Symptomatic eating epilepsy: two novel pediatric patients and review of literature

Eating epilepsy (EE) is a form of reflex epilepsy in which seizures are triggered by eating. It is a rare condition but a high prevalence has been reported in Sri Lanka. In EE, the ictal semiology includes focal seizures with or without secondary generalization or generalized seizures. Some cases are idiopathic while focal structural changes on imaging, if present, are often confined to the temporal lobe or perisylvian region. On the other hand, some cases support the hypothesis of a genetic aetiology. The prognosis of EE is extremely variable due to the different nature of the underlying disorder. We describe two patients with symptomatic eating epilepsy, a 13-year-old boy with a bilateral perisylvian polymicrogyria and a 2-year-old boy with a genetic cause. The presence of structural lesions or the dysfunction of specific cortical regions in the context of a germline genetic alteration might lead to a hyperexcitation fostering the epileptogenesis. We review the available literature to clarify the aetiopathogenesis and the mechanisms underlying EE to improve the diagnosis and the management of these rare conditions.

The Role and Controversies of Electroencephalogram in Focal versus Generalized Epilepsy

As early in 1935, Gibbs et al described electroencephalogram (EEG) features of large slow waves seen in “petit mal” seizures and change in background rhythm to a higher frequency, greater amplitude pattern in “grand mal” seizures. Studies have shown many typical EEG features in focal onset as well as generalized epilepsies.2 3 It is usually easy to delineate focal epilepsy cases when EEG onset of seizures is clear as seen in Benign focal epileptiform discharges of childhood.4 However, it is not uncommon to see cases where epileptiform discharges are not very clear. For example, there can be secondary bilateral synchrony or generalized onset of epileptiform discharges in some cases of focal epilepsy5 and nongeneralized EEG features is cases of generalized epilepsy like absence seizures.6 The awareness of occurrence of focal clinical and EEG features in generalized epilepsy is particularly important to help to select appropriate AEDs and also to avoid inappropriate consideration for epilepsy surgery.7 Lüders et al8 have shown that multiple factors like electroclinical seizure evolution, neuroimaging (both functional and anatomical) have to be analyzed in depth before defining an epileptic syndrome. Here, we are providing few examples of different situations where it is still mysterious to figure out focal onset seizures with secondary generalization versus primary generalized epilepsy.

Demographics and Pharmacotherapy in Neurocysticercosis: A hospital Based Study

Introduction: Neurocysticercosis (NCC) is one of the commonest preventable cause of seizure. It is due to development of the larval form of Taenia solium. This disease is endemic in south east Asia including Nepal and has been considered as one of the neglected tropical disease. Methods: All the patients who came to Neurosurgical outpatient department (OPD) of Annapurna Neurological Institute and Allied Sciences (ANIAS) with the diagnosis of NCC with seizure during the study time frame were included in the study. The time frame of the study was January 1st 2017 till December 31st 2018. Results: There were 167 total cases of which 108 (64.7%) were male and 59 (35.3%) were female. Mean age was 27.9 years (SD 13.1 years, range 1 year to 66 years). Frequency of patients were in the age group 20-30 years followed by 10-20 years. In terms of number of lesions, 86% of the patients had single lesion while 14% had multiple lesionsMaximum number of cases had focal seizure with secondary generalization (46%). This was followed by focal seizure (28%). Most common antiepileptics was carbamazepine (51.5%).Mean duration of antiepileptics was 2.5 years (SD 1.47, Range 9 months to 6 years) and recurrence was noted in 7.78% of cases. Conclusion: NCC affects the productive age group with higher proportion being male patient. Single lesion is more prevalent. Proper measures for treatment and prevention of neurocysticercosis is essential and can lead to better control of this condition.

Reading Epilepsy—An Interesting Case Report

Reading epilepsy is a language induced reflex epilepsy with common ictal manifestations of regional myoclonus. The electroencephalogram (EEG) often shows focal, regional, or generalized discharges, rarely there may not be any associated EEG changes. We report case of a 25-year-old male with three episodes of seizures, precipitated while reading a book. Reported semiology was stuttering while reading with jerking of tongue as perceived by the patient followed by generalized tonic–clonic seizures (GTCS). Magnetic resonance imaging (MRI) of brain with 3 Tesla (3T) was normal. During videoelectroencephalogram (vEEG), reading precipitated recurrent stuttering each lasting for 1 to 2 seconds. Corresponding vEEG showed rhythmic 1/second symmetrical generalized spike and wave discharges lasting for 2 to 4 seconds during episodes of stuttering with intervening normal background activity, followed by generalized spike and wave discharges intermixed with artifacts recorded during secondary generalization. Patient was prescribed levetiracetam and responded well and is currently seizure-free for more than 6 years.

Closed-loop stimulation of the medial septum terminates epileptic seizures

ABSTRACTTemporal lobe epilepsy with distributed hippocampal seizure foci is often intractable and its secondary generalization might lead to sudden death. Early termination through spatially extensive hippocampal intervention is not feasible directly, due to its large size and irregular shape. In contrast, the medial septum (MS) is a promising target to govern hippocampal oscillations through its divergent connections to both hippocampi. Combining this ‘proxy intervention’ concept and precisely timed stimulation, we report here that closed-loop MS electrical stimulation can quickly terminate intrahippocampal seizures and suppress secondary generalization in a rat kindling model. Precise stimulus timing governed by internal seizure rhythms was essential. Cell-type-specific stimulation revealed that precisely timed activation of MS GABAergic neurons underlay the effects. Our concept of phase-targeted proxy stimulation for intervening pathological oscillations can be extrapolated to other neurological and psychiatric disorders, and its current embodiment can be directly translated into clinical application.

Comparison of clinical, electroencephalographic and tomographic data in children with epilepsy with controlled and uncontrolled seizures

The article presents the results of a examination of 124 children with epilepsy aged 1 month to 18 years to detect clinical electroencephalographic (EEG) and tomographic correlations in patients with controlled and uncontrolled seizures. It was shown that clinical manifestations (seizure types) are not always correlated with local changes on EEG and focus on MRI. In children, especially with uncontrolled seizures, even in the case of a focal onset of the seizure, secondary generalization is often observed, which is due to the functional immaturity of the brain and the tendency to rapid generalization of the epileptic potential. In general, the coincidence between the EEG data and morphological MRI is determined in 66 % of patients, when performing high-fi eld magnetic resonance tomography (on devices with a magnetic fi eld of 1.5 T or more) in the "Epilepsy" mode — in 71 %, and using MR-spectroscopy rises to 73 %. Key words: children, epilepsy, EEG, MRI