This blinded electroencephalographic study in Creutzfeldt-Jakob disease confirms the high diagnostic value of electroencephalography, as previously reported by open studies.

Ischemic and hemorrhagic strokes are established etiological factors for recurrent seizures. Still, only few prospective data are available to predict post-stroke epilepsy and to choose the best point in time and anticonvulsive agent for treatment. In a prospective study we evaluated 264 consecutive stroke patients and assessed their post-stroke epilepsy risk within a follow-up of 1 year. Data on ten risk items concerning the stroke localisation, persisting neurological deficit, stroke subtype, established diagnosis of vascular encephalopathy, early- and late-onset seizures were collected using a post-stroke epilepsy risk scale (PoSERS). All patients underwent brain imaging with either CT, MRI or both and 148 patients underwent electroencephalography. The overall frequency of early-onset seizures within 14 days was 4.5%, of at least one late seizure 6.4% and of epilepsy 3.8%. Chi-Square tests showed significantly higher relative frequencies of seven of the ten clinical characteristics in post-stroke epilepsy patients. The total scale showed moderate sensitivity (70%) and positive predictive value (87.5%) while specificity (99.6%) and negative predictive value (98.8%) were relatively high. The EEG showed little value in predicting post-stroke epilepsy. The PoSERS appears to be a valuable tool to predict the risk for post-stroke epilepsy within the first few days after a stroke.

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Summary:Purpose: To investigate and compare the temporal profile of serial levels of neuron-specific enolase (NSE) and prolactin in serum from patients after single epileptic seizures.Methods: Measurement of NSE and prolactin by sensitive immunoassays in 21 patients with complex partial seizure (CPSs; n = 11) and secondarily generalized tonic-clonic seizures (SGTCSs; n = 10) during continuous video-EEG monitoring at four different time points (1, 3, 6, and 24 h after ictal event). Statistical analysis was performed by using a repeatedmeasures analysis of variance (ANOVA) model.Results: Mean ? SD values for NSE levels (ng/ml) were 12.5 2 4.4 ( 1 h), 10.8 ? 3.8 (3 h), 1 I. 1 f 4.9 (6 h), and 8.2 I+_ I .9 (24 h). The corresponding prolactin levels (mU/L) were 1,311 ? 1,034, 232 ? 158, 237 I+_ 175, and 251 ? 98. There was a significant decrease of NSE and prolactin levels over time (p < 0.001). The pair-wise comparison of NSE levels showed significant differences between the time points 1 vs. 24 h (p < 0.001), 3 vs. 24 h (p = 0.007), and 6 vs. 24 h (p = 0.009). In contrast, serum prolactin levels showed a significant difference between 1 vs. 3 h (p < 0.001) only. Most of the NSE levels remained normal after CPSs and SGTCSs. At I h after the seizure, only 33% of the subjects had increased NSE, whereas abnormal prolactin levels occurred with a sensitivity of 80%.Conclusions: In contrast to prolactin, serum NSE is not a sensitive marker of individual seizures. Only some individuals showed an increase of NSE beyond the prolactin-sensitive time frame after a single seizure, and mean NSE levels were not significantly increased compared with those of normal controls.

Near infrared spectroscopy (NIRS) is a non-invasive method to measure cerebral tissue oxygenation continuously with an adhesive optode system which can be easily placed on the skin. We coupled NIRS with video-electroencephalography (video-EEG) during the presurgical evaluation of two patients with intractable localization-related epilepsy of mesial temporal origin. Cerebral oxygen saturation was measured either ipsilaterally (three seizures) or contralaterally (four seizures) to the primary epileptogenic zone. Since NIRS measures cerebral tissue oxygenation in a depth of only few centimetres, it did not record within the primary epileptogenic zone in our patients. Therefore we decided to place the NIRS optodes comfortably for the patients on the hairless skin corresponding with measurement of the oxygenation within the corresponding frontal cortex. Ipsilateral measurement revealed a marked desaturation in the course of the seizure with a postictal maximum whereas contralateral findings were inconsistent. The favourable outcome of selective amygdalahippocampectomy in both cases retrospectively confirmed the correct lateralization by video-EEG and the concordant NIRS findings. Our preliminary results suggest that NIRS might be a simple, cost-effective and non-invasive additional method to lateralize the primary epileptogenic zone in temporal lobe epilepsy and should be further investigated in larger series of patients.