scholarly journals Clinical and electroencephalographic characteristics of a cohort of patients with epilepsy and absence seizures

2009 ◽  
Vol 67 (4) ◽  
pp. 986-994
Author(s):  
Soniza Vieira Alves-Leon ◽  
Maria Fátima Bento de Souza Cardoso ◽  
Valéria Coelho Santa Rita Pereira ◽  
Isabela D'Andrea Meira
Keyword(s):  
Focal Epilepsy ◽  
Clinical History ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Dramatic Improvement ◽  
Cross Sectional ◽  
Absence Seizures ◽  
Epileptic Syndromes ◽  
Drug Resistant Epilepsy ◽  
Video Eeg

BACKGROUND: Epileptic syndromes with absence seizures (AS) possess unique clinical and electroencephalographic (EEG) characteristics. In typical or atypical AS, ictal phenomenology may include various characteristics. Vídeo-EEG monitoring enables findings to be correlated with ictal phenomenology. OBJECTIVE: To evaluate the different AS in a cohort of patients with drug-resistant epilepsy (DRE) based on the International League against Epilepsy (ILAE)'s 2006 classification, to correlate with ictal phenomenology recorded and to apply the Panayiotopoulos criteria. METHOD: This study included patients with criteria of AS followed up at the Epilepsy Clinic. A dual, cross-sectional cohort study was carried out between 2005 and 2008. Patients receiving care in the Epilepsy Program of the HUCFF-UFRJ, who had been investigated by video-EEG and who presented clinical and EEG criteria for absence seizures, typical or atypical, according to the criteria defined by the ILAE, were included in the study, independent of age onset, the review of clinical history, age onset, family history, epilepsy onset and evolution, seizures phenomenology, antiepileptic drugs response and neuroimaging studies were used to classify the patients among the different epileptic syndrome associated to absence seizures. RESULTS: Typical absences were more frequent (71.4%) than atypical absences. Cases of juvenile absence epilepsy were the most frequent (19%) in this series, followed by childhood absence epilepsy (14.4%) and juvenile myoclonic epilepsy (4.8%). In 14 patients (66.67%), diagnosis was modified from focal epilepsy to primary generalized epilepsy. Clinical and EEG diagnosis of absence epilepsy resulted in a dramatic improvement in the control of seizures following modification of diagnosis and indication of an appropriate antiepileptic drug. CONCLUSION: Our results show that typical AS are more frequent than atypical. AS was successfully defined in 10 patients following application of Panayiotopoulos' criteria. The consequent change in diagnosis and therapy resulted in resolution of refractoriness in 9 patients. We concluded that in DRE, AS associated to unusual ictal phenomenology improve dramatically when diagnosed by video-EEG, permitting seizures to be controlled. Clinical and EEG evaluation confirm that myoclonus, automatisms and autonomic disorders are involved and that the consciousness may be affected to different degrees.

scholarly journals Seizure Exacerbation by Antiepileptic Drugs

2005 ◽  
Vol 5 (5) ◽  
pp. 192-193 ◽  
Author(s):  
Jacqueline A. French
Keyword(s):  
Antiepileptic Drugs ◽  
De Novo ◽  
Focal Epilepsy ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Absence Seizures ◽  
Incorrect Diagnosis ◽  
Juvenile Absence Epilepsy ◽  
Generalized Epilepsy

Worsening of Seizures by Oxcarbazepine in Juvenile Idiopathic Generalized Epilepsies Gelisse P, Genton P, Kuate C, Pesenti A, Baldy-Moulinier M, Crespel A Epilepsia 2004;45:1282–1286 Purpose Several studies have shown that carbamazepine (CBZ) may aggravate idiopathic generalized epilepsy (IGE). Oxcarbazepine (OXC) is a new drug chemically related to CBZ. We report six cases of juvenile IGE with a clear aggravation by OXC. Methods We retrospectively studied all patients with IGE first referred to our epilepsy department between January 2001 and June 2003 and treated with OXC. Results During this period, six patients were identified. All had an aggravation of their epilepsy in both clinical and EEG activities. OXC had been used because of an incorrect diagnosis of focal epilepsy or generalized tonic–clonic seizures (GTCSs) of undetermined origin (no syndromic classification of the epilepsy). Before OXC, only one patient had experienced a worsening of seizures with an inadequate drug (carbamazepine; CBZ). Four had juvenile myoclonic epilepsy, one had juvenile absence epilepsy, and one had IGE that could not be classified into a precise syndrome. OXC (dosage range, 300–1,200 mg/day) was used in monotherapy in all of them except for one patient. Aggravation consisted of a clear aggravation of myoclonic jerks (five cases) or de novo myoclonic jerks (one case). Three patients had exacerbation of absence seizures. One patient had worsened dramatically and had absence status, and one had de novo absences after OXC treatment. The effects of OXC on GTCSs were less dramatic, with no worsening in frequency in three and a slight increase in three. Conclusions OXC can be added to the list of antiepileptic drugs that can exacerbate myoclonic and absence seizures in IGE.

scholarly journals Cortical Tonic Inhibition Regulates the Expression of Spike-and-Wave Discharges Associated with Absence Epilepsy

2017 ◽  
Author(s):  
Kile P. Mangan ◽  
Aaron B. Nelson ◽  
Steven Petrou ◽  
Chiara Cirelli ◽  
Mathew V. Jones
Keyword(s):  
Absence Epilepsy ◽  
Tonic Inhibition ◽  
Absence Seizure ◽  
Optimum Level ◽  
Normal Functioning ◽  
Absence Seizures ◽  
Pharmacological Blockade ◽  
Eeg Recordings ◽  
Wave Discharge ◽  
Video Eeg

ABSTRACTSynchronous and bilateral spike-and-wave discharges accompany nonconvulsive behavioral and cognitive arrest during seizures associated with absence epilepsy. Previous investigation of multiple absence animal models suggests that the underlying cause of absence seizures is an increase in thalamic inhibitory tonic currents. In contrast, in this study we provide evidence that the level of cortical tonic inhibition also regulates absence seizure expression. Using continuous video-EEG recordings to monitor absence seizures and spike-and-wave discharge expression we show that pharmacological blockade of cortical tonic inhibition provokes absence seizures in wild-type mice. Furthermore, we show that pharmacological rescue of cortical tonic inhibition in an absence mouse (γ2R43Q) model, which lacks tonic inhibition, suppresses absence seizure and spike-and-wave discharge expression. Collectively, these results suggest an optimum level of tonic inhibition in the thalamocortical circuit is required for normal functioning and that a deviation from this optimum results in aberrant thalamocortical function, SWDs and absence seizures.

scholarly journals Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy

Neurology ◽  
2018 ◽  
Vol 91 (2) ◽  
pp. 74-81 ◽  
Author(s):  
Andres M. Kanner ◽  
Eric Ashman ◽  
David Gloss ◽  
Cynthia Harden ◽  
Blaise Bourgeois ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Seizure Frequency ◽  
Focal Epilepsy ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Review Literature ◽  
Third Generation ◽  
High Quality ◽  
New Antiepileptic Drugs ◽  
New Onset

ObjectiveTo update the 2004 American Academy of Neurology (AAN) guideline for treating new-onset focal or generalized epilepsy with second- and third-generation antiepileptic drugs (AEDs).MethodsThe 2004 AAN criteria were used to systematically review literature (January 2003–November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength.ResultsSeveral second-generation AEDs are effective for new-onset focal epilepsy. Data are lacking on efficacy in new-onset generalized tonic-clonic seizures, juvenile myoclonic epilepsy, or juvenile absence epilepsy, and on efficacy of third-generation AEDs in new-onset epilepsy.RecommendationsLamotrigine (LTG) should (Level B) and levetiracetam (LEV) and zonisamide (ZNS) may (Level C) be considered in decreasing seizure frequency in adults with new-onset focal epilepsy. LTG should (Level B) and gabapentin (GBP) may (Level C) be considered in decreasing seizure frequency in patients ≥60 years of age with new-onset focal epilepsy. Unless there are compelling adverse effect–related concerns, ethosuximide or valproic acid should be considered before LTG to decrease seizure frequency in treating absence seizures in childhood absence epilepsy (level B). No high-quality studies suggest clobazam, eslicarbazepine, ezogabine, felbamate, GBP, lacosamide, LEV, LTG, oxcarbazepine, perampanel, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or ZNS is effective in treating new-onset epilepsy because no high-quality studies exist in adults of various ages. A recent Food and Drug Administration (FDA) strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons ≥4 years old and perampanel as monotherapy received FDA approval.

scholarly journals Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy

2018 ◽  
Vol 18 (4) ◽  
pp. 260-268 ◽  
Author(s):  
Andres M. Kanner ◽  
Eric Ashman ◽  
David Gloss ◽  
Cynthia Harden ◽  
Blaise Bourgeois ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Seizure Frequency ◽  
Focal Epilepsy ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Review Literature ◽  
Third Generation ◽  
High Quality ◽  
New Antiepileptic Drugs ◽  
New Onset

Objective: To update the 2004 American Academy of Neurology (AAN) guideline for treating new-onset focal or generalized epilepsy (GE) with second- and third-generation antiepileptic drugs (AEDs). Methods: The 2004 AAN criteria was used to systematically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Results: Several second-generation AEDs are effective for new-onset focal epilepsy. Data are lacking on efficacy in new-onset generalized tonic–clonic seizures, juvenile myoclonic epilepsy, or juvenile absence epilepsy, and on efficacy of third-generation AEDs in new-onset epilepsy. Recommendations: Lamotrigine (LTG) should (Level B) and levetiracetam (LEV) and zonisamide (ZNS) may (Level C) be considered in decreasing seizure frequency in adults with new-onset focal epilepsy. LTG should (Level B) and gabapentin (GBP) may (Level C) be considered in decreasing seizure frequency in patients ≥60 years with new-onset focal epilepsy. Unless there are compelling adverse-effect–related concerns, ethosuximide (ETS) or valproic acid (VPA) should be considered before LTG to decrease seizure frequency in treating absence seizures in childhood absence epilepsy (Level B). No high-quality studies suggest clobazam, eslicarbazepine, ezogabine, felbamate, GBP, lacosamide, LEV, LTG, oxcarbazepine, perampanel, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or ZNS is effective in treating new-onset epilepsy because no high-quality studies exist in adults of various ages. A recent FDA strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons ≥4 years old and perampanel as monotherapy received FDA approval.

scholarly journals Syndromic classification of patients with typical absence seizures

2003 ◽  
Vol 61 (3A) ◽  
pp. 580-587 ◽  
Author(s):  
Laura M.F.F. Guilhoto ◽  
Maria Luíza G. Manreza ◽  
Elza M.T. Yacubian
Keyword(s):  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Childhood Absence Epilepsy ◽  
Interictal Eeg ◽  
Syndromic Diagnosis ◽  
Juvenile Absence Epilepsy ◽  
Ilae Classification ◽  
Video Eeg ◽  
Spike Wave

The aim of this study is to compare ILAE classification (1989) and Panayiotopoulos' criteria (1997) for absence epilepsies. We studied 455 typical absences (ILAE, 1981) by video-EEG in 43 patients with normal neurological and neuroradiological examinations and interictal EEG with spike-wave complexes higher than 2.5Hz. Syndromic diagnosis was possible in 60.5% and 67.4% of the patients using ILAE classification and Panayiotopoulos' proposal, respectively. According to ILAE criteria 19 patients had childhood absence epilepsy (CAE), five juvenile absence epilepsy (JAE), one juvenile myoclonic epilepsy (JME) and one epilepsy with specific modes of seizure precipitation. According to Panayiotopoulos' proposal, 10 had CAE, 14 JAE, one JME, three myoclonic absence epilepsy and one eyelid myoclonia with absences. We conclude that Panayiotopoulos' criteria and ILAE classification for absence epilepsies, which did not allow for the classification of 32.6% and 39.5% of cases, respectively, were still insufficient to classify all patients under specific diagnosis.

scholarly journals Absence status seen in an adult patient

2013 ◽  
Vol 04 (03) ◽  
pp. 342-344
Author(s):  
H Hasan ◽  
Caner F Demir ◽  
Hasan S Cura
Keyword(s):  
Status Epilepticus ◽  
Adult Patient ◽  
Absence Epilepsy ◽  
Metabolic Disturbances ◽  
Absence Seizures ◽  
Epileptiform Discharges ◽  
Epileptic Syndromes ◽  
Absence Status ◽  
Juvenile Absence Epilepsy ◽  
Consciousness Impairment

ABSTRACTAbsence status epilepticus (ASE) is a type of nonconvulsive status epilepticus in which continuous or recurrent generalized epileptiform discharges are associated with a varying grade of consciousness impairment. Absence status epilepticus may be obtained during progress of many epileptic syndromes, in several metabolic disturbances and related to use of several drugs. Absence status epilepticus is generally seen in childhood; rarely it can be seen in adulthood. In this paper, the case which has never diagnosed until now in spite of many absence seizures for years, applied for absence seizures to our clinic and diagnosed for juvenile absence epilepsy, has been discussed.

scholarly journals Additional options for non-pharmacological treatment of epilepsy

2019 ◽  
Vol 11 (1) ◽  
pp. 8-20
Author(s):  
O. M. Oleynikova ◽  
A. A. Sarapulova ◽  
G. N. Avakyan
Keyword(s):  
Clinical Symptoms ◽  
Focal Epilepsy ◽  
Epileptiform Activity ◽  
Red Light ◽  
Epileptic Activity ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Pharmacological Therapy ◽  
Eeg Recordings ◽  
Generalized Epilepsy

Objective: to study the effect of blue polarizing glasses on photosensitivity in patients with photosensitive epilepsy (PSE). Materials and methods. On the backdrop of red light stimulation, EEG and daytime video EEG recordings were performed in 19 patients with epilepsy (15 women, 4 men) aged from 14 to 41 years. Among those, 8 patients had juvenile myoclonic epilepsy (JME), 2 – eyelid myoclonus with absences, 6 – generalized epilepsy, 1 – juvenile absence epilepsy (JAA), and 2 patients had unspecified (cryptogenic) focal epilepsy. All patients underwent photo-stimulation (PS) with an increasing light frequency from 1 to 31 Hz (in 3 Hz steps). The PS procedure was carried out twice: without and with the use of blue polarizing glasses with a degree of darkness of 50%. Results. In 19 patients with PSE, we observed a photo-paroxysmal response at frequencies of 10, 13, 15, 16, 19, and 21 Hz. In the same individual, this photo-paroxysmal response could have manifested either in a burst of epileptic activity without clinical symptoms or in myoclonus / myoclonia with absences. In 8 (42.1%) patients, there was a decrease in epileptic activity upon photo-stimulation: a decrease in the duration of the acute peak-slow-wave activity or a zero epileptic activity at one frequency on the backdrop of a notable epileptic activity at other frequencies. In 3 (15.8%) patients, who were using the blue glasses, there were neither seizures nor epileptic activity at all. In one case (5.3%), there was no seizure but the PS-induced epileptiform activity did occur. The disappearance of subclinical epileptic activity was noted in 2 (10.5%) cases. Conclusion. Blue polarizing glasses can be used as an additional means of non-pharmacological therapy of PSE. The protective effect may be associated with a decrease in the melatonin content in the daytime.

scholarly journals A multi-modality approach to identifying primary generalized epilepsy that can mimic focal epilepsy

2015 ◽  
Vol 42 (S1) ◽  
pp. S22-S22
Author(s):  
BM Duaa ◽  
A Ye ◽  
S Doesburg ◽  
H Otsubo ◽  
A Ochi
Keyword(s):  
Focal Epilepsy ◽  
Final Diagnosis ◽  
Absence Seizures ◽  
Resective Surgery ◽  
Group A ◽  
Modality Approach ◽  
Interictal Discharges ◽  
Generalized Epilepsy ◽  
Group B ◽  
Video Eeg

Introduction: Evaluating the suitability for surgery in patients with epilepsy requires determining if the epilepsy is focal or generalized. Presurgical workups can indicate focal epilepsy in certain cases of generalized epilepsy (GE). The purpose of this study was to identify distinctive features which characterize patients with primary GE that mimics focal epilepsy. Method: We retrospectively identified 19 children with generalized interictal discharges during scalp video-EEG (SVEEG) and underwent invasive monitoring and/or epilepsy surgery. Two children did not undergo resective surgery due to final diagnosis of primary GE (Group A). Seventeen children underwent a resective surgery (Group B). Scalp video-EEG, MEG, MRI, and intracranial video EEG (IVEEG) were reviewed. Results: On (SVEEG), the frequency of generalized spike-and-waves (GSW) was 3Hz in Group A and 1.5-2.5Hz in Group B. Group A had only absence seizures , whereas 80% in Group B had multiple types of seizures. Both groups had lateralized MEG dipoles. One patient in Group A had a focal MRI abnormality. In Group A, IVEEG showed GSW of 3 Hz frequency with inconsistent leading. In Group B, IVEEG showed consistent localization of ictal and interictal high frequency oscillations. Conclusion: Children with generalized 3 Hz spike-and-waves and only absence seizures may be a contraindication of resective surgery even though some presurgical workup shows focality.

Sign in / Sign up

Export Citation Format

Share Document