Epileptic Seizures but not Pseudoseizures are Associated with Decreased Density of the Serotonin Transporter in Blood Platelet Membranes

The density of the serotonin transporter in the plasma membranes of blood platelets was evaluated by labelled paroxetine binding in three different groups. These groups were: normal controls, epileptic patients having undergone a recent seizure (less than 4 days before) and patients who equally recently presented psychogenic non-epileptic seizures (pseudoseizures). Real seizures resulted in a significant decrease of membrane serotonin transporter density. In the instances of pseudoseizures, its membrane density was undistinguishable from that of normal controls. These data lend further support to the idea that down regulation of serotonin transporter may play a homeostatic role in the cessation of epileptic seizures.     

Phenomenological Assessment of Psychogenic Paroxysms Using Parameters of Verbal Activity

Under the revealing of the phenomenological features of psychogenic paroxysms (panic attacks and pseudoseizures) by the use of parameters of speech, the informativeness of these indicators for diagnosis of paroxysmal disorders was shown. The data obtained allowed psychogenic seizures to be divided into emotional, motor, and ideational levels of speech. The changes recorded by the data of speech rate characteristics indicate the shift of these parameters toward psychomotor excitement in the absence of the factor of fear in the structure of paroxysms (pseudoseizures or demonstrative seizures). In the case of seizures with a component of fear in the structure of paroxysms in patients with panic attacks, psychomotor inhibition was observed.     

癫痫病人脑电信号的奇异谱

癫痫是一种常见的神经系统疾患,其唯一客观证据为脑电图的癫痫样发放。在癫痫发作间期,仅有偶发的很难辨别的癫痫样放电,为了正确诊断癫痫病,往往需要医生长时间监测病人的脑电信号,在对脑电信号进行相空间重构,进而对其进行奇异系统分析,发现癫痫病人无论在癫痫发作前、发作中、发作后,其脑电信号的奇异谱曲线不存在噪声平台,明显区别于正常人。是否可以认为脑电信号的奇异谱正代表着大脑的一种基本状态,癫痫患者在未发作时,大脑的基本状态已经处于异常。无论如休,奇异系统分析方法使得可以利用很短的一段脑电数据诊断癫痫。无疑为癫痫病人的临床诊断提供了一条简单、有效的途径。     

Complicated relationship between autism with regression and epilepsy

We retrospectively evaluated a set of 205 children with autism and compared it to the partial sub-set of 71 (34.6%) children with a history of regression. From 71 children with regression, signs of epileptic processes were present in 43 (60.6%), 28 (65.12%) suffered clinical epileptic seizures, and 15 (34.9%) just had an epileptiform abnormality on the EEG. In our analysis, autistic regression is substantially more associated with epileptic process symptoms than in children with autism and no history of regression. More than 90% of children with a history of regression also show IQ < 70 and reduced functionality. Functionality and IQ further worsens with the occurrence of epileptic seizures (98% of children with regression and epilepsy have IQ < 70). We proved that low IQ and reduced functionality significantly correlate rather with epileptic seizures than just sub-clinical epileptiform abnormality on EEG. Clinical epileptic seizures associated with regression significantly influence the age of regression and its clinical type. The age of regression is higher compared to children with regression without epileptic seizures (in median: 35 months of age in patients with seizures while only 24 months in other patients). Patients with seizures revealed regression after 24th months of age in 68% of cases, while patients without seizures only in 27%. However, coincidence with epilepsy also increased the occurrence of regression before the 18th month of age (23% of patients), while only 4% of patients without epilepsy revealed regression before the 18th month. Epileptic seizures are significantly associated especially with behaviour regression rather than speech regression or regression in both behaviour and speech. Also epileptic seizures diagnosed before correct diagnosis of autism were significantly associated with delayed regression (both behavioural and speech regression).     

THE ELECTROENCEPHALOGRAM IN EPILEPSY

In light of the considerable divergence of opinion among various investigators regarding the incidence of electroencephalographic abnormality in patients with convulsive disorders, the author made a study of his own records of 430 patients with a diagnosis of epilepsy. In 122 the seizures were symptomatic, in the remainder idiopathic, and the overall incidence of electroencephalographic abnormality was little different in the two groups. In the whole series 64.9 per cent showed abnormal tracings, while in those under 16 years of age the incidence was 71.8 per cent. The highest incidence was in patients in whom seizures had begun when they were between 10 and 15 years of age and in those with a duration of seizures from 5 to 10 years. Of patients with clinical petit mal, 76 per cent had abnormal records, but only 34.6 showed petit mal complexes. Lateralized or focal abnormality was three times as frequent in the symptomatic as in the idiopathic group.     

Diagnosis of human neurocysticerocosis in endemic countries: a clinical study in Honduras

With the purpose of evaluating the available methodology for neurocysticercosis (NCC) diagnosis, 60 neurological patients were studied during a 4-year period in Honduras. Neurological evaluation, Computed Tomography (CT), cysticercosis Enzyme-Linked Immunoelectrotransfer blot (EITB) assay, electroencephalographic studies, and collection of epidemiological information were performed to assess a final diagnosis. The presenting clinical manifestations were: epileptic seizures (52%), headache without intracranial pressure (27%) and intracranial hypertension (10%). A protocol for the diagnosis of NCC is suggested. According to this protocol, patients with active (live) cysticercus and/or antibodies in Cerebrospinal fluid (CSF) were diagnosed as definitive cases of NCC, whereas those with only brain calcifications were diagnosed as probable cases. NCC diagnosis was definitive in 14 (23%) patients, probable in 32 (54%) and ruled out in 14 (23%). Of the patients with epileptic seizures, six (19%) had definitive and 20 (65%) had probable NCC. Overall seropositivity was 28%. EITB positivity varied from 14 to 100%, and from 20 to 35% in definitive and probable cases of NCC, respectively. When compared to CT, EITB overall sensitivity for definitive, active cases, was 50% in serum and 63% in CSF. These results suggest that brain images combined with neurological evaluation remains the best approach for neurocysticercosis diagnosis, and that EITB, even though its variable sensitivity, offers valuable information, especially if performed in CSF.     

PSYCHIATRIC ASPECTS OF PSYCHOMOTOR EPILEPSY

Psychomotor or temporal lobe epilepsy is a frequently missed diagnosis. It is often confused with grand mal and petit mal epilepsy. At times it is the first symptom of an organic neurological disease. It is often masked as a psychiatric disorder or is associated with a mental illness without clinically detectable seizures.These psychic manifestations simulate all of the neuroses and major psychiatric states. Excitement states with amnesia may lead to violent antisocial behavior. All these manifestations may be aggravated by alcohol.Thalamic epilepsy shows itself in similar psychiatric manifestations and accounts for behavior disorder in children more than temporal lobe epilepsy. Atypical seizures with vegetative or emotional aura and a characteristic electroencephalogram differentiate it from temporal lobe epilepsy.Proper understanding of the varied manifestations, with positive electroencephalographic findings, leads to the correct diagnosis in most cases. All patients with unusual or atypical personality or psychiatric-like states should have careful electroencephalographic examination. Anticonvulsant therapy and other psychiatric treatment procedures can relieve most cases. Surgical therapy sometimes is necessary.     

Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project.

OBJECTIVE: To describe the immediate and long term risk of epileptic seizures after a first ever stroke. DESIGN: Cohort study following up stroke survivors for 2 to 6.5 years; comparison with age specific incidence rates of epileptic seizures in the general population. SETTING: Community based stroke register. SUBJECTS: 675 patients with a first stroke, followed up for a minimum of 2 years. MAIN OUTCOME MEASURES: Occurrence of single and recurrent seizures. RESULTS: 52 patients had one or more post stroke seizures; in 25 the seizures were recurrent. The 5 year actuarial risk of a post stroke seizure in survivors (excluding 19 patients with a history of epilepsy and 3 patients in whom the seizure occurred shortly before death from another cause) was 11.5% (95% confidence interval 4.8% to 18.2%). The relative risk of seizures, in comparison with the general population, was estimated at 35.2 in the first year after stroke and 19.0 in year 2. The risk of seizures was increased in survivors of subarachnoid and intracerebral haemorrhage (hazard ratio for intracranial haemorrhage v cerebral infarction 10.2 (3.7 to 27.9)). The risk of seizures after ischaemic stroke was substantial only in patients presenting with severe strokes due to total anterior circulation infarction. Only 9 of 295 patients (3%) independent one month after stroke suffered a seizure between 1 month and 5 years (actuarial risk 4.2% (0.1% to 8.3%)). CONCLUSION: Stroke patients have about an 11.5% risk of single or recurrent seizures in the first 5 years after a stroke. Patients with more severe strokes or haemorrhagic strokes are at higher risk.     

Angelman syndrome in three adult patients with atypical presentation and severe neurological complications

Angelman syndrome (AS) is a distinct neurogenetic disorder and the phenotype is well known in childhood and adolescence. However, with advancing age the clinical and behavioral phenotype changes. In adulthood, the phenotype can be rather aspecific. We report on AS in 3 severely to profoundly mentally retarded patients, who developed severe neurologic complications of severe tremor, spasticity and coordination problems, resulting into severe loss of function. They presented atypical craniofacial features, short stature, epileptic seizures, microcephaly, brachytelephalangy and absent speech. Two patients presented at an older age a change in day-night rhythm. Based on this experience, we conclude that all severely to profoundly mentally retarded patients with atypical phenotype, spasticity, absent speech, epileptic seizures and changed day-night rhythm are candidates for further cytogenetic and molecular investigation for AS. Clinical photographs of the patient at a younger age can be helpful. The presence of the typical EEG pattern with frontal triphasic delta waves may direct to the diagnosis of AS.     

Pediatric diagnosis not made until adulthood: A case of Wolf–Hirschhorn syndrome

Wolf–Hirschhorn syndrome is a well-known clinical entity caused by a terminal deletion of the short arm of chromosome 4 (4p-). The diagnosis is usually made in childhood because of the pathognomonic facial dysmorphism, multi-organ involvement and seizures. Epilepsy is a major medical complication during the first years of life, with seizures typically being frequent, although they tend to improve or cease with age. We report on a woman diagnosed with WHS in her thirties by array-CGH. She presents with milder dysmorphic features, recognized by stereophotogrammetry and seizures persistent in adulthood.     

The Incidence Rate of Seizures in Relation to BMI in UK Adults

A retrospective cohort study using the data from The Health Improvement Network (THIN) database in the United Kingdom was conducted to examine the incidence rates of seizures across different BMI levels in the adult population aged ≥18 years. Poisson regression was used to examine the relationship between BMI and seizures. The overall incidence rate of seizures was found to be 31.2 cases per 100,000 person‐years. The incidence rate of seizures (cases per 100,000 person‐years) in obese patients (BMI ≥ 30 kg/m²) was 34.8 (95% confidence interval (CI), 23.1, 46.4), comparable to that in patients with normal weight (BMI between 18.5 and 24.9 kg/m²) (35.8, 95%CI (26.6, 44.9)). In contrast, underweight patients (<18.5 kg/m²) or extremely obese (≥40 kg/m²) patients tended to have higher incidence rates than those with normal weight. After adjustment for age, gender, and smoking status, compared to patients with normal weight, those who were underweight or extremely obese had a rate ratio (RR) for seizures of 1.6 (95%CI (0.7, 3.8)) and 1.7 (95%CI (0.7, 3.9)), respectively. To date, we have not found any study that examines the associations between BMI or obesity and seizures. In this study, the incidence rates of seizures in the extremely obese and underweight patients tended to be higher than that in the normal‐weight patients.     

儿童癫痫的围产期高危因素分析

目的：研究儿童癫痫相关的国产期高危因素。方法：随访16986例新生儿后期癫痫的患病情况,分为儿童癫痫组与非癞痫组,比较两组各项围产期高危因素,进行单因素与多因素统计分析。结果：随访期内儿童癫痫的发病例数为118例（6．95‰）,癫痫的发病率在1岁以下的儿童最高（27．12％）。儿童癫痫的发生与孕周、高龄产妇、低出生体重、流产史、宫内窘迫、喂养方式、孕期感染、子痫、胎盘早剥、新生儿惊厥都有相关性,并且孕周、子痫和新生儿惊厥是儿童癫痫发生的独立危险因素。结论：儿童癫痫的发生与围产期高危因素密切相关,这对临床儿童癫痫的诊疗可能有提示作用。     

Prognostic index for recurrence of seizures after remission of epilepsy. Medical Research Council Antiepileptic Drug Withdrawal Study Group.

OBJECTIVES--To develop and test a prognostic index for the recurrence of seizures after a minimum remission of seizures of two years in people with a history of epilepsy. DESIGN--Information from a large prospective randomised study of withdrawal of antiepileptic drugs was used to identify clinical and treatment factors of prognostic importance in determining the recurrence of seizures. A split sample approach was used to test the internal validity of predictions made on the basis of identified prognostic factors. SETTING--Centres in six European countries. MAIN OUTCOME MEASURES--Comparison of predicted and observed rates of recurrence of seizure. SUBJECTS--1013 patients randomised to the Medical Research Council study for antiepileptic drug withdrawal. RESULTS--The Cox proportional hazards model identified several factors that increased the risk of seizures recurring. These included being 16 years or older; taking more than one antiepileptic drug; experiencing seizures after starting antiepileptic drug treatment; a history of primary or secondarily generalised tonic-clonic seizures; a history of myoclonic seizures; and having an abnormal electroencephalogram. The risks of seizures recurring decreased with increasing time without seizures. The model allowed estimation of the risk of seizures recurring in the next one and two years under the policies of continued antiepileptic drug treatment and slow withdrawal of drugs. Split sample validation suggested that the model was well calibrated. CONCLUSION--The model is currently the best available aid for counselling the many patients in the community with epilepsy currently in remission who seek advice about the risks of seizures recurring if they stop antiepileptic drug treatment. The model requires validation in a broad population of patients, and such studies are in progress.     

Epileptic dizziness.

Clinical and electroencephalographic features and the response to treatment of 30 patients with episodic dizziness due to epilepsy were noted. The symptom consisted of a brief episode of disequilibrium, often with a sensation of rotation, without evident precipitating factors or sequelae. A history of "absences" or other features suggestive of temporal lobe epilepsy was elicited in over half the patients, and seven (almost a quarter) had had one or more generalized seizures before presentation. Electroencephalography showed a posterior temporal lobe focus in all but two patients, and there was a family history of epilepsy in six. Response to treatment with phenytoin or carbamazepine was good in most patients. Epilepsy should be considered in the differential diagnosis of episodic dizziness or vertigo, especially in young people.     

基于二阶C0复杂度的癫痫发作预测

癫痫发作的预测是近年来在临床医学和神经系统科学研究领域中备受关注的问题。如果癫痫发作能够被可靠地预测,则可以提前采取有效的临床预防措施,从而能较大程度地改善癫痫患者的生活质量。文章提出了一种基于二阶C0复杂度的预测算法用于预测癫痫发作。该算法通过分析癫痫患者颅内脑电信号的二阶C0复杂度,利用发作前期复杂度曲线的变化特征预测癫痫发作。作者运用该算法对21组癫痫病人87次发作的临床颅内脑电数据和4组大鼠4次发作的颅内脑电数据进行分析计算,预测准确率分别为94.3%和100%。实验结果表明该算法可以有效地预测癫痫发作,具有潜在的重要临床应用价值。     

The role of brain scanning in the differential diagnosis of seizures

Of 200 patients with seizures who had brain scans, the studies were abnormal in 86% of patients with tumours and in 67% of those with strokes. The scan detected 84% of the 19 potentially curable lesions. There were no false positive studies. Seventy-nine per cent of patients with seizures of less than one year''s duration had an abnormal scan; however, the scan was also abnormal in 22% of patients with non-focal seizures of less than one year''s duration.     

An infantile case of Zellweger syndrome presented with Kabuki-like phenotype

Zellweger syndrome is a peroxisomal disorder resulting from the mutations in PEX genes generally presenting in the neonatal period with profound hypotonia seizures, inability to feed, liver cysts with hepatic dysfunction, chondrodysplasia punctata. Kabuki make-up syndrome is a multiple congenital anomalies and mental retardation syndrome with characteristic facial appearance, skeletal abnormalities, dermatoglyphic abnormalities, mental retardation and short stature. Abnormal liver functions and some atypical findings were also reported in some patients with Kabuki syndrome. In this report a case with late onset Zellweger syndrome who had some phenotypical findings which are also seen in Kabuki Syndrome will be presented. The inclusion of Zellweger syndrome into the differential diagnosis of the patients with Kabuki-like phenotype in addition to abnormal liver functions is emphasized.     

Reduction in polypharmacy for epilepsy.

A two-year prospective study of 40 adult outpatients with chronic epilepsy was carried out in which blood drug concentrations were monitored, and anticonvulsant polypharmacy was reduced to treatment with a single drug in 29 patients (72%). In the year after the reduction of treatment the control of seizures was improved in 16 patients (55%), unchanged in eight(28%), and worse in five (17%). Mental function was improved in 16 (55%). The main reason for failure to reduce to or maintain treatment with a single drug was exacerbation of seizures during the difficult withdrawal period, especially in patients with frequent seizures, taking several drugs, or with additional neuropsychological handicaps. It is more difficult to reduce polypharmacy than to avoid it in the first place. Polypharmacy may sometimes aggravate control of seizures.     

Ictal Depth EEG and MRI Structural Evidence for Two Different Epileptogenic Networks in Mesial Temporal Lobe Epilepsy

Hypersynchronous (HYP) and low voltage fast (LVF) activity are two separate ictal depth EEG onsets patterns often recorded in presurgical patients with MTLE. Evidence suggests the mechanisms generating HYP and LVF onset seizures are distinct, including differential involvement of hippocampal and extra-hippocampal sites. Yet the extent of extra-hippocampal structural alterations, which could support these two common seizures, is not known. In the current study, preoperative MRI from 24 patients with HYP or LVF onset seizures were analyzed to determine changes in cortical thickness and relate structural changes to spatiotemporal properties of the ictal EEG. Overall, onset and initial ipsilateral spread of HYP onset seizures involved mesial temporal structures, whereas LVF onset seizures involved mesial and lateral temporal as well as orbitofrontal cortex. MRI analysis found reduced cortical thickness correlated with longer duration of epilepsy. However, in patients with HYP onsets, the most affected areas were on the medial surface of each hemisphere, including parahippocampal regions and cingulate gyrus, whereas in patients with LVF onsets, the lateral surface of the anterior temporal lobe and orbitofrontal cortex showed the greatest effect. Most patients with HYP onset seizures were seizure-free after resective surgery, while a higher proportion of patients with LVF onset seizures had only worthwhile improvement. Our findings confirm the view that recurrent seizures cause progressive changes in cortical thickness, and provide information concerning the structural basis of two different epileptogenic networks responsible for MTLE. One, identified by HYP ictal onsets, chiefly involves hippocampus and is associated with excellent outcome after standardized anteromedial temporal resection, while the other also involves lateral temporal and orbitofrontal cortex and a seizure-free surgical outcome occurs less after this procedure. These results suggest that a more extensive tailored resection may be required for patients with the second type of MTLE.