Etiology Of Seizures Research Articles

Clinical Spectrum and Etiology of Seizures in Children in Age Group of Two Months to Twelve Years: A Cross Sectional Observational Study

Clinical Spectrum and Etiology of Seizures in Children in Age Group of Two Months to Twelve Years: A Cross Sectional Observational Study

GPR37L1 modulates seizure susceptibility: Evidence from mouse studies and analyses of a human GPR37L1 variant

Progressive myoclonus epilepsies (PMEs) are disorders characterized by myoclonic and generalized seizures with progressive neurological deterioration. While several genetic causes for PMEs have been identified, the underlying causes remain unknown for a substantial portion of cases. Here we describe several affected individuals from a large, consanguineous family presenting with a novel PME in which symptoms begin in adolescence and result in death by early adulthood. Whole exome analyses revealed that affected individuals have a homozygous variant in GPR37L1 (c.1047G>T [Lys349Asn]), an orphan G protein-coupled receptor (GPCR) expressed predominantly in the brain. In vitro studies demonstrated that the K349N substitution in Gpr37L1 did not grossly alter receptor expression, surface trafficking or constitutive signaling in transfected cells. However, in vivo studies revealed that a complete loss of Gpr37L1 function in mice results in increased seizure susceptibility. Mice lacking the related receptor Gpr37 also exhibited an increase in seizure susceptibility, while genetic deletion of both receptors resulted in an even more dramatic increase in vulnerability to seizures. These findings provide evidence linking GPR37L1 and GPR37 to seizure etiology and demonstrate an association between a GPR37L1 variant and a novel progressive myoclonus epilepsy.

Complex Partial Seizure and Hippocampus Atrophy Caused by Tramadol Abuse: A Case Study

: Generalized seizure is known as a dose- independent side effect of tramadol. The presented case is affected by complex partial seizures, following tramadol dependency. Brain magnetic imaging showed atrophy of left hippocampus, compatible with mesial temporal sclerosis. Mesial temporal sclerosis is the most common cause of treatment- resistant seizure with etiology of trauma, inflammatory processes, and recurrent seizures. It seems that recurrent generalized seizure by tramadol abuse is responsible for hippocampus atrophy, mesial temporal sclerosis, and complex partial seizures.

Mortality prediction in status epilepticus with the APACHE II score.

A retrospective study was performed of adults admitted to the intensive care unit in order to determine the utility of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting in-hospital mortality in intensive care unit patients with non-cardiac status epilepticus. The cohort consisted of 104 subjects, 50 (48.1%) male, 39 (37.5%) aged ≥65 years, with a mean APACHE II score of 17.88. Four models of the APACHE II system were assessed: numerical score, adjusted score mortality, category, and category mortality. All models demonstrated poor calibration and discrimination, even after adjustment for significantly different covariates. There were independent associations between mortality and acute or toxic-metabolic seizure etiologies, myoclonic seizures, and postoperative status. After multivariate adjustment, only the association with toxic-metabolic seizure etiologies remained. The APACHE II score is a poor predictor of mortality in intensive care unit patients with status epilepticus. Further investigation is warranted to develop better measures of acute physiological disease severity in status epilepticus and its impact on mortality.

Profile of epilepsy in a tertiary care public sector hospital of western India

Background: Epilepsy is characterised by recurrent seizures due to a chronic underlying process. Its prevalence in India is 6.24/1000 population. The study aims to evaluate the commonest types of and clinical characteristics of epilepsy, and pharmacological management in these patients. Furthermore to assess, whether these variables are in agreement with other local and international studies?Methods: This cross-sectional observational study was carried out in an epilepsy clinic of a public sector hospital in India for a period of nine months. The study analysed medical records of patients during the study period. Simple descriptive statistical tests (Mean and Standard deviation) were used to describe the numerical values of the sample while qualitative data were presented by frequency distribution.Results: A total 297 patients were enrolled, after informed consent. The male: female ratio was 1.94. The age ranged between six months and 12 years (mean±SD =6.2±2.9). Majority of patients had generalised tonic-clonic seizure (71.71%), followed by complex partial seizure (12.79%). 70.03% of our patients had idiopathic epilepsy. The commonest causes for symptomatic epilepsy were hypoxic ischaemic insult and CNS infections. Mental retardation and cerebral palsy were common comorbidities. Sodium valproate was the most commonly prescribed drug and 75.08% patients were on monotherapy.Conclusions: Seizure types, aetiology, drug therapy, comorbidities and outcome in a tertiary care hospital in India are similar to previous local and international studies. Preventable causes of epilepsy share a significant portion in the aetiology of the disease. Sodium valproate was seen to have more promising results in paediatric patients for generalized tonic clonic seizure.

Role of neuroimaging in children with first unprovoked seizure: A prospective observational study

Objective: Seizure is a common neurologic problem that occurs in 3–5% of children. Seizure may be provoked caused by a brain insult, metabolic or toxic disturbance of brain function or unprovoked. Based on several studies, the prevalence of abnormal neuroimaging in pediatric patients with a new onset afebrile seizure is estimated to be 0 % to 21%. As pointed out by previous reports aetiology and incidence of unprovoked seizures is expected to be different in developing countries like India with a high incidence of infective causes. So, this study was done to find out the proportion of cases with neuroimaging abnormality and the etiology of first unprovoked seizure in children in an Indian setup. Methods: This prospective observational study was conducted at a tertiary care teaching hospital of Northern India. Total 115 cases of 6 months to 14 years of age were enrolled over one year from September 2015 to August 2016 after obtaining written informed consent. Data collection was done on a predesigned case record form. Every enrolled child was subjected to neuroimaging either CT scan head or brain MRI. Results: Out of 115 cases 40(34.8%) had abnormal neuroimaging of which 28(70%) had inflammatory granuloma. Inflammatory granulomas all except one were due to active/calcified focus of neurocysticercosis. Proportion of children having inflammatory granuloma was significantly high in children above 2 years of age in comparison to children below 2 years of age (p=0.003) and in children with focal seizure in comparison to children with generalised tonic clonic seizure(p=0.024). Conclusion: Prevalence of neuroimaging abnormality in children presenting with first unprovoked seizure is high in India due to high prevalence of neurocysticercosis and tuberculosis. So, neuroimaging should be considered in all children with first unprovoked seizure.

A Study on Clinical Profile and Etiology of Partial Seizures in Adults at Tertiary Care Centre

A Study on Clinical Profile and Etiology of Partial Seizures in Adults at Tertiary Care Centre

Old Stroke as an Independent Risk Etiology for Todd's Paralysis

Todd's paralysis (TP) is a well-known postictal paresis in which patients present with transient weakness in their limb(s) after seizures. Although recognized as a stroke mimic in clinical practice, the pathophysiological mechanism and clinical features of TP remain unknown. Furthermore, its diagnosis can be erroneous in neurological emergency practice. We aimed to illustrate the clinical features and identify factors associated with TP. This single-center, retrospective observational study included consecutive adult patients who presented with convulsive seizure and were referred to an urban tertiary care emergency department between August 2010 and April 2016. The diagnosis of TP was set as the primary outcome measure. Clinical and laboratory variables were evaluated. Of 1381 eligible convulsive seizures in 1187 patients, TP was observed in 89 seizures (6.4%) in 75 patients. Patients with TP were significantly older, more likely to have convulsive status epilepticus, and had a longer duration of convulsion than patients without TP. TP was found in 19.7% (39 of 198) of convulsive seizures with remote etiologies including those due to old stroke. These etiologies were identified as independent significant risk factors for TP compared with seizures with cryptogenic etiology. The positive likelihood ratio of TP seizures was 11.2 for remote seizure etiologies. Our results indicated that the diagnosis of TP highly suggests premorbid or comorbid structural lesions in the central nervous system, including old stroke. This consideration in seizure etiology may help in reducing the risk of misdiagnosis of acute stroke in emergency settings and further antiepileptic treatment.

Efficacy of Vagal Nerve Stimulation for Drug-Resistant Epilepsy: Is it the Stimulation or Medication?

Vagus nerve stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug-resistant epilepsy, although modification of antiepileptic drugs (AEDs) during VNS treatment could explain the improvement in patients. We retrospectively assessed the efficacy of VNS in 30 adult patients with epilepsy treated with >6 months of follow-up. The criteria for implantation were the following: (1) not a candidate for resective epilepsy surgery, (2) drug-resistant epilepsy, (3) impairment of quality of life, (4) no other option of treatment, and (5) patients with idiopathic generalized epilepsy who fail to be controlled with appropriate AEDs. We assessed sociodemographics, seizure etiology, seizure classification, and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50% seizure improvement from baseline. Thirty patients (females, 18; males, 12; age, 35.1±13.3 years) were included. After 6, 12, 24, and 36 months of follow-up, the response rates were: 13/30 (43%), 13/27 (48%), 9/22 (41%), and 8/16 (50%), respectively; none was seizure free. Fifty-seven percent, 33%, 59%, and 81% of patients had changes of medication type or dose at 6, 12, 24, and 36 months respectively. In the majority of patients, the change of medication consisted of an increase in the dose of AEDs. Our study shows that VNS is an effective therapy, although significant changes in medications were done along with the therapy; therefore, the real effect of VNS could be controversial.

Clinical reasoning in feline epilepsy: Which combination of clinical information is useful?

We sought to identify the association between clinical risk factors and the diagnosis of idiopathic epilepsy (IE) or structural epilepsy (SE) in cats, using statistical models to identify combinations of discrete parameters from the patient signalment, history and neurological examination findings that could suggest the most likely diagnosis. Data for 138 cats with recurrent seizures were reviewed, of which 110 were valid for inclusion. Seizure aetiology was classified as IE in 57% and SE in 43% of cats. Binomial logistic regression analyses demonstrated that pedigree status, older age at seizure onset (particularly >7years old), abnormal neurological examinations, and ictal vocalisation were associated with a diagnosis of SE compared to IE, and that ictal salivation was more likely to be associated with a diagnosis of IE than SE. These findings support the importance of considering inter-ictal neurological deficits and seizure history in clinical reasoning.

Neonatal seizures and outcome in a NICU of a tertiary care hospital of Andhra Pradesh-an two year study

Background: Seizures are the most frequent clinical manifestation of central nervous system dysfunction in the newborn with the incidence varying from 1-5%. Neonatal seizures often signal an underlying ominous neurological condition, most commonly hypoxia-ischemia, and others include stroke, intraventricular hemorrhage or intraparenchymal hemorrhage, meningitis, sepsis, and metabolic disorders. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity and "prime" the brain to increased damage from seizures later in life. The present study was undertaken to delineate the various aspects of neonatal seizures, with special reference to etiology, clinical spectrum, and outcome in the Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital.Methods: A prospective cross sectional study was conducted in an NICU of a tertiary care hospital with 65 neonates in the study group for a period of 2 years. Gestational age assessment is done by modified Ballard’s scoring system and detailed neurological assessment was done. Antenatal history of mother, demographic data, and clinical history of neonate was noted and evaluated. Laboratory investigations were done and results noted and outcome was recorded.Results: Subtle seizure was the commonest (40%) clinical seizures in our study followed by tonic (21.5%). Tonic seizures were common in preterm and in full term subtle seizures. Babies with myoclonic seizures had 100% mortality. Hypoxic ischemic encephalopathy was the commonest cause (41.5%) of mortality in our study. The worst outcome was with CNS malformation (50%). A total of 10 deaths were recorded (15.4%) with maximum association in cases with history of onset 7 days (100%).Conclusions: Neonatal seizures are common and may be the first manifestation of neurological dysfunction after a variety of insults. Seizures may interfere with cardio-respiratory function and nutrition and may have detrimental effects on cerebral development. Global cerebral hypoxia-ischemia is the most common etiology of neonatal seizures, followed by intracranial bleed, hypoglycemia, septicemia, hypocalcemia, BE, CNS malformations.

Incidence and risk factors of hypotension after intravenous fosphenytoin administration.

Fosphenytoin (FOS) administered intravenously offers several benefits over intravenously administered phenytoin, including a faster infusion rate, decreased pain and irritation at the infusion site, and fewer cardiovascular complications. However, some studies suggest that the intravenous administration of FOS in some patients may also induce adverse cardiovascular events. Here, we investigated the clinical characteristics of patients who experienced hypotension following an intravenous infusion of a FOS loading dose. We reviewed the medical records of consecutive patients who received an intravenous (IV) dose of FOS between July 2013 and June 2015. Various clinical and demographic parameters were analysed, including comorbidities, drug history, seizure aetiology and type, incidence of hypotension/cardiac arrhythmia and the dosing data (ie the total dose, concentration and FOS IV infusion rate). Hypotension was defined as a ≥20mm Hg decrease in systolic blood pressure or a ≥10mm Hg decrease in diastolic blood pressure during or after FOS IV infusion. These parameters were compared between patients with and without hypotension. Of the 28 included patients, 11 (39%) had hypotension associated with an IV infusion of FOS, two of whom also had an atrioventricular block. Most patients (22/28, 79%) who received an IV infusion of FOS had status epilepticus (SE). The presence of SE was significantly associated with the development of hypotension (P=.026); hypotension occurred in half of the patients with SE, but did not occur in six patients without SE. Hypotension was also associated with old age (≥60years, P=.034) and the presence of a systemic infection (P=.04). Our study shows that hypotension associated with an IV infusion of FOS is not a rare adverse event, especially in patients with SE. Moreover, we found that old age and the presence of a systemic infection increased the risk of hypotension. These findings suggest that FOS should be infused under careful cardiovascular monitoring, especially in patients who are at higher risk of developing hypotension.

Common etiologies of acute symptomatic seizures evolving from lateralized periodic discharges in patients monitored with continuous EEG (P2.233)

Common etiologies of acute symptomatic seizures evolving from lateralized periodic discharges in patients monitored with continuous EEG (P2.233)

Magnetic resonance imaging findings in epileptic cats with a normal interictal neurological examination: 188 cases

Epilepsy is a common neurological condition in dogs and cats. Although an increased likelihood of significant brain lesions with age has been identified in neurologically normal dogs with epileptic seizures,...

New onset epilepsy in the elderly: clinical, radiological and electroencephalographic features and treatment responses.

Objective:To evaluate new onset epilepsy characteristics, etiology, radiological and electroencephalographic features and to document treatment response in the elderly.Method:This was a retrospective study carried out in King Fahd Medical City, Riyadh, Kingdom of Saudi Arabia, from 2010 to 2013. Medical records were searched to recruit patients. Hundred and nineteen patients were enrolled who fulfill the inclusion criteria. Clinical data with respect to seizure semiology, etiology, electroencephalographic findings, radiological findings, co-morbidities, and anti-epileptic drug (AED) therapy were assessed.Results:Cerebrovascular disease was the most common etiology, followed by occult cerebrovascular disease (oCVD). Focal onset seizures were the most common clinical presentation in this group of cohort. Electroencephalogram (EEG) showed generalized slowing in majority of patients (45.5%), with 21.8% interictal epileptiform activity. Patients required lower doses of AEDs to control seizures, gain better seizure control. Common co-morbidities were hypertension and diabetes mellitus.Conclusion:Patients presenting with LOE, should have search for any other cerebrovascular risk factors. Further research is needed to determine the prevalence of oCVD in LOE, and to investigate whether addressing cerebrovascular risk factors in this cohort of patients can reduce the incidence of stroke.

Neonatal Seizures: Incidence, Etiologies, Clinical Features and EEG Findings in the Neonatal Intensive Care Unit

Objective: To evaluate the incidence, etiologies, clinical features and EEG findings of seizures among the neonates admitted to one medical center. Method: We retrospectively reviewed the medical records of neonates who were diagnosed to have neonatal seizure at the Neonatal Intensive Care Unit (NICU) of one medical center in Taiwan from January to December 2015. The clinical pictures, laboratory data, image and EEG findings were reviewed in all cases. Results: Neonatal seizures were diagnosed in 22 among 122 neonatal admissions in NICU in 2015. The most common type of seizures observed were subtle (77.2%), followed by tonic (13.7%) and clonic (9.1%) seizures. Acidosis was noted in cases with perinatal asphyxia and shock. The other laboratory data was non-contributory. Seventeen (77.3%) cases had abnormal EEG (focal spikes in majority) and 12 (54.5%) cases had abnormal image findings. Perinatal asphyxia (59.1%) was the most common cause of neonatal seizures, followed by CNS infection (18.2%), malformation syndrome (9.1%) and intracranial hemorrhage (9.1%). Conclusion: Neonatal seizures were found in about 18% of our NICU admissions in one year and the most common was subtle type. Perinatal asphyxia was the most common etiology of neonatal seizures, followed by CNS infection. EEG plays a major role in the diagnosis and follow-up of neonatal seizures.

Neonatal seizures and disruption to neurotransmitter systems

Neonatal seizures and disruption to neurotransmitter systems

A Study on Clinico-Biochemical Profile of Neonatal Seizure

Background: Seizure is the most frequent sign of neurologic dysfunction in the neonate. Biochemical disturbances occur frequently in neonatal seizures either as an underlying cause or as associated abnormalities. In their presence, it is difficult to control seizures and there is a risk of further brain damage. Early recognition and treatment of biochemical disturbances are essential for optimal management and satisfactory long-term outcome. The aims were to study the biochemical abnormalities in neonatal seizures and to describe the clinical presentation, time of onset and its relation to etiology of neonatal seizures. Methods: The present study included 115 neonates presenting with seizures admitted to neonatal unit, in a teaching institute, Agartala, Tripura, India during the period of 1.5 years from November 2013 to April 2015. Detailed antenatal, natal and postnatal history was taken and examination of baby was done. Then, relevant investigations including biochemical parameters were done and etiology of neonatal seizures and their associated biochemical abnormalities were diagnosed. Results: In the present study, out of 115 neonates studied, 105 were full-term, of which 94 (81.7%) were AGA and 11 (9.6%) were SGA, nine (7.8%) were preterm and one (0.9%) was post-term babies. One hundred and thirteen (98.3%) were hospital deliveries and 104 (90.4%) were spontaneous vaginal deliveries. Seventy-five (65.2%) were with birth weight > 2.5 kg. In our study, 82 (80%) cases had onset of seizures within first 3 days. The highest number is seen on first day of life (66, 57.4%). Birth asphyxia was the cause in 92.1% of neonates who developed seizures on first day of life. Subtle seizures were the most common type of seizures in our study (49, 42.6%). Birth asphyxia was the most common cause of neonatal seizures in our study (64, 56%), followed by neonatal meningitis (24, 21%) and metabolic disorders (13, 11%). The most common biochemical abnormality detected in neonatal seizures in our study was hyponatremia (26, 65%), of which 21 (72.4%) were due to hypoxic ischemic encephalopathy (HIE), and the rest were due to neonatal meningitis (5, 55.6%). In metabolic seizures, hypoglycemia (66.7%) was common, and more so in low birth weight babies (55%). Incidence of hypomagnesemia with hypocalcemia occurred in two (1.73%) cases. Conclusions: The most common etiology of neonatal seizures is HIE and onset is during first 3 days of life. Hyponatremia is the most common biochemical abnormality associated with non-metabolic seizures, mainly HIE. Hypoglycemia is a more common metabolic disorder, more so in low birth weight. Incidence of hypomagnesemia with hypocalcemia is low but recognition of such abnormality has important therapeutic implications. J Neurol Res. 2016;6(5-6):95-101 doi: https://doi.org/10.14740/jnr404w

New-onset seizure in HIV-infected adult Zambians: A search for causes and consequences.

To identify the etiology of new-onset seizure in HIV-infected Zambian adults and identify risk factors for seizure recurrence. A prospective cohort study enrolling HIV-infected adults with new-onset seizure within 2 weeks of index seizure obtained clinical, laboratory, and neuroimaging data to determine seizure etiology. Participants were followed to identify risk factors for seizure recurrence. Risk factors for mortality were examined as mortality rates were unexpectedly high. Eighty-one patients with CSF for analysis were enrolled and followed for a median of 306 days (interquartile range 61-636). Most (91%) were at WHO stage III/IV and 66 (81%) had a pre-seizure Karnofsky score ≥50. Prolonged or multiple seizures occurred in 46 (57%), including 12 (15%) with status epilepticus. Seizure etiologies included CNS opportunistic infections (OI) in 21 (26%), hyponatremia in 23 (28%), and other infections in 8 (10%). OIs included Cryptococcus (17%), JC virus (7%) and 5% each for tuberculosis, cytomegalovirus, and varicella-zoster virus. No etiology could be identified in 16 (20%). Thirty (37%) patients died during follow-up and 20 (25%) had recurrent seizures with survival being the only identifiable risk factor. HIV-infected adults with new-onset seizure in Zambia often have advanced HIV disease with OI being the most frequent seizure etiology. Seizure recurrence is common but no risk factors for recurrence other than survival were identified. These findings suggest an urgent need for immune reconstitution in this population. Initiating treatment for seizure prophylaxis where only enzyme-inducing antiepileptic medications are available could threaten antiretroviral efficacy.

Seizure Recurrence in Children after Stopping Antiepileptic Medication: 5-Year Follow-Up

We wanted to identify in children with epilepsy the factors associated with seizure control and recurrence after a 2-year remission. We did a 5-year follow-up of epileptic children whose antiepileptic medication had been stopped. Bivariate and multivariate analyses were used to compare features of electroencephalograms (EEGs) and clinical findings. In this study, 43 patients with and 64 without a seizure recurrence (SR) were enrolled. Clinical features strongly associated with SR in the univariate analysis included a symptomatic etiology for seizures, a history of status epilepticus, treatment duration before stopping antiepileptic drugs, and abnormal EEG findings at the time of stopping antiepileptic drugs. We found that a history of status epilepticus, symptomatic partial epilepsy, treatment duration before stopping antiepileptic drugs, and an abnormal EEG when the medication was stopped are important predictors of SR. The risk factors of SR after discontinuing antiepileptic drugs have been investigated in several studies. However, a history of status epilepticus as a predictive factor is rarely mentioned.