Psychogenic Non-Epileptic Seizures (PNES)

Psychogenic non-epileptic seizures (PNES) are a common presentation to the emergency rooms and neurology departments, and they are difficult to discriminate from epileptic seizures (ES). PNES present as paroxysmal time-limited, alterations in motor, sensory, autonomic, and/or cognitive signs and symptoms, but unlike epilepsy, PNES are not caused by ictal epileptiform activity. There is no exact known etiology or mechanism for PNES so far. The most recognized factors discussed in the literature include trauma and child adversity, dissociation, somatization, emotional processing, psychiatric comorbidities, coping styles, and family dysfunction. The use of a comprehensive assessment model may ease the transition of patient care from the diagnosing team to the outpatient treatment provider. Recognition of the characteristic clinical features of PNES and utilization of video-EEG to confirm the diagnosis are critical. Communicating the diagnosis, discontinuation of treatment for epilepsy (unless comorbid PNES and epilepsy are present), and implementing proper liaison with a multidisciplinary team with clinical psychologists, neurologists, and psychiatrists improve patient and healthcare outcome

Serum level of C-reactive protein and interleukin-6 in children with drug-resistant epilepsy

There is increasing evidence that chronic inflammation affects the pathophysiology of epilepsy, especially the drug-resistant type. Drug-resistant epilepsy is a challenging condition, because of the difficulties in its management, and its unclear epileptogenesis. This study is looking at C-reactive protein (CRP) and interleukin-6 (IL-6) levels in those with drug-resistant epilepsy and the correlation of these levels with seizure frequency. Hence, 40 children with drug-resistant epilepsy were included in this study and compared with 20 healthy volunteers (as a control group). Participants were aged between 5 and 15 years. Patients were divided into two subgroups, those with daily seizures (Group A1) and those with monthly seizures (Group A2). Serum levels of CRP and IL-6 were measured in all participants. The clinical characteristics, electroencephalography, and magnetic resonance imaging (MRI) findings were then compared. CRP levels were significantly higher in Group A1, at 21.88–93.29 mg/L than both Group A2 and the control group, at 3.02–40.37 mg/L and 2.23–13.18 mg/L, P  < 0.01 and P  < 0.001, respectively. The IL-6 levels were also significantly higher in Group A1, at 153.60–597.80 ng/L than in both Group A2 and the control group, at 97.40–232.50 ng/L and 12.00–96.30 ng/L, P  < 0.01 and P  < 0.001, respectively. Significantly higher levels of CRP and IL-6 were associated with earlier age of onset ( P  < 0.01), seizure frequency ( P  < 0.05), and the frequency of status epilepticus ( P  < 0.01). Moreover, frequent-generalized motor seizures are correlated with elevated CRP and IL-6 levels. As a result, this systemic inflammatory reaction in children may contribute to drug-resistant seizure and potentially could be used as biomarkers to be correlated with disease severity and prognosis

Sonographic assessment of optic nerve and ophthalmic vessels in patients with idiopathic intracranial hypertension

<p><b>Background</b>: Early diagnosis and proper monitoring of intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) could reduce morbidity.</p> <p><b>Objectives</b>: The objective was to explore and monitor reflection of raised ICP in IIH on optic nerve sheath diameter (ONSD), papillary height and ophthalmic vessels hemodynamics, using transorbital sonography (TOS).</p> <p><b>Methods</b>: The study included 24 IIH patients and 30 controls. Patients were compared to controls (phase I) then reassessed twice; 1 week and 4 weeks later (phase II). Both groups underwent clinical evaluation and TOS to measure ONSD, papillary elevation, and color Doppler indices of the ophthalmic vessels. Patients underwent lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure.</p> <p><b>Results</b>: ONSD was significantly higher in patients compared to controls (<i>p</i> < 0.001). The cut-off value was 6.2 mm. Papillary elevation (<i>p</i> = 0.006) and ONSD (<i>p</i> = 0.006) were significantly reduced 4 weeks following LP. Baseline color Doppler indices of the ophthalmic vessels were comparable between both groups and the changes observed during the follow-up visits in the patients were insignificant.</p> <p><b>Conclusion</b>: Reflected ICP changes on ONSD and papilla, measured by TOS, could be a valuable noninvasive additional tool to diagnose and monitor IIH patients. IIH insignificantly influences ophthalmic vessels hemodynamics.</p> <p><b>Abbreviation</b> BMI: Body mass index. CSF: Cerebrospinal fluid. EDV: End diastolic velocity. ICP: Intracranial pressure. IH:intracranial hypertension. IIH: Idiopathic intracranial hypertension. LP: Lumbar puncture. MI: Mechanical index. MRI: Magnetic resonance imaging. MRV: Magnetic resonance venography. OA: Ophthalmic artery OND: Optic nerve diameter. ONSD: Optic nerve sheath diameter. OV: Ophthalmic vein. PIs: Pulsatility indices. PSV: Peak systolic velocity. ROC: Receiver operator characteristic. TOS: Trans-orbital sonography.</p

Supplemental material for Optic nerve sonographic examination to predict raised intracranial pressure in idiopathic intracranial hypertension: The cut-off points

<p>Supplemental material for Optic nerve sonographic examination to predict raised intracranial pressure in idiopathic intracranial hypertension: The cut-off points by Nirmeen A Kishk, Asmaa M Ebraheim, Amal S Ashour, Nashwa M Badr and Mohamed A Eshra in The Neuroradiology Journal</p

Physicians' beliefs about brain surgery for drug-resistant epilepsy: A global survey

Purpose: To investigate the opinions of physicians about brain surgery for drug-resistant epilepsy worldwide. Methods: Practicing neurologists, psychiatrists, and neurosurgeons from around the world were invited to participate in an online survey. The survey anonymously collected data about demographics, years in clinical practice, discipline, nation, work setting, and answers to the questions about beliefs and attitudes about brain surgery for drug-resistant epilepsy. Results: In total, 1410 physicians from 20 countries and different world regions participated. The propensity to discuss brain surgery with patients, who have drug-resistant seizures, was higher among men (versus women) [Odds Ratio (OR) 1.67, 95% CI 1.20-2.31; p = 0.002]. In comparison to neurologists, psychiatrists were less likely (OR 0.28, 95% CI 0.17-0.47; p < 0.001) and neurosurgeons were more likely (OR 2.00, 95% CI 1.08-3.72; p = 0.028) to discuss about it. Survey participants working in Africa, Asia, the Middle East, and the Former Union of Soviet Socialist Republics showed a lower propensity to discuss epilepsy surgery with patients. Conclusion: This study showed that on an international level, there is still a knowledge gap concerning epilepsy surgery and much needs to be done to identify and overcome barriers to epilepsy surgery for patients with drug-resistant seizures worldwide