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 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 EEG in genetic generalized epilepsies

2020 ◽  
Vol 12 (1S) ◽  
pp. 23-40
Author(s):  
V. Yu. Nogovitsyn ◽  
A. A. Sharkov
Keyword(s):  
Differential Diagnosis ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Night Time ◽  
Epileptiform Discharges ◽  
Atypical Features ◽  
Delta Activity ◽  
Ictal Activity ◽  
Rhythmic Delta Activity ◽  
Generalized Epilepsy

Genetic, or idiopathic, generalized epilepsies (GGEs or IGEs) includes childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and epilepsy with generalized tonic-clonic seizures alone (GTCS-a).Aim. to characterize the capabilities of electroencephalography (EEG) for the diagnosis of various forms of genetic generalized epilepsyMaterials and methods. Literature data in Pubmed, Google Scholar was analyzed. In addition, own observations and clinical cases were systematized.Results. The article presents the data of morphology and topography of spike-wave discharges, as well as other patterns of EEG in the GGE – poly-spike activity, photoparoxysmal response, occipital intermittent rhythmic delta activity (OIRDA), fixation-off sensitivity and generalized paroxysmal fast activity (GPFA), as well as epileptiform K-complexes, the allocation of which in an independent pattern is questioned by a number of neurophysiologists. The differences between interictal and ictal activity in the GGE are discussed in detail; electroencephalogram (EEG) informativity modifiers are considered. The morphology of atypical features in the GGE is considered. The role of EEG in the differential diagnosis of CAE, JAE, JME, GTCS alone with the description of typical, atypical features, study scenarios and diagnostic criteria for each form are considered.Conclusions. Typical EEG features of GGE significantly simplify the differential diagnosis of electroclinical syndromes. There are “non-classical” features of EEG in the GGE, which do not contradict the diagnosis. To reveal the peculiarities of epileptiform discharges distribution, video EEG monitoring with night-time sleep and the use of several modality stimuli is preferable. Incorrect interpretation of EEG is dangerous for the patient. 

The Ketogenic Diet and Related Therapies in “Novel” Situations

2016 ◽  
Author(s):  
Sudha Kilaru Kessler
Keyword(s):  
Ketogenic Diet ◽  
Treatment Option ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Myoclonic Epilepsy ◽  
Childhood Absence Epilepsy ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy

The ketogenic diet (KD) is often considered as a treatment option for medication-resistant focal epilepsies and symptomatic generalized epilepsies, but is perhaps less commonly considered for idiopathic generalized epilepsies. The evidence for the use of the KD in two common idiopathic generalized epilepsy syndromes, childhood absence epilepsy and juvenile myoclonic epilepsy, is presented here.

Genetic generalized epilepsy

2016 ◽  
Author(s):  
Friederike Moeller ◽  
Ronit M. Pressler ◽  
J. Helen Cross
Keyword(s):  
Clinical Presentation ◽  
Age Of Onset ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Childhood Absence Epilepsy ◽  
Juvenile Absence Epilepsy ◽  
Generalized Epilepsy ◽  
Treatment Prognosis ◽  
Electroencephalogram Eeg ◽  
Eeg Features

This chapter provides an overview of generalized epilepsies (GGE), which comprises a group of epilepsy syndromes of presumed genetic origin. They are classified into several syndromes according to their age, depending on clinical manifestation and associated electroencephalogram (EEG) features. The chapter introduces the concept of GGE before addressing different GGE syndromes, describing their clinical presentation, EEG features, treatment, prognosis, and underlying genetics. The following GGE syndromes are discussed in order of their age of onset—myoclonic astatic epilepsy, childhood absence epilepsy, epilepsy with myoclonic absences, eyelid myoclonia with absences, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic seizures on awakening. This is followed by an overview on pathophysiological mechanisms underlying GGE.

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.

Brain Morphology in Patients with Genetic Generalized Epilepsy: Its Heterogeneity among Subsyndromes

2018 ◽  
Vol 80 (5-6) ◽  
pp. 236-244 ◽  
Author(s):  
Kang Min Park ◽  
Sung Eun Kim ◽  
Byung In Lee ◽  
Yun Jung Hur
Keyword(s):  
Cortical Thickness ◽  
Brain Magnetic Resonance Imaging ◽  
Juvenile Myoclonic Epilepsy ◽  
Absence Epilepsy ◽  
Brain Morphology ◽  
Seizure Type ◽  
Healthy Controls ◽  
Surface Areas ◽  
Generalized Epilepsy ◽  
Surface Based Morphometry

Background: We aimed to evaluate the brain morphology of patients with genetic generalized epilepsy (GGE) compared to healthy subjects. In addition, we investigated whether there are differences in brain morphology among different GGE syndromes. Methods: We enrolled 100 patients with a clinical diagnosis of GGE. The patients were classified into different syndrome groups according to their predominant seizure type, age of seizure onset, and electroencephalography characteristics (12 childhood absence epilepsy [AE], 13 juvenile AE, 56 juvenile myoclonic epilepsy, and 19 epilepsy with generalized tonic-clonic alone). We used surface-based morphometry of brain magnetic resonance imaging to evaluate brain morphology. Results: We found significantly widespread alterations of brain morphology, including cortical thickness and volumes in several regions in the patients with GGE compared to healthy controls. In addition, we observed significant differences in alterations of cortical thickness and volumes among the different GGE syndromes. However, there were no differences in cortical surface areas between the patients with GGE and healthy controls. There was a significantly negative correlation between the duration of epilepsy and most of the each measures of abnormal brain morphology. Conclusions: The main finding of this study is that brain morphology in patients with GGE is significantly different from that in healthy controls. In addition, we found that the different GGE syndromes show distinct structural brain morphology, especially cortical thickness, which can help us understand the pathogenesis of GGE syndromes.

scholarly journals Full bandwidth electrophysiology of seizures and epileptiform activity enabled by flexible graphene micro-transistor depth neural probes

2021 ◽  
Author(s):  
Andrea Bonaccini Calia ◽  
Eduard Masvidal-Codina ◽  
Trevor M. Smith ◽  
Nathan Schäfer ◽  
Daman Rathore ◽  
...  
Keyword(s):  
High Frequency ◽  
Epileptiform Activity ◽  
Epileptic Activity ◽  
Absence Epilepsy ◽  
Neural Probes ◽  
Chemically Induced ◽  
Metal Microelectrode ◽  
Spike Wave Discharges ◽  
Implanted Devices

ABSTRACTMapping the entire frequency bandwidth of neuronal oscillations in the brain is of paramount importance for understanding physiological and pathological states. The ability to record simultaneously infraslow activity (<0.1 Hz) and higher frequencies (0.1-600 Hz) using the same recording electrode would particularly benefit epilepsy research. However, commonly used metal microelectrode technology is not well suited for recording infraslow activity. Here we use flexible graphene depth neural probes (gDNP), consisting of a linear array of graphene microtransistors, to concurrently record infraslow and high frequency neuronal activity in awake rodents. We show that gDNPs can reliably record and map with high spatial resolution seizures, post-ictal spreading depolarisation, and high frequency epileptic activity through cortical laminae to the CA1 layer of the hippocampus in a mouse model of chemically-induced seizures. We demonstrate functionality of chronically implanted devices over 10 weeks by recording with high fidelity spontaneous spike-wave discharges and associated infraslow activity in a rat model of absence epilepsy. Altogether, our work highlights the suitability of this technology for in vivo electrophysiology research, in particular, to examine the contributions of infraslow activity to seizure initiation and termination.

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