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Yılmaz Erol T, Cerrahoğlu Şirin T, Görkem Şirin N, Bebek N, Baykan B. Long-term prognosis of patients with photosensitive idiopathic generalized epilepsy. Seizure 2024; 117:235-243. [PMID: 38520962 DOI: 10.1016/j.seizure.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE The long-term prognosis of photosensitive idiopathic generalized epilepsy (p-IGE) is generally considered favorable; however, its specific characteristics remain unclear. Our objective was to investigate the extended prognosis of p-IGE. METHODS We analyzed the demographics, clinical, and electroencephalographic (EEG) data of consecutive patients who were diagnosed as having p-IGE, who were under follow-up for a minimum of 10 years and exhibited a photoparoxysmal response (PPR) in their EEGs. Prognostic data, epilepsy course types, and electroclinical variables were compared using appropriate statistical methods. RESULTS The mean follow-up duration for 108 consecutive patients with p-IGE (74.1 % female) was 16.8 ± 6.5 years. The main syndromes within this cohort included juvenile myoclonic epilepsy (37 %), juvenile absence epilepsy (15.7 %), and epilepsy with eyelid myoclonia (EEM) (14.8 %). In terms of epilepsy course types, 27.8 % were in the relapse-remission group, and 13.9 % had never experienced remission. A low early remission rate (5.6 %) was evident, with the remaining half of the cohort categorized as the late remission group. Several significant poor prognostic factors were identified including self-induction, clinical symptoms accompanying PPR, asynchrony and focal findings in EEG discharges, a wide frequency range of PPR, the coexistence of three seizure types, the presence of accompanying focal seizure features, and a history of convulsive status epilepticus. CONCLUSIONS Our long-term follow-up study, conducted within a substantial p-IGE group, unveiled newly proposed course types within this epilepsy category and highlighted significant poor prognostic factors related to photosensitivity. These findings furnish valuable insights for precise prognosis counselling and effective management strategies for patients with p-IGE.
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Affiliation(s)
- Tülay Yılmaz Erol
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Tuba Cerrahoğlu Şirin
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, SBU Sisli Hamidiye Etfal Education and Training Hospital, Istanbul, Turkey.
| | - Nermin Görkem Şirin
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Nerses Bebek
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, EMAR Medical Center, Istanbul, Turkey.
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Zawar I, Shreshtha B, Benech D, Burgess RC, Bulacio J, Knight EMP. Electrographic Features of Epilepsy With Eyelid Myoclonia With Photoparoxysmal Responses. J Clin Neurophysiol 2024; 41:83-92. [PMID: 35394968 DOI: 10.1097/wnp.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epilepsy with eyelid myoclonia (EMA) is characterized by eyelid myoclonia, eyelid closure sensitivity, and photosensitivity. EEG may manifest with frontal-predominant (FPEDs) or occipital-predominant epileptiform discharges (OPEDs). Data on clinical and electrographic features of these two subtypes are lacking. The purpose of our research was to look at baseline electroclinical features of EMA subtypes and to study electrographic findings of patients with EMA during intermittent photic stimulation (IPS). METHODS We retrospectively identified all patients who had photoparoxysmal responses on EEGs performed at Cleveland clinic between January 01, 2012, and December 31, 2019. Patients who met diagnostic criteria for EMA were studied further. RESULTS Of the 249 patients with photoparoxysmal responses, 70 (28.1%) had EMA (62 [88.6%] female; the mean age of epilepsy onset: 7.0 ± 7.9 years). Patients with EMA had either FPEDs or OPEDs. Eleven patients with EMA (15.7%) had seizures (4 absence, 5 myoclonic and 2 bilateral tonic-clonic) during IPS. Patients with OPEDs were more likely to have drug-resistant epilepsy; occipital focal IEDs and other focal IEDs (other than frontal/occipital) on baseline EEG; and generalized IEDs with occipital predominance, generalized IEDs with no predominance, or focal IEDs during IPS. Predictors of seizure occurrence during photic stimulation included the presence of focal occipital IEDs on baseline EEG, generalized IEDs with frontal predominance during IPS, and photoparoxysmal response outlasting the stimulus. CONCLUSIONS Our study provides evidence that EMA has two distinct subtypes, which differ in clinical characteristics, baseline EEG, and EEG during photic stimulation. We highlight diagnostic and prognostic implications of these findings. Our study also details EEG characteristics of patients with EMA during IPS.
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Affiliation(s)
- Ifrah Zawar
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
- Department of Neurology, University of Virginia School of Medicine, Virginia, U.S.A
| | - Bijina Shreshtha
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Daniela Benech
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Elia M Pestana Knight
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
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Zhang B, Chen T, Hao X, Xin M, Liang J. Electroclinical characteristics of photosensitive epilepsy: A retrospective study of 31 Chinese children and literature review. Front Pediatr 2023; 11:994817. [PMID: 36969295 PMCID: PMC10034115 DOI: 10.3389/fped.2023.994817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/27/2023] [Indexed: 03/29/2023] Open
Abstract
Objective The objective of this study was to better understand the clinical features of photosensitive epilepsy (PSE) in Chinese children. Methods Thirty-one children with PSE were screened out of 398 children with epilepsy who were consecutively diagnosed by the video-electroencephalogram (VEEG) monitoring method and by using an intermittent photic stimulation (IPS) test. Their EEGs and clinical features were retrospectively analyzed, and their treatment outcomes were followed up. Results PSE accounted for 7.79% (31/398) of children with epilepsy during the observation period in our single epilepsy center. The male to female ratio of PSE was 1:3.43, and the average seizure onset age was 7.8 ± 3.28 years. The highest range of frequency sensitivity of the IPS test for the induction of EEG epileptic discharge or electroclinical seizures was within 10-20 Hz. Electroclinical seizures were induced in 41.94% (13/31) of PSE patients by using the IPS test, while EEG discharge without clinical seizures was induced in 58.06% (18/31) of PSE patients. Among all PSE patients, an IPS-positive reaction in the eye-closure state was induced in 83.87% of patients, and this rate was significantly higher than that in the eye-opened state (41.94%) or eye-closed state (35.48%). (Eye-closure IPS stimulation means: make the subjects close their eyes at the beginning of each stimulation, open their eyes at the end of the stimulation, and close their eyes again at the beginning of the next stimulation, and so on. While Eye-closed IPS stimulation means the stimulation is started after 5 s of eye closure, and the subjects are kept closed throughout the whole process.) The common and effective drugs used for single or combined therapy in PSE children were valproic acid and levetiracetam. Conclusion This study provides some useful information about electroclinical characteristics in a cohort of 31 PSE children. It may be beneficial for pediatric neurologists in terms of paying more attention to PSE and correctly dealing with it.
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Affiliation(s)
- Bo Zhang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Tianyu Chen
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Department of Pediatrics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xiaosheng Hao
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Meiying Xin
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Jianmin Liang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
- Correspondence: Jianmin Liang
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Strzelecka J, Mazurkiewicz DW, Skadorwa T, Gąsior JS, Jóźwiak S. Photo-Dependent Reflex Seizures—A Scoping Review with Proposal of Classification. J Clin Med 2022; 11:jcm11133766. [PMID: 35807051 PMCID: PMC9267825 DOI: 10.3390/jcm11133766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
Children and adolescents are the largest at-risk group for the appearance of reflex seizures or epilepsy syndromes with a photoparoxysmal response. The aim of this study was to present an overview of the literature regarding photo-dependent reflex seizures. Epilepsy with seizures provoked by intermittent light stimulation is a distinct group of epilepsies; therefore, we focused on reflex seizures provoked by different factors whose common feature is the patient’s response to intermittent photic stimulation. A qualitative search of PubMed/MEDLINE, Scopus, EBSCO, and Cochrane Library electronic databases for selected terms was carried out for scientific articles published up to May 2020 outlining the outcomes of control, observational, and case studies. This scoping review was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review of the qualitative evidence for the synthesis of photosensitive epilepsy allowed us to distinguish the following categories: light-induced seizures and light-deprived seizures. Differentiating between intermittent photic stimulation-related epilepsy syndromes and seizures is essential in order to determine the length of appropriate treatment. Photo-dependent reflex seizures make up the majority of this type of disorder among reflex seizures. Since there are many seizures provoking factors in the world around us, it is important to distinguish amongst them in order to be able to protect the patient exposed to this factor. It is recommended that the photostimulation procedure be performed during a routine electroencephalogram study.
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Affiliation(s)
- Jolanta Strzelecka
- Department of Pediatric Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence: ; Tel.: +48-605-598-644
| | | | - Tymon Skadorwa
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Jakub S. Gąsior
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Sergiusz Jóźwiak
- Department of Pediatric Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Fisher RS, Acharya JN, Baumer FM, French JA, Parisi P, Solodar JH, Szaflarski JP, Thio LL, Tolchin B, Wilkins AJ, Kasteleijn-Nolst Trenité D. Visually sensitive seizures: An updated review by the Epilepsy Foundation. Epilepsia 2022; 63:739-768. [PMID: 35132632 DOI: 10.1111/epi.17175] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/19/2022]
Abstract
Light flashes, patterns, or color changes can provoke seizures in up to 1 in 4000 persons. Prevalence may be higher because of selection bias. The Epilepsy Foundation reviewed light-induced seizures in 2005. Since then, images on social media, virtual reality, three-dimensional (3D) movies, and the Internet have proliferated. Hundreds of studies have explored the mechanisms and presentations of photosensitive seizures, justifying an updated review. This literature summary derives from a nonsystematic literature review via PubMed using the terms "photosensitive" and "epilepsy." The photoparoxysmal response (PPR) is an electroencephalography (EEG) phenomenon, and photosensitive seizures (PS) are seizures provoked by visual stimulation. Photosensitivity is more common in the young and in specific forms of generalized epilepsy. PS can coexist with spontaneous seizures. PS are hereditable and linked to recently identified genes. Brain imaging usually is normal, but special studies imaging white matter tracts demonstrate abnormal connectivity. Occipital cortex and connected regions are hyperexcitable in subjects with light-provoked seizures. Mechanisms remain unclear. Video games, social media clips, occasional movies, and natural stimuli can provoke PS. Virtual reality and 3D images so far appear benign unless they contain specific provocative content, for example, flashes. Images with flashes brighter than 20 candelas/m2 at 3-60 (particularly 15-20) Hz occupying at least 10 to 25% of the visual field are a risk, as are red color flashes or oscillating stripes. Equipment to assay for these characteristics is probably underutilized. Prevention of seizures includes avoiding provocative stimuli, covering one eye, wearing dark glasses, sitting at least two meters from screens, reducing contrast, and taking certain antiseizure drugs. Measurement of PPR suppression in a photosensitivity model can screen putative antiseizure drugs. Some countries regulate media to reduce risk. Visually-induced seizures remain significant public health hazards so they warrant ongoing scientific and regulatory efforts and public education.
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Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jayant N Acharya
- Department of Neurology, Penn State Health, Hershey, Pennsylvania, USA
| | - Fiona Mitchell Baumer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline A French
- NYU Comprehensive Epilepsy Center, Epilepsy Foundation, New York, New York, USA
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Jessica H Solodar
- American Medical Writers Association-New England Chapter, Boston, Massachusetts, USA
| | - Jerzy P Szaflarski
- Department of Neurology, Neurobiology and Neurosurgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Liu Lin Thio
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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Abstract
Reflex seizures (RS) are epileptic events that are objectively and consistently elicited in response to a specific afferent stimulus or by an activity of the patient. The specific stimulus can be a variety of heterogenous intrinsic or extrinsic factors, ranging from the simple to the complex, such as flashing lights or reading a book. These seizures can take a variety of forms, comprising either general or focal onset, with or without secondary generalization. Reflex epilepsies (RE) are classified as a specific syndrome in which all epileptic seizures are precipitated by sensory stimuli. The few designated RE include idiopathic photosensitive occipital lobe epilepsy, other visual sensitive epilepsies, primary reading epilepsy, and startle epilepsy. RS that occurs within other focal or generalized epilepsy syndromes that are associated with distinct spontaneous seizures are classified by the overarching seizure type. Most patients experience spontaneous seizures along with their provoked events. RS originate from stimulation of functional anatomic networks normally functioning for physiological activities, that overlap or coincide with regions of cortical hyperexcitability. Generalized RS typically occur within the setting of IGEs and should be considered as focal seizures with quick secondary generalization via cortico-cortical or cortico-reticular pathways. In aggregate, activation of a critical neuronal mass, supported and sustained by cortico-subcortical and thalamocortical pathways eventually result in a seizure. Treatment includes antiseizure medication, commonly valproate or levetiracetam, along with lifestyle modifications, and when amenable, surgical intervention. High clinical suspicion and careful history taking must be employed in all epilepsy patients to identify reflex triggers.
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Affiliation(s)
- Samrina Hanif
- 1Department of Neurology, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| | - Shane T Musick
- 2Department of Neurosurgery, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
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Lo Barco T, Kaminska A, Solazzi R, Cancés C, Barcia G, Chemaly N, Fontana E, Desguerre I, Canafoglia L, Hachon Le Camus C, Losito E, Villard L, Eisermann M, Dalla Bernardina B, Villeneuve N, Nabbout R. SYNGAP1-DEE: A visual sensitive epilepsy. Clin Neurophysiol 2021; 132:841-850. [PMID: 33639450 DOI: 10.1016/j.clinph.2021.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/05/2021] [Accepted: 01/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To further delineate the electroclinical features of individuals with SYNGAP1 pathogenic variants. METHODS Participants with pathogenic SYNGAP1 variants and available video-electroencephalogram (EEG) recordings were recruited within five European epilepsy reference centers. We obtained molecular and clinical data, analyzed EEG recordings and archived video-EEGs of seizures and detailed characteristics of interictal and ictal EEG patterns for every patient. RESULTS We recruited 15 previously unreported patients and analyzed 72 EEGs. Two distinct EEG patterns emerged, both triggered by eye closure. Pattern 1 (14/15 individuals) consisted of rhythmic posterior/diffuse delta waves appearing with eye-closure and persisting until eye opening (strongly suggestive of fixation-off sensitivity). Pattern 2 (9/15 individuals) consisted of diffuse polyspike-and-wave discharges triggered by eye closure (eye-closure sensitivity). Both patterns presented in 8/15. Including archived video-EEG clips of seizures from 9/15 patients, we analyzed 254 seizures. Of 224 seizures experienced while awake, 161 (72%) occurred at or following eye closure. In 119/161, pattern 1 preceded an atypical absence, myoclonic seizure or myoclonic absence; in 42/161, pattern 2 was associated with eyelid myoclonia, absences and myoclonic or atonic seizures. CONCLUSIONS Fixation-off and eye closure were the main triggers for seizures in this SYNGAP1 cohort. SIGNIFICANCE Combining these clinical and electroencephalographic features could help guide genetic diagnosis.
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Affiliation(s)
- Tommaso Lo Barco
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France; Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy.
| | - Anna Kaminska
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, AP-HP, Paris, France
| | - Roberta Solazzi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Claude Cancés
- Department of Pediatric Neurology, Toulouse Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Giulia Barcia
- Fédération de Génétique Médicale, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France; Department of Paediatric Neurology, Necker-Enfants Malades Hospital, University of Paris, AP-HP, Paris, France
| | - Elena Fontana
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy; Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Isabelle Desguerre
- Department of Paediatric Neurology, Necker-Enfants Malades Hospital, University of Paris, AP-HP, Paris, France
| | - Laura Canafoglia
- Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Caroline Hachon Le Camus
- Department of Pediatric Neurology, Toulouse Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Emma Losito
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France
| | - Laurent Villard
- Pediatric Neurology Department, Timone Children Hospital, Reference Center for Rare Epilepsies, APHM, Marseille, France
| | - Monika Eisermann
- Department of Clinical Neurophysiology, Necker-Enfants-Malades Hospital, AP-HP, Paris, France
| | | | - Nathalie Villeneuve
- Pediatric Neurology Department, Timone Children Hospital, Reference Center for Rare Epilepsies, APHM, Marseille, France
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris, France; Department of Paediatric Neurology, Necker-Enfants Malades Hospital, University of Paris, AP-HP, Paris, France.
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Bratt NJ, Hampton CW. Intermittent photic stimulation triggering a temporal lobe seizure in a patient with schizencephaly and pachygyria. Epilepsy Behav Rep 2021; 15:100395. [PMID: 33458644 PMCID: PMC7797505 DOI: 10.1016/j.ebr.2020.100395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022] Open
Abstract
Intermittent photic stimulation can produce focal onset epileptic seizures, including temporal seizures. Schizencephaly can be the lesional source of a photosensitive focal onset epilepsy. Photosensitive temporal lobe epilepsies are rare but established in the scienfitic literature.
Photic stimulation is a common trigger for generalized epilepsies but may rarely incite focal seizures. Aside from documented cases of photosensitive occipital lobe epilepsies, few reported instances exist of focal epilepsies being triggered by intermittent photic stimulation. The case of a 12 year-old male with known schizencephaly, pachygyria, and right temporal lobe epilepsy triggered by photic stimulation is reported. To our knowledge, this is only the eighth reported case of photosensitive temporal lobe epilepsy.
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Affiliation(s)
| | - Cliff W Hampton
- University of Washington, Dept of Neurology, 700 Ironwood Dr. #158, Coeur d Alene, ID 83814, United States
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Meritam Larsen P, Wüstenhagen S, Terney D, Gardella E, Alving J, Aurlien H, Beniczky S. Photoparoxysmal response and its characteristics in a large EEG database using the SCORE system. Clin Neurophysiol 2021; 132:365-371. [PMID: 33450559 DOI: 10.1016/j.clinph.2020.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/20/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize photoparoxysmal EEG response (PPR) using a standardized protocol of intermittent photic stimulation (IPS) and standardized definitions for PPR, classified into six types. METHODS Using the SCORE system (Standardized Computer-Based Organized Reporting of EEG) we prospectively built a large database of standardized EEG annotations. In this study, we extracted the features related to PPR from the structured dataset consisting of 10,671 EEG recordings with IPS, from 7,188 patients. RESULTS The standardized IPS protocol elicited PPR in 375 recordings (3.5%), in 288 patients (4%), with a preponderance among young (11-20 years) and female patients (67%). PPR was persistent in patients with multiple recordings. The most frequent type of PPR was activation of preexisting epileptogenic area (58%), followed by generalized-PPR limited to the stimulus train (22%). We could not find any recording with self-sustained posterior response. Seizures were elicited in 27% of patients with PPR, most often myoclonic seizures and absences, in patients with self-sustained generalized PPR. CONCLUSIONS The most common type of PPR was accentuation of preexisting epileptogenic area. Self-sustained posterior response could not be documented. Self-sustained generalized-PPR had the highest association with seizures. SIGNIFICANCE Using standardized stimulation protocol and definitions for PPR types, IPS provides high diagnostic yield.
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Affiliation(s)
- Pirgit Meritam Larsen
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Stephan Wüstenhagen
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Daniella Terney
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Elena Gardella
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare); University of Southern Denmark, Denmark
| | - Jørgen Alving
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Harald Aurlien
- Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare); Department of Clinical Neurophysiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Dede HÖ, Bebek N, Emekli S, Baykan B, Yapıcı Z, Gökyiğit A. The clinical significance and electrophysiologic findings of fixation-off and closure of the eyes sensitivity: Data from a prospective unselected population. Epilepsy Res 2020; 170:106541. [PMID: 33387799 DOI: 10.1016/j.eplepsyres.2020.106541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/02/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Electroencephalography (EEG) findings related to the eye-closing motion can be defined in two ways: 'sensitivity to eyes closed' (SEC) and 'eye closure sensitivity (ECS).' Fixation-off sensitivity (FOS) is a different phenomenon induced by the elimination of central vision/fixation. The purpose of our study was to determine the frequencies of SEC, ESC, and FOS, and to analyze the relationship between eyes closure and the fixation-off phenomenon and clinical importance in an unselected population. METHODS We prospectively evaluated 200 routine interictal EEGs by adding a standardized FOS examination protocol between June and September 2015. Goggles covered with semitransparent tape were used to evaluate FOS. We determined SEC when the epileptiform discharges appeared during eye closure and continued during the eye closed state, whereas ECS was defined as transient epileptic abnormalities following the closure of the eyes lasting for 1-4 sec. The patients were evaluated in terms of demographic characteristics, clinical features, and the relationship between SEC, ECS, and FOS. RESULTS We detected SEC in 9 (4.4 %) and ECS in 11 (5.4 %) patients. FOS was detected in four (44.4 %) of the patients who showed SEC, all of whom had occipital epileptiform discharges. A statistically significant correlation was found between FOS and treatment resistance in the SEC group (p < 0.001). In logistic regression analysis, occipital lobe epilepsy (p < 0.001) and age under 20 years (p = 0.004) were found as risk factors for SEC. Another interesting finding was the suppression of epileptic discharges with fixation-off in three of 11 patients with ECS. CONCLUSIONS According to the results of our study, FOS is related to treatment resistance. Therefore, FOS should be evaluated in patients with SEC.
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Affiliation(s)
- Hava Özlem Dede
- Istanbul University Istanbul Faculty of Medicine, Neurology Department, Fatih, Millet street Istanbul, Turkey
| | - Nerses Bebek
- Istanbul University Istanbul Faculty of Medicine, Neurology Department, Fatih, Millet street Istanbul, Turkey.
| | - Serkan Emekli
- Istanbul University Istanbul Faculty of Medicine, Neurology Department, Fatih, Millet street Istanbul, Turkey
| | - Betül Baykan
- Istanbul University Istanbul Faculty of Medicine, Neurology Department, Fatih, Millet street Istanbul, Turkey
| | - Zuhal Yapıcı
- Istanbul University Istanbul Faculty of Medicine, Neurology Department, Fatih, Millet street Istanbul, Turkey
| | - Ayşen Gökyiğit
- Istanbul University Istanbul Faculty of Medicine, Neurology Department, Fatih, Millet street Istanbul, Turkey
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Kasteleijn-Nolst Trenite D. Classification of photoparoxysmal electroencephalographic response: Issue of self-sustaining response. Epilepsia 2020; 61:2857-2858. [PMID: 33137843 DOI: 10.1111/epi.16743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dorothee Kasteleijn-Nolst Trenite
- Department of Neurosurgery and Epilepsy, University Medical Center Utrecht, Utrecht, the Netherlands.,Nesmos Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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12
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Beniczky S, Aurlien H, Franceschetti S, Martins da Silva A, Bisulli F, Bentes C, Canafoglia L, Ferri L, Krýsl D, Rita Peralta A, Rácz A, Cross JH, Arzimanoglou A. Interrater agreement of classification of photoparoxysmal electroencephalographic response. Epilepsia 2020; 61:e124-e128. [PMID: 32949474 DOI: 10.1111/epi.16655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/03/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
Our goal was to assess the interrater agreement (IRA) of photoparoxysmal response (PPR) using the classification proposed by a task force of the International League Against Epilepsy (ILAE), and a simplified classification system proposed by our group. In addition, we evaluated IRA of epileptiform discharges (EDs) and the diagnostic significance of the electroencephalographic (EEG) abnormalities. We used EEG recordings from the European Reference Network (EpiCARE) and Standardized Computer-based Organized Reporting of EEG (SCORE). Six raters independently scored EEG recordings from 30 patients. We calculated the agreement coefficient (AC) for each feature. IRA of PPR using the classification proposed by the ILAE task force was only fair (AC = 0.38). This improved to a moderate agreement by using the simplified classification (AC = 0.56; P = .004). IRA of EDs was almost perfect (AC = 0.98), and IRA of scoring the diagnostic significance was moderate (AC = 0.51). Our results suggest that the simplified classification of the PPR is suitable for implementation in clinical practice.
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Affiliation(s)
- Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund and Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Harald Aurlien
- Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Silvana Franceschetti
- Neurophysiology Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Antonio Martins da Silva
- Neurophysiology Section, Department of Neurosciences, Hospital Santo António, CHU Porto and UMIB/ICBAS-University of Porto, Porto, Portugal
| | - Francesca Bisulli
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carla Bentes
- Neurology Department, Santa Maria Hospital-CHULN, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Laura Canafoglia
- Neurophysiology Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Lorenzo Ferri
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - David Krýsl
- Department of Clinical Neurophysiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ana Rita Peralta
- Neurology Department, Santa Maria Hospital-CHULN, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - J Helen Cross
- University College London Great Ormond Street National Institute for Health Research Biomedical Research Centre Institute of Child Health, Great Ormond Street Hospital for Children National Health Service Trust, London, UK
| | - Alexis Arzimanoglou
- Department of Pediatric Clinical Epileptology, Sleep Disorders, and Functional Neurology, University Hospitals of Lyon, Lyon, France.,Epilepsy Unit, San Juan de Dios Hospital, University of Barcelona, Barcelona, Spain
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13
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van Win OA, Barnes JG, Ferrier CF, Booth F, Prasad AN, Kasteleijn-Nolst Trenite DGA. A study of the significance of photoparoxysmal responses and spontaneous epileptiform discharges in the EEG in childhood epilepsy. Epilepsy Behav 2020; 107:107046. [PMID: 32304987 DOI: 10.1016/j.yebeh.2020.107046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 12/26/2022]
Abstract
AIM In clinical practice, there is a prevailing notion that photosensitivity mostly occurs in children with epilepsy (CWE) with idiopathic generalized epilepsy. We investigated the distribution of epilepsy types and etiology in photosensitive children and the associations with specific clinical and electroencephalogram (EEG) variables. METHODS In this retrospective cohort study, clinical data were acquired from all children that showed photosensitivity during systematic intermittent photic stimulation (IPS), over a 10-year interval at a tertiary level Children's Hospital, Winnipeg. Patient demographics, EEG findings, and clinical data and symptoms during IPS were abstracted. Classification of diagnoses using the International League Against Epilepsy (ILAE) 2017 guidelines was done by an expert panel. RESULTS Seventy-eight photosensitive children were identified. Forty (51.3%) had generalized epilepsy (idiopathic: 27, structural: 2, other: 11) compared with 19 (24.4%) focal (idiopathic: 1, structural: 2, other: 16), 8 (10.3%) combined focal and generalized (structural: 4, other: 4), and 11 (14.1%) unknown epilepsy (other: 11); (χ2 (3) = 32.1, p = .000). Self-sustaining or outlasting photoparoxysmal responses (PPRs) occurred in association with all epilepsy types; however, the EEGs of focal CWE without treatment comprised almost solely of PPRs which outlasted the stimulus (8/10), in contrast to only 8/17 of focal CWE with treatment and to 13/26 of generalized epilepsy without treatment. Most frequency intervals in individual patients were less under treatment: a decrease in standardized photosensitivity range (SPR) was seen in 5 CWE, an increase in 2, and no change in 1 during treatment. Both CWE with focal and generalized epilepsy showed abnormal activity on EEG during hyperventilation (40% vs 65.7%). Thirteen out of 14 CWE with clinical signs during IPS had independent spontaneous epileptiform discharges (SEDs) in the EEG recording. CONCLUSION Photosensitivity occurs in all types of epilepsy rather than in idiopathic generalized epilepsy alone. Surprisingly, there is a tendency for focal epilepsy to be associated with self-sustaining PPRs, especially when no treatment is used. Treatment tends to make the PPR more self-limiting and decrease the SPR. There is a tendency that clinical signs during IPS occur in EEGs in individuals with SEDs.
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Affiliation(s)
- Odile Alexandra van Win
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Jeffrey G Barnes
- Section of Neurology, Health Sciences Centre, St Boniface Hospital, 409 Tache Ave, Winnipeg, MB R2H 2A6, Canada
| | - Cyrille F Ferrier
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Fran Booth
- Section of Pediatric Neurology from Division of Pediatric Clinical Neurosciences, Children's Hospital, Health Sciences Centre, Winnipeg, Canada
| | - Asuri N Prasad
- Division of Pediatric Neurology and Clinical Neurosciences, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
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14
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Ferlazzo E, Trenite DKN, Haan GJD, Felix Nitschke F, Ahonen S, Gasparini S, Minassian BA. Update on Pharmacological Treatment of Progressive Myoclonus Epilepsies. Curr Pharm Des 2019; 23:5662-5666. [PMID: 28799509 DOI: 10.2174/1381612823666170809114654] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/03/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Progressive myoclonus epilepsies (PMEs) are a group of rare inherited diseases featuring a combination of myoclonus, seizures and variable degree of cognitive impairment. Despite extensive investigations, a large number of PMEs remain undiagnosed. In this review, we focus on the current pharmacological approach to PMEs. METHODS References were mainly identified through PubMed search until February 2017 and backtracking of references in pertinent studies. RESULTS The majority of available data on the efficacy of antiepileptic medications in PMEs are primarily anecdotal or observational, based on individual responses in small series. Valproic acid is the drug of choice, except for PMEs due to mitochondrial diseases. Levetiracetam and clonazepam should be considered as the first add-on treatment. Zonisamide and perampanel represent promising alternatives. Phenobarbital and primidone should be reserved to patients with resistant disabling myoclonus or seizures. Lamotrigine should be used with caution due to its unpredictable effect on myoclonus. Avoidance of drugs known to aggravate myoclonus and seizures, such as carbamazepine and phenytoin, is paramount. Psychiatric (in particular depression) and other comorbidities need to be adequately managed. Although a 3- to 4-drug regimen is often necessary to control seizures and myoclonus, particular care should be paid to avoid excessive pharmacological load and neurotoxic side effects. Target therapy is possible only for a minority of PMEs. CONCLUSIONS Overall, the treatment of PMEs remains symptomatic (i.e. pharmacological treatment of seizures and myoclonus). Further dissection of the genetic background of the different PMEs might hopefully help in the future with individualised treatment options.
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Affiliation(s)
- Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | - Gerrit-Jan de Haan
- Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede, Netherlands
| | - Felix Felix Nitschke
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Canada
| | - Saija Ahonen
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Canada
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Berge A Minassian
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics (Neurology), University of Texas Southwestern, Dallas Texas, USA
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15
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Tatum W, Rubboli G, Kaplan P, Mirsatari S, Radhakrishnan K, Gloss D, Caboclo L, Drislane F, Koutroumanidis M, Schomer D, Kasteleijn-Nolst Trenite D, Cook M, Beniczky S. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clin Neurophysiol 2018; 129:1056-1082. [DOI: 10.1016/j.clinph.2018.01.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 12/20/2022]
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16
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Karkare KD, Menon RN, Radhakrishnan A, Cherian A, Thomas SV. Electroclinical characteristics and syndromic associations of “eye-condition” related visual sensitive epilepsies—A cross-sectional study. Seizure 2018; 58:62-71. [DOI: 10.1016/j.seizure.2018.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 12/21/2022] Open
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17
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Genetic (idiopathic) epilepsy with photosensitive seizures includes features of both focal and generalized seizures. Sci Rep 2018; 8:6254. [PMID: 29674629 PMCID: PMC5908879 DOI: 10.1038/s41598-018-24644-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/05/2018] [Indexed: 12/01/2022] Open
Abstract
Clinically, some patients having genetic (idiopathic) epilepsy with photosensitive seizures were difficult to be diagnosed. We aimed to discuss whether the genetic (idiopathic) epilepsy with photosensitive seizures is a focal entity, a generalized entity or a continuum. Twenty-two patients with idiopathic epilepsies and photoconvulsive response (PCR) were retrospectively recruited. In the medical records, the seizure types included “generalized tonic-clonic seizures (GTCS)” in 15, “partial secondarily GTCS (PGTCS)” in 3, partial seizures (PS) in 3, myoclonic seizures in 2, eyelid myoclonus in one, and only febrile seizures in one. Seizure types of PCR included GTCS (1/22), PGTCS (6/22), PS (9/22), electrical seizures (ES) (3/22) and GTCS/PGTCS (3/22). Combined the medical history with PCR results, they were diagnosed as: idiopathic (photosensitive) occipital lobe epilepsy (I(P)OE) in 12, genetic (idiopathic) generalized epilepsy (GGE) in one, GGE/I(P)OE in 5, pure photosensitive seizure in one, and epilepsy with undetermined generalized or focal seizure in 3. So, the dichotomy between generalized and focal seizures might have been out of date regarding to pathophysiological advances in epileptology. To some extent, it would be better to recognize the idiopathic epilepsy with photosensitive seizures as a continuum between focal and generalized seizures.
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18
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Shih JJ, Fountain NB, Herman ST, Bagic A, Lado F, Arnold S, Zupanc ML, Riker E, Labiner DM. Indications and methodology for video‐electroencephalographic studies in the epilepsy monitoring unit. Epilepsia 2017; 59:27-36. [DOI: 10.1111/epi.13938] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Susan T. Herman
- Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Anto Bagic
- University of Pittsburgh Pittsburgh PA USA
| | | | - Susan Arnold
- University of Texas Southwestern Medical Center Dallas TX USA
| | - Mary L. Zupanc
- Children's Hospital of Orange County/University of California, Irvine Orange CA USA
| | - Ellen Riker
- National Association of Epilepsy Centers Washington DC USA
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19
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Beniczky S, Aurlien H, Brøgger JC, Hirsch LJ, Schomer DL, Trinka E, Pressler RM, Wennberg R, Visser GH, Eisermann M, Diehl B, Lesser RP, Kaplan PW, Nguyen The Tich S, Lee JW, Martins-da-Silva A, Stefan H, Neufeld M, Rubboli G, Fabricius M, Gardella E, Terney D, Meritam P, Eichele T, Asano E, Cox F, van Emde Boas W, Mameniskiene R, Marusic P, Zárubová J, Schmitt FC, Rosén I, Fuglsang-Frederiksen A, Ikeda A, MacDonald DB, Terada K, Ugawa Y, Zhou D, Herman ST. Standardized computer-based organized reporting of EEG: SCORE – Second version. Clin Neurophysiol 2017; 128:2334-2346. [DOI: 10.1016/j.clinph.2017.07.418] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
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20
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Seneviratne U, Cook MJ, D'Souza WJ. Electroencephalography in the Diagnosis of Genetic Generalized Epilepsy Syndromes. Front Neurol 2017; 8:499. [PMID: 28993753 PMCID: PMC5622315 DOI: 10.3389/fneur.2017.00499] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/07/2017] [Indexed: 01/05/2023] Open
Abstract
Genetic generalized epilepsy (GGE) consists of several syndromes diagnosed and classified on the basis of clinical features and electroencephalographic (EEG) abnormalities. The main EEG feature of GGE is bilateral, synchronous, symmetric, and generalized spike-wave complex. Other classic EEG abnormalities are polyspikes, epileptiform K-complexes and sleep spindles, polyspike-wave discharges, occipital intermittent rhythmic delta activity, eye-closure sensitivity, fixation-off sensitivity, and photoparoxysmal response. However, admixed with typical changes, atypical epileptiform discharges are also commonly seen in GGE. There are circadian variations of generalized epileptiform discharges. Sleep, sleep deprivation, hyperventilation, intermittent photic stimulation, eye closure, and fixation-off are often used as activation techniques to increase the diagnostic yield of EEG recordings. Reflex seizure-related EEG abnormalities can be elicited by the use of triggers such as cognitive tasks and pattern stimulation during the EEG recording in selected patients. Distinct electrographic abnormalities to help classification can be identified among different electroclinical syndromes.
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Affiliation(s)
- Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neuroscience, Monash Medical Centre, Melbourne, VIC, Australia
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Wendyl Jude D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
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21
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Kasteleijn- Nolst Trenite D, Genton P, Brandt C, Reed RC. The ‘Photosensitivity Model’ is ( also) a model for focal (partial) seizures. Epilepsy Res 2017; 133:113-120. [DOI: 10.1016/j.eplepsyres.2016.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/20/2016] [Accepted: 11/20/2016] [Indexed: 11/17/2022]
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22
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Vinogradova LV. Audiogenic kindling and secondary subcortico-cortical epileptogenesis: Behavioral correlates and electrographic features. Epilepsy Behav 2017; 71:142-153. [PMID: 26148984 DOI: 10.1016/j.yebeh.2015.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/05/2015] [Accepted: 06/06/2015] [Indexed: 01/14/2023]
Abstract
Human epilepsy is usually considered to result from cortical pathology, but animal studies show that the cortex may be secondarily involved in epileptogenesis, and cortical seizures may be triggered by extracortical mechanisms. In the audiogenic kindling model, recurrent subcortical (brainstem-driven) seizures induce secondary epileptic activation of the cortex. The present review focuses on behavioral and electrographic features of the subcortico-cortical epileptogenesis: (1) behavioral expressions of traditional and mild paradigms of audiogenic kindling produced by full-blown (generalized) and minimal (focal) audiogenic seizures, respectively; (2) electrographic manifestations of secondary epileptic activation of the cortex - cortical epileptic discharge and cortical spreading depression; and (3) persistent individual asymmetry of minimal audiogenic seizures and secondary cortical events produced by their repetition. The characteristics of audiogenic kindling suggest that this model represents a unique experimental approach to studying cortical epileptogenesis and network aspects of epilepsy. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
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Affiliation(s)
- Lyudmila V Vinogradova
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia.
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23
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Vaudano AE, Ruggieri A, Avanzini P, Gessaroli G, Cantalupo G, Coppola A, Sisodiya SM, Meletti S. Photosensitive epilepsy is associated with reduced inhibition of alpha rhythm generating networks. Brain 2017; 140:981-997. [PMID: 28334965 DOI: 10.1093/brain/awx009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/11/2016] [Indexed: 12/19/2022] Open
Abstract
See Hamandi (doi:10.1093/awx049) for a scientific commentary on this article.Photosensitivity is a condition in which lights induce epileptiform activities. This abnormal electroencephalographic response has been associated with hyperexcitability of the visuo-motor system. Here, we evaluate if intrinsic dysfunction of this network is present in brain activity at rest, independently of any stimulus and of any paroxysmal electroencephalographic activity. To address this issue, we investigated the haemodynamic correlates of the spontaneous alpha rhythm, which is considered the hallmark of the brain resting state, in photosensitive patients and in people without photosensitivity. Second, we evaluated the whole-brain functional connectivity of the visual thalamic nuclei in the various populations of subjects under investigation. Forty-four patients with epilepsy and 16 healthy control subjects underwent an electroencephalography-correlated functional magnetic resonance imaging study, during an eyes-closed condition. The following patient groups were included: (i) genetic generalized epilepsy with photosensitivity, 16 subjects (mean age 25 ± 10 years); (ii) genetic generalized epilepsy without photosensitivity, 13 patients (mean age 25 ± 11 years); (iii) focal epilepsy, 15 patients (mean age 25 ± 9 years). For each subject, the posterior alpha power variations were convolved with the standard haemodynamic response function and used as a regressor. Within- and between-groups second level analyses were performed. Whole brain functional connectivity was evaluated for two thalamic regions of interest, based on the haemodynamic findings, which included the posterior thalamus (pulvinar) and the medio-dorsal thalamic nuclei. Genetic generalized epilepsy with photosensitivity demonstrated significantly greater mean alpha-power with respect to controls and other epilepsy groups. In photosensitive epilepsy, alpha-related blood oxygen level-dependent signal changes demonstrated lower decreases relative to all other groups in the occipital, sensory-motor, anterior cingulate and supplementary motor cortices. Coherently, the same brain regions demonstrated abnormal connectivity with the visual thalamus only in epilepsy patients with photosensitivity. As predicted, our findings indicate that the cortical-subcortical network generating the alpha oscillation at rest is different in people with epilepsy and visual sensitivity. This difference consists of a decreased alpha-related inhibition of the visual cortex and sensory-motor networks at rest. These findings represent the substrate of the clinical manifestations (i.e. myoclonus) of the photoparoxysmal response. Moreover, our results provide the first evidence of the existence of a functional link between the circuits that trigger the visual sensitivity phenomenon and those that generate the posterior alpha rhythm.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, OCSE Hospital, Modena, Italy.,Neurology Unit, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, OCSE Hospital, Modena, Italy.,Neurology Unit, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Pietro Avanzini
- Department of Neuroscience, University of Parma, Consiglio nazionale delle Ricerche - CNR, Parma, Italy
| | - Giuliana Gessaroli
- Neurology Unit, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Gaetano Cantalupo
- Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Antonietta Coppola
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, LondonWC1N 3BG, UK.,Epilepsy Society, Chalfont-St-Peter, Bucks SL9 0RJ, UK
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, OCSE Hospital, Modena, Italy.,Neurology Unit, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy
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24
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"Selfie-epilepsy": A novel photosensitivity. Seizure 2017; 47:5-8. [PMID: 28273589 DOI: 10.1016/j.seizure.2017.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/23/2016] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Photosensitivity is a well-described phenomenon; affecting a relatively small proportion of individuals with epilepsy. Typically people with photosensitive epilepsies are at risk of seizures induced by shimmering natural light, strobe lights and with particular patterns or flicker frequencies on television and video games. METHODS & RESULTS We present a novel case of photosensitivity captured during video EEG monitoring showing reproducible photosensitivity with the ever-popular social phenomenon; the "selfie." The patient had previously demonstrated photosensitive myoclonus with intermittent photic stimulation on routine EEG. CONCLUSION This case suggests that taking "selfies" may represent a new area of caution for those with photosensitive epilepsies.
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25
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Verbeek N, Kasteleijn-Nolst Trenité D, Wassenaar M, van Campen J, Sonsma A, Gunning WB, de Weerd A, Knoers N, Spetgens W, Gutter T, Leijten F, Brilstra E. Photosensitivity in Dravet syndrome is under-recognized and related to prognosis. Clin Neurophysiol 2017; 128:323-330. [DOI: 10.1016/j.clinph.2016.11.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/27/2016] [Accepted: 11/24/2016] [Indexed: 11/25/2022]
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26
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The topographical distribution of epileptic spikes in juvenile myoclonic epilepsy with and without photosensitivity. Clin Neurophysiol 2017; 128:176-182. [DOI: 10.1016/j.clinph.2016.10.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/01/2016] [Accepted: 10/08/2016] [Indexed: 11/17/2022]
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27
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Reversible encephalopathy with photoparoxysmal response during imipenem/cilastatin treatment. J Neurol Sci 2016; 360:23-4. [DOI: 10.1016/j.jns.2015.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/06/2015] [Accepted: 11/19/2015] [Indexed: 11/21/2022]
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28
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Koepp MJ, Caciagli L, Pressler RM, Lehnertz K, Beniczky S. Reflex seizures, traits, and epilepsies: from physiology to pathology. Lancet Neurol 2015; 15:92-105. [PMID: 26627365 DOI: 10.1016/s1474-4422(15)00219-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
Abstract
Epileptic seizures are generally unpredictable and arise spontaneously. Patients often report non-specific triggers such as stress or sleep deprivation, but only rarely do seizures occur as a reflex event, in which they are objectively and consistently modulated, precipitated, or inhibited by external sensory stimuli or specific cognitive processes. The seizures triggered by such stimuli and processes in susceptible individuals can have different latencies. Once seizure-suppressing mechanisms fail and a critical mass (the so-called tipping point) of cortical activation is reached, reflex seizures stereotypically manifest with common motor features independent of the physiological network involved. The complexity of stimuli increases from simple sensory to complex cognitive-emotional with increasing age of onset. The topography of physiological networks involved follows the posterior-to-anterior trajectory of brain development, reflecting age-related changes in brain excitability. Reflex seizures and traits probably represent the extremes of a continuum, and understanding of their underlying mechanisms might help to elucidate the transition of normal physiological function to paroxysmal epileptic activity.
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Affiliation(s)
- Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK.
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK
| | - Ronit M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, London, UK; Clinical Neuroscience, UCL Institute of Child Health, London, UK
| | - Klaus Lehnertz
- Department of Epileptology, University Hospital of Bonn, Bonn, Germany
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark
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Suppa A, Rocchi L, Li Voti P, Papazachariadis O, Casciato S, Di Bonaventura C, Giallonardo A, Berardelli A. The Photoparoxysmal Response Reflects Abnormal Early Visuomotor Integration in the Human Motor Cortex. Brain Stimul 2015; 8:1151-61. [DOI: 10.1016/j.brs.2015.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 04/23/2015] [Accepted: 05/22/2015] [Indexed: 11/29/2022] Open
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Epileptic spasms and early-onset photosensitive epilepsy in Patau syndrome: An EEG study. Brain Dev 2015; 37:704-13. [PMID: 25459971 DOI: 10.1016/j.braindev.2014.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Patau syndrome, trisomy 13, is the third commonest autosomal trisomy. It is associated with a 25-50% prevalence of epilepsy, but detailed electroclinical descriptions are rare. The occurrence of early-onset photosensitivity has recently been reported in single patients. MATERIALS/PATIENTS We collected electroclinical data on 8 infants (age range from 2 months to 3 years and 9 months, median: 17 months) with Patau syndrome referred for an EEG in our Clinical Neurophysiology Department between 1991 and 2011. METHODS All EEGs, case-notes, cytogenetic diagnosis and neuroimaging when available were reviewed; data on the occurrence of seizures, epileptiform discharges, photoparoxysmal response and their characteristics in terms of positive frequencies, latencies, grade and duration were noted and analysed. RESULTS Two patients had been previously diagnosed with epilepsy (one with tonic spasms and one with multiple seizure types). We found 3 patients with photosensitive myoclonic epilepsy (37.5%), and one with non-photosensitive myoclonic epilepsy. We also recorded non-epileptic myoclonic jerks in one patient known to suffer from epileptic spasms. Among photosensitive patients we found self-limited, Waltz's grade 2-4, spike-wave/polyspike-wave discharges in low, medium and high frequency ranges in two patients and in the high frequency range in the third patient, with latencies and duration from less than 1s to a maximum of 9s. CONCLUSIONS In our cohort of Patau syndrome patients, we found a high prevalence of spasms and photic-induced myoclonic jerks. Photosensitivity shows an unusual early age of onset.
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Kasteleijn-Nolst Trenité D, Brandt C, Mayer T, Rosenow F, Schmidt B, Steinhoff BJ, Gardin A, Imbert G, Johns D, Sagkriotis A, Kucher K. Dose-dependent suppression of human photoparoxysmal response with the competitive AMPA/kainate receptor antagonist BGG492: Clear PK/PD relationship. Epilepsia 2015; 56:924-32. [DOI: 10.1111/epi.13008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Christian Brandt
- Department of General Epileptology; Bethel Epilepsy Centre; Bielefeld Germany
| | - Thomas Mayer
- Saxonian Epilepsy Center Radeberg; Radeberg Germany
| | - Felix Rosenow
- Department of Neurology; Epilepsy Center Hessen - Marburg; Philipps-University; Marburg Germany
- Epilepsy Center Franfurt Rhein-Main; Department of Neurology; Johann Wolfgang Goethe University; Frankfurt am Main Germany
| | | | | | - Anne Gardin
- Novartis Institutes for Biomedical Research; Basel Switzerland
| | - Georges Imbert
- Novartis Institutes for Biomedical Research; Basel Switzerland
| | | | | | - Klaus Kucher
- Novartis Institutes for Biomedical Research; Basel Switzerland
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Rosenow F, Klein KM, Hamer HM. Non-invasive EEG evaluation in epilepsy diagnosis. Expert Rev Neurother 2015; 15:425-44. [DOI: 10.1586/14737175.2015.1025382] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karlov VA. Photosensitivity, epilepsy, the occipital and frontal cortex. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:4-8. [DOI: 10.17116/jnevro2015115414-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Irmen F, Wehner T, Lemieux L. Do reflex seizures and spontaneous seizures form a continuum? - triggering factors and possible common mechanisms. Seizure 2014; 25:72-9. [PMID: 25645641 DOI: 10.1016/j.seizure.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/06/2014] [Accepted: 12/14/2014] [Indexed: 11/26/2022] Open
Abstract
Recent changes in the understanding and classification of reflex seizures have fuelled a debate on triggering mechanisms of seizures and their conceptual organization. Previous studies and patient reports have listed extrinsic and intrinsic triggers, albeit their multifactorial and dynamic nature is poorly understood. This paper aims to review literature on extrinsic and intrinsic seizure triggers and to discuss common mechanisms among them. Among self-reported seizure triggers, emotional stress is most frequently named. Reflex seizures are typically associated with extrinsic sensory triggers; however, intrinsic cognitive or proprioceptive triggers have also been assessed. The identification of a trigger underlying a seizure may be more difficult if it is intrinsic and complex, and if triggering mechanisms are multifactorial. Therefore, since observability of triggers varies and triggers are also found in non-reflex seizures, the present concept of reflex seizures may be questioned. We suggest the possibility of a conceptual continuum between reflex and spontaneous seizures rather than a dichotomy and discuss evidence to the notion that to some extent most seizures might be triggered.
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Affiliation(s)
- Friederike Irmen
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Tim Wehner
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom.
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Vinogradova LV. Comparative potency of sensory-induced brainstem activation to trigger spreading depression and seizures in the cortex of awake rats: Implications for the pathophysiology of migraine aura. Cephalalgia 2014; 35:979-86. [PMID: 25516507 DOI: 10.1177/0333102414565672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/15/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Migraine and epilepsy are highly co-morbid neurological disorders associated with episodic dysfunction of both cortical and subcortical networks. The study examined the interrelation between cortical spreading depression, the electrophysiological correlate of migraine aura and seizures triggered at cortical and brainstem levels by repeated sound stimulation in rats with acoustic hypersensitivity (reflex audiogenic epilepsy). METHOD In awake, freely moving rats with innate audiogenic epilepsy, 25 episodes of running seizure (brainstem seizures) were induced by repeated sound stimulation. Spreading depression and seizures were recorded using implanted cortical electrodes. RESULTS The first sound-induced brainstem seizures evoked neither spreading depression nor seizures in the cortex. With repetition, brainstem seizures began to be followed by a single cortical spreading depression wave and an epileptiform discharge. Spreading depression was more frequent an early cortical event than seizures: spreading depression appeared after 8.4 ± 1.0 repeated stimulations in 100% rats (n = 24) while cortical seizures were recorded after 12.9 ± 1.2 tests in 46% rats. Brainstem seizure triggered unilateral long-latency spreading depression. Bilateral short-latency cortical spreading depression was recorded only after intense cortical seizures. CONCLUSION These data show that episodic brainstem activation is a potent trigger of unilateral cortical spreading depression. Development of intense seizures in the cortex leads to initiation of spreading depression in multiple cortical sites of both hemispheres.
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Affiliation(s)
- Lyudmila V Vinogradova
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Russia
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Abstract
ABSTRACT:Photosensitivity, photosensitive seizures, and photosensitive epilepsy are discussed. The International League against Epilepsy has suggested the term “visual-sensitive” replace “photosensitive”. Visual-sensitive seizures may be more common than is realized. A classification for visual-sensitive epilepsies is presented. Chromosomal and DNA testing may help to refine the classification further. A standardized approach for neurophysiologic testing, such as that proposed by European experts, is recommended. These steps should promote evidenced-based management for this group of disorders.
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Affiliation(s)
- Shashi S Seshia
- Division of Pediatric Neurology, Department of Pediatrics (SSS), Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Masnou P. Epilessia e fotosensibilità. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)67976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Vaudano AE, Ruggieri A, Tondelli M, Avanzini P, Benuzzi F, Gessaroli G, Cantalupo G, Mastrangelo M, Vignoli A, Bonaventura CD, Canevini MP, Bernardina BD, Nichelli PF, Meletti S. The visual system in eyelid myoclonia with absences. Ann Neurol 2014; 76:412-27. [DOI: 10.1002/ana.24236] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 07/15/2014] [Accepted: 07/21/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Manuela Tondelli
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Pietro Avanzini
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
- Department of Neuroscience; University of Parma; Parma
| | - Francesca Benuzzi
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Giuliana Gessaroli
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Gaetano Cantalupo
- Department of Life and Reproduction Sciences; University of Verona; Verona
| | | | - Aglaia Vignoli
- Department of Health Sciences, Epilepsy Center, San Paolo Hospital; University of Milan; Milan
| | - Carlo Di Bonaventura
- Department of Neurological Sciences; University of Rome “La Sapienza,”; Rome Italy
| | - Maria Paola Canevini
- Department of Health Sciences, Epilepsy Center, San Paolo Hospital; University of Milan; Milan
| | | | - Paolo Frigio Nichelli
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
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Italiano D, Ferlazzo E, Gasparini S, Spina E, Mondello S, Labate A, Gambardella A, Aguglia U. Generalized versus partial reflex seizures: a review. Seizure 2014; 23:512-20. [PMID: 24766826 DOI: 10.1016/j.seizure.2014.03.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/24/2014] [Indexed: 11/30/2022] Open
Abstract
In this review we assess our currently available knowledge about reflex seizures with special emphasis on the difference between "generalized" reflex seizures induced by visual stimuli, thinking, praxis and language tasks, and "focal" seizures induced by startle, eating, music, hot water, somatosensory stimuli and orgasm. We discuss in particular evidence from animal, clinical, neurophysiological and neuroimaging studies supporting the concept that "generalized" reflex seizures, usually occurring in the setting of IGE, should be considered as focal seizures with quick secondary generalization. We also review recent advances in genetic and therapeutic approach of reflex seizures.
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Affiliation(s)
- Domenico Italiano
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; National Research Council, Piano Lago di Mangone, Cosenza, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
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Toyota T, Akamatsu N, Tanaka A, Tsuji S, Uozumi T. Electroencephalographic features of benign adult familial myoclonic epilepsy. Clin Neurophysiol 2013; 125:250-4. [PMID: 24011985 DOI: 10.1016/j.clinph.2013.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/31/2013] [Accepted: 08/01/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate electroencephalographic (EEG) features of benign adult familial myoclonic epilepsy (BAFME). METHODS We reviewed interictal EEG features in patients with BAFME treated between April 2005 and November 2012 at a tertiary referral center. The diagnostic criteria for BAFME were the presence of infrequent generalized tonic-clonic seizures, myoclonus or myoclonic seizures, and autosomal dominant inheritance. Interictal EEG findings of epilepsy with generalized tonic-clonic seizure only (EGTCS) were reviewed for comparison. We randomly selected 10 generalized spike/polyspike and wave complexes (GSW) for each BAFME patient and measured the duration of them. Photic stimulation and hyperventilation were performed in all. RESULTS Nineteen (eight men, 11 women) patients with BAFME were included in this study. The mean frequency of GSW was 4.3±1.0Hz (mean±SD, n=14) in BAFME and 3.2±0.8Hz (n=10) in EGTCS. There was a statistically significant difference (p=0.008) between the two. Photoparoxysmal responses (PPR) were noted in 18 (95%) patients with BAFME but 1 (10%) with EGTCS. CONCLUSION Faster frequency of GSW, compared with that in EGTCS, accompanied by PPR may be characteristic EEG features of BAFME. SIGNIFICANCE These findings may lead the diagnosis of BAFME.
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Affiliation(s)
- Tomoko Toyota
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan.
| | - Naoki Akamatsu
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Akihiro Tanaka
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Sadatoshi Tsuji
- Department of Medical Science Technology, International University of Health and Welfare, Fukuoka School of Health and Welfare, Okawa, Japan
| | - Takenori Uozumi
- Department of Neurology, Wakamatsu Hospital of the University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
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Abstract
PURPOSE OF REVIEW This article reviews the utility of EEG and prolonged video-EEG telemetry in the diagnosis and management of a patient with epilepsy. RECENT FINDINGS The EEG can be the most helpful test to determine a diagnosis of epilepsy; it can also distinguish focal and generalized neurophysiologic correlates of epilepsy. Furthermore, when paired with video monitoring, EEG can not only define epileptic and nonepileptic events but also aid in localization of seizures in patients with epilepsy. Finally, when history and other imaging modalities are considered with the EEG, the epileptic syndrome can usually be defined and the treatment can be focused. In critically ill patients, continuous EEG monitoring can define subclinical seizures, although a variety of periodic patterns may also be identified. SUMMARY EEG is an invaluable tool in the diagnosis and management of a patient with epilepsy, and continuous EEG monitoring is useful in identifying subclinical seizures and nonconvulsive status epilepticus in critically ill patients.
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Affiliation(s)
- Rama K Maganti
- Department of Neurology, University of Wisconsin, 1685 Highland Avenue, Madison, WI 53705, USA.
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Beniczky S, Aurlien H, Brøgger JC, Fuglsang-Frederiksen A, Martins-da-Silva A, Trinka E, Visser G, Rubboli G, Hjalgrim H, Stefan H, Rosén I, Zarubova J, Dobesberger J, Alving J, Andersen KV, Fabricius M, Atkins MD, Neufeld M, Plouin P, Marusic P, Pressler R, Mameniskiene R, Hopfengärtner R, van Emde Boas W, Wolf P. Standardized computer-based organized reporting of EEG: SCORE. Epilepsia 2013; 54:1112-24. [PMID: 23506075 PMCID: PMC3759702 DOI: 10.1111/epi.12135] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 12/01/2022]
Abstract
The electroencephalography (EEG) signal has a high complexity, and the process of extracting clinically relevant features is achieved by visual analysis of the recordings. The interobserver agreement in EEG interpretation is only moderate. This is partly due to the method of reporting the findings in free-text format. The purpose of our endeavor was to create a computer-based system for EEG assessment and reporting, where the physicians would construct the reports by choosing from predefined elements for each relevant EEG feature, as well as the clinical phenomena (for video-EEG recordings). A working group of EEG experts took part in consensus workshops in Dianalund, Denmark, in 2010 and 2011. The faculty was approved by the Commission on European Affairs of the International League Against Epilepsy (ILAE). The working group produced a consensus proposal that went through a pan-European review process, organized by the European Chapter of the International Federation of Clinical Neurophysiology. The Standardised Computer-based Organised Reporting of EEG (SCORE) software was constructed based on the terms and features of the consensus statement and it was tested in the clinical practice. The main elements of SCORE are the following: personal data of the patient, referral data, recording conditions, modulators, background activity, drowsiness and sleep, interictal findings, "episodes" (clinical or subclinical events), physiologic patterns, patterns of uncertain significance, artifacts, polygraphic channels, and diagnostic significance. The following specific aspects of the neonatal EEGs are scored: alertness, temporal organization, and spatial organization. For each EEG finding, relevant features are scored using predefined terms. Definitions are provided for all EEG terms and features. SCORE can potentially improve the quality of EEG assessment and reporting; it will help incorporate the results of computer-assisted analysis into the report, it will make possible the build-up of a multinational database, and it will help in training young neurophysiologists.
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Affiliation(s)
- Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.
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Abstract
Epileptic myoclonus can be defined as an elementary electroclinical manifestation of epilepsy involving descending neurons, whose spatial (spread) or temporal (self-sustained repetition) amplification can trigger overt epileptic activity and can be classified as cortical (positive and negative), secondarily generalized, thalamo-cortical, and reticular. Cortical epileptic myoclonus represents a fragment of partial or symptomatic generalized epilepsy; thalamo-cortical epileptic myoclonus is a fragment of idiopathic generalized epilepsy. Reflex reticular myoclonus represents the clinical counterpart of fragments of hypersynchronous epileptic activity of neurons in the brainstem reticular formation. Epileptic myoclonus, in the setting of an epilepsy syndrome, can be only one component of a seizure, the only seizure manifestations, one of the multiple seizure types or a more stable condition that is manifested in a nonparoxysmal fashion and mimics a movement disorder. This complex correlation is more obvious in patients with epilepsia partialis continua in which cortical myoclonus and overt focal motor seizures usually start in the same somatic (and cortical) region. In patients with cortical tremor this correlation is less obvious and requires neurophysiological studies to be demonstrated.
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Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer - University of Florence, Florence, Italy.
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Guellerin J, Hamelin S, Sabourdy C, Vercueil L. Low-Frequency Photoparoxysmal Response in Adults. J Clin Neurophysiol 2012; 29:160-4. [DOI: 10.1097/wnp.0b013e31824d949f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Beniczky S, Guaranha MSB, Conradsen I, Singh MB, Rutar V, Lorber B, Braga P, Fressola AB, Inoue Y, Yacubian EMT, Wolf P. Modulation of epileptiform EEG discharges in juvenile myoclonic epilepsy: An investigation of reflex epileptic traits. Epilepsia 2012; 53:832-9. [DOI: 10.1111/j.1528-1167.2012.03454.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Striano S, Coppola A, del Gaudio L, Striano P. Reflex seizures and reflex epilepsies: old models for understanding mechanisms of epileptogenesis. Epilepsy Res 2012; 100:1-11. [PMID: 22361339 DOI: 10.1016/j.eplepsyres.2012.01.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/22/2012] [Accepted: 01/27/2012] [Indexed: 11/28/2022]
Abstract
Reflex seizures and epilepsies represent an ancient human model to understand basic mechanisms of epilepsy. The increase of light stimulation makes this issue extremely actual and interesting. In addition, a lot of observations show the frequent occurrence of provoked seizures in malformations of cortical development and in recently defined conditions such as familial or sporadic lateral temporal epilepsy. Advances in morphological and functional neuroimaging techniques, and the possibility of their fusion with EEG (e.g., fMRI-EEG co-registration) offer a unique non-invasive opportunity to investigate cortical areas and brain networks involved in cerebral functions and in epileptic discharges.
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Affiliation(s)
- Salvatore Striano
- Epilepsy Centre, Department of Neurological Sciences, Federico II University, Napoli, Italy.
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Abstract
Idiopathic generalized epilepsy (IGE) is classified into several subsyndromes based on clinical and electroencephalography (EEG) features. The EEG signature of IGE is bisynchronous, symmetric, and generalized spike-wave complex; although focal, irregular, and so called "fragments" of discharges are not uncommon. Other characteristic EEG features include polyspikes, polyspike-wave discharges, occipital intermittent rhythmic delta activity, and photoparoxysmal response. Both human and animal data suggest involvement of the thalamus and the cortex in the generation of spike-wave discharges in IGE. Circadian variations of generalized epileptiform discharges are well described, and these can be useful in diagnostic confirmation. Those discharges tend to occur more often after awakening and during cyclic alternating pattern phase-A of non-rapid eye movement sleep. Activation procedures such as hyperventilation, intermittent photic stimulation, eye closure, and fixation-off are useful techniques to increase the yield of both interictal and ictal EEG abnormalities. Although not in routine use, specific triggers such as pattern stimulation and cognitive tasks may also be of value in eliciting rare reflex seizure-related EEG abnormalities. Variations of EEG abnormalities are evident between different electroclinical syndromes. EEG is also affected by certain external as well as internal factors, which should be borne in mind when interpreting EEG studies in IGE.
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Affiliation(s)
- Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
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Kasteleijn-Nolst Trenité D, Rubboli G, Hirsch E, Martins da Silva A, Seri S, Wilkins A, Parra J, Covanis A, Elia M, Capovilla G, Stephani U, Harding G. Methodology of photic stimulation revisited: Updated European algorithm for visual stimulation in the EEG laboratory. Epilepsia 2011; 53:16-24. [DOI: 10.1111/j.1528-1167.2011.03319.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Öztürk B, Yeni SN, Karaağaç N, Özkara Ç. No effects of the gonadal hormones on photoparoxysmal EEG responses in idiopathic generalised epilepsy. Seizure 2011; 20:598-601. [DOI: 10.1016/j.seizure.2011.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/04/2011] [Accepted: 04/22/2011] [Indexed: 11/28/2022] Open
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