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.
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.
Intracranial electrographic recording, especially stereoencephalography (SEEG), remains the gold standard for preoperative localization in epilepsy patients. However, this method is invasive and has low spatial resolution. In 1982, magnetoencephalography (MEG) began to be used in epilepsy clinics. MEG is not affected by the skull and scalp, can provide signals with high temporal and spatial resolution, and can be used to determine the epiletogensis zone (EZ) and the seizure onset zone (SOZ). Magnetic source imaging (MSI) is a method that superimposes the MEG data on a magnetic resonance image (MRI) and has become a major tool for presurgical localization. The applicability of MEG data has been largely improved by the development of many post-MRI processing methods in the last 20 years. In terms of the sensitivity of localization, MEG is superior to VEEG, MRI, PET and SPECT, despite inferiority to SEEG. MEG can also assist in the intracranial placement of electrodes and improve preoperative planning. Limitations of MEG include high cost, insensitivity to radiation source, and difficulty in locating deep EZ in the medial regions of the brain. These limitations could be overcome by new generations of equipment and improvement of algorithmics.
ObjectiveTo preliminarily explore the damage effect of stereo electroencephalogram-guided radiofrequency thermocoagulation after increasing the number of electrodes in the epileptic foci.MethodsEight cases were included from 42 patients requiring SEEG from the Department of Neurosurgery of the Second Hospital of Lanzhou University during June 2017 to Jan. 2019, of which 6 cases were hypothetical epileptogenic foci located in the functional area or deep in the epileptogenic foci that could not be surgically removed, 2 patients who were unwilling to undergo craniotomy; added hypothetical epileptic foci Electrodes, the number of implanted electrodes exceeds the number of electrodes needed to locate the epileptic foci. After radiofrequency thermocoagulation damages the epileptogenic foci, the therapeutic effect is analyzed.ResultsIn 8 patients, the number of implanted electrodes increased from 1 ~ 6, with an average of (4±2.2), and the number of thermosetting points increased by 2 ~ 10, with an average of (7±3.1); follow-up (9±3.2) months, Epilepsy control status: 3 cases of Engel Ⅰ, 3 cases of Engel Ⅱ, 2 cases of Engel Ⅲ; 8 cases of epileptic seizure frequency decreased≥50%. There was a statistically significant difference in the frequency of attacks before and after thermocoagulation (P<0.05).ConclusionsIncreasing the lesion volume of the epileptic foci can obviously improve the efficacy of epilepsy. SEEG-guided radiofrequency thermocoagulation is an effective supplementary method for classical resection.
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.
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.
ObjectiveTo analyze the risk factors for seizures in patients with autoimmune encephalitis (AE) and to assess their predictive value for seizures. MethodsSeventy-four patients with AE from the First Affiliated Hospital of Xinjiang Medical University from January 2016 to March 2023 were collected and divided into seizure group (56 cases) and non-seizure group (18 cases), comparing the general clinical information, laboratory tests and imaging examinations and other related data of the two groups. The risk factors for seizures in AE patients were analyzed by multifactorial logistic regression, and their predictive value was assessed by receiver operating characteristic (ROC) curves. ResultsThe seizure group had a higher proportion of acute onset conditions in the underlying demographics compared with the non-seizure group (P<0.05). Laboratory data showed statistically significant differences in neutrophil count, calcitoninogen, lactate dehydrogenase, C-reactive protein, homocysteine, and interleukin-6 compared between the two groups (all P<0.05). Multi-factor logistic regression analysis of the above differential indicators showed that increased C-reactive protein [Odds ratio (OR)=4.621, 95% CI (1.123, 19.011), P=0.034], high homocysteine [OR=12.309, 95CI (2.217, 68.340), P=0.004] and onset of disease [OR=4.918, 95% CI (1.254, 19.228), P=0.022] were risk factors for seizures in AE patients, and the area under the ROC curve for the combination of the three indicators to predict seizures in AE patients was 0.856 [95% CI (0.746, 0.966)], with a sensitivity of 73.2% and a specificity of 83.3%. ConclusionHigh C-reactive protein, high homocysteine and acute onset are independent risk factors for seizures in patients with AE, and the combination of the three indices can better predict seizure status in patients.
ObjectiveThe purpose of this study was to investigate the autoimmune encephalitis (AE) seizure types and EEG characteristics and the value of diagnosis. MethodsFifteen AE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from November 2012 to July 2014. Data from their clinical manifestations, seizure types, EEG characteristics and laboratory investigation were analyzed. ResultA total of 15 patients, 5 males and 10 females, aged 19-75 years were included. Eight cases of anti-NMDA receptor encephalitis, five cases of LGI1 receptor encephalitis and two cases of anti-Hu antibody encephalitis were diagnosed clinically.①Anti-NMDA receptor encephalitis:seven patients had seizures, which inclued complex partial seizure, generalized tonic-clonic seizure, simple partial seizure and status epilepticus.Three patients had extreme delta brush.②LGI1 receptor encephalitis:two cases had seizures, while four cases with FBDS. Sharp and slow waves with irregular delta waves appeared in bilateral temporal areas in EEG of three cases, while one case showed clinical seizure. Two cases detected "limb shaking and others" attack, but the corresponding EEG showed no abnormalities.③Anti-Hu antibody encephalitis:one case showed seizures, the EEG showed a lot of sharp and slow waves with irregular delta waves in bilateral temporal areas, while one case showed sharp and slow waves. ConclusionAnti-NMDA receptor encephalitis can present with various types of seizures and non-convulsive status epilepticus, interictal extreme delta brush is more specific. It has important value. LGI1 receptor encephalitis is characterized by FBDS, it has important clinical significance.Anti-Hu antibody encephalitis lesions diffuse distribution, clinical manifestations are different. It may be associated with seizures, seizure types are not-specific.It may have slow waves or sharp and slow waves.
Patients with autoimmune encephalitis are mainly characterized by behavioral, mental and motor abnormalities, neurological dysfunction, memory deficits and seizures. Different antibody types of autoimmune encephalitis its pathogenesis, clinical characteristics are different, in recent years found immune related epilepsy is closely related to autoimmune encephalitis, based on autoimmune encephalitis type is more, we choose more common autoimmune encephalitis, expounds its characteristics, to help clinical diagnosis.
Objective To preliminarily analyse the phenomenon of the first seizure in patients with epilepsy while driving a motor vehicle, and discuss its harms and possible coping strategies. Methods The first seizure while driving a motor vehicle was investigated among epilepsy patients who attended the First Affiliated Hospital of Soochow University from June 2020 to March 2023. Results A total of five patients had their first seizure while driving a motor vehicle, all causing traffic accidents. One patient had a generalized tonic-clonic seizure with a first epileptic seizure, two had focal seizures with impaired consciousness that progressed to generalized seizures, and two had focal seizures with impaired awareness. One of the patients caused a fatal traffic accident, leading to the death of another person who riding the electric bicycle. In this case, the patient's driving license was revoked. The other four patients continued to drive after the first seizure. One patient terminated driving 5 months after the diagnosis of epilepsy. Two patients drove less since then, and one patient continued driving as before. Two patients experienced seizures again while driving, and one of them coincidentally had his second seizure while driving. Conclusions The first seizure while driving may not be uncommon, reflecting the severity of epilepsy and driving, in which traffic accidents can be fatal. People with epilepsy are currently prohibited from driving in China. After the first seizure, patients should immediately stop driving and go to see an epileptologist, avoiding further endangering themselves and the public.