Status Epilepticus Research Articles

Adherence to Recommendations and Yield of Critical Care EEG Monitoring: A Prospective Multicentric Study.

The American Clinical Neurophysiology Society has provided a set of recommendations on the use of critical care EEG monitoring (CEEG). However, these recommendations have not been prospectively validated. We aimed to assess the adherence to the American Clinical Neurophysiology Society recommendations for obtaining CEEG for different indications and the yield of obtained CEEG according to these different indications. This was a multicenter prospective observational study of critically ill adult patients between April 01, 2022, and June 22, 2022, in two academic medical centers and a large teaching hospital. Indications for CEEG, according to the American Clinical Neurophysiology Society recommendations, were determined based on clinical data at the time of discharge from the intensive care unit. The use of CEEG and detection of electrographic seizures were retrieved from the EEG databases. A total of 600 patients were enrolled in this study. The primary admission diagnoses were medical (49%), surgical (30%), or neurologic/neurosurgical (21%). Approximately 60% of patients had an altered mental status. A few (6%) patients had a preceding clinical seizure, and 1% had generalized convulsive status epilepticus. Indications were identified in 226 admissions. Of these patients, 88 (39%) underwent CEEG. In addition, 12 patients underwent CEEG without clear indications. Of the 100 patients, 33 (33%) had electrographic seizures. Adherence to recommendations and yields was highest for refractory status epilepticus, altered mental status after any clinical seizure, and acute brain injury. Adherence and yield varied the most and were inversely correlated in the group of patients without acute brain injury, suggesting that additional clinical factors may have contributed to patient selection. Patients meeting American Clinical Neurophysiology Society indications and receiving CEEG had a high seizure risk. Emerging CEEG programs should focus on epilepsy-related and neurologic diagnosis. Although recommendations effectively identify groups of patients with a high seizure risk, additional clinical factors might further help select candidates in the low-risk group.

Ketogenic diet treatment for super-refractory status epilepticus in the intensive care unit: feasibility, safety and effectiveness

Background and aimsTo investigate the feasibility, safety and effectiveness of the ketogenic diet (KD) for super-refractory status epilepticus (SRSE) in the intensive care unit (ICU).MethodsWe conducted a prospective investigation on patients with SRSE treated with the KD. The primary outcome measures were ketosis development as a biomarker of feasibility and resolution of SRSE as effectiveness. KD-related side effects were also investigated.ResultsTwelve patients (9 females and 3 males) with SRSE, with a median age of 34 years [range 16–69, interquartile range (IQR) 18–52], were treated with a KD. The median duration of SRSE prior to KD treatment was 21 days (range 4–46). SRSE resolved in 75% (9/12) of patients at a median of 3 days (range 1–18) after KD initiation. Among the nine KD responders, all were successfully weaned off anesthetic agents at a median of 16 days (range 4–32) after KD initiation, and all were also successfully weaned off ventilator. Side effects varied, and included gastrointestinal intolerances, malnutrition and metabolic abnormalities, electrolyte disturbance, and acute weight loss, although most of them could be corrected. No patient died due to KD, and neurofunctions continued to improve under KD therapy.ConclusionThe KD may be feasible and effective for the treatment of SRSE in the ICU. Moreover, it is relatively safe. However, there are numerous adverse events that can be corrected under close monitoring.

Age-associated differences in FIRES: Characterizing prodromal presentation and long-term outcomes via the web-based NORSE/FIRES Family Registry.

Febrile infection-related epilepsy syndrome (FIRES) is a rare clinical presentation of refractory status epilepticus following a febrile infection. This study analyzes data from the NORSE/FIRES Family Registry, an international web-based registry available in six languages with data entered by patients, families, and clinicians to explore clinical presentations, survivorship, and long-term outcomes in adult and pediatric FIRES patients. We characterize and examine differences in demographics, prodromal symptoms, seizure frequency, anti-seizure medications (ASMs), quality of life, cognition, mood, and anxiety in adults vs pediatric populations with FIRES. Eighty-six participants were included in the study. Pediatric patients (n = 54) were predominantly male (77.8%) and experienced a significantly higher post-FIRES seizure burden than adult survivors (67.7% ≥12 seizures/month in pediatrics vs 11.8% in adults, p <.001). Adults (n = 32) were more likely to be female (59.4%) and have flu-like prodromal symptoms (90.6%). At ≥6 months post-FIRES, both groups exhibited high ASM use, with the majority (87.5%) taking three or more medications. Pediatric patients reported worse mood and anxiety outcomes compared to adults (p <.005). Self-reported quality of life and cognition were rated as moderate across in adults (5.2/10) and pediatric(4.7/10) patients, although pediatric patients indicated poorer cognition. Our findings highlight the challenges in managing post-FIRES outcomes across different age groups, particularly in pediatric patients who face a higher seizure burden and report worse cognitive outcomes.

NORSE secondary to anti-GAD65 antibody-positive encephalitis treated with novel adjunctive rapid titrationVNS protocol.

New Onset Refractory Status Epilepticus (NORSE) is a rare and severe condition characterized by refractory seizures in individuals without a prior history of epilepsy. This case report describes a 37-year-old woman diagnosed with anti-glutamic acid decarboxylase 65 (anti-GAD65) antibody-positive encephalitis-related NORSE. Her seizures were refractory to multiple interventions, including anti-seizure medications, anesthetics, immunotherapies, a ketogenic diet, and electroconvulsive therapy. Seizures recurred twice during the tapering of anesthetic medications. However, after 32 days of treatment, the seizures were successfully controlled. To maintain seizure control and facilitate the weaning of anesthetics, a Vagus Nerve Stimulator (VNS) was implanted using a novel rapid titration protocol. This allowed for the successful tapering of anesthetics by day 50, with no recurrence of seizures. At her 9-month follow-up, the patient remained seizure-free and had an improved quality of life. This case highlights that early initiation of immunosuppressive treatment may lead to a favorable prognosis. The novel application of VNS therapy assisted seizure control in NORSE, thus encouraging further research investigating the potential role of VNS in this condition. PLAIN LANGUAGE SUMMARY: New Onset Refractory Status Epilepticus (NORSE) is a rare and severe condition characterized by relentless seizures in individuals without a prior epilepsy history. This report shares the case of a 37-year-old woman with NORSE, associated with a high anti-glutamic acid decarboxylase 65 antibody titer. Her seizures were super-refractory, requiring multiple anti-seizure medications, anesthetics, immunotherapies, a ketogenic diet, and electroconvulsive therapy. Seizures recurred twice during the tapering of anesthetic medications. However, by hospital day 32, the seizures were successfully controlled with these interventions. To further stabilize seizure control and enable the successful discontinuation of anesthetics, a Vagus Nerve Stimulator (VNS) was implanted. The patient had no further seizures and gradually recovered back to her pre-disease baseline. This case suggests that a novel rapid VNS titration protocol could be a promising treatment option for NORSE, warranting further investigation.

Case Report of Status Epilepticus in a Patient with Acute HAE

Introduction: Hereditary angioedema (HAE) is a genetic disorder associated with recurrent episodes of angioedema in the absence of urticaria and pruritus. Hereditary angioedema is inherited in an autosomal dominant pattern and results in a quantitative deficiency (HAE type I) or dysfunction (HAE type II) of the C1-esterase inhibitor (C1-INH) protein. A very rare third type of HAE which is associated with normal quantitative and functional levels of C1-INH (HAE-nl-C1-INH) has been described. Case Report: A 54-year-old female with past medical history significant for HAE-nl-C1-INH presented to the emergency department (ED) for an acute attack of HAE and seizures. The patient arrived postictal after experiencing a total of three witnessed seizures, each lasting approximately 30 seconds. After the initial seizure was witnessed in the ED, the patient received 4200 Units of recombinant C1-INH intravenously. The patient’s mental status did not return to baseline, and she experienced two additional seizures. She was given a dose of the kallikrein inhibitor, ecallantide, as well as standard dosing of lorazepam and levetiracetam. The patient returned to her baseline and had no subsequent seizures while in the ED. Inpatient work-up included continuous video electroencephalography monitoring and magnetic resonance imaging of the brain, both of which were normal. The remainder of the inpatient course wasuncomplicated, and the patient was discharged home neurologically intact. Conclusion: We present a case of status epilepticus in a patient with HAE-nl-C1-INH. The focus of emergent medical management of status epilepticus includes airway protection, respiratory support, and administration of abortive and prophylactic antiepileptic drugs. The emergency medicine physician should also consider and treat possible underlying etiologies. The treatment of an acute attack of HAE should focus on replacing C1-INH and preventing the formation and limiting the action of bradykinin.

Emergency department and inpatient interhospital transfers for patients with status epilepticus.

Interhospital transfers for status epilepticus (SE) are common, and some are avoidable and likely lower yield. The use of interhospital transfer may differ in emergency department (ED) and inpatient settings, which contend with differing clinical resources and financial incentives. However, transfer from these two settings is understudied, leaving gaps in our ability to improve the hospital experience, cost, and triage for this neurologic emergency. We aimed to describe interhospital transfer for SE and examine the relationship between the site of transfer and hospital length of stay. We performed a cross-sectional study of adult patients with SE who underwent interhospital transfer using data from the State Emergency Department Databases and State Inpatient Databases of Florida (2016-2019) and New York (2018-2019). The primary outcome was discharge after undergoing transfer. Secondary outcomes were discharge within 1 day, discharge after 30 days, receipt of electroencephalography (EEG), and discharge disposition. There were 10 461 encounters for SE. Of 1790 ED encounters without admission to the same hospital, 324 (18.1%) resulted in transfer. Of 8671 hospitalizations, 629 (7.3%) resulted in transfer. Patients transferred from the ED were younger, more likely were White, more likely were in a metro area, and had fewer medical comorbidities than patients transferred from the inpatient setting. The median time to discharge was 5 days (interquartile range [IQR] = 2.0-9.0) after ED transfer and 10 days (IQR = 4.0-20.0) after inpatient transfer. There were 58 (17.9%) patients who were discharged within 1 day after undergoing transfer from an ED. ED transfers had higher rates of discharge at 30 days and higher likelihood of undergoing EEG at the receiving hospital and being discharged home. A high proportion of patients with SE are discharged shortly after undergoing interhospital transfer, particularly those transferred from the ED. Understanding reasons for transfer is a crucial next step in triaging limited inpatient epilepsy resources and reducing costs associated with interhospital transfer.

Cost Analysis of Epilepsy Healthcare in Adults: A Direct Cost Estimate From a Colombian Perspective.

To estimate the direct healthcare costs related to outpatient care and hospital stays for adults with epilepsy in the context of the Colombian healthcare system. A cost analysis was conducted from a base case, which included direct medical costs related to diagnosis, follow-up, pharmacological and surgical treatment, and in-hospital care for status epilepticus. A Delphi panel was carried out to identify and quantify cost-generating events. The monetary valuation was estimated using official databases and tariff manuals available in Colombia. The cost distribution was obtained using the bootstrapping method. Two one-way deterministic sensitivity analyses were performed. The total annual cost of an adult patient with epilepsy without including hospital stays is US dollars $2416.31. If at least 1 intensive care unit stay (8-day average) is included to treat a patient with status epilepticus, the total annual cost increases to $61 567.72. The total cost of resective surgery is $14 894.44, and the vagus nerve stimulation implant costs $26 565.86. Epilepsy in adults represents a significant economic burden for the Colombian healthcare system, comparable to that of other upper-middle-income countries. The majority of expenditure is attributed to intensive care unit stays, less financial resources would be required if patients achieve better control of the disease.

Suppression of epileptic seizures by transcranial activation of K+-selective channelrhodopsin

Optogenetics is a valuable tool for studying the mechanisms of neurological diseases and is now being developed for therapeutic applications. In rodents and macaques, improved channelrhodopsins have been applied to achieve transcranial optogenetic stimulation. While transcranial photoexcitation of neurons has been achieved, noninvasive optogenetic inhibition for treating hyperexcitability-induced neurological disorders has remained elusive. There is a critical need for effective inhibitory optogenetic tools that are highly light-sensitive and capable of suppressing neuronal activity in deep brain tissue. In this study, we developed a highly sensitive moderately K+-selective channelrhodopsin (HcKCR1-hs) by molecular engineering of the recently discovered Hyphochytrium catenoides kalium (potassium) channelrhodopsin 1. Transcranial activation of HcKCR1-hs significantly prolongs the time to the first seizure, increases survival, and decreases seizure activity in several status epilepticus mouse models. Our approach for transcranial optogenetic inhibition of neural hyperactivity may be adapted for cell type-specific neuromodulation in both basic and preclinical settings.

Utilizing natural language processing to identify pediatric patients experiencing status epilepticus.

Compare the identification of patients with established status epilepticus (ESE) and refractory status epilepticus (RSE) in electronic health records (EHR) using human review versus natural language processing (NLP) assisted review. We reviewed EHRs of patients aged 1 month to 21 years from Boston Children's Hospital (BCH). We included all patients with convulsive ESE or RSE during admission. We employed and validated a pre-trained NLP tool, Document review Tool (DrT), to identify patients from 2013-2020, excluding training years (2017-2019). DrT notes a machine-learning score based on a support vector machine (SVM) and bag-of-n-grams. Higher scores indicated more likely ESE/RSE cases. To further evaluate the effectiveness of DrT-assisted review, we compared the results to human-reviewed notes from the pediatric Status Epilepticus Research Group (pSERG) consortium at BCH. The pre-trained algorithm identified 170 patients with RSE using DrT (Sensitivity: 98.8%), compared to 116 patients identified during human review (Sensitivity: 67.4%). Additionally, we identified 207 patients with ESE using DrT (Sensitivity: 99.5%), compared to 91 patients identified using human review (Sensitivity: 43.8%). Overall, DrT missed 3 cases (2 RSE and 1 ESE cases) that were identified during human review and identified 173 cases (56 RSE and 117 ESE cases) that were not found during the human review. DrT-assisted manual review demonstrated higher sensitivity in identifying patients with ESE and RSE than the current standard of human review. This suggests that in contexts characterized by resource constraints NLP-related software like DrT can considerably enhance patient identification for research studies, treatment protocols, and preventative care interventions.

Seizures and status epilepticus in anti-NMDA receptor encephalitis.

Seizures, including status epilepticus (SE), are common in anti-NMDA receptor encephalitis (NMDARE). We aimed to describe clinical and electrographic features of patients with seizures with NMDARE, determine factors associated with SE, and describe long-term seizure outcomes. We retrospectively identified patients with seizures in the setting of NMDARE treated at inpatient Mayo Clinic sites during the acute phase of encephalitis between October 2008 and March 2023. Seizure semiology, clinical symptoms, electrographic features, neuroimaging, treatment course, complications, and outcome were abstracted. We compared clinical features between patients with and without SE. We identified 29 patients with seizures during acute NMDARE. Temporal onset was the most common EEG localization (n = 14, 48.3%). Subclinical seizures were recorded in 15 (51.7%). Twelve (41.4%) patients had SE, which was associated with temporal T2-signal hyperintensity, seizures with unilateral clonic and/or tonic movements, multiple seizure foci on EEG, temporal and midline/central onset seizures, higher acute CASE scores, intensive care unit (ICU) admission, longer length of hospitalization, and need for post-hospitalization rehabilitation. One patient (3.4%) died during the acute encephalitis. One patient (3.4%) developed chronic epilepsy. The remaining patients were seizure-free at the last follow-up (median 23months, range 2-163months). SE was not associated with differences in outcome at last follow-up. Seizures in NMDARE are frequently temporal onset. SE is common and associated with higher likelihood of ICU level care, longer hospitalization, and higher need for post-hospital rehabilitation. Despite the significant short-term impact of SE, long-term outcome was not affected, and seizure prognosis was favorable.

Differential regulation of KCC2 and NKCC1 expression by zolpidem in CA1 and CA3 hippocampal subregions of the lithium-pilocarpine status epilepticus rat model.

Status epilepticus is linked to cognitive decline due to damage to the hippocampus, a key structure involved in cognition. The hippocampus's high vulnerability to epilepsy-related damage is the main reason for this impairment. Convulsive seizures, such as those observed in status epilepticus, can cause various hippocampal pathologies, including inflammation, abnormal neurogenesis, and neuronal death. Interestingly, substantial evidence points to the therapeutic potential of the sedative/hypnotic agent zolpidem for neurorehabilitation in brain injury patients, following the unexpected discovery of its paradoxical awakening effect. In this study, we successfully established an ideal lithium-pilocarpine rat model of status epilepticus, which displayed significant deficits in hippocampal-dependent learning and memory. The Morris water maze test was used to assess zolpidem's potential to improve learning and memory, as well as its impact on anxiety-like behavior and motor function. Immunohistochemical staining and fluorescence analysis were used to examine the effect of zolpidem on KCC2 and NKCC1 protein expression in the hippocampal CA1 and CA3. Our findings showed that zolpidem did not improve learning and memory in status epilepticus rats. Additionally, its sedative/hypnotic effects were not apparent in the status epilepticus condition. However, immunohistochemical results revealed that zolpidem significantly restored altered NKCC1 levels in the CA1 and CA3 to levels similar to those seen in normal rats. These findings suggest that zolpidem may contribute to molecular restoration, particularly through its impact on NKCC1 protein expression in the hippocampus, which is crucial for proper inhibitory neurotransmission in the brain.

Favorable outcomes and FDG-PET changes following tocilizumab treatment for febrile infection-related epilepsy syndrome in a child.

Febrile Infection-Related Epilepsy Syndrome (FIRES) is an infrequent yet severe form of epilepsy that rapidly evolves into status epilepticus following a febrile episode. Prompt diagnosis coupled with effective treatment strategies is critical for improving patient outcomes. Herein, we describe the case of an 11-year-old male with FIRES who was successfully treated with tocilizumab, resulting in no further seizures or residual disability. The patient initially did not respond to antiseizure medications and first-line immunomodulatory therapy. Characteristic EEG patterns and elevated interleukin 6 levels in the cerebrospinal fluid contributed to an early presumptive diagnosis of FIRES. Tocilizumab was administered on day 10 after the seizure onset, leading to seizure cessation within 24h, with no subsequent episodes. Serial cranial MRI imaging studies demonstrated transient abnormalities that resolved over time. Notably, on day 9, the patient exhibited bilateral frontal lobe hypermetabolism on FDG-PET, with EEG showing global slow waves predominantly in the bilateral frontal regions. As seizure control was achieved and encephalopathy symptoms improved, a follow-up EEG on day 25 revealed persistent slow waves in the bilateral frontal regions, with FDG-PET hypermetabolism present only in the left frontal lobe. By day 88, both EEG and FDG-PET had returned to normal. These findings suggest tocilizumab may play a role in the management of FIRES, though further studies are required to substantiate its therapeutic efficacy. Additionally, early bilateral frontal FDG-PET hypermetabolism and EEG slow-wave activity, may serve as an early biomarker in FIRES patients. However, more research is necessary to establish its validity.

A Review of the Association between Infections, Seizures, and Drugs.

Seizures are a common presenting symptom of the central nervous system (CNS) and could occur from infections (such as toxins) or drugs. The aim of this study was to present a systematic review of the association between infections, seizures, and drugs. Through February 18, 2024, according to the PRISMA guidelines and based on the PICO standard format, relevant, in-depth consequent guide approach and evidence-based options were selected associated with a knowledgeable collection of current, high-quality manuscripts. Imbalance between inhibitory and excitatory neurotransmitters due to infections, drugs such as ticarcillin, amoxicillin, oxacillin, penicillin G, ampicillin, tramadol, venlafaxine, cyclosporine, tacrolimus, acyclovir, cellcept, the old generation of antiepileptic drugs, such as carbamazepine, phenytoin, and many other drugs could cause different stages of CNS disturbances ranging from seizure to encephalopathy. Infections could cause life-threatening status epilepticus by continuous unremitting seizures lasting longer than 5 minutes or recurrent seizures. Meningitis, tuberculosis, herpes simplex, cerebral toxoplasmosis, and many others could lead to status epilepticus. In fact, confusion, encephalopathy, and myoclonus were reported with drugs, such as ticarcillin, amoxicillin, oxacillin, penicillin G, ampicillin, and others. Penicillin G was reported as having the greatest epileptogenic potential. A high dose, in addition to prolonged use of metronidazole, was reported with seizure infection. Meropenem could decrease the concentration of valproic acid. Due to the inhibition of cytochrome P450 3A4, the combination of clarithromycin and erythromycin with carbamazepine needs vigilant monitoring. Due to changes in drug metabolism, co-administration of antiseizure drugs and antibiotics may lead to an enhanced risk of seizures. In patients with neurocysticercosis, cerebral malaria, viral encephalitis, bacterial meningitis, tuberculosis, and human immunodeficiency virus, the evidence-based study recommended different mechanisms mediating epileptogenic properties of toxins and drugs.

A Case of Wilson's Disease Preceded by Schizophrenia-like Symptoms with Frontal-dominant Leukoencephalopathy.

We herein report a 26-year-old man diagnosed with Wilson's disease (WD), initially treated for schizophrenia for 11 years. At 26 years old, he was admitted because of status epilepticus. Brain magnetic resonance imaging revealed frontal-dominant leukoencephalopathy with cystic changes and basal ganglia atrophy. The diagnosis of WD was confirmed based on neuropsychiatric symptoms, Kayser-Fleischer rings, abnormal copper metabolism, and a genetic analysis of ATP7B. Psychotic symptoms in WD can precede neurological manifestations, and extrapyramidal signs may be mistaken for drug-induced Parkinsonism. WD should be considered in patients presenting with progressive Parkinsonism preceded by schizophrenia-like psychiatric symptoms.

Electrographic Seizures and Predictors of Epilepsy after Pediatric Arteriovenous Malformation Rupture

To assess clinical and electroencephalogram (EEG) predictors of epilepsy and to describe the percentage of electrographic seizures and development of epilepsy among patients with spontaneous intracerebral hemorrhage (ICH) due to arteriovenous malformation (AVM) rupture. Retrospective review of patients admitted to the pediatric intensive care unit with ICH secondary to AVM rupture over 11years. Clinical variables were collected by review of the electronic medical record. Seizures were described as acute symptomatic (7days after AVM rupture), subacute (7-30days after AVM rupture) and remote (greater than 30days after AVM rupture). Outcome metrics included mortality, and the development of epilepsy post discharge. Descriptive statistics were used. Forty-three patients met inclusion criteria with a median age of 12.2years (IQR 7.3-14.8) and 49% (21/43) were female. Sixteen percent (7/43) presented with a clinical seizure prior to EEG placement. EEG was performed in 62% (27/43) of patients; one had electrographic status epilepticus without clinical signs. Sixteen percent (7/43) of patients were diagnosed with epilepsy, with a median time to diagnosis of 1.34years (IQR 0.55-2.07) after AVM rupture. One-year epilepsy-free survival was 84% (95% CI 70%-98%) and 2-year epilepsy-free survival was 79% (95% CI 63%-95%) Remote seizures were associated with epilepsy (P<.001), but acute symptomatic seizures were not (P=.16). EEG-confirmed seizures are uncommon in patients with ICH secondary to AVM rupture; however, when identified, the seizure burden appears to be high. Patients with seizures 30days after AVM rupture are more likely to develop epilepsy.

Automated validated tool for epileptic seizure detection using deep learning

This paper explores an innovative approach for the automatic detection of epileptic seizures from audio recordings and Heart Rate Variability (HRV) using Convolutional Neural Networks (CNNs). In medical settings, accurately labeling seizure events is critical for patient monitoring. However, manual annotation by experts is not only time-intensive but also highly repetitive. To address this challenge, we developed a structured questionnaire for patients and eyewitnesses, concentrating on observable characteristics during typical seizure events. This questionnaire was used to prospectively study 198 consecutive adult patients with either Psychogenic Non-Epileptic Seizures (PNES) or Epileptic Seizures (ES). For each question, specific signs, symptoms, and risk factors were extracted as variables. The results showed a sensitivity of 95.10% and a specificity of 97.06%, confirming the reliability of the questionnaire. Also, the method proposed in the study categorizes all seizure vocalizations into a singular target event class, modeling the detection task as a binary classification problem target (seizure event) vs. non-target (non-seizure event). The CNN is trained to detect seizure events in short time frames. Experimental results indicate that the method achieves over 92.5% detection accuracy. Furthermore, the research leverages the correlation between pre-ictal epileptic states and HRV features. By addressing the noise interference commonly present during seizures, the proposed model can robustly train the CNN to identify pre-ictal states. The model's performance is promising, yielding an accuracy of over 91.5% for both positive and negative predictions. The proposed system underwent a human evaluation by a group of physicians at Mansoura University Hospital. The results were highly satisfactory, with the doctors expressing strong approval of the system's performance.

Non-convulsive Status Epilepticus as a Potentially Under-recognised Cause of Consciousness Disturbance Following Mechanical Thrombectomy: A Case Report

Non-convulsive Status Epilepticus as a Potentially Under-recognised Cause of Consciousness Disturbance Following Mechanical Thrombectomy: A Case Report

Reversible subcortical Dark White Matter lesions in nonconvulsive status epilepticus: a rare but clinically significant finding.

Reversible subcortical Dark White Matter lesions in nonconvulsive status epilepticus: a rare but clinically significant finding.

Increased Expression of MST1 in Patients With Epilepsy and in a Rat Model of Epilepsy.

Mammalian sterile20-like kinase 1 (MST1), a serine/threonine kinase frequently expressed, has emerged as pivotal modulator of multiple physiological and pathological conditions such as cellular growth, programmed cell death, oxidative stress, neurodegeneration, inflammation, and synaptic plasticity in the central nervous system. Various neurological diseases are associated with the activation of MST1. Epilepsy is a severe neurological disorder characterized by abrupt abnormal electrical activity in the brain and recurring spontaneous seizures. The most common pathological discoveries in patients and animal models with epilepsy are neuronal death, inflammation, neurodegeneration, neurogenesis, and axonal regrowth. The purpose of this study was to assess the levels of MST1 in serum and cerebrospinal fluid (CSF) specimens obtained from individuals diagnosed with epilepsy. In addition, it aimed to explore the expression pattern of MST1 in brain tissues of epileptic rats. We used enzyme-linked immunosorbent assay to measure the levels of CSF and serum MST1 in 10 epilepsy patients and 9 control patients. After creation of epilepsy models with healthy male Sprague-Dawley rats using lithium and pilocarpine, the expression of MST1 in the temporal cortex and hippocampus was evaluated at different time points (6h, 24h, 3days, 7days, 14days, and 30days after seizures) using immunofluorescence, immunohistochemistry, and Western blotting. In patients with epilepsy, the levels of CSF-MST1 were elevated (593.90±16.28 vs. 560.40±19.42pg/mL, p<0.05) compared to the control group. Accordingly, the serum-MST1 levels were 583.40±19.70pg/mL in the epilepsy group and 555.70±20.14pg/mL in the control group, demonstrating a statistically significant distinction (p<0.05). Levels of MST1 in CSF and serum could be of diagnostic help. Neuronal apoptosis in temporal cortex and hippocampus of epileptic rats was detected using terminal deoxynucleotidyl transferase dUTP nick end labeling staining. MST1 was expressed in the neuronal membrane and cytoplasm of the temporal cortex and hippocampus. The expression of MST1 increased after seizures, showing a relatively high level within 30days and reaching its highest point on the seventh day after status epilepticus. The findings of this study indicate that the increased expression of MST1 protein in patients with epilepsy and epileptic rats might play a role in the development of epilepsy.

Leading symptom: motor manifestations with impaired consciousnes : Management of epileptic seizures and status epilepticus

Epileptic seizures, which are often accompanied by areduction in vigilance, are acommon emergency. Every first-time epileptic seizure should be investigated further. Particular attention should be paid to whether it is an acute symptomatic seizure, which is an acute event characterized by ametabolic disorder or acute cerebral damage within acertain period of time, or possibly epilepsy. In terms of differential diagnosis, psychogenic nonepileptic seizures also pose achallenge, as they are often not easy to distinguish from epileptic seizures, but require adifferent therapeutic approach. Persistent epileptic seizures in the sense of status epilepticus (duration: > 5 min) are also common in the (pre)clinical emergency situation and require immediate initiation of adequate therapy, which consists of rapid and sufficient administration of benzodiazepines. Nasal administration is aquick and simple option here, particularly in the prehospital setting. Furthermore, persistent reductions in vigilance are anot infrequently occurring phenomenon in the (pre)clinical setting, which is, however, based on numerous differential diagnoses. Here, nonconvulsive status epilepticus should be considered as apossible cause and rapid diagnosis using EEG should be sought in order to begin early treatment, which improves patient outcomes.