Epileptic Disorders最新文献

Psychosis of epileptic origin can present a wide range of cognitive and affective symptoms and is often underrecognized. Usually occurring in the inter- and postictal phase, epileptic psychosis is mostly related to temporal lobe epilepsy. Here, we describe the clinical presentation and diagnostic workup including routine EEG recording and brain MRI of a 63-year-old woman expressing isolated nihilistic delusions comprising belief of being dead and denial of self-existence. EEG showed an ictal pattern fulfilling the Salzburg criteria of nonconvulsive status epilepticus and brain MRI revealed extensive peri-ictal hyperperfusion. Delusional symptoms and EEG abnormalities subsided after acute antiseizure treatment. Our case illustrates how nihilistic delusions can occur as a direct clinical correlate of seizure activity, thereby expanding the spectrum of ictal neuropsychiatric phenomena in temporal lobe epilepsy and highlighting the need to consider an epileptic origin in patients presenting with psychotic symptoms.

The diagnosis of epilepsy is associated with loss of predictability, which invariably results in the fear of when and if future seizures will occur. For a subset of patients with epilepsy (PWE), there may be a pathological persistent fear of seizure occurrence, resulting in limitations to daily activities through avoidant behaviors. Paradoxically, the research of anticipatory anxiety of seizures (AAS; also referred to as seizure phobia) has been practically nonexistent and, not surprisingly, this condition remains underrecognized by clinicians. The available data are derived from three small case series of patients followed in tertiary epilepsy centers. In this study, we review the available data on the reported clinical manifestations of AAS in PWE, and of the potential role of variables associated with it, such as personal and family psychosocial and psychiatric history and epilepsy-related variables. In addition, we review the need for the creation of screening tools to identify patients at risk of AAS and discuss potential treatment strategies, which could be considered as part of the comprehensive management for PWE.

Paraneoplastic encephalitis includes neurological conditions with autoantibodies against neuronal proteins, likely triggered by the underlying tumor antigens.¹ We report two patients with paraneoplastic limbic encephalitis¹ with “high-risk-for-cancer” antibodies against Ma2 antigen and non-typical tumors. These cases allow consideration of autoimmune epilepsy's pathogenesis, the importance of early diagnosis, and therapy.

A 21-year-old male admitted to the Infectious Disease Unit due to confusion, visual hallucinations, and upper limbs myoclonus, following a 4-month history of antipyretic-resistant fever, sore throat, and hyperphagia. Cerebrospinal fluid (CSF) analysis was normal, blood examinations showed pancytopenia. Brain MRI, [¹⁸F]FDG-PET, and EEG (Figure 1A–D) suggested central nervous system inflammation involving basal ganglia and mesial temporal lobes. Screening for infections was negative. Anti-Ma2 antibodies were found in serum and CSF (indirect immunofluorescence on primate cerebellum, and dot-blot; Euroimmun, Germany). IV methylprednisolone (1 g/day for 5 days) and immunoglobulins (IVIg) (.4 g/kg/day for 5 days) yielded no clinical improvement. Total body CT, [¹⁸F]FDG-PET, pelvis, and testicular ultrasound excluded neoplasms, but bone marrow analysis, 6 months after symptoms' onset, showed a clonal population of CD19/CD20dim/CD21 B lymphocytes, indicating a mature B-cell indolent lymphoproliferative disorder not requiring treatment. Hospital-acquired sepsis hindered further immunosuppressive therapies and led to death (7 months after symptoms' onset).

The second patient, a 30-year-old male, presented with asthenia, insomnia, mild fever, and daily, short-lasting episodes of shivering, horripilation, heart palpitations, and unpleasant taste. Subtle sleep-related involuntary movements were reported. No EEG was performed at the time. 1 month after symptom onset, a right testicular mass was noticed and orchiectomy performed. Pathology disclosed a post-puberal teratoma. 2 months later, a scheduled total body CT showed enlargement of retroperitoneal lymph-nodes, which were completely removed. Pathology disclosed a post-puberal teratoma with embryonal cancer focus. The patients started clinical and radiological follow-up, with no further localizations detected. 5 months later, he presented a focal-to-bilateral seizure, promptingantiseizure medications. Brain MRI and [¹⁸F]FDG-PET indicated limbic encephalitiswith EEG showing interictal epileptiform discharges in left temporal lobe (Figure 1E–H). Anti-Ma2 antibodies were detected in serum and CSF (indirect immunofluorescence on primate cerebellum, and dot-blot; Euroimmun, Germany), but not anti-NMDAR (antigen-specific cell-based assay (Euroimmun, Germany)). IVIg (.4 g/kg/day for 5 days), methylprednisolone (500 mg/day for 3 days) followed by oral prednisone (50 mg/day) led to seizure frequency reduc

The presence of dysmorphic neurons with strong cytoplasmatic accumulation of heavy non-phosphorylated neurofilament is crucial for the diagnostics of focal cortical dysplasia type II (FCDII). While ILAE's classification describes neocortical dysplasias, some groups have reported patients with mesial t abnormal neurons in the hippocampus of mesial temporal lobe epilepsy. Here we report a patient with such abnormal neurons in the hippocampus and compared it with previous reports of hippocampal dysplasia. Finally, we discuss the need for diagnostic criteria of hippocampal dysplasia.

Ictal kissing (IK) is a rare type of automatism observed during epileptic seizures. Despite its uncommon occurrence, understanding the underlying mechanisms, the role of emotions, and the level of consciousness during seizures with IK is essential in providing a comprehensive understanding of epilepsy. We describe five cases (.13%) of IK after performing a retrospective analysis of 3794 long-term, ictal video-EEGs from an epilepsy monitoring unit in Mumbai, India. Our patients with drug-resistant epilepsy showed IK had a wide epileptogenic zone. We discuss the current hypotheses on the mechanisms behind IK, the involvement of temporal lobe structures, and the implications of awareness during seizures. The review concludes by suggesting future directions for research to elucidate the complex phenomenon of IK further.