scholarly journals Perampanel and Challenging Behaviour in Intellectual Disability and Epilepsy: A Management Dilemma

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Emily Dolton ◽  
Ansar Choudry
Keyword(s):  
Intellectual Disability ◽  
Antipsychotic Drugs ◽  
Seizure Control ◽  
Refractory Epilepsy ◽  
Challenging Behaviour ◽  
Her Family ◽  
Antiepileptic Medication ◽  
Life Threatening ◽  
Family Home ◽  
Treatment Refractory

We describe a case of a patient with a diagnosis of moderate learning disability with challenging behaviour and treatment refractory epilepsy. Antiepileptics can increase challenging behaviour; however, antipsychotics can provoke seizures. This results in a difficult balance for patient care. Due to worsening seizures, the patient was prescribed perampanel. This increased her aggression and agitation resulting in admission. We trialled four antipsychotic drugs to reduce her challenging behaviour, two of which worsened her seizures. It was necessary to continue antiepileptic medication to maintain adequate seizure control. However, the resulting uncontrolled challenging behaviour persisted, meaning she was unable to return to her family home on discharge. This case emphasises the difficult scenario clinician’s encounter when balancing the use of antipsychotics and antiepileptics. The case demonstrates the significant functional loss due to challenging behaviour, balanced against controlling life threatening seizures.

Fragile X Syndrome and Periventricular Heterotopias: A Rare Association

2020 ◽  
Author(s):  
Jakob Bidstrup ◽  
Jonas Kjeldbjerg Hansen
Keyword(s):  
Intellectual Disability ◽  
Fragile X Syndrome ◽  
Positive Response ◽  
Refractory Epilepsy ◽  
Fragile X ◽  
Clinical Signs ◽  
Rare Association ◽  
Favorable Prognosis ◽  
Antiepileptic Medication ◽  
The Central Nervous System

AbstractFragile X syndrome (FXS) is the most common hereditary cause of intellectual disability in males, with an estimated prevalence of 1:4000. Epilepsy occurs in 10 to 20% of males with FXS and usually has a favorable prognosis and positive response to antiepileptic medication. Numerous anomalies in the central nervous system have been reported in FXS. Among these, periventricular heterotopia (PH) has been reported in two previous cases. Epilepsy is also a common comorbidity in PH, but in contrast to epilepsy in FXS, the severity may vary markedly. We present a boy with FXS, PH, and epilepsy—a combination not previously reported in the literature. The presented case suggests a necessity to consider PH in cases of refractory epilepsy or status epilepticus in patients with FXS, emphasizes the importance of ruling out FXS in children with intellectual disability even if there are only discreet or no clinical signs of the disorder, and underscores that FXS should be considered in patients with PH if no other cause can be found.

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.

Epidemiology of Epilepsy in Older Adults With an Intellectual Disability in Ireland: Associations and Service Implications

2014 ◽  
Vol 119 (3) ◽  
pp. 253-260 ◽  
Author(s):  
Mary McCarron ◽  
Marie O'Dwyer ◽  
Eilish Burke ◽  
Eimear McGlinchey ◽  
Philip McCallion
Keyword(s):  
Older Adults ◽  
Intellectual Disability ◽  
Longitudinal Study ◽  
Refractory Epilepsy ◽  
Demographic Variables ◽  
Health Conditions ◽  
Community Settings ◽  
Morbid Conditions

Abstract There are limited studies on the prevalence of epilepsy and co-morbid conditions in older adults with an ID. To begin to address this prevalence of epilepsy was estimated for participants in the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing. Associations with demographic variables and co morbid health conditions were examined. It was found that prevalence was high (30.7%); but declined as people aged. Those with epilepsy were less likely to live with family, independently or in community settings, rates of refractory epilepsy were high and, despite medication over half of those with epilepsy still reported experiencing seizures. Given these findings, people with ID and their careers have considerable needs for information about epilepsy management, and for support from specialist ID and epilepsy services.

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.

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