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Meningioma and the brain
Published in Alex Jelly, Adel Helmy, Barbara A. Wilson, Life After a Rare Brain Tumour and Supplementary Motor Area Syndrome, 2019
Second, meningiomas can also present with seizures. A seizure is uncontrolled electrical activity in the brain. Nerve cells use electrical impulses to communicate with each other and carry out the complex processing that occurs in the brain. When this electrical activity is uncontrolled, the portion of the brain affected stops functioning. Seizures can affect one part of the brain, called partial seizures, or the whole of the brain, called generalised seizures. Partial seizures can cause a wide range of symptoms, similar to the focal neurological deficits described above. Generalised seizures cause the individual to lose consciousness, although the distinction is not always clear cut as partial seizures can start in one place and then spread throughout the whole brain (partial seizures with secondary generalisation). The wide variety of patterns of seizures can sometimes make them difficult to spot and diagnose. Seizures are usually treated in their own right with anti-seizure drugs, separate to the treatment options described below.
Classification of The Epilepsies
Published in Carl L. Faingold, Gerhard H. Fromm, Drugs for Control of Epilepsy:, 2019
Henri Gastaut, Benjamin G. Zifkin
Appendix I of the ILAE classification proposal divides these epilepsies into many categories depending on precise ictal localizations. If consciousness is unaltered during the seizures the term “simple” is used; and if not, the term “complex” is applied. Broadly speaking, seizures with simple symptomatology arise from epileptogenic lesions and associated ictal electrical activity occupying or eventually involving the specific isocortical areas associated with various elementary motor activities or sensory experiences. Thus, several such partial epilepsies can be identified, e.g., parietal lobe epilepsy, with simple partial seizures and somatosensory symptomatology; or occipital lobe epilepsy with simple partial seizures and visual symptomatology. Seizures with complex symptomatology, i.e., with alteration of consciousness, arise from ictal activity originating in or spreading to the integrative cortical areas of temporal or frontal lobe limbic structures. Different patterns of the spread of ictal epileptic activity can give rise to very different clinical seizure patterns arising from what appear to be similar interictal EEG epileptic foci.
Audiogenic Seizures in Mice and Rats
Published in Steven L. Peterson, Timothy E. Albertson, Neuropharmacology Methods in Epilepsy Research, 2019
The same drugs used to treat generalized tonic-clonic seizures are used to treat partial seizures with or without generalization. However, partial seizures can be resistant to treatment with these agents in some patients. A drug with a lower focal/generalization ratio in the GEPR than existing medications might be effective in these refractory partial seizure patients. This model also offers prediction of a novel type of antiepileptic drug, a drug with a focal/generalization ratio of 1. The wild running regression line becomes a continuation of the hindlimb extension regression line. Such a drug would be a pure antifocal agent in the GEPR. We would expect the slope of the single regression line to be steep and the nature of the anticonvulsant response to be either complete audiogenic seizure suppression or no effect at all, as a fonction of dose.
Management of epileptic disorders using nanotechnology-based strategies for nose-to-brain drug delivery
Published in Expert Opinion on Drug Delivery, 2021
Mihika Shringarpure, Sankalp Gharat, Munira Momin, Abdelwahab Omri
According to the International Classification of Epileptic Seizures, epileptic seizures can be classified into three major groups based on their onset- generalized onset, focal onset (may become secondarily generalized), and unclassified seizures [34]. Generalized seizures are a consequence of abnormal and rapid neuronal activity on both hemispheres of the brain simultaneously. The various kinds of generalized seizures include absence seizures, tonic seizures, clonic seizures, myoclonic seizures, atonic seizures, tonic-clonic seizures, and secondary generalized seizures. Focal seizures originate and affect a limited area of one hemisphere of the brain and occur in approximately 60% of cases. Focal seizures generally progress to secondary generalized tonic-clonic seizures. Partial seizures are split into two main categories, namely, simple partial seizures and complex partial seizures [28].
Intravenous sodium valproate in status epilepticus: review and Meta-analysis
Published in International Journal of Neuroscience, 2021
Ioannis Liampas, Vasileios Siokas, Alexandros Brotis, Elias Zintzaras, Ioannis Stefanidis, Efthimios Dardiotis
Therefore, seizure cessation within 30 min of drug infusion was appraised in two studies (Figure 3A). Misra et al. (India, 1-85 years) included patients with CSE using a 10 min time-frame, while Gilad et al. (Israel, >18years) included patients with complex partial seizures, generalized tonic-clonic seizures, simple partial seizure and partial with generalized seizures according to a 30 min time-frame. In both studies, interventions were deployed as first-line AEDs according to the following administration regimens (maintenance doses were not administered in either study): Misra et al.: VPA: 30 mg/kg infused over 15 min and PHT: 18 mg/kg at a rate of 50 mg/min, Gilad et al.: VPA: 30 mg/kg and PHT: 18 mg/kg both infused over 20 min. Overall, seizure cessation was accomplished in 36/53 (67.93%) patients in the VPA group and 21/42 (50%) patients in the PHT group. According to FE model (PQ=0.25, I2=25%), no significant difference was observed regarding seizure termination between VPA and PHT when deployed as first-line AEDs [FE OR = 1.99, 95% CI = (0.83–4.75)].
Avoiding complacency when treating uncontrolled seizures: why and how?
Published in Expert Review of Neurotherapeutics, 2020
Ushtar Amin, Selim R. Benbadis
The American Academy of Neurology recommends that ‘patients with disabling complex partial seizures, with or without generalized seizures, who have failed appropriate trials of first-line antiepileptic drugs, should be considered for referral to an epilepsy surgery center, although criteria for failure of drug treatment have not been definitely established’ [39]. Although failure of drug treatment remains as an unclear issue, as many patients are not being referred early enough for surgical intervention, it may be helpful for clinicians to use the ILAE guidelines as a method to follow toward determining whether patients are ready for surgical evaluation. If general neurologists find that patients who are possible candidates for surgical resection continue to experience seizures after following the medication pathway outlined by the ILAE, they may feel comfortable that surgery, although invasive, is the next best option for these patients and refer to a surgery center earlier and more often.