Rūta Mameniškienė

Epilepsia partialis continua: A review

Epilepsia partialis contina (EPC) in a narrow definition is a variant of simple focal motor status epilepticus in which frequent repetitive muscle jerks, usually arrhythmic, continue over prolonged periods of time. In a broader definition (used in this review) it also includes non-motor manifestations otherwise known as aura continua. EPC may occur as a single episode, repetitive episodes, it may be chronic progressive or non-progressive. It appears as an unusual manifestation of epilepsy in which more typical paroxysmal events are partly or entirely replaced by the sustained repetition of seizure fragments in rapid succession. The minimum duration is defined as one hour but EPC may continue for up to many years. There are multiple possible etiologies which can be local or systemic, including two disease entities, Rasmussen encephalitis and Russian tick-borne spring-summer encephalitis. Among systemic brain disorders, mitochondrial diseases and non-ketotic hyperglycemia are particularly likely to cause EPC whereas stroke is a frequent cause of acute EPC. The symptoms of motor EPC have been interpreted as cortical reflex myocloni but the pathophysiology is probably not uniform for all cases. In pathophysiological terms, EPC seems to represent an oscillation of excitation and inhibition in a feedback loop whose mechanisms are still poorly understood. However, EPC only seems to occur rarely in an otherwise healthy brain. Treatment has to take account of the etiology but, in general, EPC tends to be drug-resistant. Epilepsy surgery is often indicated in Rasmussen encephalitis.

The burden of headache in people with epilepsy

PURPOSE To investigate and classify headaches in adult people with epilepsy, to evaluate the burden of headaches, and to compare findings with a population-based epidemiological study. METHODS Two hundred eighty (61.4% women) people with epilepsy (mean age 37.8±14.5, mean duration of epilepsy 13.2±11.9years) completed a questionnaire collecting socio-demographic and clinical data, questions clarifying their type of a headache, a Qolie-10 questionnaire and a Headache-Attributed Lost Time (HALT) index. An experienced neurologist also interviewed them. RESULTS 83.2% of respondents reported some type of headache. From those with inter-ictal headaches (77.9%), 39% reported tension-type headache, 31.7% reported migraine, and 7.8% reported medication-overuse headache and 16% reported possible persistent headache attributed to traumatic head injury. The impact of headache assessed through the HALT grading showed that 40.4% were grade 1, 9.6% grade 2, 14.7% grade 3 and 35.3% grade 4. Although, the prevalences of different headache types were similar to those in our population-based study, migraine seemed to be more common in males with epilepsy than in general population, and medication-overuse headache was more common in people with epilepsy than in the general population. CONCLUSIONS People with epilepsy experience headaches irrespective of their sex or age. The burden of headaches is very important in patients with epilepsy, since headaches usually cause a moderate or severe burden to their quality of life and suggest a clear clinical need. Clinicians should recognize headache as a common comorbidity of epilepsy, as it may influence antiepileptic drug choice, and may need specific treatment.

Family and sexual life in people with epilepsy

Having epilepsy is much more than having seizures. Epilepsy can have a severe negative effect on quality of life, affecting social relationships, academic achievement, housing, employment, and the ability to live and function independently. We undertook a cross-sectional study in a tertiary epilepsy center in Lithuania, aiming to assess the influence of epilepsy and aspects relating to epilepsy (employment, stigma, anxiety) on patients and their families, and to estimate their quality of family life and sexual functioning. We asked patients to complete a questionnaire about their socio-demographic situation, their seizure types and antiepileptic medications, and their quality of family and sexual life. Our results confirmed that epilepsy seriously influences family life. One third of our patients are lonely and half are childless. Epilepsy leads to difficulty in finding a job, especially for men, and unemployment affects their status in the family. People with epilepsy are uncomfortable interacting with those of the opposite sex and tend to conceal their medical condition from their partner. One third have sexual dysfunction, yet only a quarter of them seek professional help. There is a clear need to improve self-confidence and to reduce social stigma in people with epilepsy, and to encourage them to discuss their problems with specialists.

Olfactory stimulation induces delayed responses in epilepsy

Precipitation and inhibition of seizures and epileptic discharges by sensory stimuli are receiving increasing attention because they provide insight into natural seizure generation in human epilepsies and can identify potential nonpharmacological therapies. We aimed to investigate modulation (provocation or inhibition) of epileptiform discharges (EDs) in mesial temporal lobe epilepsy (MTLE) versus idiopathic generalized epilepsy (IGE) by olfactory stimulation (OS) compared with standard provocation methods. The underlying hypothesis was that any response would be more likely to occur in MTLE, considering the anatomical connections of the temporal lobe to the olfactory system. This multicenter, international study recruited patients with either MTLE or IGE who were systematically compared for responses to OS using an EEG/video-EEG protocol including a 30-min baseline, twice 3-min olfactory stimulation with ylang-ylang, hyperventilation, and intermittent photic stimulation. The 95% confidence interval (CI) for the baseline EDs in each patient was calculated, and modulation was assumed when the number of EDs during any 3-min test period was outside this CI. A total of 134 subjects (55 with MTLE, 53 with IGE, and 26 healthy controls) were included. Epileptiform discharges were inhibited during OS in about half the patients with both MTLE and IGE, whereas following OS, provocation was seen in 29.1% of patients with MTLE and inhibition in 28.3% of patients with IGE. Olfactory stimulation was less provocative than standard activation methods. The frequent subclinical modulation of epileptic activity in both MTLE and IGE is in striking contrast with the rarity of reports of olfactory seizure precipitation and arrest. Inhibition during OS can be explained by nonspecific arousal. The delayed responses seem to be related to processing of olfactory stimuli in the temporal lobe, thalamus, and frontal cortex.

Precipitation and inhibition of seizures in focal epilepsies

ABSTRACT Introduction: There is growing awareness that reflex epileptic seizures offer unique insight into natural seizure generation in humans. In the last years, focus has mostly been on reflex seizures in generalized epilepsies whereas a comprehensive review of their role in focal epilepsies has been missing. Areas covered: This paper reviews reflex seizures strictly in focal epilepsies, not including focal reflex seizures in system epilepsies that also exist. They were categorized according to their triggers which can be sensory or cognitive, simple or complex. Numerous diverse conditions exist some of which are much better investigated than others. They required separate individual literature search in PubMed. Where recent review papers exist, it refers to these, but several conditions have never been reviewed, and here it refer to and discusses original reports. Miscellaneous case reports were only exceptionally included when they contributed aspects otherwise missing. Expert commentary: Research on focal reflex seizures with advanced methods of imaging and neurophysiology to elucidate mechanisms of focal ictogenesis will probably be rapidly increasing and will soon provide much new insight. Sensory and cognitive inhibition, i.e. the counterpart of reflex ictogenesis, is promising but needs more structured and controlled research to establish robust therapeutic approaches.

Epidemiological patterns of tick-borne encephalitis in Lithuania and clinical features in adults in the light of the high incidence in recent years: a retrospective study

Lithuania is one of the countries with the highest incidence of tick‐borne encephalitis (TBE) in Europe. The aim of this study was to describe the epidemiological patterns of TBE in Lithuania, and characterize clinical features in adults in the light of the high incidence in recent years.

Control perceptions in epilepsy: A transcultural case–control study with focus on auras

OBJECTIVE General Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsys (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras. METHODS A case-control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotters GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R). RESULTS Patients mean age was 36.15 ± 13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ± 13.59 years, and monthly seizure frequency was 8.22 ± 20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety. CONCLUSIONS General Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.