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  1. Article: The Roles of Glutamate Receptors and Their Antagonists in Status Epilepticus, Refractory Status Epilepticus, and Super-Refractory Status Epilepticus.

    Huang, Tzu-Hsin / Lai, Ming-Chi / Chen, Yu-Shiue / Huang, Chin-Wei

    Biomedicines

    2023  Volume 11, Issue 3

    Abstract: Status epilepticus (SE) is a neurological emergency with a high mortality rate. When compared to chronic epilepsy, it is distinguished by the durability of seizures and frequent resistance to benzodiazepine (BZD). The Receptor Trafficking Hypothesis, ... ...

    Abstract Status epilepticus (SE) is a neurological emergency with a high mortality rate. When compared to chronic epilepsy, it is distinguished by the durability of seizures and frequent resistance to benzodiazepine (BZD). The Receptor Trafficking Hypothesis, which suggests that the downregulation of γ-Aminobutyric acid type A (GABAA) receptors, and upregulation of N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors play major roles in the establishment of SE is the most widely accepted hypothesis underlying BZD resistance. NMDA and AMPA are ionotropic glutamate receptor families that have important excitatory roles in the central nervous system (CNS). They are both essential in maintaining the normal function of the brain and are involved in a variety of neuropsychiatric diseases, including epilepsy. Based on animal and human studies, antagonists of NMDA and AMPA receptors have a significant impact in ending SE; albeit most of them are not yet approved to be in clinically therapeutic guidelines, due to their psychomimetic adverse effects. Although there is still a dearth of randomized, prospective research, NMDA antagonists such as ketamine, magnesium sulfate, and the AMPA antagonist, perampanel, are regarded to be reasonable optional adjuvant therapies in controlling SE, refractory SE (RSE) or super-refractory SE (SRSE), though there are still a lack of randomized, prospective studies. This review seeks to summarize and update knowledge on the SE development hypothesis, as well as clinical trials using NMDA and AMPA antagonists in animal and human studies of SE investigations.
    Language English
    Publishing date 2023-02-23
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2720867-9
    ISSN 2227-9059
    ISSN 2227-9059
    DOI 10.3390/biomedicines11030686
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  2. Article: The Primary Prevention of Poststroke Epilepsy in Patients With Middle Cerebral Artery Infarct: Protocol for a Randomized Controlled Trial.

    Chen, Yu-Shiue / Sung, Pi-Shan / Lai, Ming-Chi / Huang, Chin-Wei

    JMIR research protocols

    2023  Volume 12, Page(s) e49412

    Abstract: Background: Poststroke epilepsy poses a significant clinical challenge for individuals recovering from strokes, leading to a less favorable long-term outlook and increased mortality rates. Existing studies have primarily concentrated on administering ... ...

    Abstract Background: Poststroke epilepsy poses a significant clinical challenge for individuals recovering from strokes, leading to a less favorable long-term outlook and increased mortality rates. Existing studies have primarily concentrated on administering antiseizure or anticonvulsant treatments only after the onset of late-onset seizures, without intervening during the epileptogenesis phase following a stroke.
    Objective: This research protocol is designed to conduct a randomized controlled trial to assess whether the early, preventive introduction of low-dose antiepileptic drug therapy (levetiracetam [LEV] or perampanel [PER]) in patients who have experienced middle cerebral artery (MCA) infarction can reduce the risk of developing poststroke epilepsy (primary prevention).
    Methods: Participants with MCA infarction, either with or without reperfusion treatments, will be recruited and promptly receive preventive intervention within 72 hours of the stroke occurrence. These participants will be randomly assigned to receive either PER (4 mg per day), LEV (1000 mg per day), or a placebo that matches the active drugs. This treatment will continue for 12 weeks after allocation. Brain magnetic resonance imaging will be used to confirm the presence of MCA territory infarction, and an electroencephalography will be used to ensure the absence of epileptiform discharges or electrographic seizures at the time of the stroke. All participants will undergo follow-up assessments for 72 weeks after allocation.
    Results: The primary outcome under evaluation will be the incidence of poststroke epilepsy in the 3 groups following the 18-month study period. Secondary outcomes will encompass the time to the occurrence of the first seizure, the severity of seizures, any treatment-related adverse events, and the modified Rankin scale score at 3 and 18 months. Exploratory outcomes will involve comparing the effectiveness and safety of PER and LEV.
    Conclusions: We anticipate that the intervention groups will experience a lower incidence and reduced severity of poststroke epilepsy compared to the control group after 18 months. We aim to establish evidence supporting the potential preventive effects of LEV and PER on poststroke seizures and epilepsy in patients with MCA infarction, as well as to explore the antiepileptogenic potential of both LEV and PER in patients with major ischemic strokes.
    Trial registration: ClinicalTrials.gov NCT04858841; https://clinicaltrials.gov/study/NCT04858841.
    International registered report identifier (irrid): DERR1-10.2196/49412.
    Language English
    Publishing date 2023-11-24
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2719222-2
    ISSN 1929-0748
    ISSN 1929-0748
    DOI 10.2196/49412
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  3. Article: Brain Imaging in Epilepsy-Focus on Diffusion-Weighted Imaging.

    Huang, Tzu-Hsin / Lai, Ming-Chi / Chen, Yu-Shiue / Huang, Chin-Wei

    Diagnostics (Basel, Switzerland)

    2022  Volume 12, Issue 11

    Abstract: Epilepsy is a common neurological disorder; 1% of people worldwide have epilepsy. Differentiating epileptic seizures from other acute neurological disorders in a clinical setting can be challenging. Approximately one-third of patients have drug-resistant ...

    Abstract Epilepsy is a common neurological disorder; 1% of people worldwide have epilepsy. Differentiating epileptic seizures from other acute neurological disorders in a clinical setting can be challenging. Approximately one-third of patients have drug-resistant epilepsy that is not well controlled by current antiepileptic drug therapy. Surgical treatment is potentially curative if the epileptogenic focus is accurately localized. Diffusion-weighted imaging (DWI) is an advanced magnetic resonance imaging technique that is sensitive to the diffusion of water molecules and provides additional information on the microstructure of tissue. Qualitative and quantitative analysis of peri-ictal, postictal, and interictal diffusion images can aid the differential diagnosis of seizures and seizure foci localization. This review focused on the fundamentals of DWI and its associated techniques, such as apparent diffusion coefficient, diffusion tensor imaging, and tractography, as well as their impact on epilepsy in terms of differential diagnosis, epileptic foci determination, and prognosis prediction.
    Language English
    Publishing date 2022-10-27
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics12112602
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  4. Article ; Online: Dementia with non-convulsive seizures: a case report.

    Chen, Yu-Shiue / Chen, Tsang-Shan / Huang, Chin-Wei

    The Journal of international medical research

    2021  Volume 49, Issue 12, Page(s) 3000605211062453

    Abstract: Non-convulsive seizures (NCSs) are highly treatable, but appropriate management is usually delayed because of inaccurate diagnoses as a result of variable clinical presentations, including an altered mental state. It is difficult to detect NCSs in ... ...

    Abstract Non-convulsive seizures (NCSs) are highly treatable, but appropriate management is usually delayed because of inaccurate diagnoses as a result of variable clinical presentations, including an altered mental state. It is difficult to detect NCSs in patients with dementia. We report a case of NCS superimposed on cognitive decline caused by Alzheimer's dementia. The patient's history was carefully recorded. An electroencephalogram was recorded with sphenoidal electrodes, which showed epileptiform discharges in the right mesial temporal lobe and focal, sharply contoured, slow wave activity in the left fronto-temporal area, suggesting an epileptic origin contributing to the patient's cognitive decline. After treatment with antiepileptic drugs, the patient's cognitive functioning gradually improved. An accurate diagnosis of NCS relies on performing a detailed inventory of a patient's history, thorough physical and neurological examinations, and electroencephalogram recordings. In patients with cognitive decline, testing for NCS should always be included in the differential diagnosis of cognitive impairment, even in the case of dementia. Early administration of antiepileptic drug therapy is the mainstay treatment for reversing the condition and for preventing prolonged insults from neurological sequelae.
    MeSH term(s) Alzheimer Disease/drug therapy ; Anticonvulsants/therapeutic use ; Electroencephalography ; Epilepsy/drug therapy ; Humans ; Seizures/diagnosis ; Seizures/drug therapy
    Chemical Substances Anticonvulsants
    Language English
    Publishing date 2021-12-21
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 184023-x
    ISSN 1473-2300 ; 0300-0605 ; 0142-2596
    ISSN (online) 1473-2300
    ISSN 0300-0605 ; 0142-2596
    DOI 10.1177/03000605211062453
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    In stock of ZB MED Cologne/Königswinter

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  5. Article: Non-convulsive seizure clustering misdiagnosed as vertebrobasilar insufficiency.

    Chen, Yu-Shiue / Chen, Tsang-Shan / Huang, Chin-Wei

    Heliyon

    2020  Volume 6, Issue 11, Page(s) e05376

    Abstract: Diagnosing non-convulsive seizures (NCSs) is a great challenge for most clinicians due to a wide spectrum of clinical presentations. The complexity of the disease course usually results in a delayed diagnosis or misdiagnosis so that timely and ... ...

    Abstract Diagnosing non-convulsive seizures (NCSs) is a great challenge for most clinicians due to a wide spectrum of clinical presentations. The complexity of the disease course usually results in a delayed diagnosis or misdiagnosis so that timely and appropriate treatment is not given. Herein, we report a case with NCSs misdiagnosed as vertebrobasilar insufficiency (VBI), in which the patient suffered from episodes of prominent dizziness, vertigo, becoming transfixed, and worsening response within a day. Brain magnetic resonance image findings were unremarkable, however electroencephalography (EEG) showed rhythmic epileptiform discharges that appeared to originate from the right frontal area with ipsilateral hemispheric involvement. We prescribed intravenous valproate and the seizures ceased. Few studies have reported a patient with NCS misdiagnosed with VBI, a very different entity. It is thus important that clinicians should be aware of the trivial symptoms of NCSs, and to consider implementing early EEG studies and anti-epileptic drug therapy.
    Language English
    Publishing date 2020-11-06
    Publishing country England
    Document type Case Reports
    ZDB-ID 2835763-2
    ISSN 2405-8440
    ISSN 2405-8440
    DOI 10.1016/j.heliyon.2020.e05376
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  6. Article: Status Epilepticus Mortality Risk Factors and a Correlation Survey with the Newly Modified STESS.

    Huang, Tzu-Hsin / Lai, Ming-Chi / Chen, Yu-Shiue / Huang, Chin-Wei

    Healthcare (Basel, Switzerland)

    2021  Volume 9, Issue 11

    Abstract: Background: Status epilepticus (SE) is a neurological emergency and is usually associated with significant morbidity and mortality rates. Several clinical scales have been proposed to predict the clinical outcome of such incidents, including the Status ... ...

    Abstract Background: Status epilepticus (SE) is a neurological emergency and is usually associated with significant morbidity and mortality rates. Several clinical scales have been proposed to predict the clinical outcome of such incidents, including the Status Epilepticus Severity Score (STESS), the modified STESS (mSTESS), and the Encephalitis-Nonconvulsive Status Epilepticus-Diazepam Resistance-Image Abnormalities-Tracheal intubation (END-IT). Nevertheless, there is still a need for a more practical and precise predictive scale.
    Methods: This is a retrospective cohort study which examines data from patients with SE in our Department of Neurology between 2009 and 2020. Based on the outcome of each case, the patients were divided into survivor and non-survivor groups. We analyzed the independent factors and adjusted the STESS to achieve a better prediction of prognosis. The predictive accuracy of our new STESS scale was then compared with that of the mSTESS and the END-IT.
    Results: Data on a total of 59 patients were collected, with 6 of them classified as non-survivors. The effects of the variables of age, sex, underlying disease(s), and type(s) of antiepileptic drug (AED) use showed no significant differences between the survivor and non-survivor groups. Importantly, the number of AEDs used in the first week and the use of thiobarbiturates predicted non-survival. We adjusted the STESS to create the newly modified STESS (nSTESS), which showed a better predictive capacity than the STESS, the mSTESS, and the END-IT.
    Conclusions: Our adjustment of the STESS with the addition of the factors "number of AEDs within the first week" and "use of thiobarbiturates", could have a positive impact on the prediction of mortality rates compared with currently used scales. This nSTESS could potentially be useful in clinical practices, for the early prediction of outcomes for patients with SE.
    Language English
    Publishing date 2021-11-18
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2721009-1
    ISSN 2227-9032
    ISSN 2227-9032
    DOI 10.3390/healthcare9111570
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  7. Article ; Online: Effectiveness and Safety of Lacosamide, A Third-generation Anti-seizure Medication, for Poststroke Seizure and Epilepsy: A Literature Review.

    Chen, Yu-Shiue / Lai, Ming-Chi / Chen, Tsang-Shan / Tseng, Yung-Hsin / Li, Ya Jhen / Huang, Chin-Wei

    Current neuropharmacology

    2023  Volume 21, Issue 10, Page(s) 2126–2133

    Abstract: Advances in stroke treatment have resulted in a dramatic reduction in stroke mortality. Nevertheless, poststroke seizures and epilepsy are issues of clinical importance affecting survivors. Additionally, stroke is the most common cause of epilepsy in ... ...

    Abstract Advances in stroke treatment have resulted in a dramatic reduction in stroke mortality. Nevertheless, poststroke seizures and epilepsy are issues of clinical importance affecting survivors. Additionally, stroke is the most common cause of epilepsy in older adults. Although numerous antiseizure medications exist, studies are needed to provide robust evidence of the efficacy and tolerability of these medicines for treating poststroke seizures and epilepsy. Crucially, the newer generations of antiseizure medications require testing. Lacosamide, a third-generation antiseizure medication approved for treating localization-related epilepsy, has a novel mechanism of selectively enhancing the slow inactivation of sodium channels. This literature review evaluated whether lacosamide is effective and safe for the treatment of poststroke seizures and epilepsy. This review critically analyzed studies published in major academic databases (Pubmed, Embase, and Cochrane Library) from inception through June 2022 regarding the interaction of lacosamide with poststroke seizures and epilepsy. We included clinical prospective, retrospective, and case studies on patients with poststroke seizure and epilepsy, lacosamide as a treatment for seizures, neuroprotection in animal models of seizures, and the safety of lacosamide when coadministering anticoagulants. Clinical studies revealed lacosamide to be an effective antiseizure medication with high efficacy and tolerability in patients with poststroke seizures and epilepsy. In animal models, lacosamide proved effective at seizure reduction and neuroprotection. Pharmacokinetic studies demonstrated the safety of lacosamide when coadministering conventional and new anticoagulants. The literature suggests that Lacosamide is a promising candidate antiseizure medication for patients with poststroke seizures and epilepsy.
    MeSH term(s) Animals ; Lacosamide/therapeutic use ; Anticonvulsants/therapeutic use ; Retrospective Studies ; Prospective Studies ; Treatment Outcome ; Epilepsy/drug therapy ; Epilepsy/etiology ; Stroke/complications ; Stroke/drug therapy ; Anticoagulants/therapeutic use
    Chemical Substances Lacosamide (563KS2PQY5) ; Anticonvulsants ; Anticoagulants
    Language English
    Publishing date 2023-06-21
    Publishing country United Arab Emirates
    Document type Review ; Journal Article
    ZDB-ID 2192352-8
    ISSN 1875-6190 ; 1570-159X
    ISSN (online) 1875-6190
    ISSN 1570-159X
    DOI 10.2174/1570159X21666230616114255
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 6150: Show issues Location:
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  8. Article ; Online: Nonketotic Hyperglycemia-related Seizures of Left Parieto-occipital Origin: A Case Report.

    Chen, Yu-Shiue / Chen, Tsang-Shan / Huang, Chin-Wei

    The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses

    2019  Volume 52, Issue 1, Page(s) 27–29

    Abstract: Introduction: Nonketotic hyperglycemia-related seizures are not uncommonly encountered in clinical practice. Their presentation varies, and they may cause serious consequences if they remain unnoticed.: Case: We report a case of nonketotic ... ...

    Abstract Introduction: Nonketotic hyperglycemia-related seizures are not uncommonly encountered in clinical practice. Their presentation varies, and they may cause serious consequences if they remain unnoticed.
    Case: We report a case of nonketotic hyperglycemia-related seizures of unique left parieto-occipital origin and semiology, presenting as focal aware (simple partial) and impaired awareness (complex partial) seizures, including contralateral limb convulsion and apraxialike behavior.
    Discussion: Nonketotic hyperglycemia-related seizures can present with a relatively unique semiology. Careful education to the patients and family regarding attention to the paroxysmal symptoms and an effort to maintain good glycemic control are mandatory in clinical practice.
    MeSH term(s) Administration, Intravenous ; Electroencephalography ; Female ; Humans ; Hyperglycemia/complications ; Hyperglycemia/drug therapy ; Hyperglycemia/physiopathology ; Insulin/administration & dosage ; Levetiracetam/administration & dosage ; Magnetic Resonance Imaging ; Middle Aged ; Neuroscience Nursing ; Occipital Lobe/physiopathology ; Paresis/etiology ; Parietal Lobe/physiopathology ; Seizures/etiology
    Chemical Substances Insulin ; Levetiracetam (44YRR34555)
    Language English
    Publishing date 2019-12-05
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 632790-4
    ISSN 1945-2810 ; 0888-0395
    ISSN (online) 1945-2810
    ISSN 0888-0395
    DOI 10.1097/JNN.0000000000000481
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  9. Article ; Online: Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis.

    Chen, Yu-Shiue / Lee, Huan-Fang / Tsai, Ching-Hsuan / Hsu, Yu-Yun / Fang, Ching-Ju / Chen, Chen-Ju / Hung, Yu-Hsin / Hu, Fang-Wen

    Nutritional neuroscience

    2021  Volume 25, Issue 9, Page(s) 1801–1812

    Abstract: Objective: Migraine is a common disease worldwide and migraine prevention is primarily currently based on pharmaceuticals. The mechanism of Vitamin B2 may positively contribute to migraine. This systematic review and meta-analysis aimed to evaluate the ... ...

    Abstract Objective: Migraine is a common disease worldwide and migraine prevention is primarily currently based on pharmaceuticals. The mechanism of Vitamin B2 may positively contribute to migraine. This systematic review and meta-analysis aimed to evaluate the impact of Vitamin B2 supplementation on the days, duration, frequency, and pain score of the migraine attack.
    Methods: : The PRISMA guideline was used for the studying process. Five electronic databases, PubMed, Embase, Cochrane, CINAHL, and CEPS were searched from 1990 to March 2019. The search terms were Vitamin B2, migraine, and prophylactic. A meta-analysis was performed using Comprehensive Meta-Analysis (CMA) version.
    Results: : Nine articles were included in systemic review and finally meta-analysis. Eight randomized controlled trials and one controlled clinical trial with 673 subjects were analyzed using meta-analysis. Vitamin B2 supplementation significantly decreased migraine days (
    Conclusions: A pooled analysis of available randomized controlled clinical trials demonstrated that Vitamin B2 400 mg/day for three months supplementation had significant effect on days, duration, frequency, and pain score of migraine attacks.
    MeSH term(s) Dietary Supplements ; Humans ; Migraine Disorders/drug therapy ; Migraine Disorders/prevention & control ; Pain ; Randomized Controlled Trials as Topic ; Riboflavin/therapeutic use
    Chemical Substances Riboflavin (TLM2976OFR)
    Language English
    Publishing date 2021-03-29
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 1447449-9
    ISSN 1476-8305 ; 1028-415X
    ISSN (online) 1476-8305
    ISSN 1028-415X
    DOI 10.1080/1028415X.2021.1904542
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  10. Article: Risk of Incident Epilepsy After a Middle Cerebral Artery Territory Infarction.

    Hsieh, Cheng-Yang / Su, Chien-Chou / Lai, Edward Chia-Cheng / Chen, Yu-Shiue / Huang, Tzu-Hsin / Kao Yang, Yea-Huei / Chen, Chih-Hung / Sung, Sheng-Feng / Huang, Chin-Wei

    Frontiers in neurology

    2022  Volume 13, Page(s) 765969

    Abstract: Background: Among poststroke morbidities, poststroke epilepsy (PSE) has been identified as a significant clinical issue. Although middle cerebral artery (MCA) infarct is the most common type of stroke among all vascular territories, very few studies ... ...

    Abstract Background: Among poststroke morbidities, poststroke epilepsy (PSE) has been identified as a significant clinical issue. Although middle cerebral artery (MCA) infarct is the most common type of stroke among all vascular territories, very few studies specifically focused on the risk factors leading to PSE in patients with MCA infarct.
    Methods: A population study in Taiwan has been conducted, linking the National Health Insurance Research Database and Hospital Stroke Registry, from 2001 to 2015 and 2006 to 2010, respectively. Patients were divided into MCA and non-MCA groups, and the diagnosis of incident epilepsy between the groups has been compared. The multivariable Cox proportional hazard model was used to identify the risk factors for developing PSE. The distribution of time to PSE was estimated using the Kaplan-Meier method.
    Results: In total, 1,838 patients were recruited, with 774 and 1,064 in the MCA and non-MCA groups, respectively. PSE incidence in the MCA group was 15.5% vs. 6.2% in the non-MCA group, with a hazard ratio of (95% CI) 2.06 (1.33-3.19). Factors significantly associated with PSE included atrial fibrillation, depression, National Institutes of Health Stroke Scale (NIHSS) scores of ≥ 16, and alert on arrival. For patients with MCA infarct, higher NIHSS and Glasgow coma scale scores, the presence of visual field defects and weakness, urination control impairment, and complications during hospitalization were associated with a higher risk for PSE development.
    Conclusions: This study established the conditions leading to a higher risk of PSE and identified the important clinical risk factors in patients experiencing MCA infarct. Efforts to manage these risk factors may be important in preventing PSE in patients with MCA infarct.
    Language English
    Publishing date 2022-03-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2022.765969
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