Seizure

Epilepsy is a leading neurological condition characterized by recurrent seizures and affecting more than 50 million people worldwide [1]. There is a disproportionate geographical burden of epilepsy, with 80% of cases living in low- and middle-income countries [1]. In sub–Saharan Africa (SSA), the estimated median prevalence of epilepsy is 14.2 per 1000 [2]; there is a peak prevalence in the 20–29 years age group, with both sexes being equally affected particularly for individuals under 40 years [3].

There are approximately 17-23/100,000 pediatric status epilepticus (SE) episodes per year and approximately 4-15/100,000 SE episodes per year in adults [1,2]. SE is a condition with a mortality of approximately 2-5% in children and 13-19% in adults, even higher when SE is refractory or super-refractory [3]. Therefore, SE generally requires hospital management and close monitoring, frequently in the intensive care unit (ICU). The cost of caring for SE is substantial, but there is limited literature on cost associated with SE.

Seizures have many different manifestations, with diverse clinical signs and symptoms, together referred to as ictal semiology [1–4]. Semiology can help determine the hemisphere and lobe of seizure onset. To characterise a patient’s habitual seizures, admission is often required to a long-term electroencephalography (EEG) monitoring unit (LTM). A video recording of all captured seizures is correlated with the simultaneously recorded EEG to either confirm or refute the epileptic nature of the event [5], and in presurgical cases potentially identify the ...

When the mechanisms responsible for terminating epileptic seizures fail, status epilepticus (SE) may occur, resulting in prolonged seizures that can have long-term consequences [1]. In clinical practice, magnetic resonance imaging (MRI) is commonly used in SE patients as an aid to establish the etiological diagnosis. However, recent studies have described acute MRI changes associated with SE [2–4], which are mainly restriction in diffusion-weighted imaging (DWI) in different brain areas. Based on the findings in animal models, these features are usually ...

Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) remains of special interest due to its high prevalence and frequent drug-resistance [1]. Standard surgical approaches including anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH) are established effective treatments in medically refractory MTLE-HS patients. Prospective, randomized trials have demonstrated seizure-free rates significantly greater in surgically-treated patients compared to those given best medical therapy [2–4].

Super-refractory status epilepticus has a high mortality, and its treatment remains a challenge for clinical epileptologists. Deep brain stimulation (DBS) is successfully used in pharmacotherapy-resistant epilepsy and larger studies showed significant seizure reduction by high frequency stimulation in the anterior nucleus of the thalamus (ANT) [1]. Furthermore, several case reports indicate that DBS is also effective in the management of status epilepticus. In a recent, very comprehensive publication, Lehtimäki and co-workers reported resolution of a super-refractory non-convulsive status epilepticus with ...

Psychogenic non-epileptic seizures (PNES) are noticeable changes in an individual’s consciousness or behaviour that share a similar appearance to epileptic seizures, with the key difference being that PNES are not accompanied by electrophysiological changes [1]. Although as many as 15 different names have been documented in describing this condition [2], PNES is the term that will be employed throughout this systematic review. Reuber [3] posits that these seizures are best understood through the lens of a biopsychosocial, etiologic model, whereby ...

Epilepsy is a disease that affects the electrical activity of the brain. Epileptic seizures are paroxysms of electrical discharges that disrupt the brain’s ability to process information. In between seizures, a brain with epilepsy generates isolated electrical discharges known as interictal epileptiform discharges (IEDs) (Stern and Engel, 2013). IED identification corroborates a diagnosis of epilepsy and enables classification of the underlying type of epilepsy (Stern and Engel, 2013). In some cases, IED waveforms correlate with underlying pathology (Noachtar et al., ...

The Progressive Myoclonus Epilepsies (PMEs) are a group of uncommon clinically and genetically heterogeneous disorders (mainly autosomal recessive), characterised by myoclonus, generalized epilepsy, and progressive neurological deterioration, including dementia and ataxia [1]. PMEs are disorders with debilitating evolution, resistance to treatment and poor prognosis, and it is estimated that these diseases are responsible for up to 1% of epileptic syndromes in children and adolescents around the world.

Tuberous sclerosis complex (TSC) is a rare autosomal dominant inherited disorder characterized by the growths of benign hamartomatous tumors in multiple organ systems, primarily in the brain, eyes, heart, kidney, skin and lungs [1]. The prevalence of the disease was estimated to range from 1/6000 to 1/10 000 [2]. Inactivating mutations in either of two genes, TSC1 on chromosome 9q34 (MIM 191100) and TSC2 on chromosome 16p13 (MIM 191092), were identified as responsible for TSC [3,4]. The TSC1 gene contains ...