Purpose: Webinar has more difficulty than face-to-face lectures in interacting with participants. Gamification is a way to motivate participants by applying games to non-game activities. We hypothesized that using Kahoot^®, a gamification software, in webinars can enhance participants' satisfaction.

Methods: At the 54^th Annual Meeting of the Japanese Epilepsy Society, members of Japan Young Epilepsy Section (YES-Japan), which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES), had a webinar session with the theme of “Efficient electroencephalography (EEG) education”. It consisted of a questionnaire by Kahoot, an educational lecture, and discussions. The questionnaire consisted of (1) participants' background, (2) EEG learning experience, and (3) feedback to the webinar. To assess the participants' satisfaction, the responses of those who participated in all three parts were analyzed.

Results: The average number of participants in each part of the questionnaire was 32.3 ± 4.7, and 23 participated in all parts. When asked whether Kahoot helped share opinions, of the 23 participants, 17 (74%) answered “very much” and 4 (17%) answered “a little”. When asked whether the session was meaningful, 12 (52%) answered “very much” and 7 (30%) answered “a little”.

Discussion: The participants successfully accepted the attempt to use Kahoot in the webinar. Gamification in webinars may increase participants' satisfaction and be helpful in formative assessment.

Background: It is generally accepted that 14 and 6 Hz-positive spikes (14/6 Hz PS) are normal variant electroencephalographic (EEG) patterns. Analysis of high frequency oscillations (HFOs) including fast oscillations (FOs) of extracranial EEG containing 14/6 Hz PS is difficult.

Case report: We performed an HFO analysis of the intracranial 14/6 Hz PS and interictal epileptiform discharges (IEDs) in a patient with occipital lobe epilepsy, who underwent simultaneous extracranial and intracranial EEG recordings. The 14/6 Hz PS were recorded on both extracranial and intracranial EEGs with the same waveform but different amplitudes. In contrast, the extracranial IEDs corresponding to every intracranial IED were not recorded. Intracranial 14/6 Hz PS did not have superimposing HFOs, while the intracranial IEDs had superimposing FOs such as high γ activities.

Conclusion: The finding that no HFOs were detected in intracranial 14/6 Hz PS further supports the notion that 14/6 Hz PS are not epileptogenic.

Mutations of SCN2A (which encodes the voltage-gated sodium channel Na_v1.2) cause different types of epilepsy and neurodevelopmental disorders. In this report, we present a case of epilepsy of infancy with migrating focal seizures (EIMFS) caused by a novel SCN2A missense mutation with mosaicism. From the second day of life, a full-term male infant with no perinatal abnormalities developed frequent focal seizures with symptoms that include apnea, ocular deviation, and brief tonic seizures. Based on electroencephalographic findings during an ictal phase, he was diagnosed with EIMFS. The epilepsy was resistant to several antiepileptic drugs, and phenytoin was the only effective medication. Whole-exome sequencing analysis revealed a de novo SCN2A missense mutation (c.488C>T, p.Thr163Ile) with mosaicism of about 15%. Thus, we concluded that physicians should accurately determine the genes to analyze based on medical history and that mosaicism should be considered during genetic analysis.

Insular or insulo-opercular resection for treating intractable epilepsy represents a significant neurosurgical challenge. Seizure outcomes have improved considerably with the accumulation of knowledge of insular epilepsy in the last decade. However, the surgical risks have not been well documented. In this article, we review the risks of insular or insulo-opercular epilepsy surgery, focusing on the putative roles of the insula, such as sensorimotor function, cognition, and social-emotional function. Insular resection does not cause a significant impairment of cognition, but poses a risk of postoperative motor complications and may affect emotional perception. Insular or insulo-opercular resection is a promising surgical treatment option for intractable epilepsy. However, further research is required to limit complications and improve safety.

Purpose: To under stand the needs and issues of electroencephalography (EEG) education following the onset of novel coronavirus disease 2019 (COVID-19) pandemic, and report our current EEG webinar management.

Methods: We conducted a weekly online EEG lecture at Hiroshima University Hospital in a hybrid format from July 2020 to December 2021. We recruited trainees using multiple types of social network services (SNS). We assessed the background of trainees in terms of postgraduate year, hospital size and location, area of expertise, entry route for registration, and clinical interests. We also investigated the current EEG educational needs and other relevant issues.

Results: A total of 468 trainees (419 clinicians, 49 technicians) registered from various institutes nationwide (229 hospitals and 9 clinics). As more than 60 webinars were presented over a year, a cumulative total of more than 3,000 trainees joined the webinars. Trainees' background was variable. SNS were helpful for recruitment. Major reasons for participation were to learn the minimum essentials of reading an EEG (70.1%) and to be able to read a digital EEG (56.5%). Privacy policies and web communication failures were major challenges.

Discussion: The study identified robust and nationwide needs for learning EEG regardless of area of expertise. Reduced face-to-face chance due to the pandemic greatly affected EEG education, as the education conventionally took a form of multidisciplinary collaboration in person. Our experience suggests that in addition to face-to-face education, information and communication technology can provide a sustainable learning platform.

Women with epilepsy (WWE) face many challenges all along their life, related to the influence of hormones on seizure control and antiepileptic drugs or even the effects of epilepsy on the endocrine system, fetus and newborn life. We evaluated, through a patient-oriented questionnaire, the overall management of WWE in a Moroccan series of 50 female patients. Our survey brought up some issues that need to be addressed: antiepileptic drugs undesirable for pregnancy still appear in the prescriptions for young female patients with epilepsy, contraceptive and preconceptual counselling are lacking, and vitamin supplementations are frequently overlooked. These and many other issues should be closely monitored and managed through the combined efforts of neurologists, obstetricians and gynecologists as well as family doctors, in order to ensure optimal care for WWE.

Although 22q11.2 deletion syndrome (22q11.2DS) is one of the most common chromosomal syndromes, there are only a few previous reports linking recurrent febrile seizures and 22q11.2DS. Here, we present the case of a 12-year-old boy in whom 22q11.2DS was first diagnosed at the on-set of genetic epilepsy febrile seizures plus. The patient presented with more than 10 recurrent febrile seizures since the age of 8 months. From the age of 11 years, he experienced recurrent afebrile generalized tonic-clonic seizures. He was diagnosed with 22q11.2DS for the first time at the age of 12 years. The recognition of hypocalcemia as well as atypical but characteristic facial features and symptoms such as congenital heart disease and mild developmental retardation led to the diagnosis of the syndrome. When examining children with a history of recurrent febrile seizures, 22q11.2DS should be considered as an underlying disease.

Purpose: To identify stressors among EEG technicians during the COVID-19 pandemic and to determine how these differed for groups previously identified to be at higher risk of psychological distress: female workers and those with a decrease in their salary/bonus.

Methods: A questionnaire was administered to 173 clinical neurophysiology technicians from March to April 2021. Stressors were compared between male and female sexes and between three groups with different salary/bonus changes (Down/No-change/Up). The study involved qualitative/quantitative analyses of open-ended responses to a question about stressors during the COVID-19 pandemic.

Results: Of the 142 respondents, 128 were included in the analyses. The results indicated that the words "infection" and "prevention" were characteristic of the males, while the words "patients," "anxiety," and "examination" were characteristic of the females. There was a significantly stronger connection between the words "patients" and "anxiety" in the females. For groups with different salary/bonus changes, the word "examination" was characteristic of the Down group, the word “infection” was characteristic of the No-change and Up groups, and the word “prevention” was characteristic of the Up group. The connection between the words "infection" and "examination" differed between the three groups.

Conclusion: Our results provide new insight into the factors that can increase stress among EEG technicians during the COVID-19 pandemic. Our findings may contribute to improving the work environment to optimize mental health.

The indications for surgical intervention for epilepsy associated with chromosomal abnormalities remain controversial. We report a 13-year-old girl with trisomy 21 and refractory epilepsy. The patient developed West syndrome at the age of 5 months. The seizures were refractory to multiple antiepileptic drugs, adrenocorticotropic hormone therapy, and a ketogenic diet. The patient developed Lennox-Gastaut syndrome at the age of 7 years. Frequent daily seizures including several sound-induced and tonic seizures impeded daily living of the patient and her caregivers. For alleviation of these seizures, the patient underwent total corpus callosotomy at the age of 13 years. The seizures disappeared almost completely, a state that continued throughout one year of follow-up. The patient's cognitive development also improved and her caregivers were satisfied with these outcomes. Appropriate surgical intervention may suppress seizures in patients with Lennox-Gastaut syndrome and trisomy 21.

Inherited glycosylphosphatidylinositol deficiencies (IGDs) are characterized by intractable epilepsy and developmental delay. Here, we report a three-year-old girl with an overlapping phenotype involving a compound heterozygous mutation (c.224T>C [p.I75T]; c.3139A>G [p.K1047E]) in the phosphatidylinositol glycan anchor biosynthesis class O (PIGO) gene. Our findings support the diagnosis of PIGO as a monogenic disease gene for developmental and epileptic encephalopathy. IGD-related epilepsy is usually intractable; however, seizures were completely controlled using diazepam and clonazepam with pyridoxine in our patient with mild developmental delay. Treatment with pyridoxine and benzodiazepine might be effective for the treatment of myoclonic seizure due to IGDs.