ObjectiveConstructing a prediction model for seizures after stroke, and exploring the risk factors that lead to seizures after stroke. MethodsA retrospective analysis was conducted on 1 741 patients with stroke admitted to People's Hospital of Zhongjiang from July 2020 to September 2022 who met the inclusion and exclusion criteria. These patients were followed up for one year after the occurrence of stroke to observe whether they experienced seizures. Patient data such as gender, age, diagnosis, National Institute of Health Stroke Scale (NIHSS) score, Activity of daily living (ADL) score, laboratory tests, and imaging examination data were recorded. Taking the occurrence of seizures as the outcome, an analysis was conducted on the above data. The Least absolute shrinkage and selection operator (LASSO) regression analysis was used to screen predictive variables, and multivariate Logistic regression analysis was performed. Subsequently, the data were randomly divided into a training set and a validation set in a 7:3 ratio. Construct prediction model, calculate the C-index, draw nomogram, calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) to evaluate the model's performance and clinical application value. ResultsThrough LASSO regression, nine non-zero coefficient predictive variables were identified: NIHSS score, homocysteine (Hcy), aspartate aminotransferase (AST), platelet count, hyperuricemia, hyponatremia, frontal lobe lesions, temporal lobe lesions, and pons lesions. Multivariate logistic regression analysis revealed that NIHSS score, Hcy, hyperuricemia, hyponatremia, and pons lesions were positively correlated with seizures after stroke, while AST and platelet count were negatively correlated with seizures after stroke. A nomogram for predicting seizures after stroke was established. The C-index of the training set and validation set were 0.854 [95%CI (0.841, 0.947)] and 0.838 [95%CI (0.800, 0.988)], respectively. The areas under the ROC curves were 0.842 [95%CI (0.777, 0.899)] and 0.829 [95%CI (0.694, 0.936)] respectively. Conclusion These nine variables can be used to predict seizures after stroke, and they provide new insights into its risk factors.
ObjectiveTo retrospectively study the acute epileptic seizures of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR)and anti-leucine-rich glioma-inactivated 1(anti-LGI1)encephalitis. The characteristics and short-term prognosis provide reference for early clinical diagnosis and treatment.MethodsThe patients with anti-NMDAR and anti-LGI1 encephalitis who were admitted to the Department of Neurology of Sichuan Provincial People’s Hospital from January 2018 to June 2020 were continuously included. The general information, clinical manifestations, acute seizures and types of seizures were reviewed and analyzed.To evaluate the difference between the characteristics of two kinds of autoimmune encephalitis in the acute phase of seizures and the short-term prognosis.ResultsA total of 75 patients with anti-NMDAR encephalitis and anti-LGI1 encephalitis (41 males and 34 females) were included, of which average ages are(32.8±17.9)years, average courses are(1.8±1.1)months.59 and 16 are respectively positive for anti-NMDAR and anti-LGI1 antibodies, respectively. Of the 75 cases, 56 cases (74.7%) had seizures in the acute phase. Among the 56 cases of seizures, 38 cases (67.8%) were accompanied by disturbances of consciousness, 5 cases (8.9%) of autonomic dysfunction, and 24 cases of decreased oxygenation capacity. (42.9%) and 20 cases (35.7%) who were admitted to NICU, there was a significant statistical difference compared with the seizure-free group (P<0.05). The median age of anti-NMDAR encephalitis in the acute stage of seizures was 23 years, and that of anti-LGI1 encephalitis was 56.5 years (P<0.05). Anti-NMDAR encephalitis and anti-LGI1 encephalitis are common in the acute phase of epileptic seizures (55.9%vs.53.8%). Anti-NMDAR encephalitis has more frequent seizures and status epilepticus in the acute phase (P<0.05). After early and rational use of anti-epileptic drugs(AEDs) and immunotherapy and other symptomatic and supportive treatments, 70% of 56 patients were effectively controlled for seizure. Follow-up 3 months later, 18 patients (32.1%) stopped using anti-epileptic drugs (AEDs), While 30 patients (53.5%) continued to receive AEDs treatment, of which 25 patients (44.6%) had no seizures.ConclusionBoth anti-NMDAR encephalitis and anti-LGI1 encephalitis have a higher risk of seizures in the acute phase. Patients with seizures are more likely to have disturbances in consciousness, decreased oxygenation capacity, and higher rates of admission to NICU. Anti-NMDAR encephalitis is more common in young people around 30 years old, and anti-LGI1 encephalitis is more likely to develop around 60 years old. Patients with anti-NMDAR encephalitis are more likely to have abnormal electroencephalograms, have a longer average hospital stay, and are more likely to have recurrent seizures and status epilepticus in the acute phase. After timely diagnosis and intervention treatment, most patients' seizures can be well controlled. After the acute phase, AEDs can be withdrawed in one third of patients.
Objective To explore the damage, damage model and influence factors of the empathy ability on patients with epilepsy by the Chinese version of interpersonal reaction index scale (IRI-C). Methods Eighty-eight non-symptomatic epilepsy patients who were from the First Affiliated Hospital of Dalian Medical University and 100 healthy controls were included in the study from March 2015 to January 2016. Patients with serious cognitive impairment and severe anxiety or depression were ruled out through neural psychology background screening (Montreal Cognitive Assessment, Hamilton anxiety and depression scale) due to their influence on empathy scores. Thereafter the empathy ability was compared between epilepsy patients and healthy controls using the IRI-C, and the effect of seizure type on empathy ability was analyzed. According to the epileptic seizure types of generalized tonic-clonic seizure (GTCS), patients were divided into 3 groups: non-GTCS group (simple or complex partial seizure, n=17), pure GTCS group (only primary GTCS attack, n=23) and SGS group (partial onset secondary GTCS,n=48). The control group included 100 healthy participants. In order to ensure the balance of sample size, 30 samples are randomly selected from SGS and control groups respectively for statistical analysis. Then patients were divided in two groups according to whether he/she has complex partial seizure (CPS), and 30 patients in each group. Statistical analysis was performed using SPSS18.0 software package. Results ① The total IRI-C Empathy scores, Cognitive empathy (CE) and two factors of the patients in epilepsy group were lower than those in control group (P<0.05), while there was no statistical difference in Emotional Empathy (EE) and two factors between groups (P>0.05). ②ANOVA showed the points of CE (include two factors) and total scores of empathy mean different between the four groups (P<0.05), and EE (include two factors) scores were no statistically significant differences between the four groups (P>0.05). The CE scores were differences between the GTCS group, pure GTCS group and SGS group. The scores of the perspective-taking was statistically significant differences (P<0.05) between the pure GTCS group and the SGS group. The scores of perspective-taking of SGS group were lower than the other groups (P<0.05) . In other words, the scores of the perspective-taking of SGS group were lower than those of the other three groups, and the CE scores were lower than the GTCS group and the control group. ③ The opinion selection, imagination, CE and total empathy score of CPS group were all worse than that of non-CPS group (P<0.05). Conclusions The empathy ability of epilepsy patientswere impaired in CE, but reserved in EE Epileptic subtype CPS and GTCS were risk factors of the decline in empathy ability in epilepsy patients.
ObjectiveExploring the influencing factors of acute phase (≤ 21 days) seizures and epilepsy in patients with Herpes simplex virus encephalitis (HSE) in our hospital, including emergency and inpatient wards, mainly from the perspective of the number of mNGS of Herpes simplex virus (HSV) in cerebrospinal fluid. MethodsFrom January to Octomber 2023, 28 emergency and inpatient patients in our hospital were collected, excepted clinical datas were not detailed. In the end, 24 patients with HSE diagnosed were included in the study, and their clinical datas were collected, including age, gender, acute encephalitis syndrome, the form of the seizure and the number of seizures, time of lumbar puncture, and various indicators of cerebrospinal fluid [pressure, protein, cell count (mononuclear and multinucleated cells), metagenomic Next-generation sequencing (mNGS), neural autoantibodied associated with autoimmune encephalitis], electroencephalogram, cranial imaging examination reports, and treatment plans.ResultsA total of 24 patients were enrolled, including 9 patients with a history of hypertension and 4 patients with a history of diabetes. There were 18 males and 6 females, with an average age of (53.17±17.19) years. The maximum age was 73 years old, and the minimum age was 21 years old. Among the 24 patients, one patient first presented to the local hospital and then transferred to our hospital for lumbar puncture, so the time from the onset of the disease to lumbar puncture was 30 days, and the other patient’s family members refused to complete lumbar puncture at first,so the time of lumbar puncture was 14 days from the onset of the disease. The remaining 22 patients were all completed lumbar puncture within 7 days of onset, and all emergency patients completed lumbar puncture within 24 hours of admission to the Emergency Department. mNGS results: 23 cases were HSV-1, and the remaining 1 case was HSV- 2. There were a total of 6 cases of seizures and epilepy in the acute phase (≤21 days), with focal or generalized seizures or epileptic status as the main form, and 2 cases of seizures occurred. Among these 8 patients, 5 showed lesions in the frontal and temporal lobes on enhanced cranial MRI, while the other 3 showed no specific features. At the same time, mNGS of cerebrospinal fluid suggested that the sequence number of HSV was greater than 3 000 was related with seizures and epilepsy with acute HSE. Conclusion Seizures and epileysy in acute HSE were related with the presences of intracranial cortical involvement,and the number of viral sequences in mNGS was closely related to acute phase seizures and epilepsy.
ObjectiveTo analyse the seizure semeiology of MRI negative insular epilepsy.MethodsA case of patient with insular epilepsy who presented in Epileptic Center, Guangdong 999 Brain Hospital was collected. Related literatures were thoroughly reviewed.ResultsThe patient was diagnosised as insular epilepsy by SEEG and postoperative pathology reported focal cortical dysplasia Ib.ConclusionsThe insula lobe is a part of the limbic system, and the seizure semeiology in insular epilepsy is varied. Seizure semeiology analysis is particularly important in the evaluation of presurgical especially in a MRI negative case. In this paper, we summarized the semeiology characteristics of various parts of insula lobe, and provided some references for the diagnosis and treatment of insular epilepsy.
ObjectiveTo explore the prognostic value of normal 24 hour video electroencephalography (VEEG) with different frequency on antiepileptic drugs (AEDs) withdrawal in cryptogenic epilepsy patients with three years seizure-free. MethodsA retrospective study was conducted in the Neurology outpatient and the Epilepsy Center of Xi Jing Hospital. The subject who had been seizure free more than 3 years were divided into continual normal twice group and once group according to the nomal frequence of 24 hour VEEG before discontinuation from January 2013 to December 2014, and then followed up to replase or to December 2015. The recurrence and cumulative recurrence rate of the two group after withdrawal AEDs were compared with chi-square or Fisher's exact test and Kaplan-Meier survival curve. A Cox proportional hazard model was used for multivariate analysis to identify the risk factors for seizure recurrence after univariate analysis. P value < 0.05 was considered significant, and all P values were two-tailed. Results95 epilepsy patients with cause unknown between 9 to 45 years old were recruited (63 in normal twice group and 32 in normal once group). The cumulated recurrence rates in continual two normal VEEG group vs one normal VEEG group were 4.8% vs 21.9% (P=0.028), 4.8% vs 25% (P=0.006) and 7.9% vs 25%(P=0.03) at 18 months, 24 months and endpoint following AEDs withdrawal and there was statistically difference between the two groups. Factors associated with increased risk were adolescent onset epilepsy (HR=2.404), history of withdrawal recurrence (HR=7.186) and abnormal VEEG (epileptic-form discharge) (HR=8.222) during or after withdrawal AEDs. The recurrence rate of each group in which abnormal VEEG vs unchanged VEEG during or after withdrawal AEDs was respectively 100% vs 4.92% (P=0.005), 80% vs 19.23%(P=0.009). ConclusionsContinual normal 24h VEEG twice before withdrawal AEDs had higher predicting value of seizure recurrence and it could guide physicians to make the withdrawal decision. Epileptic patients with adolescent onset epilepsy, history of seizure recurrence and abnormal VEEG (epileptic-form discharge) during or after withdrawal AEDs had high risk of replase, especially patients with the presence of VEEG abnormalities is associated with a high probability of seizures occurring. Discontinuate AEDs should be cautious.
ObjectiveWe report a special case to explain seizure semiology and epileptogenic network of seizure arising from ventral motor cortex, and to explore Focal cortical dycplasia (FCD) features on MR of epileptic patients with DEPDC5 mutation.MethodsA drug-resistant focal epilepsy patient with DEPDC5 mutation was underwent a detailed presurgical evaluation. The epileptogenic area(EA) was localized with SEEG and removed later by surgery. Related literatures were thoroughly reviewed.ResultsSubtle FCD of ventral branch of inferior precentral sulcus(IPv) on MR(1.5T) was noticed. With SEEG recording, seizure onset zone was detected on IPv with the probable lesion, early spreading to anterior insula, central operculum and ventral precentral gyrus. According to the architectures of ventral motor trend, seizure semiology with evolution from contralateral dystonia to ipsilateral chorea movement could be better comprehended. Seizure was controlled after totally resection on the sites of IPv, anterior insula, and central operculum. Pathological change was FCD type I. Other literatures reported that DEPDC5 mutation related FCD may be located in motor system, and seizure onset could also be in anterior insula cortex besides motor cortex in other SEEG cases.ConclusionsEarly contralateral dystonia and chorea movement could be definite figures of seizure arising from inferior precentral sulcus; DEPDC5 mutation maybe a clue to find subtle FCD in motor cortex.
ObjectiveImpaired breathing during and following seizures is an important cause of sudden unexpected death in epilepsy (SUDEP), but the network mechanisms by which seizures impair breathing have not been thoroughly investigated. Progress would be greatly facilitated by a model in which breathing could be investigated during seizures in a controlled setting. MethodRecent work with an acute Long-Evans rat model of limbic seizures has demonstrated that depression of brainstem arousal systems may be critical for impaired consciousness during and after seizures. We now utilize the same rat model to investigate breathing during partial seizures with secondary generalization. ResultBreathing is markedly impaired during seizures(P < 0.05;n=21), and that the severity of breathing impairment is strongly correlated with the extent of seizure propagation (Pearson R=-0.73;P < 0.001;n=30). ConclusionSeizure propagation could increase the severity of breathing impairment caused by seizures. Based on these results, we suggest that this animal model would help us to improve understanding of pathways involved in impairment of breathing caused by seizures and this is an important initial step in addressing this significant cause of SUDEP in people living with epilepsy.
Objective To explore the efficacy of low to moderate doses of levetiracetam in adult patients with newly diagnosed partial epilepsy and possible predictors for poor treatment response. Methods We retrospectively analyzed the clinical data of patients treated in West China Hospital from March 2011 to December 2015 whose clinical data were input into the Epilepsy database. Patients with newly diagnosed partial epilepsy and whose initial anti-epileptic drug was levetiracetam were screened out for this study. Their clinical data, especially responses to the treatment of levetiracetam were reviewed. Results Ninety-six patients were included in this study. Seventy-one of them achieved seizure-free for a complete year after initial treatment of levetiracetam. Forty-eight patients (50.0%) achieved seizure-free with levetiracetam monotherapy; 23 patients (24.0%) achieved seizure-free for one year with levetiracetam combination therapy. Sixty-nine (97.2%) of the 71 patients achieved seizure-free with low to moderate doses of levetiracetam (500 to 1 500 mg/day), with or without combination of other antiepileptic drugs. High baseline seizure frequency before initial therapy was an independent predictor of poor levetiracetam response in this multivariate logistic regression mode (P=0.019). Conclusions Low to moderate levetiracetam is both effective and well tolerated in newly diagnosed partial epilepsy patients. High baseline seizure frequency before initial therapy is an independent predictor of poor levetiracetam response.
ObjectiveTo investigate the clinical electrophysiological characteristics of Cyclin-dependent kinase-like 5 gene induced developmental epileptic encephalopathy (CDKL5-DEE). MethodsThe clinical data and series of video EEGs of children with CDKL5-associated developmental epileptic encephalopathy (CDKL5-DEE) who were admitted to the Children’s Medical Center of Peking University First Hospital from June 2016 to May 2024 were retrospectively analyzed. Results A total of 16 patients with CDKL5-DEE were enrolled, including 13 females and 3 males. All patients had de novo variants of CDKL5 gene, including 6 cases of missense variants, 5 cases of frameshift variants, 4 cases of nonsense variants, and 1 case of large fragment deletion. The age of onset was 8 days (d) after birth ~1 year (y) and 10 months (m), and the median age was (85.94±95.76) days. Types of seizures at onset: 4 cases of tonic seizures [age of onset 10~52 days, median age (25.5±15.84) days]; There were 5 cases of focal seizures [age of onset 8 d~8 m, median age (77.76±85.97) d]. There were 4 cases of epileptic spasmodic seizures [age of onset 3 m~1 y 10 m, median age (6.25±3.49) m]; There were 2 cases of bilateral tonic-clonic seizures [age of onset 30~40 days, median age (35.00±5.00) days]; focal concurrent epileptic spasm seizures 1 case (age of onset 2 m). A total of 59 VEEG sessions were performed in the pediatric EEG room of Peking University First Hospital for 4 hours. All the results were abnormal, including 26 normal background, 25 slow rhythm difference with background, and 8 no background. The interictal was 16 posterior or focal discharges, 19 multifocal discharges, 17 generalized or accompanied by focal/multifocal discharges, and 7 hypsarrhythmia; The ictal was 33 epileptic seizures, 6 myoclonic seizures, 5 focal seizures, 2 tonic-clonic seizures, 2 atypical absence seizures, 2 tonic seizures, 1 myoclonic sequential focal seizure, 1 focal sequential epileptic spasm, and 1 hypermotor-tonic-spasms. The background of patients within 6 months of age was normal, and the background abnormality increased significantly with age. generalized discharges are evident after 2 years of age between seizures. Conclusion CDKL5-DEE seizures have an early onset and are refractory to medications. Epileptic spasms are the most common type of seizure in every patient and long-lasting, with generalized seizures increasing markedly with age. EEG is characterized by a normal background within 6 months. With the increase of age, the background and interictal discharges have a tendency to deteriorate.