Journal of epilepsy research最新文献

Epilepsy is one of the commonest and oldest neurological diseases in the history of mankind, the exact pathophysiology of the evolution of which still remains elusive. The intimate and intriguing relation between epilepsy and sleep has been known for a long time. Rapid eye movement sleep (REMS) is well documented to exert potent antiepileptic action in human epilepsies and the underlying mechanism of which is largely based on its property to induce widespread electroencephalogram (EEG)-desynchronization. The pedunculopontine nucleus (PPN) owing to its property to enhance REMS has recently been under study for its potential role in intractable epilepsy (IE) and has been proposed as a novel deep brain stimulation target in IE. This brief paper unfolds the existing role of PPN, REMS, and EEG-desynchronization (PRED) in the evolution of epilepsy in an axial manner, the realization and comprehension of which is likely to open new avenues for further understanding of epileptogenesis, improved treatment of epilepsy and reducing the risk of IE.

Background and purpose: Accumulating evidence suggest that lenalidomide, a structural analog of thalidomide, has neuro-modulatory and neuroprotective properties. In the present study, we investigated effects of acute administration of lenalidomide on clonic seizure threshold in mice induced by pentylenetetrazole (PTZ) and possible role of N-methyl-D-aspartic acid receptor (NMDAR) and nitric oxide (NO) pathway.

Methods: We have utilized a clonic model of seizure in NMRI mice induced by PTZ to evaluate the potential effect of lenalidomide on seizure threshold. Different doses of lenalidomide (5, 10, 20, and 50 mg/kg, intraperitoneal [i.p.]) were administered 1 hour before PTZ. To evaluate probable role of NMDAR/NO signaling, the non-selective NO synthase inhibitor L-N ^G-nitroarginine methyl ester (L-NAME; 10 mg/kg, i.p.), neuronal NOS (nNOS) inhibitor 7-nitroindazole (7-NI; 30 mg/kg, i.p.), selective inducible NOS inhibitor aminoguanidine (AG; 100 mg/kg, i.p.), selective NMDAR antagonist MK-801 (0.01 mg/kg, i.p.), and selective NMDAR agonist D-serine (30 mg/kg, i.p.) were injected 15 minutes before lenalidomide.

Results: Lenalidomide at 10 and 20 mg/kg significantly elevated the PTZ-induced seizure thresholds. Interestingly, L-NAME (10 mg/kg, i.p), 7-NI (30 mg/kg, i.p), and AG (100 mg/kg, i.p) reversed the anticonvulsive effect of lenalidomide (10 mg/kg). Moreover, treatment with the NMDAR agonist D-serine (30 mg/kg, i.p.) did not alter the anticonvulsive properties of lenalidomide (10 mg/kg, i.p). However, the NMDAR antagonist MK-801 (0.01 mg/kg, i.p) significantly reversed the anticonvulsive effects of lenalidomide (10 mg/kg).

Conclusions: Our study demonstrated a role for the NMDAR/NO pathway in the anticonvulsive effects of lenalidomide on the PTZ-induced clonic seizures in mice.

Epilepsy is known to comorbid with Alzheimer's disease. It can promote cognitive decline, and eventually worsen their prognosis and mortality. It is sometimes difficult to find a suitable drug because of the adverse effects. Perampanel has a unique mechanism of action that antagonizes α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid type glutamate receptor. Here, we report a case of severe dementia due to Alzheimer's disease with intractable epilepsy, which perampanel effected for controlling seizures with less adverse effects. The subject is an 89-year-old Japanese woman with severe dementia due to Alzheimer's disease and intractable myoclonic epilepsy. She also had psychiatric symptoms, such as circadian rhythm disorder and irritability. Valproic acid, lacosamide, or carbamazepine were prescribed, but none of them was effective. Shortly after perampanel started, however, myoclonus and these psychiatric symptoms improved. Moreover, it did not cause any obvious adverse effects, which made it possible to continue perampanel until the end of her life. Perampanel may be useful for controlling intractable epilepsy accompanied by Alzheimer's disease. It may also improve psychiatric symptoms with less adverse effect. Accumulation of studies is necessary to evaluate the effectiveness of perampanel on the epilepsy of Alzheimer's disease patients and further understand that mechanism.

Abdominal epilepsy is an uncommon cause of recurrent abdominal pain with or without other complaints seen in children and adults which often goes unnoticed. Here we are presenting a case of abdominal epilepsy in a 7-year boy who had recurrent abdominal pain since many years. He had a history of ventriculoperitoneal shunting which was performed for obstructive hydrocephalus at 1 month and left hemiparesis. He was evaluated at multiple centers for abdominal complaints before being referred here. The video electroencephalogram done showed inter ictal and ictal abnormalities which correlated with magnetic resonance imaging and positron emission tomography abnormalities on the right side. He was started on antiepileptics with a partial response and continued to get events even with four antiepileptics but the frequency and severity reduced significantly. The present case report is to highlight the drug refractoriness of abdominal seizures in a patient with symptomatic focal epilepsy.

Background and purpose: To study the aetiolgic spectrum of new-onset seizures in the peripartum period in south India.

Methods: This is a retrospective analysis of case records of women with new-onset seizures in the peripartum period admitted between 2005 and 2018 (13 years).

Results: Of the 41 women (mean age, 26.20 years; range, 19-35 years) admitted, 20 patients (48.7%) had hypertensive disorders of pregnancy (HDP). Generalized tonic-clonic seizure (88%) was the common seizure type. The aetiologies of new-onset seizures were: 1) pregnancy-related aetiologies in 33 (80.5%) and 2) non-pregnancy-related aetiologies in eight (19.5%). Of the pregnancy-related aetiologies, posterior reversible encephalopathy syndrome (PRES) was the commonest cause in 24 patients (58.5%). Seizure cluster presentation was common in patients with PRES (p=0.0087). Of the eight women with non-pregnancy-related aetiologies, endemic central nervous system (CNS) infections accounted for three (7.3%; brain tuberculoma in one and neurocystocercosis in two) of the aetiology. All the women had Glasgow outcome scale-5 outcome.

Conclusions: PRES was the common cause of new-onset seizures in peripartum period in this cohort. Endemic infections of CNS accounted for 7.3% of the total aetiological spectrum. This study suggests that the possibility of PRES should be considerd in woman with HDP and seizure cluster in peripartum period.

Ictal swearing, as an epileptic manifestation, has rarely been reported. Despite its poor localization value and unclear mechanism, several previous studies have reported that it frequently originates from the temporal lobe and more often from the non-dominant hemisphere. Herein, we report a case of a 41-year-old right-handed man with a history of stereotypical manifestation of ictal swearing with a left (dominant) hemisphere origin, confirmed by video electroencephalography monitoring. Reasonable suspicion that repetitive swearing could be a manifestation of seizures is important for clinicians not to misdiagnose the disease.

Agenesis of the corpus callosum is a brain malformation that can occur in isolation or in conjunction with other congenital or developmental defects. The clinical sequelae of this condition include epilepsy, cognitive deficits, developmental delay, and various neurological and psychiatric disorders. Here we present the case of a patient with congenital complete agenesis of the corpus callosum and medically refractory epilepsy who underwent stereoelectroencephalography. This identified a left frontal ictal focus and revealed that contralateral spread occurred though the anterior commissure, a rare and interesting occurrence. Left frontal resection resulted in significant improvement. This demonstrates the role of the anterior commissure in ictal spread and the potential for novel methods of seizure spread in patients with temporal lobe epilepsy that must be considered in a surgical approach.

Background and purpose: Refractory epilepsy is when seizures are unresponsive to two or more medications. Hemispherectomy, one of the treatment options, is the complete removal or functional disconnection of a cerebral hemisphere. Hemiparesis, a symptom of epilepsy, is defined as weakness of one side of the body. Patients with refractory epilepsy, who experience extreme seizure frequency, are subjected to hemispherectomy. This study focuses on finding the correlation between hemispherectomy and hemiparesis, discovering a pattern in its severity levels before and after surgery.

Methods: Data was collected from 59 epileptic patients suffering from refractory epilepsy, who underwent hemispherectomy, at the King Faisal Specialist Hospital and Research Centre, from 1998 to 2014. Each patient was monitored over a period of 1-year post-surgery. In this study, we wanted to further explore the correlation between hemispherectomy and hemiparesis.

Results: Upon analyzing the sample size, the level of hemiparesis pre and post hemispherectomy remained the same for 32 patients, of which 13 patients had mild levels pre-surgery and 19 patients had moderate to severe levels pre-surgery. However, 20 of the patients who had moderate to severe levels of hemiparesis before the surgery had either no hemiparesis or a mild level after surgery, which signified an improvement in their severity level. On the other hand, seven of the patients went from having no hemiparesis before the surgery to having moderate or severe levels of hemiparesis post-surgery. Although the results were clinically significant, they were not statistically significant as the p-value obtained was 0.31.

Conclusions: After analyzing the results, it can be concluded that hemispherectomy does decrease the severity of hemiparesis in an epileptic patient, thereby improving his/her quality of life drastically.

Background and purpose: Patients who are non-adherent to their medication are frequently hospitalized with prolonged lengths of stay and make repeated emergency department visits. They are also more likely to miss work or school due to the seizure effects. In Ethiopia, although there is little evidence concerning anti-epileptic drug adherence, some studies were conducted with some controversy with studies done in another country. This study was therefore conducted to assess non-adherence to antiepileptic drugs and associated factors among adult epileptic patients attending in Dessie town public hospitals, northeast Ethiopia.

Methods: Hospital-based cross-sectional study design was employed on 368 patients from January 16, 2018 to March 16, 2018. A systematic random sampling technique was employed to recruit study participants. The collected data were entered into EpiData 3.1 and exported to SPSS version 22.0 for analysis. All covariates that were significant at p-value <0.25 in the bivariate logistic regression analysis were considered for further multivariable logistic regression analysis level of statistical significance at p-value <0.05.

Results: Among the respondents, 37.5% (95% confidence interval [CI], 32.1-42.9) of them were non-adhered to antiepileptic drugs. Patients who were unable to write and read (adjusted odds ratio [aOR], 22.30; 95% CI, 5.84-85.21), primary education level (aOR, 5.63; 95% CI, 1.90-16.69), being male (aOR, 2.37; 95% CI, 1.33-4.23), experience adverse effect (aOR, 13.68; 95% CI, 3.27-56.97), patients got medication by payment (aOR, 2.06; 95% CI, 1.04-4.11) were statistically associated with non-adherence.

Conclusions: This study revealed that over one-third of participants were non-adherent to antiepileptic drugs. Sex, educational level, adverse effect, and medication source were independent factors for non-adherence to antiepileptic drugs. Therefore, educations and instructions about the importance of recommended drug use can improve antiepileptic drug adherence in patients with epilepsy.

Background and purpose: Risk of seizure is significantly higher in cerebral vein and dural sinus thrombosis (CVST) compared to other stroke subtypes. There is paucity of literature on predictors of presenting seizures in CVST. This study was designed to investigate the risk and predictors of seizures in CVST at presentation.

Methods: Total 181 consecutive patients with CVST were retrospectively analyzed.

Results: Total 181 patients with CVST were enrolled (age range, 14 to 96 years; mean age, 34.64±14.66 years). A total of 44 patients had presenting seizures. Younger age (p=0.028), involvement of superficial cortical veins (p=0.016), presence of hemorrhagic venous infarct (p≤0.001) and involvement of frontal lobe (p≤0.001) were significantly related to the presenting seizures on the univariate analysis. The hemorrhagic venous infarct (odds ratio [OR], 4.44; 95% confidence interval [CI], 1.89-10.44; p=0.001) and involvement of the frontal lobe (OR, 10.66; 95% CI, 4.02-28.29; p≤0.001) were independently associated with the presenting seizures on the multivariate analysis.

Conclusions: About one fourth of the patients with CVST had presenting seizures. The patients with hemorrhagic venous infarct in the frontal region are more prone to have presenting seizures.