Clinical Features Of Seizures Research Articles

Comparing clinical and biochemical characteristics of febrile seizures in children with and without COVID-19: a retrospective study

BackgroundTransmission of COVID-19 is now normalized. There is an association between it and increased incidence of febrile seizures in children. Exploring whether COVID-19 has a specific effect on the clinical and biochemical features of febrile seizures is critical for the development of clinical treatment and prevention strategies. This study is to compare the differences in clinical features, hematological features, and cerebrospinal fluid characteristics between COVID-19 and non-COVID-19 children with febrile seizures and to provide a new perspective for further exploring the impact of COVID-19 on the nervous system of children.MethodsThis was a retrospective case–control study. The cases included children with COVID-19 and non-COVID-19 febrile seizures admitted to Xiamen Children’s Hospital from December 2022 to December 2023. The age, gender, length of hospital stay, peak body temperature, presence or absence of other viral infections, hematological characteristics, and cerebrospinal fluid characteristics were compared between children with COVID-19 febrile seizures and non-COVID-19 febrile seizures.ResultsA total of 50 COVID-19 children with febrile seizures and 192 non-COVID-19 children with febrile seizures were enrolled in this study. Multivariate analysis showed that age (OR = 0.715, P = 0.031), blood urea nitrogen (OR = 0.454, P = 0.029), platelet count (OR = 0.987, P = 0.009) and magnesium ion concentration (OR = 0.109, P < 0.001) were negatively correlated with COVID-19 febrile seizures. Albumin (OR = 1.840, P < 0.001) was positively correlated. The concentration of potassium ion in cerebrospinal fluid (OR = 0.334, P = 0.012) was negatively correlated with COVID-19 febrile seizures, and the concentration of sodium ion (OR = 4.383, P = 0.022) was positively correlated with COVID-19 febrile seizures.ConclusionThere were differences in age, blood urea nitrogen, platelet count, magnesium ion concentration, albumin, potassium ion concentration in cerebrospinal fluid, and sodium ion concentration in the cerebrospinal fluid between children with COVID-19 febrile seizures and non-COVID-19 febrile seizures. This study may provide valuable insights into the potential mechanisms of COVID-19 damage to the nervous system in children, and the long-term neurological prognosis of these children requires long-term follow-up.

New onset seizures in Octogenarians.

The occurrence of new seizure(s) in older adults is two- to three-fold higher as compared to the younger population, and previous studies have characterized the clinical features of seizures in patients beyond 60 or 65 years. This study, in response to the recent ILAE task force on epilepsy in the elderly (2023), has assessed the clinical characteristics of individuals who are over 85 years old. Data was collected from prospectively maintained electronic medical records, and the participants were divided into seizure-free and seizure-recurrence groups, and their clinical characteristics were compared. Over a 30-year period, a single comprehensive epilepsy care center included a total of 40 patients, with a mean age of 88.7 ± 2.79 years - most common seizure type was generalized tonic-clonic seizures (45%), with a positive neuroimaging yield of 42.5% and an EEG showing specific abnormalities in 50% of cases. Etiology was unidentified in 50%, while stroke was the most common among identified etiologies (27.5%). Over a mean follow-up of 1.4 [0.2-5.8] years, monotherapy effectively controlled 62.5% of patients, but 47.5% experienced recurrence. When compared to the non-recurrence group, these patients showed significant risk factors such as a history of prior stroke [47.3% versus 23.8%, p = 0.031], use of phenytoin [68.4% versus 33.3%, p = 0.056], and clobazam [42.1% vs. 19%, p = 0.049]. This study contributes to better identification and improved characterization of late-onset seizures and adds that appropriate, timely management results in better outcomes.

Latent cognitive phenotypes in juvenile myoclonic epilepsy: Clinical, sociodemographic, and neuroimaging associations.

Application of cluster analytic procedures has advanced understanding of the cognitive heterogeneity inherent in diverse epilepsy syndromes and the associated clinical and neuroimaging features. Application of this unsupervised machine learning approach to the neuropsychological performance of persons with juvenile myoclonic epilepsy (JME) has yet to be attempted, which is the intent of this investigation. A total of 77 JME participants, 19 unaffected siblings, and 44 unrelated controls, 12 to 25 years of age, were administered a comprehensive neuropsychological battery (intelligence, language, memory, executive function, and processing speed), which was subjected to factor analysis followed by K-means clustering of the resultant factor scores. Identified cognitive phenotypes were characterized and related to clinical, family, sociodemographic, and cortical and subcortical imaging features. Factor analysis revealed three underlying cognitive dimensions (general ability, speed/response inhibition, and learning/memory), with JME participants performing worse than unrelated controls across all factor scores, and unaffected siblings performing worse than unrelated controls on the general mental ability and learning/memory factors, with no JME vs sibling differences. K-means clustering of the factor scores revealed three latent groups including above average (31.4% of participants), average (52.1%), and abnormal performance (16.4%). Participant groups differed in their distributions across the latent groups (p < 0.001), with 23% JME, 22% siblings, and 2% unrelated controls in the abnormal performance group; and 18% JME, 21% siblings, and 59% unrelated controls in the above average group. Clinical epilepsy variables were unassociated with cluster membership, whereas family factors (lower parental education) and abnormally increased thickness and/or volume in the frontal, parietal, and temporal-occipital regions were associated with the abnormal cognition group. Distinct cognitive phenotypes characterize the spectrum of neuropsychological performance of patients with JME for which there is familial (sibling) aggregation. Phenotypic membership was associated with parental (education) and imaging characteristics (increased cortical thickness and volume) but not basic clinical seizure features.

Frequency and characteristics of seizures precipitated by febrile urinary tract infections in neonates and infants

BackgroundA febrile urinary tract infection (UTI) is a minor febrile seizure (FS) determinant. Seizures precipitated by febrile UTIs in neonates and infants frequently surprise parents, as they are vulnerable to bacterial meningitis and younger than the usual ages of FS. However, their frequency and characteristics are relatively unknown. MethodsThis study screened 1059 children (≤12 months) with febrile UTIs admitted to Chonnam National University Children's Hospital from January 2015 to June 2023. Patients with seizures precipitated by febrile UTIs were enrolled, and their medical records were reviewed. The frequency and clinical characteristics of seizures effectuated by febrile UTIs were investigated by comparing FS, FS+, and afebrile seizure (aFS). ResultsTwenty-eight patients (2.6%) were enrolled: 19 with early-onset FS+ (2.3% of 814 patients <6 months), nine with FS (3.7% of 245 patients), but there were none with aFS. Acute pyelonephritis was found in 80.8% of 26 patients. Clustered seizures (47.4% vs. 22.2% in FS, P = 0.197) and complex types (73.7% vs. 22.2%; P = 0.015) were frequent in early-onset FS+. Among 42 seizure episodes, bilateral tonic seizures were noted only in FS+ (44.8%; P = 0.001), but bilateral tonic-clonic seizures were frequent in FS (69.2% vs. 27.6%; P = 0.011). ConclusionSeizures precipitated by febrile UTIs occurred in 2.6% of neonates and infants: all were febrile and were predominantly with acute pyelonephritis. Infantile FS characteristics of febrile UTIs resembled those of usual FS, whereas early-onset FS + differed significantly as usually occurring in complex types and bilateral tonic ones.

Seizure Incidence among Children Hospitalized with COVID-19 during the Omicron Wave

Purpose: Since late 2019, coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. Some children with COVID-19 present with seizures; in particular, studies have reported an increase in seizure episodes during the Omicron wave of the pandemic. This study was performed to describe the clinical characteristics of seizures among children hospitalized with COVID-19 before and during the Omicron wave.Methods: A retrospective cross-sectional study was conducted on all pediatric admissions for COVID-19 at Hospital Tunku Azizah from June 2021 to May 2022.Results: During this period, 1,586 children were admitted with COVID-19, of whom 111 (7.0%) experienced seizures. Patients with seizures were more likely to have a history of seizure (odds ratio [OR], 71.4; 95% confidence interval [CI], 23.7 to 215.2; &lt;i&gt;P&lt;/i&gt;&lt;0.001) and prior antiseizure medication use (OR, 55.1; 95% CI, 6.1 to 497.4; &lt;i&gt;P&lt;/i&gt;&lt;0.001). Most seizures (55.0%) occurred on the first day of illness, with 86.5% lasting less than 5 minutes. None of the children required intubation or admission to the pediatric intensive care unit, and all were discharged without complications. Between June 2021 and January 2022, the seizure rate varied from 1.3% to 3.4%; however, it increased to 18% in April 2022, coinciding with the period of Omicron variant predominance in Malaysia. Children admitted during the Omicron wave had significantly higher odds of experiencing seizures (OR, 7.89; 95% CI, 2.07 to 13.07; &lt;i&gt;P&lt;/i&gt;&lt;0.001) than children hospitalized prior to this wave.Conclusion: In conclusion, the study revealed a marked increase in seizures associated with pediatric COVID-19 cases during the Omicron wave.

RELATED FACTORS TO RECURRENCE OF FEBRILE SEIZURES IN CHILDREN AT CAN THO CHILDREN'S HOSPITAL 2022 – 2023

Background: Febrile convulsions are a fairly common emergency in children, accounting for up to 2/3 of children with symptomatic convulsions in diseases with identified causes. Febrile seizures are a medical emergency in pediatrics. Seizure recurrence can affect the child in many ways, including the risk of injury, respiratory failure during a seizure, or increased risk of epilepsy. The recurrence of febrile seizures is directly related to prognosis and prevention in children. Objectives: 1) Describe the clinical characteristics of febrile seizures in children from 6 months to 60 months at Can Tho Children's Hospital. 2) Risk factors for recurrent febrile seizures in children from 6 months to 60 months at Can Tho Children's Hospital. Materials and methods: Crosssectional descriptive study with analysis of 125 children with febrile seizures. Results: Out of the total of 125 cases, the male/female ratio was 1.55/1, the age group with a higher percentage was 6 - 24 months old (51.2 %), 60% of children with febrile seizures were recorded with fever ≥ 390C, most cases were generalized seizures accounting for 98.4%. Regarding consciousness after a seizure, 1 case was recorded, corresponding to 0.8% of children with consciousness disorder after a seizure. The recurrence of febrile seizures was statistically significantly related to the type of febrile seizure (p &lt; 0.001), the time from fever to the onset of the first seizure (p &lt; 0.05), and morphology of seizures (p &lt; 0.05). There is no relationship between recurrence of febrile seizures and age group, gender, temperature during seizures, as well as the child's history of surgery. assisted cesarean section/birth premature birth. Conclusions: Recurrence of febrile seizures is associated with a number of clinical features such as the classification of febrile seizures, the interval between fever and the first seizure, and the morphology of seizures.

Delayed-onset seizures after subthalamic nucleus deep brain stimulation surgery for Parkinson’s disease

BackgroundDelayed-onset seizures after deep brain stimulation (DBS) surgery were seldom reported. This study summarized the clinical characteristics of delayed-onset seizures after subthalamic nucleus (STN) DBS surgery for Parkinson’s disease (PD) and analyzed risk factors. MethodsA single-center retrospective study containing consecutive STN-DBS PD patients from 2006 to 2021 was performed. Seizures occurred during the DBS surgery or within one month after DBS surgery were identified based on routine clinical records. Patients with postoperative magnetic resonance imaging (MRI) were included to further analyze the risk factors for postoperative seizures with univariate and multivariate statistical methods. Results341 consecutive PD patients treated with bilateral STN-DBS surgery wereidentified, and five patients experienced seizures after DBS surgery with an incidence of 1.47 %. All seizures of the five cases were characterized as delayed onset with average 12 days post-operatively. All seizures presented as generalized tonic-clonic seizures and didn’t recur after the first onset. In those seizures cases, peri-electrode edema was found in both hemispheres without hemorrhage and infarction. The average diameter of peri-electrode edema of patients with seizures was larger than those without seizures (3.15 ± 1.00 cm vs 1.57 ± 1.02 cm, p = 0.005). Multivariate risk factor analysis indicated that seizures were only associated with the diameter of peri-electrode edema (OR 4.144, 95 % CI 1.269–13.530, p = 0.019). ConclusionsDelayed-onset seizures after STN-DBS surgery in PD patients were uncommon with an incidence of 1.47 % in this study. The seizures were transient and self-limiting, with no developing into chronic epilepsy. Peri-electrode edema was a risk factor for delayed-onset seizures after DBS surgery. Patients with an average peri-electrode edema diameter > 2.70 cm had a higher risk to develop seizures.

Differentiating non-epileptic seizures from epileptic seizures in Glut1 deficiency syndrome.

To investigate the clinical characteristics of non-epileptic seizures due to transient brain dysfunction caused by energy deficiency after prolonged fasting or exercise in individuals with glucose transporter type 1 deficiency syndrome (Glut1DS), and then elucidate further the seizure features to distinguish non-epileptic seizures from epileptic seizures. This retrospective case-control study included 57 non-epileptic seizures and 23 epileptic seizures (control group) in 14 individuals (11 males, three females; aged 5-44 years, median = 20 years) with Glut1DS, all with a heterozygous pathogenic SLC2A1 mutation. Non-epileptic seizures were classified as paroxysmal altered consciousness (n = 8), movement disorders (n = 35) (eye-head movements, ataxia, spasticity, weakness, involuntary movement), dysaesthesia (n = 8), and vomiting (n = 6) at the peak ages at onset of 5 to 10 years. Ketogenic diet therapy was effective in 33 of 43 (77%) non-epileptic seizures. Providing supplementary food before high-impact exercise or during attacks prevented or mitigated non-epileptic seizures in some individuals. Glut1DS-associated non-epileptic seizures are fundamentally situation-related seizures with specific provoking and ameliorating factors. Non-epileptic seizures can be distinguished from epileptic seizures by the absence of complete consciousness loss and rapid postictal recovery despite prolonged seizures. Non-epileptic seizures are not well recognized but require different therapeutic approaches compared to epileptic seizures. Awareness of the differentiation of non-epileptic seizures from epileptic seizures is essential when performing preventive or therapeutic decision-making for acute exacerbation seizures. Non-epileptic seizures are invariably situation-related seizures. Non-epileptic seizures were classified as altered consciousness, movement disorders, dysaesthesia, and vomiting. Non-epileptic seizures were characterized by the absence of complete consciousness loss and were accompanied by rapid recovery. Non-epileptic seizures can occur simultaneously or consecutively with another. Supplementary food can be effective in preventing the development of sustained exercise-induced movement disorders.

Seizures in inflammatory demyelinating disorders of the central nervous system

BackgroundMultiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may be associated with acute symptomatic seizures and chronic epilepsy as well. The clinical features of the seizures and/or accompanying epilepsy seen in each disease group may vary. In this study, we aimed to contribute to the existing literature by describing the clinical features of seizures and epilepsy in our demyelinating patient population. MethodsWe retrospectively analyzed patients who were followed up in our tertiary referral center neurology demyelinating diseases outpatient clinic between 2019 and 2024. Patients who had at least one seizure before, simultaneously, or after the diagnosis of demyelinating disease were included in the study. ResultsAmong 1735 patients with MS, 40 had experienced at least one epileptic seizure (2.3 %). Thirty patients (1.7 %) had seizures that could not be explained by another factor than MS. When secondary progressive MS (SPMS) and relapsing-remitting MS (RRMS) were compared, the interval between MS-epilepsy diagnosis was longer and seizure recurrence was more in SPMS. However, the prognosis of epilepsy was good in both subtypes. There were 21 patients followed up with antibody-positive neuromyelitis optica spectrum disorder. No patient had a seizure during the follow-up. We identified 56 patients who fulfilled the criteria for MOGAD with high antibody titers. Seizures were observed in three of them (5.4 %). All of them had status epilepticus either at the onset or during the course of the disease. ConclusionEven rare, seizures constitute one of the important clinical features of the inflammatory demyelinating disorders of the central nervous system. The pathophysiologic mechanism underlying seizures in MS is still not clear. Seizures may occur through different mechanisms in patients where seizures are the initial symptom or a sign of relapse and those that occur spontaneously during the progressive course of the disease. Prevalence of status epilepticus was common in MOGAD patients. Given the rarity of the seizures in CNS demyelinating disorders, it is difficult the define clinical and pathophysiological characteristics of accompanying seizures and epilepsy. Future studies conducted on large patient groups will contribute to the existing literature.

Video-electroencephalographic findings and clinical characteristics of bathing seizures in children.

To explore the electroencephalogram (EEG) and clinical characteristics of childhood bathing epilepsy. We conducted a prospective summary of the clinical data from 10 children with bathing epilepsy who were admitted to Hunan Children's Hospital from April 2019 to November 2023 and analyzed their EEGs and clinical characteristics. Our 10 patients included eight males and two females, with seizure-onset ages ranging from 4 months and 20 days to 14 months. Nine cases showed normal intellectual development, and one case manifested delayed development. The Video-EEG (VEEG) findings showed that nine cases exhibited normal background with no interictal epileptic discharge. The seizures were characterized by lip cyanosis, tachycardia or bradycardia, weakness, paleness, and loss of consciousness. Ictal EEG revealed rhythmic fast waves, spike waves, spike-slow waves, or slow and sharp-wave activity over the temporal region (eight cases) or the occipital and temporal regions (one case), finally evolving into a delta rhythm that lasted for 57-201 s. These children exhibited no seizures after discontinuing bathing and were not administered antiseizure medication. The interictal EEG of one case reflected mild slow background and focal interictal epileptic discharge; and her semiology was eyes gazing to right, with clonic movements of the right face and lips, lip cyanosis, bradycardia, and impaired consciousness. Ictal EEG showed spike-wave and spike-slow-wave rhythms over the left central, parietal, and temporal regions; these then spread to the left hemisphere, lasting for approximately 104 s. This patient did not exhibit bathing seizures after stopping her bathing but later experienced frequent spontaneous and drug-resistant seizures. The interictal EEG background slowed down, while focal epileptic discharge increased. Her intellectual development was significantly delayed, and a novel pathogenic mutation in the SMC1A gene, c.298+2T>C, was detected. She was diagnosed with developmental and epileptic encephalopathy. A majority of children with bathing epilepsy in our study showed focal autonomic seizures accompanied by impaired consciousness. Stopping bathing could control the seizures and showed a good prognosis. A few infants manifested a poor prognosis, and we posit that bathing seizure rarely constitute the early manifestations of developmental and epileptic encephalopathy. VEEG findings and clinical features can also indicate the prognosis.

Novel CWF19L1 mutations in patients with spinocerebellar ataxia, autosomal recessive 17.

Spinocerebellar ataxia, autosomal recessive-17 (SCAR17) is a rare hereditary ataxia characterized by ataxic gait, cerebellar signs and occasionally accompanied by intellectual disability and seizures. Pathogenic mutations in the CWF19L1 gene that code for CWF19 like cell cycle control factor 1 cause SCAR17. We report here two unrelated families with the clinical characteristics of global developmental delay, cerebellar ataxia, pyramidal signs, and seizures. Cerebellar atrophy, and T2/FLAIR hypointense transverse pontine stripes were observed in brain imaging. Exome sequencing identified novel homozygous mutations including a splice acceptor site variant c.1375-2 A > G on intron 12 in a male patient and a single nucleotide variant c.452 T > G on exon 5 resulting in a missense variant p.Ile151Ser in the female patient from two unrelated families, respectively. Sanger sequencing confirmed the segregation of these variants in the family members with autosomal recessive inheritance. Transcript analysis of the splice site variant revealed activation of a novel cryptic splice acceptor site on exon 13 resulting in an alternative transcription with a loss of nine nucleotides on exon 13. Translation of this transcript predicted an in-frame deletion of three amino acids p.(459_461del). We also observed a novel exon 13 skipping which results in premature termination of the protein product. Our study expands the phenotype, radiological features, and genotypes known in SCAR17.

Characteristics of Epilepsy in Children with Cerebral Palsy: A Single Tertiary Center Study

Purpose: The aim of this study was to describe the characteristics of epilepsy in cerebral palsy (CP) patients and identify risk factors for epilepsy and drug-resistant epilepsy.Methods: CP patients aged 18 years old or younger who visited the pediatric neurology department and/or rehabilitation department of a tertiary care hospital between January 2016 and December 2022 with a minimum follow-up period of 2 years were included. Demographic and clinical data, seizure characteristics, brain imaging, electroencephalography, and genetic evaluation results were reviewed retrospectively.Results: Among 268 patients included in this study, 36.9% had epilepsy and 10.8% had drug-resistant epilepsy. Asphyxia (29.3%), hemorrhage, infarction, and brain infection (25.3%) were associated with epilepsy. Epileptic CP patients were more likely to experience neonatal seizures (18.2% vs. 4.1%, &lt;i&gt;P&lt;/i&gt;&lt;0.001) and febrile seizures (12.1% vs. 7.1%, &lt;i&gt;P&lt;/i&gt;=0.02) than non-epilepsy CP patients. The most common cerebral subtype in patients with epilepsy was spastic quadriplegia (59.6%). Epilepsy patients were more severely impaired in gross motor function, with worse intellectual disability. Patients with macrocephaly or cerebral malformation were more likely to have drug resistance. Valproate (51.7% and 25.7%) and levetiracetam (41.4% and 25.7%) were the two most commonly used antiseizure medications, both in monotherapy and polytherapy.Conclusion: A history of asphyxia, febrile seizure, neonatal seizure, spastic quadriplegia, more severely impaired gross motor function, and intellectual disability were found to be risk factors for epilepsy. Further research with prospective data collection to develop a model for predicting seizures or epilepsy in CP patients is needed.

A hospital-based retrospective study: early recognition of neuronal surface antibodies by clinical manifestations and CSF inflammation indicators in patients with unexplained epilepsy

Background There is a lack of actual and comprehensive data on the detection rate of neuronal surface antibodies in patients with unexplained epilepsy in China. Thus, we attempted to analyze the differences in clinical manifestations, cerebrospinal fluid (CSF) characteristics, seizure types and other aspects of antibody-positive and negative patients, to identify suspected antibody-positive epilepsy patients. Methods In total, 137 inpatients with unexplained epilepsy were consecutively included, and neuronal surface antibodies (NSAbs) were detected by serological and/or CSF evaluations. The clinical features and seizure characteristics were analyzed between the NSAb-positive and negative patients. In addition, patients were divided into four groups based on CSF and blood antibody titers. CSF cell count and protein content were analyzed in relation to antibody titers. Results There were 45 (32.8%) patients tested positive for antibodies. Multivariate analyses revealed that age, mental status changes or memory deterioration, CSF protein, CSF cell count, treatment, days of hospitalization, outcome, duration of symptoms before hospitalization, status epilepticus, and number of antiepileptic drugs were significantly associated with the NSAb-positive group and changes in inflammatory indicators in routine CSF analysis were associated with antibody titers. Conclusions A relatively high proportion of patients with unexplained epilepsy have positive NSAbs. Patients with the above clinical characteristics need to be highly suspected of NSAbs positivity and should be tested for antibodies in time to assist treatment. The decrease of CSF cell count and protein content has suggestive value for the decrease of antibody titer, which should be evaluated in the follow-up.

The clinical characteristics of childhood-onset and late-onset functional seizures: How do they differ?

BackgroundWe investigated childhood-onset functional seizures (FS) and late-onset FS and hypothesized that there are differences in their characteristics. MethodsIn this retrospective study, we investigated all patients with confirmed FS with an age at onset of 14 years or younger and those with an age at onset of 50 years or older, who were admitted to the epilepsy monitoring units at one center in Iran (Shiraz Comprehensive Epilepsy Center, from 2008 until 2022) and one center in the USA (Vanderbilt University Medical Center, from 2011 until 2022). ResultsOne-hundred and forty patients were included. They included 80 patients with childhood-onset FS and 60 with late-onset FS. Those with late-onset FS were more likely to have medical comorbidities compared with the patients with childhood-onset FS (OR = 13.9). Those with late-onset FS more likely had a history of head injury compared with the patients with childhood-onset FS (OR = 5.97). Duration of illness was significantly longer in patients with childhood-onset FS compared with the patients with late-onset FS (6 years vs. 2 years). ConclusionOur study identified several similarities and differences in the clinical characteristics and predisposing factors of patients with childhood-onset and late-onset FS. In addition, we found that childhood-onset FS is more likely to remain undiagnosed and thus untreated for many years. These findings provide additional evidence that FS is a heterogenous condition and we propose that a proportion of the differences between patients may be accounted for by age-associated factors.

Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months.

This study was undertaken to determine the short-term and longer term impact of sociodemographic disadvantage on the emotional-behavioral status of youths with new onset epilepsy and their unaffected siblings at the time of diagnosis and the subsequent 3 years. Three hundred twelve youths with newly diagnosed epilepsies and 223 unaffected siblings, aged 6-16 years, were independently assessed regarding their emotional and behavioral status by their parents and teachers at baseline, and at 18 at 36 months later; youths with seizures also completed self-report measures of depression, anxiety, and hostility at those three time points. A sociodemographic disadvantage score was computed for each family (children with newly diagnosed seizures and their siblings), and families were separated into four categories from most disadvantaged to least disadvantaged. In both children and siblings, the least disadvantaged group exhibited the lowest level of neurobehavioral problems, whereas the most disadvantaged group showed a higher level of neurobehavioral problems across all the same behavior metrics. Findings remained stable and significant across all informants (parent, teacher, child) and across all time periods (throughout the 3-year period). Furthermore, both corrected and uncorrected linear regression analyses indicated that disadvantage was a more constant and stable predictor of behavioral and emotional problems over time compared to clinical seizure characteristics and abnormalities in magnetic resonance imaging and electroencephalographic testing. Sociodemographic disadvantage bears a strong relationship to youths with emotional and behavioral problems both at the time of diagnosis as well as prospectively. The relationship is robust and reflected in reports from multiple informants (parent, teacher, child self-report), evident in siblings as well, and possibly more explanatory than traditional clinical seizure variables. Future studies will be needed to determine whether this disadvantage factor is modifiable with early intervention.

Clinical and laboratory characteristics of complex febrile seizures in the acute phase: a case-series study in Japan

BackgroundPatients with complex febrile seizures (CFS) often display abnormal laboratory results, unexpectedly prolonged seizures, and/or altered consciousness after admission. However, no standardized values have been established for the clinical and laboratory characteristics of CFS in the acute phase, making the management of CFS challenging. This study aimed to determine the clinical and laboratory characteristics of children with CFS during the acute phase. In particular, the duration of impaired consciousness and the detailed distribution of blood test values were focused.MethodsWe retrospectively reviewed medical records of a consecutive pediatric cohort aged 6–60 months who were diagnosed with CFS and admitted to Kobe Children’s Hospital between October 2002 and March 2017. During the study period, 486 seizure episodes with confirmed CFS were initially reviewed, with 317 seizure episodes included in the analysis. Detailed clinical and laboratory characteristics were summarized.ResultsAmong 317 seizure episodes (296 children with CFS), 302 required two or fewer anticonvulsants to be terminated. In 296 episodes showing convulsive seizures, median seizure duration was 30.5 min. The median time from onset to consciousness recovery was 175 min. Impaired consciousness lasting > 6, 8, and 12 h was observed in 13.9%, 7.6%, and 1.9% patients with CFS, respectively. Additionally, the distribution of aspartate aminotransferase, lactate dehydrogenase, creatinine, and glucose were clarified with 3, 10, 50, 90, and 97 percentile values.ConclusionThis study detailed the clinical and laboratory findings of acute-phase CFS using the data of the largest 15-year consecutive cohort of children with CFS. These results provide important information for appropriate acute management of CFS.

Clinical Characteristics of Seizures and Epilepsy in Individuals With Recurrent Deletions and Duplications in the 16p11.2 Region.

Deletions and duplications at 16p11.2 (BP4 to BP5; 29.5-30.1 Mb) have been associated with several neurodevelopmental and neuropsychiatric disorders including autism spectrum disorder, intellectual disability (ID), and schizophrenia. Seizures have also been reported in individuals with these particular copy number variants, but the epilepsy phenotypes have not been well-delineated. We aimed to systematically characterize the seizure types, epilepsy syndromes, and epilepsy severity in a large cohort of individuals with these 16p11.2 deletions and duplications. The cohort of ascertained participants with the recurrent 16p11.2 copy number variant was assembled through the multicenter Simons Variation in Individuals Project. Detailed data on individuals identified as having a history of seizures were obtained using a semistructured phone interview and review of medical records, EEG, and MRI studies obtained clinically or as part of the Simons Variation in Individuals Project. Among 129 individuals with the 16p11.2 deletion, 31 (24%) had at least one seizure, including 23 (18%) who met criteria for epilepsy; 42% of them fit the phenotype of classic or atypical Self-limited (Familial) Infantile Epilepsy (Se(F)IE). Among 106 individuals with 16p11.2 duplications, 16 (15%) had at least one seizure, including 11 (10%) who met criteria for epilepsy. The seizure types and epilepsy syndromes were heterogeneous in this group. Most of the individuals in both the deletion and duplication groups had well-controlled seizures with subsequent remission. Pharmacoresistant epilepsy was uncommon. Seizures responded favorably to phenobarbital, carbamazepine, and oxcarbazepine in the deletion group, specifically in the Se(F)IE, and to various antiseizure medications in the duplication group. These findings delineate the spectrum of seizures and epilepsies in the recurrent 16p11.2 deletions and duplications and provide potential diagnostic, therapeutic, and prognostic information.

Pre- and Post-surgical Poor Seizure Control as Hallmark of Malignant Progression in Patients With Glioma?

BackgroundRegarding brain tumor-related epilepsy (BTRE), there is an increasing number of evidence about a relationship between epileptogenesis and oncogenesis. A recent study suggests a role of post-surgery seizure outcome on the survival of patients with low-grade glioma (LGG), underlying the need for a targeted and aggressive epilepsy treatment.ObjectiveThis study aims at investigating the possible correlation between pre- and post-surgical seizure control and tumor progression in patients who underwent surgery for LGG.MethodsWe performed a retrospective analysis of patients affected by LGGs and BTRE, in a single high-volume neurosurgical center. Seizure control was assessed before surgery and at 3 years of follow-up. Patients with histological progression in high-grade glioma (HGG) have been evaluated. Clinical features, pre-surgical electroencephalograms (EEGs), and electrocorticography (ECoG) have been analyzed.ResultsAmong 154 subjects, we collected 32 patients who presented a tumor progression in HGG during the follow-up period. The majority had poor seizure control both pre- and post-surgery, never being in Engel class Ia throughout the whole history of their disease. Almost all patients with poor seizure control had pathological ECoG recording. Clinical features of seizures did not correlate with seizure outcome. On the univariate analysis, the age, the post-operative Engel class, and the extent of resection (EOR) were the prognostic factors significantly associated with oncological outcome; nevertheless, on multivariate analysis, Engel class significance was not confirmed, and the only predicting factor were age and EOR.ConclusionsAlthough not confirmed on multivariate analysis, post-surgical seizure control could be a relevant factor to consider during follow-up of BRTE, in particular, when gross total resection is not achieved. Pathological findings on the ECoG may suggest a “hidden” propensity to malignant progression, strictly related to the persistent neuronal hyper-excitability. Further studies with longer follow-up period are needed to confirm our observations.

Clinical Analysis of Childhood Acute Lymphoblastic Leukemia With Epilepsy Seizures.

ObjectiveIn order to analyze the clinical characteristics of epileptic seizures in children with acute lymphoblastic leukemia (ALL) during treatment.MethodsThe clinical and imaging data of children diagnosed as ALL with epilepsy seizures from January 2013 to December 2020 were retrospectively analyzed.ResultsA total of 2217 children with ALL were admitted during the study, of whom 229 (10.33%) had epileptic seizures after ALL treatment. Among them, 45 (19.65%) were in the high-risk group and 184 (80.35%) were in the low-risk group. Epileptic seizures mainly occurred in the induction remission period (24.02%), maintenance treatment period (25.33%) and after bone marrow transplantation (21.40%). The common causes were MTX-related demyelinating encephalopathy (34.06%) and reversible posterior encephalopathy syndrome (PRES) (25.3%). The first symptom was mainly convulsion (34.50%). The first attack had a comprehensive attack and partial attack. Most patients stop themselves. 30 cases (13.10%) had acute recurrence of epilepsy (recurrence within 3 months after the first attack), and 49 cases (25.76%) had neurological dysfunction after follow-up. 36 cases developed symptomatic epilepsy. Among the 130 children who completed the follow-up, 78 (60.00%) had no obvious neurological sequelae, and 52 (40.0%) had neurological sequelae. Among the 52 cases, there were 34 cases of mild sequelae and 18 cases of severe sequelae, including 8 cases of epilepsy combined with cognitive impairment.ConclusionEpileptic seizure is a common neurological complication during ALL treatment. The etiology and associated manifestations of the first epileptic seizure are diverse. Early neuroimaging and EEG examination are helpful for early diagnosis and treatment.

Seizures and risks for recurrence in critically ill patients: an observational cohort study

BackgroundTo assess the frequency and clinical characteristics of seizures in adult critically ill patients, to identify predictors of recurrent seizures not transforming into status epilepticus and to characterize their effects on course and outcome.MethodsICU patients at a Swiss academic medical center with seizures not transforming into status epilepticus from 2015 to 2020 were included. Recurrent seizures and associated clinical characteristics were primary, death, and return to premorbid neurologic function were secondary outcomes.ResultsTwo hundred of 26,370 patients (0.8%) with a median age of 65 years had seizures during ICU stay. Seizure semiology was described in 82% (49% generalized; 33% focal) with impaired consciousness during seizures in 80% and motor symptoms in 62%. Recurrent seizures were reported in 71% (36% on EEG) and associated with longer mechanical ventilation (p = 0.031), higher consultation rate by neurologists (p < 0.001), and increased use of EEG (p < 0.001) when compared to single seizures. The use of EEG was not associated with secondary outcomes. Acidosis at seizure onset and prior emergency operations were associated with decreased odds for seizure recurrence (OR 0.43; 95% CI 0.20–0.94 and OR 0.48; 95% CI 0.24–0.97). Epilepsy had increased odds for seizure recurrence (OR 3.56; 95% CI 1.14–11.16).ConclusionsSeizures in ICU patients are infrequent, but mostly recurrent, and associated with higher resource utilization. Whenever seizures are observed, clinicians should be vigilant about the increased risk of seizures recurrence and the need for antiseizure treatment must be carefully discussed. While known epilepsy seems to promote recurrent seizures, our results suggest that both acidosis and previous emergency surgery seem to have protective/antiseizure effects.Trial registrationClinicaltrials.gov (No. NCT03860467).