Seizures are a common presenting manifestation in patients in a nonketotic hyperglycemic(NKH) hyperosmolar state and the MR findings are typically hyperintense on T2 weighted (T2-W) and fluid attenuated inversion recovery (FLAIR) images. We recently experienced a case of the patient with partial seizure and nonketotic hyperglycemia who showed T2-W and FLAIR hypointensities with T1 weighted (T1-W) contrast enhancement.
Humans ; Hyperglycemia ; Seizures

Respiratory syncytial virus (RSV) is an extremely common cause of childhood respiratory infection resulting in significant morbidity and mortality especially in young infants and premature babies. There have been a few reports about seizures or encephalopathy in children with RSV infection. We describe here refractory status epilepticus in two preterm babies with severe respiratory illness by RSV infection. The seizures were refractory to phenobarbital and diphenylhydantoin, but ceased by continuous midazolam infusion. After several days with clinical improvement of respiratory illness, their seizures were stable on phenobarbital maintenance only. Although rare, status epilepticus can be a form of neurologic manifestation of severe RSV infection in preterm baby. We must be aware of their neurological manifestations; continuous EEG monitoring is helpful for the diagnosis of the status epilepticus in infants.
Child ; Electroencephalography ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Midazolam ; Neurologic Manifestations ; Phenobarbital ; Phenytoin ; Respiratory Syncytial Viruses ; Seizures ; Status Epilepticus

PURPOSE: The aim of this study was to evaluate the efficacy and safety of levetiracetam in children younger than 4 years with intractable epilepsy. METHODS: A retrospective analysis of pediatric epilepsy patients was performed. Data were obtained from the medical records of 30 patients (male 19, female 11) with intractable epilepsy, who were treated with levetiracetam. RESULTS: Seizure types were partial in 18, and generalized in 12. Fifteen patients had symptomatic etiologies. The median age of the patients at the time of levetiracetam administration was 26 months old (range: 4-47 months). The median starting dose was 13 mg/kg/ day, and the median maintenance dose was 52 mg/kg/day (range: 10-123 mg/kg/day). Ten (10/30, 33%) patients experienced more than 50% reduction in seizure frequency, and 4 (4/30, 13%) partial epilepsy patients became seizure-free. Eight partial epilepsy patients (44%) had more than 50% seizure reduction, while 2 patients (17%) with generalized epilepsy did. All of patients with infantile spasms and Lennox-Gastaut syndrome except one, had less than 50% reduction in seizure frequency. Adverse events reported in 8 patients (27%), included lethargy, behavioral problems, sleep disturbance, and seizure aggravation. CONCLUSIONS:Levetiracetam is effective in children aged 4 years or less with intractable epilepsy, and also seems to be safe to use in this age group.
Aged ; Anticonvulsants ; Child ; Child, Preschool ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Female ; Humans ; Infant ; Infant, Newborn ; Intellectual Disability ; Lethargy ; Medical Records ; Piracetam ; Retrospective Studies ; Seizures ; Spasms, Infantile

The definition of refractory status epilepticus (RSE) is the state of epilepticus that persists for longer than 60 minutes despite an adequate dose of benzodiazepine and an antiepileptic drug. Topiramate is a broad-spectrum antiepileptic drug used as a monotherapy as well as an adjunctive therapy in the treatment of epilepsy. We encountered a 32-month-old girl with RSE, who showed spastic quadriplegia, hydrocephalus and a previous history of 3 times recurrence of status epilepticus in the presence of global development. Although the girl was treated with lorazepam, phenytoin, phenobarbital and even with midazolam, seizure lasted for more than 60 minutes. Through pentobarbital coma, seizure was controlled clinically on the state of EEG. However, it recurred. Therefore, the patient was treated with an overdose amount of topiramate (10 mg/kg/day) by nasogastric tube without titration as an add-on therapy and then treated with a reduced amount of topiramate (4 mg/kg/day). Finally, the seizure became controlled.
Benzodiazepines ; Child, Preschool ; Coma ; Electroencephalography ; Epilepsy ; Female ; Humans ; Hydrocephalus ; Lorazepam ; Midazolam ; Pentobarbital ; Phenobarbital ; Phenytoin ; Quadriplegia ; Recurrence ; Seizures ; Status Epilepticus*

Insulinoma with hyperproinsulinemia and normal serum insulin level is a rare disease. Because of the neuroglycopenic symptoms, the initial diagnosis tends to be made as epilepsy or as psychosis. A 43-year-old man was admitted to our hospital because of recurrent confusional episodes. Symptoms are intermittent and consist of staring, confusion, amnesia, and bizarre behavior. Vital signs during the episode were normal but the serum glucose level was 27 mg/dl. The serum level of insulin during the episode was lower than normal and those of proinsulin and growth hormone were higher than normal. Solitary pancreatic mass was found by abdominal CT, measuring 15 mm in diameter. Pathologic evaluation showed islet cell tumor. This suggests that the serum level of proinsulin should be checked when insulinoma with neuroglycopenic symptom is suspected.
Adenoma, Islet Cell ; Adult ; Amnesia ; Blood Glucose ; Diagnosis ; Epilepsy ; Growth Hormone ; Humans ; Insulin ; Insulinoma* ; Proinsulin ; Psychotic Disorders ; Rare Diseases ; Seizures* ; Tomography, X-Ray Computed ; Vital Signs

Idiopathic hypertrophic pachymeningitis is a clinical disorder caused by a localized or diffuse thickening of the dura mater, with an associated chronic inflammation. This can be diagnosed when there is no evidence of other etiologies such as trauma, infection, tumors, and Wegener's disease. Clinical manifestations are chronic headache with or without neurological manifestations such as cranial nerve palsies, cerebellar ataxia, neuro-ophthalmologic complications, and rarely clinical seizures. We described a patient with simple partial seizures with focal sensory and motor symptoms in the right hand as an initial and the only clinical manifestation, accompanied by a tumor-like lesion in the left parietal convexity on brain MRI. The patient underwent a lesionectomy, and the seizures have been well controlled so far without immunosuppressant treatment.
Brain ; Cerebellar Ataxia ; Cranial Nerve Diseases ; Dura Mater ; Epilepsies, Partial ; Hand ; Headache Disorders ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Meningitis* ; Neurologic Manifestations ; Rabeprazole ; Seizures*

The psychomotor variant is a rare EEG pattern as a rhythmical activity at about 6 Hz that may occur in brief or longer runs, independently in the temporal areas during drowsy mental state. It was originally named by Gibbs and Gibbs because of its existence during the ictal or interictal period in patients with psychomotor seizures. We report a 14-year-old girl with juvenile absence epilepsy who showed the long runs of psychomotor variant followed by generalized ictal discharges.
Adolescent ; Electroencephalography ; Epilepsy, Absence* ; Female ; Humans ; Seizures

There have been very few reports on reflex seizures induced by writing. Complex precipitating behaviors such as calculation, writing, copying of complicated figure, and spatial construction have been recognized as triggering factor of epileptic seizures. We report a case of a patient with a very unusual form of complex reflex epilepsy in which seizures are usually induced by writing or spatial construction. Neurological examination was normal and brain magnetic resonance imaging showed mild brain atrophy without focal lesion. During long-term video-EEG monitoring, she was instructed to write a letter with the right hand. About 20 minutes after writing, she experienced similar aura and motion arrest and then showed an elevation of bilateral upper extremities like myoclonic jerk followed by generalized tonic clonic seizure. On ictal EEG, spike and wave complexes appeared from both centroparietal region followed by 10 Hz rhythmic activities for 20 seconds. Interictal EEG was normal. Ictal-interictal subtraction image of brain SPECT (99mTc-HMPAO) showed hyperperfusion in the middle frontal gyrus and precentral gyrus of left frontal lobe and superior and inferior frontal gyrus of right frontal lobe. We suggest that this reflex epilepsy might be originated from both central areas with maximum on the left side. Oxcarbazepine was effective in controlling this reflex epileptic seizure.
Atrophy ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Frontal Lobe ; Hand* ; Humans ; Magnetic Resonance Imaging ; Myoclonus ; Neurologic Examination ; Reflex* ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Upper Extremity ; Writing

Reflex epilepsy describes seizures which are precipitated by clearly recognized stimuli. Reflex epileptic seizures triggered by tooth brushing are rare. We report a case with reflex epilepsy occurring exclusively during tooth brushing. He began having seizures at age 28. Neurological examinations and brain magnetic resonance images were found normal. On long term video-EEG monitoring, he presented two episodes of simple partial seizure induced by brushing molar and premolar teeth, which was right facial clonic movement persisting 3-5 seconds. He was unresponsive during the event, but had no postictal confusion. Ictal EEG showed 6 Hz rhythmic theta activity in the left frontocentral area. Interictal EEG was normal. The findings of EEG suggest that this reflex epilepsy might have epileptic focus in the left frontocentral area. Reasonable precaution such as gargling or less vigorous brushing of his teeth with fingers effectively prevented seizure recurrence.
Bicuspid ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Fingers ; Molar ; Neurologic Examination ; Recurrence ; Reflex* ; Seizures ; Tooth*

PURPOSE: To determine which factors are influential in complementary and alternative medicine (CAM) utilization in people with epilepsy (PWE). METHOD: The 246 adult PWE (53.7% male, mean age 33.6 years) were recruited from out-patient clinic of a tertiary care hospital. Data about CAM utilization in the last five years and willingness of CAM use in the future were collected via a face-to-face semi-structured interview. RESULTS: 1) The utilization rate of CAM among PWE was 31.3% for the last 5 years. On univariate analyses, it was significantly associated with several variables such as men, younger age, shorter epilepsy duration, higher educational level, higher economic status, and the belief in safety of CAM use. Multivariate analyses identified men (p=.021 OR=2.3 [95% CI=1.1 to 4.9]), higher economic status (p=.010, OR=2.5 [95% CI=1.2 to 5.0]), and the belief in safety of CAM use (p=.001, OR=1.9 [95% CI=1.3 to 2.9]). 2) Out of our participants, 30.5% reported that they were willing to utilize CAM for their epilepsy in the future. Univariate analyses showed that it was related to experience of CAM use in the past, higher economic status, and the belief in safety of CAM use. Multivariate analyses identified experience of CAM use in the past (p=.000, OR=8.4 [95% CI=4.0 to 17.7]) and the belief in safety of CAM use (p=.002, OR=1.7 [95% CI=1.2 to 2.6]). CONCLUSION: One third of PWE reported to have use the CAM in the past or to have willingness of the CAM use in the future. The important factors contributing to the CAM use were gender, economic status, experience of the CAM use in the past, and the belief in safety of the CAM use.
Adult ; Complementary Therapies* ; Epilepsy* ; Humans ; Male ; Multivariate Analysis ; Outpatients ; Tertiary Healthcare