Previous History Of Seizures Research Articles

Posterior Reversible Encephalopathy Syndrome in Beta Thalassemia Major Transplants: A Single Center Experience

Background: Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by clinical finding of hypertension, seizures, behavioral changes and altered vision, coupled with MRI abnormalities, known to occur after hematopoietic stem cell transplantation, potentially associated with calcineurin inhibitors. There is limited literature on the clinical and radiological findings in patients with PRES undergoing transplant for beta thalassemia major.Method: A Retrospective analysis of the incidence and characteristics of PRES was performed on transplants done between November 2008 and May 2015. This study assessed the frequency, etiology, clinical and imaging characteristics in patients undergoing stem cell transplantation for beta thalassemia major.Results: A total of 88 bone marrow transplants (BMT) were performed for various indications and among them 39 transplants were for patients with thalassemia major. The median age among the beta thalassemia group was 9 years (range 2-18). Two different regimens were used for thalassemia. Table: 1 Cyclosporine A (CSA) and short course methotrexate were used as graft versus host disease (GVHD) prophylaxis in all allogeneic transplants.A total of 6 (6.7%) patients developed PRES. Two (4%) were among non-thalassemia transplants and 4 (10%) were among thalassemia transplants. (p= 0.276).Among the beta thalassemia transplants, 2 (7%) of them underwent matched related donor (MRD) and 2 (22%) had matched unrelated donor (MUD) transplants. All patients who developed PRES belonged to either Pesaro class II or III risk group. Table 1.High blood pressure recordings above 95th centile were noted in all the patients prior to the onset of seizure and all of them (100%) complained about persisting head ache. Two patients (50%) had visual hallucinations and one of them had transient loss of vision with no ophthalmic findings.MRI changes were seen among 3 patients (75%). Of the patients who had radiological findings, T2 hyper-intensive white matter changes were present in frontal 1 (25%), parietal 3 (75%), occipital 3 (75%), and thalamus 1 (25%). Abnormalities were bilateral all in all patients who had MRI findings, but not necessarily symmetrical. None of the patients had hemorrhage or grey matter changes. The etiological factor for 3 (75%) patients was calcineurin inhibitor (CNI), CSA and the symptoms reverted on discontinuation of CSA. An increased level of CSA was noted only in on patient with a level of 358µg/L (range 131 - 358µg/L). One patient had the seizure with MRI changes following stem cell product infusion.The occurrence of PRES was not associated with previous history of seizures in any of the patients. Time to PRES ranged between 53 to 60 days in patients on calcineurin inhibitors. All patients made a complete recovery within 24-48 hours and were continued on antiepileptics. However, one patient died after status-epilepticus and brain stem injury while on tapering doses of leviteracetam at 6 months post-transplant.Conclusion: It is important to promptly recognize this syndrome based on the post-transplant day, clinical history of head ache, hypertension, visual abnormalities and MRI findings. Early imaging, withdrawal of calcineurin inhibitors, tight blood pressure control and initiation of anticonvulsants in high risk thalassemia transplants may be helpful reducing the incidence. By analyzing larger databases it may be helpful to develop diagnostic criteria and scoring for early diagnosis and intervention.Table 1Transplant indications, types and risk stratification and conditioning regimens.Variablen (%)Total transplants88 (100)Non Thalassemia49 (56)Thalassaemia Class I Class II Class III MRD MUD39 (44) 3 (8) 9(23) 27 (69) 30 (77) 9 (23)Conditioning regimen for thalassemiaN = 39Thiotepa, Treosulfan and Fludarabine36 (92)Busulphan, Cyclophosphamide, ATG3 (8)PRESN=6Non-Thalassemia Thalassemia2 (6.7%) 4 (10%) p=0.276Etiology among thalassemia transplantsCNI Stem cell product infusionN=4 3 (75%) 1 (25%) DisclosuresNo relevant conflicts of interest to declare.

P157 – 2542: Movement disorder, periventricular nodular heterotopia and putaminal hyperintensity due to an ARFGEF2 gene mutation

Objective Periventricular heterotopia, one of the most common malformations of cortical development, is caused by extrinsic factors such as infections and prenatal injuries or genetic mutations. The most common genetic cause of periventricular heterotopia is mutations in the gene encoding filamin-A (FLNA) inherited in an X-linked dominant manner. Mutations in the ADP-ribosylation factor guanine nucleotide-exchange factor 2 (ARFGEF2) gene constitute another group of factors that cause association of autosomal recessive periventricular heterotopia with microcephaly. Methods A ten year-old girl was referred with severe developmental and growth delay, feeding problems and involuntary movements. The parents had first degree consanguinity. The birth history was unremarkable. Growth retardation and microcephaly were noticed around 4 months of age. Neurological examination revealed generalized hypotonia with poor head control and severe dystonic-choreoathetoid movements. The extended metabolic work-up of the case was unremarkable. The cranial MR imaging revealed bilateral periventricular nodular heterotopia, bilateral hyperintensity of the putamen and caudate nucleus with frontotemporal and hippocampal atrophy. The EEG of the patient who had no previous seizure history was found normal. Her echocardiography showed left ventricular non-compaction cardiomyopathy. Results The genetic analysis of ARFGEF2 gene revealed a homozygote c.5126G>A, p.Trp1709* mutation. Conclusion Mutations in the ARFGEF2 gene must be considered in the presence of bilateral periventricular nodular heterotopia and putaminal hyperintensity in children presented with movement disorders, severe developmental delay and microcephaly.

Clinical multifactorial analysis of early postoperative seizures in elderly patients following meningioma resection.

The aim of the present study was to identify the major factors correlated with early postoperative seizures in elderly patients who had undergone a meningioma resection, and subsequently, to develop a logistic regression equation for assessing the seizures risk. Fourteen factors possibly correlated with early postoperative seizures in a cohort of 209 elderly patients who had undergone meningioma resection, as analyzed by multifactorial stepwise logistic regression. Phenobarbital sodium (0.1 g, intramuscularly) was administered to all 209 patients 30 min prior to undergoing surgery. All the patients had no previous history of seizures. The correlation of the 14 clinical factors (gender, tumor site, dyskinesia, peritumoral brain edema (PTBE), tumor diameter, pre- and postoperative prophylaxes, surgery time, tumor adhesion, circumscription, blood supply, intraoperative transfusion, original site of the tumor and dysphasia) was assessed in association with the risk for post-operative seizures. Tumor diameter, postoperative prophylactic antiepileptic drug (PPAD) administration, PTBE and tumor site were entered as risk factors into a mathematical regression model. The odds ratio (OR) of the tumor diameter was >1, and PPAD administration showed an OR >1, relative to a non-prophylactic group. A logistic regression equation was obtained and the sensitivity, specificity and misdiagnosis rates were 91.4, 74.3 and 25.7%, respectively. Tumor diameter, PPAD administration, PTBE and tumor site were closely correlated with early postoperative seizures; PTBE and PPAD administration were risk and protective factors, respectively.

Epidemiology-based mortality score in status epilepticus (EMSE).

Status epilepticus (SE) is a neurological emergency with high mortality and often a poor functional outcome amongst survivors. So far, only status epilepticus severity score (STESS) is available to predict individual outcomes. STESS is based on weighted sum scores of age, type of seizure, level of consciousness and history of previous seizures. Weighting factors were based on a priori assumptions. We tested in an explorative, hypothesis generating approach, whether epidemiological data (i.e. mortality rates) can be combined to form a score (Epidemiology-based Mortality score in SE-EMSE), and further, which combination of aetiology, age, comorbidity, EEG, duration and level of consciousness yields highest test performance. Positive and negative predictive value, and correctly classified were compared to STESS (with different cut-off levels: STESS-3, STESS-4). Score points for each parameter, e.g. age, were derived from previously published specific mortality rates. For each combination of parameters, the lowest sum-score of deceased individuals was taken as cut-off. Ninety-two consecutive non-hypoxic patients (age range 20-90 years), with various forms of SE admitted to a tertiary care neurological intensive care unit were investigated retrospectively. EMSE using a combination of aetiology, age, comorbidity and EEG (NPV = 100 %, PPV = 68.8 %, correctly classified 89.1 %) was superior to STESS-3 and STESS-4 (p = 0.0022 or lower). EMSE explained individual mortality in almost 90 % of cases, and performed significantly better than previous scores. This explorative study needs external prospective corroboration. EMSE may be a valuable tool for risk stratification in interventional studies in the future.

O5.02 * CORTICAL AND SUBCORTICAL LANGUAGE MAPPING WITH HIGHFREQUENCY (HF) STIMULATION: FEASIBILITY AND CLINICAL RESULTS

Resection of language pathways tumors requires intraoperative identification of cortical and subcortical language essential sites. Language mapping is traditionally performed with LowFrequency(60Hz) stimulation. In patients with previous treatment or long history of seizures, the use of LF may be problematic and results in inadequate mapping. HighFrequency(HF)(To5) stimulation represents an alternative strategy. We present our experience with HF stimulation for language mapping in patients with gliomas involving language pathways. Efficacy of mapping was compared with LF, and clinical impact (percentage of immediate and permanent deficits) and Extent-of-Resection(EOR)) was also reported. 80 patients were included (49 were frontal, 21 temporal). HF (repetition rate of 3Hz) identified language sites in all patients. In patients with long history of seizures, high doses of antiepileptic drugs (AEDs), previous treatments, in whom LF induced seizures and was inadequate for mapping, HF efficiently identified language sites at cortical and subcortical level. In patients (30 cases) in whom LF and HF were compared, HF induced positive language responses in the same sites as LF, in frontal and temporal lobes. Intraoperative seizures were 24% with LF, 2% with HF, also in patients with previous history of seizures, high doses of AEDs. Percentage of immediate and permanent deficits were 78% and 2%, also in patients in whom only HF was used. EOR was total in 82%. HF(To5, repetition rate of 3Hz) represents an efficient alternative stimulation strategy for language mapping, particularly in patients with long history of seizures and high AEDs, associated with a low risk of intraoperative seizures.

OC-058 Ambulatory Care Alcohol Detoxification (acad) At Whittington Health: A New Approach !

IntroductionAlcohol-related harm costs NHS £3.5 billion a year. It has become a “top priority” for the NHS. Alcohol Concern reported 1.2 million alcohol-related admissions in 2011/12, an increase of 135%...

1. Incidence of seizures during intraoperative motor evoked potential monitoring in a large cohort of different surgical procedures

The incidence of seizures during intra-operative electrical brain stimulation has been previously reported in craniotomies exclusively (1–4% in short train and 5–20% in Penfield stimulation). The objective of this study was to review the incidence of seizures in patients who underwent electrical brain stimulation during different types of surgeries. We retrospectively reviewed the charts of 3952 patients who underwent intra-operative monitoring of the motor system from 2004–2012. Surgeries related with cranial structures (45.5%) included craniotomies, endovascular procedures and carotid endarterectomies. Spinal surgeries (52.4%) included degenerative, vascular and tumour pathologies. Other surgeries (2.1%) included thoraco-abdominal pathologies and procedures of neck and peripheral nerves. Motor evoked potentials (MEP) were recorded with needle electrodes inserted into target muscles and elicited by transcranial electrical stimulation (TES) ( n = 3558 ) , direct cortical stimulation (DCS) ( n = 5 ) or both modalities ( n = 389 ) . Parameters of TES and DCS were a train of five anodal electrical stimuli of 0.5 ms pulse duration, 4 ms inter-stimulus interval and 0.4–2 Hz train repetition rate. In the whole group ( n = 3952 ) , 30 patients (0.7%) developed seizures during surgery. From those, 14 had a previous history of seizure. In the group of patients who were monitored by TES, 12 patients (0.3%) had an intraoperative seizure. In the group that had electrical stimulation by both modalities (TES plus DCS), 18 patients (4.6%) had a seizure. The intraoperative seizure rate in the group of the 215 monitored supratentorial meningioma was 5.6% versus 2.7% in the 225 monitored intra-axial brain tumours. We present a review of the largest cohort of patients who underwent brain stimulation for monitoring of the motor system. The rate of seizures was 0.7% for the whole group, 1.5% for cranial surgeries and 0.1% for spine surgeries. The risk of seizures increased when TES was combined with DCS.

Non-traumatic vertebral fractures: An uncommon complication following the first episode of a convulsive seizure

Non-traumatic vertebral fractures that occur solely as a consequence of the muscle forces that develop during a convulsive seizure, has rarely been reported in orthopedic literature. Case Report: Therein, we present a case of non-traumatic vertebral compression fractures in an 18-year-old male, who presented with severe back pain following a convulsive seizure, which occurred while he was sitting in his bed. He had no other reported trauma and no previous history of seizure. A detailed neurological work-up revealed no organic cause for the seizure. His bone mineral density measurements, hormonal and metabolic profiles were normal. Conclusion: Forceful muscle contractions that develop during a single episode of convulsive seizure, occurring for the first time, can result in vertebral compression fractures, even in a normal healthy individual. Vertebral fractures occurring in a healthy young (non-epileptic) male, with normal bone mineral density, presenting with back pain after a convulsive seizure is a rare clinical presentation. These vertebral fractures can appear clinically asymptomatic and can easily be overseen, especially in the absence of overt signs of external trauma and possible postictal consciousness disturbance, which may fail to provide clue to early diagnosis. A high index of clinical suspicion is needed in patients presenting with back pain after a tonic-clonic seizure even in the absence of a f all or a significant trauma. Such patients may be subjected to a systematic musculoskeletal examination and a thorough radiological evaluation to rule out potential bony injuries.

Frequency and causes of seizure among hospitalized burned children

MethodsIn this cross-sectional retrospective study, frequency, type, time of occurrence and atiology of seizures in children with burn was investigated. All cases were under 18 years and were hospitalized in Shahid Motahari Burns Hospital during 2006–2011. Extracted data from patients’ medical records was reviewed and statistically analyzed. ResultsAmong 1103 patients, 69 (6.2%) had seizures, more frequently in the first 24h following burn. Thermal burn, especially with boiling water was the cause of burn in most of the children. Seizures occurred more commonly in children less than 3 years old and was generalized (tonic–clonic). Seizure was found to be primarily associated with febrile seizure, while hyponatremia was diagnosed as the second cause. Previous seizure history and seizure with unknown cause were identified as other etiologies.This paper summarizes the key information about seizure following burn, which health professionals, especially those in burn centers, should be aware. However, since this study was single-center more investigations in other centers are needed.

Hippocampal volume loss following childhood convulsive status epilepticus is not limited to prolonged febrile seizures

PurposeChildhood convulsive status epilepticus (CSE), in particular prolonged febrile seizures (PFS), has been linked with mesial temporal sclerosis (MTS). Previous studies have shown that hippocampal injury occurs in the acute phase immediately following CSE, but little is known about the longer term evolution of such injury. This study aimed to investigate the longer term outcome of childhood CSE with sequential magnetic resonance imaging (MRI) looking for progressive hippocampal injury during the first year post-CSE.MethodsEighty children (0.18–15.5 years) underwent brain MRI 1 month post-CSE, 50 with a repeat MRI at 6 months and 46 with repeat MRI at 12 months post-CSE. Thirty-one control subjects without neurologic problems had a single brain MRI for comparison. Hippocampal volumes were measured from each MRI scan by two independent observers, and hippocampal growth rates were estimated in each patient with suitable imaging.Key FindingsHippocampal volume loss was found in 20–30% of patients and was not associated with the etiology or clinical features of CSE, including seizure duration or focality. A borderline association was found between a history of previous seizures (p = 0.063) and the number of previous febrile seizures (p = 0.051), suggesting that multiple insults may be important in the pathogenesis of progressive hippocampal injury.SignificanceIt is apparent that progressive hippocampal damage can occur after CSE of any etiology and is not limited to PFS. Repeated seizures may play an important role, but further follow-up is needed to determine any other risk factors and proportion of children showing initial volume loss progress to clinical MTS and temporal lobe epilepsy.

États de mal épileptiques non convulsifs de l’adulte : quelles nouveautés ?

Les états de mal non convulsifs (EMNC) de l’adulte sont séparés en deux formes, l’état d’absence (EA) et l’état de mal partiel complexe (EMPC). Le diagnostic nécessite la réalisation d’un électroencéphalogramme (EEG) d’urgence. L’EA est la forme la plus fréquente. Il est caractérisé par une confusion fluctuante, d’intensité variable, souvent associée à des myoclonies palpébrales. L’EEG montre des décharges critiques généralisées qui cèdent sous benzodiazépines (BZ) alors que la conscience se normalise. Les EA peuvent survenir dans le cadre d’une épilepsie généralisée ou être inauguraux, par exemple chez le sujet âgé, sous l’influence de facteurs métaboliques, toxiques ou médicamenteux. Le pronostic est favorable. Les EMPC sont caractérisés par une confusion d’intensité variable, fluctuante, associée sur l’EEG à des décharges critiques focales. Ils nécessitent un traitement énergique en raison du risque de résistance et de la possibilité de séquelles cognitives. Les formes frontales et temporales sont les plus fréquentes. Le pronostic dépend des comorbidités. La plupart des encéphalopathies survenant en milieu de réanimation ne relèvent pas d’un EMNC, malgré certains aspects EEG trompeurs. De même, les encéphalopathies métaboliques ou toxiques et la maladie de Creutzfeldt-Jakob peuvent poser des problèmes de diagnostic électroclinique, au mieux résolus par l’injection IV de BZ et le suivi évolutif. Status epilepticus (SE) may be classified into convulsive SE, which must be rapidly stopped to prevent death or neurologic sequelae and nonconvulsive status epilepticus (NCSE), which is usually characterized by some degree of clouding of consciousness. This latter condition constitutes a diagnosis challenge, because it often goes unrecognized or is mistaken for behavioral or psychiatric disturbances. Emergency EEG is the key feature for diagnosis. NCSE are classically divided on the basis of the ictal EEG into absence status (AS), with predominantly symmetrical synchronous ictal discharges and complex partial status epilepticus (CPSE), with continuous or rapidly recurring complex partial seizures that may involve temporal and/or extratemporal regions. Typical AS occurs as part of an idiopathic generalized epilepsy (IGE) most often characterized by absences. The EEG correlates with repetitive absence seizures and shows symmetric and bilaterally synchronous spike-waves. The immediate prognosis is excellent. Atypical AS occurs in patients with symptomatic or cryptogenic epilepsies, or in patients with IGE and inappropriate medication. It is characterized by a fluctuating confusional state with more prominent tonic and/or myoclonic and/or lateralized ictal manifestations. Episodes tend to recur and to be resistant to medication. “De novo” absence status of late onset is characterized by toxic or metabolic precipitating factors leading to seizures in middle-aged or elderly subjects with no previous history of seizures. Patients often have a history of psychiatric illness with multiple psychotropic drug intake. AS with focal features occurs in subjects with a pre-existing or newly developing localization-related epilepsy, most often of extratemporal origin. The EEG shows bilateral but often asymmetric ictal discharges. CPSE is “a prolonged epileptic episode in which fluctuating or frequently recurring focal electrographic epileptic discharges, arising in temporal or extratemporal regions, result in a confusional state with variable clinical symptoms” (Shorvon, 1994). Various subtypes and precipitating factors are identified. Frontal and temporal localizations are most frequent in clinical practice. Limbic, non paraneoplastic encephalitis with VGKC autoantibodies has a characteristic clinical, MRI and immunological profile. In the recent years, many studies tend to lump together NCSE, “subtle” SE, AS, CPSE, myoclonic SE in coma, and EEG patterns suggestive of SE in comatose patients. In this group, the overall prognosis is poor, with a low response to antiepileptic drugs, but it may be particularly difficult to separate comorbidity to consequent morbidity. Post-hypoxic-ischemic encephalopathy, a life threatening condition that can express itself in the form of coma, EEG changes and myoclonus illustrates such methodological problems. NCSE should obviously be rapidly treated because of the attendant morbidity including physical injury, and because it may evolve on to generalized convulsions. Another argument is that long-term permanent neurologic damage from CPSE has been now documented, especially in the context of limbic encephalitis. IV benzodiazepines (BZ) must be performed first, with a rapid and complete recovery together with a normalization of EEG features. If BZ injection fails, IV fosphenytoin may be the drug of choice, especially in the context of symptomatic CPSE.

What is the standard approach to assessment of an unprovoked seizure in an adult?

Since Hong Kong is highly urbanized and acute public hospitals have been established across the city, most patients with unprovoked seizures not already receiving antiepileptic drug (AED) therapy, particularly convulsive seizures, will be admitted as emergency for assessment. A thorough history is taken from the patient and any witnesses to the seizure. This includes the circumstance of the seizures, detailed symptoms and signs experienced by the patient and witnessed by others before, during, and after the seizure, any potential precipitating factors, history of previous seizures (that the patient might have overlooked), and history of previous brain insults that might have increased the risk of epilepsy later in life, including gestational and birth history, history of childhood febrile seizure, significant head trauma, any family history of epilepsy or seizures, comorbidities, current medications, drug and alcohol abuse, and social history including employment, driving, and living circumstances. A detailed physical and neurologic examination is performed.

Status Epilepticus Associated With Dalfampridine in a Patient With Multiple Sclerosis

Status Epilepticus Associated With Dalfampridine in a Patient With Multiple Sclerosis

Focal nonconvulsive seizures during detoxification for benzodiazepine abuse

Chronic benzodiazepine (BDZ) abuse is currently treated with detoxification using a low-dose flumazenil infusion, a relatively recently developed and promising procedure. Given the possibility reported in the literature of the occurrence of generalized seizures during therapeutic BDZ detoxification, we usually administer preventive antiepileptic drug (AED) therapy. We describe two patients with no previous history of seizures or evidence of intracerebral lesions who, during detoxification for benzodiazepine abuse, developed repetitive focal nonconvulsive seizures instead of generalized seizures, even with appropriate doses of preventive AED therapy. There are no previous reported cases of focal nonconvulsive seizures occurring during this procedure or, more generally, during abrupt BDZ discontinuation. The cases we describe suggest that during detoxification for BDZ abuse, not only generalized, but also focal nonconvulsive seizures may occur. In this context, the focal seizures probably result from a diffuse decrease in the seizure threshold (caused by a generalized excitatory rebound), which may trigger focal seizures arising from cortical regions with higher intrinsic epileptogenicity. Detoxification for benzodiazepine abuse, even if performed with adequate-dosage AED treatment, may not be as safe a procedure as previously considered, because not only convulsive, but also nonconvulsive seizures may occur and go unnoticed. It is therefore strongly advisable to perform this detoxification under close medical supervision and to maintain a low threshold for EEG monitoring in the event of sudden onset of behavioral changes.

Nonconvulsive Status Epilepticus in Schizophrenia: Focus on Early Detection

Back to table of contents Previous article Next article LettersFull AccessNonconvulsive Status Epilepticus in Schizophrenia: Focus on Early DetectionChih-Sung Liang, M.D., and Fei-Wen Yang, M.D.Chih-Sung LiangSearch for more papers by this author, M.D., and Fei-Wen YangSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe26AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Nonconvulsive status epilepticus (NCSE) as a condition with a change in consciousness associated with continuous epileptiform discharges in the EEG is easily treated but often underdiagnosed.1 This is partially explained by its absence of major motor signs and protean manifestations seen in nonepileptic disorders. We present a case of NCSE and highlight early detection of this condition in patients with schizophrenia.Case ReportA 64-year-old woman with schizophrenia, which was well managed by risperidone 4 mg/day, fludiazepam 0.75 mg/day, and flunitrazepam 2 mg/day in recent years, was brought to the emergency department because of an abrupt onset of an altered level of consciousness, irritability, and psychosis. Laboratory results showed hyponatremia (115 mmol/liter) and hypokalemia (2.6 mmol/liter). Otherwise, abdominal ultrasonography, brain CT, CSF analysis, and other examinations revealed no remarkable findings. The family reported that for the past few days, there had been a marked excess of water intake. With a diagnosis of polydipsia-induced hyponatremia, she was admitted for electrolyte replacement.Upon admission, the treating physicians instantly discontinued all psychotropics. Because her condition did not improve even as her serum sodium and potassium concentrations were restored, psychiatric consultation was requested on Hospital Day 4. A diagnosis of delirium was made, and risperidone 4 mg/day was resumed. Her condition, however, gradually worsened. On Hospital Day 7, an EEG was obtained, which revealed generalized epileptiform discharges. The brain MRI showed negative findings. Consultation with a neurologist resulted in a diagnosis of NCSE; a regimen of levetiracetam 1,500 mg/day and intravenous valproic acid 1,200 mg/day was started, and risperidone was withheld. Four days after the initiation of antiepileptic agents, the patient's condition was notably improved. An EEG performed subsequently did not show any further epileptiform discharges.DiscussionThis case illustrates the complexities involved in distinguishing NCSE from other causes contributing to the development of delirium. Considering NCSE as a cause of delirium without an EEG is a great challenge because of the significant overlap in clinical features between NCSE and delirium. Misdiagnosis of NCSE could place psychiatrists at risk of iatrogenic error, because delayed treatment or exposure to antipsychotic agents that could lower seizure threshold might aggravate NCSE. Benzodiazepine (BZD) withdrawal, antipsychotic treatment, and delay in diagnosis might have worked in combination to exacerbate this patient's NCSE. Evidence demonstrates that patients with schizophrenia are more likely to experience seizures because of comorbid substance abuse, long-term exposure to psychotropic agents, and frequent episodes of head injury.2 Also, the behavioral and mental status changes of NCSE may incorrectly be ascribed to psychotic symptoms. A variety of precipitating factors have been implicated in NCSE, including polydipsia-induced hyponatremia,3 a previous history of seizures,1 infection,1 ECT,4 and BZD withdrawal,5 all of which are commonly associated with either the treatment of or are common comorbidities with schizophrenia.In conclusion, when evaluating patients with schizophrenia who have developed altered mental status and behavior, psychiatrists should pay more attention to whether an emergent EEG is needed in order to confirm or exclude the diagnosis of NCSE.Department of Psychiatry Beitou Armed Forces Hospital Taipei, Taiwan (R.O.C.)Correspondence: Fei-Wen Yang, M.D. Department of Psychiatry Beitou Armed Forces Hospital Taipei, Taiwan (R.O.C.) e-mail: [email protected]com.tw1. Meierkord H , Holtkamp M : Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 2007; 6:329–339Crossref, Medline, Google Scholar2. Hyde TM , Weinberger DR : Seizures and schizophrenia. Schizophr Bull 1997; 23:611–622Crossref, Medline, Google Scholar3. Azuma H , Akechi T , Furukawa TA : Absence status associated with focal activity and polydipsia-induced hyponatremia. Neuropsychiatr Dis Treat 2008; 4:495–498Crossref, Medline, Google Scholar4. Povlsen UJ , Wildschiodtz G , Hogenhaven H , et al.: Nonconvulsive status epilepticus after electroconvulsive therapy. J ECT 2003; 19:164–169Crossref, Medline, Google Scholar5. Olnes MJ , Golding A , Kaplan PW : Nonconvulsive status epilepticus resulting from benzodiazepine withdrawal. Ann Intern Med 2003; 139:956–958Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByDe-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review15 October 2021 | PLOS ONE, Vol. 16, No. 10 Volume 23Issue 4 Fall 2011Pages E26-E26 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

Analysis of factors influencing admission to intensive care following convulsive status epilepticus in children

Objectives To identify clinical features and therapeutic decisions that influence admission to the Intensive Care unit (ICU) in children presenting with convulsive status epilepticus (CSE). Methods We evaluated 47 admissions with status epilepticus to a tertiary paediatric hospital A&E over a three year period (2003–2006). Following initial management 23 episodes required admission to ICU and 24 were managed on a paediatric ward. We compared clinical, demographic data and compliance with our CSE protocol between the ICU and ward groups. Results Median age at presentation in the ICU group was 17 months (range 3 months–11 years) compared to 46 months in the ward group (range 3 months–10 years). Fifty per cent of patients in both groups had a previous history of seizures. Median duration of pre-hospital seizure activity was 30 min in both groups. More than two doses of benzodiazepines were given as first line medication in 62% of the ICU group and 33% of the ward group. Among children admitted to ICU with CSE, 26% had been managed according to the CSE protocol, compared to 66% of children who were admitted to a hospital ward. Febrile seizures were the most common aetiology in both groups. Conclusion Younger age at presentation, administration of more than two doses of benzodiazepines and deviation from the CSE protocol appear to be factors which influence admission of children to ICU. Recognition of pre-hospital administration of benzodiazepines and adherence to therapeutic guidelines may reduce the need for ventilatory support in this group.

Status epilepticus in a patient treated with olanzapine and mirtazapine

Few cases of seizures associated with olanzapine therapy and even fewer with mirtazapine have been published, most of them in patients with confounding risk factors. Our objective was to report a case of Status epilepticus in a patient receiving olanzapine and mirtazapine, with no previous history of seizure and no confirmed underlying cause for seizure. A 48-year-old white, psychotic woman developed generalized tonic-clonic seizures that progressed to Status epilepticus during hospitalization. 4 days before the incident, mirtazapine (30 mg) was added to the treatment, while 2 days before the incident, the treatment switched from quetiapine to olanzapine, and mirtazapine was increased to 60 mg. No other toxic, metabolic, electrolyte or anatomic abnormality was identified. After discontinuation of olanzapine, the patient remained seizure-free. To our knowledge, this is the second reported case of Status epilepticus that has been associated with the use of olanzapine, while only one report of seizures, but none of Status epilepticus connected to mirtazapine is found in the literature. Although olanzapine has infrequently been associated with epileptogenic risk, it should be used cautiously especially when concomitant medication or other predisposing factors exist.

A Seizure Attributed to Ofloxacine in a Woman Undergoing Detoxification for Alcohol Dependence

Objective. To report one case of seizure following administration of ofloxacin. Case Summary. A 38-year-old woman with alcohol dependence but no prior history of seizure disorder admitted in our inpatient alcohol detoxification program was prescribed ofloxacin four days after admission for a lower urinary tract infection. She was currently prescribed diazepam 30 mg per day. This treatment was continued without modification following admission. Forty eight hours after starting ofloxacin and after receiving five doses of oral ofloxacin, the patient experienced a seizure. Ofloxacin treatment was stopped and no further seizures occurred. Neurological examination of the patient, laboratory tests, computerized tomography with contrast enhancement and electroencephalography did not detect any abnormalities. Up to the last consultation, six months after admission, the patient has reported no recurrence of the seizure. Discussion. Quinolone antibiotics vary in their ability to induce seizures, with ofloxacin having one of the least potentials. In the present case, the seizure could be attributed in all probability to taking ofloxacin; since she had no previous history of seizures, she did not present an alcohol withdrawal syndrome, benzodiazepine treatment was not modified, the seizure occurred 48 h after taking ofloxacin, but seven days after stopping drinking, no alternative aetiologies for the seizure could be identified and no seizure recurrence was reported over the following seven months. Of reported cases of seizures in patients treated with fluoroquinolones, none concerned patients with alcohol dependence or patients treated with benzodiazepines. Conclusions. The present case alerts us to the possibility that seizures may occur in alcohol dependent patients treated with benzodiazepines who concomitantly prescribed a fluoroquinolone. These widely-used antibiotics should thus be prescribed with caution to patients undergoing detoxification for alcohol dependence, particularly if they are also taking benzodiazepines, irrespective of whether they have a previous history of seizures or not.

467: Clonazepam Plus Levetiracetam (CL) for the Prevention of Busulfan-Induced Seizures: A Single Center Experience

Seizure prophylaxis • Phenytoin is the most commonly used prophylactic anticonvulsant agent • Widely used and effective in both adults and pediatrics • Requires loading dose(s) prior to first busulfan dose and daily maintenance dosing • Serum monitoring available but not required • Inexpensive and widely available medicine • Background • High dose busulfan (> 1 mg/kg) used in hematopoietic stem cell transplant (HSCT) conditioning regimens causes a decrease in seizure threshold. • Up to 10%of people, without a previous seizure history, will have partial or generalized seizures while receiving busulfan • Patients require seizure prophylaxis when receiving high dose busulfan.

Seizure and prominent abdominal veins

In January, 2007, a 55-year-old man was brought to our hospital, 30 min after having a generalised tonic-clonic seizure. He had diabetes and hypertension, and was prescribed glibenclamide and amlodipine. He had no other medical history of note—in particular, there was no history of previous seizures, meningitis, encephalitis, febrile convulsions in infancy, birth trauma, head injury, a space-occupying lesion, or psychiatric illness. He was a farmer; he had a low income, but was eligible for state medical care.