Anticonvulsant Doses Research Articles

HP22: Daily evolution of brain connectivity during the pre-ictal period in intracranial recordings of epileptic patients

Our understanding of epilepsy mechanisms has shifted its focus towards a dynamic, whole-brain network perspective. Several factors, such as circadian and multi-day cycles, are assumed to influence the likelihood of seizure occurrence. Moreover, this seizure susceptibility is critically dependent on anti-epileptic drug dosage. In this study, we aim to uncover changes in inter-regional communication that are associated with a systematic increase in seizure susceptibility. Uncovering this relationship is important to understand the mechanisms of seizure generation. Method: We investigated long-term, intracranial EEG recordings of 9 drug-refractory epileptic patients. In the context of their presurgical evaluation, anti-epileptic drugs were continuously decreased until seizures occurred (typically between fourth and sixth day). We quantified brain network changes using Directed Transfer Function in the interval between admission and first seizure. Furthermore, each measurement was characterized by various factors, such as time, drug dose, and interictal epileptic spike rate. Finally, to track connectivity changes in time, we projected them into low-dimensional space using Principal Component Analysis. Result: Connectivity changes were consistently linked to time (Pearson’s r range 0.22-0.82), drug dosage (0.24-0.79), interictal spikes and high-frequency oscillations (0.25-0.94), and circadian rhythm (0.21-0.74). These correlations were significant in 8/9 subjects (p<0.05, FDR corrected). When analyzing connectivity dynamics, we observed time points linked with seizure buildup. Their timing was patient-specific and varied between one and three days before seizure. Conclusion: Seizure susceptibility influences inter-regional communication. Interictal spikes and high-frequency oscillations are the most prominent factor. Connectivity investigations can unveil patient-specific critical time points during seizure buildup.

Fits in Pregnant Women with Previously Controlled Epilepsy: A Cross Sectional Study

Background and Aim: Pregnant women with epilepsy require stability in maternal fits and antiepileptic drugs have potentially adverse effects in developing fetuses. Hypoxemia and blunt trauma cause convulsive fits which are treacherous to both maternal and fetus. Limited data available regarding frequency of fits in pregnant women with previously controlled epilepsy. The present study was carried out to evaluate the frequency of fits in pregnant women with previously controlled epilepsy. Methodology: This cross-sectional study was conducted on 70 pregnant women with a previous history of epilepsy in the Department of Obstetrics and Gynecology, Ayub Teaching Hospital, Abbottabad and Holy Family Hospital, Rawalpindifrom January 2021 to December 2021. The incidence of Fits during pregnancy was compared through a peripartum period (epoch 1) and during the postpartum period (epoch 2). Non-pregnant epilepsy women were enrolled as controls and were followed for 18 months period. A higher frequency of Fits was the prime outcome in epoch 1 compared to epoch 2. Administrated drugs such as antiepileptic drugs doses were compared. Results: A total of 70 pregnant and 60 controls women with epilepsy were enrolled. Out of 70, about 60 had a history of previous fits or Fits. The prevalence of fits was significantly higher during epoch 1 whereas in epoch 2, about 21% had Fits and 23% in control had Fits (Odd ratio: 0.89; 95% CI: 0.49-1.57). Of those 60, 22 (36.7%) of the pregnant subjects recruited had a history of eclampsia-related fits. An antiepileptic drug dose during pregnancy was changed in 69% of pregnant women and 29% in control (odd ratios; 6.41; 95% CI, 3.79-10.63). Conclusion: Our study found that the percentage of epilepsy diagnosed women had a higher frequency of fits during pregnancy compared to the postpartum period was comparable to the control group (non-pregnant) women. During comparable time periods, pregnant women experienced more changes in antiepileptic drug doses than non-pregnant women. Keywords: Fits, epilepsy, pregnancy

Якість життя як показник ефективності комбінованої терапії з використанням транскраніальної магнітної стимуляції при епілепсії

У статті наводиться аналіз якості життя згідно з опитувальником QOLIE‑31 у 48 пацієнтів з епілепсією, яким здійснювалася ритмічна транскраніальна магнітна стимуляція (рТМС). Аналіз результатів проведеного дослідження з використанням рТМС і мінімальних терапевтичних доз антиепілептичних препаратів показав, що подібна комбінація фармакологічних і фізичних чинників дозволяє контролювати перебіг епілепсії та забезпечує досить високу протисудомну дію. Отримані результати дозволили обгрунтовано доповнити медикаментозне лікування епілепсії проведенням курсу рТМС, домогтися оптимального терапевтичного результату в кожного пацієнта з мінімальним ризиком побічних ефектів, а також поліпшити якість його життя.

Pharmacokinetic changes for newer antiepileptic drugs and seizure control during pregnancy.

ObjectiveTo investigate pharmacokinetic changes in newer antiepileptic drugs (AEDs) and assess seizure frequencies and risk factors of increased seizures during pregnancy in women with epilepsy (WWE).MethodsA total of 56 pregnancies in 53 WWE who received newer antiepileptic drugs (AEDs) were enrolled. Data on seizure activity and types, daily dose, and AEDs blood levels were derived from routine clinical follow‐up. Changes in AEDs clearance were compared between each trimester and nonpregnant baseline. The ratio of AED levels of each trimester to their targets (nonpregnant baseline) concentrations (RTC) was compared between patients with and without an increased seizure. A binary logistic regression was used to investigate the risk factors contributing to seizure worsening during pregnancy.ResultsIncreased clearances of LTG, LEV, and OXC were observed in all trimesters versus nonpregnant baseline. The peak changes in the clearance of LTG (3.42‐fold baseline clearance) (p < 0.001) and LEV (2.78‐fold) (p < 0.001) occurred in the second trimester during pregnancy, followed by oxcarbazepine (2.11‐fold) in the third trimester (p < 0.03). Plasma concentrations of LTG and LEV during pregnancy were significantly decreased compared to baseline levels, except for OXC. However, no significant differences in RTC values were observed between patients with and without seizure worsening. Some risk factors as seizures for the prior nine months could significantly affect seizure frequency during pregnancy.ConclusionWe found substantial changes in the pharmacokinetics of multiple newer AEDs in WWE, reinforcing the need for therapeutic drug monitoring (TDM) during pregnancy. We would encourage at least one monitoring every trimester and probably more frequently for women with poorly seizure control before pregnancy, and AEDs dose adjustment should keep up with clearance changes. In addition, a well‐controlled seizure nine months before pregnancy could lower the risks of seizure during pregnancy, highlighting the importance of pre‐pregnancy counseling and seizure management before pregnancy.

Prescription patterns and dosages of antiepileptic drugs in prevalent patients with epilepsy in Taiwan: A nationwide retrospective cross-sectional study

ObjectiveTo evaluate the prescription patterns and prescribed daily dose (PDD)/defined daily dose (DDD) ratios of antiepileptic drugs (AEDs) in prevalent patients with epilepsy in Taiwan. Materials and methodsA nationwide retrospective cross-sectional study was conducted for prevalent patients with epilepsy in 2016 using the Taiwanese National Health Insurance Research Database. The prescription records of AEDs of all prevalent patients with epilepsy were retrieved. The mean PDDs and PDD/DDD ratios of AEDs in adult patients were obtained to evaluate dosing adequacy. A chi-square test and two-sample t test were used to analyze the differences in AED prescription patterns and dosages, respectively, among patients with different ages, sexes, comorbidities, and therapeutic approaches. ResultsA total of 118,937 prevalent patients with epilepsy were enrolled. The predominant therapeutic approach was monotherapy, especially in the elder adults, accounting for 82.9% of elder adult patients with epilepsy. The proportion of AED monotherapy was higher in patients with dementia (78.9%) and stroke (80.6%). The top three antiepileptic monotherapies were valproic acid (28.7%), levetiracetam (19.1%), and phenytoin (16.9%); however, oxcarbazepine (22.8%) was substituted for carbamazepine (3.9%) as monotherapy for patients aged 0–17 years. Among adult patients with epilepsy, the PDD/DDD ratio of each AED in monotherapy was less than 1.00. The mean PDD of each AED was higher in polytherapy than in monotherapy (p < 0.01), except for lacosamide. The mean PDDs of all evaluated AEDs in monotherapy were lower in elder adult patients than in younger adult patients, most of which reached statistical significance (p < 0.001). ConclusionsIn Taiwan, valproic acid was the most prescribed AED for prevalent patients with epilepsy. The mean PDDs of most AEDs were lower than the DDDs developed by the World Health Organization.

Status epilepticus—Therapeutic management at the pediatric emergency department

IntroductionStatus epilepticus is an important cause of pediatric neurological emergency. Immediate treatment is essential to prevent definitive neurological damage. Several antiepileptic drugs are available for the management of status epilepticus. MethodsRetrospective study of patients admitted at the emergency department of a tertiary hospital for 5 years (2014–2019). We analyzed the compliance to the treatment guidelines for pediatric status epilepticus. ResultsOne hundred and seventeen admissions were identified, 23.9% of these were febrile status epilepticus. Among the other cases, the most frequent cause was genetic (22.2%). The majority were convulsive status epilepticus (93.1%), 58.7% of which were generalized tonic–clonic seizures. Benzodiazepines were the most used first and second line drug (98.2% and 94.8%). The most frequent third drug used was diazepam (56.4%) followed by phenytoin (18.2%). An infra-therapeutic antiepileptic drug dose was given in 48.7% of cases. 49.6% presented with a prolonged status epilepticus and 6.8% needed intensive care. Incorrect sequence of drugs and infra-therapeutic doses were associated with prolonged status (p<0.001 and p<0.05) and an increased number of antiepileptic drugs used (p<0.001 and p<0.05). ConclusionsBenzodiazepines were the most frequently first and second line drugs used for status epilepticus management. Surprisingly, the most frequently third line drugs used were also benzodiazepines. These findings were partially explained by the misuse of infra-therapeutic doses of these drugs. Noncompliance with the implemented guidelines was associated with unfavorable outcomes.

DISCONTINUATION (СANCELLATION) OF TREATMENT OF EPILEPTIC SEIZURES

Currently, special attention is paid to the quality of life of patients with epilepsy. Therefore, great importance is given to the possibility of canceling antiepileptic therapy with prolonged remission. Before discontinuation of therapy, it is necessary to conduct electroencephalography (EEG) and determine the level of antiepileptic drugs (AED) in blood plasma. The presence of signs of typical epileptic activity on the EEG is a likely question of the correctness of the chosen tactics and the need to identify possible symptomatic mild seizures has no clearly defined standards for reducing the dosage of AED. On the recommendation of some experts, benzodiazepines and barbiturates are canceled within 4-8 weeks, with a combination therapy with a break for each drug of 1 month for 4-8 weeks for each.

Apnea Spells in a Term Neonate.

Apnea Spells in a Term Neonate.

Changes in Seizure Frequency and Antiepileptic Therapy During Pregnancy

(N Engl J Med. 2020;383:2547–2556) The management of pregnant women with epilepsy involves weighing the need to control seizures with the risks of antiepileptic drugs negatively affecting the development of the fetus. Epilepsy is associated with higher rates of maternal mortality compared with nonepileptic mothers. Pregnancy has been reported to increase the rate of seizures in women with epilepsy. This study aimed to compare the frequency of seizures in pregnant and nonpregnant women and investigated changes in required doses of antiepileptic drugs in pregnant women compared with nonpregnant women.

Carbamazepine/oxcarbazepine and valproate have different effects on the electroconvulsive therapy seizure threshold

Patients receiving mood stabilizers such as valproate (VAL) and carbamazepine (CMZP)/Oxcarbazepine (OX) may be referred for electroconvulsive therapy (ECT). The relative effects of these anticonvulsants on seizure threshold and seizure duration are unknown. We extracted data for a 20-month period from the medical records of patients who received bilateral ECT while on treatment with VAL (n=102) or CMZP/OX (n=31; 20 on CMZP, 11 on oxcarbazepine). Age-matched ECT-treated anticonvulsant-free patients (n=133) formed the control group. Seizure threshold in these patients had been determined by stimulus dose titration. The effect of VAL vs CMZP/OX on seizure threshold was examined using multivariable regression with adjustment for confounders. The mean (standard deviation) seizure threshold at the first ECT was highest in the CMZP/OX group (243.9 [106.1] mC), intermediate in the VAL group (177.7 [97.0] mC), and lowest in the control group (138.7 [86.0 Mc]). The regression model explained 37.5% of the variance in seizure threshold at the first ECT. Age, use of CMZP/OX, and anticonvulsant dose were each significantly associated with higher seizure threshold. CMZP/OX was associated with a higher initial ECT seizure threshold than VAL. ECT practitioners may prefer to start with a higher initial stimulus dose in patients receiving CMZP/OX or VAL, and more so for CMZP/OX than VAL, to avoid repeated sub-convulsive stimuli being administered.

Modulation of PTZ-induced convulsions in rats using topiramate alone or combined with low dose gamma irradiation: Involving AKT/m-TOR pathway

ABSTRACT The current study evaluates the anticonvulsant effect low dose whole body gamma irradiation (LDR) alone or combined with topiramate (TOP) against pentylenetetrazol (PTZ)-induced convulsions. Male Wister rats received either saline or pentylenetetrazole (75 mg/kg i.p.). The other three groups were pretreated with single low dose radiation (o.5 Gy), Topiramate (50 mg/kg, p.o., 7 days) and TOP with LDR respectively before PTZ injection. Racine’ score, latency and duration of the convulsions were assessed. Glutamate and GABA were measured. As well as AKT/m-TOR signalling pathway including AKT (protein kinase –B), m-TOR (mammalian target of rapamycin), protein S6 and caspase3 were also assessed. Measurements of markers of oxidative stress including MDA (malondialdehyde), GSH (glutathione) and NO (nitric oxide) were carried out. Histological examinations of hippocampi were done. Results: PTZ produced behavioural changes (high Racine score, short latency and long duration. It elevated MDA and NO contents, while reduced GSH content. TOP treatment alone or combined with LDR ameliorated the PTZ-induced convulsions and caused significant improvement in behavioural changes, brain mediators, m-TOR pathway, oxidative stress and histological pictures in hippocampal regions. Histopathological examinations of the normal group showed normal structure with intact cells, while PTZ- treated rats exhibited necrosis, pyknosis and atrophy of pyramidal cells. The histological findings corroborated with the amendment of biochemical parameters. Conclusions The positive effects of LDR could offer a possible contributor in management of convulsions due to modulation of AkT/m-TOR signalling pathway, reduction of oxidative stress and modulation of brain amino acids. LDR improved the oxidative stress side effects of topiramate. Highlights Male Wistar rats were treated with topiramate 50 mg/kg p.o. for 7 days. on the 6th day of topiramate treatment, rats were exposed to a single low dose whole body gamma radiation (0.5 Gy). on the 7th day of topiramate treatment, rats were injected with pentylenetetrazole 75 mg/kg i.p. 2h after the 7th dose of TOP to illustrate the protective effects of TOP against acute convulsions induced by PTZ. Low dose whole body gamma irradiation purveyed novel anticonvulsant activity which could offer a possible contributor in the basic management of convulsions to avoid side effects of traditional anticonvulsant drugs such as liver and kidney impairments.

The relationship between antiepileptic drug load and challenging behaviors in older adults with intellectual disability and epilepsy

Antiepileptic drugs (AEDs) may affect mood and behavior in people with epilepsy and intellectual disability. A high AED load, derived from AED polytherapy and/or high doses of AEDs, has been suggested to be a risk factor for behavioral side effects. Data were drawn from Wave 3 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). The Behavior Problems Inventory Short Form (BPI-S) was used to assess challenging behaviors. AED load was calculated and median AED loads obtained. Non-parametric tests and binary logistic regression were performed to determine the relationship between AED load and challenging behaviors. Of participants with a reported diagnosis of epilepsy who were taking a regular AED and had completed BPI-S (n = 142), 62.7% (n = 89) exhibited challenging behaviors. Challenging behavior was found to be more prevalent in those with more severe levels of intellectual disability (p < 0.001). Aggressive/destructive behavior and stereotyped behavior were significantly more likely in participants living in residential/campus settings. For participants with a severe/profound intellectual disability, a significantly higher median AED load was found for participants exhibiting aggressive/destructive behavior and self-injurious behavior (SIB) compared to participants not exhibiting these behaviors, indicating a high AED load may contribute to some behavioral problems in this population group. However, many factors can influence behavioral outcomes, creating difficulties in determining those that are associated and the nature of the association. Careful monitoring of AED load, together with increased vigilance for breakthrough behavioral issues is essential for dealing with these complex cases. Larger studies are needed to account for the potential confounding factors.

Detrimental effect of antiepileptic drugs dose in pediatric children with epilepsy in Saudi Arabia: A prospective cohort study.

This study aims to evaluate the effect of dose titration for different oral antiepileptic medications among children with epilepsy in Riyadh, Saudi Arabia.A single-center prospective pilot, cohort study was undertaken at a tertiary hospital in Riyadh, Saudi Arabia. All medical records of pediatric patients below the age of 14 years of age who has been newly diagnosed with epilepsy by attending a medical specialist or on a new epileptic treatment plans were enrolled in the study.A total of 76 epileptic patients were screened for 3 months’ period and 48 patients were included in this study. Out of the 48 patients, 31 patients followed the regular practice in the titration processes and 17 patients were in the British national formulary (BNF) guideline. Fifteen children who were on monotherapy of levetiracetam were in regular practice guideline experienced poor seizure control with a recorded number of seizure incidence (n = 10). The patient in regular practice guidelines using a combination therapy of phenytoin and levetiracetam were experiencing some behavioral disturbance and sedation effect. Seventeen patients followed in the BNF guideline who were on levetiracetam were experienced less adverse effect (n = 2) with no behavioral changes.The group who followed the regular practice found having a greater incidence of documented adverse effects compared to the patients following the BNF guideline. The titrating antiepileptic medication has a detrimental effect on the pediatric population as observed in this study.

Evaluation of an ex-vivo neonatal extracorporeal membrane oxygenation circuit on antiepileptic drug sequestration.

Antiepileptic dosing information used to manage neonatal patients receiving extracorporeal membrane oxygenation (ECMO) is limited. The objective of this study is to quantify the extent of sequestration of various antiepileptic drugs using an ex-vivo neonatal ECMO circuit. Two neonatal closed-loop ECMO circuits were prepared using a Rotaflow centrifugal pump, custom polyvinylchloride tubing and a Quadrox-i Neonatal membrane oxygenator. After 5 minutes of circuit priming and stabilization with normal saline/albumin or expired human whole blood, single boluses of levetiracetam (200 mg), lacosamide (20 mg), and phenytoin (200 mg) were injected into the circuit. To account for spontaneous drug degradation, two polyvinylchloride beakers were filled with normal saline/albumin or expired human whole blood and equivalent antiepileptic drug doses were prepared. Simultaneous pharmacokinetic samples were collected from the control solution and the pre-centrifugal pump, pre-oxygenator, and post-oxygenator sampling ports from each circuit. Similar drug recovery profiles were observed among the three sampling sites investigated. Percent drug sequestration after a 24-hour circuit flow period was relatively similar between the two different circuits and ranged between 5.5%-13.2% for levetiracetam, 18.4%-22.3% for lacosamide, and 24.5%-30.2% for phenytoin. A comparison at 12 and 24 hours demonstrated similar percent drug sequestration across all three drugs in each circuit. Percent drug sequestrations for levetiracetam and lacosamide were less than 20% and for phenytoin were as high as 30% based on the sampling following single bolus dose administration into a neonatal ECMO circuit. Careful consideration of patient clinical status should be taken in consideration when optimizing antiepileptic therapy in neonates receiving ECMO.

Psychiatric disorders of the combination of levetiracetam either with lacosamide or perampanel: a retrospective cohort study.

Background The number of patients with epilepsy receiving perampanel or lacosamide as an add-on treatment following levetiracetam treatment has increased. Although levetiracetam causes psychiatric disorders, it is unclear whether they occur with the combined use of these antiepileptic drugs. Objective To determine the frequency of psychiatric disorders in patients received lacosamide or perampanel in combination with levetiracetam. Setting A single-center retrospective cohort study. Method Patients who received levetiracetam + lacosamide or levetiracetam + perampanel were selected. Medical records from the start of combination therapy contained characteristics of patients and the incidence of psychiatric disorders. Main outcome measure The frequency of psychiatric disorders, the time to onset, dose reduction or discontinuation following psychiatric disorders, and the clinical course following disorder onset. Results Forty-four patients used levetiracetam + lacosamide and 50 used levetiracetam + perampanel. The incidence of psychiatric disorders was significantly lower (p < 0.001) with levetiracetam + lacosamide (6.8%) than with levetiracetam + perampanel (44%). The incidence of affect lability was significantly higher with levetiracetam + perampanel than with levetiracetam + lacosamide (p = 0.018). The time to the onset of psychiatric disorders was within 1 month of dose initiation or increase in one case (33.3%) with levetiracetam + lacosamide and 16 cases (72.7%) with levetiracetam + perampanel. There was no significant difference in clinical characteristics and antiepileptic drug dosages owing to the presence or absence of psychiatric disorders. Conclusion As the frequency of psychiatric disorders was higher with levetiracetam + perampanel therapy, levetiracetam + lacosamide may be preferable. These disorders tended to develop within 1 month of therapy and were not dose-dependent. Antiepileptic drugs should be cautiously prescribed to avoid psychiatric disorders.

Efficacy of High-Voltage Pulsed Radiofrequency for the Treatment of Elderly Patients with Acute Herpes Zoster Neuralgia.

The aim of this study was to evaluate the efficacy of high-voltage pulsed radiofrequency in comparison with standard-voltage pulsed radiofrequency for the treatment of elderly patients with acute herpes zoster neuralgia. Sixty-four elderly acute herpes zoster neuralgia patients were randomly assigned to the standard-voltage pulsed radiofrequency group (i.e., group S, 32 cases) and the high-voltage pulsed radiofrequency group (i.e., group H, 32 cases), which received the standard-voltage and high-voltage pulsed radiofrequency treatment, respectively. The doses of gabapentin and tramadol for analgesia were adjusted based on pain degree of patients. The therapeutic effectiveness were assessed using the numeric rating scale and the sleep quality scale. The doses of gabapentin and tramadol before pulsed radiofrequency and 1, 2, 4, 8, and 12 weeks after pulsed radiofrequency were measured. The incidence of clinically meaningful postherpetic neuralgia (pulsed radiofrequency) 12 weeks after pulsed radiofrequency was noted. After pulsed radiofrequency, the numeric rating scale score and the doses of gabapentin and tramadol in group H were significantly lower than those in group S, respectively (p<0.05). The sleep quality scale score in group H was significantly higher than that in group S (p<0.05). The incidence of clinically meaningful pulsed radiofrequency in group H was significantly lower than that in group S (p<0.05). For the treatment of elderly patients with acute herpes zoster neuralgia, when compared with the standard-voltage pulsed radiofrequency, the high-voltage pulsed radiofrequency can rapidly and steadily reduce the pain degree, improve the sleep quality, reduce the doses of anticonvulsants and analgesics, and decrease the incidence of clinically meaningful postherpetic neuralgia.

Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom.

This study was undertaken to improve understanding of late relapse following epilepsy surgery in pharmacoresistant epilepsy. Retrospective comparison was made of 99 of 1278 patients undergoing surgery during 1999-2015 with seizure relapses after at least 2years of complete seizure freedom with matched controls experiencing continued long-term seizure freedom. Univariate and multivariate analyses were performed. With a mean follow-up of 9.7years, mean time to seizure relapse was 56.6months. In multivariate analysis, incomplete resection based on magnetic resonance imaging (MRI), bilateral lesions on preoperative MRI, and epilepsy onset in the first year of life carried a significantly higher risk of late relapse. In patients with late relapse, additional functional imaging with positron emission tomography had been performed significantly more often. Although the differences were not significant in multivariate analysis, doses of antiepileptic drugs were higher in the relapse group preoperatively and in the first 24months and complete withdrawal was more frequent in the control group (68% vs. 51%). Regarding seizure frequency, most patients had mild seizure relapse (single relapse seizure or <1/month). In our predominantly lesional cohort, complete resection of the MRI lesion is the most important factor to maintain long-term seizure freedom. Two patterns of recurrence were identified: (1) incomplete resected lesions with seizure generation in proximity to the initial resection and (2) epileptogenic networks not detected preoperatively or evolving in the postoperative interval and manifesting with new clinical and diagnostic features.

Fetomaternal outcome in epilepsy in pregnancy in a tertiary care hospital

Introduction: Epilepsy is one of the most common neurological disorders in obstetrics. Pregnancy with epilepsy is associated with increased risk of complications such as preeclampsia, antepartum hemorrhage, stillbirths, neonatal deaths, intrauterine growth restriction (IUGR), and preterm delivery. Aims and Objectives: To study the fetomaternal outcome of pregnancies complicated by epilepsy. Materials and Methods: This was a single center retrospective study conducted over a period of 27 months from March 2017 to June 2019. Maternal variables studied included baseline parameters such as age, parity, and mode of delivery. Other variables studied included duration of epilepsy, seizure during pregnancy, antiepileptic drug usage in pregnancy, and maternal complications. Fetal outcome variables analyzed were number of live birth, stillbirth, birth weight, Apgar score, congenital anomalies, and perinatal complications. Results: Out of 40 patients with epilepsy in pregnancy, 28 were on antiepileptic drugs (AEDs) during the current pregnancy. The cesarean section rate was 65% in these patients which were higher than in patients without epilepsy. Fourteen patients (35%) delivered vaginally out of which ten were induced. There were six patients who had convulsions four had convulsions in the antepartum period and two had convulsions in the postpartum period. Maternal outcome included gestational hypertension in 6 (15%), postpartum hemorrhage in 1 (2.5%), premature rupture of membranes in 2 (5%), hypothyroidism in 2 (5%), and no maternal death. Prematurity was observed in 10%, low birth weight in 22.5%, and IUGR in 15%. All the neonates received 1 mg of Vitamin K at birth liveborn infants were delivered in 36. Conclusion: There was no maternal mortality in our study. The good maternal outcome is because of early booking, regular antenatal visits and regular intake of folic acid, and appropriate number and dose of AEDs. Epilepsy in pregnancy is a high-risk factor which needs thorough evaluation and care from preconception to delivery. These women need delivery at a tertiary care center for the optimum outcome for the perinatal complications.

Effects of Patient and Seizure-Related Factors on Drug Load in Seizure-Free Patients with Idiopathic Generalized Epilepsy

Introduction: Idiopathic generalized epilepsies (IGEs) include four different epilepsy syndromes and IGE have mostly a good response to antiepileptic drugs (AEDs). The most common IGE subgroup is juvenile myoclonic epilepsy (JME). It generally responds well to low doses of AEDs; however, some patients need higher doses of medication. In this study was hypothesized that patient and epilepsy characteristics of seizure-free patients with high drug load might differ from those with low drug load. For this purpose, it was aimed to compare patients with JME and patients with other generalized epilepsies (non-JME IGE) regarding these factors concerning drug load. Patients and Methods: The records of the epilepsy outpatient clinic from 2010 to 2020 were retrospectively evaluated for patients with IGEs. Patients without any epileptic seizures in the last year were accepted as seizure-free. Drug load is calculated by dividing the prescribed daily dose by defined daily dose (PDD/DDD). A total drug load (TDL) equal to one and greater was considered as a high TDL (≥1, high-TDL group), where a drug load of below one was considered as a low TDL (&lt;1, low-TDL group). The high-TDL and low-TDL groups in patients with JME and non-JME IGE were compared in terms of sociodemographic characteristics, personal and family histories, duration of epilepsy, seizure characteristics, epilepsy syndromes, electroencephalography findings, and AEDs and doses. Results: In this study, 119 patients (69 females, 50 males) with a mean age of 30.11 (range, 18–65) years were included. The mean age of onset and duration of the disease was 16.21 (range, 3–47) years and 13.6 (1–45) years, respectively. Sixty-three of the patients were diagnosed as having JME, and 56 patients were diagnosed as having non-JME IGE (39 with generalized tonic-clonic seizures alone, 17 juvenile absence epilepsy). According to the TDL, 35 patients were classified in the low-TDL group and 84 patients in the high-TDL group. The age of disease onset was higher in the non-JME IGE group (P = 0.027). Triple-type seizures were significantly more common in the JME group (P &lt; 0.001). No statistically significant differences were found between the low- and high-TDL groups regarding patient and epilepsy characteristics in the JME and non-JME IGE groups. Conclusion: Most seizure-free patients had low-TDL in the JME and non-JME IGE groups. No association was observed in the JME and non-JME IGE groups regarding the total AED load.

Limited care offered to people with epilepsy in Mwanza, Tanzania: need for intervention.

Introductionepilepsy is a very common neurological disorder which is associated with high socioeconomic burden. While up to 90% of people with epilepsy (PWE) in developing countries do not get appropriate treatment, there is limited information about care offered to PWE in Tanzania. This study aimed to describe available care offered to PWE in Mwanza.Methodsa cross-sectional study involving health care workers (HCWs) and PWE attending five selected hospitals outpatient clinics of Mwanza region was done. HCWs completed self-administered questionnaires while PWE or caretakers were interviewed using structured questionnaires. Coded data were analyzed using SPSS.Resultsa total of 18 HCWs and 218 PWE (or their care takers) participated in this study. Health care workers rarely used investigations to confirm epilepsy diagnosis or explore its causes. 10/18 (55.6%) of HCWs reported that counseling was given to patients but counseling information was largely inadequate regarding the use of anti-epileptic drugs (AEDs). The AEDs prescriptions were dictated by drug availability and affordability to patients. Among 197 PWE, whose AEDs doses were revealed, 136 (69.0%) were under-medicated. No follow-up investigation was done to all PWE who were interviewed. There was discrepancy between hospitals and practitioners regarding withdrawal of AEDs.Conclusionpeople with epilepsy in Mwanza received limited care. Patients were not thoroughly investigated, counseled and followed-up, and had limited choice and accessibility to AEDs. Some patients particularly in district hospitals were under-medicated despite of seizure recurrence. We recommend short-course training about epilepsy management to the HCWs who diagnose and treat PWE regularly.