Frequency Of Epileptic Seizures Research Articles

Oxidative Stress Measurement and Prediction of Epileptic Seizure in Children and Adults With Severe Motor and Intellectual Disabilities.

BackgroundThe medical care of severe motor and intellectual disabilities (SMID) depends on the empirical medical care. Epileptic seizure specific to SMID is difficult to suppress using anti-epileptic drugs, and its tendency to persist for long periods poses an issue. The present study was undertaken to evaluate the relationship between epileptic seizure in cases with SMID and oxidative stress in the living body by examining endogenous antioxidants, the degree of oxidation (reactive oxygen metabolites (d-ROMs)), and the biological antioxidant potential (BAP) as indicators.MethodsTarget patients were 43 SMID epilepsy patients. Blood was sampled before breakfast and medication. As for the specimen, d-ROMs and BAP were measured using the free radical analyzer.ResultsThe present study did not reveal any correlation between endogenous antioxidants (albumin) and the frequency of epileptic seizures. On the other hand, d-ROMs were correlated with the frequency of epileptic seizure. In particular, strong correlations between the frequency of epileptic seizures and the d-ROMs/BAP ratio as well as the BAP/d-ROMs ratio were noted.ConclusionsThese results indicate that the use of d-ROMs and BAP as biomarkers can provide a tool for predicting the prognosis of epileptic seizures in patients with SMID.

Systemic Family Therapy of Comorbidity of Anxiety and Depression with Epilepsy in Adolescents

ObjectiveThe aim of this study was to find if systemic family therapy (SFT) does work in anxiety and depression with epilepsy in adolescents (ADAE).Methods104 adolescents with epilepsy, aged 13–20 years old, were included from December 2009 to December 2010, the enrolled patients were with anxiety [Hamilton Anxiety Scale (HAMA) score ≥14 points] or depression [Hamilton Depression Scale (HAMD) score ≥20 points]. The patients were randomly divided into the control group (n=52) treated with antiepileptic drugs (AED) and the intervention group (n=52) undergone Systemic Family Therapy (SFT) as well as AED. The AED improvements, anxiety and depression scores, Social Support Rating Scale (SSRS), Family Assessment Device (FAD) and scale of systemic family dynamics (SSFD) were observed after 3-month treatment.ResultsThe frequencies of epileptic seizures in intervention group was decreased much more significantly than the control group (4.22±3.54 times/month vs. 6.20±5.86 times/month, p=0.04); and the scores of anxiety (9.52±6.28 points vs. 13.48±8.47 points, p=0.01) and depression (13.86±9.17 points vs. 18.89±8.73 points, p=0.02) were significantly decreased than the control group; meanwhile, the family dynamics and family functions were significantly improved, and the social support was also increased (p<0.05).ConclusionSFT combined with AEDs had better efficacies than AEDs alone, not only the frequency of epileptic seizures was decreased, but also the patients' anxiety and depression were improved, and the family dynamics, family functions and social support were improved.

The characteristics of the patients with Rett syndrome: Case series

Rett syndrome is a neurodevelopmental disorder caused by mutation in the gene MECP2 on the X chromosome. The main clinical characteristics are breathing disorders, epileptic seizures, scoliosis, walking disability and constipation with frequent growth failure and malnutrition. Our transversal study included 29 female patients with Rett syndrome treated in the Institute for Mother and Child Health Care ''Dr Vukan Cupic'' in Belgrade. The patients were anthropometrically measured by their height and weight and caluculating body mass index. The degree of scolisios, the frequency of epileptic seizures, walking ability and grade of respiratory dysfunction were assessed based on the clinical scales for disease severity estimation. The statistical data analysis was done in the software package PASW Statistics 18. The average age of the patients was 145.5±90.1 months. The average height was 125.2±22.1cm, the average weight 27.6±12.3kg, and the average body mass index was 16.6±3.5kg/m2. The average z scores for height, weight and BMI-for-age were statistically significantly lower in comparison to general population, which is given with negative z scores. There was the statistically significant negative coorelation between the age of patients and the average z scores for height-for-age (r=-0.464 p=0.011), weight-for-age (r=-0.433 p=0.019) and BMI-for-age (r=-0.433 p=0.019). The statistically significant negative coorelation was found between the degree of scoliosis and the average z scores for height and weight-for-age, but not with the average z score for BMI-for-age. The growth failure and malnutrition represent significant problems which are found in Rett syndrome. The detection of factors affecting the growth and nutrition in patients with Rett syndrome could greatly contribute to the improvement of the quality of life in the patients with Rett syndrome and perhaps lead to the correction of the approach of symptomatic and supportive therapy.

Complex evaluation of clinical and instrumental data for grounding of the tactics of operative treatment in patients with resistant epilepsy forms

Frequent epileptic seizures and side effects of drugs have a significant negative impact on the quality of life. The main goal in the treatment of such patients is not only to decrease the number of attacks and their severity, but also to improve social adaptation. Surgical treatment for some forms of pharmacoresistant epilepsy improves prognosis and enhances the quality of life of patients, and the result depends on the duration of the disease. The main task of the preoperative examination is the most accurate localization of the epileptogenic zone. In the case of proximity or the overlapping of the epileptogenic zone with functionally significant parts of the crust, additional surveys to determine the latter are conducted. The survey may be conducted using non-invasive techniques, such as MRI, functional MRI, positron emission tomography (PET), single photon emission computed tomography (SPECT) and extracranial electrical stimulation or invasive direct electrical stimulation of the cortex.

Study on protective effect of ketogenic diet against hippocampal neurons of kainic acid-induced epileptic rats

Objective To investigate the protective effects of ketogenic diet on hippocampal neurons of kainic acid (KA)-induced epileptic rats. Methods A total of 40 healthy male specific pathogen free (SPF) Sprague-Dawley (SD) rats were randomly divided into 4 groups, with each group containing 10 rats. Epileptic rat models were formed by injection of KA through lateral ventricle with brain stereotactic instrument. According to Racine classification, epileptic seizures in rats above grade Ⅳ were defined successful. Then the rats were given different dietary treatment: Group C with normal saline and normal diet, Group K with normal saline and ketogenic diet, Group E with KA and normal diet, Group EK with KA and ketogenic diet. All rats were observed for 21 d, and were recorded each body weight. The epileptic seizure frequency and duration were observed at 12:00-15:00 daily. At the 21st day, all rats were put to death, and the brain hippocampus tissues were separated. Neuron injury of rat hippocampal CA3 region in Group E and EK was observed by HE staining. Normal neuron number of rat hippocampal CA3 region in Group E and EK was counted by Nissl staining. Results Group C and K had no epileptic seizures, and the neuron number in hippocampal CA3 region was normal. Rats in both Group E and EK had grade Ⅳ or Ⅴ seizures. The number of seizures in Group EK [(17.90 ± 4.12) times] after 21-day ketogenic diet was decreased significantly compared to Group E [(30.50 ± 4.40) times] after 21-day normal diet ( t = 6.606, P = 0.000). The seizure duration in Group EK [(212.70 ± 17.75) s] after 21-day ketogenic diet was shortened compared to Group E [(335.00 ± 14.21) s] after 21-day normal diet ( t = 17.011, P = 0.000). The normal neuron number in hippocampal CA3 region in Group EK (117.67 ± 7.51) was more than those in Group E (71.33 ± 6.11), with statistically significant difference ( t = 9.614, P = 0.000). Conclusions Ketogenic diet has protective effect on hippocampal neurons of kainic acid-induced epileptic rats. DOI: 10.3969/j.issn.1672-6731.2015.11.011

Ian Curtis: Punk rock, epilepsy, and suicide.

Ian Curtis was the front man of the post-punk band Joy Division. He suffered from epilepsy and actively incorporated his experiences of the disease in his lyrics. Curtis had frequent epileptic seizures, both on and off stage. After dying from suicide in 1980, he became a legend in the post-punk milieu. The impact which the epilepsy, the epilepsy treatment, and comorbid depression had on his artistic life and premature death is not well known.

Epilepsy and skin anomalies in tuberous sclerosis complex: Report of five cases and review of the sub-Saharan African literature

Tuberous sclerosis complex (TSC) is a multi-organ disease characterized by hamartomatous involvement of several organs notably the brain, skin, eye, kidneys, heart and lungs. This rare disorder (incidence is estimated between 1/5,800 and 1/10,000 births) results from mutation of the TSC1 gene on chromosome 9q34 or from mutation of the TSC2 gene on chromosome 16q13. In 80% of cases, it is a consequence of a de novo mutation while in the remaining cases its transmission follows an autosomal dominant pattern. Epilepsy is the main neurological complication associated with TSC, with 80 to 90% of patients having epilepsy in their lifetime while skin anomalies are seen in 60 to 70% of cases. There have been few reports on TSC from sub-Saharan Africa and to the best of our knowledge none has focused specifically on neurological complications mainly epilepsy and specificities of skin abnormalities in the sub-Saharan black Africans. Five cases of TSC with characteristics skin lesions and drug resistant epilepsy are reported. Children presenting with epilepsy, especially focal epilepsy should have a careful dermatological examination. Similarly, all suspected cutaneous lesions must be evaluated with imaging study for the detection of signs of TSC. An earlier management of epilepsy may prevent cognitive impairment associated with frequent epileptic seizures.

Rufinamide as an adjunctive therapy for Lennox–Gastaut syndrome: A randomized double-blind placebo-controlled trial in Japan

To evaluate the efficacy, safety, and pharmacokinetics of rufinamide as an adjunctive therapy for patients with Lennox-Gastaut syndrome (LGS) in a randomized, double-blind, placebo-controlled trial. We conducted a multicenter clinical trial with a 4-week baseline, a 2-week titration, a 10-week maintenance, and either a follow-up visit or entry into an open-label extension. Patients with LGS (4 to 30 years old) taking between one and three antiepileptic drugs were recruited. After the baseline period, patients were randomly assigned to rufinamide or placebo. The primary efficacy variable was the percent change in the tonic-atonic seizure frequency per 28 days. Of the 59 patients, 29 were randomized to the rufinamide group and 30 to the placebo group. The frequency of epileptic seizures was significantly decreased in the rufinamide group than in the placebo group; the median percent change in frequency of tonic-atonic seizures was -24.2% and -3.3%, respectively, (p=0.003) and that of total seizures was -32.9% and -3.1%, respectively (p<0.001). Subgroup analyses indicated that the efficacy of rufinamide was consistent independent of clinical background characteristics. The common treatment-related adverse events in the rufinamide group were decreased appetite (17.2%), somnolence (17.2%), and vomiting (13.8%). Transient seizure aggravations were observed in 13 (22.0%) of the 59 patients, though a causal relationship with rufinamide was suspected in only one patient. All adverse events were mild to moderate in severity. The mean plasma concentration of rufinamide between 1 and 9 within 12h after administration was 17.2 μg/mL. The present results showed a favorable risk-benefit profile for rufinamide as an adjunctive therapy for patients with LGS.

Factors associated with treatment gap in children and adolescents with epilepsy in a rural Nigerian community.

Background: The campaign against epilepsy is hampered by the difference between those with the active disorder and the number of them receiving appropriate treatment (treatment gap) in sub-Saharan Africa. Identifying the determinants of this gap is crucial to providing and achieving optimal care.Objective: To identify the determinants of epilepsy treatment gap (ETG) in children and adolescents (Subjects) with epilepsy in a rural community.Methods: Subjects were identified through a community house to house survey. Information obtained from Subjects and their care givers included: sociodemographic characteristics, type and frequency of epileptic seizures,current and past treatment options utilized, reasons for treatment options used, and treatment options utilized for other health complaints.Results: Twenty three Subjects (6.4/1000 of the child and adolescent population) were identified as having epilepsy. Their age range was 4-19 years (mean 14.3±4.7 years). Most were males (82.6%) and adolescents (78.3%). Seizures were mostly generalized (95.7%) and occurred most frequently daily. Current treatment modalities were use of traditional medication (100%) and prayers (34.8%).None was currently on orthodox medical therapy (ETG, 100%) but 5(21.7%) had utilized orthodox medical therapy in the past. The main determinants of the ETG were strong cultural belief, weakness in the health system to epilepsy treatment and low socioeconomic status. Fever was the commonest other health complaint and use of orthodox medical therapy was significantly (p˂ 0.05) the main (16, 69.6%) treatment option utilized.Conclusion: Cultural belief, weak health system and low socioeconomic status were determinants of an absolute ETG. It highlights the need to strengthen initiatives that enhance accessibility to standard epilepsy treatment.Key words: Epilepsy treatmentgap, determinants, children, adolescents, rural community

Impact of planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and neonatal outcomes

PurposeTo investigate whether planning of pregnancy in women with epilepsy affects seizure control during pregnancy and to compare the maternal and neonatal outcomes in planned and unplanned pregnancies. MethodsThis was a retrospective cohort study of 153 pregnant women with epilepsy who were treated at the University of Tsukuba Hospital and Hokkaido University Hospital between 2003 and 2011. Twenty-one pregnancies were excluded due to insufficient data. Data of patients followed by neurologists during their planned pregnancies (planned-pregnancy group, n=51) were compared to those of patients referred to neurologists after conception for managing epilepsy during pregnancy (unplanned-pregnancy group, n=81). The treatment profile for epilepsy, seizure control, and maternal and neonatal outcomes in both groups were compared using Chi-square test or Fisher's exact test and Mann–Whitney U test. ResultsCompared to the unplanned-pregnancy group, the planned-pregnancy group showed a significantly greater proportion of patients receiving monotherapy with antiepileptic drugs (80% vs. 61%: planned vs. unplanned, P=0.049) and those not requiring valproic acid (77% vs. 56%, P=0.031). Furthermore, the frequency of epileptic seizures (16% vs. 35%, P=0.018) and changes in antiepileptic drugs (24% vs. 41%, P=0.042) were significantly lower in the planned-pregnancy group than in the unplanned-pregnancy group. No significant intergroup differences were noted in the obstetric complications and neonatal outcomes, including congenital malformations. ConclusionFor women with epilepsy, planning of pregnancy is associated with good seizure control during pregnancy and less fetal exposure to antiepileptic drugs.

2. Fetal alcohol spectrum disorder: Epilepsy and neuropsychiatric disorders

The Fetal Alcohol Syndrome (FAS) is a congenital disorder due to prenatal exposure to alcohol, leading to a dysmorphic infant: microcephaly, developmental delay and often seizures. Many offspring at risk are non-dysmorphic, referred to as Fetal Alcohol Spectrum Disorder (FASD), including possible and probable FAS and FRND, requiring high diagnostic acumen. Aim A retrospective analysis of 400 cases of FAS, FASD and FRND revealed an unexpectedly high incidence of seizure disorder in 20%, including frequent epileptic seizures in 12% (Bell et al. ACER 2010). The current study examines a cohort for neuropsychiatric difficulties encountered in the management of these adolescents and adults ( N =10). Methods Only those subjects that came to medical attention and/or psychosocial intervention had detailed neuropsychiatric assessment. Hence there is a bias towards over-estimating the prevalence of neuropsychiatric difficulties. They were all examined by the same neuropsychiatrist (MGS), had EEG recorded with electrodes in the 10–20 system plus zygomatics, almost always with sleep: spontaneous, after sleep-deprivation or overnight polysomnographic recording with video-EEG in a sleep lab. All EEGs were read blind by the same board-certified clinical neurophysiologist (PAH). Representative subjects are reviewed. Results In addition to a high prevalence of seizure disorder (approximately 10 times normal), recurrent afebrile unprovoked seizures (epileptic) were found in 12% of the study cohort (>10×normal), requiring long-term follow-up and treatment with AEDs appropriate for the seizure types: CBZ, OxCBZ, VPA, LMT or TPM. Breakthrough seizures require (BZDs) benzodiazepines for acute management, loading doses of PHT and/or PB for status epilepticus. Neuropsychiatric issues included attention deficit +/− hyperactivity, mood instability, dysprosody and depression, often responding to the same AEDs as above, plus SSRI or antipsychotics. The adolescents experienced learning difficulties in school and/or at work, requiring cognitive behavior therapy, speech therapy and possibly EEG biofeedback. Conclusion The FASD is associated with increased seizure risk, learning disorder, neuropsychiatric difficulties that require further intervention. Whether these are due to developmental cerebral dysgenesis, neurotoxicity of ethanol or metabolites in utero, or sequelae of postnatal traumatic brain injuries, vitamin deficiency or a disorder in brain metabolism as a result of epigenetic response to a hostile neural environment, remains to be determined in future studies.

The Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder in Patients with Epilepsy

Attention deficit/hyperactivity disorder (AD/HD) can cause significant impairment in psychosocial and scholastic achievement. AD/HD should be appropriately managed even if patients have comorbid epilepsy. The diagnosis and treatment of AD/HD in patients with epilepsy presents several challenges. Differentiating independent problems in attention from frequent epileptic seizures is the first step in evaluating these individuals. Once this is accomplished the formal independent diagnosis of AD/HD can be pursued. Data from non-epileptic AD/HD populations should be applied with caution to patients with epilepsy. Once attention deficit disorder has been diagnosed formally, choices in treatment can create other problems as some pharmacological treatments for AD/HD pose a risk of exacerbating seizures. This article serves as a review for the diagnosis and treatment of AD/HD spectrum disorders in patients with epilepsy.

Сlinical and biochemical assessment of dynamics of an acute period of brain injury and combined cranio-facial injury

The purpose of the study was to assess clinical effects and dynamics of the changes in the parameters of lipid peroxidation and antioxidant system in patients with acute traumatic brain injury and combined injuries treated with the peptide drug cortexin. As the result of this work, the ability of the drug to reduce the intensity of the of lipid peroxidation process in brain injury was revealed. Clinical effect was expressed by the reduction of asthenic symptoms, significant improvement of attention and memory, and increase of the working capacity and the tempo of mental activity, which was confirmed by psychometric tests. It was shown that cortexin use in an acute period of traumatic brain injury and combined cranio-facial injury significantly increased the patients’ quality of life, had sedative and antidepressant effect, reduced epileptic activity and decreased the frequency of epileptic seizures.

Use of miglustat in a child with late-infantile-onset Niemann-Pick disease type C and frequent seizures: a case report

IntroductionNiemann-Pick disease type C is a rare genetic lysosomal storage disease associated with impaired intracellular lipid trafficking and a range of progressive neurological manifestations. The influence of seizure activity on disease course and response to miglustat therapy is not currently clear.Case presentationNiemann-Pick disease type C homozygous for NPC1 mutation p.S940L [c. 2819 C>T] was diagnosed in a four-and-a-half-year-old Norwegian Caucasian girl. The patient, who died at eight years and seven months of age, had a history of prolonged neonatal jaundice and subsequently displayed progressive neurological manifestations that started with delayed speech, ataxia, and gelastic cataplexy. A regimen of 100mg of miglustat three times a day was initiated when she was four years and 11 months old. She showed decreased neurological deterioration during about three and a half years of treatment. However, she displayed periods of distinct worsening that coincided with frequent epileptic seizures. Anti-epileptic therapy reduced seizure frequency and severity and allowed re-stabilization of her neurological function. Prior to her death, which was possibly due to acute cardiac arrest, seizure activity was well controlled.ConclusionsMiglustat delayed the expected deterioration of neurological function in this patient with p.S940L-homozygous late-infantile-onset Niemann-Pick disease type C and provided important quality-of-life benefits. This case demonstrates the importance of effective seizure control therapy in achieving and maintaining neurological stabilization in Niemann-Pick disease type C.

Neuropsychological profile and clinical effects of arginine treatment in children with creatine transport deficiency

BackgroundSLC6A8, an X-linked gene, encodes the creatine transporter (CRTR) and its mutations lead to cerebral creatine (Cr) deficiency which results in mental retardation, speech and language delay, autistic-like behaviour and epilepsy (CRTR-D, OMIM 300352). CRTR-D represents the most frequent Cr metabolism disorder but, differently from Cr synthesis defects, that are partially reversible by oral Cr supplementation, does not respond to Cr treatment even if precociously administrated. The precursors of Cr are the non-essential amino acids Glycine (Gly) and Arginine (Arg), which have their own transporters at the brain–blood barrier level and, therefore, their supplementation appears an attractive and feasible therapeutic option aimed at stimulating Cr endogenous synthesis and, in this way, at overcoming the block of Cr transport within the brain. However, until now the effects of Arg and/or Gly supplementation on Cr brain levels and behaviour have been controversial.MethodsIn this study five Italian male patients affected by CRTR-D were supplemented with oral L-Arg at a dosage of 300 mg/kg/day divided into 3 doses, for 24–36 months. Biochemical and plasmatic amino acids examinations and thyroid hormone dosages were periodically performed. Moreover, Proton and Phosphorus Magnetic Resonance Spectroscopy (MRS) was monitored during follow-up in concurrence with neuropsychological evaluations.ResultsDuring L-Arg treatment a clinical improvement in motor skills and to a lesser extent in communication and attention was observed. In addition, all patients had a reduction in the number and frequency of epileptic seizures. Daily living skills appeared also to be positively influenced by L-Arg treatment. Moreover, Total Cr and especially PhosphoCr, evaluated by proton and phosphorus spectroscopy, showed a mild increase, although well below the normal range.ConclusionThis study provides information to support the effectiveness of L-Arg supplement treatment in CTRT-D patients; in fact the syndromic pattern of cognitive and linguistic deficit presented by CRTR-D patients was partially altered by L-Arg supplementation especially at a qualitative clinical level. Oral L-Arg may represent not only a protective factor towards a further cognitive decline, but can lead to the acquisition of new skills.

Epileptic seizures in early-onset multiple sclerosis.

Early-onset multiple sclerosis (EOMS) is defined as the first presentation of symptoms in childhood (before the age of 16 years). EOMS occurs in about 0.4% to 10.5% of multiple sclerosis (MS) patients. In this retrospective population-based study we aimed to describe the clinical/paraclinical details and frequency of epileptic seizures in Iranian EOMS patients registered with the Isfahan Multiple Sclerosis Society (IMSS) from April 2003 to July 2010. EOMS cases were extracted from the Isfahan total MS cohort and included 3522 patients. A total of 117 EOMS patients (19 males and 98 females) with a mean age at onset of 14.2 ± 2.0 years (range: 7-16 years) were extracted from our database (3.3% of the total cohort). Of cases, ten (one male and nine females) had experienced at least two epileptic seizures, providing a crude prevalence of 8.5%. The frequency of epilepsy in EOMS patients (8.5%, 10/117) was significantly greater (P < 0.001) than that of non-EOMS cohort (2.0%, 71/3405). Epileptic seizures occurred before MS onset in two patients, after MS onset in seven, and at MS onset in one as the presenting symptom of the disease. Our findings mostly indicate an excessive prevalence of epileptic seizures in Iranian EOMS patients (8.5%), which is higher than any other report concerning seizures or epileptic seizures in a large MS series.

Effect of Melatonin on Seizure Frequency in Intractable Epilepsy

Melatonin is effective for treating sleep-wake cycle disturbances and has been reported occasionally to decrease epileptic seizure frequency, with no long-term side effects. In this pilot study, the investigators examined the effect of melatonin on seizures, sleep quality, and behavior in 10 patients aged 9 to 32 years with intractable epilepsy. Patients were randomized to receive melatonin (10 mg daily at bedtime) followed by placebo or placebo followed by melatonin for 3 weeks each, with a 1-week washout period in between. Seizure frequency was monitored by daily diaries and actigraphy recordings; behavioral and sleep parameters were rated by caregivers. Diurnal seizures decreased significantly with melatonin compared with placebo (P = .034, Wilcoxon test). Maximal number of seizures, seizure duration, sleep efficiency or latency, and behavioral parameters remained unchanged. No major side effects or seizure aggravation were documented. It is concluded that melatonin could be effective and safe for decreasing daytime seizure frequency in patients with intractable epilepsy.

Epilepsy and menopause

Epilepsy and menopause have complicated interactions. Treatment of epilepsy may cause exacerbation of osteoporosis and alter the effects of hormone replacement therapy (HRT) whereas HRT may influence the frequency of seizures. An extensive search was performed in the Cochrane Central Trials Registry, the Web of Science, and PubMed for publications using the keywords "(epilepsy OR Seizure) AND (menopause OR osteoporosis)"; "Anti-epileptic drugs AND (menopause OR osteoporosis); HRT AND epilepsy" between 1970 and 2010 and English language. All eligible trials were included. The frequency of catamenial type of epileptic seizures may increase during perimenopause due to hyperestrogenism and subside after menopause. Sexual dysfunction can be severe depending upon the effect of lack of estrogen in menopause and epilepsy itself. Osteoporosis and fractures may increase due to hypoestrogenism in menopause and cytochrome P450 inducing anti-epileptic drugs. According to the current data, conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate may increase the frequency of epileptic seizures. Women with epilepsy may need to take HRT, at least for symptomatic relief and to allow adequate sleep when "hot flushes" are disruptive. A combination of a single estrogenic compound such as 17-β-estradiol along with natural progesterone could be considered in these patients.

Efficacy and safety of methylphenidate in treating ADHD symptoms in children and adolescents with uncontrolled seizures: A Brazilian sample study and literature review

Objective Attention-deficit/hyperactivity disorder (ADHD) is observed in 30% of children and adolescents with epilepsy. Recent studies have demonstrated the safety of methylphenidate (MPH) in patients with controlled epilepsy. There are few studies of patients with uncontrolled epilepsy. The goal was to study the efficacy and safety of MPH use in children and adolescents diagnosed with ADHD and uncontrolled epilepsy. Methods We evaluated 24 patients ranging from 7 to 16 years of age who took MPH for 6 months. Inclusion criteria were at least two epileptic seizures in the previous 6 months and a diagnosis of ADHD based on DSM-IV criteria. Conclusion Patients were classified according to ADHD subtype as follows: 41.7% inattentive type, 37.5% combined, and 20.8% hyperactive/impulsive type; 58.3% had partial epilepsy and 41.7% generalized epilepsy. There was an overall improvement in ADHD symptoms in 70.8% of patients, and there was no increase in frequency of epileptic seizures in 22 patients (91.6%).

Long-term Impact of Cognitive Deficits and Epilepsy on Quality of Life in Patients With Low-Grade Meningiomas

WHO Grade I meningiomas are common, usually benign, primary brain tumors. Little is known about the health-related quality of life (HRQOL) of patients with meningiomas. To investigate the long-term HRQOL in patients with meningiomas and its association with cognitive deficits and epilepsy. HRQOL was assessed by the Short-Form Health Survey questionnaire (SF-36) in 89 patients with WHO Grade I meningiomas at least 1 year following neurosurgery with or without radiotherapy. Cognitive functioning was measured by a neuropsychological test battery, and epileptic seizure frequency and antiepileptic drug (AED) use were determined for each patient. HRQOL of patients was compared to that of 89 healthy controls individually matched for age, sex, and educational level. As a group, patients with meningiomas did not differ from healthy controls on 7 out of 8 SF-36 scales; the only difference was that patients reported more role limitations caused by physical problems (P < .05). Patients with meningiomas had significant impairment in 4 of 6 cognitive domains, most pronounced in the domain of executive functioning. Both impaired cognitive functioning and AED use were associated with a compromised HRQOL. Of the 23 patients using AEDs, HRQOL was significantly impaired on 5 out of 8 SF-36 scales. In patients using AED, neither cognitive functioning nor HRQOL differed between those with and those without seizure control. The HRQOL of most patients with WHO Grade I meningiomas is comparable to that of the general population. However, HRQOL is worse in patients with major cognitive deficits and those using AEDs, irrespective of seizure control.