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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].
Psychiatric Disorders and Epilepsy
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Gregory L. Krauss, Ronald P. Lesser
A cluster of personality traits has been reported to occur in association with temporal lobe epilepsy (24). These traits included viscosity, circumstantiality, religiosity or philosophical interest, humorlessness, sadness, and hypergraphia. Altered sexuality had previously been reported to be a component of the cluster of traits found in temporal lobe epilepsy (25), but was later found to occur as frequently in generalized epilepsy (26). Studies have demonstrated that these personality traits are common not only in patients with CPSs of temporal lobe origin, but also in those with other seizure types and those with other psychiatric and neurologic disorders (23,27). A number of authors have suggested that these clusters are indicative of seizure-related personality traits and hypothesize that these traits are due to subclinical seizure discharges. The specificity of the traits has not been clearly confirmed, however, and could also be related to a behavioral response to chronic disease.
The Kindling Model of Temporal Lobe Epilepsy
Published in Steven L. Peterson, Timothy E. Albertson, Neuropharmacology Methods in Epilepsy Research, 2019
There are two lines of evidence supportive of a role for a kindling-like mechanism in clinical epilepsy. First, the progressive nature of experimental kindling would suggest that if kindling-like mechanisms were operative in human epilepsy one should also observe progression or worsening of clinical symptoms. Though there is much debate as to whether epilepsy should be viewed as a progressive disorder, evidence is available indicating that seizures in some patients become more severe, more frequent and more refractory to medical treatment with time.6 Determining the extent to which clinical seizures are indeed progressive is difficult. Most patients have already experienced one or more spontaneous epileptic events before seeking medical attention. It would be erroneous to assume that these presenting forms of seizure were not preceded by spontaneous subclinical seizures that progressed over time.
Levetiracetam dosing for seizure prophylaxis in neurocritical care patients
Published in Brain Injury, 2023
Ashley Hedges, Matthew C. Findlay, Gary E. Davis, Brianne M. Wolfe, Gregory W.J. Hawryluk, Sarah T. Menacho, Safdar Ansari
Our seizure incidence of 11.5% at the lower TDD is higher than the range of 2.4–8.3% previously cited in the literature (15,31). This higher incidence is likely influenced by our decision to capture a combined seizure incidence, which includes subclinical seizures in addition to clinical seizures. Given the findings from Jones et al. (6), we thought it was important to capture patients presenting with subclinical seizures. Notably, our neurocritical care team has a 24/7 staffing model and a low threshold for EEG screening in patients with disturbances in consciousness. Moreover, our institution has a high patient acuity because it serves as a referral site for a very large catchment area. Apart from higher seizure incidence, our data show a trend toward more frequent treatment escalation in the lower levetiracetam dosing scheme of 1000-mg TDD. This is consistent with published reports except for one retrospective cohort of 169 TBI patients that reported a low seizure incidence of 2.4% with lower levetiracetam dosing (1000-mg TDD); however, there was no control group for comparison in that study (31).
Electric Fence Artifact on Ambulatory EEG and Review of Common EEG Electrical Artifacts
Published in The Neurodiagnostic Journal, 2021
Lorena Figueredo Rivas, Maria Bruzzone Giraldez, Alexis N. Simpkins
An 86-year-old female with a history of hypertension and hyperlipidemia was wearing an AEEG monitor to evaluate recurrent transient episodes of confusion due to concerns for possible subclinical seizures. During the AEEG recording, she accidentally touched an electric animal fence. The patient received a brief electric jolt on her bare right hand while attempting to pet a horse at a family farm. The event was described as a hot vibration lasting only a few seconds. There was no sustained muscle contraction, thereby allowing for a quick response and minimizing encounter time with the live wire. She was not wearing jewelry on that extremity, was not barefoot, and both the fence and her hand were dry. After the shock, the patient reported feeling well and continued without further sequelae. She did not experience any burns, injuries, right-upper-extremity paresthesia or pain. The estimated output of the fence was 3 to 4 kilovolts. The EEG showed a train of 1 Hertz (Hz) high amplitude identical spikes of negative polarity, with a diffuse distribution maximal over the bilateral posterior head regions, right greater than left. The spikes were also seen on EKG (Figures 1 and 2). This artifact lasted for 20 minutes, after which it suddenly disappeared and did not disrupt the underlying EEG background. Subclinical seizures were ruled out in the absence of epileptiform findings, requiring no further electroencephalographic monitoring.
Epilepsy after severe traumatic brain injury: frequency and injury severity
Published in Brain Injury, 2020
Hanna Siig Hausted, Jørgen F. Nielsen, Lene Odgaard
First, classifying the symptoms of PTE correctly in the initial period after the injury is difficult due to the fact that many individuals with severe TBI may have subclinical seizures while still intubated and sedated as part of the ICU care (32). As such the most severe patients may have undetected subclinical seizures, while seizures in the less severely injured patients may be detected earlier. The tendency that less severely injured patients had higher rates of PTE was most pronounced among older patients, which indicates that especially older, severely injured patients have undetected subclinical seizures. Subclinical seizures may be detected by EEG, which is now routinely implemented in Danish ICU care to identify subclinical epileptiform activity in patients with TBI (33). Therefore, the contradictory tendency with higher PTE rates early after injury among patients with less severe injuries may only be present if EEG is not standard ICU care.