Hippocampal sclerosis in women with temporal lobe epilepsy:seizure and pregnancy outcomes

Background Temporal lobe epilepsy with hippocampal sclerosis(TLE-HS)is typically resistant to pharmacological interventions;however,achieving seizure freedom is possible through surgery.Our objective was to focus on the pregnancy and seizure outcomes during pregnancy of women with TLE-HS,and aim to identify predictors of seizure control.Methods The West China Registry of Pregnancy of Women with Epilepsy(WCPR_EPi)was a monocentric prospective cohort study of women with epilepsy(WWE).We screened women with TLE-HS in this database.Their clinical profile,anti-seizure medication(ASM)use,and pregnancy outcomes were extracted from the records of the registry(2010–2023).Results Out of 2320 WWE followed up,47 pregnancies in women with TLE-HS were identified and analyzed.Seizure exacerbation occurred in 40.4%of pregnancies,and seizure freedom was present in 34.0%of these during pregnancy.Factors associated with seizure exacerbation during pregnancy was ASM non-adherence(odds ratio[OR]=7.00,95%confidence interval[CI]1.43–34.07,P=0.016).The surgery group showed a significantly higher seizure freedom rate(OR=6.87,95%CI 1.02–46.23,P=0.016)and lower rate of induced labor(0.0%vs 26.5%,P=0.047)compared to the medically-treated group alone.Caesarean section was chosen in 77.1%of cases due to seizure concerns,with comparable in epilepsy-related(n=20)and obstetric causes(n=24).No major congenital malformations were reported.Conclusions Surgical treatment before pregnancy appears to offer a higher chance of seizure freedom compared to medication alone.Most of women with TLE-HS can deliver healthy offspring regardless of suboptimal seizure control and unwarranted concerns.

Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions:a meta-analysis

To the Editor:Acute large vessel occlusion(LVO)is responsible for most acute ischemic stroke(AIS),a common cause of disability and death worldwide.Randomized controlled clinical trials(RCTs)provided evidence endorsing intravenous thrombolysis(IVT,also termed bridging therapy[IVT])and endovascular thrombectomy over IVT alone as the current standard treatment for people with LVO in the anterior circulation.[1]The current American and European guidelines recommend using IVT for all eligible individuals with LVO before direct mechanical thrombectomy(d-MT)(class of recommendation-I).Recent RCTs suggest that MT was noninferior to BT in terms of efficacy and safety,[2,3]which contradict the results from multiple meta-analyses favoring BT over d-MT.[4]The benefit of routine IVT for eligible individuals before thrombectomy has become controversial.BT is associated with complications,including the risk of vasospasm,distal emboli,or symptomatic intracranial hemorrhage.

Seizures in posterior reversible encephalopathy syndrome:blood pressure management in normotensive patients

Posterior reversible encephalopathy syndrome(PRES)is a rare clinical disease that refers to the subcortical vasogenic edema involving bilateral parieto-occipital regions,with a usually reversible syndrome when causes are eliminated or controlled.Hypertension or blood pressure fluctuations are most common causes of PRES,but other contributors like chemotherapy and autoimmune disorders have also been reported.PRES has rapid onset of symptoms.Therefore,it is of major importance to determine whether blood pressure management plays an important role in prognosis.We presented two PRES patients who developed non-convulsive seizure but had normal baseline blood pressure at the time of presence of cause.The diagnosis of PRES was made by neurologists.The patients had no history of seizure or hypertension,but during the disease course they presented with temporal elevation of blood pressure with different durations.The second patients without instant blood pressure control developed residual symptoms of seizure at 90-and 120-day follow-up.Although the exact pathophysiology of PRES remains to be fully understood,primary and secondary prolonged blood pressure fluctuations may be associated with the prognosis of this syndrome.Early blood pressure management would be critical to favorable outcome.