“Ictal” Bradyarrhythmias in Patients with Drug-Resistant Epilepsy: Results of Long-Term Heart Rhythm Monitoring

Aim To determine the type and incidence of ictal bradyarrhythmias in patients with drug-resistant types of epilepsy by long-term electrocardiogram (ECG) monitoring.Material and methods Subcutaneous ECG monitors programed for recording pauses >3 sec and episodes of bradycardia ≤45 bpm were implanted in 193 patients with persistent epileptic seizures without organic pathology of the myocardium. Recording was activated by the patient/family at the onset of epileptic seizure. The follow-up period was 36 months with visits to the clinic every three months.Results For 36 months of monitoring, 6494 ECG fragments were recorded. Ictal bradycardia was observed in 6.7 % of patients, including ictal asystole in 2.6 % of patients. Episodes of bradycardia and asystole during epileptic seizures were transient and developed significantly more frequently in men, patients with long duration of the disease, bilateral tonic-clonic or focal seizures with disorder of consciousness, during sleep, on the background of treatment with several antiepileptic agents, mostly from the group of potassium channel blockers.Conclusion Bradyarrhythmias accompanying epileptic seizures are transient and reproducible from seizure to seizure. They reflect functional changes in the myocardium and do not determine the life prediction for patients with epilepsy without organic pathology of the heart.

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Long-term use of the ketogenic diet in drug resistant epilepsy syndromes during childhood: Differences between responders and non-responders in seizure types, EEG, and outcome

Neuropediatrics ◽

10.1055/s-0029-1215729 ◽

2008 ◽

Vol 39 (05) ◽

Author(s):

A Dressler ◽

E Reithofer ◽

B Stöcklin ◽

F Benninger ◽

M Freilinger ◽

...

Keyword(s):

Ketogenic Diet ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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The use of progesterone during pregnancy in women with epilepsy as an alternative to the correction of doses of anticonvulsants

GYNECOLOGY ◽

10.26442/20795696.2019.6.190708 ◽

2020 ◽

Vol 21 (6) ◽

pp. 12-15

Author(s):

Elena V. Tsallagova ◽

Vasily O. Generalov ◽

Timur R. Sadykov

Keyword(s):

Clinical Remission ◽

Epileptic Seizures ◽

Progesterone Concentration ◽

Teratogenic Effects ◽

Safe Alternative ◽

Patients With Epilepsy

Pregnancy is the most dangerous period in terms of interruption of even persistent and long-term remission. At the same time increasing the dose of anticonvulsant increases the risk of teratogenic effects. Aim. to assess the possibility of using progesterone to prevent relapse of epileptic seizures during pregnancy. Materials and methods. 38 pregnant patients with epilepsy with clinical remission before pregnancy, with relapse of epileptic seizures in I trimester of pregnancy, age 31.81.4 years. Dydrogesterone in a dose of 10 to 60 mg/day was prescribed after the relapse of remission. Anticonvulsant dosage was not changed. The blood progesterone concentration and EEG control was carried out. Results. During pregnancy, the level of progesterone in the blood gradually increased from 77.8 nmol/l at 78 weeks of pregnancy to 521.1 nmol/l at 3637 weeks of pregnancy, without exceeding the limits. EEG results did not deteriorate. None of the patients had seizures during pregnancy. Conclusion. Progesterone therapy is an adequate and safe alternative to increasing the dose of anticonvulsants in case of recurrent seizures during pregnancy.

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Heart rate variability analysis for the identification of the preictal interval in patients with drug-resistant epilepsy

Scientific Reports ◽

10.1038/s41598-021-85350-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Adriana Leal ◽

Mauro F. Pinto ◽

Fábio Lopes ◽

Anna M. Bianchi ◽

Jorge Henriques ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Linear Time ◽

Epileptic Seizures ◽

Heart Rate Variability Analysis ◽

Drug Resistant ◽

Clustering Methods ◽

Temporal Lobe Seizures ◽

New Perspective ◽

Drug Resistant Epilepsy

AbstractElectrocardiogram (ECG) recordings, lasting hours before epileptic seizures, have been studied in the search for evidence of the existence of a preictal interval that follows a normal ECG trace and precedes the seizure’s clinical manifestation. The preictal interval has not yet been clinically parametrized. Furthermore, the duration of this interval varies for seizures both among patients and from the same patient. In this study, we performed a heart rate variability (HRV) analysis to investigate the discriminative power of the features of HRV in the identification of the preictal interval. HRV information extracted from the linear time and frequency domains as well as from nonlinear dynamics were analysed. We inspected data from 238 temporal lobe seizures recorded from 41 patients with drug-resistant epilepsy from the EPILEPSIAE database. Unsupervised methods were applied to the HRV feature dataset, thus leading to a new perspective in preictal interval characterization. Distinguishable preictal behaviour was exhibited by 41% of the seizures and 90% of the patients. Half of the preictal intervals were identified in the 40 min before seizure onset. The results demonstrate the potential of applying clustering methods to HRV features to deepen the current understanding of the preictal state.

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Long‐term outcomes of children with drug‐resistant epilepsy across multiple cognitive domains

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14815 ◽

2021 ◽

Author(s):

Klajdi Puka ◽

Mary Lou Smith

Keyword(s):

Drug Resistant ◽

Long Term Outcomes ◽

Cognitive Domains ◽

Drug Resistant Epilepsy

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Vagus nerve stimulation for drug-resistant epilepsy

Practical Neurology ◽

10.1136/practneurol-2019-002210 ◽

2019 ◽

Vol 20 (3) ◽

pp. 189-198 ◽

Cited By ~ 1

Author(s):

Laura Pérez-Carbonell ◽

Howard Faulkner ◽

Sean Higgins ◽

Michalis Koutroumanidis ◽

Guy Leschziner

Keyword(s):

Vagus Nerve ◽

Seizure Frequency ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Therapeutic Option ◽

Drug Resistant ◽

Drug Resistant Epilepsy ◽

Randomised Controlled

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

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Effect and Safety of Shihogyejitang for Drug Resistant Childhood Epilepsy

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/3410213 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Jinsoo Lee ◽

Kwanghyun Son ◽

Gwiseo Hwang ◽

Moonju Kim

Keyword(s):

Adverse Events ◽

Antiepileptic Drugs ◽

Retention Rate ◽

Seizure Type ◽

Drug Resistant ◽

Exact Test ◽

Alternative Treatment Option ◽

Drug Resistant Epilepsy ◽

Intent To Treat ◽

Patients With Epilepsy

Objective. Herbal medicine has been widely used to treat drug resistant epilepsy. Shihogyejitang (SGT) has been commonly used to treat epilepsy. We investigated the effect and safety of SGT in children with drug resistant epilepsy.Design. We reviewed medical records of 54 patients with epilepsy, who failed to respond to at least two antiepileptic drugs and have been treated with SGT between April 2006 and June 2014 at the Department of Pediatric Neurology, I-Tomato Hospital, Korea. Effect was measured by the response rate, seizure-free rate, and retention rate at six months. We also checked adverse events, change in antiepileptic drugs use, and the variables related to the outcome.Results. Intent-to-treat analysis showed that, after six months, 44.4% showed a >50% seizure reduction, 24.1% including seizure-free, respectively, and 53.7% remained on SGT. Two adverse events were reported, mild skin rash and fever. Focal seizure type presented significantly more positive responses when compared with other seizure types at six months (p=0.0284, Fisher’s exact test).Conclusion. SGT is an effective treatment with excellent tolerability for drug resistant epilepsy patients. Our data provide evidence that SGT may be used as alternative treatment option when antiepileptic drug does not work in epilepsy children.

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Long-term effectiveness and adverse effects of ketogenic diet therapy in infants with drug-resistant epilepsy treated at a single center in Argentina

Epilepsy Research ◽

10.1016/j.eplepsyres.2021.106793 ◽

2021 ◽

pp. 106793

Author(s):

Marisa Armeno ◽

Antonella Verini ◽

Eugenia Caballero ◽

Araceli Cresta ◽

Gabriela Reyes Valenzuela ◽

...

Keyword(s):

Adverse Effects ◽

Ketogenic Diet ◽

Diet Therapy ◽

Drug Resistant ◽

Single Center ◽

Drug Resistant Epilepsy

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Drug-resistant epilepsy and topiramate: Plasma concentration and frequency of epileptic seizures

Clinical and Experimental Pharmacology and Physiology ◽

10.1111/1440-1681.12923 ◽

2018 ◽

Vol 45 (7) ◽

pp. 652-658

Author(s):

Fabiana Angelo Marques ◽

Nayara Cristina Perez de Albuquerque ◽

Marília Silveira de Almeida Campos ◽

Priscila Freitas-Lima ◽

André Oliveira Baldoni ◽

...

Keyword(s):

Plasma Concentration ◽

Epileptic Seizures ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Long-Term Effects of a Classic Ketogenic Diet on Ghrelin and Leptin Concentration: A 12-Month Prospective Study in a Cohort of Italian Children and Adults with GLUT1-Deficiency Syndrome and Drug Resistant Epilepsy

Nutrients ◽

10.3390/nu11081716 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1716 ◽

Cited By ~ 2

Author(s):

Ramona De Amicis ◽

Alessandro Leone ◽

Chiara Lessa ◽

Andrea Foppiani ◽

Simone Ravella ◽

...

Keyword(s):

Body Composition ◽

Nutritional Status ◽

Body Fat ◽

Deficiency Syndrome ◽

Drug Resistant ◽

Z Score ◽

Glut1 Deficiency ◽

Glut1 Deficiency Syndrome ◽

Drug Resistant Epilepsy

The classical ketogenic diet (cKD) is an isocaloric, high fat, very low-carbohydrate diet that induces ketosis, strongly influencing leptin and ghrelin regulation. However, not enough is known about the impact of a long-term cKD. This study evaluated the effects of a 12-month cKD on ghrelin and leptin concentrations in children, adolescents and adults affected by the GLUT1-Deficiency Syndrome or drug resistant epilepsy (DRE). We also investigated the relationship between the nutritional status, body composition and ghrelin and leptin variations. We carried out a longitudinal study on 30 patients: Twenty-five children and adolescents (15 females, 8 ± 4 years), and five adults (two females, 34 ± 16 years). After 12-monoths cKD, there were no significant changes in ghrelin and leptin, or in the nutritional status, body fat, glucose and lipid profiles. However, a slight height z-score reduction (from −0.603 ± 1.178 to −0.953 ± 1.354, p ≤ 0.001) and a drop in fasting insulin occurred. We found no correlations between ghrelin changes and nutritional status and body composition, whereas leptin changes correlated positively with variations in the weight z-score and body fat (ρ = 0.4534, p = 0.0341; ρ = 0.5901, p = 0.0135; respectively). These results suggest that a long-term cKD does not change ghrelin and leptin concentrations independently of age and neurological condition.

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