Philippe Gelisse
@phi3417
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Neurologist/epileptologist, works in the Epilepsy unit in Montpellier's hospital. This unit is designed for the management of resistant epilepsy.
Montpellier, FRANCE
Joined July 2023
When considering the use of IV BZP administration during EEG as a diagnostic test, the sequence of disappearance of periodic discharges at sleep onset and reappearance after each stimulation or sleep apnea episode is compelling evidence against NCSE.
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Famous cartoon, reproduced in a well-known publication in 2015 but legend and concept modified. The cartoon is also often presented at conferences without any reference to the original cartoon. For the authors (2001), it was the true NCSE (rare) versus the false NCSE (common).
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When patients with Creutzfeldt–Jakob disease are misdiagnosed as having nonconvulsive status epilepticus - Full text views in one month: 1,273. Gélisse & Crespel - Epilepsia - Wiley Online Library
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VPA used to be considered the first-line treatment for LGS, and its combinaition with LTG is particularly benefical for LGS patients so that the VPA+LTG cotherapy could be considered the actual first-line pharmacological treatment of LGS (Crespel et al., 2019).
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Clobazam was introduced in France by Henri Gastaut more than 50 years ago. If it had been a particularly effective medication, this would have been known for many years. Clobazam can be useful but in combination with valproate and lamotrigine.
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In Lennox-Gastaut syndrome, valproate in women of childbearing potential is not a problem. These patients have mental retardation and poorly controlled epilepsy, and therefore pregnancies are contraindicated.
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@NeurologiaHosp1 The brain metastasis caused the NCSE in this patient. Metastasis may exhibit hypermetabolism and can be detected in various parts of the body through PET scans. However, unlike focal seizures, there is no major hypervascularization.
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In Airy's classic drawing, we can observe a colored halo, which differs from visual hallucinations seen in epileptic seizures.
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For this patient, all standard MRI sequences, including FLAIR and DWI, showed no abnormalities. However, the ALS sequence was the only one that yielded positive results.
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RT @phi3417: @epilepsiOUH Indeed, DWI and FLAIR may indeed show persistent changes after status epilepticus, but the ASL is sensitive enoug…
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RT @epilepsiOUH: @phi3417 Not sure if feasible. Too many false negative patients and the MRI signal may persit for days….
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@epilepsiOUH Indeed, DWI and FLAIR may indeed show persistent changes after status epilepticus, but the ASL is sensitive enough to detect perfusion changes immediately. Hyperperfusion will not persist after the condition is stopped.
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@CyChuan I don't have a definitive answer, but PRES syndrome may be also linked to seizures, as demonstrated in the following case. Here, status epilepticus was evident, characterized by convulsive seizures and brief ictal rhythmic discharges observed on the EEG.
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