Seizure Medications Effects on Fetus, Neonate, and Lactation

2018 ◽  
Author(s):  
Tara A. Lynch ◽  
J. Christopher Glantz
Keyword(s):  
Seizure Control ◽  
Refractory Epilepsy ◽  
Severe Disease ◽  
Medication Use ◽  
Disease Treatment ◽  
Teratogenic Risk ◽  
Antiepileptic Medications ◽  
Patients With Epilepsy ◽  
In Pregnancy ◽  
The Ideal

Medication use in pregnancy requires a careful balance between the risks of fetal teratogenicity and the maternal benefits of disease treatment. For women with epilepsy, there are many antiepileptic medications available for use in pregnancy. Each varies in their safety profile, risk for fetal anomalies, and effectiveness of seizure control. In most scenarios, the benefits of maternal treatment outweigh the risk of fetal effects, especially in cases of refractory epilepsy or severe disease. Many of the newer anti-epileptic drugs appear to have less teratogenic risk than the older medications. The ideal AED is one that is effective from the woman, is least teratogenic, and used at the lowest possible dose. Overall, a detailed understanding of antiepileptic efficacy, the pharmacologic differences in pregnancy, and the potential adverse fetal effects are required for optimal treatment of pregnant patients with epilepsy.

Seizure Surgery

2018 ◽  
Author(s):  
Caroll N. Vazquez-Colon ◽  
Srijaya K. Reddy
Keyword(s):  
Pediatric Patients ◽  
Perioperative Management ◽  
Seizure Control ◽  
Refractory Epilepsy ◽  
Intraoperative Neuromonitoring ◽  
Anesthetic Agents ◽  
Anesthetic Drugs ◽  
Seizure Surgery ◽  
Antiepileptic Medications

Epilepsy is a disorder of the nervous system that affects over 2 million people worldwide, with the highest incidence in children. Surgical management of a child with refractory epilepsy may result in improved seizure control and better quality of life. The perioperative management of the pediatric patient for seizure surgery presents a considerable challenge to the anesthesiologist. Primary concerns include the interactions of antiepileptic medications with anesthetic drugs, the effects of anesthetic agents and medications on intraoperative neuromonitoring, and management of seizures while under anesthesia. This chapter will focus on anesthetic concerns and management for pediatric patients presenting for seizure surgery.

scholarly journals Nonadherence to Antiepileptic Medications: Still a Major Issue to be Addressed in the Management of Epilepsy

2019 ◽  
Vol 10 (01) ◽  
pp. 106-112 ◽  
Author(s):  
Azra Zafar ◽  
Rizwana Shahid ◽  
Saima Nazish ◽  
Danah Aljaafari ◽  
Fahd Ali Alkhamis ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Seizure Control ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Seizure Freedom ◽  
Cross Sectional ◽  
The Social ◽  
Antiepileptic Medications ◽  
The University ◽  
Patients With Epilepsy

ABSTRACT Context: Medication nonadherence is a significant barrier in achieving seizure freedom in patients with epilepsy. There is a deficiency of data about the reasons for nonadherence in Saudi population. Aims: The aim of this study is to prove the existence of nonadherence to antiepileptic drugs (AEDs) in patients with epilepsy and identify the responsible factors. Setting and Design: This is a prospective, cross-sectional study carried in the Department of Neurology at King Fahd Hospital of the University affiliated with Imam Abdulrahman Bin Faisal University. Subjects and Methods: Patients of all ages diagnosed to have epilepsy as mentioned in their medical record and taking antiepileptic medications were interviewed using a questionnaire. Statistical Analysis Used: Statistical analysis was performed using IBM Statistical Package for the Social Sciences version 21 (IBM Corp., Armonk, NY, USA). Statistical significance was defined as two-tailed with a P ≤ 0.05. Results: Among 152 participants, 52.6% were male and 47.4% were female. Mean age of the patients was 28 ± 14.3 (mean ± standard deviation) years. Of 152 patients, 48.7% were found to be nonadherent to their AED therapy. The most commonly identified factor was forgetfulness. Nonadherence was significantly associated with poor seizure control (P = 0.002). Conclusion: Nonadherence to the AED is common among patients with epilepsy and affects seizure control adversely.

scholarly journals Epilepsy and cannabidiol - a new perspective for seizures treatment

2021 ◽  
Vol 11 (8) ◽  
pp. 226-235
Author(s):  
Ilona Kozioł ◽  
Julia Budzyńska ◽  
Magdalena Leśniewska ◽  
Joanna Milanowska
Keyword(s):  
Seizure Control ◽  
Cannabis Sativa ◽  
Refractory Epilepsy ◽  
Adult Population ◽  
Dravet Syndrome ◽  
Therapeutic Effects ◽  
Cannabis Indica ◽  
New Perspective ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

BACKGROUND: Despite the fact that the number of antiepileptic drugs is constantly increasing, epilepsy can still be a therapeutic challenge. Approximately one-third of patients with epilepsy have persistent seizures refractory to treatment. The limited number of effective alternatives motivates researchers to seek new solutions. There is some hope for cannabidiol (CBD) preparations.AIM OF THE STUDY: The purpose of this study was to review the most recent available literature on the use of cannabidiol in the treatment of refractory epilepsy in children and adults. For this purpose, the PubMed and Google Scholar databases were reviewed. The phrase "cannabidiol and epilepsy"  was used to search the database. After Screening titles and abstracts a total of 19 papers and articles cited in them were received and analyzed in detail. RESULTS:  Nowadays there are many CBD related products available in the market, Cannabis sativa and Cannabis indica are the plants used due to their strong therapeutic effects and also seizure control. Regulations regarding the use of raw marijuana, cannabis extracts, and cannabinoid-based drugs vary from place to place. Many studies have been generated on the efficacy of cannabinoid therapy in the treatment of epilepsy. This therapy in patients with Dravet syndrome and Lennox-Gaust syndrome results in a reduction in the frequency of motor and total seizures. The most commonly reported side effects of CBD are drowsiness, seizures and diarrhea, but the therapy is generally well tolerated.SUMMARY AND CONCLUSIONS: Many available studies support the efficacy of CBD as a treatment option to reduce seizure frequency in children with drug-resistant epilepsy, particularly in patients with Dravet and Lennox-Gastaut syndrome. However, there is a lack of reports on the use of CBD in the adult population, which may be an area for further research.

Seizures following surgery for supratentorial extratemporal low-grade tumors in children: a multicenter retrospective study

2020 ◽  
Vol 26 (1) ◽  
pp. 27-33
Author(s):  
Jonathan Roth ◽  
Or Bercovich ◽  
Ashton Roach ◽  
Francesco T. Mangano ◽  
Arvind C. Mohan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Brain Tumors ◽  
Seizure Control ◽  
Seizure Activity ◽  
Refractory Epilepsy ◽  
Low Grade ◽  
Refractory Seizures ◽  
Low Rate ◽  
Over Time ◽  
New Onset

OBJECTIVEResection of brain tumors may lead to new-onset seizures but may also reduce seizure rates in patients presenting with seizures. Seizures are seen at presentation in about 24% of patients with brain tumors. For lesional epilepsy in general, early resection is associated with improved seizure control. However, the literature is limited regarding the occurrence of new-onset postoperative seizures, or rates of seizure control in those presenting with seizures, following resections of extratemporal low-grade gliomas (LGGs) in children.METHODSData were collected retrospectively from 4 large tertiary centers for children (< 18 years of age) who underwent resection of a supratentorial extratemporal (STET) LGG. The patients were divided into 4 groups based on preoperative seizure history: no seizures, up to 2 seizures, more than 2 seizures, and uncontrolled or refractory epilepsy. The authors analyzed the postoperative occurrence of seizures and the need for antiepileptic drugs (AEDs) over time for the various subgroups.RESULTSThe study included 98 children. Thirty patients had no preoperative seizures, 18 had up to 2, 16 had more than 2, and 34 had refractory or uncontrolled epilepsy. The risk for future seizures was higher if the patient had seizures within 1 month of surgery. The risk for new-onset seizures among patients with no seizures prior to surgery was low. The rate of seizures decreased over time for children with uncontrolled or refractory seizures. The need for AEDs was higher in the more active preoperative seizure groups; however, it decreased with time.CONCLUSIONSThe resection of STET LGGs in children is associated with a low rate of postoperative new-onset epilepsy. For children with preoperative seizures, even with uncontrolled epilepsy, most have a significant improvement in the seizure activity, and many may be weaned off their AEDs.

Sleep and epilepsy—chicken or egg?

2018 ◽  
Author(s):  
Dora A. Lozsadi
Keyword(s):  
Side Effects ◽  
Sleep Disorders ◽  
Learning Disability ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Seizure Control ◽  
Subjective Sleep ◽  
Neurological Conditions ◽  
The Uk ◽  
Patients With Epilepsy

Epilepsy is the commonest serious chronic neurological condition, affecting 0.5% of the population in the UK. Subjective sleep disturbance and excessive daytime sleepiness are reported to be 50% more frequent in those with epilepsy than in controls. Causes are multiple. Both poor seizure control and nocturnal attacks are known to contribute to such sleep disorders. Epilepsy also increases the risk of associated sleep disorders, and additional neurological conditions, such as dementia, learning disability, and depression. These all affect sleep hygiene. Prescribed anti-epileptic drugs will further aggravate the problem. Side-effects will include drowsiness. Sedating benzodiazepines and barbiturates are considered worst offenders. Others affect sleep architecture to varying degrees and/or cause insomnia. While hyper-somnolence in patients with epilepsy will raise the possibility of any of the above issues, sleep deprivation is one of the commonest seizure triggers. This chapter will shed more light on the intricate relationship between sleep and epilepsy.

Psychiatric and psychosocial morbidity 1 year after epilepsy surgery

2020 ◽  
pp. 1-8
Author(s):  
S. Patel ◽  
M. Clancy ◽  
H. Barry ◽  
N. Quigley ◽  
M. Clarke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Post Surgery ◽  
Axis I ◽  
Patients With Epilepsy ◽  
The Impact

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.

Medication use in pregnancy and lactation: A gap to be filled in postgraduate medical education

2021 ◽  
Vol 260 ◽  
pp. 52-55
Author(s):  
Claire M. McCarthy ◽  
Fergal O’Shaughnessy ◽  
Nicola Maher ◽  
Brian J. Cleary ◽  
Jennifer C. Donnelly
Keyword(s):  
Medical Education ◽  
Postgraduate Medical Education ◽  
Medication Use ◽  
Pregnancy And Lactation ◽  
In Pregnancy

scholarly journals Keto-Sleuths – An Unusual Cause of Loss of Ketosis?

2021 ◽  
Vol 8 ◽  
pp. 2329048X2110297
Author(s):  
Christine M. Foley ◽  
Christopher Ryan ◽  
Stacey Tarrant ◽  
Ann M. Bergin
Keyword(s):  
Effective Treatment ◽  
Seizure Control ◽  
Refractory Epilepsy ◽  
Clinical Scenario ◽  
Diet Restriction ◽  
Ketogenic Diets ◽  
Control And Prevention

Ketogenic diets provide a non-pharmaceutical alternative for treatment of refractory epilepsy. When successful in reducing or eliminating seizures, medication numbers or doses may be reduced. Unexpected loss of ketosis is a common problem in management of patients on ketogenic diets and, especially when the diet is an effective treatment, loss of ketosis may be associated with an exacerbation in seizures. Identification of the cause of loss of ketosis is critical to allow rapid resumption of seizure control, and prevention of unnecessarily increased diet restriction or increased medication doses. Here an unusual environmental cause of loss of ketosis is described (contamination with starch-containing drywall dust), illustrating the extent of investigation sometimes necessary to understand the clinical scenario.

Infections Caused by Spirochetes: Syphilis, Lyme Disease, Leptospirosis

2018 ◽  
Author(s):  
Patrick Duff
Keyword(s):  
Lyme Disease ◽  
Latent Infection ◽  
Congenital Syphilis ◽  
Ixodes Scapularis ◽  
Severe Disease ◽  
Erythema Migrans ◽  
Treponema Pallidum ◽  
Mild Disease ◽  
Drug Of Choice ◽  
In Pregnancy

Syphilis is caused by the spirochete Treponema pallidum. It is classified as primary, secondary, tertiary, and latent infection. If left untreated, syphilis can cause devastating injury to the fetus. The drug of choice for treatment of syphilis in pregnancy is penicillin. Lyme disease is caused by Borrelia burgdorferi and is transmitted by the Ixodes scapularis tick. The principal clinical manifestation of Lyme disease is erythema migrans, but patients may also develop arthritis and cardiac and neurologic abnormalities. Congenital Lyme disease has not been reported. The drug of choice for treatment of Lyme disease in pregnancy is amoxicillin. Leptospirosis is usually acquired from direct contact with urine of infected animals or through contaminated water, soil, or vegetation. Pregnant women with mild disease should be treated with oral amoxicillin. Patients with severe disease should be hospitalized and treated with intravenous penicillin or ampicillin. This review contains 5 figures, 5 tables, and 19 references. Key Words: clinical infection, congenital syphilis, latent infection, leptospirosis, Lyme disease, syphilis

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