Abdurrahman Ciger

Generalised periodic epileptiform discharges: clinical features, neuroradiological evaluation and prognosis in 37 adult patients

Generalised periodic epileptiform discharges (GPEDs) are very rare patterns and are classified as periodic short-interval diffuse discharges (PSIDDs), periodic long-interval diffuse discharges (PLIDDs) and suppression-burst patterns according to the interval between the discharges. In this study we analysed the demographics, history of the seizures during the current illness, mental status, diagnosis, metabolic abnormalities, neuroimaging studies and prognosis of 37 adult patients who had GPEDs in their EEGs. Ages ranged from 17 to 82 years (mean 45 years). There were 19 males and 18 females. The most common aetiology of GPEDs was metabolic and/or infectious disease which was established in 22 patients (59.5%). Other aetiologies included subacute sclerosing panencephalitis (SSPE) in 11 patients (29.7%) and Creutzfeld-Jakob disease (CJD) in 4 patients (10.8%). We showed that structural lesions were found in most of the patients with GPEDs, but concurrent metabolic abnormalities and/or infectious diseases were also detected. Consciousness was impaired and clinical conditions were poor in various degrees in all of the patients when GPEDs were seen. Relatively little is known regarding the mechanism of GPEDs. When GPEDs are seen in EEG, the patient should carefully be checked for metabolic abnormalities and/or infectious diseases and intracranial lesions. GPEDs may be helpful in the determination of prognosis, showing the poor prognosis especially in cases when suppression-burst pattern is seen.

Investigation of HSV-1, HSV-2, CMV, HHV-6 and HHV-8 DNA by real-time PCR in surgical resection materials of epilepsy patients with mesial temporal lobe sclerosis

OBJECTIVE The objective of this study is to investigate the presence of viral DNAs of HSV-1, HSV-2, HHV-6, HHV-8, and CMV in hippocampus of the patients with mesial temporal lobe epilepsy (MTLE) syndrome. METHODS Pathological specimens were obtained from 33 patients with MTLE undergone temporal lobectomy with amygdalo-hippocampectomy due to intractable seizures. Autopsy materials from the hippocampus of 7 patients without neurological disease were used as controls. The data was also correlated with the clinical history of patients including febrile convulsions, age, and history of CNS infections. Real-time polymerase chain reaction method was performed for detection of DNAs of these viruses. RESULTS HHV-6, HSV-1 and HHV-8 were detected in the hippocampus of 3, 2 and 1 patients with MTLE respectively. None of the hippocampus of patients with MTLE was positive for DNA of HSV-2 and/or CMV. Three patients with positive HHV-6 DNAs had febrile convulsions and family history for epilepsy. None of our control specimens showed PCR positivity to any of the 5 tested viruses. CONCLUSIONS Our study is the first to report the presence of HHV-8 viral genome in the brain tissue of patient with MTLE. Viral DNAs were detected in a total of 18% of the patients in this study; we can conclude that activity of the latent virus in patients with hippocampal sclerosis should be more extensively studied to establish its role in active infection.

Prognosis of patients with mesial temporal lobe epilepsy due to hippocampal sclerosis

PURPOSE Hippocampal sclerosis (HS) is the most common pathology in mesial temporal lobe epilepsy (MTLE). There are a few reports concerning prognosis in patients with MTLE-HS treated medically. The study was carried out to determine the clinical risk factors affecting prognosis. METHODS We enrolled 287 patients with MTLE-HS treated medically. Gender, age at onset of epilepsy, history of trauma, infection, febrile convulsion, status epilepticus, mental retardation, handedness, consanguinity, side of hippocampal sclerosis, additional extrahippocampal temporal lesion, aura, seizures types, antiepileptic drugs, psychiatric disturbances and seizure frequency were noted. All patients were divided into three groups. Group I: patients seizure-free during follow up, Group II: patients with improved seizure control whose seizure frequency had decreased >50% after the treatment, and Group III: patients with poor seizure control whose seizure frequency had no change or increased. Each clinical feature was also compared among three subgroups statistically. RESULTS Early age of seizure onset [Group II-III (p=0.000) and Group I-III (p=0.0004)], age of head trauma [Group II-III (p=0.04)], the presence of mental retardation (p=0.04) and female sex (p=0.03) were risk factors for poor prognosis. However, the other parameters did not affect prognosis. CONCLUSION Recognizing bad prognostic features such as the presence of mental retardation, early age of seizure onset, age of head trauma and female gender may help physicians to identify risk groups with MTLE-HS and drug resistance seizures for epilepsy surgery.

Epilepsia partialis continua: clinical and electrophysiological features of adult patients.

In this study we reviewed the clinical, electrophysiological and neuroimaging data of 21 patients with epilepsia partialis continua (EPC), which is a rare form of epilepsy with focal motor seizures persisting hours to years. We found infections, cerebrovascular events and tumors as the most common causes of EPC in adults. SSPE was also shown as a cause of EPC. EPC in SSPE patients was resistant to therapies and persisted more than 1 year. EPC is usually a predictor of poor outcome and 29% of patients died after EPC in this study. As prognosis is usually bad and as response to treatment is poor in patients who had EPC, early diagnosis and treatment of the underlying cause is important. Although the most common etiologies are infections, cerebrovasculer events and tumors, if EPC persists several months SSPE should be kept in mind as a rare cause of EPC. MRI should be repeated in chronic cases to show dysplastic cortex, which was shown in 1 patient in this study.

The prognosis of subacute sclerosing panencephalitis in adults. Report of 8 cases and review of the literature.

In this article, 8 cases of subacute sclerosing panencephalitis (SSPE) are presented with a review of the literature. The symptoms developed during pregnancy in 2 cases. All of the patients died within 1 year duration except one. According to the reviewed literature, the prognosis in the adult cases is worse than in children; the two sexes are equally affected in adult SSPE.

Atypical EEG Findings in Subacute Sclerosing Panencephalitis

A total of 72 EEGs from 57 patients with SSPE were studied. The EEG studies in SSPE revealed periodic high amplitude complexes in all except one. Besides periodic complexes, we found several atypical EEG findings including frontal rhythmic delta activity in intervals between periodic complexes, electrodecremental periods following EEG complexes, diffuse sharp waves and sharp-and-slow-wave complexes over frontal regions, and focal abnormalities, such as sharp wave and sharp and slow wave foci, which have been rarely reported previously. We also described a new finding characterized by high amplitude generalized rhythmic sharp wave activity following periodic complexes in one patient.

Whistling Epilepsy: A Case Report

Whistling, as an ictal symptom, has been previously reported in frontal lobe epilepsy. For the first time in the literature, we present a patient with complex partial seizures of the temporal region associated with this peculiar symptom.

Hot Water Epilepsy

The clinical and EEG features of 10 patients with hot water epilepsy were presented. Eight of the 10 cases were male. The mean age of onset was 4.7 years. In four patients partial and in six cases generalized seizures were seen. Three patients also had non-hot water precipitated seizures. Interictal EEGs showed generalized abnormalities in eight and focal abnormalities in two cases. CT was performed and found normal in two patients. Anticonvulsant therapy was instituted for all patients. In six cases with adequate follow-up, complete remission was obtained in four and the frequency of the seizures was decreased in two, with anticonvulsant therapy.

The Yield of Preoperative Sequential Routine Scalp EEGs in Patients Who Underwent Anterior Temporal Lobectomy for Mesial Temporal Sclerosis

Mesial temporal lobe epilepsy syndrome (MTLES) is the most common surgically remediable epileptic syndrome in adults. Its diagnosis is easy when clinical history is supported by positive laboratory findings. However, routine EEG may not be informative in some patients, thus delaying accurate diagnosis. Therefore, we sought to determine how often routine EEGs displayed epileptiform discharges pre-operatively in a group of patients who underwent surgery for MTLES. Retrospectively, we reviewed the outpatient EEG records of MTLES patients who underwent surgery at our epilepsy center between 1997–2008 and had at least one routine pre-operative EEG recording in our outpatient laboratory. For each patient, serial EEGs were coded as normal, displaying nonspecific abnormalities or lateralized and localized interictal epileptiform discharges. Seventy patients were included in the study. We reviewed 230 EEGs. In almost half of the patients (47.1%) all EEGs were normal or revealed nonspecific findings. In patients who had >1 EEG, almost 3 EEGs had to be recorded to detect the epileptiform discharges for the first time and 6.23 years were needed to accomplish this. Sleep deprivation considerably increased the yield. In summary, patients who have a clinical history suggesting MTLES may need at least 3 routine scalp EEG recordings (with at least one of them after sleep deprivation) to detect epileptiform abnormalities and it may take much time. Therefore, a single prolonged outpatient video-EEG monitoring or an overnight inpatient monitoring might be reasonable alternatives to serial EEGs.

Late onset absence seizures in multiple sclerosis: a case report.

A 38-year-old woman was admitted to hospital because of generalized tonic-clonic attacks and late onset absence seizures. EEG and Video-EEG showed 3-4 hz generalized spike and wave discharges lasting 1-8 seconds, which were associated with impairment of consciousness and unresponsiveness. MR scan revealed multiple demyelinating lesions, including the most prominent one in the mesial frontal region that we suppose might be responsible for electroclinical absence seizures. After investigation the diagnosis of multiple sclerosis was made. Possible pathophysiological mechanisms and differential diagnosis of tonic-clonic and absence seizures in MS are discussed.