Epileptic Seizures In Patients Research Articles

Risk Factors for the Development of De Novo Generalized Tonic-Clonic Epileptic Seizures in Patients with Supratentorial Meningiomas after Neurosurgical Treatment

Risk Factors for the Development of De Novo Generalized Tonic-Clonic Epileptic Seizures in Patients with Supratentorial Meningiomas after Neurosurgical Treatment

Against vivisection: Charcot and Pitres’ discovery of the human motor cortex and the birth of modern neurosurgery and of the surgical treatment of epilepsy

ABSTRACT This article addresses the discrepancy between Edouard Hitzig’s and David Ferrier’s findings on the cortical localization of movements in animals and Jean-Martin Charcot’s findings in humans. The results of Hitzig’s and Ferrier’s vivisections were criticized by experimentalists in England and France as discordant, irreproducible, and inconclusive, and they were rejected by clinicians as irrelevant. Charcot addressed the gap between animal and human motor function by correlating motor deficits and focal epileptic seizures in patients to their autopsy findings. By this method he discovered the functional organization of the human motor cortex and produced the first accurate human motor brain map. Ferrier, William Osler, and Hughlings Jackson acknowledged Charcot’s findings, and his findings guided the first neurosurgeons in localizing and resecting intracranial mass lesions presenting with focal epileptic seizures. Although his contributions in these fields have been neglected by modern historians, Charcot made significant contributions to the neurobiology of the human motor system, to epileptology, and to the birth of modern neurosurgery.

Intranasal oxytocin suppresses seizure-like behaviors in a mouse model of NGLY1 deficiency

NGLY1 deficiency is a genetic disease caused by biallelic mutations of the Ngly1 gene. Although epileptic seizure is one of the most severe symptoms in patients with NGLY1 deficiency, preclinical studies have not been conducted due to the lack of animal models for epileptic seizures in NGLY1 deficiency. Here, we observed the behaviors of male and female Ngly1−/− mice by video monitoring and found that these mice exhibit spontaneous seizure-like behaviors. Gene expression analyses and enzyme immunoassay revealed significant decreases in oxytocin, a well-known neuropeptide, in the hypothalamus of Ngly1−/− mice. Seizure-like behaviors in Ngly1−/− mice were transiently suppressed by a single intranasal administration of oxytocin. These findings suggest the therapeutic potential of oxytocin for epileptic seizure in patients with NGLY1 deficiency and contribute to the clarification of the disease mechanism.

Transcranial electrical stimulation during functional magnetic resonance imaging in patients with genetic generalized epilepsy: a pilot and feasibility study.

A third of patients with epilepsy continue to have seizures despite receiving adequate antiseizure medication. Transcranial direct current stimulation (tDCS) might be a viable adjunct treatment option, having been shown to reduce epileptic seizures in patients with focal epilepsy. Evidence for the use of tDCS in genetic generalized epilepsy (GGE) is scarce. We aimed to establish the feasibility of applying tDCS during fMRI in patients with GGE to study the acute neuromodulatory effects of tDCS, particularly on sensorimotor network activity. Seven healthy controls and three patients with GGE received tDCS with simultaneous fMRI acquisition while watching a movie. Three tDCS conditions were applied: anodal, cathodal and sham. Periods of 60 s without stimulation were applied between each stimulation condition. Changes in sensorimotor cortex connectivity were evaluated by calculating the mean degree centrality across eight nodes of the sensorimotor cortex defined by the Automated Anatomical Labeling atlas (primary motor cortex (precentral left and right), supplementary motor area (left and right), mid-cingulum (left and right), postcentral gyrus (left and right)), across each of the conditions, for each participant. Simultaneous tDCS-fMRI was well tolerated in both healthy controls and patients without adverse effects. Anodal and cathodal stimulation reduced mean degree centrality of the sensorimotor network (Friedman's ANOVA with Dunn's multiple comparisons test; adjusted p = 0.02 and p = 0.03 respectively). Mean degree connectivity of the sensorimotor network during the sham condition was not different to the rest condition (adjusted p = 0.94). Applying tDCS during fMRI was shown to be feasible and safe in a small group of patients with GGE. Anodal and cathodal stimulation caused a significant reduction in network connectivity of the sensorimotor cortex across participants. This initial research supports the feasibility of using fMRI to guide and understand network modulation by tDCS that might facilitate its clinical application in GGE in the future.

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.

Implantation accuracy of novel polyimide stereotactic electroencephalographic depth electrodes-a human cadaveric study.

Stereoelectroencephalography (sEEG) is a minimally invasive procedure that uses depth electrodes stereotactically implanted into brain structures to map the origin and propagation of seizures in epileptic patients. Implantation accuracy of sEEG electrodes plays a critical role in the safety and efficacy of the procedure. This study used human cadaver heads, simulating clinical practice, to evaluate (1) neurosurgeon's ability to implant a new thin-film polyimide sEEG electrode according to the instructions for use (IFU), and (2) implantation accuracy. Four neurosurgeons (users) implanted 24 sEEG electrodes into two cadaver heads with the aid of the ROSA robotic system. Usability was evaluated using a questionnaire that assessed completion of all procedure steps per IFU and user errors. For implantation accuracy evaluation, planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative computer tomography (CT) images. Implantation accuracy was quantified using the Euclidean distance for entry point error (EPE) and target point error (TPE). All sEEG electrodes were successfully placed following the IFU without user errors, and post-implant survey of users showed favorable handling characteristics. The EPE was 1.28 ± 0.86 mm and TPE was 1.61 ± 0.89 mm. Long trajectories (>50 mm) had significantly larger EPEs and TPEs than short trajectories (<50 mm), and no differences were found between orthogonal and oblique trajectories. Accuracies were similar or superior to those reported in the literature when using similar experimental conditions, and in the same range as those reported in patients. The results demonstrate that newly developed polyimide sEEG electrodes can be implanted as accurately as similar devices in the marker without user errors when following the IFU in a simulated clinical environment. The human cadaver ex-vivo test system provided a realistic test system, owing to the size, anatomy and similarity of tissue composition to that of the live human brain.

Reducing False Alarms in Wearable Seizure Detection with EEGformer: A Compact Transformer Model for MCUs.

The long-term, continuous analysis of electroencephalography (EEG) signals on wearable devices to automatically detect seizures in epileptic patients is a high-potential application field for deep neural networks, and specifically for transformers, which are highly suited for end-to-end time series processing without handcrafted feature extraction. In this work, we propose a small-scale transformer detector, the EEGformer, compatible with unobtrusive acquisition setups that use only the temporal channels. EEGformer is the result of a hardware-oriented design exploration, aiming for efficient execution on tiny low-power micro-controller units (MCUs) and low latency and false alarm rate to increase patient and caregiver acceptance. Tests conducted on the CHB-MIT dataset show a 20% reduction of the onset detection latency with respect to the state-of-the-art model for temporal acquisition, with a competitive 73% seizure detection probability and 0.15 false-positive-per-hour (FP/h). Further investigations on a novel and challenging scalp EEG dataset result in the successful detection of 88% of the annotated seizure events, with 0.45 FP/h. We evaluate the deployment of the EEGformer on three commercial low-power computing platforms: the single-core Apollo4 MCU and the GAP8 and GAP9 parallel MCUs. The most efficient implementation (on GAP9) results in as low as 13.7 ms and 0.31 mJ per inference, demonstrating the feasibility of deploying the EEGformer on wearable seizure detection systems with reduced channel count and multi-day battery duration.

Predictive capability of Cys112Arg single nucleotide polymorphisms of the apolipoprotein E gene in assessing the risk of immediate and early post-traumatic seizures

This study is aimed at investigating epileptic seizures, one of the consequences of traumatic brain injury (TBI). Immediate and early post-traumatic seizures, as well as late post-traumatic epileptic seizures or post-traumatic epilepsy, can have different pathogenetic bases. The following key risk factors associated with post-traumatic epilepsy are known: duration of unconsciousness, gunshot wounds, intracranial hemorrhage, diffuse axonal injury, prolonged (more than 3 days) post-traumatic amnesia, acute subdural hematoma with surgical evacuation, immediate and early post-traumatic epileptic seizures, fracture of the skull bones. The role of genetic factors in post-traumatic seizures is poorly understood due to the complexity and multiple causal mechanisms. This paper addresses the role of genetic factors in the occurrence and severity of epileptic events in patients with TBI. In particular, we investigated the role of the Cys112Arg single nucleotide polymorphism of the apolipoprotein E gene. Apolipoprotein E is known for its role in the transport and metabolism of lipids and, therefore, the development of cardiovascular diseases; it is also associated with Alzheimer's disease and has recently been studied in the context of association with epilepsy. The study shows an association between this polymorphism and the risk of immediate and early epileptic seizures in patients with severe TBI.

Retracted: Automatic Detection and Classification of Epileptic Seizures in Patients with Liver Cirrhosis and Overlapping Hev Infection Based on Deep Multimodal Fusion Technology

Retracted: Automatic Detection and Classification of Epileptic Seizures in Patients with Liver Cirrhosis and Overlapping Hev Infection Based on Deep Multimodal Fusion Technology

Risk factors for preoperative and postoperative seizures in patients with glioblastoma according to the 2021 World Health Organization classification.

To identify risk factors for developing glioblastoma (GBM) related preoperative (PRS) and postoperative seizures (POS). Also, we aimed to analyze the impact of PRS and POS on survival in a GBM cohort according to the revised 2021 WHO glioma classification. We performed a single-center retrospective cohort study of patients with GBM (according to the 2021 World Health Organization Classification) treated at Mayo Clinic Florida between January 2018 and July 2022. Seizures were stratified into preoperative seizures (PRS) and postoperative seizures (POS, >7 days after surgery). Associations between patients' characteristics and overall survival with PRS and POS were assessed. One hundred nineteen adults (mean =60.9 years), 49 (41.2%) females, were identified. The rates of PRS and POS in the cohort were 35.3% (n=42) and 37.8% (n=45), respectively. Patients with PRS were younger (p = 0.035) and were likely to undergo intraoperative electrocorticography. The incidence of PRS (p = 0.049) and POS (p<0.001) was lower among patients with tumors located in the occipital location. PRS increased the risk of POS after adjusting for age and sex (RR: 2.59, CI=1.44-4.65, p = 0.001). There was no association between PRS or POS and other patient-related factors, including several tumor molecular markers (TMMs) examined. PRS (p = 0.036), POS (p<0.001), and O6-Methylguanine-DNA Methyltransferase (MGMT) promotor methylation status (p = 0.032) were associated with longer survival time. PRS and POS are associated with non-occipital tumor location and longer survival time in patients with GBM. While younger ages predicted PRS, PRS predicted POS. Well-designed prospective studies with larger sample sizes are needed to clarify the influence of TMMs in the genesis of epileptic seizures in patients with GBM.

The efficacy and safety of patent Foramen Ovale Closure for Refractory Epilepsy (PFOC-RE): a prospectively randomized control trial of an innovative surgical therapy for refractory epilepsy patients with PFO of high-grade right-to-left shunt

BackgroundA significant proportion of patients with epilepsy have an unknown etiology and lack effective targeted therapeutic drugs. Patent Foramen Ovale (PFO) induces hypoxia and microembolism, leading to cerebral neurological dysfunction and increased epilepsy risk. This study aims to assess the efficacy and safety of PFO closure for relieving epileptic seizures in patients with refractory epilepsy associated with PFO.Methods/designRecruitment takes place at the West China Hospital of Sichuan University, China, for an open-label, randomized controlled clinical trial. The trial will include 110 patients with refractory epilepsy and PFO. Disease diagnoses will conform to the diagnostic criteria of the International League Against Epilepsy (ILAE) for refractory epilepsy and the American Society of Echocardiography (ASE) for PFO. Refractory epilepsy and high-grade right-to-left shunt (RLS) of the PFO will be further diagnosed using 24-hour video electroencephalogram and transthoracic echocardiography with contrast injection, respectively. Eligible participants require a secondary or higher volume of RLS.Trial registrationChinese Clinical Trial Registry (ChiCTR2200065681). Registered on November 11, 2022.

Classification Model for Epileptic Seizure Using Simple Postictal Laboratory Indices.

Distinguishing syncope from epileptic seizures in patients with sudden loss of consciousness is important. Various blood tests have been used to indicate epileptic seizures in patients with impaired consciousness. This retrospective study aimed to predict the diagnosis of epilepsy in patients with transient loss of consciousness using the initial blood test results. A seizure classification model was constructed using logistic regression, and predictors were selected from a cohort of 260 patients using domain knowledge and statistical methods. The study defined the diagnosis of seizures and syncope based on the consistency of the diagnosis made by an emergency medicine specialist at the first visit to the emergency room and the diagnosis made by an epileptologist or cardiologist at the first outpatient visit using the International Classification of Diseases 10th revision (ICD-10) code. Univariate analysis showed higher levels of white blood cells, red blood cells, hemoglobin, hematocrit, delta neutrophil index, creatinine kinase, and ammonia levels in the seizure group. The ammonia level had the highest correlation with the diagnosis of epileptic seizures in the prediction model. Therefore, it is recommended to be included in the first examination at the emergency room.

Clinical features of epileptic seizures in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes

Background and purposeThis study aimed to characterize the clinical features of epilepsy in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) and analyze the clinical determinants for drug-resistant epilepsy in MELAS. MethodsA single-center, retrospective study was conducted to investigate the clinical features of epilepsy in patients with MELAS. Collected variables included seizure semiology, electroencephalography (EEG), muscle biopsy, genetic testing, neuroimaging findings, resting serum lactic value and modified Rankin scale (mRS) of patients with MELAS. We also investigated the differences between the adult-onset group and the child-onset group and analyzed the risk factors for drug-resistant epilepsy in MELAS. ResultsWe studied 97 patients (56 males: 41 females) with confirmed MELAS. Epileptic seizure occurred in 100.0% of patients and the initial symptom of 69.1% patients was epileptic seizure. The average age of disease onset was 21.0 years, ranging from 2 to 60 years. The seizure types of these patients with MELAS were variable, with generalized onset (51.5%) to be the most common type. The EEG changes in the patients with MELAS were mainly slow wave (90.9%) and epileptiform discharge (68.2%). The child-onset group with earlier seizure onset presented significantly higher resting serum lactic value (p = 0.0048) and lower incidence of stroke-like lesion in the brain (p = 0.003), especially in the temporal lobe (p < 0.001), compared with the adult-onset group. Importantly, drug-resistant epilepsy in MELAS was demonstrated to be closely related to the earlier age of seizure onset (p = 0.013), as well as the higher mRS score (p < 0.001) and higher resting serum lactic value (p = 0.009). ConclusionEarly identification of MELAS should be considered among individuals with recurrent epilepsy through clinical screening. Age of seizure onset and resting serum lactic value may predict the development of drug-resistant epilepsy in MELAS. Close observation and appropriate anti-epileptic treatment are indispensable for individuals with MELAS to improve the prognosis. Further studies with larger sample size are required to further evaluate the risk factors of drug-resistant epilepsy in MELAS and provide guidance on treatment of MELAS.

Perampanel in adjunctive therapy of patients with brain tumor-related epilepsy: real-world data

Background. Brain tumor-related epilepsy (BTRE) is an important and insufficiently studied interdisciplinary problem. In a significant part of brain tumor patients, the disease onsets with epileptic seizures. The course of tumor-associated epilepsy is often pharmacoresistant and requires rational polytherapy. To date, there are no uniform recommendations on the choice of an antiepileptic drug (AED) for the initial therapy of BTRE.Objective: retrospective analysis of the efficacy/tolerability of adjunctive therapy with perampanel in relation to epileptic seizures in patients with epilepsy associated with glial brain tumors and metastases.Material and methods. The analysis included 51 patients with glial tumors and brain metastases who were prescribed perampanel as part of adjunctive therapy. Its effectiveness against focal seizures (FS) and bilateral tonic-clonic seizures (BTCS) was evaluated at follow-up periods of &gt;1≥3≥6 months. A decrease in the frequency of seizures by 50% or more (responders) or by 100% (seizure freedom) was analyzed. An analysis of the influence of intervening factors in a multifactorial model, an assessment of the effectiveness of perampanel as a whole and a stratified assessment of intervening factors were carried out. The frequency and profile of adverse events (AEs) were also evaluated, including their possible association with the use of other AED.Results. In the multifactorial model, independent predictors of the clinical effect were the onset of the disease in the form of FS at &gt;1≥3≥6 months follow-up. None of AEDs used in the first line of therapy demonstrated an impact on the clinical effect. There were no predictors of clinical effect in patients with BTCS during the entire follow-up period. Out of 51 patients, 48 (94.1%) were responders, and in 36 of them (70.6%) the seizure freedom was registered. Among patients with FS, the proportion of responders was 83.3–90.9% at different follow-up periods, including 31.2–50.0% who showed seizure freedom. Among patients with BTCS, 86.7–92.3% became responders, including 56.1–88.5% who achieved seizure freedom. AEs were noted in 7 (13.7%) patients, the most common was aggression – 4 patients (7.8%). There were no cases required reduction the dose or discontinuation the treatment with perampanel due to AEs. In most patients at &gt;1≥3≥6 months follow-up, the median was 6 mg/day.Conclusion. The study performed in real-world practice confirmed the high efficiency and safety of perampanel in the adjunctive therapy of epileptic seizures associated with glial brain tumors and metastases, which together with the low potential of drug interactions allow us recommend the drug to this contingent of patients.

Features of epileptiform activity in patients with diagnosed glioblastoma: from genetic and biochemical mechanisms to clinical aspects

Introduction. glioblastomas multiforme (grade Iv gliomas) are common and the most aggressive primary tumors of the brain with very unfavorable prognosis. In all previously published papers on epileptiform activity in glioblastomas, not enough information on encephalogram results is presented.Aim. To study the features of epileptiform activity in patients with glioblastomas and development of a plan for further study of these patients.Materials and methods. An analysis of articles from Elsevier, Embase, Scopus, The Cochrane Library, global Health, Russian Science Citation Index (RSCI) databases, Scholar, google, web of Science, pubmed search engines and scientific electronic library CyberLeninka was performed. materials were selected considering journal indexing system and citations, scientific novelty of the studies, statistical significance of the results. publications repeating data from previous articles or describing animal experiments were excluded from analysis.Results. During the study, data on mechanisms of epileptiform activity pathogenesis, predisposing factors (tumor location in the temporal, frontal or parietal lobes, IDH-1 and / or IDH-2 gene mutations), treatment options in patients with glioblastomas were systemized. Additionally, and original plan of data accumulation for clinical studied taking into account limitations of the previous studies was developed to increase quality of results interpretation.Conclusion. Epileptiform symptoms in glioblastomas negatively affect patients’ quality of life and lifespan. Currently, researchers actively search for an effective method of treatment of epileptic seizures in patients with glioblastomas. The most effective is combination of temozolomide with valproate and levetiracetam due to good control of seizure frequency, low toxicity, and pharmacological synergy between the drugs.

A DESCRIPTIVE STUDY OF EPILEPTIC PATIENTS IN HERAT CITY OF AFGHANISTAN

Epilepsy is one of the most common and serious neurological disorders which is characterized by recurrent unprovoked seizures. Its prevalence ranges from 0.5% to 1% of the population in developed countries, and even higher in developing countries. Around 70 million people worldwide have epilepsy.This research aims to perform a descriptive study on epileptic children 7-18 years old in Herat city of Afghanistan.This descriptive study was performed on 7-18 years old children with epilepsy, which was conducted from in 2021 in Herat city of Afghanistan. The study included 100 patients with epileptic disorders, in this study Encephalography, Magnetic resonance imaging, Computed tomography, and Sociodemographic information were used to describe the patients.The main group of this study included 100 epileptic children. The age of study participants ranged from 7- 18 years and the mean age was 9.21 ± 2.64 years.&nbsp;46 (51.1%) were males and 44 (48.9%) were females. More often Epilepsy cases were observed in patients with focal seizures. Hereditary predisposition was found as a risk factor and it was statistically significant, the p-value was less than 0.0007. Having status epilepsy was also found a risk factor for epilepsy and the p-value was 0.001. Also, prognostic factors for refractory epilepsy were determined in this study.The risk factors that were found in epileptic patients, were high and comparable with other studies in the world literature. More often epilepsy cases were determined in patients with focal seizures, hereditary predisposition, and having status epilepsy also found as prevalent risk factors for refractory epilepsy. Also, prognostic factors for epilepsy were identified. Negative factors were a high number of seizures, abnormal electroencephalography findings, and early onset of seizures in epileptic patients.

The effect of COVID-19 vaccination on epileptic seizures in patients with epilepsy: A clinical observation in China

ABSTRACT This observational retrospective study was conducted on patients with epilepsy (PWE) in China who had at least one dose of COVID-19 vaccine and it investigated the safety of vaccination by analyzing changes in epileptic seizures and their influencing factors. Consecutive PWE who were followed up in the epilepsy clinic between June 2021 and May 2022 were enrolled. Data on vaccine type, demographic information, clinical characteristics of epilepsy, and treatment were collected through a questionnaire survey and retrospectively analyzed. PWE were divided into a stable seizure group and a worsening seizure group based on seizure episodes at least 90 days after the first vaccine dose. A total of 79 PWE were included. After vaccination, 14 patients (17.7%) had worsening seizures, 92.9% of whom had an increased seizure frequency. Compared with patients in the stable seizure group, patients in the worsening seizure group had significant differences in baseline monthly seizure frequency (P = .012), improper antiseizure medication (ASM) administration (P = .003) and a disrupted sleep routine (P = .016). Multivariate logistic regression analysis showed that improper ASM administration (OR 6.186, 95% confidence interval [CI] 1.312–29.170; p = .021) and a disrupted sleep routine (OR 6.326, 95% CI 1.326–30.174; p = .021) were significantly associated with seizure worsening. In short, COVID-19 vaccination is safe for PWE, and only those with poor seizure control have the possibility of seizure exacerbation after COVID-19 vaccination. The vaccination per se does not represent a major influencing factor, but the improper use of ASMs and a disrupted sleep routine may be correlated with seizure aggravation after vaccination.

Epileptic seizures in patients with anti-IgLON5 disease

BackgroundAnti-IgLON5 is a rare neurologic disease that can present with epileptic seizures. However, epileptic seizures have not been characterized and are underreported. We aimed to investigate the clinical characteristics and demographics of epileptic seizures in patients with anti-IgLON5 disease. MethodsWe reported a case of anti-IgLON5 disease presenting with epileptic seizures and presented a comprehensive literature review on epileptic seizures in patients with the anti-IgLON5 disease. We searched the Medline, Pubmed, and Web of Science databases using the following search algorithm: “IgLON5” or “anti-IgLON5” or “IgLON5 antibody” limited to publications in English. ResultsWe identified 183 cases from 66 publications. In addition to our case, nine (4.9%) patients with anti-IgLON5 disease had reported epileptic seizures, either focal or generalized. Of those, epileptic seizures were one of the main reasons for neurology consultation in six (3.2%). Patients with epileptic seizures affected both sexes similarly and usually developed in middle age. In addition to epileptic seizures, a majority of patients had sleep disorders and cognitive impairment. The frequency of epileptic seizures was reduced with the treatment of immunotherapy and antiseizure medication. ConclusionAnti-IgLON5 disease can present with epileptic seizures, and our study expands the clinical spectrum of the anti-IgLON5 disease.

Quantitative measurement of peritumoral concentrations of glutamate, N-acetyl aspartate, and lactate on magnetic resonance spectroscopy predicts glioblastoma-related refractory epilepsy.

Increased extracellular glutamate is known to cause epileptic seizures in patients with glioblastoma (GBM). However, predicting whether the seizure will be refractory is difficult. The present study investigated whether evaluation of the levels of various metabolites, including glutamate, can predict the occurrence of refractory seizure in GBM by quantitative measurement of metabolite concentrations on magnetic resonance spectroscopy (MRS). Forty patients were treated according to the same treatment protocol for primary GBM at Ehime University Hospital between April 2017 and July 2021. Of these patients, 23 underwent MRS to determine concentrations of metabolites, including glutamate, N-acetylaspartate, creatine, and lactate, in the tumor periphery by applying LC-Model. The concentration of each metabolite was expressed as a ratio to creatine concentration. Patients were divided into three groups: Type A, patients with no seizures; Type B, patients with seizures that disappeared after treatment; and Type C, patients with seizures that remained unrelieved or appeared after treatment (refractory seizures). Relationships between concentrations of metabolites and seizure types were investigated. In 23 GBMs, seizures were confirmed in 11 patients, including Type B in four and Type C in seven. Patients with epilepsy (Type B or C) showed significantly higher glutamate and N-acetylaspartate values than did non-epilepsy patients (Type A) (p < 0.05). No significant differences in glutamate or N-acetylaspartate levels were seen between Types B and C. Conversely, Type C showed significantly higher concentrations of lactate than did Type B (p = 0.001). Cutoff values of lactate-to-creatine, glutamate-to-creatine, and N-acetylaspartate-to-creatine ratios for refractory seizure were > 1.25, > 1.09, and > 0.88, respectively. Extracellular concentrations of glutamate, N-acetylaspartate, and lactate in the tumor periphery were significantly elevated in patients with GBM with refractory seizures. Measurement of these metabolites on MRS may predict refractory epilepsy in such patients and could be an indicator for continuing the use of antiepileptic drugs.

Polymorphism of IL-1B rs16944 (T/C) associated with serum levels of IL-1β affects seizure susceptibility in ischemic stroke patients.

Seizures and the subsequent development of epilepsy after stroke may not only hinder patient's recovery but also increase the risk of complications. Interleukin (IL)-1β has been shown to be acutely upregulated after ischemic stroke and play a role in the recurrence of seizures following the first epileptic seizure in patients suffering an ischemic stroke. Meanwhile, variants of the IL-1B gene encoding IL-1β are involved in the stimulation of febrile seizures. To study the potential associations of the 5 polymorphisms of the IL-1B gene with seizure susceptibility in ischemic stroke patients, and to explore the possible mechanisms. A total of 856 ischemic stroke patients were allocated into the control group (patients without post-stroke seizures) and the case group (patients with post-stroke seizures). The IL-1B polymorphisms rs10490571 (T/C), rs114363 (C/T), rs1143623 (G/C), rs16944 (T/C), and rs2853550 (A/G) were detected using TaqMan SNP genotyping assays, and serum IL-1β levels were measured using the enzyme-linked immunosorbent assay (ELISA). Demographic data, clinical characteristics and cerebrovascular disease risk factors at admission were collected. Multivariate analysis was performed to determine independent associations, and IL-1β levels were compared using analysis of variance (ANOVA) followed by a post hoc test. In 74 patients (8.6%, 74/856), post-stroke seizures occurred within 1 year of stroke onset. The multivariate analysis showed that the rs16944 polymorphism of IL-1B, cortical involvement and National Institutes of Health Stroke Scale (NIHSS) score on admission were correlated with post-stroke seizures after adjusting for stroke laterality, thrombolysis, use of statins, and IL-1B rs10490571. The IL-1B rs16944 TT (odds ratio (OR): 1.923, 95% confidence interval (95% CI): 1.257-4.185) and TC genotypes (OR: 1.469, 95% CI: 1.130-2.974) were associated with a significantly increased risk of post-stroke seizures compared to the CC genotype. One-way ANOVA for IL-1β levels demonstrated a tendency for higher levels in TT > TC > CC genotypes (6.41 compared to 4.53 compared to 2.10 pg/mL, respectively). The IL-1B rs16944 polymorphism had an independent association with seizure susceptibility after ischemic stroke. The mechanism might be associated with the regulation of IL-1β levels.