Cases Of Seizures Research Articles

A New Epileptic Seizure Prediction Framework Based on Electroencephalography Signals

This research seeks to evaluate how effectively seizures can be predicted and managed in epilepsy using a specialized deep learning model based on Long Short-Term Memory (LSTM) neural networks. The model leverages non-invasive scalp electroencephalography (EEG) recordings for predicting seizures. To develop and assess the proposed LSTM neural network model, a comprehensive dataset was gathered. The model emphasizes achieving high sensitivity and reducing false alarms to improve its real-time applicability. The evaluation involved various metrics to measure accuracy, sensitivity, and rates of false positives and false negatives. The effectiveness of the proposed LSTM neural network model was outstanding, with accuracy rates ranging from 99.07% to 99.95%. Notably, the sensitivity score of 1 confirmed precise prediction for all seizure cases. The model demonstrated minimal false positive and false negative rates, highlighting its reliability in predicting seizures. This study emphasizes the promising potential of the proposed LSTM neural network model in providing advanced warning for seizures. The high accuracy and sensitivity rates suggest its usefulness in enabling timely preventive measures for patients, ultimately reducing the occurrence of seizures. This innovative approach holds significance in enhancing the overall management and quality of life for individuals dealing with epilepsy.

Rapid Electroencephalography and Artificial Intelligence in the Detection and Management of Nonconvulsive Seizures

Nonconvulsive status epilepticus is a commonly overlooked cause of altered mental status. This study assessed nonconvulsive status epilepticus prevalence in emergency department (ED) patients with acute neurologic presentations using limited electroencephalogram (EEG) coupled with artificial intelligence (AI)-enhanced seizure detection technology. We then compared the accuracy of the AI EEG interpretations to those performed by an epileptologist. In a prospective observational cohort analysis, adult patients with unexplained mental status changes identified by emergency physicians received expedited placement of a limited EEG. Data collected encompassed patient demographics, clinical history, EEG interpretations by the AI algorithm and epileptologists, treatments, and disposition determinations. There were 134 device applications on 132 patients (2 received the device twice) enrolled in the study, but 16 were missing data critical for identification or analysis and 9 did not meet the selection criteria. Of the 108 limited EEGs interpreted by an epileptologist, 69 were abnormal (diffuse slowing, highly epileptiform patterns, or spikes and sharps), 41 were normal, 5 were uninterpretable, and 3 captured episodes of seizure or status epilepticus. Limited EEG AI interpretation detected >90% seizure burden in 2 of 3 cases of seizure or status epilepticus as well as in 2 abnormal EEGs and 1 normal EEG, providing a sensitivity of 66.7% (95% confidence interval 9.4 to 99.2), a specificity of 97.0% (95% confidence interval 91.5 to 99.4), and a disease prevalence of 2.9%. Limited AI-enhanced EEG can detect nonconvulsive status epilepticus in the ED; however, the technology tended to overestimate seizure burden in our cohort. This study found a lower nonconvulsive status epilepticus prevalence compared to prior literature reports.

Unexpected consequences: A case of ketamine-induced seizure in procedural sedation

Abstract This case report describes a 32-year-old male who underwent ketamine procedural sedation and experienced a generalized tonic–clonic seizure. Despite its rapid onset and favorable tolerance profile, this case emphasizes the potential convulsive side effects of ketamine, which is commonly used for procedural sedation. While ketamine has shown promise in treating acute pain, refractory status epilepticus, and treatment-resistant depression and schizophrenia, it is associated with side effects such as hallucinations, visual disturbances, dizziness, nausea, and vomiting. The patient in this case received a carefully titrated dose of 40 mg of ketamine intravenously and underwent successful shoulder reduction while under sedation. However, within 60 s of receiving the ketamine, the patient experienced a 60-s seizure that was stopped with the administration of 5 mg of diazepam intravenously. The patient was hospitalized for further evaluation, including an electroencephalography (EEG) that showed no abnormalities. This case highlights the need for health-care professionals to be aware of the potential convulsive side effects of ketamine and to carefully monitor patients who receive ketamine sedation.

Prevalence and Patterns of Seizure-related Injuries: A Study of People Living with Epilepsy Found in a Community-based Door-to-door Survey in Southeast Nigeria.

Epileptic seizures and the unpredictable falls resulting from epileptic seizures predispose the people living with epilepsy (PLWE) to various physical injuries as well as postictal cognitive and behavioral changes. The aim of the study was to determine the frequency and patterns of seizure-related physical injuries, postictal cognitive impairments, and behavioral changes. This was a cross-sectional descriptive study in a Southeast Nigeria local government area. PLWE identified during a two-phase door-to-door survey and their caregivers were interviewed using a semi-structured questionnaire. The Statistical Package for the Social Sciences version 22.0 was used. There were 56 cases of active convulsive seizures comprising 33 (58.9%) males and 23 (41.1%) females, with a mean age of 32.9 ± 14.2. The lifetime prevalence of seizure-related physical injuries, postictal behavioral changes, and postictal cognitive impairments was 9.8 per 1000 (95% confidence interval [CI]: 9.1-10.0), 8.4 per 1000 (95% CI: 7.2-9.2), and 6.3 per 1000 (95% CI: 4.9-7.5), respectively. Skin/soft-tissue injuries and tongue laceration were the most frequent physical injuries found in 66.1% ( n = 37/56) and 60.7% ( n = 34/56) of cases, respectively. The frequency of soft-tissue injuries was significantly higher (χ 2 = 5.038; P = 0.0248) in the females 78.3% ( n = 18/23) than the males 48.5% ( n = 16/33). About a third of the females 39.1% had burn injuries compared to 18.1% of the males. Seizure-related injuries are common and have the tendency to increase the burden of epilepsy and epilepsy-related stigma from deformities and the chronic disfiguring scars resulting from such injuries.

Neurocysticercosis- An overlooked tropical disease

Introduction. Background: Neurocysticercosis (NCC), a parasitic disease caused by the pork tapeworm Taenia solium (T. solium), is a significant public health concern in endemic countries. It is estimated to contribute to roughly 30% of all epilepsy cases and leads to chronic morbidity in nearly 70% of affected patients. This study aimed to determine the prevalence of anti-cysticercus antibodies to T. solium in individuals with recent-onset seizures. We employed two serological techniques: Enzyme-Linked Immuno Sorbent Assay (ELISA) and Enzyme-Linked Immuno Transfer Blot (EITB). Materials and Methods: A total of 100 serum samples were collected: 50 from patients experiencing recent-onset seizures (cases) and 50 from age-matched healthy controls. All samples were analyzed for the presence of anti-cysticercus antibodies to T. solium. Results: Among the 50 cases, EITB detected anti-cysticercus antibodies in six patients (12%), while ELISA identified antibodies in three patients (6%). Notably, only two cases tested positive using both EITB and ELISA. In the control group, one individual was seropositive by EITB, and none were positive by ELISA. Conclusion: This study underscores the critical role of implementing high-quality screening methods, employing a vigilant diagnostic approach, and taking prompt preventive measures to mitigate the burden of morbidity associated with NCC.

Frequency of Hypocalcemic Seizures in Children with Afebrile Seizure: From 2 months - 2 years in a Tertiary Care Hospital

Objective: To determine the frequency of hypocalcemic seizures in children with afebrile seizure from age 2 months - 2 years. Methodology: This Descriptive Cross-Sectional study was conducted in Pediatric Department of Ayub Teaching Hospital Abbottabad for a period of six months (15th April, 2017 to 15th October, 2017). Total 130 cases fulfilling the inclusion criteria were enrolled in the study after approval from ethical committee of hospital and informed consent from the parents of children. A detailed history and examination were done and blood samples for serum calcium level were sent to the hospital laboratory along with other routine investigation to rule out the cause. All data was analyzed using SPSS version 21. Results: Out of 130 cases 48(36.9%) children had hypocalcemia while 82(63.1%) were normocalcemic. 79 (60.8%) were males and 51 (39.2%) were females. The mean age of children was 13.03 ± 6.81 months. The average calcium level was 8.23±1.51mg/dl. Conclusion: It has been concluded that afebrile seizures occur frequently in children with hypocalcemia. Thus, we got the local evidence regarding this association and recommend to screen all new afebrile seizure cases for hypocalcemia. Key words: Hypocalcemic fits, children, afebrile seizures, hypocalcemia

Population-Based Analysis of 6534 Seizure Emergency Cases from Emergency Medical Services Data.

Seizures are common reasons to call an ambulance, and this study aims to analyze the burden of seizures in the prehospital setting based on incidence, hospital admission rate, and costs. This was a population-based, cross-sectional analysis of prehospital emergency medical services (EMS) data on suspected seizure cases from the federal state of Hesse, Germany, in 2019. A total of 6534 suspected seizure cases were identified, of which most were those with a known seizure disorder. Incidence rate for epilepsy-related seizures (ES; pediatric epilepsy, first seizure [1stS], seizure with known seizure disorder [SEPI]) was 205.7 per 100,000 inhabitants and incidence rate for pediatric febrile seizures (PFS) was 36.7 per 100,000 inhabitants, corresponding to 171,275 ES and 28,500 PFS (99.3% < 18years) cases in Germany. A prehospital EMS physician was involved in 40.0% (SEPI) to 54.4% (PFS) of suspected seizure cases. Depending on the type of seizure, 70.7% (SEPI) to 80.9% (1stS) were admitted to hospital for inpatient stay of ≥ 24h. An additional 4% (PFS) to 16% (1stS) of cases needed immediate intervention at hospital. Prehospital EMS staff needed 8:24min:s (SD 7:24; n = 5004) after the emergency call to arrive at the scene of the ES and 10:58min:s (SD 27:39; n = 321) for PFS. ES and PFS cases caused estimated costs of 48.5 and 8.1million euros for Germany in 2019, respectively, not including hospital treatment-related costs. This study identified a high number of suspected seizure-related emergency casesand proportion of patients admitted to hospitals, as well as high associated costs in Germany.

SMARTSeiz: Deep Learning With Attention Mechanism for Accurate Seizure Recognition in IoT Healthcare Devices.

The Internet of Things (IoT) is capable of controlling the healthcare monitoring system for remote-based patients. Epilepsy, a chronic brain syndrome characterized by recurrent, unpredictable attacks, affects individuals of all ages. IoT-based seizure monitoring can greatly enhance seizure patients' quality of life. IoT device acquires patient data and transmits it to a computer program so that doctors can examine it. Currently, doctors invest significant manual effort in inspecting Electroencephalograph (EEG) signals to identify seizure activity. However, EEG-based seizure detection algorithms face challenges in real-world scenarios due to non-stationary EEG data and variable seizure patterns among patients and recording sessions. Therefore, a sophisticated computer-based approach is necessary to analyze complex EEG records. In this work, the authors proposed a hybrid approach by combining traditional convolution neural (CN) and recurrent neural networks (RNN) along with an attention mechanism for the automatic recognition of epileptic seizures through EEG signal analysis. This attention mechanism focuses on significant subsets of EEG data for class recognition, resulting in improved model performance. The proposed methods are evaluated using a publicly available UCI epileptic seizure recognition dataset, which consists of five classes: four normal conditions and one abnormal seizure condition. Experimental results demonstrate that the suggested approach achieves an overall accuracy of 97.05% for the five-class EEG recognition data, with an accuracy of 99.52% for binary classification distinguishing seizure cases from normal instances. Furthermore, the proposed intelligent seizure recognition model is compatible with an IoMT (Internet of Medical Things) cloud-based smart healthcare framework.

Association of Simple Febrile Seizure with Iron Deficiency Anemia in Children: A Case Control Study

Abstract: Background: Febrile seizure is an established entity in Pediatrics which characterizes with absence of any intracranial infection or metabolic disorders. Simple febrile seizure carries a favorable prognosis without any sequelae. Still, it emerges as the most common etiology of seizure till the age of five years. Iron deficiency anemia is a commonly witnessed micro-nutrient deficiency with a worldwide distribution. Objective: To establish relation of simple febrile seizure with iron deficiency anemia in paediatric population. Materials and Methods: Case-control study, conducted in Pediatric Medicine Department, King Fahad Armed Forces Hospital Southern Region, Khamis Mushayat, Kingdom of Saudi Arabia, from1st January 2022 to 30th June 2023. The 102 children, having age six months to five years, with a diagnosis of first simple febrile seizure were assessed. Likewise, the control group included 102 febrile children without convulsion. The hematological parameters evaluated for diagnosis of iron deficiency anemia included hemoglobin, mean corpuscular volume, serum ferritin, serum iron, total iron binding capacity &amp; red cell distribution width. Result: The mean age for first simple febrile seizure was 23 months. Acute respiratory infection was the most common etiology (80%). Iron deficiency anemia was identified in 17% of cases of simple febrile seizure, in contrary to 6% of cases with febrile illness without seizure, with odds ratio of 3.2. Conclusion: This study demonstrated that the children with iron deficiency anemia are at significantly higher risk of having febrile convulsions compare to control group with fever but without anemia. Keywords: Fever, Febrile seizure, Iron Deficiency anemia, Serum ferritin, Hemoglobin, Convulsion, Mean corpuscular hemoglobin.

Evaluating the effectiveness of the maximum permitted dose of midazolam in seizure termination: Insights from New South Wales, Australia.

Out-of-hospital seizures demand rapid management. Midazolam plays a key role in stopping seizures. At times the first dose of midazolam proves insufficient, necessitating additional doses. Within the New South Wales Ambulance (NSWA) service, the upper limit for midazolam administration is set at 15 mg. However, the outcomes and safety of using midazolam at this maximum dosage have not been thoroughly investigated. A retrospective analysis of out of hospital electronic health records from New South Wales, Australia, over the year 2022, was conducted. The study manually reviewed cases where adult patients received the maximum dose of midazolam for seizure management by paramedics. It focused on seizure cessation success rates and the incidence of adverse effects to evaluate the clinical implications of high-dose midazolam administration. Of 818 790 individual attendances by NSWA clinicians, a total of 11 392 (1.4%) adults had seizures noted, of which midazolam was administered in 2565 (22.5%). An algorithm shows that in 2352 (91.7%) instances the midazolam was associated with the apparent termination of seizures. Analysis revealed that 176 (1.5%) proportion of all adult's seizure patients required the maximum dose of midazolam for seizure control. These higher doses successfully terminate seizures in about half of the instances. AEs following the maximum dose of midazolam included hypoxia in 26.7% of patients and respiratory depression in 9.7%, indicating significant side effects at higher dosages. In New South Wales, Australia, administering the maximum dose of midazolam to seizure patients is rare but proves effective in approximately half of the refractory seizure cases. Therefore, assessing the potential for additional doses of midazolam or the use of a second-line agent is advisable.

Comparison of the effect of isotonic and hypotonic saline solutions for children with mild dehydration at Lampang Hospital

Administering the appropriate type and rate of fluids is crucial for pediatric patients. Young patients should be given isotonic solutions, as they are safer than hypotonic solutions for fluid maintenance. However, limited studies exist on the efficacy and complications of isotonic solutions for treating acutely ill pediatric patients with mild dehydration. This study aimed to compare isotonic and hypotonic solutions in such cases. A stratified randomized controlled trial was conducted on patients aged 6 months to 15 years with acute illness and mild dehydration in two disease groups: acute gastroenteritis and other diseases. The trial involved administering intravenous fluids, either isotonic or hypotonic solution, for at least 24 hours. Pre and post-treatment serum sodium levels and treatment complications were assessed and compared between patients who received isotonic and hypotonic solutions. A total of 144 patients were randomly assigned to receive either isotonic solution or hypotonic solution. Of the 144 patients, 72 received isotonic and 72 received hypotonic solutions. The isotonic group comprised 51.4% males with a median age of 27.5 months. On the other hand, the hypotonic group comprised 56.9% males with a median age of 38 months. At baseline, both groups' sodium levels were similar at 136.2±2.5 and 136.8±2.5 mmol/L, respectively. After 24 hours, the isotonic group had a statistically significant increase in sodium levels (138.8±2.2 mmol/L; increased median 2.3) compared to the hypotonic group (138.1±2.0 mmol/L; increased median 1.5). In conclusion, no cases of hypernatremia, drowsiness, or seizures were observed, suggesting isotonic solutions can be safely used in these selected groups of acutely ill pediatric patients with mild dehydration.

Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation: A Pilot Study.

The majority of pediatric patients in the United States (US) are evaluated and treated at general emergency departments. It is possible that discrepancies in length of emergency medicine (EM) residency training may allow for variable exposure to pediatric patients, critical resuscitations, and didactic events. The goal of this pilot study was to compare leadership skills of graduating EM residents from 3- to 4-year programs during simulated pediatric resuscitations using a previously validated leadership assessment tool, the Concise Assessment of Leader Management (CALM). This was a prospective, multicenter, simulation-based cohort pilot study that included graduating 3 rd - and 4 th -year EM resident physicians from 6 EM residency programs. We measured leadership performance across 3 simulated pediatric resuscitations (sepsis, seizure, cardiac arrest) using the CALM tool and compared leadership scores between the 3 rd - and 4 th -year resident cohorts. We also correlated leadership to self-efficacy scores. Data was analyzed for 47 participating residents (24 3 rd -year residents and 23 4 th -year residents). Out of a total possible CALM score of 66, residents from 3-year programs scored 45.2 [SD ± 5.2], 46.8 [SD ± 5.0], and 46.6 [SD ± 4.7], whereas residents from 4-year programs scored 45.5 [SD ± 5.2], 46.4 [SD ± 5.0], and 48.2 [SD ± 4.3] during the sepsis, seizure, and cardiac arrest cases, respectively. The mean leadership score across all 3 cases for the 3-year cohort was 46.2 [SD ± 4.8] versus 46.7 [SD ± 4.5] ( P = 0.715) for the 4-year cohort. These data show feasibility for a larger cohort project and, while not statistically significant, suggest no difference in leadership skills between 3 rd - and 4 th -year EM residents in our study cohort. This pilot study provides the basis of future work that will assess a larger multicenter cohort with the hope to obtain a more generalizable dataset.

Fluorodeschloroketamine found as a street drug in drug seizures and drug driving cases in Hong Kong

BackgroundWith the decline of the use of ketamine, one of the common drugs of abuse in Hong Kong, detection of ketamine-related analogues in local laboratories has been encountered. Aim: A brief account of the occurrence of fluorodeschloroketamine (FDCK) in forensic cases is reported through a retrospective study of all drug seizures and driving under the influence of drugs (DUID) cases since its first appearance. Methods: Identification of FDCK in drug seizures was achieved through gas chromatography – mass spectrometry (GC-MS) and/or liquid chromatography – diode array detection (LC-DAD) methods while its quantification was performed using gas chromatography – flame ionization detection (GC-FID). For the analysis of blood samples in DUID cases, identification and quantification were performed using LC-MS/MS by monitoring the respective transitions of FDCK and fluorodeschloronorketamine (FDCNK) using ketamine-d4 and norketamine-d4 respectively as internal standards. Results: Since its first submission in November 2018, a total of 74 drug seizure cases (151 items) and 6 drug driving cases were encountered till December 2019. Drug seizures found with FDCK were physically similar to those of ketamine seizures. The majority of items were detected with FDCK only (103 items, ∼67%) or as a mixture of FDCK with ketamine (42 items, ∼28%). The drug purity detected with either FDCK only or FDCK mixed with ketamine was high which was similar to those purity found in ketamine seizures. The blood drug concentrations of FDCK of the 6 drug driving cases were in the range of <0.002–1.1 μg/mL and other psychoactive drug(s)/metabolite(s) were also identified. Except for one case where the analysis of the metabolite, fluorodeschloronorketamine (FDCNK), was not conducted due to insufficient sample, the FDCK (FDCNK) concentrations in blood found in the 6 cases were <0.002 (0.005), 0.002 (0.002), 0.002 (0.003), 0.02 (0.035), 0.87 (0.44) and 1.1 (not determined) μg/mL. Conclusions: With the drug seizures found with FDCK resembled in physical appearance with ketamine seizures, users might likely misuse it as ketamine. Though complicated by other drugs found, it is speculated that the two cases with higher concentration of FDCK found in blood (1.1 and 0.87 μg/mL) might have contributed to the impairment observed.

Robot-assisted treatment of secondary epilepsy caused by parasitic infection: a case report

BackgroundCerebral sparganosis represents the most severe manifestation of sparganosis, with a relatively low global incidence. For cases of secondary epileptic seizures caused by sparganosis infection in the functional areas of the brain, what advanced neurosurgical techniques should be employed to precisely identify and excise the epileptic lesions in the deep functional areas of the brain, aiming to achieve maximal removal while minimising the risk of neurological deficits? This remains a current challenge for epilepsy surgeons.Case presentationA 24-year-old Chinese male was admitted to our hospital, presenting with a history of left limb twitching persisting for over a year. His main clinical symptoms presented twitching and numbness of his left limb without loss of consciousness. Under the premise of inappropriate anti-seizure treatment, recurrent epilepsy attacked persist. The patient's diagnosis was considered as “space-occupying lesions in the several lobes of brain, secondary epilepsy” after comprehensive assessment and discussion. And experts considered that the patient's space-occupying lesions in the right frontal and parietal lobes were highly suspected to be infected by parasites. This report delved into the application of neurosurgery robot-assisted frameless stereotaxic technology and intraoperative stereotactic electroencephalography (SEEG) monitoring technology to accurately locate and optimize removal of parasite-related epileptic lesions situated in functional areas of the brain. As a result, the patient had achieved seizure freedom, leaving no symptoms of neurological deficit.ConclusionsWith the highly integrated development of imaging technology, mechanical technology, computer control technology, and artificial intelligence, surgical robots are poised to play a larger role across various neurosurgical specialties in the future. Considering benefits for patients and the promising application of this technology, its utilization holds significant value.

Posterior cingulate epilepsy: Seizure semiology and intracranial electrical stimulation using SEEG

PurposeThis study aimed to explore seizure semiology and the effects of intracerebral electrical stimulation on the human posterior cingulate cortex (PCC) using Stereoelectroencephalography (SEEG) to deepen our comprehension of posterior cingulate epilepsy (PCE). MethodsThis study examined the characteristics of seizures through video documentation, by assessing the outcomes of intracranial electrical stimulation (iES) during SEEG. We further identified the connection between the observed semiology and precise anatomical locations within the PCC subregions where seizure onset zones (SOZ) were identified. ResultsAnalysis was conducted on 59 seizures from 15 patients recorded via SEEG. Behavioural arrest emerged as the predominant manifestation across the PCC subregions. Where ictal activity extended to both the mesial and lateral temporal cortex, automatism was predominantly observed in seizures originating from the ventral PCC (vPCC). The retrosplenial cortex (RSC) is associated with complex motor behaviour, with seizure discharges spreading to the temporal lobe. Seizures originating from the PCC include axial tonic and autonomic seizures. Only one case of positive clinical seizures was documented. High frequencies of iES within the PCC induced various clinical responses, categorised as vestibular, visual, psychological, and autonomic, with vestibular reactions primarily occurring in the dorsal PCC (dPCC) and RSC, visual responses in the left RSC, and autonomic reactions in the vPCC and RSC. ConclusionThe manifestations of seizures in PCE vary according to the SOZ and the patterns of seizure propagation. The occurrence of seizures induced by iES is exceedingly rare, indicating that mapping of the PCC could pinpoint the primary sector of PCC.

Delayed-onset seizures after subthalamic nucleus deep brain stimulation surgery for Parkinson’s disease

BackgroundDelayed-onset seizures after deep brain stimulation (DBS) surgery were seldom reported. This study summarized the clinical characteristics of delayed-onset seizures after subthalamic nucleus (STN) DBS surgery for Parkinson’s disease (PD) and analyzed risk factors. MethodsA single-center retrospective study containing consecutive STN-DBS PD patients from 2006 to 2021 was performed. Seizures occurred during the DBS surgery or within one month after DBS surgery were identified based on routine clinical records. Patients with postoperative magnetic resonance imaging (MRI) were included to further analyze the risk factors for postoperative seizures with univariate and multivariate statistical methods. Results341 consecutive PD patients treated with bilateral STN-DBS surgery wereidentified, and five patients experienced seizures after DBS surgery with an incidence of 1.47 %. All seizures of the five cases were characterized as delayed onset with average 12 days post-operatively. All seizures presented as generalized tonic-clonic seizures and didn’t recur after the first onset. In those seizures cases, peri-electrode edema was found in both hemispheres without hemorrhage and infarction. The average diameter of peri-electrode edema of patients with seizures was larger than those without seizures (3.15 ± 1.00 cm vs 1.57 ± 1.02 cm, p = 0.005). Multivariate risk factor analysis indicated that seizures were only associated with the diameter of peri-electrode edema (OR 4.144, 95 % CI 1.269–13.530, p = 0.019). ConclusionsDelayed-onset seizures after STN-DBS surgery in PD patients were uncommon with an incidence of 1.47 % in this study. The seizures were transient and self-limiting, with no developing into chronic epilepsy. Peri-electrode edema was a risk factor for delayed-onset seizures after DBS surgery. Patients with an average peri-electrode edema diameter > 2.70 cm had a higher risk to develop seizures.

Transient hypoxia causing midline seizures in an adult- Case report

Midline epileptiform discharges are reported very rarely in adult population. Most cases of midline seizures are reported in children. The significance of midline spikes in adults is poorly understood. This is an interesting case report of an adult patient, who had midline epileptiform discharges following transient hypoxia, which subsided with anti seizure medications and correction of hypoxia. There has not been a definite study on the importance of independent midline epileptiform discharges in adults so far.

Comparative analysis of software used in anonymised search and seizure cases: acquisition, examination and analysis

It is discussed that within the production of digital evidence, the use of forensic software to support the acquisition, examination and analysis of evidence in a correct manner plays a role of great importance, mainly to maintain the credibility of evidence and its acceptance in the judiciary. The objective is to evaluate a sample of real judicial search and seizure cases that occurred between 2014 and 2023, presenting the forensic software used in each stage of each evaluated case. A random selection of one case will be made for each year, with anonymised data, to carry out a continuity analysis of the software used. The article seeks to identify whether these software remain in force or whether it has been discontinued, rendered obsolete or replaced over the selected sampling period, The research is structured in operational stages, starting with the selection of cases until the analysis of software continuity, revealing a predominance of software with valid status and indicating a tendency to update technological solutions in the field of digital forensics. The results also highlight the need for periodic reviews of the solutions that exist in the market. Based on the sample analyzed, the software evaluated shows, in their majority, continuity, with 87.5% of the solutions considered current when adding the software in force and replaced. This study contributes to the understanding of the evolution of forensic software by offering details on the status of continuity of such software for the digital evidence production process and the respective credibility of the acceptance of evidence in the judicial environment.

Location and size of the reverse Hill-Sachs lesion in patients with traumatic posterior shoulder instability

BackgroundIn patients with traumatic posterior shoulder instability, little is known about the precise location and size of the reverse Hill-Sachs lesion. MethodsForty-nine shoulders of 47 patients with traumatic posterior instability were included in this study based on the following inclusion criteria: 1) a primary or recurrent traumatic posterior shoulder dislocation, and 2) the initial event was caused by trauma. Patients were excluded if they had: 1) no history of trauma, 2) prior shoulder surgery, 3) no CT examination, or 4) seizure cases. Three-dimensional images of the humerus reconstructed from CT images were reviewed using an image analysis software. The location and size of the reverse Hill-Sachs lesion were measured and described on a clock face on the humeral head. ResultsThe reverse Hill-Sachs lesion was observed in 25 of 49 shoulders (51%). The reverse Hill-Sachs lesions were located between 1:37 and 2:48. The depth of the reverse Hill-Sachs lesion (mean ± SD) was 5.8 ± 2.2 mm. The extent of the reverse Hill-Sachs lesion was 35° ± 12°. The average orientation of the reverse Hill-Sachs lesion, represented by an angle measured from the 12 o'clock position, was 64° ± 12° and pointing towards 2:09 on a clock face. Length and width of reverse Hill-Sachs lesions were 9.7 ± 4.7 mm, 11.1 ± 3.6 mm, respectively. ConclusionThe reverse Hill-Sachs lesion was a semicircular compression fracture located on the anteromedial aspect of the humeral head. Compared with shoulders with anterior shoulder instability, the humeral defect was smaller and located more inferiorly in shoulders with posterior instability.

Etiologies and Seizure Outcome of Neonatal Seizures: A Tertiary University Hospital Experience

Context: Despite the vast developments in medical sciences in recent decades, seizures remain a common occurrence among neonates, associated with high rates of morbidity and mortality. Aims: The aim of this study was to assess and analyze the presentation and outcome of neonates who were previously exposed to seizures. Subjects and Methods: Following a retrospective research design, this study included 50 cases of neonatal seizures (29 males and 21 females), who were admitted to the neonatal intensive care unit at King Abdulaziz University Hospital, Jeddah City, Saudi Arabia. Data were collected from the hospital records and included all visits between January 2022 and December 2022. Results: The most common types of neonatal seizures were clonic and myoclonic seizures (44% and 28%, respectively). Apgar score at 5 min was &lt;7 in 30% of cases. The main diagnosis was hypoxic-ischemic encephalopathy (HIE) in 28 children (56%), and central nervous system (CNS) infection in 18 children (36%). Children with neonatal seizures mainly received phenobarbital, benzodiazepines, or levetiracetam (48%, 46%, and 36%, respectively). Mechanical ventilation was applied to 20 children (40%). A total of 15 children (30%) had developmental delays, being global delay in 7 children (14%), or motor in 8 children (16%), while 6 children died (12%). Seizures could be controlled in 37 children (74%). Children who presented early (during the 1st week of life) and those who had Apgar scores &lt;7 at 5 min had significantly worse outcomes, with higher case fatality and less seizure control than those who had Apgar scores of 7–10 (P &lt; 0.001). Conclusions: Seizures are a common occurrence among neonates, especially males during the 1st week of their lives. HIE and CNS infections are the main diagnoses. The most administered medications are phenobarbital, benzodiazepines, and levetiracetam. Children who present during their 1st week of life and those who have 5-min Apgar scores &lt;7 have significantly higher case fatality and less seizure control.