This educational review article aims to provide information on the central nervous system (CNS) infectious and parasitic diseases that frequently cause seizures and acquired epilepsy in the ...developing world. We explain the difficulties in defining acute symptomatic seizures, which are common in patients with meningitis, viral encephalitis, malaria, and neurocysticercosis, most of which are associated with increased mortality and morbidity, including subsequent epilepsy. Geographic location determines the common causes of infectious and parasitic diseases in a particular region. Management issues encompass prompt treatment of acute symptomatic seizures and the underlying CNS infection, correction of associated predisposing factors, and decisions regarding the appropriate choice and duration of antiseizure therapy. Although healthcare provider education, to recognize and diagnose seizures and epilepsy related to these diseases, is a feasible objective to save lives, prevention of CNS infections and infestations is the only definitive way forward to reduce the burden of epilepsy in developing countries.
Abstract Cluster B personality disorders (PD), characterized as emotional instability, immaturity, lack of discipline, and rapid mood changes, have been observed among patients with juvenile ...myoclonic epilepsy (JME) and have been associated with a worse seizure outcome. Proper understanding of the neurobiology of PD associated with JME could contribute to understanding the basis for earlier and more effective interventions. In the present study, volumetric and geometric features of cortical structure were assessed through an automated cortical surface reconstruction method aiming to verify possible structural cortical alterations among patients with JME. Twenty-two patients with JME with cluster B PD, 44 patients with JME without psychiatric disorders, and 23 healthy controls were submitted to a psychiatric evaluation through SCID I and SCID II and to an MRI scan. Significant cortical alterations in mesiofrontal and frontobasal regions, as well as in other limbic and paralimbic regions, were observed mainly in patients with JME with PD. The present study adds evidence to the hypothesis of frontal and limbic involvement in the pathophysiology of cluster B PD in JME, regions linked to mood and affective regulation, as well as to impulsivity and social behavior. Moreover, a multidimensional pattern of frontal, limbic, and paralimbic changes was observed through a method of structural analysis which offers different and simultaneous geometric features, allowing the elaboration of important pathophysiologic insights about cluster B PD in JME.
Abstract Purpose To investigate if phenotypic variations have prognostic implications in juvenile myoclonic epilepsy (JME). Methods Sixty-five consecutive JME patients had video-EEG recording and ...were followed for at least three years. Reflex traits were defined as seizures and/or EEG discharges induction by eye-closure, photic stimulation, language, praxis or calculation. Patients had psychiatric evaluation and answered to STAI (State–Trait Anxiety Inventory). Seizure control was classified according to Prasad et al. (2003). Patients were divided into Group 1: good seizure control and Group 2: moderate or poor seizure control. Video-EEG/EEG evaluation was repeated in 21 patients. Results Forty of 65 (61.5%) patients reached good seizure control, 25 (38.5%) of whom became seizure free. Group 2 patients had longer epilepsy duration (13.9 ± 9.0 vs. 8.7 ± 8.2; p = 0.019); higher prevalence of the combination of all three seizure types (72.0% vs. 30.0%; p = 0.003); discharges in baseline EEG (56.0% vs. 22.5%; p = 0.008); seizure recording (68% vs. 20%; p < 0.001) and sensitivity to praxis (63.6% vs. 29.6%; p = 0.023). Compared to seizure-free patients, those with persistent seizures presented younger age at epilepsy onset (12.6 ± 3.33 years vs. 15.4 ± 5.47 years; p = 0.015); higher prevalence of personality disorders (25% vs. 4%; p = 0.029); higher scores in STAI-T (45.9 ± 11.31 vs. 36.6 ± 11.43; p = 0.011) and higher incidence of sensitivity to praxis (58.6% vs. 25.0%; p = 0.04) and to language (53.8 vs. 16.7%; p = 0.026) tasks. Repetition of EEG/video-EEG revealed a parallel evolution of reflex traits disappearance and seizure control. Discussion Clinical features and reflex traits have prognosis implications in JME.
Highlights • Clinical significance of temporopolar blurring. • Temporopolar blurring as a lateralizing sign of epileptogenic zone. • Temporopolar blurring as a marker of earlier epilepsy onset. • ...Temporopolar blurring does not influence long term post-surgical seizure outcome.
To assess self-perception of factors that precipitate or inhibit seizures in patients with juvenile myoclonic epilepsy (JME).
Thirty-six males and 39 females with JME and mean age of 25.8
±
8.7 years ...were analysed. All patients completed a standardized questionnaire to assess for the presence or absence of precipitant or inhibitory factors for their seizures in a face-to-face interview. These data were statistically analysed through logistic and linear regression models and Phi coefficient.
Ninety-two percent of the patients identified at least one precipitating factor (PF). In order of frequency the following PFs were recorded: stress (83%), sleep deprivation (77%), specific thoughts/mental concentration (23%), performance of hand activities and complex finger movements (20%), flashing lights and playing games (15%), speaking out in public (11%) and alcohol intake (11%), reading (7%), calculating and writing (5%), playing musical instruments (4%), drawing (3%), and specific types of music (1%). Menstrual cycle was the third most important PF in the women (33%). Although PFs were easily recognized, 77% of the patients stated that they were unable to avoid the occurrence of the seizures.
Structured questionnaire is useful in stimulating patients to self-report seizure precipitants. Patients with higher education and uncontrolled seizures identified them more easily. The presence of a significant number of uncommon PFs, such as mental and motor hand tasks, considered uncommon for other epileptic syndromes, suggests that the role of these factors may be under-recognized in JME.
Abstract In the literature, psychosis of epilepsy (POE) has been described as one of the most frequent psychiatric comorbidities of epilepsy, occurring particularly in association with temporal lobe ...epilepsy. However, the presence of such psychiatric disorders among patients with idiopathic generalized epilepsies has also been mentioned. In this study, we evaluated the clinical features of psychotic disorders in a series of patients with temporal lobe epilepsy related to mesial temporal sclerosis (TLE-MTS) and juvenile myoclonic epilepsy with the aim of describing and comparing the clinical patterns of the psychotic symptoms in such frequent and important epilepsy syndromes. POE occurred most frequently in patients with TLE-MTS ( P = 0.01), but no differences were observed between the groups with respect to the subtypes and core symptoms of psychoses. The clinical implications of POE in both epilepsy syndromes are discussed.
Summary
Purpose: Personality traits characterized by emotional instability and immaturity, unsteadiness, lack of discipline, hedonism, frequent and rapid mood changes, and indifference toward one’s ...disease have been associated with patients who have juvenile myoclonic epilepsy (JME). Literature data demonstrate worse seizure control and more psychosocial dysfunctions among patients with JME who have those traits. In this controlled study we performed a correlation analysis of psychiatric scores with magnetic resonance spectroscopy (MRS) values across JME patients, aiming to verify the existence of a possible relation between frontal lobe dysfunction and the prevalence of personality disorders (PDs) in JME.
Methods: Sixteen JME patients with cluster B PDs, 41 JME patients without any psychiatric disorder, and 30 healthy controls were submitted to a psychiatric evaluation and to a quantitative multivoxel MRS of thalamus; insula; cingulate gyrus; striatum; and frontal, parietal, and occipital lobes. Groups were homogeneous according to age, gender, and manual dominance. Psychiatric evaluation was performed through the Scheduled Clinical Interview for DSM‐IV, Axis I and II (SCID I and II, respectively).
Results: A significant reduction of N‐acetyl‐aspartate over creatinine (NAA/Cr) ratio was observed mainly in the left frontal lobe in the JME and PD group. In addition, a significant increase in the glutamate–glutamine over creatinine GLX/Cr ratio was also observed in this referred region in the same group.
Discussion: These data support the hypothesis that PDs in JME could represent neuronal dysfunction and possibly a more severe form of this epileptic syndrome.
Abstract We examined the relationship between presence and frequency of different types of auras and side of lesion and post surgical outcomes in 205 patients with medically intractable mesial ...temporal lobe epilepsy (MTLE) with unilateral hippocampal sclerosis (HS). With respect to the number of auras, multiple auras were not associated with side of lesion (p = 0.551). The side of HS was not associated with the type of auras reported. One hundred fifty-seven patients were operated. The occurrence of multiple auras was not associated with post-surgical outcome (p = 0.740). The presence of extratemporal auras was significantly higher in patients with poor outcome. In conclusion, this study suggests that the presence of extratemporal auras in patients with MTLE-HS possibly reflects extratemporal epileptogenicity in these patients, who otherwise showed features suggestive of TLE. Therefore, TLE-HS patients undergoing pre-surgical evaluation and presenting clinical symptoms suggestive of extratemporal involvement should be more extensively evaluated to avoid incomplete resection of the epileptogenic zone.
Abstract In this controlled study we evaluated the frequency of psychiatric disorders (PDs) in 100 patients with juvenile myoclonic epilepsy (JME) and compared it with that of 100 healthy controls ...matched with respect to age, gender, schooling, and socioeconomic status. Our aim was to quantify the frequency of PDs and evaluate the relationship between PDs and factors related to epilepsy. Subjects were evaluated with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) and Axis II disorders (SCID-II). Patients with JME presented with significantly more PDs ( P < 0.01) and psychosocial problems ( P < 0.01) than the controls. PDs were diagnosed in 49 patients with JME. Anxiety and mood disorders, present in 23 and 19 patients, respectively, were the most frequently observed. Twenty patients fulfilled criteria for personality disorders; 17 (85%) patients had cluster B personalities comprising the behavioral characteristics impulsivity, humor reactivity, emotional instability, and difficulty in accepting social rules, similar to those cited in the earliest mentioned description of this syndrome. PDs were more frequently observed in patients with higher seizure frequency ( P < 0.05).
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