Epilepsy research
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This retrospective study evaluates the impact of postoperative antiepileptic drug (AED) withdrawal on psychomotor speed in seizure-free children, operated for medically refractory epilepsy. Post-surgical medication policy and neuropsychological assessments (performed shortly before and 6, 12 and 24 months after surgery), were evaluated in 57 children (32 female, median age at surgery 13 years). Patients were divided into a withdrawal (n=29) and a no-withdrawal group (n=28). ⋯ At 24 months, the withdrawal group had improved significantly more than the no-withdrawal group on three of four tests; reaction time to light (p=0.031), reaction time to sound (p=0.045) and tapping (p=0.003). At 12 months, a non-significant tendency in the same direction was found for both reaction time tests. Drug withdrawal after surgery improves psychomotor speed and may unleash the potential for cognitive improvement.
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Non-convulsive seizures/status epilepticus occur in approximately 20% of comatose, non-cardiac arrest intensive care unit (ICU) patients, and are associated with increased mortality. The prevalence and clinical significance of seizures in comatose survivors of cardiac arrest undergoing therapeutic hypothermia is not well described. ⋯ Seizures are common in comatose patients treated with therapeutic hypothermia after cardiac arrest. All patients with seizures were deceased within 30 days of discharge. Routine use of EEG monitoring could assist in early detection of seizures in this patient population, providing an opportunity for intervention to potentially improve outcomes.
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Generalized periodic epileptiform discharges (GPDs) are a specific periodic EEG pattern, reported as having a poor clinical outcome. The incidence and clinical implications of this EEG pattern in children are not known. In this study, we examined the clinical features of children with GPDs. ⋯ GPDs are seen during the course of RSE in critically ill children and are associated with seizure recurrence. A lower mortality rate occurs in children with GPDs compared to adult counterparts, likely related to different etiologies. Although the significance of GPDs must be determined within the context of the clinical situation, GPDs suggest a still active epileptic process.
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Review Meta Analysis
A meta-analysis of voxel-based morphometry studies on gray matter volume alteration in juvenile myoclonic epilepsy.
The findings of structural neuroimaging studies on gray matter volume (GMV) of juvenile myoclonic epilepsy (JME) with voxel-based morphometry (VBM) were inconsistent. We aim to evaluate consistent gray matter changes in JME quantitatively. A systematic review of VBM studies on GMV of patients with JME and healthy control (HC) subjects indexed in PubMed and EMBASE from January 1990 to June 2012 was conducted. ⋯ Increased GMV were observed in the bilateral medial frontal gyrus and anterior cingulate, whereas decreased GMV in the bilateral thalamus. The findings remain largely unchanged in the jackknife sensitivity analyses. The meta-analysis not only identified consistent changes in some regions of gray matter in patients with JME, but also supports the notion of thalamocortical circuitry involved in the pathogenesis of JME.
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The main purpose of this retrospective analysis was to evaluate the incidence and lateralization value of rhythmic ictal nonclonic hand (RINCH) motions in patients with temporal lobe epilepsy (TLE), who were classified as Engel I at least 2 years after epilepsy surgery. We analyzed the distribution of ictal activity at the time of RINCH appearance in patients in whom RINCH motions were present during invasive EEG monitoring. A group of 120 patients was included in this study. ⋯ They have a high lateralizing value in these patients, occurring contralateral to the ictal onset. RINCH motions usually occur after the spread of ictal activity beyond the temporal lobe, and their appearance is usually associated with the presence of ictal activity in various regions of the contralateral frontal lobe, mainly the orbitofrontal cortex and anterior cingulate gyrus. This is the first study analysing this phenomenon during invasive EEG recording.