Severe acute respiratory syndrome coronavirus 2 and seizure: An insight into the pathophysiologic mechanisms.

Based on previous studies, seizure has been reported to accompany coronavirus disease 2019 (COVID-19). Underlying mechanisms are those leading to the direct central nervous system (CNS) invasion through hematogenous spread or trans-synaptic retrograde invasion, causing meningoencephalitis. On the other hand, there are pathophysiologic mechanisms that seizure would be one of their early consequences, such as cytokine storm, hypoxemia, metabolic derangement, and structural brain lesions. Herein, we focused on available evidence to provide an insight into the pathophysiologic mechanisms that link seizure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as a better understanding of pathophysiology would lead to better diagnosis and treatment.

The Significance of Interictal Spike Frequency in Temporal Lobe Epilepsy.

Purpose. In this study, the frequency of interictal epileptiform discharges (IEDs) in patients with drug-resistant temporal lobe epilepsy (TLE) was measured to determine its correlation with epilepsy duration, seizure frequency, brain magnetic resonance imaging (MRI) findings, and recent occurrence of focal to bilateral tonic clonic seizures (FBTCS). Methods. Our study was performed on TLE patients, who admitted to epilepsy monitoring unit of Loghman-Hakim hospital, Tehran, from 2016 to 2018. The patients' IEDs frequency were measured from their scalp EEG recording during no-rapid eye movement (NREM) sleep. The IEDs frequency was classified into 3 groups of rare, occasional, and frequent. Results. A total of 142 patients, with the mean age of 33.95 ± 12.73 years, were included in the study. The patients' mean epilepsy duration was 17.27 ± 12.19 years and the mean seizure frequency was 10.56 ± 12.95 attacks per month. The mean IEDs frequency was 123.48 ± 513.01 per hour. Thirty-five (24.6%) patients had history of FBTCS in the past year. Our findings revealed no significant association between IEDs frequency with epilepsy duration (P = .22), the recent occurrence of FBTCS (P = .42), and the type of MRI abnormalities (P = .66). There was only a weak positive correlation between seizure frequency and interictal spike density (r = 0.2, P = .007). Conclusions. In patients with TLE, standard EEG recording may not be a reliable method to predict the probability of occurring future seizures.

Two predictors of postictal generalized EEG suppression: Tonic phase duration and postictal immobility period.

PURPOSE: To determine the effect of different seizure characteristics on the occurrence of postictal generalized EEG suppression (PGES). PGES is considered as a potential risk factor of sudden unexpected death in epilepsy (SUDEP) by several studies. METHODS: In this retrospective cross-sectional study, episodes of generalized convulsive seizures (GCS) were reviewed in regard to state at seizure-onset, the seizure and tonic phase durations, postictal immobility (PI) duration and whether the patient received oxygen (O2) mask during the post-ictal phase. Moreover, the presence and duration of PGES was determined for each seizure. RESULTS: Among 98 episodes of GCSs, 56 (57.1%) had PGES and 42 (42.9%) did not have PGES. The mean seizure duration for attacks with and without PGES was 106.62 ± 97.04 and 104.85 ± 91.81 s, respectively (P > 0.05). The tonic phase duration was significantly longer in PGES positive compared to PGES negative seizures (4.25 ± 3.17 s vs. 2.82 ± 3.58 s, P < 0.05). Early O2 mask administration and state of wakefulness at seizure-onset did not show any significant correlation with the presence of PGES (P > 0.05). Seizures with PGES had higher PI duration than those without PGES (156.24 s vs. 124.73 s) (P < 0.05). Interestingly, in seizures with PGES, there was a positive correlation between PI and tonic phase durations (r: 0.4, P < 0.05). CONCLUSIONS: According to our findings, higher tonic phase duration and longer PI period increased the odds of PGES formation.

Human Subconjunctival Dirofilariasis Presenting as the Daytime Photophobia: A Case Report.

We report a case of subconjunctival worm with a rare presentation of diurnal photophobia and temporal conjunctival injection. This case report describes a subconjunctival dirofilariasis in a 59-year-old man presented with foreign body sensation, localized tenderness, and eye redness during the day. After removal of subconjunctival 10 cm worm, the diagnosis was compatible with Dirofilaria immitis. Proof of identity was based on the morphological appearance, which were reliable diagnostic clues. Ocular examination was normal one month later except for faint temporal conjunctival scar. Subconjunctival dirofilariasis could present as diurnal photophobia and conjunctival injection.