Research progress of nerve stimulation in the treatment of epilepsy in children

1. This study presents the results of the preliminary screening of vigabatrin as add-on therapy in an open, non-controlled multicentre study in children with refractory epilepsy. 2. There were 135 children, with an age range of 2 months-12 years. Main seizure type was partial in 42%, generalized in 29%, Lennox-Gastaut syndrome in 19% and West syndrome in 10%. 3. Vigabatrin was added onto current antiepileptic treatment in an initially recommended dose of 40-80 mg kg-1 day-1. However, the doses were frequently increased when tolerance allowed it, and the final mean dose used was 87 mg kg-1 day-1 (27-600). 4. A 75% to 100% reduction in seizure frequency was observed in 25% of patients (11 patients became seizure free) and 50 to 75% decrease in a further 13%. Efficacy was better in partial seizures, with good to excellent results in 49% of patients. The use of high doses, above 100 mg kg-1 day, was not associated with greater efficacy in this preliminary study. 5. No side effects were reported in 79% of patients. Agitation and insomnia were observed in 8.8% and somnolence in 6%. Other adverse events included ataxia (2.2%), nausea (2.2%) and increased appetite (1%). A moderate and transient decrease in haemoglobin was reported in six patients from the same centre; these patients were all receiving very high doses of vigabatrin (250 to 600 mg kg-1 day-1). 6. Vigabatrin thus appears to be a safe antiepileptic drug that may be effective in the treatment of severe epilepsy in children.

ObjectiveTo observe the clinical effect and adverse reactions of perampanel in the treatment of epilepsy in children.MethodsA retrospective analysis was performed on 83 children with epilepsy who were treated with perampanel in the Department of Pediatric Neurology, Second Affiliated Hospital of Xi'an Jiaotong University from April to August 2021. The treatment status, prognosis and adverse reactions were followed up. The effective rates of different age groups, different seizure types and epilepsy syndromes, and different treatment methods were statistically analyzed. The effective rate and adverse reactions of all patients were statistically analyzed.ResultsThe overall effective rate of perampanel in the treatment of epilepsy was 62.03%, and there was no significant difference in the effective rate of perampanel in the treatment of epilepsy in patients of different ages (P > 0.05). The effective rates of perampanel in the treatment of focal seizures and generalized seizures were 60.38% and 65.38%, and the effective rates of benign childhood epilepsy with centrotemporal spikes (BECT), BECT combined with electrical status epilepticus during sleep (ESES) and frontal lobe epilepsy (FLE) were 88.89, 72.73, and 66.67%. The effective rates of monotherapy and combination therapy were 88.88 and 58.57%, respectively. The above statistical differences were not statistically significant (P > 0.05). In addition, the adverse reaction rate of perampanel treatment was 16.45%, including irritability, drowsiness, dizziness, nausea, vomiting and abnormal liver function.ConclusionPerampanel has a high efficiency and controllable adverse reactions in the treatment of childhood epilepsy. This drug can be used as a reliable choice for long-term use in the treatment of epilepsy in children.

OBJECTIVE: Due to the development of new antiepileptic drugs, epilepsy treatment has presented substantial progress in the last decade. In spite of presenting more adequate profile, these drugs have not shown better efficiency in seizure control than the traditional drugs. The objective of this revision is to provide up-to-date data for the treatment of epilepsy in childhood and the role of the new antiepileptic drugs. SOURCES: Bibliographic review has been performed at Medline for the last 10 years, and the most pertinent papers and abstracts presented in International Epilepsy Meetings were selected. SUMMARY OF THE FINDINGS: The new antiepileptic drugs could be indicated in the treatment of some specific epileptic syndromes. Serious side effects have been described with the use of these drugs. CONCLUSIONS: The traditional drugs must be considered as the primary choice in the treatment of ordinary epilepsy.

Factors associated with relapse after antiepileptic drug withdrawal in a selected population with partial epilepsy' SIR-When a patient who has been taking antiepileptic drugs (AED) is seizure-free for several years, the question of withdrawing medication arises. Several studies of adults and children with epilepsy have reported on the results of AED withdrawal and the factors that predict relapse after withdrawal

Epilepsy is one of the most common pediatric neurological diseases, and antiepileptic drug therapy is the preferred method at present. The new antiepileptic drugs (AED) with the advantages of wide spectrum, less adverse reaction, high tolerance and safety than traditional AED, have given physicians new options for the treatment of children with epilepsy. However, due to the lack of global clinical trials in children, most of the drugs, including AED, are lack of clinical efficacy and safety data for children, and just use in children with a dosage of a simple conversion from adult dose, witch neglected children distinction between adults. Recently, several studies suggested evidence-based guidelines for the efficacy and tolerability of the new AED and offered expert opinions, including those concerned with pediatric patients, to facilitate more reasonable selection of the new AED. In this article, we review the progress and evidence-based evidence of common new AED in treatment of epilepsy in children and summarized below. Key words: Epilepsy; Anticonvulsants; Treatment; Child

Determination of healthcare resource and cost implications of using alternative sodium valproate formulations in the treatment of epilepsy in children in England: A retrospective database review

Preface to the Third Edition. Acknowledgements. 1 Definitions and Epidemiology. Definitions. Frequency and population features of epilepsy. 2 Seizure Type and Anatomical Location of Seizures. Seizure type. Classifi cation of partial seizures by anatomical site of seizure onset. 3 Epilepsy Syndromes. ILAE Classifi cation of the Epilepsies and Epilepsy Syndromes. The epilepsy syndromes. 4 The Causes of Epilepsy. Idiopathic epilepsy. Symptomatic epilepsy of genetic or congenital origin. Symptomatic epilepsy due to acquired causes. Provoked seizures. 5 Principles of Treatment. Why treat epilepsy? The aims of treatment. The risks of epilepsy and its treatment. Choice of antiepileptic drug therapy based on seizure type. Treatment of specifi c epilepsy syndromes. Principles of treatment of newly diagnosed patients. Principles of treatment of patients with established active epilepsy. Treatment of patients with epilepsy in remission. Psychiatric disorders in epilepsy. Life-threatening idiosyncratic reactions. Complementary and alternative therapy in epilepsy. Genetic counselling in epilepsy. 6 Treatment of Epilepsy in Specifi c Groups. Treatment of epilepsy in children. Treatment of epilepsy in patients with additional handicaps. Epilepsy in elderly people. Treatment of epilepsy in women. 7 Pharmacokinetic Principles of Antiepileptic Drug Treatment. Drug absorption. Drug distribution. Drug elimination (metabolism and excretion). Blood level measurements. 8 The Antiepileptic Drugs. Carbamazepine. Clobazam. Clonazepam. Eslicarbazepine acetate. Ethosuximide. Gabapentin. Lacosamide. Lamotrigine. Levetiracetam. Oxcarbazepine. Phenobarbital. Phenytoin. Pregabalin. Primidone. Rufi namide. Tiagabine. Topiramate. Valproate. Vigabatrin. Zonisamide. Other drugs used in the treatment of epilepsy. Acetazolamide. Benzodiazepines. Corticosteroids and ACTH. Felbamate. Piracetam. Stiripentol. 9 The Emergency Treatment of Epilepsy. How to deal with a seizure. Status epilepticus. Antiepileptic drugs used in status epilepticus. 10 The Surgical Therapy of Epilepsy. Presurgical assessment - general points. Surgery in epilepsy arising in the mesial temporal lobe. Surgery in epilepsy arising in extratemporal regions and the temporal neocortex. Cortical dysplasia (malformations of cortical development). Surgery where no lesion is apparent on neuroimaging ('MRI-negative cases') Hemispherectomy, hemispherotomy and other large resections. Corpus callosectomy (corpus callosum section, corpus callosotomy). Multiple subpial transection. Vagal nerve stimulation. Other functional surgical procedures. The organization of epilepsy surgery care: the epilepsy surgery centre. Pharmacopoeia. Antiepileptic drugs - indications in epilepsy. Antiepileptic drugs - dose, average adult values. Antiepileptic drugs - dose, interactions. Antiepileptic drugs - dose, in children. Antiepileptic drugs - summary of side effects. Antiepileptic drugs - summary of metabolism. Antiepileptic drugs - summary of pharmacokinetic values (typical adult values). Antiepileptic drugs - modes of action. Further Reading. Index.

A retrospective review of the neuropsychological and medical variables of 26 children who underwent a cortical resection as part of the management of their medically refractory epilepsy was conducted. Neuropsychological variables included pre- and postoperative measures of intelligence (Wechsler Scales) and memory functioning (Wide Range Assessment of Memory and Learning). Medical variables included age at onset of seizures, age at surgery, site of resection, and degree of seizure control postoperatively. Twenty patients had temporal resections (13 left-sided). Six had extratemporal resections. In this series, cortical resection as treatment of epilepsy in children did not result in a significant change in performance on measures of intelligence or memory functioning. No significant correlation was found between the medical variables and the neuropsychological outcome.

Surgical treatment of epilepsy in children often involves brain areas outside the temporal lobe and, therefore, techniques for extratemporal surgery must be included in the armamentarium of epilepsy surgery centers. Nowadays, disconnective procedures are preferable to traditional resective operations because they reduce the rate of complications related to extensive resections while achieving equivalent seizure outcomes. This article describes the practical anatomy and surgical techniques used for temporoparietooccipital (TPO), parietooccipital, and frontal disconnections, as well as the possibility of extending previous lobar disconnections to the whole hemisphere (hemispherotomy).

Oxcarbazepine in treatment of childhood epilepsy: A survey of 46 children and adolescents

BackgroundEpilepsy is one of the most common neurological diseases, affecting people of any age. Although the treatments of epilepsy are more and more diverse, the uncertainty regarding efficacy and adverse events still exists, especially in the control of childhood epilepsy.MethodsWe performed a systematic review and meta- analysis following the Cochrane Handbook and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Four databases including PubMed, Embase, Web of Science and Cochrane library were searched. Studies reporting the use of brivaracetam monotherapy or adjuvant therapy in children (aged ≤18 years) were eligible for inclusion. Each stage of the review was conducted by two authors independently. Random-effects models were used to combine effect sizes for the estimation of efficacy and safety.ResultsA total of 1884 articles were retrieved, and finally 9 articles were included, enrolling 503 children with epilepsy. The retention rate of BRV treatment was 78% (95% CI: 0.64–0.91), the responder rate (reduction of seizure frequency ≥ 50%) was 35% (95% CI: 0.24–0.47), the freedom seizure rate (no seizure) was 18% (95% CI: 0.10–0.25), and the incidence rate of any treatment-emergent adverse events (TEAE) was 39% (95% CI: 0.09–0.68). The most common TEAE was somnolence, which had an incidence rate of 9% (95% CI: 0.07–0.12). And the incidence rate of mental or behavioral disorders was 12% (95% CI: 0.06–0.17).ConclusionOur systematic review and meta-analysis showed that BRV seemed to be safe and effective in the treatment of childhood epilepsy.

Article1 June 1929The Ketogenic Diet in the Treatment of EpilepsyWILLIAM A. SMITH, M.D.WILLIAM A. SMITH, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-2-12-1300 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptEpilepsy is a symptom-complex consisting of sudden periodic loss of consciousness, convulsive movements or both. Of the same nature are certain other phenomena referred to as epileptic equivelants, such as migraine, certain cases of periodic vertigo, periodic voracity, dipsomania and other periodic mental disorders. Epilepsy is thus a periodic reaction of the nervous system, in which various motor, sensory, visceral and psychic syndromes may occur. Levy and Patrick (1) have recently described a number of so-called pre-epileptic phenomena, which may antedate the major seizure for many years; these consist of minor, but sudden and periodic symptoms, such as pallor of...References(1) LEVYPATRICK DMH: Recurrent 'attacks' Other Than Migraine and Infantile Convulsions Preceding 'True' Epilepsy. Arch. Neurol. and Psychiat. 20: 443. Sept. 1928. CrossrefGoogle Scholar(2) BLOCK EB: Epilepsy and Organic Brain Disease." Ann. Int. Med. 2: 531. Dec. 1928. LinkGoogle Scholar(3) LENNOXCOBB WGS: Epilepsy. Medicine 7: 105. May 1928. CrossrefGoogle Scholar(4) MUSKENS LJ: Epilepsy.—Comparative Pathogenesis, Symptoms, Treatment. Wm. Wood and Co. New York. 1928. Google Scholar(5) COLLIER J: Epilepsy. Lumleian Lectures. Lancet 1: 687. April 7, 1928. CrossrefGoogle Scholar(6) ULRICH A: The Bromide-Chloride Treatment of Epilepsy. Med. J. and Rec. 126: 1, 41. July 4, 1927. Google Scholar(7) WUTH O: Rational Bromide Treatment: New Methods of its Control. J. A. M. A. 88: 2013. June 25, 1927. CrossrefGoogle Scholar(8) LENNOXWRIGHT WGLH: Comparative Effects of Borotartrate and of Luminal in Seizures of Epilepsy. Dec. 23, 1926. Bost. Med. and Surg. Journ. 195: 1195. CrossrefGoogle Scholar(9) CUNEO G: Studi sulla patogenes dell epilessia. La genesi dell' albumosoluria epilettica a la digestione intestinale dell proteine, degli idrati di Carbonio e dei grassi. Note e riv. di. psichiat. 14: 381, Sept.-Dec. 1926. Google Scholar(10) CONKLIN HW: The Cause and Treatment of Epilepsy. J. Am. Osteo. Ass'n. 22: 11. Sept. 1922. Google Scholar(11) GEYELIN HR: Fasting as a Method of Treating Epilepsy. Med. Rec. 99: 1037. June 11, 1921. Google Scholar(12) LENNOXCOBB WGS: Studies in Epilepsy, viii- The Clinical Effect of Fasting. Arch. Neurol. and Psychiat. 20: 771. Oct. 1928. CrossrefGoogle Scholar(13) WILDER RM: The Effect of Ketonuria on the Course of Epilepsy. Bull. Mayo Clinic 2: 307. 1921. Google Scholar(14) TALBOTMETCALFMORIARTY JFKMM: Epilepsy—Chemical Investigations of Rational Treatment by Production of Ketosis. Am. J. Dis. Child. 33: 218. Feb. 1927. KOHN, J. L., FRIES, M. E. AND FELSHIN, G.: Spontaneous and Induced Ketosis in Children. Effect on the Glucose Tolerance Test. Arch. Dis. Child. 34: 857. Nov. 1927. SHAW, E. B. AND MORIARTY, M.: Hypoglycemia and Acidosis in Fasting Children with Idiopathic Epilepsy. Arch. Dis. Child. 28: 553. Nov. 1924. HOEFFE, G. AND MORIARTY, M.: The Effect of Fasting on the Metabolism of Epileptic Children. Arch. Dis. Child. 28: 16. July, 1924. LENNOX, W. G.: Increase of Uric Acid in the Blood During Prolonged Starvation. J. A. M. A. 82: 602. Feb. 23, 1924. CrossrefGoogle Scholar(15) PETERMAN MG: The Ketogenic Diet. J. A. M. A. 90: 1427. May 5, 1928. CrossrefGoogle Scholar(16) BARBORKA CJ: The Ketogenic Diet Treatment of Epilepsy in Adults. J. A. M. A. 91: 73. July 14, 1928. CrossrefGoogle Scholar(17) See footnote 14. Google Scholar(18) HELMHOLTZ HF: The Treatment of Epilepsy in Childhood. J. A. M. A. 88: 2028. June 25, 1927. CrossrefGoogle Scholar(19) MCQUARRIEKEITH JHM: Epilepsy in Children. Relationship of Variations in the Degree of Ketonuria to Occurrence of Convulsions in Children on Ketogenic Diets. Arch. Dis. Child. 34: 1013. Dec. 1927. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: WILLIAM A. SMITH, M.D.Affiliations: Atlanta, Georgia*Read at the Fulton County Medical Society, Atlanta, Ga. February 21, 1929. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHistory and Origin of the Ketogenic Diet 1 June 1929Volume 2, Issue 12Page: 1300-1308KeywordsDietEpilepsyEpileptic seizuresLoss of consciousnessMigraineNervous systemVertigo ePublished: 1 December 2008 Issue Published: 1 June 1929 PDF downloadLoading ...

The management of epilepsy in children requires careful evaluation, classification, and pharmacologic treatment. With classic antiepileptic drugs (AEDs), at least 25% of children remain refractory to appropriate therapy. The past decade has allowed the introduction of a number of newer AEDs for treatment of both adults and children with epilepsy. These include felbamate, gabapentin, lamotrigine, topiramate, tiagabine, and vigabatrin. Emerging information regarding the efficacy of these AEDs in treating childhood epilepsy syndromes suggests advantages for many patients. Limited data are available that define the optimal use of new AEDs in pediatric patients. Further research must be completed to validate the positive effects described in existing clinical trials of the new AEDs in the treatment of childhood epilepsy.

To conduct the first randomized trial on classical and medium-chain triglyceride (MCT) versions of the ketogenic diet, examining efficacy and tolerability after 3, 6, and 12 months. One hundred forty-five children with intractable epilepsy were randomized to receive a classical or an MCT diet. Seizure frequency was assessed after 3, 6, and 12 months. Treatment withdrawals were documented. Tolerability was assessed by questionnaire, and blood ketone levels were measured. Of the 61 children who started a classical diet and the 64 who started an MCT diet, data from 94 were available for analysis: 45 classical and 49 MCT. After 3, 6, and 12 months there were no statistically significant differences in mean percentage of baseline seizures between the two groups (3 months: classical 66.5%, MCT 68.9%; 6 months: classical 48.5%, MCT 67.6%; 12 months: classical 40.8%, MCT 53.2%; all p > 0.05). There were no significant differences between groups in numbers achieving greater than 50% or 90% seizure reduction. Serum acetoacetate and beta-hydroxybutyrate levels at 3 and 6 months were significantly higher in children on the classical diet (p < 0.01); this was the case at 12 months for acetoacetate. There were no significant differences in tolerability except increased reports in the classical group of lack of energy after 3 months and vomiting after 12 months. This study has shown classical and MCT ketogenic diet protocols to be comparable in efficacy and tolerability; both ways of implementing the diet have their place in the treatment of childhood epilepsy.

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