Antiepileptic Treatment Research Articles

Psychosocial Stress, Epileptic-Like Symptoms and Psychotic Experiences.

BackgroundCurrent research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions.MethodsThe current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis.ResultsHair cortisol levels among patients experiencing their initial episode of psychosis, were significantly correlated with stress symptoms measured by Trauma Symptom Checklist-40 (r = − 0.48, p < 0.01), and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory (r = − 0.33, p < 0.05) and LSCL-33 (r = − 0.33, p < 0.05). Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale.ConclusionThese findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication.

P 62 Does Photosensitivity matter? Clinical relevance

Photosensitivity is a phenomenon which is defined more precisely by intermittent photic stimulation that elicits a photoparoxysmal response (PPR). Data about the prognosis of people with PPR are scarce. Pure PPR mostly appears in later childhood and adolescence, has a female preponderance and disappears in many people during the third decade. However, whether or not it disappears is mainly dependent whether or not it is associated with an underlying disease with a benign spontaneous course like Rolandic epilepsy, a good therapy prognosis like juvenile myoclonic epilepsy (which is the epilepsy syndrome with the highest proportion of PPR) or a bad prognosis like progressive myoclonic epilepsies. If PPR persists in epilepsy patients stimulus avoidance and suppression is an appropriate additional approach beyond antiepileptic drug treatment. A typical case is reported. Keywords photosensitivity photoparoxysmal response prognosis

P 70 Amplitude-integrated EEG (AEEG) and Conventional EEG in the Diagnosis of Seizures and Cerebral Infarction in a Newborn

Introduction: Newborn seizures are one of the most common neurological emergencies in the neonatal period, especially in the first 1-2 days to the first week after birth. In most cases, it is an acute symptomatic condition (cerebral infarction, bleeding, infection, etc.). Therefore, timely detection of seizures determines the further treatment tactics and prognosis. The further development of the child depends on this. It underlines the relevance of this topic. Materials and Methods: We present the case of a newborn baby. Gestational age (weeks + days): 37 + 2. Birth weight 2935 G. Length: 51 cm. Head circumference: 34 cm. Perinatal B-streptococcal infection. Sepsis. After birth, repetitive twitching of the right extremities, head and eye movements to the right. The child was monitored along with vital parameters by means of an amplitude-integrated EEG (AEEG). In the dynamics, the analysis and interpretation of AEEG, EEG changes with EEG amplitude mapping, EEG frequency mapping and MRI were carried out. Results: The AEEG showed repetitive seizures on the left side and a side difference (sudden increase especially in the lower edge and partly also in the upper edge, triggered by the permanent increased amplitude in the EEG on the left). No epiactivity on the right side. In the conventional EEG, repetitive epilepsy-typical patterns in the form of spike-sharp waves limited to the left hemisphere at the age of 3 days. An anticonvulsant treatment was recommended (phenobarbital 7.5 mg 2 x gl). MRI: the image of an acute ischemic event in the area of the middle cerebral artery on the left frontoparietotemporal. EEG control on the 6th day: significant amplitude asymmetry (T4O2>T3O1, C4O2>C3O1, FP2C4>FP1C3). No epilepsy-typical potentials, no seizure patterns, no hypersynchronous activity. Conclusion: Our case study describes a child with neonatal seizures and a media infarction on the left. The amplitude-integrated EEG with two channels (C3-P3 and C4-P4) can be an early marker of neonatal seizures and unilateral cerebral infarctions with a clear side difference. The amplitude- integrated EEG should be used as a screening method for the detection of high-risk newborns who need the conventional EEG and MRI for final verification and diagnosis. It is important for further treatment tactics and prognosis.

A Child with Developmental Regression and Electroencephalographic Abnormalities.

A 5-year-and-9-month-old boy was referred for investigation of underlying neurometabolic disease. Developmental milestones were normal until 2 years of age when his social and language skills started to regress following a mild infection. He became withdrawn, and stopped speaking and making eye contact. Family history revealed consanguineous parents and a healthy brother. Physical examination was normal except for speech delay, poor social interaction, and poor eye contact, but did not meet the criteria of autism spectrum disorder due to lack of restrictive, repetitive patterns. He did not have clinically evident seizures, but the electroencephalogram showed bilateral frontal and temporal paroxysmal activity that did not resolve with antiepileptic treatment. Brain magnetic resonance imaging was normal. The metabolic workup revealed normal plasma acylcarnitines, moderately increased blood lactate (4.3 mmol/L; reference interval: <2.1), striking increases of proline in plasma (2926 µmol/L; reference interval: 40 to 332) and urine (99 160 nmol/mg creatinine; reference interval: 0 to 250), and urinary 2-ketoglutarate (29 640 mmol/mol creatinine; reference interval: <80) and excretion of pyrrole-2-carboxylglycine (4160 mmol/mol creatinine; not detectable in healthy individuals).

Comparison of Rates of Type 2 Diabetes in Adults and Children Treated With Anticonvulsant Mood Stabilizers

Anticonvulsant mood stabilizer treatment is associated with an increased risk of weight gain, but little is known about the risk of developing type 2 diabetes (T2D). To evaluate the comparative safety of anticonvulsant mood stabilizers on risk of T2D in adults and children by emulating a target trial. This observational cohort study used data from IBM MarketScan (2010-2019), with a 5-year follow-up period. The nationwide sample of US commercially insured patients included children (aged 10-19 years) and adults (aged 20-65 years) who initiated anticonvulsant mood stabilizer treatment. Data were analyzed from August 2020 to May 2021. Initiation and continuation of carbamazepine, lamotrigine, oxcarbazepine, or valproate. Onset of T2D during follow-up. Weighted pooled logistic regression was used to estimate the association of initiation and continuation of carbamazepine, lamotrigine, oxcarbazepine, or valproate with the risk of developing T2D. Inverse probability weights were used to control for confounding and loss to follow-up by measured baseline and time-varying covariates. The analysis included 274 206 adults (159 428 women [58%]; mean [SD] age, 39.9 [13.2] years) and 74 005 children (38 672 girls [52%]; mean [SD] age, 15.6 [2.6] years) who initiated an anticonvulsant mood stabilizer. In adults, initiation of valproate was associated with an increased risk of developing T2D compared with initiation of lamotrigine (5-year risk difference [RD], 1.17%; 95% CI, 0.66% to 1.76%). The number needed to harm was 87 patients initiating valproate for 1 patient to develop T2D within 5 years compared with initiation of lamotrigine. Point estimates were similar when evaluating the association of treatment continuation (5-year RD, 1.99%; 95% CI, -0.64% to 5.31%). The estimated association was smaller and more variable comparing carbamazepine and oxcarbazepine to lamotrigine. In children, RDs were much smaller and more variable (5-year RD for initiation of oxcarbazepine vs lamotrigine, 0.29%; 95% CI, -0.12% to 0.69%; 5-year RD for initiation of valproate vs lamotrigine, 0.18%; 95% CI, -0.09% to 0.49%). In this cohort study, valproate was associated with the highest risk of developing T2D in adults. The comparative safety was generally similar in children, but estimates were small and variable. In the absence of randomized trials, emulating target trials within health care databases can generate the age-specific drug safety data needed to inform treatment decision-making.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

An Examination of sex hormone levels in epilepsy patients taking antiepileptic treatment

Aim Reproductive adverse events may be observed in patients with epilepsy associated with antiepileptic drugs. This study aimed to evaluate changes in sex hormone levels in patients receiving antiepileptic treatment as monotherapy and polytherapy. Method In this case-control study, the sex hormone levels and free androgen indexes were evaluated in 83 patients and 40 controls. In the hormone evaluations, measurements were performed for dehydroepiandrosterone sulfate, sex hormone-binding globulin, follicle-stimulating hormone, luteinizing hormone, total and free testosterone, prolactin and estradiol levels. Results A total of 83 patients (42 males, 41 females) with a mean age of 28±7.2 years and a control group of 40 healthy subjects (14 males, 26 females) with a mean age of 33±8.7 years were included. In the patient group, 45 were receiving monotherapy and 38 polytherapy, 13 (15.7%) patients had focal onset seizures, 68 (81.9%) had generalized onset seizure and 2 (2.4%) had seizure type of unknown origin. In the males of the study group, no difference was determined in the hormone levels. In the females of the study group, the free androgen index was determined to be significantly low in the carbamazepine group compared to the control group (p=0.04) and the sex hormone-binding globulin values were significantly high (p=0.01). In males, a significant positive correlation was determined between serum carbamazepine and follicle-stimulating hormone (p=0.046) and prolactin (p=0.035) and a significant negative correlation was determined with the free androgen index (p=0.032). In females, a statistically significant positive correlation was determined between carbamazepine and prolactin (p=0.036). Conclusion The use of antiepileptic drugs creates changes in the sex hormone levels in males, and associated reproductive side-effects may be seen. In the management of patients with epilepsy, an awareness of these side-effects and individual evaluation could have a positive effect on treatment compliance and patient satisfaction.

Acute encephalopathy associated with anaphylactic shock caused by angiographic radiocontrast media: An unusual case

Radiocontrast media have been used with increasing frequency for centuries. Radiocontrast media may have the spectrum up to anaphylaxis as a side effect. The case presented here is of a patient with acute encephalopathy, associated with the anaphylactic shock of angiographic radiocontrast media. A 67-year old male patient with a diagnosis of abdominal aortic aneurysm (AAA) was referred for coronary and peripheral angiographic evaluation before the AAA operation. After the angiographic examination was completed, the patient developed complaints of dyspnea, stridor, flushing and eruption. The patient recovered totally after a successful medical intervention was performed for anaphylaxis. Decorticated posture gradually developed, and the patient lost consciousness again. After cranial computed tomography, diffusion magnetic resonance imaging and electroencephalography were performed, levetiracetam treatment was started to the patient after the patient had a tonic-clonic convulsion. The patient recovered completely after a seizure with antiepileptic treatment without. Nonconvulsive status epilepticus must be considered after the allergic reaction, and anti-epileptic agents should be taken into consideration in addition to preventing hypoxia and hypoperfusion.

A new phenotype of aldolase a deficiency in a 14 year-old boy with epilepsy and rhabdomyolysis \u2013 case report

BackgroundGlycogen storage disease type XII is a rare metabolic disease resulting from Aldolase A deficiency that causes muscle glycogen accumulation, with crisis of rhabdomyolysis and hemolytic anemia. In the very few cases described, rhabdomyolysis crises are caused by fever and/or exercise and can accompany acute hemolytic anemia. Although currently there is no therapy available for this disease, the guidelines for the management of other forms of glycogen storage diseases recommend a nutritional therapy in order to avoid hypoglycemia or prevent exercise-induced rhabdomyolysis.Case presentationIn this case report we describe a new phenotype of the disease in a 14-year-old boy, characterized by seizures and rhabdomyolysis. Beside an antiepileptic treatment, we propose a new therapeutic approach based on ketogenic diet in order to supply an energetic substrate for skeletal muscle and neurons.ConclusionsThe anti-epileptic therapy and the dietetic approach were well tolerated by the patient who showed good compliance. This led to a deceleration of the disease with no other acute episodes of seizures and rhabdomyolysis, without any side effects observed.

Effect of Sleep on Epileptic Discharges in Patients with Idiopathic Generalized Epilepsy.

Background. It is known that sleep and sleep deprivation affect the EEG findings, onset, frequency and semiology of the seizures. Generalized spike and wave discharges were found more common in drowsiness and sleep states, especially in childhood and juvenile absence epilepsy syndromes. Aim. In this study we aimed to show the effects of short sleep on the interictal and ictal discharges of the patients with genetic generalized epileptic seizures and to show the effects of treatment on the discharges during awake and sleep states. Method. 37 patients (29 females and 8 males) with a diagnosis of genetic generalized epilepsy syndrome were included. All the patients were investigated with video-EEG recording during awake, sleep and post sleep states. Epileptic discharges were counted manually. Discharge numbers and their relation with triggers were analyzed to see the difference between different vigilance states. Results. Number of ictal discharges is found to be increased after sleep. There was no difference in the control EEGs, which were taken under treatment. Conclusion. Sleep is a trigger of epileptic discharges in ictal nature, but an effective antiepileptic treatment prevents this effect.

Natural Course, Clinical Profile, and Treatment Strategies for Cerebral Cavernous Malformations

A large body of evidence has suggested that the natural biology for symptomatic cerebral cavernous malformations (CCMs) is dynamic. These lesions exhibit a temporal clustering epiphenomenon and usually manifest with multispectral clinical patterns, the most relevant being hemorrhagic and seizurogenic events. Most patients with cerebral cavernous malformations are asymptomatic, and the lesions are detected as incidentalomas. However, association with the CCM3 gene, Zabramski type I and II lesions, and brainstem location have the propensity toincrease the bleeding events. The rebleeding risk is 20%/year per lesion, which supports the need for surgical strategies for brainstem cavernous malformations; paradoxically, almost 50% of these patients develop new deficits postoperatively. A navigation-aided approach through safe entry zones is therefore of paramount importance in mitigating the surgical risks. Radiosurgery is currently reserved for biologically aggressive lesions that are not amenable for excision. Similarly, antiepileptic drug treatment is advised following the index seizure event. Early resection of the astrogliotic tissue, barring tissues within the brainstem, following detailed seizure semiology may be beneficial to patients with mesiotemporal lesions and in patients with noncompliance and severe adverse reactions to antiepileptic drug treatment. The proper dichotomization of symptomatic and high-risk cohorts and implementation of stringent surgical strategies performed by experienced surgeons result in good surgical outcomes. The guidelines from the Angioma Alliance Scientific Advisory Board Clinical Experts Panel greatly facilitate in formulating the proper management algorithm.

Ketogenic diet: a therapeutic alternative in pediatric refractory epilepsies

Several studies have demonstrated the effectiveness of ketogenic diet (KD) on refractory epilepsies, especially in children. In this category of patients, a strong collaboration between the healthcare providers and the full engagement of parents is required. The regimen is significantly effective for different types of epilepsy that are resistant to medical treatment. It can also be used as a first-line treatment, given its well tolerance. Treatment has been rolled out for children but research into its use in adults is promising. There is no international or national protocol, the implementation of this diet follows a rigor being specific to every ketogenic center. The understanding of the underlying mechanisms is not well elucidated, it would make it possible to optimize the clinical use of the ketogenic diet, but also to develop novel antiepileptic treatments. This article aims to review the different variants of KD and their prescription terms in children with intractable epilepsy. Keywords: drug-resistant epilepsy, ketogenic diet, children, Modified Atkins Diet.

Neuron Specific Enolase, S100-beta protein and progranulin as diagnostic biomarkers of status epilepticus.

Status epilepticus (SE) is a life-threatening prolonged epileptic seizure. A rapid diagnosis is fundamental to initiate antiepileptic treatment and to prevent the development of neurological sequels. Several serum and cerebrospinal fluid biomarkers have been proposed to help in the diagnosis of SE. Nevertheless, previous studies were conducted on too small patient cohorts, precluding the utilization of interesting biomarkers for the SE diagnosis. Here, we aimed to assess the ability of Neuron Specific Enolase (NSE), S100-beta protein (S100B) and progranulin to help in the diagnosis of SE in a large cohort of patients (36 control patients, 56 patients with pharmacoresistant epilepsy and 82 SE patients). Blood NSE, S100B and progranulin levels were higher in SE patients when compared with control patients or patients with pharmacoresistant epilepsy. Both NSE and progranulin levels were higher in cerebrospinal fluid from SE patients when compared with control patients. The receiver-operating characteristics curves revealed good accuracy at detecting SE for serum S100B (AUC 0.748) and plasma progranulin (AUC 0.756). The performances were lower for serum NSE (AUC 0.624). Eighty-four percent of patients with serum S100B levels above 0.09ng/mL presented with a SE, whereas 90% of patients without SE had serum S100B levels lower than 0.09ng/mL. Serum S100B levels were not significantly different according to SE etiology, SE semiology or SE refractoriness. Our results confirm that NSE, S100B and progranulin levels are increased after SE. We suggest that serum S100B levels might be added to clinical evaluation and electroencephalogram to identify difficult-to-diagnose form of SE.

Correlation between Level of Serum Transaminases and Duration of Antiepileptic Drugs in Epilepsy Children in Sanglah Hospital

BACKGROUND: Some antiepileptic drugs (AEDs), particularly sodium valproate, phenytoin, phenobarbital, and carbamazepine induce and increase production of hepatic enzymes. The adverse metabolic effects of AEDs treatments have become main concern, however data about evaluation of serum transaminases and duration of AEDs in Indonesia still limited. AIM: The aim of the study was to investigate correlation of AEDs and serum transaminases in children with epilepsy. METHODS: This cross-sectional research was conducted in pediatric neurology outpatient clinic in Sanglah Hospital. The target was children with epilepsy who had taken AEDs for at least 6 months. Data were collected from January 2020 to the number of samples were achieved. The exclusion criteria were concomitant liver disease, taking drugs which induce elevated serum transaminase or alcohol abuse. Data including age, gender, nutritional status, type, and duration of AEDs were obtained from medical record. Correlation was analyzed by Pearson’s or Spearman’s correlation, p &lt; 0.05 was considered significant. RESULTS: Total 148 epileptic children enrolled in this study. Aspartate transaminase (AST) and alanine aminotransferase (ALT) level were highest in the group receiving combination therapy (34.37 ± 24.9 U/L and 35.96 ± 23.3 U/L). There was a significant negative correlation between duration of carbamazepine and AST (r = –0.723, p = 0.0001) and ALT (r = –0.457, p = 0.009), as well as duration of valproic acid with AST and ALT (r = –0.689 and –0.677, p = 0.0001). Duration of phenobarbital administration was positively correlated with AST and ALT (r = 0.546 and 0.425, p = 0.0001). Combination therapy also had positive correlation with AST and ALT (r = 0.815 and 0.781, p = 0.0001, respectively). CONCLUSION: Duration administration of carbamazepine and valproic acid had negative correlation with AST and ALT; however, phenobarbital and combination therapy were positively correlated with AST and ALT.

Long-term clinical course and prognosis of hot water epilepsy: 15-Year follow-up

ObjectiveHot water epilepsy (HWE) is a type of reflex epilepsy triggered by bathing with hot water. Hot water epilepsy is generally considered as a self-limiting benign disease although its long-term course and prognosis remains unknown. In this study, we aimed to determine the long-term clinical course and prognosis of hot water epilepsy and possible factors affecting them. MethodsThe diagnosis of HWE was made based on the clinical history obtained from patients and their first degree relatives witnessing to the seizures and video recordings of seizures if available; then, the type of seizure was identified. Good prognosis was defined as patients whose seizures were controlled with or without preventive measures and who did not require antiepileptic treatment. The poor prognosis was defined as patients whose seizures continued despite preventive measures and required antiepileptic treatment. ResultsThe study included 50 (31 male and 19 female) patients with a mean follow-up of 17.63 ± 10.46 (median, 15.0) years. The age at onset of seizure was 14.52 ± 12.71 (median: 10.0) years. There were 38 (76%) patients in the good prognosis group. 18 (36%) of them achieved complete remission, who did not require preventive measures. In the remaining 20 (40%) patients, seizures could be controlled with only preventive measures. Seizures could be controlled with antiepileptic treatment in only 1 (2%) of 12 (24%) patients in the poor prognosis group. A significant relationship was found between the frequency of hot water seizures (HWSs) and poor prognosis (p = 0.019), as well as the presence of spontaneous seizures outside of bathing and poor prognosis (p = 0.000). SignificanceHot water epilepsy, as previously known, is not a self-limiting benign disease. Approximately ¾ of the cases have a good prognosis, but the rest are in the case of chronic epilepsy. The low response rate to antiepileptics’ treatment suggests that the pathogenesis of the HWE may differ from other epilepsies.

OC05: Measuring the effects of first antiepileptic medication in Temporal Lobe Epilepsy: Predictive value of quantitative-EEG analysis

To determine the quantitative EEG responses in a population of drug-naïve patients with Temporal Lobe Epilepsy (TLE) after Levetiracetam (LEV) initiation as first antiepileptic drug (AED). We hypothesized that the outcome of AED treatment can be predicted from EEG data in patients with TLE. Methods: Twenty-three patients with TLE and twenty-five healthy controls were examined. Clinical outcome was dichotomized into seizure-free (SF) and non-seizure-free (NSF) after two years of LEV. EEG parameters were compared between healthy controls and patients with TLE at baseline (EEGpre) and after three months of AED therapy (EEGpre-post) and between SF and NSF patients. Receiver Operating Characteristic curves models were built to test whether EEG parameters predicted outcome. Results: AED therapy induces an increase in EEG power for Alpha (p = 0.06) and a decrease in Theta (p < 0.05). Connectivity values were lower in SF compared to NSF patients (p < 0.001). Quantitative EEG predicted outcome after LEV treatment with an estimated accuracy varying from 65.2% to 91.3% (area under the curve [AUC] = 0.56–0.93) for EEGpre and from 69.9% to 86.9% (AUC = 0.69–0.94) for EEGpre-post. Conclusions: AED therapy induces EEG modifications in TLE patients, and such modifications are predictive of clinical outcome. Significance: Quantitative EEG may help understanding the effect of AEDs in the central nervous system and offer new prognostic biomarkers for patients with epilepsy.

Magnetic resonance imaging features of hippocampus and mechanism of neurocognitive dysfunction for antiepileptic drugs in treatment of depression rats

ABSTRACT To explore the effects of antiepileptic drug sodium valproate on magnetic resonance imaging (MRI) images, neurological cognition, and JAK1/STAT3 pathway in hippocampus of rats with depression, 30 Sprague Dawley (SD) rats were included. The depression model (DM) was prepared through the chronic stress restraint test. Some model rats were injected with 10 mg/kg sodium valproate into abdominal cavity before modeling (RT group)), and healthy rats were selected as controls (healthy control (HC) group). Depth of split brain was greatly increased in DM group, and nitrogen-acetyl aspartic acid (NAA)/creatine (Cr), glutamic acid (Glu)/Cr, and choline (Cho)/Cr ratios were greatly reduced (P < 0.05). Behavioral test results showed that sugar water preference rate, escape latency, and divergence index in DM group were greatly reduced (P < 0.05), and cumulative immobility time, target quadrant stay time, and number of crossings in forced swimming and tail suspension were prolonged dramatically (P < 0.05), with no difference between the two groups (P > 0.05). Expression levels of interleukin 1β (IL-1β) and interleukin 6 (IL-6) in hippocampus of DM group were obviously increased (P < 0.05), and expression levels of JAK1 and STAT3 were decreased visibly (P < 0.05), with no difference between the two (P > 0.05). In summary, anti-epileptic drug sodium valproate effectively improves hippocampal volume characteristics and memory and neurocognitive dysfunction of depression models.

Analysis of corticosteroid and antiepileptic drug treatment effects on heme biosynthesis mRNA expression in lower-grade gliomas: Potential implications for 5-ALA metabolization

ObjectivesIntraoperative visualization of gliomas with 5-aminolevulinic acid (5-ALA) induced fluorescence constitutes a powerful technique. While visible fluorescence is typically observed in high-grade gliomas, fluorescence is considerably less common in lower-grade gliomas (LGGs) WHO grade II&III. Whereas the exact mechanisms determining fluorescence in LGGs are not fully understood, metabolization of non-fluorescent 5-ALA to fluorescent Protoporphyrin IX by specific heme biosynthesis enzymes/transporters has been identified as relevant mechanism influencing fluorescence behavior. Furthermore, recent in-vitro studies have suggested preoperative treatment with corticosteroids and anti-epileptic drugs (AED) as potential factors influencing 5-ALA induced fluorescence. MethodsThe goal of this study was thus to investigate the effect of preoperative corticosteroid/AED treatment on heme biosynthesis mRNA expression in a clinically relevant patient population. For this purpose, we analyzed the mRNA expression levels of specific heme biosynthesis factors including ALAD, HMBS, UROS, UROD, CPOX, PPOX, FECH, ABCB6, ACG2, SLC15A1 and SLC15A2, ABCB1, ABCB10 in a cohort of LGGs from “The Cancer Genome Atlas”. ResultsAltogether, 403 patients with available data on preoperative corticosteroid/AED treatment and heme biosynthesis mRNA expression were identified. Regarding corticosteroid treatment, no significant differences in expression of any of the 11 investigated heme biosynthesis factors were found. In contrast, a marginal yet statistically significant increase in SLC15A1 levels and decrease in ABCB6 levels were observed in patients with preoperative AED treatment. ConclusionWhile no significant differences in heme biosynthesis mRNA expression were observed according to preoperative corticosteroid treatment, changes in SLC15A1 as well as ABCB6 expression were detected in patients treated with AED. However, since these alterations were minor and have opposing effects on 5-ALA metabolization, our findings do not support a distinct effect of AED and corticosteroid treatment on heme biosynthesis regulation in LGGs.

Comparative analysis of background EEG activity in juvenile myoclonic epilepsy during valproic acid treatment: a standardized, low-resolution, brain electromagnetic tomography (sLORETA) study

BackgroundBy definition, the background EEG is normal in juvenile myoclonic epilepsy (JME) patients and not accompanied by other developmental and cognitive problems. However, some recent studies using quantitative EEG (qEEG) reported abnormal changes in the background activity. QEEG investigation in patients undergoing anticonvulsant treatment might be a useful approach to explore the electrophysiology and anticonvulsant effects in JME.MethodsWe investigated background EEG activity changes in patients undergoing valproic acid (VPA) treatment using qEEG analysis in a distributed source model. In 17 children with JME, non-parametric statistical analysis using standardized low-resolution brain electromagnetic tomography was performed to compare the current density distribution of four frequency bands (delta, theta, alpha, and beta) between untreated and treated conditions.ResultsVPA reduced background EEG activity in the low-frequency (delta-theta) bands across the frontal, parieto-occipital, and limbic lobes (threshold log-F-ratio = ±1.414, p < 0.05; threshold log-F-ratio= ±1.465, p < 0.01). In the delta band, comparative analysis revealed significant current density differences in the occipital, parietal, and limbic lobes. In the theta band, the analysis revealed significant differences in the frontal, occipital, and limbic lobes. The maximal difference was found in the delta band in the cuneus of the left occipital lobe (log-F-ratio = −1.840) and the theta band in the medial frontal gyrus of the left frontal lobe (log-F-ratio = −1.610).ConclusionsThis study demonstrated the anticonvulsant effects on the neural networks involved in JME. In addition, these findings suggested the focal features and the possibility of functional deficits in patients with JME.

Use of complementary and alternative medicine among adult with epilepsy - experiences from a single epilepsy center in Malaysia

Complementary and alternative medicine (CAM) usage were reported in Europe, the United States of America and monoethnic Asian countries such as Korea and Taiwan. However, limited literature is available on the variability of CAM usage patterns among people with epilepsy (PWE) in a multi-racial country in particular Malaysia. This cross-sectional study assessed the prevalence, types, predictors and impact of CAM use among adult PWE and their adherence to anti-epileptic drugs (AEDs) treatment.140 patients were recruited, with a median age of 37.5 (IQR,28.0-51.5) years, majority female, had secondary or lower education level, earn &lt;USD1077 and seizure frequency of &lt;1 per month. One quarter (25.7%) used CAM for seizure control, of which 94.4% adhered to AEDs treatment while on CAM. Common CAM used were prayers, traditional herbal remedies, massage, and acupuncture. Only 33.3% have discussed CAM usage with their physician. The main reason for CAM usage was patients’ willingness to try other alternatives for seizure control. Although most patients had not used CAM, 20.2% were receptive to using CAM as concomitant treatment. Buddhists were more open to CAM while Muslims uses CAM selectively and avoid amulets, acupuncture, chiropractic, Ayurveda, yoga, and reiki. Logistic regression analysis showed Buddhist’s religion (OR,11.01), Muslims (OR,4.04), ≥1 seizure per month (OR,3.85) and monthly income of ≥USD1077 (OR,2.92) as the predictors for CMA usage. CAM use is common in Malaysia, especially among Buddhists and Muslims, with higher socio-economic status, and uncontrolled seizures. CAM is mostly used to complement but not in replacement of AEDs.