Patients with autoimmune encephalitis are mainly characterized by behavioral, mental and motor abnormalities, neurological dysfunction, memory deficits and seizures. Different antibody types of autoimmune encephalitis its pathogenesis, clinical characteristics are different, in recent years found immune related epilepsy is closely related to autoimmune encephalitis, based on autoimmune encephalitis type is more, we choose more common autoimmune encephalitis, expounds its characteristics, to help clinical diagnosis.
Objective To explore the damage, damage model and influence factors of the empathy ability on patients with epilepsy by the Chinese version of interpersonal reaction index scale (IRI-C). Methods Eighty-eight non-symptomatic epilepsy patients who were from the First Affiliated Hospital of Dalian Medical University and 100 healthy controls were included in the study from March 2015 to January 2016. Patients with serious cognitive impairment and severe anxiety or depression were ruled out through neural psychology background screening (Montreal Cognitive Assessment, Hamilton anxiety and depression scale) due to their influence on empathy scores. Thereafter the empathy ability was compared between epilepsy patients and healthy controls using the IRI-C, and the effect of seizure type on empathy ability was analyzed. According to the epileptic seizure types of generalized tonic-clonic seizure (GTCS), patients were divided into 3 groups: non-GTCS group (simple or complex partial seizure, n=17), pure GTCS group (only primary GTCS attack, n=23) and SGS group (partial onset secondary GTCS,n=48). The control group included 100 healthy participants. In order to ensure the balance of sample size, 30 samples are randomly selected from SGS and control groups respectively for statistical analysis. Then patients were divided in two groups according to whether he/she has complex partial seizure (CPS), and 30 patients in each group. Statistical analysis was performed using SPSS18.0 software package. Results ① The total IRI-C Empathy scores, Cognitive empathy (CE) and two factors of the patients in epilepsy group were lower than those in control group (P<0.05), while there was no statistical difference in Emotional Empathy (EE) and two factors between groups (P>0.05). ②ANOVA showed the points of CE (include two factors) and total scores of empathy mean different between the four groups (P<0.05), and EE (include two factors) scores were no statistically significant differences between the four groups (P>0.05). The CE scores were differences between the GTCS group, pure GTCS group and SGS group. The scores of the perspective-taking was statistically significant differences (P<0.05) between the pure GTCS group and the SGS group. The scores of perspective-taking of SGS group were lower than the other groups (P<0.05) . In other words, the scores of the perspective-taking of SGS group were lower than those of the other three groups, and the CE scores were lower than the GTCS group and the control group. ③ The opinion selection, imagination, CE and total empathy score of CPS group were all worse than that of non-CPS group (P<0.05). Conclusions The empathy ability of epilepsy patientswere impaired in CE, but reserved in EE Epileptic subtype CPS and GTCS were risk factors of the decline in empathy ability in epilepsy patients.
ObjectiveExploring the influencing factors of acute phase (≤ 21 days) seizures and epilepsy in patients with Herpes simplex virus encephalitis (HSE) in our hospital, including emergency and inpatient wards, mainly from the perspective of the number of mNGS of Herpes simplex virus (HSV) in cerebrospinal fluid. MethodsFrom January to Octomber 2023, 28 emergency and inpatient patients in our hospital were collected, excepted clinical datas were not detailed. In the end, 24 patients with HSE diagnosed were included in the study, and their clinical datas were collected, including age, gender, acute encephalitis syndrome, the form of the seizure and the number of seizures, time of lumbar puncture, and various indicators of cerebrospinal fluid [pressure, protein, cell count (mononuclear and multinucleated cells), metagenomic Next-generation sequencing (mNGS), neural autoantibodied associated with autoimmune encephalitis], electroencephalogram, cranial imaging examination reports, and treatment plans.ResultsA total of 24 patients were enrolled, including 9 patients with a history of hypertension and 4 patients with a history of diabetes. There were 18 males and 6 females, with an average age of (53.17±17.19) years. The maximum age was 73 years old, and the minimum age was 21 years old. Among the 24 patients, one patient first presented to the local hospital and then transferred to our hospital for lumbar puncture, so the time from the onset of the disease to lumbar puncture was 30 days, and the other patient’s family members refused to complete lumbar puncture at first,so the time of lumbar puncture was 14 days from the onset of the disease. The remaining 22 patients were all completed lumbar puncture within 7 days of onset, and all emergency patients completed lumbar puncture within 24 hours of admission to the Emergency Department. mNGS results: 23 cases were HSV-1, and the remaining 1 case was HSV- 2. There were a total of 6 cases of seizures and epilepy in the acute phase (≤21 days), with focal or generalized seizures or epileptic status as the main form, and 2 cases of seizures occurred. Among these 8 patients, 5 showed lesions in the frontal and temporal lobes on enhanced cranial MRI, while the other 3 showed no specific features. At the same time, mNGS of cerebrospinal fluid suggested that the sequence number of HSV was greater than 3 000 was related with seizures and epilepsy with acute HSE. Conclusion Seizures and epileysy in acute HSE were related with the presences of intracranial cortical involvement,and the number of viral sequences in mNGS was closely related to acute phase seizures and epilepsy.
ObjectiveTo preliminarily explore the damage effect of stereo electroencephalogram-guided radiofrequency thermocoagulation after increasing the number of electrodes in the epileptic foci.MethodsEight cases were included from 42 patients requiring SEEG from the Department of Neurosurgery of the Second Hospital of Lanzhou University during June 2017 to Jan. 2019, of which 6 cases were hypothetical epileptogenic foci located in the functional area or deep in the epileptogenic foci that could not be surgically removed, 2 patients who were unwilling to undergo craniotomy; added hypothetical epileptic foci Electrodes, the number of implanted electrodes exceeds the number of electrodes needed to locate the epileptic foci. After radiofrequency thermocoagulation damages the epileptogenic foci, the therapeutic effect is analyzed.ResultsIn 8 patients, the number of implanted electrodes increased from 1 ~ 6, with an average of (4±2.2), and the number of thermosetting points increased by 2 ~ 10, with an average of (7±3.1); follow-up (9±3.2) months, Epilepsy control status: 3 cases of Engel Ⅰ, 3 cases of Engel Ⅱ, 2 cases of Engel Ⅲ; 8 cases of epileptic seizure frequency decreased≥50%. There was a statistically significant difference in the frequency of attacks before and after thermocoagulation (P<0.05).ConclusionsIncreasing the lesion volume of the epileptic foci can obviously improve the efficacy of epilepsy. SEEG-guided radiofrequency thermocoagulation is an effective supplementary method for classical resection.
The deep learning-based automatic detection of epilepsy electroencephalogram (EEG), which can avoid the artificial influence, has attracted much attention, and its effectiveness mainly depends on the deep neural network model. In this paper, an attention-based multi-scale residual network (AMSRN) was proposed in consideration of the multiscale, spatio-temporal characteristics of epilepsy EEG and the information flow among channels, and it was combined with multiscale principal component analysis (MSPCA) to realize the automatic epilepsy detection. Firstly, MSPCA was used for noise reduction and feature enhancement of original epilepsy EEG. Then, we designed the structure and parameters of AMSRN. Among them, the attention module (AM), multiscale convolutional module (MCM), spatio-temporal feature extraction module (STFEM) and classification module (CM) were applied successively to signal reexpression with attention weighted mechanism as well as extraction, fusion and classification for multiscale and spatio-temporal features. Based on the Children’s Hospital Boston-Massachusetts Institute of Technology (CHB-MIT) public dataset, the AMSRN model achieved good results in sensitivity (98.56%), F1 score (98.35%), accuracy (98.41%) and precision (98.43%). The results show that AMSRN can make good use of brain network information flow caused by seizures to enhance the difference among channels, and effectively capture the multiscale and spatio-temporal features of EEG to improve the performance of epilepsy detection.
Epilepsy is a complex and widespread neurological disorder that has become a global public health issue. In recent years, significant progress has been made in the use of wearable devices for seizure monitoring, prediction, and treatment. This paper reviewed the applications of invasive and non-invasive wearable devices in seizure monitoring, such as subcutaneous EEG, ear-EEG, and multimodal sensors, highlighting their advantages in improving the accuracy of seizure recording. It also discussed the latest advances in the prediction and treatment of seizure using wearable devices.
ObjectiveTo retrospectively study the acute epileptic seizures of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR)and anti-leucine-rich glioma-inactivated 1(anti-LGI1)encephalitis. The characteristics and short-term prognosis provide reference for early clinical diagnosis and treatment.MethodsThe patients with anti-NMDAR and anti-LGI1 encephalitis who were admitted to the Department of Neurology of Sichuan Provincial People’s Hospital from January 2018 to June 2020 were continuously included. The general information, clinical manifestations, acute seizures and types of seizures were reviewed and analyzed.To evaluate the difference between the characteristics of two kinds of autoimmune encephalitis in the acute phase of seizures and the short-term prognosis.ResultsA total of 75 patients with anti-NMDAR encephalitis and anti-LGI1 encephalitis (41 males and 34 females) were included, of which average ages are(32.8±17.9)years, average courses are(1.8±1.1)months.59 and 16 are respectively positive for anti-NMDAR and anti-LGI1 antibodies, respectively. Of the 75 cases, 56 cases (74.7%) had seizures in the acute phase. Among the 56 cases of seizures, 38 cases (67.8%) were accompanied by disturbances of consciousness, 5 cases (8.9%) of autonomic dysfunction, and 24 cases of decreased oxygenation capacity. (42.9%) and 20 cases (35.7%) who were admitted to NICU, there was a significant statistical difference compared with the seizure-free group (P<0.05). The median age of anti-NMDAR encephalitis in the acute stage of seizures was 23 years, and that of anti-LGI1 encephalitis was 56.5 years (P<0.05). Anti-NMDAR encephalitis and anti-LGI1 encephalitis are common in the acute phase of epileptic seizures (55.9%vs.53.8%). Anti-NMDAR encephalitis has more frequent seizures and status epilepticus in the acute phase (P<0.05). After early and rational use of anti-epileptic drugs(AEDs) and immunotherapy and other symptomatic and supportive treatments, 70% of 56 patients were effectively controlled for seizure. Follow-up 3 months later, 18 patients (32.1%) stopped using anti-epileptic drugs (AEDs), While 30 patients (53.5%) continued to receive AEDs treatment, of which 25 patients (44.6%) had no seizures.ConclusionBoth anti-NMDAR encephalitis and anti-LGI1 encephalitis have a higher risk of seizures in the acute phase. Patients with seizures are more likely to have disturbances in consciousness, decreased oxygenation capacity, and higher rates of admission to NICU. Anti-NMDAR encephalitis is more common in young people around 30 years old, and anti-LGI1 encephalitis is more likely to develop around 60 years old. Patients with anti-NMDAR encephalitis are more likely to have abnormal electroencephalograms, have a longer average hospital stay, and are more likely to have recurrent seizures and status epilepticus in the acute phase. After timely diagnosis and intervention treatment, most patients' seizures can be well controlled. After the acute phase, AEDs can be withdrawed in one third of patients.
ObjectiveTo explore the predictors of seizures during pregnancy, and to explore whether seizure control in the 6 months and 1 year prior to pregnancy can predict the risk of seizures during pregnancy and the occurrence of adverse maternal and infant outcomes, so as to guide the choice of the best fertility timing for women with epilepsy (WWE).MethodsA total of 46 WWE with 48 pregnancies were enrolled in Epilepsy Clinics of Tianjin Medical University from August 2016 to January 2020. Retrospective analysis was used to analyze the risk factors of epileptic seizures in pregnancy. The patients were grouped according to the time of absence of seizures during pregnancy. To analyze the influence of epileptic seizure, pregnancy complications and pregnancy outcome.Results Among 48 pregnancies, the risk of premature rupture of membranes was significantly higher in patients with epilepsy than those without epilepsy (34.6% vs. 0.0%), and the difference was statistically significant (P<0.01). There was no significant difference in the risk of PIH, GDM, gestational anemia and pregnancy complications (P>0.05). For women who had seizure during pregnancy, the mean birth weight of the offspring was slightly lower, and the incidence of low birth weight and fetal distress was higher, but the difference was not statistically significant (P>0.05); Seizures in the 6 months before pregnancy were significantly associated with seizures during pregnancy [RR=4.28, 95%CI (2.10, 8.74), P<0.01]. Further, the risk of adverse pregnancy outcomes increased significantly [RR=2.00, 95%CI (1.10, 3.65), P<0.05] for WWE who had seizure in 6 month before pregnancy; The rates of seizures during pregnancy in the two groups were 25.0% and 20.0%, but the difference was not statistically significant (P>0.05). Compared with the 6-months, the ≥1 year group had a lower risk of PIH and gestational anemia, and the offspring had a lower risk of low birth weight, premature delivery and fetal distress, but the difference was not statistically significant (P>0.05).ConclusionEnsuring seizure-free at least 6 months before pregnancy will significantly reduce the probability of seizures during pregnancy, and is significantly associated with a lower incidence of adverse pregnancy outcomes. Women of childbearing age with epilepsy are advised to plan pregnancy after reaching seizure-free at least 6 months.
ObjectiveTo investigate the neuroprotective effects and mechanisms of selective histone deacetylases inhibitor MS-275 on rats after seizures. MethodsA total of 75 rats were randomly divided into 5 groups for treatment:control group,pilocarpine group, treatment group Ⅰ(administered with MS-275, 20mg/kg, once a day,intraperitoneally in 7 consecutive days), treatment group Ⅱ(administered with MS-275, 40mg/kg, once a day, intraperitoneally in 7 consecutive days), MS-275 pretreatment group. We used lithium and pilocarpin to induce seizures. Behaviors of rats in each group were observed. At 72 hours after seizures, Nissl staining and immunohistochemical were respectively used to evaluate the loss of neurons and histone acetylation levels of hippocampal CA1 and CA3 regions in each group. Escape latency in the control group, treatment group Ⅰ, treatment group Ⅱ and MS-275 pretreatment group were longer than pilocarpine group(P<0.05). ResultsCompared with the pilocarpine group, rats in MS-275 pretreatment group could delay pilocarpine-induced seizures and reduce mortality (P<0.05). Degree of neuronal loss and degeneration in both treatment group Ⅰ and treatment group Ⅱ were reduced compared with the pilocarpine group (P<0.05) and the level of histone acetylation in hippocampal CA1 and CA3 regions of the rats were increased compared with the pilocarpine group (P<0.05). ConclusionHDACs inhibitors MS-275 can improve the neuronal damage, histone deacetylation of rats' brain and rats cognitive decline, which can exert an neuroprotective effect on rats after seizures, whose mechanism may be related to its antiinflammatory effect.
ObjectiveTo investigate characteristics of motor semiology of epileptic seizure originated from dorsolateral frontal lobe. MethodsRetrospectively analysis the clinical profiles of patients who were diagnosed dorsolateral frontal lobe epilepsy (FLE) based on stereoelectroencephalography (SEEG) and underwent respective surgeries subsequently. Component of motor semiology in a seizure can be divided into elementary motor (EM, include tonic, versive, clonic, and myoclonic seizures) and complex motor (CM, include automotor, hypermotor, and so on). A Talairach coordinate system was constructed in the sagittal series of MRI images in each case. From the cross point of VAC and the Sylvian Fissure, a line was drawn antero-superiorly, which made an angle of 60° with the AC-PC line, then the frontal lobe could be divided into anterior and posterior portion. The epileptogenic zone, which was defined as ictal onset and early spreading zone in SEEG, was classified into three types, according to the positional relationship of the responding electrodes contacts and the "60° line": the anterior, posterior, and intermediate FLE. The correlation of the components of motor semiology in seizures and the location of the epileptogenic zone was analyzed. ResultsFive cases (26.3%) were verified as anterior FLE, among which there were 2 of EM, one of CM, and 2 of EM+CM. In 7 cases (36.8%) of intermediate FLE, there were one of EM, none of CM, and 6 of EM+CM. In the rest 7 cases of posterior FLE, there were 6 of EM, none of CM, and one of EM+CM. Compared with the cases that the epileptogenic zone involved anterior portion, the posterior FLE is more likely to present EM seizures (85.7%), and less likely to show CM components (P < 0.05). And Compared with the anterior FLE and posterior FLE, the intermediate FLE is more likely to present EM+CM seizures (85.7%)(P < 0.05). ConclusionThe motor seizure semiology of dorsolateral FLE has significant correlation with the localization of the epileptogenic zone. Posterior FLE mainly present a pure elementary motor seizure, and once the epileptogenic zone involved anteriorly beyond the "60° line", the component of complex motor seizure would be seen. Intermediate FLE, as its specialty of transboundary, is more likely to show "comprised semiology" of EM and CM. Construction of the "60° line" with AC-PC coordinate system in the MRI images may play an useful role in semiology analysis in presurgical evaluation of FLE.