scholarly journals Seizure Exacerbation and Developmental Regression with Carbamazepine

1998 ◽  
Vol 25 (4) ◽  
pp. 287-294 ◽  
Author(s):  
A.N. Prasad ◽  
M. Stefanelli ◽  
L Nagarajan
Keyword(s):  
Seizure Control ◽  
Tertiary Care ◽  
Dramatic Improvement ◽  
Idiopathic Generalized Epilepsy ◽  
Careful Patient ◽  
Developmental Regression ◽  
Group I ◽  
Neurological Exam ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy

ABSTRACT:Background:Unexpected exacerbation of seizures may occur following initiation of treatment with carbamazepine (CBZ). We reviewed the occurrence of such reactions in our patient population at a tertiary care children's hospital.Methods:A retrospective analysis of our clinic database identified 129/691 (18.6%) patients with epilepsy treated with CBZ, as monotherapy. 38/129 children were later switched to another drug. In 11/38 (28.5 %) clinical and/or EEG deterioration was observed. Two patients identified at another institution with similar exacerbation were also included in our analysis. We report on the findings in these 13 cases.Results:Two groups were identified: Group I - 6 patients with normal neurological exam, normal EEG background, and a diagnosis of idiopathic generalized epilepsy. Group II - 7 patients with an abnormal neurological exam and/or abnormal EEG background. Following introduction of CBZ therapy, worsening of preexisting seizures, appearance of new seizure types, behavioral regression, and accompanying EEG deterioration were reported in both groups. Dramatic improvement in seizure control occurred, following withdrawal of CBZ and substitution of another anticonvulsant.Conclusion:Physicians treating epilepsy must be aware that CBZ can exacerbate seizures, and cause developmental regression in children. Careful patient selection, when choosing CBZ as treatment, and prompt recognition of clinical deterioration and intervention, may help avoid or reverse these paradoxical reactions.

scholarly journals Polygenic risk scores of several subtypes of epilepsies in a founder population

2020 ◽  
Vol 6 (3) ◽  
pp. e416
Author(s):  
Claudia Moreau ◽  
Rose-Marie Rébillard ◽  
Stefan Wolking ◽  
Jacques Michaud ◽  
Frédérique Tremblay ◽  
...  
Keyword(s):  
Mixed Model ◽  
Focal Epilepsy ◽  
Population Based ◽  
Risk Scores ◽  
Founder Population ◽  
Idiopathic Generalized Epilepsy ◽  
Polygenic Risk ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy ◽  
Variance Explained

ObjectivePolygenic risk scores (PRSs) are used to quantify the cumulative effects of a number of genetic variants, which may individually have a very small effect on susceptibility to a disease; we used PRSs to better understand the genetic contribution to common epilepsy and its subtypes.MethodsWe first replicated previous single associations using 373 unrelated patients. We then calculated PRSs in the same French Canadian patients with epilepsy divided into 7 epilepsy subtypes and population-based controls. We fitted a logistic mixed model to calculate the variance explained by the PRS using pseudo-R2 statistics.ResultsWe show that the PRS explains more of the variance in idiopathic generalized epilepsy than in patients with nonacquired focal epilepsy. We also demonstrate that the variance explained is different within each epilepsy subtype.ConclusionsGlobally, we support the notion that PRSs provide a reliable measure to rightfully estimate the contribution of genetic factors to the pathophysiologic mechanism of epilepsies, but further studies are needed on PRSs before they can be used clinically.

scholarly journals Exacerbation of Pre-existing Epilepsy by Mild Head Injury: a Five Patient Series

2004 ◽  
Vol 31 (3) ◽  
pp. 394-397 ◽  
Author(s):  
P.C. Tai ◽  
D.W. Gross
Keyword(s):  
Head Injury ◽  
Temporal Relationship ◽  
Seizure Control ◽  
Head Injuries ◽  
Neurological Deficits ◽  
Mild Head Injury ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
One Year ◽  
Patients With Epilepsy

Objective:While the risk of developing seizures following a mild head injury has been reported and is thought to be low, the effect of mild head injury on patients with a pre-existing seizure disorder has not been reported. We present a series of cases where a strong temporal relationship between mild head injury and worsening of seizure frequency was observed.Methods:Five cases were identified and reviewed in detail. Information was derived from clinic and hospital charts with attention to the degree of injury, pre- and postinjury seizure patterns and frequency.Results:One patient has primary generalized epilepsy and four have localization related epilepsy. Prior to the head injury, three of the patients were seizure free (range: two to 24 years). The patients suffered from mild head injuries with no or transient loss of consciousness and no focal neurological deficits. In all cases, the patients experienced a worsening of seizure control within days of the injury. In one case, the patient's seizure pattern returned to baseline one year after the accident, while in the remaining four cases, the patients continue to have medically refractory seizures.Conclusion:A close temporal relationship between mild head injury and a worsening of seizure control was observed in five patients with epilepsy. Although further study is required, this observation suggests that a head injury that would be considered benign in the general population can have serious consequences such as recurrence of seizures and medical intractability in patients with epilepsy.

Rapid eye movement (REM) sleep and seizure control in idiopathic generalized epilepsy

2020 ◽  
Vol 107 ◽  
pp. 107064
Author(s):  
Mohamed M. Hamdy ◽  
Amr M. Elfatatry ◽  
Jaidaa F. Mekky ◽  
Eman Hamdy
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
Seizure Control ◽  
Rapid Eye Movement ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy

scholarly journals Efficacy of Vagal Nerve Stimulation for Drug-Resistant Epilepsy: Is it the Stimulation or Medication?

2017 ◽  
Vol 44 (5) ◽  
pp. 532-537 ◽  
Author(s):  
Jaylynn Arcand ◽  
Karen Waterhouse ◽  
Lizbeth Hernandez-Ronquillo ◽  
Aleksander Vitali ◽  
Jose F. Tellez-Zenteno
Keyword(s):  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Drug Resistant ◽  
Idiopathic Generalized Epilepsy ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy ◽  
Seizure Classification

AbstractBackground: Vagus nerve stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug-resistant epilepsy, although modification of antiepileptic drugs (AEDs) during VNS treatment could explain the improvement in patients. Methods: We retrospectively assessed the efficacy of VNS in 30 adult patients with epilepsy treated with >6 months of follow-up. The criteria for implantation were the following: (1) not a candidate for resective epilepsy surgery, (2) drug-resistant epilepsy, (3) impairment of quality of life, (4) no other option of treatment, and (5) patients with idiopathic generalized epilepsy who fail to be controlled with appropriate AEDs. We assessed sociodemographics, seizure etiology, seizure classification, and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50% seizure improvement from baseline. Results: Thirty patients (females, 18; males, 12; age, 35.1±13.3 years) were included. After 6, 12, 24, and 36 months of follow-up, the response rates were: 13/30 (43%), 13/27 (48%), 9/22 (41%), and 8/16 (50%), respectively; none was seizure free. Fifty-seven percent, 33%, 59%, and 81% of patients had changes of medication type or dose at 6, 12, 24, and 36 months respectively. In the majority of patients, the change of medication consisted of an increase in the dose of AEDs. Conclusions: Our study shows that VNS is an effective therapy, although significant changes in medications were done along with the therapy; therefore, the real effect of VNS could be controversial.

Responsive Neurostimulation of the Thalamus Improves Seizure Control in Idiopathic Generalized Epilepsy: A Case Report

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. E578-E583 ◽  
Author(s):  
Vasileios Kokkinos ◽  
Alexandra Urban ◽  
Nathaniel D Sisterson ◽  
Ningfei Li ◽  
Danielle Corson ◽  
...  
Keyword(s):  
Case Report ◽  
Neural Activity ◽  
Seizure Control ◽  
Clinical Presentation ◽  
Idiopathic Generalized Epilepsy ◽  
Absence Seizures ◽  
Level Of Consciousness ◽  
Spike Wave Discharges ◽  
Generalized Epilepsy ◽  
Spike Wave

Abstract BACKGROUND AND IMPORTANCE At least 25% of patients with idiopathic generalized epilepsy do not obtain adequate seizure control with medication. This report describes the first use of responsive neurostimulation (RNS), bilaterally targeting the centromedian/ventrolateral (CM/VL) region in a patient with drug-refractory Jeavons syndrome (eyelid myoclonia with absences). CLINICAL PRESENTATION A patient, diagnosed with eyelid myoclonia with absences (EMA) and refractory to medication, was offered RNS treatment in the CM/VL region of the thalamus. Stimulation was triggered by thalamic neural activity having morphological, spectral, and synchronous features that corresponded to 3- to 5-Hz spike-wave discharges recorded on prior scalp electroencephalography. CONCLUSION RNS decreased daily absence seizures from a mean of 60 to ≤10 and maintained the patient's level of consciousness during the occurring episodes. This therapy should be evaluated further for its potential to treat patients with pharmaco-refractory generalized epilepsy.

scholarly journals Psychiatric morbidity in epilepsy

2017 ◽  
Vol 5 (10) ◽  
pp. 4267 ◽  
Author(s):  
Prem Singh ◽  
Achyut K. Pandey
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Psychiatric Morbidity ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
The Mean ◽  
Antiepileptic Medications ◽  
Generalized Epilepsy ◽  
One Year ◽  
Patients With Epilepsy

Background: Psychiatric morbidity occurs more frequently in patients with epilepsy than in the general population. Routine evaluation and treatment of psychiatric morbidity can be helpful in improving epilepsy care but such data are relatively meagre from developing countries.Methods: The study was conducted in the Epilepsy Clinic of Department of Neurology at a tertiary care hospital over a period of one year.101 patients were included after fulfilling the inclusion criteria. All the patients seeking treatment in the OPD were screened, assessed and then all procedures were fully explained to them. History regarding name, age sex, socio-demographic profile and detailed history regarding seizure disorder was taken from both the patient and the reliable informant. Bengali version of SRQ-24 was used to screen for psychiatric morbidity.Results: One hundred and one patients with epilepsy consisting of 70 men (69.3%) and 31 women (30.7%) were included. Their ages ranged from 15 to 52, the mean age being 26.17 (SD = 7.84). Out of the 101 patients, 65 patients (64.4%) were suffering from partial epilepsies and 36 patients (35.6%) were suffering from generalized epilepsies. 50.49% of the subjects screened positive for psychiatric morbidity. Psychiatric morbidity was higher in unmarried, unemployed males from rural background who were suffering from generalized epilepsy and taking multiple antiepileptic medications. Psychiatric morbidity was statistically significant in people with poor education and those born at home (p<0.05) as compared to well educated, institutionally born persons.Conclusions: 50.49% of the subjects screened positive for psychiatric morbidity.

scholarly journals Prevalence of depression in Patients with Epilepsy: A study from Tribhuvan University- Teaching Hospital

2014 ◽  
Vol 2 (2) ◽  
pp. 39-42
Author(s):  
AP Adhikari ◽  
SP Ojha ◽  
M Chapagai ◽  
P Tulachan
Keyword(s):  
Teaching Hospital ◽  
Tertiary Care ◽  
University Teaching ◽  
Psychiatric Evaluation ◽  
Care Hospital ◽  
Younger Age ◽  
Co Morbidity ◽  
Prevalence Of Depression ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy

Background: Epilepsy is often associated with mental and behavioral problems. Depression is one of the commonest psychiatric comorbidity among patients suffering from epilepsy leading to poorer seizure control and adversely affecting their quality of life. The objectives of this study were to know the prevalence of depression among patients with epilepsy and to see for any association with demographic and clinical variables.   Method: A cross sectional study was carried out in patients with epilepsy attending psychiatry outpatient department in a tertiary care hospital, Tribhuvan University-Teaching Hospital (TUTH). All consecutive patients with epilepsy meeting inclusion and exclusion criteria were involved in the study after obtaining informed consent. Depression was diagnosed using semi structured proforma and ICD-10 DCR criteria. Data was analyzed using SPSS version 16 and analysis carried out using descriptive statistics.   Results: Out of total 68 patients, 58.8% were male. About 54.4% of subjects were single and 26.5%were students. Out of the total subject, 79.4% were from rural areas. About 37%cases were having depression at the time of the interview. Male gender, younger age, having generalized epilepsy was more associated with depression.   Conclusion: Depression was found to be highly prevalent psychiatric co- morbidity among the patients with epilepsy. Patients of younger age group, men and having generalized epilepsy were more prone to have depression. The study emphasized need for proper psychiatric evaluation for overall management of patients with epilepsy. DOI: http://dx.doi.org/10.3126/jpan.v2i2.9725 J Psychiatrists’ Association of Nepal Vol.2, No.2, 2013 39-42

scholarly journals Chronotypes in Patients with Epilepsy: Does the Type of Epilepsy Make a Difference?

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hallie Kendis ◽  
Kelly Baron ◽  
Stephan U. Schuele ◽  
Bhavita Patel ◽  
Hrayr Attarian
Keyword(s):  
Seizure Control ◽  
Focal Epilepsy ◽  
Healthy Controls ◽  
Circadian Misalignment ◽  
Age Related ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy ◽  
The Impact ◽  
Related Increase

Circadian rhythms govern all biological functions. Circadian misalignment has a major impact on health. Late chronotype is a risk factor for circadian misalignment which in turn can affect the control of seizures in epilepsy patients. We compared a group of 87 confirmed epilepsy patients regardless of subtypes with age- and sex-matched healthy controls. We compared generalized epilepsy patients with localization related epilepsy patients and with healthy controls. We found that primary generalized epilepsy patients were 5 times more likely to have a late chronotype than healthy controls. We did not find any significant differences between localization related epilepsy patients and healthy controls or between the overall epilepsy cohort and healthy controls. Generalized epilepsy patients are more likely to be evening types as compared to those with focal epilepsy or subjects without epilepsy. Epilepsy patients do not experience the same age related increase in morningness as do age-matched healthy controls. This is important in regard to timing of AED, identifying and preventing sleep deprivation, and integrating chronotype evaluations and chronotherapy in comprehensive epilepsy care. Further studies, using objective phase markers or the impact of chronotherapy on seizure control, are necessary.

scholarly journals Functional network topology in drug resistant and well-controlled idiopathic generalized epilepsy: a resting state functional MRI study

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Emily J Pegg ◽  
Andrea McKavanagh ◽  
R Martyn Bracewell ◽  
Yachin Chen ◽  
Kumar Das ◽  
...  
Keyword(s):  
Network Topology ◽  
Resting State ◽  
Betweenness Centrality ◽  
Path Length ◽  
Seizure Control ◽  
Drug Resistant ◽  
Idiopathic Generalized Epilepsy ◽  
Characteristic Path Length ◽  
Graph Theoretic ◽  
Generalized Epilepsy

Abstract Despite an increasing number of drug treatment options for people with idiopathic generalized epilepsy (IGE), drug resistance remains a significant issue and the mechanisms underlying it remain poorly understood. Previous studies have largely focused on potential cellular or genetic explanations for drug resistance. However, epilepsy is understood to be a network disorder and there is a growing body of literature suggesting altered topology of large-scale resting networks in people with epilepsy compared with controls. We hypothesize that network alterations may also play a role in seizure control. The aim of this study was to compare resting state functional network structure between well-controlled IGE (WC-IGE), drug resistant IGE (DR-IGE) and healthy controls. Thirty-three participants with IGE (10 with WC-IGE and 23 with DR-IGE) and 34 controls were included. Resting state functional MRI networks were constructed using the Functional Connectivity Toolbox (CONN). Global graph theoretic network measures of average node strength (an equivalent measure to mean degree in a network that is fully connected), node strength distribution variance, characteristic path length, average clustering coefficient, small-world index and average betweenness centrality were computed. Graphs were constructed separately for positively weighted connections and for absolute values. Individual nodal values of strength and betweenness centrality were also measured and ‘hub nodes’ were compared between groups. Outcome measures were assessed across the three groups and between both groups with IGE and controls. The IGE group as a whole had a higher average node strength, characteristic path length and average betweenness centrality. There were no clear differences between groups according to seizure control. Outcome metrics were sensitive to whether negatively correlated connections were included in network construction. There were no clear differences in the location of ‘hub nodes’ between groups. The results suggest that, irrespective of seizure control, IGE interictal network topology is more regular and has a higher global connectivity compared to controls, with no alteration in hub node locations. These alterations may produce a resting state network that is more vulnerable to transitioning to the seizure state. It is possible that the lack of apparent influence of seizure control on network topology is limited by challenges in classifying drug response. It is also demonstrated that network topological features are influenced by the sign of connectivity weights and therefore future methodological work is warranted to account for anticorrelations in graph theoretic studies.

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