Sleep organization in patients with primary generalized epilepsy without medication and with ethosuximide (ES) and sodium valproate (VPA)

Status epilepticus has been defined as continuous seizure activity or intermittent seizure activity without recovery of consciousness between seizures that lasts for more than 30 minutes. However, if a seizure has continued unabated for 5 minutes, status epilepticus should be presumed and therapy initiated. Status epilepticus is a medical emergency, and all primary care physicians should know how to initiate its treatment. Usually status epilepticus consists of generalized or asymmetric clonic activity with unconsciousness. However, prolonged absence or partial seizures comprise 10% of episodes. Absence status epilepticus usually occurs in children who have severe primary generalized epilepsy or Lennox-Gastaut syndrome. Partial status epilepticus occurs in children who have focal brain pathology. The initial treatment of both is like that for generalized status epilepticus, with only slightly less urgency. The remainder of this review concerns generalized status epilepticus. Etiology It is important to obtain both remote and recent histories from the child's family or attendant as soon as possible so that an appropriate differential diagnosis may be developed. In 25% of cases, status is idiopathic. In another 25% it is provoked only by fever (febrile status). In the 20% of children who have a static encephalopathy, the condition is termed remote symptomatic status epilepticus. In another 20%, status is termed acute symptomatic and is an expression of an acute encephalopathy or brain injury.

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Exacerbation of Pre-existing Epilepsy by Mild Head Injury: a Five Patient Series

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100003516 ◽

2004 ◽

Vol 31 (3) ◽

pp. 394-397 ◽

Cited By ~ 12

Author(s):

P.C. Tai ◽

D.W. Gross

Keyword(s):

Head Injury ◽

Temporal Relationship ◽

Seizure Control ◽

Head Injuries ◽

Neurological Deficits ◽

Mild Head Injury ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

One Year ◽

Patients With Epilepsy

Objective:While the risk of developing seizures following a mild head injury has been reported and is thought to be low, the effect of mild head injury on patients with a pre-existing seizure disorder has not been reported. We present a series of cases where a strong temporal relationship between mild head injury and worsening of seizure frequency was observed.Methods:Five cases were identified and reviewed in detail. Information was derived from clinic and hospital charts with attention to the degree of injury, pre- and postinjury seizure patterns and frequency.Results:One patient has primary generalized epilepsy and four have localization related epilepsy. Prior to the head injury, three of the patients were seizure free (range: two to 24 years). The patients suffered from mild head injuries with no or transient loss of consciousness and no focal neurological deficits. In all cases, the patients experienced a worsening of seizure control within days of the injury. In one case, the patient's seizure pattern returned to baseline one year after the accident, while in the remaining four cases, the patients continue to have medically refractory seizures.Conclusion:A close temporal relationship between mild head injury and a worsening of seizure control was observed in five patients with epilepsy. Although further study is required, this observation suggests that a head injury that would be considered benign in the general population can have serious consequences such as recurrence of seizures and medical intractability in patients with epilepsy.

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Role of Short Term Video Encephalography with Induction by Verbal Suggestion in Diagnosis of Suspected Paroxysmal Nonepileptic Seizure-Like Symptoms

Epilepsy Research and Treatment ◽

10.1155/2016/2801369 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Soaham Dilip Desai ◽

Devangi Desai ◽

Trilok Jani

Keyword(s):

Developing Countries ◽

Heart Block ◽

Focal Epilepsy ◽

Diagnostic Yield ◽

Cost Effective ◽

Short Term ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

Outpatient Settings

Purpose. To determine the diagnostic yield and utility of STVEEG with verbal suggestion in diagnosis of patients presenting with transient unresponsiveness and suspected psychogenic nonepileptiform seizures. Methods. A retrospective analysis of STVEEG records of patients with transient unresponsiveness and suspected PNES between 1 Jan 2009 and 28 Feb 2014 was done. Results. Amongst 155 patients [38 males, 117 females], with mean age 32 [8–67], PNES were identified in 109 [70.3%], focal epilepsy was identified in 24 [15.4%], and actual seizure was recorded in 7 [4.5%]. Nine [5.8%] patients were found to have both epilepsy and PNES. Primary generalized epilepsy was diagnosed in 2 [1.2%]. A diagnosis of other paroxysmal nonepileptiform events [tachyarrhythmia and heart block] was done in 3 [1.9%]. A normal EEG and no inducible episode and hence an uncertain diagnosis at the end of STVEEG were seen in only 17 [10.9%] patients. A STVEEG of approximately one hour duration was able to establish the diagnosis in 138 [89.1%] patients with transient unresponsiveness. Conclusion. STVEEG with verbal suggestion is a useful and cost effective diagnostic test for diagnosis of PNES. It can be a good modality for diagnosis in patients with transient abnormalities in sensorium in the outpatient settings in developing countries.

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Psychiatric Aspects of Self-Induced Epileptic Seizures

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2002.01050.x ◽

2002 ◽

Vol 36 (4) ◽

pp. 534-543 ◽

Cited By ~ 9

Author(s):

Beng-Yeong Ng

Keyword(s):

Seizure Control ◽

Epileptic Seizures ◽

Behavioural Modification ◽

Intermittent Photic Stimulation ◽

Contradictory Evidence ◽

Psychiatric Intervention ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

Eye Closure ◽

Spike Wave

Objective: To review the literature on self-induced epileptic seizures and apply psychiatric knowledge to define possible causes and treatment recommendations. Methods: A review of MEDLINE literature on self-induced epileptic seizures was conducted, followed by cross-referencing with the relevant neurologic, psychiatric and paediatric books and journals. Results: The reported prevalence of self-induction varies depending on the setting. In most instances, self-inducers are people affected by photosensitive primary generalized epilepsy, in whom self-induction is by intermittent photic stimulation or, more rarely, pattern stimulation or eye closure. Self-induced seizures are most commonly absences with spike-wave, though eyelid myoclonia and generalized myoclonic jerks occur. Earlier studies indicate that the majority of self-inducers were of subnormal intelligence but more recent ones indicate that as a group they could not be considered mentally retarded. Monitoring in a well-lit environment is indicated in any therapy-resistant photosensitive patient to determine whether or not selfinduction occurs. Self-induced epilepsy is notoriously resistant to therapy and reasons for this resistance are discussed. An explanatory model for the initiation and maintenance of selfinduction behaviour is also included. Conclusions: It is difficult to determine from published papers just what level of clinical difficulty self-induction of seizures actually posed to the patients and clinicians. In some cases there is contradictory evidence as to the degree of willfulness or self-induction. Self-induced epileptic seizures may be an important aspect of poor seizure control in a subgroup of epilepsy sufferers. These seizures might be modifiable by psychiatric intervention or behavioural modification.

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Carbamazepine-Induced Seizures: A Case Report and Review of the Literature

Clinical Electroencephalography ◽

10.1177/155005940203300408 ◽

2002 ◽

Vol 33 (4) ◽

pp. 174-177 ◽

Cited By ~ 8

Author(s):

M. Gansaeuer ◽

T. M. Alsaadi

Keyword(s):

Case Report ◽

Adult Patient ◽

Mentally Retarded ◽

Review Of The Literature ◽

Partial Seizures ◽

Absence Seizures ◽

Carbamazepine Therapy ◽

Frequent Absence ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy

Carbamazepine has been reported to exacerbate seizures in children with primary generalized epilepsy and epilepsy with mixed seizure types. Seizure exacerbation has been rarely observed in adults, mainly in the mentally retarded or in those with primary generalized epilepsy. We present an adult patient who had frequent absence seizures and simple partial seizures for 20 years. She was treated with carbamazepine for over 16 years. The patient's EEG showed generalized spike and wave complexes. Her seizures remitted and the EEG normalized after the discontinuation of carbamazepine therapy.

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Regional Cerebral Blood Flow during Interictal State: Differences between Temporal Lobe Epilepsy and Primary Generalized Epilepsy

European Neurology ◽

10.1159/000115986 ◽

1986 ◽

Vol 25 (1) ◽

pp. 43-52 ◽

Cited By ~ 7

Author(s):

J. Touchon ◽

J. Valmier ◽

M. Baldy-Moulinier ◽

J. Cadilhac

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Regional Cerebral Blood Flow ◽

Regional Cerebral Blood ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

Interictal State

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Small calcified lesions suggestive of neurocysticercosis are associated with mesial temporal sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140080 ◽

2014 ◽

Vol 72 (7) ◽

pp. 510-516 ◽

Cited By ~ 12

Author(s):

Marcos C. B. Oliveira ◽

Maria G. M. Martin ◽

Miriam H. Tsunemi ◽

Gilson Vieira ◽

Luiz H. M. Castro

Keyword(s):

Case Control Study ◽

Independent Predictor ◽

Structured Interview ◽

Mesial Temporal Sclerosis ◽

Symptomatic Epilepsy ◽

Independent Association ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

Head Computed Tomography ◽

Control Study

Recent studies have suggested a possible relationship between temporal lobe epilepsy with mesial temporal sclerosis (MTS) and neurocysticercosis (NC). We performed a case-control study to evaluate the association of NC and MTS. Method: We randomly selected patients with different epilepsy types, including: MTS, primary generalized epilepsy (PGE) and focal symptomatic epilepsy (FSE). Patients underwent a structured interview, followed by head computed tomography (CT). A neuroradiologist evaluated the scan for presence of calcified lesions suggestive of NC. CT results were matched with patients’ data. Results: More patients in the MTS group displayed calcified lesions suggestive of NC than patients in the other groups (p=0.002). On multivariate analysis, MTS was found to be an independent predictor of one or more calcified NC lesions (p=0.033). Conclusion: After controlling for confounding factors, we found an independent association between NC calcified lesions and MTS.

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Electroclinical Analysis of Postictal Noserubbing

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100052239 ◽

2000 ◽

Vol 27 (2) ◽

pp. 131-136 ◽

Cited By ~ 14

Author(s):

Richard Wennberg

Keyword(s):

Temporal Lobe ◽

Seizure Onset ◽

Scalp Eeg ◽

Autonomic Activation ◽

Ictal Activity ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

Temporal Lobe Seizure ◽

Intracranial Electrodes ◽

Video Eeg

ABSTRACT:Background:Postictal noserubbing (PIN) has been identified as a good, albeit imperfect, lateralizing and localizing sign in human partial epilepsy, possibly related to ictal autonomic activation.Methods:PIN was studied prospectively in a group of consecutive patients admitted for video-EEG monitoring, with the laterality of noserubbing correlated with electrographic sites of seizure onset, intra- and interhemispheric spread, and sites of seizure termination.Results:PIN was significantly more frequent in temporal than extratemporal epilepsy (p<0.001; 23/41 (56%) patients and 41/197 (21%) seizures in temporal lobe epilepsy compared with 4/34 (12%) patients and 12/167 (7%) seizures in extratemporal epilepsy). The hand used to rub the nose was ipsilateral to the side of seizure onset in 83% of both temporal and extratemporal seizures. Seizures with contralateral PIN correlated with spread to the contralateral temporal lobe on scalp EEG (p<0.04). All extratemporal seizures with PIN showed spread to temporal lobe structures. One patient investigated with intracranial electrodes showed PIN only when ictal activity spread to involve the amygdala: seizures confined to the hippocampus were not associated with PIN. PIN was not observed in 63 nonepileptic events in 17 patients. Unexpectedly, one patient with primary generalized epilepsy showed typical PIN after 1/3 recorded absence seizures.Conclusions:This study confirms PIN as a good indicator of ipsilateral temporal lobe seizure onset. Instances of false lateralization and localization appear to reflect seizure spread to contralateral or ipsilateral temporal lobe structures, respectively. Involvement of the amygdala appears to be of prime importance for induction of PIN.

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