Photosensitive occipital lobe epilepsy (POLE) is a rare idiopathic reflex focal epilepsy that can occur in all age groups. It is characterized by occipital lobe seizures induced by flashing stimuli (flashing sunlight, video games, TV commercials and programs, etc.). Photoparoxysmal response on EEG is induced by intermittent photic stimulation; Ictal EEG shows rapid spike rhythms are originated from the occipital region. There are no obvious abnormalities in brain image. POLE responds well to anti-seizure medications and has a good prognosis. This article reviews the research progress on POLE in order to improve the clinician’s understanding and reduce the rates of missed diagnosis and misdiagnosis.
ObjectiveTo investigate the effect of acoustic earplugs combined with sedative drugs on improving the success rate of MRI examinations in children with epilepsy, and to provide an effective clinical evidence for MRI examination in children with epilepsy for the future.MethodsSeventy-four children with epilepsy who came to the Second Affiliated Hospital of Guangzhou Medical University, between July 2016 and February 2018 were included in this research. To test the effectiveness of acoustic earplugs on children with epilepsy in improving MRI success rates, participants were divided into two groups randomly. The control group only took the drug and withont using the acoustic earplugs. The observation group used both the drug and acoustic earplugs. The comparing the success rate of MRI examination between the two groups.ResultsThe observed group (with the acoustic earplugs) showed a success rate of 97.29% (36/37), the control group (without the acoustic earplugs) showed a success rate of 18.91% (7/37). The success rate of the observed group was higher than the control group (P<0.05) significantly.ConclusionsThe use of acoustic earplugs combined with sedative drugs is effective in improving the success rate of MRI examination in children with epilepsy and can be widely used in clinical practice.
ObjectiveTo analyze the effect of magnetic resonance-guided laser interstitial thermal therapy (Magnetic resonance-guided laser interstitial thermal therapy , MRgLITT) for drug resistant epilepsy (DRE). MethodsThe present study analyzed the clinical information of DRE patients treated by MRgLITT in Beijing Tiantan Hospital from August 2020 to February 2021, including the type of disease, postoperative complications, and prognosis (Engel classification) in the one year after surgery. ResultsA total of 55 patients were enrolled. There were 27 males and 28 females, with an average of (21.7±14.1) years, all of whom successfully completed the operation and were followed up for the 1 year after surgery. The diagnosis included intracranial tumors, hypothalamic hamartoma (HH), focal cortical dysplasia (FCD), cavernous malformations (CM), mesial temporal lobe epilepsy (mTLE), and idiopathic generalized epilepsy (underwent corpus callosotomy). The patients with seizure freedom accounted for 59.6% (31/52), and the average remission rate of palliative surgery was 68.6%. The short-term postoperative complications included bleeding in neurological deficit in 6 cases (10.9%), 4 cases (7.3%), and noninfectious fever in 2 cases (3.6%). No serious, long-term complications occurred. The average postoperative hospital stay was (4.7±1.6) days. ConclusionsMRgLITT is gradually mature and has a wide range of indications. This technology provides a safe and effective therapy for DRE patients.
Electroencephalogram (EEG) analysis has been widely used in disease diagnosis. The EEG detection of the patients with epilepsy can be used to make judgments about patients' conditions in time, which is of great practical value. Therefore, the techniques of automatic detection, diagnosis and classification of epileptic EEG signals are urgently needed. In order to realize fast and accurate automatic detection and classification of the EEG signals during the normal, interictal and ictal periods of epilepsy, we propose an automatic classification and recognition method which combines the Real Adaboost algorithm based on error-correcting output codes (ECOC) with a feature extraction method based on sample entropy (SampEn) and wavelet packet energy in this paper. In the present study, we used the sample entropy of input signals and the energy of some parts of frequency bands as features, and then we classified the extracted features with the method combining ECOC with Real AdaBoost algorithm. In order to test the validity, we used the epilepsy database from the University of Bonn. The database has 5 groups of EEG signals, which contains the data of normal people with their eyes open or closed, the data collected inside and outside of the epileptic foci from patients during their interictal period and the data from patients during their ictal period. The results showed that the method had strong abilities of classification and recognition of the EEG signals, and especially the recognition rate had been improved significantly. The average recognition rate of the EEG signals with different features during the three periods of the five groups mentioned above can reach 96.78%, which is superior to those with algorithms recorded in many other literatures. The method has better stability, processing speed and potential of real-time application, and it plays a supporting role in the prediction and detection of epilepsy in clinical practice.
Glioma related epilepsy (GRE) is a complication that seriously affects the quality of life and treatment process of glioma patients. The genes and biomolecules in the tumor microenvironment may contribute to the mechanisms and pathways of epilepsy. In addition, it has been found that epileptic seizures can promote the growth of brain tumors, making controlling epilepsy a key factor in treating brain tumors., However, in current understanding, not all genetic molecular features carried by gliomas themselves are involved in the pathogenesis of GRE. With the deepening understanding of GRE, it has been discovered that some molecular features of gliomas are involved in the pathogenesis of GRE, mainly through the Ras/Raf/MAPK (MEK)/ERK and PI3K/AKT/mTOR pathways, which are also involved in the pathogenesis of gliomas. In 2021, the World Health Organization (WHO) classified diffuse gliomas into two categories: adult and pediatric, and further subdivided them into types such as astrocytoma, oligodendroglioma, and glioblastoma. This classification helps to more accurately understand and apply the molecular characteristics of gliomas, promote the standardization of tumor pathological diagnosis, and may have an impact on the treatment and prognosis evaluation of GRE. This review links genes and biomolecules in the tumor microenvironment through the latest WHO classification, summarizes previous research and recent findings, and provides a deeper understanding of the molecular characteristics of gliomas and their relationship with epilepsy related molecular pathways. It explores more effective treatment methods to suppress epilepsy symptoms and tumor growth, which is of great significance for improving the diagnosis and treatment of GRE.
ObjectiveTo investigate the establishment of a risk nomogram model for predicting vagus excitatory response in patients with functional epilepsy after radiofrequency thermocoagulation.MethodsA total of 106 patients with epilepsy admitted to the neurosurgery department of our hospital from January 2016 to June 2020 were selected and divided into the Vagus excitatory response (VER) group and the non-VER group according to their occurrence or absence. Logistic regression analysis was used to screen out the risk factors of VER during SEEG-guided Percutaneous radiofrequency thermocoagulation (PRFT) in patients with functional epilepsy, and R software was used to establish a histogram model affecting VER in SEEG-guided PRFT. Bootstrap method was used for internal verification. C-index, correction curve and ROC curve were used to evaluate the prediction ability of the model.ResultsLogistic regression analysis showed that age [OR=0.235, 95%CI (0.564, 3.076)], preoperative fugl-meyer score [OR=4.356, 95%CI (1.537, 6.621)], depression [OR=0.995, 95%CI (1.068, 7.404)], and lesion range [OR=1.512, 95%CI (0.073, 3.453)] were independent risk factors for the occurrence of VER in PRFT under the guidance of SEEG (P<0.05), and were highly correlated with the occurrence of VER in PRFT. Based on the above six indicators, a SEEG-guided colograph model of VER risk in PRFT was established, and the model was validated internally. The results showed that the C-index of the modeling set and validation set were 0.779 [95%CI (0.689, 0.869)] and 0.782 [95%CI (0.692, 0.872)], respectively. The calibration curves of the two groups fit well with the standard curves. The areas under the ROC curve (AUC) of the two groups were 0.779 and 0.782 respectively, which proved that the model had good prediction accuracy.ConclusionFor patients with functional epilepsy requiring seeg-guided PRFT therapy, age, preoperative Fugl-meyer score, depression and lesion range should be taken into full consideration to comprehensively assess the incidence of VER, and early intervention measures should be taken to reduce and reduce the incidence, which has good clinical application value.
ObjectiveTo observe the clinical efficacy of Xiao’er kang xian capsule added to anti-seizure medications (ASMs) in the treatment of children with refractory epilepsy and its influence on serum neuron-specific enolase (NSE) and cludter of differentiation 19+ (CD19+) levels. Methods A total of 60 children with refractory epilepsy were selected from the pediatric outpatient department and ward of Guangdong Provincial People's Hospital from February 2021 to June 2023. The study subjects were divided into two groups by numerical random method,with 30 cases in each group. The children with Xiao’er kang xian capsule added to the original treatment were the treatment group and the children without Xiao’er kang xian capsule added to the original treatment were the control group. The frequency, duration, EEG characteristics, adverse reactions and changes in serum NSE and CD19+ levels of the two groups were compared after treatment. Results Self-control before and after treatment in the treatment group: the frequency and duration of seizures were significantly reduced, with statistical difference (P<0.05). EEG discharge index in awake period and sleep period were significantly decreased, with statistical difference (P<0.05). After 6 months of treatment, comparison between the two groups of children: the seizure frequency of children in the treatment group was significantly decreased compared with the control group (P=0.03). There was a statistical difference (P<0.05), and the seizure duration in the treatment group was less than that in the control group (P=0.863), the clinical effective rate of treatment group 83.33% was higher than that of control group 63.33% (P=0.08), the effective rate of EEG in treatment group 80% was higher than that of control group 60% (P=0.091), serum NSE and CD19+ in treatment group were lower than that of control group, with no statistical difference (P>0.05). After 12 months of treatment, the frequency and duration of seizures in the treatment group were significantly decreased (P<0.05). The clinical efficacy and effectiveness of treatment group were significantly higher than that of control group (P=0.038). The incidence of adverse reactions in both groups was 16.67% (P>0.05). The effective rate of EEG in treatment group was significantly higher than that in control group (P=0.053). Serum NSE and CD19+ in treatment group were significantly lower than those in control group (P<0.05). ConclusionFor children with refractory epilepsy, the addition of Xiao’er kang xian capsule on the basis of the original treatment has obvious effect low adverse reaction and high safety. NSE and CD19+ can be used as monitoring indicators for the influence of the disease and prognosis evaluation during the treatment of children with epilepsy.
ObjectiveThe purpose of this study was to find a new method for the treatment of drug-resistant epilepsy, and to study the efficacy and safety of Bacteroidesfragilis (BF839) in the adjunctive treatment of refractory epilepsy, as well as the improvement of comorbidity.MethodsA prospective, single-arm, open pilot clinical study was designed for the additive treatment of drug-resistant epilepsy using BacteroidesFragilis 839 (BF839). 47 patients with refractory epilepsy, who were admitted to the epilepsy outpatient clinic of the Second Affiliated Hospital of Guangzhou Medical University from April 2019 to October 2019, were enrolled and treated with BF839 adjunct treatment. The primary efficacy endpoint was median percent reduction from baseline in monthly (28-day) seizure frequency for the 16-week treatment period. Other efficacy analysis included response rate(proportion of patients with ≥ 50% seizure reduction) in the 16 weeks period, the proportion of patients seizure free and the retention rate after12 months intervention, and the observance of the side effects and comorbidities.ResultsThe median reduction percent of all seizure types was −53.5% (P=0.002). The response rate was 61.1% (22/36). 8.5% (4/47) patients seizure free at 12 months. The retention rate at 12 months was 57.4% (27/47). The side effects were diarrhea 4.3% (2/47) and constipation 4.3% (2/47). 48.9% (23/47) of the patients reported improvement in comorbidities, with cognitive improvement of 21.2% (10/47).ConclusionBF839 can be used as an effective additive therapy to treat drug-resistant epilepsy. It is safe and beneficial to the improvement of comorbidities. This is the first time in the world that a single intestinal strain has been reported to be effective in treating drug-resistant epilepsy. This research has important implications.
Electroencephalogram(EEG) analysis has important reference value in the diagnosis of epilepsy. The automatic classification of epileptic EEG can be used to judge the patient’s situation in time,which is of great significance in clinical application. In order to solve the problem that the recognition accuracy is not high by using the single feature of EEG signals and avoid the influence of wavelet basis function selection on recognition results,a method of automatic discrimination of epileptic EEG signals based on S transform and permutation entropy is proposed. Firstly, the original signals are decomposed by discrete S transform, and then we calculate the fluctuation index of coefficients of each rhythm and combine the permutation entropy of EEG signals into a feature vector and use Real AdaBoost classifier to discriminate the epileptic EEG signals in muti-period. In this study, we used the epilepsy database from University of Bonn. Three groups of EEG signals, including the data of normal people with their eyes open, the data collected inside of the epileptic foci from patients during their interictal period and the data during their ictal period, were used to test effectiveness. The results of this study showed that the fluctuation index of each rhythm could be used to characterize the normal, interictal and ictal epileptic EEG signals effectively, and the recognition accuracy of multiple features was much higher than that of single feature. The average recognition accuracy could reach 98.13%. Compared with time-frequency feature extraction method or nonlinear feature extraction method only,the recognition accuracy was increased by more than 1.2% and 8.1% respectively, which was superior to the methods recorded in many other literatures. Therefore, this method has a good application prospect in diagnosis of epilepsy.
ObjectiveTo explore the pathogenic mechanism of human herpesvirus 6B (HHV-6B) in the intractable mesial temporal lobe epilepsy (MTLE).Methods42 cases of intractable MTLE and 17 cases of non-MTLE patients who treated in Wuhan Brain Hospital from Jan. 2012 to Dec. 2018 were enrolled in this study. Resected hippocampus, amygdala and mixed uncus samples were examined by real-time polymerase chain reaction (PCR) and reverse-transcriptase PCR to detect viral DNA and message RNA. Comparative analysis was used between the clinical characteristics and the HHV-6 detection.ResultsDetection of HHV-6 DNA was higher in MTLE patients (40.48%) than non-MTLE patients (11.7%). HHV-6B viral DNA was determined in 15/30 HHV-6 DNA-positive samples, and no HHV-6B mRNA were detected in all HHV-6 DNA negative samples. The patient’s age was the only influencing factor of HHV-6 expressing in MTLE. While the patient’s gender, onset age and possible disease cause had no effect on the HHV-6 content.ConclusionsThis study suggests that HHV-6B may play an important role in the pathogenesis of MTLE, but the mechanism needs further study.