Early specialized care after a first unprovoked epileptic seizure

Fisch, L.; Lascano, Agustina Maria; Vernaz, Nathalie; Girardin, François; Kapina, Viktoria; Heydrich, Lukas; Rutschmann, O.; Sarasin, François; Vargas, Maria Isabel; Picard, Fabienne; Vulliémoz, Serge; Héritier-Barras, Anne-Chantal; Seeck, Margitta

doi:10.1007/s00415-016-8272-3

Cited by 26 publications

(29 citation statements)

References 24 publications

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“…To the best of our knowledge, this study is the first demonstration of a dynamical change in focal epilepsy. Identifying such critical changes in human epilepsy would undoubtedly influence the timing of interventional treatments (Fisch et al, 2016) that are essential to avoid potentially dangerous, lengthy drug trials. Very few studies exist on early surgical treatments (Engel et al, 2012) and their long-term outcomes compared with conventional studies in which the average duration of epilepsy is ϳ18 -25 years.…”

Section: Ef Silencing Is Ineffective In Treating the Epileptic Networmentioning

confidence: 99%

Electrophysiological Evidence for the Development of a Self-Sustained Large-Scale Epileptic Network in the Kainate Mouse Model of Temporal Lobe Epilepsy

et al. 2018

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Most research on focal epilepsy focuses on mechanisms of seizure generation in the primary epileptic focus (EF). However, neurological deficits that are not directly linked to seizure activity and that may persist after focus removal are frequent. The recruitment of remote brain regions of an epileptic network (EN) is recognized as a possible cause, but a profound lack of experimental evidence exists concerning their recruitment and the type of pathological activities they exhibit. We studied the development of epileptic activities at the large-scale in male mice of the kainate model of unilateral temporal lobe epilepsy using high-density surface EEG and multiple-site intracortical recordings. We show that, along with focal spikes and fast ripples that remain localized to the injected hippocampus (i.e., the EF), a subpopulation of spikes that propagate across the brain progressively emerges even before the expression of seizures. The spatiotemporal propagation of these generalized spikes (GSs) is highly stable within and across animals, defining a large-scale EN comprising both hippocampal regions and frontal cortices. Interestingly, GSs are often concomitant with muscular twitches. In addition, while fast ripples are, as expected, highly frequent in the EF, they also emerge in remote cortical regions and in particular in frontal regions where GSs propagate. Finally, we demonstrate that these remote interictal activities are dependent on the focus in the early phase of the disease but continue to be expressed after focus silencing at later stages. Our results provide evidence that neuronal networks outside the initial focus are progressively altered during epileptogenesis. It has long been held that the epileptic focus is responsible for triggering seizures and driving interictal activities. However, focal epilepsies are associated with heterogeneous symptoms, calling into question the concept of a strictly focal disease. Using the mouse model of hippocampal sclerosis, this work demonstrates that focal epilepsy leads to the development of pathological activities specific to the epileptic condition, notably fast ripples, that appear outside of the primary epileptic focus. Whereas these activities are dependent on the focus early in the disease, focus silencing fails to control them in the chronic stage. Thus, dynamical changes specific to the epileptic condition are built up outside of the epileptic focus along with disease progression, which provides supporting evidence for network alterations in focal epilepsy.

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Section: Ef Silencing Is Ineffective In Treating the Epileptic Networmentioning

confidence: 99%

Electrophysiological Evidence for the Development of a Self-Sustained Large-Scale Epileptic Network in the Kainate Mouse Model of Temporal Lobe Epilepsy

et al. 2018

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“…In our study, only 49% of patients referred to our First Seizure Clinic were given a diagnosis of epilepsy or a true first seizure, reflecting the poor diagnostic accuracy of the referral source. This low diagnostic specificity of referrals has been noted in other First Seizure Clinics 6–9 . In our study, out of 181 patients, 39 patients were given the diagnosis of epilepsy and 50 patients were given the diagnosis first seizures when assessed in the First Seizure Clinic.…”

Section: Discussionmentioning

confidence: 51%

Long‐term outcome of 200 patients referred to a first seizure clinic

et al. 2020

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Patients presenting to the emergency department or their GP's office with a witnessed or unwitnessed first seizure is a frequent clinical challenge. There are estimates that 8% of the population will experience a seizure in their lifetimes 1 but if these events reflect true epileptic seizures is unclear. Although not every patient with a seizure will go on to develop epilepsy, the likelihood of recurrence

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“…Early consultation with an epileptologist after the first seizure and a comprehensive follow up with investigations such as EEG and MRI scanning has shown benefit for a faster diagnosis, better patient compliance with anti-epileptic medication and to delay a recurrence of seizures (for up to 12 months of follow up) [ 8 ]. However, this ideal picture is difficult to achieve in the “real world”.…”

Section: Main Textmentioning

confidence: 99%

Is there a delay in seeking medical care after the first seizure in “resource limited settings”: a pilot study from Sri Lanka

et al. 2018

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ObjectivesCurrent guidelines suggest that patients presenting with the first seizure should be assessed by a specialist, preferably with investigations such as electroencephalography and imaging to reach a definitive diagnosis. We conducted a cross sectional study among patients with confirmed epilepsy, at a tertiary level neurology clinic in Sri Lanka with the aim of assessing delays in first contact with a medical doctor and in performing key investigations after the first seizure.ResultsMajority had sought medical attention within 24 h of the first seizure (71.2%) and had seen a specialist within the 1st week since the seizure (61%). Also a significant proportion had completed key investigations such as electroencephalography (63.2%) and brain imaging within a month (51%) since the first medical consultation. Of many socio-demographic and illness related factors examined, only a non-generalized tonic–clonic presentation was significantly associated with delay in seeking medical help.

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Early specialized care after a first unprovoked epileptic seizure

Cited by 26 publications

References 24 publications

Electrophysiological Evidence for the Development of a Self-Sustained Large-Scale Epileptic Network in the Kainate Mouse Model of Temporal Lobe Epilepsy

Electrophysiological Evidence for the Development of a Self-Sustained Large-Scale Epileptic Network in the Kainate Mouse Model of Temporal Lobe Epilepsy

Long‐term outcome of 200 patients referred to a first seizure clinic

Is there a delay in seeking medical care after the first seizure in “resource limited settings”: a pilot study from Sri Lanka

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