Status Epilepticus and Multiple Sclerosis: A Case Presentation and Literature Review

Purpose. To search the literature for the frequency, pathogenesis, prognosis, and treatment of seizures and status epilepticus (SE) in patients with multiple sclerosis (MS). Methods. We report 2 patients with MS who presented with SE and review the literature. Results. Seizures and SE episodes worsened during MS relapses in the first patient. SE episodes and MS relapses significantly decreased after initiation of natalizumab treatment but she still had seizures and was taking 4 antiepileptic drugs (AEDs). The second patient had super refractory SE and was treated with AEDs and coma induction; SE was controlled in 1 week. Antibodies against glycine receptors were reported in her serum after her death. Conclusion. SE has been reported to remain refractory to conventional AEDs, and improve with treatment of MS relapse. Seizures often occur during MS relapses, and might be the presenting symptom of MS or the only symptom of a relapse. Patients with MS and epilepsy have been reported to have more severe MS disease courses. Seizures are refractory to treatment in patients with MS with chronic epilepsy; however, prognosis is quite good in patients experiencing provoked seizures during an MS relapse. Since some EEG findings may have prognostic value, their evaluation is invaluable for the determination of outcome. No treatment guidelines have been specified for patients with MS and SE. However, treatment with AEDs, ideally new-generation AEDs, and an MS treatment review with a new protocol will ensure a fast response to the improvement of SE

Blood-brain barrier, epileptogenesis, and treatment strategies in cortical dysplasia

Cortical dysplasia (CD) is one of the most important causes of intractable epilepsy. The precise mechanisms of epileptogenesis in CD are not known. Using CD animal models, we attempted to understand the mechanisms and efficacy of various antiepileptic drugs. In two separate studies, we assessed (1) the effects of levetiracetam (LEV) and vagus nerve stimulation (VNS) on pentylenetetrazol (PTZ)kindled rats, and (2) the effects of LEV and topiramate (TPM) on rats with CD and hyperthermia (HT). In the HT-induced rats with CD study, LEV and TPM decreased both the intensity of seizures and the number of rats with seizure. In these studies, we used immunocytochemistry (occludin, glial fibrillary acidic protein [GFAP], and P-glycoprotein [Pgp antibodies] and electron microscopy (EM) (sodium fluorescein [NaFlu]) and horseradish peroxidase [HRP]) to assess bloodbrain barrier (BBB) integrity. Both LEV and TPM protected BBB. In PTZ- kindled rats with CD, both LEV and VNS reduced the duration of seizures. Immunocytochemistry and EM revealed no BBB impairment in any of the treatment groups. In a second set of experiments, we assessed the relationship between disruption of vascular components and epileptogenesis. Astrocytic albumin uptake in focal epileptogenic lesions with vascular components suggested that dysfunction of the BBB contributes immediately to epileptogenesis, rather than simply resulting from seizure activity. Hemosiderin deposits were seen as potential epileptogenic triggers in vascular malformations (e.g., cavernomas [CA] or arteriovenous malformations [AVMs] with or without a dysplastic cortical component). However, we found strikingly high accumulation of astrocytic albumin deposits in surgically removed brain parenchyma in the vicinity of CAs and AVMs from patients with pharmacoresistant epilepsy, which suggests different pathophysiologic dispersion pathways for hemosiderin and albumin in vascular lesions

First Results of Intravenous Levetiracetam Use in Turkey

Objective: Status epilepticus is a neurological emergency feature with a risk of high mortality and morbidity which requires immediate intervention. Many of the medications used in standard treatment have systemic side effects. Levetiracetam (LEV) is one of the new antiepileptic agents which are not metabolized through the liver and have minimal drug interaction. Positive outcomes with intravenous (IV) form of LEV on patients with refractory seizures and status have been reported

Clinical events in psychogenic non-epileptic seizures based on semiological seizure classification

Objectives: None of the classifications of psychogenic non-epileptic seizures (PNES) have been widely accepted and used by physicians so far. In this study we aimed at classifying PNES on the basis of a modified version of semiological seizure classification (SSC). We also sought to assess the interrater reliability (IRR) of the PNES diagnosis based on SSC

Lack of Prominent Cognitive Regression in the Long-term Outcome of Patients Having Electrical Status Epilepticus During Sleep With Different Types of Epilepsy Syndromes

The purpose was to document 4 patients with different epilepsy syndromes, showing electrical status epilepticus during sleep (ESES), without marked cognitive and behavioral regression in the long-term follow-up. The mean age at onset of seizures was 8 years. Absences, myoclonic, focal motor, or generalized tonic - clonic seizures and drop attacks were the prominent seizure types. The neurological examination and neuroimaging findings revealed no abnormality. Focal epileptiform electroencephalographic (EEG) activity was seen in 3 cases, whereas generalized photosensitive epileptic discharges were detected in 1 patient with juvenile myoclonic epilepsy. Neuropsychological evaluations of all cases were within the normal range, and deterioration in mental status was not observed during their mean follow-up duration of 14 years. Our data support the view that ESES can emerge along with different types of childhood epilepsy syndromes, including idiopathic generalized epilepsies, and may not always be a poor prognostic factor

Intravenous levetiracetam treatment in status epilepticus: A prospective study

Objective: To assess the efficacy of intravenous (IV) levetiracetam (LEV) in the treatment of status epilepticus (SE) and treatment outcomes

Using personality disorders to distinguish between patients with psychogenic nonepileptic seizures and those with epileptic seizures

Identifying psychiatric disorders rather than psychiatric symptoms might help to distinguish patients with psychogenic nonepileptic seizures (PNES) from those with epileptic seizures (ES). Patients with PNES (n = 35), patients with ES (n = 35), and healthy controls (n = 37) were compared with respect to the prevalence of psychiatric disorders in this study. We tested the predictive power of having axis I psychiatric disorders, as well as personality disorders, in distinguishing ES from PNES. There was no significant difference between the patient groups in the prevalence of axis I psychiatric disorders. Personality disorders were more prevalent in the PNES group than in the ES group (P<0.05). Having a personality disorder was the only predictor for the PNES group. Having a personality disorder seems to be a more significant predictor for PNES than having an axis I psychiatric disorder. Greater attention should be paid to personality disorders in the differentiation of PNES and ES and the provision of effective treatment. (C) 2011 Elsevier Inc. All rights reserved

Prognosis and Clinical Features of Idiopathic Generalised Epilepsy Patients Older Than 40 Years

Introduction: Idiopathic generalised epilepsies (IGE) are usually seen in the first two decades of life. There is a paucity of data of these patients when they get older

A Detailed Evaluation of Centers that Use Video-Electroencephalogram Monitorization and Epilepsy Surgery in Turkey

Objectives: The aim of this study was to collect data through the Epilepsy Surgery Commission of the Turkish Epilepsy Society to obtain a comprehensive assessment of the status of epilepsy patients in Turkey, to identify the existing infrastructure-service potential of video-electroencephalogram (EEG) monitoring (VEM) centers and epilepsy surgery, to initiate standardization activities, to create awareness of the data, and to ensure that the necessary precautions are taken by the health authorities

Epilepsia partialis continua: Correlation of semiology, outcome and electrophysiologic features

Objective: Epilepsia partialis continua (EPC) is a special form of cortical epilepsy. Several studies have described the ictal and interictal electroencephalography (EEG) findings in patients with EPC; however, lateralizing and localizing values of these findings have been evaluated rarely. This study investigated the correlation of semiologic and EEG findings, and outcomes in patients with EPC