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A 21-year-old male with history of refractory epilepsy presented for long-term video EEG monitoring. His home antiepileptic medications were weaned off over a seven-day period. On hospital day 4, he had a right temporal electro clinical seizure with secondary generalization and a second right temporal electrographic seizure. On hospital day 8, MRI brain identified an ovoid circumscribed lesion in the splenium of the corpus callosum which had not been present on prior scans (Figure 1).

OBJECTIVE Drug-resistant focal epilepsy is widely recognized as a network disease in which epileptic seizure propagation is likely coordinated by different neuronal oscillations such as low-frequency activity (LFA), high-frequency activity (HFA), or low-to-high cross-frequency coupling. However, the mechanism by which different oscillatory networks constrain the propagation of focal seizures remains unclear. METHODS We studied focal epilepsy patients with invasive electrocorticography (ECoG) recordings and compared multilayer directional network interactions between focal seizures either with or without secondary generalization. Within-frequency and cross-frequency directional connectivity were estimated by an adaptive directed transfer function and cross-frequency directionality, respectively. RESULTS In the within-frequency epileptic network, we found that the seizure onset zone (SOZ) always sent stronger information flow to the surrounding regions, and secondary generalization was accompanied by weaker information flow in the LFA from the surrounding regions to SOZ. In the cross-frequency epileptic network, secondary generalization was associated with either decreased information flow from surrounding regions' HFA to SOZ's LFA or increased information flow from SOZ's LFA to surrounding regions' HFA. INTERPRETATION Our results suggest that the secondary generalization of focal seizures is regulated by numerous within- and cross-frequency push-pull dynamics, potentially reflecting impaired excitation-inhibition interactions of the epileptic network. ANN NEUROL 2019;86:683-694.

Experiments with animal models of epilepsy have consistently shown that focal cooling of epilepsy-induced brain region reversibly suppresses or terminates epileptic discharge activity. Recently, we formulated a physiologically plausible temperature dependence in a neural mass model that can reproduce the effect of focal cooling on epileptic discharge activity. This can be used to implement a temperature control in an implantable cooling device for thermal neuromodulation of the epileptogenic zone in patients with partial epilepsy when seizure activity is detected. However, there have been no experiments that looked into the effect of focal cooling in animal models of epilepsy with secondary generalization in which the seizure activity spreads from the pathologic region to other regions of the brain. Using the temperature-dependent neural mass model and a physiological coupling model, we show that focal cooling stops the propagation of low-frequency discharge activity; on the other hand, it increases the amount of coupling required to propagate high-frequency discharge activity. Moreover, discharge activities that are propagated with cooling are lower in both magnitude and frequency compared to those propagated without cooling. These results suggest the feasibility of focal cooling as an effective alternative therapeutic treatment for medically intractable partial epilepsy even with secondary generalization.Clinical Relevance— The computational study establishes focal cooling of the brain region with partial epilepsy not only suppresses epileptic discharges but can also prevent its generalization to other brain regions.

Objective: The aim of this work is to evaluate bone mineral density (BMD) in children with idiopathic epilepsy under anti-epileptic drugs and to determine the effect of the type and the duration of drug administration on BMD. Subjects and methods: This study conducted on 120 children divided into two groups, Epileptic group included 60 children diagnosed as having epilepsy on the basis of clinical examination receiving antiepileptic drugs (AEDS). Control group included 60 healthy children. All patients subjected to clinical examination and determination of bone mineral density. Results: Among epileptic children, there were 35 children (58.3%) with generalized tonic clonic seizures, 11(18.3%) were partial, 10(16.7%) were partial with secondary generalization, 4(6.7%) were absence seizures. 41(68.3%) epileptic patients were on antiepileptic monotherapy while 19 (31.7%) were on polytherapy. Seventeen children with low bone mineral density state (LBMD) and 43 with normal bone density. Epileptic patients had lower BMD, Z- score, and AM compared with controls (P value

Seizure types have been described that do not conform to traditional classification schemes. We present another unusual type characterized by focal onset with secondary generalization, that is followed immediately by continued focal activity that generalizes again without an intervening break. Better understanding of these seizure types may allow improved targeted therapies and help shed light on the mechanistic underpinnings of epilepsy. Keywords: Focal-general-focal-general, Secondary focal, Focal evolution, Secondary focal evolution, Regeneralization

To investigate the neurophysiological basis of secondary generalization of partial epileptic seizures.Inter-ictal, resting-state EEG functional connectivity (EEGfC) was evaluated and compared: patients with exclusively simple partial seizures (sp group) were compared to patients with simple partial and secondary generalized seizures (spsg group); patients with exclusively complex partial seizures (cp group) were compared to patients with cp and secondary generalized seizures (cpsg group); the collapsed sp+cp group (spcp) was compared to those who had exclusively secondary generalized seizures (sg group). EEGfC was computed from 21-channel waking EEG. 3 minutes of waking EEG background activity was analyzed by the LORETA Source Correlation (LSC) software. Current source density time series were computed for 23 pre-defined cortical regions (ROI) in each hemisphere, for the 1-25 Hz very narrow bands (1 Hz bandwidth). Thereafter Pearson correlation coefficients were calculated between all pairs of ROI time series in the same hemisphere. Z-scored correlation coefficients were compared at the group level (t-tests and correction for multiple comparisons by local false discovery rate, FDR).Statistically significant (corrected p0.05) EEGfC differences emerged at specific frequencies (spsgsg; cpsgcp), and at many frequencies (sgspcp). The findings indicated increased coupling between motor cortices and several non-motor areas in patients with partial and sg seizures as compared to patients with partial seizures and no sg seizures. Further findings suggested increased coupling between medial parietal-occipital areas (structural core of the cortex) and lateral hemispheric areas.Increased inter-ictal EEGfC is associated with habitual occurrence of secondary generalized seizures.A másodlagos generalizáció idegélettani alapjainak vizsgálata parciális rohamokban.Adatbázisunkból 131 parciális epilepsziás beteget gyűjtöttünk ki, akikből a rohamspekt­rum alapján hat betegcsoportot képeztünk: kizárólag egyszerű parciális rohamok (sp), kizárólag komplex parciális rohamok (cp), sp és cp betegek összevont csoportja (spcp), egyszerű parciális rohamok generalizációval és a nélkül (spsg), komplex parciális rohamok generalizációval és a nélkül (cpsg), kizárólag másodlagosan generalizált rohamok (sg). A 21 csatornás, éber-relaxált állapotban elvezetett interictalis EEG háttértevékenységből betegenként összesen 3 percet elemeztünk a LORETA Source Correlation szoftverrel. Féltekénként 23 agykérgi régió (ROI) egymás közötti korrelációját vizsgáltuk (EEG funkcionális konnektivitás, EEGfC) a jobb és bal féltekén belül, 1-25 Hz között 1 Hz szélességű frekvenciasávokban. A Pearson-korrelációs koefficienseket életkorra korrigáltuk és Z-transzformáltuk. A csoportokat t-tesztek segítségével hasonlítottuk össze. A statisztikailag szignifikáns (korrigált p0.05) EEGfC-értékekből előálló hálózati mintákat elemeztük.Nagyobb EEGfC-értékekből származó túlkapcsoltság jelentkezett specifikus frekvenciákon (spsgsg; cpsgcp) és számos frekvencián (sgspcp). Az eredmények a motoros és több, nem motoros kérgi terület közti túlkapcsoltságot tükrözik a betegekben, akiknek másodlagosan generalizálódó rohamai vannak. Túlkapcsoltság igazolódott a medialis parietooccipitalis régiók és a féltekék lateralis részei között is.Az interictalis állapotban mért hálózati túlkapcsoltság összefügg a másodlagos generalizációra való hajlammal.

Objectives. To assess the incremental budget impact (BI) of using of utilizing perampanel to treat partial-onset seizures (POS) and primary generalized tonic-clonic seizures (PGTCS) in patients who are 12 years of age and older in Russia. Methods. The budget impact was estimated by comparing two different scenarios: Cost of POS & PGTCS without Perampanel and Cost of POS & PGTCS with Perampanel (Perampanel Adoption). In the latter scenario, market share of perampanel was assumed to increase every year for up to five years. The model was developed from a payer perspective with a time horizon of five years. Direct costs included drugs and medical resources (hospitalization, emergency care costs, visits to physician). BI was calculated as the difference in costs between Perampanel Adoption scenario and the cost without Perampanel. Results. In Russia, approximately 125,499 patients who are at least 12 years old are treated for refractory POS & PGTCS each year. The market share of perampanel in the perampanel adoption scenario from year 1 to year 5 was 0.1%, 0.5%, 1.0%, 2.0% and 3.0%, respectively. During the same period, the adoption of perampanel is projected to increase drug costs (in millions) by RUB15.2 (1.2%), RUB76.1 (6.2%), RUB152.4 (12.3%), RUB305.4 (24.7%), and RUB459.0 (37.0%), respectively. A significant portion of the 5-year cumulative increase in drug costs (RUB 1,008 million) will be offset by a decrease in non-drug medical resources (-RUB152.7 million). The cumulative budget impact from perampanel adoption for the first five years is projected to be RUB855 million (0.7%), with an additional 231 patients gaining seizure freedom over a period of 5 years from the adoption of perampanel. Conclusion. Perampanel should be considered as an alternative alongside current antiepileptic drugs in patients with symptoms refractory to prior antiepileptic treatments.

Kleine-Levin syndrome (KLS) is an uncommon syndrome characterized by recurrent episodes of hypersomnia, behavioural and/or cognitive disturbances, abnormal eating and hypersexual behaviour. The diagnosis is clinical and requires a high index of suspicion and exclusion of other neurological conditions and sleep disorders. We report a case of 15-year-old male who had recurrent episodes of hypersomnia with hyperphagia, hypersexuality, disinhibition and cognitive dysfunction. His brain CT scan shows Mega cistern magna and EEG during the episode shows sharp and spike wave in both frontal and temporal lobes with secondary generalization. The patient became symptom-free after receiving Na Valporate.

Frontal lobe epilepsy (FLE) frequently leads to secondary generalized tonic-clonic seizures (SGTCS). However, little is known about the clinical, electrophysiologic, and radiologic correlates of SGTCS and whether these could influence diagnosis and treatment.A cohort of 48 patients with confirmed FLE was retrospectively identified and dichotomized into a group with and a group without SGTCS defined by history (≥1/year) or video-electroencephalography (vEEG). Demographics, seizure semiology, vEEG, neuroimaging data, and estimated seizure-onset zone were tabulated, and their association with the occurrence of SGTCS was evaluated with use of a chi-square test. Independent predictors of SGTCS were confirmed using a stepwise multivariate analysis. Similarly, these predictors as well as a history of SGTCS were tested as multivariate predictors of the postoperative International League Against Epilepsy (ILAE) score in the surgical subgroup (n = 25).We identified three independent predictors of a history of SGTCS in FLE, including loss of responsiveness at seizure onset (corrected p = 0.04), a semiology involving early elementary motor signs (corrected p = 0.01), and multifocal spikes on EEG (corrected p = 0.02). A seizure-free outcome occurred in 57% of surgical cases and was more likely in the group without SGTCS (100%, p = 0.001). When considering only SGTCS occurring during video-EEG monitoring, the association with semiology and surgical outcome vanished, but the association with preserved awareness and a multifocal EEG persisted.A history of SGTCS is related to a specific ictal semiology and interictal EEG, and may have a role in surgical risk stratification.

We propose a system based on the first five seconds of intracerebrally recorded focal seizures to predict their evolution from focal to bilateral tonic-clonic seizure (FTC), to spread outside the onset zone but without tonic-clonic component (FS), or to a seizure remaining focal (F).Nineteen time and frequency domain features were extracted from 39 seizures of 32 patients and were subjected to support vector machine based classification. Three prediction approaches regarding seizure evolution were (1) FTC vs FS vs F, (2) FTC vs FS or F and (3) FTC or FS vs F.We used 21 seizures for training. Most features had significantly different distributions in the three seizure types (p 0.05). Eighteen seizures were used for testing. We predicted the evolution of 12 seizures in FTC vs FS vs F, 13 seizures in FTC vs FS or F and 14 seizures in FTC or FS vs F.The first five seconds of a focal seizure contains information regarding the eventual evolution of the seizure, which could be predicted in most seizures.The proposed system could alert the health care team when a patient is hospitalized for intracerebral EEG and improve safety and eventually result in an implantable device.

Background and objectives: The main aim of this study is to prove the association of seizure types with the MRI findings of the brain (etiological factor). Also, to prove which type of lesion is mostly represented in which age-group, and with which type of seizure. Methods: A total of 100 patients with symptomatic epilepsy, aged from 16 to 80 years, were hospitalized at the Neurology Clinic or in its Outpatient Unit, in the period from 2009 to 2012. They were neurologically examined and the seizure type registered. All patients underwent MRI of the brain. Results: (56%) men and 44 (44%) women were examined. The represented type of epileptic seizures were 41.0% with SPC + CPC, followed by 15.0% GTCC, and 14.0% CPC with secondary generalization, 12,0% CPC, 10,0% SPC and 8.0% with absences. The epileptic lesions of 25.0% were hippocampal sclerosis, 20.0% post-traumatic injuries, 19.0%, post-vascular and brain tumours, and the lowest percentage of 17.0% with post-infectious lesions. Conclusions: Post-traumatic lesions occur more frequently in the elderly population with the accent on the male, while hippocampal sclerosis occurs in the adolescent and younger population with higher frequency in the female.

Surgical intervention often fails to achieve seizure-free results in patients with intractable epilepsy. Identifying features of the epileptic brain that dispose certain patients to unfavorable outcomes is critical for improving surgical candidacy assessments. Recent research by Martinet, Ahmad, Lepage, Cash, and Kramer ( J Neurosci 35: 9477–9490, 2015) suggests that pathways of secondary seizure generalization distinguish patients with favorable (i.e., seizure free) vs. unfavorable (i.e., seizure persistent) surgical outcomes, lending insights into the network mechanisms of epilepsy surgery failure.

To determine clinical/instrumental predictors of symptomatic epilepsy after ischemic stroke in children.One hundred and thirty-six patients, aged 0-15 years, with the diagnosis of ischemic stroke (ICD-10 I63.0-I63.9) were examined. The duration of the study was 18 months - 12 years. Patients were stratified into post-stroke (n=22) and control (n=114) groups, the latter included patients without epilepsy regardless of the presence of convulsive seizures in the acute stage of stroke. Predictors were determined based on EEG and characteristics of convulsive syndrome in the acute stage of stroke.The following prognostic criteria were found: generalized type of seizures, focal type of seizures with secondary generalization, epileptiform (peak and/or peak-wave) activity, focal character of epileptiform activity, generalized type of seizures in the combination with slow wave background activity on EEG, generalized type of seizures in the combination with slow wave activity and disorganized activity on EEG.Цель исследования. Установление клинических и инструментальных предикторов развития симптоматической эпилепсии после ишемического инсульта (ИИ) в детском возрасте. Материал и методы. Были обследованы 136 пациентов в возрасте 0-15 лет с диагностированным ИИ (I63.0-I63.9 по МКБ-10). Период наблюдения за детьми составил 18 мес - 12 лет. Из общего числа больных были сформированы группы с постинсультной эпилепсией (22 человека) и контрольная группа (114), в которую вошли пациенты, не страдавшие эпилепсией (независимо от наличия или отсутствия судорожного синдрома в остром периоде инсульта). Предикторы определялись по данным ЭЭГ и характеристикам судорожного синдрома в остром периоде ИИ. Результаты и обсуждение. Были выявлены следующие прогностические критерии: генерализованный тип приступов, фокальный тип приступов с вторичной генерализацией, эпилептиформная (пиковая и/или пик-волновая) активность, фокальный характер эпилептиформной активности, генерализованный тип приступов в комбинации с изменением фоновой активности на ЭЭГ, генерализованный тип приступов в сочетании с медленноволновой фоновой активностью на ЭЭГ, генерализованный тип приступов в комбинации с медленноволновой активностью и дезорганизованной активностью на ЭЭГ.

To the Editor,I read with great interest the article by Guldiken et al. (2015) in which they report an interesting patient with temporal lobe epilepsy, in whom the change in seizure semiology was firstly interpreted as secondary generalization of seizures. However, after video-EEG monitoring (VEEGM), ictal asystole was detected and implantation of a pacemaker provided a total cure of the newly developed seizures, characterized by falls and myoclonic jerks (Guldiken et al., 2015). I appreciate their [...]

An 18-year-old woman had a partial seizure affecting the left arm with secondary generalization. There was no history of seizures. Her mother recalled that the patient sustained a head injury as a 3-week-old neonate, falling from the sofa onto …

Objectives/Aims The study was designed to evaluate the optimal dosage of lamotrigine, as monotherapy, in the treatment of adults suffering from complex partial seizures with or without secondary generalization in everyday clinical practice. Materials and Methods The ones used in this study was the collection of the data of all adult patients treated with lamotrigine, retrospectively. The dosage and efficacy of treatment were evaluated along with side effects and retention rate. Results They showed that, out of 188 patients, 77% continued lamotrigine treatment; the mean effective dose was 250 mg or higher of lamotrigine, and the results more pronounced in older patients (age above 30 years) and those with a longer disease duration (5 years and more). Conclusion It may be appropriate to reach a daily lamotrigine dose above 250 mg in adult patients suffering from epilepsy for more than 5 years using lamotrigine as monotherapy.

In focal epilepsy, ictal version and ictal dystonia are thought to reflect seizure spread into the frontal eye field and the basal ganglia, respectively. Here we investigated whether the occurrence of dystonia during seizure evolution reflects mechanisms preventing secondary generalization. To this aim, the evolution of seizures in patients with focal epilepsies was compared as to whether concomitant (1) dystonia, (2) dystonia and version, or (3) version occurred.Seizure evolutions of 79 patients characterized by either dystonia (n=29; 232 seizures), dystonia and head version in the same seizure evolution (n=9; 83 seizures) or head version (n=41; 330 seizures), were included in the study.The rate of secondary generalization was significant lower in seizures with ictal dystonia (8%, 6 of 72 seizures) compared to seizures with ictal dystonia and version (62%, 13 of 21 seizures, p0.0001) or compared to seizures with version (95%, 82 of 86 seizures, p0.0001).This study shows that seizures with unilateral ictal dystonia are less likely to generalize as compared to seizures associated with version. This effect is likely to reflect the involvement of inhibitory mechanisms related to the basal ganglia, which exert an inhibiting effect on secondary seizure generalization.

There are only a few case reports of photic stimulation induced partial seizures arising from the temporal lobe. A 12-year-old female with a history of three convulsions was admitted for a diagnostic evaluation. During continuous video-electroencephalogram monitoring, a complex partial seizure with secondary generalization was induced immediately after a photoparoxysmal response with a 15-Hz photic stimulation. This is a rare case of photosensitive temporal lobe seizure.

Seizures are relatively common in Alzheimer disease (AD) and other neurodegenerative disorders. To our knowledge, however, there have been no reports of seizures associated with corticobasal degeneration (CBD). We describe a patient with brain biopsy features suggestive of CBD whose course was complicated by complex partial seizures with secondary generalization. Thus, the occurrence of seizures in a patient with dementia should not exclude the diagnosis of CBD.

Neurological manifestations such as seizures although rare are well recognized presentations of cardiac arrhythmias. Almost always, such events are primarily generalized in nature leading on to loss of consciousness. Rarely however, cardiac seizures can manifest with focal neurological events. We report a case of a sexagenarian who presented with recurrent focal seizures with secondary generalization, who was misdiagnosed and treated as seizure disorder; only a careful history and focussed investigations helped in realising a precise diagnosis.

The diagnosis of epilepsy primarily depends on description of the observed seizure. The aim of this study was to determine the reliability of witness' description among groups with different medical education.A group of 44 respondents (15 laymen, 15 medical students, and 14 doctors at neurology residency program) were shown video footages of focal epileptic seizure (ES) with secondary generalization and psychogenic non-epileptic seizure (PNES) of the same patient. The ability to describe ES and PNES characteristics, to estimate duration of seizures, and to detect of accurate seizure type was evaluated using a questionnaire. For the analysis of primary data obtained from questionnaires, we used descriptive statistical methods and methods for testing statistical hypotheses.The sensitivity (Sn) and specificity (Sp) for accurate recognition of ES are different in the examined groups (laymen Sn = 53.3%, Sp = 33.3%; medical students Sn = 100%, Sp = 13.3%; neurology residents Sn = 100%, Sp = 71.4%). Evaluated duration of PNES and ES do not differ between examined groups. The impression that ES and PNES are distinct events is reciprocal for medical students and neurology residents, but not in laymen group. Neurology residents notice the essential characteristics of ES in high percentage.Accurate classification of the attacks is associated with the observers' level of medical knowledge. Witnesses with specific, neurological knowledge with higher probability, compared to the laity and medical students, differentiate ES from PNES.

Seizures are not infrequent among patients with intracerebral hemorrhage (ICH). Acutely, seizures in ICH are thought to be due to structural and biochemical disruption, whereas late seizures and epilepsy are likely related to inflammation and gliosis. Early seizures may occur in 3.4–41 % of patients and the risk of epilepsy is 2.3–31 % depending on the definitions used and time of follow-up. The frequency of seizures in ICH may be underestimated as a significant number of patients may have electrographic nonconvulsive seizures. While status epilepticus is generally uncommon in patients with ICH, it may represent 20 % among patients with ICH and seizures. Partial seizures or partial seizures with secondary generalization are the most common type. There are factors that increase the risk of seizures. There is conflicting evidence with regard to the impact of seizures on the outcome of ICH although it is clear that status epilepticus increases mortality rate. Evidence supporting the use of antiepileptic drugs in patients with ICH is scarce. There is general agreement that clinical and electrographic seizures should be treated and prophylactic therapy avoided; though, there is uncertainty with regard to the duration of therapy and its role in epilepsy prevention.

Patients with lesions treated with radiosurgery frequently present with or later develop seizures. The seizures produced by these lesions are always partial seizures with or without secondary generalization. The acute local tissue reactions produced by radiosurgery may result in transient seizure exacerbation. The medical management and treatment considerations of seizures in these patients during these various periods are discussed. Since virtually all antiepileptic drugs (AED) are effective for the treatment of partial seizures and because comparative trials demonstrating superior efficacy are lacking with the newer agents, often AED selection is based on other considerations.

The scientific collaboration in networks may be developed among countries, academic institutions and among peer researchers. Once established, they contribute for knowledge dissemination and a strong structure for research in health. Several advantages are attributed to working in networks: the inclusion of a higher number of subjects in the studies; generation of stronger evidence with a higher representativeness of the population (secondary generalization and external validity); higher likelihood of articles derived from these studies to be accepted in high impact journals with a wide coverage; a higher likelihood of obtaining budgets for sponsorship; easier data collection on rare conditions; inclusions of subjects from different ethnic groups and cultures, among others. In Brazil, the Brazilian Network for Studies on Reproductive and Perinatal Health was created in 2008 with the initial purpose of developing a national network of scientific cooperation for the surveillance of severe maternal morbidity. Since the establishment of this Network, five studies were developed, some of them already finished and others almost being completed, and two new ones being implemented. Results of the activities in this Network have been very productive and with a positive impact on not only the Postgraduate Program of Obstetrics and Gynecology from the University of Campinas, its coordinating center, but also on other participating centers. A considerable number of scientific articles was published, master´s dissertations and PhD theses were presented, and post-doctorate programs were performed, including students from several areas of health, from distinct regions and from several institutions of the whole country. This represents a high social impact taking into account the relevance of the studied topics for the country. As colaboracoes cientificas em rede podem ocorrer entre paises, instituicoes academicas e entre pares de pesquisadores e, uma vez estabelecidas, contribuem para a disseminacao do conhecimento e estruturacao da pesquisa em saude. Diversas vantagens sao atribuidas ao trabalho em rede como: a inclusao de maior numero de participantes nos estudos; gerar evidencias mais fortes e com maior representatividade da populacao (generalizacao secundaria e validade externa); maior facilidade das publicacoes oriundas dos estudos serem aceitas em periodicos de impacto e abrangencia; maior probabilidade de obtencao de verbas para financiamento; maior facilidade na coleta de dados sobre condicoes raras; inclusao de participantes de diferentes grupos etnicos e culturas, entre outras. No Brasil a Rede Brasileira de Estudos em Saude Reprodutiva e Perinatal foi criada em 2008 com o objetivo inicial de desenvolver rede nacional de cooperacao cientifica para vigilância da morbidade materna grave. Desde sua formacao, cinco estudos foram desenvolvidos, alguns ja encerrados e outros em fase de finalizacao, com outros dois em fase final de implantacao. Os resultados das atividades desta Rede tem sido bastante produtivos e impactaram positivamente nao apenas no Programa de Pos-Graduacao em Tocoginecologia da Universidade Estadual de Campinas, seu centro coordenador, mas tambem o de outros centros participantes, uma vez que expressivo numero de artigos cientificos foi publicado, mestrados e doutorados foram defendidos e pos-doutorados finalizados, de alunos de diversas areas da saude, de diferentes regioes e de varias instituicoes de todo o pais, com alto impacto social dada a relevância dos temas estudados para o pais.

Although the ability of magnetoencephalography (MEG) to detect epileptiform discharges noninvasively has long been known, only recently has it become a common tool in clinical settings. Whether MEG or electroencephalography (EEG) is superior has been controversial; MEG has a theoretic edge over EEG for precise localization, but EEG has many practical advantages. Experience has shown that they often provide different and complementary information. Although the results of careful MEG analysis can be quite precise, MEG interpretation, like that of EEG, is partly subjective and reader dependent. Therefore, the appearance of well-defined foci on MEG should not reflexively be regarded as conclusive, but weighed by judgment, experience, and an understanding of the assumptions and behavior of the localization model. We review selected studies in the past 2 years that are relevant to epilepsy. In particular, studies are described that provide insights into MEG's relation to EEG, its contribution to preoperative decision making, its application to benign Rolandic epilepsy, and analysis of secondary generalization.

To estimate the prevalence and define the clinical characteristics of epileptic disorders in the 13,431 residents of the Sicilian Aeolian archipelago, on June 1, 1999.All established or suspected cases were identified by the neurologists of our working group from available medical information sources. Possible epilepsy cases were then evaluated by the epileptologists by using a standardized questionnaire. The patients were further reviewed by the whole research team to confirm the clinical diagnosis. For a more detailed syndromic definition, some patients underwent EEG or neuroradiologic investigations or both.The crude point prevalence rate of active epilepsy was 3.13 (95% confidence interval, 2.2-4.2). The prevalence rate age-adjusted to the 2001 Italian population was 3.01. Females had a slightly higher prevalence rate than did males. The highest age-specific prevalence was found in patients aged 5 to 14 years (5.05) and in those aged 65 to 74 years (5.41). Partial seizures with or without secondary generalization were more common (61.7%) than were generalized seizures. Eighty-three percent of cases had symptomatic or cryptogenic localization-related epilepsies, and 8.5% had idiopathic (generalized or partial) epilepsies. Epilepsy was unclassified in 8.5% of cases.The prevalence of active epilepsy in the Aeolian islands is lower than that in other developed areas, including northern Italy, but is similar to that in Sicily. Partial seizures were the most common type, and localization-related symptomatic epilepsies were the largest syndromic category.

We present five patients of epilepsy in which seizures were triggered by playing or watching the traditional Chinese gambling game “Mah-Jong.” One patient also experienced seizures while playing a computer version of the Mah-Jong game. This condition appeared to have a predominance of males (80%) and middle-aged onset (39.4 years). Four patients had generalized tonic-clonic seizures and one patient had partial seizures with secondary generalization. No spontaneous seizure occurred in these patients. Three patients had been receiving antiepileptic drug therapy, but without effective control over their seizures. Mah-Jong-induced epilepsy is a very peculiar form of complex reflex epilepsy that involves the higher mental activities. This phenomenon may consist of distinct pathophysiologic mechanisms from other reflex epilepsy induced by thinking and spatial tasks in idiopathic generalized epilepsies. This unusual reflex epilepsy is relatively benign in nature and antiepileptic drug therapy has uncertain benefits. It may be necessary to avoid playing the Mah-Jong game in order to prevent seizures.

Research with adults with epilepsy consistently indicates deficits in executive function (EF). There is less research specific to children with epilepsy and EF. The purpose of this study was to consider EF deficits in children with complex partial epilepsy and complex partial with secondary generalization epilepsy with onset localized to the frontal or temporal lobes. This was a retrospective study of 28 children followed in an outpatient pediatric epilepsy clinic who were consecutively referred for neuropsychological assessment, which included measures of EF. The sample was predominantly White and male, with a mean age of 12.88 years (SD = 1.64) and mean cognitive ability of 89.39 (SD = 13.41). Comparison of right-temporal, left-temporal, and frontal groups yielded significant differences (p = .01) between the left-temporal and frontal groups on the Wisconsin Card-Sorting Test (WCST) Categories with the frontal group demonstrating the greatest deficits. Although mean differences were not significant, the frequency of impaired performance by the frontal group on the Attention/Concentration Index was greater than in the temporal groups. Results indicate that for children with complex partial and complex partial with secondary generalized seizures localized to the frontal and temporal lobes, there is an increased likelihood for impaired EF evident on the WCST, but not on others. Implications of these findings for prevention and intervention are discussed.

“Apparently generalized” reflex seizures usually occur in the setting of idiopathic generalized epilepsies. Several animal, neurophysiological and neuroimaging evidences strongly suggest that such reflex seizures should be considered as focal with quick secondary generalization through cortico-reticular or cortico-cortical pathways. The aim of this article is to highlight mechanisms underlying “apparently generalized” reflex seizures provoked by intermittent light stimulations, reading, thinking and praxis.

To determine the importance of fornix and mamillary body atrophy in the secondary generalization of the complex partial seizures fornix and mamillary bodies of 11 hippocampal sclerosis patients with secondary generalization (SG) and 3 without secondary generalization (WSG) were retrospectively evaluated using MRI images. Small fornix and/or mamillary body was not found in WSG group. In SG group the frequencies of small fornix and mamillary body were 64% and 45%, respectively, all being ipsilateral to sclerotic side. The frequency of small fornix in the SG group was statistically higher than WSG group (p

Benign familial infantile convulsion is a syndrome recently identified among the epileptic seizures of infancy. The main characteristics are: occurrence before one year of age, brief epileptic bursts of partial type seizures with secondary generalization, excellent prognosis with normal mental and motor development, high familial incidence. This syndrome appears genetically heterogeneous.

Glioneuronal rather than glial tumors are found in around 20% of patients with drug-resistant focal epilepsies. Gangliogliomas, dysembryoplastic neuroepithelial tumours (DNTs), angiocentric gliomas, pilocytic astrocytomas, and pleomorphic xanthoastrocytomas (PXAs) show characteristic imaging profiles clearly different from diffusely infiltrating gliomas. Epidermoids and dermoids are considered tumor like lesions with likewise specific imaging findings.

Objective: To report a case of seizures that probably developed because of the disinfectant and antiseptic agent povidone iodine (PVI). Case Summary: A 67-year-old healthy white man developed pleural empyema that was treated with drainage and intrapleural PVI irrigation. Within 10 minutes, complex partial seizures with secondary generalization lasting several minutes were documented. Several hours later, the patient developed a similar episode. Both events resolved spontaneously and, in 10 months of follow-up, there was no recurrence. Discussion: The adverse effects of iodine are known; however, little has been reported about seizures following the administration of PVI. This complication is thought to be due to either the osmotic and hydrophilic qualities or the presence of ionic changes and lipid solubility of PVI. Conclusions: Intracavitary PVI should be considered in the differential diagnosis of localized and generalized seizures.