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Introduction: Epilepsy
Published in Candace M. Kent, David M. Chan, Analysis of a Model for Epilepsy, 2022
Candace M. Kent, David M. Chan
Glia are specialized cells in the brain that make up part of the supportive tissue surrounding neurons and that include such cells as astrocytes and oligodendrocytes. Neurons are interconnected and communicate with each other through special junctions called synapses. A synapse is made up of a presynaptic element on the neuron sending the signal, a postsynaptic element on the neuron receiving the signal, and a gap junction between the two elements [42]. The term ictal is used when describing seizures, and the term interictal is used when describing the interim period between seizures. Epileptiform discharges are what are seen on electroencephalograms (EEGs) of epileptic individuals, but also of individuals without epilepsy but with a propensity toward having seizures.
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
As previously discussed, the most difficult issues in the diagnosis of neonatal seizures are (a) to decide which atypical ictal behavioural events can be regarded as epileptic seizures and (b) whether subclinical EEG seizures are occurring. For both purposes, EEG monitoring is essential and should be prolonged to answer the question regarding subclinical seizures. Aetiological context and global neurological evaluation provide a solid, and indispensable, basis for decision-making [11].
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Temporal lobe epilepsy is a common cause of complex partial seizures and is associated with mesial temporal or hippocampal sclerosis. MRI findings which suggest the diagnosis are hippocampal T2 signal hyperintensity and volume loss. The mesial temporal lobes are best assessed on coronal acquisitions and T2 or FLAIR sequences are most helpful. Nuclear medicine can also have a role with SPECT and PET studies demonstrating hyperperfusion immediately following a seizure. It can be important to identify as the ictal focus can be treated surgically if seizures continue despite anti-epileptic medication.
EEG in neonatal seizures: where to look and what to see
Published in Expert Review of Neurotherapeutics, 2022
Francesco Pisani, Carlotta Spagnoli
Neonatal seizures diagnosis is complex and should not rely exclusively on clinical grounds. The use of conventional long-term video-EEG monitoring can give an optimal characterization of seizures semiology, duration, and burden, and is therefore considered as gold standard. Differences between preterm and fullterm infants also add to complexity. The neonatal brain’s unique characteristics make ictal discharges and associated clinical semiology different from any other period of life. A cornerstone in the evaluation of neonates with seizures is the prompt distinction between acute symptomatic etiologies and neonatal-onset seizures and developmental and epileptic encephalopathies. Ictal and interictal EEG and clinical data are essential in order to make such a distinction. Some of the clinical and EEG characteristics are useful in forecasting long-term quoad vitam and neurological outcome, and in some instances can suggest etiology.
Role of EEG in Predicting Outcome of Hepatic Encephalopathy Patients
Published in The Neurodiagnostic Journal, 2020
Roshan Koul, Rakhi Maiwall, Archana Ramalingam, Satyendra Kumar, Ravinder Mohan Dhamija, Viniyendra Pamecha, Shiv Kumar Sarin
Seizures are not commonly reported in HE. The incidence varies between 2% and 33% depending on the stage of liver disease and associated systemic illness (Prabhakar and Bhatia 2003). Thirty of 151 (20.1%) patients had seizures in our study. Twenty-one of these 30 patients (70%) had clinical seizures and interictal seizure discharges on EEG. Nine other patients had subtle seizures which were observed clinically (i.e., repeated eye blinking and tonic lateral eye deviations) but there were no ictal discharges on EEG. An absence of ictal discharges could be due to the seizure focus originating from deeper sites of brain, concurrent use of antiepileptic drugs, encephalopathic EEG and administration of propofol. Focal seizures are the most common type of seizures seen in HE (Prabhakar and Bhatia 2003). Twenty-four of 30 patients (80%) had focal seizures. Subtle seizures in the form of frequent eyelid blinking or tonic lateral eye deviations may be the only manifestation of clinical seizures in HE patients. These HE patients are often intubated and on propofol which will suppress any motor phenomenon. Though the patients with seizures had worse outcomes than those without seizures (50% expired vs 44.6%), this difference was not statistically significant (p > 0.05) (Table 6).
Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality
Published in Current Medical Research and Opinion, 2020
Boulenouar Mesraoua, Dirk Deleu, Al Hail Hassan, Melykian Gayane, Alsheikh Lubna, Musab Abdalhalim Ali, Torbjorn Tomson, Bassel Abou Khalil, J. Helen Cross, Ali A. Asadi-Pooya
The risk of injuries in PWE clearly varies between different parts of the world for many different reasons including geographical, economic, and social circumstances, availability of effective treatments, workplace conditions and individual life styles. Some general epilepsy-related risk factors have, however, been identified. The most consistent findings regarding risk factors for injuries are occurrence of generalized convulsive seizures (focal to bilateral or generalized tonic-clonic seizures)21,22,30,33, but atonic seizures and ictal falls have also been associated with increased risks21,33,34. Intractable epilepsy, uncontrolled seizures, or high seizure frequency are also consistent risk factors for seizure-related injuries21–23,31,35. Polytherapy with AEDs was reported to be associated with increased risk in a few studies21,31,34 although it is not clear if polytherapy is a risk factor as such or just a reflection of a more difficult to treat epilepsy with poor seizure control. Some studies have identified comorbidities as another risk factor for injuries21,26,30,33.