<strong>Background:</strong> Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis. <st...<strong>Background:</strong> Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis. <strong>Case Presentation:</strong> We present 3 cases of young adult men admitted to psychiatric ward as functional psychosis. They presented with irritability, physical aggression and mild cognitive impairment with intense emotional symptoms, and persecutory ideas and delusions. Two were wrongly diagnose as mania while the third was mimicking schizophrenia in its presentation. They received antipsychotic treatment and misdiagnosed as functional psychosis. They did not respond well to such treatment, until, series electroencephalograms were taken which revealed evidence of ictal psychosis. All, thence, responded well to addition of antiepileptic treatment. This, not only, proves to be effective, but also determined future management and prognosis. <strong>Conclusion: </strong>These cases shine light onto the role of the frontal cortex in the genesis of quasi-manic episodes and highlight the importance of EEG investigations in first episode of acute psychosis.展开更多
We present a case of ictal asystole in an 81-year-old female, with no prior history of epileptic activity, or cardiac history suggestive of arrhythmia, who suffered several seemingly unrelated epileptic and asyst...We present a case of ictal asystole in an 81-year-old female, with no prior history of epileptic activity, or cardiac history suggestive of arrhythmia, who suffered several seemingly unrelated epileptic and asystolic episodes prior to finally having a witnessed seizure followed by an asystolic event. Following this event, all atrioventricular (AV) nodal blockers, and medications with potential seizure threshold lowering activity were stopped, and anti-epileptic medication was optimized. Due to the wishes of the patient’s family, no invasive interventions were pursued.However, the patient continued to be medically treated with anti-epileptic therapy and had no further asystolic events. Unfortunately, the patient’s overall clinical status deteriorated, and she subsequently passed during her hospital stay after being made do not resuscitate and do not intubate (DNR/DNI) by the family and then subsequently comfort care. Prior to her passing, however, she had remained free of epileptic events for 10 days and free of asystolic events for 21 days.展开更多
Background Ictal examination based on video-based electroencephalography(EEG)is crucial for locating and lat-eralizing seizures.In this study,we aimed to evaluate the quality of ictal examination in the Comprehensive ...Background Ictal examination based on video-based electroencephalography(EEG)is crucial for locating and lat-eralizing seizures.In this study,we aimed to evaluate the quality of ictal examination in the Comprehensive Epilepsy Center of West China Hospital,Sichuan University,in order to provide information for quality improvement in daily clinical practice.Methods Video recordings of 100 patients with epilepsy were retrospectively reviewed.The performance of the ictal examination was independently reviewed by two epileptologists using an ictal examination protocol.Results In this retrospective analysis,589 seizure episodes from 100 patients with epilepsy were reviewed.The ages of the patients ranged from 3 to 77 years,with a mean age of 25.8±12.8 years.Among the 589 seizure episodes,a majority(93.7%)were focal seizures.For 226(38.4%)seizures,the medical staff arrived at the bedside.Among them,153(153/226,64.7%)seizure episodes,the medical staff arrival at the bedside within 30 s of onset,and 120(120/226,53.1%)seizures were tested by the medical staff.The compliance rates for"safety"and"visibility"reached 80%or higher while"naming","retelling",and“memory testing”only reach less than 3%.Conclusions Our survey identified the main problems in ictal assessments.It is challenging to complete a standard-ized examination for new trainees at Epilepsy Monitoring Units.Regularly strengthening training in ictal examination and understanding of semiology may improve patients’examination ability.However,further study of the implemen-tation of training is necessary.展开更多
Although presurgical evaluation of patients with pharamacoresistent focal epilepsies provides essential information for successful epilepsy surgery,there is still a need for further improvement.Developments of noninva...Although presurgical evaluation of patients with pharamacoresistent focal epilepsies provides essential information for successful epilepsy surgery,there is still a need for further improvement.Developments of noninvasive electrophysiological recording and analysis techniques offer additional information based on interictal and ictal epileptic activities.In this review,we provide an overview on the application of ictal magnetoencephalography(MEG).The results of a literature research for published interictal/ictal MEG findings and experiences with own cases are demonstrated and discussed.Ictal MEG may provide added value in comparison to interictal recordings.The results may be more focal and closer to the invasively determined seizure onset zone.In some patients without clear interictal findings,ictal MEG could provide correct localization.Novel recording and analysis techniques facilitate ictal recordings.However,extended recording durations,movement and artifacts still represent practical limitations.Ictal MEG may provide added value regarding the localization of the seizure onset zone but depends on the selection of patients and the application of optimal analysis techniques.展开更多
Background:The insula is a hidden part in the cerebral cortex.Insular epilepsy is underrecognized and it bears a special risk for misdiagnosis with regard to nonepileptic seizures or wrong localization of epileptic se...Background:The insula is a hidden part in the cerebral cortex.Insular epilepsy is underrecognized and it bears a special risk for misdiagnosis with regard to nonepileptic seizures or wrong localization of epileptic seizures.Case presentations:The manuscript describes 2 cases with ictal semiology of paresthesia and pain followed by hyperkinetic movements,noninvasive findings of source localization and/or invasive SEEG exploration.Conclusion:Magnetic source imaging,ictal SPECT as noninvasive and invasive recordings with depth electrodes(SEEG)can provide important preoperative information for the involvement of insular and periinsular regions in focal pharmacoresistant epilepsies.The optimal use of these methods presupposes extensive knowledge of ictal semiology and other clinical characteristics.The clinical localization hypothesis can be optimally proofed by SEEG exploration.展开更多
Introduction:Hypersalivation has been associated with Rolandic epilepsy and other childhood epilepsy syndromes.However,pure salivatory seizures are a rare type of focal seizure in which ictal hypersalivation is the do...Introduction:Hypersalivation has been associated with Rolandic epilepsy and other childhood epilepsy syndromes.However,pure salivatory seizures are a rare type of focal seizure in which ictal hypersalivation is the dominant feature throughout the seizures.Case presentation:We present a case of pure salivatory seizures originating from the right post-central operculum cortex,confirmed by the favorable surgical outcome.We attempt to analyze the symptom from behavioral and neural network perspectives and propose a possible mechanism to generate ictal hypersalivation and pure salivatory seizures.Conclusion:Based on previous reports in the literature and our case,we emphasize the importance of the operculum in patients with ictal hypersalivation,particularly in patients with pure salivatory seizures.展开更多
Background Various cardiac and autonomic manifestations are frequently reported during seizures.Among the seizure-related arrhythmia,ictal tachycardia is the most common,followed by ictal bradycardia,with ictal asysto...Background Various cardiac and autonomic manifestations are frequently reported during seizures.Among the seizure-related arrhythmia,ictal tachycardia is the most common,followed by ictal bradycardia,with ictal asystole being the rarest.The occurrence of ictal asystole may obscure the clinical presentation and delay the diagnosis,representing a life-threatening presentation of epilepsy,with an elevated risk of sudden unexpected death in epilepsy patients(SUDEP).These cardiac abnormalities are being increasingly recognized as the key to elucidating the mechanisms of SUDEP.Case presentation We present a 35-year-old man with a history of focal-onset seizures with impaired consciousness since his mid-20 s.He developed different types of seizures for 2 years,described as tonic seizure and atonic seizure(drop attack).During such clinical events,he suffered from falls and cardiac arrest.However,thorough cardiac electrophysiology and imaging workup failed to reveal a cardiac etiology.Subsequent video electroencephalograph(EEG)monitoring was performed,and ictal bradycardia and ictal asystole were discovered.A cardiac pacemaker was implanted,and at 3-year follow-up,the patient did not suffer more atonic seizures,or falls.Genetic tests discovered a de novo variant of Adhesion G Protein-Coupled Receptor V1(ADGRV1),which may provide a clue for the patient’s ictal asystole and the increased risk of SUDEP.Conclusions Considering the important impact of ictal bradycardia and asystole on the morbidity and potential mortality of epileptic patients,it is important to simultaneously utilize EEG and electrocardiogram to confirm the diagnosis.This case report highlights the link between the de novo variant of ADGRV1 and the ictal bradycardia/asystole phenotype and implicates the importance of genetic testing in adult epilepsy patients.展开更多
Objective To investigate the lateralizing value of ictal face wiping(FW)in patients with refractory mesial temporal lobe epilepsy(MTLE).Methods Presurgical video types were retrospectively reviewed among 96 patients w...Objective To investigate the lateralizing value of ictal face wiping(FW)in patients with refractory mesial temporal lobe epilepsy(MTLE).Methods Presurgical video types were retrospectively reviewed among 96 patients who were seizure-free for at least 3 years after temporal lobectomy between 1997 and 2012.Attention展开更多
目的探讨发作期直流电漂移(ictal DC shift)在难治性伴海马硬化的内侧颞叶癫痫(MTLE-HS)中的定位价值。方法回顾性分析18例MTLE-HS患者的临床资料,进行非侵袭性和侵袭性术前评估,对发作起始区分别使用传统频段颅内电极脑电(iEEG)技术和...目的探讨发作期直流电漂移(ictal DC shift)在难治性伴海马硬化的内侧颞叶癫痫(MTLE-HS)中的定位价值。方法回顾性分析18例MTLE-HS患者的临床资料,进行非侵袭性和侵袭性术前评估,对发作起始区分别使用传统频段颅内电极脑电(iEEG)技术和基于宽频脑电技术的ictal DC shift进行定位,比较两组之间的时空分布差异及其与术后病理和预后之间的关系。结果 Ictal DC shift组空间分布明显较iEEG组更为局限,时间分布晚于iEEG组。结论 Ictal DC shift可能为致痫灶的电生理标志物。展开更多
There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and de...There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guidelinedirected therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials. Cardiac pacemaker therapy is commonly used for these patients; however, currently, there is no universal agreement on the pacing indications for these patients. In this review, we focus on the pathophysiology and clinical presentation of ictal bradyarrhythmias and then discuss the pacing need based on the available literature data.展开更多
文摘<strong>Background:</strong> Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis. <strong>Case Presentation:</strong> We present 3 cases of young adult men admitted to psychiatric ward as functional psychosis. They presented with irritability, physical aggression and mild cognitive impairment with intense emotional symptoms, and persecutory ideas and delusions. Two were wrongly diagnose as mania while the third was mimicking schizophrenia in its presentation. They received antipsychotic treatment and misdiagnosed as functional psychosis. They did not respond well to such treatment, until, series electroencephalograms were taken which revealed evidence of ictal psychosis. All, thence, responded well to addition of antiepileptic treatment. This, not only, proves to be effective, but also determined future management and prognosis. <strong>Conclusion: </strong>These cases shine light onto the role of the frontal cortex in the genesis of quasi-manic episodes and highlight the importance of EEG investigations in first episode of acute psychosis.
文摘We present a case of ictal asystole in an 81-year-old female, with no prior history of epileptic activity, or cardiac history suggestive of arrhythmia, who suffered several seemingly unrelated epileptic and asystolic episodes prior to finally having a witnessed seizure followed by an asystolic event. Following this event, all atrioventricular (AV) nodal blockers, and medications with potential seizure threshold lowering activity were stopped, and anti-epileptic medication was optimized. Due to the wishes of the patient’s family, no invasive interventions were pursued.However, the patient continued to be medically treated with anti-epileptic therapy and had no further asystolic events. Unfortunately, the patient’s overall clinical status deteriorated, and she subsequently passed during her hospital stay after being made do not resuscitate and do not intubate (DNR/DNI) by the family and then subsequently comfort care. Prior to her passing, however, she had remained free of epileptic events for 10 days and free of asystolic events for 21 days.
基金supported by the West China Nursing Discipline Development Special Fund Project,Sichuan University(HXHL20004).
文摘Background Ictal examination based on video-based electroencephalography(EEG)is crucial for locating and lat-eralizing seizures.In this study,we aimed to evaluate the quality of ictal examination in the Comprehensive Epilepsy Center of West China Hospital,Sichuan University,in order to provide information for quality improvement in daily clinical practice.Methods Video recordings of 100 patients with epilepsy were retrospectively reviewed.The performance of the ictal examination was independently reviewed by two epileptologists using an ictal examination protocol.Results In this retrospective analysis,589 seizure episodes from 100 patients with epilepsy were reviewed.The ages of the patients ranged from 3 to 77 years,with a mean age of 25.8±12.8 years.Among the 589 seizure episodes,a majority(93.7%)were focal seizures.For 226(38.4%)seizures,the medical staff arrived at the bedside.Among them,153(153/226,64.7%)seizure episodes,the medical staff arrival at the bedside within 30 s of onset,and 120(120/226,53.1%)seizures were tested by the medical staff.The compliance rates for"safety"and"visibility"reached 80%or higher while"naming","retelling",and“memory testing”only reach less than 3%.Conclusions Our survey identified the main problems in ictal assessments.It is challenging to complete a standard-ized examination for new trainees at Epilepsy Monitoring Units.Regularly strengthening training in ictal examination and understanding of semiology may improve patients’examination ability.However,further study of the implemen-tation of training is necessary.
文摘Although presurgical evaluation of patients with pharamacoresistent focal epilepsies provides essential information for successful epilepsy surgery,there is still a need for further improvement.Developments of noninvasive electrophysiological recording and analysis techniques offer additional information based on interictal and ictal epileptic activities.In this review,we provide an overview on the application of ictal magnetoencephalography(MEG).The results of a literature research for published interictal/ictal MEG findings and experiences with own cases are demonstrated and discussed.Ictal MEG may provide added value in comparison to interictal recordings.The results may be more focal and closer to the invasively determined seizure onset zone.In some patients without clear interictal findings,ictal MEG could provide correct localization.Novel recording and analysis techniques facilitate ictal recordings.However,extended recording durations,movement and artifacts still represent practical limitations.Ictal MEG may provide added value regarding the localization of the seizure onset zone but depends on the selection of patients and the application of optimal analysis techniques.
文摘Background:The insula is a hidden part in the cerebral cortex.Insular epilepsy is underrecognized and it bears a special risk for misdiagnosis with regard to nonepileptic seizures or wrong localization of epileptic seizures.Case presentations:The manuscript describes 2 cases with ictal semiology of paresthesia and pain followed by hyperkinetic movements,noninvasive findings of source localization and/or invasive SEEG exploration.Conclusion:Magnetic source imaging,ictal SPECT as noninvasive and invasive recordings with depth electrodes(SEEG)can provide important preoperative information for the involvement of insular and periinsular regions in focal pharmacoresistant epilepsies.The optimal use of these methods presupposes extensive knowledge of ictal semiology and other clinical characteristics.The clinical localization hypothesis can be optimally proofed by SEEG exploration.
文摘Introduction:Hypersalivation has been associated with Rolandic epilepsy and other childhood epilepsy syndromes.However,pure salivatory seizures are a rare type of focal seizure in which ictal hypersalivation is the dominant feature throughout the seizures.Case presentation:We present a case of pure salivatory seizures originating from the right post-central operculum cortex,confirmed by the favorable surgical outcome.We attempt to analyze the symptom from behavioral and neural network perspectives and propose a possible mechanism to generate ictal hypersalivation and pure salivatory seizures.Conclusion:Based on previous reports in the literature and our case,we emphasize the importance of the operculum in patients with ictal hypersalivation,particularly in patients with pure salivatory seizures.
文摘Background Various cardiac and autonomic manifestations are frequently reported during seizures.Among the seizure-related arrhythmia,ictal tachycardia is the most common,followed by ictal bradycardia,with ictal asystole being the rarest.The occurrence of ictal asystole may obscure the clinical presentation and delay the diagnosis,representing a life-threatening presentation of epilepsy,with an elevated risk of sudden unexpected death in epilepsy patients(SUDEP).These cardiac abnormalities are being increasingly recognized as the key to elucidating the mechanisms of SUDEP.Case presentation We present a 35-year-old man with a history of focal-onset seizures with impaired consciousness since his mid-20 s.He developed different types of seizures for 2 years,described as tonic seizure and atonic seizure(drop attack).During such clinical events,he suffered from falls and cardiac arrest.However,thorough cardiac electrophysiology and imaging workup failed to reveal a cardiac etiology.Subsequent video electroencephalograph(EEG)monitoring was performed,and ictal bradycardia and ictal asystole were discovered.A cardiac pacemaker was implanted,and at 3-year follow-up,the patient did not suffer more atonic seizures,or falls.Genetic tests discovered a de novo variant of Adhesion G Protein-Coupled Receptor V1(ADGRV1),which may provide a clue for the patient’s ictal asystole and the increased risk of SUDEP.Conclusions Considering the important impact of ictal bradycardia and asystole on the morbidity and potential mortality of epileptic patients,it is important to simultaneously utilize EEG and electrocardiogram to confirm the diagnosis.This case report highlights the link between the de novo variant of ADGRV1 and the ictal bradycardia/asystole phenotype and implicates the importance of genetic testing in adult epilepsy patients.
文摘Objective To investigate the lateralizing value of ictal face wiping(FW)in patients with refractory mesial temporal lobe epilepsy(MTLE).Methods Presurgical video types were retrospectively reviewed among 96 patients who were seizure-free for at least 3 years after temporal lobectomy between 1997 and 2012.Attention
文摘目的探讨发作期直流电漂移(ictal DC shift)在难治性伴海马硬化的内侧颞叶癫痫(MTLE-HS)中的定位价值。方法回顾性分析18例MTLE-HS患者的临床资料,进行非侵袭性和侵袭性术前评估,对发作起始区分别使用传统频段颅内电极脑电(iEEG)技术和基于宽频脑电技术的ictal DC shift进行定位,比较两组之间的时空分布差异及其与术后病理和预后之间的关系。结果 Ictal DC shift组空间分布明显较iEEG组更为局限,时间分布晚于iEEG组。结论 Ictal DC shift可能为致痫灶的电生理标志物。
文摘There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guidelinedirected therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials. Cardiac pacemaker therapy is commonly used for these patients; however, currently, there is no universal agreement on the pacing indications for these patients. In this review, we focus on the pathophysiology and clinical presentation of ictal bradyarrhythmias and then discuss the pacing need based on the available literature data.
