Postictal aggression (PIA) is an under-researched phenomenon with potentially harmful consequences for patients and their environment. This study assessed the prevalence of PIA, its associated clinical variables, and its relationship with quality of life (QoL), anxiety, and depression. In this cross-sectional study, consecutive patients with epilepsy (≥ 1 seizure in the past 12 months; age ≥ 16 years) were surveyed using standardized questionnaires in a tertiary epilepsy center. Occurrence of PIA was retrospectively assessed over the preceding 12 months and defined by a score of ≥ 2 on the Overt aggression scale modified (OAS-M). Anxiety and depression were measured with the Hospital anxiety and depression scale (HADS-A, HADS-D) and the Neurological disorders depression inventory in epilepsy (NDDI-E). A total of 201 patients were included (57

Der unfreiwillige Fahrraddiebstahl -62-jährige Patientin mit fulminant verlaufender akuter Bewusstseinsstörung Anamnese Eine 62-jährige Patientin wurde mit dem Rettungswagen aufgrund einer qualitativen Bewusstseinsstörung und Fieber (39,5 °C) in unsere Klinik eingeliefert.Sie war zuvor verwirrt auf der Straße aufgefunden worden, als

Die meisten epileptischen Anfälle stellen per se keinen Notfall dar, sie sind das führende Symptom der Erkrankung Epilepsie. Ein erster epileptischer Anfall ist aber bis zum Beweis des Gegenteils ein Notfall, da er in ca. 30 % der Fälle akut-symptomatischer Genese und somit Ausdruck einer gravierenden systemischen Störung oder einer akuten Hirnerkrankung ist. Treten innerhalb von 24 h 3 oder mehr epileptische Anfälle auf, spricht man von einer Anfallsserie. Ein Anfall mit einer Dauer > 5 min definiert einen Status epilepticus. Beide Konstellationen sind ein Notfall, zu dessen Unterbrechung initial Benzodiazepine zum Einsatz kommen. Psychogene nicht-epileptische Anfälle stellen eine besondere Herausforderung in der differenzialdiagnostischen Abgrenzung zu epileptischen Anfällen und im akuten Management dar. Insbesondere generalisierte tonisch-klonische Anfälle können zu äußeren Verletzungen, Frakturen, Rhabdomyolyse und zum SUDEP („sudden unexpected death in epilepsy“) führen.

Introduction. In patients with focal drug-resistant epilepsy (DRE), intracranial electroencephalography (iEEG) with subdural electrodes (SDE) is used to delineate the seizure onset zone (SOZ) and to distinguish eloquent cortex areals, if non-invasive diagnostics did not yield conclusive results. Previous studies have shown ambiguous findings on the significance of iEEG parameters with respect to prediction of seizure freedom after resective epilepsy surgery. Most studies focused on subgroups of patients, such as those with frontal or temporal lobe epilepsy, or on some iEEG parameters, only. To that end, we comprehensively analyzed the significance of several iEEG parameters in one set of consecutive patients with DRE.Methods. All patients who had undergone invasive monitoring with SDE between 2005 and 2015 at our tertiary epilepsy center were included in this study1. We retrospectively analyzed iEEG parameters including seizure onset pattern (SOP), size of SOZ, latency to EEG seizure propagation and latency from clinical to EEG seizure onset. Furthermore, we assessed associations with post-operative seizure freedom, histopathology und brain region of SOZ.Results. Eighty-one patients (34 female) with 324 seizures were assessed. Low-voltage fast activity (LVFA, 37%) and sharp activity < 13 Hz (30%) were the most frequent SOPs. Focal SOZ (≤2 cm) was the only iEEG parameter independently associated with 1-year post-operative seizure freedom (OR 4.1, 95% CI 1.433–11.679). While no SOP was linked to specific histopathologies, LVFA was associated with temporal neocortical SOZ (p < 0.01). Median latencies to EEG seizure propagation were significantly longer (p < 0.001) in seizures originating from temporo-mesial SOZ (median 16.0 s) compared with temporo-neocortical (median 8.0 s) and frontal seizure onset (median 5.5 s). Also, latencies from clinical to EEG seizure onset were significantly longer (p < 0.001) in seizures from temporo-mesial SOZ (median −20.0 s) compared with temporo-neocortical (median −12.0 s) and frontal seizure onset (median −6.0 s).Discussion. A focal EEG seizure onset but no specific SOP predicted seizure freedom after surgery. Also, different SOPs could be generated by the same histopathology and vice versa, putting clinical significance of SOPs into question. LVFA was associated with temporal neocortical seizure onset, possibly indicating a close-by seizure generator. Longer latencies until seizure spread and clinical signs or symptoms in seizures originating from temporo-mesial SOZ may be explained by inhibitory circuits in the hippocampus.Reference1. Steinbart D, Steinbrenner M, Oltmanns F, Holtkamp M. Prediction of seizure freedom after epilepsy surgery – critical reappraisal of significance of intracranial EEG parameters. Clin Neurophysiol. 2020;131(11):2682-2690. doi:https://doi.org/10.1016/j.clinph.2020.08.018