Signs Of Seizures Research Articles

Managing multidrug-resistant Acinetobacter baumannii in a premature neonate with sepsis: A case report

Background: Neonatal sepsis, which is a systemic response to infection, is a significant cause of morbidity and mortality in newborns, with an incidence of 1 to 8 per 1,000 live births. Acinetobacter baumannii is a common nosocomial pathogen, often associated with antibiotic resistance, complicating treatment and worsening outcomes [1,2]. Case Description: A neonate born prematurely at 34 weeks due to eclampsia (Apgar score 5/7, birth weight 2100 grams), presented with signs of severe infection, including fever, abdominal distension, seizures, and hypotonia. Laboratory results indicated severe thrombocytopenia, and elevated CRP. Blood cultures identified Acinetobacter baumannii resistant to 10 antibiotics. The patient was treated with oxazolidinones and third-generation cephalosporins for 21 days, resulting in gradual clinical improvement. Conclusion: Blood culture remains the gold standard for diagnosing neonatal sepsis. This case highlights the importance of comprehensive antibiotic sensitivity testing in managing multidrug-resistant infections, ensuring appropriate and effective therapy.

CHANTER syndrome in the context of pain medication: a case report

BackgroundCHANTER (Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion) is a recently described syndrome occurring in the context of drug abuse. While clinical findings are rather unspecific (disorientation, unresponsiveness), MR imaging (MRI) discloses a characteristic pattern (restricted diffusion in the basal ganglia and hippocampi, cerebellar oedema and haemorrhage), allowing for timely diagnosis before complications such as cerebellar swelling and herniation do occur. Here we report a case of CHANTER primarily based on imaging findings, as there was no evidence of drug abuse on admission.Case presentationA 62-year-old Patient was admitted to our hospital after being unresponsive at home. Prehospital intubation was performed, which limited neurological assessment. Under these circumstances no obvious symptoms could be determined, i.e. pupils were isocoric and responsive, and there were no signs of seizures. While the initial CT scan was unremarkable, the subsequent MRI scan showed a distinct imaging pattern: moderately enhancing areas in the basal ganglia and hippocampi with diffusion restriction, accompanied by cerebellar haemorrhage and oedema (Figs. 1 and 2). A comprehensive clinical and laboratory work-up was performed, including drug screening, spinal tap, Holter ECG, echocardiography and EEG. The only conspicuous anamnestic finding was a chronic pain syndrome whose medication had been supplemented with opioids two months previously. The opioid medication was discontinued, which led to a rapid improvement in the patient’s clinical condition without any further measures. The patient was able to leave the intensive care unit and was discharged 10 days after admission without persistent neurological deficits.ConclusionFamiliarity with typical MRI patterns of toxic encephalopathy in patients from high-risk groups, such as drug abusers, is crucial in emergency neuroradiology. In the presence of typical MRI findings, CHANTER syndrome should be included in the differential diagnosis, even if there is no history of drug abuse, to avoid delay in diagnosis and treatment.

Comparison of Continuous Intracortical and Scalp Electroencephalography in Comatose Patients with Acute Brain Injury.

Depth electroencephalography (dEEG) is a recent invasive monitoring technique used in patients with acute brain injury. This study aimed to describe in detail the clinical manifestations of nonconvulsive seizures (NCSzs) with and without a surface EEG correlate, analyze their long-standing effects, and provide data that contribute to understanding the significance of certain scalp EEG patterns observed in critically ill patients. We prospectively enrolled a cohort of 33 adults with severe acute brain injury admitted to the neurological intensive care unit. All of them underwent multimodal invasive monitoring, including dEEG. All patients were scanned on a 3T magnetic resonance imaging scanner at 6months after hospital discharge, and mesial temporal atrophy (MTA) was calculated using a visual scale. In 21 (65.6%) of 32 study participants, highly epileptiform intracortical patterns were observed. A total of 11 (34.3%) patients had electrographic or electroclinical seizures in the dEEG, of whom 8 had both spontaneous and stimulus-induced (SI) seizures, and 3 patients had only spontaneous intracortical seizures. An unequivocal ictal scalp correlate was observed in only 3 (27.2%) of the 11 study participants. SI-NCSzs occurred during nursing care, medical procedures, and family visits. Subtle clinical manifestations, such as restlessness, purposeless stereotyped movements of the upper limbs, ventilation disturbances, jerks, head movements, hyperextension posturing, chewing, and oroalimentary automatisms, occurred during intracortical electroclinical seizures. MTA was detected in 18 (81.8%) of the 22 patients. There were no statistically significant differences between patients with MTA with and without seizures or status epilepticus. Most NCSzs in critically ill comatose patients remain undetectable on scalp EEG. SI-NCSzs frequently occur during nursing care, medical procedures, and family visits. Semiology of NCSzs included ictal minor signs and subtle symptoms, such as breathing pattern changes manifested as patient-ventilator dyssynchrony.

Neuroimaging Changes and Treatment Outcome of Tubercular Meningitis- Experiences 22 Cases in a Tertiary Care Center

Background: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis (M. tuberculosis) and is the most common form of central nervous system (CNS) tuberculosis (TB).The prevalence of TB meningitis remains largely underestimated because clinical manifestations are nonspecific in early stages of the disease. Prompt diagnosis is critical for initiating appropriate therapy, facilitating measures to prevent dissemination of this highly contagious disease and to combat fatal complication in children Aims: To evaluate the role of neuroimaging changes and treatment outcome of tubercular meningitis. Methods: This prospective hospital-based cohort study was conducted in Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during January 2022 to December 2022. Children age belonged to 1 month to 10 year diagnosed as TBM during study period were enrolled in this study. Detailed history, clinical examination, CSF analysis and other relevant investigations were done. Data were recorded in standard questionnaire. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Total 22 diagnosed case of TBM was enrolled and evaluated. Among them two third (63.63%) children were in 5-10 year age group. Male (59%) were outnumbered than female (36.36 %).Male female ratio was 1.6:1. More than half (59%) of patients came from urban area. All of the patients were vaccinated. Cent percent (100%) patients were presented with fever followed by headache (77.27%), sign of meningeal irritation (54.54%), vomiting (54.54%) and seizures (50%). Most common complication was hemiparesis (45.45%) followed by cranial nerve palsy (40.90%), visual problem (9.09%) and hydrocephalus (4.54%). Abnormal neuroimaging changes were found in 100% cases. Common findings were hydrocephalus (40.90%), tubercloma (36.36%), basilar enhancement (18.18%), Benign enlargement of subdural space & cerebellar hyperintensity (9%) and thalamic infract was present in 4.54% cases. Anti TB and steroid treatment were given in 100% cases and among them18.18% cases were required shunt procedure. More than one-third cases (40.90%) were completely normal without any no sequelae. Among abnormal sequelae found in two third (59%) cases. Speech impairment (36.36%) was most common followed by GDD (18.18%), hemiparesis (13.63%), quadriparesis (9.09%) and epilepsy in 9.09% cases. Conclusion: In our study all children of TBM were presented with fever followed by other predominant clinical features headache, vomiting, seizures and sign of meningeal irritation. Abnormal neuroimaging changes were found in all cases. Common findings were basilar enhancement, hydrocephalus, tubercloma, benign enlargement of subdural space & cerebellar hyper intensity and thalamic infract. After treatment more than one-third cases were completely normal without any no sequelae. J Bangladesh Coll Phys Surg 2024; 42: 214-218

Accidental isoniazid toxicosis in a dog

AbstractA 7‐month‐old, male, spitz dog was presented with history of accidental ingestion of isoniazid tablets. On presentation, signs of seizures, involuntary defecation and urination, vomiting and excess salivation were noticed. Clinical examination revealed tachycardia, ataxia, increased respiratory rate and severe dehydration. Therapy was aimed at stabilisation of the dog with fluid therapy, anti‐convulsants and antidote pyridoxine (at the dose rate of 60 mg/kg bodyweight). The clinical signs subsided in 4 hours of therapy. Complete blood profile revealed mild neutrophilia, hypoproteinemia, elevated blood urea nitrogen, creatinine and alkaline phosphatase. After 24 hours of therapy, apart from vomiting no other clinical signs were noticed. Fluid therapy along with anti‐emetics, proton pump inhibitors and oral pyridoxine was administered for 2 more days following first day. The dog showed complete recovery on Day 3 of therapy, and the biochemical values were back to normal on seventh day. The present case reports a dog with accidental oral ingestion of isoniazid, its clinical signs and therapeutic management.

Successfully treated anti-GAD limbic encephalitis in a 15-year-old diabetic boy with intravenous immunoglobulin: case report

Introduction and importance: Limbic encephalitides (LE) have symptoms and signs of new-onset seizures accompanied by cognitive impairment and signal changes in the MRI of the limbic system in the brain. Numerous antibodies against the neurons and synapses have been detected so far. Of those, antiglutamic acid decarboxylase antibody (Anti-GAD Ab) impairs the gamma amino butyric acid, one of the primary mediators that naturally prevents abnormal neuronal activity causing seizure. Case presentation: The authors have reported a case of anti-GAD Ab LE in a diabetic male adolescent who responded dramatically to intravenous immunoglobulin and reviewed all similar pediatric cases for 15 years now. Clinical discussion: The symptoms in children suffering from anti-GAD LE in three categories, systemic, psychiatric, and neurological, are heterogeneous. The most common manifestations were seizures followed by altered mental status and behavioral changes, respectively. The two main clinical scenarios described in GAD65-mediated autoimmune epilepsy are (1) an acute/subacute onset of seizures alone or seizures (including new-onset refractory status epilepticus, NORSE) accompanied by some degrees of cognitive and psychiatric manifestations, including amnesia and mesiotemporal inflammatory involvement consistent with LE and (2) epilepsy without clinical or MRI evidence of active central nervous system inflammation. Conclusion: Although rare, the neurologist should consider the potential role of anti-GAD ab-associated encephalitis in the presence of diabetes mellitus.

Cycloserine- and Fluoroquinolone-Induced Seizure in Multidrug-Resistance Tuberculosis (MDR-TB) Patient: A Case Report

Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a type of tuberculosis (TB) that is resistant to at least two of the most effective first-line anti-TB drugs, isoniazid (H) and rifampicin (R). Cycloserine (Cs) and levofloxacin (Lfx) are second-line anti-TB drugs used in MDR-TB therapy. Even though they are considered to have high effectiveness, both drugs have the potential to cause side effects. One important side effect is neurotoxicity. Seizures have been reported as a common complication of some drugs. Case: A 39-year-old man was diagnosed with MDR-TB and was treated with individual regimens consisting of Lfx, bedaquiline (Bdq), linezolid (Lzd), clofazimine (Cfz), and Cs. After consuming anti-TB drugs for 27 days, the patient had seizures several times. The patient experienced full-body seizures and loss of consciousness during the seizures. Cs and Lfx were discontinued and replaced by other regimens. Serial electroencephalogram (EEG) showed normal results. After Cs and Lfx were discontinued, the patient never had another seizure. Conclusion: Management of MDR-TB is sometimes complicated because of severe drug side effects. Patients taking Cs and fluoroquinolones (FQs) should be advised to report any sign of seizure or changes in mental status to their healthcare provider.

Ictal hand signs: Minimal previous attention to these diagnostic indicators

AbstractIctal hand signs manifest as dystonic, tonic, or non-convulsive rhythmic elementary motor patterns, as well as finger snapping or automatic movement patterns (e.g. fumbling), and psychogenic movements have been reported in a small number of patients. This study demonstrates the various ictal hand signs and discusses the data on lateralization and localization as reported in the literature. In addition to published reports, our case studies are presented.

THU391 A Case Of Unrecognized Hypoglycemia Due To Methadone Use In A Non-Diabetes Patient

Abstract Disclosure: D. Owais: None. J.R. Fredrick: None. Y. Jamal: None. S. Sajnani: None. Introduction: Methadone is a rare cause of insulin-mediated hypoglycemia. Hypoglycemia can be manifested as autonomic instability (palpitations and diaphoresis) and neuroglycopenia (agitation and altered mentation). We present the case of hypoglycemia in a non-diabetic patient with no renal insufficiency and who was on a high dose of Methadone. Case: A 76-year-old male with a medical history of HTN, CAD, CVA, dementia, chronic opioid use (on methadone 80 mg) initially presented two times to an outside hospital for intractable seizures. The diagnosis of seizure disorder was made and was discharged on valproate. Per his wife, he had a few low blood sugars during those hospitalizations. Within a month of discharge, he was admitted to another hospital for severe bradycardia and had undergone pacemaker implantation. He was then discharged to nursing home (NH). In the NH, the routine laboratory work showed a serum blood glucose of 42; however, it was interpreted as a lab error. The next day, he developed severe metabolic encephalopathy, intractable seizures and transferred to our hospital. On arrival, serum blood sugar was 59, corrected by 50% of dextrose. His physical examination was significant for a thin-built elderly male, lethargic but in no acute distress. The dose of antiseizure medication was adjusted. The Methadone 80 mg daily was resumed. He continued to have intermittent hypoglycemia to as low as 33 despite being on intravenous (IV) dextrose solutions. His symptoms used to improve temporarily after the correction of hypoglycemia. (Positive Whipple’s triad). Blood cultures and urine cultures were negative. Serum cortisol level, IGF -1, TSH levels, blood pressure, and electrolytes were within normal limits. The hypoglycemia workup performed in a fasting state (off IV dextrose) showed endogenous hyperinsulinism with insulin level >3, C-peptide level >0.2, beta-hydroxybutyrate level of <2.7, and negative sulfonylurea screen. CT scan and ultrasound of the abdomen were performed to rule out insulinoma; however, it demonstrated complete atrophy of the pancreas. Therefore, a high dose of methadone was assumed to cause hypoglycemia, as the patient had no hypoglycemic episodes when he could not receive two doses of methadone due to encephalopathy. The trough levels of methadone in the blood were high at 650 ng/dl. Methadone dose was tapered to 60 mg daily. He was also started on octreotide to manage his hypoglycemia. However, the patient developed severe pneumonia, and family opted for hospice. Conclusion: Our case is unique as the patient was developing severe signs of hypoglycemia, including bradycardia and seizures, and treated with a pacemaker and antiseizure medications. His Methadone-induced hypoglycemia was identified late as the cause of his symptoms. Therefore, it is crucial to recognize this side effect of Methadone in differentials in a patient with hypoglycemia. Presentation: Thursday, June 15, 2023

Prevalence of ictal injuries in functional (psychogenic nonepileptic) seizures: A systematic review and meta-analysis.

Ictal injuries have long been considered typical signs of epileptic seizures. However, studies have shown that patients with functional seizures (FS)-also named psychogenic nonepileptic seizures-can also present these signs, misleading physicians and delaying a correct diagnosis. This systematic review aimed to assess the prevalence of injuries from FS. A literature search was performed in PubMed, Embase, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Web of Science, PsycINFO, Google Scholar, OpenGrey, and ProQuest. Observational studies were included. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for studies reporting prevalence data. RStudio was used for meta-analyses. Cumulative evidence was evaluated according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. From the 2607 identified records, 41 studies were included in the qualitative synthesis, and 28 were included in meta-analyses. A meta-analysis of 13 studies, including 1673 individuals, resulted in an overall lifetime prevalence of injuries due to FS per person of 25% (95% confidence interval [CI] = 19%-32%, I2 = 88%). Considering a limited period (video-electroencephalographic [VEEG] monitoring days), a meta-analysis of 13 studies, including 848 individuals, resulted in an injury prevalence due to FS per person of .7% (95% CI = 0%-3%, I2 = 73%). Also, a meta-analysis of eight studies, including 1000 individuals, resulted in a prevalence of injuries per FS of .1% (95% CI = 0%-.98%, I2 = 49%). The certainty in cumulative evidence assessed by GRADE was rated "very low" for lifetime prevalence of injuries per person, "low" for prevalence per person during VEEG monitoring, and "moderate" for prevalence per number of FS. Overall pooled lifetime prevalence of injuries due to FS per person was 25%. In comparison, the prevalence of injuries per person during VEEG monitoring and per functional seizure was .7% and .1%, respectively. [Correction added on 07 October 2023, after first online publication: In the preceding sentence, 'consecutively' was corrected to 'respectively'.] The evidence of the occurrence of injuries due to FS breaks the paradigm that epileptic seizures can cause injuries but FS cannot.

Neonatal Paenibacilliosis: Paenibacillus Infection as a Novel Cause of Sepsis in Term Neonates With High Risk of Sequelae in Uganda.

Paenibacillus thiaminolyticus may be an underdiagnosed cause of neonatal sepsis. We prospectively enrolled a cohort of 800 full-term neonates presenting with a clinical diagnosis of sepsis at 2 Ugandan hospitals. Quantitative polymerase chain reaction specific to P. thiaminolyticus and to the Paenibacillus genus were performed on the blood and cerebrospinal fluid (CSF) of 631 neonates who had both specimen types available. Neonates with Paenibacillus genus or species detected in either specimen type were considered to potentially have paenibacilliosis, (37/631, 6%). We described antenatal, perinatal, and neonatal characteristics, presenting signs, and 12-month developmental outcomes for neonates with paenibacilliosis versus clinical sepsis due to other causes. Median age at presentation was 3 days (interquartile range 1, 7). Fever (92%), irritability (84%), and clinical signs of seizures (51%) were common. Eleven (30%) had an adverse outcome: 5 (14%) neonates died during the first year of life; 5 of 32 (16%) survivors developed postinfectious hydrocephalus (PIH) and 1 (3%) additional survivor had neurodevelopmental impairment without hydrocephalus. Paenibacillus species was identified in 6% of neonates with signs of sepsis who presented to 2 Ugandan referral hospitals; 70% were P. thiaminolyticus. Improved diagnostics for neonatal sepsis are urgently needed. Optimal antibiotic treatment for this infection is unknown but ampicillin and vancomycin will be ineffective in many cases. These results highlight the need to consider local pathogen prevalence and the possibility of unusual pathogens when determining antibiotic choice for neonatal sepsis.

Non-traumatic Cerebral Fat Emboli Syndrome in a patient with Sickle Cell Crisis (P2-5.006)

<h3>Objective:</h3> To report a patient with Sickle Cell Disease who developed Cerebral Fat Embolism Syndrome. <h3>Background:</h3> A review of literature showed that cerebral fat embolism syndrome (CFES) can occur as a symptom of bone necrosis and vaso-occlusive crisis in patients with sickle cell disease (SCD), especially in those with heterozygous variants. <h3>Design/Methods:</h3> Case report and literature review <h3>Results:</h3> We present a 67-year-old female with a PMH of Sickle cell (HbSC) disease with retinopathy, splenectomy, cholecystectomy, atrial fibrillation on Eliquis, and hypertension who was initially admitted for management of vaso-occlusive crisis and presumed avascular necrosis of the right hip. Stroke code called for deteriorating mental status. CT Head and CTA of the Head &amp; Neck were unremarkable but hyper-acute MRI of the brain was performed which showed multiple scattered embolic infarcts in both cerebral and cerebellar hemispheres. Patient was later intubated and monitored on LTM which did not show any signs of seizures or ictal-interictal abnormalities. Patient underwent erythocytopheresis with exchange of 8 Units. Pre and Post-HbS were 54% and 7% respectively. Given lack of improvement in exam, MRI Brain was repeated which showed additional foci of diffusion restriction as well as dispersed micro-hemorrhages concerning for CFES. Patient additionally underwent two sessions of plasmapheresis. <h3>Conclusions:</h3> This case illustrates that CFES should be suspected in patients with SCD when there is a change in mental status or neurologic deficit which is likely from bone marrow necrosis leading to fat globules being released into the systemic circulation. Early MRI is useful in establishing a diagnosis for prompt, timely treatment. <b>Disclosure:</b> Dr. Ebrahimi has nothing to disclose. Dr. Balabhadra has nothing to disclose. Dr. Mittal has nothing to disclose.

Ictal semiology of gelastic seizures

Gelastic seizures are rare epileptic manifestations characterized by laughter or a smile. The main etiology is represented by hypothalamic hamartoma, but also focal localization of the epileptogenic zone is described.We reviewed a group of patients with gelastic seizures to describe the semiology and to establish any difference related to diverse epilepsy etiologies.Thirty-five seizures from 16 patients (6 females) were reviewed.The study confirms that hypothalamic hamartoma is the more frequent etiology associated with gelastic seizures. Laughter represented the majority of gelastic ictal signs, while the ictal smile was less frequent. In 87.5% of patients, the manifestation of laughter or smile was the only ictal phenomenon, or the first and the most important clinical sign.Interestingly, it has been observed that patients with a lesion localized in the hypothalamic region had more frequently laughter with emotional involvement and that laughter was the only manifestation of the seizure. On the contrary, patients with lesions localized outside the hypothalamic region had more often seizures with laugh without emotional involvement, resembling a more mechanical action, and associated with other semeiological signs.It, therefore, seems possible to assume that the emotional involvement and the expression of mirth during the seizure, especially in children, are more frequently associated with hypothalamic hamartoma. On the contrary, when the semiology includes less conveyed emotion similar to a mechanical action and other symptoms, an extra hypothalamic localization should be considered.

Association of ictal aphasia with hypoperfusion in language areas in temporal lobe epilepsy patients

Ictal clinical phenomenology, including aphasia, is usually associated with increased regional cerebral perfusion. We present an unusual pattern of ictal cerebral perfusion in three patients with pharmacoresistant, lesional temporal lobe epilepsy and ictal/postictal aphasia studied with prolonged video-EEG, ictal, and interictal SPECT and MRI for pre-surgical evaluation. Subtraction of ictal-interictal SPECT images co-registered with MRI (SISCOM) showed ictal hyperperfusion in the temporal epileptogenic area in all patients. In addition, hypoperfusion of Broca's area in one case, Wernicke's area in other patient, and both areas in the remaining one were observed. Ictal aphasia in these patients may be explained by functional inhibition of a primary language area, driven by the epileptogenic network. This pattern can contribute to understand the pathophysiology of some ictal signs, with an impact on the evaluation of individual surgical risks.

Reducing the shock factor with new anti-epilepsy drugs

Epilepsy is one of the most common serious neurological conditions, affecting 1 in 131 people in the UK. Patients with epilepsy suffer recurrent spontaneous seizures when neuronal activity elevates beyond physiological limits. Although current anti-epileptic drugs can effectively prevent seizures in some patients, up to 20% of paediatric and 40% of adult patients are refractory to treatment. One therapeutic avenue that has not yet been pursued for epilepsy is targeting neuronal homeostasis. PUMILIO (PUM) is a transcriptional repressor that maintains neuron action potentials within physiological limits and, importantly, is abnormally reduced in patients with epilepsy. In their recent article, Richard Baines and colleagues, therefore, investigated PUM as a therapeutic target for epilepsy.The authors identified a new compound, 4-tert-butyl-benzaldehyde (4-TBB), which could increase expression and stability of PUM in Drosophila and mice, and had physiochemical properties compatible with clinical use. They pre-treated diverse Drosophila and mouse models of epilepsy with 4-TBB prior to electrical or chemical induction of seizures. The team found that 4-TBB acts as an anticonvulsant, significantly reducing behavioural and physiological signs of seizure. The authors also confirmed that 4-TBB acts – at least in part – through modulation of PUM, as protein levels of downstream targets of PUM were reduced in treated mouse brains and because RNAi-induced reduction of PUM significantly diminished the anticonvulsant activity of 4-TBB in Drosophila.The authors then identified RAB216, a more-potent analogue of 4-TBB, which also increased PUM expression, and induced anticonvulsant activity in Drosophila and mice, at significantly lower concentrations than 4-TBB. Moreover, RAB216 also reduced the duration of seizures in an electrically induced seizure assay within a murine model that recapitulates drug-refractory epilepsy.The Baines lab identified two anticonvulsant compounds that modulate PUM expression and activity to oppose the high neuronal activity associated with seizures. This approach modulates neuronal homeostasis, which may incur fewer side effects, as these mechanisms are tightly controlled to avoid under- or over-activation. Interestingly, although mice were pre-treated with 4-TBB for 3 days prior to seizure induction, there were no overt signs of side effects. However, future work is required to investigate the full mode of action of the new compounds, beyond the modulation of PUM activity. Moreover, as PUM is expressed systemically, the development of compounds targeting central nervous system-specific downstream targets or co-factors of PUM could further minimise potential side effects. Nevertheless, the authors have demonstrated the potential of a novel approach to treating epilepsy, which may reduce the proportion of drug-refractory patients.

Epilepsy-Specific Anxiety: A Potential Clue to the Seizure Onset Zone.

Anticipatory Anxiety of Seizures is Associated With Ictal Emotional Distress and Amygdala Onset Seizures Tarrada A, Aron O, Vignal JP, Ertan D, Maillard L, Hingray C. Epilepsia. 2022;63(5):1130-1140. doi:10.1111/epi.17215.Objective:Anxiety disorders are a frequent psychiatric condition in patients with epilepsy. Anticipatory anxiety of seizures (AAS) is described as a daily persistent fear or excessive worry of having a seizure. AAS seems to be related to “subjective ictal anxiety” reported by patients. The current study aimed to assess the association between objective ictal features and the presence of AAS.Methods:Ninety-one patients with drug-resistant focal epilepsy underwent a standardized psychiatric assessment, specific for epilepsy, and presurgical long-term video-electroencephalography (EEG) or stereo-EEG (SEEG). We compared seizure semiology and epilepsy features of patients with AAS (n = 41) to those of patients without AAS (n = 50). We analyzed emotional and motor behavior ictal signs as well as ictal consciousness. We further assessed amygdala ictal involvement in seizures recorded with SEEG (n = 28).Results:AAS was significantly associated with the presence of ictal emotional distress; negative emotional behavior (P < .01) and negative emotion were explicitly reported to the examiner during recording (P = .015), regardless of the ictal level of consciousness. Among the patients recorded with SEEG, we found a significant involvement of amygdala within the seizure onset zone (P < .01) for patients with AAS.Significance:Higher risk of developing AAS is associated with seizures expressing negative emotional symptoms, independently of ictal consciousness level. Persistent interictal fear of seizures might be viewed as the consequence of a reinforcement of the emotional networks secondary to amygdala involvement in seizures of temporal origin. Physicians should screen for AAS not only to assess the impact of epilepsy on daily life, but also as an interictal biomarker of ictal semiology and emotional network involvement at seizure onset.

Shame, stigma, and social exclusion: The lived experiences of epileptic patients in a health facility in Ilorin, Nigeria

ABSTRACT Background The highest number of persons living with epilepsy (PLWE) are in Africa and the majority live in deplorable conditions, while dealing with varying layers of stigma, social exclusion, and discrimination. Objective This study explored the lived experiences of PLWE in Ilorin. Methods Adopting a qualitative design and a phenomenological lens, 10 PLWE between the ages of 18 and 60 were purposively selected from the University of Ilorin Teaching Hospital (UITH) for in-depth interviews. Results Findings suggest that PLWE bear multiple and intersecting burdens, including physical injuries; institutional, cultural, and economic constraints; psychological strain; social exclusion; and stigma. These disadvantages are often sustained and reproduced by various assumptions about epilepsy; as such, PLWE conceal their condition, and this implicatively reinforce stigma. Difficulty sustaining intimate relationships, overt physical scars, and inferiority complexes are recurrent challenges for PLWE. The study showed that adherence to drugs, self-management, personal precautions towards seizure signs, and family support are important coping strategies. Conclusion The study recommends that it is imperative to enhance and sustain systems, processes, and attitudes that prioritise the physical, social, and emotional needs of PLWE, because this is significant for their enhanced quality of life (QoL).

Correlation Between Ictal Signs and Anatomical Subgroups in Temporal Lobe Seizures: A Stereoelectroencephalography Study.

ObjectiveIctal semiology is a fundamental part of the presurgical evaluation of patients with temporal lobe epilepsy. We aimed to identify different anatomical and semiologic subgroups in temporal lobe seizures, and investigate the correlation between them.MethodsWe enrolled 93 patients for whom stereoelectroencephalography exploration indicated that the seizure-onset zone was within the temporal lobe. Ictal signs and concomitant stereoelectroencephalography changes were carefully reviewed and quantified, and then cluster analysis and the Kendall correlation test were used to associate ictal signs with the temporal structures of patients.ResultsClustering analysis identified two main groups of temporal structures. Group 1 consisted of the medial temporal lobe structures and the temporal pole, which were divided into two subgroups. Group 1A included the hippocampal head, hippocampal body, and amygdala, and this subgroup correlated significantly with oroalimentary automatisms, feeling of fear, and epigastric auras. Group 1B included the hippocampal tail, temporal pole, and parahippocampal gyrus, and this subgroup correlated significantly with manual and oroalimentary automatisms. Group 2 consisted of the cortical structures of the temporal lobe and was also divided into two subgroups. Group 2A included the superior and middle temporal gyrus, correlated significantly with bilateral rictus/facial contraction, generalized tonic–clonic seizure, and manual automatisms. Group 2B included Heschl's gyrus, the inferior temporal gyrus, and the fusiform gyrus, and this subgroup correlated significantly with auditory auras, focal hypokinetics, unilateral upper and lower limbs tonic posture/clonic signs, head/eye deviation, unilateral versive signs, and generalized tonic–clonic seizure.SignificanceThe temporal structures can be categorized according to the level at which each structure participates in seizures, and different anatomical subgroups can be correlated with different ictal signs. Identifying specific semiologic features can help us localize the epileptogenic zone and thus develop stereoelectroencephalography electrode implantation and surgical resection protocols for patients with temporal lobe epilepsy.

Modified Time-Frequency Marginal Features for Detection of Seizures in Newborns.

The timely detection of seizure activity in the case of newborns can help save lives. Clinical signs of seizures in newborns are difficult to observe, so, in this study, we propose an automated method of detecting seizures in newborns using multi-channel electroencephalogram (EEG) recording acquired from 36 newborns admitted to Royal Women’s Hospital, Brisbane, Australia. A novel set of time-frequency marginal features are defined to detect seizure activity in newborns. The proposed set is based on the observation that EEG seizure signals appear either as a train of spikes or as a summation of frequency-modulated chirps with slow variation in the instantaneous frequency curve. The proposed set of features is obtained by extracting the time-frequency (TF) signature of seizure spikes and frequency-modulated chirps by exploiting the direction of ridges in the TF plane. Based on extracted TF signature of spikes, the modified time-marginal is computed whereas based on the extracted TF signature of frequency-modulated chirps, the modified frequency-marginal is computed. It is demonstrated that features extracted from the modified time-domain marginal and frequency-domain marginal in combination with TF statistical and frequency-related features lead to better accuracy than the existing TF signal classification method, i.e., the proposed method achieves an F1 score of 70.93% which is 5% greater than the existing method.

Anticipatory anxiety of seizures is associated with ictal emotional distress and amygdala onset seizures

Anxiety disorders are a frequent psychiatric condition in patients with epilepsy. Anticipatory anxiety of seizures (AAS) is described as a daily persistent fear or excessive worry of having a seizure. AAS seems to be related to "subjective ictal anxiety" reported by patients. The current study aimed to assess the association between objective ictal features and the presence of AAS. Ninety-one patients with drug-resistant focal epilepsy underwent a standardized psychiatric assessment, specific for epilepsy, and presurgical long-term video-electroencephalography (EEG) or stereo-EEG (SEEG). We compared seizure semiology and epilepsy features of patients with AAS (n=41) to those of patients without AAS (n=50). We analyzed emotional and motor behavior ictal signs as well as ictal consciousness. We further assessed amygdala ictal involvement in seizures recorded with SEEG (n=28). AAS was significantly associated with the presence of ictal emotional distress; negative emotional behavior (p<.01) and negative emotion were explicitly reported to the examiner during recording (p=.015), regardless of the ictal level of consciousness. Among the patients recorded with SEEG, we found a significant involvement of amygdala within the seizure onset zone (p<.01) for patients with AAS. Higher risk of developing AAS is associated with seizures expressing negative emotional symptoms, independently of ictal consciousness level. Persistent interictal fear of seizures might be viewed as the consequence of a reinforcement of the emotional networks secondary to amygdala involvement in seizures of temporal origin. Physicians should screen for AAS not only to assess the impact of epilepsy on daily life, but also as an interictal biomarker of ictal semiology and emotional network involvement at seizure onset.