Sleep and Epilepsy

It is well known that clinical and EEG manifestations of many epilepsy syndromes are related to sleep-and-waking cycles. Epilepsies are thought as disorders reflecting abnormalities in neuronal networks underlying sleep process. Patients with epilepsy, on the other hand, are generally reported to have poor sleep quality when compared with healthy controls. Furthermore, poor sleep quality or sleep-deprivation may worsen seizure control and set a vicious cycle. Anti-epileptic drugs may also affect sleep architecture. Here, we aim to review the complex relationship of sleep and epilepsy in the light of relevant literature

Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis

Summary Background A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed – last updated on March 11, 2021 – including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings  368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68–0·73). Interpretation We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding MING fonds

Nonconvulsive Status Epilepticus

Nonconvulsive status epilepticus (NCSE) has a wide range of clinical presentations, ranging from confusion to coma accompanied by many kinds of continuous or recurrent epileptic discharges on the electroencephalogram (EEG). It may occur not only in epileptic patients but also in adults with no previous history of epilepsy. EEG is the only reliable method of diagnosing NCSE. The identification of NCSE may be particularly difficult and therefore, a high level of suspicion is essential for early diagnosis. In this review, clinical and electrophysiological findings, types, frequency, diagnosis, differential diagnosis, treatment, and prognosis of NCSE are discussed in the light of the relevant literature

Clinical and EEG Analysis of Patients With Idiopathic Generalized Epilepsy and Photosensitivity

Introduction: Our aim is to define the electroclinical characteristics of patients with photosensitive idiopathic generalized epilepsy (IGE) and to investigate the differences in seizure types, therapy and outcome between subgroups, based on photoparoxysmal response (PPR)/EEG characteristics and different syndromes

Do the neurologists recognize autoimmune epilepsy well enough? What is the effect of the pandemic on this matter?

Introduction The concept of "autoimmune epilepsy" (AE) has been emphasized more frequently through the recent increase in recognition of various autoantibodies specific to neuronal proteins

Different attitudes in the management of different types of status epilepticus: A survey study among neurologists demonstrating evidence gap

© 2021 Neurological Sciences and Neurophysiology | Published by Wolters Kluwer-Medknow.Purpose: The aim is to identify current diagnostic and therapeutic approach to different types of status epilepticus (SE) including convulsive SE (CSE), non-CSE (NCSE), and epilepsia partialis continua (EPC) to detect unmet needs and problems encountered during the management of these neurological emergencies in our country, Turkey. Methods: The specifically designed SE survey included 31 questions that were related to the incidence, the distribution of etiological causes, the diagnostic process, and the treatment approaches of the neurologists and individual electroencephalography (EEG) facilities of the institutions. Results: The total number of respondents was 152 with a median years of experience in professional practice of 10.8 years (1–39 years). The great majority of the neurologists preferred diazepam plus phenytoin as the first choice drug in the treatment of CSE. Of the respondents, only 55% accepted the SE as refractory after applying the second drug and they monitored these patients in the intensive care unit (ICU). Most of the participants (67.7%) did not provide any treatment except the standard medical approaches, while only 39 (30.7%) had used immunotherapy in the treatment of super-refractory SE. Forty-seven respondents (37%) indicated that they had difficulty identifying NCSE on EEG. While 37% of the participants treated EPC patients with preserved consciousness in ICU by general anesthesia, only 15% were previously applied immunotherapy. Strikingly, 41% of the participants stated that they did not feel themselves as sufficiently competent in terms of practical and theoretical knowledge about the management of SE. Conclusion: We demonstrated that there are no standardized attitudes for the management of different types of SE among neurologists. It is worth to emphasize that the neurologists did not feel themselves sufficiently competent in terms of practical and theoretical knowledge, especially with regard to the subtypes of SE

Does semiology tell us the origin of seizures consisting mainly of an alteration in consciousness?

Purpose: Studies on seizures only with an alteration of consciousness were limited mainly to generalized epilepsy. This seizure type has been described rarely in focal epilepsy. We aimed to analyze the semiologic features of this seizure type in focal and generalized epilepsies in a blinded design

Reduced axon number in juvenile myoclonic epilepsy demonstrated by motor unit number estimation analysis

Some conventional and quantitative EMG studies have already demonstrated a subclinical lower motor neuron involvement in juvenile myoclonic epilepsy (JME). Our aim was to investigate this subclinical involvement by using motor unit number estimation (MUNE) analysis with modified McComas' technique

Magnetic Resonance Spectroscopy Findings in Photosensitive Idiopathic Generalized Epilepsy

Studies investigating the pathophysiology of epileptic photosensitivity indicate variable involvement of particular brain regions. Our aim was to identify metabolic differences between photosensitive idiopathic generalized epilepsy (IGE) patients and nonphotosensitive IGE patients and normal healthy subjects by using Magnetic Resonance Spectroscopy (MRS)

Magnetic Resonance Spectroscopy Findings in Photosensitive Idiopathic Generalized Epilepsy

WOS: 000274832000007PubMed ID: 20307015Studies investigating the pathophysiology of epileptic photosensitivity indicate variable involvement of particular brain regions. Our aim was to identify metabolic differences between photosensitive idiopathic generalized epilepsy (IGE) patients and nonphotosensitive IGE patients and normal healthy subjects by using Magnetic Resonance Spectroscopy (MRS). Fourteen patients diagnosed with photosensitive IGE were investigated. The control groups consisted of 14 age- and sex-matched healthy volunteers and 14 IGE patients without photosensitivity. MRS measurements of N-acetylaspartate (NAA), choline-containing compounds (Cho), creatine (Cr) were performed in the frontal and occipital cortex and the thalamus bilaterally using a stimulated echo acquisition mode (STEAM) technique with a voxel size of 20x20x20 mm. The values of the patients with IGE were compared with those of the normal controls and within subgroups according to the clinical variables by appropriate statistical tests. Photosensitive IGE patients showed significantly decreased concentrations of NAA in the right frontal lobe and left thalamus, decreased NAA/Cr ratio in left thalamus and significantly increased concentrations of Cho/Cr ratio in the right frontal lobe and NAA/Cr in the left occipital lobe when compared to normal controls. Furthermore, left occipital NAA concentration increased and left thalamus NAA/Cr ratios were decreased from the IGE patients without photosensitivity but without reaching statistical significance. Our results support previous MR studies suggesting an asymmetrical neuronal dysfunction in favor of the dominant occipital cortex and thalamus in photosensitive IGE patients