Epilepsy is a chronic brain dysfunction disease with complex and diverse causes, but 70%-80% of patients do not have obvious characteristic phenotypic symptoms. In order to provide precise treatment for epilepsy patients, research on the genetic pathogenic factors and pathogenesis of epilepsy has attracted much attention. Different types of epilepsy are constantly found to be closely related to mutations in specific genes, such as SCN1A, KCNA2, KCNT1, GABRA1, TSCs, CDKL5, and so on. Therefore, the development of broad-spectrum antiepileptic drugs is very difficult. However, plant-based drugs or functional ingredients derived from traditional medicinal herbs, such as cannabinol, aconitine, and dodecenal, will expand the development of safer and more effective anti epileptic drugs.
Currently, about one-third of patients with anti-epilepsy drug or resective surgery continue to have sezure, the mechanism remin unknown. Up to date, the main target for presurgical evaluation is to determene the EZ and SOZ. Since the early nineties of the last century network theory was introduct into neurology, provide new insights into understanding the onset, propagation and termination. Focal seizure can impact the function of whole brain, but the abnormal pattern is differet to generalized seizure. Brain network is a conception of mathematics. According to the epilepsy, network node and hub are related to the treatment. Graphy theory and connectivity are main algorithms. Understanding the mechanism of epilepsy deeply, since study the theory of epilepsy network, can improve the planning of surgery, resection epileptogenesis zone, seizure onset zone and abnormal node of hub simultaneously, increase the effect of resectiv surgery and predict the surgery outcome. Eventually, develop new drugs for correct the abnormal network and increase the effect. Nowadays, there are many algorithms for the brain network. Cooperative study by the clinicans and biophysicists instituted standard and extensively applied algorithms is the precondition of widely used clinically.
Cerebral amyloid angiopathy (CAA) is an age-dependent disease affecting older subjects. CAA is characterized by lobar intracerebral hemorrhage (ICH), lobar cerebral microbleeds (CMBs), nontraumatic subarachnoid hemorrhage, and cortical superficial siderosis (cSS), which is the main causes of spontaneous intracranial hemorrhage in the elderly. If a patient had experienced dementia, psychiatric symptoms, recurrent or multiple lobar hemorrhage, the possibility of CAA should be considered. Epilepsy can be associated with CAA. Literature studies had found that CAA-related inflammation are predisposing factors for the development of epilepsy. It is a unique subtype of CAA, which is a form of inflammation and a rare clinical manifestation of sporadic CAA. CAA-ri is a special type of central nervous system vasculitis. Once CAA patients had exhibited atypical clinical manifestations, such as headache, epilepsy, behavioral changes, focal neurological signs, consciousness impairment combined with asymmetric T2 weighted magnetic resonance imaging high signal lesions, clinicians had to consider it maybe CAA-ri. Although CAA- ri is rare, timely diagnosis is important because once seizure had occured, which may indicated the inflammation in CAA patients may had reached a very serious level. Therefore, timely identification and treatment are particularly important. Literature shows that most patients responded well to immunosuppressants. Because of its uncommon, researches on epilepsy in CAA mainly focused on case reports currently, and there were many controversies about its pathological mechanism, treatment and prognosis. This article mainly reviews the incidence rate , pathological mechanism, treatment and prognosis of epilepsy in CAA.
ObjectiveTo investigate the correlation between epileptic seizure and lipid metabolism and nutritional index in patients with glioma.Methods380 patients with glioma admitted to Linyi People's Hospital Affiliated to Shandong University from January 2017 to December 2019 were selected. According to whether the first symptom is epilepsy or not, patients with glioma were divided into epileptic group (n=72) and control group (n=308). Combined with the basic demographic information, lipid metabolism and nutrition indicators in the medical records, the two groups of patients were analyzed retrospectively.ResultsThe mean age of epileptic group was (39.38±13.40) years, and the sex ratio was 1.88∶1. The mean age of the control group was (46.25±15.97) years, and the sex ratio was 1.20∶1. Chi-square test results showed that there was a statistical correlation between gender, alcohol consumption, history of hypertension and seizures (χ2=0.813, P<0.05). The results of multiple logistic regression analysis showed that there were differences in age, weight, LDL-C and potassium between the epilepsy group and the control group (P<0.05).ConclusionMale, age, weight, LDL-C and abnormal potassium concentration are risk factors for epilepsy in patients with brain tumor, and effective prevention and treatment measures should be taken in time for patients with abnormal lipid metabolism and nutritional indicators.
ObjectiveTo reveal impairments in the perceptual networks in tuberous sclerosis complex (TSC) with epilepsy by functional connectivity MRI (fcMRI). MethodsThe fcMRI-based independent component analysis (ICA) was used to measure the resting state functional connectivity in nine TSC patients with epilepsy recruited from June 2010 to June 2012 and perceptual networks including the sensorimotor network (SMN), visual network (VN), and auditory network (AN) were investigated. The correlation between Z values in regions of interest (ROIs) and age of seizure onset or duration of epilepsy were analyzed. ResultsCompared with the controls, the TSC patients with epilepsy presented decreased functional connectivity in primary visual cortex within the VN networks and there were no increased connectivity. Increased connectivity in left middle temporal gyrus and inferior temporal gyrus was found and decreased connectivity was detected in right inferior frontal gyrus within AN networks. Decreased connectivity was detected at the right inferior frontal gyrus and the increase in connectivity was found in right thalamus within SMN netwoks. No significant correlations were found between Z values in ROIs including the primary visual cortex within the VN, right thalamus and inferior frontal gyrus within SMN, left temporal lobe and right inferior frontal gyrus within AN and the duration of the disease or the age of onset. ConclusionFhere is altered (both increased and decreased) functional connectivity in the perceptual networks of TSC patients with epilepsy. The decreased functional connectivity may reflect the dysfunction of correlative perceptual networks in TSC patients, and the increased functional connectivity may indicate the compensatory mechanism or reorganization of cortical networks. Our fcMRI study may contribute to the understanding of neuropathophysiological mechanisms underlying perceptual impairments in TSC patients with epilepsy.
ObjectiveTo evaluate the effect of the timing of surgery on treating refractory epilepsy caused by cavernomas. Method63 patients with refractory epilepsy caused by intracranial supratentorial cavernomas were retrospectively analyzed on the duration of epilepsy, epileptogenesis sitations, and epileptic seizure types. After resection surgeries of cavernomas, the surgical outcomes were compared between the patients with shorter duration of seizures and the longer ones. ResultThe durations of epilepsy were beteen 3 months and 25 years, median 4.5 years. The temporal epilepsies were 43, frontal 12, parietal 3, occipital 1, cingulate gyrus 1, and multiple lobe 3. The overall ILAE class 1 outcome was 71.4% in 63 patients at 2-year-followup, and ILAE class 1 and 2 outcome was 81.6%. The seizure free rate in the group with epilepsy duration shorter than 5 years was 92.1%, better than the 56.0% in the group with epilepsy duration longer than 5 years. ConclusionOnce the diagnosis of medical refractory epilepsy caused by cavernoma was confirmed, the early surgical operation should be considered seriously.
At present, there are few studies on patients with epilepsy (PWE) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the results of many studies are inconsistent. SARS-CoV-2 may cause new seizures through a variety of mechanisms, and the susceptibility and mortality of PWE to SARS-CoV-2 remains controversial. During the SARS-CoV-2 pandemic, anxiety, depression and other psychological problems were common among epileptic patients. Clinicians providing telemedicine, telephone chat and video call can effectively reduce the risk of psychological disorders in PWE patients. At the same time, there are many interactions between antiepileptic drugs and various antiviral drugs, which should be carefully considered when using. Considering that the research results are few and many studies contradict each other, PWE and SARS-CoV-2 deserve further exploration in future studies.
ObjectiveTo investigate the anxious level of people with epilepsy (PWE) during the outbreak of 2019 Novel Coronavirus Diseases (COVID-19) and explore the reasons of anxiety.MethodsAn internet questionnaire survey were conducted on the anxiety state of PWE and health controls (HC) aged 18 to 45 years old between Feb 9, 2020 and Feb 17, 2020. The questionnaire included demographic information, general status and the State-Trait Anxiety Inventory (STAI).ResultsIn all, 148 PWE and 300 HC were included in this study. The total SAI score (46.72±9.98 vs. 41.77±10.20, P<0.001) and the total TAI score (44.18±8.88 vs. 31.27±17.44, P<0.001) were significantly higher in PWE than in HC. PWE concerned most (69.9%) about the difficulty of obtaining antiepileptic drugs (AEDs) while HC concerned most about the lack of face masks (73.3%).ConclusionHigh anxious level in PWE during the outbreak of COVID is probably due to the difficulty of obtaining AEDs. Thus, the society should strengthen the solution of the problem of purchasing AEDs and conduct timely psychological counseling.
ObjectiveTo explore the clinical characteristics and surgical effect of low-grade glioma (LGG) secondary epilepsy.Methods45 cases of low-grade glioma secondary epilepsy were retrospectively studied during December 2010 and December 2020.There were 27 males and 18 females in this group. Their ages ranged from 10 to 69 years [mean (42.8±15.61) years]. And the illness duration ranged from 3 months to 5 years [mean (12.5±4.12) months]. The initial manifestation of all LGG was seizure attack.All the patients underwent CT and MRI examination before the operation. The LGG was located in the frontal lobe in 17 cases, temporal lobe in 8 cases, parietal lobe in 4 cases, frontal-temporal lobe in 7 cases, frontal-parietal lobe in 5 cases. Meanwhile the LGG was located in the left side in 31 cases, right side in 14 cases. The long-term video-EEG monitoring showed the epileptogenic lesion was located in the ispilateral frontal lobe in 20 cases, temporal lobe in 8 cases, frontal-temporal lobe in 12 cases, frontal-parietal lobe in 5 cases.All the patients were performed operation under the intra-operative electrocorticography (ECoG) monitoring.If necessary, enlarged epileptogenic cortical resection, cortical coagulation or MST was added.After the operation, all the patients were followed-up for half a year to 10 years [mean (4.7±1.83) years] to observe the surgical effect.Results42 cases of LGG underwent gross total resection and 3 subtotal resection intra-operatively. Anterial temporal lobectomy (ALT) was added in 19 cases whose LGG were invovled with temporal lobe.13 cases were added cortical cogulation and 5 cases MST.The post-operative pathology showed astrocytoma grade Ⅰin 20 cases, astrocytoma grade Ⅱ in 12 cases, oligodendroglioma in 11 cases and dysembryoplastic neuroepithelial tumor (DNET) in 2 cases. The post-operative follow-up showed that 30 cases lived well, 12 cases recurred and received re-operation, 3 cases died. Meanwhile, 42 cases were seizure free and 3 cases had occasional seizure attack during the follow-up.ConclusionsTo the patients with LGG secondary epilepsy, if pre-operative long-term EEG monitoring is in accordance with imaging examination, early LGG resection combined with epileptogenic lesion resection should be performed under the guidance of ECoG monitoring.And the post-operative effect is satisfactory.
ObjectiveTo explore the clinical features and surgical treatment effects of cavernous angioma in the temporal lobe secondary to epilepsy.Method38 cases of patients with cavernous angioma in the temporal lobe secondary to epilepsy were collected in Department of Neurosurgery of Wuhan Brain Hospital from Jan. 2010 to Jan. 2019. There were 17 males and 21 females, their age range from 8 to 57 years, average (40.05±14.64) years. Their illness duration ranged from 1 to 10 years, average (1.25±2.19) years. The clinical manifestations showed complex partial seizure in 7 cases, partial-secondary-generalized seizure in 8 cases, and generalized tonic-clonic seizure in 23 cases. All the patients underwent CT/MRI and long-term VEEG monitoring examination. Based on their results of clinical manifestations, combined with CT/MRI and VEEG results, all the patients underwent microsurgical cavernous angioma resection under the guidance of ECoG. If necessary, anterior temporal lobectomy or coortical coagulation should be added. The surgical effect were evaluated by Engel levels by followed up.ResultsThe postoperative pathology confirmed the diagnosis of cavernous angioma. The follow-up of 1 ~ 9 years showed the seizure disappeared in 36 cases, and bad effect in 2 cases. The total surgical effect rate was 94.74% (36/38).ConclusionsTo the patients of cavernous angioma in the temporal lobe secondary to epilepsy, the glial scar and hemosiderin sedimentary zone should be resected after resecting the lesion, and if necessary, anterior temporal lobectomy or cortical coagulation could be added. If it is difficult to locate the lesion, neuronavigation and ultrasound can be used, and the postoperative curative result is satisfactory.