bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Exchange and Interest Rates on Foreign Direct Investment in Nigeria 2006-2018
Authors: Emmanuel Benson , Ike Eya Criscent , Alhasan Yunusa
Published: August 2019

This study examined the Effect of Exchange and Interest Rates on Foreign Direct Investment in Nigeria 2006-2018. Secondary data was used for the study and it was obtained from the financial statement of the Central Bank of Nigeria for the period 2000-2018. The unit root property of the data was analyzed using the Augmented Dickey Fuller Test and the variables were all stationary at first difference. Also, Johansen Co-integration test statistics was used to test the cointegrating nature of the data while the longrun and the shortrun relationship between the variables of the study were examined using the error correction model. The data was tested for normality using the Jarque-Bera test statistics. The result of the study indicates that a positive relationship exist between Exchange Rate and Foreign Direct Investment (FDI). The relationship is statistically significant (as tcal = 7.25891) is greater than ttab = 2.101 df 17) and in line with a priori expectation. The longrun co-integrating equation shows that a negative relationship exit between Interest Rate (INT) and Foreign Direct Investment (FDI) and the result is not statistically significant (as tcal = -12.5639 is greater than ttab = 2.101 @ df 17). Inflation (INF) was negatively related to Foreign Direct Investment (FDI) in the long-run. A unit increase in Inflation (INF) will lead to a corresponding increase in Foreign Direct Investment by GDP by 23.37%. This relationship is statistically significant (p<0.05) (as tcal = -12.5639) is less than ttab = 2.101@ df 17) and in line with our a priori expectation. It was recommended among others that board composition effect on total voluntary disclosure can be increased when appointment is made sometimes of an outside director who is an official of a financial firm as it has been found to increase firm share value. It was concluded that FDI is an important avenue for investment in agricultural, manufacturing and transfer of technology to an economy. It was recommended among others that the government should seek to stabilize exchange rates, through adoption of sound fiscal and monetary policies.
Analysis of Information Interaction Efficiency in Low-Orbit Satellite Constellations
Authors: Karsaev Oleg
Published: August 2019

The objects of the research are networks and information interactions in low-orbit satellite constellations performing tasks of remote sensing of the Earth. Research of network creation questions in this case is a necessary condition as opportunities and efficiency of information interaction directly depend on opportunities of a network. DTN (Delay-and-Disruption Tolerant Networking) technology is a basis of the network creation and CGR (Contact Graph Routing) approach is a basis of message routing. DTN technology and CGR approach are originally developed and used to provide communication with spacecraft located in a deep space. Therefore, the article discusses issues and problems arising in the context of their use in relation to low-orbit satellite constellations. The purpose of the information interaction study is development of effective interaction schemes (protocols). In the paper, the schemes of information interaction that can be used by a group of satellites in case of autonomous planning are considered. Along with autonomous planning, the paper also considers information interaction that can be used to implement network control of a satellite constellation in the case of ground planning. The effectiveness of the information interaction schemes are assessed by efficiency of orders’ execution. Measurement of efficiency is estimated via simulation of the communication network and the corresponding scheme of information interaction.
Experimental study of seismic in-plane elliptical damper with empirical design formulae
Authors: Lee Chien-Liang , Chen Yung-Tsang , Cai Meng-Yan , Wang Yen-Po
Published: August 2019

A seismic steel damper designed to deform inelastically in an in-plane flexural bending mode for more efficient utilisation of the material was investigated. This proposed device, referred to as an in-plane elliptical damper (i-PED), consists of two circular arches with intermediate straight arms connected in a closed form to eliminate end rotation at the symmetric axis in order to enhance the ultimate capacity. Test results obtained from a series of component tests on i-PEDs with various dimensions indicated that the energy-dissipation capacities of the dampers under cyclic loads were rich and consistently stable. The i-PED with a shorter arm length and smaller radius of curvature of arch exhibited higher strength and energy-dissipation capacity. Empirical formulae for estimating the mechanical properties of the dampers were developed for preliminary design purposes. The numerical predictions were found to correlate well with the experimental results, demonstrating that using the Bouc–Wen model is sufficient for simulating the inelastic mechanical behaviour of steel dampers. Furthermore, shaking table tests of a five-storey modal frame implemented with i-PEDs were conducted, with non-linear time history analyses carried out for comparison. Encouraging results on seismic response control with good numerical prediction were obtained, suggesting the feasibility of the proposed damper and design scheme for practical application.
Fixation‐off sensitivity in epilepsies other than the idiopathic epilepsies of childhood with occipital paroxysms: a 12‐year clinical‐video EEG study
Authors: Koutroumanidis Michail , Tsatsou Katerina , Sanders Sue , Michael Michael , Tan Stella V. , Agathonikou Alexandros , Panayiotopoulos Chrysostomos P.
Published: August 2019

Purpose

To define the spectrum of the epileptic syndromes and epilepsies (other than the idiopathic epilepsies of childhood with occipital paroxysms) that can be associated with fixation‐off sensitivity (FOS), delineate the electrographic types of FOS abnormalities and identify the patterns that can be associated with clinical seizures, and examine whether there may be a pure form of fixation‐off sensitive epilepsy.

Methods

We reviewed the clinical and video EEG data of all our patients with FOS over the last 12 years. Children with idiopathic focal epilepsies and occipital EEG paroxysms were excluded.

Results

From January 1995 to December 2006, 19 of about 8,500 patients had had one or more video‐EEGs with FOS, yielding an approximate incidence of 0.2%. From the 14 patients with full clinical and EEG data available, 12 had various epilepsies that included IGE phenotypes (7), symptomatic or probably symptomatic focal (3), cryptogenic generalised (1), and adult onset idiopathic photosensitive occipital (1), and two had no seizures. Seven patients (50%) were photosensitive. FOS EEG abnormalities were occipital in six patients, generalised in eight, and generalised with posterior emphasis in two patients. Seven of these patterns were associated with habitual seizures in seven patients, but actual FOS‐induced seizures (absences) were documented with video EEG in only one patient; three others had some historical evidence suggesting that, under some circumstances, their FOS EEG abnormalities might generate clinical seizures.

Conclusions

Despite the association of FOS with generalised and focal, symptomatic and cryptogenic and mild or pharmaco‐resistant epilepsies, closer analysis of our data, and supportive evidence from functional imaging and physiological observations on alpha rhythm generation, disclose a prominent role of the occipital areas, even when FOS EEG abnormalities and seizures are ostensibly generalised. Although FOS appears to be of relatively low epileptogenicity, an electroclinical profile of pure FOS epilepsy may exist [Published with video sequences].
Stressors at the onset of adult epilepsy: implications for practice
Authors: Koutsogiannopoulos Sheila , Adelson Francine , Lee Virginia , Andermann Frederick
Published: August 2019

‐ The association between major life events and seizure frequency in patients with chronic epilepsy has previously been suggested in the literature. However, significant life events as precipitating factors for the occurrence of the first seizure have been considered but not documented. Recognition of such triggers may lead to a better understanding of the cause and mechanism of the epilepsy. Using a phenomenological approach, 19 participants were interviewed and recalled the occurrence of significant life events in the year prior to a diagnosis of generalized or focal epilepsy. There were gender and age‐related differences in the types of triggering events, e.g. men tended to specify work related stressors while women generally cited relationship issues. None of the participants reported constraining beliefs about the cause of their epilepsy. Most respondents incorporated their knowledge of seizure triggers into strategies to achieve control of their epilepsy. This study highlights the potential value of questioning possible life stressors as triggers for the onset of epilepsy. Early awareness of high risk factors for seizures may lead to strategies of seizure self control by avoiding situations associated with high risks, improving lives disrupted by the uncertainty of epilepsy.
Antiepileptic drugs and psychopathology of epilepsy: an update
Authors: Mula Marco , Monaco Francesco
Published: August 2019

Anti‐epileptic drugs (AEDs) continue to be the mainstay of epilepsy treatment, but the benefits of seizure control need to be weighed carefully against possible adverse effects, which can include behavioral problems and psychiatric disorders. In this paper, the associations between AEDs and psychosis, depression and behavioral changes are reviewed. The concept of forced normalization and its clinical counterpart, alternative psychosis, are also discussed. Depression seems to be linked with AEDs potentiating GABAergic neurotransmission in patients with limbic system abnormalities such as hippocampal sclerosis. Psychoses have been described as associated with several of the new AEDs, and they are often seen in a setting in which previously refractory patients suddenly become seizure‐free. In general terms, the use of AEDs in monotherapy, adopting slow titration schedules and low doses when possible, can significantly reduce the occurrence of behavioral adverse effects. A previous history of psychiatric disorder or a familial predisposition are important risk factors and should be always considered when choosing the appropriate AED.
Epilepsy surgery in the elderly
Authors: Tellez‐Zenteno Jose F. , Sadanand Venkatraman , Riesberry Martha , Robinson Christopher A. , Ogieglo Lissa , Masiowski Paul , Vrbancic Mirna
Published: August 2019

Background. Epilepsy surgery is increasingly well‐supported as an effective treatment for patients with intractable epilepsy. It is most often performed on younger patients and the safety and efficacy of epilepsy surgery in elderly patients are not frequently described. Case report. We report a case of a 75‐year‐old right‐handed man who underwent a left fronto‐temporal craniotomy for resection of a suprasellar meningioma in 2002. Immediately following hospital discharge, he began to experience complex partial seizures. He continued to have frequent seizures despite treatment with multiple combinations of antiepileptic medications. He presented with status epilepticus every two or three months, and required long periods of hospitalization on each occasion for post‐ictal confusion and aphasia. Scalp EEG showed continuous spikes and polyspikes and persistent slowing in the left temporal area, as well as spikes in the left frontal area. EEG telemetry recorded multiple seizures, all with a clear focus in the left temporal area. MRI scan showed an area of encephalomalacia in the left temporal lobe, as well as post‐surgical changes in the left frontal area. Neuropsychological testing showed bilateral memory impairment with no significant cognitive decline expected after unilateral temporal lobe resection. A left anteromesial temporal lobectomy was performed with intraoperative electrocorticography. Since surgery, the patient was not seizure‐free (Engel class II‐b), but had no further episodes of status epilepticus in one year and two months of follow‐up. Conclusions. This is one of the oldest patients reported in the literature with epilepsy surgery and supports the possibility of epilepsy surgery in elderly patients for particular cases. In addition, few cases with such a malignant evolution of temporal lobe epilepsy have been described in this age group.
Quality of life after vagal nerve stimulator insertion
Authors: Mikati Mohamad A. , Ataya Nour F. , El‐Ferezli Jessica C. , Baghdadi Tarafa S. , Turkmani Ali H. , Comair Youssef G. , Kansagra Sujay , Najjar Marwan W.
Published: August 2019

Aim

Assess quality‐of‐life after vagal nerve stimulation and determine patient characteristics associated with improvement in quality‐of‐life.

Methods

Sixteen patients (11 children, 5 adults) who had vagal nerve stimulation at our center were studied. Quality‐of‐life was assessed pre‐ and post‐vagal nerve stimulation using the Quality‐of‐Life in Childhood Epilepsy questionnaire for children and the Epilepsy Surgery Inventory‐55 for adults.

Results

Sixteen patients who did not qualify for resective surgery were included; seven (43.75%) were males and 9 (56.25%) were females. Mean age at onset of seizures was 3.96 ± 4.00 years and at surgery was 15.78 ± 10.78. Follow‐up time was 1.26 ± 0.92 years. Fourteen patients (87.5%) were mentally retarded. Ten (62.5%) had cryptogenic etiology and 6 patients (37.5%) symptomatic etiology. Fifty percent had localization‐related epilepsy. Six of 7 patients with generalized cryptogenic etiology (85.71%) had Lennox‐Gastaut syndrome. Seizures dropped from 122.31 ± 159.49 to 67.84 ± 88.22 seizures/month. Seizure reduction (> 50%) correlated with improvement in total quality‐of‐life (p = 0.034). Post‐vagal nerve stimulation, the total group scored significantly higher in the social domain (p = 0.039). In patients with localization‐related epilepsy, significant improvements were detected in the social domain (p = 0.049) and in total quality‐of‐life (p = 0.042).

Conclusion

Despite a diverse and small population size, we observed significant improvements in the social domain 1.26 years post‐vagal nerve stimulation. In addition, there was an improvement in total quality‐of‐life amongst patients with partial seizures. Finally, seizure reduction was associated with quality‐of‐life improvement. Our results support previous studies from the West reporting improvement in quality‐of‐life following vagal nerve stimulation, contradict those studies that did not show such differences, and are the first coming from a developing country.
Anatomo‐electro‐clinical correlations: the Freiburg, Germany Case Report Case 02‐2009: Functional hemispherectomy in adults with intractable epilepsy syndromes: a report of 4 cases
Authors: Steinhoff Bernhard J. , Staack Anke Maren , Bilic Sofia , Kraus Uwe , Schulze‐Bonhage Andreas , Zentner Josef
Published: August 2019

[Case records of Epileptic Disorders. Anatomo‐electro‐clinical correlations. Case 02‐2009]

Background

Functional hemispherectomy (FH) is mainly performed in children with catastrophic epilepsies and preexisting severe hemiparesis. It is accepted that mainly patients at young ages with more or less complete loss of their hand function are suitable candidates for FH. However, we feel that FH should be considered also in some adults with devastating unilateral epilepsy syndromes.

Patients and methods

We report four cases of adults who underwent FH because of their intractable epilepsy syndromes. Three of the four patients had reduced but not complete loss of hand function. Careful weighing‐up of the risk‐benefit ratio still led to the decision to perform FH in order to achieve complete seizure relief.

Results

All patients had a surgical outcome of Engel class I; one of them suffered from post‐operative psychogenic non‐epileptic seizures which were treated successfully by psychotherapy. No clinically relevant complications occurred.

Conclusion

We wish to point out that FH is a possible surgical option in cases with catastrophic epilepsies in adulthood. Patients and relatives should strongly consider that the likelihood of at least partially, impaired hand function or other surgery‐related additional handicaps may be outweighed by the chance of freedom of seizures in a limited number of patients. In all of our cases, patients and relatives agreed that the surgical outcome led to a marked improvement of quality of life and that it had been the right decision to proceed with FH in spite of the expected negative impacts of the operation. Video examples of the pre‐ and post‐surgical hand function of one sample patient are enclosed. [Published with video sequences]
Paradoxical ictal EEG lateralization in children with unilateral encephaloclastic lesions
Authors: Garzon Eliana , Gupta Ajay , Bingaman William , Sakamoto Americo C. , Lüders Hans
Published: August 2019

Background

Describe an ictal EEG pattern of paradoxical lateralization in children with unilateral encephaloclastic hemispheric lesion acquired early in life.

Methods

Of 68 children who underwent hemispherectomy during 2003‐2005, scalp video‐EEG and brain MRI of six children with an ictal scalp EEG pattern discordant to the clinical and imaging data were reanalyzed. Medical charts were reviewed for clinical findings and seizure outcome.

Results

Age of seizure onset was 1 day‐4 years. The destructive MRI lesion was an ischemic stroke in 2, a post‐infectious encephalomalacia in 2, and a perinatal trauma and hemiconvulsive‐hemiplegic syndrome in one patient each. Ictal EEG pattern was characterized by prominent ictal rhythms with either 3‐7 Hz spike and wave complexes or beta frequency sharp waves (paroxysmal fast) over the unaffected (contralesional) hemisphere. Scalp video‐EEG was discordant, however, other findings of motor deficits (hemiparesis; five severe, one mild), seizure semiology (4/6), interictal EEG abnormalities (3/6), and unilateral burden of MRI lesion guided the decision for hemispherectomy. After 12‐39 months of post‐surgery follow up, five of six patients were seizure free and one has brief staring spells.

Conclusion

We describe a paradoxical lateralization of the EEG to the “good” hemisphere in children with unihemispheric encephaloclastic lesions. This EEG pattern is compatible with seizure free outcome after surgery, provided other clinical findings and tests are concordant with origin from the abnormal hemisphere.
Selection of ideal candidates for extratemporal resective epilepsy surgery in a country with limited resources
Authors: Chaudhry Neera , Radhakrishnan Ashalatha , Abraham Mathew , Kesavadas Chandrasekharan , Radhakrishnan Venkataraman V. , Sarma P. Sankara , Radhakrishnan Kurupath
Published: August 2019

Aim

To investigate how to select ideal candidates for extratemporal resective epilepsy surgery, without compromising efficacy and safety, in countries with limited pre‐surgical diagnostic facilities.

Method

From the prospective database maintained at an epilepsy surgery centre in southern India, we reviewed the attributes of consecutive patients who had completed at least two years of follow‐up after resections involving frontal, parietal and occipital lobes for medically refractory focal seizures.

Results

Of 386 patients diagnosed with extratemporal refractory epilepsies during the study period, 61 (15.8%) were selected based on the presence of magnetic resonance imaging (MRI)‐identified lesions (in all) and concordant scalp recorded electroencephalographic (EEG) data (in nearly two thirds). Seventeen (27.8%) required invasive investigations either to define the ictal onset zone, eloquent area, or both. During a median follow‐up period of five years, 63% of our patients were seizure‐free, excluding the presence of auras. Permanent disabling neurological sequelae occurred in three (4.9%) patients. According to univariate analysis, pre‐operative secondary generalised seizures and interictal epileptiform discharges (IEDs), during a one‐year post‐operative EEG monitoring period, portended unfavourable seizure outcome. In multivariate analysis, frontal lobe resections and IEDs in post‐operative EEGs were independent predictors of unfavourable outcome.

Conclusions

Extratemporal resective epilepsy surgery can be undertaken in countries with limited resources with efficacy and safety, comparable to that in developed countries, when patients are selected based on the presence of MRI‐identified lesions and scalp EEG concordance. In such patients, invasive EEG examinations, when necessary, can be undertaken by limited coverage of cortical areas at an affordable cost.
The evolution of antiepileptic drug development and regulation
Authors: Arzimanoglou Alexis , Ben‐Menachem Elinor , Cramer Joyce , Glauser Tracy , Seeruthun Rav , Harrison Miranda
Published: August 2019

The early years of antiepileptic drug development were characterised by observation and serendipity, rather than a rational, targeted approach to drug development. Control of seizures was seen as the primary aim of therapy, with much less focus on safety and tolerability. However, experience with thalidomide in the 1960s brought safety to the fore, resulting in an era of much tighter regulatory control that still persists today. A direct consequence of this was an increased emphasis on the importance of evidence from randomised controlled trials. Despite the continuing reliance on randomised controlled trials for regulatory approval and the formulation of evidence‐based guidelines, the modern era has seen an increasing acknowledgment of their limitations and the need for complementary sources of ‘real‐world’ evidence. Such sources include registries and studies that are designed to provide a much broader assessment of a drug's overall effectiveness; for example, by incorporating patient‐reported outcomes to assess the effects of treatment on quality of life or functional status. Such changes reflect a more patient‐centric approach to treatment, since it is now recognised that epilepsy can only be effectively managed if patients' individual real‐life needs are addressed, since a key to successful treatment is long‐term compliance. Alongside these changes in approach, the modern era has witnessed important advances in antiepileptic drugs themselves, either through development of novel molecules, or targeted, structural improvements of older agents. [Published with video sequences and a set of slides]
A seizure response dog: video recording of reacting behaviour during repetitive prolonged seizures
Authors: Di Vito Lidia , Naldi Ilaria , Mostacci Barbara , Licchetta Laura , Bisulli Francesca , Tinuper Paolo
Published: August 2019

Seizure response and alerting behaviour may spontaneously develop in dogs living with children or adults with epilepsy. Some dogs can also be reliably trained to respond and anticipate seizures. We describe the case of a dog, not previously trained for assistance work, showing complex seizure response behaviour. This is the first release of a home video recording of a dog reacting to its owner's seizure. [Published with video sequences]
Evolution and management of Lennox‐Gastaut syndrome through adolescence and into adulthood: are seizures always the primary issue?
Authors: Kerr Michael , Kluger Gerhard , Philip Sunny
Published: August 2019

Although Lennox‐Gastaut syndrome (LGS) typically begins during childhood, it frequently persists through adolescence and on into adulthood. It may also, rarely, have late onset during adolescence or adulthood. Longitudinal studies have highlighted that the “typical” features of LGS observed during childhood evolve and change over time, so that by adulthood it might be difficult to recognise LGS in previously undiagnosed patients. Approaches to treatment must therefore adapt to the changes in a patient's condition as they progress through life. Effective management of LGS requires a global approach to care that not only encompasses seizure control, but also the management of co‐morbidities associated with the condition, such as cognitive and behavioural problems, sleep disturbances and physical disability, together with the specific educational and psychosocial needs of the individual. This is particularly relevant during adolescence, when patients have to cope with a host of additional issues alongside those relating to their epilepsy. During all stages of life, management of LGS must carefully balance the need for treatment against its side effects, with the patient's overall quality of life always being the primary focus. The transition of care from paediatric to adult services presents important challenges for patients, their families and healthcare providers, and requires particular consideration to ensure that it is as smooth as possible. It also presents an important opportunity to review and reappraise a patient's condition, treatment and other longer‐term needs as they journey into adulthood.
Epilepsy in adult patients with Down syndrome: a clinical‐video EEG study
Authors: Vignoli Aglaia , Zambrelli Elena , Chiesa Valentina , Savini Miriam , Briola Francesca La , Gardella Elena , Canevini Maria Paola
Published: August 2019

Patients with Down syndrome are now living longer and the overall prevalence of epilepsy is increasing, however, full characterisation of epilepsy in adult age is still incomplete. We describe the electroclinical characteristics of epilepsy in 22 adult patients with Down syndrome (11 males, 11 females), with a mean age of 46 years (range: 28‐64 years), followed at the Epilepsy Centre, San Paolo Hospital in Milan. Mean age at epilepsy onset was 36.8 years (range: 6‐60 years). Nine out of 22 patients had focal epilepsy, while nine had late‐onset myoclonic epilepsy. In four patients, epilepsy was unclassified. The EEG pattern of our patients was characterised by a progressive slowing of the background activity with sharp‐and‐slow waves with frontal predominance. In the patients diagnosed with late‐onset myoclonic epilepsy, the EEGs showed generalised polyspike waves. Three subjects had an episode of myoclonic status epilepticus at the beginning or in the course of the disorder. After the first descriptions of late‐onset myoclonic epilepsy by Genton and Paglia (1994), this is one of the largest patient cohorts reported. Our data confirm that epilepsy in adult patients with Down syndrome presents peculiar electroclinical characteristics which should be recognized early as prompt, effective treatment may be beneficial. [Published with video sequences]
Side effects of phenobarbital in epilepsy: a systematic review
Authors: Zhang Ling‐Li , Zeng Li‐Nan , Li You‐Ping
Published: August 2019

Aim

In recent years, phenobarbital, as an antiepileptic drug, has become less popular based on adverse events, especially cognitive and behavioural side effects. Despite the development of better tolerated new generation AEDs, phenobarbital is still widely used particularly in developing countries because of its low cost. The purpose of this review was to: (i) investigate whether phenobarbital can be safely used as an antiepileptic drug and (ii) determine the questions which need to be addressed in order to comprehensively and adequately evaluate the safety of phenobarbital for the treatment of epilepsy.

Methods

The literature was searched using the Cochrane Central Register of randomised controlled trials (1800‐2009), Medline (1966‐2009), Embase (1966‐2009) and three Chinese databases.

Results

Twenty studies were finally included in this systematic review. The determination of adverse effects of combined antiepileptic drugs (AEDs) from different studies was complicated by numerous factors including study design, different descriptions of adverse events and a lack of standardised data collection. These factors may also have been responsible for the heterogeneity present in the meta‐analysis. The data did not demonstrate any evidence of association between phenobarbital and a higher risk of adverse events. However, phenobarbital appeared to be associated with a higher rate of adverse drug reaction related withdrawal (ADR‐related withdraw), compared to carbamazepine, valproic acid and phenytoin. This may have been due to a concern for possible adverse effects of phenobarbital.

Conclusions

Phenobarbital was associated with a higher rate of drug withdrawal although there was no evidence to suggest that phenobarbital caused more adverse events compared to carbamazepine, valproic acid or phenytoin. However, in the case of pregnant women, it is important for clinicians to evaluate the benefits and risks of phenobarbital administration before making a final recommendation. Furthermore, unified scales for the assessment of cognitive function should be applied for future studies particularly in children.
Confusion and SIRPIDs regress with parenteral lorazepam
Authors: Kaplan Peter W. , Duckworth Josh
Published: August 2019

Stimulus‐induced rhythmic, periodic or ictal discharges (SIRPIDs) are EEG epileptiform periodic discharges (PD) induced by arousal. SIRPIDs lie along an ictal‐interictal continuum with debate regarding urgency of treatment. In a patient with SIRPIDs, aphasia and confusion, i.v. lorazepam during EEG resulted in improved level of consciousness, return of verbal interaction and regression of SIRPIDs. This suggests that some forms of SIRPIDs may be associated with an ictal confusional state.
Montreal Cognitive Assessment in cryptogenic epilepsy patients with normal Mini‐Mental State Examination scores
Authors: Phabphal Kanitpong , Kanjanasatien Janyapon
Published: August 2019

This cross‐sectional study examined the Montreal Cognitive Assessment (MoCA) performance in cryptogenic epileptic patients aged more than 15 years with normal global cognition according to the Mini‐Mental State Examination (MMSE) score. We tested our hypothesis that the prevalence of mild cognitive impairment and associated patient correlation factors might be increased (score < 26) according to the MoCA, in spite of a normal MMSE score, and that cognitive impairment might occur in a range of domains of the MoCA. Eighty‐five patients participated in this study. The mean MoCA score was 22.44 (± 4.32). In spite of a normal MMSE score, which was an inclusion criterion, cognitive impairment was detected in 60% patients based on the MoCA score. The variable that correlated with a higher risk of cognitive impairment was the number of antiepileptic drugs (polytherapy: OR 2.71; CI 1.03‐7.15). The mean scores of visuospatial and executive function, naming ability, attention, language, abstraction, delayed recall and orientation among patients with mild cognitive impairment were significantly lower than those of patients with normal cognitive function. These findings suggest that mild cognitive impairment in cryptogenic epileptic patients is common. We suggest using MoCA as a screening test for patients with epilepsy.
Reflex seizures in Rett syndrome
Authors: Martínez Ana Roche , Colmenero M Itziar Alonso , Pereira Andreia Gomes , Vilaplana Francesc X Sanmartí , Morón Judith Armstrong , Marfa Mercé Pineda
Published: August 2019

Reflex seizures are a rare phenomenon among epileptic patients, in which an epileptic discharge is triggered by various kinds of stimuli (visual, auditory, tactile or gustatory). Epilepsy is common in Rett syndrome patients (up to 70%), but to the authors' knowledge, no pressure or eating‐triggered seizures have yet been reported in Rett children. We describe three epileptic Rett patients with reflex seizures, triggered by food intake or proprioception. One patient with congenital Rett Sd. developed infantile epileptic spasms at around seven months and two patients with classic Rett Sd. presented with generalised tonic‐clonic seizures at around five years. Reflex seizures appeared when the patients were teenagers. The congenital‐Rett patient presented eating‐triggered seizures at the beginning of almost every meal, demonstrated by EEG recording. Both classic Rett patients showed self‐provoked pressure ‐triggered attacks, influenced by stress or excitement. Non‐triggered seizures were controlled with carbamazepine or valproate, but reflex seizures did not respond to antiepileptic drugs. Risperidone partially improved self‐provoked seizures. When reflex seizures are suspected, reproducing the trigger during EEG recording is fundamental; however, self‐provoked seizures depend largely on the patient's will. Optimal therapy (though not always possible) consists of avoiding the trigger. Stress modifiers such as risperidone may help control self‐provoked seizures.
Patients with generalised epilepsy have a higher white blood cell count than patients with focal epilepsy
Authors: Sarkis Rani A , Jehi Lara , Silveira Diosely , Janigro Damir , Najm Imad
Published: August 2019

Background. Immunological alterations have been noted following seizures in the acute period, however little is known about the effect of type and severity of epilepsy on leukocyte count in the absence of seizures. Methods. We performed a retrospective chart review of adult epilepsy patients presenting for evaluation over a four‐month period. Demographics, epilepsy type and characteristics, number and type of antiepileptic drugs, as well as medical co‐morbidities were noted. Results. A total of 241 patients fulfilled study criteria. Variables correlating with leukocyte count were identified using univariate analysis. Based on multivariate analysis, only the correlation with type of epilepsy and use of more than two antiepileptic drugs remained statistically significant. Patients with generalised epilepsy had a higher leukocyte count (7.21 k/μL) compared to those with focal epilepsy (6.53 k/μL); the main difference was due to the number of monocytes. Conclusion. These findings raise the possibility that there are different neuro‐immune profiles between patients with generalised and focal epilepsy.
Late‐onset Lennox‐Gastaut syndrome as a phenotype of 15q11.1q13.3 duplication
Authors: Rocha João , Guerra Cátia , Oliveira Renata , Dória Sofia , Rego Ricardo , Rosas Maria José
Published: August 2019

The clinical symptoms associated with chromosome 15q duplication syndrome manifest through a heterogeneous group of symptoms characterised by hypotonia, delay in motor skills and language development, cognitive and learning disabilities, autism spectrum disorder and refractory epilepsy. The late development of Lennox‐Gastaut syndrome in patients with 15q11q13 duplication is a possibility that physicians should be aware of. We report the case of a 27‐year‐old man with a neurodevelopmental syndrome due to a 15q duplication, with intellectual disability, psychiatric disturbances, and an epileptic phenotype diagnosed as late‐onset Lennox‐Gastaut syndrome.
Electroclinical, MRI and surgical outcomes in 100 epileptic patients with type II FCD
Authors: Tassi Laura , Garbelli Rita , Colombo Nadia , Bramerio Manuela , Russo Giorgio Lo , Mai Roberto , Deleo Francesco , Francione Stefano , Nobili Lino , Spreafico Roberto
Published: August 2019

Focal cortical dysplasias (FCDs) are highly epileptogenic malformations associated with drug‐resistant epilepsy, susceptible to surgical treatment. Among the different types of FCD, the type II includes two subgroups based on the absence (IIa) or presence (IIb) of balloon cells. The aim of this retrospective study was to investigate possible differences in electroclinical presentations and surgical outcomes between the two subgroups in 100 consecutive surgically treated patients with type II FCDs. All patients underwent a comprehensive presurgical assessment including stereo‐EEG (SEEG) when necessary. No significant differences in gender, age at epilepsy onset, duration of epilepsy, age at surgery or seizure frequency were found between the two subgroups. Patients with type IIb FCD frequently showed sleep‐related epilepsy. Their peculiar electrographic pattern was characterised by localised rhythmic or pseudo‐rhythmic spikes or polyspikes (“brushes”) enhanced during non‐REM sleep and also associated with well‐localised, brief, low‐voltage fast activity. The incidence and frequency of short bursts of fast discharges, interrupted by activity suppression, increased during slow‐wave sleep and often recurred pseudoperiodically. The occurrence of “brushes”, present in 76% of the patients with type IIb FCD, was significantly associated (p<0.001) with the presence of balloon cells. We discuss the possible pathogenetic mechanisms underlying this activity. MRI diagnosis of type II FCD was made in 93% of the patients with balloon cells (BCs), suggesting that the presence of balloon cells might be, at least partially, responsible for the MRI features. Patients had very good postsurgical outcomes (83% in Engel class I) even after a long period of follow‐up.
Successful treatment of POLG‐related mitochondrial epilepsy with antiepileptic drugs and low glycaemic index diet
Authors: Martikainen Mika H , Päivärinta Markku , Jääskeläinen Satu , Majamaa Kari
Published: August 2019

Epilepsy is a common manifestation of mitochondrial disease associated with mutations of the mitochondrial polymerase γ (POLG). Prognosis of mitochondrial epilepsy is often poor and there are few reports of successful treatment of POLG‐related epilepsy. We describe a 26‐year‐old woman who experienced severe headache during a three‐day period, followed by symptoms of visual flashing, speech difficulty, and generalised seizures. EEG recording showed non‐convulsive status epilepticus (left occipital area) and brain MRI revealed parieto‐occipital T2‐hyperintensities. Visual aura and aphasia persisted despite antiepileptic medication with phenytoin, oxcarbazepine, and levetiracetam. Mitochondrial disorder was clinically suspected and a homozygous c.2243G>C mutation (p.Trp748Ser) was discovered in the POLG1 gene. The patient was then set on a low glycaemic index treatment (LGIT) variant of the ketogenic diet, after which the headaches, aphasia, and visual aura progressively improved and disappeared. She returned home two weeks after onset of symptoms and has not had further seizures. She continues to receive levetiracetam monotherapy and LGIT. We conclude that, at least for this patient, the combination of three antiepileptic drugs and LGIT is effective and well tolerated as treatment for severe episodes of POLG‐related mitochondrial epilepsy.
Head atonic attacks: a new type of benign non‐epileptic attack in infancy strongly mimicking epilepsy
Authors: Capovilla Giuseppe , Montagnini Alessandra , Peruzzi Cinzia , Beccaria Francesca
Published: August 2019

Non‐epileptic attacks (NEAs) are a heterogeneous group of clinical entities which often complicate the differential diagnosis of epilepsy. NEAs usually have a benign course and are limited to a specific period of life. If motor manifestations are strongly suggestive of an epileptic phenomenon, the risk of misdiagnosis is greater. Here, we describe a novel NEA with infantile onset, characterised by repeated head drops, mimicking epileptic negative myoclonus of the neck. The frequency of the episodes was very high, at hundreds or thousands per day. The episodes appeared in the second semester of the first year of life and spontaneously disappeared within a few months. [Published with video sequences]
Intracranial video‐EEG and surgery for focal atonic seizures
Authors: Donadío Martín , Ugarnes Gabriela , Segalovich Mónica , Arakaki Naomi , Gonzalez Federico Sanchez , Petre César , Pomata Hugo , D'Giano Carlos
Published: August 2019

Atonic seizures are epileptic attacks characterised by a sudden loss or diminution of muscle tone. Structures corresponding to inhibitory cortical areas, such as the primary negative motor area or the supplementary negative motor area, could be responsible. We present findings observed in a patient with atonic seizures due to focal epilepsy, who underwent intracranial video‐EEG monitoring and epilepsy surgery, and discuss possible underlying mechanisms. [Published with video sequences]
Pure epileptic headache and related manifestations: a video‐EEG report and discussion of terminology
Authors: Cianchetti Carlo , Pruna Dario , Porcu Lucia , Peltz Maria Teresa , Ledda Maria Giuseppina
Published: August 2019

We present the first video‐EEG recording of episodes of “epileptic headache”. The case reported is that of a 9‐year‐old girl with brief episodes (of a few minutes) of severe frontal headache, which corresponded to the presence of concurrent spikes and slow waves, starting in the right temporal area. A dysplastic lesion of the right temporal lobe was observed by MRI and the patient received surgery, with subsequent disappearance of headaches. This case highlights ictal EEG as the main diagnostic tool for epileptic headache. We discuss the terminology regarding this type of manifestation and believe that cases without subsequent epileptic manifestations, as in the present case, should be more appropriately referred to as “pure ictal epileptic headache” or simply “pure epileptic headache”. [Published with video sequences]
Misleading features of neuroimaging and electroencephalography: insulinoma misdiagnosed as temporal lobe epilepsy
Authors: Aupy Jérôme , Benoilid Aurélien , Sarhan Maysa , Dalvit Constanza , Valenti Maria‐Paola , Hirsch Edouard
Published: August 2019

Epilepsy is a common disorder but diagnosis remains largely clinical. Although MRI and EEG significantly aid the diagnosis of epilepsy, these techniques may also be misleading and indicate abnormalities not related to phenomenology. Consequences of erroneous diagnosis of epilepsy may lead to aggressive and escalating pharmacotherapy with potentially serious side effects. Metabolic disorders, which may mimic epilepsy, should always be considered as they are potentially curable and may be fatal if untreated. We report a case of an insulinoma, misdiagnosed as temporal lobe epilepsy. We highlight the risks associated with misinterpretation of neuroimaging and EEG and outline an approach to differentiate between symptoms of insulinoma or neuroglycopenia and temporal epileptic seizures.
Spatiotemporal profiles of focal and generalised spikes in childhood absence epilepsy
Authors: Kokkinos Vasileios , Koupparis Andreas M , Tsiptsios Dimitrios , Kostopoulos George K , Koutroumanidis Michalis
Published: August 2019

The EEG in childhood absence epilepsy (CAE) may contain focal and generalised spike‐wave discharges (SWDs) with focal, mainly frontal, “lead‐in”. The term “frontal absence” has been used to imply fast, secondary, 3‐Hz generalisation from occult frontal foci with potential impact on clinical EEG interpretation and syndrome classification. The aim of this study was to investigate the relationship between focal and generalised SWDs. We studied five children with CAE and examined a sufficient number of focal (“interictal”) and generalised SWDs in order to obtain reliable analysis. All generalised SWDs with focal lead‐in were “decomposed” into their “pre‐generalisation” focal and “generalised” constituents, which were studied separately. Two types of focal SWD (“interictal” and “pregeneralisation”) and generalised SWD were visually clustered into groups, waveform‐averaged, and plotted in the 2D‐electrode space. Spatiotemporal analysis demonstrated a variety (mean: 4.2 per child; SD: 2.12) of mainly frontal and occipital locations for pre‐generalisation focal SWDs with propagation along the longitudinal axis in either direction and across homologous sites. Interictal focal SWDs demonstrated similar spatiotemporal characteristics. In contrast, the topography and propagation patterns of the first generalised spike of the SWD showed less variability (mean: 2.5 per child; SD: 2.07), mainly involved the fronto‐temporal/temporal areas, and correlated poorly (<10%) with that of the pre‐generalisation focal SWD. Our findings suggest that the process of generalised epileptogenesis in genetic epilepsies with electrographic “frontal absences” is far more complex than that proposed by the model for occult frontal focus with fast secondary generalisation. (Published with Supplemental data)
Hypohidrosis induced by topiramate in an adult patient
Authors: Karachristianou Styliani , Papamichalis Evangelos , Sarantopoulos Alexandros , Boura Panagiota , Georgiadis George
Published: August 2019

Hypohidrosis is an uncommon and reversible side effect of topiramate treatment, reported mainly in children. This report presents an adult patient with complex partial seizures who was treated with topiramate and developed hypohidrosis coupled with hyperthermia, related to high environmental temperature and physical exercise. Reduced sweat response was confirmed using the Neuropad test. Signs and symptoms ceased after drug discontinuation. During topiramate treatment, it is important to recognise this side effect, although the exact causal mechanism has not yet been clarified.
Valproic acid‐induced hyperammonaemic coma and unrecognised portosystemic shunt
Authors: Nzwalo Hipólito , Carrapatoso Leonor , Ferreira Fátima , Basilio Carlos
Published: August 2019

Hyperammonaemic encephalopathy is a rare and potentially fatal complication of valproic acid treatment. The clinical presentation of hyperammonaemic encephalopathy is wide and includes seizures and coma. We present a case of hyperammonaemic coma precipitated by sodium valproate use for symptomatic epilepsy in a patient with unrecognised portosystemic shunt, secondary to earlier alcoholism. The absence of any stigmata of chronic liver disease and laboratory markers of liver dysfunction delayed the recognition of this alcohol‐related complication. The portal vein bypass led to a refractory, valproic acid‐induced hyperammonaemic coma. The patient fully recovered after dialysis treatment.
Levetiracetam add‐on therapy in Japanese patients with refractory partial epilepsy
Authors: Tanaka Shigeya , Tanaka Tatsuya
Published: August 2019

The aim of this observational study was to obtain information regarding efficacy and safety of add‐on levetiracetam (LEV; n=32) in Japanese patients with refractory partial seizures in an everyday clinical setting, relative to control AEDs (n=30). This is the first study of LEV add‐on therapy conducted in Japan since approval was made. The medical charts of patients were retrospectively reviewed. The efficacy variables were seizure freedom and ≥50% reduction in seizure frequency. A significantly higher response to LEV was demonstrated in patients with all seizure types at base‐line, relative to control AEDs. In patients with a duration of epilepsy of at least 10 years, significant effects in response to LEV were demonstrated with regards to efficacy variables, relative to control AEDs, thus providing meaningful results. Only two patients (6.2%) discontinued LEV treatment due to worsening of seizures, but no discontinuation was reported due to adverse events. LEV as add‐on therapy to other AEDs is a promising useful treatment option for patients with refractory partial seizures without notable effects on safety, indicating that this treatment regimen might be recommended for such patients.