Episodes Of Epileptic Seizures Research Articles

A new, neuromarker-based, form of combined neurofeedback EEG/tDCS training in the reduction of occupational burnout syndrome in an anaesthetic nurse working with COVID-19 patients

Anesthesia nurses working with COVID-19 patients experience exceptional emotional and physical strain due to the nature of their work in a high-risk environment. This has negative consequences for their physical and mental health and often leads to the development of occupational burnout syndrome. The purpose of this study was to evaluate a new neuromarker-based form of combined EEG / TDCS training in reducing occupational burnout syndrome in a nurse anesthetist working with patients with COVID-19.The patient, an unmarried 30-year-old anaesthetic nurse who had been working in the profession for six years, was referred to the Reintegration and Training Center of the Polish Neuropsychological Society in late 2022. A clinical interview and analysis of her medical records established that for the past two years (from early April 2020 to mid-April 2022), during which she had worked at a closed Intensive Care Unit (ICU) for patients infected with SARS-CoV-2 and contracting COVID-19, had been extremely taxing and anxiety-producing. With each successive wave of the pandemic, when the ICU was in a critical situation full of all kinds of stressors, including numerous cardiac arrests and the deaths of those she was caring for, she became increasingly mentally and physically exhausted. In addition, she experienced two losses of consciousness, but EEG and CT scans showed no changes. Her medical condition, especially her attention deficit disorder, working memory and confusion, caused her to lose her ability to work. She went on a disability pension due to full-blown occupational burnout syndrome (ICD-10 code 273.0) with a variety of psychosomatic symptoms. Several episodes of epileptic seizures were observed during her 40-minute qEEG recording with eyes open and closed and her performance of the PsyTask. The independent component analysis (ICA) extracted, among other things, a delta that corresponded to a 3Hz seizure and was generated in the prefrontal-temporal region of the right cerebral hemisphere. Functional neuromarkers of anxiety and depression were also detected in both the raw EEG recordings and data obtained from qEEG/ERPs analysis compared to the norm from the Human Brain Index (HBI). The new, neuromarker-based, form of combined EEG/tDCS training carried out the basisof these neuromarkers, conducted in 32 treatment sessions, proved effective in reducing individual disorders, including seizure activity.The examined anaesthetic nurse recovered from anxiety and depression, as well as occupational burnout syndrome and other psychosomatic disorders after 32 sessions of the new, combined neurofeedback EEG/tDCS training, and she returned to work at the ICU. Specific patterns of qEEG and ERPs serve as neuromarkers for constructing the protocol and for monitoring the results of intervention. HBI methodology can be successfully used in neurodiagnosis and neurotherapy offered to patients with occupational burnout syndrome.

A comprehensive study of machine learning-based methods to predict epileptic seizures

People with epilepsy have many difficulties as a result of this complicated brain condition, which is typified by frequent convulsions. Symptoms of these seizures include bizarre behaviors, odd sensations, and in extreme cases, loss of awareness. These seizures appear as episodes of aberrant electrical impulses in the central nervous system. Successful epilepsy management depends on early seizure detection and identification, which allows for appropriate intervention to minimize risks and improve patient outcomes. Two major reasons have contributed to the extraordinary advancements in the area of epilepsy investigations in the last few years: the explosive development of machine learning techniques and the decreasing cost of non-invasive electroencephalography (EEG) apparatus. The availability of low-cost EEG equipment has made it easier to gather information on brain activity, which has opened up new avenues for monitoring and analyzing episodes of epileptic seizures away from conventional medical settings. The abundance of data and the advancement of machine learning methods have created new opportunities for the early identification and forecasting of seizures. Machine learning algorithms can predict seizures based on EEG data, providing patients with epilepsy with more control and informed decision-making. This paper offers a current review of current methods for treating epileptic seizures. The feature extraction techniques and classification algorithms receive particular focus. The most popular EEG datasets and their accessibility are listed. The approaches that are examined range from those that use more established machine learning techniques, such as naive Bayes models, Support Vector Machines (SVM), and Linear Discriminant Analysis (LDA), to those that take advantage of more recent deep learning techniques, like (Long-Short Term Memory, or LSTM), and deep Convolutional-Neural-Networks (CNN).

A novel wearable device for automated real-time detection of epileptic seizures

BackgroundEpilepsy is a neurological disorder that has a variety of origins. It is caused by hyperexcitability and an imbalance between excitation and inhibition, which results in seizures. The World Health Organization (WHO) and its partners have classified epilepsy as a major public health concern. Over 50 million individuals globally are affected by epilepsy which shows that the patient’s family, social, educational, and vocational activities are severely limited if seizures are not controlled. Patients who suffer from epileptic seizures have emotional, behavioral, and neurological issues. Alerting systems using a wearable sensor are commonly used to detect epileptic seizures. However, most of the devices have no multimodal systems that increase sensitivity and lower the false discovery rate for screening and intervention of epileptic seizures. Therefore, the objective of this project was, to design and develop an efficient, economical, and automatically detecting epileptic seizure device in real-time.MethodsOur design incorporates different sensors to assess the patient’s condition such as an accelerometer, pulsoxymeter and vibration sensor which process body movement, heart rate variability, oxygen denaturation, and jerky movement respectively. The algorithm for real-time detection of epileptic seizures is based on the following: acceleration increases to a higher value of 23.4 m/s2 or decreases to a lower value of 10 m/s2 as energy is absorbed by the body, the heart rate increases by 10 bpm from the normal heart rate, oxygen denaturation is below 90% and vibration should be out of the range of 3 Hz -17 Hz. Then, a pulsoxymeter device was used as a gold standard to compare the heart rate variability and oxygen saturation sensor readings. The accuracy of the accelerometer and vibration sensor was also tested by a fast-moving and vibrating normal person’s hand.ResultsThe prototype was built and subjected to different tests and iterations. The proposed device was tested for accuracy, cost-effectiveness and ease of use. An acceptable accuracy was achieved for the accelerometer, pulsoxymeter, and vibration sensor measurements, and the prototype was built only with a component cost of less than 40 USD excluding design, manufacturing, and other costs. The design is tested to see if it fits the design criteria; the results of the tests reveal that a large portion of the scientific procedures utilized in this study to identify epileptic seizures is effective.ConclusionThis project is objectively targeted to design a medical device with multimodal systems that enable us to accurately detect epileptic seizures by detecting symptoms commonly associated with an episode of epileptic seizure and notifying a caregiver for immediate assistance. The proposed device has a great impact on reducing epileptic seizer mortality, especially in low-resource settings where both expertise and treatment are scarce.

Rasmussen encephalitis after traumatic brain injury in a young adult / Encefalite de Rasmussen após lesão cerebral traumática em um jovem adulto

CASE PRESENTATION: Male, 33 years old, previously healthy, presented a single episode of epileptic seizure four years ago after a traumatic brain injury suffered in 2005. Throughout the evolution, seizures appeared as left eye blinks with progression to myoclonus in left hemiface, some with secondary generalization. It became more frequent, reaching about hundreds a day despite the use of carbamazepine CR 1200 mg/day, valproic acid 1500 mg/day and clobazam 60 mg/day. Video encephalogram demonstrated severe cortical dysfunction on the right hemisphere and focal epilepsy involving an ipsilateral perisylvian region. Magnetic resonance imaging revealed hippocampal sclerosis on the right, moderate volumetric reduction in the right hemisphere and cerebellum. The seizures became more frequent despite the drug adjustment with carbamazepine, acetazolamida and lamotrigina. In addition, left hand paresis appeared, and the condition evolved with epileptic status in May 2019 which partially improved after levetiracetam administration. After three months, a frontal and temporoparietal multilobar section was performed on the right hemisphere, and histopathological analysis demonstrated mild cortical atrophy, architectural disorganization of the neuronal layers and lymphohistiocytic infiltrate with microglial arrangement, compatible with Rasmussen encephalitis in subacute stage. DISCUSSION: Rasmussen encephalitis is a unilateral inflammatory brain disease of unknown etiology and progressive character. It typically manifests in childhood and early adolescence, although there are reports in adults after traumatic brain injury [1,2]. Clinically, it presents with polymorphics seizures that invariably increase in frequency, being refractory to antiepileptics. It necessarily evolves with hemiparesis, and, often, with cognitive impairment [3,4] Magnetic resonance imaging shows unihemispheric focal cortical atrophy, and electroencephalogram shows slow unihemispheric activity, with or without epileptiform activity and unilateral start of the crises. Histopathologically, there are dominant T cell encephalitis. Pharmacological management of the disease is inefficient and surgery is the preferably treatment. FINAL COMMENTS: Rasmussen encephalitis is a rare disease that typically begins in childhood and adolescence. It's pathophysiological relation with previous traumatic brain injury is not well defined. The clinical presentation is marked by cognitive deficit and polymorphic epileptic seizures, and surgery is the best option as treatment.

Selection of features for patient-independent detection of seizure events using scalp EEG signals

Epilepsy involves brain abnormalities that may cause sudden seizures or other uncontrollable body activities. Epilepsy may have substantial impacts on the patient's quality of life, and its detection heavily relies on tedious and time-consuming manual curation by experienced clinicians, based on EEG signals. Most existing EEG-based seizure detection algorithms are patient-dependent and train a detection model for each patient. A new patient can only be monitored effectively after several episodes of epileptic seizures. This study investigates the patient-independent detection of seizure events using the open dataset CHB-MIT Scalp EEG. First, a novel feature extraction algorithm called MinMaxHist is proposed to measure the topological patterns of the EEG signals. Following this, MinMaxHist and several other feature extraction algorithms are applied to parameterize the EEG signals. Next, a comprehensive series of feature screening and classification optimization experiments are conducted, and finally, an optimized EEG-based seizure detection model is presented that can achieve overall values for accuracy, sensitivity, specificity, Matthews correlation coefficient, and Kappa of 0.8627, 0.8032, 0.9222, 0.7504 and 0.7254, respectively, with only 30 features. The classification accuracy of the method with MinMaxHist features was 0.0464 higher than that without MinMaxHist features. Compared with existing methods, the proposed algorithm achieved higher accuracy and sensitivity, as shown in the experimental results.

Synchronization structure of evolving epileptic networks using cross-entropy

In this paper we present connectivity patterns of evolving large scale epileptic networks. We employed a cross-entropy measure in the frequency domain on EEG signals to infer the networks, before and during episodes of epileptic seizures. This measure allowed us to make a richer portrait about the node interactions on the graph and to identify emergent structures associated with the synchronization of brain activity. Our results points to a more complex scenario of network organization than the synchronized/unsynchronized dichotomy, with two main results: first, showing regions with unsynchronized (or independent) behavior, even during absence seizures, contradicting the concept of hypersynchrony. Furthermore, we explore the cross-entropy fluctuations along the seizure: a group of nodes became more similar over time while another group became more different, showing a complementary behaviour and different local brain activities. These results bring new questions about the spreading and the sustenance of the epileptic seizures and others synchronization phenomena in living systems.

Epileptic syndrome in systemic lupus erythematosus and neuronal autoantibody associations.

We investigated systemic lupus erythematosus (SLE) patients with epilepsy, a major and organic neurological symptom. Our aim was to test patients for the autoimmune epilepsy-associated antibodies anti-GAD, anti-NMDAR, anti-AMPAR1/2, anti-GABABR and anti-VGKC. We tested sera from ten SLE patients with current or previous episodes of epileptic seizures. In addition, sera were tested for staining on primary hippocampal neurons. The patients' clinical and neuroimaging profile, disease activity and accumulated damage scores and therapeutic regimens administered were recorded, and correlations were evaluated. Patients were negative for all anti-neuronal autoantibodies tested, and showed no staining on primary hippocampal cells, which suggests the absence of autoantibodies against neuronal cell surface antigens. Epileptic seizures were all tonic-clonic, and all patients had high disease activity (mean SLE Damage Acticity Index score 19.3 ± 7.3). Six patients had minor or no brain magnetic resonance imaging findings, and three had major findings. 9/10 patients received immunosuppression for 5 ± 4 months, while anti-convulsive treatment was administered to all patients (4.2 ± 3 years). Our results suggest that the majority of SLE-related epileptic seizures cannot be attributed to the action of a single antibody against neuronal antigens. Studies with larger neuropsychiatric SLE populations and stricter inclusion criteria are necessary to verify these findings.

The paediatric rheumatologist and orphan disease - a story without happy ending.

Orphan diseases are not a common challenge in the everyday practice of the rheumatologist. Despite their extremely rare occurrence one of the patients under our care developed one of them – neuronal ceroid lipofuscinosis, the most frequent neurodegenerative disease observed in the paediatric population. We report a case of 2-year-old girl diagnosed with oligoarticular form of juvenile idiopathic arthritis treated in our Department with steroids and methotrexate and staying in the stage of disease remission. During routine checkups at Outpatient Clinic we observed progressive deterioration of girls neurological condition resulting in ataxia, gait disturbances with no rheumatological cause behind and speech impairment. The appearance of the symptoms was accompanied by frequent episodes of epileptic seizures, with little clinical improvement on combined antiepileptic treatment. Magnetic resonance imaging that we performed showed a picture highly suggestive of neuronal ceroid lipofuscinosis – atrophy of the patients cerebrum and cerebellum. Genetic testing conducted resulted in the diagnosis of late infantile neuronal ceroid lipofuscinosis (LINCL).

Seizure-Precipitating Factors in Relation to medical Recommendations: Especially Those Limiting Physical Activity.

Identification of factors precipitating epileptic seizures should always have practical implications and should always result in special recommendations given to patients. The purpose of our study is to analyze the relation between seizure-triggering factors and restrictive recommendations involving limitation of physical activity in particular. The research group consisted of 407 children hospitalized due to seizures. Their precipitants were identified in 27.5% of the patients. The most common included infection/fever, stress, and flashing lights. Although sport was documented as a precipitant in only 3.4% of all children, 8.1% of the investigated group were recommended to limit physical activity. As some episodes of epileptic seizures are reported to be provoked by sport, multiple restrictions are imposed on children. In the light of the worldwide academic literature and the present study, the recommendation of limiting sports activity is no longer supported.

Dermatoneuro syndrome au cours d’un scléromyxœdème : efficacité des plasmaphérèses et des immunoglobulines intraveineuses

Dermato-neuro syndrome is a specific neurological complication of scleromyxedema presenting with fever, coma, seizures and flu-like syndrome. To our knowledge, it has only been reported about twenty times in the literature. Its outcome is uncertain. We describe the case of a patient in whom a favorable outcome was achieved using a combination of plasmapheresis and intravenous immunoglobulin (IVIG). A 57-year-old woman was diagnosed 14 years ago with scleromyxedema resistant to multiple lines of treatment. In November 2011, she presented an initial episode of epileptic seizure followed by post-seizure coma, and later, confusional state with visual hallucinations. She recovered spontaneously within a few days. CT scan, MRI, EEG and screening for infection were perfectly normal, resulting in suspicion of neurological involvement associated with her scleromyxedema. In December 2012 and August 2013, she presented two further episodes of status epilepticus, followed once more by a confusional state, with etiological explorations again proving unfruitful. On this occasion, her confusional state persisted for two months until the initiation of plasmapheresis and IVIG. This combination therapy led to rapid regression of all neurological symptoms and an improvement in her general condition. The dermato-neuro syndrome is a rare neurological complication of scleromyxedema. Its pathophysiology is unknown. The monoclonal gammopathy induced by the scleromyxedema could account for the patient's hypercoagulable state and for the formation of neutrophilic aggregates leading to impaired microcirculation. Treatment is empirical and poorly codified. The course of the disease is unpredictable and may be lethal.

Bumetanide Alleviates Epileptogenic and Neurotoxic Effects of Sevoflurane in Neonatal Rat Brain

We tested the hypothesis that in newborn rats, sevoflurane may cause seizures, neurotoxicity, and impairment in synaptic plasticity-effects that may be diminished by the Na-K-2Cl cotransporter 1 inhibitor, bumetanide. Electroencephalography, activated caspase-3, and hippocampal long-term potentiation were measured in rats exposed to 2.1% sevoflurane for 0.5-6 h at postnatal days 4-17 (P4-P17). Arterial blood gas samples drawn at a sevoflurane concentration of 2.1% showed no evidence of either hypoxia or hypoventilation in spontaneously breathing rats. Higher doses of sevoflurane (e.g., 2.9%) caused respiratory depression. During anesthesia maintenance, the electroencephalography exhibited distinctive episodes of epileptic seizures in 40% of P4-P8 rats. Such seizure-like activity was not detected during anesthesia maintenance in P10-P17 rats. Emergence from 3 h of anesthesia with sevoflurane resulted in tonic/clonic seizures in some P10-P17 rats but not in P4-P8 rats. Bumetanide (5 micromol/kg, intraperitoneally) significantly decreased seizures in P4-P9 rats but did not affect the emergence seizures in P10-P17 rats. Anesthesia of P4 rats with sevoflurane for 6 h caused a significant increase in activated caspase-3 and impairment of long-term potentiation induction measured at 1 and 14-17 days after exposure to sevoflurane, respectively. Pretreatment of P4 rats with bumetanide nearly abolished the increase in activated caspase-3 but did not alleviate impairment of long-term potentiation. These results support the possibility that excitatory output of sevoflurane-potentiated gamma-aminobutyric acid type A/glycine systems may contribute to epileptogenic and neurotoxic effects in early postnatal rats.

痙攣と視神経炎を反復した抗ＮＭＤＡ受容体脳炎の１０歳女児例

A previously healthy, 10-year-old girl developed left optic neuritis that treated with oral prednisolon (PSL). During the following 8 months, the patient exhibited right optic neuritis 3 days after discontinuation of PSL therapy and three episodes of epileptic seizures 3 weeks after PSL withdrawal Cerebrospinal fluid (CSF) examination revealed pleocytosis (mononuclear cells), increased IgG index, and positive oligoclonal IgG expression. Brain MRI showed multiple cortical, subcortical, and leptomeningeal enhanced lesions. However, spinal cord MRI revealed no lesions. Neither autoantibodies to nuclear, thyroid, alpha-enolase, glutamic acid decarboxylase, nor aquaporin 4 was detected. However, anti-NMDA receptor antibodies (NMDAR-Ab) were present in her CSF. This patient is the second reported case of NMDAR-related encephalitis with recurrent optic neuritis. The possibility of seronegative neuromyelitis optica (NMO) could not be ruled out for the symptom of recurrent optic neuritis. However, the presence of NMDAR-Ab in the CSF together with increased IgG index and oligoclonal IgG bands, which are usually negative in NMO suggested that this patient is NMDAR-related encephalitis combined with rare symptom of optic neuritis for this type of encephalitis, though we need to wait larger number of patients' accumulation to conclude that the optic neuritis could be one of the features of NMDAR-related encephalitis.

Takayasu arteritis presenting as epileptic seizures: a case report and brief review of the literature

Neurological manifestations may complicate Takayasu arteritis (TA) but seizures are rare. A 40-year-old man with TA presented with recurrent episodes of epileptic seizures. Episodes consisted of a brief period of unresponsiveness followed by sudden falling, tonic stiffening and limb jerking. A postictal period with drowsiness, urine incontinence and a temporal loss of memory was also present. A carotid and intracranial duplex ultrasound revealed a reverse flow within the left vertebral artery indicating the presence of subclavian stealing syndrome while extracranial MRA suggested some stenosis at the origin of the left common carotid artery. The EEG was consistent with epilepsy. Neurological manifestations are secondary to ischemia caused by decreased blood flow in the involved carotid and vertebral arteries. Antiepileptic treatment proved effective and may be considered as a reasonable first approach. The stenotic lesions can be managed successfully with angioplasty but these procedures are associated with a high failure rate and may not be needed.

Epidural Empyema Secondary to Orbital Cellulitis: A Case Report

To report a case of epidural empyema, a rare complication of orbital cellulitis, underlining the importance of early diagnosis and appropriate therapy to avoid severe complications often associated with this disease. The treatment was initiated with extended spectrum antibiotics such as third generation cephalosporins along with aminoglycoside or metronidazole for anaerobes. The patient responded well and was asymptomatic after 15 days. Radiologic investigations (computed tomography/magnetic resonance imaging) should be done on an emergency basis. Treatment should be aggressive with parenteral use of extended spectrum antibiotics. The role of steroid is when proptosis is causing lagophthalmos with exposure keratitis and/or optic nerve compression. Judicious surgical intervention can be life saving in this emergency. Peribulbar antibiotic injection has no role in the therapy. The authors present a unique case of epidural empyema secondary to orbital cellulitis associated with an episode of epileptic seizure.

Enfermedad de Behçet en la infancia: calcificaciones corticoencefálicas

Between 5 and 48% of the patients with Behçet s disease have neurological abnormalities. In children, meningoencephalitis as an initial manifestation of the disease is not frequent. We present a four years old girl with a Behçet s disease. When she was six months of age, during an hospitalization caused by malnutrition and respiratory infection, she had developed an aseptic meningoencephalitis and laboratory test showed hypergammaglobulinemia. When she was 21 months old, she had seizures as epilepticus status, and good response was achieve treating with anticonvulsive drugs. She did not repeat episodes of epileptic seizures, but the patient showed language and neuromotor problems. CT was abnormal with asymmetric ventricular dilatation and increased subarachnoides cortical sulci with multiple calcifications in those areas. She also suffered respiratory and gastrointestinal infections that required hospitalization. At the age of 3 years and 6 months, she had occular affection with uveitis, oral and genital ulceration. The clinical history of the girl consisting of meningoencephalitis, gastrointestinal and respiratory disorders, later presentation of uveitis and oral and genital ulcers confirmed the Behçet s disease diagnosis. We present a girl with multisystemic disorders characteristic of the Behçet s disease. Initially she had an aseptic meningoencephalitis developing cortical calcifications.

CONGENITAL HYPOPARATHYROIDISM SIMULATING EPILEPSY, WITH OTHER SYMPTOMS AND DENTAL SIGNS OF INTRA-UTERINE HYPOCALCEMIA

A 10-year-old girl presented with bilateral cataracts, nail deformities, and dental changes associated with hypocalcemia. Past history revealed the occurrence of several episodes of epileptic seizures, which were treated unsuccessfully with anti-epileptic drugs. Clinical signs and laboratory tests confirmed the diagnosis of idiopathic hypoparathyroidism, and the patient was treated successfully with viatmin D2 and oral calcium. The improvement in the patient's condition, as indicated by the rise of serum calcium level, was further demonstrated by improvement in the electrocardiographic and electroencephalographic examinations, which prior to treatment showed disturbed patterns of the type observed in severe hypocalcemia and convulsive disorders. The interesting observation of episodes of intrauterine hypocalcemia, probably due to hypoparathyroidism in utero, is made on noting the effects on dentition. The problem of intrauterine suppression of the fetal parathyroid glands is discussed.