Cognitive Performance of Patients with Epilepsy and Calcified Neurocysticercotic Lesions: A Case-Control Study

Neuropsychological tests were applied to 20 patients with focal epilepsy related to calcified neurocysticercosis (NCC) (mean: three lesions/patient; NCC group), 22 patients with focal epilepsy without NCC (EPI group), and 29 healthy controls matched for age, sex, and educational level. The EPI and NCC groups were matched for age at onset of epilepsy, epilepsy duration, frequency of attacks, seizure semiology, interictal EEG findings, and antiepileptic drugs used. There were no differences in the digit span, word span, calculus, and Mini-Mental State examination among the three groups studied. The NCC and EPI groups showed lower scores than controls in immediate and delayed verbal memory, famous faces test, spatial recognition span, abstractions and judgment, and visuoconstructional abilities. The EPI group, but not the NCC group, also had lower scores in a praxis tests. There were no differences between the NCC and EPI groups in any of the tests applied (P > 15), except for the spatial recognition span, which was lower in the former. Cognitive impairment is a prevalent neuropsychological feature of patients with epilepsy and NCC.     

婴儿痉挛症血清NSE、S100B水平动态变化

目的探讨婴儿痉挛症(infantile spasm,IS)患儿痉挛发作期间及发作控制后神经元特异性烯醇化酶(neuron specificenolase,NSE)、S100B的表达水平及其与脑损伤的关系。方法采用ELISA方法定量检测30例IS患儿发作期间、发作控制48h内及1周后血清NSE、S100B浓度;30名同年龄组健康体检儿设为对照。实验结果进行统计学处理。结果IS发作期和发作控制48h内血清NSE水平有显著差异(P<0.05),但二者均显著高于发作控制1周后水平(P<0.01)。S100B血清浓度在治疗前与发作控制48h内无显著差异(P>0.05),二者也显著高于发作控制1周后(P<0.01)。观察组治疗前和发作控制48h内NSE、S100B血清浓度显著高于对照组(P<0.01);IS发作控制1周后血清NSE、S100B浓度和对照组无明显差异(P>0.05)。结论IS患儿痉挛发作期间和发作控制短期内NSE、S100B水平持续增加,可作为判断IS早期脑损伤的生化标记并可能影响IS患儿的远期预后。     

Ictal cerebral perfusion related to EEG in drug resistant focal epilepsy of childhood.

OBJECTIVES: To evaluate the EEG changes during seizures in children with drug resistant focal epilepsy who demonstrate hypoperfusion at the "seizure focus" interictally, but no perfusion change during the seizure. METHODS: Ictal EEG findings of six children with focal epilepsy who demonstrated hypoperfusion on rCBF SPECT after an interictal injection of (99)Tc(m) HMPAO concordant with the seizure focus, but who did not demonstrate rCBF change after an ictal injection (group 1) were reviewed. These were contrasted with the EEG data of six children matched as closely as possible for age, type of epilepsy, and pathology who did show hyperperfusion at the seizure focus on ictal scan when compared with the interictal study (group 2). RESULTS: The children in group 1 showed slowing of the EEG at the time of the (99)Tc(m) HMPAO injection relative to that seen at the onset of the seizure. Those in group 2 showed rhythmic activity, or sharp waves, or both on EEG at the time of injection. This last change was also seen consistently when the EEG data of a further 13 children who also showed ictal hyperperfusion at the seizure focus were reviewed. CONCLUSION: Ictal rCBF does not invariably increase at the seizure focus in patients with drug resistant focal epilepsy.     

Contribution of magnetic resonance imaging in 100 cases of refractory partial epilepsy with normal CT scans

One hundred epileptic patients were included in this study according to the following criteria: intractable partial epilepsy, normal CT scan and focal EEG abnormalities. Eighty-nine patients were suffering from complex partial seizures of temporal or frontal origin, 55 and 34 cases respectively. Eleven patients presented with only simple partial seizures. MRI was abnormal in 31 patients. The abnormalities were: focal T2 increased signal intensity (13 cases) most often temporal (10 cases), cryptic arteriovenous malformation (4 cases), focal T1 and T2 signal abnormality (4 cases), focal atrophy (2 cases) and multiple abnormal T2 signals scattered in the white matter (8 cases). The site of MRI abnormalities was consistent with electroclinical data in 22 patients, of whom 20 had a temporal lobe epilepsy. Thus MRI proved to be more often abnormal in temporal than in frontal lobe epilepsy (36 p. 100 and 5.9 p. 100 respectively) when the CT scan is normal. However MRI data, particularly focal T2 hypersignals should be confronted to electroclinical and metabolic findings whenever functional surgery is considered.     

Usefulness of intracranial EEG in the decision process for epilepsy surgery

BACKGROUND AND PURPOSE: In patients with discordant results, non-localizing EEG, or bitemporal seizure onset, intracranial monitoring is done to confirm the seizure onset. Our aim was to assess the yield of intracranial recordings in patients with different clinical scenarios. METHODS: The records of all patients who underwent prolonged intracranial EEG monitoring (IEM) at the London Health Sciences Centre, University of Western Ontario, Canada, between 1993 and 1999, identified using our EEG patient database in continuous use since December 1972, were reviewed. Patients were analyzed in the following groups according to perceived increasing degrees of uncertainty of epileptic zone localization-group 1: lesion on MRI congruent with focal ictal and interictal scalp EEG, but findings are subtle and of low level of certainty (n=13), group 2: focal MRI, focal ictal and multifocal interictal scalp EEG (n=11), group 3: focal MRI, non-localizing or incongruent scalp EEG (n=73), group 4: normal of multifocal MRI, focal ictal scalp EEG (n=11), group 5: multifocal MRI, non-localizing scalp EEG (n=18), and group 6: normal MRI, multifocal scalp EEG (n=36). RESULTS: One hundred and seventy one patients underwent IEM at the London Health Sciences Centre between 1993 and 1999. All patients had localization-related epilepsy, plus or minus secondary generalization. IEM was helpful overall in 86% of patients, in 69% of group 1, 36% of group 2, 90% of group 3, 81% of group 4, 100 of group 5 and 92% of group 6. CONCLUSIONS: Our study shows that the yield of the IEM was higher in the groups of patients with lack of congruence between the MRI and the scalp EEG. The yield was lower in patients with congruent but subtle or uncertain scalp EEG and MRI findings.     

Magnetic Resonance Imaging and Late-Onset Epilepsy

The value of magnetic resonance imaging (MRI) in investigation of patients with late-onset epilepsy has not been studied systematically. We evaluated prospectively the usefulness of MRI in 50 patients with late-onset epilepsy in whom a computed tomography (CT) scan was normal (32), did not allow a definitive diagnosis to be made (12), or showed irrelevant lesions (6). Patients were assessed clinically and had an EEG, and CT and MRI scans were reported by one neuroradiologist blinded to clinical and laboratory data. Of the 32 patients with a normal CT scan, MRI was normal in 20, showed irrelevant ischemic lesions in 8, and showed the cause of seizures in 4 patients. Of the 12 patients with nondiagnostic CT, MRI clarified the diagnosis in 5 and was normal in 2 patients. In 6 patients, both scans showed irrelevant ischemic lesions, and in 1 patient MRI showed a relevant additional lesion. The incidence of MRI-detected white matter ischemic lesions was no greater than in an age- and sex-matched group of subjects without seizures. MRI was diagnostic in 32% of the patients with partial seizures and/or focal EEG findings, as compared with 0% of patients without focal features (p less than 0.01). We conclude that MRI is useful in investigation of patients with late-onset epilepsy with focal features.     

Focal clinical and electroencephalographic features in patients with juvenile myoclonic epilepsy

Jayalakshmi SS, Srinivasa Rao B, Sailaja S. Focal clinical and electroencephalographic features in patients with juvenile myoclonic epilepsy.
Acta Neurol Scand: 2010: 122: 115–123.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To identify prevalence and factors associated with occurrence of focal clinical and electroencephalogram (EEG) abnormalities in patients with juvenile myoclonic epilepsy (JME). Materials and methods – Clinical asymmetries in the seizures and focal EEG abnormalities were analyzed in 266 patients with JME. Results – All the patients had myoclonic jerks (MJ) and generalized tonic‐clonic seizures (GTCS); 56 (21%) had absence seizures. Asymmetry in clinical seizures was reported in 45 (16.9%) and focal EEG abnormalities were noted in 92 (45.5%) patients. Amplitude asymmetry or focal onset of generalized discharges was noted in 41 (44.6%) and independent focal EEG abnormalities in 30 (32.6%) patients. A statistically significant association was seen with the presence of GTCS and MJ (P = 0.007), a family history of epilepsy (P = 0.001) and drug resistance (P = 0.04) and the occurrence of focal EEG abnormalities. Conclusion – Patients with JME showed focal clinical and EEG features. These features should not be misinterpreted as indicative of partial epilepsy.     

Maternal and fetal outcome in women with epilepsy associated with neurocysticercosis.

AIM: We wanted to characterize the clinical profile and outcome of pregnancy in women with epilepsy due to neurocysticercosis (NCC) enrolled in the Indian Registry of Epilepsy and Pregnancy (IREP). METHODS: We identified all women with NCC in the IREP between January 2000 and September 2005. Age- and parity-matched patients without NCC were identified from the respective centers of IREP for comparison. Statistical analysis was performed using SPSS version 11. RESULTS: There were 30 women with NCC (mean age 24.3 +/- 4 years) among 1071 registrations in the IREP. All the patients had NCC prior to the pregnancy. Fourteen (47%) NCC patients had calcified lesions and 16 (53%) had ring lesions in a CT scan of the brain. Compared to women without NCC, the NCC group had later age-at-onset of seizures (20.7 +/- 4.4 years, p = 0.008) and epilepsy (21.1 +/- 5.2 years, p = 0.01). They were more likely to have partial seizures (70% versus 30%, p = 0.002), an EEG without epileptiform abnormalities (50% versus 100%, p = 0.01), and better control of seizures before (47% versus 3%, p = 0.001) and during pregnancy (33% versus 10%, p = 0.02). Maternal and neonatal complications did not differ between the groups. CONCLUSIONS: NCC is an uncommon cause of epilepsy in pregnant women enrolled in IREP. To be noted, as a limitation of our study, that the IREP is a hospital-based registry, which may not reflect global epilepsy characteristics of the community. The maternal and fetal outcome for NCC patients was not different from those women without NCC.     

Psychological Disturbances and Folic Acid in Chronic Epileptic Outpatients

The relationship between serum folate level and psychological disturbances was studied in a series of 95 chronic epileptic outpatients. All were nondrinkers. Serum folic acid in all cases and vitamin B12 in 83 cases were determined by radioimmunoassay. Only three factors were significantly related with psychological disturbances: serum levels of folic acid were significantly lower and the mean corpuscular volume of the erythrocytes was significantly higher in disturbed patients, particularly in those with the most severe psychiatric syndromes, and the incidence of disturbances was significantly higher in patients treated with three or more drugs. Conversely, variables such as number or type of seizures, duration of epilepsy, duration of treatment, presence of structural neurological lesions, previous mental retardation, or focal temporal lobe disturbances in the EEG did not show any statistical relationship to the presence of psychological disturbances. No relevant relationship was found between serum vitamin B12 and psychological disturbances.