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Background: Cerebral sparganosis represents the most severe manifestation of sparganosis, with a relatively low global incidence. For cases of secondary epileptic seizures caused by sparganosis infection in the functional areas of the brain, what advanced neurosurgical techniques should be employed to precisely identify and excise the epileptic lesions in the deep functional areas of the brain, aiming to achieve maximal removal while minimising the risk of neurological deficits? This remains a current challenge for epilepsy surgeons. Case presentation: A 24-year-old Chinese male was admitted to our hospital, presenting with a history of left limb twitching persisting for over a year. His main clinical symptoms presented twitching and numbness of his left limb without loss of consciousness. Under the premise of inappropriate anti-seizure treatment, recurrent epilepsy attacked persist. The patient's diagnosis was considered as "space-occupying lesions in the several lobes of brain, secondary epilepsy" after comprehensive assessment and discussion. And experts considered that the patient's space-occupying lesions in the right frontal and parietal lobes were highly suspected to be infected by parasites. This report delved into the application of neurosurgery robot-assisted frameless stereotaxic technology and intraoperative stereotactic electroencephalography (SEEG) monitoring technology to accurately locate and optimize removal of parasite-related epileptic lesions situated in functional areas of the brain. As a result, the patient had achieved seizure freedom, leaving no symptoms of neurological deficit. Conclusions: With the highly integrated development of imaging technology, mechanical technology, computer control technology, and artificial intelligence, surgical robots are poised to play a larger role across various neurosurgical specialties in the future. Considering benefits for patients and the promising application of this technology, its utilization holds significant value. [ABSTRACT FROM AUTHOR]

ABSTRACT: Mycobacterium iranicum is characterized by rapid growth and orange-pigmented scotochromogenic colonies. However, it is uncommon for M. iranicum to invade the central nervous system. A man nearly 60 years old was referred to our hospital because of a seizure and unconsciousness. After admission, the patient had fever and dizziness without obvious abnormalities in the cerebrospinal fluid, except for an increase in neutrophils. Metagenomic next-generation sequencing and DNA testing were positive for M. iranicum. The patient was treated with imipenem, minocycline, moxifloxacin, and linezolid, and he gradually recovered during follow-up.

• Rare Mycobacterium iranicum meningitis can cause fever, headache, and epilepsy. • Metagenomic next-generation sequencing is the key to diagnosing purulent meningitis. • Β-Lactam, quinolones, and tetracycline can treat M. iranicum meningitis. Mycobacterium iranicum is characterized by rapid growth and orange-pigmented scotochromogenic colonies. However, it is uncommon for M. iranicum to invade the central nervous system. A man nearly 60 years old was referred to our hospital because of a seizure and unconsciousness. After admission, the patient had fever and dizziness without obvious abnormalities in the cerebrospinal fluid, except for an increase in neutrophils. Metagenomic next-generation sequencing and DNA testing were positive for M. iranicum. The patient was treated with imipenem, minocycline, moxifloxacin, and linezolid, and he gradually recovered during follow-up. [ABSTRACT FROM AUTHOR]

Wu Yang, Tingting Liu Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Tingting Liu, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-13588785095, Fax +86 571-87236838, Email echo5001@163.comAbstract: Disseminated nocardiosis is a rare, life-threatening disease that usually found in immunocompromised patients, and Nocardia farcinica is one of the most common causative pathogens. The difficulty in identifying the bacterium and the delay in initiating appropriate therapy often influence the prognosis of patients with disseminated nocardiosis. Here, we present a rare case of disseminated nocardiosis in a 61-year-old female with pulmonary fungus and secondary epilepsy. She received targeted antibiotic therapy and showed a great recovery in clinical symptoms and radiological signs. Disseminated nocardiosis can be easily overlooked due to the absence of characteristic symptoms and limitations of clinical examinations. Given the variability in antibiotic susceptibility patterns, the management of disseminated nocardiosis must be individualized. Therefore, early diagnosis and targeted antibiotic treatment are critical for the prognosis of disseminated nocardiosis.Keywords: disseminated nocardiosis, Nocardia farcinica, pulmonary fungus, secondary epilepsy

• The incidence and the independent risk factors of SRS-related epilepsy in st-BMs patients is still unclear. • The present study review the patients with st-BMs from four gamma knife centers SRS and the secondary epilepsy was found in 11.3 % patients in median 21 days after SRS and with low severity. • For patients with the tumor located in cortex or hippocampus, with peri -tumor edema larger than 20.3 cm3 before SRS, without receiving bevacizumab during SRS, with epilepsy history, the risk of secondary epilepsy is significantly higher. • Whether patients experience secondary epilepsy or not after SRS does not affect their OS. To evaluate the incidence and the independent risk factors of SRS-related epilepsy in patients with supratentorial brain metastases (st-BMs), providing evidences for prevention or reduction secondary epilepsy after SRS. Patients with st-BMs from four gamma knife centers who developed secondary epilepsy after SRS were retrospectively studied between January 1, 2017 and June 31, 2023. The incidence and clinical characteristics of the patients with secondary epilepsy were analyzed. The predictive role of baseline clinical-demographic variables was evaluated according to univariate and multivariate logistic regression model. The impact of secondary epilepsy on patients' OS was evaluated as well by log-rank test. 11.3 % (126/1120) of the patients with totally 158 st-BMs experienced secondary epilepsy after SRS in median 21 days. 61.9 % (78/126) of the patients experienced simple partial seizures. 91.3 % (115/126) patients achieved good seizure control after received 1–2 kinds of AEDs for median 90 days, while 7.1 % (9/126) of the patients suffered from refractory epilepsy. Patients had higher risk of secondary epilepsy if the tumor located in cortex and/or hippocampus, peri -tumor edema larger than 20.3 cm3 before SRS, had epilepsy history, and failed to receive bevacizumab prior to SRS. There was no difference in the OS of patients who experience secondary epilepsy or not after SRS. The incidence of SRS-related secondary epilepsy is 11.3 % in patients with st-BMs in this retrospective study. The risk of secondary epilepsy is higher in patients with st-BM located in cortex and/or hippocampus area, peri -tumor edema larger than 20.3 cm3 before SRS, and epilepsy history. Bevacizumab is suggested prior to SRS therapy, as it could be used for the control of peri -tumor edema and SRS-related damage, hence reduce the risk of secondary epilepsy. However, whether or not patients suffered from secondary epilepsy after SRS does not affect their OS. [ABSTRACT FROM AUTHOR]

Pseudorabies virus (PRV) is a common pig infectious disease. There have been few reports of PRV infection in humans. The patient in this article had acute onset, which was manifested by fever, epilepsy, disturbance of consciousness, and other symptoms. The disease progressed rapidly and worsened in a short time so the ventilator had to be used to assist breathing. In the later stage of treatment, serious visual impairment also occurred. Pseudorabies virus was found in cerebrospinal fluid by second-generation gene sequencing (NGS). This indicates that the pseudorabies virus can spread across species, leading to human encephalitis and severe visual impairment. Therefore, attention should be paid to this disease, active prevention, and early detection are helpful to improve the treatment effect. [ABSTRACT FROM AUTHOR]

To observe the therapeutic effect of conventional decompressive craniectomy with hematoma evacuation and frame-based stereotactic minimally invasive surgery (MIS) for supratentorial intracranial hematoma with herniation.

Cerebrospinal fluid (CSF) leak is a rare complication in of the prolactinomas treatment with dopamine agonists. In most cases CSF leak develops within the first three months of treatment starting. The article presents a rare clinical case later development of CSF leak after pharmacological treatment of giant prolactinoma. Women 29 years with giant endo-supra-infra-laterasellar pituitary adenoma (8,7 cm in diameter), visual impairment, cachexia, secondary amenorrhea and prolactin level more than 2 million 200 thousand mU/l treated with cabergoline. On this background, complete regression of the tumor, recovery of visual function, body mass and normalization of prolactin level was marked. Nevertheless, after 6.5 years after beginning of cabergoline therapy CSF leak occured, which required endoscopic endonasal surgery with the plastic of a CSF fistula. All patients with large and giant prolactinomas which invade into skull base structures, receiving cabergoline even for a long time, should be aware of the possibility of such complications as CSF leak and, if necessary, should urgent appeals to the otolaryngologist and the neurosurgeon. In this case closure of skull base defect is a main tactics of treatment.

To study the diagnostic value of video EEG (V-EEG) and imaging examination for children with secondary epilepsy. A total of 168 children with epilepsy, who were treated in First Hospital of Qinhuangdao from March 2014 to April 2017, were selected in this study. V-EGG and magnetic resonance imaging (MRI) diagnosis were performed in all children respectively, and the diagnostic value of the two methods was compared. Among the 168 patients, abnormal EEG signals were detected in 154 patients (120 patients had epileptiform discharges), V-EEG showed that the distribution of epileptiform discharges in the left and right leads were significantly higher than that in bilateral leads, and the differences were significant (P<0.05). MRI test showed that 140 patients had intracranial structural lesions or abnormal development, and 28 patients were not found abnormal. Among the 168 cases, 72 cases were pure partial type, the highest proportion was 42.86%; Among the main causes, the type of intracranial infection was mainly systemic, accounting for 11.31%. The type of cerebral infarction was mainly partial type, accounting for 8.33%. The main types of intracranial softening lesions were complex part, accounting for 6.55%. The type of intracranial tumor was mainly partial type, accounting for 6.55%. The location ofMRI was mainly unilateral, in which the left side was 38.10%and the right side was 29.76%. V-EEG monitoring showed abnormal discharge was found in 154 cases, accounting for 91.67%, of which intracranial infection and cerebral infarction, as well as intracranial tumors and intracranial softening of the positive detection rate were the highest, respectively 24.40%, 13.10%, 11.90% and 10.71%. The sensitivity and specificity ofV-EEGdiagnosis were significantly higher than those ofMRI (P<0.05). V-EEG is more valuable than MRI in the diagnosis of secondary epilepsy. It can provide more accurate diagnostic data and is worthy of promotion and application in the clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective To observe the incidence of secondary epilepsy in patients with cerebral infarction and explore the risk factors of secondary epilepsy. Methods Eighty-four patients with secondary epilepsy diagnosed as cerebral infarction from April 2016 to August 2017 in our hospital were selected as the observation group， and 84 patients of cerebral infarction without epilepsy in the same period were selected as the control group. Follow-up of secondary epileptic seizures， the general information of patients， basic diseases， hypertension grade， blood electrolytes， lesion location， diameter of lesion were recorded，and the risk factors of secondary epilepsy in cerebral infarction were screened， and the status of secondary epilepsy were analyzed. Results (1) The types of epilepsy in secondary epilepsy: partial seizure in 69 cases， complete attack in 15 cases; onset time: early onset in 60 cases， late in 24 cases. (2) There was no significant difference between the two groups in general information， underlying disease， lesion diameter and grade ofhypertension (p＞0.05). The differences statistically significento significance in the consist of lesion location and lesion specific location and blood electrolyte levels(p＜0.05). Unconditional multivariate logistic regression analysis showed thoao infarction involving the cortex， temporal lobe， and serum chloride value was correlated with the occurrence of secondary epilepsy (p＜0.05). (3) Multivariate Logistic regression analysis showed tthat infaretion involving the cortex(OR = 3.10， Pp=0.004， 95% CI = 1.52-7.41)，locating in the temporal lobe， (OR = 2.98， Pp=0.012， 95% CI = 1.32-7.35) and serum chlorine (OR = 1.25， Pp=0.017， 95%CI = 1.00-1.38) were the risk factors for secondary epilepsy in cerebral infarction．Conclusions Partial and early onset of seizures are the most common in cerebral infarction secondary epilepsy．Infarction involving the cortex， locating in the temporal lobe and serum chlorine are the risk factors for secondary epilepsy in patients with cerebral infarction. Necessary measures should be taken to intervene at high risk of secondary epilepsy and to improve the clinical quality of life of patients. [ABSTRACT FROM AUTHOR]

Levels of high mobility group box 1 (HMGB1), an important inflammatory mediator, are high in the serum of febrile seizure (FS) patients. However, its roles in FS and secondary epilepsy after prolonged FS are poorly understood. We demonstrate HMGB1's role in the pathogenesis of hyperthermia-induced seizures (HS) and secondary epilepsy after prolonged hyperthermia-induced seizures (pHS). In the first experiment, 14-15-day-old male rats were divided into four groups: high-dose HMGB1 (100 μg), moderate-dose (10 μg), low-dose (1 μg), and control. Each rat was administered HMGB1 intranasally 1 h before inducing HS. Temperature was measured at seizure onset with electroencephalography (EEG). In the second experiment, 10-11-day-old rats were divided into four groups: pHS + HMGB1 (10 μg), pHS, HMGB1, and control. HMGB1 was administered 24 h after pHS. Video-EEGs were recorded for 24 h at 90 and 120 days old; histological analysis was performed at 150 days old. In the first experiment, the temperature at seizure onset was significantly lower in the high- and moderate-dose HMGB1 groups than in the control group. In the second experiment, the incidence of spontaneous epileptic seizure was significantly higher in the pHS + HMGB1 group than in the other groups. Comparison between pHS + HMGB1 groups with and without epilepsy revealed that epileptic rats had significantly enhanced astrocytosis in the hippocampus and corpus callosum. In developing rats, HMGB1 enhanced HS and secondary epilepsy after pHS. Our findings suggest that HMGB1 contributes to FS pathogenesis and plays an important role in the acquired epileptogenesis of secondary epilepsy associated with prolonged FS. [ABSTRACT FROM AUTHOR]

We present the case of a 60 year-old woman diagnosed with meningiomatosis (multiple sporadic meningiomas), in the absence of neurofibromatosis type 2. The cerebral computerized axial tomography (CT scan) revealed six expansive lesions (one isodense and five spontaneously hyperdense partially or completely calcified), which at the cerebral magnetic resonance imaging (MRI) examination showed typical features of meningiomas. Case particularity: the very low incidence of sporadic multiple meningiomas and a rare cause of secondary epilepsy.

Objective: To explore EPHX2 polymorphism and post-stroke epilepsy susceptibility in Changsha Han population. Methods: Using a case-control study, we collected the blood samples from 402 stroke patients without epilepsy and 124 post-stroke epilepsy patients in Xiangya Hospital and The Third Xiangya Hospital of Central South University. The subjects were divided into case group (EP group) and the control group (non EP group), genomic DNA were extracted from blood samples. Then, we designed EPHX2 rs1042032 PCR primers according to the DNA sequence of the human genome, the target gene was amplified by PCR. By polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method, the PCR products were digested by restriction endonuclease Ⅰ, restricted DNA products were then separated by using 3% agarose gel electrophoresis and visuslized by UV light. Results: The frequency distribution of EPHX2rs1042032 between EP group and non EP group was not significantly different. Conclusion: The data suggests that EPHX2rs1042032 may not be associated with post-stroke epilepsy. [ABSTRACT FROM AUTHOR]

We present the case of a 60 year-old woman diagnosed with meningiomatosis (multiple sporadic meningiomas), in the absence of neurofi bromatosis type 2. The cerebral computerized axial tomography (CT scan) revealed six expansive lesions (one isodense and fi ve spontaneously hyperdense partially or completely calcifi ed), which at the cerebral magnetic resonance imaging (MRI) examination showed typical features of meningiomas. Case particularity: the very low incidence of sporadic multiple meningiomas and a rare cause of secondary epilepsy. [ABSTRACT FROM AUTHOR]

A retrospective analysis of 183 consecutive patients operated on for ruptured cerebral aneurysms and surviving at least one year revealed appearance of postoperative epilepsy in 14 cases (8 per cent) on an average of 10 months (range 0-23 months) after the operation. Factors associated with the development of secondary epilepsy were localization of the aneurysm on the middle cerebral artery, temporary clipping intraoperatively, wrapping technique to treat the aneurysm, and vasospasm seen on the postoperative control angiogram. Intraoperative and/or postoperative ischaemia seems to be the crucial phenomenon favouring the development of epilepsy. Identification of the risk factors may help to focus the anti-epileptic prophylaxis in cases prone to develop seizures. [ABSTRACT FROM AUTHOR]

Introduction Epilepsy is a burdensome disorder for affected individuals and community. There is limited data available on the epidemiological aspects of seizures in Pakistan and further research is necessary. We aimed to fill this gap by studying this information in epilepsy patients presenting to our neurology department. The purpose of this study is to evaluate the causes and types of seizures among the target population. Method This is a cross-sectional study conducted at the Department of Neurology, Dr. Ruth K.M. Pfau Civil Hospital Karachi. In this study we evaluated the causes and types of seizures among patients presenting to our department during the two-year study duration (January 2018-December 2019). Informed consent was taken. Detailed history was taken including features of seizure episodes, age at first seizure, family history and comorbid conditions. Relevant investigations were carried out. The data was compiled to deduce the relevant information using SPSS v20.0. T-test and Chi-square were used for analyzing the data. Results A total of 996 patients presented during the study duration. Primary seizures were found in 58% cases while secondary seizures were found in 42% cases. This distribution was more equal in children with 49.6% primary seizures and 50.4% secondary seizures; the gap widened in adults with 64.3% primary seizures and 35.7% secondary seizures. The most common cause of secondary seizures was neonatal encephalopathy which was present in 18.7% patients, followed by traumatic head injury in 18.2% patients. Central nervous system (CNS) infection was the cause in 17.9% patients, cerebral tumors in 14.1% patients, stroke in 11.5%, metabolic encephalopathy in 7.4%, febrile seizures in 6.5% and CNS malformations in 5.7% patients. The top three causes in children were neonatal encephalopathy (28.3%), CNS infections (19.3%) and febrile seizures (12.7%). Adults with secondary seizures were diagnosed most often with head trauma (25.2%), cerebral tumors (19.9%) and stroke (18.4%) as causative factors. The most common type of seizures was generalized onset tonic-clonic seizures which was found in 73.0% patients followed by focal to bilateral tonic-clonic seizures in 8.9% patients. Other types of seizures included focal aware seizures in 5.0%, mixed seizure types in 4.2%, focal impaired awareness seizures in 3.1%, absence seizures in 2.7%, myoclonic seizures in 2.0% and atonic seizures in 1.0% patients. Seizures in children were mostly generalized onset tonic-clonic seizures (75.4%), mixed seizure types (5.7%) and focal to bilateral tonic-clonic seizures (5.2%). In adults the three most common types corresponded to the overall result: generalized onset tonic-clonic seizures (71.2%), focal to bilateral tonic-clonic seizures (11.6%) and focal aware seizures (6.6%). Conclusion We found that the most common cause of seizures overall in our study population was primary seizures, though primary and secondary seizures were more evenly present in children. Among secondary causes neonatal encephalopathy stood out as the most common cause in children; head trauma was the predominant cause in adults. Most common type of seizures overall and in adults was generalized onset tonic-clonic seizures, followed by focal to bilateral tonic-clonic and focal aware seizure types. Pediatric patients presented most often with generalized onset tonic-clonic seizures, followed by mixed seizure types and focal to bilateral tonic-clonic seizures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Jawaid et al.)