Symptomatic Epilepsy Research Articles

Drug-resistant epilepsy treated with a vagus nerve stimulator – case report and literature review

The average incidence of epilepsy worldwide is estimated at 7.60 cases per 1,000 inhabitants, with an average annual incidence of 67.77 cases per 100,000 inhabitants. Epilepsy is one of the most common neurological diseases. However, it is not a disease entity, but a set of symptoms that may occur against the background of various morphological and metabolic changes in the brain. Symptoms of epilepsy include epileptic seizures, i.e. temporary disturbances in the bioelectric activity of brain nerve cells. Epilepsy is a brain disorder characterized by a persistent predisposition to trigger seizures, and the condition has neurobiological, cognitive, psychological, and social consequences. Effective treatment of epilepsy may require the use of various methods. In this paper, we would like to present a case report on the treatment of drug-resistant epilepsy using a vagus nerve stimulator (VNS). The described case may prove the effectiveness of treatment of focal drug-resistant epilepsy using vagus nerve stimulation (VNS). Choosing an appropriate, effective method of treating children with drug-resistant epilepsy is crucial; it is especially worth thinking about innovative methods such as VNS.

Effectiveness of Shugan Jieyu capsules for psychiatric symptoms of epilepsy: a systematic review and meta-analysis

BackgroundThe relationship between epilepsy and depression is bidirectional. One condition exacerbates the other. However, there are no current guidelines for treating depression in epilepsy patients. In some cases, seizures worsen when antidepressants (AD) are prescribed or when they are discontinued due to adverse events. The Shugan Jieyu capsule, composed of Acanthopanax senticosus and Hypericum perforatum, is a widely used herbal medicine for treating depression. This study aimed to explore the effectiveness and safety of Shugan Jieyu capsules (SJC) in relieving depression in patients with epilepsy.MethodsWe searched English, Korean, Japanese, and Chinese databases in October 2023 to collect all relevant randomized clinical trials (RCTs). The primary outcomes were the depression scale scores and seizure frequency. The secondary outcomes were quality of life (QoL) and adverse events.ResultsNine RCTs were included in this meta-analysis. Compared with AD, SJC showed significant differences in the improvement of depression (SMD: 3.82, 95% CI: 3.25, 4.39) and reduction in seizure frequency (MD: 0.39 times/month, 95% CI: 0.28, 0.50). SJC showed more beneficial results than antiepileptic drugs (AED) in terms of antidepressant effects (SMD: 1.10, 95% CI: 0.69, 1.51) and QoL (MD: 11.75, 95% CI: 10.55, 12.95). When patients were prescribed AED, the additional administration of SJC improved depression symptoms (SMD: 0.96, 95% CI: 0.28, 1.63). The SJC treatment group had a lower incidence of side effects than the control group. However, the difference was not statistically significant.ConclusionsOur results suggest that SJC may be effective in treating depression in patients with epilepsy. Additionally, SJC has the potential to help reduce seizure frequency in epilepsy patients with depression.

Exacerbation of Mirror Movement Disorder: A Complex Case of Childhood-onset Mirror Movements Aggravated by Essential Tremors, and Parkinson's Disease

Background Mirror movement (MM), also known as bimanual synkinesis, is characterized by simultaneous involuntary movements of homologous muscles accompanying voluntary movements of contralateral body regions. MM can be observed in various neurological conditions, including cerebral palsy, corticobasal syndrome, Parkinson's disease, certain types of symptomatic epilepsies, Creutzfeldt-Jakob's disease, Huntington's disease, and others. Case Description A 52-year-old female with a history of epileptic seizures, essential tremors and mild MM was presented to a neurology clinic for seizure management. She had a long-standing history of seizures since childhood. Initial neurological examination revealed mild MM disorder. During the follow up visits, patient’s mirror movements were exacerbated months before she was diagnosed with Parkinson’s disease. Multiple antiepileptic drug regiments along with Carbidopa-levodopa were used and dose adjustments were done during follow up visits to help stabilize the patient’s symptoms. Conclusion In conclusion, this case highlights the progressive nature of mirror movement disorder (MMD) and its association with other neurological conditions, such as epilepsy, essential tremors, and Parkinson's disease. The primary aim of this study was to showcase that individuals with early childhood onset of MMD may experience a deterioration of their condition as they acquire additional neurological disorders, such as essential tremors or Parkinson's disease. Moreover, this study seeks to elucidate how the exacerbation of mirror movement symptoms in such cases can serve as an early indicator of the onset of Parkinson's disease. Medication adjustments played a crucial role in managing the patient's symptoms, emphasizing the importance of individualized treatment plans and close monitoring.

Feeding metformin during pregnancy and lactation periods improved learning and memory impairment in the rat offspring exposed to febrile seizure: Role of oxidative stress and inflammatory response.

Many clinical evidences have reported the higher risk of seizure in young children and infants after exposure to hyperthermia, which more likely can cause brain damage and affect cognitive function, so, many researches were focused on prevention or treatment of febrile seizure (FS) with minimal adverse effects. Considering the potential effects of oxidative stress as a prominent trigger in FS, and demonstrating the anti-oxidant effects of metformin, the present study aimed to investigate the protective effect of metformin administration in prenatal and lactation periods in rat pups exposed to hyperthermia by which induced seizure. Pregnant rats were divided into six groups: (1) vehicle: pregnant rats received normal saline during pregnancy and lactation; (2) FS: pregnant rats received normal saline during pregnancy and lactation; (3-5) FS-Met50/100/150 mg/kg: pregnant rats received different doses of metformin including 50, 100 and 150 mg/kg during pregnancy and lactation; (6) Met150 mg/kg: pregnant rats received Met150 mg/kg during pregnancy and lactation. The male pups born to mothers received in all FS groups exposed to hyperthermia. All experimental groups were allowed to grow up, and after the lactation period, they were subjected for behavioural tests and biochemical analysis. According to the present findings, the prenatal and lactation exposure to the highest dose of metformin demonstrated significant difference with FS group in both behavioural and biochemical test analyses. Although the remaining doses of metformin were also effective, the much better results were reported with the highest dose of metformin (150 mg/kg). Interestingly, the highest dose of metformin administered alone demonstrated better result than vehicle in probe trial test. Considering the present research and related study in relation to metformin in ameliorating the epilepsy symptoms, there are numerous evidences on positive effect of metformin on seizure. Although the exact mechanism is unclear, the anti-oxidant effect of metformin is strongly supported.

Late infantile epileptic encephalopathy: A distinct developmental and epileptic encephalopathy syndrome.

Within the spectrum of developmental and epileptic encephalopathy (DEE), there are a group of infants with features that are distinct from the well-recognized syndromes of early infantile developmental and epileptic encephalopathy (EIDEE), infantile epileptic spasm syndrome (IESS), and Lennox-Gastaut syndrome (LGS). We refer to this condition as late infantile epileptic encephalopathy (LIEE). Our objective was to highlight the characteristics of this group by analyzing patients who exhibit prototypical features. From July 2022 to May 2023, we searched for LIEE features in pediatric patients who underwent epilepsy follow-up at the University of Chicago Comer Children's Hospital. Out of 850 patients evaluated, thirty patients (3.5%) were identified with LIEE based on electroclinical characteristics. These patients had an average onset of epilepsy at 6.8 months and an average onset of LIEE features at 18.1 months. The epilepsy etiology was most commonly genetic and metabolic (50%), followed by congenital cortical malformations (23%), acquired structural abnormalities (20%), and unknown (7%). The predominant seizure types were myoclonic-tonic (70%), spasm-tonic (50%), epileptic spasms (47%), tonic (43%), and myoclonic (43%) seizures. All patients reported a history of either spasm-tonic or myoclonic-tonic seizures in addition to other types. All patients had EEGs showing discontinuity, electrodecrements, or both along with diffuse slowing, background voltages between 100 and 300 μV, and superimposed multifocal, diffuse epileptiform discharges. Every patient, except one, fulfilled the definition of drug-resistant epilepsy, and all reported either moderate-to-severe or severe developmental delay. Late infantile epileptic encephalopathy (LIEE) is characterized by several unique clinical and electrographic features. Typically, LIEE manifests in patients during the second year of life and occurs before two years of age, hence late infantile onset. The condition is commonly observed in infants with symptomatic epilepsy. Myoclonic-tonic and spasm-tonic seizures are the quintessential seizure types. The inter-ictal EEG exhibits more organization and lower voltages than seen with hypsarrhythmia and lacks the defining EEG characteristics of EIDEE, IESS, or LGS. We propose that LIEE is a distinct electroclinical syndrome within the spectrum of developmental and epileptic encephalopathies.

Interpretable synthetic signals for explainable one-class time-series classification

This research paper introduces an innovative approach for explainable one-class time-series classification (XOCTSC). The proposed method involves generating pseudounseen synthetic signals by altering the amplitude and cycle of the original signals. Subsequently, a classification process is performed to distinguish between the original and synthetic signals, and the resulting model is applied to testing data. Instances classified as synthetic classes are treated as unseen classes, and the dissimilarity with the training data can be elucidated through an explanation of the synthetic class creation process. This approach aims to enhance the interpretability of one-class time-series classification models by providing insights into the reasoning behind their decisions. The proposed method is demonstrated with a ballistocardiogram (BCG) signal for the breathing dataset and an electroencephalogram (EEG) signal for the epilepsy dataset. The proposed method recognizes BCG amplitude reduction during breath holding. Moreover, EEG cycle changes during epileptic seizures are observed across multiple channels. These observations align with actual epilepsy symptoms and breathing behaviors.

Non-ictal, interictal and ictal déjà vu: a systematic review and meta-analysis.

Déjà vu, French for "already seen," is a phenomenon most people will experience at least once in their lifetime. Emerging evidence suggests that déjà vu occurs in healthy individuals (as "non-ictal déjà vu") and in epilepsy patients during seizures (as "ictal déjà vu") and between seizures (as "interictal déjà vu"). Although the ILAE has recognized déjà vu as a feature of epileptic seizures, it is notably absent from the ICD-11. A lack of evidence-based research may account for this omission. To our knowledge, this study represents the first systematic review and meta-analysis on déjà vu experiences. Through detailed examinations of non-ictal, interictal and ictal déjà vu, we seek to highlight possible clinical implications. Rethinking the status quo of ictal déjà vu could potentially lead to earlier interventions and improve outcomes for epilepsy patients. This study was registered in PROSPERO (ID: CRD42023394239) on 5 February 2023. Systematic searches were conducted across four databases: EMBASE, MEDLINE, PsycINFO, and PubMed, from inception to 1 February 2023, limited to English language and human participants. Studies were included/excluded based on predefined criteria. Data was extracted according to the PICO framework and synthesized through a thematic approach. Meta-analyses were performed to estimate prevalence's of the phenomena. Study quality, heterogeneity, and publication bias were assessed. Database searching identified 1,677 records, of which 46 studies were included. Meta-analyses of prevalence showed that non-ictal déjà vu was experienced by 0.74 (95% CI [0.67, 0.79], p < 0.001) of healthy individuals, whereas interictal déjà vu was experienced by 0.62 (95% CI [0.48, 0.75], p = 0.099) and ictal déjà vu by 0.22 (95% CI [0.15, 0.32], p = 0.001) of epilepsy patients. Examinations of phenomenological (sex, age, frequency, duration, emotional valence, and dissociative symptoms) and neuroscientific (brain structures and functions) data revealed significant variations between non-ictal, interictal and ictal déjà vu on several domains. This systematic review and meta-analysis do not support the notion that non-ictal, interictal and ictal déjà vu are homogenous experiences. Instead, it provides insight into ictal déjà vu as a symptom of epilepsy that should be considered included in future revisions of the ICD-11. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394239, CRD42023394239.

Cerebral Proliferative Angiopathy as the Cause of Symptomatic Epilepsy in a Young Adult Male: A First Case Report from Indonesia

Background: Cerebral proliferative angiopathy (CPA) is a rare and distinct vascular malformation that was once considered a subset of cerebral arteriovenous malformation (AVM). Due to its relatively benign course with no distinctive clinical feature, CPA may often be overlooked and misdiagnosed with other diseases. We report a case of CPA as the underlying cause of symptomatic epilepsy. Case: A 31-year-old male presented to the outpatient clinic with a history of focal to bilateral tonic-clonic seizure for 2 years. Following conservative management with an oral antiepileptic agent, the seizure frequency significantly decreased from once daily to once or twice monthly. The patient was lost to follow-up; however, he was incidentally referred back to our clinic two years later for further evaluation. A head Magnetic Resonance Imaging and Magnetic Resonance Angiography revealed a suspicion of giant AVM in the left hemisphere. Cerebral digital subtraction angiography (DSA) was performed and revealed a CPA in the left frontal area. The patient was managed conservatively and during the 6-month follow-up period, the patient did not have any seizures. Discussion: In young adults, seizures may be caused by an underlying vascular abnormality. Cerebral DSA remained the gold standard for distinguishing various etiologies of vascular malformation, including CPA. Conservative treatment using oral antiepileptic agents was effective in controlling the seizure frequency in CPA. However, a complete diagnostic evaluation is still warranted to determine the most appropriate treatment, revealing some peculiar and unexpected etiologies in the process.

Hypothalamic-Pituitary-Adrenal Axis and Epilepsy.

Epilepsy is a recurrent, transient seizure disorder of the nervous system that affects the intellectual development, life and work, and psychological health of patients. People with epilepsy worldwide experience great suffering. Stressful stimuli such as infection, mental stress, and sleep deprivation are important triggers of epilepsy, and chronic stressful stimuli can lead to frequent seizures and comorbidities. The hypothalamic-pituitary-adrenal (HPA) axis is the most important system involved in the body's stress response, and dysfunction thereof is thought to be associated with core epilepsy symptoms and related psychopathology. This article explores the intrinsic relationships of corticotropin-releasing hormone, adrenocorticotropic hormone, and glucocorticoids with epilepsy in order to reveal the role of the HPA axis in the pathogenesis of epilepsy. We hope that this information will yield future possible directions and ideas for fully understanding the pathogenesis of epilepsy and developing antiepileptic drugs.

Antiepileptic therapy algorithms in patients with primary and metastatic brain tumors

Up to date the brain tumors incidence keeps growing worldwide. Epilepsy and epileptic seizures are one of the most common clinical features of brain tumors. The aim of the study was to invent the algorithms antiepileptic treatment of patients with primary and metastatic brain tumors based on literature data. We searched eLIBRARY, PubMed databases by keywords. We concluded, that preventive antiepileptic drugs administration in patients with primary or metastatic brain lesions does not lower the risk of acute symptomatic postoperative seizures or epilepsy incidence, and therefore should not be recommended. Experts’ opinion states that in patients with brain tumors even one unprovoked seizure makes it feasible to initiate antiepileptic drugs therapy as soon as possible. In case of two or more unprovoked episodes (with over 24 hours difference) the diagnosis of “epilepsy” is legitimate and antiepileptic therapy should be started. The treating physician’s choice of antiepileptic therapy is based on type of seizures, age and sex of the patient, the comorbidity and potential antiepileptic drugs pharmacokinetic interactions with other drugs (including chemotherapy), in particular, one should avoid the use of liver microsomal-inducing antiepileptic drugs. The presented algorithms provide the decision-making guidelines in case of intraoperative focal seizures, acute symptomatic seizures and status epilepticus occurrence in early postoperative period.

Emotional-personality changes in patients with symptomatic epilepsy depending on etiology

Emotional-personality changes in patients with symptomatic epilepsy depending on etiology

Preparedness of Citizens in Al-Madinah City to Deliver Seizure First Aid Measures.

Introduction Epilepsy is a neurologic disease that causes a predisposition to recurrent seizure attacks. It affects a large number of people around the world and in Saudi Arabia. Seizures can be a source of distress for both the affected person and those witnessing them. Thus, being able to deliver first aid is important, as it improves safety and decreases the burden of visits to the emergency room that are unnecessary, since many attacks of seizure can be managed in the community. Weak knowledge regarding seizure first aid measures is reported many times across Saudi Arabia, with a high prevalence of misconceptions. Methods This study employed a descriptive cross-sectional design, utilizing a questionnaire-based approach. The data was collected from a sample of 1871 individuals residing in Al-Madinah City, Saudi Arabia. The participants completed a self-administered online questionnaire and ensured anonymity. The questionnaire used in this study was previously validated and used in another study. We used descriptive statistics to summarize the data, and Chi-square test was employed to establish the association between sociodemographic data and knowledge of seizure first aid. Results Most of the participants were females (70.0%, N=1310), and the majority (76.1%, N=1423) fell within the 18-30 age group. A high percentage were single (71.6%, N=1339), college graduates (64.3%, N=1201), and unemployed (58.7%, N=1099). The study results revealed that 31.9% (N=597) had a good knowledge level of epilepsy, while 68.1% (N=1274) had poor knowledge. Nearly half (48.4%, N=905) believed that epilepsy was caused by genetic factors, and 61.4% (N=1149) of the respondents reported loss of consciousness as the most common clinical symptom of epilepsy. With regards to correct action during seizures, 48.0% (N=899) knew to place the patient on their side, and 85.0% (N=1591) thought calling 997 ("the ambulance") was necessary if seizures lasted over five minutes. The study showed a statistically significant association between the level of education, employment, and knowledge of epilepsy first aid management (p=0.001 and p=0.003, respectively). However, no significant associations were found between gender, age, marital status, and knowledge of epilepsy first aid management (p>0.005). Conclusion The study unveiled poor overall epilepsy knowledge among Al-Madinah City residents, with only 31.9% (N=597) demonstrating good knowledge. This indicates the community's limited ability to respond to seizures. Most citizens were unfamiliar with seizure first-aid, lacking the capability to provide assistance. A significant association was found between education, employment, and epilepsy first aid knowledge. Respondents with higher education had better epilepsy knowledge. Attending epilepsy education courses is vital for enhancing overall awareness and readiness to provide seizure first aid.

The role of CT scan in diagnosing neurocysticercosis in patients with seizures: a case report

Background: Neurocysticercosis is the most common parasitic infectious disease affecting the human central nervous system in endemic countries. It is caused by the ingestion of Taenia solium eggs excreted in the faeces of human tapeworm carriers. The disease is often asymptomatic, but can also cause seizures, disorientation, visual disturbances, focal neurologic deficits, psychiatric symptoms, strokes, and elevated intracranial blood pressure. Neuroimaging remains the gold standard for diagnosis, which includes the CT scan. This case report aimed to discuss the role of the CT scan in the diagnosis of neurocysticercosis in a 40-year-old male patient with a history of seizures. Case presentation: A 40-year-old male complained of seizures one hour before admission. Before the seizure, the patient reported that he was active as usual and had no complaints. The patient stated that he likes to eat pork and red lawar, which is made from raw pig blood. Physical examination revealed that the patient had a fever. Neurologic examination was within the normal range. Axial view CT scan of the head without contrast showed multiple calcifications with a hypodense area around them. Then, the patient was diagnosed with serial seizures due to symptomatic epilepsy and cerebral neurocysticercosis. He was treated with anthelmintic, antiseizure and symptomatic medication. After one month following therapy, there were no reports of headaches or seizures. The follow-up CT scan at the same slice as the lesion decreased the amount of calcifications, but the right frontal and left parietal regions were still visible. Conclusion: Neuroimaging studies such as CT scans are among the tests that can be performed on seizure patients to detect neurocysticercosis in endemic areas.

Abstract 14779: Whole Exome Sequencing Study in Pediatric Postural Orthostatic Tachycardia Syndrome Unveils a Path Forward From Genes to Drugs

Introduction: Postural orthostatic tachycardia syndrome (POTS) is more common in Caucasian individuals with a positive family history, while the risk in females is ~4-times of that in males. To date, the etiology of POTS is poorly understood. Hypothesis: Integrative sequencing and translational approaches to identify its genetic underpinning may better understand its pathogenesis and molecular mechanisms for the development of novel precision-based therapies. Methods: We adopted exome sequencing to evaluate the etiology and molecular mechanisms of POTS. We examined a unique collection of 87 unrelated pediatric POTS cases (61 females and 26 males, 6~21 years old), using exome sequencing. Non-relationship between individuals were validated by genome wide genotyping and identity by descent (IBD) analysis. Results: All the individuals were classified as European by principal component analysis (Figure 1). We identified 184 pathogenic (P) or likely pathogenic (LP) variants (in 162 genes). Sixty-eight (78%) cases have at least one P/LP variant. Each P/LP mutation is supported by a minimum of two databases, including ClinVar, InterVar or HGMD_Pro_2023.1. Over-representation analysis (ORA) by the DisGeNET approach showed the enriched gene sets of muscle hypotonia and epilepsy/seizures with statistical significance (FDR&lt;E-10). Clinically, among the 87 WES patients, 41 (47%) suffered from chronic fatigue, and 13 (15%) patients have the symptoms of epilepsy, seizure or convulsion. A number of drug targets in these gene sets are highlighted, including vitamin D receptor, carbamoyl-phosphate synthase 1, methylmalonyl-CoA mutase, androgen receptor, and phenylalanine hydroxylase. Conclusions: Our results suggests that chronic fatigue and epilepsy/seizure symptoms are comorbid symptoms in POTS patients, resulting from common genetic defects. Future precision-based therapies targeting these specific genetic defects may lead to improved outcome in POTS.

Comorbid mental disorders with epilepsy in childhood

The clinical and anamnestic method analyzed 496 outpatient records of children and adolescents suffering from epilepsy in order to identify data contributing to the development and influencing the nature and severity of comorbid mental disorder. The presence of cognitive and affective disorders of varying severity was noted in 415 (83.6%) patients. As an addition to the neurological diagnosis was revealed: 171 patients (61.3%) had anxiety-depressive syndrome, 245 patients (87.8%) had emotional-volitional instability syndrome, and 101 patients (36.2%) had autism spectrum disorder (ASD). But further psychiatric verification of these syndromes in accordance with ICD-10 was not carried out. Clinical, neurophysiological and morphological characteristics of comorbid mental symptoms in epilepsy in childhood and adolescence were revealed.

Primary Angiitis of the Central Nervous System in Adults: A Comprehensive Review of 76 Biopsy-Proven Case Reports.

Primary angiitis of the adult central nervous system (PACNS) is an increasingly recognized but limited disease. Using previous case reports, we sought to summarize the clinical symptoms, imaging manifestations, treatment, and prognosis of patients with biopsy-confirmed PACNS to guide clinical diagnosis and management. We searched the Web of Science database for studies published from January 2000 to April 2023, with the language set to English and the document type limited to [Article or Review or Letter or Editorial Material]. A systematic review of all case reports met the inclusion and exclusion criteria was performed. These patients' clinical, pathological, and imaging characteristics were analyzed, and treatment and prognostic data were summarized. We analyzed 69 articles, including 76 patients with biopsy-confirmed PACNS. And 57.9% of the patients were male, the median age at presentation was 47.0 years, and focal neurological deficits were the most common symptom in patients (78.9%), followed by headache (52.6%). The median duration of biopsy was 1.1 months, of which 49 (64.5%) patients were lymphocytic, 13 (17.1%) were granulomatous, 11 (14.5%) were amyloidotic, and 3 (3.9%) were necrotizing PACNS. Relapse events occurred in 41 (53.9%) patients, including 34 (44.2%) relapses and 8 (10.5%) deaths. Univariate logistic regression analysis revealed that symptomatic epilepsy, prolonged biopsy time window, and CD20 expression in pathological tissues might be independent risk factors for recurrent events in patients (HR=4.69, 95% CI: 1.51-14.54, p=0.007; HR=1.11, 95% CI: 1.00-1.22, p=0.043; HR=5.33, 95% CI: 1.07-26.61, p=0.041). Adult PACNS is associated with frequent relapses and high mortality. Symptomatic epilepsy, prolonged biopsy time window, and CD20 expression in pathological tissue may be associated with recurrent events.

P2.09-42 Aumolertinib Combined with Carbamazepine and Intrathecal Pemetrexed for EGFR-mutated LM NSCLC with Symptomatic Epilepsy

P2.09-42 Aumolertinib Combined with Carbamazepine and Intrathecal Pemetrexed for EGFR-mutated LM NSCLC with Symptomatic Epilepsy

Are There any Possible Side Effects of Neurofeedback? A Systematic Literature Review and Meta-analysis

Context: This study aimed to investigate the pieces of evidence related to the possible side effects of neurofeedback (NFB) for individuals suffering from attention-deficit hyperactivity disorder (ADHD) and epilepsy. In this systematic review of randomized controlled trials (RCTs) for individuals suffering from these two conditions, several databases were investigated. Evidence Acquisition: To achieve this goal, the table of the first outcomes was to rate the symptoms of epilepsy based on the evaluation of patients. CANTAB (Cambridge Neuropsychological Test Automated Battery), Wechsler Intelligence Scale for Children II (WISC II), and attention span test. Additionally, side effects were assessed by ADHD and epilepsy side effect checklists. Among the documents, 17 of them had the criteria to be included. Results: It was a randomized effect model that was used to evaluate the pooled prevalence of side effects with confidence intervals (CI) of 95%. Moreover, in Stata software (version 14), a Metaprop command was deployed. The approximate pooled prevalence of the side effects was 0.05 (95% CI: 0.03 - 0.08). To measure heterogeneity among studies, I2 statistics and the Galbraith diagram were applied. I2 statistics were estimated as 2.34%, and the Galbraith diagram did not indicate any heterogeneity. The univariate meta-regression (UMR) model showed despite a decreasing trend, the results were not statistically significant. Conclusions: It could be inferred from the results that preliminary evidence is that NFB is a non-invasive treatment and a more beneficial clinical method. It is proposed that to compare standard treatments, such as medication, neurological, and behavioral interventions, further RTCs are required.

Differences in the distribution of triggers among resting state networks in patients with juvenile myoclonic epilepsy explained by network analysis.

Juvenile myoclonus epilepsy (JME) is an idiopathic generalized epilepsy syndrome. Functional connectivity studies based on graph theory have demonstrated changes in functional connectivity among different brain regions in patients with JME and healthy controls. However, previous studies have not been able to clarify why visual stimulation or increased cognitive load induces epilepsy symptoms in only some patients with JME. This study constructed a small-world network for the visualization of functional connectivity of brain regions in patients with JME, based on system mapping. We used the node reduction method repeatedly to identify the core nodes of the resting brain network of patients with JME. Thereafter, a functional connectivity network of the core brain regions in patients with JME was established, and it was analyzed manually with white matter tracks restriction to explain the differences in symptom distribution in patients with JME. Patients with JME had 21 different functional connections in their resting state, and no significant differences in their distribution were noted. The thalamus, cerebellum, basal ganglia, supplementary motor area, visual cortex, and prefrontal lobe were the core brain regions that comprised the functional connectivity network in patients with JME during their resting state. The betweenness centrality of the prefrontal lobe and the visual cortex in the core functional connectivity network of patients with JME was lower than that of the other brain regions. The functional connectivity and node importance of brain regions of patients with JME changed dynamically in the resting state. Abnormal discharges originating from the thalamus, cerebellum, basal ganglia, supplementary motor area, visual cortex, and prefrontal cortex are most likely to lead to seizures in patients with JME. Further, the low average value of betweenness centrality of the prefrontal and visual cortices explains why visual stimulation or increased cognitive load can induce epileptic symptoms in only some patients with JME.

An Interesting Case of Eating Epilepsy

Abstract Eating epilepsy (EE) is a rare form of reflex epilepsy, characterized by seizures triggered by food intake. We describe the case of a 30-year-old male with symptomatic EE, wherein consumption of food precipitated focal seizures with impaired awareness. The seizures were precipitated at the beginning of the meal, lasted up to 30 s at a time, were not preceded by an aura, and the patient had complete amnesia for the events once the seizures subsided. No predilection to a particular food type was noted. The seizures were not precipitated by any other activity.