Epilepsy Research and Treatment

Why Are Seizures Rare in Rapid Eye Movement Sleep? Review of the Frequency of Seizures in Different Sleep Stages

Marcus Ng and Milena Pavlova — Tue, 18 Jun 2013 11:47:13 +0000

Since the formal characterization of sleep stages, there have been reports that seizures may preferentially occur in certain phases of sleep. Through ascending cholinergic connections from the brainstem, rapid eye movement (REM) sleep is physiologically characterized by low voltage fast activity on the electroencephalogram, REMs, and muscle atonia. Multiple independent studies confirm that, in REM sleep, there is a strikingly low proportion of seizures (~1% or less). We review a total of 42 distinct conventional and intracranial studies in the literature which comprised a net of 1458 patients. Indexed to duration, we found that REM sleep was the most protective stage of sleep against focal seizures, generalized seizures, focal interictal discharges, and two particular epilepsy syndromes. REM sleep had an additional protective effect compared to wakefulness with an average 7.83 times fewer focal seizures, 3.25 times fewer generalized seizures, and 1.11 times fewer focal interictal discharges. In further studies REM sleep has also demonstrated utility in localizing epileptogenic foci with potential translation into postsurgical seizure freedom. Based on emerging connectivity data in sleep, we hypothesize that the influence of REM sleep on seizures is due to a desynchronized EEG pattern which reflects important connectivity differences unique to this sleep stage.

Influence of Sleep and Sleep Deprivation on Ictal and Interictal Epileptiform Activity

Antonio Díaz-Negrillo — Wed, 12 Jun 2013 18:02:10 +0000

Sleep is probably one of the most important physiological factors implicated both in epileptic seizures and interictal epileptiform discharges. The neurophysiology concerning the relationship between sleep and epilepsy is well described in the literature; however, the pathological events that culminate in the seizures are poorly explored. The present paper intends to make a rigorous approach to the main mechanisms involved in this reciprocal relation. Knowledge of sleep and sleep deprivation effects in epilepsy stands as crucial in the understanding of how seizures are produced, their possible lines of treatment, and future research.

Controversial Issues on EEG after Sleep Deprivation for the Diagnosis of Epilepsy

Wed, 12 Jun 2013 13:17:57 +0000

EEG after sleep deprivation (SD-EEG) is widely used in many epilepsy centers as an important tool in the epilepsy diagnosis process. However, after more than 40 years of use, there are a number of issues which still need to be clarified concerning its features and role. In particular, the many scientific papers addressing its role in epilepsy diagnosis often differ remarkably from each other in terms of the type of patients assessed, their description and study design. Furthermore, also the length and the type of EEG performed after SD, as well as the length of SD itself, vary dramatically from one study to another. In this paper we shortly underscore the abovementioned differences among the different reports, as well as some interpretations of the findings obtained in the different studies. This analysis emphasizes, if needed, how SD-EEG still represents a crucial step in epilepsy diagnosis, and how additional, controlled studies might further shape its precise diagnostic/prognostic role.

Increased Seizure Latency and Decreased Severity of Pentylenetetrazol-Induced Seizures in Mice after Essential Oil Administration

Sun, 02 Jun 2013 18:46:07 +0000

The effect of pretreatment with essential oils (EOs) from eight aromatic plants on the seizure latency and severity of pentylenetetrazol- (PTZ-) induced seizures in mice was evaluated. Weight-dependent doses of Rosmarinus officinalis, Ocimum basilicum, Mentha spicata, Mentha pulegium, Lavandula angustifolia, Mentha piperita, Origanum dictamnus, and Origanum vulgare, isolated from the respective aromatic plants from NE Greece, were administered 60 minutes prior to intraperitoneal (i.p.) injection of a lethal dose of PTZ to eight respective groups of Balb-c mice. Control group received only one i.p. PTZ injection. Motor and behavioral activity of the animals after EOs administration, development of tonic-clonic seizures, seizure latency and severity, and percentage of survival after PTZ administration were determined for each group. All groups of mice treated with the EOs showed reduced activity and stability after the administration of the oil, except for those treated with O. vulgare (100% mortality after the administration of the oil). After PTZ administration, mice from the different groups showed increased latency and reduced severity of seizures (ranging from simple twitches to complete seizures). Mice who had received M. piperita demonstrated no seizures and 100% survival. The different drastic component and its concentration could account for the diversity of anticonvulsant effects.

Metabolic Causes of Epileptic Encephalopathy

Joe Yuezhou Yu and Phillip L. Pearl — Wed, 22 May 2013 14:50:15 +0000

Epileptic encephalopathy can be induced by inborn metabolic defects that may be rare individually but in aggregate represent a substantial clinical portion of child neurology. These may present with various epilepsy phenotypes including refractory neonatal seizures, early myoclonic encephalopathy, early infantile epileptic encephalopathy, infantile spasms, and generalized epilepsies which in particular include myoclonic seizures. There are varying degrees of treatability, but the outcome if untreated can often be catastrophic. The importance of early recognition cannot be overemphasized. This paper provides an overview of inborn metabolic errors associated with persistent brain disturbances due to highly active clinical or electrographic ictal activity. Selected diseases are organized by the defective molecule or mechanism and categorized as small molecule disorders (involving amino and organic acids, fatty acids, neurotransmitters, urea cycle, vitamers and cofactors, and mitochondria) and large molecule disorders (including lysosomal storage disorders, peroxisomal disorders, glycosylation disorders, and leukodystrophies). Details including key clinical features, salient electrophysiological and neuroradiological findings, biochemical findings, and treatment options are summarized for prominent disorders in each category.

Investigation of Anti-Toxocara Antibodies in Epileptic Patients and Comparison of Two Methods: ELISA and Western Blotting

Mohammad Zibaei, Farzaneh Firoozeh, Parviz Bahrami, and Seyed Mahmoud Sadjjadi — Mon, 22 Apr 2013 09:24:50 +0000

The relationship between Toxocara infection and epilepsy was previously demonstrated by several case-control studies and case reports. These previous studies were often based on the enzyme-linked immunosorbent assay (ELISA) using Toxocara excretory-secretory antigens, which are not specific due to cross-reactivity with other parasitic infections such as ascariasis, trichuriasis, and anisakiasis. An immunoblot analysis is highly specific and can detect low levels of Toxocara antibodies. Therefore, this assay may be useful in the identification of toxocariasis in epileptic patients. We examined patients who had epilepsy and healthy subjects for seropositivity for Toxocara infection by ELISA and Western blotting. Out of 85 epileptic patients, 10 (11.8%) and 3 (3.5%) persons exhibited Toxocara immunoglobulin G (IgG) antibodies responses by ELISA and by both techniques, respectively. Moreover, in the healthy group (), 3 (3.5%) persons were positive by ELISA, but none was detected by Western blotting. This study indicates that Toxocara infection is a risk factor for epilepsy in Iran. These findings strongly suggest the need to perform Western blotting immunodiagnosis, as well as the ELISA using Toxocara excretory-secretory antigens, to improve diagnosis of human toxocariasis in patients with epilepsy.

The Role of Epilepsy Surgery in the Treatment of Childhood Epileptic Encephalopathy

Husam R. Kayyali, Ahmed Abdelmoity, and Saleh Baeesa — Thu, 18 Apr 2013 15:03:05 +0000

Children with epileptic encephalopathy often have global impairment of brain function and frequent intractable seizures, which contribute further to their developmental disability. Many of these children have identifiable brain lesion on neurological imaging. In such cases, epilepsy surgery may be considered as a treatment option despite the lack of localized epileptic pattern on electroencephalogram (EEG). In this paper, we summarize the clinical features of epileptic encephalopathy syndromes and review the reported literature on the surgical approach to some of these disorders.

Update on Temporal Lobe Epilepsy

Seyed M. Mirsattari and Warren T. Blume — Tue, 26 Feb 2013 08:02:28 +0000

Slowly Evolving Trends in Temporal Lobe Epilepsy Management at London Health Sciences Centre

Warren T. Blume — Mon, 25 Feb 2013 14:13:58 +0000

Although the advent of MRI impacted significantly our presurgical investigation, ictal semiology with interictal and ictal EEG has clearly retained its roles in localizing epileptogenesis. MRI-identified lesions considered epileptogenic on semiological and electroencephalographic grounds have increased the likelihood of resective surgery effectiveness whereas a nonlesional MRI would diminish this probability. Ictal propagation and the interplay between its source and destination have emerged as a significant component of seizure evaluation over the past 30 years.

Epileptic Encephalopathy

Nicola Specchio, Marina Trivisano, Rod C. Scott, and Colin Ferrie — Mon, 31 Dec 2012 13:58:12 +0000

Changing Global Trends in Seizure Outcomes Following Resective Surgery for Tuberous Sclerosis in Children with Medically Intractable Epilepsy

George M. Ibrahim, Aria Fallah, O. Carter Snead, and James T. Rutka — Sun, 25 Nov 2012 14:40:23 +0000

Introduction. Tuberous sclerosis (TS) is the leading cause of genetic epilepsy worldwide. Here, we evaluate changes in seizure outcomes following resective epilepsy surgery in children with TS over time. Methods. A systematic review of the literature was performed to identify studies reporting seizure outcomes following resective epilepsy surgery in children with TS. Using an individual participant meta-analysis approach, seizure outcomes and associated covariates were combined. Multivariate logistic regression was used to determine significant associations between seizure outcomes and time of surgery. Results. Twenty studies from 1966 to present, yielding 186 participants, met the inclusion criteria for the study. On univariate analysis, there was a significant improvement in seizure outcomes in children who underwent resective epilepsy surgery within the last 15 years compared to older cohorts (chi-square 4.1; ). On multivariate analysis, adjusting for length of followup, this trend was not significant (OR 0.52; 95% CI 0.23–1.17; ). In the last 15 years, a greater proportion of younger children also underwent resective surgery compared to older cohorts (OR 0.93; 95% CI 0.89–0.97; ). Conclusions. A trend towards improved seizure outcomes following resective surgery for TS was observed from 1966 to present on multivariate analysis.

Epileptic Encephalopathies: An Overview

Sonia Khan and Raidah Al Baradie — Tue, 20 Nov 2012 15:38:10 +0000

Epileptic encephalopathies are an epileptic condition characterized by epileptiform abnormalities associated with progressive cerebral dysfunction. In the classification of the International League Against Epilepsy eight age-related epileptic encephalopathy syndromes are recognized. These syndromes include early myoclonic encephalopathy and Ohtahara syndrome in the neonatal period, West syndrome and Dravet syndrome in infancy, myoclonic status in nonprogressive encephalopathies, and Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and epilepsy with continuous spike waves during slow wave sleep in childhood and adolescences. Other epileptic syndromes such as migrating partial seizures in infancy and severe epilepsy with multiple independent spike foci may be reasonably added. In this paper, we provide an overview of epileptic encephalopathies including clinical neurophysiological features, cognitive deterioration, and management options especially that these conditions are generally refractory to standard antiepileptic drugs.

Role of Electroencephalography in Presurgical Evaluation of Temporal Lobe Epilepsy

Seetharam Raghavendra, Javeria Nooraine, and Seyed M. Mirsattari — Wed, 31 Oct 2012 14:48:39 +0000

Surgery remains a therapeutic option for patients with medically refractory epilepsy. Comprehensive presurgical evaluation includes electroencephalography (EEG) and video EEG in identifying patients who are likely to benefit from surgery. Here, we discuss in detail the utility of EEG in presurgical evaluation of patients with temporal lobe epilepsy along with illustrative cases.

Beliefs and Attitudes about Childhood Epilepsy among School Teachers in Two Cities of Southeast Brazil

Karina Piccin Zanni, Thelma Simões Matsukura, and Heber de Souza Maia Filho — Mon, 15 Oct 2012 15:24:53 +0000

Childhood epilepsy is a chronic neurological disorder associated with profound psychosocial limitations epileptic children's routine. Lack of information and inappropriate beliefs are still the factors that most contribute to the stigma and discrimination. This study aimed at characterizing teacher's beliefs and attitudes at regular and special schools in two cities of southeastern Brazil where students with epilepsy studied. Fifty-six teachers of public regular schools and specialized educational institutions for children with disabilities from two cities of Southeast Brazil who had epileptic children in their classroom completed the Brazilian version of The Epilepsy Beliefs and Attitudes Scale: Adult Version and answered a data sheet about sociodemographic characteristics. The results showed that no significant differences () have been found between the beliefs and attitudes of teachers in mainstream and special schools but both schoolteachers had more inappropriate beliefs and attitudes than appropriate ones against childhood epilepsy. These findings raise an important issue, providing us with the knowledge that epilepsy is still a condition which is surrounded by wrong beliefs. Also, educational programs could help reduce the gaps in knowledge about how such disease has been perceived worldwide.

Epileptic Encephalopathies in Adults and Childhood

Zekiye Kural and Ali Fahir Ozer — Thu, 27 Sep 2012 10:24:26 +0000

Epileptic encephalopathies are motor-mental retardations or cognitive disorders secondary to epileptic seizures or epileptiform activities. Encephalopaties due to brain damage, medications, or systemic diseases are generally not in the scope of this definition, but they may rarely accompany the condition. Appropriate differential diagnosis of epileptic seizures as well as subclinical electroencephalographic discharges are crucial for management of seizures and epileptiform discharges and relative regression of cognitive deterioration in long-term followup. Proper antiepileptic drug, hormonal treatment, or i.v. immunoglobulin choice play major role in prognosis. In this paper, we evaluated the current treatment approaches by reviewing clinical electrophysiological characteristics of epileptic encephalopathies.

Cognitive Outcome of Status Epilepticus in Children

Emilie Sheppard and Sarah Lippé — Mon, 13 Aug 2012 12:10:18 +0000

Epileptic encephalopathy encompasses conditions in which cognitive, motor, or sensory deficits result as a consequence of epileptic activity defining certain syndromes. It therefore represents a more severe subset of epilepsy, which can be generally characterized as frequent or severe seizures leading to cerebral dysfunction. This disturbance in cerebral functioning can in turn hinder, somewhat dramatically, cognitive development and further impact the future lives of patients. In this paper, we describe the cognitive consequences of status epilepticus in children and in adults in the context of plasticity theories. Recent studies maintain that consequences of SE may be severe cognitive sequelae, especially in early life. Since the residual consequences of SE in adulthood seem less detrimental and long-lasting, we argue that early life insults, such as those created by SE, during a rapid period of development and functional specialization, result in specific cognitive deficits dependent on the sensitive period at which SE occurred.

Epileptic Encephalopathies with Status Epilepticus during Sleep: New Techniques for Understanding Pathophysiology and Therapeutic Options

Tue, 07 Aug 2012 07:42:46 +0000

Encephalopathy with status epilepticus during sleep (ESES) is an epileptic encephalopathy, as defined by the International League Against Epilepsy (ILAE) Task Force on Classification and Terminology, that is, a condition in which the epileptic processes themselves are believed to contribute to the disturbance in cerebral function. Clinical manifestations of ESES are heterogeneous: apart from different seizure types, they consist in combinations of cognitive, motor, and behavioural disturbances associated with a peculiar electroencephalographic pattern of paroxysmal activity significantly activated during slow sleep, which culminates in a picture of continuous spikes and waves during sleep (CSWS). The pathophysiological mechanisms underlying this condition are still incompletely understood. Establishing a clear-cut correlation between EEG abnormalities and clinical data, though interesting, is very complex. Computer-assisted EEG analyses especially if combined with functional magnetic resonance imaging (EEG-fMRI) and metabolic neuroimaging have recently emerged as useful approaches to better understand the pathophysiological processes underlying ESES. Treatment of ESES is not just limited to seizures control but it should be focused on controlling neuropsychological outcome through an improvement of the continuous epileptiform activity. General agreement on treatment guidelines is still lacking. Implementation of new techniques might allow a better understanding of the pathophysiology of ESES and could enhance therapeutics options.

Functional Magnetic Resonance Imaging for Language Mapping in Temporal Lobe Epilepsy

An Wang, Terry M. Peters, Sandrine de Ribaupierre, and Seyed M. Mirsattari — Wed, 25 Jul 2012 09:05:58 +0000

Functional magnetic resonance imaging (fMRI) is a noninvasive technique that is increasingly used to understand the cerebral cortical networks and organizations. In this paper, we describe the role of fMRI for mapping language networks in the presurgical workup of patients with medically intractable temporal lobe epilepsy (TLE). Studies comparing fMRI with the intracarotid sodium amobarbital (Wada) test and fMRI with intraoperative cortical stimulation mapping for language lateralization and/or localization in medically intractable TLE are discussed.

Neocortical Temporal Lobe Epilepsy

Eduard Bercovici, Balagobal Santosh Kumar, and Seyed M. Mirsattari — Mon, 16 Jul 2012 11:42:30 +0000

Complex partial seizures (CPSs) can present with various semiologies, while mesial temporal lobe epilepsy (mTLE) is a well-recognized cause of CPS, neocortical temporal lobe epilepsy (nTLE) albeit being less common is increasingly recognized as separate disease entity. Differentiating the two remains a challenge for epileptologists as many symptoms overlap due to reciprocal connections between the neocortical and the mesial temporal regions. Various studies have attempted to correctly localize the seizure focus in nTLE as patients with this disorder may benefit from surgery. While earlier work predicted poor outcomes in this population, recent work challenges those ideas yielding good outcomes in part due to better localization using improved anatomical and functional techniques. This paper provides a comprehensive review of the diagnostic workup, particularly the application of recent advances in electroencephalography and functional brain imaging, in neocortical temporal lobe epilepsy.

Epileptic Encephalopathy in Children with Risk Factors for Brain Damage

Thu, 12 Jul 2012 13:28:50 +0000

In the study of 887 new born infants with prenatal and perinatal risk factors for brain damage, 11 children with West syndrome that progressed into Lennox-Gastaut syndrome and another 4 children with Lennox-Gastaut syndrome that had not been preceded by West syndrome were found. In this study we present the main findings of these 15 subjects. In all infants multifactor antecedents were detected. The most frequent risk factors were prematurity and severe asphyxia; however placenta disorders, sepsis, and hyperbilirubinemia were also frequent. In all infants MRI direct or secondary features of periventricular leukomalacia were observed. Followup of all infants showed moderate to severe neurodevelopmental delay as well as cerebral palsy. It is concluded that prenatal and perinatal risk factors for brain damage are very important antecedents that should be taken into account to follow up those infants from an early age in order to detect and treat as early as possible an epileptic encephalopathy.

Electroencephalography in Mesial Temporal Lobe Epilepsy: A Review

Manouchehr Javidan — Sun, 17 Jun 2012 15:16:46 +0000

Electroencephalography (EEG) has an important role in the diagnosis and classification of epilepsy. It can provide information for predicting the response to antiseizure drugs and to identify the surgically remediable epilepsies. In temporal lobe epilepsy (TLE) seizures could originate in the medial or lateral neocortical temporal region, and many of these patients are refractory to medical treatment. However, majority of patients have had excellent results after surgery and this often relies on the EEG and magnetic resonance imaging (MRI) data in presurgical evaluation. If the scalp EEG data is insufficient or discordant, invasive EEG recording with placement of intracranial electrodes could identify the seizure focus prior to surgery. This paper highlights the general information regarding the use of EEG in epilepsy, EEG patterns resembling epileptiform discharges, and the interictal, ictal and postictal findings in mesial temporal lobe epilepsy using scalp and intracranial recordings prior to surgery. The utility of the automated seizure detection and computerized mathematical models for increasing yield of non-invasive localization is discussed. This paper also describes the sensitivity, specificity, and predictive value of EEG for seizure recurrence after withdrawal of medications following seizure freedom with medical and surgical therapy.

Active Epilepsy as Indicator of Neurocysticercosis in Rural Northwest India

Wed, 13 Jun 2012 11:49:44 +0000

Objective. To determine the contribution of neurocysticercosis as a cause for active epilepsy and to establish Neurocysticercosis as major definable risk of epilepsy in our setup. Methods. We conducted a door-to-door survey of 2,209 individuals of Bhore Pind and Bhore Kullian villages in Chattah zone of district Jammu (Jumma and Kashmir, Northwest India) to identify patients with symptomatic epilepsy. Patients with active epilepsy were investigated with neuroimaging techniques to establish diagnosis of NCC (neurocysticercosis). Results. Among 25 patients with epilepsy 10(40%) had CT/MR evidence of past or recent NCC infection. This gave us the point prevalence of 4.5/1000 for Neurocysticercosis in our study population. Interpretation. The study shows a high prevalence of NCC accounting for symptomatic epilepsy in our part of India.

A Seizure Care Pathway in the Emergency Department: Preliminary Quality and Safety Improvements

Tue, 29 May 2012 08:02:52 +0000

Aim. To evaluate the utility of a seizure care pathway for seizure presentations to the emergency department (ED) in order to safely avoid unnecessary admission and to provide early diagnostic and therapeutic guidance and minimize length of stay in those admitted. Methods. 3 studies were conducted, 2 baseline audits and a 12-month intervention study and prospective data was collected over a 12-month period (Nov 2008-09). Results. Use of the Pathway resulted in a reduction in the number of epilepsy related admissions from 341 in 2004 to 276 in 2009 (𝑃=0.0006); a reduction in the median length of stay of those admittedfrom 4-5 days in the baseline audits to 2 days in the intervention study (𝑃≤0.001); an improvement in time to diagnostic investigations such as CT brain, MRI brain and Electroencephalography (𝑃≤0.001, 𝑃≤0.048, 𝑃≤0.001); a reduction in readmission rates from 45.1% to 8.9% (𝑃≤0.001); and an improvement in follow-up times from a median of 16 weeks to 5 weeks (𝑃<0.001). From a safety perspective there were no deaths in the early discharged group after 12 months follow-up. Conclusion. The burden of seizure related admissions through the ED can be improved in a safe and effective manner by the provision of a seizure care pathway.

Microsurgical Anatomy of the Temporal Lobe and Its Implications on Temporal Lobe Epilepsy Surgery

Mon, 21 May 2012 08:47:50 +0000

Objective. We review the neuroanatomical aspects of the temporal lobe related to the temporal lobe epilepsy. The neuronal, the ventricular, and the vascular structures are demonstrated. Methods. The previous articles published from the laboratory of the senior author are reviewed. Results. The temporal lobe has four surfaces. The medial surface has a complicated microanatomy showing close relation to the intraventricular structures, such as the amygdala or the hippocampus. There are many white matter bundles in the temporal lobe showing relation to the extra- and intraventricular structures. The surgical approaches commonly performed to treat temporal lobe epilepsy are discussed under the light of these data. Conclusion. A thorough knowledge of the microanatomy is necessary in cortical, subcortical, and intraventricular structures of the temporal lobe to achieve better results.

Role of Functional MRI in Presurgical Evaluation of Memory Function in Temporal Lobe Epilepsy

Chusak Limotai and Seyed M. Mirsattari — Tue, 15 May 2012 08:05:19 +0000

Many diagnostic tools have been employed to predict the likelihood of a postoperative memory decline after a standard temporal lobectomy, including the intracarotid amobarbital testing (IAT) or Wada, regarded as the gold standard test for over the past half a century. Functional MRI (fMRI) is also a promising tool in that regard. Its routine use to predict the postoperative memory decline has been limited because of the varied study paradigms, discrepancies in analysis, and interpretation of the results. Based on the existing literatures, fMRI cannot replace IAT for the routine presurgical evaluation of the patients with temporal lobe epilepsy (TLE) yet. Large multicentre studies with a panel of memory test are required to determine the full potential of fMRI and use it reliably to replace IAT in the routine clinical practice. In this paper, we review various aspects of memory fMRI, including the experimental designs, data analysis, and findings.

Physiopathogenetic Interrelationship between Nocturnal Frontal Lobe Epilepsy and NREM Arousal Parasomnias

Péter Halász, Anna Kelemen, and Anna Szűcs — Thu, 10 May 2012 11:14:50 +0000

Aims. To build up a coherent shared pathophysiology of NFLE and AP and discuss the underlying functional network. Methods. Reviewing relevant published data we point out common features in semiology of events, relations to macro- and microstructural dynamism of NREM sleep, to cholinergic arousal mechanism and genetic aspects. Results. We propose that pathological arousals accompanied by confused behavior with autonomic signs and/or hypermotor automatisms are expressions of the frontal cholinergic arousal function of different degree, during the condition of depressed cognition by frontodorsal functional loss in NREM sleep. This may happen either if the frontal cortical Ach receptors are mutated in ADNFLE (and probably also in genetically not proved nonlesional cases as well), or without epileptic disorder, in AP, assuming gain in receptor functions in both conditions. This hypothesis incorporates the previous “liberation theory” of Tassinari and the “state dissociation hypothesis” of Bassetti and Terzaghi). We propose that NFLE and IGE represent epileptic disorders of the two antagonistic twin systems in the frontal lobe. NFLE is the epileptic facilitation of the ergotropic frontal arousal system whereas absence epilepsy is the epileptic facilitation of burst-firing working mode of the spindle and delta producing frontal thalamocortical throphotropic sleep system. Significance. The proposed physiopathogenesis conceptualize epilepsies in physiologically meaningful networks.

Assessment of Psychological Distress in Epilepsy: Perspective from Pakistan

Najam-us Sahar — Sun, 29 Apr 2012 15:49:59 +0000

The unpredictable nature & elongated course of epilepsy affect all dimensions (physical, psychological, and social) of an individual’s life. People with the diagnosis of epilepsy are a high-risk group for different psychiatric problems that is anxiety, depression as well as social problems (marriage, education, and daily activities). The findings of present research revealed high rate (70%) of psychological distress among fifty adult individuals with epilepsy. It was also found that people with uncontrolled epilepsy experience high level of psychological distress (100%) as compared to those with controlled (42%). Demographic and clinical factors associated with distress include lack of occupation, the presence of an underlying disabling condition (with treatment), and the severity of epilepsy. The finding generated here showed that 13 out of 19 females with epilepsy reported psychological distress. It was also found that none of these women was employed (a cultural specific phenomenon) with a slightly high number of unmarried females (74%). So by understanding the relationship between clinical and psychosocial variables, a good management plan can be devised with a focus on social and gender differences. The present research can also help to increase the awareness and to lower the stigmatization related to epilepsy.

Atypical Febrile Seizures, Mesial Temporal Lobe Epilepsy, and Dual Pathology

Nathalie T. Sanon, Sébastien Desgent, and Lionel Carmant — Mon, 23 Apr 2012 11:26:56 +0000

Febrile seizures occurring in the neonatal period, especially when prolonged, are thought to be involved in the later development of mesial temporal lobe epilepsy (mTLE) in children. The presence of an often undetected, underlying cortical malformation has also been reported to be implicated in the epileptogenesis process following febrile seizures. This paper highlights some of the various animal models of febrile seizures and of cortical malformation and portrays a two-hit model that efficiently mimics these two insults and leads to spontaneous recurrent seizures in adult rats. Potential mechanisms are further proposed to explain how these two insults may each, or together, contribute to network hyperexcitability and epileptogenesis. Finally the clinical relevance of the two-hit model is briefly discussed in light of a therapeutic and preventive approach to mTLE.

Temporal Lobe Epilepsy Surgery Failures: A Review

Adil Harroud, Alain Bouthillier, Alexander G. Weil, and Dang Khoa Nguyen — Sun, 22 Apr 2012 13:58:37 +0000

Patients with temporal lobe epilepsy (TLE) are refractory to antiepileptic drugs in about 30% of cases. Surgical treatment has been shown to be beneficial for the selected patients but fails to provide a seizure-free outcome in 20–30% of TLE patients. Several reasons have been identified to explain these surgical failures. This paper will address the five most common causes of TLE surgery failure (a) insufficient resection of epileptogenic mesial temporal structures, (b) relapse on the contralateral mesial temporal lobe, (c) lateral temporal neocortical epilepsy, (d) coexistence of mesial temporal sclerosis and a neocortical lesion (dual pathology); and (e) extratemporal lobe epilepsy mimicking TLE or temporal plus epilepsy. Persistence of epileptogenic mesial structures in the posterior temporal region and failure to distinguish mesial and lateral temporal epilepsy are possible causes of seizure persistence after TLE surgery. In cases of dual pathology, failure to identify a subtle mesial temporal sclerosis or regions of cortical microdysgenesis is a likely explanation for some surgical failures. Extratemporal epilepsy syndromes masquerading as or coexistent with TLE result in incomplete resection of the epileptogenic zone and seizure relapse after surgery. In particular, the insula may be an important cause of surgical failure in patients with TLE.

Neuropathology of Temporal Lobe Epilepsy

Fahd Al Sufiani and Lee Cyn Ang — Thu, 12 Apr 2012 10:36:38 +0000

Pathologic findings in surgical resections from patients with temporal lobe epilepsy include a wide range of diagnostic possibilities that can be categorized into different groups on the basis of etiology. This paper outlines the various pathologic entities described in temporal lobe epilepsy, including some newly recognized epilepsy-associated tumors, and briefly touch on the recent classification of focal cortical dysplasia. This classification takes into account coexistent pathologic lesions in focal cortical dysplasia.