Epilepsy and suicide

Although statistics dealing with the causes of death are often difficult to compare, in some cases they indicate that suicide rates are high among people suffering from seizures. The author considers this critically. At present the number of attempted suicides among this group is at least five times higher than among the average population. The author reports on his own findings, on factors indicating potential suicide victims, and on the possible prevention of suicide, particularly in connection with pharmaceutical treatment.     

Epilepsy and pregnancy--results of interdisciplinary cooperation

A total of 19 female epileptics were jointly counselled, cared for and delivered during 21 pregnancies. Special aspects that must be taken into account during pregnancy in epileptics are described. Due to changes in the pharmacokinetics of anti-epileptic drugs, plasma level checks must be performed every four weeks during early pregnancy. The possible teratogenic effects of anticonvulsants and other factors tending to increase the malformation rate are discussed. An explanation is given for the use of prophylactic folic acid and vitamin k treatment in connection with anti-epileptic therapy. Breast feeding has not only proved advantageous from the nutritional standpoint but also helps withdraw the new-born, who is habituated to anticonvulsants, from the drugs without negative symptoms. The benefits of counselling prior to pregnancy and general questions relating to women who are prone to seizures while they are of child-bearing age is discussed.     

Epilepsy, consciousness and neurostimulation

Consciousness is often disrupted in epilepsy. This may involve altered responsiveness or changes in awareness of self and subjective experiences. Subcortical arousal systems and paralimbic fronto-parietal association cortices are thought to underpin current concepts of consciousness. The Network Inhibition Hypothesis proposes a common neuroanatomical substrate for impaired consciousness during absence, complex partial and tonic-clonic seizures. Neurostimulation in epilepsy remains in its infancy with vagal nerve stimulation (VNS) as the only firmly established technique and a series of other methods under investigation including deep brain stimulation (DBS), intracranial cortical stimulation and repetitive transcranial magnetic stimulation (rTMS). Many of these systems impact on the neural systems thought to be involved in consciousness as a continuous duty cycle although some adaptive (seizure triggered) techniques have been developed. Theoretically, fixed duty cycle neurostimulation could have profound effects on responsiveness, awareness of self and subjective experience. Animal studies suggest vagal nerve stimulation positively influences hippocampal long term potentiation. In humans, a chronic effect of increased alertness in VNS implanted subjects and acute effect on memory consolidation have been reported but convincing data on either improvements or deterioration in attention and memory is lacking. Thalamic deep brain stimulation (DBS) is perhaps the most interesting neurostimulation technique in the context of consciousness. Neither bilateral anterior or centromedian thalamic nucleus DBS seem to affect cognition. Unilateral globus pallidus internus DBS caused transient wakefulness in an anaesthetised individual. As intracranial neurostimulation, particularly thalamic DBS, becomes more established as a clinical intervention, the effects on consciousness and cognition with variations in stimulus parameters will need to be studied to understand whether these secondary effects of neurostimulation make a significant positive (or adverse) contribution to quality of life.     

对癫痫的认识及其外科治疗

人们对癫痫的认识及其外科治疗的发展是一个漫长而复杂的过程,经历高潮、低谷的更迭。科技进步使人们对癫痫正确认识,也使治疗手段更趋于多样化、个性化。     

Language Organization and Reorganization in Epilepsy

The vast majority of healthy individuals are left hemisphere dominant for language; however, individuals with left hemisphere epilepsy have a higher likelihood of atypical language organization. The cerebral organization of language in epilepsy has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping (ESM), and more recently, with noninvasive neuroimaging techniques such as functional magnetic resonance imaging (fMRI). Investigators have used these techniques to explore the influence of unique clinical features inherent in epilepsy that might contribute to the reorganization of language, such as location of seizure onset, age of seizure onset, and extent of interictal epileptiform activity. In this paper, we review the contribution of these and other clinical variables to the lateralization and localization of language in epilepsy, and how these patient-related variables affect the results from these three different, yet complementary methodologies. Unlike the abrupt language changes that occur following acute brain injury with disruption of established language circuits, converging evidence suggests that the chronic nature of epileptic activity can result in a developmental shift of language from the left to the right hemisphere or re-routing of language pathways from traditional to non-traditional areas within the dominant left hemisphere. Clinical variables have been shown to contribute to cerebral language reorganization in the setting of chronic seizure disorders, yet such factors have not been reliable predictors of altered language networks in individual patients, underscoring the need for language lateralization and localization procedures when definitive identification of language cortex is necessary for clinical care.     

对癫痫的认识及其外科治疗

人们对癫痫的认识及其外科治疗的发展是一个漫长而复杂的过程,经历高潮、低谷的更迭.科技进步使人们对癫痫正确认识,也使治疗手段更趋于多样化、个性化.     

癫痫的诊治与人文思想

癫痫是神经科常见的疾病之一,对于患者的学习、生活和工作均有不同程度影响。它的发病机制尚不十分清楚,主要是以药物治疗为主。在癫痫的诊断中要根据病情和患者的实际情况选择合适的检查;在癫痫的治疗中须按照最优化的医疗原则选择最佳的治疗方案。在治疗中要注意结合人文思想来提高癫痫的治疗效果。     

癫痫的诊治与人文思想

癫痫是神经科常见的疾病之一,时于患者的学习、生活和工作均有不同程度影响.它的发病机制尚不十分清楚,主要是以药物治疗为主.在癫痫的诊断中要根据病情和忠者的实际情况选择合适的检查;在癫痫的治疗中须按照最优化的医疗原则选择最佳的治疗方案.在治疗中要注意结合人文思想来提高癫痫的治疗效果.     

Cognitive Progression in Epilepsy

The issue of cognitive progression in people with epilepsy is of considerable interest and has important clinical and theoretical implications. In this paper, we review recent studies in both the adult and childhood epilepsy literature which have included a longitudinal test–retest design to examine this question. Several important methodological issues of this literature are highlighted and areas which require more investigation are identified.     

Literary Factitious Epilepsy Syndromes

Several factitious epileptic syndromes have been associated with famous literary characters. While these syndromes include symptoms other than pseudoseizures, and while pseudoseizures can occur in other syndromes, a review of these disorders provides insights into factitious seizures and epilepsy.     

Olfactory Information Processing and Temporal Lobe Epilepsy

It has been suggested that olfactory information processing is impaired in patients with temporal lobe epilepsy. However, the existing evidence is not wholly in accordance with this notion. Patients with epileptogenic foci in the left temporal lobe, the right temporal lobe, or other brain regions were compared with normal control subjects in the identification and retention of common odors. All three patient groups were substantially and equally impaired in verbally labelling the odors in question. The patients with epilepsy associated with the left temporal lobe or with nontemporal regions showed no sign of any impairment on a test of immediate recognition memory for common odors. However, the patients with epilepsy associated with the right temporal lobe showed a specific disturbance in their retention of nameable odors. It is suggested that the latter patients were selectively impaired in their retrieval of the episodic memories which provide the context for the encoding of distinctive odors.     

Review of Commercially Available Epilepsy Genetic Panels

Next generation sequencing panels have revolutionized the diagnostic approach to patients with epilepsy. There are several commercial epilepsy panels available. We assessed the list of genes tested and consent forms for epilepsy panels available at seven laboratories. The panels varied in the number of genes included (70–465 genes). In some panels, genes not currently associated with epilepsy were included (up to 4 % of panel content). The panels also included genes for lysosomal storage disorders (6–12 %), congenital disorders of glycosylation (0–8.5 %), metabolic disorders (3.5–34 %), neurological syndromes (18–43 %) and multisystemic genetic syndromes (6.4–21 %). Informed consents differed significantly between laboratories ranging from basic information about genetic testing and possible results to information about insurance, genetic counseling and familial testing, and incidental findings.Our findings suggest that it is important to consider the range of genes offered on epilepsy panels and their predicted phenotypes in an effort toward improving the informed consent process.     

关于提高癫痫正确诊断率的思考

癫痫是神经系统常见疾病之一 ,临床上常有误诊误治现象。无论是癫痫的诊断 ,还是治疗药物的选择 ,都给临床医生的哲学思维提出了很高的要求。因此临床医生不仅要注重积累自己的专业知识 ,而且要努力提高自己的哲学修养。     

Epilepsy by looking at patterns]

The author, after pointing out the rare occurence and peculiarities of pattern-sensitive forms of epilepsy, reports the case of a seven-year-old boy with infantile cerebral paresis characterized by symptomatic attacks, who was observed to show absence-like conditions when looking at small-checkered patterns of nylon fabric. Grasping and looking at such fabrics assumed the form of an addiction, with a sense of pleasure being believed to be derived therefrom. Although anticonvulsive therapy resulted in attacks of epilepsy being no longer detectable clinically and by electroencephalography, seizures were still triggered by looking at patterns. Also discussed in this article is the problem of transition from real to psychogenic attacks.     

Neuropsychological Deficits in Childhood Epilepsy Syndromes

Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.