The postictal generalized EEG suppression and its significance in sudden unexpected death in epilepsy / 中国神经精神疾病杂志

Sudden unexpected death in epilepsy(SUDEP)is the leading cause of accidental death in epileptic patients.The postictal generalized EEG suppression(PGES)is related to SUDEP.The age,seizure type,tonic seizure/tonic muscle contraction,ictal and post-ictal respiratory dysfunction and autonomic dysregulation is associated with PGES with significant individual variation.Progressive slowing of clonic phase(PSCP)in generalized tonic-clonic seizures(GTCS)is an independent predictor of the onset and prolongation of PGES.

Opinions on the nomenclature of familial cortical myoclonic tremor with epilepsy / 中华神经科杂志

Familial cortical myoclonic tremor with epilepsy (FCMTE) is a rare neurological disorder. There were more than 10 different terms of disease name in domestic and international published articles by searching FCMTE from PubMed and Wanfang database (from 1990 to 2022), which indicated the different understanding of the disease. It is necessary to discuss the correct and consentaneous name of the disease to facilitate the professional investigation in the future. The name evolution of FCMTE and the author′s views are described in this article.

The clinical and neuroelectrophysiological characteristics of patients with sudden unexpected death in epilepsy / 中华神经科杂志

Objective:To investigate the clinical and electrophysiological characteristics of patients with sudden unexpected death of epilepsy (SUDEP).Methods:Using "epilepsy" as the keyword, the relevant cases entered from October 2011 to March 2012 were searched in the database of the Electroencephalogram (EEG) Monitoring Center, Xijing Hospital, the Air Force Military Medical University. Telephone follow-up was conducted for all confirmed epilepsy patients, and for the death cases confirmed by telephone follow-up, the patients identified as consistent with SUDEP diagnosis were included in this study based on their past medical history, clinical data, death details, etc, and their clinical and neuroelectrophysiological characteristics were summarized and analyzed.Results:Among the 1 232 patients who underwent 24-hour video-EEG monitoring during the study period, 354 patients were successfully followed up by telephone interview, of whom 17 patients were died (4.8%), 12 individuals met the diagnosis of SUDEP (7 men, 5 women). The duration of the disease in 9 patients exceeded 10 years. Eight cases presented with focal-bilateral tonic clonic seizures. Nine patients were treated with anti-seizure drug monotherapy. All the 24-hour video EEG of 12 patients were abnormal. There were 8 occasions when the EEG occipital α background rhythm slowed down compared with the standard frequency of peers or was dominated by slow waves. Interictal epileptic discharge (IED) located in temporal lobe were found in 12 EEG records, of which 9 EEG records were found with frontal IED. One of the 12 cases received 24-hour video EEG twice within 6 years, and his EEG background rhythm was significantly slower and the IED region was expanded compared with the first EEG record. At the third year after reexamination of EEG, SUDEP developed in this patient.Conclusions:SUDEP patients have a long course of disease and bilateral tonic-clonic seizure. The interictal EEG shows occipital slow α activity and temporofrontal epileptiform discharges, which may increase the risk of SUDEP.

Clinical and electrophysiological study of sleep-related hypermotor epilepsy during rapid eye movement sleep / 中华神经科杂志

Objective:To explore the electro-clinical characteristics of sleep-related hypermotor epilepsy (SHE) in rapid eye movement (REM) stage.Methods:Five patients of SHE in REM stage were studied and followed up in the Electroencephalogram Monitoring Center, Department of Neurology, Xijing Hospital, the Air Force Military Medical University, from January 2016 to August 2021.Results:Among the 5 patients, there are 3 male patients, aged 21 to 46 years. A total of 23 seizures were monitored in 5 patients, of which 22 occurred in REM sleep and 1 occurred in non-REM Ⅲ sleep. Each attack lasted from 30 seconds to 1 minute, and was manifested as "hyperkinetic attack" during sleep, with or without disturbance of consciousness. There were no obvious abnormalities in electroencephalography during 13 attacks, with the focal sharp slow waves or slow waves during 9 attacks, and the focal slow waves occurrence at the end of the 10 attacks.Conclusion:Most of the hypermotor epileptic seizures in REM stage started from awakening reaction, and the interictal discharges occured in waking and non-REM sleep stage, which is necessary to distinguish from the REM sleep behavior disorder.

Clinical and electro-physiological characteristics of reflex epilepsy induced by thinking activities / 中华神经科杂志

Objective:To explore the clinical and electro-physiological characteristics of reflex epilepsy induced by thinking activities.Methods:Five patients of reflex epilepsy induced by thinking activities during electroencephalogram (EEG) monitoring in the EEG Monitoring Center, Department of Neurology, Xijing Hospital,the Air Force Military Medical University from January 2017 to September 2019 were studied and followed up.Results:All the 5 patients are male, aged 14 to 33 years, with the disease course of 3 to 9 years and the follow-up of 1 to 4 years. The myoclonic jerks, spasms seizure and generalized tonic and clonic seizure occured to the 5 patients. The EEG background of low amplitude alpha rhythm was recorded in the 5 patiens. The ictal-EEG of 2 cases showed the spike wave or spike slow complex waves in the central, parietal area, and the ictal-EEG of 1 case showed the generalized spike-wave discharge. There were no seizures occuring to the 2 cases during video-electroencephalography monitoring. There were no abnormalities in cranial magnetic resonance imaging. The arterial spin labeling of 2 cases suggested that the right cerebral hemisphere cerebral blood flow was lower than contralateral. Antiseizure drugs (levetiracetam in 4 cases and levetiracetam+magnesium valproate in 1 case) were administered, 4 cases were seizure free and 1 case was uncontrolled.Conclusions:The reflex epilepsy induced by thinking activities is common in young men, and the EEG background with low amplitude alpha rhythm may be the characteristic of the reflex epilepsy induced by thinking activities. The levetiracetam may be the good choice for the reflex epilepsy induced by thinking activities and the prognosis of reflex epilepsy induced by thinking activities is good.

The study of cardiac respiratory dysfunction in peri-epileptic period / 中风与神经疾病杂志

@#Objective　To explore the clinical and electrophysiological characteristics of cardiac-respiratory dysfunction during the peri-epileptic seizure period.Methods　A retrospective analysis was made from 12 000 patients with long-term video electroencephalograph （EEG）monitoring from October 2016 to April 2022 in the Department of Neurology,Xijing Hospital.Epilepsy patients with cardiac and respiratory dysfunction during peri- epileptic seizure period were enrolled,and their clinical and electrophysiological changes during the peri- epileptic seizure period were analyzed.Results　Three patients experienced five seizures with cardiopulmonary dysfunctions during the EEG monitoring.Two of them were female and one was male,and their age was from 23 to 55 years old with epilepsy history of 9~40 years.One patient experienced sGTCS (secondly generalized tonic-clonic seizures) followed by generalized EEG suppression (PGES),during which respiratory movements disappeared for 74 s and the heart rate was as low as 25 bpm.One patient experienced ictal asytole lasting for 15 s during a seizure induced by flash stimulation;one patient experienced ictal asytole during two seizures,which lasted for 5 s and 3 s respectively.Follow-up time ranged from 6 months to 7 years,and all the three patients were seizure free.Conclusion 　Cardiopulmonary dysfunction occurs during PGES after seizures,and ictal asytole occurs during seizures,which maybe related with sudden unexpected death in epilepsy (SUDEP).

Clinical and electrophysiological features of patients with coexistence of epilepsy and narcolepsy / 中华神经科杂志

Objective:To describe the electroclinical features of the coexistence of epilepsy and narcolepsy.Methods:The electroencephalography database was searched using the terms “epilepsy” and “narcolepsy” over a four-year period from January 2016 to December 2019 in the Xijing Hospital. The clinical and electrophysiological characteristics of patients with coexistence of epilepsy and narcolepsy were studied.Results:Five patients with comorbidity for epilepsy and narcolepsy were found, of which three patients were female, two patients were male. The age at epilepsy onset and narcolepsy onset was 2-12 years and 8-17 years, respectively. There were two patients with juvenile myoclonic epilepsy, one with sleep-related hypermoter epilepsy, one with epilepsy with retardation of brain development, one with symptomatic epilepsy with cognitive decline. All the patients had narcolepsy with cataplexy, which followed the onset of epilepsy by three months to eight years. All the patients accepted 24 h video electroencephalography monitoring and multiple sleep latency test. Interictal epileptic discharges were found, mean sleep latency was<8 min, and two or more sleep onset rapid eye movement periods were recorded. Duloxetine hydrochloride can effectively improve the drowsiness and catalepsy symptoms of narcolepsy, and seizures did not worsen in patients using duloxetine hydrochloride.Conclusions:Both generalized and focal epilepsy can occur in narcolepsy with cataplexy. Duloxetine hydrochloride may be safe and effective in treating narcolepsy in patients with epilepsy.

Clinical and electrophysiological study of neck myoclonus during sleep / 中华神经科杂志

Objective:To discuss the clinical and electrophysiological characteristics of neck myoclonus during sleep.Methods:The clinical and electrophysiological characteristics of 31 patients in the Electroencephalography Monitoring Center of Xijing Hospital from January 2020 to August 2020 were studied retrospectively. All the patients received video-polysomnography and video-electroencephalography.Results:There were 22 males (71%) and nine females (29%) in the 31 patients. The mean age of the patients at the time of inclusion in the study was 27.8 years. Neck myoclonus was most common in patients with narcolepsy ( n=8), followed by epilepsy ( n=4), obstructive sleep apnea syndrome ( n=4), anxiety and depression ( n=3), snoring ( n=3), etc. A total of 555 motor events were considered and analyzed, 89.5% (497/555) of which occurred during rapid eye movement (REM) sleep. The mean neck myoclonus index in REM sleep (5.8) was significantly higher than that in non-rapid eye movement sleep (0.2). Totally 48.3% (268/555) of neck myoclonus were accompanied by an arousal, 0.7% (4/555) by a full awakening, and 2.7% (15/555) by limb movements. Conclusions:Neck myoclonus is common during REM sleep, which can occur in patients with sleep disorders and epilepsy. Physiological or pathological significance of neck myoclonus has to be investigated in further studies.

Clinical and electrophysiological study of familial cortical myoclonic tremor with epilepsy with fixation-off sensitivity / 中华神经科杂志

Objective:To discuss the clinical and electrophysiological characteristics of familial cortical myoclonic tremor with epilepsy (FCMTE) with fixation-off sensitivity (FOS).Methods:The clinical and electrophysiological characteristics of four patients diagnosed as FCMTE with FOS in the Electroencephalography (EEG) Monitoring Center of Xijing Hospital from May 2016 to December 2017 were studied and followed up.Results:The four patients were all female. The age was ranged from 29 to 67 years. The course was from six to 30 years, and the follow-up time was at least two years. The tremors and jerks occurred to the four patients frequently when the eyes were closed, which prevented their falling a sleep, and three of them had generalized tonic-clonic seizure occasionally. The FOS was monitored in the all four patients, and the photosensitivity occured to the three of them.Conclusions:The fixation-off sensitive trail during EEG monitoring is helpful to find the FCMTE with FOS. It is necessary to determine the potential clinical significance of FOS and photosensitivity coexisting in patients with FCMTE.

Clinical and electrophysiological features of epilepsy combined with neck myoclonus / 中风与神经疾病杂志

@#To describe the electroclinical features of epilepsy and neck myoclonus.Methods We searched the EEG database using the terms “epilepsy” and “neck myoclonus” over a 2-year period from January 2018 to January 2020 in the Xijing Hospital，Xi’an，China. The clinical and electrophysiological characteristics were studied. Results Four patients with epilepsy and neck myoclonus were male.They were diagnosed with genetic generalized epilepsy，of which 3 patients were epilepsy of generalized tonic-clonic seizures alone，1 patient was epilepsy of eyelid myoclonia with absences.The mean age at epilepsy onset was 9～27 years. Epilepsy and valproate treatment preceded neck myoclonus in two patients，and the neck myoclonus disappeared after discontinuation of valproate in one of them. A total of 254 neck myoclonus were recorded，92.5% of the events occurred during Rapid eye movement sleep，and then non-rapid eye movement 1 sleep. Conclusion Neck myoclonus may be more common in genetic generalized epilepsy. Video electroencephalography monitoring may be helpful to confirm the type of the myoclonus. The electroclinical features and mechanisms of the coexistence of epilepsy and neck myoclonus need further study.