Non-convulsive seizures and non-convulsive status epilepticus monitoring in the intensive care unit. A real need for the Gulf Cooperation Council countries

Continuous EEG [cEEG] monitoring in the intensive care unit [ICU] is essential for detecting non-convulsive seizures/status epilepticus [NCSs, NCSE]. Currently there exist a number of continuous EEG monitoring systems adapted for use in the ICU. However, these systems have been trained using EEG data collected from healthy, neurologically intact patients with epileptic seizures, a very different patient population from ICU patients. The review consists of 2 parts, clinical and technological aspects. In the first one, we summarize the electroencephalographic aspects of NCSs/NCSE and other EEG patterns encountered in the ICU. In the second part, we explain how to develop a novel cEEG monitoring system to be used in Hamad Medical Corporation ICUs, Doha, Qatar, that is able to detect pathological EEG patterns commonly occurring in the critically ill patient. Real-time monitoring of seizure discharges, and other pathological EEG patterns will allow correct diagnosis and adequate treatment in a timely fashion

Short-term efficacy and safety of valproate sustained-release formulation in newly diagnosed partial epilepsy [VIPe-study]. a multicenter observational open-label study

To evaluate the efficacy and safety of valproate [VPA] sustained-released in monotherapy across all ages in newly-diagnosed epileptic patients with partial seizures [PS] with or without secondary generalization. This was a multicenter, prospective, observational, open-label, non-comparative study involving the Gulf Cooperation Council [GCC] countries except the Kingdom of Saudi Arabia, and was performed between November 2004 and May 2006. Adults and children [6 years or older with newly diagnosed partial epilepsy [PE]] with or without secondary generalization were enrolled. The primary efficacy parameter was 6 month-remission rate [proportion of seizure-free patients in relation to total number of retained patients]. Secondary efficacy parameters included: 6 month-retention rate, investigator's clinical global impression rating, maximal effective dose and safety profile. Seventy-seven patients were enrolled; 56% adults and 44% children, with average duration of epilepsy of 5 months in the pediatric and 17 months in the adult group. Seizures type distribution: PS with secondary generalization [62%], complex PS [53%] and simple PS [14%]. The majority had idiopathic seizures [48%]. Sixty-six patients completed the study [treatment retention rate 80.5%]. At 6 months, 87% of patients became seizure free with VPA sustained-release monotherapy [average dose 22 mg/kg/day]. Adverse drug reactions [hair loss and tremor] were recorded in <20% of patients, mostly affecting adults. In this population, short-term treatment with VPA sustained-release in monotherapy provides good seizure control and is well tolerated

Hemifacial spasm resulting from vertebral artery dolichoectasia

A 32-year-old man presented with left hemifacial spasm. Neurophysiological findings revealed an absent ipsilateral R1 on blink reflex. An MRI showed a dolichoectatic left vertebral artery impinging on the root exit zone of the left facial nerve. Botulinum toxin infections relieved the manifestations of hemifacial spasm. This case demonstrates that MRI/MRA is an essential part of the work-up for hemifacial spasm, and shows that in accordance with the literature, vertebral dolichoectasia is an uncommon cause of hemifacial spasm

Hemifacial spasm resulting from vertebral artery dolichoectasia

A 32-year-old man presented with left hemifacial spasm. Neurophysiological findings revealed an absent ipsilateral R1 on blink reflex. An MRI showed a dolichoectatic left vertebral artery impinging on the root exit zone of the left facial nerve. Botulinum toxin infections relieved the manifestations of hemifacial spasm. This case demonstrates that MRI/MRA is an essential part of the work-up for hemifacial spasm, and shows that in accordance with the literature, vertebral dolichoectasia is an uncommon cause of hemifacial spasm