Epileptic seizures of suspected autoimmune origin: a multicentre retrospective study

2020 ◽  
Vol 91 (11) ◽  
pp. 1145-1153
Author(s):  
Silvia Bozzetti ◽  
Fabio Rossini ◽  
Sergio Ferrari ◽  
Rachele Delogu ◽  
Gaetano Cantalupo ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Neuropsychiatric Symptoms ◽  
Laboratory Data ◽  
Epileptic Seizures ◽  
Unknown Aetiology ◽  
Cancer History ◽  
Autoimmune Epilepsy ◽  
Good Treatment Response ◽  
Antibody Positivity ◽  
Paired Serum

ObjectiveTo analyse autoantibody status in a well-defined European multicentre cohort of patients with epilepsy of unknown aetiology and to validate the recently proposed Antibody Prevalence in Epilepsy (APE2) and Response to ImmunoTherapy in Epilepsy (RITE2) scores.MethodsWe retrospectively collected clinical and paraclinical data of 92 patients referred to the Neurology Units of Verona and Salzburg between January 2014 and July 2019 with new-onset epilepsy, status epilepticus or chronic epilepsy of unknown aetiology. Fixed and live cell-based assays, tissue-based assays, immunoblot, and live rat hippocampal cell cultures were performed in paired serum/cerebrospinal fluid (CSF) to detect antineuronal and antiglial antibodies. The APE2 and RITE2 scores were then calculated and compared with clinical and laboratory data.ResultsAutoantibodies were detected in 29/92 patients (31.5%), with multiple positivity observed in 6/29 cases. The APE2 score (median 5, range 1–15) significantly correlated with antibody positivity (p=0.014), especially for the presence of neuropsychiatric symptoms (p<0.01), movement disorders (p<0.01), dysautonomia (p=0.03), faciobrachial dyskinesias (p=0.03) and cancer history (p<0.01). Status epilepticus was significantly more frequent in antibody-negative patients (p<0.01). Among the items of the RITE2 score, early initiation of immunotherapy correlated with a good treatment response (p=0.001), whereas a cancer history was significantly more common among non-responders (p<0.01). Persistence of neuropsychiatric symptoms and seizures correlated with antiepileptic maintenance after at least 1 year.ConclusionsThis is the first study that independently validates the APE2 and RITE2 scores and includes the largest cohort of patients whose paired serum and CSF samples have been tested for autoantibodies possibly associated with autoimmune epilepsy.

scholarly journals Course of epilepsy in patients with clinical manifestations of cranio-cerebral imbalance and a low scf-cranial index

2018 ◽  
Vol 10 (3) ◽  
pp. 38-43
Author(s):  
V. I. Larkin ◽  
N. S. Stelmakh
Keyword(s):  
Head Circumference ◽  
Therapy Group ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Epileptic Seizures ◽  
Occurrence Rate ◽  
Group I ◽  
Cranial Index ◽  
Seizure Rate ◽  
Group Ii

The aim of the study was to assess the course of epilepsy in patients with signs of cranio-cerebral imbalance with a low CSF-cranial index.Materials and methods. We conducted a prospective analysis of clinical, instrumental and laboratory data from the case histories of 78 patients with epileptic seizures (cryptogenic epilepsy). Group I included 36 patients with normal reserve CSF volumes and physiological values of the CSF-cranial index; these patients received standard multicomponent therapy. Group II was comprised of 42 patients with abnormally small reserve CSF spaces and a lower than normal CSF-cranial index; patients in group II received the same treatment as did patients in group I.Results. We found a moderate correlation between the head circumference and the values of the CSF-cranial index. A strong correlation between the seizure occurrence rate and the values of the CSF-cranial index was also found (R=0.32, p=0.0043); the seizure rate correlation with the head circumference was less obvious (R=0.11, p=0.037). Most of the patients in group I had bilateral seizures, whereas in patients of group II the seizures were of a mixed character.Conclusion. The results of this clinical study suggest that the course of epilepsy in patients with a low CSF-cranial index is determined by the severity of anatomical reduction in the CSF dynamics; in most cases of a low CSF-cranial index, the course of epilepsy is severe. These findings should be considered at the starting and the later stages of antiepileptic therapy.

Neurologist, 26 years’ experience, Turkey

2020 ◽  
pp. 269-271
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Status Epilepticus ◽  
Behavioral Problems ◽  
Psychiatric Treatment ◽  
Past History ◽  
Epileptic Seizures ◽  
Teenage Girl ◽  
The Third ◽  
Physical Injuries ◽  
Serious Infection ◽  
Different Types

This chapter explores the experience of a Neurologist who has seen many different types of Non-Epileptic Seizures, from very hyperactive and even aggressive movements to dissociative-like symptoms. It specifically considers the stories of three patients at different ages with different manifestations. The first patient was an older lady whose seizures seemed to be aggravated after menopause. Her past history revealed a serious infection during her first pregnancy, which had resulted in the loss of her baby. During her visit with the Neurologist, she had a seizure in which she was not able to speak, her eyes were deviated upward with eye blinking, and her face looked pale. The second patient was a teenage girl who had started to have seizures diagnosed as status epilepticus after she had been involved in an accident. Later, the Neurologist found out that she had not suffered any serious physical injuries in her head associated with the accident and that she was undergoing psychiatric treatment because of her behavioral problems. The third patient was in her twenties and had had seizures for several years, which always happened at night during sleep. The seizures were described as involving excessive movement and were happening three to four times a month.

Reevaluation of the Critically Ill Patients With Nonconvulsive Status Epilepticus by Using Salzburg Consensus Criteria

2018 ◽  
Vol 49 (6) ◽  
pp. 425-432 ◽  
Author(s):  
Ozlem Gungor Tuncer ◽  
Ebru Altindag ◽  
Sevda Ozel Yildiz ◽  
Mecbure Nalbantoglu ◽  
Mehmet Eren Acik ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Real Life ◽  
Nonconvulsive Status Epilepticus ◽  
Life Evaluation ◽  
Ictal Eeg ◽  
Eeg Data

Objective. We aimed to assess the usefulness of the Salzburg Consensus Criteria (SCC) for determining the prognosis of critically ill patients with nonconvulsive status epilepticus (NCSE). Methods. We retrospectively reviewed consecutive patients with unconsciousness followed up in the intensive care unit (ICU). Three clinical neurophysiologists, one of them blinded to clinical and laboratory data, reevaluated all EEG data independently and determined NCSE according to SCC. The incidence of NCSE and ictal EEG patterns and their relationship to clinical, laboratory, neuroradiological, and prognostic findings were assessed. Results. A total of 107 consecutive patients with mean age 68.2 ± 15.3 years (57 females) were enrolled in the study. Primary neuronal injury was detected in 59 patients (55.7%). Thirty-three patients (30.8%) were diagnosed as NCSE. While authors decided to treat 33 patients (30.8%), 32 patients (29.9%) had been treated in real-life evaluation. Clinical and EEG improvement were detected in 12 patients (11.3%) in real-life treatment group showing correlation with lack of intubation and ICU stay related to postsurgical event. Rate of mortality (45.8%) was high showing association with systemic-metabolic etiology, severity of coma and presence of “plus” modifiers in the EEG. Conclusion and Significance. Our findings suggest that SCC is highly compatible with clinical practice in the decision for treatment of patients with NCSE. The presence of “plus” modifiers in the EEG was found to be associated with mortality in these patients and was a significant marker for the high mortality rate.

scholarly journals Continuous Visual Focal Status Epilepticus as the Primary Presentation of NMDA-R and GAD65-R Autoimmune Epilepsy

2020 ◽  
Vol 11 ◽  
Author(s):  
Elma M. Paredes-Aragón ◽  
Héctor E. Valdéz-Ruvalcaba ◽  
Andrea Santos-Peyret ◽  
Marcela Cisneros-Otero ◽  
Raúl Medina-Rioja ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Early Identification ◽  
Acid Decarboxylase ◽  
Visual Aura ◽  
Epilepsia Partialis Continua ◽  
Autoimmune Epilepsy ◽  
Immune Mediated ◽  
Focal Status Epilepticus ◽  
Patients With Epilepsy ◽  
Primary Presentation

Epilepsia partialis continua (EPC) has changed in its clinical and pathophysiological definition throughout time. Several etiologies have been described in addition to classic causes of EPC. The following case depicts a young woman who had a peculiar onset of epilepsy with a continuous visual aura becoming a form of chronic recurrent and non-progressive EPC. The patient was initially misdiagnosed as a non-neurological entity (assumed psychiatric in origin), but finally, an immune-mediated epilepsy was diagnosed, and EEG showed focal status epilepticus during evolution. Once the diagnosis was achieved and immune treatment was established, the patient is seizure free. Early identification of an immune basis in patients with epilepsy is important because immunotherapy can reverse the epileptogenic process and reduce the risk of chronic epilepsy. To date, this is the only case reported with EPC manifesting as a continuous visual aura associated with antiglutamic acid decarboxylase 65 (anti-GAD65) and anti-N-methyl-d-aspartate (anti-NMDA) antibodies.

Parkinson's disease: Less epileptic seizures more status epilepticus

2014 ◽  
Vol 108 (2) ◽  
pp. 349-354 ◽  
Author(s):  
Berend Feddersen ◽  
Jan Rémi ◽  
Marion Einhellig ◽  
Cordula Stoyke ◽  
Philipp Krauss ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Status Epilepticus ◽  
Epileptic Seizures

scholarly journals Windows to the Ward: Graphically Oriented Report Forms. Presentation of Complex, Interrelated Laboratory Data for Electrophoresis/Immunofixation, Cerebrospinal Fluid, and Urinary Protein Profiles

2003 ◽  
Vol 49 (1) ◽  
pp. 41-50 ◽  
Author(s):  
Axel Regeniter ◽  
Jürg U Steiger ◽  
André Scholer ◽  
Peter R Huber ◽  
Werner H Siede
Keyword(s):  
Cerebrospinal Fluid ◽  
Laboratory Data ◽  
Protein Profiles ◽  
Marker Protein ◽  
Urinary Marker ◽  
Graphic Presentation ◽  
Knowledge Based ◽  
Fluid Analysis ◽  
Signature Pattern ◽  
Paired Serum

Abstract Background: Automated laboratory analyzers that mass produce data have been linked to information systems for more than two decades, but little progress has been made in developing more comprehensible report forms. Results are still reported in computer-generated printouts containing hundreds of numbers crowded into columns on each printed page. Methods: We developed three software applications focusing on the graphic presentation of laboratory results. Results: The first application summarizes data for a patient with a monoclonal gammopathy. The report provides a cumulative graphic presentation of immunofixation/electrophoresis data without any additional interpretation, focuses on a color-coded electrophoresis scan, and records up to 5 years on a single page. The second application deals with cerebrospinal fluid analysis. The report calculates relevant data and graphs the complex relationship between albumin and immunoglobulin results from paired serum and cerebrospinal fluid samples. Manually added interpretive text assures an output comprehensible to clinicians in all specialties. The third application produces a report summarizing quantitatively measured urinary marker protein profiles. The report form is generated by a flexible, completely user-definable knowledge-based system. It calculates numerous ratios and formulae, supports reflex testing, supplies an automated interpretation, and generates a specific graphic signature pattern of the results (MDI LabLink proteinuria differentiation). Conclusions: Increased clinical demand for graphically oriented report forms 5 years after their introduction has provided evidence that these reports transfer complex laboratory data and results to the clinician more effectively. The highest (more than threefold) increase in demand has been for reports for urinary marker protein profiles that feature a largely self-explanatory graphic signature pattern.

Ifosfamide-Induced Nonconvulsive Status Epilepticus

1995 ◽  
Vol 29 (12) ◽  
pp. 1237-1239 ◽  
Author(s):  
Ashwani Bhardwaj ◽  
Pritam S Badesha
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Status Epilepticus ◽  
Temporal Relationship ◽  
Pediatric Population ◽  
Laboratory Data ◽  
Nonconvulsive Status Epilepticus ◽  
Case Summary ◽  
History Of ◽  
Clonic Seizures

Objective: To describe a patient with ifosfamide-induced nonconvulsive status epilepticus. Case Summary: A 71-year-old woman with a history of malignant mixed mesodermal tumor involving the uterus, cervix, and vagina was admitted because of local recurrence. After receiving 3 doses of ifosfamide/mesna, she was found to be unresponsive. Physical examination and laboratory data revealed no significant changes. An electroencephalogram was consistent with the diagnosis of nonconvulsive status epilepticus. The patient's mental status returned to baseline after treatment with intravenous phenytoin and discontinuation of ifosfamide therapy. Discussion: Central nervous system (CNS) toxicity has been described with ifosfamide, with most cases reported in the pediatric population. Among CNS toxicities, generalized tonic-clonic seizures have been reported in both children and adults. This represents the first report of nonconvulsive status epilepticus induced by ifosfamide. Conclusions: There was a temporal relationship between the onset of nonconvulsive status epilepticus and initiation of ifosfamide infusion. No other identifiable factor contributed to the unresponsiveness.

scholarly journals Surveillance study of acute neurological manifestations among 439 Egyptian patients with COVID-19 in Assiut and Aswan university hospitals

2020 ◽  
Author(s):  
Eman M Khedr ◽  
Noha Abo-Elfetoh ◽  
Enas Daef ◽  
Hebatallah M. Hassan ◽  
Mariam T Amin ◽  
...  
Keyword(s):  
Neurological Disease ◽  
Respiratory Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Laboratory Data ◽  
Neurological Complications ◽  
Neurological Manifestations ◽  
Common Complication ◽  
University Hospitals ◽  
Egyptian Patients ◽  
The University

AbstractBackgroundCOVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study we estimate the frequency of such complications among hospital in-patients with COVID-19 in Assiut and Aswan University Hospitals.Material and MethodsWe screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory data, CT/MRI of chest and brain, and neurophysiology were performed for each patient if indicated.Results439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these 117 had acute neurological disease; the remainder had non-specific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke; the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of RR-MS (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31); the others had GBS (4), peripheral neuropathy (3), myasthenia gravis (2), or myositis (2). Fever, respiratory symptoms and headache, were the most common general symptoms. Hypertensions, Diabetes Mellitus, ischemic heart disease were the most common comorbidities in patients with CNS affection.ConclusionIn COVID⍰19, both the CNS and PNS are affected. Stroke was the most common complication for CNS and anosmia and/or ageusia were common for PNS diseases. However there were 6 cases encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG and 2 cases of myositis.

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