1/7. Convulsive syncope following placement of sphenoidal electrodes.Two cases of convulsive syncope following the insertion of sphenoidal electrodes are reported. The episodes occurred shortly after an uneventful insertion of the needle. Both patients exhibited behavioral arrest with loss of muscle tone, followed by flexor posturing, jerking of the extremities, then followed by what appeared to be a panic attack. Episodes were clinically distinct from the patients' typical spells and were initially interpreted as representing psychogenic events. EEGs during the episodes showed diffuse slowing followed by generalized suppression of rhythms. Simultaneous EKG showed bradycardia followed by brief asystole and then resumption of normal heart rhythms in both cases. Vagally mediated cardioinhibitory reactions induced by fear, pain and possibly stimulation of branches of the trigeminal nerve in the face represent an uncommon but potentially serious complication of placement of sphenoidal electrodes.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
2/7. Psychogenic seizures--why women?The only consistent finding in studies of psychogenic seizures is the approximately threefold higher incidence in women. Therefore, why women? Charcot and Freud emphasized the sexual aspects of the seizure as has the current interest in childhood sexual abuse. From case studies and review of the literature the author believes that psychogenic seizures in women express rage, fear, and helplessness against the dominant and abusive male rather than sexual conflicts. Emphasizing the aggressive component of seizures does not minimize the traumatic effects of sexual abuse but rather includes it as leading to rage and helplessness.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
3/7. Intractable epilepsy after a functional hemispherectomy: important lessons from an unusual case. Case report.Residual seizures after functional hemispherectomy occur in approximately 20% of patients with catastrophic epilepsy. These episodes are traditionally attributed to incomplete disconnection, persistent epileptogenic activity in the ipsilateral insular cortex, or bilateral independent epileptogenic activity. The authors report on the case of an 8-year-old boy with an intractable seizure disorder who had classic frontal adversive seizures related to extensive unilateral left hemispheric cortical dysplasia. The initial intervention consisted of extensive removal of the epileptic frontal and precentral dysplastic tissue and multiple subpial transections of the dysplastic motor strip, guided by intraoperative electrocorticography, Subsequently, functional hemispherectomy including insular cortex resection was performed for persistent attacks. After a seizure-free period of 6 months, a new pattern ensued, consisting of an aura of fear, dystonic posturing of the right arm, and unusual postictal hyperphagia coupled with an interictal diencephalic-like syndrome. electroencephalography and ictal/interictal single-photon emission computerized tomography were used to localize the residual epileptic discharges to deep ipsilateral structures. Results of magnetic resonance imaging indicated a complete disconnection except for a strip of residual frontobasal tissue. Therefore, a volumetric resection of the epileptogenic frontal basal tissue up to the anterior commissure was completed. The child has remained free of seizures during 21 months of follow-up review. Standard hemispherectomy methods provide extensive disconnection, despite the presence of residual frontal basal cortex. However, rarely, and especially if it is dysplastic, this tissue can represent a focus for refractory seizures. This is an important consideration in determining the source of ongoing seizures posthemispherectomy in patients with extensive cortical dysplasia. It remains important to assess them fully before considering their disease refractory to surgical treatment.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
4/7. fear, anger and compulsive behavior during seizure: involvement of large scale fronto-temporal neural networks.Seizure-related, abnormal affective and gestural behavior may involve some of the same processes as those underlying non-pathological behavior, but their mechanisms remain largely unknown. In this report, we studied a patient in whom seizures initially involved the medial temporal region before involving the frontal cortex. Seizure semiology of the second part of the seizure included marked emotional disturbances (dominated by intense fear and anger) and compulsive behavior to bite into something. This patient underwent presurgical evaluation including intracerebral electroencephalographic recordings (SEEG, stereoelectroencephalography). methods: In addition to SEEG examination, we used coherence analysis of signals as a means of studying functional coupling between different regions of the brain. Two seizures were studied. Coherence values from different periods of interest were compared to identify the neural structures involved at the onset of seizure activity as well as during the emotional behavioral changes. RESULTS: A first network of neural structures was identified within the right anterior temporal regions (amygdala, temporal pole, hippocampus, temporal neocortex). At the time of intense affective and compulsive changes, and by comparison with the first ictal period, a second network was identified characterized by significant functional coupling between the amygdala, the orbito-frontal structures and the frontal opercular region, while a decrease in functional coupling between these regions and the dorsolateral region and the cingulate gyrus was apparent. CONCLUSION: This study show that the emergence of an intense affective and behavioral state during a temporal lobe seizure could be related to the involvement of a network of structures including the anterior temporal lobe and the orbito-frontal cortex. The decrease of coupling between these regions and the lateral prefrontal and cingulate regions could also participate in these phenomena.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
5/7. conversion disorder with convulsion and motor deficit mimicking the adverse effects of high-dose Ara-C treatment in a posttransplant acute myeloid leukemia patient: a case report and review of the literature.In this communication, we report an acute leukemia patient who developed conversion disorder mimicking the adverse effects of high-dose cytosine arabinoside (Ara-C) treatment after the patient received high-dose Ara-C treatment. A 21-year-old woman, with acute recurrent leukemia after bone marrow transplantation, received high-dose Ara-C treatment and 10 days later was referred for psychiatric consultation because of an abrupt onset of convulsion. On neurologic examination, she showed convulsion of all the limbs without loss of consciousness. All limbs looked paretic; however, tendon reflexes in all limbs were normal and pathological reflex was not recognized. When her hand was dropped onto her own face, it fell next to her face but not on her face. Laboratory data were unremarkable. She had no history of psychiatric illness or drug or alcohol abuse. The patient explained that she knew about the recurrence of her own leukemia and the news of the death of a close friend due to leukemia at the same time, which was a shocking event for her, focusing her attention on her own fears of dying from the same disease. conversion disorder in cancer patients is not common; however, appropriate diagnosis is very important to avoid inappropriate examinations and treatments. In leukemia patients receiving chemotherapy, various kinds of signs and symptoms may develop due to the adverse effects of chemotherapy and/or infection. Therefore, conversion disorder might be overlooked and inappropriate treatment and examinations might be performed. Clinicians should consider conversion disorder in the differential diagnosis when patients develop unexplained neurological symptoms.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
6/7. seizures of fronto-orbital origin: a proven case.Distinguishing characteristics of seizures of frontal origin have not been clearly delineated. We describe a case of seizures of proven fronto-orbital origin to provide further definition of characteristics of seizures arising in that lobe. A 36-year-old man had medically intractable seizures since age 8 years. Clinically the seizures were stereotyped, with cessation of activity followed by turning of head and body to the right and then by struggling, kicking, and vocalizations indicating fear. Total seizure duration was approximately 30 s, with an apparent abrupt return of consciousness. The interictal scalp EEGs were similar to those of primary generalized epilepsy, with bisynchronous though asymmetric epileptiform activity anteriorly. Ictal scalp recordings were not localizing. Recordings from bilateral frontal and temporal subdural electrodes showed an electrical focus in the right fronto-orbital region which was confirmed by electrocorticography (ECoG) at the time of craniotomy. The right fronto-orbital cortex was resected and on pathologic examination showed gliotic tissue and intracytoplasmic neuronal inclusions of periodic acid-Schiff (PAS)-positive granules consistent with lipofuscinosis. The patient has remained seizure-free for 6 years after operation.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
7/7. fear of seizures: an investigation and treatment.Despite the wealth of epidemiological evidence showing the comorbidity of epilepsy with various forms of psychopathology, there has been little systematic investigation of its relationship with affective disorders. This study aims to explore the phenomenon of seizure fear. Survey data have suggested that patients commonly fear death and/or brain damage as a result of their seizures, but documented cases of seizure phobia are rare and infrequently address issues of treatment. The study describes the exploration and successful cognitive behavioural treatment of a case of seizure phobia in a 26 year old woman with a 9 year history of epilepsy following a subarachnoid haemorrhage. The findings represent an important development in the much-neglected study of seizure fear. The case highlights some of the factors which may contribute to the genesis and maintenance of epilepsy-related psychopathologies and consequently has important implications for theoretical modelling in this area. Furthermore, it provides encouraging evidence to support the use of cognitive-behavioural techniques in treatment of these disorders.- - - - - - - - - - ranking = 3keywords = fear (Clic here for more details about this article) |