Control Of Intractable Seizures Research Articles

Intractable Epilepsy Controlled by Neurofeedback and Adjunctive Treatments: A Case Report

This case report documents the treatment of a female patient with intractable temporal lobe epilepsy with secondary generalization. At the age of 13, the patient was hospitalized with ~120 seizures in a day, some of which were life-threatening. After hospital discharge, despite a regimen of multiple antiseizure medications, the patient still experienced ~90 seizures per day. After the interventions described in this work, over 500 neurofeedback sessions guided by EEG or qEEG data and adjunctive treatments including mental skills coaching, the patient became seizure- and medication-free, progressing from poor academic performance and inability to carry out normal daily life to attending university as a student athlete playing an NCAA Division I sport. This case emphasizes that, with professional guidance and supervision, it is possible for people with epilepsy or their caregivers to provide the extensive, long-term neurofeedback and adjunctive training necessary for reduction and control of intractable seizures.

臭化カリウムが奏効した特異な脳炎・脳症後てんかんの一群 (粟屋・福山) 類似の最重症例

臭化カリウムが奏効した特異な脳炎・脳症後てんかんの一群 (粟屋・福山) 類似の最重症例

Ketogenic diet in pediatric epilepsy patients with gastrostomy feeding

Ketogenic diet is effective in the control of intractable seizures. Poor compliance is a major limiting factor. In one study, only 50% of children receiving the oral ketogenic diet remained on the diet after 1 year. Twelve children with static encephalopathy and intractable symptomatic epilepsy were given the ketogenic diet via gastrostomy tube. Mean age was 3 years (range, 7 months to 6.5 years). Mean seizure frequency at baseline was 199/month. Seizure frequency after 12 and 18 months of diet was compared with baseline. After 12 months on the diet, the number of antiepileptic drugs was compared with baseline. Median seizure reduction at 1 year and 18 months was 61% and 66%, respectively (P = 0.02). Individually, six patients had 90% seizure reduction, one had 75% reduction, three had 50% reduction, and two patients did not improve. Mean antiepileptic drugs at baseline was 2.8; at 12 months 1.6 (49% reduction). Three patients had weight loss. Two patients discontinued the diet at 13 months and 21 months, respectively, because of diarrhea and weight loss. Compliance with diet was 100% during treatment. This study suggests that the ketogenic diet via gastrostomy feeding tube is safe and effective in children with intractable seizures and ensures compliance.

Seizure suppression by adenosine A1 receptor activation in a mouse model of pharmacoresistant epilepsy.

Because of the high incidence of pharmacoresistance in the treatment of epilepsy (20-30%), alternative treatment strategies are needed. Recently a proof-of-principle for a new therapeutic approach was established by the intraventricular delivery of adenosine released from implants of engineered cells. Adenosine-releasing implants were found to be effective in seizure suppression in a rat model of temporal lobe epilepsy. In the present study, activation of the adenosine system was applied as a possible treatment for pharmacoresistant epilepsy. A mouse model for drug-resistant mesial temporal lobe epilepsy was used, in which recurrent spontaneous seizure activity was induced by a single intrahippocampal injection of kainic acid (KA; 200 ng in 50 nl). After injection of the selective adenosine A1-receptor agonist, 2-chloro-N6-cyclopentyladenosine (CCPA; either 1.5 or 3 mg/kg, i.p.), epileptic discharges determined in EEG recordings were completely suppressed for a period of </=3.5 h after the injections. Seizure suppression was maintained when 8-sulfophenyltheophylline (8-SPT), a non-brain-permeable adenosine-receptor antagonist, was coinjected systemically with CCPA. In contrast, systemic injection of carbamazepine or vehicle alone did not alter the seizure pattern. This study demonstrates that activation of central adenosine A1 receptors leads to the suppression of seizure activity in a mouse model of drug-resistant epilepsy. We conclude that the local delivery of adenosine into the brain is likely to be effective in the control of intractable seizures.