Prior History Of Epilepsy Research Articles

Clinical and Radiological Parameters Affecting the Yield of Routine Electroencephalography in Various Indications.

To highlight the significance of various clinical and radiological parameters in association with specific electroencephalographic (EEG) patterns in order to prioritize EEG referrals. This retrospective, cross-sectional study was conducted in the neurology department of King Fahad University Hospital, Alkhobar, and involved a review and analysis of EEG and medical records pertaining to 604 patients referred for routine EEG. The data were analyzed using SPSS version 22. An association between various parameters and EEG yield was established. Factors associated with the yield of abnormal EEG patterns were diverse, like generalized tonic-clonic seizures (GTCs) (P =.05), status epilepticus (SE) (P =.05), altered level of consciousness (ALC) (P =.00), abnormal movement (P =.00), cardiac arrest (P =.00), prior history of epilepsy (P =.04), chronic renal disease (CRD) (P =.03), abnormal neurological exam (P =.00), and cortical lesions on brain imaging (P =.00). Among the abnormal EEG patterns, epileptiform activity (EA) in EEG was associated with focal seizures (P =.03), GTCs (P =.00), falls (P =.05), cardiac arrest (P =.00), a history of epilepsy (P =.00), and hypoxic ischemic injury (P =.03). Encephalopathy in EEG was also associated with focal sz (P =.02), GTCs (P =.00), SE (P =.01), ALC (P =.00), cardiac arrest (P =.00), history of stroke (P =.01), and epilepsy (P =.00). Among the studied parameters, patient level of consciousness, neurological exam findings, and neuroimaging findings, with some discrepancies, were found to be the most consistent in predicting the EEG yield. The study demonstrated the value of a proper neurological exam and careful selection of patients to gain the optimum benefit from the routine EEG.

Revascularization Therapies for Ischemic Stroke and Association With Risk of Epilepsy: A Danish Nationwide Register-Based Study.

The association between stroke revascularization therapies and poststroke epilepsy is only sparsely investigated, and results are conflicting. The aim of this study is to investigate whether stroke revascularization therapies are associated with different risks of poststroke epilepsy. We conducted a nationwide, register-based, propensity score-matched cohort study. We identified 40 816 patients admitted with a first ischemic stroke and no prior history of epilepsy in Denmark between January 1, 2011, and December 16, 2018. Of these, 6541 were treated with thrombolysis, 379 with thrombectomy, and 1005 with both thrombolysis and thrombectomy. The 3 treatment groups were each matched 1:1 to patients with stroke not treated with revascularization. Exact matching was done for sex, while propensity scores included information on stroke severity, cortical involvement, age, comorbidities, and socioeconomic parameters. Outcome was any diagnosis of epilepsy. We used Cox regressions to estimate adjusted hazard ratios (HRs) of epilepsy after ischemic stroke. Compared with matched patients with ischemic stroke not receiving revascularization treatment, patients who received thrombolysis alone had 32% lower risk of epilepsy (adjusted HR, 0.68 [95% CI, 0.57-0.81]) and patients who received thrombolysis and thrombectomy had 45% lower risk of epilepsy (adjusted HR, 0.55 [95% CI, 0.41-0.73]). Thrombectomy alone was not associated with significantly lower risk of epilepsy compared with matched patients with ischemic stroke not receiving revascularization therapy (adjusted HR, 0.78 [95% CI, 0.57-1.29]). Thrombolysis alone and in combination with thrombectomy in ischemic stroke was associated with lower risk of epilepsy, whereas thrombectomy alone was not associated with lower risk of epilepsy.

New-onset seizures misdiagnosed as psychogenic non-epileptic seizures: a case of paraneoplastic limbic encephalitis with primary testicular cancer

BackgroundBehavioral psychiatric symptoms can be the only warning signs of more serious conditions such as paraneoplastic limbic encephalitis. Differentiating between primary psychiatric disorders and paraneoplastic neurological syndromes is crucial as they require distinct treatment approaches. In this case report, we provide an overview of paraneoplastic encephalitis and introduce a unique case that showcases a misdiagnosis of psychogenic non-epileptic seizures (PNES) in a male as the primary symptom of paraneoplastic encephalitis due to pure seminoma. This case highlights the underlying pathophysiology of antibody-mediated paraneoplastic encephalitis and its significance.Case presentationA 31-year-old male with no known past medical history presented due to recurrent seizures. There was no prior history of epilepsy or exposure to seizure-triggering agents. Imaging and electroencephalogram findings during his initial hospitalizations pointed to a potential diagnosis of PNES. The patient continued to experience seizures following discharge, leading to repeat hospitalizations. During the fourth hospitalization, the patient received mood-stabilizing anti-seizure medications and benzodiazepines, but he deteriorated and required intubation. It was during this time that the patient was transferred to our facility. Magnetic resonance imaging of the brain revealed multifocal areas of hyperintensity and restricted diffusion with avid enhancement. Immunotherapy was initiated with improvement of non-epileptic spells and encephalopathy. Outpatient workup uncovered malignant pure seminoma with metastases to the retroperitoneum. The authors theorize that paraneoplastic neurological disorders stemming from testicular cancer led to the neurological symptoms seen in this case.ConclusionThis report highlights a rare occurrence of paraneoplastic limbic encephalitis associated with pure testicular seminoma, clinically manifested as PNES. The diagnostic challenge posed by variability of presenting symptoms in paraneoplastic encephalitis emphasizes the importance of accurate differentiation from conditions such as autoimmune encephalitis. Current diagnostic approaches for paraneoplastic and autoimmune etiologies involve detection of known antibodies, as well as brain imaging. Notable antibodies associated with psychogenic non-epileptic seizures symptoms include anti-GAD-65, anti-Ma2, KLH11-antibodies, anti-Hu, and NMDA receptor antibodies. Recognizing paraneoplastic limbic encephalitis symptoms is challenging and often leads to misdiagnosis or overlooking of malignancies highlighting the need for awareness, comprehensive evaluation and timely treatment. Through this comprehensive case analysis, we enhance the understanding of underlying mechanisms, associated symptoms, and treatment options.

A case of new onset refractory status epilepticus in a U.S. traveler with Japanese encephalitis

New onset refractory status epilepticus (NORSE) is a rare but critical condition characterized by refractory status epilepticus (RSE) in an individual without prior history of epilepsy or known structural, toxic, or metabolic cause. Postinfectious immune activation is an important cause of NORSE. Early testing for autoimmune antibodies is strongly recommended (Wickstrom et al., 2022). We report a case of NORSE triggered by Japanese encephalitis (JE) in an unvaccinated US adult traveler. Her CSF later revealed positive anti-N-methyl-d-aspartate (NMDA)-receptor antibody. The patient responded well to first line immunotherapy with favorable functional outcome. This case highlights the diagnostic and treatment challenges in this rare presentation.

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy.

The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel-based lesion symptom mapping (VLSM). Patients with imaging-confirmed first-ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90-day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age- and sex-matched patients with first-ever ischemic strokes without PSE after 90days served as controls for the VLSM analysis. The stroke database contained 809 patients (mean age: 68.4±14.2years) with first-ever imaging-confirmed ischemic strokes without history of epilep. Incidence of PSE after 90-day follow-up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90-day follow-up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE (p<.05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere-specific VLSM analysis shows associations between PSE and damaged voxels in the left-hemispheric temporo-occipital transition zone. The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo-occipital cortex are vulnerable to develop PSE.

A retrospective multicentric study on the effectiveness of intravenous brivaracetam in seizure clusters: Data from the Italian experience

ObjectiveNearly half of people with epilepsy (PWE) are expected to develop seizure clusters (SC), with the subsequent risk of hospitalization. The aim of the present study was to evaluate the use, effectiveness and safety of intravenous (IV) brivaracetam (BRV) in the treatment of SC. MethodsRetrospective multicentric study of patients with SC (≥ 2 seizures/24 h) who received IV BRV. Data collection occurred from January 2019 to April 2022 in 25 Italian neurology units. Primary efficacy outcome was seizure freedom up to 24 h from BRV administration. We also evaluated the risk of evolution into Status Epilepticus (SE) at 6, 12 and 24 h after treatment initiation. A Cox regression model was used to identify outcome predictors. Results97 patients were included (mean age 62 years), 74 (76%) of whom had a history of epilepsy (with drug resistant seizures in 49% of cases). BRV was administered as first line treatment in 16% of the episodes, while it was used as first or second drug after benzodiazepines failure in 49% and 35% of episodes, respectively. On the one hand, 58% patients were seizure free at 24 h after BRV administration and no other rescue medications were used in 75 out of 97 cases (77%) On the other hand, SC evolved into SE in 17% of cases. A higher probability of seizure relapse and/or evolution into SE was observed in patients without a prior history of epilepsy (HR 2.0; 95% CI 1.03 – 4.1) and in case of BRV administration as second/third line drug (HR 3.2; 95% CI 1.1 – 9.7). No severe treatment emergent adverse events were observed. SignificanceIn our cohort, IV BRV resulted to be well tolerated for the treatment of SC and it could be considered as a treatment option, particularly in case of in-hospital onset. However, the underlying etiology seems to be the main outcome predictor.

EEG Characteristics in Hospitalized Patients With Acute COVID-19 Symptoms

Objective Our objective was to evaluate the incidence of seizures, pattern of EEG abnormalities, and localization of abnormal discharges in hospitalized patients with COVID-19. Background The COVID-19 epidemic has revealed significant neurological manifestations including de novo seizures in patients who do not have a prior history of epilepsy or clear epilepsy risk factors. Our center is located in Arizona, which in the early part of January 2021 had more cases per capita than any other place in the world. Design/Methods We performed a retrospective review to observe the electroencephalogram (EEG) patterns of hospitalized adult patients with COVID-19 between March 2020 and February 2021. Results We identified 99 patients who were COVID-19 positive and had EEG testing during the same hospitalization. The most common EEG abnormality was diffuse background slowing, which was seen in 63.6% of patients (n = 63/99), compare to 15.1% of focal background slowing. Epileptiform discharges were seen in 11.1% of patients and seizures were found in 5.1% of patients, as newly diagnosed seizures. When combining all focal abnormalities, the most common location for these abnormalities was in the frontal regions 36.4% (n = 8/22). Even though 21 patients had acute focal neuroradiologic findings, only 5 had correlated EEG abnormalities within the same region. When EEG was obtained with suspected seizures (n = 33), 4 cases (12.1%, n = 4/33) indeed showed ictal pattern compared to 1.6% when seizures was not suspected (p = 0.087). Conclusions Abnormal EEG findings are most commonly found in the frontal lobe among hospitalized patients with acute COVID-19 symptoms. De novo seizures may be seen with COVID-19 infection. Suspicion of seizures should be raised in patients with COVID-19 encephalopathy. The utility of an EEG may help allow us better insight into how and where the COVID infection affects our central nervous system.

Epidemiology and Risk Factors of Convulsive Status Epilepticus Patients Admitted in the Emergency Department of Tertiary Hospital in Mogadishu, Somalia.

Status epilepticus (SE) is one of the most common neurologic emergencies and is associated with significant morbidity and mortality. The underlying cause of SE varies between patients with epilepsy and those presenting without. The aim of this study was to evaluate the epidemiology, risk factors and outcomes of patients presenting with convulsive SE in the emergency department (ED) of a tertiary hospital in Mogadishu. This was a cross-sectional study conducted between July 2021 and June 2022. The study included both patients with epilepsy and those without epilepsy presenting to the ED with SE. Risk factors and underlying etiologies were evaluated in the patients in both the pediatric group (0-18 years) and adult group (18 years and above).Clinical history, neurologic examinations, neuroimaging, electroencephalography findings, and laboratory investigations were all evaluated. The mean age for pediatric patients was 6 (SD±4.7), while the mean age for adult patients was 38 (SD±10.4). About 33 (36%) of the subjects had previous history of epilepsy, while 59 (64%) presented to the ED with their first seizure. About 80 (87%) had generalized seizure while 12 (13%) had focal seizure. Poor antiepileptic compliance was the most common risk factor for SE 20 (21.7%), followed by CNS infections 14 (15%), and prolonged febrile seizures 7 (7.6%). Poor antiepileptic drug compliance, cerebrovascular disorders, electrolyte imbalance, metabolic conditions, and drug abuse were the most common underlying etiologies of SE in patients older than 18 years. Prolonged febrile seizure, meningitis, encephalitis, systemic infections, and structural brain abnormalities were the most common underlying etiologies of SE in patients younger than 18 years. CNS infections, CVDs, metabolic disturbances, electrolyte imbalances, and systemic infections are major etiological risk factors of SE in patients without prior history of epilepsy. Medication adherence was the major etiological risk factor for SE identified in patients with epilepsy.

Provoked seizures and status epilepticus in a pediatric population with COVID-19 disease.

We are reporting 16 pediatric patients (ages 0–18‐years‐old) who presented to our urban hospital emergency room with seizures and coronavirus disease 2019 (COVID‐19) during the surge of the Omicron variant. There was an increased number of pediatric patients with seizures and COVID‐19 during this period as compared to prior COVID‐19 surges. The 16 patients ranged in age from 3 months to 12 years of age. Five of the 16 patients (31%) had a prior history of epilepsy. Eight patients (50%) presented in status epilepticus, and in six patients (38%) the seizures appeared to have focal features. Fourteen patients (88%) presented with a complex provoked seizure defined as exhibiting either focality, seizure >5 min in length, or more than one seizure in 24 h. We suggest that in the pediatric population, when compared to prior variants of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the Omicron variant is more likely to be associated with neurologic symptoms, including complex provoked seizures.

Seizures and COVID-19: Results from the Spanish Society of Neurology’s COVID-19 registry

We describea series of patients with COVID-19 who presented with seizures, reported in the Spanish Society of Neurology’s COVID-19 Registry.This observational, descriptive,multicentre, registry-based study includes patients with confirmed COVID-19 who experienced seizures during active infection.Wedescribe theclinicalpresentation of COVID-19,seizures,and resultsof complementary tests.Wealsodescribe the suspectedaetiologyof the seizures.Of 232 reported cases, 26 (11.2%) presented with seizures;7 of these patients (26.9%) had prior history of epilepsy, whereas the remaining 19 (73.1%) had no history of seizures.In most cases, seizures presented on days 0 and 7 after onset of COVID-19. By seizure type, 8 patients (30.7%) presentedgeneralised tonic-clonic seizures, 7 (26.9%) status epilepticus, 8 (30.7%) focal impaired-awareness seizures, and 4 (11.7%) secondary generalised seizures.Six patients (23.1%) also presented other neurological symptoms, includingaltered mental status and decreased level of consciousness. Predisposing factors for seizures (eg, dementia, tumour, cerebrovascular disease) were observed in 10 of the 19 patients with no prior history of epilepsy (52.6%).Patients with COVID-19 may present with seizures over the course of the disease,either alone or in the context of encephalopathy.Seizures may present in patients with no prior history of epilepsy; however, most of these patients present predisposing factors.

Clinical Profile of Posterior Reversible Encephalopathy Syndrome(PRES)-Related Epilepsy in Patients Following Haploidentical Hematopoietic Stem Cell Transplantation:a 10-Year Study

AbstractIntroductionPosterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity characterized by seizures, headache, altered mental status and visual disturbances associated with typical transient lesions on magnetic resonance imaging (MRI). Haploidentical hematopoietic stem cell transplant (haplo-HSCT) is an upfront and effective therapy for hematological patients, but it has a large spectrum of neurological complications including PRES. Epilepsy is a common manifestation but there is no information on epilepsy following PRES. The aim of the present study was to describe clinical characteristics and potentially unrecognized risk factors for PRES-related epilepsy following haplo-HSCT.MethodsA nested case-control study was conducted at the Institute of Hematology, Peking University People's Hospital between January 2007 and July 2017.Forty patients with PRES-related epilepsy were identified, and 122 controls were matched for transplantation type, and time of transplantation. The diagnosis of PRES was based on characteristic clinical findings and characteristic findings of subcortical white matter lesions on CT or MRI of the brain. PRES-related epilepsy was defined as at least two unprovoked seizures occurring >24 h apart more than one month after the inciting episode with complete or near complete resolution of imaging abnormalities (Fisher RS, et al. Epilepsia 2014; Sha Z,et al. Epilepsy Behav 2015; Hinduja,et al. Epilepsy Behav 2016).Additionally, patients with prior history of epilepsy were excluded. A provoked seizure was defined as a seizure that occurred in the context of a precipitating cause that could lower the seizure threshold.ResultsForty patients were defined as PRES-related epilepsy. The cumulative incidences of the disease at 100 days, 1 year and 2 years post-transplantation were 0.4%, 1.7%, 2.2%, respectively.Magnetic resonance imaging (MRI) or computed tomography(CT) was collected during 4 days of the onset of epilepsy seizures. CT was performed in 3 patients. The median time of appearance for PRES-related epilepsy was 107.1 days(rang:15-839). The mean age at the time of presentation was 18 years(range:5-47). Eleven patients had acute myeloid leukemia,12 patients had acute lymphoblastic leukemia,4 patients had chronic myelogenous leukemia,6 patients had aplastic anemia,7 patients had myelodysplastic syndrome.Thirty-two patients (80%) were diagnosed with GVHD, and 8 patients (20%) had grade Ⅲ to IV GVHD before day 100.Five patients died from disease relapse,6 patients from infection.In univariate analysis, an increased risk of PRES-related epilepsy was associated with age (<10years/³10years), mean arterial pressure (MAP), hyponatremia, hypochloremia, serum lactate dehydrogenase (LDH) and Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) (³1) were related to the occurrence of PRES-related epilepsy. Multivariate analysis showed that MAP (OR= 1.053,95% CI 1.031 to 1.075,P=0.000), hyponatremia (OR=1.27,95% CI 1.139 to 1.417,P=0.000), hypochloremia (OR=0.77,95% CI 0.692 to 0.856,P=0.000) and HCT-CI (³1) (OR=9.505, 95% CI 1.262 to 71.574,P=0.027) were risk factors for PRES-related epilepsy.The median follow-up for the survivors was 1423 days (rang:95-3018).The 10-year overall survival did not significantly differ between the two groups (PRES-related epilepsy 73.2% and control 82.8%,P = 0.184).ConclusionMAP, hyponatremia, hypochloremia and HCT-CI(³1) are related with the occurrence of PRES-related epilepsy after haplo-HSCT. PRES-related epilepsy had no influence on long-term survival. DisclosuresNo relevant conflicts of interest to declare.

Epilepsy and the smell of fear

ObjectiveIn our canine scent detection research involving a specific volatile organic compound (VOC) associated with human epileptic seizure, we began to suspect involvement of the primitive neural networks associated with production of a previously undescribed human alarm pheromone as the origin of our seizure scent. We hypothesized that if we presented fear-scented sweat to our canine seizure scent detection team, and they identified the fear scent as their seizure scent, then that would suggest that they are identical compounds. MethodsFollowing consent and approval, sweat samples taken from volunteers associated with the Brooke Gordon Comprehensive Epilepsy Center at Denver Health were processed by the Canine Assistants (CA) service dog team that had been imprinted to recognize the unique seizure scent from our previous study. In part one, sweat samples were collected from subjects, who had no prior history of epilepsy or seizures, under two different testing environments: watching a scary movie (It) and a neutral/comedy movie (Airplane!). In part two, a larger follow-up study utilizing fear sweat, exercise sweat, epilepsy sweat, and other distractor scents were provided in a multiple choice paradigm to better understand the inter-rater reliability of the canine responses. ResultsIn part one, our canine seizure scent detection team identified fear-scented sweat samples as their seizure scent in 4 of 5 study participants. There was almost perfect agreement of seizure scent detection during fear scent trials between the canine seizure scent detectors with a kappa value of 0.814 (95% CI: 0.668–0.960). In part two, (utilizing eleven different subjects) our canine scent detection team identified samples of either fear or seizure sweat with a sensitivity of 82% and a specificity of 100% (no false positives) from among the multiple choices offered. Additionally, there was 92% agreement between the members of the canine scent detection team. SignificanceWhile this hypothesis testing study is small and deserves replication, it confirms that the Canine Assistants seizure scent detection team consistently and accurately identified fear-scented sweat as their seizure scent, implying that the VOC, menthone, is common to both conditions. This further implies that human seizure propagation and fear network circuitry may share a common anatomy, and that menthone may not only be an early seizure biomarker, but a newly described human alarm pheromone.

Response: Epileptic discharges in acutely ill patients investigated for SARS-CoV-2/COVID-19 and the absence of evidence.

Response: Epileptic discharges in acutely ill patients investigated for SARS-CoV-2/COVID-19 and the absence of evidence.

Aphasic status epilepticus in a tertiary referral center in Turkey: Clinical features, etiology, and outcome

ObjectiveAphasic status epilepticus (ASE), although rare, may often remain underdiagnosed. We aimed to report the patients diagnosed with ASE and describe their clinical presentation, etiology, electrophysiological findings, neuroimaging, treatment options, and outcome. MethodsWe retrospectively analyzed a series of 28 patients diagnosed with ASE between January 2010 and August 2019 in our tertiary referral center. We reviewed medical files, patient charts, and short- and long-term intermittent electroencephalogram (EEG) recordings. Demographical, historical, clinical, neuroimaging, electrophysiological parameters, administered antiseizure medications, and prognosis of all patients were recorded. Furthermore, EEGs were re-evaluated according to Salzburg criteria. ResultsMost patients presented with tumors (n = 11) and cerebrovascular disease (CVD) (n = 11), while the rest were diagnosed with hyperglycemia (n = 2), autoimmune encephalitis (n = 1), remote intracranial abscess (n = 1), mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) attack (n = 1), or unknown cause (n = 1). Seventy-one percent of patients had prior history of epilepsy. The most common EEG findings were rhythmic delta activity with fluctuation and epileptiform discharges ≤ 2.5 Hz with spatiotemporal evolution (66 %). Magnetic resonance imaging (MRI) and EEG findings indicated dominant hemisphere involvement in all patients. No casualties occurred; 71 % patients exhibited total recovery, while 29 % had mild-moderate sequela aphasia. None of the patients received aggressive treatment for ASE. SignificanceA relatively higher number of ASE patients could be contributed to the literature through this study. ASE should be considered in patients with prolonged unexplained aphasia, especially with pre-existing risk factors, such as prior history of epilepsy, structural lesion, and metabolic disorders accompanied by concordant EEG findings. Although the underlying cause is a determining prognostic factor, this study shows a significant number of patients with complete remission; thus, the prognosis of ASE may be considered more favorable than other types of nonconvulsive status epilepticus.

Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system.

There is evidence for central nervous system complications of coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Encephalopathy caused by or arising from seizures, especially nonconvulsive seizures (NCS), often requires electroencephalography (EEG) monitoring for diagnosis. The prevalence of seizures and other EEG abnormalities among COVID-19-infected patients is unknown. Medical records and EEG studies of patients hospitalized with confirmed COVID-19 infections over a 2-month period at a single US academic health system (four hospitals) were reviewed to describe the distribution of EEG findings including epileptiform abnormalities (seizures, periodic discharges, or nonperiodic epileptiform discharges). Factors including demographics, remote and acute brain injury, prior history of epilepsy, preceding seizures, critical illness severity scores, and interleukin 6 (IL-6) levels were compared to EEG findings to identify predictors of epileptiform EEG abnormalities. Of 111 patients monitored, most were male (71%), middle-aged or older (median age 64years), admitted to an intensive care unit (ICU; 77%), and comatose (70%). Excluding 11 patients monitored after cardiac arrest, the most frequent EEG finding was moderate generalized slowing (57%), but epileptiform findings were observed in 30% and seizures in 7% (4% with NCS). Three patients with EEG seizures did not have epilepsy or evidence of acute or remote brain injury, although all had clinical seizures prior to EEG. Only having epilepsy (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-21) or seizure(s) prior to EEG (OR 4.8, 95% CI 1.7-13) was independently associated with epileptiform EEG findings. Our study supports growing evidence that COVID-19 can affect the central nervous system, although seizures are unlikely a common cause of encephalopathy. Seizures and epileptiform activity on EEG occurred infrequently, and having a history of epilepsy or seizure(s) prior to EEG testing was predictive of epileptiform findings. This has important implications for triaging EEG testing in this population.

The Clinical Spectrum of New-Onset Status Epilepticus.

There is a paucity of data on patients with new-onset status epilepticus in patients without a prior history of epilepsy; we aimed to describe clinical characteristics and assess variables predictive of outcomes. Retrospective cohort. Quaternary academic medical center. Adult patients with new-onset status epilepticus. Retrospective review of adults with new-onset status epilepticus admitted to Mayo Clinic, Rochester MN between January 1, 1990, and December 31, 2015, was performed. Patient demographics, status epilepticus etiology, Status Epilepticus Severity Score, and status epilepticus classification per the Status Epilepticus Severity Score were recorded. Six-month mortality and functional outcomes defined as modified Rankin scale (≥3 at last follow-up was considered poor) were primary outcomes. Refractory status epilepticus was a secondary outcome. None. One-hundred seventy-seven patients were included. Status epilepticus was convulsive in 124 (70.1%) and nonconvulsive in 53 (29.9%); 96 cases (54.2%) were refractory status epilepticus. Mean age at onset was 63 ± 18 years; 52.5% were greater than or equal to 65 years. Etiologies were acute in 50.8%, progressive in 18.1%, remote in 19.2%, and unknown in 11.9% patients. Six-month mortality was 32.2%, and 70.1% had poor modified Rankin scale at mean follow-up 3.1 ± 3.5 years. Age greater than or equal to 65 was a significant predictor of poor functional outcome and 6-month mortality. Loss of consciousness, status epilepticus classification, or age greater than or equal to 65 did not predict progression to refractory status epilepticus. Progression to refractory status epilepticus did not impact functional outcome or mortality at last follow-up. Poor outcomes in new-onset status epilepticus were associated with older age as well as predominantly progressive or remote symptomatic disease. Further prospective investigations assessing the course and outcomes of these patients would be useful in management and prognostication.

First Attack of Status Epilepticus in Adults: Etiology and Risk Factors

AbstractBackground: Status Epilepticus (SE) is a common life-threatening neurological emergency the etiology of SE varies according to age and prior history of seizures. In people known to be epileptic poor compliance and drug withdrawal are the commonest causes of SE. On the other hand in patients with no prior seizure history strokes, head traumas, CNS infections, cardiac arrests and metabolic disturbances are the most com-mon causes.Aim of Study: Is to study the possible etiologies and outcome of first attack of SE in adults.Patients and Methods: This was a 6-month duration cross sectional study done at Neuropsychiatry Department, Tanta University Hospital, started from July 2016. All patients presented by first attack of SE over the age of 18 years and didn't have previous history of SE, were considered.Results: Of 42 patients included in the study 35 (83.3%) had non refractory SE while 7 (16.7%) had RSE. 37 patients survived (88.1%) and 5 patients died (11.9%). Analysis of statistically significant and most clinically important variables showed that these factors were significantly higher in RSE, cryptogenic etiology (p=0.024), EEG changes (p=0.015). number of AEDs (p=0.001), duration of hospitalization (p= 0.037), complications due to hospitalization (p=0.015), EMSE scores (p=0.001).Conclusion: Most patients presented by SE over the age of 18 has no prior history of epilepsy. CVAs are the leading cause of de novo SE in adults followed by metabolic derange-ments. Refractory Status Epilepticus (RSE) is associated with prolonged duration of hospitalization and higher rates of complications compared to non-refractory SE. Complications due to seizures were the most common followed by side effects of AEDs while complications of prolonged hospitali-zation were the least common. EEG monitoring is an important tool both in managing and predicting the outcome of status epilepticus. STESS and EMSE scoring systems are easy to use bed side tools to help in predicting the outcome of SE.

Status Epilepticus in Our Patients, 15-Years Follow-Up Study

Introduction: Status epilepticus (SE) is the second most frequent neurological emergency. The purpose of this study was to analyse clinical presentation, causes and outcome of SE. Aim of the Study: The aim was to establish clinical characteristics, etiology and the outcome of status epilepticus as well as sex and age distribution in patients hospitalized at the Clinic of Neurology UCC RS in a 15-year follow-up. Patients and Methods: In this prospective 15-year study, all patients with SE admitted to the University Clinical Center of Republic of Srpska, Clinic of Neurology, were treated in the period of 15 years (2003-2017). Demographic and clinical data were collected. Results: In the aforesaid period, 124 patients with SE were treated, and there were 71 man (57%) with mean age of 59 years and 54 woman (43%), with mean age of 52.5 years. Primarily generalized tonic-clonic SE was identified in 70 (56%) and 44 (35.2%) patients, retrospectively. Simple partial SE occurred in 10 (8%) patients. 62% of the patients had previously had epilepsy while 38% had not. The main underlying causes were noncompliance to treatment in the first group (n=56; 72%) and cerebrovascular disease (n=36; 75%) in the second group. Overall mortality rate was 11.2% , which correlated with acute symptomatic etiology and patients of older age (mean: 73 years). Conclusion: Epileptic patients are at greater risk to develop SE. However, in patients with no prior history of epilepsy and acute neurological problems SE may also occur. Cerebrovascular disease was the most common cause of SE in those with the initial seizure. Noncompliance to treatment was the major cause in patients with preexisting epilepsy.

Platform Session – Evoked potentials & NIOM: Factors that modify the risk of intraoperative seizures triggered by electrical stimulation during supratentorial functional mapping

Introduction Neurophysiologic mapping via electrical stimulation is the gold standard for intraoperative functional mapping during surgeries in close proximity to eloquent cortical and subcortical regions. While it’s temporal and spatial resolution are far superior to other intraoperative and extraoperative techniques, the method carries a relatively high risk for triggering after discharges and seizures. These can not only lead to inaccurate mapping results but also pose an immediate safety risk to the patient. In the current study we aim to identify factors that impact this risk. Particularly, we are aim to study whether administration of antiepileptic (AED) drugs prior to and/or at surgery decrease the probability of triggering seizures. Methods We studied 544 consecutive mapping cases performed at an institution with tertiary care centers for epilepsy and brain tumor surgery. Applying a multivariate logistic regression model, we analyzed whether certain stimulation paradigms, patient’s state (awake versus general anesthesia), history of epilepsy, maintenance AED administration prior to surgery, and loading with AED at the beginning of the surgery do impact the risk of triggering seizures, after adjusting for potential confounders. Results Seizures were triggered in 135 patients. Penfield method of stimulation independently increased the odds of triggering seizures 5.5 times, when compared to high frequency anodal stimulation (OR = 5.6, p = 0.03) while diffuse pathology increased this risk 2.7 times (OR = 2.7. p Conclusion Intravenous administration of a loading dose of AED at the beginning of the surgery does reduce the risk of stimulation triggering intraoperative seizures, regardless of whether patient has had preoperative seizures or not. Penfield method is more epileptogenic than multipulse train technique and thus the latter should be used preferentially. Prior history of epilepsy does not increase the risk of triggering seizures, while preoperative administration of maintenance AEDs does not decrease it. Mapping in proximity to poorly defined lesions carries a significantly higher risk for triggering seizures.

F80. Seizures and hyperexcitable EEG patterns in spontaneous deep intraparenchymal hemorrhage

Introduction The incidence of electrographic seizures after non-traumatic intraparenchymal hemorrhage (IPH) ranges from 1.7% to 31%. It is unclear if the risk of seizures or hyperexcitable patterns (HEPs: any rhythmic delta activity except generalized, any periodic discharges, or any spike-wave pattern, using ACNS criteria) for deep IPH is similar to lobar, subarachnoid and subdural hemorrhages. We hypothesized that the incidence of seizures or hyperexcitable patterns (SZ or HEPs) in deep IPH is lower than reported, but thalamic involvement may confer higher risk due to its role in physiologic and pathologic rhythmic activity, such as sleep spindles and generalized spike wave discharges. Methods On retrospective review, 45 patients had deep IPH (defined as IPH not involving cortex/juxtacortical regions other than the insula (analyzed separately), with or without intraventricular hemorrhage IVH) and underwent continuous EEG (cEEG) between 1/2013 and 12/2016. Patients with involvement of cortex, subarachnoid or subdural areas were excluded. Age, sex, prior history of epilepsy, clinical seizure at ictus, anti-seizure drugs (ASDs), sedative infusions during EEG and surgical interventions such as ventriculostomy (EVD) or decompressive hemicraniectomy (DHC) were reviewed. The cEEG closest to admission was reviewed for seizures, HEPs, and generalized rhythmic delta activity (GRDA). The head CT in closest proximity to the index cEEG was reviewed for hematoma volume, thalamic involvement and insular involvement. Results Two of 45 patients had SZ, 7/45 had HEPs, 1/45 had both and a total of 8/45 had SZ or HEPs. Of the HEPs , LRDA was seen in 4/8, LPDs in 2/8, both LPDs and LRDA in 1/8. Of those with the lateralized HEPs, 4/7 were contralateral to IPH, 1/7 (14.2%) were bilateral and 2/7 were ipsilateral. Of the 5/7 with HEPs contralateral to the IPH, 2 had an EVD ipsilateral to the HEPs. Patients with SZ or HEPs had significantly higher hematoma volume compared to patients who did not have SZ or HEPs (32.7 ± 19.4 vs 15.4 ± 17.7, p = 0.02). Patients who underwent surgery (DHC/EVD or both) had higher incidence of HEPs or SZ compared to those who did not (7/23, 30.4% vs 1/22, 4.5%, p = 0.047). DHC was associated with significantly higher risk of SZ or HEPs (4/4, 100% vs 4/41, 9.8%, p Conclusion Risk of SZ or HEPs with deep IPH ± IVH was 17.7% and correlated with mean hematoma volume and DHC. The, risk in the absence of a surgical intervention was low (1/22, 4.5%, vs 7/23, 30.4% p = 0.047). Thalamic involvement did not correlate with SZ or HEPs in this small cohort of patients with deep IPH.