Seizure

The International League Against Epilepsy (ILAE) Task Force on Nosology and Definitions has recently provided a position statement on the definition of the idiopathic generalized epilepsy (IGE) Syndromes[1]. They have included four syndromes in their definition: childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and epilepsy with generalized tonic-clonic seizures (GTCS) alone[1]. In their definition of IGEs, seizure types include one or a combination of the following types: absences, myoclonic seizures, GTCS, and myoclonic-tonic- clonic seizures.

Prior studies have identified the important role of cerebral magnetic resonance imaging (MRI) in providing information on ictal and peri-ictal phases in patients with epilepsy [1, 2]. The main MRI sequences used in diagnosing patients with epilepsy include arterial spin labeling (ASL) and diffusion-weighted imaging (DWI) [2]. The diagnostic findings include hyperintense abnormalities on DWI and hyperperfusion on ASL observed in the focal cortex or the thalamus (otherwise called the “pulvinar sign”) or splenium in patients with focal status epilepticus ...

Transient loss of consciousness (TLOC) has a diverse etiology with a lifetime prevalence of 50% [1]. Differential diagnosis includes syncope, orthostatic hypotension, seizures, psychogenic non-epileptic seizures (PNES), and cardiac arrhythmias [2]. Unfortunately, diagnosis of the underlying cause can be a challenge in the emergency department (ED), where there is a 20-30% misdiagnosis rate for TLOC [3,4,5] with most epileptic seizures wrongly diagnosed as syncope [6]. Overall, syncope accounts for 76% of cases of TLOC [7,8], whereas seizures account for 1% ...

Cenobamate (CNB) is a new antiseizure medication (ASM) that has been approved by the US Food and Drug Administration in November 2019, and in March 2021 by the European Medicines Agency for the adjunctive treatment of focal onset seizures in adults. CNB is a novel tetrazole-derived carbamate compound with one chiral center. Dual, complementary mechanisms of action may contribute to its antiseizure activity. CNB has been shown to reduce neuronal excitability by enhancing the fast and slow inactivation of sodium ...

A substantial proportion of new-onset cryptogenic epilepsies have been attributed to a probable autoimmune cause, especially in adolescents and adults [1,2]. As timely immunotherapy can bring a dramatic improvement in achieving seizure control in these patients and most of them do not respond to conventional antiseizure medication (ASM) regimen, early suspicion and timely identification are important in clinical practice [3]. In the pediatric population, definite autoimmune encephalitis in which neural-specific autoantibodies are positive in high titers in plasma or cerebrospinal ...

Brivaracetam (BRV) is a recently released antiepileptic drug (AED), currently approved as adjunctive therapy for focal seizures in patients aged 4 years and older in the European Union, and as monotherapy and adjunctive therapy in patients aged 4 years and older in the United States (US) [1,2]. BRV is a 2S)-2-[(4R)-2-oxo-4-propylpyrrolidin-1-yl] butanamide, with four different diastereomers, with high-affinity binding to SV2A [3,4]. This mechanism of action partially mirrors that of levetiracetam (LEV), a previously discovered and widely used AED.

Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy1, characterized by multiple intractable seizure types and frequent episodes of status epilepticus (SE). Seizures usually start in the first year of life2. DS is usually caused by dominant pathogenic variants in the Sodium voltage-gated channel alpha subunit 1 (SCN1A) gene3. Most affected individuals meet the criteria for intellectual disability and behavioral problems are common4. The incidence has been calculated to 1 per 15,500 live births in a prospective study5.

Epilepsy is a neurological disorder that affects almost 50 million people around the world.[1] It is characterized by the disturbance of electric activity in the brain and can be attributed to various etiologies.[2,3] People living with epilepsy and their families face psychological, physical, and social consequences, leading to a significant burden.[1–3] Treatment is primarily focused on the control of seizures (e.g., antiseizure medications [ASMs), with monotherapy being the first-line treatment, followed by polytherapy based on seizure control and the severity ...

Seizures are known to occur non-uniformly throughout the sleep-wake cycle. Retrospective studies showed that different seizure types occur preferentially during certain times based on sleep/wakefulness and/or clock time[1–4]. Data from patients with drug-resistant epilepsy (DRE) using seizure tracking devices found seizures to have frequent diurnal and occasional circaseptan rhythms[5]. A systematic review noted that diurnal rhythms of generalized seizures and parietal-lobe seizures appear to resemble the physiologic rhythm of cortisol[6].

Status epilepticus (SE) is a common neurological emergency, which may be associated with significant short and long term neurological and systemic morbidity. A staged treatment protocol for management of status epilepticus is generally followed. The first line of treatment is administration of benzodiazepines; intravenous lorazepam, intravenous diazepam or intramuscular midazolam. [1, 2] However, approximately 30–40 % of all patients fail to respond to initial treatment with benzodiazepines. [3] The estimates may be higher based on recent population-based studies.