History Of Seizures Research Articles

Prevalence, Risk Factors and Prognosis of Seizures After Ischemic Stroke

Introduction and objectives Epileptic seizures (ES) are a recognized complication of stroke, commonly associated with extensive ischemic regions and cortical damage. Despite thorough investigation, reports on the incidence, risk factors, and functional implications of post-stroke ES vary widely in the literature. We aimed to evaluate the predictive factors for post-stroke ES and their effects on the clinical outcome at hospital discharge. Methods Patients with acute ischemic stroke (AIS) admitted to our stroke unit from 2015 to 2017 were eligible to this study. A multivariable logistic regression modeling was built to assess associated variables with acute symptomatic seizures (AS). We defined AS as seizures that occurred within the period of hospitalization (stroke unit discharge) without a history of seizures with clinical or electroencephalographic evidence. Results Four hundred ninety-two were included in the final analysis. The patients had a mean of 66.7 (±14.4) years; 56% were male. Thirty-eight (7.7%) patients experienced clinical ES in-hospital, with a higher incidence in those with total anterior circulation syndrome. The NIH Stroke Scale score (odds ratio [OR] 1.07, 95% confidence interval [CI], p = .03) and symptomatic hemorrhagic transformation (HT) (OR: 3.53, 95% CI: 1.38–8.99, p = .01) independently predicted ES. We did not find an association between the occurrence of seizures and unfavorable outcomes (Modified Rankin Scale 3–6) at discharge (OR1.26, 95% CI: 0.3–5.32, p = .75). Patients with seizures had a longer hospital stay (18.5 [11–35] vs. 9 [7–14] days). Conclusions Patients presenting higher NIH Stroke Scale scores upon admission or experiencing symptomatic HT face an increased risk of in-hospital ES. Nonetheless, acute symptomatic ES following AIS does not independently predict adverse functional outcomes at discharge.

Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome.

Patients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair. Retrospective chart review. Tertiary neurotology single-institution care center. The primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (cVEMP) thresholds were compared via univariate χ2 and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups. Of 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution (n = 82, 62.1%) or improvement (n = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4-28), 1-124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, p = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, p = 0.043) and higher cervical vestibular evoked myogenic potential (cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, p = 0.033). A migraine diagnosis (14.0% vs. 41.9% p < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, p = 0.034) and revision cases (0.0% vs. 14.0%, p = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05). Surgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds, cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.

Heterozygous CAPZA2 mutations cause global developmental delay, hypotonia with epilepsy: a case report and the literature review.

CAPZA2 encodes the α2 subunit of CAPZA, which is vital for actin polymerization and depolymerization in humans. However, understanding of diseases associated with CAPZA2 remains limited. To date, only three cases have been documented with neurodevelopmental abnormalities such as delayed motor development, speech delay, intellectual disability, hypotonia, and a history of seizures. In this study, we document a patient who exhibited seizures, mild intellectual disability, and impaired motor development yet did not demonstrate speech delay or hypotonia. The patient also suffered from recurrent instances of respiratory infections, gastrointestinal and allergic diseases. A novel de novo splicing variant c.219+1 G > A was detected in the CAPZA2 gene through whole-exome sequencing. This variant led to exon 4 skipping in mRNA splicing, confirmed by RT-PCR and Sanger sequencing. To our knowledge, this is the third study on human CAPZA2 defects, documenting the fourth unambiguously diagnosed case. Furthermore, this splicing mutation type is reported here for the first time. Our research offers additional support for the existence of a CAPZA2-related non-syndromic neurodevelopmental disorder. Our findings augment our understanding of the phenotypic range associated with CAPZA2 deficiency and enrich the knowledge of the mutational spectrum of the CAPZA2 gene.

Factors Predicting Seizure Outcome After Surgical Excision Of Meningioma : A Systematic Review

Abstract&#x0D; Background Seizures in meningiomas occur in approximately 30% of patients. Meningiomas that press on the cortical area, as well as larger meningiomas have a greater tendency to cause focal or generalized seizures. The risk of seizures is increased in tumors that grow along the surface of the brain compared to the base of the calvaria because these tumors are more often located in areas where they can compress cortical tissue that is susceptible to epileptogenesis. The study also aimed to discuss the predictors of seizure/epilepsy in post-operative patients.&#x0D; Methods We searched PubMed gateway database and searched the studies published between the years 2020 and 2023. The following keywords were used to search for the specific article, single and/or in combination: meningioma, seizure, epilepsy, primary brain tumor, craniotomy, predictor, and surgery. the inclusion criteria for the studies were published in English and with “human” specified as the study category. We excluded review articles, expert opinions, and other language articles.&#x0D; Results We included 10 studies we found that most seizures in meningioma post-operative patients are male gender, size &gt; 8 cm, cortical location, peritumoral edema, and history of previous seizures. The occurrence of early in-hospital seizures was associated with motor cortex involvement, postoperative Karnofsky performance score &lt;70, postoperative complications, and preoperative seizures&#x0D; Conclusion This systematic review shows are several predictors that can used to predict the seizure/epilepsy outcome in patients who underwent surgery for meningioma&#x0D; Keywords: meningioma, post-operative, seizure, epilepsy, predictors&#x0D;

CHARACTERISTIC OF PATIENTS WITH ORBITAL MENINGIOMA IN DR. KARIADI GENERAL HOSPITAL SEMARANG

Abstract&#x0D; Introduction &amp; Objectives : Meningioma is a neoplasm arising from arachnoid cap cells in the meninges. They can arise in the orbit as primary or secondary orbital meningioma. The characteristic and risk factors of orbital meningioma are essential to acknowledge. The aim of this study is to describe the characteristic and risk factors of patients with orbital meningioma in Dr.Kariadi Hospital.&#x0D; Methods : A retrospective study was held from the medical record of patients with a diagnosis of meningioma between January 2020-December 2022. The data of 58 patients included age, sex, duration of proptosis, length of proptosis, history of seizure, diplopia, history of contraceptive and trauma, RAPD, fundus examination, and CT-Scan results.&#x0D; Results : Most of the meningioma patients had female 98,27%, 70,68% in the fourth decade of life. The visual acuity of 25,88% of patients &gt;6/18, and 22,41% were blind. Around 72,41% of proptosis occurred ≥ 1 year, 87,93% had signs of headache, only 1,72% underwent seizure, 8,62% had double vision, and 5,17% had a history of head trauma. Relative afferent pupillary defect occurred in 53,44% of the affected eye with 20,68% atrophic papil and 15,51% edema papil. CT-Scan result of 86,2% had sphenoid meningioma, and only 13,79% had optic sheath meningioma. Most of the patients (72,41%) used 3 months cycle hormonal injection contraceptive.&#x0D; Conclusion : The characteristic of orbital meningioma patients in DR.Kariadi Hospital were mostly women in the fourth decade of life, had proptosis and headache as primary signs and 3 months of intramuscular hormonal contraceptives were suspected to have a correlation.

Studi Kasus Pasien Dengan Meningitis Tuberkulosis Dalam Pengobatan Tuberkulosis Paru

TB meningitis is the most severe manifestation of tuberculosis infection and causes death and disability in 50% of sufferers. Tuberculosis primarily affects adults at their most productive ages. However, all age groups remain at risk. Tuberculous meningitis is a form of extra-pulmonary tuberculosis with neurological abnormalities that accounts for 70-80% of all neurological tuberculosis cases, 5.2% of all extrapulmonary tuberculosis and 0.7% of all tuberculosis cases. Tuberculous meningitis (TB) is preceded by prodromal symptoms such as headache, anorexia, nausea/vomiting, subfebrile fever, accompanied by behavioural changes, and decreased consciousness. The patient, a 42-year-old male Mr SM, presented with decreased consciousness, a history of seizures and was taking tuberculosis drugs. Meningeal stimulation was found to be rigid, laseque test and kernique test were positive. Motor system impression of lateralisation to the right. Laboratory examination showed leukocytes 13,500/uL, platelets 728,000/uL, sodium 123 mmol, Kgd 135, thoracic X-ray with the impression of pulmonary tuberculosis with pneumonia, cranial CT-scan obtained with the impression of appropriate Tb meningitis, Non Communicating hydrocephalus. Specific treatments given were IVFD NaCL 0.9 % 20 drops / m, Omeprazole vial 2x40 mg, paracetamol infusion 3x1000 mg, Ceftriaxone 1 gram Vial, dexamethason ampoule loading 2 ampoules then 3x5 mg, Phenytoin 3x100 mg, Levofloxacin 750 mg, rifampicin 1x450 mg, isoniazid 1x300 mg, pyrazinamide 1x1000 mg, ethambutol 1x1000 mg, mg, B6 and B12 2x1 tablets.

Guidelines for Seizure Prophylaxis in Adults Hospitalized with Moderate-Severe Traumatic Brain Injury: A Clinical Practice Guideline for Health Care Professionals from the Neurocritical Care Society.

There is practice heterogeneity in the use, type, and duration of prophylactic antiseizure medications (ASMs) in patients with moderate-severe traumatic brain injury (TBI). We conducted a systematic review and meta-analysis of articles assessing ASM prophylaxis in adults with moderate-severe TBI (acute radiographic findings and requiring hospitalization). The population, intervention, comparator, and outcome (PICO) questions were as follows: (1) Should ASM versus no ASM be used in patients with moderate-severe TBI and no history of clinical or electrographic seizures? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT/fPHT) be preferentially used? (3) If an ASM is used, should a long versus short (> 7 vs. ≤ 7days) duration of prophylaxis be used? The main outcomes were early seizure, late seizure, adverse events, mortality, and functional outcomes. We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to generate recommendations. The initial literature search yielded 1998 articles, of which 33 formed the basis of the recommendations: PICO 1: We did not detect any significant positive or negative effect of ASM compared to no ASM on the outcomes of early seizure, late seizure, adverse events, or mortality. PICO 2: We did not detect any significant positive or negative effect of PHT/fPHT compared to LEV for early seizures or mortality, though point estimates suggest fewer late seizures and fewer adverse events with LEV. PICO 3: There were no significant differences in early or late seizures with longer versus shorter ASM use, though cognitive outcomes and adverse events appear worse with protracted use. Based on GRADE criteria, we suggest that ASM or no ASM may be used in patients hospitalized with moderate-severe TBI (weak recommendation, low quality of evidence). If used, we suggest LEV over PHT/fPHT (weak recommendation, very low quality of evidence) for a short duration (≤ 7days, weak recommendation, low quality of evidence).

Abstract WP224: Association of Quality-of-Life Domains and Clinical Symptoms in Pediatric Cerebral Cavernous Malformation Patients

Introduction: Cerebral cavernous malformations (CCMs) in children are associated with focal seizures, intracranial hemorrhage, and neurologic deficits, impacting quality of life (QoL). However, previous studies have not evaluated the impact of CCMs on QoL domains in pediatric populations. Methods: Completed self-reports (n=16) or parent-proxy reports (n=32) measuring patient outcomes in physical, mental and social health domains were collected from 48 pediatric familial CCM patients (5-17 years) enrolled in the Brain Vascular Malformation Consortium (BVMC) CCM study between 2019-2022. Survey responses were converted into domain T-scores and standardized against a reference population (mean ( M )=50, SD=10). Scores were oriented for higher scores to reflect worse outcomes. One-sample t-tests analyzed whether mean T scores for each domain differed significantly from 50 (p&lt;0.05). Multivariable linear regression tested whether PROMIS domain T scores were associated with (a) prior hemorrhage, (b) history of seizures, and (c) history of headaches, adjusting for age and sex. Standardized effect sizes were reported. Results: Compared to the reference population, pediatric CCM patients reported significantly better levels of mobility ( M= -2.47, 95% CI=-4.25 to -0.08; p=0.042), anxiety ( M =-4.66, 95% CI=-8.37 to -0.04, p=0.02), depression ( M= -6.13, 95% CI=-8.79 to -3.47, p&lt;0.01), fatigue ( M = -7.40, 95% CI=-10.64 to -4.16, p&lt;0.01), and pain (M =-6.71, 95% CI=-9.79 to -3.63, p&lt;0.01). Multivariable linear regression showed that CCM patients with a history of headaches had impacted peer relationships compared to those without headaches, with an effect size of 7.86 (95% CI=0.162 to 15.55, p=0.05). Patients with a history of seizures reported higher pain scores compared to those without seizures, with an effect size of 5.58 (95% CI=-0.603 to 11.77, p=0.08). Conclusion: Psychological and social functioning domains, particularly experiences in pain and relationships, were impacted in the pediatric CCM population. Further studies conducted with larger sample sizes could determine if the PROMIS questionnaire can reliably assess patient or proxy-reported outcomes in the pediatric CCM population and evaluate within-person changes over time.

Early life seizures and epileptic spasms in STXBP1-related disorders.

Individuals with disease-causing variants in STXBP1 frequently have epilepsy onset in the first year of life with a variety of seizure types, including epileptic spasms. However, the impact of early onset seizures and antiseizure medication (ASM) on the risk of developing epileptic spasms and impact on their trajectory are poorly understood, limiting informed and anticipatory treatment, as well as trial design. We retrospectively reconstructed seizure and medication histories in weekly intervals for individuals with STXBP1 developmental and epileptic encephalopathy (DEE) with epilepsy onset in the first year of life and quantitatively analyzed longitudinal seizure histories and medication response. We included 61 individuals with early onset seizures, 29 of whom had epileptic spasms. Individuals with neonatal seizures were likely to have continued seizures after the neonatal period (25/26). The risk of developing epileptic spasms was not increased in individuals with neonatal seizures or early infantile seizures (21/41 vs. 8/16, odds ratio [OR] = 1, 95% confidence interval [CI] = .3-3.9, p = 1). We did not find any ASM associated with the development of epileptic spasms following prior seizures. Individuals with prior seizures (n = 16/21, 76%) had a higher risk of developing refractory epileptic spasms (n = 5/8, 63%, OR = 1.9, 95% CI = .2-14.6, p = .6). Individuals with refractory epileptic spasms had a later onset of epileptic spasms (n = 20, median = 20 weeks) compared to individuals with nonrefractory epileptic spasms (n = 8, median = 13 weeks, p = .08). We provide a comprehensive assessment of early onset seizures in STXBP1-DEE and show that the risk of epileptic spasms is not increased following a prior history of early life seizures, nor by certain ASMs. Our study provides baseline information for targeted treatment and prognostication in early life seizures in STXBP1-DEE.

Characterization of alcohol-related seizures in withdrawal syndrome.

Alcohol-related seizures (ARS) are one of the most important consequences of alcohol withdrawal syndrome (AWS). However, demographic and clinical characteristics, and furthermore, the relationship of ARS with delirium tremens (DT), have not yet been evaluated in detail. Therefore, the aim of the present study was to reveal the correlates of ARS and examine the interaction of ARS with the occurrence of DT and with the severity of AWS. In the retrospective study (Study 1) 2851 medical charts of inpatient admissions characterized by AWS and DT were listed. Demographic and clinical variables of ARS were assessed. In the follow-up study (Study 2), patients admitted with AWS without (N = 28) and with (N = 18) ARS were enrolled. Study 1 was performed between 2008 and 2023, and Study 2 was performed in 2019 in Hungary. To determine the severity of AWS, the Clinical Institute Withdrawal Assessment Scale for Alcohol, Revised (CIWA-Ar) was used. ARS is a provoked, occasional seizure; therefore, patients with epilepsy syndrome were excluded from the two studies. Statistical analyses were performed by the means of chi-square tests, multinomial logistic regressions, mixed ANOVA, and derivation. The occurrence of DT, the history of ARS, and somatic co-morbidities were found to be risk factors for the appearance of ARS. ARS was proved to be a risk factor for the development of DT. In the follow-up study, there was no difference in the decrease of CIWA-Ar scores between the groups. Our present findings support the likelihood of kindling, which is one of the most important mechanisms underlying the development of ARS, but do not directly prove its presence. Additionally, our results revealed that the severity of AWS is not influenced by the presence of ARS. Provoked, occasional seizures during AWS are defined as ARS. In the present study, predictors and interactions of these seizures with DT-the most severe form of withdrawal-and with the severity of withdrawal were examined in retrospective and follow-up studies. The present study shows that a history of withdrawal seizures, the occurrence of DT, and somatic comorbidities are predictors of the development of seizures. Furthermore, our findings suggest that the presence of seizures does not influence the severity of withdrawal.

Phenobarbital Versus Benzodiazepines for the Treatment of Severe Alcohol Withdrawal.

Phenobarbital may offer advantages over benzodiazepines for severe alcohol withdrawal syndrome (SAWS), but its impact on clinical outcomes has not been fully elucidated. The purpose of this study was to determine the clinical impact of phenobarbital versus benzodiazepines for SAWS. This retrospective cohort study compared phenobarbital to benzodiazepines for the management of SAWS for patients admitted to progressive or intensive care units (ICUs) between July 2018 and July 2022. Patients included had a history of delirium tremens (DT) or seizures, Clinical Institute Withdrawal Assessment of Alcohol-Revised (CIWA-Ar) >15, or Prediction of Alcohol Withdrawal Severity Scale (PAWSS) score ≥4. The primary outcome was hospital length of stay (LOS). Secondary outcomes included progressive or ICU LOS, incidence of adjunctive pharmacotherapy, and incidence/duration of mechanical ventilation. The final analysis included 126 phenobarbital and 98 benzodiazepine encounters. Patients treated with phenobarbital had shorter median hospital LOS versus those treated with benzodiazepines (2.8 vs 4.7 days; P < 0.0001); a finding corroborated by multivariable analysis. The phenobarbital group also had shorter median progressive/ICU LOS (0.7 vs 1.3 days; P < 0.0001), and lower incidence of dexmedetomidine (P < 0.0001) and antipsychotic initiation (P < 0.0001). Fewer patients in the phenobarbital group compared to the benzodiazepine group received new mechanical ventilation (P = 0.045), but median duration was similar (1.2 vs 1.6 days; P = 1.00). Scheduled phenobarbital was associated with decreased hospital LOS compared to benzodiazepines for SAWS. This was the first study to compare outcomes of fixed-dose, nonoverlapping phenobarbital to benzodiazepines in patients with clearly defined SAWS and details a readily implementable protocol.

Prevalence of epileptiform electroencephalographic abnormalities in people without a history of seizures: A systematic review and meta-analysis.

Abnormal patterns identified on electroencephalogram (EEG) are one of the primary diagnostic tests for epilepsy. However, epidemiological studies have established that both benign and epileptiform abnormalities (EAs) occur on the EEG of nonepileptic, seizure-free people as well. The reported rates of EAs in nonepileptic, seizure-free populations vary, and the true prevalence is unknown. The primary objective of this systematic review and meta-analysis was to estimate the overall prevalence of EAs in the EEG of people without a history of seizures. Secondary aims were to characterize (1) the cortical localization of focal abnormalities, (2) the proportion of findings that occurred during standard EEG stimulation protocols, and (3) the persistence and implications of abnormalities at follow-up. A comprehensive electronic search of six bibliographic databases was completed: Embase, MEDLINE, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register for Controlled Trials, and Web of Science. No search date restrictions were applied. Overall effect size was calculated using a generalized linear mixed-effects model. Fifty-three studies, totaling 73 990 individuals, met our inclusion criteria. The overall point prevalence of EAs was 1.74% (95% confidence interval [CI] = 1.13-2.67). Due to the risk of bias in the literature, especially from participant selection, we believe this to be an overestimate of the true prevalence. Prevalence of EAs was greater in children (2.45%, 95% CI = 1.41-4.21) and the elderly (5.96%, 95% CI = 1.39-22.13) compared with adults (.93%, 95% CI = .48-1.80). Reports of developing epilepsy after an EA-positive EEG were rare. The likelihood of subsequent positive findings on follow-up EEG may be as high as 50%. Our study has limitations in that males were overrepresented in the study samples, there is substantial heterogeneity among studies, and many studies provided insufficient detail about their exclusion criteria. Nonetheless, our estimates provide benchmark data for future studies examining EAs in clinical populations, particularly behavioral and psychiatric populations.

Psychedelics, epilepsy, and seizures: a review.

Psychedelic compounds have been utilized by humans for centuries for medicinal, religious, and tribal purposes. Clinical trial data starting from the early 2000s and continuing today indicates that psychedelics are a clinically efficacious treatment for a variety of neurological and psychiatric disorders. However, all clinical trials examining these substances have excluded any individual with a past or current history of seizures, leaving a large cohort of epilepsy and non-epilepsy chronic seizure disorder patients without anywhere to turn for psychedelic-assisted therapy. These exclusions were made despite any significant evidence that clinically supervised psychedelic use causes or exacerbates seizures in this population. To date, no clinical trial or preclinical seizure model has demonstrated that psychedelics induce seizures. This review highlights several cases of individuals experiencing seizures or seizure remission following psychedelic use, with the overall trend being that psychedelics are safe for use in a controlled, supervised clinical setting. We also suggest future research directions for this field.

Retrospective Analysis of Presymptomatic Treatment In Sturge-Weber Syndrome.

Ninety percent of infants with Sturge-Weber syndrome (SWS) brain involvement have seizure onset before 2 years of age; this is associated with worse neurologic outcome. Presymptomatic treatment before seizure onset may delay seizure onset and improve outcome, as has been shown in other conditions with a high-risk of developing epilepsy such as tuberous sclerosis complex. Electroencephalogram (EEG) may be a biomarker to predict seizure onset. This retrospective clinical data analysis aims to assess impact of presymptomatic treatment in SWS. This two-centered, IRB-approved, retrospective study analyzed records from patients with SWS brain involvement. Clinical data recorded included demographics, age of seizure onset (if present), brain involvement extent (unilateral versus bilateral), port-wine birthmark (PWB) extent, family history of seizure, presymptomatic treatment if received, neuroscore, and anti-seizure medication. EEG reports prior to seizure onset were analyzed. Ninety-two patients were included (48 females), and 32 received presymptomatic treatment outside of a formal protocol (5 aspirin, 16 aspirin and levetiracetam; 9 aspirin and oxcarbazepine, 2 valproic acid). Presymptomatically-treated patients were more likely to be seizure-free at 2 years (15 of 32; 47% versus 7 of 60; 12%; p<.001). A greater percentage of presymptomatically-treated patients had bilateral brain involvement (38% treated versus 17% untreated; p=.026). Median hemiparesis neuroscore at 2 years was better in presymptomatically-treated patients. In EEG reports prior to seizure onset, the presence of slowing, epileptiform discharges, or EEG-identified seizures was associated with seizure onset by 2 (p=.001). Presymptomatic treatment is a promising approach to children diagnosed with SWS prior to seizure onset. Further study is needed, including prospective drug trials, long-term neuropsychological outcome, and prospective EEG analysis to assess this approach and determine biomarkers for presymptomatic treatment.

Exacerbation of Mirror Movement Disorder: A Complex Case of Childhood-onset Mirror Movements Aggravated by Essential Tremors, and Parkinson's Disease

Background Mirror movement (MM), also known as bimanual synkinesis, is characterized by simultaneous involuntary movements of homologous muscles accompanying voluntary movements of contralateral body regions. MM can be observed in various neurological conditions, including cerebral palsy, corticobasal syndrome, Parkinson's disease, certain types of symptomatic epilepsies, Creutzfeldt-Jakob's disease, Huntington's disease, and others. Case Description A 52-year-old female with a history of epileptic seizures, essential tremors and mild MM was presented to a neurology clinic for seizure management. She had a long-standing history of seizures since childhood. Initial neurological examination revealed mild MM disorder. During the follow up visits, patient’s mirror movements were exacerbated months before she was diagnosed with Parkinson’s disease. Multiple antiepileptic drug regiments along with Carbidopa-levodopa were used and dose adjustments were done during follow up visits to help stabilize the patient’s symptoms. Conclusion In conclusion, this case highlights the progressive nature of mirror movement disorder (MMD) and its association with other neurological conditions, such as epilepsy, essential tremors, and Parkinson's disease. The primary aim of this study was to showcase that individuals with early childhood onset of MMD may experience a deterioration of their condition as they acquire additional neurological disorders, such as essential tremors or Parkinson's disease. Moreover, this study seeks to elucidate how the exacerbation of mirror movement symptoms in such cases can serve as an early indicator of the onset of Parkinson's disease. Medication adjustments played a crucial role in managing the patient's symptoms, emphasizing the importance of individualized treatment plans and close monitoring.

Factors Associated with Pathway-Concordant Neuroimaging for Pediatric Ischemic Stroke

ObjectiveTo determine factors associated with magnetic resonance imaging (MRI) and non-invasive diagnostic angiography among children presenting to the emergency department (ED) with acute ischemic stroke. Study DesignWe performed a cross-sectional study using data from >50 US children’s hospitals. We included children 29 days through 17 years old hospitalized from the ED with an International Classification of Disease, 10th revision, diagnosis code for acute ischemic stroke between October 1, 2015, and November 30, 2022. We excluded children with a principal diagnosis code of trauma/external injury, without neuroimaging on day of presentation, and into-ED transfers. Our outcomes were defined as acquisition of MRI (versus computed tomography only) and angiography (versus no angiography) on day of presentation. We performed generalized linear mixed modeling with hospital as a random effect to determine the association of demographics, known comorbidities, and treatment factors with each outcome. ResultsWe included 1,601 children. In multivariable analysis, younger age, mechanical ventilation, and Black race were associated with lower odds of MRI acquisition, while history of moyamoya disease and sickle cell disease were associated with higher odds. Younger age, mechanical ventilation, Hispanic ethnicity, Black race, other races, history of metabolic disease, and history of seizures were associated with lower odds of angiography. ConclusionsYounger and non-White children experienced lower odds of MRI and angiography, which may be driven by health system limitations or provider implicit biases or both. Our results expose risk factors for underdiagnosis of ischemic stroke and provide opportunities to tailor institutional pathways reflective of underlying pathophysiology.

Epilepsy in dystrophinopathies: A retrospective cohort and review of the literature

ObjectiveThis study aimed to assess the prevalence and characteristics of epilepsy in dystrophinopathies within a cohort of 142 patients at a tertiary neuromuscular center in Istanbul, Turkey. MethodsWe recorded the age at seizure onset, seizure type, family history, history of febrile seizures, treatment, and EEG results. Epilepsy was classified according to the latest International League Against Epilepsy (ILAE) classification. ResultsOf the 142 DMD patients, 8 experienced epileptic seizures (5.6 %). The median age of the patients was 11 years (8.0–15.2). The median age for the first DMD symptoms was 24 months (16.5–37.5). All seizures were consistent with generalized tonic-clonic seizures. Three patients are currently on anti-seizure medication. SignificanceThe prevalence of epilepsy in our study (5.6 %) exceeds that of the general pediatric population (0.5–1 %). However, the frequency of febrile seizures in children with dystrophinopathy is similar to that of the general population.

Late infantile epileptic encephalopathy: A distinct developmental and epileptic encephalopathy syndrome.

Within the spectrum of developmental and epileptic encephalopathy (DEE), there are a group of infants with features that are distinct from the well-recognized syndromes of early infantile developmental and epileptic encephalopathy (EIDEE), infantile epileptic spasm syndrome (IESS), and Lennox-Gastaut syndrome (LGS). We refer to this condition as late infantile epileptic encephalopathy (LIEE). Our objective was to highlight the characteristics of this group by analyzing patients who exhibit prototypical features. From July 2022 to May 2023, we searched for LIEE features in pediatric patients who underwent epilepsy follow-up at the University of Chicago Comer Children's Hospital. Out of 850 patients evaluated, thirty patients (3.5%) were identified with LIEE based on electroclinical characteristics. These patients had an average onset of epilepsy at 6.8 months and an average onset of LIEE features at 18.1 months. The epilepsy etiology was most commonly genetic and metabolic (50%), followed by congenital cortical malformations (23%), acquired structural abnormalities (20%), and unknown (7%). The predominant seizure types were myoclonic-tonic (70%), spasm-tonic (50%), epileptic spasms (47%), tonic (43%), and myoclonic (43%) seizures. All patients reported a history of either spasm-tonic or myoclonic-tonic seizures in addition to other types. All patients had EEGs showing discontinuity, electrodecrements, or both along with diffuse slowing, background voltages between 100 and 300 μV, and superimposed multifocal, diffuse epileptiform discharges. Every patient, except one, fulfilled the definition of drug-resistant epilepsy, and all reported either moderate-to-severe or severe developmental delay. Late infantile epileptic encephalopathy (LIEE) is characterized by several unique clinical and electrographic features. Typically, LIEE manifests in patients during the second year of life and occurs before two years of age, hence late infantile onset. The condition is commonly observed in infants with symptomatic epilepsy. Myoclonic-tonic and spasm-tonic seizures are the quintessential seizure types. The inter-ictal EEG exhibits more organization and lower voltages than seen with hypsarrhythmia and lacks the defining EEG characteristics of EIDEE, IESS, or LGS. We propose that LIEE is a distinct electroclinical syndrome within the spectrum of developmental and epileptic encephalopathies.

Postictal vertebral fractures: Incidence, risk factors, and clinical outcomes. A systematic review

IntroductionVertebral fractures in postictal patients with no prior acute or chronic trauma history are rare but can lead to severe neurological complications if missed during the initial evaluation. Research questionWhat are the prevalence and risk factors associated with vertebral fractures? What are the characteristics of these fractures in terms of their location, severity, and clinical outcome? Materials and methodsA comprehensive literature search using MeSH terms was conducted. Data from previously published studies and three new cases from the authors' institution were collected. The variables included demographic information, seizure history, medical comorbidities, fracture characteristics, and treatment details. Descriptive statistics summarize the data. Inferential statistics (t-test, Mann-Whitney U test, chi-squared test, Fisher's exact test, and logistic regression) were used to identify the risk factors for vertebral fractures. ResultsThe review included nine studies with a total of 19 patients, and three additional unpublished cases from the authors' institution. The median patient age was 50 years, with male predominance. No significant differences were found between the groups in osteoporosis, seizure history, antiepileptic drug use, or alcohol or drug abuse. The most common sites of fracture were the midthoracic spine for compression fractures and thoracolumbar junction for burst fractures. Risk factors for fractures include greater muscle mass, lower bone mineral density, longer convulsions, and recurrent convulsions. DiscussionThe mechanism of injury involved violent muscle contractions during seizures. ConclusionThis review summarizes the current knowledge and provides evidence for best practices in the management of seizure-induced vertebral fractures.

Risk Factors of Seizure in Childhood Shigellosis.

Shigellosis is one of the common causes of bacterial diarrhea in children. Seizures are common in shigellosis. It is essential to identify the risk factors of seizure in this disease. This study was conducted on 224 children with shigellosis. The patients were divided into: With (case groups = 63 cases) and without seizures (control group = 161 cases). Groups were compared regarding different variables such as age, gender, clinical symptoms, and laboratory findings. Data analysis was done using statistical tests and SPSS software. Logistic regression analysis was used to determine the risk factors of seizures. Out of 224 cases of children with shigellosis, 107 (47.8%) were male and 117 (52.2%) female. Significant differences were observed between the two groups in terms of age, history of febrile convulsions, frequency of bloody diarrhea, frequency of fever, duration of diarrhea before hospitalization, abdominal pain, increase in BUN, hyponatremia, hypocalcemia, and red blood cell count in stool (P<0.05). Logistic regression analysis showed that a history of febrile seizure, fever, and hyponatremia are the risk factors for seizures in shigellosis. This study concluded that a history of febrile seizure, fever, and hyponatremia are risk factors for seizure in childhood shigellosis, thus rapid diagnosis and treatment of childhood shigellosis with risk factors is very important.