Dementia with non-convulsive seizures: a case report

Non-convulsive seizures (NCSs) are highly treatable, but appropriate management is usually delayed because of inaccurate diagnoses as a result of variable clinical presentations, including an altered mental state. It is difficult to detect NCSs in patients with dementia. We report a case of NCS superimposed on cognitive decline caused by Alzheimer’s dementia. The patient’s history was carefully recorded. An electroencephalogram was recorded with sphenoidal electrodes, which showed epileptiform discharges in the right mesial temporal lobe and focal, sharply contoured, slow wave activity in the left fronto-temporal area, suggesting an epileptic origin contributing to the patient’s cognitive decline. After treatment with antiepileptic drugs, the patient’s cognitive functioning gradually improved. An accurate diagnosis of NCS relies on performing a detailed inventory of a patient’s history, thorough physical and neurological examinations, and electroencephalogram recordings. In patients with cognitive decline, testing for NCS should always be included in the differential diagnosis of cognitive impairment, even in the case of dementia. Early administration of antiepileptic drug therapy is the mainstay treatment for reversing the condition and for preventing prolonged insults from neurological sequelae.

Pharmacological management of seizures in patients with COVID-19: a systematic review

Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 18 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laninamivir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.

Pharmacological management of seizures in patients with COVID-19: a systematic review

Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 19 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laminavir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.

The Antiepileptic Drugs Therapy Practice in Epileptic Patients: What Does Evidence Show?

Introduction: Though studies regarding epilepsy have been conducted in different parts of the world, there is a scarcity of established studies regarding treatment outcomes among patients with epilepsy. Therefore, the aim of this review is to assess antiepileptic drug therapy among patients with epilepsy. This will help in exploring the existing AEDs therapy practice including the outcomes. Methods: Using different search engines like EndNote (Pubmed), Google, Google Scholar and Hinari, literatures were searched for review. Different literatures like, research reports, articles, documents, books and internet findings relevant to this study were reviewed. Findings and discussion: Outcome of AEDs therapy is affected by several factors including patient-related factors, disease related factors and drug related factors. The selection of the most appropriate AEDs for a patient with seizures depends upon the accurate classification of the seizures, the type of epilepsy or epileptic syndromes, and drug such as availability and accessibility of drugs, their efficacy, side effect and comfort use as well as patient factors. So, the selection of AED therapy at present is an empirical process, based on seizure and patient-specific variables and a working knowledge of available AEDs, including AED mechanism of action, pharmacokinetics, drug-drug interactions, and medication side effects and ultimately the treatment outcomes. Conclusion: It is recommended that researchers need to focus on further longitudinal and interventional studies in providing adequate evidence about the cause-effect relationship between the AEDs therapy practice and seizure control.

Cytotoxic lesion of corpus callosum in cerebral venous thrombosis—a case report

Background Veiled by a myriad of monikers, there has been a growing recognition of cytotoxic lesions in the splenium of the corpus callosum as a distinct clinical entity. Despite the varied nomenclature, they all describe restricting callosal lesions on diffusion weighted magnetic resonance imaging with near-complete reversibility on therapy. The currently accepted terminology for these lesions is cytotoxic lesions of the corpus callosum (CLOCC). Only one case of CLOCC associated with cerebral venous Thrombosis has been reported in literature to date. Case presentation While these lesions have most commonly been linked to antiepileptic drug therapy, we describe a case of a young adult who developed CLOCC in the background of cerebral venous thrombosis. We hypothesize that occlusion of the posterior pericallosal vein led to the lesion in the splenium. Early institution of anticoagulation therapy resulted in complete reversal of the abnormality, leading to full clinical recovery. Conclusion Cytotoxic lesions of the corpus callosum may rarely be associated with cerebral venous thrombosis. We emphasize the need for greater awareness, early imaging and aggressive therapy of this potentially curable entity. We further highlight cerebral venous thrombosis as a cause for CLOCC.

Eucalyptus Oil-Induced Seizures in Children: Case Reports and Review of the Literature

Objective Eucalyptus oil (EO)-induced seizures (EOIS) in children is a less recognized entity and a rare cause of acute symptomatic seizures. The purpose of this review outlines the clinical features and outcomes of EOIS with observed cases. Patients and Methods We identified three pediatric patients with EOIS who were treated at Prathima Institute of Medical Sciences, Karim Nagar, India. Results Seizures were developed in three children within 15 to 25 minutes after the ingestion of EO. All the children have taken EO first time and all have the first episode of seizures. One child had status epilepticus. Neuroimaging and electroencephalogram were normal. Two children were treated with antiepileptic drugs for 2 weeks. All the children were recovered within 2 days and none of them had a recurrence of seizures. Conclusion EOIS is an underrecognized and rare entity. The knowledge or awareness of EOIS among health care professionals can prevent unnecessary investigations and long-term antiepileptic drug therapy.