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P6-20 A case of status epilepticus preceding cerebral infarction
S138 P6-18 SCORE: standardised computer-based organised reporting of EEG S. Beniczky1 , H. Aurlien2 , A. Martins-da-Silva3 , G. Visser4 , G. Rubboli5 , H. Hjalgrim1 , H. Stefan6 , I. Rosen7 , J. Zarubova8 , J. Dobesberger9 , J. Alving1 , K.V. Andersen10 , M. Fabricius10 , M.D. Atkins1 , M. Neufeld11 , P. Plouin12 , P. Marusic1,8 , R. Lees1 , R. Pressler13 , R. Hopfengaertner6 , R. Mameniskiene14 , W.v. Emde Boas15 , A. Fuglsang-Frederiksen16 , E. Trinka9 , P. Wolf1 1 Danish Epilepsy Centre, Dianalund, Denmark, 2 Department of Neurology, University of Bergen, Norway, 3 Neurological Department, University of Porto, Portugal, 4 Department of Clinical Neurophysiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands, 5 Department of Neurological Sciences, University of Bologna, Italy, 6 University Hospital Erlangen, Epilepsy Center Neurological Clinic, Germany, 7 Department of Clinical Neurophysiology, University of Lund, Sweden, 8 Neurology Department, Charles University, Praha, Czech Republic, 9 Department of Neurology, Medical University Innsbruck, Austria, 10 Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Denmark, 11 EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel, 12 Clinical Neurophysiology Department, Hˆ opital Saint-Vincent de Paul, Paris, France, 13 Great Ormond Street Hospital for Children NHS Trust, London, England, UK, 14 Department of Neurology, Vilnius University Santariskiu Klinikos Hospital, Lithuania, 15 Dutch Epilepsy Clinics Foundation, S.E.I.N., Heemstede, The Netherlands, 16 Department of ˚ rhus, Denmark Clinical Neurophysiology, University of A Objective: In the clinical practice EEG recordings are described in free-text format. This leads to significant inter-observer variability. We propose a standardised system for EEG description, where the electroencephalographers construct the reports by choosing from predefined elements for each relevant EEG feature, as well as the clinical phenomena for long term monitoring. Methods: A group of 25 European neurophysiologists/epileptologists from 17 centres developed a consensus-statement on the clinically relevant features that have to be scored in an EEG report, and the possible options for each feature. Results: Besides the demographic data and the recording conditions, the main elements of SCORE are: background activity, non-ictal findings, ictal findings, normal variants and patterns, artefacts, technical notes, polygraphic channels, summary, and diagnostic significance. The content of each-part is context-sensitive: the possible options depend on the age of the patient, the recording conditions, and the previous features scored by the electroencephalographer. The 2 most important considerations in constructing the SCORE flowchart were: clinical relevance and userfriendly interaction. Conclusions: SCORE makes possible the standardised reporting of EEG in the clinical practice. While scoring the relevant features, the electroencephalographer generates the report and (in the same time) builds up a database. The standardization of the EEG reporting will contribute to quality-control, facilitate the training, and allow the creation of international database. P6-19 Adult onset of eating epilepsy N. Fumoto1 , M. Inouchi2 , T. Hitomi3 , H. Saiki4 , R. Matsumoto1 , Y. Shirasaka5 , J. Takahashi6 , A. Ikeda1 , R. Takahashi1 1 Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2 Department of Neurology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan, 3 Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 4 Department of Neurology, Kitano Hospital, Osaka, Japan, 5 Shirasaka Clinic, Kobe, Japan, 6 Department of Neurosurgery, Kitano Hospital, Osaka, Japan Eating epilepsy (EE) is a type of reflex epilepsy closely related with eating, which is relatively frequent in India and Sri Lanka but is rare in the whole epilepsy in the world. Little has been known in the etiology, and inducing stimuli vary such as smell, swallowing, taste, or elevation of blood glucose. We present experienced 3 patients suggestive of adult onset EE, and discuss the seizure generator mechanisms. The first patient was a 38-year-old male of right frontal lobe epilepsy (FLE). He had the first seizure at age 26, as left adversive seizure during eating. Since the onset, seizures occurred immediately after he started eating noodle. The seizures started with feeling of suffocation
Posters followed by left adversive seizure and secondarily generalized seizures. Both ictally and interictally, spikes existed in the right frontal area by prolonged video/EEG monitoring. A head MRI revealed the tumor (asctocytoma) in the right frontal lobe. No seizure occurred after resection. The second patients was a 36-year-old male of left FLE. He had the seizure onset at age 34 as generalized tonic-clonic seizure (GTCS). Most seizures started just after starting supper with right adversive seizure preceded by uncomfortable feeling. The third patient was a 32-year-old male of left temporal lobe epilepsy. At age 20, he had episodes of depersonalization, emotion change, linguistic impairment after meals with a feeling of fullness. He had a conscious loss at age 24 and a GTCS at age 26. Intermittent slow activity existed in the left middle temporal area in EEG. No episode occurred after start of carbamazepine. According to previous literatures, EE is derived from either suprasylvian area or temporal-limbic area. It’s suggestive that various mechanism of seizure generators is suspected and that EE may not be rare. It’s important to ensure and deal with the possible factors, and to treat with AEDs. P6-20 A case of status epilepticus preceding cerebral infarction H.s. Jeong1 , H.-J. Kwag1 , S.-H. Jeong1 , E.-H. Sohn1 , J.-M. Kim1 Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
1
Background: Seizure and epilepsy can be an acute or late complication of cerebrovascular disease which usually precedes seizures or occasionally they may occur simultaneously. Cerebrovascular disease following status epilepticus (SE) is extremely rare and was not well documented yet. We experienced a patient whose seizure precedes left MCA infarction. Case report: A 58-year-old woman, with no prior history of medical illnesses, presented with abrupt onset of global aphasia and right side weakness. She arrived at ER 6 hours after the symptom onset. She was drowsy without visible convulsions or involuntary movements during the exam. Emergency EEG at ER revealed repetitive sharp or fast rhythms and there was focal high signal intensity on left frontal cortex on the diffusion weighted image. After initiation of anti-status treatment, global aphasia and right side weakness were rapidly improved and fully resolved within 24 hours. During the OPD follow-up, she had complained of sustained mild dysarthria. On follow-up MRI, more extended lesion on left frontal lobe which suggesting subacute cerebral infarction was shown. Conclusion: This patient was initially diagnosed as a NCSE and follow up MRI revealed left MCA infarction. SE preceding stroke is rarely reported and it should be emphasized that SE or seizure may be a preceding symptoms of stroke. P6-21 A case of epilepsy with nonprogressive myoclonic status S. Watanabe1,2 , Y. Murata2 , K. Kataoka2 , S. Takagi2 , M. Watanabe2 , E. Matsushima1 1 Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan, 2 Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, Tokyo. Japan Objective: Spike and wave complex and slow waves are characteristics of ictal EEG patterns in myoclonic seizures. In this case, we show atypical EEG changes in myoclonic seizures and discuss its mechanism. Case report: This 26-year-old man was the product of a normal pregnancy and delivery. He presented with myoclonic seizures and fever at age ten months. At age seventeen months he started having myoclonic seizures without fever. He was diagnosed with severe myoclonic epilepsy in infancy at hospital A and he was prescribed valproic acid (VPA). At age three, his seizures became more severe and they persisted throughout the day. At age of five, he switched to the hospital B. His seizure frequency reduced from once a month to a few times a year with VPA, carbamazepine, and clonazepam. His seizures disappeared at age nineteen. At age twenty-six, his seizures recurred and persisted all day long. Most of his seizures were noted at the onset of sleep. Topiramate and diazepam were ineffective. He had myoclonic status and was admitted into hospital C. Infusion of midazolam stopped seizures and he was transferred to our hospital. Myoclonic status began again while in our hospital. We observed 15 Hz to 16 Hz generalized fast waves as his ictal
Posters followed by left adversive seizure and secondarily generalized seizures. Both ictally and interictally, spikes existed in the right frontal area by prolonged video/EEG monitoring. A head MRI revealed the tumor (asctocytoma) in the right frontal lobe. No seizure occurred after resection. The second patients was a 36-year-old male of left FLE. He had the seizure onset at age 34 as generalized tonic-clonic seizure (GTCS). Most seizures started just after starting supper with right adversive seizure preceded by uncomfortable feeling. The third patient was a 32-year-old male of left temporal lobe epilepsy. At age 20, he had episodes of depersonalization, emotion change, linguistic impairment after meals with a feeling of fullness. He had a conscious loss at age 24 and a GTCS at age 26. Intermittent slow activity existed in the left middle temporal area in EEG. No episode occurred after start of carbamazepine. According to previous literatures, EE is derived from either suprasylvian area or temporal-limbic area. It’s suggestive that various mechanism of seizure generators is suspected and that EE may not be rare. It’s important to ensure and deal with the possible factors, and to treat with AEDs. P6-20 A case of status epilepticus preceding cerebral infarction H.s. Jeong1 , H.-J. Kwag1 , S.-H. Jeong1 , E.-H. Sohn1 , J.-M. Kim1 Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
1
Background: Seizure and epilepsy can be an acute or late complication of cerebrovascular disease which usually precedes seizures or occasionally they may occur simultaneously. Cerebrovascular disease following status epilepticus (SE) is extremely rare and was not well documented yet. We experienced a patient whose seizure precedes left MCA infarction. Case report: A 58-year-old woman, with no prior history of medical illnesses, presented with abrupt onset of global aphasia and right side weakness. She arrived at ER 6 hours after the symptom onset. She was drowsy without visible convulsions or involuntary movements during the exam. Emergency EEG at ER revealed repetitive sharp or fast rhythms and there was focal high signal intensity on left frontal cortex on the diffusion weighted image. After initiation of anti-status treatment, global aphasia and right side weakness were rapidly improved and fully resolved within 24 hours. During the OPD follow-up, she had complained of sustained mild dysarthria. On follow-up MRI, more extended lesion on left frontal lobe which suggesting subacute cerebral infarction was shown. Conclusion: This patient was initially diagnosed as a NCSE and follow up MRI revealed left MCA infarction. SE preceding stroke is rarely reported and it should be emphasized that SE or seizure may be a preceding symptoms of stroke. P6-21 A case of epilepsy with nonprogressive myoclonic status S. Watanabe1,2 , Y. Murata2 , K. Kataoka2 , S. Takagi2 , M. Watanabe2 , E. Matsushima1 1 Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan, 2 Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, Tokyo. Japan Objective: Spike and wave complex and slow waves are characteristics of ictal EEG patterns in myoclonic seizures. In this case, we show atypical EEG changes in myoclonic seizures and discuss its mechanism. Case report: This 26-year-old man was the product of a normal pregnancy and delivery. He presented with myoclonic seizures and fever at age ten months. At age seventeen months he started having myoclonic seizures without fever. He was diagnosed with severe myoclonic epilepsy in infancy at hospital A and he was prescribed valproic acid (VPA). At age three, his seizures became more severe and they persisted throughout the day. At age of five, he switched to the hospital B. His seizure frequency reduced from once a month to a few times a year with VPA, carbamazepine, and clonazepam. His seizures disappeared at age nineteen. At age twenty-six, his seizures recurred and persisted all day long. Most of his seizures were noted at the onset of sleep. Topiramate and diazepam were ineffective. He had myoclonic status and was admitted into hospital C. Infusion of midazolam stopped seizures and he was transferred to our hospital. Myoclonic status began again while in our hospital. We observed 15 Hz to 16 Hz generalized fast waves as his ictal