Neuropathology of the 21th century for the Latin American epilepsy community

In 1825, Camille Bouchet and Jean-Baptiste Cazauvieilh published gross neuroanatomy-pathological findings from postmortem studies of several epilepsy cases [1,2]. Some years later, Wilhelm Sommer focused on histopathology findings of the human hippocampus in a series of 90 patients with epilepsy. He thoroughly described the common pattern of pyramidal neuronal cell loss in CA1 with concomitant gliosis as a structural correlate of the tissue hardening (sclerosis) [3]. Shortly after, hippocampal sclerosis was associated with different neuronal cell loss patterns throughout all ...

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Epilepsy, dissociative seizures, and mixed: associations with time to video-EEG

Video-electroencephalographic monitoring (VEM) is critical to the evaluation and treatment of patients with medication resistant epilepsy, defined by failure of two adequate trials of tolerated, appropriately-chosen antiseizure medications (ASM) at appropriate doses [1,2]. While some studies demonstrated that early surgical therapy for epilepsy may be more effective, the time from first seizure to VEM (TVEM) remains around 20 years and VEM remains underutilized [3–20]. For comparison, it typically takes 9 years to meet the definition of medication resistant epilepsy [13].

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Brains, Complex Systems and Therapeutic Opportunities in Epilepsy

The notion of epilepsy as a network disease is rapidly gaining traction, particularly in the domains of whole brain networks as measured with MRI, MEG and EEG[1]. This concept is illustrated by the growing recognition that lesional focal epilepsies are disorders that widely disrupt neural systems that are outside of the lesion, but which are part of a brain network that have capacity to generate seizures[2]. However, the network concept can be applied far more broadly than the level of ...

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Transcranial direct current stimulation (tDCS) in the management of epilepsy: a systematic review

Epilepsy is a prevalent chronic neurologic disease that affects over 50 million people worldwide.[1] Mortality in epilepsy populations is three times higher compared to the general population and death causes are mainly epilepsy-related.[2] Moreover, the condition poses a high societal burden, ranking fifth amongst neurological disorders in disability-adjusted life years (DALY).[3]

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Comparative 12-month retention rate, effectiveness and tolerability of perampanel when used as a first add-on or a late add-on treatment in patients with focal epilepsies: The COM-PER study

Perampanel (PER) is a first-in-class selective, non-competitive antagonist of the glutamate α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor that has demonstrated broad-spectrum anticonvulsant activity [1,2]. In Europe, once-daily PER is indicated for the adjunctive treatment of focal-onset seizures (FOS), including focal to bilateral tonic-clonic seizures (FBTCS), and for primary generalized tonic-clonic seizures in patients over 12 years of age [3].

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Unique ictal signature: Delta brush as part of an ictal morphology in a patient with hypoglycemic neuronal injury

Our patient is a 2-year-old male with previously undiagnosed long chain 3-hydroxyacylCoA dehydrogenase deficiency (LCHAD). He presented with neuronal injury secondary to hypoglycemia. Upon arrival to our medical center, he was unresponsive, sedated and intubated. Continuous EEG monitoring was begun to evaluate for presence of seizures and the patient was treated with levetiracetam for seizure prophylaxis and midazolam for sedation. He was not treated with a paralytic agent. Approximately 24 h following injury, EEG recording showed a subclinical seizure with left ...

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Breaking the Spell: Narrative Medicine Applications for Psychogenic Nonepileptic Seizures (PNES)

Narrative Medicine (NM) is a communication therapy that engages the patient’s story of illness or injury and treatment in the context of their identity, values, fears, and hopes. The NM practitioner invites the patient to put significant experiences into words and share in a dialogue where unstated concerns can be given voice and new insights can be discovered. Patients may also respond to prompts for journal writing that may be discussed with the NM provider and in workshop groups. NM ...

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Potential interactions between COVID-19 vaccines and antiepileptic drugs

Fırat et al. [1] discussed the potential drug-drug interactions between antiepileptic drugs and therapeutic drugs currently used in the management of coronavirus disease 2019 (COVID-19). This piece of discussion is relevant and indeed is of utmost importance given that clinicians specialized in the management of COVID-19 may not be familiar with the use of antiepileptic drugs and thus they may be of little knowledge how best to manage the potential drug-drug interactions involving antiepileptic drugs and the therapeutic drugs for ...

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