Document Type : Original Article
1 Epilepsy Monitoring Unit, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Brain Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background: We aimed to identify the potential risk factors associated with seizure clusters in patients with temporal lobe epilepsy (TLE).
Methods: This retrospective cross-sectional study was performed on all the consecutive patients with TLE, who were admitted to the Epilepsy Monitoring Unit (EMU), Loghman-Hakim Hospital, Tehran, Iran. Seizure cluster was defined as three or more habitual seizures occurring within 24 hours, in over 50% of ictal events, with inter-seizure interval of less than 8 hours. The patients’ demographic data, epilepsy duration, seizure frequency, frequency of interictal epileptiform discharges (IEDs), and brain magnetic resonance imaging (MRI) findings were collected
Results: Among a total number of 124 patients with TLE, 62 (50.0%) patients reported seizure clusters. In addition, 44 (37.9%), 42 (36.2%), and 30 (25.9%) patients had normal-appearing brain MRI, mesial temporal sclerosis (MTS), and other brain pathologies, respectively. In terms of IEDs frequency, 35 (29.4%), 43 (36.1%), 17 (14.3%), and 24 (20.2%) patients had respectively frequent, occasional, rare, and no spikes in one-hour of interictal scalp electroencephalography (EEG) recording. In our study, seizure clusters were not associated with the epilepsy duration (P = 0.100), the amount of IEDs (P = 0.764), or MRI findings (P = 0.112).
Conclusion: In patients with TLE, seizure clustering had no correlation with the epilepsy duration, the amount of IEDs, or brain MRI findings.
- Brodie MJ, Barry SJ, Bamagous GA, Norrie JD, Kwan P. Patterns of treatment response in newly diagnosed epilepsy. Neurology 2012; 78(20): 1548-54.
- Maglalang PD, Rautiola D, Siegel RA, Fine JM, Hanson LR, Coles LD, et al. Rescue therapies for seizure emergencies: New modes of administration. Epilepsia 2018; 59(Suppl 2): 207-15.
- Buelow JM, Shafer P, Shinnar R, Austin J, Dewar S, Long L, et al. Perspectives on seizure clusters: Gaps in lexicon, awareness, and treatment. Epilepsy Behav 2016; 57(Pt A): 16-22.
- Haut SR. Seizure clusters: Characteristics and treatment. Curr Opin Neurol 2015; 28(2): 143-50.
- Haut SR. Seizure clustering. Epilepsy Behav 2006; 8(1): 50-5.
- Haut SR, Lipton RB, LeValley AJ, Hall CB, Shinnar S. Identifying seizure clusters in patients with epilepsy. Neurology 2005; 65(8): 1313-5.
- McKee HR, Abou-Khalil B. Outpatient pharmacotherapy and modes of administration for acute repetitive and prolonged seizures. CNS Drugs 2015; 29(1): 55-70.
- Detyniecki K, O'Bryan J, Choezom T, Rak G, Ma C, Zhang S, et al. Prevalence and predictors of seizure clusters: A prospective observational study of adult patients with epilepsy. Epilepsy Behav 2018; 88: 349-56.
- Detyniecki K, Van Ess PJ, Sequeira DJ, Wheless JW, Meng TC, Pullman WE. Safety and efficacy of midazolam nasal spray in the outpatient treatment of patients with seizure clusters-a randomized, double-blind, placebo-controlled trial. Epilepsia 2019; 60(9): 1797-808.
- Haut SR, Shinnar S, Moshe SL. Seizure clustering: risks and outcomes. Epilepsia 2005; 46(1): 146-9.
- Sinha S, Satishchandra P, Kalband BR, Thennarasu K. New-onset status epilepticus and cluster seizures in the elderly. J Clin Neurosci 2013; 20(3): 423-8.
- Sillanpaa M, Schmidt D. Seizure clustering during drug treatment affects seizure outcome and mortality of childhood-onset epilepsy. Brain 2008; 131(Pt 4): 938-44.
- Martinez C, Sullivan T, Hauser WA. Prevalence of acute repetitive seizures (ARS) in the United Kingdom. Epilepsy Res 2009; 87(2-3): 137-43.
- Fisher RS, Bartfeld E, Cramer JA. Use of an online epilepsy diary to characterize repetitive seizures. Epilepsy Behav 2015; 47: 66-71.
- Jobst BC, Williamson PD. Frontal lobe seizures. Psychiatr Clin North Am 2005; 28(3): 635-9.
- Komaragiri A, Detyniecki K, Hirsch LJ. Seizure clusters: A common, understudied and undertreated phenomenon in refractory epilepsy. Epilepsy Behav 2016; 59: 83-6.
- Cereghino JJ. Identification and treatment of acute repetitive seizures in children and adults. Curr Treat Options Neurol 2007; 9(4): 249-55.
- Haut SR, Shinnar S, Moshe SL, O'Dell C, Legatt AD. The association between seizure clustering and convulsive status epilepticus in patients with intractable complex partial seizures. Epilepsia 1999; 40(12): 1832-4.
- Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, et al. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol 2013; 30(1): 1-27.
- Penovich PE, Buelow J, Steinberg K, Sirven J, Wheless J. Burden of seizure clusters on patients with epilepsy and caregivers: survey of patient, caregiver, and clinician perspectives. Neurologist 2017; 22(6): 207-14.
- Ferastraoaru V, Schulze-Bonhage A, Lipton RB, Dumpelmann M, Legatt AD, Blumberg J, et al. Termination of seizure clusters is related to the duration of focal seizures. Epilepsia 2016; 57(6): 889-95.
- Bauman K, Devinsky O. Seizure clusters: Morbidity and mortality. Front Neurol 2021; 12: 636045.
- Kudlacek J, Chvojka J, Kumpost V, Hermanovska B, Posusta A, Jefferys JGR, et al. Long-term seizure dynamics are determined by the nature of seizures and the mutual interactions between them. Neurobiol Dis 2021; 154: 105347.
- Herzog AG, Harden CL, Liporace J, Pennell P, Schomer DL, Sperling M, et al. Frequency of catamenial seizure exacerbation in women with localization-related epilepsy. Ann Neurol 2004; 56(3): 431-4.
- Desai B, Whitman S, Bouffard DA. The role of the EEG in epilepsy of long duration. Epilepsia 1988; 29(5): 601-6.
- Sundaram M, Hogan T, Hiscock M, Pillay N. Factors affecting interictal spike discharges in adults with epilepsy. Electroencephalogr Clin Neurophysiol 1990; 75(4): 358-60.
- Drury I, Beydoun A. Interictal epileptiform activity in elderly patients with epilepsy. Electroencephalogr Clin Neurophysiol 1998; 106(4): 369-73.
- Katz A, Marks DA, McCarthy G, Spencer SS. Does interictal spiking change prior to seizures? Electroencephalogr Clin Neurophysiol 1991; 79(2): 153-6.
- Krendl R, Lurger S, Baumgartner C. Absolute spike frequency predicts surgical outcome in TLE with unilateral hippocampal atrophy. Neurology 2008; 71(6): 413-8.
- Karoly PJ, Freestone DR, Boston R, Grayden DB, Himes D, Leyde K, et al. Interictal spikes and epileptic seizures: their relationship and underlying rhythmicity. Brain 2016; 139(Pt 4): 1066-78.
- Haut SR, Swick C, Freeman K, Spencer S. Seizure clustering during epilepsy monitoring. Epilepsia 2002; 43(7): 711-5.
- Bauer J, Ghane Y, Flugel D, Wildt L, Stefan H. Etiology, follow-up and therapy of seizure clusters in temporal lobe epilepsy and catamenial epileptic seizures. Schweiz Arch Neurol Psychiatr (1985) 1992; 143(2): 117-34. [In German].
- Chen B, Choi H, Hirsch LJ, Katz A, Legge A, Wong RA, et al. Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res 2017; 133: 98-102.