Epileptic Discharges Research Articles

Cognitive deficit in post-acute COVID-19: an opportunity for EEG evaluation?

Among the most common post-COVID symptoms, many patients experienced subjective cognitive deficit, commonly named "brain fog," that might be present also in those individuals without severe acute COVID-19 respiratory involvement. Some studies have investigated some of the mechanisms that might be associated with the brain fog with objective techniques including transcranial magnetic stimulation and neuroimaging. The aim of this studywas to investigate the presence of electroencephalographic (EEG) alterations in people with post-COVID self-reportedcognitive deficit. Out of the 90 patients attending the post-COVID neurology ambulatory service, twenty patientspresenting brain fog at least 4 weeks after acute non-severe COVID-19 infection, and without previous history of epilepsy,were investigated with 19-channel EEG, Montreal Cognitive Assessment (MoCA), and magnetic resonance imaging (MRI).EEG was found altered in 65% of the sample, among which 69% presented a slowing activity and 31% were characterizedby epileptic discharges principally in the frontal areas. None of the patients showed DWI MRI lesions. These findings highlight the usefulness of EEG analysis to objectively describe possible neurophysiological abnormalities in post-COVID patients presenting subjective cognitive deficit.

Chronological changes in phase-amplitude coupling during epileptic seizures in temporal lobe epilepsy

ObjectiveTo analyze chronological changes in phase-amplitude coupling (PAC) and verify whether PAC analysis can diagnose epileptogenic zones during seizures. MethodsWe analyzed 30 seizures in 10 patients with mesial temporal lobe epilepsy who had ictal discharges with preictal spiking followed by low-voltage fast activity patterns on intracranial electroencephalography. We used the amplitude of two high-frequency bands (ripples: 80–200 Hz, fast ripples: 200–300 Hz) and the phase of three slow wave bands (0.5–1 Hz, 3–4 Hz, and 4–8 Hz) for modulation index (MI) calculation from 2 minutes before seizure onset to seizure termination. We evaluated the accuracy of epileptogenic zone detection by MI, in which a combination of MI was better for diagnosis and analyzed patterns of chronological changes in MI during seizures. ResultsMIRipples/3–4 Hz and MIRipples/4–8 Hz in the hippocampus were significantly higher than those in the peripheral regions from seizure onset. Corresponding to the phase on intracranial electroencephalography, MIRipples/3–4 Hz decreased once and subsequently increased again. MIRipples/4–8 Hz showed continuously high values. ConclusionsContinuous measurement of MIRipples/3–4 Hz and MIRipples/4–8 Hz could help identify epileptogenic zones. SignificancePAC analysis of ictal epileptic discharges can help epileptogenic zone identification.

Genetic and clinical variations of developmental epileptic encephalopathies

ABSTRACT Objective The concept of ‘developmental and epileptic encephalopathy (DEE)’ recognises that in infants presenting with severe early-onset epilepsy, neurodevelopmental comorbidity may be attributable to both the underlying cause and to adverse effects of uncontrolled epileptic activity. There is no direct genotype – phenotype correlation in DEEs. This study aimed to report the genetic and phenotypic differences in patients with DEE. Methods Genetic evaluations of the patients were performed due to epilepsy combined with developmental delay, epileptic encephalopathy, motor deficits, autistic features, or cognitive impairment. Patients were assessed for demographic characteristics, medical history, family history, psychomotor development, seizure control interventions, electroencephalogram (EEG) and magnetic resonance imaging (MRI) findings. Results This study included 20 children aged 0–16 years who were diagnosed as having DEE.The types of DEE detected in our study were DEE 2, 4, 6B, 7, 11, 26, 30, 33, 35, 42, 58, 62, and 67.Status epilepticus was recorded in only DEE7. The most common EEG abnormality was multifocal epileptic discharges (35%,) followed by burst-suppression patterns in patients with neonatal-onset seizures. Thirteen of the children were aged over 2 years, two (15%) were non-ambulatory and six (46%) were non-verbal. MRI scans were normal in 80% of the patients. Refractory epilepsy seen in 33% of cases.De-novo mutation, microcephaly and dysmorphic findings accompany resistant seizures and are associated with poor prognosis Discussion For patients with movement disorders, developmental delay, autism, and ID with or without epilepsy in any period of their life, next-generation sequencing is the only diagnostic technique available, with genetic analysis often being the only diagnostic method.

Extracting the Invisible: Mesial Temporal Source Detection in Simultaneous EEG and SEEG Recordings.

Epileptic source detection relies mainly on visual expertise of scalp EEG signals, but it is recognised that epileptic discharges can escape to this expertise due to a deep localization of the brain sources that induce a very low, even negative, signal to noise ratio. In this methodological study, we aimed to investigate the feasibility of extracting deep mesial temporal sources that were invisible in scalp EEG signals using blind source separation (BSS) methods (infomax ICA, extended infomax ICA, and JADE) combined with a statistical measure (kurtosis). We estimated the effect of different methodological and physiological parameters that could alter or improve the extraction. Using nine well-defined mesial epileptic networks (1949 spikes) obtained from seven patients and simultaneous EEG-SEEG recordings, the first independent component extracted from the scalp EEG signals was validated in mean from 46 to 80% according to the different parameters. The three BSS methods equally performed (no significant difference) and no influence of the number of scalp electrodes used was found. At the opposite, the number and amplitude of spikes included in the averaging before the extraction modified the performance. Anyway, despite their invisibility in scalp EEG signals, this study demonstrates that deep source extraction is feasible under certain conditions and with the use of common signal analysis toolboxes. This finding confirms the crucial need to continue the signal analysis of scalp EEG recordings which contains subcortical signals that escape to expert visual analysis but could be found by signal processing.

A Drimane Meroterpenoid Borate as a Synchronous Ca+ Oscillation Inhibitor from the Coral-Associated Fungus Alternaria sp. ZH-15.

Territrem F (1), a drimane meroterpenoid bearing a unique borate ring system, was isolated together with its diol precursor territrem B (2) from the fungus Alternaria sp. ZH-15 associated with the soft coral Lobophytum crassum collected in the South China Sea. The structure of the new compound was elucidated by spectroscopic analysis and an X-ray single-crystal diffraction study, representing a new type of boron-containing natural product. Both compounds significantly inhibited spontaneous synchronous Ca2+ oscillations (SCOs) and epileptic discharges induced by 4-aminopyridine, showing the potential for antiepileptic drug research. The 5,9-boronic ester derivative of 2 did not change its SCO inhibitory activity.

A case of migraine misdiagnosed as epilepsy

BackgroundMigraine and epilepsy are both episodic disorders, with some overlapping symptoms, mechanisms and therapies. Clinically, there is a comorbid relationship between them. Some migraine patients may exhibit epileptic discharges by electroencephalogram (EEG) recording. Therefore, the two conditions are easily misdiagnosed.Case presentationWe reported a 16-year-old female patient who was admitted to our hospital due to repeated headaches with disturbance of consciousness. Epileptic discharge was recorded by long-term EEG. The patient had been misdiagnosed as epilepsy, and had no response to anti-seizure medicines (ASMs). We revised her diagnosis and prescribed ibuprofen in her acute episode and prophylactic medicine, including flunarizine and amitriptyline in her interictal period. One week later, her headache disappeared.ConclusionsThis patient manifested with altered levels of consciousness during headache episodes, and the abnormal EEG results lead to the misdiagnosis as epilepsy. Clinicians should be cautious to the distinction between migraine and epilepsy.

Tramadol Abuse-associated Seizure: An Epidemiological and Electroencephalographic Study

Background: Seizure is one of the most severe side effects of tramadol abuse that can be irreversible. Objectives: This study aimed to investigate the frequency of tramadol abuse-associated seizure and electroencephalogram findings in patients with seizures. Patients and Methods: This cross-sectional study was conducted on patients with generalized tonic-clonic seizures caused by tramadol abuse. After history examination and systemic and neurologic evaluation, patients with abnormality in the neurological examination, metabolic evaluation, or non-contrast CT scan were excluded. Electroencephalography was performed between the third and fifth day. Demographic data and electroencephalographic findings were recorded and analyzed. Results: A total of 356 patients with seizures was enrolled, and tramadol abuse-associated seizure was the initial diagnosis in 12.9% of the patients. Among them, 9.3% had tramadol abuse seizures, which followed the study protocol completely. Abnormal electroencephalography was found in 48.5% of the patients, and epileptic discharges were observed in 21.2% of them. The consumed amount of tramadol, the duration of consumption, and the time interval between the consumption of tramadol and the onset of seizure were associated with electroencephalogram abnormality. Conclusions: Tramadol abuse-associated seizures occurred in a significant number of patients. Half of the patients had electroencephalogram abnormalities.

Vagus nerve stimulation for pharmacoresistant epilepsy secondary to encephalomalacia: A single-center retrospective study.

Vagus nerve stimulation (VNS) is an adjunctive treatment for pharmacoresistant epilepsy. Encephalomalacia is one of the most common MRI findings in the preoperative evaluation of patients with pharmacoresistant epilepsy. This is the first study that aimed to determine the effectiveness of VNS for pharmacoresistant epilepsy secondary to encephalomalacia and evaluate the potential predictors of VNS effectiveness. We retrospectively analyzed the seizure outcomes of VNS with at least 1 year of follow-up in all patients with pharmacoresistant epilepsy secondary to encephalomalacia. Based on the effectiveness of VNS (≥50% or <50% reduction in seizure frequency), patients were divided into two subgroups: responders and non-responders. Preoperative data were analyzed to screen for potential predictors of VNS effectiveness. A total of 93 patients with epilepsy secondary to encephalomalacia who underwent VNS therapy were recruited. Responders were found in 64.5% of patients, and 16.1% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time, with 36.6, 50.5, 64.5, and 65.4% at the 3-, 6-, 12-, and 24-month follow-ups, respectively. After multivariate analysis, seizure onset in adults (>18 years old) (OR: 0.236, 95%CI: 0.059-0.949) was found to be a positive predictor, and the bilateral interictal epileptic discharges (IEDs) (OR: 3.397, 95%CI: 1.148-10.054) and the bilateral encephalomalacia on MRI (OR: 3.193, 95%CI: 1.217-8.381) were found to be negative predictors of VNS effectiveness. The results demonstrated the effectiveness and safety of VNS therapy in patients with pharmacoresistant epilepsy secondary to encephalomalacia. Patients with seizure onset in adults (>18 years old), unilateral IEDs, or unilateral encephalomalacia on MRI were found to have better seizure outcomes after VNS therapy.

A case of cryptogenic new-onset refractory status epilepticus (NORSE) in which cerebrospinal fluid IL-6 was elevated with increased seizure frequency early in the disease: a case report

A 25-year-old male presented with clonic seizures three days following a fever. The patient developed status epilepticus and required mechanical ventilation and intravenous anesthesia. The patient's epileptic seizures persisted despite administering intravenous anesthesia and multiple anti-epileptic drugs. The clinical presentation in this case, without pre-existing relevant neurological disorder and an active structural, toxic, or metabolic cause in the acute phase, was compatible with new-onset refractory status epilepticus (NORSE). After immunotherapy, including intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulin therapy, the epileptic discharge on electroencephalogram (EEG) decreased gradually, and mechanical ventilation was discontinued. Neversless the final outcome was poor. The patient's condition was finally diagnosed as cryptogenic NORSE. The IL-6 levels in the cerebrospinal fluid showed a significant increase between day 6 and 11 after onset, during which time there was a rapid escalation in seizure frequency on EEG. Considering this, IL-6 may be involved in the process of seizure exacerbation.

Temporal lobe epilepsy in cats.

In recent years there has been increased attention to the proposed entity of feline temporal lobe epilepsy (TLE). Epileptic discharges in certain parts of the temporal lobe elicit very similar semiology, which justifies grouping these epilepsies under one name. Furthermore, feline TLE patients tend to have histopathological changes within the temporal lobe, usually in the hippocampus. The initial aetiology is likely to be different but may result in hippocampal necrosis and later hippocampal sclerosis. The aim of this article was not only to summarise the clinical features and the possible aetiology, but also being work to place TLE within the veterinary epilepsy classification. Epilepsies in cats, similar to dogs, are classified based on the aetiology into idiopathic epilepsy, structural epilepsy and unknown cause. TLE seems to be outside of this classification, as it is not an aetiologic category, but a syndrome, associated with a topographic affiliation to a certain anatomical brain structure. Magnetic resonance imaging, histopathologic aspects and current medical therapeutic considerations will be summarised, and emerging surgical options are discussed.

Transcranial focused ultrasound and electrocorticography-based closed-loop epilepsy control system for an awake rat model

Abstract Neurostimulation with closed-loop interaction is one of the clinical solutions for patients with drug-resistant epilepsy. However, there are growing demands for an epilepsy control system with minimal invasiveness. Transcranial focused ultrasound (tFUS) is a promising non-invasive neuromodulation technique for controlling epileptic seizures due to its superior spatial specificity and depth penetrability. Here, we demonstrated a tFUS-based closed-loop system in combination with electrocorticography (ECoG), which provides precise monitoring of epileptic discharge for epileptic patients. In-house built 16-ch ECoG electrodes were attached to the Sprague-Dawley rat’s dura for detecting seizure spike-wave proceeding high-frequency oscillations (HFO) and monitoring epileptic discharges. After recovery from the surgery, kainic acid (5 mg/kg) was injected to generate a temporal lobe epilepsy rat model. An ultrasonic transducer operating at a fundamental frequency of 300 kHz was attached to the scalp for tFUS stimulation, which was automatically controlled by the system based on the HFO detection algorithm with real-time ECoG monitoring. The closed-loop tFUS stimulation on the right hippocampus with 40 Hz pulse-repetition frequency (PRF) and 5 % duty cycle induced the diminution of the duration of seizure spike-wave and the suppression of the power of brain oscillations such as theta, gamma bands from the bilateral hemisphere, compared to sham stimulation. Furthermore, the developed system is able to adjust the sonication protocol by monitoring seizure spike-wave. We therefore could provide optimized control of tFUS stimulation for seizure suppression. We demonstrated an ultrasound-based closed-loop system inhibiting epileptiform activity by providing tFUS stimulation before the generation of an epileptic spike-wave. The proposed system in this study shows the potential for developing a system that provides non-invasive seizure control without additional surgical burden for patients who are wearing medical brain implants such as ECoG or other types of intracranial EEG electrodes. Research Category and Technology and Methods Basic Research: 6. Pulsed Ultrasound (pUS) Keywords: transcranial focused ultrasound, closed-loop control, epilepsy, ECoG

Electrocorticography for the Evaluation of Focus Resection

Electrocorticography(ECoG)with intracranial electrodes has a higher spatial resolution and higher sensitivity than conventional electroencephagrahy. Chronic VIDEO-ECoG with subdural grid electrodes has been used to determine the resection border of epileptic focus, and to evaluate cortical function prior to resective surgery. Recording multiple seizures is necessary to determine whether they are the same as habitual seizures and whether they are reproducible, to allow subsequent identification of the seizure onset zone. It is also necessary to understand the ictal ECoG patterns of various seizure onsets. Recent advances in engineering technology have made wideband(0.01 Hz-600Hz)analysis possible. The resection of the area with the ictal DC shift and high frequency oscillation is reported to improve surgical outcome. Although the procedure of subdural grid insertion is technically easy, high rates of complications, such as infections and bleeding, have been reported. Intraoperative acute ECoG was used to validate the extent of resection area. Overall, intraoperative ECoG is greatly affected by anesthetics, and the interictal epileptic discharge should be evaluated carefully.

A hippocampal-entorhinal cortex neuronal network for dynamical mechanisms of epileptic seizure.

Temporal lobe epilepsy (TLE) is thought to be associated with neuronal hyperexcitability in the hippocampal-entorhinal cortical (EC) circuit. Due to the complexity of the hippocampal-EC network connections, the biophysical mechanisms of the different circuits in epilepsy generation and propagation are still not fully established. In this work, we propose a hippocampal-EC neuronal network model to explore the mechanism of epileptic generation. We demonstrate that enhanced excitability of pyramidal neurons in cornu ammonis 3 (CA3) can drive hippocampal-EC to produce a transition from background to seizure state and cause exaggerated phase-amplitude coupling (PAC) phenomenon of theta modulated high-frequency oscillations (HFO) in CA3, cornu ammonis 1 (CA1), dentate gyrus, and EC. Interestingly, PAC strength indirectly responds to the degree of CA3 pyramidal (PY) neuron hyperexcitability, suggesting that PAC can be used as a potential marker of seizures. Furthermore, we find that enhanced synaptic connectivity of mossy cells to granule cells and CA3 PY neurons drives the system to produce epileptic discharges. These two channels may play a key role in mossy fiber sprouting. In particular, the PAC phenomenon of delta-modulated HFO and theta-modulated HFO can be generated according to the different degrees of moss fiber sprouting. Finally, the results suggest that hyperexcitability of stellate cells in EC can lead to seizures, which supports the argument that EC can act as an independent source of seizures. Overall, these results highlight the key role of different circuits in seizures, providing a theoretical basis and new insights into the generation and propagation of TLE.

Mathematical model for epileptic seizures detection on an EEG recording

Purpose of this study — analysis of the possibility of using convolutional neural networks as a model for detecting epileptic seizures on real EEG data Methods. In this paper, wavelet analysis is used for time-frequency analysis. To localize epileptic discharges, the task of detecting them was reduced to the classification task and the ResNet18 architecture of neural network was used. Techniques were used to augment and balance the biomedical data dataset under consideration. Wavelet analysis is used for time-frequency analysis. To localize epileptic discharges, the problem of their detection was reduced to the classification task, and the ResNet18 neural network architecture was used. Techniques were used to augment and balance the considered biomedical dataset. Results. Convolutional neural network can be successfully used to detect epileptic seizures, a method of postprocessing the results of primary detection is proposed to improve the quality of the model. It is shown that the developed model demonstrates high accuracy in comparison with other methods based on classical machine learning algorithms. The value of the 𝐹1-score metric reaches 0.44, which is a high value for classification of the real biological data. Conclusion. The presented model based on a convolutional neural network for detecting epileptic seizures on an EEG recording can become the main one in medical decision support systems for epileptologist

Efficacy of vagus nerve stimulation for drug-resistant epilepsy in a survivor of poor-grade subarachnoid hemorrhage: A case report

A man in his 60s had undergone clipping for a subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm in his 40s. He survived cerebral vasospasms following surgery for poor-grade SAH and required anti-seizure medications (ASMs) for post-stroke epilepsy. More than 20 years after the clipping, he developed focal impaired awareness seizure, which decreased his quality of life (QOL). Computed tomography (CT) showed an infarct in the left frontal lobe. 123I-iomazenil single-photon emission CT showed decreased benzodiazepine accumulation in the left frontal and medial temporal lobes. An interictal electroencephalogram showed epileptic discharges in the left temporal region. We diagnosed focal epilepsy and adjusted ASMs based on seizure control. However, the seizures were not controlled, and the adverse effects worsened with dosage increase. The condition was diagnosed as drug-resistant epilepsy, and the patient underwent vagus nerve stimulation. Postoperatively, we confirmed control of seizures and improvement of QOL.

Sleep slow-wave oscillations trigger seizures in a genetic epilepsy model of Dravet syndrome.

Sleep is the preferential period when epileptic spike-wave discharges appear in human epileptic patients, including genetic epileptic seizures such as Dravet syndrome with multiple mutations including SCN1A mutation and GABAA receptor γ2 subunit Gabrg2Q390X mutation in patients, which presents more severe epileptic symptoms in female patients than male patients. However, the seizure onset mechanism during sleep still remains unknown. Our previous work has shown that the sleep-like state-dependent homeostatic synaptic potentiation can trigger epileptic spike-wave discharges in one transgenic heterozygous Gabrg2+/Q390X knock-in mouse model.1 Here, using this heterozygous knock-in mouse model, we hypothesized that slow-wave oscillations themselves in vivo could trigger epileptic seizures. We found that epileptic spike-wave discharges in heterozygous Gabrg2+/Q390X knock-in mice exhibited preferential incidence during non-rapid eye movement sleep period, accompanied by motor immobility/facial myoclonus/vibrissal twitching and more frequent spike-wave discharge incidence appeared in female heterozygous knock-in mice than male heterozygous knock-in mice. Optogenetically induced slow-wave oscillations in vivo significantly increased epileptic spike-wave discharge incidence in heterozygous Gabrg2+/Q390X knock-in mice with longer duration of non-rapid eye movement sleep or quiet-wakeful states. Furthermore, suppression of slow-wave oscillation-related homeostatic synaptic potentiation by 4-(diethylamino)-benzaldehyde injection (i.p.) greatly attenuated spike-wave discharge incidence in heterozygous knock-in mice, suggesting that slow-wave oscillations in vivo did trigger seizure activity in heterozygous knock-in mice. Meanwhile, sleep spindle generation in wild-type littermates and heterozygous Gabrg2+/Q390X knock-in mice involved the slow-wave oscillation-related homeostatic synaptic potentiation that also contributed to epileptic spike-wave discharge generation in heterozygous Gabrg2+/Q390X knock-in mice. In addition, EEG spectral power of delta frequency (0.1-4 Hz) during non-rapid eye movement sleep was significantly larger in female heterozygous Gabrg2+/Q390X knock-in mice than that in male heterozygous Gabrg2+/Q390X knock-in mice, which likely contributes to the gender difference in seizure incidence during non-rapid eye movement sleep/quiet-wake states of human patients. Overall, all these results indicate that slow-wave oscillations in vivo trigger the seizure onset in heterozygous Gabrg2+/Q390X knock-in mice, preferentially during non-rapid eye movement sleep period and likely generate the sex difference in seizure incidence between male and female heterozygous Gabrg2+/Q390X knock-in mice.

Artificial Intelligence-based Detection of Epileptic Discharges from Pediatric Scalp Electroencephalograms: A Pilot Study.

We developed an artificial intelligence (AI) technique to identify epileptic discharges (spikes) in pediatric scalp electroencephalograms (EEGs). We built a convolutional neural network (CNN) model to automatically classify steep potential images into spikes and background activity. For the CNN model' training and validation, we examined 100 children with spikes in EEGs and another 100 without spikes. A different group of 20 children with spikes and 20 without spikes were the actual test subjects. All subjects were ≥ 3 to < 18 years old. The accuracy, sensitivity, and specificity of the analysis were >0.97 when referential and combination EEG montages were used, and < 0.97 with a bipolar montage. The correct classification of background activity in individual patients was significantly better with a referential montage than with a bipolar montage (p=0.0107). Receiver operating characteristic curves yielded an area under the curve > 0.99, indicating high performance of the classification method. EEG patterns that interfered with correct classification included vertex sharp transients, sleep spindles, alpha rhythm, and low-amplitude ill-formed spikes in a run. Our results demonstrate that AI is a promising tool for automatically interpreting pediatric EEGs. Some avenues for improving the technique were also indicated by our findings.

Advances in epilepsy monitoring by detection and analysis of brain epileptiform discharges.

Brain interictal and pre-ictal epileptiform discharges (EDs) are transient events occurred between two or before seizure onsets visible in intracranial electroencephalographs. In the diagnosis of epilepsy and localization of seizure sources, both interictal and ictal recordings are extremely informative. For this propose, computerized intelligent spike and seizure detection techniques have been researched and are constantly improving. This is not only to detect more EDs from over the scalp but also to classify epileptic and non-epileptic discharges. Tensor factorization and deep learning are two advanced and powerful techniques which have been recently suggested for ED detection. Here, our main contribution is to review recent ED detection methods with emphasis on multi-way analysis and deep learning approaches. These techniques have opened a new window to the epilepsy diagnosis and management spheres.

Gentiopicroside alleviated epileptogenesis in immature rats through inactivation of NLRP3 inflammasome by inhibiting P2X7R expression.

This study aimed to elucidate the effects of Gentiopicroside (Gent) on epileptogenesis and underlying mechanisms. The status epilepticus (SE) model was established by intraperitoneal (i.p.) injection of lithium chloride (127 mg/kg) and pilocarpine (50 mg/kg) in immature rats. HAPI microglial cellular inflammation model was induced by lipopolysaccharide (LPS, 1μg/ml) and adenosine triphosphate (ATP, 5mM). The differential concentrations of Gent were used to pretreat animal (200, 400, and 800 mg/kg) and model cells (50, 100, and 200 μM). Epileptic discharges were assessed by electroencephalography (EEG) and Racine scale. Changes in spatial memory function were measured using the Morris water maze task test. Nissl and FJB staining were employed to assess the damage to hippocampus tissues. ELISA was used to detect the production of IL-1β, IL-18, and TNF-α. The expressions of P2X7R and NLRP3 were detected by q-PCR, immunofluorescence staining, and Western blot, and cell viability was determined by cell counting kit-8 (CCK-8). Lithium chloride and pilocarpine (LICL-PILO) induced abnormal EEG activities, behavioral alterations, brain damage, and inflammatory responses in immature rats. However, Gent pretreatment significantly reduced the neuronal damage and spatial memory dysfunction induced by LICL-PILO. Additionally, Gent suppressed the production of inflammatory cytokines and inhibited the expression of P2X7R, NLRP3, ASC, and Caspase-1 in LPS/ATP-induced HAPI microglial cells. Gent intervention could improve epileptogenesis in immature rats partially due to suppressing P2X7R and NLRP3 inflammasome.

Analysis of Pediatric Rasmussen Encephalitis: Experience from A Tertiary Care Hospital in Bangladesh

Background: Rasmussens encephalitis (RE) is rare progressive cerebral inflammatory disease predominantly affecting pediatric population. The key clinical features are seizure and hemiparesis. Seizure is mostly focal with or without epileptia partialis continua (EPC). Diagnosis is established by EEG showing epileptic discharges with focal slowing, focal cortical atrophy in neuroimaging and T cell dominated encephalitis in biopsy or autopsy. This study was done to describe the clinical, laboratory features and treatment of RE in Bangladesh perspective.&#x0D; Materials &amp; Methods: This study was done in Department of Pediatric Neurology, IPNA, BSMMU, Dhaka, Bangladesh. Four admitted children who were diagnosed as RE from January 2016 to July 2019 were included in this study. Retrospective detail data of the all four patients were collected and analyzed.&#x0D; Results: The age ranging was 3-12 years, all were male. Cognitive decline, speech disorder, hemiparesis were observed in all the patients. Among them 1 had prodrome of fever. All the patients had seizure, mostly focal onset. Among them 2 had EPC. Treatment was given mainly with immune modulatory drugs (Intravenous methyl prednisolone, IV immunoglobulin, oral steroids) and antiepileptic drugs. On follow up all the patients had consequences in the form of hemiparesis, epilepsy, dysphasia, cognitive disorder etc.&#x0D; Conclusion: Cognitive decline, speech disorder, focal seizure and hemiparesis were the common presentation. EPC was observed in 50% of cases and consequences on follow up in all cases.&#x0D; BANGLADESH J CHILD HEALTH 2021; VOL 45 (3) : 147-154