Safety and efficacy of levetiracetam in juvenile patients with focal epilepsy with and without secondary generalisation

OBJECTIVEPatients with medically refractory localization-related epilepsy (LRE) may be candidates for surgical intervention if the seizure onset zone (SOZ) can be well localized. Stereoelectroencephalography (SEEG) offers an attractive alternative to subdural grid and strip electrode implantation for seizure lateralization and localization; yet there are few series reporting the safety and efficacy of SEEG in pediatric patients.METHODSThe authors review their initial 3-year consecutive experience with SEEG in pediatric patients with LRE. SEEG coverage, SOZ localization, complications, and preliminary seizure outcomes following subsequent surgical treatments are assessed.RESULTSTwenty-five pediatric patients underwent 30 SEEG implantations, with a total of 342 electrodes placed. Ten had prior resections or ablations. Seven had no MRI abnormalities, and 8 had multiple lesions on MRI. Based on preimplantation hypotheses, 7 investigations were extratemporal (ET), 1 was only temporal-limbic (TL), and 22 were combined ET/TL investigations. Fourteen patients underwent bilateral investigations. On average, patients were monitored for 8 days postimplant (range 3–19 days). Nearly all patients were discharged home on the day following electrode explantation.There were no major complications. Minor complications included 1 electrode deflection into the subdural space, resulting in a minor asymptomatic extraaxial hemorrhage; and 1 in-house and 1 delayed electrode superficial scalp infection, both treated with local wound care and oral antibiotics.SEEG localized the hypothetical SOZ in 23 of 25 patients (92%). To date, 18 patients have undergone definitive surgical intervention. In 2 patients, SEEG localized the SOZ near eloquent cortex and subdural grids were used to further delineate the seizure focus relative to mapped motor function just prior to resection. At last follow-up (average 21 months), 8 of 15 patients with at least 6 months of follow-up (53%) were Engel class I, and an additional 6 patients (40%) were Engel class II or III. Only 1 patient was Engel class IV.CONCLUSIONSSEEG is a safe and effective technique for invasive SOZ localization in medically refractory LRE in the pediatric population. SEEG permits bilateral and multilobar investigations while avoiding large craniotomies. It is conducive to deep, 3D, and perilesional investigations, particularly in cases of prior resections. Patients who are not found to have focally localizable seizures are spared craniotomies.

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P50 Safety and efficacy of transcranial direct current stimulation in adult patients with focal epilepsy syndromes: A prospective pilot study

Clinical Neurophysiology ◽

10.1016/j.clinph.2019.12.056 ◽

2020 ◽

Vol 131 (4) ◽

pp. e203

Author(s):

M. Hordt ◽

U. Palm ◽

S. Noachtar ◽

E. Hartl

Keyword(s):

Pilot Study ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Focal Epilepsy ◽

Adult Patients ◽

Safety And Efficacy ◽

Direct Current Stimulation ◽

Prospective Pilot Study

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The safety and efficacy of add-on levetiracetam in elderly patients with focal epilepsy: A one-year observational study

Seizure ◽

10.1016/j.seizure.2010.12.015 ◽

2011 ◽

Vol 20 (4) ◽

pp. 305-311 ◽

Cited By ~ 32

Author(s):

Konrad J. Werhahn ◽

Sven Klimpe ◽

Sonja Balkaya ◽

Eugen Trinka ◽

Günter Krämer

Keyword(s):

Observational Study ◽

Elderly Patients ◽

Focal Epilepsy ◽

Safety And Efficacy ◽

One Year

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Meningioangiomatosis: an uncommon cause of focal epilepsy with characteristic neuroimaging and neuropathology

BMJ Case Reports ◽

10.1136/bcr-2021-242953 ◽

2021 ◽

Vol 14 (6) ◽

pp. e242953

Author(s):

Kunle Oyedokun ◽

Maha ME Agabna ◽

Anil Israni ◽

Daniel du Plessis

Keyword(s):

Inflammatory Process ◽

Focal Epilepsy ◽

Brain Biopsy ◽

Acute Onset ◽

Precise Nature ◽

Secondary Generalisation ◽

Focal Seizures ◽

Neoplastic Process ◽

Process Decision

A 3-year-old boy presented with acute onset of prolonged right sided focal seizures with secondary generalisation. The investigation findings were suggestive of a neoplastic process more than an inflammatory process. Decision to perform brain biopsy from the lesion to establish the precise nature of lesion was undertaken.

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Effectiveness of clobazam as add-on therapy in children with refractory focal epilepsy

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2006000500001 ◽

2006 ◽

Vol 64 (3b) ◽

pp. 705-710 ◽

Cited By ~ 7

Author(s):

Mariana Ribeiro Marcondes da Silveira ◽

Maria Augusta Montenegro ◽

Renata Cristina Franzon ◽

Carlos A.M. Guerreiro ◽

Marilisa M. Guerreiro

Keyword(s):

Adverse Events ◽

Antiepileptic Drugs ◽

Seizure Frequency ◽

Focal Epilepsy ◽

Safety And Efficacy ◽

Refractory Seizures ◽

One Year

The objective of this study was to evaluate the safety and efficacy of clobazam in children with refractory focal epilepsy. We investigated 100 consecutive patients concerning etiology of epilepsy, previously used antiepileptic drugs, seizure frequency and adverse events. Clobazam was introduced as add-on therapy in patients with previous failure of at least two monotherapies. Mean age was eight years-old and 39 patients were girls. Clobazam mean dosage was 23.6 mg/day. Mean use of clobazam was 18.6 months. Twenty-two patients had adverse events. Twenty-six patients became seizure-free, 11 had an improvement of >75% and in 58 there was no modification in seizure frequency. Five patients had an increase in seizure frequency. Clobazam efficacy lasted for more than one year in 42% of the seizure-free patients. Clobazam seems to be safe and effective in the treatment of focal epilepsy in childhood and should be considered in patients with refractory seizures.

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Safety and Efficacy of Perampanel as Adjunctive Therapy in Patients with Refractory Focal Epilepsy Over 12 Months: Clinical Experience in a Real-World Setting

International Journal of Epilepsy ◽

10.1055/s-0038-1675546 ◽

2018 ◽

Vol 05 (02) ◽

pp. 075-079

Author(s):

Fabrizio Rinaldi ◽

Giovanni De Maria

Keyword(s):

Side Effects ◽

Focal Epilepsy ◽

Seizure Freedom ◽

Open Label ◽

Meaningful Improvement ◽

Safety And Efficacy ◽

Real World Setting ◽

Duration Of Disease ◽

The Mean

Abstract Background The main purpose of this study is to assess efficacy and tolerability of perampanel (PER), a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor antagonist, as an add-on treatment in adult patients with refractory focal-onset seizures. Patients and Methods A prospective, open label, observational study was conducted in patients with refractory focal-onset seizures treated with PER at our Epilepsy Unit, from May 2015 to February 2016. Patients were followed up for 1 year. Frequency of seizure and tolerability was assessed every 3 months. Patients were under a polytherapy, and the mean number of concomitant antiepileptic drugs (AEDs) at PER initiation was 2.9. Results We consecutively enrolled 52 patients (M/F = 18/34). Three were lost on follow-up. Mean age was 38.7 years, with a mean duration of disease of 28.1 years. After 1 year of treatment, 57.14% reported a 50% or greater reduction in seizure frequency; five (10.21%) were seizure free. Six (12.25%) patients reported a reduction lower than 50%. Mean dosage of PER was 7.57 mg. Thirty-one patients were taking enzyme-inducing AEDs (carbamazepine, oxcarbazepine, phenytoin). In this subgroup, the responder rate was 45.2%. Twenty-one patients reported side-effects, most frequently somnolence (11), vertigo/ataxia (6), and aggressiveness (5). Eleven (22.4%) patients reduced or discontinued at least one concomitant AED, while the electroencephalography improved in four (8.16%). Sixteen (32.65%) patients withdrew PER, after a mean duration of 163 days, the mean dosage being 6.4 mg (range 4–12). Conclusions Adjunctive PER can achieve clinically meaningful improvement, or even seizure freedom, in almost two-thirds of patients suffering from refractory focal-onset epilepsies. It seems similarly safe and well-tolerated. Enzyme-inducing AEDs may limit the efficacy of PER.

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