Maromi Nei

EKG Abnormalities During Partial Seizures in Refractory Epilepsy

Summary: Purpose: This study assessed the frequency and character of ictal cardiac rhythm and conduction abnormalities in intractable epilepsy. Sudden unexpected death in epilepsy (SUDEP) is a major cause of excess mortality in people with refractory epilepsy, and cardiac arrhythmias during seizures may be responsible. The frequency of cardiac abnormalities during seizures in patients with refractory epilepsy must be determined.

EEG and ECG in Sudden Unexplained Death in Epilepsy

Summary:  Purpose: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality for patients with epilepsy. Cardiac factors may be involved and were evaluated in this study.

Refractory Generalized Seizures: Response to Corpus Callosotomy and Vagal Nerve Stimulation

Summary:  Purpose: The vagal nerve stimulator (VNS) and corpus callosotomy can reduce seizure frequency when seizures are refractory to medications. However, the efficacy and safety of these two procedures have not been compared. This study evaluates the two procedures for generalized seizures.

The EEG and Prognosis in Status Epilepticus

Summary: Purpose: To examine the relation between specific EEG features and clinical outcome, determine whether a predictable sequence of EEG patterns exists during status epilepticus (SE), and examine the relation between periodic epileptiform discharges (PEDs) and SE.

Mortality after epilepsy surgery.

Summary:  Mortality rates are higher in people with refractory epilepsy than in the general population. We assessed mortality rates in a prospectively followed cohort who had epilepsy surgery, to examine the factors related to mortality and to assess the relationship between seizure control and mortality. Five hundred eighty‐three patients were evaluated. Mortality was strongly related to seizure control (p = 0.001), with 18 deaths observed in patients with recurrent seizures (mortality rate = 11.4 per 1,000 person‐years) and 1 death in patients with no recurrent seizures (mortality rate = 0.85 deaths per 1,000 person‐years). Patients with generalized epilepsy who had corpus callosotomy had a higher mortality rate than patients who had resective or transective surgery. The side of surgery and gender did not influence mortality rates. The standardized mortality ratio was 5.75 for patients with recurrent seizures and was significantly higher for females than males. These data show that the excess mortality associated with refractory epilepsy is eliminated after epilepsy surgery when seizures are abolished and suggest that epilepsy surgery reduces the risk of epilepsy‐associated death.

Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy

To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in patients with medically intractable mesial temporal lobe epilepsy (mTLE) treated with magnetic resonance imaging (MRI)–guided stereotactic laser interstitial thermal therapy (LiTT).

Surgical outcome in PET-positive, MRI-negative patients with temporal lobe epilepsy

Purpose:  Fluorodeoxyglucose positron emission computed tomography (FDG‐PET) hypometabolism is important for surgical planning in patients with temporal lobe epilepsy (TLE), but its significance remains unclear in patients who do not have evidence of mesial temporal sclerosis (MTS) on magnetic resonance imaging (MRI). We examined surgical outcomes in a group of PET‐positive, MRI‐negative patients and compared them with those of patients with MTS.

Sudden Unexpected Death in Epilepsy

Sudden unexpected death in epilepsy (SUDEP) is a significant cause of death for people with epilepsy. Recent research suggests that multiple factors may contribute and that both cardiac and respiratory mechanisms are involved. Both human and animal data suggest that specific genetic factors might play a role in some cases. Recent animal data suggest that serotonin might affect respiratory mechanisms and may be involved. Both cardiac and respiratory abnormalities are more likely with generalized tonic–clonic seizures. Uncontrolled epilepsy, particularly with generalized tonic–clonic seizures, appears to be the most highly associated modifiable risk factor for SUDEP.

A maternal complex partial seizure in labor can affect fetal heart rate

We describe a 33-year-old woman who had a complex partial seizure during labor. Intrauterine pressure catheter and fetal heart monitoring during the seizure revealed a strong, prolonged uterine contraction and simultaneous significant fetal heart rate deceleration for 3.5 minutes. This patient demonstrates that complex partial seizures may result in uterine hyperactivity during labor, which may result in fetal hypoxia.

Cardiac Effects of Seizures

Seizures frequently affect the heart rate and rhythm. In most cases, seizure-related cardiac changes are transient and do not appear to cause clinically significant abnormalities for the patient. Great interest in this area of research has been generated because of a possible connection with sudden unexpected death in epilepsy (SUDEP). While there are clear, but rare complications from seizure-related cardiac arrhythmias, such as ictal asystole that causes syncope, the overall risk of seizures on cardiac status and any potential connection between seizures and SUDEP still remain uncertain.