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Alencar SD, Cendes F, de Morais ABCG, Ribeiro VCAF, Frota NAF, Pinto LF. Déjà vu in idiopathic generalized epilepsy: A systematic review. Seizure 2024; 118:53-57. [PMID: 38640571 DOI: 10.1016/j.seizure.2024.03.015] [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: 09/15/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Déjà vu (DV), a French term meaning "already seen," refers to inappropriate sensation of familiarity in the present moment, as if it had been experienced before without a specific recollection of when or where. Traditionally, DV has been closely associated with focal seizures originating from the medial temporal lobe. However, there are occasional reports of DV occurring in idiopathic generalized epilepsies (IGEs). The objective of our study was to assess the presence and frequency of DV in individuals with IGE. METHODS We used the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) and searched PubMed and Embase from January 2000 to July 2022. RESULTS 5 studies were included with a total of 1177 IGE and 1026 with temporal lobe epilepsy (TLE) patients. The frequency of DV in IGE ranged from 0 to 11 %, and the average was 3 %, compared to 19.6 % in TLE. Broadly, 40 % of patients with IGE reported some type of aura. EEG correlation of DV in IGE was not appropriately evaluated in the studies. CONCLUSION Clinicians should be aware that individuals with IGE may experience DV and other types of auras. Recognizing these auras is crucial in order to avoid misdiagnosing IGE as focal epilepsy. This is important to prevent unnecessary investigations and incorrect treatment decisions.
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Barrios MS, Rainey C, Feyissa AM. A seizure in the eye of the beholder: painting an absence-to-bilateral-tonic-clonic seizure. Neurol Sci 2024; 45:1799-1801. [PMID: 38216850 DOI: 10.1007/s10072-024-07313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/06/2024] [Indexed: 01/14/2024]
Affiliation(s)
- Maria S Barrios
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Christian Rainey
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Kwack DW, Kim DW. Headache Is a Common Aura in Patients with Generalized Seizures. J Epilepsy Res 2023; 13:51-54. [PMID: 38223359 PMCID: PMC10783966 DOI: 10.14581/jer.23008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/15/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Background and Purpose Although aura in epilepsy is usually considered as a phenomenon in patients with focal seizures, headache can occur as an aura or solitary epileptic symptom in patients with generalized seizures. Methods We performed a 14-year retrospective study of patients with generalized seizures and analyzed the proportion and characteristics of patients with auras including headache. Results Among the 102 patients diagnosed with generalized seizures, aura was reported in 45 patients and headache was the most common aura in 26 patients. The age of onset of seizures was significantly lower in patients with headache as an aura than in patients without headache (14.8±3.8 vs. 24.7±16.2; p=0.003). Conclusions Our study showed that headache was the most common aura in patients with generalized seizures and patients with a younger age of onset of seizures were more likely to experience headache as an aura in these patients.
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Affiliation(s)
- Dong Won Kwack
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
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Caprara ALF, Tharwat Ali H, Elrefaey A, Elejla SA, Rissardo JP. Somatosensory Auras in Epilepsy: A Narrative Review of the Literature. MEDICINES (BASEL, SWITZERLAND) 2023; 10:49. [PMID: 37623813 PMCID: PMC10456342 DOI: 10.3390/medicines10080049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/06/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
An aura is a subjective experience felt in the initial phase of a seizure. Studying auras is relevant as they can be warning signs for people with epilepsy. The incidence of aura tends to be underestimated due to misdiagnosis or underrecognition by patients unless it progresses to motor features. Also, auras are associated with seizure remission after epilepsy surgery and are an important prognostic factor, guiding the resection site and improving surgical outcomes. Somatosensory auras (SSAs) are characterized by abnormal sensations on one or more body parts that may spread to other parts following a somatotopic pattern. The occurrence of SSAs among individuals with epilepsy can range from 1.42% to 80%. The upper extremities are more commonly affected in SSAs, followed by the lower extremities and the face. The most common type of somatosensory aura is paresthetic, followed by painful and thermal auras. In the primary somatosensory auras, sensations occur more commonly contralaterally, while the secondary somatosensory auras can be ipsilateral or bilateral. Despite the high localizing features of somatosensory areas, cortical stimulation studies have shown overlapping sensations originating in the insula and the supplementary sensorimotor area.
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Affiliation(s)
| | | | - Ahmed Elrefaey
- Faculty of Medicine, Ain Shams University, Cairo 11835, Egypt;
| | - Sewar A. Elejla
- Medicine Department, Alquds University, Jerusalem P850, Palestine;
| | - Jamir Pitton Rissardo
- Medicine Department, Federal University of Santa Maria, Santa Maria 97105-900, Brazil;
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Abstract
SUMMARY Long-term video-EEG monitoring has been the gold standard for diagnosis of epileptic and nonepileptic events. Medication changes, safety, and a lack of recording EEG in one's habitual environment may interfere with diagnostic representation and subsequently affect management. Some spells defy standard EEG because of ultradian and circadian times of occurrence, manifest nocturnal expression of epileptiform activity, and require classification for clarifying diagnostic input to identify optimal treatment. Some patients may be unaware of seizures, have frequent events, or subclinical seizures that require quantification before optimal management. The influence on antiseizure drug management and clinical drug research can be enlightened by long-term outpatient ambulatory EEG monitoring. With recent governmental shifts to focus on mobile health, ambulatory EEG monitoring has grown beyond diagnostic capabilities to target the dynamic effects of medical and nonmedical treatment for patients with epilepsy in their natural environment. Furthermore, newer applications in ambulatory monitoring include additional physiologic parameters (e.g., sleep, detection of myogenic signals, etc.) and extend treatment relevance to patients beyond seizure reduction alone addressing comorbid conditions. It is with this focus in mind that we direct our discussion on the present and future aspects of using ambulatory EEG monitoring in the treatment of patients with epilepsy.
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Asadi-Pooya AA, Farazdaghi M. Aura: epilepsy vs. functional (psychogenic) seizures. Seizure 2021; 88:53-55. [PMID: 33812308 DOI: 10.1016/j.seizure.2021.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare auras between three groups of people with seizures [i.e., Idiopathic generalized epilepsies (IGE) vs. Temporal lobe epilepsy (TLE) vs. Functional seizures (FS)]. METHODS All patients, 10 years of age or older, with a diagnosis of IGE, TLE, or FS were prospectively registered in an electronic database and retrospectively studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. RESULTS One thousand and three hundred ninety-one patients were studied (480 with IGE, 617 with TLE, and 294 with FS). Among patients with TLE, 63.5% of individuals reported auras; this figure was 68% in the FS and 12.7% in the IGE groups (p < 0.00001). Odds ratio of having auras in the TLE group compared with the IGE group was 11.96 (95% CI: 8.73-16.39; p = 0.0001). Odds ratio of having auras in the TLE group compared with the FS group was 0.81 (95% CI: 0.61-1.10; p = 0.1840). Odds ratio of having auras in the FS group compared with the IGE group was 14.61 (95% CI: 10.15-21.02; p = 0.0001). The following auras were more frequent among patients with TLE: emotional, cognitive, epigastric, and olfactory/gustatory. The following auras were more frequent among patients with FS: headache and dizziness/vertigo. CONCLUSION Auras are not specific to focal epilepsies. Future studies should investigate auras in large cohorts of patients with focal or generalized epilepsies and also those with FS to determine the exact clinical value of each aura.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Marashly A. Seizure Semiology in Focal and Generalized Epilepsies: Distinctive and Overlapping Features. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0040-1722300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractStudying seizure semiology is the first step in evaluating any patient with epilepsy which leads the way to further investigations and management, particularly in differentiating focal and generalized epilepsies. While the usefulness of semiological analysis has been confirmed through decades' worth of research and clinical practice, there remains some instances when the line between focal and generalized semiological features is blurred leading to difficulties identifying the type of epilepsy at hand. This in turn can lead to delayed or wrong diagnoses with significant implications.In this review article, we explain the role of semiology in epilepsy, specifically in differentiating focal versus generalized epilepsies and cover the semiological features for both groups. We also discuss the occasional overlapping semiology between the two groups and provide case examples.
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Affiliation(s)
- Ahmad Marashly
- Division of Pediatric Neurology, University of Washington/Seattle Children's Hospital, Seattle, Washington
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Guery D, Rheims S. Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies. Neuropsychiatr Dis Treat 2021; 17:2229-2242. [PMID: 34285484 PMCID: PMC8286073 DOI: 10.2147/ndt.s256699] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients' quality of life.
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Affiliation(s)
- Deborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France.,Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy Institute, Lyon, France
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Moritz JLW, Mameniškienė R, Rimšienė J, Budriūnienė A, de Almeida Calado G, Rigon IB, Cantú PLM, Meneguzzi C, Walz R, Lin K, Wolf P. Control perceptions in epilepsy: A transcultural case-control study with focus on auras. Epilepsy Behav 2018; 88:130-138. [PMID: 30269031 DOI: 10.1016/j.yebeh.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/08/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE General Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsy's (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras. METHODS A case-control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotter's GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R). RESULTS Patient's mean age was 36.15 ± 13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ± 13.59 years, and monthly seizure frequency was 8.22 ± 20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety. CONCLUSIONS General Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.
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Affiliation(s)
- Jorge Luís Wollstein Moritz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Rūta Mameniškienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Justė Rimšienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Atėnė Budriūnienė
- Department of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | | | - Isadora Barazzetti Rigon
- Curso de Graduação em Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | - Caroline Meneguzzi
- Curso de Graduação em Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Roger Walz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Kátia Lin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Peter Wolf
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark.
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Gawlak D, Łuniewska J, Stojak W, Hovhannisyan A, Stróżyńska A, Mańka-Malara K, Adamiec M, Rysz A. The prevalence of orodental trauma during epileptic seizures in terms of dental treatment - Survey study. Neurol Neurochir Pol 2017; 51:361-365. [PMID: 28711375 DOI: 10.1016/j.pjnns.2017.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 02/14/2017] [Accepted: 06/19/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Epilepsy is one of the most common neurological disorders. Seizures that occur during attacks may lead to head injuries. It is crucial to establish proper prophylactic management against trauma occurrence, as nowadays prevention is not sufficient. AIM Assessment of the frequency of head and intraoral trauma during epileptic seizures and to evaluate factors that may predispose to injuries. MATERIAL AND METHODS The questionnaire was carried out among 106 patients with epilepsy. Survey conducted questions regarding development of the disease and occurrence of orodental and head trauma. Results were statistically analyzed with the chi-square test (p<0.05). RESULTS 52.4% of subjects admitted the occurrence of oral trauma during epileptic seizures. The most common were lips, tongue or cheeks injuries. 18% patients suffered from tooth crack and 17% from tooth fracture. 50% of respondents suffered from head trauma during seizures: 41% patients reported bruises, 39% burns, 37% wounds, 10% nose fractures, 7% eye socket trauma and 3% skull crack. 14.1% of respondents experienced dentist refusal to undertake treatment, while 4% of patients had epileptic attack during dental procedures. CONCLUSIONS Dental trauma is common result of epileptic seizures. It is necessary to implement prophylactic management to prevent hard and soft tissues injuries, for example by using custom-made mouthguards. Moreover, specially designed dental programs for this group of patients should be provided.
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Affiliation(s)
- Dominika Gawlak
- Department of Prosthetics, Medical University of Warsaw, ul. Nowogrodzka 59, 02 - 006 Warsaw, Poland.
| | - Joanna Łuniewska
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Wiktoria Stojak
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Anahit Hovhannisyan
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Anna Stróżyńska
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Katarzyna Mańka-Malara
- Department of Prosthetics, Medical University of Warsaw, ul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Marcin Adamiec
- Department of Oral Surgery, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Andrzej Rysz
- Department of Neurosurgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland; Department of Neurology, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland
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Chen B, Choi H, Hirsch LJ, Katz A, Legge A, Wong RA, Jiang A, Kato K, Buchsbaum R, Detyniecki K. Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res 2017; 133:98-102. [PMID: 28475999 DOI: 10.1016/j.eplepsyres.2017.04.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/17/2017] [Accepted: 04/22/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE In the current study, we explored the prevalence of physician-confirmed seizure clusters. We also investigated potential clinical factors associated with the occurrence of seizure clusters overall and by epilepsy type. METHODS We reviewed medical records of 4116 adult (≥16years old) outpatients with epilepsy at our centers for documentation of seizure clusters. Variables including patient demographics, epilepsy details, medical and psychiatric history, AED history, and epilepsy risk factors were then tested against history of seizure clusters. Patients were then divided into focal epilepsy, idiopathic generalized epilepsy (IGE), or symptomatic generalized epilepsy (SGE), and the same analysis was run. RESULTS Overall, seizure clusters were independently associated with earlier age of seizure onset, symptomatic generalized epilepsy (SGE), central nervous system (CNS) infection, cortical dysplasia, status epilepticus, absence of 1-year seizure freedom, and having failed 2 or more AEDs (P<0.0026). Patients with SGE (27.1%) were more likely to develop seizure clusters than patients with focal epilepsy (16.3%) and IGE (7.4%; all P<0.001). Analysis by epilepsy type showed that absence of 1-year seizure freedom since starting treatment at one of our centers was associated with seizure clustering in patients across all 3 epilepsy types. In patients with SGE, clusters were associated with perinatal/congenital brain injury. In patients with focal epilepsy, clusters were associated with younger age of seizure onset, complex partial seizures, cortical dysplasia, status epilepticus, CNS infection, and having failed 2 or more AEDs. In patients with IGE, clusters were associated with presence of an aura. Only 43.5% of patients with seizure clusters were prescribed rescue medications. CONCLUSION Patients with intractable epilepsy are at a higher risk of developing seizure clusters. Factors such as having SGE, CNS infection, cortical dysplasia, status epilepticus or an early seizure onset, can also independently increase one's chance of having seizure clusters.
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Affiliation(s)
- Baibing Chen
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, United States.
| | - Hyunmi Choi
- Comprehensive Epilepsy Center, Dept. of Neurology, Columbia University, New York, NY, United States
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, United States
| | - Austen Katz
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, United States
| | - Alexander Legge
- Comprehensive Epilepsy Center, Dept. of Neurology, Columbia University, New York, NY, United States
| | - Rebecca A Wong
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, United States
| | - Alfred Jiang
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, United States
| | - Kenneth Kato
- Comprehensive Epilepsy Center, Dept. of Neurology, Columbia University, New York, NY, United States
| | - Richard Buchsbaum
- Comprehensive Epilepsy Center, Dept. of Neurology, Columbia University, New York, NY, United States
| | - Kamil Detyniecki
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, United States
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Focal interictal epileptiform discharges in idiopathic generalized epilepsy. Neurol Sci 2016; 37:1071-7. [PMID: 26956566 DOI: 10.1007/s10072-016-2538-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
Abstract
Are idiopathic generalized epilepsies (IGEs) truly generalized? Do IGEs represent a continuum or rather distinct syndromes? Focal changes in the electroencephalography (EEG) have been reported in IGEs. The aim of this work is to investigate focal interictal epileptiform discharges (IEDs) in IGEs, and their relation to clinical variables. Forty-one IGE patients (classified according to ILAE, 2001) were recruited from a tertiary center (age 23 ± 10.938 years). Their files were reviewed and they were subjected to clinical examination and interictal EEG. Patients with focal IEDs were compared to those without focal IEDs. Nine patients had juvenile myoclonic epilepsy (JME) and 32 had idiopathic epilepsy with generalized tonic-clonic seizures only (EGTCSA). Focal IEDs were found in 20 patients, mostly in the frontal (45.5 %) and temporal (31.8 %) distribution. Patients with focal IEDs were treated with a larger number of combined antiepileptic drugs (AEDs) (p value = 0.022). No significant difference was found between the two groups regarding age, sex, age at onset, epilepsy syndrome, seizure frequency, family history, AEDs used (sodium valproate and carbamazepine) and their doses. Seventeen EGTCSA patients had focal IEDs. They were treated with larger number of combined AEDs (p value = 0.0142). No significant difference was found between the EGTCSA patients with and those without focal IEDs regarding age, sex, age at onset, seizure frequency, family history and AEDs doses. Caution must be applied in the interpretation of interictal focal IEDs. These focal changes may be related to prognosis, however this needs further investigation.
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14
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Seneviratne U, Woo JJ, Boston RC, Cook M, D'Souza W. Focal seizure symptoms in idiopathic generalized epilepsies. Neurology 2015; 85:589-95. [DOI: 10.1212/wnl.0000000000001841] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/27/2015] [Indexed: 11/15/2022] Open
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Dugan P, Carlson C, Bluvstein J, Chong DJ, Friedman D, Kirsch HE. Auras in generalized epilepsy. Neurology 2014; 83:1444-9. [PMID: 25230998 DOI: 10.1212/wnl.0000000000000877] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We studied the frequency of auras in generalized epilepsy (GE) using a detailed semistructured diagnostic interview. METHODS In this cross-sectional study, participants with GE were drawn from the Epilepsy Phenome/Genome Project (EPGP). Responses to the standardized diagnostic interview regarding tonic-clonic (grand mal) seizures were then examined. This questionnaire initially required participants to provide their own description of any subjective phenomena before their "grand mal seizures." Participants who provided answers to these questions were considered to have an aura. All participants were then systematically queried regarding a list of specific symptoms occurring before grand mal seizures, using structured (closed-ended) questions. RESULTS Seven hundred ninety-eight participants with GE were identified, of whom 530 reported grand mal seizures. Of these, 112 (21.3%) reported auras in response to the open-ended question. Analysis of responses to the closed-ended questions suggested that 341 participants (64.3%) experienced at least one form of aura. CONCLUSIONS Auras typically associated with focal epilepsy were reported by a substantial proportion of EPGP subjects with GE. This finding may support existing theories of cortical and subcortical generators of GE with variable spread patterns. Differences between responses to the open-ended question and closed-ended questions may also reflect clinically relevant variation in patient responses to history-taking and surveys. Open-ended questions may underestimate the prevalence of specific types of auras and may be in part responsible for the underrecognition of auras in GE. In addition, structured questions may influence participants, possibly leading to a greater representation of symptoms.
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Affiliation(s)
- Patricia Dugan
- From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco.
| | - Chad Carlson
- From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco
| | - Judith Bluvstein
- From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco
| | - Derek J Chong
- From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco
| | - Daniel Friedman
- From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco
| | - Heidi E Kirsch
- From the Department of Neurology (P.D., J.B., D.J.C., D.F.), New York University Langone Medical Center, New York; Department of Neurology (C.C.), Medical College of Wisconsin, Milwaukee; and Department of Neurology (H.E.K.), University of California, San Francisco
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Seneviratne U, Cook M, D'Souza W. Focal abnormalities in idiopathic generalized epilepsy: A critical review of the literature. Epilepsia 2014; 55:1157-69. [DOI: 10.1111/epi.12688] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Udaya Seneviratne
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Melbourne Victoria Australia
- Department of Neuroscience; Monash Medical Centre; Melbourne Victoria Australia
| | - Mark Cook
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Wendyl D'Souza
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Melbourne Victoria Australia
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Importance of Video-EEG Monitoring in the Diagnosis of Epilepsy in a Psychiatric Patient. Case Rep Neurol Med 2013; 2013:159842. [PMID: 23585974 PMCID: PMC3621157 DOI: 10.1155/2013/159842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 03/04/2013] [Indexed: 11/18/2022] Open
Abstract
Epilepsy is a chronic medical condition which is disabling to both patients and caregivers. The differential diagnosis of epilepsy includes psychogenic nonepileptic spells or "pseudoseizures." Epilepsy is due to abnormal electrical activity in the brain, and pseudoseizure is a form of conversion disorder. The brain waves remain normal in pseudoseizures. The problem arises when a patient with significant psychiatric history presents with seizures. Pseudoseizures become high on the differential diagnosis without extensive work up. This is a case of woman with significant psychiatric issues which resulted in a delay in the diagnosis of epilepsy.
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Prevalence and characteristics of visual aura in idiopathic generalized epilepsy. Epilepsy Behav 2012; 25:573-6. [PMID: 23159381 DOI: 10.1016/j.yebeh.2012.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/20/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022]
Abstract
Some patients with idiopathic/genetic generalized epilepsy (IGE) experience visual aura, which can confuse the diagnosis. We sought to determine the frequency and characteristics of visual auras in IGE patients. Among the 176 IGE patients, 4 men and 7 women reported visual auras (mean age - 24 years). Syndromic diagnoses were juvenile myoclonic epilepsy in four, eyelid myoclonia with absences (EMA) in three, juvenile absence epilepsy in three, and other in one. Visual auras consisted of flashing lights, macropsia, illusional movements, and blindness. Eyelid myoclonia with absences was significantly more common in the group with visual aura (3 of 11 patients vs. 8 of 165 IGE patients; P=0.02). Furthermore, photosensitivity was found significantly more common in IGE patients with visual aura (90% vs 46% of the total IGE patients) (P=0.004). In conclusion, the visual auras do not exclude a diagnosis of IGE. The presence of visual aura in the EMA syndrome is also remarkable.
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Gursahani R, Gupta N. The adolescent or adult with generalized tonic-clonic seizures. Ann Indian Acad Neurol 2012; 15:81-8. [PMID: 22566718 PMCID: PMC3345605 DOI: 10.4103/0972-2327.94988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/03/2012] [Accepted: 02/25/2012] [Indexed: 01/26/2023] Open
Abstract
Primary and secondary generalized tonic-clonic seizures (GTCs) together constitute up to 50% of adolescent and adult patients with epilepsy as diagnosed by history and EEG. Syncope and psychogenic nonepileptic seizures are major differential diagnoses and must be carefully excluded in therapy-resistant cases. Individual episodes can have up to seven phases in secondarily generalized GTCs. The distinction between primary and secondary GTCs depends mainly on history and EEG, and yield can be improved with sleep deprivation or overnight recording. Epilepsies with primary or unclassified GTCs can respond to any one of the five broad-spectrum antiepileptic drugs (AEDs): valproate, lamotrigine, levetiracetam, topiramate and zonisamide. Unless a focal onset is clearly confirmed, a sodium-channel blocking AED should not be used in the initial treatment of these conditions.
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Affiliation(s)
- Roop Gursahani
- Department of Neurology, P.D. Hinduja National Hospital, Mumbai, India
| | - Namit Gupta
- Department of Neurology, Sir J.J. Hospital, Mumbai, India
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Abstract
"If I wished to show a student the difficulties of getting at truth from medical experience, I would give him the history of epilepsy to read." Oliver Wendell Holmes (1)If the medical experience of epilepsy is obscured by uncertainties, then its classification is mired in the mud of expert opinion. The newly revised terms and concepts for "organizing" (also known as "classifying") seizures and epilepsy provide a humble and modern perspective, with many superb suggestions (2). The central points are well articulated and valid: 1) divorcing classification from "expert opinion" and marrying it to science; 2) acknowledging what is unknown; and 3) simplifying and clarifying terminology. Yet, the revision lacks the crisp clarity needed to educate students, patients, and colleagues. And some recommendations lack a clear scientific or semantic basis.
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Vendrame M, Zarowski M, Alexopoulos AV, Wyllie E, Kothare SV, Loddenkemper T. Localization of pediatric seizure semiology. Clin Neurophysiol 2011; 122:1924-8. [PMID: 21474374 DOI: 10.1016/j.clinph.2011.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/03/2011] [Accepted: 03/02/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between semiology of seizures in children and adolescents to the corresponding EEG localization. METHODS Charts of 225 consecutive pediatric epilepsy patients undergoing Video-EEG monitoring (VEM) over 2 years were reviewed. Seizure semiology recorded during VEM was classified according to ILAE seizure semiology terminology and EEG localization, and analyzed based on onset as defined by the EEG data (generalized, frontal, temporal, parietal, occipital or multilobar). RESULTS A total of 1008 seizures were analyzed in 225 children (mean age 8.5 years, range 0-20), with 50% boys. Auras and seizures with automatisms arose predominantly from the temporal lobes (p<0.001). Tonic, clonic and tonic-clonic seizures had most commonly generalized onset (p<0.001). Hypomotor seizures were most frequently seen from the frontal lobes (p<0.001). Hypermotor seizures had most commonly temporal lobe or multiple lobe onset (p<0.001 and p<0.05 respectively). Atonic, myoclonic seizures and epileptic spasms had almost exclusively a generalized onset (p<0.001). CONCLUSIONS Different seizure semiologies relate to specific brain regions, with overlap between focal and generalized semiological seizure types, as identified electrographically. SIGNIFICANCE Semiology of seizures can provide important information for epilepsy localization, and should not be overlooked, especially in patients undergoing pre-surgical evaluation. Separation of clinical seizure description and EEG findings may be useful, in particular when only incomplete information is available. i.e. during the first office visit.
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Affiliation(s)
- Martina Vendrame
- Epilepsy and Clinical Neurophysiology, Children's Hospital Boston, Boston, MA 02115, United States
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Betting LE, Li LM, Lopes-Cendes I, Guerreiro MM, Guerreiro CAM, Cendes F. Correlation between quantitative EEG and MRI in idiopathic generalized epilepsy. Hum Brain Mapp 2011; 31:1327-38. [PMID: 20082332 DOI: 10.1002/hbm.20944] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The objective of this study was to investigate the relationship between the focal discharges sometimes observed in the electroencephalogram of patients with idiopathic generalized epilepsies and subtle structural magnetic resonance imaging abnormalities. The main hypothesis to be assessed is that focal discharges may arise from areas of structural abnormality which can be detected by quantitative neuroimaging. Focal discharges were used for quantitative electroencephalogram source detection. Neuroimaging investigations consisted of voxel-based morphometry and region of interest volumetry. For voxel-based morphometry, volumetric MRI were acquired and processed. The images of each patient were individually compared with a control group. Statistical analysis was used to detect differences in gray matter volumes. Region of interest-based morphometry was automatically performed and used essentially to confirm voxel-based morphometry findings. The localization of the focal discharges on the electroencephalogram was compared to the neuroimaging results. Twenty-two patients with idiopathic generalized epilepsies were evaluated. Gray matter abnormalities were detected by voxel-based morphometry analysis in 77% of the patients. There was a good concordance between EEG source detection and voxel-based morphometry. On average, the nearest voxels detected by these methods were 19 mm (mm) apart and the most statistically significant voxels were 34 mm apart. This study suggests that in some cases subtle gray matter abnormalities are associated with focal epileptiform discharges observed in the electroencephalograms of patients with idiopathic generalized epilepsies.
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Affiliation(s)
- Luiz E Betting
- Department of Neurology, Faculty of Medical Sciences, University of Campinas--UNICAMP, Campinas, SP, Brazil
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Nakken KO, Solaas MH, Kjeldsen MJ, Friis ML, Pellock JM, Corey LA. The occurrence and characteristics of auras in a large epilepsy cohort. Acta Neurol Scand 2009; 119:88-93. [PMID: 18638041 DOI: 10.1111/j.1600-0404.2008.01069.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Despite several studies, estimates of the frequency with which auras occur in conjunction with epilepsy continue to be imprecise. The aim of this study was to assess the occurrence and characteristics of auras in a large population-based epilepsy cohort. MATERIALS AND METHODS Subjects with verified epilepsy were recruited from population-based twin registries in the USA, Denmark and Norway. Using a structured interview in which a list of auras was provided, subjects were asked about the warning symptoms preceding their epileptic attacks. RESULTS 31% of the total sample (n = 1897) and 39% of those with active epilepsy (n = 765) had experienced an aura. Six percent reported more than one type. Non-specified auras were most frequently reported (35%), followed by somatosensory (11%) and vertiginous (11%). While the majority of those reporting auras (59%) had focal epilepsies, auras of a mostly non-specific nature were experienced by 13% of those with generalized epilepsies. CONCLUSION Auras serve an important purpose in that they may prevent seizure-related injuries and could provide an indication as to where the seizures originate. The occurrence of auras often is underestimated, especially in children and those with learning disabilities.
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Affiliation(s)
- K O Nakken
- National Centre for Epilepsy, Sandvika, Norway.
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Gelisse P, Coubes P, Crespel A. Auras visuelles dans les épilepsies généralisées idiopathiques. Rev Neurol (Paris) 2008; 164:258-63. [DOI: 10.1016/j.neurol.2007.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 10/17/2007] [Accepted: 10/27/2007] [Indexed: 11/29/2022]
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Chandrasekar T, Sharan AD, Sperling MR. Postoperative auras and the risk of recurrent seizures. Epilepsy Res 2008; 78:195-200. [DOI: 10.1016/j.eplepsyres.2007.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
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