scholarly journals Role of Short Term Video Encephalography with Induction by Verbal Suggestion in Diagnosis of Suspected Paroxysmal Nonepileptic Seizure-Like Symptoms

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Soaham Dilip Desai ◽  
Devangi Desai ◽  
Trilok Jani
Keyword(s):  
Developing Countries ◽  
Heart Block ◽  
Focal Epilepsy ◽  
Diagnostic Yield ◽  
Cost Effective ◽  
Short Term ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
Outpatient Settings

Purpose. To determine the diagnostic yield and utility of STVEEG with verbal suggestion in diagnosis of patients presenting with transient unresponsiveness and suspected psychogenic nonepileptiform seizures. Methods. A retrospective analysis of STVEEG records of patients with transient unresponsiveness and suspected PNES between 1 Jan 2009 and 28 Feb 2014 was done. Results. Amongst 155 patients [38 males, 117 females], with mean age 32 [8–67], PNES were identified in 109 [70.3%], focal epilepsy was identified in 24 [15.4%], and actual seizure was recorded in 7 [4.5%]. Nine [5.8%] patients were found to have both epilepsy and PNES. Primary generalized epilepsy was diagnosed in 2 [1.2%]. A diagnosis of other paroxysmal nonepileptiform events [tachyarrhythmia and heart block] was done in 3 [1.9%]. A normal EEG and no inducible episode and hence an uncertain diagnosis at the end of STVEEG were seen in only 17 [10.9%] patients. A STVEEG of approximately one hour duration was able to establish the diagnosis in 138 [89.1%] patients with transient unresponsiveness. Conclusion. STVEEG with verbal suggestion is a useful and cost effective diagnostic test for diagnosis of PNES. It can be a good modality for diagnosis in patients with transient abnormalities in sensorium in the outpatient settings in developing countries.

scholarly journals Diagnostic exome sequencing in non-acquired focal epilepsies highlights a major role of GATOR1 complex genes

2020 ◽  
Vol 57 (9) ◽  
pp. 624-633 ◽  
Author(s):  
Martin Krenn ◽  
Matias Wagner ◽  
Christoph Hotzy ◽  
Elisabeth Graf ◽  
Sandrina Weber ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Rare Variants ◽  
Focal Epilepsy ◽  
Diagnostic Yield ◽  
Mammalian Target Of Rapamycin ◽  
High Rate ◽  
Molecular Heterogeneity ◽  
Pathogenic Variants ◽  
Uncertain Significance

BackgroundThe genetic architecture of non-acquired focal epilepsies (NAFEs) becomes increasingly unravelled using genome-wide sequencing datasets. However, it remains to be determined how this emerging knowledge can be translated into a diagnostic setting. To bridge this gap, we assessed the diagnostic outcomes of exome sequencing (ES) in NAFE.Methods112 deeply phenotyped patients with NAFE were included in the study. Diagnostic ES was performed, followed by a screen to detect variants of uncertain significance (VUSs) in 15 well-established focal epilepsy genes. Explorative gene prioritisation was used to identify possible novel candidate aetiologies with so far limited evidence for NAFE.ResultsES identified pathogenic or likely pathogenic (ie, diagnostic) variants in 13/112 patients (12%) in the genes DEPDC5, NPRL3, GABRG2, SCN1A, PCDH19 and STX1B. Two pathogenic variants were microdeletions involving NPRL3 and PCDH19. Nine of the 13 diagnostic variants (69%) were found in genes of the GATOR1 complex, a potentially druggable target involved in the mammalian target of rapamycin (mTOR) signalling pathway. In addition, 17 VUSs in focal epilepsy genes and 6 rare variants in candidate genes (MTOR, KCNA2, RBFOX1 and SCN3A) were detected. Five patients with reported variants had double hits in different genes, suggesting a possible (oligogenic) role of multiple rare variants.ConclusionThis study underscores the molecular heterogeneity of NAFE with GATOR1 complex genes representing the by far most relevant genetic aetiology known to date. Although the diagnostic yield is lower compared with severe early-onset epilepsies, the high rate of VUSs and candidate variants suggests a further increase in future years.

scholarly journals Neuromodulation Therapy with Vagus Nerve Stimulation for Intractable Epilepsy: A 2-Year Efficacy Analysis Study in Patients under 12 Years of Age

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Suresh Gurbani ◽  
Sirichai Chayasirisobhon ◽  
Leslie Cahan ◽  
SooHo Choi ◽  
Bruce Enos ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Focal Epilepsy ◽  
Intractable Epilepsy ◽  
Cumulative Effect ◽  
Adjunctive Treatment ◽  
Seizure Freedom ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy

To study the efficacy of vagus nerve stimulation (VNS) therapy as an adjunctive treatment for intractable epilepsy in patients under 12 years of age, we analyzed 2-year postimplant data of 35 consecutive patients. Of the 35 patients, 18 (51.4%) at 6 months, 18 (51.4%) at 12 months, and 21 (60.1%) at 24 months showed ≥50% reduction in seizure frequency (responders). Although incremental seizure freedom was noted, no patient remained seizure-free throughout the 3 study periods. Partial response (≥50% seizure reduction in 2 or less study periods) was seen in 8 (22.9%) patients. Twelve patients (34.3%) were nonresponders. Out of 29 patients with primary generalized epilepsy, 20 (68.9%) and, out of 6 patients with focal epilepsy, 3 (50%) had ≥50% seizure control in at least one study period. No major complications or side effects requiring discontinuation of VNS therapy were encountered. We conclude that (1) patients with intractable primary generalized epilepsy respond better to VNS therapy, (2) cumulative effect of neuromodulation with improving responder rate to seizure freedom with continuation of VNS therapy is noted, and (3) VNS therapy is safe and is well tolerated in children receiving implant under 12 years of age.

scholarly journals Role of allo-trilaminar dermal regenerative template in management of burns

2021 ◽  
Vol 7 (3) ◽  
pp. 88-90
Author(s):  
Ravi Kumar Chittoria ◽  
Neljo Thomas ◽  
Padmalakshmi Bharathi Mohan ◽  
Shijina Koliyath ◽  
Imran Pathan ◽  
...  
Keyword(s):  
Developing Countries ◽  
Medical Management ◽  
Third World ◽  
Treatment Options ◽  
Cost Effective ◽  
Dermal Regeneration Template ◽  
Dermal Regeneration ◽  
Dressing Materials ◽  
Methods Of Treatment

Different methods of treatment options and dressing materials are available in today’s era of medical management of wounds. Trilaminar dermal regeneration template (TDRT) has been in use since the 1980s but owing to its high cost, its affordability and availability in third world developing countries is sparse. Here we have described our experience with the use of an indigenously made cost effective dermal regeneration template made from available materials in management of burns

scholarly journals Ultra-rare genetic variation in the epilepsies: a whole-exome sequencing study of 17,606 individuals

2019 ◽  
Author(s):  
◽  
Yen-Chen Anne Feng ◽  
Daniel P. Howrigan ◽  
Liam E. Abbott ◽  
Katherine Tashman ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Focal Epilepsy ◽  
Single Gene ◽  
European Ancestry ◽  
Whole Exome ◽  
Genes Encoding ◽  
Rare Genetic Variation ◽  
Generalized Epilepsy

AbstractSequencing-based studies have identified novel risk genes for rare, severe epilepsies and revealed a role of rare deleterious variation in common epilepsies. To identify the shared and distinct ultra-rare genetic risk factors for rare and common epilepsies, we performed a whole-exome sequencing (WES) analysis of 9,170 epilepsy-affected individuals and 8,364 controls of European ancestry. We focused on three phenotypic groups; the rare but severe developmental and epileptic encephalopathies (DEE), and the commoner phenotypes of genetic generalized epilepsy (GGE) and non-acquired focal epilepsy (NAFE). We observed that compared to controls, individuals with any type of epilepsy carried an excess of ultra-rare, deleterious variants in constrained genes and in genes previously associated with epilepsy, with the strongest enrichment seen in DEE and the least in NAFE. Moreover, we found that inhibitory GABAA receptor genes were enriched for missense variants across all three classes of epilepsy, while no enrichment was seen in excitatory receptor genes. The larger gene groups for the GABAergic pathway or cation channels also showed a significant mutational burden in DEE and GGE. Although no single gene surpassed exome-wide significance among individuals with GGE or NAFE, highly constrained genes and genes encoding ion channels were among the top associations, including CACNA1G, EEF1A2, and GABRG2 for GGE and LGI1, TRIM3, and GABRG2 for NAFE. Our study confirms a convergence in the genetics of common and rare epilepsies associated with ultra-rare coding variation and highlights a ubiquitous role for GABAergic inhibition in epilepsy etiology in the largest epilepsy WES study to date.

Worsening seizures after surgery for focal epilepsy due to emergence of primary generalized epilepsy

Neurology ◽  
1998 ◽  
Vol 51 (4) ◽  
pp. 1178-1180 ◽  
Author(s):  
B. Diehl ◽  
E. Wyllie ◽  
A. D. Rothner ◽  
W. Bingaman
Keyword(s):  
Focal Epilepsy ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy

scholarly journals The Role Of Private And Public Sectors: An Analysis Of Methodological Steps In Understanding Growth Cycles

2008 ◽  
Vol 4 (3) ◽  
pp. 225-233
Author(s):  
Santosh Singh Bais ◽  
Jagannath B. Kukkudi
Keyword(s):  
Developing Countries ◽  
Business Cycles ◽  
21St Century ◽  
Current Fluctuations ◽  
Short Term ◽  
Policy Makers ◽  
Growth Cycles ◽  
Private And Public ◽  
History Of

Though with a very long standing history of a century the growth cycles have once again been in the limelight of thinking of modern economists of 1960 and that of 1995. However, the 21st century growth cycles have been in the focus for policy makers of both developed and developing countries alike. The globalization phenomena has added new  dimension to these business cycles and have been a matter of time to time concerns of the policy makers of the developing countries which by nature have a vivid experience in different sectors of the economy. Indeed in the result years it is the current fluctuations which have occupied a prime place in all the economy which are going to be tied or cemented through trade, what attempts are essential and harmonious so as to control these short term growth fluctuations and what political and economic compromises are needed requires a brief analysis this what had been attempted in the paper.

scholarly journals The Role of Controlling Inflation in the Perspective of Al-Qur'an

2019 ◽  
Vol 2 (1) ◽  
pp. 20
Author(s):  
Kuni Zakiyah
Keyword(s):  
Developing Countries ◽  
Inflation Rate ◽  
Economic Policies ◽  
Short Term ◽  
High Inflation ◽  
Stable Economy

The phenomenon of inflation that exists is actually not a short-term phenomenon and occurs situationally. However, like in other developing countries, the problem of inflation is more on the issue of long-term inflation that is increasingly complex and increasingly difficult to control. Conventional economic policies are no longer able to solve this problem. According to the perspective of the Qur'an, the source of the emergence of economic turmoil, which is indicated by high inflation, is due to the use of currencies that deviate from the Qur'an. The deviation is nothing but making the currency a commodity in order to make a profit. The advantage is called by the Qur'an in terms of usury, both usury nasi’ah and fadhl. Therefore, if we want to create a more stable economy, with a more controlled inflation rate, then there must be courage to eliminate the source of the main cause.

scholarly journals Chronotypes in Patients with Epilepsy: Does the Type of Epilepsy Make a Difference?

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hallie Kendis ◽  
Kelly Baron ◽  
Stephan U. Schuele ◽  
Bhavita Patel ◽  
Hrayr Attarian
Keyword(s):  
Seizure Control ◽  
Focal Epilepsy ◽  
Healthy Controls ◽  
Circadian Misalignment ◽  
Age Related ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy ◽  
The Impact ◽  
Related Increase

Circadian rhythms govern all biological functions. Circadian misalignment has a major impact on health. Late chronotype is a risk factor for circadian misalignment which in turn can affect the control of seizures in epilepsy patients. We compared a group of 87 confirmed epilepsy patients regardless of subtypes with age- and sex-matched healthy controls. We compared generalized epilepsy patients with localization related epilepsy patients and with healthy controls. We found that primary generalized epilepsy patients were 5 times more likely to have a late chronotype than healthy controls. We did not find any significant differences between localization related epilepsy patients and healthy controls or between the overall epilepsy cohort and healthy controls. Generalized epilepsy patients are more likely to be evening types as compared to those with focal epilepsy or subjects without epilepsy. Epilepsy patients do not experience the same age related increase in morningness as do age-matched healthy controls. This is important in regard to timing of AED, identifying and preventing sleep deprivation, and integrating chronotype evaluations and chronotherapy in comprehensive epilepsy care. Further studies, using objective phase markers or the impact of chronotherapy on seizure control, are necessary.

The Role and Controversies of Electroencephalogram in Focal versus Generalized Epilepsy

2021 ◽  
Vol 10 (02) ◽  
pp. 058-064
Author(s):  
Shoba Jayaram ◽  
Modhi Alkhaldi ◽  
Asim Shahid
Keyword(s):  
Focal Epilepsy ◽  
Multiple Factors ◽  
Epileptiform Discharges ◽  
Grand Mal ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
Electroencephalogram Eeg ◽  
Amplitude Pattern ◽  
Eeg Features ◽  
Secondary Generalization

AbstractAs early in 1935, Gibbs et al described electroencephalogram (EEG) features of large slow waves seen in “petit mal” seizures and change in background rhythm to a higher frequency, greater amplitude pattern in “grand mal” seizures. Studies have shown many typical EEG features in focal onset as well as generalized epilepsies.2 3 It is usually easy to delineate focal epilepsy cases when EEG onset of seizures is clear as seen in Benign focal epileptiform discharges of childhood.4 However, it is not uncommon to see cases where epileptiform discharges are not very clear. For example, there can be secondary bilateral synchrony or generalized onset of epileptiform discharges in some cases of focal epilepsy5 and nongeneralized EEG features is cases of generalized epilepsy like absence seizures.6 The awareness of occurrence of focal clinical and EEG features in generalized epilepsy is particularly important to help to select appropriate AEDs and also to avoid inappropriate consideration for epilepsy surgery.7 Lüders et al8 have shown that multiple factors like electroclinical seizure evolution, neuroimaging (both functional and anatomical) have to be analyzed in depth before defining an epileptic syndrome. Here, we are providing few examples of different situations where it is still mysterious to figure out focal onset seizures with secondary generalization versus primary generalized epilepsy.

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