Febrile seizures in patients with complex partial seizures

Febrile seizures occurred in 14 of 155 (9%) out-patients with complex partial seizures. Twelve patients had prolonged or recurrent febrile seizures, convulsive status epilepticus or a transient postictal neurological deficit. Febrile seizures were associated with perinatal abnormalities, an earlier onset of epilepsy and with a poor seizure control. Recurrent febrile seizures or those with complicating features are associated with an unfavourable therapeutic outcome in adult patients with complex partial seizures.     

Prevalence of alexithymia in patients with psychogenic non-epileptic seizures and epileptic seizures and predictors in psychogenic non-epileptic seizures

ObjectiveThe first objective of this study was to determine the prevalence rate of alexithymia (dysregulation and unawareness of emotion) in patients with psychogenic non-epileptic seizures (PNESs) and epileptic seizures (ESs). The second objective was to identify the predictors of alexithymia in patients with PNESs.MethodsWe studied 66 consecutive patients with PNESs and 35 patients with ESs with the Toronto Alexithymia Scale-20. The prevalence of alexithymia was determined in both groups. In order to identify the risk factors of alexithymia in PNES, the Trauma Symptom Inventory-II (TSI-II), the MMPI 2-RF, a clinical history, and demographic variables were studied.ResultsOur study revealed a prevalence of alexithymia in PNES and ES of 36.9% and 28.6%, respectively (not a significant difference). Upon examining the group with PNES, we found a significant correlation between alexithymia and Anxious Arousal (r = .497, p < .000), Intrusive Experiences (r = .541, p < .000), Dissociation (r = .421, p < .001), and Defensive Avoidance (r = .444, p < .000) from the TSI-II. Minnesota Multiphasic Personality Inventory-2-RF RCd (r = .512, p < .000), RC1 (r = .346, p < .017), RC2 (r = .355, p < .017), RC3 (r = .467, p < .001), and EID (r = .567, p < .000) also correlated significantly with alexithymia. However, stepwise regression analysis only retained Intrusive Experiences and Defensive Avoidance from the TSI-II and the cynicism RC3 scale from the MMPI 2-RF.ConclusionSymptoms of psychological trauma and cynicism in patients diagnosed with PNESs were associated with alexithymia. These findings are encouraging, as they assist in better understanding the condition and in treatment design for this subset of patients.     

Nonepileptic seizures in children

PURPOSE: To determine if the clinical characteristics of nonepileptic seizures (NES) are different in children younger than 13 years age as compared to adolescents. METHODS: Retrospective review of medical records and video-EEGs (VEEG) of all patients with NES confirmed on VEEG monitoring was performed. RESULTS: Sixty-eight (3.5%) of 1,967 patients monitored with VEEG had a clinical diagnosis of NES. Fifty-nine of 68 patients had their habitual event recorded. Mean age at the time of the VEEG diagnosis was 13 years 4 months. Twenty-two patients were less than 13 years (group A) and 37 were 13 years and older (group B). The male to female ratio was equal in group A, with female predominance seen in group B. NES commonly manifested as subtle motor activity in group A (p < 0.01) and prominent motor activity in group B (p < 0.001). Difficulties at school, family discord, and interpersonal conflicts, were frequent stressors in both groups. Sexual abuse was the least frequent. Depression was more common in group B; cognitive dysfunction (p < 0.001) and epilepsy (p < 0.01) were more common in group A. CONCLUSIONS: Differences in clinical semiology and predisposing factors may help identify young children and adolescents who might be at risk for the development of NES.     

Neuroimaging in neonatal seizures

Seizures are the most common sign of neurological dysfunction in full‐term neonates, with an incidence estimated at 0.15–3.5/1,000 live births. Neonatal seizures often reflect severe underlying brain injury and are associated with high rates of mortality and morbidity. Prognosis is primarily determined by the nature, site and extent of the underlying aetiology, making accurate diagnosis and identification of associated brain lesions essential. Data on neuroimaging in newborns presenting with seizures is limited and most studies report on MRI findings in infants with a specific underlying problem, such as hypoxic‐ischaemic encephalopathy, stroke or metabolic disorders. The aim of this review is to discuss the spectrum of neuroimaging findings in full‐term newborns presenting with seizures, divided into subgroups with different underlying aetiologies. A standard neonatal MRI protocol is presented.     

Seizure susceptibility in aged rats--pentylenetetrazol-induced seizures and amygdaloid kindling seizures]

Seizure susceptibility in male aged rats (21-25 mo. age) was investigated by pentylenetetrazol (PTZ)-induced seizures and amygdaloid kindling seizures. Male adult rats (3-4 mo. of age) were used as the control group. During 60 min. after the administration of PTZ (70 mg/kg, s.c.), the aged rats had a higher incidence and a significantly longer duration of generalized convulsion than the control group. On the other hand, the kindling rate of the aged rats was significantly slower than that of the control. The aged rats remained longer at stage 1-2 indicative of partial seizures. However, the aged rats skipped stage 3 on their way to stage 4-5 (generalized seizures), and showed a more violent stage 5 seizure than the control group. They had a longer duration of afterdischarges (AD) through the kindling process with a significantly faster propagation of AD to the contralateral amygdala as compared with the control group. The present study suggests that aged rats are prone to convulsion, while they have a difficulty in acquisition of epileptogenesis.     

Rotavirus-induced seizures in childhood

Rotavirus infection is a frequent cause of gastroenteritis in children and accounts for significant morbidity and mortality, especially in the developing world. Less well recognized is the association of rotavirus-induced central nervous system dysfunction, which has been associated with seizure, encephalopathy, and death. Symptoms may vary widely, however, and children can experience short afebrile convulsions as the only manifestation of rotavirus encephalopathy. We report 4 further cases of rotavirus-induced seizures with mild neurologic manifestations. The condition is reviewed and practical management strategies are suggested.     

Conversion disorder and coexisting nonepileptic seizures in patients with refractory seizures

Nonepileptic seizures (NES) are commonly observed in patients with seizures resistant to antiepileptic drugs (AEDs). However, NES may be symptomatic of different diagnoses, in particular, conversion disorder (CD) and coexisting NES and epileptic seizures (CENES). We compared the clinical characteristics of these disorders in 219 patients with refractory seizures. The prevalence of NES was similar in children (11%) and adults (16%). In both groups, CENES represented the most frequent cause of NES (75%). In adults, CD was associated with a shorter duration of illness and normal neuroimaging and interictal EEG compared with the other groups. Patients with CD represented one-quarter of all patients with AED-resistant seizures with normal presentation during interictal investigations. In both children and adults with AED-resistant seizures, NES are frequently observed and are three times more likely to be CENES than CD.     

Visual seizures in children

Twenty-one children (11 boys, 10 girls) suffering from visual seizures were studied. The visual seizures manifested as loss of vision, flickering light, blurring or figurative hallucinations. Ictal EEGs during visual seizures were recorded in 4 cases; the ictal discharges all originated in the occipital area. Visual seizures appeared in association with two or more non-visual ictal signs. In 18 cases, interictal EEGs revealed epileptiform discharges in the occipital area. In 3 cases, all girls, interictal EEGs showed photoconvulsive responses and focal spikes outside the occipital areas. They experienced clinical seizures when watching television and were thought to have photosensitive partial seizures.     

Hyperkinetic seizures in children

The objective of this study was to delineate the clinical and video-electroencephalographic (EEG) manifestations of children with complex partial seizures with a predominant "hyperkinetic" presentation. Certain types of partial seizures can be difficult to differentiate from nonepileptic seizures because of their intense motor presentation and, at times, lack of alteration of consciousness. Based on a published semiologic seizure classification, this type of seizures can be described as "hyperkinetic," characterized by intense motor activity involving the extremities and trunk. We report five children diagnosed with hyperkinetic seizures by video-EEG monitoring. All patients were referred for video-EEG evaluation because of an initial suspicion of pseudoseizures. Presented in this study is a review of the patients' clinical data, including video-EEG evaluation. There were three boys and two girls; the mean age at presentation was 10 +/- 3 years. In four patients, there was a history of behavioral disorder, with two patients carrying a diagnosis of attention-deficit hyperactivity disorder (ADHD). One girl had significant developmental delay and an abnormal neurologic examination. Brain magnetic resonance imaging was normal in three patients and abnormal in two. The semiology of the seizures consisted of stereotypic intense motor activity, mainly upper extremity flailing and kicking. Screaming and shouting were noted in three cases, and intense fear was present in two patients. The hyperkinetic ictal activity progressed to tonic-clonic seizures in two patients. Seizures occurred out of sleep or on awakening in four patients. The interictal EEG activity was normal in one patient and revealed a continuous generalized slowing and slowing of the posterior dominant rhythm in two patients. One of the latter patients had interictal epileptiform activity in the frontal and midline regions. An intermittent rhythmic slow activity of the left hemisphere with superimposed bifrontal sharp waves was noted in the fifth patient. The ictal EEG revealed profuse superimposed electromyographic (EMG) activity in all patients, making some of the EEG interpretation difficult to analyze, particularly a longitudinal bipolar montage. However, with digital manipulation of the ictal EEG data, such as changes in EEG sensitivity, application of fast frequency filters, and use of different EEG montages, it was possible to discern an ictal EEG pattern or postictal slowing following the diffuse EMG artifact in all patients. On clinical follow-up, adequate seizure control was achieved in three patients. Based on the clinical history, one patient was diagnosed with autosomal dominant nocturnal frontal lobe epilepsy. Diagnosis of hyperkinetic seizures can be difficult because of the similarity of the clinical manifestations with nonepileptic events such as certain parasomnias and pseudoseizures. Video-EEG is the most effective way of diagnosing this type of seizure.     

Nonepileptic seizures in pregnancy

The authors report five patients with recurrent psychogenic seizures (PS) during pregnancy, with multiple emergency room visits and continued intake of antiepileptic drugs obtained from various sources, despite awareness of the psychogenic nature of their attacks and the risks of antiepileptic drug use in pregnancy. These patients demonstrate that preexisting PS may persist during pregnancy, and there will be patients who continue to take antiepileptic drugs despite awareness of the risks inherent to these treatments. New-onset or persisting PS with pregnancy can be indicative of serious emotional conflicts, and the child should be considered at risk.     

Nocturnal seizures

As a subset of epilepsy, nocturnal seizures amplify one of the major problems of epilepsy in general: episodes are less likely to be directly witnessed than daytime seizures, and therefore diagnosis and characterization are more difficult. As a sleep problem, nocturnal seizures are not benign, and the resulting sleep disruption can cause daytime somnolence and concentration difficulty. This article outlines three major topics in nocturnal seizures: differential diagnosis (distinguishing between seizures and parasomnias), the effects of nocturnal seizures on sleep structure, and specific syndromes of primarily or exclusively nocturnal seizures.     

Afebrile seizures associated with minor infections: comparison with febrile seizures and unprovoked seizures

This study aimed to demonstrate that afebrile seizures provoked by minor infections constitute a distinct epilepsy syndrome different from febrile seizures and unprovoked afebrile seizures. Of the children who were admitted to hospitals for their first seizure, 1170 had febrile seizures, 286 had provoked seizures, and 125 had unprovoked afebrile seizures. Children with provoked seizures were afebrile at the time of seizure but manifested definite symptoms or signs of minor infection, for example, cough, coryza, vomiting or diarrhea, normal metabolic and cerebrospinal fluid investigations, and no obvious cause for their seizures. The average follow-up was 6.1 years. The Kaplan-Meier estimate of risk at 5 years for subsequent unprovoked afebrile seizures after a first febrile seizure, provoked seizure, or unprovoked afebrile seizure was 1.6%, 5.7%, and 65.7% respectively. All differences were statistically significant (P < 0.0014). In conclusion, afebrile seizures provoked by minor illnesses constitute a distinct type of situation-related seizures, which have not been previously described. Children with provoked seizures have a much lower risk of subsequent unprovoked afebrile seizures than patients with the first afebrile seizure. Careful inquiry for symptoms of minor infections when children present with their first afebrile seizure will help determine the risk for subsequent seizures and the need for antiepileptic drugs.     

Febrile seizures

A door-to-door survey was carried out to screen a community of 14,010 people (Parsis living in colonies in Bombay, India) for possible neurological diseases. High school graduates, social workers, and a medical student administered a screening questionnaire that, in a pilot study, had a high sensitivity for identifying febrile seizures in children under the age of 14 years. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. There were 1,581 children under the age of 14 years. Twenty-eight children (19 boys, 9 girls) suffered from febrile seizures (17.7/1,000 population). The present prevalence study is the first from India and suggests that, contrary to expectation, the frequency of febrile seizures may be no different in developing and developed countries.     

Pilomotor seizures

A 44-year-old man had frequent episodes of piloerection, or " gooseflesh ." Clinical and EEG evidence suggested that the attacks were pilomotor seizures, originating in the right temporal lobe. The cause was a glioblastoma. Paroxysmal piloerection is a rare manifestation of epilepsy.