bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serial EEG and MRI changes in status epilepticus‐induced excitotoxic neuronal necrosis
Authors: Arman Fehim , Kaya Dilaver , Dincer Alp , Sav Aydin , Pamir M. Necmettin 
Published: August 2019

ABSTRACTProlonged status epilepticus may directly cause selective neuronal necrosis due to excitotoxic mechanisms, as observed in experimental models and described in case reports. A 36‐year‐old woman presented with right hemiplegia and aphasia following a generalised tonic‐clonic status epilepticus of two hours duration. Accompanying serial MRI with advanced imaging techniques, EEG and histopathology of the cortical tissue of the patient were all compatible with excitotoxic neuronal necrosis. In this histopathologically‐proven rare case of status epilepticus‐induced excitotoxic neuronal injury, the observation of delayed cortical laminar necrosis on MRI, together with paroxysmal lateralised epileptiform discharges on the EEG, suggests that these changes may be an early sign of impending and ongoing excitotoxic neuronal injury and delayed cell death caused by glutamate release due to excessive neuronal firing in status epilepticus.
Limited resection of focal cortical dysplasia and associated epileptogenic cortex may lead to positive surgical outcome
Authors: Garganis Kyriakos , Kokkinos Vasileios , Zountsas Basilios 
Published: August 2019

ABSTRACTA drug‐resistant epilepsy patient with premotor type IIb focal cortical dysplasia is described with a positive postoperative outcome following partial resection of the lesion and epileptogenic zone. Presurgical fMRI of the sensorimotor areas showed haemodynamic responses over the posterior border of the lesion and ictal EEG‐fMRI revealed activation of both the primary sensorimotor strip and premotor lesion area. Almost continuous 1‐2 Hz interictal spiking was recorded during a chronic ECoG study over the primary sensorimotor cortex. Following partial resection of the lesion, an acute ECoG revealed marked reduction of epileptic activity over the sensorimotor area. Post‐operatively, seizure control was significantly improved (class IV ILAE outcome). Although partial FCD resections predict a worse postoperative outcome, individual patients may still respond favourably. The type of lesion, resected portion, and histopathology may be included among factors related to successful outcome.
Intracranial localisation of ictal urinary urge epileptogenic zone to the non‐dominant temporal lobe
Authors: Gurgenashvili Khatuna , Massey Shavonne L , Grant Mitzie , Piatt Joseph , Legido Agustin , Valencia Ignacio 
Published: August 2019

ABSTRACTIctal urinary urge is a rare symptom of focal epilepsy usually localising to the non‐dominant hemisphere, specifically, the temporal lobe. Lateralisation in previously described cases has been established using scalp video‐EEG monitoring or functional imaging. We report the case of a 19‐year‐old girl with refractory epilepsy and ictal urinary urge arising from the non‐dominant temporal lobe, confirmed by invasive, subdural EEG monitoring. Since undergoing a temporal lobectomy two and a half years ago, the patient has not experienced ictal urinary urge. To our knowledge, this is the first report demonstrating localisation of ictal urinary urge epileptogenic zone to the non‐dominant temporal lobe by invasive intracranial monitoring.
Mirth and laughter elicited during brain stimulation
Authors: Vaca Guadalupe Fernández‐Baca , Lüders Hans O , Basha Maysaa Merhi , Miller Jonathan P 
Published: August 2019

ABSTRACTThere are few reports of laughter and/or mirth evoked by electrical stimulation of the brain. In this study, we present a patient with intractable epilepsy in whom mirth and laughter was consistently produced during stimulation of the left inferior frontal gyrus (opercular part) using stereotactically placed depth electrodes. A review of the literature shows that cortical sites that produce mirth when stimulated are located in the dominant hemisphere close to language areas or cortical negative motor areas.
Therapy of encephalopathy with status epilepticus during sleep (ESES/CSWS syndrome): an update
Authors: Veggiotti Pierangelo , Pera Maria Carmela , Teutonico Federica , Brazzo Daniela , Balottin Umberto , Tassinari Carlo Alberto 
Published: August 2019

ABSTRACTElectrical status epilepticus in sleep (ESES)/continuous spikes and waves during slow sleep (CSWS) is an age‐related, self‐limiting disorder characterised by epilepsy with different seizure types, global or selective neuropsychological regression, motor impairment, and a typical EEG pattern of continuous epileptiform activity for more than 85% of non‐rapid eye movement (NREM) sleep. Although the first description of ESES/CSWS dates back to 1971, an agreement about the optimal treatment for this condition is still lacking. ESES/CSWS is rare (incidence is 0.2‐0.5% of all childhood epilepsies) and no controlled clinical trials have been conducted to establish the efficacy of different antiepileptic drugs; only uncontrolled studies and case reports are reported in the literature. Treatment options for ESES/CSWS include some antiepileptic drugs (valproic acid, ethosuximide, levetiracetam, and benzodiazepines), steroids, immunoglobulins, the ketogenic diet, and surgery (multiple subpial transections). In this study, the comparative value of each of these treatments is reviewed and a personal therapeutic approach is proposed.
Parietal lobe epilepsy: the great imitator among focal epilepsies
Authors: Ristić Aleksandar J , Alexopoulos Andreas V , So Norman , Wong Chong , Najm Imad M 
Published: August 2019

ABSTRACTAim. Comprising large areas of association cortex, the parietal lobe is part of an extensive synaptic network elaborately intertwined with other brain regions. We hypothesize that such widespread projections are responsible for producing inaccurate localisation readings on scalp EEG and clinical semiology in patients with parietal lobe epilepsies, as opposed to frontal or temporal lobe epilepsies. Methods. Our study included 50 patients with pharmacoresistant focal epilepsy, who were subsequently rendered seizure‐free for ≥12 months (median: 23 months) following resections limited to the frontal (n=17), temporal (n=17), or parietal (n=16) lobes. Interictal and ictal EEG data with accompanying seizure video recordings were extracted from archived files of scalp video‐EEG monitoring. Two blinded raters independently reviewed the EEG according to predetermined criteria. Videos of seizures were then observed, as raters formulated their final electroclinical impression (ECI), identifying patients' abnormal neuronal activities with parietal, temporal, and frontal lobe epilepsy, or unspecified localisation. Results. Groups did not differ significantly in demographics, age at epilepsy onset, or presence of MRI abnormalities. Interictal discharges in parietal lobe epilepsy showed the greatest magnitude of scatter outside the lobe of origin; the majority of patients with parietal lobe epilepsy had more than one spike population (p<0.045). Localised ictal EEG recognition was most frequent in temporal, followed by frontal and parietal lobe epilepsy cases (p=0.024). Whenever raters confidently limited their ECI to one lobar subtype, overall accuracy was excellent. Lobar classifications by ECI were highly accurate for temporal lobe epilepsy, vacillating in frontal lobe epilepsy, and least accurate in parietal lobe epilepsy subjects. Conclusion. Scalp EEG readings of parietal lobe epilepsy patients showed a more variable scatter of interictal discharges and a lower localisation value of ictal recordings compared to temporal and frontal lobe epilepsy subjects, suggesting an increased likelihood of misidentification and mislocalisation of parietal lobe epilepsy. Combining seizure semiology with scalp interictal and ictal EEG readings facilitates a more accurate lobar classification in patients with temporal and frontal, but not parietal, lobe epilepsy.
Bálint‐like syndrome as an unusual representation of non‐convulsive status epilepticus
Authors: Ristić Aleksandar J , Marjanović Ivan , Brajković Leposava , Wolgamuth Barbara R , Odalović Strahinja , Lavrnić Slobodan , Vojvodić Nikola , Janković Slavko , Baščarević Vladimir , Sokić agoslav 
Published: August 2019

ABSTRACTThe clinical signs of posterior cortex dysfunction are, due to their paucity and subtlety, very often ignored as non‐specific during clinical evaluation of non‐convulsive status epilepticus. Therefore, focal non‐convulsive status epilepticus emerging from the posterior cortex, and especially the parietal lobes, can be fairly under‐recognised. We report a 66‐year‐old patient with focal non‐convulsive status epilepticus presenting as isolated Bálint‐like syndrome, successfully treated to full clinical and electrophysiological recovery. The diagnostic and pathophysiological features are discussed. Focal non‐convulsive status epilepticus can be associated with negative phenomena such as neuropsychological deficits mimicking those detected more often in degenerative and vascular brain diseases. [Published with video sequences]
Gaucher disease: successful treatment of myoclonic status epilepticus with levetiracetam
Authors: Vaca Guadalupe Fernandez‐Baca , Lenz Timothy , Knight Elia M Pestana , Tuxhorn Ingrid 
Published: August 2019

ABSTRACTWe present the first reported case of a rapid clinical and electroencephalographic response to intravenous levetiracetam infusion of myoclonic status epilepticus in a patient with progressive myoclonus epilepsy due to Gaucher disease. Under continuous video‐EEG monitoring, the clinical myoclonic status and the electrographic ictal discharges resolved within 10 minutes after the infusion was initiated. The patient tolerated the treatment well without any reported side effects. This case suggests that levetiracetam may be a safe, effective, and well tolerated intravenous drug in patients with metabolic myoclonic status epilepticus such as Gaucher disease.
Carbamazepine‐induced non‐epileptic myoclonus and tic‐like movements
Authors: Magaudda Adriana , Di Rosa Gabriella 
Published: August 2019

ABSTRACTCarbamazepine‐induced abnormal movements have been reported in children and adult patients, and both non‐epileptic myoclonus and tic‐like movements have been reported in the same patient. Although a pathogenetic mechanism underlying carbamazepine‐induced epileptic negative myoclonus has been proposed, a causative role of carbamazepine for positive myoclonus has not been fully identified. Here, we describe the video‐documented case of an adult patient with non‐epileptic myoclonus and tic‐like movements persisting for 21 years, which appeared after he started carbamazepine treatment at 10 years of age. [Published with video‐sequences]
Gelastic seizures in ring chromosome 20 syndrome: a case report with video illustration
Authors: Dimova Petia , Boneva Iliyana , Todorova Albena , Minotti Lorella , Kahane Philippe 
Published: August 2019

ABSTRACTAlthough increasingly recognised, ring chromosome 20 (r[20]) syndrome is still diagnosed with delay, sometimes leading to inappropriate presurgical evaluation. The focal, presumed frontal, character of the seizures manifesting with fear and hypermotor behaviour and episodes of non‐convulsive status epilepticus (NCSE) are most typical, as well as cognitive impairment with behavioural problems and, sometimes, dysmorphic signs. We present a girl diagnosed at the age of 13 years who suffered from an atypical clinical presentation, with minimal cognitive problems, absence of dysmorphic symptoms, and hypermotor/gelastic seizures. [Published with video sequences]
Falsely pessimistic prognosis by EEG in post‐anoxic coma after cardiac arrest: the borderland of nonconvulsive status epilepticus
Authors: Sreedharan Jemeen , Gourlay Elizabeth , Evans Matthew R. , Koutroumanidis Michalis 
Published: August 2019

ABSTRACTBackgroundPrognostication following anoxic coma relies on clinical assessment and is assisted by neurophysiology. A non‐evolving EEG spike burst/isoelectric suppression pattern after the first 24 hours almost invariably indicates poor outcome, while an evolving pattern implies nonconvulsive status epilepticus (NCSE) that may “hide” surviving brain activity and is amenable to treatment.Case studyWe present the case of a 53‐year‐old woman who had a witnessed out‐of‐hospital ventricular fibrillation cardiac arrest, was resuscitated by paramedics, but remained comatose. An EEG, performed 36 hours post‐insult, showed an unremitting, non‐evolving, unresponsive 2‐6 Hz high‐voltage spike burst/isoelectric suppression pattern, which remained unchanged at 96 hours post‐insult, following therapeutic hypothermia. During this period, she was completely off sedation and taking triple antiepileptic treatment, without systemic confounding disorders. Although the initial pattern was indicative of poor neurological outcome, she eventually made meaningful functional recovery; the last EEG showed satisfactory background rhythms and stimulus‐induced epileptiform discharges without seizures.ConclusionIn post‐anoxic coma, non‐evolving >2 Hz spike burst/isoelectric suppression pattern may still reflect NCSE and therefore should be considered in the diagnostic EEG criteria for NCSE. Such borderline patterns should not dissuade physicians from intensifying treatment until more confident prognostication can be made.
Epilepsy surgery in a developing country (Lebanon): ten years experience and predictors of outcome
Authors: Mikati Mohamad A. , Ataya Nour , El‐Ferezli Jessica , Shamseddine Alhan , Rahi Amal , Herlopian Aline , Kurdi Rana , Bhar Saleh , Hani Abeer , Comair Youssef G. 
Published: August 2019

ABSTRACTWe present our 10‐year experience and preoperative predictors of outcome in 93 adults and children who underwent epilepsy surgery at the American University of Beirut. Presurgical evaluation included video‐EEG monitoring, MRI, neuropsychological assessment with invasive monitoring, and other tests (PET, SPECT, Wada). Surgeries included temporal (54%), extratemporal (22%), and multilobar resections (13%), hemispherectomy (4%), vagal nerve stimulation (6%), and corpus callosotomy (1%). Mesial temporal sclerosis was the most common aetiology (37%). After resective surgery, 70% had Engel class I, 9% class II, 14% class III, and 7% class IV. The number of antiepileptic drugs before surgery was the only preoperative factor associated with Engel class I (p=0.005). Despite the presence of financial and philanthropic aid, many patients could not be operated on for financial reasons. We conclude that advanced epilepsy presurgical workups, surgical procedures, and favourable outcomes, comparable to those of developed countries, are achievable in developing countries, but that issues of financial coverage remain to be addressed.
Epilepsy and anxiety: epidemiology, classification, aetiology, and treatment
Authors: Kimiskidis Vasilios K. , Valeta Thalia 
Published: August 2019

ABSTRACTAnxiety in epilepsy has recently become a focus of interest for a number of reasons. Epidemiological studies have established that anxiety disorders are twice as common in patients with epilepsy compared to the general population, while in referral centres their prevalence is even higher. In addition, it has been recently appreciated that anxiety exerts a significant negative impact on the quality of life of patients with epilepsy of any age. With regard to the pathogenesis of anxiety in epilepsy, a number of theories have been put forward including those based on psychodynamics, learningcognition, and neurobiology. From a clinical point of view, anxiety may occur as a comorbid disorder with epilepsy or be directly linked with epilepsy as a preictal, ictal, postictal or interictal phenomenon. The treatment of anxiety in patients with epilepsy requires a comprehensive, multidisciplinary, clinical assessment. Regarding pharmacological therapies, it should be recognised that some drugs prescribed for anxiety disorders are associated with a high risk of seizures, whereas some antiepileptic drugs possess anxiolytic properties that could be of use in the management of epileptic patients with anxiety. The correct diagnosis and successful treatment of anxiety is expected to have significant benefits for the quality of life of epileptic patients.
Animal models of drug‐resistant epilepsy*
Authors: Potschka Heidrun 
Published: August 2019

ABSTRACTSeveral animal models are discussed in order to outline features of difficult‐to‐treat or drug‐resistant epilepsy. These models can be categorised as those which show a poor response to different antiepileptic drugs and those in which subgroups of drug‐resistant animals are selected, based on interindividual differences. Non‐responders to antiepileptic drugs have been described in the amygdala kindling model, as well as the chronic phase of post‐status epilepticus models. Epileptic dogs which do not respond to standard antiepileptic drugs may serve as a translational model to provide a more clinical environment for drug testing. Drug resistance or a poor response to several antiepileptic drugs has been reported for the 6‐Hz model, lamotrigine‐pretreated kindled rats, pentylentetrazole‐induced seizures in rats pre‐exposed to pilocarpine, as well as following intrauterine exposure of rats to methylazoxymethanol. Using models to select non‐responders is highly time‐consuming and elaborate, limiting their use in routine drug‐screening procedures. Current efforts to identify biomarkers of drug resistance may simplify the selection process, e.g. replacing several weeks of seizure monitoring by a single imaging scan. Moreover, further elucidation of mechanisms of resistance may help to design a series of ex vivo or in vitro screening procedures in order to evaluate whether a test compound is affected.
Photosensitivity: epidemiology, genetics, clinical manifestations, assessment, and management
Authors: Verrotti Alberto , Beccaria Francesca , Fiori Federica , Montagnini Alessandra , Capovilla Giuseppe 
Published: August 2019

ABSTRACTPhotosensitivity is a genetically determined trait that may be asymptomatic throughout life or manifest with epileptic seizures. Photosensitivity usually begins before the age of 20 years with a peak age at onset at around 12. Both natural and artificial light may trigger seizures. Precise investigation must be carried out by intermittent photic stimulation that can elicit a clearly defined EEG response; video‐EEG samples are reported to illustrate the various determinants of response and the main factors altering the effectiveness of intermittent photic stimulation. Management of photosensitive epilepsy includes non‐pharmacological (e.g.avoidance of the provocative stimuli and wearing appropriate tinted glass) and pharmacological treatment. This review focuses on the emerging aspects of photosensitivity, in particular, the new guidelines for intermittent photic stimulation and briefly addresses epidemiological (in non‐epileptic and epileptic subjects), genetic, diagnostic, and therapeutic issues. [Published with video sequences]
Effect of pregabalin add‐on treatment on seizure control, quality of life, and anxiety in patients with brain tumour‐related epilepsy: a pilot study
Authors: Maschio Marta , Dinapoli Loredana , Sperati Francesca , Pace Andrea , Fabi Alessandra , Vidiri Antonello , Pompili Alfredo , Carapella Carmine Maria 
Published: August 2019

ABSTRACTObjectiveAn open pilot study to evaluate the effect of pregabalin (PGB) as add‐on therapy on seizure control, quality of life, and anxiety in patients with brain tumour‐related epilepsy (BTRE).Materials and methodsWe recruited 25 consecutive patients with BTRE and uncontrolled seizures. At baseline and during follow‐up, patients underwent a complete physical and neurological examination and were evaluated using the QOLIE 31P (V2), EORTC QLQ C30, Adverse Events Profile, and Hamilton Anxiety Rating Scale (HAM‐A). At baseline, a seizure diary was given.ResultsDuring follow‐up, 17 patients underwent chemotherapy, none underwent radiotherapy, 9 had disease progression, and 3 died. Mean duration of follow‐up was 4.1 months. Mean PGB dosage was 279 mg/day. At baseline, mean weekly seizure frequency was 5.3 (±10) and at last available follow‐up visit was 2.8±5. This difference was statistically significant (p=0.016). The responder rate was 76%. Ten patients dropped out; 4 as a result of seizure worsening, 1 as a result of unchanged seizure frequency, 3 as a result of a lack of compliance, and 2 as a result of side effects. Based on the QOLIE‐31‐P, a significant improvement of the subscale “seizure worry” (p=0.004) and a significant decrease in distress scores related to AEDs and social life (p=0.009 and p=0.008, respectively) were observed. A significant decrease in HAMA score (p=0.002) was documented.ConclusionsThese data indicate that PGB may represent a valid alternative as add‐on treatment in this patient population, based on its efficacy on seizure control and anxiety.
Seizure control with antiepileptic drug therapy in 517 consecutive adult outpatients at the Kork Epilepsy Centre
Authors: Steinhoff Bernhard J , Staack Anke Maren , Wisniewski Ilona 
Published: August 2019

ABSTRACTIn order to assess the efficacy of modern antiepileptic drug (AED) therapy, we collected data from 517 consecutive adult outpatients referred to our centre between March and August 2011. In total, 211 patients (40.8%) were treated with monotherapy, 208 patients (40.2%) with a combination of two AEDs, and for the remaining patients (n=98; 19%) more than two AEDs were combined. The most common AEDs were valproate, lamotrigine, carbamazepine, and levetiracetam. Of the recent AEDs, leve‐tiracetam was the leading drug with regards to drug combinations. Freedom of seizures for more than one year was achieved in 291 patients (56.3%). Under monotherapy, 168 patients (32.5% of all patients; 79.6% of patients with monotherapy) became seizure‐free. Seizure‐freedom with two AEDs was achieved in 103 patients (19.9% of all patients; 49.5% of patients with two AEDs) and in 20 patients with three AEDs (3.9% of all patients; 25.3% of patients with three AEDs). We conclude from this cross‐sectional survey in a large patient group that combinations may still lead to treatment success in a considerable proportion of patients.
Crying with sorrow evoked by electrocortical stimulation
Authors: Burghardt Tyson , Basha Maysaa M , Fuerst Darren , Mittal Sandeep 
Published: August 2019

ABSTRACTDacrystic seizures are rare and have been reported in patients with hypothalamic hamartoma as well as fronto‐temporal epilepsy, involving the non‐dominant hemisphere. We describe the first reported case of cortical stimulation of the left posterior orbito‐frontal gyrus, generating consistent and reproducible crying with affective content in a 41‐year‐old woman with medically intractable left temporal lobe epilepsy, who underwent extraoperative intracranial video‐EEG monitoring for resective non‐lesional epilepsy surgery.
Ictal unilateral hyperkinetic proximal lower limb movements: an independent lateralising sign suggesting ipsilateral seizure onset
Authors: Teotónio Rute , Rodionov Roman , McEvoy Andrew W , Duncan John , Diehl Beate , Wehner Tim 
Published: August 2019

ABSTRACTOur aim was to determine the lateralising value of ictal repetitive unilateral hyperkinetic proximal lower limb movements. Among 16 patients with ictal hyperkinetic features who underwent intracranial EEG between 2008 and 2011 in our centre, three had repetitive unilateral hyperkinetic proximal lower limb movements, sometimes associated with “hemiballic‐like” movements of the ipsilateral upper limb. There were no other consistent lateralising signs. In all patients, these movements were ipsilateral to the ictal onset zone and started a few seconds after electro‐encephalographic seizure onset. In two patients, intracranial EEG showed seizure onset within the parietal lobe and mesial temporal ictal onset was recorded in a third. Two patients underwent resection and became seizure‐free. Our results suggest that unilateral ictal repetitive hyperkinetic proximal lower limb movements may be an independent lateralising sign to the ipsilateral hemisphere.