Diagnostic Usefulness of Arterial Spin Labeling in MR Negative Children with New Onset Seizures

Epilepsy is the most frequent and chronic neurologic disorder and carries risks of significant morbidity and mortality. Despite the introduction of new antiepileptic drugs, one-third of patients suffer from drug resistant epilepsy [1]. In these patients, especially those with focal epilepsy, surgical treatment aiming to remove the seizure focus may represent the only available option for becoming seizure free. If the magnetic resonance (MR) result does not reveal structural abnormalities, identifying the epileptogenic zone is more challenging in these patients ...

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Sudden cardiac death in a patient with LGI1 antibody-associated encephalitis

Anti-leucine-rich glioma-inactivated 1 limbic encephalitis (LGI1-LE) is one of the clinical syndromes associated with antibodies to voltage-gated potassium channels (VGKCs) [1]. In addition to the common LE symptoms such as cognitive impairment, psychiatric disturbances and seizures, patients with LGI1-LE manifest hyponatremia, and faciobrachial dystonic seizures (FBDS) in about 50% of cases. MRI abnormalities usually involve the medial temporal lobe and basal ganglia. LE typically affects middle-aged patients with a 2:1 male to female ratio and is rarely associated with cancer ...

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Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Stereotactic neurosurgery was initially developed in the second half of the XXth century as a solution to the high morbidity of invasive open surgery [1]. Historically, in epilepsy surgery stereotactic procedures were mainly used to localize the seizure onset zones through the recording of intracranial-EEG by stereoelectroencephalography (SEEG) [2]. More recently, following the growing accuracy of the delineation of the seizure onset zone and epileptic networks, the surgical management of drug-resistant epileptic patients faced new challenges [3–5].

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Different types of suppression-burst patterns in patients with epilepsy of infancy with migrating focal seizures (EIMFS)

In rare cases, patients with epilepsy of infancy with migrating focal seizures (EIMFS) exhibit suppression-burst (SB) patterns on electroencephalography (EEG), similar to the findings observed for patients with Ohtahara syndrome and early myoclonic encephalopathy. In this report, we discuss six cases of EIMFS in which patients exhibited two types of SB patterns.

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Sleep disturbances in patients with psychogenic non-epileptic seizures: Is it all subjective? A prospective pilot study of sleep-wake patterns

Poor sleep is a frequent complaint of patients with psychogenic non-epileptic seizures (PNES). Our group has recently reported that PNES subjects more frequently complained of poor sleep patterns relative to those with epilepsy [1], however the study was limited by use of a single item from the Beck Depression Inventory to assess changes in sleep patterns. Currently, little is known about the pattern and cause of sleep problems in PNES. One prior study investigated sleep architecture of 8 PNES and ...

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Co-medication and potential drug interactions among patients with epilepsy

Management of epilepsy usually involves the long-term use of antiepileptic drugs (AEDs) and a substantial percentage of patients require polytherapy to control their seizures [1]. The use of multiple AEDs poses a risk of drug interactions including enzyme induction or inhibition, alterations in protein-binding and expression of transporter proteins [2]. It may result in decreased efficacy or increased toxicity of AEDs. The use of some older AEDs (e.g. carbamazepine or phenytoin), known as potent hepatic enzyme-inducers is a major source ...

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Patient management conference: Correlating pre-surgical data

The epilepsy surgery patient management conference (PMC) is a fundamental part of the pre-surgical evaluation and represents the final stage of the process [1–3]. Previous work has demonstrated high inter-rater reliability of surgical decision making among epilepsy centers utilizing multidisciplinary PMC [4]. Less is known about the accuracy of predicting outcomes using this approach. Studies are identifying ways to improve predictions of post-operative outcomes [5,6]. During this meeting attended by staff in epilepsy, neurosurgery, neuroradiology, nuclear medicine, neuropsychology, psychiatry, social ...

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Comparing the efficacy of sodium valproate and levetiracetam following initial lorazepam in elderly patients with generalized convulsive status epilepticus (GCSE): A prospective randomized controlled pilot study

Status epilepticus (SE) is a neurological emergency with severe consequences especially in elderly with other co-morbidities (1). SE has a bimodal distribution with the highest incidence in children <1 year and adults older than 60 years (2,3). Generalized convulsive status epilepticus (GCSE) is the most common and life-threatening type of SE with an overall mortality of around 20%. Mortality is higher in the elderly being 30% to 70% (4,5).

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