the role of these peptides in the brain in seizure-induced oxidative stress and immune system physiology and also presents new approaches to the etiology and treatment of tendency to epileptic seizures.

  4. 50 CFR 12.5 - Seizure by other agencies. (United States)


    ... 50 Wildlife and Fisheries 1 2010-10-01 2010-10-01 false Seizure by other agencies. 12.5 Section 12... SEIZURE AND FORFEITURE PROCEDURES General Provisions § 12.5 Seizure by other agencies. Any authorized... the laws listed in § 12.2 will, if so requested, deliver such seizure to the appropriate Special Agent...

  5. 19 CFR 162.92 - Notice of seizure. (United States)


    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Notice of seizure. 162.92 Section 162.92 Customs... (CONTINUED) INSPECTION, SEARCH, AND SEIZURE Civil Asset Forfeiture Reform Act § 162.92 Notice of seizure. (a) Generally. Customs will send written notice of seizure as provided in this section to all known interested...

  6. Overexpression of γ-aminobutyric acid transporter subtype I leads to susceptibility to kainic acid-induced seizure in transgenic mice

    Institute of Scientific and Technical Information of China (English)


    γ-aminobutyric acid (GABA) is the principal inhibitory neurotransmitter,and the GABAergic synaptic transmission is normally terminated by the rapid uptake through GABA transporters.With transgenic mice ubiquitously overexpressing GABA transporter subtype I (GAT1),the present study explored the pathophysiological role of GAT1 in epileptogenesis.Though displaying no spontaneous seizure activity,these mice exhibit altered electroencephalographic patterns and increased susceptibility to seizure induced by kainic acid.In addition,the GABAA receptor and glutamate transporters are up-regulated in transgenic mice,which perhaps reflects a compensatory or corrective change to the elevated level of GAT1.These preliminary findings support the hypothesis that excitatory and inhibitory neurotransmission,and seizure susceptibility can be altered by neurotransmitter transporters.

  7. Management Of Post Stroke Seizures

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari


    Full Text Available The incidence of seizures in relation to stroke is 8.9%, with a frequency of 10.6 and 8.6% in haemorrhagic and ischaemic stroke, respectively. In subarachnoid haemorrhage the incidence is 8.5%. Due to the fact that infarcts are significantly more frequent than haemorrhages, seizures are mainly related to occlusive vascular disease of the brain. The general view is to consider stroke-related seizures as harmless complications in the course of a prolonged vascular disease involving the heart and brain. Seizures can be classified as those of early and those of late onset in a paradigm comparable to post-traumatic epilepsy, with an arbitrary dividing point of two weeks after the event. Most early-onset seizures occur during the first day after the stroke. Late-onset seizures occur three times more often than early-onset ones. A first late-onset epileptic event is most likely to take place between six months and two years after the stroke. However, up to 28% of patients develop their first seizure several years later. Simple partial seizures, with or without secondary generalisation, account for about 50% of total seizures, while complex partial spells, with or without secondary generalisation, and primary generalised tonic–clonic insults account for approximately 25% each. Status epilepticus occurs in 12% of stroke patients, but the recurrence rate after an initial status epilepticus is not higher than after a single seizure. Inhibitory seizures, mimicking transient ischaemic attacks, are observed in 7.1% of cases. The only clinical predictor of late-onset seizures is the initial presentation of partial anterior circulation syndrome due to a territorial infarct. Patients with total anterior circulation syndrome have less chance of developing epileptic spells, not only due to their shorter life expectancy but also due to the fact that the large infarcts are sharply demarcated in these patients. The optimal timing and type of antiepileptic drug

  8. De-novo mutations and genetic variation in the SCN1A gene in Malaysian patients with generalized epilepsy with febrile seizures plus (GEFS+). (United States)

    Tan, Emmilia Husni; Razak, Salmi Abdul; Abdullah, Jafri Malin; Mohamed Yusoff, Abdul Aziz


    Generalized epilepsy with febrile seizures plus (GEFS+) comprises a group of clinically and genetically heterogeneous epilepsy syndrome. Here, we provide the first report of clinical presentation and mutational analysis of SCN1A gene in 36 Malaysian GEFS+ patients. Mutational analysis of SCN1A gene revealed twenty seven sequence variants (missense mutation and silent polymorphism also intronic polymorphism), as well as 2 novel de-novo mutations were found in our patients at coding regions, c.5197A>G (N1733D) and c.4748A>G (H1583R). Our findings provide potential genetic insights into the pathogenesis of GEFS+ in Malaysian populations concerning the SCN1A gene mutations. Copyright © 2012 Elsevier B.V. All rights reserved.

  9. Galactosemia and phantom absence seizures

    Directory of Open Access Journals (Sweden)

    Zeynep Aydin-Özemir


    Full Text Available Generalized and focal seizures can rarely be seen in galactosemia patients, but absence seizures were not reported previously. An 18-year-old male was diagnosed as galactosemia at the age of 8 months. No family history of epilepsy was present. His absence seizures realized at the age of 9 years. Generalized 3-4 Hz spike-wave discharges were identified in his electroencephalography. Homozygous mutation at exon 6 c. 563A > G was identified. The electroencephalogram of his sibling was unremarkable. Our aim was to present the long-term follow-up of a patient diagnosed with galactosemia, who had phantom absence seizures and typical 3-4 Hz spike-wave discharges in his electroencephalogram to draw attention to this rare association.

  10. Recurrence Risk of Febrile Seizures in Children. (United States)

    Agrawal, J; Poudel, P; Shah, G S; Yadav, S; Chaudhary, S; Kafle, S


    Identifying children with febrile seizure who are at risk for recurrence is important so that special attention can be given to them. The objective of this study was to identify the risk factors for recurrence of febrile seizures in children. This prospective hospital based study was conducted from July 2013 to August 2014 'among children of 6 months to 6 years of age at Bishweshwar Prasad Koirala Institute of Health Sciences (BPKIHS), Nepal. Children meeting the selection criteria were enrolled in study. Clinical, investigation, treatment and outcome parameters were analyzed. A total of 92 children with febrile seizure were enrolled in study. Males accounted for 70% and females 30%. Simple febrile seizure was present in 48% and complex febrile seizures were seen in 52%. Recurrence of seizure was seen in one third of cases. Loss of consciousness was most common post-ictal phenomenon followed by confusion and lethargy. Upper respiratory infection was the most common precipitating factor. Generalized Tonic Clonic Seizure was the most common seizure type present in 79% of cases. Significant risk factors for recurrence occurred in males (p=0.088), age less than 1 year (p=0.003). Most of the recurrence occurred within one year of first seizure. Febrile Seizure is common in males. Almost one third of children with febrile seizure are at risk for recurrence. The significant risk factors for recurrences are male gender and age <1year.

  11. Lead (United States)

    ... found? Who is at risk? What are the health effects of lead? Get educational material about lead Get certified as a Lead Abatement Worker, or other abatement discipline Lead in drinking water Lead air pollution Test your child Check and maintain your home ...

  12. Mean daily plasma concentrations of beta-endorphin, leu-enkephalin, ACTH, cortisol, and DHEAS in epileptic patients with complex partial seizures evolving to generalized tonic-clonic seizures. (United States)

    Marek, Bogdan; Kajdaniuk, Dariusz; Kos-Kudła, Beata; Kapustecki, Janusz; Swietochowska, Elzbieta; Ostrowska, Zofia; Siemińska, Lucyna; Nowak, Mariusz; Głogowska-Szelag, Joanna; Borgiel-Marek, Halina; Ciesielska-Kopacz, Nelly; Foltyn, Wanda; Pierzchała, Krystyna; Krysiak, Robert; Bienek, Radosław


    A multitude of mechanisms have been implicated in the pathophysiology of epilepsy. To assess mean daily plasma concentrations of ACTH, cortisol, DHEAS, leu-enkephalin, and beta-endorphin in epileptic patients with complex partial seizures evolving to tonic-clonic in relation to frequency of seizure occurrence (groups with seizure occurrences - several per week and several per year) and duration of the disease (groups less than and more than 10 years). We decided to analyse mean daily values of beta-endorphin and leu-enkephalin because of significant differences in concentrations of these substances in blood during the day. The study was performed on 17 patients (14 males + 3 females; mean age 31.8 yrs) treated with carbamazepine (300-1800 mg/day). The control group consisted of six age-matched healthy volunteers. Blood was collected at 8 a.m., 2 p.m., 8 p.m., and 2 a.m. Intergroup analysis was performed with the use of ANOVA Kruskal-Wallis test. Mean daily concentrations of ACTH and cortisol in the blood of the patients with epilepsy were higher in comparison with those of the healthy volunteers, independently of the frequency of seizures and duration of the disease. Mean daily concentrations of beta-endorphin in the blood of the patients with epilepsy were higher in the groups of patients with more severe clinical course of disease (with more frequently occurring epilepsy seizures and longer duration of the disease) in comparison with healthy subjects. Mean daily concentrations of leu-enkephalin in the blood of the patients with epilepsy were higher in the group of patients with short duration of the disease in comparison with the group with long duration of the disease. 1. Pituitary-adrenal axis hyperactivity is observed in patients with clinically active epilepsy, independently of the frequency of seizures and duration of the disease. 2. Changes in endogenous opioid system activity are related to the clinical activity of epilepsy - beta-endorphin concentrations

  13. Do seizures and epileptic activity worsen epilepsy and deteriorate cognitive function? (United States)

    Avanzini, Giuliano; Depaulis, Antoine; Tassinari, Alberto; de Curtis, Marco


    Relevant to the definition of epileptic encephalopathy (EE) is the concept that the epileptic activity itself may contribute to bad outcomes, both in terms of epilepsy and cognition, above and beyond what might be expected from the underlying pathology alone, and that these can worsen over time. The review of the clinical and experimental evidence that seizures or interictal electroencephalography (EEG) discharges themselves can induce a progression toward more severe epilepsy and a regression of brain function leads to the following conclusions: The possibility of seizure-dependent worsening is by no means a general one but is limited to some types of epilepsy, namely mesial temporal lobe epilepsy (MTLE) and EEs. Clinical and experimental data concur in indicating that prolonged seizures/status epilepticus (SE) are a risky initial event that can set in motion an epileptogenic process leading to persistent, possibly drug-refractory epilepsies. The mechanisms for SE-related epileptogenic process are incompletely known; they seem to involve inflammation and/or glutamatergic transmission. The evidence of the role of recurrent individual seizures in sustaining epilepsy progression is ambiguous. The correlation between high seizure frequency and bad outcome does not necessarily demonstrate a cause-effect relationship, rather high seizure frequency and bad outcome can both depend on a particularly aggressive epileptogenic process. The results of EE studies challenge the idea of a common seizure-dependent mechanism for epilepsy progression/intellectual deterioration.

  14. Cumulant generating function formula of heat transfer in ballistic systems with lead-lead coupling and general nonlinear systems (United States)

    Li, Huanan


    Based on a two-time observation protocol, we consider heat transfer in a given time interval tM in a lead-junction-lead system taking coupling between the leads into account. In view of the two-time observation, consistency conditions are carefully verified in our specific family of quantum histories. Furthermore, its implication is briefly explored. Then using the nonequilibrium Green's function method, we obtain an exact formula for the cumulant generating function for heat transfer between the two leads, valid in both transient and steady-state regimes. Also, a compact formula for the cumulant generating function in the long-time limit is derived, for which the Gallavotti-Cohen fluctuation symmetry is explicitly verified. In addition, we briefly discuss Di Ventra's repartitioning trick regarding whether the repartitioning procedure of the total Hamiltonian affects the nonequilibrium steady-state current fluctuation. All kinds of properties of nonequilibrium current fluctuations, such as the fluctuation theorem in different time regimes, could be readily given according to these exact formulas. Finally a practical formalism dealing with cumulants of heat transfer across general nonlinear quantum systems is established based on field theoretical/algebraic method.

  15. Seizures and Teens: Stress, Sleep, & Seizures (United States)

    Shafer, Patricia Osborne


    Most parents are used to erratic sleep patterns and mood swings in their teenagers. When these occur in an adolescent with seizures, however, the parent may wonder if sleep and mood problems are related to seizures. Sorting out the cause and effects of sleep in an adolescent with seizures can be confusing. Since stress can be a contributor to both…

  16. Ketamine Induced Seizures in an Autistic Child

    Directory of Open Access Journals (Sweden)

    Geetanjali S Verma


    Full Text Available An autistic child of eight years age, with attention deficit hyperactivity syndrome presented for tooth extraction under general anaesthesia. Ketamine was used for induction and the child developed seizures following its administration. Seizures were controlled, extraction done and post-operative period was uneventful. Ketamine was suspected to have caused seizures though safe use of Ketamine has been reported in autistic patient.

  17. Genetic effects on sleep/wake variation of seizures (United States)

    Winawer, Melodie R.; Shih, Jerry; Beck, Erin S.; Hunter, Jessica E.; Epstein, Michael P.


    Summary Objective There is a complex bidirectional relationship between sleep and epilepsy. Sleep/wake timing of seizures has been investigated for several individual seizure types and syndromes, but few large-scale studies of the timing of seizures exist in people with varied epilepsy types. In addition, the genetic contributions to seizure timing have not been well studied. Methods Sleep/wake timing of seizures was determined for 1,395 subjects in 546 families enrolled in the Epilepsy Phenome/Genome Project (EPGP). We examined seizure timing among subjects with different epilepsy types, seizure types, epilepsy syndromes, and localization. We also examined the familial aggregation of sleep/wake occurrence of seizures. Results Seizures in nonacquired focal epilepsy (NAFE) were more likely to occur during sleep than seizures in generalized epilepsy (GE), for both convulsive (odds ratio [OR] 5.2, 95% confidence interval [CI] 3.59–7.52) and nonconvulsive seizures (OR 4.2, 95% CI 2.48–7.21). Seizures occurring within 1 h of awakening were more likely to occur in patients with GE than with NAFE for both convulsive (OR 2.3, 95% CI 1.54– 3.39) and nonconvulsive (OR 1.7, 95% CI 1.04–2.66) seizures. Frontal onset seizures were more likely than temporal onset seizures to occur during sleep. Sleep/wake timing of seizures in first-degree relatives predicted timing of seizures in the proband. Significance We found that sleep/wake timing of seizures is associated with both epilepsy syndrome and seizure type. In addition, we provide the first evidence for a genetic contribution to sleep/wake timing of seizures in a large group of individuals with common epilepsy syndromes. PMID:26948972

  18. Can Seizure-Alert Dogs predict seizures? (United States)

    Brown, Stephen W; Goldstein, Laura H


    An index observation where a dog was trained to alert to, as well as respond to, human tonic-clonic seizures led to further research and refinement of training techniques. This was followed by anecdotal reports of pet dogs spontaneously anticipating human epileptic seizures. An industry has since developed training Seizure-Alert Dogs (SADs) to give humans warnings of their seizures. In some cases this has been accompanied by a reduction in seizure frequency. SADs may be trained along with the person with epilepsy, responding specifically to that person's seizures, or may be trained separately. Recent sceptical reports of non-epileptic seizures in some people with SADs have cast doubt on dogs' ability to anticipate true epileptic seizures. This may reflect selection criteria for training programmes as well as training methods used, but does not necessarily indicate that SADs might not be able to predict epileptic seizures. Whether the seizures are epileptic or non-epileptic, it is speculated that SADs probably alert to subtle pre-ictal human behaviour changes, but may also be sensitive to heart rate or olfactory cues. As yet, however, no rigorous data exist as to whether seizure prediction by SADS is better than chance, and what false positive and negative prediction rates might be.

  19. Seizure Associated Takotsubo Syndrome: A Rare Combination (United States)

    Kyi, Htay Htay; Aljariri Alhesan, Nour; Upadhaya, Sunil


    Takotsubo cardiomyopathy (TC) is increasingly recognized in neurocritical care population especially in postmenopausal females. We are presenting a 61-year-old African American female with past medical history of epilepsy, bipolar disorder, and hypertension who presented with multiple episodes of seizures due to noncompliance with antiepileptic medications. She was on telemetry which showed ST alarm. Electrocardiogram (ECG) was ordered and showed ST elevation in anterolateral leads and troponins were positive. Subsequently Takotsubo cardiomyopathy was diagnosed by left ventriculography findings and absence of angiographic evidence of obstructive coronary artery disease. Echocardiogram showed apical hypokinesia, ejection fraction of 40%, and systolic anterior motion of mitral valve with hyperdynamic left ventricle, in the absence of intracoronary thrombus formation in the angiogram. Electroencephalography showed evidence of generalized tonic-clonic seizure. She was treated with supportive therapy. This case illustrates importance of ECG in all patients with seizure irrespective of cardiac symptoms as TC could be the cause of Sudden Unexpected Death in Epilepsy (SUDEP) and may be underdiagnosed and so undertreated. PMID:28811941

  20. Explosive Blast Neuropathology and Seizures

    Directory of Open Access Journals (Sweden)

    S. Krisztian eKovacs


    Full Text Available Traumatic brain injury (TBI due to explosive blast exposure is a leading combat casualty. It is also implicated as a key contributor to war related mental health diseases. A clinically important consequence of all types of TBI is a high risk for development of seizures and epilepsy. Seizures have been reported in patients who have suffered blast injuries in the Global War on Terror but the exact prevalence is unknown. The occurrence of seizures supports the contention that explosive blast leads to both cellular and structural brain pathology. Unfortunately, the exact mechanism by which explosions cause brain injury is unclear, which complicates development of meaningful therapies and mitigation strategies. To help improve understanding, detailed neuropathological analysis is needed. For this, histopathological techniques are extremely valuable and indispensable. In the following we will review the pathological results, including those from immunohistochemical and special staining approaches, from recent preclinical explosive blast studies.

  1. 22q11.2 deletion syndrome lowers seizure threshold in adult patients without epilepsy. (United States)

    Wither, Robert G; Borlot, Felippe; MacDonald, Alex; Butcher, Nancy J; Chow, Eva W C; Bassett, Anne S; Andrade, Danielle M


    Previous studies examining seizures in patients with 22q11.2 deletion syndrome (22q11.2DS) have focused primarily on children and adolescents. In this study we investigated the prevalence and characteristics of seizures and epilepsy in an adult 22q11.2DS population. The medical records of 202 adult patients with 22q11.2DS were retrospectively reviewed for documentation of seizures, electroencephalography (EEG) reports, and magnetic resonance imaging (MRI) findings. Epilepsy status was assigned in accordance with 2010 International League Against Epilepsy Classification. Of 202 patients, 32 (15.8%) had a documented history of seizure. Of these 32, 23 (71.8%) had acute symptomatic seizures, usually associated with hypocalcemia and/or antipsychotic or antidepressant use. Nine patients (9/32, 28%; 9/202, 4%) met diagnostic criteria for epilepsy. Two patients had genetic generalized epilepsy; two patients had focal seizures of unknown etiology; two had epilepsy due to malformations of cortical development; in two the epilepsy was due to acquired structural changes; and in one patient the epilepsy could not be further classified. Similarly to children, the prevalence of epilepsy and acute symptomatic seizures in adults with 22q11.2DS is higher than in the general population. Hypocalcemia continues to be a risk factor for adults, but differently from kids, the main cause of seizures in adults with 22q11.2DS is exposure to antipsychotics and antidepressants. Further prospective studies are warranted to investigate how 22q11.2 microdeletion leads to an overall decreased seizure threshold. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  2. New onset seizures in HIV--seizure semiology, CD4 counts, and viral loads. (United States)

    Modi, Mala; Mochan, Andre; Modi, Girish


    Thirty-seven HIV-positive patients with new-onset seizures (NOS) were prospectively identified during a 1-year study period. The patients were categorized according to the different mechanisms causing NOS in HIV, namely focal brain lesion (FBL) in 21 patients (57%), meningitis in 6 patients (16%), metabolic derangement (no patient), and no identified cause (NIC) other than HIV itself (10 patients, 27%). Seizure semiology, CD4 counts, and blood and cerebral spinal fluid (CSF) viral loads were studied to identify any special characteristics of the different categories. With respect to seizure semiology, all NIC patients had generalized seizures. Two-thirds of the meningitis patients had generalized seizures with one-third having focal seizures. Half of the patients with FBL had generalized seizures and one-third had focal seizures. Status epilepticus was strongly associated with FBL. No significant difference could be detected between the subgroups with respect to CD4 counts and serum and CSF viral loads. The median CD4 count in all patients was 108 cells/ml, indicating advanced immunosuppression. In the FBL group this was 104 cells/ml. In the meningitis group the median CD4 count was 298 cells/ml, and in the NIC group this was 213 cells/ml. Similarly, no differences were noted in the NOS categories with respect to serum and CSF viral loads. Seizures in HIV are a nonspecific manifestation of the seizure mechanism.

  3. Lead optimization attrition analysis (LOAA): a novel and general methodology for medicinal chemistry. (United States)

    Munson, Mark; Lieberman, Harvey; Tserlin, Elina; Rocnik, Jennifer; Ge, Jie; Fitzgerald, Maria; Patel, Vinod; Garcia-Echeverria, Carlos


    Herein, we report a novel and general method, lead optimization attrition analysis (LOAA), to benchmark two distinct small-molecule lead series using a relatively unbiased, simple technique and commercially available software. We illustrate this approach with data collected during lead optimization of two independent oncology programs as a case study. Easily generated graphics and attrition curves enabled us to calibrate progress and support go/no go decisions on each program. We believe that this data-driven technique could be used broadly by medicinal chemists and management to guide strategic decisions during drug discovery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Disparity in regional cerebral blood flow during electrically induced seizure

    DEFF Research Database (Denmark)

    Sestoft, D; Meden, P; Hemmingsen, R


    This is a presentation of 2 cases in which the intraictal regional cerebral blood flow distribution was measured with the 99mTc-HMPAO single photon emission computerized tomography technique during an electrically induced seizure. Although the seizure was verified as generalized on electroencepha......This is a presentation of 2 cases in which the intraictal regional cerebral blood flow distribution was measured with the 99mTc-HMPAO single photon emission computerized tomography technique during an electrically induced seizure. Although the seizure was verified as generalized...... electroencephalography-verified generalized seizures....

  5. The adult seizure and social outcomes of children with partial complex seizures. (United States)

    Camfield, Carol S; Camfield, Peter R


    Most intellectually normal children with focal epilepsy have partial complex or focal with secondary generalization seizures without a precise epilepsy syndrome. Their long-term outcome is largely unknown. Cases were identified from the population-based Nova Scotia Childhood Epilepsy cohort. Those eligible had seizure onset at 1 month to 16 years between 1977 and 1985, normal intelligence, ≥10 years of follow-up, only focal seizures and no benign epilepsy syndromes. There were 108 patients with partial complex with or without secondary generalization as the only seizure type(s) throughout (partial complex group) and 80 with secondary generalization as the only seizure type (secondary generalization group). Average age ± standard deviation at onset was 7.3 ± 4.5 years and follow-up was 27.9 ± 5.4 years. At follow-up, 57% of the partial complex group were in remission versus 81% of the secondary generalization group (P = 0.001). The partial complex group was more likely to be intractable or have undergone epilepsy surgery (36% versus 5%, P = 0.000). In the partial complex group, 28% had seizure free versus 5% in the secondary generalized group (P = 0.000). More patients in the partial complex group had undergone mental health assessments (59% versus 32%, P = 0.000), and 33% had a psychiatric diagnosis versus 15% in the secondary generalized group (P = 0.004). More patients with partial complex seizures had specific learning disorders (63% versus 45%, P = 0.03). Seven markers of poor social outcome were more common in patients with partial complex seizures (>2 markers: 34% versus 10%, P = 0.000). During 25-30 years of follow-up, >50% of intellectually normal patients with childhood-onset partial complex seizures had difficult-to-control seizures and learning and psychiatric/social problems. Most with secondary generalized seizures only had remission and better academic and psychiatric/social outcomes.

  6. Lead (United States)

    ... Chapter 6 Chapter 7 Chapter 8 Chapter 9 Appendix I Appendix II Tables Figures State Programs Alabama Alaska Arizona ... Tool Kit Resources Healthy Homes and Lead Poisoning Prevention Training Center (HHLPPTC) Training Tracks File Formats Help: ...

  7. 28 CFR 0.86 - Seizure of gambling devices. (United States)


    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Seizure of gambling devices. 0.86 Section... Bureau of Investigation § 0.86 Seizure of gambling devices. The Director, Associate Director, Assistants... General to make seizures of gambling devices (18 U.S.C. 1955(d), 15 U.S.C. 1171 et seq.) and wire or oral...

  8. Seizure characteristics in Pallister-Killian syndrome. (United States)

    Candee, Meghan S; Carey, John C; Krantz, Ian D; Filloux, Francis M


    Pallister-Killian syndrome (PKS) is a congenital disorder attributed to supernumerary isochromosome 12p mosaicism. Craniofacial dysmorphism, learning impairment and seizures are considered cardinal features. However, little is known regarding the seizure and epilepsy patterns in PKS. To better define the prevalence and spectrum of seizures in PKS, we studied 51 patients (39 male, 12 female; median age 4 years and 9 months; age range 7 months to 31 years) with confirmed 12p tetrasomy. Using a parent-based structured questionnaire, we collected data regarding seizure onset, frequency, timing, semiology, and medication therapy. Patients were recruited through our practice, at PKS Kids family events, and via the PKS Kids website. Epilepsy occurred in 27 (53%) with 23 (85%) of those with seizures having seizure onset prior to 3.5 years of age. Mean age at seizure onset was 2 years and 4 months. The most common seizure types were myoclonic (15/27, 56%), generalized convulsions (13/27, 48%), and clustered tonic spasms (similar to infantile spasms; 8/27, 30%). Thirteen of 27 patients with seizures (48%) had more than one seizure type with 26 out of 27 (96%) ever having taken antiepileptic medications. Nineteen of 27 (70%) continued to have seizures and 17/27 (63%) remained on antiepileptic medication. The most commonly used medications were: levetiracetam (10/27, 37%), valproic acid (10/27, 37%), and topiramate (9/27, 33%) with levetiracetam felt to be "most helpful" by parents (6/27, 22%). Further exploration of seizure timing, in-depth analysis of EEG recordings, and collection of MRI data to rule out confounding factors is warranted.

  9. Evaluation of first nonfebrile seizures. (United States)

    Wilden, Jessica A; Cohen-Gadol, Aaron A


    Nonfebrile seizures may indicate underlying disease or epilepsy. The patient history can often distinguish epileptic seizures from nonepileptic disorders by identifying the events directly preceding the convulsion, associated conditions, and details of the seizure, including triggers, length, and type of movements. Laboratory testing, lumbar puncture, and neuroimaging may be indicated depending on the presentation, suspected etiology, and patient's age. Electroencephalography should be performed 24 to 48 hours after a first seizure because of its substantial yield and ability to predict recurrence. Neuroimaging is recommended for adults, infants, and children who have cognitive or motor developmental delay or a focal seizure. Neuroimaging may be scheduled on an outpatient basis for patients with stable vital signs who are awake and have returned to neurologic baseline. Emergent neuroimaging should be performed in patients with persistent decreased mental status or a new focal neurologic abnormality. Although magnetic resonance imaging is generally preferred to head computed tomography because of its greater sensitivity for intracranial pathology, computed tomography should be performed if intracranial bleeding is suspected because of recent head trauma, coagulopathy, or severe headache. Treatment with an antiepileptic drug after a first seizure does not prevent epilepsy in the long term, but it decreases the short-term likelihood of a second seizure. Adults with an unremarkable neurologic examination, no comorbidities, and no known structural brain disease who have returned to neurologic baseline do not need to be started on antiepileptic therapy. Treatment decisions should weigh the benefit of decreased short-term risk of recurrence against the potential adverse effects of antiepileptic drugs.

  10. The adjoint method for general EEG and MEG sensor-based lead field equations

    Energy Technology Data Exchange (ETDEWEB)

    Vallaghe, Sylvain; Papadopoulo, Theodore; Clerc, Maureen [INRIA, Projet Odyssee, Sophia Antipolis (France)], E-mail:


    Most of the methods for the inverse source problem in electroencephalography (EEG) and magnetoencephalography (MEG) use a lead field as an input. The lead field is the function which relates any source in the brain to its measurements at the sensors. For complex geometries, there is no analytical formula of the lead field. The common approach is to numerically compute the value of the lead field for a finite number of point sources (dipoles). There are several drawbacks: the model of the source space is fixed (a set of dipoles), and the computation can be expensive for as much as 10 000 dipoles. The common idea to bypass these problems is to compute the lead field from a sensor point of view. In this paper, we use the adjoint method to derive general EEG and MEG sensor-based lead field equations. Within a simple framework, we provide a complete review of the explicit lead field equations, and we are able to extend these equations to non-pointlike sensors.

  11. Seizures in the critically ill. (United States)

    Ch'ang, J; Claassen, J


    Critically ill patients with seizures are either admitted to the intensive care unit because of uncontrolled seizures requiring aggressive treatment or are admitted for other reasons and develop seizures secondarily. These patients may have multiorgan failure and severe metabolic and electrolyte disarrangements, and may require complex medication regimens and interventions. Seizures can be seen as a result of an acute systemic illness, a primary neurologic pathology, or a medication side-effect and can present in a wide array of symptoms from convulsive activity, subtle twitching, to lethargy. In this population, untreated isolated seizures can quickly escalate to generalized convulsive status epilepticus or, more frequently, nonconvulsive status epileptics, which is associated with a high morbidity and mortality. Status epilepticus (SE) arises from a failure of inhibitory mechanisms and an enhancement of excitatory pathways causing permanent neuronal injury and other systemic sequelae. Carrying a high 30-day mortality rate, SE can be very difficult to treat in this complex setting, and a portion of these patients will become refractory, requiring narcotics and anesthetic medications. The most significant factor in successfully treating status epilepticus is initiating antiepileptic drugs as soon as possible, thus attentiveness and recognition of this disease are critical.

  12. Temporal Lobe Seizure (United States)

    ... t respond to medication. More study is needed. Pregnancy and seizures The most important thing to remember ... have a seizure while doing them. Activities include: Swimming. If you go in water, don't go ...

  13. Leading twist nuclear shadowing, nuclear generalized parton distributions and nuclear DVCS at small x

    Energy Technology Data Exchange (ETDEWEB)

    Guzey, Vadim; Goeke, Klaus; Siddikov, Marat


    We generalize the leading twist theory of nuclear shadowing and calculate quark and gluon generalized parton distributions (GPDs) of spinless nuclei. We predict very large nuclear shadowing for nuclear GPDs. In the limit of the purely transverse momentum transfer, our nuclear GPDs become impact parameter dependent nuclear parton distributions (PDFs). Nuclear shadowing induces non-trivial correlations between the impact parameter $b$ and the light-cone fraction $x$. We make predictions for the deeply virtual Compton scattering (DVCS) amplitude and the DVCS cross section on $^{208}$Pb at high energies. We calculate the cross section of the Bethe-Heitler (BH) process and address the issue of the extraction of the DVCS signal from the $e A \\to e \\gamma A$ cross section. We find that the $e A \\to e \\gamma A$ differential cross section is dominated by DVCS at the momentum transfer $t$ near the minima of the nuclear form factor. We also find that nuclear shadowing leads

  14. Are seizures in the setting of sleep deprivation provoked? (United States)

    Lawn, Nicholas; Lieblich, Sam; Lee, Judy; Dunne, John


    It is generally accepted that sleep deprivation contributes to seizures. However, it is unclear whether a seizure occurring in the setting of sleep deprivation should be considered as provoked or not and whether this is influenced by seizure type and etiology. This information may have an important impact on epilepsy diagnosis and management. We prospectively analyzed the influence of sleep deprivation on the risk of seizure recurrence in patients with first-ever unprovoked seizures and compared the findings with patients with first-ever provoked seizures. Of 1026 patients with first-ever unprovoked seizures, 204 (20%) were associated with sleep deprivation. While the overall likelihood of seizure recurrence was slightly lower in sleep-deprived patients with first-ever seizures (log-rank p=0.03), sleep deprivation was not an independent predictor of seizure recurrence on multivariate analysis. Seizure recurrence following a first-ever unprovoked seizure associated with sleep deprivation was far more likely than for 174 patients with a provoked first-ever seizure (log-rank psleep deprivation should not be regarded as provoked. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Moxifloxacin Induced Seizures -A Case Report.

    Directory of Open Access Journals (Sweden)

    Jiana Shi


    Full Text Available A 73-year-old female patient developed a generalized tonic-clonic seizure on the 6th day after treatment with moxifloxacin 400 mg daily intravenously for appendicitis. This patient had atrial fibrillation and history of a surgery for intracerebral hemorrhage, with impaired renal function and liver function, but without history of seizures. Moxifloxacin was discontinued and switched to cefuroxime. The patient remained seizure-free at discharge four days later. The naranjo adverse drug reaction probability scale score was 4, indicating a possible adverse reaction to moxifloxacin. The potential risk factors related to moxifloxacin-induced seizures are discussed. It highlights that preexisting central nervous system disease, elderly female with lower bodyweight and severe renal impairment may be the risk factors involved in moxifloxacin-induced seizures.

  16. Detection and Prediction of Epileptic Seizures

    DEFF Research Database (Denmark)

    Duun-Henriksen, Jonas

    monitoring of their brain waves. More specifically, three issues were investigated: The feasibility of automatic seizure prediction, optimization of automatic seizure detection algorithms, and the link between intra- and extracranial EEG. Regarding feasibility of automatic seizure prediction, neither...... seizure prediction algorithms. More promising results were obtained in the investigating of possible use of an outpatient EEG monitoring device for idiopathic generalized epilepsy patients. Combined with an automatic seizure detection algorithm such a device can give an objective account of the paroxysm...... frequency, duration, and time of occurrence. Based on standard EEG data from 20 patients recorded in the clinic, the log-sum of wavelet transform coefficients were used as feature input to a classifier consisting of a support vector machine. 97% of paroxysms lasting more than two seconds were correctly...

  17. Abstract ‘why’ thoughts about success lead to greater positive generalization in sport participants

    Directory of Open Access Journals (Sweden)

    Jens eVan Lier


    Full Text Available Generalizing from a single failure or success to future performances and their self-concept could have an important impact on sport participants. This study examined the impact of the way sport participants think about success on positive generalization. Sport participants (N=222 completed an online experimental study in which they were induced to think about meanings, causes and implications (i.e., abstract-‘why’-thinking or about more perceptual concrete aspects of their performance (i.e., concrete-‘how’-thinking. We hypothesized that abstract-‘why’-thinking would lead to greater positive generalization and that this effect would be moderated by self-esteem. Our results supported our hypothesis that abstract thinking increased positive generalization, and this effect was more clearly visible in sport participants with higher self-esteem. These results suggest that retrospective thinking about the ‘why’ of a good performance may benefit athletes in the long run because they generalize the outcome to future performances and their self-concept which may boost their motivation and consequently their performance.

  18. Early and late postoperative seizure outcome in 97 patients with supratentorial meningioma and preoperative seizures: a retrospective study. (United States)

    Zheng, Zhe; Chen, Peng; Fu, Weiming; Zhu, Junming; Zhang, Hong; Shi, Jian; Zhang, Jianmin


    We identified factors associated with early and late postoperative seizure control in patients with supratentorial meningioma plus preoperative seizures. In this retrospective study, univariate analysis and multivariate logistic regression analysis compared 24 clinical variables according to the occurrence of early (≤1 week) or late (>1 week) postoperative seizures. Sixty-two of 97 patients (63.9 %) were seizure free for the entire postoperative follow-up period (29.5 ± 11.8 months), while 13 patients (13.4 %) still had frequent seizures at the end of follow-up. Fourteen of 97 patients (14.4 %) experienced early postoperative seizures, and emergence of new postoperative neurological deficits was the only significant risk factor (odds ratio = 7.377). Thirty-three patients (34.0 %) experienced late postoperative seizures at some time during follow-up, including 12 of 14 patients with early postoperative seizures. Associated risk factors for late postoperative seizures included tumor progression (odds ratio = 7.012) and new permanent postoperative neurological deficits (odds ratio = 4.327). Occurrence of postoperative seizures in patients with supratentorial meningioma and preoperative seizure was associated with new postoperative neurological deficits. Reduced cerebral or vascular injury during surgery may lead to fewer postoperative neurological deficits and better seizure outcome.

  19. Neurogenesis in a young dog with epileptic seizures. (United States)

    Borschensky, C M; Woolley, J S; Kipar, A; Herden, C


    Epileptic seizures can lead to various reactions in the brain, ranging from neuronal necrosis and glial cell activation to focal structural disorganization. Furthermore, increased hippocampal neurogenesis has been documented in rodent models of acute convulsions. This is a report of hippocampal neurogenesis in a dog with spontaneous epileptic seizures. A 16-week-old epileptic German Shepherd Dog had marked neuronal cell proliferation (up to 5 mitotic figures per high-power field and increased immunohistochemical expression of proliferative cell nuclear antigen) in the dentate gyrus accompanied by microglial and astroglial activation. Some granule cells expressed doublecortin, a marker of immature neurons; mitotically active cells expressed neuronal nuclear antigen. No mitotic figures were found in the brain of age-matched control dogs. Whether increased neurogenesis represents a general reaction pattern of young epileptic dogs should be investigated.

  20. Suspected exercise-induced seizures in a young dog. (United States)

    Motta, L; Dutton, E


    A 12-month-old female neutered crossbreed was referred for investigation of seizure-like episodes occurring only at intense exercise. Thorough medical, neurological and cardiac investigations were performed and excluded the most commonly known causes of seizure-like activity. The dog was fitted with an ambulatory electrocardiography device and underwent another exercise-induced seizure. The electrocardiogram during the episode revealed a sinus tachycardia at approximately 300 beats/minute. A video recording of the episode revealed generalised tonic clonic limb activity with jaw chomping and frothing at the mouth typical of seizure activity. Antiepileptic medications were not prescribed and the owner was advised not to exercise the dog intensely. The dog responded well and did not seizure after 12 months of mild-moderate off-lead exercise. As all the seizures in this case were triggered by intense physical activity, it is suggested that this may be a new form of reflex seizure activity.

  1. Crisis epilépticas generalizadas asociadas a intoxicación pasiva por cocaína en un lactante Generalized epileptic seizures in an infant due to passive exposure to cocaine

    Directory of Open Access Journals (Sweden)

    S. Aguilera


    Full Text Available Fundamento. Las crisis convulsivas sin fiebre en lactantes implican un diagnóstico diferencial amplio. Caso clínico. Lactante mujer de 7 meses que presenta, estando afebril, dos crisis generalizadas tónico-clónicas breves en 23 horas. Su desarrollo psicomotor y estaturo-ponderal seguía un curso normal. Se obtuvo analítica de sangre, ecografía cerebral y electroencefalograma, normales. Debido a una situación sociofamiliar desfavorable, se realizaron tóxicos en orina, positivos para cocaína en dos muestras sucesivas; se negativizaron en 48 horas. Estuvo en contacto con humo ambiental horas previas al inicio de las crisis. Sin crisis en los siguientes 6 meses, con desarrollo normal, sigue bajo vigilancia por asistencia social. Discusión. La inhalación pasiva de humo de cocaína se asocia a crisis convulsivas en lactantes. Este riesgo es casi desconocido en nuestro país, a pesar del aumento del consumo de crack. Ante una primera crisis epiléptica afebril en cualquier edad, se debe incluir de forma rutinaria la detección de tóxicos en orina.Background. The differential diagnosis of afebrile seizures in the first year of life is extensive. Case report. A 7-month old infant presented two afebrile generalized tonic-clonic seizures in 23 hours; her psychomotor and growth development followed a normal course. Laboratory analysis, cerebral echography and electroencephalogram were normal. Urine toxicology was positive for cocaine on two occasions. A negative urine sample was obtained 48 hours later. The parents denied drug abuse but explained a recent exposure to smoke some hours before the episode. The patient had no seizures in the following six months, with normal psychomotor development. Discussion. Passive inhalation of cocaine is associated with seizures in infants. There is no perception of the risk of passive exposure to cocaine in our country, despite the increasing consumption of crack in young adults. Urine toxicology should be

  2. Value and limitations of seizure semiology in localizing seizure onset. (United States)

    So, Elson L


    Seizure semiology has been the foundation of clinical diagnosis of seizure disorders. This article discusses the value and the limitations of behavioral features of seizure episodes in localizing seizure onset. Studies have shown that some semiologic features of seizures are highly accurate in the hemispheric lateralization and lobar localization of seizures. There is good agreement between blinded reviewers in lateralizing video-recorded seizures in temporal lobe and extratemporal lobe epilepsies. However, seizure semiology alone should not be used to determine the site of seizure onset. Each semiologic feature may falsely localize seizure onset. Seizure semiology in some patients may signify the site of seizure propagation rather than origination. Moreover, seizure semiology may not be as reliable in multifocal epilepsies as it is in unifocal epilepsies. Many semiologic features of seizures of adults are often missing in seizures of children. Seizure semiology should be analyzed and integrated with EEG and neuroimaging data to localize the seizure focus. A sample of the recorded seizures should be shown to the patient's relatives or friends to verify that it is representative of habitual seizures.

  3. Exposure of Prague's homeless population to lead and cadmium, compared to Prague's general population. (United States)

    Hrncírová, Dana; Batáriová, Andrea; Cerná, Milena; Procházka, Bohumír; Dlouhý, Pavel; Andel, Michal


    Homelessness is a growing problem in the Czech Republic where homeless people represent a specific minority group beset by many problems linked to their divergent lifestyle. It was therefore expected that the homeless population would be at greater risk of exposure to environmental pollutants than the general population. The aim of our study was to compare blood lead (B-Pb) and blood cadmium (B-Cd) levels in the homeless population (HP) with those obtained from the Human Biomonitoring Project (CZ-HBM), which used blood donors considered representative of the general population (GP). We present data obtained between 2004 and 2006 for B-Pb and B-Cd in 257 Prague homeless adults and compare them to B-Pb and B-Cd levels in 104 Prague adult blood donors from the CZ-HBM project in 2005. The mean (geometric) B-Pb levels in men were 36.5 (HP) and 35.4microg/l (GP), which is not significantly different. However, statistically significant differences were observed between men and women in the GP (Phomeless nonsmokers (geometric means 1.06 and 1.18microg/l in men and women, respectively) were more than 2.5 times higher than in the nonsmoking GP (0.36 and 0.38microg/l for men and women, respectively). B-Cd levels were significantly (Phomeless population under study might be exposed to lead and cadmium more extensively than the general population of Prague and that homeless women represent a particularly vulnerable population group.

  4. Seizure characteristics in multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    Vahid Shaygannejad


    Full Text Available Background: To evaluate seizure characteristic among multiple sclerosis patients with coexistent seizure activity compared to control group. Materials and Methods : This study is a cross-sectional study which was conducted by reviewing the clinical records of patients with definite diagnosis of MS according to McDonald′s criteria from March 2007 to June 2011, who referred to the MS clinic of the university. Results : A total of 920 patients with a diagnosis of MS were identified, among whom 29 patients (3.15% with seizure activity (case due to MS with the mean age of 32.6 ± 6.23 years were analyzed. Also, fifty MS patients without any seizure occurrence with the mean age of 33.7 ± 7.4 years were used as our control group. In case group, seizure was general tonic clonic in 23 patients (79.3%, complex partial in four (13.8%, and simple partial in two (5.9%. The 26 available interictal EEGs in MS patients showed abnormal EEG pattern in 22 (84.6% of them, including focal epileptic form discharge or focal slowing in 10 (38.5%, generalized discharge (spike-wave, polyspike, or general paroxysmal fast activity in 10 (38.5%, and general slowing activity in 10 record (38.5%. MRI reviews of the 26 available brain MRIs showed subcortical white mater lesions in 22 (84.6% of patients with seizure. All MRIs were performed within one month after the first seizure episode. Amongst 48 available MRIs in our control group, 91.7% (44 cases showed periventricular lesions and in 8.3% (4 cases subcortical white matter lesions were reported. Conclusion : The result of this study demonstrated the higher rate of subcortical whit matter lesion in MS patients with seizure occurrence compared to control group.

  5. Mutation of neuronal channels of sodium and chloride associated with generalized epilepsy with febrile seizures plus (gefs+ Mutaciones de los canales neuronales de sodio y cloro asociadas a epilepsia generalizada con convulsiones febriles plus

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    Gabriel Bedoya Berrío


    Full Text Available Generalized Epilepsy with Febrile Seizures Plus (GEFS+ is a frequent entity characterized by generalized seizures with a wide phenotypic variety; the age of onset is 3 months and it persists beyond 6 years. Seizures may or may not be induced by fever. The disease has shown an autosomic dominant trait, incomplete penetrance and association with mutations on the genes that encode voltage-dependent sodium channels and the chloride neuronal channels on the central nervous system. The wide spectrum GEFS+ phenotype has been related with others entities such as Severe Myoclonic Epilepsy of Infancy (SMEI and Intractable Childhood Epilepsy with Frequent Generalized Tonic-Clonic Seizures (ICEGTC; they have mutations in common with GEFS+ according to several recently published articles. This review compiles up to date information about EGCF+ with the aim of giving the reader a knowledge of this entity and of its association with mutations that participate in its pathogenesis. La Epilepsia Generalizada Con Convulsiones Febriles Plus (EGCF+, es una entidad relativamente común. Se caracteriza por convulsiones de tipo generalizado con una gran variabilidad fenotípica; se presenta desde los 3 meses de edad y persiste más allá de los 6 años; las convulsiones pueden ser precipitadas por fiebre pero se presentan también sin ella. La enfermedad se ha asociado a herencia autosómica dominante con penetrancia incompleta, en la que intervienen mutaciones de los genes que codifican los canales iónicos de sodio dependientes del voltaje y de los canales iónicos de cloro en las neuronas del Sistema Nervioso Central (SNC. El amplio fenotipo de la EGCF+ se ha encontrado en asociación con otras entidades como la Epilepsia Mioclónica Severa del Lactante (EMSL y la Epilepsia Generalizada Tónico-Clónica Intratable de la Infancia (EGTCII, las cuales han presentado mutaciones comunes con las de la EGCF+, según informes recientemente publicados. Esta revisi

  6. Detecting Neonatal Seizures With Computer Algorithms. (United States)

    Temko, Andriy; Lightbody, Gordon


    It is now generally accepted that EEG is the only reliable way to accurately detect newborn seizures and, as such, prolonged EEG monitoring is increasingly being adopted in neonatal intensive care units. Long EEG recordings may last from several hours to a few days. With neurophysiologists not always available to review the EEG during unsociable hours, there is a pressing need to develop a reliable and robust automatic seizure detection method-a computer algorithm that can take the EEG signal, process it, and output information that supports clinical decision making. In this study, we review existing algorithms based on how the relevant seizure information is exploited. We start with commonly used methods to extract signatures from seizure signals that range from those that mimic the clinical neurophysiologist to those that exploit mathematical models of neonatal EEG generation. Commonly used classification methods are reviewed that are based on a set of rules and thresholds that are either heuristically tuned or automatically derived from the data. These are followed by techniques to use information about spatiotemporal seizure context. The usual errors in system design and validation are discussed. Current clinical decision support tools that have met regulatory requirements and are available to detect neonatal seizures are reviewed with progress and the outstanding challenges are outlined. This review discusses the current state of the art regarding automatic detection of neonatal seizures.

  7. Epileptic seizures in Neuro-Behcet disease: why some patients develop seizure and others not? (United States)

    Kutlu, Gulnihal; Semercioglu, Sencer; Ucler, Serap; Erdal, Abidin; Inan, Levent E


    Behcet disease (BD) is a chronic relapsing inflammatory disorder. Neuro BD (NBD) is seen in approximately 5% of all patients. The aim of this study is to investigate the frequency, type and prognosis of epileptic seizures in different forms of NBD. All files of 42 patients with NBD were evaluated between 2006 and 2012, retrospectively. The demographic data, the presentation of NBD, clinical findings including seizures, EEG and neuroimaging findings were reviewed. The mean age of patients was 35.02±8.43 years. Thirty (71.4%) patients were male; the remaining 12 of them were female. Twenty-four patients had brainstem lesions; 16 patients had cerebral venous thrombosis. Spinal cord involvement was seen in two patients. Seven patients had epileptic seizures (six partial onset seizures with or without secondary generalization). Six of them had cerebral sinus thrombosis (CVT). Four patients had a seizure as the first symptom of the thrombosis. One patient had late onset seizure due to chronic venous infarct. The other patient with seizure had brainstem involvement. The remaining was diagnosed as epilepsy before the determination of NBD. CVT seen in BD seems to be the main risk factor for epileptic seizures in patients with NBD. The prognosis is usually good especially in patients with CVT. Epileptic seizures in patients with brainstem involvement may be an indicator for poor prognosis. Superior sagittal thrombosis or cortical infarct would be predictor of seizures occurrence because of the high ratio in patients with seizures. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  8. Ionic changes during experimentally induced seizure activity. (United States)

    Lux, H D; Heinemann, U


    Changes in intra- and extracellular ionic activity and their relation to generation and termination of seizure phenomena can be studied with the help of ion-selective microelectrodes. Transient changes in extracellular potassium activity (aK) of the cortex regularly accompany paroxysmal activity induced by electrical stimulation and pentylenetetrazol injections or occur within active penicillin and aluminum foci. A rise of aK from baseline levels of about 3 mmoles/l up to ceiling levels of 8--12 mmoles/l, followed by subnormal K activity, is typically found during seizure discharge. Extracellular K accumulation during seizures facilitates the spread into extrafocal regions. Ceiling levels of extracellular aK are characterized by pronounced K reabsorption which is probably a limiting mechanism for the rise in extracellular aK. It may be a consequence of a simultaneous rise in intracellular Na activity that an electrogenic Na--K exchange process is involved in the termination of ictal activity. Seizures are also accompanied by significant reductions in extracellular Ca2+ activity (aCa) to as low as 0.7 mmoles/l (resting aCa 1.25 mmoles/l). There is no critical level of lowered aCa at which a seizure ultimately results. However, unlike changes in aK reductions in aCa can precede ictal activity. Thus, a fall of aCa occurs before the onset of paroxysmal periods during cyclical spike driving in a penicillin focus and before seizures induced by pentylenetetrazol. Ca2+-dependent mechanisms may contribute to seizure generation. In addition to changes in aK and aCa, intracellular chloride activity (aCl) can increase during seizure activity, as a result of an impaired chloride extrusion mechanism, which would lead to a reduced efficacy of inhibitory synaptic transmission and, therefore, to facilitation of seizure generation.

  9. Reporting quality of randomized controlled trial abstracts: survey of leading general dental journals. (United States)

    Hua, Fang; Deng, Lijia; Kau, Chung How; Jiang, Han; He, Hong; Walsh, Tanya


    The authors conducted a study to assess the reporting quality of randomized controlled trial (RCT) abstracts published in leading general dental journals, investigate any improvement after the release of the Consolidated Standards of Reporting Trials (CONSORT) for Abstracts guidelines, and identify factors associated with better reporting quality. The authors searched PubMed for RCTs published in 10 leading general dental journals during the periods from 2005 to 2007 (pre-CONSORT period) and 2010 to 2012 (post-CONSORT period). The authors evaluated and scored the reporting quality of included abstracts by using the original 16-item CONSORT for Abstracts checklist. The authors used risk ratios and the t test to compare the adequate reporting rate of each item and the overall quality in the 2 periods. The authors used univariate and multivariate regressions to identify predictors of better reporting quality. The authors included and evaluated 276 RCT abstracts. Investigators reported significantly more checklist items during the post-CONSORT period (mean [standard deviation {SD}], 4.53 [1.69]) than during the pre-CONSORT period (mean [SD], 3.87 [1.10]; mean difference, -0.66 [95% confidence interval, -0.99 to -0.33]; P 80%). In contrast, the authors saw sufficient reporting of randomization, recruitment, outcome in the results section, and funding in none of the pre-CONSORT abstracts and less than 2% of the post-CONSORT abstracts. On the basis of the multivariate analysis, a higher impact factor (P journals has improved significantly, but there is still room for improvement. Joint efforts by authors, reviewers, journal editors, and other stakeholders to improve the reporting of dental RCT abstracts are needed. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  10. Seizure semiology of lesional frontal lobe epilepsies in children. (United States)

    Battaglia, D; Lettori, D; Contaldo, I; Veredice, C; Sacco, A; Vasco, J; Martinelli, D; Chieffo, D; Tartaglione, T; Colosimo, C; Di Rocco, C; Guzzetta, F


    The aim of the study was to analyse the semiology of seizures in children with frontal lobe epilepsy (FLE) and to compare them with other paediatric cohorts described in the literature as well as with adult counterparts. We analysed 174 registered seizures of 18 cases under 12 years with lesional epilepsy whose frontal origin was defined by the concordance of neuroimaging and ictal electrographic findings, and confirmed by surgery in the six cases operated on. Seizures were generally short, with a high daily frequency and usually related to sleep. The most characteristic semiological pattern consisted of complex motor seizures, particularly hypermotor. Often seizures corresponded to a mixture of different semiological patterns (tonic, gelastic, automotor, hypermotor, versive) presenting in the same seizure, often as a unique type in the same patient. With regard to several aspects the semiology of FLE in our cohort looks like that reported in adult series, in particular as to the frequency of complex motor seizures. However, our cohort was also characterised by a more protean array of seizure semiology, stressing the occurrence of seizures typically present in adults (versive and complex motor) and of some seizure patterns more characteristic in children such as epileptic spasms; moreover, the rare occurrence of secondarily generalised tonic clonic seizures (SGTCS) was confirmed.

  11. Autosomal dominant cortical myoclonus and epilepsy (ADCME) with complex partial and generalized seizures: A newly recognized epilepsy syndrome with linkage to chromosome 2p11.1-q12.2. (United States)

    Guerrini, R; Bonanni, P; Patrignani, A; Brown, P; Parmeggiani, L; Grosse, P; Brovedani, P; Moro, F; Aridon, P; Carrozzo, R; Casari, G


    We describe a pedigree in which eight individuals presented with a non-progressive disorder with onset between the ages of 12 and 50 years. It was characterized by predominantly distal, semi-continuous rhythmic myoclonus (all patients), generalized tonic-clonic seizures (all patients) and complex partial seizures (three patients). Most individuals had rarely suffered seizures and had a normal cognitive level, but three individuals with intractable seizures had mild mental retardation. The pattern of inheritance was autosomal dominant with high penetrance. We defined this disorder as autosomal dominant cortical myoclonus and epilepsy (ADCME). All patients had frontotemporal as well as generalized interictal EEG abnormalities. A neurophysiological study of the myoclonus suggested a cortical origin. Back-averaging of the data generated a series of waves with a frequency that mirrored the frequency of EMG bursts. Frequency analysis identified significant peaks with coherence between EMG and EEG, which were recorded over the contralateral rolandic area in five patients. The frequency of coherence was 8-25 Hz and phase spectra confirmed that EEG activity preceded EMG activity by 8-15 ms. In two individuals there was also significant coherence between the ipsilateral EEG and EMG, consistent with the transcallosal spread of myoclonic activity. The C-reflex at rest was enhanced and somatosensory and visual evoked potentials were of high amplitude. The resting motor threshold intensity to transcranial magnetic stimulation was significantly reduced (38%; SD +/- 7; P = 0.01) and the post-motor evoked potential silent period (101 ms; SEM +/- 10) was significantly shortened compared with the controls (137 ms; SEM +/- 18). These clinical and neuro- physiological characteristics suggest diffuse cortical hyperexcitability and high propensity for intra-hemispheric and inter-hemispheric cortical spread, as well as rhythmic myoclonic activity. Genome-wide linkage analysis identified a

  12. Fever, febrile seizures and epilepsy



    Seizures induced by fever (febrile seizures) are the most common type of pathological brain activity in infants and children. These febrile seizures and their potential contribution to the mechanisms of limbic (temporal lobe) epilepsy have been a topic of major clinical and scientific interest. Key questions include the mechanisms by which fever generates seizures, the effects of long febrile seizures on neuronal function and the potential contribution of these seizures to epilepsy. This revi...

  13. Efficacy of lacosamide by focal seizure subtype. (United States)

    Sperling, Michael R; Rosenow, Felix; Faught, Edward; Hebert, David; Doty, Pamela; Isojärvi, Jouko


    The purpose of this post hoc exploratory analysis was to determine the effects of the antiepileptic drug, lacosamide, on focal (partial-onset) seizure subtypes. Patient data from the three lacosamide pivotal trials were grouped and pooled by focal seizure subtype at Baseline: simple partial seizures (SPS), complex partial seizures (CPS), and secondarily generalized partial seizures (SGPS). Both efficacy outcomes (median percent change from Baseline to Maintenance Phase in seizure frequency per 28 days and the proportion of patients experiencing at least a 50% reduction in seizures) were evaluated by lacosamide dose (200, 400, or 600 mg/day) compared to placebo for each seizure subtype. An additional analysis was performed to determine whether a shift from more severe focal seizure subtypes to less severe occurred upon treatment with lacosamide. In patients with CPS or SGPS at Baseline, lacosamide 400 mg/day (maximum recommended daily dose) and 600 mg/day reduced the frequency of CPS and SGPS compared to placebo. Likewise, a proportion of patients with CPS and SGPS at Baseline experienced at least a 50% reduction in the frequency of CPS and SGPS (≥50% responder rate) in the lacosamide 400 and 600 mg/day groups compared with placebo. For both outcomes, numerically greatest responses were observed in the lacosamide 600 mg/day group among patients with SGPS at Baseline. In patients with SPS at Baseline, no difference between placebo and lacosamide was observed for either efficacy outcome. An additional exploratory analysis suggests that in patients with SPS at Baseline, CPS and SGPS may have been shifted to less severe SPS upon treatment with lacosamide. The results of these exploratory analyses revealed reductions in CPS and SGPS frequency with adjunctive lacosamide. Reduction in CPS and SGPS may confound assessment of SPS since the CPS or SGPS may possibly change to SPS by effective treatment.

  14. Viruses and febrile seizures

    NARCIS (Netherlands)

    Zeijl, J.H. van


    We conclude that viral infections are the main cause of febrile seizures, with an important role for influenza A, HHV-6 and HHV-7. We showed that several viral infections not only contribute to initial febrile seizures, but also to recurrences. Viruses could not be detected in the CSF of children

  15. Management of provoked seizure

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    Misra Usha


    Full Text Available A provoked seizure may be due to structural damage (resulting from traumatic brain injury, brain tumor, stroke, tuberculosis, or neurocysticercosis or due to metabolic abnormalities (such as alcohol withdrawal and renal or hepatic failure. This article is a part of the Guidelines for Epilepsy in India. This article reviews the problem of provoked seizure and its management and also provides recommendations based on currently available information. Seizure provoked by metabolic disturbances requires correction of the triggering factors. Benzodiazepines are recommended for treatment of seizure due to alcohol withdrawal; gabapentin for seizure seen in porphyria; and antiepileptic drugs (AED, that are not inducer of hepatic enzymes, in the seizures seen in hepatic dysfunction. In severe traumatic brain injury, with or without seizure, phenytoin (PHT may be given for 7 days. In ischemic or hemorrhagic stroke one may individualize the AED therapy. In cerebral venous sinus thrombosis (CVST, AED may be prescribed if there is seizure or computed tomographic (CT abnormalities or focal weakness; the treatment, in these cases, has to be continued for 1 year. Prophylactic AED is not recommended in cases of brain tumor and neurosurgical procedures and if patient is on an AED it can be stopped after 1 week.

  16. The neural correlates of altered consciousness during epileptic seizures. (United States)

    Cavanna, Andrea E; Bagshaw, Andrew P; McCorry, Dougall


    Epileptic seizures are characterized by a multifaceted spectrum of alterations in the general level of awareness and/or the subjective contents of consciousness. Complete loss of consciousness occurs when epileptic activity involves both cortical and subcortical structures, as in generalized seizures. On the other hand, simple partial seizures can spare both the level and contents of consciousness. Finally, complex partial seizures associated with medial temporal lobe discharges can selectively impair the patient's subjective experiences with variable degrees of responsiveness. The differences in ictal semiology between patients with epilepsy offer unique avenues for understanding the relationship between pathological brain function and altered conscious states.

  17. Computed Tomography Findings in Patients with Seizure Disorder

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    Sumnima Acharya


    Full Text Available Introduction: Seizure occurs in up to 10% of the population, whereas epilepsy is a chronic disease characterized by recurrent seizures that may affect up to 2% of the population. Modern neuroimaging is useful in diagnosis of  abnormalities underlying the epilepsies, but the information provided by imaging techniques can also contribute to proper classification of certain epileptic disorders and can delineate the genetics of some underlying syndromes. Neuroimaging is even more important for those patients who have medically intractable seizures. This study was carried out to establish different etiologies of seizures, to correlate the clinical data and radiological findings in cases of seizure, and to identify the common etiologies in different types of seizures.   Methods: This was a retrospective hospital-based study conducted in the Department of Radiodiagnosis of Lumbini Medical College Teaching Hospital. Records of patients of past two years, admitted in any department of the hospital with history of seizure disorder and underwent a Computed Tomography  (CT of brain were included. The CT patterns were assessed and the data were tabulated and statistically analyzed.   Results: There were a total of 480 cases out of which 263 (55% were male and 217 (45% were female with M:F ratio of 1.2:1. Generalized seizure was more frequent than partial seizure in both gender. In 274 cases of generalized seizures, CT scan findings were abnormal in 151 cases and normal finding observed in 123 cases. In 206 cases of partial seizures, 125 cases were abnormal and 81 having normal CT scan findings. Age wise distribution showed highest number (n=218 of cases in young group (60 yr. The most common cause of seizure  was  calcified granuloma (n=79, 16.5% followed by neurocysticercosis (NCC, n=64, 13%. Diffuse cerebral edema, sub-arachnoid hemorrhage, and hydrocephalus was seen only in lower age group particularly among 1-20 years. Infarct and diffuse cortical

  18. Reliability of seizure semiology in patients with 2 seizure foci. (United States)

    Rathke, Kevin M; Schäuble, Barbara; Fessler, A James; So, Elson L


    To determine whether seizure semiology is reliable in localizing and distinguishing seizures at 2 independent brain foci in the same patient. Two masked reviewers localized seizures from 2 foci by their clinical semiology and intracranial electroencephalograms (EEGs). Epilepsy monitoring unit of referral comprehensive epilepsy program. Seventeen consecutive patients (51 seizures) with sufficient video and intracranial EEG data were identified by reviewing medical records of 366 patients older than 10 years. The primary outcome measures were interobserver agreement between the 2 masked reviewers; the proportion of seizures localized by semiology; the proportion of localized seizures concordant with intracranial EEG localization; and comparison between concordant and nonconcordant seizures in latency of intracranial EEG seizure spread. Interobserver agreement was 41% (κ score, 0.16). Only 30 of 51 seizures (59%) were localized by seizure semiology. The focus localized by semiology was concordant with the location of intracranial EEG seizure onset in 16 of 30 seizures (53%). No significant difference was observed between concordant and nonconcordant seizures in relation to the speed with which the EEG discharge spread from the location of seizure onset to another lobar region (P = .09, Wilcoxon rank sum test). Clinical seizure semiology is not as useful as intracranial EEG in localizing seizure onset in patients with dual seizure foci.

  19. Epilepsy after Febrile Seizures

    DEFF Research Database (Denmark)

    Seinfeld, S. A.; Pellock, J M; Kjeldsen, Lone Marianne Juel


    Background A history of complex febrile seizures can increase the risk of epilepsy, but the role of genetic factors is unclear. This analysis evaluated the relationship between febrile seizures and epilepsy. Methods Information on the history of seizures was obtained by a questionnaire from twin...... epilepticus. There were 78 twins who developed epilepsy. The highest rate of epilepsy (22.2%) occurred in the febrile status epilepticus group. Concordance was highest in simple group. Conclusion A twin with febrile status epilepticus is at the highest risk of developing epilepsy, but simple febrile seizures...... and emotional burden. It is currently not possible to accurately identify which children will develop recurrent febrile seizures, epilepsy, or neuropsychological comorbidities. © 2016 Elsevier Inc. All rights reserved....

  20. Seizures in horses: diagnosis and classification

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    Lacombe VA


    Full Text Available Véronique A Lacombe Department of Physiological Sciences, Oklahoma State University Center for Veterinary Health Sciences, Stillwater, OK, USA Abstract: Seizures are a diverse and very common set of chronic neurologic disorders in humans and dogs but are less common in horses. Seizures refer to a specific clinical event (described as sudden and severe regardless of the etiology, which includes both intracranial and extracranial causes. Therefore, after briefly reviewing some definitions, this article aims to describe the use of a standardized classification, which could facilitate a logical approach for the clinician to establish a diagnosis, as well as to use a consistent mode of communication. For instance, seizures can be classified by type (ie, focal vs generalized or etiology (ie, reactive, symptomatic, cryptogenic, idiopathic. In particular, epilepsy, a brain disorder characterized by recurrent seizures can be classified as primary (ie, genetic origin or secondary (ie, acquired. This review further discusses the limitations associated with the clinical workup of horses with seizures. This is germane to the fact that the identification of the underlying cause remains challenging due to the technical limitations of imaging the equine adult brain. Indeed, as in man and dogs, epilepsies of unknown cause (ie, cryptogenic account for the majority of all epilepsies. Therefore, although electroencephalography and advanced brain imaging techniques (eg, computed tomography and magnetic resonance imaging are becoming increasingly available, information obtained from the history, physical, and neurologic examinations and progression of clinical signs and response to treatment remain essential in the workup of horses with seizures. Keywords: focal seizure, generalized seizure, symptomatic, cryptogenic, electroencephalography, computed tomography

  1. Noradrenergic mechanism in the regulation of seizures in GEPR.

    Institute of Scientific and Technical Information of China (English)

    Kwang-HoKo; Dong-OokSeo; Jae-RyunRyu; Chan-YoungShin


    Genetically epilepsy prone rat (GEPR) is a model of generalized tonic/clonic epilepsy and a useful tool in the understanding of basic mechanisms of human epilepsy. GEPR is susceptible to audiogenic seizure, hyperthermia induced seizure,and has lower threshold for electrical and chemical stimuli. Several strains of GEPR, from GEPR-3 to GEPR-9, are available depending on the degree of the intensity of audiogenic seizure.

  2. Order-disorder transition in conflicting dynamics leading to rank-frequency generalized beta distributions (United States)

    Alvarez-Martinez, R.; Martinez-Mekler, G.; Cocho, G.


    The behavior of rank-ordered distributions of phenomena present in a variety of fields such as biology, sociology, linguistics, finance and geophysics has been a matter of intense research. Often power laws have been encountered; however, their validity tends to hold mainly for an intermediate range of rank values. In a recent publication (Martínez-Mekler et al., 2009 [7]), a generalization of the functional form of the beta distribution has been shown to give excellent fits for many systems of very diverse nature, valid for the whole range of rank values, regardless of whether or not a power law behavior has been previously suggested. Here we give some insight on the significance of the two free parameters which appear as exponents in the functional form, by looking into discrete probabilistic branching processes with conflicting dynamics. We analyze a variety of realizations of these so-called expansion-modification models first introduced by Wentian Li (1989) [10]. We focus our attention on an order-disorder transition we encounter as we vary the modification probability p. We characterize this transition by means of the fitting parameters. Our numerical studies show that one of the fitting exponents is related to the presence of long-range correlations exhibited by power spectrum scale invariance, while the other registers the effect of disordering elements leading to a breakdown of these properties. In the absence of long-range correlations, this parameter is sensitive to the occurrence of unlikely events. We also introduce an approximate calculation scheme that relates this dynamics to multinomial multiplicative processes. A better understanding through these models of the meaning of the generalized beta-fitting exponents may contribute to their potential for identifying and characterizing universality classes.

  3. Epileptic seizures in patients with a posterior circulation infarct

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    Yüksel Kaplan


    Full Text Available OBJECTIVE: The aim of this study was to investigate the frequency of seizures and the clinical features of patients with seizures related to a posterior circulation infarct (POCI. METHODS: We reviewed all ischemic stroke patients admitted to our clinic between January 2011 and January 2012. The patients’ database information was retrospectively analyzed. Fifty-five patients with a POCI were included in the study. We reviewed all patients with epileptic seizures related to a POCI. Age, gender, recurrent stroke, risk factors, etiology, radiographic localization, the seizure type and onset time, and the electroencephalographic findings of patients were evaluated. We excluded all patients who had precipitating conditions during seizures such as taking drugs, acid-base disturbances, electrolyte imbalance, and history of epilepsy. RESULTS: Seizures were observed in four patients (3 male, 1 female with a POCI related epileptic seizures (7.2%. The etiology of strokes was cardiac-embolic in 3 patients and vertebral artery dissection in 1 patient. Seizures occurred in 2 patients as presenting finding, in 1 patient within 7 days, and 1 patient within 28 days. Primary generalized tonic-clonic seizures occurred in 3 patients and simple partial seizures with secondary generalization in 1 patient. Three patients had cerebellum infarction at the left hemisphere. One patient had lateral medullary infarction at the right side. The electroencephalographic findings of patients were normal. CONCLUSION: Studies involving patients with seizures related to a POCI are novel and few in number. Three patients with seizure had cerebellum infarction. The cerebellum in these patients may contribute via different mechanisms over seizure activity.

  4. Epileptic fast intracerebral EEG activity: evidence for spatial decorrelation at seizure onset (United States)

    Wendling, Fabrice; Bartolomei, Fabrice; Bellanger, Jean-Jacques; Bourien, Jérôme; Chauvel, Patrick


    Low-voltage rapid discharges (or fast EEG ictal activity) constitute a characteristic electrophysiological pattern in focal seizures of human epilepsy. They are characterized by a decrease of signal voltage with a marked increase of signal frequency (typically beyond 25 Hz). They have long been observed in stereoelectroencephalographic (SEEG) signals recorded with intra-cerebral electrodes, generally occurring at seizure onset and simultaneously involving distinct brain regions. Spectral properties of rapid ictal discharges as well as spatial correlations measured between SEEG signals generated from distant sites before, during and after these discharges were studied. Cross-correlation estimates within typical EEG sub-bands and statistical tests performed in ten patients suffering from partial epilepsy (frontal, temporal or fronto-temporal) reveal that SEEG signals are significantly de-correlated during the discharge period compared to periods that precede and follow this discharge. These results can be interpreted as a functional decoupling of distant brain sites at seizure onset followed by an abnormally high re-coupling when the seizure develops. They lead to the concept of “disruption” that is complementary of that of “activation” (revealed by significantly high correlations between signals recorded during seizures), both giving insights into our understanding of pathophysiological processes involved in human partial epilepsies as well as in the interpretation of clinical semiology. PMID:12764064

  5. Enhanced steroid dosing reduces seizures during antiparasitic treatment for cysticercosis and early after (United States)

    Garcia, Hector H.; Gonzales, Isidro; Lescano, Andres G.; Bustos, Javier A.; Pretell, E. Javier; Saavedra, Herbert; Nash, Theodore E.


    SUMMARY Objective Neurocysticercosis is a major cause of seizures and epilepsy in endemic countries. Antiparasitic treatment of brain cysts leads to seizures due to the host’s inflammatory reaction, requiring concomitant steroids. We hypothesized that increased steroid dosing will reduce treatment-associated seizures. Methods Open-label randomized trial comparing 6 mg/d dexamethasone for 10 days (conventional) with 8 mg/d for 28 days followed by a 2 week taper (enhanced) in neurocysticercosis patients receiving albendazole. Follow up included active seizure surveillance and brain imaging. Study outcomes were seizure days and patients with seizures, both measured in days 11-42. Additional analyses compared days 1-10, 11-21, 22-32, 33-42, 43-60, and 61-180. Results Thirty-two individuals were randomized into each arm, two did not complete follow up. From days 11 to 42, 59 partial and 6 generalized seizure days occurred in 20 individuals, non-significantly fewer in the enhanced arm (12 versus 49, p=0.114). The numbers of patients with seizures in this period showed similar non-significant differences. In the enhanced steroid arm there were significantly fewer days and individuals with seizures during antiparasitic treatment (days 1-10: 4 versus 17, p=0.004, and 1 versus 10, p=0.003, number needed to treat 4.6, relative risk 0.1013, 95%CI: 0.01 – 0.74) and early after dexamethasone cessation (days 11-21: 6 versus 27, p=0.014, and 4 versus 12, p=0.021, NNT 4.0, RR 0.33, 95%CI: 0.12 – 0.92) but not after day 21. There were no significant differences in antiparasitic efficacy or relevant adverse events. Significance Increased dexamethasone dosing results in fewer seizures for the first 21 days during and early after antiparasitic treatment for viable parenchymal neurocysticercosis but not during the first 11-42 days, which was the primary predetermined time of analysis. PMID:25092547

  6. Constipation enhances the propensity to seizure in pentylenetetrazole-induced seizure models of mice. (United States)

    Moezi, Leila; Pirsalami, Fatema; Inaloo, Soroor


    Epilepsy is characterized by spontaneous recurrent seizures and represents one of the most frequent neurological diseases, affecting about 60 million people worldwide. The cellular and neurocircuit bases of epilepsy are poorly understood. Constipation is a common gastrointestinal disorder characterized by symptoms such as straining, hard stool, and infrequent defecation. Population-based studies have shown that the prevalence of constipation is up to 30% of the population in developed countries. The causal link between seizure and constipation is a common belief among patients and physicians, but there are no scientific data to support this association. The current investigation evaluated the effects of constipation induced by loperamide (a peripheral μ-opioid receptor agonist without effect on central nervous system receptors) and clidinium (a quaternary amine antimuscarinic agent with reduced central nervous system effects) on two different seizure models of mice: (1) myoclonic, clonic, and generalized tonic seizures and death induced by intraperitoneal administration of pentylenetetrazole and (2) clonic seizure threshold induced by intravenous infusion of pentylenetetrazole. We demonstrated that the measured intestinal transit (%intestinal transit) decreased after loperamide or clidinium treatment for 3days. Constipation in mice which was induced by loperamide or clonidine caused a decrease in threshold to clonic seizure in the intravenous pentylenetetrazole seizure model. Moreover loperamide- or clidinium-induced constipation decreased latencies to, clonic, and tonic seizures and death in the intraperitoneal pentylenetetrazole model of mice. Serum ammonia levels were slightly elevated in both loperamide- and clidinium-treated mice. In conclusion, loperamide- or clidinium-induced constipated mice are more prone to seizure which might confirm the belief of patients and physicians about constipation as a trigger of seizure.

  7. Canine and feline epileptic seizures and the lunar cycle: 2,507 seizures (2000-2008). (United States)

    Browand-Stainback, Laura; Levesque, Donald; McBee, Matthew


    Epileptic seizures in 211 canine and feline patients diagnosed with idiopathic epilepsy were evaluated for temporal significance in relation to the lunar cycle. Seizure counts were compared among each of the eight individual lunar phases, among each of eight exact lunar phase dates, and by percent of lunar illumination using generalized estimating equations. No statistical significance was found in any of these comparisons excluding a relationship between the onset of epileptic seizures and the phases of the moon. Alteration in anticonvulsant treatment or monitoring of canine and feline patients with idiopathic epilepsy at large was not warranted based on the lunar cycle.

  8. Benign focal epilepsy of childhood with centrotemporal spikes (BECTS: clinical characteristics of seizures according to age at first seizure

    Directory of Open Access Journals (Sweden)

    Miziara Carmen Silvia M.G.


    Full Text Available BECTS is characterized by the presence of simple partial motor seizures in the face and/or oropharynx, with or without sensory symptoms and often with secondary generalization. These seizures tend to occur more often during sleep or drowsiness. According to some authors, generalized seizures prevail over other types particularly among children aged five or less. The purpose of this study is to determine the characteristics of the first epileptic episode among children with BECTS, grouped by age as of their first epileptic seizure, as well as to analyze how such seizures change over the course of clinical evolution. A total of 61 children were examined, 16 of whom below the age of 5 and 45 above. With regard to the first and recurrent epileptic episodes, our final assessment showed that partial seizures occurred more frequently than generalized tonic-clonic seizures in both groups. Although no conclusive relation could be established between the type of partial seizure (i.e. simple versus complex and the children's age as of their first epileptic episode, it was possible to correlate the type of epileptic seizure with their clinical evolution, in which case simple partial seizures proved to be more frequent than complex partial seizures. It should be noted that the number of children under the age of five was relatively small, which evinces the need for further studies. It should also be borne in mind that the reported frequency of generalized seizures in these children's first epileptic episode may be due to their parents' lack of attention and familiarity with this pathology and their attendant difficulty in characterizing its clinical symptoms.

  9. Neuro-inflammation, blood-brain barrier, seizures and autism

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    Theoharides Theoharis C


    Full Text Available Abstract Many children with Autism Spectrum Diseases (ASD present with seizure activity, but the pathogenesis is not understood. Recent evidence indicates that neuro-inflammation could contribute to seizures. We hypothesize that brain mast cell activation due to allergic, environmental and/or stress triggers could lead to focal disruption of the blood-brain barrier and neuro-inflammation, thus contributing to the development of seizures. Treating neuro-inflammation may be useful when anti-seizure medications are ineffective.

  10. Bleeding from a gut lesion as a cause of seizure. (United States)

    Watari, Takashi; Tokuda, Yasuharu


    The differential diagnosis of causes of seizure is important since appropriate management depends on correct diagnosis. Making a misdiagnosis of epilepsy may lead to erroneous clinical management, and can be minimised with careful history taking and physical examination. Our educational case illustrates a patient with presumed epilepsy based on a witnessed generalised tonic-clonic seizure; he was ultimately diagnosed as upper gastrointestinal bleeding initially considered by careful attention of vital signs and rectal examination, and confirmed and treated by emergent endoscopy. Paying careful attention to the symptoms and signs in patients with seizure episodes is crucial to establishing a correct causative diagnosis for seizure. 2015 BMJ Publishing Group Ltd.

  11. Childhood epileptic seizures imitating migraine and encephalitis

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    Kravljanac Ružica


    Full Text Available Introduction. Paroxismal events can resemble epileptic seizures, however, some epileptic seizures, especially benign occipital childhood epilepsies can imitate migraine, cycling vomiting or encephalitis. Objective. The aim of this study was evaluation of clinical and electroencephalographic (EEG features and outcome in children with benign occipital childhood epilepsies. Methods. Investigation included 18 patients with benign occipital childhood epilepsies hospitalized in the period from 2007 to 2010. The diagnosis was based on clinical and EEG characteristics of seizures, while treatment included acute therapy for seizures and chronic antiepileptic drugs. Prognosis was analyzed in terms of neurological outcome and seizure recurrence rate. Results. Benign occipital childhood epilepsy with early onset was diagnosed in 15 children. Vegetative symptoms, mostly ictal vomiting (13, eye deviation and loss of consciousness (13 dominated in the clinical presentation. The most frequent EEG findings showed occipital epileptic discharges. Benign occipital childhood epilepsy with late onset was diagnosed in three cases. Seizures were manifested by visual hallucinations, headache and secondary generalized convulsions. All three patients were administered chronic antiepileptic drugs and had good outcome. Conclusion. In our patients, clinical manifestations of benign occipital epilepsies had some similarities with clinical features of migraine and encephalitis. It could explain misdiagnosis in some of them. Knowledge about main features and differences between each of these disorders is crucial for making appropriate diagnosis.

  12. Seizure risk from cavernous or arteriovenous malformations (United States)

    Josephson, C.B.; Leach, J.-P.; Duncan, R.; Roberts, R.C.; Counsell, C.E.


    Objectives: To determine the risk of epileptic seizures due to a brain arteriovenous malformation (AVM) or cavernous malformation (CM). Methods: In a prospective population-based study of new diagnoses of AVMs (n = 229) or CMs (n = 139) in adults in Scotland in 1999–2003, we used annual medical records surveillance, general practitioner follow-up, and patient questionnaires to quantify the risk of seizures between clinical presentation and AVM/CM treatment, last follow-up, or death. Results: The 5-year risk of first-ever seizure after presentation was higher for AVMs presenting with intracranial hemorrhage or focal neurologic deficit (ICH/FND: n = 119; 23%, 95% confidence interval [CI] 9%–37%) than for incidental AVMs (n = 40; 8%, 95% CI 0%–20%), CMs presenting with ICH/FND (n = 38; 6%, 95% CI 0%–14%), or incidental CMs (n = 57; 4%, 95% CI 0%–10%). For adults who had never experienced ICH/FND, the 5-year risk of epilepsy after first-ever seizure was higher for CMs (n = 23; 94%, 95% CI 84%–100%) than AVMs (n = 37; 58%, 95% CI 40%–76%; p = 0.02). Among adults who never experienced ICH/FND and presented with or developed epilepsy, there was no difference in the proportions achieving 2-year seizure freedom over 5 years between AVMs (n = 43; 45%, 95% CI 20%–70%) and CMs (n = 35; 47%, 95% CI 27%–67%). Conclusions: AVM-related ICH confers a significantly higher risk of a first-ever seizure compared to CMs or incidental AVMs. Adults with a CM have a high risk of epilepsy after a first-ever seizure but achieve seizure freedom as frequently as those with epilepsy due to an AVM. PMID:21536634

  13. Generalized versus non-generalized neural network model for multi-lead inflow forecasting at Aswan High Dam

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    A. El-Shafie


    Full Text Available Artificial neural networks (ANN have been found efficient, particularly in problems where characteristics of the processes are stochastic and difficult to describe using explicit mathematical models. However, time series prediction based on ANN algorithms is fundamentally difficult and faces problems. One of the major shortcomings is the search for the optimal input pattern in order to enhance the forecasting capabilities for the output. The second challenge is the over-fitting problem during the training procedure and this occurs when ANN loses its generalization. In this research, autocorrelation and cross correlation analyses are suggested as a method for searching the optimal input pattern. On the other hand, two generalized methods namely, Regularized Neural Network (RNN and Ensemble Neural Network (ENN models are developed to overcome the drawbacks of classical ANN models. Using Generalized Neural Network (GNN helped avoid over-fitting of training data which was observed as a limitation of classical ANN models. Real inflow data collected over the last 130 years at Lake Nasser was used to train, test and validate the proposed model. Results show that the proposed GNN model outperforms non-generalized neural network and conventional auto-regressive models and it could provide accurate inflow forecasting.

  14. Delayed development of spontaneous seizures and prolonged convulsive state in rats after massed stimulation of the anterior piriform cortex. (United States)

    Timofeeva, O A; Peterson, G M


    We studied the short- and long-term epileptogenic effects of massed stimulation (MS) of the piriform cortex. Sprague-Dawley rats with electrodes implanted bilaterally in the anterior piriform cortex and the dorsal and ventral hippocampi underwent MS: electrical stimulation of the left piriform cortex every 5 min for 6 h (afterdischarge threshold, 60 Hz, 1 ms, 1 s). Animals were retested (5 stimulations) 3-4 times later at different time points to check for the kindled state. Our data showed that MS resulted in delayed development of severe epilepsy. The interval between MS and the first appearance of convulsive response (2 weeks) was characterized by deep refractoriness to seizure (silent period). Unexpectedly, dramatic seizure activity occurred 4-7 weeks after MS. This was manifested by (1) generalized tonic-clonic convulsions with multiple failings, which were elicited repeatedly during retest; (2) frequent progression of elicited generalized convulsions into a prolonged (> 8 min) postictal convulsive state expressed mainly by continuous partial seizures and even new bouts of generalized seizures, and (3) development of mild spontaneous seizures. We found that epileptiform activity predominated in the ventral hippocampus. Mossy fiber sprouting was also most pronounced in this area. We propose that the MS resulted in formation of pathological circuits which involve both piriform cortex and ventral hippocampus and lead to severe epilepsy.

  15. Ketogenic diet therapy is effective in encephalitis with refractory seizures. (United States)

    Matsuzono, Kosuke; Kurata, Tomoko; Deguchi, Shoko; Yamashita, Toru; Deguchi, Kentaro; Abe, Koji


    Although ketogenic diet therapy is effective in refractory seizures in childhood, its effect on adult encephalitis with similar refractory seizures and prolonged encephalopathy has not been well reported. We report here a case of a 22-year-old man with acute encephalitis with refractory repetitive partial seizures (AERRPS). Partial seizures of the face developed to repeated generalized convulsions, which were refractory against anti-epileptic drugs and a high dose of propofol. After struggling for 9 months, he dramatically recovered after ketogenic diet therapy. Ketogenic diet therapy may be an important tool to help cure AERRPS.

  16. Seizures and the Role of Anticonvulsants After Traumatic Brain Injury. (United States)

    Zimmermann, Lara L; Diaz-Arrastia, Ramon; Vespa, Paul M


    Posttraumatic seizures are a common complication of traumatic brain injury. Posttraumatic epilepsy accounts for 20% of symptomatic epilepsy in the general population and 5% of all epilepsy. Early posttraumatic seizures occur in more than 20% of patients in the intensive care unit and are associated with secondary brain injury and worse patient outcomes. Most posttraumatic seizures are nonconvulsive and therefore continuous electroencephalography monitoring should be the standard of care for patients with moderate or severe brain injury. The literature shows that posttraumatic seizures result in secondary brain injury caused by increased intracranial pressure, cerebral edema and metabolic crisis. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Diazepam for Febrile Seizures



    The efficacy and side effects of intermittent oral diazepam for the prevention of febrile seizure recurrence were investigated in the Departments of Clinical Pharmacology, Neurosurgery, and Biostatistics, University of Tours, France.

  18. Seizures after intravenous tramadol given as premedication

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    Lalit Kumar Raiger


    Full Text Available A 35-year-old, 50-kg female with a history of epilepsy was scheduled for elective breast surgery (fibroadenoma under general anaesthesia. She was given glycopyrrolate 0.2 mg, ondansetron 4 mg and tramadol 100 mg i.v. as premedication. Within 5 min, she had an acute episode of generalised tonic-clonic seizure that was successfully treated with 75 mg thiopentone i.v. and after 30 min, she was given general anaesthesia with endotracheal intubation. Surgery, intra-operative period, extubation and post-operative period were uneventful. We conclude that tramadol may provoke seizures in patients with epilepsy even within the recommended dose range.

  19. Multi-modal Intelligent Seizure Acquisition (MISA) system - A new approach towards seizure detection based on full body motion measures

    DEFF Research Database (Denmark)

    Conradsen, Isa; Beniczky, Sándor; Wolf, Peter


    Many epilepsy patients cannot call for help during a seizure, because they are unconscious or because of the affection of their motor system or speech function. This can lead to injuries, medical complications and at worst death. An alarm system setting off at seizure onset could help to avoid...

  20. Seizure-triggered Takotsubo syndrome rarely causes SUDEP. (United States)

    Finsterer, Josef; Bersano, Anna


    Since almost 20 y it is known that seizures may trigger Takotsubo syndrome (TTS). Since then it has been repeatedly proposed that TTS could be the cause of sudden unexpected death in epilepsy (SUDEP). A review of the so far reported cases of seizure-triggered TTS was carried out to see how often seizure-triggered TTS is fatal. Altogether 59 papers were identified which reported altogether 74 patients with seizure-triggered TTS. Age was reported in 70 patients and ranged from 18 to 82 y. Gender was reported in 70 cases and was female in 60 cases (86%). The type of triggering seizure was reported in 47 cases. In 28 patients (60%) the trigger was a generalized tonic clonic seizure, in 15 cases (32%) a generalized status epilepticus, and in 3 cases a complex partial seizure. The outcome was mentioned in 63 of the 74 patients. Full recovery was reported in 61 cases (97%), incomplete recovery in none of the patients, and a fatal outcome in 2 patients (3%). Fatalities are rare in patients experiencing seizure-triggered TTS. This is why seizure-triggered TTS does not seem to play a major role in the pathogenesis of SUDEP. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  1. Evaluating the frequency and characteristics of seizures in 142 Japanese patients with Prader-Willi syndrome. (United States)

    Takeshita, Eri; Murakami, Nobuyuki; Sakuta, Ryoichi; Nagai, Toshiro


    Prader-Willi syndrome (PWS) has not been widely regarded as a disorder with a risk factor for seizures. We retrospectively investigated the frequency and characteristics of seizures and examined genotype-phenotype correlations with respect to seizures in PWS. We analyzed 142 patients with PWS and identified 31 (22%) with seizures. The most common seizure type was febrile convulsion (12%, 17/142). Epilepsy occurred in 6% of the patients in our cohort (9/142). The frequencies of febrile seizure and epilepsy in PWS were higher than those in the general population. Our study suggested that the frequency of seizures was not associated with genotypes of PWS (P = 0.35). In our study patients with PWS, 68% of the patients with seizures experienced initial episodes before they were 2 years old, and the seizures were relatively easier to manage.

  2. Does generalized social trust lead to associational membership? Unraveling a bowl of well-tossed spaghetti

    DEFF Research Database (Denmark)

    Sønderskov, Kim Mannemar


    Within the social capital literature it is often assumed that membership of voluntary associations causes generalized social trust and not the other way around. This study challenges this assumption by investigating if generalized social trust causes membership in a novel design that yields valid...... provide rare individual level evidence for a connection between generalized social trust and collective action in that generalized social trust in particular increases membership of associations producing public goods....

  3. Does generalized social trust lead to associational membership? Unraveling a bowl of well-tossed spaghetti

    DEFF Research Database (Denmark)

    Sønderskov, Kim Mannemar

    Within the social capital literature it is often assumed that membership of voluntary associations causes generalized social trust and not the other way around. This study challenges this assumption by investigating if generalized social trust causes membership in a novel design that yields valid....... Moreover, the study provide rare individual level evidence for a connection between generalized social trust and collective action in that generalized social trust in particular increases membership of associations producing public goods....

  4. Seizure susceptibility due to antihistamines in febrile seizures. (United States)

    Takano, Tomoyuki; Sakaue, Yuko; Sokoda, Tatsuyuki; Sawai, Chihiro; Akabori, Shie; Maruo, Yoshihiro; Taga, Takashi; Ohno, Masaki; Takeuchi, Yoshihiro


    The aim of this study was to determine whether seizure susceptibility due to antihistamines is provoked in patients with febrile seizures. The study population comprised 14 patients with simple febrile seizures and 35 patients with complex febrile seizures. Detailed clinical manifestations were compared between patients with and without administration of antihistamine. The time from fever detection to the seizure onset was significantly shorter in the antihistamine group than that in the nonantihistamine group, and the duration of seizures was significantly longer in the antihistamine group than that in nonantihistamine group. Interleukin-1beta is thought to be associated with causing febrile seizures via its dual role as a pyrogen and convulsant substance. Moreover, interleukin-1beta may activate the turnover of hypothalamic neural histamine. These considerations, along with the present results, suggest that the depletion of hypothalamic neuronal histamine induced by antihistamines may increase neuronal excitability, thereby increasing seizure susceptibility in patients with febrile seizures. Copyright 2010 Elsevier Inc. All rights reserved.

  5. Zotepine-induced convulsive seizures in a chronic case of treatment resistant paranoid schizophrenia

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    Praveen Khairkar


    Full Text Available Adverse effects to antipsychotics are varied, frequently intolerable, often serious and sometimes fatal in clinical practice. Seizures are one of these adverse effects. Almost all first and second generation antipsychotics elicit dose-dependent lowering of seizure threshold, indicating increased seizure risk at higher drug dosages. The adverse event of zotepine induced seizure is published in few case reports. We report the occurrence of myoclonic seizure progressing to generalized tonic-clonic seizures with zotepine along with clear temporal association of dose dependent modulation evident in this case.

  6. What is a seizure network? Long-range network consequences of focal seizures. (United States)

    Blumenfeld, Hal


    What defines the spatial and temporal boundaries of seizure activity in brain networks? To fully answer this question a precise and quantitative definition of seizures is needed, which unfortunately remains elusive. Nevertheless, it is possible to ask under conditions where clearly divergent patterns of activity occur in large-scale brain networks whether certain activity patterns are part of the seizure while others are not. Here we examine brain network activity during focal limbic seizures, including diverse regions such as the hippocampus, subcortical arousal systems and fronto-parietal association cortex. Based on work from patients and from animal models we describe a characteristic pattern of intense increases in neuronal firing, cerebral blood flow, cerebral blood volume, blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI) signals and cerebral metabolic rate of oxygen consumption in the hippocampus during focal limbic seizures. Similar increases are seen in certain closely linked subcortical structures such as the lateral septal nuclei and anterior hypothalamus, which contain inhibitory neurons. In marked contrast, decreases in all of these parameters are seen in the subcortical arousal systems of the upper brainstem and intralaminar thalamus, as well as in the fronto-parietal association cortex. We propose that the seizure proper can be defined as regions showing intense increases, while those areas showing opposite changes are inhibited by the seizure network and constitute long-range network consequences beyond the seizure itself. Importantly, the fronto-parietal cortex shows sleep-like slow wave activity and depressed metabolism under these conditions, associated with impaired consciousness. Understanding which brain networks are directly involved in seizures versus which sustain secondary consequences can provide new insights into the mechanisms of brain dysfunction in epilepsy, hopefully leading to innovative treatment

  7. Effect of berberine on pentylenetetrazol-induced seizures in rats

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    Hamid Reza Sadeghnia


    Results: Intraperitoneal administration of lower doses of berberine (100 and 200 mg/kg had no significant effects on minimal clonic seizures (MCS and generalized tonic-clonic seizures (GTCS latencies, while injection of 400 mg/kg caused significant increase in both MCS and GTCS latencies (p

  8. Disparity in regional cerebral blood flow during electrically induced seizure

    DEFF Research Database (Denmark)

    Sestoft, D; Meden, P; Hemmingsen, R


    This is a presentation of 2 cases in which the intraictal regional cerebral blood flow distribution was measured with the 99mTc-HMPAO single photon emission computerized tomography technique during an electrically induced seizure. Although the seizure was verified as generalized on electroencepha...

  9. Seizures beget seizures in temporal lobe epilepsies: the boomerang effects of newly formed aberrant kainatergic synapses. (United States)

    Ben-Ari, Yehezkel; Crepel, Valérie; Represa, Alfonso


    Do temporal lobe epilepsy (TLE) seizures in adults promote further seizures? Clinical and experimental data suggest that new synapses are formed after an initial episode of status epilepticus, however their contribution to the transformation of a naive network to an epileptogenic one has been debated. Recent experimental data show that newly formed aberrant excitatory synapses on the granule cells of the fascia dentate operate by means of kainate receptor-operated signals that are not present on naive granule cells. Therefore, genuine epileptic networks rely on signaling cascades that differentiate them from naive networks. Recurrent limbic seizures generated by the activation of kainate receptors and synapses in naive animals lead to the formation of novel synapses that facilitate the emergence of further seizures. This negative, vicious cycle illustrates the central role of reactive plasticity in neurological disorders.

  10. Study of intelligence quotient and influencing factors on the children with idiopathic generalized tonic-clonic seizure%特发性全身强直-阵挛发作患儿智商及影响因素

    Institute of Scientific and Technical Information of China (English)

    黄会芝; 胡晓峰; 温晓红; 唐章龙; 李晓燕; 金岚; 吴晓燕; 储微; 唐久来


    Objective To study the intelligence quotient(IQ) profile of the children with idiopathic generalized tonic-clonic seizure (GTCS) and the factors influencing IQ of them.Methods All 28 children with GTCS were selected who were aged 9 ~ 16 years in 20 GTCS families in a mountain area of the south of Anhui Province,all available healthy siblings of the children included in the epilepsy group,did not have epilepsy,and were nearest in age to the children with GTCS ( control group 1 ),and thirty children aged 9 ~ 16 years old who had lived in the same village ( control group 2) entered into our study.The IQ was studied of the three groups of children and the factors influencing IQ of children with GTCS at the same time.The data were input SPSS12.0 and analyzed.Results The IQ of children with GTCS(85.64 ±20.57)was lower than that control group 1( 103.39 ± 11.17)and the control group 2 ( 106.17 ± 11.67).The difference between children with GTCS and the two control groups were significant for almost all the subtest quotients except completion of drawing and picture arrangement.No significant differences were found between the control group 1 and the control group 2 on the IQ and the subtest quotients.IQ scores of children with GTCS showed significant linear correlation with father's education( r=0.453,P<0.01 ),age at onset of epilepsy( r=0.506,P<0.01 ),duration of seizure disorder( r=-0.533,P<0.0l ),status epilepticus( r=-0.732,P<0.01),total number of seizures( r=-0.761,P<0.01) and seizure frequency ( r=-0.708,P < 0.01 ).Conclusion The IQ scores of the children with idiopathic GTCS are lower significantly than general children population.Epilepsy-related variables affecting IQ scores of the children with idiopathic GTCS are duration of seizure disorder,status epilepticus,age at onset of epilepsy,total number of seizures,seizure frequency.%目的 研究特发性全身强直-阵挛发作(GTCS)患儿智商(IQ)及影响因素.方法 选择皖南区20

  11. MMR Vaccination and Febrile Seizures

    DEFF Research Database (Denmark)

    Vestergaard, Mogens; Hviid, Anders; Madsen, Kreesten Meldgaard


    CONTEXT: The rate of febrile seizures increases following measles, mumps, and rubella (MMR) vaccination but it is unknown whether the rate varies according to personal or family history of seizures, perinatal factors, or socioeconomic status. Furthermore, little is known about the long-term outcome...... of febrile seizures following vaccination. OBJECTIVES: To estimate incidence rate ratios (RRs) and risk differences of febrile seizures following MMR vaccination within subgroups of children and to evaluate the clinical outcome of febrile seizures following vaccination. DESIGN, SETTING, AND PARTICIPANTS......: Incidence of first febrile seizure, recurrent febrile seizures, and subsequent epilepsy. RESULTS: A total of 439,251 children (82%) received MMR vaccination and 17,986 children developed febrile seizures at least once; 973 of these febrile seizures occurred within 2 weeks of MMR vaccination. The RR...

  12. Sex Differences in Seizure Types and Symptoms (United States)

    Carlson, Chad; Dugan, Patricia; Kirsch, Heidi E; Friedman, Daniel


    Background Despite the increasing interest in sex differences in disease manifestations and responses to treatment, very few data are available on sex differences in seizure types and semiology. The Epilepsy Phenome/Genome Project (EPGP) is a large-scale, multi-institutional, collaborative study that aims to create a comprehensive repository of detailed clinical information and DNA samples from a large cohort of people with epilepsy. We used this well-characterized cohort to explore differences in seizure types as well as focal seizure symptoms between males and females. Methods We reviewed the EPGP database and identified individuals with generalized epilepsy of unknown etiology (GE) (n=760; female 446, male 314), non-acquired focal epilepsy (NAFE) (n=476; female 245, male 231), or both (n=64; female 33, male 31). Demographic data along with characterization of seizure type and focal seizure semiologies were examined. Results In GE, males reported atonic seizures more frequently than females (6.5% vs. 1.7%; p<0.001). No differences were observed in other generalized seizure types. In NAFE, no sex differences were seen for seizure types with or without alteration of consciousness or progression to secondary generalization. Autonomic (16.4% vs. 26.6%; p=0.005), psychic (26.7% vs. 40.3%; p=0.001), and visual symptoms (10.3% vs. 19.9%; p=0.002) were more frequently reported in females than males. Specifically, of psychic symptoms, more females than males endorsed déjà vu (p=0.001), but not forced thoughts, derealization/depersonalization, jamais vu, or fear. With corrections for multiple comparisons, there were no significant differences in aphasic, motor, somatosensory, gustatory, olfactory, auditory, vertiginous, or ictal headache symptoms between sexes. Conclusions Significant differences between the sexes were observed in the reporting of atonic seizures, which was more common in males with GE, and for autonomic, visual, and psychic symptoms associated with NAFE

  13. Detection of early seizures by diffuse optical tomography (United States)

    Zhang, Tao; Hajihashemi, M. Reza; Zhou, Junli; Carney, Paul R.; Jiang, Huabei


    In epilepsy it has been challenging to detect early changes in brain activity that occurs prior to seizure onset and to map their origin and evolution for possible intervention. Besides, preclinical seizure experiments need to be conducted in awake animals with images reconstructed and displayed in real-time. We demonstrate using a rat model of generalized epilepsy that diffuse optical tomography (DOT) provides a unique functional neuroimaging modality for noninvasively and continuously tracking brain activities with high spatiotemporal resolution. We developed methods to conduct seizure experiments in fully awake rats using a subject-specific helmet and a restraining mechanism. For the first time, we detected early hemodynamic responses with heterogeneous patterns several minutes preceding the electroencephalographic seizure onset, supporting the presence of a "pre-seizure" state both in anesthetized and awake rats. Using a novel time-series analysis of scattering images, we show that the analysis of scattered diffuse light is a sensitive and reliable modality for detecting changes in neural activity associated with generalized seizure. We found widespread hemodynamic changes evolving from local regions of the bilateral cortex and thalamus to the entire brain, indicating that the onset of generalized seizures may originate locally rather than diffusely. Together, these findings suggest DOT represents a powerful tool for mapping early seizure onset and propagation pathways.

  14. Lead shot: its settlement, oxidation, and general availability to waterfowl in Utah marshes. (United States)

    US Fish and Wildlife Service, Department of the Interior — In an attempt to further knowledge in the area of lead poisoning of waterfowl from spent shot pellets, students from the Utah Cooperative Wildlife Research Unit...

  15. Catatonia in encephalitis and nonconvulsive seizures: a case report and review of the literature. (United States)

    Sahaya, Kinshuk; Lardizabal, David


    A 20-year-old woman was admitted for psychosis. On further investigation, she was found to be have viral encephalitis and generalized nonconvulsive seizures. After the seizures were controlled, she remained in a prolonged catatonic state. Repeated intravenous benzodiazepine administration, improved her cognition dramatically. This case emphasizes that catatonia may occur after encephalitis and nonconvulsive seizures.

  16. Treatment Outcome Of Seizures Associated With Intracranial Cavernous Angiomas

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    Nievera Conrad C


    Full Text Available Seizures are among the typical presentations of intracranial cavernous angiomas (ICA. Twenty-one patients (age range: 2 to 53 years treated for seizures associated with ICA between 1983 and 1997 were restrospectively studied to evaluate their outcome following medical or surgical intervention. The mean interval between seizure onset and initial presentation at our institution was 7.6 years. Seizures were simple partial in 3 patients, complex partial in 15 and secondarily generalized tonic-clonic in 13. The commonest site of the lesion was the temporal lobe (52%. Multiple angiomas were observed in 5 (24% patients. Seven (32% patients were medically-managed with antiepileptic therapy and 14 (68% underwent either lesionectomy with resection of the epileptogenic zone (9 patients or temporal lobectomy (5 patients. Mean follow-up time was 4 years (range: 3 months to 14 years. Of the medically-managed patients, 3 (43% remained seizure-free whereas 4 (57% continued to have seizures with an average frequency of one per day. Of the surgically-managed patients, 12 (86% became seizure-free and 2 (14% had no more than two seizures per year. Surgery appears to be extremely effective in the management of seizures associated with ICA and should receive a strong and early consideration in patients who fail medical therapy.

  17. Seizure susceptibility of neuropeptide-Y null mutant mice in amygdala kindling and chemical-induced seizure models. (United States)

    Shannon, Harlan E; Yang, Lijuan


    Neuropeptide Y (NPY) administered exogenously is anticonvulsant, and, NPY null mutant mice are more susceptible to kainate-induced seizures. In order to better understand the potential role of NPY in epileptogenesis, the present studies investigated the development of amygdala kindling, post-kindling seizure thresholds, and anticonvulsant effects of carbamazepine and levetiracetam in 129S6/SvEv NPY(+/+) and NPY(-/-) mice. In addition, susceptibility to pilocarpine- and kainate-induced seizures was compared in NPY(+/+) and (-/-) mice. The rate of amygdala kindling development did not differ in the NPY(-/-) and NPY(+/+) mice either when kindling stimuli were presented once daily for at least 20 days, or, 12 times daily for 2 days. However, during kindling development, the NPY(-/-) mice had higher seizure severity scores and longer afterdischarge durations than the NPY(+/+) mice. Post-kindling, the NPY(-/-) mice had markedly lower afterdischarge thresholds and longer afterdischarge durations than NPY (+/+) mice. Carbamazepine and levetiracetam increased the seizure thresholds of both NPY (-/-) and (+/+) mice. In addition, NPY (-/-) mice had lower thresholds for both kainate- and pilocarpine-induced seizures. The present results in amygdala kindling and chemical seizure models suggest that NPY may play a more prominent role in determining seizure thresholds and severity of seizures than in events leading to epileptogenesis. In addition, a lack of NPY does not appear to confer drug-resistance in that carbamazepine and levetiracetam were anticonvulsant in both wild type (WT) and NPY null mutant mice.

  18. Pre-seizure state identified by diffuse optical tomography (United States)

    Zhang, Tao; Zhou, Junli; Jiang, Ruixin; Yang, Hao; Carney, Paul R.; Jiang, Huabei


    In epilepsy it has been challenging to detect early changes in brain activity that occurs prior to seizure onset and to map their origin and evolution for possible intervention. Here we demonstrate using a rat model of generalized epilepsy that diffuse optical tomography (DOT) provides a unique functional neuroimaging modality for noninvasively and continuously tracking such brain activities with high spatiotemporal resolution. We detected early hemodynamic responses with heterogeneous patterns, along with intracranial electroencephalogram gamma power changes, several minutes preceding the electroencephalographic seizure onset, supporting the presence of a ``pre-seizure'' state. We also observed the decoupling between local hemodynamic and neural activities. We found widespread hemodynamic changes evolving from local regions of the bilateral cortex and thalamus to the entire brain, indicating that the onset of generalized seizures may originate locally rather than diffusely. Together, these findings suggest DOT represents a powerful tool for mapping early seizure onset and propagation pathways.

  19. Intergenerational Transmission of Enhanced Seizure Susceptibility after Febrile Seizures

    National Research Council Canada - National Science Library

    Wu, Dengchang; Feng, Bo; Dai, Yunjian; Wu, Xiaohua; Chen, Bin; Xu, Cenglin; Tang, Yangshun; Wang, Kang; Zhang, Shihong; Wang, Shuang; Luo, Benyan; Chen, Zhong


    .... Here, we demonstrate that prolonged febrile seizures induced by exposure of rat pups to a hyperthermic environment enhance seizure susceptibility not only in these hyperthermia-treated rats but also...

  20. Predictors of seizure freedom after resection of supratentorial low-grade gliomas. A review. (United States)

    Englot, Dario J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F


    Seizures are the most frequent presenting symptom in patients with low-grade gliomas (LGGs), and significantly influence quality of life if they are uncontrolled. Achieving freedom from seizures is of utmost importance in surgical planning, but the factors associated with seizure control remain incompletely understood. The authors performed a systematic literature review of seizure outcomes after resection of LGGs causing seizures, examining 773 patients across 20 published series. Rates of seizure freedom were stratified across 7 variables: patient age, tumor location, preoperative seizure control with medication, seizure semiology, epilepsy duration, extent of resection, and the use of intraoperative electrocorticography (ECoG). Gross-total resection was most predictive of complete seizure freedom, when compared with subtotal resection (OR 3.41, 95% CI 2.36-4.93). Other predictors of seizure freedom included preoperative seizure control on antiepileptic medication (OR 2.12, 95% CI 1.33-3.38) and duration of seizures of ≤ 1 year (OR 1.85, 95% CI 1.22-2.79). Patients with simple partial seizure semiology achieved seizure freedom less often than those with complex partial, generalized, or mixed seizure types (OR 0.46, 95% CI 0.26-0.80). No significant differences in seizure outcome were observed between adults versus children, patients with temporal lobe versus extratemporal tumors, or with the use of intraoperative ECoG. Seizure control is one of the most important considerations in planning surgery for low-grade brain tumors. Gross-total resection is a critical factor in achieving seizure freedom.

  1. Types of Seizures Affecting Individuals with TSC (United States)

    ... infantile spasms. Older children and adults may develop multiple types of seizures including generalized, complex partial and ... caused by air forced through contracted vocal cord). Limbs may be extended, ... bluish skin, possible loss of bladder or bowel control, usually lasts a ...

  2. Incidence of febrile seizures in the Netherlands.

    NARCIS (Netherlands)

    Verburgh, M.E.; Bruijnzeels, M.A.; Wouden, J.C. van der; Suijlekom-Smit, L.W.A. van; Velden, J. van der; Hoes, A.W.; Offringa, M.


    To assess the incidence of febrile seizures in The Netherlands, we analyzed data from a population-based study carried out in 161 Dutch general practices. The overall incidence rate was 4.8/1,000 person-years. Considerable age and seasonal variation was found. The chance of a child suffering a

  3. Automated Video Detection of Epileptic Convulsion Slowing as a Precursor for Post-Seizure Neuronal Collapse. (United States)

    Kalitzin, Stiliyan N; Bauer, Prisca R; Lamberts, Robert J; Velis, Demetrios N; Thijs, Roland D; Lopes Da Silva, Fernando H


    Automated monitoring and alerting for adverse events in people with epilepsy can provide higher security and quality of life for those who suffer from this debilitating condition. Recently, we found a relation between clonic slowing at the end of a convulsive seizure (CS) and the occurrence and duration of a subsequent period of postictal generalized EEG suppression (PGES). Prolonged periods of PGES can be predicted by the amount of progressive increase of interclonic intervals (ICIs) during the seizure. The purpose of the present study is to develop an automated, remote video sensing-based algorithm for real-time detection of significant clonic slowing that can be used to alert for PGES. This may help preventing sudden unexpected death in epilepsy (SUDEP). The technique is based on our previously published optical flow video sequence processing paradigm that was applied for automated detection of major motor seizures. Here, we introduce an integral Radon-like transformation on the time-frequency wavelet spectrum to detect log-linear frequency changes during the seizure. We validate the automated detection and quantification of the ICI increase by comparison to the results from manually processed electroencephalography (EEG) traces as "gold standard". We studied 48 cases of convulsive seizures for which synchronized EEG-video recordings were available. In most cases, the spectral ridges obtained from Gabor-wavelet transformations of the optical flow group velocities were in close proximity to the ICI traces detected manually from EEG data during the seizure. The quantification of the slowing-down effect measured by the dominant angle in the Radon transformed spectrum was significantly correlated with the exponential ICI increase factors obtained from manual detection. If this effect is validated as a reliable precursor of PGES periods that lead to or increase the probability of SUDEP, the proposed method would provide an efficient alerting device.

  4. Choosing Surgery: Identifying Factors Leading to Increased General Surgery Matriculation Rate. (United States)

    Pointer, David T; Freeman, Matthew D; Korndorffer, James R; Meade, Peter C; Jaffe, Bernard M; Slakey, Douglas P


    Tulane graduates have, over the past six years, chosen general surgical residency at a rate above the national average (mean 9.6% vs 6.6%). With much of the recent career choice research focusing on disincentives and declining general surgery applicants, we sought to identify factors that positively influenced our students' decision to pursue general surgery. A 50-question survey was developed and distributed to graduates who matched into a general surgery between the years 2006 and 2014. The survey evaluated demographics, exposure to surgery, and factors affecting interest in a surgical career. We achieved a 54 per cent (61/112) response rate. Only 43 per cent considered a surgical career before medical school matriculation. Fifty-nine per cent had strongly considered a career other than surgery. Sixty-two per cent chose to pursue surgery during or immediately after their surgery clerkship. The most important factors cited for choosing general surgery were perceived career enjoyment of residents and faculty, resident/faculty relationship, and mentorship. Surgery residents and faculty were viewed as role models by 72 and 77 per cent of responders, respectively. This study demonstrated almost half of those choosing a surgical career did so as a direct result of the core rotation experience. We believe that structuring the medical student education experience to optimize the interaction of students, residents, and faculty produces a positive environment encouraging students to choose a general surgery career.

  5. Phenomenology and psychiatric origin of psychogenic nonepileptic seizures

    Directory of Open Access Journals (Sweden)

    Ristić Aleksandar J.


    Full Text Available INTRODUCTION Psychogenic nonepileptic seizure (PNES is a sudden change in a person's behavior, perception, thinking, or feeling that is usually time limited and resembles, or is mistaken for, epilepsy but does not have the characteristic electroencephalographic (EEG changes that accompanies a true epileptic seizure [1]. It is considered that PNES is a somatic manifestation of mental distress, in response to a psychological conflict or other Stressors [2]. A wide spectrum of clinical presentation includes syncope, generalized tonic-clonic seizure, simple and complex partial seizure, myoclonic seizure, frontal lobe seizures and status epilepticus [3]. Coexistence of epilepsy and PNES is seen in approximately 9% of cases [5]. Between 25-30% of patients referred to tertiary centers and initially diagnosed as refractory epilepsy were on further examination diagnosed as PNES [6,7]. In DSM-IV [12] PNES are usually categorized under conversion disorder with seizures or convulsions. However, psychiatric basis of PNES may be anxiousness (panic attack, somatization or factitious disorder, simulation, dissociative disorders and psychosis [1]. AIM The aim of the study was to establish clinical phenomenology and EEG characteristics as well as basic psychiatric disorder in patients with PNES. METHOD In a retrospective study covering the period from January 1st 1999 till April 31 st 2003, 24 patients (22 female, 2 male treated at the Institute of Neurology in Belgrade were analyzed. PNES were defined as sudden change in behavior incoherent with epileptiform activity registered on EEG. Possible PNES were determined on the basis of history data and clinical examination during the attack but definitive confirmation was established only by the finding of no ictal EEG changes during typical seizure of each patient. Patients with coexisting epilepsy were included in the study, too. At least two standard EEG (range 2-6, median 4 were performed at the beginning of

  6. Management of dental patients with seizure disorders. (United States)

    Bryan, Robert B; Sullivan, Steven M


    Dental practitioners from time to time must treat patients with epilepsy or similar seizure disorders. This article describes the various classification for epilepsy, explains how such disorders are evaluated and diagnosed, discusses management methods, and addresses related issues for special populations, such as pregnant women and elderly. In addition, the article offers information about what special steps dentists should take in treating such epileptic patients and others vulnerable to seizures and in preparing offices and staff for the possibility that a patient will have a seizure in the office. In general, a patient with severe, poorly controlled epilepsy should be treated in a hospital. Otherwise, a well-controlled patient should easily be treated in the office.

  7. Epileptic Seizures: Quakes of the brain?

    CERN Document Server

    Osorio, Ivan; Sornette, Didier; Milton, John; Lai, Ying-Cheng


    The concept of universality proposes that dynamical systems with the same power law behaviors are equivalent at large scales. We test this hypothesis on the Earth's crust and the epileptic brain, and discover that power laws also govern the distributions of seizure energies and recurrence times. This robust correspondence is extended over seven statistics, including the direct and inverse Omori laws. We also verify in an animal seizure model the earthquake-driven hypothesis that power law statistics co-exist with characteristic scales, as coupling between constitutive elements increases towards the synchronization regime. These observations point to the universality of the dynamics of coupled threshold oscillators for systems even as diverse as Earth and brain and suggest a general strategy for forecasting seizures, one of neurosciences' grails.

  8. Revising the Rule Of Three For Inferring Seizure Freedom (United States)

    Westover, M. Brandon; Cormier, Justine; Bianchi, Matt T.; Shafi, Mouhsin; Kilbride, Ronan; Cole, Andrew J.; Cash, Sydney S.


    Summary Purpose How long after starting a new medication must a patient go without seizures before they can be regarded as seizure free? A recent ILAE task force proposed using a “Rule of Three” as an operational definition of seizure freedom, according to which a patient should be considered seizure-free following an intervention after a period without seizures has elapsed equal to three times the longest pre-intervention inter-seizure interval over the previous year. This rule was motivated in large part by statistical considerations advanced in a classic 1983 paper by Hanley and Lippman-Hand. However, strict adherence to the statistical logic of this rule generally requires waiting much longer than recommended by the ILAE task force. Therefore, we set out to determine whether an alternative approach to the Rule of Three might be possible, and under what conditions the rule may be expected to hold or would need to be extended. Methods Probabilistic modeling and application of Bayes’ rule. Key Findings We find that an alternative approach to the problem of inferring seizure freedom supports using the Rule of Three in the way proposed by the ILAE in many cases, particularly in evaluating responses to a first trial of anti-seizure medication, and to favorably-selected epilepsy surgical candidates. In cases where the a priori odds of success are less favorable, our analysis requires longer seizure-free observation periods before declaring seizure freedom, up to six times the average pre-intervention insterseizure interval. The key to our approach is to take into account not only the time elapsed without seizures but also empirical data regarding the a priori probability of achieving seizure freedom conferred by a particular intervention. Significance In many cases it may be reasonable to consider a patient seizure free after they have gone without seizures for a period equal to three times the pre-intervention inter-seizure interval, as proposed on pragmatic

  9. Age-dependent seizure semiology in temporal lobe epilepsy. (United States)

    Fogarasi, András; Tuxhorn, Ingrid; Janszky, József; Janszky, Imre; Rásonyi, György; Kelemen, Anna; Halász, Péter


    To examine the effects of age on different aspects of temporal lobe seizure semiology. We performed a video analysis of 605 archived seizures from 155 consecutive patients (age 10 months to 49 years) selected by seizure freedom after temporal lobectomy. Eighty patients had hippocampal sclerosis (HS). Beside semiological seizure classification, we assessed age dependency of several axes of seizure semiology: (1) aura, (2) number of different lateralizing signs, occurrence of ictal (3) emotional signs, (4) autonomic symptoms, (5) automatisms, and (6) secondary generalization as well as (7) the ratio of motor seizure components. From the 155 patients, 117 reported aura, 39 had ictal emotional signs, 51 had autonomic symptoms, 130 presented automatisms, while 18 patients showed secondary generalization at least once during their seizures. Altogether 369 (median: 2/patient) different lateralizing signs were recorded. Frequency of HS (p semiology. Conversely, other aspects (aura, emotional, and autonomic signs) are independent of the maturation process. This is the first report investigating age dependency of epileptic seizure semiology comparing all age groups.

  10. Japanese representation in leading general medicine and basic science journals: a comparison of two decades. (United States)

    Fukui, Tsuguya; Takahashi, Osamu; Rahman, Mahbubur


    During 1991-2000, Japan contribution to the top general medicine journals was very small although the contribution to the top basic science journals was sizeable. However, it has not been examined whether the contribution to the top general medicine and basic science journals has changed during the last decade (2001-2010). The objective of this study was to compare Japan representation in high-impact general medicine and basic science journals between the years 1991-2000 and 2001-2010. We used PubMed database to examine the frequency of articles originated from Japan and published in 7 high-impact general medicine and 6 high-impact basic science journals. Several Boolean operators were used to connect name of the journal, year of publication and corresponding authors' affiliation in Japan. Compared to the 1991-2000 decade, Japan contribution to the top general medicine journals did not increase over the 2001-2010 period (0.66% vs. 0.74%, P = 0.255). However, compared to the same period, its contribution to the top basic science journals increased during 2001-2010 (2.51% vs. 3.60%, P journals showed an upward trend over the 1991-2000 period (P journals remained flat both during 1991-2000 (P = 0.273) and 2001-2010 (P = 0.073). Overall, Japan contribution to the top general medicine journals has remained small and unchanged over the last two decades. However, top basic science journals had higher Japan representation during 2001-2010 compared to 1991-2000.

  11. Instruction manual for the ILAE 2017 operational classification of seizure types. (United States)

    Fisher, Robert S; Cross, J Helen; D'Souza, Carol; French, Jacqueline A; Haut, Sheryl R; Higurashi, Norimichi; Hirsch, Edouard; Jansen, Floor E; Lagae, Lieven; Moshé, Solomon L; Peltola, Jukka; Roulet Perez, Eliane; Scheffer, Ingrid E; Schulze-Bonhage, Andreas; Somerville, Ernest; Sperling, Michael; Yacubian, Elza Márcia; Zuberi, Sameer M


    This companion paper to the introduction of the International League Against Epilepsy (ILAE) 2017 classification of seizure types provides guidance on how to employ the classification. Illustration of the classification is enacted by tables, a glossary of relevant terms, mapping of old to new terms, suggested abbreviations, and examples. Basic and extended versions of the classification are available, depending on the desired degree of detail. Key signs and symptoms of seizures (semiology) are used as a basis for categories of seizures that are focal or generalized from onset or with unknown onset. Any focal seizure can further be optionally characterized by whether awareness is retained or impaired. Impaired awareness during any segment of the seizure renders it a focal impaired awareness seizure. Focal seizures are further optionally characterized by motor onset signs and symptoms: atonic, automatisms, clonic, epileptic spasms, or hyperkinetic, myoclonic, or tonic activity. Nonmotor-onset seizures can manifest as autonomic, behavior arrest, cognitive, emotional, or sensory dysfunction. The earliest prominent manifestation defines the seizure type, which might then progress to other signs and symptoms. Focal seizures can become bilateral tonic-clonic. Generalized seizures engage bilateral networks from onset. Generalized motor seizure characteristics comprise atonic, clonic, epileptic spasms, myoclonic, myoclonic-atonic, myoclonic-tonic-clonic, tonic, or tonic-clonic. Nonmotor (absence) seizures are typical or atypical, or seizures that present prominent myoclonic activity or eyelid myoclonia. Seizures of unknown onset may have features that can still be classified as motor, nonmotor, tonic-clonic, epileptic spasms, or behavior arrest. This "users' manual" for the ILAE 2017 seizure classification will assist the adoption of the new system. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  12. Lead exposure in the general population of the Metropolitan Area of Barcelona. Blood levels and related factors

    Energy Technology Data Exchange (ETDEWEB)

    Sole, E. [Pediatrics Service, Hospital Universitari Arnau de Vilanova, Lleida (Spain); Ballabriga, A.; Dominguez, C. [Centre d`Investigacions en Bioquimica y Biologia Molecular, Vall d`Hebron Hospitals, School of Medicine, Pediatrics Department, Universitat Autonoma de Barcelona, Barcelona (Spain)


    A cross-sectional was conducted on 254 individuals not occupationally exposed to lead to determine the degree of lead exposure in the general population of the Metropolitan Area of Barcelona. Blood lead levels (BPb) were analysed by atomic absorption spectrophotometry and zinc protoporphyrin (ZPP) by haemofluorimetry. Blood lead levels were analysed with respect to individuals` age, sex, area of residence, the season of the year the blood was drawn and ZPP. Mean blood lead in our series was 0.22{+-}0.011 {mu}mol/l (mean{+-}S.E.); no significant differences were found with respect to area of residence, sex or season. A linear relationship was observed between BPb and individuals` age (BPb=0.08+0.05xage; r=0.37). The prevalence of lead intoxication (BPb>0.48 {mu}mol/l) was 7.1%. No linear relationship was observed between BPb and ZPP. ZPP determination does not appear to be a good screening method for lead intoxication since it presents low specificity and sensitivity values with an area below the ROC curve similar to the null value line (area below the curve=0.5052, IC 95%=0.443-0.568). We conclude that lead exposure does not constitute a serious health problem in the area studied, since BPb levels found are far below the toxic limit and the prevalence of intoxication is similar to that reported in other studies conducted in other developed countries

  13. "Simple febrile seizures plus (SFS+)": more than one febrile seizure within 24 hours is usually okay. (United States)

    Grill, Marie F; Ng, Yu-Tze


    This study aimed to investigate whether children with recurrent febrile seizures within a 24-hour period need to be worked up differently from children with simple febrile seizures. Inclusion criteria included the following: (i) children with first seizure cluster between 4 months and 3 years of age, (ii) children who had more than one febrile seizure within 24 hours, and (iii) children who returned to baseline between and after each event. Thirty-two patients met the inclusion criteria over a 3-year period. All patients underwent brain CT and/or MRI and EEG. All head CTs were normal. Two children had abnormal MRI findings - both benign: one is thought to represent postictal changes, and the other one is an incidental arachnoid cyst. Of the 4 abnormal EEGs, one showed epileptiform discharges, while the others showed generalized ictal or postictal features. We propose the term "simple febrile seizures plus (SFS+)" to describe children who have more than one seizure within 24 hours but who are otherwise not different in presentation from children with SFS. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. [Effects of automobile lead on the general growth and sexual activity of the rat]. (United States)

    el Feki, A; Ghorbel, F; Smaoui, M; Makni-Ayadi, F; Kammoun, A


    To identify the active element of automotive exhaust gas responsible for masculine infertility, previously proved by our laboratory, we undertook these experiments. Four hundred young male and female rats were exposed during two months (30 min/d) to three types of automotive exhaust gases. The first type emanated from an engine running on gasoline with lead, the second from an unleaded gasoline engine, the third from a diesel engine. These three engines had the same power (5 horsepower vehicles gas also induced in male rats the atrophy of the testicle, seminal vesicle and epididym, certain pathological changes in spermatogenesis shown by the histologic study, and a decrease of the serum's testosterone level. In female rats, the relative weights of the ovary and uterus, as well as the percentage of the arrival of oestrus, were not affected by the gaseous treatment. Both the second and third types of gases seemed less active on the masculine sex as far as these parameters are concerned. Our study suggests that, for light vehicles, leaded gasoline pollutes more than unleaded gasoline or diesel fuels, and that the lead present only in the first type would be the active element responsible for the masculine infertility and body weight gain reduction in rats.

  15. Neurodiagnostic Evaluation of a Child with First Complex Febrile Seizure

    Directory of Open Access Journals (Sweden)

    Arpita S Thakker


    Full Text Available Background: Febrile seizure is the most common type of childhood seizure and complex febrile seizure has been associated with the risk of epilepsy. The neurodiagnostic evaluation of a child with first CFS is still unclear. Aim & Objective: To assess the clinical characteristics and diagnostic evaluation of children aged 1 month to 5 years presenting with first Complex Febrile Seizure (CFS and to determine the utility of various investigations in a case of first CFS. Material and Methods: A prospective study was conducted in the pediatric department of a tertiary hospital. Fortynine children aged 1 month-5 years with first CFS fulfilling the inclusion criteria were enrolled in the study over duration of 8-months. All the cases were evaluated with complete blood count, serum calcium, serum electrolytes, Electroencephalography (EEG, CT/MRI and lumbar puncture. Results: The investigation results were analyzed with respect to different CFS parameter like type of seizure (focal or generalized and duration of seizure(less than or more than 15 minutes. Upper respiratory tract infection is the main cause of febrile seizure. The duration of CFS did not vary according to the underlying cause. Serum calcium levels are found to be lower in children with complex febrile seizure. All children with CFS, whether focal or multiple generalized, whether of long or short duration, had a normal EEG. Children who had prolonged focal and multiple generalized seizures had abnormal neuroimaging but it was not statistically significant. Conclusion: We conclude from our study that a child with first CFS may not need EEG and neuroimaging as a diagnostic evaluation test. Hypocalcemia can be identified in these children and can be corrected to stop the seizure. Further studies are needed on a large series of children with first CFS to form guidelines for their neurodiagnostic evaluation.

  16. Why Are Seizures Rare in Rapid Eye Movement Sleep? Review of the Frequency of Seizures in Different Sleep Stages

    Directory of Open Access Journals (Sweden)

    Marcus Ng


    Full Text Available Since the formal characterization of sleep stages, there have been reports that seizures may preferentially occur in certain phases of sleep. Through ascending cholinergic connections from the brainstem, rapid eye movement (REM sleep is physiologically characterized by low voltage fast activity on the electroencephalogram, REMs, and muscle atonia. Multiple independent studies confirm that, in REM sleep, there is a strikingly low proportion of seizures (~1% or less. We review a total of 42 distinct conventional and intracranial studies in the literature which comprised a net of 1458 patients. Indexed to duration, we found that REM sleep was the most protective stage of sleep against focal seizures, generalized seizures, focal interictal discharges, and two particular epilepsy syndromes. REM sleep had an additional protective effect compared to wakefulness with an average 7.83 times fewer focal seizures, 3.25 times fewer generalized seizures, and 1.11 times fewer focal interictal discharges. In further studies REM sleep has also demonstrated utility in localizing epileptogenic foci with potential translation into postsurgical seizure freedom. Based on emerging connectivity data in sleep, we hypothesize that the influence of REM sleep on seizures is due to a desynchronized EEG pattern which reflects important connectivity differences unique to this sleep stage.

  17. Management of seizures in children. (United States)

    El-Radhi, A Sahib

    Seizures are common events in children and up to 10% of all children experience at least one seizure during their childhood. They can be triggered by many conditions such as fever, medications or injury. Febrile seizures are the most common types of seizures, affecting 3-4% of children. While epilepsy is typically recurrent and unprovoked, a single, isolated seizure is not epilepsy. Taking a detailed history of the seizure description helps establish the diagnosis. A video recording of the event can also support the diagnosis and rule out non-epileptic seizures that resemble seizures, such as pseudo-seizure. Seeing a child having a seizure, particularly if it is the first one, is usually frightening and distressing for the parents. First seizure should always be evaluated by health professionals because of a possible serious underlying cause. If the seizure occurs at home, the child should be placed in the recovery side position to prevent the swallowing of any vomit. The care of a child who does have epilepsy is best achieved by a community or hospital epilepsy specialist nurse. These nurses play a pivotal role in providing a close link between the epileptic children and their families. Such a nurse is also in an ideal position to establish a link between the doctor and affected families, offering valuable advice and support, and visiting the epileptic child at home.


    Directory of Open Access Journals (Sweden)

    M. B. Mironov


    Full Text Available The authors consider the historical description, nosological entity, clinical and electroencephalographic manifestations of gelastic seizures, a rare type of epileptic seizures manifesting as sudden attacks of spasmodic laughter. They describe their case of gelastic seizures in a child with tuberous sclerosis.

  19. Terminology of psychogenic nonepileptic seizures. (United States)

    Brigo, Francesco; Igwe, Stanley C; Ausserer, Harald; Nardone, Raffaele; Tezzon, Frediano; Bongiovanni, Luigi Giuseppe; Tinazzi, Michele; Trinka, Eugen


    Several different terms have been used to describe "psychogenic nonepileptic seizures" (PNES) in the literature. In this study, we evaluated the most common English terms used to describe PNES on Google and in PubMed using multiple search terms ( and The information prevalence of the five terms most frequently used to refer to PNES in PubMed were: psychogenic non(-)epileptic seizure(s), followed by pseudo(-)seizure(s), non(-)epileptic seizure(s), psychogenic seizure(s), and non(-)epileptic event(s). The five most frequently adopted terms to describe PNES in Google were: psychogenic non(-)epileptic seizure(s), followed by non(-)epileptic event(s), psychogenic attack(s), non(-)epileptic attack(s), and psychogenic non(-)epileptic attack(s). The broad spectrum of synonyms used to refer to PNES in the medical literature reflects a lack of internationally accepted, uniform terminology for PNES. In addition to "seizure(s)," lay people use the word "attack(s)" to describe PNES. Although considered obsolete, some terms, e.g., pseudoseizure(s), are still used in the recent medical literature. Adopting a uniform terminology to describe PNES could facilitate communication between epileptologists, physicians without specific expertise in epilepsy, and patients.

  20. Generalized laws of refraction that can lead to wave-optically forbidden light-ray fields. (United States)

    Courtial, Johannes; Tyc, Tomáš


    The recent demonstration of a metamaterial phase hologram so thin that it can be classified as an interface in the effective-medium approximation [Science 334, 333 (2011)] has dramatically increased interest in generalized laws of refraction. Based on the fact that scalar wave optics allows only certain light-ray fields, we divide generalized laws of refraction into two categories. When applied to a planar cross section through any allowed light-ray field, the laws in the first category always result in a cross section through an allowed light-ray field again, whereas the laws in the second category can result in a cross section through a forbidden light-ray field.

  1. Inhibition of adenylyl cyclase in amygdala blocks the effect of audiogenic seizure kindling in genetically epilepsy-prone rats. (United States)

    Tupal, Srinivasan; Faingold, Carl


    Genetically epilepsy-prone rats of the severe seizure strain (GEPR-9s) exhibit audiogenic seizures (AGS) beginning with wild running and ending with tonic hind limb extension (TE). AGS kindling in GEPR-9s involves periodic repetition of >/=14 seizures over 7-21 days and results in prolonged seizures and an additional phase of generalized post-tonic clonus (PTC) that follows TE. AGS kindling behavior changes are long-lasting and involve expansion of the requisite seizure neuronal network from the brainstem to include the amygdala, mediated by neuroplasticity in lateral amygdala. Recent evidence indicates that focal activation of adenylyl cyclase (AC) in lateral amygdala leads to precipitous acquisition of AGS-kindled seizure behaviors, suggesting that activation of AC activity is important in development and maintenance of AGS kindling. The present study further examined the role of AC in AGS-kindled seizures in GEPR-9s by focally inhibiting AC in the amygdala. Bilateral microinjection of an AC inhibitor, SQ22,536 (0.25 and 0.50 nmol/side), in AGS-kindled GEPR-9s selectively blocked PTC during AGS at 1 h after microinjection, but the pre-kindled AGS behaviors remained intact. The incidence of PTC during AGS returned to pre-drug levels 12 h after the lower dose of SQ22,536 (0.25 nmol/side). However, after the higher dose of SQ22,536 (0.5 nmol/side), complete return to AGS with PTC was seen in all GEPR-9s at 120 h. These results indicate that maintenance of AGS kindling-mediated PTC in GEPR-9s may involve activation of AC. These data provide further evidence for the involvement of AC in the epileptogenic mechanisms subserving AGS kindling.

  2. The M/M/1 queue with inventory, lost sale and general lead times

    DEFF Research Database (Denmark)

    Saffari, Mohammad; Asmussen, Søren; Haji, Rasoul

    We consider an M/M/1 queueing system with inventory under the (r,Q) policy and with lost sales, in which demands occur according to a Poisson process and service times are exponentially distributed. All arriving customers during stockout are lost. We derive the stationary distributions of the joi...... queue length (number of customers in the system) and on-hand inventory when lead times are random variables and can take various distributions. The derived stationary distributions are used to formulate long-run average performance measures and cost functions in some numerical examples....

  3. Electrocorticography and seizure outcomes in children with lesional epilepsy. (United States)

    Gelinas, Jennifer N; Battison, Andrew W; Smith, Sherry; Connolly, Mary B; Steinbok, Paul


    The use of electrocorticographically (ECoG)-guided cortical resection in children with lesional epilepsy is controversial. Given the important developmental issues associated with recurrent childhood seizures, sustained seizure control is a key therapeutic goal. We therefore evaluated the effect of the decision to perform lesionectomy or ECoG-guided cortical resection on seizure outcome and surgical morbidity in the pediatric population. We retrospectively analyzed seizure outcomes in 67 patients between the ages of 3 months and 16 years who underwent surgery for lesional epilepsy at British Columbia Children's Hospital. Thirty-four patients underwent ECoG, and 33 patients had lesionectomy without ECoG. One year post-operatively, 80% of patients who had ECoG-guided cortical resection or lesionectomy were seizure free. However, there was a trend toward improved seizure freedom in patients who had ECoG at most recent follow-up (79% patients with ECoG seizure free, vs. 61% with lesionectomy only; mean follow-up time 5.8 year, P=0.078). There was no increase in neurological morbidity in patients who had ECoG-guided cortical resection, and these patients were less likely to experience repeat epilepsy surgery. Overall, using ECoG to guide additional cortical resection may lead to more robust seizure freedom in children with lesional epilepsy without increasing their risk of surgical morbidity. © Springer-Verlag 2010

  4. Intracerebroventricular administration of histamine H3 receptor antagonists decreases seizures in rat models of epilepsia. (United States)

    Harada, C; Hirai, T; Fujii, Y; Harusawa, S; Kurihara, T; Kamei, C


    The effects of histamine H3 antagonists on amygdaloid kindled and maximal electroshock seizures in rats were studied to determine their potential as new antiepileptic drugs. Under pentobarbital anesthesia, rats were fixed to a stereotaxic apparatus and a stainless steel guide cannula for drug administration was implanted into the lateral ventricle. In amygdaloid kindled seizures, electrodes were implanted into the right amygdala and electroencephalogram was recorded bipolarly; stimulation was applied bipolarly every day by a constant current stimulator and continued until a generalized convulsion was obtained. In the maximal electroshock (MES) seizure test, electroconvulsion was induced by stimulating animals through ear-clip electrodes, and the durations of tonic and clonic seizures were measured. Thioperamide, clobenpropit, iodophenpropit, VUF5514, VUF5515 and VUF4929 caused a dose-dependent inhibition of both seizure stage and afterdischarge (AD) duration of amygdaloid kindled seizures. The duration of tonic seizure induced by MES was also inhibited by H3 antagonists, but the duration of clonic seizures were unchanged. Among the H3 antagonists tested, clobenpropit and iodophenpropit were somewhat more potent than the other drugs on amygdaloid kindled seizures and MES seizures, respectively. These results indicate that some H3 antagonists may be useful as antiepileptic drugs, especially for secondary generalized seizures and/or tonic-clonic seizures in humans.

  5. Epilepsy, unawareness of seizures and driving license: the potential role of 24-hour ambulatory EEG in defining seizure freedom. (United States)

    Fattouch, J; Di Bonaventura, C; Lapenta, L; Casciato, S; Fanella, M; Morano, A; Manfredi, M; Giallonardo, A T


    Seizures represent a potential source of accidents/death. Permission to drive may, therefore, be granted in a seizure-free period. Laws and regulations regarding this issue vary widely, and the onus of reporting seizures ultimately rests on the individual. Unfortunately, as some patients are unaware of their seizures, their reports may be unreliable. In this retrospective study, we selected, from a group of 1100 consecutive patients, 57 cases (26 males/31 females; mean age: 42.5 years) in whom the AEEG documented ictal events (UIEs) not reported in a self-kept diary. By means of a simple questionnaire, we interviewed all these patients to collect information on driving licenses. We, thus, assessed how many of these patients (both drug resistant and seizure free) drove regularly. Our study shows a relatively large number of patients with epilepsy and UIEs. Fifteen patients suffered from idiopathic generalized epilepsy (IGE) while 42 had partial epilepsy (PE). The patients were seizure free in 21 cases and 36 had drug-resistant seizures. Many patients in both these subgroups had a driving license and drove normally (active driving in 12/36 drug-resistant patients and in 18/21 seizure-free patients). Worthy of note is the finding that an "apparently" seizure-free group of patients drove regularly. This study revealed a large number of patients (both drug resistant and seizure free) with AEEG-documented UIEs. This finding highlights the usefulness of AEEG in clinical practice as a means of more accurately ascertaining seizure freedom and supporting decisions involving the renewal or granting of a driving license. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Frequency and causes of seizure among hospitalized burned children. (United States)

    Abedipour, Marzieh; Tavasouli, Azita; Sobouti, Behnam; Mansourimanesh, Mahzad; Saeedi Eslami, Nasir; Bodaghy Alny, Mehdi


    In this cross-sectional retrospective study, frequency, type, time of occurrence and atiology of seizures in children with burn was investigated. All cases were under 18 years and were hospitalized in Shahid Motahari Burns Hospital during 2006-2011. Extracted data from patients' medical records was reviewed and statistically analyzed. Among 1103 patients, 69 (6.2%) had seizures, more frequently in the first 24 h following burn. Thermal burn, especially with boiling water was the cause of burn in most of the children. Seizures occurred more commonly in children less than 3 years old and was generalized (tonic-clonic). Seizure was found to be primarily associated with febrile seizure, while hyponatremia was diagnosed as the second cause. Previous seizure history and seizure with unknown cause were identified as other etiologies. This paper summarizes the key information about seizure following burn, which health professionals, especially those in burn centers, should be aware. However, since this study was single-center more investigations in other centers are needed. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  7. Seizures beget seizures: the quest for GABA as a key player. (United States)

    Ben-Ari, Yehezkel


    Synapses mediated by gamma-aminobutyric acid (GABA) A receptors are notoriously altered during periods of enhanced activity. Since a loss of inhibitory tone is a basic cause of seizures and epilepsies, it is important to determine the underlying mechanisms and the way this could be alleviated or at least reduced. Alterations of the intracellular content of chloride are thought to be a major player in the sequence of events that follow episodes of hyperactivity. In this review, I discuss these mechanisms both in the adult and developing brain, relying on studies in which chloride and GABAergic currents were measured by electrophysiological and imaging techniques. The main conclusion is that in adult systems, status epilepticus induces a complete re-organization of the networks, with cell death, axonal growth, and glutamatergic neosynapse formation leading to an increased glutamatergic drive. This, in turn, will decrease the threshold of seizure generation and thus contribute to seizure generation. In contrast, GABAergic synapses are not readily "plastic" as the lost interneurones and synapses are not replaced. Somatostatin-positive 0-LM Interneurons that innervate the dendrites of the principal cells in the hippocampus degenerate selectively, leading to a loss of the inhibitory drive in the dendrites, whereas somatic projecting basket cells and somatic inhibitory drives are relatively spared. This imbalance leads to a reduction of the inhibitory strength that is necessary but not sufficient to generate ongoing seizures. An additional important factor is the persistent increase of the intracellular chloride concentration that leads to a long-lasting shift in the depolarizing direction of the actions of GABA that will also contribute to seizure generation. In the developing brain, a major source of seizure generation is the depolarizing and often excitatory actions of GABA due to a higher intracellular chloride concentration ([Cl-]I) in immature neurons, a property

  8. Seizure semiology and EEG findings in mitochondrial diseases. (United States)

    Chevallier, Justyna A; Von Allmen, Gretchen K; Koenig, Mary Kay


    Seizures constitute a frequent yet under-described manifestation of mitochondrial disorders (MDs). The aim of this study was to describe electroencephalography (EEG) findings and clinical seizure types in a population of children and adults with mitochondrial disease. Retrospective chart review of 165 records of children and adults with mitochondrial disease seen in the University of Texas Houston Mitochondrial Center between 2007 and 2012 was performed; all subjects were diagnosed with confirmed mitochondrial disease. EEG findings and clinical data, including seizure semiology and response to antiepileptic drugs (AEDs), were analyzed and categorized. Sixty-six percent (109/165) of subjects had a routine EEG performed. Sixty-one percent (67/109) of EEG studies were abnormal and 85% (56/67) had epileptiform discharges. The most common EEG finding was generalized slowing (40/67, 60%). The most frequent category of epileptiform activity seen was multifocal discharges (41%), followed by focal (39%) and generalized (39%) discharges. Clinical seizures were seen in 55% of subjects and the most common types of seizures observed were complex partial (37%) and generalized tonic-clonic (GTC; 37%). The most common seizure type in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) was GTC (33%), with generalized or focal discharges seen on EEG. In Leigh syndrome GTC (11%) and complex partial (11%) seizures were the most frequent types. Of 60 subjects with clinical seizures, 28% were intractable to medical treatment. Mitochondrial disorder should be included in the list of differential diagnosis in any child that presents with encephalopathy, seizures, and a fluctuating clinical course. Given the relatively high prevalence of EEG abnormalities in patients with MD, EEG should be performed during initial evaluation in all patients with MD, not only upon clinical suspicion of epilepsy. Wiley Periodicals, Inc. © 2014 International

  9. Prevalence and risk factors of seizure clusters in adult patients with epilepsy. (United States)

    Chen, Baibing; Choi, Hyunmi; Hirsch, Lawrence J; Katz, Austen; Legge, Alexander; Wong, Rebecca A; Jiang, Alfred; Kato, Kenneth; Buchsbaum, Richard; Detyniecki, Kamil


    In the current study, we explored the prevalence of physician-confirmed seizure clusters. We also investigated potential clinical factors associated with the occurrence of seizure clusters overall and by epilepsy type. We reviewed medical records of 4116 adult (≥16years old) outpatients with epilepsy at our centers for documentation of seizure clusters. Variables including patient demographics, epilepsy details, medical and psychiatric history, AED history, and epilepsy risk factors were then tested against history of seizure clusters. Patients were then divided into focal epilepsy, idiopathic generalized epilepsy (IGE), or symptomatic generalized epilepsy (SGE), and the same analysis was run. Overall, seizure clusters were independently associated with earlier age of seizure onset, symptomatic generalized epilepsy (SGE), central nervous system (CNS) infection, cortical dysplasia, status epilepticus, absence of 1-year seizure freedom, and having failed 2 or more AEDs (Pseizure clusters than patients with focal epilepsy (16.3%) and IGE (7.4%; all Pepilepsy type showed that absence of 1-year seizure freedom since starting treatment at one of our centers was associated with seizure clustering in patients across all 3 epilepsy types. In patients with SGE, clusters were associated with perinatal/congenital brain injury. In patients with focal epilepsy, clusters were associated with younger age of seizure onset, complex partial seizures, cortical dysplasia, status epilepticus, CNS infection, and having failed 2 or more AEDs. In patients with IGE, clusters were associated with presence of an aura. Only 43.5% of patients with seizure clusters were prescribed rescue medications. Patients with intractable epilepsy are at a higher risk of developing seizure clusters. Factors such as having SGE, CNS infection, cortical dysplasia, status epilepticus or an early seizure onset, can also independently increase one's chance of having seizure clusters. Copyright © 2017. Published

  10. Seizure following the Use of the COX-2 Inhibitor Etoricoxib (United States)

    Arnao, Valentina; Riolo, Marianna; Fierro, Brigida


    We describe a case of epileptic seizures occurring after the use of a COX-2 inhibitor. A 61-year-old man was admitted to our department because of a generalized tonic-clonic seizure. EEG showed generalized slowdown of the activity. Neuroimaging and blood samples studies did not evidence alterations, but a careful pharmacological history revealed that the patient had taken the COX-2 inhibitor etoricoxib to treat lumbago few days before the onset of clinical symptoms. No seizures were reported after etoricoxib discontinuation and an EEG resulted to be normal two months after this. Conclusion. Knowing the pharmacological history of a patient is important for understanding the clinical presentation and selecting appropriate treatment. This is, to the best of our knowledge, the first reported case of generalized seizures associated with the use of COX-2 inhibitors. PMID:28210513

  11. Posterior reversible encephalopathy syndrome and acute post-streptococcal glomerulonephritis mimicking breakthrough seizures

    Directory of Open Access Journals (Sweden)

    Kamille Abdool


    Full Text Available We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated antistreptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed.

  12. Death from seizures induced by chronic alcohol abuse--does it exist?

    DEFF Research Database (Denmark)

    Christoffersen, S


    may die from these seizures. A literature study was performed of deaths due to alcohol-induced seizures, either during withdrawal or as late-onset seizures where the aetiology was established as long time alcohol abuse and a necropsy had shown no other possible cause of death than a seizure. RESULTS......: It was not possible to find any well-documented cases. It is, however, difficult to compare cases in the literature, as there is no generally accepted classification or nomenclature of seizures related to alcohol abuse....... aetiologies, but in police reports a person known to have seizures is most likely to be reported as suffering from epilepsy. It is a well-known fact that alcoholics have seizures either due to "alcohol-induced epilepsy" or due to withdrawal from drinking. It also seems to be generally accepted that alcoholics...

  13. Emergence of semiology in epileptic seizures. (United States)

    Chauvel, Patrick; McGonigal, Aileen


    Semiology, the manifestation of epilepsy, is dependent upon electrical activity produced by epileptic seizures that are organized within existing neural pathways. Clinical signs evolve as the epileptic discharge spreads in both time and space. Studying the relation between these, of which the temporal component is at least as important as the spatial one, is possible using anatomo-electro-clinical correlations of stereoelectroencephalography (SEEG) data. The period of semiology production occurs with variable time lag after seizure onset and signs then emerge more or less rapidly depending on seizure type (temporal seizures generally propagating more slowly and frontal seizures more quickly). The subset of structures involved in semiological production, the "early spread network", is tightly linked to those constituting the epileptogenic zone. The level of complexity of semiological features varies according to the degree of involvement of the primary or associative cortex, with the former having a direct relation to peripheral sensory and motor systems with production of hallucinations (visual and auditory) or elementary sensorimotor signs. Depending on propagation pattern, these signs can occur in a "march" fashion as described by Jackson. On the other hand, seizures involving the associative cortex, having a less direct relation with the peripheral nervous system, and necessarily involving more widely distributed networks manifest with altered cognitive and/or behavioral signs whose neural substrate involves a network of cortical structures, as has been observed for normal cognitive processes. Other than the anatomical localization of these structures, the frequency of the discharge is a crucial determinant of semiological effect since a fast (gamma) discharge will tend to deactivate normal function, whereas a slower theta discharge can mimic physiological function. In terms of interaction between structures, the degree of synchronization plays a key role in

  14. MRI and EEG as long-term seizure outcome predictors in familial mesial temporal lobe epilepsy. (United States)

    Morita, Marcia E; Yasuda, Clarissa Lin; Betting, Luiz E; Pacagnella, Denise; Conz, Livia; Barbosa, Patricia Horn; Maurer-Morelli, Claudia Vianna; Costa, Andre Luiz F; Kobayashi, Eliane; Lopes-Cendes, Iscia; Cendes, Fernando


    To evaluate the natural history and outcome predictors in familial mesial temporal lobe epilepsy (FMTLE). We conducted a longitudinal study of 103 individuals from 17 FMTLE families (mean follow-up: 7.6 years). We divided subjects into 3 groups: FMTLE (n = 53), unclassified seizure (n = 18), and asymptomatics (n = 32). We divided FMTLE patients into 3 subgroups: seizure-free (n = 19), infrequent (n = 17) seizures, and frequent (n = 17) seizures and further reclassified them into favorable and poor outcome. We defined hippocampal atrophy (HA) by visual MRI analysis and performed volumetry in those who had 2 MRIs. FMTLE patients with infrequent seizures evolved to either frequent seizures (17.6%) or seizure freedom (23.5%). In the seizure-free group, most remained seizure-free and 21% developed infrequent seizures. All patients with frequent seizures remained in the same status or underwent surgery. Twelve percent of the asymptomatics and 22% of the unclassified-seizure group evolved to FMTLE with infrequent seizures. Predictive factors of poor outcome were presence of HA (p = 0.0192) and interictal epileptiform discharges (p = 0.0174). The relationship between initial precipitating incidents and clinical outcome was not significant although a tendency was observed (p = 0.055). Use of antiepileptic drugs and secondary generalized seizures during the patient's lifetime did not predict poor outcome. We observed progression of HA only in the group with frequent seizures. Most patients with FMTLE continued in the same clinical status. However, patients with frequent seizures had progression of HA and none improved except those who underwent surgery. Interictal epileptiform discharges and HA predicted poorer outcome in FMTLE, and there was a tendency in favor of initial precipitating incidents as outcome predictors.

  15. Feasibility study of a caregiver seizure alert system in canine epilepsy. (United States)

    Coles, Lisa D; Patterson, Edward E; Sheffield, W Douglas; Mavoori, Jaideep; Higgins, Jason; Michael, Bland; Leyde, Kent; Cloyd, James C; Litt, Brian; Vite, Charles; Worrell, Gregory A


    A device capable of detecting seizures and alerting caregivers would be a major advance for epilepsy management, and could be used to guide early intervention and prevent seizure-related injuries. The objective of this work was to evaluate a seizure advisory system (SAS) that alerts caregivers of seizures in canines with naturally occurring epilepsy. Four dogs with epilepsy were implanted with a SAS that wirelessly transmits continuous intracranial EEG (iEEG) to an external device embedded with a seizure detection algorithm and the capability to alert caregivers. In this study a veterinarian was alerted by automated text message if prolonged or repetitive seizures occurred, and a rescue therapy protocol was implemented. The performance of the SAS caregiver alert was evaluated over the course of 8 weeks. Following discontinuation of antiepileptic drugs, the dogs experienced spontaneous unprovoked partial seizures that secondarily generalized. Three prolonged or repetitive seizure episodes occurred in 2 of the dogs. On each occasion, the SAS caregiver alert successfully alerted an on call veterinarian who confirmed the seizure activity via remote video-monitoring. A rescue medication was then administered and the seizures were aborted. This study demonstrates the feasibility of a SAS to alert caregivers to the occurrence of prolonged or repetitive seizures and enables rescue medications to be delivered in a timely manner. The SAS may improve the management of human epilepsy by alerting caregivers of seizures, enabling early interventions, and potentially improving outcomes and quality of life of patients and caregivers.

  16. [Epileptic seizures in childhood: from seizure type to diagnosis]. (United States)

    Milh, M; Ticus, I; Villeneuve, N; Hugonencq, C; Mancini, J; Chabrol, B


    Epileptic seizures can be difficult to recognize in infancy and childhood because the semeiology can be misleading. Already, in the acute phase, precise assessment of the seizure is required, with active questioning about circumstances of occurrence, clinical manifestations and postictal symptoms. Laboratory tests and toxicologic screening should only be performed according to the circumstances and clinical examination in order to distinguish between symptomatic seizure and epilepsy at the beginning. Epilepsy consists in repetition of several unprovoked epileptic seizure. Assessment of the age of onset, type of seizures, interictal EEG and the neuropsychological profile are instrumental for both the diagnosis of epileptic syndrome and the choice of the right treatment. Epileptic seizures cause distress to parents and the fear they experience of death must always be taken into account.

  17. Seizures and epilepsy in cats

    Directory of Open Access Journals (Sweden)

    Moore SA


    Full Text Available Sarah A Moore Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA Abstract: Seizures are a common presenting complaint in cats, although causes and options for the treatment of seizures in this species have been historically poorly described in the veterinary literature. Seizure manifestation in cats may be different than what is typically seen in dogs, but the underlying causes of seizure activity are the same. These include primary epilepsies, structural epilepsies, and reactive seizures. Although primary epilepsy was once believed to be rare in cats, we now commonly appreciate this syndrome, albeit at a lower frequency than in dogs. Because of this, a complete diagnostic work-up is recommended for all cats presenting for initial evaluation of seizures. Symptomatic treatment of seizures in cats is similar to dogs, with only a few limitations related to species-specific antiepileptic drug toxicities. The goal of this review is to summarize the recent veterinary literature related to feline seizures, with a focus on seizure classification, clinical manifestation, diagnostic evaluation, and treatment options. Keywords: antiepileptic drug, seizure classification, levetiracetam, zonisamide, phenobarbital

  18. Treatment Of Seizures In The Elderly

    Directory of Open Access Journals (Sweden)

    Aleem MA


    Full Text Available The increasing life expectancy over the preceding decades and trend towards further increase means that the elderly is now a growing section of the population. Seizures are a particularly common disorder in the age group. Considering that above the age of 50 years, one is prone to suffer from atleast one chromic illness, the interplay between associated medical and neurologic diseases and seizures need to be understood. These comorbidities like hypertension, cerebrovascular accidents, diabetes, renal failure and others not only contribute to seizures, they may also interfere with their appropriate treatment. Seizures, on the other hand, may be the cause of added morbidity like fractures, head injury and poor self esteem which may lead to poor quality of life. In addition, the unique pharmacokinetics, pharmacodynamics and side effect profile of the various antieplileptic drugs in the elderly and the multiple drug interactions, require judicious use along with regular monitoring. However, an ideal antiepileptic drug for the elderly is yet to be found.

  19. Is it All About the Money? Not All Surgical Subspecialization Leads to Higher Lifetime Revenue when Compared to General Surgery. (United States)

    Baimas-George, Maria; Fleischer, Brian; Slakey, Douglas; Kandil, Emad; Korndorffer, James R; DuCoin, Christopher


    It is believed that spending additional years gaining expertise in surgical subspecialization leads to higher lifetime revenue. Literature shows that more surgeons are pursuing fellowship training and dedicated research years; however, there are no data looking at the aggregate economic impact when training time is accounted for. It is hypothesized that there will be a discrepancy in lifetime income when delay to practice is considered. Data were collected from the Medical Group Management Association's 2015 report of average annual salaries. Fixed time of practice was set at 30 years, and total adjusted revenue was calculated based on variable years spent in research and fellowship. All total revenue outcomes were compared to general surgery and calculated in US dollars. The financial data on general surgeons and 9 surgical specialties (vascular, pediatric, plastic, breast, surgical oncology, cardiothoracic, thoracic primary, transplant, and trauma) were examined. With fellowship and no research, breast and surgical oncology made significantly less than general surgery (-$1,561,441, -$1,704,958), with a difference in opportunity cost equivalent to approximately 4 years of work. Pediatric and cardiothoracic surgeons made significantly more than general surgeons, with an increase of opportunity cost equivalent to $5,301,985 and $3,718,632, respectively. With 1 research year, trauma surgeons ended up netting less than a general surgeon by $325,665. With 2 research years, plastic and transplant surgeons had total lifetime revenues approximately equivalent to that of a general surgeon. Significant disparities exist in lifetime total revenue between surgical subspecialties and in comparison, to general surgery. Although most specialists do gross more than general surgeons, breast and surgical oncologists end up netting significantly less over their lifetime as well as trauma surgeons if they do 1 year of research. Thus, the economic advantage of completing additional

  20. Epileptic seizures precipited by eating: a case report

    Directory of Open Access Journals (Sweden)

    Fernando Carlos Aleixo Sepulveda


    Full Text Available The case of one 23 year-old girl who had epileptic manifestations is reported. At first, generalized tonic seizures; afterwards, epileptic seizures precipited by eating. The electroencephalograms showed left temporal lobe disfunctions. Different types of drugs were used with no sucess. The best results were obtained by association of sodium valproate, clonazepan and phenobarbital. Comments are made about clinic and etiopathogenesis, believing the authors in the hipothesis of nervous structures chronic hiperactivity. To Walker8 the hiperactivity was reached by hormones production under neural control of specific cerebral centers. The continuous bombardment of epileptic discharges to hypothalamic centers is the probably responsible by epileptic seizures precipited by eating.

  1. Automated differentiation between epileptic and non-epileptic convulsive seizures

    DEFF Research Database (Denmark)

    Beniczky, Sándor; Conradsen, Isa; Moldovan, Mihai


    Our objective was the clinical validation of an automated algorithm based on surface electromyography (EMG) for differentiation between convulsive epileptic and psychogenic nonepileptic seizures (PNESs). Forty-four consecutive episodes with convulsive events were automatically analyzed...... with the algorithm: 25 generalized tonic-clonic seizures (GTCSs) from 11 patients, and 19 episodes of convulsive PNES from 13 patients. The gold standard was the interpretation of the video-electroencephalographic recordings by experts blinded to the EMG results. The algorithm correctly classified 24 GTCSs (96......%) and 18 PNESs (95%). The overall diagnostic accuracy was 95%. This algorithm is useful for distinguishing between epileptic and psychogenic convulsive seizures....

  2. Spatiotemporal differences in the c-fos pathway between C57BL/6J and DBA/2J mice following flurothyl-induced seizures: A dissociation of hippocampal Fos from seizure activity. (United States)

    Kadiyala, Sridhar B; Papandrea, Dominick; Tuz, Karina; Anderson, Tara M; Jayakumar, Sachidhanand; Herron, Bruce J; Ferland, Russell J


    Significant differences in seizure characteristics between inbred mouse strains highlight the importance of genetic predisposition to epilepsy. Here, we examined the genetic differences between the seizure-resistant C57BL/6J (B6) mouse strain and the seizure-susceptible DBA/2J (D2) strain in the phospho-Erk and Fos pathways to examine seizure-induced neuronal activity to uncover potential mechanistic correlates to these disparate seizure responsivities. Expression of neural activity markers was examined following 1, 5, or 8 seizures, or after 8 seizures, a 28 day rest period, and a final flurothyl rechallenge. Two brain regions, the hippocampus and ventromedial nucleus of the hypothalamus (VMH), had significantly different Fos expression profiles following seizures. Fos expression was highly robust in B6 hippocampus following one seizure and remained elevated following multiple seizures. Conversely, there was an absence of Fos (and phospho-Erk) expression in D2 hippocampus following one generalized seizure that increased with multiple seizures. This lack of Fos expression occurred despite intracranial electroencephalographic recordings indicating that the D2 hippocampus propagated ictal discharge during the first flurothyl seizure suggesting a dissociation of seizure discharge from Fos and phospho-Erk expression. Global transcriptional analysis confirmed a dysregulation of the c-fos pathway in D2 mice following 1 seizure. Moreover, global analysis of RNA expression differences between B6 and D2 hippocampus revealed a unique pattern of transcripts that were co-regulated with Fos in D2 hippocampus following 1 seizure. These expression differences could, in part, account for D2's seizure susceptibility phenotype. Following 8 seizures, a 28 day rest period, and a final flurothyl rechallenge, ∼85% of B6 mice develop a more complex seizure phenotype consisting of a clonic-forebrain seizure that uninterruptedly progresses into a brainstem seizure. This seizure phenotype

  3. Seizure activity post organophosphate exposure. (United States)

    Tattersall, John


    Electrographic seizures are a feature of organophosphate anticholinesterase intoxication. Clinical studies of pesticide poisonings suggest that seizures are more common in children than in adults. Since flaccid paralysis, a characteristic sign of organophosphate poisoning, can mask convulsions, the most reliable indicator of seizures is the electroencephalogram, but this has not been widely used in clinical studies. Seizures can rapidly progress to status epilepticus, contributing to mortality and, in survivors, to neuronal damage and neurological impairment. Anticonvulsant drugs can significantly reduce the lethal and toxic effects of these compounds. A benzodiazepine, usually diazepam, is the treatment currently indicated for control of seizures. Animal studies have indicated that the early phase of seizure activity (0-5 min after seizure onset) is purely cholinergic, predominantly involving muscarinic mechanisms. Seizure activity subsequently progresses through mixed cholinergic and noncholinergic modulation (5-40 min) into a final noncholinergic phase. Neuropathology caused by seizures is most likely associated with glutamatergic excitotoxicity. Future prospects for improved treatments include new benzodiazepines, glutamate receptor antagonists, antimuscarinics with additional antiglutamatergic activity and adenosine receptor antagonists.

  4. Seizure outcome in 175 patients with juvenile myoclonic epilepsy--a long-term observational study. (United States)

    Höfler, Julia; Unterberger, Iris; Dobesberger, Judith; Kuchukhidze, Giorgi; Walser, Gerald; Trinka, Eugen


    Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy syndrome. Under appropriate antiepileptic drugs (AED) up to 85% of patients become seizure-free, but many may have a relapse after AED withdrawal. We retrospectively studied 242 patients with JME at the Department of Neurology, Medical University Innsbruck, Austria (1975-2006). We analyzed age at seizure onset, age at last follow up, seizure types, photosensitivity, seizure outcome and neuroimaging findings; inclusion criterion was a medical treatment period of >2 years; exclusion criteria were traumatic or infectious brain injury before the onset of JME and/or gross structural pathology on neuroimaging. We identified 175 patients (111 women) with a median age at seizure onset of 15 years, (range 3-46) and a median age at follow-up (FU) of 38 years (range 14-87; median FU 8 years, range 2-38). Fourteen percent showed (24/175) photosensitivity on routine EEG. Seizure outcome: 62% (109/175) were seizure-free of myoclonic seizures (MS), generalized tonic clonic seizures (GTCS) and absence seizures (AS) for >1 year, and 53% (94/175) for >2 years, including 16 patients (9%) without AEDs. Thirty-one percent (54/175) were seizure-free between 2 and 5 years, 15% (26/175) between 6 and 10, and 8% (14/175) >10 years; 38% (66/175) were not seizure-free. Not seizure-free patients had more often MS, AS and GTCS within the first year of epilepsy than those who were seizure-free at last FU (11% vs. 3%, Chi(2)=4.679, df=1, p=0.043). Seizure-free patients had more often MS and GTCS as last seizure types in the year before becoming seizure-free (37% vs. 15%, p=0.003), whereas in not seizure-free group MS only and GTCS only persisted. JME does not always need lifelong treatment, as a substantial minority of patients remain seizure-free without AEDs. AS, MS and GTCS at onset of the disease are indicators of poor long-term seizure control. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  5. Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures.

    Directory of Open Access Journals (Sweden)

    Evonne Low

    Full Text Available Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases.To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS seizures.Retrospective observational study.Neonates >37 weeks born between 2003 and 2011 in two hospitals.Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized.Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1-2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%.Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.

  6. Increased levels of HMGB1 and pro-inflammatory cytokines in children with febrile seizures. (United States)

    Choi, Jieun; Min, Hyun Jin; Shin, Jeon-Soo


    Febrile seizures are the most common form of childhood seizures. Fever is induced by pro-inflammatory cytokines during infection, and pro-inflammatory cytokines may trigger the development of febrile seizures. In order to determine whether active inflammation, including high mobility group box-1 (HMGB1) and pro-inflammatory cytokines, occurs in children with febrile seizures or epilepsy, we analyzed cytokine profiles of patients with febrile seizures or epilepsy. Forty-one febrile seizure patients who visited the emergency department of Seoul National University Boramae Hospital from June 2008 to May 2009 were included in this study. Blood was obtained from the febrile seizure child patients within 30 minutes of the time of the seizure; subsequently, serum cytokine assays were performed. Control samples were collected from children with febrile illness without convulsion (N = 41) and similarly analyzed. Serum samples from afebrile status epilepticus attacks in intractable epilepsy children (N = 12), afebrile seizure attacks in generalized epilepsy with febrile seizure plus (GEFSP) children (N = 6), and afebrile non-epileptic controls (N = 7) were also analyzed. Serum HMGB1 and IL-1β levels were significantly higher in febrile seizure patients than in fever only controls (p febrile seizures than in fever only controls (p febrile seizure children. Although it is not possible to infer causality from descriptive human studies, our data suggest that HMGB1 and the cytokine network may contribute to the generation of febrile seizures in children. There may be a potential role for anti-inflammatory therapy targeting cytokines and HMGB1 in preventing or limiting febrile seizures or subsequent epileptogenesis in the vulnerable, developing nervous system of children.

  7. A case of seizures induced by abstract reasoning. (United States)

    Tatsuzawa, Yasutaka; Yoshino, Aihide; Nomura, Soichiro


    We describe a case of reflex seizures induced by abstract reasoning but not other cognitive processes. The patient, a 46-year-old man, experienced myoclonic seizures whenever he played shogi (Japanese chess). To identify the critical thought processes responsible for inducing his seizures, we monitored his clinical seizures and epileptiform discharges while he performed comprehensive neuropsychological tests, including the Wechsler Adult Intelligence Scale-Revised (WAIS-R), spatial working memory, mental rotation, and Wisconsin Card Sorting Test (WCST) tasks. A myoclonic seizure occurred only during the WCST. Generalized 3- to 5-Hz spike-and-slow-wave bursts occurred repeatedly during the Block Design subtest of the WAIS-R and the WCST, whereas no discharges occurred during other subtests of the WAIS-R including the calculation, spatial working memory, and mental rotation tasks. These results indicate that abstract reasoning, independent of other cognitive processes, could induce the patient's epileptiform discharges, suggesting that his reflex seizures might be a distinct subtype of nonverbal thinking-induced seizures.

  8. Revising the "Rule of Three" for inferring seizure freedom. (United States)

    Westover, M Brandon; Cormier, Justine; Bianchi, Matt T; Shafi, Mouhsin; Kilbride, Ronan; Cole, Andrew J; Cash, Sydney S


    How long after starting a new medication must a patient go without seizures before they can be regarded as seizure-free? A recent International League Against Epilepsy (ILAE) task force proposed using a "Rule of Three" as an operational definition of seizure freedom, according to which a patient should be considered seizure-free following an intervention after a period without seizures has elapsed equal to three times the longest preintervention interseizure interval over the previous year. This rule was motivated in large part by statistical considerations advanced in a classic 1983 paper by Hanley and Lippman-Hand. However, strict adherence to the statistical logic of this rule generally requires waiting much longer than recommended by the ILAE task force. Therefore, we set out to determine whether an alternative approach to the Rule of Three might be possible, and under what conditions the rule may be expected to hold or would need to be extended. Probabilistic modeling and application of Bayes' rule. We find that an alternative approach to the problem of inferring seizure freedom supports using the Rule of Three in the way proposed by the ILAE in many cases, particularly in evaluating responses to a first trial of antiseizure medication, and to favorably-selected epilepsy surgical candidates. In cases where the a priori odds of success are less favorable, our analysis requires longer seizure-free observation periods before declaring seizure freedom, up to six times the average preintervention interseizure interval. The key to our approach is to take into account not only the time elapsed without seizures but also empirical data regarding the a priori probability of achieving seizure freedom conferred by a particular intervention. In many cases it may be reasonable to consider a patient seizure-free after they have gone without seizures for a period equal to three times the preintervention interseizure interval, as proposed on pragmatic grounds in a recent ILAE

  9. Microscale spatiotemporal dynamics during neocortical propagation of human focal seizures. (United States)

    Wagner, Fabien B; Eskandar, Emad N; Cosgrove, G Rees; Madsen, Joseph R; Blum, Andrew S; Potter, N Stevenson; Hochberg, Leigh R; Cash, Sydney S; Truccolo, Wilson


    Some of the most clinically consequential aspects of focal epilepsy, e.g. loss of consciousness, arise from the generalization or propagation of seizures through local and large-scale neocortical networks. Yet, the dynamics of such neocortical propagation remain poorly understood. Here, we studied the microdynamics of focal seizure propagation in neocortical patches (4×4 mm) recorded via high-density microelectrode arrays (MEAs) implanted in people with pharmacologically resistant epilepsy. Our main findings are threefold: (1) a newly developed stage segmentation method, applied to local field potentials (LFPs) and multiunit activity (MUA), revealed a succession of discrete seizure stages, each lasting several seconds. These different stages showed characteristic evolutions in overall activity and spatial patterns, which were relatively consistent across seizures within each of the 5 patients studied. Interestingly, segmented seizure stages based on LFPs or MUA showed a dissociation of their spatiotemporal dynamics, likely reflecting different contributions of non-local synaptic inputs and local network activity. (2) As previously reported, some of the seizures showed a peak in MUA that happened several seconds after local seizure onset and slowly propagated across the MEA. However, other seizures had a more complex structure characterized by, for example, several MUA peaks, more consistent with the succession of discrete stages than the slow propagation of a simple wavefront of increased MUA. In both cases, nevertheless, seizures characterized by spike-wave discharges (SWDs, ~2-3 Hz) eventually evolved into patterns of phase-locked MUA and LFPs. (3) Individual SWDs or gamma oscillation cycles (25-60 Hz), characteristic of two different types of recorded seizures, tended to propagate with varying degrees of directionality, directions of propagation and speeds, depending on the identified seizure stage. However, no clear relationship was observed between the MUA


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    Full Text Available Background:Febrile Convulsion is the most common convulsive disorder in children,occurring in 2 to 4% of the pediatric population and recurring in 30-50% of cases. Considering the varying recurrence rates reported, thisstudy was conducted at the pediatric ward of the Shaheed BeheshtiGeneral Hospital, between 2000-2001 to determine the frequencyof recurrence and related risk factors in children presenting with theirfirst episode of febrile convulsionMaterials & Methods:A two–year cohort study was performed on 50 children presentingwith the first attack of febrile convulsion. Patient demographic dataincluding age, sex, type and duration of seizure, family history offebrile seizure or epilepsy and the interval between fever onset andoccurrence of seizure were recorded in questionnaires. Those patients,for whom prophylactic medication was not administered, werefollowed at three–month intervals for up to one year. Findings werestatistically analyzed using Fisher’s exact testResults:Recurrence was observed in twelve children (24% out of the fifty,being most common in patients aged less than one year (54.4%.Recurrence rates among children with a positive family history offebrile convulsion, presence of complex febrile seizure and positivefamily history of epilepsy were 42.1%, 42.8% and 25% respectively.From among those children with a “less than one hour” intervalbetween fever onset and occurrence of seizure, recurrence occurredin 43-7% of cases, while in those with a “more than one hourinterval”, 14.7% experienced recurrence.Conclusion:Recurrence rates are increased by certain factors including age-belowone year-, positive family history of febrile convulsion, and a “lessthan one hour” interval between time of fever onset and seizureoccurrence.

  11. Seizures and Teens: Using Technology to Develop Seizure Preparedness (United States)

    Shafer, Patricia O.; Schachter, Steven C.


    Most people learn about seizures from their doctors, but others know only what they have seen on television. Unfortunately, visits to doctor's office aren't long enough to learn all that is needed, and often times, doctors and nurses aren't available to teach this information. Seizures are often represented inaccurately and too dramatically on…

  12. Characteristics of the initial seizure in familial febrile seizures

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); E. van Beijeren; N.H. Wils; G. Derksen-Lubsen (Gerarda); C.M. van Duijn (Cock); H.A. Moll (Henriëtte)


    textabstractComplex seizure characteristics in patients with a positive family history were studied to define familial phenotype subgroups of febrile seizures. A total of 51 children with one or more affected first degree relatives and 177 without an affected first degree relative

  13. Profile of children admitted with seizures in a tertiary care hospital of Western Nepal (United States)


    Background Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes form the developing countries. Current study aims to find the common etiology of seizure and classify seizure types in various age groups presenting to tertiary center in Western Nepal. Methods This was a hospital based retrospective study carried out in the data retrieved from the records maintained in the Department of Pediatrics, Manipal Teaching Hospital, Pokhara from 1st July 2007 to 31st July 2011.Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course. Results A total of 551 patients were admitted for seizures with 338 (61.3%) males and 213 (38.7%) females. Among these patients, 295 (53.5%) presented with fever and 317 (57.5%) of children were less than 5 years of age. Generalized tonic-clonic seizures were the most common seizure type (69.9%). Seizure disorder (33.4%), febrile seizures (30.7%), CNS infections and neurocysticercosis were common etiologies. Abnormal brain images were noted in 111 (45.9%) of 242 patients and most common abnormality was neurocysticercosis 66 (59.5%). Conclusion CNS infections and febrile convulsions were common causes of seizures in febrile children. Neuroimaging should be advised in all afebrile children for the diagnosis of neurocysticercosis. Children diagnosed as seizure disorder require long term follow up studies including neurophysiologic studies. PMID:23536998

  14. Clinical Microbiological Aspects of Epileptic Seizures in the Tropical Countries with Specific Focus on Nigeria

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    Ijeoma Kanu


    Full Text Available Epilepsy is a common neurological disorder; however, in Nigeria and other tropical regions, the causes of epileptic seizures differ greatly in etiology. This paper is an attempt to highlight some possible microbiological aspects of epileptic seizures. A literature review was carried out to identify the extent to which microbial infections were involved in the elicitation of epileptic seizures. Data were collected from several clinics in the community and hospitals in Nigeria and correlated with the evidence from the literature review. It was found that different microbial agents including viral, bacterial, protozoa, and fungal agents were involved in several aspects of epileptic seizures. Malaria was found to cause more than 88% of childhood epileptic seizures and 12% of adult seizures. Generalized tonic-clonic seizures occurred in more than 40% of adult patients. Partial seizures were uncommon. Cases of epileptic seizures associated with bacteria (e.g., brucellosis, viral, fungal, and protozoa infections were frequently reported. Malaria, tapeworm, and cysticercosis were some of the common infectious causes of epilepsy; however, in some cases, the cause remained unknown. From these findings, it was evident that microbiological aspects of epilepsies are possible research areas that might be developed. It is believed that the unraveling of the various microbiological factors in epileptic seizures would have important implications for understanding the underlying neurobiology, evaluating treatment strategies, and perhaps planning health-care resources for the affected. It will also help to improve the prognostic factors in initial seizure symptomatic etiology and presence of any structural cerebral abnormalities.


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    Parvaneh KARIMZADEH


    Full Text Available ObjectivePhenylketonuria (PKU is an autosomal recessive metabolic genetic disorder characterized by a deficiency in the hepatic enzyme phenylalanine hydroxylase (PAH which can cause problems with brain development, leading to progressive mental retardation, brain damage, and seizures. In this study we evaluated the frequency of seizure, EEG abnormality and behavioral disorders.Materials & Methods In this case study, 94 PKU children aged between 1 month and 23 years who were referred to Mofid children Hospital between 2009 and 2010 were enrolled.Patients were age and sex matched. Statistical tests were used for comparing patients' data.Results The mean age of patients was 8.4 years. Parents were relatives in 80.9% of the cases (76 patients. Of all, 43% (45 patients had seizure but EEG was abnormal only in 81% of them (35 patients out of 43 patients. Totally, EEG was abnormal in 67% of the cases (63 patients of whom 44.4% (28 patients of 63 patients did not have seizure. Therefore, there was a significant relationship between seizure and EEG abnormality. The phenylalanine level ranged from 8mg/dL to 50mg/dL (mean: 18.88 mg/dL at the time of diagnosis and from 0.4mg/dL to 18mg/dL (mean: 7.37mg/dL at the time of evaluation. On the other hand,we observed abnormal behaviors in all EEG abnormalities and there was a significant relationship between EEG abnormality and behavioral disorders.ConclusionIn our study, the prevalence of seizure was less than EEG abnormality and there was a significant relationship between EEG abnormalities and behavioral disorders in patients with Phenylketonuria regardless of seizure.The authors believe that treatment of EEG abnormalities may lead to the correction of behavioral disorders in these patients.Keywords:Phenylketonuria, Seizure, EEG abnormality, behavioral disorder

  16. Effect of Various Antiepileptic Drugs in Zebrafish PTZ-Seizure Model


    P Gupta; S B Khobragade; Shingatgeri, V. M.


    Recently zebrafish larvae have emerged as a high-throughput model for screening pharmacological activities. The present study was undertaken to investigate the effect of established anticonvulsants, such as valproic acid, carbamazepine, gabapentin, diazepam, lacosamide and pregabalin against pentylenetetrazole (6 mM) seizures in adult zebrafish. Different phases of seizures (increase swim activity, rapid whirlpool-like circling swim behaviour and brief clonus-like seizures leading to loss of ...

  17. Mapping preictal networks preceding childhood absence seizures using magnetoencephalography. (United States)

    Jacobs-Brichford, Eliza; Horn, Paul S; Tenney, Jeffrey R


    The electrographic hallmark of childhood absence seizures is 3 Hz generalized spike and wave discharges; however, there is likely a focal thalamic or cortical onset that cannot be detected using scalp electroencephalography (EEG). The purpose of this study was to study the earliest preictal changes in children with absence epilepsy. In this report, magnetoencephalography recordings of 44 absence seizures recorded from 12 children with drug-naïve childhood absence seizures were used to perform time frequency analysis and source localization prior to the onset of the seizures. Evidence of preictal magnetoencephalography frequency changes were detected a mean of 694 ms before the initial spike on the EEG. A consistent pattern of focal sources was present in the frontal cortex and thalamus during this preictal period, but source localization occurred synchronously so that independent activity between the 2 structures could not be distinguished.

  18. [Reflex seizures, cinema and television]. (United States)

    Olivares-Romero, Jesús


    In movies and television series are few references to seizures or reflex epilepsy even though in real life are an important subgroup of total epileptic syndromes. It has performed a search on the topic, identified 25 films in which they appear reflex seizures. Most seizures observed are tonic-clonic and visual stimuli are the most numerous, corresponding all with flashing lights. The emotions are the main stimuli in higher level processes. In most cases it is not possible to know if a character suffers a reflex epilepsy or suffer reflex seizures in the context of another epileptic syndrome. The main conclusion is that, in the movies, the reflex seizures are merely a visual reinforcing and anecdotal element without significant influence on the plot.

  19. A study of the dynamics of seizure propagation across micro domains in the vicinity of the seizure onset zone (United States)

    Basu, Ishita; Kudela, Pawel; Korzeniewska, Anna; Franaszczuk, Piotr J.; Anderson, William S.


    Objective. The use of micro-electrode arrays to measure electrical activity from the surface of the brain is increasingly being investigated as a means to improve seizure onset zone (SOZ) localization. In this work, we used a multivariate autoregressive model to determine the evolution of seizure dynamics in the 70-110 Hz high frequency band across micro-domains sampled by such micro-electrode arrays. We showed that a directed transfer function (DTF) can be used to estimate the flow of seizure activity in a set of simulated micro-electrode data with known propagation pattern. Approach. We used seven complex partial seizures recorded from four patients undergoing intracranial monitoring for surgical evaluation to reconstruct the seizure propagation pattern over sliding windows using a DTF measure. Main results. We showed that a DTF can be used to estimate the flow of seizure activity in a set of simulated micro-electrode data with a known propagation pattern. In general, depending on the location of the micro-electrode grid with respect to the clinical SOZ and the time from seizure onset, ictal propagation changed in directional characteristics over a 2-10 s time scale, with gross directionality limited to spatial dimensions of approximately 9 m{{m}2}. It was also seen that the strongest seizure patterns in the high frequency band and their sources over such micro-domains are more stable over time and across seizures bordering the clinically determined SOZ than inside. Significance. This type of propagation analysis might in future provide an additional tool to epileptologists for characterizing epileptogenic tissue. This will potentially help narrowing down resection zones without compromising essential brain functions as well as provide important information about targeting anti-epileptic stimulation devices.

  20. Topographic movie of intracranial ictal high-frequency oscillations with seizure semiology: epileptic network in Jacksonian seizures. (United States)

    Akiyama, Tomoyuki; Chan, Derrick W; Go, Cristina Y; Ochi, Ayako; Elliott, Irene M; Donner, Elizabeth J; Weiss, Shelly K; Snead, O Carter; Rutka, James T; Drake, James M; Otsubo, Hiroshi


    We developed a technique to produce images of dynamic changes in ictal high-frequency oscillations (HFOs) >40 Hz recorded on subdural electroencephalography (EEG) that are time-locked to the ictal EEG and ictal semiology video. We applied this technique to Jacksonian seizures to demonstrate ictal HFO propagation along the homunculus in the primary sensory-motor cortex to visualize the underlying epileptic network. We analyzed intracranial ictal EEGs from two patients with intractable Jacksonian seizures who underwent epilepsy surgery. We calculated the degrees of increase in amplitude within 40-80, 80-200, and 200-300 Hz frequency bands compared to the interictal period and converted them into topographic movies projected onto the brain surface picture. We combined these data with the ictal EEGs and video of the patient demonstrating ictal semiology. The ictal HFOs began in the sensory cortex and appeared concomitantly with the sensory aura. They then propagated to the motor cortex at the same time that focal motor symptoms evolved. As the seizure progressed, the ictal HFOs spread or reverberated in the rolandic region. However, even when the seizure became secondarily generalized, the ictal HFOs were confined to the rolandic region. In both cases, there was increased amplitude of higher frequency bands during seizure initiation compared to seizure progression. This combined movie showed the ictal HFO propagation corresponding to the ictal semiology in Jacksonian seizures and revealed the epileptic network involved in seizure initiation and progression. This method may advance understanding of neural network activities relating to clinical seizure generation and propagation. Wiley Periodicals, Inc. © 2010 International League Against Epilepsy.

  1. Predicting epileptic seizures in advance.

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    Negin Moghim

    Full Text Available Epilepsy is the second most common neurological disorder, affecting 0.6-0.8% of the world's population. In this neurological disorder, abnormal activity of the brain causes seizures, the nature of which tend to be sudden. Antiepileptic Drugs (AEDs are used as long-term therapeutic solutions that control the condition. Of those treated with AEDs, 35% become resistant to medication. The unpredictable nature of seizures poses risks for the individual with epilepsy. It is clearly desirable to find more effective ways of preventing seizures for such patients. The automatic detection of oncoming seizures, before their actual onset, can facilitate timely intervention and hence minimize these risks. In addition, advance prediction of seizures can enrich our understanding of the epileptic brain. In this study, drawing on the body of work behind automatic seizure detection and prediction from digitised Invasive Electroencephalography (EEG data, a prediction algorithm, ASPPR (Advance Seizure Prediction via Pre-ictal Relabeling, is described. ASPPR facilitates the learning of predictive models targeted at recognizing patterns in EEG activity that are in a specific time window in advance of a seizure. It then exploits advanced machine learning coupled with the design and selection of appropriate features from EEG signals. Results, from evaluating ASPPR independently on 21 different patients, suggest that seizures for many patients can be predicted up to 20 minutes in advance of their onset. Compared to benchmark performance represented by a mean S1-Score (harmonic mean of Sensitivity and Specificity of 90.6% for predicting seizure onset between 0 and 5 minutes in advance, ASPPR achieves mean S1-Scores of: 96.30% for prediction between 1 and 6 minutes in advance, 96.13% for prediction between 8 and 13 minutes in advance, 94.5% for prediction between 14 and 19 minutes in advance, and 94.2% for prediction between 20 and 25 minutes in advance.

  2. Local cerebral metabolism during partial seizures

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    Engel, J. Jr.; Kuhl, D.E.; Phelps, M.E.; Rausch, R.; Nuwer, M.


    Interictal and ictal fluorodeoxyglucose scans were obtained with positron CT from four patients with spontaneous recurrent partial seizures, one with epilepsia partialis continua, and one with a single partial seizure induced by electrical stimulation of the hippocampus. Ictal metabolic patterns were different for each patient studied. Focal and generalized increased and decreased metabolism were observed. Ictal hypermetabolism may exceed six times the interictal rate and could represent activation of excitatory or inhibitory synapses in the epileptogenic region and its projection fields. Hypometabolism seen on ictal scans most likely reflects postictal depression and may indicate projection fields of inhibited neurons. No quantitative relationship between alterations in metabolism and EEG or behavioral measurements of ictal events could be demonstrated.

  3. Treating acute seizures with benzodiazepines: does seizure duration matter? (United States)

    Naylor, David E


    Several clinical trials have shown improved seizure control and outcome by early initiation of treatment with benzodiazepines, before arrival in the emergency department and before intravenous access can be established. Here, evidence is provided and reviewed for rapid treatment of acute seizures in order to avoid the development of benzodiazepine pharmacoresistance and the emergence of self-sustaining status epilepticus. Alterations in the physiology, pharmacology, and postsynaptic level of GABA-A receptors can develop within minutes to an hour and hinder the ability of synaptic inhibition to stop seizures while also impairing the efficacy of GABAergic agents, such as benzodiazepines, to boost impaired inhibition. In addition, heightened excitatory transmission further exacerbates the inhibitory/excitatory balance and makes seizure control even more resistant to treatment. The acute increase in the surface expression of NMDA receptors during prolonged seizures also may cause excitotoxic injury, cell death, and other pathological expressions and re-arrangements of receptor subunits that all contribute to long-term sequelae such as cognitive impairment and chronic epilepsy. In conclusion, a short window of opportunity exists when seizures are maximally controlled by first-line benzodiazepine treatment. After that, multiple pathological mechanisms quickly become engaged that make seizures increasingly more difficult to control with high risk for long-term harm.

  4. Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations. (United States)

    Englot, Dario J; Han, Seunggu J; Lawton, Michael T; Chang, Edward F


    Seizures are the most common presenting symptom of supratentorial cerebral cavernous malformations (CCMs) and progress to medically refractory epilepsy in 40% of patients. Predictors of seizure freedom in the resection of CCMs are incompletely understood. The authors systematically reviewed the published literature on seizure freedom following the resection of supratentorial CCMs in patients presenting with seizures. Seizure outcomes were stratified across 12 potential prognostic variables. A total of 1226 patients with supratentorial CCMs causing seizures were identified across 31 predominantly retrospective studies; 361 patients had medically refractory epilepsy. Seventy-five percent of the patients were seizure free after microsurgical lesion removal, whereas 25% continued to have seizures. All patients had had preoperative seizures and > 6 months of postoperative follow-up. Modifiable predictors of postoperative seizure freedom included gross-total resection (OR 36.6, 95% CI 8.5-157.5) and surgery within 1 year of symptom onset (OR 1.83, 95% CI 1.30-2.58). Additional prognostic indicators of a favorable outcome were a CCM size seizures (OR 2.38, 95% CI 1.29-4.39), and the lack of secondarily generalized seizures (OR 3.33, 95% CI 2.09-5.30). Other factors, including extended resection of the hemosiderin ring, were not significantly predictive. In the surgical treatment of supratentorial CCMs, gross-total resection and early operative intervention may improve seizure outcome. While surgery should not be considered the first-line treatment for CCM-related epilepsy, it is important to understand the variables associated with seizure freedom in CCM resection given the considerable morbidity and diminished quality of life associated with epilepsy.

  5. Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery. (United States)

    McIntosh, Anne M; Averill, Clare A; Kalnins, Renate M; Mitchell, L Anne; Fabinyi, Gavin C A; Jackson, Graeme D; Berkovic, Samuel F


    We aimed to assess long-term seizure outcome and risk factors for seizure recurrence in a cohort of patients who have undergone extratemporal resection for management of refractory seizures. Eighty-one patients underwent extratemporal resection at Austin Health, Melbourne, Australia (1991-2004). Seizure recurrence was any postoperative disabling seizure (complex partial seizure [CPS] ± secondary generalization). Multivariate Cox proportional hazards regression models examined potential preoperative and perioperative risk factors and the risk associated with early postoperative seizures (≤ 28 days postsurgery). The change between preoperative and postoperative seizure frequency was also measured. Median follow-up was 10.3 years (range 1-17.7). The probabilities of freedom from disabling seizures (on or off antiepileptic medication) were 40.7% (95% confidence interval [CI] 30-51) at 1 month, 23.5% (95% CI 15-33) at 1 year, and 14.7% (95% CI 8-23) at 5 years postoperative. Reduction of disabling seizures to at least 20% of preoperative frequency was attained by 57% of patients at 5 postoperative years. Of the preoperative/perioperative factors, focal cortical dysplasia (FCD) type 1 (hazard ratio [HR] 1.90, 95% CI 1.08-3.34, p = 0.025) and incomplete resection (HR 1.71, 95% CI 1.06-2.76, p = 0.028) were independent recurrence risks. After surgery, an early postoperative seizure was the only factor associated with higher risk (HR 4.28 [2.42-7.57], p = 0.00). Distinction between subtypes of focal cortical dysplasia, which can be made using magnetic resonance imaging (MRI) criteria, may be useful for preoperative prognostication. Early seizures after surgery are not benign and may be markers of factors that contribute to seizure recurrence. Most patients achieve substantial reduction in seizure frequency. Further study of the significance of this reduction in terms of surgical "success" or otherwise is required. Wiley Periodicals, Inc. © 2012 International League

  6. Comparison between febrile and afebrile seizures associated with mild rotavirus gastroenteritis. (United States)

    Kang, Ben; Kim, Dong Hyun; Hong, Young Jin; Son, Byong Kwan; Kim, Dong Wook; Kwon, Young Se


    We aimed on identifying the differences of febrile and afebrile seizures associated with mild rotavirus gastroenteritis (RVGE) in the pediatric population. Medical charts of pediatric patients who had been admitted between July 1999 and June 2011 due to RVGE were retrospectively reviewed. Subjects were ultimately divided into three groups; 'no seizure' (NS: patients without seizure), 'febrile seizure' (FS: patients with fever during seizure), 'afebrile seizure' (AFS: patients without fever during seizure). Comparisons between groups were carried out on demographic and clinical characteristics, laboratory test results, electroencephalogram findings, brain magnetic resonance imaging findings, antiepileptic treatment, and prognosis. Among the 755 subjects who had been admitted due to mild rotavirus enteritis, 696 (90.3%) did not have any seizures, 17 (2.2%) had febrile seizures, 42 (5.5%) had afebrile seizures. The duration of gastrointestinal symptoms before the onset of seizures were significantly shorter in the FS group compared to the AFS group (1.3±0.8 vs. 2.8±1.0 days; pseizure attack was significantly higher in the AFS group (3.0±1.6 vs. 1.7±1.0 episodes; p=0.0003), and the frequency of seizures that were of focal type with or without secondary generalization were significantly higher in the AFS group (33.3% vs. 6.0%; p=0.0139). All patients among the FS and AFS group had not received further antiepileptic treatment after discharge, and none developed epilepsy during follow up period. Despite some differences in seizure characteristics, both febrile and afebrile seizures associated with mild RVGE were mostly benign with a favorable prognosis. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  7. Approach To The First Unprovoked Seizure- PART II

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    Mohammad GHOFRANI


    Full Text Available How to Cite This Article: Ghofrani M. Approach To The First Unprovoked Seizure- PART II. Iran J Child Neurol. 2013 Autumn; 7(4:1-5.Abstract The approach to a child who has experienced a first unprovoked generalized tonic-clonic seizure is challenging and at the same time controversial.How to establish the diagnosis, ways and means of investigation and whether treatment is appropriate, are different aspects of this subject. In this writing the above mentioned matters are discussed. References31.Berg AT, Testa FM., Levy SR, Shinnar S. Neuroimaging in children with newly diagnosed epilepsy. A community based study. Pediatrics 2000;106:527-532.32.Shinnar S, Odell C. Treating childhood seizure; when and for how long. In: Shinnar S, Amir N, Branski D (Eds. Childhood seizure. S Karger Basel. 1995. P.100-110.33.Shinnar S, Berg AT, Moshe Sl, et al. Risk of Seizure recurrence following a first unprovoked seizure in childhood; A prospective study. Pediatrics 1990;85:1076-2085.34.Shinnar S, Berg At, Moshe SL, et al. The risk of seizure recurrence after a first unprovoked febrile seizure in childhood: An extended follow up. Pediatrics 1996:98:216-225.35.Hauser WA, Rich SS, Annegers JF, Anderson VE. Seizure recurrence after a first unprovoked seizure: An extended follow up. Neurology 1990;40:1163-1170.36.Stroink H, Brouwer O F, Arts WF, Greets AT, Peter AC, Van Donselaar CA. The First unprovoked, untreated seizure in childhood: A hospital based study of the accuracy of diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch study of epilepsy in childhood. J Neurol Neurosurg Psychiatry 1998;64:595-600. 37.Shinnar S, Berg AT, O’Dell C. Newstein D, et al. Predictors of multiple seizure in a cohort of children prospectively followed from the time of their first unprovoked seizure, Ann Neurol 2000; 48:140-147.38.Martinovie Z, Jovic N. Seizure recurrence after a first generalized tonic-clonic seizure in children

  8. Long-term risk of seizures in adult survivors of sepsis. (United States)

    Reznik, Michael E; Merkler, Alexander E; Mahta, Ali; Murthy, Santosh B; Claassen, Jan; Kamel, Hooman


    To examine the association between sepsis and the long-term risk of seizures. We conducted a retrospective population-based cohort study using administrative claims data from all emergency department visits and hospitalizations at nonfederal acute care hospitals in California, Florida, and New York from 2005 to 2013. Using previously validated diagnosis codes, we identified all adult patients hospitalized with sepsis. Our outcome was any emergency department visit or hospitalization for seizure. Poisson regression and demographic data were used to calculate age-, sex-, and race-standardized incidence rate ratios (IRR). To confirm our findings, we used a matched cohort of hospitalized patients without sepsis for comparison and additionally assessed claims data from a nationally representative 5% sample of Medicare beneficiaries. We identified 842,735 patients with sepsis. The annual incidence of seizure was 1.29% (95% confidence interval [CI] 1.27%-1.30%) in patients with sepsis vs 0.16% (95% CI 0.16%-0.16%) in the general population (IRR 4.98; 95% CI 4.92-5.04). A secondary analysis using matched hospitalized patients confirmed these findings (IRR 4.33; 95% CI 4.13-4.55), as did a separate analysis of Medicare beneficiaries, in whom we found a similar strength of association (IRR 2.72; 95% CI 2.60-2.83), as we did in patients ≥65 years of age in our primary statewide data (IRR 2.83; 95% CI 2.78-2.88). We found that survivors of sepsis faced a significantly higher long-term risk of seizures than both the general population and other hospitalized patients. Our findings suggest that sepsis is associated with pathways that lead to permanent neurologic sequelae. © 2017 American Academy of Neurology.

  9. Localization value of seizure semiology analyzed by the conditional inference tree method. (United States)

    Kim, Dong Wook; Jung, Ki-Young; Chu, Kon; Park, So-Hee; Lee, Seo-Young; Lee, Sang Kun


    Although accurate interpretation of seizures is important for the management of patients with epilepsy, studies on the localizing value of seizure semiology and the reliability of the semiology descriptions are scarce. The objective of our study is to investigate the accuracy of video-recorded seizure semiology in the classification and localization of epileptic seizures. We also evaluated the reliability of the semiology descriptions provided by the patients or their caregivers. Video-recorded clinical seizures from 831 consecutive patients (391 females; 31.7 ± 11.6 years) were analyzed retrospectively. Epileptic seizures were classified as generalized and partial seizures, and patients with partial seizures were further divided into five ictal onset areas. In order to analyze the diagnostic value of individual semiologic features for clinical diagnosis, we used the conditional inference tree method. Generalized and partial seizures were differentiated with high accuracy (97.1%), but the accuracy of localization among the five ictal onset areas was relatively low (56.1%), which was largely attributed to the difficulty in the discrimination between mesial and lateral temporal onset seizures. Lateralization of the ictal onset area in partial seizures was possible in 427 (55.1%) patients based on video analysis, nevertheless it was possible in only 158 (20.4%) patients based on historical semiology descriptions. The results of our study suggest that careful observation of seizure semiology may be useful for the differentiation of ictal onset areas. However, the semiologic differentiation between mesial and lateral temporal onset seizures is difficult, and historical semiologic descriptions should be interpreted carefully because of their low reliability. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Serotonin neurones have anti-convulsant effects and reduce seizure-induced mortality (United States)

    Buchanan, Gordon F; Murray, Nicholas M; Hajek, Michael A; Richerson, George B


    Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. Defects in central control of breathing are important contributors to the pathophysiology of SUDEP, and serotonin (5-HT) system dysfunction may be involved. Here we examined the effect of 5-HT neurone elimination or 5-HT reduction on seizure risk and seizure-induced mortality. Adult Lmx1bf/f/p mice, which lack >99% of 5-HT neurones in the CNS, and littermate controls (Lmx1bf/f) were subjected to acute seizure induction by maximal electroshock (MES) or pilocarpine, variably including electroencephalography, electrocardiography, plethysmography, mechanical ventilation or pharmacological therapy. Lmx1bf/f/p mice had a lower seizure threshold and increased seizure-induced mortality. Breathing ceased during most seizures without recovery, whereas cardiac activity persisted for up to 9 min before terminal arrest. The mortality rate of mice of both genotypes was reduced by mechanical ventilation during the seizure or 5-HT2A receptor agonist pretreatment. The selective serotonin reuptake inhibitor citalopram reduced mortality of Lmx1bf/f but not of Lmx1bf/f/p mice. In C57BL/6N mice, reduction of 5-HT synthesis with para-chlorophenylalanine increased MES-induced seizure severity but not mortality. We conclude that 5-HT neurones raise seizure threshold and decrease seizure-related mortality. Death ensued from respiratory failure, followed by terminal asystole. Given that SUDEP often occurs in association with generalised seizures, some mechanisms causing death in our model might be shared with those leading to SUDEP. This model may help determine the relationship between seizures, 5-HT system dysfunction, breathing and death, which may lead to novel ways to prevent SUDEP. PMID:25107926

  11. Brain State Is a Major Factor in Preseizure Hippocampal Network Activity and Influences Success of Seizure Intervention (United States)

    Ewell, Laura A.; Liang, Liang; Armstrong, Caren; Soltész, Ivan; Leutgeb, Stefan


    Neural dynamics preceding seizures are of interest because they may shed light on mechanisms of seizure generation and could be predictive. In healthy animals, hippocampal network activity is shaped by behavioral brain state and, in epilepsy, seizures selectively emerge during specific brain states. To determine the degree to which changes in network dynamics before seizure are pathological or reflect ongoing fluctuations in brain state, dorsal hippocampal neurons were recorded during spontaneous seizures in a rat model of temporal lobe epilepsy. Seizures emerged from all brain states, but with a greater likelihood after REM sleep, potentially due to an observed increase in baseline excitability during periods of REM compared with other brains states also characterized by sustained theta oscillations. When comparing the firing patterns of the same neurons across brain states associated with and without seizures, activity dynamics before seizures followed patterns typical of the ongoing brain state, or brain state transitions, and did not differ until the onset of the electrographic seizure. Next, we tested whether disparate activity patterns during distinct brain states would influence the effectiveness of optogenetic curtailment of hippocampal seizures in a mouse model of temporal lobe epilepsy. Optogenetic curtailment was significantly more effective for seizures preceded by non-theta states compared with seizures that emerged from theta states. Our results indicate that consideration of behavioral brain state preceding a seizure is important for the appropriate interpretation of network dynamics leading up to a seizure and for designing effective seizure intervention. SIGNIFICANCE STATEMENT Hippocampal single-unit activity is strongly shaped by behavioral brain state, yet this relationship has been largely ignored when studying activity dynamics before spontaneous seizures in medial temporal lobe epilepsy. In light of the increased attention on using single

  12. [Psychogenic non epileptic seizures: a review]. (United States)

    Auxéméry, Y; Hubsch, C; Fidelle, G


    This paper summarizes the recent literature on the phenomena of psychogenic non epileptic seizures (PNES). DEFINITION AND EPIDEMIOLOGY: PNES are, as altered movement, sensation or experience, similar to epilepsy, but caused by a psychological process. Although in the ICD-10, PNES belong to the group of dissociative disorders, they are classified as somatoform disorders in the DSM-IV. That represents a challenging diagnosis: the mean latency between manifestations and diagnosis remains as long as 7 years. It has been estimated that between 10 and 30% of patients referred to epilepsy centers have paroxysmal events that despite looking like epileptic episodes are in fact non-epileptic. Many pseudo epileptic seizures have received the wrong diagnosis of epilepsy being treated with anticonvulsants. The prevalence of epilepsy in PNES patients is higher than in the general population and epilepsy may be a risk factor for PNES. It has been considered that 65 to 80% of PNES patients are young females but a new old men subgroup has been recently described. POSITIVE DIAGNOSIS AND PSYCHIATRIC COMORBIDITIES: Even if clinical characteristics of seizures were defined as important in the diagnosis algorithm, this point of view could be inadequate because of its lack of sensitivity. Because neuron-specific enolase, prolactin and creatine kinase are not reliable and able to validate the diagnosis, video electroencephalography monitoring (with or without provocative techniques) is currently the gold standard for the differential diagnosis of ES, and PNES patients with pseudoseizures have high rates of psychiatric disorders such as depression, anxiety, somatoform symptoms, dissociative disorders and post-traumatic stress disorder. We found evidence for correlations between childhood trauma, history of childhood abuse, PTSD, and PNES diagnoses. PNES could also be hypothesized of a dissociative phenomena generated by childhood trauma. Some authors report that PNES can be associated with

  13. Sleep seizures versus wake seizures: A comparative hospital study on clinical, electroencephalographic and radiological profile

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    Goel Deepak


    Full Text Available Background: Epileptic seizures, predominantly or exclusively during sleep had been the focus of attention for many electroencephalographers. Though few epileptic syndromes are associated with sleep seizures (SS its frequencies in Indian patients is still unknown. Aim: To find out the patterns of epilepsies in patients having SS and compare them with patients having wake seizures (WS. Setting and Design : Open label hospital based study. Materials and Methods: One hundred and forty-four (13% patients having predominantly SS were compared with 976 (87% patients of WS by various clinical, electrophysiological and radiological factors. Statistical Analysis: Chi square test and student T test, using software SPSS (version 10, 1999 was applied to compare various parameters. Relative risk was calculated by 2 x 2 contingency table. Results: The seizure semiology was better defined in patients with WS and GTCS was more common in SS ( P = 0.001. Wake-electroencephalogram (EEG was abnormal in significantly ( P = 0.001 higher number of patients with WS. Symptomatic etiologies were found in more than half patients. Left lobe involvement was more common in patients having SS ( P = 0.000. After symptomatic, idiopathic generalized and frontal lobe epilepsy were most frequent with SS. Undetermined epilepsy was found in 37 (25.7% patients with SS. Conclusion: Epilepsies associated with SS were less frequent and had symptomatic cause in most cases. Left hemispherical and frontal lobe lesion were more commonly associated with SS. Frontal lobe and idiopathic generalized epilepsy was most frequent in patients of SS. Sleep EEG should always be done in patients with sleep seizures.


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    Full Text Available BACKGROUND AND OBJECTIVES: In patients with seizures a dedicated MRI protocol is a useful tool in the detection of an epileptogenic focus, including congenital, neoplastic and degenerative. Resection of these lesions can lead to seizure freedom in most patients. In this context, a prospective study was conducted to evaluate the etiology of seizures using MRI brain. METHODOLOGY: 120 patients presenting with seizures, above the age of 2years, referred to the Department of Radio - diagnosis were included in this study. RESULTS: In this study, the MR examination revealed pathological findi ngs i n 32.50% (39 out of 120 patients which includes: mesial temporal sclerosis - 14.2% (17, cerebral infarct with gliosis - 6.6% (8, meningioma - 2.5% (3, hypoxic ischemic encephalopathy - 1.6% (2, cortical dysplasia - 1.6% (2, tuberous sclerosis - 11.6% (2, nodula r heterotopias - 0.83% (1, neurocysticercosis - 0.83% (1%, metastasis - 0.83% (1, Dyke Davidoff Maison syndrome - 0.83% (1 and Arnold Chiari Malformation 0.83% (1. CONCLUSION: This study concludes that MR imaging plays a pivotal role in the evaluation of pati ents with seizures using a dedicated MRI seizure protocol to confirm or rule out any organic or developmental lesions. The most common abnormality seen in this study was mesial temporal sclerosis.

  15. Seizure Prediction: Science Fiction or Soon to Become Reality? (United States)

    Freestone, Dean R; Karoly, Philippa J; Peterson, Andre D H; Kuhlmann, Levin; Lai, Alan; Goodarzy, Farhad; Cook, Mark J


    This review highlights recent developments in the field of epileptic seizure prediction. We argue that seizure prediction is possible; however, most previous attempts have used data with an insufficient amount of information to solve the problem. The review discusses four methods for gaining more information above standard clinical electrophysiological recordings. We first discuss developments in obtaining long-term data that enables better characterisation of signal features and trends. Then, we discuss the usage of electrical stimulation to probe neural circuits to obtain robust information regarding excitability. Following this, we present a review of developments in high-resolution micro-electrode technologies that enable neuroimaging across spatial scales. Finally, we present recent results from data-driven model-based analyses, which enable imaging of seizure generating mechanisms from clinical electrophysiological measurements. It is foreseeable that the field of seizure prediction will shift focus to a more probabilistic forecasting approach leading to improvements in the quality of life for the millions of people who suffer uncontrolled seizures. However, a missing piece of the puzzle is devices to acquire long-term high-quality data. When this void is filled, seizure prediction will become a reality.

  16. Semiology of hypermotor (hyperkinetic) seizures. (United States)

    Alqadi, Khalid; Sankaraneni, Ram; Thome, Ursula; Kotagal, Prakash


    Hypermotor seizures (HMSs) consist of complex movements involving proximal segments of the limbs and trunk that appear violent and inappropriate for the situation. We analyzed hypermotor seizure videos in seizure-free patients (Engel class I) following resective epilepsy surgery. After completion of video analysis, we reviewed EEG and neuroimaging data. Search of our epilepsy surgery database yielded 116 patients classified as having hypermotor seizures between 1996 and 2013. From this subset, 17/31 (55%) patients had been seizure-free for >6months (mean follow-up: 3.3years). Mean seizure duration was 35s (range: 6-91s), of which the HM phase lasted a mean of 22s (range: 3-53s). In 16 patients (95%), hypermotor activity was seen at or within 10s of clinical seizure onset. Type I semiology occurred in 6 patients, type II semiology in 10 patients, and 1 patient exhibited features of both. Type I and type II semiologies were noted in patients who had frontal lobe as well as extrafrontal resections. Nonversive head and body turning occurred in 10 patients (ranging from 90° to 270°) which was ipsilateral to the side of resection in all patients and seen both in frontal and extrafrontal resections. Six out of eleven patients with abnormal MRI and 4/6 patients with nonlesional MRI underwent invasive EEG evaluation. Eight patients (47%) had frontal lobe resection, 4/17 (23%) patients had temporal lobe resection, and one patient each had parietal lobe, insular, temporoparietooccipital, or motor sparing resection; 1 patient had functional hemispherectomy. Hypermotor semiology typically occurs at or within 10s after seizure onset. Ipsilateral head/body turning appears to be of lateralizing value whereas asymmetry of limb movement was not lateralizing. Hypermotor semiology is most often seen in frontal lobe epilepsy but may occur in seizures arising from other locations. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Frontal lobe seizures: from clinical semiology to localization. (United States)

    Bonini, Francesca; McGonigal, Aileen; Trébuchon, Agnès; Gavaret, Martine; Bartolomei, Fabrice; Giusiano, Bernard; Chauvel, Patrick


    . The proposed electroclinical categorization offers pointers as to the likely zone of organization of networks underlying semiologic production, thus aiding presurgical localization. Furthermore, analysis of ictal motor behavior in prefrontal seizures, including stereotypies, leads to deciphering the cortico-subcortical networks that produce such behaviors. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.


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    M. B. Mironov


    Full Text Available The paper deals with the study of a group of patients with focal automotor seizures, by taking into consideration their nosological, anamnestic, clinical, electroencephalographic, and neuroimaging features.


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    Sidhartha Kiran


    Full Text Available BACKGROUND Seizure disorders are fairly common in children. Almost 5% of children at risk of experiencing a seizure. The aetiology of seizures is different in India and other developing countries as compared to the developed world. Tuberculoma and neurocysticercosis have relatively high frequency in India. 1 Most of the Indian studies on seizure disorders were done in mixed population of adults and children. Only few Indian studies looked at the prevalence, incidence, causative factors and other aspects of childhood seizures. The present study emphasizing on clinical profile of seizures concentrating only on paediatric age group and to evaluate the role of EEG and CT scan brain as a diagnostic aid in various seizure disorders in children. This study focusses on CT findings, which are more easily available in peripheries where MRI facilities may not be available, though MRI may be superior to CT in identifying the lesions. STUDY METHODS The study includes 108 children from 1 year to less than 12 years of age with various seizure disorders, who are coming to Paediatric Outpatient and Inpatient Department, Govt. General Hospital, Kakinada, from November 2014 to October 2015. This is a cross sectional observation study. RESULTS Out of the 108 cases studied, half of the patients (n=55, 50.9% presented with GTCS. Complex partial seizures is the second most common type of seizure disorder (n=29, 26.9%. Maximum number of children were in the 3-10 years’ age group (n=65, 60.18%. Maximum number of patients presented during 12th year (n=17, 15.7% followed by 8th year (n=14, 13%. Out of 108 children studied, 70 (64.81% are male children and 38 (35.19% are female children. The male:female ratio is 1.8:1. Among the patients with abnormal CT, solitary tuberculoma was the most frequent abnormality which was detected in 22 patients (40%, Neurocysticercosis was the second common abnormality detected in the present study. Among the patients with abnormal EEG

  20. Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures. (United States)

    Lhatoo, Samden D; Nei, Maromi; Raghavan, Manoj; Sperling, Michael; Zonjy, Bilal; Lacuey, Nuria; Devinsky, Orrin


    To describe the phenomenology of monitored sudden unexpected death in epilepsy (SUDEP) occurring in the interictal period where death occurs without a seizure preceding it. We report a case series of monitored definite and probable SUDEP where no electroclinical evidence of underlying seizures was found preceding death. Three patients (two definite and one probable) had SUDEP. They had a typical high SUDEP risk profile with longstanding intractable epilepsy and frequent generalized tonic-clonic seizures (GTCS). All patients had varying patterns of respiratory and bradyarrhythmic cardiac dysfunction with profound electroencephalography (EEG) suppression. In two patients, patterns of cardiorespiratory failure were similar to those seen in some patients in the Mortality in Epilepsy Monitoring Units Study (MORTEMUS). SUDEP almost always occur postictally, after GTCS and less commonly after a partial seizure. Monitored SUDEP or near-SUDEP cases without a seizure have not yet been reported in literature. When nonmonitored SUDEP occurs in an ambulatory setting without an overt seizure, the absence of EEG information prevents the exclusion of a subtle seizure. These cases confirm the existence of nonseizure SUDEP; such deaths may not be prevented by seizure detection-based devices. SUDEP risk in patients with epilepsy may constitute a spectrum of susceptibility wherein some are relatively immune, death occurs in others with frequent GTCS with one episode of seizure ultimately proving fatal, while in others still, death may occur even in the absence of a seizure. We emphasize the heterogeneity of SUDEP phenomena. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  1. Hyperspherical Manifold for EEG Signals of Epileptic Seizures

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    Tahir Ahmad


    Full Text Available The mathematical modelling of EEG signals of epileptic seizures presents a challenge as seizure data is erratic, often with no visible trend. Limitations in existing models indicate a need for a generalized model that can be used to analyze seizures without the need for apriori information, whilst minimizing the loss of signal data due to smoothing. This paper utilizes measure theory to design a discrete probability measure that reformats EEG data without altering its geometric structure. An analysis of EEG data from three patients experiencing epileptic seizures is made using the developed measure, resulting in successful identification of increased potential difference in portions of the brain that correspond to physical symptoms demonstrated by the patients. A mapping then is devised to transport the measure data onto the surface of a high-dimensional manifold, enabling the analysis of seizures using directional statistics and manifold theory. The subset of seizure signals on the manifold is shown to be a topological space, verifying Ahmad's approach to use topological modelling.

  2. The semiology of febrile seizures: Focal features are frequent. (United States)

    Takasu, Michihiko; Kubota, Tetsuo; Tsuji, Takeshi; Kurahashi, Hirokazu; Numoto, Shingo; Watanabe, Kazuyoshi; Okumura, Akihisa


    To clarify the semiology of febrile seizures (FS) and to determine the frequency of FS with symptoms suggestive of focal onset. FS symptoms in children were reported within 24h of seizure onset by the parents using a structured questionnaire consisting principally of closed-ended questions. We focused on events at seizure commencement, including changes in behavior and facial expression, and ocular and oral symptoms. We also investigated the autonomic and motor symptoms developing during seizures. The presence or absence of focal and limbic features was determined for each patient. The associations of certain focal and limbic features with patient characteristics were assessed. Information was obtained on FS in 106 children. Various events were recorded at seizure commencement. Behavioral changes were observed in 35 children, changes in facial expression in 53, ocular symptoms in 78, and oral symptoms in 90. In terms of events during seizures, autonomic symptoms were recognized in 78, and convulsive motor symptoms were recognized in 68 children. Focal features were evident in 81 children; 38 children had two or more such features. Limbic features were observed in 44 children, 9 of whom had two or more such features. There was no significant relationship between any patient characteristic and the numbers of focal or limbic features. The semiology of FS varied widely among children, and symptoms suggestive of focal onset were frequent. FS of focal onset may be more common than is generally thought. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Somatic overgrowth predisposes to seizures in autism spectrum disorders.

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    Giulia Valvo

    Full Text Available BACKGROUND: Comorbidity of Autism Spectrum Disorders with seizures or abnormal EEG (Autism-Epilepsy Phenotype suggests shared pathomechanisms, and might be a starting point to identify distinct populations within the clinical complexity of the autistic spectrum. In this study, we tried to assess whether distinct subgroups, having distinctive clinical hallmarks, emerge from this comorbid condition. METHODS: Two-hundred and six individuals with idiopathic Autism Spectrum Disorders were subgrouped into three experimental classes depending on the presence of seizures and EEG abnormalities. Neurobehavioral, electroclinical and auxological parameters were investigated to identify differences among groups and features which increase the risk of seizures. Our statistical analyses used ANOVA, post-hoc multiple comparisons, and the Chi-squared test to analyze continuous and categorical variables. A correspondence analysis was also used to decompose significant Chi-squared and reduce variables dimensions. RESULTS: The high percentage of children with seizures (28.2% of our whole cohort and EEG abnormalities (64.1% confirmed that the prevalence of epilepsy in Autism Spectrum Disorders exceeds that of the general population. Seizures were associated with severe intellectual disability, and not with autism severity. Interestingly, tall stature (without macrocephaly was significantly associated with EEG abnormalities or later onset seizures. However, isolated macrocephaly was equally distributed among groups or associated with early onset seizures when accompanied by tall stature. CONCLUSIONS: Tall stature seems to be a phenotypic "biomarker" of susceptibility to EEG abnormalities or late epilepsy in Autism Spectrum Disorders and, when concurring with macrocephaly, predisposes to early onset seizures. Growth pattern might act as an endophenotypic marker in Autism-Epilepsy comorbidity, delineating distinct pathophysiological subtypes and addressing personalized

  4. Seizures in Children With Cerebral Palsy and White Matter Injury. (United States)

    Cooper, Monica S; Mackay, Mark T; Fahey, Michael; Reddihough, Dinah; Reid, Susan M; Williams, Katrina; Harvey, A Simon


    The goal of this study was to describe the prevalence, syndromes, and evolution of seizure disorders in children with cerebral palsy (CP) due to white matter injury (WMI). For this population-based cohort study, brain MRI scans and medical records were reviewed in children in the Victorian Cerebral Palsy Register born between 1999 and 2006 recorded as having WMI. Children were excluded if they had features of an undiagnosed syndrome, associated cortical malformation or injury, or no medical contact in the preceding year. Included were 166 children with CP and isolated WMI due to presumed vascular insufficiency or hemorrhage; 87 were born preterm. Seizure and CP details were obtained from medical records and interviews, and EEG recordings were reviewed. Forty-one children (25%) had seizures beyond the neonatal period. Four children had West syndrome, which resolved with treatment. Thirteen children had febrile seizures that they outgrew. Thirty children had focal epilepsy with seizure manifestations and EEG discharges typical of early-onset childhood occipital epilepsy or childhood epilepsy with centrotemporal spikes; 23 have outgrown these seizures. Two children had idiopathic generalized epilepsy; it was ongoing in 1 child. Fourteen children had evolution from 1 epileptic syndrome to another. At last follow-up (median age, 12.7 years; minimum age, 9.7 years), 80% had not had a seizure for >2 years. The electroclinical features of seizure disorders associated with CP and WMI are those of the age-limited, epileptic syndromes of childhood, with favorable outcome in the majority. The findings have important implications for counseling and drug treatment. Copyright © 2017 by the American Academy of Pediatrics.

  5. Predicting seizure freedom after two or more chronic invasive evaluations in patients with intractable epilepsy. (United States)

    Nagel, Sean J; Jehi, Lara E; O'Dwyer, Rebecca; Bidros, Dani; Hiremath, Girish K; Bingaman, William E


    In patients with intractable epilepsy, failure to localize and/or resect the epileptic focus after invasive monitoring is multifactorial. Rarely do these patients return for a second invasive evaluation, and their outcome is not clearly characterized. This study aims to determine the seizure outcome after a second invasive electroencephalographic (EEG) evaluation, and its possible predictors. We retrospectively reviewed 30 patients who underwent two or more invasive evaluations at Cleveland Clinic between 1980 and 2007. Clinical, surgical, imaging, and pathology information was analyzed using a multivariate regression model. A favorable outcome was defined as complete seizure freedom, allowing for auras and seizures restricted to the first postoperative week. Ten patients (33%) became seizure free after the second operation (mean follow-up duration 3.13 years [range 6 months-17 years]). Seizure freedom was more likely in patients reporting fewer seizures per month preoperatively (mean 19 seizures/mo), and in those with a predominantly regional/lateralized scalp EEG ictal pattern (32% seizure free), as opposed to those with higher seizure frequency (mean 70 seizures/month; P = 0.02) or diffuse ictal EEGs (0% seizure free; P = 0.04). There was a significant association between acute postoperative seizures and failure of repeat surgery (P = 0.0083). In 17 of 30 patients, at least one complication was reported (57%) after the second invasive evaluation compared with a complication rate of 23% after the first invasive evaluation. A second invasive evaluation may lead to seizure freedom in one-third of patients. However, this must be weighed against the increased complication rate with reoperation. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in the Treatment of Refractory Serial Seizures in Children

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    Afshin FAYYAZI


    Full Text Available How to Cite this Article: Fayyazi A, Karimzadeh P, Torabian S, Damadi S, Khaje A. Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in The Treatment of Refractory Serial Seizures in Children. Iran J Child Neurol 2012; 6(3: 15-19. ObjectiveSerial seizures occur commonly in inpatient epileptic children. This type ofseizure due to its characteristics has a significant impact on the patient’s health.Untreated serial seizures lead to status epilepticus; therefore, finding a moreeffective treatment for such patients is essential. This study was performed tocompare the outcome of intermittent intravenous diazepam in the pediatricneurology clinic and intravenous midazolam in the pediatric intensive care unit(PICU, in order to introduce an alternative treatment for serail seizures.Materials & MethodsIn this study, 38 inpatient children aged 6 mo-15 years with refractory serialseizures were treated by first line antiepileptic drugs and then randomlytreated with either intermittent intravenous diazepam in the neurology ward orintravenous midazolam in PICU.ResultsFourteen (70% diazepam group patients and 13 (72.2% midazolam grouppatients had good response to treatment, there was no significant differencebetween the two groups. Four midazolam group patients and two diazepamgroup patients needed mechanical ventilation and were intubated duringtreatment, with no significant difference between the two groups. Durationsof mechanical ventilation and PICU and hospital stay were not significantlydifferent between the two groups.ConclusionIntermittent intravenous diazepam is an effective alternative therapy formidazolam drip in the treatment of serial seizures due to similar therapeuticeffects and fewer side effects.ReferencesHaut SR. Seizure clustering. Epilepsy Behav 2006Feb;8(1:50-5.Caraballo RH, Cersosimo RO, Fejerman N. Benign focal seizures of adolescence: a prospective study. Epilepsia 2004 Dec;45(12:1600-3.Haut SR, Swick C

  7. Acute fracture of the acetabulum secondary to a convulsive seizure 3 years after total hip arthroplasty. (United States)

    Atilla, Bulent; Caglar, Omur; Akgun, Rahmi Can


    While aseptic loosening, osteolysis, and infection are the most common causes of failure after total hip arthroplasty (THA), late hip pain can also be the result of acetabular fracture related to trauma and resultant prosthetic failure. However, atraumatic fracture of the acetabulum around a well-fixed acetabular component is unusual. We present a patient with an acetabular fracture resulting from a generalized convulsive attack 3 years after an uncomplicated primary THA. A 33-year-old man presented with acute left hip pain. He had chronic renal insufficiency and had undergone bilateral THA due to avascular necrosis. The night prior to his admission, he suffered a generalized convulsive attack with severe extremity contractions. Afterwards, he had acute left groin pain and had difficulty walking. Physical examination revealed moderate left hip pain as well as a 1-cm shortening of the affected limb. Radiological examination demonstrated an acetabular fracture with medial wall comminution. The acetabular component had migrated medially and rotated horizontally. Revision of the acetabular component with a reinforcement ring and implantation of a cemented acetabular component was realized. Severe muscle spasms during generalized seizures are known to lead to various musculoskeletal injuries (fractures of the proximal humerus, femur, acetabulum, and dislocation of the shoulder). Seizures could also lead to acute periprosthetic fracture of the acetabulum in patients with osteopenia. Therefore careful reaming is required to avoid overmedialization of the acetabular component in those patients.

  8. Recent Research on Febrile Seizures: A Review (United States)

    Syndi Seinfeld, DO; Pellock, John M.


    Febrile seizures are common and mostly benign. They are the most common cause of seizures in children less than five years of age. There are two categories of febrile seizures, simple and complex. Both the International League against Epilepsy and the National Institute of Health has published definitions on the classification of febrile seizures. Simple febrile seizures are mostly benign, but a prolonged (complex) febrile seizure can have long term consequences. Most children who have a febrile seizure have normal health and development after the event, but there is recent evidence that suggests a small subset of children that present with seizures and fever may have recurrent seizure or develop epilepsy. This review will give an overview of the definition of febrile seizures, epidemiology, evaluation, treatment, outcomes and recent research. PMID:25383238

  9. Characterization of febrile seizures and febrile seizure susceptibility in mouse inbred strains. (United States)

    van Gassen, K L I; Hessel, E V S; Ramakers, G M J; Notenboom, R G E; Wolterink-Donselaar, I G; Brakkee, J H; Godschalk, T C; Qiao, X; Spruijt, B M; van Nieuwenhuizen, O; de Graan, P N E


    Febrile seizures (FS) are the most prevalent seizures in children. Although FS are largely benign, complex FS increase the risk to develop temporal lobe epilepsy (TLE). Studies in rat models for FS have provided information about functional changes in the hippocampus after complex FS. However, our knowledge about the genes and pathways involved in the causes and consequences of FS is still limited. To enable molecular, genetic and knockout studies, we developed and characterized an FS model in mice and used it as a phenotypic screen to analyze FS susceptibility. Hyperthermia was induced by warm air in 10- to 14-day-old mice and induced FS in all animals. Under the conditions used, seizure-induced behavior in mice and rats was similar. In adulthood, treated mice showed increased hippocampal Ih current and seizure susceptibility, characteristics also seen after FS in rats. Of the seven genetically diverse mouse strains screened for FS susceptibility, C57BL/6J mice were among the most susceptible, whereas A/J mice were among the most resistant. Strains genetically similar to C57BL/6J also showed a susceptible phenotype. Our phenotypic data suggest that complex genetics underlie FS susceptibility and show that the C57BL/6J strain is highly susceptible to FS. As this strain has been described as resistant to convulsants, our data indicate that susceptibility genes for FS and convulsants are distinct. Insight into the mechanisms underlying seizure susceptibility and FS may help to identify markers for the early diagnosis of children at risk for complex FS and TLE and may provide new leads for treatment.

  10. Generalized colloidal synthesis of high-quality, two-dimensional cesium lead halide perovskite nanosheets and their applications in photodetectors (United States)

    Lv, Longfei; Xu, Yibing; Fang, Hehai; Luo, Wenjin; Xu, Fangjie; Liu, Limin; Wang, Biwei; Zhang, Xianfeng; Yang, Dong; Hu, Weida; Dong, Angang


    All-inorganic cesium lead halide perovskite (CsPbX3, X = Cl, Br, and I) nanocrystals (NCs) are emerging as an important class of semiconductor materials with superior photophysical properties and wide potential applications in optoelectronic devices. So far, only a few studies have been conducted to control the shape and geometry of CsPbX3 NCs. Here we report a general approach to directly synthesize two-dimensional (2D) CsPbX3 perovskite and mixed perovskite nanosheets with uniform and ultrathin thicknesses down to a few monolayers. The key to the high-yield synthesis of perovskite nanosheets is the development of a new Cs-oleate precursor. The as-synthesized CsPbX3 nanosheets exhibit bright photoluminescence with broad wavelength tunability by composition modulation. The excellent optoelectronic properties of CsPbX3 nanosheets combined with their unique 2D geometry and large lateral dimensions make them ideal building blocks for building functional devices. To demonstrate their potential applications in optoelectronics, photodetectors based on CsPbBr3 nanosheets are fabricated, which exhibit high on/off ratios with a fast response time.All-inorganic cesium lead halide perovskite (CsPbX3, X = Cl, Br, and I) nanocrystals (NCs) are emerging as an important class of semiconductor materials with superior photophysical properties and wide potential applications in optoelectronic devices. So far, only a few studies have been conducted to control the shape and geometry of CsPbX3 NCs. Here we report a general approach to directly synthesize two-dimensional (2D) CsPbX3 perovskite and mixed perovskite nanosheets with uniform and ultrathin thicknesses down to a few monolayers. The key to the high-yield synthesis of perovskite nanosheets is the development of a new Cs-oleate precursor. The as-synthesized CsPbX3 nanosheets exhibit bright photoluminescence with broad wavelength tunability by composition modulation. The excellent optoelectronic properties of CsPbX3 nanosheets


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    RAHIMPOUR Feisal


    Full Text Available ObjectivePhenylketonuria (PKU is an autosomal recessive metabolic genetic disorder characterized by a deficiency in the hepatic enzyme phenylalanine hydroxylase (PAH which can cause problems with brain development, leading to progressive mental retardation, brain damage, and seizures. In this study we evaluated the frequency of seizure, EEG abnormality and behavioral disorders.Materials & Methods In this case study, 94 PKU children aged between 1 month and 23 years who were referred to Mofid children Hospital between 2009 and 2010 were enrolled.Patients were age and sex matched. Statistical tests were used for comparing patients' data.Results The mean age of patients was 8.4 years. Parents were relatives in 80.9% of the cases (76 patients. Of all, 43% (45 patients had seizure but EEG was abnormal only in 81% of them (35 patients out of 43 patients. Totally, EEG was abnormal in 67% of the cases (63 patients of whom 44.4% (28 patients of 63 patients did not have seizure. Therefore, there was a significant relationship between seizure and EEG abnormality. The phenylalanine level ranged from 8mg/dL to 50mg/dL (mean: 18.88 mg/dL at the time of diagnosis and from 0.4mg/dL to 18mg/dL (mean: 7.37mg/dL at the time of evaluation. On the other hand,we observed abnormal behaviors in all EEG abnormalities and there was a significant relationship between EEG abnormality and behavioral disorders.Conclusion In our study, the prevalence of seizure was less than EEG abnormality and there was a significant relationship between EEG abnormalities and behavioral disorders in patients with Phenylketonuria regardless of seizure.The authors believe that treatment of EEG abnormalities may lead to the correction of behavioral disorders in these patients.

  12. Management of Reflex Anoxic Seizures

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    J Gordon Millichap


    Full Text Available Investigators at the Roald Dahl EEG Unit, Alder Hey Children’s NHS Foundation, Liverpool, UK, review the definition, pathophysiology, clinical presentation, and management of reflex anoxic seizures (RAS in children.

  13. Reading-Induced Absence Seizures


    J Gordon Millichap


    A 12-year-old girl with a 2-year history of absence seizures induced by reading and diagnosed by video EEG is reported from The University of Texas Southwestern Medical Center, Dallas, and Riyadh Armed Forces Hospital, Saudi Arabia.

  14. Failure of antiepileptic drugs in controlling seizures in epilepsy: What do we do next?

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    Brahyan Galindo-Mendez


    Full Text Available Medically intractable epilepsy is a clinical condition of concern that arises when a patient with epilepsy suffers seizures, despite a trial of two or more antiepileptic drugs (AEDs suitable for the type of epilepsy that are prescribed at maximum tolerated doses, does not achieve control of seizures. This diagnosis could be related to cortical dysplasias. We report the case of a 5-year-old girl with a previous normal neurological development and no family history of epilepsy who presented with focal-type seizures at age 4. She started treatment by taking different AEDs for seizure control. She continued having frequent seizures that sometimes progressed to generalized seizures and status epilepticus. After a focal cortical resection performed in the area where interictal spikes were detected, the pathology confirmed a type IIb cortical dysplasia as the cause of the epilepsy. This article discusses cortical dysplasias as a cause of pharmacoresistant epilepsy and its treatment.

  15. Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy. (United States)

    Englot, Dario J; Rolston, John D; Wright, Clinton W; Hassnain, Kevin H; Chang, Edward F


    Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response. To elucidate rates and predictors of seizure freedom with VNS. We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies. Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom. Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients. AED, antiepileptic drugVNS, vagus nerve stimulation.

  16. Treatment of febrile seizures with intermittent clobazam



    Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that experienced at least one febrile seizure (FS) entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, symptomatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified i...

  17. Temporal seizure focus and status epilepticus are associated with high-sensitive troponin I elevation after epileptic seizures. (United States)

    Chatzikonstantinou, Anastasios; Ebert, Anne D; Hennerici, Michael G


    Postictal elevation of high-sensitive troponin I (TNI), a highly specific biomarker for myocardial ischemia, has been reported. We aimed at evaluating its association of high-sensitive troponin I (TNI) with seizure type and focus, as well as vascular risk factors. TNI was measured in 247 patients admitted to our clinic via the emergency room with an acute epileptic seizure. TNI control measurements were performed in 61.5% of cases. All patients underwent electroencephalography and cerebral imaging. Seizure focus - when possible - was determined using results from these examinations as well as clinical data. Of 247 patients, 133 (53.8%) were men, the mean age was 59 ± 18 years. 70 (28.3%) patients had focal and 177 (71.7%) generalized seizures. Status epilepticus was present in 38 cases (15.4%). Mean TNI was 0.05 ± 0.17. TNI was elevated in 27 patients (10.9%). Higher age, status epilepticus and temporal seizure focus were significantly associated with TNI elevation in multivariate analysis. In 21 (13.8%) of the patients with TNI control measurement, TNI was continuously elevated. Higher age and temporal seizure focus were significantly associated with continuously high TNI. Coronary heart disease and vascular risk factors were significantly associated with high TNI only in univariate analysis. No patient had a symptomatic myocardial ischemia. Postictal TNI elevation is relatively common in older patients with status epilepticus or temporal seizure focus. These data support the concept of relevant and possibly dangerous ictal effects on cardiac function especially in temporal lobe seizures. Although the risk of manifest postictal myocardial infarction seems to be very low, selected patients could profit from closer monitoring. Copyright © 2015 Elsevier B.V. All rights reserved.


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    Soroor INALOO


    Full Text Available ObjectiveFebrile seizure is the most common seizure disorder in children. Its pathophysiology is not fully understood yet; however, some risk factors have been cited for it. Iron is one of these influential elements and is involved in the metabolism of some neurotransmitters which are reduced in irondeficiency anemia and also increases the sensitivity of neural cells during a febrile episode. The present study aimed to determine the rate of febrile seizure in thalassemic patients and to compare it with the corresponding rate in the normal population.Materials & MethodsThis descriptive cross-sectional study was conducted on 766 patients with thalassemia major. They were all older than 6 months and were referred to Dastghaib Cooly's Clinic, affiliated to Shiraz University of Medical Sciences, from Oct 2006 to May 2007, and 766 normal and healthy children as the control group. Questionnaires containing demographic data and past history of febrile seizure, age of febrile seizure, number of episodes, hospitalization, and related family history were prepared and filled through interviewing the parents.ResultsFebrile seizure was detected in 7 cases of the patient group (0.9% versus 18 cases (2.3% of the control group. The frequency of febrile seizure in the controls was 2.5 times more than that in the thalassemia group, which was statistically significant (P ConclusionThis study showed a lower rate of febrile convulsion in thalassemic patients compared to the control group. Accordingly, it could be suggested that high iron storage is a protective factor against febrile convulsion.Keywords:seizure, febrile, thalassemia, convulsion

  19. Seizure characteristics and outcomes in 508 Chinese adult patients undergoing primary resection of low-grade gliomas: a clinicopathological study (United States)

    You, Gan; Sha, Zhi-Yi; Yan, Wei; Zhang, Wei; Wang, Yong-Zhi; Li, Shao-Wu; Sang, Lin; Wang, Zi; Li, Gui-Lin; Li, Shou-Wei; Song, Yi-Jun; Kang, Chun-Sheng; Jiang, Tao


    Seizure is a common presenting manifestation and plays an important role in the clinical presentation and quality of life for patients with low-grade gliomas (LGGs). The authors set out to identify factors that influence preoperative seizure characteristics and postoperative seizure control. Cases involving adult patients who had undergone initial surgery for LGGs in a single institution between 2005 and 2009 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to identify factors associated with preoperative seizures and postoperative seizure control. Of the 508 patients in the series, 350 (68.9%) presented with seizures. Age less than 38 years and cortical involvement of tumor were more likely to be associated with seizures (P = .003 and .001, respectively, multivariate logistic analysis). For the cohort of 350 patients with seizures, Engel classification was used to evaluate 6- and 12-month outcome after surgery: completely seizure free (Engel class I), 65.3% and 62.5%; not seizure free (Engel classes II, III, IV), 34.7% and 37.5%. After multivariate logistic analysis, favorable seizure prognosis was more common in patients with secondary generalized seizure (P = .006) and with calcification on MRI (.031). With respect to treatment-related variables, patients achieved much better seizure control after gross total resection than after subtotal resection (P seizure control in the patients with a history of seizure if overexpressed but was not a predictor for those without preoperative seizures. These factors may provide insight into developing effective treatment strategies aimed at prolonging patients' survival. PMID:22187341

  20. Brugada syndrome masquerading as febrile seizures. (United States)

    Skinner, Jonathan Robert; Chung, Seo-Kyung; Nel, Carey-Anne; Shelling, Andrew Neil; Crawford, Jackie Robyn; McKenzie, Neil; Pinnock, Ralph; French, John Kerswell; Rees, Mark Ian


    Fever can precipitate ventricular tachycardia in adults with Brugada syndrome, but such a link has not been reported in children. A 21-month-old white girl presented repeatedly with decreased conscious level and seizures during fever. During a typical episode, rapid ventricular tachycardia was documented. The resting 12-lead electrocardiogram revealed a Brugada electrocardiogram signature. Resting electrocardiograms of the asymptomatic brother and mother were normal, but fever in the mother and pharmacologic stress with ajmaline in the brother revealed Brugada electrocardiogram features. Genetic testing revealed an SCN5A mutation in the affected family members.

  1. Assimilating seizure dynamics.

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    Ghanim Ullah


    Full Text Available Observability of a dynamical system requires an understanding of its state-the collective values of its variables. However, existing techniques are too limited to measure all but a small fraction of the physical variables and parameters of neuronal networks. We constructed models of the biophysical properties of neuronal membrane, synaptic, and microenvironment dynamics, and incorporated them into a model-based predictor-controller framework from modern control theory. We demonstrate that it is now possible to meaningfully estimate the dynamics of small neuronal networks using as few as a single measured variable. Specifically, we assimilate noisy membrane potential measurements from individual hippocampal neurons to reconstruct the dynamics of networks of these cells, their extracellular microenvironment, and the activities of different neuronal types during seizures. We use reconstruction to account for unmeasured parts of the neuronal system, relating micro-domain metabolic processes to cellular excitability, and validate the reconstruction of cellular dynamical interactions against actual measurements. Data assimilation, the fusing of measurement with computational models, has significant potential to improve the way we observe and understand brain dynamics.

  2. Characterization of PTZ-induced seizure susceptibility in a down syndrome mouse model that overexpresses CSTB.

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    Véronique Brault

    Full Text Available Down syndrome (DS is a complex genetic syndrome characterized by intellectual disability, dysmorphism and variable additional physiological traits. Current research progress has begun to decipher the neural mechanisms underlying cognitive impairment, leading to new therapeutic perspectives. Pentylenetetrazol (PTZ has recently been found to have positive effects on learning and memory capacities of a DS mouse model and is foreseen to treat DS patients. But PTZ is also known to be a convulsant drug at higher dose and DS persons are more prone to epileptic seizures than the general population. This raises concerns over what long-term effects of treatment might be in the DS population. The cause of increased propensity for epilepsy in the DS population and which Hsa21 gene(s are implicated remain unknown. Among Hsa21 candidate genes in epilepsy, CSTB, coding for the cystein protease inhibitor cystatin B, is involved in progressive myoclonus epilepsy and ataxia in both mice and human. Thus we aim to evaluate the effect of an increase in Cstb gene dosage on spontaneous epileptic activity and susceptibility to PTZ-induced seizure. To this end we generated a new mouse model trisomic for Cstb by homologous recombination. We verified that increasing copy number of Cstb from Trisomy (Ts to Tetrasomy (Tt was driving overexpression of the gene in the brain, we checked transgenic animals for presence of locomotor activity and electroencephalogram (EEG abnormalities characteristic of myoclonic epilepsy and we tested if those animals were prone to PTZ-induced seizure. Overall, the results of the analysis shows that an increase in Cstb does not induce any spontaneous epileptic activity and neither increase or decrease the propensity of Ts and Tt mice to myoclonic seizures suggesting that Ctsb dosage should not interfere with PTZ-treatment.

  3. Febrile Seizures and Behavioural and Cognitive Outcomes in Preschool Children: The Generation R Study (United States)

    Visser, Annemarie M.; Jaddoe, Vincent W. V.; Ghassabian, Akhgar; Schenk, Jacqueline J.; Verhulst, Frank C.; Hofman, Albert; Tiemeier, Henning; Moll, Henriette A.; Arts, Willem Frans M.


    Aim: General developmental outcome is known to be good in school-aged children who experienced febrile seizures. We examined cognitive and behavioural outcomes in preschool children with febrile seizures, including language and executive functioning outcomes. Method: This work was performed in the Generation R Study, a population-based cohort…

  4. Does semiology tell us the origin of seizures consisting mainly of an alteration in consciousness? (United States)

    Baykan, Betül; Altindag, Ebru; Feddersen, Berend; Ozel, Sevda; Noachtar, Soheyl


    Studies on seizures only with an alteration of consciousness were limited mainly to generalized epilepsy. This seizure type has been described rarely in focal epilepsy. We aimed to analyze the semiologic features of this seizure type in focal and generalized epilepsies in a blinded design. A total of 338 seizure videos in 100 patients were included exclusively by semiologic criteria. Two investigators evaluated the seizure semiology (aura, seizure duration, blinking, mild motor phenomena including automatisms, and so on) from the videos. Primarily the ictal electroencephalography (EEGs) studies and all laboratory findings were evaluated for the localization of the epileptogenic zone and delineating the syndromes, in the second step. Of the focal epilepsy patients (n = 57), the epileptogenic zone could be localized to the temporal (n = 20), frontal (n = 9), and parietooccipital (n = 3) regions. The most common etiology of the generalized epilepsy patients (n = 43) was presumably genetic (n = 33). The presence of aura (none in generalized epilepsy vs. 35% in focal epilepsy; p = 0.0008), lack of blinking (19.3% in focal vs 65.1% in generalized epilepsy; p = 0.01), and longer seizure duration (generalized 14.3 ± 17.7 s vs focal 54.9 ± 40.1 s; p semiologic and clinical features that help to differentiate between focal and generalized epilepsy should be considered in the syndrome diagnosis. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  5. Myoclonus precipitated by oral suspension of oxcarbazepine in idiopathic generalized epilepsy. (United States)

    Deng, Songqing; Luo, Rong; Mao, Meng; Huang, Liang


    Oxcarbazepine (OXC) is widely registered for the treatment of partial seizures and generalized tonic-clonic seizures (GTCS). Myoclonic seizures induced by OXC are uncommon. We report a child with idiopathic generalized epilepsy who developed myoclonic seizures and had an abnormal electroencephalogram (EEG) when oral suspension of OXC was introduced. This study suggests that oral suspension of OXC can precipitate myoclonus.

  6. Refractory Seizures in Tramadol Poisoning: A Case Report

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    Mohammad Majidi


    Full Text Available Background: Tramadol, an analgesic drug abused by opioid addicts, is also abused accidentally or for suicidal purposes. Tramadol poisoning can induce CNS depression, seizures, coma, and ultimately death. Case: In this report, a 30-year-old male was admitted to the emergency department due to suicidal attempt with ingestion of 14000 mg (140 tablet 100 mg of tramadol. He had history of suicidal attempts in past years as well as depression in his past medical history, but he had not abused tramadol and other drugs in his history. There was no history of epilepsy or head trauma in. He presented with generalized seizures two hours post ingestion, and, then, he was referred to hospital four hours later. Generalized seizures were poorly controlled by multiple medications. Due to respiratory arrest, endotracheal tube was inserted and he was admitted to the ICU immediately. At admission, he experienced hypovolemic shock, hypoglycemia, coma, apnea, refractory seizures, muscle spasms, acute respiratory distress syndrome, coagolative disorder, rhabdomyolysis, and acute renal failure. Despite medical managements, he died 38 days after ingestion. Conclusion: In this report, despite using inhalational anesthetic drugs, seizures continued and were very poorly controlled. Cause of death in this patient can be seen as the side effects of tramadol poisoning.

  7. Seizures and Meperidine: Overstated and Underutilized. (United States)

    Schlick, Konrad H; Hemmen, Thomas M; Lyden, Patrick D


    Meperidine is used for pain control and treatment of shivering. Concerns about neurotoxicity, particularly seizures, have led to efforts limiting meperidine use. We reviewed the body of evidence linking meperidine to seizures. We searched PubMed for the terms meperidine, normeperidine, pethidine, and norpethidine; each was combined with the terms: seizure, epilepsy, epileptogenic, toxicity, overdose, seizure threshold, and convulsion. Articles were assessed for relevance. Semiologies were reviewed to ascertain seizure likelihood. Our search yielded 351 articles, of which 66 were relevant. Of these, 33 had primary clinical data on meperidine-associated seizures, comprising 50 patients. Twenty events were deemed likely to be seizures, 26 indeterminate, and 4 unlikely. Most studies were case reports. Confounding comorbidities were frequent. The evidence base for meperidine-associated seizures in man is scant. Seizure risk associated with meperidine appears to be overstated. The utility of meperidine should continue to be explored, especially for therapeutic hypothermia.

  8. Mechanisms and Treatment of OP-Induced Seizures and Neuropathology (United States)


    120 Figure 36. EPSP responses to olfactory nerve layer stimulation ......................................................... 121 Figure 37...For example, inhibition of GABAergic interneurons could lead to increased activity and/or excitability, promoting seizure generation. We recognize that...area; DA in the olfactory bulb derives entirely from a large population of intrinsic DAergic interneurons in the glomerular layer of the bulb. The

  9. Seizure-induced muscle force can caused lumbar spine fracture

    DEFF Research Database (Denmark)

    Mehlhorn, A T; Strohm, P C; Hausschildt, O;


    Patients suffering form epilepsy have an increased risk for fractures. Beside fractures caused by fall or accident muscles forces alone generated during tonic-clonic seizure can result in severe musculoskeletal injury. Contractions of strong paraspinal muscles can lead to compression fracture of ...

  10. Seizure freedom reduces illness intrusiveness and improves quality of life in epilepsy. (United States)

    Poochikian-Sarkissian, Sonia; Sidani, Souraya; Wennberg, Richard; Devins, Gerald M


    Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these stressors is the concept of illness intrusiveness: the disruption of lifestyles, activities, and interests due to the constraints imposed by chronic disease and its treatment. The purpose of this study was to examine illness intrusiveness and QOL in epilepsy in patients with different levels of seizure control. Cross-sectional data were obtained and compared between two groups of patients categorized by presence of seizures: seizure freedom or continued seizures (N = 145). Standard instruments measured the following variables: illness intrusiveness, perceived personal control, subjective well-being, and disease specific QOL. Illness intrusiveness varied inversely and significantly with seizure control. Complete seizure freedom, whether achieved by pharmacological or surgical treatment, was associated with the lowest levels of illness intrusiveness. Seizure freedom was also associated with increased perceived control, positive affect, self-esteem and QOL in epilepsy. The most robust benefits of decreased illness intrusiveness in epilepsy occur when treatment leads to complete seizure control. Therefore every effort should be made by health care providers to achieve seizure freedom to reduce illness intrusiveness and improve QOL in epilepsy.


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    Soroor INALOO,


    Full Text Available Febrile seizure is the most common seizure disorder in children. Its pathophysiology is not fully understood yet; however, some risk factors have been cited for it. Iron is one of these influential elements and is involved in the metabolism of some neurotransmitters which are reduced in irondeficiency anemia and also increases the sensitivity of neural cells during a febrile episode. The present study aimed to determine the rate of febrile seizure in thalassemic patients and to compare it with the corresponding rate in the normal population.Materials & MethodsThis descriptive cross-sectional study was conducted on 766 patients with thalassemia major. They were all older than 6 months and were referred to Dastghaib Cooly's Clinic, affiliated to Shiraz University of Medical Sciences, from Oct 2006 to May 2007, and 766 normal and healthy children as the control group. Questionnaires containing demographic data and past history of febrile seizure, age of febrile seizure, number of episodes, hospitalization, and related family history were prepared and filled through interviewing the parents.ResultsFebrile seizure was detected in 7 cases of the patient group (0.9% versus 18 cases (2.3% of the control group. The frequency of febrile seizure in the controls was 2.5 times more than that in the thalassemia group, which was statistically significant (P < 0.05.ConclusionThis study showed a lower rate of febrile convulsion in thalassemic patients compared to the control group. Accordingly, it could be suggested that high iron storage is a protective factor against febrile convulsion.

  12. Approach To The First Unprovoked Seizure- PART I

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    Mohammad GHOFRANI


    Full Text Available How to Cite This Article: Ghofrani M. Approach To The First Unprovoked Seizure- PART I. Iran J Child Neurol. 2013 Summer; 7(3: 1- 5. The approach to a child who has experienced a first unprovoked generalized tonic-clonic seizure is challenging and at the same time controversial.How to establish the diagnosis, ways and means of investigation and whether treatment is appropriate, are different aspects of this subject.In this writing the above mentioned matters are discussed.References1. Bluvstein JS, Moshe SL. First unprovoked seizure CurrentManagement in child Neurology, third ed. 2005.P.89-92.2. Hirtz D, Berg A, Bettis D, et al. Practice Parameter: treatment of the child with a first unprovoked seizure. American Academy of Neurology 2003;60:166-175.3. Verity GM, Ross EN, Golding J. Epilepsy in the first ten years of life: finding of the child health and education study. Br Med J 1992;305:857-861.4. Camfiled CS, Camfield PB, Gordon K, et al. Incidence of epilepsy in childhood and adolescence: A populationbasedstudy in Nova Scotia from 1977 to 1985. Epilepsia 1996;37:19-23.5. Hauser W, Annegers J, Kurland L. Incidence of epilepsy and unprovoked seizure in Rochester, Minnisota, 1935- 1984. Epilepsia 1993;34:453-468.6. Jallon P, Goumaz M, Haenggeli G, Morabia A. Incidenceof first epileptic seizure in the canton of Geneve Switzerland. Epilepsia 1997;38:547-552.7. Camfiled PR, Camfiled CS. Pediatric Epilepsy: An overview. Swaiman’s pediatric Neurology, 5th ed, 2012. P.703-710.8. Gowers WB. Epilepsy and other chronic convulsive diseases; their causes, symptoms and treatment. London: J&A Churchill,1881. P.242.9. Goddard GV, Mc Intyre DC, Leech CK. A permanent change in brain function resulting from daily electrical stimulation- Exp Neural 1969;25:295-330.10. Berg AT, Shinnar S. Do seizures beget seizure? An assessment of the clinical evidence in human. J ClinicalNeurophysiol 1993: 14: 102-110.11. Wasterlain CG. Recurrent seizures in developing brain

  13. Prevalence and Complications of Drug-induced Seizures in Baharloo Hospital, Tehran, Iran

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    Behnam Behnoush


    Full Text Available Background: Seizure is a frequent and important finding in the field of clinical toxicology. Almost all poisons and drugs can produce seizure. We have evaluated frequency and complications of drug-induced seizure in present study. Methods: The present descriptive cross-sectional study was done on patients who were referred to Baharloo Hospital, Tehran, Iran, that had developed seizure before or after hospitalization following intoxication between 20 March 2010 and 20 March 2011. The exclusion criteria were a positive history of epilepsy, head trauma, or abnormal findings in EEG or brain CT scan. Results: Tramadol and tricyclic antidepressants were the most common causes of drug-induced seizure (31.5% and 14.7% of the cases, respectively. Overall, 6 patients (4.2% had developed persistent vegetative state in consequence of brain hypoxia, 16 patients (11.2% had died due to complications of seizure or the poisoning itself. Tramadol was the leading cause of drug-induced seizure and its morbidity and mortality. Tonic-colonic seizure was the most common type of drug-induced seizure. Seizure had occurred once in 58% of the patients, twice in 37.1% of the patients, and had been revolutionized to status epilepticus in 4.9% of them. Among the 7 patients who had developed status epilepticus, 3 cases had died. Conclusion: Appropriate measures for treatment of seizure and prevention of its complications should be taken when patients with drug poisoning are admitted into hospital, especially when the offending drug(s has a higher likelihood to induce seizure.

  14. The influence of seizure frequency on anterograde and remote memory in mesial temporal lobe epilepsy. (United States)

    Voltzenlogel, Virginie; Vignal, Jean-Pierre; Hirsch, Edouard; Manning, Liliann


    Seizure frequency, although considered as an important factor in memory impairment in mesial temporal epilepsy (mTLE), is mostly confounded with other clinical variables, making it unclear to what extent recurrent seizures actually interfere with memory. The present study focuses on the influence of seizure frequency, studied as a main variable, on anterograde and remote memory. Seventy-one patients with unilateral mTLE were divided into two subgroups, as a function of their seizure frequency (monthly versus weekly seizures). Other seizure-related variables were controlled, namely, lateralisation and type of lesion, age at onset, years of ongoing seizures, etiologic factors, and number of AED. A comprehensive neuropsychological examination, including anterograde memory (verbal and non verbal recognition memory and free recall) tasks together with a large range of tests exploring different domains of remote memory, was carried out. Despite similar results on IQ, executive functions and attention, the low seizure-frequency group performed significantly better than the high seizure-frequency group on anterograde memory tests. Loss of autobiographical episodes and public-events memory, concomitant with spared personal semantic knowledge, was observed in both patient groups compared with healthy subjects. A worsening effect of high seizure frequency was recorded for autobiographical incidents and news-events memory, but unexpectedly, not for memory for famous people. The study of seizure frequency as the main variable leads us to suggest that high seizure frequency, itself, potentiates the effects of mesial temporal lobe damage on episodic memory deficits. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  15. Evaluation of Risk Factors Associated with First Episode Febrile Seizure. (United States)

    Sharawat, Indar Kumar; Singh, Jitender; Dawman, Lesa; Singh, Amitabh


    Febrile seizure (FS) is the single most common type of seizure seen in children between 6 months to 5 years of age. The purpose of our study was to identify the risk factors associated with the first episode of febrile seizures, which would help in the better management and preventive measures in children at risk for FS episodes. To evaluate the risk factors associated with the first episode of febrile seizures in Indian children. This was a hospital based, case control study. The purpose of this study was to identify the risk factors associated with the first FS episode in children. Seventy (70) children between age 6 months to 5 years with their first episode of FS were compared with 70 children with fever but without seizures based on various risk factors. The mean age was 24.90±16.11 months in cases and 26.34±16.93 months in controls. Male: female ratio was 2:1. A positive family history was found in 31.4% of first degree and 11.4% in second degree relatives. Mean maximum temperature was 102.06±1.1°F and URI (upper respiratory infection) was most common cause of fever. Antenatal complication was significantly higher in the case group. RBC (Red Blood Cells) indices like lower mean haemoglobin, MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Haemoglobin concentration) and higher RDW (Red Cell Distribution Width) values were seen in patients. Serum sodium, Serum calcium and random blood sugar values of the cases were significantly lower than those of controls (pfebrile seizures, peak body temperature, underlying cause of fever, antenatal complications, low serum calcium, sodium, blood sugar and microcytic hypochromic anaemia are the risk factors associated with the occurrence of first episode of febrile seizure and, thus, preventive measures in removing these risk factors could lead to a decrease in incidence of FS.

  16. Risk of seizure recurrence after achieving initial seizure freedom on the ketogenic diet. (United States)

    Taub, Katherine S; Kessler, Sudha Kilaru; Bergqvist, A G Christina


    Few studies have examined the long-term sustainability of complete seizure freedom on the ketogenic diet (KD). The purpose of this study was to describe the risk of seizure recurrence in children who achieved at least 1 month of seizure freedom on the KD, and to assess clinical features associated with sustained seizure freedom. Records of patients initiated on the KD at The Children's Hospital of Philadelphia (CHOP) from 1991 to 2009 were reviewed. Subjects who attained seizure freedom for at least 1 month within 2 years were included in the study. Seizure frequency was recorded based on caregiver-reported seizure diaries as unchanged, improved, or worse compared to baseline. Those patients with seizure freedom ≥1 year were compared to those with seizure freedom seizure onset, number of antiepileptic drugs (AEDs) prior to KD, and epilepsy classification. Of 276 patients initiated on the KD, 65 patients (24%) attained seizure freedom for a minimum of 1 month. The majority of these patients had daily seizures. The median time to seizure freedom after KD initiation was 1.5 months. Seizures recurred in 53 patients (82%), with a median time to seizure recurrence of 3 months. However, seizure frequency after initial recurrence remained far less than baseline. No clinical features were identified as risk factors for seizure recurrence. Seizure recurrence on the KD after 1 month of seizure freedom most often occurred as occasional breakthrough seizures and not a return to baseline seizure frequency. This study provides evidence to support the continued use of the KD in patients with initial seizure freedom even after breakthrough seizures. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  17. Intergenerational Transmission of Enhanced Seizure Susceptibility after Febrile Seizures. (United States)

    Wu, Dengchang; Feng, Bo; Dai, Yunjian; Wu, Xiaohua; Chen, Bin; Xu, Cenglin; Tang, Yangshun; Wang, Kang; Zhang, Shihong; Wang, Shuang; Luo, Benyan; Chen, Zhong


    Environmental exposure early in development plays a role in susceptibility to disease in later life. Here, we demonstrate that prolonged febrile seizures induced by exposure of rat pups to a hyperthermic environment enhance seizure susceptibility not only in these hyperthermia-treated rats but also in their future offspring, even if the offspring never experience febrile seizures. This transgenerational transmission was intensity-dependent and was mainly from mothers to their offspring. The transmission was associated with DNA methylation. Thus, our study supports a "Lamarckian"-like mechanism of pathogenesis and the crucial role of epigenetic factors in neurological conditions. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  18. Seizures after liver transplantation: a clinicopathologic study. (United States)

    Estol, C J; Lopez, O; Brenner, R P; Martinez, A J


    We reviewed the clinical and neuropathologic findings in 21 patients who had seizures after orthotopic liver transplants. Tonic-clonic seizures were the most common seizure type. Six patients developed status epilepticus. In 9 patients, seizures occurred within 1 week following transplantation. We found CNS lesions that were probably responsible for the occurrence of seizures in most patients; some had more than 1 finding. Neuropathologic examination revealed ischemic or hemorrhagic strokes in 18 patients, central pontine myelinolysis in 5, and CNS infections in 5. Multiple metabolic abnormalities were a contributing factor to the onset of seizures in some patients.

  19. Ischemia-induced degeneration of CA1 pyramidal cells decreases seizure severity in a subgroup of epileptic gerbils and affects parvalbumin immunoreactivity of CA1 interneurons. (United States)

    Winkler, D T; Scotti, A L; Nitsch, C


    Mongolian gerbils are epilepsy-prone animals. In adult gerbils two major groups can be differentiated according to their seizure behavior: Highly seizure-sensitive gerbils exhibit facial and forelimb clonus or generalized tonic-clonic seizures from the first test on, while kindled-like gerbils are seizure free for the first three to six consecutive tests, later develop forelimb myoclonus, and eventually progress to generalized tonic-clonic seizures. In the hippocampus, seizure history of the individual animal is mirrored in the intensity in which GABAergic neurons are immunostained for the calcium-binding protein parvalbumin: they lose parvalbumin with increasing seizure incidence. In a first step to clarify the influence of hippocampal projection neurons on spontaneous seizure behavior and related parvalbumin expression, we induced degeneration of the CA1 pyramidal cells by transient forebrain ischemia. This results in a decreased seizure sensitivity in highly seizure-sensitive gerbils. The kindling-like process, however, is not permanently blocked by the ischemic nerve cell loss, suggesting that an intact CA1 field is not a prerequisite for the development of seizure behavior. The seizure-induced loss of parvalbumin from the ischemia-resistant interneurons recovers after ischemia. Thus, changes in parvalbumin content brought about by repeated seizures are not permanent but can rather be modulated by novel stimuli.

  20. Prognosis of juvenile myoclonic epilepsy 45 years after onset: seizure outcome and predictors. (United States)

    Senf, Philine; Schmitz, Bettina; Holtkamp, Martin; Janz, Dieter


    Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized epilepsy subsyndrome, contributing to approximately 3% to 11% of adolescent and adult cases of epilepsy. However, little is known about the long-term medical evolution of this clinical entity. The aim of this study was to analyze long-term outcome in a clinically well-defined series of patients with JME for seizure evolution and predictors of seizure outcome. In this retrospective cohort study, we analyzed seizure outcome in 66 patients who had JME, were treated at the Department of Neurology, Charité-Universitätsmedizin Berlin, and were initially diagnosed by a single senior epileptologist. After a mean follow-up time of 44.6 years (20-69 years), 59.1% of patients remained free of seizures for at least 5 years before the last contact. Among the seizure-free patients, 28 (71.8%) were still taking antiepileptic drugs and 11 (28.2%) were off medication for at least the last 5 years. We identified manifestation of additional absence seizures at onset of JME as an independent predictor of an unfavorable outcome regarding seizure freedom. A significant proportion of patients with JME were seizure-free and off antiepileptic drug therapy in the later course of their disorder. Patients with JME and additional absence seizures might represent a different JME subtype with a worse outcome.

  1. Factors associated with seizure freedom in the surgical resection of glioneuronal tumors. (United States)

    Englot, Dario J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F


    Gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNETs) are low-grade brain tumors of glioneuronal origin that commonly present with seizures. Achieving seizure control in patients with glioneuronal tumors remains underappreciated, as tumor-related epilepsy significantly affects patients' quality-of-life. We performed a quantitative and comprehensive systematic literature review of seizure outcomes after surgical resection of GGs and DNETs associated with seizures. We evaluated 910 patients from 39 studies, and stratified outcomes according to several potential prognostic variables. Overall, 80% of patients were seizure-free after surgery (Engel class I), whereas 20% continued to have seizures (Engel class II-IV). We observed significantly higher rates of seizure-freedom in patients with ≤1 year duration of epilepsy compared to those with >1 year of seizures [odds ratio (OR) 9.48; 95% confidence interval (CI) 2.26-39.66], and with gross-total resection over subtotal lesionectomy (OR 5.34; 95% CI 3.61-7.89). In addition, the presence of secondarily generalized seizures preoperatively predicted a lower rate of seizure-freedom after surgery (OR 0.40; 95% CI 0.24-0.66). Outcomes did not differ significantly between adults and children, patients with temporal lobe versus extratemporal tumors, pathologic diagnosis of GG versus DNET, medically controlled versus refractory seizures, or with the use of electrocorticography (ECoG). Extended resection of temporal lobe tumors, with hippocampectomy and/or corticectomy, conferred additional benefit. These results suggest that early operative intervention and gross-total resection are critically important factors in achieving seizure-freedom, and thus improving quality-of-life, in patients with glioneuronal tumors causing epilepsy. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  2. Automated seizure detection systems and their effectiveness for each type of seizure. (United States)

    Ulate-Campos, A; Coughlin, F; Gaínza-Lein, M; Fernández, I Sánchez; Pearl, P L; Loddenkemper, T


    Epilepsy affects almost 1% of the population and most of the approximately 20-30% of patients with refractory epilepsy have one or more seizures per month. Seizure detection devices allow an objective assessment of seizure frequency and a treatment tailored to the individual patient. A rapid recognition and treatment of seizures through closed-loop systems could potentially decrease morbidity and mortality in epilepsy. However, no single detection device can detect all seizure types. Therefore, the choice of a seizure detection device should consider the patient-specific seizure semiologies. This review of the literature evaluates seizure detection devices and their effectiveness for different seizure types. Our aim is to summarize current evidence, offer suggestions on how to select the most suitable seizure detection device for each patient and provide guidance to physicians, families and researchers when choosing or designing seizure detection devices. Further, this review will guide future prospective validation studies. Copyright © 2016. Published by Elsevier Ltd.

  3. Healthcare-seeking behavior after seizures in children

    Directory of Open Access Journals (Sweden)

    Bavdekar Sandeep


    Full Text Available Background: Hardly any Indian data is available regarding practices employed by parents for preventing injuries and aspiration and controlling convulsions in children. Aims: To describe the health care-seeking behavior and practices employed by parents when a child has convulsions. Settings and Design: Prospective questionnaire-based study in a tertiary care hospital setting. Materials and Methods: Parents of children (age: 1 month -12 years admitted with history of convulsions were enrolled and information regarding demographic characteristics, time lag, preferred health care provider and measures taken in a convulsing child was elicited using a pretested questionnaire. Statistical Analysis Used: Demographic parameters and measures employed described as percentages. Results: One hundred and forty parents were interviewed. Seventy-six children had first episode. Forty-nine of 64 children with subsequent seizures had contact with a health care provider during the previous seizure episode. The median duration of seizures was 10 minutes (Mean: 54.15±366.39 min; but children were brought to the hospital after a median of 2 hours (Mean: 5.22±10.37 h. Measures such as smelling onions, oral administration of cold water, reading religious texts and insertion of mouth gag were employed. Although 45 with previous seizure-related health care contact agreed that they were informed about measures to be taken, none of them could remember more than one measure for preventing injuries and aspiration and controlling seizures. Only four narrated "per-rectal administration of diazepam" as a measure, although only one implemented it. Only four general practitioners used per-rectal diazepam to control seizures. Conclusions: Children with seizures reach health care providers after a considerable delay putting them at higher risk for developing neurological sequel. There is a need to develop appropriate strategies for disseminating information about "first aid

  4. Can semiology predict psychogenic nonepileptic seizures? A prospective study. (United States)

    Syed, Tanvir U; LaFrance, W Curt; Kahriman, Emine S; Hasan, Saba N; Rajasekaran, Vijayalakshmi; Gulati, Deepak; Borad, Samip; Shahid, Asim; Fernandez-Baca, Guadalupe; Garcia, Naiara; Pawlowski, Matthias; Loddenkemper, Tobias; Amina, Shahram; Koubeissi, Mohamad Z


    Reducing health and economic burdens from diagnostic delay of psychogenic nonepileptic seizures (PNES) requires prompt referral for video electroencephalography (VEEG) monitoring, the diagnostic gold standard. Practitioners make VEEG referrals when semiology suggests PNES, although few semiological signs are supported by well-designed studies, and most VEEG studies neglect to concurrently measure how accurately seizure witnesses can ascertain semiology. In this study, we estimate the value of eyewitness-reported and video-documented semiology for predicting PNES, and we measure accuracy of eyewitness reports. We prospectively interviewed eyewitnesses of seizures in patients referred for VEEG monitoring, to inquire about 48 putative PNES and ES signs. Multiple, EEG-blinded, epileptologists independently evaluated seizure videos and documented the presence/absence of signs. We used generalized estimating equations to identify reliable video-documented PNES and ES signs, and we compared eyewitness reports with video findings to assess how accurately signs are reported. We used logistic regression to determine whether eyewitness reports could predict VEEG-ascertained seizure type. We analyzed 120 seizures (36 PNES, 84 ES) from 35 consecutive subjects. Of 45 video-documented signs, only 3 PNES signs ("preserved awareness," "eye flutter," and "bystanders can intensify or alleviate") and 3 ES signs ("abrupt onset," "eye-opening/widening," and postictal "confusion/sleep") were significant and reliable indicators of seizure type. Eyewitness reports of these 6 signs were inaccurate and not statistically different from guessing. Consequentially, eyewitness reports of signs did not predict VEEG-ascertained diagnosis. We validated our findings in a second, prospective cohort of 36 consecutive subjects. We identified 6 semiological signs that reliably distinguish PNES and ES, and found that eyewitness reports of these signs are unreliable. We offer suggestions to improve the

  5. Bumetanide-Enhanced Phenobarbetal in Neonatal Seizure Model

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    J Gordon Millichap


    Full Text Available Anticonvulsant efficacy of phenobarbital, bumetanide, and a combination of these drugs was studied in an in vitro hippocampal rat pup (4-7 days preparation, with recurrent seizures induced by exposure to low-Mg solution, at the Department of Neurology, Massachusetts General Hospital, Boston.

  6. Diagnostic decision-making after a first and recurrent seizure in adults. (United States)

    Askamp, Jessica; van Putten, Michel J A M


    The role of EEG after a first seizure has been debated. Epileptiform EEG activity is a good predictor of seizure recurrence, but is reported in only 8-50% of first-seizure adult patients. Even if the EEG is abnormal, the opinions about treatment after a first seizure differ. The role of EEG in treatment decisions after remission or recurrence is also unclear. This study aims to identify neurologists' diagnostic strategies compared to guidelines about the use of EEG (i) after a first unprovoked generalized seizure in adults, (ii) after a recurrent seizure and (iii) in treatment decisions after recurrence or remission. All members of the Dutch Neurological Society were invited to participate in our on-line survey about the use of EEG after a first seizure, after recurrent seizures and in treatment decisions. Ten percent (N=110) of invitees participated, including mainly clinical neurophysiologists, general neurologists and neurologists-in-training. Ninety-five percent of the respondents would request a routine EEG after a first seizure. After normal MRI and EEG findings, 4% would record a second routine EEG, 48% a sleep-deprived EEG and 45% would not repeat the EEG. If a recurrent seizure occurs within six, or after 12 or 24 months, 87%, 67% and 44% would respectively conclude that the patient has epilepsy, while 57%, 65% and 72% would request an EEG. When a patient experiences a recurrence while being treated with anti-epileptic drugs, 11% of the respondents would request an EEG. Twenty-five percent would request an EEG before stopping medication after two years of remission. The variability in neurologists' reported strategies about the use of EEG in the diagnosis of seizures is remarkably large. Consequences for the individual patient may be significant, including treatment decisions and driving restrictions. The availability and use of more sensitive diagnostic methods may be necessary to enhance agreement between neurologists. Copyright © 2013 British Epilepsy

  7. Impaired consciousness in temporal lobe seizures: role of cortical slow activity (United States)

    Englot, Dario J.; Yang, Li; Hamid, Hamada; Danielson, Nathan; Bai, Xiaoxiao; Marfeo, Anthony; Yu, Lissa; Gordon, Aliza; Purcaro, Michael J.; Motelow, Joshua E.; Agarwal, Ravi; Ellens, Damien J.; Golomb, Julie D.; Shamy, Michel C. F.; Zhang, Heping; Carlson, Chad; Doyle, Werner; Devinsky, Orrin; Vives, Kenneth; Spencer, Dennis D.; Spencer, Susan S.; Schevon, Catherine; Zaveri, Hitten P.


    Impaired consciousness requires altered cortical function. This can occur either directly from disorders that impair widespread bilateral regions of the cortex or indirectly through effects on subcortical arousal systems. It has therefore long been puzzling why focal temporal lobe seizures so often impair consciousness. Early work suggested that altered consciousness may occur with bilateral or dominant temporal lobe seizure involvement. However, other bilateral temporal lobe disorders do not impair consciousness. More recent work supports a ‘network inhibition hypothesis’ in which temporal lobe seizures disrupt brainstem–diencephalic arousal systems, leading indirectly to depressed cortical function and impaired consciousness. Indeed, prior studies show subcortical involvement in temporal lobe seizures and bilateral frontoparietal slow wave activity on intracranial electroencephalography. However, the relationships between frontoparietal slow waves and impaired consciousness and between cortical slowing and fast seizure activity have not been directly investigated. We analysed intracranial electroencephalography recordings during 63 partial seizures in 26 patients with surgically confirmed mesial temporal lobe epilepsy. Behavioural responsiveness was determined based on blinded review of video during seizures and classified as impaired (complex-partial seizures) or unimpaired (simple-partial seizures). We observed significantly increased delta-range 1–2 Hz slow wave activity in the bilateral frontal and parietal neocortices during complex-partial compared with simple-partial seizures. In addition, we confirmed prior work suggesting that propagation of unilateral mesial temporal fast seizure activity to the bilateral temporal lobes was significantly greater in complex-partial than in simple-partial seizures. Interestingly, we found that the signal power of frontoparietal slow wave activity was significantly correlated with the temporal lobe fast seizure

  8. CSF glutamate/GABA concentrations in pyridoxine-dependent seizures: etiology of pyridoxine-dependent seizures and the mechanisms of pyridoxine action in seizure control. (United States)

    Goto, T; Matsuo, N; Takahashi, T


    Several lines of evidence suggest that the binding affinity of glutamate decarboxylase (GAD) to the active form of pyridoxine is low in cases of pyridoxine-dependent seizures (PDS) and that a quantitative imbalance between excitatory (i.e. glutamate) and inhibitory (i.e. gamma-aminobutyric acid, GABA) neurotransmitters could cause refractory seizures. However, inconsistent findings with GAD insufficiency have been reported in PDS. We report a case of PDS that is not accompanied by an elevated cerebrospinal fluid (CSF) glutamate concentration. Intravenous pyridoxine phosphate terminated generalized seizures which were otherwise refractory to conventional anti-epileptic medicines. No seizure occurred once oral pyridoxine (13.5 mg/kg per day) was started in combination with phenobarbital sodium (PB, 3.7 mg/kg per day). The electroencephalogram (EEG) normalized approximately 8 months after pyridoxine was started. The patient is gradually acquiring developmental milestones during the 15 months follow-up period. The CSF glutamate and GABA concentrations were determined on three separate occasions: (1) during status epilepticus; (2) during a seizure-free period with administration of pyridoxine and PB; and (3) 6 days after suspension of pyridoxine and PB and immediately before a convulsion. The CSF glutamate level was below the sensitivity of detection (pyridoxine supplementation, were within the normal range. We suggest that (1) PDS is not a discrete disease of single etiology in that insufficient activation of GAD may not account for seizure susceptibility in all cases and (2) mechanism(s) of anti-convulsive effect of pyridoxine, at least in some cases, may be independent of GAD activation.

  9. Hemispheric surgery for refractory epilepsy: a systematic review and meta-analysis with emphasis on seizure predictors and outcomes. (United States)

    Hu, Wen-Han; Zhang, Chao; Zhang, Kai; Shao, Xiao-Qiu; Zhang, Jian-Guo


    Conflicting conclusions have been reported regarding several factors that may predict seizure outcomes after hemispheric surgery for refractory epilepsy. The goal of this study was to identify the possible predictors of seizure outcome by pooling the rates of postoperative seizure freedom found in the published literature. A comprehensive literature search of PubMed, Embase, and the Cochrane Library identified English-language articles published since 1970 that describe seizure outcomes in patients who underwent hemispheric surgery for refractory epilepsy. Two reviewers independently assessed article eligibility and extracted the data. The authors pooled rates of seizure freedom from papers included in the study. Eight potential prognostic variables were identified and dichotomized for analyses. The authors also compared continuous variables within seizure-free and seizure-recurrent groups. Random- or fixed-effects models were used in the analyses depending on the presence or absence of heterogeneity. The pooled seizure-free rate among the 1528 patients (from 56 studies) who underwent hemispheric surgery was 73%. Patients with an epilepsy etiology of developmental disorders, generalized seizures, nonlateralization on electroencephalography, and contralateral MRI abnormalities had reduced odds of being seizure-free after surgery. Hemispheric surgery is an effective therapeutic modality for medically intractable epilepsy. This meta-analysis provides useful evidence-based information for the selection of candidates for hemispheric surgery, presurgical counseling, and explanation of seizure outcomes.

  10. Lacosamide: A Review in Focal Seizures in Patients with Epilepsy. (United States)

    Scott, Lesley J


    Lacosamide (Vimpat(®)) is a functionalized amino acid available orally (as a solution or tablets) and as an intravenous infusion for use as monotherapy (only in the USA) or adjunctive therapy for the treatment of focal seizures in adult and adolescent (aged ≥17 years in the USA) patients with epilepsy. As adjunctive therapy to other antiepileptic drugs (AEDs), lacosamide provided effective seizure control and was generally well tolerated in adults and adolescents (aged ≥16 years) in randomized clinical trials and in the real-world setting. In clinical trials, adjunctive lacosamide provided significantly greater reductions in 28-day seizure rates than adjunctive placebo, with these benefits maintained after up to 8 years of therapy in open-label extension studies. Moreover, patients were effectively switched from oral to short-term intravenous adjunctive therapy at the same dosage, which may be particularly beneficial in situations where oral therapy is not suitable. Conversion to lacosamide monotherapy was superior to a historical-control cohort in patients with focal seizures converting from previous AED therapy. In the absence of head-to-head comparisons with other AEDs, the exact position of lacosamide relative to other AEDs remains to be fully determined. In the meantime, oral and intravenous lacosamide provides a useful option as monotherapy (only in the USA) or adjunctive therapy for the treatment of focal seizures in adult and adolescent (aged ≥17 years in the USA) patients with epilepsy.

  11. A patient with atonic seizures mimicking transient ischemic attacks

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    Min-Ju Kang


    Full Text Available A focal atonic seizure is a partial seizure in which the ictal manifestation consists of paresis of the extremities or muscles on one side of the body, and this phenomenon can easily be misdiagnosed as a transient ischemic attack. An 86-year-old woman visited our hospital complaining of transient right upper extremity weakness lasting for 10 min following an unusual sensation in her chest accompanied by palpitations. On the third hospital day, she again complained of right arm weakness, which progressed to jerky movements of her right extremity accompanied by facial twitching and then generalized into a tonic–clonic seizure. The EEG displayed several interictal spikes in the contralateral temporal area, and the ictal SPECT, analyzed using the SISCOM system, showed an increased signal in both the contralateral superior parietal area and the mesial frontal area. In this case, the patient was diagnosed with focal atonic seizures as the cause of the monolimb weakness, which had been initially misdiagnosed aas transient ischemic attacks. In cases in which a patient presents with monolimb paresis, physicians should consider the possibility of an atonic seizure as the cause.

  12. Migraine with aura and photosensitive epileptic seizures: a case report. (United States)

    de Carolis, P; Tinuper, P; Sacquegna, T


    An 18-year-old female presented with two seizures induced by photic stimulation. She had a positive family history for migraine and a history of febrile convulsions. Since the age of 13 she had suffered from migraine attacks with aura. A brain computerized tomography with contrast enhancement was negative and several electroencephalograms showed a photoparoxysmal response. At the age of 18 she had a partial secondary generalized seizure after photic stimulation during routine electroencephalogram. The onset of seizure was in the occipital region. Two days later, the patient presented with a typical migrainous attack with aura. Interictal apomorphine test (1.5 mg s.c.) blocked the photoparoxysmal response. According to Quesnay, dopaminergic failure of the occipital cortex may account for both epileptic and migraine features.

  13. Febrile Seizures: Controversy and Consensus (United States)

    Doiron, Omer A.


    Although febrile convulsions are a relatively common complaint, the approach to their management is far from uniform and highly controversial. This article reviews the consensus statement on febrile convulsions arrived at by the Consensus Development Conference held in 1980 by the National Institutes of Health, together with other literature of interest to family physicians. Guidelines are given for the assessment, diagnosis and emergency treatment of febrile seizures. Epilepsy and atypical febrile convulsions are distinguished from simple febrile seizures. Prognosis, prevention, and the importance of counselling parents are discussed, as well as the controversial issue of prophylactic treatment. PMID:21286583

  14. Traditional and non-traditional treatments for autism spectrum disorder with seizures: an on-line survey

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    Sreenivasula Swapna


    Full Text Available Abstract Background Despite the high prevalence of seizure, epilepsy and abnormal electroencephalograms in individuals with autism spectrum disorder (ASD, there is little information regarding the relative effectiveness of treatments for seizures in the ASD population. In order to determine the effectiveness of traditional and non-traditional treatments for improving seizures and influencing other clinical factor relevant to ASD, we developed a comprehensive on-line seizure survey. Methods Announcements (by email and websites by ASD support groups asked parents of children with ASD to complete the on-line surveys. Survey responders choose one of two surveys to complete: a survey about treatments for individuals with ASD and clinical or subclinical seizures or abnormal electroencephalograms, or a control survey for individuals with ASD without clinical or subclinical seizures or abnormal electroencephalograms. Survey responders rated the perceived effect of traditional antiepileptic drug (AED, non-AED seizure treatments and non-traditional ASD treatments on seizures and other clinical factors (sleep, communication, behavior, attention and mood, and listed up to three treatment side effects. Results Responses were obtained concerning 733 children with seizures and 290 controls. In general, AEDs were perceived to improve seizures but worsened other clinical factors for children with clinical seizure. Valproic acid, lamotrigine, levetiracetam and ethosuximide were perceived to improve seizures the most and worsen other clinical factors the least out of all AEDs in children with clinical seizures. Traditional non-AED seizure and non-traditional treatments, as a group, were perceived to improve other clinical factors and seizures but the perceived improvement in seizures was significantly less than that reported for AEDs. Certain traditional non-AED treatments, particularly the ketogenic diet, were perceived to improve both seizures and other clinical

  15. Pentylenetetrazole-induced seizures in developing rats prenatally exposed to valproic acid

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    Angel A. Puig-Lagunes


    Full Text Available Background Epidemiological evidence indicates epilepsy is more common in patients with autism spectrum disorders (ASD (20–25% than in the general population. The aim of this project was to analyze seizure susceptibility in developing rats prenatally exposed to valproic acid (VPA as autism model. Methods Pregnant females were injected with VPA during the twelfth embryonic day. Seizures were induced in fourteen-days-old rat pups using two models of convulsions: pentylenetetrazole (PTZ and lithium-pilocarpine (Li-Pilo. Results Two subgroups with different PTZ-induced seizure susceptibility in rats exposed to VPA were found: a high susceptibility (VPA+ (28/42, seizure severity 5 and a low susceptibility (VPA− (14/42, seizure severity 2. The VPA+ subgroup exhibited an increased duration of the generalized tonic-clonic seizure (GTCS; 45 ± 2.7 min, a higher number of rats showed several GTCS (14/28 and developed status epilepticus (SE after PTZ injection (19/27 compared with control animals (36.6 ± 1.9 min; 10/39; 15/39, respectively. No differences in seizure severity, latency or duration of SE induced by Li-Pilo were detected between VPA and control animals. Discussion Prenatal VPA modifies the susceptibility to PTZ-induced seizures in developing rats, which may be linked to an alteration in the GABAergic transmission. These findings contribute to a better understanding of the comorbidity between autism and epilepsy.

  16. Stopping epilepsy treatment in seizure remission: Good or bad or both? (United States)

    Schmidt, Dieter; Sillanpää, Matti


    To review the outcome of epilepsy after stopping antiepileptic drugs in remission. Stopping antiepileptic drugs (AEDs) in remission is routinely done in many patients. Although the consequences of an unexpected relapse seizure in the 2 years after stopping AEDs may cause anguish and social issues, the impact on the long term seizure outlook of the epilepsy is minimal, if any. Discontinuation of drug treatment does not seem to affect the long-term prognosis but exposes patients who were seizure-free for years to a transient two-fold risk of seizures for the first 2 years after stopping AEDs. In addition, 20% of patients who were seizure-free for years, do not become seizure-free immediately after restarting AED treatment after relapse. The list of potential pitfalls is long. Patients with juvenile myoclonic epilepsy, those with prior withdrawal attempts and late remission have a higher risk of relapse. Stopping AEDs in remission does not affect the long-term patterns of epilepsy and some patients report a better general health in a life without AEDs. High-risk patients should not be generally encouraged to stop their AEDs in remission. We need new drugs that combine anti-seizure and antiepileptogenic effects to prevent seizure relapse and flare up of epilepsy after stopping AEDs in remission. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  17. Temperature, age, and recurrence of febrile seizure

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); E.W. Steyerberg (Ewout); G. Derksen-Lubsen (Gerarda); H.A. Moll (Henriëtte)


    textabstractOBJECTIVE: Prediction of a recurrent febrile seizure during subsequent episodes of fever. DESIGN: Study of the data of the temperatures, seizure recurrences, and baseline patient characteristics that were collected at a randomized placebo controlled trial of ibuprofen s

  18. Temperature, age, and recurrence of febrile seizure

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); E.W. Steyerberg (Ewout); G. Derksen-Lubsen (Gerarda); H.A. Moll (Henriëtte)


    textabstractOBJECTIVE: Prediction of a recurrent febrile seizure during subsequent episodes of fever. DESIGN: Study of the data of the temperatures, seizure recurrences, and baseline patient characteristics that were collected at a randomized placebo controlled trial of ibuprofen

  19. Pyridoxine-dependent seizures and microcephaly. (United States)

    Tan, Hüseyin; Kardaş, Fatih; Büyükavci, Mustafa; Karakelleoğlu, Cahit


    Pyridoxine dependency is a rare autosomal-recessive disorder causing intractable seizures in neonates and infants. This case report describes an infant with pyridoxine-dependent seizures with microcephaly and discusses a probable pathogenetic mechanism of microcephaly in this condition.

  20. Seizure complicating interscalene brachail plexus block | Idehen ...

    African Journals Online (AJOL)

    Seizure complicating interscalene brachail plexus block. ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING AJOL · RESOURCES ... We describe a case of seizure occurring immediately after completion of ...

  1. Role of electroencephalogram and neuroimaging in first onset afebrile and complex febrile seizures in children from Kashmir

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    Akhter Rasool


    Full Text Available Objectives: (1 To determine the frequency of abnormal neuroimaging in children with new-onset afebrile and complex febrile seizures; (2 to draw a correlation between Electroencephalogram (EEG and neuroimaging. Study Design: A hospital-based prospective study. Materials and Methods: A total of 276 children (6 months to 14 years of age, who presented with new-onset afebrile or complex febrile seizures, underwent EEG and neuroimaging [Computed Tomography (CT and/or Magnetic Resonance Imaging (MRI]. Results: Generalized seizures constituted the major seizure group in our study - 116/276 (42% - followed by partial seizures 86/276 (31.2% and complex febrile seizure in 64/276 (23.2%. Generalized as well as partial seizures were more common in children aged 6-14 years, while complex febrile seizures were predominantly seen in children less than 6 years old. Most of the patients with generalized and partial seizures had EEG abnormalities, while EEG abnormalities were uncommon in patients with complex febrile seizures. A total of 27/276 (9.8% patients with seizure disorder had abnormal CT scans and this abnormality was more common in patients with partial seizures. CT abnormality was seen more commonly in those patients who had an abnormal EEG. EEG and CT correlation showed that patients with abnormal EEG had higher rates of CT abnormality, ie, 16.1% (25/155. Abnormal MRI was seen in 32/157 (20.4% of patients; accuracy of picking abnormality by MRI, when EEG was abnormal, was 24.8% (P<0.05. Conclusion: Our findings indicate that clinical examination and EEG results are good indicators for neuroimaging, and these can be used as one of the criteria for ordering neuroimaging in new-onset seizures.

  2. Utility of different seizure induction protocols in psychogenic nonepileptic seizures. (United States)

    Goyal, Gourav; Kalita, Jayantee; Misra, Usha K


    Psychogenic non epileptic seizure (PNES) can be induced by several induction tests but their relative usefulness has not been evaluated. In this study, we report the sensitivity and specificity of various induction tests in the diagnosis of PNES and assess their discomfort level. The induction tests were: (a) compression of temple region (CTR), (b) verbal suggestion (VS), (c) tuning fork application (TFA), (d) moist swab application (MSA), (e) torch light stimulation (TLS) and (f) saline injection (SI). Up to 3 trials were done for each test except for normal saline injection which was given once. For comparison of these tests, patients with epileptic seizures were included as controls. The time to precipitate PNES was recorded and patients' discomfort levels were noted on a 0-10 scale. Video EEG was recorded in the PNES patients. 140 patients with PNES and 50 controls with epileptic seizures were included. The diagnostic yield of CTR was 65.7%, TFA 61.4%, MSA 60.7%, SI 55.6%, VS 54.3% and TLS 40.7%. These tests did not induce seizures in the controls. All these tests had 100% specificity and 100% positive predictive value in the diagnosis of PNES. The maximum discomfort was reported with SI and minimum with MSA. The similarity of efficacy and discomfort with CTR and TFA appear to be the most optimal induction techniques when compared with VS, AMS, TLS, and SI.

  3. Epileptic Seizures from Abnormal Networks: Why Some Seizures Defy Predictability (United States)


    are provoked (e.g. medications and alcohol) and less than half of these patients have recurrent seizures. The life- time cumulative risk of developing... microwire and clinical macroelectrode recordings. Brain 131 (Pt 4), 928—937. Worrell, G.A., Parish, L., Cranstoun, S.D., Jonas, R., Bal- tuch, G., Litt

  4. Perioperative seizures in patients with a history of a seizure disorder. (United States)

    Niesen, Adam D; Jacob, Adam K; Aho, Lucyna E; Botten, Emily J; Nase, Karen E; Nelson, Julia M; Kopp, Sandra L


    The occurrence of perioperative seizures in patients with a preexisting seizure disorder is unclear. There are several factors unique to the perioperative period that may increase a patient's risk of perioperative seizures, including medications administered, timing of medication administration, missed doses of antiepileptic medications, and sleep deprivation. We designed this retrospective chart review to evaluate the frequency of perioperative seizures in patients with a preexisting seizure disorder. We retrospectively reviewed the medical records of all patients with a documented history of a seizure disorder who received an anesthetic between January 1, 2002 and December 31, 2007. Patients excluded from this study include those who had an outpatient procedure or intracranial procedure, ASA classification of V, pregnant women, and patients younger than 2 years of age. The first hospital admission of at least 24 hours during which an anesthetic was provided was identified for each patient. Patient demographics, character of the seizure disorder, details of the surgical procedure, and clinically apparent seizure activity in the perioperative period (within 3 days after the anesthetic) were recorded. During the 6-year study period, 641 patients with a documented seizure disorder were admitted for at least 24 hours after an anesthetic. Twenty-two patients experienced perioperative seizure activity for an overall frequency of 3.4%(95% confidence interval, 2.2%-5.2%). The frequency of preoperative seizures (P seizure (P seizure. As the number of antiepileptic medications increased, so did the frequency of perioperative seizures (P seizures in this patient population. We conclude that the majority of perioperative seizures in patients with a preexisting seizure disorder are likely related to the patient's underlying condition. The frequency of seizures is not influenced by the type of anesthesia or procedure. Because patients with frequent seizures at baseline are

  5. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. (United States)

    Fisher, Robert S; Cross, J Helen; French, Jacqueline A; Higurashi, Norimichi; Hirsch, Edouard; Jansen, Floor E; Lagae, Lieven; Moshé, Solomon L; Peltola, Jukka; Roulet Perez, Eliane; Scheffer, Ingrid E; Zuberi, Sameer M


    The International League Against Epilepsy (ILAE) presents a revised operational classification of seizure types. The purpose of such a revision is to recognize that some seizure types can have either a focal or generalized onset, to allow classification when the onset is unobserved, to include some missing seizure types, and to adopt more transparent names. Because current knowledge is insufficient to form a scientifically based classification, the 2017 Classification is operational (practical) and based on the 1981 Classification, extended in 2010. Changes include the following: (1) "partial" becomes "focal"; (2) awareness is used as a classifier of focal seizures; (3) the terms dyscognitive, simple partial, complex partial, psychic, and secondarily generalized are eliminated; (4) new focal seizure types include automatisms, behavior arrest, hyperkinetic, autonomic, cognitive, and emotional; (5) atonic, clonic, epileptic spasms, myoclonic, and tonic seizures can be of either focal or generalized onset; (6) focal to bilateral tonic-clonic seizure replaces secondarily generalized seizure; (7) new generalized seizure types are absence with eyelid myoclonia, myoclonic absence, myoclonic-atonic, myoclonic-tonic-clonic; and (8) seizures of unknown onset may have features that can still be classified. The new classification does not represent a fundamental change, but allows greater flexibility and transparency in naming seizure types. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.


    Directory of Open Access Journals (Sweden)



    Full Text Available This paper aims to be a comparative analysis of the special seizure as a safety measure, as it is regulated in Romanian special criminal legislation, and also a way to highlight certain discrepancies between the general and special criminal legislation. Special seizure, as a safety measure, may be disposed under Criminal Code regulations, as a general norm, but also under some stipulations included in special Criminal laws. Moreover, when there are such special stipulations, they have under the rules of specialty principle, priority in implementing to the general norm. In our opinion, in these cases, special seizure is also disposed under the Criminal Code provisions, as general norm, because the general terms nondescript by others field of incidence, are the ones who set by the Criminal law. In fact, in such cases, the special seizure is ordered under both Criminal provisions. In analysis of the paper, is made reference to the applicability of special seizure measure inmatter of corruption offences, in customs, money laundering, illicit trafficking of drugs and fisheries and fish farming, and as a result of their presentation, we concluded that although is in question the specialty principle, mainly would find application the general norm in comparison with special norm. Moreover, corroborating the actually general norm with the provisions of the New Criminal Code, we believe the special seizure, should operate exclusively under the general law, or the provisions of the special norm, should be modified.

  7. Neonatal Seizures. Advances in Mechanisms and Management.



    Seizures occur in approximately 1–5 per 1,000 live births, and are among the most common neurologic conditions managed by a neonatal neurocritical care service. There are several, age-specific factors that are particular to the developing brain, which influence excitability and seizure generation, response to medications, and impact of seizures on brain structure and function. Neonatal seizures are often associated with serious underlying brain injury such as hypoxia-ischemia, stroke or hemor...

  8. The Life Time Prevalence of Childhood Seizure


    P AlizadehTaheri; Naseri, M; M Lahooti; Sadeghi, M


    "nBackground: Seizure is the most common pediatric neurologic disorder. Epidemiological studies of childhood epilepsy are of importance to compare incidence and prevalence rates, age distribution, inheritance, seizure types, epilepsy syn­dromes and treatment strategies. Since there is little information about prevalence of childhood seizure in Iran, this study was aimed to determine the life time prevalence of childhood seizure and some of its determining factors in Tehran, Iran....

  9. Clinical profile of patients with nascent alcohol related seizures

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    P Sandeep


    Full Text Available Aim: The aim of this study is to characterize the clinical profile of patients with alcohol related seizures (ARS and to identify the prevalence of idiopathic generalized epilepsy (IGE in the same. Materials and Methods: 100 consecutive male patients presenting to a tertiary care center in South India with new onset ARS were analyzed with alcohol use disorders identification test (AUDIT score. All underwent 19 channel digital scalp electroencephalography (EEG and at least computed tomography (CT scan. Results: A total of 27 patients (27% who had cortical atrophy on CT had a mean duration of alcohol intake of 23.62 years compared with 14.55 years in patients with no cortical atrophy (P < 0.001. Twenty-two patients (22% had clustering in the current episode of whom 18 had cortical atrophy. Nearly, 88% patients had generalized tonic clonic seizures while 12% who had partial seizures underwent magnetic resonance imaging (MRI, which identified frontal focal cortical dysplasia in one. Mean lifetime duration of alcohol intake in patients presenting with seizures within 6 hours (6H-gp of intake of alcohol was significantly lower (P = 0.029. One patient in the 6H-gp with no withdrawal symptoms had EEG evidence for IGE and had a lower AUDIT score compared with the rest. Conclusion: CT evidence of cortical atrophy is related to the duration of alcohol intake and portends an increased risk for clustering. Partial seizures can be a presenting feature of ARS and those patients may benefit from MRI to identify underlying symptomatic localization related epilepsy (8.3% of partial seizures. IGE is more likely in patients presenting with ARS within first 6 hours especially if they do not have alcohol withdrawal symptoms and scalp EEG is helpful to identify this small subgroup (~1% who may require long-term anti-epileptic medication.

  10. Massively multiplayer online role-playing game-induced seizures: a neglected health problem in Internet addiction. (United States)

    Chuang, Yao-Chung


    As the Internet has become rapidly and widely integrated into society, Internet addiction has become a growing psychosocial problem. However, epileptic seizure, another out-of-the-ordinary health problem, is often neglected in this regard. Ten patients who experienced epileptic seizures while playing the newest genre of electronic games -- Massively Multiplayer Online Role-Playing Games (MMORPGs) -- were investigated. Patients were predominantly male young adults, and most of the events were generalized tonic-clonic seizures, myoclonic seizures, and absences. These patients should be categorized into idiopathic generalized epilepsies. Even though photosensitivity was an important factor, behavioral and higher mental activities also seemed to be significant seizure precipitants. Results demonstrated that MMORPG-induced seizures were not analogous to the ordinary video game-induced seizures. Significantly, an epileptic seizure warning did not always appear on the websites of MMORPGs and instructions for the software. While the prevalence of MMORPG-induced seizures remains unknown, it may exceed our expectations and impact our society. Not only for clinical neurologists but also for the primary physicians, educators, sociologists, and global online game publishers, there should be an awareness of this special form of reflex seizures in order to provide an appropriate health warning to MMORPG players.

  11. Panchagavya Ghrita, an Ayurvedic formulation attenuates seizures, cognitive impairment and oxidative stress in pentylenetetrazole induced seizures in rats. (United States)

    Joshi, R; Reeta, K H; Sharma, S K; Tripathi, M; Gupta, Y K


    Panchagavya Ghrita (PG), according to Ayurvedic formulary of India (AFI), is used to treat epilepsy (apasmara), fever (jvara), mania (unmade) and jaundice (kamala). In the present study, we examined its effect on convulsions, oxidative stress and cognitive impairment in pentylenetetrazole (PTZ) induced seizures in rats. PG @ 250, 500, 1000, 2000 and 4000 mg/kg was administered orally for 7 days to male Wistar rats. On day 7, PTZ (60 mg/kg) was injected intraperitoneally 2 h after the last dose of PG. Sodium valproate (300 mg/kg) was used as positive control. Latency to myoclonic jerks, clonus and generalized tonic clonic seizures (GTCS) were recorded for seizure severity. Cognitive impairment was assessed using elevated plus maze and passive avoidance tests. Malondialdehyde and reduced glutathione levels were measured in rat brain. The results have shown that pretreatment with PG @ 500, 1000, 2000 and 4000 mg/kg exhibited 16.6, 33.3, 50 and 100% protection against occurrence of GTCS. The pretreatment with PG has significantly improved cognitive functions and the oxidative stress induced by seizures demonstrating its protective effect against PTZ induced seizures, and further, use of PG as an anticonvulsant in Ayurvedic system of medicine.

  12. Suppression of epileptogenesis-associated changes in response to seizures in FGF22-deficient mice

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    Clara H Lee


    Full Text Available In the developing hippocampus, fibroblast growth factor (FGF 22 promotes the formation of excitatory presynaptic terminals. Remarkably, FGF22 knockout (KO mice show resistance to generalized seizures in adults as assessed by chemical kindling, a model that is widely used to study epileptogenesis (Terauchi et al., 2010. Repeated injections of low dose pentylenetetrazol (PTZ induce generalized seizures ("kindled" in wild type (WT mice. With additional PTZ injections, FGF22KO mice do show moderate seizures, but they do not kindle. Thus, analyses of how FGF22 impacts seizure susceptibility will contribute to the better understanding of the molecular and cellular mechanisms of epileptogenesis. To decipher the roles of FGF22 in the seizure phenotype, we examine four pathophysiological changes in the hippocampus associated with epileptogenesis: enhancement of dentate neurogenesis, hilar ectopic dentate granule cells (DGCs, increase in hilar cell death, and formation of mossy fiber sprouting (MFS. Dentate neurogenesis is enhanced, hilar ectopic DGCs appeared, and hilar cell death is increased in PTZ-kindled WT mice relative to PBS-injected WT mice. Even in WT mice with fewer PTZ injections, which showed only mild seizures (so were not kindled, neurogenesis, hilar ectopic DGCs, and hilar cell death are increased, suggesting that mild seizures are enough to induce these changes in WT mice. In contrast, PTZ-injected FGF22KO mice do not show these changes despite having moderate seizures: neurogenesis is rather suppressed, hilar ectopic DGCs do not appear, and hilar cell death is unchanged in PTZ-injected FGF22KO mice relative to PBS-injected FGF22KO mice. These results indicate that FGF22 plays important roles in controlling neurogenesis, ectopic migration of DGCs, and hilar cell death after seizures, which may contribute to the generalized seizure-resistant phenotype of FGF22KO mice and suggests a possibility that inhibition of FGF22 may alleviate

  13. Treatment of seizures in multiple sclerosis

    NARCIS (Netherlands)

    Koch, Marcus W.; Polman, Susanne K. L.; Uyttenboogaart, Maarten; De Keyser, Jacques


    Background Epileptic seizures occur in only a minority of patients with multiple sclerosis (MS), but can have serious consequences. The available literature suggests an association of seizures in MS with cortical and subcortical demyelinating lesions, which suggest that seizures in MS are probably m

  14. Association between hypocapnia and febrile seizures. (United States)

    Kilicaslan, Buket; Erol, Ilknur; Ozkale, Yasemin; Saygi, Semra; Sariturk, Cagla


    The purpose of this study is to determine whether hyperthermia-induced hyperventilation with subsequent hypocapnia is relevant to febrile seizures in children. This is only the second study to measure pCO2 and pH values in children with febrile seizures. This prospective case-control study enrolled 18 children who presented with febrile seizures and 18 children who presented with a febrile illness without seizures. Venous blood gas analyses were measured both from the febrile seizure and control group. There was no significant difference in mean blood pH between the febrile seizure and control groups but blood pCO2 was significantly lower in the febrile seizure group. Patients with complex febrile seizures exhibited significantly lower pCO2 levels within 1 hour of seizure onset than patients with simplex febrile seizures. These data indicate that febrile seizures may be associated with hyperventilation and that the ensuing hypocapnia may contribute to the development of febrile seizures.

  15. Effect of Combined Ketogenic Diet and Valproate Treatment for Intractable Seizures

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    J Gordon Millichap


    Full Text Available The safety and tolerability of ketogenic diet (KGD and valproate (VPA cotherapy in the treatment of intractable seizures were evaluated retrospectively at the Massachusetts General Hospital, Boston.

  16. Hippocampal Abnormalities and Seizure Recurrence

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    J Gordon Millichap


    Full Text Available Hippocampal volumetry and T2 relaxometry were performed on 84 consecutive patients (adolescents and adults with partial epilepsy submitted to antiepileptic drug (AED withdrawal after at least 2 years of seizure control, in a study at State University of Campinas-UNICAMP, Brazil.

  17. Migrating Partial Seizures of Infancy

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    J Gordon Millichap


    Full Text Available A national surveillance study in conjunction with the British Paediatric Neurology Unit was undertaken to further define the clinical, pathological and molecular genetic features of migrating partial seizures of infancy (MPSI, a rare early infantile epileptic encephalopathy with poor prognosis.

  18. The role of seizure disorders in burn injury and outcome in Sub-Saharan Africa. (United States)

    Boschini, Laura P; Tyson, Anna F; Samuel, Jonathan C; Kendig, Claire E; Mjuweni, Stephano; Varela, Carlos; Cairns, Bruce A; Charles, Anthony G


    Patients with epilepsy have higher incidence and severity of burn injury. Few studies describe the association between epilepsy and burns in low-income settings, where epilepsy burden is highest. The authors compared patients with and without seizure disorder in a burn unit in Lilongwe, Malawi. The authors conducted a retrospective study of patients admitted to the Kamuzu Central Hospital burn ward from July 2011 to December 2012. Descriptive analysis of patient characteristics and unadjusted and adjusted analyses of risk factors for mortality were conducted for patients with and without seizure disorder. Prevalence of seizure disorder was 10.7% in the study population. Adults with burns were more likely to have seizure disorder than children. Flame injury was most common in patients with seizure disorder, whereas scalds predominated among patients without seizure disorder. Whereas mortality did not differ between the groups, mean length of stay was longer for patients with seizure disorder, 42.1 days vs 21.6 days. Seizure disorder continues to be a significant risk factor for burn injury in adults in Malawi. Efforts to mitigate epilepsy will likely lead to significant decreases in burns among adults in Sub-Saharan Africa and must be included in an overall burn prevention strategy in our environment.

  19. Pretreatment seizure semiology in childhood absence epilepsy. (United States)

    Kessler, Sudha Kilaru; Shinnar, Shlomo; Cnaan, Avital; Dlugos, Dennis; Conry, Joan; Hirtz, Deborah G; Hu, Fengming; Liu, Chunyan; Mizrahi, Eli M; Moshé, Solomon L; Clark, Peggy; Glauser, Tracy A


    To determine seizure semiology in children with newly diagnosed childhood absence epilepsy and to evaluate associations with short-term treatment outcomes. For participants enrolled in a multicenter, randomized, double-blind, comparative-effectiveness trial, semiologic features of pretreatment seizures were analyzed as predictors of treatment outcome at the week 16 to 20 visit. Video of 1,932 electrographic absence seizures from 416 participants was evaluated. Median seizure duration was 10.2 seconds; median time between electrographic seizure onset and clinical manifestation onset was 1.5 seconds. For individual seizures and by participant, the most common semiology features were pause/stare (seizure 95.5%, participant 99.3%), motor automatisms (60.6%, 86.1%), and eye involvement (54.9%, 76.5%). The interrater agreement for motor automatisms and eye involvement was good (72%-84%). Variability of semiology features between seizures even within participants was high. Clustering analyses revealed 4 patterns (involving the presence/absence of eye involvement and motor automatisms superimposed on the nearly ubiquitous pause/stare). Most participants experienced more than one seizure cluster pattern. No individual semiologic feature was individually predictive of short-term outcome. Seizure freedom was half as likely in participants with one or more seizure having the pattern of eye involvement without motor automatisms than in participants without this pattern. Almost all absence seizures are characterized by a pause in activity or staring, but rarely is this the only feature. Semiologic features tend to cluster, resulting in identifiable absence seizure subtypes with significant intraparticipant seizure phenomenologic heterogeneity. One seizure subtype, pause/stare and eye involvement but no motor automatisms, is specifically associated with a worse treatment outcome. © 2017 American Academy of Neurology.

  20. Silent seizures in sick infants in early life. Diagnosis by continuous cerebral function monitoring. (United States)

    Hellström-Westas, L; Rosén, I; Swenningsen, N W


    Cerebral electric activity was surveilled with a Cerebral Function Monitor (CFM) technique in 87 newborn infants under neonatal intensive care. A total of 26 infants had electrographical signs of repeated seizure activity. Among these infants 14 had periods of one hour or more of silent seizures activity. Among these infants 14 had periods of one hour or more of silent seizures, i.e. typical pattern of ictal epileptic activity on CFM without clinical symptoms or signs of convulsions. The occurrence of silent seizures and their pattern in relation to the clinical condition and management was unpredictable in most cases. Besides general limpness or flaccidity in an outward quiet baby these infants showed no clinical fits or clonic convulsions. The findings indicate that anticonvulsive therapy in small infants may be insufficient and need re-evaluation, since the long-term effect of silent seizures on cerebral function and activity is still uncertain.

  1. Risk factors of recurrent seizure, co-morbidities, and mortality in new onset seizure in elderly. (United States)

    Phabphal, Kanitpong; Geater, Alan; Limapichat, Kitti; Sathirapanya, Pornchai; Setthawatcharawanich, Suwanna


    To determine the risk factors of seizure recurrence and the most common comorbidities in elderly patients with epilepsy. We did a retrospective study of 278 patients older than 65 years with first seizure. We evaluated electrolytes, blood glucose, urea and creatinine levels, and performed electrocardiography (ECG), and routine electroencephalogram (EEG) on all patients. We evaluated seizure recurrence and comorbidities at 2 years. Univariate analysis found that significant (Pseizure recurrence were etiology of seizure, EEG, and status epilepticus at first presentation. In multivariate regression analysis, etiology of seizure and EEG were significant statistical factors in seizure recurrence at 2 years follow up. Age, sex, duration of time between first seizure and diagnosis of seizure, seizure type, misdiagnosis of non-epileptic seizure, and use of antiepileptic drugs were not significant factors for predicting seizure recurrence. Depression and anxiety were the most common comorbidities in our study, followed by sleep-related disorders and stroke. There were no statistically significantly differences in comorbidities between patients who remained seizure free and patients who had recurrent seizure. Most of the new onset seizures in our elderly patients were focal onset. Acute symptomatic etiology, remote symptomatic etiology, progressive symptomatic etiology and abnormal EEG features were powerful predictors of seizure recurrence, and mood disorder, sleep disorder and stroke were the common comorbidities. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  2. Prophylactic drug management for febrile seizures in children. (United States)

    Offringa, Martin; Newton, Richard; Cozijnsen, Martinus A; Nevitt, Sarah J


    benefit for intermittent phenobarbitone, phenytoin, valproate, pyridoxine, ibuprofen or zinc sulfate versus placebo or no treatment; nor for diclofenac versus placebo followed by ibuprofen, acetaminophen or placebo; nor for continuous phenobarbitone versus diazepam, intermittent rectal diazepam versus intermittent valproate, or oral diazepam versus clobazam.There was a significant reduction of recurrent febrile seizures with intermittent diazepam versus placebo or no treatment, with a risk ratio (RR) of  0.64 (95% confidence interval (CI) 0.48 to 0.85 at six months), RR of 0.69 (95% CI 0.56 to 0.84) at 12 months, RR 0.37 (95% CI 0.23 to 0.60) at 18 months, RR 0.73 (95% CI 0.56 to 0.95) at 24 months, RR 0.58 (95% CI 0.40 to 0.85) at 36 months, RR 0.36 (95% CI 0.15 to 0.89) at 48 months, with no benefit at 60 to 72 months. Phenobarbitone versus placebo or no treatment reduced seizures at 6, 12 and 24 months but not at 18 or 72 month follow-up (RR 0.59 (95% CI 0.42 to 0.83) at 6 months; RR 0.54 (95% CI 0.42 to 0.70) at 12 months; and RR 0.69 (95% CI 0.53 to 0.89) at 24 months). Intermittent clobazam compared to placebo at six months resulted in a RR of 0.36 (95% CI 0.20 to 0.64), an effect found against an extremely high (83.3%) recurrence rate in the controls, which is a result that needs replication.The recording of adverse effects was variable. Lower comprehension scores in phenobarbitone-treated children were found in two studies. In general, adverse effects were recorded in up to 30% of children in the phenobarbitone-treated group and in up to 36% in benzodiazepine-treated groups. We found evidence of publication bias in the meta-analyses of comparisons for phenobarbitone versus placebo (eight studies) at 12 months but not at six months (six studies); and valproate versus placebo (four studies) at 12 months, with too few studies to identify publication bias for the other comparisons.Most of the reviewed antiepileptic drug trials are of a methodological quality graded

  3. Dysfunction of thermoregulation contributes to the generation of hyperthermia-induced seizures. (United States)

    Feng, Bo; Tang, Yang-Shun; Chen, Bin; Dai, Yun-Jian; Xu, Ceng-Lin; Xu, Zheng-Hao; Zhang, Xiang-Nan; Zhang, Shi-Hong; Hu, Wei-Wei; Chen, Zhong


    Febrile seizures (FS) are generally defined as seizures taking place during fever. Long-term prognosis, including development of epilepsy and malformation of cognitive function, has been demonstrated after infantile FS. However, the mechanism that triggers seizures in hyperthermic environment is still unclear. We here found that the body temperature of rat pups that experienced experimental FS was markedly decreased (∼28°C) after they were removed from the hyperthermic environment. Both the seizure generation and the temperature drop after seizure attack were abolished by either pre-treatment with chlorpromazine (CPZ), which impairs the thermoregulation, or by an electrolytic lesion of the preoptic area and anterior hypothalamus (PO/AH). However, the non-steroidal anti-inflammatory drug celecoxib did not affect the seizure incidence and the decrease in body temperature after seizure attack. In addition, pentobarbital prevented the generation of seizures, but did not reverse the decrease of body temperature after FS. Therefore, our work indicates that an over-regulation of body temperature occurs during hyperthermic environment, and that the dysfunction of thermoregulation in the PO/AH following hyperthermia contributes to the generation of FS. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Using wearable sensors for semiology-independent seizure detection - towards ambulatory monitoring of epilepsy. (United States)

    Heldberg, Beeke E; Kautz, Thomas; Leutheuser, Heike; Hopfengartner, Rudiger; Kasper, Burkhard S; Eskofier, Bjoern M


    Epilepsy is a disease of the central nervous system. Nearly 70% of people with epilepsy respond to a proper treatment, but for a successful therapy of epilepsy, physicians need to know if and when seizures occur. The gold standard diagnosis tool video-electroencephalography (vEEG) requires patients to stay at hospital for several days. A wearable sensor system, e.g. a wristband, serving as diagnostic tool or event monitor, would allow unobtrusive ambulatory long-term monitoring while reducing costs. Previous studies showed that seizures with motor symptoms such as generalized tonic-clonic seizures can be detected by measuring the electrodermal activity (EDA) and motion measuring acceleration (ACC). In this study, EDA and ACC from 8 patients were analyzed. In extension to previous studies, different types of seizures, including seizures without motor activity, were taken into account. A hierarchical classification approach was implemented in order to detect different types of epileptic seizures using data from wearable sensors. Using a k-nearest neighbor (kNN) classifier an overall sensitivity of 89.1% and an overall specificity of 93.1% were achieved, for seizures without motor activity the sensitivity was 97.1% and the specificity was 92.9%. The presented method is a first step towards a reliable ambulatory monitoring system for epileptic seizures with and without motor activity.

  5. Rufinamide for refractory focal seizures: an open-label, multicenter European study. (United States)

    Coppola, Giangennaro; Zamponi, Nelia; Kluger, Gerhard; Mueller, Arndt; Anna Rita, Mazzotta; Parisi, Pasquale; Isone, Claudia; Santoro, Elena; Curatolo, Paolo; Verrotti, Alberto


    The present study aimed to assess the efficacy and tolerability of rufinamide as adjunctive drug for the treatment of a large series of children, adolescents and adults with refractory cryptogenic or symptomatic focal epilepsy. Patients were recruited in a prospective, add-on, open-label treatment study from six Italian and one German centers for pediatric and adolescent epilepsy care. Inclusion criteria were: (1) age 3 years or more; (2) diagnosis of cryptogenic or symptomatic focal epilepsy refractory to at least three previous antiepileptic drugs (AEDs), alone or in combination; (3) more than one seizure per month in the last 6 months; (4) use of at least one other AED, but no more than three, at baseline; (5) informed consent from parents and/or caregivers. Sixty-eight patients (40 males, 28 females), aged between 3 and 63 years (mean 19.9 years, median 16.0)±SD 12.58, with cryptogenic (28 pts, 41.2%) or symptomatic focal epilepsy (40 pts, 58.8%), were recruited in the study. After a mean follow-up period of 10.4±10.29 months, twenty-two patients (32.3%) had a 50-99% seizure reduction, and none became seizure-free. Twelve patients (17.6%) had a 25-49% seizure decrease, while in 30 (44.1%) seizure frequency was unchanged. A seizure worsening was reported in 5 patients (7.3%). A better response to rufinamide occurred in frontal lobe seizures (51.6%) and secondary generalized tonic-clonic seizures (50%). Rufinamide was effective against focal-onset seizures, particularly in the treatment of secondary generalized frontal lobe seizures. Copyright © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  6. Nonlinear analysis of EEG for epileptic seizures

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    Hively, L.M.; Clapp, N.E.; Daw, C.S.; Lawkins, W.F. [Oak Ridge National Lab., TN (United States); Eisenstadt, M.L. [Knoxville Neurology Clinic, St. Mary`s Medical Center, Knoxville, TN (United States)


    We apply chaotic time series analysis (CTSA) to human electroencephalogram (EEG) data. Three epoches were examined: epileptic seizure, non-seizure, and transition from non-seizure to seizure. The CTSA tools were applied to four forms of these data: raw EEG data (e-data), artifact data (f-data) via application of a quadratic zero-phase filter of the raw data, artifact-filtered data (g- data) and that was the residual after subtracting f-data from e-data, and a low-pass-filtered version (h-data) of g-data. Two different seizures were analyzed for the same patient. Several nonlinear measures uniquely indicate an epileptic seizure in both cases, including an abrupt decrease in the time per wave cycle in f-data, an abrupt increase in the Kolmogorov entropy and in the correlation dimension for e-h data, and an abrupt increase in the correlation dimension for e-h data. The transition from normal to seizure state also is characterized by distinctly different trends in the nonlinear measures for each seizure and may be potential seizure predictors for this patient. Surrogate analysis of e-data shows that statistically significant nonlinear structure is present during the non-seizure, transition , and seizure epoches.

  7. Lipopolysaccharide potentiates hyperthermia-induced seizures. (United States)

    Eun, Baik-Lin; Abraham, Jayne; Mlsna, Lauren; Kim, Min Jung; Koh, Sookyong


    Prolonged febrile seizures (FS) have both acute and long-lasting effects on the developing brain. Because FS are often associated with peripheral infection, we aimed to develop a preclinical model of FS that simulates fever and immune activation in order to facilitate the implementation of targeted therapy after prolonged FS in young children. The innate immune activator lipopolysaccharide (LPS) was administered to postnatal day 14 rat (200 μg/kg) and mouse (100 μg/kg) pups 2-2.5 h prior to hyperthermic seizures (HT) induced by hair dryer or heat lamp. To determine whether simulation of infection enhances neuronal excitability, latency to seizure onset, threshold temperature and total number of seizures were quantified. Behavioral seizures were correlated with electroencephalographic changes in rat pups. Seizure-induced proinflammatory cytokine production was assessed in blood samples at various time points after HT. Seizure-induced microglia activation in the hippocampus was quantified using Cx3cr1(GFP/+) mice. Lipopolysaccharide priming increased susceptibility of rats and mice to hyperthemic seizures and enhanced seizure-induced proinflammatory cytokine production and microglial activation. Peripheral inflammation appears to work synergistically with hyperthermia to potentiate seizures and to exacerbate seizure-induced immune responses. By simulating fever, a regulated increase in body temperature from an immune challenge, we developed a more clinically relevant animal model of prolonged FS.

  8. Noether Symmetry Can Lead to Non-Noether Conserved Quantity of Holonomic Nonconservative Systems in General Lie Transformations

    Institute of Scientific and Technical Information of China (English)

    LUO Shao-Kai; JIA Li-Qun; CAI Jian-Le


    For the holonomic nonconservative system, by using the Noether symmetry, a non-Noether conserved quantity is obtained directly under general infinitesimal transformations of groups in which time is variable. At first,the Noether symmetry, Lie symmetry, and Noether conserved quantity are given. Secondly, the condition under which the Noether symmetry is a Lie symmetry under general infinitesimal transformations is obtained. Finally, a set of nonNoether conserved quantities of the system are given by the Noether symmetry, and an example is given to illustrate the application of the results.

  9. Localizing epileptic seizure onsets with Granger causality (United States)

    Adhikari, Bhim M.; Epstein, Charles M.; Dhamala, Mukesh


    Accurate localization of the epileptic seizure onset zones (SOZs) is crucial for successful surgery, which usually depends on the information obtained from intracranial electroencephalography (IEEG) recordings. The visual criteria and univariate methods of analyzing IEEG recordings have not always produced clarity on the SOZs for resection and ultimate seizure freedom for patients. Here, to contribute to improving the localization of the SOZs and to understanding the mechanism of seizure propagation over the brain, we applied spectral interdependency methods to IEEG time series recorded from patients during seizures. We found that the high-frequency (>80 Hz) Granger causality (GC) occurs before the onset of any visible ictal activity and causal relationships involve the recording electrodes where clinically identifiable seizures later develop. These results suggest that high-frequency oscillatory network activities precede and underlie epileptic seizures, and that GC spectral measures derived from IEEG can assist in precise delineation of seizure onset times and SOZs.

  10. Glycolysis in energy metabolism during seizures

    Institute of Scientific and Technical Information of China (English)

    Heng Yang; Jiongxing Wu; Ren Guo; Yufen Peng; Wen Zheng; Ding Liu; Zhi Song


    Studies have shown that glycolysis increases during seizures, and that the glycolytic metabolite lactic acid can be used as an energy source. However, how lactic acid provides energy for seizures and how it can participate in the termination of seizures remains unclear. We reviewed possible mechanisms of glycolysis involved in seizure onset. Results showed that lactic acid was involved in seizure onset and provided energy at early stages. As seizures progress, lactic acid reduces the pH of tissue and induces metabolic acidosis, which terminates the seizure. The specific mechanism of lactic acid-induced acidosis involves several aspects, which include lactic acid-induced inhibition of the glycolytic enzyme 6-diphosphate kinase-1, inhibition of the N-methyl-D-aspartate receptor, activation of the acid-sensitive 1A ion channel, strengthening of the receptive mechanism of the inhibitory neurotransmitter γ-aminobutyric acid, and changes in the intra- and extracellular environment.


    Directory of Open Access Journals (Sweden)

    K. Yu. Мukhin


    Full Text Available The article is devoted to rare and unique type of epileptic seizures – inhibitory motor seizures, characterized by the inability to execute a voluntary movement with preserved consciousness. The exact prevalence of this type of seizures is not known, but many cases are unrecognized or non-correctly diagnosed as Todd's paralysis. Therefore practical doctors should know the clinical and electroencephalographic characteristics of this type of seizures andtake them into account in the differential diagnoses . The authors presented a detailed review of the literature, including the historical data, etiology, pathogenesis and proposed mechanisms of formation of inhibitory motor seizures, clinical and EEG characteristics, therapeutic approaches. Antiepileptic drugs of choice used in the treatment of inhibitory motor seizures are valproic acid (preferably depakine chronosphere – original prolonged form of valproate. The authors also presented their observations of patients with inhibitory motor seizures.

  12. The Best Time for EEG Recording in Febrile Seizure

    Directory of Open Access Journals (Sweden)

    Parvaneh KARIMZADEH


    Full Text Available How to Cite This Article: Karimzadeh P, Rezayi A, Togha M, Ahmadabadi F, Derakhshanfar H, Azargashb E, Khodaei F. The Best Time for EEG Recording in Febrile Seizure. Iran J Child Neurol. 2014 Winter; 8(1:20-25.ObjectiveSome studies suggest that detection of epileptic discharge is unusual during the first postictal week of febrile seizure and others believe that EEGs carried out on the day of the seizure are abnormal in as many as 88% of the patients. In thisstudy, we intend to compare early and late EEG abnormalities in febrile seizure.Materials & Methods EEG was recorded during daytime sleep, 24-48 hours (early EEG and 2 weeks (late EEG after the seizure in 36 children with febrile seizure (FS, aged between 3 months and 6 years. EEGs that showed generalized or focal spikes, sharp, spike wave complex, and slowing were considered as abnormal EEG.Abnormalities of the first EEG were compared with those of second EEG.ResultsThe most common abnormal epileptiform discharges recorded in the early EEG were slow waves (27.6% and sharp waves in late EEG (36%. Distribution of abnormalities in early and late EEG showed no significant statistical difference.ConclusionThe early and late EEG recording had the same results in patient with febrile seizure. Reference:Hauser WA, Kurland LT. The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia 1975;16(1:1-66.Freeman JM. Febrile seizures: a consensus of their significance, evaluation, and treatment. Pediatrics 1980;66(6:1009.Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child 2004;89(8:751-6.ILAE. Guidelines for epidemiologic studies on epilepsy, International League against Epilepsy. Epilepsia 1993;34(4:592-6.Annegers JF, Hauser WA, Shirts SB, Kurland LT. Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med 1987;316(9:493-8.Berg AT, Shinnar S, Darefsky AS, Holford TR, Shapiro ED, Salomon ME, et al. Predictors of recurrent febrile

  13. Anticonvulsant effects of the wasp Polybia ignobilis venom on chemically induced seizures and action on GABA and glutamate receptors. (United States)

    Cunha, Alexandra Olimpio Siqueira; Mortari, Márcia Renata; Oliveira, Luciana; Carolino, Ruither Oliveira Gomes; Coutinho-Netto, Joaquim; dos Santos, Wagner Ferreira


    Venoms of spiders and wasps are well recognized to present high affinity to the central nervous tissue of many mammalian species. Here we describe the effects of direct exposure of rat (Rattus norvegicus) brains to the crude and denatured venom of the Brazilian social wasp Polybia ignobilis. Lower doses of crude venom injected via intracerebroventricular (i.c.v.) inhibited the exploratory activity of animals, while higher doses provoked severe generalized tonic-clonic seizures, with hind limb extension. The status epilepticus lasted for few minutes leading the animals to respiratory depression and death. In contrast, the denatured venom was anticonvulsant against acute seizures induced by the i.c.v. injection of bicuculline, picrotoxin and kainic acid, but it was ineffective against seizures caused by systemic pentylenetetrazole. Moreover, the [3H]-glutamate binding in membranes from rat brain cortex was inhibited by the denatured venom in lower concentrations than the [3H]-GABA binding. The denatured venom contains free GABA and glutamate (34 and 802 pg/microg of venom, respectively), but they are not the major binding inhibitors. These interactions of venom components with GABA and glutamate receptors could be responsible for the anticonvulsant effects introducing the venom from P. ignobilis as a potential pharmacological source of anticonvulsant drugs.

  14. Seizure Control in a Computational Model Using a Reinforcement Learning Stimulation Paradigm. (United States)

    Nagaraj, Vivek; Lamperski, Andrew; Netoff, Theoden I


    Neuromodulation technologies such as vagus nerve stimulation and deep brain stimulation, have shown some efficacy in controlling seizures in medically intractable patients. However, inherent patient-to-patient variability of seizure disorders leads to a wide range of therapeutic efficacy. A patient specific approach to determining stimulation parameters may lead to increased therapeutic efficacy while minimizing stimulation energy and side effects. This paper presents a reinforcement learning algorithm that optimizes stimulation frequency for controlling seizures with minimum stimulation energy. We apply our method to a computational model called the epileptor. The epileptor model simulates inter-ictal and ictal local field potential data. In order to apply reinforcement learning to the Epileptor, we introduce a specialized reward function and state-space discretization. With the reward function and discretization fixed, we test the effectiveness of the temporal difference reinforcement learning algorithm (TD(0)). For periodic pulsatile stimulation, we derive a relation that describes, for any stimulation frequency, the minimal pulse amplitude required to suppress seizures. The TD(0) algorithm is able to identify parameters that control seizures quickly. Additionally, our results show that the TD(0) algorithm refines the stimulation frequency to minimize stimulation energy thereby converging to optimal parameters reliably. An advantage of the TD(0) algorithm is that it is adaptive so that the parameters necessary to control the seizures can change over time. We show that the algorithm can converge on the optimal solution in simulation with slow and fast inter-seizure intervals.

  15. Seizures in the intrahippocampal kainic acid epilepsy model: Characterization using long-term video-EEG monitoring in the rat

    NARCIS (Netherlands)

    R. Raedt; A. Van Dycke; D. Van Melkebeke; T. De Smedt; P. Claeys; T. Wyckhuys; K. Vonck; W. Wadman; P. Boon


    Objective - Intrahippocampal injection of kainic acid (KA) in rats evokes a status epilepticus (SE) and leads to spontaneous seizures. However to date, precise electroencephalographic (EEG) and clinical characterization of spontaneous seizures in this epilepsy model using long-term video-EEG monitor

  16. Seizure-induced disinhibition of the HPA axis increases seizure susceptibility. (United States)

    O'Toole, Kate K; Hooper, Andrew; Wakefield, Seth; Maguire, Jamie


    Stress is the most commonly reported precipitating factor for seizures. The proconvulsant actions of stress hormones are thought to mediate the effects of stress on seizure susceptibility. Interestingly, epileptic patients have increased basal levels of stress hormones, including corticotropin-releasing hormone (CRH) and corticosterone, which are further increased following seizures. Given the proconvulsant actions of stress hormones, we proposed that seizure-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis may contribute to future seizure susceptibility. Consistent with this hypothesis, our data demonstrate that pharmacological induction of seizures in mice with kainic acid or pilocarpine increases circulating levels of the stress hormone, corticosterone, and exogenous corticosterone administration is sufficient to increase seizure susceptibility. However, the mechanism(s) whereby seizures activate the HPA axis remain unknown. Here we demonstrate that seizure-induced activation of the HPA axis involves compromised GABAergic control of CRH neurons, which govern HPA axis function. Following seizure activity, there is a collapse of the chloride gradient due to changes in NKCC1 and KCC2 expression, resulting in reduced amplitude of sIPSPs and even depolarizing effects of GABA on CRH neurons. Seizure-induced activation of the HPA axis results in future seizure susceptibility which can be blocked by treatment with an NKCC1 inhibitor, bumetanide, or blocking the CRH signaling with Antalarmin. These data suggest that compromised GABAergic control of CRH neurons following an initial seizure event may cause hyperexcitability of the HPA axis and increase future seizure susceptibility.

  17. Body Packing: From Seizures to Laparotomy

    Directory of Open Access Journals (Sweden)

    Joanna M. Janczak


    Full Text Available Body packing is a common method for illegal drug trafficking. Complications associated with body packing can be severe and even lead to rapid death. Thus, a timely diagnosis is warranted. As most body packers initially do not show any symptoms, making a correct diagnosis can be rather challenging. We describe a case of a 41-year-old male, who was admitted with an epileptic seizure and who turned out to be a cocaine intoxicated body packer. Due to neurological and cardiovascular deterioration an emergency surgery was performed. Four bags of cocaine could be removed. We discuss the current management regimen in symptomatic and asymptomatic body packers and highlight pearls and pitfalls with diagnosis and treatment.

  18. Seizure characteristics of epilepsy in childhood after acute encephalopathy with biphasic seizures and late reduced diffusion. (United States)

    Ito, Yuji; Natsume, Jun; Kidokoro, Hiroyuki; Ishihara, Naoko; Azuma, Yoshiteru; Tsuji, Takeshi; Okumura, Akihisa; Kubota, Tetsuo; Ando, Naoki; Saitoh, Shinji; Miura, Kiyokuni; Negoro, Tamiko; Watanabe, Kazuyoshi; Kojima, Seiji


    The aim of this study was to clarify characteristics of post-encephalopathic epilepsy (PEE) in children after acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), paying particular attention to precise diagnosis of seizure types. Among 262 children with acute encephalopathy/encephalitis registered in a database of the Tokai Pediatric Neurology Society between 2005 and 2012, 44 were diagnosed with AESD according to the clinical course and magnetic resonance imaging (MRI) findings and were included in this study. Medical records were reviewed to investigate clinical data, MRI findings, neurologic outcomes, and presence or absence of PEE. Seizure types of PEE were determined by both clinical observation by pediatric neurologists and ictal video-electroencephalography (EEG) recordings. Of the 44 patients after AESD, 10 (23%) had PEE. The period between the onset of encephalopathy and PEE ranged from 2 to 39 months (median 8.5 months). Cognitive impairment was more severe in patients with PEE than in those without. Biphasic seizures and status epilepticus during the acute phase of encephalopathy did not influence the risk of PEE. The most common seizure type of PEE on clinical observation was focal seizures (n = 5), followed by epileptic spasms (n = 4), myoclonic seizures (n = 3), and tonic seizures (n = 2). In six patients with PEE, seizures were induced by sudden unexpected sounds. Seizure types confirmed by ictal video-EEG recordings were epileptic spasms and focal seizures with frontal onset, and all focal seizures were startle seizures induced by sudden acoustic stimulation. Intractable daily seizures remain in six patients with PEE. We demonstrate seizure characteristics of PEE in children after AESD. Epileptic spasms and startle focal seizures are common seizure types. The specific seizure types may be determined by the pattern of diffuse subcortical white matter injury in AESD and age-dependent reorganization of the brain

  19. Ketogenic diet prevents neuronal firing increase within the substantia nigra during pentylenetetrazole-induced seizure in rats. (United States)

    Viggiano, Andrea; Stoddard, Madison; Pisano, Simone; Operto, Francesca Felicia; Iovane, Valentina; Monda, Marcellino; Coppola, Giangennaro


    The mechanism responsible for the anti-seizure effect of ketogenic diets is poorly understood. Because the substantia nigra pars reticulata (SNr) is a "gate" center for seizures, the aim of the present experiment was to evaluate if a ketogenic diet modifies the neuronal response of this nucleus when a seizure-inducing drug is administered in rats. Two groups of rats were given a standard diet (group 1) or a ketogenic diet (group 2) for four weeks, then the threshold for seizure induction and the firing rate of putative GABAergic neurons within the SNr were evaluated with progressive infusion of pentylenetetrazole under general anesthesia. The results demonstrated that the ketogenic diet abolished the correlation between the firing rate response of SNr-neurons and the seizure-threshold. This result suggests that the anti-seizure effect of ketogenic diets can be due to a decrease in reactivity of GABAergic SNr-neurons.

  20. A novel seizure detection algorithm informed by hidden Markov model event states (United States)

    Baldassano, Steven; Wulsin, Drausin; Ung, Hoameng; Blevins, Tyler; Brown, Mesha-Gay; Fox, Emily; Litt, Brian


    Objective. Recently the FDA approved the first responsive, closed-loop intracranial device to treat epilepsy. Because these devices must respond within seconds of seizure onset and not miss events, they are tuned to have high sensitivity, leading to frequent false positive stimulations and decreased battery life. In this work, we propose a more robust seizure detection model. Approach. We use a Bayesian nonparametric Markov switching process to parse intracranial EEG (iEEG) data into distinct dynamic event states. Each event state is then modeled as a multidimensional Gaussian distribution to allow for predictive state assignment. By detecting event states highly specific for seizure onset zones, the method can identify precise regions of iEEG data associated with the transition to seizure activity, reducing false positive detections associated with interictal bursts. The seizure detection algorithm was translated to a real-time application and validated in a small pilot study using 391 days of continuous iEEG data from two dogs with naturally occurring, multifocal epilepsy. A feature-based seizure detector modeled after the NeuroPace RNS System was developed as a control. Main results. Our novel seizure detection method demonstrated an improvement in false negative rate (0/55 seizures missed versus 2/55 seizures missed) as well as a significantly reduced false positive rate (0.0012 h versus 0.058 h-1). All seizures were detected an average of 12.1 ± 6.9 s before the onset of unequivocal epileptic activity (unequivocal epileptic onset (UEO)). Significance. This algorithm represents a computationally inexpensive, individualized, real-time detection method suitable for implantable antiepileptic devices that may considerably reduce false positive rate relative to current industry standards.

  1. Refractory seizures in children

    Directory of Open Access Journals (Sweden)

    Seyed Ebrahim Mansoorinejad


    Full Text Available Epilepsy is described as a heterogeneous clinical syndrome results from various cerebral destructions. It is categorized to partial and generalized forms. Degree of neural system impairment and affected area determine the severity and pattern of symptoms. Patients might experience sensory, motor, or both signs and symptoms. About 60% of epileptic patients suffer from partial type. It is estimated that up to 30% of epilepsy cases would not be controlled adequately despite sufficient and proper management. Anacyclus pyrethrum, Citrus aurantium var. amara, Paeonia officinalis, Rosa Damascena and Nigella Sativa are some of herbal drugs which have antiepileptic effect. Natural agents are valuable sources to treat chronic diseases and a huge number of world`s population believe herbs are effective and safe for daily primary health care needs. There is not enough evidence about their efficacy and safety obtained from randomized control trials.

  2. Smartphone applications for seizure management. (United States)

    Pandher, Puneet Singh; Bhullar, Karamdeep Kaur


    Technological advancements continue to provide innovative ways of enhancing patient care in medicine. In particular, the growing popularity of smartphone technology has seen the recent emergence of a myriad of healthcare applications (or apps) that promise to help shape the way in which health information is delivered to people worldwide. While limited research already exists on a range of such apps, our study is the first to examine the salient features of smartphone applications as they apply to the area of seizure management. For the purposes of this review, we conducted a search of the official online application stores of the five major smartphone platforms: iPhone, Android, Blackberry, Windows Mobile and Nokia-Symbian. Apps were included if they reported to contain some information or tools relating to seizure management and excluded if they were aimed exclusively at health professionals. A total of 28 applications met these criteria. Overall, we found an increasing number of epilepsy apps available on the smartphone market, but with only a minority offering comprehensive educational information alongside tools such as seizure diaries, medication tracking and/or video recording.

  3. Seizure semiology and electroencephalography in young children with lesional temporal lobe epilepsy. (United States)

    Lv, Rui-Juan; Sun, Zhen-Rong; Cui, Tao; Shao, Xiao-Qiu


    This study aimed to discuss the clinical features of seizure semiology and electroencephalography (EEG) in young children with lesional temporal lobe epilepsy (TLE). Children with lesional TLE received presurgical evaluation for intractable epilepsy. They were followed up for more than one year after temporal lobectomy. We reviewed the medical history and video-EEG monitoring of children with TLE to analyze the semiology of seizures and EEG findings and compared the semiology of seizures and EEG findings of childhood TLE and adult TLE. A total of 84 seizures were analyzed in 11 children (aged 23-108 months). The age of seizure onset was from 1 month to 26 months (a mean of 17.6 months). All of the patients exhibited prominent motor manifestations including epileptic spasm, tonic seizure, and unilateral clonic seizure. Seven children manifested behavioral arrest similar to an automotor seizure in adult TLE but with a shorter duration and higher frequency. The automatisms were typically orofacial, whereas manual automatisms were rarely observed. The EEG recordings revealed that diffuse discharge patterns were more common in younger children, whereas focal or unilateral patterns were more typical in older children. All of the patients were seizure-free after temporal lobectomy with more than one-year follow-up. All of the children had a mental development delay or regression; however, there was improvement after surgery, especially in those with surgery performed early. In contrast to TLE in adults, young children with lesional TLE probably represent a distinct nosological and probably less homogeneous syndrome. Although they had generalized clinical and electrographic features, resective epilepsy surgery should be considered as early as possible to obtain seizure control and improvement in mental development. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  4. Pattern of seizure cases in tertiary care hospitals in Karnataka state of India

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    Nitin Joseph


    Full Text Available Background: The prevalence and incidence of epilepsy is higher in developing countries than in developed countries. Understanding pattern and risk factors of seizure cases will help in suggesting appropriate preventive measures. Objectives: This study was carried out to assess the pattern of seizure, its management and compliance with treatment. Materials and Methods: Data from medical records of seizure cases in three tertiary care hospitals of Mangalore city in south India admitted from January 2006 to December 2011 were collected and analyzed. Results: Nearly half (44.4% of the 196 cases belonged to productive age group (15-45 years and 2/3 rd (60.7% were males. Majority (>80% cases were unskilled workers and of low socio-economic status groups. Family history of seizures was present in 8.4% cases. Mean age of onset of seizure was found to be 19.9 years. Proportion of generalized tonic clonic seizure cases was 78.1%. Secondary seizures were seen in 66 (33.7% cases with the most common cause being trauma to the head (24.2%. Refractory seizures were present in 2.7% cases. Monotherapy was the most commonly followed treatment regimen and phenytoin was the most popular anti-epileptic drug (AED used. Non-compliance with AEDs was seen in 18.1% cases and was more among patients on polytherapy (P = 0.032. Conclusion: Seizure manifestations and treatment compliance vary widely in the studied population. In depth analysis of each seizure type will give more information about the factors associated with it.

  5. Power Series Approximation for the Correlation Kernel Leading to Kohn-Sham Methods Combining Accuracy, Computational Efficiency, and General Applicability (United States)

    Erhard, Jannis; Bleiziffer, Patrick; Görling, Andreas


    A power series approximation for the correlation kernel of time-dependent density-functional theory is presented. Using this approximation in the adiabatic-connection fluctuation-dissipation (ACFD) theorem leads to a new family of Kohn-Sham methods. The new methods yield reaction energies and barriers of unprecedented accuracy and enable a treatment of static (strong) correlation with an accuracy of high-level multireference configuration interaction methods but are single-reference methods allowing for a black-box-like handling of static correlation. The new methods exhibit a better scaling of the computational effort with the system size than rivaling wave-function-based electronic structure methods. Moreover, the new methods do not suffer from the problem of singularities in response functions plaguing previous ACFD methods and therefore are applicable to any type of electronic system.

  6. Safety and efficacy of levetiracetam for the treatment of partial onset seizures in children from one month of age

    Directory of Open Access Journals (Sweden)

    Cormier J


    Full Text Available Justine Cormier, Catherine J ChuMassachusetts General Hospital, Department of Neurology, Programs in Child Neurology and Neurophysiology, Boston, MA, USAAbstract: Epilepsy is a common neurological disorder in the pediatric population, affecting up to one percent of children, and for which the mainstay of treatment is anticonvulsant medication. Despite the frequent use of anticonvulsant drugs, remarkably little is known about the safety and efficacy of most of these medications in the pediatric epilepsy population. Of 34 anticonvulsants currently approved for use by the US Food and Drug Administration (FDA, only 13 have been approved for use in children. Although infants and young children are disproportionately affected by epilepsy, there are currently only three anticonvulsant medications that have been specifically evaluated and approved for use in children younger than 2 years of age. In 2012, the FDA approved levetiracetam as an adjunctive treatment for partial onset seizures in infants and children from one month of age. Here we review the available data on levetiracetam in the pediatric epilepsy population. We first discuss the pharmacological profile of levetiracetam, including its mechanism of action, formulations and dosing, and pharmacokinetics in children. We then review the available efficacy, safety, and tolerability data in children from one month of age with partial onset seizures. We conclude that the current data leading to the approval of levetiracetam for use in infants and children with partial onset seizures is encouraging, although more work needs to be done before definitive conclusions can be drawn about the efficacy of levetiracetam across different pediatric age groups.Keywords: levetiracetam, anticonvulsant drug, partial seizures, pediatric epilepsy

  7. Detection of Paroxysms in Long-Term, Single Channel EEG-Monitoring of Patients with Typical Absence Seizures

    DEFF Research Database (Denmark)

    Kjær, Troels W.; Sørensen, Helge Bjarup Dissing; Groenborg, Sabine


    Absence seizures are associated with generalized 2.5-5 Hz spike-wave discharges in the EEG. Rarely are patients, parents or physicians aware of duration or incidence of seizures. Six patients were monitored with a portable EEG-device over four times 24 hours to evaluate how easily outpatients...

  8. Neglected Bilateral Posterior Shoulder Fracture Dislocation in an Uncontrolled Seizure patient (United States)

    Amir, Moaath A.; Alenazi, Bashir; Wyse, Richard K.H.; Tamimi, Waleed; Kujan, Omar; Khan, Tajdar; Alenzi, Faris Q.


    Posterior dislocation of the shoulder is a rare injury that occurs secondary to trauma and seizures. Diagnosis is often missed and treatment is challenging. Neglected posterior dislocation is associated with Hill-Sachs lesion which leads to locking of dislocation. Correct diagnosis is achieved by history taking, a physical examination and appropriate imaging. In neglected shoulder dislocation with uncontrolled seizure and humeral head defects of up to 45% the McLaughlin procedure shows excellent results at follow-up. PMID:26430452

  9. Increase of the seizure threshold in C57BL/6 mice after citicoline administration. (United States)

    Karpova, M N; Zin'kovskii, K A; Kuznetsova, L V; Klishina, N V


    We studied the dose-dependent effect of preventive intraperitoneal injection of citicoline (cytidine 5'-diphosphocholine) on acute generalized epileptiform activity in C57Bl/6 mice. The duration of citicoline action was also evaluated. Administration of citicoline in doses of 500 and 1000 mg/kg 1 h before treatment with the convulsant agent pentylenetetrazole produced an anticonvulsant effect. This effect was manifested in an increase of the threshold of clonic seizures and tonic phase of seizures with lethal outcome. Moreover, the latency of seizure development was elevated under these conditions. The anticonvulsant effect of citicoline persisted for 6 h after its injection.

  10. Channel selection for automatic seizure detection

    DEFF Research Database (Denmark)

    Duun-Henriksen, Jonas; Kjaer, Troels Wesenberg; Madsen, Rasmus Elsborg


    Objective: To investigate the performance of epileptic seizure detection using only a few of the recorded EEG channels and the ability of software to select these channels compared with a neurophysiologist. Methods: Fifty-nine seizures and 1419 h of interictal EEG are used for training and testing...... of an automatic channel selection method. The characteristics of the seizures are extracted by the use of a wavelet analysis and classified by a support vector machine. The best channel selection method is based upon maximum variance during the seizure. Results: Using only three channels, a seizure detection...... sensitivity of 96% and a false detection rate of 0.14/h were obtained. This corresponds to the performance obtained when channels are selected through visual inspection by a clinical neurophysiologist, and constitutes a 4% improvement in sensitivity compared to seizure detection using channels recorded...

  11. Marked Seizure Reduction after MCT Supplementation

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    Raed Azzam


    Full Text Available We report the case of a 43-year-old man with history of nonsurgical partial epilepsy who previously failed multiple trials of antiepileptic drugs. Medium-chain triglycerides (MCT were added to his regular diet in the form of pure oil. Subsequently, his seizure frequency was markedly reduced from multiple daily seizures to one seizure every four days. His seizures recurred after transient discontinuation of MCT over a period of ten days. His seizure improvement was achieved at a dose of four tablespoons of MCT twice daily with no reported side effects. He developed significant diarrhea and flatulence at higher doses. We conclude that MCT oil supplementation to regular diet may provide better seizure control in some patients. MCT oil supplementation may be a more tolerable alternative to the standard ketogenic diet.

  12. Seizure detection algorithms based on EMG signals

    DEFF Research Database (Denmark)

    Conradsen, Isa

    Background: the currently used non-invasive seizure detection methods are not reliable. Muscle fibers are directly connected to the nerves, whereby electric signals are generated during activity. Therefore, an alarm system on electromyography (EMG) signals is a theoretical possibility. Objective......: to show whether medical signal processing of EMG data is feasible for detection of epileptic seizures. Methods: EMG signals during generalised seizures were recorded from 3 patients (with 20 seizures in total). Two possible medical signal processing algorithms were tested. The first algorithm was based...... on the amplitude of the signal. The other algorithm was based on information of the signal in the frequency domain, and it focused on synchronisation of the electrical activity in a single muscle during the seizure. Results: The amplitude-based algorithm reliably detected seizures in 2 of the patients, while...

  13. A critical role for network structure in seizure onset: a computational modelling approach

    Directory of Open Access Journals (Sweden)

    George ePetkov


    Full Text Available Recent clinical work has implicated network structure as critically important in the initiation of seizures in people with idiopathic generalized epilepsies. In line with this idea, functional networks derived from the electroencephalogram (EEG at rest have been shown to be significantly different in people with generalized epilepsy compared to controls. In particular, the mean node degree of networks from the epilepsy cohort was found to be statistically significantly higher than those of controls. However, the mechanisms by which these network differences can support recurrent transitions into seizures remain unclear. In this study we use a computational model of the transition into seizure dynamics to explore the dynamic consequences of these differences in functional networks. We demonstrate that networks with higher mean node degree are more prone to generating seizure dynamics in the model and therefore suggest a mechanism by which increased mean node degree of brain networks can cause heightened ictogenicity.

  14. Evaluation of novel algorithm embedded in a wearable sEMG device for seizure detection

    DEFF Research Database (Denmark)

    Conradsen, Isa; Beniczky, Sandor; Wolf, Peter;


    We implemented a modified version of a previously published algorithm for detection of generalized tonic-clonic seizures into a prototype wireless surface electromyography (sEMG) recording device. The method was modified to require minimum computational load, and two parameters were trained...... on prior sEMG data recorded with the device. Along with the normal sEMG recording, the device is able to set an alarm whenever the implemented algorithm detects a seizure. These alarms are annotated in the data file along with the signal. The device was tested at the Epilepsy Monitoring Unit (EMU......) at the Danish Epilepsy Center. Five patients were included in the study and two of them had generalized tonic-clonic seizures. All patients were monitored for 2–5 days. A double-blind study was made on the five patients. The overall result showed that the device detected four of seven seizures and had a false...

  15. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. (United States)

    Bergey, Gregory K; Morrell, Martha J; Mizrahi, Eli M; Goldman, Alica; King-Stephens, David; Nair, Dileep; Srinivasan, Shraddha; Jobst, Barbara; Gross, Robert E; Shields, Donald C; Barkley, Gregory; Salanova, Vicenta; Olejniczak, Piotr; Cole, Andrew; Cash, Sydney S; Noe, Katherine; Wharen, Robert; Worrell, Gregory; Murro, Anthony M; Edwards, Jonathan; Duchowny, Michael; Spencer, David; Smith, Michael; Geller, Eric; Gwinn, Ryder; Skidmore, Christopher; Eisenschenk, Stephan; Berg, Michel; Heck, Christianne; Van Ness, Paul; Fountain, Nathan; Rutecki, Paul; Massey, Andrew; O'Donovan, Cormac; Labar, Douglas; Duckrow, Robert B; Hirsch, Lawrence J; Courtney, Tracy; Sun, Felice T; Seale, Cairn G


    The long-term efficacy and safety of responsive direct neurostimulation was assessed in adults with medically refractory partial onset seizures. All participants were treated with a cranially implanted responsive neurostimulator that delivers stimulation to 1 or 2 seizure foci via chronically implanted electrodes when specific electrocorticographic patterns are detected (RNS System). Participants had completed a 2-year primarily open-label safety study (n = 65) or a 2-year randomized blinded controlled safety and efficacy study (n = 191); 230 participants transitioned into an ongoing 7-year study to assess safety and efficacy. The average participant was 34 (±11.4) years old with epilepsy for 19.6 (±11.4) years. The median preimplant frequency of disabling partial or generalized tonic-clonic seizures was 10.2 seizures a month. The median percent seizure reduction in the randomized blinded controlled trial was 44% at 1 year and 53% at 2 years (p < 0.0001, generalized estimating equation) and ranged from 48% to 66% over postimplant years 3 through 6 in the long-term study. Improvements in quality of life were maintained (p < 0.05). The most common serious device-related adverse events over the mean 5.4 years of follow-up were implant site infection (9.0%) involving soft tissue and neurostimulator explantation (4.7%). The RNS System is the first direct brain responsive neurostimulator. Acute and sustained efficacy and safety were demonstrated in adults with medically refractory partial onset seizures arising from 1 or 2 foci over a mean follow-up of 5.4 years. This experience supports the RNS System as a treatment option for refractory partial seizures. This study provides Class IV evidence that for adults with medically refractory partial onset seizures, responsive direct cortical stimulation reduces seizures and improves quality of life over a mean follow-up of 5.4 years. © 2015 American Academy of Neurology.

  16. Healthcare-seeking behavior of patients with epileptic seizure disorders attending a tertiary care hospital, Kolkata

    Directory of Open Access Journals (Sweden)

    Abhik Sinha


    Full Text Available Introduction : Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. Aims and Objectives: The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. Materials and Methods: Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. Results and Conclusion: More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.

  17. Autonomic changes in psychogenic nonepileptic seizures: toward a potential diagnostic biomarker? (United States)

    Reinsberger, Claus; Sarkis, Rani; Papadelis, Christos; Doshi, Chiran; Perez, David L; Baslet, Gaston; Loddenkemper, Tobias; Dworetzky, Barbara A


    Disturbances of the autonomic nervous system (ANS) are common in neuropsychiatric disorders. Disease specific alterations of both sympathetic and parasympathetic activity can be assessed by heart rate variability (HRV), whereas electrodermal activity (EDA) can assess sympathetic activity. In posttraumatic stress disorder (PTSD), parasympathetic HRV parameters are typically decreased and EDA is increased, whereas in major depressive disorder (MDD) and dissociation, both parasympathetic and sympathetic markers are decreased. ANS abnormalities have also been identified in psychogenic nonepileptic seizures (PNES) by using HRV, indicating lower parasympathetic activity at baseline. In addition to reviewing the current literature on ANS abnormalities in PTSD, MDD, and disorders with prominent dissociation, including borderline personality disorder (BPD), this article also presents data from a pilot study on EDA in patients with PNES. Eleven patients with PNES, during an admission to our epilepsy monitoring unit (EMU), were compared with 9 with generalized tonic-clonic seizures (GTCS). The area under the EDA curve, the number of EDA responses lasting longer than 2 seconds, and the number of EDA surges during sleep (sympathetic sleep storms) were calculated on ictal and interictal days by an automated algorithm. EDA changes in PNES patients did not follow a systematic pattern of sympathetic hyperarousal (like EDA after GTCS) but were more variable. How specific PNES semiologies, and/or underlying neuropsychiatric disorders, may influence ictal and interictal EDA patterns, and lead to a novel diagnostic biomarker remains to be evaluated in future larger studies.

  18. Family history and recurrence of febrile seizures.



    To determine the value of a detailed family history for the assessment of the risk of recurrence of febrile seizures, 115 children who visited the emergency room of an academic children's hospital were studied prospectively. The recurrence risk of febrile seizures was analysed in relation to the child's family history and the proportion of relatives affected by febrile seizures using Kaplan-Meier estimates and Cox proportional hazard models. A first degree family history positive for febrile ...

  19. Seizures and X-linked intellectual disability


    Stevenson, Roger E; Holden, Kenton R.; Rogers, R. Curtis; Schwartz, Charles E.


    Intellectual disability occurs as an isolated X-linked trait and as a component of recognizable X-linked syndromes in the company of somatic, metabolic, neuromuscular, or behavioral abnormalities. Seizures accompany intellectual disability in almost half of these X-linked disorders. The spectrum of seizures found in the X-linked intellectual disability syndromes is broad, varying in time of onset, type of seizure, and response to anticonvulsant therapy. The majority of the genes associated wi...

  20. Effect of various antiepileptic drugs in zebrafish PTZ-seizure model

    Directory of Open Access Journals (Sweden)

    P Gupta


    Full Text Available Recently zebrafish larvae have emerged as a high-throughput model for screening pharmacological activities. The present study was undertaken to investigate the effect of established anticonvulsants, such as valproic acid, carbamazepine, gabapentin, diazepam, lacosamide and pregabalin against pentylenetetrazole (6 mM seizures in adult zebrafish. Different phases of seizures (increase swim activity, rapid whirlpool-like circling swim behaviour and brief clonus-like seizures leading to loss of posture were elicited in zebrafish on exposure for 15 min to 6 mM pentylenetetrazole. The exposure of zebrafish to an increasing concentration of the anticonvulsants alongside 6 mM pentylenetetrazole showed concentration-dependent elevation of seizure latency against pentylenetetrazole-induced seizures except for pregabalin, which failed to produce any anticonvulsant activity in zebrafish. Moreover the proconvulsant activity of caffeine was also evaluated using suboptimal concentration (4 mM of pentylenetetrazole in adult zebrafish. Decrease in seizure latency of different phases of seizures was observed with increasing concentration of caffeine compared with its respective control group. In view of the above findings, the results of the present study suggested that adult zebrafish produce the expected anticonvulsive and proconvulsive effects and could potentially be used as a screen in future epilepsy research.

  1. Cerebral oxygenation during postasphyxial seizures in near-term fetal sheep. (United States)

    Gonzalez, Hernan; Hunter, Christian J; Bennet, Laura; Power, Gordon G; Gunn, Alistair J


    After exposure to asphyxia, infants may develop both prolonged, clinically evident seizures and shorter, clinically silent seizures; however, their effect on cerebral tissue oxygenation is unclear. We therefore examined the hypothesis that the increase in oxygen delivery during postasphyxial seizures might be insufficient to meet the needs of increased metabolism, thus causing a fall in tissue oxygenation, in unanesthetized near-term fetal sheep in utero (gestational age 125+/-1 days). Fetuses were administered an infusion of the specific adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine, followed by 10 mins of asphyxia induced by complete umbilical cord occlusion. The fetuses then recovered for 3 days. Sixty-one episodes of electrophysiologically defined seizures were identified in five fetuses. Tissue PO(2) (tPO(2)) did not change significantly during short seizures (seizures lasting more than 3.5 mins (Pseizures, cortical blood flow did not begin to increase until tPO(2) had begun to fall, and then rose more slowly than the increase in metabolism, with a widening of the brain to blood temperature gradient. In conclusion, in the immature brain, during prolonged, but not short seizures, there is a transient mismatch between cerebral blood flow and metabolism leading to significant cerebral deoxygenation.

  2. Use of anticonvulsants as prophylaxis for seizures in patients on clozapine. (United States)

    Caetano, Dorgival


    The aim of this study is to conduct a critical review of the literature regarding the use of anticonvulsants in the prophylaxis of clozapine-induced seizures, to examine the relationship of the latter with clozapine daily dose, serum concentration and other factors than dosage that effect clozapine blood concentration, and to make recommendations for the management of clozapine-induced seizures. A systematic review of English-language MEDLINE articles was undertaken. Clozapine-induced seizures may occur at any dose; the risk increases with dose and goes up to 4% at ≥ 600 mg/day. Some authors have advocated that patients on that dose regimen have anticonvulsant added as a primary prophylactic measure. The author discusses the pitfalls of this recommendation and highlights that seizures are better predicted from serum concentration (1300 ng/ml) rather than dose alone, and that serum concentration is strongly influenced by sex, age, smoking habit, drug-drug interactions and variations in the 1A2, 2D6 and 3A4 genotypes. Anticonvulsants are not recommended as a primary prophylaxis for clozapine-induced seizures. When deemed necessary as secondary prophylaxis, the clinician's choice should consider drug-drug interactions that may increase/decrease clozapine serum concentration and lead to more side effects, including neutropenia/agranulocytosis and seizures, or compromise therapeutic response. Recommendations for primary and secondary prophylaxis of clozapine related-seizures are provided.

  3. Cognitive performance and convulsion risk after experimentally-induced febrile-seizures in rat. (United States)

    Rajab, Ebrahim; Abdeen, Zahra; Hassan, Zuhair; Alsaffar, Yousif; Mandeel, Mohammad; Al Shawaaf, Fatima; Al-Ansari, Sali; Kamal, Amer


    Many reports indicated that small percentage of children with febrile seizures develop epilepsy and cognitive disorders later in adulthood. In addition, the neuronal network of the hippocampus was reported to be deranged in adult animals after being exposed to hyperthermia-induced seizures in their neonatal life. The aims of this study were to investigate (1) latency and probability of seizures, (2) spatial learning and memory, in adult rats after neonatal hyperthermia-induced febrile seizures (FS). Prolonged FS were elicited in 10-day old, male Sprague Dawleys (n=11/group) by exposure to heated air (48-52 °C) for 30 min; control rats were exposed to 30 °C air. After 1.5 months the animal's cognitive performance was assessed by 5 day trial in the Morris water maze. In another experiment the latency and probability of seizures were measured in response to pentylenetetrazole (PTZ) injections (increased doses ranged from 7 to 140 mg/kg; i.p.). In water maze, both groups showed improvements in escape latency and distance swam to reach the platform; effects were significantly greater in control versus hyperthermia-treated animals on days 3 and 4. Latency and probability of PTZ-induced seizures were shorter and higher respectively, in hyperthermia-treated animals compared to controls. We concluded that FS in neonatal rats leads to enhanced susceptibility for seizures, as well as cognitive deficits in adults.

  4. Stimulation of Central A1 Adenosine Receptors Suppresses Seizure and Neuropathology in a Soman Nerve Agent Seizure Rat Model (United States)


    Seaford, DE) and then had wire-electrodes implanted into the skull for recording brain electroencephalo- graphic (EEG) activity. A stereotaxic frame with...purchased from Wedgewood Pharmacy (Swedesboro, NJ). The rat’s brain activity was recorded from EEG and used to detect seizure onset. The electrodes implanted ...into the rat’s skull were connected to recording leads via a connecting plug that attached to the rat’s head with dental cement. At the time of

  5. A seizure response dog: video recording of reacting behaviour during repetitive prolonged seizures. (United States)

    Di Vito, Lidia; Naldi, Ilaria; Mostacci, Barbara; Licchetta, Laura; Bisulli, Francesca; Tinuper, Paolo


    Seizure response and alerting behaviour may spontaneously develop in dogs living with children or adults with epilepsy. Some dogs can also be reliably trained to respond and anticipate seizures. We describe the case of a dog, not previously trained for assistance work, showing complex seizure response behaviour. This is the first release of a home video recording of a dog reacting to its owner's seizure.

  6. Seizure-Induced Neuronal Injury: Vulnerability to Febrile Seizures in an Immature Rat Model


    Toth, Zsolt; Yan, Xiao-Xin; Haftoglou, Suzie; Ribak, Charles E.; Tallie Z. Baram


    Febrile seizures are the most common seizure type in young children. Whether they induce death of hippocampal and amygdala neurons and consequent limbic (temporal lobe) epilepsy has remained controversial, with conflicting data from prospective and retrospective studies. Using an appropriate-age rat model of febrile seizures, we investigated the acute and chronic effects of hyperthermic seizures on neuronal integrity and survival in the hippocampus and amygdala via molecular and neuroanatomic...

  7. Porencephaly and cortical dysplasia as cause of seizures in a dog


    Machado Gisele Fabrino; Laranjeira Maria-Gisela; Schweigert Augusto; de Melo Guilherme Dias


    Abstract Background Seizures are a common problem in small animal neurology and it may be related to underlying diseases. Porencephaly is an extremely rare disorder, and in Veterinary Medicine it affects more often ruminants, with only few reports in dogs. Case presentation A one-year-old intact male Shih-Tzu dog was referred to Veterinary University Hospital with history of abnormal gait and generalized tonic-clonic seizures. Signs included hypermetria, abnormal nystagmus and increased myota...

  8. Treating seizures in Creutzfeldt–Jakob disease

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    Marcus C. Ng


    Full Text Available Seizures are known to occur in Creutzfeldt–Jakob disease (CJD. In the setting of a rapidly progressive condition with no effective therapy, determining appropriate treatment for seizures can be difficult if clinical morbidity is not obvious yet the electroencephalogram (EEG demonstrates a worrisome pattern such as status epilepticus. Herein, we present the case of a 39-year-old man with CJD and electrographic seizures, discuss how this case challenges conventional definitions of seizures, and discuss a rational approach toward treatment. Coincidentally, our case is the first report of CJD in a patient with Stickler syndrome.

  9. Diagnosing Functional Seizures in Children and Adolescent

    DEFF Research Database (Denmark)

    Wichaidit, Bianca Taaning; Rask, Charlotte Ulrikka; Ostergaard, John R


    Functional seizures (FS) is a condition where the child experiences seizure-like events, without abnormal electrical discharge as measured by EEG, and with high risk of misdiagnosis. Diagnosing FS contains: 1) video-EEG, 2) anamnestic evaluation, focusing on the presence of psychosocial stressors......, psychiatric co-morbidity and functional symptoms other than FS, and 3) evaluation of seizure characteristics such as long duration, seizure initiation during wakefulness and in the presence of witnesses asynchronous movements, and no incontinence, tongue bite and injury related to the event....

  10. Febrile seizures: risks, evaluation, and prognosis. (United States)

    Graves, Reese C; Oehler, Karen; Tingle, Leslie E


    Febrile seizures are common in the first five years of life, and many factors that increase seizure risk have been identified. Initial evaluation should determine whether features of a complex seizure are present and identify the source of fever. Routine blood tests, neuroimaging, and electroencephalography are not recommended, and lumbar puncture is no longer recommended in patients with uncomplicated febrile seizures. In the unusual case of febrile status epilepticus, intravenous lorazepam and buccal midazolam are first-line agents. After an initial febrile seizure, physicians should reassure parents about the low risk of long-term effects, including neurologic sequelae, epilepsy, and death. However, there is a 15 to 70 percent risk of recurrence in the first two years after an initial febrile seizure. This risk is increased in patients younger than 18 months and those with a lower fever, short duration of fever before seizure onset, or a family history of febrile seizures. Continuous or intermittent antiepileptic or antipyretic medication is not recommended for the prevention of recurrent febrile seizures.

  11. Febrile seizures: Mechanisms and relationship to epilepsy (United States)

    Dubé, Céline M.; Brewster, Amy L.; Baram, Tallie Z.


    Studies of febrile seizures have been driven by two major enigmas: first, how these most common of human seizures are generated by fever has not been known. Second, epidemiological studies have linked prolonged febrile seizures with the development of temporal lobe epilepsy, yet whether long or recurrent febrile seizures cause temporal lobe epilepsy has remained unresolved. To investigate these questions, a model of prolonged (complex) febrile seizures was developed in immature rats and mice, permitting mechanistic examination of the potential causal relationships of fever and seizures, and of febrile seizures and limbic epilepsy. Although the model relied on hyperthermia, it was discovered that the hyperthermia-induced secretion of endogenous fever mediators including interleukin-1β, which contributed to the generation of these ‘febrile’ seizures. In addition, prolonged experimental febrile seizures provoked epilepsy in a third of the animals. Investigations of the mechanisms of this epileptogenesis demonstrated that expression of specific ion (HCN) channels and of endocannabinoid signaling, may be involved. These may provide novel drug targets for intervention in the epileptogenic process. PMID:19232478

  12. Cellular and network mechanisms of electrographic seizures (United States)

    Bazhenov, Maxim; Timofeev, Igor; Fröhlich, Flavio; Sejnowski, Terrence J.


    Epileptic seizures constitute a complex multiscale phenomenon that is characterized by synchronized hyperexcitation of neurons in neuronal networks. Recent progress in understanding pathological seizure dynamics provides crucial insights into underlying mechanisms and possible new avenues for the development of novel treatment modalities. Here we review some recent work that combines in vivo experiments and computational modeling to unravel the pathophysiology of seizures of cortical origin. We particularly focus on how activity-dependent changes in extracellular potassium concentration affects the intrinsic dynamics of neurons involved in cortical seizures characterized by spike/wave complexes and fast runs. PMID:19190736

  13. Metalloproteinase inhibition prevents inhibitory synapse reorganization and seizure genesis. (United States)

    Pollock, Emily; Everest, Michelle; Brown, Arthur; Poulter, Michael O


    The integrity and stability of interneurons in a cortical network are essential for proper network function. Loss of interneuron synaptic stability and precise organization can lead to disruptions in the excitation/inhibition balance, a characteristic of epilepsy. This study aimed to identify alterations to the GABAergic interneuron network in the piriform cortex (PC: a cortical area believed to be involved in the development of seizures) after kindling-induced seizures. Immunohistochemistry was used to mark perineuronal nets (PNNs: structures in the extracellular matrix that provide synaptic stability and restrict reorganization of inhibitory interneurons) and interneuron nerve terminals in control and kindled tissues. We found that PNNs were significantly decreased around parvalbumin-positive interneurons after the induction of experimental epilepsy. Additionally, we found layer-specific increases in GABA release sites originating from calbindin, calretinin, and parvalbumin interneurons, implying that there is a re-wiring of the interneuronal network. This increase in release sites was matched by an increase in GABAergic post-synaptic densities. We hypothesized that the breakdown of the PNN could be due to the activity of matrix metalloproteinases (MMP) and that the prevention of PNN breakdown may reduce the rewiring of interneuronal circuits and suppress seizures. To test this hypothesis we employed doxycycline, a broad spectrum MMP inhibitor, to stabilize PNNs in kindled rats. We found that doxycycline prevented PNN breakdown, re-organization of the inhibitory innervation, and seizure genesis. Our observations indicate that PNN degradation may be necessary for the development of seizures by facilitating interneuron plasticity and increased GABAergic activity.

  14. Non-EEG based ambulatory seizure detection designed for home use: What is available and how will it influence epilepsy care? (United States)

    van Andel, Judith; Thijs, Roland D; de Weerd, Al; Arends, Johan; Leijten, Frans


    This study aimed to (1) evaluate available systems and algorithms for ambulatory automatic seizure detection and (2) discuss benefits and disadvantages of seizure detection in epilepsy care. PubMed and EMBASE were searched up to November 2014, using variations and synonyms of search terms "seizure prediction" OR "seizure detection" OR "seizures" AND "alarm". Seventeen studies evaluated performance of devices and algorithms to detect seizures in a clinical setting. Algorithms detecting generalized tonic-clonic seizures (GTCSs) had varying sensitivities (11% to 100%) and false alarm rates (0.2-4/24 h). For other seizure types, detection rates were low, or devices produced many false alarms. Five studies externally validated the performance of four different devices for the detection of GTCSs. Two devices were promising in both children and adults: a mattress-based nocturnal seizure detector (sensitivity: 84.6% and 100%; false alarm rate: not reported) and a wrist-based detector (sensitivity: 89.7%; false alarm rate: 0.2/24 h). Detection of seizure types other than GTCSs is currently unreliable. Two detection devices for GTCSs provided promising results when externally validated in a clinical setting. However, these devices need to be evaluated in the home setting in order to establish their true value. Automatic seizure detection may help prevent sudden unexpected death in epilepsy or status epilepticus, provided the alarm is followed by an effective intervention. Accurate seizure detection may improve the quality of life (QoL) of subjects and caregivers by decreasing burden of seizure monitoring and may facilitate diagnostic monitoring in the home setting. Possible risks are occurrence of alarm fatigue and invasion of privacy. Moreover, an unexpectedly high seizure frequency might be detected for which there are no treatment options. We propose that future studies monitor benefits and disadvantages of seizure detection systems with particular emphasis on Qo

  15. PRRT2 Mutations Are Related to Febrile Seizures in Epileptic Patients

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    Zheng-Wen He


    Full Text Available Previous studies reported that the proline-rich transmembrane protein 2 (PRRT2 gene was identified to be related to paroxysmal kinesigenic dyskinesia (PKD, infantile convulsions with PKD, PKD with migraine and benign familial infantile epilepsy (BFIE. The present study explores whether the PRRT2 mutation is a potential cause of febrile seizures, including febrile seizures plus (FS+, generalized epilepsy with febrile seizures plus (GEFS+ and Dravet syndrome (DS; thus, it may provide a new drug target for personalized medicine for febrile seizure patients. We screened PRRT2 exons in a cohort of 136 epileptic patients with febrile seizures, including FS+, GEFS+ and DS. PRRT2 genetic mutations were identified in 25 out of 136 (18.4% febrile seizures in epileptic patients. Five loss-of-function and coding missense mutations were identified: c.649delC (p.R217Efs*12, c.649_650insC (p.R217Pfs*8, c.412C>G (p.Pro138Ala, c.439G>C (p.Asp147His and c.623C>A (p.Ser208Tyr. PRRT2 variants were probably involved in the etiology of febrile seizures in epileptic patients.

  16. Rufinamide: treatment of seizures associated with Lennox and ndash;Gastaut syndrome

    Directory of Open Access Journals (Sweden)

    Haritha Allu


    Full Text Available Rufinamide (RUF is FDA-approved for adjunctive management of seizures related with Lennox and ndash;Gastaut syndrome (LGS. This new anti-epileptic drug (AED adds to the AEDs previously used for LGS together with valproic acid, lamotrigine, felbamate, and topiramate. Its mechanism of action includes preventive the excessive firing of sodium-dependent action potentials, but RUF also exhibits a broad spectrum of action in animal models. The plasma concentration of other AEDs does not change by the RUF. Dizziness, nausea, diplopia, and ataxia vomiting and somnolence are most common adverse effects taking place with RUF. Status epilepticus has been reported, but were uncommon (0.9%. A recent randomized, double-blinded, placebo-controlled trial of RUF in patients with LGS and generalized seizures, including atypical absence and tonic-atonic seizures, showed a 32.7% median percentage decreased in total seizures and a 42.5% median percentage decreased in tonic-atonic seizures. RUF also considerably decreased seizure severity. RUF has been studied as adjunctive therapy for partial seizures in adults and adolescents. In a study of three healthy volunteers, an oral dose of 600 mg RUF recognized high absorption and monoexponential elimination with a mean half-life (t and frac12; of 9 hrs. Excretion was mainly renal (85% and complete (98% within 7 days. [Int J Basic Clin Pharmacol 2014; 3(6.000: 937-942

  17. Predictors for long-term seizure outcome in juvenile myoclonic epilepsy: 25-63 years of follow-up. (United States)

    Geithner, Julia; Schneider, Felix; Wang, Zhong; Berneiser, Julia; Herzer, Rosemarie; Kessler, Christof; Runge, Uwe


    The long-term seizure outcome of juvenile myoclonic epilepsy (JME) is still controversial; the value of factors that are potentially predictive for seizure outcome remains unclear. The aim of this study was both to investigate the long-term seizure outcome in patients with JME after a follow-up of at least 25 years and to identify factors that are predictive for the seizure outcome. Data from 31 patients (19 women) with JME were studied. All of them had a follow-up of at least 25 years (mean 39.1 years) and were reevaluated with a review of their medical records and direct telephone or face-to-face interview. Of 31 patients 21 (67.7%) became seizure-free; in six of them (28.6%) antiepileptic drug (AED) treatment was discontinued due to seizure freedom. The occurrence of generalized tonic-clonic seizures (GTCS) preceded by bilateral myoclonic seizures (BMS) (p = 0.03), a long duration of epilepsy with unsuccessful treatment (p = 0.022), and AED polytherapy (p = 0.023) were identified as significant predictors for a poor long-term seizure outcome, whereas complete remission of GTCS under AED significantly increased the chance for complete seizure freedom (p = 0.012). The occurrence of photoparoxysmal responses significantly increases the risk of seizure recurrence after AED discontinuation (p = 0.05). This study shows conclusively that JME is a heterogeneous epilepsy syndrome. Life-long AED treatment is not necessarily required to maintain seizure freedom. Several long-term outcome predictors that can potentially increase the ability of clinicians and their confidence to recommend different treatment options to patients with JME were identified. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

  18. Local cerebral blood flow and glucose metabolism during seizure in spontaneously epileptic El mice

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    Hosokawa, Chisa; Ochi, Hironobu; Yamagami, Sakae; Kawabe, Joji; Kobashi, Toshiko; Okamura, Terue; Yamada, Ryusaku [Osaka City Univ. (Japan). Faculty of Medicine


    Local cerebral blood flow and glucose metabolism were examined in spontaneously epileptic El mice using autoradiography with {sup 125}I-IMP and {sup 14}C-DG in the interictal phase and during seizure. El (+) mice that developed generalized tonic-clonic convulsions and El (-) mice that received no stimulation and had no history of epileptic seizures were examined. The seizure non-susceptible, maternal strain ddY mice were used as control. Uptake ratios for IMP and DG in mouse brain were calculated using the autoradiographic density. In the interictal phase, the pattern of local cerebral blood flow of El (+) mice was similar to that of ddY and El (-) mice, and glucose metabolism in the hippocampus was higher in El (+) mice than in El (-) and ddY mice, but flow and metabolism were nearly matched. During seizure, no significant changed blood flow and increased glucose metabolism in the hippocampus, the epileptic focus, and no markedly changed blood flow and depressed glucose metabolism in other brain regions were observed and considered to be flow-metabolism uncoupling. These observations have never been reported in clinical or experimental studies of epilepsy. Seizures did not cause large regional differences in cerebral blood flow. Therefore, only glucose metabolism is useful for detection of the focus of secondary generalized seizures in El mice, and appeared possibly to be related to the pathophysiology of secondary generalized epilepsy in El mice. (author).

  19. Association between iron deficiency anemia and febrile seizure in children. (United States)

    Derakhshanfar, Hojjat; Abaskhanian, Ali; Alimohammadi, Hosein; ModanlooKordi, Mona


    Febrile convulsion (FC) is a common cause of seizure in young children, with an excellent prognosis. In addition to genetic predisposition, FCs are generally thought to be induced by elemental changes such as iron deficiency. Regarding the high prevalence of febrile seizure and iron deficiency anemia in children, the aim was to investigate the role of iron deficiency anemia in FC patients. This case-control study was performed in 500 children with febrile seizures (case) and 500 febrile children without seizures (control), referred to Mofid hospital in Tehran during one year (Nov 2009-Nov 2010). All children were aged between 6-60 months. The groups were matched in age and gender and use of supplemental iron. Laboratory tests consisted of Complete Blood Count (CBC). Serum iron, plasma ferritin and Total Iron Binding Capacity (TIBC) analyses were done in each patient. The patients and controls were 26.49+12.65 and 26.84+11.70 months of mean age, respectively. The amount of Hb, Hct, MCV, MCH, MCHC, RBC count, serum iron and plasma ferritin were significantly higher and TIBC was significantly lower among the cases with febrile convulsion than the controls. The incidence of iron deficiency anemia was significantly higher in controls compared with the cases (p less than 0.016). The mean of temperature peak on admission was significantly higher in the febrile convulsion group than controls. The results of this study suggest that the risk of febrile seizure occurrence in anemic children is less common as compared to non-anemic ones.

  20. Anti-Seizure Medications: Relief from Nerve Pain (United States)

    Anti-seizure medications: Relief from nerve pain Anti-seizure drugs often are used to help control the type of ... by damaged nerves. By Mayo Clinic Staff Anti-seizure medications were originally designed to treat people with ...

  1. Genetics Home Reference: genetic epilepsy with febrile seizures plus (United States)

    ... Health Conditions genetic epilepsy with febrile seizures plus genetic epilepsy with febrile seizures plus Printable PDF Open ... Javascript to view the expand/collapse boxes. Description Genetic epilepsy with febrile seizures plus (GEFS+) is a ...

  2. Complex partial seizure, disruptive behaviours and the Nigerian ...

    African Journals Online (AJOL)

    Complex partial seizure, disruptive behaviours and the Nigerian Legal System. ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING ... Background: Complex partial seizure is an epileptic seizure which results in ...

  3. Differences between two feline epilepsy models in sleep and waking state disorders, state dependency of seizures and seizure susceptibility: amygdala kindling interferes with systemic penicillin epilepsy. (United States)

    Shouse, M N


    The objective of the study was to determine whether contemporary feline models of petit mal (systemic penicillin epilepsy) or temporal lobe epilepsy (amygdala kindling) resemble human seizure disorders with respect to disturbances of sleep and waking states, the state dependency of seizures, and transference of seizure susceptibility. These variables were examined in 6-h polygraphic recordings before and during exposure to both seizure models in 24 cats; 12 cats had intramuscular (i.m.) injections of 300,000 or 400,000 IU/kg of penicillin prior to kindling, and 12 were kindled before penicillin challenge. Results were as follows. First, penicillin increased light slow wave sleep (SWS) and drowsiness, during which spike-wave (SW) activity was maximal. Generalized tonic-clonic convulsions (GTCs) occurred predominantly in drowsiness after awakening from SWS. Second, kindling produced more deep SWS than did penicillin; susceptibility to kindled GTCs peaked during deep SWS, especially in transition to rapid eye movement sleep (REM). Third, penicillin did not influence subsequent sleep disorders or seizure susceptibility during kindling; kindling interfered with penicillin-induced GTCs, SW activity, and sleep disorders. Collectively, the findings suggest distinct state disorders and state-dependent seizure profiles in the two models. These differences parallel human analogues and may have contributed to the transference results. Kindling is a chronic model with persistent sleep and seizure abnormalities that differ from and may have discouraged penicillin epilepsy. Penicillin is an acute model with transient state and seizure disorders, a fact that may account for the absence of penicillin transference to kindling.


    Directory of Open Access Journals (Sweden)

    Chalapathi Rao


    Full Text Available BACKGROUND: Epilepsy is one of the most familiar neurological disorders which can cause bodily injury and death from inadequately treated or untreated cases. The imaging and EEG of new onset seizures is done with different indications, to identify an acute illness as the underline course for the seizure and possible neurological deficit. To this purpose we have evaluated new onset seizures in adult patients in correlation with their clinical profile, Electroencephalography (EEG and Computerized tomography (CT imaging of brain. METHODS: This cro ss sectional study was studied in 100 adult patients, presenting with seizures attending the Emergency department, General Medicine and Neurology wards and OPD of Tertiary care teaching hospital during the period of March 2006 to March 2008. All the patien ts were examined clinically and subjected to CT imaging of brain and EEG. Other necessary blood investigations were also done. Correlation between various seizures and CT scan brain and EEG were studied. Descriptive statistics were used to analyze the data . RESULTS: 63% of patients were in the age group of 20 - 39 years, 63% were males and 37% were females. 65% presented with GTCS, 35% with partial seizures. CT scan was found abnormal in 49.2% patients in GTCS, 71.4% in partial seizures. EEG showed abnormal p attern in 39% patients. 40% of the patients with partial seizures had epileptic form discharges. 33% patients had focal lesions on CT brain with normal EEG. CONCLUSION: Generalized Tonic clonic seizures were the commonest type of seizures was present, seen mostly in male patients. CT scan brain was abnormal in 57% of the patients. Neurocysticercosis and calcified granuloma were the commonest causes for seizures up to 3 rd decade of life. Majority of the patients with focal lesions on CT scan brain had epileptic form discharges on EEG which indicate a strong correlation of EEG with CT findings. Initiating the treatment with antiepileptic drugs was

  5. TLR9 signalling in microglia attenuates seizure-induced aberrant neurogenesis in the adult hippocampus. (United States)

    Matsuda, Taito; Murao, Naoya; Katano, Yuki; Juliandi, Berry; Kohyama, Jun; Akira, Shizuo; Kawai, Taro; Nakashima, Kinichi


    Pathological conditions such as epilepsy cause misregulation of adult neural stem/progenitor populations in the adult hippocampus in mice, and the resulting abnormal neurogenesis leads to impairment in learning and memory. However, how animals cope with abnormal neurogenesis remains unknown. Here we show that microglia in the mouse hippocampus attenuate convulsive seizure-mediated aberrant neurogenesis through the activation of Toll-like receptor 9 (TLR9), an innate immune sensor known to recognize microbial DNA and trigger inflammatory responses. We found that microglia sense self-DNA from degenerating neurons following seizure, and secrete tumour necrosis factor-α, resulting in attenuation of aberrant neurogenesis. Furthermore, TLR9 deficiency exacerbated seizure-induced cognitive decline and recurrent seizure severity. Our findings thus suggest the existence of bidirectional communication between the innate immune and nervous systems for the maintenance of adult brain integrity.

  6. The diagnostic and therapeutic challenge of nonepileptic seizures: An interdisciplinary approach

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    Shirley Ferguson Rayport


    Full Text Available Nonepileptic seizures were recognized in antiquity, but their diagnosis continues to be challenging in the present day. The diagnosis of seizures as nonepileptic has been based on associated physical conditions, social factors, laboratory findings, or psychological test findings. Pitfalls remain in the use of electroencephalography. We present several case studies of representative etiologies that demonstrate the value and the need for an interdisciplinary approach focusing on the individual, in the present, in all current dimensions, with careful consideration of seizure phenomena, physical explanations for symptoms, and psychodynamic profile in order to make the diagnosis and formulate successful treatment. This interdisciplinary approach provides a more comprehensive understanding of nonepileptic seizures and, more often, leads to successful outcome.

  7. Dietary and medication adjustments to improve seizure control in patients treated with the ketogenic diet (United States)

    Selter, Jessica H.; Turner, Zahava; Doerrer, Sarah C.; Kossoff, Eric H.


    Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007-2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments lead to >50% further seizure reduction in-18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs. 15%, p = 0.08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit). PMID:24859788

  8. Role of Intravenous Levetiracetam in Seizure Prophylaxis of Severe Traumatic Brain Injury Patients

    Directory of Open Access Journals (Sweden)



    Full Text Available Traumatic brain injury (TBI can cause seizures and the development of epilepsy. The incidence of seizures varies from 21% in patients with severe brain injuries to 50% in patients with war-related penetrating TBI. In the acute and sub-acute periods following injury, seizures can lead to increased intracranial pressure and cerebral edema, further complicating TBI management. Anticonvulsants should be used for seizure prophylaxis and treatment. Phenytoin is the most widely prescribed anticonvulsant in these patients. Intravenous levetiracetam, made available in 2006, is now being considered as an alternative to phenytoin in acute care settings. When compared with phenytoin, levetiracetam has fewer side-effects and drug-drug interactions. In the following, the role of levetiracetam in TBI care and the supporting evidence is discussed.

  9. Baccoside A suppresses epileptic-like seizure/convulsion in Caenorhabditis elegans. (United States)

    Pandey, Rakesh; Gupta, Shipra; Tandon, Sudeep; Wolkenhauer, Olaf; Vera, Julio; Gupta, Shailendra K


    The 1 mm long Caenorhabditis elegans is one of the prime research tools to study different human neurodegenerative diseases. We have considered the case in which increase in the surrounding temperature of this multicellular model leads to abnormal bursts of neuronal cells that can be linked to seizure or convulsion. The induction of such seizure/convulsion mechanism was done by gradually increasing the temperature with 1x buffer (100 mM NaCl, 50 mM MgCl(2)) in adult C. elegans. In the present experiment it is demonstrated that Baccoside A can significantly reduce the seizure/convulsion in C. elegans at higher temperatures (26-28+/-1 degrees C). Furthermore, in T-type Ca(2+) channel cca-1 mutant worms, no convulsion was recorded. Our experimental results suggest that plant molecules from Bacopa monnieri may be useful in suppressing the seizure/convulsion in worms.

  10. De novo psychogenic seizures after epilepsy surgery: case report

    Directory of Open Access Journals (Sweden)



    Full Text Available The occurrence of de novo psychogenic seizures after epilepsy surgery is rare, and is estimated in 1.8% to 3.6%. Seizures after epilepsy surgery should be carefully evaluated, and de novo psychogenic seizures should be considered especially when there is a change in the ictal semiology. We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. Once psychogenic seizures were diagnosed and psychiatric treatment was started, seizures stopped.

  11. Stress as a seizure precipitant: Identification, associated factors, and treatment options. (United States)

    McKee, Heather R; Privitera, Michael D


    Stress is a common and important seizure precipitant reported by epilepsy patients. Studies to date have used different methodologies to identify relationships between epilepsy and stress. Several studies have identified anxiety, depression, and childhood trauma as being more common in patients with epilepsy who report stress as a seizure precipitant compared to patients with epilepsy who did not identify stress as a seizure precipitant. In one survey study it was found that a majority of patients with stress-triggered seizures had used some type of stress reduction method on their own and, of those who tried this, an even larger majority felt that these methods improved their seizures. Additionally, small to moderate sized prospective trials, including randomized clinical trials, using general stress reduction methods have shown promise in improving outcomes in patients with epilepsy, but results on seizure frequency have been inconsistent. Based on these studies, we recommend that when clinicians encounter patients who report stress as a seizure precipitant, these patients should be screened for a treatable mood disorder. Furthermore, although seizure reduction with stress reduction methods has not been proven in a randomized controlled trial, other important endpoints like quality of life were improved. Therefore, recommending stress reduction methods to patients with epilepsy appears to be a reasonable low risk adjunctive to standard treatments. The current review highlights the need for future research to help further clarify biological mechanisms of the stress-seizure relationship and emphasizes the need for larger randomized controlled trials to help develop evidence based treatment recommendations for our epilepsy patients. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  12. A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures. (United States)

    Thakker, Arpita; Shanbag, Preeti


    The objective of this study is to compare the safety and efficacy of midazolam given intranasally with diazepam given intravenously in the treatment of acute childhood seizures. A randomized controlled study was conducted in a pediatric emergency department in a tertiary general hospital. Fifty children aged from 1 month to 12 years presenting with acute seizures of at least 10 min duration were enrolled during a 12 month period. Intranasal midazolam (0.2 mg/kg) and intravenous diazepam (0.3 mg/kg) were administered. The main outcome measures were interval between arrival at hospital and starting treatment and interval between arrival at hospital and cessation of seizures. Intranasal midazolam and intravenous diazepam were equally effective. Overall 18 of 27 seizures were controlled with midazolam and 15 of 23 with diazepam. The mean interval between arrival at hospital and starting treatment was significantly shorter in the midazolam group [3.37 min (SD 2.46)] as compared to the diazepam group [14.13 min (SD 3.39)]. The mean interval between cessation of seizures and arrival at hospital was significantly shorter in the midazolam group [6.67 min (SD 3.12)] as compared to the diazepam group [17.18 min (SD 5.09)]. The mean interval between control of seizures and administration of the drug was shorter in the diazepam group [2.67 min (SD 2.31)] as compared to the midazolam group [3.01 min (SD 2.79)]. No significant side effects were observed in either group. Seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam. Midazolam was as safe and effective as diazepam. The overall interval between arrival at hospital and cessation of seizures was shorter with intranasal midazolam than with intravenous diazepam. The intranasal route can be possibly used not only in medical centres, but with appropriate instruction by the parents of children with acute seizures at home.

  13. Complex partial seizures: cerebellar metabolism

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    Theodore, W.H.; Fishbein, D.; Deitz, M.; Baldwin, P.


    We used positron emission tomography (PET) with (/sup 18/F)2-deoxyglucose to study cerebellar glucose metabolism (LCMRglu) and the effect of phenytoin (PHT) in 42 patients with complex partial seizures (CPS), and 12 normal controls. Mean +/- SD patient LCMRglu was 6.9 +/- 1.8 mg glucose/100 g/min (left = right), significantly lower than control values of 8.5 +/- 1.8 (left, p less than 0.006), and 8.3 +/- 1.6 (right, p less than 0.02). Only four patients had cerebellar atrophy on CT/MRI; cerebellar LCMRglu in these was 5.5 +/- 1.5 (p = 0.054 vs. total patient sample). Patients with unilateral temporal hypometabolism or EEG foci did not have lateralized cerebellar hypometabolism. Patients receiving phenytoin (PHT) at the time of scan and patients with less than 5 years total PHT exposure had lower LCMRglu, but the differences were not significant. There were weak inverse correlations between PHT level and cerebellar LCMRglu in patients receiving PHT (r = -0.36; 0.05 less than p less than 0.1), as well as between length of illness and LCMRglu (r = -0.22; 0.05 less than p less than 0.1). Patients with complex partial seizures have cerebellar hypometabolism that is bilateral and due only in part to the effect of PHT.

  14. Seizure phenotypes, periodicity, and sleep-wake pattern of seizures in Kcna-1 null mice. (United States)

    Wright, Samantha; Wallace, Eli; Hwang, Youngdeok; Maganti, Rama


    This study was undertaken to describe seizure phenotypes, natural progression, sleep-wake patterns, as well as periodicity of seizures in Kcna-1 null mutant mice. These mice were implanted with epidural electroencephalography (EEG) and electromyography (EMG) electrodes, and simultaneous video-EEG recordings were obtained while animals were individually housed under either diurnal (LD) condition or constant darkness (DD) over ten days of recording. The video-EEG data were analyzed to identify electrographic and behavioral phenotypes and natural progression and to examine the periodicity of seizures. Sleep-wake patterns were analyzed to understand the distribution and onset of seizures across the sleep-wake cycle. Four electrographically and behaviorally distinct seizure types were observed. Regardless of lighting condition that animals were housed in, Kcna-1 null mice initially expressed only a few of the most severe seizure types that progressively increased in frequency and decreased in seizure severity. In addition, a circadian periodicity was noted, with seizures peaking in the first 12h of the Zeitgeber time (ZT) cycle, regardless of lighting conditions. Interestingly, seizure onset differed between lighting conditions where more seizures arose out of sleep in LD conditions, whereas under DD conditions, the majority occurred out of the wakeful state. We suggest that this model be used to understand the circadian pattern of seizures as well as the pathophysiological implications of sleep and circadian disturbances in limbic epilepsies. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Effect of Seizure Clustering on Epilepsy Outcome

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    J Gordon Millichap


    Full Text Available A prospective, long-term population-based study was performed to determine whether seizure clustering (3 or more afebrile seizures during a 24 hour period is associated with drug resistance and increased mortality in childhood-onset epilepsy, in a study at University of Turku, Finland, and the Epilepsy Research Group, Berlin, Germany.

  16. Febrile Seizures: clinical and genetic studies

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet)


    textabstractFebrile seizures are described as a temporary seizure disorder of childhood; the attacks occur by definition in association with fever and are usually accompanied by sudden tonic-clonic muscle contractions and reduced consciousness, usually lasting not longer than 5 to 10 minutes. Accord

  17. 43 CFR 3.16 - Seizure. (United States)


    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Seizure. 3.16 Section 3.16 Public Lands: Interior Office of the Secretary of the Interior PRESERVATION OF AMERICAN ANTIQUITIES § 3.16 Seizure. Any object of antiquity taken, or collection made, on lands owned or controlled by the United States, without...

  18. Febrile Seizures: clinical and genetic studies

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet)


    textabstractFebrile seizures are described as a temporary seizure disorder of childhood; the attacks occur by definition in association with fever and are usually accompanied by sudden tonic-clonic muscle contractions and reduced consciousness, usually lasting not longer than 5 to 10 minutes.

  19. Childhood Febrile Seizures: Overview and Implications (United States)

    Jones, Tonia; Jacobsen, Steven J.


    This article provides an overview of the latest knowledge and understanding of childhood febrile seizures. This review also discusses childhood febrile seizure occurrence, health services utilization and treatment costs. Parental reactions associated with its occurrence and how healthcare providers can assist parents with dealing effectively with this potentially frightening and anxiety-producing event are also discussed. PMID:17479160


    Directory of Open Access Journals (Sweden)

    Avadhesh Pratap Singh


    Full Text Available BACKGROUND Seizure is a paroxysmal alteration in neurologic function resulting from abnormal excessive neuronal electrical activity. Epilepsy is a chronic condition characterized by recurrent seizures unprovoked by an acute systemic or neurologic insult.1 An epileptic seizure is a clinical manifestation of abnormal, excessive neuronal activity arising in the grey matter of the cerebral cortex. MATERIALS AND METHODS Prospective studies of 100 patients with clinical impression of seizures were examined by 1.5 Tesla magnetic resonance imaging. RESULT A total of 100 patients satisfying the inclusion criteria were included in the study. The age range of patients was from neonate to elderly with male predominance, male 64 (64% and female 36 (36%. GTCS was the most common clinical diagnosis constituting (80% cases. The common abnormalities were cerebral infarction with gliosis (16%, infections – NCC (7% and tuberculoma (10%, cerebral atrophy (1%, developmental cortical malformations (2%, venous thrombosis (4%, low-grade glioma (9%, meningioma (3%. CONCLUSION MRI is the investigation of choice in patients with seizure disorder. The sensitivity of MRI in detecting abnormalities in patients with seizure disorder is in part associated to the underlying pathologies and by the MRI techniques and experience of the interpreting physician. Accurate diagnosis of the cause of seizure is crucial for finding an effective treatment. With its high spatial resolution, excellent inherent soft tissue contrast, multiplanar imaging capability and lack of ionizing radiation, MR imaging has emerged as a versatile tool in the evaluation of patients with seizure disorder.

  1. Transient inhibitory seizures mimicking crescendo TIAs. (United States)

    Lee, H; Lerner, A


    Somatic inhibitory seizures are thought to occur rarely. We describe a patient with somatic inhibitory seizures who initially presented with a clinical picture of crescendo transient ischemic attacks. He did not improve with anticoagulation, but the episodes ceased promptly after the administration of an anticonvulsant.

  2. Seizure prediction: any better than chance? (United States)

    Andrzejak, Ralph G; Chicharro, Daniel; Elger, Christian E; Mormann, Florian


    To test whether epileptic seizure prediction algorithms have true predictive power, their performance must be compared with the one expected under well-defined null hypotheses. For this purpose, analytical performance estimates and seizure predictor surrogates were introduced. We here extend the Monte Carlo framework of seizure predictor surrogates by introducing alarm times surrogates. We construct artificial seizure time sequences and artificial seizure predictors to be consistent or inconsistent with various null hypotheses to determine the frequency of null hypothesis rejections obtained from analytical performance estimates and alarm times surrogates under controlled conditions. Compared to analytical performance estimates, alarm times surrogates are more flexible with regard to the testable null hypotheses. Both approaches have similar, high statistical power to indicate true predictive power. For Poisson predictors that fulfill the null hypothesis of analytical performance estimates, the frequency of false positive null hypothesis rejections can exceed the significance level for long mean inter-alarm intervals, revealing an intrinsic bias of these analytical estimates. Alarm times surrogates offer important advantages over analytical performance estimates. The key question in the field of seizure prediction is whether seizures can in principle be predicted or whether algorithms which have been presumed to perform better than chance actually are unable to predict seizures and simply have not yet been tested against the appropriate null hypotheses. Alarm times surrogates can help to answer this question.

  3. Redefining outcome of first seizures by acute illness. (United States)

    Martin, Emily T; Kerin, Tara; Christakis, Dimitri A; Blume, Heidi K; Gospe, Sidney M; Vinje, Jan; Bowen, Michael D; Gentsch, Jon; Zerr, Danielle M


    Seizures are common in children, but the causes and recurrence risk for children with a nonfebrile first seizure remain poorly understood. In a prospective longitudinal study of children who presented with a first-time seizure, we investigated the viral etiology of associated infectious illnesses and sought to determine the risk of recurrent seizures stratified by fever and type of illness. Children (aged 6 months to 6 years) were enrolled at the time of evaluation for their first seizure and followed monthly for up to 5 years. Seizure and illness data were collected through parent interviews and medical-record reviews. Stool, serum, and cerebrospinal fluid collected within 48 hours of the first seizure were evaluated for viral gastrointestinal pathogens. Of the 117 children enrolled, 78 (67%) had febrile seizures, 34 (29%) had nonfebrile-illness seizures, and 5 (4%) had unprovoked seizures. Children with nonfebrile-illness seizures were more likely than those with febrile seizures to have acute gastroenteritis (47% and 28%, respectively; P = .05). No significant differences in seizure recurrence were found between children with or without a fever at first seizure. Children with acute gastroenteritis at first seizure, regardless of fever, had a lower risk of seizure recurrence compared with children with other acute illnesses (hazard ratio: 0.28; 95% confidence interval: 0.09-0.80). Our results confirm the role of gastrointestinal illness as a distinguishing feature in childhood seizures. Children with this distinct presentation have a low rate of seizure recurrence and few neurologic complications.

  4. The Role of Seizure-Related SEZ6 as a Susceptibility Gene in Febrile Seizures

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    John C. Mulley


    Full Text Available Sixty cases of febrile seizures from a Chinese cohort had previously been reported with a strong association between variants in the seizure-related (SEZ 6 gene and febrile seizures. They found a striking lack of genetic variation in their controls. We found genetic variation in SEZ6 at similar levels at the same DNA sequence positions in our 94 febrile seizure cases as in our 96 unaffected controls. Two of our febrile seizure cases carried rare variants predicted to have damaging consequences. Combined with some of the variants from the Chinese cohort, these data are compatible with a role for SEZ6 as a susceptibility gene for febrile seizures. However, the polygenic determinants underlying most cases of febrile seizures with complex inheritance remain to be determined.

  5. Do recurrent seizure-related head injuries affect seizures in people with epilepsy? (United States)

    Friedman, David E.; Chiang, Sharon; Tobias, Ronnie S.


    Seizure-related head injuries (SRHIs) are among the most commonly encountered injuries in people with epilepsy (PWE). Whether head injury has an effect on preexisting epilepsy is not known. The purpose of this study was to systematically assess for any possible effects of SRHIs on seizure frequency and seizure semiology over a 2-year period. We identified 204 patients who have been followed at the Baylor Comprehensive Epilepsy Center from 2008 to 2010. SRHI occurred in 18.1% of the cohort. Most injuries (91%) were classified as mild. Though seizure frequency varied following head injury, overall seizure frequency was not significantly impacted by presence or absence of SRHI over the 2-year study period. Changes in seizure semiology were not observed in those with SRHIs. Although mild SRHI is common among PWE, it does not appear to have an effect on seizure characteristics over a relatively short period. PMID:22227592

  6. Seizure activity occurring in two dogs after S-ketamine-induction. (United States)

    Adami, C; Spadavecchia, C; Casoni, D


    Two healthy dogs were anaesthetized to undergo elective orthopaedic procedures. After premedication with methadone and acepromazine, general anaesthesia was induced with midazolam and S-ketamine. Immediately after anaesthetic induction, seizures occurred in both dogs. In the first dog the syndrome was characterized by tonic and clonic motor activity, muscular hypertone, hypersalivation, urination, defecation and hyperthermia. In the second dog muscular twitches of the temporal and masseter regions were observed, followed by increased skeletal muscles tone, hypersalivation, spontaneous urination and increase in body temperature. Recoveries from anaesthesia were uneventful and no seizures were observed. Considering the temporal association between anaesthetic induction and occurrence of seizures, and the fact that other causative factors could not be identified, it is hypothesized that S-ketamine played a role in determining the convulsive phenomena observed in these patients. S-ketamine might carry the potential for inducing seizures in otherwise healthy dogs, despite the concomitant use of GABA-ergic drugs.

  7. Gelastic seizures involving the left parietal lobe. (United States)

    Machado, René Andrade; Astencio, Adriana Goicoechea


    Gelastic seizures have been described in various epilepsies arising from the temporal or frontal lobes, although the most commonly encountered form is related to the presence of a hypothalamic hamartoma. We describe a patient with gelastic seizures involving the left parietal lobe. Our patient, an 8-year-old girl, underwent interictal video/EEG monitoring and MRI. The seizures consisted of brief staring followed by smiling and laughing. Electroencephalography during the gelastic seizures showed rhythmic spikes and waves in the left parietal lobe. MRI revealed the characteristic features of focal cortical dysplasia. Our findings suggest that the left parietal lobe may actively participate in the particular epileptogenic network generating gelastic seizures. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Febrile seizures and risk of schizophrenia

    DEFF Research Database (Denmark)

    Vestergaard, Mogens; Pedersen, Carsten Bøcker; Christensen, Jakob


    BACKGROUND: Febrile seizure is a benign condition for most children, but experiments in animals and neuroimaging studies in humans suggest that some febrile seizures may damage the hippocampus, a brain area of possible importance in schizophrenia. METHODS: A population-based cohort of all children...... born in Denmark between January 1977 and December 1986 was followed until December 2001 by using data from nationwide registries. RESULTS: We followed 558,958 persons including 16,429 with a history of febrile seizures for 2.8 million person-years and identified 952 persons who were diagnosed...... with schizophrenia. A history of febrile seizures was associated with a 44% increased risk of schizophrenia [relative risk (RR)=1.44; 95% confidence interval (CI), 1.07-1.95] after adjusting for confounding factors. The association between febrile seizures and schizophrenia remained virtually unchanged when...

  9. Febrile seizures and risk of schizophrenia

    DEFF Research Database (Denmark)

    Vestergaard, Mogens; Pedersen, Carsten Bøcker; Christensen, Jakob


    with schizophrenia. A history of febrile seizures was associated with a 44% increased risk of schizophrenia [relative risk (RR)=1.44; 95% confidence interval (CI), 1.07-1.95] after adjusting for confounding factors. The association between febrile seizures and schizophrenia remained virtually unchanged when...... restricting the analyses to people with no history of epilepsy. A history of both febrile seizures and epilepsy was associated with a 204% increased risk of schizophrenia (RR=3.04; 95% CI, 1.36-6.79) as compared with people with no such history. CONCLUSIONS: We found a slightly increased risk of schizophrenia......BACKGROUND: Febrile seizure is a benign condition for most children, but experiments in animals and neuroimaging studies in humans suggest that some febrile seizures may damage the hippocampus, a brain area of possible importance in schizophrenia. METHODS: A population-based cohort of all children...

  10. Inclusive photoproduction of D{sup *{+-}} mesons at next-to-leading order in the general-mass variable-flavor-number scheme

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    Kniehl, B.A.; Kramer, G. [Hamburg Univ. (Germany). 2. Inst. fuer Theoretische Physik; Schienbein, I. [Univ. Joseph Fourier/CNRS-IN2P3, INPG, Grenoble (France). Lab. de Physique Subatomique et de Cosmologie; Spiesberger, H. [Mainz Univ. (Germany). Inst. fuer Physik


    We discuss the inclusive production of D{sup *{+-}} mesons in {gamma}p collisions at DESY HERA, based on a calculation at next-to-leading order in the general-mass variable-flavor-number scheme. In this approach, MS subtraction is applied in such a way that large logarithmic corrections are resummed in universal parton distribution and fragmentation functions and finite mass terms are taken into account. We present detailed numerical results for a comparison with data obtained at HERA and discuss various sources of theoretical uncertainties. (orig.)

  11. Folinic acid-responsive neonatal seizures. (United States)

    Torres, O A; Miller, V S; Buist, N M; Hyland, K


    We report three cases of folinic acid-responsive intractable neonatal seizures. All patients were born at term following normal gestation and delivery. In the first infant, seizures began on the 5th day of life and were unresponsive to phenobarbital, pyridoxine, and valproate, but stopped within 24 hours of initiation of folinic acid treatment at the age of 6 months. Her sibling had died at age 6 months with intractable seizures. In the second infant, seizures began in the 2nd hour of life. These were initially controlled with phenobarbital; however, at 3 months of age she developed status epilepticus refractory to anticonvulsants, steroids, and pyridoxine and she required repeated induction of pentobarbital coma. Seizures stopped within 24 hours of starting folinic acid. Seizures and encephalopathy were noted in the third infant on the 2nd day of life. These were controlled with phenobarbital, but at 8 weeks of age seizures recurred and were difficult to control despite the addition of phenytoin. Immediately after folinic acid was initiated the seizures stopped. Breakthrough seizures in all patients have responded to increases in folinic acid; two of the three remain on standard anticonvulsants. All patients have global developmental delay. Cranial magnetic resonance imaging in the second patient shows diffuse atrophy, and in the third patient shows increased signal on T2 images in the white matter of the frontal and parietal lobes. Analysis of cerebrospinal fluid from these patients using high-performance liquid chromatography with electrochemical detection has consistently revealed an as-yet unidentified compound, which can be used as a marker for this condition. We suggest that cerebrospinal fluid be analyzed for the presence of this compound and a trial of folinic acid be considered in neonates with unexplained early onset intractable seizures.

  12. [Postoperative seizure in an epileptic patient with dentatorubral pallidoluysian atrophy]. (United States)

    Yanagidate, Fumi; Dohi, Shuji; Hamaya, Yoshihiro; Ueda, Norio


    A 28-year-old male with dentatorubral pallidoluysian atrophy (DRPLA) was scheduled for evulsion of bone marrow nail after tibia fracture. He was diagnosed as having DRPLA at the age of 12. Although he was receiving anticonvulsants, regular seizures had occurred occasionally and his symptoms were exacerbating. General anesthesia was induced and maintained with intravenous propofol supplemented with fentanyl, nitrous oxide, and oxygen. The operation was performed uneventfully. After the surgery, his breathing was depressed and naloxone was administered to reverse the depression. Thereafter, generalized tonic seizure associated with involuntary movement of the left arm occurred. These symptoms ceased soon after rapid injection of diazepam. Inhaled and intravenous anesthetics have been alleged to have both proconvulsant and anticonvulsant activities in humans. In the present patient with DRPLA, propofol, fentanyl, nitrous oxide, naloxone, and neostigmine administered might be factors, which could have lowered the threshold for seizure activity. Further, patients with DRPLA might have decreased GABA in the basal ganglia, and anesthetics would affect GABA receptors. Thus we should be aware of occurrence of convulsion in DRPLA patients during and after anesthesia.

  13. Effect of chronic electrical stimulation of the centromedian thalamic nuclei on various intractable seizure patterns: I. Clinical seizures and paroxysmal EEG activity. (United States)

    Velasco, F; Velasco, M; Velasco, A L; Jiménez, F


    Twenty-three patients with various intractable seizure patterns were divided into four groups based on their most frequent seizure type and their clinical and EEG response to chronic electrical stimulation of the centromedian thalamic nuclei (ESCM): group A, generalized tonic-clonic (GTC, n = 9); group B, partial motor (Rasmussen type) (n = 3); group C, complex partial seizures (CPS, n = 5); and group D, generalized tonic seizures (Lennox-Gastaut type) (n = 6). CM were radiologically and electrophysiologically localized by means of stereotaxic landmarks and by thalamically induced scalp recruiting-like responses and desynchronization. ESCM consisted of daily 2-h stimulation sessions for 3 months. Each stimulus consisted of a 1-min train of square pulses with a 4-min interstimulus interval, alternating right and left CM. Each pulse was 1.0 ms in duration at 60/s frequency and 8-15 V (400-1,250 microA) amplitude. Voltage (V), current flow (microA) and impedance (k omega) at the electrode tips were kept constant. A significant decrease in the number of seizures per month and paroxysmal EEG waves per 10-s spochs occurred in group A patients between the baseline period (BL) and the ESCM period. These changes persisted for > 3 months after discontinuation of ESCM (poststimulation period, Post). Post was accompanied by a significant decrease in the number of paroxysmal EEG discharges. A substantial decrease in seizures and paroxysmal discharges was also observed in patients of group B. In contrast, patients of groups C and D showed no significant changes from BL to ESCM and Post periods, except for a significant decrease in the number of seizures in group D patients from BL to Post periods.

  14. The effective connectivity of the seizure onset zone and ictal perfusion changes in amygdala kindled rhesus monkeys. (United States)

    Cleeren, Evy; Premereur, Elsie; Casteels, Cindy; Goffin, Karolien; Janssen, Peter; Van Paesschen, Wim


    Epileptic seizures are network-level phenomena. Hence, epilepsy may be regarded as a circuit-level disorder that cannot be understood outside this context. Better insight into the effective connectivity of the seizure onset zone and the manner in which seizure activity spreads could lead to specifically-tailored therapies for epilepsy. We applied the electrical amygdala kindling model in two rhesus monkeys until these animals displayed consistent stage IV seizures. At this stage, we investigated the effective connectivity of the amygdala by means of electrical microstimulation during fMRI (EM-fMRI). In addition, we imaged changes in perfusion during a seizure using ictal SPECT perfusion imaging. The spatial overlap between the connectivity network and the ictal perfusion network was assessed both at the regional level, by calculating Dice coefficients using anatomically defined regions of interest, and at the voxel level. The kindled amygdala was extensively connected to bilateral cortical and subcortical structures, which in many cases were connected multisynaptically to the amygdala. At the regional level, the spatial extents of many of these fMRI activations and deactivations corresponded to the respective increases and decreases in perfusion imaged during a stage IV seizure. At the voxel level, however, some regions showed residual seizure-specific activity (not overlapping with the EM-fMRI activations) or fMRI-specific activation (not overlapping with the ictal SPECT activations), indicating that frequently, only a part of a region anatomically connected to the seizure onset zone participated in seizure propagation. Thus, EM-fMRI in the amygdala of electrically-kindled monkeys reveals widespread areas that are often connected multisynaptically to the seizure focus. Seizure activity appears to spread, to a large extent, via these connected areas.

  15. Predictors of anti-convulsant treatment failure in children presenting with malaria and prolonged seizures in Kampala, Uganda

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    Byarugaba Justus


    Full Text Available Abstract Background In endemic areas, falciparum malaria remains the leading cause of seizures in children presenting to emergency departments. In addition, seizures in malaria have been shown to increase morbidity and mortality in these patients. The management of seizures in malaria is sometimes complicated by the refractory nature of these seizures to readily available anti-convulsants. The objective of this study was to determine predictors of anti-convulsant treatment failure and seizure recurrence after initial control among children with malaria. Methods In a previous study, the efficacy and safety of buccal midazolam was compared to that of rectal diazepam in the treatment of prolonged seizures in children aged three months to 12 years in Kampala, Uganda. For this study, predictive models were used to determine risk factors for anti-convulsant treatment failure and seizure recurrence among the 221 of these children with malaria. Results Using predictive models, focal seizures (OR 3.21; 95% CI 1.42–7.25, p = 0.005, cerebral malaria (OR 2.43; 95% CI 1.20–4.91, p = 0.01 and a blood sugar ≥200 mg/dl at presentation (OR 2.84; 95% CI 1.11–7.20, p = 0.02 were independent predictors of treatment failure (seizure persistence beyond 10 minutes or recurrence within one hour of treatment. Predictors of seizure recurrence included: 1 cerebral malaria (HR 3.32; 95% CI 1.94–5.66, p Conclusion Specific predictors, including cerebral malaria, can identify patients with malaria at risk of anti-convulsant treatment failure and seizure recurrence.

  16. A Case of Fahr Syndrome Presenting with Seizures

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    Mustafa Calik


    Full Text Available Fahr syndrome is characterized with calcification in basal ganglia, dentate nucleus of cerebellum and centrum semiovale. Frequent clinical findings include Parkinsonism, dystonia, tremor, chorea, ataxia, dementia, and mood disorders. 13 years old male was admitted with generalized tonic-clonic seizures in our clinic. His neurological examination was normal. No abnormalities were determined in biochemical and hormonal examinations. Cranial computed tomography and magnetic resonance imaging demonstrated alterations in signal intensity suggestive of extensive calcifications in basal ganglia, thalami, periventricular white matter and centrum semiovale. Although, extra pyramidal system findings are the most common signs in Fahr syndrome, we aimed to point out that some of the patients might also present with epileptic seizures.

  17. Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); G. Derksen-Lubsen (Gerarda); E.W. Steyerberg (Ewout); J.D.F. Habbema (Dik); H.A. Moll (Henriëtte)


    textabstractOBJECTIVES: Febrile seizures recur frequently. Factors increasing the risk of febrile seizure recurrence include young age at onset, family history of febrile seizures, previous recurrent febrile seizures, time lapse since previous seizure <6 months,

  18. Febrile seizures in children with familial Mediterranean fever: Coincidence or association? (United States)

    Çomak, Elif; Tüfekçi, Özlem; Kılıçbay, Fatih; Isıyel, Emel; Sever, Ali Haydar; Aslanger, Ayça; Ekici, Barış


    Familial Mediterranean fever (FMF) is an inherited disease characterized by recurrent bouts of fever and polyserositis and caused by MEditerranean FeVer gene (MEFV) mutations. Given the febrile characteristics of the disease one would expect higher frequency of febrile seizure in this group of pediatric patients. To evaluate the frequency of febrile seizure and related factors in patients with FMF. The children with the diagnosis of FMF were enrolled in the study. Information including clinical features, type of mutation and the history of febrile seizure were all noted. A total of 97 patients, 43 (44.3%) girls with a median age of 7.93 ± 4.05 years (2-16) and a median follow-up period of 20.65 ± 24.33 months (6-135) were included in the study. The frequency of febrile seizure in children with FMF was found as 13.4%, which is higher than the general population [p = 0.04, OR: 2.9 (95% CI: 1.0-8.5)]. The allele frequency of exon 2 mutations in MEFV genes was higher in the patients with febrile seizure (p = 0.03). Frequency of FMF related clinical findings (fever, abdominal pain, arthralgia/myalgia, arthritis, chest pain and erysipelas-like erythema) was similar between the two groups. However, frequency of headache was higher in the patients with febrile seizure (p = 0.014). The frequency of febrile seizure in children with FMF was found to be higher than the general population. Although this finding may be related to high fever during FMF attacks in individuals with genetic propensity of febrile seizure, it may also be a neurologic complication of FMF. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  19. Classification of clinical semiology in epileptic seizures in neonates. (United States)

    Nagarajan, Lakshmi; Palumbo, Linda; Ghosh, Soumya


    The clinical semiology of 61 neonatal seizures with EEG correlates, in 24 babies was analysed. Most seizures (89%) had multiple features during the EEG discharge. The seizures were classified using the prominent clinical feature at onset, and all features seen during the seizure, using an extended classification scheme. Orolingual features occurred most frequently at onset (30%), whereas ocular phenomena occurred most often during the seizure (70%). Orolingual, ocular and autonomic features were seen at onset in 55% of the seizures. Seizure onsets with clonic, tonic and hypomotor features were seen in 20%, 8% and 18% respectively. Clinico-electrical correlations were as follows. The EEG discharge involved both hemispheres in 54% of all seizures, in clonic seizures this was 93%. Focal clonic seizures were associated with EEG seizure onset from the contralateral hemisphere. Majority of the clonic and hypomotor seizures had a left hemisphere ictal EEG onset. Orolingual seizures frequently started from the right hemisphere, whereas ocular and autonomic seizures arose from either hemisphere. There was no significant difference in mortality, morbidity, abnormal neuroimaging and EEG background abnormalities in babies with or without clonic seizures. This study provides insights into neuronal networks that underpin electroclinical seizures, by analysing and classifying the obvious initial clinical features and those during the seizure. Copyright © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  20. Long-term seizure outcome in patients with juvenile absence epilepsy; a retrospective study in a tertiary referral center. (United States)

    Danhofer, Pavlína; Brázdil, Milan; Ošlejšková, Hana; Kuba, Robert


    The study aim was to evaluate pharmacotherapy effects and long-term seizure outcomes in patients with juvenile absence epilepsy (JAE) during a five-year follow-up period. The secondary aim was to identify factors from patient history and determine their influence on seizure control. We retrospectively studied 46 patients with JAE in the period between 2006 and 2011. The age at seizure onset, onset seizure type, family history of epilepsy, status epilepticus in history, medication history, and the rate of seizure control were studied. There were 30 females (65.2%) and 16 males (34.8%) in the study. The mean age at seizure onset was 12.9±5.6 years (ranged from 3 to 28 years). In 30 patients (65.2%), seizure onset was with absences, in 15 patients (32.6%) with generalized tonic-clonic seizure (GTCS), and in 1 patient (2.2%) with absence status. In 43 patients (93.5%), GTCS occurred in the course of the disease. Family history for epilepsy was positive in 10 patients (21.7%). In the five-year follow-up period, seizure freedom (Group 1) was achieved in 7 patients (15.2%). In total, 22 patients (47.8%) were classified into the groups involving very poor seizure control and antiepileptic drug resistance (Groups 5 and 6). The mean number of antiepileptic drugs (AEDs) used in the course of the disease in appropriate therapeutic doses was 3.8±2.3 (1-10 AEDs). The study results show that almost half of JAE patients have poor seizure control with a high rate of pharmacoresistance. The outcome of JAE can be very uncertain. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  1. Thiol/disulfide homeostasis as a novel indicator of oxidative stress in children with simple febrile seizures. (United States)

    Elmas, Bahri; Erel, Özcan; Ersavaş, Dilek; Yürümez, Yusuf


    Simple febrile seizures are generally benign, but during the seizure, elevated levels of glutamate and high levels of oxygen use due to the high metabolic brain activity result in oxidative stress. However, the relationship between febrile seizures and oxidative stress remains unclear. In this study, we investigated thiol/disulfide homeostasis as a new oxidative stress parameter in patients with simple febrile seizures. This study was performed between February 2016 and May 2016 at the Pediatric Emergency Unit. The study population consisted of 40 patients with a diagnosis of simple febrile seizure and 30 control participants aged 8-59 months. Total thiol, native thiol and disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were used as thiol/disulfide homeostasis parameters and were quantified in patient and control groups. Furthermore, correlations with seizure duration were investigated. In the patient group, native and total thiol levels and native thiol/total thiol ratios were low, and disulfide levels, disulfide/native thiol, and disulfide/total thiol ratios were significantly higher than in the control group. Negative correlations were observed between seizure duration, total and native thiol levels, and native thiol/total thiol ratio, whereas positive correlations were observed between seizure duration and disulfide/native thiol and disulfide/total thiol ratio. The sensitivities of both disulfide/native thiol and disulfide/total thiol ratios were high for simple febrile seizures. Simple febrile seizures may cause impairment in favor of disulfide bonds in thiol/disulfide homeostasis. Overall, these changes may contribute to neuronal cell damage after simple febrile seizures.

  2. The Effect of Quercetin on Pro- and Anti-Inflammatory Cytokines in a Prenatally Stressed Rat Model of Febrile Seizures. (United States)

    Mkhize, Nombuso Valencia Pearl; Qulu, Lihle; Mabandla, Musa Vuyisile


    Febrile seizures are childhood convulsions resulting from an infection that leads to an inflammatory response and subsequent convulsions. Prenatal stress has been shown to heighten the progression and intensity of febrile seizures. Current medications are costly and have adverse effects associated with prolonged use. Quercetin flavonoid exhibits anti-inflammatory, anti-convulsant, and anti-stress effects. This study was aimed to investigate the therapeutic effect of quercetin in a prenatally stressed rat model of febrile seizures. We hypothesized that quercetin will alleviate the effects of prenatal stress in a febrile seizure rat model. On gestational day 13, Sprague-Dawley rat dams were subjected to restraint stress for 1 hour/d for 7 days. Febrile seizures were induced on postnatal day 14 on rat pups by intraperitoneally injecting lipopolysaccharide followed by kainic acid and quercetin on seizure onset. Hippocampal tissue was harvested to profile cytokine concentrations. Our results show that quercetin suppresses prenatal stress-induced pro-inflammatory marker (interleukin 1 beta) levels, subsequently attenuating febrile seizures. This shows that quercetin can be therapeutic for febrile seizures in prenatally stressed individuals.

  3. Comparison of impact on seizure frequency and epileptiform discharges of children with epilepsy from topiramate and phenobarbital. (United States)

    Wang, Y-Y; Wang, M-G; Yao, D; Huang, X-X; Zhang, T; Deng, X-Q


    To study the impact on seizure frequency and epileptiform discharges of children with epilepsy from topiramate (TPM) and phenobarbital (PB). Two hundred cases children with epilepsy from August 2010 to August 2013 in our hospital were sampled and randomly divided into two groups. The observation group was treated with TPM while the control group with PB, and then comparing seizure frequency, efficiency, and adverse reactions of two groups. The reduced number of partial seizures, generalized seizures, and total seizures in the observation group were significantly higher than those in the control group, and the rate of cure, markedly effective and total efficiency in observation group were significantly higher than those in the control group. However, the adverse reactions in observation group were significantly lower than those in the control group. Thus, differences were statistically significant (p<0.05). Compared with PB, TPM showed a better effect on epilepsy treatment with less adverse reactions which were worthy of clinical recommendation.

  4. Nonepileptic Seizures: An Updated Review (United States)

    Perez, David L.; LaFrance, W. Curt


    Psychogenic nonepileptic seizures are a Functional Neurological Disorder/ Conversion Disorder subtype, which are neurobehavioral conditions at the interface of Neurology and Psychiatry. Significant advancements over the past decade have been made in the diagnosis, management and neurobiological understanding of PNES. This article reviews published PNES research focusing on semiologic features that distinguish PNES from epileptic seizures, consensus diagnostic criteria, the intersection of PNES and other comorbidities, neurobiological studies, evidence-based treatment interventions and outcome studies. Epidemiology and health care utilization studies highlight a continued unmet medical need in the comprehensive care of PNES. Consensus guidelines for diagnostic certainty are based on clinical history, semiology of witnessed typical event(s), and EEG findings. While certain semiologic features may aid the diagnosis of PNES, the gold standard remains capturing a typical event on video electroencephalography (EEG) showing the absence of epileptiform activity with history and semiology consistent with PNES. Medical-neurologic and psychiatric comorbidities are prevalent in PNES and should be assessed in diagnostic evaluations, and integrated into treatment interventions and prognostic considerations. Several studies, including a pilot multicenter, randomized clinical trial, have now demonstrated that a cognitive behavioral therapy informed psychotherapy is an efficacious treatment for PNES, and additional efforts are necessary to evaluate the utility of pharmacologic and other psychotherapy treatments. Neuroimaging studies, while requiring replication, suggest that PNES may occur in the context of alterations within and across sensorimotor, emotion regulation/processing, cognitive control and multimodal integration brain systems. Future research could investigate similarities and differences between PNES and other somatic symptom disorders. PMID:26996600

  5. Do oral contraceptives increase epileptic seizures? (United States)

    Reddy, Doodipala Samba


    Hormonal contraceptives are used by over 100 million people worldwide. Recently, there has been an emerging interest in studying the potential impact of oral contraceptives (OCs) on certain neurological conditions. It has been suspected for some time that hormonal birth control increases seizure activity in women with epilepsy, but there is little supportive data. Areas covered: Literature from PubMed and online sources was analyzed with respect to hormonal contraception and epilepsy or seizures. New evidence indicates that OCs can cause an increase in seizures in women with epilepsy. The epilepsy birth control registry, which surveyed women with epilepsy, found that those using hormonal contraceptives self-reported 4.5 times more seizures than those that did not use such contraceptives. A preclinical study confirmed these outcomes wherein epileptic animals given ethinyl estradiol, the primary component of OCs, had more frequent seizures that are more likely to be resistant. Expert commentary: OC pills may increase seizures in women with epilepsy and such refractory seizures are more likely to cause neuronal damage in the brain. Thus, women of child bearing age with epilepsy should consider using non-hormonal forms of birth control to avoid risks from OC pills. Additional research into the mechanisms and prospective clinical investigation are needed.

  6. Oxaliplatin-Induced Tonic-Clonic Seizures

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    Ahmad K. Rahal


    Full Text Available Oxaliplatin is a common chemotherapy drug used for colon and gastric cancers. Common side effects are peripheral neuropathy, hematological toxicity, and allergic reactions. A rare side effect is seizures which are usually associated with posterior reversible leukoencephalopathy syndrome (PRES. A 50-year-old male patient presented with severe abdominal pain. CT scan of the abdomen showed acute appendicitis. Appendectomy was done and pathology showed mixed adenoneuroendocrine carcinoma. Adjuvant chemotherapy was started with Folinic acid, Fluorouracil, and Oxaliplatin (FOLFOX. During the third cycle of FOLFOX, the patient developed tonic-clonic seizures. Laboratory workup was within normal limits. EEG and MRI of the brain showed no acute abnormality. The patient was rechallenged with FOLFOX but he had tonic-clonic seizures for the second time. His chemotherapy regimen was switched to Folinic acid, Fluorouracil, and Irinotecan (FOLFIRI. After 5 cycles of FOLFIRI, the patient did not develop any seizures, making Oxaliplatin the most likely culprit for his seizures. Oxaliplatin-induced seizures rarely occur in the absence of PRES. One case report has been described in the literature. We present a rare case of tonic-clonic seizures in a patient receiving Oxaliplatin in the absence of PRES.

  7. Glial activation precedes seizures and hippocampal neurodegeneration in measles virus-infected mice. (United States)

    Lehrmann, Elin; Guidetti, Paolo; Löve, Arthur; Williamson, John; Bertram, Edward H; Schwarcz, Robert


    Intracerebral injection of hamster neurotropic (HNT) measles virus in weanling Balb/C mice leads to an encephalitis, which is characterized by glial activation, behavioral seizures, selective neurodegeneration, and, after approximately 7 days, death. To provide a better understanding of the underlying molecular pathology, we studied seizure evolution by continuously monitoring electroencephalographic (EEG) activity, examined neuroglia and neurons histologically, and measured the brain content of glia-derived neuroactive metabolites of the kynurenine pathway of tryptophan degradation. Microglia and astrocytes were activated as early as postinoculation day (PID) 1, with reactive microglia lining the extent of the alveus. This was followed by a more extensive microglial activation that specifically outlined hippocampal pyramidal neurons in areas CA1-CA3 and by increases in the hippocampal levels of the neurotoxins 3-hydroxykynurenine (3-HK) and quinolinic acid (QUIN). These changes preceded the onset of EEG seizures, which had a mean onset of 108 h after inoculation. Prominent hippocampal cell loss, demonstrated by Nissl- and silver staining, was apparent by PID 5. Thus, we speculate that early glial reactions to HNT inoculation result in the excess formation of 3-HK and QUIN, which in turn causes subclinical seizure activity, behavioral seizures, and, eventually, neurodegeneration. In addition to its conceptual implications, our study indicates that timely interventions modulating glial activation or 3-HK/QUIN synthesis may be of benefit in preventing or arresting seizure-induced neuronal damage.

  8. Modeling absence seizure dynamics: implications for basic mechanisms and measurement of thalamocortical and corticothalamic latencies. (United States)

    Roberts, James A; Robinson, Peter A


    A successful physiologically based continuum model of the corticothalamic system is applied to determine the relative contributions of axonal and intrinsic cellular delays to the waveforms of absence seizures. The predicted period of the absence seizure depends linearly on model parameters describing thalamocortical, corticothalamic, intracortical, and synaptodendritic delays, and these dependences are linked to the seizure mechanism by showing how time intervals between peaks in the waveforms depend on the parameters. Counterintuitively, it is found that a peak in the local field potential recorded in the thalamic relay nuclei can precede the peak in the cortical field that drove it, without violating causality, but rendering naive interpretation of time intervals between peaks invalid. We argue that a thalamocortical loop mechanism for absence seizures is consistent with intrathalamic cellular properties being the leading determinant of the frequency of spike-wave discharges in rat genetic models, with the combination of network and cellular properties providing a natural explanation for the lower frequency of human absence seizures. Finally, our results imply that the seizure frequency is not determined by the fastest thalamocortical and corticothalamic fibers, but rather depends on an effective weighted conduction velocity of all pathways present.

  9. ATPergic signalling during seizures and epilepsy. (United States)

    Engel, Tobias; Alves, Mariana; Sheedy, Caroline; Henshall, David C


    Much progress has been made over the last few decades in the identification of new anti-epileptic drugs (AEDs). However, 30% of epilepsy patients suffer poor seizure control. This underscores the need to identify alternative druggable neurotransmitter systems and drugs with novel mechanisms of action. An emerging concept is that seizure generation involves a complex interplay between neurons and glial cells at the tripartite synapse and neuroinflammation has been proposed as one of the main drivers of epileptogenesis. The ATP-gated purinergic receptor family is expressed throughout the brain and is functional on neurons and glial cells. ATP is released in high amounts into the extracellular space after increased neuronal activity and during chronic inflammation and cell death to act as a neuro- and gliotransmitter. Emerging work shows pharmacological targeting of ATP-gated purinergic P2 receptors can potently modulate seizure generation, inflammatory processes and seizure-induced brain damage. To date, work showing the functional contribution of P2 receptors has been mainly performed in animal models of acute seizures, in particular, by targeting the ionotropic P2X7 receptor subtype. Other ionotropic P2X and metabotropic P2Y receptor family members have also been implicated in pathological processes following seizures such as the P2X4 receptor and the P2Y12 receptor. However, during epilepsy, the characterization of P2 receptors was mostly restricted to the study of expressional changes of the different receptor subtypes. This review summarizes the work to date on ATP-mediated signalling during seizures and the functional impact of targeting the ATP-gated purinergic receptors on seizures and seizure-induced pathology. This article is part of the Special Issue entitled 'Purines in Neurodegeneration and Neuroregeneration'.

  10. Instantaneous frequency based newborn EEG seizure characterisation (United States)

    Mesbah, Mostefa; O'Toole, John M.; Colditz, Paul B.; Boashash, Boualem


    The electroencephalogram (EEG), used to noninvasively monitor brain activity, remains the most reliable tool in the diagnosis of neonatal seizures. Due to their nonstationary and multi-component nature, newborn EEG seizures are better represented in the joint time-frequency domain than in either the time domain or the frequency domain. Characterising newborn EEG seizure nonstationarities helps to better understand their time-varying nature and, therefore, allow developing efficient signal processing methods for both modelling and seizure detection and classification. In this article, we used the instantaneous frequency (IF) extracted from a time-frequency distribution to characterise newborn EEG seizures. We fitted four frequency modulated (FM) models to the extracted IFs, namely a linear FM, a piecewise-linear FM, a sinusoidal FM, and a hyperbolic FM. Using a database of 30-s EEG seizure epochs acquired from 35 newborns, we were able to show that, depending on EEG channel, the sinusoidal and piecewise-linear FM models best fitted 80-98% of seizure epochs. To further characterise the EEG seizures, we calculated the mean frequency and frequency span of the extracted IFs. We showed that in the majority of the cases (>95%), the mean frequency resides in the 0.6-3 Hz band with a frequency span of 0.2-1 Hz. In terms of the frequency of occurrence of the four seizure models, the statistical analysis showed that there is no significant difference( p = 0.332) between the two hemispheres. The results also indicate that there is no significant differences between the two hemispheres in terms of the mean frequency ( p = 0.186) and the frequency span ( p = 0.302).

  11. Benign occipital lobe seizures: Natural progression and atypical evolution

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    Prithika Chary


    Full Text Available Benign occipital seizure syndromes are benign childhood epilepsy syndromes and are mainly of two types, Panayiotopoulos syndrome, an autonomic epilepsy and idiopathic childhood occipital epilepsy of Gastaut (ICOE-G including the idiopathic photosensitive occipital lobe epilepsy. Although both these types are categorized as occipital seizures, they are distinct in presentation and management. They can also be tricky to diagnose as visual symptoms may not always be the presenting feature and it is also not very easy to elicit visual hallucinations during history taking. These seizures have a good response to treatment; however, there could be atypical evolution and refractoriness to treatment especially with ICOE-G. We describe three children who presented with visual and non-visual symptoms and the electroencephalography (EEG in all the three cases showed occipital paroxysms. We have emphasized the clues in the clinical history and EEG leading to the diagnosis of these distinct epilepsy syndromes. We have also discussed the natural course of these epilepsy syndromes with some atypical evolution, which clinicians need to be aware of during treatment of these children.

  12. [Portable Epileptic Seizure Monitoring Intelligent System Based on Android System]. (United States)

    Liang, Zhenhu; Wu, Shufeng; Yang, Chunlin; Jiang, Zhenzhou; Yu, Tao; Lu, Chengbiao; Li, Xiaoli


    The clinical electroencephalogram (EEG) monitoring systems based on personal computer system can not meet the requirements of portability and home usage. The epilepsy patients have to be monitored in hospital for an extended period of time, which imposes a heavy burden on hospitals. In the present study, we designed a portable 16-lead networked monitoring system based on the Android smart phone. The system uses some technologies including the active electrode, the WiFi wireless transmission, the multi-scale permutation entropy (MPE) algorithm, the back-propagation (BP) neural network algorithm, etc. Moreover, the software of Android mobile application can realize the processing and analysis of EEG data, the display of EEG waveform and the alarm of epileptic seizure. The system has been tested on the mobile phones with Android 2. 3 operating system or higher version and the results showed that this software ran accurately and steadily in the detection of epileptic seizure. In conclusion, this paper provides a portable and reliable solution for epileptic seizure monitoring in clinical and home applications.

  13. The effects of classic ketogenic diet on serum lipid profile in children with refractory seizures. (United States)

    Zamani, Gholam Reza; Mohammadi, Mahmoud; Ashrafi, Mahmoud Reza; Karimi, Parviz; Mahmoudi, Maryam; Badv, Reza Shervin; Tavassoli, Ali Reza; Azizi Malamiri, Reza


    More than 25 % of children with epilepsy develop refractory seizures unresponsive to both old and new generation anticonvulsants. Since such seizures have a serious negative impact on the quality of life, other treatment options are considered. The ketogenic diet is a well-known treatment for managing refractory seizures, although its mechanism of action is unknown. Studies have shown that this diet is as good as, or better than, any of the newer medications in reducing seizure frequency. However, concerns about adverse effects have been raised. We conducted an open label trial to show the effects of this diet on serum lipid profile. Thirty-three children with refractory epilepsy were treated with the ketogenic diet and were followed for 6 months. Their serum lipid profile was assessed at baseline, and at 3 and 6 months after initiating the diet. Seizure frequency was reduced in 63 % of children (no seizures in 2/33 and reduced >50 % in 19/33). However, after 6 months of administering the diet, median triglyceride was significantly increased (from 84 to 180 mg/dl, P < 0.001), median total cholesterol was significantly increased (from 180 to 285 mg/dl, P < 0.001), median serum low-density lipoprotein (LDL) was significantly increased (from 91 to 175 mg/dl, P < 0.001), and median serum high-density lipoprotein (HDL) was significantly increased (from 51 to 58 mg/dl, P < 0.001). Results of this study indicate that a classic ketogenic diet in children with refractory seizures is effective in seizure reduction, but leads to development of hypercholesterolemia and hypertriglyceridemia.

  14. Huperzine A provides robust and sustained protection against induced seizures in Scn1a mutant mice

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    Jennifer C. Wong


    Full Text Available De novo loss-of-function mutations in the voltage-gated sodium channel (VGSC SCN1A (encoding Nav1.1 are the main cause of Dravet syndrome (DS, a catastrophic early-life encephalopathy associated with prolonged and recurrent early-life febrile seizures (FSs, refractory afebrile epilepsy, cognitive and behavioral deficits, and a 15-20% mortality rate. SCN1A mutations also lead to genetic epilepsy with febrile seizures plus (GEFS+, which is an inherited disorder characterized by early-life FSs and the development of a range of adult epilepsy subtypes. Current antiepileptic drugs often fail to protect against the severe seizures and behavioral and cognitive deficits found in patients with SCN1A mutations. To address the need for more efficacious treatments for SCN1A-derived epilepsies, we evaluated the therapeutic potential of Huperzine A, a naturally occurring reversible acetylcholinesterase inhibitor. In CF1 mice, Hup A (0.56 or 1 mg/kg was found to confer protection against 6 Hz-, pentylenetetrazole (PTZ-, and maximal electroshock (MES-induced seizures. Robust protection against 6 Hz-, MES-, and hyperthermia-induced seizures was also achieved following Hup A administration in mouse models of DS (Scn1a+/- and GEFS+ (Scn1aRH/+. Furthermore, Hup A-mediated seizure protection was sustained during 3 weeks of daily injections in Scn1aRH/+ mutants. Finally, we determined that the muscarinic and GABAA receptors play a role in Hup A-mediated seizure protection. These findings indicate that Hup A might provide a novel therapeutic strategy for increasing seizure resistance in DS and GEFS+, and more broadly, in other forms of refractory epilepsy.

  15. Benign epilepsy with centrotemporal spikes: Relationship between type of seizures and response to medication in a Greek population

    Directory of Open Access Journals (Sweden)

    Anastasia Gkampeta


    Full Text Available Purpose: Benign epilepsy with centrotemporal spikes (BECTS is considered to be the most common childhood epileptic syndrome. We studied the relationship between the type of seizures and response to medication in a Greek population. Materials and Methods: We studied 60 neurodevelopmentally normal children diagnosed with BECTS. Children were subdivided into three groups, based on type of seizures: Group A comprised 32 children with generalized tonic-clonic seizures, Group B 19 children with focal seizures and Group C 9 children with focal seizures with secondary generalization. All patients in the present study were started on an antiepileptic medication after the third seizure (sodium valproate, carbamazepine, and oxcarbazepine, and we studied the response to medication. Results: 10 from 13 (76.92% of patients in Group A, 13 from 15 (86.66% patients in Group B, and all 6 patients (100% in Group C started carbamazepine or oxcarbazepine had a favorable respond. Similarly, 16 from 19 (84.2% of patients in Group A, 3 from 4 patients (75% in Group B, and 1 from 3 patients (33.3% in Group C, started sodium valproate responded well to medication. Conclusions: The majority of children responded well to the first antiepileptic treatment and had a favorable outcome, regardless of type of seizures. 88.3% of children became seizure free by 1 or 2 years after seizure onset. These findings are indicative that the type of seizures has no major effect neither in response to antiepileptic treatment or in the final outcome. Further research in a larger number of children is needed.

  16. Are afebrile seizures associated with minor infections a single seizure category? A hospital-based prospective cohort study on outcomes of first afebrile seizure in early childhood. (United States)

    Zhang, Ting; Ma, Jiannan; Gan, Xiaoming; Xiao, Nong


    To explore if afebrile seizures associated with minor infections are a single category of seizure, or a set of different kinds of seizures. We conducted this prospective cohort study on three kinds of first afebrile seizure: first afebrile seizure associated with gastrointestinal infection (AS-GI), first afebrile seizure associated with nongastrointestinal infection (AS-nGI), and first unprovoked seizure (US). The Kaplan-Meier estimate risks of recurrent seizures were analyzed and compared pairwise. The characteristics of recurrent seizures were also compared pairwise. The Kaplan-Meier estimate risks of recurrent seizure at 2 years of the AS-GI, AS-nGI, and US groups were 6.9%, 23.7%, and 37.8%, respectively. The pairwise differences were significant between the AS-GI and US groups (p seizures in patients with recurrence, the pairwise differences were significant between the AS-GI and US groups (p seizures associated with minor infections are indeed of two distinguishable kinds: AS-GI, if free of risk factors such as a family history of epilepsy, had a better prognosis and should be categorized as an acute symptomatic seizure, whereas patients with first AS-nGI, like patients with first US, may have recurrent unprovoked seizures, which suggests this category's essential difference from AS-GI. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  17. On the nature of seizure dynamics (United States)

    Stacey, William C.; Quilichini, Pascale P.; Ivanov, Anton I.


    Seizures can occur spontaneously and in a recurrent manner, which defines epilepsy; or they can be induced in a normal brain under a variety of conditions in most neuronal networks and species from flies to humans. Such universality raises the possibility that invariant properties exist that characterize seizures under different physiological and pathological conditions. Here, we analysed seizure dynamics mathematically and established a taxonomy of seizures based on first principles. For the predominant seizure class we developed a generic model called Epileptor. As an experimental model system, we used ictal-like discharges induced in vitro in mouse hippocampi. We show that only five state variables linked by integral-differential equations are sufficient to describe the onset, time course and offset of ictal-like discharges as well as their recurrence. Two state variables are responsible for generating rapid discharges (fast time scale), two for spike and wave events (intermediate time scale) and one for the control of time course, including the alternation between ‘normal’ and ictal periods (slow time scale). We propose that normal and ictal activities coexist: a separatrix acts as a barrier (or seizure threshold) between these states. Seizure onset is reached upon the collision of normal brain trajectories with the separatrix. We show theoretically and experimentally how a system can be pushed toward seizure under a wide variety of conditions. Within our experimental model, the onset and offset of ictal-like discharges are well-defined mathematical events: a saddle-node and homoclinic bifurcation, respectively. These bifurcations necessitate a baseline shift at onset and a logarithmic scaling of interspike intervals at offset. These predictions were not only confirmed in our in vitro experiments, but also for focal seizures recorded in different syndromes, brain regions and species (humans and zebrafish). Finally, we identified several possible biophysical

  18. Ambroxol-induced focal epileptic seizure. (United States)

    Lapenta, Leonardo; Morano, Alessandra; Fattouch, Jinane; Casciato, Sara; Fanella, Martina; Giallonardo, Anna Teresa; Di Bonaventura, Carlo


    It is well known that in epileptic patients some compounds and different drugs used for the treatment of comorbidities can facilitate or provoke seizures, this evidence regarding a wide spectrum of pharmacological categories. The potential facilitating factors usually include direct toxic effects or pharmacological interactions of either active ingredients or excipients. We report the case of a patient with drug-resistant epilepsy who experienced focal epileptic seizures, easily and constantly reproducible, after each administration of a cough syrup. This is, to our knowledge, the first electroencephalogram-documented case of focal epileptic seizures induced by cough syrup containing ambroxol as active ingredient.

  19. On the nature of seizure dynamics. (United States)

    Jirsa, Viktor K; Stacey, William C; Quilichini, Pascale P; Ivanov, Anton I; Bernard, Christophe


    Seizures can occur spontaneously and in a recurrent manner, which defines