Drug Treatment of Epilepsy: When Does It Fail and How to Optimize Its Use?

CNS Spectrums ◽  
2004 ◽  
Vol 9 (2) ◽  
pp. 110-119 ◽  
Author(s):  
Patrick Kwan ◽  
Martin J. Brodie
Keyword(s):  
Mesial Temporal Lobe Epilepsy ◽  
Epilepsy Syndrome ◽  
Combination Regimen ◽  
First Line ◽  
Community Based ◽  
Early Use ◽  
History Of ◽  
Mesial Temporal Lobe ◽  
History Of Epilepsy

AbstractAlthough modern community-based studies have shown that a majority of people with newly diagnosed epilepsy will enter long-term remission, seizures remain refractory to treatment in a substantial proportion of this population—perhaps as much as 40%. A consensus is being reached that, for operational purposes, pharmacoresistance can be suspected when two appropriately chosen, well-tolerated, first-line antiepileptic drugs (AEDs) or one monotherapy and one combination regimen have failed due to lack of efficacy. Poor prognostic factors include lack of response to the first AED, specific syndromes, symptomatic etiology, family history of epilepsy, psychiatric comorbidity, and high frequency of seizures. These observations suggest that prognosis can often be determined early in the course of the disorder. We propose a management paradigm that aims to maximize the chance of successful AED therapy, including the early use of “rational polytherapy” for patients not responding to monotherapy, and to identify efficiently patients suitable for “curative” resective surgery, in particular those with mesial temporal lobe epilepsy. An orderly approach to each epilepsy syndrome will optimize the chance of perfect seizure control and help more patients achieve a fulfilling life.

Predictive factors of long-term outcomes of surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis

Epilepsia ◽  
2017 ◽  
Vol 58 (8) ◽  
pp. 1473-1485 ◽  
Author(s):  
Bertrand Mathon ◽  
Franck Bielle ◽  
Séverine Samson ◽  
Odile Plaisant ◽  
Sophie Dupont ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Predictive Factors ◽  
Hippocampal Sclerosis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Long Term Outcomes ◽  
Mesial Temporal Lobe

National Foresight in Korea: History of Futures Studies and Foresight in Korea

2018 ◽  
Vol 11 (3) ◽  
pp. 232-244
Author(s):  
Kyungmoo Heo ◽  
Yongseok Seo
Keyword(s):  
National Development ◽  
Futures Studies ◽  
Government Officials ◽  
Community Based ◽  
Public Interests ◽  
Public And Private ◽  
National Assembly ◽  
The Public ◽  
History Of

Public interests in coming futures of Korea continue to be increasing. Fears on uncertainties and pending challenges as well as demands on a new but Korea-own development model trigger a quantitative increase of futures research and relevant organizations in both public and private. The objective of this paper is to review history of futures studies and national development plan and strategy linked with foresight along with its challenges and recommendations. This paper identifies drawbacks and limits of Korea foresight such as misapplication of foresight as a strategic planning tool for modernization and economic development and its heavy reliance on government-led mid- and long-term planning. As a recommendation, an implementation of participatory and community-based foresight is introduced as a foundation for futures studies in Korea. A newly established research institute, the National Assembly Futures Institute, has to be an institutional passage to deliver opinions of the public, a capacity-building platform to increase the citizen’s futures literacy, and a cooperative venue for facilitating a participation and dialogue between politicians, government officials, and researchers.

Delta Brush Pattern Is Not Unique to NMDAR Encephalitis: Evaluation of Two Independent Long-Term EEG Cohorts

2017 ◽  
Vol 49 (4) ◽  
pp. 278-284 ◽  
Author(s):  
Betul Baykan ◽  
Ozlem Gungor Tuncer ◽  
Ebru Nur Vanli-Yavuz ◽  
Leyla Baysal Kirac ◽  
Gokcen Gundogdu ◽  
...  
Keyword(s):  
Mesial Temporal Lobe Epilepsy ◽  
Good Prognosis ◽  
Icu Patients ◽  
Antineuronal Antibodies ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Delta Activity ◽  
Mesial Temporal Lobe ◽  
Eeg Pattern

Purpose. Although its specificity has not previously been investigated in other cohorts, delta brush pattern (DBP) is increasingly reported in the EEGs of patients with anti- N-methyl-d-aspartate receptor (NMDAR) encephalitis. Methods. We aimed to investigate the DBP in the EEGs of 2 cohorts; patients with change in consciousness for various causes monitored in the intensive care unit (ICU) (n = 106) and patients with mesial temporal lobe epilepsy (MTLE) with or without antineuronal antibodies (n = 76). Results. These patients were investigated for the presence of DBP, defined as an EEG pattern characterized by delta activity at 1 to 3 Hz with superimposed bursts of rhythmic 12- to 30-Hz activity. Two investigators blindfolded for the clinical and immunological data independently analyzed the EEGs for recognition of this pattern. An EEG picture compatible with DBP was observed in 4 patients; only 1 of them (1.3%) belonged to the MTLE group. She did not bear any of the investigated autoantibodies and was seizure-free after epilepsy surgery. In the ICU group, there were 3 additional patients showing DBP with various diagnoses such as hypoxic encephalopathy, brain tumor, stroke, and metabolic derangements. All of them had died in 1-month period. Conclusions. Our results underlined that DBP is not unique to NMDAR encephalitis; it may very rarely occur in MTLE with good prognosis after surgery and second, in ICU patients who have high mortality rate. Therefore, the presence of this pattern should alert the clinician for NMDAR encephalitis but other possible etiologies should not be ignored.

scholarly journals Stereotactic laser ablation of amygdala and hippocampus using a Leksell stereotactic frame

2018 ◽  
Vol 44 (videosuppl2) ◽  
pp. V1 ◽  
Author(s):  
Ahmed J. Awad ◽  
Ha S. Nguyen ◽  
Elsa Arocho-Quinones ◽  
Ninh Doan ◽  
Wade Mueller ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Perioperative Complications ◽  
Mesial Temporal Lobe Epilepsy ◽  
Stereotactic Frame ◽  
History Of ◽  
Mesial Temporal Lobe ◽  
Invasive Techniques ◽  
Patients With Epilepsy

Approximately one-third of patients with epilepsy are resistant to medical therapy, particularly in those with mesial temporal lobe epilepsy. While there are several surgical modalities, efforts have been focused on developing safer and minimally invasive techniques. In this video, the authors present the case of a 45-year-old woman with a 2-year history of refractory left mesial temporal lobe epilepsy who underwent MRI-guided laser ablation of amygdala and hippocampus. There were no perioperative complications.The video can be found here: https://youtu.be/XFHt2jTdE_4.

scholarly journals Interleukin-1β secretion in hippocampal sclerosis patients with mesial temporal lobe epilepsy

2013 ◽  
Vol 5 (3) ◽  
pp. 17 ◽  
Author(s):  
Nihal Olgac Dundar ◽  
Berrin Aktekin ◽  
Nilufer Cicek Ekinci ◽  
Duygu Sahinturk ◽  
Ugur Yavuzer ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Promoter Region ◽  
Mononuclear Cells ◽  
Hippocampal Sclerosis ◽  
Intractable Epilepsy ◽  
Mesial Temporal Lobe Epilepsy ◽  
Epilepsy Syndrome ◽  
Significant Difference ◽  
Mesial Temporal Lobe

Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a common medically intractable epilepsy syndrome. Although pathogenesis of HS still remains highly controversial, genetics may play a role as a predisposing factor. Previous evidence in a Japanese population revealed that the homozygotes for allele T at position −511 of the interleukin (IL)-1β gene promoter region (IL-1β-511 T/T) confers susceptibility to the development of HS. However, whether this polymorphism has an effect on IL-1β levels in MTLE-HS patients was not demonstrated. This study aimed to analyze the distribution of this particular polymorphism in a group of Turkish HS patients and correlate the polymorphism with IL-1β secretion from the lymphocytes, thus revealing a functional role for IL-1β in the etiopathogenesis of HS. A single base pair polymorphism at position −511 in the promoter region of the IL-1β gene was analyzed. The spontaneous and 1 ng/mL lipopolysaccharide-stimulated production of IL-1β by peripheral blood mononuclear cells after 4 and 24 h of incubation were measured by ELISA method. The heterozygous type (−511 C/T) was the most common genotype. There was no difference in frequency of allele −511 T between patients and controls. Analysis of IL-1β levels, genotype and allele distributions showed no significant difference among the groups (P>0.05). Nevertheless, it was seen that patients who carry a T allele at position -511 of the IL-1β gene had increased IL-1β levels. T-allele carriage may be important. Only IL-1β secretion from the lymphocytes has been assessed in this study. Considering the importance of IL-1β in the etiopathogenesis of HS, further studies are needed to evaluate locally produced IL-1β levels.

scholarly journals Isolated myxoid degeneration of aortic valve: diagnostic dilemma

2019 ◽  
Vol 12 (3) ◽  
pp. e228414
Author(s):  
Htay Htay Kyi ◽  
Kewan Hamid ◽  
Luay Alkotob ◽  
Thair Dawood
Keyword(s):  
Aortic Valve ◽  
Acute Pulmonary Oedema ◽  
Diagnostic Dilemma ◽  
Positron Emission ◽  
Valve Insufficiency ◽  
History Of ◽  
History Of Epilepsy ◽  
The Right ◽  
Myxoid Degeneration

Myxoid degeneration of the aortic valve as a cause of acute aortic valve regurgitation in young age is uncommon. We report a 39-year-old African-American man with a history of epilepsy and hypertension who presented with a 1-month history of worsening shortness of breath. He was diagnosed with acute pulmonary oedema. Transoesophageal echocardiogram showed normal ejection fraction but severe aortic valve insufficiency with small masses on the ventricular side of the right and non-coronary cusps, small vegetations cannot be ruled out but other valves were normal. Subsequent cultures were negative for endocarditis. Myocardial positron emission tomography (PET) scan was strongly suggestive of cardiac sarcoidosis. However, this diagnosis was ruled out as well when he underwent aortic valve replacement with bioprosthetic valve as he did not want to take long-term anticoagulation. Histological examination of the aortic valve showed myxoid degeneration. The patient was doing very well 1 year after the surgery.

scholarly journals Wells’ Syndrome Successfully Treated with Colchicine

2017 ◽  
Vol 9 (2) ◽  
pp. 65-69 ◽  
Author(s):  
Álvaro Iglesias Puzas ◽  
Laura Mesa Álvarez ◽  
Ángeles Flórez Menéndez ◽  
Susana Romero Yuste ◽  
Olga Prieto Gómez
Keyword(s):  
Skin Lesions ◽  
Unknown Etiology ◽  
First Line ◽  
Steroid Resistant ◽  
Chronic Disorder ◽  
Eosinophilic Cellulitis ◽  
History Of ◽  
Excellent Safety Profile ◽  
Wells Syndrome

Eosinophilic cellulitis is an uncommon, inflammatory and chronic disorder of unknown etiology. Corticosteroids are currently considered as the first-line treatment but they are not without significant disadvantages such as contraindications in steroid-resistant cases and patients with frequent recurrences. We report a patient suffering from Wells’ syndrome with a 24-year history of symptomatic and generalized skin lesions. After consultation in our department, treatment with colchicine 1 mg/day was prescribed resulting in large clinical improvement. No side effects have been recorded. To our knowledge, this is an original disease approach. Although small, our clinical experience supports the inclusion of colchicine in the drug armamentarium when treating patients suffering from Wells’ syndrome. Indeed, its excellent safety profile makes it very attractive for patients with frequent recurrent episodes who need secure options for the medium- and long-term disease control.

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