Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type

Objective:To assess whether increased seizure frequency during pregnancy and post-partum is influenced by epilepsy type, seizure location, and antiseizure medications.Methods:Clinical data was collected in a longitudinal prospective database of pregnant women with epilepsy at Brigham and Women’s Hospital. Within each individual participant, baseline seizure frequency was calculated for the 9 months preconception, and it was determined if seizure frequency increased during pregnancy or the postpartum period. Seizure frequency was calculated for each 4-week interval during pregnancy. Generalized estimating equations for logistic regression were applied.Results:Ninety-nine patients contributing 114 pregnancies were included from 2013-2018. Increased seizure frequency occurred more often during pregnancies of women with focal versus generalized epilepsy (21.1% vs 5.3%, OR 4.70; 95% CI (1.00, 22.00); p = 0.0497). Among women with focal epilepsy, increased seizure frequency occurred more often in those with frontal lobe epilepsy (OR 8.00; 95 % CI (2.19, 29.21); p = 0.0017). There was no difference in seizure worsening in the postpartum period between focal and generalized (11.1% vs 9.1%, p=0.4478), or frontal and other focal (18.8% vs 6.0%; p=0.1478) epilepsy groups. Pregnancies on polytherapy had higher odds of seizure worsening compared to monotherapy (OR = 8.36, 95% CI = (2.07, 33.84), p = 0.0029), regardless of the medication or epilepsy type. A lack of preconception seizure freedom was also associated with increased seizure frequency during pregnancy (OR = 6.418; p = 0.0076).Conclusion:Women with focal epilepsy have higher likelihood of seizure worsening during pregnancy compared to women with generalized epilepsy; frontal lobe epilepsy poses an especially elevated risk. Polytherapy and lack of preconception seizure freedom are additional predictors for an increased likelihood of seizure worsening.

Bilateral Orbitofrontal Repetitive Transcranial Magnetic Stimulation in Frontal Lobe Epilepsy: A Case Report

Epilepsy is a common and severe neurological disorder affecting millions of people worldwide. Nowadays, antiseizure medications (ASMs) are the main treatment for most epilepsy patients, although many of them do not respond to ASMs and suffer from drug-resistant epilepsy (DRE). Alternative and novel treatment methods have been offered nowadays, showing promising results for the treatment of DRE. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that has become increasingly popular in the last decades. This article reports a patient with frontal lobe epilepsy. We aimed to investigate whether bilateral orbitofrontal (OFC) low-frequency rTMS (LF-rTMS) is feasible and tolerable, safe, and potentially clinically effective in treating epileptic seizures. The patient’s satisfaction with rTMS therapy was self-reported to be high, as rTMS helped in reducing the frequency of the focal attacks and completely abolished the preceding feeling of fear and panic. Therefore, bilateral OFC rTMS treatment can be well tolerated in patients with frontal epilepsy although the findings of the present case report with regard to clinical efficacy warrant further investigation.

Frontale epilepsie; impact op cognitie en gedrag bij kinderen

Lydia van den Berg promoveerde op 19 april 2021 aan de Rijksuniversiteit Groningen op het proefschrift Epilepsy out of control; when frontal lobe epilepsy becomes more than seizures. In haar proefschrift is er vooral aandacht voor executieve functies bij kinderen met frontale epilepsie. Welke gedrags- en cognitieve problemen ondervinden deze kinderen en verschilt de rapportage hierover van leerkrachten en ouders?

Arterial spin labeling for presurgical localization of refractory frontal lobe epilepsy in children

Background Epilepsy is one of the most common chronic neurological diseases. Despite the great variety and prevalence of antiepileptic drug treatments, one-third of epilepsies remain drug resistant. The frontal lobe is extensive, and frontal lobe seizures are difficult to locate, which increases the difficulty of the preoperative localization of the epileptogenic zone. Case presentation Two previously healthy girls with refractory frontal lobe epilepsy showed significant perfusion abnormalities in the right frontal lobe using the cerebral blood perfusion (CBF) quantitative analysis system. They became seizure-free after lesionectomy of the frontal lobe by ASL combined with electroencephalography (EEG) rapid localization. The histopathological diagnosis was focal cortical dysplasia (FCD) type IIa and IIb. Conclusions The positive outcome suggests that the combined use of ASL with EEG could be a beneficial option for the presurgical evaluation of pediatric epilepsy.

Brain structural differences in temporal lobe and frontal lobe epilepsy patients: A voxel-based morphometry and vertex-based surface analysis

Purpose Exploration of the effect of chronic recurrent seizures in focal epilepsy on brain volumes has produced many conflicting reports. To determine differences in brain structure in temporal lobe epilepsy (TLE) and extratemporal epilepsy (using frontal lobe epilepsy (FLE) a surrogate) further, we performed a retrospective analysis of a large cohort of patients with seizure-onset zone proven by intracranial monitoring. Methods A total of 120 TLE patients, 86 FLE patients, and 54 healthy controls were enrolled in this study. An analysis of variance of voxel-based morphometry (VBM) was used to seek morphometric brain differences among TLE patients, FLE patients, and healthy controls. Additionally, a vertex-based surface analysis was utilized to analyze the hippocampus and thalamus. Significant side-specific differences in hippocampal gray matter volume were present between the left TLE (LTLE), right TLE RTLE (RTLE), and control groups ( p<0.05, family-wise error (FWE) corrected). Results Vertex analyses revealed significant volume reduction in inferior parts of the left hippocampus in the LTLE group and lateral parts of the right hippocampus in the RTLE group compared to controls ( p<0.05, FWE corrected). Significant differences were also detected between the LTLE and control group in the bilateral medial and inferior thalamus ( p<0.05, FWE corrected). FLE patients did not exhibit focal atrophy of gray matter across the brain. Conclusion Our results highlight the variation in morphometric lateralized changes in the brain between different epilepsy onset zones, providing critical insight into the natural history of people with drug-resistant focal epilepsies.