Critique of the 2017 epileptic seizure and epilepsy classifications.

This article critiques the International League Against Epilepsy (ILAE) 2015-2017 classifications of epilepsy, epileptic seizures, and status epilepticus. It points out the following shortcomings of the ILAE classifications: (1) they mix semiological terms with epileptogenic zone terminology; (2) simple and widely accepted terminology has been replaced by complex terminology containing less information; (3) seizure evolution cannot be described in any detail; (4) in the four-level epilepsy classification, level two (epilepsy category) overlaps almost 100% with diagnostic level one (seizure type); and (5) the design of different classifications with distinct frameworks for newborns, adults, and patients in status epilepticus is confusing. The authors stress the importance of validating the new ILAE classifications and feel that the decision of Epilepsia to accept only manuscripts that use the ILAE classifications is premature and regrettable.

Noninvasive correlates of subdural grid electrographic outcome.

PURPOSE: To investigate reasons for patients not proceeding to resective epilepsy surgery after subdural grid evaluation (SDE). To correlate noninvasive investigation results with invasive EEG observations in a set of patients with nonlesional brain MRIs. METHODS: Retrospective study of adult epilepsy patients undergoing SDE during an 8-year period at Cleveland Clinic. Construction of semiquantitative "scores" and Bayesian predictors summarizing the localizing value and concordance between noninvasive parameters in a subset with nonlesional MRIs. RESULTS: One hundred forty patients underwent SDE, 25 of whom were subsequently denied resective surgery. In 10 of 25, this was caused by a nonlocalizing subdural ictal EEG onset. Eight of 10 such patients were nonlesional on MRI. Among all nonlesional patients (n = 34 of 140), n1 = 10 of 34 patients had nonlocalizing and n2 = 24 of 34 had localizing, subdural ictal onsets. As groups, n1 and n2 were statistically disjoint relative to their noninvasive scores. Bayesian measures predictive of focal invasive ictal EEG were highest for complete concordance of noninvasive parameters, decreasing with lesser degrees of concordance. A localizing scalp interictal EEG was a particularly good Bayesian prognosticator. CONCLUSIONS: A small but significant proportion of SDE patients are denied subsequent therapeutic resective surgery. This is due to several reasons, including a nonlocalizing intracranial ictal EEG. The majority of such patients have nonlesional MRIs. The noninvasive data may be summarized by a semiquantitative score, as well as Bayesian likelihood ratios, which correlate with subsequent invasive outcome. This approach may find use in the selection and counseling of potential surgical candidates offered SDE.

Wada memory asymmetry scores and postoperative memory outcome in left temporal epilepsy.

BACKGROUND: Memory asymmetry scores are used in intracarotid amobarbital procedure (IAP) to predict memory outcome after anterior temporal lobectomy (ATL) in patients with temporal lobe epilepsy (TLE). Reversed asymmetry (RA) of memory scores occurs in a minority of patients, with better memory performance observed following contralateral injection. Left ATL patients with RA are reported to have poorer postoperative verbal memory outcome. Studies also suggest that dysphasia during language dominant left hemisphere injection may contribute to lower right-sided memory scores seen in RA. PURPOSE: To examine the role of dysphasia in RA and investigate the relationship between RA scores and memory outcome after ATL. METHOD: IAP asymmetry scores and duration of speech arrest following bilateral IAP injection were examined in 50 patients with unilateral left TLE. Postoperative memory outcome was examined in a subset of patients (n=31). RESULTS: Thirty-nine percent of patients had RA on IAP. The duration of speech arrest after left injection was significantly longer in the RA group compared to the expected asymmetry (EA) group. RA was not associated with negative postoperative memory outcome. CONCLUSIONS: In left TLE patients, RA of IAP memory scores does not preclude good postoperative memory outcome. Prolonged speech arrest after left injection may lower right side memory scores contributing to misleading RA. Memory asymmetry patterns are sensitive to IAP protocol effects; therefore, RA may not be a robust predictor of memory outcome following left ATL.

Subacute encephalopathy with seizures in alcoholism.

Generalised seizures are a common manifestation of acute alcohol intoxication. Alcohol is known to precipitate generalised seizures in patients with focal brain pathology. A rare case of secondarily generalised seizures precipitated by alcohol in a patient without an underlying focal brain lesion is reported. Electroencephalopgraphy (EEG) showed periodic lateralised epileptiform discharges (PLEDs) on the side contralateral to the focal motor fits.