Cross sectional study to determine the cognitive impairment among epilepsy patients

Background: The study was aimed to screen cognitive impairment and assess its levels among epilepsy patients, also study the prevalence and the relationships between specific seizure subtype and determine the correlation between seizure frequency, seizure duration and abnormal EEG finding with cognitive impairment among epilepsy patients.Methods: The study was conducted in a tertiary care hospital over a period of 1yr after taking informed consent from 100 patients by random sampling after fulfilling the inclusion criteria.Results: Out of 100 patients 64% did not have cognitive impairment, 36% had cognitive impairment. Among 36%, 7% had definitive cognitive impairment and 29% had mild cognitive impairment. It was observed that the other group of seizure subtypes which included atonic, myoclonic, focal sensory, focal motor, absence seizure with secondary generalization had low mean cognitive scores signifying cognitive impairment, where as those with complex partial seizure with secondary generalization group had high mean cognitive scores signifying no cognitive dysfunction. However, the observed difference is statistically significant (p<0.05). Patients who had higher seizure frequency had low mean cognitive scores indicating cognitive decline and those with very low seizure frequency had high mean cognitive scores indicating no cognitive decline. However, the observed difference is statistically significant. It was observed that the mean cognitive score for abnormal EEG patients was 24.68 indicating mild cognitive decline whereas for normal EEG patients the mean cognitive score was 26.27 indicating no cognitive decline however the observed difference is statistically significant since P<0.05.Conclusions: The high prevalence of cognitive impairment among epilepsy patients calls for early neuropsychological assessment soon after the diagnosis of epilepsy beyond that, the baseline screening may also guide treatment plan and serve as an early indicator for rehabilitative care.

MR Signal Change in a Patient with Partial Seizure and Nonketotic Hyperglycemia / 대한간질학회지

Seizures are a common presenting manifestation in patients in a nonketotic hyperglycemic(NKH) hyperosmolar state and the MR findings are typically hyperintense on T2 weighted (T2-W) and fluid attenuated inversion recovery (FLAIR) images. We recently experienced a case of the patient with partial seizure and nonketotic hyperglycemia who showed T2-W and FLAIR hypointensities with T1 weighted (T1-W) contrast enhancement.

Transient Hyperorality during Automotor Seizure in a Patient with Right Temporal Lobe Epilepsy. Epileptic Kluver-Bucy Syndrome? / 대한간질학회지

Kluver-Bucy Syndrome (KBS) is consisting of hyperorality, emotional blunting, hypersexuality, altered dietary habits, visual and auditory agnosia. It has been reported in variable neurological diseases. However, only a few cases reported in epilepsy. We report a patient with unilateral temporal lobe epilepsy who presents transient hyperorality during seizure. A 46-year-old man has complex partial seizures which were abdominal aura followed by hyperorality and hand automatisms. Hyperorality was characterized by putting patient's hand or seizure button into his mouth. Brain MRI demonstrated right hippocampal sclerosis. The interictal and ictal SPECT suggested right temporal lobe dysfunction, and PET showed bitemporal hypometabolism. Rhythmic ictal activities were arising from right temporal region when patient presented hyperorality. We speculate that transient hyperorality in this patient could be a symptom of KBS. This case suggests that transient KBS can be occurred in a unilateral temporal lobe epilepsy when ictal discharges cause bitemporal dysfunction during temporal lobe seizure.

Non-convulsive Complex Partial Status Epilepticus as a Manifestation of Non-Ketotic Hyperglycemia

Status complex partial seizure caused by non-ketotic hyperglycemia (NKH) has been known to be rare. A 42-year-old diabetic man was admitted because of abnormal behavior. Video-EEG monitoring revealed an ictal EEG correlate of this behavior. Brain MRI showed an abnormal signal intensity in the right temporal cortex. Seizures were controlled by lowering glucose levels and a follow-up MRI showed resolution of the abnormal signal. We report a case of non-convulsive status epilepticus as a complex partial seizure type by NKH.

A Case of Suspicious Focal Atonic Seizure Characterized by Drop Attack / 대한소아신경학회지

Atonic seizures exhibits loss of postural tone, resulting in head drops or falling. When this event is extremely brief, It has been known as a drop attack. Atonic seizure are firmly placed under the category of generalized seizures. However, a various phenomena satisfying the above description has been recognized in patients with partial seizures. A 13-year-old girl had brief episodes of drop attacks. She complained of weakness of both legs in the absence of consciousness loss. These episodes occurred at a frequency of 4 or 5 time per day for 1 year. Her developmental and physical examinations were normal. Also, the brain MRI was normal. However, her Interictal EEG showed the repetitive spike and wave complexes on C(z) electrode. She was controlled completedly by antiepileptic drungs. We report a patient who suffered from focal atonic seizures characterized by drop attack.

The Effects of Hippocampal Sclerosis Revealed by MRI on the Pharmacoresistance of Temporal Lobe Epilepsy / 대한간질학회지

PURPOSE: Hippocampal sclerosis is known to strongly correlate with medical intractability of temporal lobe epilepsy. However, the informations about this have been biased due to improper selection of the sampling obtained from severe cases of tertiary epilepsy center and surgical epilepsy field. We tried to investigate the influence of hippocampal sclerosis on the pharmacoresistance in temporal lobe epilepsy by group comparison study. METHODS: The fifty patients with complex partial seizures of temporal lobe origin, and temporal spike on EEG and/or hippocampal sclerosis on brain MRI were selected. Follow-up period of them were more than 2 years. The patients who had a seizure or seizures during the last 1-year period and had already been in adequate doses of two or more antiepileptic drugs were considered to be poorly controlled epileptics. RESULTS: Five of 17 patients without hippocampal sclerosis (29. 4%) and 24 of 33 patients with hippocampal sclerosis (72.7%) were poorly controlled by medication and the difference was significant (p=0.003, chi-square). Other factors, including sex, age of onset, febrile convulsion, secondary generalization, familial history of epilepsy, duration of disease, and delay of initial therapy had no significant effects on medical response (p>0.05). The only independent predictor of intractable epilepsy after multiple logistic regression analysis was also hippocampal sclerosis (p=0.005). CONCLUSION: Medical response in temporal lobe epilepsy was significantly associated with hippocampal sclerosis. Hippocampal sclerosis on brain MRI itself may be a crucial factor determining pharmacoresistance of temporal lobe epilepsy.

An Atypical Case of Aicardi Syndrome with Favorable Outcome

Aicardi syndrome is a severe congenital disorder characterized by infantile spasms, chorioretinal lacunae, and agenesis or hypogenesis of the corpus callosum. A 6 month old female had developed abnormal eye movement and seizures of the complex partial type and myoclonic type. MRI pictures of the patient revealed the presence of genu associated with agenesis of the rest of corpus callosum. A funduscopic examination revealed bilateral small, solitary, pale areas with sharp borders, some of which had minimal surrounding pigmentation (chorioretinal lacunae), especially clustered around the disc, and they were more prominent on the left side. We report here on the unusual findings of a complex partial seizure, myoclonic seizure and the atypical EEG finding in addition to the well-known characteristic clinical and imaging findings of a patient with Aicardi syndrome.

Complex Partial Seizure Like Symptoms Presented by a Patient with Insulinoma and Hyperproinsulinemia / 대한간질학회지

Insulinoma with hyperproinsulinemia and normal serum insulin level is a rare disease. Because of the neuroglycopenic symptoms, the initial diagnosis tends to be made as epilepsy or as psychosis. A 43-year-old man was admitted to our hospital because of recurrent confusional episodes. Symptoms are intermittent and consist of staring, confusion, amnesia, and bizarre behavior. Vital signs during the episode were normal but the serum glucose level was 27 mg/dl. The serum level of insulin during the episode was lower than normal and those of proinsulin and growth hormone were higher than normal. Solitary pancreatic mass was found by abdominal CT, measuring 15 mm in diameter. Pathologic evaluation showed islet cell tumor. This suggests that the serum level of proinsulin should be checked when insulinoma with neuroglycopenic symptom is suspected.

Reliability of Semiology Descriptions by Frequent Observers

BACKGROUND: Semiology of epileptic seizure is very important for diagnosis and treatment. However, little is known about the reliability of the observers' description. This study aims to determine the description reliability of seizures in the aspects of classification and lateralization. METHODS: We recorded 72 patients with habitual seizures during video-EEG monitorings. We, then, compared the ictal behaviors described by frequency observers and those recorded on the videotape to compare the accuracy of the observers' descriptions. Finally, we reviewed which aspects of the informants affected the reliability of the data. RESULTS: The classification of seizures based only on the observer-description was somewhat discordant from the videotape (correct classification: 82%) especially in dividing simple partial from complex partial seizures. Description of many ictal behaviors in presumed complex partial seizure such as oroalimentary automatism, motionless staring, tonic/clonic posture and version was accurate except for the hand automatism. A specified direction by the observer has a very high true positive rate. The accuracy of the description was related to the educational status of the observer. CONCLUSIONS: Semiology description by well-educated observers is may be reliable, but every physician should keep its limitation in mind and judge accordingly.

An Intracranial Metallic Nail Manifesting as Late Onset Epileptic Seizures / 대한간질학회지

A 32-year-old man with an intracranial nail lodged in the right temporo-occipital lobes for 21 years presented late onset epileptic seizures. His neurologic examination revealed no abnormality and electroencephalography showed only continuous slow waves localized in right temporo-occipital region. Skull X-ray showed the nail head was caught in the posterior maxillary wall and the nail body was through the temporal lobe. After removing the nail, his postoperative course was uneventful, and he has become seizure-free. The metallic nail was toxic to the adjacent brain and may have caused chronic inflammation, which may have been a cause of remote onset epileptogenesis.

Clinical Study of Effectiveness Topiramate in Children with Intractable Epilepsy

PURPOSE: Topiramate(TPM) is a new anticonvulsant with multiple action mechanisms which should theoretically represent a wide therapeutic spectrum. However, there is still little clinical experience of its use in Asian children with epilepsy. METHODS: The patients were total 96 children who were treated with more than 2 anticonvulsants but poorly controlled seizure activity. TPM was given as add-on therapy and evaluated the efficacy and adverse events prospectively. This study consisted of 8 weeks of baseline phase, 10- 16 weeks titration phase, and 8 weeks of stabilization phase. Clinical efficacy was classified into 4 groups : disappearance, marked improvement, improvement, no improvement. RESULTS: When TPM was prescribed, a response of >50% reductions in seizure attacks was seen in 90.6% of cases(95.5% of partial type epilepsy) and disappearance was seen in 67.7% of cases (83.3% of generalized type epilepsy). Concommitent with the larger number of anticonvulsants a longer duration of epilepsy and more frequent seizure attack was showed more lower disappearance rate of seizure attack. Adverse event weight loss(9.4%), somnolence(7.3%), dizziness(5.2%), skin rash, decreased cognitive function, nocturia(3.1%) and headache(2.1%) were noted, but were mostly not serious. CONCLUSION: TPM seems to be a promising new broad-spectrum anticonvulsant, which is efficacious and safe in children with intractable epilepsy.

Use of Risperidone in a Patient with Psychotic Disorder due to Complex Partial Seizure: A Case Report / 대한정신약물학회지

A new atypical antipsychotics, risperidone has been shown to be an effective drug in the treatment of schizophrenia and other psychotic disorders. We present a case report of successful treatment in a psychotic patient with complex partial seizure. A case history, of 26-year-old women in whom psychotic symptoms due to temporal lobe epilepsy was successfully treated with risperidone and anticonvulsants, is presented. A prospective clinical trial of risperidone with a randomized controlled design in patients with epileptic psychosis is warranted.

Modulation of Interictal Spikes by Sleep Structure in Complex Partial Seizure

We analyzed interictal spikes of complex partial seizure by two parameters of sleep structure. They are macrostrure and microstructure of sleep. The macrostructure of sleep is traditional parameter and includes REM and NREM sleep. The microstructure of sleep is recently identified modalities of arousal control during NREM sleep: (a) the cyclic alternating pattern (CAP) expressed by alternating and successive phasic fluctuation of sleep; and (b) non-CAP(NCAP) characterized by prolonged stable periods of EEG. We performed polygraphical analysis of extended daytime-sleep of eight patients with complex partial seizure. The mean spike index(SI) was 4.9+3.6. The percentage of CAP time in total NREM was 50.7+5.8 and phase A in CAP time was 32.5+4.2. Significant increase in discharge rates was observed in NREM compared with REM sleep (pO. 05). Spiking activities were significantly enhanced during CAP sleep. Patients showed significant SI differences between CAP and NCAP sleep (p

Electroencephalographic, Behavioral and Pathologic Characteristics in Experimental Complex Partial Seizure Induced by Microinjection of Kainic Acid into the Unilateral Amygdala in the Rat

Kainic acid(KA) is an excitotoxic analogue of glutamate which is now widely used in the studies of epilepsy. Electroencephalographic, behavioral and pathologic observation were done for 2 months after microinjection of kainic acid(Kainic acid group;0.4 microgram, 0.8 microgram, 1.2 microgram, 1.6 microgram, 2.0 microgram, 3.0 microgram) and phosphate buffer solution(Control group) into the left basolateral amygdala(AMG) in 30 Spaque-Doley rats. The control group showed no change in EEG and behavior during the observation period and pathologic findings were normal. One of four rats which 1.2 microgram of KA was injected, four of six rats of 1.6 microgram, all six rats of 2.0 microgram, one of four rats of 3.0 microgram developed acute complex partial seizure and multiple epileptic spikes with high amplitude in EEG. One of four rats of 1.2 microgram, one of six rats of 1.6 microgram, three of six rats of 2.0 microgram, showed spontaneous limbic seizure 14~21days after kainic acid injection. Among those which developed spontaneous limbic seizure, two rats demonstrated spontaneous secondarily generalized seizure 30~60days after kainic acid injection. Pathological examination revealed focal necrosis with perifocal gliosis at the tip of the cannula in the left amygdala. Neuronal cell loss was observed in the CA3 portion of pyramidal cell layer of the hippocampus on the injected side of KA, which developed spontaneous secondarily generalized seizure. But the cellular architecture was normal in the contralateral hippocampus. This is regarded as a good medel of spontaneous generalized complex partial seizure, which is similar to that of temporal lobe epilepsy in human.