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Aykac SC, Ekinci AS, Tabakoglu AY, Gulluoglu H, Aydogdu I, Bademkıran F, Uludag B, Arac N, Guler A. What does epileptic nystagmus show us in cases presenting acute neurological symptoms? Seizure 2022; 101:184-189. [PMID: 36058101 DOI: 10.1016/j.seizure.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This study aims to determine the clinical significance of epileptic nystagmus in patients with acute neurological symptoms. METHOD The clinical findings of patients with documented epileptic nystagmus, their original video and EEG data, and cranial imaging and laboratory tests were analyzed retrospectively. RESULTS 20 patients were included in the study and 21 epileptic nystagmus attacks were determined from patients' clinical and video-EEG recordings. All recorded seizures with epileptic nystagmus were focal onset in nature. The ictal discharge pattern was rhythmic fast activity with a mean frequency of 15 Hz. The ictal discharges originated from the parieto-occipital (n = 8), temporo-occipital (n = 7), parieto-occipito-temporal (n = 3), temporal (n = 2), occipital (n = 1), and centroparietal (n = 1) areas. In the fast phase, the nystagmus was beating away from the side of ictal discharges. The origin of the ictal discharges on EEG images was compatible with the lesion localization at cranial MRI in all patients. Etiologies were epilepsy in seven patients, non-ketotic hyperglycemia in four, ketotic hyperglycemia in one, PRES in three, acute stroke in three, HSV encephalitis in one, and MELAS in one. CONCLUSIONS Epileptic nystagmus represents a guide to the lateralization and localization of the lesion in cases presenting with acute neurological symptoms. In these patients, the lesion is frequently in the posterior regions of the hemispheres. Although various diseases affect these regions in terms of etiology, such cases should be evaluated in terms of the presence of hyperglycemia.
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Affiliation(s)
| | - Aysen Suzen Ekinci
- Neurology Department, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Aycin Yıldız Tabakoglu
- Department of Neurology and Neurophysiology, University Of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Halil Gulluoglu
- Neurology Department, Economy University, Medicalpark Hospital, Izmir, Turkey
| | - Ibrahim Aydogdu
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey
| | - Fikret Bademkıran
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey
| | | | - Nilgün Arac
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey
| | - Ayse Guler
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey.
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Baltyde D, De Toffol B, Nacher M, Sabbah N. Epileptic seizures during Non-Ketotic Hyperglycemia (NKH) in French Guiana: A retrospective study. Front Endocrinol (Lausanne) 2022; 13:946642. [PMID: 36060985 PMCID: PMC9433648 DOI: 10.3389/fendo.2022.946642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Epileptic seizures during non-ketotic hyperglycemia (NKH) represent a rare complication of uncontrolled diabetes mellitus. The definition associates a blood sugar level > 200mg/dL (11mmol/L), hyperosmolality, absence of ketosis, dehydration and seizure control after normalization of blood sugar levels. MATERIAL AND METHODS This retrospective observational study included patients hospitalized for epileptic seizures and NKH in the Cayenne Hospital Center between January 2010 and June 2020. The clinical, biological, and radiological results were collected. RESULTS 18 out of 228 (7.9%) patients with both diabetes and epileptic seizures had NKH. The mean age of the 12 women and 6 men was 64.8 years. In 8 patients, brain imaging did not show acute lesions and the seizures disappeared with control of hyperglycemia by hydration and insulin. In 6 patients, the seizures revealed a stroke, hemorrhagic in 4 cases, ischemic in 2 cases. 4 patients had a seizure in a context of known vascular epilepsy. The epileptic seizures were mainly focal seizures with motor symptoms that could be repeated, focal to bilateral tonic-clonic or focal status. CONCLUSION Seizures in NKH are symptomatic of an acute brain lesion or vascular epilepsy more than 1 in 2 times. However, isolated NKH can cause seizures with a suggestive brain MRI.
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Affiliation(s)
- Dimitri Baltyde
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Bertrand De Toffol
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424) Cayenne Hospital Center, Cayenne, French Guiana
- Department of Neurology, Cayenne Hospital Center, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424) Cayenne Hospital Center, Cayenne, French Guiana
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424) Cayenne Hospital Center, Cayenne, French Guiana
- *Correspondence: Nadia Sabbah,
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Pappas A, Kubsad S, Baud MO, Wright KE, Kollmyer DM, Warner NM, Haltiner AM, Gwinn RP, Doherty MJ. Does glucose influence multidien cycles of interictal and/or ictal activities? Seizure 2021; 85:145-150. [PMID: 33465639 DOI: 10.1016/j.seizure.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE There are multidien patterns of seizure occurrence. Predicting seizure risk may be easier with biomarker correlates to multidien patterns. We hypothesize multiday hyper or hypoglycemia contributes to seizure risk. METHODS In a type I diabetic (T1D) with focal onset epilepsy with continuous glucose monitoring (CGM) and responsive neurostimulation (RNS) devices, we studied multiday interictal activities (IEA), seizures, and glucose. Hourly CGM data was matched to hourly RNS captures of interictal and ictal activities over 33 months. RNS detection settings were unchanged. Multidien cycles were analyzed, active blocks of IEA and ictal episodes defined, and tissue glucose averages studied. RESULTS Average glucose was 161 mg/dl. A 40-day cycle of interictal and ictal activities occurred, though no similar glucose cycle was evident. Glucose elevations relative to patient average were associated with increases in IEA but not seizure. Frequent seizures were not associated with obvious elevations or decreases of glucose from baseline, most seizures occurred at +/- 10 mg/dl of average daily glucose (i.e. 150-170 mg/dl). CONCLUSION Tissue glucose may influence IEA but may not influence multiday seizure activity or very frequent seizures. In an ambulatory T1D patient multiday hypo or hyperglycemic extremes do not appear to provoke seizure activities.
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Affiliation(s)
- Alexa Pappas
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - Sanjay Kubsad
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Maxime O Baud
- Wyss Center for Bio and Neuroengineering, Geneva, 1202, Switzerland; Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, University Hospital, University of Bern, Bern, 3010, Switzerland
| | | | | | - Nicole M Warner
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Alan M Haltiner
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Ryder P Gwinn
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Michael J Doherty
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA.
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Satte A, Benmoh Y, Raggabi A, Ahizoune A, Bourazza A, Mounach J. Ictal apraxia revealing non-ketotic hyperglycemia. Rev Neurol (Paris) 2020; 177:446-448. [PMID: 33272562 DOI: 10.1016/j.neurol.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 10/22/2022]
Affiliation(s)
- A Satte
- Neurophysiology Department, Neurology Department, Mohammed V Teaching Military Hospital, Mohammed V University in Rabat, Anenue des FAR, Rabat, Morocco.
| | - Y Benmoh
- Neurophysiology Department, Neurology Department, Mohammed V Teaching Military Hospital, Mohammed V University in Rabat, Anenue des FAR, Rabat, Morocco
| | - A Raggabi
- Neurophysiology Department, Neurology Department, Mohammed V Teaching Military Hospital, Mohammed V University in Rabat, Anenue des FAR, Rabat, Morocco
| | - A Ahizoune
- Neurophysiology Department, Neurology Department, Mohammed V Teaching Military Hospital, Mohammed V University in Rabat, Anenue des FAR, Rabat, Morocco
| | - A Bourazza
- Neurophysiology Department, Neurology Department, Mohammed V Teaching Military Hospital, Mohammed V University in Rabat, Anenue des FAR, Rabat, Morocco
| | - J Mounach
- Neurophysiology Department, Neurology Department, Mohammed V Teaching Military Hospital, Mohammed V University in Rabat, Anenue des FAR, Rabat, Morocco
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Gorijala VK, Shaik L, Kowtha P, Kaur P, Nagarjunakonda VS. A Case Report of Nonketotic Hyperglycemic Seizures: A Diagnostic Dilemma. Cureus 2020; 12:e11416. [PMID: 33312812 PMCID: PMC7725492 DOI: 10.7759/cureus.11416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 01/15/2023] Open
Abstract
Nonketotic hyperglycemia (NKH) is a rare but serious complication of uncontrolled diabetes mellitus that occurs acutely with a mortality rate of more than 50%. This condition presents with a clinical syndrome consisting of profound hyperglycemia, hyperosmolality, and dehydration. Infrequently, the patients also present with seizure activity. The most common types of seizures observed in this condition are focal seizures, as opposed to the generalized seizures observed in hypoglycemia-induced seizures. Though various hypotheses tried to explain NKH-induced seizure activity, the actual mechanism remains unknown. The treatment modalities include the management of hyperglycemia and circulatory collapse. However, the role of anti-epileptics is controversial. We herein illustrate an atypical case of focal faciobrachial seizures in a young female patient, which occurred as a rare complication of NKH. A 21-year-old female was admitted with multiple jerking and spasmodic movements of the right upper limb and face, with no significant neurological findings. Past medical history was significant for uncontrolled type 2 diabetes mellitus and multiple episodes of focal seizures. On laboratory examination, serum osmolarity was 309 mOsm/L, blood glucose was 364 mg/dL, HbA1c was 12.1%, and ketone bodies were absent. MRI brain showed large subtle T2 FLAIR (T2-weighted fluid-attenuated inversion recovery) cortical hyperintensities in the left frontal, temporal, parietal, and occipital regions with subcortical hypointense areas. The EEG illustrated a background slowing and generalized spikes, polyspikes, and sharp-wave discharges with post-ictal slowing. The patient's seizures were initially refractory to insulin therapy and resolved with the use of dual anti-epileptics. Thus, to conclude, our case represents a diagnostic dilemma with MRI findings pointing towards NKH as the underlying etiology of focal seizures, with the resolution of seizures only occurring with the addition of anti-epileptics to insulin therapy.
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Affiliation(s)
| | | | | | - Parneet Kaur
- Internal Medicine, Department of Health and Family Welfare, Government of Punjab, Chandigarh, IND
- Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
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De Martino SRM, Toni F, Spinardi L, Cirillo L. Magnetic resonance imaging findings in patients with non-ketotic hyperglycaemia and focal seizures. Neuroradiol J 2020; 33:416-423. [PMID: 32539656 PMCID: PMC7482045 DOI: 10.1177/1971400920929554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
We present the neuroimaging findings of three cases of non-ketotic hyperglycaemia (NKH) associated with focal seizures and a review of the previous cases and series reported in literature. NKH is a cause of seizures in both long-standing and newly diagnosed diabetic patients. They are usually focal motor seizures, rarely with a secondary generalisation. This condition does not fully respond to anticonvulsant therapy if glycaemic levels are not normalised. Of interest, magnetic resonance imaging (MRI) of NKH could be different from those observed during other kinds of seizures. Indeed, seizure-related MRI abnormalities mainly involve the cortical grey matter, while NKH-related seizures usually appear as reversible subcortical T2/fluid attenuation inversion recovery (FLAIR) hypointensity. This latter abnormality shows a good spatial correlation with the area of the ictal focus on electroencephalogram and could be associated with other more common post-ictal MRI changes (cortical grey matter T2/FLAIR hyperintensity, cortical or leptomeningeal enhancement). Although these abnormalities tend to be transient, a focal volume loss or gliosis can result on follow-up imaging. Our cases confirm T2/FLAIR subcortical hypointensity as a main neuroradiological hallmark of NKH-induced seizures.
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Affiliation(s)
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Italy
| | - Luca Spinardi
- Neuroradiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Luigi Cirillo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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Kinnear KM, Warner NM, Haltiner AM, Doherty MJ. Continuous monitoring devices and seizure patterns by glucose, time and lateralized seizure onset. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:65-70. [PMID: 30073145 PMCID: PMC6068315 DOI: 10.1016/j.ebcr.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 01/14/2023]
Abstract
Objectives To investigate if glucose levels influence seizure patterns. Materials and methods In a patient with RNS/NeuroPace implanted bi-temporally and type 1 diabetes mellitus, seizure event times and onset locations were matched to continuous tissue glucose. Results Left focal seizure (LFS, n = 22) glucoses averaged 169 mg/dL, while right focal seizure (RFS, n = 23) glucoses averaged 131 mg/dL (p = 0.03). LFS occurred at mean time 17:02 while RFS occurred at 04:23. LFS spread to the contralateral side (n = 19) more than RFS (n = 2). Conclusion Seizure onset laterality and spread vary with glucose and time of seizure.
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Abstract
Hyperglycemia rarely manifests as hemichorea-hemiballism (HH), which is characterized by simple partial motor seizures. One of the difficulties in the management of hyperglycemia-induced HH is the failure to recognize this entity due to its relatively uncommon presentation. We herein present a case series of hyperglycemia-associated dyskinesias, highlighting the different possible clinical presentations of this entity. Both hyperglycemia and hyperosmolality are probable predisposing factors, while ketoacidosis has a protective role in preventing the dyskinesias. One of our patients had ketotic hyperglycemia leading to HH, a previously unreported finding. Early recognition of this entity is crucial as prompt glycemic control leads to the resolution of symptoms and signs.
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Affiliation(s)
- Pc Lee
- Department of Endocrinology, Singapore General Hospital, Singapore
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Jaime GF, Reinaldo US. Estado epiléptico del adulto. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Donat A, Guilloton L, Bonnet C, Depreux G, Lamboley JL, Drouet A. [Partial visual seizures induced by non-ketosic hyperglycemia: magnetic resonance imaging and visual evoked potential descriptions. A study of two cases reports with radiologic and electrophysiologic abnormalities]. Rev Neurol (Paris) 2012; 169:154-61. [PMID: 23079857 DOI: 10.1016/j.neurol.2012.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 05/02/2012] [Accepted: 05/30/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Non-ketosic hyperglycemia (NKH) may increase the likelihood of focal epileptic seizures, including commonly motor expression; rarely, they can have a visual expression. METHODS The authors describe the observation of two men, who were hospitalized for visual manifestations; with episodes of homonymous hemianopia and hallucinations, revealing occipital seizure, secondary to NKH. Clinical data and characteristics of the investigations, including radiological imaging (MRI) and electrophysiological results of visual evoked potentials (VEP) are specified. RESULTS MRI showed transitory low signal on T2 and FLAIR in occipital areas. Spectro-MR identified a moderate diminution of the NAA and lipids spikes, compatible with laminar necrosis. VEP revealed a transient decrease of the P100 amplitude. DISCUSSION These two observations underline the existence of acute symptomatic seizures with a visual starting point which is often indicative of diabetes. Through these observations with a review of 28 patients from the literature, MR imaging characteristics and possible anomalies collected on VEP are discussed. Such seizures are resistant to anticonvulsant treatment and respond best to insulin and rehydration. CONCLUSION The visual manifestations indicative of seizures with an occipital starting point in the context of NKH are possible enabling rapid initiation of effective symptomatic treatment with insulin.
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Affiliation(s)
- A Donat
- Service de neurologie, HIA Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
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Procaccianti G, Zaniboni A, Rondelli F, Crisci M, Sacquegna T. Seizures in acute stroke: incidence, risk factors and prognosis. Neuroepidemiology 2012; 39:45-50. [PMID: 22777596 DOI: 10.1159/000338374] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 03/27/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Studies on post-stroke seizures have produced conflicting results. Our study aim was to further elucidate the incidence and predictive factors of early post-stroke seizures (ES) and their relationship with outcome. METHODS relevant clinical data were prospectively collected in 2,053 patients with acute stroke admitted to the Stroke Unit from 2004 to 2008. RESULTS Sixty-six patients (8 hemorrhagic and 58 ischemic strokes) aged 73-88 years (mean age 82 years) presented seizures in the first week after stroke onset. The type of ischemic stroke was atherothrombotic in 10 patients, cardioembolic in 21, lacunar in 4, undetermined in 19, and of other etiology in 4. Twenty-seven patients had generalized convulsive, 6 had complex partial, and 33 had simple partial seizures. Status epilepticus was observed in 13 patients. The severity of strokes in patients with ES was greater than in those without (National Institutes of Health Stroke Scale >14 in 50 vs. 25%), so mortality (30 days) was higher (29 vs. 14%). Independent seizure predictors were: total anterior circulation infarct, hemorrhagic transformation, hyperglycemia, and the interaction term diabetes × hyperglycemia. CONCLUSIONS ES may be considered a marker of stroke severity. Cortical location of the lesion, hemorrhagic transformation, and hyperglycemia in patients without diabetes are important predictors of ES.
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Affiliation(s)
- Gaetano Procaccianti
- Neurologia-Stroke Unit, Ospedale Maggiore, IRCCS, Istituto di Scienze neurologiche, Bologna, Italy.
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Tiamkao S, Janon C, Sawanyawisuth K, Pratipanawatr T, Jitpimolmard S. Prediction of seizure control in non-ketotic hyperglycemic induced seizures. BMC Neurol 2009; 9:61. [PMID: 20003412 PMCID: PMC2797492 DOI: 10.1186/1471-2377-9-61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 12/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To study the factors predictive for seizure control in non-ketotic hyperglycemic induced seizures (NKHS). METHODS We studied 21 patients who were clinically diagnosed as NKHS at Khon Kaen University hospital, Thailand. Multiple linear regression analysis was used to identify the factors predictive for seizure control. RESULTS Most patients had no previous history of diabetes and presented with repetitive partial seizures. The mean number of seizure attacks was 45 times prior to admission. The average duration to terminate seizure was 36 hours and significantly predicted by frequency of seizures (estimate 0.9, p value 0.013). CONCLUSION Frequency of seizures is the only predictive factor for the success of seizure control in NKHS.
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Affiliation(s)
- Somsak Tiamkao
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
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Martínez-Fernández R, Gelabert A, Pablo MJ, Carmona O, Molins A. Status epilepticus with visual seizures in ketotic hyperglycemia. Epilepsy Behav 2009; 16:660-2. [PMID: 19884045 DOI: 10.1016/j.yebeh.2009.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 09/30/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
Abstract
Metabolic disturbances are often associated with epileptic seizures, but the pathogenesis of this relationship is poorly understood. We describe the case of a 48-year-old man who presented with complex partial status epilepticus with visual seizures in the context of ketotic hyperglycemia. The EEG revealed a temporal epileptogenic focus and alterations were apparent on MRI in the acute phase and 4 months later. Very few cases of seizures in ketotic patients have been reported because ketone bodies have a protective effect against epilepsy. Seizures in hyperglycemia tend to be partial, and the only reports of visual seizures were due to occipital foci. Neuroradiological alterations have been reported in epileptic seizures, although usually in generalized seizures. The clinical, electrical, and imaging characteristics of this case are interesting and suggest that partial seizures can also cause long-term neuronal damage.
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Sinha S, Satishchandra P. Epilepsia Partialis Continua over last 14 years: Experience from a tertiary care center from south India. Epilepsy Res 2007; 74:55-9. [PMID: 17292588 DOI: 10.1016/j.eplepsyres.2006.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Revised: 11/28/2006] [Accepted: 12/23/2006] [Indexed: 11/20/2022]
Abstract
Epilepsia Partialis Continua (EPC), a subtype of status epilepticus has varied etiology and the outcome depends on the cause. The aim of this study was to analyze the demographic, semiology, etiology, radiological findings, therapeutic response and outcome of EPC. This is a retrospective analysis of 76 patients (M:F: 46:30; mean age: 30.2+/-23.4 years; median age: 26 years) evaluated at our center over last 14 years. Twenty-three subjects (30.3%) had epilepsy for a mean of 25.8+/-52.3 months (range: 1-81 years; median: 14) before developing EPC and in half of them, seizures were controlled with anti-epileptic drugs (AEDs). Rest 53 (69.3%) manifested as de novo. The mean duration of EPC was 47.02+/-188.2 days (range: 1h to 48 months; median: 3 days). One patient of generalized convulsive SE (GCSE) evolved into EPC while five patients of EPC evolved into GCSE. CT scan of brain (n-76) was abnormal in 53 (69.7%) while all the 11 MRI scans which were available were abnormal. EEG (n-21) was abnormal in all but one, however it was non-specific in 7. The diagnoses were-idiopathic: 17, ischemic stroke: 15, meningo-encephalitis: 8, Rasmussen's encephalitis (RE): 7, granuloma: 6, diabetic-non-ketotic-hyperosmolar-coma (DNKHC): 6, CNS malignancies (primary/secondary): 4, birth injury: 4, cerebral venous thrombosis: 3, CNS tuberculosis: 2, and cerebritis, HIV-related, toxemia of pregnancy, and MERRF one each. Patients of >40 years (n=21) had stroke (10), idiopathic (6), DNKHC (4) and metastasis (1) as common causes. Only 12 of them received single AED, while others required 2 or more AEDs to control the seizures. The outcome (n=72) was-controlled: 43 (59.7%); uncontrolled: 26 (36.1%) (RE: 7, idiopathic: 5, birth injury: 4, encephalitis: 3, malignancy: 2, granuloma and MERRF: 1 each) and three patients succumbed (encephalitis: 2, idiopathic: 1). Causes of EPC are varied and it depends on age. Underlying cause determined the outcome and could be refractory in RE, idiopathic, and when associated with birth injury, malignancy and encephalitis. Treatment of underlying cause is essential in addition to AEDs.
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Affiliation(s)
- S Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560 029, India.
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