Obstetric and neonatal outcomes, antiseizure medication profile, and seizure types in pregnant women in a vulnerability state from Brazil.

This retrospective cohort study described the obstetric and neonatal outcomes, antiseizure medication (ASM) use, and types of seizures in pregnant women with epilepsy (PWWE). Data collected from the medical records of 224 PWWE aged < 40 years with controlled or refractory seizures and 492 pregnant women without epilepsy (PWNE) control group from high-risk maternity hospitals in Alagoas between 2008 and 2021 were included in this study. The obstetric and neonatal outcomes observed in PWWE were pregnancy-related hypertension (PrH) (18.4%), oligohydramnios (10.3%), stillbirth (6.4%), vaginal bleeding (6%), preeclampsia (4.7%), and polyhydramnios (3%). There was a greater likelihood of PrH in PWWE with generalized tonic-clonic seizures (GTCS) and that of maternal intensive care unit (ICU) admissions in those with GTCS and status epilepticus, and phenytoin and lamotrigine use. PWWE with GTCS had a higher risk of stillbirth and premature delivery. PWWE with status epilepticus were treated with lamotrigine. Phenobarbital (PB) with diazepam were commonly used in GTCS and status epilepticus. Total 14% patients did not use ASM, while 50.2% used monotherapy and 35.8% used polytherapy. Total 60.9% of patients used PB and 25.2% used carbamazepine. This study described the association between the adverse obstetric and neonatal outcomes and severe seizure types in PWWE.

Neurocisticercosis infantil. A propósito de un caso / Infantile neurocysticercosis. About a case

La neurocisticercosis es una de las infecciones parasitarias más frecuentes, originada por la larva de la Taenia solium al invadir el sistema nervioso central. Esta patología es endémica de algunos países de África, y está relacionada con hábitos dietéticos, costumbres, higiene y factores socioeconómicos, con mayor incidencia en pacientes escolares y adolescentes, aunque puede presentarse a cualquier edad. Su clínica es variable, unida a criterios epidemiológicos que hacen indispensable al médico de asistencia realizar examen clínico y estudios imagenológicos. Se presenta el caso clínico de una niña de 10 años de edad procedente de Kuito-Bie, Angola, que acude a consulta de neurología, con pérdida de la visión de aproximadamente seis meses de evolución, disminución de la fuerza muscular, episodios de alucinaciones, lenguaje incoherente y convulsiones tónico-clónicas generalizadas de siete días de evolución. Se solicita, de urgencia, una tomografía axial computarizada de cráneo, donde se confirma neurocisticercosis activa, con epilepsia sintomática en el curso de la misma. Los hallazgos clínicos e imagenológicos permiten un diagnóstico oportuno y tratamiento eficaz, lo que determina la evolución clínica de la neurocisticercosis en la infancia, según el estadio clínico y la respuesta inmunológica del huésped(AU)

Neurocysticercosis is one of the most frequent parasitic infections caused by the larva of Taenia solium when invading the central nervous system. This pathology is endemic to some African countries, and is related to dietary habits, customs, hygiene and socioeconomic factors, with a higher incidence in school patients and adolescents, although it can occur at any age. Its clinical symptoms are variable, linked to epidemiological criteria that make it essential for the attending physician to perform a clinical examination and imaging studies It is presented the clinical case of a 10-year-old girl from Kuito-Bie, Angola, who attended the neurology clinic with vision loss of approximately 6 months of evolution, decreased muscle strength, episodes of hallucinations, incoherent speech, and generalized tonic-clonic seizures of 7 days of evolution. An emergency computed axial tomography of the skull was requested, where active neurocysticercosis is confirmed, with symptomatic epilepsy in its course. Clinical and imaging findings allow timely diagnosis and effective treatment, which determines the clinical evolution of neurocysticercosis in childhood, depending on the clinical stage and the host's immune response(AU)

Prevalence of ictal injuries in functional (psychogenic nonepileptic) seizures: A systematic review and meta-analysis.

OBJECTIVE: Ictal injuries have long been considered typical signs of epileptic seizures. However, studies have shown that patients with functional seizures (FS)-also named psychogenic nonepileptic seizures-can also present these signs, misleading physicians and delaying a correct diagnosis. This systematic review aimed to assess the prevalence of injuries from FS. METHODS: A literature search was performed in PubMed, Embase, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Web of Science, PsycINFO, Google Scholar, OpenGrey, and ProQuest. Observational studies were included. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for studies reporting prevalence data. RStudio was used for meta-analyses. Cumulative evidence was evaluated according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS: From the 2607 identified records, 41 studies were included in the qualitative synthesis, and 28 were included in meta-analyses. A meta-analysis of 13 studies, including 1673 individuals, resulted in an overall lifetime prevalence of injuries due to FS per person of 25% (95% confidence interval [CI] = 19%-32%, I2 = 88%). Considering a limited period (video-electroencephalographic [VEEG] monitoring days), a meta-analysis of 13 studies, including 848 individuals, resulted in an injury prevalence due to FS per person of .7% (95% CI = 0%-3%, I2 = 73%). Also, a meta-analysis of eight studies, including 1000 individuals, resulted in a prevalence of injuries per FS of .1% (95% CI = 0%-.98%, I2 = 49%). The certainty in cumulative evidence assessed by GRADE was rated "very low" for lifetime prevalence of injuries per person, "low" for prevalence per person during VEEG monitoring, and "moderate" for prevalence per number of FS. SIGNIFICANCE: Overall pooled lifetime prevalence of injuries due to FS per person was 25%. In comparison, the prevalence of injuries per person during VEEG monitoring and per functional seizure was .7% and .1%, respectively. [Correction added on 07 October 2023, after first online publication: In the preceding sentence, 'consecutively' was corrected to 'respectively'.] The evidence of the occurrence of injuries due to FS breaks the paradigm that epileptic seizures can cause injuries but FS cannot.

Extracorporeal Membrane Oxygenation for Neonates With Congenital Diaphragmatic Hernia: Prevalence of Seizures and Outcomes.

OBJECTIVES: We aimed to determine the prevalence of electrographic seizures and associated odds of adverse outcomes of electrographic seizures in neonates with congenital diaphragmatic hernia (CDH) receiving extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective, descriptive case series. SETTING: Neonatal ICU (NICU) in a quaternary care institution. PATIENTS: All neonates with CDH receiving ECMO undergoing continuous electroencephalographic monitoring (CEEG) and follow-up between January 2012 and December 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All eligible neonates with CDH receiving ECMO underwent CEEG (n = 75). Electrographic seizures occurred in 14 of 75 (19%): they were exclusively electrographic-only in nine of 14, both electrographic-only and electroclinical in three of 14, and electroclinical only in two of 14. Two neonates developed status epilepticus. We identified an association between presence of seizures, rather than not, and longer duration of initial session of CEEG monitoring (55.7 hr [48.2-87.3 hr] vs 48.0 hr [43.0-48.3 hr]; p = 0.001). We also found an association between presence of seizures, rather than not, and greater odds of use of a second CEEG monitoring (12/14 vs 21/61; odds ratio [OR], 11.43 [95% CI, 2.34-55.90; p = 0.0026). Most neonates with seizures (10/14), experienced their onset of seizures more than 96 hours after the start of ECMO. Overall, the presence of electrographic seizures, compared with not, was associated with lower odds of survival to NICU discharge (4/14 vs 49/61; OR 0.10 [95% CI 0.03 to 0.37], p = 0.0006). Also, the presence of seizures-rather than not-was associated with greater odds of a composite of death and all abnormal outcomes on follow-up (13/14 vs 26/61; OR, 17.5; 95% CI, 2.15-142.39; p = 0.0074). CONCLUSIONS: Nearly one in five neonates with CDH receiving ECMO developed seizures during the ECMO course. Seizures were predominantly electrographic-only and when present were associated with great odds of adverse outcomes. The current study provides evidence to support standardized CEEG in this population.

Variable Association of Physiologic Changes With Electrographic Seizure-Like Events in Infants Born Preterm.

OBJECTIVES: To determine the incidence of seizure-like events in a cohort of infants born preterm as well as the prevalence of associated vital sign changes (heart rate [HR], respiratory rate, and pulse oximetry [SpO2]). STUDY DESIGN: We performed prospective conventional video electroencephalogram monitoring on infants born at 23-30 weeks of gestational age during the first 4 postnatal days. For detected seizure-like events, simultaneously captured vital sign data were analyzed during the pre-event baseline and during the event. Significant vital sign changes were defined as HR or respiratory rate >±2 SD from the infant's own baseline physiologic mean, derived from a 10-minute interval before the seizure-like event. Significant change in SpO2 was defined as oxygen desaturation during the event with a mean SpO2 <88%. RESULTS: Our sample included 48 infants with median gestational age of 28 weeks (IQR 26-29) and birth weight of 1125 g (IQR 963-1265). Twelve (25%) infants had seizure-like discharges with a total of 201 events; 83% (10/12) of infants had vital sign changes during these events, and 50% (6/12) had significant vital sign changes during the majority of the seizure-like events. Concurrent HR changes occurred the most frequently. CONCLUSIONS: Individual infant variability was observed in the prevalence of concurrent vital sign changes with electroencephalographic seizure-like events. Physiologic changes associated with preterm electrographic seizure-like events should be investigated further as a potential biomarker to assess the clinical significance of such events in the preterm population.

[Depression in patients with epilepsy: experience in a private hospital in Argentina]. / Depresión en pacientes con epilepsia. Experiencia en un hospital privado de Argentina.

INTRODUCTION: Depression is the most frequent psychiatric disorder in patients with epilepsy, with an estimated prevalence between 35% and 60%, associated with poorer control of epileptic seizures. Despite the high prevalence of depression, many patients are not diagnosed, presenting a worse clinical course and quality of life. There are no prevalence studies in our population. The main objective was to determinate the prevalence of depression in epilepsy and its relationship with seizure control. MATERIALS AND METHODS: It is a prospective, descriptive and cross-sectional study of a cohort of patients who underwent the Depression Inventory in Patients with Neurological Disorders for Epilepsy (NDDI-E) and the data from the medical records were analyzed. RESULTS: A total of 121 patients were inluded, and the prevalence of depression was 43% (n:52), of whom 77% were women (p = 0.01). A 63% of patients with depression was diagnosed in this study. Most of them with good seizure control (70%) did not present depression, while the majority of those with poor (57%) and regular (63%) seizure control presented depression (p < 0.001). DISCUSSION: Comorbidity between depression and epilepsy is highly prevalent, negatively influencing the control of epileptic seizures. Most patients are underdiagnosed. Screening for major depression in patients with epilepsy is necessary, contributing to the clinical improvement.

Introducción: La depresión es el trastorno psiquiátrico más frecuente en pacientes con epilepsia, con una prevalencia estimada entre 35% y 60%, asociándose a un peor control de crisis epilépticas. A pesar de la gran prevalencia de depresión, muchos pacientes no son diagnosticados, presentando una peor evolución clínica y calidad de vida. No existen estudios de prevalencia en nuestro medio. El objetivo fue determinar la prevalencia de depresión en epilepsia y su relación con el control de crisis. Materiales y métodos: Es un estudio prospectivo, descriptivo y transversal de una cohorte de pacientes a los cuales se les realizó el Inventario de Depresión en Pacientes con Trastornos Neurológicos para Epilepsia (NDDIE) y se analizaron datos de las historias clínicas. Resultados: Se incluyeron 121 pacientes, la prevalencia de depresión fue 43% (n:52), el 77% eran mujeres (p = 0.01). Del total de pacientes con depresión, el 63% fue diagnosticado en este estudio. La mayoría tuvo buen control de la crisis (70%) y no presentó depresión, mientras que la mayoría con mal (57%) y regular (63%) control de la crisis presentó depresión (p < 0.001). Discusión: La comorbilidad entre depresión y epilepsia es altamente prevalente, influyendo negativamente en el control de las crisis epilépticas. La mayoría de los pacientes se encuentran subdiagnosticados. El tamizaje de la depresión mayor en aquellos con epilepsia es necesario, contribuyendo a la mejoría clínica.

The burden of T. solium cysticercosis and selected neuropsychiatric disorders in Mocuba district, Zambézia province, Mozambique

Background: Taenia solium (neuro-)cysticercosis, a neglected tropical disease, can be associated with epileptic seizures and other neuropsychiatric (= neurological and psychiatric) disorders. This study aimed to evaluate the association of T. solium cysticercosis with selected neuropsychiatric disorders and/or symptoms (chronic headache, epileptic seizures/epilepsy and psychosis) in Mocuba district, Mozambique. Methodology: Between March and May 2018, a cross-sectional study was conducted among 1,086 participants aged 2 years or above in Mocuba district, Zambézia province, central Mozambique, to assess the seroprevalence of human cysticercosis and risk factors for infection, as well as to explore its relation to selected neuropsychiatric disorders. Socio-demographic and clinical data were collected from each participant using a modified questionnaire designed by the Cysticercosis Working Group for Eastern and Southern Africa. Additionally, neuropsychiatric disorders, such as chronic headache, epileptic seizures/epilepsy and psychosis were assessed using four vignettes. T. solium antigen and cysticercosis IgG in serum were detected using both T. solium antigen B158/B60 enzyme linked immunosorbent assay (ELISA) and LDBIO Cysticercosis Western Blot, respectively. Principal findings: Overall, 112/1,086 participants (10.3%) were sero-positive for T. solium antigen or antibodies. Prevalence of antibodies (6.6%; n = 72) was higher than of antigens (4.9%; n = 54). In the questionnaires, 530 (49.5%) of participants reported chronic headache, 293 (27%) had generalized epileptic seizures, 188 (18%) focal seizures and 183 (18.3%) psychosis. We found a statistically significant association between seropositivity for T. solium and chronic headache (p = 0.013). Additionally, increasing age (p = 0.03) was associated with Ag-ELISA seropositivity. Conclusions: Our study revealed that in Mocuba, T. solium cysticercosis is prevalent and associated with self-reported chronic headache. Additionally, in the study setting, the seroprevalence of cysticercosis increased with age. However, it is not associated with other neuropsychiatric disorders such epileptic seizures/epilepsy and psychosis. Future studies are needed to confirm the high burden of neuropsychiatric disorders and their possible etiology, including neurocysticercosis, using additional serological, molecular biological and radiological diagnostic tools, as well as in-depth clinical examinations.

Clinical characteristics of patients with epilepsy attending primary health care. / Características clínicas de pacientes con epilepsia atendidos en la atención primaria.

OBJECTIVE: This study aimed to fill the current knowledge gap in the literature by identifying the demographic and clinical characteristics of patients with epilepsy attending primary health care (PHC). PATIENTS AND METHODS: This was a cross-sectional study involving adults (= 18 years of age) with epilepsy attending PHC from a developing country between 2015 and 2019. Demographic information and epilepsy-related data were collected. RESULTS: A total of 140 patients (51.4% male; mean [± SD] age 44.9 ± 17.8 years) were evaluated. The mean age at onset of seizures was 29.9 ± 22.9 years, with a mean evolution of 14.3±15.4 years. Focal seizures accounted for 88.57% of cases and evolved into bilateral tonic-clonic attack (45.16%). Of those that were generalized, motor seizures accounted for 81.82%, absence 9.09%, and motor + absence 9.09%. Among generalized onset motor seizures, tonic-clonic was predominant, accounting for 55.56%. Among types, focal epilepsy predominated (88.57%). The primary etiologies were unknown (62.14%), structural causes (27.85%) and infectious (9.28%). Patients undergoing monotherapy accounted for 66.1%, with epilepsy control in 92.4%. The most commonly used antiepileptic drugs were carbamazepine (33.1%), valproic acid (28.2%), and phenobarbital (10.4%). CONCLUSIONS: Male sex, seizures, and focal epilepsy were prevalent. Magnetic resonance imaging was more useful than computed tomography. Most etiologies were unknown; however, mesial temporal sclerosis and neurocysticercosis were the most prevalent known causes. Most patients were controlled using a monotherapy regimen. The implementation of International League Against Epilepsy classifications and definitions was feasible and useful.

TITLE: Características clínicas de pacientes con epilepsia atendidos en la atención primaria.Objetivo. Este estudio tuvo como objetivo llenar el vacío de conocimiento actual en la bibliografía mediante la identificación de las características demográficas y clínicas de los pacientes con epilepsia que asisten a la atención primaria de salud. Pacientes y métodos. Éste fue un estudio transversal que involucró a adultos (18 años o mayores) con epilepsia que asistieron a atención primaria de salud de un país en desarrollo entre 2015 y 2019. Se recopilaron información demográfica y datos relacionados con la epilepsia. Resultados. Se evaluó a un total de 140 pacientes ­51,4%, varones; edad media (± desviación estándar), 44,9 ± 17,8 años­. La edad media de inicio de las crisis fue de 29,9 ± 22,9 años, con una evolución media de 14,3 ± 15,4 años. Las crisis focales presentes en el 88,57% de los casos y evolucionaron a crisis tonicoclónicas bilaterales (45,16%). De las generalizadas, las crisis motoras predominaron con el 81,82%; las ausencias, el 9,09%; y las motoras + ausencias, el 9,09%. Entre las crisis motoras de inicio generalizado, predominó la tonicoclónica, con un 55,56%. Entre los tipos, predominó la epilepsia focal (88,57%). Las etiologías primarias fueron desconocidas (62,14%), causas estructurales (27,85%) e infecciosas (9,28%). Los pacientes en monoterapia representaron el 66,1%, con control de la epilepsia en el 92,4%. Los fármacos antiepilépticos más utilizados fueron la carbamacepina (33,1%), el ácido valproico (28,2%) y el fenobarbital (10,4%). Conclusiones. Predominaron el sexo masculino, las convulsiones y la epilepsia focal. La resonancia magnética fue más útil que la tomografía computarizada. La mayoría de las etiologías se desconocían; sin embargo, la esclerosis temporal mesial y la neurocisticercosis fueron las causas conocidas más prevalentes. La mayoría de los pacientes se controlaron con un régimen de monoterapia. La implementación de las clasificaciones y definiciones de la Liga Internacional contra la Epilepsia fue factible y útil.

Are seizures associated with neuroschistosomiasis mansoni? An exploratory survey in an endemic area of Brazil.

BACKGROUND: Deposition of Schistosoma mansoni eggs in the brain of patients with hepatosplenic schistosomiasis (HS-SM) is frequent and usually asymptomatic. However, it is questioned whether it could cause seizures. Thus, we investigated the occurrence of seizures in these patients and also searched for parameters associated with this disorder. METHODS: In a cross-sectional survey, we compared 128 patients with HS-SM with 102 patients with portal hypertension due to compensated chronic hepatic disease of other etiologies. A standardized questionnaire, emphasizing epilepsy-related parameters, was applied to all participants. RESULTS: Eight (6.3%) patients with HS-SM had a history of seizures, whereas this condition was reported by three (2.9%) individuals from the comparison group (p=0.354). None of the variables were associated with the occurrence of seizures, either in univariate or in multivariate analysis. CONCLUSIONS: The frequency of seizures was similar in both study groups. However, it was higher than that described in population-based studies. Thus, we hypothesize that HS-SM individuals may have a higher frequency of seizure. The lack of difference between the two study groups may be explained by the inclusion of cases of HS-MS overlapping other chronic liver diseases in the comparison group, because this finding is relatively common in schistosome-endemic areas.

Neurological manifestations as prognostic factors in COVID-19: a retrospective cohort study.

BACKGROUND: Neurological manifestations are frequent during COVID-19 but have been poorly studied as prognostic markers of COVID-19. OBJECTIVES: The aim of this study was to assess whether neurological manifestations are associated with a poor prognosis of COVID-19, and which patient and COVID-19 characteristics were associated with encephalopathy. METHODS: This was a retrospective cohort study and included patients admitted with COVID-19 in four hospitals from Recife, Brazil. Data were collected by reviewing medical records. RESULTS: 613 were included; 54.6% were male, the median age was 54 (41-68) years, 26.4% required mechanical ventilation, and 24.1% died. The neurological symptoms presented were: myalgia (25.6%), headache (22%), fatigue (22%), drowsiness (16%), anosmia (14%), disorientation (8.8%), ageusia (7.3%), seizures (2.8%), and dizziness (1.5%). Twelve patients (2%) had strokes (ischemic strokes: 9) and 149 (24.3%), encephalopathy. Older age, a prolonged hospitalization, diabetes mellitus, a previous history of stroke and having epileptic seizures during hospitalization were significantly associated with the occurrence of encephalopathy. Older age, smoking and requiring mechanical ventilation were associated with prolonged hospitalization. Older patients, those requiring mechanical ventilation and those with encephalopathy presented a significantly higher risk, while those who had anosmia presented a significantly lower risk of dying. CONCLUSIONS: Neurological symptoms are frequent among patients with COVID-19. Encephalopathy was the most frequent neurological complication and was associated with a higher mortality. Those with anosmia had a lower mortality.

Independent risk factors for seizures in critically ill patients on continuous EEG.

OBJECTIVE: The objective of this study was to characterize the independent risk factors for seizures in critically ill patients monitored with continuous EEG (cEEG). METHODS: We retrospectively investigated variables associated with cEEG seizures, first in the entire cohort of 156 patients and, subsequently, in the subgroup without seizures in the first 30 minutes of monitoring. RESULTS: Seizures were observed in 19.2% of recordings, and in 50% of these, seizures occurred in the first 30 minutes. In the entire cohort, epilepsy, acute seizures prior to cEEG, interictal epileptiform discharges (IEDs), lateralized periodic discharges (LPDs), and brief potentially ictal rhythmic discharges (BIRDs) were associated with a higher incidence of cEEG seizures, whereas coma, intravenous anaesthetic drugs, and generalized periodic discharges (GPDs) were associated with a lower incidence of seizures. On multivariate analysis, this association was maintained for acute seizures before cEEG (OR: 5.92) and IEDs (OR: 6.81). Excluding patients with seizures at the beginning of monitoring, acute seizures before cEEG, IEDs, LPDs, and BIRDs were associated with an increased risk of seizures. The presence of IEDs or LPDs in the first 30 minutes was associated with a 4.14-fold greater chance of seizures on cEEG. On multivariate analysis, acute seizures prior to recording (OR 7.29) and LPDs (OR: 5.38) remained associated with seizures on cEEG. Due to the sample size, BIRDs were not included in multivariate models. SIGNIFICANCE: Acute seizures prior to monitoring, IEDs, LPDs and BIRDs are important risk factors for cEEG seizures in critically ill patients.

Relationship of white matter hyperintensities with clinical features of seizures in patients with epilepsy / A relação das hiperintensidades da substância branca com as características clínicas das crises em pacientes com epilepsia

ABSTRACT Background: Although epilepsy is primarily known as a cortical disorder, there is growing body of research demonstrating white matter alterations in patients with epilepsy. Objective: To investigate the prevalence of white matter hyperintensities (WMH) and its association with seizure characteristics in patients with epilepsy. Methods: The prevalence of WMH in 94 patients with epilepsy and 41 healthy controls were compared. Within the patient sample, the relationship between the presence of WMH and type of epilepsy, frequency of seizures, duration of disease and the number of antiepileptic medications were investigated. Results: The mean age and sex were not different between patients and healthy controls (p>0.2). WMH was present in 27.7% of patients and in 14.6% of healthy controls. Diagnosis of epilepsy was independently associated with the presence of WMH (ß=3.09, 95%CI 1.06-9.0, p=0.039). Patients with focal epilepsy had higher prevalence of WMH (35.5%) than patients with generalized epilepsy (14.7%). The presence of WMH was associated with older age but not with seizure characteristics. Conclusions: WMH is more common in patients with focal epilepsy than healthy controls. The presence of WMH is associated with older age, but not with seizure characteristics.

RESUMO Antecedentes: Embora a epilepsia seja principalmente conhecida como um distúrbio cortical, há um crescente corpo de pesquisas que demonstra alterações na substância branca em pacientes com epilepsia. Objetivo: Investigar a prevalência de hiperintensidades da substância branca (WMH) e sua associação com características das crises em pacientes com epilepsia. Métodos: A prevalência de WMH em 94 pacientes com epilepsia e 41 controles saudáveis ​​foi comparada. Na amostra de pacientes, foi investigada a relação entre a presença de WMH e o tipo de epilepsia, a frequência das crises, a duração da doença e o número de medicamentos antiepilépticos. Resultados: A média de idade e o sexo não diferiram entre pacientes e controles saudáveis ​​(p>0,2). WMH estava presente em 27,7% dos pacientes, enquanto em 14,6% dos controles saudáveis. O diagnóstico de epilepsia foi independentemente associado à presença de WMH (ß=3,09, IC95% 1,06-9,0, p=0,039). Pacientes com epilepsia focal apresentaram maior prevalência de WMH (35,5%) do que pacientes com epilepsia generalizada (14,7%). A presença de WMH foi associada à idade avançada, mas não a características das crises. Conclusões: Pacientes com epilepsia focal têm WMH mais comum do que controles saudáveis. A presença de WMH está associada à idade avançada, mas não a características das crises epilépticas.

Sleep Disruption Worsens Seizures: Neuroinflammation as a Potential Mechanistic Link.

Sleep disturbances, such as insomnia, obstructive sleep apnea, and daytime sleepiness, are common in people diagnosed with epilepsy. These disturbances can be attributed to nocturnal seizures, psychosocial factors, and/or the use of anti-epileptic drugs with sleep-modifying side effects. Epilepsy patients with poor sleep quality have intensified seizure frequency and disease progression compared to their well-rested counterparts. A better understanding of the complex relationship between sleep and epilepsy is needed, since approximately 20% of seizures and more than 90% of sudden unexpected deaths in epilepsy occur during sleep. Emerging studies suggest that neuroinflammation, (e.g., the CNS immune response characterized by the change in expression of inflammatory mediators and glial activation) may be a potential link between sleep deprivation and seizures. Here, we review the mechanisms by which sleep deprivation induces neuroinflammation and propose that neuroinflammation synergizes with seizure activity to worsen neurodegeneration in the epileptic brain. Additionally, we highlight the relevance of sleep interventions, often overlooked by physicians, to manage seizures, prevent epilepsy-related mortality, and improve quality of life.

[Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic]. / Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.

TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.

Relationship of white matter hyperintensities with clinical features of seizures in patients with epilepsy.

BACKGROUND: Although epilepsy is primarily known as a cortical disorder, there is growing body of research demonstrating white matter alterations in patients with epilepsy. OBJECTIVE: To investigate the prevalence of white matter hyperintensities (WMH) and its association with seizure characteristics in patients with epilepsy. METHODS: The prevalence of WMH in 94 patients with epilepsy and 41 healthy controls were compared. Within the patient sample, the relationship between the presence of WMH and type of epilepsy, frequency of seizures, duration of disease and the number of antiepileptic medications were investigated. RESULTS: The mean age and sex were not different between patients and healthy controls (p>0.2). WMH was present in 27.7% of patients and in 14.6% of healthy controls. Diagnosis of epilepsy was independently associated with the presence of WMH (ß=3.09, 95%CI 1.06-9.0, p=0.039). Patients with focal epilepsy had higher prevalence of WMH (35.5%) than patients with generalized epilepsy (14.7%). The presence of WMH was associated with older age but not with seizure characteristics. CONCLUSIONS: WMH is more common in patients with focal epilepsy than healthy controls. The presence of WMH is associated with older age, but not with seizure characteristics.

[Neurology and COVID-19: Case Series of Neurological Complications in 96 patients Admitted at a University Hospital]. / Neurología hospitalaria y COVID-19: serie de 96 pacientes evaluados en un hospital universitario.

BACKGROUND: There are multisystemic consequences secondary to SARS- CoV-2 infection. AIM: To characterize neurological complications in patients admitted due to SARS-CoV-2 infection. METHODS: Review of medical records of patients aged over 15 years with COVID-19 evaluated by the neurology team between April and August 2020 at a university hospital. Severity of the infection, referral reasons, neurological diagnoses and laboratory results were registered. The diagnoses were defined by consensus among the members of the hospital neurology group. Cerebrovascular and inflammatory diseases of the central and peripheral nervous system were defined as "probably associated" or "possibly associated" to COVID-19. RESULTS: Ninety-six patients had at least 1 new neu- rological complication. 74% were admitted due to pneumonia and 20% due to a neurological disease. The most common reasons for neurological referral were impaired consciousness (39%), focal neurological deficit (24%), headache (9%) and seizures (5%). The most relevant neurological diagnoses were delirium in 48 patients, stroke in 24, critical illness polyneuropathy and myopathy in 17, seizures in 14, brachial plexopathy in 3, compressive neuropathies in 5, encephalitis in 1, possible vasculitis in 1 and Guillain-Barré syndrome in 1. Stroke and epilepsy were associated with increased length of hospital stay, but without differences in mortality. CONCLUSIONS: The spectrum of neurological complications of COVID-19 is wide. There are clinical entities typical of critically ill patients and also diseases associated directly and indirectly with the SARS-CoV2 infection.

Psychiatric disorders, depression and quality of life in patients with psychogenic non-epileptic seizures and drug resistant epilepsy living in Argentina.

OBJECTIVES: Psychiatric disorders are frequently found in both patients with PNES and DRE, making the differential diagnosis even more complex. The aim of this study was to analyze and compare psychiatric aspects and the quality of life in patients with psychogenic non-epileptic seizures (PNES) and drug resistant epilepsy (DRE). METHODS: Patients admitted to video-electroencephalograpy (VEEG) unit with confirmed PNES and DRE were included. Demographical characteristics, psychiatric diagnosis according to SCID I and II of DSM IV, pharmacological treatment, general functioning measured with GAF (Global assessment of functionality), quality of life (QoL) using QlesQSF (Quality of Life Enjoyment and Satisfaction Questionnaire Short Form) and depression severity using BDI II (Beck depression inventory), were compared between the groups. Non-parametric tests, chi square test, and logistic regression were used for statistical analysis. RESULTS: 148 patients consecutively admitted to VEEG were included (DRE n = 97; PNES n = 51). Somatization disorder (RR: 13.02, 95% CI: 1.23-137.39, p = 0.03) and a history of trauma (RR: 8.66, 95% CI: 3.21-23.31, p = 0.001) were associated with PNES. The QlesQ score and the GAF score were lower with a higher prevalence of suicide attempts in the PNES group (p < 0.01). A negative correlation was observed between the severity of depression and the quality of life (DRE r = - 0.28, p = 0.013; PNES r = - 0.59, p = 0.001). CONCLUSIONS: Higher psychiatric comorbidity with poorer QoL were found in PNES patients compared to DRE. However, depression comorbidity negatively affected the QoL in both groups. Future studies based on illness perception will be orientated to complete this analysis.

Neurocysticercosis. A frequent cause of seizures, epilepsy, and other neurological morbidity in most of the world.

Neurocysticercosis is endemic in most of the world and in endemic areas it accounts for approximately 30% of cases of epilepsy. Appropriate diagnosis and management of neurocysticercosis requires understanding the diverse presentations of the disease since these will vary in regards to clinical manifestation, sensitivity of diagnostic tests, and most importantly, therapeutic approach. This review attempts to familiarize tropical neurology practitioners with the diverse types of neurocysticercosis and the more appropriate management approaches for each.

Systemic lupus erythematosus in children and adults: A retrospective study in Brazilian patients.

BACKGROUND: Systemic lupus erythematosus (SLE) may have a different serological and clinical profile according to age of disease onset. AIM: To compare clinical presentation and serological data from patients with SLE onset in childhood (cSLE) with disease onset in adulthood (aSLE) in a sample of Brazilian patients. METHODS: Retrospective study of 614 SLE patients from a single Rheumatology Unit from Brazil: 77 (12.5%) cSLE and 537 (87.4%) aSLE. Clinical and serological data were obtained from the charts. Comparisons of cSLE with aSLE in general and according to patient's gender were made. RESULTS: The comparison of whole sample showed that children had more malar rash (p = 0.04), seizures (p < 0.0001), psychosis (p = 0.02), glomerulonephritis (p = 0.001), anti-dsDNA (p = 0.008), anticardiolipin IgM (p = 0.04) but less discoid lesions (p = 0.01), anti-Ro (p < 0.0001) and anti-La antibodies (p = 0.007). When only the male sample was compared, no differences in glomerulonephritis and anti-dsDNA frequencies were found. CONCLUSION: Children had a higher frequency of severe manifestations (glomerulonephritis and central nervous system) than adults. The difference in glomerulonephritis occurrence disappeared when only males were compared.