ObjectiveTo explore the prognostic value of normal 24 hour video electroencephalography (VEEG) with different frequency on antiepileptic drugs (AEDs) withdrawal in cryptogenic epilepsy patients with three years seizure-free. MethodsA retrospective study was conducted in the Neurology outpatient and the Epilepsy Center of Xi Jing Hospital. The subject who had been seizure free more than 3 years were divided into continual normal twice group and once group according to the nomal frequence of 24 hour VEEG before discontinuation from January 2013 to December 2014, and then followed up to replase or to December 2015. The recurrence and cumulative recurrence rate of the two group after withdrawal AEDs were compared with chi-square or Fisher's exact test and Kaplan-Meier survival curve. A Cox proportional hazard model was used for multivariate analysis to identify the risk factors for seizure recurrence after univariate analysis. P value < 0.05 was considered significant, and all P values were two-tailed. Results95 epilepsy patients with cause unknown between 9 to 45 years old were recruited (63 in normal twice group and 32 in normal once group). The cumulated recurrence rates in continual two normal VEEG group vs one normal VEEG group were 4.8% vs 21.9% (P=0.028), 4.8% vs 25% (P=0.006) and 7.9% vs 25%(P=0.03) at 18 months, 24 months and endpoint following AEDs withdrawal and there was statistically difference between the two groups. Factors associated with increased risk were adolescent onset epilepsy (HR=2.404), history of withdrawal recurrence (HR=7.186) and abnormal VEEG (epileptic-form discharge) (HR=8.222) during or after withdrawal AEDs. The recurrence rate of each group in which abnormal VEEG vs unchanged VEEG during or after withdrawal AEDs was respectively 100% vs 4.92% (P=0.005), 80% vs 19.23%(P=0.009). ConclusionsContinual normal 24h VEEG twice before withdrawal AEDs had higher predicting value of seizure recurrence and it could guide physicians to make the withdrawal decision. Epileptic patients with adolescent onset epilepsy, history of seizure recurrence and abnormal VEEG (epileptic-form discharge) during or after withdrawal AEDs had high risk of replase, especially patients with the presence of VEEG abnormalities is associated with a high probability of seizures occurring. Discontinuate AEDs should be cautious.
ObjectiveTo analyse the seizure semeiology of MRI negative insular epilepsy.MethodsA case of patient with insular epilepsy who presented in Epileptic Center, Guangdong 999 Brain Hospital was collected. Related literatures were thoroughly reviewed.ResultsThe patient was diagnosised as insular epilepsy by SEEG and postoperative pathology reported focal cortical dysplasia Ib.ConclusionsThe insula lobe is a part of the limbic system, and the seizure semeiology in insular epilepsy is varied. Seizure semeiology analysis is particularly important in the evaluation of presurgical especially in a MRI negative case. In this paper, we summarized the semeiology characteristics of various parts of insula lobe, and provided some references for the diagnosis and treatment of insular epilepsy.
ObjectiveExploring the influencing factors of acute phase (≤ 21 days) seizures and epilepsy in patients with Herpes simplex virus encephalitis (HSE) in our hospital, including emergency and inpatient wards, mainly from the perspective of the number of mNGS of Herpes simplex virus (HSV) in cerebrospinal fluid. MethodsFrom January to Octomber 2023, 28 emergency and inpatient patients in our hospital were collected, excepted clinical datas were not detailed. In the end, 24 patients with HSE diagnosed were included in the study, and their clinical datas were collected, including age, gender, acute encephalitis syndrome, the form of the seizure and the number of seizures, time of lumbar puncture, and various indicators of cerebrospinal fluid [pressure, protein, cell count (mononuclear and multinucleated cells), metagenomic Next-generation sequencing (mNGS), neural autoantibodied associated with autoimmune encephalitis], electroencephalogram, cranial imaging examination reports, and treatment plans.ResultsA total of 24 patients were enrolled, including 9 patients with a history of hypertension and 4 patients with a history of diabetes. There were 18 males and 6 females, with an average age of (53.17±17.19) years. The maximum age was 73 years old, and the minimum age was 21 years old. Among the 24 patients, one patient first presented to the local hospital and then transferred to our hospital for lumbar puncture, so the time from the onset of the disease to lumbar puncture was 30 days, and the other patient’s family members refused to complete lumbar puncture at first,so the time of lumbar puncture was 14 days from the onset of the disease. The remaining 22 patients were all completed lumbar puncture within 7 days of onset, and all emergency patients completed lumbar puncture within 24 hours of admission to the Emergency Department. mNGS results: 23 cases were HSV-1, and the remaining 1 case was HSV- 2. There were a total of 6 cases of seizures and epilepy in the acute phase (≤21 days), with focal or generalized seizures or epileptic status as the main form, and 2 cases of seizures occurred. Among these 8 patients, 5 showed lesions in the frontal and temporal lobes on enhanced cranial MRI, while the other 3 showed no specific features. At the same time, mNGS of cerebrospinal fluid suggested that the sequence number of HSV was greater than 3 000 was related with seizures and epilepsy with acute HSE. Conclusion Seizures and epileysy in acute HSE were related with the presences of intracranial cortical involvement,and the number of viral sequences in mNGS was closely related to acute phase seizures and epilepsy.
At present, there are few studies on patients with epilepsy (PWE) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the results of many studies are inconsistent. SARS-CoV-2 may cause new seizures through a variety of mechanisms, and the susceptibility and mortality of PWE to SARS-CoV-2 remains controversial. During the SARS-CoV-2 pandemic, anxiety, depression and other psychological problems were common among epileptic patients. Clinicians providing telemedicine, telephone chat and video call can effectively reduce the risk of psychological disorders in PWE patients. At the same time, there are many interactions between antiepileptic drugs and various antiviral drugs, which should be carefully considered when using. Considering that the research results are few and many studies contradict each other, PWE and SARS-CoV-2 deserve further exploration in future studies.
ObjectiveTo investigate characteristics of motor semiology of epileptic seizure originated from dorsolateral frontal lobe. MethodsRetrospectively analysis the clinical profiles of patients who were diagnosed dorsolateral frontal lobe epilepsy (FLE) based on stereoelectroencephalography (SEEG) and underwent respective surgeries subsequently. Component of motor semiology in a seizure can be divided into elementary motor (EM, include tonic, versive, clonic, and myoclonic seizures) and complex motor (CM, include automotor, hypermotor, and so on). A Talairach coordinate system was constructed in the sagittal series of MRI images in each case. From the cross point of VAC and the Sylvian Fissure, a line was drawn antero-superiorly, which made an angle of 60° with the AC-PC line, then the frontal lobe could be divided into anterior and posterior portion. The epileptogenic zone, which was defined as ictal onset and early spreading zone in SEEG, was classified into three types, according to the positional relationship of the responding electrodes contacts and the "60° line": the anterior, posterior, and intermediate FLE. The correlation of the components of motor semiology in seizures and the location of the epileptogenic zone was analyzed. ResultsFive cases (26.3%) were verified as anterior FLE, among which there were 2 of EM, one of CM, and 2 of EM+CM. In 7 cases (36.8%) of intermediate FLE, there were one of EM, none of CM, and 6 of EM+CM. In the rest 7 cases of posterior FLE, there were 6 of EM, none of CM, and one of EM+CM. Compared with the cases that the epileptogenic zone involved anterior portion, the posterior FLE is more likely to present EM seizures (85.7%), and less likely to show CM components (P < 0.05). And Compared with the anterior FLE and posterior FLE, the intermediate FLE is more likely to present EM+CM seizures (85.7%)(P < 0.05). ConclusionThe motor seizure semiology of dorsolateral FLE has significant correlation with the localization of the epileptogenic zone. Posterior FLE mainly present a pure elementary motor seizure, and once the epileptogenic zone involved anteriorly beyond the "60° line", the component of complex motor seizure would be seen. Intermediate FLE, as its specialty of transboundary, is more likely to show "comprised semiology" of EM and CM. Construction of the "60° line" with AC-PC coordinate system in the MRI images may play an useful role in semiology analysis in presurgical evaluation of FLE.
The deep learning-based automatic detection of epilepsy electroencephalogram (EEG), which can avoid the artificial influence, has attracted much attention, and its effectiveness mainly depends on the deep neural network model. In this paper, an attention-based multi-scale residual network (AMSRN) was proposed in consideration of the multiscale, spatio-temporal characteristics of epilepsy EEG and the information flow among channels, and it was combined with multiscale principal component analysis (MSPCA) to realize the automatic epilepsy detection. Firstly, MSPCA was used for noise reduction and feature enhancement of original epilepsy EEG. Then, we designed the structure and parameters of AMSRN. Among them, the attention module (AM), multiscale convolutional module (MCM), spatio-temporal feature extraction module (STFEM) and classification module (CM) were applied successively to signal reexpression with attention weighted mechanism as well as extraction, fusion and classification for multiscale and spatio-temporal features. Based on the Children’s Hospital Boston-Massachusetts Institute of Technology (CHB-MIT) public dataset, the AMSRN model achieved good results in sensitivity (98.56%), F1 score (98.35%), accuracy (98.41%) and precision (98.43%). The results show that AMSRN can make good use of brain network information flow caused by seizures to enhance the difference among channels, and effectively capture the multiscale and spatio-temporal features of EEG to improve the performance of epilepsy detection.
Objective To explore the damage, damage model and influence factors of the empathy ability on patients with epilepsy by the Chinese version of interpersonal reaction index scale (IRI-C). Methods Eighty-eight non-symptomatic epilepsy patients who were from the First Affiliated Hospital of Dalian Medical University and 100 healthy controls were included in the study from March 2015 to January 2016. Patients with serious cognitive impairment and severe anxiety or depression were ruled out through neural psychology background screening (Montreal Cognitive Assessment, Hamilton anxiety and depression scale) due to their influence on empathy scores. Thereafter the empathy ability was compared between epilepsy patients and healthy controls using the IRI-C, and the effect of seizure type on empathy ability was analyzed. According to the epileptic seizure types of generalized tonic-clonic seizure (GTCS), patients were divided into 3 groups: non-GTCS group (simple or complex partial seizure, n=17), pure GTCS group (only primary GTCS attack, n=23) and SGS group (partial onset secondary GTCS,n=48). The control group included 100 healthy participants. In order to ensure the balance of sample size, 30 samples are randomly selected from SGS and control groups respectively for statistical analysis. Then patients were divided in two groups according to whether he/she has complex partial seizure (CPS), and 30 patients in each group. Statistical analysis was performed using SPSS18.0 software package. Results ① The total IRI-C Empathy scores, Cognitive empathy (CE) and two factors of the patients in epilepsy group were lower than those in control group (P<0.05), while there was no statistical difference in Emotional Empathy (EE) and two factors between groups (P>0.05). ②ANOVA showed the points of CE (include two factors) and total scores of empathy mean different between the four groups (P<0.05), and EE (include two factors) scores were no statistically significant differences between the four groups (P>0.05). The CE scores were differences between the GTCS group, pure GTCS group and SGS group. The scores of the perspective-taking was statistically significant differences (P<0.05) between the pure GTCS group and the SGS group. The scores of perspective-taking of SGS group were lower than the other groups (P<0.05) . In other words, the scores of the perspective-taking of SGS group were lower than those of the other three groups, and the CE scores were lower than the GTCS group and the control group. ③ The opinion selection, imagination, CE and total empathy score of CPS group were all worse than that of non-CPS group (P<0.05). Conclusions The empathy ability of epilepsy patientswere impaired in CE, but reserved in EE Epileptic subtype CPS and GTCS were risk factors of the decline in empathy ability in epilepsy patients.
ObjectiveThis study aims to examine the possible association between C-reactive protein (CRP) concentration and post-stroke seizures. MethodsPatients with a first-ever ischemic stroke and no history of epilepsy before stroke who admitted to Western China Hospital were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset. After a mean follow-up period of 2.5 years, a follow-up assessment was performed to identify post-stroke epilepsy. Logistic regression and Cox regression analyses were used to assess the relationship between CRP levels and post-stroke early-onset seizures or post-stroke epilepsy. ResultsAmong the 1, 116 patients included in our study, 36 (3.2%) patients had post-stroke early-onset seizures and 65 (5.8%) patients had post-stroke epilepsy. Elevated CRP levels were associated with a higher risk of post-stroke early-onset seizures (51.4±49.2 vs 15.9±12.9, P=0.023). This correlation was persisted even after adjusting for potential confounders[OR=1.008, 95%CI (1.003, 1.018); P=0.003]. No association was observed between CRP levels and post-stroke epilepsy. ConclusionsElevated CRP levels may be associated with higher risk of post-stroke seizures. However, because of the observational nature of the study, more studies are needed to confirm the results.
Seizure clusters, a severe form of epilepsy requiring urgent intervention, are challenging to manage in out-of-hospital settings due to limitations of traditional benzodiazepine administration routes. Diazepam nasal spray (DZP-NS), a novel intranasal formulation, achieves rapid absorption through the nasal mucosa, bypassing first-pass metabolism, with bioavailability comparable to rectal gel and faster onset. Clinical studies demonstrate its high efficacy in treating seizure clusters and prolonged seizures (≥5 minutes), with an initial control rate of 87.4% and low second-dose utilization (12.6%). No severe adverse reactions, such as cardiorespiratory depression, were observed. Long-term use (12 months) showed no tolerance development, significantly extending seizure intervals (SEIVAL) (from 12.2 to 25.7 days) and improving quality of life scores, particularly in "epilepsy-related concerns" and "social functioning" domains. The non-invasive delivery method was favored by over 80% of patients and healthcare providers for its convenience compared to rectal administration. Subgroup analyses confirmed consistent safety and efficacy across genders, ages, concomitant medications (including cannabidiol), and patients with allergy histories. In conclusion, DZP-NS provides an efficient, safe, and socially accepted out-of-hospital rescue therapy for seizure clusters, positioning it as a potential cornerstone in standardized epilepsy emergency care.
Epilepsy is a complex and widespread neurological disorder that has become a global public health issue. In recent years, significant progress has been made in the use of wearable devices for seizure monitoring, prediction, and treatment. This paper reviewed the applications of invasive and non-invasive wearable devices in seizure monitoring, such as subcutaneous EEG, ear-EEG, and multimodal sensors, highlighting their advantages in improving the accuracy of seizure recording. It also discussed the latest advances in the prediction and treatment of seizure using wearable devices.