Previous Diagnosis Of Epilepsy Research Articles

Spike count and morphology in the classification of epileptiform discharges.

The purpose of this study is to investigate the impact of Bergen Epileptiform Morphology Score (BEMS) and interictal epileptiform discharge (IED) candidate count in EEG classification. We included 400 consecutive patients from a clinical SCORE EEG database during 2013-2017 who had focal sharp discharges in their EEG, but no previous diagnosis of epilepsy. Three blinded EEG readers marked all IED candidates. BEMS and IED candidate counts were combined to classify EEGs as epileptiform or non-epileptiform. Diagnostic performance was assessed and then validated in an external dataset. Interictal epileptiform discharge (IED) candidate count and BEMS were moderately correlated. The optimal criteria to classify an EEG as epileptiform were either one spike at BEMS > = 58, two at > = 47, or seven at > = 36. These criteria had almost perfect inter-rater reliability (Gwet's AC1 0.96), reasonable sensitivity of 56-64%, and high specificity of 98-99%. The sensitivity was 27-37%, and the specificity was 93-97% for a follow-up diagnosis of epilepsy. In the external dataset, the sensitivity for an epileptiform EEG was 60-70%, and the specificity was 90-93%. Quantified EEG spike morphology (BEMS) and IED candidate count can be combined to classify an EEG as epileptiform with high reliability but with lower sensitivity than regular visual EEG review.

Epidemiological profile of epileptic seizures related to alcohol withdrawal syndrome

Introduction. Alcohol withdrawal syndrome (AWS) can occur in about half of patients with alcohol use disorder who abruptly reduce or cease consumption of this substance. Epileptic seizures are one of the possible manifestations. Objective. Evaluate epidemiological data, clinical characteristics, length of hospital stay and recurrence of emergency medical care between patients with alcohol withdrawal-related epileptic seizures. Method. This is a retrospective observational study, with data collection from medical records of patients treated for epileptic seizures caused by AWS in a public hospital in Minas Gerais within a year. Inferential statistical association between nominal variables was assessed by cross-tabulation with the chi-square test. Results. 45 patients were included in the study. The most prevalent age group was 35 to 45 years (37.7%). In 46.6%, it was described a previous diagnosis of epilepsy. There was an association between the previous diagnosis of epilepsy and the presence of epileptic seizures (p<0.001). The type of seizure was generalized tonic-clonic since the onset in 92% of cases. 78% had seizures up to 48 hours after the last alcohol consumption. The rate of recurrence at the emergency department during the year was 31%. Conclusion. AWS-related epileptic seizures predominantly affect young men and are associated with a high recurrence rate of need of emergency hospital care, being a complex public health problem. These data point to the need to strengthen strategies for primary prevention.

Treatment of benzodiazepine-refractory status epilepticus: A retrospective, cohort study

IntroductionStatus epilepticus (SE) is a frequent neurological emergency, derived from the failure of mechanisms responsible for seizure termination. The present study aims to compare the efficacy of the most common antiseizure medications (ASMs) employed for the treatment of benzodiazepine-refractory SE. MethodsWe performed a retrospective cohort study of all SE episodes treated in our hospital between January 2016 and December 2020. Inclusion criteria were: age ≥ 18 years; a diagnosis of status epilepticus. Exclusion criteria were: status epilepticus resolved by initial therapy with benzodiazepines; impossibility to retrieve medical records. We considered as effective the ASM that was the last drug introduced or increased in dose before termination of SE and without changes in the co-medication. ResultsA total of 244 episodes in 219 patients were included in the study. The mean age of the final study cohort was 63.6 ± 19.2, with 108 (49%) men. In the total cohort, phenytoin (PHT) showed the highest response rate (57.6%), followed by lacosamide (LCM) (40.7%) and valproate (VPA) (39.8%). The comparative efficacy among the different drugs was significantly different (p < 0.001). In the pairwise comparisons, VPA was superior to levetiracetam (LEV) (response rate: 39.75% vs 24.71%; p = 0.004), but not to LCM. Phenytoin had a significantly higher resolution rate compared to VPA (response rate: 57.63% vs 39.75%; p = 0.02) and LEV (response rate: 57.63% vs 24.71; p < 0.001). The clinical predictors of anaesthetics administration were a disorder of consciousness upon clinical presentation, previous diagnosis of epilepsy, and younger age. ConclusionIn our cohort of SE, PHT showed higher effectiveness in terminating established SE, as well as refractory SE in the subgroup of patients treated with anaesthetics.

Is Seizure an Adverse Effect of Salbutamol in the Pediatric Population?

Background:Although studies on epileptic seizures occurring during acute asthma attacks are limited, there is widespread belief among families and physicians that salbutamol causes seizures.Aims:To investigate whether salbutamol triggers seizures in patients with epilepsy and asthma.Study Design:A retrospective cohort study.Methods:Epilepsy and asthma in patients aged 2-18 years who were admitted to the pediatric emergency department because of asthma attacks between January 2016 and December 2016 in a university hospital were evaluated retrospectively. The inclusion criteria were age 2–18 years, previous diagnosis of epilepsy and asthma, and admission to the pediatric emergency department due to asthma attacks.Results:276 medical records were evaluated. The seizure group had a longer period of diagnosis for epilepsy than the seizure absent group in the pediatric emergency department (5.4 years and 3.1, respectively). According to the logistic regression analysis, the duration of seizures in the emergency department, duration of asthma diagnosis, duration of epilepsy diagnosis, uncontrolled asthma, and severity of asthma attack in the pediatric emergency department have significantly increased the possibility of having a seizure during an asthma attack in our study population.Conclusion:This study shows that patients using salbutamol have a lower risk of epileptic seizures than those who do not use salbutamol. This result should be verified by studies containing a large number of patients.

Relationship between cognitive ability and predictors for age at the time of autism spectrum disorder diagnosis

The rising prevalence of autism spectrum disorder (ASD) has increased awareness of the need for early diagnosis and intervention; however, not all children are diagnosed at preschool age. In the literature, findings regarding factors that may play a role in later diagnosis are inconsistent. Presence or absence of intellectual disability is a possible factor. This study aimed to identify factors associated with later diagnosis of ASD among children grouped according to low and high cognitive levels. Data of children who were previously diagnosed with ASD between 2002 and 2016 at a national autism center were analyzed. Better cognitive ability, having more siblings, and previous diagnosis of attention-deficit/hyperactivity disorder were predictors of later diagnosis among the entire cohort. Children exhibiting lower cognitive levels (LC-ASD; DQ/IQ < 70; n = 209) were diagnosed much earlier. Among this group, later ASD diagnosis was predicted by poorer adaptive behavior, more severe restricted and repetitive behaviors, and previous diagnosis of epilepsy. In the higher cognitive level group (HC-ASD; DQ/IQ ≥ 70; n = 321), familial variables and more severe social impairments were predictors of later ASD diagnosis. Clinicians should be aware of variables that may affect ASD diagnostic age among children with varying cognitive abilities.

Association of allergic diseases and epilepsy with risk of glioma, meningioma and acoustic neuroma: results from the INTERPHONE international case-control study.

We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case-control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs), adjusted for education and time at interview. Reduced ORs were observed for glioma in relation to physician-diagnosed asthma (OR = 0.73; CI 0.58-0.92), hay fever (OR 0.72; CI 0.61-0.86), and eczema (OR 0.78, CI 0.64-0.94), but not for meningioma or acoustic neuroma. Previous diagnosis of epilepsy was associated with an increased OR for glioma (2.94; CI 1.87-4.63) and for meningioma (2.12; CI 1.27-3.56), but not for acoustic neuroma. This large-scale case-control study adds to the growing evidence that people with allergies have a lower risk of developing glioma, but not meningioma or acoustic neuroma. It also supports clinical observations of epilepsy prior to the diagnosis of glioma and meningioma.

De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.

Non-convulsive status epilepticus (NCSE) often goes unnoticed and is not easily detected in patients with a decreased level of consciousness, especially in older patients. In this sense, lack of data in this population is available. The aim of the present study was to examine daily clinical practice and evaluate factors that may influence the prognosis of NCSE in non-epileptic medical inpatients. We conducted a retrospective analysis including patients admitted by any cause in an Internal Medicine ward. All patients with compatible symptoms, exclusion of other causes, clinical suspicion or diagnosis of NCSE, and compatible EEG were included. Patients with a previous diagnosis of epilepsy were excluded. We also conducted a literature review by searching the PubMed/Medline database with the terms: Nonconvulsive Status OR Non-Convulsive Status. We included 54 patients, mortality rate reached 37% and the main factors linked to it were hypernatremia (OR = 16.2; 95% CI, 1.6-165.6; P = 0.019) and atrial fibrillation (OR = 6.7; 95% CI, 1.7-26; P = 0.006). There were no differences regarding mortality when comparing different diagnosis approach or treatment regimens. Our literature review showed that the main etiology of NCSE were neurovascular causes (17.8%), followed by antibiotic treatment (17.2%) and metabolic causes (17%). Global mortality in the literature review, excluding our series, reached 20%. We present the largest series of NCSE cases in medical patients, which showed that this entity is probably misdiagnosed in older patients and is linked to a high mortality. The presence of atrial fibrillation and hypernatremia in patients diagnosed with NCSE should advise physicians of a high mortality risk.

Intravenous brivaracetam in status epilepticus: A multicentric retrospective study in Italy

Purposeto evaluate the use, effectiveness, and adverse events of intravenous brivaracetam (BRV) in status epilepticus (SE). Methodsa retrospective multicentric study involving 24 Italian neurology units was performed from March 2018 to June 2020. A shared case report form was used across participating centres to limit biases of retrospective data collection. Diagnosis and classification of SE followed the 2015 ILAE proposal. We considered a trial with BRV a success when it was the last administered drug prior the clinical and/or EEG resolution of seizures, and the SE did not recur during hospital observation. In addition, we considered cases with early response, defined as SE resolved within 6 h after BRV administration. Results56 patients were included (mean age 62 years; 57 % male). A previous diagnosis of epilepsy was present in 21 (38 %). Regarding SE etiology classification 46 % were acute symptomatic, 18 % remote and 16 % progressive symptomatic. SE episodes with prominent motor features were the majority (80 %). BRV was administered as first drug after benzodiazepine failure in 21 % episodes, while it was used as the second or the third (or more) drug in the 38 % and 38 % of episodes respectively. The median loading dose was 100 mg (range 50−300 mg). BRV was effective in 32 cases (57 %). An early response was documented in 22 patients (39 % of the whole sample). The use of the BRV within 6 h from SE onset was independently associated to an early SE resolution (OR 32; 95 % CI 3.39–202; p = 0.002). No severe treatment emergent adverse events were observed. ConclusionBRV proved to be useful and safe for the treatment of SE. Time to seizures resolution appears shorter when it is administered in the early phases of SE.

EEG Findings in Coronavirus Disease.

Neurologic manifestations of coronavirus disease (COVID-19) such as encephalopathy and seizures have been described. To our knowledge, detailed EEG findings in COVID-19 have not yet been reported. This report adds to the scarce body of evidence. We identified eight COVID-19 positive patients who underwent EEG monitoring in our hospital system. EEGs were most commonly ordered for an altered level of consciousness, a nonspecific neurologic manifestation. We observed generalized background slowing in all patients and generalized epileptiform discharges with triphasic morphology in three patients. Focal electrographic seizures were observed in one patient with a history of focal epilepsy and in another patient with no such history. Five of eight patients had a previous diagnosis of epilepsy, suggesting that pre-existing epilepsy can be a potential risk factor for COVID-19-associated neurological manifestations. Five of eight patients who underwent EEG experienced a fatal outcome of infection. Our findings underscore previous observations that neurologic manifestations are common in severe cases. COVID-19 patients with epilepsy may have an increased risk of neurological manifestations and abnormal EEG.

Prognostic impact of misdiagnosis of cardiac channelopathies as epilepsy.

Cardiac channelopathies are a frequent cause of sudden cardiac death (SCD) and often manifest with convulsive syncope, leading to a misdiagnosis of epilepsy. We aim to evaluate the clinical impact of epilepsy misdiagnosis in a cohort of patients with cardiac channelopathies. Fifty probands/families with a cardiac channelopathy were included. We retrospectively collected information from medical records to identify all patients who presented with convulsive syncope and were diagnosed with epilepsy after neurological evaluation. Clinical data and outcome were compared with those of patients without a previous epilepsy diagnosis. Eight patients had a previous diagnosis of epilepsy. At first episode, 3 of them presented a positive family history of SCD and 5 showed a pathological electrocardiogram; half presented with sudden cardiac arrest (SCA) and the rest with recurrent syncope despite treatment with 1 or more anti-epileptic drugs. Five patients had long QT syndrome, 2 had catecholaminergic polymorphic ventricular tachycardia, and 1 had Brugada syndrome. Epilepsy misdiagnosis was associated with an increased risk of SCA/SCD (OR 6.92, P = .04), a delay of 12 years (P = .047) in correct diagnosis, and a delay from first symptom to channelopathy diagnosis of 18.45 years (P < .0001). Cardiac channelopathy patients can be misdiagnosed with epilepsy. This involves a delayed diagnosis, a delay from the first symptom to a correct diagnosis, and an increased risk of SCA/SCD.

Clinical Profile and Short-term Outcome of Pediatric Status Epilepticus at a Tertiary-care Center in Northern India

To assess clinical profile and short term treatment outcomes of pediatric status epilepticus (SE) at a tertiary-care center in northern India. Prospective cohort study enrolled children aged 1 month to 18 years presenting with SE to the emergency department. Enrolled children (109) were treated as per hospital protocols. Clinical features during hospitalization were noted. Pediatric overall performance category (POPC) scale was used for classification of outcome at the time of discharge. Acute symptomatic etiology was identified in 66 (60.6%) cases (CNS infections were predominant). Previous diagnosis of epilepsy was found in 32 (29.4%) children; and benzodiazepine responsive SE were seen in 65 (59.6%) children. Predictors of unfavorable outcome were acute symptomatic etiology (adjusted OR 4.50; 95% CI 1.49, 13.62) and no treatment administered prior to hospital (adjusted OR 3.97; 95% CI 1.06, 14.81). Acute symptomatic etiology, mainly acute CNS infections, is the leading cause of SE in this region. Early and pre-hospital management with benzodiazepines may improve SE outcome.

Janz Syndrome (Youth Mioclonics), Two Brothers Case Report and Literature Review

Introduction: Juvenile myoclonic epilepsy classified as a generalized genetic epilepsy, It occurs with sudden jerks of the upper limbs and if the lower limbs are affected, with falls and without loss of consciousness. They occur preferably in the first minutes upon waking. They are triggered by sleep deprivation and alcohol intake. The disease follows a non-progressive course Clinical Case: A 15-year-old female patient presented to the service due to an absence crisis and an apparent insomnia problem. The semiology of absence crisis is interrogated and in effect, as well as occasional nocturnal myoclonus, electroencephalogram is performed and a 4 Hz slow wave poly tip pattern is found throughout the stroke, especially in photo stimulation (Figure 1, 2). The patient has an older brother of 17 years who has developed school problems without a previous diagnosis of epilepsy, electroencephalogram is performed and also presents a generalized slow-wave poly tip pattern (Figure 3, 4) treatment with valproate is initiated with good response

Predicting first attendance at psychiatry appointments in patients with dissociative seizures

PurposePatients with dissociative (non-epileptic) seizures typically receive their diagnosis from neurologists, but are often referred to psychiatrists, whom they may be reluctant to go and see. We aimed to assess which factors were associated with first attendance at psychiatric services. MethodsA cohort study of 698 participants involved in the pre-randomisation phase of the CODES trial, a randomised controlled trial assessing the benefit of cognitive behavioural therapy for dissociative seizures when added to standardised medical (including psychiatric) care. Patients diagnosed by neurologists from 27 UK centres provided demographic information and a measure of diagnostic confidence. Neurologists described predominant seizure type and comorbidity with epilepsy. We analysed hypothesised (young age, male, residing in areas of higher deprivation, low belief in diagnosis) and exploratory factors for their association with first attendance with the psychiatrist about 3 months later. Results568/698 (81.4 %) participants attended a psychiatry appointment. None of the following were associated with attendance: Location, age, gender, deprivation score, relationship status, ethnicity, level of education, employment status, receipt of disability benefits, duration, previous diagnosis of epilepsy or mental health problems and degree of confidence in the diagnosis. The only variable differing between groups was having a carer (21.5 % not attending vs 38.6 % attending). ConclusionFirst attendance at a psychiatry appointment after a neurologist had given a diagnosis of dissociative seizures was not associated with any hypothesised predictors, including patient confidence in the diagnosis. Neurologists should put aside any expectations about these variables when referring to and anticipating attendance with a psychiatrist.

Risk factors associated with alcohol-related seizures

Alcohol dependence is one of the most common causes of adult-onset seizures. Management of these patients remains a challenge, despite years of clinical practice. The current state of knowledge suggests that the occurrence of seizures in chronic alcoholism is not necessarily due to withdrawal but may have multiple etiologies. Many factors have been reported to be associated with seizures in alcohol dependence therefore we intended to evaluate certain potential risk factors such as previous diagnostic of epilepsy and withdrawal-associated delirium tremens. This study has a descriptive design, outlining the clinical profile of patients with alcohol related seizures, while controlling for socio-demographical factors. Data were obtained from records of consults and admissions, in the emergency department of Psychiatric Clinic 2, Targu-Mures, during January-December 2018. Of the 274 patients included in the study, with mean age of 49.9 ± 11.3 years, only 19% (n=52) developed seizures and 7.3% (n=20) had been previously diagnosed with epilepsy. The logistic regression analysis found a significant effect of withdrawal on occurrence of seizures (p=0.01, OR=2.78, CI(1.19, 6.52)) compared to other admission diagnoses. Age group „20-39” years was significantly associated with a fourfold increased risk of seizures compared to other age groups (p=0.02, OR=4.19, CI(1.22, 14.33)). The previous diagnosis of epilepsy had also a statistically significant effect on increasing the risk of alcohol related seizures (p&lt;0.001, OR=10.73, CI(4.48, 25.71). Our study suggest that alcohol-related seizures may occur most frequently in the context of alcohol withdrawal and young age. Patients with a history of epilepsy are ten times more predisposed to develop seizures in the context of chronic alcohol abuse.

Etiology, seizure type, and prognosis of epileptic seizures in the emergency department

Epileptic seizures are a common reason for emergency department (ED) admittance. We aimed to describe the etiological distribution of epileptic seizures and the relationships between etiology and semiology in patients admitted to the emergency room, and to identify early prognostic factors for recurrence and mortality. MethodsA retrospective observational study was conducted in adult patients consecutively attended in the emergency room with epileptic seizures over a 2-year period. We recorded data on the etiological and syndromic classification of the seizure, and on recurrence and mortality at 1 year of follow-up. ResultsIn total, 289 patients were included. Mean age was 55.9 (±21.9 years). There were 38.6% with a previous diagnosis of epilepsy and 49.8% with new-onset seizures. Among structural epilepsies, a vascular etiology was the most common overall (28.3%) but particularly in elderly (>65 years) patients (50.9%), followed by brain tumors (15.5%). In both etiologies, most patients presented with nonconvulsive seizures.Seizure recurrence during follow-up was reported in 37.1% and was most common in patients with symptomatic remote seizures (50 patients, 41%). Brain tumors (odds ratio (OR): 5.1, confidence interval (CI): 1.7–11.8; p < 0.01), younger age (OR: 0.9, CI: 0.97–0.99; p < 0.05), and a previous diagnosis of epilepsy (OR: 3.5, CI: 1.9–6.3; p < 0.01) were independent predictors of recurrence. Overall mortality was 8.6%. Symptomatic epilepsy was an independent predictor of mortality (hazard ratio (HR): 6.3, CI 1.4–23.4; p < 0.05). ConclusionsThe most common etiologies of seizures in patients admitted to the ED are seizures of unknown cause and vascular disorder-related seizures. Seizures are more likely to recur in younger patients with a tumor whereas symptomatic epilepsy is associated with a higher risk of death at a 1-year follow-up.

Acute seizure epidemiology in a neurological emergency department.

Acute seizures in patients with epilepsy are a potential of source of neurological damage; their causes must be researched. To explore the epidemiology of acute seizure exacerbations in patients with epilepsy in a neurological emergency department in Mexico City. Descriptive prospective study of patients with a previous diagnosis of epilepsy that receive medical care in an emergency department due to acute seizures. 100 patients were analyzed between august 2016 and January 2017. 86 patients presented with focal seizures, of which 76 were focal to bilateral tonic-clonic, 2 with impaired awareness and motor onset, 3 with impaired awareness and non-motor onset, 1 without impaired awareness and motor onset, and 4 without impaired awareness and non-motor onset. 14 patients had generalized seizures with motor onset. The causes of exacerbation were as follows: 26 patients due to antiepileptic dose omission, 21 due to a unknown cause, 19 due to infection, 13 due to sleep deprivation, 3 due to stress, 3 were catamenial, 2 due to alcohol abuse and 3 due to other reasons. Of the 26 patients with dose omission, 10 were due to forgetfulness, 7 refused to comply with their prescription, 6 could not afford to buy their prescription and 3 had their prescription changed by another doctor. In Mexico, antiepileptic drug dose omission represents up to 25% of patients with acute seizure exacerbations; increased patient education on epilepsy hygiene measures may be an area of opportunity for reducing its frequency.

The diagnostic value of continuous EEG for the detection of non-convulsive status epilepticus in neurosurgical patients – A prospective cohort study

ObjectiveTo prospectively compare the diagnostic yields of standard EEG and continuous EEG (cEEG) monitoring for the diagnosis of non-convulsive status epilepticus (NCSE) in neurosurgical patients in the intensive care unit. MethodsWe included 50 consecutive patients with clinical suspicion of NCSE due to unexplained coma or subtle clinical phenomena such as discrete myoclonus. The initial 30-minute EEG recording and the following cEEG were analyzed separately for seizure activity. Data were collected on neurosurgical diagnosis, previous diagnosis of epilepsy, current medication, level of consciousness, and outcome at discharge from the neurosurgical department. ResultsRecurrent electrographic seizure activity was detected in five patients. This was within the first 30 mins for three patients and on the following cEEG for two patients. Antiepileptic treatment had been initiated in three of these patients. Most of the 50 patients had severe newly acquired neurological disability at discharge. ConclusionsThe prospective finding of a 10% seizure incidence was lower than reports from retrospective studies. SignificanceUse of cEEG led to detection of seizure activity in 2 of 50 patients (4%) and was thus a low-yield method in neurosurgical patients with suspicion of NCSE. Specific markers for patient selection for cEEG are needed.

Acute seizure management in a private hospital

Objectives To examine the management of first-ever seizures and untreated recurrent seizures presenting to a major comprehensive private hospital in Melbourne. Methods We reviewed medical records of patients with discharge ICD-10 codes of G40 (epilepsy) or G41 (status epilepticus) discharged between 1 January 2008 and 30 November 2016. Patients were included if they presented with a first ever seizure or untreated recurrent seizures either to the ED or during hospitalisation for other reasons. Patients were excluded if they had previous diagnosis of epilepsy or had non-epileptic event. Results Two-hundred and forty four patients were identified. One-hundred and fifty nine were excluded and 76 were included for analysis. Among those included, 65.8% presented to ED and 34.2% had seizures during hospitalisation. Their median age was 75.5 years (range 14 to 91); 48.7% were male. Seizure classifications included acute symptomatic (19.7%), remote symptomatic (19.7%), association with idiopathic generalised epileptic syndromes (5.3%), and unclassified (55.3%). 80% presenting to ED received CT brain; 54% within 2 hours. 50% underwent MRI and 60.5% EEG, with a median time from admission to test of 2 days and 3 days, respectively. Phenytoin was prescribed as the initial antiepileptic drug (AED) for (46.9%) patients with a first ever seizure. A broader range of initial AEDs were used in those with untreated, recurrent seizures. EEG resulted in identification of IGE syndromes in 4 patients, leading to medication alteration. 84% of patients were reviewed or admitted under a neurologist. Follow-up with neurologist was planned for 60.5% at discharge. Conclusions Timely investigations and neurological review are valuable in the diagnosis and treatment of patients with first seizures or recurrent, untreated seizures. Future studies should focus on identifying factors associated with rapid diagnosis and treatment decision that may ultimately lead to improved seizure control.

When seizures are non-epileptic

IntroductionNon-epileptic seizures (NES) are a diverse group of disorders, whose paroxysmal events can be mistaken for epilepsy, although they are caused by a mental or psychogenic process rather than a neurological cause.Objectives/methodsWe present a case of a 45-year-old female patient with history of generalized seizures prior to Meningioma resection in August 2015, referred to the Liaison Psychiatry outpatient follow up clinic at the Royal London Hospital after has gone several times to emergency department complaining about flush and hot sensation that proceeded to corners of mouth turning down, teeth chattering, shaking of left arm and torso at first and then legs. During the episodes, she was awake with no consciousness loss. Her mood was low, with clinical evidence of depression and she had very high levels of health anxiety.DiscussionA diagnosis of non-epileptic attacks was made in the sequence of those episodes. A holistic and multidisciplinary approach was made, including pharmacotherapy, cognitive-behavioral therapy and domiciliary support. The clinical response was good regarding both mood, anxiety levels and NES.ConclusionsApproximately 25% of patients who have a previous diagnosis of epilepsy and are not responding to drug therapy are found to be misdiagnosed and it is common that epileptic patients have both epileptic and non-epileptic seizures. Although distinguishing epileptic and non-epileptic seizures is not easy, there are some clinical clues that the physicians should look for, like age of onset, time of the day that episodes occur and presence or absence of postictal confusion.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Status epilepticus in the elderly: Prognostic implications of rhythmic and periodic patterns in electroencephalography and hyperintensities on diffusion-weighted imaging

ObjectiveTo delineate the clinical characteristics and functional outcome of status epilepticus (SE) in elderly people, and elucidate prognostic implications of SE-associated rhythmic and periodic patterns (RPPs) in electroencephalography and hyperintensities on diffusion-weighted imaging. MethodsWe retrospectively investigated 107 consecutive patients with SE aged≥65years in a comprehensive community hospital. RPPs were classified using the 2012 American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology. Poor outcome was defined as an increase in modified Rankin Scale (mRS) score at discharge compared with that at baseline, including death. ResultsMedian age of patients was 80.0years. Median mRS score at baseline was 3. Thirty-four patients (31.8%) had a previous diagnosis of epilepsy. Cerebrovascular disease and dementia were major etiologies. Poor outcome occurred in 41 (38.3%). In electroencephalography, periodic discharges (PDs) were present in 21.0% (22/105), rhythmic delta activity (RDA) in 10.5% (11/105), and conventional seizure patterns in 9.5% (10/105). Diffusion-weighted hyperintensities associated with SE were observed in 28.0% (26/93). With univariate analysis, poor outcome was significantly associated with no previous diagnosis of epilepsy, etiology, refractory SE, specific electroencephalographic patterns (PDs and conventional seizure patterns, but not RDA), and diffusion-weighted hyperintensities. With multivariate logistic regression analysis, diffusion-weighted hyperintensities (OR 6.13 [95% CI 1.72–21.9]) and refractory SE (OR 5.36 [95% CI 1.28–22.4]) were independently associated with poor outcome. ConclusionsSE often occurred as the first seizure in already disabled elderly people, further worsening their functional disabilities. Diffusion-weighted hyperintensities and refractory SE, but not RPPs in electroencephalography, were independent functional prognostic factors.