A rare case of post-ictal diffuse alveolar hemorrhage due to seizures

Diffuse alveolar hemorrhage is persistent or recurrent pulmonary hemorrhage that occurs due to a variety of causes. Here, we present the case of a 15-year-old male child who presented with chief complaints of involuntary jerking movements of the entire body in the morning followed by coughing out a massive amount of blood. At presentation, the patient’s blood glucose level was high. Bronchoscopy revealed bleeding in the middle and lower lobes of both lungs. Computed tomography (CT) brain was suggestive of cerebral edema and the CT chest was suggestive of diffuse opacities in bilateral lung fields. The patient was started on corticosteroids, antiplatelet drugs, antiepileptics, insulin, and oxygen inhalation which helped the patient to recover and was discharged in a week’s time.

Application of 18F-flurodeoxyglucose positron emission tomography in patients with status epilepticus / 中华神经科杂志

Status epilepticus is a neurological emergency with unknown pathogenesis, controversial treatment options, and poor prognosis. In recent years, with the development of 18F-flurodeoxyglucose positron emission tomography ( 18F-FDG PET) imaging technology, further studies on status epilepticus have been carried out from the perspective of molecular metabolism. This article reviews the current role of 18F-FDG PET in patients with status epilepticus on etiology, disease activity, electric activity, location of epileptogenic foci, and prognosis evaluation.

Clinical features of infants with breath-holding spells and the characteristics of electroencephalogram as well as heart rate during the episode / 中华实用儿科临床杂志

Objective:To analyze the electroencephalogram (EEG) characteristics, heart rate (HR) changes and clinical characteristics during the episode of breath-holding spells(BHS), thus providing refe-rences for the differential diagnosis of infants with BHS.Methods:This was a retrospective single-center analysis involving consecutive 14 infants with HBS admitted in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from November 2016 to December 2019.Results:A total of 16 episodes of crying-induced BHS were detected in the EEG of 14 infants, of which 3 were mild episodes without loss of consciousness and 13 were severe episodes with loss of consciousness.During the mild episodes, EEG presented a phase with slow-slow mode, and the average duration of each phase was (23.3±5.8) s and (16.7±5.8) s, respectively.In addition, the average recovery time from unconsciousness in 13 severe episodes was (16.7±12.3) s. Among the 13 severe episodes, EEG of 12 episodes presented a phase with slow-flat-slow mode, and the average duration of each phase was (26.4±8.5) s, (8.0±5.1) s and (84.6±46.6) s, respectively.Besides, the second slow wave phase usually started by the generalized delta rhythm with predominance in leads of anterior brain, with the average duration at (6.7±1.5) s. During the 16 episodes of BHS, cyanosis occurred in the first phase of slow wav, and loss of consciousness occurred in the flat phase.Transient bradycardia was observed in the second slow wave phase of 7 episodes, the first slow wave phase of 4 episodes and the flat phase of 2 episodes.Conclusions:Typical EEG pattern of in infants with mild BHS is slow-slow mode, and most of them with severe BHS is slow-flat-slow mode.In the first slow wave phase, slow wave always evolves rapidly.The unconsciousness mostly occurs in the flat period, the lasting time of which is closely related to the duration of the flat phase.The generalized delta rhythm with predominance in leads of anterior brain mostly starts in the second slow wave phase.A brief bradycardia often accompanies with the episodes of BHS in infants.

A Study of Clinical Profile of Headache in Epilepsy Patients

Background: Headache is the most common symptom encountered in neurology outpatient department (OPD). One-fifth of patients in neurology clinics present with headache. Headache was long been found to be associated with epilepsy, especially migraine both chronic neurologic disorders share possible clinical interrelationships. Studying their association is necessary as identification of clinical subgroups vulnerable to develop to both disorders can be made possible in the future. Aims and Objectives: The objective of the study was to analyze the characteristic features of various types of headaches in epilepsy patients and their causal association. Materials and Methods: A total of 100 epilepsy patients with headache were recruited from the OPD of the neurology department in a tertiary care center and interviewed regarding the characteristic features of headache through a questionnaire. Results: Out of our study population, female outweighs the male (53, 47). Out of all, interictal was more prevalent (57%), followed by post-ictal (48%), pre-ictal (22%), and intra-ictal (0%) among epilepsy patients. Migraine was found to be the most common type of headache in all subgroups of headaches in epilepsy patients (pre-ictal – 77% of migraine, postictal – 81% of migraine, and interictal – 61% of migraine). Associated characters of headaches such as photophobia (42%) and their prevalence are also studied. Conclusions: Stronger association between migraine and headache is validated, and the strongest associated with migraine in postictal headache is highlighted (81%). This can strengthen the theories proposed so far such as the frequent triggering of headache by a seizure. Further research on common etiologic or pathophysiological processes to these associations can lead to a common therapeutic strategy and prevention of morbidity in patients.

Panayiotopoulos syndrome: a clinico-electroencephalographic presentation of three cases from Nigeria

Panayiotopoulos syndrome (PS) is a common benign, childhood, focal, seizure susceptibility syndrome presenting with mainly focal aware or focal impaired awareness autonomic seizures and autonomic status epilepticus that is under diagnosed in our locality. Increased awareness through reporting will aid diagnosis, reduce misdiagnosis and prevent aggressive and deleterious interventions. The classic clinical and electroencephalographic (EEG) features of three cases are described and the literature reviewed. The aim is to underscore the presence in our locality of this remarkably benign epileptic syndrome that must be differentiated from febrile seizures, encephalopathy, migraine or cardiogenic syncope.

Characteristics of Nystagmus during Attack of Vestibular Migraine / 대한평형의학회지

OBJECTIVES: The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders. METHODS: This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p<0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups. CONCLUSION: Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.

Episodios Ictales: Descripción de un Caso Clínico / Ictal events: a case report

Caso clínico de una paciente de once años que debuta con episodios de pérdida de tono y luego hipersomnolencia. Consulta en reiteradas ocasiones con el diagnóstico de epilepsia, con estudios electroencefalográficos y resonancia magnética cerebral, normales. Tratada durante un año con ac. valproico. Posteriormente se indica realización de Polisomnograma y Test de latencias múltiples de Sueño, confirmándose diagnóstico de narcolepsia y un trastorno del ánimo. Se inicia tratamiento con psicoestimulantes y antidepresivos. Evoluciona, con una mejoría de su cataplejía, hipersomnia y aspecto anímico. Se analiza caso, como diagnóstico diferencial de niños con episodios de pérdida de tono muscular e hipersomnolencia diurna, con conservación de conciencia y además se discute el manejo y las comorbilidades asociadas.Palabras claves: Episodios ictales, hipersomnolencia, narcolepsia, cataplejía, síncope

Summary: Case report of an eleven year old patient who debuts with hypersomnolence and episodes of muscle tone loss. She repeatedly receives a diagnosis of epilepsy, with normal EEG studies and brain MRI. She received a 12 month course of valproic acid treatment. A polysomnogram and multiple sleep latency test were subsequently performed, confirming a diagnosis of narcolepsy and a mood disorder. She begins treatment with antidepressants and psychostimulants. At follow up, she shows an improvement of her cataplexy, hypersomnia and mood disorder.We analyze this case to consider this pathology in the differential diagnosis of children with daytime hypersomnolence and episodes of muscle tone loss, with conserved awareness, as well as to discuss management and associated comorbidities. Key words: Ictal hypersomnolence, narcolepsy, cataplexy, syncopal episodes.

Verification of dipole fit source localization in patients with epilepsy using postoperative MRI

@#Objective: Dipole fit source (DFS) localisation is a non-invasive imaging process used to identify the epileptogenic zone (EZ) in the brain. The purpose of the present study was to verify the use of DFS localisation for identifying the EZ in patients with and without lesions using magnetic resonance imaging (MRI). Methods: In this study, DFS localisation was used in 16 patients, of whom 7 had no lesions and 9 had lesions on MRI post-surgery, with at least 3 years of follow-up data. For DFS localisation, different scalp electroencephalogram (EEG) ictal activity was assessed (ictal spikes, rhythmic, paroxysmal fast, and obscured activity). DFSs were superimposed with postoperative MRIs to confirm the accuracy of the determined EZs. Results: The DFS correctly identified EZ localization within the resection area in 14 of the 16 patients. These 14 patients were all seizure free after surgery. The two remaining patients, in whom the DFS was adjacent to the resected area, had a decreased seizure frequency following surgery.Conclusions: DFSs determined during preoperative evaluations can provide information on EZ lateralisation and localisation and contribute to the presurgical decision process. Thus, the accurate identification of EZ boundaries is important and can be achieved more reliably with the use of multiple quantitative EEG analysis methods.

Transient Abnormalities on Magnetic Resonance Imaging after Absence Seizures / 대한소아신경학회지

Magnetic resonance imaging (MRI) is recommended for patients with epileptic seizures to rule out an underlying focal lesion. However, abnormalities in idiopathic generalized epilepsy, including childhood absence epilepsy, cannot usually be identified using brain imaging modalities such as MRI. Peri-ictal MRI abnormalities have been most commonly reported secondary to status epilepticus and are rarely observed in patients with focal seizures and generalized tonic-clonic seizures. Transient peri-ictal MRI abnormalities in absence epilepsy are extremely rare. A five-year-old girl presented with a three-day history of absence seizures that persisted despite continued treatment with sodium valproate. Electroencephalography showed bursts of generalized 3-Hz spike-and-wave discharges, during and after hyperventilation. Abnormal cortex thickening in the left perisylvian region was detected on T2-weighted brain MRI, and cortical dysplasia or a tumor was suspected. The patient started treatment with lamotrigine and was seizure-free after one month. The abnormal MRI lesion was completely resolved at the two-month follow-up. We report on a patient with childhood absence epilepsy and reversible brain MRI abnormalities in the perisylvian region. To our knowledge, this is the first report of transient MRI abnormalities after absence seizures. Transient peri-ictal MRI abnormalities should be considered for differential diagnosis in patients with absence seizures and a focal abnormality on brain MRI.

Ictal Asystole Caused by Epileptic Seizure due to Brain Metastases

<p>Bradycardia or asystole during epileptic seizure are referred to as ictal bradycardia syndrome. Ictal asystole is very rare, and there is no report about ictal bradycardia syndrome caused by brain metastases. A 62-year old man was diagnosed as having lung cancer and had multiple brain metastases. The patient had no history of epilepsy and syncope. The patient developed cardiac asystole with sinus arrest for up to 16 seconds. The bradycardia was associated with other signs and symptoms, including abdominal pain, nausea, low blood pressure, sinus arrest, decreased level of consciousness, and staring at a single point. Electroencephalograms showed multiple sharp waves. Repeated seizures, ictal asystole, and coexisting symptoms disappeared after improved treatment of brain metastases by radiation therapy. Therefore, a diagnosis of ictal asystole caused by brain metastases was made. There is no recommended treatment for ictal bradycardia syndrome. However, in the case of ictal bradycardia syndrome caused by brain metastases, treatment of the metastatic tumor might be useful. When patients with cancer present with syncope or sick sinus syndrome, we should consider the possibility of cardiac arrest caused by an epileptic seizure.</p>

Ictal EEG Non-linear And High Order Spectral Analysis Methods In Electroconvulsive Therapy And Its Clinical Utility.

Introduction: Analysis of ictal electroencephalogram (EEG) during electroconvulsive therapy (ECT) early in the course provides information to predict clinical outcome. Previous studies used visual, power spectral and non linear methods to analyze EEG. EEG signals are non stationary, non linear, non Gaussian and chaotic in nature. Such signals can be better characterized by non linear and higher order spectrum analysis. However there is scarcity of data assessing such measurers in predicting clinical outcome. We conducted nonlinear and high order spectrum analyses of ictal EEG recorded during ECT and correlated the measures with clinical outcome. Methods: Schizophrenia patients receiving ECT were assessed using the brief psychiatric rating scale (BPRS) before and 2 weeks after the start of ECT. EEG was recorded during seizure from left frontal-pole (FP1) channel. In 26 patients, completely artifact-free EEG was available. Approximate entropy (ApEn), Sample entropy (SamEn), Hurst exponent (H), Bispectrum entropy (HOS.En), correlation dimension (CD) and Largest Lyapunov exponent (LLE) were computed for EEG from the earliest ECT session (2nd or 3rd). Results: HOS.En emerged as a significant measure which predicted outcome at two weeks (HOS En1: r = - 0.434; p = 0.027 & En2: r = -0.414; 0.036) other measures, viz., ApEn (r = -0.001; p = 0.995), SampEn (r = - 0.152; p = 0.458), H (r = 0.123; p = 0.549), CD (r = 0.119; p = 0.563) and LLE (r = -0.293; p = 0.146) did not predict the outcome. Conclusion: In patients with schizophrenia receiving ECT higher bispectrum entropy of ictal EEG early in the ECT course predicts better clinical outcome at the end of two weeks. None of the other non linear measures evaluated in the study predicted clinical outcome.

Hipermetabolismo temporal izquierdo en síndrome de Landau-Kleffner demostrado con PET F18-FDG: reporte de un caso con remisión metabólico-clínica postratamiento / Left temporal hypermetabolism detected in Landau-Kleffner syndrome with F18-FDG PET/CT: report of a case with metabolic and clinical remission after treatment

Brain F18-FDG Positron Emission Tomography (PET) has been used for studying focal epilepsy, with high sensitivity in detection of epileptogenic foci, even with normal magnetic resonance imaging (MRI). Some cases of Landau-Kleffner Syndrome (LKS) have shown PET abnormalities, mostly showing uni- or bilateral temporoparietal hypometabolism, although a heterogeneous group of alterations have been described. We report a case of LKS with a left hypermetabolic temporo-occipital area that responded to treatment, with clinical improvement and remission of PET hypermetabolic focus.

La positron emission tomography (PET) cerebral con F18-FDG ha sido utilizado para estudiar epilepsias focales con alta sensibilidad en la detección del área epileptógena, aun con resonancia magnética (RM) normal. La PET ha mostrado positividad en algunos casos de síndrome de Landau-Kleffner (SLK), la mayoría de las veces evidenciando hipometabolismo temporoparietal uni o bilateral, aunque un grupo heterogéneo de alteraciones asociadas ha sido descrito. Presentamos un caso de SLK con un área hipermetabólica temporooccipital izquierda, que respondió al tratamiento, con mejoría clínica y regresión del foco hipercaptante a la PET.

Recurrent Syncope Triggered by Ictal Asystole

No abstract available.

Refractory nonconvulsive status epilepticus in coma: analysis of the evolution of ictal patterns / Estado de mal epiléptico não convulsivo refratário no coma: análise da evolução dos padrões ictais

OBJECTIVE: Nonconvulsive status epilepticus (NCSE) is currently considered as one of the most frequent types of status epilepticus (SE). The objective of the present study was to identify the natural history of the electrographical evolution of refractory NCSE and to establish the relationship between ictal patterns and prognosis. METHODS: We analyzed, retrospectively, 14 patients with loss of consciousness and NCSE. The ictal patterns were classified as discrete seizures (DS), merging seizures (MS), continuous ictal discharges (CID), continuous ictal discharges with flat periods (CID-F), and periodic lateralized epileptiform discharges (PLEDs). RESULTS: The ictal patterns were DS (n=7; 50.0%), PLEDs (n=3; 1.4%), CID (n=2; 14.3%), MS (n=1; 7.1%), and CID-F (n=1; 7.1%). CONCLUSIONS: NCSE electrographic findings are heterogeneous and do not follow a stereotyped sequence. PLEDs were related to a higher probability of neurological morbidity and mortality.

OBJETIVO: Estado de mal epiléptico não convulsivo (EMENC) é atualmente considerado uma das formas mais frequentes de estado de mal epiléptico. O objetivo deste estudo foi identificar a história natural da evolução eletrográfica do EMENC refratário, bem como estabelecer relações entre padrões ictais e o prognóstico. MÉTODOS: Foram analizados, retrospectivamente, 14 pacientes com comprometimento da consciência e EMENC. Os padrões ictais foram classificados em crises isoladas (CI), crises subintrantes (CS), descarga ictal contínua (DIC), descarga ictal contínua com períodos de atenuação (DIC-A) e descargas epileptiformes periódicas lateralizadas (PLEDs). RESULTADOS: Os padrões ictais observados foram CI (n=7; 50,0%), PLEDs (n=3; 1,4%), DIC (n=2; 14,3%), CS (n=1; 7,1%) e DIC-A (n=1; 7,1%). CONCLUSÕES: Achados eletrográficos no EMENC refratário são heterogêneos e não obedecem a uma sequência estereotipada. As PLEDs estão associadas à maior probabilidade de morbidade e mortalidade neurológica.

Indução prévia de LTP na via CA1-córtex pré-frontal medial de ratos bloqueia os prejuízos de plasticidade pré-sináptica induzidos por modelo de psicose pós-ictal in vivo / Prevention of the CA1-mPFC pre-synaptic plasticity impairments in a post-ictal psychosis model 'in vivo'

O objetivo do presente trabalho foi testar se a indução de potenciação de longa duração (LTP) no córtex frontal seria capaz de bloquear os efeitos depressores sobre a plasticidade pré-sináptica da via hipocampo (CA1)-córtex pré-frontal medial (mPFC) induzidos por pós-descarga no hipocampo (AD; atividade epiléptica) ou pela injeção sistêmica de cetamina (KET; modelo farmacológico de psicose). Ratos anestesiados com uretana receberam implantes de eletrodos de estimulação e registro, em CA1 e mPFC, respectivamente. Estímulos elétricos monofásicos pareados foram aplicados em CA1 a cada 20s para eliciar potenciais pós-sinápticos de campo (P1 e P2) no mPFC. Avaliamos a plasticidade de curta duração através da facilitação por pulso pareado (PPF), definida pela razão entre as amplitudes de P2 e P1. Após 90min de registros de linha de base, grupos independentes de animais receberam aplicação de AD, injeção de KET-S(+) (12,5 mg/kg i.p.) ou injeção de veículo (NaCl 0,15M), e foram registrados por mais 120min. Em outro experimento registramos 30min de linha de base e aplicamos estímulos de alta frequência (HFS) para indução de LTP aos 30 e 60min. Trinta minutos depois, os animais receberam KET, AD ou veículo e tiveram seus potenciais corticais registrados por mais 120 min. Nossos resultados mostram que AD gera significativa redução (-50%) da eficiência de transmissão basal na via CA1-mPFC, enquanto KET promove leve aumento (+10%). Ambos os tratamentos também promovem prejuízo significativo da PPF na mesma via (-15%). Além disso, observamos que a indução prévia de LTP atenua as alterações da eficiência basal e bloqueia os prejuízos da PPF na via CA1-mPFC induzidos por KET e AD. Nossos achados reforçam evidências recentes de que moduladores alostéricos positivos de NMDA e AMPA atenuam os prejuízos cognitivos em modelos animais de psicose. Acreditamos, portanto, que a aplicação prévia de HFS na região CA1 do hipocampo pode ser uma ferramenta útil para melhor entendermos como prevenir os prejuízos de plasticidade sináptica no mPFC em modelos de psicose e psicose pós-ictal.

The present work aimed to test whether the induction of cortical long-term potentiation (LTP) was able to prevent the presynaptic plasticity impairment in the hippocampus (CA1)-medial prefrontal cortex (mPFC) pathway induced by hippocampal after-discharge (AD; epileptic activity) or systemic injection of ketamine (KET; pharmacological model of psychosis). Electrodes were stereotaxically positioned into CA1 and mPFC in urethane-anesthetized rats. Monophasic paired-pulses of electrical stimuli were applied to CA1 in order to evoke field post-synaptic potentials (P1 and P2) in the mPFC every 20s. Short-term plasticity was evaluated by measuring paired-pulse facilitation (PPF), defined as the amplitude ratio P2/P1. After 90min of baseline recordings, three independent groups of animals received hippocampal-AD, KET-S(+) (12.5mg/kg, i.p.) or vehicle (NaCl 0.15M) followed by 120min of evoked response monitoring. In an additional experiment, two applications of high-frequency stimuli (HFS) were given at 30 and 60min after baseline. Thirty minutes after the second HFS, the rats received KET, AD or vehicle and their cortical evoked potentials were monitored for further 120min. Our results showed that AD significantly decreased (-50%) whereas KET enhanced (+10%) CA1-mPFC basal synaptic transmission. In addition, AD and KET similarly impaired short-term plasticity in the mPFC (-15%). Interestingly, pre-induction of LTP in the mPFC prevented the PPF disruption induced by KET and AD. Altogether, our findings support recent evidences that positive allosteric modulators of NMDA and AMPA receptors attenuate cognitive impairments in animal models of psychosis. We believe that controlled HFS in CA1 can be a useful tool to better understand how to prevent synaptic plasticity disruptions observed in experimental models of psychosis and pos-ictal psychosis.

Ictal patterns in children: an illustrated review / Padrão ictal em crianças: uma revisão ilustrada

Detailed knowledge of electroencephalographic patterns accompanying epileptic seizures in children is paramount to the correct identification of epileptic seizures and syndromes. In this article, we present a review of ictal patterns of different seizure types in children, illustrating with examples collected in our video-EEG laboratory at Pequeno Príncipe Hospital.

O conhecimento detalhado dos padrões eletrencefalográficos que acompanham crises epilépticas em crianças é essencial para a correta identificação de crises e síndromes epilépticas. Neste artigo apresentamos uma revisão dos padrões ictais de diferentes crises em crianças, ilustrando com exemplos coletados na nossa unidade de vídeo-eletrencefalograma no Hospital Pequeno Príncipe.

Cardiovascular Autonomic Dysfunction in Migraine Attack

BACKGROUND: There has been proposing reports that the autonomic nervous system (ANS) is involved in the pathophysiological mechanism of migraine. However, previous reports suggesting ANS dysfunction during migraine attack was not consistent and were focused mainly on comparison between migraine patients in interictal period and normal controls. The current study is designed to evaluate quantitative evidence of ANS dysfunction by comparing patients in ictal period with those in interictal period. METHODS: We prospectively included 30 migraineurs in ictal period and 30 migraineurs in interictal period from August 2008 to August 2009. Sympathetic function was evaluated by blood pressure response to standing and isometric exercise. Parasympathetic function was evaluated by heart rate response to deep breathing, standing and the Valsalva maneuver. RESULTS: In orthostatic test, falling of systolic blood pressure (SBP) after standing was prominent in ictal group. Although both groups showed elevation of diastolic blood pressure (DBP) after standing, the change was smaller in ictal group than intercital group. Elevation of DBP after isometric exercise was lower in ictal group without statistical significance. Results of parasympathetic function test were not significantly different between ictal and interictal patients. CONCLUSIONS: This study suggests that subjects with migraine had sympathetic hypofunction during migraine attack.

Current-source Analysis of Interictal Spikes in a Patient With Ictal Crying

Ictal crying has been associated with ictal activities in the medial frontal or medial temporal area of the nondominant hemisphere. We applied current-source analysis to the interictal spikes of a patient with episodes of ictal crying without sad feelings, but fear sensation. The current sources were in the medial frontal area of both cerebral hemispheres, the temporal area and the posterior cingulate gyrus of the right hemisphere.

Peri-ictal Heart Rate Changes in Patients With Localization-Related Epilepsy

BACKGROUND: Epileptic seizures can be associated with changes in autonomic functions. This study evaluated heart rate (HR) changes at the transition from the preictal to the ictal state in patients with epileptic seizures, and investigated whether peri-ictal HR changes can help to predict electroencephalography (EEG) seizures prior to their onset. METHODS: We retrospectively studied 94 seizures in 33 patients who underwent video-EEG monitoring with scalp EEG and electrocardiography. The existence and initial timing of HR changes relative to the onset of EEG seizures were determined by analyzing consecutive RR-interval changes in 10-minute recordings. We evaluated the correlation between the peri-ictal HR changes and the type of localization-related epilepsy. RESULTS: Peri-ictal HR changes were documented in 70.2% (66/94) of all seizures, of which 62 were tachycardia (66.0%) and 4 were bradycardia (4.3%). Peri-ictal tachycardia occurred significantly with seizures as an ictal manifestation, more often in seizures with a right hemispheric onset than in those with a left hemispheric onset (77.4% vs. 50%, p=0.016). Peri-ictal HR changes were observed much earlier in seizures of mesial temporal lobe epilepsy (TLE) than in those of extratemporal lobe epilepsy (-54.4 s vs. -6.7 s, p<0.001). CONCLUSIONS: Peri-ictal HR changes were observed in 70.2% of seizures, 94% of which were tachycardia. These changes could be helpful in predicting seizure onset, especially in mesial TLE.

Factores predicoores de recurrencia ictal. estudio comunitario / Predictive Factors of ictal recurrency . Communitary study

La recurrencia del ictus es causa directa de morbimortalidad, discapacidad, minusvalía e institucionalización prolongada entre los sobrevivientes a un primer evento ictal. Estimar que factores de riesgo presentan mayor valor para los eventos recurrentes, permite establecer medidas de prevención secundaria y terciaria, más individualizadas y eficientes. Se realizó un estudio poblacional analítico y prospectivo en pacientes sobrevivientes a un primer evento ictal isquémico pertenecientes al área de salud del policlínico Cristóbal Labra en el período comprendido entre enero del 2004 y enero del 2006. Se logró un seguimiento efectivo en 289 pacientes por 24 meses. Predominó el sexo masculino con 161 casos. El grupo etáreo más afectado fue el de 65 a 79 años. Se registró un total de 39 casos de ictus recurrentes para una incidencia acumulada de 0.13. Los factores de riesgo que mostraron mayor valor para el ictus recurrente fueron el hábito de fumar (OR: 1.03,IC 95% 0.60-1.78,p :0.05) hipertensión arterial (OR: 2.94, IC95%1.00-8.67, p:0,00), cardiopatía isquémica (OR:1.95,IC95%:0.76-3.02,p:0.03), la hiperlipoproteinemia (OR:2.28, IC95%-1.46-3.55,p:0.00), ATI previo, Diabetes Mellitus y la enfermedad arterial peri-férica. Las formas clínicas más relacionadas con el daño de grandes y medianas arterias prevalecieron en 66% de los ictus recurrentes; igualmente se evidenció la aterotrombosis como el mecanismo etiopatogénico más prevalerte de los ictus recurrentes. Se registró mayor porciento de recurrencias en las etapas tempranas del seguimiento y tendencia a la recurrencia en aquellos pacientes clasificados como ligeros y moderados en el índice de Katz.

Stroke recurrence is a direct cause of morbility, mortality and discapacity and lingering institucionalitatión among the survivors to a first event stroke. To estimate that factors of risk present bigger value for the recurrent events allows to establish secondary and tertiary, more individualized and efficient measures of prevention. we was carried out a populational analytic and prospective study in surviving patients to a first event ischemic stroke belonging to the area of health of the policlínico "Cristóbal it Works" in the period understood between January of the 2004 and January of the 2006. An effective pursuit was achieved in 289 patients for 24 months. The masculine sex prevailed with 161 cases. The group more affected went the one from 65 to 79 years. They registered a total of 39 cases of recurrent ictus for an accumulated incidence of 0.13. The factors of risk that showed bigger value for the recurrent ictus were the habit of smoking (OR: 1.03, IC 95% 0.60-1.78, p: 0.05) the arterial hypertension (OR: 2.94, IC95%1 .00-8.67, p:0 ,00), the ischemic (OR:1 .95, IC95%:0 .76-3.02, p:0 .03) cardiopatía the hiperlipoproteinemia (OR:2 .28, IC95%1 .46-3.55, p:0 .00), previous ATI, Diabetes Mellitus and the arterial outlying illness. The clinical forms more related with the damage of big and medium arteries they prevailed in 66% of the recurrent ictus, equally it was evidenced the aterotrombosis like the mechanism etiopatogénico more prevalerte of the recurrent ictus. the registered bigger recurrences percent in the early stages of the pursuit and tendency to the recurrencia in those patients classified as slight and moderated in the index of Katz.