Different Types Of Seizures Research Articles

Discrimination of Types of Seizure Using Brain Rhythms Based on Markov Transition Field and Deep Learning

Discrimination of types of seizure using the Electroencephalogram (EEG) signal has always been a challenging task due to minuscule differences among different types of seizures. In this regard, deep learning (DL) which has already evidenced notable performance in image recognition could be suitable. However, a few attempts have been made so far in this regard mainly by constructing 2D input images for DL from 1D EEG signals directly using various techniques. Besides, the quality of the generated images has not been verified. Therefore, in this work, 2D images for the DL pipeline have been generated from brain rhythms, which already displayed remarkable performance in analyzing various brain activities. For this purpose, the Markov transition field transformation technique has been employed for 2D image construction by preserving statistical dynamics characteristics of EEG signals, which are very important during the discrimination of different types of seizures. And, a convolution neural network (CNN) has been used for classification. Further, the quality of the 2D image along with appropriate brain rhythms have also been investigated. For experimental validation, EEG recordings of six different types of seizure that are provided by the Temple University EEG dataset (TUH v1.5.2) has been taken into account. The proposed method has achieved the highest classification accuracy and weighted F1-score up to 91.1% and 91.0% respectively. Further analysis shows that higher image resolution can provide the best classification accuracy. In addition, the d rhythm has been found the most suitable in seizure type classification. In a comparative study, the proposed idea demonstrated its superiority by displaying the uppermost classification performance.

A Survey of Physicians’ Opinion and Treatment Preferences Regarding Febrile Seizures in Children

Background: Fever of either low or high-grade is a big concern when present in the pediatric age group; it is much more worrisome if children are younger than 5 years of age. Fever can subside on its own or with the help of simple remedies and or medications. However, some children will develop seizures when they have a fever. Febrile seizures are one of the most common presenting complaints seen in pediatric patients in emergency room visits and physician consult. Two different types of seizures are seen in children, simple and complex seizures. Simple febrile seizures are non harming and self-limiting, while, complex seizures are prone to have long-term side effects on children. Febrile seizures can occur with or without a source of an underlying cause. In this study, we aimed to identify physicians’ opinions, knowledge, and suggestions to improve guidelines on current treatment trends for fever and fever’s association with febrile seizures in children less than 5 years of age.
 Objectives: To determine physicians’ opinion knowledge, and suggestions to improve guidelines on current treatment trends for fever and fever’s association with febrile seizures in children less than 5 years of age.
 Methods: A cross-sectional study plan was designed and conducted in June - July 2021 involving general physicians and pediatricians (n = 600). The questionnaire form including 15 closed-end questions was distributed to physicians. Descriptive statistics were used to analyse the data.
 Results: 100% of physicians prescribed antipyretics to control fever and or to prevent complications, especially febrile seizures. All participants were aware that axillary temperature of > 37.2 ° C is defined as fever. All most all, general physicians and most pediatricians used antipyretics to treat other associated symptoms and signs, even when the fever was absent. 76.3% believed that high fever might be an indicator of underlying serious occult bacterial infection. Almost all physicians (91.3%) advised parents to switch to the use of alternate medication when the fevers did not subside after initial treatment with paracetamol; everyone recommended that non-medical supportive treatments like tepid sponging along with antipyretics and ibuprofen to reduce the fever soonest possible. 68% of pediatricians and 90% of general practitioners believe that febrile seizures will cause brain damage. 74% of general practitioners preferred to refer children immediately to specialty centers, for further management of seizures. However, Pediatricians at tertiary care centers, as well as those in private practice used diazepam or lorazepam. 
 Conclusion: Differences are negligible between general physicians and pediatricians while managing fever and fever complications including febrile seizures. Irrespective of the knowledge, awareness and the availability of fever guidelines by many national and international organizations, physicians are leaning towards child and parents comfort in treatment fever. The gap is wider in general physicians’ preparedness than pediatricians. A considerable gap exists to improve physicians' approach, diagnosis, and management of fever in the pediatric population.

Features of epilepsy in different groups of patients in Uzbekistan

The aim of this study was to investigate the features of different types of seizures in group of patients in Uzbekistan.

Dual-model wearable photoacoustic microscopy and electroencephalograph: study of neurovascular coupling in anesthetized and freely moving rats.

Observing microscale neurovascular dynamics under different physiological conditions is of great importance to understanding brain functions and disorders. Here, we report a dual-model wearable device and an auxiliary data processing algorithm to derive neurovascular dynamics. The device integrates high-resolution photoacoustic microscopy and electroencephalography (EEG), which allows observing capillary-level hemodynamics and neural activities in anesthesia and freely moving rats. By using the developed algorithm, multiple photoacoustic/EEG parameters extracted and correlated enables investigation of the interplay between neural and vascular activities. We employed this platform to study the neurovascular coupling during different types of seizures in rats under various physiological conditions. We observed cerebral vascular vasodilation/constriction corresponding well to the seizure on/off in rats under regular anesthesia conditions, showing a strong neurovascular coupling coefficient. In rats under weak anesthesia and freely moving conditions, more intense cerebral hemodynamics and neural activities occurred with a weaker neurovascular coupling coefficient. The comprehensively quantitative analyses suggest that anesthesia has a dominant impact on the seizure onset and affect the neurovascular coupling correlation in the current drug-induced localized seizure model. Our study reveals that the designed platform has the potential to support studies on brain functions and disorders in diseased rodent models in various physiological states.

P-EP029. Variability in seizure phenotypes in individual epilepsy rat model contributes to the propagation of the seizure

Introduction . Among 16 possible types of ictal onset and offset based on seizure dynamics, the saddle node/homoclinic (SN/SH), which is characterized by ictal Direct Current shift (ictal DC), seems to be predominant across species. We predicted that individuals with epilepsy may express different types of seizures, and thus, which may show different propagation patterns during the ictal period. We tested these hypotheses in an experimental model of temporal lobe epilepsy. Method . We enrolled 10 male Sprague-Dawley rats treated with pilocarpine (380 mg/kg, i.p.), which developed spontaneous epileptic seizures. Electroencephalogram (EEG) was obtained with a Microdrive with bandpass filter (0.1 Hz-) and sampling rate 2 kHz. Each seizure was classified based upon the type of onset (SN, SNIC, SupH, or SubH) and offset (SH, SNIC SupH, or FLC). We evaluated i) seizure duration, ii) the amplitude of ictal DC, iii) the number of brain regions involved during seizure propagation using gamma (γ: 30-50 Hz) power. Results . In line with our hypotheses, we confirmed that each animal expresses different types of seizures during the day and across days. The most common form of seizure is characterized by ictal DC at onset. The spatiotemporal extension of seizures is variable from seizure to the next but follows simple rules. For seizures with ictal DC, we find that their duration and the size of propagation area are inversely proportional to the amplitude of the ictal DC. For all types of seizures, their duration and the size of the propagation area are proportional to the time from seizure onset and the occurrence of maximum gamma power in the seizure-onset zone. Conclusion . The most frequent form of seizures with ictal DC (SN onset) is characterized by faster propagation to surrounding regions, and a duration that is inversely proportional to the amplitude of ictal DC.

Fly seizure EEG: field potential activity in the Drosophila brain

Hypersynchronous neural activity is a characteristic feature of seizures. Although many Drosophila mutants of epilepsy-related genes display clear behavioral spasms and motor unit hyperexcitability, field potential measurements of aberrant hypersynchronous activity across brain regions during seizures have yet to be described. Here, we report a straightforward method to observe local field potentials (LFPs) from the Drosophila brain to monitor ensemble neural activity during seizures in behaving tethered flies. High frequency stimulation across the brain reliably triggers a stereotypic sequence of electroconvulsive seizure (ECS) spike discharges readily detectable in the dorsal longitudinal muscle (DLM) and coupled with behavioral spasms. During seizure episodes, the LFP signal displayed characteristic large-amplitude oscillations with a stereotypic temporal correlation to DLM flight muscle spiking. ECS-related LFP events were clearly distinct from rest- and flight-associated LFP patterns. We further characterized the LFP activity during different types of seizures originating from genetic and pharmacological manipulations. In the ‘bang-sensitive’ sodium channel mutant bangsenseless (bss), the LFP pattern was prolonged, and the temporal correlation between LFP oscillations and DLM discharges was altered. Following administration of the pro-convulsant GABAA blocker picrotoxin, we uncovered a qualitatively different LFP activity pattern, which consisted of a slow (1-Hz), repetitive, waveform, closely coupled with DLM bursting and behavioral spasms. Our approach to record brain LFPs presents an initial framework for electrophysiological analysis of the complex brain-wide activity patterns in the large collection of Drosophila excitability mutants.

Molecular-Genetic Characteristics and Genotype-Phenotype Correlations in Bulgarian Patients with Tuberous Sclerosis Complex

Abstract Objective The aim of the study was to determine the molecular-genetic characteristics of the autosomal dominant systematic disorder Tuberous Sclerosis Complex (TSC1 and TSC2) in Bulgarian patients and to derive some genotype-phenotype correlations. Material and Methods In total 42 patients/families with suspected clinical diagnosis of TSC were analyzed. We used direct sequencing and MLPA for the TSC1 and TSC2 gene analysis. Results In 38 families (90.5%) we confirmed the suspected clinical diagnosis – 15 with TSC1 (35.7%) and 23 (54.8%) with TSC2. In 4 families (9.5%) pathogenic variants were not found. In all 38 patients with proven diagnosis of TSC, we found 38 different mutations, 15 of which (39%) were detected for the first time by our research group. The mutation “hotspots“ in TSC1 gene are exons 9, 15, 17 and 18, where 73% of the TSC1 mutations are localized, while the TSC2 gene mutation “hotspots“ are exons 13 and 34, with 22% of the mutations situated there. In the TSC2 patients the common clinical findings include subcortical tubers, epilepsy with generalized tonic-clonic seizures, subependymal giant cell astrocytoma, facial angiofibromas, ungual fibromas, cardiac rhabdomyomas and renal angiomyolipomas, while in the TSC1 patients typically cortical tubers, cortical dysplasia and subependymal nodules were registered. In patients with aggressive frameshift and nonsense TSC1 and TSC2 mutations commonly hypomelanotic macules, cortical and subcortical tubers, cortical dysplasia, epilepsy with different types of seizures were found. Renal angiomyolipomas and cysts were detected mainly in patients with large deletions. Shagreen patches and intellectual disability were typically registered in equal degree in patients with frameshift, nonsense and missense mutations. Conclusion Although some genotype-phenotype correlations were derived, there is a great inter- and intrafamilial clinical variability in TSC, so it is impossible to predict the course of the disease on the basis of the detected molecular defect. The obtained results helped us to develop a diagnostic algorithm for proper molecular-genetic diagnostics which permits adequate genetic counseling, prophylaxis and treatment in the affected TSC families.

Epilepsy at the intersection of disability, gender, and culture: A duoethnography

Epilepsy is a neurodevelopmental disorder that affects millions of adults and children. Several different types of seizures, ranging from generalized which affect both sides of the brain to focal seizures that are rooted in one location of the brain. In addition to the physical impact of epilepsy, there are many emotional and identity consequences of living with epilepsy. An area that is not yet explored is the impact of epilepsy on the lives of women of color. In this paper, we fill this gap by exploring the experiences of two women of color who have had epilepsy beginning in early childhood through motherhood. One of the women is Mexican-American and an early career faculty in social work. The other identifies as a Chinese immigrant doctoral student in disability studies. Together, these stories bring to the literature voices that have not been actively engaged by epilepsy research or academia. We use a duoethnographic approach in this work given that this method provides an opportunity to explore identity and intersectionality and juxtapose our narratives surrounding epilepsy. By applying disability critical race theory (DisCrit) to our narratives, we identified how fluctuating epileptic symptoms, gender, and culture, interact with the layers of our epileptic identities. Furthermore, we discuss how our experiences with epilepsy exposes the lack of accommodative efforts in both the healthcare and education systems for individuals with invisible neurodevelopmental disabilities. This duoethnography has important implications for engaging youth with epilepsy and other invisible disabilities. By showcasing our journey of “coming to terms” with epilepsy, our dialog provides insights into how to support youth in building a positive disability identity. Our experiences in academia set up a basis to discuss accommodations for students with epilepsy and other invisible disabilities.

WDR45 Gene and Its Role in Pediatric Epilepsies

AbstractWD repeat domain 45 (WDR45) gene has been increasingly found in patients with developmental delay (DD) and epilepsy. Previously, WDR45 de novo mutations were reported in sporadic adult and pediatric patients presenting iron accumulation, while heterozygous mutations were associated with β-propeller protein-associated neurodegeneration (BPAN), a subtype of neurodegeneration with brain iron accumulation disorders, characterized by extrapyramidal movement disorders and abnormal accumulation of iron in the basal ganglia. Overall, people harboring WDR45 mutations have moderate to severe DD and different types of seizures. The phenotype of adult patients is characterized by extrapyramidal movement, dystonia, parkinsonism, language impairment, and involvement of the substantia nigra and in the globus pallidus at brain magnetic resonance imaging. Importantly, there are no findings of brain iron accumulation in brain in BPAN patients in the first decade of life, thus suggesting a progressive course of the disease. Comparatively, the main phenotype of pediatric patients is epilepsy with early onset, most of which present infantile spasms and arrest or regression of psychomotor development. The phenotype of patients with WDR45 mutations is variable, being different if caused by somatic mosaicism or germline mutations, and presenting with a different spectrum of manifestations in males and females. The treatment of affected individuals is symptomatic. Regarding the seizures, specific, gene-based approaches with specific antiepileptic drugs are not currently available. The early diagnosis of BPAN could be useful in some aspects, such as providing families a supportive treatment to their affected children.

Epileptic Classification With Deep-Transfer-Learning-Based Feature Fusion Algorithm

Epilepsy ictal detection based on scalp electroencephalograms (EEGs) has been comprehensively studied in the past decades. But few attentions have been paid to the preictal classification. In this article, a comprehensive study on epileptic state classification based on deep transfer learning (TL) is presented. The main contributions include: 1) the subband mean amplitude spectrum (MAS) map that characterizes the typical rhythms of brain activities is extracted for EEG representation; 2) five representative deep neural networks (DNNs) pretrained on ImageNet are applied for EEG feature TL; and 3) a 7-layer hierarchical neural network (HNN) that consists of three fully connected (Fc) and three dropout layers followed by a Softmax layer is developed to perform the epileptic state probability learning and classification. Experiments on the benchmark CHB-MIT and iNeuro EEG databases that contain several different types of seizures show that the proposed algorithm achieves the highest overall accuracies of 96.97% and 87.87% on the 5-state epileptic classification, respectively, that outperforms many existing state-of-the-art methods presented in this article.

Influence of titration of antiseizure medications on treatment selection: Results of an online survey with clinicians in the United States

IntroductionMost antiseizure medications (ASM) need to be titrated before the optimal dose is achieved. Titration can last several weeks to months. We assessed the impact titration schedules have on ASM treatment-related decisions in the United States (US). MethodsAn online survey was conducted with different healthcare providers (HCPs) in the US involved in the treatment and management of patients with epilepsy. The survey contained three sections: the first section with screening questions; the second on key factors that influence a HCP’s decision-making when selecting treatments for different types of seizures and different treatment lines; and the third on the HCP’s knowledge and perceptions regarding ASM titration for the treatment of patients with epilepsy. ResultsOne-hundred and fifty HCPs (63% neurologists) completed the survey. Most HCPs considered titration schedule to be important, with only 1–3% of HCPs, depending on type of seizure, considering the titration schedule to be “not important at all” when prescribing therapy. Healthcare providers’ acceptance of titration increased with shorter durations (≥50% accepted titration periods of ≤2 weeks), and lower number of tablets/capsules per dose (≥50% accepted ≤3 tablets/capsules per dose), doses (≥50% accepted ≤2 doses/day), and steps (≥50% accepted ≤3 steps/dose change). Most HCPs (68–91% depending on type of seizure) considered a titration duration of 6 or more weeks only somewhat acceptable or somewhat or highly unacceptable. Almost all HCPs selected “somewhat familiar”, “familiar”, or “very familiar” as the attribute that best defines their knowledge level of titration, with only 4% selecting “a little familiar”. While 87% of HCPs agreed or strongly agreed that they could easily understand titration schedules, only 27% of them agreed or strongly agreed that patients could easily understand titration schedules and 58% of HCPs considered that adhering to the titration schedule was difficult for patients. Most HCPs agreed or strongly agreed that a complex or long titration schedule renders it difficult to achieve their treatment objectives. ConclusionsHealthcare providers take into account the duration and complexity of the titration period in their ASM prescribing decision-making and prefer shorter and simpler titration schedules, particularly for patients who are experiencing convulsive seizures and starting monotherapy. There was a clear difference between the HCP’s belief in their own ability to understand a titration schedule, and their belief that the patient would be able to follow the titration schedule appropriately

Managing Chronic Health Needs in Child Care and Schools—Seizures, Nonfebrile (Epilepsy)

Patient Education| 2021 Managing Chronic Health Needs in Child Care and Schools—Seizures, Nonfebrile (Epilepsy) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Managing Chronic Health Needs in Child Care and Schools—Seizures, Nonfebrile (Epilepsy). Pediatric Patient Education 2021; 10.1542/ppe_document030 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Managing Chronic Health Needs in Child Care Seizures are sudden abnormal events or episodes that happen because of a problem with the way that brain cells communicate through electrical signals.During a seizure, some brain cells send abnormal and exaggerated electrical signals that stop other cells from working properly.A seizure causes the patient to experience temporary disturbances in awareness or in consciousness, movement, sensation, and behavior. Seizures represent the most common neurologic disorder in children. About 1% of all children in the United States will have epilepsy (≥2 unprovoked seizures). Different types of seizures represent different parts of brain involvement.Generalized (formerly also called grand mal) seizures occur when both sides of the brain and the whole body are involved. A child may stiffen (tonic) and shake (clonic) all over in a rhythmic fashion. Children may fall to the ground and hurt... © 2019 American Academy of Pediatrics. All rights reserved. You do not currently have access to this content.

Identification of an Identical de Novo SCAMP5 Missense Variant in Four Unrelated Patients With Seizures and Severe Neurodevelopmental Delay.

Objective: To establish and broaden the phenotypic spectrum of secretory carrier membrane protein (SCAMP5) associated with epilepsy and neurodevelopmental delay. Methods: A Chinese patient was identified at the First Hospital of Peking University, and the three unrelated patients were recruited from two different countries (Italy and United States) through GeneMatcher. SCAMP5 pathogenic variants were identified by whole exome sequencing; clinical data of the patients were retrospectively collected and analyzed. Result: The onset age of seizures was ranged from 6 to 15 months. Patients had different types of seizures, including focal seizures, generalized tonic-clonic seizures and tonic seizure. One patient showed typical autism spectrum disorder (ASD) symptoms. Electroencephalogram (EEG) findings presented as focal or multifocal discharges, sometimes spreading to generalization. Brain magnetic resonance imaging (MRI) abnormalities were present in each patient. Severe intellectual disability and language and motor developmental disorders were found in our patients, with all patients having poor language development and were nonverbal at last follow-up. All but one of the patients could walk independently in childhood, but the ability to walk independently in one patient had deteriorated with age. All patients had abnormal neurological exam findings, mostly signs of extrapyramidal system involvement. Dysmorphic features were found in 2/4 patients, mainly in the face and trunk. All four unrelated patients were found to have the same heterozygous pathogenic SCAMP5 de novo variant (p. Gly180Trp). Conclusion: Epilepsy, severe developmental delay, abnormal neurological exam findings, with or without ASD or variably dysmorphic features and were common in patients with SCAMP5 variant. The onset time and type of seizure varied greatly. The EEG and brain MRI findings were not consistent, but diverse and nonspecific. The motor ability of patients with heterozygous SCAMP5 variant might have a regressive course; language development was more severely affected.

Quality of Life in Childhood Epilepsy

Abstract Background: Epilepsy is a common chronic neurological condition in developing years that can negatively impact one's physical, social and emotional function. Aim of Study: The aim of this study was to assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt, comparing the relationship between different types of seizures and the HRQOL and increasing the awareness of the importance of assessing physical, psychosocial, and behavioral well-being of children with epilepsy in Egypt. Patients and Methods: To assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt during the period from August 2019 and December 2019. This cross-sectional study was conducted at Ain Shams Neurology Department and included 75 children with epilepsy of 11-18 years. The tools used to assess children's QOL were pediatric QOL questionnaires. Parents' QOL was assessed using SF36 inventory. Results: Children with epilepsy have an affected quality of life according to the PedQOL assessment tool with a mean PedQOL total score 64.4±6.9 and ranged from 56.1 to 83.6. Among the different domains of the PedQOL inventory, the results of our study showed that children with epilepsy have got higher scores in the physical and the school domains than in the emotional and social domains. Our sample was drawn from Ain Shams University Hospital. Patients attending this health facility are usually from low to intermediate socio-economic status which may explain this result. Conclusion: Epilepsy in children has a great impact on the quality of life of those children particularly on the emotional and social domains. Some antiepileptic drugs like valproic acid have a better effect on the quality of life than others. The higher the children's quality of life the higher is the parents' quality of life. The highly impacted domains of the parents quality of life according to the SF36 questionnaire were role limitation (physical or social), social functioning and mental health domain.

Early-onset epileptic encephalopathy related to germline PIGA mutations: A series of 5 cases.

The molecular diagnosis of early-onset epileptic encephalopathy (EOEE), an expanding field in child neurology, is becoming increasingly possible thanks to the widespread availability of next-generation sequencing and whole-exome sequencing. In the past 15 years, mutations in STXBP1, KCNQ2, SCN2A, SCN8A and numerous other genes have been reported, giving a more accurate insight for these rare diseases. Among these genes, germline mutations in Phosphatidyl Inositol Glycan A (PIGA) gene were first reported in 2012. Located on Xp22.2, PIGA is involved in the synthesis of GPI (glycosylphosphatidylinositol) which acts as a membrane anchor for different proteins: enzymes, adhesion molecules, regulation of the complement way, and co-receptor in transduction signal. Children suffering from this condition exhibit developmental delay with early-onset epilepsy, severe dysmorphic signs, multi-visceral anomalies and early death in the most severe forms. Here, we report five cases of germline PIGA mutations, with two missense mutations that have not been reported to date. We provide a new insight into the electroclinical phenotype. At the onset, epileptic spasms and focal-onset seizures with upper limbs and ocular involvements were present. Epilepsy proved pharmacoresistant in 4 out of 5 cases. Interictal EEG may be normal at the onset of epilepsy, but abnormalities in electroencephalographic studies were eventually present in all cases. Different types of seizures may be present simultaneously, and epileptic phenotypes evolve with aging.

Convolutional neural network for detection and classification of seizures in clinical data.

Epileptic seizure detection and classification in clinical electroencephalogram data still is a challenge, and only low sensitivity with a high rate of false positives has been achieved with commercially available seizure detection tools, which usually are patient non-specific. Epilepsy patients suffer from severe detrimental effects like physical injury or depression due to unpredictable seizures. However, even in hospitals due to the high rate of false positives, the seizure alert systems are of poor help for patients as tools of seizure detection are mostly trained on unrealistically clean data, containing little noise and obtained under controlled laboratory conditions, where patient groups are homogeneous, e.g. in terms of age or type of seizures. In this study authors present the approach for detection and classification of a seizure using clinical data of electroencephalograms and a convolutional neural network trained on features of brain synchronisation and power spectrum. Various deep learning methods were applied, and the network was trained on a very heterogeneous clinical electroencephalogram dataset. In total, eight different types of seizures were considered, and the patients were of various ages, health conditions and they were observed under clinical conditions. Despite this, the classifier presented in this paper achieved sensitivity and specificity equal to 0.68 and 0.67, accordingly, which is a significant improvement as compared to the known results for clinical data. Graphical abstract.

A Review on Epilepsy and its Management

Today, people face various types of stress in everyday fast life and most people in the world suffer from various neurological disorder. Epilepsy is one of the most common neurological disorders of the brain, affecting about 50 million people around the world, and 90% of them are coming from developing countries. Genetic factors and brain infection, stroke, tumors and epilepsy cause high fever. It imposes a great economic burden on the health systems of countries associated with stigma and discrimination against the patient and also his family in the community, in the workplace, school and home. Many patients with epilepsy suffer from severe emotional stress, behavioral disorders and extreme social isolation. There are many different types of seizure and mechanisms by which the brain generates seizures. The two features of generating seizures are hyperexcitability of neurons and a hyper synchronousneural circuits. A variety of mechanisms alters the balance between excitation and inhibition in predisposing brain local or generalized hyperexcitability region and a hypersynchronia. Purpose of the review is to discuss the history, epidemiology, etiology, pathophysiology, classification of epilepsy, symtomps, diagnosis, management of epilepsy and future trends.
 Keywords: Anti-epileptic drugs, pathophysiology, seizures, epidemiology, hypersynchrony

Fitness to drive in seizure and epilepsy: A protocol for Iranian clinicians

Driving restriction is a well-known undesirable consequence of epilepsy and causes significant problems regarding independence and employment for epileptic patients. Many countries all over the world have provided comprehensive protocols in this regard with the aim of providing the possibility of less restricted, but safe driving for epileptic patients and also providing the opportunity for uniform decision-making for clinicians. However, the available fitness to drive protocol in Iran still lacks sufficient details and clinicians might encounter serious problems in terms of the driving issue in epileptic patients. In order to provide a uniform protocol containing adequate practical data, a systematic review of literature addressing guidelines about driving and epilepsy and driving laws of different countries for epileptic patients was performed and, after consideration of cultural issues, a practical protocol for Iranian neurologists was suggested.

Prescription pattern of antiepileptic drugs in a tertiary care center of India.

OBJECTIVES:The present study aimed to determine the pattern of prescription of antiepileptic drugs (AEDs) in a cohort of patients with epilepsy (PWE) attending a tertiary care center of North India.MATERIALS AND METHODS:Demographic variables including age, gender, age at onset, type and frequency of seizures, and prescription of all AEDs (dose and duration) were noted. Descriptive analysis of the use of AEDs was done, and their different combinations were studied.RESULTS:A total of 1187 prescriptions were evaluated. Demography showed 65.7% of males; mean age of 21.9 years (range: 2–77 years), generalized seizures (53%), and focal seizures (47%). Only 21.8% of the patients were seizure free with no seizure in 1 year of treatment. The five most frequently prescribed AEDs out of 12 AEDs were sodium valproate (VPA) (49.6%), clobazam (CLB) (39.3%), levetiracetam (LEV) (28.4%), carbamazepine (CBZ) (27.3%), and phenytoin (PHT) (26.5%). Monotherapy was effective in 36.6% of the patients. Sodium VPA (39.4%), PHT (25.6%), and CBZ (20.1%) were commonly used as monotherapy. Polytherapy was required in 63.4% of the patients, and most commonly prescribed combinations were PHT + CLB (n = 53), sodium VPA + CLB (n = 62), CBZ + CLB (n = 45), PHT + sodium VPA + CLB (n = 28), and CBZ + sodium VPA + CLB (n = 31).CONCLUSIONS:Polytherapy is a very common practice in our tertiary care center. Sodium VPA, a highly prescribed AED, results in good control of generalized seizures, whereas focal seizures are well controlled by CBZ alone as well as in combination. The present study highlights the commonly prescribed combinations of AEDs resulting in control of different types of seizures.

Clinical characteristics of children with epilepsy managed at an urban hospital in Africa: a retrospective study

Background
 Most children with epilepsy reside in resource-limited regions such as sub-Saharan Africa, where the majority of studies have been conducted in rural areas with limited investigations. Medical records from children with epilepsy seen at an urban hospital in Kenya were examined to provide a comprehensive description of epilepsy in children from this hospital.
 
 Methods
 A retrospective observational study was conducted which involved reviewing medical records of 426 epilepsy patients (260 males and 166 females) aged 0 - 18 years, seen at Aga Khan University Hospital, Nairobi, Kenya between February 2011 and December 2014.
 
 Results
 The most frequent age at presentation; documented in 29% was in infancy. Generalized seizures due to structural brain abnormalities were the most common form of epilepsy (28%). Lennox-Gastaut Syndrome was the most common electroclinical syndrome (7%). Focal seizures and focal seizures with loss of awareness were identified in 12% of the population. There were no cases of childhood absence epilepsy in this group. Brain atrophy was the most common MRI finding, occurring in a fifth of the population (20%), while cystic encephalomalacia occurred in 13%. Half (50%) of all EEG recordings performed for this cohort were abnormal. Generalized seizures due to structural brain abnormalities and Lennox-Gastaut Syndrome (LGS) were significant predictors of a treatment history of three or more AEDs. At the conclusion of the review period, 16% of the patients had not visited the clinic for more than 12 months and were considered to be lost to follow-up.
 
 Conclusion
 The highest frequency of epilepsy cases was documented in children less than one year of age. Generalized seizures due to structural abnormalities and Lennox-Gastaut syndrome were the most common seizure type and syndrome. Improvement of public awareness of different types of seizures in children may increase identification of children with childhood absence epilepsy.