Antiepileptic Therapy Research Articles

Microstructural Injury to Corpus Callosum and Intrahemispheric White Matter Tracts Correlate With Attention and Processing Speed Decline After Brain Radiation

The corpus callosum (CC) and intrahemispheric white matter tracts (IHWM) subserve critical aspects of attention and processing speed. We analyzed imaging biomarkers of microstructural injury within these regions and association with attention and processing speed performance before and after radiation therapy in primary brain tumor patients. In a prospective clinical trial, 44 primary brain tumor patients underwent cognitive testing and magnetic resonance imaging/diffusion-weighted imaging at baseline (pre-radiation therapy) and 3-, 6-, and 12-months post-radiation therapy. CC (subregions, total) and IHWM tracts (left/right without CC, total) were autosegmented; tumor, tumor bed, and edema were censored. Biomarkers included volume changes (cm3), mean diffusivity ([MD]; higher values indicate white matter injury), fractional anisotropy ([FA]; lower values indicate white matter injury). Reliable-change indices measured changes in attention (Weschler Adult Intelligence Scale [WAIS-IV] digits-forward; Delis-Kaplan Executive Function System Trail Making [D-KEFS-TM] visual-scanning), and processing speed (WAIS-IV coding; D-KEFS-TM number-sequencing, letter-sequencing), accounting for practice effects. Linear mixed-effects models evaluated associations between mean radiation dose and biomarkers (volume, MD, FA) and imaging biomarkers and neurocognitive performance. Statistics were corrected for multiple comparisons. Processing speed declined at 6 months following radiation therapy (number sequencing, letter sequencing; P < .04). Seizures and antiepileptic drug therapy were associated with lower visual-scanning attention reliable-change indices at 6 months (P = .039). Higher radiation dose correlated with smaller midanterior CC volume (P = .023); lower FA in posterior CC, anterior CC, and total CC (all P < .03); and higher MD in anterior CC (P = .012). Smaller midanterior CC and left IHWM volume correlated with worse processing speed (coding, letter-sequencing, number-sequencing; all P < .03). Higher FA in right, left, and total IHWM correlated with better coding scores (all P < .01). Lower FA in total IHWM (P = .009) was associated with worse visual-scanning attention scores. Higher FA in midposterior CC (P = .029) correlated with better digits-forward attention scores. The CC demonstrated radiation dose-dependent atrophy and WM injury. Microstructural injury within the CC and IHWM was associated with attention and processing speed decline after radiation therapy. These areas represent possible avoidance regions for preservation of attention and processing speed.

Pregnancy with epilepsy and antiepileptic drug therapy on fetomaternal outcome

Background: Pregnancy women with epilepsy may have higher chances of obstetric complications, aggregative seizures, major congenital malformations, and abnormal deliveries. Monotherapy or polytherapy of anti-epileptic drugs are usually associated with adverse outcomes in pregnant women with epilepsy. Aim and Objectives: The aim of the study was to evaluate the effect of epilepsy and antiepileptic drug (AED) therapy on the fetomaternal outcome in pregnant women. Material and Methods: A total of 46 pregnant women with epileptic seizures between 18 and 35 years with mean age of 26.46 years were included in the study. The demographic, clinical, and obstetrical data were collected from the medical records. The AED monotherapy and polytherapy with drug dosage details were noted. The details of mode of delivery, outcome of seizures in post-natal period and fetal outcome were gathered. Results: About 65.21% cases were under AED polytherapy and 34.78% cases were under AED monotherapy. Majority cases had carbamazepine (CBZ) and sodium valproate mono and polytherapy. Majority had normal vaginal delivery (65.11%). Single or in combination use of sodium valproate, CBZ, and phenytoin are associated with major congenital malformations (9%). Postpartum hemorrhage was observed in 6.52% cases and postpartum seizure occurrence was observed in 8.69% cases. Conclusion: A well planned pregnancy, continuous monitoring for congenital malformations and fetal growth restriction is necessary in pregnant women under AED therapy for better maternal and fetal outcome.

Involvement of Incomplete Hippocampal Inversion in Intractable Epilepsy: Evidence from Neuropsychological Studies.

The age of onset of seizure, seizure types, frequency of seizure, structural abnormalities in the brain, and antiepileptic medication (polytherapy) causes increased incidence of anxiety and depression in intractable epilepsy patients. To compare the anxiety and depression levels in intractable epileptic patients with structural abnormalities [malformations of cortical development (MCD) and incomplete hippocampal inversion (IHI)] and without structural abnormalities. Participants were selected from (239 males and 171 females) intractable epilepsy patients. They were grouped into four groups; Group 1: 51 nonepileptic age-matched controls, Group 2: 41 intractable epilepsy patients without any brain abnormality, Group 3: 17 intractable epilepsy patients with MCD, and Group 4: 30 intractable epilepsy patients with isolated IHI. Neuropsychiatric tools used were Multiphasic Personality Questionnaire and Weschlers Adult Intelligence Scale to assess anxiety, depression, and intelligence. Groups were classified using 1.5T conventional magnetic resonance imaging and hippocampal volumetric studies. Group comparison design was used. Demographic variables of intractable epilepsy, including seizure types, the frequency of seizure, the age of seizure onset, and antiepileptic drug therapies, did not show significant association between the groups using Chi-square P value. Analysis of variance showed significant anxiety and depression in epileptic patients than the control group (P < 0.01). Post hoc analysis using Tukey's B test showed significant difference in anxiety and depression scores between group value. In group 3 and 4, anxiety scores were significantly different but not depression scores. The present study concludes high prevalence of anxiety and depression in intractable seizure. Anxiety is observed predominantly when there is IHI along with depression. We emphasize the need to identify IHI in intractable epilepsy and assess anxiety and depression to treat them effectively.

Neonatal Outcomes in the MONEAD Study of Pregnant Women with Epilepsy

To determine whether growth measures at birth differ between offspring of pregnant women with epilepsy and healthy pregnant women. The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a National Institutes of Health-funded, prospective, observational, multicenter investigation of pregnancy outcomes for mothers and their infants. Between 2012 and 2016, pregnant women with epilepsy and healthy pregnant women were enrolled at 20 US epilepsy centers. Pregnant women with epilepsy were exposed to various antiepileptic drugs. The main outcome measure was small for gestational age at birth. Principal univariate and multivariate analyses compared outcomes between pregnant women with epilepsy and healthy pregnant women. Secondary analyses focused on outcomes among mothers receiving different antiepileptic drug therapies. In total, 345 infants were born to 331 pregnant women with epilepsy and 106 infants were born to 102 healthy pregnant women. No differences were seen between infants born to pregnant women with epilepsy vs healthy pregnant women in preterm births, major congenital malformations, 5-minute Apgar <6, special care nursery or neonatal intensive care unit admission, gestational age, or any growth measure. There was no difference in the rates of small for gestational age status among infants born to pregnant women with epilepsy vs healthy pregnant women; however, infants born to mothers receiving topiramate had lower birth weight z scores and lamotrigine higher birth weight z scores compared with other monotherapies. The greatest rate of special care nursery or neonatal intensive care unit admission was observed among those on oxcarbazepine monotherapy. Maternal treatment with antiepileptic drugs, overall, appears unassociated with adverse early neonatal outcomes. However, specific monotherapies appear to affect fetal growth with, on average, the greatest reduction in birth weight z score observed among infants born to pregnant women with epilepsy exposed to topiramate monotherapy.

Factors Associated with Pregnancy Outcomes in Hypertensive Pregnant Women in a District Hospital in Benin

Introduction: Hypertension is a major cause of maternal and perinatal morbidity and mortality. This study aims at exploring the outcomes of pregnancy and associated factors in hypertensive pregnant women in Come district hospital from 2014 to 2016. Methods: This is a retrospective, analytical study carried out in June 2016, involving a total of 345 hypertensive patients. Socio-demographic and medical features, including pregnancy and foetal outcomes parameters, were recorded in the case files. Top-down stepwise logistic regression was performed at the 5% threshold. Results: The frequency of hypertensive disorders during pregnancy was estimated at 7.32% and unfavourable outcomes at 35.65%. The adverse maternal outcomes recorded were postpartum death and haemorrhage whereas adverse foetal issues were prematurity, low birth weight, low Apgar scores, stillbirth and death. Factors statistically associated with pregnancy outcome were paucigravida (OR = 2.01 ([1.05 - 3.88]), p = 0.035), history of stillbirth (OR = 4.75 ([1.01 - 22.1]), p = 0.048) and anticonvulsant therapy (OR = 0.32 ([0.19 - 0.54]), p < 0.001). Conclusion: Adequate monitoring via Antenatal Care (ANC) check-ups, timely recourse to care and an effective communication strategy should reduce hypertensive disorders incidence and adverse outcomes in pregnant women.

Клинический случай синдрома задней обратимой энцефалопатии у пациентки молодого возраста

Posterior reversible encephalopathy syndrome (PRES) is characterized by a spectrum of neurological and radiological features. The article presents a clinical report of the posterior reversible encephalopathy syndrome developed due to cerebral edema caused by vasorenal hypertension, uremia, and kidney pathology in a young female patient. The clinical manifestations were characterized by a combination of general cerebral and focal neurological symptoms as the severe cephalgia with nausea and vomiting; psychomotor agitation; convulsive syndrome; visual disorders. Neurological symptoms required a differential diagnosis with a wide range of conditions, including venous stroke, ischemic stroke in the vertebrobasilar system, subarachnoid hemorrhage, viral encephalitis, demyelinating diseases, toxic damage of the nervous system. The magnetic resonance imaging examination revealed the presence of vasogenic edema in the white matter of the occipital, parietal, frontal lobes, and in the medulla oblongata. The regression of neurological symptoms on the second day of hospitalization occurred due to the antihypertensive, anticonvulsant therapy, correction of electrolyte disorders. In the diagnosis of posterior reversible encephalopathy syndrome, magnetic resonance imaging of the brain is informative, revealing areas of vasogenic edema, mainly localized in the occipital and parietal lobes, sometimes extending to the frontal lobes and the brain stem.

Single and in combination antiepileptic drug therapy in children with epilepsy: how to use it

Treatment of childhood seizures is a pressing challenge within neuropediatrics because of its severe impact to the children and families affected by these debilitating disorders. It is of upmost importance to make an early diagnosis, to start a promptly treatment, to use therapy and dosage of the drug appropriately, based on the specific epileptic type and epileptic syndrome. Single therapy with appropriate dosage is the main approach to treatment. When the drug is the cause of an idiosyncratic reaction it is advisable to replace the suboptimal seizure response with another antiepileptic drug, combined therapy with two antiepileptic drugs is also a viable option. In childhood, polytherapy using more than two antiepileptic drugs remains controversial because the harm of interaction with deleterious drugs could potentially replace the damage caused by the seizures themselves. The use of three or more antiepileptic drugs should be limited to epileptic seizures that are particularly resistant to drugs and when non-drug antiepileptic therapies have failed. An approach to the difficult topic of epileptic treatment in childhood is reported. Key point: mono vs polytherapy in epileptic children; single and alternative therapy in epileptic children; use or three or more AEDs in children.

Alzheimer disease and epilepsy

Alzheimer Disease (AD) is a progressive neurodegenerative disorder characterized by loss of memory, difficulty in thinking, changes in behavior and personality disorders. The risk of developing epileptic seizures (ES) in patients with AD increases significantly. Animal and human studies have shown a close relationship between the pathogenesis of ES and AD. The exact prevalence of ES in AD remains unclear due to methodological difficulties, in particular, detection of ES in patients with cognitive impairment. EP types differ in sporadic and hereditary forms of AD. Antiepileptic therapy in AD has its own characteristics. Certain antiepileptic drugs can have a positive effect on cognitive function.

EFFECT OF ANTIEPILEPTIC DRUGS ON P300 EVENT-RELATED POTENTIALS IN PATIENTS WITH EPILEPSY.

Epilepsy is one of the most prevalent chronic neurological diseases, affecting about 70 million people worldwide. Patients with epilepsy often encounter cognitive dysfunction, which is influenced by different factors including age at the onset of epilepsy, etiology of epilepsy, type of seizures, seizure frequency and duration, psychiatric comorbidity, and antiepileptic drug (AED) therapy. Event-related potentials are useful, noninvasive, objective clinical and research instrument for evaluation of cognitive functions in patients. The aim of this study was to investigate and determine the effect of AED monotherapy and polytherapy on cognitive changes in patients with epilepsy, detected with P300 event-related potentials and compared with age- and gender-matched healthy individuals. The study was conducted in 82 patients with generalized and focal epilepsy and 82 healthy individuals aged 18-65 years. Cognitive evoked P300 potentials were recorded in all study subjects using auditory 'oddball' paradigm. The results showed the patients taking AED polytherapy to have a significantly longer P300 latency and significantly lower N200-P300 amplitude. These results indicate that AED polytherapy might worsen cognitive impairment in patients with epilepsy.

A Case of Refractory Absence Epilepsy Precedes Anti-MOG Associated Optic Neuritis

Childhood absence epilepsy (CAE) is one of the most common forms of pediatric epilepsy. While most patients become seizure free with anti-epileptic drug therapy approximately 20% do not achieve seizure remission and are defined as having refractory CAE. Epilepsy is generally thought of as a grey matter disease but has also been associated with abnormal white matter. Optic neuritis (ON), on the other hand, is typically a white matter disorder characterized by inflammation and demyelination of the myelin sheath due to autoantibodies, such as the anti-myelin oligodendrocyte glycoprotein (MOG) antibody. We present the case of an 11-year-old female with refractory CAE who developed anti-MOG antibody positive ON. CAE and ON are not commonly co-morbid and to our knowledge their co-occurrence in a patient has not been previously described. However, in this case, the CAE and ON may be related as her seizures dramatically improved after initiating immunomodulatory treatments for the ON. This may indicate a relationship between ON (potentially specific to anti-MOG positive ON) and CAE, or may suggest that there is an inflammatory component to CAE and that immunomodulatory therapies may have a role in seizure control. Thus, in cases of treatment resistant absence epilepsy, an immune work up may be helpful.

Eucalyptus Oil-Induced Seizures in Children: Case Reports and Review of the Literature.

Objective Eucalyptus oil (EO)-induced seizures (EOIS) in children is a less recognized entity and a rare cause of acute symptomatic seizures. The purpose of this review outlines the clinical features and outcomes of EOIS with observed cases. Patients and Methods We identified three pediatric patients with EOIS who were treated at Prathima Institute of Medical Sciences, Karim Nagar, India. Results Seizures were developed in three children within 15 to 25 minutes after the ingestion of EO. All the children have taken EO first time and all have the first episode of seizures. One child had status epilepticus. Neuroimaging and electroencephalogram were normal. Two children were treated with antiepileptic drugs for 2 weeks. All the children were recovered within 2 days and none of them had a recurrence of seizures. Conclusion EOIS is an underrecognized and rare entity. The knowledge or awareness of EOIS among health care professionals can prevent unnecessary investigations and long-term antiepileptic drug therapy.

Catatonia associated with seizures due to parietal cavernoma.

Catatonia associated with seizures due to parietal cavernoma.

Hot water epilepsy under 3 years of age: A short term follow-up study

Aim: Hot water epilepsy (HWE) is a type of reflex epilepsy that occurs as a result of immersing or pouring hot water over the head. Clinical and laboratory findings and short-term neurodevelopmental outcomes of patients were discussed in this report. Materials and Methods: Eight patients under the age of three and followed-up with a diagnosis of HWE between 2017 and 2020 were enrolled in the study. Patient files were evaluated retrospectively. Results: All our patients except one were boys. The patients’ mean age at admission was 16.6 months (min: 10, max: 36), and the mean follow-up period was 13.5 months (min: 6, max: 25). Two patients also experienced non-reflex motor seizures not related to bathing, and these received daily oral antiepileptic therapy. Six patients had focal onset secondary generalized seizures, while one had focal seizures and one has hypomotor seizures accompanied by loss of consciousness. neurodevelopmental milestones were compatible with the patient’s age in all followed-up cases. Clobazam administration before bathing is currently an effective and easily applicable method for this condition. Conclusion: Hot water epilepsy is mostly benign. Clobazam before bathing is an effective option. Daily oral antiepileptic therapy should be administered to patients with seizures accompanying HWE.

Effects of Long-term Antiepileptic Therapy on Carotid Artery Intima- Media Thickness.

ABSTRACTBackground:Common first-line antiepileptic drugs (AEDs) used in children are valproate, phenytoin, and levetiracetam. Many side effects for these AEDs are reported including obesity, atherosclerosis, and metabolic syndrome. The aim of our study was to evaluate changes in carotid artery intima-media thickness (CIMT) in epileptic children and to correlate with lipid profile of those who are on long-term antiepileptic therapy.Materials and Methods:This case–control study was done over 18 months in department of pediatrics. Sample size was 84 with equal number of cases and controls. Epileptic children between 1 and 18 years of age receiving monotherapy with valproate, phenytoin, or levetiracetam for at least 6 months were included in the study. Measurement of CIMT was done by B mode ultrasonography. Lipid profile was analyzed. Statistical analysis was performed using one-way analysis of variance (ANOVA) test and Pearson correlation.Results:Among 42 cases of epilepsy, 30 were on valproate, 9 on phenytoin, and 3 on levetiracetam monotherapy. No significant difference was noted in body mass index (BMI) among children receiving AED compared with that of controls (P = 0.82). Mean value for CIMT was significantly higher among valproate (0.43 ± 0.04, P ≤ 0.001), phenytoin (0.44 ± 0.04, P ≤ 0.001), and levetiracetam group (0.43 ± 0.03, P = 0.01) compared to controls (0.39 ± 0.01). Significant correlation was noted between CIMT and total cholesterol (P = 0.034), triglyceride (P = 0.011), low-density lipoprotein (P = 0.008), and very low-density lipoprotein (P = 0.011).Conclusion:Children on long-term monotherapy with valproate, phenytoin, and levetiracetam have significantly abnormal CIMT. This might be associated with atherosclerotic changes, and these children may require close follow-up to prevent cardiovascular and cerebrovascular risks.

A case report of ictal bradycardia and asystole: An uncommon manifestation of epilepsy

The ictal bradycardia syndrome occurs when epileptic discharges disrupt normal cardiac rhythms leading to a reduction of heart rate that is more than 10 beats/min below the baseline. Mostly documented ictal bradycardias are accompanied by complex partial seizures of temporal lobe origin. Sudden unexpected death in epilepsy is often assumed to be associated with a concomitant seizure, but it is almost impossible to prove conclusively. Here, we report the case of a 52-year-old female patient admitted with the complaints of two episodes of generalized tonic–clonic seizures and vomiting followed by presyncope and syncope. The patient was admitted in a drowsy disoriented state with hypotension and electrocardiogram (ECG) illustrating sinus tachycardia. Later during admission, the patient developed complex focal seizures with secondary generalization and cardiac arrest. During video electroencephalogram/ECG, she had another similar episode and cardiac arrest. ECG showed rapid progression to asystole and ventricular pause of 25 s followed by complete heart block with ventricular escape rhythm of 17 beats/min. She was implanted with a temporary pacemaker but later during the hospitalization, sudden unexpected death in epilepsy occurred in spite of cardiac pacing and optimum antiepileptic medication. Most documented pauses are of nonlife-threatening duration (range 3–20 s) with longer pauses being observed. Cardiac pacing may help to reduce the risk of falls, but in the absence of official practice guidelines, cardiac pacing should only be considered for patients in whom conventional antiepileptic therapy has failed to prevent ictal asystole. Early diagnosis, interventions, and optimum antiepileptic dose escalation with occasional epilepsy surgery are the mainstay to prevent mortality and severe prognosis of the ictal bradycardia syndrome.

Features of electrophysiological activity in a neonate with severe post-hypoxic brain damage (post-hypoxic cerebral depression)

The article briefly presents the literature data and a description of the clinical dynamic observation of a patient with severe hypoxic brain damage (from the neonatal period to 4 months of life), in the conditions of the neonatal intensive care unit. The article describes the clinical picture, features of paroxysmal states and antiepileptic therapy, dynamics of neuroimaging data, electroencephalographic phenomena recorded in a patient with cerebral depression and structural cerebral injuries. The significance of electroencephalographic examination in the intensive care unit as an informative method for assessing cerebral activity in young children with central nervous system depression syndrome is shown. Disorganization of background activity, indicating structural cerebral damage, long-term persistence of slow-wave activity, detection of epileptic changes in the form of generalized flashes of pointed waves in the theta range, alpha-coma pattern, subsequently replaced by suppression of the background pattern in the patient, are typical electrophysiological disorders recorded in severe hypoxic encephalopathy. In conditions of limited opportunities for visual diagnosis of a patient with impaired consciousness, EEG remains the only method of obtaining information about the functional state of the brain, the data obtained during the study are an important prognostic criterion.

Parathyroid hormone (1-34) can reverse the negative effect of valproic acid on the osseointegration of titanium rods in ovariectomized rats.

ObjectiveThe present work was aimed to evaluate the effect of valproic acid (VPA)，Parathyroid hormone (1–34) (PTH)+VPA on Ti rods osseointegration in ovariectomized rats and further investigation of the possible mechanism.MethodsThe MC3T3-E1 cells were co-cultured with VPA，PTH ​+ ​VPA and induced to osteogenesis, and the cell viability，mineralization ability were observed by MTT and ALP staining，Alizarin Red staining and Western blotting. Twelve weeks after bilateral ovariectomy, all animals were randomly divided into four groups: group OVX and VPA，PTH ​+ ​VPA, and all the rats received Ti implants and animals belong to group VPA，PTH ​+ ​VPA received valproic acid (300 ​mg/day), valproic acid (300 ​mg/day) plus Parathyroid hormone (1–34) every 3 days (60 ​μg/kg), respectively, treatment until death at 12 weeks. Micro-CT, histology, biomechanical testing, bone metabolism index and Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis were used to observe the therapeutic effect and explore the possible mechanism.ResultsResults shown that VPA decreased new bone formation around the surface of titanium rods and push-out force other than group OVX. Histology, Micro-CT and biochemical analysis results showed combined application of systemic VPA showed harmful effects than OVX group on bone formation in osteopenia rats, with the worse effects on CTX-1, P1NP and microarchitecture as well as biomechanical parameters by down-regulated gene expression of Runx2, OCN, Smad1, BMP-2 and OPG, while up-regulated RANKL. However, after PTH treatment, the above indicators were significantly improved.ConclusionsThe present study suggests that systemic use of VPA may bring harm to the stability of titanium implants in osteoporosis, PTH can reverse the negative effect of VPA on the osseointegration of titanium rods in ovariectomized rats.Translational potential of this articleAccording to our research, when patients with epilepsy have osteoporotic fractures, after joint replacement or internal fixation, continue to use sodium valproate for anti-epileptic therapy, the possibility of postoperative loosening increases, again on the basis of It can be reversed with the anti-osteoporosis drug parathyroid hormone (1-34).

Changes in Seizure Frequency and Antiepileptic Therapy during Pregnancy

BackgroundAmong women with epilepsy, studies regarding changes in seizure frequency during pregnancy have been limited by the lack of an appropriate nonpregnant comparator group to provide data on the natural course of seizure frequency in both groups.MethodsIn this prospective, observational, multicenter cohort study, we compared the frequency of seizures during pregnancy through the peripartum period (the first 6 weeks after birth) (epoch 1) with the frequency during the postpartum period (the following 7.5 months after pregnancy) (epoch 2). Nonpregnant women with epilepsy were enrolled as controls and had similar follow-up during an 18-month period. The primary outcome was the percentage of women who had a higher frequency of seizures that impaired awareness during epoch 1 than during epoch 2. We also compared changes in the doses of antiepileptic drugs that were administered in the two groups during the first 9 months of epoch 1.ResultsWe enrolled 351 pregnant women and 109 controls with epilepsy. Among the 299 pregnant women and 93 controls who had a history of seizures that impaired awareness and who had available data for the two epochs, seizure frequency was higher during epoch 1 than during epoch 2 in 70 pregnant women (23%) and in 23 controls (25%) (odds ratio, 0.93; 95% confidence interval [CI], 0.54 to 1.60). During pregnancy, the dose of an antiepileptic drug was changed at least once in 74% of pregnant women and in 31% of controls (odds ratio, 6.36; 95% CI, 3.82 to 10.59).ConclusionsAmong women with epilepsy, the percentage who had a higher incidence of seizures during pregnancy than during the postpartum period was similar to that in women who were not pregnant during the corresponding epochs. Changes in doses of antiepileptic drugs occurred more frequently in pregnant women than in nonpregnant women during similar time periods. (Funded by the National Institutes of Health; MONEAD ClinicalTrials.gov number, NCT01730170.)

Gingival overgrowth induced by anticonvulsant drugs: A cross-sectional study on epileptic patients.

Our aim was to estimate the prevalence of gingival overgrowth (hyperplasia) and to determine whether active molecules affect the severity of overgrowth in a group of epileptic patients. The effects of phenytoin on oral health have been explored in different studies, yet little information is available on other antiepileptic drugs. Data were collected from 213 subjects of both sexes, from 5 to 80years. Patients taking the same antiepileptic therapy for at least 1year and meeting the inclusion criteria of the study (n=162) were subjected to measurement of gingival overgrowth according to the modified Harris and Ewalt classification and O'Leary's plaque control record (OLR). Descriptive statistics were calculated. Data were analyzed using Pearson's r correlation coefficient and chi-square test. Significance level was set at 5%. The active drugs lamotrigine, oxcarbazepine, and phenobarbital were significantly associated with gingival overgrowth in 61%, 71%, and 53% of cases, respectively, and phenytoin, valproic acid, and carbamazepine in 50%, 44%, and 32% of cases, respectively. Different antiepileptic molecules may be related to gingival overgrowth. In addition to phenytoin, also lamotrigine, oxcarbazepine, and phenobarbital were associated with increased prevalence of gingival overgrowth. In the management of epileptic patients, dentists should take into account different drugs as possible causes for gingival overgrowth and warn for possible alternatives.

Leigh Syndrome—TUFM Gene Mutation as a New Probable Genetic Marker: A Case Report

AbstractLeigh's syndrome is a rare neurodegenerative disorder which is of autosomal recessive or mitochondrial inheritance. Global incidence is 1 in 40,000 although very few cases have been reported from India. Respiratory failure is the main cause of death in these children. An 8-year-old female presented to pediatric intensive care unit with chief complaints of seizure (generalized tonic-clonic seizure type), generalized weakness, and swelling, which on MRI and genetic study was diagnosed as Leigh syndrome or Leigh like syndrome. Genetic study revealed a new TUFM gene mutation. Patient improved over the time, oxygen was weaned gradually, and nasogastric tube feeding started, and patient shifted to ward, and discharged on oral antiepileptic therapy. A genetic counseling, early diagnosis, better understanding of disease can result in good seizure control and improved quality of life of these patients. TUFM gene mutation must be considered as a new probable genetic marker.