Lisa M. Caylor

Serum and CSF Glutamine Levels in Valproate‐related Hyperammonemic Encephalopathy

Summary:  Purpose: To investigate ammonia and glutamine levels in valproate (VPA)‐related hyperammonemic encephalopathy (VHE).

Ictal stuttering A sign suggestive of psychogenic nonepileptic seizures

Objective: To determine if ictal stuttering (IS) is more common among patients with psychogenic nonepileptic seizures (PNES) than patients with epileptic seizures (ES). Methods: The authors prospectively reviewed the medical records, EEG-video recordings, and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scores of consecutive adults of normal intelligence diagnosed with either PNES or ES. Results: A total of 230 (117 PNES and 113 ES) patients were studied. PNES patients were older (p = 0.029), more likely to be female (p < 0.001), and had a shorter duration of seizure disorder (p < 0.001) than ES cases. Ten (8.5%) PNES subjects and no ES cases demonstrated IS. The proportion of patients with IS in these two groups was significantly different (p = 0.004). PNES patients with IS were of similar age as but had an even shorter (p = 0.010) duration of seizure disorder (mean = 3.0 years) than those without IS. Scores on the hypochondriasis, depression (D), and hysteria scales of the MMPI-2 were significantly higher among PNES subjects than in ES patients (p ≤ 0.002). However, seven PNES patients with IS had a lower mean score on the D scale than did 98 PNES cases without stuttering (p = 0.005). This produced a more sharply defined “conversion V” appearance on the MMPI-2 graph in the stutterers. Conclusions: Ictal stuttering was present in 8.5% of 117 consecutive patients with psychogenic nonepileptic seizures, but was not observed in a consecutive series of 113 adults with epileptic seizures. Patients with psychogenic nonepileptic seizures with ictal stuttering had a shorter duration of seizure disorder and a more prominent conversion profile on the Minnesota Multiphasic Personality Inventory than either patients with psychogenic nonepileptic seizures without stuttering or subjects with epileptic seizures.

Managing epilepsy well: Self-management needs assessment

Epilepsy self-management interventions have been investigated with respect to health care needs, medical adherence, depression, anxiety, employment, and sleep problems. Studies have been limited in terms of representative samples and inconsistent or restricted findings. The direct needs assessment of patients with epilepsy as a basis for program design has not been well used as an approach to improving program participation and outcomes. This study investigated the perceived medical and psychosocial problems of adults with epilepsy, as well as their preferences for self-management program design and delivery format. Results indicated a more psychosocially challenged subgroup of individuals with significant depressive and cognitive complaints. A self-management program that involves face-to-face individual or group meetings led by an epilepsy professional and trained peer leader for 60 minutes weekly was preferred. Six to eight sessions focused on diverse education sessions (e.g., managing disability and medical care, socializing on a budget, and leading a healthy lifestyle) and emotional coping strategies delivered on weeknights or Saturday afternoons were most highly endorsed. Emotional self-management and cognitive compensatory strategies require special emphasis given the challenges of a large subgroup.

Intracranial EEG in Temporal Lobe Epilepsy: Location of Seizure Onset Relates to Degree of Hippocampal Pathology

Summary:  Purpose: To determine whether the specific location of electrographic seizure onset in the temporal lobe is related to hippocampal pathology in temporal lobe epilepsy (TLE).

Does aspirin use make it harder to collect seizures during elective video-EEG telemetry?

Aspirin has shown promise as an anticonvulsant drug in animal models. Whether aspirin alters seizure frequency in humans remains unstudied. We retrospectively looked at adults with focal onset epilepsy who took aspirin daily while undergoing elective video-EEG monitoring and compared them with similar age- and sex-matched controls to see if seizure frequencies were different between those two populations. Significantly fewer seizures were seen on day two of monitoring for patients on aspirin therapies. Higher aspirin doses were correlated with fewer seizures collected during the monitoring stay. Further prospective study is needed to determine whether aspirin affects more robust seizure control.

Holohemispheric developmental venous anomaly

Developmental venous anomalies (DVA) are normally diminutive and incidental.1,2 In this 33-year-old patient with epilepsy, the DVA is holohemispheric. Her epilepsy probably originates from the left side based on semiology; the EEG displayed left-sided slowing. Axial T1-weighted sequences show skull atrophy, ventricular widening, and satellite cavernous malformations with accumulation of subacute blood products including hemosiderin (figure, A and B). T2 gradient echo illustrates pockets of chronic hemorrhage (figure, C and D). Engorged holohemispheric anomalous venous structures channel into ventricular periependymal veins, illustrated by mulitplanar T1 echo spin postcontrast sequences (figure, E and F). Time to minimum perfusion reflects elevated transit times, suggesting venous hypertension and capillary backpressures.

Mitigating bit flips or single event upsets in epilepsy neurostimulators

Objectives The objective of this study was to review software errors known as single event upsets (SEUs) or bit flips due to cosmic rays in epilepsy neurostimulators. Materials and methods A case report of a single event upset or bit flip is discussed; device manufacturers and publicly available data were queried for both incidence and types of error as well as strategies of software error mitigation. Results Neurostimulators, like other implanted devices such as pacemakers, are prone to single event upsets. Strategies for SEU mitigation are reviewed. Conclusions Cosmic radiation can threaten RAM and settings of neurostimulators; neuromodulation teams and device designers need to take this threat into account when designing multifunctional neuromodulation systems.