Seizure

Seizures represent approximately 1% of emergency department (ED) visits and, among those, approximately 6% are convulsive status epilepticus (SE) [1]. SE is one of the most common neurological emergencies, affecting 17-23/100,000 children per year [2–4] and 10-17/100,000 adults per year [3–5].

The first vagus nerve stimulator (VNS) was approved in the United States in 1997 for patients with drug resistant epilepsy (DRE). DRE is defined by the International League Against Epilepsy (ILAE) as persistent seizures within a 12-month period during which time an individual with epilepsy is treated with at least two properly chosen, properly dosed and well-tolerated anti-seizure medications (ASM) [1]. VNS therapy was reviewed by the American Academy of Neurology in 1997 [2], 1999 [3], and 2013 [4] and ...

Dissociative seizures (DS), also known as functional or psychogenic nonepileptic seizures, can be disabling for patients [1–3]. Patients with undiagnosed DS often receive inappropriate treatment for their seizures. This could be because, most frequently, DS are signs and symptoms of a functional neurological disorder (FND) where patients may have alteration in the function but not necessarily structure of the brain where psychological stress may be expressed through physical neurological symptoms [4,5].

Epilepsy surgery is the treatment of choice in patients with drug resistant epilepsy (DRE) which is defined as having continued seizures on maximum tolerated doses of two or more appropriately chosen antiepileptic drugs (AEDs).(1) Accurate localization of the epileptogenic zone is imperative for postoperative seizure freedom. Preoperative planning for epilepsy surgery involves analyzing seizure history, semiology, electrophysiological and neuroimaging findings. MRI reveals structural abnormalities, while single photon emission computed tomography (SPECT) detects regional cerebral perfusion during an ictal event (2).

Epileptic seizures are a common symptom in the acute stage of autoimmune encephalitis (AE), conceptually these are regarded as acute-symptomatic seizures [1]. In a few cases only, beyond the acute phase of AE, autoimmune-associated epilepsy (AAE) with recurrent unprovoked seizures develops. AAE may occur more frequently in patients with antibodies targeting glutamic acid decarboxylase (GAD) [2,3], with onconeural protein antibodies (e.g., Hu, Ma2, collapsing response mediator protein 5/CV2) [4], and with Rasmussen encephalitis [5].

Epilepsy surgery is an effective therapeutic option for patients with focal seizures who do not respond to appropriate treatment with antiepileptic drugs (AEDs) [1]. Patients with temporal lobe epilepsy (TLE) are the most common surgical candidates. Anterior temporal lobectomy (ATL), which removes the anterior portion of temporal lobe along with the hippocampus and amygdala, has been the standard surgical technique when MRI indicates the mesial temporal area as being the only epileptogenic area [2–4].

Diffusion-weighted magnetic resonance imaging (MRI) has provided a noninvasive insight into the microstructural characteristics of tissue and anatomical connectivity without exogenous contrast agents. In particular, the tensor model [1] has been extensively used in the field of epilepsy for assessing hippocampal cell death, gliosis, and even axonal plasticity in humans [2,3] and experimental animals [4–8]. One of the most commonly derived diffusion tensor imaging (DTI) measures is fractional anisotropy (FA), which may be interpreted as a marker to identify subtly ...

Focal cortical dysplasia (FCD), often caused by abnormal neuronal growth, is strongly associated with epilepsy and neurodevelopmental disorders [1,2]. Drug-resistant epilepsy is a common characteristic in FCD [3]. Local lesions have been clearly linked to seizure onset, and anomalies in gray matter structure and interhemispheric connections are often observed beyond the primary lesion [4,5].

Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy in adults [1]. One of the main causes of TLE is hippocampal sclerosis (HS) [2]. TLE has a constellation of signs and symptoms, but the main criterion for diagnosis is the presence of characteristic seizure semiology [3]. The clinical definition of TLE with HS (TLE-HS) is based on electroencephalograms (EEGs), video EEGs, magnetic resonance imaging (MRI) findings, and neuropsychological tests [2].

Epilepsy is a disease that affects more than 50 million people in the world, with a higher prevalence in low-income countries [1]. Although several anti-seizure medicines are available for treatment [2], more than one-third of the patients with epilepsy present recurrent, drug-resistant seizures [3,4]. These uncontrollable seizures promote significant damage to life quality [5] and increase the chance of sudden unexpected death [6]. Surgery is the most effective and definitive treatment available for focal drug-resistant epilepsy [7].