Unusual cause for seizure after surgical closure of CSF rhinorrhoea.

Seizure following cerebrospinal fluid (CSF) rhinorrhoea surgery or surgery of the skull base almost always implies postoperative meningoencephalitis, unless proven otherwise. Here, we present the case of a middle-aged female in her 40's who underwent surgical CSF fistula closure and developed seizure on the eighth postoperative day. She was diagnosed to have posterior reversible encephalopathy syndrome (PRES). Early diagnosis and prompt initiation of treatment ensured that she had a complete recovery. Although not reported in the literature, PRES should always be a differential diagnosis in such situations, as delay in diagnosis may result in significant morbidity and rarely mortality.

Complications in Intracranial Surgery of Companion Animals.

The most common complications of intracranial surgery in companion animals chiefly consist of brain swelling, hemorrhage, seizures, and worsening of neurologic status, aspiration pneumonia, and anesthetic death. Further dividing these into intraoperative and postoperative complications, postoperative are more common. Preventative measures can include careful surgical planning, cerebro-protective anesthetic regimes, seizure prophylaxis, and postoperative sedation/pain management that allows for an early return to function and ambulation and an adequate and accelerated nutrition.

Frontal lobe closed-lip schizencephaly as an atypical cause of adult-onset seizures.

Schizencephaly arises from irregular neuronal migration leading to clefts development in the cerebral cortex. The condition is often detected in childhood and it is extremely rare to go unnoticed. This case highlights a 45-year-old male with no previous medical history who presented with a seizure for the first time in the emergency department after which an MRI was done and detected schizcenphaly which at this point was the first time for the patient to be diagnosed with this condition. The available data on schizcencphaly in the literature is very little and the data on the condition when diagnosed in adulthood is even less, hence our case report aims to shed light on this unthought etiology of adult-onset seizures which could have major potential risks if not detected. Adults who receive a diagnoses later in life may face prognosis issues hence imaging should be encouraged to be a part of seizure workup to avoid underdiagnoses of brain abnormalities that may go unnoticed in childhood.

Midazolam-Induced Seizure-Like Activity in Five Neonates: A case series.

An intravenous (IV) administration of midazolam may result in seizure-like activity or movement. This report describes 5 neonates who developed seizure-like movements after IV midazolam injection. The patients presented between 2019 and 2022 and were admitted to a neonatal intensive care unit located within an academic centre in Muscat, Oman. The abnormal movements occurred shortly after IV bolus administration of midazolam. None of the patients experienced seizure-like movements after receiving midazolam infusions. The seizure-like movements were aborted either spontaneously or by antiseizure medications. In addition, seizure recurrence was not observed in any of the infants during the later stages of their treatment. Since this adverse effect might be related to the speed of the bolus administration, IV midazolam must be given as a slow bolus over 2-3 minutes followed by a slow flush of normal saline. To prevent midazolam's potential adverse effect on newborns, neonatal caregivers must be aware of it.

Effect of Kruppel-like factor 4 on PTZ-induced acute seizure mice.

Kruppel-like factor 4 (Klf4) is a transcription factor that is involved in neuronal regeneration and the development of glutamatergic systems. However, it is unknown whether Klf4 is involved in acute seizure. To investigate the potential role of Klf4 in pentylenetetrazol (PTZ)-induced seizure, western blotting, immunofluorescence, behaviour test and electrophysiology were conducted in this study. We found that Klf4 protein and mRNA expression were increased in both the hippocampus (HP) and prefrontal cortex (PFC) after PTZ-induced seizure in mice. HP-specific knockout (KO) of Klf4 in mice decreased protein expression of Klf4 and the down-stream Klf4 target tumour protein 53 (TP53/P53). These molecular changes are accompanied by increased seizure latency, reduced immobility time in the forced swimming test and tail suspension test. Reduced hippocampal protein levels for synaptic proteins, including glutamate receptor 1 (GRIA1/GLUA1) and postsynaptic density protein 95 (DLG4/PSD95), were also observed after Klf4-KO, while increased mRNA levels of complement proteins were observed for complement component 1q subcomponent A (C1qa), complement component 1q subcomponent B (C1qb), complement component 1q subcomponent C (C1qc), complement component 3 (C3), complement component 4A (C4a) and complement component 4B (C4b). Moreover, c-Fos expression induced by PTZ was reduced by hippocampal conditional KO of Klf4. Electrophysiology showed that PTZ-induced action potential frequency was decreased by overexpression of Klf4. In conclusion, these findings suggest that Klf4 plays an important role in regulating PTZ-induced seizures and therefore constitutes a new molecular target that should be explored for the development of antiepileptic drugs.

Stopping runaway seizures with a chill pill.

The neuropeptide neurotensin can reduce status epilepticus and its associated consequences through induction of therapeutic hypothermia when bound to a molecule that can penetrate the blood-brain barrier.

Self-Limited Epilepsy With Autonomic Seizures: A Case Report.

This case report describes a six-year-old girl without relevant personal or family history, who had a seizure at awakening with loss of muscle tone, sialorrhea and ocular retroversion. The episode lasted >5 minutes, with vomiting and post-ictal confusion. Upon the hospital visit, she was misdiagnosed with acute gastroenteritis and discharged with symptomatic treatment. After another seizure, she was diagnosed with Panayiotopoulos syndrome and started receiving treatment. Since then, the child has been followed up through neuropediatric appointments and by her family doctor. The psychological assessment revealed normal general intellectual functioning with vulnerability in the language area.

Magnetic resonance imaging patterns and perfusion changes of posterior reversible encephalopathy syndrome in children with clinical outcome correlation.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) in children has a propensity towards atypical features on magnetic resonance (MR) imaging, with limited literature on perfusion changes and clinicoradiological correlation. OBJECTIVE: We aimed to comprehensively study MR imaging patterns of pediatric PRES, including cerebral blood flow variations on arterial spin labeling, and looked for any MR biomarkers of poor clinical outcome. MATERIALS AND METHODS: In this retrospective observational study conducted in a tertiary hospital setting, MR records over a 4-year period (May 2019 to May 2023) were systematically searched along with their clinical details. Patients with an age less than 18 years and a clinicoradiological constellation consistent with PRES were included. MR scans were analyzed by two neuroradiologists with 8 years' and 10 years' experience. Association was sought with poor clinical outcome (defined as modified Rankin Scale score at discharge of > 2). RESULTS: A total of 45 patients (29 boys) were included in the study, with a mean age (± standard deviation) of 11.19 (± 4.53) years. On MR imaging, 95.6% of patients (n = 43) showed atypical features and/or atypical areas of involvement. The superior frontal sulcus (n = 18) was the most predominant MR pattern, and cerebellar involvement was not uncommon (n = 15). Unilateral involvement (n = 3), isolated central pattern (n = 1), and spinal cord involvement (PRES-SCI: n = 1) were also encountered. Brainstem involvement (n = 4) showed a characteristic "V-sign" of anterior medullary hyperintensity. Patchy restricted diffusion (46.6%), punctate hemorrhages (37.7%), and leptomeningeal contrast enhancement (36%) were not uncommon. Arterial spin labeling sequence (available in 24 patients) showed increased cerebral blood flow in the involved areas in 79.2% of patients. Univariate analysis showed a significant association of the presence of hemorrhage (P = 0.003), involvement of brainstem (P = 0.007), deep white matter (P = 0.008), and thalamus (P = 0.026) with poor clinical outcome. Multivariate regression analysis found that hemorrhage on MRI (P = 0.011, odds ratio 8) was an independent factor associated with poor clinical outcome. CONCLUSIONS: The conventionally described atypical features in PRES are common in children and therefore may no longer be considered exceptions. Raised perfusion on arterial spin labeling sequence was seen in the majority of cases. Hemorrhage on MRI was an independent predictor of poor clinical outcome in pediatric PRES.

Exploring patients' views on telephone consultations in the seizure clinic: A qualitative interview study.

The COVID-19 pandemic brought telemedicine into mainstream medical practice. Although it is widely agreed that telemedicine could be beneficial for patients with seizures, there has been little prior research investigating patients' views on this subject. In this qualitative study, we conducted semi-structured interviews with 10 patients and one companion about their experiences of telemedicine. We also received written thoughts from one additional patient. Participants' views fell under three broad themes. The first, "Convenience and practicality", saw participants praising the flexibility of telephone consultations while noting that such consultations could introduce new practical problems. The second, "(Lack of) shared presence", covered participants' generally negative feelings about not being in the same room as their neurologists. The third, "Situation dependency", saw participants drawing fine distinctions about the circumstances in which face-to-face and telephone consultations were suitable. Overall, although patients with seizures are generally positive about the convenience of telephone consultations, they have concerns about how they may lead to misunderstandings or affect the doctor-patient relationship. These concerns could be assuaged to some extent by offering video consultations or scheduling alternating telephone and face-to-face consultations.

Unraveling the Puzzle: A Case of Intricate Neurological Presentation Attributable to Hypomagnesemia.

Hypomagnesemia can occasionally present with severe neurological deficiencies, and it is usually attributed to an underlying renal and/or gastrointestinal pathology. Rarely, patients may present with neurological symptoms in the absence of an obvious cause. Our case highlights the importance of considering hypomagnesemia as a primary cause of those presenting with severe neurological deficits in an intensive care unit setting, as well as the significance of conducting a thorough social and medical history on these patients to elucidate their underlying causes. We discuss the case of a 48-year-old Caucasian male who acutely presented with seizures, tremors, visual hallucinations, diplopia, personality changes, and ataxia with recurring severely low magnesium (0.4 mg/dL) at times in the absence of renal, gastrointestinal, hormonal, infectious, or autoimmune pathology.

Exacerbation of Psychogenic Non-epileptic Seizures Related to the Diagnosis and Disease Burden of Epilepsy: A Case Report.

Psychogenic non-epileptic seizures (PNES), which closely resemble epileptic seizures (ES), are typically triggered by psychological distress and represent the most prevalent form of conversion disorder encountered in clinical practice. Multiple physical conditions can both precipitate and sustain PNES episodes. Epilepsy, a common neurological disorder, imposes significant emotional and physical burdens, frequently resulting in elevated levels of anxiety and depression. This case report details the clinical course of a 19-year-old female whose PNES was exacerbated by the diagnosis and disease burden of epilepsy. The patient's background of childhood trauma, bullying, and sexual abuse likely predisposed her to the development of PNES. Upon receiving a diagnosis of epilepsy, characterized by focal seizures originating from the left parietal region, the patient experienced increased anxiety and required frequent hospitalizations. Despite adjustments to her treatment regimen, including the administration of levetiracetam (LEV) and lacosamide (LCM), her seizures persisted. Comprehensive evaluations, comprising electroencephalography (EEG) and single-photon emission computed tomography (SPECT), indicated the coexistence of epilepsy and PNES. Although surgical intervention was initially considered, it was ultimately deemed unnecessary, which subsequently alleviated the patient's anxiety. Psychoeducation highlighting the manageability of her epilepsy with ongoing pharmacotherapy significantly reduced her PNES episodes. This case emphasizes the critical role of addressing the psychosocial burden associated with an epilepsy diagnosis, as these factors may exacerbate PNES. It also underscores the importance of a holistic treatment approach that integrates psychological support with medical management.

GABA(A) Receptor Subunit (γ2, δ, ß1-3) Variants in Genetic Epilepsy: A Comprehensive Summary of 206 Clinical Cases.

Epilepsy is identified in individuals who experienced 2 or more unprovoked seizures occurring over 24 hours apart, which can have a profound impact on a person's neurobiological, cognitive, psychological, and social well-being. Epilepsy is considerably diverse, with classifications such as genetic epilepsy that result directly from a known or presumed genetic variant with the core symptoms of seizures. The GABAA receptor primarily functions as a heteropentamer, containing 3 of 8 subunit types: α, ß, γ, δ, ε, π, θ, and ρ. In the adult brain, the GABAA receptor is the primary inhibitory component in neural networks. The involvement of GABAA receptors in the pathogenesis of epilepsy has been proposed. We extensively reviewed all relevant clinical data of previously published cases of GABAA receptor subunit γ2, δ, ß1-3 variants included in PubMed up to February 2024, including the variant types, loci, postulated mechanisms, their relevant regions, first onset ages, and phenotypes. We summarized the postulated mechanisms of epileptic pathogenesis. We also divided the collected 206 cases of epilepsy into 4 epileptic phenotypes: genetic generalized epilepsies, focal epilepsy, developmental and epileptic encephalopathies, and epilepsy with fever sensibility. We showed that there were significant differences in the likelihood of the γ2, ß2, and ß3 subunit variants causing genetic generalized epilepsies, focal epilepsy, developmental and epileptic encephalopathies, and epilepsy with fever sensibility. Patients with the ß3 subunit variant seemed related to an earlier first onset age. Our review supports that GABAA receptor subunit variants are a crucial area of epilepsy research and treatment exploration.

The effect of the modified Atkins diet and anti-seizure medications on lipid marker levels in adults with epilepsy.

OBJECTIVES: Some anti-seizure medications (ASMs) are known to induce liver enzymes and impact lipid values that include total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglyceride (TG). In addition, use of ketogenic diet therapies, including the modified Atkins diet (MAD), has also influenced lipids. Here, we explored the combined impact of enzyme inducing ASMs (EIASMs) and MAD on lipid values in adults with epilepsy. METHODS: Diet-naïve adults with epilepsy who began MAD were divided into three groups based on ASM use: EIASMs, non-EIASMs, and those on no ASMs. Demographic information, epilepsy-specific clinical history, anthropometrics and lipid values were obtained through retrospective chart review at baseline and after a minimum of 12 months of MAD use. RESULTS: Forty-two adults on MAD had baseline and follow up 12-month lipid outcomes. There was a significant increase in median levels of TC, LDL, non-HDL, and HDL after 12 months of MAD use. There was no change in median levels of TG. When separated according to ASM category, adults on non-EIASMs showed significant elevations in TC, HDL, and LDL after 12 months of MAD use. In contrast, adults on EIASMs only showed a significant increase in HDL after 12 months of MAD use. DISCUSSION: The increase in atherogenic cholesterol levels observed after 12 months of MAD use was most pronounced in adults with epilepsy on non-EIASMs and not observed in adults with epilepsy on EIASMs despite a higher proportion of abnormal cholesterol levels at baseline in those on EIASMs.

Unexpected Strikes: Sjögren Syndrome Triggering Multiple Evolving Cerebral Strokes in a Young Patient.

Neurological complications are observed less frequently with primary Sjögren syndrome (SS). The central nervous system (CNS) has seldom been shown to exhibit symptoms of SS, making the diagnosis of SS with neurological involvement difficult. We present a rare case scenario in which a young 23-year-old male presenting with an acute history of fever, headache, vomiting, altered sensorium, and seizures was admitted and diagnosed as a sub-acute infarct in the right frontal-parietal-temporal lobes on a computed tomography (CT) scan. Upon further examination, laboratory investigations were suggestive of viral encephalitis. The patient was treated accordingly with antiviral drugs, and the patient improved. The patient took "discharge against medical advice" after 12 days, only to return to the hospital with similar complaints within 15 days. Magnetic resonance imaging (MRI) was done, which suggested an acute evolving infarct in the right frontal and parietal lobe, and further evaluation yielded a diagnosis of SS. The patient was treated with high-dose steroids for seven days. A repeat MRI showed new acute infarcts with dilatation of the ventricular system with periventricular ooze. The patient could not be revived and succumbed after one week of steroid therapy.

Case Report: resolution of refractory seizures after neurosurgical intervention in newborns with cerebral extra-axial hemorrhages.

Introduction: Intracranial hemorrhage is a significant cause of neurological damage in newborns. Extra-axial hemorrhages with intraparenchymal extension can precipitate acute clinical deterioration. Seizures are one of the presenting symptoms, which can be refractory to treatment. These hemorrhages can result in considerable long-term morbidity and mortality. Aim: The objective of this report was to present three cases of extra-axial hemorrhages in neonates, all exhibiting refractory seizures that resolved after neurosurgical intervention. In addition, a review of literature is provided. Methods: Data collected included clinical history, laboratory findings, neuroimaging studies, type of neurosurgical intervention, and patient outcome. All infants presented with extra-axial hemorrhages along with clinical and radiological signs of increased intracranial pressure within the first 6 days of life. These manifestations included a decreased level of consciousness, hypertension, bradycardia, and cerebral midline shift on imaging. Refractory seizures were present in all cases. Urgent magnetic resonance imaging was performed followed by neurosurgical intervention (two needle aspirations, one cranial trepanation), leading to amelioration of clinical symptoms and complete resolution of seizures. Follow-up outcomes included normal psychomotor development in one infant, mild cerebral paresis in another, and delayed motor development in the third. None of the infants developed epilepsy. Conclusion: This study underscores the critical importance of monitoring seizure activity, conducting urgent and appropriate imaging, and implementing targeted neurosurgical intervention, preferably through minimally invasive methods such as percutaneous needle aspiration. Clinicians should be aware of this clinical picture and respond promptly to mitigate neurological damage.

Risk Factors for Post-Stroke Seizures in a Tertiary Care Center: A Case-Control Study.

Purpose: Stroke is the second leading cause of global deaths. Post-stroke seizures (PSS) can lead to lasting complications, such as prolonged hospitalizations, increased disability rates, and higher mortality. Our study investigates the associated factors that contribute to post-stroke seizures in patients at a local tertiary hospital. Patients and Methods: We designed a case-control study where patients admitted with PSS were recruited with consent. Controls admitted for stroke without seizure were then included. Suitability based on exclusion criteria was ensured before recording their sociodemographic and clinical data. An EEG was performed and read by two certified neurologists before the data was analyzed. Results: We recruited 180 participants, 90 cases and 90 matched controls. Gender (p=0.013), race (p=0.015), dyslipidemia (p<0.001), prior stroke (p<0.031), large artery atherosclerosis (p<0.001), small vessel occlusions (p<0.001), blood pressure on presentation (p<0.028) and thrombolysis administration (p<0.029) were significantly associated with the occurrence of PSS. An increase in odds of PSS was observed in the male gender (1.974), dyslipidemia (3.480), small vessel occlusions (4.578), and in participants with epileptiform changes on EEG (3.630). Conversely, lower odds of PSS were seen in participants with high blood pressure on presentation (0.505), large artery atherosclerosis (0.266), and those who underwent thrombolysis (0.319). Conclusion: This study emphasized that identifying post-stroke seizures may be aided by EEGs and recognizing at-risk groups, which include males of Chinese descent in Asia, dyslipidemia, small vessel occlusions, those with low to normal blood pressure on presentation, and epileptiform changes in EEGs.

The research aims to establish the risk factors associated with post-stroke seizures in an Asian population and their similarity to the Western literature. Our findings highlight the critical risk factors to identify in at-risk patients, which may prompt changes in guidelines in future to enhance patient outcomes and improve the quality of care.

Protective effect of crocin-loaded nanoparticles in rats following epileptic seizures: Biochemical, behavioral and histopathological outcomes.

Epilepsy is a condition resulting from complex interactions involving excessive neuronal electrical activity and oxidative stress, which can lead to chronic neurological conditions. This study evaluates crocin encapsulated in SLNC for neuroprotective and countering pentylenetetrazole (PTZ) -induced oxidative damage. The rats were pre-treated with SLNC and FC (25, 50 mg/kg/day; P.O.) for 28 days before being induced with PTZ. Various standard tests were conducted to assess their behavioral functions, such as Y-maze, Open field test (OFT), and elevated plus maze (EPM) tests. ELISA measured brain tissue catalase activity (CAT) and nitric oxide status (NO). The expression of Nuclear factor kappa B (NF-κB) and the number of dendrite spines were examined through Immunohistochemical and Golgi-Cox staining, respectively. The Pretreating rats with SLNC plus PTZ significantly boosted memory and reduced anxiety levels in Y-maze, OFT, and EPM tests. In addition, it decreased NO levels and increased CAT levels. SLNC also showed a significant decrease in NF-κB expression and an increase in neurons and the number of spines. The positive effects of SLNC in improving memory and learning deficits after PTZ injection can be attributed to its anti-inflammatory and anti-oxidative effects.

Automated algorithms for seizure forecast: a systematic review and meta-analysis.

This study aims to review the proposed methodologies and reported performances of automated algorithms for seizure forecast. A systematic review was conducted on studies reported up to May 10, 2024. Four databases and registers were searched, and studies were included when they proposed an original algorithm for automatic human epileptic seizure forecast that was patient specific, based on intraindividual cyclic distribution of events and/or surrogate measures of the preictal state and provided an evaluation of the performance. Two meta-analyses were performed, one evaluating area under the ROC curve (AUC) and another Brier Skill Score (BSS). Eighteen studies met the eligibility criteria, totaling 43 included algorithms. A total of 419 patients participated in the studies, and 19442 seizures were reported across studies. Of the analyzed algorithms, 23 were eligible for the meta-analysis with AUC and 12 with BSS. The overall mean AUC was 0.71, which was similar between the studies that relied solely on surrogate measures of the preictal state, on cyclic distributions of events, and on a combination of these. BSS was also similar for the three types of input data, with an overall mean BSS of 0.13. This study provides a characterization of the state of the art in seizure forecast algorithms along with their performances, setting a benchmark for future developments. It identified a considerable lack of standardization across study design and evaluation, leading to the proposal of guidelines for the design of seizure forecast solutions.

Recent Progresses in Development of Heterocyclic Compounds For Epilepsy Treatment: Key Research Highlights From 2019-2024.

Epilepsy which is a chronic neurological disorder is characterized by recurrent seizure poses a significant challenge to healthcare professionals worldwide. Most of antiepileptic drugs have serious side effects that might affect the quality of life such as fatigue, dizziness, weight gain and cognitive impairments. In this context, the search for more effective and potential antiepileptic drug candidate has led to a growing interest in the field of synthesis of heterocyclic compounds. This review will focus on the utilization of heterocyclic moieties including imidazole, indole, thiazole, triazine, quinazoline and oxazole which show remarkable anticonvulsant properties. Furthermore, the exploration of various methodologies for the synthesis of heterocyclic anticonvulsant drugs such as green methodologies and microwave assisted protocols have contributed to the development of environment friendly,  more efficient and potential approaches. The review will distinguish from previous ones by specifically focusing on innovative synthetic methodologies, including greener methodologies and micro-assisted techniques, that contribute to eco-friendly and environment benign approaches during 2019-2024. In addition to this, the review will focus on the Structure Activity Relationship (SAR) studies of heterocyclic compounds in order to offer insight into the design of next generation antiepileptic drugs with improved efficacy and reduced side effects.

Arachnoid cysts and epilepsy: seizures and epileptogenesis.

Arachnoid cysts are sacs within the arachnoid membrane, filled with cerebrospinal fluid, and overwhelmingly asymptomatic; however, they can also lead to neurological symptoms such as epilepsy. The dependence of AC on epilepsy has been a subject of controversy because of studies with mixed results on whether AC contributes to seizure activity. This is a narrative review for the synthesis of available present research on the pathophysiological mechanisms of epilepsy, clinical presentation, and treatment options in patients with epilepsy and ACs. Some find no impactful association between ACs and seizures, while others point out the probable role of ACs in Epileptogenesis. Endoscopic fenestration and similar surgical interventions were found quite effective at reducing the frequency of seizures for selected patients, although not all of them achieve complete seizure control. Such a decision needs to be tailored on the basis of considerations such as localization and size of cysts and general health conditions. Future research should investigate the genetic and molecular basis of ACs and, based on large prospective long-term studies, define the AC-epilepsy relationship and refine treatment strategies in affected individuals.