John Gibbs

Epilepsy associated with lupus anticoagulant

INTRODUCTION Lupus anticoagulant (LA) is commonly present in patients with systemic lupus erythematosus (SLE) who present with an ischemic cerebral stroke. Reports have noted the presence of LA in patients with epilepsy who do not have SLE. These patients are usually elderly, and it has been postulated that their epilepsy is due to subclinical ischemic infarcts. METHODS Two cases are presented in young patients (age < 35 years) who developed epileptic seizures and were LA positive. These patients did not have SLE or have cerebral infarcts that could explain the presence of their seizures. RESULTS A 28-year-old woman was admitted for aortic insufficiency and new onset seizures. The clinical history, physical examination and magnetic resonance imaging did not reveal an antecedent cortical ischemic event. Serological testing revealed the presence of LA. The second patient was a 33-year-old man with medically intractable epilepsy in whom serological testing revealed the presence of LA. The clinical history, physical examination, and MRI did not reveal any evidence of an antecedent ischemic event. Neither patient had SLE. CONCLUSIONS In young patients without SLE and cerebral infarcts, LA may be associated with epileptic seizures.

Panayiotopoulos syndrome and benign partial epilepsy with centro-temporal spikes: A comparative incidence study

PURPOSE To compare the de novo incidence of Panayiotopoulos syndrome (PS, early-onset childhood occipital epilepsy) and a common epilepsy syndrome, benign epilepsy with centro-temporal spikes (BECTS), in children and young people. METHODS The incidence of PS and BECTS was recorded over 16 months in a population of children and young people (aged <16 years) living within a specific geographic area and epilepsy network within the North West of England and North Wales and the catchment area of the tertiary paediatric epilepsy centre. Monthly data collection proformas were circulated to the paediatricians and paediatric neurologists responsible for the evaluation of epilepsy in children within this area. This also included monthly reminders of the electro-clinical criteria for these syndromes. EEGs were undertaken in the neurophysiology department of the tertiary paediatric epilepsy centre. The departmental EEG database on all <16 year olds that underwent an EEG during the study period was examined to identify additional patients that may not have been reported via a proforma-reporting system. RESULTS The incidence of PS and BECTS was found to be 0.8 and 6.1 per 100,000 <16 year olds, respectively. The ages at seizure onset and diagnosis were similar for BECTS and PS. CONCLUSION This study is the first to determine a comparative incidence of PS and BECTS. The findings suggest BECTS is eight times more common than PS and that the incidence of PS is lower than previously suggested.

Surgical treatment of epilepsy

Purpose of Review: This article outlines indications for neurosurgical treatment of epilepsy, describes the presurgical workup, summarizes surgical approaches, and details expected risks and benefits. Recent Findings: There is class I evidence for the efficacy of temporal lobectomy in treating intractable seizures, and accumulating documentation that successful surgical treatment reverses much of the disability, morbidity, and excess mortality of chronic epilepsy. Summary: Chronic, uncontrolled focal epilepsy causes progressive disability and increased mortality, but these can be reversed with seizure control. Vigorous efforts to stop seizures are warranted. If two well-chosen and tolerated medication trials do not achieve seizure control, an early workup for epilepsy surgery should be arranged. If this workup definitively identifies the brain region from which the seizures arise, and this region can be removed with a low risk of disabling neurologic deficits, neurosurgery will have a much better chance of stopping seizures than further medication trials. Continuum (Minneap Minn) 2013;19(3):730–742. REASONS FOR EPILEPSY SURGERY About one-third of epilepsy patients have seizures that cannot be controlled with medication. This has severe consequences, including interference with school and work, loss of independence and social isolation, and increased risk of injury, depression, and suicide. Patients with uncontrolled epilepsy also have a significantly increased long-term mortality rate (1.59% per year), with sudden unexpected death in epilepsy (SUDEP) being the most common cause. Furthermore, uncontrolled temporal lobe epilepsy is associated with slowly progressive cortical atrophy and cognitive deterioration. For selected patients, resection of epileptogenic brain has a far better chance of controlling drug-resistant seizures than further medication trials. There is also class I evidence for the efficacy of temporal lobectomy and evidence that successful neurosurgical treatment reverses much of the disability and increased mortality of chronic epilepsy. For all of these reasons, clinicians treating chronic epilepsy must recognize which patients to refer for epilepsy surgery and what it can accomplish.