Clinical Neuroscience

[Short- term video EEG analysis in a useful tool in the diagnosis of epileptic phenomena]

CLEMENS Béla1, KIRÁLY Csaba1

JULY 20, 1997

Clinical Neuroscience - 1997;50(07-08)

[Short-term (30–120 min) video- EEG recording and split-screen analysis is a very useful tool in investigating short- lasting epileptic or non- epileptic phenomena. The authors use this technique in different clinical situations as follows: frequent seizure- like episodes of suspected or proven epileptic etiology, with special reference to absence like and myoclonus- like episodes; motor manifestations, paroxysmal psychic phenomena, and fits induced by visual stimulation. Further indications were as follows: long-lasting pathological stupor states of suspected epileptic origin, long-lasting EEG discharges with unclear clinical correlations, precise analysis of partial epileptic seizures. The results show that, depending on patient selection, video- EEG analysis significantly contributed to precise diagnosis of epileptic seizures as well as to differentiation between epileptic and nonepileptic fits. In a few cases, rare, unsuspected epileptic conditions could only be identified by means of video- EEG analysis. The paper has been completed with a few brief illustrative case reports.]

AFFILIATIONS

  1. Kenézy Gyula Kórház, Neurológiai Osztály, Epilepszia Centrum, Debrecen

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Patient characteristics at the stroke unit of a clinical department of neurology during a 12-month period - methods of database management, demographic characteristics and inhospital mortality]

MIHÁLKA László, BERECZKI Dániel, FEKETE István, CSABA Béla, CSÉPÁNY Tünde, CSIBA László

[Hungary is among the countries with the highest rates of stroke mortality. Accuracy of data in international statistical reports have been crlticized by several authors. The aim of the present study was to give a methodological description of the database, to report basic patient characteristics and to discuss causes of discrepancies between national and hospital stroke morbidity and mortality data. Data from a stroke unit with a catchment area of 210 000 inhabitants were used to create a database from about 100 parameters per patient discharged from the stroke unit during a 12-month period. During this period 505 patients with acute stroke were treated at the stroke unit. Of the patients admitted 15% did not have stroke. Fatality among inpatients with acute stroke was 18.6% (n=94). Assuming that all stroke patients of the catchment area were treated at the stroke unit and that stroke mortality in the catchment area equals that of the national value, 410 deaths should have occurred at the unit. The discrepancy between the number of the expected and detected stroke fatality cases might imply that either a large number of stroke patients from the catchment area do not reach the stroke unit, or actual stroke mortality is lower in our region than the national average. To examine these hypotheses, a population based prospective study should be performed. ]

Clinical Neuroscience

[Experiences of surgically treated temporal epileptic patients - multicentre study ]

BALOGH Atilla, BORBÉLY Katalin, CZIRJÁK Sándor, HALÁSZ Péter, JUHOS Vera, KENÉZ József, VAJDA János

[Our experiences on surgically treated temporal lobe epileptic patients are presented. Involved in the disease are the process of preoperative investigations, clinical data, types of operation and their indications, and the postoperative controls. Pre- and postoperative data of 36 surgically treated, intractable temporal lobe epileptic patients were analysed. A postoperative follow-up of longer than two years was carried out on 24 patients. The experiences of these patients on postoperative seizure frequency were evaluated using Engel's classification. Among these 24 temporal lobe epileptic patients 19 are seizure free (Engel I.), the seizure frequency significantly decreased in 3 of them (Engel II.), in the case of 2 patients the number of seizures was reduced (Engel III.). Our experiences show that neurosurgical investigation seems to be an increasingly useful, alternative way for treating intractable temporal lobe epileptic patients.]

Clinical Neuroscience

[Lumbar pseudoradicular pain part 1: anatomical principles]

KASÓ Gábor, DÓCZI Tamás, DÁVID Károly

[Most low back and leg pain, caused by degenerative disorders of the lumbar spine can be classified as referred (projected) pain. One of the types of referred pain is pseudoradicular pain originating from the characteristics of innervation of the spinal motion segment. Ventral parts of the spinal motion segment are supplied by the sinuvertebral nerve and the sympathetic nervous system, while the dorsal compartment is innervated by dorsal rami of the spinal nerves and both systems show considerable segmental overlap]

Clinical Neuroscience

[Gasoline caused hexacarbon polyneuropathy - description of five cases]

VIDA Zsuzsanna, FOLYOVICH András, GÁCS Gyula

[Based on five cases a description is given n-hexane induced polyneuropathy caused by laundry cleaning gasoline, a kind of exposition that has not been published up till now. The symptoms (subacute sensomotor polyneuropathy) and the peculiar course (further deterioration after the exposition has ceased) of hexacarbon polyneuropathy caused by gasoline were similar to that of other cases induced by other n-hexane containing materials such as diluting agents, glues, lacquers etc.]

Clinical Neuroscience

[Phrenic nerve pacemaker- the first implantation in Hungary]

KLAUBER András, MORVAY Balázs, GERHARD Exner, PASI Talonen

[As a result of a traffic accident on July 15, 1994 a 20 years-old girl immediately became tetraplegic at the C2 level. She had no spontaneous respiration and she needed a respirator. The neurological status has not changed, the total spinal cord lesion has not improved. Her general condition was satisfactory after the treatment of complications (some pneumonia, decubitus, etc.). She underwent an operation on May 31, 1995 and she was given a phrenic pacemaker. The equipment has been working without any problem for fifteen months. Although phrenic nerve pacing is not new for experts, our case is worth presenting since she was the first in Hungary who survived the high cervical spine injury. She lives at home without a respirator, restrained but yet tolerably. ]

All articles in the issue

Related contents

Clinical Neuroscience

Effects of valproate, carbamazepine and levetiracetam on Tp-e interval, Tp-e/QT and Tp-e/QTc ratio

YASAR Altun, ERDOGAN Yasar

Aim - To evaluate P-wave dispersion before and after antiepileptic drug (AED) treatment as well as to investigate the risk of ventricular repolarization using the Tpeak-Tend (Tp-e) interval and Tp-e/QT ratio in patients with epileptic disorder. Methods - A total of 63 patients receiving AED therapy and 35 healthy adults were included. ECG recordings were obtained before and 3 months after anti-epileptic treatment among patients with epilepsy. For both groups, Tp-e and Tp-e/QT ratio were measured using a 12-lead ECG device. Results - Tp-e interval, Tpe/QT and Tp-e/QTc ratios were found to be higher in the patient group than in the control group (p<0.05, for all), while QTmax ratio was significantly lower in the patient group. After 3 months of AED therapy, significant increases in QT max, QTc max, QTcd, Tp-e, Tp-e/QT, and Tp-e/QTc were found among the patients (p<0.05). When the arrhythmic effects of the drugs before and after treatment were compared, especially in the valproic acid group, there were significant increases in Tp-e interval, Tp-e/QT and Tp-e/QTc values after three months of treatment (p<0.05). Carbamazepine and levetiracetam groups were not statistically significant in terms of pre- and post-treatment values. Conclusions - It was concluded that an arrhythmogenic environment may be associated with the disease, and patients who received AED monotherapy may need to be followed up more closely for arrhythmia.

Clinical Neuroscience

Management of bone metabolism in epilepsy

UÇAN TOKUÇ Ezgi Firdevs , FATMA Genç, ABIDIN Erdal, YASEMIN Biçer Gömceli

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

Clinical Neuroscience

[Personalised epilepsy treatment]

ALTMANN Anna

[Epilepsy is one of the most common chronic neurological disease in childhood. Patients with epilepsy – even with so-called benign epilepsy – need medication for years. During this time, children go through a very big change, not only gaining weight and height, but also changing hormonal and metabolic processes. Maturation processes in different brain areas also take place at different rates depending on age. All of these should be considered when preparing a therapeutic plan. In everyday practice after the diagnosis of epilepsy, the applied drug is most often selected based on the shape and type of seizure. However, a number of other factors need to be considered when designing a therapeutic strategy: 1. efficacy (form of epilepsy, type of seizure), 2. age, gender, 3. pharmacological properties of the drug, 4. adverse drug reaction profile, 5. lifestyle (community), figure (skinny, corpulent, obese), 6. other comorbidities (nutrition, behavioral and learning problems, circulatory disorders, kidney or liver disease), 7. expected interactions with other drugs already used, 8. genetics, 9. other aspects (drug registration and prescription rules). The purpose of this article is to help to decide which antiepileptic drugs are expected to have the least side effects in a particular child with different comorbidities and which medications should be avoided if possible.]

Lege Artis Medicinae

[Epilepsy in coronavirus pandemic]

SZŰCS Anna, HALÁSZ Péter, NARULA Lalit

[We aim to review the impact of COVID-19 pandemic on epilepsy and epilepsy-care. While the virus has no specific link with epilepsy, it may affect the nervous system both directly and indirectly, leading to seizures in several ways. The hyper-coagulable state occurring with the infection may cause strokes leading to seizures. The infection may first manifest in the form of disturbances of consciousness and behaviour, seizures, and even status epilepticus. The interactions of antiviral/antiepileptic drugs need to be taken into account during treatment. The hypercoagulable state induced by COVID-2 infection may cause stroke, which leads to seizures. The infection can occur also as an impaired consciousness of non-epileptic origin. Interactions of antiviral/antiepileptic drugs have also to be taken into account. The pandemic itself as well as quarantines and social distancing may cause anxiety and insomnia, challenge continuous antiepileptic supply; each one carrying the risk of seizing. Young epilepsy patients with learning disabilities and mental health issues are most vulnerable, justifying their hyper-protection. The danger of infection has highlighted the role of telemedicine. Internet-based video communication may ensure full care for chro­nic patients. Those methods favour bes­­ted patients with higher education. Epilepsy does not increase directly the risk of infection, but its comorbidities may worsen the course of the disease. Brain lesions and hypoxia, stress, insomnia and fever joining the infection increase seizure susceptibility. Because the danger of infection ma­de telemedicine an essential tool of pa­tient care, education and better computer supply for those in need is crucial. ]

Clinical Neuroscience

[The role of zonisamide in the treatment of women with epilepsy]

JUHOS Vera

[The antiepileptic drugs can effect fertility, development of gynecological diseases and occurence of sexual problems. They can cause a number of “cosmetic” problem and also influence the selection of safe contraceptive method. Many antiepileptic drugs can cause congenital malformations or affect the new-born child’s psychomotor and cognitive development, therefore during pregnancy should be treated with extreme caution in women with epilepsy. Most types of epilepsies accompany the patient through their whole life. Women spend almost the third of their lives after menopause and - due to the formation of associated diseases as well - this period is also special. According to the 2013 recommendation of International League Epilepsy (ILAE), zonisamide is one of the first-line antiepileptic drugs in focal epilepsy. In my review I discuss women’s epilepsy in the viewpoint of the application of zonisamid. ]