Seizure

Although numerous new antiepileptic drugs (AEDs) have been introduced over the last decades, offering advantages in terms of tolerability and drug interactions, most clinical trials and meta-analyses have failed to demonstrate any significant superiority in terms of efficacy of these newer AEDs as compared to older AEDs. [1–3] Also, it is well established that seizure response rates to add-on AED treatment decrease with subsequent AED trials [4–6]. For these reasons, overall drug response rates in patients with epilepsy have not ...

New-onset refractory status epilepticus (NORSE) is a rare but devastating condition. Overall, approximately 200 cases of NORSE in adults [1–12] and 200 cases of FIRES in children [13–30] have been reported in the literature.

Epilepsy is a disorder of the brain characterised by abnormal neuronal activity [1]. Psychogenic nonepileptic seizures (PNES) are episodes of impaired self-control, which superficially resemble epileptic seizures. However, most PNES are considered as a dissociative psychological response to aversive stimuli [2]. Epilepsy and PNES are two of the three most common reasons why patients present with transient loss of consciousness [3].

It is generally accepted that epilepsy surgery is an excellent treatment option for achieving permanent seizure control in patients with temporal lobe epilepsies but it bears the risk of new and additional memory impairments after surgery [1–3].

Lennox-Gastaut syndrome (LGS) is a paediatric epilepsy syndrome described as a triad consisting of multiple seizure types, such as tonic –mostly occurring at night–, atonic, and atypical absence seizures, intellectual disability or regression, and abnormal electroencephalography (EEG) findings with a symptom onset before 12-24 months of age [1]. The EEG abnormalities consist primarily of an interictal pattern of diffuse, slow spike-wave complexes at 2.5 Hz during wakefulness and paroxysmal fast rhythms (10–20 Hz) during sleep, mainly in the non-rapid eye movement phase, ...

Focal cortical dysplasia (FCD) is a subgroup of cortical malformations characterized by abnormal regional neuronal migration and differentiation that result in aberrant cortical organization. [1] It is the most common anatomo-pathological feature in patients undergoing epilepsy surgery in childhood [2]. Prevalence figures have been rising over recent years due to improved MRI quality, but, even with the best methodology currently available, the sensitivity and specificity of imaging findings are limited and a diagnosis of FCD requires histological confirmation.

Ictal-interictal single photon emission computed tomography (SPECT) with co-registration to MRI (SISCOM) has proven its value in localizing epileptogenic zones [1–7]. This non-invasive tool remains crucial in challenging cases such as extra-temporal and/or non-lesional epilepsies [8]. Cerebral blood flow changes demonstrated during seizures reflect brain activation and its pathways of spread [9,10]. Its usefulness to establish sites for intracranial implantation and improve surgical outcome is now widely recognized [11,12].

It is well established in the literature that psychiatric and behavioral side effects (PBSE) are common in patients using antiepileptic drugs (AED) [1–4]. These adverse effects can range from minor behavioral changes to debilitating depressive symptoms and even suicidality [1–6]. PBSEs may oftentimes lead to discontinuation of medication, and it has been reported by several studies that previous psychiatric history is a highly important independent predictor of PBSE incidence in epilepsy patients using AEDs [1–4].

Idiopathic generalized epilepsy (IGE) patients usually present normal neuroimaging findings and adequate seizure control if treated with an appropriate antiepileptic drug regimen. Abnormalities in conventional neuroimaging in IGE patients usually represent incidental findings, not related to epilepsy pathophysiology. A significant minority of IGE patients present breakthrough seizures despite appropriate treatment [1]. These patients usually receive higher antiepileptic drug loads.

Status epilepticus (SE) is a time-sensitive and life-threatening medical emergency. The occurrence of seizures and SE appears often random and difficult to predict, reducing the quality of life in patients with epilepsy and their families [1]. Here, we summarize the literature on ambulatory seizure detection (focusing on detection modalities and devices for ambulatory monitoring), seizure prediction (focusing on patterns of epileptic seizure and SE occurrence as well as EEG features), and tentatively SE prevention (using closed-loop warning and treatment systems ...