Gayane Melykian

By Boulenouar Mesraoua, Musab Ali, Dirk Deleu, Hassan Al Hail, Gayane Melikyan, Naim Haddad, Osama Alalamy, Covanis Athanasios and Ali A. Asadi-Pooya

Abnormalities of muscle tone, movement, and motor skills are the hallmark of cerebral palsy (CP) which results from injury to the developing brain. Clinically, the syndrome evolves over time and may only be apparent after 3–5 years of age, although suggestive signs and symptoms may be present at an earlier age. Epilepsy is common in CP and occurs in about 30% of patients. Generally, the onset is within the first 2 years of life. Epilepsy is commonly observed in children with spastic hemiplegia, followed by quadriplegia and diplegia. Significant risk factors for the development of epilepsy in patients with CP are family history, neonatal seizure, structural abnormalities, low Apgar scores, and mental retardation. Focal to bilateral tonic-clonic seizures are the most prominent seizure types, followed by focal aware or impaired awareness seizures, while infantile spasms and myoclonic jerks are seen in 25% of cases. Mental retardation is a predisposing factor for early onset of seizures and more severe epilepsy. The overall outcome of seizures in children with CP is generally poor, requiring prolonged course of antiepileptic medication, usually polytherapy with higher incidence of refractory seizures, side effects, comorbidities, and hospital admissions for drug-resistant seizures or status epilepticus.

Part of the book: Neurodevelopment and Neurodevelopmental Disorder

By Boulenouar Mesraoua, Dirk Deleu, Hassan Al Hail, Musab Ali, Naim Haddad, Gayane Melykian, Yasser Osman M. Ali, Lubna El Sheikh, Ali A. Asadi-Pooya and Peter Kaplan

This is a prospective, hospital-based study reporting an update and the prevalence of nonconvulsive status epilepticus (NCSE) in patients with altered mental status (AMS) in Qatar. Patients presenting with NCSE are compared to controls. Two-hundred and fifty patients with AMS are involved. Patients with NCSE are: 65 (12–79 years, m, 37, f, 28); controls: 185 (12–80 years, m, 101, f, 84). Occurrence of NCSE in patients with AMS was 26%. NCSE patients were younger than controls (p < 0.001). Deaths in the NCSE group occurred in 31% and 19% in controls (p < 0.0007). Hospitalization length was longer in NCSE proper and in comatose NCSE compared to controls (p < 0.02, p < 0.03). Recovery occurred in 40% of NCSE patients and 53% of controls (p < 0.08). About 31% of patients (n = 21) had refractory NCSE and 9 died. This is the first study reporting the prevalence of NCSE in Qatar. This prevalence (26%) is in the middle range. NCSE did not do better than the controls, result being disappointing regarding comatose NCSE. NCSE is an emerging condition requiring rapid diagnosis and rapid treatment. Regarding the optimal duration of continuous EGG (cEEG) monitoring to diagnose the majority of NCSE cases, 3 days of cEEG monitoring could accomplish this task.

Part of the book: Epilepsy

By Boulenouar Mesraoua, Musab Abdalhalim Ali, Rola Hosni Mohamed Hashem Khodair, Yazan Nofal, Dirk Theophiel O. Deleu, Hassan Jasim Al Hail, Osama Robin Elalamy, Gayane Melikyan, Covanis Athanasios and Ali Akbar Asadi-Pooya

Periodic electroencephalographic (EEG) patterns are frequently recorded during ICU EEG monitoring in patients with altered mental status; these EEG features represent electrical discharges, ictal in appearance, occuring at regular intervals. They are known as lateralized periodic discharges (LPDs), bilateral independent periodic discharges (BIPDS), generalized periodic discharges (GPDs), continuous 2/s GPDs with triphasic morphology or triphasic waves (TWs) and Stimulus Induced Evolving Lateralized Rhytmic delta activity or Si-Evolving LRDA (previously SIRPIDS); other periodic, rhythmic patterns are Occasional frontally predominant brief 2/s GRDA (FIRDA previously), Lateralized rhythmic delta activity (LRDA) and Brief potentially ictal rhythmic discharges or B (I)RDs. The role of most (not all) of these EEG patterns is controversial; there is no consensus on which patterns are associated with ongoing seizure injury, which patterns need to be treated, and how aggressively they should be treated. Many authors consider these patterns as an unstable state on an ictal-interictal EEG continuum; the aim of the present chapter is to gain knowledge of these EEG features, show their association with known neurologic pathologies/syndromes and finally how to manage them.

Part of the book: Electroencephalography