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Case presentation: Male, 6 years old, presenting seizures since the age of 4 and evolving with refractory epilepsy, in use of several medications for focal seizures, including Lacosamide, Cannabidiol, Phenobarbital and Sulthiame. A 24-hour electroencephalogram showed bursts of bilateral sharp waves and focal seizures in front rolandic region, with no adequate localization of the epileptogenic zone. Resonance imaging examination revealed a right lesion compatible with focal cortical dysplasia close to motor strip. Patient was submitted to stereoEEG (SEEG) evaluation, with deep electrodes implanted in the left frontal and rolandic region. After seizures mapping patient was submitted to lesionectomy and became seizure free. Discussion: SEEG is a technique that is being used to investigate refractory epilepsy in adults for many years. However, there are few reports addressing the utility and safety of the SEEG methodology applied to children. The main age limitation is related to bone thickness and fear of surgical complications. Although surgical strategies can often be defined based on non-invasive diagnostic procedures, and despite the recent advances in this field, an increasing number of more complex cases requires invasive EEG to provide precise information on the localization of the epileptogenic zone, its relationships with eloquent cortex, and the feasibility of a tailored surgical resection. Final comments: Our data supports current literature that SEEG is a safe and effective method of electrophysiological evaluation in children with refractory epilepsy, with no difference in complication rates when compared with adults. [ABSTRACT FROM AUTHOR]

Case presentation: Male, 9 years old, healthy, after a dental procedure, he started with clonic seizures on the left side and an episode of tonic-clonic seizure. In the evolution patient developed Epilepsia Partialis Continua (EPC) at the left side. Liquor investigation was positive to herpes virus and despite acyclovir treatment for 21 days patient persisted with seizures. Resonance image demonstrated an atrophic lesion at the left frontobasal region. There was no response to anticrisis medication (phenobarbital, oxcarbazepine, levetiracetam, lacosamide and cannabidiol). A partial response was observed with corticosteroid therapy. Patient underwent left frontal resection with electrocorticography and evolved with complete seizures remission. Anatomopathological was consistent with unspecified gliosis. Discussion: EPC is a rare condition that is usually reported in patients with chronic brain inflammatory diseases. The main exponent related to this condition is Rasmussen Encephalitis. Natural history consists of an initial infectious or inflammatory peripheral disease that after a latent period evolve to EPC. Our patient had a similar evolution, related to herpetic encephalitis. This presentation form is rarely described in the literature. Final comments: The present case shows atypical presentation of herpetic encephalitis, progressing to chronic EPC. This case is an example of the challenge in the etiological investigation of patients with epilepsy. [ABSTRACT FROM AUTHOR]

Case presentation: Male, 4 years old, diagnosed with Tay-Sachs syndrome. Patient with neuropsychomotor developmental delay, presented with polymorphic behaviors such as arrests, tonic posturing and laughter that were treated in another facility with a series of anti-crisis medications with no response. At first evaluation patient was in use of Levetiracetam, Clobazan, Phenobarbital, Oxcarbazepine and Cannabidiol. A 24-hour prolonged videoelectroencephalogram (VEEG) was performed, and 18 clinical events were recorded, however, none of them were accompanied by electrographic changes. Progressive and gradual withdrawal of anticrisis medication was performed and patient evolved with improvement in sedation, without significant modification of events previously considered as epileptic seizures. Discussion: Mental retardation is a condition that can be present in several conditions in children and adolescents, usually associated with some comorbidity. The condition encompasses a series of behaviors, whether motor or non-motor, which can be confused with epileptic seizures. It is important to differentiate such events form epileptic seizures to avoid overtreatment that can worsen the patient's clinical condition. Prolonged VEEG is an available diagnostic method and should be indicated in patients with cognitive impairment who have a history of refractory epileptic seizures, being the best method to identify non-epileptic events. Final comments: Non-epileptic events are common in patients treated with suspected epilepsy. In patients with cognitive impairment unspecific movements are usually confused with epileptic seizures. Studies have demonstrated that almost 40% of children treated as having epilepsy may have no-epileptic events. Correct diagnosis may avoid unnecessary use of anticrisis medication and consequently its side effects. [ABSTRACT FROM AUTHOR]

Case presentation: Female, 8 years old, with onset of seizures at 2 months, evolving with refractory epilepsy. The seizures were characterized by behavioral arrest and vacant gaze, in addition to episodes of loss of tone and head turn to the right with intense salivation. Patient has used topiramate, nitrazepam, carbamazepine and valproate. On examination, he is moderately mentally retarded and does not speak. Prolonged videoelectroencephalogram demonstrated focal seizures in the right cerebral hemisphere and resonance image showed right frontal cortical dysplasia associated with right occipital heterotopic nodule. Surgery was performed with intraoperative monitoring. After complete resection of the lesion and the initial epileptiform discharges, a greater extension of the epileptiform pattern was observed, which became more diffuse with each resection extension. At follow up patient persisted with seizures with only a discrete frequency reduction. Discussion: Epilepsies in childhood have several causes, including genetic and structural ones, emphasizing the importance of overlapping etiologies. Encephalopathy, characterized by diffuse brain dysfunction, should be considered even in patients with predefined lesions, as it is an important cause of epileptic seizures. Final comments: The case in question shows persistence of epileptiform paroxysms even with resection of the lesion and the initial epileptiform discharges. This finding may be related to the epileptic encephalopathy that patients with early onset epilepsies present. Although it is not possible to absolutely affirm, earlier surgery could have avoided this pattern of secondary epileptogenesis. [ABSTRACT FROM AUTHOR]

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Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Epilepsy is the most common serious neurological condition and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but high seizure frequency is a potential risk factor. Additionally, potential pathomechanisms for SUDEP are unknown, but it is very probable that cardiac arrhythmias during and between seizures or transmission of epileptic activity to the heart via the autonomic nervous system potentially play a role. In parallel, studies have shown a link between vitamin D dysfunction and epilepsy. Moreover, several evidences in the literature suggest an association between low vitamin D and seizures, indicating the possibility of anticonvulsant properties of this hormone. Quite interesting, a growing body of data suggests that low vitamin D levels may adversely affect cardiovascular health, directly associated with death from heart failure and sudden cardiac death. In view of the above findings, our research group focused in this review article that SUDEP, at least in some cases, could be related with low vitamin D levels. [Copyright &y& Elsevier]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: People with schizophrenia show a two- to three-fold increased risk to die prematurely. Mortality is accounted for by a combination of factors (patients’ life style, suicide, premature cardiovascular disease, metabolic syndromes and, not so often mentioned, sudden death). The cause of sudden death in schizophrenia is unknown, but cardiac arrhythmia plays a potential role. Patients with schizophrenia are at high risk for cardiovascular disease, and some antipsychotics may be associated with cardiovascular adverse events (e.g., electrocardiograph QT interval prolongation), suggesting that this could lead to sudden cardiac death. Animal and clinical studies have shown that omega-3 fatty acids could be useful in the prevention and treatment of schizophrenia. As omega-3 fatty acids have been considered a cardioprotector agent, reducing cardiac arrhythmias and hence sudden cardiac deaths and given their relative safety and general health benefits, our update article summarizes the knowledge by the possible positive effects of omega-3 supplementation and fish consumption against sudden cardiac death in patients with schizophrenia. However, fish species should be selected with caution due to contamination with toxic methylmercury. [Copyright &y& Elsevier]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Purpose: To assess the relationship between the presence of pets in homes of epilepsy patients and the occurrence of sudden unexpected death in epilepsy (SUDEP). Methods: Parents or relatives of SUDEP patients collected over a ten-year period (2000–2009) in a large epilepsy unit were asked if the patient lived together with any domestic pet at the time of death or not. Patients who did not experience SUDEP served as controls. Results and conclusions: Eleven out of the 1092 included patients (1%) experienced SUDEP, all with refractory symptomatic epilepsy, but none of them had pets in their homes at the time of death. In contrast, the frequency of pet-ownership in the control group (n =1081) was 61%. According to previous studies there are some indications that human health is directly related to companionship with animals in a way that domestic animals prevent illness and facilitate recovery of patients. Companion animals can buffer reactivity against acute stress, diminish stress perception and improve physical health. These factors may reduce cardiac arrhythmias and seizure frequency, factors related to SUDEP. Companion animals may have a positive effect on well-being, thus improving epilepsy outcome. [Copyright &y& Elsevier]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: People with schizophrenia show a two to threefold increased risk to die prematurely than those without schizophrenia. Patients’ life style, suicide, premature development of cardiovascular disease, high prevalence of metabolic syndrome and sudden cardiac death are well-known causes of the excess mortality. The exact pathophysiological cause of sudden death in schizophrenia is unknown, but it is likely that cardiac arrhythmia and respiratory abnormalities play potential role. Some antipsychotics may be associated with cardiovascular adverse events (e.g., QT interval prolongation) and lesions in specific brain regions, such as cerebella may be associated with respiratory abnormalities, suggesting that metabolic and brain dysfunction could lead to sudden cardiac death in patients with schizophrenia. However, exact knowledge regarding the association of these findings and schizophrenia is lacking. As subclinical hyperthyroidism has been linked with increased risk of cardiovascular disease and cerebella progressive atrophy has been observed in patients with schizophrenia, we propose in this paper that subclinical thyroid dysfunction and cerebella volume loss could be considered as new risk factor for sudden cardiac death in schizophrenia. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Epilepsy is the most common serious neurological condition and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but high seizure frequency is a potential risk factor. Additionally, potential pathomechanisms for SUDEP are unknown, but it is very probable that cardiac arrhythmias during and between seizures or transmission of epileptic activity to the heart via the autonomic nervous system potentially play a role. In parallel, several studies have shown a link between hormones and epilepsy. However, exact knowledge regarding the association of thyroid hormones and epilepsy is lacking. As subclinical hyperthyroidism has been linked with increased risk of cardiovascular disease, we propose in this paper that SUDEP, at least in some cases, could be related with subclinical thyroid dysfunction. [Copyright &y& Elsevier]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An introduction is presented in which the authors discuss various reports within the issue on topics including a relapse-remitting seizure pattern in mesial temporal lobe epilepsy (MTLE) patients with or without hippocampal sclerosis (HS), seizure outcome in surgical and non-surgical children suffering from MTLE, and changes in the definition of the term "epilepsy."

The authors focus on the possible link between seizure frequencies in patients with end-stage renal disease (ESRD) undergoing regular dialysis. In their study, they note some ESRD patients who had suffered convulsive seizure during dialytic program. They also mentioned that cardiovascular abnormalities and sudden unexplained death in epilepsy (SUDEP) is a rare event in ESRD patients with epilepsy. They recommend some strategies to prevent these occurrences such as maintenance of a healthy weight and inclusion of omega 3 fatty acids from fish in the diet.

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on the role of circadian rhythms in the sudden unexpected death in epilepsy (SUDEP) of a 15-year old boy. The magnetic resonance imaging scans of his brain found reduction in his left temporal pole while video electrocardiogram (ECG) found interictal frontal and rolandic spikes. He was found dead on his bed after a long sleep with conjunctiva hyperemia. The authors believe that cold temperature may have increase the role of circadian rhythms after the patient died in winter.