A Study On Clinical Profile And Semiology In Complex Partial Seizures And Its Radiological Correlation

Background: Epilepsy is the second most common and frequently encountered neurological disorder which poses huge threat to known healthcare systems worldwide also causing financial, socio economic burden to the community. Complex Partial Seizures are a form of focal epileptic seizures that may impair consciousness. Aim and objectives: Our motivation for the study was to understand the extent of patients with complex partial seizures associated with medial temporal lobe sclerosis. Materials and methods: We performed a cross sectional study about patients with complex partial seizures in Thanjavur medical college and hospital about their clinical profile and neuro-radiological correlation. Statistical analysis and results: Through our multimodal study with EEG, MRI on N=118 (female / male, age range, Most common age group- 10-20 years, mean age of 23 years, SD- 14 years, 66% males), we observed that atypical febrile seizures and fever provoked seizures has more association (18%) to complex partial seizures and to medial temporal lobe sclerosis in comparison to 12% in an earlier study. Conclusion: We believe this study summarizes the complex partial seizure features, origin, and their link to Medial Temporal lobe Sclerosis in our subject pool from Thajavur, India. Limitation: There are some limitations to our study, especially with no video EEG monitoring and no invasive EEG recording. We aim to improve them in our future studies.

Unique Presentation and Diagnostic Challenges in Metastatic Cerebral Angiosarcoma: Case Report

BACKGROUND AND IMPORTANCE Angiosarcoma is a malignant endothelial tumor arising from vascular or lymphatic tissue. Metastatic cerebral angiosarcoma has been rarely reported and is associated with a poor prognosis. CLINICAL PRESENTATION We report a 22-yr-old man who presented with a complex partial seizure. Contrasted brain magnetic resonance imaging (MRI) revealed 3 enhancing masses of the left frontal-parietal junction, right occipital lobe, and right caudate nucleus. Computed tomography (CT) of the chest, abdomen, and pelvis and a cardiac MRI revealed no evidence of primary tumor. Immunohistochemistry following biopsy was positive for the ETS transcription factor ERG, CD31, FLI-1, and FosB, confirming angiosarcoma. CT/positron emission tomography (PET) scan showed skeletal metastases in the left iliac bone, sacrum, and T6 vertebral body. The patient underwent resection of the 2 cortical masses, stereotactic radiosurgery to the intracranial lesions as well as to his oligometastases, and was treated with 9 cycles of paclitaxel and bevacizumab. Brain MRI and CT/PET body imaging after cycle 9 revealed no tumor recurrence or progression. The progression-free and overall survival following the diagnosis of brain metastases was 27 mo. CONCLUSION Neurosurgeons should be aware of the unique presentation and diagnostic challenges in metastatic cerebral angiosarcoma, particularly in cases when the primary tumor site is unknown. Furthermore, combined surgery, ablative radiation, and targeted systemic and biological therapy can result in prolonged survival even in patients with metastases.

Artificial Neural Network analysis of EEG waves in complex partial seizure patients

Background: Brain dynamics associated with epilepsy remains limited. EEG-based epilepsy diagnosis and seizure detection is still in its infancy. The problem is further amplified for the design and development of automated algorithms, which requires a quantitative parametric representation of the qualitative or visual aspect of the markers. This study proposes an automatic classification system for epilepsy based on neural networks and EEG signals. Material and Method: The present study made use of EEG data from 16 controls and 16 temporal lobe epilepsy (TLE) patients in order to comparatively assess neural dynamics in normal healthy young adults and epileptic patients treated with anti-epileptic drugs in the context of resting state during eye close session. Such tangible differences could be appreciated through artificial neural network (ANN) classifiers. Results: During eye closed session of EEG in order to diagnose temporal lobe epileptic patient, the extracted features of EEG activity are given to the classifier algorithm for training and test performance. Artificial Neural Network (ANN) classifier was used for the diagnosis task. Fractal dimension (Katz, Higuchi and Permission entropy) were analyzed, in which the best results was observed in trained set of data of Katz (93.18%). Conclusion: Non-linear analysis plays an important role in prediction of complex partial seizure during interictal period.

Intractable Temporal Lobe Epilepsy (TLE) From Tuberculoma; Microneurosurgical Management of by Amygdalohippocampectomy with Lesionectomy Plus Standard Anterior Temporal lobectomy: A Case Report and Short Review of Literature

Patient presenting as a case of Temporal Lobe Epilepsy (TLE) are usually resistant to antiepileptic drugs and surgery is the treatment of choice. This type of epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-venous Malformation (AVM) etc], trauma, infection (Tuberculosis) etc. Here we report a case of surgically treated TLE that was due to a large tuberculoma in medial temporal lobe. Intractable epilepsy caused by tuberculoma is rare. The only presenting symptoms was Complex partial seizure (Psychomotor epilepsy) for which the patient underwent scalp EEG (Electro Encephalography) and MRI (Magnetic resonance imaging) of brain. The patient was managed by amygdalohippocampectomy with lesionectomy plus standard anterior lobectomy. Postoperatively she was on anti-tubercular therapy and on carbamazepine. The case was seizure and disease free till last follow up. Journal of Surgical Sciences (2012) Vol. 16 (2) : 106-109

Complex partial seizure with postictal aggression as a presentation of atypical eclampsia: a case report

Background: Complex partial seizure with sudden onset in near term pregnancy can be challenging to the attending clinician and it is essential to proceed with a presumptive diagnosis of eclampsia, especially in resource poor settings. Unlike generalized tonic clonic seizures, which are more common in eclampsia, complex partial seizures may not jeopardize the fetus with the same severity. However the associated postictal aggression manifested in self-inflicted trauma poses an imminent risk onto the fetus. Case presentation: A nineteen year old gravida two para one living zero woman presented with seizure at thirty six weeks and three days of gestation in a district hospital. The blood pressure recordings during her entire pregnancy were normal and proteinuria was not present. Her previous pregnancy had a similar course, with self-inflicted trauma to her abdomen in a postictal state and resulted in loss of fetus. She did not have any seizures in between then and the current admission. While being managed in the labor ward, the family physicians witnessed complex partial seizure with postictal aggression. The delivery was expedited with caesarean section and she had no further seizure activity. Conclusion: Complex partial seizures with postictal aggression in pregnancy are rare but can be an atypical presentation of eclampsia and poses a diagnostic dilemma to the clinician.