Brain tumour related epilepsy with co-existing non epileptic attacks: Characteristics of a clinically challenging cohort

Aims The co-existence of non-epileptic attacks (NEAD) in patients with brain tumour related epilepsy (BTRE) is poorly described. Non epileptic attacks (NEAD) co-occur in up to 30% of patients with epilepsy PWE. Adverse life events are associated with development of NEAD; their co-occurrence in those with BTRE is potentially un-surprising. We sought to characterise the evolution of symptoms in this cohort. Method Clinical trajectories of patients with BTRE and co-existing NEAD were characterised. The diagnosis of NEAD was based on the epilepsy specialist’s observation of attacks and /or capture of attacks on video. Some patients had additional video EEG correlate. Patients had been referred because of persisting symptoms in spite of escalating antiepileptic therapy. Results Of eight patients, six were initially misdiagnosed with escalating seizures. One patient developed NEAD de novo following tumour biopsy, the remaining patients developed NEAD following onset of BTRE. Onset of NEAD was not temporally linked with the diagnosis of a brain tumour. In five patients, NEAD onset occurred when seizures were controlled (< 1 seizure/ month). All patients reported fear of developing uncontrolled seizures as being associated with their symptoms and identified their NEAD as more disabling than their epilepsy. Patients were eventually managed with polytherapy -two found adjunctive clobazam helpful and four were offered antidepressant/ anxiolytic medication. Behavourial strategies including mindfulness were also discussed. At time of last follow up, seven patients had on-going NEAD symptoms in spite of good seizure control. Conclusion NEAD can co-occur with BTRE and should be considered in those with rapidly escalating symptoms in spite of antiepileptic therapy and radiologically stable lesions. Both making the diagnosis of NEAD and providing ongoing support is challenging. These patients require a multidisciplinary approach with support from allied specialties including neuropsychiatry and neuropsychology.

Modern possibilities of antiepileptic therapy at the start of treatment of focal epilepsy

The report presents data on the evaluation of efficacy and tolerability, as well as the dynamics of epileptiform activity index in adolescents and adults with newly diagnosed focal epilepsy during lacosamide therapy.

Farmaci epilettici, vitamina D e mineralizzazione ossea: le evidenze e le azioni

The possible negative effects of antiepileptic drugs on bone metabolism with the consequent possible risks have been discussed in the literature for more than 30 years. Two reviews of the literature attempted to answer the following clinical questions: “Should vitamin D supplementation be used in children receiving antiepileptic drugs?”, “Do children on chronic antiepileptic drug therapy have to perform bone densitometry (DEXA) to assess the state of bone mineralization”? The evidence suggests to prescribe a prophylaxis with vitamin D at 400 IU/day to children on antiepileptic therapy and without other risk factors and provide them with indications regarding correct eating, motor and sun exposure lifestyles. Higher doses will be evaluated in case of coexistence of risk factors. DEXA screening may be useful in children on antiepileptic therapy and with a history of fractures (particularly multiple or low impact fractures) or in children on prolonged antiepileptic therapy and in the presence of additional risk factors (e.g. infantile cerebral palsy).

Results of the expert forum on the use of perampanel in adolescents with epilepsy in everyday clinical practice

In June 2020, an online forum of experts on the use of perampanel in adolescents with epilepsy in everyday clinical practice was held. The main goal was to discuss the features of juvenile epilepsy, its diagnosis, the possibilities of using perampanel in this category of patients, and the effectiveness of using the drug in everyday clinical practice. The forum was attended by leading experts in neurology and epileptology. Current data on the epidemiology of epilepsy in the child and juvenile population were presented; the issues of difficulties and diagnostic errors were considered, as well as features of managing adolescents with epilepsy, adverse events of antiepileptic therapy, results of studies on the effectiveness of perampanel, and many social aspects of the life of patients in this category.