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Michaelis R, Schöller H, Popkirov S, Edelhäuser F, Kolenik T, Trinka E, Schiepek G. Psychological precursors of epileptic seizures. Epilepsia 2024; 65:e35-e40. [PMID: 38100099 DOI: 10.1111/epi.17865] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
Psychological stress is the most commonly self-reported precursor of epileptic seizures. However, retrospective and prospective studies remain inconclusive in this regard. Here, we explored whether seizures would be preceded by significant changes in reported stressors or resource utilization. This study is based on high-frequency time series through daily online completion of personalized questionnaires of 9-24 items in epilepsy outpatients and compared responses 1-14 days before seizures with interictal time series. Fourteen patients (79% women, age = 23-64 years) completed daily questionnaires over a period of 87-898 days (median = 277 days = 9.2 months). A total of 4560 fully completed daily questionnaires were analyzed, 685 of which included reported seizure events. Statistically significant changes in preictal compared to interictal dynamics were found in 11 of 14 patients (79%) across 41 items (22% of all 187 items). In seven of 14 patients (50%), seizures were preceded by a significant mean increase of stressors and/or a significant mean decrease of resource utilization. This exploratory analysis of long-term prospective individual patient data on specific stressors and personal coping strategies generates the hypothesis that medium-term changes in psychological well-being may precede the occurrence of epileptic seizures in some patients.
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Affiliation(s)
- Rosa Michaelis
- Witten/Herdecke University, Herdecke, Germany
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Helmut Schöller
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- University Hospital of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Friedrich Edelhäuser
- Witten/Herdecke University, Herdecke, Germany
- Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Tine Kolenik
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- University Hospital of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Neurointensive Care, and Neurorehabilitation, member of the European Reference Network EpiCARE, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- University Hospital of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
- Faculty of Psychology and Educational Sciences, Ludwig Maximilian University of Munich, Munich, Germany
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Hong L. Bilateral Anterior Shoulder Dislocations Following a Clozapine-Induced Seizure. Cureus 2023; 15:e45778. [PMID: 37872936 PMCID: PMC10590618 DOI: 10.7759/cureus.45778] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Posterior shoulder dislocations are a recognised complication of generalised seizure episodes. Although less frequent, anterior shoulder dislocations are now being acknowledged as an emerging consequence. Particularly when they occur bilaterally, they can contribute to diagnosing a seizure disorder in a patient who shows no other signs during the post-ictal period. This article presents a case of bilateral anterior shoulder dislocations in an otherwise physically healthy young Sudanese gentleman following a generalised seizure episode on clozapine for a schizoaffective disorder. The case aims to raise awareness of the occurrence of this phenomenon and emphasises the importance of timely diagnostic testing, seizure prophylaxis, and follow-up to minimise the risk of further seizure episodes and potential consequences. Additionally, there is a discussion regarding the utility of monitoring clozapine concentrations.
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Affiliation(s)
- Lewis Hong
- Intensive Care Unit, Royal Perth Hospital, Perth, AUS
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Shebani Z, Brown AJ, Narvaez Caicedo C, Rane S, Masel T. Seizures Provoked by Greasy Pork in a Patient With Refractory Focal Epilepsy. Cureus 2023; 15:e40155. [PMID: 37431336 PMCID: PMC10329567 DOI: 10.7759/cureus.40155] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
Seizures have been reported to be directly triggered by certain foods in some people with epilepsy. On the other hand, eating epilepsy has been mentioned in the literature as a rare disorder characterized by clinical and EEG findings that vary from patient to patient and are interestingly prevalent in certain geographic areas. Epilepsy in these patients is either idiopathic or due to underlying brain pathology. We present a case of refractory focal epilepsy in which the patient reports seizures provoked by eating greasy pork. During the admission to the epilepsy monitoring unit (EMU), the patient did not have seizures during the first three days of the admission despite antiepileptic medication withdrawal, sleep deprivation, and photic stimulation. However, when he consumed greasy pork, he had tonic-clonic convulsions about five hours after eating. On the following day, he had another tonic-clonic seizure after eating greasy pork.
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Affiliation(s)
- Zacharia Shebani
- Neurology, The University of Texas Medical Branch, Galveston, USA
| | | | | | - Schweta Rane
- Neurology, The University of Texas Medical Branch, Galveston, USA
| | - Todd Masel
- Neurology, The University of Texas Medical Branch, Galveston, USA
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Sharma A, Besbris JM, Kramer NM, Daly FN, Singhal D, Jones CA, Mehta AK. Top Ten Tips Palliative Care Clinicians Should Know About Seizures at the End of Life. J Palliat Med 2021; 24:760-766. [PMID: 33787329 DOI: 10.1089/jpm.2021.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Seizures are physically burdensome and emotionally distressing for patients, families, caregivers, and clinicians. Patients with neurological diseases are at increased risk of having complex, difficult-to-control seizures at the end of life. Palliative care (PC) clinicians asked to provide management of these seizures may not be familiar or comfortable with more complex seizures or epilepsy. A team of neurologists and PC specialists have compiled a list of tips to guide clinicians on how to care for patients having seizures and to support their families/caregivers.
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Affiliation(s)
- Akanksha Sharma
- Department of Translational Neurosciences, Pacific Neuroscience Institute at Saint John Cancer Institute, Los Angeles, California, USA
| | - Jessica M Besbris
- Department of Neurology and Supportive Care Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Neha M Kramer
- Departments of Medicine and Neurology, Rush University School of Medicine, Chicago, Illinois, USA
| | - Farrah N Daly
- Goodwin House Palliative Care and Hospice, Alexandria, Virginia, USA
| | - Divya Singhal
- Department of Neurology, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Christopher A Jones
- Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambereen K Mehta
- Department of General Internal Medicine and Palliative Care, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Wolf P, Benbadis S, Dimova PS, Vinayan KP, Michaelis R, Reuber M, Yacubian EM. The importance of semiological information based on epileptic seizure history. Epileptic Disord 2020; 22:15-31. [PMID: 32096471 DOI: 10.1684/epd.2020.1137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Semiology is the backbone of any correct categorization of seizures, as epileptic or not, focal or bilateral, and is fundamental to elucidating how they are anatomically generated in the brain. An anatomical hypothesis derived from seizure history is the precondition for optimally designed ancillary studies. Without understanding seizure semiology, no rational therapy is possible. This article describes the semiological approach using patient history based on full use of patients' self-reports as well as descriptions by witnesses. Auras represent the subjective aspects of seizures and provide important semiological clues as observable signs, sometimes including rather precise direct anatomical information. Methods of extracting, facilitating and analysing self-reports including linguistic conversation analysis are presented in detail. It is highlighted that prodromes, seizure triggers and reflex epileptic mechanisms can provide crucial information for diagnostics and therapy. Special issues considering seizure semiology in children are discussed in a separate section. Other sections are dedicated to the two most important issues of differential diagnosis: how to distinguish (1) focal from "generalized" epilepsies, particularly when focal seizure phenomena appear in a bilateral epilepsy; and (2) epileptic from a series of non-epileptic events.
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Affiliation(s)
- Peter Wolf
- Danish Epilepsy Centre Filadelfia, Dianalund, Denmark, Postgraduate Programme in Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Selim Benbadis
- Comprehensive Epilepsy Program, University of South Florida and Tampa General Hospital, Tampa, FL, USA
| | - Petia S Dimova
- Epilepsy Centre, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | | | - Rosa Michaelis
- Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany, Integrated Curriculum for Anthroposophical Medicine (ICURAM), Witten/Herdecke University, Herdecke, Germany
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom
| | - Elza Márcia Yacubian
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
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Michaelis R, Schonfeld W, Elsas SM. Trigger self-control and seizure arrest in the Andrews/Reiter behavioral approach to epilepsy: a retrospective analysis of seizure frequency. Epilepsy Behav 2012; 23:266-71. [PMID: 22341960 DOI: 10.1016/j.yebeh.2011.11.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 11/11/2011] [Accepted: 11/25/2011] [Indexed: 11/24/2022]
Abstract
The aim of this retrospective study is to describe changes of seizure frequency in epilepsy patients who participated in the Andrews/Reiter behavioral intervention for epilepsy. For this uncontrolled retrospective study, data were extracted from patients' medical journals. Intention-to-treat-analyses were restricted to patients with sufficient documentation supporting a diagnosis of probable or definite epilepsy. Main outcome variable was a comparison of mean seizure frequency at baseline and toward completion of the program. The seizure frequency of 30 (50%) patients showed a clinically meaningful improvement (>50% reduction of seizures) toward the end of the intervention. Twenty-two (37%) patients became seizure-free at the end of the intervention. In summary, a clinically meaningful reduction in reported seizure frequency was observed in epilepsy patients who received the Andrews/Reiter intervention for epilepsy. Prospective trials are needed to further investigate the program's efficacy and to study epileptic seizure triggers.
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