- N Engl J Med 2022; 386:791-792
The introduction of electroencephalography (EEG) into hospital practice generated interest in monitoring patients with severe brain injury after cardiac arrest. As early as 1964, a study involving 50 comatose patients who had been resuscitated after cardiac arrest showed “bursts of very large amplitude spikes, sharp waves, or complex wave forms...
- N Engl J Med 2022; 386:724-734
A trial involving comatose survivors of cardiac arrest tested whether aggressively treating rhythmic and periodic EEG activity would improve neurologic outcomes. Despite suppression of abnormal EEG activity, the incidence of a poor neurologic outcome did not differ significantly from that with standard care, and mortality was high in both groups.
- N Engl J Med 2021; 385:2563-2572
A 9-year-old boy was transferred to this hospital because of transient weakness, facial droop, and slurred speech that occurred after an episode of crying. The symptoms lasted approximately 2 minutes and then resolved. Two years earlier, the patient had been evaluated for episodes of shaking in the arms and legs....
- N Engl J Med 2021; 385:1894-1902
A 38-year-old man was evaluated in the emergency department because of altered mental status and a first seizure. Examination revealed an involuntary upward gaze and confusion. Laboratory evaluation revealed leukocytosis and lactic acidosis. A diagnosis was made.
- N Engl J Med 2021; 385:251-263
A detailed history taking and an eyewitness account are important in diagnosing a seizure. Antiseizure medication is generally not prescribed after a single seizure, except for patients with a high risk of recurrence. The medication choice varies according to the type of seizure and the patient’s coexisting conditions and childbearing...
- N Engl J Med 2021; 385:189-191
In this letter, the investigators report that continuous subcutaneous infusion of parathyroid hormone (1-34) in six patients who were between the ages of 5 weeks and 22 years and who had autosomal dominant hypocalcemia type 1 caused by mutations in the calcium-sensing receptor ameliorated hypocalcemic seizures.
- N Engl J Med 2020; 383:2547-2556
In a prospective study involving women with epilepsy, the incidence of seizures was similar regardless of whether women were pregnant or not pregnant during similar time periods. Pregnant women had more changes in the dose of anticonvulsant drugs during pregnancy than did nonpregnant women.
- N Engl J Med 2020; 383:2462-2470
A 29-month-old boy with a history of febrile seizure, atopic dermatitis, and multiple environmental and food allergies was transferred to the hospital because of a seizure and a blood calcium level of 5.0 mg per deciliter (reference range, 8.5 to 10.5). He had a pes planus deformity. A diagnostic test...
- N Engl J Med 2020; 383:787-789
Encephalopathy and coma developed in a 13-year-old boy shortly after he received a single dose of ivermectin to prevent scabies infection. ABCB1 sequencing identified the child as a compound heterozygote for two nonsense mutations.
- N Engl J Med 2020; 382:2569-2572
This interactive feature about a woman with idiopathic generalized epilepsy that has progressed to status epilepticus offers a case vignette accompanied by three essays, each of which recommends treatment with a different non-benzodiazepine medication. Vote and comment at NEJM.org.
- N Engl J Med 2020; 382:1943-1950
A 79-year-old man was admitted to this hospital because of hyponatremia and involuntary movements, which would start in the left arm and hand and then involve the left side of the face, such that he would look as though he was grimacing. After he received treatment for hyponatremia, the involuntary...
- N Engl J Med 2020; 382:457-467
A 52-year-old woman with refractory status epilepticus was admitted to the hospital. Despite treatment with a five-drug regimen, electroencephalography showed ongoing seizure activity. Fever, hypotension, a new wide-complex tachycardia, and diffuse global ventricular hypokinesis developed. A diagnosis was made.
- N Engl J Med 2019; 381:2171-2172
Status epilepticus is a medical emergency characterized either by continued seizures or by a lack of full recovery between seizures. It is relatively common, with a reported annual incidence of between 10 and 41 cases per 100,000 population (the variation partly reflects differing diagnostic criteria) and a mortality of approximately...
- N Engl J Med 2019; 381:2103-2113
Intravenous valproate, levetiracetam, and fosphenytoin stopped status epilepticus that was resistant to initial treatment with lorazepam in approximately half the patients and did not differ significantly in effectiveness. Hypotension was numerically — but not significantly — more frequent with fosphenytoin.
- N Engl J Med 2019; 381:1644-1652
A child with a neuronal ceroid lipofuscinosis was found to carry loss-of-function mutations in the gene MFSD8 (CLN7 ). A year after genetic diagnosis, the child began treatment with an oligonucleotide drug that was designed to correct the aberrant pre–messenger RNA splicing caused by one of these...
- N Engl J Med 2019; 380:1267-1267
An 18-year-old man presented to the emergency department with generalized tonic–clonic seizures. MRI of the head showed numerous well-defined cystic lesions in the brain that were consistent with cysticercosis.
- N Engl J Med 2018; 379:870-878
A 3-year-old boy was admitted to the hospital because of a seizure. Decreased language output, lethargy, mood lability, unsteady gait, and abnormal movements developed. CSF analysis revealed lymphocytic pleocytosis. A diagnosis and management decisions were made.
- N Engl J Med 2018; 379:8-9
A baby is rushed to the ED, seizing, heart beat slow and stuttering. Above the right eyebrow appears a big, violent, purple lump — the physician’s gaze stumbles over it: such an ugly wound on the surface, yet no match for the devastation hidden underneath.
- N Engl J Med 2018; 378:1888-1897
This randomized trial showed that two different doses of oral cannabidiol resulted in greater reductions in drop-seizure and total-seizure frequencies than placebo among patients with the Lennox–Gastaut syndrome, a severe developmental epileptic encephalopathy.
- N Engl J Med 2018; 378:1646-1648
In 10 of 120 family trios (consisting of a child with de novo epileptic encephalopathy and the child’s biologic parents), one parent was found to have mosaicism for the etiologic variant. This finding has implications for determining the risk of recurrence.