Antiepileptic Medication Research Articles

Neuroimaging Abnormalities in Patients with Subacute Sclerosing Panencephalitis : Prospective Follow-up Study.

This study aimed to assess the neuroimaging abnormalities and their progression in patients with Subacute sclerosing panencephalitis (SSPE) and identify clinical predictors of these imaging findings. This prospective observational study evaluated clinical and neuroimaging features in patients with SSPE. Patients were categorized using Dyken's criteria, Jabbour's staging system, and the definition of fulminant SSPE. They underwent comprehensive clinical assessments, cerebrospinal fluid examination, Electroencephalogram (EEG), and Magnetic Resonance Imaging (MRI) scans. Treatment involved intrathecal interferon‑α and antiepileptic medications. Functional disability was assessed using the modified Barthel index. Follow-ups were performed at 6 months, including reassessment of Modified Barthel Index (MBI) and Jabbour's staging and EEG and MRI scans. The mean age was 13.9 ± 6.7years, with males comprising 81.5% (44/54) of the cohort. Fulminant SSPE was noted in 33% (18/54) of cases. Disease duration before presentation varied significantly between fulminant and non-fulminant forms (p = 0.001). Neuroimaging abnormalities were more prevalent in JSIII stage patients, with diffuse cerebral atrophy being asignificant finding (p = 0.011). Basal ganglia involvement correlated with movement disorders. The 6‑month follow-up showed increased cerebral atrophy (p = 0.004). Increasing disease duration was an independent predictor of cerebral atrophy. An Intercomplex interval (ICI) of more than 10minutes correlated with normal neuroimaging, 10 patients died within the study period, 8 of whom had fulminant SSPE. Parieto-occipital White matter hyperintensity (WMH) is the most prevalent and sensitive neuroimaging finding for the diagnosis of SSPE. Despite interferon treatment, cerebral atrophy progressed in both aggressive and fulminant SSPE. Increasing disease duration is an independent predictor of cerebral atrophy.

Challenges to epilepsy management in Rwandan women living with epilepsy.

In Rwanda, epilepsy prevalence ranges between 29‰ and 49‰. Many women living with epilepsy (WwE) are of childbearing age. Epilepsy characteristics and management, contraception, pregnancy, puerperium and stigma in WwE presenting at the neurology clinic of Ndera, Rwanda, were investigated. This prospective cross-sectional study investigated demographics, epilepsy characteristics, treatment, contraception, folic acid use, pregnancy, puerperium and stigma in WwE aged ≥18 years. Subgroups were analysed by status of any pregnancy and time of epilepsy diagnosis relative to pregnancy, with significant differences expected. During December 2020 and January 2021, a hundred WwE were enrolled (range 18-67 years). Fifty-two women had never been pregnant, 39 women had epilepsy onset before pregnancy and nine were diagnosed after pregnancy. No significant differences in age, marital status or occupation were observed. Contraception was used by 27%, of whom 50% were taking enzyme-inducing anti-epileptic medication. Valproate was used by 46% of WwE of reproductive age. Thirty-nine women with epilepsy onset before pregnancy reported 91 pregnancies, with 14% spontaneous abortions. None used folic acid before conception, and 59% only during pregnancy. Five of 78 newborns were preterm. No offspring had major congenital malformations. Nearly 25% of WwE were not compliant with their anti-epileptic medication schedule during pregnancy or breastfeeding. Internalized stigma was observed in more than 60%. Up to 25% had been discriminated against at school or work. A comprehensive strategy considering the reproductive health and societal challenges of WwE is needed to drive optimal epilepsy management, reproductive health outcomes and societal inclusion.

In Rat Organotypic Hippocampal Slice Cultures, Conventional Antiepileptic Medications are Unable to Inhibit Epileptiform Activity

Context and Goal: Prior research has shown that organotypic hippocampal slice cultures (OHSCs) can elicit tonic-clinic seizure-like events (SLEs), which resemble the electroencephalographic correlates of limbic seizures in humans and animals. We have investigated whether OHSCs can be used as in vitro models of limbic seizures to research seizures processes and vetting novel antiepileptic substances. Experimental Strategy: The interface method was used to cultivate OHSCs. Under submerged conditions, the levels of extracellular potassium and neuronal activity were observed. Lowering magnesium concentrations or administering the potassium channel blocker 4-aminopyridine both caused SLEs. Analysis was done on the impact of common antiepileptic medications (AEDs) on SLEs, including carbamazepine, phenytoin, valproic acid, clonazepam, diazepam, and phenobarbital sodium. Important Outcomes: AEDs did not stop the over 93% of OHSCs from happening induction of SLEs or cease current seizure activity even in the presence of hazardous dosages. The postnatal age at explanation (P2–P10), the manner of seizure provocation, and the length of in vitro cultivation (2 months) had no bearing on this chemoresistance. GABAA-agonist muscimol or glutamate antagonists were able to reversibly block SLEs. Inferences and Conclusions: Unlike animal models of thermoresistant seizures, where responders and nonresponses may only be distinguished after an experiment, we describe an easy to set up in vitro model of tonic-clinic SLEs that is a priori thermoresistant. OHSCs may be useful for investigating the mechanisms underlying medication-resistant seizures and for the discovery of novel anticonvulsive substances that may one day be used to treat drugresistant epilepsy.

Association between CNS-active drugs and risk of Alzheimer's and age-related neurodegenerative diseases.

As neuropsychiatric conditions can increase the risk of age-related neurodegenerative diseases (NDDs), the impact of CNS-active drugs on the risk of developing Alzheimer's Disease (AD), non-AD dementia, Multiple Sclerosis (MS), Parkinson's Disease (PD) and Amyotrophic Lateral Sclerosis (ALS) was investigated. A retrospective cohort analysis of a medical claims dataset over a 10 year span was conducted in patients aged 60 years or older. Participants were propensity score matched for comorbidity severity and demographic parameters. Relative risk (RR) ratios and 95% confidence intervals (CI) were determined for age-related NDDs. Cumulative hazard ratios and treatment duration were determined to assess the association between CNS-active drugs and NDDs at different ages and treatment duration intervals. In 309,128 patients who met inclusion criteria, exposure to CNS-active drugs was associated with a decreased risk of AD (0.86% vs 1.73%, RR: 0.50; 95% CI: 0.47-0.53; p <.0001) and all NDDs (3.13% vs 5.76%, RR: 0.54; 95% CI: 0.53-0.56; p <.0001). Analysis of impact of drug class on risk of AD indicated that antidepressant, sedative, anticonvulsant, and stimulant medications were associated with significantly reduced risk of AD whereas atypical antipsychotics were associated with increased AD risk. The greatest risk reduction for AD and NDDs occurred in patients aged 70 years or older with a protective effect only in patients with long-term therapy (>3 years). Furthermore, responders to these therapeutics were characterized by diagnosed obesity and higher prescriptions of anti-inflammatory drugs and menopausal hormonal therapy, compared to patients with a diagnosis of AD (non-responders). Addition of a second CNS-active drug was associated with greater reduction in AD risk compared to monotherapy, with the combination of a Z-drug and an SNRI associated with greatest AD risk reduction. Collectively, these findings indicate that CNS-active drugs were associated with reduced risk of developing AD and other age-related NDDs. The exception was atypical antipsychotics, which increased risk. Potential use of combination therapy with atypical antipsychotics could mitigate the risk conferred by these drugs. Evidence from these analyses advance precision prevention strategies to reduce the risk of age-related NDDs in persons with neuropsychiatric disorders.

Neurophysiological Methods for Diagnostics and Treatment Monitoring in Patients of Advanced Age with Epilepsy

Through the last decades the duration of life and the number of elderly people is rapidly growing. In this age group morbidity of epilepsy is increasing very fast. Neurophysiological methods play an important role in diagnostics, classification of the disease and the type of the seizures, and in treatment monitoring in the elderly with epilepsy. The aim of the present study was to establish the significance of neurophysiological methods for diagnostics and treatment monitoring, as well as their relation with particular clinical characteristics of the disease in elderly patients. The study group consisted of 297 consecutive patients with epilepsy (average age 69.25±5.00 years). The methods used were documentary analysis, an interview of clinical factors, EEG (basic and control), video-EEG and statistical methods. Patients with longer duration of the disease were with significant worse neurophysiological results, higher seizure frequency and more in number antiepileptic medications. Epilepsy in the elderly is a major and growing issue. The results of the study will be useful in diagnostics and treatment monitoring in this age group.

Research Status, Synthesis and Clinical Application of Antiepileptic Drugs.

According to the 2017 ILAE's official definition, epilepsy is a slow brain disease state characterized by recurrent episodes. Due to information released by ILAE in 2017, it can be divided into four types, including focal epilepsy, generalized epilepsy, combined generalized, and focal epilepsy, and unknown epilepsy. Since 1989, 24 new antiepileptic drugs have been approved to treat different types of epilepsy. Besides, there are a variety of antiepileptic medications under clinical monitoring. These novel antiepileptic drugs have plenty of advantages. Over the past 33 years, there have been many antiepileptic drugs on the mearket, but no one has been found that can completely cure epilepsy. In this paper, the mentioned drugs were classified according to their targets, and the essential information, and clinical studies of each drug were described. The structure-activity relationship of different chemical structures was summarized. This paper provides help for the follow-up research on epilepsy drugs.

Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital.

Objective: The objective was to determine the incidence of leukocytosis associated with carbamazepine, lamotrigine, and phenobarbital. Data sources: A comprehensive literature review was conducted with the assistance of a medical reference librarian on PubMed, MEDLINE, Embase, and Google Scholar through June 2023 using the following search terminology: "leukocytosis/chemically induced"[MeSH Terms] AND ("Anticonvulsants"[MeSH Terms] OR ("Anticonvulsants"[Pharmacological Action] OR "Anticonvulsants"[MeSH Terms] OR "Anticonvulsants"[All Fields] OR "anticonvulsant"[All Fields] OR "anticonvulsion"[All Fields] OR "anticonvulsive"[All Fields] OR "anticonvulsives"[All Fields]) OR ("Anticonvulsants"[Pharmacological Action] OR "Anticonvulsants"[MeSH Terms] OR "Anticonvulsants"[All Fields] OR "antiepileptic"[All Fields] OR "antiepileptics"[All Fields])). Study selection and data extraction: Thirteen reports were included from 64 potential results of our literature review following the application of inclusion and exclusion criteria: 7 of the reports involved carbamazepine, 4 of the reports involved lamotrigine, and 2 of the reports involved phenobarbital. Data synthesis: Drug-induced leukocytosis is commonly a diagnosis of exclusion and is a phenomenon that has numerous ramifications to patients and clinicians at the bedside, including mandating a full infectious evaluation, the identification of confounding variables, and the eventual discontinuation of the offending agent. Despite several medications and medication classes possessing this adverse drug effect, an evaluation of the specific clinical presentation and management strategies for drug-induced leukocytosis associated with anticonvulsant medications has not been elucidated in the literature. Conclusions: Clinicians should be judicious when evaluating leukocytosis in patients on potentially precipitating medications, including carbamazepine, lamotrigine, and phenobarbital.

Rare neurologic sequelae: A case report of toxic metabolic encephalopathy caused by carbamazepine-induced hypovolemic hyponatremia

Metabolic or secondary encephalopathies originate from non-cerebral organ system failures, often with multifactorial origins. Toxic-metabolic encephalopathy (TME) results from acute cerebral dysfunction due to metabolic disruptions, including drug effects. TME leads to altered consciousness, from delirium to coma, necessitating intensive care and mechanical ventilation. This study delves into TME, a reversible brain pathology triggered by extracerebral factors, notably drug-induced disturbances. Clinical presentation involves nonspecific altered consciousness, sometimes with asterixis or myoclonus. Carbamazepine (CBZ), a common antiepileptic medication, is linked to hyponatremia, defined by serum sodium levels below 135 mmol/l. The complexity of AED-induced hyponatremia is explored through a comprehensive patient analysis, revealing an array of symptoms including altered mentality, seizures, respiratory distress, and even coma or death. The case study dissects a patient's experience with toxic-metabolic encephalopathy secondary to CBZ-induced hypovolemic hyponatremia. This underscores the need for vigilant monitoring and management of adverse drug reactions, spotlighting the intricate interplay of drug-induced metabolic encephalopathies within clinical practice. The study reinforces the importance of awareness and tailored management strategies to enhance treatment outcomes for individuals with epilepsy.

The relationship between stress, anxiety, depression and medication adherence behavior in patients with epilepsy: A cross-sectional study

ObjectiveTo investigate the relationships between stress, anxiety, and depression and medication adherence behavior in patients with epilepsy (PEW). MethodsA cross-sectional study design was conducted on 235 PEW in the Qazvin's Boo Ali Sian Hospital. Data collection tools included socio demographic and clinical data form, morisky medication adherence scale (MMAS-8), depression anxiety stress scales -21(DASS-21). We used adjusted multivariate logistic regression model for statistical analysis. ResultsA considerable proportion of patients reported mild, moderate, severe and extremely severe symptoms of depression (177 [75/3%]), anxiety (169 [71.9 %]), and stress (158 [67.2 %]). However, 61/8% of the participant had proper medication adherence and 38/3% had poor medication adherence. The results of adjusted multivariate logistic regression showed that in patients who had severe and extremely severe depression and anxiety, the probability of poor medication adherence was higher (P < 0.05). The levels of stress were not significant predictors for medication adherence behavior (P > 0.05). ConclusionAccording to this study, severe and extremely severe depression and anxiety can be considered as an important predicting factor in the lack of adherence to antiepileptic medication. Practice ImplicationsHealthcare professionals can improve care of patients with PEW by considering patients’ mental and psychological health problems in educational, counseling and supportive programs.

Expert Opinion on the Prescription Practice of Levetiracetam for Different Types of Epilepsy in Indian Clinical Settings

Despite some studies assessing antiepileptic drug usage patterns in single-centre settings, there was a lack of consensus regarding usage patterns, drug choices for various seizure types, and the sociodemographic and clinical factors that influence treatment decisions in India. So, this current survey-based study was intended to gather expert opinions regarding the clinical use of anti-epileptic drugs with a special focus on levetiracetam for the management of epilepsy in Indian settings. A questionnaire-based cross-sectional study involving 25 questions collected perspectives of experts across India regarding the prescription practice of anti-epileptic drugs for epilepsy management. It was noted that majority of the responders (85.93% of 192 experts) stated levetiracetam as a preferred therapeutic option for patients with newly diagnosed epilepsy. Levetiracetam 1000 mg/day was the frequently recommended dosage for such patients in clinical practice (66%). Approximately 76% of the experts suggested that patients receiving the drug might experience behavioural changes. About 49% and 82% of responders recommended levetiracetam for treating resistant epilepsy and pregnant epilepsy respectively. Nearly 62% of the clinicians recommended levetiracetam for paediatric patients with partial seizures over other antiepileptic drugs. Levetiracetam and brivaracetam were both rated as beneficial for treating epileptic patients by 50% of clinicians. Levetiracetam was rated as being more effective than brivaracetam by 28% of clinicians, while brivaracetam was rated as being more effective by 14% of clinicians. Hence, this consensus among clinician’s highlights levetiracetam as the preferred antiepileptic medication for the management of patients with recently diagnosed epilepsy. This recommendation extends patients with refractory epilepsy, pregnant subjects with epilepsy, and young children experiencing partial seizures, where the majority of the clinicians endorse levetiracetam over alternative antiepileptic medications. Both levetiracetam and brivaracetam offer comparable treatment benefits for patients with epilepsy.

Clozapine and Modified Electroconvulsive Therapy Resolving Forced Normalization: A Rare Case Report

Abstract Multiple studies have been done in the past to understand the relationship between seizure and psychosis, still no conclusive point has been found yet. The mechanism behind the relationship is unknown. Seizures may cause brain damage, increasing the chance of schizophrenia and psychosis, or the two illnesses may share etiological elements. We present a case of a 45-year-old male with a prior history of viral meningoencephalitis, axonal motor polyneuropathy, encephalopathy, and well-controlled generalized tonic–clonic seizures. However, the patient presented to us with a new onset of behavioral disturbances in the form of severe aggression, disinhibition, homicidality, and suicidality during treatment with multiple antiepileptics drugs but with no response to multiple antipsychotics. This patient had an adequate response to clozapine and modified electroconvulsive therapy. No such case has been reported in literature, till date. During the phase of forced normalization, the patient may experience behavioral issues following the management of their seizures with antiepileptic medications and the normalization of their electroencephalography. Any unusual behavior observed in epilepsy patients following the initiation of therapy and seizure control should alert clinicians to the likelihood of this condition.

Efficacy and safety of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) in the treatment of paediatric drug-resistant epilepsy: A retrospective analysis.

This investigation evaluates the effectiveness and safety of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) as a treatment modality for drug-resistant epilepsy. A retrospective review of clinical data from 40 paediatric patients with drug-resistant epilepsy, who underwent SEEG-guided RF-TC at our Epilepsy Center between 2020 and 2022, was conducted. This review included the patients' medical history, imaging and electroencephalography results, surgical procedures, and follow-up outcomes. The duration of SEEG monitoring, accompanied by concurrent electrical stimulation tests, varied from 3 days to 4 weeks. Following RF-TC surgery, 4 patients demonstrated temporary neurological impairments, including central facial and tongue weakness, reduced limb strength, and challenges in fine motor hand movements. All these symptoms were related to lesions in the central region, but showed improvement within 2 weeks to 3 months post-surgery. There were no reported instances of status epilepticus, intracranial haemorrhage, or infections. During a follow-up period of 6 months to 2.5 years, seizure control was achieved in 25 patients (62.5%) at 6 months post-surgery, and a > 50% decrease in seizure frequency was observed in 10 patients. In 5 patients where seizure control was not achieved, the management of epilepsy seemed to be independent of factors such as age at surgery, duration of preoperative disease, seizure type, or negative MRI findings ( p > 0.05). Patients with controlled epilepsy exhibited cognitive improvement, with some demonstrating no EEG abnormalities upon follow-up and a decrease in antiepileptic medication. SEEG-guided RF-TC appears to be a potentially effective and safe therapeutic approach for paediatric patients with drug-resistant epilepsy.

A Review on Epilepsy: Exploring the Classification, Metabolic Foundation, and Genetic Aspects of Epileptic Disorder

Epilepsy is a prominent neurological disorder caused by a range of factors, including epilepsy-associated genes, hereditary variables, environmental factors such as oxidative stress and depression, and inflammatory molecules that influence it. Worldwide, more than 65 million individuals are afflicted by epilepsy. The majority of individuals with epilepsy live in nations with low to middle-income levels. In Pakistan, the incidence of epilepsy is at 10 cases per 1000 inhabitants. There are distinct classifications of epilepsy based on the frequency of seizures, which include generalized epilepsy, localized epilepsy, and epilepsy of uncertain origin. Based on the etiology of epilepsy, it is well acknowledged that this condition is characterized by a highly active network that originates from ionic transmission. Brain injury, including traumatic and ischemic injuries, leads to the production of inflammatory chemicals. The excessive production of inflammatory mediators leads to the impairment of the blood-brain barrier (BBB), which induces inflammation in both the central and peripheral regions, leading to epileptic diseases. Over a thousand genes are thought to be involved in developing epilepsy; the most extensively researched genes comprise GABRG2, SCN, CACN, KCN1A, MTHFR, MTTL1, and EFHC1 gene. Various therapeutic approaches have been devised to treat epilepsy, including neurosurgical interventions, antiepileptic medications, anticonvulsant pharmaceuticals, ketogenic dietary regimens, and herbal remedies. This review article provides a thorough analysis of epilepsy, encompassing its categorization, the inflammatory agents accountable for its onset, the genetic factors linked to its progression, and the current therapeutic approaches for this disease.

Epilepsy and pregnancy, mother and neonatal outcomes; systematic review

It is necessary to quantify the relationship between pregnancy outcomes and epilepsy and antiepileptic medication exposure. To look into the relationship between epilepsy and reproductive outcomes, whether or not antiepileptic medication exposure was involved, this systematic review was conducted. This review was conducted following PRISMA guidelines. Hence, studies that discussed the newborn and maternal outcomes of mothers with epilepsy, were published between the years 2011 and 2024 and were searched using electronic databases including MEDLINE, Cochrane, AMED, and Embase, without regard to language limitations. Fourteen articles totaling 3,177,752 participants (16,647 with epilepsy and 3,161,105 without epilepsy) were included in the systematic review; twelve of the included studies discussed both maternal and neonatal outcomes, one study focused solely on neonatal outcomes, and one study solely on maternal outcomes. It was found that there is a correlation between epilepsy, antiepileptic medication exposure, and unfavorable outcomes for the mother, newborn, and infants during pregnancy.

Bone Health and Antiepileptic Drugs in Children with Epilepsy: A Pilot Study

Epilepsy, a chronic neurological disorder necessitating prolonged antiepileptic medication, has been associated with deficiencies in vitamin D and related bone disorders in children. This study aims to investigate the prevalence of vitamin D deficiency, calcium deficiency, and bone diseases in children undergoing antiepileptic drug (AED) therapy. A retrospective study was conducted on 60 children (0-16 years old) with epilepsy at King Fahad Specialist Hospital-Dammam from 2016 to 2018. Participants were administered 800 IU/day of vitamin D for 6 months. Comprehensive assessments, including tests for calcium, phosphorus, 25-hydroxyvitamin D (25-OHD), 1,25-hydroxyvitamin D (1,25 OHD), parathyroid hormone (PTH), thyroid function [thyroid-stimulating hormone (TSH)], alkaline phosphatase (ALP), and bone density, were performed after 6 months of oral vitamin D supplementation. No significant associations were observed between age, sex, age of onset, duration of epilepsy, symptoms of vitamin D deficiency, dietary factors, and the levels of calcium, phosphorus, 25-OHD, 1,25-OHD, PTH, TSH, ALP, and bone scan. Carbamazepine (CBZ) was the only AED that affected bone metabolism in general (P = 0.024). Calcium was mostly found to be abnormal after using AED with vitamin D (800 IU/day) for 6 months (P = 0.05). 25-OHD deficiency was associated with use of CBZ in pediatric epilepsy. Considering its potential impact on bone metabolism, higher vitamin D doses may be advisable for children on long-term AED therapy to mitigate these abnormalities.

Personalized support programs with innovative digital tools to manage and monitor patients suffering from epilepsy: EpiOnApp case study

Epilepsy is one of the most common serious chronic neurological diseases affecting around 50 million people globally and 500,000 patients in Italy. It causes uncontrollable, unprovoked, and unpredictable seizures that reduce the quality of life of those afflicted.&#x0D; It is widely recognized that the most important strategy for controlling seizures and enhance well-being includes receiving and adhering to anti-seizure medications as well as making appropriate lifestyle adjustments. However it is estimated that 30–60% of patients do not adhere to their antiepileptic medication regimens. EpiOnApp is a digital Patients Support Program (PSP) designed to empower patients with epilepsy who are taking Cenobamate for their chronic condition to take control of their health care pathway, from inception throughout the duration of the treatment, and to have a meaningful dialogue with their neurologist by sharing health records and emotional states. Moreover, as patients may have limited mobility, they can order their therapy and have it home delivered in a very easy way, and they can benefit from continuous human support through the figure of a dedicated Care Manager. The advantage for the neurologist is that the platform stores seizure data, facilitating the drug titration and better assessing at the time of the follow-up visit. The efficacy of the program is currently being evaluated. So far, the level of satisfaction expressed by patients and neurologists shows that a well-designed and tailored PSP can address the challenge of improving long-term adherence, helping people with epilepsy through the on-boarding and initial treatment period, reducing discontinuation, and ultimately, delivering a better health outcome.

Oral self-administration of pregabalin in a mouse model and the resulting drug addiction features

Prescription drug abuse is an issue that is rapidly growing globally. Pregabalin, an anticonvulsant, analgesic, and anxiolytic medication, is effective in the management of multiple neurological disorders; however, there is increasing concern regarding its widespread illicit use. It has been previously reported in mice that pregabalin can induce conditioned place preference. In this current investigation, the potential of pregabalin to elicit free-choice drinking in a mouse model of drug addiction, and its effect on recognition and withdrawal behaviors after forced abstinence, were studied. Twenty-two male BALB/c mice were randomly divided into three groups (n = 7–8/group); control, pregabalin-30, and pregabalin-60. The study had three phases: habituation (days 1–5) with free water access, free-choice drinking (days 6–13) with pregabalin groups receiving one water and one pregabalin bottle, and forced abstinence (days 14–21) with free water access. On day 13, the first open field test was conducted, followed by the Novel Object Recognition Test. On day 21, the second open field test was performed, followed by the Tail Suspension Test and Forced Swimming Test. Pregabalin elicited voluntary drinking in the higher-dose group, concurrently causing a decline in recognition memory performance in the novel object recognition test. Moreover, pregabalin induced withdrawal behavior after a period of forced abstinence in the forced swimming and tail suspension tests. This is the first report to establish an animal model of free-choice pregabalin drinking that may be used for further molecular studies and targeted therapy for pregabalin addiction.

Facial dysmorphology in children exposed in pregnancy to anticonvulsant medications correlates with deficits in IQ.

Some children exposed at conception to the antiepileptic drugs (AEDs) phenytoin (PHT), phenobarbital (PB), and carbamazepine (CBZ) have changes in their midface and fingers. It has been suggested that the anticonvulsant-exposed child with these subtle changes in facial features (the "anticonvulsant face") has a greater likelihood of having deficits in IQ in comparison with children exposed to the same anticonvulsants who do not have these features. 115 AED-exposed children (40, PHT; 34, PB; and 41, CBZ) between 6.5 and 16 years of age and 111 unexposed children matched by sex, race, and year in school were evaluated. The evaluations were (WISC-III), physical examination with measurements of facial features and digits and photographs. The AED-exposed children had cephalometric radiographs, but not the unexposed. Each parent had a similar examination of face and hands plus tests of intelligence. These AED-exposed children showed an increased frequency of a short nose and anteverted nares, features of the "anticonvulsant face." Lateral skull radiographs showed a decrease in the angle between the anterior cranial base and nasal bone, which produces anteverted nares. Mean IQs were significantly lower on one or more IQ measures for the children with these facial features. Shortening of the distal phalanges and small fingernails correlated with the presence of a short nose in that child. The findings in 115 children exposed at conception to either phenytoin, phenobarbital, or carbamazepine, as monotherapy, confirmed the hypothesis that those with a short nose and anteverted nares had a lower IQ than exposed children without those features.

Epidemiology of engagement in physical activity behaviors in people with epilepsy from National Health Interview Survey 2017

ObjectivePhysical activity (PA) participation may be beneficial for people with epilepsy (PWE) but has been discouraged due to a fear that it may induce seizures. Using data from the 2017 National Health Interview Survey, we aimed to describe current rates of PA sufficient to meet US PA Aerobic and Strength Training Guidelines (Aim #1), compare the average time PWE spend on aerobic activity and strength training activity (Aim #2), and compare rates of engagement with various types of PA (e.g., moderate, vigorous, strength training, and mind–body activities) among PWE to the general population (Aim #3). MethodsCross-sectional data (n = 26,728) were analyzed via logistic and zero-inflated Poisson regression models. PA participation was analyzed based on the US PA Guidelines (neither, strength training [≥2 times/wk], moderate to vigorous physical activity [MVPA; ≥ 150 min/wk], or both; Aim #1), time spent on activity/week (Aim #2), and activity participation (yes/no; Aim #3). Epilepsy status was coded as active epilepsy (doctor-diagnosed and either taking antiepileptic medication or had at least one seizure in 12 months; n = 335), inactive epilepsy (doctor-diagnosed, not taking antiepileptic medication nor had a seizure in 12 months; n = 213), and no history of epilepsy (n = 26,180). ResultsPeople with active epilepsy were more likely to report meeting neither (68 %, 95 % CI = 63–74 %) of the PA Guidelines compared to people with no history of epilepsy (59 %, 58–60 %). The mean duration of time reported on vigorous activity for people with inactive epilepsy was significantly higher than people with no history of epilepsy (p = 0.01). People with active epilepsy were 32–39 % less likely to report participating in any moderate or vigorous activity compared to people with no history of epilepsy. SignificanceThis study highlights activity disparities among PWE and the general population, indicating substantially lower activity and higher likelihood of inactivity in PWE, particularly active epilepsy.

Perception of the general population on Epilepsy and Antiepileptic drugs: A questionnaire-based study

The impact of epilepsy is multidimensional, ranging from socioeconomic to medical to psychological problems. The additional burden on quality of life is not only due to disease but also to the antiepileptic medication-related adverse effects. Though the majority of epileptics dwell in developing countries, studies have found a lack of knowledge, attitude, and practice towards epilepsy and its management, leading to a large treatment gap. This study aimed to assess the knowledge, attitude, and practice of epilepsy and antiepileptic medication among the general population, including epileptics or caregivers. A 6 month (August 2022 to February 2023) prospective, cross-sectional online questionnaire-based study utilizing Google Forms as a data collection tool was conducted among the general population at a tertiary care hospital in Coimbatore employing convenient sampling. Descriptive and inferential statistics (paired t-test, chi-square test) were used. The results were presented as numbers and percentages. The data obtained was analyzed using Statistical Package for the Social Sciences, version 27. We received 123 responses. 87.8% and 85.4% linked epilepsy to insanity and spiritual possession/trance, respectively. More than 90% opined that epilepsy was contagious, due to patient or ancestral sins, and treatable by faith healers. The mean knowledge, attitude, and practice scores (%) were found to be 78.04 ± 1.32, 71.23 ± 1.23, and 53.15 ± 1.38, respectively. Even though the urban population had satisfactory knowledge, the same was not translated into attitude and practice. There was a wide gap between knowledge, attitude, and practice. Considering the significant disparities in awareness, attitude, and practice even after decades in urban regions, policymakers and public health professionals must incorporate health education programs and healthcare services for the masses to bring about changes in a country like India. Keywords Knowledge, Attitude, Practice, Stigma, Quality of life, People living with epilepsy