Seizure : the journal of the British Epilepsy Association
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We report on a case of epilepsia partialis continua with rapid response to intravenous bolus administration of levetiracetam. A 60-year-old woman presented with continuous jerking of the right foot and hallux persisting for more than two days. ⋯ After hospital admission, the twitching of the foot and toe was refractory to add-on treatment with lorazepam and diazepam but stopped within 15 min after intravenous bolus administration of 2000 mg levetiracetam. This observation suggests that intravenous bolus administration of levetiracetam may be an effective therapeutic option in epilepsia partialis continua.
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Migraine, with or without aura, affects from 10% to 14% of the population, and is as such one of the most common headache disorders. A unified hypothesis for the physiopathology of migraine and its relationship with epileptic migraine and migralepsy has yet to be formulated. Trigemino-vascular system (TVS) activation is believed to play a crucial role in the "pain phase" in migraine; cortical spreading depression (CSD) is considered to be the primary cause of TVS activation. On the basis of data in the literature, I would like to stress that TVS activation may originate at different cortical and subcortical levels. For example, as recently reported, an epileptic focus, originating and propagating along cortical non-eloquent/silent areas, through CSD, rarely causes TVS activation with migraine as the sole ictal epileptic manifestation. ⋯ The multiple considerations that arise from this hypothesis, including the under-diagnosed ictal epileptic headache, are discussed; EEG (ictal and inter-ictal) recording with intermittent photic stimulation (IPS), according to the standardized international protocol, is strongly recommended in selected migraine populations.
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To assess the inter-observer agreement of the electroencephalogram (EEG) diagnosis of (non-convulsive) seizures in comatose patients. ⋯ The EEG diagnosis of (non-convulsive) seizures in ICU patients is not very reliable, even when strict criteria such as proposed by Young are applied. There is a need for less ambiguous EEG criteria for (non-convulsive) seizures and status epilepticus.
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To assess the role of various pre-surgical evaluations in posterior cortex epilepsy (PCE) and its surgical outcome. ⋯ Surgical treatment is effective for PCE. Accurate localization of epileptogenic zone and eloquent cortex are two key factors for favorable outcome. None of the diagnostic modalities shows obvious predictive value for favorable surgical outcome.
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Corpus callosotomy can be an effective surgical treatment for medically intractable generalized seizures, particularly for drop attacks. We studied long-term seizure outcomes after callosotomy, mainly focusing on drop attacks as the seizure type. ⋯ These findings confirmed that callosotomy is the treatment of choice for disabling generalized seizures, especially for drop attacks. Total section is far more effective than partial section in terms of control of drop attacks and prevention of seizure relapse. However, new types of seizure could occur after callosotomy. When newly developed postural seizures were very severe, patients may fall due to sudden torsion of body, but the entire process of falling was not as sudden as that observed during previous drop attacks.