MA Arami, Neurologist
Milad General Hospital, aliarami40@gmail.com

Abstract: Corticography during surgery is a relatively new method, which can be used to improve surgical outcomes if selected and appropriately performed.
Besides recording and identifying seizure focuses, corticography is also required in the brain mapping process. This issue is also important during awakening craniotomy and can prevent false interpretations in mapping of eloquent areas including languag corteex and subcortex areas.
However, there is no consensus on its effectiveness and usefulness. Depending on the underlying pathology, its usefulness may vary. Sometimes technical problems also interfere with standard corticography.
This article describes how to conduct corticography during surgery and its problems and how they are managed, as well as their indications and existing discrepancies.

دکتر محمدعلی آرامی,  نورولوژیست
بیمارستان میلاد تهران

aliarami40@gmail.com

خلاصه
کورتیکوگرافی حین عمل جراحی روشی نسبتا جدید است که در صورت انتخاب موارد مناسب و اجرای صحیح آن میتواند برای بهبود نتایج جراحی بکار گرفته شود.
علاوه بر ثبت و شناسایی فوکوس های تشنجی, کورتیکوگرافی در فرایند نقشه برداری مغزی نیز ضروری است. این موضوع هنگام کرانیوتومی در حالت بیداری هم اهمیت بسزایی دارد و میتواند از تفسیرهای نادرست جلوگیری کند. موضوعی که در تعیین مناطق تکلم اهمیت ویژه دارد.
با این حال در مورد اثربخشی و مفید بودن چشمگیر آن اتفاق نظر کامل وجود ندارد. بسته به پاتولوژی زمینه ای ممکن است سودمندی آن متفاوت باشد. همچنین گاهی مشکلات تکنیکی نیز برای انجام یک کورتیکوگرافی استاندارد مزاحمت ایجاد میکنند.
در این مقاله در خصوص نحوه انجام کورتیکوگرافی حین عمل و مشکلات موجود و نحوه مدیریت آنها و همچنین اندیکاسیون های انجام آن و اختلاف نظرهای موجود توضیحاتی داده خواهد شد.

Siamak Afshinmajd: Department of neurology. Neurophysiology research center. Shahed university

Massoud Moghadamnia. Department of psychiatry .Shahed university

Objectives: Epilepsy is a common disorder in all societies, especially in psychiatric patient communities. This study is designed to compare the rate of seizure attacks in depressed patients treated by tricyclic antidepressants (TCA) with patients treated with serotonin reuptake inhibitors (SSRI).

Methods: Two-hundred and forty three depressed patients selected according to DSM4 criteria in two years duration in mostafa Khomeini hospital. The only problem of these patients were depression and they were treated with only single drugm which were TCA or SSRI’S. Patients with other kind of psychiatric or neurologic disorders (especially previous  seizure attacks) except depression is not permitted. All patients were above eighteen and below sixty –five years old and examined by a psychiatrist and neurologist for detection of depression. All patients were followed for appearance of seizure for at least three years.

Results: There were one hundred and fifty- two females (63%) and eighty –eight(37%) males’ patients.  Thirty – three(14%) patients had seizure attacks in two years duration. Twenty- five(76%) attacks were in patients taking TCA and eight(24%) patients were in those who received SSRI’S.   

Conclusion: Seizure  attacks is more prevalent in patients who receive TCA in comparison to patients who receive SSRI’S. It is rationale to use paramedical items or at least   SSRI’S in patients with history of  seizure attacks instead of TCA’S.

Mohsen Aghaee Hakak, MD

Department of neurology, Epilepsy Center, Razavi Hospital, Mashhad, Iran

Email: Mohsen.hakak@gmail.com

Seizures that occur in close proximity to an event should be considered as situational or acute symptomatic or provoked seizures. By definition, provoked seizures are classified as resulting from transient derangements that involve metabolic, toxic, or medication side-effects, whereas acute symptomatic seizures are caused by an acute event such as stroke, traumatic brain injury (TBI), or CNS infection.  40% of all first Seizures (50% to 70% of Status Epilepticus) are acute symptomatic seizures. These seizures are different from unprovoked seizures both in prognosis and management. In this review we will discuss about therapeutic approach and risk of recurrence of acute symptomatic seizures.

In acute phase of brain insult, patients who experience provoked seizures have higher rate of morbidity and mortality. In certain conditions due to higher risk of seizure recurrence, short-term (a few weeks) antiepileptic medications are recommended in acute period (such as penetrating traumatic brain injuries, subdural hematoma, venous sinus thrombosis, viral encephalitis and cortical strokes). In patients with persistent epileptic activity on EEG and structural lesions on imaging longer treatment is recommended (a few months). In patients who have an unprovoked seizure subsequently (> week after an event), long-term medication with antiepileptic drugs should be considered.

Multiple studies have confirmed that anti-seizure medications may reduce risk of seizure recurrence in the short-term but it does not appear to alter rate of developing epilepsy in long-term (In other words, anti-seizure medication is not anti-epileptogenic).

Keywords: Acute symptomatic seizures, Provoked seizures, Antiepileptic drugs

Reza Shervin Badv MD; Pediatric Neurologist and epileptologist

Children’s Medical Center, Pediatrics center of excellence

Tehran University of Medical Sciences

Lennox-Gastaut syndrome(LGS)  is  severe epileptic encephalopathic state which consist of multiple seizure types including short tonic ,atypical absence and atonic  seizures in background of intellectual disability.

Generally the triad of multiple seizure types; a slow spike-and-wave pattern (less than 2.5 Hz) on EEG (+/-GPFA) ; and cognitive dysfunction are necessary for the diagnosis of this electro-clinical epileptic syndrome.

In many cases, prior epileptic spasms meets the further LGS. Etiologies are variable from genetic, structural, metabolic and even well stablished acquired epilepsies.

LGS are usually tends to be pharmacologically resistant and polytherapy with appropriate anti epileptic drugs, ketogenic diet , VNS and surgical intervention ( such as callosotomy) should be considered as a part of treatment strategies.

Recently successful use of “cannabidiol oil (CBD)” has opened a new window for control of this severe epileptic condition. In this lecture I will discuss more details and updates about LGS.

Reza Azizimalamiri; Assistant Professor of Paediatric Neurology, Department of Paediatric Neurology, Golestan Medical, Educational, and Research Center , Ahvaz Jundishapur University of Medical Sciences

azizi.ramin@gmail.com

According to the ILAE new classification of epilepsies, West syndrome is among developmental encephalopathies. In these conditions, the epileptic activity itself contributes to severe cognitive and behavioral impairment beyond that expected from the underlying pathology and that these can worsen over time. West syndrome is in continuum with Ohtahara and early myoclonic encephalopathy (EME) as neonatal epileptic encephalopathies. West syndrome could also develop to lennox‑Gastaut syndrome, another developmental encephalopathy of childhood. These epileptic syndromes are severely drug-resistant and have a huge negative impact on the quality of life of children and their families. Almost all the infants with West syndrome have a developmental delay or could regress over time. Therefore, this condition should be considered in every infant with developmental regression.

West syndrome is characterized by epileptic spasms, developmental delay or regression, and an interictal EEG pattern called hypsarrhythmia. Many infants with West syndrome suffer from structural brain disorders or have neurometabolic diseases. Just a minority of these infants is classified as unknown etiology. In some infants who have West syndrome along with the normal gross structure of the brain in their MRI, PET scans of glucose metabolism and SPECT scans of cerebral blood flow often disclose abnormalities. Therefore, normal MRI of the brain is not equal to a normal brain in these infants.

West syndrome is a drug-resistant epileptic syndrome and the response to different treatment modalities is poor. Among the different anti-seizure medications, ACTH and Sabril are the main agents that frequently try in these infants. However, many infants show no acceptable results and frequently need other treatment modalities such as the ketogenic diet. In those infants who had a focal cortical dysplasia, epilepsy surgery could show acceptable results by removing the abnormal cortex and prevent from encephalopathy.

Unfortunately, even after successful control of spasms, these infants would not develop normally and many of them finally will show autistic features. After infancy, many children with West syndrome develop other types of seizure such as atypical absences, tonic, and atonic seizures and will become children with Lennox­‑Gastaut syndrome.

Keywords: West syndrome, infancy, drug-resistant

Mahmoud Reza Ashrafi

Professor of Pediatric Neurology , Children’s Medical Center , Tehran University of Medical Sciences

Benign childhood focal seizures and epileptic syndromes are one of  the most common seizure disorders of children and  affect 25% of cases  with nonfebrile seizures of this age group .

The three most common and recognized syndromes of idiopathic childhood focal epilepsies are

1. benign childhood epilepsy with centrotemporal spikes (BCECTS)
2. early onset benign childhood occipital epilepsy (Panayiotopoulos type)
3. late-onset childhood occipital epilepsy (Gastaut type) .

BCECTS or rolandic seizures is the most common manifestation of benign childhood seizures with excellent prognosis and remission within 2–4 years of onset . Onset is from age 1 to 14 years and peak  age of 8 or 9 years.The cardinal clinical manifestations of rolandic seizures are infrequent, often single, focal seizures of facial muscles with sensorimotor symptoms , oropharyngolaryngeal manifestations, speech arrest and drooling . BCECTS is a genetic epilepsy with autosomal dominant inheritance . Except  the EEG, all paraclinical findings including brain imaging  are normal. In inter-ictal EEG , central temporal spikes  are the hallmark of BCECTS . In some children with rolandic seizures , particularly if the seizures are infrequent, mild or nocturnal, may be no need for therapy . Carbamazepine is the preferred AED and Levetiracetam seems to be highly effective.

بهشته امیری *: دانشگاه علوم پزشکی شهرکرد، معاونت درمان- کارشناس پرستاری اداره پرستاری

شیرین اصغریان: مرکز تحقیقات گیاهان دارویی، دانشگاه علوم پزشکی شهرکرد، پژوهشیار مرکز،

زهرا ایازی: دانشگاه علوم پزشکی شهرکرد-معاونت درمان،اداره پرستاری، کارشناس ارشدپرستاری،آموزش پزشکی

زمینه: بیماری صرع شایعترین اختلال عملکردی مغز می باشد. اثر طبیعی روان شناختی، اجتماعی و اقتصادی آن می تواند به طور جدی بر کیفیت زندگی بیمار و خانواده مؤثر باشد. تشخیص صحیح نوع تشنج به همراه انتخاب صحیح دارو و برخورد درمانی مناسب، می تواند این تأثیر را کاهش دهد. مراقبت های پرستاری متناسب با علل بروز صرع می تواند به شدت بر روی کاهش موارد بیماری مؤثر باشد.

روش مطالعه: این مقاله یک مطالعه مروری است که به روش جستجوی کتابخانه ای والکترونیک در سال 1397 به رشته تحریر در آمده است.

یافته ها: عوامل ایجاد کننده صرع به طور کلی مربوط به علل قبل از تولد، زمان تولد و علل بعد از تولد می باشد. برخی از عوامل قبل از تولد شامل عوامل ارثی و عفونت های حین بارداری می باشد. انجام مراقبت های پرستاری و مراقبت های بهداشتی در زمان بارداری و همچنین مشاوره ژنتیک می تواند باعث کاهش موارد بیمار صرع در جوامع شود. همچنین پژوهش های انجام شده در کشورهای توسعه یافته بیانگر آن است که 14-12 درصد موارد بروز صرع مربوط به آسیب در زمان تولد است. در این موارد بیماری های جفت، بند ناف، زایمان غیر طبیعی و طولانی مدت و انسداد مجاری هوایی نوزاد گزارش شده اند. مراقبت های پرستاری از طریق توجه به علامت های کلیدی برای شناسایی زودرس کمبود اکسیژن میتواند منجر به اقدامات لازم پرستاری برای درمان آسم و تشنج شود که برای جنین و مادر سودمند است.همچنین کاربرد روشهای پیشگیری و آموزش بیماران، روی کاهش بروز فوریت های پزشکی مانند حمله های تکرار شونده آسم و حمله های تکرار شونده صرع مؤثرند. در بعد عوامل پس از تولد می توان به تب و صدمات مغزی اشاره نمود که به آسانی می توان نسبت به پیشگیری از آنها اقدام نمود. بیماریهای عفونی همانند دیفتری، سیاه سرفه، کزاز ، سرخک، فلج اطفال، عفونت های پنوموکوکی و … که می توانند به طور مستقیم و غیر مستقیم به وسیله افزایش درجه حرارت بدن عملکرد مغز را تحت تأثیر قرار دهند، براحتی قابل پیشگیری می باشند.

نتیجه گیری: اهمیت بیماری صرع بر همگان آشکار است، اما اهمیت توجه به مراقبت های پرستاری با تأکید بر آموزش به مادران باردار و پیگیری دوران بارداری آنان به طور جدی مورد تأکید قرار نگرفته است مسئله ای که می تواند به میزان قابل توجهی موارد ابتلا به صرع را کاهش دهد.

کلمات کلیدی: پیشگیری، صرع

Siamak Afshinmajd: Department of neurology. Neurophysiology research center. Shahed university

Massoud Moghadamnia. Department of psychiatry .Shahed university

Objectives: Epilepsy is a common disorder in all societies, especially in psychiatric patient communities. This study is designed to compare the rate of seizure attacks in depressed patients treated by tricyclic antidepressants (TCA) with patients treated with serotonin reuptake inhibitors (SSRI).

Methods: Two-hundred and forty three depressed patients selected according to DSM4 criteria in two years duration in mostafa Khomeini hospital. The only problem of these patients were depression and they were treated with only single drugm which were TCA or SSRI’S. Patients with other kind of psychiatric or neurologic disorders (especially previous  seizure attacks) except depression is not permitted. All patients were above eighteen and below sixty –five years old and examined by a psychiatrist and neurologist for detection of depression. All patients were followed for appearance of seizure for at least three years.

Results: There were one hundred and fifty- two females (63%) and eighty –eight(37%) males’ patients.  Thirty – three(14%) patients had seizure attacks in two years duration. Twenty- five(76%) attacks were in patients taking TCA and eight(24%) patients were in those who received SSRI’S.   

Conclusion: Seizure  attacks is more prevalent in patients who receive TCA in comparison to patients who receive SSRI’S. It is rationale to use paramedical items or at least   SSRI’S in patients with history of  seizure attacks instead of TCA’S.

دکتر طیبه عباسیون- بیمارستان آراد

صرع بیماری مزمنی است که با حمله های تشنجی تکرار شونده تظاهر می کند. این بیماری ناشی از دشارژ های الکتریکی ناگهانی کنترل نشده نورون های قشر خاکستری مغز می باشد. صرع تظاهرات بالینی وسیعی دارد که از یک حملۀ کوتاه اختلال هوشیاری تا حملۀ بزرگ تونیک کلونیک حرکتی متغیر می باشد. حملات صرعی استریوتیپیک بوده و کاملاً مشابه هم هستند که نشانۀ بارز حمله های صرعی است. حمله های غیر صرعی می تواند از لحاظ بالینی بسیار شبیه به صرع باشد و عدم تشخیص صحیح این حمله ها، منجر به درمان های نادرست شده که می تواند صدمه های جدی به بیمار وارد کند که بستری در بخش مراقبت های ویژه و یا انتوباسیون غیر ضروری بیمار از این موارد است. نوار طولانی مدت مغز همراه با ویدئو می تواند حمله های صرعی را از غیر صرعی افتراق دهد. حمله های غیر صرعی به دو گروه حمله های غیر صرعی سایکوژنیک و غیر سایکوژنیک تقسیم بندی می شود. حمله های غیر صرعی غیر سایکوژنیک به موارد سنکوپ، میگرن، اختلالات خواب و …. تقسیم بندی می شوند.

واژگان کلیدی : حمله های غیر صرعی ، نوار مغز طولانی مدت