Browsing by Author "Franco, Ana Catarina"
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- Anti-glutamic acid decarboxylase encephalitis presenting with choreo‐dystonic movements and coexisting electrographic seizuresPublication . Azevedo Kauppila, Linda; Coelho, Miguel; Franco, Ana Catarina; Teodoro, Tiago; Peralta, Ana Rita; Bentes, Carla; Falcão, Filipa; Albuquerque, LuísaGlutamic acid decarboxylase (GAD) antibodies (ab) have been associated with rare disorders, such as Stiff-person syndrome, limbic encephalitis, cerebellar ataxia, and temporal lobe epilepsy. Other systemic autoimmune disorders have been linked to antiGAD ab, among them, diabetes mellitus (DM).
- Early EEG predicts poststroke epilepsyPublication . Bentes, Carla; Martins, Hugo; Peralta, Ana Rita; Morgado, Carlos; Casimiro, Carlos; Franco, Ana Catarina; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Melo, Teresa Pinho e; Paiva, Teresa; Ferro, JoséObjective: Electroencephalography (EEG) can identify biomarkers of epileptogenesis and ictogenesis. However, few studies have used EEG in the prediction of poststroke seizures. Our primary aim was to evaluate whether early EEG abnormalities can predict poststroke epilepsy. Methods: A prospective study of consecutive acute anterior circulation ischemic stroke patients, without previous epileptic seizures, who were admitted to a stroke unit over 24 months and followed for 1 year. All patients underwent standardized clinical and diagnostic assessment during the hospital stay and after discharge. Video-EEG was performed in the first 72 h (first EEG), daily for the first 7 days, in case of neurological deterioration, at discharge, and at 12 months after stroke. The occurrence of epileptic seizures in the first year after stroke (primary outcome) was evaluated clinically and neurophysiologically during the hospital stay and at 12 months. A telephone interview was also performed at 6 months. The primary outcome was the occurrence of at least one unprovoked seizure (poststroke epilepsy). Secondary outcomes were the occurrence of at least one acute symptomatic seizure and (interictal and/or ictal) epileptiform activity on at least one EEG during the hospital stay for acute stroke. The first EEG variables were defined using international criteria/terminology. Bivariate and multivariate analyses with adjustment for age, admission National Institutes of Health Stroke Scale (NIHSS) score, and Alberta Stroke Program Early CT Score (ASPECTS) were performed. Results: A total of 151 patients were included; 38 patients (25.2%) had an acute symptomatic seizure and 23 (16%) had an unprovoked seizure.The first EEG background activity asymmetry and first EEG with interictal epileptiform activity were independent predictors of poststroke epilepsy during the first year after stroke (P = 0.043 and P = 0.043, respectively). No EEG abnormality independently predicted acute symptomatic seizures. However, the presence of periodic discharges on the first EEG was an independent predictor of epileptiform activity (p = 0.009) during the hospital stay. Significance: An early poststroke EEG can predict epilepsy in the first year after stroke, independently from clinical and imaging-based infarct severity.
- Frequency of post-stroke electroencephalographic epileptiform activity : a systematic review and meta-analysis of observational studiesPublication . Bentes, Carla; Rodrigues, Filipe Brogueira; de Sousa, Diana Aguiar; Duarte, Gonçalo Silva; Franco, Ana Catarina; Marques, Raquel; Nzwalo, Hipólito; Peralta, Ana; Ferro, José; Costa, JoãoIntroduction: Cerebrovascular diseases are the most frequent risk factor for epilepsy in the elderly, and epileptic phenomenon following stroke is known to worsen the prognosis. Although electroencephalography is the gold standard epilepsy biomarker, it is rarely used in post-stroke studies, and the frequency of post-stroke epileptiform activity is still uncertain. Patients and methods: We analysed studies indexed to MEDLINE, Embase, Web of Science, PsycINFO and OpenGrey (up to March 2015), reporting post-stroke electroencephalographic epileptiform activity frequency in adults. Epileptiform activity was classified as ictal (electrographic seizures) and interictal (non-periodic spikes and sharp waves). Data selection, extraction and appraisal were done in duplicate. Random-effects meta-analysis was used to pool frequencies. Results: The pooled frequency of post-stroke ictal and interictal epileptiform activity was 7% (95% CI 3%–12%) and 8% (95% CI 4%–13%), respectively. The use of continuous electroencephalogram was not associated with an increased frequency of electrographic seizures (p ¼ 0.05), nor did the management setting (Intensive Care Unit versus nonIntensive Care Unit, p ¼ 0.31). However, studies with continuous electroencephalogram showed a higher frequency of interictal epileptiform activity (p ¼ 0.01). Discussion: This study provides the best available estimates of the frequency of post-stroke electroencephalographic epileptiform activity. Due to detection bias, it was not possible to correlate clinical and electrographic seizures. Conclusion: The frequency of ictal and interictal epileptiform activity in the electroencephalogram was comparable with previous frequency analyses of clinical seizures. The frequency of ictal epileptiform activity did not change with continuous record or clinical setting, while the frequency of interictal epileptiform activity increased with continuous record.
- Histopathological characterization of cerebral small vessel disease in epilepsy patients with temporal lobe epilepsy submitted to surgery: a case–control studyPublication . Coelho, Pedro; Madureira, João; Franco, Ana Catarina; Peralta, Ana; Bentes, Carla; Rainha Campos, Alexandre; Anink, Jasper; Aronica, Eleonora; Roque, Rafael; Pimentel, JoséBackground: Cerebrovascular disease (CVD) is a major contributor to epilepsy; however, patients with epilepsy also have a significantly increased risk of stroke. The way in which epilepsy contributes to the increased risk of stroke is still uncertain and is ill-characterized in neuropathological studies. A neuropathological characterization of cerebral small vessel disease (cSVD) in patients with chronic epilepsy was performed. Methods: Thirty-three patients with refractory epilepsy and hippocampal sclerosis (HS) submitted to epilepsy surgery from a reference center were selected between 2010 and 2020 and compared with 19 autopsy controls. Five randomly selected arterioles from each patient were analyzed using a previously validated scale for cSVD. The presence of CVD disease imaging markers in pre-surgical brain magnetic resonance imaging (MRI) was studied. Results: There were no differences in age (43.8 vs. 41.6 years; p = 0.547) or gender distribution (female gender 60.6% vs. male gender 52.6%; p = 0.575) between groups. Most CVD findings in brain MRI were mild. Patients had a mean time between the epilepsy onset and surgery of 26 ± 14.7 years and were medicated with a median number of three antiseizure medication (ASMs) [IQR 2-3]. Patients had higher median scores in arteriolosclerosis (3 vs. 1; p < 0.0001), microhemorrhages (4 vs. 1; p < 0.0001) and total score value (12 vs. 8.9; p = 0.031) in comparison with controls. No correlation was found between age, number of years until surgery, number of ASMs or cumulative defined daily dosage of ASM. Conclusion: The present study provides evidence supporting the increased burden of cSVD in the neuropathological samples of patients with chronic epilepsy.
- Personality patterns of people with medically refractory epilepsy : does the epileptogenic zone matter?Publication . Novais, Filipa; Franco, Ana Catarina; Loureiro, Susana; Andrea, Mafalda; Figueira, Maria Luísa; Pimentel, José; Pestana, Luís CâmaraObjectives: The aims of this study were to determine the rate of dysfunctional personality patterns before and after epilepsy surgery, their types, and the importance of the epileptogenic zone in a sample of people with refractory epilepsy. Methods: We conducted an ambispective observational study, including refractory epilepsy surgery candidates. Demographic, psychiatric, and neurological data were recorded. Evaluation of personality was made using the Millon Clinical Multiaxial Inventory-II (MCMI-II). Presurgical predictors of personality patterns were determined using a linear regression model. The proportion of patients with dysfunctional personality patterns, before and after surgery, was compared using the Mcnemar's test. Then a generalized estimating equation model was performed to include predictors of changes in this rate. Results: One hundred and ninety-nine participants were included. Seventy percent had a dysfunctional personality pattern before surgery. After surgery, this percentage dropped to 58%. The difference was statistically significant after adjusting for potential confounders (p = 0.013). The most common types were Cluster C personality patterns. Temporal epileptogenic zone was a significant predictor of higher scores of the Avoidant (Coef. 11.8; Confidence Interval (CI) −0.59 23.7; p = 0.051) and Compulsive (Coef. 9.55; CI 2.48 16.6; p = 0.008) personality patterns and lower scores of Histrionic (Coef. −11.4; CI −21.2 −1.55; p = 0.024) and Antisocial (Coef. −8.4; CI−15.6 −1.25; p = 0.022) personality patterns, compared to extratemporal epileptogenic zone. Conclusion: People with refractory epilepsy have high rates of dysfunctional personality patterns. These patterns differ according to the epileptogenic zone.
- Post-stroke seizures are clinically underestimatedPublication . Bentes, Carla; Martins, Hugo F G; Peralta, Ana Rita; Casimiro, Carlos; Morgado, Carlos; Franco, Ana Catarina; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Melo, Teresa Pinho e; Paiva, Teresa; Ferro, JoséCerebrovascular disease is the leading cause of epilepsy in adults, although post-stroke seizures reported frequency is variable and few studies used EEG in their identification. To describe and compare EEG and clinical epileptic manifestations frequency in patients with an anterior circulation ischaemic stroke. Prospective study of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for 1 year. All patients underwent standardized clinical and diagnostic assessment. Seizure occurrence was clinically evaluated during hospitalization and by a telephone interview at 6 months and a clinical appointment at 12 months after stroke. Video-EEG was performed in the first 72 h (1st EEG), daily after the 1st EEG for the first 7 days after the stroke, or later if neurological worsening, at discharge, and at 12 months. 151 patients were included (112 men) with a mean age of 67.4 (11.9) years. In the 1st year after stroke, 38 patients (25.2%) had an epileptic seizure. During hospitalization, 27 patients (17.9%) had epileptiform activity (interictal or ictal) in the EEG, 7 (25.9%) of them electrographic seizures. During the first week after stroke, 22 (14.6%) patients had a seizure and 4 (2.6%) non-convulsive status epilepticus criteria. Five (22.7%) acute symptomatic seizures were exclusively electrographic. At least one remote symptomatic seizure occurred in 23 (16%) patients. In the first 7 days after stroke, more than one-fifth of patients with seizures had exclusively electrographic seizures. Without a systematic neurophysiological evaluation the frequency of post-stroke seizures are clinically underestimated.
- Quantitative EEG and functional outcome following acute ischemic strokePublication . Bentes, Carla; Peralta, Ana; Viana, Pedro; Martins, Hugo F G; Morgado, Carlos; Casimiro, Carlos; Franco, Ana Catarina; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Melo, Teresa Pinho e; Paiva, Teresa; Ferro, JoséObjective: To identify the most accurate quantitative electroencephalographic (qEEG) predictor(s) of unfavorable post-ischemic stroke outcome, and its discriminative capacity compared to already known demographic, clinical and imaging prognostic markers. Methods: Prospective cohort of 151 consecutive anterior circulation ischemic stroke patients followed for 12 months. EEG was recorded within 72 h and at discharge or 7 days post-stroke. QEEG (global band power, symmetry, affected/unaffected hemisphere and time changes) indices were calculated from mean Fast Fourier Transform and analyzed as predictors of unfavorable outcome (mRS ≥ 3), at discharge and 12 months poststroke, before and after adjustment for age, admission NIHSS and ASPECTS. Results: Higher delta, lower alpha and beta relative powers (RP) predicted outcome. Indices with higher discriminative capacity were delta-theta to alpha-beta ratio (DTABR) and alpha RP. Outcome models including either of these and other clinical/imaging stroke outcome predictors were superior to models without qEEG data. In models with qEEG indices, infarct size was not a significant outcome predictor. Conclusions: DTAABR and alpha RP are the best qEEG indices and superior to ASPECTS in post-stroke outcome prediction. They improve the discriminative capacity of already known clinical and imaging stroke outcome predictors, both at discharge and 12 months after stroke. Significance: qEEG indices are independent predictors of stroke outcome.
- Seizures, electroencephalographic abnormalities, and outcome of ischemic stroke patientsPublication . Bentes, Carla; Peralta, Ana Rita; Martins, Hugo F G; Casimiro, Carlos; Morgado, Carlos; Franco, Ana Catarina; Viana, Pedro; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Melo, Teresa Pinho e; Paiva, Teresa; Ferro, JoséObjective: Seizures and electroencephalographic (EEG) abnormalities have been associated with unfavorable stroke functional outcome. However, this association may depend on clinical and imaging stroke severity. We set out to analyze whether epileptic seizures and early EEG abnormalities are predictors of stroke outcome after adjustment for age and clinical/imaging infarct severity. Methods: A prospective study was made on consecutive and previously independent acute stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 on admission and an acute anterior circulation ischemic lesion on brain imaging. All patients underwent standardized clinical and diagnostic assessment during admission and after discharge, and were followed for 12 months. Video-EEG (<60 min) was performed in the first 72 h. The Alberta Stroke Program Early CT Score quantified middle cerebral artery infarct size. The outcomes in this study were an unfavorable functional outcome (modified Rankin Scale [mRS] ≥ 3) and death (mRS = 6) at discharge and 12 months after stroke. Results: Unfavorable outcome at discharge was independently associated with NIHSS score (p = 0.001), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Unfavorable outcome 1 year after stroke was independently associated with age (p = 0.001), NIHSS score (p < 0.001), remote symptomatic seizures (p = 0.046), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Death in the first year after stroke was independently associated with age (p = 0.028), NIHSS score (p = 0.001), acute symptomatic seizures (p = 0.015), and EEG suppression (p = 0.019). Significance: Acute symptomatic seizures were independent predictors of vital outcome and remote symptomatic seizures of functional outcome in the first year after stroke. Therefore, their recognition and prevention strategies may be clinically relevant. Early EEG abnormalities were independent predictors and comparable to age and early clinical/imaging infarct severity in stroke functional outcome discrimination, reflecting the concept that EEG is a sensitive and robust method in the functional assessment of the brain.
- Stereo-EEG recording and minimally invasive treatment of a periventricular nodular heterotopy : two-in-one strategyPublication . Franco, Ana Catarina; Peralta, Ana Rita; Morgado, Carlos; Gonçalves Ferreira, António; Rainha Campos, Alexandre; Bentes, CarlaPeriventricular nodular heterotopias (PNHs) are malformations of cortical development. These are frequently associated with drug-resistant epilepsy. Stereo-electroencephalography (SEEG) is usually part of the epilepsy pre-surgical evaluation in order to find the epileptogenic zone (EZ). SEEG-guided radiofrequency-thermocoagulation (RF-TC) has been used to ablate or disrupt the EZ and proved to be effective, with seizure freedom rates of 38-50%, a responder rate of 81% and a favorable safety profile.
- Syncope due to ictal asystole : a challenging semiologyPublication . Leal Rato, Miguel; Ionel, Cristina; Baduro, Yanina; Oliveira, Renato; Franco, Ana Catarina; Peralta, Ana Rita; Bentes, CarlaCardiac rhythm abnormalities are a possibly serious manifestation of epilepsy and seizures. We present a 36-year-old woman with episodes of altered mental status and loss of muscle tone for 20-30 seconds, preceded by déjà vu, bilateral tinnitus and generalized coldness.