A STUDY OF ETIOLOGICAL AND CLINICAL PROFILE OF ACUTE SYMPTOMATIC SEIZURES IN ADULTS

The word seizure is derived from Latin word “Sacire” meaning ‘to take possession of’. Seizure disorders are found Epilepsy can be broadly divided into idiopathic and symptomatic disorders. Idiopathic epilepsies are not associated with brain lesions or neurological abnormalities. They tend to be self limited and often respond well to antiepileptic therapy.An acute symptomatic seizure was defined in a recent recommendation from the International League Against Epilepsy (ILAE ) as a clinical seizure occurring in close temporal relationship with an acute central nervous system insult which may be metabolic, toxic, infectious or inflammatory. Seizures are common disorders found all over the that may require urgent attention and treatment to reverse world and are encountered frequently during medical potentially damaging causes. Such seizures are practice in variety of settings. Annually approximately considered to be an acute manifestation of the insult and 150,000 adults will present with a first seizure in the may not recur when the underlying cause has been United State1. India is home to about 10 million people removed or the acute phase has elapsed. The knowledge with epilepsy (prevalence of about 1%). An epileptic of the etiologic risk factors of acute symptomatic seizures seizure is an episode of neurologic dysfunction in which in third-world countries will invariably contribute to the abnormal neuronal firing is manifest clinically by changes effort aimed at preventing and managing medical conditions frequently complicated by seizures. The differential diagnosis of a single seizure includes psychogenic non-epileptic events, cardiac and neurogenic syncope, transient ischemic attacks, sleep disorders, and panic attacks.

EEG in asymptomatic relatives of idiopathic epilepsy; a prospective study

Introduction: The mainstay of diagnosis in Idiopathic Epilepsies (IE) is the electroencephalogram (EEG). The characteristic EEG of each syndrome is an electrographic endophenotype of the larger clinical phenotype of each and more directly associated with potential gene defects than the full phenotype. Endophenotypes represents primary abnormalities elicited by the gene defect, which, in some patients, blossom into full seizures. Revealing the percentage of abnormal EEGs in asymptomatic relative of patients with IE may help to describe the mode of inheritance that would help the ongoing genetics studies to discover the pathologic gene defect. Method: This is a prospective cohort study to identify the percentage of abnormal EEG in asymptomatic first-degree relatives of patients with IE Results: 20 out of 141 EEGs (14%) of first-degree relatives were abnormal. The abnormalities included generalized polyspikes and waves , generalized 3-Hz spike and waves or centro-temporal spikes in 50% of the abnormal EEGs. 50% of the abnormalities were nonspecific. Conclusion: These results may indicate that the EEG endophenotypes in IEs do not follow a Mendelian pattern of inheritance. Nevertheless, the EEG endophenotype is relatively common and thus genetically simpler than the full epilepsy, which will aid in gene identification

Do Seizures Promote Epileptogenesis and Cause Cognitive Decline?

The assumption that repeated seizures may induce a progression of epilepsies towards an intractable condition and a cognitive decline does not hold true for idiopathic epilepsies but can only be considered for mesial temporal lobe epilepsy and epileptic encephalopathies. The available evidence leads to the conclusion that in most cases the epilepsy worsening and cognitive decline are due to the progression of the underlying pathology or to its interference with the developmental programme, the notable exception being the epileptic encephalopathies with continuous epileptic activity during sleep.

Genetic epilepsies. Remarks on the proposed “Organization of the Epilepsies”

SUMMARYIntroduction.Genetic findings in several epilepsy syndromes provide insights into the pathophysiology of specific subtypes of epilepsy and into mechanisms of epileptogenesis, because the genes encoding ion channels, and proteins associated to the vesical synaptic cycle, or involved in energy metabolism, influence neuronal excitability.Aim.The following aspects of genetic epilepsies will be discussed: new proposed “organization of the epilepsies”, genetic and other etiologies, electroclinical syndromes and their genetics and genetic testing in the epilepsies.Methods.The updated review is based on OMIM™ (Online Mendelian Inheritance in Man).Review and remarks.Because of the vast genetic and phenotypic heterogeneity, bridging genotype and phenotype remains a major challenge in epilepsy genetics. The so-called “idiopathic” epilepsies are genetically determined. The new ILAE proposal on the “organization” of the epilepsies takes into account the genetic advances. However, despite proposed changes in the nomenclature, the concept of the electroclinical syndrome, i.e. seizure types, age-dependent onset, electroencephalographic criteria, and concomitant symptoms, such as movement disorders or developmental delay, remain important criteria to group the epilepsies. Although also the differentiation “generalized” versus “focal” is nowadays discussed critically, for practical reasons these categories remain valid. Similarly the categories “benign” syndromes of early childhood, epileptic encephalopathies, and fever-associated syndromes, have their utility.Conclusions.The large number of genetic defects in the epilepsies complicates their analysis. However, it is anticipated that novel genetic methods, that are able to analyze all known genes at a reasonable price, will help identify novel diagnostic and therapeutic avenues, including prognostic and genetic counseling. Today it is already possible to include into genetic testing genes responsible for the side effects of AEDs. In addition, for some epilepsy phenotypes it has became possible to predict the most efficacious antiepileptic drugs for patients based on their genetic makeup. Thus, the development of individualized medicine is expected to greatly improve the management of epilepsy patients.