Complete Cessation Of Seizures Research Articles

Treatment of schizencephaly: A brief review and case study

Introduction: Schizencephaly is a rare disease. It is a poorly understood pathology. The clinical signs are variable and the diagnosis is made by elimination. The treatment is varied with poor results. Corticosteroids are not commonly used medications. Case Presentation: The observation concerns a 5-month-old child, born with a motor deficit in the right hemibody. His parents had an unremarkable medical history. After brain imaging for epileptic seizures, the child is referred for neurosurgery 5 months later. The diagnosis of schizencephaly was mentioned. Antiepileptic treatment associated with corticosteroid therapy for two weeks was started. Motor physiotherapy began at the same time. At 6 months after start of treatment, the evolution was satisfactory marked by a clear improvement in the motor deficit and a complete cessation of seizures. Conclusions: Due to its rarity, the diagnosis of schizencephaly is made by elimination. Brain MRI is the best radiological examination. Corticosteroid therapy combined with physiotherapy can have an impact on good progress. Treatment should be early.

Electroconvulsive Therapy in Refractory and Super-Refractory Status Epilepticus in Adults: A Scoping Review.

Electroconvulsive therapy (ECT) has been suggested as a treatment option for refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). The objective of this scoping review was to conduct an extensive literature review on the role of ECT as a treatment option for RSE and SRSE. We searched Ovid MEDLINE and Scopus for journal articles from database inception until February 2024. Articles were then selected based on predetermined inclusion and exclusion criteria. We identified five retrospective case series with 28 adult patients receiving ECT for RSE or SRSE. ECT was administered within 3-70days (mean 20days) after the development of SE, and the mean number of ECT courses ranged from 1 to 12 sessions for each patient. ECT was administered in fixed or titrated doses. A total of 20 out of 28 patients (71%) showed clinical improvement, with two (7%) having complete cessation of seizures. It is essential to note that given the lack of control, there could be overreporting of clinical improvement in these studies. 11 patients (39%) were reported as deceased due to causes that were not directly related to ECT treatment. Four patients (14%) reported adverse effects of ECT, including memory, concentration, and/or cognitive impairment. There are level-4 Oxford Centre for Evidence-Based Medicine evidence and low-level Grading of Recommendations Assessment Development and Education evidence that suggest ECT as a treatment option for RSE and SRSE. In light of the limitations of the existing evidence, clinicians should carefully consider individual patients' clinical contexts when deciding on the appropriateness of ECT as a treatment option. Further research, including prospective studies with controlled designs, is needed to elucidate the efficacy, safety, and optimal regime of ECT in the management of RSE and SRSE.

Drug resistant epilepsies: A multicentre case series of steroid therapy

PurposeOur study aimed to evaluate the effectiveness of corticosteroids on seizure control in drug-resistant epilepsies (DREs). Our primary goal was to assess the response to steroids for various underlying etiologies, interictal electroencephalographic (EEG) patterns and electroclinical seizure descriptions. Our second goal was to compare steroid responsiveness to different treatment protocols. MethodsThis is a retrospective multicentre cohort study conducted according to the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology). The following data were collected for each patient: epilepsy etiology, interictal EEG pattern, seizure types and type of steroid treatment protocol administered. ResultsThirty patients with DRE were included in the study. After 6 months of therapy, 62.7 % of patients experienced reduced seizure frequency by 50 %, and 6.6 % of patients experienced complete seizure cessation. Findings associated with favourable response to steroids included structural/lesional etiology of epilepsy, immune/infectious etiology and focal interictal abnormalities on EEG. Comparing four different steroid treatment protocols, the most effective for seizure control was treatment with methylprednisolone at the dose of 30 mg/kg/day administered for 3 days, leading to greater than 50 % seizure reduction at 6 months in 85.7 % of patients. Treatment with dexamethasone 6 mg/day for 5 days decreased seizure frequency in 71.4 % of patients. Hydrocortisone 10 mg/kg administered for 3 months showed a good response to treatment in 71 %. ConclusionsIn our study, two-thirds of patients with DRE experienced a significant seizure reduction following treatment with steroids. We suggest considering steroids as a potential therapeutic option in children with epilepsy not responding to conventional antiseizure medicines (ASM).

Is sulthiame effective and tolerated as add-on therapy for infants with epilepsy? A Cochrane Review summary with commentary.

Is sulthiame effective and tolerated as add-on therapy for infants with epilepsy? A Cochrane Review summary with commentary.

What are the effects of intravenous immunoglobulins on seizures and quality of life of people with epilepsy? A Cochrane Review summary with commentary.

What are the effects of intravenous immunoglobulins on seizures and quality of life of people with epilepsy? A Cochrane Review summary with commentary.

Efficacy and safety of using eslicarbazepine in treating focal epilepsy in clinical practice (based on international Euro-Esli study and personal experience)

The latest data on the eslicarbazepine (ESL) efficacy, tolerability and safety in treatment of focal epilepsy are presented based on the results of the European study in clinical practice Euro-Esli that enrolled 2058 patients from 14 European centers, a detailed subgroup analysis, as well as our own data on the follow-up of 65 patients with focal epilepsy receiving ESL in monotherapy or combination therapy. According to the Euro-Esli study, a 12-months follow-up allowed to conclude that therapy retention comprised 73.4%; percentage of responders was 75.6%, whereas proportion of patients with complete seizure cessation was 41.3 %. Regarding ESL efficacy it may be concluded that our personal data were comparable to those obtained during the international study Euro-Esli so that retention was 80%; percentage of responders was 75.4%, whereas seizure-free rate was 58.5%. As for the ESL safety profile our study demonstrated that adverse events (AEs) were registered at lower rate in as few as 21.5% of patients compared to 34% found in the Euro-Esli study. No unexpected serious AEs during the long-term follow-up period were documented in the both studies, which evidence about favorable ESL safety profile elderly patients, patients with comorbid intellectual and mental disorders as well as patients with post-stroke epilepsy.

A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity

The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.

High-Dose Levetiracetam for Neonatal Seizures: A Retrospective Review

BackgroundNeonatal seizures are frequently encountered in the neonatal intensive care unit and may be associated with serious long-term neurological sequelae. Response to treatment continues to be modest, and treatment guidelines remain unclear. The use of levetiracetam has been on the rise in the past several years due to its favorable safety profile in the face of limited data on its efficacy and optimal dosing regimens. Unlike the older age groups, the benefit of escalating to high-dose levetiracetam of 80-100 mg/kg/day in neonates not responding to the standard used dosing regimen (40-60 mg/kg/day) is not studied. We sought to investigate the safety and efficacy of levetiracetam escalation to high dose regimens for neonatal seizures. MethodsA retrospective chart review over a 7-year period was conducted at the American University of Beirut to identify neonates with electrographically proven seizures treated with levetiracetam. Data was collected on electroclinical seizure characteristics, underlying etiology, seizure control, other anti-seizure medications, and adverse effects. ResultsElectronic chart review revealed a total of 15 neonates with electrographically confirmed seizures treated with levetiracetam, with escalation to high doses in seven. As a first line drug, levetiracetam monotherapy terminated seizures in six out 10 neonates, two of whom had complete seizure cessation only after escalation to high doses of 80 or 100 mg/kg/day. When used in combination with other anti-seizure medications, four out of five neonates achieved complete seizure cessation upon escalation to high doses of levetiracetam. No adverse effects were noted. ConclusionsIn neonates not responding to the standard used levetiracetam doses, incremental increases to 80-100 mg/kg/day may be considered. Prospective studies are needed to confirm the promising role of such high dosing regimens, and to better elucidate the role of levetiracetam in neonatal seizures.

Sulthiame add-on therapy for epilepsy.

This is an updated version of the Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 10. Epilepsy is a common neurological condition, characterised by recurrent seizures. Most people respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures, despite treatment with multiple antiepileptic drugs. Sulthiame, also known as sultiame, is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add-on therapy in epilepsy. To assess the efficacy and tolerability of sulthiame as add-on therapy for people with epilepsy of any aetiology compared with placebo or another antiepileptic drug. For the latest update, we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group's Specialized Register and CENTRAL (17 January 2019), MEDLINE Ovid (1946 to January 16, 2019), ClinicalTrials.gov and the WHO ICTRP Search Portal (17 January 2019). We imposed no language restrictions. We contacted the manufacturers of sulthiame, and researchers in the field to seek any ongoing or unpublished studies. Randomised controlled trials of add-on sulthiame, with any level of blinding (single, double or unblinded) in people of any age, with epilepsy of any aetiology. Two review authors independently selected trials for inclusion, and extracted relevant data. We assessed these outcomes: (1) 50% or greater reduction in seizure frequency between baseline and end of follow-up; (2) complete cessation of seizures during follow-up; (3) mean seizure frequency; (4) time-to-treatment withdrawal; (5) adverse effects; and (6) quality of life. We used intention-to-treat for primary analyses. We presented results as risk ratios (RR) with 95% confidence intervals (CIs). However, due to the paucity of trials, we mainly conducted a narrative analysis. We included one placebo-controlled trial that recruited 37 infants with newly diagnosed West syndrome. This trial was funded by DESITIN Pharma, Germany. During the study, sulthiame was given as an add-on therapy to pyridoxine. No data were reported for the outcomes: 50% or greater reduction in seizure frequency between baseline and end of follow-up; mean seizure frequency; or quality of life. For complete cessation of seizures during a nine-day follow-up period for add-on sulthiame versus placebo, the RR was 11.14 (95% CI 0.67 to 184.47; very low-certainty evidence), however, this difference was not shown to be statistically significant (P = 0.09). The number of infants experiencing one or more adverse events was not significantly different between the two treatment groups (RR 0.85, 95% CI 0.44 to 1.64; very low-certainty evidence; P = 0.63). Somnolence was more prevalent amongst infants randomised to add-on sulthiame compared to placebo, but again, the difference was not statistically significant (RR 3.40, 95% CI 0.42 to 27.59; very low-certainty evidence; P = 0.25). We were unable to conduct meaningful analysis of time-to-treatment withdrawal and adverse effects due to incomplete data. Sulthiame may lead to a cessation of seizures when used as an add-on therapy to pyridoxine in infants with West syndrome, however, we are very uncertain about the reliability of this finding. The included study was small and had a significant risk of bias, largely due to the lack of details regarding blinding and the incomplete reporting of outcomes. Both issues negatively impacted the certainty of the evidence. No conclusions can be drawn about the occurrence of adverse effects, change in quality of life, or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add-on therapy in people with epilepsy outside West syndrome.Large, multi-centre randomised controlled trials are needed to inform clinical practice, if sulthiame is to be used as an add-on therapy for epilepsy.

P36 A 1 and 5 year outcome analysis of epilepsy surgery in adults and children

ObjectivesTo evaluate the efficacy of epilepsy surgery at 1 year following surgery and to assess sustainability of seizure control at 5 years post-surgery. To find prognostic factors for good surgical outcomes.DesignRetrospective case notes analysis.Subjects82 consecutive patients operated on for epilepsy by a single surgeon between 2008–2013.MethodsPatients were identified in pre-existing hospital databases and included if 5 year follow-up was available. Their clinical records were accessed via the electronic patient records system at each site. The Engel Classification was used to grade seizure outcome at years 1 and 5 post-surgery. We classified Engel Class I and II as a good outcome and Engel class III and IV as a poor outcome. Case notes were also examined to find prognostic factors for a good long-term surgical outcome.Results86.4% of patients had a good outcome 1 year post-surgery and 77.9% had a good outcome at 5 years. The surgery site (temporal or otherwise) and the presence of a good outcome at year one were found to contribute significantly to odds of a good outcome at year 5. The ability to wean off medication is also commonly an important factor for patients and 24.4% of patients were AED free at 5 years.ConclusionsSurgery is an effective management option for intractable epilepsy in suitably selected patients with complete or near complete seizure cessation in about 80% of the patients and about a quarter of the patients no longer requiring AEDs.

Dietary intervention for canine epilepsy: Two case reports.

SummaryEpilepsy is a common neurologic disorder in humans and domesticated canines. In both species the etiology is diverse and complex, and even with medication a significant portion of the population does not experience sufficient seizure control and/or has unacceptable side effects. Humans often try alternatives such as dietary therapy or brain surgery, but in dogs, brain surgery is rarely an option and, despite potential benefits, there are no standard recommendations for a dietary approach. Herein we describe 2 retrospective case studies detailing the effects of homemade diets prepared for dogs with uncontrolled epileptic seizures and/or toxic side effects of medication. Basic recipes are provided for each formula—a high‐fat “ketogenic” diet and a partial “whole food” diet. Carbohydrate content was reduced or controlled, and in one case this was proven to be essential for seizure control: ingesting carbohydrates would reverse the benefits of the diet and precipitate a seizure. Both dogs experienced fewer seizures and side effects when eating these modified diets compared to when they were administered antiepileptic drugs, including complete cessation of seizures for extended periods. Practical advantages and success of these homemade dietary interventions highlight the potential for diet‐based metabolic therapy as a treatment option for seizures not only in humans but also in dogs.

New approaches in the treatment of epilepsy

Introduction. Despite the significant progress made in the treatment of epilepsy in recent years, no less than 30–40% of patients cannot achieve complete cessation of seizures. Objective. To evaluate new approaches in the epilepsy treatment with nano-sized dosage forms and 3-benzylamino-metilenpirrolidin-2,4-dion (beprodone). Materials and methods. Evaluation of the anticonvulsant activity of nano-phenazepam in comparison with bromine-dihydrochlorophenyl-benzodiazepine (phenazepam) in substances was carried out. 2-aethylium-6-methyl-3-hydroxypyridine succinate (Mexidol) encapsulated on copolymers of lactic and glycolic acids was chosen as the second medicine for evaluation. Beprodone dosed 100 mg/kg intraperitoneally was the third drug assessed in rats. Chronic cobalt-induced epileptogenic focus was chosen as an experimental model. Additional clinical study of beprodone was conducted in 75 patients with epilepsy (men and women, age ranging 18–65 years) with uncontrolled focal seizures with or without secondary generalization. Results. In secondary generalized epilepsy model in rats, nanophenazepam significantly reduced epileptiform discharges in the cortex and hypothalamus along with hippocampus. In the chronic model of cobalt epilepsy, nanomexidol reduced the number of epileptiform discharges 3 times and also stopped the status epilepticus (reducing 7.8 times the number of secondary generalized tonic-clonic seizures). The targets for beprodon are cortical foci and, in the second stage, subcortical foci which generate epileptic activity. In 75 patients with epilepsy who had uncontrolled focal seizures with or without secondary generalization, a significant increase in days without seizures was noted on beprodon; the number of seizures decreased 2 times (p <0.01). Conclusion. Further investigation of new targets for novel antiepileptic drugs and introduction of the latter into clinical practice can be considered as one of the ways to solve the problem of drug resistance.

Prefrontal Lobe Growth Disturbance in a Patient with Frontal Absence Seizures

Absence seizures sometimes present in patients with frontal lobe epilepsy. Cognitive and behavioral problems in patients with absence seizures may be correlated with frontal lobe dysfunction. We report a 15-year-old female patient with absence seizures. She showed learning and behavioral problems such as inattention and impulsivity. We studied serial changes in frontal and prefrontal lobe volume to clarify such correlations among three-dimensional magnetic resonance imaging (MRI). We compared frontal and prefrontal lobe volumes between this patient, the childhood absence epilepsy group ( n = 4, age 8–11 y), and controls ( n = 10, age 6–15 y). Three-dimensional MRI was performed four times in the case (at worsening of absence seizures and 1, 2, and 4 y later) and three times in the childhood absence epilepsy group (at onset and 1 and 2 y later). Even after the complete cessation of seizures, frontal and prefrontal lobe volumes were lower in the case than in patients with childhood absence epilepsy and control subjects. Also, prefrontal-to-frontal lobe volume ratio increased over time in the childhood absence epilepsy and control subjects, whereas its increase was slight in the case. Patients presenting with frontal absence may show prefrontal lobe growth disturbance, which may manifest as poor frontal lobe function.

Sulthiame add-on therapy for epilepsy

Epilepsy is a common neurological condition characterised by recurrent seizures. Most patients respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures despite multiple antiepileptic drugs. Sulthiame, also known as sultiame, is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add-on therapy in epilepsy. To compare the efficacy and side-effect profile of sulthiame as add-on therapy compared with placebo or another antiepileptic drug. We searched the Cochrane Epilepsy Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov and the WHO ICTRP Search Portal on 11 August 2015. No language restrictions were imposed. We contacted the manufacturers of sulthiame and researchers in the field to seek any ongoing or unpublished studies. Randomised controlled add-on trials of sulthiame in people of any age with epilepsy of any aetiology. Two review authors independently selected trials for inclusion and extracted relevant data. The following outcomes were assessed: 1) reduction in seizure frequency of 50% or greater between baseline and end of follow-up; 2) complete cessation of seizures during follow-up; 3) mean seizure frequency; 4) time to treatment withdrawal; 5) adverse drug effects; and 6) quality of life scoring. Primary analyses were intention-to-treat. We present a narrative analysis. We included one trial with 37 participants with a new diagnosis of West syndrome. Sulthiame was given as an add-on therapy to pyridoxine. No data were reported for outcomes 1), 3) or 6). Overall risk ratio with 95% confidence intervals (CI) for complete cessation of seizures during a nine-day follow-up period versus placebo was 0.71 (95% CI 0.53 to 0.96). Meaningful analysis of time to treatment withdrawal and adverse drug effects was not possible due to incomplete data. Sulthiame may lead to a cessation of seizures when used as an add-on therapy to pyridoxine in patients with West syndrome. The included study was small and had a significant risk of bias which limits the impact of the evidence. No conclusions can be drawn about the occurrence of adverse drug effects, change in quality of life or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add-on therapy in patients with epilepsy outside West syndrome. Large, multi-centre randomized controlled trials are necessary to inform clinical practice if sulthiame is to be used as an add-on therapy for epilepsy.

Efficacy of corticosteroid therapy in treating epileptic encephalopathies and refractory epilepsies other than West syndrome

To evaluate the efficacy of steroid therapy in epileptic encephalopathies and refractory epilepsies other than West syndrome. Retrospective analysis of treatment and outcome data of patients treated with steroids for epileptic encephalopathies. Outcome was analyzed in terms of the patient’s epileptic syndrome, age at seizure onset, duration of seizure disorder, age at treatment, abnormalities noted on neurological examination, developmental status and type of steroid. Fifty-eight consecutive patients from six pediatric neurology outpatient clinics were included in the study. The epileptic syndrome and types were as follows: myoclonic epilepsy (n = 16), epilepsy with continuous spike waves during slow-wave sleep (n = 12), partial epilepsy (n = 10), Landau-Kleffner syndrome (n = 6), generalized epilepsy with multiple epileptic seizure types (n = 5), Rasmussen’s encephalitis (n = 3), Lennox-Gastaut syndrome (n = 2), atypical absence (n = 2) and spasms (n = 2). Sixteen patients (27%) had received adrenocorticotrophic hormone (ACTH) and 42 (73%) had received prednisone (22 of the latter patients were given initial pulse methylprednisolone). Complete cessation of seizures as well as disappearance of epileptic discharges in electroencephalogram were achieved in 16 patients (28%); 15 other patients (26%) had improvement of > 50%. Of the 31 patients with > 50% improvement and follow-up of at least 1 year, 16 (52%) subsequently relapsed. ACTH was found to be significantly more efficacious than prednisone in controlling seizures and improving function. Initiation of treatment with high-dose methylprednisolone did not increase efficacy. ACTH may be more efficacious than prednisone in treating epileptic encephalopathies and refractory epilepsies other than West syndrome.

Efficacy of levetiracetam as first add-on therapy to carbamazepine and valproate sodium for children with epilepsy

We examined the effectiveness of levetiracetam (LEV) as add-on therapy after failed treatment with a first anti-epileptic drug in a prospective cohort of children with epilepsy. Eligible patients with epilepsy experienced uncontrolled seizures with the first anti-epileptic drug and were 1-15-year-old. Afte ra3m obaseline period, patients were administered LEV at an initial dose of 10 mg/kg/d, which, if needed, was incrementally increased by 5 mg/kg/d weekly up to a maximum dose of 60 mg/kg/d. Seizure frequency was defined as the mean seizure frequency per month. Clinical response to LEV over the following period of at least 6 mo was divided into five categories. A total of 37 patients were enrolled. The majority of patients (97.30%) had localization-related epilepsy. The responder rate (rate of patients with ≥50% reduction in seizure frequency) was 30/37 (81.08%). In addition, 20 of 37 (54.05%) patients showed complete seizure cessation. Mean percentage reduction in seizure frequency (all types of seizures) during the first 6 mo treatment period compared to baseline was 89.28% in responders, compared with 25.22% in non-responders. This proportion remained stable during the second 6 mo period (90.17%). Significant changes in seizure frequency were seen between before LEV administration and both the first 6 mo (P < 0.01) and second 6 mo (P < 0.01) in responders, but not in non-responders. Mean effective dose of LEV was 27.51 mg/kg/d. Somnolence was the only reported individual adverse event (5.41%), and was mild in all cases, so LEV discontinuation was not needed. LEV appears useful as a first add-on treatment in children with localization-related epilepsy.

The Ketogenic Diet as Broad-Spectrum Treatment for Super-Refractory Pediatric Status Epilepticus

Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients.

Optimization of the Treatment of Focal Forms of Epilepsy in Young Children

A total of 30 children aged from 24 to 46 months were observed and were divided into two groups on the basis of clinical and instrumented signs: 22 patients (73%) had symptomatic focal epilepsy and eight patients (27%) had cryptogenic (presumptively symptomatic) focal epilepsy. Topamax (topiramate) was used as monotherapy (eight children) or in combined treatment (22 patients). The mean therapeutic dose of Topamax was 5.9 mg/kg/day. Treatment efficacy was assessed in terms of changes in seizure frequency. Positive results (complete cessation of seizures or decreases by at least 50%) were seen at six months in 19 patients (63.75%). Effects were absent or minimal in nine patients (29.5%). Increases in seizure frequency occurred in two cases (6.75%). Adverse events were recorded in 11 patients (36%); side effects requiring withdrawal of Topamax were seen in five cases (16%) and consisted of vomiting, increased seizure frequency, and enuresis.

Reduction of seizure occurrence from exposure to auditory stimulation in individuals with neurological handicaps: a randomized controlled trial.

BackgroundThe purpose of this work was to determine in a clinical trial the efficacy of reducing or preventing seizures in patients with neurological handicaps through sustained cortical activation evoked by passive exposure to a specific auditory stimulus (particular music). The specific type of stimulation had been determined in previous studies to evoke anti-epileptiform/anti-seizure brain activity.MethodsThe study was conducted at the Thad E. Saleeby Center in Harstville, South Carolina, which is a permanent residence for individuals with heterogeneous neurological impairments, many with epilepsy. We investigated the ability to reduce or prevent seizures in subjects through cortical stimulation from sustained passive nightly exposure to a specific auditory stimulus (music) in a three-year randomized controlled study. In year 1, baseline seizure rates were established. In year 2, subjects were randomly assigned to treatment and control groups. Treatment group subjects were exposed during sleeping hours to specific music at regular intervals. Control subjects received no music exposure and were maintained on regular anti-seizure medication. In year 3, music treatment was terminated and seizure rates followed. We found a significant treatment effect (p = 0.024) during the treatment phase persisting through the follow-up phase (p = 0.002). Subjects exposed to treatment exhibited a significant 24% decrease in seizures during the treatment phase, and a 33% decrease persisting through the follow-up phase. Twenty-four percent of treatment subjects exhibited a complete absence of seizures during treatment.Conclusion/SignificanceExposure to specific auditory stimuli (i.e. music) can significantly reduce seizures in subjects with a range of epilepsy and seizure types, in some cases achieving a complete cessation of seizures. These results are consistent with previous work showing reductions in epileptiform activity from particular music exposure and offers potential for achieving a non-invasive, non-pharmacologic treatment of epilepsy.Trial RegistrationClinicaltrials.gov NCT01459692

Experience in using injectable valproic acid (convulex) in patients with serial epileptic seizures and status epilepticus at the prehospital stage

Objective: to evaluate the efficacy of injectable valproate (convulex) in patients with serial epileptic seizures and status epilepticus (SE) at the prehospital stage. Patients and methods. Thirty-two adult patients, including 17 (53%) men and 15 (47%) women, were examined. Most patients were aged over 40 years (mean age 54.7±9.4 years). To define the required dose of the drug, the authors estimated the patient's weight that averaged 76.8±1.9 kg, i.e. there was a preponderance of patients who needed convulex, more than 500 mg, to achieve a therapeutic effect. Results. It was impossible to reliably and validly evaluate the type of a seizure as the medical emergency team (MET) generally observed the patient with a just evolving seizure and the medical history data were not always valid therefore the type of convulsions and the type of a seizure were evaluated. In most cases, solitary convulsive attacks (tonic and/or clonic convulsions) and/or serial seizures were observed in 12 (37.5%) and 14 (43.7%) patients, respectively; SE was recorded in 6 (8.8%) patients. Generalized seizures (without a clear focal onset) were prevalent in 24 (75%) patients while 8 (25%) patients were found to have partial seizures (seizure onset lateralization, a focal onset). According to the pattern of convulsions, seizures may be classified into three types: tonic-clonic, clonic, and tonic in 22 (68.8%), 7 (21.9%), and 3 (9.3%) patients, respectively. Analysis of the efficacy of intravenously injectable valproate (convulex) in the group of patients with SE and epileptic seizures indicated that complete cessation of seizures could be achieved in 68.8%, their rate decreased in other 9.4% of the patients. Seizures were preserved in 7 (21.8%) cases, which required additional administration of drugs. Conclusion. Injectable valproic acid (convulex) has a high efficacy and may be preclinically used as the drug of choice to arrest SE and serial seizures caused by both epilepsy and other diseases of the brain. Convulex is easy-to-use (a ready-to-use solution), particularly in the work of MET. The ready-to-use formulation allows for its bolus administration within minutes, the drug does not affect hemodynamic parameters, which is particularly important for elderly patients and children. The administration of convulex makes it possible to prevent respiratory depression and fails to affect the level of patient consciousness.