Focal Seizure Frequency Research Articles

Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review

Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review

Rufinamide efficacy and safety as adjunctive treatment in children with focal drug resistant epilepsy: The first Italian prospective study

Rufinamide is a new antiepileptic drug approved as add-on treatment in Lennox-Gastaut syndrome from the age of 4 years, and for the treatment of focal seizures in adults and adolescents. The aim of this prospective study was to evaluate the safety and efficacy of add-on Rufinamide in the treatment of childhood focal drug resistant epilepsy. We recruited 70 patients for a prospective, add-on, open-label study. Inclusion criteria were: 3 years of age or more; focal drug resistant epilepsy despite the use of three previous AEDs; use of at least one other AED, but no more than three at baseline; more than one seizure per month in the previous 6 months. Rufinamide efficacy was observed up to 12 months of follow-up, with a total responder rate of 38.57%. We found the best results in focal epilepsies due to structural/metabolic etiology (42.6%). The responder rate was similar for focal seizures with secondary generalization, simple focal seizures other than myoclonic jerks, and complex partial seizures. Response to Rufinamide was not related to the age. Our experience suggests that Rufinamide can be effective in reducing focal seizure frequency in children with drug resistant epilepsy, and that it can be considered as a safe drug.

Long term outcome in patients not initially seizure free after resective epilepsy surgery

Purpose To assess the long-term seizure outcome and find predictors of outcome for patients who were not initially seizure free 6 months after epilepsy surgery. Methods We retrospectively reviewed all adult patients who underwent epilepsy surgery at the Epilepsy Center Bethel, between 1992 and 2003. There were 266 patients included in this analysis. Results Of the 266 patients who were included in this study, the probability of becoming seizure free was 12% (95%CI 8–16%) after 2 years, 19.5% (95%CI 15–24%) after 5 years and 34.7% (95%CI 28–41%) after 10 years. In patients who had auras only, the probability of being seizure free was 18.2% after 2 years, 25.5% after 5 years, and 39.1% after 10 years. In the multiregression analysis, the EEG carried out 2 years after surgery, a psychic aura, the frequency of postoperative focal seizures and hypermotor seizures predicted seizure remission in the long-term outcome. Conclusions The frequency and type of postoperative seizures are critical determinants for long-term outcome. Seizure semiology may be the clue to a precise diagnosis and long-term prognosis of epilepsy.

A case of Rasmussen encephalitis treated with rituximab

A 20-year-old woman was referred to our intensive care unit with a high frequency (every 1-2 min) of focal motor seizures. She had been diagnosed as having biopsy-proven Rasmussen encephalitis (RE) of the right hemisphere 7 years previously, since when she had been treated with numerous antiepileptic drugs, as well as with continuous immunotherapies, such as tacrolimus, corticosteroids, mycophenolate mofetil, intravenous immunoglobulin and immunoadsorption. Although hemispherectomy had been avoided due to slow progression of RE, she had not been seizure-free for more than 7 weeks since diagnosis. EEG and MRI. Focal motor status epilepticus associated with right hemispheric RE, causing continuous epileptic activity and unilateral atrophy with edema in the right hemisphere. Immunoadsorption was used initially to treat the seizures. Once they had ceased, we used 375 mg/m2 intravenous rituximab--a monoclonal anti-CD20 antibody--once-weekly for 4 weeks to stabilize the condition, leading to complete depletion of CD19+ B cells. Rituximab infusions were used again when concentrations of CD19+ B cells rose and focal seizures re-emerged. The patient remained on antiepileptic therapy (levetiracetam, oxcarbazepine, zonisamide and phenobarbital) throughout treatment.

Risk factors for depression in patients with epilepsy

Purpose Symptoms of depression are present in 40 to 60 percent of patients with epilepsy. Prior research indicated significant correlation between the incidence and frequency of focal seizures and clinical depression, especially in patients with temporal lobe epilepsy. Anticonvulsive drugs and psychosocial factors contribute to the occurrence of depression as well. The aim of the study was to determine the major depression risk factors in patients with epilepsy. Methods The research was conducted on 203 patients with epilepsy (117 females and 86 males), aged 18 to 50 years, with total time of illness ranging from 60 to 580 months. All subjects underwent the same research protocol, which was applied interictally. Interictal depression was diagnosed according to ICD-10 diagnostic criteria for affective and delusional disorders. The diagnosis was supported by Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D) and Montgomery-Åsberg Depression Rating Scale (MADRS). Statistical analysis included χ 2 test, Fisher’s exact test and stepwise logical regression model analysis. Results In our study 100 patients with epilepsy out of 203 suffered from concurrent depression (49.2%); 76 of them had severe depression (37.4%) and 24 patients had mild depression (11.8%). Complex partial seizures and absence of secondary generalized tonic–clonic seizures were found to be the risk factors for depression. Treatment with clonazepam, frequent hospitalizations (drug-resistancy) and lack of occupational activity were revealed to be additional significant contributing factors. Conclusions Depression in patients with epilepsy is a serious medical and social problem since it afflicts almost one half of all patients treated in epilepsy referral centers. It seems to be correlated with certain types of epileptic seizures, with high frequency of seizures, sub-optimal pharmacologic treatment and lack of occupational and social activity.

Levetiracetam in patients with refractory epilepsy: Results of the SKATE trial in Austria, Germany and Switzerland

To further evaluate the safety, efficacy and optimal dose of levetiracetam (LEV) in daily clinical practice among patients with uncontrolled partial epilepsy with or without secondary generalization. In this phase IV, open-label, 16-week community-based study, 178 at least 16-year-old patients with refractory focal epilepsy were treated with 1000, 2000 or 3000 mg levetiracetam as adjunctive therapy. All patients started with 500 mg LEV b.i.d. (1000 mg/day); the dose was adjusted in 2-week intervals up to 1500 b.i.d. (3000 mg/day) depending on seizure control and tolerability. The main objectives were the adverse events, the percentage reduction in partial and total seizure frequency per week from baseline and the retention rate, defined as the percentage of patients taking LEV at the end of the 16-week treatment period. Of the 178 patients who took at least one dose of LEV 151 completed the study. Thus, the retention rate (number of patients taking LEV at the end of the 16-week treatment period) was 84.8%. Most frequently reported adverse events were asthenia, dizziness, headache, nausea, somnolence and hostility; the majority of these events were of mild to moderate intensity. The seizure-free rate of the ITT population with focal seizures was 16.7%, for all seizures 16.6%; the median reduction of focal seizure frequency was 47.6%, and 46.5% for all seizures. The 50% responder rate was 46.6% for focal seizures and 45.1% for all seizures. Add-on treatment with LEV in patients with refractory partial epilepsy was safe and effective in this study.

Temporal Evolution of Rasmussen's Encephalitis.

The Natural History of Rasmussen's Encephalitis Bien CG, Widman G, Urbach H, Sassen R, Kuczaty S, Wiestler OD, Schramm S, Elger CE Brain 2002;125:1751–1759 Rasmussen's encephalitis (RE) is a chronic inflammatory disease of unknown origin, usually affecting one brain hemisphere. In the present study, a comprehensive assessment of the natural history of the disorder is presented. Seizure frequency, degree of hemiparesis, and degree of cerebral hemiatrophy in 13 patients with histopathologically proven RE were analyzed over the time course before resective epilepsy surgery or introduction of long-term immunosuppressive pharmacotherapy. For the assessment of the degree of cerebral hemiatrophy, on defined slices comprising the sylvian fissure of hard copies of serial magnetic resonance imaging (MRI) investigations, the hemispheric ratio (HR) was determined. The data show an initial prodromal phase with an intermediate frequency of focal onset seizures and mostly no hemiparesis. The occurrence of this stage was observed mainly in adolescent and adult patients. All patients went through an acute phase with a median duration of 8 months. During this stage, there were frequent simple partial motor seizures, development of hemiparesis, and volume loss of the affected hemisphere. After this, the patients passed into a residual stage with a marked decrease in seizure frequency. Twelve months after the onset of the acute stage, the average HR was 0.72. These data allow an estimation of the prognosis of newly affected patients and demonstrate that most of the brain damage in RE occurs during the first 8 to 12 months. These findings should be taken into consideration when future therapeutic approaches to RE are evaluated.

The natural history of Rasmussen's encephalitis.

Rasmussen's encephalitis (RE) is a chronic inflammatory disease of unknown origin, usually affecting one brain hemisphere. In the present study, a comprehensive assessment of the natural history of the disorder is presented. Seizure frequency, degree of hemiparesis and degree of cerebral hemiatrophy in 13 patients with histopathologically proven RE are analysed over the time course prior to resective epilepsy surgery or introduction of long-term immunosuppressive pharmacotherapy. For the assessment of the degree of cerebral hemiatrophy, on defined slices comprising the Sylvian fissure of hard copies of serial MRI investigations, the hemispheric ratio (HR) was determined. The data show an initial prodromal phase with an intermediate frequency of focal onset seizures and mostly no hemiparesis. The occurrence of this stage was mainly observed in the adolescent and adult patients. All patients went through an acute phase with a median duration of 8 months. During this stage, there were frequent simple partial motor seizures, development of hemiparesis and volume loss of the affected hemisphere. After this, the patients passed into a residual stage with a marked decrease in seizure frequency. Twelve months after the onset of the acute stage, the average HR was 0.72. These data allow an estimation of the prognosis of newly affected patients, and demonstrate that most of the brain damage in RE occurs during the first 8-12 months. These findings should be taken into consideration when future therapeutic approaches to RE are evaluated.

Effects of chronic stimulation of the caudate nucleus on a preexisting alumina seizure focus

The effect of chronic stimulation of the monkey caudate nucleus on the frequency of alumina cream focal motor seizures is presented. In animals with appropriately placed electrodes, a decline in seizure frequency was noted with continuous 100-Hz stimulation at 1 to 4.0 mA, and 1-ms duration. This same effect was not seen with alternating stimulation cycles or lesions. A rebound increase in seizure frequency after the termination of stimulation was noted. The decrease in seizure frequency appears to be grossly topographically dependent on electrode position.