Side Effects Of Antiepileptic Drugs Research Articles

The importance of assessing behaviour and cognition in antiepileptic drug trials in children and adolescents.

It has long been recognised that uncontrolled childhood epilepsy is detrimental to cognition and behaviour, impacting on a patient's ability to succeed academically. Patients who experience more frequent and serious seizures are at greater risk for cognitive decline, emphasising the need for more effective epilepsy treatments to bring seizures under control. That said, although more effective antiepileptic drugs (AEDs) have the potential to limit the impact of uncontrolled seizures on cognitive and behavioural function, recently it has been acknowledged that deficits in these functions may be caused by AEDs themselves. The cognitive and behavioural effects of older-generation AEDs have been determined largely from AE reporting rather than from specific assessment. Recently, clinical trials of newer-generation AEDs, such as topiramate, levetiracetam and perampanel, have included standardised neuropsychological tests as outcome measures to assess their impact on cognition and behaviour in children and adolescents. However, to understand how we may limit the cognitive and behavioural side effects of AEDs, it is necessary for us to gain a fuller, more accurate, characterisation of their true impact. Such insight will depend on sophisticated and standardised approaches to the design of AED clinical trials. This review provides a general overview of our current understanding of the impact of both epilepsy and AEDs on cognition and behaviour, before focusing on the AEDs for which more detailed assessment, using standardised cognitive and behavioural measures, has been undertaken. We will then go on to discuss the key elements in the design of future AED clinical trials to address current unmet needs.

Prevalence of alcohol use disorders and associated factors among people with epilepsy attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.

IntroductionAlcohol use disorders represent one of the leading causes of preventable death, illness, and injury in many societies throughout the world. Heavy alcohol consumption has multiple negative consequences for people with epilepsy such as precipitation of seizure, exacerbation of seizure, poor seizure control, increased side effects of antiepileptic drugs, noncompliance to antiepileptic drugs, alcohol withdrawal seizures, long-term hospital admission, status epilepticus, sudden unexpected death, and premature mortality.MethodsAn institution-based cross sectional study was conducted from April 15, 2014 to May 15, 2014 with the aim of assessing prevalence of alcohol use disorders and associated factors among people with epilepsy attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. A total of 413 randomly selected epileptic patients were included in this study. Data were structured using the 10-item Alcohol Use Disorders Identification questionnaire. Data were analyzed using SPSS Version 20. Bivariate and multivariate logistic regression analyses were performed to study the association, and variables with P-value <0.05 were considered as having a statistically significant association at 95% confidence interval.ResultsA total of 423 study participants were selected, of whom 413 completely filled the questionnaire making the response rate 97.6%. The mean age of the respondents was 31.9 years with standard deviation of ±10.97, and 248 (60%) were males. The prevalence of alcohol use disorder was 17.4%. Educational status (grade 9–12) (adjusted odds ratio [AOR] =3.25, [1.21, 8.69]), not living with family members (AOR =1.89, [1.06, 3.39]), availability of house (AOR =2.04, [1.10, 3.78]), taking carbamazepine (AOR =2.38, [1.13, 5.01]), and drinking alcohol to find relief from stress (AOR =4.28, [1.89, 9.67]) were significantly associated with alcohol use disorder among people with epilepsy.Conclusion and recommendationThe findings of this study revealed that the prevalence of alcohol use disorder among people with epilepsy was high. Routine screening of epileptic patients with the Alcohol Use Disorders Identification Test is recommended.

Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy.

Background and aimAdherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence.Patients and methodsThis study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions.ResultsSixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20).Discussion and conclusionAmong patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence.

Perception of stigma and associated factors in people with epilepsy at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia

Objective: Stigma is a major problem for people living with epilepsy. Perceived stigma may be more prevalent than enacted stigma and causes excessive worry for the individual even if it does not arise from a social interaction. Therefore, we assessed perceived stigma and associated factors among people with epilepsy.Methods: An institution-based cross-sectional study was conducted from April to May, 2013, among 423 samples of people with epilepsy.Results: One hundred sixty-nine (40.7%) of the respondents perceived as they were stigmatised by other people with 19.5% highly stigmatised by their illness. Most of the respondents (54.9%) had one or more seizure attacks per month, 61.9% were under monotherapy and 52.5% had no side effects of antiepileptic drugs. Those respondents who were from rural, low income, divorced/widowed, with frequent seizure attack and side effects of antiepileptic drugs were more likely to felt stigmatised by other people due to their illness.Conclusions: Perceived stigma was found to be a common problem among people living with epilepsy. Therefore, the finding suggests that the need of creating awareness and addressing incorrect conceptions attached to epilepsy.

Marijuana use in adults admitted to a Canadian epilepsy monitoring unit.

Epidemiologic evidence supporting antiseizure properties of cannabis is limited and controversial. We determined the prevalence of marijuana use and its perceived effects in patients with and without epilepsy. Information was collected over 14months from consecutive adult patients admitted to an epilepsy monitoring unit using a 27-item anonymous questionnaire. Patients with cognitive impairment unable to understand the questions or give informed consent and readmissions were not recruited. Subjects were divided into 4 groups, those with epileptic seizures, those with psychogenic nonepileptic seizures (PNES), those with both epileptic and PNES, and those with other nonepileptic events. Patients with exclusively epileptic seizures were compared with those with exclusively PNES. From 310 patients, 18 undiagnosed cases were excluded leaving a cohort of 292 patients with median age 35 (range: 27-49) years; 57.2% female. Epilepsy was documented in 190 (65.1%), PNES in 64 (21.9%), and both types of seizures in 26 (8.9%). Median duration of seizure disorder was longer (2 [1-9] vs. 13 [5.7-25] years; p<0.001) and seizure frequency lower (daily or weekly in 62.3% vs. 44.9%; p=0.03) in patients with epilepsy compared with those in patients with PNES. Overall, 166 (57%) had tried marijuana, and 36.2% used it over the past year. Utilization was 57.1% in sole epilepsy and 64.1% in sole PNES, but daily use was more likely in epilepsy (59% vs. 33.3%). Estimated mean dose was 1g/day. Marijuana use was associated with tobacco smoking (p<0.001) but not alcohol use. Eight patients used other street drugs. Improvement in seizures was perceived by 84% in those with epilepsy and 72.7% in those with PNES. In the 2 groups, stress was decreased in 84.9% and 88%, sleep improved in 77.3% and 88%, and memory/concentration was better in 32% and 28%, respectively. Antiepileptic drug side effects were decreased in 53.2% of marijuana users. Perceived effect on epileptic seizures correlated with effect on stress (r=0.35, p=0.004). Adverse effects of marijuana were mild and reported in 30.7% but included possible seizure precipitation in 5 patients with epilepsy. Patients with uncontrolled epilepsy or nonepileptic events had a high rate of marijuana use with associated perceived improvements in seizure control, stress, sleep, and drug side effects. Stress reduction may contribute to the perceived impact of marijuana on seizures and nonepileptic events in adults.

Poststroke epilepsy: update and future directions.

Stroke is among the most common causes of epilepsy after middle age. Patients with poststroke epilepsy (PSE) differ in several respects from patients with other forms of structural-metabolic epilepsy; not least in age, age-related sensitivity to side effects of antiepileptic drugs (AEDs), and specific drug-drug interaction issues related to secondary-stroke prophylaxis. Encouragingly, there has lately been remarkable activity in the study of PSE. Three developments in PSE research deserve particular focus. First, large prospective trials have established the incidence and risk factors of PSE in the setting of modern stroke care. Stroke severity, cortical location, young age, and haemorrhage remain the most important risk factors. Second, although more studies are needed, epidemiological data indicate that the risk of PSE may be influenced, for instance, by statin treatment. Third, studies are emerging regarding the treatment and prognosis of PSE. Levetiracetam and lamotrigine may be well tolerated treatment options and seizure freedom is achieved in at least a similar proportion of patients as in other epilepsies. Furthermore, new animal models such as photothrombotic stroke gives hope of a more clear understanding of PSE epileptogenesis in the near future. In summary, PSE shows indications of maturing into an independent epilepsy research field. This review summarizes recent advances in our understanding of PSE and provides an update on management issues such as diagnosis, AED selection, and prognosis. Finally, future research challenges in the field are outlined.

Psychiatric antiepileptics side effects: A case report

IntroductionPsychiatric disorders in epilepsy have a multifactorial etiology, being pharmacotherapy only one of many risk factors, which can be both biological and psychosocial. The adverse effects of antiepileptics (AEDs) embrace all categories of psychiatric symptomatology, including disturbances of consciousness, psychotic state, neurotic state, behaviour and character disorder. In fact, Psychotropic effects of AEDs require further research because many relevant parameters related to pathological mechanisms, frequency, psychopathology, and prognosis are not well understood.ObjectivesThe authors aim to present a case of an adolescent with epilepsy who has developed secondary psychiatric symptoms.AimsTo understand and deal with the most common Psychiatric side effects of AEDs.MethodsA non-systematic review of English scientific literature was conducted using keywords “Epilepsy” and “antiepileptic side effects”.DiscussionA 14-year-old female adolescent with history of seven years of Epilepsy (usual medication: carabamazepine 45 mg/kg/day, Lamotrigine 8 mg/kg/day; pregabaline 8 mg/kg/day) was admitted in the paediatric ward due to behaviour disorder characterized by agitation, anxiety and seizures-like symptoms. A therapeutic adjust was made (Fenetoíne and Levetiracetam). After this medication change, the adolescent presented psychotic symptoms namely auditory and tactile hallucinations. A complete clinical investigation was performed and the hypothesis of drugs side effects was considered. After AEDs reduction, a total remission of the symptoms was obtained.ConclusionPsychiatric disorders in epilepsy have a multifactorial etiology and are not yet well understood. Behavioural side-effect profiles of AEDs (both negative and positive effects) should be considered in the choice of the optimal drug for each patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Medical management of epileptic seizures: challenges and solutions.

Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical–psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and “pseudoseizure” patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.

Depression and epilepsy: comorbidities, pathogenesis, principles of therapy

Numerous trials of last years confirm the bilateral link between depression and epilepsy with mutual complication of both diseases. Depression increases the risk of the first unprovoked paroxysm, worsens the compliance of epileptic patients, leads to decrease of the response both to therapeutic and surgical treatment and to increase of side effects of antiepileptic drugs. Depression is associated with high risk of suicidal behavior and reduces the quality of life level. Depression in epileptic patients is characterized by atypical clinical course in most cases what makes its diagnostics difficult and becomes the reason of the absence of the necessary pharmacologic and psychotherapeutic treatment. All of the above creates significant economical burden for the community because the epileptic patient with comorbid depression visits the physicians 2-4 times more often.

IMPACT OF ANTIEPILEPTIC DRUGS ON COGNITIVE FUNCTIONS: FOCUS ON PERAMPANEL

Cognitive problems in epilepsy have a multifactorial origin with etiology, seizures, and the «central» side-effects of drug treatment being involved. Cognitive side effects of antiepileptic drugs (AEDs) have been demonstrated to be one of the most important tolerability problems in chronic AED treatment, especially in children with epilepsy. Memory impairments, mental slowing, and attentional deficits are the most frequently reported ones. Neuropsychological profiles of AEDs are important considerations for treatment selection, particularly in children and adolescents. In evaluating studies of the cognitive effects of AEDs we must follow an evidence-based approach, but in the majority of cases, specific data on cognitive functions in children and adolescents with epilepsy are not yet available. A randomized double blind trial on cognitive effects of adjunctive perampanel for partial-onset seizures is cited (Meador K. F. et al, 2015) and discussed. In this trial adjunctive perampanel did not have any significant overall negative cognitive effect and was improving episodic memory in adolescent patients with inadequately controlled partial-onset seizures.

Toxicity of Antiepileptic Drugs to Mitochondria.

Some of the side and beneficial effects of antiepileptic drugs (AEDs) are mediated via the influence on mitochondria. This is of particular importance in patients requiring AED treatment for mitochondrial epilepsy. AED treatment in patients with mitochondrial disorders should rely on the known influences of AEDs on these organelles. AEDs may influence various mitochondrial functions or structures in a beneficial or detrimental way. There are AEDs in which the toxic effect outweighs the beneficial effect, such as valproic acid (VPA), carbamazepine (CBZ), phenytoin (PHT), or phenobarbital (PB). There are, however, also AEDs in which the beneficial effect on mitochondria outweighs the mitochondrion-toxic effect, such as gabapentin (GBT), lamotrigine (LTG), levetiracetam (LEV), or zonisamide (ZNS). In the majority of the AEDs, however, information about their influence of mitochondria is lacking. In clinical practice mitochondrial epilepsy should be initially treated with AEDs with low mitochondrion-toxic potential. Only in cases of ineffectivity or severe mitochondrial epilepsy, mitochondrion-toxic AEDs should be given. This applies for AEDs given orally or intravenously.

Pharmacogenetics of antiepileptic drugs: A brief review

The goal of pharmacogenetic research is to assist clinicians in predicting patient response to medications when genetic variations are identified. The pharmacogenetic variation of antiepileptic drug response and side effects has yielded findings that have been included in drug labeling and guidelines. The goal of this review is to provide a brief overview of the pharmacogenetic research on antiepileptic drugs. It will focus on findings that have been included in drug labeling, guidelines, and candidate pharmacogenetic variation. Overall, several genes have been included in guidelines by national and international organizations; however, much work is needed to implement and evaluate their use in clinical settings.

Clinical characteristics of epilepsy of unknown origin in the Rottweiler breed

BackgroundEpilepsy is one of the most common neurological conditions in dogs. Despite that epilepsy appears to be common in the Rottweiler breed, published literature about the phenotype of epilepsy in this breed is lacking. The aim of this questionnaire-based study was to describe the clinical characteristics of epilepsy in the Rottweiler breed including; signalment, pedigree, housing conditions and information about the seizures such as age at onset, seizure type, duration, and progression, as well as number of seizure days (24 h), effect and side effects of anti-epileptic drugs, and potential comorbidities. The diagnosis for epilepsy of unknown origin was based on the following inclusion criteria: ≥2 seizure days, starting between 6 months and 7 years of age, no known history of poisoning or serious head trauma, and (when available), pre-study routine serum biochemical parameters were within the reference intervals.ResultsA total of 37 cases (23 females and 14 males) were included in the study. The median age at onset of seizures was 36 months (range 8–84 months). The dogs suffered from generalized tonic–clonic seizures, and more than 50 % of the dogs had experienced cluster seizures (>1 seizure in 24 h). The dogs commonly started to seizure while resting (23/36) and/or sleeping (20/36). Only 3 of the 36 dogs experienced seizures during activities such as walking or training. All of the 24/37 (64.9 %) dogs on antiepileptic drugs received phenobarbital. Five dogs needed add-on treatment (n = 5), and of these: one dog was on 3 drugs (phenobarbital, potassium bromid and levetiracetam) (n = 1), three dogs were on phenobarbital and potassium bromide (n = 3), and one dog received phenobarbital and imepitoin (n = 1). Seizure frequency did not necessarily improve following antiepileptic treatment, and for six of 21 (28.6 %) of the dogs, seizure frequency increased. All of the Rottweilers in this study had relatives with epilepsy reported.ConclusionsThe Rottweilers suffering from epilepsy in this study presented with generalized tonic–clonic seizures, and their response to antiepileptic treatment was variable. More than 50 % of the dogs had experienced cluster seizures (>1 seizure in 24 h).Electronic supplementary materialThe online version of this article (doi:10.1186/s13028-015-0168-1) contains supplementary material, which is available to authorized users.

The importance of botanical treatments in traditional societies and challenges in developing countries.

Epilepsy is one of the most common neurological conditions worldwide, with many affected persons found in Asia, Latin America, and sub-Saharan Africa. Relatedly, the large majority found in these regions does not receive the appropriate therapy with antiepileptic drugs (AEDs), stemming from various reasons among which are lack of access to AEDs, social stigma, and negative cultural attitudes. The presence of epilepsy resistant to the available AEDs coupled with the frequent AED side effects has further fueled the widespread and growing use of botanicals as alternative therapy in several traditional societies in these developing countries since people with epilepsy (PWE) consider them as safe and effective. There have, however, been few botanicals that have been examined for their pharmacological activities related to traditional uses, and there is hardly any conclusive evidence regarding their efficacy in humans or knowledge about the exact mechanism(s) of action. This review discusses some botanical treatments that have been used for epilepsy in developing countries and the challenges faced. This article is part of a Special Issue entitled "Botanicals for Epilepsy".

Health care charges for youth with newly diagnosed epilepsy.

To estimate first-year health care charges for youth with newly diagnosed epilepsy seen within an interdisciplinary pediatric epilepsy team and examine demographic, clinical, and psychosocial predictors of annual charges. Retrospective chart review was conducted to extract medical, hospital, and physician billing data from the year following an epilepsy diagnosis for 258 patients (aged 2-18 years) seen in a New Onset Seizure Clinic between July 2011 and December 2012. Descriptive statistics were used to estimate per-patient total first-year charges and health care utilization patterns (e.g., hospitalizations, emergency department visits, outpatient visits). Univariate analyses examined differences in health care charges between demographic, clinical, and psychosocial factors. Predictors of health care charges were examined using hierarchical multiple regression analysis. The estimated per-patient total first-year health care charge was $20,084 (95% confidence interval [CI] $16,491-$23,677). Charges were higher for patients who reported having seizures since diagnosis ($25,509; 95% CI $20,162-$30,856) and were associated with more antiepileptic drug side effects (r = 0.18; 95% CI 0.03-0.32). Controlling for demographic and clinical factors, poorer baseline health-related quality of life was associated with higher per-patient health care charges (B = -445.40; 95% CI -865 to -25). The economic impact of pediatric epilepsy in the year following diagnosis is substantial. Cost reduction efforts would be optimized by improving seizure control and targeting health-related quality of life, an outcome amenable to behavioral intervention.

Aspectos dietéticos en el paciente epiléptico

IntroductionEpilepsy is the second most common neurological disease. The patients can live on a normal diet, but certain eating habits contribute to improving their quality of life. ObjectiveAn evaluation is made on the correctable aspects of diet that would improve their quality of life and provide examples on how to achieve this. MethodA literature review was performed on the side effects of antiepileptic drugs, the ketogenic diet, and difficulties in invasive procedures, selecting those that were modifiable through diet. ResultsIt was observed that some antiepileptic drugs increase cardiovascular risk (dyslipidaemia), favour the reduction of bone mass, and also show difficulty in chewing and swallowing by invasive techniques performed on some patients (surgery or implantation of vagus nerve stimulator).A ketogenic diet was found to be an alternative, effective in some patients by reducing the number of seizures, although there are controversies about the application of a ketogenic diet. Discussion and conclusionsIt may be worthwhile for these patients to follow a heart-healthy diet mitigate these adverse effects, which contribute to bone mineralization, always evaluating the risk-benefit, as could be the case of the ketogenic diet, With this review basic dietary guidelines are set out, as well as the different facets that can be affected or with the modifications that should be considered.

Parents' Subjective Assessment of Effects of Antiepileptic Drug Discontinuation.

Background and Purpose:Many parents express worries about potential negative side effects of antiepileptic drugs (AED) on cognition, behavior, mood, and academic achievement. We aimed to evaluate parents’ subjective feelings about cognitive or behavioral changes in their children and their quality of life after antiepileptic drug (AED) discontinuation.Methods:A modified questionnaire based on the Korean-Quality of Life in Childhood Epilepsy and the Korean-Child Behavior Checklist was answered by parents whose children were seizure-free over the course of 1 month after AED discontinuation. All children were seizure-free for at least 2 years before AED withdrawal.Results:Fifty-eight eligible patients (mean age, 14.1 ± 4.5 years) were examined. Except valproate in cognition (p = 0.03), parents did not feel significant change after discontinuation of different drugs. They felt improvement of behavior in generalized epilepsy (p = 0.04) and better quality of life in children less than 6 year of age at diagnosis of epilepsy (p = 0.02).Conclusions:We propose that factors such as earlier age at diagnosis of epilepsy or type of epilepsy might influence parents’ subjective feelings about their children’s well-being after drug discontinuation, rather than the drug itself.

Translation, Adaptation And Validation Of The Bulgarian Version Of The SIDAED Questionnaire

Summary The aim of the study is the translation, adaptation and validation of Side effects of antiepileptic drugs questionnaire in Bulgarian language (SIDAED-BG) in order to use it for objective monitoring of patients with epilepsy. One hundred and thirty one patients (mean age 40.13±13.37 years) took part in the investigation. The internal consistency and test-retest reliability were tested by Cronbach's α and ICC estimations. The convergent construct validity was evaluated by estimating the correlation of SIDAED-BG with the QOLIE-89 and the discriminant validity - by evaluation of the difference between SIDAED-BG scores and clinical parameters such as type of epilepsy using Kruskal-Wallis ANOVA. The Cronbach's α of the total scale was 0.93. The test-retest reliability was higher and determined the strong positive correlations between the first and second examination. The SIDAED-BG questionnaire showed good internal consistency (Cronbach's alpha ranged from 0.37 to 0.86) and the scores significantly correlated with other questionnaires such as QOLIE-89 and showed a good discriminative validity between groups with different levels of self-assessed adverse effects of antiepileptic drugs. The Bulgarian version of SIDAED is a reliable and valid tool in assessing the patient-reported adverse effects of antiepileptic drugs and their impact on the patient's outcome.

How predictable is the erectile function of patients with epilepsy?

Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties. This study aimed to identify independent predictor factors for ED in patients with epilepsy. the five-question form of the International Index of Erectile Function (IIEF-5). Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis. Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B=0.005; p=0.05), education levels in years (B=0.54; p=0.03), depressive symptoms determined by HADS depression subscale (B=-0.49; p=0.03), and prolactin levels (B=-0.45; p=0.07) showed a moderate association (r=0.64) with the IIEF questionnaire and explained 41% (r(2)=0.41) of its variation. Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy.

Marijuana use in intractable epilepsy

Background: In Canada, marijuana is legal for those with seizures. We determined the prevalence of marijuana use in intractable epilepsy patients and assessed the perceived effects. Methods: Information about marijuana use was collected over 12 months from consecutive adult patients admitted to an 8 bed Epilepsy Monitoring Unit using a 27 item self-administered questionnaire. Patients unable to understand and give consent for participation were excluded. Results: 215 of 310 patients median age 36 (interquartile range 27-49) years, 57% female had proven epilepsy. Median duration of seizures was 12 years (interquartile range 5-24) occurring daily or weekly in 47%. 37% of patients used marijuana over the previous year, 85% by smoking and 56% on a daily basis. Mean dose was 1 gm/day. Another 19% had used it previously. Use of cigarettes was 27%, alcohol, 40% and street drugs 2%. Seizure improvement was perceived by 91%, decreased stress by 99%, improved sleep by 98% and reduction in antiepileptic drug side effects by 88%. Minor adverse effects of marijuana occurred in 13% including seizures worse in 3%. Conclusions: Patients investigated for intractable epilepsy use marijuana more than the general population and perceive improved seizure control, lower stress, better sleep and reduced side effects from antiseizure drugs.