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Smith KM, Wirrell EC, Andrade DM, Choi H, Trenité DKN, Knupp KG, Nordli DR, Riva A, Stern JM, Striano P, Thiele EA, Zawar I. A comprehensive narrative review of epilepsy with eyelid myoclonia. Epilepsy Res 2023; 193:107147. [PMID: 37121024 DOI: 10.1016/j.eplepsyres.2023.107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
Epilepsy with eyelid myoclonia (EEM) is a generalized epilepsy syndrome with childhood-onset and 2:1 female predominance that consists of: 1. eyelid myoclonia with or without absence seizures, 2. eye closure induced seizures or EEG paroxysms, 3. clinical or EEG photosensitivity. While eyelid myoclonia is the disease hallmark, other seizure types, including absence seizures and generalized tonic-clonic seizures, may be present. It is thought to have a genetic etiology, and around one-third of patients may have a positive family history of epilepsy. Recently, specific genetic mutations have been recognized in a minority patients, including in SYNGAP1, NEXMIF, RORB, and CHD2 genes. There are no randomized controlled trials in EEM, and the management literature is largely restricted to small retrospective studies. Broad-spectrum antiseizure medications such as valproate, levetiracetam, lamotrigine, and benzodiazepines are typically used. Seizures typically persist into adulthood, and drug-resistant epilepsy is reported in over 50%.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.
| | - Elaine C Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Hyunmi Choi
- Department of Neurology, Columbia University, New York, NY, United States
| | | | - Kelly G Knupp
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Douglas R Nordli
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Antonella Riva
- IRCCS Istituto Giannina Gaslini", Genova, Italy and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - John M Stern
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini", Genova, Italy and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Elizabeth A Thiele
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Ifrah Zawar
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
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Abstract
INTRODUCTION Photosensitivity, which is a main feature of Jeavons syndrome, can be seen in other types of idiopathic or genetic epilepsies with focal or generalized seizures and tends to disappear spontaneously usually in the second decade. Although it responds well to antiepileptic treatment, especially to valproic acid, it may continue into adulthood in rare cases. CASE REPORT We describe a 63-year-old male patient with eyelid myoclonia with absences, generalized tonic-clonic seizures, and severe photosensitivity accompanied by eyelid myoclonia. Seizures were treated with antiepileptic treatment, whereas photosensitivity still continued on electroencephalogram without clinical findings. CONCLUSION Our elderly patient with Jeavons syndrome with ongoing remarkable photosensitivity demonstrated that it may continue to older ages, although it is uncommon.
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Hall SP, Traub RD, Adams NE, Cunningham MO, Schofield I, Jenkins AJ, Whittington MA. Enhanced interlaminar excitation or reduced superficial layer inhibition in neocortex generates different spike-and-wave-like electrographic events in vitro. J Neurophysiol 2018; 119:49-61. [PMID: 28954894 PMCID: PMC5866469 DOI: 10.1152/jn.00516.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 12/19/2022] Open
Abstract
Acute in vitro models have revealed a great deal of information about mechanisms underlying many types of epileptiform activity. However, few examples exist that shed light on spike-and-wave (SpW) patterns of pathological activity. SpW are seen in many epilepsy syndromes, both generalized and focal, and manifest across the entire age spectrum. They are heterogeneous in terms of their severity, symptom burden, and apparent anatomical origin (thalamic, neocortical, or both), but any relationship between this heterogeneity and underlying pathology remains elusive. In this study we demonstrate that physiological delta-frequency rhythms act as an effective substrate to permit modeling of SpW of cortical origin and may help to address this issue. For a starting point of delta activity, multiple subtypes of SpW could be modeled computationally and experimentally by either enhancing the magnitude of excitatory synaptic events ascending from neocortical layer 5 to layers 2/3 or selectively modifying superficial layer GABAergic inhibition. The former generated SpW containing multiple field spikes with long interspike intervals, whereas the latter generated SpW with short-interval multiple field spikes. Both types had different laminar origins and each disrupted interlaminar cortical dynamics in a different manner. A small number of examples of human recordings from patients with different diagnoses revealed SpW subtypes with the same temporal signatures, suggesting that detailed quantification of the pattern of spikes in SpW discharges may be a useful indicator of disparate underlying epileptogenic pathologies. NEW & NOTEWORTHY Spike-and-wave-type discharges (SpW) are a common feature in many epilepsies. Their electrographic manifestation is highly varied, as are available genetic clues to associated underlying pathology. Using computational and in vitro models, we demonstrate that distinct subtypes of SpW are generated by lamina-selective disinhibition or enhanced interlaminar excitation. These subtypes could be detected in at least some noninvasive patient recordings, suggesting more detailed analysis of SpW may be useful in determining clinical pathology.
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Affiliation(s)
- Stephen P Hall
- Hull York Medical School, University of York , Heslington , United Kingdom
| | - Roger D Traub
- Department of Physical Sciences, IBM Thomas J. Watson Research Center , Yorktown Heights, New York
| | - Natalie E Adams
- Hull York Medical School, University of York , Heslington , United Kingdom
| | - Mark O Cunningham
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , United Kingdom
| | - Ian Schofield
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne , United Kingdom
| | - Alistair J Jenkins
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne , United Kingdom
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