Spotlight on EEG in epilepsy

In this article, Dr. William Tatum, Dr. Nimit Desai, and Dr. Jason Siegel of Mayo Clinic discuss the use of electroencephalogram for evaluating people with possible epilepsy. EEG is most useful because it may provide specific neurophysiological information to support the clinical diagnosis. Based on the type of interictal epileptiform discharges, EEG may help classify the seizure type or epilepsy syndrome. EEG findings can guide management, from directing antiseizure drug management to localizing an epileptogenic zone for neurosurgical treatment. Furthermore, EEG is an important adjunct to the clinical examination in the critically ill patients for diagnosing and treating unrecognized seizures and nonconvulsive status epilepticus.

The utility of EEG has extended from a widely available, versatile, portable electrophysiological study to a sophisticated computer-based clinical and research metric that is elemental in exploring fundamental brain function.

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Spotlight on Spinal epidural abscess

Spinal epidural abscess represents loculated infection within the fat-filled space that separates the spinal dura and arachnoid. The condition is a neurologic and neurosurgical emergency that, if unrecognized, may cause devastating neurologic injury or death. Because of its infrequent occurrence, however, the possibility of epidural abscess tends not to be considered in patients presenting with fever and back or neck pain; for this reason, failure to recognize this spinal epidural abscess makes this condition a significant cause of litigation for malpractice.

In this article, Dr. John Greenlee of the University of Utah School of Medicine reviews the pathogenesis, clinical features, diagnosis, and treatment of this disorder.

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Spotlight on Isolated fourth nerve palsy

In this article, Dr. Lulu Bursztyn of Western University discusses isolated fourth nerve palsy, which is usually benign and causes vertical or oblique binocular diplopia. The most important etiologies for a fourth nerve palsy are decompensation of a congenital weakness, head or surgical trauma, extra-axial nerve ischemia, nerve inflammation, and local compression by tumor. Thyroid-related orbitopathy, skew deviation, myasthenia gravis, and sagging eye syndrome may mimic fourth nerve palsy. Spectacle prisms and strabismus surgery can be effective treatments for cases that do not resolve spontaneously.

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Spotlight on Sleep terror

Sleep terrors consist of abrupt arousals out of sleep stage 3 NREM, primarily in the first third of the night, with disordered motor agitation, screaming, fear, and autonomic activation. Sleep terrors affect between 1% to 6% of prepubertal children with a peak incidence between 5 and 7 years of age and a strong familial clustering. Sleep terrors are usually benign and tend to spontaneously decrease in frequency or cease during adolescence.

In this update, Dr. Federica Provini of the University of Bologna and IRCCS Institute of Neurological Sciences of Bologna addresses the latest clinical and polygraphic criteria for the differential diagnosis between sleep terrors and other motor phenomena occurring during sleep, focusing on sleep-related hypermotor epilepsy in which the differential diagnosis poses particular problems.

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Spotlight on Chorea in childhood

Chorea is a manifestation of a number of neurologic disorders in childhood; Sydenham chorea is one of the most representative. Over the past decade, chorea has been increasingly seen in a number of conditions that affects children. In this article, Dr. Baizabal-Carvallo of Baylor College of Medicine presents the most common neurologic disorders for which chorea is or may be one of the most prominent manifestations in individuals younger than 18 years of age. New information has been added that should be considered with presentation of chorea.

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Spotlight on Cervical dystonia

In this article, Dr. Kristopher Grajny of Georgetown University Medical Center and Dr. Eric Molho of Albany Medical Center discuss cervical dystonia, which is the most common focal dystonia. Cervical dystonia consists of involuntary head and neck movements, which result in abnormal postures, tremor, and associated pain. The etiology remains unclear but appears heterogeneous, and the authors discuss possible roles played by genetics and trauma. Botulinum toxin injections have been a breakthrough in the treatment of this condition for the last three decades. Deep brain stimulation has been an alternative option for intractable cases.

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Spotlight on Migraine: psychiatric comorbidities

Psychiatric conditions, especially mood, anxiety, and personality disorders, are common in persons suffering from migraine. These psychiatric comorbidities can alter the clinical course of migraine, its prognosis, and the quality of life of the sufferers. Therefore, diagnosis and treatment of these coexisting conditions are crucial parts of managing persons with migraine. In this article, the authors review the recent findings as well as summarize the key concept of the association between migraine and these psychiatric conditions.

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Spotlight on Juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy is a form of generalized epilepsy with a strong genetic component characterized by myoclonic jerks and bilateral tonic-clonic seizures (generalized tonic-clonic seizures). Typical absence seizures may also occur, but these are infrequent and short and are often ignored by the patient. The differential diagnosis includes other types of genetic generalized epilepsies, juvenile absence epilepsy, and generalized epilepsy with bilateral tonic-clonic seizures on awakening.

In this updated article, Dr. Fernando Cendes of the University of Campinas – UNICAMP discusses evidence concerning brain network damage and dysfunction, genetic factors, as well as prognosis and antiepileptic drug treatment in juvenile myoclonic epilepsy.

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Spotlight on CADASIL

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant genetic disease that induces recurrent subcortical ischemic strokes and ultimately leads to severe disability and death.

In this updated article, Dr. Daniel Bonthius of Atrium Health/Levine Children’s Hospital discusses advances in the pathogenesis and pathophysiology of this disorder, the differential diagnosis and diagnostic approach, and experimental approaches utilizing immunotherapy to treat this important genetically-induced cause of stroke.

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Spotlight on Diabetic neuropathies

Diabetic neuropathies include a variety of disorders that afflict diabetics fairly exclusively and are characterized by variable degrees of peripheral nerve damage. Dr. Bashar Katirji of Case Western Reserve University emphasizes the diversity of the resulting clinical syndromes. In terms of arresting or reversing the commonest type, chronic diabetic sensory-motor polyneuropathy, unfortunately no progress has been made. Other types of neuropathy in the diabetic, such as proximal diabetic neuropathy, sometimes respond to immunomodulatory and/or anti-inflammatory treatments. Several randomized controlled studies show the efficacy of some of the newer anticonvulsant medications such as pregabalin, or antidepressants, such as duloxetine, in the treatment of diabetic neuropathic pain.

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