Carbamazepine-Induced Nonepileptic Myoclonus in a Child with Autism and Epilepsy

2021 ◽  
Author(s):  
Serkan Kırık ◽  
Uluç Yiş
Keyword(s):  
Antiepileptic Drugs ◽  
Seizure Frequency ◽  
Epileptic Seizure ◽  
Treatment Dosage

AbstractThis study deals with a child with different type of seizures several times in week and unresponsive to antiepileptic drugs. Distinguishing between epileptic seizure and motor tic in a patient diagnosed with epilepsy and autism can be challenging. In this study we present a boy on carbamazepine (CBZ) therapy. In the first days of treatment seizure frequency decreased, but after CBZ treatment dosage reached 15 mg/kg/day (at the 25th day of the treatment), he presented to the clinic describing several episodes of myoclonus. There were no changes in electroencephalography during the myoclonus. In follow-up, myoclonus was not described after the cessation of CBZ.

Impact of temozolomide chemotherapy on seizure frequency in patients with low-grade gliomas

2011 ◽  
Vol 114 (6) ◽  
pp. 1617-1621 ◽  
Author(s):  
Jonathan H. Sherman ◽  
Krisztina Moldovan ◽  
H. Kwang Yeoh ◽  
Robert M. Starke ◽  
Nader Pouratian ◽  
...  
Keyword(s):  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Seizure Frequency ◽  
Intractable Epilepsy ◽  
Age At Diagnosis ◽  
Control Group ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Significant Difference

Object Seizures occur in approximately 80% of patients with low-grade gliomas (LGGs). The majority of patients are treated with anticonvulsant monotherapy; however, many patients require multidrug therapy, or their seizures are refractory to antiepileptic drugs altogether. The oral alkylating agent temozolomide has emerged as a potential initial treatment option for LGG. A few reports suggest an association between temozolomide and reduced seizure frequency in patients with intractable epilepsy. Methods Using their clinical database, the authors identified adult patients whose LGGs were treated using temozolomide as the initial antineoplastic therapy at the University of Virginia Health System. As a control group, the authors assessed patients whose LGGs were under observation. All patients had seizure disorders that were treated with anticonvulsants. Seizure frequency in patients with intractable epilepsy was analyzed before and after treatment with temozolomide. Age at diagnosis, sex, antiepileptic drugs, pathological subtype, surgical treatment, and follow-up until progression were also assessed. Interval seizure frequency was meticulously analyzed at each neurooncology clinic visit. A meaningful difference in seizures was defined as a reduction in seizure frequency of greater than 50% per month. Results Thirty-nine patients were identified in the temozolomide cohort and 30 patients in the control cohort. The median age at diagnosis was 46 years for the former cohort and 41.5 years for the latter. The median length of follow-up was 39 months for the temozolomide group and 37 months for the control group. There was a significant difference in reduced seizure frequency between patients receiving temozolomide (59%) and those who did not receive temozolomide (13%, p < 0.001). Seven patients (18%) in the temozolomide group displayed this improvement independent of antiepileptic drug adjustment compared with no patient in the control group (p < 0.001). Conclusions The authors' data suggest that a subset of patients with LGGs experience improvement in seizure frequency during treatment with temozolomide independent of antiepileptic drug adjustment. This decrease in seizure frequency appears independent of the natural history of seizures in patients whose tumors are under observation. Consequently, seizures in patients with LGGs may be better controlled with the combination of AEDs and temozolomide.

Preschool behavioral problems in children prenatally exposed to antiepileptic drugs — A follow-up study

2013 ◽  
Vol 29 (2) ◽  
pp. 407-411 ◽  
Author(s):  
D. Kjaer ◽  
J. Christensen ◽  
B.H. Bech ◽  
L.H. Pedersen ◽  
M. Vestergaard ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Behavioral Problems ◽  
Prenatally Exposed ◽  
Follow Up Study

scholarly journals First, do no harm: the risks of overtreating children with epilepsy

2007 ◽  
Vol 65 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Eunice Chuang ◽  
Marilisa M. Guerreiro ◽  
Sara Y. Tsuchie ◽  
Angelica Santucci ◽  
Carlos A. M. Guerreiro ◽  
...  
Keyword(s):  
Adverse Events ◽  
Prospective Study ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Seizure Frequency ◽  
Seizure Control ◽  
Control Method ◽  
Refractory Epilepsy ◽  
Do No Harm ◽  
A Prospective Study

BACKGROUND: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated. OBJECTIVE: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control. METHOD: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced. RESULTS: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%). CONCLUSION: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.

scholarly journals Characteristics of seizure frequency among Malaysian children diagnosed with structural– metabolic epilepsy

2012 ◽  
Vol 03 (03) ◽  
pp. 244-250 ◽  
Author(s):  
Muhannad RM Salih ◽  
Mohd Baidi Bahari ◽  
Mohamed Azmi Ahmad Hassali ◽  
Asrul Akmal Shafie ◽  
Omer Qutaiba B Al-lela ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Developmental Delay ◽  
Seizure Frequency ◽  
Substantial Reduction ◽  
Focal Seizure ◽  
Global Developmental Delay ◽  
Neurology Clinic ◽  
Collection Form ◽  
Metabolic Epilepsy

ABSTRACT Introduction: Seizure-free patients or substantial reduction in seizure frequency are the most important outcome measures in the management of epilepsy. The study aimed to evaluate the patterns of seizure frequency and its relationship with demographics, clinical characteristics, and outcomes. Materials and Methods: A retrospective cohort study was conducted at the Pediatric Neurology Clinic, Hospital Pulau Pinang. Over a period of 6 months, the required data were extracted from the medical records using a pre-designed data collection form. Results: Seizure frequency showed no significant association with patient’s demographics and clinical characteristic. However, significant reduction in seizure frequency from the baseline to the last follow-up visit was only seen in certain subgroups of patients including Malays, females, patients <4 years of age, patients with global developmental delay/intellectual disability, and patients with focal seizure. There was no significant association between seizure frequency and rate of adverse events. Polytherapy visits were associated with higher seizure frequency than monotherapy visits (27.97 ± 56.66, 10.94 ± 30.96 attack per month, respectively) (P < 0.001). There was a clear tendency to get antiepileptic drugs used at doses above the recommended range in polytherapy (8.4%) rather than in monotherapy (1.4%) visits (P < 0.001). A significant correlation was found between seizure frequency and number of visits per patient per year (r = 0.450, P < 0.001). Conclusion: Among children with structural–metabolic epilepsy, Malays, females, patients <4 years of age, patients with global developmental delay/intellectual disability and patients manifested with focal seizure are more responsive antiepileptic drug therapy than the other subgroups of patients.

scholarly journals Evaluation of ubiquitin C-terminal hydrolase-L1 enzyme levels in patients with epilepsy

2020 ◽  
Vol 78 (7) ◽  
pp. 424-429
Author(s):  
Ibrahim Halil YASAK ◽  
Mustafa YILMAZ ◽  
Murat GÖNEN ◽  
Metin ATESCELIK ◽  
Mehtap GURGER ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Epileptic Seizure ◽  
Epileptic Seizures ◽  
Healthy Individuals ◽  
Roc Curve Analysis ◽  
Remission Period ◽  
Significant Difference ◽  
Epileptic Attack ◽  
Patients With Epilepsy

ABSTRACT Objective: Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) enzyme levels were investigated in patients with epilepsy, epileptic seizure, remission period, and healthy individuals. Methods: Three main groups were evaluated, including epileptic seizure, patients with epilepsy in the non-seizure period, and healthy volunteers. The patients having a seizure in the Emergency department or brought by a postictal confusion were included in the epileptic attack group. The patients having a seizure attack or presenting to the Neurology outpatient department for follow up were included in the non-seizure (remission period) group. Results: The UCH-L1 enzyme levels of 160 patients with epilepsy (80 patients with epileptic attack and 80 patients with epilepsy in the non-seizure period) and 100 healthy volunteers were compared. Whereas the UCH-L1 enzyme levels were 8.30 (IQR=6.57‒11.40) ng/mL in all patients with epilepsy, they were detected as 3.90 (IQR=3.31‒7.22) ng/mL in healthy volunteers, and significantly increased in numbers for those with epilepsy (p<0.001). However, whereas the UCH-L1 levels were 8.50 (IQR=6.93‒11.16) ng/mL in the patients with epileptic seizures, they were 8.10 (IQR=6.22‒11.93) ng/mL in the non-seizure period, and no significant difference was detected (p=0.6123). When the UCH-L1 cut-off value was taken as 4.34 mg/mL in Receiver Operating Characteristic (ROC) Curve analysis, the sensitivity and specificity detected were 93.75 and 66.00%, respectively (AUG=0.801; p<0.0001; 95%CI 0.747‒0.848) for patients with epilepsy. Conclusion: Even though UCH-L1 levels significantly increased more in patients with epilepsy than in healthy individuals, there was no difference between epileptic seizure and non-seizure periods.

Extent of Mesiobasal Resection Determines Outcome after Temporal Lobectomy for Intractable Complex Partial Seizures

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Mohamed H. Nayel ◽  
Issam A. Awad ◽  
Hans Luders
Keyword(s):  
Temporal Lobe ◽  
Seizure Frequency ◽  
Compartment Model ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Lateral Structures

Abstract The extent of resection was assessed in 94 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Postoperative magnetic resonance imaging in the coronal plane was used to quantify the extent of resection of lateral and mesiobasal structures according to a 20-compartment model of the temporal lobe. Successful seizure outcome (≥90% reduction in seizure frequency) was accomplished in 83% of the patients (all followed up for more than 1 year; mean duration of follow-up, 25.2 months) and correlated significantly (P&lt;0.05) with the extent of mesiobasal resection, regardless of the extent of resection of lateral structures. Successful seizure outcome was accomplished in 81% of the patients with no structural lesions, and also correlated significantly (P&lt;0.05) with the extent of mesiobasal resection regardless of the extent of lateral resection. A successful seizure outcome was accomplished in 90% of the 21 patients with structural lesions documented by neuroimaging studies. Two patients who underwent extensive lobectomy without resection of the structural lesion had no reduction in seizure frequency postoperatively. We conclude that the most important factor in determining the outcome of temporal lobectomy in patients with unilateral anteromesial temporal lobe epileptogenicity is the extent of resection of structures in the mesiobasal temporal lobe. In patients with structural lesions, lesion resection may be an added contributor to successful seizure outcome. (Neurosurgery 29:55-61, 1991)

Comparison of immunotherapy and prognosis of seizures caused by viral encephalitis and autoimmune encephalitis

2021 ◽  
Author(s):  
Xianjun Zhang ◽  
Yanbing Han ◽  
Xiaojuan Liu ◽  
Wenqiu Yang ◽  
Ting Wang ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Lower Risk ◽  
Yunnan Province ◽  
Viral Encephalitis ◽  
Autoimmune Encephalitis ◽  
Seizure Outcome ◽  
Acute Encephalitis ◽  
Free Rate

Abstract Background: The immunotherapy that is more effective for seizures caused by viral encephalitis and autoimmune encephalitis and the long-term use of anti-epileptic drugs is not clear. We aimed to compare the immunotherapy and prognosis of seizures caused by viral encephalitis and autoimmune encephalitis.Methods: Clinical data of 121 patients with seizures caused by viral encephalitis and autoimmune encephalitis diagnosed and treated in the two largest tertiary general hospitals in the Yunnan Province were retrospectively collected to compare the immunotherapy used. Dynamic follow-up was performed to observe seizures and the use of antiepileptic drugs.Results: The seizure-free rates at 6 months and 12 months after the onset of viral encephalitis were 77.8% and 80.8%, respectively. In total, 79.1% of autoimmune encephalitis cases were seizure-free at 6 months after onset, and the seizure-free rate at 12 months was 91.9%. A total of 75.0% of viral encephalitis and 67.7% of autoimmune encephalitis patients discontinued antiepileptic drugs and were seizure-free at 12 months after onset. Patients with viral encephalitis treated with glucocorticoids alone had a lower risk of seizures after the acute phase than those treated with glucocorticoids combined with immunoglobulin (P < 0.05). The risk of seizures in patients with autoimmune encephalitis treated with glucocorticoids combined with immunoglobulin was lower than that in patients treated with glucocorticoids and immunoglobulin alone (P < 0.05).Conclusions: Immunotherapy may improve the seizure prognosis of patients with acute encephalitis. The prognosis of seizures due to viral encephalitis may be determined as early as 6 months after onset, while the seizure outcome of autoimmune encephalitis is further improved 12 months after onset.

Long-term effectiveness and safety of antiepileptic drugs in children and adults

2021 ◽  
Vol 19 (2) ◽  
pp. 221-228
Author(s):  
Roza M. Shaimardanova ◽  
Rimma G. Gamirova
Keyword(s):  
Valproic Acid ◽  
Antiepileptic Drugs ◽  
Focal Epilepsy ◽  
City Hospital ◽  
Long Term Follow Up ◽  
Short And Long Term ◽  
Long Term Observation ◽  
Patients With Epilepsy

AIM: To conduct a retrospective comparative analysis of the efficacy and safety of epilepsy therapy with antiepileptic drugs. MATERIALS AND METHODS: The analysis of the treatment of 428 patients with epilepsy at the Childrens City Hospital No. 8 in Kazan, receiving antiepileptic drugs. RESULTS: It was found that valproic acid is more effective in the treatment of idiopathic generalized epilepsies compared to focal epilepsies (p = 0.0006). Valproate and carbamazepine were the most effective in the treatment of focal epilepsy with short- and long-term follow-up. Valproic acid is more effective than topiramate (p = 0.02), oxcarbazepine (p = 0.003), and levetiracetam (p = 0.003) in the treatment of focal epilepsy in short- and long-term follow-up. Carbamazepine is more effective than topiramate (p = 0.01), oxcarbazepine (p = 0.02), and levetiracetam (p = 0.001) in the treatment of focal epilepsy in long-term follow-up. It was revealed that more often they complained about side effects when using carbamazepine (63.2%). Levetiracetam was found to be better tolerated compared to valproate (p = 0.0006) and carbamazepine (p = 0.0006). Topiramate is better tolerated than carbamazepine (p = 0.02) and valproate (p = 0.03). Oxcarbazepine is better tolerated than carbamazepine in women (p = 0.04). CONCLUSIONS: When choosing an antiepileptic drug, it is necessary to be guided by the principle: first the basic, and then the drugs of the next generations, in the future, rely on information about the tolerability of the drug. It is necessary to evaluate the therapeutic effect of antiepileptic drugs with long-term observation, and use the criterion of complete absence of seizures as an indicator of the effectiveness of drugs.

Thermocoagulation of the Ictal Onset Zone Using SEEG (Thermo-SEEG)

2018 ◽  
pp. 467-475
Author(s):  
Marc Guénot ◽  
Pierre Bourdillon
Keyword(s):  
Side Effects ◽  
Seizure Frequency ◽  
Phase 2 ◽  
Show Evidence ◽  
Radiofrequency Current ◽  
Cortical Grey Matter ◽  
Spike Wave Discharges ◽  
Low Amplitude ◽  
Stereotactic Procedure

Stereo-EEG (SEEG)-guided radiofrequency thermocoagulation (thermo-SEEG), is a stereotactic lesioning procedure in which the SEEG electrodes are used to deliver a radiofrequency current. This technique offers drug-resistant epileptic patients undergoing phase 2 investigations the possibility to benefit from lesions of the ictal onset zone without any additional invasive stereotactic procedure. A SEEG recording site can be considered eligible for thermo-SEEG if bipolar recordings through two adjacent contacts of the same electrode, located in cortical grey matter, show evidence of either spike-wave discharges or low-amplitude fast pattern at the onset of seizures. Electrical stimulations are systematically performed during video-SEEG recording sessions to avoid possible side-effects of a lesion. After 1-year follow-up, 45.6% of patients show greater than 50% improvement in terms of seizure frequency and 11.9% are seizure-free. Moreover, thermo-SEEG is safer than conventional surgery, with only a 3.2% rate of side-effects, which are almost always transient, including the expected ones.

scholarly journals Vagus nerve stimulation may be a sound therapeutic option in the treatment of refractory epilepsy

2013 ◽  
Vol 71 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Murilo S. Meneses ◽  
Samanta F. B. Rocha ◽  
Cristiane Simão ◽  
Heraldo Nei Hardt Laroca dos Santos ◽  
Cleudi Pereira ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Palliative Treatment ◽  
Refractory Epilepsy ◽  
Therapeutic Option ◽  
Treatment Objective

INTRODUCTION: Refractory epilepsy accounts for 20 to 30% of epilepsy cases and remains a challenge for neurologists. Vagus nerve stimulation (VNS) is an option for palliative treatment. OBJECTIVE: It was to study the efficacy and tolerability of VNS in patients implanted with a stimulator at the Curitiba Institute of Neurology (INC). METHODS: A case study of six patients with refractory epilepsy submitted to a VNS procedure at the INC in the last four years was described and discussed. RESULTS: Mean age at time of implantation was 29 years. Mean follow-up was 26.6 months. Seizure frequency decreased in all patients (40-50% (n=2) and >80% (n=4)). Three patients no longer required frequent hospitalizations. Two patients previously restricted to wheelchairs started to walk, probably because of improved mood. CONCLUSION: In this population, VNS proved to be a sound therapeutic option for treating refractory epilepsy.

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