Characteristics Of Epilepsy In Patients Research Articles

Relationship between epilepsy and patent foramen ovale

This study aimed to investigate the prevalence and clinical characteristics of epilepsy in patients with patent foramen ovale (PFO) and the effect of PFO closure on seizures. Patients diagnosed with PFO were recruited and underwent brain magnetic resonance imaging, electrocardiography, transesophageal echocardiography, and transthoracic echocardiography with right ventriculography. In patients with epilepsy, electroencephalography was performed. A total of 110 patients completed the assessment. A chief complaint of chest tightness or palpitations was proportionately higher in patients aged<18 years, whereas headaches and seizures were higher in patients aged≥18 years (χ2=4.69,P<0.05). Comorbid epilepsy was observed in 20.9% of patients with PFO. The age at admission in the epileptic group (14-66(27±14)years) was significantly lower than that in the non-epileptic group (16-81(38±21)years) and that in patients with headache as the chief complaint (16-68(39±12)years) (t=3.29, P<0.05). The multivariate analysis found no risk factors related to the prognosis of epilepsy. The incidence of epilepsy was significantly higher in patients with PFO than in the general population.

The prevalence and characteristics of epilepsy in patients with relapsing-remitting multiple sclerosis treated with disease-modifying therapy

Cil: Cilem bylo vyhledat pacienty s relabujici-remitujici formou RS (RRMS) lecene imunomodulacni terapii, kteři maji v anamneze neprovokovaný epileptický zachvat, ci se leci s epilepsii, a zhodnotit vliv epilepsie na průběh a prognozu RS. Soubor a metodika: Do studie byli zařazeni pacienti s RRMS leceni imunomodulacni lecbou a dochazejici do centra RS fakultni nemocnice k 1. lednu 2019. Byly hodnoceny rocni mira relapsů a Expanded Disability Status Scale (EDSS) před a po prvnim zachvatu. Výsledky: V kohortě pacientů s RRMS (n = 750) bylo nalezeno 17 pacientů (2,27 %) s historii neprovokovaných zachvatů nebo epilepsie. Aktivni epilepsie, defi novana uživanim antiepileptik ci výskytem zachvatů v poslednich 5 letech, byla zjistěna u 13 pacientů (73 %). Tři pacienti měli již diagnostikovanou epilepsii před prvnimi symptomy RS. Median rocni miry relapsů u pacientů s epilepsii byl 0,12 před prvnim zachvatem a 0,5 po prvnim zachvatu (p = 0,1). Nebyl nalezen signifi kantni rozdil mezi zhorsovanim EDSS 2 roky před a 2 roky po prvnim zachvatu (0,55 vs. 0,7; p = 0,38). Zachvat byl hodnocen jako fokalni na zakladně klinicke manifestace a/nebo EEG u 8 ze 17 pacientů (47 %). Zavěr: Frekvence neprovokovaneho epileptickeho zachvatu ci epilepsie u pacientů s RRMS byla v nasi kohortě 2,27 %.

Epileptic trances – focal motor epileptic seizures: past, present and a little bit of future

This article provides a detailed description of clinical and electroanatomical characteristics of epilepsy in patients suffering from epileptic trances – a rare type of focal motor seizures with ambulatory automatism manifesting as an unplanned travel. We reviewed the currently available data on the nature of psychical seizures in patients with epilepsy and the role of social and legal expertise for this disease. We developed the criteria for differential diagnosis between epileptic trances and other conditions with similar manifestations (for example, epileptic fugues) and identified a diagnostic minimum. We also proposed a hypothesis of ictal spatial migration. We emphasized the efficiency of surgical treatment in the case of compliance with a proper diagnostic algorithm.

The prevalence and characteristics of epilepsy in patients with multiple sclerosis in Nordland county, Norway

PurposeThe prevalence of epilepsy among patients with multiple sclerosis (MS) has been found higher than in the general population. Although cortical pathology may be involved, the causal link between MS and epileptic seizures is still unclear. We aimed to identify and describe the patients with active epilepsy in a previously described population based MS-cohort. MethodsMedical records of all patients with MS in Nordland County on January 1, 2010, were scrutinizing for evidence of comorbid seizures and epilepsy. ResultsAmong 431 patients with MS, we identified 19 (4.4%) with a history of seizures or epilepsy. Fourteen (3.2%) of these had active epilepsy defined as use of antiepileptic drugs or seizures within the last 5 years. One patient got epilepsy before other signs of MS. In patients with relapsing-remitting MS (RRMS) at onset and active epilepsy (n=10), 70% had converted to secondary progressive (SPMS) at prevalence date, compared to only 35% of those without active epilepsy (p=0.02). 43% had converted to SPMS before they got epilepsy. Attack semiology or electroencephalogram recordings indicated a focal onset of seizures in 12 of 14 (86%) with active epilepsy. ConclusionThe frequency of active epilepsy among MS patients in Nordland was 3.2%, approximately 4.5 times higher than in the general Norwegian population. RRMS patients with active epilepsy had more likely converted to SPMS than patients without active epilepsy. With a high frequency of focal epilepsy, the study supports that focal MS brain pathology is the cause of the comorbid epilepsy.

Epilepsy in neurofibromatosis type 1.

To describe the characteristics of epilepsy in patients with Neurofibromatosis type 1 (NF1). Analysis of a cohort of consecutive NF1 patients seen in our NF1 clinic during a three-year period. Of the 184 NF1 patients seen during that period, 26 had epilepsy and three had febrile seizures. Of the 26, 17 (65%) had localization-related epilepsy, seven of whom (41%) were drug resistant. Six (23%) had apparently primary generalized epilepsy (0/6 drug resistant), two (8%) Lennox-Gastaut syndrome, and one (4%) West syndrome (all three were drug-resistant). As compared to the patients with no epilepsy, those with epilepsy were more likely to have MRI findings of mesial temporal sclerosis (MTS) (23% vs. 5%, p=0.0064), and cerebral hemisphere tumors (31% vs. 10%, p=0.0079), but not of the other MRI findings including neurofibromatosis bright objects, or optic gliomas. Three of the six patients with MTS underwent temporal lobectomy with subsequent control of their seizures with confirmation of MTS on pathology in 3/3 and presence of coexisting focal cortical dysplasia (FCD) in 2/3. We also have observed three additional patients outside the above study with the association of NF1, MTS, and intractable epilepsy. Epilepsy is relatively common in NF1, often occurs in patients with brain tumors or with MTS which can coexist with FCD, can be associated with multiple types of epilepsy syndromes, and when localization-related is often drug-resistant. Patients with NF1 and MTS can respond to medial temporal lobectomy and may have coexisting medial temporal lobe cortical dysplasia.

Characteristics of epilepsy in patients with Kabuki syndrome with KMT2D mutations

BackgroundThe characteristics of epilepsy in patients with Kabuki syndrome with KMT2D mutations (KABUK1) have not yet been well documented. This is the first review to explore this. Materials & methodsWe enrolled 14 patients with KABUK1, whose median age was 13.6years (range=4.1–21.3years). Their medical records from October 1981 to May 2016 were retrospectively analyzed. ResultsEpilepsy was present in 5 (36%) patients. Four of these patients presented with nonsense mutations and one with missense mutations. None presented with brain abnormalities. Four patients presented with annual or monthly focal seizures, of which three evolved to bilateral convulsive seizures. Median onset age of focal epilepsy was 11.8years (range=9.5–12.8years). One presented with monthly myoclonic seizures from age 11.2, whose mother with no other KABUK1 features, had focal epilepsy. The cumulative incidence of epilepsy related to KABUK1 up until age 13 was 45%. Interictal electroencephalogram revealed focal paroxysmal epileptiform discharges (in frontal, central, and parietal regions) in three patients, diffuse high-voltage spike-and-waves in one patient, and normal sleep record in one patient. Myoclonic seizures were rapidly controlled by levetiracetam. In contrast, focal seizures were not controlled in the early period of antiepileptic therapy. ConclusionThis long-term follow-up of patients with KABUK1 revealed a higher prevalence of epilepsy than previously reported. The age of epilepsy onset and rate of focal seizures evolving to bilateral convulsive seizures in KABUK1 were also higher than previously reported in patients with clinically diagnosed Kabuki syndrome. Although seizure outcome is reported to be favorable in Kabuki syndrome, focal seizures in patients with KABUK1 were not immediately responsive to medication.

OP17 – 2537: Epilepsy, clinical presentation and MRI features in patients with COL4A1 mutations

Objective COL4A1 mutations disrupt the integrity of basement membranes and therefore predispose to a broad spectrum of disorders affecting multiple organ systems, but most notably causing cerebral small vessel disease. There is little data on epilepsy in these patients. The aim of our study was to describe characteristics of epilepsy in patients with COL4A1-mutations including therapeutical aspects, to establish diagnostic criteria on the basis of typical MRI findings and to evaluate co-morbidities. Patients and methods Data was collected retrospectively by attending physicians via standardized questionnaires. MRI images were reviewed by one experienced pediatric radiologist in our centre (PW). Results All 6 patients had history of pre- or perinatal stroke or cerebral hemorrhage and later showed impairment of cognitive functions and motor development. Epilepsy in all patients manifested within the first year of life (3–10 months, mean: 6 months). Multiple antiepileptic drugs were administered (4–11; mean: 6.3); among those, valproic acid (4/6) and vigabatrin (4/6) proved effective whereas oxcarbazepine had aggravating effects in 2/6 patients. All patients showed co-morbidities such as ophthalmological disorders (6/6), microcephaly (6/6), and elevation of plasma creatine kinase levels (4/6). We identified generalized leukomalacia in one or both cerebral hemispheres, focal cystlike white matter defects and focal or multifocal (susceptibility-related) residual signs of hemorrhage/hemosiderin deposition not related to arterial infarction as concordant MRI findings in all 6 patients. Conclusion COL4A1 mutations should be considered as differential diagnosis in children with history of pre-/perinatal stroke or cerebral hemorrhage, impairment of cognitive and motor development and epilepsy. Despite the heterogeneity of the clinical phenotype, typical MRI findings and co-morbidities can lead to the correct diagnosis. Epilepsy in our patients with COL4A1-mutations manifested in the first year of life; in the small collective of our ongoing study, valproic acid and vigabatrin were the most effective antiepileptic drugs.

Epilepsy in children with Menkes disease: a systematic review of literature.

Menkes disease is a lethal multisystemic disorder of copper metabolism characterized by connective tissue abnormalities, progressive neurodegeneration and peculiar "kinky hair." Epilepsy is one of the main clinical features of this disease but it has been described in detail by only a few authors. Most patients develop seizures from 2 to 3 months of age, accompanied by a neurodevelopmental regression. The history of epilepsy is usually characterized by 3 stages: an early stage with focal clonic seizures and status epilepticus, an intermediate stage with infantile spasms, and a late stage with multifocal, myoclonic, and tonic seizures. At the onset, epilepsy can be controlled with anticonvulsant therapy, whereas with the progression of disease, it becomes extremely resistant to all antiepileptic drugs. In this article, we analyze clinical and electroencephalographic (EEG) characteristics of epilepsy in patients with this syndrome.

Epilepsy in children with trisomy 18

Although the reported incidence of epilepsy associated with trisomy 18 is 25-50%, there have been no detailed descriptions of the characteristics of trisomy 18-related epilepsy. We investigated the characteristics of epilepsy in children with trisomy 18 who remained alive for over 1 year by sending questionnaires to pediatric neurologists belonging to the Kyoto Multi-institutional Study Group of Pediatric Neurology. Eleven patients with trisomy 18 were enrolled (age at the study, from 15 to 134 months; median, 43 months), of whom seven (64%) had epilepsy. The age at seizure onset ranged from 1 to 42 months (median: 11 months). Among the seven patients with epilepsy, two had focal epilepsy, four had generalized epilepsy including infantile spasms in three, and the remaining one had an unclassified type. Seizure seminology included complex partial seizures in both the patients with focal epilepsy. At the time of the investigation, three children with generalized epilepsy still had daily seizures, while the remaining four were seizure-free. In conclusion, the characteristics of epilepsy in patients with trisomy 18 were as follows: over half of the children developed epilepsy during infancy or early childhood; infantile spasms might be one of the common epileptic syndromes; the epilepsy was intractable in half of the children, especially in those with generalized epilepsy.

もやもや病におけるてんかんの臨床的特徴7例の検討

もやもや病におけるてんかんの臨床的特徴7例の検討

Macroprolactinomas and epilepsy

To assess the prevalence and characteristics of epilepsy in patients with macroprolactinomas. Secondly, to report the response to dopamine agonist (DA) therapy. A case note analysis of all patients with a diagnosis of macroprolactinoma attending a neuroendocrine clinic between 1996 and 2006. Those with epilepsy at diagnosis of macroprolactinoma were examined in detail. There were 64 patients with macroprolactinoma and 29 of these had tumours with suprasellar extension compressing/invading the optic apparatus and/or surrounding brain structures. Six of these 29 patients (four men), had a history of seizures at the time of diagnosis, five of whom had features suggestive of temporal lobe epilepsy. None of the other 35 patients had epilepsy. All six patients with epilepsy had invasive prolactinomas on cranial imaging and marked hyperprolactinaemia (median prolactin 369 000 mU/l, range 28 000 to > 750 000). Seizures had been present for a median of 2 years (range 1-23 years) before the diagnosis of macroprolactinoma. A rapid reduction in seizure frequency occurred in all patients with initiation of DA therapy. Four have been seizure-free between 18 months to 15 years despite only small reductions in tumour size. Invasive macroprolactinomas can commonly be associated with epilepsy, particularly of temporal lobe origin. It is essential to enquire about epileptic symptoms, as the seizure disorder may have been undiagnosed/untreated for years. DA therapy can reduce ictal frequency and the doses of anti-epileptic drugs. Complete freedom from epilepsy can also occur.

Epilepsy in children with cerebral palsy.

To describe the prevalence and characteristics of epilepsy in patients with cerebral palsy in a tertiary center. a total of 100 consecutive patients with cerebral palsy were retrospectively studied. Criteria for inclusion were follow-up period for at least 2 years. Types and incidence of epilepsy were correlated with the different forms of cerebral palsy. Other factors associated with epilepsy such as age of first seizure, neonatal seizures and family history of epilepsy were also analysed. follow-up ranged between 24 and 151 months (mean 57 months). The overall prevalence of epilepsy was 62%. Incidence of epilepsy was predominant in patients with hemiplegic and tetraplegic palsies: 70.6% and 66.1%, respectively. First seizure occurred during the first year of life in 74.2% of patients with epilepsy. Generalized and partial were the predominant types of epilepsy (61.3% and 27.4%, respectively). Thirty-three (53.2%) of 62 patients were seizure free for at least 1 year. Neonatal seizures and family history of epilepsy were associated with a higher incidence of epilepsy. epilepsy in cerebral palsy can be predicted if seizures occur in the first year of life, in neonatal period and if there is family history of epilepsy.

Seizures in multiple sclerosis.

In patients with multiple sclerosis (MS), epileptic seizures occur more frequently than in the general population. The aim of this study was to analyze clinical characteristics of epilepsy in patients with MS, potential correlation between the semiology of seizures, EEG and magnetic resonance imaging (MRI) findings in these patients, as well as to examine the response to anticonvulsant therapy. In a series of 268 consecutive patients with definite MS hospitalized at the Institute of Neurology, Belgrade, we identified 20 (7.5%) patients with seizures or epilepsy. All patients with seizures or epilepsy were submitted to standard EEG and brain MRI with gadopentetate dimeglumine. In four patients, epilepsy occurred 1-5 years before other clinical manifestations of MS. Eight patients had seizures only during MS relapses (provoked seizures). In two of them, seizures were the only manifestations of relapse. In 12 patients, seizures occurred regardless of the phase of MS (chronic epilepsy). In the majority of patients, seizures were partial with secondary generalization. Five patients experienced episodes of status epilepticus, and they all had dementia. Abnormal EEG pattern was found in 11 patients. Brain MRI disclosed cortical-subcortical lesions in nine patients and focal cortical atrophy in one, whereas in the remaining patients, findings were inconclusive. Probable EEG-MRI-seizure type correlation existed in 10 patients. Our data suggest that epilepsy may represent an initial symptom of MS and a single clinical manifestation of a relapse, and further support the assumption of the existing correlation between the presence of cortical-subcortical lesions and epileptic seizures or epilepsy in patients with MS.

Characteristics of epilepsy in severely mentally retarded individuals

In order to clarify the characteristics of epilepsy in patients with severe mentally retarded (SMR) subjects, we analyzed 52 SMR subjects with epilepsy from the institute for SMR subjects at Kikuchi National Hospital, Kumamoto, Japan. A total of 61.5% patients had uncontrolled seizures which were resistant to treatment. The most common combinations of seizure types in those not responding to conventional anticonvulsants were generalized tonic-clonic seizures (GTCS) with tonic seizure and GTCS with atypical absence. Their clinical features were characterized by spastic paralysis associated with a slower background electroencephalogram and abnormal computed tomography scans of the head, suggesting the involvement of cortical damage. These findings suggest that a large proportion of epilepsy in SMR subjects does not respond to treatment and that the severity of organic brain damage may therefore affect the natural course of epilepsy in such patients.