scholarly journals Potentially Pathological Alpha-Pattern as a Variant of Vigilance EEG in Drug-Resistant Epilepsy

2017 ◽  
Vol 8 (4) ◽  
pp. 48-56
Author(s):  
Aleksandr A. Chukhlovin ◽  
Mikhail V. Aleksandrov ◽  
Sergey A. Lytaev ◽  
Vugar R. Kasumov ◽  
Marina E. Pavlovskaya ◽  
...  
Keyword(s):  
Alpha Rhythm ◽  
Refractory Epilepsy ◽  
Functional Decline ◽  
Clinical Signs ◽  
Epileptic Seizures ◽  
Alpha Activity ◽  
Drug Resistant ◽  
Scalp Eeg ◽  
Russian Scientific Research Institute ◽  
Drug Resistant Epilepsy

As a result of pathomorphosis affecting the mechanisms of electrical activity generation interictal EEG may show reduced epileptiform changes whereas clinically apparent epileptic seizures may be present. In these cases patterns of dominant alpha activity are sometimes recorded on the scalp. In this study variations of alpha activity in patients with refractory epilepsy are classified. A group of 50 refractory epilepsy patients aged between 20 and 55 years who were submitted to Polenov Russian Scientific Research Institute of Neurosurgery in 2014-2017 was included in this study. They underwent scalp EEG as a part of their presurgical assessment. In 12 cases patterns of potentially pathological alpha activity were observed. Three variations of alpha-patterns were described: 1) alpha-rhythm with decreased regional diversity and a marked synchronization in temporal areas; 2) alpha-rhythm with reduced epileptiform complexes integrated into the spindles, 3) decelerated non-rhythmic alpha activity distorted by the higher frequency components. Distinguished varieties of potentially pathological alpha-activity according to their order here represent gradual functional decline of normal thalamo-cortical interaction. Considering clinical manifestation of drug-resistant epilepsy with frequent seizures in these patients, reported varieties of alpha activity can not be interpreted as Landolt’s syndrome (forced normalization of EEG). Invasive electrocorticographic monitoring demonstrated that bursts of sharpened polyphasic waves coinciding with alpha-rhythm on scalp EEG are consistent with epileptic discharges on the brain cortex surface. This allows to think of these components as correlates of epileptic activity. Therefore, on a number of occasions in patients with epilepsy a dissonance between clinical signs and electroencephalographic patterns recorded during restful wakefulness may be observed, when epileptiform components are absent or reduced to nonspecific complexes.

scholarly journals Heart rate variability analysis for the identification of the preictal interval in patients with drug-resistant epilepsy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Adriana Leal ◽  
Mauro F. Pinto ◽  
Fábio Lopes ◽  
Anna M. Bianchi ◽  
Jorge Henriques ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Linear Time ◽  
Epileptic Seizures ◽  
Heart Rate Variability Analysis ◽  
Drug Resistant ◽  
Clustering Methods ◽  
Temporal Lobe Seizures ◽  
New Perspective ◽  
Drug Resistant Epilepsy

AbstractElectrocardiogram (ECG) recordings, lasting hours before epileptic seizures, have been studied in the search for evidence of the existence of a preictal interval that follows a normal ECG trace and precedes the seizure’s clinical manifestation. The preictal interval has not yet been clinically parametrized. Furthermore, the duration of this interval varies for seizures both among patients and from the same patient. In this study, we performed a heart rate variability (HRV) analysis to investigate the discriminative power of the features of HRV in the identification of the preictal interval. HRV information extracted from the linear time and frequency domains as well as from nonlinear dynamics were analysed. We inspected data from 238 temporal lobe seizures recorded from 41 patients with drug-resistant epilepsy from the EPILEPSIAE database. Unsupervised methods were applied to the HRV feature dataset, thus leading to a new perspective in preictal interval characterization. Distinguishable preictal behaviour was exhibited by 41% of the seizures and 90% of the patients. Half of the preictal intervals were identified in the 40 min before seizure onset. The results demonstrate the potential of applying clustering methods to HRV features to deepen the current understanding of the preictal state.

scholarly journals Diagnosis, treatment and postsurgical complications in a dog with epileptic seizures and a naso-ethmoidal meningoencephalocele

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Abtin Mojarradi ◽  
Sofie Van Meervenne ◽  
Alejandro Suarez-Bonnet ◽  
Steven De Decker
Keyword(s):  
Surgical Resection ◽  
Medical Management ◽  
Surgical Intervention ◽  
Clinical Signs ◽  
Epileptic Seizures ◽  
Nasal Discharge ◽  
Dural Defect ◽  
Drug Resistant ◽  
Tension Pneumocephalus ◽  
Postsurgical Complications

Abstract Background Naso-ethmoidal meningoencephalocele is usually a congenital anomaly consisting of a protrusion of cerebral tissue and meninges into the ethmoidal labyrinth. The condition is a rare cause of structural epilepsy in dogs. We report the clinical presentation, surgical intervention, postoperative complications and outcome in a dog with drug resistant epilepsy secondary to a meningoencephalocele. Case presentation A 3.3-year-old male neutered Tamaskan Dog was referred for assessment of epileptic seizures secondary to a previously diagnosed left-sided naso-ethmoidal meningoencephalocele. The dog was drug resistant to medical management with phenobarbital, potassium bromide and levetiracetam. Surgical intervention was performed by a transfrontal craniotomy with resection of the meningoencephalocele and closure of the dural defect. Twenty-four hours after surgery the dog demonstrated progressive cervical hyperaesthesia caused by tension pneumocephalus and pneumorrhachis. Replacement of the fascial graft resulted in immediate resolution of the dog’s neurological signs. Within 5 months after surgery the dog progressively developed sneezing and haemorrhagic nasal discharge, caused by sinonasal aspergillosis. Systemic medical management with oral itraconazole (7 mg/kg orally q12h) was well-tolerated and resulted in resolution of the clinical signs. The itraconazole was tapered with no relapsing upper airway signs. The dog’s frequency of epileptic seizures was not affected by surgical resection of the meningoencephalocele. No treatment adjustments of the anti-epileptic medication have been necessary during the follow-up period of 15 months. Conclusions Surgical resection of the meningoencephalocele did not affect the seizure frequency of the dog. Further research on prognostic factors associated with surgical treatment of meningoencephaloceles in dogs is necessary. Careful monitoring for postsurgical complications allows prompt initiation of appropriate treatment.

Drug-resistant epilepsy and topiramate: Plasma concentration and frequency of epileptic seizures

2018 ◽  
Vol 45 (7) ◽  
pp. 652-658
Author(s):  
Fabiana Angelo Marques ◽  
Nayara Cristina Perez de Albuquerque ◽  
Marília Silveira de Almeida Campos ◽  
Priscila Freitas-Lima ◽  
André Oliveira Baldoni ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Epileptic Seizures ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy

scholarly journals Drug Resistant Epilepsy Among Patients Attended The Neurosciences Hospital

2019 ◽  
Vol 13 (1) ◽  
pp. 108-115
Author(s):  
Nael Husain Zaer
Keyword(s):  
Drug Resistance ◽  
Medical History ◽  
Refractory Epilepsy ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Past Medical History ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

Background: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. Up to 30% of patients referred to clinics with a diagnosis of pharmaco-resistant epilepsy may have been misdiagnosed, and many can be helped by optimizing their treatment.Pseudoresistance, in which seizures persist because the underlying disorder has not been adequately or appropriately treated, must be ruled out or corrected before drug treatment can be considered to have failed. Objectives: The objectives of this study were to determine the causes of drug failure in patients with epilepsy and to differentiate between drug resistant epilepsy and pseudoresistant epilepsy. Type of the study: This is a retrospective study. Method: It is conducted in Baghdad governorate at the epilepsy clinic in the neurosciences hospital during the period from the 1st of February through July 2013. Two hundred patients with refractory epilepsy were involved. These patients attended the epilepsy clinic during 2011 and 2012. The data was collected from the files of the patients including age, gender, weight, history of presenting illness, type of seizure, drugs used, duration of disease, EEG and imaging findings, compliance and follow up. Results: Drug resistance epilepsy constituted a prevalence of 24% (128) as the total number of patients with epilepsy attending the hospital during the same period was 527.The mean age of patients with refractory epilepsy was 25 years. Male were 56.5% (113/200) and urban residents were 70.5% (141/200). The study revealed that 64% (128/200) of refractory epilepsy was attributed to drug resistance; while the remaining proportion was pseudoresistance 36% (72/200). The main cause of pseudoresistance was poor compliance 36.1% (26/72).The most common type of seizure in the sampled patients was generalized tonic clonic seizures in 51.5% (103/200).Compliance was found to be statistically associated with abnormal EEG finding, past medical history (hypertension, cardiac diseases, encephalitis, diabetes mellitus and any significant history) and quality of follow up. The follow-up was found to be statistically associated with the family history, past medical history( encephalitis and hypertension) and compliance of patient. Conclusion:A considerable number of patientsdiagnosed as cases of drug resistant epilepsy had another explanation causing drug failure.The study recommends the application of consensus definition for drug resistant epilepsy and periodic evaluation of patients with drug resistant epilepsy to exclude pseudoresistance.

scholarly journals “Ictal” Bradyarrhythmias in Patients with Drug-Resistant Epilepsy: Results of Long-Term Heart Rhythm Monitoring

Kardiologiia ◽  
2021 ◽  
Vol 60 (12) ◽  
pp. 90-96
Author(s):  
S. E. Serdyuk ◽  
K. V. Davtyan ◽  
S. G. Burd ◽  
E. S. Mishina ◽  
O. M. Drapkina ◽  
...  
Keyword(s):  
Heart Rhythm ◽  
Epileptic Seizures ◽  
Channel Blockers ◽  
Drug Resistant ◽  
Disorder Of Consciousness ◽  
Functional Changes ◽  
Long Duration ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

Aim      To determine the type and incidence of ictal bradyarrhythmias in patients with drug-resistant types of epilepsy by long-term electrocardiogram (ECG) monitoring.Material and methods  Subcutaneous ECG monitors programed for recording pauses >3 sec and episodes of bradycardia ≤45 bpm were implanted in 193 patients with persistent epileptic seizures without organic pathology of the myocardium. Recording was activated by the patient/family at the onset of epileptic seizure. The follow-up period was 36 months with visits to the clinic every three months.Results For 36 months of monitoring, 6494 ECG fragments were recorded. Ictal bradycardia was observed in 6.7 % of patients, including ictal asystole in 2.6 % of patients. Episodes of bradycardia and asystole during epileptic seizures were transient and developed significantly more frequently in men, patients with long duration of the disease, bilateral tonic-clonic or focal seizures with disorder of consciousness, during sleep, on the background of treatment with several antiepileptic agents, mostly from the group of potassium channel blockers.Conclusion      Bradyarrhythmias accompanying epileptic seizures are transient and reproducible from seizure to seizure. They reflect functional changes in the myocardium and do not determine the life prediction for patients with epilepsy without organic pathology of the heart.

scholarly journals Ketogenic Diets for Adults with Highly Refractory Epilepsy

2017 ◽  
Vol 17 (6) ◽  
pp. 346-350 ◽  
Author(s):  
Tanya J. W. McDonald ◽  
Mackenzie C. Cervenka
Keyword(s):  
Status Epilepticus ◽  
Side Effects ◽  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Diet Therapy ◽  
Drug Resistant ◽  
Ketogenic Diets ◽  
Current Review ◽  
Drug Resistant Epilepsy

The current review highlights the evidence supporting the use of ketogenic diets in the management of drug-resistant epilepsy and status epilepticus in adults. Ketogenic diet variants are compared and advantages and potential side effects of diet therapy are discussed.

Vagus nerve stimulation

2009 ◽  
Vol 27 (3) ◽  
pp. E5 ◽  
Author(s):  
Dzenan Lulic ◽  
Amir Ahmadian ◽  
Ali A. Baaj ◽  
Selim R. Benbadis ◽  
Fernando L. Vale
Keyword(s):  
Vagus Nerve ◽  
Mechanism Of Action ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Drug Resistant ◽  
Nonpharmacological Treatment ◽  
History Of ◽  
Drug Resistant Epilepsy ◽  
Medically Refractory Epilepsy

Vagus nerve stimulation (VNS) is a key tool in the treatment of patients with medically refractory epilepsy. Although the mechanism of action of VNS remains poorly understood, this modality is now the most widely used nonpharmacological treatment for drug-resistant epilepsy. The goal of this work is to review the history of VNS and provide information on recent advances and applications of this technology.

scholarly journals Antiseizure Effects of Fully Characterized Non-Psychoactive Cannabis sativa L. Extracts in the Repeated 6-Hz Corneal Stimulation Test

2021 ◽  
Vol 14 (12) ◽  
pp. 1259
Author(s):  
Anna-Maria Costa ◽  
Lara Senn ◽  
Lisa Anceschi ◽  
Virginia Brighenti ◽  
Federica Pellati ◽  
...  
Keyword(s):  
Olive Oil ◽  
High Performance ◽  
Theta Rhythm ◽  
Cannabis Sativa ◽  
Epileptic Seizures ◽  
Stimulation Test ◽  
Drug Resistant ◽  
Exact Test ◽  
Convulsive Seizures ◽  
Drug Resistant Epilepsy

Compounds present in Cannabis sativa L. preparations have recently attracted much attention in the treatment of drug-resistant epilepsy. Here, we screened two olive oil extracts from a non-psychoactive C. sativa variety, fully characterized by high-performance liquid chromatography and gas chromatography. Particularly, hemp oils with different concentrations of terpenes were administered at the same dose of cannabidiol (25 mg/kg/day orally), 1 h before the 6-Hz corneal stimulation test (44 mA). Mice were stimulated once a day for 5 days and evaluated by video-electrocorticographic recordings and behavioral analysis. Neuronal activation was assessed by FosB/ΔFosB immunoreactivity. Both oils significantly reduced the percentage of mice experiencing convulsive seizures in comparison to olive oil-treated mice (p < 0.050; Fisher’s exact test), but only the oil enriched with terpenes (K2) significantly accelerated full recovery from the seizure. These effects occurred in the presence of reduced power of delta rhythm, and, instead, increased power of theta rhythm, along with a lower FosB/ΔFosB expression in the subiculum (p < 0.050; Duncan’s method). The overall findings suggest that both cannabinoids and terpenes in oil extracts should be considered as potential therapeutic agents against epileptic seizures and epilepsy.

scholarly journals Interictal Epileptiform Discharge Dynamics in Peri-sylvian Polymicrogyria Using EEG-fMRI

2021 ◽  
Vol 12 ◽  
Author(s):  
Noa Cohen ◽  
Yoram Ebrahimi ◽  
Mordekhay Medvedovsky ◽  
Guy Gurevitch ◽  
Orna Aizenstein ◽  
...  
Keyword(s):  
Case Series ◽  
Epileptic Seizures ◽  
Epileptic Activity ◽  
Scalp Eeg ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Malformation Of Cortical Development ◽  
Interictal Epileptiform Discharge ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

Polymicrogyria (PMG) is a common malformation of cortical development associated with a higher susceptibility to epileptic seizures. Seizures secondary to PMG are characterized by difficult-to-localize cerebral sources due to the complex and widespread lesion structure. Tracing the dynamics of interictal epileptiform discharges (IEDs) in patients with epilepsy has been shown to reveal the location of epileptic activity sources, crucial for successful treatment in cases of focal drug-resistant epilepsy. In this case series IED dynamics were evaluated with simultaneous EEG-fMRI recordings in four patients with unilateral peri-sylvian polymicrogyria (PSPMG) by tracking BOLD activations over time: before, during and following IED appearance on scalp EEG. In all cases, focal BOLD activations within the lesion itself preceded the activity associated with the time of IED appearance on EEG, which showed stronger and more widespread activations. We therefore propose that early hemodynamic activity corresponding to IEDs may hold important localizing information potentially leading to the cerebral sources of epileptic activity. IEDs are suggested to develop within a small area in the PSPMG lesion with structural properties obscuring the appearance of their electric field on the scalp and only later engage widespread structures which allow the production of large currents which are recognized as IEDs on EEG.

FACTORS PROVOKING EPILEPTIC SEIZURES

2021 ◽  
pp. 52-59
Author(s):  
Tokareva N.G. ◽  
Ignatieva O.I.
Keyword(s):  
Antiepileptic Drugs ◽  
Anticonvulsant Drug ◽  
Epileptic Seizures ◽  
Epileptic Activity ◽  
International Standards ◽  
Lower Percentage ◽  
Drug Resistant ◽  
Therapy Regimen ◽  
First Choice ◽  
Drug Resistant Epilepsy

Currently, the most significant problems of adherence to modern pharmacotherapy have been identified. The urgency of the treatment of epilepsy is confirmed by its frequency of spread. In Russian neurology, epilepsy is treated in accordance with international standards and recommendations. For a number of years, the drugs of the first stage of choice have proven their effectiveness. Monotherapy is preferred; with the development of drug-resistant epilepsy, the possibilities of using a combination of antiepileptic drugs are considered. Epileptic activity in the form of increased seizure frequency can be triggered by alcohol consumption, sleep disturbance - wakefulness, stressful situations, eye strain, somatic diseases and other factors. The aim of this study was to determine the main factors of provocation leading to an increase in the frequency of seizures in epilepsy. Materials and methods: we carried out a retrospective analysis of 43 case histories of patients with increased seizure rates who were hospitalized in the neurological department of one of the central clinical hospitals in Saransk. The initiation of anticonvulsant drug therapy in all patients coincided with the justification of the diagnosis. Seizure remission was achieved in the first year of treatment in most patients, which indicates a good level of compliance and coincides with clinical guidelines. Most patients in the sample received monotherapy with antiepileptic drugs of the first choice. An increase in seizures in patients taking antiepileptic drugs was noted at 3 years of treatment. Results: the most frequent factor provoking seizures was non-adherence to the therapy regimen, which was often mistakenly interpreted by outpatient doctors as the development of drug-resistant epilepsy; patients were referred to inpatient treatment for alternative monotherapy or combination therapy. Non-compliance with the therapy regimen was noted in the form of a decrease in the dose of the drug, irregularity of administration, and forgetfulness of the patient. Other factors provoking an increase in the frequency of epileptic seizures accounted for a significantly lower percentage and did not have a relevant significance

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