Side Effects Of Antiepileptic Drugs Research Articles

Does levetiracetam use affect visual evoked potentials in the treatment of childhood epilepsy?

Side effects of antiepileptic drugs vary depending on the drug itself, drug dose and duration of use. One of these side effects is related to vision. Patients who had been ordered visual evoked potential (VEP) measurements for various reasons between October 1st, 2017 and October 1st, 2019 at a pediatric neurology outpatient clinic and who were on levetiracetam monotherapy for at least six months for the treatment of focal/generalized epilepsy were included in the study and their files were scanned retrospectively (study group: SG). Patient files were evaluated for age, gender, dose and duration of levetiracetam use, presence of a family history of epilepsy, EEG result, cranial magnetic resonance imaging and VEP test results and the parameters were recorded. Twenty-four patients of similar age range without epilepsy were included in the study as the control group (CG). Eighteen patients 8 boys (44.4%), 10 girls (55.6%) and 24 healthy controls 9 boys (37.5%), 15 girls (62.5%) were included in the study and control groups, respectively. No statistically significant difference was found when the mean VEP latencies were compared between the patient and control groups for the right (P=0.451) and left (P=0.323) eyes. There was a statistically significant difference between the groups, respectively, when VEP amplitudes of the right and left eyes of the SG and CG were compared (P=0.001; P=0.001). There is no correlation between levetiracetam dose and duration of treatment and VEP parameters. The data obtained in this study showed that levetiracetam use affected VEP amplitude outcome but did not affect VEP latency outcome in pediatric patients.

Patients with epilepsy as drivers in Poland.

Drivers suffering from epilepsy are commonly regarded as a threat to road safety. However, inability to use their own means of transport very often implies specific professional effects and lowers the quality of life. The aim of this study was to analyze the driving status of patients with epilepsy in Poland. The prospective study was performed using an independent questionnaire developed by the authors, consisting of 4 parts: 1) socio-demographic information, 2) clinical information, 3) driving information, and 4) opinions about patients with epilepsy as drivers. The study was conducted in November 2018-September 2019. A total of 188 patients completed this study. More than one-quarter of the patients have a driving license. Among them, 35 individuals (accounting for 18.62% of the whole study group) said that they had received their driving license after the diagnosis of epilepsy. In 10 cases (5.32%), seizures occurred while the patients were driving and in 72 cases (38.30%) while they were traveling as passengers. Among all socio-clinical factors, having a driving license was conditioned by the marital status (p = 0.008) and education (p = 0.007). Other factors did not affect having a driving license or the time of obtaining the license (p > 0.05 for all cases). A relationship was observed between the occurrence of side effects of antiepileptic drugs and the occurrence of seizures while traveling as a car passenger (p = 0.001). Other factors did not affect the occurrence of epileptic seizures while traveling by car, either as a driver or a passenger (p > 0.05). A significant proportion of the respondents were of the opinion that patients with epilepsy should not be allowed to obtain a driving license, which is probably related to concerns about the occurrence of epileptic seizures while driving. It is necessary to conduct a nationwide educational and information campaign on epilepsy in various aspects. Med Pr. 2021;72(4):341-50.

Effects of antiepileptic drugs on hormones

Epilepsy, a common neurological disorder, affects about 50 million people around the world. The prevalence of epilepsy is approximately 6.8 per 1000 in the US [1].Since it is a chronic disease, it often requires lifelong treatment. The severity of epilepsy may vary from well controlled seizure on monotherapy to refractory seizures on polytherapy with many comorbidities and several drug related side effects and interactions [2]. Although there are many alternative treatment options for for epilepsy, such as vagus nerve stimulation (VNS), surgery, and a ketogenic diet, antiepileptic drugs (AEDs) are accepted as the first choice [2].Common adverse effects of AEDs include dizziness, drowsiness, mental slowing, skin rashes, hepatotoxicity, movement and behavioral disorders, and metabolic disturbances, such as weight gain, metabolic acidosis, and nephrolithiasis [3].Although some of AED side effects may be cosmetic changes such as weight gain, hair loss, acne, or masculine hair distribution in women, hormonal effects of antiepileptic drugs can have a significant impact on the life quality of patients. AEDs can affect hormonal balance in different areas, from bone health to fertility, sexual dysfunction,and thyroid abnormalities [4].

A Review on conceptual framework of Drug Side Effects and Pharmacoresistance in Epilepsy

Epileptic seizures in the form of involuntary body movements have made patients’ lives extremely difficult. There are mainly two types of seizures partial or focal seizure affect just one side of the brain and generalised seizures affect the whole brain of a person. The person suffers from neuro-sensory deregulation and consciousness loss, coupled with episodes of seizures. Different drug therapies have been used for epilepsy patients targeting neurotransmitters regulation mechanisms. The drug targets and mechanism of action in polytherapy remain ambiguous. However, 6 out of 10 patients quit antiepileptic drug (AED) therapy due to side effects like depression, aggression and psychosis. Several behavioral side effects make them socially awkward, due to which patients cease to continue drug therapies. The combined effect of AED side effects and resorting therapies lead to recurrent seizures which further disturb the neurotransmission on account of every seizure episode. The present review describes epilepsy in terms of clinical treatments and associated side effects. The study provides a novel conceptual loop of correlation between AED polytherapy, side effects and Pharmacoresistance. This review creates caution for clinicians to think intricately before prescribing drugs for epilepsy and ensure communication of side effects. The review opens research prospectives for drug targets to break the conceptual loop for the Pharmacoresistance. Further, this paper enhances the understanding of epilepsy and improves diseases condition.

A Review on conceptual framework of Drug Side Effects and Pharmacoresistance in Epilepsy

Epileptic seizures in the form of involuntary body movements have made patients’ lives extremely difficult. There are mainly two types of seizures partial or focal seizure affect just one side of the brain and generalised seizures affect the whole brain of a person. The person suffers from neuro-sensory deregulation and consciousness loss, coupled with episodes of seizures. Different drug therapies have been used for epilepsy patients targeting neurotransmitters regulation mechanisms. The drug targets and mechanism of action in polytherapy remain ambiguous. However, 6 out of 10 patients quit antiepileptic drug (AED) therapy due to side effects like depression, aggression and psychosis. Several behavioral side effects make them socially awkward, due to which patients cease to continue drug therapies. The combined effect of AED side effects and resorting therapies lead to recurrent seizures which further disturb the neurotransmission on account of every seizure episode. The present review describes epilepsy in terms of clinical treatments and associated side effects. The study provides a novel conceptual loop of correlation between AED polytherapy, side effects and Pharmacoresistance. This review creates caution for clinicians to think intricately before prescribing drugs for epilepsy and ensure communication of side effects. The review opens research prospectives for drug targets to break the conceptual loop for the Pharmacoresistance. Further, this paper enhances the understanding of epilepsy and improves diseases condition.

Factors Associated with Poor Antiepileptic Drugs Adherence in Below Poverty Line Persons with Epilepsy: A Cross-Sectional Study.

Background Adherence to antiepileptic drugs (AED) is essential for adequate seizure control in epilepsy. People with low socioeconomic status are more vulnerable to poor adherence to AED. The present study aimed to explore factors associated with poor adherence to antiepileptic drugs in below poverty line (BPL) persons with epilepsy (PWE). Methods The research had a cross-sectional design with inclusion of persons aged 18 to 65 years and an established diagnosis of epilepsy. Holding a BPL card (Yellow card) was taken as a measure for BPL criteria. Adherence to antiepileptic drugs was assessed using medication adherence rating scale (MARS). Univariate analysis with Chi-square test was used to determine the association between various variables and AED adherence, while the predictors of adherence were identified using multivariate logistic regression analysis. Results There was a total of 88 BPL PWE. The mean age of male and female patients was 35.0 ± 15.0 & 32.0 ± 10.1 years, respectively. Adherence for drugs were found to be 30.7% and nonadherence to be 44.3%. Low (illiterate or primary) education (OR 0.041 [0.01–0.21]), polytherapy (OR 0.088 [0.02–0.40]), and substance abuse (OR 0.05 [0.01–0.58]) were found to have significant association with nonadherence to AEDs. Age, gender, marital status, family composition, occupation, rural urban background, distance from health care facility, duration of epilepsy, and side effects of AED were not found to have significant association with adherence. Conclusion There is a need for psychoeducational programs for the people having low education status and polytherapy to form positive beliefs in AEDs. Substance abuse should also be addressed while treating them.

Management of bone metabolism in epilepsy.

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

Evaluation of the effects of antiepileptic drugs on complete blood count parameters

Aim: The incidence of pediatric epilepsy ranges between 1-3%, and various anticonvulsant drugs are used in its treatment. Seizure type, effectiveness and side effects are important in drug selection. Various hematological side effects of anticonvulsants have been reported. This study aims to determine the hematological side effects of the anticonvulsants used in our clinic. Methods: A total of 87 epilepsy patients between the ages of 1 and 15 years, who were diagnosed and followed up in the Pediatric Neurology Outpatient Clinic of Health Sciences University, Okmeydanı Training and Research Hospital between January 2017-2018 and who received anticonvulsant medication for at least 3 months were included in this study. The blood values and hematological side effects of the anticonvulsants were noted from the patient files. The statistical analyses were performed with IBM SPSS Statistics v.22 (SPSS IBM, Turkey). Results: Among all, 44.8% of the patients were using Valproic acid (VPA), 28.7%, Levetiracetam (LEV), 12.6%, Oxcarbazepine (OXC), 8%, Phenobarbital (PB), and 4.6%, Carbamazepine (CBZ). Platelet values were below 150,000/ul in 7.6% of VPA users and 14.2% of PB users. The hemoglobin value fell below 10 g/dl in 2.5% of VPA users, 14.2% of PB users, and 8% of LEV users. Absolute neutrophil count fell below 1500/ul in 9% of the patients using OXC and 14.2% of those using PB. The decrease in platelet values before and after anticonvulsant use was statistically significant (P=0.039), while the decrease in hemoglobin and neutrophil values were not. Conclusion: In patients using antiepileptic drugs, complete blood count may be affected. Periodic monitoring of blood parameters is important in the close follow-up of patients. It is not known exactly how and how often the hematological side effects of antiepileptic drugs take place. Future studies on this subject are necessary.

Epileptiform activity index for assessing oxcarbazepin therapy of newly-diagnosed focal epilepsy in adolescents and adults

Introduction. Oxcarbazepine (OXC) is approved for initial and adjunctive therapy of focal epilepsy (FE), being also a drug of choice in case of pediatric FE. Despite that OXC has been used in the Russian Federation (RF) since 2007, studies assessing its efficacy and tolerability are scarce. Aim. To evaluate efficacy and tolerability of OXC therapy in patients with newly-diagnosed epilepsy. Patients and methods . There were enrolled 103 patients (56 (54.4%) into the study: males and 47 (45.6%) females with FE, aged 44.32±19.71 years. Depending on the OXC daily dose, all patients were divided into 3 subgroups: 1200 mg/day (n=16; 15.5%). Video-electroencephalographic (video-EEG) monitoring was performed at each visit (at baseline, 1, 3, 6 and 12 months after then onset of therapy). Treatment efficacy was assessed by using the criteria of retention on treatment, seizure absence, seizure rate decrease by >50%, seizure rate decrease by <50% (insufficient efficacy). Adverse effects (AEs) were assessed in accordance to the Side Effects of Anti-Epileptic Drugs (SIDAED) treatment scale and emerging pharmacodynamics aggravation (increased seizure rate compared to baseline/emergence of new seizure type). Results . It was found that retention on OXC monotherapy during the 12-month follow-up period was achieved in 69.0% (n=71) patients, among which 15.5% (n=16) received less than OXC at dose of 1200 mg/day, 44.7% (n=46) - 1200 mg/ day, and 8.8% (n=9) - more than 1200 mg/day, respectively. Total rate of intolerable AEs during the follow-up period was 13.6% (n=14). Comparing initial vs. 12-month timepoint EAI magnitude after the onset of OXC therapy revealed that it was significantly decreased by 6.9-fold (p<0.05). Conclusions. OXC is an effective drug for the initial treatment of FE in adolescents and adults highlighted with favorable tolerability profile. 12-month follow-up monitoring demonstrated that EAI was reduced almost by 7-fold allowing to consider it as an objective quantitative marker for assessing treatment efficacy.

Drug Utilization Pattern and Prescription Auditing of Antiepileptic Drugs and its Adverse Effects in Private Hospital

Background: Epilepsy is a common medical condition characterized by repeated seizures due to a disorder of the brain cells. The data was limited regarding the prescribing pattern and side effects of various antiepileptic drugs in private hospitals. The objective of the present study was to evaluate the prescribing pattern of Antiepileptic drugs in the management of various types of epileptic seizures over a period of twelve months. Methods: A prospective observational study was conducted among epileptic patients on follow up at neurology department of Life line hospital, Azamgarh. During the twelve months study period, epileptic patients who were prescribed with AED’s (antiepileptic drugs) were included in this study. Data were collected through the Patients case files. Results: Our study revealed male predominance over female. In 18-30(35.66%) age group, Patients were more prone to epilepsy. Total 145(48.33%) patients were diagnosed with generalized seizure. Headache (27.55%) was most commonly observed ADRs. Total 959 (94.57%) number of drugs were prescribed with brand name. Valproic acid (15.18%) was most commonly prescribed drugs for treatment of epilepsy for treatment of epilepsy which included 154 encounters. Avg. cost for 6 months of epileptic treatment was 64752.02. Average cost per prescription was Rs. 1553.50. Conclusion: This study highlights the need of drug utilization evaluation as it will help in analysing on-going health care practices, so that lacunae in the system can be identified and Proper strategies can be planned to rectify them. In recent times, there has been done an immense effort to ensure and implement rational drug use.

Calcium channel blocker induced gingival enlargement following implant placement in a fibula free flap reconstruction of the mandible: a case report

BackgroundGingival tissue enlargement is a common side effect of antiepileptic medications (e.g. phenytoin and sodium valproate), immunosuppressing drugs (e.g. cyclosporine) and calcium channel blockers (e.g. nifedipine, verapamil, amlodipine) (Murakami et al. 2018, Clin Periodontol 45:S17–S27, 2018). The clinical and histological appearances of lesions caused by these drugs are indistinguishable from one another (Murakami et al. 2018, Clin Periodontol 45:S17–S27, 2018). Drug-induced gingival enlargement is rarely seen in edentulous patients.Case presentationThis case presents a 72-year-old female with a history of squamous cell carcinoma of the floor of the mouth treated with surgical excision and fibula-free flap reconstruction. Following the uncovering of osseointegrated implants placed in the fibular-free flap, the patient developed gingival enlargement of the floor of the mouth. Cessation of amlodipine and switching to an alternative medication lead to a resolution of the enlarged tissue.ConclusionsThis case illustrates that gingival enlargement can occur around dental implants, most notably in rehabilitation cases in patients who have had head and neck cancer. Clinicians should be aware of the risk of gingival enlargement in hypertensive patients taking calcium channel blockers prior to implant placement.

PATTERN OF ANTI EPILEPTIC DRUG ADVERSE EFFECT IN TERTIARY REFERRAL HOSPITAL

Background: Epilepsy is a major chronic neurological problem in the world. The goal of epilepsy therapy is seizure-free and without side effects. The emergence of side effects in patients with epilepsy will be its limitations that can cause the failure of epilepsy therapy. Therefore, it is necessary to do a simple descriptive study, which illustrates the pattern of side effects of anti-epileptic drugs that occur in people with epilepsy, so that later clinicians are more alert and can take preventative measures.Objective: Knowing the pattern of side effects of antiepileptic drugs at the Neurology Outpatient Clinic dr. Saiful Anwar hospital.Methods: This research is an observational descriptive study. Samples were taken by filling the questionnaire at the Neurology Outpatient Clinic dr. Saiful Anwar hospital. Demographic data in this study will be presented in the frequency distribution table. Chi Square test is used to determine the relationship of demographic data, also the pattern of therapy with the side effects that arise.Results: 93 epilepsy patients were involved in the study. More than 40% of patients experience side effects. The most common side effects appear in idiopathic epilepsy (30.1%). Based on the duration of epilepsy, the most side effects appear in epilepsy duration&gt; 10 years (17.2%). However, from the results of the influence test using chi square, there was no significant difference between the duration of epilepsy with the appearance of side effects, even the type of epilepsy (p-value&gt; 0.05). 28 patients who experience side effects, appear after the duration of use of AED 1 - 5 years. It was found that the duration of AED uses affected the emergence of side effects (p-value &lt;0.05).Conclusion: Side effects occur in patients taking anti-epileptic drugs, and are related to the duration of drug use. This data can be used to increase the awareness of clinicians related to the emergence of side effects in patients who consume AED.

Monitoring and Managing Depressive Symptoms in Adolescents with Epilepsy

Depressive disorders are the most frequent psychiatric disturbances associated with epilepsy in adolescents and include a broad and heterogeneous spectrum of conditions that share hallmark features and symptoms such as sadness, irritability, decreased motivation or interests, fatigue, withdrawal, hopelessness, anhedonia, changes in appetite and weight, and sleep disturbances that are persistent and pervasive most days for at least 2 weeks. Using generic self-report depression surveys and current diagnostic codes, clinical and surveillance studies have revealed prevalence rates of 20–25% for depression in youth with epilepsy, with adolescents showing particular vulnerability. Furthermore, 20% of youth with epilepsy endorse suicidal ideation, and youth endorsing suicidal ideation do not necessarily have clinical symptoms of depression. Considering that depression in youth with epilepsy is a common comorbidity, characterized by poorer psychosocial and healthy-related outcomes and increased risk of suicide, a brief, free measure of specific depressive symptoms in youth with epilepsy would be beneficial. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and validated in many countries. NDDI-E-Y showed reliable and construct validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care.For the management of depressive symptoms in adolescents, interventions can be distinguished in non-pharmacological and pharmacological. The first includes psychoeducation which should clarify to adolescents and parents the main features of epileptic disorder, side effects of antiepileptic drugs, treatment modalities, how to cope with learning and social difficulties, in order to improve quality of life. Concurrently, a cognitive-behavioral therapy (CBT) including individual therapy, supportive and family therapy and school services, should be carried on. Psychopharmacology for depressive symptoms should be deserved to moderate to severe depressive symptomatology, only after deep assessment of prior and current antiepileptic and/or psychopharmacologic treatment. SSRIs including fluoxetin, sertraline, fluvoxamine and escitalopram should be first considered. Data coming from experimental studies in animals and humans seem to confirm no decrease of seizure threshold by SSRI adjunctive therapy.

The efficiency and tolerability of lacosamide therapy in adolescents and adults with new-onset focal epilepsy in terms of the epileptiform activity index

Lacosamide (LCM) is one of the most promising antiepileptic drugs (AEDs) for focal epilepsy (FE); however, in Russia there are only a few works devoted to its practical application. Objective : to evaluate the efficiency of LCM therapy in adolescents and adults with new-onset FE. Patients and methods . The investigation enrolled 36 patients aged 16-78 years. All the patients underwent video-ECG monitoring with quantification of the epileptiform activity index (EAI) at baseline and 1, 3, 6 and 12 months of treatment. The treatment efficiency was evaluated using the standard measures: drug-induced remission, a response rate of ≥50%, an insufficient efficiency of ≤50%, higher seizure frequency, and therapy retention rates. Adverse events (AEs) were assessed using the SIDe-effects of AntiEpileptic Drugs (SIDAED) questionnaire. Results and discussion . Just 3 months after starting treatment, the total EAI substantially decreased from 2.92 [0; 6.7] to 1.95 [0; 3.07] (p<0.05). LCM demonstrated a high efficacy and a good tolerance in the therapy of FE: by the end of 12-month follow-up, there was a considerable decrease in EAI by 1.57 times (p<0.05); the LCM monotherapy retention rate of 72.2% was achieved in 26 patients: 20 (55.6%) patients had drug-induced remission; six (16.7%) patients were responders. AEs were recorded in 5 (13.8%) cases. Conclusion . LCM is an effective AED for the initial monotherapy of FE. The use of LCM in FE causes a considerable decrease in EAI by 1.57 times (p<0.05).

MR-Guided Focused Ultrasound Central Lateral Thalamotomy for Trigeminal Neuralgia. Single Center Experience.

Background: Trigeminal neuralgia (TN) is a recognized pain condition the treatment of which can be very challenging. Various surgical interventions can be applied in cases of therapy-resistance to drug treatments. The central lateral thalamotomy (CLT) against neurogenic (or neuropathic) pain is based on multiarchitectonic histological as well as physiopathological studies, and integrates the nucleus in a large thalamocortical (TC) and corticocortical network responsible for the sensory, cognitive and affective/emotional components of pain. The advent of the magnetic resonance imaging guided high intensity focused ultrasound (MRgFUS) brought a strong reduction in morbidity and increase in accuracy compared to penetration techniques.Objective: This study was aimed at analyzing the outcome of bilateral MRgFUS CLT for chronic therapy-resistant trigeminal pain, all performed in one single center.Methods: Patients were categorized in Classical, Idiopathic and Secondary TN. By definition, paroxysms lasted for seconds up to 2 min. All patients were screened for trigeminal neurovascular conflict. In case of classical TN, microvascular decompression was proposed. Therapy-resistance and thus indication for MRgFUS CLT was based on the lack of efficacy and/or side effects of antiepileptic and antidepressant drugs. Good outcome was defined by a pain relief ≥50%.Results: Eight patients suffering from chronic therapy-resistant trigeminal neuralgia were treated. All suffered from pain with paroxysmal character. Six patients reported additionally continuous pain. Mean follow-up was 53 months (range: 12–92, median: 60 months). The mean pain relief assessed by patients was 51% (median: 58%, range: 0–90%) at 3 months, 71% (median: 65%, range: 40–100%) at 1 year and 78% (median: 75%, range: 50–100%) at their longest follow-up. This represents 63% good outcomes at 3 months, 88% at 1 year and 100% at last follow-up. Frequency of the mean pain paroxysms decreased from 84 per day preoperative to 3.9 at 1 year postoperatively. There were no serious adverse events in this series.Conclusion: Our study provides preliminary support for the safety and efficacy of MRgFUS CLT, a histologically and pathophysiologically based medial thalamotomy against chronic therapy-resistant trigeminal neuralgia.

Inter-ictal fatigue and antiepileptic drugs in patients with epilepsy.

Fatigue is a frequently reported symptom in patients with epilepsy (PWE) while the pathophysiology, causes and effects on the disease are not yet fully understood. Fatigue may occur as a side effect of antiepileptic drugs (AEDs); however, it varies greatly depending on both the characteristics of the patients and the AEDs used. The aim of this study was to investigate the relation between fatigue, clinical features and AEDs and doses used in monotherapy in PWE. Ninety consecutive patients with the diagnosis of epilepsy, treated as monotherapy were included in the study. Demographic data, seizure type and frequency, AEDs and their doses were recorded. Fatigue severity scale (FSS) was used in the evaluation of fatigue. Cases of fatigue were defined by a FSS score ≥ 4. The mean age of the patients (57 females, 33 males) was 33 ± 12.7years and the mean disease duration was 11.7 ± 9.1years. Used as monotherapy, AEDs included carbamazepine (n = 29, 32.2%), valproic acid (n = 28, 31.1%), levetiracetam (n = 23, 25.6%) and lamotrigine (n = 10, 11.1%). Fatigue was reported by 52.2% of patients (FSS score ≥ 4). It was found that patients with fatigue had more seizures in the last year than those without (p = 0.031). There was no relation between fatigue and AEDs. The doses of carbamazepine and levetiracetam were significantly correlated with the scores of FSS (p = 0.042 and p = 0.023, respectively), and there was no correlation between the doses of valproic acid and lamotrigine and the scores of FSS. The results of our study showed that; approximately half of the patients with epilepsy had fatigue. Although the relation between AEDs and fatigue was not detected, it was pointed out that AED doses may play a role in the development of fatigue.

Common mental illness among epilepsy patients in Bahir Dar city, Ethiopia: A cross-sectional study.

BackgroundCommon mental illness has a substantial impact on seizure control and negatively affects the overall quality of life among individuals with epilepsy. However, there is a dearth of studies that examined the associated factors of common mental illness among epilepsy patients in Ethiopia, particularly in the study area. This study aimed to assess the magnitude and factors associated with common mental disorders in epilepsy patients who attended government health institutions in Bahir Dar city, Ethiopia.MethodHealth institution based cross-sectional study was conducted using a systematic sampling technique among people living with epilepsy in Bahir Dar City Administration. Common mental illness was assessed using a self-reporting questionnaire and a semi-structured questionnaire was employed to collect data on socio-demographic and clinical related characteristics. Data were analyzed using descriptive statistics, univariate logistic regression, and multivariable logistic regression.ResultsThe magnitude of comorbid common mental illness among people living with epilepsy was found 35.4%. High magnitude of common mental illness was reported among females (39.9%) when compared to males (32.3%). The most prevalent common mental disorders symptoms include being worried, unhappy feeling, trouble thinking clearly, and difficult to enjoy daily activities. Family history of epilepsy, frequent seizures attacks, side effects of antiepileptic drugs, lack of social support and not adherent to antiepileptic drugs were factors associated with common mental illness.ConclusionsCommon mental illness was found to be prevalent among people living with epilepsy. Therefore, it is recommended that great attention should be given to mental illness besides controlling seizure attacks.

Is it possible to predict the treatment efficacy in adult patients with focal epilepsy?

The aim was to determine the factors impacting the treatment efficacy in patients with focal epilepsy. Materials and methods . This was a prospective, comparative, observational study conducted in real clinical practice. We adhered to the following inclusion criteria: age over 18 years; history of two or more epileptic seizures with the focal onset; the presence of epileptic seizures at the time of the initial examination. The exclusion criteria were the history of nonepileptic seizures of any etiology and the inability to perform MRI and/or EEG. The primary and the follow-up examinations were separated by 3-12 months. Eighty three patients with focal epilepsy who met the inclusion criteria (37 men and 46 women aged 19 to 70 years) were examined. The examination included history taking, analysis of the seizure diary, clinical and neurological examination, routine EEG and/or EEG-video monitoring, brain MRI, laboratory tests. Therapy with antiepileptic drugs was maintained throughout the study period. All patients were followed-up for at least 1 year. Results . Cessation of seizures was observed in 36.2% of patients and a &gt;50% reduction in seizure frequency – in 32.5% of patients. The occurrence of side effects of antiepileptic drugs decreased from 56.6% to 26.5%. Conclusion . The introduction into clinical practice of methods for assessing the factors impacting the treatment outcome in patients with focal epilepsy will allow for monitoring of the treatment efficacy and improve the patient quality of life. The authors declare the absence of conflict of interest with respect to this publication. All authors contributed equally to this article.

Sudden unexpected death in epilepsy: a review of literature and own observations

The purpose. To analyze the current state of scientific data related to sudden unexpected death in epilepsy (SUDEP) based on the study of recent investigations presented in the sources of scientific information about definition and classification of SUDEP, its risk factors, epidemiological data, pathophysiology, validity of proposed biomarkers, results of post-mortem examinations, measures of SUDEP prevention and also to present own observations of deaths with their classification. Numerous studies of the recent years have demonstrated the high medical and social significance of the problem of sudden unexpected death in epilepsy, the prevalence of which in patients with epilepsy is 20 times higher than in the general population. The proven association of such a death with a generalized tonic-clonic seizure (GTCS) indicates a real potential threat to life of patients with an unfavorable pharmacoresistant course of the disease. Possible, but not definitively evident, risk factors for SUDEP could be nighttime seizures during sleep, absence of witnesses who could help, prone position during sleep, male gender, age of epilepsy onset before 16 years and its duration more than 15 years, psychiatric comorbidity, simultaneous use of several anti-epileptic drugs (AEDs) or absence of any treatment, symptomatic etiology of epilepsy, use of lamotrigine in idiopathic epilepsy. The exact pathophysiology of SUDEP is unknown. The proposed clinical, genetic, electrophysiological, radiological SUDEP biomarkers for the purpose of identifying individuals with an increased risk of sudden death also do not have sufficient evidence base. Possible preventive SUDEP measures include monitoring of patients’ night sleep with the use of acoustic and biosensor devices, special smart-watches, usage of oxygen mask during or immediately after GTCS. There is a need to inform patients, especially those with unsatisfactory adherence to treatment, about the possibility of sudden death in order to improve their compliance. The main measure of prevention is the search for effective treatment with the best seizure control and minimal AEDs side effects. At present, only this way has an evidence base for reducing the risk of SUDEP. Own observations that meet the criteria for different types of SUDEP are presented.

Cognitive Impairments in Young Men Suffering from Epilepsy

Epilepsy is a chronic disease of the central system with a wide range of neuropsychiatric disorders. Cognitive disorders are quite common with this disease and significantly reduce the quality of life of patients and their families. In approximately 35% of patients, despite treatment, various impairments of memory, attention and bradyphrenia persist in the interictal period. Causes of cognitive impairment in patients with epilepsy can be directly the underlying factor of epilepsy (genetic disease, structural brain defect, etc.), epileptic seizures, interictal epileptiform activity, side effects of antiepileptic drugs (AEDs). Modern neurophysiological and neuroimaging diagnostic methods allow us to identify new features of the course and progression of dysfunctions of higher nervous activity in epilepsy