Seizure-like Symptoms Research Articles

Granulomatous amebic encephalitis in a patient treated with chemotherapy: a case report and literature review

Background: Granulomatous amebic encephalitis (GAE) is caused by Acanthamoeba species or Balamuthia mandrillaris, which are microscopic, free-living amoebas found worldwide. People with compromised immune systems are at an increased risk of fatal cerebral infection caused by Acanthamoeba species, whereas B. mandrillaris can affect both immunocompromised and immunocompetent patients. Infections can involve the central nervous system causing GAE.Case Report: A 71-year-old Caucasian woman, previously diagnosed with chronic lymphocytic leukemia and undergoing chemotherapy, arrived at the emergency department exhibiting seizure-like symptoms. Brain imaging revealed bilateral cerebral masses with central necrosis and hemorrhage, among other findings. The patient underwent a biopsy and was diagnosed with GAE. Conclusion: Unfortunately, even with the correct diagnosis, GAE leads to rapid deterioration and a higher risk of mortality. This case demonstrates the rapid and severe nature of GAE and emphasizes the need for ongoing studies and better treatment options to improve GAE outcomes.

Seizure-like Symptoms Induced by Hypomagnesemia in a Patient with Incomplete Small Bowel Obstruction; A Case Report.

Seizure-like symptoms are rare in older patients without brain damage. Small bowel obstruction is a common clinical disorder for older patients that can cause electrolyte disturbances and nutritional disorders. Hypomagnesemia is a frequently overlooked electrolyte disorder. Moreover, magnesium deficiency can lead to severe seizure-like symptoms. An 85-year-old man was admitted to the hospital with weakness and slow movement. Shortly after hospitalization, he experienced incomplete small bowel obstruction; thus, parenteral nutrition and intravenous esomeprazole were administered. When intestinal obstruction was relieved, the patient suddenly experienced seizure-like symptoms three times, and 24-h electroencephalogram did not capture any epileptiform pattern. After excluding other causes, we considered serum magnesium deficiency as a diagnosis. Low serum magnesium levels were related to a shortage of absorption due to small bowel obstruction, excess excretion of renal dysfunction, and the use of proton pump inhibitor. However, the exact mechanism underlying the hypomagnesemia-induced seizure-like activity remained unclear. After adjusting the nutritional support and magnesium supplementation, the patient's serum magnesium level returned to normal, and he was free of seizure-like activity. Hypomagnesemia is often asymptomatic, but it can lead to severe seizure-like symptoms. It is important to pay attention to the serum magnesium level and nutritional intake in patients with an incomplete small bowel obstruction.

White Matter Structural Connectivity and Its Impact on Psychogenic Non-Epileptic Seizures: An Evidence-Based Review.

Psychiatric non-epileptic seizure (PNES), also known as a form of functional neurological disorders (FND), is a common but still underrecognized disorder presenting seizure-like symptoms and no electrophysiological abnormality. Despite the significant burden of this disorder, the neurobiological mechanisms are not clearly understood, which hinders the development of better diagnosis and treatment. In the recent neuroimaging research on PNES, brain network analysis has become a relevant topic beyond conventional methodologies. The human brain is a highly intricate system of interconnected regions that collaborate to facilitate a wide range of cognitive and behavioral functions. White matter tracts, which are comprised of bundles of axonal fibers, are the primary means by which information is transmitted between different brain regions. As such, comprehending the organization and structure of the brain's white matter network is critical for gaining insight into its functional architecture. This review article aims to provide an overview of the brain mechanisms underlying PNES, with a special focus on analyzing brain networks.

Socioemotional self- and co-regulation in functional seizures: comparing high and low posttraumatic stress.

Functional seizures (FS) are seizure-like symptoms without electroencephalogram (EEG)-based epileptic activity. Those with FS often show emotion-related dysfunction and disrupted interpersonal relationships, in which posttraumatic stress disorder symptoms (PTS) may play a role. We sought to better understand trauma comorbidities and socioemotional processes in FS, including affectionate touch, a form of social connection linked to emotion regulation and awareness. We administered questionnaires online to a community sample of 89 trauma-exposed FS participants (FS diagnoses were self-reported), 51 with and 38 without clinical-level PTS (FS-PTShi, FS-PTSlo) and 216 seizure-free matched trauma-exposed controls (TCs), 91 with and 125 without clinical-level PTS (TC-PTShi, TC-PTSlo) per the Posttraumatic Stress Disorder Symptom Checklist (PCL). As hypothesized, both FS-PTShi and FS-PTSlo reported more emotional avoidance (Brief Experiential Avoidance Questionnaire), more emotion regulation difficulties (Difficulties in Emotion Regulation Scale), and more perceived stress (Perceived Stress Scale) than PTS-matched counterparts. FS-PTShi also reported less reappraisal (Emotion Regulation Questionnaire), more loneliness (UCLA Loneliness Scale), and less frequent affectionate touch (Physical Affection Scale) during waking and surrounding sleep than TC-PTShi, whereas FS-PTSlo and TC-PTSlo did not differ. Neither FS group differed from PTS-matched controls in emotion suppression (Emotion Regulation Questionnaire) or comfort with social touch (Social Touch Questionnaire). Among FS, FS-PTShi reported more difficulties than FS-PTSlo on nearly all measures (non-significant trend for social support). Findings underscore potential synergistic effects of FS and PTS clinical symptoms in shaping experiences of one's emotions and social world, suggesting fostering meaningful connections with others, including via affectionate touch, is an important treatment target.

Clinical side-effects based drug repositioning for anti-epileptic activity

Several generations of anti-epileptic drugs (AEDs) are available but have several associated side effects apart from a limited success rate. Drug repositioning strategies have gained importance in the last two decades owing to lower failure rates and economic burden. Drugs with similar side effect profiles may share a common mechanism of action and thus can be linked to other disease treatments. The present study was carried out to identify the newly approved drug candidate(s) as AEDs using clinical side-effects drug repositioning strategy. The clinical side effect similarity of drugs available in the SIDER v4.1 database was estimated against common side effects of 5 major marketed AEDs, using the ‘dplyr’ package library in the R. Further drugs were filtered based on Blood Brain Barrier permeability prediction and FDA-approval status. Molecular docking studies were performed for selected 26 hits (drugs) against previously identified epilepsy target receptors: Voltage-gated sodium channel α2 (Nav1.2), GABA receptor α1-β1 (GABAr α1-β1), and Voltage-gated calcium channel α-1 G (Cav3.1). Only 2 drugs (Ziprasidone and Paroxetine) showed better binding affinities against studied epilepsy receptors Nav1.2, GABAr α1-β1, and Cav3.1, than their corresponding standard AEDs, i.e. Carbamazepine, Clonazepam, and Pregabalin, respectively. Ziprasidone reportedly showed seizure-like symptoms in ∼3% of patients and was hence omitted from further study. The MDS study of docked complexes of Paroxetine with selected epilepsy target receptors showed stable RMSD values and better interaction energies. The study reveals Paroxetine as a potential candidate to be repurposed for 1st line epileptic seizure medication. Communicated by Ramaswamy H. Sarma

Uncommon Presentation of Second Branchial Cyst Compression on the Carotid Bifurcation: A Case Report

The aim of this case report is to disclose atypical manifestations of non-epileptic seizures caused by cerebral ischemia as a result of a progressively large infected second branchial cyst compressing over the carotid bifurcation for the past three years. A female patient who presented to our clinic with symptoms of a constantly growing neck mass, pain, headache, difficulty turning the head, convulsions, teeth clenching, and syncope as a result of delayed appropriate treatment. After taking a thorough history of her signs and symptoms, along with laboratory tests and an electroencephalogram (EEG), we come to the definite diagnosis of the reason for her seizure-like symptoms, which were caused by the pressure exerted by the enlarged, infected second branchial cyst.

Basic symptoms of schizophrenia are related to symptoms of traumatic stress: A pivotal role of sensitization. An observational study.

Subjective cognitive deficits have been broadly reported in schizophrenia and described by Huber as basic symptoms. It remains unclear however to what extent they may be related to psychosocial stressors including trauma. We assessed basic symptoms using the Frankfurt Complaint Questionnaire (FCQ) in a sample of 40 patients with schizophrenia. Trauma-related symptoms were assessed concurrently using the Trauma Symptom Checklist-40, symptoms of dissociation using the Dissociative Experiences Scale, and sensitization phenomena using the Complex Partial Seizure-like Symptoms Inventory and Limbic System Checklist-33. Psychotic symptoms were measured by Health of the Nation Outcome Scales. The dosage of antipsychotic medication was assessed in terms of equivalents of chlorpromazine, and antidepressant medication in terms of equivalents of fluoxetine. Spearman correlations were performed to explore the relationship between FCQ and other trauma-related measures. To determine the relative contributions of trauma-related symptoms to basic symptoms a linear regression analysis was performed. The results showed that higher levels of basic symptoms of schizophrenia were associated with greater levels of symptoms of dissociation, traumatic stress, and sensitization or kindling-like processes in schizophrenia. Among the trauma-related variables, sensitization phenomena assessed with Complex Partial Seizure-like Symptoms Inventory were closely associated with basic symptoms. These results indicate that basic symptoms measured by FCQ might be related to trauma. The potential of trauma to influence neurodevelopmental hypotheses of schizophrenia is discussed.

Quantitative Electroencephalography in Patients With Depression and Epilepsy Spectrum Disorder and Its Correlation With Clinical Features of Depression.

To determine the associations of epilepsy spectrum disorder (ESD) with brain insult and certain quantitative electroencephalographic (QEEG) and clinico-demographic parameters in patients with depression. 21 right-handed patients aged 18 to 50 years with the diagnosis of depression and ESD (scored ≥70 in Iowa Interview for Partial seizure-like symptoms) were compared with 21 patients with depression but without ESD (scored <70) and 21 normal subjects with <3 positive scores on the 12-Item General Health Questionnaire. Their QEEG parameters such as power spectrum and coherence of five frequency bands in 11 regions were compared. Patients with ESD had more minor traumatic brain injury along with more severe and multiple depressive episodes. Patients with ESD had significantly higher beta1 power over all regions on the left scalp than did normal subjects. Patients with ESD had significantly higher beta2 power over the left central region than did patients with no ESD and normal subjects. For patients with severe recurrent depression, clinicians should systematically check for episodic partial seizure-like phenomena, especially when QEEG shows electrical disorganisation in the left side in those with mild traumatic brain injury.

Art and psychogenic nonepileptic seizures

Psychogenic nonepileptic seizures (PNES) are episodes of seizure-like symptoms that are not associated with epileptiform discharges on electroencephalogram (EEG). They can be remarkably difficult to distinguish from epileptic seizures: both may involve alterations in mental status and behavior, sensory or perceptual disturbances, as well as simple or complex motor patterns. Pictorial expressions of PNES have always attracted attention from the lay public and medical practitioners alike, by showing the rich variety of semiologies seen in the condition and its differences with epileptic seizures. In this article, we present two new contemporary artistic descriptions by the Canadian artist Iris Hauser about PNES. The depictions highlight key signs seen in PNES such as “eyes closed during events”, “the hyperextension of the back and limbs”, and the “claw-like finger posturing”. We believe that the drawings can provide a valuable educational component in the initial assessment of patients suspected of having PNES as a training tool to identify and refer patients for more advanced testing.

New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: A retrospective multicenter study.

Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 (COVID‐19). This multicenter retrospective study enrolled people with COVID‐19 from January 18 to February 18, 2020 at 42 government‐designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and Chongqing municipality. Data were collected from medical records by 11 neurologists using a standard case report form. A total of 304 people were enrolled, of whom 108 had a severe condition. None in this cohort had a known history of epilepsy. Neither acute symptomatic seizures nor status epilepticus was observed. Two people had seizurelike symptoms during hospitalization due to acute stress reaction and hypocalcemia, and 84 (27%) had brain insults or metabolic imbalances during the disease course known to increase the risk of seizures. There was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID‐19. Neither the virus nor potential risk factors for seizures seem to be significant risks for the occurrence of acute symptomatic seizures in COVID‐19.

Abstract 239: 911 Caller Description of Seizure-Like Symptoms and Delays to Starting Telecommunicator CPR

Background: Bystander cardiopulmonary resuscitation (BCPR) improves survival after out-of-hospital cardiac arrest (OHCA). Identifying delays to starting Telecommunicator CPR (TCPR) may improve outcomes. Identifying terms callers use to describe seizure-like symptoms may improve accuracy and expedite TCPR. Methods: A total of 586 confirmed OHCA calls from 3 regional 911 centers in Arizona were reviewed between 2013 to 2016. Frequency of terms callers use to describe seizure-like symptoms were assessed. Demographics and TCPR process measures were compared between the seizure and non-seizure cohorts using Chi-square analysis for categorical variables and Kruskal-Wallis test for continuous variables. Other data points were time to start of seizure description, time to end of description, and time to start of seizure intervention. Results: There were 545 calls after exclusions. Twenty-six (.05%) had seizure-like symptoms described. Of these, “seizure” or “seizing” were used in 22 (84.6%) calls, “shaking” in 6 (23.1%), “cramping up” in 2 (7.7%) and convulsing in 2 (7.7%). Descriptions were more common in witnessed arrests [65.4% (17/26) vs. 34.6% (9/26); p=0.045] and in younger patients [median age=57 (QI=45, Q3=68) vs. 66 (Q1=51, Q3=77); p=0.036.] In calls with descriptions, telecommunicators were less likely to recognize OHCA [56.0% (14/25) vs. 74.5% (382/513), .031% (17/545) missing; (p=0.041] but bystanders were not less likely to start compressions [42.3% (11/26) vs. 57.6% (289/501), .033% (18/545) missing; p=0.122]. Median time to recognition in calls with descriptions was delayed vs. calls without descriptions [142 s (Q1=74 s, Q3=194 s), n=13, vs. 63 s (Q1=40 s, Q3=112 s), n=336; p=0.005], as was time to first chest compression [262 s (Q1=182 s, Q3=291 s), n=6 vs. 154 s (Q1=110 s, Q3=206 s), n=155; p=0.011]. Median times to start of description, end of description, and start of intervention were respectively: 33 s (Q1=20 s, Q3=40 s; 54 s (Q1=37 s, Q3=138 s; and 50 s (Q1=38 s, Q3=162 s). Conclusion: Description of seizure-like symptoms were uncommon and were associated with reduced and delayed OHCA recognition and delayed start of compressions.

Epilepsy and seizures in young people with 22q11.2 deletion syndrome: Prevalence and links with other neurodevelopmental disorders.

SummaryObjectiveThe true prevalence of epileptic seizures and epilepsy in 22q11.2 deletion syndrome (22q11.2DS) is unknown, because previous studies have relied on historical medical record review. Associations of epilepsy with other neurodevelopmental manifestations (eg, specific psychiatric diagnoses) remain unexplored.MethodsThe primary caregivers of 108 deletion carriers (mean age 13.6 years) and 60 control siblings (mean age 13.1 years) completed a validated epilepsy screening questionnaire. A subsample (n = 44) underwent a second assessment with interview, prolonged electroencephalography (EEG), and medical record and epileptologist review. Intelligence quotient (IQ), psychopathology, and other neurodevelopmental problems were examined using neurocognitive assessment and questionnaire/interview.ResultsEleven percent (12/108) of deletion carriers had an epilepsy diagnosis (controls 0%, P = 0.004). Fifty‐seven of the remaining 96 deletion carriers (59.4%) had seizures or seizurelike symptoms (controls 13.3%, 8/60, P < 0.001). A febrile seizure was reported for 24.1% (26/107) of cases (controls 0%, P < 0.001). One deletion carrier with a clinical history of epilepsy was diagnosed with an additional type of unprovoked seizure during the second assessment. One deletion carrier was newly diagnosed with epilepsy, and two more with possible nonmotor absence seizures. A positive screen on the epilepsy questionnaire was more likely in deletion carriers with lower performance IQ (odds ratio [OR] 0.96, P = 0.018), attention‐deficit/hyperactivity disorder (ADHD) (OR 3.28, P = 0.021), autism symptoms (OR 3.86, P = 0.004), and indicative motor coordination disorder (OR 4.56, P = 0.021).SignificanceEven when accounting for deletion carriers diagnosed with epilepsy, reports of seizures and seizurelike symptoms are common. These may be “true” epileptic seizures in some cases, which are not recognized during routine clinical care. Febrile seizures were far more common in deletion carriers compared to known population risk. A propensity for seizures in 22q11.2DS was associated with cognitive impairment, psychopathology, and motor coordination problems. Future research is required to determine whether this reflects common neurobiologic risk pathways or is a consequence of recurrent seizures.

Behavioral and electrophysiological changes in female mice overexpressing ORAI1 in neurons

Orai proteins form highly selective Ca2+ release-activated channels (CRACs). They play a critical role in store-operated Ca2+ entry (SOCE; i.e., the influx of external Ca2+ that is induced by the depletion of endoplasmic reticulum Ca2+ stores). Of the three Orai homologs that are present in mammals (Orai1–3), the physiological function of Orai1 is the best described. CRACs are formed by both homomeric assemblies and heteromultimers of Orais. Orai1 and Orai2 can form heteromeric channels that differ in conductivity during SOCE, depending on their Orai1-to-Orai2 ratio. The present study explored the potential consequences of ORAI1 overexpression in neurons where the dominant isoform is Orai2. We established the Tg(ORAI1)Ibd transgenic mouse line that overexpresses ORAI1 in brain neurons. We observed seizure-like symptoms in aged (≥15-month-old) female mice but not in males of the same age. The application of kainic acid and bicuculline to slices that were isolated from 8-month-old (±1 month) female Tg(ORAI1)Ibd mice revealed a significantly lower frequency of interictal bursts compared with samples that were isolated from wildtype mice. No differences were observed in male mice of a similar age. A battery of behavioral tests showed that context recognition decreased only in female transgenic mice. The phenotype that was observed in female mice suggests that ORAI1 overexpression may affect neuronal activity in a sex-dependent manner.This article is part of a Special Issue entitled: ECS Meeting edited by Claus Heizmann, Joachim Krebs and Jacques Haiech.

Tonic Upward Eyeball Deviation Mimicking Non-Convulsive Occipital Lobe Status Epilepticus That Was Induced by Hydrocephalus

Several seizure-like symptoms are difficult to differentiate from epileptic convulsion, and then if they were misdiagnosed, they could be led to grave prognosis. A 41-year-old man was referred to the emergency room due to unconsciousness. Brain computed tomography (CT) revealed acute subdural hemorrhage along the left frontal lobe, and intraparenchymal hemorrhage in the left temporo-occipital lobe. After emergent decompressive craniectomy, he recovered an alert mental state but became progressively drowsy. Four days later, virtually continuous tonic upward eyeball deviation was observed. He had been taking antiepileptic drugs following an occipital lobectomy 20 years prior due to intractable epilepsy, and we assumed these upward eyeball deviations were symptoms of non-convulsive occipital lobe status epilepticus. Hence, doses and classes of antiepileptic drugs were modified, but clinical manifestations did not improve. Follow-up brain CT revealed newly developed hydrocephalus and compression of the mesencephalon. His symptoms fully resolved after a ventriculo-peritoneal shunt operation. In this case report, we describe the case of a patient exhibiting tonic upward eyeball deviation induced by hydrocephalus that was not associated with a seizure.

Fatal neurological complication after liver transplantation in acute hepatic failure patient with hepatic encephalopathy

Liver transplantation is a current definitive treatment for those with end-stage liver disease. Hepatic encephalopathy is a common complication of hepatic failure, which can be improved and aggravated by various causes. It is important to differentiate hepatic encephalopathy from other diseases causing brain dysfunction such as cerebral hemorrhage, which is also related to high mortality after liver transplant surgery. A 37-year-old patient was presented with acute liver failure and high ammonia levels and seizure-like symptoms. Computed tomography (CT) of his brain showed mild brain atrophy, regarded as a symptom of hepatic encephalopathy, and treated to decrease blood ammonia level. Deceased donor liver transplantation was performed and liver function and ammonia level normalized after surgery, but the patient showed symptoms of involuntary muscle contraction and showed loss of pupil reflex and fixation without recovery of consciousness. Brain CT showed brain edema and bilateral cerebral infarction, and the patient died after a few days. The purpose of this case report is to emphasize the importance of preoperative neurological evaluation, careful transplantation decision, and proper perioperative management of liver transplantation in patients with acute hepatic encephalopathy.

Heart Transplantation in a Toddler with Cardiac Kawasaki Disease

Kawasaki disease is very rare in Western Europe. The disease may involve coronary arteries. A 2-year-old boy diagnosed with Kawasaki disease had had seizure-like symptoms. Further evaluation revealed recurrent myocardial ischemia and myocardial infarction. Due to extraordinary extension of the coronary disease, myocardial revascularization was not feasible and the toddler underwent successful heart transplantation after 97 days on waiting list.

Sometimes Those Hoofbeats Are Zebras: A Narrative Analysis

The case of BB, an 11-year-old girl who was hospitalized because of sudden odd seizure-like symptoms and catatonic affect, highlights several ethical issues and communication problems. The correct diagnosis was initially missed, partly because physicians are trained to think of the most common explanation for a patient's symptoms; the medical education truism "when you hear hoofbeats, think horses, not zebras" was not helpful in BB's case. The common habit of medical professionals to not revisit a diagnosis once one is established also led to missed opportunities to provide appropriate care for this young patient. The difficulty nurses and/or family members have in questioning a diagnosis and treatment plan are also discussed.

Different functional networks observed in multiple sclerosis during rest and motor task fMRI

Event Abstract Back to Event Computational Neurosciences of Cerebellar Circuit Disorders Shyam Diwakar1 1 Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham (Amrita University), India Spinocerebellar ataxias, Parkinson’s disease, Alzheimer’s dementia and other neurological disorders are associated with dysfunction attributed to various brain regions, including the cerebellum. Neuronal dynamics of the cerebellum correlate with learning and memory processes, via interactions at the synaptic levels forming neuronal microcircuits. Brain regions, including the cerebellum, have been known to include representations of internal models, transferring relevant information via their inputs and outputs [1]. The cerebellum, also known as the little brain, previously known for its role in motor coordination and timing [2], is now being implicated in autism [3], ataxias [4], dyskinesia [5], Alzheimer’s disease [6] and Parkinson’s disease [7]. As part of this study, we will discuss perspectives of cerebellum function as well as its interaction with basal ganglia and thalamo-cortical-thalamic circuitry. Computational models of individual circuits within the cerebellum allow validating and predicting behavioral functions and disease conditions observed during neurological disorders. The study will also look into multiple levels of analysis as this is important for determining physiological function and upstream and downstream roles during disease states and dysfunction. A modeling study of cerebellar function [8] during impaired motor control involved interlinking ion channel mutations to function at cellular and circuit level computations [9]. A study had looked into sodium channel excitability disruptions caused by fibroblast growth factor homologous factor mutations where an ataxia-like condition were observed in adult Wistar rats [10]. Sodium excitability has also been noted and mathematical modeling show spike suppression roles in juvenile prion protein knock-out mice with impaired motor control [9]. Epileptic seizure-like symptoms observed in mutant animals’ granule neurons suggest that sparse and asynchronous neuronal activity evolves into a single hyper-synchronous cluster with elevated spiking rates at seizure initiation [10]. In another study, blocking NMDA receptors in granule neurons showed reduced excitation. A selective blocking of NMDA receptors is seen during NR2A/NR2B mutations. Such simulations implicate a decreased number of spikes as seen via a change in N2A amplitude compared to controls in the generated local field response. A similar selective loss of neural activity in thalamo-cortical circuitry had resulted in glaucoma in human subjects [11]. Computational neuroscience of cerebellar [12] and cortical circuits [13] allowed reconstructing local field potentials[14] and fMRI Blood Oxygen-Level Dependent (BOLD) [15] signals via approximations of intercellular [16] and extracellular spiking activity [17]. We were also able to model local field potentials, cortical EEG and activity-dependent fMRI BOLD signals to correlate neural activity and dysfunction to population behavior. Acknowledgements This work derives direction and ideas from the Chancellor of Amrita University, Sri Mata Amritanandamayi Devi. This work was partially funded by Grants SR/CSI/49/2010, SR/CSI/60/2011, SR/CSRI/60/2013, SR/CSRI/61/2014 and Indo-Italy POC 2012-2013 from DST and BT/PR5142/MED/30/764/2012 from DBT, Government of India and by Embracing The World.

Role of Short Term Video Encephalography with Induction by Verbal Suggestion in Diagnosis of Suspected Paroxysmal Nonepileptic Seizure-Like Symptoms.

Purpose. To determine the diagnostic yield and utility of STVEEG with verbal suggestion in diagnosis of patients presenting with transient unresponsiveness and suspected psychogenic nonepileptiform seizures. Methods. A retrospective analysis of STVEEG records of patients with transient unresponsiveness and suspected PNES between 1 Jan 2009 and 28 Feb 2014 was done. Results. Amongst 155 patients [38 males, 117 females], with mean age 32 [8–67], PNES were identified in 109 [70.3%], focal epilepsy was identified in 24 [15.4%], and actual seizure was recorded in 7 [4.5%]. Nine [5.8%] patients were found to have both epilepsy and PNES. Primary generalized epilepsy was diagnosed in 2 [1.2%]. A diagnosis of other paroxysmal nonepileptiform events [tachyarrhythmia and heart block] was done in 3 [1.9%]. A normal EEG and no inducible episode and hence an uncertain diagnosis at the end of STVEEG were seen in only 17 [10.9%] patients. A STVEEG of approximately one hour duration was able to establish the diagnosis in 138 [89.1%] patients with transient unresponsiveness. Conclusion. STVEEG with verbal suggestion is a useful and cost effective diagnostic test for diagnosis of PNES. It can be a good modality for diagnosis in patients with transient abnormalities in sensorium in the outpatient settings in developing countries.

Recovery of absence seizure-like symptoms in a patient after slow pathway radiofrequency ablation

Epileptic seizures result from electrical hypersynchronization of neuronal networks in the cerebral cortex and characterized by recurrent epileptic seizures due to a genetically determined or acquired brain disorder [1]. Nonepileptic seizures are sudden changes in behavior that resemble epileptic seizures but are not associated with the typical neurophysiological changes that characterize epileptic seizures [2]. Absence seizures or complex partial seizures can be difficult to distinguish from nonepileptic seizure or events when using only the patient's history or by observation [3].