Construction of an epileptic seizure prediction model using a semi-supervised method of generative adversarial and long short term memory network combined with Stockwell transform / 南方医科大学学报

OBJECTIVE@#To propose a semi-supervised epileptic seizure prediction model (ST-WGAN-GP-Bi-LSTM) to enhance the prediction performance by improving time-frequency analysis of electroencephalogram (EEG) signals, enhancing the stability of the unsupervised feature learning model and improving the design of back-end classifier.@*METHODS@#Stockwell transform (ST) of the epileptic EEG signals was performed to locate the time-frequency information by adaptive adjustment of the resolution and retaining the absolute phase to obtain the time-frequency inputs. When there was no overlap between the generated data distribution and the real EEG data distribution, to avoid failure of feature learning due to a constant JS divergence, Wasserstein GAN was used as a feature learning model, and the cost function based on EM distance and gradient penalty strategy was adopted to constrain the unsupervised training process to allow the generation of a high-order feature extractor. A temporal prediction model was finally constructed based on a bi-directional long short term memory network (Bi-LSTM), and the classification performance was improved by obtaining the temporal correlation between high-order time-frequency features. The CHB-MIT scalp EEG dataset was used to validate the proposed patient-specific seizure prediction method.@*RESULTS@#The AUC, sensitivity, and specificity of the proposed method reached 90.40%, 83.62%, and 86.69%, respectively. Compared with the existing semi-supervised methods, the propose method improved the original performance by 17.77%, 15.41%, and 53.66%. The performance of this method was comparable to that of a supervised prediction model based on CNN.@*CONCLUSION@#The utilization of ST, WGAN-GP, and Bi-LSTM effectively improves the prediction performance of the semi-supervised deep learning model, which can be used for optimization of unsupervised feature extraction in epileptic seizure prediction.

Risk factors and correlation with prognosis of epileptic seizures in 284 pediatric patients in pediatric intensive care unit with electroencephalography monitoring / 中华实用儿科临床杂志

Objective:To illustrate the onset of epileptic seizures in children with brain injury admitted in pediatric intensive care unit (PICU), and to explore the risk factors and the correlation between epileptic seizures and the prognosis.Methods:Clinical data of pediatric patients with brain injury who were admitted to PICU of Peking University First Hospital from January 2013 to December 2019, and monitored by video electroencephalography (VEEG) were retrospectively collected, including general demographic information, etiological data, clinical seizures prior to VEEG performing, in-hospital mortality, brain function score, VEEG manifestations, etc.Seizures detected by VEEG were the primary outcome, and prognosis when discharged from PICU was the secondary outcome. Logistic regression was used to analyze the factors associated with seizures and poor outcome. Results:A total of 284 children were included, involving 54.9%(156/284) males.The median age of included children was 1.7(0.5, 5.0) years.Stratified by the cause of disease, 45.1%(128/284) had epilepsy, 26.1%(74/128) had genetic metabolic disease, and 14.4%(41/284) had central nervous system infection.A total of 82.0%(233/284) children had abnormal VEEG background activities, and 59.5%(169/284) had interictal epileptic discharges.Seizures were detected in 106 cases, including 39.6%(42/106) of non-convulsive seizures and 24.5%(26/106) of non-convulsive epileptic states.There were 12.0% (34/284) had poor prognosis at discharge, including 24 patients died in-hospital, and Pediatric Cerebral Performance Category scores were increased in 10 survivors.Multivariate Logistic regression analysis showed that seizures existed before VEEG monitoring and interictal epileptiform discharge were the independent risk factors for seizure.Besides, mental retardation, sepsis related encephalopathy, consciousness abnormality during VEEG, abnormal VEEG background activity, and epileptic status were significantly correlated with the poor prognosis of children with brain injury in PICU. Conclusions:The incidence of electrographic seizure is higher in children with brain injury in PICU, and VEEG monitoring is beneficial to children with brain injury that achieves an early identification of seizures and prediction of prognosis.

Crisis focal motora sin alteración de conciencia secundaria a accidente cerebrovascular. Reporte de un caso y diagnóstico diferencial con Limb Shaking

Introducción: Si bien la primera causa de crisis epilépticas en la población adulta mayor es el accidente cerebrovascular, un importante diagnóstico diferencial corresponde al limb shaking syndrome, una manifestación clínica particular de un accidente isquémico transitorio. Caso clínico: Se describe entonces el caso de un hombre chileno de 62 años de edad que sufre una crisis focal motora sin alteración de conciencia con evidencia imagenológica de injuria isquémica de unos 10 días de antigüedad y de estenosis carotídea significativa, la cual es manejada quirúrgicamente. Discusión: Existen diferentes elementos que pueden distinguir una crisis epiléptica de un limb shaking sryndrome. La fisiopatología de la primera corresponde un fenómeno irritativo post isquémico con una clara manifestación electroencefalográfica, mientras que la segunda es producida por hipoperfusión relativa gatillada por ortostatismo en el contexto de una enfermedad carotídea oclusiva. El cuadro clínico del paciente se consideró más compatible con una crisis epiléptica que con un limb shaking syndrome.

Introduction: Although the leading cause of seizures in the older adult population is cerebrovascular accident, limb shaking syndrome is an important differential diagnosis, being a particular clinical manifestation of a transient ischemic attack. Clinical case: We thus describe a clinical case of a 62-year-old Chilean man who suffers a simple focal motor epileptic seizure, with imaging evidence of ischemic injury about 10 days old and significant carotid stenosis which is managed surgically. Discussion: There are different elements that can distinguish an epileptic seizure from a limb shaking syndrome. The pathophysiology of the first corresponds to a post-ischemic irritative phenomenon with a clear electroencephalographic manifestation, while the second is produced by relative hypoperfusion triggered by orthostatism in the context of carotid occlusive disease. The patient's clinical picture was considered more compatible with an epileptic seizure than with a limb shaking syndrome syndrome.

Depresión en pacientes con epilepsia. Experiencia en un hospital privado de Argentina / Depression in patients with epilepsy: experience in a private hospital in Argentina

Resumen Introducción: La depresión es el trastorno psiquiátrico más frecuente en pacientes con epilepsia, con una prevalencia estimada entre 35% y 60%, asociándose a un peor control de crisis epilép ticas. A pesar de la gran prevalencia de depresión, muchos pacientes no son diagnosticados, presentando una peor evolución clínica y calidad de vida. No existen estudios de prevalencia en nuestro medio. El objeti vo fue determinar la prevalencia de depresión en epilepsia y su relación con el control de crisis. Materiales y métodos: Es un estudio prospectivo, descriptivo y transversal de una cohorte de pacientes a los cuales se les realizó el Inventario de Depresión en Pacientes con Trastornos Neurológicos para Epilepsia (NDDI-E) y se analizaron datos de las historias clínicas. Resultados: Se incluyeron 121 pacientes, la prevalencia de depresión fue 43% (n:52), el 77% eran mujeres (p = 0.01). Del total de pacientes con depresión, el 63% fue diagnosticado en este estudio. La mayoría tuvo buen control de la crisis (70%) y no presentó depresión, mientras que la mayoría con mal (57%) y regular (63%) control de la crisis presentó depresión (p < 0.001). Discusión: La comorbilidad entre depresión y epilepsia es altamente prevalente, influyendo negativamen te en el control de las crisis epilépticas. La mayoría de los pacientes se encuentran subdiagnosticados. El tamizaje de la depresión mayor en aquellos con epilepsia es necesario, contribuyendo a la mejoría clínica.

Abstract Introduction: Depression is the most frequent psychiatric disorder in patients with epilepsy, with an estimated prevalence between 35% and 60%, associated with poorer control of epileptic seizures. Despite the high prevalence of depression, many patients are not diagnosed, presenting a worse clinical course and quality of life. There are no prevalence studies in our population. The main objective was to determinate the prevalence of depression in epilepsy and its relationship with seizure control. Materials and methods: It is a prospective, descriptive and cross-sectional study of a cohort of patients who underwent the Depression Inventory in Pa tients with Neurological Disorders for Epilepsy (NDDI-E) and the data from the medical records were analyzed. Results: A total of 121 patients were inluded, and the prevalence of depression was 43% (n:52), of whom 77% were women (p = 0.01). A 63% of patients with depression was diagnosed in this study. Most of them with good seizure control (70%) did not present depression, while the majority of those with poor (57%) and regular (63%) seizure control presented depression (p < 0.001). Discussion: Comorbidity between depression and epilepsy is highly prevalent, negatively influencing the control of epileptic seizures. Most patients are underdiagnosed. Screening for major depression in patients with epilepsy is necessary, contributing to the clinical improvement.

Tratamiento farmacológico de la epilepsia en el adulto mayor, revisión de la literatura / Pharmacological treatment of epilepsy in elderly people, a literature review

RESUMEN Los adultos mayores tienen mayor riesgo de desarrollar epilepsia. Con un aumento progresivo de la expectativa de vida, este grupo muestra el más rápido incremento entre los pacientes con epilepsia. El tratamiento en sí se complica debido a los cambios fisiológicos relacionados con el envejecimiento, las comorbilidades, los problemas cognitivos concomitantes, las interacciones farmacológicas complejas y las dificultades en la adherencia a regímenes medicamentosos. Las crisis epilépticas se pueden controlar en la mayoría de los pacientes adultos mayores con dosis bajas de un solo fármaco anticrisis epiléptica de efecto específico. La tolerabilidad es un factor importante en la selección del fármaco, ya que los pacientes adultos mayores tienden a ser muy sensibles a los efectos secundarios. Para los fármacos anticrisis epiléptica que operan como inductores enzimáticos se debe valorar su retiro del arsenal terapéutico en favor de nuevos agentes que han demostrado similar eficacia y mejor tolerabilidad. Lamotrigina y levetiracetam son los fármacos anticrisis epiléptica más recomendados actualmente para el manejo de este cuadro en los adultos mayores. Aun cuando puede tratarse de una epilepsia fácilmente controlable, es recomendable mantener el tratamiento de forma indefinida en los adultos mayores dada la tendencia recurrente de las crisis. Se requieren más estudios que aborden los mecanismos fisiopatológicos de la epilepsia en este grupo etario y una mayor inclusión de los adultos mayores en ensayos clínicos, así como el desarrollo de modelos de atención integral que optimice el cuidado de estos pacientes.

SUMMARY Elderly people are at a higher risk of developing epilepsy. With a progressive increase in life expectancy, this is the fastest growing group of epilepsy patients. Their treatment is complicated by the presence of physiological changes related to aging, comorbidities, concomitant cognitive problems, complex drug interactions, and difficulties in the adherence to medication regimes. Seizures can be controlled in elderly people patients with low doses of a single epileptic seizure drug. Tolerability is an important factor in drug selection, as elderly people patients tend to be very sensitive to side effects. Enzyme-inducing anti-seizure drugs should gradually be left out of the therapeutic arsenal in favor of new anti-seizure drugs that have shown similar efficacy and better tolerability. Levetiracetam and lamotrigine are the most recommended anti-seizure drugs for older adults with epilepsy nowadays. Although it could be easily controlled, it is recommended that older adults continue their treatment indefinitely, due to the recurrent seizures' proclivity. More studies are needed to address the pathophysiological mechanisms of epilepsy in this age group, and greater inclusion of elderly people in clinical trials is needed, as is the development of comprehensive care models to provide optimal patient care.

Successfully Treated Psychogenic Non-Epileptic Seizure with Shigyakusan and Hangebyakujutsutemmato / 日本東洋医学雑誌

We report a case of loss of consciousness multiple times with and without focal to bilateral tonic-clonic seizure-like episodes that we diagnosed as psychogenic non-epileptic seizures, and successfully treated with shigyakusan and hangebyakujutsutemmato. The patient did not have fullness and discomfort in the chest and hypochondrium (kyokyokuman), nor spasmodic bilateral rectus abdominis in an interictal state. On the other hand, she had extremely cold limbs, especially feet and hands, with fingers being flexion and rigid under the status of loss of consciousness even without tonic-clonic seizure-like episodes in the ictal state. After being warmed and loosened, her consciousness level slowly recovered. She had headaches frequently in a non-ictal state, too. We identified that she had qi deficiency (kikyo), qi depression (kiutsu), fluid retention (suitai) and qi counter flow (kigyaku) in the interictal state, while kiutsu and kigyaku were extremely strong in the ictal state. In this case, the combined use of shigyakusan and hangebyakujutsutemmato was useful, considering that the patient had two different locations of disease (byoi) that required treatment.

Epilepsy detection and analysis method for specific patient based on data augmentation and deep learning / 生物医学工程学杂志

In recent years, epileptic seizure detection based on electroencephalogram (EEG) has attracted the widespread attention of the academic. However, it is difficult to collect data from epileptic seizure, and it is easy to cause over fitting phenomenon under the condition of few training data. In order to solve this problem, this paper took the CHB-MIT epilepsy EEG dataset from Boston Children's Hospital as the research object, and applied wavelet transform for data augmentation by setting different wavelet transform scale factors. In addition, by combining deep learning, ensemble learning, transfer learning and other methods, an epilepsy detection method with high accuracy for specific epilepsy patients was proposed under the condition of insufficient learning samples. In test, the wavelet transform scale factors 2, 4 and 8 were set for experimental comparison and verification. When the wavelet scale factor was 8, the average accuracy, average sensitivity and average specificity was 95.47%, 93.89% and 96.48%, respectively. Through comparative experiments with recent relevant literatures, the advantages of the proposed method were verified. Our results might provide reference for the clinical application of epilepsy detection.

Medication Analysis and Care for Acute Renal Failure with Epileptic Seizure Caused by Excretion Delay of HD- MTX by Clinical Pharmacists / 中国药房

OBJECTIVE：To investi gate the role of clinical pharmacists in the treatment of delayed excretion of acute renal failure （ARF） with epileptic seizure caused by HD-MTX in a patient ，and to provide reference for rational drug use and pharmaceutical care in such type of patients. METHODS ：A patient with diffuse large B-cell lymphoma was given HD-MTX for chemotherapy，and ARF caused by delayed methotrexate excretion occurred on the second day after methotrexate administration. Clinical physicians adjusted the rescue dose and frequency of calcium folinate but the effect was poor. Clinical pharmacists analyzed the causes of delayed methotrexate excretion by reviewing literature and combining with the patient ’s condition. It was suggested to monitor the blood concentration of methotrexate ，strengthen alkalization and hydration ，increase the volume of intravenous sodium bicarbonate from 125 mL to 250 mL，take Sodium bicarbonate tablets orally ，and monitor the pH value of urine （pH value of urine maintained above 7）. In addition ，the pharmacist told the patient to drink water as much as possible to ensure the daily urine output reached 3 000 to 4 000 mL. The blood concentration of methotrexate was 16.14 μmol/L 44 h after administration ，which proved to be excretion delay. The patient had epileptic seizure on the 13th day after methotrexate medication. The physician gave sodium valproate 0.8 g intravenously to control epilepsy. The clinical pharmacist conducted pharmaceutical care for the patient ，and found that the compliance of the patient taking Sodium bicarbonate tablets and Sodium valproate tablets orally was not good ，so medication education and pharmaceutical care were conducted ，then the patient accepted and took the drugs on time. RESULTS ： The physician adopted the suggestions of the pharmacist to monitor the blood concentration of methotrexate and performed symptomatic treatment. The urine volume of the patient increased ，the edema was reduced ，serum creatinine gradually returned to normal，and renal function recovered gradually ；the symptoms of epilepsy was controlled. CONCLUSIONS ：In the treatment process of ARF complicated with epileptic seizure caused by excretion delay of HD-MTX ，the clinical pharmacist assisted physician to improve the treatment plan and conducted pharmaceutical care and medication education for the patient ，therefore ensure the safe and rational use of drugs .

Automatic epileptic seizure detection algorithm based on dual density dual tree complex wavelet transform / 生物医学工程学杂志

It is very important for epilepsy treatment to distinguish epileptic seizure and non-seizure. In this study, an automatic seizure detection algorithm based on dual density dual tree complex wavelet transform (DD-DT CWT) for intracranial electroencephalogram (iEEG) was proposed. The experimental data were collected from 15 719 competition data set up by the National Institutes of Health (NINDS) in Kaggle. The processed database consisted of 55 023 seizure epochs and 501 990 non-seizure epochs. Each epoch was 1 second long and contained 174 sampling points. Firstly, the signal was resampled. Then, DD-DT CWT was used for EEG signal processing. Four kinds of features include wavelet entropy, variance, energy and mean value were extracted from the signal. Finally, these features were sent to least squares-support vector machine (LS-SVM) for learning and classification. The appropriate decomposition level was selected by comparing the experimental results under different wavelet decomposition levels. The experimental results showed that the features selected in this paper were different between seizure and non-seizure. Among the eight patients, the average accuracy of three-level decomposition classification was 91.98%, the sensitivity was 90.15%, and the specificity was 93.81%. The work of this paper shows that our algorithm has excellent performance in the two classification of EEG signals of epileptic patients, and can detect the seizure period automatically and efficiently.

Características clínicas, electroencefalográficas, terapéuticas y recurrencia de la epilepsia en el lactante / Clinical, therapeutic, electroencephalographic characteristics and recurrence of epilepsy in nursing babies

Introducción: La epilepsia es motivo de consulta frecuente en los servicios de neuropediatría a nivel mundial, con incidencia máxima en el menor de un año, se asocia con retraso del neurodesarrollo y recurrencia de las crisis. Objetivo: Caracterizar a los lactantes con epilepsia según aspectos clínicos, electro-encefalográficos, terapéuticos y la recurrencia de las crisis epilépticas. Métodos: Estudio observacional, prospectivo y longitudinal en 50 lactantes con epilepsia ingresados en el Hospital William Soler: 2016 a 2018. Se analizaron variables demográficas, clínicas y paraclínicas, tratamiento y recurrencia a los seis meses de iniciado el tratamiento antiepiléptico. Resultados: El inicio de las crisis se presentó de 1 a 4 meses en 60 por ciento, con predominio del sexo masculino (60 por ciento). El 44 por ciento presentó retraso del neurodesarrollo global y 32 por ciento parálisis cerebral. Predominaron las crisis epilépticas generalizadas motoras espasmos epilépticos (32 por ciento); la epilepsia generalizada (60 por ciento), el síndrome epiléptico: el síndrome de West (32 por ciento) y de etiología: desconocida (48 por ciento). El trazado electroencefalográfico más frecuente fue el generalizado (26 por ciento) seguido de hisparritmia (24 por ciento) La vigabatrina y el fenobarbital fueron los antiepilépticos más utilizados al inicio del tratamiento (24 por ciento cada uno. La recurrencia fue alta (62 por ciento). Conclusiones: La epilepsia en el lactante es más frecuente en varones y de inicio precoz. El retraso del neurodesarrollo global constituyó un factor asociado a la recurrencia de las crisis epilépticas. La parálisis cerebral, los hallazgos en estudios de neuroimagen y la etiología estructural son factores clínicamente significativos para la recurrencia(AU)

Introduction: Epilepsy is a reason of frequent consultation in neuropediatrics services at the global level, with peak incidence in infants of less than one year old. This is associated with neurodevelopmental delay and seizures recurrence. Objective: To characterize infants with epilepsy according to clinical, electro-encephalographic, therapeutic aspects and the seizures recurrence. Methods: Observational, prospective and longitudinal study in 50 infants with epilepsy whom were admitted in William Soler Hospital from 2016 to 2018. There were analysed demographic, clinical and paraclinical variables, and the treatment and recurrence six months after the beginning of the antiepileptic treatment. Results: The beginning of the seizures was at 1 to 4 months in the 60 percent, with predominance of males (60 percent). 44 percent presented global neurodevelopmental delay and 32 percent cerebral palsy. Generalized motor epileptic seizures and epileptic spasms predominated (32 percent); generalized epilepsy (60 percent), epilepsy syndrome: West syndrome (32 percent); and of unknown etiology (48 percent). The most frequent electroencephalographic tracing was the generalized one (26 percent) followed by hypsarrhythmia (24 percent). Vigabatrin and phenobarbital were the most commonly antiepileptic drugs used at the beginning of treatment (24 percent) each. Recurrence was high (62 percent). Conclusions: Epilepsy in the infant is more common in males and of early-onset. The delay in the global neurodevelopment was a factor associated with the recurrence of seizures. Cerebral palsy, findings in neuroimaging studies and the structural etiology are clinically significant factors for recurrence(AU).

Exercise-induced acute renal failure with posterior reversible encephalopathy syndrome

@#Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, mental changes, epileptic seizures, visual disturbances, and transient changes in the posterior circulation system of the brain. Rhabdomyolysis is a clinical condition characterized by muscle pain, weakness, dark-colored urine, and elevated creatine kinase levels. The common causes of rhabdomyolysis are trauma, excessive fatigue and intense exercise. A 23-year-old male soldier developed rhabdomyolysis-induced acute kidney injury after intense exercise and secondary PRES. The patient also had generalized convulsive seizures. There is no similar case of PRES from acute renal failure induced by muscle injury previously reported in the literature.

Emergency multimodal computed tomography for the diagnosis of stroke mimic--epileptic seizure

@#Background and Objectives: Stroke mimics are medical conditions producing stroke-like symptoms but eventually get diagnosed as non-stroke diseases. Epileptic seizure is a common type of stroke mimic. The purpose of this study is to investigate the application of emergency multimodal computed tomography (CT) in the diagnosis of epileptic seizure. Methods: We retrospectively reviewed the case group of patients with suspected stroke in the emergency stroke care service of the First Affiliated Hospital of Suzhou University from September 2017 to October 2019. We included those who underwent multimodal CT, including non-contrasted cranial CT, CT perfusion with CT angiography, and were ultimately diagnosed as epileptic seizures. Ten patients with acute anterior circulation ischemic stroke were assigned as controls. Results: A total of five cases met the inclusion criteria. Multimodal CT was completed within 2.25 to 3.50h from symptom onset. On CT perfusion, hyperperfusion was shown in four cases and slightly increased perfusion in one case with epileptic seizures. Cerebral blood flow and cerebral blood volume were significantly increased, while time to peak and mean transit time decreased in the regions of interest of the epileptic hemisphere when compared to either the non-affected hemisphere or the ischemic area in the control group (P<0.05). The abnormal perfusion areas did not follow vascular territory supply and CT angiography did not show vessel occlusion in the case group. Conclusion: Emergency multimodal CT could be used effectively to differentiate epileptic seizure from stroke.

Vinpocetina de liberación prolongada: un posible tratamiento adyuvante en crisis epiléptica de inicio focal / Extended-release vinpocetine: a possible adjuvant treatment for focal onset epileptic seizures

Resumen Introducción: La vinpocetina de liberación prolongada ha demostrado ser efectiva en el control de crisis de inicio focal en pacientes epilépticos con una baja frecuencia de eventos adversos. Se realizó un estudio clínico para evaluar la eficacia y tolerabilidad de la vinpocetina como tratamiento adyuvante en pacientes con este padecimiento. Métodos: Se realizó un estudio clínico, doble ciego, de grupos paralelos. Se reclutaron 87 pacientes con diagnóstico de epilepsia focal tratados con uno a tres fármacos antiepilépticos. Los pacientes se aleatorizaron para ser tratados con vinpocetina (n = 41) o placebo (n = 46) de manera adyuvante a su tratamiento, e ingresaron a la fase basal (4 semanas), a la fase de titulación (4 semanas) y a la fase de evaluación (8 semanas) conservando estables las dosis de la vinpocetina y de los fármacos antiepilépticos. Resultados: La vinpocetina fue más efectiva que el placebo en la reducción de las crisis al finalizar la fase de evaluación (p < 0.0001). El 69% de los pacientes tratados con vinpocetina presentaron una reducción mayor al 50% en las crisis en comparación con el 13% de los pacientes tratados con placebo. No se presentaron diferencias significativas en cuanto a la presencia de efectos adversos en los pacientes tratados con vinpocetina comparados con los tratados con placebo. Los eventos adversos más frecuentes observados con vinpocetina fueron cefalea (7.9%) y diplopía (5.2%). Conclusiones: Como tratamiento adyuvante, la vinpocetina (2 mg/kg/día) redujo eficazmente la frecuencia de crisis epilépticas y demostró ser bien tolerada. Presenta un amplio perfil de seguridad y eventos adversos conocidos, que son transitorios y sin secuelas.

Abstract Background: Extended-release vinpocetine is effective to control focal onset epileptic seizures with a low rate of adverse events. A clinical study was performed to evaluate the efficacy and tolerability of vinpocetine as an adjuvant treatment in patients with this condition. Methods: A double-blind clinical study of parallel groups was conducted, in which 87 patients with a diagnosis of focal epilepsy treated with one to three antiepileptic drugs were recruited. Patients were randomized to receive vinpocetine (n = 41) or placebo (n = 46) adjuvant to their treatment. Patients entered the baseline phase (4 weeks), the titration phase (4 weeks) and the evaluation phase (8 weeks), maintaining stable doses of vinpocetine and their respective antiepileptic drug treatment. Results: Vinpocetine was more effective than placebo in reducing seizures at the end of the evaluation phase (p < 0.0001). Sixty-nine percent of the vinpocetine-treated patients had a 50% reduction in seizures compared to 13% of placebo-treated patients. No significant differences in the presence of adverse effects in patients treated with vinpocetine compared to those treated with placebo were observed. The most frequent adverse events observed with vinpocetine were headache (7.9%) and diplopia (5.2%). Conclusions: As an adjuvant treatment, vinpocetine (2 mg/kg/day) effectively reduced the frequency of epileptic seizures and proved to be well tolerated. Vinpocetine has a wide safety profile and well-known adverse events, which are transient and with no sequelae.

Analysis of epileptic seizure detection method based on improved genetic algorithm optimization back propagation neural network / 生物医学工程学杂志

In order to improve the accuracy and efficiency of automatic seizure detection, the paper proposes a method based on improved genetic algorithm optimization back propagation (IGA-BP) neural network for epilepsy diagnosis, and uses the method to achieve detection of clinical epilepsy rapidly and effectively. Firstly, the method extracted the linear and nonlinear features of the epileptic electroencephalogram (EEG) signals and used a Gaussian mixture model (GMM) to perform cluster analysis on EEG features. Next, expectation maximization (EM) algorithm was used to estimate GMM parameters to calculate the optimal parameters for the selection operator of genetic algorithm (GA). The initial weights and thresholds of the BP neural network were obtained through using the improved genetic algorithm. Finally, the optimized BP neural network is used for the classification of the epileptic EEG signals to detect the epileptic seizure automatically. Compared with the traditional genetic algorithm optimization back propagation (GA-BP), the IGA-BP neural network can improve the population convergence rate and reduce the classification error. In the process of automatic detection of epilepsy, the method improves the detection accuracy in the automatic detection of epilepsy disorders and reduced inspection time. It has important application value in the clinical diagnosis and treatment of epilepsy.

Dynamic variety of serum Nesfatin-1 and its clinical values in evaluation on illness condition and short-term prognosis in patients with epileptic seizure / 吉林大学学报(医学版)

Objective: To analyze the dynamic variety of serum Nesfatin-1 in the patients with status epilepticus (SE), and to explore the clinical values of the serum Nesfatin-1 in evaluation on the illness condition and short-term prognosis in the patients with epileptic seizure. Methods: A total of 43 patients diagnosed as primary epilepsy were collected as the subjects and received the regular clinical therapy. The serum levels of Nesfatin-1 of the patients were detected before treatment and at the end of the 1st week after treatment, the end of the 2nd week therapy after treatment and the end of the 1st month after treatment, respectively. Liverpool Seizure Severity Scale 2.0 (LSSS2. 0) was used to evaluate in the patients. The correlations of the serum levels of Nesfatin-1 of the patients at each time point with the scores of LSSS were analyzed. After one year of follow-up,all patients were divided into two groups according to the prognosis, which were survival group (31 cases) and death group (12 cases). The risk factors of one-year prognosis were analyzed by multivariate Logistic regression analysis. The sensitivity and specificity of the serum values of Nesfatin-1 to the one-year prognosis were analyzed by receiver operating characteristic (ROC) curve. Results: Compared with before treatment, the LSSS scores and the serum Nesfatin-1 levels of the patients in two groups were decreased with the increasing of treatment time ( P0. 05). The LSSS scores and the serum levels of Nesfatin-1 of the SE patients in survival group were lower than these in death group from the end of the 1st week after treatment to the end of the 1st month after treatment ( P<0. 05 or P

Dynamic variety of serum Nesfatin-1 and its clinical values in evaluation on illness condition and short-term prognosis in patients with epileptic seizure / 吉林大学学报(医学版)

Objective:To analyze the dynamic variety of serum Nesfatin-1in the patients with status epilepticus (SE) , and to explore the clinical values of the serum Nesfatin-1in evaluation on the illness condition and short-term prognosis in the patients with epileptic seizure.Methods:A total of 43patients diagnosed as primary epilepsy were collected as the subjects and received the regular clinical therapy.The serum levels of Nesfatin-1of the patients were detected before treatment and at the end of the 1st week after treatment, the end of the 2nd week therapy after treatment and the end of the 1st month after treatment, respectively.Liverpool Seizure Severity Scale 2.0 (LSSS2.0) was used to evaluate in the patients.The correlations of the serum levels of Nesfatin-1of the patients at each time point with the scores of LSSS were analyzed.After one year of follow-up, all patients were divided into two groups according to the prognosis, which were survival group (31cases) and death group (12cases) .The risk factors of one-year prognosis were analyzed by multivariate Logistic regression analysis.The sensitivity and specificity of the serum values of Nesfatin-1to the one-year prognosis were analyzed by receiver operating characteristic (ROC) curve.Results:Compared with before treatment, the LSSS scores and the serum Nesfatin-1levels of the patients in two groups were decreased with the increasing of treatment time (P＜0.05) .The LSSS scores and the serum levels of Nesfatin-1of the patients were not different between two groups before treatment (P＞0.05) .The LSSS scores and the serum levels of Nesfatin-1of the SE patients in survival group were lower than these in death group from the end of the 1st week after treatment to the end of the 1st month after treatment (P＜0.05or P＜0.01) .The positive correlations of the serum levels of Nesfatin-1and the LSSS scores of the patients at each time point were confirmed (r=0.617-0.726, P＜0.05) .The serum high level of Nesfatin-1was the risk factor of the one-year prognosis analyzed by multivariate Logistic regression analysis.The ROC curve identified the cutoff level of serum Nesfatin-1 (2.7μg·L-1) to the one-year prognosis with the sensitivity of88.5％and specificity of 79.6％.Conclusion:The dynamic variety of serum Nesfatin-1can reflect the condition of illness, and the serum level of Nesfatin-1is decreased gradually with the prolongation of time, and has application value in predicting the prognosis of the patients with epileptic seizure.

A case of epileptic seizure due to lidocaine local anesthesia

Lidocaine is an amide-structured local anesthetic commonly used in practice in anesthesiology. Because of its rapid onset, it is frequently used in topical and infiltration anesthesia, regional blocks, regional intravenous anesthesia (RIVA) and general anesthesia to suppress hemodynamic responses to intubation, as well as some cardiac arrhythmias and epileptic seizures. Here, we present a case with seizures and impaired consciousness following iv lidocaine treatment during sedoanalgesia without a history of epilepsy. A thirty-seven-year-old female patient, who was scheduled for a cervical biopsy operation in the Gynecology and Obstetrics clinic, developed a loss of consciousness due to lidocaine with tonic-clonic epileptic seizures during treatment with sedoanalgesia. The patient was intubated with 2 mg midazolam, 200 mg propofol and 50 mg rocuronium intravenously, while oxygen was provided by mask at 6 liters / min. Anesthesia was maintained with 4 lt / min 50% oxygen and 50% air mixture and 2% sevoflurane. There were signs of respiratory acidosis in the blood gas analysis. She was intubated for half an hour by a mechanical ventilator. The operation was canceled. In blood gas monitoring the values were within normal limits. Sugammadex was applied by the gynecology and obstetrics department. In all cases where local anesthetic is planned, necessary precautions should be taken to cope with rare complications

Valoración del niño con una primera crisis no provocada / Evaluation of a child with a first unprovoked seizure

Los episodios paroxísticos son uno de los trastornos neurológicos más frecuentes en niños. Es importante diferenciar entre los trastornos paroxísticos no epilépticos, las crisis sintomáticas agudas, las crisis febriles y las crisis no provocadas. La historia clínica permite, en la gran mayoría de los casos, poder llegar al diagnóstico. Las crisis no provocadas únicas son frecuentes en el niño. La tasa de recurrencia tras una primera crisis no provocada varía entre un 23-96% en los dos años siguientes a la primera crisis. El objetivo de este trabajo es describir cómo evaluar al paciente con una primera crisis no provocada y revisar el valor predictivo de los distintos factores de riesgo de recurrencia. Entre dichos factores de riesgo, se evalúan datos como la presencia de antecedentes familiares de epilepsia, historia previa de crisis febriles, edad de debut, tipo de crisis, presencia de crisis prolongadas o crisis agrupadas, crisis de presentación en sueño, anomalías neurológicas, evidencia de una etiología definida, y presencia de anomalías epileptiformes en el electroencefalograma. Los factores de riesgo de recurrencia más importantes son la etiología de las crisis y la presencia de anomalías epileptiformes en el electroencefalograma.

Paroxysmal episodes are one of the most common neurological disorders in children. It is important to distinguish between paroxysmal non-epileptic events, symptomatic seizures, febrile seizures, and unprovoked seizures. Patient's history is the key to proper diagnosis in most of the cases. A single unprovoked seizure is a frequent phenomenon in the pediatric population. Studies of recurrence after a first unprovoked seizure show percentages between 23% and 96% over a median follow-up of two years. The aim of this study is to define how to evaluate the first unprovoked epileptic seizure in a child and to review the weight of the different recurrence risk factors. Several factors enable us to predict the recurrence risk after a first unprovoked seizure including family history of epilepsy, prior history of febrile seizures, age at onset, type of seizure, prolonged seizures at onset, multiple seizures in a single day, sleep state, neurological abnormalities, etiology, and abnormalities in the electroencephalogram. The most important of these risk factors are the etiology of the seizures and the evidence of epileptiform abnormalities in the electroencephalogram.

Primera crisis epiléptica en pediatría: evaluación clínica y manejo / First epileptic crisis in pediatrics: clinical evaluation and management

Las crisis epilépticas en Pediatría son un importante motivo de consulta. En este artículo se revisará la importancia de la primera crisis epiléptica, cómo enfrentarse a esta situación desde los antecedentes y el examen físico, diagnósticos diferenciales y además se revisará el manejo de la crisis en urgencia y su posterior estudio.

Pediatric seizures are a major complaint. In this article the importance of the first seizure is reviewed, how to deal with this situation from the history and physical examination, and further management and study will be reviewed.

Anticonvulsant effects of medicinal plants with emphasis on mechanisms of action

Epilepsy is a disorder in brain in which clusters of nerve cells, or neurons, occasionally signal abnormally and cause strange emotions, sensations, and behavior, or sometimes muscle spasms, convulsions, and loss of consciousness. Neurotransmitters in central nervous system greatly affect and play a very important part in neuronal excitability. Traditional treatments are still a component of health care system in many communities despite the fact that well-established alternatives are available. In this review article, we addressed epilepsy and its treatments with emphasis on medical plants and introduction of antiepileptic plants and their action mechanisms. Relevant articles published since 2010 were retrieved using the search terms including epileptic seizure, anticonvulsant, me-dicinal plants, and oxidative stress. Most plants/herbal preparations that are ethnomedi-cally used to treat epilepsy or those which have been tested for anticonvulsant activity were reported. Overall, the results of the published articles show that the symptoms of epilepsy seizure can be inhibited or treated by active ingredients derived from medicinal plants.