Inflammatory reaction In epilepsy / Reação inflamatória na epilepsia / Reacción inflamatoria En la epilepsia

Epilepsies are the second most common neurological disease. The pathological mechanisms of this disease are not fully unders- tood. Several studies claim that inflammation plays a significant role both in structural and physiological changes that lead to the emergence of seizures. Although in some epilepsies, such as Rasmussen?s encephalitis, the inflammation has definite importance, in several other epileptic syndromes, the participation of inflammatory reaction still lacks evidence. In such cases, the experimental models are useful for reveal how cytokines, molecules that modulate the inflammatory response, may affect seizures and how seizures may change the expression of these inflammatory molecules. Even with these works, much remains to be clarified with regard to the influence of inflammation on epileptic syndromes. The purpose of this brief review is to discuss the links between inflammatory processes, the origin of crises, and tissue damages in epilepsy.

As epilepsias são a segunda doença neurológica mais frequentes. Os mecanismos patológicos dessa doença ainda não são completamente compreendidos. Vários trabalhos alegam que a inflamação tem um papel importante tanto nas alterações estruturais quanto fisiológicas que levam à geração de crises. Embora em alguns tipos de epilepsia, como a encefalite de Rasmussen, a inflamação tenha importância evidente, em várias outras síndromes epilépticas ainda faltam evidências para confirmar a participação da reação inflamatória. Nesses casos, os modelos experimentais são úteis para revelar como as citocinas, moléculas que modulam a resposta inflamatória, podem afetar as crises e como as crises podem alterar a expressão dessas moléculas inflamatórias. Mesmo com esses trabalhos, muito ainda precisa ser esclarecido com relação à influência da inflamação sobre as síndromes epilépticas. O objetivo desta breve revisão foi discutir as ligações entre os processos inflamatórios, a origem das crises e os danos teciduais na epilepsia.

Las epilepsias son la segunda enfermedad neurológica más común. Los mecanismos patológicos de esta enfermedad no se entienden completamente. Varios estudios afirman que la inflamación juega un papel importante tanto en los cambios estructurales como en los fisiológicos que conducen a la generación de las convulsiones. Aunque en algunos tipos de epilepsia, tales como la encefalitis de Rasmus- sen, la inflamación tiene una importancia evidente, en varios otros síndromes epilépticos todavía carecen de pruebas para confirmar la participación de la reacción inflamatoria. En estos casos, los modelos experimentales son útiles para revelar cómo las citoquinas, molé- culas que modulan la respuesta inflamatoria, pueden afectar a las convulsiones y cómo las convulsiones pueden cambiar la expresión de estas moléculas inflamatorias. Incluso con estos trabajos, queda mucho por aclarar con respecto a la influencia de la inflamación en los síndromes epilépticos. El propósito de esta breve revisión es discutir los vínculos entre los procesos inflamatorios, el origen de la crisis y el daño tisular en la epilepsia.

Looking for complexity in quantitative semiology of frontal and temporal lobe seizures using neuroethology and graph theory.

Epileptic syndromes and seizures are the expression of complex brain systems. Because no analysis of complexity has been applied to epileptic seizure semiology, our goal was to apply neuroethology and graph analysis to the study of the complexity of behavioral manifestations of epileptic seizures in human frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). We analyzed the video recordings of 120 seizures of 18 patients with FLE and 28 seizures of 28 patients with TLE. All patients were seizure-free >1 year after surgery (Engel Class I). All patients' behavioral sequences were analyzed by means of a glossary containing all behaviors and analyzed for neuroethology (Ethomatic software). The same series were used for graph analysis (CYTOSCAPE). Behaviors, displayed as nodes, were connected by edges to other nodes according to their temporal sequence of appearance. Using neuroethology analysis, we confirmed data in the literature such as in FLE: brief/frequent seizures, complex motor behaviors, head and eye version, unilateral/bilateral tonic posturing, speech arrest, vocalization, and rapid postictal recovery and in the case of TLE: presence of epigastric aura, lateralized dystonias, impairment of consciousness/speech during ictal and postictal periods, and development of secondary generalization. Using graph analysis metrics of FLE and TLE confirmed data from flowcharts. However, because of the algorithms we used, they highlighted more powerfully the connectivity and complex associations among behaviors in a quite selective manner, depending on the origin of the seizures. The algorithms we used are commonly employed to track brain connectivity from EEG and MRI sources, which makes our study very promising for future studies of complexity in this field.

Opercular myoclonic-anarthric status epilepticus due to glutamic acid decarboxylase antibody-associated encephalitis.

We report a patient who was diagnosed with opercular myoclonic-anarthric status epilepticus and found to have glutamic acid decarboxylase antibody (GADA)-associated encephalitis, a previously unrecognised aetiology of this condition. The patient was a 23-year-old female admitted for investigation of focal myoclonic status epilepticus in the right side of the face and glossopharyngeal area. Intravenous corticosteroid was administered and improvement was observed in seizure activity and overall general health. A video sequence of opercular myoclonia is included. Due to the presence of inflammatory elements based on brain MRI and CSF studies, a decision to investigate autoimmune encephalitis was undertaken. Anti-GAD65 radioimmunoassay was markedly positive. This case study highlights the need for awareness of the clinical presentation of GADA-associated encephalitis. [Published with video sequences].