Aura Continua

The importance of timing in epilepsia partialis continua

INTRODUCTION

Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyse the relationship between EPC duration and outcomes.

METHODS

We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018.

RESULTS

The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n = 6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4 hours. The median time to treatment onset (TT) for all patients was 12.3 hours. The median time from treatment onset to EPC control (TC) was 30 hours; TC showed a strong positive correlation with TT (Spearman's rho = 0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with TC (rho = 0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode.

CONCLUSIONS

Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

The importance of timing in epilepsia partialis continua

INTRODUCTION

Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyze the relationship between EPC duration and outcomes.

METHODS

We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018.

RESULTS

The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n=6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4hours. The median time to treatment onset for all patients was 12.3hours. The median time from treatment onset to EPC control was 30hours; time from treatment onset to EPC control showed a strong positive correlation with TT (Spearman's rho=0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with time from treatment onset to EPC control (rho=0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode.

CONCLUSIONS

Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

Clinical Analysis of Partial Epilepsy with Auras

Background:

An aura is usually considered to be the initial clinical sign of a seizure. The types of abnormal neuron activities (i.e., localized and generalized firing) play an important role in the diagnosis of epilepsy. The goal of this study was to investigate the types of auras and its correlation with the localization and treatment of epilepsy.

Methods:

The 426 epileptic patients with auras from a single center were reviewed with reference to International League Against Epilepsy (ILAE, 1981) classification; the clinical manifestations and incidence of auras were analyzed in this retrospective study, as well as the results of electroencephalogram (EEG), brain magnetic resonance imaging (MRI) and the treatment methods.

Results:

Among the 426 epileptic patients, six different types of auras were defined, including autonomic auras, sensory auras, mental and affective auras, aura as vertigo, cognitive auras, and unspeakable feelings. Duration of auras ranged from 2 s to 7 min; the median duration of auras was 64.2 s. Abnormal EEG was observed in 297 (69.72%) patients. Moreover, abnormal brain MRI was observed in 125 (29.34%) patients. Nineteen (4.46%) epilepsy patients with auras underwent both surgeries and antiepileptic drugs (AEDs) while others were treated only with AEDs.

Conclusions:

This study suggested that auras played an important role in the diagnosis, classification, and localization of epilepsy. Epileptic aura could help differentiate partial seizure from generalized seizure.

Phenomenology of hallucinations, illusions, and delusions as part of seizure semiology

In partial epilepsy, a localized hypersynchronous neuronal discharge evolving into a partial seizure affecting a particular cortical region or cerebral subsystem can give rise to subjective symptoms, which are perceived by the affected person only, that is, ictal hallucinations, illusions, or delusions. When forming the beginning of a symptom sequence leading to impairment of consciousness and/or a classic generalized seizure, these phenomena are referred to as an epileptic aura, but they also occur in isolation. They often manifest in the fully awake state, as part of simple partial seizures, but they also can be associated to different degrees of disturbed consciousness. Initial ictal symptoms often are closely related to the physiological functions of the cortical circuit involved and, therefore, can provide localizing information. When brain regions related to sensory integration are involved, the seizure discharge can cause specific kinds of hallucinations, for example, visual, auditory, gustatory, olfactory, and cutaneous sensory sensations. In addition to these elementary sensory perceptions, quite complex hallucinations related to a partial seizure can arise, for example, perception of visual scenes or hearing music. By involving psychic and emotional spheres of human perception, many seizures also give rise to hallucinatory emotional states (e.g., fear or happiness) or even more complex hallucinations (e.g., visuospatial phenomena), illusions (e.g., déjà vu, out-of-body experience), or delusional beliefs (e.g., identity change) that often are not easily recognized as epileptic. Here we suggest a classification into elementary sensory, complex sensory, and complex integratory seizure symptoms. Epileptic hallucinations, illusions, and delusions shine interesting light on the physiology and functional anatomy of brain regions involved and their functions in the human being. This article, in which 10 cases are described, introduces the fascinating phenomenology of subjective seizure symptoms.

Autonomic Status Epilepticus in Panayiotopoulos Syndrome and Other Childhood and Adult Epilepsies: A Consensus View

PURPOSE

To discuss and propose a definition of autonomic status epilepticus (SE), describe its clinical and EEG features, and review what is known about its epidemiology, pathophysiology, differential diagnosis, and management.

METHODS

An international consortium of established researchers in the field was identified from their published work, agreed the purpose of the project, searched the literature, and, by use of e-mail communication, agreed the consensus document.

RESULTS

Autonomic SE is a condition lasting at least 30 min and characterized by epileptic activity causing altered autonomic function of any type at seizure onset or in which manifestations consistent with altered autonomic function are prominent (quantitatively dominant or clinically important) even if not present at seizure onset. It is best described, and probably most commonly encountered in children, with Panayiotopoulos syndrome. However, it also occurs in children with symptomatic epilepsies and, exceptionally, in adults. Its pathogenesis and most appropriate management are poorly understood.

CONCLUSIONS

It is hoped that this document will help clinical recognition of Autonomic SE, reduce misdiagnosis, and promote further interest and studies into what has been a relatively neglected area.

Non-convulsive status epilepticus in adults: clinical forms and treatment

Non-convulsive status epilepticus (NCSE) is one of the great diagnostic and therapeutic challenges of modern neurology. Because the clinical features of this disorder may be very discrete and sometimes hard to differentiate from normal behaviour, NCSE is usually overlooked and consequently not treated properly. It is important to be familiar with the clinical subtypes such as absence, simple and complex partial, and subtle status epilepticus because each requires tailored management. In order to improve overall care of patients with NCSE, strict diagnostic criteria are needed that should be based on clinical alterations and ictal electroencephalographic changes. NCSE should be terminated rapidly to prevent patients from serious injuries, particularly if consciousness is impaired.