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Grau-López L, Flores-Pina B, Jiménez M, Carbonell J, Ciurans J, Chies E, Fagundez O, Fumanal A, Becerra JL. Epileptiform electroencephalogram discharges increase seizure recurrence risk in patients with acute symptomatic seizure due to a structural brain lesion. Seizure 2024; 117:56-59. [PMID: 38330750 DOI: 10.1016/j.seizure.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE The risk factors for seizure recurrence after acute symptomatic seizure due to a structural brain lesion are not well established. The aim of this study was to analyze possible associations between demographic, clinical, and electroencephalographic variables and epilepsy development in patients with acute symptomatic seizure due to an acute structural brain lesion. METHODS We designed an observational prospective study of patients with acute symptomatic seizure due to an acute structural brain lesion (hemorrhagic stroke, ischemic stroke, traumatic brain injury, or meningoencephalitis) who underwent EEG during their initial admission between January 2015 and January 2020. We analyzed prospectively recorded demographic, clinical, electroencephalographic (EEG), and treatment-related variables. All variables were compared between patients with and without seizure recurrence during 2 years of follow up. RESULTS We included 194 patients (41.2 % women; mean [SD] age, 57.3 [15.8] years) with acute symptomatic seizure due to an acute structural brain lesion. They all underwent EEG during admission and were followed for at least 2 years. The identifiable causes were hemorrhagic stroke (44.8 %), ischemic stroke (19.5 %), traumatic brain injury (18.5 %), and meningoencephalitis (17 %). Fifty-six patients (29 %) experienced a second seizure during follow-up. Seizure recurrence was associated with epileptiform discharges on EEG (52% vs 32 %; OR 2.3 [95 % CI, 1.2-4.3], p = 0.008) and onset with status epilepticus (17% vs 0.05 %, OR 4.03 [95 % CI 1.45-11.2], p = 0.009). CONCLUSIONS Epileptiform discharges on EEG and status epilepticus in patients with acute symptomatic seizure due to an acute structural brain lesion are associated with a higher risk of epilepsy development.
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Affiliation(s)
- Laia Grau-López
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain.
| | - Belén Flores-Pina
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Marta Jiménez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Jaime Carbonell
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Jordi Ciurans
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Eva Chies
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Olga Fagundez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Alejandra Fumanal
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Juan Luis Becerra
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
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Brigo F, Zelano J, Abraira L, Bentes C, Ekdahl CT, Lattanzi S, Ingvar Lossius M, Redfors P, Rouhl RPW, Russo E, Sander JW, Vogrig A, Wickström R. Proceedings of the "International Congress on Structural Epilepsy & Symptomatic Seizures" (STESS, Gothenburg, Sweden, 29-31 March 2023). Epilepsy Behav 2024; 150:109538. [PMID: 38039602 DOI: 10.1016/j.yebeh.2023.109538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Laura Abraira
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carla Bentes
- Neurophysiological Monitoring Unit - EEG/Sleep Laboratory, Refractory Epilepsy Reference Centre (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro de Estudos Egas Moniz, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Christine T Ekdahl
- Division of Clinical Neurophysiology and Department of Clinical Sciences, Lund University, Sweden; Lund Epilepsy Center, Department of Clinical Sciences, Lund University, Sweden
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Morten Ingvar Lossius
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petra Redfors
- Department of Neurology, Member of the ERN EpiCARE, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands; Academic Centre for Epileptology Kempenhaeghe/MUMC+ Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Italy
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK; Centre for Epilepsy, Chalfont St Peter, Bucks., SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 610041, China
| | - Alberto Vogrig
- Department of Medicine (DAME), University of Udine, Udine, Italy; Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Ronny Wickström
- Neuropediatric Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Kim JW, Stetefeld HR, Fink GR, Malter MP. Seizures at stroke onset: A case-control study. Seizure 2023; 113:28-33. [PMID: 37948903 DOI: 10.1016/j.seizure.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Seizures occurring at the immediate onset of a stroke, abbreviated "seizures at onset" (SaO), pose a diagnostic and therapeutic challenge for physicians. In this study, we report on the current clinical practice in managing stroke patients with SaO from a large tertiary stroke center in Germany. METHODS We selected all patients with SaO and acute ischemic or hemorrhagic stroke admitted to the Department of Neurology at the University Hospital of Cologne between 2019 and 01-01 and 2020-12-31. SaO patients were then compared to patients with acute ischemic or hemorrhagic stroke without SaO from the local stroke registry. Further, we compared SaO patients who received intravenous recombinant tissue-type plasminogen activator (rt-PA) and/or mechanical thrombectomy with matched controls. RESULTS Overall, 54 out of 2312 stroke patients (2.3 %) in the examined period presented with SaO. The most prevalent SaO semiology was focal to bilateral tonic-clonic (42.6 %). SaO was associated with hemorrhagic strokes and higher in-hospital mortality in all stroke patients. The rate of acute stroke therapy was not influenced by the occurrence of SaO. In patients that received acute stroke therapy, patients with SaO had higher scores on the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) at admission, and longer door-to-needle times for the administration of rt-PA, while none of the examined outcome parameters revealed a difference between patients with and without SaO after adjusting for potential confounders. CONCLUSION Data show that SaO is rare in stroke patients but associated with more extensive strokes.
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Affiliation(s)
- Ji-Won Kim
- Department of Neurology, Faculty of Medicine, University of Cologne, and University Hospital Cologne, Kerpener Strasse, 62, Cologne 50937, Germany.
| | - Henning R Stetefeld
- Department of Neurology, Faculty of Medicine, University of Cologne, and University Hospital Cologne, Kerpener Strasse, 62, Cologne 50937, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University of Cologne, and University Hospital Cologne, Kerpener Strasse, 62, Cologne 50937, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Germany
| | - Michael P Malter
- Department of Neurology, Faculty of Medicine, University of Cologne, and University Hospital Cologne, Kerpener Strasse, 62, Cologne 50937, Germany
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Herzig-Nichtweiß J, Salih F, Berning S, Malter MP, Pelz JO, Lochner P, Wittstock M, Günther A, Alonso A, Fuhrer H, Schönenberger S, Petersen M, Kohle F, Müller A, Gawlitza A, Gubarev W, Holtkamp M, Vorderwülbecke BJ. Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study. Ann Intensive Care 2023; 13:85. [PMID: 37712992 PMCID: PMC10504169 DOI: 10.1186/s13613-023-01183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Acute symptomatic epileptic seizures are frequently seen in neurocritical care. To prevent subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is lacking. This study aimed at prospectively assessing the risk of unprovoked seizure relapse with respect to the use of antiseizure medications. It was hypothesized that after a first acute symptomatic seizure of structural etiology, the cumulative 12-month risk of unprovoked seizure relapse is ≤ 25%. METHODS Inclusion criteria were age ≥ 18 and acute symptomatic first-ever epileptic seizure; patients with status epilepticus were excluded. Using telephone and mail interviews, participants were followed for 12 months after the acute symptomatic first seizure. Primary endpoint was the occurrence and timing of a first unprovoked seizure relapse. In addition, neuro-intensivists in Germany were interviewed about their antiseizure treatment strategies through an anonymous online survey. RESULTS Eleven of 122 participants with structural etiology had an unprovoked seizure relapse, resulting in a cumulative 12-month risk of 10.7% (95%CI, 4.7%-16.7%). None of 19 participants with a non-structural etiology had a subsequent unprovoked seizure. Compared to structural etiology alone, combined infectious and structural etiology was independently associated with unprovoked seizure relapse (OR 11.1; 95%CI, 1.8-69.7). Median duration of antiseizure treatment was 3.4 months (IQR 0-9.3). Seven out of 11 participants had their unprovoked seizure relapse while taking antiseizure medication; longer treatment durations were not associated with decreased risk of unprovoked seizure relapse. Following the non-representative online survey, most neuro-intensivists consider 3 months or less of antiseizure medication to be adequate. CONCLUSIONS Even in case of structural etiology, acute symptomatic seizures bear a low risk of subsequent unprovoked seizures. There is still no evidence favoring long-term treatments with antiseizure medications. Hence, individual constellations with an increased risk of unprovoked seizure relapse should be identified, such as central nervous system infections causing structural brain damage. However, in the absence of high-risk features, antiseizure medications should be discontinued early to avoid overtreatment.
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Affiliation(s)
- Julia Herzig-Nichtweiß
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Farid Salih
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Sascha Berning
- Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - Michael P Malter
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Johann O Pelz
- Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany
| | - Matthias Wittstock
- Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Albrecht Günther
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Angelika Alonso
- Department of Neurology, Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany
| | - Hannah Fuhrer
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | - Silvia Schönenberger
- Department of Neurology, Medical Faculty Heidelberg, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | | | - Felix Kohle
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Annekatrin Müller
- Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany
| | - Alexander Gawlitza
- Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany
| | - Waldemar Gubarev
- Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Bernd J Vorderwülbecke
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany.
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Li L, Deng Y, Chen J, Xie L, Lan X, Hu Y, Hong S, Jiang L. Clinical and electroencephalography characteristics of 45 patients with neonatal seizures. Neurophysiol Clin 2023; 53:102886. [PMID: 37295040 DOI: 10.1016/j.neucli.2023.102886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES The aim of our study was to retrospectively research the semiology of neonatal seizures (NSs) based on the 2021 classification scheme of the International League Against Epilepsy, and the relationship between etiology and electroclinical features. METHODS Patients admitted to Children's Hospital of Chongqing Medical University from May 1, 2020 to March 30, 2022 and diagnosed with NSs were included to retrospectively investigate the etiology, seizure characteristics, prognosis, and ictal and interictal video electroencephalography (EEG) characteristics. RESULTS Of the 45 patients, 73.3% had definite etiology. Twenty-seven patients had electro-clinical seizures, of which two had both electro-clinical and electrographic-only seizures. Electrographic-only seizures were reported in 18 patients. The tonic, clonic, and electrographic-only seizures were associated with various etiologies. Both tonic and clonic seizures occurred in acute symptomatic seizures and were associated with neonatal epilepsy. 50% of tonic seizures were related to genetic factors. Among the clonic seizures, 50.0% occurred in acute symptomatic seizures. Epileptic spasms always indicated neonatal epilepsy. There were few patients who experienced automatisms and sequential seizures, and these two seizure types were associated with brain malformation and genetic factors, respectively. Patients with a normal interictal EEG had acute symptomatic seizures. whereas the interictal EEG of patients with neonatal epilepsy mainly showed burst-suppression or multifocal discharges. The ictal EEG recordings were related to seizure semiology. CONCLUSION Seizure semiology and video EEG are suggestive of potential causes but do not provide a definite etiology.
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Affiliation(s)
- Luying Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Yu Deng
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Lingling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Xinghui Lan
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, NO. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
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Licchetta L, Ferri L, Morsillo F, Faustini-Fustini M, Toni F, Pondrelli F, Nonino F, Bisulli F, Tinuper P. Clinical characterization of non-ketotic hyperglycemia-related seizures: A systematic review and individual participant data meta-analysis. Seizure 2023; 106:50-57. [PMID: 36773573 DOI: 10.1016/j.seizure.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/09/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Abstract
New-onset epileptic seizures and status epilepticus (SE) are the most frequent neurological manifestations of non-ketotic hyperglycemia (NKH), an acute complication of diabetes mellitus (DM). Treatment consists of the correction of the underlying metabolic disorder, whereas anti-seizure medications (ASMs) may even worsen seizures. Evidence on NKH-related seizures is currently restricted to case reports and small case-series. We conducted a systematic review of the PubMed, Embase, and Cochrane Library databases to provide a comprehensive description of NKH-related seizures. Statistical analyses were performed to explore possible associations of glycemic and osmolarity levels with clinical variables. We selected 130 publications and 332 patients (186 males, mean age: 61.1 years). DM was newly-diagnosed in 40%. Mean glycemia and osmolarity levels at presentation were 529.7 mg/dL and 309.6 mmol/mol, respectively; 22.6% showed other neurological symptoms besides seizures. Focal motor seizures were the prominent seizure type (49.4%); non-motor focal seizures (23.2%) most commonly manifested as visual symptoms. Reflex seizures occurred in 10.5%. Brain MRI in 48.7% of cases showed focal T2 subcortical hypodensity and/or overlying cortical T2 hyperintensity with DWI restriction. ASMs were administered in 54.2% of cases, achieving seizure control in just 18.3%. Higher osmolarity levels were associated with newly-diagnosed DM (p = 0.002) and other symptoms at presentation (p < 0.001). Glycemic values were higher in patients with focal aware seizures with motor onset compared to those with focal seizures without motor onset (p = 0.0046) or focal seizures with impaired awareness (p = 0.0306). Lower glycemic values were associated with reflex seizures (p = 0.036) and ASM administration (p < 0.001). NKH-related seizures should be suspected in adults with new-onset clustering focal seizures arising from the motor or posterior cortices, even in the absence of a history of DM. Typical focal changes on brain MRI, while not pathognomonic, can drive the clinical diagnosis. Statistical associations suggest a key role of hyperglycemia in the excitability of higher-energy-demanding cortical areas.
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Affiliation(s)
- Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy.
| | - Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Filomena Morsillo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
| | | | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | - Federica Pondrelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Rajper SB, Moazzam M, Zeeshan A, Abbas Q. Acute Symptomatic Seizures in Critically Ill Children: Frequency, Etiology and Outcomes. J Pediatr Neurosci 2021; 15:375-378. [PMID: 33936301 PMCID: PMC8078641 DOI: 10.4103/jpn.jpn_140_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/15/2020] [Accepted: 03/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Critically ill individuals have an increased risk of acute symptomatic seizures secondary to systemic illnesses; unrecognized or untreated seizures can quickly convert into status epilepticus, which is associated with high morbidity and mortality. Objective: The aim of this study was to determine frequency, etiology, and outcome of seizures in critical ill children admitted in intensive care unit of a tertiary care hospital. Materials and Methods: Retrospective review of medical records of all children admitted in pediatric intensive care unit (PICU) of the Aga Khan University from January 2016 to December 2018 and who had a new-onset seizure irrespective of underlying diagnosis was carried out after ethical review committee approval. Data were collected on a structured proforma; it included demographic information as well as relevant clinical and outcome information. The data were analyzed on Statistical Package for the Social Sciences (SPSS) software program, version 19.0. The descriptive statistics frequency and percentage was computed for qualitative variable. Mean and standard deviation were computed for quantitative variable, and univariate analysis was performed. Results: During the study period, a total 2053 patients were admitted in the PICU. One hundred six (5%) had seizure. Sixty-three (59.5%) were males. Meningitis 21 (20%), sepsis 21 (20%), complicated pneumonia 18 (17%) were the major primary diagnosis in these children. Mean age of the study population was 75 months (standard deviation [SD] ± 54.4) and 72 (68%) were <5 years of age, whereas 63 (59.5%) were males. The seizures lasted >10min in 10 (10%) and were associated with high had neurological deficit (P = 0.001). We did not observe any correlation with electrolyte imbalance, renal failure, need of ventilator support with duration of seizure, and type of seizure (P > 0.005). Conclusion: Infection was the most common etiology associated with a new-onset seizure in children admitted in our PICU. Seizures lasting for >10min were observed with high neurological deficit. We did not find any association of mortality with seizure duration.
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Affiliation(s)
- Sanam B Rajper
- Department of Pediatrics and Child Health, Aga Khan University Karachi, Karachi, Pakistan
| | - Mujtaba Moazzam
- Medical College, Aga Khan University Karachi, Karachi, Pakistan
| | - Arsheen Zeeshan
- Department of Pediatrics and Child Health, Aga Khan University Karachi, Karachi, Pakistan
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Aga Khan University Karachi, Karachi, Pakistan
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Zaccara G, Citerio G, Del Gaudio A, Ferlisi M, Pugliese FR, Toni D. Clinical pathways of epileptic seizures and status epilepticus: results from a survey in Italy. Neurol Sci 2020; 41:1571-5. [PMID: 31989348 DOI: 10.1007/s10072-020-04270-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Abstract
Objective Patients with seizures or status epilepticus (SE) access the hospital through emergency departments and may be admitted into different wards according to the level of care required. Clinicians with different expertise are in charge of taking critical therapeutic decisions. To date, very few studies have investigated the stage at which these patients are referred to neurologists or epileptologists and how guideline recommendations are applied in clinical practice. Methods A survey was used to investigate how patients with epileptic seizures or SE are managed in emergency and in subsequent hospital pathways in Italy. Results One hundred and seventy-seven physicians (mainly neurologists) from all parts of Italy filled in a questionnaire. Less than half of the participants (35%) answered that, in their hospital, patients with epilepsy were managed by epileptologists. The percentages were lower for patients presenting with acute seizures (21%) or SE (16%). Diagnostic, therapeutic, and assistance pathways (PDTA) for patients presenting with seizure(s) or SE were available for both conditions in about 50% of cases, while, in the rest of the hospitals, participants indicated informal agreements (about 25% of cases) or lack of any agreement (about 25% of cases) between clinicians. Professionals more often involved in PDTA were epileptologists/neurologists, emergency physicians, and intensivists. More than half ot the participants (55%) thought that organizational issues are the most important criticalities for such patients and need to be improved (61%). Significance There is a high variability in hospital clinical pathways for epilepsy in Italy. Electronic supplementary material The online version of this article (10.1007/s10072-020-04270-3) contains supplementary material, which is available to authorized users.
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Abstract
Following stroke, 3-6% of patients develop acute symptomatic seizures within the first 7 days. The rate is higher after cerebral haemorrhage compared to ischaemia. In 10-12% of patients, after more than 7 days unprovoked seizures occur. Due to these low incidence rates, primary prophylaxis with antiepileptic drugs is generally not necessary. Following one acute symptomatic seizure, recurrence risk within the first 7 days post-stroke is 10-20%, generally arguing against secondary prophylaxis with an antiepileptic drug. In clinical practice however, antiepileptic drug treatment in this constellation is often initiated. If this is done, the antiepileptic drug should be withdrawn soon after the acute phase, as the long-term risk for manifestation of an unprovoked seizure is approximately 30%. Following one post-stroke unprovoked seizure, recurrence risk within the next 10 years is more than 70%, this defines epilepsy. In this case, antiepileptic drug treatment is regularly recommended.
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Affiliation(s)
- F Benninger
- Klinik für Neurologie, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Medizinische Fakultät, Tel Aviv University, Tel Aviv, Israel
| | - M Holtkamp
- Epilepsie-Zentrum Berlin-Brandenburg, Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Wither RG, Borlot F, MacDonald A, Butcher NJ, Chow EWC, Bassett AS, Andrade DM. 22q11.2 deletion syndrome lowers seizure threshold in adult patients without epilepsy. Epilepsia 2017; 58:1095-1101. [PMID: 28448680 DOI: 10.1111/epi.13748] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Previous studies examining seizures in patients with 22q11.2 deletion syndrome (22q11.2DS) have focused primarily on children and adolescents. In this study we investigated the prevalence and characteristics of seizures and epilepsy in an adult 22q11.2DS population. METHODS The medical records of 202 adult patients with 22q11.2DS were retrospectively reviewed for documentation of seizures, electroencephalography (EEG) reports, and magnetic resonance imaging (MRI) findings. Epilepsy status was assigned in accordance with 2010 International League Against Epilepsy Classification. RESULTS Of 202 patients, 32 (15.8%) had a documented history of seizure. Of these 32, 23 (71.8%) had acute symptomatic seizures, usually associated with hypocalcemia and/or antipsychotic or antidepressant use. Nine patients (9/32, 28%; 9/202, 4%) met diagnostic criteria for epilepsy. Two patients had genetic generalized epilepsy; two patients had focal seizures of unknown etiology; two had epilepsy due to malformations of cortical development; in two the epilepsy was due to acquired structural changes; and in one patient the epilepsy could not be further classified. SIGNIFICANCE Similarly to children, the prevalence of epilepsy and acute symptomatic seizures in adults with 22q11.2DS is higher than in the general population. Hypocalcemia continues to be a risk factor for adults, but differently from kids, the main cause of seizures in adults with 22q11.2DS is exposure to antipsychotics and antidepressants. Further prospective studies are warranted to investigate how 22q11.2 microdeletion leads to an overall decreased seizure threshold.
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Affiliation(s)
- Robert G Wither
- Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada
| | - Felippe Borlot
- Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, U.S.A.,Krembil Neurosciences Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alex MacDonald
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eva W C Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Danielle M Andrade
- Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada.,Krembil Neurosciences Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Holtkamp M, Beghi E, Benninger F, Kälviäinen R, Rocamora R, Christensen H. European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy. Eur Stroke J 2017; 2:103-115. [PMID: 31008306 DOI: 10.1177/2396987317705536] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022] Open
Abstract
Background Following stroke, acute symptomatic seizures (manifestation within seven days) and epilepsy, i.e. occurrence of at least one unprovoked seizure (manifestation after more than seven days), are reported in 3-6% and up to 12% of patients, respectively. Incidence of acute symptomatic seizures is higher in intracranial haemorrhage (10-16%) than in ischaemic stroke (2-4%). Acute symptomatic seizures and unprovoked seizure may be associated with unfavourable functional outcome and increased mortality. In view of the clinical relevance, the European Stroke Organisation has issued evidence-based guidelines on the management of post-stroke seizures and epilepsy. Method A writing committee of six clinicians and researchers from five European countries and Israel identified seven questions relating to prevention of (further) post-stroke seizures and epilepsy and to amelioration of functional outcome and prevention of mortality. Recommendations are based on findings in randomised controlled trials and observational studies using the grading of recommendations assessment, development and evaluation approach. Results In the absence of adequately powered randomised controlled trials, evidence for all recommendations is very low. Based on findings in observational studies, some weak recommendations have been made. In most instances, we suggest not to administer antiepileptic drugs. Due to high incidence of seizure recurrence after one post-stroke unprovoked seizure, secondary antiepileptic drugs prophylaxis needs to be considered. Conclusion Due to very low evidence, these guidelines only give some weak recommendations on prevention of occurrence and recurrence of post-stroke acute symptomatic seizures and unprovoked seizure. Adequately powered randomised controlled trials are required to assess interventions for post-stroke seizure management.
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Affiliation(s)
- Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Ettore Beghi
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Dipartimento di Neuroscienze, Milano, Italy
| | - Felix Benninger
- Rabin Medical Center, Department of Neurology, Faculty of Medicine, Tel Aviv University, Beilinson Hospital, Tel Aviv, Israel
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center/NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Rodrigo Rocamora
- Epilepsy Unit, Department of Neurology, Hospital Universitario del Mar, Barcelona, Spain
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
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Howe J, Lu X, Thompson Z, Peterson GW, Losey TE. Intraoperative seizures during craniotomy under general anesthesia. Seizure 2016; 38:23-5. [PMID: 27082030 DOI: 10.1016/j.seizure.2016.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/01/2016] [Accepted: 03/28/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE An acute symptomatic seizure is a clinical seizure occurring at the time of or in close temporal association with a brain insult. We report an acute symptomatic seizure occurring during a surgical procedure in a patient who did not have a prior history of epilepsy and who did not have a lesion associated with an increased risk of epilepsy. To characterize the incidence and clinical features of intraoperative seizures during craniotomy under general anesthesia, we reviewed cases where continuous EEG was acquired during craniotomy. METHOD Records of 400 consecutive cases with propofol as general anesthesia during craniotomy were reviewed. Demographic data, indication for surgery, clinical history, history of prior seizures, duration of surgery and duration of burst suppression were recorded. Cases where seizures were observed were analyzed in detail. RESULTS Two out of 400 patients experienced intraoperative seizures, including one patient who appeared to have an acute symptomatic seizure related to the surgical procedure itself and a second patient who experienced two seizures likely related to an underlying diagnosis of epilepsy. CONCLUSIONS This is the first report of an acute symptomatic seizure secondary to a neurosurgical procedure. Overall, 0.5% of patients monitored experienced seizures, indicating that intraoperative seizures are rare, and EEG monitoring during craniotomies is of low yield in detecting seizures.
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Affiliation(s)
- John Howe
- Loma Linda University, School of Medicine, Loma Linda, CA 92354, USA.
| | - Xiaoying Lu
- Loma Linda University, Department of Neurology, Loma Linda, CA 92354, USA.
| | - Zoe Thompson
- University of California Riverside, Biology, Riverside, CA, USA.
| | - Gordon W Peterson
- Loma Linda University, Department of Neurology, Loma Linda, CA 92354, USA.
| | - Travis E Losey
- Loma Linda University, Department of Neurology, Loma Linda, CA 92354, USA.
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