Symptomatic epilepsy as a result of stroke

Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64

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Abstract—WCN 2013 No: 313 Topic: 1—Epilepsy Epilepsy: Analysis of electroencephalograms and cerebral maturation

Conclusion: Hypertension was the main cause of stroke determining seizures and women were more affected. Ischemic stroke slightly prevailed, while lobar F and T localization were mostly affected.

Y. Bahbitia, F. Moutaouakilb, B. Benazzouza, A. Ouichoua, A. El Hessnia, A. Mesfiouia. aBiology, Laboratory of Genetics, Neuroendocrinology and Biotechnology, Unit of Nervous and Endocrine Physiology, Faculty of Sciences, University Ibn Tofail, Kenitra, Morocco; bNeurology, Al Kortobi Hospital, Tangier, Morocco

doi:10.1016/j.jns.2013.07.037

The objective of this study was to emphasize why and how the change in brain electrical activity in children, adolescents, adults and old men, and take, therefore, a relationship between the evolution of the EEG and epilepsy related to cerebral maturation. Methods: A clinical study based on analysis of 100 electroencephalograms (EEGs) of epileptic and normal subjects of different ages was carried out at the hospital Al-Kortobi of Tangier, Service of Neurology (Morocco). Results: Analysis of electroencephalograms showed, first, that during childhood the EEG is characterized by the gradual transformation of brain waves (Delta–Theta–Beta–Alpha) in time reflecting the different stages of brain maturation. On the other hand, there is a regional component of brain maturation in a posterior–anterior gradient chronological. Completion maturation is set between 12 and 14 years. Conclusions: One thus understands why the newborn babies make mainly motor seizures and why the occipital epilepsy begin preferentially in the very first months from life, while the frontal epilepsy appear only seldom before the 2 year age, and the temporal epilepsy seldom before 8–10 years. doi:10.1016/j.jns.2013.07.036

Abstract—WCN 2013 No: 373 Topic: 1—Epilepsy Vascular seizures D. Ndojaa, A. Kuqoa, A. Rrojib, S. Mijoc, E. Kikuc, J. Krujac, L. Budac. aUHC Mother Theresa, Service of Neurology, Tirana, Albania; bNeuroradiology, UHC Mother Theresa, Tirana, Albania; cNeurology, UHC Mother Theresa, Tirana, Albania Objective: 39 vascular seizure patients admitted on last 6 months 2012, aged from 20 to 88 years (mean 60. 71 years), 18 M; 21 F were evaluated. Previously hypertension prevailed in 32 patients isolated or associated with: atrial fibrillation, smokers, diabetes mellitus, cerebral palsy, thrombotic syndrome, post-traumatic vertebral dissection stroke, mitral stenosis and clipped aneurisma. Etiology: hemorrhagic (49%), ischemic (61%); post-ischemic 22, post-hemorrhagic 8, acute ischemic 3, acute repeated ischemic 4 and acute hematoma 3 patients. Seizures determining epilepsy followed stroke meanly 15 months/mostly 1–6 m after (74%), while immediate seizures occurred in (26%). Partial motor mostly secondary generalized prevailed (59%), generalized without evident laterality (18%), partial complex (18%), and partial sensory seizures (5%). 16% had secondary generalized SE from partial motor onset. Stroke lateralization; left (46%) to right sided (39%) while bilateral (15%). Lobar localization; F (44%) isolated or spread to P/T (9/8), T (41%) lying to P in 9 or T/T-insular in 7, while bilateral localization in 6 (15%). EEG: Ictal; F, F-T discharge (5%), right F dominated PLEDS (10%). Unrealized (5%) or interictal (80%) in which anterior bilateral unilaterally predominated (41%), focal (23%), bilaterally anterior / posterior to diffuse (16%). AEDs: VPA 13, CBZ 8, TPM 2, LEV 2, GBP 4, DHT 6, CNZ in 3 while two cases of repeated ischemic hemispheric stroke died.

Abstract—WCN 2013 No: 375 Topic: 1—Epilepsy Seizure severity and health related quality of life of adult Nigerian patients with epilepsy P.B. Adebayoa, R.O. Akinyemib, S.A. Ogunc, A. Ogunniyid. aDepartment of Medicine, Neurology Unit, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; bDepartment of Medicine, Division of Neurology, Federal Medical Centre, Abeokuta, Nigeria; cDepartment of Medicine, Neurology Unit, Olabisi Onabanjo University, Sagamu, Nigeria; dDepartment of Medicine, Neurology Unit, University College Hospital, University of Ibadan, Ibadan, Nigeria Backgrounds: There is paucity of information about the association of seizure severity and quality of life in PWE in sub-Saharan Africa. We hypothesized that seizure severity will significantly influence QoL of Nigerian PWE. Objective: We evaluated the relationship of seizure severity to health related quality of life of patients with epilepsy being followed up in an outpatient neurology clinic in southwestern Nigeria. Materials and methods: Eighty-eight consecutive patients with epilepsy who met the recruitment criteria completed the study questionnaire in company of an eyewitness. The study questionnaire comprised of the National Hospital Seizure Severity Scale (NHS3), the Quality of Life Inventory in Epilepsy (QOLIE-31) and the Beck's Depression Inventory— II (BDI-II). Results: We found a minute association between seizure severity and QOLIE-31 total score (r = −.262, p = .014). This association was washed off in the context of depression. However, increased seizure severity predicted a worse QOLIE-31 seizure worry (R2 = 0.311, β = −.289; p = 0.003,). On a multivariate regression analysis, generalization of seizures and the presence of falls were items on NHS3 that predicted a worse QOLIE-31 seizure worry score and time to recover predicted a worse QOLIE-31 total score. Conclusions: Reducing seizure severity may be an alternate endpoint in epilepsy care in Nigeria (particularly difficult to control seizures) because of its practical clinical relevance in view of the fact that state of the art epilepsy care is still farfetched. Mood stabilizing antiepileptic medications may be useful in this respect. doi:10.1016/j.jns.2013.07.038

Abstract—WCN 2013 No: 378 Topic: 1—Epilepsy Symptomatic epilepsy as a result of stroke S.T. Ristica, D.T. Risticb, I. Marinkovicc. aDepartment of Neurology, Clinical Centre Nis, Serbia; bInstitute for Pulmonary Disease, Serbia; c Medical Faculty, Nis, Serbia Objectives: Cerebrovascular diseases are significant aetiological factors of epilepsy. Seizures may appear in the acute phase of the insult, or during the reconvalescence. Our goal was to analyse the frequency and correlation between epileptic seizures and the type and size of cerebrovascular lesion. Methods: In this prospective study, we evaluated patients with stroke who were hospitalised at the Department of Neurology in Nis,

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Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64

between January and December 2012. Witnessed epileptic seizures occurred in 129 patients. Patients were evaluated and had the same investigations with anamnestic, clinical, neurological, EEG and neuroimaging (CT, MRI) variables which were compared. Results: Of the 1386 patients with stroke who were admitted to the hospital, 482 (34,78%) had haemorrhagic, and 904 (65,22%) had ischemic stroke. Mean age was 52 ± 30 years. Of a total of 129 patients with witnessed epileptic seizures, 76 were male and 53 female.46 (35, 66%) patients with haemorrhagic and 83 (64, 34%) patients with ischemic stroke developed seizures after 14 days of the stroke. Partial motor seizures (PMS) were registered in 73 (59, 35%) patients, partial seizures with secondary tonic–clonic generalisation (GTC) in 39 (31, 70%) patients and primary GTC seizures in 17 (13, 82%) patients. Status epilepticus (SE) was registered in 9 patients. 69 (53, 49%) patients had EEG pathological changes (spike or sharpwaves) and 36 (27, 90%) patients had focal or diffuse Theta–Delta waves. Normal EEG patterns were registered in 24 (18.60) patients. Conclusion: Patients with ischaemic stroke and cortical lesions are at a higher risk of developing seizures. Partial motor seizures and partial seizures with secondary tonic–clonic generalisation are a dominant feature. Our results differ from the ones in literature, in which patients with haemorrhagic stroke are more likely to develop seizures. It may be the consequence of the fact that the mortality in haemorrgahic stroke patients is higher. doi:10.1016/j.jns.2013.07.039

Abstract—WCN 2013 No: 381 Topic: 1—Epilepsy The spectrum of fixation-off sensitivity and scotosensitivity: Typical and atypical forms I.Y. Saadeldin. Pediatrics, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates

Abstract—WCN 2013 No: 389 Topic: 1—Epilepsy Ketogenic diet in Cdkl5-related epilepsy E.C. Wirrella, D. Kenneyb, S. Eckertb, L. Wong-Kisiela, K. Nickelsa. a Epilepsy and Child and Adolescent Neurology, Rochester, MN, USA; b Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA Purpose: To review efficacy and tolerability of a ketogenic diet (KD) in children with intractable epilepsy and CDKL5 mutations. Methods: Children with a CDKL5 mutation initiated on the KD from 01/2009 to 12/2012 were identified from the KD diet database at Mayo Clinic. Charts were reviewed to determine seizure types and frequencies (a) prior to KD onset, (b) 3 months after KD onset and (c) at final follow-up on the KD. Significant improvement was defined as a N50% decrease in that seizure type. Results: Seven children (4 female, median age at seizure onset 2 months) were initiated on a KD at median age 13 months (IQR 8, 19). Children were on a median of 3 AEDs (2, 3) and had previously failed 1 (0, 3) AED for lack of efficacy. Median duration of KD was 15 months (IQR 5, 27) and at follow-up, 5/7 remained on the diet. At 3 months after initiation, significant improvement was seen in 3/6 with spasms, 2/6 with focal, 2/3 with tonic and 1/1 with myoclonic seizures. At final follow-up on KD, significant improvement was seen in 3/6 with spasms, 3/6 with focal, 2/3 with tonic and 0/1 with myoclonic seizures. However, after initiation of the KD, new seizure types emerged in 4 children (1-focal, 2-tonic, 1-atonic/absence).The KD was well-tolerated, with 2/7 children developing mild and 1/7 severe adverse effects. Diet was discontinued in 2 (1-lack of efficacy, 1-adverse effects). Conclusions: The KD was well tolerated and provided improved seizure control for the majority of children with CDKL5-related intractable epilepsy. doi:10.1016/j.jns.2013.07.041

Background and objectives: To define the spectrum of the epileptic syndromes and epilepsies that can be associated with fixation-off sensitivity (FOS) and delineate the electro-clinical types of FOS. Design and methods: Clinical and video EEG data of all our patients with FOS over the last 7 years were reviewed using FOS technique described by Koutroumanidis and Tsiptsios. Results: From January 2005 to October 2012, 14 of about 1900 patients had one or more video-EEGs with FOS (0.7%). From the 14 patients with full clinical and EEG data available, 10 had various epilepsies that included: symptomatic or probably symptomatic focal (9), cryptogenic generalized (3), and two had no seizures. Two patients (33%) were photosensitive and one was scotosensitive. FOS EEG abnormalities were occipital in 8 patients, and generalized in two. Two showed atypical forms. One boy of normal intelligence showed abnormal behavior associated with disorientation and confusion and postictal amnesia. His video/EEG evaluation unexpectedly documented the presence of FOS. Another patient was diagnosed with atypical benign partial epilepsy, and his repeated video/EEG recordings showed FOS. His sister was diagnosed with epileptic encephalopathy with continuous spike and wave complexes. Three patients were diagnosed as childhood absence epilepsy. Conclusions: Irrespective of classification, routine video-EEG monitoring for documenting FOS using Panayiotopoulos technique should be offered to selected patients with epilepsy. Unusual and rare cases within the spectrum of benign childhood seizure susceptibility syndrome can explain the atypical cases. doi:10.1016/j.jns.2013.07.040

Abstract—WCN 2013 No: 405 Topic: 1—Epilepsy Major obstacles in the management of adult epileptics in a tertiary referral hospital in Northeast Nigeria F.K. Salawua, A.B. Olokobab, B.I. Mohammedc, A. Danburamd, D. Machungad. aInternal Medicine, Federal Medical Centre, Yola, Nigeria; bMedicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria; c Department of Medicine, Yola, Nigeria; dMedicine, Federal Medical Centre, Yola, Nigeria Background: In Nigeria epilepsy affects hundreds of thousands of people with only a few neurologists available. Objectives: We set out to assess the present state of epilepsy care in a district tertiary care hospital in northeast Nigeria, and to compare with modern management. Materials and method: This was a retrospective study of hospital records of 200 adults with established epilepsy over the previous 4 years. We used a questionnaire to collect relevant data relating to the diagnosis and management of epilepsy. Results: There were 150 (75%) males and 50 (25%) females with a mean age of 30.2 years (SD 5.8 years). The main aetiology was post traumatic (37%), cerebrovascular disease (22.5%), partially treated meningitis (17.5%), encephalitis (12%), and alcohol (10%). The majority of cases (85%) were generalized tonic clonic seizures. Less than a fifth had EEG and neuroimaging before commencement of AEDs. Patients referred had to travel long distances for EEG, CT and MRI brain and