ObjectiveThis study aims to examine the possible association between C-reactive protein (CRP) concentration and post-stroke seizures. MethodsPatients with a first-ever ischemic stroke and no history of epilepsy before stroke who admitted to Western China Hospital were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset. After a mean follow-up period of 2.5 years, a follow-up assessment was performed to identify post-stroke epilepsy. Logistic regression and Cox regression analyses were used to assess the relationship between CRP levels and post-stroke early-onset seizures or post-stroke epilepsy. ResultsAmong the 1, 116 patients included in our study, 36 (3.2%) patients had post-stroke early-onset seizures and 65 (5.8%) patients had post-stroke epilepsy. Elevated CRP levels were associated with a higher risk of post-stroke early-onset seizures (51.4±49.2 vs 15.9±12.9, P=0.023). This correlation was persisted even after adjusting for potential confounders[OR=1.008, 95%CI (1.003, 1.018); P=0.003]. No association was observed between CRP levels and post-stroke epilepsy. ConclusionsElevated CRP levels may be associated with higher risk of post-stroke seizures. However, because of the observational nature of the study, more studies are needed to confirm the results.
ObjectiveTo investigate the neuroprotective effects and mechanisms of selective histone deacetylases inhibitor MS-275 on rats after seizures. MethodsA total of 75 rats were randomly divided into 5 groups for treatment:control group,pilocarpine group, treatment group Ⅰ(administered with MS-275, 20mg/kg, once a day,intraperitoneally in 7 consecutive days), treatment group Ⅱ(administered with MS-275, 40mg/kg, once a day, intraperitoneally in 7 consecutive days), MS-275 pretreatment group. We used lithium and pilocarpin to induce seizures. Behaviors of rats in each group were observed. At 72 hours after seizures, Nissl staining and immunohistochemical were respectively used to evaluate the loss of neurons and histone acetylation levels of hippocampal CA1 and CA3 regions in each group. Escape latency in the control group, treatment group Ⅰ, treatment group Ⅱ and MS-275 pretreatment group were longer than pilocarpine group(P<0.05). ResultsCompared with the pilocarpine group, rats in MS-275 pretreatment group could delay pilocarpine-induced seizures and reduce mortality (P<0.05). Degree of neuronal loss and degeneration in both treatment group Ⅰ and treatment group Ⅱ were reduced compared with the pilocarpine group (P<0.05) and the level of histone acetylation in hippocampal CA1 and CA3 regions of the rats were increased compared with the pilocarpine group (P<0.05). ConclusionHDACs inhibitors MS-275 can improve the neuronal damage, histone deacetylation of rats' brain and rats cognitive decline, which can exert an neuroprotective effect on rats after seizures, whose mechanism may be related to its antiinflammatory effect.
Patients with autoimmune encephalitis are mainly characterized by behavioral, mental and motor abnormalities, neurological dysfunction, memory deficits and seizures. Different antibody types of autoimmune encephalitis its pathogenesis, clinical characteristics are different, in recent years found immune related epilepsy is closely related to autoimmune encephalitis, based on autoimmune encephalitis type is more, we choose more common autoimmune encephalitis, expounds its characteristics, to help clinical diagnosis.
ObjectiveExploring the influencing factors of acute phase (≤ 21 days) seizures and epilepsy in patients with Herpes simplex virus encephalitis (HSE) in our hospital, including emergency and inpatient wards, mainly from the perspective of the number of mNGS of Herpes simplex virus (HSV) in cerebrospinal fluid. MethodsFrom January to Octomber 2023, 28 emergency and inpatient patients in our hospital were collected, excepted clinical datas were not detailed. In the end, 24 patients with HSE diagnosed were included in the study, and their clinical datas were collected, including age, gender, acute encephalitis syndrome, the form of the seizure and the number of seizures, time of lumbar puncture, and various indicators of cerebrospinal fluid [pressure, protein, cell count (mononuclear and multinucleated cells), metagenomic Next-generation sequencing (mNGS), neural autoantibodied associated with autoimmune encephalitis], electroencephalogram, cranial imaging examination reports, and treatment plans.ResultsA total of 24 patients were enrolled, including 9 patients with a history of hypertension and 4 patients with a history of diabetes. There were 18 males and 6 females, with an average age of (53.17±17.19) years. The maximum age was 73 years old, and the minimum age was 21 years old. Among the 24 patients, one patient first presented to the local hospital and then transferred to our hospital for lumbar puncture, so the time from the onset of the disease to lumbar puncture was 30 days, and the other patient’s family members refused to complete lumbar puncture at first,so the time of lumbar puncture was 14 days from the onset of the disease. The remaining 22 patients were all completed lumbar puncture within 7 days of onset, and all emergency patients completed lumbar puncture within 24 hours of admission to the Emergency Department. mNGS results: 23 cases were HSV-1, and the remaining 1 case was HSV- 2. There were a total of 6 cases of seizures and epilepy in the acute phase (≤21 days), with focal or generalized seizures or epileptic status as the main form, and 2 cases of seizures occurred. Among these 8 patients, 5 showed lesions in the frontal and temporal lobes on enhanced cranial MRI, while the other 3 showed no specific features. At the same time, mNGS of cerebrospinal fluid suggested that the sequence number of HSV was greater than 3 000 was related with seizures and epilepsy with acute HSE. Conclusion Seizures and epileysy in acute HSE were related with the presences of intracranial cortical involvement,and the number of viral sequences in mNGS was closely related to acute phase seizures and epilepsy.
ObjectiveConstructing a prediction model for seizures after stroke, and exploring the risk factors that lead to seizures after stroke. MethodsA retrospective analysis was conducted on 1 741 patients with stroke admitted to People's Hospital of Zhongjiang from July 2020 to September 2022 who met the inclusion and exclusion criteria. These patients were followed up for one year after the occurrence of stroke to observe whether they experienced seizures. Patient data such as gender, age, diagnosis, National Institute of Health Stroke Scale (NIHSS) score, Activity of daily living (ADL) score, laboratory tests, and imaging examination data were recorded. Taking the occurrence of seizures as the outcome, an analysis was conducted on the above data. The Least absolute shrinkage and selection operator (LASSO) regression analysis was used to screen predictive variables, and multivariate Logistic regression analysis was performed. Subsequently, the data were randomly divided into a training set and a validation set in a 7:3 ratio. Construct prediction model, calculate the C-index, draw nomogram, calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) to evaluate the model's performance and clinical application value. ResultsThrough LASSO regression, nine non-zero coefficient predictive variables were identified: NIHSS score, homocysteine (Hcy), aspartate aminotransferase (AST), platelet count, hyperuricemia, hyponatremia, frontal lobe lesions, temporal lobe lesions, and pons lesions. Multivariate logistic regression analysis revealed that NIHSS score, Hcy, hyperuricemia, hyponatremia, and pons lesions were positively correlated with seizures after stroke, while AST and platelet count were negatively correlated with seizures after stroke. A nomogram for predicting seizures after stroke was established. The C-index of the training set and validation set were 0.854 [95%CI (0.841, 0.947)] and 0.838 [95%CI (0.800, 0.988)], respectively. The areas under the ROC curves were 0.842 [95%CI (0.777, 0.899)] and 0.829 [95%CI (0.694, 0.936)] respectively. Conclusion These nine variables can be used to predict seizures after stroke, and they provide new insights into its risk factors.
ObjectiveTo investigate the clinical electrophysiological characteristics of Cyclin-dependent kinase-like 5 gene induced developmental epileptic encephalopathy (CDKL5-DEE). MethodsThe clinical data and series of video EEGs of children with CDKL5-associated developmental epileptic encephalopathy (CDKL5-DEE) who were admitted to the Children’s Medical Center of Peking University First Hospital from June 2016 to May 2024 were retrospectively analyzed. Results A total of 16 patients with CDKL5-DEE were enrolled, including 13 females and 3 males. All patients had de novo variants of CDKL5 gene, including 6 cases of missense variants, 5 cases of frameshift variants, 4 cases of nonsense variants, and 1 case of large fragment deletion. The age of onset was 8 days (d) after birth ~1 year (y) and 10 months (m), and the median age was (85.94±95.76) days. Types of seizures at onset: 4 cases of tonic seizures [age of onset 10~52 days, median age (25.5±15.84) days]; There were 5 cases of focal seizures [age of onset 8 d~8 m, median age (77.76±85.97) d]. There were 4 cases of epileptic spasmodic seizures [age of onset 3 m~1 y 10 m, median age (6.25±3.49) m]; There were 2 cases of bilateral tonic-clonic seizures [age of onset 30~40 days, median age (35.00±5.00) days]; focal concurrent epileptic spasm seizures 1 case (age of onset 2 m). A total of 59 VEEG sessions were performed in the pediatric EEG room of Peking University First Hospital for 4 hours. All the results were abnormal, including 26 normal background, 25 slow rhythm difference with background, and 8 no background. The interictal was 16 posterior or focal discharges, 19 multifocal discharges, 17 generalized or accompanied by focal/multifocal discharges, and 7 hypsarrhythmia; The ictal was 33 epileptic seizures, 6 myoclonic seizures, 5 focal seizures, 2 tonic-clonic seizures, 2 atypical absence seizures, 2 tonic seizures, 1 myoclonic sequential focal seizure, 1 focal sequential epileptic spasm, and 1 hypermotor-tonic-spasms. The background of patients within 6 months of age was normal, and the background abnormality increased significantly with age. generalized discharges are evident after 2 years of age between seizures. Conclusion CDKL5-DEE seizures have an early onset and are refractory to medications. Epileptic spasms are the most common type of seizure in every patient and long-lasting, with generalized seizures increasing markedly with age. EEG is characterized by a normal background within 6 months. With the increase of age, the background and interictal discharges have a tendency to deteriorate.