Responsive Neurostimulation of the Thalamus Improves Seizure Control in Idiopathic Generalized Epilepsy: A Case Report

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. E578-E583 ◽  
Author(s):  
Vasileios Kokkinos ◽  
Alexandra Urban ◽  
Nathaniel D Sisterson ◽  
Ningfei Li ◽  
Danielle Corson ◽  
...  
Keyword(s):  
Case Report ◽  
Neural Activity ◽  
Seizure Control ◽  
Clinical Presentation ◽  
Idiopathic Generalized Epilepsy ◽  
Absence Seizures ◽  
Level Of Consciousness ◽  
Spike Wave Discharges ◽  
Generalized Epilepsy ◽  
Spike Wave

Abstract BACKGROUND AND IMPORTANCE At least 25% of patients with idiopathic generalized epilepsy do not obtain adequate seizure control with medication. This report describes the first use of responsive neurostimulation (RNS), bilaterally targeting the centromedian/ventrolateral (CM/VL) region in a patient with drug-refractory Jeavons syndrome (eyelid myoclonia with absences). CLINICAL PRESENTATION A patient, diagnosed with eyelid myoclonia with absences (EMA) and refractory to medication, was offered RNS treatment in the CM/VL region of the thalamus. Stimulation was triggered by thalamic neural activity having morphological, spectral, and synchronous features that corresponded to 3- to 5-Hz spike-wave discharges recorded on prior scalp electroencephalography. CONCLUSION RNS decreased daily absence seizures from a mean of 60 to ≤10 and maintained the patient's level of consciousness during the occurring episodes. This therapy should be evaluated further for its potential to treat patients with pharmaco-refractory generalized epilepsy.

scholarly journals Co-existence of Rolandic and 3 Hz Spike-Wave Discharges on EEG in Children with Epilepsy

2018 ◽  
Vol 46 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Anita N. Datta ◽  
Laura Wallbank ◽  
Peter K. H. Wong
Keyword(s):  
Clinical Data ◽  
Seizure Control ◽  
Age Of Onset ◽  
Absence Epilepsy ◽  
Childhood Absence Epilepsy ◽  
Drug Induced ◽  
Favorable Prognosis ◽  
Spike Wave Discharges ◽  
Spike Wave

AbstractObjectiveBenign epilepsy of childhood with central temporal spikes (BECTS) and absence epilepsy are common epilepsy syndromes in children with similar age of onset and favorable prognosis. However, the co-existence of the electrocardiogram (EEG) findings of rolandic spike and 3 Hz generalized spike-wave (GSW) discharges is extremely rare, with few cases reported in the literature. Our objective was to characterize the EEG findings of these syndromes in children in our center and review the electro-clinical features.MethodsAll EEGs at BC Children’s Hospital are entered in a database, which include EEG findings and clinical data. Patients with both centro-temporal spikes and 3 Hz GSW discharges were identified from the database and clinical data were reviewed.ResultsAmong the 43,061 patients in the database from 1992 to 2017, 1426 with isolated rolandic discharges and 528 patients with isolated 3 Hz GSW discharges were identified, and 20 (0.05%) patients had both findings: 3/20 had BECTS, and subsequently developed childhood absence epilepsy and 17/20 had no seizures characteristic for BECTS. At follow-up, 17 (85%) were seizure-free, 1 (5%) had rare, and 2 (10%) had frequent seizures.ConclusionsThis is the largest reported group of patients to our knowledge with the co-existence of rolandic and 3 Hz GSW discharges on EEGs in one institution, not drug-induced. As the presence of both findings is extremely rare, distinct pathophysiological mechanisms are likely. The majority had excellent seizure control at follow-up, similar to what would be expected for each type of epilepsy alone.

scholarly journals Regulatory Mechanism for Absence Seizures in Bidirectional Interactive Thalamocortical Model via Different Targeted Therapy Schemes

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hudong Zhang ◽  
Xiaolong Tan ◽  
Yufeng Pan ◽  
Yuan Chai
Keyword(s):  
Targeted Therapy ◽  
Regulatory Mechanism ◽  
Cortical Region ◽  
Neural Pathways ◽  
Absence Seizures ◽  
Theoretical Simulation ◽  
Biphasic Pulse ◽  
Bidirectional Communication ◽  
Spike Wave Discharges ◽  
Spike Wave

Recent clinical practice has found that the spike-wave discharge (SWD) scopes of absence seizures change from small cortical region to large thalamocortical networks, which has also been proved by theoretical simulation. The best biophysics explanation is that there are interactions between coupled cortico-thalamic and thalamocortical circuits. To agree with experiment results and describe the phenomena better, we constructed a coupled thalamocortical model with bidirectional channel (CTMBC) to account for the causes of absence seizures which are connected by the principle of two-way communication of neural pathways. By adjusting the coupling strength of bidirectional pathways, the spike-wave discharges are reproduced. Regulatory mechanism for absence seizures is further applied to CTMBC via four different targeted therapy schemes, such as deep brain stimulation (DBS), charge-balanced biphasic pulse (CBBP), coordinated reset stimulation (CRS) 1 : 0, and (CRS) 3 : 2. The new CTMBC model shows that neurodiversity in bidirectional interactive channel could supply theory reference for the bidirectional communication mode of thalamocortical networks and the hypothesis validation of pathogenesis.

Psychiatric Aspects of Self-Induced Epileptic Seizures

2002 ◽  
Vol 36 (4) ◽  
pp. 534-543 ◽  
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.

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

2002 ◽  
Vol 33 (4) ◽  
pp. 174-177 ◽  
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.

Rapid eye movement (REM) sleep and seizure control in idiopathic generalized epilepsy

2020 ◽  
Vol 107 ◽  
pp. 107064
Author(s):  
Mohamed M. Hamdy ◽  
Amr M. Elfatatry ◽  
Jaidaa F. Mekky ◽  
Eman Hamdy
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
Seizure Control ◽  
Rapid Eye Movement ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy

scholarly journals Automatisms in Absence Seizures in Children With Idiopathic Generalized Epilepsy

2009 ◽  
Vol 66 (6) ◽  
Author(s):  
Lynette G. Sadleir ◽  
Ingrid E. Scheffer ◽  
Sherry Smith ◽  
Mary B. Connolly ◽  
Kevin Farrell
Keyword(s):  
Idiopathic Generalized Epilepsy ◽  
Absence Seizures ◽  
Generalized Epilepsy

scholarly journals Percheron Artery Ischemia: Case Report

2021 ◽  
Author(s):  
Lília Tereza Diniz Nunes ◽  
Flávia S. Silva ◽  
Karyme G. Aota ◽  
Maria Beatriz Miranda. S. B. de Assis ◽  
João Fellipe B. Bento ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Cervical Dystonia ◽  
Clinical Presentation ◽  
Posterior Cerebral Artery ◽  
Artery Of Percheron ◽  
Thalamic Infarction ◽  
Level Of Consciousness ◽  
Artery Segment ◽  
Thalamic Infarct

Context: The Artery of Percheron (AOP) is an uncommon anatomic vascular variation derivated from posterior cerebral artery segment P1, wich branchs to irrigate bilaterally the thalamus in it is paramedian portion. Amidst vascular cerebral events of the ischemic type, thalamic infarction occour in 11% of the cases. The typical clinical presentation is constituted by the triad: cogniyivebehavior comitente, oculomotors and consience disturbs. Case report: J.F.M.L, 51 years old, male, was found unconscious in his residence by SAMU and then interned in Stroke Room of HGP in 02/06/2020 with a lowered level of consciousness (Glasgow 8). The tests demonstrated a bilateral thalamic infarct due to Artery of Percheron Ischemia. In 02/09/2020 it evolved into a Glasgow 9 being extubated. The CT after 3 days demonstrated absence of bleeding and prophylatically initiated simvastatin, clexane, physiotherapy and phonoaudiology. In 02/15/2020, during physical exam, the pacient was lucid, presented behavior alterations, had left cervical dystonia and ataxia. The patient progressed well and was discharged the next day. Conclusions: The AOP, when occluded, results in bilateral paramedian thalamic and the rostral midbrain infarctions wich may cause diagnosis issues, mainly because of the vast specter of diferential diagnosis. In the presence of triad signals characteritic of bilateral thalamic infarction in CT, it must suspect the manifestation of such entity.

scholarly journals Seizure Exacerbation and Developmental Regression with Carbamazepine

1998 ◽  
Vol 25 (4) ◽  
pp. 287-294 ◽  
Author(s):  
A.N. Prasad ◽  
M. Stefanelli ◽  
L Nagarajan
Keyword(s):  
Seizure Control ◽  
Tertiary Care ◽  
Dramatic Improvement ◽  
Idiopathic Generalized Epilepsy ◽  
Careful Patient ◽  
Developmental Regression ◽  
Group I ◽  
Neurological Exam ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy

ABSTRACT:Background:Unexpected exacerbation of seizures may occur following initiation of treatment with carbamazepine (CBZ). We reviewed the occurrence of such reactions in our patient population at a tertiary care children's hospital.Methods:A retrospective analysis of our clinic database identified 129/691 (18.6%) patients with epilepsy treated with CBZ, as monotherapy. 38/129 children were later switched to another drug. In 11/38 (28.5 %) clinical and/or EEG deterioration was observed. Two patients identified at another institution with similar exacerbation were also included in our analysis. We report on the findings in these 13 cases.Results:Two groups were identified: Group I - 6 patients with normal neurological exam, normal EEG background, and a diagnosis of idiopathic generalized epilepsy. Group II - 7 patients with an abnormal neurological exam and/or abnormal EEG background. Following introduction of CBZ therapy, worsening of preexisting seizures, appearance of new seizure types, behavioral regression, and accompanying EEG deterioration were reported in both groups. Dramatic improvement in seizure control occurred, following withdrawal of CBZ and substitution of another anticonvulsant.Conclusion:Physicians treating epilepsy must be aware that CBZ can exacerbate seizures, and cause developmental regression in children. Careful patient selection, when choosing CBZ as treatment, and prompt recognition of clinical deterioration and intervention, may help avoid or reverse these paradoxical reactions.

Temporal seizure emerging from a cluster of eyelid myoclonia in a teenager with Jeavons syndrome

2020 ◽  
pp. 10.1212/CPJ.0000000000000864 ◽  
Author(s):  
Ifrah Zawar ◽  
Linda Franic ◽  
Elia Pestana Knight
Keyword(s):  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
Eye Closure ◽  
Spike Wave

Eyelid myoclonia with absences (EMA) or Jeavons Syndrome is an idiopathic generalized epilepsy (IGE) characterized by eyelid myoclonia with or without absences, eye-closure elicited EEG paroxysms (generalized polyspikes or spike-wave-complexes) and photosensitivity1.

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