Epileptic Disorders最新文献

Objective: To quantify the additional detection yield of the 25-channel electrode array recommended by the International Federation of Clinical Neurophysiology (IFCN), which includes six inferior-temporal electrodes beyond the conventional 10-20 International System (IS) in identifying interictal epileptiform discharges (IEDs) and focal slow activity (SA).

Methods: We analyzed 258 consecutive adult EEGs (routine or sleep-deprived; mean age, 57 ± 19 years; 55% female; 61% on anti-seizure medication). Indications were suspected epilepsy (33%) and seizure follow-up (28%). Two blinded neurophysiologists harmonized IED/SA terminology and applied the validated three-item subset of the IFCN's operational IED criteria. Each EEG was reviewed twice: first with the standard 19-electrode 10-20 system and, after a ≥ 4-week washout, with the 25-channel IFCN array. Reading lists were randomized between reviewers so that the sequence of cases differed, thereby reducing recall bias. Abnormalities were classified by type and lobe. Agreement was measured using Cohen's κ; yield gain was the detection-rate difference.

Results: Agreement ranged from substantial to almost perfect (κ = .65-.88; 95% CI: .48-1.00), with disagreement rates of 1.2-7.8%. Temporal IEDs were detected more frequently with IFCN (72/71 patients) than with 10-20 (63 each), corresponding to gains of 12.5% and 11.3%, respectively. Temporal SA was also higher (98 vs. 86; +12.2% for both). Gains in extratemporal SA were smaller (10.7% and 9.5%) and differences in extratemporal IEDs were minimal (≤3.6%). Pooled across all abnormalities, IFCN detected 183 and 182 patients versus 172 and 170 with 10-20, respectively, an overall gain of 11.5%. The largest relative increase was seen in temporal IEDs, with an additional 11-12% of patients identified using the IFCN array compared with 10-20.

Significance: The addition of six inferior-temporal electrodes increased the relative detection yield of EEG abnormalities by 11.5%, with the largest gains for temporal IEDs, and required only minimal extra setup time. Although the true diagnostic accuracy of these additional detections cannot be determined without an external gold standard, the findings support the routine use of the IFCN 25-electrode array to address a major blind spot of the 10-20 system in adult EEG practice.

Epilepsy is more common in the elderly population, with a higher prevalence of epilepsy-related neurological diseases, such as stroke and traumatic brain injury. Although dementia is also known to be a potential cause of epilepsy in the elderly, estimating its accurate contribution is challenging because of its high prevalence in the general elderly population. To characterize the clinical features of patients with comorbid dementia, we compared the characteristics of these patients with those of elderly patients with post-stroke epilepsy and an unidentified etiology. Of the 494 patients who were first diagnosed with epilepsy after the age of 65 years, 194 were classified as having post-stroke epilepsy, 105 as having comorbid dementia, and 71 as having epilepsy of unidentified etiology. Patients with comorbid dementia were older at seizure onset (p < .001) and at the last treatment (p < .001) than those in the other groups. They were more likely to have depression (p = .04) and were more frequently treated with acetylcholine esterase inhibitors and memantine before the diagnosis of epilepsy (p < .001). In contrast, stroke-related risk factors, such as hypertension (p < .001) and dyslipidemia (p = .01), were more prevalent in patients with post-stroke epilepsy. Considering that stroke itself is a well-recognized risk factor for dementia and epilepsy in the elderly, our study suggests that dementia may be a major comorbidity and a risk factor for late-onset epilepsy.

We conducted a systematic review and meta-analysis of the ictal semiology associated with supplementary motor area (SMA) and pre-supplementary motor area (pre-SMA) epilepsy, to summarize current knowledge of related anatomo-clinical correlations in the context of presurgical evaluation. We conducted the review and reported its results according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA). We searched PubMed and Embase using relevant keywords related to the SMA and pre-SMA localization, seizure semiology, and scalp electroencephalography (EEG) or stereo-EEG. The risk of bias was evaluated using the QUADAS2 score. Twenty articles were included, with extractable data from 37 patients. We analyzed the included studies and extracted data on the presence of 12 different symptoms. We then performed a meta-analysis of the proportion of patients with each symptom. The most frequently reported ictal feature in SMA epilepsy was asymmetric tonic posturing, observed in 47% of cases. Automatisms (25%) and versive seizures (23%) were also common, while loss of consciousness occurred in 19% of patients. Sensory phenomena (11%) and speech arrest/inhibition (10%) were less frequent. Other features, including symmetric tonic posturing, elementary motor signs, hyperkinetic patterns, affective phenomena, grimacing, and negative motor phenomena, were rarely observed. Little evidence is available on the distinct involvement of the pre-SMA. Although asymmetric tonic posturing appears to be the most common feature of SMA epilepsy, it occurs in fewer than 50% of patients and the level of evidence of this association remains low. The same semiological feature may result from the rapid propagation to adjacent or connected regions; hence, semiology should always be interpreted in the context of a multimodal evaluation. Stereo-EEG investigation remains crucial when EEG and imaging are inconclusive or conflicting.

Objective: To identify long-term predictors of seizure outcome after anterior temporal lobectomy (ATL) in a large, homogeneous cohort of patients with drug-resistant temporal lobe epilepsy (TLE) and MRI-defined unilateral hippocampal sclerosis (HS), all operated on by a single neurosurgeon with extended follow-up.

Methods: We retrospectively analyzed 281 consecutive patients with unilateral HS who underwent standardized ATL performed by the same senior neurosurgeon. All patients had at least two years of follow-up (mean 10.8 ± 5.79 years). Clinical history, neuropsychological evaluation, long-term video-EEG monitoring, and 1.5T MRI constituted the preoperative dataset. Twenty-one variables were assessed as potential predictors of seizure outcome. Kaplan-Meier survival curves and univariate log-rank tests identified candidate predictors; variables with p < .10 were entered into a multivariate Cox regression model. Cognitive and quality-of-life outcomes were evaluated using standardized neuropsychological batteries and the ESI-55 questionnaire.

Results: At 10 years postoperatively, 62.6% of patients remained seizure-free (Engel I). Univariate analysis identified seven factors associated with seizure freedom, including history of focal-to-bilateral tonic-clonic seizures, history of status epilepticus, presence of psychogenic non-epileptic seizures, IED predominance or exclusivity in the operated lobe, ictal onset exclusively in the operated lobe, and a preoperative neuropsychological deficit confined to the operated temporal lobe. Multivariate analysis revealed three independent predictors of seizure outcome: history of status epilepticus (HR = 2.11; p = .002), ictal onset confined to the operated temporal lobe (HR = .57; p = .018), and preoperative neuropsychological deficit restricted to the operated temporal lobe (HR = .59; p = .040). Cognitive outcomes were generally stable; left ATL was associated with greater verbal memory decline. Quality-of-life improved significantly at 2-year follow-up (p < .001), with better outcomes among seizure-free patients.

Significance: In this large single-surgeon cohort with one of the longest follow-up durations reported, most patients with unilateral HS achieved durable seizure freedom after ATL. Status epilepticus, consistent ictal localization to the operated temporal lobe, and concordant preoperative neuropsychological deficit emerged as robust long-term predictors. These findings reinforce the value of detailed presurgical evaluation-particularly ictal EEG concordance and neuropsychological lateralization-in optimizing surgical counseling, risk stratification, and patient selection.

Objective: Abrupt benzodiazepine (BDZ) withdrawal may induce nonconvulsive status epilepticus (NCSE), but information regarding its clinical and EEG features is limited. Our aim was to better characterize this condition.

Methods: Patients with NCSE according to Salzburg criteria secondary to abrupt BDZ withdrawal identified at our center (2009-2024) were included. Clinical data, seizure semiology, and EEG, were described using ILAE, ACNS, and Salzburg criteria; clinical response to BDZ was quantified using the NCSE response scale (NRS). Recurrences at long-term follow-up were documented.

Results: Fifteen patients (median age 68 years, 53% male) were identified, accounting for 4% of all NCSE cases. None had epilepsy, 80% had psychiatric disorders, and 47% had cognitive impairment. Six (40%) subjects were taking only a low-dose BDZ, and only one was above the therapeutic range. Potential seizure facilitators were identified in all but one patient, including withdrawal from other drugs (60%) or infections (33%). There were two clinical presentations: (1) recurrent absence seizures lasting ≤15 min with asymptomatic periods in-between (67%); and (2) continuous, fluctuating consciousness impairment (33%). Motor phenomena (67%) - including increased or decreased blinking, movement-induced myoclonus or automatisms-, and generalized tonic-clonic seizures (60%) were frequent. Before EEG, BDZ withdrawal was not suspected in any case. The ictal EEG activity consisted of generalized, rhythmic, or irregular polyspike-slow waves and spike-slow waves with gradual onset and offset. However, in 20%, this ictal pattern was less developed. Intravenous clonazepam induced an immediate EEG and clinical improvement, but complete control of seizures required 1-3 days. At follow-up, a new abrupt BDZ withdrawal caused absence seizures recurrence in 4/7 patients still on BDZ treatment, but in none of the eight patients who had gradually discontinued BDZ.

Significance: NCSE secondary to BDZ withdrawal has distinctive clinical and EEG features but is misdiagnosed without an EEG. Reintroduction of BDZ stops seizures, but long-term management requires gradual BDZ discontinuation to prevent recurrences.