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Background and ObjectivesThis systematic review with meta-analysis (PROSPERO: CRD42021249336) was performed to estimate the pooled lifetime prevalence of bipolar symptoms (BS) and bipolar disorder (BD) in people with epilepsy (PWE).MethodsA search was performed on June 5, 2021, in 4 databases (MEDLINE/PubMed, Ovid EMBASE, Ovid APA PsycInfo, and Web of Science) for original research reporting on BS/BD in PWE, with no restriction on language or time of publication. Inclusion criteria were as follows: (1) original research, (2) cross-sectional study design component, (3) reported lifetime prevalence of BS/BD or enough information to calculate an estimate, and (4) reported the method by which participants were deemed bipolar. Studies based on an exclusively pediatric population were excluded. To calculate pooled lifetime prevalence of BS/BD, 2 meta-analytic random-effects models were fitted, one for BS and the other for BD. Risk of bias was assessed using a standardized appraisal tool for studies reporting prevalence. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.ResultsA total of 750 records were screened and 17 studies were included for analysis: 7 provided prevalence estimates for only BS, 8 for only BD, and 2 for both BS and BD. After outlier exclusion and subgroup analysis using screening method as a moderator, the pooled prevalence of BS in PWE was 12.3% (95% CI 10.6%–14.1%) (7,506 PWE). The pooled prevalence of BD in PWE was 4.5% (95% CI 2.2%–7.4%) (48,334 PWE). Considerable heterogeneity was present, more so for BD than for BS, and could be explained through differences in population demographics and study methodology.DiscussionThis study's main limitation was regarding the certainty of evidence. However, our estimates of prevalence should prompt further research on BS/BD in PWE. Given the significant morbidity associated with BD, clinicians should carefully screen PWE for BS. more...

Background:Caring for women with epilepsy (WWE) during pregnancy poses unique challenges. We conducted an audit of the care our epilepsy clinic provided to pregnant WWE.Methods:We performed a retrospective study on all pregnancies followed by an epileptologist at a Canadian tertiary care centre’s epilepsy clinic between January 2003 and March 2021. Among 81 pregnancies in 53 patients, 72 pregnancies in 50 patients were analyzed to determine patient-related, follow-up-related, antiseizure-medication-related, and child-related pregnancy characteristics. Univariate analyses were performed to explore if these characteristics were associated with disabling seizure occurrence during pregnancy.Results:Most pregnancies were intended (72%) and occurred in women who used folic acid pre-pregnancy (76%) and who followed recommended blood tests for antiseizure medication (ASM) levels (71%). In 49% of pregnancies, ASM dosage was modified; 53% of these modifications were made in response to ASM blood levels. Most often used ASMs were lamotrigine (43%), followed by carbamazepine (32%) and levetiracetam (13%). One child was born with a thyroglossal duct cyst; our congenital malformation rate was thus 2%. Disabling seizures occurred in 24% of pregnancies. Exploratory analyses suggested that disabling seizure occurrence during pregnancy was associated with younger patient age (p = 0.018), higher number of ASMs used during pregnancy (p = 0.048), lamotrigine usage in polytherapy (p = 0.008), and disabling seizure occurrence pre-pregnancy (p = 0.027).Conclusion:This Canadian audit provides an in-depth description of pregnancies benefiting from specialized epilepsy care. Our results suggest an association between disabling seizure occurrence during pregnancy and lamotrigine usage in polytherapy that warrants further evaluation. more...

The photoparoxysmal response (PPR) is defined as the occurrence of generalized spike, spike-wave or polyspike-wave discharges consistently elicited by intermittent photic stimulation (IPS). PPR is not well studied in Sub-Saharan African people. We prospectively studied the epidemiological, clinical, and EEG characteristics of PPR among consecutive patients recorded at the clinical neurophysiology unit of Fann University Hospital (Dakar, Senegal). Among 6,808 EEG recordings including 3,065 pathological EEGs, we collected 56 EEGs with PPR (0.8% of all recorded EEGs and 1.8% of anormal EEGs), from 31 women and 25 men (sex ratio: 0.8). The mean age was 13.3 years (range: 8 months to 59 years). The peak of photosensitivity was found in the range of 6 to 10 years. Of the PPR cases, 12 had clinical manifestations during IPS. Generalized epilepsy was diagnosed in 23 (41%) patients and 18 (32%) had focal epilepsies. The most epileptogenic stimulation frequencies were between 12 and 24 Hz (range: 1-28 Hz). PPR were mainly triggered during eye closure (64%), and 41 patients (73% of PPR cases) were classified as Type 4 (Waltz classification). Our results confirm lower rates of photosensitivity in African Sub-Saharan people compared with others. Although the current data do not support a role of short-term ambient light levels, subject to consistent data from larger cohorts, it may be interesting to study the probable epigenetic-mediated protective role of sunshine against photosensitivity. more...

Déjà-vu is a mental phenomenon commonly experienced during temporal lobe seizures and can be evoked by electrical stimulation of the temporal lobe. We analyzed reproducible déjà-vu experiences evoked by stimulating the insula in two patients with pharmacoresistant temporal lobe epilepsy.We reviewed video-electroencephalography (EEG) recordings from extraoperative electrical cortical stimulation sessions. In addition, we performed the directed transfer function (DTF) effective connectivity measure of monopolar signals in Patient 1. To highlight elective changes due to each stimulation, we subtracted pre-stimulation DTF matrices from early poststimulation matrices. This analysis was performed for both non-inducing-déjàvu stimulation (control matrix) and déjà-vu-inducing stimulation (active matrix). Finally, the control matrix was subtracted from the active matrix.Comparison of effective connectivity during control stimulation versus déjà-vu-inducing stimulation revealed a reversal of connectivity levels in three main regions: the contralateral inferior insula (the ipsilateral insula could not be analyzed), bilateral mesiotemporal regions and the ipsilateral superior frontal gyrus. The drivers of evoked déjà-vu were the mesiotemporal regions (mainly ipsilateral) and the ipsilateral superior frontal gyrus.Although our findings are possibly anecdotal, the insula may (in rare instances) remotely generate unexpected déjà-vu. If confirmed by further studies, this might change the assessment strategy for possible causes of anterior temporal lobectomy failure. more...

Background:There is limited data on the utility, yield, and cost efficiency of genetic testing in adults with epilepsy. We aimed to describe the yield and utility of genetic panels in our adult epilepsy clinic.Methods:We performed a retrospective, cross-sectional study of all patients followed by an epileptologist at a Canadian tertiary care centre’s epilepsy clinic between January 2016 and August 2021 for whom a genetic panel was ordered. A panel was generally ordered when the etiology was unknown or in the presence of a malformation of cortical development. We determined the yield of panel positivity and of confirmed genetic diagnoses. We also estimated the proportion of these diagnoses that were clinically actionable.Results:In total, 164 panels were ordered in 164 patients. Most had refractory epilepsy (80%), and few had comorbid intellectual disability (10%) or a positive family history of epilepsy (11%). The yield of panel positivity was 11%. Panel results were uncertain 49% of the time and negative 40% of the time. Genetic diagnoses were confirmed in 7 (4.3%) patients. These genetic conditions involved the following genes: SCARB2, DEPDC5, PCDH19, LGI1, SCN1A, MT-TL1, and CHRNA7. Of the seven genetic diagnoses, 5 (71%) were evaluated to be clinically actionable.Conclusion:We report a lower diagnostic yield for genetic panels in adults with epilepsy than what has so far been reported. Although the field of the genetics of epilepsy is a fast-moving one and more data is required, our findings suggest that guidelines for genetic testing in adults are warranted. more...

Objective The study of seizure onset and termination patterns has the potential to enhance our understanding of the underlying mechanisms of seizure generation and cessation. It is largely unclear whether seizures with distinct onset patterns originate from varying network interactions and terminate through different termination pathways. Methods We investigated the morphology and location of 103 intracranial EEG seizure onset and termination patterns from 20 patients with drug-resistant focal epilepsy. We determined if seizure onset patterns were associated with specific termination patterns. Finally, we looked at network interactions prior to the generation of distinct seizure onset patterns by calculating directed functional connectivity matrices. Results We identified nine seizure onset and six seizure termination patterns. The most common onset pattern was Low-Voltage Fast Activity (36 %), and the most frequent termination pattern was Burst Suppression (44 %). All seizures with fast (>13 Hz) termination patterns had a fast (>13 Hz) onset pattern type. Almost any onset pattern could terminate with the Burst Suppression and rhythmic Spike/PolySpike and Wave (rSW/rPSW) termination patterns. Seizures with a fast activity onset had higher inflow to the seizure onset zone from other regions in the gamma and high gamma frequency ranges prior to their generation compared to seizures with a slow onset. Significance Our observations suggest that different mechanisms underlie the generation of different seizure onset patterns although seizure onset patterns can share a common termination pattern. Possible mechanisms underlying these patterns are discussed. more...

Background:Intervention time (IT) in response to seizures and adverse events (AEs) have emerged as key elements in epilepsy monitoring unit (EMU) management. We performed an audit of our EMU, focusing on IT and AEs.Methods:We performed a retrospective study on all clinical seizures of admissions over a 1-year period at our Canadian academic tertiary care center’s EMU. This EMU was divided in two subunits: a daytime three-bed epilepsy department subunit (EDU) supervised by EEG technicians and a three-bed neurology ward subunit (NWU) equipped with video-EEG where patients were transferred to for nights and weekends, under nursing supervision. Among 124 admissions, 58 were analyzed. A total of 1293 seizures were reviewed to determine intervention occurrence, IT, and AE occurrence. Seizures occurring when the staff was present at bedside at seizure onset were analyzed separately.Results:Median IT was 21.0 (11.0–40.8) s. The EDU, bilateral tonic–clonic seizures (BTCS), and the presence of a warning signal were associated with increased odds of an intervention taking place. The NWU, BTCS, and seizure rank (seizures were chronologically ordered by the patient for each subunit) were associated with longer ITs. Bedside staff presence rate was higher in the EDU than in the NWU (p < 0.001). AEs occurred in 19% of admissions, with no difference between subunits. AEs were more frequent in BTCS than in other seizure types (p = 0.001).Conclusion:This study suggests that close monitoring by trained staff members dedicated to EMU patients is key to optimize safety. AE rate was high, warranting corrective measures. more...

Our purpose was to determine the role of CHRNA4 and CHRNB2 in insular epilepsy.We identified two patients with drug-resistant predominantly sleep-related hypermotor seizures, one harboring a heterozygous missense variant (c.77CT; p. Thr26Met) in the CHRNB2 gene and the other a heterozygous missense variant (c.1079GA; p. Arg360Gln) in the CHRNA4 gene. The patients underwent electrophysiological and neuroimaging studies, and we performed functional characterization of the p. Thr26Met (c.77CT) in the CHRNB2 gene.We localized the epileptic foci to the left insula in the first case (now seizure-free following epilepsy surgery) and to both insulae in the second case. Based on tools predicting the possible impact of amino acid substitutions on the structure and function of proteins (sorting intolerant from tolerant and PolyPhen-2), variants identified in this report could be deleterious. Functional expression in human cell lines of α4β2 (wild-type), α4β2-Thr26Met (homozygote), and α4β2/β2-Thr26Met (heterozygote) nicotinic acetylcholine receptors revealed that the mutant subunit led to significantly higher whole-cell nicotinic currents. This feature was observed in both homo- and heterozygous conditions and was not accompanied by major alterations of the current reversal potential or the shape of the concentration-response relation.This study suggests that variants in CHRNB2 and CHRNA4, initially linked to autosomal dominant nocturnal frontal lobe epilepsy, are also found in patients with predominantly sleep-related insular epilepsy. Although the reported variants should be considered of unknown clinical significance for the moment, identification of additional similar cases and further functional studies could eventually strengthen this association. more...

Three decades after its introduction as an adjuvant therapeutic option in the management of selective drug-resistant epilepsy cases (DRE), vagus nerve stimulation (VNS) retains growing interest. An implantable device was first approved for epilepsy in Europe in 1994 and in the United States (US) in 1997. Subsequent modifications improved the safety and the efficacy of the system. The most recent application of vagal neurostimulation is represented by transcutaneous devices that are claimed to have strong therapeutic potential. In this review, we sought to analyze the most meaningful available data describing the indications, safety and efficacy of the different approaches of VNS in clinical practice. Therefore, we identified studies reporting VNS efficacy and/or safety in epilepsy and its comorbidities from January 1990 to February 2020 from various databases including PubMed, Scopus, Cochrane, US government databases and VNS manufacturer published resources. In general, VNS efficacy becomes optimal around the sixth month of treatment and a 50-100 % seizure frequency reduction is achieved in approximately 45-65 % of the patients. However, some clinically relevant differences have been reported with specific factors such as epilepsy etiology or type, patient age as well as the delay of VNS therapy onset. VNS efficacy on seizure frequency has been demonstrated in both children and adults, in lesional and non-lesional cases, in focal and generalized epilepsies, on both seizures and epilepsy comorbidities. Regarding the latter, VNS can lead to an improvement of about 25-35 % in depression scores, 35 % in anxiety scores and 25 % in mood assessment scores. If non-invasive devices are undeniably safer, their efficacy is limited due to the scarcity of large cohort studies and the disparity of methodological approaches (study design and stimulation parameters). Overall, we believe that there is a progress margin for improving the safety of implantable devices and, above all, the effectiveness of the various VNS approaches. more...

Calcium and magnesium are divalent multipotent ions playing a major role in metabolism, excitability and neuroglial plasticity. Because of these multiple properties, their deficiency induces complex brain processes leading to acute or even lasting disorders in excitability and neural networks. These ions are usually prescribed in clinical contexts of neuronal hyperexcitability such as preeclampsia and chronic stress. Our aim was to evaluate whether magnesium at 20 mg/kg and calcium at 100 mg/kg could improve the memory prognosis in the kainic model of mesial temporal epilepsy in mice. The animals were organized into 6 groups: control group (without kainate), reference group (GR) without administration of ions, groups treated with magnesium or calcium from the third day (respectively G1m, G1c), groups treated with magnesium or calcium from the third week (respectively G2m, G2c). The mice treated by ions performed better than GR mice, but magnesium was more effective. Memory (short term-long term) was differently affected by kainate or improved by magnesium-calcium. In addition, magnesium demonstrated an increasing therapeutic effect over time while calcium had an acute and apparently decreasing action in the G1c group that received calcium early. more...

Introduction Les crises hypermotrices du sommeil, generalement frontales, sont parfois associees a une mutation interessant les genes des recepteurs nicotiniques cholinergiques CHRNA4 ou CHRNB2. Nous rapportons deux cas d’HMS avec de telles mutations, mais avec des foyers insulaires. Observation Le cas 1, pharmacoresistant, est une fille de 7 ans avec debut des crises hypermotrices surtout morpheiques a 4 ans. L’EEG retrouvait une localisation centro-temporale droite. La TEMP demontra une activation ictale insulaire droite. La MEG revela des amas de sources au niveau insulaire posterieur et operculaire parietal droits. Les genes CHRNB2 (NM_000748), CHRNA2 (NM_000742) et CHRNA4 (NM_000744) furent sequences par la methode Sanger ; le gene CHRNA4 a ete analyse pour la suppression/duplication par PCR quantitatif. Les tests genetiques ont revele une mutation heterozygote faux-sens (c.77C > T ; p.Thr26Met) du gene CHRNB2. Son pere asymptomatique presentait une mutation similaire. La resection de l’insula posterieur droit et de l’opercule parietal guidee par electrocorticographie a conduit a un arret des crises (FU 5 ans). Le cas 2, egalement pharmacoresistant, est une femme de 34 ans presentant des crises hypermotrices surtout morpheiques ayant debute a 1 an. L’EEG a suggere des foyers dans les regions fronto-temporales gauche et droite. La MEG a identifie des sources insulaires bilaterales. Un panel de 36 genes associes a l’epilepsie a ete explore par sequencage de nouvelle generation. Les tests genetiques revelerent alors une mutation heterozygote faux-sens (c.1079G > A ; p.Arg360Gln) dans le gene CHRNA4. Le traitement avec des patchs quotidiens de nicotine (7 mg avant le coucher) a ete partiellement efficace. Discussion Les mutations retrouvees dans ces deux cas ne sont pas reputees symptomatiques dans les bases de donnees genetiques disponibles. Toutefois, elles affichent un potentiel pathologique en raison des genes concernes et de la possibilite d’un determinisme genetique multifactoriel. Conclusion Les variantes des genes CHRNB2 et CHRNA4 peuvent etre associees a une epilepsie insulaire a crises hypermotrices principalement morpheiques. Des travaux supplementaires sont requis. more...

As a dynamical system, the brain constantly modulates its state and epileptic seizures have been hypothesized to be low dimensional periodic states of the brain. With this assumption, seizures have previously been investigated to identify patterns of these recurrent states; however, these attempts have generated conflicting results. These discrepant observations led us to reconsider the dynamic of state transitions during seizures.Using intracerebral recordings of 17 refractory epilepsy patients assessed prior to surgery, we studied ictal states with several state-of-the-art methods in order to investigate their dynamics. Global states were identified based on distinct functional connectivity measures in the time domain, frequency domain, and phase-space. We further investigated the state transitions in different brain regions locally using a univariate measure based on dynamical system analysis named the Recurrence Plot (RP).For the ictal period, we detected lower global state transition rates compared to pre- and post-ictal periods (p 0.05 for seizure-free (SF) and p 0.05 for non-seizure-free (NSF) groups post-surgery); however, the structure of RPs pointed towards higher state transition rates in some regions like the seizure-onset-zone (p 0.001 for SF and p 0.05 for NSF group). Moreover, a direct comparison of state transition dynamics between SF and NSF patients revealed different patterns for local state transitions between SF and NSF patients (p 0.05 for seizure-onset-zone while p 0.05 for other regions) and no significant difference in global state transition rates (p 0.05).Our findings pointed to distinct dynamics for state transitions at different spatial scales. While the pattern of global state transitions led to the conclusion that the brain changes state less frequently during ictal activity, locally, it experienced a higher rate of state transition. Furthermore, our results for different patterns of state transitions in the seizure-onset-zone between SF and NSF patients could have a practical application in predicting surgical outcome. more...

We present an intraoperative hyperspectral imaging system and the hemodynamics data acquired in 12 epileptic patients, allowing detection of the hemodynamic response function associated with interictal spikes, and localization of the area with the highest epileptic activity. more...

Ictal asystole is a rare epileptic phenomenon, though usually self-limiting, which has been associated with an increased risk of sudden death in epileptic patients. Although early recognition is desirable, the diagnosis can be delayed until prolonged video-EEG monitoring is completed. We report a case of ictal asystole in a 74-year-old patient with co-morbid cardiac conditions leading to a delay in diagnosis of approximately 10 years. Indeed, multiple cardiac investigations and EEGs failed to reveal that the recurrent syncope was seizure induced. A detailed description of the case with an emphasis on the prolonged diagnostic process, as well as the clinical and EEG findings, is provided. This case highlights the complexity of the diagnosis of some ictal asystole cases and the need to perform continuous video-EEG monitoring for confirmation. [Published with video sequence]. more...

Introduction Les DVA cerebrales sont des malformations vasculaires alterant le drainage veineux cerebral. Malgre leur frequence (2–4 % de la population generale et 50–60 % des malformations vasculaires cerebrales), elles sont habituellement asymptomatiques. Objectifs L’objectif etait d’etablir les principales caracteristiques cliniques et paracliniques des epilepsies symptomatiques des DVA. Accessoirement, l’etude a evalue leur pharmacosensibilite, vu la relative complexite d’une resection de ces malformations. Patients et methodes Nous avons mene une revue systematique des cas cliniques et des series detaillees de cas d’epilepsie ou de crises compliquant une DVA. Les manuscrits publies entre janvier 1965 et mai 2020 furent selectionnes en utilisant les mots-cles « epilepsy », « seizure », « venous angioma », « developmental venous anomaly » sur Pubmed, Medline et Scopus. Les cas avec une lesion comorbide potentiellement epileptogene et proche du foyer epileptique probable ont ete exclus. Resultats Les localisations frontales (36 %) et parietales (27 %) predominaient (n = 44). Le sinus sagittal superieur (SSS) et la veine de Galien drainaient respectivement 50 % et 19 % des DVA (n = 26). Pour les cas sans complication (n = 25), environ 94 % des EEG etaient anormaux (n = 17), mais seulement 35 % revelaient des pointes. Les crises etaient inaugurales dans 92 % des cas (n = 25) avec 33 % (n = 15) des cas pharmacoresistants. Pour les cas avec hemorragie/thrombose 89 % des tableaux evolutifs suggeraient des crises aigues symptomatiques. Discussion L’incidence des crises epileptiques est de 8–29 % des DVA symptomatiques. Notre etude suggere une localisation frontoparietale predominante et une faible probabilite de developper une epilepsie si celle-ci est non-inaugurale. Des EEG repetes ou prolonges peuvent palier la faible sensibilite des EEG de routine. Enfin, les cas d’epilepsie sur DVA semblent avoir une pharmacosensibilite similaire a la moyenne des epilepsies. Conclusion L’epilepsie complique rarement les DVA, et est generalement pharmacosensible. Le foyer est habituellement frontal ou parietal avec un drainage via le SSS ou la veine de Galien. more...

Introduction Les MCD sont dues a des anomalies in utero de la proliferation et/ou de la migration neurogliale. Elles sont frequemment responsables d’une epilepsie pharmacoresistante et/ou d’autres alterations des fonctions corticales. Observation Nous rapportons le cas d’une patiente de 35A, droitiere, presentant deux types de crises pharmacoresistantes depuis l’enfance: – hypertonie hemicorporelle gauche (MSG ± MIG) accompagnee ou non de clonies et d’une alteration de la conscience (AEC), durant 15–60 s (frequence: 2–4/jour, pics de 20–40 episodes en 1 h); – AEC avec ou sans auras («boule dans la gorge», survenant dans 50 % des cas), durant 1–2 min (frequence: 1–3/jour). L’IRM retrouvait une pachygyrie et une polymicrogyrie perisylvienne droites s’etendant en mesiotemporal ainsi que des heterotopies periventriculaires et une microcephalie droites. L’IRM fonctionnelle suggerait entre autres, une dominance langagiere droite ainsi qu’une representation bilaterale a predominance insulo-perisylvienne posterieure droite de la motricite et de la sensibilite tactile de l’hemicorps gauche. La stereo-electroencephalographie a enregistre une abondante activite epileptiforme ictale et interictale essentiellement d’origine mesiotemporale et insulo-perisylvienne droites. La stimulation corticale extra-operatoire de la region insulaire posterieure et de l’opercule parietal droit a revele une somatotopie motrice peu systematisee du MSG. La motricite du MIG etait quant a elle essentiellement parietale inferieure droite en retrosylvien avec une representation de la jambe gauche au niveau insulaire posterieur. Discussion Les MCD, notamment les polymicrogyries, sont reputees tres epileptogenes (33–87 % des cas). Elles sont associees a une desorganisation corticale complexe qui altere plus ou moins significativement les connexions intra- et inter-corticales. Meme s’il n’est pas rare d’observer une reorganisation des aires corticales, le cas present est extreme avec une organisation anarchique insulo-operculo-parietale droite des fonctions motrices de l’hemicorps gauche. Conclusion Ce cas tres atypique demontrant une desorganisation extreme de l’architecture corticale rappelle l’interet crucial d’une etude intracrânienne avec cartographie fonctionnelle minutieuse dans les cas de MCD epileptogene. more...

Introduction La photosensibilite est un phenomene anormal detecte sur l’electroencephalogramme (EEG) pendant la stimulation lumineuse intermittente (SLI) sous forme de decharges epileptiques ou reponse photoparoxystique (RPP). Objectifs Mise a jour des donnees recentes sur la photosensibilite humaine en Afrique noire car tres peu de travaux sont reportes et notamment au Senegal. Patients et methodes Une etude prospective sur les caracteristiques epidemio-cliniques des patients epileptiques presentant une RPP vu au CHU de Fann de Dakar. Resultats Sur 3065 EEG de patients epileptiques de l’annee 2016, 56 EEG (1,8 %) presentaient une RPP, avec un sexe ratio : 0,8. L’âge moyen etait de 13,3 ans, pour des pics de photosensibilite entre 6 et 10 ans. L’epilepsie etait generalisee chez 23 (41 %) des patients et focale chez 18 (32 %). Les frequences de stimulation les plus epileptogenes etaient comprises entre 12 et 24 Hz. La RPP a ete obtenue le plus souvent lorsque les yeux sont fermes chez 64 % patients et 41 patients (73 % des patients) ont ete classes dans le type 4 (classification de Waltz). Discussion En Hollande, en Allemagne la RPP est retrouve chez 5 a 8 % des patients epileptiques, contre seulement 1 a 2 % au Nigeria ou au Zimbabwe. Des auteurs ont retrouve des frequences de SLI epileptogenes maximum entre 10 et 25 Hz. RPP liees aux epilepsies generalisees idiopathiques sont constatees dans pres de 50 % des cas. Conclusion La photosensibilite est plus faible chez les patients noirs subsahariens comparativement aux Caucasiens. Il serait interessant de faire une etude de cohorte multicentrique afin d’etudier la valeur epigenetique protectrice probable de l’ensoleillement sur cette forme d’epilepsie. more...

OBJECTIVEFor patients with nonlesional refractory focal epilepsy (NLRFE), localization of the epileptogenic zone may be more arduous than for other types of epilepsy and frequently requires information from multiple noninvasive presurgical modalities and intracranial EEG (icEEG). In this prospective, blinded study, the authors assessed the clinical added value of magnetic source imaging (MSI) in the presurgical evaluation of patients with NLRFE.METHODSThis study prospectively included 57 consecutive patients with NLRFE who were considered for epilepsy surgery. All patients underwent noninvasive presurgical evaluation and then MSI. To determine the surgical plan, discussion of the results of the presurgical evaluation was first undertaken while discussion participants were blinded to the MSI results. MSI results were then presented. MSI influence on the initial management plan was assessed.RESULTSMSI results influenced patient management in 32 patients. MSI results led to the following changes in surgical strategy in 14 patients (25%): allowing direct surgery in 6 patients through facilitating the detection of subtle cortical dysplasia in 4 patients and providing additional concordant diagnostic information to other presurgical workup in another 2 patients; rejection of surgery in 3 patients originally deemed surgical candidates; change of plan from direct surgery to icEEG in 2 patients; and allowing icEEG in 3 patients deemed not surgical candidates. MSI results led to changed electrode locations and contact numbers in another 18 patients. Epilepsy surgery was performed in 26 patients influenced by MSI results and good surgical outcome was achieved in 21 patients.CONCLUSIONSThis prospective, blinded study showed that information provided by MSI allows more informed icEEG planning and surgical outcome in a significant percentage of patients with NLRFE and should be included in the presurgical workup in those patients. more...

Magnesium (Mg) is a crucial divalent cation with more than 300 cellular functions. This ion shows therapeutic properties in several neurological diseases. Although there are numerous basic evidences showing that Mg can inhibit pathological processes involved in neuroglial degeneration, this low-cost option is not well-considered in clinical research and practice for now. Nevertheless, none of the expensive drugs currently recommended by the classic guidelines (in addition to physiological rehabilitation) had shown exceptional effectiveness. Herein, focusing on Alzheimer's disease (AD), we analyze the therapeutic pathways that support the use of Mg for neurogenesis and neuroprotection. According to experimental findings reviewed, Mg shows interesting abilities to facilitate toxin clearance, reduce neuroinflammation, inhibit the pathologic processing of amyloid protein precursor (APP) as well as the abnormal tau protein phosphorylation, and to reverse the deregulation of N-methyl-D-aspartate receptors. Currently, some crucial details of the mechanisms involved in these proved effects remain elusive and clinical background is poor. Therefore, further studies are required to enable a better overview on pharmacodynamic targets of Mg and thus, to find optimal pharmacologic strategies for clinical use of this ion. more...

Introduction The photoparoxysmal response (PPR) is defined as the occurrence of generalized spike, spike-wave or polyspike-wave discharges consistently elicited by intermittent photic stimulation (IPS). PPR is not well studied in the African black subject Method We prospectively studied the epidemiological, clinical and EEG characteristics of PPR among consecutive epileptic patients seen in the EEG laboratory at Fann University Hospital at Dakar in Senegal. Result Among 3065 pathological EEGs for one year, we collected 56 EEGs (1.8%) with PPR, including 31 women and 25 men (sex ratio: 0.8). The mean age was 13.3 years (range: 8 months to 59 years). The peak of photosensitivity was found in the range of 6 to 10 years. Of the PPR cases, 40 were not known epileptic, of whom 12 had had clinical manifestations during IPS. 23% of patients were classified with generalized epilepsy, followed by 17% of focal epilepsy. The most epileptogenic stimulation frequencies are between 12 and 24 Hz. PPR were obtained most often when the eyes are closed (64%) and 41 patients (73% of patients) were classified as Type 4 (Waltz classification). Conclusion Our results suggests lower rates of photosensitivity in sub-Saharan people compared with Caucasians. Therefore, subject to consistent larger cohorts data, it would be interesting to study a probable epigenetic protective value of sunshine against photosensitivity. more...

Taenia solium neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. Variability in the neuropathology and clinical presentation of NCC often make it difficult to diagnose and manage. Diagnosis of NCC can be challenging especially in endemic and resource-limited countries where laboratory and imaging techniques are often lacking. NCC management can also be challenging as current treatment options are limited and involve symptomatic agents, antiparasitic agents, or surgery. Although antiparasitic treatment probably reduces the number of active lesions and long-term seizure frequency, its efficacy is limited and strategies to improve treatment regimens are warranted. Treatment decisions should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management, with antiparasitic therapy only to be considered later on, when appropriate. Symptomatic treatment remains the cornerstone in NCC management which should not only focuses on epilepsy, but also on other manifestations that cause considerable burden (recurrent headaches, cognitive decline). Accurate patients’ categorization, better antiparasitic regimens, and definition of new clinical outcomes for trials on NCC could improve management quality and prognosis of NCC. Prevention strategies targeting tapeworm carriers and infected pigs are yielding good results in local models. If local elimination of transmission is confirmed and replicated, this will open the door to cysticercosis eradication efforts worldwide., Video abstract more...

Marijuana is the most widely used illicit substance in the world. The relation between marijuana use and epileptic seizures is still controversial. We report a case of late onset epilepsy associated with marijuana abuse, with brain magnetic resonance imaging (MRI) findings. A 44-year-old patient was admitted for 03 isolated episodes of secondary generalized tonic-clonic seizures. He had a history of 26 years regular marijuana smoking. On admission, we found a tachycardia, psychomotor slowing, asymmetric hyperreflexia, bilateral Babinski sign without weakness. Laboratory work-up showed a high level of urine of Δ-9-tétrahydroxycannabinol. Electroencephalogram was normal. Brain MRI revealed abnormal signal intensities in the right frontal lobe and basal ganglia. Seizures cessation was obtained with anti-epileptic treatment. We suggest that marijuana abuse through vascular and toxic mechanisms could explain seizures in this case.Key words: Symptomatic epilepsy, intracerebral haemorrhage, marijuana, Magnetic Resonance Imaging more...