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Deng DZ, Husari KS. Approach to Patients with Seizures and Epilepsy: A Guide for Primary Care Physicians. Prim Care 2024; 51:211-232. [PMID: 38692771 DOI: 10.1016/j.pop.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Seizures and epilepsy are common neurologic conditions that are frequently encountered in the outpatient primary care setting. An accurate diagnosis relies on a thorough clinical history and evaluation. Understanding seizure semiology and classification is crucial in conducting the initial assessment. Knowledge of common seizure triggers and provoking factors can further guide diagnostic testing and initial management. The pharmacodynamic characteristics and side effect profiles of anti-seizure medications are important considerations when deciding treatment and counseling patients, particularly those with comorbidities and in special populations such as patient of childbearing potential.
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Affiliation(s)
- Doris Z Deng
- Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD 21287, USA
| | - Khalil S Husari
- Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD 21287, USA.
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Aldosari AN, Alghamdi A, Alharthi A, Albuhayri A, Ghurab S, Alghamdi M, Aldosari M. The Frequency and Precipitating Factors for Breakthrough Seizures in Children with Epilepsy. J Epilepsy Res 2023; 13:13-18. [PMID: 37720680 PMCID: PMC10501813 DOI: 10.14581/jer.23003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 09/19/2023] Open
Abstract
Background and Purpose To determine the common precipitating factors for breakthrough seizures in children with epilepsy. Methods This retrospective study reviewed the charts of children with epilepsy who were followed up in the pediatric neurology clinic of King Fahad Hospital in Al-Baha region, Saudi Arabia, between January 2015 and August 2022. Children between 1 to 14 years of age who had epilepsy, as per the International League Against Epilepsy definition and received anti-seizure medication with a seizure-free period of at least 2 months before breakthrough seizure episode, were included in the study. Results Of the 108 children included in the study, the mean age was 6.8±1.6 years, and among them (55.5%) were male. Most parents (69.5%) were unaware of the triggering factors of seizure. The majority of patients (88%) reported at least one precipitating factor for breakthrough seizures and the most common one was systemic infection associated with fever (52.8%), and then non-compliance to medications in (34.3%) of the patients. In terms of the electroencephalogram, around 84 patients (77.8%) had abnormal electroencephalogram. Finally, monotherapy was maintained in 63.9% of patients. Conclusions We conclude that the most common trigger for breakthrough seizure is a systemic infection associated with fever and non-compliance to anti-seizure medications. Increasing the level of awareness by different methods may help limit or even prevent seizures from occurring. Randomized controlled trials could shed light on the adjustment of anti-seizure medications temporarily by increasing the dosage or giving extra doses during the infection to avoid breakthrough seizures.
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Affiliation(s)
| | - Ahmed Alghamdi
- Department of Pediatrics, King Fahad Hospital, Al Baha, Saudi Arabia
| | - Ayidh Alharthi
- Department of Pediatrics, King Fahad Hospital, Al Baha, Saudi Arabia
| | | | - Suhaib Ghurab
- Department of Pediatrics, King Fahad Hospital, Al Baha, Saudi Arabia
| | | | - Mufleh Aldosari
- Department of Epidemiology, As Sulayyil General Hospital, Riyadh, Saudi Arabia
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Passaro EA. Neuroimaging in Adults and Children With Epilepsy. Continuum (Minneap Minn) 2023; 29:104-155. [PMID: 36795875 DOI: 10.1212/con.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article discusses the fundamental importance of optimal epilepsy imaging using the International League Against Epilepsy-endorsed Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS) protocol and the use of multimodality imaging in the evaluation of patients with drug-resistant epilepsy. It outlines a methodical approach to evaluating these images, particularly in the context of clinical information. LATEST DEVELOPMENTS Epilepsy imaging is rapidly evolving, and a high-resolution epilepsy protocol MRI is essential in evaluating newly diagnosed, chronic, and drug-resistant epilepsy. The article reviews the spectrum of relevant MRI findings in epilepsy and their clinical significance. Integrating multimodality imaging is a powerful tool in the presurgical evaluation of epilepsy, particularly in "MRI-negative" cases. For example, correlation of clinical phenomenology, video-EEG with positron emission tomography (PET), ictal subtraction single-photon emission computerized tomography (SPECT), magnetoencephalography (MEG), functional MRI, and advanced neuroimaging such as MRI texture analysis and voxel-based morphometry enhances the identification of subtle cortical lesions such as focal cortical dysplasias to optimize epilepsy localization and selection of optimal surgical candidates. ESSENTIAL POINTS The neurologist has a unique role in understanding the clinical history and seizure phenomenology, which are the cornerstones of neuroanatomic localization. When integrated with advanced neuroimaging, the clinical context has a profound impact on identifying subtle MRI lesions or finding the "epileptogenic" lesion when multiple lesions are present. Patients with an identified lesion on MRI have a 2.5-fold improved chance of achieving seizure freedom with epilepsy surgery compared with those without a lesion. This clinical-radiographic integration is essential to accurate classification, localization, determination of long-term prognosis for seizure control, and identification of candidates for epilepsy surgery to reduce seizure burden or attain seizure freedom.
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Ojha V. Association between Clinical Features and Magnetic Resonance Imaging Findings in Patients with Temporal Lobe Epilepsy. JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2022. [DOI: 10.5005/japi-11001-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Apolot D, Erem G, Nassanga R, Kiggundu D, Tumusiime CM, Teu A, Mugisha AM, Sebunya R. Brain magnetic resonance imaging findings among children with epilepsy in two urban hospital settings, Kampala-Uganda: a descriptive study. BMC Med Imaging 2022; 22:175. [PMID: 36203127 PMCID: PMC9541090 DOI: 10.1186/s12880-022-00901-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Epilepsy is one of the most common neurological conditions in children worldwide. Its presentation is heterogeneous, with diverse underlying aetiology, clinical presentation, and prognosis. Structural brain abnormalities are among the recognized causes of epilepsy. Brain Magnetic Resonance Imaging (MRI) is the imaging modality of choice for epilepsy workup. We aimed to determine the prevalence and describe the structural abnormalities identified in the brain MRI studies performed on children with epilepsy from two urban hospitals in Kampala, Uganda. Methods This was a cross-sectional descriptive study performed at two urban hospital MRI centres. The study population was 147 children aged 1 day to 17 years with confirmed epilepsy. Brain MRI was performed for each child and a questionnaire was used to collect clinical data. Results The prevalence of structural abnormalities among children with epilepsy was 74.15% (109 out of 147). Of these, 68.81% were male, and the rest were female. Among these, the majority, 40.14% (59 of 144) were aged 1 month to 4 years. Acquired structural brain abnormalities were the commonest at 69.22% with hippocampal sclerosis (HS) leading while disorders of cortical development were the most common congenital causes. An abnormal electroencephalogram (EEG) was significant for brain MRI abnormalities among children with epilepsy with 95% of participants with an abnormal EEG study having epileptogenic structural abnormalities detected in their brain MRI studies. Conclusion and recommendation Two-thirds of children with epilepsy had structural brain abnormalities. Abnormal activity in the EEG study was found to positively correlate with abnormal brain MRI findings. As such, EEG study should be considered where possible before MRI studies as a determinant for children with epilepsy who will be having imaging studies done in the Ugandan setting.
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Affiliation(s)
- Denise Apolot
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Geoffrey Erem
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rita Nassanga
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Kiggundu
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Crescent Max Tumusiime
- Department of Radiology, Mother Kevin Postgraduate Medical School, Uganda Martyrs University School of Medicine, Kampala, Uganda.,St.Francis hospital, Nsambya, Uganda
| | - Anneth Teu
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Mwesigwa Mugisha
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Sebunya
- Department of Pediatrics, Mother Kevin Postgraduate Medical School, Uganda Martyrs University School of Medicine, Kampala, Uganda.,St.Francis hospital, Nsambya, Uganda
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Alsfouk BAA, Hakeem H, Chen Z, Walters M, Brodie MJ, Kwan P. Characteristics and treatment outcomes of newly diagnosed epilepsy in older people: A 30‐year longitudinal cohort study. Epilepsia 2020; 61:2720-2728. [DOI: 10.1111/epi.16721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Bshra Ali A. Alsfouk
- Department of Pharmaceutical Sciences College of Pharmacy Princess Nourah Bint Abdulrahman University Riyadh Saudi Arabia
- University of Glasgow Glasgow UK
| | - Haris Hakeem
- Department of Neuroscience Central Clinical School Monash University Alfred Hospital Melbourne Vic. Australia
| | - Zhibin Chen
- Department of Neuroscience Central Clinical School Monash University Alfred Hospital Melbourne Vic. Australia
- Department of Medicine – Royal Melbourne Hospital The University of Melbourne Melbourne Vic. Australia
- Clinical Epidemiology School of Public Health and Preventive Medicine Monash University Melbourne Vic. Australia
| | | | | | - Patrick Kwan
- Department of Neuroscience Central Clinical School Monash University Alfred Hospital Melbourne Vic. Australia
- Department of Medicine – Royal Melbourne Hospital The University of Melbourne Melbourne Vic. Australia
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Watkins L, O'Dwyer M, Shankar R. New anti-seizure medication for elderly epileptic patients. Expert Opin Pharmacother 2019; 20:1601-1608. [PMID: 31112437 DOI: 10.1080/14656566.2019.1618272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Epilepsy treatment in older people requires specific consideration owing to more physical co-morbidities, the risk of drug-to-drug interactions through polypharmacy, and differences in pharmacodynamics and pharmacokinetics. There are many 'newer' antiepileptic drugs (AEDs) widely used for various seizure types and seizure disorders. However, there is limited specific evidence for the efficacy, safety, and tolerability of these treatments in the elderly population. Areas covered: This review summarises the current most robust evidence available for the use of the newer AEDs belonging to generation two and three in elderly people with epilepsy. The article provides practical evidenced based clinical information to help prescribers choose the most appropriate AED from the drugs discussed. Expert opinion: Diagnosing new onset epilepsy in the elderly population requires specialist assessment. Treatment plans need to be tailored to accommodate an individual's co-morbidities, concurrent medications, and general health status. To date, few clinical investigations consider the elderly population specifically despite the increased risk factors. There is a need for large quality trial data to assess the impact of the newest AEDs on seizure control and quality of life in this population with complex needs.
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Affiliation(s)
- Lance Watkins
- Neath Port Talbot CLDT, Mental Health & Learning Disability Delivery Unit, Abertawe Bro Morgannwg University Health Board, LLwyneryr Unit , Morriston , UK
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin , Dublin , Ireland
| | - Rohit Shankar
- Developmental Neuropsychiatry Department, Cornwall Partnership NHS Foundation Trust , Truro , UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital , Truro , UK
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Ponnatapura J, Vemanna S, Ballal S, Singla A. Utility of Magnetic Resonance Imaging Brain Epilepsy Protocol in New-Onset Seizures: How is it Different in Developing Countries? J Clin Imaging Sci 2018; 8:43. [PMID: 30546927 PMCID: PMC6251247 DOI: 10.4103/jcis.jcis_38_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/03/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction Magnetic resonance imaging (MRI) is the current imaging tool of choice in the investigation of patients with seizures. The advent of high-resolution MRI with a dedicated seizure protocol has significantly increased the chances of identifying a cause, resulting in a positive clinical impact on the management of these patients. Aims The aims of this study were to evaluate the diagnostic efficacy of standard MRI, identify whether there is an increase in the diagnostic yield with the addition of dedicated seizure protocol, and compare the diagnostic yields of MRI and electroencephalogram (EEG) individually and in combination. Subjects and Methods This is a prospective study of 129 consecutive patients who presented with new-onset seizures over an 18-month period. The MRI scans performed on 1.5T were reviewed for their diagnostic yield and their association with abnormal electrical activity on EEG. Chi-square test of significance (P < 0.05) was used to test for the difference in proportion. The correlation between MRI brain and EEG was studied using McNemer test. Results MRI detected potentially epileptogenic lesions in 59 patients (47%). The frequency of epileptogenic lesions was highest in patients who had focal-onset seizures (81%). The most common lesion type was infection and inflammation (28%), with neurocysticercosis being the most common, followed by mesial temporal sclerosis, ischemia, and tumor. About 37% of epileptogenic lesions were missed by standard protocol, which were detected on a dedicated seizure protocol MRI. The diagnostic yield of EEG was 31%. Abnormal MRI and EEG were concordant in 18% of patients, with EEG being normal in 37% of patients with epileptogenic lesions. Conclusions MRI detects epileptogenic lesions in almost one half who presented with new-onset seizures and of these, more than third of them were detected using a "dedicated seizure protocol." While almost 50% with seizures will have a cause identified on MRI, the sensitivity can be substantially improved by utilizing a dedicated seizure protocol.
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Affiliation(s)
- Janardhana Ponnatapura
- Department of Radiodiagnosis, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Suresh Vemanna
- Department of Radiodiagnosis, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Sandeep Ballal
- Department of Radiodiagnosis, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Avisha Singla
- Department of Radiodiagnosis, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
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Mohan M, Keller S, Nicolson A, Biswas S, Smith D, Osman Farah J, Eldridge P, Wieshmann U. The long-term outcomes of epilepsy surgery. PLoS One 2018; 13:e0196274. [PMID: 29768433 PMCID: PMC5955551 DOI: 10.1371/journal.pone.0196274] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 04/10/2018] [Indexed: 02/07/2023] Open
Abstract
Objective Despite modern anti-epileptic drug treatment, approximately 30% of epilepsies remain medically refractory and for these patients, epilepsy surgery may be a treatment option. There have been numerous studies demonstrating good outcome of epilepsy surgery in the short to median term however, there are a limited number of studies looking at the long-term outcomes. The aim of this study was to ascertain the long-term outcome of resective epilepsy surgery in a large neurosurgery hospital in the U.K. Methods This a retrospective analysis of prospectively collected data. We used the 2001 International League Against Epilepsy (ILAE) classification system to classify seizure freedom and Kaplan-Meier survival analysis to estimate the probability of seizure freedom. Results We included 284 patients who underwent epilepsy surgery (178 anterior temporal lobe resections, 37 selective amygdalohippocampectomies, 33 temporal lesionectomies, 36 extratemporal lesionectomies), and had a prospective median follow-up of 5 years (range 1–27). Kaplan-Meier estimates showed that 47% (95% CI 40–58) remained seizure free (apart from simple partial seizures) at 5 years and 38% (95% CI 31–45) at 10 years after surgery. 74% (95% CI 69–80) had a greater than 50% seizure reduction at 5 years and 70% (95% CI 64–77) at 10 years. Patients who had an amygdalohippocampectomy were more likely to have seizure recurrence than patients who had an anterior temporal lobe resection (p = 0.006) and temporal lesionectomy (p = 0.029). There was no significant difference between extra temporal and temporal lesionectomies. Hippocampal sclerosis was associated with a good outcome but declined in relative frequency over the years. Conclusion The vast majority of patients who were not seizure free experienced at least a substantial and long-lasting reduction in seizure frequency. A positive long-term outcome after epilepsy surgery is possible for many patients and especially those with hippocampal sclerosis or those who had anterior temporal lobe resections.
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Affiliation(s)
- Midhun Mohan
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Simon Keller
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Andrew Nicolson
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Shubhabrata Biswas
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - David Smith
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Jibril Osman Farah
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Paul Eldridge
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Udo Wieshmann
- The Walton Centre, NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
- * E-mail:
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Sun MY, Lü JQ, Ma ZC, Lü JJ, Huang Q, Sun YN, Liu Y. Effects of the Inertia Barbell Training on Lumbar Muscle T2 Relaxation Time. J Strength Cond Res 2017; 34:3454-3462. [PMID: 28475549 DOI: 10.1519/jsc.0000000000001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sun, M-Y, Lu, J-Q, Ma, Z-C, Lü, J-J, Huang, Q, Sun, Y-N, and Liü, Y. Effects of the inertia barbell training on lumbar muscle T2 relaxation time. J Strength Cond Res 34(12): 3454-3462, 2020-The purpose of this study was to investigate variations in T2 relaxation time in normal human lumbar muscles caused by inertia barbell training. Thirty undergraduate healthy men (mean age = 19 ± 1.2 years, body mass = 72 ± 10.0 kg, and height = 1.78 ± 0.1 m) were recruited to participate in this study. Subjects were randomly assigned into 2 groups: an inertia barbell training group (IBTG) (n = 15) and a normal barbell-training group (NBTG) (n = 15). All subjects participated in lumbar flexion and extension muscle strength training for 1 hour per time, 3 times per week for a total of 8 weeks. The lumbar area of each subject was scanned before and after the experiment using a 3.0T superconductive magnetic resonance imaging system. The T2 values measured after intervention were significantly different compared with the T2 values measured before the experiment in both the IBTG and NBTG groups (p < 0.001). After intervention, there was no significant difference in T2 values between the IBTG and NBTG groups (p = 0.17). The ([INCREMENT]T2)/T2 percentage was significantly different in the IBTG group (p < 0.01). This study demonstrated that 8 weeks of strength training led to significant improvements in the values for T2 relaxation time of the lumbar muscles. Furthermore, the ([INCREMENT]T2)/T2 percentage for IBTG was higher than that for NBTG, which suggested that lumbar muscle activity increased more with inertial barbell training.
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Affiliation(s)
- Ming-Yun Sun
- Institute of Physical Education, Anqing Normal University, Anqing, China.,Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei, China; and
| | - Jian-Qiang Lü
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Zu-Chang Ma
- Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei, China; and
| | - Jiao-Jiao Lü
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Qing Huang
- Institute of Physical Education, Anqing Normal University, Anqing, China
| | - Yi-Ning Sun
- Institute and Intelligent of Machines, Chinese Academy of Sciences, Hefei, China; and
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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Bolen RD, Koontz EH, Pritchard PB. Prevalence and distribution of MRI abnormalities in patients with psychogenic nonepileptic events. Epilepsy Behav 2016; 59:73-6. [PMID: 27104810 DOI: 10.1016/j.yebeh.2016.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/21/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Both structural and functional abnormalities have been reported in patients with psychogenic nonepileptic events (PNEEs), although no truly consistent abnormalities have been found. METHODS We retrospectively identified patients discharged from our EMU with video-EEG diagnoses of epileptic seizures, PNEEs, epileptic seizures plus PNEEs, interictal epileptiform abnormalities only, and nondiagnostic admissions. We then collected brain MRI results for analysis. RESULTS We found significant brain MRI abnormalities in 33.8% of patients with PNEEs, clearly higher than the rate of brain MRI abnormalities in the healthy population. In addition, we found statistically significant differences in the locations of brain MRI abnormalities in patients with epileptic seizures (more frequently temporal) versus PNEEs (more frequently multifocal). CONCLUSION This multifocal nature of abnormalities in patients with psychogenic nonepileptic events may help to explain the underlying pathophysiology as it relates to psychiatric disorders which are so frequently comorbid with PNEEs.
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Affiliation(s)
- Robert D Bolen
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States.
| | - Elizabeth H Koontz
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Paul B Pritchard
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
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Sundararajan T, Tesar GE, Jimenez XF. Biomarkers in the diagnosis and study of psychogenic nonepileptic seizures: A systematic review. Seizure 2015; 35:11-22. [PMID: 26774202 DOI: 10.1016/j.seizure.2015.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/22/2015] [Accepted: 12/24/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Video electroencephalography (vEEG) is the gold-standard method for diagnosing psychogenic nonepileptic seizures (PNES), but such assessment is expensive, unavailable in many centers, requires prolonged hospitalization, and many times is unable to capture an actual seizure episode. This paper systematically reviews other non-vEEG candidate biomarkers that may facilitate both diagnosis and study of PNES as differentiated from epileptic seizures (ES). METHODS PubMed database was searched to identify articles between 1980 and 2015 (inclusion: adult PNES population with or without controls, English language; exclusion: review articles, meta-analyses, single case reports). RESULTS A total of 49 studies were examined, including neuroimaging, autonomic nervous system, prolactin, other (non-prolactin) hormonal, enzyme, and miscellaneous marker studies. Functional MRI studies have shown PNES is hyperlinked with dissociation and emotional dysregulation centers in the brain, although conflicting findings are seen across studies and none used psychiatric comparators. Heart rate variability suggests increased vagal tone in PNES when compared to ES. Prolactin is elevated in ES but not PNES, although shows low diagnostic sensitivity. Postictal cortisol and creatine kinase are nonspecific. Other miscellaneous biomarkers (neuron specific enolase, brain derived neurotropic factor, ghrelin, leptin, leukocytosis) showed no conclusive evidence of utility. Many studies are limited by lack of psychiatric comparators, size, and other methodological issues. CONCLUSION No single biomarker successfully differentiates PNES from ES; in fact, PNES is only diagnosed via the negation of ES. Clinical assessment and rigorous investigation of psychosocial variables specific to PNES remain critical, and subtyping of PNES is warranted. Future investigational and clinical imperatives are discussed.
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Affiliation(s)
- T Sundararajan
- Cleveland Clinic Department of Psychiatry and Psychology, United States
| | - G E Tesar
- Cleveland Clinic Department of Psychiatry and Psychology, United States; Cleveland Clinic Epilepsy Center, United States
| | - X F Jimenez
- Cleveland Clinic Department of Psychiatry and Psychology, United States.
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Abstract
Approximately 20% of paediatric patients with epilepsy are refractory to medical therapies. In this subgroup of patients, neuroimaging plays an important role in identifying an epileptogenic focus. Successful identification of a structural lesion results in a better outcome following epilepsy surgery. Advances in imaging technologies, methods of epileptogenic region localisation and refinement of clinical evaluation of this group of patients in epilepsy centres have helped to widen the spectrum of children who could potentially benefit from surgical treatment. In this review, we discuss ways to optimise imaging techniques, list typical imaging features of common pathologies that can cause epilepsy, and potential pitfalls to be aware of whilst reviewing imaging studies in this challenging group of patients. The importance of multidisciplinary meetings to analyse and synthesise all the non-invasive data is emphasised. Our objectives are: to describe the four phases of evaluation of children with drug-resistant localisation-related epilepsy; to describe optimal imaging techniques that can help maximise detection of epileptogenic foci; to describe a systematic approach to reviewing magnetic resonance imaging of children with intractable epilepsy; to describe the features of common epileptogenic substrates; to list potential pitfalls whilst reviewing imaging studies in these patients; and to highlight the value of multimodality and interdisciplinary approaches to the management of this group of children.
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Golden MJ, Morrison LA, Kim H, Hart BL. Increased number of white matter lesions in patients with familial cerebral cavernous malformations. AJNR Am J Neuroradiol 2015; 36:899-903. [PMID: 25556204 DOI: 10.3174/ajnr.a4200] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/22/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Familial cerebral cavernous malformations, an autosomal dominant disorder, result in excess morbidity and mortality in affected patients. The disorder is most prevalent in the Southwest United States, where the affected families are most often carriers of the CCM1-KRIT1 Common Hispanic Mutation. The brain and spinal cord parenchyma in these individuals is usually affected by multiple cavernous malformations. Previous studies have shown abnormalities of endothelial cell junctions and the blood-brain barrier in cerebral cavernous malformations. Endothelial cell abnormalities have also been described in pathologic studies of white matter hyperintensities. We compared the prevalence of white matter hyperintensities in a population with known familial cerebral cavernous malformations. MATERIALS AND METHODS We examined 191 subjects with familial cerebral cavernous malformations who were enrolled into an institutional review board-approved study. All carry the same Common Hispanic Mutation in the CCM1 gene. Each subject underwent 3T MR imaging, including gradient recalled-echo, SWI, and FLAIR sequences. The number of cavernous malformations and the number of nonhemorrhagic white matter hyperintensities were counted. Subjects older than 60 years of age were excluded due to the high prevalence of white matter lesions in this population, and children younger than 6 were excluded due to potential sedation requirements. Logistic regression analysis was performed to determine the prevalence of abnormal white matter hyperintensities in those with familial cerebral cavernous malformations compared with healthy controls or those with sporadic cerebral cavernous malformation within the familial cerebral cavernous malformations group; it was also performed to evaluate the associations between abnormal white matter hyperintensities and age, sex, headaches, thyroid disease, diabetes, hypertension, hyperlipidemia, seizure history, or modified Rankin Scale score. RESULTS Familial CCM1 carriers have a higher prevalence of abnormal white matter hyperintensities (15.4%) compared with both control populations (2.1% and 2.5%, respectively) (P < .05). Logistic regression showed no statistical association with sex, headaches, hyperlipidemia, hypertension, thyroid disease, seizure history, number of cerebral cavernous malformations, or modified Rankin Scale score among those with familial cerebral cavernous malformation. An expected correlation with age was shown. CONCLUSIONS Familial CCM1 carriers have not only an increased number of cerebral cavernous malformations but also an increased number of white matter T2 hyperintensities, spatially distinct from cerebral cavernous malformations, which exceeded that of a healthy population. Clinical findings did not explain the association with abnormal white matter hyperintensities in the familial cerebral cavernous malformation population. To our knowledge, these relationships have not been previously reported. This finding suggests an additional manifestation of endothelial abnormalities in this population.
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Affiliation(s)
- M J Golden
- From the Departments of Radiology (M.J.G., B.L.H.)
| | - L A Morrison
- Neurology (L.A.M.), University of New Mexico, Albuquerque, New Mexico
| | - H Kim
- Departments of Anesthesiology and Perioperative Care (H.K.) Epidemiology and Biostatistics (H.K.), University of California, San Francisco, San Francisco, California
| | - B L Hart
- From the Departments of Radiology (M.J.G., B.L.H.)
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15
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Autobiographical memory in children with Idiopathic Generalised Epilepsy. Neuropsychologia 2015; 66:10-7. [DOI: 10.1016/j.neuropsychologia.2014.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 11/03/2014] [Accepted: 11/08/2014] [Indexed: 11/17/2022]
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16
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Degnan AJ, Samtani R, Paudel K, Levy LM. Neuroimaging of epilepsy: a review of MRI findings in uncommon etiologies and atypical presentations of seizures. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: Imaging patients with seizures presents a challenge to both clinician and radiologist, especially when symptoms or EEG features are atypical, not conforming to established epilepsy syndromes or EEG patterns. Appropriate, directed use of MRI enhances the detection of underlying epileptogenic foci and can evaluate both common and unusual etiologies. This review examines imaging evaluation of epilepsies due to uncommon presentations of common conditions, unusual conditions and atypical seizure presentations. Understanding these uncommon presentations of seizures ensures optimal clinical management and can guide appropriate intervention. Advances in newer imaging methods including diffusion tensor imaging, functional connectivity MRI, magnetic source imaging and magnetic resonance spectroscopic imaging can further increase sensitivity to detect subtle structural abnormalities causing epilepsy and can also be used to plan more successful epilepsy surgery.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Rajeev Samtani
- Department of Radiology, George Washington University Medical Center, Washington, DC 20037, USA
| | - Kalyan Paudel
- Department of Radiology, George Washington University Medical Center, Washington, DC 20037, USA
| | - Lucien M Levy
- Department of Radiology, George Washington University Medical Center, Washington, DC 20037, USA
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17
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Abstract
Epilepsy is the most common serious neurological disease. Seizures are refractory to medication in approximately 30% of patients with focal epilepsy, and surgical treatment is potentially curative should the epileptic focus be accurately localized. MRI has revolutionized the investigation of such patients; however, up to 20% of patients with refractory focal epilepsy have an undetermined etiological basis for their epilepsy despite extensive investigation. Diffusion imaging is an advanced MRI technique that is sensitive to the molecular displacement of water molecules and provides additional information on the microstructural arrangement of tissue. Both qualitative and quantitative analyses of the interictal and peri-ictal states are possible and provide valuable insights into the epileptic brain in vivo. Furthermore, advanced postacquisition processing can reveal additional information on, for example, anatomical connectivity. The description, application and limitations of diffusion imaging in epilepsy are the focus of this review. Future directions of research required in this area are also discussed in the context of existing literature.
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Affiliation(s)
- Fergus J Rugg-Gunn
- Institute of Neurology, Department of Clinical & Experimental Epilepsy, University College London, Queen Square, London, UK.
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18
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Abstract
Purpose: To detect the possible structural brain lesions in the patients suffering from various kinds of epilepsy during the routine neuroimaging. Materials and Methods: Prospective study of 366 epileptic patients conducted at epilepsy clinic, Rawalpindi-Islamabad Pakistan in an outpatient setting. MRI or CT scan of the brain without contrast was advised in all patients to detect any underlying pathology. Results: A total 21.31% scans were found to be abnormal. Many cases of familial, idiopathic epilepsy and patients without any neurological deficit were found to have structural brain lesions, which might be responsible for their seizures. Conclusion: CT/MRI scan of the brain should be advised in all patients of epilepsy regardless of cause and type of epilepsy. The presence of neurological deficit should not be the sole indication for neuroimaging.
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Affiliation(s)
- Ahmed Bakhsh
- Department of Neuroscience, Saad Specialist hospital, Al-khober, Saudi Arabia
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19
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Babtain FA. Impact of a family history of epilepsy on the diagnosis of epilepsy in southern Saudi Arabia. Seizure 2013; 22:542-7. [DOI: 10.1016/j.seizure.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022] Open
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20
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Chui J, Venkatraghavan L, Manninen P. Presurgical Evaluation of Patients with Epilepsy. Anesth Analg 2013; 116:881-8. [DOI: 10.1213/ane.0b013e31828211af] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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The appropriate neuroimaging study in persons with epilepsy. Neurol Sci 2011; 32:969-71. [PMID: 21647630 DOI: 10.1007/s10072-011-0640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
This article presents the appropriate neuroimaging for persons with epilepsy (PWE) in resource-limited facilities. PWE from the Epilepsy Clinic, Srinagarind Hospital between November 1, 2003 and January 30, 2005 were enrolled. The inclusion criteria were PWE aged more than 15 years who underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. We compared the abnormal neuroimaging findings by both imaging modalities. A total of 180 out of 370 PWE met the inclusion criteria, comprising 101 men (56.1%) and 79 women (43.9%). There were 75 PWE who underwent only CT imagings, 85 PWE who underwent only MRI and 20 PWE who underwent both CT and MRI studies. CT scan significantly detected brain abnormalities more than MRI in PWE (P = 0.0131). It was also found that CT scan was superior than MRI in detecting stroke and cysticercosis in PWE, whereas MRI was significantly better in the diagnosis of hippocampal sclerosis. Clinicians should be able to choose appropriate brain imaging for PWE, particularly in resource-limited countries. MRI should be preserved for particular brain lesion owing to availability and cost effectiveness.
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22
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Abstract
The various findings observed on computed tomography (CT) and magnetic resonance (MR) imaging examinations in patients with seizures reflect the variety of different causes that give rise to this common neurologic symptom. In the emergency setting, CT is most valuable in its ability to accurately identify acute abnormalities that require emergent medical or surgical treatment. MR imaging, by contrast, is usually reserved for patients with recurrent or refractory seizures. The accurate interpretation of either modality requires familiarity with how seizures are classified clinically, the most common presenting features of different causes for seizures, the relevant neuroanatomy, and the imaging manifestations of both common and uncommon causes of seizures and epilepsy. Of particular practical importance to the radiologist is the ability to recognize (1) the most common findings in patients with recurrent seizures and (2) potentially reversible causes for seizures that require prompt intervention to avoid or minimize permanent brain injury. This article surveys a variety of different causes for seizures and epilepsy, focusing on specific clinical features that can help to refine differential diagnosis, and on imaging findings characteristic of different disorders.
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Affiliation(s)
- Christopher P Hess
- UCSF Department of Radiology & Biomedical Imaging, 505 Parnassus Avenue, Room L-358, San Francisco, CA 94143-0628, USA.
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23
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Abstract
In the second in a series of six articles on packages of care for mental health disorders in low- and middle-income countries, Caroline Mbuba and Charles Newton discuss treatment for epilepsy.
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Affiliation(s)
- Caroline K. Mbuba
- The Centre for Geographic Medicine Research (Coast), KEMRI, Kilifi, Kenya
| | - Charles R. Newton
- The Centre for Geographic Medicine Research (Coast), KEMRI, Kilifi, Kenya
- Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom
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24
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Zijlmans M, de Kort GA, Witkamp TD, Huiskamp GM, Seppenwoolde JH, van Huffelen AC, Leijten FS. 3T versus 1.5T phased-array MRI in the presurgical work-up of patients with partial epilepsy of uncertain focus. J Magn Reson Imaging 2009; 30:256-62. [DOI: 10.1002/jmri.21811] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Clinical MRI in children and adults with focal epilepsy: a critical review. Epilepsy Behav 2009; 15:40-9. [PMID: 19236945 DOI: 10.1016/j.yebeh.2009.02.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 11/21/2022]
Abstract
Hippocampal sclerosis in adults and focal cortical dysplasia in children with epilepsy are frequent lesions, but they are overlooked on standard MRI. Errors in the interpretation of MRI in epilepsy can be attributed mainly to poor technique and perceptual misses, but incomplete knowledge and poor judgment are also possible sources. This review covers what to expect in structural MRI of an adult patient with mesial temporal lobe epilepsy (TLE) and how to find hippocampal sclerosis (HS). It also covers the clinical MRI-based detection of focal cortical dysplasia (FCD) in extratemporal lobe epilepsy, mainly in children. In a stepwise approach, first, a typical epilepsy MRI protocol at 1.5 T includes axial and coronal fluid-attenuated inversion recovery (FLAIR) imaging, T2- and T2 *-weighted images, and a T1-weighted, three-dimensional volume acquisition. Advanced MR techniques (quantitation, new contrasts like diffusion, MR spectroscopy, high-contrast high-resolution imaging on high-field MR scanners > or = 3 T) are used to increase the method's sensitivity to detect a lesion in an individual patient. Exploiting increased sensitivity, we can avoid false-positive results in the light of a clinical hypothesis, possibly isolating a localized brain area by seizure semiology and EEG prior to MR reading.
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26
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Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, Vezina LG. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009; 50:2147-53. [PMID: 19389145 DOI: 10.1111/j.1528-1167.2009.02075.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The International League Against Epilepsy (ILAE) Subcommittee for Pediatric Neuroimaging examined the usefulness of, and indications for, neuroimaging in the evaluation of children with newly diagnosed epilepsy. The retrospective and prospective published series with n > or = 30 utilizing computed tomography (CT) and magnetic resonance imaging (MRI) (1.5 T) that evaluated children with new-onset seizure(s) were reviewed. Nearly 50% of individual imaging studies in children with localization-related new-onset seizure(s) were reported to be abnormal; 15-20% of imaging studies provided useful information on etiology or and seizure focus, and 2-4% provided information that potentially altered immediate medical management. A significant imaging abnormality in the absence of a history of a localization-related seizure, abnormal neurologic examination, or focal electroencephalography (EEG) is rare. Imaging studies in childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and benign childhood epilepsy with centrotemporal spikes (BECTS) do not identify significant structural abnormalities. Imaging provides important contributions to establishing etiology, providing prognostic information, and directing treatment in children with recently diagnosed epilepsy. Imaging is recommended when localization-related epilepsy is known or suspected, when the epilepsy classification is in doubt, or when an epilepsy syndrome with remote symptomatic cause is suspected. When available, MRI is preferred to CT because of its superior resolution, versatility, and lack of radiation.
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Affiliation(s)
- William D Gaillard
- Department of Neuroscience, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.
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27
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Imaging malformations of cortical development. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18809040 DOI: 10.1016/s0072-9752(07)87026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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28
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Wang R, Li SY, Chen M, Zhou C. Diagnostic value of interictal diffusion-weighted imaging in evaluation of intractable temporal lobe epilepsy. ACTA ACUST UNITED AC 2008; 23:68-72. [PMID: 18686624 DOI: 10.1016/s1001-9294(09)60015-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the ability of interictal diffusion-weighted imaging (DWI) to localize the temporal lobe of seizure origin and to predict postoperative seizure control in patients with temporal lobe epilepsy (TLE). METHODS Twenty-seven patients with intractable TLE considered for surgery and 19 healthy volunteers were studied with conventional magnetic resonance imaging (MRI) and DWI. Apparent diffusion coefficients (ADCs) of bilateral hippocampi in both TLE patients and control subjects were obtained. Lateralization to either temporal lobe with hippocampal ADC was based on the threshold values derived from +/- SD of right/left ratios in normal subjects. And the postoperative pathology was reviewed. RESULTS Hippocampal ADCs were higher on the side of surgery compared with those on the contralateral side as well as the ipsilateral side in control subjects [resected side (109.8 +/- 7.3) x 10(-5) cm2/s, contralateral side (91.7 +/- 4.7) x 10(-5) cm2/s, control subjects (81.6 +/- 5.2) x 10(-5) cm2/s, all P < 0.01]. Right/left hippocampal ADC ratio and conventional MRI lateralized to the operated temporal lobe in 21 of 27 (77.8%) and in 18 of 27 (66.7%) patients. Lateralization to the surgical side was not associated with postoperative seizure control with right/left hippocampal ADC ratio (P > 0.05). CONCLUSIONS Conventional MRI is a sensitive method to detect hippocampal sclerosis. Accuracy of the right/left hippocampal ADC ratio for lateralizing to the side of surgery is very high, but it isn't a better predictor of surgical outcome.
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Affiliation(s)
- Rui Wang
- Department of Radiology, Beijing Hospital, Beijing 100730
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29
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30
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Kuzniecky RI. NEUROIMAGING IN EPILEPSY. Continuum (Minneap Minn) 2008. [DOI: 10.1212/01.con.0000333206.49924.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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Karis JP. Epilepsy. AJNR Am J Neuroradiol 2008; 29:1222-1224. [PMID: 18544672 PMCID: PMC8118855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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32
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Kuzniecky R, Devinsky O. Surgery Insight: surgical management of epilepsy. ACTA ACUST UNITED AC 2008; 3:673-81. [PMID: 18046440 DOI: 10.1038/ncpneuro0663] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 09/18/2007] [Indexed: 11/09/2022]
Abstract
Epilepsy surgery has been shown to be an effective treatment for patients with intractable epilepsy. The only randomized controlled trial conducted in this setting to date found a dramatic advantage for surgery over medical treatment in temporal lobe epilepsy. In carefully selected patients, epilepsy surgery can control seizures, improve quality of life and reduce costs of medical care. Advances in diagnostic techniques are likely to improve patient selection, facilitate localization of epileptic foci and functional areas, and enable better prediction of outcomes.
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Affiliation(s)
- Ruben Kuzniecky
- New York University Comprehensive Epilepsy Center, New York, NY 10016, USA.
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33
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Johnson RE, Nolan MA. Evaluation of first unprovoked seizures in children by general paediatricians in New Zealand. J Paediatr Child Health 2006; 42:721-5. [PMID: 17044901 DOI: 10.1111/j.1440-1754.2006.00958.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine current practice of general paediatricians in New Zealand in the investigation and management of a first unprovoked seizure in childhood. METHODS A self-administered questionnaire was emailed to 109 general paediatricians in New Zealand. The questionnaire presented the participant with three hypothetical case scenarios representing a generalised tonic clonic seizure, a complex partial seizure and an episode of non-specific collapse. The participant was asked to indicate what investigations and course of management was required. RESULTS Forty-seven questionnaires were returned. Primary investigations included an electroencephalogram (EEG) in 47% of cases after a first generalised tonic clonic seizure increasing to 89% after a second. Ninety-one per cent of paediatricians were likely to request an EEG after a complex partial seizure. No paediatrician would request neuroimaging following a first generalised tonic clonic seizure. Neuroimaging was requested by 10% of paediatricians following a second generalised tonic clonic seizure and by 47% following a complex partial seizure. No paediatrician elected to initiate antiepileptic drugs after a first generalised tonic clonic seizure, but 49% would initiate treatment after a second generalised tonic clonic seizure. Eleven per cent of paediatricians would start treatment after a single complex partial seizure. CONCLUSION Less than 50% of general paediatricians would request an EEG after a first unprovoked seizure. This is an unexpectedly low rate that may reflect accessibility. New Zealand paediatricians had an appropriately low rate of requesting neuroimaging. As currently recommended no general paediatricians began antiepileptic drugs in the scenario of a single uncomplicated seizure in the absence of other risk factors.
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Affiliation(s)
- Rachel E Johnson
- Department of Neurology, Starship Children's Health, Auckland, New Zealand
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34
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Bösebeck F, Möddel G, Anneken K, Fischera M, Evers S, Ringelstein EB, Kellinghaus C. [Refractory status epilepticus: diagnosis, therapy, course, and prognosis]. DER NERVENARZT 2006; 77:1159-60, 1162-4, 1166-75. [PMID: 16924462 DOI: 10.1007/s00115-006-2125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Status epilepticus (SE) is a frequent neurological emergency with an annual incidence of 10-20/100,000 individuals. The overall mortality is about 10-20%. Patients present with long-lasting fits or series of epileptic seizures or extended stupor and coma. Furthermore, patients with SE can suffer from a number of systemic complications possibly also due to side effects of the medical treatment. In the beginning, standardized treatment algorithms can successfully stop most SE. A minority of SE cases prove however to be refractory against the initial treatment and require intensified pharmacologic intervention with nonsedating anticonvulsive drugs or anesthetics. In some partial SE, nonpharmacological approaches (e.g., epilepsy surgery) have been used successfully. This paper reviews scientific evidence of the diagnostic approach, therapeutic options, and course of refractory SE, including nonpharmacological treatment.
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Affiliation(s)
- F Bösebeck
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48129, Münster.
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Mraovitch S, Calando Y, Régnier A, Lamproglou I, Vicaut E. Post-seizures amygdaloallocortical microvascular lesion leading to atrophy and memory impairment. Neurobiol Dis 2005; 19:479-89. [PMID: 16023590 DOI: 10.1016/j.nbd.2005.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 01/25/2005] [Accepted: 01/28/2005] [Indexed: 12/01/2022] Open
Abstract
Although the incidence of seizures after a cerebrovascular event including intracerebral hemorrhage has been widely recognized, the present studies have demonstrated that generalized convulsive seizures can cause multifocal amygdaloallocortical hemorrhage and tissue necrosis, the origin of which remains to be established. The seizure-elicited amygdaloallocortical injured area, which we refer to as a focal injury-prone area (FIPA), was caused by cholinergic stimulation of the ventroposterolateral and thalamic reticular nuclei. The amygdaloallocortical injury was preceded by focal absence of neuronal COX-2 and presence of microvascular immunoreactivity to the pro-inflammatory cytokines, IL-1beta and TNF-alpha. The microvascular inflammation was followed by edema and multifocal amygdaloallocortical microhemorrhages, leading to atrophy and cognitive impairment. On the basis of the present results, we conclude that generalized convulsive seizures may be at the origin of amygdaloallocortical microvascular injury suggesting that, in addition to anticonvulsant treatment, an appropriate clinical evaluation and therapy for seizures-associated cerebrovascular accidents should be considered.
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Affiliation(s)
- Sima Mraovitch
- Laboratoire de Recherche Cérébrovasculaires CNRS URA 641, Université Paris VII, 10, av de Verdun, 75010 Paris, France.
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Gomez-Hassan DM, Blaesing C, Shattock S, Chenevert TL. Improving Cerebral Cortical Magnetic Resonance Imaging Using a Readily Available Surface Coil. J Neuroimaging 2004. [DOI: 10.1111/j.1552-6569.2004.tb00243.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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