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Postictal sneezing: A case study
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Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
After 7 years of follow-up, 40 patients (78.4%) are in class I of Engel's classification, among them 31 (60.7%) are seizure free (class IA), 5 patients in class II, 6 patients in class III, and no patients in class IV. The outcome is almost identical to the group with hippocampal sclerosis and the other group with other types of lesions for the first four years, after seven years of follow-up, 50% of the first group are in class I and 66.7% for the second group. Our experience demonstrates the feasibility of epilepsy surgery in developing countries particularly in Africa and appropriateness of non-invasive method evaluation. doi:10.1016/j.jns.2013.07.191
Abstract — WCN 2013 No: 2711 Topic: 1 – Epilepsy α7-Containing nicotinic acetylcholine receptors on interneurons of the basolateral amygdala and their role in the regulation of the network excitability V.I. Pidoplichkoa, E.M. Pragerb, V. Aroniadou-Anderjaskaa, M.F.M. Bragaa. Department of Anatomy, Physiology and Genetics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; bProgram in Neuroscience, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA a
The basolateral amygdala (BLA) plays a key role in fear-related learning and memory, in the modulation of cognitive functions, and in the overall regulation of emotional behavior. Pathophysiological alterations involving hyperexcitability in this brain region underlie anxiety and other emotional disorders, as well as some forms of epilepsy. GABAergic interneurons exert a tight inhibitory control over the BLA network; understanding the mechanisms that regulate their activity is necessary for understanding physiological and disordered BLA functions. The BLA receives dense cholinergic input from the basal forebrain, affecting both normal functions and dysfunctions of the amygdala, but the mechanisms involved in the cholinergic regulation of inhibitory activity in the BLA are unclear. Here, we demonstrate that the α7-containing nicotinic acetylcholine receptors (α7-nAChRs) are present on somatic or somatodendritic regions of interneurons, in the rat BLA. These receptors are active in the basal state enhancing GABAergic inhibition, and their further – exogenous – activation dramatically increases spontaneous inhibitory postsynaptic currents (sIPSCs) in principal BLA neurons. When α7-nAChRs are activated in all of the BLA network, both inhibitory and excitatory currents increase in BLA principal cells, but the inhibitory currents are enhanced significantly more than the excitatory currents; the result is reduced excitability, as suggested by the decrease in the amplitude of evoked field potentials. The anxiolytic effects of nicotine, as well as the role of the α7-nAChRs in seizure activity involving the amygdala and in mental illnesses such as schizophrenia and Alzheimer's disease may be better understood in light of the present findings. doi:10.1016/j.jns.2013.07.192
Abstract — WCN 2013 No: 2536 Topic: 1 — Epilepsy Postictal sneezing: A case study P. Myrianthopoulou, S.S. Papacostas. Neurology Clinic B, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus Objective: To describe a patient with epilepsy who had postictal sneezing during long-term video-encephalography (EEG) monitoring. In the literature, sneezing is reported to be an autonomic phenomenon
as an aura in epilepsy. One case of postictal sneezing was reported previously. Method: The patient underwent video-EEG monitoring for probable focal onset epilepsy. Three episodes of postictal sneezing were recorded and studied clinically and electrographically. Results: Three seizures were recorded which were followed by sneezing twice when he became responsive. For the first seizure, the patient was off-camera and clinical features could not be determined except for sneezing. The two visible seizures were characterized by oral automatisms, staring, head posturing to the right, unresponsiveness, and in one of the two, upper limb dystonia and bilateral bicycling movements. All seizures concluded with sneezing twice. The EEG record was characterized by a buildup in fast activity in the left temporal regions and slowing in the left hemisphere in all three episodes, with attenuation in amplitude in one. In one of the three episodes, the slowing spreads bilaterally with a left-sided predominance. In all three episodes, sneezing occurred after the patient was responsive, and in two of the three, while left temporal slowing or amplitude attenuation was still present on the EEG. Conclusion: Two of the three episodes of sneezing occurred while EEG was not back to baseline but the patient was responsive. In our case sneezing appeared to be a postictal event, probably representing a release phenomenon. doi:10.1016/j.jns.2013.07.193
Abstract — WCN 2013 No: 2793 Topic: 1 — Epilepsy Vagus nerve stimulation in 19 patients with drug-resistant epilepsy in Western China Y. Shena, F. Xiaa, L. Liua, W. Linb, Y. Liua, M. Shia, X. Rena, B. Dinga, Y. Chena, H. Jiaa, J. Wanga, G. Zhaoa, Y. Denga. aDepartment of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China; bDepartment of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China Objective: To assess the efficacy and safety of vagus nerve stimulation (VNS) in drug-resistant epilepsy in Western China. Methods: In this retrospective review of 19 patients who underwent VNS for drug-resistant epilepsy, there were 17 (89.5%) males and 2 (10.5%) females ranging in age from 7 to 58 years at the time of implantation. The generator was turned on two or three weeks after the plantation operation. Stimulation parameters were adjusted gradually. The output currents were adjusted from 0.25 mA, stimulative time was 30 s ON and 5 min OFF, the frequency was 20–30 Hz, and the pulse width was 500 μs. Then the change of the output currents was 0.25 mA every 1–3 months. Results: Duration of vagus nerve stimulation treatment varied from 3 to 29 months. Seizure freedom was achieved in 10 patients (52.5%). Seizure control ≥90% was achieved in 11 patients (57.9%), ≥75% seizure control in 12 patients (63.2%), ≥50% improvement in 16 patients (84.2%), and b50% improvement in 3 patients (15.8%). There is no change of antiepileptic drugs (AEDs) in 14 patients; reduction of AEDs in 4 patients; increase of AEDs in one patient. Three patients (15.8%) reported one transient mild adverse effect. Conclusion: VNS is a safe and effective palliative treatment for drugresistant epilepsy in Western China. The key to the effectiveness of VNS is adjusting the right parameters to each patient. We believe better seizure control can be achieved as long as allowing more titration of the stimulation parameters and further AED regimen adjustments over time by the qualified epileptologists. doi:10.1016/j.jns.2013.07.194
Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
After 7 years of follow-up, 40 patients (78.4%) are in class I of Engel's classification, among them 31 (60.7%) are seizure free (class IA), 5 patients in class II, 6 patients in class III, and no patients in class IV. The outcome is almost identical to the group with hippocampal sclerosis and the other group with other types of lesions for the first four years, after seven years of follow-up, 50% of the first group are in class I and 66.7% for the second group. Our experience demonstrates the feasibility of epilepsy surgery in developing countries particularly in Africa and appropriateness of non-invasive method evaluation. doi:10.1016/j.jns.2013.07.191
Abstract — WCN 2013 No: 2711 Topic: 1 – Epilepsy α7-Containing nicotinic acetylcholine receptors on interneurons of the basolateral amygdala and their role in the regulation of the network excitability V.I. Pidoplichkoa, E.M. Pragerb, V. Aroniadou-Anderjaskaa, M.F.M. Bragaa. Department of Anatomy, Physiology and Genetics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; bProgram in Neuroscience, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA a
The basolateral amygdala (BLA) plays a key role in fear-related learning and memory, in the modulation of cognitive functions, and in the overall regulation of emotional behavior. Pathophysiological alterations involving hyperexcitability in this brain region underlie anxiety and other emotional disorders, as well as some forms of epilepsy. GABAergic interneurons exert a tight inhibitory control over the BLA network; understanding the mechanisms that regulate their activity is necessary for understanding physiological and disordered BLA functions. The BLA receives dense cholinergic input from the basal forebrain, affecting both normal functions and dysfunctions of the amygdala, but the mechanisms involved in the cholinergic regulation of inhibitory activity in the BLA are unclear. Here, we demonstrate that the α7-containing nicotinic acetylcholine receptors (α7-nAChRs) are present on somatic or somatodendritic regions of interneurons, in the rat BLA. These receptors are active in the basal state enhancing GABAergic inhibition, and their further – exogenous – activation dramatically increases spontaneous inhibitory postsynaptic currents (sIPSCs) in principal BLA neurons. When α7-nAChRs are activated in all of the BLA network, both inhibitory and excitatory currents increase in BLA principal cells, but the inhibitory currents are enhanced significantly more than the excitatory currents; the result is reduced excitability, as suggested by the decrease in the amplitude of evoked field potentials. The anxiolytic effects of nicotine, as well as the role of the α7-nAChRs in seizure activity involving the amygdala and in mental illnesses such as schizophrenia and Alzheimer's disease may be better understood in light of the present findings. doi:10.1016/j.jns.2013.07.192
Abstract — WCN 2013 No: 2536 Topic: 1 — Epilepsy Postictal sneezing: A case study P. Myrianthopoulou, S.S. Papacostas. Neurology Clinic B, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus Objective: To describe a patient with epilepsy who had postictal sneezing during long-term video-encephalography (EEG) monitoring. In the literature, sneezing is reported to be an autonomic phenomenon
as an aura in epilepsy. One case of postictal sneezing was reported previously. Method: The patient underwent video-EEG monitoring for probable focal onset epilepsy. Three episodes of postictal sneezing were recorded and studied clinically and electrographically. Results: Three seizures were recorded which were followed by sneezing twice when he became responsive. For the first seizure, the patient was off-camera and clinical features could not be determined except for sneezing. The two visible seizures were characterized by oral automatisms, staring, head posturing to the right, unresponsiveness, and in one of the two, upper limb dystonia and bilateral bicycling movements. All seizures concluded with sneezing twice. The EEG record was characterized by a buildup in fast activity in the left temporal regions and slowing in the left hemisphere in all three episodes, with attenuation in amplitude in one. In one of the three episodes, the slowing spreads bilaterally with a left-sided predominance. In all three episodes, sneezing occurred after the patient was responsive, and in two of the three, while left temporal slowing or amplitude attenuation was still present on the EEG. Conclusion: Two of the three episodes of sneezing occurred while EEG was not back to baseline but the patient was responsive. In our case sneezing appeared to be a postictal event, probably representing a release phenomenon. doi:10.1016/j.jns.2013.07.193
Abstract — WCN 2013 No: 2793 Topic: 1 — Epilepsy Vagus nerve stimulation in 19 patients with drug-resistant epilepsy in Western China Y. Shena, F. Xiaa, L. Liua, W. Linb, Y. Liua, M. Shia, X. Rena, B. Dinga, Y. Chena, H. Jiaa, J. Wanga, G. Zhaoa, Y. Denga. aDepartment of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China; bDepartment of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China Objective: To assess the efficacy and safety of vagus nerve stimulation (VNS) in drug-resistant epilepsy in Western China. Methods: In this retrospective review of 19 patients who underwent VNS for drug-resistant epilepsy, there were 17 (89.5%) males and 2 (10.5%) females ranging in age from 7 to 58 years at the time of implantation. The generator was turned on two or three weeks after the plantation operation. Stimulation parameters were adjusted gradually. The output currents were adjusted from 0.25 mA, stimulative time was 30 s ON and 5 min OFF, the frequency was 20–30 Hz, and the pulse width was 500 μs. Then the change of the output currents was 0.25 mA every 1–3 months. Results: Duration of vagus nerve stimulation treatment varied from 3 to 29 months. Seizure freedom was achieved in 10 patients (52.5%). Seizure control ≥90% was achieved in 11 patients (57.9%), ≥75% seizure control in 12 patients (63.2%), ≥50% improvement in 16 patients (84.2%), and b50% improvement in 3 patients (15.8%). There is no change of antiepileptic drugs (AEDs) in 14 patients; reduction of AEDs in 4 patients; increase of AEDs in one patient. Three patients (15.8%) reported one transient mild adverse effect. Conclusion: VNS is a safe and effective palliative treatment for drugresistant epilepsy in Western China. The key to the effectiveness of VNS is adjusting the right parameters to each patient. We believe better seizure control can be achieved as long as allowing more titration of the stimulation parameters and further AED regimen adjustments over time by the qualified epileptologists. doi:10.1016/j.jns.2013.07.194