Unprovoked Seizures Research Articles

Risk of Recurrence in Patients with an Unprovoked Tonic-Clonic Seizure and Generalized Epileptiform Discharges on EEG.

The decision to initiate treatment in patients with a first unprovoked seizure remains controversial. Studies have reported a recurrence rate ranging from 21-50%, but most have included patients with different etiologies, EEG findings, and seizure types. This study aimed to determine the risk of recurrence in patients with a first unprovoked generalized tonic-clonic (GTC) seizure with evidence of generalized spike-wave discharges (GSWD) on EEG and compare the efficacy of antiseizure medications (ASM) in preventing recurrence. This prospective study included consecutive patients who presented with a single GTC seizure, evidence of GSWD on EEG, and a follow-up period of at least one year. All patients underwent extensive evaluation, including a 3-hour sleep-deprived video-EEG recording and an epilepsy protocol brain MRI. Treatment with ASM was recommended for all patients. The decision regarding the specific ASM to be used was left to the treating physician's discretion. A total of 57 patients with a median age of 19 years were included. A total of 41 patients agreed to be started on an ASM while 16 declined. Seizure recurred in 6/41 (14.6%) patients in the treated group compared to 11/16 (68.8%) in the untreated group (P = 0.00006). Valproate was significantly more efficacious than levetiracetam or lamotrigine (P = 0.04). Of the 15 patients who discontinued ASM treatment after remaining seizure free for an average of 30 months, 6 (40%) experienced a seizure recurrence. Patients with a first unprovoked GTC seizure and evidence of GSWD on EEG have a high risk of recurrence if left untreated. Valproate is the most efficacious ASD for preventing recurrence in this population. A sizeable proportion of patients can be successfully tapered off medication after a period of seizure freedom. This study provides valuable information for guiding treatment decisions in this patient population.

Prevalence of anti-seizure medication nonadherence and its associated factors, among people with epilepsy in North Shewa, Ethiopia, 2021

BackgroundEpilepsy is a worldwide neurologic illness, characterized by recurrent unprovoked epileptic seizures and can affect people of all age groups. Patients who are receiving drug therapy for chronic diseases, such as epilepsy, must fit complex medication regimens into their everyday routines. Managing medication schedules may pose a significant burden on patients’ lives. Anti-seizure medication choices should therefore be tailored to patients’ factors that may limit medication use. The study aimed to determine the prevalence and Predictors of anti-seizure medication nonadherence among patients with epilepsy. MethodologyAn institutional-based cross-sectional study was conducted among 352 people with epilepsy who were selected by systematic random sampling method at government hospitals in North Shewa Ethiopia. Data were collected by reviewing patients’ charts and interviewing people with epilepsy by using structured and pretested questionnaires. Data obtained were encoded into EPI-INFO software and exported to SPSS version 25 for analysis. Logistic regression was employed to assess independent factors associated with medication non-adherence. ResultThe prevalence of anti-seizure medication non-adherence was 40%. Being female [AOR = 3.37, 95%, CI: 1.84, 6.18], Divorced [AOR = 9.13, 95%, CI: 1.80, 46.34], Being jobless [AOR = 7.33, 95%, CI: 3.24, 16.56], Perceived poor social support [AOR = 2.73, 95%, CI: 1.28, 5.82], perceived stigma [AOR = 5.07, 95%, CI: 2.40, 10.68], polytherapy [AOR = 2.23, 95%, CI: 1.06, 4.71], drug side effects[AOR = 6.03, 95%, CI: 3.17, 11.45], buying medications [AOR = 5.81, 95%, CI: 3.63,16.79] and duration of stay on treatment [AOR = 4.31, 95%, CI: 1.863, 9.97] were significant predictors of anti-seizure medication non-adherence. ConclusionNon-adherence to anti-seizure medication among people with epilepsy in the study area was relatively higher as compared with study reports from different parts of the country. Health and clinical, socio-economy, and patients’ psychological mindset were among the determinant factors affecting the consistency of epilepsy treatment adherence. Enhanced professional, health education for patients as well as for society and financial support, are basic pillars to reduce the constraints of effective treatment.

Antiepileptogenesis after stroke-trials and tribulations: Methodological challenges and recruitment results of a Phase II study with eslicarbazepine acetate.

There is currently no evidence to support the use of antiseizure medications to prevent unprovoked seizures following stroke. Experimental animal models suggested a potential antiepileptogenic effect for eslicarbazepine acetate (ESL), and a Phase II, multicenter, randomized, double-blind, placebo-controlled study was designed to test this hypothesis and assess whether ESL treatment for 1 month can prevent unprovoked seizures following stroke. We outline the design and status of this antiepileptogenesis study, and discuss the challenges encountered in its execution to date. Patients at high risk of developing unprovoked seizures after acute intracerebral hemorrhage or acute ischemic stroke were randomized to receive ESL 800 mg/d or placebo, initiated within 120 hours after primary stroke occurrence. Treatment continued until Day 30, then tapered off. Patients could receive all necessary therapies for stroke treatment according to clinical practice guidelines and standard of care, and are being followed up for 18 months. The primary efficacy endpoint is the occurrence of a first unprovoked seizure within 6 months after randomization ("failure rate"). Secondary efficacy assessments include the occurrence of a first unprovoked seizure during 12 months after randomization and during the entire study; functional outcomes (Barthel Index original 10-item version; National Institutes of Health Stroke Scale); post-stroke depression (Patient Health Questionnaire-9; PHQ-9); and overall survival. Safety assessments include the evaluation of treatment-emergent adverse events; laboratory parameters; vital signs; electrocardiogram; suicidal ideation and behavior (PHQ-9 question 9). The protocol aimed to randomize approximately 200 patients (1:1), recruited from 21 sites in seven European countries and Israel. Despite the challenges encountered, particularly during the COVID-19 pandemic, the study progressed and included a remarkable number of patients, with 129 screened and 125 randomized. Recruitment was stopped after 30 months, the first patient entered in May 2019, and the study is ongoing and following up on patients according to the Clinical Trial Protocol.

Seizure After Ischemic Stroke; A Diagnostic and Management Challenge in a Resource Limited Setting: A Case Report

Background: Poststroke seizures occur in 6-8% of the adult population that suffer an ischaemic stroke. This pathological process increases metabolic stress and cell death, the extent of vascular obstruction in the brain, the mortality rate and long term morbidity. Poststroke seizures represent one of the most important complications of stroke that must be recognised and treated in a timely fashion. These are classified as either early or late depending on the time of onset after stroke. Case Report: A 51 year old woman presented to the Emergency Department of RSUD Dr Murjani following a generalised tonic-clonic seizure 3 hours prior that had lasted for two minutes. On arrival the patient subsequently had two further generalised tonic-clonic seizures with a one hour interval between. Whole body stiffness and a fixed upward gaze were observed. A non-contrast CT Head displayed a diffuse infarct of the left frontotemporoparietooccipital lobes. The patient had a history of stroke one year previously and a second stroke one month ago with resultant persistent weakness of the right upper and lower limbs. This patient was diagnosed with poststroke seizure of late onset and treated in hospital with diazepam 10mg and phenytoin 100mg three times per day. Discussion: Poststroke seizure is described as either early-onset (occurring in the first week after a stroke) or late-onset (occurring after the first week). Based on the International League Against Epilepsy (ILAE) definition, a single unprovoked late-onset poststroke seizure occurring more than seven days after a stroke is considered as epilepsy with a high risk (>60%) of recurrent seizures that may occur for up to ten years thereafter. Hence this risk factor must be identified and treated correctly to prevent significantly increased morbidity for the patient

Driving regulations for epilepsy in Europe

BackgroundAcross Europe, there are differences regarding driving restrictions for patients with epilepsies and seizures. In the light of increasing mobility, knowledge about those different regulations is of high importance for counseling patients, and physicians. MethodsA structured online survey was sent to the official representatives of the different European ILAE chapters, asking for the local driving restrictions for patients with epilepsies, first seizures, syncopes, and psychogenic non-epileptic seizures. ResultsThe survey was sent to 38 chapters or representatives of 47 European Countries. 33 chapters answered. The majority of countries require 1 year of seizure-freedom for the ability to drive (Group 1, former categories A, B, B + E, F, G. H, K, L, and P; driving license which authorizes its holder to drive vehicle classes categories of the motor vehicle), usually with the need to continue antiseizure medication (ASM). Some countries have much stricter regulations before allowing for driving. Legal regulations after a first unprovoked seizure differ between 6 months for Group 1 license holders in most European countries, and one year in Luxembourg and Malta. In Serbia, there is no legal regulation for this special situation. The situation after a first seizure is even more complex for Group 2 license holders (former categories C1, C1+E, C, C + E, D1, D1+E, D, D + E). ConclusionKnowledge of the different recommendations of the individual European countries is of high relevance in the counseling of epilepsy patients. Europe-wide regulations, e.g. following the IBE-recommendations are needed to facilitate the patients’ situation.

Clinical & etiological profile of new onset unprovoked seizure in children aged 2 months to 18 years

Seizure is defined as abnormal paroxysmal neuronal discharge, which is clinically manifested by motor, sensory, autonomic or behavioral disturbances. Seizures are common in pediatrics age group and occur in 10% of children. Less than 1/3of seizures in children are caused by epilepsy. The objective of the study was to determine the clinical and etiological profile of new onset unprovoked seizure in children aged between 2 month to 18 years. A hospital based prospective single centre study at RNT Medical College, Udaipur. 111 patients admitted in Balchikitsalya with new onset unprovoked seizures during one year. Out of 111 patients with new onset unprovoked seizures, majority of patients were between 1-5 years of age with male predominance. In which most common diagnosis was seizure disorder in 78 pts (70.2%) [Generalised 76 pts (97.4%) > Focal 2 pts (2.6%)] followed by 13.5% hypocalcemic seizure, 8.1% hypoglycemic seizure. Other diagnosis was tuberous sclerosis (2.7%), white matter changes (1.8%), adrenoleukodystrophy (0.9%), arachnoid cyst (0.9%), tuberculoma (0.9%) and HIE changes (0.9%). EEG abnormality was seen in 46% of patients. Hyponatremia (36%) was significantly associated with abnormal EEG changes. MRI was done in 38.7% of the patients, out of which, abnormality was seen in only 8.6% of the children. Seizure is mainly diagnosed clinically and EEG can be normal in many patients. First episode of unprovoked seizure was common in age group of 1-5 years. EEG and Neuroimaging is useful for better diagnosis, treatment can be started on clinical diagnosis.

Diagnostic Accuracy of Ambulatory EEG vs Routine EEG in Patients With First Single Unprovoked Seizure.

To evaluate the diagnostic accuracy of the ambulatory EEG (aEEG) at detecting interictal epileptiform discharges (IEDs)/seizures compared with routine EEG (rEEG) and repetitive/second rEEG in patients with a first single unprovoked seizure (FSUS). We also evaluated the association between IED/seizures on aEEG and seizure recurrence within 1 year of follow-up. We prospectively evaluated 100 consecutive patients with FSUS at the provincial Single Seizure Clinic. They underwent 3 sequential EEG modalities: first rEEG, second rEEG, and aEEG. Clinical epilepsy diagnosis was ascertained based on the 2014 International League Against Epilepsy definition by a neurologist/epileptologist at the clinic. An EEG-certified epileptologist/neurologist interpreted all 3 EEGs. All patients were followed up for 52 weeks until they had either second unprovoked seizure or maintained single seizure status. Accuracy measures (sensitivity, specificity, negative and positive predictive values, and likelihood ratios), receiver operating characteristic (ROC) analysis, and area under the curve (AUC) were used to evaluate the diagnostic accuracy of each EEG modality. Life tables and the Cox proportional hazard model were used to estimate the probability and association of seizure recurrence. Ambulatory EEG captured IED/seizures with a sensitivity of 72%, compared with 11% for the first rEEG and 22% for the second rEEG. The diagnostic performance of the aEEG was statistically better (AUC: 0.85) compared with the first rEEG (AUC: 0.56) and second rEEG (AUC: 0.60). There were no statistically significant differences between the 3 EEG modalities regarding specificity and positive predictive value. Finally, IED/seizure on the aEEG was associated with more than 3 times the hazard of seizure recurrence. The overall diagnostic accuracy of aEEG at capturing IED/seizures in people presenting with FSUS was higher than the first and second rEEGs. We also found that IED/seizures on the aEEG were associated with an increased risk of seizure recurrence. This study provides Class I evidence supporting that, in adults with First Single Unprovoked Seizure (FSUS), 24-h ambulatory EEG has increased sensitivity when compared with routine and repeated EEG.

CLINICO-ETIOLOGICAL PROFILE OF FIRST EPISODE OF SEIZURE AND ITS CORRELATION WITH ELECTROENCEPHALOGRAM AND IMAGING SPECTRUM IN CHILDREN AGED ABOVE 5 YEARS OF AGE IN A TERTIARY CARE HOSPITAL: A PROSPECTIVE OBSERVATIONAL STUDY

Seizures, a transient occurrence of signs and/or symptoms resulting from abnormal excessive or synchronous neuronal activity in the brain [1, 2].Seizure is one of the commonest neurological illnesses. About 4-10% of children experience at least one episode in the rst 16 years of life. Where 1/5th of total children with unprovoked seizures may develop epilepsy. Risk is approximately 20% if neurological examination, electroencephalogram (EEG) and neuroimaging is normal[1]. EEG abnormalities can be detected in up to 59% of children with rst afebrile seizure and can identify subtle focality in presence of normal magnetic resonance imaging of brain[1]. Neuroimaging has an important role in children with focal seizure, persistent seizure activity, focal neurologic decit, neurocutaneous disorder etc.Right assessment and scrutiny of rst seizure is crucial, not only for abortion of acute attack but also for long term control of epilepsy. Aim and methods- The objective of the study is to determine the age of onset, etiology of rst episode of seizure in children between the age group of above 5 yearsto15 years and the pattern of EEG changes and MRI ndings in the above group of children. In a prospective single centre observational study at GIMS GADAG, around 60 children who were admitted with rst episode of seizure at age group of above 5 years to 15 years to our emergency department between October 2021 to July-2022 (10 months) were studied. Seizures dened using international league against epilepsy (ILAE). EEG and MRI were done in all 60 children and their records were analysed. Results- A total of 60 children presenting with rst episode of seizures were included in the study. 9-12 year age group were major portion of our study with male gender predominance. Generalized seizures were more common accounting for 78%. Idiopathic seizure was the most common etiology identied (40%), followed by meningitis (27%) and other causes. EEG abnormality was seen in 50% of the children.

Natural History of Seizures in Alexander Disease (P10-9.011)

<h3>Objective:</h3> To describe seizure burden in Alexander disease (AxD) <h3>Background:</h3> Seizures in AxD contribute to both burden of disease and neurologic deterioration. Patients with provoked seizures at presentation are often not initiated on anti-seizure medication (ASM) in the setting of delayed recognition of AxD. Improved understanding of seizure burden over time in AxD may aid in diagnosis, anticipatory guidance, and management. <h3>Design/Methods:</h3> Medical records and structured interviews of AxD participants in a natural history study (1/2016–9/2022) were reviewed for occurrence of seizures and presence of provoking factors (illnesses with or without fever, ingestions, head trauma). Descriptive statistics were used to quantify seizure burden over time. <h3>Results:</h3> Of 81 patients with a median age at last follow-up of 10.1 years (IQR11.3), 46 (57%) had ≥1 seizure. First seizure occurred at a mean age of 29.9 months (SD45.6) overall, with no significant difference between patients whose first seizure was provoked vs unprovoked (22.4 months, SD18.0 vs 45.3 months, SD75.0, p=0.3). Overall, 96% of patients had additional seizures; of these 87% had multiple unprovoked seizures. Only 9% had exclusively provoked seizures. Excluding two outliers, first seizure preceded the diagnosis of AxD by a mean of 20.8 months (SD41.5). EEG abnormalities (generalized or focal slowing, epileptiform discharges) were similarly common prior to diagnosis. Of these patients, 63% had their first seizure, provoked or unprovoked, prior to 2 years of age. At this same age 94% of the cohort had already demonstrated developmental delay. <h3>Conclusions:</h3> Provoked seizures are common in patients with AxD, often occurring concurrently with developmental delays and prior to the diagnosis of underlying leukodystrophy. Provoked seizures in the setting of developmental delays, even when mild, should prompt additional evaluation. Given high incidence of unprovoked seizures over time as well as associated risk of neurologic regression, provoked seizures in patients with AxD should prompt consideration of ASM. <b>Disclosure:</b> Miss Gallison has nothing to disclose. Dr. Porcari has nothing to disclose. Ms. Sergio has nothing to disclose. Dr. Waldman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for SwanBio. An immediate family member of Dr. Waldman has stock in Pfizer. The institution of Dr. Waldman has received research support from Ionis Pharmaceuticals. Dr. Waldman has received publishing royalties from a publication relating to health care.

Impact of a Free Anti-seizure Medication Intervention on Anxiety and Depression in People Living with Epilepsy in the Republic of Guinea (S1.001)

<h3>Objective:</h3> To quantify anxiety and depression in people living with epilepsy (PLWE) in Guinea before and after anti-seizure medication (ASM) intervention. <h3>Background:</h3> Little is known about mental health in PLWE in Sub-Saharan Africa and how seizure freedom could improve outcomes. <h3>Design/Methods:</h3> PLWE were prospectively recruited in Conakry (March 2022) to receive free clinical consultations with neurologists to implement/augment treatment regimens with free ASMs. Inclusion criteria were: &gt;12 years old and &gt;=2 unprovoked seizures. As part of a broader interview, participants reported seizure frequency and completed scales screening for depression (PHQ-9) and anxiety (GAD-7). 90-day follow-up assessed adherence to ASMs and re-assessed seizure frequency and mental health scales. <h3>Results:</h3> Of 148 participants enrolled (mean age=27.3 years, range 12–72; 45% female), 53.3% regularly took ASMs. Average seizure frequency over the 30 days pre-enrollment was 3.2 (SD=5.9; 28% seizure-free during this period). Treatment regimens were modified for 95% of participants, mostly consisting of new levetiracetam provision (n=115). At 90 days, retention was 78.4% (n=116). Average adherence was 87.0%. Average seizure frequency over the prior 30 days was 1.5 (SD=5.7; 66% seizure-free during this period). At baseline, average PHQ-9 score was 21.2 (95%CI [20.2,22.2]), indicating severe depressive symptoms, and average GAD-7 score was 16.5 [15.6,17.4], indicating severe anxious symptoms. At 90-days, average PHQ-9 was 17.5 [16.4,18.5] and significantly lower than baseline (p&lt;.001). Average GAD-7 was 14.4 [13.6,15.3] and significantly lower than baseline (p=.002). Seizure frequency was not correlated with PHQ-9 (p=.50) nor GAD-7 (p=.10) scores at baseline but was at 90-days (PHQ-9: r=.24, p=.01; GAD-7: r=.22, p=.02). <h3>Conclusions:</h3> High levels of anxiety and depression occur in PLWE in Guinea, underscoring the unmet psychiatric needs in un- and under-treated epilepsy and the need for collaboration between neurologists and psychiatrists. Medication intervention may positively impact mental health, highlighting seizure control in addition to psychiatric intervention for this population. <b>Disclosure:</b> Mr. Rice has nothing to disclose. Guelngar Carlos Othon has nothing to disclose. Dr. Traore has nothing to disclose. Mohamed Lamine Conde has nothing to disclose. Miss Diallo has nothing to disclose. Dr. Lee has nothing to disclose. Fode Abass Cisse has nothing to disclose. Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Mateen has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from NIH. The institution of Dr. Mateen has received research support from Sumaira Foundation. The institution of Dr. Mateen has received research support from EMD Serono. Dr. Mateen has received research support from Biogen.

Implementation and Assessment of A Pilot Workshop on Inpatient First Time Seizure History Taking and Counseling (P14-2.002)

<h3>Objective:</h3> To implement an intervention aimed at improving neurology residents’ history-taking and counseling skills when consulted for a “first-time seizure.” This intervention comprises three interactive, practice-based workshops implemented by a chief resident and epileptologist. <h3>Background:</h3> Neurology residents at our institution are frequently consulted for “first-time seizures,” but lack structured training. A structured workshop was planned to provide instruction and real-time feedback. <h3>Design/Methods:</h3> Four interactive cases were prepared with the brief: “You are consulted by the emergency department overnight for a ‘first-time seizure.’” The chief resident and eplileptologist acted as standardized patients; participants obtained a history and formulated a preliminary diagnosis. The history-taking goals were to 1) distinguish epileptic seizures from seizure mimics; 2) distinguish unprovoked, provoked, and acute symptomatic seizures; 3) to identify underlying epilepsy. Residents then provided counseling, including 1) the diagnosis, 2) diagnostic testing, 3) treatment, 4) driving and seizure precautions, and 5) gender-specific considerations as appropriate. Residents were presented with a 5-question pre- and post-quiz to assess their knowledge and a 5-question survey to assess their subjective confidence before and after the intervention. <h3>Results:</h3> Of eight residents who participated in the workshop, seven responded to the surveys. Subjectively, 5 (71%) reporting improved confidence in history taking and 6 (86%) reporting improved confidence in counseling. However, we did not see an objective change in the quiz results (pre: 71%–100%, post: 71%–100%). <h3>Conclusions:</h3> While the residents performed well on the knowledge-based quiz, this intervention was still able to improve participants’ confidence in their history-taking and counseling skills. This finding reflects the complexity of the topic and the need for ongoing training among residents. <b>Disclosure:</b> Dr. Rehim has nothing to disclose. Dr. Zobel has nothing to disclose. Dr. Husain has a non-compensated relationship as a member, Medical Board of Directors with Epilepsy Foundation of Eastern Pennsylvania that is relevant to AAN interests or activities.

What is the prognosis of adults and children following a first unprovoked seizure?

What is the prognosis of adults and children following a first unprovoked seizure?

Targeting ferroptosis as novel therapeutic approaches for epilepsy.

Epilepsy is a chronic disorder of the central nervous system characterized by recurrent unprovoked seizures resulting from excessive synchronous discharge of neurons in the brain. As one of the most common complications of many neurological diseases, epilepsy is an expensive and complex global public health issue that is often accompanied by neurobehavioral comorbidities, such as abnormalities in cognition, psychiatric status, and social-adaptive behaviors. Recurrent or prolonged seizures can result in neuronal damage and cell death; however, the molecular mechanisms underlying the epilepsy-induced damage to neurons remain unclear. Ferroptosis, a novel type of regulated cell death characterized by iron-dependent lipid peroxidation, is involved in the pathophysiological progression of epilepsy. Emerging studies have demonstrated pharmacologically inhibiting ferroptosis can mitigate neuronal damage in epilepsy. In this review, we briefly describe the core molecular mechanisms of ferroptosis and the roles they play in contributing to epilepsy, highlight emerging compounds that can inhibit ferroptosis to treat epilepsy and associated neurobehavioral comorbidities, and outline their pharmacological beneficial effects. The current review suggests inhibiting ferroptosis as a therapeutic target for epilepsy and associated neurobehavioral comorbidities.

Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model

Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. Type of acute symptomatic seizure. All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up.

Core Features Differentiate Dravet Syndrome from Febrile Seizures

An 11-month-old girl with febrile seizures and first unprovoked seizures was evaluated in the hospital. Relevant history included developmental delay and strong family history of febrile seizures and migraines. A routine electroencephalogram was performed and was abnormal due to the presence of a slowed posterior dominant rhythm, generalized spike-wave discharges, and multifocal sharp waves. The findings were concerning for a developmental and epileptic encephalopathy. Given the concern for a developmental and epileptic encephalopathy, a next generation sequence epilepsy gene panel was ordered which identified a pathogenic variant in SCN1A. The clinical history, electroencephalogram, and pathogenic variant were compatible with a diagnosis of Dravet syndrome. This Grand Rounds manuscript highlights the thought process, evaluation, differential diagnosis, treatment, and prognosis in Dravet syndrome.

Epilepsy and Driving

Driving is an important issue for people with epilepsy. Doctors need to understand the Road Traffic Act and give appropriate advice and guidance to patients. Driving is legally allowed for a person without seizures, impaired awareness, or motor components for more than 2 years. Although there is no specific rule about the first unprovoked seizure, observing for 6 months is recommended before starting to drive. If we notice a patient driving despite having seizures, we can report this to the National Public Safety Commission without violating confidentiality.

Pathomorphological Diagnostic Criteria for Focal Cortical Dysplasias and Other Common Epileptogenic Lesions-Review of the Literature.

Focal cortical dysplasia (FCD) represents a heterogeneous group of morphological changes in the brain tissue that can predispose the development of pharmacoresistant epilepsy (recurring, unprovoked seizures which cannot be managed with medications). This group of neurological disorders affects not only the cerebral cortex but also the subjacent white matter. This work reviews the literature describing the morphological substrate of pharmacoresistant epilepsy. All illustrations presented in this study are obtained from brain biopsies from refractory epilepsy patients investigated by the authors. Regarding classification, there are three main FCD types, all of which involve cortical dyslamination. The 2022 revision of the International League Against Epilepsy (ILAE) FCD classification includes new histologically defined pathological entities: mild malformation of cortical development (mMCD), mild malformation of cortical development with oligodendroglial hyperplasia in frontal lobe epilepsy (MOGHE), and "no FCD on histopathology". Although the pathomorphological characteristics of the various forms of focal cortical dysplasias are well known, their aetiologic and pathogenetic features remain elusive. The identification of genetic variants in FCD opens an avenue for novel treatment strategies, which are of particular utility in cases where total resection of the epileptogenic area is impossible.

Role of EEG and MRI brain in the diagnosis of unprovoked seizures in children in a tertiary care centre

Role of EEG and MRI brain in the diagnosis of unprovoked seizures in children in a tertiary care centre

The Role of Decompressive Craniectomy on Functional Outcome, Mortality and Seizure Onset after Traumatic Brain Injury

Decompressive craniectomy (DC) to treat increased intracranial pressure after a traumatic brain injury (TBI) is a common but controversial choice in clinical practice. This study aimed to determine the impact of DC on functional outcomes, mortality and the occurrence of seizures in a large cohort of patients with TBI. This retrospective study included patients with TBI consecutively admitted for a 6-month neurorehabilitation program between 1 January 2009 and 31 December 2018. The radiological characteristics of brain injury were determined with the Marshall computed tomographic classification. The neurological status and rehabilitation outcome were assessed using the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM), which were both assessed at baseline and on discharge. Furthermore, the GCS was recorded on arrival at the emergency department. The DC procedure, prophylactic antiepileptic drug (AED) use, the occurrence of early or late seizures (US, unprovoked seizures) and death during hospitalization were also recorded. In our cohort of 309 adults with mild-to-severe TBI, DC was performed in 98 (31.7%) patients. As expected, a craniectomy was more frequently performed in patients with severe TBI (p < 0.0001). However, after adjusting for the confounding variables including GCS scores, age and the radiological characteristics of brain injury, there was no association between DC and poor functional outcomes or mortality during the inpatient rehabilitation period. In our cohort, the independent predictors of an unfavorable outcome at discharge were the occurrence of US (β = -0.14, p = 0.020), older age (β = -0.13, p = 0.030) and the TBI severity on admission (β = -0.25, p = 0.002). Finally, DC (OR 3.431, 95% CI 1.233-9.542, p = 0.018) and early seizures (OR = 3.204, 95% CI 1.176-8.734, p = 0.023) emerged as the major risk factors for US, independently from the severity of the brain injury and the prescription of a primary prophylactic therapy with AEDs. DC after TBI represents an independent risk factor for US, regardless of the prescription of prophylactic AEDs. Meanwhile, there is no significant association between DC and mortality, or a poor functional outcome during the inpatient rehabilitation period.

Effect of the revised definition of epilepsy on treatment decisions and seizure recurrence after a first epileptic seizure.

Studies on risk factors for epilepsy and seizure recurrence after a first seizure are usually based on the old definition of epilepsy with the need for two unprovoked seizures. The current definition of epilepsy allows diagnosis and treatment of epilepsy after a first seizure if the recurrence risk is >60%. We evaluate treatment decisions, seizure recurrence and risk factors for epilepsy related to the application of the new definition of epilepsy. Data of 629 patients with a first seizure were analyzed to investigate changes of treatment decisions and seizure recurrence after the revised definition of epilepsy. We used binary logistic regression to investigate the impact of multiple factors influencing seizure recurrence like electroencephalogram (EEG) and magnetic resonance imaging (MRI) results and administration of antiseizure medication (ASM). The proportion of patients receiving ASM significantly increased from 70.4% to 80.5% (p=0.015) following the new epilepsy definition, without any significant changes in the recurrence rate (40.8% vs. 45.5% after 2 years, p > 0.05). The presence of interictal epileptiform discharges (IED) in the EEG increased (OR=1.98) and administration of ASM decreased (OR=0.43) recurrence rates significantly. The new definition of epilepsy was associated with increased application of ASM, but not with reduced recurrence rates. The study confirms the presence of IED as a strong risk factor for seizure recurrence and the protective effect of ASM. The influence of imaging findings, which have a strong impact on the new definition of epilepsy, could not be confirmed.