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

Ictal asystole: a case presentation

Abstract Background Epileptic seizures can lead to cardiac arrhythmias. The arrhythmias may be in the form of tachycardia, bradycardia or asystole. Ictal bradycardia and asystole can lead to sudden unexpected death. Case presentation A case report of a 40-year-old male with complex partial temporal lobe epilepsy. He has coincident attacks of fall and pallor. The patient underwent simultaneous electrocardiogram (ECG) and video electroencephalogram (EEG) monitoring. The slow activity in EEG coincide with the appearance of bradycardia in ECG then cardiac asystole which clinically correspond to the patient syncope. After insertion of a cardiac pacemaker, only complex partial attacks develop with a marked reduction in frequency and no more fall attacks. Conclusion Epileptic seizures can present with cardiac arrhythmias, with ictal asystole leading to sudden unexpected death. Simultaneous EEG and ECG are essential for the diagnosis. A cardiac pacemaker can be lifesaving for patients with ictal arrhythmias

Assessment of postural balance in multiple sclerosis patients

Abstract Background Disturbance of balance and falls are commonly observed in people with multiple sclerosis (MS). Objectives The aim of this study is to assess the postural balance in patients with MS by using clinical and instrumental methods and to specify the most direction of balance instability among MS patients using Biodex stability system (BSS). Methods Fifty ambulatory individuals with MS [42 relapsing-remitting (RRMS) and 8 secondary progressive (SPMS)] were evaluated for balance using quantitative Berg balance scale (BBS) and BSS. Twenty healthy volunteers were selected as a control group. Results There was a statistically significant difference between the patient and control groups assessed by BBS. Moreover, patients with SPMS had worse postural balance when compared with RRMS. According to BSS, MS group showed more sway in the three limits of stability (mediolateral, antroposterior, and overall) when compared to the control group. The least stability level was observed in mediolateral direction in the patient group. The degree of tilt was higher in SPMS than RRMS as regard the three limits of stability. The BBS was significantly negatively correlated with age, Expanded Disability Status Scale (EDSS), duration of illness, and the Biodex tilt. Also, there were positive significant correlation between age, EDSS score, and the duration of illness of the disease with parameters of BSS (mediolateral, antroposterior, and overall). Conclusion BSS was significantly correlated with clinical balance measurement scale using BBS in MS patients. Moreover, BSS can provide more objective, quantitative measures of postural imbalance

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