ObjectiveTo investigate the clinical characteristics of epileptics with pregnancy and then provide reference for standardized management of epileptics with pregnancy. MethodsFrom June 2012 to June 2021, epileptics with pregnancy who delivered in Jinan Central Hospital were selected as the research subjects. The clinical data such as the application of Antiseizure medications (ASMs) during pregnancy, seizure frequency, pregnancy outcomes, delivery ways, offspring feeding ways and the incidence of complications were investigated and analyzed. ResultsAmong 36 epileptics with pregnancy, 20 cases (55.56%) were treated with ASMs alone, 5 cases (13.88%) were treated with combined medication, and 11 cases (30.56%) were treated without ASMs during pregnancy. 15 cases (41.67%) adhered to systematic application of ASMs, 17 cases (47.22%) did not adhere to systematic application of ASMs, and 4 cases (11.11%) had unknown medication history. The frequency of seizures increased in 5 cases, decreased in 7 cases and unchanged in 24 cases during pregnancy. Pregnancy outcomes: full-term delivery in 33 cases (91.67%), preterm delivery in 1 case (2.78%) and abortion in 2 cases (5.56%). Delivery mode: cesarean section in 31 cases (91.18%), vaginal delivery in 3 cases (8.82%). After delivery, 4 cases (11.76%) were fed with milk powder and 30 cases (88.24%) were breast-fed. Complications: There were 6 cases complicated with anemia (16.67%), 5 cases complicated with gestational hypertension (13.89%), 3 cases complicated with gestational diabetes (8.33%), 4 cases complicated with premature rupture of membranes (11.11%), 2 cases complicated with fetal growth restriction (5.56%), 2 cases complicated with oligohydramnios (5.56%), 3 cases complicated with fetal distress (8.33%) and 3 cases complicated with neonatal asphyxia (8.33%). ConclusionsThe proportion of epileptics with pregnancy who were systematically treated with ASMs was low and the seizures were poorly controlled. There is a lack of standardized management for such patients in clinical practice.
ObjectiveTo investigate the efficacy and safety of the phase Ⅰ corpus callosotomy in the treatment of adult refractory epilepsy. MethodsWe conducted a retrospective analysis of 56 adults with intractable epilepsy in Tangdu Hospital from January 2011 to July 2016.All patients were treated for the phase Ⅰ total corpus callosotomy, followed up 1~5 years after surgery. Results14 cases (25.0%) patients achieved complete seizure free after surgery, 19 cases (33.9%) whose seizures reduced more than 90%, 10 cases (17.9%) reduced between 50%~90%, 7 cases (12.5%) between 30%~50%, 6 cases (10.7%) decreased below 30%; Drop attacks of 47 cases (83.9%) patients disappeared. Postoperative complications occurred in 13 cases(23.2%), and most of them recovered well. 5 cases(8.9%) had long-term sensory disassociation, no serious complications and death. The percentage of patients reporting improvement in quality of life was 67.9%. ConclusionsFor patients with intractable epilepsy who can not undergo focal resection, Ⅰ phase total corpus callosotomy has a certain effect on reducing seizure frequency, eliminating drop attacks, and improving the quality of life.
Overexcitation of neurons in brain can lead to epilepsy seizures, and the key to control epilepsy seizures is to keep the balance between excitation and inhibition. In this paper, epileptiform index is presented to denote the seizure degree and used as control variable of PID controller to control epilepsy seizures. Neural mass model (NMM) is used as a test-bed to simulate the change of seizure degree with the increase of excitatory strength and two control strategies. Experimental results showed that the increase of excitatory strength could lead to a substantial increase of epileptiform index and trigger seizures. PID controller which is used to decrease excitatory strength or increase inhibitory strength can keep excitation-inhibition balance and inhibit epilepsy seizures. Epileptiform index can describe the linear and nonlinear feature of electroencephalogram (EEG) comprehensively, and PID controller is simple and independent of underlying physiological structure, which lays the foundation for its application in the clinic.
Gelastic seizure (GS) is a type of epilepsy characterized primarily by inappropriate bursts of laughter, with or without other epileptic events. Based on the timing of symptoms, the presence of emotional changes, and disturbances of consciousness, GS is classified into simple and complex types. The generation of laughter involves two major neural pathways: the emotional pathway and the volitional pathway. The neural network involved in GS includes structures such as the frontal lobe, insula, cingulate gyrus, temporal lobe, and brainstem.The most common cause of GS is a hypothalamic hamartoma, and stereotactic electroencephalography can record discharges from the lesion itself. Surgical removal of the hypothalamic hamartoma can result in immediate cessation of GS in the majority of patients, while some may experience partial improvement with persistent epileptic-like discharges detectable on scalp electroencephalography (EEG). Early surgical intervention may improve prognosis.In cases of non-hypothalamic origin of GS with no apparent imaging abnormalities, focal discharges are often observed on EEG and these cases respond well to antiepileptic drugs. Conversely, patients with structural abnormalities suggested by imaging studies tend to have multifocal discharges and a poorer response to medication. In a small subset of medically refractory non-hypothalamic GS, surgical intervention can effectively control symptoms.This article provides a comprehensive review of the etiology, neural networks involved, EEG characteristics, and treatment options for GS, with the goal of improving understanding of this relatively rare type of epileptic seizure.
In recent years, epileptic seizure detection based on electroencephalogram (EEG) has attracted the widespread attention of the academic. However, it is difficult to collect data from epileptic seizure, and it is easy to cause over fitting phenomenon under the condition of few training data. In order to solve this problem, this paper took the CHB-MIT epilepsy EEG dataset from Boston Children's Hospital as the research object, and applied wavelet transform for data augmentation by setting different wavelet transform scale factors. In addition, by combining deep learning, ensemble learning, transfer learning and other methods, an epilepsy detection method with high accuracy for specific epilepsy patients was proposed under the condition of insufficient learning samples. In test, the wavelet transform scale factors 2, 4 and 8 were set for experimental comparison and verification. When the wavelet scale factor was 8, the average accuracy, average sensitivity and average specificity was 95.47%, 93.89% and 96.48%, respectively. Through comparative experiments with recent relevant literatures, the advantages of the proposed method were verified. Our results might provide reference for the clinical application of epilepsy detection.
Epilepsy and sleep disorders are common health problems in the world, and sleep disorders as a common comorbidity of epilepsy patients, there are high prevalence, low attention rate, low treatment rate phenomenon. In addition, epilepsy and sleep disorders can affect each other, exacerbating the onset of their own symptoms. Therefore, timely identification and treatment of these comorbidities are crucial to improve patients' quality of life, increase daytime alertness and reduce the occurrence of seizures. This article reviews the effects of different anti-seizure programs on patients with epilepsy comorbidities sleep disorders, in order to provide references for how to better choose epilepsy treatment measures for these patients.
ObjectiveThe optimal target of deep brain stimulation (DBS) for treating intractable epilepsy is still undefined. Cumulative studies suggest that the mediodorsal thalamic nucleus (MD) is involved in seizure activity, the purpose of this study was to investigate the effect of high frequency stimulation in MD on pentylenetetrazole (PTZ)-induced seizures in rats. MethodsThe experimental rats (Male Sprague-Dawley rats 280-350 g) were all provided by Experimental Animal Center, Zhejiang Academy of Medical Science, Hangzhou, China. The rats were given unilateral or bilateral stimulation of the MD at 100 Hz (HFS group) and sham stimulation, others were given unilateral stimulation of the MD at 1 Hz (LFS group). EEGs in the cortex and seizure behavior were recorded with the Neuroscan system at the same time. ResultsNeither LFS nor HFS of the MD changed the latency to the first spikes or EEG manifestations for stage 3 and stage 5 seizures; animals receiving unilateral or bilateral HFS of the MD decreased the number of stage 5 EEG seizure synchronized with the convulsive episodes; LFS and sham stimulation showed multiple periods of continuous spikes which accompanied stage 5 or stage 4 seizures. HFS of unilateral or bilateral MD, but not LFS, decreased the seizure stage, the number of clonic movement episodes, and the duration of acute PTZ-induced seizures. The average latency to onset of myoclonic jerks did not differ among groups. Unilateral and bilateral HFS of the MD had a similar antiepileptic effect. ConclusionHFS of the MD may be of value as a new antiepileptic approach for patients with generalized epilepsy, besides, the seizure model, should be fully considered in clinical application.
ObjectiveTo explore and clarify the relationship between epileptic seizure and inducing factors. Avoid inducing factors and reduce epileptic seizure, so as to improve the quality of life in patients with epilepsy.MethodsClinical data of 604 patients diagnosed with epilepsy in Xijing Hospital of Air Force Military Medical University from January 2018 to January 2019 were collected. The clinical data of patients with epilepsy were followed up 6 months.ResultsAmong the 604 patients, 318 (52.6%) were seizure-free in the last 6 months, 286 (47.4%) had seizures. 169 (59.1%) had seizures with at least one inducing factor. Common inducing factors: 123 cases of sleep disorder (72.8%), 114 cases of emotion changes (67.5%), 87 cases of irregular medication (51.5%), 97 cases of diet related (57.4%), 33 cases of menstruation and pregnancy (19.5%), etc. Using the χ2 test, seizures with age, gender differences had no statistical significance (P > 0.05), but seizure type was statistically different between inducing factors. In generalized seizures, tonic-clonic seizures associated with sleep deprivation (χ2= 0.189), absence seizures and anger (χ2= 0.237), pressure (χ2= 0.203), irregular life (χ2= 0.214). In the focal seizures, focal motor seizures was correlated with coffee consumption (χ2=0.145), focal sensory seizures with cold (χ2=0.235), electronic equipment use (χ2 =0.153), satiety (χ2 =0.257). Complex partial seizures was correlated with anger (χ2 =0.229), stress (χ2 =0.187), and cold (χ2 =0.198). The secondarily generalized seizures was correlated with drug missing (χ2 =0.231), sleep deprivation (χ2 =0.158), stress (χ2 =0.161), cold (χ2 =0.263), satiety (χ2 =0.182). Among the inducing factors, sleep deprivation was correlated with anger (χ2 =0.167), fatigue (χ2 =0.283), and stress (χ2 =0.230).ConclusionsEpileptic seizure were usually induced by a variety of factors. Generalized seizures were associated with sleep disorders, emotional changes, stress, irregular life, etc. While focal seizures were associated with stress, emotional changes, sleep disorders, cold, satiety, etc. An analysis of the triggers found that sleep deprivation was associated with anger, fatigue, and stress. Therefore, to clarify the inducing factors of epileptic seizure, avoid the inducing factors as much as possible, reduce the harm caused by seizures, and improve the quality of life of patients.
The postictal state which describes changes in behavior, motor function, and neuropsychological performance that occur after a seizure and persist until these variables return to their normal baseline, which can take anywhere from a few seconds to a few hours to a few days. The degree and intensity of the postictal state significantly affects the patient's quality of life and is strongly associated with the patient's rating of the severity of the seizure, but receives little attention in the treatment of epilepsy, and anti-seizure medications prevent postictal events by making the patient seizures-free, or will attenuate or shorten the time after the seizure. Therefore, it is of great clinical significance to evaluate the efficacy of anti-seizure medications in the post-seizure state. This article reviews the effects of the main anti-seizure medications on the postictal state
Genetic epilepsy with febrile seizures plus (GEFS+) is a new type of genetic epilepsy syndrome with a marked hereditary tendency. Febrile seizure is the most common clinical symptom, followed by febrile seizure plus, and with/without absence seizures, focal seizures, and generalized tonic-clonic seizures. Results of the polymerase chain reaction (PCR), exon sequencing and single nucleotide polymorphism (SNP) analysis showed that the occurrence of GEFS+ is mainly related to the mutation of gamma aminobutyric acid type A receptor gamma 2 subunit (GABRG2), but its pathogenesis was still unclear. The main types of GABRG2 mutations include missense mutation, nonsense mutation, frameshift mutation, point mutation and splice site mutation. All these types of mutations can reduce the function of ion channels on cell membrane, but the degree and mechanism of dysfunction are different, which may be the main mechanism of epilepsy. This article will focus on the relationship between GEFS+ and the mutation types of GABRG2 in recent years, which is of great significance for clinical accurate diagnosis, anti-epileptic treatment strategy and new drug development.