Objective To observe the clinical characteristics and influencing factors of post-stroke epilepsy. Methods Our research wasaretrospective study, the data came from the information of patients diagnosed with post-stroke epilepsy from our hospital on October 2000 to December 2014 withatotal of 160 cases. With the general collection of clinical data, including gender, past history, clinical manifestations, laboratory examinations and treatment informations. Results The shortest time of post-stroke seizures were occur immediately, the longest was 15 years after the stroke. Peak onset is as early as onset of stroke immediately, late-onset seizures after stroke peaks between 6 months to 1.5 years. 59 patients occurred early epileptic seizures, partial seizures were the most common, accounting for 47.46%; 101 patients occurred late epilepsy, generalized tonic-clonic seizures were the most common, accounting for 56.44%. 25% of patients wereasingle-site lesions, the most common site was temporal lobe; 75% of patients were multifocal lesions. Most were located in the temporal lobe, frontal lobe and the basal ganglia. 42 cases of patients performed EEG, 30 patients (71.43%) of the EEG abnormalities, including 22 cases (73.33%) recurrent epileptic seizures; 12 cases (28.57%) patients with an edge or normal EEG, including 3 cases (25%) relapsed. 54.38% patients with drug therapy to single-agent therapy, two patients with refractory epilepsy to be combination therapy. Conclusions This group of post stroke epilepsy patients were more common as late-onset epilepsy, early onset of stroke peaks is the first day, and delayed the onset of the peak after stroke is within 6 months to 18 months. Lesions in the cortex:alarge area and multiple lesions were risk factors for post-stroke epilepsy, cortical damage to the temporal lobe is most prevalent. 71.43% of patients may have abnormal EEG, EEG abnormalities have higher relapse rate in patients with epilepsy.
ObjectiveThe purpose of this study was to investigate the autoimmune encephalitis (AE) seizure types and EEG characteristics and the value of diagnosis. MethodsFifteen AE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from November 2012 to July 2014. Data from their clinical manifestations, seizure types, EEG characteristics and laboratory investigation were analyzed. ResultA total of 15 patients, 5 males and 10 females, aged 19-75 years were included. Eight cases of anti-NMDA receptor encephalitis, five cases of LGI1 receptor encephalitis and two cases of anti-Hu antibody encephalitis were diagnosed clinically.①Anti-NMDA receptor encephalitis:seven patients had seizures, which inclued complex partial seizure, generalized tonic-clonic seizure, simple partial seizure and status epilepticus.Three patients had extreme delta brush.②LGI1 receptor encephalitis:two cases had seizures, while four cases with FBDS. Sharp and slow waves with irregular delta waves appeared in bilateral temporal areas in EEG of three cases, while one case showed clinical seizure. Two cases detected "limb shaking and others" attack, but the corresponding EEG showed no abnormalities.③Anti-Hu antibody encephalitis:one case showed seizures, the EEG showed a lot of sharp and slow waves with irregular delta waves in bilateral temporal areas, while one case showed sharp and slow waves. ConclusionAnti-NMDA receptor encephalitis can present with various types of seizures and non-convulsive status epilepticus, interictal extreme delta brush is more specific. It has important value. LGI1 receptor encephalitis is characterized by FBDS, it has important clinical significance.Anti-Hu antibody encephalitis lesions diffuse distribution, clinical manifestations are different. It may be associated with seizures, seizure types are not-specific.It may have slow waves or sharp and slow waves.
ObjectiveTo observe the expressions of p-mTOR, p-S6K1 and p-4EBP1 in the human brain with refractory epilepsy and to explore the role of mTOR signaling pathway in intractable epilepsy. MethodsCollecting the brain tissues of 24 patients with refractory epilepsy for surgical treatment from March 2010 to July 2011 as experimental group in hospitalized Epilepsy Center at the First Hospital of Jilin University, Changchun City. Collecting temporal lobe or frontal lobe brain tissue from 6 autopsy of patients who had emergency surgery for neurosurgery brain tranma during the same period. Using immunohistochemistry to observe the expression of p-mTOR, p-S6K1, p-4EBP1 in the two groups of brain tissues, and analyzed statistically. Results① p-mTOR, p-S6K1 and p-4EBP1 were expressed in both neurons and glial cells of experimental and control groups. P-mTOR, p-S6K1, p-4EBP1 positive cells of experimental group was significantly higher than the control group(P<0.01). The expression level of p-mTOR, p-S6K1, p-4EBP1 in the brain tissues of patients with different seizure frequency and with different duration:the expression level of p-mTOR, p-S6K1, p-4EBP1 in the brain tissues of patients in the group of epilepsy 10 years and more than 10 years were significantly higher than the group of epilepsy fewer than 10 years and the difference was statistically significant (P<0.05). ② The structural changes of brain tissues were observed under the optical microscope and electron microscope. Under the optical microscope:the distribution of nerve cells were uneven, the nucleus was vacuolated, the cytoplasm was less and gliosis. Under the transmission electron microscope:the number of neurons was reduced, nuclear condensation, the heterochromatin was increased, the nucleolus were dissymmetry and the nuclear membrane was breakage, also see neurons became psychotic, cell body became smaller, astrocyte cell membrane became edema, chromatin was dissymmetry, some mitochondrial were swelling and transparent, and others were vacuolated, the mitochondrial crista was in disorder. ③ p-mTOR, p-S6K1 and p-4EBP1 are expressed in the cerebral vascular of the brain in both experimental and control groups.In the experimental group, the expression is high concentration.In the control group, the expression is scattered in a small amount. Conclusionsp-mTOR, p-S6K1 and p-4EBP1 are widely expressed in neurons and glial cells with refractory epilepsy, which was significantly increased compared with control group. The expression of p-mTOR, p-S6K1and p-4EBP1 is related to frequency of epileptic seizures and course.
ObjectiveTo investigate the etiology, clinical features, treatment, and prognosis of Partial status epilepticus (PSE). MethodsSeventeen PSE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from April 2013 to June 2015. Clinical data were retrospectively analyzed. ResultsA total of 17 patients, 8 male and 9 female, 18~91years old, at mean age (48.90±21.17) years were included. About 12 cases (70.59%) had acute symptomatic status epilepticus, the etiologies including central nervous system inflammation (5 cases), cortical infarction (3 cases), metabolic disorder (1 case), hypoxic-ischemic encephalopathy (1 case), space-occupying lesions(1 case) and degeneration (1 case); four cases (23.53%) were diagnosed with epilepsy, one case (5.88%) had no definite pathogenesis. The seizure types included complex partial status epilepticus (8 cases, 47.06%), complex part of the secondary comprehensive status epilepticus (3 cases, 17.65%), supplementary motor area (SMA) status epilepticus (4 cases, 23.53%), epilepsia partialis continua (EPC) (1case, 5.88%)and complex partial status epilepticus & aura continua (1case, 5.88%). Nine cases (52.94%) were effective after one hour treament, eight cases (47.06%) were negative. 17 cases are followed-up and 4 cases lost, the average follow-up time is (10.89±8.64) months. 8 cases are completely seizure free, and 3 cases have experience less seizures or the symptom is relived; the other 2 cases die from Creutzfeldt-Jacob desease(case No.10) and Respiratory failure(case No.12). ConclusionsThe inpatients of partial status epilepticus are mostly "situation related". Patients with clinical suspect should be administrated with long term video-Electroencephalogram(EEG) monitoring timely. Early diagnosis, treatment and the aggressive treatment can help to improve the prognosis. Patients of encephalitis usually progress into refractory status epilepticus, the anesthetic drugs should be used as soon as possible.
ObjectiveTo investigate clinical features and progress in women with catamenial epilepsy. MethodsThe data obtained from retrospective study in 20 patients with catamenial epilepsy and reviewing published study of catamenial epilepsy. ResultsSeizures of all cases were relatived with the menstrual cycle. Seizures that only occured perimenstrually in 7 cases, 13 cases experienced exacerbation during this time. Only 2 of the 20 cases pointed to generalized sizures.12 of 18 cases which were partial seizures identified with complex partial seizures. Of 17 patients who had EEG results, 1 showed mild abnormal waves, 1 showed slow waves, 1 showed sharp waves, 1 showed spike and slow wave complex, 2 showed generalized polyspike and slow wave complex, 11 showed focal sharp waves,spike waves and spike and slow wave complex. All patients accepted 1 or more AEDs treatment.1 patient seizure free for 2 years after menopause, 2 cases of treatment were unclear, 5 cases had positive outcomes(4 cases seizure free for 1 and more years,1 case for 6 months), 12 cases were poorly controlled, especially 9 cases were refractory epilepsy. ConclusionIt is found that catamenial epilepsy more commonly in facal and the rate of refractory epilepsy is higher. Treatment of catamenial epilepsy power with more samples, multi-center clinical trials.
ObjectivesTo evaluate the efficacy and safety of lacosamide (200mg/d and 400mg/d)when added to 1 to 3 antiepileptic drugs (AEDs) in adults with uncontrolled partial-onset seizures. MethodsDuring this multicenter, double-blind, placebo-controlled trial, patients were randomized to placebo or lacosamide 200 or 400mg/day after an 8-week baseline period. Lacosamide was titrated in weekly increments to target dose over 4 weeks and maintained for 12 weeks followed by 12 weeks for withdrawal. The reductions of seizure frequence during maintain period and proportion of ≥50% reduction of seizures frequence were analysed. Besides,adverse effects were also recorded. ResultsFive hundred fourty patients were randomized, 515 patients completed the trial (Full analysis set, FAS), including 394 were per-protocol set (PPS). The reduction of seizure frequence during maintain period every 4 weeks among 200mg/d,400mg/d group and placebo group were 26.35%,40.12%,21.69%(P=0.000 5) and 25.61%,46.86%,23.06%(P<0.000 1), respectively in FAS and PPS. The proportion of ≥50% reduction of seizures frequence among three groups were 29.82%,38.15%,22.49%(P=0.006 8) and 27.94%,42.37%,22.86%(P=0.002 3), respectively in FAS and PPS. The incidences of adverse events were 5.84%, 36.11%, 19.55% among three groups. Compared with each other, there was statistic significance between 400mg/d and placebo groups. ConclusionIn this trial, adjunctive lacosamide significantly reduced seizure frequency in patients with uncontrolled partial-onset seizures. Along with favorable pharmacokinetic and tolerability profiles, these results support further development of lacosamide as an AED.