PURPOSE: These case reports have been prepared to highlight the uncommon occurrence of anterior shoulder dislocation after an epileptic seizure, the recognition of which is important as this type of injury is associated with bony lesions and a high incidence of recurrence. MATERIALS AND METHODS: We report two cases of recurrent anterior dislocation of the shoulder due to grand mal epilepsy. These cases were treated as usual anterior dislocations of the shoulder, and were regularly followed to detect any recurrence of shoulder instability. RESULTS: Outcome of the surgery in the two cases was different because of the differences in seizure control. In the patient in whom seizures were well-controlled, there was no recurrence of instability, while the patient with poorly controlled seizures developed a recurrence of the dislocation following shoulder repair. CONCLUSION: The authors emphasize the need to control seizures in order to prevent injury recurrence in this subset of patients.
Dislocations ; Epilepsy ; Epilepsy, Tonic-Clonic ; Humans ; Incidence ; Recurrence ; Seizures ; Shoulder ; Shoulder Dislocation

OBJECTIVE: To investigate whether the tonic-clonic seizure (TCS) induced by intermittent photic stimulation (IPS)was generalized tonic-clonic seizure (GTCS)or partial secondarily tonic-clonic seizure (PGTCS),and to analyze the relationship between them. METHODS: Video-electroencephalogram (VEEG)database of Peking University First Hospital from March 2010 to October 2018 were reviewed. Fifteen cases with idiopathic epilepsy who had TCS induced by IPS were included in this study, and their clinical and electroencephalogram (EEG)characteristics were retrospectively analyzed. RESULTS: In this study, 4 of the 15 cases were boys and 11 were girls. The age of seizure onset ranged from 1 to 13 years. According to the medical records: 12 cases were considered as GTCS,while the remaining 3 cases were considered as PGTCS. The age at VEEG monitoring ranged from 2.5 to 16.0 years. All backgrounds of the VEEG were normal. Interictal discharges:generalized discharges in 11 cases, of which 4 cases coexisted with posterior discharges, 2 cases coexisted with Rolandic discharges, the other 5 cases merely had generalized discharges; merely focal discharges in two cases, one in the Rolandic area and the other in the posterior area; no interictal discharge in the remaining 2 cases. IPS induced photoparoxysmal response (PPR)results: 2 cases without PPR,the remaining 13 cases with PPR of generalized discharges, and 6 of the 13 cases coexisted with posterior discharges. IPS induced photoconvulsive response (PCR)results: GTCS in one case (contradictory to medical history),PGTCS in 11 cases (consistent with medical history),and GTCS and PGTCS hardly to distinguish in the remaining 3 cases. Of the three conditions above, there were generalized myoclonic seizures induced by IPS before TCS in 7 cases. CONCLUSION The medical history was unreliable in determining whether TCS was generalized or focal. Myoclonic seizures can coexist with PGTCS, and sometimes GTCS was indistinguishable from PGTCS, indicating that the dichotomy of seizure types need to be improved. Photosensitive TCS should be regarded as a continuum between focal and generalized seizures.
Electroencephalography ; Epilepsy, Generalized ; Epilepsy, Tonic-Clonic ; Female ; Humans ; Male ; Retrospective Studies ; Seizures

Epilepsy, Tonic-Clonic ; genetics ; physiopathology ; Genetic Diseases, Inborn ; genetics ; physiopathology ; Humans ; Syndrome

OBJECTIVETo summarize the value of clinical features, CSF, imaging and EEG in diagnosing viral encephalitis accompanying generalized tonic clonic seizure (GTCS).

METHODSThe clinical, imaging and EEG characteristic of 30 patients with viral encephalitis accompanying GTCS were retrospectively analyzed.

RESULTSOf the 30 cases with viral encephalitis, 21 cases GTCS attacked (70%) within 14 days, 9 cases had GTCS (30%) in 15-28 days. 27 cases CSF were abnormal with the pressure, cell number, protein. The incidence of positive pathogenicity was 12/16; 19 cases MRI had abnormal signal. All the patients had abnormal EEG during the disease.

CONCLUSIONThe clinical features, CSF, imaging and EEG were all important in diagnosing and estimate of viral encephalitis accompanying GTCS.

Adolescent ; Adult ; Aged ; Electroencephalography ; Encephalitis, Viral ; diagnosis ; Epilepsy, Tonic-Clonic ; diagnosis ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Primary disorders of the nervous system admitted to the Pediatric ward of Seoul National University Hospital during 10 years from January 1969 till December 1978 were analysed to observe particularly the annual change of the incidence. Total number of the diseases of the nervous system was 1522, about 20.2% of the total admitted patients during this period. Annual incidence of the diseases of the nervous system was decreasing. It is mainly due to decreased incidence of the infectious diseases, such as tuberculous meningitis, encephalitis and encephalopathy. The most common deseases of the nervous system during the 10 years were tuberculous meningitis 370 cases (24.3%), aseptic meningitis 122 cases (8.0%), grand mal epilepsy 102 cases (6.7%), unspecified convulsion 79 cases (5.2%), bacterial meningitis 77 cases (5.1%), infectious polyneuritis 68 cases (4.5%), encephalitis 63 cases (4.1%), febrile convulsion 59 cases (3.9%), and unspecified encephalopathy 57 cases (3.7%) in the order of frequency. The incidences of tuberculous meningitis was noted in March, April and May, aseotic meningitis in June, July, August and September, encephalitis in September and October, encephalopathy in June, July, and August, and infectious polyneuritis, in July and August. Mumps meningo encephalities predominantly affected male children. Bacterial meningitis was most common before 2 years of age, especially before 6 months, and tuberculous meningitis during second and third year of life. Aseptic meningitis and mumps meningitis wee mots common at 7 years of age. Encephalopathy occured commonly before one year of age, and Reye's syndrome before four years of age. Unspecified convulsion was commonly observeb before 6 months of age, and febrile convulsion before one year. Infectius ployneuritis was common due to meninitis (76 cases) particularly tuberculous meningitis (50 cases), the next was encephalopathy, unspecified (31 cases).
Child ; Communicable Diseases ; Encephalitis ; Epilepsy, Tonic-Clonic ; Humans ; Incidence* ; Male ; Meningitis ; Meningitis, Aseptic ; Meningitis, Bacterial ; Mumps ; Nervous System* ; Neuritis ; Reye Syndrome ; Seizures ; Seizures, Febrile ; Seoul ; Tuberculosis, Meningeal

A 38-year-old woman presented with massive hemoptysis ( 200 mL/ 24 hours) occurring abruptly after generalized tonic clonic seizure. She experienced similar episodes of hemoptysis on three later occasions. Although the coexistence of hemoptysis and seizure has been reported, albeit rarely, as a clinical manifestation of postictal neurogenic pulmonary edema, massive hemoptysis after seizure is an extremely rare event with no recurrent cases of such episodes having ever been reported. The coexistence of hemoptysis and seizure increases the difficulty in diagnosis for the clinician. We describe the differential diagnosis among the diseases capable of causing seizure and hemoptysis.
Adult ; Case Report ; Diagnosis, Differential ; Epilepsy, Tonic-Clonic/*complications ; Female ; Hemoptysis/*diagnosis/etiology ; Human ; Pulmonary Alveoli ; Pulmonary Edema/complications ; Recurrence ; *Respiration, Artificial

A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients.
Adolescent ; Adult ; Brain ; Bullying ; Child ; Depression ; Early Intervention (Education) ; Epilepsy ; Epilepsy, Temporal Lobe* ; Epilepsy, Tonic-Clonic ; Female ; Fluoxetine ; Hallucinations ; Humans ; Magnetic Resonance Imaging ; Male ; Memory, Episodic ; Residence Characteristics ; Sclerosis* ; Sex Offenses ; Suicidal Ideation ; Aripiprazole

OBJECTIVE: To examine the changes of metabolites in the bilateral thalamus of patients with secondarily generalized tonic-clonic seizure (SGTCS) and to explore the mechanism of SGTCS. METHODS: Thirty patients with SGTCS (epilepsy group) and 30 matched healthy controls (control group) were examined by 1H-magnetic resonance spectroscopy (1H-MRS). The levels of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine phosphocreatine (Cr-PCr), and myo-inositol (mI) of the bilateral thalamus were measured in both the epilepsy group and the control group. The ratios of NAA/Cr-PCr, NAA/(Cr-PCr+Cho), Cho/Cr-PCr and mI/Cr-PCr were compared and analyzed in the 2 groups. RESULTS: The ratios of NAA/Cr-PCr, and NAA/(Cr-PCr+Cho)(1.7074 ± 0.2214; 0.9333 ± 0.2173) in the left thalamus in the epilepsy group were significantly lower than those in the control group(1.8834 ±0.2093; 1.1243 ±0.2447)(P<0.05). The ratios of NAA/Cr-PCr, and NAA/(Cr- PCr+Cho) (1.7472 ±0.2439; 0.9165 ±0.2462) in the right thalamus in the epilepsy group were also significantly lower than those in the control group(1.8925 ± 0.2004; 1.0941 ± 0.2372)(P<0.05). There were no significant differences in the ratios of NAA/Cr-PCr, NAA/(Cr-PCr+Cho), Cho/Cr- PCr, and mI/Cr-PCr between the bilateral thalamis in the epilepsy group (P>0.05). CONCLUSION There is neuronal dysfunction in the bilateral thalamus in the epilepsy group. Abnormal changes of the bilateral thalamus are involved in the mechanism of SGTCS.
Adolescent ; Adult ; Aspartic Acid ; analogs & derivatives ; analysis ; Brain Chemistry ; Case-Control Studies ; Choline ; analysis ; Energy Metabolism ; physiology ; Epilepsy, Generalized ; metabolism ; physiopathology ; Epilepsy, Tonic-Clonic ; metabolism ; physiopathology ; Female ; Humans ; Magnetic Resonance Spectroscopy ; methods ; Male ; Middle Aged ; Thalamus ; metabolism ; physiopathology ; Young Adult

OBJECTIVEThe study was designed to examine the clinical and electroencephalographic characteristics of children with Jeavons syndrome.

METHODVideo-electroencephalography (VEEG) monitoring was carried out in 9 patients with Jeavons syndrome. The clinical and electroencephalographic characteristics, treatment and prognoses were analyzed.

RESULTOf the 9 patients, 8 were female, and 1 was male. The onset age of children with eyelid myoclonia (EM) was from 3 to 9 years old. It was obtained through the chief complaint, prosecution or VEEG monitoring. Three cases were misdiagnosed and 2 cases were overlooked initially. Seven out of 9 patients had generalized tonic clonic seizures (GTCS) during the course of disease, of whom 5 experienced only one episode. GTCS was the cause for the first visits to hospital in 5 patients. Since the clinical manifestations of EM with or without absence were often slight, VEEG monitoring with eye closure and intermittent photic stimulation tests helped to induce discharges and seizures. Eye closure was more potent than intermittent photic stimulation as a triggering factor. Ictal EEG showed 3 - 6 Hz generalized spike and waves and polyspikes burst. The main treatment option was valproate monotherapy (6 cases) or combined with other antiepileptic drugs (1 case). Levetiracetam, lamotrigine and topiramate were also used in patients and effective to some degree. Two patients lost follow up. The age of 7 patients at follow-up ranged from 9 y to 15 y. Seizures were controlled in 1 case, suspiciously controlled in 1 case, decreased in frequency in 4 cases and were still frequent in 1 case. During follow-up, normal intelligence was found in the former 2 cases, difficult learning in 2 cases, and slightly intellectual impairment in 2 cases.

CONCLUSIONJeavons syndrome is one of the idiopathic generalized epilepsies characterized by EM with or without absence. The age of seizure onset might be difficult to be exactly established, as EM was often misinterpreted and overlooked initially. Clinical history combined with VEEG monitoring with eye closure and intermittent photic stimulation tests could diagnose this disease. Valproate and other new antiepileptic drugs were effective for this disease. Jeavons syndrome is a lifelong disorder. Seizures sometimes could be well controlled. When seizures were resistant to treatment, cognitive and intellectual impairment might occur.

Adolescent ; Age of Onset ; Anticonvulsants ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Electroencephalography ; Electromyography ; Epilepsies, Myoclonic ; diagnosis ; drug therapy ; physiopathology ; Epilepsy, Tonic-Clonic ; diagnosis ; drug therapy ; physiopathology ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Male ; Myoclonus ; diagnosis ; drug therapy ; physiopathology ; Photic Stimulation ; methods ; Retrospective Studies ; Seizures ; physiopathology ; Syndrome ; Valproic Acid ; administration & dosage ; therapeutic use

INTRODUCTIONNeuropsychiatric manifestations can occur in up to two-thirds of patients with systemic lupus erythematosus (SLE). The presentations as well as the underlying immunopathogenic mechanisms can be heterogeneous and therefore have an enormous impact on therapeutic options.

CLINICAL PICTUREWe describe 2 patients who presented similarly with acute onset binocular reversible visual loss. The first patient had anti-phospholipid syndrome and optic neuritis, while the second patient suffered from posterior reversible leukoencephalopathy syndrome.

TREATMENTPatient one was treated with anti-coagulation and immunosuppression while the second patient required the withdrawal of immunosuppression and supportive therapy.

OUTCOMEBoth patients responded favourably and had complete visual recovery.

CONCLUSIONSDifferent management strategies have to be employed for similar presentations having different aetiologies, underscoring the need for constant clinical vigilance.

Adult ; Antiphospholipid Syndrome ; complications ; etiology ; Brain Diseases ; etiology ; immunology ; Epilepsy, Tonic-Clonic ; etiology ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; microbiology ; physiopathology ; therapy ; Lupus Vasculitis, Central Nervous System ; diagnosis ; Magnetic Resonance Imaging ; Optic Neuritis ; etiology ; Salmonella Infections ; complications ; Salmonella enteritidis ; Time Factors ; Vision Disorders ; etiology ; immunology