Electroencephalogram findings in 10 patients with post-stroke epilepsy:A retrospective study

BACKGROUND Post-stroke epilepsy is a common and easily overlooked complication of acute cerebrovascular disease.Long-term seizures can seriously affect the prognosis and quality of life of patients.Electroencephalogram(EEG)is the simplest way to diagnose epilepsy,and plays an important role in predicting seizures and guiding medication.AIM To explore the EEG characteristics of patients with post-stroke epilepsy and improve the detection rate of inter-seizure epileptiform discharges.METHODS From January 2017 to June 2020,10 patients with post-stroke epilepsy in our hospital were included.The clinical,imaging,and EEG characteristics were collected.The stroke location,seizure type,and ictal and interictal EEG manifestations of the patients with post-stroke epilepsy were then retrospectively analyzed.RESULTS In all 10 patients,epileptiform waves occurred in the side opposite to the stroke lesion during the interictal stage;these manifested as sharp wave,sharp-wave complex,or spike discharges in the anterior head lead of the side opposite to the lesion.CONCLUSION In EEG,epileptiform waves can occur in the side opposite to the stroke lesion in patients with post-stroke epilepsy.

Post-Stroke Epilepsy within a Teaching Hospital in Cotonou, Benin

Seizures occurring after stroke are risk factors for the onset of ensuing epilepsy. However, the incidence of vascular epilepsy is low. The purpose of this study was to study vascular epilepsy features in a teaching university. It was a retrospective, descriptive and analytical study, conducted from 1st January 2015 to 31st December 2016 in Cotonou Teaching Hospital (CNHU-HKM), Benin. It involved 35 patients brought together through comprehensive sampling. Vascular epilepsy hospital attendance rate was 2%. There were simple partial seizures in 74.28% of cases while cerebral ischemia was recorded in 44.44% of patients. Neurological consultation after stroke occurrence was a protective factor against the occurrence of vascular epilepsy with significant p at 0.001.

Post-stroke seizures in consecutive elderly stroke patients

This prospective study sought to investigate the clinical, radiological and electroencephalographic （EEG） characteristics of seizures in elderly stroke patients, and their outcomes. Over a 2-year study period, 158 consecutive elderly patients with stroke were examined and followed up. Of these patients, 32 （20%） developed seizures, primarily related to stroke, within a follow up period between 5 months and 2 years. Of these 32 cases, 20 experienced infarctions, and 12 experienced hemorrhages. Involvement of cortical regions was detected in most of the patients exhibiting seizures. In these patients, 44% of the lesions involved cortical areas exclusively or in addition to subcortical areas observed on computed tomography （CT） images. Twenty-five patients （78%） developed early seizures （within 2 weeks after stroke）, and half exhibited immediate post-stroke seizures. None of the patients exhibiting early onset seizures developed recurrent seizures or epilepsy, while 57% of late onset seizures （four cases） developed epilepsy. No specific EEG pattems were apparent in those who later developed epilepsy. Overall, early onset seizures after stroke were found to be relatively common, and did not affect outcome. Late onset seizures were less common, but were associated with chronic epilepsy.

Delayed post-hypoxic leukoencephalopathy following barbiturate overdose: A case report

Rationale:Delayed post-hypoxic leukoencephalopathy(DPHL)is usually an overlooked condition,which arises as a result of a multitude of reversible and irreversible conditions.Patient’s Concern:A 50-year-old female with a history of epilepsy,who developed DPHL 12 days after respiratory failure secondary to barbiturate toxicity.Diagnosis:DPHL on magnetic resonance imaging of the brain.Interventions:Mechanical ventilation was initiated for respiratory failure and hemodialysis for barbiturate toxicity.Outcomes:The patient developed akinetic mutism due to infirmity and had a residual disability,which led to permanent dependency.Lessons:The diagnosis of DPHL is often delayed or missed,given the rarity of this condition and its inconsistent clinical symptomatology.Diagnostic delay can be avoided by early recognition of the classical“delayed onset”symptoms.

Case Report of Management Problem of Juvenile Myoclonic Epilepsy

Juvenile myoclonic epilepsy (JME) is one of the most common types of idiopathic generalised epilepsy. It starts in teenage years, yet it is frequently misdiagnosed or diagnosed very late, thereby resulting in inadequate therapy plan and worsening of symptoms. Timely diagnosis of JME is crucial for the correct management of symptoms and prevention of disease development. In this case report we describe a case of a 33-year-old woman who did not receive appropriate care due to a late diagnosis of her JME condition.

Research progress on the prediction of post-stroke epilepsy

Epilepsy is a common neurological disease that not only causes difficulties in the work and life activities of patients,but also brings complex social problems.Cerebrovascular disease is currently the main cause of epilepsy in the elderly.With the increased survival rate of patients after stroke,the incidence of epilepsy after stroke has also increased.Effective prediction of epilepsy after stroke is extremely crucial for the prognosis of patients,the initiation of antiepileptic therapy and the reduction of epileptic seizures.In this review,we summarize and compare the current models for the prediction of epilepsy after stroke,including the SeLECT prediction model,Post-Stroke Epilepsy Risk Scale(PoSERS),CAVE score,electroencephalogram(EEG)prediction model,and Scandinavian Stroke Scale(SSS)score,in order to provide reference for clinical practice and future research.Prediction models can be selected based on the clinical classification of cerebrovascular events.The SeLECT score prognostic model is a better choice for ischemic stroke,especially for the exclusive prediction of mild post stroke epilepsy.The CAVE score model is suitable for intra-cerebral hemorrhage patients.It is simple and offers high correlation between the risk factors and epilepsy.The PoSERS score simultaneously predicts ischemic and hemorrhagic stroke,and is superior to other methods in specificity as well as positive and negative prediction rate.The SSS score,which only measures stroke severity,is not strictly considered as a mature predictor,but it can be used as a first step screening tool.A growing number of large studies are under the way to identify risk factors of poststroke epilepsy(PSE)and to improve the inclusion of predictive indicators.New and advanced findings by EEG recordings may further improve the prediction of PSE.

Blood and CSF biomarkers for post-stroke epilepsy:a systematic review

Post-stroke epilepsy is a common complication of ischemic stroke which adversely affects the prognosis of patients.Clinical and radiological parameters cannot adequately predict the risk.Therefore,the discovery of biomarkers is imperatively needed for predicting post-stroke epilepsy.We conducted a systematic review of diagnostic and prognostic biomarkers for post-stroke epilepsy through a comprehensive literature search in different databases.All articles that met our inclusion criteria were assessed for quality using the modified Quality Assessment of Diagnostic Accuracy Studies questionnaire.Eight eligible studies were included in this systematic review.Out of 22 assessed biomarkers,nine biomarkers showed significant association with post-stroke epilepsy.The T allele of CD40(cluster of differentiation 40)−1C/T polymorphism,the CC genotype of TRPM6(transient receptor potential cation channel subfamily M member 6)rs2274924,the allele polymorphism of MAD2(mitochondrial aldehyde dehydrogenase 2),the mRNA level of interleukin-6(IL-6),the plasma level of endostatin,and the mRNA expression of IL-1βshow a positive correlation with post-stroke epilepsy;while S100 calcium-binding protein B,heat shock 70 kDa protein-8 and neuropeptide Y are inversely associated with post-stroke epilepsy.As a small number of patients were recruited,further studies are needed to confirm their potential use for predicting post-stroke epilepsy.

Current advances on mechanisms and treatment of post-stroke seizures

Cerebrovascular diseases are among the most common causes of seizures in adults,especially in the elderly.With the increased incidence of stroke,the population with post-stroke seizures has grown,leading to the increased awareness of this disorder in the society.The most common seizure type after stroke is the focal seizure with or without evolution into bilateral convulsive seizures.Post-stroke seizures impair the quality of life,as well as the physical and mental health of those patients.Currently,the pathological and physical processes of post-stroke seizures are not quite clear yet.In this review,we summarize current advances in the pathogenesis,risk factors,and therapeutic targets of post-stroke seizures.

PACS gene family-related neurological diseases: limited genotypes and diverse phenotypes

Background The PACS gene family has been demonstrated to be related to intracellular vesicular trafficking.The phenotypic manifestations caused by the pathogenic variants of PACS include epilepsy,intellectual disability/developmental delay,and malformations,such as facial abnormalities.Methods We identified seven new cases with pathogenic or likely pathogenic PACS variants using next-generation sequencing.Detailed information obtained from these patients was analyzed along with that obtained from previously reported patients.Results With the inclusion of the newly diagnosed cases in this study,103 cases with PACS gene family-related neurological diseases were reported,of which 43 were PACS2-related cases and the remaining were PACSI-related cases.Most patients had seizures,which have been reported to be effectively controlled by several types of anti-seizure medications(ASMs).The most efficacious and frequently prescribed ASMs included sodium valproate(43.3%,13/30),oxcarbazepine/carbamazepine(26.7%,8/30),and levetiracetam(20%,6/30).Almost all patients had intellectual disability/developmental delay.The most common pathogenic missense variants were PACSI p.Arg203Trp and PACS2 p.Glu209Lys.In addition,we report a patient carrying a likely pathogenic copy number variation(CNV)(de novo heterozygous deletion of chr14:105821380-106107443,286 kilobase,destroyed part of the furin-binding region domain and the protein structure after it)with more severe and refractory late-onset epilepsy.Conclusions The clinical phenotypes of the different PACS heterozygous missense variants were similar.The pathogenic variant sites of PACSI and PACS2 were quite limited but located in different regions.A CNV destroying part of the PACS2 gene might also be pathogenic.These findings may provide an important clue for further functional studies on the pathogenic mechanism of neurological disorders related to the PACS gene family.

Abnormal gait and hypoglycorrhachia in a toddler with seizures

Introduction:Glucose transporter type 1(Glut1)deficiency syndrome is a treatable neurometabolic disorder characterized by seizures,developmental delay,and hypoglycorrhachia.Due to the rareness and non-specific clinical manifestations,it is usually mis-or underdiagnosed.Case presentation:We report the case of a toddler who presented with afebrile epileptic seizures and abnormal gait.Brain imaging and electroencephalogram were normal.Further investigation of the cerebrospinal fluid revealed hypoglycorrhachia that was the clue to the diagnosis of Glut1 deficiency syndrome and the initiation of treatment with ketogenic diet.Conclusion:Our case highlights the importance of lumbar puncture while investigating a child with epileptic seizures and abnormal gait or developmental delay,in order not to miss treatable neurometabolic conditions,such as Glut1 deficiency syndrome.