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Moyamoya disease is a cerebrovascular pathology characterized by progressive stenosis of the internal carotid arteries and their branches, leading to ischemic and/or hemorrhagic disorders of the cerebral circulation, primarily affecting children and young adults. We present a case of a 23-year-old woman with a history of recurrent cerebrovascular accidents since childhood. Despite experiencing focal motor seizures and transient ischemic attacks, her condition remained undiagnosed until 2006, when, at the age of 7, a digital subtraction angiography revealed characteristic bilateral internal carotid artery occlusions. Subsequent diagnostic challenges and treatments preceded a worsening of symptoms in adulthood, including generalized tonic–clonic seizures. Upon presentation to our clinic, the patient exhibited upper motor neuron syndrome and occipital lobe syndrome, consistent with the disease's pathophysiology, neuroimaging, and clinical manifestations. Imaging studies confirmed multiple ischemic lesions throughout the cerebral vasculature. Treatment adjustments were made due to the increased incidence of seizures, and the dose of her anti-seizure medication—divalproex sodium—was increased. This case underscores the diagnostic complexities and challenges in managing moyamoya disease, emphasizing the importance of early recognition and prompt intervention. [ABSTRACT FROM AUTHOR]

Byline: Ekaterina. Viteva Introduction: The data in the scientific literature about the significance of seizure severity and frequency for the quality of life (QOL) of patients with refractory epilepsy (RE) [...]

Introduction: The data in the scientific literature about the significance of seizure severity and frequency for the quality of life (QOL) of patients with refractory epilepsy (RE) are contradictory. Objective: Our objective was to assess the impact of the seizure severity and frequency on the QOL of Bulgarian patients with RE. Materials and Methods: A total of 70 patients with RE were studied by examining the medical documentation and seizure diaries. All study participants completed quality of life epilepsy inventory (QOLIE-89). Seizure severity of only 59 patients who had a seizure in the last month was assessed by the Liverpool seizure severity scale. Results: A limited negative impact of the seizure severity and frequency on some aspects of the physical health, epilepsy, all aspects of the social health and epilepsy and the overall QOL has been demonstrated. A weak to moderate reverse correlation between the specified factors and the respective QOLIE-89 subscales has been found. Conclusion: The clinical factors seizure severity and seizure frequency have a limited negative impact mostly on the social aspects of QOL. The study results support the multidisciplinary approach to persons with epilepsy. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study is to assess the clinical manifestations, investigation results, and outcomes in Bulgarian patients with seizures in the course of COVID-19 infection., Methods: We performed an open, prospective study during a 12-month period from January 2021 with the participation of 290 inpatients and outpatients with seizures who attended the Clinic of Neurology at the University Hospital in Plovdiv, Bulgaria. After a detailed anamnesis, they underwent neurological examination, EEG, neuroimaging, and lumbar puncture when needed. There was a prospective one-year follow-up regarding seizure frequency, EEG, and treatment., Results: In 18 (5.9%) patients, seizures were related to COVID-19 infection. Nine (3.1%) patients had new-onset seizures, and in nine (3.1%) participants with epilepsy, there was a worsening of seizure frequency. New-onset seizures were more likely to occur in people above 65 years of age, within one to two months from the infection diagnosis. In one participant, seizures were related to fever. The most common seizure types were generalized tonic-clonic and focal motor seizures with/without loss of awareness. Antiseizure medications were started in seven participants. Viral encephalopathy was confirmed in two patients, one of them died. EEG showed focal epileptiform activity in four participants. The one-year prospective observation showed a favorable outcome in five patients who were without seizures, had normal EEG, and three were without treatment. Seizure frequency increase or seizure recurrence was typically observed for a short period of time in the epilepsy group. EEG was worsened in one patient and treatment changes were needed in five participants., Conclusion: In conclusion, our study results provide evidence about the progress and possible relationship between new-onset seizures and seizure worsening with COVID-19 infection., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Local Ethics Committee of Medical University, Plovdiv issued approval C-10-4/2020. The study was conducted in accordance with the local legislation and institutional requirements. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Viteva et al.)

Introduction: The quality of life in epilepsy inventory (QOLIE-89) is the most comprehensive and widely used instrument for assessment of the quality of life of patients with epilepsy., Aim: To prove that the Bulgarian version of QOLIE-89 shows good reliability and validity., Patients and Methods: The study included 35 patients with refractory epilepsy: 20 women (57.14%) and 15 men (42.86%) at the mean age of 43.11 +/- 2.38 years and mean duration of epilepsy 22.46 +/- 2.05 years. All respondents completed QOLIE-89 twice at an interval of one to three weeks; they also completed QOLIE-31 once., Results: Cronbach's alpha was between 0.90 and 0.92 for all subscales, the mean assessment score was 0.91. These results, the high Spearman-Brown coefficient (0.90) and the low mean inter-item correlation (0.33) suggest that the Bulgarian version of QOLIE-98 shows excellent internal consistency and high reliability. This is supported by the high coefficient of correlation (0.83-0.98) between the subscales scores and the overall assessment of the quality of life in the two completions of the questionnaire. The questionnaire proved to be valid based on the strong correlation we found between the overall assessment score (0.91) of QOLIE-31 and QOLIE-89 and the subscales of seizure worry, overall quality of life, energy/fatigue and overall scores--all in the range of 0.95-1.00. The correlations of coefficients for the other subscales were between 0.69-0.86., Conclusions: The psychometric properties of the Bulgarian version of QOLIE-98 are good; they are similar to those of the original American version and the validated Norwegian and Chinese versions. It shows high reliability and validity and can be used to assess the quality of life of elderly people with epilepsy.

Introduction: In pseudorefractory epilepsy (20% of the cases diagnosed with refractory epilepsy) the factors responsible for triggering the seizures are extraneous to epilepsy and the seizures can be controlled after diagnostic and therapeutic re-evaluation., Aim: To determine the factors causing development of pseudoresistance in patients with epilepsy., Patients and Methods: Detailed case histories of 191 patients with a diagnosis of drug-resistant epilepsy were collected; the medical records were analyzed retrospectively. Thirty-nine patient (20.42%) were found to be with pseudorefractory epilepsy. The patients were classified by demographic criteria and specific clinical signs, and by laboratory findings., Results: The patients (age range 18 to 72 years, mean duration of disease 27 years) presented with partial (56.41%), generalized (43.59%) and polymorphic seizures (17.95%) with a higher relative percentage of the patients with symptomatic (41.03%) and cryptogenic (35.9%) epilepsy. The main groups of factors that determined pseudoresistance were diagnostic (46.15%) and therapeutic errors (69.23%), poor compliance (33.33%), external factors (5.12%), as well as a combination of these (53.84%). We found that compliance correlated weakly with age and education, but showed high and moderate correlation with duration of epilepsy less than 20 years and male gender. Therapy adjustment had a beneficial effect in 16 of 24 patients (66.67%) in our study., Conclusion: The detailed analysis of the causes for pseudoresistance focuses on some pitfalls of the diagnostic and therapeutic process, compliance of the patient and influence of external factors aiming at reduction of the number of cases with pseudorefractory epilepsy and achieving more favourable clinical effect of treatment.

Introduction: Depressive and anxiety disorders are very often comorbid with refractory epilepsy., Aim: To determine the impact of depressivity and anxiety on some aspects of the quality of life of patients with refractory epilepsy., Patients and Methods: The present open prospective study included 94 patients (67 women) with refractory epilepsy (mean age 42 years) who were categorised according to their medical history, individual clinical parameters and results of paraclinical studies. Beside these, the patients completed the questionnaires for depression (BDI-II), anxiety (HAS) and quality of life (QOLIE-89)., Results: We found different degrees of depressivity in 59 patients (63.44%). Only three of the participants (3.19%) were found to have no depressivity or anxiety. In the remaining 91 patients (96.81%) we diagnosed anxiety in a different degree. The QOLIE-89 showed a low overall assessment of the quality of life in 54 patients (57.45%). We found: 1. A strong correlation between depressivity and the low overall assessment of quality of life as well as the assessment in the subscales for limitations due to physical problems, emotional wellbeing, attention/concentration, and memory. 2. A strong correlation between the increase of severity of depressivity and decrease of the overall assessment of quality of life. 3. A weak correlation between anxiety and the low overall assessment of QOL as well as the assessment in all subscales., Conclusions: Depressivity is a factor which worsens significantly all aspects of quality of life of patients with refractory epilepsy. This makes the timely diagnosis and treatment of the disease absolute necessity.