Ictal kissing: occurrence and etiology.

Ictal kissing is a rare semiological manifestation in patients with epilepsy. We tried to estimate its occurrence and characterize the underlying etiology. We retrospectively reviewed all video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term kiss . We then searched the electronic database PubMed on September 21, 2016 using the following search terms in the English language: ictal OR seizure OR epilepsy AND kiss OR kissing . Relevant original studies were included. During the study period, 5133 patients were investigated in our epilepsy monitoring unit. One patient (0.02%) had one episode of documented ictal kissing. He had drug-resistant right mesial temporal lobe epilepsy. In total, five studies met the criteria for inclusion in the review. These studies described nine patients with drug-resistant focal epilepsy and ictal kissing behavior. Six out of ten patients with ictal kissing had hippocampal sclerosis. We add to the literature on ictal kissing by providing additional information on its frequency and etiology. The most common underlying etiology for ictal kissing is hippocampal sclerosis. However, this semiological ictal phenomenon is not pathognomonic for any etiology or localization

Is Interictal EEG Correlated with the Seizure Type in Idiopathic (Genetic) Generalized Epilepsies?

How to Cite this Article: Asadi-pooya AA, Emami M. Is Interictal EEG Correlated with the Seizure Type in Idiopathic (Genetic) Generalized Epilepsies? Iran J Child Neurol 2012;6(2): 25-28. Objective We investigated the correlation between different interictal EEG abnormalities observed in patients with idiopathic (genetic) generalized epilepsies (IGEs) and their seizure types. Material & Methods In this cross-sectional study, all patients with the diagnosis of IGE, were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 through 2010. Demographic variables and relevant clinical and EEG variables were summarized descriptively. Statistical analyses were performed using independent samples T-test, Chi square and Fisher's Exact tests to determine potentially significant differences. Results Three-hundred thirty-six patients were diagnosed ashaving IGE. Interictal EEG findings in patients with generalized tonic-clonic seizure (GTCS) compared to patients without GTCS were not different. Abnormal EEG findings in patients with myoclonic seizures compared to patients without these were not different either. However, normal EEGs were more frequently observed in patients with history of myoclonic seizures (P = 0.0001). EEG findings in patients with absences compared to patients without absences were not different. Conclusion Interictal EEG cannot differentiate the seizure types and therefore different syndromes of IGEs. Polyspikes, 3-Hz generalized spike-wave (GSW) complexes and 3.5 - 6 Hz GSW complexes, alone or in combinations, could be observed in various seizure types and syndromes of IGE. The key element in making the correct diagnosis is a detailed clinical history. References Panayiotopoulos CP. Idiopathic generalized epilepsies. In: Panayiotopoulos CP, editor. The epilepsies: seizures, syndromes and management. Oxford: Bladon Medical Publishing 2005. p. 271-348. Lagerlund TD, Cascino GD, Cicora KM, Sharbrough FW. Long-term electroencephalographic monitoring for diagnosis and management of seizures. Mayo Clin Proc 1996 Oct;71(10):1000-6. Betting LE, Mory SB, Lopes-Cendes I, Li LM, Guerreiro MM, Guerreiro CA et al. EEG features in idiopathic generalized epilepsy: clues to diagnosis. Epilepsia 2006 Mar;47(3):523-8. Yenjun S, Harvey AS, Marini C, Newton MR, King MA, Berkovic SF. EEG in adult-onset idiopathic generalized epilepsy. Epilepsia 2003 Feb;44(2):252-6. Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J Jr. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001;42(9):1212-8. Engel J Jr. A proposed diagnostic scheme for people with epileptic seizures and epilepsy: report of the ILAE task force on classification and terminology. Epilepsia 2001 Jun;42(6):796-803. Engel J. Jr. Report of the ILAE Classification Core Group. Epilepsia 2006 Sep;47(9):1558-68. Asadi-Pooya AA, Emami M. Effects of antiepileptic drugs on electroencephalographic findings in patients with idiopathic generalized epilepsies. Iran J Child Neurol 2011;5(4):33-6. Asadi-Pooya AA, Emami M, Nikseresht A. Early-onset versus typical childhood absence epilepsy; clinical and electrographic characteristics. Seizure 2012;21:273-5. Nordi DR. Idiopathic generalized epilepsies recognized by the International League Against Epilepsy. Epilepsia 2005;46(Suppl. 9):48-56. Panayiotopoulos CP. Syndromes of idiopathic generalized epilepsies not recognized by the International League Against Epilepsy. Epilepsia 2005;46(Suppl. 9):57-66. Asadi-Pooya AA, Sperling MR. Choices of antiepileptic drugs based on specific epilepsy syndromes and seizure types. In: Asadi-Pooya AA, Sperling MR. Antiepileptic Drugs: A Clinician’s Manual. Oxford, UK: Oxford University Press; 2009. p. 95-102.  

Ictal pain: occurrence, clinical features, and underlying etiologies.

PURPOSE: We analyzed a series of patients with ictal pain to estimate its occurrence and characterize the underlying etiologies. METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term pain in the text body. All the extracted reports were reviewed, and patients with at least one documented episode of ictal pain in the epilepsy monitoring unit (EMU) were included in the study. RESULTS: During the study period, 5133 patients were investigated in our EMU. Forty-six patients (0.9%) had at least one documented episode of ictal pain. Twenty-four patients (0.5%) had psychogenic nonepileptic seizures (PNES), 10 patients (0.2%) had epilepsy, 11 patients (0.2%) had migraine, and one woman had a cardiac problem. Pain location was in the upper or lower extremities (with or without other locations) in 80% of the patients with epilepsy, 33% of the patients with PNES (p=0.01), and none of the patients with migraine. CONCLUSION: Ictal pain is a rare finding among patients evaluated in EMUs. Psychogenic nonepileptic seizures are the most common cause, but ictal pain is not specific for this diagnosis. Location of the ictal pain in a limb may help differentiate an epileptic cause from others

Effects of Antiepileptic Drugs on Electroencephalographic Findings in Patients with Idiopathic Generalized Epilepsy

How to Cite this Article: Asadi-Pooya AA, Emami M. Effects of Antiepileptic Drugs on Electroencephalographic Findings inPatients with Idiopathic Generalized Epilepsy. Iranian Journal of Child Neurology 2011;5(4):33-36.ObjectiveSeveral antiepileptic drugs (AEDs) such as phenobarbital (Pb), carbamazepine (CBZ), and valproate (VPA) may suppress interictal epileptiform activity. We investigated the effects of AEDs on electroencephalography (EEG) data from patients with idiopathic generalized epilepsy (IGE).Materials & MethodsIn this cross-sectional study, all patients electroclinically diagnosed with IGE were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 through August 2010. A routine EEG was requested at the time of referral for all patients. Statistical analyses were performed using Chi square and Fisher’s exact test.ResultsThis study comprised of 336 patients. For about 20.8% (70 patients) of them, the initial EEG appeared normal. The first EEG was normal in 14.2% of the patients who had newly diagnosed IGE (19 patients). Normal EEG was also detected for 27.6% of the patients who received VPA monotherapy (16 patients), 31% of the patients who received CBZ monotherapy (9 patients), 29.4% of the patients who received Pb monotherapy (5 patients), and 11.1% of the patients who received lamotrigine (LTG) (1 patient).ConclusionThis study shows that compared to LTG, VPA suppresses generalized interictal epileptiform activity in patients with IGE more effectively. Theoretically, if a drug can frequently induce normalization of EEG, then it may be a better drug for treating IGEs.References1. Betting LE, Mory SB, Lopes Cendes I, Li LM, GuerreiroMM, Guerreiro CAM, et al. EEG features in idiopathic generalized epilepsy: clues to diagnosis. Epilepsia.2006;47(3):523-8.2. Libenson MH, Caravale B. Do antiepileptic drugs differin suppressing interictal epileptiform activity in children? Pediatr Neurol 2001;24(3):214-8.3. Pro S, Vicenzini E, Pulitano P, Li Voti P, Zarabla A, Randi F, et al. Effects of levetiracetam on generalized discharges monitored with ambulatory EEG in epileptic patients. Seizure 2009;18(2):133-8.4. Rocamora R, Wagner K, Schulze - Bonhage A. Levetiracetam reduces frequency and duration ofepileptic activity in patients with refractory primarygeneralized epilepsy. Seizure 2006;15(6):428-33.5. Szaflarski JP. Effects of zonisamide on  the electroencephalogram of a patient with juvenile myoclonic epilepsy. Epilepsy Behav 2004;5(6):1024 -6.6. Covanis A. Photo sensitivity in idiopathic generalized epilepsies. Epilepsia 2005;46(suppl 9):67-72.7. Asadi-Pooya AA, Sperling M. Antiepileptic Drugs: AClinician’s Manual. Oxford University Press, USA; 2009

Semiological classification of psychogenic nonepileptic seizures.

PURPOSE: We classified patients with psychogenic nonepileptic seizures (PNESs) according to a newly proposed classification system. Then, we investigated the demographic and clinical differences between various classes of the patients. METHODS: We retrospectively investigated all patients with PNESs admitted to the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We classified the patients into four distinct classes: patients with generalized motor seizures, patients with akinetic seizures, patients with focal motor seizures, and patients with seizures with subjective symptoms. All patients were interviewed by a neuropsychologist and were administered psychological assessment measures, including questions about PNES risk factors. For the statistical analyses, we compared patients who had generalized motor seizures with patients who had nonmotor seizures. RESULTS: Sixty-three patients were studied. Thirty-five (55.6%) patients had generalized motor seizures, 14 (22.2%) had seizures with subjective symptoms, 12 (19%) had akinetic seizures, and two (3.2%) patients had focal motor seizures. Patients with generalized motor seizures (35 patients) demonstrated a trend for later age at onset (p=0.06), more frequently had a history of substance abuse (p=0.001), and more often had loss of responsiveness with their seizures (p=0.04) compared with patients who had nonmotor seizures (26 patients). CONCLUSION: The recently proposed PNES classification system is useful and practical. This proposed classification of PNESs may address proper diagnosis and provide standardization across future studies. This may also potentially shed light on the etiologic understanding and management of various classes of patients affected with PNESs

Ictal crying

PURPOSE: The purpose of this study was to describe a series of patients with ictal crying to estimate its occurrence and characterize the clinical features and the underlying etiology. METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the terms cry or sob or weep in the text body. All the extracted reports were reviewed, and patients with at least one episode of documented ictal crying at the epilepsy monitoring unit (EMU) were included in the study. RESULTS: During the study period, 5133 patients were investigated at our EMU. Thirty-two patients (0.6%) had at least one documented seizure accompanied by crying. Twenty-seven patients (26 women and one man) had psychogenic nonepileptic seizures (PNES), and five patients (0.1%) had epilepsy. Among patients with epileptic ictal crying, four patients had focal epilepsy (two had definite, and two had probable frontal lobe epilepsy), while one patient had Lennox-Gastaut syndrome. CONCLUSION: Ictal crying is a rare finding among patients evaluated at the EMUs. The most common underlying etiology for ictal crying is PNES. However, ictal crying is not a specific sign for PNES. Epileptic ictal crying is often a rare type of partial seizure in patients with focal epilepsy. Dacrystic seizures do not provide clinical value in predicting localization of the epileptogenic zone

Age at onset in patients with medically refractory temporal lobe epilepsy and mesial temporal sclerosis: impact on clinical manifestations and postsurgical outcome.

PURPOSE: To evaluate the demographic and clinical manifestations and postsurgical outcome of childhood-onset mesial temporal sclerosis and temporal lobe epilepsy (MTS-TLE) and establishing the potential differences as compared to the patients with adult-onset MTS-TLE. METHOD: In this retrospective study all patients with a clinical diagnosis of medically refractory TLE due to mesial temporal sclerosis, who underwent epilepsy surgery at Jefferson comprehensive epilepsy center, were recruited. Patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was classified into two groups; seizure-free or relapsed. Clinical manifestations and outcome were compared between patients with childhood-onset MTS-TLE (i.e., age at onset of the first afebrile habitual seizure below 10 years) and those with adult-onset MTS-TLE (i.e., age at onset of the first afebrile habitual seizure 20 years or above). RESULTS: One hundred and twelve patients had childhood-onset MTS-TLE and 76 had adult-onset MTS-TLE. Demographic, clinical, EEG and MRI characteristics of these two groups were similar. Postoperative outcome was not statistically different between these two groups of patients (P=0.9). CONCLUSION: Temporal lobe epilepsy due to mesial temporal sclerosis is a common cause of epilepsy that can start from early childhood to late adulthood. The etiology of MTS-TLE may be different in various age groups, but it seems that when mesial temporal sclerosis is the pathological substrate of TLE, clinical manifestations and response to surgical treatment of patients are very similar in patients with childhood-onset MTS-TLE compared to those with adult-onset disease

Knowledge and Attitude Towards Epilepsy Among Biology Teachers in Fars Province, Iran

How to Cite this Article: Asadi-Pooya AA, Torabi-Nami M. Knowledge and Attitude Towards Epilepsy Among Biology Teachers in Fars Province, Iran. IranianJournal of Child Neurology 2012;6(1):13-18.ObjectiveThis study investigates the awareness and perception on “epilepsy” amongst biology teachers in Fars province, Iran.Materials & MethodsA sample of high school biology teachers in Fars province, Iran, filled out an investigator designed questionnaire including questions about their knowledge and attitude concerning “epilepsy”. There were 17 questions in the questionnaire. Nine questions addressed the knowledge and the rest were about attitude and perception.ResultsForty two teachers completed the questionnaires. More than two-thirds of the participants had a fairly desirable awareness about the definition; whereas, only approximately 40% knew something about the etiology and treatment of epilepsy. More than two-thirds of the participants had a positive attitude towards epilepsy; however, misconceptions and negative attitudes were observed.ConclusionEducational programs for biology teachers and also other teachers are necessary to improve their knowledge, attitude and perception about epilepsy.References Sander JW, Shorvon SD. Incidence and prevalence studies in epilepsy and their methodological problems: a review. J Neurol Neurosurg Psychiatry 1987;50:829-39. Saraceno B. The WHO world health report 2001 on mental health. Epidemiol Psychiatr Soc 2002;11(2):83-7. Kim MK, Cho KH, Shin J, Kim SJ. A study of public attitudes towards epilepsy in Kwang-Juarea. J Kor Neurol Assoc 1994;12:410-27. DiIorio C, Shafer PO, Letz R, Henry T, Schomer DL, Yeager K, etal. The association of stigma with self-management and perception of health care among adults with epilepsy. Epilepsy Behav 2003;4(3):259-67. Aziz H, Akhtar SW, Hasan KZ. Epilepsy in Pakistan: stigma and psychological problems: a population-based epidemiologic study. Epilepsia 1997;38:1069-73. Ablon. The nature of stigma and medical conditions. Epilepsy Behav 2002;3:2-9. Jacoby A. Stigma, epilepsy and quality of life. Epilepsy Behav 2002;3:10-20. McLin WM, de Boer HM. Public perceptions about epilepsy. Epilepsia 1995;36:957-9. Daoud A, Al-Safi S, Otoom S, Wahba L, Alkofahi A. Public knowledge and attitudes towards epilepsy in Jordan. Seizure 2007;16:521-6. Ndour D, Diop AG, Ndiaye M, Niang C, Sarr MM, Ndiaye IP. A survey of school teachers’ knowledge and behaviour about epilepsy, in a developing country such as Senegal. [Article in French]. Aert Rev Neurol 2004;160(3):338-41. Millogo A, Siranyan AS. Knowledge of epilepsy and attitudes towards the condition among school-teachers in Bobo-Dioulasso (Burkina Faso). Epileptic Disord 2004;6(1):21-6. Masoudnia E. Awareness, understanding and attitudes towards epilepsy among Iranian ethnic groups. Seizure 2009;18(5):369-73. Fernandes PT, Noronha AL, Araújo U, Cabral P, Pataro R, de Boer HM, Prilipko L, Sander JW, Li LM. Teachers’ perception about epilepsy. Arq Neuropsiquiatr 2007;65(1):28-34. Aydin K, Yildiz H.Teacher’s perceptions in central turkey concerning epilepsy and asthma and short term effect of a brief education on the perception of epilepsy. Epilepsy Behav 2007;10:280-90. Caixeta J, Frenandes PT, Bell GS, Sander JW, Li LM. Epilepsy perception amongst university students. A survey. Arq Neuropsiquiatr 2007;65 (suppl 1):43-8

Auras in patients with temporal lobe epilepsy and mesial temporal sclerosis.

We investigated auras in patients with drug-resistant temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS). We also investigated the clinical differences between patients with MTS and abdominal auras and those with MTS and non-mesial temporal auras. All patients with drug-resistant TLE and unilateral MTS who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center from 1986 through 2014 were evaluated. Patients with good postoperative seizure outcome were investigated. One hundred forty-nine patients (71 males and 78 females) were studied. Thirty-one patients (20.8%) reported no auras, while 29 patients (19.5%) reported abdominal aura, and 30 patients (20.1%) reported non-mesial temporal auras; 16 patients (10.7%) had sensory auras, 11 patients (7.4%) had auditory auras, and five patients (3.4%) reported visual auras. A history of preoperative tonic-clonic seizures was strongly associated with non-mesial temporal auras (odds ratio 3.8; 95% CI: 1.15-12.98; p=0.02). About one-fifth of patients who had MTS in their MRI and responded well to surgery reported auras that are historically associated with non-mesial temporal structures. However, the presence of presumed non-mesial temporal auras in a patient with MTS may herald a more widespread epileptogenic zone