Late Seizures Research Articles

Use of an antiepileptic drug to control epileptic seizures associated with cranioplasty: A randomized controlled trial

BackgroundEpilepsy is a common complication of cranioplasty. The present study was designed to explore the clinical effect of prophylactic anti-epilepsy drugs (AED) to control epileptic seizures associated with cranioplasty. Methodsand design: This trial was a prospective, randomized, open-label, single-centre, active controlled study designed to investigate the use of antiepileptic drug to control epileptic seizures associated with cranioplasty. We tested the necessity and methods of drug use. Three hundred twenty epilepsy patients who underwent cranioplasty were included in this study. The patients were randomly divided into the control group (160 cases) and the experimental group (160 cases). AED were administered to experimental group from 4 days before the surgery until 1 month after the surgery. The incidence of early and late epileptic seizures after cranioplasty was analyzed. The liver function, abnormal blood test 1 month after surgery were compared between these two groups. ResultsThe incidence of seizures in the Control group was 28.6% (43 cases in 149 cases) while in the experimental group was only 5.9% (9 cases in 151 cases), which had statistical significance. The incidence of epileptic seizure was significantly higher in patients who received no AED treatment than in those who received AED treatment. Besides, the abnormal liver function and blood routine examination in both control and experimental group had no significant differences. ConclusionThe incidence of epilepsy associated with the cranioplasty is high and early use of anti-epileptic drugs can effectively reduce the occurrence of seizures.

Clinical and radiological profile of post-Stroke seizures

Aims: To know the incidence of early versus late post stroke seizures, and its type and time of occurrence after the stroke as well as its relation with different type of stroke and location of the involvement and correlation with different risk factors along with to know occurrence early versus late post stroke seizures in young versus old stroke patients. Study Design: Observational study. Methodology: All the patients with the diagnosis of post-stroke seizures were included. Those with known epilepsy, sepsis, electrolyte imbalance, patient having old stroke presenting with fresh stroke and any other reversible precipitating factors were excluded. Data collected regarding the age, co-morbid conditions, details of seizures and radiological findings including type and location of stroke. Results: Total of 100 subjects with post-stroke seizures were included. Fifty eight percent were males while 42% were females. Mean age of the study population was 57.6 ± 15 years. Eighteen patients had young stroke ( 45 years. Early post-stroke seizures were seen in 54% of patients. Rest of the patients i.e. 46%, had late-seizures. GTCS were the most common type of seizures seen in 72% patients, followed by partial motor with secondary generalization and partial motor seen in 20% and 8% of the patients respectively. Sixty two percent of the patients had multiple episodes of seizures i.e. two or more than two episode while 38% had only single episode of seizure. Only 2% had status epilepticus. Eighty percent of the patient had Ischemic stroke while hemorrhagic stroke was seen in 20% of the patients. Sixty two percent of the patient had cortical location of stroke while 38% had subcortical location. Comparison between early and late onset seizures revealed significant association between ischemic heart disease (IHD) and hypertension with late onset seizures (p < 0.05). There was no significant difference in occurrence of early compared to late onset seizures in young and old patients. Conclusion: Post-stroke seizures were more frequent in males, older age with history of hypertension, and with cortical ischemic strokes. Early seizures, multiple episodes and generalized seizure type were more common. History of ischemic heart disease and hypertension showed a strong relationship with the occurrence of late onset seizures. Long term prospective studies are required to know whether control of hypertension and IHD may lead to decrease incidence of post stroke seizures. Keyword: Seizures, Stroke, Early versus Late Post stroke seizures

Prognostic significance of clinical seizures after cardiac arrest and target temperature management

AimClinical seizures are common after cardiac arrest and predictive of a poor neurological outcome. Seizures may be myoclonic, tonic-clonic or a combination of seizure types. This study reports the incidence and prognostic significance of clinical seizures in the target temperature management (TTM) after cardiac arrest trial. Our hypotheses were that seizures are associated with a poor prognosis and that the incidence of seizures is not affected by the target temperature. MethodsPost-hoc analysis of reported clinical seizures during day 1–7 in the TTM-trial including their treatment, EEG-findings, and long-term neurological outcome. The trial randomised 939 comatose survivors to TTM at 33°C or 36°C with strict criteria for withdrawal of life-sustaining therapies. Sensitivity, specificity and false positive rate for poor outcome were reported for different types of seizures. ResultsClinical seizures were registered in 268 patients (29%), similarly distributed in both intervention arms. Early and late seizures were equally predictive of poor outcome. Myoclonic seizures were the most common (240 patients, 26%) and the most predictive of a poor outcome (sensitivity 36.1%, false positive rate 4.3%). Two patients with status myoclonus regained consciousness, one with a good neurological outcome, generating a false positive rate of poor outcome of 0.2% (95%CI 0.0–1.0). ConclusionClinical seizures are common after cardiac arrest and indicate poor outcome with limited specificity. Prolonged seizures are a very grave sign but occasional patients may have a good outcome. The level of the target temperature does not affect the prevalence or prognostic significance of seizures.

A comparative study of seizures in arterial and venous stroke

ObjectiveThis study was undertaken to compare the frequency, spectrum and predictors of seizures in arterial stroke and cerebral venous sinus thrombosis (CVST). MethodsThe patients having seizures following arterial stroke or CVST during 2010–2015 were included. Stroke was confirmed by computerized tomography (CT) scan, magnetic resonance imaging (MRI) and or MR Venography (MRV). The seizures were categorized into early seizures (<14days) and late seizures (≥14days) of arterial stroke or CVST. Neurological findings, risk factors for stroke and CVST were noted. The severity of stroke was defined by National Institute of Health Stroke Scale (NIHSS). The outcome on discharge was assessed by modified Rankin Scale (mRS) as good (0–2) or poor (>2). ResultsThere were 870 patients with arterial stroke and 128 with CVST. Seizures occurred in 74 (57.8%) of CVST and 119 (13.7%) of arterial stroke. Early seizures were more common in CVST than arterial stroke (98.6% vs. 47.9%, p=0.001) whereas late seizures were more common after arterial stroke than CVST (52.1% vs. 1.4%, p=0.001). In the arterial stroke, seizures were predicted by carotid territory ischemic stroke (OR 3.95, 95% CI 1.51–10.32, p=0.005) and CVST by parenchymal involvement (OR 2.61, 95% CI 1.04–6.55, p=0.04) ConclusionCVST results in more frequent and early seizures whereas in arterial stroke late seizures are common. Post stroke seizures in ischemic stroke were predicted by carotid territory infarction and venous stroke by parenchymal involvement.

Late Seizures after Stroke in Clinical Practice: The Prevalence of Non-convulsive Seizures

Objective The prevalence of the non-convulsive type of late seizure after stroke is unknown. The aim of the present study was to clarify the characteristics of late seizure in clinical practice, mainly focusing on the prevalence of non-convulsive seizure. Methods A total of 178 consecutive patients who were admitted and diagnosed with late seizure after stroke were retrospectively enrolled, and the data of 127 patients for whom the complete seizure was observed by a bystander were analyzed. Clinical information was obtained from the medical records and nursing notes. Results A non-convulsive seizure was observed in 37 patients (29%). A focal seizure and its secondary generalization accounted for 79% of the seizure types. Status epilepticus was observed in 60 patients (47%), including 11 patients (9%) without convulsion. The patients with non-convulsive seizures were significantly younger than those with convulsive seizures, but there were no other significant differences between the two groups with respect to sex, classification or the lesion of stroke. Conclusion There was a high rate of non-convulsive seizures in patients with late seizure after stroke. A non-convulsive seizure may be caused by any type or location of preceding stroke. More attention is needed in the differential diagnosis of neurological deterioration after stroke.

Posterior reversible encephalopathy syndrome – unusual manifestation of late postpartum eclampsia

Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome associated with headache, convulsions, visual disturbance and encephalopathy. Cerebral imaging of the condition is dominated by parieto-occipital white matter changes. We report a case of a 33-year-old multiparous woman with late postpartum seizures preceded by severe headache and visual disturbances. She was initially diagnosed with post-spinal headache but developed seizures. She was then diagnosed as having eclamptic fits and magnetic resonance venography revealed lesions suggestive of PRES. With prompt management the patient improved. This emphasizes the importance of early diagnosis of postpartum eclampsia to allow prompt management and prevent neurological sequelae.

Intraoperative seizures and seizures outcome in patients undergoing awake craniotomy.

Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure (IOS) is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in AC. Bibliographic searches of the Embase, Medline, were performed to identify articles and conference abstracts that investigated the IOS frequency of patients underwent AC. Twenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general IOS rate for patients with AC was 8% (fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%. This systematic review and meta-analysis shows that AC is a safe technique with relatively low IOS occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

41. Epileptiform activity and epileptic seizures in brain injured patients with prolonged disorders of consciousness

Brain injured patients might show “late” seizures beyond one week from injury. In the present observational study we analyzed occurrence of epileptiform activity (EA) and late Epileptic Seizures (ES) during neurorehabilitation stay in 130 traumatic, vascular and anoxic DOC patients (77 males, mean age: 55.8 ± 17.33), with a clinical diagnosis of vegetative state (n = 97) or minimally conscious state (n = 33). We also investigated impact of EA and ES on patients’ long-term (30 months post-onset) clinical outcome. EA resulted to be present in 61/130 (46.9%) DOC patients and ES occurred in 35/130 (26.9%) DOC without significant differences in the clinical diagnosis or etiology. Among patients with EA, only 26/61 (42.6%) develop clinically evident ES. Mortality at 30 months did not significantly differ in DOC patients with or without ES and in DOC patients with of without EA (37.5% vs. 35.8%; p = .86). The proportion of “recovered” patients was higher in patients without ES than in patients with ES (70.5% vs. 48.0%; p = .064), whereas the proportion of recovered patients did not differ between patients without or with EA (64.7% vs. 60.0%; chi-square < 1). Presence of ES, but not of EA, significantly impact on recovery of consciousness and level of responsiveness at long-term outcome.

Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study

Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years. Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined. PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively). In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.

PGR-3Long-Term Outcome Following Late Seizure Control in a Child with Early Onset Medically Refractory Epilepsy and Intellectual Disability Neuroimmunological Disease

PGR-3Long-Term Outcome Following Late Seizure Control in a Child with Early Onset Medically Refractory Epilepsy and Intellectual Disability Neuroimmunological Disease

Seizure Prophylaxis in Patients with Traumatic Brain Injury: A Single-Center Study

The use of prophylactic anticonvulsants to prevent early post-traumatic seizures (PTSs) is recommended but inconsistently employed in patients with traumatic brain injury (TBI). The authors evaluated outcomes associated with prophylaxis administration in patients with TBI at a Level 1 trauma center. All patients admitted with TBI from October 2007 through May 2012 were included. Our primary outcome was the incidence of early PTSs. Secondary outcomes included mortality, length of hospital and intensive care unit (ICU) stays, and incidence of late seizures. Of the 2,111 patients with TBI, 557 (26.4%) received seizure prophylaxis and 1,554 (73.6%) did not. Two early PTSs occurred in the prophylaxis group (0.4%), whereas 21 occurred in the non-prophylaxis group (1.4%) (p = 0.05). The overall mortality rate was higher in patients who received prophylaxis (14.2% vs. 6.2%; p < 0.001), and the mean hospital length of stay (LOS) was longer (6.8 ± 6.9 vs. 3.8 ± 5 days; p < 0.001). In patients with severe and moderate TBI, the rate of prophylaxis administration was approximately half, whereas significantly fewer patients with mild TBI received prophylaxis than did not (20.2% vs 79.8%, p < 0.001). Lower Glasgow Coma Scale (GCS) score and longer hospital LOS were associated with early PTS (p = 0.008 for both comparisons), but sex and age were not. Brain hemorrhage was present in 78.3% of those patients who experienced early seizures. In our cohort, patients who received seizure prophylaxis had a lower GCS score, higher overall mortality rate, longer LOS, and more frequent ICU admissions, suggesting that patients who received prophylaxis were likely more severely injured.

Delayed seizures after intracerebral haemorrhage.

Late seizures after intracerebral haemorrhage occur after the initial acute haemorrhagic insult subsides, and represent one of its most feared long-term sequelae. Both susceptibility to late seizures and their functional impact remain poorly characterized. We sought to: (i) compare patients with new-onset late seizures (i.e. delayed seizures), with those who experienced a recurrent late seizure following an immediately post-haemorrhagic seizure; and (ii) investigate the effect of late seizures on long-term functional performance after intracerebral haemorrhage. We performed prospective longitudinal follow-up of consecutive intracerebral haemorrhage survivors presenting to a single tertiary care centre. We tested for association with seizures the following neuroimaging and genetic markers of cerebral small vessel disease: APOE variants ε2/ε4, computer tomography-defined white matter disease, magnetic resonance imaging-defined white matter hyperintensities volume and cerebral microbleeds. Cognitive performance was measured using the Modified Telephone Interview for Cognitive Status, and functional performance using structured questionnaires obtained every 6 months. We performed time-to-event analysis using separate Cox models for risk to develop delayed and recurrent seizures, as well as for functional decline risk (mortality, incident dementia, and loss of functional independence) after intracerebral haemorrhage. A total of 872 survivors of intracerebral haemorrhage were enrolled and followed for a median of 3.9 years. Early seizure developed in 86 patients, 42 of whom went on to experience recurrent seizures. Admission Glasgow Coma Scale, increasing haematoma volume and cortical involvement were associated with recurrent seizure risk (all P < 0.01). Recurrent seizures were not associated with long-term functional outcome (P = 0.67). Delayed seizures occurred in 37 patients, corresponding to an estimated incidence of 0.8% per year (95% confidence interval 0.5-1.2%). Factors associated with delayed seizures included cortical involvement on index haemorrhage (hazard ratio 1.63, P = 0.036), pre-haemorrhage dementia (hazard ratio 1.36, P = 0.044), history of multiple prior lobar haemorrhages (hazard ratio 2.50, P = 0.038), exclusively lobar microbleeds (hazard ratio 2.22, P = 0.008) and presence of ≥ 1 APOE ε4 copies (hazard ratio 1.95, P = 0.020). Delayed seizures were associated with worse long-term functional outcome (hazard ratio 1.83, P = 0.005), but the association was removed by adjusting for neuroimaging and genetic markers of cerebral small vessel disease. Delayed seizures after intracerebral haemorrhage are associated with different risk factors, when compared to recurrent seizures. They are also associated with worse functional outcome, but this finding appears to be related to underlying small vessel disease. Further investigations into the connections between small vessel disease and delayed seizures are warranted.

The progression of electrophysiologic abnormalities during epileptogenesis after experimental traumatic brain injury.

Posttraumatic epilepsy (PTE) accounts for 20% of acquired epilepsies. Experimental models are important for studying epileptogenesis. We previously reported that repetitive high-frequency oscillations with spikes (rHFOSs) occur early after lateral fluid percussion injury (FPI) and may be a biomarker for PTE. The objective of this study was to use multiple electrodes in rat hippocampal and neocortical regions to describe the long-term electroencephalographic and behavioral evolution of rHFOSs and epileptic seizures after traumatic brain injury (TBI). Adult male rats underwent mild, moderate, or severe FPI or sham injury followed by video-electroencephalography (EEG) recordings with a combination of 16 neocortical and hippocampal electrodes at an early, intermediate, or late time-point after injury, up to 52 weeks. Recordings were analyzed for the presence of rHFOSs and seizures. Analysis was done on 28 rats with FPI and 7 shams. Perilesional rHFOSs were recorded in significantly more rats after severe (70.3%) than mild (20%) injury or shams (14.3%). Frequency of occurrence was significantly highest in the early (10.8/h) versus late group (3.2/h). Late focal seizures originating from the same electrodes were recorded in significantly more rats in the late (87.5%) versus early period (22.2%), occurring almost exclusively in injured rats. Seizure duration increased significantly over time, averaging 19 s at the beginning of the early period and 27 s at the end of the late period. Seizure frequency also increased significantly over time, from 4.4 per week in the early group to 26.4 per week in the late group. Rarely, rats displayed early seizures or generalized seizures. FPI results in early rHFOSs and later spontaneous focal seizures arising from peri-lesional neocortex, supporting its use as a model for PTE. Epilepsy severity increased over time and was related to injury severity. The association between early rHFOSs and later focal seizures suggests that rHFOSs may be a potential noninvasive biomarker of PTE.

Long-term outcome characteristics in mesial temporal lobe epilepsy with and without associated cortical dysplasia

ObjectThe intention of our study was to identify predictive characteristics for long-term seizure control and running down phenomenon after surgical treatment of pharmacoresistant mesiotemporal lobe epilepsy (mTLE) with and without associated cortical dysplasia. Materials and methodsOur study comprises a consecutive series of 458 patients who underwent surgical treatment for intractable mTLE at the Epilepsy Center Freiburg. Data evaluated included semiology, duration and frequency of seizures, results of presurgical diagnostics including video-EEG monitoring, MRI, PET and SPECT as well as postoperative seizure outcome. Results were evaluated forming two groups: Group A consisted of isolated mesiotemporal lesions. Group B comprised patients with mTLE and additional focal cortical dysplasia (FCD). Statistical evaluation was based on the Kaplan Meier survival analysis, using log-rank-tests and a multivariate regression model. Postoperative running down phenomenon was defined as seizure freedom after a period of gradual reduction of postoperative seizure frequency. This was compared to patients with ongoing epilepsy. ResultsComplete seizure freedom was achieved in 65.0% of investigated patients at 1year and in 56.5% at long-term follow-up of ≥5 years after surgery. Corresponding results were 64.2% and 56.8% at 1 and ≥5 years, respectively in group A and 66.4% and 56.0%, respectively in group B. Predictive for favorable postoperative outcome in the total group were younger age at surgery, shorter duration of epilepsy, absence of secondarily generalized tonic-clonic seizures (SGTCS), presence of strictly ipsilateral temporal interictal epileptiform discharges (IEDs), complete resection of the lesion as well as absence of postoperative epileptiform activity and of early postoperative seizures. In subgroup analyses, patients of group A demonstrated longer postoperative seizure-free intervals with adolescent age at surgery, short duration of epilepsy before surgery and absence of SGTCS, whereas in patients of group B ipsilateral temporal seizure onset and strictly unilateral IEDs in EEG as well as complete resection were predictors for favorable seizure outcome. Furthermore, absence of early postoperative seizures and of spikes in EEG were predictive factors for long-term seizure-freedom in both subgroups.The running down phenomenon was found in 33 (7.2%) patients. None of the parameters evaluated demonstrated significant predictive power. Only late seizure onset and neoplastic lesions showed a trend for postoperative gradual seizure reduction in multivariate analyses. ConclusionDepending on the presence or absence of focal cortical dysplasia in addition to mesiotemporal structural alterations, predictors of long-term seizure control differed regarding the relevant clinical and electrophysiological features. This is important for specific patient counseling in respective groups.

Levetiracetam Versus Phenytoin for Seizure Prophylaxis Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Seizure following traumatic brain injury (TBI) constitutes a common complication that requires effective prevention to improve the outcome of TBI. Phenytoin has been the only recommended antiepileptic drug (AED) for seizure prophylaxis; however, several shortcomings have affected its use. Intravenous levetiracetam has been available since 2006 and has been increasingly accepted as a seizure prophylaxis for brain injury, mainly due to its favorable pharmacokinetic features and minimal adverse events profile. However, the efficacy and safety of levetiracetam versus phenytoin for seizure prophylaxis following TBI are not well clarified. The aim of this study was to assess the efficacy and safety of levetiracetam versus phenytoin for seizure prophylaxis following TBI. We conducted a search of the MEDLINE, EMBASE, and Cochrane library databases to March 2016, and screened original research that included patients with TBI who received levetiracetam. We included randomized controlled trials (RCTs) or controlled observational cohort studies that compared levetiracetam and phenytoin, as well as uncontrolled case series regarding prophylactic levetiracetam following TBI. The outcomes included early or late seizure prophylaxis and safety. The estimates of seizure prophylaxis were pooled using a meta-analysis, and the estimates for the case series were pooled using descriptive statistics. A total of 1614 patients from 11 studies were included in this review, of whom 1285 patients from eight controlled studies (one RCT and seven cohort studies) were included in the meta-analysis. Levetiracetam was not superior to phenytoin with regard to early seizure prophylaxis (risk ratio [RR] 1.10, 95% confidence interval [CI] 0.64-1.88); the estimate of early seizure incidence was 0.05 (95% CI 0.02-0.08). Three studies that assessed late seizure did not indicate the superiority of levetiracetam to phenytoin. There were no differences in mortality during hospitalization or after 6months, or in the number of patients with adverse reactions between levetiracetam and phenytoin. Levetiracetam does not appear to be superior to phenytoin in efficacy or safety with regard to early or late seizure prophylaxis following TBI; however, no class I evidence was identified. Additional evidence from high-quality studies is required.

The safety and efficacy of levetiracetam versus phenytoin for seizure prophylaxis after traumatic brain injury: A systematic review and meta-analysis

Background: The standard for early traumatic brain injury (TBI) seizure prophylaxis is phenytoin (PHT). Levetiracetam (LEV) has been proposed as an alternative to PHT. The aim of this study was to evaluate the safety and efficacy of LEV on TBI seizure when compared with PHT.Methods: A search was carried out based on the databases from Pubmed, Embase and the Cochrane database up to May 2015. The relative risk (RR) and the relevant 95% confidence intervals (CI) were determined.Results: Eight observational studies and one randomized controlled trial involving 2035 cases were included. The results indicated that no significant differences in terms of overall seizure (RR = 0.90; 95% CI = 0.51–1.53; p = 0.68), early seizure (RR = 1.06; 95% CI = 0.37–3.07; p = 0.92) and late seizure (RR = 1.10; 95% CI = 0.43–2.79; p = 0.85) occurrence. However, LEV was associated with a lower adverse drug reaction rate (RR = 0.43; 95% CI = 0.23–0.81; p = 0.01). Moreover, there were no significant differences in terms of mortality, length of ICU or hospital stay between groups.Conclusions: The meta-analysis suggests that LEV appears to have a similar efficacy to PHT on TBI. A better safety profile of LEV is supported by this analysis.

Five-Year Long-Term Prognosis of Epileptic Children After Hemispheric Surgery: A Systematic Review and Meta-analysis.

To estimate children's long-term seizure outcomes after hemispheric surgery and the associated predictors.A systematic review of 4 databases and a meta-analysis were performed from January 1, 1995 to August 31, 2015. The databases included PubMed, Embase, Science Direct, and Web of Science; patients were classified into the Engel Class I group and the Engel Class II to IV group, according to their seizure outcomes. Nine potential predictors were then stratified across the groups and estimated using the Wilcoxon rank-sum test for continuous variables and the Chi-squared test for categorical variables.The search yielded 15 retrospective studies, with a total sample size of 380. Five years after surgery, 268 (0.71, 95% confidence interval [CI]: 0.64–0.78) children were seizure free; the seizure onset age in the Engel Class I group was significantly higher than that of the Engel Class II to IV group (standardized mean difference [SMD] = 0.26, 95% CI: 0.03–0.49, P = 0.028); specifically, when predicting the positive long-term outcomes, the odds ratio for late onset age (≥3.6 months, median value of the Engel Class II–IV group) versus early onset age was 2.65 (95% CI: 1.454–4.836, z = 3.18, P = 0.001). The abnormal magnetic resonance imaging (MRI) findings were more predictive for positive seizure outcomes than the normal findings (odds ratio [OR] = 4.60, 95% CI: 1.27–16.62, P = 0.02).Following hemispheric surgery, the long-term prognosis of children with epilepsy was good. Late seizure onset (age ≥ 3.6 months) and abnormal MRI findings were positive predictors for long-term seizure control in children.

Early Life Seizures and Learning Impairment: Neither the Time nor the Place

Early Life Seizures and Learning Impairment: Neither the Time nor the Place

Brain inflammation, neurodegeneration and seizure development following picornavirus infection markedly differ among virus and mouse strains and substrains

Infections, particularly those caused by viruses, are among the main causes of acquired epilepsy, but the mechanisms causing epileptogenesis are only poorly understood. As a consequence, no treatment exists for preventing epilepsy in patients at risk. Animal models are useful to study epileptogenesis after virus-induced encephalitis and how to interfere with this process, but most viruses that cause encephalitis in rodents are associated with high mortality, so that the processes leading to epilepsy cannot be investigated. Recently, intracerebral infection with Theiler's murine encephalomyelitis virus (TMEV) in C57BL/6 (B6) mice was reported to induce early seizures and epilepsy and it was proposed that the TMEV mouse model represents the first virus infection-driven animal model of epilepsy. In the present study, we characterized this model in two B6 substrains and seizure-resistant SJL/J mice by using three TMEV (sub)strains (BeAn-1, BeAn-2, DA). The idea behind this approach was to study what is and what is not necessary for development of acute and late seizures after brain infection in mice. Receiver operating characteristic (ROC) curve analysis was used to determine which virus-induced brain alterations are associated with seizure development. In B6 mice infected with different TMEV virus (sub)strains, the severity of hippocampal neurodegeneration, amount of MAC3-positive microglia/macrophages, and expression of the interferon-inducible antiviral effector ISG15 were almost perfect at discriminating seizing from non-seizing B6 mice, whereas T-lymphocyte brain infiltration was not found to be a crucial factor. However, intense microglia/macrophage activation and some hippocampal damage were also observed in SJL/J mice. Overall, the TMEV model provides a unique platform to study virus and host factors in ictogenesis and epileptogenesis.

Abstract TP341: Risk Factors of Seizure Recurrence in First-ever Post-stroke Seizure

Background: Both early seizure (ES) and late seizure (LS) are common complications after stroke. However, clinical characteristics, treatments and recurrences after ES/LS remain unclarified. Methods: We enrolled the patients with first-ever post-stroke seizures between July 2010 and June 2014, and followed up until June 2015. Seizures were classified into ES (within one week after stroke) and LS (the second week or later). We compared baseline clinical characteristics, status epilepticus, surgery (removal of hematoma, ventricular drainage), neurological deterioration by index stroke (defined as an increase of the NIHSS score by one or more between the baseline and at hospital discharge), and duration of antiepileptic drug (AED) therapy between two groups. We also investigated factors (patients’ background and treatment of seizure) that determined the seizure recurrence after discharge. Results: Clinical data were collected for 153 patients (82 men; age, 73.7±12.3, 73 intracerebral hemorrhage and 80 ischemic stroke). ES occurred in 62 and LS in 91 patients. Patients with LS more commonly received surgery (ES 3% vs. LS 17%, p=0.008) and more commonly had neurological deterioration (ES 71% vs. LS 87%, p=0.02) than those with ES. LS received AED therapy more frequently both during hospitalization (ES 71% vs. LS 94%, p=0.0003) and after hospitalization (ES 49% vs. LS 92%, p&lt;0.0001). Seizure recurred in 56 patients (14 ES, 41 LS) after discharge during a median follow-up of 29 months. In a multivariate Cox proportional-hazards model of these patients, independent predictors of recurrence included status epilepticus (HR 2.28,95% CI 1.08-5.17) and LS (HR 3.62,95% CI 1.11-10.09)(p&lt;0.05, respectively). Conclusion: Status epilepticus and LS were risk factors of seizure recurrence in first-ever post-stroke seizure.