Electroencephalographic Abnormalities Research Articles

CASPR2-IgG-associated autoimmune seizures.

This study was undertaken to report clinical presentations and outcomes of CASPR2-IgG-associated seizures. Mayo Clinic Neuroimmunology database was queried to identify CASPR2-IgG-seropositive (CASPR2-IgG+) patients evaluated at our institution (2009-2019). Of the 53 CASPR2-IgG+ patients (titer ≥ 1:10), 20had seizures (38%). All seizure patients were male, with median onset age of 68years. Eighteen (90%) had seizures at initial presentation. One patient was found to have malignancy (colon adenocarcinoma). Two patients had coexisting LGI1-IgG. Twelve patients had archived sera, which on titration had CASPR2-IgG titers ≥ 1:100. Fifteen patients (75%) met criteria for autoimmune encephalitis. Patients most commonly presented with focal onset, nonmotor seizures with impaired awareness (n=14, 70%). Eleven patients also had focal motor and/or sensory seizures as one of the seizure semiologies. The majority of patients (n=11, 55%) developed generalized tonic-clonic seizures during their disease course. Seizure clusters occurred in 12 patients. In addition to seizures, patients developed cognitive disturbance (n=16, 80%), episodic emotional lability (n=13, 65%), paroxysmal dizziness (n=9, 45%), episodic ataxia (n=6, 30%), and chronic ataxia (n=9, 45%). Only three patients (15%) had coexisting peripheral nervous system involvement. Frontotemporal or temporal ictal and/or interictal electroencephalographic abnormalities were present among nine patients, and three had multifocal epileptiform abnormalities. Eight patients (40%) had medial temporal T2/fluid-attenuated inversion recovery hyperintensity on brain magnetic resonance imaging. Elevated cerebrospinal fluid protein and/or lymphocytic pleocytosis was present in most cases (13/14, 93%). Thirteen patients reached seizure freedom following initiation of antiseizure medication (ASM; n=4) or a combination of immunotherapy and ASM (n=9). Median duration of follow-up was 25months (range = 2-136months). CASPR2-IgG evaluation should be considered among older male patients with new onset focal seizures and impaired awareness often occurring in clusters with/without features of encephalitis. Coexisting neurological manifestations, including episodic emotional lability, ataxia, and paroxysmal dizziness, also aid in the diagnosis.

Parkinson's Disease With Visual Hallucinations Is Associated With Epileptiform Activity on EEG.

Background: Visual hallucinations (VHs) in Parkinson's disease (PD) are the cardinal symptoms which declare the onset of PD psychosis (PDP). The anthropomorphic and zoomorphic VHs of PD resemble those of Charles Bonnet syndrome and temporal lobe epilepsy. In both of these disorders electroencephalography (EEG) abnormalities have been described. We therefore sought to examine whether VHs in PD were associated with similar EEG abnormalities.Methods: This retrospective observational study searched the medical records of 300 PD patients and filtered for those containing clinical 20-min scalp EEGs. Remaining records were separated into two groups: patients with reported VHs and those without. The prevalence of epileptiform discharges in the EEGs of both groups was identified.Results: Epileptiform discharges were present in 5 of 13 (38.5%) PD patients with VHs; all localized to the temporal lobe. No epileptiform discharges were observed in the EEGs of the 31 PD patients without VHs.Conclusion: The significantly high incidence of temporal lobe epileptiform discharges in PD patients with VHs as compared to those without VHs lends to the possibility of an association visual cortex epileptogenic focus. Accordingly, for treatment-refractory patients, antiepileptic drugs might be considered, as in the case of Charles Bonnet syndrome, temporal lobe epilepsy and migraine with visual aura. Future prospective studies involving larger samples and multi-center cohorts are required to validate these observational findings.

Rapid versus slow withdrawal of antiepileptic drugs.

The ideal objective of treating a person with epilepsy is to induce remission (free of seizures for some time) using antiepileptic drugs (AEDs) and withdraw the AEDs without causing seizure recurrence. Prolonged usage of AEDs may have long-term adverse effects. Hence, when a person with epilepsy is in remission, it is logical to attempt to discontinue the medication. The timing of withdrawal and the mode of withdrawal arise while contemplating withdrawal of AEDs. This review examines the evidence for the rate of withdrawal of AEDs (whether rapid or slow tapering) and its effect on seizure recurrence. This is an updated version of the Cochrane Review previously published in 2020. To quantify risk of seizure recurrence after rapid (tapering period of three months or less) or slow (tapering period of more than three months) discontinuation of antiepileptic drugs in adults and children with epilepsy who are in remission, and to assess which variables modify the risk of seizure recurrence. For the latest update, on 8 November 2021, we searched: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid), and SCOPUS. There were no language restrictions. CRS Web includes randomized or quasi-randomized, controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), CENTRAL, and the Specialized Registers of Cochrane Review Groups including Epilepsy. Randomized controlled trials that evaluated withdrawal of AEDs in a rapid or slow tapering after varying periods of seizure control in people with epilepsy. Two review authors independently assessed the trials for inclusion and extracted the data. The outcomes assessed included seizure freedom after one, two, or five years of AED withdrawal; time to recurrence of seizure following withdrawal; occurrence of status epilepticus; mortality; morbidity due to seizure, such as injuries, fractures, and aspiration pneumonia; and quality of life (assessed by validated scale). There are two included studies in this review. One study randomized 57 children with epilepsy with seizure freedom for at least two years to taper down the AED over one or six months. The study was not blinded and there were no details of randomization. Over the period of 54 months of follow-up, 20/30 participants in the one-month group remained seizure-free compared to 15/27 participants in the six-month group (no evidence of a difference). There was no information on time of seizure recurrence for each group to allow a comparison. The other study involved 149 children. There was a non-significant trend towards a lower risk of seizure recurrence after one year of AED withdrawal in participants allocated to slow tapering (risk ratio (RR) 0.76, 95% confidence interval (CI) 0.58 to 1.01; P = 0.06; very low-certainty evidence). At the end of two years, 30 participants were seizure free in the rapid-tapering group and 29 participants in the slow-tapering group (RR 0.87, 95% CI 0.58 to 1.29; P = 0.48; very low-certainty evidence). At the end of five years, 10 participants were seizure free in the rapid-tapering group and six participants in the slow-tapering group (RR 1.40, 95% CI 0.54 to 3.65; P = 0.49; very low-certainty evidence). There were no data for the other outcomes. Due to the methodological heterogeneity and the difference in the duration of tapering, we did not perform a quantitative synthesis of these studies. Currently, one Italian trial is ongoing that is investigating if a slow or a rapid withdrawal schedule of AEDs influences return of seizures (relapse) in adults with focal or generalized epilepsy who have been seizure free for at least two years (no preliminary results available). In view of methodological deficiencies, and small sample size of the two included studies, we cannot draw any reliable conclusions regarding the optimal rate of tapering of AEDs. Using GRADE, we assessed the certainty of the evidence as very low for outcomes for which data were available. We judged both studies to be at an overall high risk of bias. Further studies are needed in adults and children to investigate the optimal rate of withdrawal of AEDs and to study the effects of variables such as seizure types, aetiology, intellectual disability, electroencephalography abnormalities, presence of neurological deficits, and other comorbidities on the rate of tapering.

Epilepsy and electroencephalographic abnormalities in children with autism spectrum disorders

Epilepsy and electroencephalographic abnormalities in children with autism spectrum disorders

Disease Characteristics, Treatment, and Prognosis of Chinese Patients with Autoimmune Encephalitis: A Retrospective Study

To investigate the clinical features and prognosis of autoimmune encephalitis (AE). Accessing data from the electronic medical records of patients receiving care at West China Hospital, Sichuan University, China between 2013 and 2019, we conducted a retrospective study of the disease characteristics, laboratory examinations, treatment, and prognosis of AE patients. Before they were discharged, modified Rankin Scale (mRS) was used to assess the prognosis of AE patients and their mRS scores were then used to categorize patients as having good prognosis (mRS scores of 0-2) or poor prognosis (mRS scores of 3-6). Multivariate logistic regression was used to analyze risk factors associated with poor prognosis. A total of 121 patients were included in the study. The male-to-female ratio was 1∶1.1. At the time of diagnosis, patients were mainly from the age group of young to middle-aged individuals. Among the 121 patients, 64.5% (78 patients) had anti-N-methyl D-aspartate receptor (NMDAR) encephalitis, accounting for the largest proportion. 33.1% (40 patients) first visited the Department of Psychiatry for medical assistance. 62.8% (76 patients ) showed prodromal symptoms. The common clinical manifestations of the AE patients at the time of admission included cognitive dysfunction (104 patients, 86.0%), thought disorder (90 patients, 74.4%), and altered behaviors (88 patients, 72.7%). The NMDAR antibody titers were higher in the cerebrospinal fluid (CSF) than those in the serum. Double-positive antibodies were detected in 6 patients. No abnormality was observed in the brain magnetic resonance imaging (MRI) of 42 patients (34.7%) . Electroencephalography abnormalities were observed in 71 patients (58.7%). 111 patients (91.7%) received first-line immunotherapy and 61 patients (50.4%) still had neuropsychiatric deficits when they were discharged. Multivariate logistic regression revealed that consciousness disorder (odds ratio [ OR] =4.230, 95% confidence interval [ CI] : 1.540-11.617; P=0.005), altered behavior ( OR=2.997, 95% CI: 1.068-8.406; P=0.037) and movement disorder ( OR=7.753, 95% CI: 1.446-41.578; P=0.017) were risk factors for poor clinical prognosis of AE patients. Patients with AE mainly manifest cognitive damage. Half of the patients left neuropsychiatric deficits. The relationship between CSF titers and serum titers is unparalleled. The options of immunotherapy show no difference in their influence on prognosis. Cognitive dysfunction, altered behavior and movement disorder are independent risk factors for a poor prognosis at discharge.

The frequency of abnormal electroencephalography for detecting acute ischemic stroke

Introduction. Cerebrovascular accident is defined as rapidly developing symptoms or signs of focal and global loss of cerebral function lasting for 24 hours or more with no apparent cause other than that of vascular origin. Stroke is the fifth leading cause of death in the United States and it is one of the most disabling cause of neurological disorders. The attack of cerebrovascular accident begins abruptly, the focal neurologic deficit either fully evolved at the onset or it progress over minutes to hours or within days. Electroencephalogram (EEG) is used to detect electrical activity in the brain for various neurologic disorders like epilepsy, encephalopathy, prion diseases (CJD), Alzheimer disease and also stroke. Objective. To determine the frequency of abnormal EEG for detecting acute ischemic stroke. Methods. This was a cross sectional study conducted at Department of Medicine, Dow University of Health Sciences Karachi OJHA Campus, Dow International Medical College (DIMC), and Duration of study was 06 month from 1st October 2020 to 30th March 2021. Non-probability consecutive sampling technique was used. A total of 460 patients of acute ischemic stroke were included in this study. Patients were diagnosed on the basis of CT scan brain or diffusion weighted imaging. Within 24 hours the EEG was done in all admitted patients. The potentials recorded by EEG were cumulated excitatory and inhibitory postsynaptic potentials in neuronal dendrites, usually in most superficial regions of cerebral cortex. All data was entered and analyzed using SPSS v25.0. Data were stratified for age, gender, BMI and duration of stroke to address the effect modifiers. Post-stratification, Chi-square test was used by taking p-value ≤0.05 as significant. Results. 460 patients were selected for this study. Mean age was 40.04±9.1 years. Among cases, there were 276 (60%) males and 184 (40%) females. 235 patients (51.08%) had abnormal EEG. By stratification of abnormal EEG, it was found that duration of acute stroke had significant effect having abnormal EEG (p = 0.000001). Conclusions. The role of complexity of abnormal Electro Encephalogram is useful following acute ischemic stroke. The various parameters of EEG help to evaluate the large ischemic stroke.

Epilepsy and EEG Abnormalities in Children with Autism Spectrum Disorders.

To evaluate the prevalence of epilepsy and electroencephalographic abnormalities in children with autism spectrum disorders (ASD) and determine their risk factors. This cross-sectional study was conducted over one year in children with ASD aged between 3 and 14 y. Classification of epilepsy and routine electroencephalography (EEG) recordings were done for all the patients. Developmental and cognitive assessments were done using Developmental Profile 3. Children were divided into three groups: ASD with epilepsy, ASD with isolated electroencephalographic abnormalities, and ASD with neither epilepsy nor electroencephalographic abnormalities. One hundred children with ASD were enrolled. Epilepsy was reported in 23% and subclinical electroencephalographic abnormalities were documented in 8%. The most common seizure types were generalized-onset tonic-clonic (48%), focal-onset with impaired awareness (17%), and focal to bilateral tonic-clonic seizures (17%). In children with subclinical epileptiform discharges, focal abnormalities were most common (75%) and were maximally seen over the temporal region (50%). Subnormal intellect (88.6%) and abnormal global developmental score (82%) were noted in the majority of children. Female gender, abnormal neurological examination, and adverse perinatal events were significantly associated with epilepsy. Of these, female gender and adverse perinatal events were independent predictors of epilepsy. Isolated EEG abnormalities were significantly associated with abnormal neurological examination in comparison with autistic children without epilepsy/EEG abnormalities. Epilepsy is seen in up to one-fourth children with ASD. Female gender and adverse perinatal events are independent risk factors for epilepsy. Subclinical or isolated EEG abnormalities are associated with abnormal neurological examination.

The clinical features, treatment and outcomes of 33 children from Northwestern China with Anti-N-methyl-D-aspartate receptor encephalitis

ABSTRACT Objectives We analyzed the clinical features and outcomes of children with anti-N-methyl-D–aspartate receptor (anti-NMDAR) encephalitis in Northwestern China. Methods We retrospectively recruited 33 pediatric patients with anti-NMDAR encephalitis in Northwestern China from December 2013 to April 2020. The demographics, clinical features, treatments, and outcomes were reviewed. Results 33 patients with anti-NMDAR encephalitis were enrolled in this study (a median age of 6.8 years, 20 females and 13 males). The initial symptoms included seizures (42.4%), psychiatric symptoms (39.4%), speech dysfunction (12.1%), and paralysis (6.1%). During the course of the disease, 31 patients (93.9%) presented with psychiatric symptoms, 29 patients (87.9%) presented with speech dysfunction, 25 patients (75.8%) presented with movement disorders and 24 patients (72.7%) presented with sleep disorders followed by seizures, consciousness disturbance, autonomic nervous dysfunction, paralysis, and hypoventilation. 12 patients (36.4%) had abnormal cerebrospinal fluid (CSF) findings, 10 patients (30.3%) exhibited abnormal brain magnetic resonance imaging (MRI) results, and 29 patients (87.9%) showed abnormal Electroencephalography (EEG) findings. None of the patients had tumors. All patients received first-line immunotherapy and 8 patients both received first and second-line immunotherapy. 30 of the 33 patients achieved good outcomes (score on the modified Rankin Scale [mRS] of 0–2), whilst the other 3 patients had poor outcomes (mRS score of 3–6). Conclusions Patients with higher CSF anti-NMDAR body titer were more likely to develop sleep disorders, consciousness disturbances and more severe disease states.

Electroencephalographic and morphometric abnormalities in psychopath offenders.

The main goals of the present study were to replicate and extend current knowledge related to paralimbic dysfunctions associated with psychopathy. The research evaluated the quantitative electroencephalography, current density (CD) source and synchronization likelihood analysis during the rest condition and structural magnetic resonance imaging images to compare volumetric and cortical thickness, in inmates recruited from two prisons located in Havana City. The Psychopathy Checklist-Revised (PCL-R) was used as a quantitative measure of psychopathy. This study showed most beta energy and less alpha activity in male psychopath offenders. Low-resolution electromagnetic tomography signified an increase of beta activity in psychopath offender groups within paralimbic regions. The superior temporal gyrus volume was associated with the F1 factor while the fusiform, anterior cingulate and associative occipital areas were primarily associated with the F2 factor of PCL-R scale. Cortical thickness in the left dorsal anterior cingulate cortex and the temporal pole was negatively associated with PCL-R total score.

Comparison of 4 weeks versus 12 weeks antiseizure medication for acute symptomatic seizures in children with Acute Encephalitis Syndrome: An open-label, randomized controlled trial

ObjectiveTo compare the proportion of children with seizure recurrence/s during 6-18 months of follow-up among children with acute symptomatic seizures underlying acute encephalitis syndrome (AES) treated with either 4 weeks or 12 weeks of antiseizure medication (ASM). MethodsEligible children aged 3 months to 12 years with acute symptomatic seizures underlying AES, receiving a single ASM at 4 weeks of illness, and without seizure recurrence from day 7–28 of illness were included in this comparative, parallel-group assignment, open-label, randomized control study (either 4 weeks or 12 weeks duration). The primary outcome was to compare proportions of children developing seizure recurrence over six months of follow-up. The secondary outcomes were to study seizure recurrence over 12–18 months follow-up and factor(s) associated with seizure recurrence. ResultsOf 232 children with AES screened, 60 eligible children were randomized in two groups. Baseline demographics were comparable (except the duration of illness) between the groups. Seizure recurrences at 6, 12 and 18 months were none, two (one in each group, relative risk 1.0, 95% CI 0.06–16.76; p-value >0.99), and six (one and five children in 4 and 12 weeks groups respectively, relative risk 0.17, 95% CI 0.01–1.62; p-value 0.19) respectively. There was no association of seizure recurrences with seizure characteristics, abnormal electroencephalography and neuroradiology. Children with disabilities at randomization had a higher risk of seizure recurrence at 18 months of follow-up (relative risk 7.16, 95% CI 1.1–43.9; p-value 0.049). SignificanceWith limitations of the study design, this study provides Class I evidence that a shorter duration (4 weeks) of ASM is comparable with 12 weeks therapy for preventing seizure recurrences in children with AES. Trial registrationClinical Trials.gov identifier: NCT03181945; Clinical Trial Registry of India identifier: CTRI/2017/06/008783.

Clinical and socio-demographic factors associated with electroencephalographic abnormalities in children with epilepsy

Electroencephalography (EEG) makes critical contribution to the management of epilepsies. Few studies have examined the clinical and socio-demographic factors that are likely to predict finding an abnormal or epileptiform EEG in children with epilepsy (CWE). Knowledge of clinical variables and socio demographic factors that determine EEG abnormalities may inform careful selection of children for EEG and improve the cost-effectiveness of this investigation. Therefore, this study was carried out to assess the relationship between the occurrence of EEG abnormalities and certain factors such as age, gender, clinical neurologic state, seizure type, anti-epileptic drug therapy, activation procedure such as sleep and etiology of epilepsy in children who had EEG in Owerri, Nigeria. The clinical and EEG records of children who had EEG at a tertiary referral center over a period of two years were retrospectively reviewed. Relevant data including demographics, clinical neurologic state, seizure type, EEG findings were extracted. Statistical analysis was used to determine association between categorical variables. The variables noted to be significantly associated with abnormal EEG recordings were the presence of abnormal neurologic findings (p=0.020) and etiology of epilepsy (p=0.045). There were no significant association between abnormal EEG findings and age (p=0.680), gender (p=0.802) and seizure types (p=0.157). The clinical neurological state and etiology of epilepsy in children were significantly associated with the occurrence of abnormalities and yield of interictal scalp EEG. Children with epilepsy who are neurologically abnormal or have multiple etiological factors could be prioritized in EEG appointments in resource-poor settings. Further research in children with epilepsy is needed to confirm these findings.

Hippocampal atrophy and quantitative EEG markers in mild cognitive impairment in temporal lobe epilepsy versus extra-temporal lobe epilepsy.

Cognitive impairment in temporal lobe epilepsy is widely acknowledged as one of the most well-known comorbidities. This study aimed to explore cognitive impairment and to determine the potential clinical, radiological, and quantitative electroencephalography markers for cognitive impairment in temporal lobe epilepsy patients versus extra-temporal lobe epilepsy. Forty-five patients with temporal lobe epilepsy and forty-five patients with extra-temporal lobe epilepsy were recruited for an administered digit span test, verbal fluency test, mini-mental state examination, digital symbol test, and Montreal cognitive assessment. Also, they were subjected to magnetic resonance imaging assessment for hippocampal atrophy and a quantitative electroencephalography assessment for electroencephalography markers (median frequency, peak frequency, and the alpha-to-theta ratio). Patients with extra-temporal lobe epilepsy showed non-significant higher epilepsy durations and a higher frequency of seizures. Temporal lobe epilepsy patients showed a more statistically significant family history of epilepsy (37.7%), more history of febrile convulsions (13.3%), higher hippocampal atrophy (17.8%), and lower cognitive scales, especially mini-mental state examination and Montreal cognitive assessment; lower digital symbol test, verbal fluency test, and backward memory of digit span test. Also, temporal lobe epilepsy patients had a strong negative correlation with electroencephalography markers: median frequency, peak frequency, and the alpha-to-theta ratio (r = - 0.68, P < 0.005 and r = - 0.64, P < 0.005 and r = - 0.66, P < 0.005 respectively). Cognitive impairment in patients with temporal lobe epilepsy was correlated with hippocampal atrophy and quantitative electroencephalography abnormalities, especially peak frequency, median frequency, and alpha-to-theta ratio that could be used alone for the identification of early cognitive impairment. Clinicaltrials.gov: NCT04376671.

Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations

BackgroundTuberous sclerosis complex (TSC) is an autosomal dominant genetic disease affecting multiple body systems with wide variability in presentation. In 2013, Pediatric Neurology published articles outlining updated diagnostic criteria and recommendations for surveillance and management of disease manifestations. Advances in knowledge and approvals of new therapies necessitated a revision of those criteria and recommendations. MethodsChairs and working group cochairs from the 2012 International TSC Consensus Group were invited to meet face-to-face over two days at the 2018 World TSC Conference on July 25 and 26 in Dallas, TX, USA. Before the meeting, working group cochairs worked with group members via e-mail and telephone to (1) review TSC literature since the 2013 publication, (2) confirm or amend prior recommendations, and (3) provide new recommendations as required. ResultsOnly two changes were made to clinical diagnostic criteria reported in 2013: “multiple cortical tubers and/or radial migration lines” replaced the more general term “cortical dysplasias,” and sclerotic bone lesions were reinstated as a minor criterion. Genetic diagnostic criteria were reaffirmed, including highlighting recent findings that some individuals with TSC are genetically mosaic for variants in TSC1 or TSC2. Changes to surveillance and management criteria largely reflected increased emphasis on early screening for electroencephalographic abnormalities, enhanced surveillance and management of TSC-associated neuropsychiatric disorders, and new medication approvals. ConclusionsUpdated TSC diagnostic criteria and surveillance and management recommendations presented here should provide an improved framework for optimal care of those living with TSC and their families.

P-EG003. Electroencephalography (EEG) abnormalities pattern in brain tumor and stroke

Introduction . Electroencephalography (EEG) is commonly used to identify epileptiform discharge confirming the diagnosis of epilepsy. However, EEG is rarely used in brain tumor and stroke patients. The EEG abnormalities in brain tumor and stroke patients are not well determined. Aim: To identify the EEG abnormalities pattern in brain tumor and stroke patients. Methods . Thirty-seven brain tumor patients and 28 stroke patients, during their hospitalization in general neurology ward and stroke unit, underwent the EEG examination at Electromedical Clinic in Sardjito Hospital, Yogyakarta, Indonesia. Results . EEG abnormal result was found in 32 (86.5%) brain tumor patients and 20 (71.4%) stroke patients. The most common type was the abnormalities of both epileptiform discharge and background. It was found in 19 (51,4%) brain tumor and 9 (32,1%) stroke patients. The second common type was the abnormality of background only; 5 (13,5%) brain tumor and 6 (21,4%) stroke patients. More than a half of brain tumor (73%) and stroke (53,6%) patients showed the existence of epileptiform discharge; dominated by sharp wave. The existence of epileptiform discharge may reveal the possibility of functional brain lesion; meanwhile the existence of background abnormality may reveal the possibility of structural brain lesion. Conclusion . EEG in brain tumor and stroke patients showed the same abnormalities pattern, which is the abnormalities of epileptiform discharge and background. It may suggest that there are both structural and functional brain lesions in brain tumor and stroke cases.

Language regression as a manifestation of epilepsy

Introduction: Childhood epileptic encephalopathies are age-dependent brain disorders in which ictal and interictal epileptogenic activity is the apparent cause of progressive cognitive and neuro-psychological impairment. Case report: A previously healthy four-year-old boy presented to the Emergency Department with a history of receptive and expressive language regression with four days of evolution, associated with seizure onset. Clinical features and electroencephalographic findings led to diagnosis of Landau-Kleffner syndrome. The boy was treated with valproate, clobazam, and prednisolone, with language improvement. Discussion/Conclusion: Landau-Kleffner syndrome is a rare epileptic encephalopathy with pathognomonic sudden aphasia, epilepsy, and paroxysmal electroencephalographic abnormalities. The condition should be suspected in children with normal development who show a deterioration of established language skills. Early diagnosis and treatment are important to improve outcome.

First description of Nodding Syndrome in the Central African Republic.

The term Nodding Syndrome (NS) refers to an atypical and severe form of childhood epilepsy characterized by a repetitive head nodding (HN). The disease has been for a long time limited to East Africa, and the cause is still unknown. The objective of this study was to confirm the existence of NS cases in Central African Republic (CAR). This was a cross-sectional descriptive study in the general population. The identification of NS cases was conducted through a door-to-door survey in a village near Bangui along the Ubangui River. Based on Winkler's 2008 and the World Health Organization (WHO)'s 2012 classifications, the confirmation of cases was done by a neurologist who also performed the electroencephalograms. No laboratory tests were done during this investigation. Treatment was offered to all patients. A total of 6,175 individuals was surveyed in 799 households. After reviewing the cases, we identified 5 NS cases in girls aged between 8 and 16. The age of onset of the seizures was between 5 and 12 years of age. Two cases were classified as "HN plus" according to Winkler's 2008 classification. Four NS cases were classified as probable and one as confirmed according to the WHO's 2012 classification. Three of them presented with developmental delay and cognitive decline, and one had an abnormally low height-for-age z-score. Electroencephalographic abnormalities were found in four patients. Nodding Syndrome cases were described in CAR for the first time. Despite certain peculiarities, these cases are similar to those described elsewhere. Given that only a small part of the affected area was investigated, the study area along the Ubangui River needs to be expanded in order to investigate the association between Onchocerca volvulus and NS and also evaluate the real burden of NS in CAR.

Classification of Dementia in EEG with a Two-Layered Feed Forward Artificial Neural Network

Dementia has become a global public health issue. The current study is focused on diagnosing dementia with Electro Encephalography (EEG). The detection of the advancement of the disease is carried out by detecting the abnormal behavior in EEG measurements. Assessment and evaluation of EEG abnormalities is conducted for all the subjects in order to detect dementia. EEG feature analysis, namely dominant frequency, dominant frequency variability, and frequency prevalence, is done for abnormal and normal subjects and the results are compared. For dementia with Lewy bodies, in 85% of the epochs, the dominant frequency is present in the delta range whereas for normal subjects it lies in the alpha range. The dominant frequency variability in 75% of the epochs is above 4Hz for dementia with Lewy bodies, and in normal subjects at 72% of the epochs, the dominant frequency variability is less than 2Hz. It is observed that these features are sufficient to diagnose dementia with Lewy bodies. The classification of Lewy body dementia is done by using a feed-forward artificial neural network wich proved to have a 94.4% classification accuracy. The classification with the proposed feed-forward neural network has better accuracy, sensitivity, and specificity than the already known methods.

Autoimmune encephalitis in a tertiary hospital in the Philippines

BackgroundAutoimmune encephalitis (AE) is an emerging disorder in adults and children. Due to its potentially reversible nature, prompt recognition and intervention are of utmost importance. ObjectiveTo describe the clinical and paraclinical features, as well as treatment outcomes of patients with AE admitted in a Philippine tertiary hospital. MethodsRetrospective case series of patients with definite AE. ResultsEighteen (18) patients were included (12 adults, 6 children), majority of whom had anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. The median age of onset was 32 (IQR: 10.8) years old and 13 (IQR: 4.8) years old in the adult and pediatric population, respectively. In both age groups, most presented with psychiatric symptoms and normal imaging findings. Cerebrospinal fluid (CSF) pleocytosis was detected in 8/12 (66.7%) adults and 2/6 (33.3%) children, while CSF protein elevation was only seen in 6/12 (50%) adults. Most patients presented with seizures, and the most frequent electroencephalography (EEG) abnormality detected was slow activity (70.5%). A high proportion of patients received high dose steroids, alone (35.3%) or in combination with intravenous immunoglobulin (IVIG, 52.9%). Overall, 66.7% had improved outcomes, mostly seen in the pediatric population. ConclusionThis study highlighted the broad clinical phenotype, as well as the similarities and differences of AE manifestations in adults and children. It demonstrated the limited but supportive role of laboratory investigations in the diagnosis of AE. It also underscored the importance of early intervention in AE and highlighted factors influencing treatment practices and discharge outcomes in the local setting.

Children With Complex Febrile Seizures: Is Hospital Admission Necessary?

Children with complex febrile seizure (CFS) are often hospitalized for concerns for serious bacterial infection (SBI) or seizure recurrence. We describe the yield of diagnostic studies and seizure recurrence during hospitalization in CFS children. We performed a retrospective review of 372 visits in 350 developmentally normal children aged 6 to 60 months between 2011 and 2016 for CFS. Majority of patients were male (200; 57.1%), with a mean age of 19.8 ± 11.3 months. Active seizures were noted in 42 (11.3%), status epilepticus in 35 (9.4%) while 97 (26.1%) had a seizure in the pediatric emergency department. The distribution of SBI was as follows: bacteremia (3; 1.1%), urinary tract infection (7; 3.7%), pneumonia (15; 6.8%), and bacterial meningitis (0; 0%). Electroencephalography (EEG) abnormality was rare (7/158; 4.4%). Seizure recurrence during hospitalization was uncommon (19; 5.1%). Logistic regression analysis did not reveal any predictors for seizure recurrence. The seizure recurrence rate during hospitalization, EEG yield, and SBI incidence was low in children with CFS.

Hypothermia‐induced triphasic waves

AbstractA 79‐year‐old Japanese woman was admitted to our hospital with consciousness disturbance and difficulty in moving. On admission, her core temperature was 28°C. Electroencephalography showed slow waves and frontal‐dominant triphasic waves. After rewarming, her symptoms and electroencephalography abnormality disappeared. Triphasic waves and their resembling appear in numerous cerebral diseases, for example, metabolic encephalopathy, antibiotic encephalopathy, and stroke; however, there are only a few case reports of hypothermia‐associated triphasic waves.