Epileptic Attacks Research Articles

Sida cordifolia Linn- An widely used herbs in the village of Falta, west Bengal, India: Pharmacological evaluation of antiepileptic activity of root extract of Sida cordifolia Linn.

As per the observation of the social work activitist it was found that the raw extract of the root of Sida cordifolia Linn. Are been used by some old people in the village of Falta Block of South 24 PGS district of West Bengal, India to treat epileptic attack on some villagers. The identified plant were collected and handed over the research scientists for the further study. The dried coarse powder of the root of Sida cordifolia Linn. Were soxheleted successively with petroleum ether (PESC), methanol (MESE), with boiled water (AESC) and the epileptic study was performed on the Albino mice using 100 and 300 mg/kg body weight of PESC, MESE and using clonazepam as standard using Maximum Electroshock induced seizure model and result depicted that PESC exhibited a significant antiepileptic effect at both low and high doses where as MESC exhibited the significant antiepileptic effect only at high dose. Hence, the petroleum ether extract may be chosen to be more effective than that of the methanol extract.

Effect of Helicobacter pylori Eradication on Serum Level of Valproic Acid in Children with Idiopathic Generalized Epilepsy.

The purpose of this study was to determine the influence of H. pylori eradication on the serum level of the orally administered valproic acid (VPA) in children with idiopathic generalized epilepsy; Methods: This prospective cohort observational study included 100 children with idiopathic generalized epilepsy, recruited from a neurology clinic from May 2021 to December 2021. The patients were divided into two groups, each containing 50 children. The first group had a positive H. pylori stool antigen and H. pylori-related symptoms, while the second group had a negative antigen. H. pylori Eradication therapy was given to the positive H. pylori group. The serum level of VPA was obtained at baseline and 4 weeks after eradication therapy. Despite there being no significant difference between the H. pylori-positive and H. pylori-negative groups regarding the baseline VPA serum level (79.9 ± 13.9 and 77.9 ± 13.1 mcg/mL), respectively, the serum VPA level had significantly increased after H. pylori eradication therapy (99.4 ± 11 mcg/mL) (p value = 0.000), as opposed to the H. pylori-negative group (85.3 ± 10.9 mcg/mL) (p value = 0.142). Furthermore, there was a statistically significant association with a negative correlation between the VPA serum level after eradication and the number of epileptic attacks per month (p value = 0.033, R value = -0.301) and the dose of VPA (p value = 0.046, R value = -0.284). The eradication of H. pylori resulted in a highly significant improvement in the serum level of the orally given VPA in children with idiopathic generalized epilepsy, as well as an indirect decrease in the frequency of epileptic events per month, allowing for dose reduction. Eradication therapy may have anticonvulsant properties and might indirectly aid in the management of epileptic activity. H. pylori screening for children with idiopathic generalized epilepsy can optimize serum VPA levels, potentially leading to better seizure control. To our knowledge, this is the first study in the literature to describe the effect of H. pylori eradication on the serum level of the orally administered VPA in children with idiopathic generalized epilepsy.

Dietary management and access to treatment for patients with glucose deficiency syndrome type 1: an overview review with focus on the European regulatory framework.

Glut-1 deficiency Syndrome (GLUT-1 DS) is a rare disease caused by a mutation in the SLC2A1 gene that codes for the glucose transporter protein GLUT-1 DS. Currently, there is no indicated drug therapy for this condition and ketogenic diet (KD) is the most effective remedy to treat it. The objective of this study was to review the published literature that evaluated the effectiveness of KD in the dietary management of GLUT-1 DS syndrome, describing the state-of-the-art the treatment pathway for patients with GLUT-1 DS syndrome in light of the current European regulatory framework within the National Health Services. The literature search was carried out on September 10, 2023, and all studies conducted in humans diagnosed with GLUT-1 deficiency syndrome and treated with KD were included. A total of 156 scientific papers have been extracted. Applying the exclusion criteria, 38 articles have been considered eligible. In 29 out of 38 studies, the main outcome for determining the efficacy of KD was the measurement of the number of epileptic seizures, demonstrating that patients treated with KD experienced improvements with a clear reduction in the number of epileptic attacks. Currently, in the European Union, only one country provides full reimbursement by the national health system for KD. Although they are crucial for the treatment of GLUT-1 DS, according with current food regulations, KD are not evaluated on the basis of an unambiguous efficacy result, but only on the basis of safety. As a result, it is desirable to carry out clinical studies in the coming years based on the determination of efficacy in target populations, also in view of the marketing of these products on the European market.

Propagation of transient explosive synchronization in a mesoscale mouse brain network model of epilepsy.

Generalized epileptic attacks, which exhibit widespread disruption of brain activity, are characterized by recurrent, spontaneous, and synchronized bursts of neural activity that self-initiate and self-terminate through critical transitions. Here we utilize the general framework of explosive synchronization (ES) from complex systems science to study the role of network structure and resource dynamics in the generation and propagation of seizures. We show that a combination of resource constraint and adaptive coupling in a Kuramoto network oscillator model can reliably generate seizure-like synchronization activity across different network topologies, including a biologically derived mesoscale mouse brain network. The model, coupled with a novel algorithm for tracking seizure propagation, provides mechanistic insight into the dynamics of transition to the synchronized state and its dependence on resources; and identifies key brain areas that may be involved in the initiation and spatial propagation of the seizure. The model, though minimal, efficiently recapitulates several experimental and theoretical predictions from more complex models and makes novel experimentally testable predictions.

Chronic stress intensify PTZ-induced seizures by triggering neuroinflammation and oxidative stress

BackgroundEpilepsy is a paroxysmal abnormal hypersynchronous electrical discharge characterized by recurrent seizures. It affects more than 50 million people worldwide. Stress is the leading cause of neurodegeneration and can produce seizures that may lead to or aggravate epilepsy. Inflammation plays a vital role in epilepsy by modulating oxidative stress, and levels of neuroinflammatory cytokines including NF-κB, TNF-α, and IL-1β. MethodsStress-induced changes in behavior were evaluated in mice by employing behavioral assessment tests such as an elevated plus maze, light-dark box, open field test, tail suspension test, Y-maze, novel object recognition test, and Morris water maze in pentylenetetrazole (PTZ) kindled mice. Behavioral changes in all these paradigms including seizure score, latency, and frequency showed an increase in symptoms in PTZ (35 mg/kg) induced seizures in stressed mice (RS-PTZ) as compared to PTZ, Stress, and normal animals. ResultsThe Enzyme-linked immunosorbent assay (ELISA) results confirmed increased in serum cortisol levels. Histological examinations showed neurodegenerative changes in the hippocampus and cortex regions. The spectrophotometric evaluation showed an increase in oxidative stress by decreasing antioxidant production i.e. reduced glutathione, glutathione -s- transferase, and catalase (CAT), and increasing oxidant levels such as maloaldehyde and nitric oxide. Immunohistochemistry results showed increased expression of NF-κB, TNF-α, and IL-1β in the cortex and hippocampus of mice brains. ConclusionsResults from the study conclude that stress increases the likelihood of eliciting an epileptic attack by increasing the level of reactive oxygen species and neuroinflammation.

Antiepileptic drug-loaded and multifunctional iron oxide@silica@gelatin nanoparticles for acid-triggered drug delivery

The current study developed an innovative design for the production of smart multifunctional core-double shell superparamagnetic nanoparticles (NPs) with a focus on the development of a pH-responsive drug delivery system tailored for the controlled release of Phenytoin, accompanied by real-time monitoring capabilities. In this regard, the ultra-small superparamagnetic iron oxide@silica NPs (IO@Si MNPs) were synthesized and then coated with a layer of gelatin containing Phenytoin as an antiepileptic drug. The precise saturation magnetization value for the resultant NPs was established at 26 emu g-1. The polymeric shell showed a pH-sensitive behavior with the capacity to regulate the release of encapsulated drug under neutral pH conditions, simultaneously, releasing more amount of the drug in a simulated tumorous-epileptic acidic condition. The NPs showed an average size of 41.04 nm, which is in the desired size range facilitating entry through the blood–brain barrier. The values of drug loading and encapsulation efficiency were determined to be 2.01 and 10.05%, respectively. Moreover, kinetic studies revealed a Fickian diffusion process of Phenytoin release, and diffusional exponent values based on the Korsmeyer-Peppas equation were achieved at pH 7.4 and pH 6.3. The synthesized NPs did not show any cytotoxicity. Consequently, this new design offers a faster release of PHT at the site of a tumor in response to a change in pH, which is essential to prevent epileptic attacks.

An Ayurveda Case Study on GTCS w.s.r to Apasmara Roga

The word ‘Epilepsy’ is derived from Greek meaning- ‘to seize upon’. The disease Apasmara is diagnosed based upon shrewd observation of the symptoms, with the main presenting feature of this disease as “Apaya (loss) of Smriti (memory)” i.e., ‘loss of memory/ consciousness’. Apasmara occurs due to an aberration of not only the physical bio-entities Vata, Pitta and Kapha dosha but also of the psychological (Manasika) attributes like Sattva (harmonious), Rajah (passion/activity), and Tamah (inertia/ignorance). It is presented with transient appearance of unconsciousness (Tamah Pravesha) with abhorrent activities like froth from mouth, abnormal postures of the body (Vibhatsa Cheshta, referring to the involuntary movements during the seizures) and psychological symptoms like perversion of memory and cognition (Smriti-buddhi Samplava). Here the case was pre diagnosed with GTCS (generalised toni-clonic seizures) having symptoms such as decreased memory, epileptic attack 3 months ago which impersonates with Vataja Apasmara. So, in this case study an effort is made to correct the cause and the epileptic attacks with other associated symptoms by giving oral medications having predominantly Vata Shamak properties as well as Shodhana Chikitsa (Nasya).

USE OF JRQA INDICATORS OF ELECTROENCEPHALOGRAPHY DATA FOR THEIR TYPIFICATION

The paper calculated JRQA indicators from real data from group E of the Bonn Medical University database during an epileptic attack. An analysis of the corresponding calculated JRQA parameter values for the same data is presented. Comparison and comparison of these parameters allows us to consider the issue of their use to clarify the problem of fuzzy typing the presented information.

The impact of omega-3 on recurrent seizures in epileptic patients: A case study with evidence-based approaches

Background: Epileptogenesis is also associated with increased production of excessive pro-inflammatory cytokines” which shows connection between pro-inflammatory cytokines as triggering factor with omega-3 which has anti-inflammatory effect. Omega-3, known for its neuroprotective and anticonvulsant properties, exhibits promising effects on epileptic seizure attacks.
 Objective: This study aimed to evaluate the effect of omega-3 supplementation on the incidence of seizures in epilepsy patients.
 Methods: This study used a literature search using advanced queries in the databases PubMed, Scopus, ProQuest, and Cochrane Library, and combined MeSH terms with Title/Abstract. The collected literature is discarded if there are duplicates, then literature is filtered that meets the eligibility criteria. We used the Oxford Center for Evidence-Based Medicine as a means of critical appraisal and determining the level of evidence of the selected literature.
 Results: Four chosen literatures were critically assessed. Two articles indicating no significant difference between omega-3 and placebo and two articles showed had a significantly higher number of seizure-free days than placebo. The first article, involving 78 adults, reported a 50% reduction in seizure risk with a frequency RR of 0.57, 95% CI 0.19 to 1.75 (IS = 0%) indicating no significant difference between omega-3 and placebo groups after 12 weeks of treatment. The second study, comprising mostly non-significant findings, demonstrated no significant correlation between omega-3 and epilepsy attacks in epilepsy patients. The third literature revealed seizure occurrences per month in the EPA group (9.7±1.2), DHA group (11.7±1.5), and placebo group (16.6±1.5). Incidence rate ratio (IRR) adjusted for seizure type in EPA and DHA groups compared to the placebo group were 0.61 (CI = 0.42–0.88, p = 0.008, a 42% reduction) and 0.67 (CI = 0.46–1.0, p = 0.04, a 39% reduction), respectively. Both treatment groups had a significantly higher number of seizure-free days compared to the placebo group (p < 0.05). The fourth study reported intervention group frequency (4.72 ± 1.6, p= 0.014) and placebo frequency (11.64 ± 1.63, p=0.014) with intervention group seizure duration (6.64 ± 1.39, p=0.009) compared to placebo group (14.36 ± 2.18, p=0.009).
 Conclusion: Omega-3 supplementation may be considered for management in patients with recurrent epileptic seizures, although its effect on reducing seizure frequency remains inconsistent.

Hypoxic convulsions induced by adult respiratory distress syndrome in Covid-19 patient

Covid 19 is one of the major infections that primarily attacks the respiratory tract. The most common symptoms at onset of COVID-19 illness are temperature, cough, dyspnea, hemoptysis and diarrhea. In severe cases, patients may develop severe pneumonia - often billateral, acute respiratory distress syndrome (ARDS) and multi-organ failure including perimyocarditis. Hypoxic convulsions is a rare finding, however it is associated with very dangerous disease and poor prognosis. This current report presents severe Covid-19 patient with ARDS and severe hypoxia accompanied with hypoxic seizures after exclusion of meningoencephalitis and other possible etiologies for epileptic attack.

Cyber Security Based Application-Specific Integrated Circuit for Epileptic Seizure Prediction Using Convolutional Neural Network

In the event of an epileptic attack, the Field-Programmable Gate Array (FPGA)-accelerated Convolutional Neural Network (CNN) model is paired with Electroencephalogram (EEG) acquisition equipment to produce a reliable production system that can be used in clinical medical diagnosis. Additionally, this study includes cybersecurity to protect both the epileptic patient’s data and the prediction system. Epilepsy is a frequent neurological disorder that manifests as recurrent seizures, a sign that indicates rapid intervention is necessary to minimize adverse events and improve patient health. The study provides a new real-time design for predicting epileptic seizures based on the Application-Specific Integrated Circuit (ASIC)-based Very Large-Scale Integration (VLSI) architecture. As a first step, EEG data from epilepsy patients were captured and pre-processed. Afterwards, faults and artefacts in the data were removed. Additionally, data was divided into short-time windows and then classified as either ictal, pre-seizure, or interictal. The CNN model was adapted for EEG signal analysis and then trained with categorized data. This technique is more effective and efficient for predicting epileptic seizures accurately, which is advantageous for patient monitoring and treatment. Additionally, cybersecurity measures were implemented to secure patient data and the prediction system.

Study of the Potential of MRI (Magnetic Resonance Imaging) in Detecting Epileptogenic Zones in the Brain

The epileptogenic zone is an area of the brain that is a source of uncontrolled epileptic activity. MRI can produce images of the brain with high spatial resolution, allowing detailed visualization of brain structure. This allows identification of pathological changes, such as lesions, hemorrhages, or vascular malformations, that may be a cause or indicator of an epileptogenic zone. MRI offers a variety of scanning techniques, including structural MRI (T1-weighted and T2-weighted), diffusion MRI, functional MRI (fMRI), and proton spectroscopy MRI. The literature search process was carried out on various databases (PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar) regarding the potential of MRI (Magnetic Resonance Imaging) in detecting epileptogenic zones in the brain. This study follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) recommendations. MRI can produce images of the brain with high spatial resolution, allowing detailed identification of brain structures that may be associated with the epileptogenic zone. Lesions such as tumors, blood clots, or scar tissue that are the focus of epileptic activity can be clearly seen on MRI. Various MRI techniques, such as structural MRI, diffusion MRI, functional MRI, and proton spectroscopy MRI, can be used together to provide comprehensive information about the epileptogenic zone. MRI allows monitoring of brain structural changes over time, which is useful in determining the evolution of the epileptogenic zone. fMRI techniques help understand brain activity during epileptic attacks or as part of the epileptogenic zone.

Evaluation of the Effects of Fasting During the Holy Month of Ramadan on Patients with Epileptic Attacks Who Visited the Emergency Room

Background: Epilepsy is one of the most common disorders of the central nervous system. Many factors affect the occurrence and severity of epileptic attacks (EAs). Food is one of the most challenging of the factors. Fasting during Ramadan is one of the important requirements in Islam, and it has always been challenging for epileptic patients. This study evaluated the number of EA cases admitted to the emergency room (ER) during Ramadan. Methods: This prospective and cross-sectional study evaluated all ER visits by EA patients during the months of Shaaban, Ramadan, and Shawwal (all were convulsions). In this study, the mean average ER visit frequency was compared in the three months. The differences between the mean averages of EA visits were significant (P<0.05). Results: Of the 156 cases, half were male and half were female. The frequency of EAs was 68, 35, and 53 for the months of Shaaban, Ramadan, and Shawwal, respectively. It was found that there was about 40% reduction in ER visits during the month of Ramadan, mainly due to the discontinuation of antiepileptic drugs. Conclusion: During the Holy month of Ramadan, the number of visits to the ER due to EA (convulsions) decreased. Two mechanisms are involved in the reduced number of epileptic occurrences and their control: First, the consumption of a high-fat diet and bigger protein portions, and, second, reduced food consumption. Other possible factors are reduced travel during Ramadan, better administration of drugs, and the peaceful mind attributed to this month.

Treatment of epileptic drop attacks (atonic seizures) not only depends on skills, but also etiology, tolerability, and EEG.

Treatment of epileptic drop attacks (atonic seizures) not only depends on skills, but also etiology, tolerability, and EEG.

Resting-state fMRI in patients with refractory epilepsy with and without drop attacks: exploring the connectivity of sensorimotor cortex

ObjectivePatients with multifocal or generalized epilepsies manifesting with drop attacks have severe refractory seizures and significant cognitive and behavioural abnormalities. It is unclear to what extent these features relate to network abnormalities and how networks in sensorimotor cortex differ from those in patients with refractory focal epilepsies. Thus, in this study we sought to provide preliminary data on connectivity of sensorimotor cortex in patients with epileptic drop attacks, in comparison to patients with focal refractory epilepsies. MethodsResting-state fMRI (rs-fMRI) data was available for 5 patients with epileptic drop attacks and 15 with refractory focal epilepsies undergoing presurgical evaluation. Functional connectivity was analyzed with a seed-based protocol, with primary seeds placed at the precentral gyrus, the postcentral gyrus and the premotor cortex. For each seed, the subjects’ timeseries were extracted and transformed to Z scores. Between-group analysis was then performed using the 3dttest+ + AFNI program. ResultsTwo clusters of reduced connectivity in the group with drop attacks (DA group) in relation to those with focal epilepsies were found in the between-group analysis: the precentral seed showed reduced connectivity in the surrounding motor area, and the postcentral seed, reduced connectivity with the ipsilateral posterior cingulate gyrus. In the intra-group analyses, sensorimotor and premotor networks were abnormal in the DA group, whereas patients with focal epilepsies had the usual connectivity maps with each seed. ConclusionThis pilot study shows differences in the cerebral connectivity in the sensorimotor cortex of patients with generalized epilepsies and drop attacks which should be further explored to better understand the biological bases of the seizure generation and cognitive changes in these people.

P10-05: The relationship between environmental air pollution, meteorological factors, and emergency service admissions for epileptic attacks in children

P10-05: The relationship between environmental air pollution, meteorological factors, and emergency service admissions for epileptic attacks in children

The relationship between the lunar cycle and epileptic attacks and their treatment

Objective: The purpose of the present study was to evaluate the potential association between the phases of the moon and seizure attacks and treatment in patients diagnosed with epilepsy at a pediatric neurology clinic. Materials and Methods: 199 patients presenting to the Balıkesir University Medical Faculty pediatric neurology clinic, Turkey, diagnosed with epilepsy based on ILAE criteria were included in the study. The patients’ demographic characteristics, medications used, and family histories, and the frequency and duration of attacks were investigated retrospectively. Results: The mean age of the patients enrolled in the study (N=199) was 10.07±4.90 years. The patients were most frequently in the 12-18 age range (N=83, 41.7%). The majority of patients were male (N=104, 52.3%). Analysis revealed that seizures were most frequent in the full moon (N=54, 27.1%), followed by the new moon (N=52, 26.1%) and first quarter (N=47, 23.6%), and were least common in the third quarter (N=46, 23.1%). No statistically significant variation was determined in terms of attack frequencies during the different lunar phases between patients receiving monotherapy and polytherapy (p=0.206). Conclusion: The results of the present study suggest that there is no relationship between the lunar cycle and the frequency

Evaluating the bioequivalence of levetiracetam brand and generic oral tablets available in the Saudi market in vivo

BackgroundEpilepsy is a common global neurological disorder. About 30% of epileptic patients are managed with anti-epileptic Drugs (AEDs). Since 2000, Levetiracetam (LEV) has been marketed around the world as an AED under the brand name Keppra, and recently more generics are found in the Saudi market as cheaper alternatives. The objective of this study is to evaluate the bioequivalence of LEV brand and generics available in the Saudi market in mice. MethodsPharmacokinetics (PK), liver function test, and behavioral studies were conducted for LEV brand and generic in different groups of Blab/c mice. ResultsPK results show a significance difference in PK parameters mostly evidenced with generic 3, then generic 2. The only significant different between Keppra and generic 1 was in T1/2. In addition, Keppra did not significantly increase liver enzymes in comparison to other generics. On the other hand, other generics showed less favorable results in increasing liver enzymes. Keppra reduced the number and intensity of epileptic attacks, had no mortality rate due to epilepsy, and was associated with less sever seizures attacks. ConclusionKeppra, the brand form of LEV, has better safety and efficacy profiles in mice compared to 3 generics found in the Saudi market. Therefore, we recommend evaluating the same parameters tested in this study in patients utilizing similar generics and brand to establish the existence of bioequivalence between LEV brand and generics.

Treatment of drop attacks: Anti-seizure drug choices of pediatric neurologists in Saudi Arabia.

To evaluate Epileptic drop attacks (EDAs) treatment options among pediatric neurologists in Saudi Arabia (SA) and to develop a recommendation scheme for the management of EDAs in SA. Epileptic drop attacks are one of the most pharmaco-resistant epileptic seizures. The different approaches to EDA treatment are influenced by a variety of factors, including pharmaceutical availability, costs, side effects, treating physicians' experience and personal preferences. This cross-sectional study was conducted online. A structured questionnaire that aimed to measure the therapeutic options for patients with EDA was electronically distributed to pediatric neurologists across SA. It contained 21 questions, and the data were collected in Excel sheets and analyzed. Our study included a cohort of 71 pediatric neurologists from SA, of which male doctors represented 60%. Most of the participating pediatric neurologists had more than 10 years of experience in the field. We found that 77% of the included pediatric neurologists used valproic acid as a first-line drug in patients with EDA. Further, in the different case scenarios provided to participants, levetiracetam, clobazam, topiramate, and rufinamide were included in the initial management protocol for EDA. The majority of pediatric neurologists in Saudi Arabia chose valproic acid and/or levetiracetam as the first line of treatment for EDA. These results highlight the need for an evidence-based clinical guidelines to treat EDA.

A Rare Case of Infantile Otalgia and Otorrhagia due to Alive Leech Bite

Abstract Pediatric ear infestation with leeches is a rare event; however, it can lead to serious complications. Leeches usually make their way into the human body through bathing with or drinking of contaminated water from nonhygienic sources and swimming in infested water. To our knowledge, this is the first report of leech removal from the external auditory canal in an infant. We described the case of a 3-month-old infant who presented to our institution with sudden left otalgia, otorrhagia, poor oral intake, and prolonged crying for 4 days, culminating in a single epileptic attack, drowsiness, and electrolyte disturbances. Microscopic visualization of the left ear revealed minimal oozing of blood with clots obscuring the ear canal and a live motile 3 cm leech deeply seated near the tympanic membrane. Extraction was performed. The bloody discharge ceased completely and all symptoms were relieved. Leech infestation is typically considered after other potential etiologies in infants with sudden otorrhagia and otalgia living in an endemic region. It should be considered a hidden cause of pediatric discomfort. Detailed history taking and meticulous ear examinations are vital for the prompt management to avoid unnecessary computed tomography imaging and radiation, unhelpful interventions, and delayed treatment. A diagnosis was reached and treatment performed by careful inspection and leech removal, respectively.