Journal of epilepsy research最新文献

[This corrects the article DOI: 10.14581/jer.23001.].

Background and purpose: To determine the common precipitating factors for breakthrough seizures in children with epilepsy.

Methods: This retrospective study reviewed the charts of children with epilepsy who were followed up in the pediatric neurology clinic of King Fahad Hospital in Al-Baha region, Saudi Arabia, between January 2015 and August 2022. Children between 1 to 14 years of age who had epilepsy, as per the International League Against Epilepsy definition and received anti-seizure medication with a seizure-free period of at least 2 months before breakthrough seizure episode, were included in the study.

Results: Of the 108 children included in the study, the mean age was 6.8±1.6 years, and among them (55.5%) were male. Most parents (69.5%) were unaware of the triggering factors of seizure. The majority of patients (88%) reported at least one precipitating factor for breakthrough seizures and the most common one was systemic infection associated with fever (52.8%), and then non-compliance to medications in (34.3%) of the patients. In terms of the electroencephalogram, around 84 patients (77.8%) had abnormal electroencephalogram. Finally, monotherapy was maintained in 63.9% of patients.

Conclusions: We conclude that the most common trigger for breakthrough seizure is a systemic infection associated with fever and non-compliance to anti-seizure medications. Increasing the level of awareness by different methods may help limit or even prevent seizures from occurring. Randomized controlled trials could shed light on the adjustment of anti-seizure medications temporarily by increasing the dosage or giving extra doses during the infection to avoid breakthrough seizures.

Background and purpose: Ketogenic diet (KD) improves seizure control in patients with drug-resistant epilepsy. As increased mitochondrial levels of glutathione (GSH) might contribute to a change in seizure susceptibility, we quantified changes of absolute GSH levels in the brain by in vivo 1H magnetic resonance spectroscopy (1H MRS) and correlate that with degree of seizure control in patients on KD.

Methods: Five cognitively normal adult patients with drug-resistant epilepsy were initially included and 2 completed the study. Each patient was evaluated by a neurologist and registered dietitian at baseline, 1, 3, and 6 months for seizure status and diet adherence after initiation of a modified atkins diet. Multiple metabolites including GSH were quantified using LCModel (version 6.3-1P; Stephen Provencher, Oakville, ON, CA) on a short echo time single-voxel 1H MRS in parieto/occipital grey matter and parietal white matter on a 3 Tesla General Electric magnet prior to starting the ketogenic diet and at 6 months.

Results: Both patients (42-years-old male and 35-years-old female) demonstrated marked increases in absolute GSH level in both gray matter (0.12 to 1.40 and 0.10 to 0.70 international unit [IU]) and white matter (0.65 to 1.50 and 0.80 to 2.00 IU), as well as 50% improvements in seizure duration and frequency. Other metabolites including ketone bodies did not demonstrate consistent changes.

Conclusions: Markedly increased levels of GSH (7-fold and 14-fold) were observed in longitudinal prospective study of two adult patients with intractable epilepsy with 50% seizure improvement after initiation of ketogenic diets. This pilot study supports the possible anticonvulsant role of GSH in the brain.

Background and purpose: During the coronavirus disease 19 (COVID-19) pandemic, a considerable number of studies have focused on the difficulties for accessing the medical services and telemedicine-related issues. However, it is not clear whether COVID-19 affects the clinical course of epilepsy. Therefore, in the current study we aimed to assess the effects of COVID-19 infection on seizure frequency in patients with epilepsy (PWE).

Methods: We evaluated PWE who consecutively referred to the neurology clinics of 22 Bahman and Qaem hospitals, who had experienced a recent polymerase chain reaction-confirmed-COVID-19 infection. Data were collected through a pre-defined electronic questionnaire.

Results: A total of 104 patients were included. Females represented 52% of the population. The mean age of the patients was 36.73±17.87. Thirty-six patients (34%) reported increased seizure frequency. The mean age of the patients who had exacerbated seizure frequency was significantly lower than the non-exacerbated group (27.50±9.8 vs. 40.14±18.39; p=0.005). The number of the male patients were significantly higher in the exacerbated group (52% vs. 25%; p=0.014). The majority of exacerbated group had a history of drug resistance (44.4% vs. 8.5%; p=0.022). The number of epileptic seizures before COVID-19 infection was higher in the exacerbated (p=0.04).

Conclusions: About 34% of PWE experienced exacerbated epileptic seizures after COVID-19 infection. Male patients, young patients, patients with the history of drug resistance, and the patients who had higher seizure frequency were at increased risk for seizure exacerbation. Our results highlight the importance of screening, early diagnosis, and treatment in PWE.

Psychiatric disorders are commonly observed in patients with epilepsy. Among them, the phenomenon known as forced normalization is scarce. Herein, we report the case of a 41-year-old patient who showed long-term first-onset psychiatric symptoms after seizure remission and normalization of electroencephalography. After changing the antiepileptic drug regimen and psychiatric treatment, the patient's symptoms regressed. However, the exact pathological mechanisms remain to be elucidated. Changing the regimen of antiepileptic drugs and long-term psychiatric treatment may help control this phenomenon.

Juvenile myoclonic epilepsy (JME) has well-defined clinical and electrophysiological features. On the other hand, large case series have shown that focal and asymmetrical discharges may accompany generalized epileptiform activities in JME. Although it is known that these non-generalized electrophysiological findings do not exclude the diagnosis of this syndrome, some findings may create confusion in the differential diagnosis. In this case report, a case of JME with electroencephalographic findings characterized by isolated unilateral epileptiform activities without typical generalized discharges was discussed. The current case clinically presented with involuntary jerk movements in the bilateral upper extremities. It has been determined that these movements are uni/bilateral myoclonic beats based on home video recordings. Metabolic, toxic and structural problems were excluded in the investigations for the etiology of myoclonus. In the electrophysiological examination performed for epileptic processes, epileptiform discharges localized to the isolated right hemisphere were observed. JME was considered primarily due to clinical findings in the patient, and effective seizure control was achieved in a 4-year follow-up under anti-seizure treatment. The peculiarity of the case is the presence of electrophysiology recordings of isolated unilateral epileptiform activity during the 4-year follow-up period. It should be emphasized that there is no case of JME diagnosed with isolated unilateral epileptiform activity in the absence of generalized spike-slow waves or multiple spike-slow waves in the literature.