The role of picornavirus infection in epileptogenesis

Picornaviridae are a family of small positive-strand RNA viruses,and transmitted via the respiratory or fecal-oral route.The neurotropic picornaviruses can induce acute or late recurrent seizures following central nervous system infection,by infecting the peripheral nerve,crossing the blood-brain barrier and migrating in the Trojan-horse method.Theiler’s murine encephalomyelitis virus(TMEV),as a member of Picornaviridae family,can cause encephalitis,leading to chronic spontaneous seizures.TMEV-infected C57BL/6 mice have been used as an animal model for exploring the mechanism of epileptogenesis and assessing new antiepileptic drugs.Astrogliosis,neuronal death and microglial recruitment have been detected in the hippocampus following the picornaviruse-induced encephalitis.The macrophages,monocytes,neutrophils,as well as IL-6 and TNF-αreleased by them,play an important role in the epileptogenesis.In this review,we summarize the clinical characteristics of picornavirus infection,and the immunopathology involved in the TMEV-induced epilepsy.

Emerging personalized virtual brain models: next-generation resection neurosurgery for drug-resistant epilepsy?

Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine and Epilepsia.This method involves creating an individualized virtual brain model based on computational modelling,which can facilitate clinical decision-making by estimating the epileptogenic zone and performing the virtual surgery.Here,we summarize brief workflow,strengths,and limitations of VEP,as well as its performance in a retrospective study of 53 patients with drug-resistant focal epilepsy who underwent stereoelectroencephalography.A large-scale clinical trial(NCT03643016)is underway to further assess VEP,which is expected to enroll 356 patients prospectively.As supporting evidence accumulates,the clinical application of VEP has the potential to improve clinical practice,leading to better outcomes and qualities of life of patients.

Heterogeneity of clinical features, EEG and brain imaging findings in anti‑leucine‑rich glioma‑inactivated protein 1 autoimmune encephalitis: a retrospective case series study and review of the literature

Background Anti-leucine-rich glioma-inactivated 1(LGI-1)autoimmune encephalitis(AE),characterized by rapid decline of memory,seizures,and neuropsychiatric abnormalities,is a rare but devastating disorder.Early diagnosis and treatment are essential to prevent long-term sequelae.In this report,we provide a detailed description of clinical characteristics,laboratory test results,imaging,and electroencephalography(EEG)findings,as well as treatment responses of eight patients with anti-LGI-1 AE treated at our center.Case presentation At the onset,all eight patients presented with confusion/memory deterioration,seizures(including faciobrachial dystonic seizures or other types of seizure),and behavioral changes such as hallucination,paranoia,and anxiety.Four patients were found with severe hyponatremia.Anti-LGI1 antibodies were detected in the cerebrospinal fluid and/or serum of all patients.For patients with faciobrachial dystonic seizures,no discernible scalp EEG change was detected,while EEG recording of patients experiencing other types of seizure showed focal slowing,focal epileptiform discharges,and focal onset seizures.All patients showed abnormal brain magnetic resonance imaging signals,mainly involving the mesial temporal lobe and the hippocampus.In addition,one patient also experienced fulminant cerebral edema during the acute phase of the illness.All patients received immunotherapy and anti-seizure medications and achieved good seizure control.Nevertheless,these patients continued to experience cognitive impairment during their long-term follow-ups.Conclusions The care of anti-LGI1 AE patients requires rapid evaluation,prompt initiation of immunotherapy,and long-term follow-up.The long-term presence of neurocognitive complications observed in these patients underline the importance of developing reliable biomarkers that can distinguish between different subtypes of this disease with heterogeneous clinico-electrographico-radiological features.Further research is needed to understand the molecular mechanisms underlying the heterogeneity,in order to facilitate development of more effective treatments for anti-LGI1 AE.

Expert consensus on clinical applications of high-frequency oscillations in epilepsy

Studies in animal models of epilepsy and pre-surgical patients have unanimously found a strong correlation between high-frequency oscillations(HFOs,>80 Hz)and the epileptogenic zone,suggesting that HFOs can be a potential biomarker of epileptogenicity and epileptogenesis.This consensus includes the definition and standard detection techniques of HFOs,the localizing value of pathological HFOs for epileptic foci,and different ways to distinguish physiological from epileptic HFOs.The latest clinical applications of HFOs in epilepsy and the related findings are also discussed.HFOs will advance our understanding of the pathophysiology of epilepsy.

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.

Genetic mechanisms in generalized epilepsies

The genetic generalized epilepsies(GGEs)have been proved to generate from genetic impact by twin studies and family studies.The genetic mechanisms of generalized epilepsies are always updating over time.Although the genetics of GGE is complex,there are always new susceptibility genes coming up as well as copy number variations which can lead to important breakthroughs in exploring the problem.At the same time,the development of ClinGen fades out some of the candidate genes.This means we have to fgure out what accounts for a reliable gene for GGE,in another word,which gene has sufcient evidence for GGE.This will improve our understanding of the genetic mechanisms of GGE.In this review,important up-to-date genetic mechanisms of GGE were discussed.

Development from recurrent anti‑N‑methyl‑D‑aspartate receptor encephalitis with seizures as the first symptom to autoimmune‑associated epilepsy: a case report

Background Anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis is a novel autoimmune encephalitis(AE)first identified in 2007.It provides a new direction for clinicians when encountering unexplained symptoms such as seizures,psychotic behavioral abnormalities,speech disorders,and involuntary movements.Most patients have a good prognosis after immunotherapy,but some may experience relapses.Case presentation We report a Chinese female patient diagnosed with anti-NMDAR encephalitis.Over the past 30 years,the patient had experienced eight episodes with seizures as the first symptom,which eventually progressed to autoimmune-associated epilepsy.In the last two episodes,both serum and cerebrospinal fluid of the patient were negative for AE-related antibodies,and brain magnetic resonance imaging(MRI)revealed abnormal hyperintensity in the bilateral hippocampi.The patient’s symptoms were poorly controlled by immunotherapy but well controlled by anti-seizure medicines.Conclusions Patients with a long history of AE and multiple relapses that start with seizures may display alterations of brain structure.Physicians should pay attention to autoimmune-associated epilepsy.

Biomolecular mechanisms of epileptic seizures and epilepsy: a review

Epilepsy is a recurring neurological disease caused by the abnormal electrical activity in the brain. This disease has caused about 50 new cases in 100,000 populations every year with the clinical manifestations of awareness loss, bruising, and mobility abnormalities. Due to the lack understanding of the pathophysiology behind the illness, a wide variety of medications are available to treat epilepsy. Epileptogenesis is the process by which a normally functioning brain undergoes alterations leading to the development of epilepsy, involving various factors. This is related to the inflammation which is driven by cytokines like IL-1 and tumor necrosis factor-α (TNF-α) leads to neuronal hyperexcitability. Pro-inflammatory cytokines from activated microglia and astrocytes in epileptic tissue initiate an inflammatory cascade, heightening neuronal excitability and triggering epileptiform activity. The blood-brain barrier (BBB) maintains central nervous system integrity through its tight endothelial connections, but inflammation impact BBB structure and function which leads to immune cell infiltration. The mammalian target of rapamycin (mTOR) pathway’s excessive activation influences epileptogenesis, impacting neuronal excitability, and synapse formation, with genetic mutations contributing to epilepsy syndromes and the modulation of autophagy playing a role in seizure onset. The apoptotic pathway contribute to cell death through glutamate receptor-mediated excitotoxicity, involving pro-apoptotic proteins like p53 and mitochondrial dysfunction, leading to the activation of caspases and the disruption of calcium homeostasis. Ionic imbalances within neural networks contribute to the complexity of epileptic seizures, involving alterations in voltage-gated sodium and potassium channels, and the formation of diverse ion channel subtypes. Epileptogenesis triggers molecular changes in hippocampus, including altered neurogenesis and enhanced expression of neurotrophic factors and proteins. Oxidative stress leads to cellular damage, disrupted antioxidant systems, and mitochondrial dysfunction, making it a key player in epileptogenesis and potential neuroprotective interventions. Thalamocortical circuitry disruption is central to absence epilepsy, the normal circuit becomes faulty and results in characteristic brain wave patterns.

Effective treatment of NR2F1-related epilepsy with perampanel

Background NR2F1 mutations are associated with Bosch-Boonstra-Schaaf optic atrophy syndrome(BBSOAS).Although~46.7%of BBSOAS patients present with epilepsy,which is always drug-resistant and associated with higher rates of behavioral and cognitive problems,the treatment and outcomes of NR2F1-related epilepsy have rarely been described.Here,we present new cases of BBSOAS-related epilepsy and summarize all previously reported cases to explore the effective treatment for this type of epilepsy.Methods We identified six new Chinese cases of BBSOAS with epilepsy.Five different de novo heterozygous NR2F1 mutations were identified in these cases,including two novel mutations c.365G>T,p.Cys122Phe and c.449G>T,p.Gly150Val.By combining the six cases and 14 previously reported cases,we analyzed the characteristics and treatment outcomes of NR2F1-related epilepsy.Results Twelve of the 20 patients(60%)had infantile epileptic spasms,while the other patients had generalized tonic/tonic-clonic,focal,myoclonic,absence,or unclassified seizures.Several anti-seizure medications,steroids,and a ketogenic diet were administered in these cases.However,seizures were controlled in only 50%of previously reported cases,while all of the six new cases became seizure-free after perampanel as an add-on treatment.The average time from the addition of perampanel to seizure control was 7.33±4.59 months(range,1–12 months).The median time to seizure freedom was 14 months(1–32 months,>19 months in 3 cases).The average dosage of perampanel needed for epilepsy control was 0.22±0.17 mg/kg per day.Conclusions In this paper,we comprehensively summarized the clinical characteristics,treatments and outcomes of NR2F1-related epilepsy for the first time.Perampanel exhibits dramatic efficacy for NR2F1-related epilepsy.This will help optimize the treatment of this type of epilepsy and provide clues for its pathogenic mechanisms.The two novel mutations expand the genotype spectrum of this disease.

Utilization of quantitative electroencephalogram in China:an online questionnaire survey

Background:Quantitative electroencephalogram(QEEG)is a tool that uses a computer to analyze brain activity monitored by electroencephalogram(EEG)according to measurements such as frequency,amplitude,and slope.The purpose of this study was to understand the current situation of QEEG utilization in China and further compare the situations among different regions and different levels of hospitals.Methods:An online questionnaire comprising 14 questions was designed.Statistical description and analysis were made for the results of the questionnaire survey.Results:A total of 158 people from 134 medical institutions participated in the survey.The participants came from 21 provinces,accounting for 61.76%(21/34)of the 34 provincial administrative regions in China.The Eastern China region accounted for 66.42%(89/134)of all the medical institutions that participated in this survey.Among the institutions surveyed,QEEG was routinely used in only 23.88%(32/134)of them.Among the medical institutions in which QEEG was routinely used,87.50%(28/32)of them were 3A-grade hospitals.Among the institutions with routine use of QEEG,56.25%(18/32)were affiliated hospitals of medical schools.There was a significant difference in the utilization of QEEG between the 3A-grade and non-3A-grade hospitals(P=0.040)and between the hospitals affiliated to medical schools and those non-affiliated to medical schools(P=0.020).Conclusions:The utilization of QEEG is still limited in China.There are differences in the use of QEEG among different hospitals and regions.

Acute symptomatic seizures in newborns:a narrative review

Acute symptomatic seizures are the main sign of neurological dysfunction in newborns.This is linked to the unique characteristics of the neonatal brain,making it hyperexcitable compared to older ages,and to the common occurrence of some forms of acquired brain injury,namely hypoxic-ischemic encephalopathy.In this narrative review we will provide an overview of neonatal seizures definition,their main underlying etiologies,diagnostic work-up and differential diagnoses,and will discuss about therapeutic options and prognostic outlook.The latest publications from the ILAE Task Force on Neonatal Seizures will be presented and discussed.Of note,they highlight the current lack of robust evidence in this field of clinical neurology.We will also report on specificities pertaining to low-and-middle income countries in terms of incidence,main etiologies and diagnosis.The possibilities offered by telemedicine and automated seizures detection will also be summarized in order to provide a framework for future directions in seizures diagnosis and management with a global perspective.Many challenges and opportunities for improving identification,monitoring and treatment of acute symptomatic seizures in newborns exist.All current caveats potentially represent different lines of research with the aim to provide better care and reach a deeper understanding of this important topic of neonatal neurology.

Improvement of epilepsy secondary to acquired immunodeficiency syndrome with intestinal microbiota preparations:a case report

Background Epilepsy secondary to acquired immunodeficiency syndrome(AIDS)can be challenging to manage.The potential interactions between antiretroviral drugs and antiepileptic drugs may result in the failure of both treat-ments.Therefore,it is crucial to develop more effective strategies to enhance the clinical outcomes of patients.Case presentation We report a case of epilepsy secondary to AIDS.After administration of Bacteroides Fragilis 839(BF839),the secondary generalized tonic-clonic seizures disappeared,the frequency of complex partial seizures decreased by 70%,and the duration of each episode was shortened.Additionally,long-term diarrhea associated with antiretroviral therapy for AIDS resolved,and the syphilis serofast reaction turned negative.No serious adverse reactions were observed during the three-year follow up.Conclusions This case report suggests that the specific gut microbiota preparation could possibly improve refrac-tory epilepsy in HIV patients while also potentially alleviating adverse reactions to antiretroviral drugs and concurrent syphilis infection.Our case may provide a new perspective for the treatment of HIV infection/AIDS.

Pathogenesis of seizures and epilepsy after stroke

Stroke is the most frequent cause of secondary epilepsy in the elderly.The incidence of cerebral stroke is increasing with the extension of life expectancy,and the prevalence of post-stroke epilepsy(PSE)is rising.There are various seizure types after stroke,and the occurrence of epilepsy is closely related to the type and location of stroke.Moreover,the clinical treatment of post-stroke epilepsy is difficult,which increases the risk of disability and death,and affects the prognosis and quality of life of patients.Now seizure and epilepsy after stroke is more and more get the attention of the medical profession,has been more and more researchers have devoted to seizures after stroke and PSE clinical and basic research,and hope to get a scientific and unified guideline,to give timely and effective treatment,but the exact pathophysiologic mechanism has not yet formed a unified conclusion.It has been found that ion channels,neurotransmitters,proliferation of glial cells,genetics and other factors are involved in the occurrence and development of PSE.In this review,we discuss the pathogenesis of early-onset epileptic seizures and late-onset epilepsy after stroke,in order to provide a basis for clinicians to understand the disease,and expect to provide ideas for future exploration.

Efficacy and tolerability of ketogenic diet therapy in 55 Chinese children with drug-resistant epilepsy in Northwest China

Background:Due to the tradition of carbohydrate-rich diet,challenges exist for ketogenic diet(KD)implementation in Northwest China.This study was aimed to investigate the efficacy and tolerability of KD therapy administered with gradual initiation protocols in Chinese children with pharmacoresistant epilepsy in Northwest China.Methods:In this single-center study,55 children with drug-resistant epilepsy were enrolled from June 2013 to June 2019.The efficacy of KD,reasons for discontinuation,duration of retention and rate of adverse events were evaluated.Results:Fifty-five children aged from 2.2 months to 169.7 months were included,with a median age at KD initiation of 14.1 months,and 32 cases(58.2%)responded to the diet therapy at the last contact.The responder rates were 16.4%(9/55);36.4%(20/55),30.9%(17/55),27.3%(15/55)at 1,3,6 and 12 months,respectively.Univariate analysis indicated that the duration of epilepsy and the duration of KD therapy were predictors for KD effectiveness.Poor compliance and lack of response were main reasons for discontinuation of KD.There are a few side effects of KD,most of which were minor.Conclusions:The KD therapy with a gradual-initiation protocol is effective and tolerable for children with drug-resist-ant epilepsy in Northwest China.Early start of KD and KD duration of more than 6 months may be predictive factors for KD efficacy.

Detection method of absence seizures based on Resnet and bidirectional GRU

Background Epilepsy is a common chronic neurological disease.Its repeated seizure attacks have a great negative impact on patients’physical and mental health.The diagnosis of epilepsy mainly depends on electroencephalogram(EEG)signals detection and analysis.There are two main EEG signals detection methods for epilepsy.One is the detection based on abnormal waveform,the other is the analysis of EEG signals based on the traditional machine learning.The feature extraction method of the traditional machine learning is difcult to capture the high-dimension information between adjacent sequences.Methods In this paper,redundant information was removed from the data by Gaussian fltering,downsampling,and short-time Fourier transform.Convolutional Neural Networks(CNN)was used to extract the high-dimensional features of the preprocessed data,and then Gate Recurrent Unit(GRU)was used to combine the sequence information before and after,to fully integrate the adjacent information EEG signals and improve the accuracy of the model detection.Results Four models were designed and compared.The experimental results showed that the prediction model based on deep residual network and bidirectional GRU had the best efect,and the test accuracy of the absence epilepsy test set reached 92%.Conclusions The prediction time of the network is only 10 sec when predicting four-hour EEG signals.It can be efectively used in EEG software to provide reference for doctors in EEG analysis and save doctors’time,which has great practical value.

Social support for and features of Chinese adults with epilepsy

Background:The lack of social support for adults with epilepsy(AWEs)is receiving increased attention,as it may result in low quality of life.This study was aimed to confirm the demographic characteristics of and clinical factors associated with social support for AWEs.Methods:AWEs were consecutively recruited from our hospital.The 10-term Social Support Rating Scale(SSRS)was used to measure social support.A linear regression analysis with stepwise selection was performed to analyze the independent variables associated with social support for AWEs.Results:In total,165 AWEs were consecutively included in the present study.Linear regression analysis showed that the marital status(t=-3.550,β=-0.272,P=0.001),the age at onset(t=2.545,β=0.192,P=0.012),and the QOLIE-31 score(t=3.144,β=0.221,P=0.002)were independent variables associated with social support for AWEs.Conclusions:Our findings suggest that the poor social support is associated with childhood onset of epilepsy and the unmarried status.This study also confirmed a negative influence of low social support on quality of life in AWEs.

Refex seizures induced by micturition: a case report

Background Refex seizures(RS)induced by micturition are extremely rare,and the clinical and electroencephalogram features of RS are not widely known among clinicians.In particular,the origin of the epileptic area is still unclear.Case presentation An 8-year-old girl who had generalized tonic-clonic seizures was diagnosed with RS induced by micturition based on the clinical manifestation and EEG recordings.We also reviewed the clinical and EEG characteristics of RS induced by micturition in literature by searching the databases of PubMed and MEDLINE using keywords“micturition refex seizure”,“refex seizure induced by micturition”,and“micturition induced seizure”by January 2022.We speculate that the mechanism of micturition-induced RS may involve excessive neuronal excitation in regions that participate in micturition.Conclusions The RS in this patient was considered to be induced by micturition.Awareness should be raised to this rare form of RS among practitioners.

A multicenter retrospective cohort study of ketogenic diet therapy in 481 children with infantile spasms

Background:Ketogenic diet(KD)therapy is one of the main treatments for drug-resistant epilepsy.However,the KD therapy has been applied in only a small number of infantile spasm cases.In this large multicenter study,we investigated the efficacy of KD therapy in the treatment of infantile spasms.Methods:In this retrospective,multicenter cohort study,clinical data from main epilepsy centers were analyzed.Patients were classified into different groups according to age,type of drug and whether glucocorticoid was used before initiation of KD.Results:From October 2014 to March 2020,481 patients(308 males and 173 females)with infantile spasms were treated with the KD therapy.The age of the patients ranged from 2 months to 20 years,with a mean age of 1 year and 10 months.The number of anti-seizure medications(ASMs)used before KD initiation ranged 0-6,with a median of 3.In different time from initiation(1,3,6,and 12 months),the rates of seizure freedom after KD were 6.9,11.6;16.0 and 16.8%,respectively(x^(2)=27.1772,P<0.0001).There was a significant difference in the rate of seizure freedom between 3 months and 1 month(x^(2)=6.5498,P=0.0105)groups,and 6 months and 3 months(x^(2)=3.8478,P=0.0498)groups,but not between 12 months and 6 months(x^(2)=0.1212,P=0.7278)groups.The rates of effectiveness were 44.7;62.8,49.1 and 32.0%(x^(2)=93.2674,P<0.0001),respectively.The retention rates were 94.0,82.5,55.7 and 33.1%(x^(2)=483.7551,P<0.0001),correspondingly.The rate of effectiveness and the retention rate of KD were significantly different among the 1,3,6 and 12 months.KD treatment was the first choice in 25 patients(5.2%),55 patients(11.4%)started KD after the failure of the first ASM,158 patients(32.8%)started KD after the failure of the second ASM,157 patients(32.6%)started KD after the failure of the third drug,and 86 patients(17.9%)started KD after the failure of the fourth and more.The KD effect was not related to the number of ASMs used before KD startup(P>0.05).Two hundred and eighteen patients(45.3%)failed to respond to corticotropin or glucocorticoid before initiation.There was no significant difference in the effectiveness rate at different time points between the group of KD therapy after glucocorticoid failure and the group after non-hormone failure (x^(2)=0.8613,P=0.8348).The rate of adverse events of KD in 1,3,6,and 12 months after KD initiation were 22.3,21.7,16.8 and 6.9%,respectively.The adverse events mainly occurred during the first 3 months of KD,and the main adverse events were gastrointestinal disturbance and constipation.Conclusions:The efficacy of the KD treatment for infantile spasms was not affected by age,medication,and glucocorticoid use before initiation.KD is one of the effective treatments for infantile spasms.

Robot-assisted treatment of secondary epilepsy caused by parasitic infection:a case report

Background Cerebral sparganosis represents the most severe manifestation of sparganosis,with a relatively low global incidence.For cases of secondary epileptic seizures caused by sparganosis infection in the functional areas of the brain,what advanced neurosurgical techniques should be employed to precisely identify and excise the epi-leptic lesions in the deep functional areas of the brain,aiming to achieve maximal removal while minimising the risk of neurological deficits?This remains a current challenge for epilepsy surgeons.Case presentation A 24-year-old Chinese male was admitted to our hospital,presenting with a history of left limb twitching persisting for over a year.His main clinical symptoms presented twitching and numbness of his left limb without loss of consciousness.Under the premise of inappropriate anti-seizure treatment,recurrent epilepsy attacked persist.The patient’s diagnosis was considered as“space-occupying lesions in the several lobes of brain,secondary epilepsy”after comprehensive assessment and discussion.And experts considered that the patient’s space-occupying lesions in the right frontal and parietal lobes were highly suspected to be infected by parasites.This report delved into the application of neurosurgery robot-assisted frameless stereotaxic technology and intraopera-tive stereotactic electroencephalography(SEEG)monitoring technology to accurately locate and optimize removal of parasite-related epileptic lesions situated in functional areas of the brain.As a result,the patient had achieved seizure freedom,leaving no symptoms of neurological deficit.Conclusions With the highly integrated development of imaging technology,mechanical technology,computer control technology,and artificial intelligence,surgical robots are poised to play a larger role across various neurosur-gical specialties in the future.Considering benefits for patients and the promising application of this technology,its utilization holds significant value.

Three cases of paroxysmal alien limb phenomena due to epileptic seizures and review of literatures

Background:The alien hand phenomenon(AHP)is a rare disorder of involuntary limb movement together with a loss of sense of limb ownership.AHP occurs as a consequence of frontal,callosal,or posterior cerebral lesions.To characterize the phenomenon of AHP,three patients with paroxysmal AHP were described and proved to be focal seizures by using video-EEG monitoring.Method:Clinical history of 3 epileptic patients with AHP was collected.EEG and MRI were performed in each patient.One patient completed EEG monitoring and postoperative pathological examination.We also review the recent literatures and summarize the characteristics,types and hypothetic mechanisms of epileptic AHP.Results:Case 1 had AHP of the left arm followed by the left arm convulsion or AHP only.MRI imaging showed a lesion in the posterior parietal lobe.After complete resection of the lesion,he remained seizure free for 1.5 years.Cases 2 and 3 had AHP and convulsion.The three cases did not have auto-motor signs,so they were identified to be the posterior type of APH.Conclusions:The mechanism underlying AHP remains poorly.understood.Currently,little is known for the epileptic paroxysmal AHP,a quite rare form of AHP.AHP can be represented before or immediately after convulsion,or be represented by the paroxysmal symptom only.