Seizures In Children Research Articles

Multi-branch fusion graph neural network based on multi-head attention for childhood seizure detection

The most common manifestation of neurological disorders in children is the occurrence of epileptic seizures. In this study, we propose a multi-branch graph convolutional network (MGCNA) framework with a multi-head attention mechanism for detecting seizures in children. The MGCNA framework extracts effective and reliable features from high-dimensional data, particularly by exploring the relationships between EEG features and electrodes and considering the spatial and temporal dependencies in epileptic brains. This method incorporates three graph learning approaches to systematically assess the connectivity and synchronization of multi-channel EEG signals. The multi-branch graph convolutional network is employed to dynamically learn temporal correlations and spatial topological structures. Utilizing the multi-head attention mechanism to process multi-branch graph features further enhances the capability to handle local features. Experimental results demonstrate that the MGCNA exhibits superior performance on patient-specific and patient-independent experiments. Our end-to-end model for automatic detection of epileptic seizures could be employed to assist in clinical decision-making.

Febrile seizures and childhood epilepsy and risk of internalizing and psychotic symptoms.

To assess whether children with febrile seizures and/or epilepsy were at increased risk of experiencing internalizing symptoms or psychotic-like experiences at age 11 years. This cohort study includes 44 819 children from the 11-year follow up of the Danish National Birth Cohort. Information on childhood seizures was retrieved from the Danish National Patient Registry, whereas child psychiatric symptoms were assessed in a web-based questionnaire using the Adolescent Psychotic-like Symptom Screener and the Strength and Difficulties Questionnaire. Adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs) for the association between childhood seizures and internalizing symptoms (symptom score ≥8) and psychotic-like experiences (≥2 definite experiences) were obtained using logistic regression models. A total of 1620 children with febrile seizures (3.6%), and 311 children with epilepsy (0.7%) were identified. When adjusted for potential confounders, no association between febrile seizures and psychiatric symptoms was observed, and no association was observed between epilepsy and psychotic-like experiences. However, the OR for internalizing symptoms was 1.76 (95% CI: 1.20-2.58) in children with epilepsy compared to children without. This higher risk was evident mainly in boys (OR 2.30, 95% CI 1.37-3.85), children with ≥2 epilepsy-related hospital admissions (OR 2.79, 95% CI 1.81-4.32), and children whose age at first epilepsy-related hospital admission was 0-3 years (OR 2.47, 95% CI 1.45-4.19). No association was found between febrile seizures and psychiatric symptoms or epilepsy and psychotic-like experiences at age 11. However, boys with epilepsy were at higher risk of experiencing internalizing symptoms.

Is vitamin D deficiency a risk factor in the occurrence and recurrence of febrile convulsions in children?

Background: Febrile seizure (FS) is the commonest childhood seizure. Our aim was to evaluate low Serum 25(OH) vitamin D level (vitamin D) as a risk factor for FS and whether vitamin D supplementation reduces its recurrence. Methods: A prospective cohort of children aged 6-60 months with FS (cases) and children with fever ≤3 days without seizures (controls) were recruited over a 2-year period. Vitamin D level was measured; those with low levels (<20 ng/ml) were treated with vitamin D for 3 months. Telephonic follow up was done upto 3 months regarding compliance, thereafter, upto 24 months for seizure recurrence. Results: 259 children (125 cases,134 controls) were recruited. Overall, 90 children (34.7%) had low vitamin D level. There was no difference between cases and controls with low vitamin D levels (p=0.37). 22 (17.6%) children had seizure recurrence. Of this serum vitamin D level was low in 2 (9.1%) while 20 (90.9%) had sufficient levels (p=0.021). The odds ratio for FS recurrence was 5.8 times higher among cases with normal vitamin D level (>20 ng/ml). Conclusions: There was no difference in mean vitamin D levels between cases and controls. However, there was significantly lower seizure recurrence in children who had low vitamin D level at presentation and had received vitamin D therapy. We postulate that treatment with vitamin D may reduce risk of FS recurrence even in those with serum vitamin D level in the “sufficient” range as per the recommended guidelines. Larger RCTs are needed to confirm these findings.

Influenza Infection During Pregnancy and Risk of Seizures in Offspring

Seizure is a common neurological problem among infants and children up to age 6 years. Prenatal exposure to maternal influenza infection has been reported to be associated with childhood seizures. To evaluate the association between maternal influenza infection and risk of childhood seizures. This cohort study identified mother-offspring pairs from January 1, 2004, to December 31, 2013, using records in Taiwan's Maternal and Child Health Database. Mothers who had influenza infection during pregnancy and their first offspring were identified and assigned to the influenza group. Mothers in the control group were those without influenza during pregnancy and were matched 1:4 with mothers in the influenza group by maternal age, offspring sex, and date of delivery. Offspring were followed up until December 31, 2020. Data were analyzed between March 2023 and July 2024. Diagnosis of influenza infection during pregnancy defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes 487.0, 487.1, and 487.8, or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes J09, J10, and J11. The primary outcome was the association between maternal influenza infection during pregnancy and risk of any type of seizures during childhood, including both epilepsy and febrile seizures. Adjusted hazard ratios (AHRs) and 95% CIs were estimated using Cox proportional hazards regression models. Pregnancy-related complications were collected as covariates. A total of 1 316 107 mother-offspring pairs were enrolled, of whom 75 835 mothers (predominant maternal age, 25-29 years; 39 324 male offspring [51.9%]) were assigned to the influenza group and 1 240 272 were matched and assigned to the control group (n = 303 340; predominant maternal age, 30-34 years; 157 296 male offspring [51.9%]). In the influenza group, there was a slightly higher prevalence of placenta previa or abruption compared with the control group (1.6% [1241] vs 1.4% [4350]; P < .001). The cumulative risk of seizures was higher among offspring whose mothers had influenza infection. After controlling for potential confounders, the AHRs were 1.09 (95% CI, 1.05-1.14) for seizures, 1.11 (95% CI, 1.06-1.17) for febrile convulsions, and 1.04 (95% CI, 0.97-1.13) for epilepsy. In the subgroup analysis, no statistically significant differences were observed between the trimesters regarding the timing of influenza infection. Results of this cohort study suggest that maternal influenza infection during pregnancy was associated with an increased risk of childhood seizures, especially febrile seizures, but not epilepsy. Further studies are needed to elucidate the mechanisms underlying childhood neurological development.

A - 63 Sotos Syndrome: a Case Study

Abstract Objective Sotos syndrome is a genetic disorder characterized by pre and postnatal overgrowth and a non-progressive neurological disorder frequently accompanied by intellectual disability. The estimated prevalence is 1:14,000 live births; however, misdiagnosis is common due to features being attributable to other conditions. This case study highlights the broad range of symptom presentation in individuals with Sotos syndrome and adds to the limited available literature on this rare condition. Method The patient is a 26-year-old female with no prior neuropsychological testing presenting with concerns for cognitive functioning, regression of skills, and emotional/behavioral dysregulation. Concerns were raised for an underlying autism spectrum disorder. She presents with large stature, prominent facial configuration, and hypotonia. Developmental history was significant for delayed motor and language milestones. She has a history of absence seizures in childhood and was evaluated by neurology and medical genetics and diagnosed with Sotos syndrome. Results The patient’s overall intellectual functioning was in the exceptionally low range with a personal strength in verbal skills. Her neurocognitive results and low adaptive skills are indicative of a moderate intellectual disability. The patient’s developmental history, social difficulties, restrictive interests, and repetitive behaviors met criteria for autism spectrum disorder. Another notable finding was frequent starring spells in which she became unresponsive for approximately 15 seconds. Conclusion Delayed motor and language milestones, hypotonia, behavioral problems, and intellectual disability are common in individuals with Sotos syndrome and were present in the patient. Seizures and scoliosis are less common in individuals diagnosed, for which she was referred to a neurologist for further work-up.

Predictive Value of Neutrophil-Lymphocyte Ratio and Other Inflammation Indices in Febrile Seizures in Children.

Objective: There is increasing evidence for the effect of inflammation on the etiology of febrile seizure (FS) patients. We aimed to investigate the role of easily accessible inflammatory markers such as the neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte-platelet ratio (NLPR), and pan-immune-inflammation value (PIV) in febrile seizure. Methods: A total of 300 children, including 100 with febrile convulsions (FS), 100 febrile controls (FCs), and 100 healthy controls (HCs), were included in this retrospective study. The FS group was compared with the FC and HC groups in terms of these inflammatory indexes. Results: Between the FS group and the FC group, the neutrophil count was significantly higher in the FS group (p = 0.001) and the lymphocyte count was significantly lower (p < 0.001). The NLR (p < 0.001), SII (p < 0.001), SIRI (p < 0.001), NLPR (p < 0.001), and PIV (p < 0.001) were significantly higher in the FS group than in both the FC and healthy control groups. The optimal cut-off values for predicting FS in febrile conditions were 3.59> for NLR, >870.47 for SII, >1.96 for SIRI, 0.96> for NLPR, and >532.75 for PIV. Conclusions: The inflammatory indices are inexpensive, easily accessible hematological markers that can contribute to the diagnosis of FS.

Identifying Clinical and Biochemical Predictors of Seizures in Children with Acute Bacterial Meningitis: Insights from a Cross-Sectional Study

Identifying Clinical and Biochemical Predictors of Seizures in Children with Acute Bacterial Meningitis: Insights from a Cross-Sectional Study

Distinctive Clinico-electrographic and Radiological Profile of Childhood and Adolescent Seizures.

Electroencephalogram (EEG) is specific, but not sensitive, for the diagnosis of epilepsy. This study aimed to correlate the clinico-electrographic and radiological features of seizure disorders in children attending a tertiary care centre in northern India. Children aged between one to 18 years with seizure episodes were included. Clinical details, including historical as well as physical findings, were evaluated along with EEG and neuroimaging (Magnetic resonance imaging). Details were noted on pre-designed proforma. Variables were analysed by using appropriate statistical methods. A total of 110 children with seizures were enrolled in the study. Male to female ratio was 1.6: 1, and the mean age of the study children was 8 years. The majority of the children were symptomatic for more than one year. The most common seizure type was Generalised Tonic Clonic Seizure (GTCS), and Hypoxic-ischemic Encephalopathy (HIE) sequelae was the most commonly attributed etiology, followed by neurocysticercosis. EEG and neuroimaging findings were found to correlate well with seizure semiology from history. The incidence of febrile seizures was 10% in this study, with nearly three-fourths of them being simple febrile seizures. Microcephaly and developmental delay were the most distinctive clinical correlates in children with seizures. There was a fair agreement between the types of seizures described in history and depicted on EEG with Cohen's kappa of 0.4. Also, there was a significant association between the type of seizures on EEG and the duration of symptoms.

Discontinuation of antiseizure medication in patients with epilepsy

Approximately two thirds of patients with epilepsy become seizure-free with antiseizure medication (ASM). Acentral question is whether and when ASM can be discontinued. To present an overview of the current knowledge about risks and benefits of discontinuation of ASM. Review of the current literature, discussion of data on and recommendations for discontinuation of ASM. The risk of seizure recurrence after discontinuation of ASM is approximately 40-50% and thus twice as high as continuing with ASM. Guidelines recommend considering discontinuation of ASM at earliest after aseizure-free period of 2years. Predictive variables for seizure recurrence after stopping ASM include longer duration of epilepsy and higher number of seizures until remission, ashorter seizure-free interval until stopping ASM, older age at epilepsy onset, developmental delay or IQ < 70, febrile seizures in childhood, absence of aself-limiting epilepsy syndrome, and evidence of epileptiform activity in the electroencephalograph (EEG). The individual risk of seizure recurrence after stopping ASM can be estimated using an online prediction tool. Discontinuation of ASM should be discussed with patients at the earliest after 2years of seizure freedom in ashared decision-making process weighing up the risks and benefits. The risk of aseizure recurrence depends on anumber of clinical variables. Psychosocial aspects, such as impact on driving and occupational issues must be taken into consideration as well as individual fears and concerns of patients about seizure recurrence or the long-term use of ASM.

Hot water epilepsy with alone and spontaneous seizures in childhood

ObjectivesHot water epilepsy (HWE) is a type of epilepsy that primarily affects children. This study was aimed to evaluate the clinical, electroencephalogram (EEG), neuroimaging findings, and treatment options in children with HWE. MethodsThe medical records of 24 patients who had HWE were evaluated retrospectively. ResultsThere were 2767 patients diagnosed with epilepsy during the seven-year period, and 0.86 % of the patients had HWE. The median age of the patients was three (range 1.2–7 years), with a male predominance (male/female ratio: 7.1). Six patients (25 %) had HWE with spontaneous seizures (HWESS) and 18 patients (75 %) had HWE alone (HWEA). 11 patients had focal onset seizures, 13 patients had generalized onset seizures. EEG abnormalities were found in 7 patients (29.2 %). Three patients (12.5 %) had nonspecific MRI findings. Developmental abnormalities (autism spectrum disorder, learning disability and speech disturbance.) were detected in 8 patients (33.3 %). Only one patient's (4.2 %) seizure could be controlled by changing bathroom habits. Twenty-three patients (95.8 %) were given antiepileptic drugs. 18 of 24 patients had come for follow-up visits for two years, nine of them used monotherapy and seizures did not recur. The treatment response was 55.5 %. Oxcarbazepine (8 patients, 33.3 %) and valproic acid (7 patients, 29.2 %) were the most chosen two drugs for HWE. The genetic tests performed were not accepted relevant to the patients' clinical conditions and epilepsy. ConclusionThe frequency of the HWE was not as high in the literature. Male predominance, EEG abnormalities may be seen. Changing bath room habits did not improve the treatment as a first line management, all the patients except one used antiepileptic drug treatment. Until now, there has been no study in Turkey showing the frequency of HWE exclusively in children.

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

Prevalence of Seizures in Children Diagnosed With Neurodevelopmental Disorders.

Introduction Neurodevelopmental disorders (NDDs) typically emerge in early childhood and have a profound impact on the development of the nervous system, leading to various neurological challenges in cognition, communication, social interaction, motor skills, and behavior. These disorders arise from disruptions in brain development mechanisms. NDDs include conditions such as cerebral palsy (CP), global developmental delay (GDD), intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), with ADHD and ASD being the most prevalent. However, there is a lack of comprehensive research on the causes of NDDs in children receiving care at tertiary hospitals in Saudi Arabia. Therefore, in this study, we aimto investigate the characteristics of patients with NDDs and explore the association between NDDs and seizures. It also focuses on identifying specific risk factors that may influence the relationship between NDDs and seizures. Methods We conducted a retrospective cross-sectional study at the pediatric neurology and developmental assessment clinic of King Abdulaziz University Hospital in Jeddah, Saudi Arabia. The study involved a review of electronic medical records from January 2021 to May 2023 for 200 pediatric patients who attended the clinic for NDD and seizures. Descriptive statistics summarized the data, using frequencies and percentages for categorical variables, and mean ± standard deviation for quantitative variables. The chi-square test identified differences between qualitative variables, with a significance threshold of p < 0.05. Results The study sample comprised 200 children ranging in age from one month to 14 years, with the majority of patients being from Jeddah city. Participants were categorized into four age groups: 17.0% (n=34) were aged between one month and three years, 18.5% (n=37) were aged between three and six years, 55.0% (n=110) were aged between six and 12 years old, and 9.5% (n=19) were aged between 12 and 14 years. The NDD subtypes identified were ASD 9.5%, ADHD 16.0%, CP 8.5%, GDD 30.5%, ID 5.5%, and 30% had multiple types of NDD. Generalized tonic-clonic seizures were the most common type observed. Conclusion Children with NDDs exhibit a high prevalence of seizures, with the age of the patient and consanguinity emerging as significant influencing factors in this correlation. Among the key findings is an emphasis on the importance of early detection and intervention for children with NDDs at higher risk of developing seizures. Overall, the study sheds light on the characteristics of NDD patients and their association with seizures, contributing to a better understanding of the complex relationship between NDDs and seizure occurrence. It also emphasizes the need for comprehensive assessment and management strategies that consider seizures in children with NDDs.

Seizures in Children With Severe Acute Respiratory Syndrome Coronavirus 2 Infection

BackgroundAlthough respiratory symptoms are the most prominent manifestations of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and especially the omicron variant, may cause neurological manifestations such as seizures. It remains unclear if specific variants of the virus increase the risk of seizures more than others. Material and MethodsThis was a retrospective multicenter study of pediatric (zero to 16 years) patients with COVID-19 who attended five pediatric emergency departments in Madrid, Spain, between March 2020 and July 2022. An analysis of demographics, medical history, and seizure characteristics was conducted. The data obtained were correlated with the incidence of the different strains of SARS-CoV-2 in the Community of Madrid. ResultsA total of 2411 seizures (infectious and noninfectious) were recorded, and 35 of them (1.4%) were positive for SARS-CoV-2. Of those 35 patients, 18 (51.4%) reported a history of previous seizures. The highest percentage of cases occurred when the omicron variant was the most prevalent (28 [80%] vs 7 [20%] before omicron variant). Typical febrile seizures accounted for 52.9% of the cases. No treatment was required in more than half (57.1%) of the cases. Conclusionduring the emergence of the omicron variant, there has been an increase in the number of COVID-19-associated seizures. These findings highlight the need for SARS-CoV-2 screening in patients with febrile and afebrile seizures, in addition to other microbiological, biochemical, or neuroimaging tests, depending on the patient's age and clinical presentation.

Periventricular nodular heterotopia in patients with a prenatal diagnosis of myelomeningocele/myeloschisis: associations with seizures and neurodevelopmental outcomes during early childhood.

Historically, the presence of gray matter heterotopia was a concern for adverse postnatal neurocognitive status in patients undergoing fetal closure of open spinal dysraphism. The purpose of this study was to evaluate neurodevelopmental outcomes and the onset of seizures during early childhood in patients with a prenatal diagnosis of myelomeningocele/myeloschisis (MMC) and periventricular nodular heterotopia (PVNH). All patients evaluated at the Center for Fetal Diagnosis and Treatment with a diagnosis of MMC between June 2016 to March 2023 were identified. PVNH was determined from prenatal and/or postnatal MRI. The Bayley Scales of Infant and Toddler Development (edition III or IV) were used for neurodevelopmental assessments. Patients were screened for seizures/epilepsy. Of 497 patients evaluated with a prenatal diagnosis of MMC, 99 were found to have PVNH on prenatal MRI, of which 35 had confirmed PVNH on postnatal imaging. From the 497 patients, 398 initially did not exhibit heterotopia on prenatal MRI, but 47 of these then had confirmed postnatal PVNH. The presence of PVNH was not a significant risk factor for postnatal seizures in early childhood. The average neurodevelopmental scores were not significantly different among heterotopia groups for cognitive, language, and motor domains. The presence of PVNH in patients with a prenatal diagnosis of MMC does not indicate an increased risk for neurodevelopmental delay at 1year of age. We did not demonstrate an association with seizures/epilepsy. These findings can aid clinicians in prenatal consultation regarding fetal repair of open spinal dysraphism. Long-term follow-up is required to discern the true association between PVNH seen on prenatal imaging and postnatal seizures/epilepsy and neurodevelopmental outcomes.

Clinical Impact of Coronavirus Disease 2019 Outbreaks in Korea on Seizures in Children

Purpose: Coronavirus disease 2019 (COVID-19) can be associated with neurological complications. This study investigated the impact of COVID-19 outbreaks on seizure incidence and duration in children in Korea. Methods: We retrospectively analyzed medical records from Kyungpook National University Children’s Hospital, including 768 children with seizures during the peak COVID-19 outbreaks in March and August 2022, and compared patterns with the same periods in 2021. We examined demographic and clinical characteristics, causes of seizures, underlying conditions, seizure durations, and COVID-19 test results. Results: Out of 16,373,836 COVID-19 cases during the first peak, 25.6% were children (4,184,383), and during the second peak, 20.5% of 6,400,244 cases were children (1,314,331). No significant age differences were observed between either peak and the previous year. However, when compared to the previous year, febrile seizures (FS) were more common during both peaks (25.9% vs. 65.1% in the first peak; 34.3% vs. 59.2% in the second peak). The prevalence of FS was significantly higher in the COVID-19-positive group (84.1%) than in the COVID-19-negative group (51.9%). The incidence of new-onset seizures or breakthrough seizures showed no significant difference. Seizure duration and the incidence of status epilepticus (SE) showed no significant changes, but SE was more common in the COVID-19-negative group (17.1% vs. 6.2%). The clinical features of FS were similar in both groups. Conclusion: COVID-19 appeared to increase the risk of FS in children, but there was no significant impact on the risk of breakthrough seizures or SE in children with epilepsy. Nevertheless, larger-scale studies are necessary.

Risk Factors for Febrile Seizures in Children Under 5 at a Tertiary Care Teaching Hospital

Introduction: Convulsion is most common neurological disorder finding in children having high grade fever.Factors affecting convulsions and prevention of febrile seizures are therefore of utmost importance. The aim of study was to study the risk factors associated with febrile seizures among under 5 children.Methods: A cross sectional study was conducted in the department of Pediatrics GS Medical College and HospitalPilakhuwa, a tertiary care teaching hospital in North India. All children under 5years of age who had febrileconvulsions from March2022 to March2023 were included in the study.Results: In a total of 100 children in the study, 59 were boys (59%) and 41 were girls (41%). 59% of children were in the age group of 6months to 3 years. Mean age was 2.23 years (+_1.19years). 32% of children had positive family history. 80% children had simple and 20% children had complex seizures.Conclusions: Respiratory tract infection and acute gastroenteritis were two most common comorbidity. It was seen more in boys than in girls.

Atypical electroclinical presentation of Landau Kleffner syndrome: a case report of an 8 year old Nigerian child

Epileptic seizures account for common neurologic presentations in paediatric neurology units in developing countries. Atypical presentation of syndromic epilepsy may be missed especially sensory, psychic or autonomic manifestations. An 8 year old male Nigerian child presented with recurrent vomiting and delayed motor milestones, regression of speech (acquired aphasia) with unremarkable birth history or any underlying medical or surgical condition. He had delayed gross motor development and continuous bilateral polyspike waves of slow sleep on EEG. Self-limited autonomic epileptic seizure syndrome which was a strong differential of autonomic seizures in early childhood was not suggestive as his EEG findings failed to demonstrate occipital spike wave pattern nor did photic stimulation evoke any epileptiform waves. Child made significant clinical improvement with anticonvulsants, neuro vitamins, and behavioural therapy, evidenced by regain of non-verbal communication, resolution of autonomic symptoms and temper tantrums. A high index of suspicion should be applied in patients with acquired aphasia with subclinical or recurrent autonomic symptoms.

Electroclinical features of myoclonic-tonic and spasm-tonic seizures in childhood.

Myoclonic-tonic (MT) and spasm-tonic (ST) seizures represent distinctive features in late infantile epileptic encephalopathy (LIEE). This commentary aims to delineate the electroclinical characteristics of MT and ST seizures, setting them apart from other seizure types. Our analysis encompasses 211 ST and MT seizures observed in 31 patients diagnosed with LIEE, providing a comprehensive overview of video-EEG features and polygraphic signatures. In MT seizures, EEG findings reveal a high-voltage diffuse spike/polyspike and wave discharge, often succeeded by diffuse electrodecrements. The amplitude-integrated EEG (aEEG) signature is described as a "reversed checkmark." Conversely, ST seizures exhibit EEG findings such as a vertex positive deflection after a slow-wave and relative electrodecrement, with intermixed epileptiform discharges. In comparison to MT seizures, polygraphic characteristics in ST seizures appear more distinct, featuring a brief rhomboid shape corresponding to the spasm, followed by a lengthier rectangular shape indicative of the tonic phase of the ST seizure. While the pathophysiology of ST and MT seizures remains inadequately understood, their concurrent occurrence and association with other seizure types (tonic, epileptic spasm, myoclonic) within the temporal context of LIEE and other epileptic encephalopathies prompt us to anticipate advancements in our understanding through future research. We hope that this study serves as a foundation for unraveling these complexities in the times to come.

Early Initiation of Antiretroviral Therapy is Protective Against Seizures in Children With HIV in Zambia: A Prospective Case-Control Study.

Seizures are relatively common among children with HIV in low- and middle-income countries and are associated with significant morbidity and mortality. Early treatment with antiretroviral therapy (ART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy. We conducted a prospective, unmatched case-control study. We enrolled children with new-onset seizure from University Teaching Hospital in Lusaka, Zambia and 2 regional hospitals in rural Zambia. Controls were children with HIV and no history of seizures. Recruitment took place from 2016 to 2019. Early treatment was defined as initiation of ART before 12 months of age, at a CD4 percentage >15% in children aged 12-60 months or a CD4 count >350 cells/mm 3 for children aged 60 months or older. Logistic regression models were used to evaluate the association between potential risk factors and seizures. We identified 73 children with new-onset seizure and compared them with 254 control children with HIV but no seizures. Early treatment with ART was associated with a significant reduction in the odds of seizures [odds ratio (OR) 0.04, 95% confidence interval: 0.02 to 0.09; P < 0.001]. Having an undetectable viral load at the time of enrollment was strongly protective against seizures (OR 0.03, P < 0.001), whereas history of World Health Organization Stage 4 disease (OR 2.2, P = 0.05) or CD4 count <200 cells/mm 3 (OR 3.6, P < 0.001) increased risk of seizures. Early initiation of ART and successful viral suppression would likely reduce much of the excess seizure burden in children with HIV.

Stimulation-Induced Seizures in Children Undergoing Stereo-EEG Evaluation.

This study reports our center's initial experience with the use of low-frequency stimulation in provoking stimulation-induced seizures (SIS) in children with drug-resistant epilepsy undergoing stereo-EEG evaluations. This retrospective study enrolled children aged 2 to 18 years with drug-resistant focal epilepsy who underwent stereo-EEG evaluation and extraoperative direct electrical cortical stimulation to elicit seizures. The low-frequency stimulation parameters consisted of biphasic square waveforms at frequency of 1 Hz, pulse width 1 millisecond, current 1 to 3 mA, and train duration of 20 seconds. Various epilepsy-related, imaging, neurophysiology, and surgery-related variables were collected and summarized. Fourteen children (mean age 13 years; 57.1% girls) were included, 10 of whom had unilateral stereo-EEG coverage. Cortical stimulation for provoking seizures was performed after a median of 5 days after electrode implantation. The median number of electrode-contacts stimulated per patient was 42. Four patients (28.6%) experienced habitual SIS (all extratemporal). The etiology in three patients was focal cortical dysplasia. Interictal high-frequency oscillations at electrode-contacts provoking SIS were observed in three cases (75%). Two of these individuals (50%) had class 1 International League Against Epilepsy seizure outcome at last follow-up, after the resection of the brain regions generating SIS. Low-frequency (1-Hz) stimulation could provoke habitual SIS in nearly one-fourth of children with focal epilepsy undergoing stereo-EEG monitoring. This study provides a limited pediatric experience with the low-frequency cortical stimulation and SIS.