ObjectiveTo investigate the classification of seizures, etiology,EEG examination, treatment and prognosis of senile epilepsy. MethodsThe clinical data of 92 senile epileptsy patients in the Second Affiliated Hospital Of Chongqing Medical University from January 2012 to September 2015 were retrospectively analyzed. ResultsFrom the selected sample,15 cases suffered from SPS(16.3%),22 cases suffered from CPS(23.9%),40 cases suffered from GTCS(43.5%),4 cases suffered from partial seizures with secondary generalization(4.3%),11 cases suffered from both partial seizures and generalized seizures(12.0%).The common causes include cerebrovascular disease (57.6%),intracranial tumors (10.9%), degenerative brain diseases (7.6%) and so on.The abnormal ratio of REEG and AEEG was 87.1% and 91.7% respectively.The ratio of typical epileptiform activity in the REEG and AEEG was 22.6% and 70.8% respectively.82 cases(89.1%) were treated with AED,but only 69 cases had been taking orally AED among the patients treated with AED.57 cases(82.6%) were on monotherapy.55 cases (67.1%) were controlled effectively with drug treatment,11 cases (13.4%) were ineffective and 16 patients (19.5%) died. Advanced age was the important cause of death. Age was positively correlated with the fatality rate.9 cases(10.9%) appeared side effect,the frequency of sleepiness was the highest among all the adverse reactions. ConclusionThe majority of senile epilepsy suffer from symptomatic epilepsy.The main cause is cerebrovascular disease,the generalized tonic-clonic seizures constituted a high proprotion in the sample.The ratio of typical epileptic discharge in the REEG was low from senile patients with epilepsy,we recommend the AEEG examination in the senile patients suspected with epilepsy. AED has excellent therapeutic effects in senile epileptics,and a few patients appeared light adverse reactions.
Objective To explore the effects of propofol and thiopental sodium injection on convulsive seizure in electro-convulsive therapy(ECT) and to provide evidence to help the selection of intravenous anaesthetics in improved ECT. Methods Total of 111 patients who received ECT in the 3rd Pepole’s Hospital of Panzhihua from July to December 2005 were divided into a thiopental sodium group (n =62) and a propofol group (n =49). These patients received intravenous anaesthesia with suxamethonium plus thiopental sodium or propofol for the implementation of ECT, respectively. The status of convulsive seizure was compared between the two groups. Results There were no significant differences between the two groups in terms of main demographic data, disease category and ECT parameters (Pgt;0.05). Motor seizure and electricity discharge lasted significantly longer in the propofol group than in the thiopental sodium group (Plt;0.01). Conclusion Thiopental sodium can increase the excitation threshold of brain cortical neurons and decrease the level of convulsive seizure induced by ECT. Propofol may decrease the excitation threshold, and increase the level of convulsive seizure under the same ECT parameters, but may have the potential to induce epileptic seizure.
ObjectiveTo investigate the clinical characteristics of epileptics with pregnancy and then provide reference for standardized management of epileptics with pregnancy. MethodsFrom June 2012 to June 2021, epileptics with pregnancy who delivered in Jinan Central Hospital were selected as the research subjects. The clinical data such as the application of Antiseizure medications (ASMs) during pregnancy, seizure frequency, pregnancy outcomes, delivery ways, offspring feeding ways and the incidence of complications were investigated and analyzed. ResultsAmong 36 epileptics with pregnancy, 20 cases (55.56%) were treated with ASMs alone, 5 cases (13.88%) were treated with combined medication, and 11 cases (30.56%) were treated without ASMs during pregnancy. 15 cases (41.67%) adhered to systematic application of ASMs, 17 cases (47.22%) did not adhere to systematic application of ASMs, and 4 cases (11.11%) had unknown medication history. The frequency of seizures increased in 5 cases, decreased in 7 cases and unchanged in 24 cases during pregnancy. Pregnancy outcomes: full-term delivery in 33 cases (91.67%), preterm delivery in 1 case (2.78%) and abortion in 2 cases (5.56%). Delivery mode: cesarean section in 31 cases (91.18%), vaginal delivery in 3 cases (8.82%). After delivery, 4 cases (11.76%) were fed with milk powder and 30 cases (88.24%) were breast-fed. Complications: There were 6 cases complicated with anemia (16.67%), 5 cases complicated with gestational hypertension (13.89%), 3 cases complicated with gestational diabetes (8.33%), 4 cases complicated with premature rupture of membranes (11.11%), 2 cases complicated with fetal growth restriction (5.56%), 2 cases complicated with oligohydramnios (5.56%), 3 cases complicated with fetal distress (8.33%) and 3 cases complicated with neonatal asphyxia (8.33%). ConclusionsThe proportion of epileptics with pregnancy who were systematically treated with ASMs was low and the seizures were poorly controlled. There is a lack of standardized management for such patients in clinical practice.
Cenobamate is one of the latest antiseizure medications (ASMs) developed for the treatment of focal onset seizures in adult patients. Cenobamate is characterized by a peculiar pharmacology. The mechanisms responsible for its anti-seizure activity include enhancement of the inactivated state of voltage-gated sodium channels with blockade of the persistent sodium current and positive allosteric modulation of GABAa receptors at a non-benzodiazepine binding site. Studies showed that cenobamate appears to be an effective treatment for focal epilepsy, showing reductions in seizure frequency, increased responder rates, and high rates of seizure freedom, and is well tolerated and safe. This article reviews the mechanism, pharmacokinetic characteristics, clinical efficacy, and safety of cenobamate as a novel anti-seizure drug
The clinical electroencephalogram (EEG) monitoring systems based on personal computer system can not meet the requirements of portability and home usage. The epilepsy patients have to be monitored in hospital for an extended period of time, which imposes a heavy burden on hospitals. In the present study, we designed a portable 16-lead networked monitoring system based on the Android smart phone. The system uses some technologies including the active electrode, the WiFi wireless transmission, the multi-scale permutation entropy (MPE) algorithm, the back-propagation (BP) neural network algorithm, etc. Moreover, the software of Android mobile application can realize the processing and analysis of EEG data, the display of EEG waveform and the alarm of epileptic seizure. The system has been tested on the mobile phones with Android 2.3 operating system or higher version and the results showed that this software ran accurately and steadily in the detection of epileptic seizure. In conclusion, this paper provides a portable and reliable solution for epileptic seizure monitoring in clinical and home applications.
In order to improve the accuracy and efficiency of automatic seizure detection, the paper proposes a method based on improved genetic algorithm optimization back propagation (IGA-BP) neural network for epilepsy diagnosis, and uses the method to achieve detection of clinical epilepsy rapidly and effectively. Firstly, the method extracted the linear and nonlinear features of the epileptic electroencephalogram (EEG) signals and used a Gaussian mixture model (GMM) to perform cluster analysis on EEG features. Next, expectation maximization (EM) algorithm was used to estimate GMM parameters to calculate the optimal parameters for the selection operator of genetic algorithm (GA). The initial weights and thresholds of the BP neural network were obtained through using the improved genetic algorithm. Finally, the optimized BP neural network is used for the classification of the epileptic EEG signals to detect the epileptic seizure automatically. Compared with the traditional genetic algorithm optimization back propagation (GA-BP), the IGA-BP neural network can improve the population convergence rate and reduce the classification error. In the process of automatic detection of epilepsy, the method improves the detection accuracy in the automatic detection of epilepsy disorders and reduced inspection time. It has important application value in the clinical diagnosis and treatment of epilepsy.
ObjectiveTo analyze the clinical features of psychogenic non-epileptic seizures (Psychogenic nonepileptic seizures, PNES) in Tibetan population in Tibet, so as to help clinicians identify the disease.MethodsRetrospective analyzed the clinical data of patients with PNES in the Department of Neurology, People's Hospital of Tibet Autonomous Region from June 2016 to December 2018.ResultsIn general clinical data, there were significant differences between male and female patients in the results of video electroencephalogram (EEG) monitoring the non-epileptic seizures (P< 0.05). There were no significant differences in mean age, mean onset time, family history of epilepsy, head injury and marital status between male and female patients (P> 0.05). There was no significant difference in symptoms between male and female, but there were differences among different age groups (P> 0.05). In the onset age, the main manifestation was young women, but there was no significant difference in the onset of PNES among different age groups.ConclusionsThere was significant differences between male and female PNES petients, but no significant differences in onset time, marriage and family history of epilepsy between the male and female patients with PNES in Tibet. The clinical manifestations of PNES were different in different ages of patients in Tibet.
ObjectiveTo explore the clinical features and EEG features of gelastic seizures, and analyze its value of lateral localization of epileptogenic area. MethodsAll patients with gelastic seizures admitted to the Sanbo Brain Hospital of Capital Medical University between January 2014 and December 2023 were reviewed and analyzed for history, symptomatology, imaging, electroencephalographic features and surgical protocols in patients who met the inclusion criteria and were followed up for at least 1 year, and surgical efficacy was assessed by using the Engel grading. ResultsA total of 51 patients with gelastic seizures were included, there were 32 (62.75%) males and 19 (37.25%) females, 21 (41.18%) with hypothalamic hamartomas (HH) and 30 (58.82%) with non-hypothalamic hamartomas. The age of onset was earlier in the HH group than in the non-HH group, with a median age of onset of 24.00 (0.00 ~ 96.00) and 78.00 (1.00 ~ 396.00) months (P<0.001). There are three types of laughter according to their characteristics: smiling or pleasant expressions, laughing out loud, crying or bitter laughter, with smiling or pleasant expressions being the most common (49.02%). Simple laughter is rare in all patients and is often accompanied by other manifestations such as autonomic symptoms, automatic movements, complex movements, and tonic seizures. Most of the HH group started with laughter whereas in the non-HH group laughter appeared mostly in the mid to late stages (P=0.007). Most of the HH group (57.14%) had preserved consciousness whereas most of the non-HH group (83.33%) had loss of consciousness (P=0.003). The interictal discharges in the HH group were mostly diffuse or multiregional, whereas those in the non-HH group were mostly regional (P=0.035). The onset of EEG during the seizure period in the HH group was mostly diffuse, whereas those in the non-HH group were mostly regional, mainly in the frontal and temporal regions, but there was no significant difference between the two groups (P=0.148). The non-HH group was mostly seen in those with definite lesions, and the most common type of lesion was FCD (focal cortical dysplasia, FCD). All patients enrolled in the group underwent surgical treatment, and stereoelectroencephalogram (SEEG) electrode implantation was performed in 13 cases in the HH group and in 17 cases in the non-HH group. 61.90% of the patients in the HH group had an Engel grade I, and 73.33% of the patients in the non-HH group had an Engel grade I. ConclusionsGelastic seizures has a complex neural network, with common causes other than hypothalamic hamartomas, and is most commonly seen in frontal or temporal lobe epilepsy, as well as in the insula or parietal lobe, with the most common type of lesion being FCD. The symptomatology, stage of onset, and electroencephalographic features of gelastic seizures can help in the differential diagnosis, and SEEG can help define the origin of the seizure and its diffusion pathway. The overall prognosis of surgical treatment was better in both the hypothalamic hamartomas and non-hypothalamic hamartomas groups.
ObjectiveTo explore and clarify the relationship between epileptic seizure and inducing factors. Avoid inducing factors and reduce epileptic seizure, so as to improve the quality of life in patients with epilepsy.MethodsClinical data of 604 patients diagnosed with epilepsy in Xijing Hospital of Air Force Military Medical University from January 2018 to January 2019 were collected. The clinical data of patients with epilepsy were followed up 6 months.ResultsAmong the 604 patients, 318 (52.6%) were seizure-free in the last 6 months, 286 (47.4%) had seizures. 169 (59.1%) had seizures with at least one inducing factor. Common inducing factors: 123 cases of sleep disorder (72.8%), 114 cases of emotion changes (67.5%), 87 cases of irregular medication (51.5%), 97 cases of diet related (57.4%), 33 cases of menstruation and pregnancy (19.5%), etc. Using the χ2 test, seizures with age, gender differences had no statistical significance (P > 0.05), but seizure type was statistically different between inducing factors. In generalized seizures, tonic-clonic seizures associated with sleep deprivation (χ2= 0.189), absence seizures and anger (χ2= 0.237), pressure (χ2= 0.203), irregular life (χ2= 0.214). In the focal seizures, focal motor seizures was correlated with coffee consumption (χ2=0.145), focal sensory seizures with cold (χ2=0.235), electronic equipment use (χ2 =0.153), satiety (χ2 =0.257). Complex partial seizures was correlated with anger (χ2 =0.229), stress (χ2 =0.187), and cold (χ2 =0.198). The secondarily generalized seizures was correlated with drug missing (χ2 =0.231), sleep deprivation (χ2 =0.158), stress (χ2 =0.161), cold (χ2 =0.263), satiety (χ2 =0.182). Among the inducing factors, sleep deprivation was correlated with anger (χ2 =0.167), fatigue (χ2 =0.283), and stress (χ2 =0.230).ConclusionsEpileptic seizure were usually induced by a variety of factors. Generalized seizures were associated with sleep disorders, emotional changes, stress, irregular life, etc. While focal seizures were associated with stress, emotional changes, sleep disorders, cold, satiety, etc. An analysis of the triggers found that sleep deprivation was associated with anger, fatigue, and stress. Therefore, to clarify the inducing factors of epileptic seizure, avoid the inducing factors as much as possible, reduce the harm caused by seizures, and improve the quality of life of patients.
Perampanel (PER) is a third-generation novel anti-seizure drug, a postsynaptic neuronal (α-Amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid, AMPA) receptor antagonist, which effectively controls seizures by inhibiting glutamate-induced neurological hypertransmission. PER can not only be used for the addition of focal epilepsy 4 years old and above, but also monotherapy for children (≥ 4 years old) for the treatment of focal epilepsy patients, its efficacy and safety is relatively good, has been used clinically in many countries, the article overviewed the pharmacokinetics, mechanism, and the addition and monotherapy in different epilepsy types of childhood epilepsy and other aspects, in order to provide a reference for clinical medication, and provide individualized treatment for children with epilepsy.