Functional seizures: Are they consistent over time?

Background: Our previous study showed that functional seizures (FS) are consistent in the same patient during a single video EEG monitoring (VEEG). This study aimed to check whether FS remains consistent across VEEG sessions even after several years.

Methods: The study evaluated the consistency of FS across different VEEG sessions using five criteria: FS type, the main anatomical region involved (specifically, the body part most affected during the seizure), other involved anatomical regions, frequency of movements, and duration of FS.

Which psychogenic nonepileptic seizure (PNES) patients are more likely to be treated with anti-seizure medications?

Background: The average time for psychogenic nonepileptic seizures (PNES) diagnosis is about 7.5 years. Many patients receive inadequate treatment and sometimes even life-threatening treatments such as tracheal intubation during this time.

Utilizing risk-controlling prediction calibration to reduce false alarm rates in epileptic seizure prediction.

Introduction: Epilepsy is a neurological disease characterized by sudden, unprovoked seizures. The unexpected nature of epileptic seizures is a major component of the disease burden. Predicting seizure onset and alarming patients may allow timely intervention, which would improve clinical outcomes and patient quality of life.

Drug Resistance in Late-onset Epilepsy.

Background: The annual incidence of epilepsy increases with age, from nearly 28 per 100,000 by the age of 50 years to 139 per 100,000 by the age of 75 years. Late-onset epilepsy differs from epilepsy at a young age in the prevalence of structural-related epilepsy, types of seizures, duration of seizures, and presentation with status epilepticus.

Objectives: To check the response to treatment in patients with epilepsy with age of onset of 50 years and older.

Utility and Validity of Incidental Video Recordings in the Differential Diagnosis of Consciousness Loss.

Background: Loss of consciousness (LOC) is one of the most common reasons for seeking neurological advice in clinics and emergency departments. There is considerable difficulty in determining the nature of the events according to patient reports, and collateral history is often difficult to interpret due to multiple versions and observer interpretations.

Objectives: To examine the utility and validity of incidental video recordings (IVR) in the differential diagnosis of LOC.

Knowledge and emotional attitudes of health care practitioners regarding patients with psychogenic nonepileptic seizures.

Background: Psychogenic nonepileptic seizures (PNESs) are paroxysmal events that resemble epileptic seizures without concomitant changes in electroencephalograms (EEGs) or any other physiological cause. These seizures are one of the most common and dramatic conversion disorders. First responders treat many PNES patients with unnecessary emergency abortive medication and sometimes even intubate them.

Psychogenic nonepileptic seizures: Are they a freeze reaction?

Psychogenic nonepileptic seizures (PNES) clinically resemble epileptic seizures (ES) but lack epileptic activity at the time of the seizure and are also not due to any other pathophysiological disorder. The integrative cognitive model (ICM) suggests that PNES is an automatic reaction generated from distorted memory and is perceived as uncontrollable and unwanted. Furthermore, the ICM model implies that a PNES event occurs due to an external or internal cue.

Using nirmatrelvir/ritonavir in patients with epilepsy: An update from the Israeli chapter of the International League Against Epilepsy.

Presented herein are recommendations for use of nirmatrelvir/ritonavir in patients with epilepsy, as issued by the Steering Committee of the Israeli chapter of the International League Against Epilepsy. The recommendations suggest that patients on moderate-to-strong enzyme-inducing antiseizure medications (ASMs) and everolimus should not be treated with nirmatrelvir/ritonavir; rectal diazepam may be used as an alternative to buccal midazolam; doses of ASMs that are cytochrome P450 (CYP3A4) substrates might be adjusted; and patients treated with combinations of nirmatrelvir/ritonavir and ASMs that are CYP3A4 substrates or lamotrigine should be monitored for drug efficacy and adverse drug reactions.

The Effect of Anti-seizure Medications on the Propagation of Epileptic Activity: A Review.

The propagation of epileptiform events is a highly interesting phenomenon from the pathophysiological point of view, as it involves several mechanisms of recruitment of neural networks. Extensive and research has been performed, suggesting that multiple networks as well as cellular candidate mechanisms govern this process, including the co-existence of wave propagation, coupled oscillator dynamics, and more. The clinical importance of seizure propagation stems mainly from the fact that the epileptic manifestations cannot be attributed solely to the activity in the seizure focus itself, but rather to the propagation of epileptic activity to other brain structures.

Longitudinally Extensive Transverse Myelitis in a Lupus-Neuromyelitis Optica Overlap.

Transverse myelitis is an inflammatory lesion of the spinal cord, occurring in different autoimmune, infectious, and traumatic diseases but is the hallmark of neuromyelitis optica (NMO), a rare neurologic autoimmune disease. Patients with systemic lupus erythematosus (SLE) may develop transverse myelitis as a neuropsychiatric complication of active disease; however, at times, NMO co-exists as an additional primary autoimmune condition in a SLE patient. Correct diagnosis of a SLE-NMO overlap is important not only for the different disease course and prognosis compared with SLE-related LETM, but especially for the emerging and highly specific NMO treatment options, not established for SLE-related LETM-such as anti-aquaporin 4 antibodies, anti-VEGF antibodies, complement modulation, or IVIg.

Treating Epilepsy Patients with Investigational Anti-COVID-19 Drugs: Recommendations by the Israeli Chapter of the ILAE.

The coronavirus disease-2019 (COVID-19) and its management in patients with epilepsy can be complex. Prescribers should consider potential effects of investigational anti-COVID-19 drugs on seizures, immunomodulation by anti-seizure medications (ASMs), changes in ASM pharmacokinetics, and the potential for drug-drug interactions (DDIs). The goal of the Board of the Israeli League Against Epilepsy (the Israeli Chapter of the International League Against Epilepsy, ILAE) was to summarize the main principles of the pharmacological treatment of COVID-19 in patients with epilepsy.

[UTILITY OF INPATIENT LONG TERM VIDEO EEG MONITORING].

Introduction: Ambulatory interictal EEG cannot always clarify the nature of spells in patients with suspected epilepsy. Long term Video EEG Monitoring can help to diagnose the nature of recurrent attacks, classify epileptic seizures and aid with the localization of seizures in preoperative epilepsy surgery candidates.

Objectives: The aim of this study was to investigate the usefulness of performing long term video EEG monitoring in patients undergoing this test in Rambam's epilepsy unit.

Epileptic vs psychogenic nonepileptic seizures: a video-based survey.

Psychogenic non epileptic seizures (PNES) are present in up to 30% of patients undergoing video EEG. Delay in PNES diagnosis is an average of 7.2years.

Stereotypy of psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures (PNES) are defined as paroxysmal episodes in which epileptic semiology features are manifested, without the characteristic concomitant electrical discharges seen in epileptic seizures. Although many studies have dealt with semiologic classification of PNES, most of the studies did not raise the question of consistency of PNES in the same patient. The aim of this study was to measure the degree of consistency of PNES among individual patients.

Yield of Non-Invasive Phase 1 Presurgical Evaluation in Drug-Resistant Epilepsy Patients.

Background: Resective epilepsy surgery is an accepted treatment option for patients with drug-resistant epilepsy (DRE). Presurgical evaluation consists of a phase 1 non-invasive evaluation and a phase 2 invasive evaluation, when necessary.

Objectives: To assess the results of phase 1 evaluation in patients with focal DRE.

Psychogenic nonepileptic seizure patterns in patients with epilepsy.

Background: Psychogenic nonepileptic seizures (PNESs) clinically resemble epileptic seizures (ESs) without concomitant electroencephalograph (EEG) changes. Although most studies focus on the differences between ESs and PNESs in different groups of patients, few studies have focused on patients with a comorbidity of PNESs and ESs.

Objectives: The aim of this study, was to establish the pattern of relationships between PNESs and ESs in patients who had both types of events during long-term video EEG monitoring, expecting to find that PNESs would be longer, more frequent, and more dramatic than ESs.

Diabetic neuropathic cachexia: a case report.

Introduction: We report a case of the rare entity of diabetic neuropathic cachexia, in order to remind clinicians that these cases still exist.

Case Presentation: A 71-year-old Moslem Arab man with type 2 diabetes along with diabetic neuropathic cachexia complicated by a hyperfunctioning autonomous thyroid nodule, and undiagnosed acromegaly came under our care. We report the unique challenges as to what are the priorities to consider in the course of investigation and treatment.

Subependymal mass lesions and peripheral polyneuropathy in adult-onset glutaric aciduria type I.

Glutaric aciduria type I (GA-I) is an autosomal recessive disease caused by a deficiency of the mitochondrial enzyme glutaryl CoA dehydrogenase (GCDH). This metabolic block causes increased urinary concentrations of glutaric and 3-hydroxyglutaric acids. The accumulation and excretion of glutarylcarnitine esters leads to secondary carnitine deficiency.

Young patient with acute ischemic stroke due to papillary carcinoma of the thyroid.

Hypercoagulability is a condition predisposing to arterial or venous thrombosis and is associated frequently with malignancy. We present a rare acute ischemic stroke in a young patient that was the presenting feature for a newly diagnosed papillary carcinoma of the thyroid. Extensive vascular and hematological work-up was normal except for a large patent foramen ovale (PFO).

Prolonged ictal aphasia: a diagnosis to consider.

Aphasia is a common symptom encountered by clinical neurologists. It is usually caused by strokes or lesions involving language regions of the brain, yet prolonged aphasia is rarely the sole manifestation of a simple partial status epilepticus. We report six patients, who suffered from prolonged ictal aphasia.