Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy.

BACKGROUND: Valproic acid (VPA) may induce hyperammonemic encephalopathy. On the other hand, seizure-inducing effects of antiepileptic drugs (AEDs) may be a paradoxical reaction or a result of AED-induced encephalopathy (commonly induced by VPA). METHODS: We present the case of a 19-year-old male who developed acute mental status changes consistent with encephalopathy evolving into repetitive seizures with oral automatisms induced by relatively small doses of VPA. RESULTS: Although serum hepatic enzymes, such as AST and ALT, were normal, serum ammonia concentration was high, i.e. 70 micromol/l (normal range 9-33 micromol/l). Administration of VPA was discontinued immediately after admission. The patient's condition improved during the second week of hospitalization and ammonium levels returned to normal. CONCLUSION: In conclusion, although uncommon, a possible induction of non-convulsive status epilepticus by valproate-induced hyperammonemic encephalopathy should be taken into account and properly managed by discontinuation of the drug.

The impact of migraine on epilepsy: a prospective prognosis study.

The effect of migraine on the prognosis of epilepsy has not been reported. The aim of this prospective 5-10-year follow-up study was to examine some outcome measures and the cumulative probability of being seizure-free in epilepsy patients with migraine, and to compare their results with those of epilepsy patients without migraine. Fifty-nine patients (40 women; mean age 25 years) were diagnosed with both epilepsy and migraine (EM group). The control group consisted of 56 patients with epilepsy but without migraine (E group). Both groups were recruited and followed up over similar periods. We compared the outcome variables in the EM group with those in the E group. Kaplan-Meier methods were used to assess the seizure-free curves. The EM group had a significantly lower cumulative probability of being seizure-free over 10 years compared with the E group. The other epilepsy outcome measures at follow-up differed significantly between the groups, with the EM group having a longer duration of epilepsy, a lower early treatment response, and a higher incidence of intractable epilepsy and achieving remission with polytherapy, and more seizure control and medication problems for at least the last 2 years of follow-up. Comorbid migraine had a negative effect on the prognosis of epilepsy.

Status epilepticus after stroke.

BACKGROUND AND PURPOSE: objective of our study was to determine the risk and predictive factors of status epilepticus (SE) after stroke. METHODS: From 1988 to 2000, 1174 patients were admitted to the Department of Neurology at the Karadeniz Technical University Farabi Hospital with first-time strokes. Of these, 180 patients had poststroke first-time seizures (PFSs). We followed these 180 PFS patients for an average of 3.7 years or until death to determine the occurrence rate of SE. By comparing these data with those of PFS patients without SE, we investigated whether there were significant differences. RESULTS: A total of 17 of the 180 PFS patients (9%) had SE. There was no relationship between the occurrence of SE and stroke risk factors, stroke type (ischemic or hemorrhagic stroke), stroke topography and cause, cortical involvement, size of lesion, seizure type, or electroencephalographic findings. SE occurred more frequently among patients with a higher disability rating (Rankin scale >3; odds ratio, 4.36). Recurrent SE was identified in 5 of 17 patients with SE. In all 5 of these patients, the first episode of SE occurred within the first 7 days after stroke (early-onset SE). Statistical analysis demonstrated that early-onset SE was associated with a higher risk for SE recurrence (P=0.003) and a higher mortality rate (P=0.04). CONCLUSIONS: SE was not associated with a higher mortality rate but with higher functional disability. We also found that early-onset SE (within the first 7 days after stroke) was associated with a higher risk for SE recurrence and a higher mortality rate than late-onset SE (after 7 days after stroke).

Cerebral infarction following intravenous immunoglobulin therapy for Guillain-Barre syndrome.

Intravenous immunoglobulin (IVIg) therapy is used increasingly for different immune-mediated diseases, such as the Guillain-Barre syndrome. We report the case of a 55-year-old man who developed a cerebral infarction 2 days after completion of treatment with intravenous immunoglobulin for Guillain-Barre syndrome.

Cerebellar atrophy following acute phenytoin intoxication.

A 25-year-old woman was admitted to our hospital with encephalopathy and clinical signs of cerebellar dysfunction. She had recently received an overdose of phenytoin. On admission, plasma phenytoin level was high (50 microg/ml, therapeutic range 10-20 mg/ml). Magnetic resonance imaging showed no signs of cerebellar atrophy. The patient's neurological condition improved rapidly after withdrawal of phenytoin. Eight months later, the neurological examination disclosed minimal cerebellar disorders and magnetic resonance imaging showed cerebellar atrophy. Cerebellar atrophy due to acute phenytoin intoxication is very unusual but few cases have been reported. The present clinical and radiological findings suggest that short-term phenytoin overdose alone may cause cerebellar atrophy.

Migraine-related seizures in an epileptic population.

A relationship between epilepsy and migraine has long been postulated, but the nature of this interaction is still debated. We studied adult patients with epilepsy and investigated the relationship between migraine and epilepsy. Fourteen percent (n = 412) of adult patients with seizures were identified with a diagnosis of migraine. We also found a direct relationship between migraine and epilepsy (a migraine-induced epilepsy) in 1.7% (seven patients) of the patients with seizures. Patients were at increased risk for both conditions if they had migraine with aura and catamenial epilepsy. The seizure began during or shortly after the migraine aura in all of the cases and preceded the headache. Three of four patients who were refractory to management with antiepileptic drugs using either mono or combination therapy improved seizure control with combination antimigraine and antiepileptic drugs.

EEG investigation of temporal lobe epilepsy.

We report the results of the study assessing the role of electroencephalogram (EEG) in the evaluation of patients with temporal lobe epilepsy (TLE). A prospective interictal EEG study was performed in 80 patients with TLE, and the results were compared with those of neuroimaging magnetic resonance imaging (MRI) and computed tomography (CT). All patients had interictal scalp-recorded electroencephalographic monitoring with a full array of electrodes placed according to the International 10-20 Placement System, CT and MRI. Scalp EEG had a success rate of 70% in TLE patients, this rate was 50% for MRI and 15% for CT. Epileptiform EEG abnormalities were unilateral in 25 (31%) and bilateral in 31 (39%) patients. In 56% of patients with unilateral interictal activity and 97% of patients with bilateral interictal activity, epileptiform activity was localized at the temporal electrodes. The wave morphology which we most frequently saw in our study was the sharp, sharp-slow wave or spike, or spike-wave. A correlation was observed between the focal MRI-CT abnormalities and the EEG findings. We found abnormal imaging incidence in patients with unilateral EEG findings to be significantly greater than in patients with bilateral EEG findings (chi 2 = 4.62, p = .032). EEG showed abnormality in 28 (70%) of 40 patients whose neuroimaging (NI) tests were found abnormal and also did in 70% of 40 patients whose NI tests were normal. In our study EEG has remained as the most efficient test in the localization of an epileptogenic focus.