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Electrophysiology
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
These are a primary generalised type of seizure. Electroencephalogram changes on their own cannot indicate the diagnosis of epilepsy. However, in absence seizures, the typical 3 Hz spike and wave charges can be seen if the patient has a seizure during the recording. This type of seizure can often be provoked by hyperventilation.1,2
Neurologic Diagnosis
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Generalized: several types of general epileptiform abnormalities are recognized. Well-formed 3-Hz spike and wave (“typical”) is characteristic of childhood absence epilepsy; slow 2-Hz sharp and wave with an abnormally slow background is seen with the symptomatic generalized epilepsies (developmental and epileptic encephalopathies); and “atypical” spike and wave, other than 3 Hz and may include multiple spikes (polyspike wave complexes), and with a normal background (Figure 1.41) is seen with other idiopathic generalized epilepsies. However, the generalized epilepsies may also show asymmetric and even focal epileptiform fragments, particularly during drowsiness.
Neurology and neurosurgery
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
The drug of choice for treatment of petit mal epilepsy is ethosuximide. It also responds to treatment with valproic acid and tridione. It commences between 4 and 10 years and is characterized by staring and arrest of activity. The EEG shows the characteristic 3/s spike and wave pattern. There is rarely an aura preceding an attack and it has no relationship to pertussis vaccine.
Waveform Window #53: Hypersynchrony in REM Sleep
Published in The Neurodiagnostic Journal, 2023
Donna Young, Stacey D. Elkhatib Smidt, Sushanth Bhat, Sudhansu Chokroverty
Paroxysmal epileptiform discharges are included in the differential diagnosis due to their rhythmic nature. These discharges are associated with progression, interspersed spikes and/or notched delta waves, and uniform appearance, which was not observed in our case. Hypnagogic and hypnopompic/post-arousal hypersynchrony can be confused with paroxysmal epileptiform discharges given that spikes can be embedded within their waveforms (Asadi-Pooya and Sperling 2019; Ofer and Pien n.d.). The difference is that hypnagogic and hypnopompic/post-arousal hypersynchrony waveforms have both a variable amplitude and spike location within the slow wave whereas paroxysmal epileptiform discharges, such as generalized spike-and-wave discharges, have an unvarying waveform amplitude and spike location (Ofer and Pien n.d.). Furthermore, epileptiform discharges are unlikely in REM sleep. Other findings to be considered in the differential diagnosis include sawtooth waves and 6-Hz phantom spike and wave. Although sawtooth waves are predominant centrally and are associated with REM sleep, they are sharply shaped, which is different than the high-amplitude sinusoidal waveforms we observed (Malhotra and Avidan 2014). The other finding, 6-Hz phantom spike and wave, is a normal variant seen predominantly in the anterior or posterior regions during NREM sleep and of a faster frequency than was noted in our case (Amin et al. 2023).
Ganaxolone treatment for epilepsy patients: from pharmacology to place in therapy
Published in Expert Review of Neurotherapeutics, 2021
Simona Lattanzi, Antonella Riva, Pasquale Striano
Like many other GABA-enhancers, GNX has been shown to exacerbate spike-wave discharges in pentylenetetrazol, γ-hydroxybutyric acid, and genetic animal models of absences [27]. However, it suppressed discharges when microinjected into the perioral region of the primary somatosensory cortex in WAG/Rij rats [34]. As the pathogenesis of absence seizures is associated with GABA hyperfunction rather than hypofunction [47], the worsening of absence seizures may be due to the enhancement of the GABA-ergic inhibition at the level of thalamic relay neurons. The suppression of spike-wave discharges following cortical GNX injection could be, instead, responsible for the activation of an inhibitory circuit within the cortical area with subsequent inhibition of excitatory projections from the cortex to the thalamus [34]. Of note, the neocortex can also be involved: an increase in synaptic excitability mediated by NMDA receptors has been observed in neurons located in neocortical deep layers in the experimental model of absence seizures, and this mechanism may play a role in initiating and maintaining generalized spike and wave discharges in vivo [48].
Features of Childhood Arterial Ischemic Stroke in China
Published in Fetal and Pediatric Pathology, 2019
Qingjun Cao, Fenghua Yang, Junmei Zhang, Huo Liang, Xueyan Liu, Hua Wang
Other laboratory and auxiliary examinations that were reviewed included ASO, CRP, ESR, liver and kidney function, blood lipid series, coagulation function, immunoglobulin, and virus antibody. The WBC count was in the normal range in 47 patients (62.67%) and was abnormally high in 28 patients (37.33%). The CRP level was high in 34 patients (45.33%). 25 patients (33.33%) had thrombophilia. The antinuclear antibody level was tested in 65 patients, and was normal in 58 patients. Anti-double stranded DNA antibody level was abnormal in 3 patients (4.6%), anti-SS-A was abnormal in 2 patients (3.08%), and anti-Ro-52 was abnormal in 2 patients (3.08%). Thyroid tests were performed in 55 patients: results were normal in 40 patients, high in 10 patients, and low in 5 patients. Lumbar puncture was performed in 42 patients; 38 patients had increased cerebrospinal fluid pressure, 8 patients had mild WBC increase, and 5 patients had increased protein quantities. No evidence of Mycoplasma pneumoniae, virus, tuberculosis, or fungal infection was found. Electroencephalography (EEG) was performed in 75 patients; 43 patients were normal, 27 patients displayed a slow wave, and 5 patients displayed a spike-slow wave. All patients underwent intracranial Doppler ultrasonography; 25 patients were abnormal, which were consistent with the results of the cranial MRA scans. The range of blood vessels abnormalities detected by intracranial Doppler was less than cranial MRA. The number of abnormalities in patients detected by intracranial Doppler was less than detected by cranial MRA.