Update on first unprovoked seizure in children and adults: A narrative review.

OBJECTIVE: First seizures are always challenging for physicians. Determining etiology, risk of recurrence, need for diagnostic electroencephalogram (EEG) or neuroimaging, balancing starting anti-seizure medication (ASM) versus its potential adverse effects, and addressing patient and family concerns about social or emotional impact in lifestyle issues is always demanding. METHOD: a narrative review providing information from a database search between January 1970 to November 2020 was conducted, with the following search terms: first seizure, epidemiology, treatment, neuroimaging, electroencephalogram, impact, lifestyle. RESULTS: Incidence rates of single unprovoked seizures range from 23 to 64.1 /100000/person-years. The risk of recurrence depends on several clinical, etiological, EEG, and neuroimaging findings that should be approached on an individual basis. Initiating ASM is not generally advised, but shall be considered in individual situations. The emotional and social impact of single seizures must not be underestimated. Some interesting clues are pointing out at risks to present or prevent a first seizure. CONCLUSION: Presentation of first seizure, diagnostic workup, treatment, and impact should be considered individually based on continuously updated knowledge of treating physicians.

Gut-microbiota-directed strategies to treat epilepsy: clinical and experimental evidence.

A growing appreciation that the intestinal microbiota might exert changes on the central nervous system via the gut-brain has emerged as a new research frontier in neurological disorders. Moreover, new approaches for studying and manipulating the gut microbiome, including metabolomics and faecal microbiota transplantation, have highlighted the tremendous potential that microbes have on neuroinflammation, metabolic, and neuroendocrine signaling pathways. Despite the large proliferation of studies in animal models examining the linkage between microbial disequilibrium and epilepsy, intestinal profiles at a functional level in humans have remained scarce. We reviewed the scientific evidence on gut microbiota's role in epilepsy, both in clinical and experimental studies, to better understand how targeting the gut microbiota could serve as a diagnostic or prognostic research tool. Likewise, translating microbial molecular mechanisms to medical settings could fill the gaps related to alternative therapies for patients with epilepsy, mainly in cases with refractory phenotypes.

Periictal sign of the cross or Signum Crucis as a lateralizing sign in focal epilepsies: Not only a right temporal lobe epilepsy feature.

INTRODUCTION: The sign of the cross (SC) is a catholic ritual that has been described as an automatism during the ictal phase in patients with right temporal lobe epilepsy. OBJECTIVE: The study aimed to describe the prevalence of the SC and analyze the characteristics of patients who presented this phenomenon during the video-electroencephalography (VEEG) admission in our Epilepsy department. METHODS: This is a retrospective analysis of 1308 recorded seizures; 14 patients presented the SC during the admission. Seizure semiology, electroencephalography (EEG), etiology, neuroimaging, and surgical findings were analyzed. RESULTS: A prevalence of 1.1% was found, and the sign was not only an ictal finding (21% was postictal) but also exclusive of patients with temporal lobe epilepsy (15% were extratemporal) in contrast to what has been reported so far. The localizing and lateralizing value of the ictal SC was low (sensitivity 75%, specificity 33.3%, positive predictive value 60%, negative predictive value 50% for a right temporal epileptogenic zone (EZ)) compared with other previously described signs. Regardless of the lateralization of the EZ, the sign was always performed with the right hand supporting the hypothesis of a possible learned behavioral automatism. CONCLUSION: The SC is a rare ictal or postictal manifestation that occurs in patients with temporal and extratemporal epilepsies without clear localizing and lateralizing value compared with previously described signs.