Luigi Bongiovanni | Università di Verona (original) (raw)

Papers by Luigi Bongiovanni

Research paper thumbnail of 58. Cardiovascular responses in patients with symptoms of orthostatic intolerance

Clinical Neurophysiology, 2015

Research paper thumbnail of Subclinical rhythmic electrographic discharges of adults and transient global amnesia: a causal or casual association?

Subclinical rhythmic electrographic discharges of adults (SREDA) is an uncommon distinctive EEG r... more Subclinical rhythmic electrographic discharges of adults (SREDA) is an uncommon distinctive EEG rhythmic pattern with uncertain significance. We report a patient with transient global amnesia in whom an EEG recording, performed after the acute phase of the neurological event, showed SREDA. Based on this EEG finding, we discuss about a possible correlation between SREDA and transient global amnesia. The presence of SREDA in our patient with transient global amnesia seems to be incidental. When described in association with transient global amnesia, SREDA should be recognized in order to avoid misdiagnosis. Although SREDA has been fortuitously described in association with transient global amnesia, a patho-physiological correlation with mechanisms which produce it seems unlikely.

Research paper thumbnail of Infliximab-related seizures: a first case study

Seizures following infliximab treatment are very rare and, to date, there is no detailed descript... more Seizures following infliximab treatment are very rare and, to date, there is no detailed description of EEG abnormalities with cerebral radiological findings reported in cases with infliximab-related seizures. We describe a patient who acutely developed seizures temporally related to infliximab treatment, which disappeared after drug withdrawal. MRI showed encephalopathy involving mainly cortical regions and EEGs showed focal paroxysmal activity which completely disappeared a few days after infliximab withdrawal. No other plausible cause of the seizures was identified. The clear temporal association between seizure onset and infliximab treatment as well as the clinical improvement and disappearance of focal epileptiform activity after drug withdrawal indicated an evident correlation between seizures and infliximab therapy. The coexistence of pathological findings on MRI suggested that seizures were secondary to the encephalopathy. Further studies are required to evaluate whether infliximab per se has an epileptogenic effect or whether the seizures are caused by encephalopathy involving cortico-subcortical regions.

Research paper thumbnail of Terminology of psychogenic nonepileptic seizures

Epilepsia, 2015

Several different terms have been used to describe "psychogenic nonepileptic seizures" (PNES) in ... more Several different terms have been used to describe "psychogenic nonepileptic seizures" (PNES) in the literature. In this study, we evaluated the most common English terms used to describe PNES on Google and in PubMed using multiple search terms (https://www.google.com and http://www.ncbi.nlm.nih.gov/pubmed). The information prevalence of the five terms most frequently used to refer to PNES in PubMed were: psychogenic non(-)epileptic seizure(s), followed by pseudo(-)seizure(s), non(-)epileptic seizure(s), psychogenic seizure(s), and non(-)epileptic event(s). The five most frequently adopted terms to describe PNES in Google were: psychogenic non(-)epileptic seizure(s), followed by non(-)epileptic event(s), psychogenic attack(s), non(-)epileptic attack(s), and psychogenic non(-)epileptic attack(s). The broad spectrum of synonyms used to refer to PNES in the medical literature reflects a lack of internationally accepted, uniform terminology for PNES. In addition to "seizure(s)," lay people use the word "attack(s)" to describe PNES. Although considered obsolete, some terms, e.g., pseudoseizure(s), are still used in the recent medical literature. Adopting a uniform terminology to describe PNES could facilitate communication between epileptologists, physicians without specific expertise in epilepsy, and patients.

Research paper thumbnail of EEG-fMRI Evaluation of Patients with Mesial Temporal Lobe Sclerosis

The Neuroradiology Journal, 2014

This preliminary study sought more information on blood oxygen level dependent (BOLD) activation,... more This preliminary study sought more information on blood oxygen level dependent (BOLD) activation, especially contralateral temporal/extratemporal spread, during continuous EEG-fMRI recordings in four patients with mesial temporal sclerosis (MTS). In two patients, EEG showed unilateral focal activity during the EEG-fMRI session concordant with the interictal focus previously identified with standard and video-poly EEG. In the other two patients EEG demonstrated a contralateral diffusion of the irritative focus. In the third patient (with the most drug-resistant form and also extratemporal clinical signs), there was an extratemporal diffusion over frontal regions, ipsilateral to the irritative focus. fMRI analysis confirmed a single activation in the mesial temporal region in two patients whose EEG showed unilateral focal activity, while it demonstrated a bilateral activation in the mesial temporal regions in the other two patients. In the third patient, fMRI demonstrated an activation in the supplementary motxor area. This study confirms the most significant activation with a high firing rate of the irritative focus, but also suggests the importance of using new techniques (such as EEG-fMRI to examine cerebral blood flow) to identify the controlateral limbic activation, and any other extratemporal activations, possible causes of drug resistance in MTS that may require a more precise pre-surgical evaluation with invasive techniques.

Research paper thumbnail of Lateral tongue biting versus biting at the tip of the tongue in differentiating between epileptic seizures and syncope

Seizure, 2013

Lateral tongue biting versus biting at the tip of the tongue in differentiating between epileptic... more Lateral tongue biting versus biting at the tip of the tongue in differentiating between epileptic seizures and syncope

Research paper thumbnail of Value of tongue biting in the differential diagnosis between epileptic seizures and syncope

Research paper thumbnail of The diagnostic value of urinary incontinence in the differential diagnosis of seizures

Research paper thumbnail of Common reference-based indirect comparison meta-analysis of intravenous valproate versus intravenous phenobarbitone in generalized convulsive status epilepticus

Journal of the Neurological Sciences, 2013

A common reference-based indirect comparison meta-analysis of intravenous valproate versus intrav... more A common reference-based indirect comparison meta-analysis of intravenous valproate versus intravenous phenobarbitone for convulsive status epilepticus paru dans Epileptic Disorders, 2013, Volume 15, Numéro 3

Research paper thumbnail of ECG myogenic artifacts during clonic seizures: a disturbing (and interesting) finding

Journal of Clinical Monitoring and Computing, 2011

artifacts during clonic seizures: a disturbing (and interesting) finding. J Clin Monit Comput 201... more artifacts during clonic seizures: a disturbing (and interesting) finding. J Clin Monit Comput 2011; 25:151-153

Research paper thumbnail of IV Valproate in generalized convulsive status epilepticus: a systematic review

European Journal of Neurology, 2012

Aim of this review was to evaluate efficacy and safety of intravenous valproate (IV VPA) in the t... more Aim of this review was to evaluate efficacy and safety of intravenous valproate (IV VPA) in the treatment of generalized convulsive status epilepticus (GCSE) in patients of any age, synthesizing available evidences from randomized controlled trials (RCTs). RCTs on IV VPA administered in patients (no age restriction) for GCSE at any stage were searched in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Studies were selected and data independently extracted. Following outcomes were considered: clinical seizure cessation after drug administration, seizure freedom at 24 h, and adverse effects. Outcomes were assessed using standard methods to calculate risk ratio (RR) with 95% confidence intervals. Five trials met inclusion criteria. Two different comparisons were available (IV VPA versus phenytoin (PHT), IV VPA versus IV Diazepam), but only the former included more than one study with enough information to permit a meta-analysis. Compared with PHT, VPA had statistically lower risk of adverse effects (RR 0.31, 95% CI 0.12-0.85), with no differences in GCSE cessation after drug administration (RR 1.31, 95% CI 0.93-1.84) and in seizure freedom at 24 h (RR 0.96, 95% CI 0.88-1.06). This review suggests that IV VPA has a better tolerability than PHT in treatment of GCSE, without any statistically significant differences in terms of efficacy. More rigorous RCTs of VPA versus an appropriate comparator, in a well-defined population with a systematic definition of SE, are however required to conclude about efficacy and tolerability of VPA in clinical practice.

Research paper thumbnail of Resting motor threshold in idiopathic generalized epilepsies: A systematic review with meta-analysis

Epilepsy Research, 2012

Please cite this article in press as: Brigo, F., et al., Resting motor threshold in idiopathic ge... more Please cite this article in press as: Brigo, F., et al., Resting motor threshold in idiopathic generalized epilepsies: A systematic review with meta-analysis. Epilepsy Res. (2012), http://dx.

Research paper thumbnail of Clinical utility of ictal eyes closure in the differential diagnosis between epileptic seizures and psychogenic events

Epilepsy Research, 2013

The presence of ictal eye closure (IEC) has been considered to represent an additional clinical s... more The presence of ictal eye closure (IEC) has been considered to represent an additional clinical sign supporting the diagnosis of psychogenic non-epileptic events (PNEEs).

Research paper thumbnail of Fear as the only clinical expression of affective focal status epilepticus

Epilepsy & Behavior, 2011

Affective seizures consist of fear, depression, joy, and (rarely) anger. A correct diagnosis is o... more Affective seizures consist of fear, depression, joy, and (rarely) anger. A correct diagnosis is often delayed as the behavioral features, like fear, are interpreted as psychiatric disorders. We describe a patient with affective focal status epilepticus (AFSE) in which fear was the only clinical manifestation. We present electroencephalographic correlates and discuss the diagnostic difficulties that can be encountered in similar cases. AFSE with fear as the only clinical expression may represent a diagnostic challenge. When fear is the only or the prominent behavioral feature, seizures may be diagnosed as panic attacks, leading to erroneous therapy. In such situations, electroencephalography is an essential tool in differentiating between psychiatric disorders and epileptic events.

Research paper thumbnail of Highly focal BOLD activation on functional MRI in a patient with progressive myoclonic epilepsy and diffuse giant somatosensory evoked potentials

Epilepsy & Behavior, 2011

We analyzed the effect of afferent input on patterns of brain electrical activation in a 31-year-... more We analyzed the effect of afferent input on patterns of brain electrical activation in a 31-year-old man with progressive myoclonic epilepsy (PME) by measuring the somatosensory evoked potential (SSEP) amplitude at the scalp after median nerve stimulation and examining the changes in the functional magnetic resonance imaging blood oxygen level-dependent (fMRI BOLD) signal. High-amplitude SSEPs were elicited at the wrist in association with highly focal BOLD activation of the contralateral sensorimotor areas. By contrast, no diffuse activation of either the frontal or the posterior parietal cortical areas was observed, as seen in previously recorded data on SSEPs from a healthy control group. The highly focal BOLD activation in this patient suggests that cortex hyperexcitability might be limited to the sensorimotor cortex in PME. The combined EEG-fMRI findings highlight a dissociation between BOLD activation and neurophysiological findings.

Research paper thumbnail of Visual cortex hyperexcitability in idiopathic generalized epilepsies with photosensitivity: A TMS pilot study

Epilepsy & Behavior, 2013

Background: The current understanding of the mechanisms underlying photosensitivity is still limi... more Background: The current understanding of the mechanisms underlying photosensitivity is still limited, although most studies point to a hyperexcitability of the visual cortex. Methods: Using transcranial magnetic stimulation, we determined the resting motor threshold (rMT) and the phosphene threshold (PT) in 33 patients with IGEs (8 with photosensitivity) compared with 12 healthy controls. Results: Eleven controls (92%) reported phosphenes compared with fifteen (46%) patients with idiopathic generalized epilepsy (p = 0.015). Phosphenes were reported more frequently among patients with epilepsy with photosensitivity (87.5%) than in patients with active epilepsy without photosensitivity (30.8%) (p = 0.038) and patients with epilepsy in remission without photosensitivity (33.3%) (p = 0.054); no differences were found between patients with epilepsy with photosensitivity and controls (p = 0.648). Resting motor threshold and phosphene threshold were significantly higher among patients with epilepsy (active epilepsy or epilepsy in remission without photosensitivity) compared to healthy controls (p b 0.01). Conversely, patients with active epilepsy and photosensitivity had significantly lower values than controls (p = 0.03). Conclusions: The marked decrease in PT and the high phosphene prevalence in patients with IGE with photosensitivity indicate a regional hyperexcitability of the primary visual cortex. Results of this study also suggest that the PT may serve as a biomarker for excitability in patients with IGE and photosensitivity.

Research paper thumbnail of Focal nonconvulsive seizures during detoxification for benzodiazepine abuse

Epilepsy & Behavior, 2012

Chronic benzodiazepine (BDZ) abuse is currently treated with detoxification using a low-dose flum... more Chronic benzodiazepine (BDZ) abuse is currently treated with detoxification using a low-dose flumazenil infusion, a relatively recently developed and promising procedure. Given the possibility reported in the literature of the occurrence of generalized seizures during therapeutic BDZ detoxification, we usually administer preventive antiepileptic drug (AED) therapy. We describe two patients with no previous history of seizures or evidence of intracerebral lesions who, during detoxification for benzodiazepine abuse, developed repetitive focal nonconvulsive seizures instead of generalized seizures, even with appropriate doses of preventive AED therapy. There are no previous reported cases of focal nonconvulsive seizures occurring during this procedure or, more generally, during abrupt BDZ discontinuation. The cases we describe suggest that during detoxification for BDZ abuse, not only generalized, but also focal nonconvulsive seizures may occur. In this context, the focal seizures probably result from a diffuse decrease in the seizure threshold (caused by a generalized excitatory rebound), which may trigger focal seizures arising from cortical regions with higher intrinsic epileptogenicity. Detoxification for benzodiazepine abuse, even if performed with adequate-dosage AED treatment, may not be as safe a procedure as previously considered, because not only convulsive, but also nonconvulsive seizures may occur and go unnoticed. It is therefore strongly advisable to perform this detoxification under close medical supervision and to maintain a low threshold for EEG monitoring in the event of sudden onset of behavioral changes.

Research paper thumbnail of Fixation-off sensitivity

Clinical Neurophysiology, 2013

Fixation-off sensitivity (FOS) is a phenomenon induced by elimination of central vision/fixation,... more Fixation-off sensitivity (FOS) is a phenomenon induced by elimination of central vision/fixation, and may either manifest clinically with seizures or only represent an EEG abnormality. FOS is characterized by posterior or generalized epileptiform discharges that consistently occur after closing of the eyes and last as long as the eyes are closed. It is most commonly encountered in patients with idiopathic childhood occipital epilepsies, but may also be observed in cases of symptomatic or cryptogenic focal and generalized epilepsies, as well as in asymptomatic non-epileptic individuals. FOS should be differentiated from pure forms of scotosensitivity, in which EEG discharges or epileptic seizures are elicited by darkness, and from epileptiform discharges triggered by eye closure, which refer to eye closure sensitivity. Although FOS is probably associated with occipital hyperexcitability its intrinsic epileptogenic potential is presumed to be low.

Research paper thumbnail of The breach rhythm

Clinical Neurophysiology, 2011

Research paper thumbnail of Subclinical Rhythmic Electroencephalogram Discharge of Adults Occurring During Sleep: A Diagnostic Challenge

Clinical EEG and Neuroscience, 2013

Subclinical rhythmic electroencephalogram discharge of adults (SREDA) is an electroencephalogram ... more Subclinical rhythmic electroencephalogram discharge of adults (SREDA) is an electroencephalogram (EEG) pattern of uncertain significance, which occurs without any correlation with epilepsy. It resembles epileptiform activity, and is therefore likely to be misinterpreted as an authentic epileptiform pattern. We describe the occurrence of SREDA during stage II nonrapid eye movement (NREM) sleep and discuss the diagnostic difficulties that may arise when such a pattern is encountered during sleep EEG recordings. SREDA may occur during sleep, leading to difficulties in correct identification of this pattern, as the patient is unconscious and unable to report any symptoms. Although there are rather distinctive EEG features, the lack of changes in electrocardiogram rhythm and the absence of ocular/muscular artifacts suggest a nonepileptic phenomenon. The ultimate diagnosis, and the correct identification of SREDA, may be achieved by a comparison of EEG features between the pattern occurring during sleep and that recorded in the awake state.

Research paper thumbnail of 58. Cardiovascular responses in patients with symptoms of orthostatic intolerance

Clinical Neurophysiology, 2015

Research paper thumbnail of Subclinical rhythmic electrographic discharges of adults and transient global amnesia: a causal or casual association?

Subclinical rhythmic electrographic discharges of adults (SREDA) is an uncommon distinctive EEG r... more Subclinical rhythmic electrographic discharges of adults (SREDA) is an uncommon distinctive EEG rhythmic pattern with uncertain significance. We report a patient with transient global amnesia in whom an EEG recording, performed after the acute phase of the neurological event, showed SREDA. Based on this EEG finding, we discuss about a possible correlation between SREDA and transient global amnesia. The presence of SREDA in our patient with transient global amnesia seems to be incidental. When described in association with transient global amnesia, SREDA should be recognized in order to avoid misdiagnosis. Although SREDA has been fortuitously described in association with transient global amnesia, a patho-physiological correlation with mechanisms which produce it seems unlikely.

Research paper thumbnail of Infliximab-related seizures: a first case study

Seizures following infliximab treatment are very rare and, to date, there is no detailed descript... more Seizures following infliximab treatment are very rare and, to date, there is no detailed description of EEG abnormalities with cerebral radiological findings reported in cases with infliximab-related seizures. We describe a patient who acutely developed seizures temporally related to infliximab treatment, which disappeared after drug withdrawal. MRI showed encephalopathy involving mainly cortical regions and EEGs showed focal paroxysmal activity which completely disappeared a few days after infliximab withdrawal. No other plausible cause of the seizures was identified. The clear temporal association between seizure onset and infliximab treatment as well as the clinical improvement and disappearance of focal epileptiform activity after drug withdrawal indicated an evident correlation between seizures and infliximab therapy. The coexistence of pathological findings on MRI suggested that seizures were secondary to the encephalopathy. Further studies are required to evaluate whether infliximab per se has an epileptogenic effect or whether the seizures are caused by encephalopathy involving cortico-subcortical regions.

Research paper thumbnail of Terminology of psychogenic nonepileptic seizures

Epilepsia, 2015

Several different terms have been used to describe "psychogenic nonepileptic seizures" (PNES) in ... more Several different terms have been used to describe "psychogenic nonepileptic seizures" (PNES) in the literature. In this study, we evaluated the most common English terms used to describe PNES on Google and in PubMed using multiple search terms (https://www.google.com and http://www.ncbi.nlm.nih.gov/pubmed). The information prevalence of the five terms most frequently used to refer to PNES in PubMed were: psychogenic non(-)epileptic seizure(s), followed by pseudo(-)seizure(s), non(-)epileptic seizure(s), psychogenic seizure(s), and non(-)epileptic event(s). The five most frequently adopted terms to describe PNES in Google were: psychogenic non(-)epileptic seizure(s), followed by non(-)epileptic event(s), psychogenic attack(s), non(-)epileptic attack(s), and psychogenic non(-)epileptic attack(s). The broad spectrum of synonyms used to refer to PNES in the medical literature reflects a lack of internationally accepted, uniform terminology for PNES. In addition to "seizure(s)," lay people use the word "attack(s)" to describe PNES. Although considered obsolete, some terms, e.g., pseudoseizure(s), are still used in the recent medical literature. Adopting a uniform terminology to describe PNES could facilitate communication between epileptologists, physicians without specific expertise in epilepsy, and patients.

Research paper thumbnail of EEG-fMRI Evaluation of Patients with Mesial Temporal Lobe Sclerosis

The Neuroradiology Journal, 2014

This preliminary study sought more information on blood oxygen level dependent (BOLD) activation,... more This preliminary study sought more information on blood oxygen level dependent (BOLD) activation, especially contralateral temporal/extratemporal spread, during continuous EEG-fMRI recordings in four patients with mesial temporal sclerosis (MTS). In two patients, EEG showed unilateral focal activity during the EEG-fMRI session concordant with the interictal focus previously identified with standard and video-poly EEG. In the other two patients EEG demonstrated a contralateral diffusion of the irritative focus. In the third patient (with the most drug-resistant form and also extratemporal clinical signs), there was an extratemporal diffusion over frontal regions, ipsilateral to the irritative focus. fMRI analysis confirmed a single activation in the mesial temporal region in two patients whose EEG showed unilateral focal activity, while it demonstrated a bilateral activation in the mesial temporal regions in the other two patients. In the third patient, fMRI demonstrated an activation in the supplementary motxor area. This study confirms the most significant activation with a high firing rate of the irritative focus, but also suggests the importance of using new techniques (such as EEG-fMRI to examine cerebral blood flow) to identify the controlateral limbic activation, and any other extratemporal activations, possible causes of drug resistance in MTS that may require a more precise pre-surgical evaluation with invasive techniques.

Research paper thumbnail of Lateral tongue biting versus biting at the tip of the tongue in differentiating between epileptic seizures and syncope

Seizure, 2013

Lateral tongue biting versus biting at the tip of the tongue in differentiating between epileptic... more Lateral tongue biting versus biting at the tip of the tongue in differentiating between epileptic seizures and syncope

Research paper thumbnail of Value of tongue biting in the differential diagnosis between epileptic seizures and syncope

Research paper thumbnail of The diagnostic value of urinary incontinence in the differential diagnosis of seizures

Research paper thumbnail of Common reference-based indirect comparison meta-analysis of intravenous valproate versus intravenous phenobarbitone in generalized convulsive status epilepticus

Journal of the Neurological Sciences, 2013

A common reference-based indirect comparison meta-analysis of intravenous valproate versus intrav... more A common reference-based indirect comparison meta-analysis of intravenous valproate versus intravenous phenobarbitone for convulsive status epilepticus paru dans Epileptic Disorders, 2013, Volume 15, Numéro 3

Research paper thumbnail of ECG myogenic artifacts during clonic seizures: a disturbing (and interesting) finding

Journal of Clinical Monitoring and Computing, 2011

artifacts during clonic seizures: a disturbing (and interesting) finding. J Clin Monit Comput 201... more artifacts during clonic seizures: a disturbing (and interesting) finding. J Clin Monit Comput 2011; 25:151-153

Research paper thumbnail of IV Valproate in generalized convulsive status epilepticus: a systematic review

European Journal of Neurology, 2012

Aim of this review was to evaluate efficacy and safety of intravenous valproate (IV VPA) in the t... more Aim of this review was to evaluate efficacy and safety of intravenous valproate (IV VPA) in the treatment of generalized convulsive status epilepticus (GCSE) in patients of any age, synthesizing available evidences from randomized controlled trials (RCTs). RCTs on IV VPA administered in patients (no age restriction) for GCSE at any stage were searched in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Studies were selected and data independently extracted. Following outcomes were considered: clinical seizure cessation after drug administration, seizure freedom at 24 h, and adverse effects. Outcomes were assessed using standard methods to calculate risk ratio (RR) with 95% confidence intervals. Five trials met inclusion criteria. Two different comparisons were available (IV VPA versus phenytoin (PHT), IV VPA versus IV Diazepam), but only the former included more than one study with enough information to permit a meta-analysis. Compared with PHT, VPA had statistically lower risk of adverse effects (RR 0.31, 95% CI 0.12-0.85), with no differences in GCSE cessation after drug administration (RR 1.31, 95% CI 0.93-1.84) and in seizure freedom at 24 h (RR 0.96, 95% CI 0.88-1.06). This review suggests that IV VPA has a better tolerability than PHT in treatment of GCSE, without any statistically significant differences in terms of efficacy. More rigorous RCTs of VPA versus an appropriate comparator, in a well-defined population with a systematic definition of SE, are however required to conclude about efficacy and tolerability of VPA in clinical practice.

Research paper thumbnail of Resting motor threshold in idiopathic generalized epilepsies: A systematic review with meta-analysis

Epilepsy Research, 2012

Please cite this article in press as: Brigo, F., et al., Resting motor threshold in idiopathic ge... more Please cite this article in press as: Brigo, F., et al., Resting motor threshold in idiopathic generalized epilepsies: A systematic review with meta-analysis. Epilepsy Res. (2012), http://dx.

Research paper thumbnail of Clinical utility of ictal eyes closure in the differential diagnosis between epileptic seizures and psychogenic events

Epilepsy Research, 2013

The presence of ictal eye closure (IEC) has been considered to represent an additional clinical s... more The presence of ictal eye closure (IEC) has been considered to represent an additional clinical sign supporting the diagnosis of psychogenic non-epileptic events (PNEEs).

Research paper thumbnail of Fear as the only clinical expression of affective focal status epilepticus

Epilepsy & Behavior, 2011

Affective seizures consist of fear, depression, joy, and (rarely) anger. A correct diagnosis is o... more Affective seizures consist of fear, depression, joy, and (rarely) anger. A correct diagnosis is often delayed as the behavioral features, like fear, are interpreted as psychiatric disorders. We describe a patient with affective focal status epilepticus (AFSE) in which fear was the only clinical manifestation. We present electroencephalographic correlates and discuss the diagnostic difficulties that can be encountered in similar cases. AFSE with fear as the only clinical expression may represent a diagnostic challenge. When fear is the only or the prominent behavioral feature, seizures may be diagnosed as panic attacks, leading to erroneous therapy. In such situations, electroencephalography is an essential tool in differentiating between psychiatric disorders and epileptic events.

Research paper thumbnail of Highly focal BOLD activation on functional MRI in a patient with progressive myoclonic epilepsy and diffuse giant somatosensory evoked potentials

Epilepsy & Behavior, 2011

We analyzed the effect of afferent input on patterns of brain electrical activation in a 31-year-... more We analyzed the effect of afferent input on patterns of brain electrical activation in a 31-year-old man with progressive myoclonic epilepsy (PME) by measuring the somatosensory evoked potential (SSEP) amplitude at the scalp after median nerve stimulation and examining the changes in the functional magnetic resonance imaging blood oxygen level-dependent (fMRI BOLD) signal. High-amplitude SSEPs were elicited at the wrist in association with highly focal BOLD activation of the contralateral sensorimotor areas. By contrast, no diffuse activation of either the frontal or the posterior parietal cortical areas was observed, as seen in previously recorded data on SSEPs from a healthy control group. The highly focal BOLD activation in this patient suggests that cortex hyperexcitability might be limited to the sensorimotor cortex in PME. The combined EEG-fMRI findings highlight a dissociation between BOLD activation and neurophysiological findings.

Research paper thumbnail of Visual cortex hyperexcitability in idiopathic generalized epilepsies with photosensitivity: A TMS pilot study

Epilepsy & Behavior, 2013

Background: The current understanding of the mechanisms underlying photosensitivity is still limi... more Background: The current understanding of the mechanisms underlying photosensitivity is still limited, although most studies point to a hyperexcitability of the visual cortex. Methods: Using transcranial magnetic stimulation, we determined the resting motor threshold (rMT) and the phosphene threshold (PT) in 33 patients with IGEs (8 with photosensitivity) compared with 12 healthy controls. Results: Eleven controls (92%) reported phosphenes compared with fifteen (46%) patients with idiopathic generalized epilepsy (p = 0.015). Phosphenes were reported more frequently among patients with epilepsy with photosensitivity (87.5%) than in patients with active epilepsy without photosensitivity (30.8%) (p = 0.038) and patients with epilepsy in remission without photosensitivity (33.3%) (p = 0.054); no differences were found between patients with epilepsy with photosensitivity and controls (p = 0.648). Resting motor threshold and phosphene threshold were significantly higher among patients with epilepsy (active epilepsy or epilepsy in remission without photosensitivity) compared to healthy controls (p b 0.01). Conversely, patients with active epilepsy and photosensitivity had significantly lower values than controls (p = 0.03). Conclusions: The marked decrease in PT and the high phosphene prevalence in patients with IGE with photosensitivity indicate a regional hyperexcitability of the primary visual cortex. Results of this study also suggest that the PT may serve as a biomarker for excitability in patients with IGE and photosensitivity.

Research paper thumbnail of Focal nonconvulsive seizures during detoxification for benzodiazepine abuse

Epilepsy & Behavior, 2012

Chronic benzodiazepine (BDZ) abuse is currently treated with detoxification using a low-dose flum... more Chronic benzodiazepine (BDZ) abuse is currently treated with detoxification using a low-dose flumazenil infusion, a relatively recently developed and promising procedure. Given the possibility reported in the literature of the occurrence of generalized seizures during therapeutic BDZ detoxification, we usually administer preventive antiepileptic drug (AED) therapy. We describe two patients with no previous history of seizures or evidence of intracerebral lesions who, during detoxification for benzodiazepine abuse, developed repetitive focal nonconvulsive seizures instead of generalized seizures, even with appropriate doses of preventive AED therapy. There are no previous reported cases of focal nonconvulsive seizures occurring during this procedure or, more generally, during abrupt BDZ discontinuation. The cases we describe suggest that during detoxification for BDZ abuse, not only generalized, but also focal nonconvulsive seizures may occur. In this context, the focal seizures probably result from a diffuse decrease in the seizure threshold (caused by a generalized excitatory rebound), which may trigger focal seizures arising from cortical regions with higher intrinsic epileptogenicity. Detoxification for benzodiazepine abuse, even if performed with adequate-dosage AED treatment, may not be as safe a procedure as previously considered, because not only convulsive, but also nonconvulsive seizures may occur and go unnoticed. It is therefore strongly advisable to perform this detoxification under close medical supervision and to maintain a low threshold for EEG monitoring in the event of sudden onset of behavioral changes.

Research paper thumbnail of Fixation-off sensitivity

Clinical Neurophysiology, 2013

Fixation-off sensitivity (FOS) is a phenomenon induced by elimination of central vision/fixation,... more Fixation-off sensitivity (FOS) is a phenomenon induced by elimination of central vision/fixation, and may either manifest clinically with seizures or only represent an EEG abnormality. FOS is characterized by posterior or generalized epileptiform discharges that consistently occur after closing of the eyes and last as long as the eyes are closed. It is most commonly encountered in patients with idiopathic childhood occipital epilepsies, but may also be observed in cases of symptomatic or cryptogenic focal and generalized epilepsies, as well as in asymptomatic non-epileptic individuals. FOS should be differentiated from pure forms of scotosensitivity, in which EEG discharges or epileptic seizures are elicited by darkness, and from epileptiform discharges triggered by eye closure, which refer to eye closure sensitivity. Although FOS is probably associated with occipital hyperexcitability its intrinsic epileptogenic potential is presumed to be low.

Research paper thumbnail of The breach rhythm

Clinical Neurophysiology, 2011

Research paper thumbnail of Subclinical Rhythmic Electroencephalogram Discharge of Adults Occurring During Sleep: A Diagnostic Challenge

Clinical EEG and Neuroscience, 2013

Subclinical rhythmic electroencephalogram discharge of adults (SREDA) is an electroencephalogram ... more Subclinical rhythmic electroencephalogram discharge of adults (SREDA) is an electroencephalogram (EEG) pattern of uncertain significance, which occurs without any correlation with epilepsy. It resembles epileptiform activity, and is therefore likely to be misinterpreted as an authentic epileptiform pattern. We describe the occurrence of SREDA during stage II nonrapid eye movement (NREM) sleep and discuss the diagnostic difficulties that may arise when such a pattern is encountered during sleep EEG recordings. SREDA may occur during sleep, leading to difficulties in correct identification of this pattern, as the patient is unconscious and unable to report any symptoms. Although there are rather distinctive EEG features, the lack of changes in electrocardiogram rhythm and the absence of ocular/muscular artifacts suggest a nonepileptic phenomenon. The ultimate diagnosis, and the correct identification of SREDA, may be achieved by a comparison of EEG features between the pattern occurring during sleep and that recorded in the awake state.