Nonsymptomatic Generalized Epilepsy in Children Younger than Six Years: Excellent Prognosis, but Classification Should Be Reconsidered after Follow-up: The Dutch Study of Epilepsy in Childhood

Epilepsia ◽  
2002 ◽  
Vol 43 (7) ◽  
pp. 734-739 ◽  
Author(s):  
C. M. Middeldorp ◽  
A. T. Geerts ◽  
O. F. Brouwer ◽  
A. C. B. Peters ◽  
H. Stroink ◽  
...  
Keyword(s):  
Dutch Study ◽  
Generalized Epilepsy

scholarly journals Retention Rate and Efficacy of Perampanel with a Slow Titration Schedule in Adults

2020 ◽  
pp. 1-7
Author(s):  
Mazen Basheikh ◽  
R. Mark Sadler
Keyword(s):  
Seizure Frequency ◽  
Retention Rate ◽  
Responder Rate ◽  
Dose Titration ◽  
Seizure Freedom ◽  
Chart Audit ◽  
Generalized Seizures ◽  
Included Patient ◽  
Generalized Epilepsy

ABSTRACT: Rationale: The manufacturer of perampanel (PER) suggests an initial adult dose of 2–4 mg/day and an upward dose titration of 2 mg at no more frequently than 1- or 2-week intervals when used with enzyme-enhancing antiepileptic drugs (AEDs) or nonenzyme-enhancing AEDs, respectively. The general practice in our clinic is an initial dose of PER 2 mg/day and titrated by 2 mg/4 weeks to an initial target of 6 mg/day. Methods: Retrospective chart audit of patients starting PER in an adult epilepsy clinic between September 2013 and November 2016 with at least one 6-month follow-up visit was reviewed. Data collection included patient demographics, seizure characteristics, past and concurrent therapy, monthly seizure frequency before PER and at 6-month visit, and characteristics of PER discontinuation. Efficacy of treatment was assessed with the Engel classification and 50% responder rate. Results: N = 102 patients; mean age = 40 years and 54% females. Focal onset seizures 85%, generalized 13%, and unknown 2%. Median prior AED exposure = 6 (range 3–20); median concomitant AED use = 2 (range 1–5). Follow-up range was 6–37 months. The median seizure frequency/month prePER treatment was 6 (range 0–30) for focal onset seizures and 1 (range 0–6) for generalized seizures. The retention rate amongst all patients at 6 months was 78.4%. At 6-month follow-up, 36% of all patients achieved Engel class I (seizure freedom) (30.7% of patients with focal onset seizures and 63.6% with generalized epilepsy). The 50% responder rate was 52% and 82% for focal and generalized epilepsy, respectively. Conclusion: PER has a good retention rate when titrated slowly and thus encouraging seizure freedom results in an otherwise medically refractory epilepsy population.

CORTICAL EXCITABILITY AND REFRACTORY EPILEPSY: A THREE-YEAR LONGITUDINAL TRANSCRANIAL MAGNETIC STIMULATION STUDY

2012 ◽  
Vol 23 (01) ◽  
pp. 1250030 ◽  
Author(s):  
RADWA A. B. BADAWY ◽  
GRAEME D. JACKSON ◽  
SAMUEL F. BERKOVIC ◽  
RICHARD A. L. MACDONELL
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Refractory Epilepsy ◽  
Cortical Excitability ◽  
Focal Epilepsy ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
Effective Medication ◽  
Over Time

Transcranial magnetic stimulation was used to study the effect of recurrent seizures on cortical excitability over time in epilepsy. 77 patients with firm diagnoses of idiopathic generalized epilepsy (IGE) or focal epilepsy were repeatedly evaluated over three years. At onset, all groups had increased cortical excitability. At the end of follow-up the refractory group was associated with a broad increase in cortical excitability. Conversely, cortical excitability decreased in all seizure free groups after introduction of an effective medication.

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.

scholarly journals A.6 Vagus Nerve Stimulation in patients with therapy resistant generalized epilepsy

2021 ◽  
Vol 48 (s3) ◽  
pp. S15-S15
Author(s):  
AS Suller Marti ◽  
SM Mirsattari ◽  
KW MacDougall ◽  
D Steven ◽  
A Parrent ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Hospital Admissions ◽  
Focal Epilepsy ◽  
Limited Information ◽  
Best Response ◽  
History Of ◽  
Generalized Epilepsy

Background: For patients with generalized epilepsy who do not respond to anti-seizure medications, the therapeutic options are limited. Vagus nerve stimulation (VNS) is a treatment mainly approved for therapy resistant focal epilepsy. There is limited information on the use of VNS on generalized epilepsies, including Lennox Gastaut Syndrome(LGS) and genetic generalized epilepsy(GGE). Methods: We identified patients with a diagnosis of Lennox-Gastaut Syndrome or Genetic Generalized Epilepsy, who underwent VNS implantation, between1997 and July 2018. Results: A total of 46 patients were included in this study with a history of therapy resistant generalized epilepsy. The mean age at implantation was 24 years(IQR= 17.8-31 years) and 50%(n=23) were female. The most common etiologies were GGE in 37%(n=17) and LGS in 63%(n=29). Median follow-up since VNS implantation was 63 months(IQR:31-112.8months). 41.7%(n=12) of the LGS group became responders, and 64.7%(n=11) in the GGE group. The best response in seizure reduction was seen in generalized tonic-clonic seizures. There was a reduction of seizure-related hospital admissions from 89.7%(N=26) pre-implantation, to 41.4%(N=12) post-implantation (p<0.0001). The frequency of side effects due to the stimulation was similar in both groups(62.1% in LGS and 61.1% in GGE). Conclusions: VNS is an effective treatment in patients with therapy resistant generalized epilepsy, especially GGE.

Fifteen-year follow-up of a patient with a DHDDS variant with non-progressive early onset myoclonic tremor and rare generalized epilepsy

2020 ◽  
Vol 42 (9) ◽  
pp. 696-699
Author(s):  
Noriko Togashi ◽  
Atsushi Fujita ◽  
Moriei Shibuya ◽  
Saki Uneoka ◽  
Takuya Miyabayashi ◽  
...  
Keyword(s):  
Early Onset ◽  
Generalized Epilepsy

General Practitioner, 7 years’ experience, UK

2020 ◽  
pp. 168-170
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Medical Records ◽  
Discharge Summary ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Prolonged Seizure ◽  
Neurology Clinic ◽  
Acute Symptomatic Seizure ◽  
Epileptic Attack ◽  
Generalized Epilepsy

This chapter details the stories of two patients which illustrate the confusion and uncertainty that surrounds Non-Epileptic Attack Disorder (NEAD). The first patient has multiple health problems. His medical records list the following diagnoses: reflex anoxic seizures, epilepsy, NEAD, Chronic Obstructive Pulmonary Disease (COPD), heart failure, anemia, and a small meningioma. On a busy on-call, he presented with acute confusion, fever, and tachycardia. Once on the ward, he had a prolonged seizure. This was diagnosed as an acute symptomatic seizure and follow-up in the Neurology clinic was arranged. The patient did not attend the follow-up appointment, but he had another seizure a few weeks later in the street. An ambulance took him to the hospital and the very brief discharge summary referred to “dissociative epilepsy.” Unfortunately, the patient declined psychotherapy because the seizures were “not in his mind.” He was equally reluctant to start other antiepileptic drugs in addition to his long list of other medications. Meanwhile, the second patient’s medical records referred to localization-related epilepsy, generalized epilepsy, and NEAD. However, like the first patient, the second patient resisted psychotherapy.

Dutch study of epilepsy in childhood: Preliminary results after 2 years of follow-up

1994 ◽  
Vol 11 (2) ◽  
pp. 95 ◽  
Author(s):  
Willem F. Arts ◽  
Cees A. van Donselaar ◽  
Ada T. Geerts ◽  
Oebele F. Brouwer ◽  
Hans Stroink ◽  
...  
Keyword(s):  
Preliminary Results ◽  
Dutch Study

Tailored Temporal Lobectomy for Medically Intractable Epilepsy

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 703-709 ◽  
Author(s):  
Steven M. Falowski ◽  
David Wallace ◽  
Andres Kanner ◽  
Michael Smith ◽  
Michael Rossi ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Class I ◽  
Visual Field Defects ◽  
Seizure Outcome ◽  
Temporal Lobe Resection ◽  
Generalized Epilepsy

Abstract BACKGROUND: There have been only a few large series that have used a tailored temporal lobectomy. OBJECTIVE: To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections. METHODS: Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated. RESULTS: Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections. CONCLUSION: Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.

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