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Holman O, Bibawy JM, Wadi L, Morgenlander JC, Hauck EF. Early cerebral venous drainage associated with focal seizures: a correlation of digital subtraction angiography and electroencephalography. Illustrative case. J Neurosurg Case Lessons 2024; 7:CASE2445. [PMID: 38684133 PMCID: PMC11058406 DOI: 10.3171/case2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/22/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Early venous drainage is a critical diagnostic feature of arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). However, other conditions associated with early venous drainage can mimic AVMs and AVFs and mislead the treating physician team. OBSERVATIONS The authors present a unique case of a 56-year-old man with new left hemianopsia. Workup with magnetic resonance imaging and magnetic resonance angiography had revealed cortical enhancement and early venous drainage, possibly caused by an AVF or AVM. Catheter angiography confirmed the presence of early venous drainage of specifically the right occipital lobe. The early venous drainage occurred as the result of local hyperperfusion limited to the right occipital lobe. Subsequent electroencephalography confirmed focal seizure activity in the right occipital lobe. After seizure control with multiple antiepileptic medications, the patient regained his vision. Repeat digital subtraction angiography revealed restoration of normal cerebral blood flow. LESSONS Early venous drainage observed during catheter angiography can be associated with seizure activity. Differentiation from other conditions, such as AVM, AVF, or ischemic stroke, is critical to facilitate prompt and appropriate treatment.
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Affiliation(s)
| | | | - Lara Wadi
- 2Neurology, Duke University, Durham, North Carolina
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2
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Atsuji K, Neshige S, Ohno N, Maruyama H. Chronic Visual Abnormality in an Elderly Patient With Temporal Lobe Epilepsy. Cureus 2024; 16:e56696. [PMID: 38646321 PMCID: PMC11032511 DOI: 10.7759/cureus.56696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/23/2024] Open
Abstract
A 79-year-old woman visited our department for chronic visual field abnormalities with a floating sensation for two months. Neurological and ophthalmologic examinations yielded normal results, except for brain MRI indicating left hippocampal atrophy. Cognitive function tests were normal. EEG revealed frequent spikes and slow waves in the left frontotemporal region, corroborated by reduced accumulation in 123I-iomazenil single photon emission computed tomography. A diagnosis of temporal lobe epilepsy was established, and treatment with lacosamide resulted in a remarkable improvement in symptoms and EEG findings. Mild focal seizures from the temporal region might cause mild impaired awareness, resulting in the patient's report as a sensation of uncertainty between the self and the outside world, mimicking ophthalmologic abnormalities. The repeated nature of the seizures contributed to the absence of the term "transient" in symptom description. Diagnosing epilepsy in the elderly proves challenging due to nonspecific complaints.
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Affiliation(s)
- Kiyohiro Atsuji
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
| | - Narumi Ohno
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
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Marx B, Medina-Villalon S, Bartolomei F, Lagarde S. How Can a Focal Seizure Lead to a Dacrystic Behavior? A Case Analyzed with Functional Connectivity in Stereoelectroencephalography. Clin EEG Neurosci 2024; 55:272-277. [PMID: 37340756 DOI: 10.1177/15500594231182808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
We present a case of a patient with focal non-motor emotional seizures with dacrystic expression in the context of drug-resistant magnetic resonance imaging negative epilepsy. The pre-surgical evaluation suggested a hypothesis of a right fronto-temporal epileptogenic zone. Stereoelectroencephalography recorded dacrystic seizures arising from the right anterior operculo-insular (pars orbitalis) area with secondary propagation to temporal and parietal cortices during the dacrystic behavior. We analyzed functional connectivity during the ictal dacrystic behavior and found an increase of the functional connectivity within a large right fronto-temporo-insular network, broadly similar to the "emotional excitatory" network. It suggests that focal seizure, potentially, from various origins but leading to disorganization of these physiological networks may generate dacrystic behavior.
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Affiliation(s)
- Barbara Marx
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
| | - Samuel Medina-Villalon
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Stanislas Lagarde
- APHM, Timone Hospital, Epileptology Department, Member of the ERN EpiCARE, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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4
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Adjei P, Obese V, Tang R, Manu KO, Boateng YOA, Donkor EA. Neurocysticercosis: A neglected but preventable cause of seizure in adults. Clin Case Rep 2024; 12:e8454. [PMID: 38268622 PMCID: PMC10805999 DOI: 10.1002/ccr3.8454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
Neurocysticercosis is an infection of the central nervous system caused by the larval stage of Taenia solium. Although endemic in sub-Saharan Africa, it is neglected but remains a significant cause of preventable seizure in adults. Its diagnosis is challenging and is frequently missed due to its variable clinical manifestations and lack of diagnostic facilities in most areas of sub-Saharan Africa. This report discusses two cases of parenchymal neurocysticercosis in Ghanaians who presented to the emergency unit of a District Hospital with adult-onset seizures. The two cases highlight the need for a high index of suspicion and also underscore the important role of neuroimaging in the evaluation of patients presenting with adult-onset seizures in neurocysticercosis endemic areas. This is necessary for prompt detection and initiation of appropriate therapy in order to improve prognosis.
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Affiliation(s)
- Prosper Adjei
- Department of Internal MedicineMethodist HospitalWenchiGhana
| | - Vida Obese
- Directorate of Internal MedicineKomfo Anokye Teaching HospitalKumasiGhana
| | - Richard Tang
- Department of Internal MedicineMethodist HospitalWenchiGhana
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Siddiqui F, Soomro BA, Badshah M, Rehman EU, Numan A, Ikram A, Khan MWA, Ali S, Hashim H, Salam JU, Akram A, Irfan Hashmat M, Iqbal S, Zeeshan Javed M, Iqbal SZ, Maqsood A, Khan A, Maheshwary N, Khan MA. Efficacy and Safety of Brivaracetam in Persons With Epilepsy in a Real-World Setting: A Prospective, Non-Interventional Study. Cureus 2023; 15:e50313. [PMID: 38205459 PMCID: PMC10777439 DOI: 10.7759/cureus.50313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND AIM Epilepsy stands out as one of the most prevalent neurological conditions. Brivaracetam (BRV) is a noteworthy antiseizure medication (ASM) distinguished by its pronounced and selective interaction with the synaptic vesicle protein 2A (SV2A) within the brain. Prior investigations, including regulatory trials, post-marketing assessments, and comparative meta-analyses, have consistently underscored BRV's equivalency in efficacy and superior tolerability when pitted against other antiseizure drugs. This study aimed to evaluate the effectiveness, safety, and acceptability of BRV in treating epileptic patients in the Pakistani population. METHODS This prospective observational study, conducted in Pakistan from February to December 2022, employed a non-probability consecutive sampling technique. This study included 368 adult patients diagnosed with epilepsy, with a focus on those aged 18 and above experiencing focal seizures. Demographic data, clinical history, seizure types, and epilepsy profiles were recorded. Patients were administered BRV (Brivera; manufactured by Helix Pharma Pvt Ltd., Sindh, Pakistan) monotherapy therapy under physician guidance and followed up for three months. The study assessed changes in seizure frequency, side effects, and drug resistance at baseline, 14th day, and 90th day. Safety aspects were monitored, including documenting any adverse effects associated with BRV therapy. RESULTS A total of 368 epileptic patients were included in this study, of which 287 (61.3%) were males and 181 (38.7%) were females. The mean age was 32.91±17.11 years. The mean number of seizures at the baseline visit was 5.74±6.21, at 14 days was 2.89±3.84 and at 90 days was 1.73±5.01 (p<0.001). Overall, a more than 50% reduction in seizure episodes was achieved in 178 (56.3%) patients at day 90, and less than 50% reduction in seizure episodes was achieved by 95 (26.8%) patients on Day 14, with a highly significant association between them (p<0.001). Among 316 patients, only 41 (4.4%) of all BRV-treated patients experienced adverse events; Of these 41 patients, 17 (41.7%) reported dizziness and 14(34.2%) reported behavioral issues. CONCLUSIONS Epileptic patients receiving BRV demonstrated a substantial reduction of greater than 50% seizure episodes at the end of follow-up visits. Moreover, BRV exhibited fewer adverse effects in individuals with epilepsy.
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Affiliation(s)
- Fowzia Siddiqui
- Neurology, The Aga Khan University Hospital (AKUH), Karachi, PAK
| | | | - Mazhar Badshah
- Neurology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Ehsan U Rehman
- Neurology, Akhtar Saeed Medical and Dental College, Islamabad, PAK
| | - Ahsan Numan
- Neurology, Mayo Hospital, King Edward Medical University, Lahore, PAK
| | - Amer Ikram
- Neurology, Doctors Hospital Lahore, Lahore, PAK
| | | | - Sajjad Ali
- Neurology, Dar ul Shifa Hospital Sialkot, Sialkot, PAK
| | | | - Jawwad-Us Salam
- Medicine/Neurology, Dow International Medical College, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Shahid Iqbal
- Neurology, Rehman Medical Institute, Peshawar, PAK
| | | | - S Zafar Iqbal
- Neurology, Tahsil Head Quarter (TQH) Hospital Sadiqabad, Sadiqabad, PAK
| | - Atif Maqsood
- Neurology, Aziz Fatima Hospital, Faisalabad, PAK
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Darıcı D, Gönül Öner Ö, Ertürk Çetin Ö, Zanapalıoğlu Ü, Önal Y, Karadeli HH. Limb-shaking transient ischemic attack misdiagnosed as focal seizure: A video case report. Epileptic Disord 2023; 25:567-570. [PMID: 36938896 DOI: 10.1002/epd2.20041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/21/2023]
Abstract
Content available: Video
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Affiliation(s)
- Didem Darıcı
- Department of Neurology, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Özge Gönül Öner
- Department of Neurology, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Özdem Ertürk Çetin
- Department of Neurology, Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ümit Zanapalıoğlu
- Department of Neurology, Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yılmaz Önal
- Interventional Radiology Department, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Hasan Hüseyin Karadeli
- Department of Neurology, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
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Bach KT, Ananth S, Thind I, Zhong N, Lui F. Co-occurrence of Anti-GAD65 Syndrome, Type 1 Diabetes Mellitus, and Focal Seizures With Impaired Awareness. Cureus 2023; 15:e40611. [PMID: 37476109 PMCID: PMC10354376 DOI: 10.7759/cureus.40611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/22/2023] Open
Abstract
Glutamic acid decarboxylase (GAD) is an intracellular enzyme found in the presynaptic end of nerve terminals that functions to synthesize gamma-aminobutyric acid (GABA) via decarboxylation. Autoantibodies to the GAD65 isoform have been found in high levels in neurological disorders including stiff person syndrome (SPS), autoimmune encephalitis, and refractory epilepsy. Low levels of anti-GAD65 have also been noted in type 1 diabetes mellitus. We present the unusual case of a woman with a longstanding history of focal seizures with impaired awareness and type 1 diabetes mellitus who was found to have extremely high titers of anti-GAD65 and clinical presentation suggestive of stiff person syndrome. This case highlights the increasing significance of autoimmune etiologies within neurologic disorders, as well as the importance of maintaining a high index of suspicion for rare anti-GAD65 syndromes. Although uncommon and with an unclear pathophysiology, we discuss the importance of establishing SPS diagnostic criteria to facilitate timely diagnosis and quickly direct patient management towards immunotherapy.
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Affiliation(s)
- Kieu-Tram Bach
- Clinical Sciences, California Northstate University College of Medicine, Sacramento, USA
| | - Shahini Ananth
- Clinical Sciences, California Northstate University College of Medicine, Sacramento, USA
| | - Ikjot Thind
- Clinical Sciences, California Northstate University College of Medicine, Sacramento, USA
| | - Ning Zhong
- Neurology, Kaiser Permanente Sacramento Medical Center, Sacramento, USA
| | - Forshing Lui
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
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Farkas MK, Beller C, Bozorg A, McClung C, Roebling R, Yates T, Yuen N, Makedonska I. Safety and tolerability of short-term infusions of intravenous lacosamide in pediatric patients with epilepsy: An open-label, phase 2/3 trial. Epilepsia Open 2023; 8:146-153. [PMID: 36529709 PMCID: PMC9977742 DOI: 10.1002/epi4.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the safety and tolerability of intravenous (IV) lacosamide infusion in patients aged ≥1 month to <17 years with epilepsy. METHODS This Phase 2/3 open-label trial (EP0060; NCT02710890) enrolled patients in two age cohorts (cohort 1: ≥8 to <17 years; cohort 2: ≥1 month to <8 years). Eligible patients were receiving oral lacosamide as adjunctive treatment or monotherapy (in an open-label long-term trial or by prescription) or were not receiving lacosamide before enrolment. Patients initiated IV lacosamide (2-12 mg/kg/day or 100-600 mg/day; 15-60 minutes infusion) as a replacement for oral lacosamide or as adjunctive treatment. The primary outcomes were treatment-emergent adverse events (TEAEs) and discontinuations due to TEAEs. RESULTS In total, 103 patients were enrolled and completed the trial; 55 patients were included in cohort 1 (≥8 to <17 years), 48 in cohort 2 (≥1 month to <8 years). During the 4 weeks before screening, 74 (71.8%) patients had focal seizures, 12 (11.7%) had generalized seizures, and two (1.9%) had unclassified seizures. Most patients (74 [71.8%]) initiated lacosamide as adjunctive IV treatment. The mean overall duration of exposure to IV lacosamide was 1.18 days. Seventy-nine (76.7%) patients had one IV lacosamide infusion, 20 (19.4%) had two, one (1.0%) had three, and three (2.9%) had 10 infusions. Overall, five (4.9%) patients had a total of seven TEAEs. The only TEAEs reported in two or more patients were increased blood triglycerides (two [1.9%]). No serious or severe TEAEs were reported, and no patients discontinued due to TEAEs. No TEAEs were considered drug-related by the investigator. No consistent or clinically relevant treatment-related changes from baseline were observed for hematology, clinical chemistry parameters, vital signs, or 12-lead electrocardiograms. SIGNIFICANCE IV lacosamide was generally well tolerated in pediatric patients (≥1 month to <17 years) with epilepsy, and no new safety concerns were identified.
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Affiliation(s)
| | | | - Ali Bozorg
- UCB Pharma, Morrisville, North Carolina, USA
| | | | | | | | - Nancy Yuen
- UCB Pharma, Morrisville, North Carolina, USA
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Macea J, Bhagubai M, Broux V, De Vos M, Van Paesschen W. In-hospital and home-based long-term monitoring of focal epilepsy with a wearable electroencephalographic device: Diagnostic yield and user experience. Epilepsia 2023; 64:937-950. [PMID: 36681896 DOI: 10.1111/epi.17517] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/02/2023] [Accepted: 01/19/2023] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim is to report the performance of an electroencephalogram (EEG) seizure-detector algorithm on data obtained with a wearable device (WD) in patients with focal refractory epilepsy and their experience. METHODS Patients used a WD, the Sensor Dot (SD), to measure two channels of EEG using dry electrode patches during presurgical evaluation and at home for up to 8 months. An automated seizure detection algorithm flagged EEG regions with possible seizures, which we reviewed to evaluate the algorithm's diagnostic yield. In addition, we collected data on usability, side effects, and patient satisfaction with an electronic seizure diary application (Helpilepsy). RESULTS Sixteen inpatients used the SD for up to 5 days and had 21 seizures. Sixteen outpatients used the device for up to 8 months and reported 101 focal impaired awareness seizures during the periods selected for analysis. Focal seizure detection sensitivity based on behind-the-ear EEG was 52% in inpatients and 23% in outpatients. False detections/h, positive predictive value (PPV), and F1 scores were 7.13%, .11%, and .002% for inpatients and 7.77%, .04%, and .001% for outpatients. Artifacts and low signal quality contributed to poor performance metrics. The seizure detector identified 19 nonreported seizures during sleep, when the signal quality was better. Regarding patients' experience, the likelihood of using the device at 6 months was 62%, and side effects were the main reason for dropping out. Finally, daily and monthly questionnaire completion rates were 33% and 65%, respectively. SIGNIFICANCE Focal seizure detection sensitivity based on behind-the-ear EEG was 52% in inpatients and 23% in outpatients, with high false alarm rates and low PPV and F1 scores. This unobtrusive wearable seizure detection device was well received but had side effects. The current workflow and low performance limit its implementation in clinical practice. We suggest different steps to improve these performance metrics and patient experience.
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Affiliation(s)
- Jaiver Macea
- Laboratory for Epilepsy Research, Department of Neurosciences and Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Department of Neurology, Leuven University Hospitals, Leuven, Belgium
| | - Miguel Bhagubai
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Victoria Broux
- Department of Neurology, Leuven University Hospitals, Leuven, Belgium
| | - Maarten De Vos
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, Department of Neurosciences and Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Department of Neurology, Leuven University Hospitals, Leuven, Belgium
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Tobochnik S, Bateman LM, Akman CI, Anbarasan D, Bazil CW, Bell M, Choi H, Feldstein NA, Kent PF, McBrian D, McKhann GM, Mendiratta A, Pack AM, Sands TT, Sheth SA, Srinivasan S, Schevon CA. Tracking Multisite Seizure Propagation Using Ictal High-Gamma Activity. J Clin Neurophysiol 2022; 39:592-601. [PMID: 34812578 PMCID: PMC8611231 DOI: 10.1097/wnp.0000000000000833] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Spatial patterns of long-range seizure propagation in epileptic networks have not been well characterized. Here, we use ictal high-gamma activity (HGA) as a proxy of intense neuronal population firing to map the spatial evolution of seizure recruitment. METHODS Ictal HGA (80-150 Hz) was analyzed in 13 patients with 72 seizures recorded by stereotactic depth electrodes, using previously validated methods. Distinct spatial clusters of channels with the ictal high-gamma signature were identified, and seizure hubs were defined as stereotypically recruited nonoverlapping clusters. Clusters correlated with asynchronous seizure terminations to provide supportive evidence for independent seizure activity at these sites. The spatial overlap between seizure hubs and interictal ripples was compared. RESULTS Ictal HGA was detected in 71% of seizures and 10% of implanted contacts, enabling tracking of contiguous and noncontiguous seizure recruitment. Multiple seizure hubs were identified in 54% of cases, including 43% of patients thought preoperatively to have unifocal epilepsy. Noncontiguous recruitment was associated with asynchronous seizure termination (odds ratio = 19.7; p = 0.029). Interictal ripples demonstrated greater spatial overlap with ictal HGA in cases with single seizure hubs compared with those with multiple hubs (100% vs. 66% per patient; p = 0.03). CONCLUSIONS Ictal HGA may serve as a useful adjunctive biomarker to distinguish contiguous seizure spread from propagation to remote seizure sites. High-gamma sites were found to cluster in stereotyped seizure hubs rather than being broadly distributed. Multiple hubs were common even in cases that were considered unifocal.
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Affiliation(s)
- Steven Tobochnik
- Brigham and Women’s Hospital, Department of Neurology, Boston, MA
| | - Lisa M. Bateman
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Cigdem I. Akman
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | | | - Carl W. Bazil
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Michelle Bell
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Hyunmi Choi
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Neil A. Feldstein
- Columbia University Medical Center, Department of Neurological Surgery, New York, NY
| | - Paul F. Kent
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Danielle McBrian
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | - Guy M. McKhann
- Columbia University Medical Center, Department of Neurological Surgery, New York, NY
| | - Anil Mendiratta
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Alison M. Pack
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Tristan T. Sands
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | - Sameer A. Sheth
- Baylor College of Medicine, Department of Neurosurgery, Houston, TX
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Rademacher M, Toledo M, Van Paesschen W, Liow KK, Milanov IG, Esch M, Wang N, MacPherson M, Byrnes WJ, Minh TDC, Webster E, Werhahn K. Efficacy and safety of adjunctive padsevonil in adults with drug-resistant focal epilepsy: Results from two double-blind, randomized, placebo-controlled trials. Epilepsia Open 2022; 7:758-770. [PMID: 36176044 PMCID: PMC9712475 DOI: 10.1002/epi4.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To characterize efficacy, safety/tolerability, and pharmacokinetics of padsevonil (PSL) administered concomitantly with ≤3 antiseizure medications (ASMs) for observable focal seizures in adults with drug-resistant epilepsy in two multicenter, randomized, double-blind, placebo-controlled, parallel-group trials. METHODS The phase 2b dose-finding trial (EP0091/NCT03373383) randomized patients 1:1:1:1:1 to PSL 50/100/200/400 mg or placebo twice daily (b.i.d.). The phase 3 efficacy trial (EP0092/NCT03739840) randomized patients 1:1:1:1 to PSL 100/200/400 mg or placebo b.i.d. Patients with observable (focal aware with motor symptoms, focal impaired awareness, focal to bilateral tonic-clonic) focal seizures for ≥3 years, experiencing them ≥4 times per 28 days including during the 4-week baseline period despite treatment with ≥4 lifetime ASMs including current ASMs, were enrolled. RESULTS In EP0091 and EP0092, 410 and 231 patients, respectively, were randomized and received at least one dose of trial medication. In patients in EP0091 on PSL 50/100/200/400 mg b.i.d. (n = 80/82/81/81, respectively) versus placebo (n = 81), outcomes included percentage reductions over placebo in observable focal seizure frequency during the 12-week maintenance period: 17.2%, 19.1% (p = 0.128), 19.2% (p = 0.128), 12.4% (p = 0.248); 75% responder rates (p-values for odds ratios): 13.8%, 12.2% (p = 0.192), 11.1% (p = 0.192), 16.0% (p = 0.124) versus 6.2%; 50% responder rates: 33.8% (p = 0.045), 31.7% (p = 0.079), 25.9% (p = 0.338), 32.1% (p = 0.087), versus 21.0%; TEAEs were reported by 82.7% (67/81), 78.3% (65/83), 74.4% (61/82), 90.1% (73/81) versus 78.3% (65/83). In patients in EP0092 on PSL 100/200/400 mg b.i.d. (n = 60/56/56, respectively) versus placebo (n = 54), outcomes included percentage reductions over placebo: -5.6% (p = 0.687), 6.5% (p = 0.687), 6.3% (p = 0.687); 75% responder rates: 15.3% (p = 0.989), 12.5% (p = 0.989), 14.3% (p = 0.989) versus 13.0%; 50% responder rates: 35.6% (p = 0.425), 33.9% (p = 0.625), and 42.9% (p = 0.125) versus 27.8%; TEAEs were reported by 80.0% (48/60), 78.9% (45/57), 83.1% (49/59) versus 67.3% (37/55). SIGNIFICANCE In both trials, the primary outcomes did not reach statistical significance in any PSL dose group compared with placebo. PSL was generally well tolerated, and no new safety signals were identified.
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Affiliation(s)
| | - Manuel Toledo
- Epilepsy Unit, Neurology DepartmentVall d'Hebron University HospitalBarcelonaSpain
| | | | - Kore K. Liow
- Comprehensive Epilepsy CenterHawaii Pacific NeuroscienceHonoluluHawaiiUSA
| | | | | | - Nan Wang
- UCB PharmaMorrisvilleNorth CarolinaUSA
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12
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Kim S, Degrauw T, Berg AT, Koh S. Staring Spells: How to Distinguish Epileptic Seizures from Nonepileptic Staring. J Child Neurol 2022; 37:738-743. [PMID: 35746887 DOI: 10.1177/08830738221103090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the nature of staring spells and factors distinguishing epileptic from nonepileptic staring spells, we studied the clinical and demographic features of children with staring spells referred to a regional new-onset seizure clinic. STUDY DESIGN Our retrospective chart review encompassed 2818 consecutive patients evaluated in the new-onset seizure clinic between September 22, 2015, and March 19, 2018. We identified 121 patients with newly presenting staring spells. RESULTS Sixty-two of 121 (51%) children were diagnosed with nonepileptic staring spells and 59 (49%) with epileptic seizures (24 with absence epilepsy, 35 with focal epilepsy). Patients with nonepileptic staring spells were younger (4.8 vs 7.1 years, P = .001) and more likely to have developmental delay (P = .005) than the seizure group. There was an 8.9-month delay on average from the onset of staring spells to the new-onset seizure clinic visit. The emergency department was a referral source for 80% (28/35) of focal seizures. In children with focal seizures, the staring spells typically lasted >1minute (29/35, 83%), whereas only 19 of 62 (31%) of children with nonepileptic staring spells had events lasting this long (P = .04). All children had a routine electroencephalography (EEG) on the day of new-onset seizure clinic visit. EEG was diagnostic in 100% (24/24) of absence seizures and 51% (18/35) of focal seizures. CONCLUSIONS In children presenting with staring spells, the differential diagnosis of epileptic staring spells vs nonepileptic staring spells can be made by history and routine EEG. Staring was as likely to be epileptic as nonepileptic spells. Younger children with developmental delay were more likely to have nonepileptic events. Our simple approach based on event duration, postictal symptoms, and EEG allowed identification of epileptic staring on first visit to new-onset seizure clinic but requires validation in future prospective studies including long-term video EEG monitoring and follow-up.
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Affiliation(s)
- Seunghyo Kim
- Department of Pediatrics, 138610Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, 37984Jeju National University School of Medicine, Jeju-si, Jeju, South Korea
| | - Ton Degrauw
- Department of Pediatrics, 138610Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne T Berg
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Sookyong Koh
- Department of Pediatrics, 138610Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, 12284University of Nebraska Medical Center and Children's Hospital & Medical Center, Omaha, NE, USA
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13
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Hu Y, Dai H. Cost-effectiveness of perampanel as an adjunctive treatment for uncontrolled focal seizures in pediatric patients: a Chinese perspective. Ann Transl Med 2022; 10:364. [PMID: 35433936 PMCID: PMC9011307 DOI: 10.21037/atm-22-994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
Background The incidence of epilepsy is 41-187 per 100,000 person-year in children. The health care costs for children with uncontrolled epilepsy is a huge burden. Perampanel (PER) was effective, safety and well-tolerated as add-on therapy in pediatric patients aged 4 to <12 years with uncontrolled focal seizures. However, there is still limited evidence on cost-effectiveness of PER in pediatric patients. We aimed to evaluate the cost-effectiveness of PER as an add-on therapy for pediatric patients with uncontrolled focal seizures. Methods A Markov model was established to conduct an analysis from the perspective of the Chinese health system and society. The incremental cost-effectiveness ratio (ICER) of patients using PER and conventional therapy versus patients using conventional therapy alone were estimated and compared. The transition probability of the response level, health state utility values, and costs were derived from clinical trials and the literature. Costs, including medical, drug, transportation and indirect costs, were calculated. We performed 1-way sensitivity analyses and probabilistic sensitivity analyses. A subgroup analysis of different ages was also conducted. Results The base-case analysis indicated that compared to maintaining conventional therapy, adding PER as an adjuvant drug therapy had an increased cost of $3,449.85 over 5 years, with an incremental quality-adjusted life years (QALY) value of 0.40, resulting in an ICER of $8,582.58 per additional QALY. The health state utility value had the greatest effect on the ICER. The probabilistic sensitivity analyses showed that the probability of PER being cost-effective was 76.72% at a willingness-to-pay of $11,293/QALY. The ICER of the subgroup ranged from $7,167.95/QALY to $19,710.96/QALY. Conclusions Our study demonstrated that PER is a cost-effective add-on therapy for pediatric patients.
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Affiliation(s)
- Yani Hu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibin Dai
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Farkas MK, Kang H, Fogarasi A, Bozorg A, James GD, Krauwinkel W, Morita D, Will E, Elshoff JP. Pharmacokinetics, safety, and tolerability of intravenous brivaracetam in pediatric patients with epilepsy: An open-label trial. Epilepsia 2022; 63:855-864. [PMID: 35196395 PMCID: PMC9303197 DOI: 10.1111/epi.17187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
Objective To evaluate the pharmacokinetics, safety, and tolerability of brivaracetam (BRV) as 15‐min intravenous (IV) infusion and bolus (≤2‐min injection). Methods EP0065 (ClinicalTrials.gov: NCT03405714) was a Phase 2, multicenter, open‐label trial in patients ≥1 month to <16 years of age with epilepsy. Patients received up to 5 mg/kg/day BRV (not exceeding 200 mg/day). Enrollment was sequential by descending age, depending on safety review. Outcomes included BRV plasma concentrations before and after IV administration, treatment‐emergent adverse events (TEAEs), and discontinuations due to TEAEs. Results Fifty patients were enrolled, received BRV, and completed the trial. Twenty‐six patients (52.0%) received 15‐min infusions and 24 (48.0%) received bolus injections. Most patients (80.0%) received one IV dose. In the 15‐min infusion group, geometric mean (GeoMean) BRV concentrations 15 (±2) min (n = 21) and 3 h (±15 min) (n = 21) post dose were 1903.0 ng/mL (geometric coefficient of variation [GeoCV]: 60.7%) and 1130.3 ng/mL (58.8%), respectively. In the bolus group, GeoMean BRV concentrations 15 (±2) min (n = 19) and 3 h (±15 min) (n = 21) post dose were 1704.8 ng/mL (GeoCV: 74.5%) and 1383.9 ng/mL (85.0%), respectively. Overall, 14 patients (28.0%) had TEAEs (15‐min infusion: 8 [30.8%]; bolus: 6 [25.0%]), most commonly (≥5% of patients) somnolence (3 [6.0%]). Ten patients (20.0%) had drug‐related TEAEs (15‐min infusion: 6 [23.1%]; bolus: 4 [16.7%]). No patients discontinued due to TEAEs, and no deaths occurred. Significance IV BRV (up to 200 mg/day) was well tolerated in patients ≥1 month to <16 years of age, regardless of whether BRV was administered as 15‐min infusion or bolus. No unexpected safety or pharmacokinetic differences were observed between patients receiving 15‐min infusions or bolus, and plasma concentrations were in the expected range. Safety results were consistent with the known safety profile of oral BRV, with no new safety concerns identified.
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Affiliation(s)
| | - Harriet Kang
- Department of Neurology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Andras Fogarasi
- Child Neurology Department, Bethesda Children's Hospital, Budapest, Hungary
| | - Ali Bozorg
- UCB Pharma, Morrisville, North Carolina, USA
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15
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Neshige S, Yamada H, Maruyama H. Emotional Facial Paresis in Temporal Lobe Epilepsy. Intern Med 2021; 60:2705-2706. [PMID: 33678751 PMCID: PMC8429307 DOI: 10.2169/internalmedicine.6970-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
- Epilepsy Center, Hiroshima University Hospital, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
- Epilepsy Center, Hiroshima University Hospital, Japan
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16
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Fonti D, Lagarde S, Scholly J, Lépine A, Scavarada D, Puligheddu M, McGonigal A, Bartolomei F. Anatomical electroclinical correlations during an SEEG-recorded seizure with autoscopic hallucination. Epileptic Disord 2020; 22:817-22. [PMID: 33331274 DOI: 10.1684/epd.2020.1228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Autoscopic phenomena (AP) are characterized by seeing an image of oneself in extra-personal space. These phenomena are rare and the anatomy of brain regions producing these phenomena is not well defined. We report anatomical electroclinical correlations during a stereoelectroencephalography-recorded seizure with autoscopic hallucination (a form of AP in which the double of oneself is seen from an internal point of view). Seizure onset zone was quantified using the epileptogenicity index method (EI). Maximal EI values were obtained in the left lateral parietal cortex (supramarginal gyrus) and high values were also found in the left posterior-superior insular cortex, left temporo-occipital junction and contralateral inferior parietal lobule. Our case confirms the involvement of the inferior parietal lobule, temporo-parieto-occipital junction and posterior insula in the genesis of autoscopic hallucination.
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17
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Najafi MR, Najafi MA, Shayan-Moghadam R, Saadatpour Z, Ghadimi K. Comparison of the efficacy of Tegatard and Tegretol as a monotherapy in patients with focal seizure with or without secondary generalization. Am J Clin Exp Immunol 2020; 9:58-63. [PMID: 33235821 PMCID: PMC7677516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/22/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Carbamazepine is a first line treatment for focal epilepsy. Tegretol and Tegatard are two trade name of Carbamazepine. Tegretol is produced by Novartis Pharmaceutical Company, Switzerland. Recently, Raha pharmaceutical Company in Iran has produced CBZ which trade named is Tegatard. Extended usage of Tegatard instead of Tegretol has economic benefits for Iranian families. In this clinical trial, we aimed to compare therapeutic efficacy and safety of Tegretol and Tegatard in patients suffering from focal seizures with or without secondary generalization. METHODS 200 patients with provoked or non-provoked focal seizure with or without secondary generalization were screened and 180 patients were fulfilled the criteria to enter this double blinded clinical trial study. Patients were divided into two groups, the first group (A) received Tegretol and the second group (B) Tegatard. Carbamazepine (CBZ) was prescribed with doses 10-20 mg/kg every 12 hours by neurologists. The patients were visited after 1, 3 and 6 months and the side effects and lab data in patients were investigated. RESULTS Patients were divided into two groups, 88 patients in group A (Tegretol) (50 males and 38 females) and 92 in group B (Tegatard) (51 males and 41 females). Mean age of patients was 35.39±11.17 years. There was no significant difference according to age and gender, Carbamazepine dosage, EEG recording, neuroimaging change and adverse effects of antiepileptic drug between two groups (P>0.05). Regarding the drug efficacy, in group A and B, 60 (68%) and 58 (63%) patients were seizure free after 6 month follow up; respectively. The differences between two groups were not statistically significant (P value =0.46). CONCLUSION Tegatard is an effective drug with similar efficacy, similar side effects and cost-effectiveness compared with Tegretol and could be used widely when indicated.
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Affiliation(s)
- Mohammad Reza Najafi
- Professor of Neurology, Department of Neurology, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mohammad Amin Najafi
- Medical Student, Isfahan University of Medical Sciences, Faculty of MedicineIsfahan, Iran
- Isfahan Neurosciences Research Centre (INRC), Affiliated to Isfahan University of Medical SciencesIsfahan, Iran
| | - Ramin Shayan-Moghadam
- Medical Student, Isfahan University of Medical Sciences, Faculty of MedicineIsfahan, Iran
- Isfahan Neurosciences Research Centre (INRC), Affiliated to Isfahan University of Medical SciencesIsfahan, Iran
| | - Zahra Saadatpour
- Department of Radiology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Keyvan Ghadimi
- Medical Student, Isfahan University of Medical Sciences, Faculty of MedicineIsfahan, Iran
- Isfahan Neurosciences Research Centre (INRC), Affiliated to Isfahan University of Medical SciencesIsfahan, Iran
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18
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Abramo TJ, McKinney S, Moore J, Jacobs R, Albert G, Meredith M, Porter NH, Storm E, Willis E, Gonzalez CV, Hargrave H, Schneider B, Sharp G. Hemispheric Cerebral Oximetry Monitoring During Pediatric Seizure Activity in a Pediatric Emergency Department. Pediatr Emerg Care 2020; 36:e513-26. [PMID: 29140931 DOI: 10.1097/PEC.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sustained neuronal activity during seizures causes cellular perturbations, alterations in cerebral physiology, and potentially neurological injury, a neurological emergency. With variable clinical manifestations of seizures, frequent failure of seizure recognition by providers in pediatric and developmentally challenged patients can increase seizure complications. Neuroresuscitation should include rapid cerebral physiology assessment for increased seizure recognition and optimal neurological outcomes. In neurological emergencies, cerebral oximetry has demonstrated its utility in altered cerebral physiology and a standard combat neurological assessment tool. During adult seizures, cerebral oximetry (regional cerebral oxygen saturation [rcSO2]) has been shown as a useful neurological assessment tool, but research is lacking in pediatric emergency department (PED) seizure patients. OBJECTIVE The aim of this study was to identify trends in rcSO2 readings for patients presenting to the PED with seizure activity and in the postseizure state in order to evaluate usefulness of rcSO2 as a neurological assessment tool in pediatric seizure patients. METHODS This was a PED observational case series comparing hemispheric rcSO2 readings in first-time clinically evident generalized and focal seizure patients to first-time postseizure patients with no PED seizures. RESULTS Generalized or focal seizure (n = 185) hemispheric rcSO2 revealed significant differences compared with nonseizure and controls' rcSO2 readings (n = 115) (P < 0.0001). Generalized and focal seizure rcSO2's were either less than 60% or greater than 80% compared with nonseizure rcSO2 (P < 0.0001). Ipsilateral focal seizure rcSO2 correlated to seizure side (P < 0.0001) and was less than the contralateral rcSO2 (P < 0.0001), with interhemispheric rcSO2 discordance greater than 16 (P < 0.0001). Seizure to preseizure rcSO2 discordance was as follows: generalized 15.2, focal: left 19.8, right 20.3 (P < 0.0001). CONCLUSIONS Hemispheric during-seizure rcSO2 readings significantly correlated with generalized and focal seizures and reflected altered cerebral physiology. Ipsilateral focal seizure rcSO2 readings correlated to the focal side with wide interhemispheric rcSO2 discordance. All postseizure rcSO2 readings returned to preseizure readings, showing altered cerebral physiology resolution. Overall, in generalized or focal seizure, rcSO2 readings were less than 60% or greater than 80%, and in focal seizure, interhemispheric rcSO2 discordance was greater than 10. During seizures, hemispheric rcSO2 readings demonstrated its potential pediatric seizure utility. Utilizing rcSO2 readings related to seizure activity could expedite pediatric and developmentally challenged patients' seizure recognition, cerebral assessment, and interventions especially in pharmacoresistant seizures.
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19
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Mehta D, Davis M, Epstein AJ, Williams GR. Healthcare Resource Utilization Pre- and Post-Initiation of Eslicarbazepine Acetate Among Pediatric Patients with Focal Seizure: Evidence from Routine Clinical Practice. Clinicoecon Outcomes Res 2020; 12:379-387. [PMID: 32801808 PMCID: PMC7384864 DOI: 10.2147/ceor.s261960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the impact of initiating treatment with eslicarbazepine acetate (ESL) on healthcare resource utilization (HCRU) among pediatric patients with focal seizures (FS). Methods This retrospective study used Symphony Health’s Integrated Dataverse® claims data. Patients aged 4 to 17 years with a diagnosis of FS and a new prescription for ESL between April 2015 and June 2018 were included and defined as the overall patient population. Index date was the first dispensed claim for ESL. Baseline period was the 90-day block immediately prior to the index date. The follow-up period comprised up to 4 consecutive 90-day blocks immediately following the index date. Subgroups were defined based on the presence (DP+) or absence (DP−) of developmental and/or psychiatric disorders at baseline. All-cause and FS-related inpatient (IP), emergency room (ER), outpatient (OP) hospital, and office (OF) visits were measured during the follow-up period. Reduction in HCRU per block in the post-ESL period was assessed using fixed-effects linear regression models. Results A total of 234 patients were included in the overall study population, of whom 86 (36.8%) were DP+ and 148 (63.2%) were DP−. Relative to the baseline period, significant reductions were observed in the overall population for all-cause ER (P=0.001), OP (P<0.001), and OF (P<0.001) visits and FS-related IP (P=0.037) and OF (P<0.001) visits in the follow-up period. Among DP+ and DP− patients, significant reductions were observed for all-cause ER (DP+: P=0.024; DP−: P=0.017), OP (DP+: P<0.001; DP−: P=0.035), and OF (DP+: P=0.004; DP−: P=0.001) visits during the follow-up period. No significant differences were observed between DP+ and DP− patients in the change in all-cause or FS-related HCRU from baseline to the follow-up period. Conclusion Pediatric patients with FS (DP+ and DP-) who initiated ESL had significant reductions in all-cause ER, OP, and OF visits and FS-related IP and OF visits.
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Affiliation(s)
- Darshan Mehta
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Matthew Davis
- Health Economics and Outcomes Research, Medicus Economics, LLC, Milton, MA, USA
| | - Andrew J Epstein
- Health Economics and Outcomes Research, Medicus Economics, LLC, Milton, MA, USA
| | - G Rhys Williams
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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20
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Ryvlin P, Cammoun L, Hubbard I, Ravey F, Beniczky S, Atienza D. Noninvasive detection of focal seizures in ambulatory patients. Epilepsia 2020; 61 Suppl 1:S47-S54. [PMID: 32484920 PMCID: PMC7754288 DOI: 10.1111/epi.16538] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 02/02/2023]
Abstract
Reliably detecting focal seizures without secondary generalization during daily life activities, chronically, using convenient portable or wearable devices, would offer patients with active epilepsy a number of potential benefits, such as providing more reliable seizure count to optimize treatment and seizure forecasting, and triggering alarms to promote safeguarding interventions. However, no generic solution is currently available to reach these objectives. A number of biosignals are sensitive to specific forms of focal seizures, in particular heart rate and its variability for seizures affecting the neurovegetative system, and accelerometry for those responsible for prominent motor activity. However, most studies demonstrate high rates of false detection or poor sensitivity, with only a minority of patients benefiting from acceptable levels of accuracy. To tackle this challenging issue, several lines of technological progress are envisioned, including multimodal biosensing with cross‐modal analytics, a combination of embedded and distributed self‐aware machine learning, and ultra–low‐power design to enable appropriate autonomy of such sophisticated portable solutions.
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Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland
| | - Leila Cammoun
- Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland
| | - Ilona Hubbard
- Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland
| | - France Ravey
- Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - David Atienza
- Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland.,Embedded Systems Laboratory, Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland
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21
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Borges K, Kaul N, Germaine J, Carrasco-Pozo C, Kwan P, O'Brien TJ. Open-label long-term treatment of add-on triheptanoin in adults with drug-resistant epilepsy. Epilepsia Open 2020; 5:230-239. [PMID: 32524048 PMCID: PMC7278596 DOI: 10.1002/epi4.12391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/09/2020] [Accepted: 03/19/2020] [Indexed: 12/30/2022] Open
Abstract
Objective To investigate feasibility, safety, and tolerability of long‐term (48 weeks) add‐on treatment with triheptanoin (UX007), the triglyceride of heptanoate, in adults with drug‐resistant epilepsy. Methods This extension study was offered to adult participants with drug‐resistant epilepsy who completed a 12‐week randomized controlled trial of add‐on medium‐chain triglycerides (MCT) vs triheptanoin. Participants were asked to titrate triheptanoin to their maximum tolerated dose over 3 weeks, followed by 48‐week maintenance before tapering or treatment extension. The primary aims were to assess retention and safety of the triheptanoin treatment, and secondary aims to assess the tolerated doses and changes in seizure frequency. Results Eleven adults were enrolled and ten people were analyzed (because one patient was diagnosed as having nonepileptic seizures while on the study). Two adults finished the study and extended their treatment. Eight participants withdrew from the study, due to lack of efficacy (n = 3), unknown reasons (n = 2), belief of weight gain (n = 1), wanting to try a different treatment (n = 1), and a colonoscopy (n = 1). Diarrhea in two people and bloating in one person were deemed possibly related to treatment, but other adverse events were not. The duration of maintenance treatment dose was 27‐513 days (median 247 days, range 27‐513 days), and 0.49 ‐1.1 mL/kg triheptanoin was taken per day (0.77 ± 0.19 mL/kg, mean ± standard deviation, 40‐100 mL/d). Two participants experienced >90% and three people >50% reduction in seizure frequency, and all had focal seizures. The median seizure reduction was 48% (average 38%). Significance Our results indicate antiseizure effects of triheptanoin on focal seizures in 5 out of 10 adults. However, only two people finished and extended the 48‐week add‐on treatment phase, despite lack of safety or tolerability issues. More studies focused on improved treatment formulations, the potential of lower dosages, and efficacy are needed. Trial registration number: ACTRN12615000406505.
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Affiliation(s)
- Karin Borges
- School of Biomedical Sciences Faculty of Medicine The University of Queensland St. Lucia QLD Australia
| | - Neha Kaul
- Department of Allied Health (Clinical Nutrition) Royal Melbourne Hospital University of Melbourne Parkville Vic Australia.,Departments of Medicine and Neurology Royal Melbourne Hospital University of Melbourne Parkville Vic Australia.,Departments of Neuroscience and Neurology The Central Clinical School Monash University and The Alfred Hospital Melbourne Vic Australia
| | - Jack Germaine
- Departments of Neuroscience and Neurology The Central Clinical School Monash University and The Alfred Hospital Melbourne Vic Australia
| | - Catalina Carrasco-Pozo
- Discovery Biology Griffith Institute for Drug Discovery Griffith University Nathan QLD Australia
| | - Patrick Kwan
- Departments of Medicine and Neurology Royal Melbourne Hospital University of Melbourne Parkville Vic Australia.,Departments of Neuroscience and Neurology The Central Clinical School Monash University and The Alfred Hospital Melbourne Vic Australia
| | - Terence J O'Brien
- Departments of Medicine and Neurology Royal Melbourne Hospital University of Melbourne Parkville Vic Australia.,Departments of Neuroscience and Neurology The Central Clinical School Monash University and The Alfred Hospital Melbourne Vic Australia
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22
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O'Brien TJ, Borghs S, He QJ, Schulz AL, Yates S, Biton V. Long-term safety, efficacy, and quality of life outcomes with adjunctive brivaracetam treatment at individualized doses in patients with epilepsy: An up to 11-year, open-label, follow-up trial. Epilepsia 2020; 61:636-646. [PMID: 32221987 PMCID: PMC7384045 DOI: 10.1111/epi.16484] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/05/2022]
Abstract
Objective To evaluate long‐term safety/tolerability of brivaracetam at individualized doses ≤200 mg/d (primary) and maintenance of efficacy over time (secondary) in adults with focal seizures or primary generalized seizures (PGS) enrolled in phase 3, open‐label, long‐term follow‐up trial N01199 (NCT00150800). Methods Patients ≥16 years of age who had completed double‐blind, placebo‐controlled adjunctive brivaracetam trials NCT00175825, NCT00490035, NCT00464269, or NCT00504881 were eligible. Outcomes included safety, efficacy, and quality of life. Results The safety set included 667 patients (focal seizures, 97.8%; PGS, 2.2%); the efficacy set included 648 patients with focal seizures and 15 patients with PGS. Overall, 49.2% of patients had ≥48 months of exposure. Treatment‐emergent adverse events (TEAEs) occurred in 91.2% of all patients (91.3% of focal seizures group), brivaracetam discontinuation due to TEAEs in 14.8%, drug‐related TEAEs in 56.7%, and serious TEAEs in 22.8%. The most common TEAEs in the focal seizures group (≥15%) were headache (25.3%) and dizziness (21.9%). Mean changes from baseline in Hospital Anxiety and Depression Scale scores at last value during 2‐year evaluation were −0.7 (standard deviation [SD] = 4.3) and −0.2 (SD = 4.4) overall. In the focal seizures group, median reduction from baseline in focal seizure frequency/28 days was 57.3%, 50% responder rate was 55.6%, and 6‐month and 12‐month seizure freedom rates were 30.3% and 20.3%, respectively. Efficacy outcomes improved by exposure duration cohort and then stabilized through the 108‐month cohort. Mean improvement from baseline in Patient‐Weighted Quality of Life in Epilepsy Inventory total score (efficacy set) was 5.7 (SD = 16.1, Cohen's d = 0.35) at month 12 and 6.5 (SD = 18.0, Cohen's d = 0.36) at month 24. Significance Adjunctive brivaracetam was well tolerated, with a good safety profile in long‐term use in adults with epilepsy at individualized doses. Approximately half of the patients remained in the trial at 4 years. Brivaracetam reduced focal seizure frequency versus baseline. Efficacy improved with increasing exposure duration and remained stable through the 9‐year cohort.
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Affiliation(s)
- Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Alfred Health, Monash University, Melbourne, Victoria, Australia.,Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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23
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Liou JY, Smith EH, Bateman LM, Bruce SL, McKhann GM, Goodman RR, Emerson RG, Schevon CA, Abbott LF. A model for focal seizure onset, propagation, evolution, and progression. eLife 2020; 9:50927. [PMID: 32202494 PMCID: PMC7089769 DOI: 10.7554/elife.50927] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/04/2020] [Indexed: 12/16/2022] Open
Abstract
We developed a neural network model that can account for major elements common to human focal seizures. These include the tonic-clonic transition, slow advance of clinical semiology and corresponding seizure territory expansion, widespread EEG synchronization, and slowing of the ictal rhythm as the seizure approaches termination. These were reproduced by incorporating usage-dependent exhaustion of inhibition in an adaptive neural network that receives global feedback inhibition in addition to local recurrent projections. Our model proposes mechanisms that may underline common EEG seizure onset patterns and status epilepticus, and postulates a role for synaptic plasticity in the emergence of epileptic foci. Complex patterns of seizure activity and bi-stable seizure end-points arise when stochastic noise is included. With the rapid advancement of clinical and experimental tools, we believe that this model can provide a roadmap and potentially an in silico testbed for future explorations of seizure mechanisms and clinical therapies.
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Affiliation(s)
- Jyun-You Liou
- Department of Physiology and Cellular Biophysics, Columbia University, New York, United States.,Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, United States.,Department of Neurology, Columbia University Medical Center, New York, United States
| | - Elliot H Smith
- Department of Neurological Surgery, Columbia University Medical Center, New York, United States
| | - Lisa M Bateman
- Department of Neurology, Columbia University Medical Center, New York, United States
| | - Samuel L Bruce
- Vagelos College of Physicians & Surgeons, Columbia University, New York, United States
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, United States
| | - Robert R Goodman
- Department of Neurological Surgery, Columbia University Medical Center, New York, United States
| | - Ronald G Emerson
- Department of Neurology, Columbia University Medical Center, New York, United States
| | - Catherine A Schevon
- Department of Neurology, Columbia University Medical Center, New York, United States
| | - L F Abbott
- Department of Physiology and Cellular Biophysics, Columbia University, New York, United States.,Mortimer B. Zuckerman Mind Brain Behavior Institute, Department of Neuroscience, Columbia University, New York, United States
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24
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Devarbhavi H. Rolandic Epilepsy as a Heralding Manifestation of Wilson Disease in a 6-Year-Old Girl. J Clin Exp Hepatol 2020; 10:633-635. [PMID: 33311898 PMCID: PMC7720023 DOI: 10.1016/j.jceh.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Wilson disease (WD) manifesting as seizure is rare. Rolandic epilepsy as presenting feature of WD has been reported only once before. METHODS A 6-year-old girl of nonconsanguineous parentage presented with focal seizures. There was associated fatty hepatomegaly and elevated aminotransferases. RESULTS Brain magnetic resonance imaging (MRI) was unremarkable. Electroencephalogram demonstrated bilateral centrotemporal spike classical of Rolandic epilepsy. Serum ceruloplasmin was low and 24-h urinary copper levels were elevated. Genetic mutational analysis showed she carried the rare homozygous p.Asn1270Ser genetic mutation. Administration of d-penicillamine gradually halted seizure activity together with near normalization of serum aminotransferases. CONCLUSIONS Rolandic epilepsy associated with elevated liver enzymes should undergo evaluation for WD. Chelators have a salutary effect on seizure activity, as well as elevated serum aminotransferases.
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Affiliation(s)
- Harshad Devarbhavi
- Address for correspondence: Harshad Devarbhavi, MD, Department of Gastroenterology & Hepatology, St. John's Medical College Hospital, Bangalore 560034, India.
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25
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Abstract
Coughing is a reflex phenomenon that is protective for the upper airways, involving both a reflex arc in the brainstem and cortical control. Ictal coughing has been prominently reported in temporal lobe seizures, but precise anatomo-electrical correlations are lacking. We report a patient who presented with persistent coughing at seizure onset. We studied intracerebrally recorded seizures (using stereo-electroencephalography) in order to describe the anatomo-functional correlations associated with this sign. Coughing followed seizure onset in the medial temporal lobe. A functional connectivity study (h2 estimation of interdependencies) showed that during coughing, a network of cortical and subcortical regions was involved, particularly the perisylvian cortices and the caudate nucleus.
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26
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Iimura Y, Jones K, Takada L, Shimizu I, Koyama M, Hattori K, Okazawa Y, Nonoda Y, Asano E, Akiyama T, Go C, Ochi A, Snead OC, Donner EJ, Rutka JT, Drake JM, Otsubo H. Strong coupling between slow oscillations and wide fast ripples in children with epileptic spasms: Investigation of modulation index and occurrence rate. Epilepsia 2018; 59:544-554. [PMID: 29315516 DOI: 10.1111/epi.13995] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Epileptic spasms (ES) often become drug-resistant. To reveal the electrophysiological difference between children with ES (ES+) and without ES (ES-), we compared the occurrence rate (OR) of high-frequency oscillations (HFOs) and the modulation index (MI) of coupling between slow and fast oscillations. In ES+, we hypothesized that (1) pathological HFOs are more widely distributed and (2) slow oscillations show stronger coupling with pathological HFOs than in ES-. METHODS We retrospectively reviewed 24 children with drug-resistant multilobar onset epilepsy, who underwent intracranial video electroencephalography prior to multilobar resections. We measured the OR of HFOs and determined the electrodes with a high rate of HFOs by cluster analysis. We calculated MI, which reflects the degree of coupling between HFO (ripple/fast ripple [FR]) amplitude and 5 different frequency bands of delta and theta activities (0.5-1 Hz, 1-2 Hz, 2-3 Hz, 3-4 Hz, 4-8 Hz). RESULTS In ES+ (n = 10), the OR(FRs) , the number of electrodes with high-rate FRs, and the MI(FRs & 3-4 Hz) in all electrodes were significantly higher than in ES- (n = 14). In both the ES+ and ES- groups, MI(ripples/FRs & 3-4 Hz) was the highest among the 5 frequency bands. Within the good seizure outcome group, the OR(FRs) and the MI(FRs & 3-4 Hz) in the resected area in ES+ were significantly higher than in ES- (OR[FRs] , P = .04; MI[FRs & 3-4 Hz] , P = .04). SIGNIFICANCE In ES+, the larger number of high-rate FR electrodes indicates more widespread epileptogenicity than in ES-. High values of OR(FRs) and MI(FRs & 3-4 Hz) in ES+ compared to ES- are a signature of the severity of epileptogenicity. We proved that ES+ children who achieved seizure freedom following multilobar resections exhibited strong coupling between slow oscillations and FRs.
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Affiliation(s)
- Yasushi Iimura
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin Jones
- Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lynne Takada
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Itsuki Shimizu
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Misaki Koyama
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyoko Hattori
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yushi Okazawa
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yutaka Nonoda
- Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | - Eishi Asano
- Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | - Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Hospital, Okayama, Japan
| | - Cristina Go
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth J Donner
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
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27
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Abstract
Seizures are a diverse and very common set of chronic neurologic disorders in humans and dogs but are less common in horses. Seizures refer to a specific clinical event (described as sudden and severe) regardless of the etiology, which includes both intracranial and extracranial causes. Therefore, after briefly reviewing some definitions, this article aims to describe the use of a standardized classification, which could facilitate a logical approach for the clinician to establish a diagnosis, as well as to use a consistent mode of communication. For instance, seizures can be classified by type (ie, focal vs generalized) or etiology (ie, reactive, symptomatic, cryptogenic, idiopathic). In particular, epilepsy, a brain disorder characterized by recurrent seizures can be classified as primary (ie, genetic origin) or secondary (ie, acquired). This review further discusses the limitations associated with the clinical workup of horses with seizures. This is germane to the fact that the identification of the underlying cause remains challenging due to the technical limitations of imaging the equine adult brain. Indeed, as in man and dogs, epilepsies of unknown cause (ie, cryptogenic) account for the majority of all epilepsies. Therefore, although electroencephalography and advanced brain imaging techniques (eg, computed tomography and magnetic resonance imaging) are becoming increasingly available, information obtained from the history, physical, and neurologic examinations and progression of clinical signs and response to treatment remain essential in the workup of horses with seizures.
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Affiliation(s)
- Véronique A Lacombe
- Department of Physiological Sciences, Oklahoma State University Center for Veterinary Health Sciences, Stillwater, OK, USA,
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28
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Martinet LE, Ahmed OJ, Lepage KQ, Cash SS, Kramer MA. Slow Spatial Recruitment of Neocortex during Secondarily Generalized Seizures and Its Relation to Surgical Outcome. J Neurosci 2015; 35:9477-90. [PMID: 26109670 DOI: 10.1523/JNEUROSCI.0049-15.2015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Understanding the spatiotemporal dynamics of brain activity is crucial for inferring the underlying synaptic and nonsynaptic mechanisms of brain dysfunction. Focal seizures with secondary generalization are traditionally considered to begin in a limited spatial region and spread to connected areas, which can include both pathological and normal brain tissue. The mechanisms underlying this spread are important to our understanding of seizures and to improve therapies for surgical intervention. Here we study the properties of seizure recruitment-how electrical brain activity transitions to large voltage fluctuations characteristic of spike-and-wave seizures. We do so using invasive subdural electrode arrays from a population of 16 patients with pharmacoresistant epilepsy. We find an average delay of ∼30 s for a broad area of cortex (8 × 8 cm) to be recruited into the seizure, at an estimated speed of ∼4 mm/s. The spatiotemporal characteristics of recruitment reveal two categories of patients: one in which seizure recruitment of neighboring cortical regions follows a spatially organized pattern consistent from seizure to seizure, and a second group without consistent spatial organization of activity during recruitment. The consistent, organized recruitment correlates with a more regular, compared with small-world, connectivity pattern in simulation and successful surgical treatment of epilepsy. We propose that an improved understanding of how the seizure recruits brain regions into large amplitude voltage fluctuations provides novel information to improve surgical treatment of epilepsy and highlights the slow spread of massive local activity across a vast extent of cortex during seizure.
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29
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Zimmerman EM, Konopka LM. Preliminary Findings of Single- and Multifocused Epileptiform Discharges in Nonepileptic Psychiatric Patients. Clin EEG Neurosci 2014; 45:285-292. [PMID: 24293160 DOI: 10.1177/1550059413506001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 07/15/2013] [Accepted: 08/14/2013] [Indexed: 11/17/2022]
Abstract
Epileptiform discharges (EDs) in nonepileptic populations remain controversial as to their role in psychopathology. Previous studies have unsuccessfully attempted to correlate specific waveforms of EDs, defined by duration and morphology, with broad diagnostic categories such as depression and anxiety. These diagnostic categories often include heterogeneous patient populations, with potentially divergent biological underpinnings of clinical presentation. This study examined epileptiform activities as a single phenomenon, identifying the relationships between distribution patterns of EDs and endorsement of clinical symptoms across affective, cognitive, and somatic domains. In a sample of 71 nonepileptic psychiatric patients, those with EDs appearing in homologous electrode pairs endorsed significantly fewer symptoms related to affective deregulation. These patients were also significantly less likely to endorse a history of severe symptomatology, including suicidal ideation/previous attempt, self-injurious behavior, psychoses or dissociation, and previous psychiatric hospitalization. Conversely, patients with isolated EDs focused to a single brain region endorsed greater affective deregulation and severe clinical symptoms. These findings offer new possibilities regarding the potentially protective role that EDs may play when distributed across hemispheres, particularly in light of recent theories exploring functional connectivity of neuronal networks.
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Affiliation(s)
| | - Lukasz M Konopka
- Yellowbrick, Evanston, IL, USA.,Loyola University, Chicago, IL, USA
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30
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Abstract
BACKGROUND Cerebral aneurysms most commonly present with subarachnoid hemorrhage (SAH), a catastrophic event. However, 11-15% of unruptured aneurysms are symptomatic, with presentations including seizures, unilateral cranial nerve deficits, visual loss, headache, and ischemia. Of patients presenting with seizures, the semiology described includes speech arrest, "feelings of dread," localized pins and needles, and tonic clonic episodes. We report the case of a patient who presented to the emergency department (ED) with complex partial seizures secondary to a cerebral aneurysm. CASE REPORT A 54-year-old woman presented to the ED after an episode where she had noticed a "bad smell" and sensations of nausea and dizziness. This was the third episode she had experienced in 2 weeks, and other than migraine, she had no significant medical or family history. Physical examination was normal, but a computed tomography (CT) scan of the brain revealed a 15-mm aneurysm of the right middle cerebral artery. The patient was subsequently transferred for urgent neurosurgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The emergency physician should strongly consider the use of head CT in the evaluation of adults presenting with a first unprovoked seizure, as rarely they can be caused by urgent pathologies including cerebral aneurysms. If a patient is found to have a possible symptomatic unruptured aneurysm, they should be referred for urgent neurosurgical consultation, as these lesions have an increased risk of rupture.
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Affiliation(s)
- Maia E Walsh
- Department of Emergency Medicine, Maidstone and Tunbridge Wells Trust, Tunbridge Wells, Kent, UK
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