SUDEP classification: Discordances between forensic investigators and epileptologists

We compared sudden unexpected death in epilepsy (SUDEP) diagnosis rates between North American SUDEP Registry (NASR) epileptologists and original death investigators, to determine degree and causes of discordance. In 220 SUDEP cases with post-mortem examination, we recorded the epileptologist adjudications and medical examiner- and coroner- (ME/C) listed causes of death (CODs). COD diagnosis concordance decreased with NASR’s uncertainty in the SUDEP diagnosis: highest for Definite SUDEP (84%, n = 158), lower in Definite Plus (50%, n = 36), and lowest in Possible (0%, n = 18). Rates of psychiatric comorbidity, substance abuse, and toxicology findings for drugs of abuse were all higher in discordant cases than concordant cases. Possible SUDEP cases, an understudied group, were significantly older, and had higher rates of cardiac, drug, or toxicology findings than more certain SUDEP cases. With a potentially contributing or competing COD, ME/Cs favored non–epilepsy-related diagnoses, suggesting a bias toward listing CODs with structural or toxicological findings; SUDEP has no pathognomonic features. A history of epilepsy should always be listed on death certificates and autopsy reports. Even without an alternate COD, ME/Cs infrequently classified COD as “SUDEP.” Improved collaboration and communication between epilepsy and ME/C communities improve diagnostic accuracy, as well as bereavement and research opportunities.     

Neonatal seizure automatism and human inborn pattern of quadrupedal locomotion

Seizures in newborns do not always show a clear electro-clinical correlation. The real epileptic nature of some stereotyped rhythmic movements, included in the ‘subtle seizures’ and considered as brainstem release phenomena, is still debated. We report a brain injured newborn, who displayed several episodes of repetitive limb movements. The ictal EEG discharge, during one of these episodes, was associated with a motor pattern modification, which was endowed with quadrupedal locomotion kinematic features. This might represent an indirect evidence of cervical and lumbar Central Pattern Generators interconnection with in-phase coordination between diagonal limbs since the first hours of life in humans.     

布洛芬混悬滴剂和对乙酰氨基酚治疗小儿热性惊厥的疗效观察

目的 观察布洛芬混悬滴剂和对乙酰氨基酚治疗小儿热性惊厥(FS)的疗效。方法 选取2017年4月—2019年4月于本院就诊的FS患儿80例,随机分为对照组与观察组,每组40例,均进行抗惊厥、物理降温等常规治疗,在此基础上,对照组采用对乙酰氨基酚治疗,观察组采用布洛芬混悬滴剂治疗,观察2组临床疗效、退热效果、实验室检查结果(血红蛋白、血钠、血钙)及不良反应情况。结果 对照组治疗总有效率为77.5%,观察组为95%,差异有统计学意义(P<0.05);治疗后1 h,2组患儿体温差异无统计学意义(P>0.05),治疗后3 h、6 h,2组体温均低于服药前,观察组患儿体温低于对照组,差异有统计学意义(P<0.05);治疗后,2组血红蛋白、血钠、血钙浓度较服药前均显著升高(P<0.05),且观察组高于对照组(P<0.05);对照组不良反应率为7.5%,观察组为5%,差异无统计学意义(P>0.05)。结论 布洛芬混悬滴剂对小儿热性惊厥临床症状改善作用显著,值得推介。     

Panayiotopoulos syndrome with convulsive status epilepticus at the onset: A long-term study

PurposeTo better define the convulsive status epilepticus (CSE) as a possible manifestation at the onset of Panayiotopoulos syndrome (PS) and to assess its prognostic value in these children.MethodsChildren with CSE and diagnostic criteria of PS were identified, followed clinically and compared with a group of patients with PS without CSE from 1993 to 2012.ResultsWe identified 37 patients with CSE at the onset of PS. During the same period we identified 72 children with autonomic symptoms of PS without CSE. The first episode of CSE occurred at a mean age of 6.5 years. Generalized clonic seizures were the most common ictal event and one-third of the patients required admission to Intensive Care Units. Interictal EEGs showed occipital spike activity in 31 (83.7%) subjects. Only 14 (37.8%) patients were treated with valproic acid and for two of them (5.40%) it was necessary to administer other drugs. There were no intractable cases. The overall prognosis was excellent. After the first event, 15 subjects (40.54%) experienced at least another typical PS seizure, but all patients were seizure free at the last follow-up.ConclusionCSE is not uncommon in PS and it may occur at the onset of benign childhood epilepsy, without leading to a poor prognosis.     

Participation of bone marrow-derived cells in hippocampal vascularization after status epilepticus

PurposeDiseases such as temporal lobe epilepsy, brain trauma and stroke can induce endothelial cell proliferation and angiogenesis in specific brain areas. During status epilepticus (SE), bone marrow-derived cells are able to infiltrate and proliferate, dramatically increasing at the site of injury. However, it is still unclear whether these cells directly participate in vascular changes induced by SE.MethodTo investigate the possible role of bone marrow-derived cells in angiogenesis after seizures, we induced SE by pilocarpine injection in previously prepared chimeric mice. Mice were euthanized at 8 h, 7 d or 15 d after SE onset.ResultsOur results indicated that SE modified hippocampal vascularization and induced angiogenesis. Further, bone marrow-derived GFP⁺ cells penetrated through the parenchyma and participated in the formation of new vessels after SE. We detected bone marrow-derived cells closely associated with vessels in the hippocampus, increasing the density of blood vessels that had decreased immediately after pilocarpine-induced SE.ConclusionWe conclude that epileptic seizures directly affect vascularization in the hippocampus mediated by bone marrow-derived cells in a time-dependent manner.