AED Therapy Research Articles

Constant rate infusion of diazepam or propofol for the management of canine cluster seizures or status epilepticus.

Cluster seizures (CS) and status epilepticus (SE) in dogs are severe neurological emergencies that require immediate treatment. Practical guidelines call for constant rate infusion (CRI) of benzodiazepines or propofol (PPF) in patients with seizures not responding to first-line treatment, but to date only few studies have investigated the use of CRI in dogs with epilepsy. Retrospective clinical study. Dogs that received CRI of diazepam (DZP) or PPF for antiepileptic treatment during hospitalization at the Veterinary Teaching Hospital of the University of Turin for CS or SE between September 2016 and December 2019 were eligible for inclusion. Favorable outcome was defined as cessation of clinically visible seizure activity within few minutes from the initiation of the CRI, no seizure recurrence within 24 h after discontinuation of CRI through to hospital discharge, and clinical recovery. Poor outcome was defined as recurrence of seizure activity despite treatment or death in hospital because of recurrent seizures, catastrophic consequences of prolonged seizures or no return to an acceptable neurological and clinical baseline, despite apparent control of seizure activity. Comparisons between the number of patients with favorable outcome and those with poor outcome in relation to type of CRI, seizure etiology, reason for presentation (CS or SE), sex, previous AED therapy and dose of PPF CRI were carried out. A total of 37 dogs, with 50 instances of hospitalization and CRI administered for CS or SE were included in the study. CRI of diazepam (DZP) or PPF was administered in 29/50 (58%) and in 21/50 (42%) instances of hospitalization, respectively. Idiopathic epilepsy was diagnosed in 21/37 (57%), (13/21 tier I and 8/21 tier II); structural epilepsy was diagnosed in 6/37 (16%) of which 4/6 confirmed and 2/6 suspected. A metabolic or toxic cause of seizure activity was recorded in 7/37 (19%). A total of 38/50 (76%) hospitalizations were noted for CS and 12/50 (24%) for SE. In 30/50 (60%) instances of hospitalization, the patient responded well to CRI with cessation of seizure activity, no recurrence in the 24 h after discontinuation of CRI through to hospital discharge, whereas a poor outcome was recorded for 20/50 (40%) cases (DZP CRI in 12/50 and PPF CRI in 8/50). Comparison between the number of patients with favorable outcome and those with poor outcome in relation to type of CRI, seizure etiology, reason for presentation (CS or SE), sex and previous AED therapy was carried out but no statistically significant differences were found. The present study is the first to document administration of CRI of DZP or PPF in a large sample of dogs with epilepsy. The medications appeared to be tolerated without major side effects and helped control seizure activity in most patients regardless of seizure etiology. Further studies are needed to evaluate the effects of CRI duration on outcome and complications.

Frequency of Non-Adherence to Antiepileptic Drugs in Patients with Epilepsy

Background: Epilepsy is a chronic medical ailment or condition that typically causes unexpected, unprovoked repeated seizures that impair a number of mental and physical abilities. Non adherence to antiepileptic drugs is an emerging issue. Objective: To measure the frequency of non-adherence of AEDs among epilepsy patients presenting to a tertiary care hospital Material and Methods: This study was conducted at Chandka Medical College Hospital Larkana and the duration of this study in which this study was completed was 6 months from 29-9-2020 to 29-3-2021. A total of 183 patients were the participants of this study and all the patients were calculated through the calculator of WHO. The method of non-probability sequential sampling was utilized. Forms for ethical approval and permission were completed. The Morisky 8-Item Medication Adherence Questionnaire was used to assess non-adherence. SPSS was used to analyze the data. The P value of 0.05 was deemed important. Results: 183 patients were the participants of this study. There were 103(56.3%) male and 80(43.7%) female. Mean age of patients was 32.1 years ±5.6SD. Among all the patients 183(100%), 68(37%) had non adherence while 115(63%) did not had non adherence to antiepileptic drugs. A substantial association between non adherence and residential status (p=0.02), duration of diseases (p=0.00), educational status (p=0.00), employment status (p=0.00), marital status (p=0.00) and type of medication dose(p=0.00) was found. Conclusion: Non adherence in epileptic patients, resistance to AED therapy has been identified as a key impediment to obtaining the therapeutic aim of seizure independence. Frequency of non-adherence in epileptic patients was moderately high. Keywords: Non adherence, antiepileptic drugs, epilepsy

Effects of levetiracetam on sleep architecture and daytime sleepiness.

Sleep is a reversible behavioural state of perceptual disengagement from and unresponsiveness to the environment, which is required for neural plasticity and memory consolidation. Sleep disorders are common in patients with epilepsy. The main causes of sleep disturbances are coexisting sleep disorders, impact of seizures and epileptic activity, and the effects of antiepileptic drugs. Sleep and epilepsy have reciprocal effects - on one hand electrical brain activity during sleep is a strong modulator of epileptic activity and on the other epileptic activity during sleep may disrupt sleep architecture. The most common side effects of anticonvulsants include alterations in sleep architecture and variation in the degree of daytime sleepiness. Their effects on sleep and daytime sleepiness are variable and it is often difficult to distinguish whether the improved seizure control and epileptic activity is a direct result of anticonvulsants or associated with improved sleep quality. Levetiracetam is a new generation anticonvulsant used to treat both focal and generalized epilepsy. Its satisfactory safety and tolerability explain its wide usage in the clinical practice and necessitates more profound knowledge on its effects on sleep quality. There have been few reports about its effects on sleep architecture and daytime sleepiness. A short summary of the studies concerning this topic is presented. Main disadvantages of the studies are: the small sample size, comparison of the results obtained in healthy volunteers with patients with epilepsy, short observation duration, variations of dosage, different evaluation modalities and concomitant AED therapy. Future prospective studies on subjective and objective effects of Levetiracetam on sleep architecture and daytime sleepiness are needed to better understand its impact on sleep in order to improve epilepsy patients' quality of life, seizure control and sleep disturbances.

The Antiepileptic Drugs Therapy Practice in Epileptic Patients: What Does Evidence Show?

Introduction: Though studies regarding epilepsy have been conducted in different parts of the world, there is a scarcity of established studies regarding treatment outcomes among patients with epilepsy. Therefore, the aim of this review is to assess antiepileptic drug therapy among patients with epilepsy. This will help in exploring the existing AEDs therapy practice including the outcomes.
 Methods: Using different search engines like EndNote (Pubmed), Google, Google Scholar and Hinari, literatures were searched for review. Different literatures like, research reports, articles, documents, books and internet findings relevant to this study were reviewed.
 Findings and discussion: Outcome of AEDs therapy is affected by several factors including patient-related factors, disease related factors and drug related factors. The selection of the most appropriate AEDs for a patient with seizures depends upon the accurate classification of the seizures, the type of epilepsy or epileptic syndromes, and drug such as availability and accessibility of drugs, their efficacy, side effect and comfort use as well as patient factors. So, the selection of AED therapy at present is an empirical process, based on seizure and patient-specific variables and a working knowledge of available AEDs, including AED mechanism of action, pharmacokinetics, drug-drug interactions, and medication side effects and ultimately the treatment outcomes.
 Conclusion: It is recommended that researchers need to focus on further longitudinal and interventional studies in providing adequate evidence about the cause-effect relationship between the AEDs therapy practice and seizure control.

COVID-19 outbreak: The impact of stress on seizures in patients with epilepsy.

ObjectiveStress is a known trigger for seizures in patients with epilepsy (PWE). However, the association between stress and seizures has not been thoroughly investigated. In December 2019, an outbreak of coronavirus disease (COVID‐19) occurred in Wuhan, Hubei province, China, causing tremendous collateral stress. This study was designed to evaluate the influence of the COVID‐19 outbreak on seizures in PWE in the most severely affected area, Wuhan, and its surrounding cities.MethodsIn this single‐center, cross‐sectional study, PWE were surveyed via online questionnaires between February 23 and March 5, 2020. Collected data included demographic information, epilepsy‐related characteristics (seizure type, frequency, antiepileptic drugs [AEDs], and medication management), direct and perceived threat of COVID‐19, and changes in seizures during the outbreak. Psychological comorbidities were evaluated by the Patient Health Questionnaire–9, Generalized Anxiety Disorder–7 items, and Insomnia Severity Index (ISI). Multivariate logistic regression was used to identify precipitants for seizure exacerbation.ResultsWe received 362 completed questionnaires after excluding 12 duplicates (response rate = 63.51%). A total of 31 (8.56%) patients had increased seizures during the outbreak. Exposure history to COVID‐19 (P = .001), uncontrolled seizure after AED therapy (P = .020), seizure frequency of two or more times per month before the outbreak (P = .005), change of AED regimen during the outbreak (AED reduction, withdrawal, replacement, skipping altogether; P = .002), and worry about the adverse effect of the outbreak on overall seizure‐related issues (severity = moderate to critical; P = .038) were risk factors for increased seizures.SignificanceA minority of PWE experienced seizure exacerbation during the outbreak of COVID‐19. Stress, uncontrolled seizures, and inappropriate change in AED regimen were associated with increased seizures. Based on these findings, stress might be an independent precipitant for triggering seizures in some PWE.

Diagnostic and therapeutic experience of child with neonatal epilepsy: from ICU to home (сlinical case)

Ohtahara syndrome is the earliest of age-dependent epileptic encephalopathies, characterized by an early onset at the age of 3 months (most often the first 10 days of life), ‘suppression-burst’ pattern on EEG both in wakefulness and in sleep, resistance to standard AED therapy, a high probability of poor prognosis in the form of severe psychomotor retardation and death in infancy.

Patients with resistant focal epilepsy: what affects the quality of life?

The aim is to assess the impact of resistant focal epilepsy on the quality of patients' life.Materials and methods. Prospective, comparative, observational study conducted under conditions of real clinical practice. Inclusion criteria: age over 18 years; the presence of two or more epileptic seizures in history; a long history of treatment-resistant focal epileptic seizures; current AED therapy. Exclusion criteria: history of non-epileptic seizures of any etiology; inability to perform an MRI and/or EEG. The design included two patient visits, the second 3-12 months after the first ("primary" and "repeated" examinations). The examination included the medical history, analysis of seizure diary, clinical and neurological examination, routine EEG and/or EEG video monitoring, brain MRI, and laboratory tests. During the initial and repeated visits, the patients were asked to answer the QOLIE-31, NHS3, HADS questionnaires. The patients were also asked to give their own subjective assessment of their physical and psychological state, treatment results, side effects, social situation, and the quality of life. All patients had a follow-up history of at least one year.Results. In total, 120 patients with current or past treatment-resistant epileptic seizures were examined (53 men and 67 women aged 18 to 77 years). At the time of the re-examination (under continuing AED therapy), seizures stopped in 50.8% of them. The number of seizure types decreased in 65.9% of people. The effect of resistant focal epilepsy on the patient's quality of life was determined.Conclusion. The use of commonly accepted tests (QOLIE-31, HADS, etc.) in the "expertise" mode is incorrect, probably because these tests had been originally created for the "client" situation. A discrepancy was found between an objective improvement in the clinical picture as a result of successful treatment and a subjective "insignificant" improvement in the quality of life as per patients' assessments.

The investigation of EEG specificity in epileptic children during AED therapy

The investigation of EEG specificity in epileptic children during AED therapy

Clinical relevance of genetic polymorphism in CYP2C9 gene to pharmacodynamics and pharmacokinetics of phenytoin in epileptic patients: validatory pharmacogenomic approach to pharmacovigilance.

Variations in drug metabolizing genes are known to have a clinical impact on AED therapy. We genotyped normal and epileptic patient cohorts of monoethnic population of Kashmir valley for CYP2C9 gene and allelic polymorphism and investigated the effect of CYP2C9*2 and *3 polymorphism on the Pharmacokinetic and therapeutic and/or adverse pharmacodynamic responses to Phenytoin in the idiopathic epilepsy patients. PCR-RFLP methods were used for genotyping of 121 normal controls and 92 idiopathic epilepsy patients for CYP2C9*2 and *3 polymorphism, the results were validated by direct sequencing. Phenytoin pharmacokinetic (PK) analysis in idiopathic epilepsy patients was done using a validated EMIT assay technique. Pharmacodynamic analysis was done by evaluating clinical response to phenytoin therapy and ADR monitoring. The respective frequencies of CYP2C9 *1, *2, and *3 alleles were 64%, 6.6%, 29.3%, and 58%, 9.8%, 32.6% in controls and idiopathic epilepsy patients from Kashmir valley. PK analysis revealed that AUC0–4 was a better surrogate biomarker of CYP2C9 metabolizer status compared to C4 and C0 concentrations alone. A comparison of “phenytoin response categories” among CYP2C9 Wild and Heterozygous groups did not reveal any significant difference between the groups (p=0.3800). CYP2C9* 3 was the most frequent mutant allele found in healthy controls and idiopathic epilepsy patients of ethnic Kashmiri population. CYP2C9 genotype based phenytoin therapy is highly relevant in Kashmiri population due to a high incidence of genetic variations associated with therapeutic and adverse responses to phenytoin. Phenytoin AUC0–4 tends to correlate better with genetic polymorphism of CYP2C9.

Single small enhancing CT Lesions, with special reference to neurocysticercosis: How I treat.

Single small enhancing CT lesions (SSECTL) have been very commonly encountered in clinical practice. These lesions typically are small (often < 20 mm), enhancing as a ring lesion or a disc and with varying amounts of surrounding edema. Most SSECTL present as focal seizures. Once the diagnosis of SSECTL and likely to be a solitary cysticercus lesion is made, the patient is given appropriate AED therapy. Depending on the resolution pattern on repeat imaging performed at intervals not less than six months if patient remains asymptomatic, cysticidal therapy is instituted along with AEDs. Any deviation from the classical clinical or radiological patterns needs further evaluation and other etiologies described for the SSECTL will need to be ruled out, including that of tuberculosis. Largely these lesions resolve and the clinical condition remains benign and in most patients AEDs can be withdrawn in two to three years period.

Considerations in prophylaxis for tumor-associated epilepsy: Prevention of status epilepticus and tolerability of newer generation AEDs

ObjectiveTo identify risk factors for the development of tumor-associated epilepsy (TAE) and potential benefit of newer generation AEDs in seizure prevention. MethodsWe performed an IRB approved retrospective study of newly diagnosed GBM patients at the University of Rochester between 1/1/05 and 5/13/11. Records were reviewed to describe demographics, seizure incidence, occurrence of status epilepticus, and AED use and toxicity. Results172 patients with newly diagnosed GBM were included in the study. 53.4% developed TAE. 31.4% had seizure prior to diagnosis. 118 patients were seizure-free at diagnosis: 32.2% developed post-diagnosis TIE (PostTAE) and 60.2% remained seizure-free. 70 seizure-free patients received an AED peri-operatively. 36 were weaned off AEDs and 31 were continued. Incidence of PostTAE and time to first seizure were comparable in AED-treated and untreated patients. 4 PostTAE patients presented with status epilepticus (SE), all were not AED treated. AEDs were withdrawn in 10 patients due to toxicity: 9 from phenytoin and 1 from levetiracetam. ConclusionThere is a high incidence of PostTAE in GBM. Prophylactic AED therapy did not reduce PostTAE but may have prevented SE. Minimal toxicity was observed on 2nd generation AEDs. The high burden of epilepsy in this population and tolerability of newer AEDS suggest that AAN guidelines should be revisited.

Fracture risk with use of liver enzyme inducing antiepileptic drugs in people with active epilepsy: Cohort study using the General Practice Research Database

PurposeLiver enzyme inducing antiepileptic drugs (LEI AEDs) have adverse effects on bone metabolism but it is unclear whether this translates into increased fracture risk. This population based cohort study aimed to evaluate whether treatment with LEI AEDs is associated with increased risk of fracture in people with active epilepsy. MethodsThe cohort included patients diagnosed with epilepsy and prescribed AEDs while registered at a GPRD general practice during 1993–2008. The hazard ratio with current use of LEI AEDs for fracture at any site and hip fracture was estimated using Cox proportional hazards models. ResultsThere were 7356 fractures (788 hip fractures) in 63259 participants. In women, the adjusted hazard ratio with use of LEI AEDs was 1.22 for fracture (95% CI 1.12–1.34; p<0.001) and 1.49 for hip fracture (1.15–1.94; p=0.002). In men, the hazard ratio for fracture was 1.09 (0.98–1.20; p=0.123) and for hip fracture 1.53 (1.10–2.12; p=0.011). For every 10000 women treated with LEI AEDs for one year, there could be 48 additional fractures, including 10 additional hip fractures. For every 10000 men treated with LEI AEDs for one year, there could be 4 additional hip fractures. ConclusionsLEI AEDs may increase the risk of fracture in people with epilepsy. In patients at high risk of osteoporotic fracture alternative AED therapy may be appropriate. Further information is urgently needed on the safety of valproate and newer AEDs and on strategies to maintain bone health in people who need to be treated with LEI.

1500 Oxidative Stress in Iranian Epileptic Children

BackgroundLipid peroxidation is an indicator of free radical metabolism and oxidative stress in human beings and other organisms. Malondialdehyde (MDA), an end product of lipid peroxidation, is a metabolite that...

Seizure Prophylaxis in Patients with De Novo Glioblastoma: Should AAN Guidelines Be Revisited? (P04.185)

Objective: To characterize current incidence and treatment patterns of tumor associated epilepsy (TAE) in glioblastoma. Background AAN guidelines from 2000 recommended against seizure prophylaxis in patients with brain tumors due to AED toxicity but did not include patients receiving 2nd generation AEDs. No studies have sufficiently evaluated the benefit of 2 nd generation AEDs for prophylaxis of TAE. Design/Methods: We performed an IRB approved retrospective study of newly diagnosed GBM patients at the University of Rochester between 7/1/07 and 4/15/11. Records were reviewed to describe demographics, seizure incidence, time-to-first seizure, occurrence of status epilepticus, AED use and toxicity. Results: 175 patients with newly diagnosed GBM were identified. 94 (54%) developed TAE. 55 (31.4%) had early onset TAE (EOTAE), defined as having a seizure prior to diagnosis. 119 patients were seizure-naive at diagnosis: 39 (32.5%) developed late onset TAE (LOTAE), 71 (59.6%) remained seizure free and 9 patients were lost to follow up. 72 seizure-naive patients received an AED peri-operatively. 37 (51.4%) were weaned off AEDs and 32 (44.4%) were continued. Incidence of LOTAE and time to first seizure were comparable in AED-treated and untreated patients. 4 LOTAE patients presented with status epilepticus (SE), all in non AED-treated cases. In 10 patients, AEDs were withdrawn due to toxicity: 9 on phenytoin, with 1 case of toxic epidermal necrolysis and 1 on levetiracetam from depression. Conclusions: There is a high incidence of LOTAE in GBM. Prophylactic AED therapy did not reduce LOTAE but may have prevented SE. Minimal toxicity was observed with 2nd generation AEDs. The high burden of epilepsy in this population and tolerability of newer AEDS suggest that AAN guidelines should be revisited. A prospective study evaluating seizure prophylaxis with newer generation AEDs in glioblastoma is warranted. Disclosure: Dr. Wychowski has nothing to disclose. Dr. Buniak has nothing to disclose. Dr. Serventi has nothing to disclose. Dr. Henry has nothing to disclose. Dr. Mohile has nothing to disclose.

Fundal Changes in Children Receiving Vigabatrin

Visual field defects and other abnormalities are reported in patients receiving the newer antiepileptic Vigabatrin (VGB). Field testing in children younger than 6 years and those with mental retardation is difficult. The authors, therefore, studied ophthalmoscopic abnormalities in seven pediatric patients receiving VGB for median duration of 9 month (range, 3-32 months). Abnormal findings were seen in two (33.3%) in the form of surface wrinkling retinopathy and abnormal macular reflexes. The proportion of abnormal findings was in agreement with previous reports. Thus it is concluded that simple ophthalmoscopy by an ophthalmologist picks up the abnormalities due to ocular toxicity of VGB, and helps in rationalizing further AED therapy in the clinic.

The effect of anti epileptic drug therapy on serum 25-hydroxyvitamin D and parameters of calcium and bone metabolism—A longitudinal study

Background Chronic antiepileptic drug use is associated with bone loss. We sought to assess the longitudinal effect of antiepileptic drug on serum 25-hydroxyvitamin D [25(OH)D] levels and bone mineral metabolism markers. Methods Patients in the emergency services or those in neurology outpatient department with history of seizure were characterized and included in the study prospectively. Daily dietary intake of calories, calcium, phosphorus and phytates were characterized by dietary recall method. Base line bone mineral parameters – serum calcium, phosphorus, alkaline phosphatase (SAP), tartrate resistant acid phosphatase (TRACP), 25(OH)D levels, parathyroid hormone (PTH) and urinary calcium creatinine ratio (Ca.Cr), urinary calcium/kg/bodyweight (BW) and phosphate excretion index (PEI) were determined. Patients on AED therapy with normal 25(OH)D levels were followed up and were re-evaluated at the end of 6 months. Results The daily dietary calcium intake of the subjects was lower than the RDA (Recommended Dietary Allowance) by ICMR (Indian Council of Medical Research). The diet was high in phytates. Two-thirds of the recruited subjects were vitamin D deficient. Subjects with normal 25(OH)D levels at base line showed a significant fall of 25(OH)D levels, urinary calcium, urinary calcium/kg/BW and TRACP levels at the end of 6 months irrespective of the AED used or the plasma level of AED. Conclusions Hypovitaminosis D is common in our population. Subjects with normal 25(OH)D levels, irrespective of the type of antiepileptic medications even at sub-therapeutic serum levels of the drug, went into 25(OH)D deficiency and insufficiency states. Theoretically it can be worthwhile to supplement calcium and vitamin D even before initiation of antiepileptic therapy.

Association between SCN1A polymorphism and carbamazepine‐resistant epilepsy

To establish whether the SCN1A IVS5-91 G > A polymorphism of the SCN1A gene, which encodes the neuronal sodium channel alpha subunit, affects responsiveness to the antiepileptic drugs (AEDS) carbamazepine and/or phenytoin. SCN1A IVS5-91 G > A polymorphism was genotyped in 228 Japanese epileptic patients treated with AEDs. The association between AED responsiveness and the polymorphism was estimated by logistic regression analysis, adjusting for clinical factors affecting the outcome of AED therapy. The frequency of the AA genotype was significantly higher in carbamazepine-resistant patients (odds ratio, 2.7; 95% confidence interval (CI), 1.1, 7.1) and was insignificantly higher in AED-resistant patients. This is the first report demonstrating an association between the SCN1A polymorphism and carbamazepine-resistant epilepsy.

Intellectual impairment in patients with epilepsy in Ile-Ife, Nigeria

Epilepsy is the most common non-infectious neurologic disease in developing countries such as Africa, including Nigeria. This study was designed to assess the intellectual performance of patients with epilepsy (PWE) in Nigeria hoping that the result will serve as the basis for educational, vocational, and social counseling. Forty-one PWE were studied along with 41 age-, sex- and education-matched healthy controls. A questionnaire was developed and applied to all subjects and history was taken from patients and eyewitness. The intellectual function of each subject was assessed with the aid of Wechsler Adult Intelligence Scale adapted for Nigerians. All patients subsequently had electroencephalography (EEG) performed and the EEG findings were noted. SPSS statistical package was used to analyze the data. The PWE performed poorly on the verbal IQ, performance IQ, and full scale IQ scores when compared with controls (P < 0.05) and 20% of PWE had mental retardation. Long duration of epilepsy, long duration of antiepileptic drug therapy, younger age at onset of epilepsy, increased frequency of seizures, and low educational status were found to have negative impacts on intellectual performance in PWE (P < 0.05) while seizure types and type of antiepileptic drugs (carbamazepine or phenytoin) did not influence intellectual performance. This study shows that PWE had significant intellectual impairment when compared with controls. In addition, long duration of epilepsy, long duration of AED therapy, earlier age of onset, increased seizure frequency, and low educational status had a negative impact on intellectual functioning in PWE.

Lipid peroxidation in women with epilepsy

Background:Lipid peroxidation is an indicator of free radical metabolism and oxidative stress in human beings and other organisms. Malondialdehyde (MDA), an end product of lipid peroxidation, is a metabolite that can be readily estimated in serum samples. Excess oxidative stress may be a final common pathway through which anti epileptic drugs may exert their teratogenic potential in pregnant women with epilepsy. Our objective in this study was to ascertain the variations in malondialdehyde (MDA) in women with epilepsy.Material and Methods:This study was carried out in the Kerala Registry of Epilepsy and pregnancy after obtaining clearance from the Institutional Ethics Committee. Informed consent was obtained from all the subjects. The quantitative examination of MDA was performed according to standard procedures. The ideal plasma level of MDA is below 2 nmol/ml.Results:Fifteen women with confirmed epilepsy (mean age 26.9 ± 3.5) were included in the study. Two women were pregnant. MDA levels ranged from 1.7 to 2.8 nmol/ml (mean level = 2.13 ± 0.37 nmol/ml). Eight women (53 %) had MDA levels above the upper limit of normal. Three patients had levels above 2.5 nmol/ml, which corresponded to the 75 centile.Conclusions:This study had shown that the estimation of MDA levels in plasma is a convenient method to study lipid peroxidation and thereby oxidative stress in women with epilepsy. Over half of Women With Epilepsy (WWE) have excess oxidative stress as indicated by high levels of MDA in the plasma. Correlations between MDA level and characteristics of epilepsy, AED therapy, nutritional status and other medical conditions need to be observed in a larger cohort.

An evidence‐based approach to the first seizure

Evidence-based care (EBC) is an explicit approach to applying the best evidence to the care of individual patients. We outline the basic principles of EBC and apply them to various clinical questions pertaining to a patient presenting with a first seizure, providing a summary of the best available evidence for each question. Depending on the question at hand, the evidence derives from retrospective, prospective, and randomized controlled studies in children and adults. There is solid evidence that early seizure recurrence is reduced by early initiation of AEDs. A meta-analysis of six randomized trials revealed an average absolute risk reduction of 34% (95% CI 15-52) with AED therapy. However, the prognosis for the development of epilepsy is not altered by early intervention. EEG epileptiform abnormalities, family history of epilepsy, imaging lesions, and remote symptomatic seizures increase the risk of recurrence, and impact the risk-benefit ratio of treatment after a single event. In the end, clinicians must evaluate patients with a first unprovoked seizure on a case-by-case basis to determine the appropriateness of treatment with a given AED.