Seizure frequency, patient-perceived seizure severity and the psychosocial consequences of intractable epilepsy

1991 ◽  
Vol 9 (3) ◽  
pp. 231-241 ◽  
Author(s):  
David F. Smith ◽  
Gus A. Baker ◽  
Michael Dewey ◽  
Ann Jacoby ◽  
David W. Chadwick
Keyword(s):  
Seizure Frequency ◽  
Intractable Epilepsy ◽  
Seizure Severity ◽  
Psychosocial Consequences

scholarly journals Botulinum Toxin Injections for Simple Partial Motor Seizures Associated with Pain

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Edward C. Mader ◽  
Bruce J. Fisch ◽  
Nicole R. Villemarette-Pittman ◽  
Piotr W. Olejniczak ◽  
Michael E. Carey
Keyword(s):  
Botulinum Toxin ◽  
Pain Relief ◽  
Muscle Contraction ◽  
Seizure Frequency ◽  
Adjunctive Therapy ◽  
Seizure Control ◽  
Intractable Epilepsy ◽  
Seizure Severity ◽  
The Right ◽  
Botulinum Toxin Injections

Intractable epilepsy with painful partial motor seizures is a relatively rare and difficult disorder to treat. We evaluated the usefulness of botulinum toxin to reduce ictal pain. Two patients received two or four botulinum toxin (BTX) injections at one-to-two-month intervals. Patient 1 had painful seizures of the right arm and hand. Patient 2 had painful seizures involving the left foot and leg. Injections were discontinued after improved seizure control following resective surgery. Both patients received significant pain relief from the injections with analgesia lasting at least two months. Seizure severity was reduced, but seizure frequency and duration were unaffected. For these patients, BTX was effective in temporarily relieving pain associated with muscle contraction in simple partial motor seizures. Our findings do not support the hypothesis that modulation of motor end-organ feedback affects focal seizure generation. BTX is a safe and reversible treatment that should be considered as part of adjunctive therapy after failure to achieve control of painful partial motor seizures.

Seizure severity is associated with quality of life independent of seizure frequency

2009 ◽  
Vol 16 (2) ◽  
pp. 325-329 ◽  
Author(s):  
Ramon Edmundo D. Bautista ◽  
E. Tannahill Glen
Keyword(s):  
Quality Of Life ◽  
Seizure Frequency ◽  
Seizure Severity

scholarly journals Patient-assessed satisfaction and outcome after microsurgical resection of cavernomas causing epilepsy

2010 ◽  
Vol 29 (3) ◽  
pp. E16 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
W. Richard Marsh ◽  
Fredric B. Meyer ◽  
Gregory A. Worrell
Keyword(s):  
Seizure Frequency ◽  
Intractable Epilepsy ◽  
Survey Study ◽  
Intractable Seizures ◽  
Select Group ◽  
Age At Surgery ◽  
Survey Results ◽  
Microsurgical Resection

Object Microsurgical resection of supratentorial cavernomas associated with intractable epilepsy is performed frequently. Despite its common occurrence, little is known about patient perceptions of microsurgical resection for cavernomas. This survey study was performed to investigate patient perceived outcome after surgery for cavernomas associated with intractable epilepsy. Methods The authors' surgical database was searched for cavernoma resection performed between 1971 and July of 2006. Of the initial 173 patients identified, 102 met criteria for medically intractable seizures. These 102 patients were then mailed a survey to determine follow-up and patient satisfaction. Thirty-nine surveys were returned as undeliverable, and 30 (48%) of the remaining 63 patients responded. Results The average age at surgery for patients responding to this survey was 40 ± 16 years compared with 35 ± 15 years for all 102 patients. At prolonged follow-up, 87% of patients reported being seizure-free. Of those with seizures, 2 (7%) reported being nearly seizure-free (rare disabling seizures), 2 (7%) believed they had a worthwhile improvement in seizure frequency, and no patient (0%) in this series believed they did not have a worthwhile improvement in seizure frequency. Ninety percent of responders stated they definitely, and 10% probably, would have surgery again. No patient responded that they probably or definitely would not have epilepsy surgery. Mean clinical follow-up was 36 ± 8 months and survey follow-up was 97 ± 13 months for these 30 patients. Use of the mail-in survey increased follow-up length 2.7 times longer compared with clinical follow-up. Conclusions It is clear from this select group of survey responders that patients undergoing surgery for cavernomas associated with medically intractable epilepsy are happy they underwent surgery (100%) and had excellent surgical outcomes (87% seizure-free) at prolonged follow-up of 97 ± 13 months. These survey results support that microsurgical resection for cavernomas is highly effective and significantly improves these patients' quality of life.

P6-1 Effect of vagus nerve stimulation on EEG and seizure frequency in children with intractable epilepsy

2010 ◽  
Vol 121 ◽  
pp. S134
Author(s):  
B. Unay ◽  
E. Erdogan ◽  
S. Vurucu ◽  
Z. Gokcil ◽  
N. Bulakbasi ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Intractable Epilepsy

Reoperative Hemispherectomy for Intractable Epilepsy

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 388-393 ◽  
Author(s):  
Sumeet Vadera ◽  
Ahsan N.V. Moosa ◽  
Lara Jehi ◽  
Ajay Gupta ◽  
Prakash Kotagal ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Medical Records ◽  
Cleveland Clinic ◽  
Intractable Epilepsy ◽  
Patient Characteristics ◽  
Cortical Dysplasia ◽  
Seizure Freedom ◽  
Management Options ◽  
Functional Hemispherectomy

Abstract BACKGROUND: In patients with medically intractable epilepsy and diffuse unilateral hemispheric disease, functional or disconnective hemispherectomy is a widely accepted and successful treatment option. If recurrent seizures develop after disconnective hemispherectomy, management options become more complex and include conversion to anatomic hemispherectomy. OBJECTIVE: To present the outcomes of all patients undergoing reoperative hemispherectomy in 1 institution by 1 surgeon since 1998. METHODS: The medical records, operative reports, and imaging studies for 36 patients undergoing reoperative hemispherectomy for continuing medically intractable epilepsy from 1998 to 2011 at Cleveland Clinic were reviewed. Patient characteristics, cause of seizure, imaging findings, surgery-related complications, and long-term seizure outcomes were evaluated. RESULTS: Patients presented with a variety of seizure origins, including Rasmussen encephalitis, perinatal infarction, cortical dysplasia, and hemimegalencephaly. Overall, 19% of patients were seizure free after conversion to anatomic hemispherectomy, and 45% reported a decrease in seizure frequency by ≥ 90%. An additional 36% reported no improvement. Generalized ictal electroencephalography tended to confer a poorer prognosis, as did cortical dysplasia as the underlying diagnosis. CONCLUSION: The possibility that residual epileptogenic tissue in the operated hemisphere remains connected should be considered after failed functional hemispherectomy because our data suggest that improvement in seizure frequency is possible after reoperative hemispherectomy, although the chance of obtaining seizure freedom is relatively low. The decision to proceed with reoperative hemispherectomy should be made after proper discussion with the patient and family and informed consent is given.

scholarly journals Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy

Neurosurgery ◽  
2015 ◽  
Vol 79 (3) ◽  
pp. 345-353 ◽  
Author(s):  
Dario J. Englot ◽  
John D. Rolston ◽  
Clinton W. Wright ◽  
Kevin H. Hassnain ◽  
Edward F. Chang
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Intractable Epilepsy ◽  
Progressive Increase ◽  
Seizure Type ◽  
Seizure Freedom ◽  
Outcome Registry ◽  
Over Time

AbstractBACKGROUND:Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response.OBJECTIVE:To elucidate rates and predictors of seizure freedom with VNS.METHODS:We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies.RESULTS:Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio “OR”, 1.89; 95% confidence interval “CI”, 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom.CONCLUSION:Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients.

scholarly journals Topiramate Effectiveness as Add-on Therapy in Bulgarian Patients with Drug-resistant Epilepsy

Folia Medica ◽  
2020 ◽  
Vol 62 (4) ◽  
pp. 712-722
Author(s):  
Ekaterina Viteva ◽  
Zahari Zahariev
Keyword(s):  
Adverse Events ◽  
Seizure Frequency ◽  
Dynamic Assessment ◽  
University Hospital ◽  
Drug Resistant ◽  
Seizure Severity ◽  
Impaired Awareness ◽  
Eeg Recordings ◽  
Drug Resistant Epilepsy ◽  
Stable Improvement

Introduction: There are no reliable prospective studies on the effectiveness of topiramate in Bulgarian adult patients with drug-resistant epilepsy. Aim: The aim of the study was to conduct an open, prospective study on various aspects of topiramate (TPM) effectiveness in Bulgarian patients with drug-resistant epilepsy.  Patients and methods: The study included patients with epilepsy who attended the Clinic of Neurology at the University Hospital in Plovdiv, Bulgaria. Patients completed diaries for seizure frequency, seizure severity, and adverse events. There were regular documented visits at 3 or 6 months during the first year of TPM treatment and at 6 months afterwards, with a dynamic assessment of seizure fre-quency, severity, adverse events, and EEG recordings.  Results: TPM was used as an add-on treatment in 120 patients (69 males, mean age 37 years). There was a relatively mild and stable dynamic improvement of seizure severity, a satisfactory seizure frequency reduction in 37% of participants, a stable mean seizure fre-quency reduction (47%) from month 6 to month 24 of treatment and a stable responder rate (48-51%) during the same period. New seizure types (focal with impaired awareness with/without evolution to bilateral tonic-clonic seizures) occurred in 5 patients. There were adverse events (dizziness/vertigo, irritability, speech disturbances, memory impairment, concentration problems, tremor, loss of appe-tite and weight, weakness, numbness, bradypsychia, confusion, visual hallucinations, sleepiness, insomnia, headache, itching, unstable gait, nausea, and vomiting) in 20% of patients.  Conclusions: TPM treatment is associated with low and stable improvement of seizure severity, good and stable improvement of sei-zure frequency, possible worsening of seizure control and appearance of new seizure types, good safety and tolerability.

Methsuximide for Intractable Childhood Seizures

PEDIATRICS ◽  
1991 ◽  
Vol 87 (2) ◽  
pp. 186-189
Author(s):  
Michael B. Tennison ◽  
Robert S. Greenwood ◽  
Michael V. Miles
Keyword(s):  
Adverse Effects ◽  
Seizure Frequency ◽  
Intractable Epilepsy ◽  
Intractable Seizures

Methsuximide was added to the therapeutic regimens of 25 children with intractable epilepsy. In 15 patients the drug was well tolerated and resulted in a 50% or greater reduction in seizure frequency. No serious or irreversible adverse effects were seen. Methsuximide is frequently overlooked and may be an effective adjunctive antiepileptic for children with intractable seizures.

Cerebellar stimulation in the management of medically intractable epilepsy: a systematic and critical review

2010 ◽  
Vol 29 (2) ◽  
pp. E8 ◽  
Author(s):  
Kostas N. Fountas ◽  
Eftychia Kapsalaki ◽  
Georgios Hadjigeorgiou
Keyword(s):  
Deep Brain Stimulation ◽  
Seizure Frequency ◽  
Brain Stimulation ◽  
Clinical Studies ◽  
Intractable Epilepsy ◽  
Implantation Technique ◽  
Seizure Outcome ◽  
Double Blind ◽  
Deep Brain ◽  
Cerebellar Stimulation

Object The wide application of deep brain stimulation in the management of movement as well as other degenerative neurological and psychiatric disorders has renewed the interest in using deep brain stimulation in the management of medically intractable epilepsy. Various stimulation targets have been used with significantly varying results in aborting seizure activity. Electrical cerebellar stimulation (CS) has been used for more than 50 years in the management of epilepsy, with conflicting results. In the current study, the authors review the pertinent literature to outline the role of CS in the management of medically refractory epilepsy. Methods The PubMed medical database was systematically searched for the following terms: “cerebellar,” “epilepsy,” “stimulation,” and “treatment,” and all their combinations. Case reports were excluded from this study. Results The pertinent articles were categorized into 2 large groups: animal experimental and human clinical studies. Particular emphasis on the following aspects was given when reviewing the human clinical studies: their methodological characteristics, the number of participants, their seizure types, the implantation technique and its associated complications, the exact stimulation target, the stimulation technique, the seizure outcome, and the patients' psychological and social poststimulation status. Three clinical double-blind studies were found, with similar implantation surgical technique, stimulation target, and stimulation parameters, but quite contradictory results. Two of these studies failed to demonstrate any significant seizure reduction, whereas the third one showed a significant poststimulation decrease in seizure frequency. All possible factors responsible for these differences in the findings are analyzed in the present study. Conclusions Cerebellar stimulation seems to remain a stimulation target worth exploring for defining its potential in the treatment of medically intractable epilepsy, although the data from the double-blind clinical studies that were performed failed to establish a clear benefit in regard to seizure frequency. A large-scale, double-blind clinical study is required for accurately defining the efficacy of CS in epilepsy treatment.

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