Generalised Onset Tonic-clonic Seizures Research Articles

PHARMACOLOGICAL EVALUATION OF LEVETIRACETAM AS ADD-ON DRUG TO EITHER PHENYTOIN OR SODIUM VALPROATE IN PATIENTS OF GENERALIZED ONSET TONIC-CLONIC SEIZURES HAVING BREAKTHROUGH SEIZURES: A RANDOMIZED AND COMPARATIVE STUDY

Objective: Breakthrough seizures are sudden and unexpected seizures that occur in people with epilepsy who generally have good control over the symptoms. The present study is aimed to compare phenytoin plus levetiracetam versus sodium valproate plus levetiracetam to control breakthrough seizures. Methods: A prospective, comparative study was carried out in Generalized onset tonic-clonic seizures (GTCS) patients with breakthrough seizures in Gajra Raja Medical College, Gwalior (M.P.) from February 2021 to August 2022. Participants were randomly allocated to 2 groups, namely phenytoin + levetiracetam (PL) (n=62) and sodium valproate + levetiracetam (SL) (n=61). Patients in group PL received phenytoin at the dose of 200 mg twice a day in adults, 5 mg/kg/day in two divided doses in children plus levetiracetam 500 mg twice a day in adults and 30 mg/kg/day in three divided doses in children. Patients in group SL received sodium valproate 600 mg 3 times a day in adults, 30 mg/kg/day in three divided doses in children plus levetiracetam 500 mg twice a day in adults and 30 mg/kg/day in three divided doses in children. The mean reduction in seizure frequency and patients response to the treatment in the last 30 days were recorded before the start of therapy and at 3 and 6 months after therapy. Adverse drug reactions were recorded during the study period. Statistical analysis was performed using (Statistical Package for the Social Sciences) software. Results: Mean seizure frequency decreased by 59 and 85% in PL and by 59 and 91% in the SL group and is significant (p<0.05) from baseline value at 3 and 6 months, respectively, in both the groups. SL group showed significantly (p<0.05) better response, than PL group in controlling seizures at 6 months. Excellent response by patients was seen by 21% and 49% in PL and SL groups, respectively. Adverse effects noted during the study were mild, including somnolence, headache, dizziness, GIT stress, and fatigue, and responded to symptomatic treatment. Twenty-nine (29%) of PL cases and 6% of SL cases underwent fatigue as adverse drug reactions that showed better tolerability of the SL group. Conclusion: Sodium valproate plus levetiracetam is more efficacious and safer than phenytoin plus levetiracetam in the management of breakthrough seizures in GTCS patients.

Improving epilepsy control among children with cerebral palsy in rural Bangladesh: a prospective cohort-based study

ObjectiveTo define the prevalence and seizure subtypes among children with cerebral palsy (CP) in rural Bangladesh and explore barriers to optimum epilepsy control.DesignProspective cohort study.SettingThe study was conducted in Shahjadpur,...

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

A Case of PLA2G6-Associated Neurodegeneration with Frequent Myoclonus And Generalized Onset Tonic-Clonic Seizures: Successful Treatment with Zonisamide.

A Case of PLA2G6-Associated Neurodegeneration with Frequent Myoclonus And Generalized Onset Tonic-Clonic Seizures: Successful Treatment with Zonisamide.

Conversational analysis of consciousness during seizures

ObjectiveThe objectives of the study were to 1) investigate how patients with epilepsy describe the subjective, conscious experience of having a seizure and 2) determine whether certain themes and descriptions correspond to specific types of epilepsy. MethodsWe interviewed thirteen patients with electroencephalographically confirmed epilepsy about their subjective experience of having a seizure and used conversational analysis (CA) to analyze the language they used to describe this experience. ResultsSeven patients had focal to bilateral tonic–clonic seizures (FBTCS), 7 had focal impaired awareness seizures (FIAS), 1 had focal aware seizures (FAS), and one had generalized onset tonic–clonic (GTC) seizures. Three had multiple types of seizures. Focal seizure origin was frontal in 2 patients, right hemisphere in 1, parieto-occipital in 1, and temporal in 8. Focal to bilateral tonic–clonic and GTC seizures were most frequently associated with descriptions of a total loss of consciousness (n = 8), whereas FIAS were most frequently associated with a perceived loss of consciousness but able to describe some aspects of being unconscious (n = 5). Temporal seizures most frequently accompanied reports of memory loss/impairment (n = 4). Ten patients provided specific descriptions of the transition between the interictal and ictal state or auras. Descriptions consciousness and unconsciousness ranged significantly, resembling a continuum rather than corresponding to distinct levels. ConclusionThe subjective experience of consciousness for patients with epilepsy may differ by seizure type and origin. These may reflect different involvement of brain regions involved in producing consciousness and arousal. Conversational analysis and narrative approaches can significantly aid clinicians in the diagnosis and management of epilepsy.

Etiology and Types of Seizures in Patients Presenting to a Tertiary Care Hospital in Karachi: A Cross-Sectional Study.

IntroductionEpilepsy is a burdensome disorder for affected individuals and community. There is limited data available on the epidemiological aspects of seizures in Pakistan and further research is necessary. We aimed to fill this gap by studying this information in epilepsy patients presenting to our neurology department. The purpose of this study is to evaluate the causes and types of seizures among the target population.MethodThis is a cross-sectional study conducted at the Department of Neurology, Dr. Ruth K.M. Pfau Civil Hospital Karachi. In this study we evaluated the causes and types of seizures among patients presenting to our department during the two-year study duration (January 2018-December 2019). Informed consent was taken. Detailed history was taken including features of seizure episodes, age at first seizure, family history and comorbid conditions. Relevant investigations were carried out. The data was compiled to deduce the relevant information using SPSS v20.0. T-test and Chi-square were used for analyzing the data.ResultsA total of 996 patients presented during the study duration. Primary seizures were found in 58% cases while secondary seizures were found in 42% cases. This distribution was more equal in children with 49.6% primary seizures and 50.4% secondary seizures; the gap widened in adults with 64.3% primary seizures and 35.7% secondary seizures. The most common cause of secondary seizures was neonatal encephalopathy which was present in 18.7% patients, followed by traumatic head injury in 18.2% patients. Central nervous system (CNS) infection was the cause in 17.9% patients, cerebral tumors in 14.1% patients, stroke in 11.5%, metabolic encephalopathy in 7.4%, febrile seizures in 6.5% and CNS malformations in 5.7% patients. The top three causes in children were neonatal encephalopathy (28.3%), CNS infections (19.3%) and febrile seizures (12.7%). Adults with secondary seizures were diagnosed most often with head trauma (25.2%), cerebral tumors (19.9%) and stroke (18.4%) as causative factors. The most common type of seizures was generalized onset tonic-clonic seizures which was found in 73.0% patients followed by focal to bilateral tonic-clonic seizures in 8.9% patients. Other types of seizures included focal aware seizures in 5.0%, mixed seizure types in 4.2%, focal impaired awareness seizures in 3.1%, absence seizures in 2.7%, myoclonic seizures in 2.0% and atonic seizures in 1.0% patients. Seizures in children were mostly generalized onset tonic-clonic seizures (75.4%), mixed seizure types (5.7%) and focal to bilateral tonic-clonic seizures (5.2%). In adults the three most common types corresponded to the overall result: generalized onset tonic-clonic seizures (71.2%), focal to bilateral tonic-clonic seizures (11.6%) and focal aware seizures (6.6%).ConclusionWe found that the most common cause of seizures overall in our study population was primary seizures, though primary and secondary seizures were more evenly present in children. Among secondary causes neonatal encephalopathy stood out as the most common cause in children; head trauma was the predominant cause in adults. Most common type of seizures overall and in adults was generalized onset tonic-clonic seizures, followed by focal to bilateral tonic-clonic and focal aware seizure types. Pediatric patients presented most often with generalized onset tonic-clonic seizures, followed by mixed seizure types and focal to bilateral tonic-clonic seizures.

Uni-hemispheric hyperperfusion in the early postictal state: case report

BackgroundIn the emergency setting of acute ischemic stroke, seizures have been reported in up to 4% of patients. In the absence of arterial occlusion, seizures may also cause abnormalities in CT perfusion in 78% of cases when the time window from onset to imaging is short. Both hyperperfusion and hypoperfusion in the postictal state have been described. Also, though rarely reported, postictal perfusion changes can be uni-hemispheric. In these cases, perfusion maps should be analyzed thoroughly, since perfusion reconstruction software relies heavily on a “normal” contralateral perfusion status.Case presentationA 39-year-old man was found on the ground with a minor head injury. On admission, his reactions were generally slow, but there were no other neurological symptoms, and blood pressure was low. The patient had a history of primary generalized epilepsy and admitted to dropping off his anti-epileptic medication. He was transferred to the radiological department for imaging but shortly before began to experience generalized onset tonic-clonic seizures which were brought under control by intravenous therapy with 10 mg diazepam. After approximately 15 min, a multimodal CT scan was performed, revealing marked changes in the perfusion of the brain hemispheres and posterior fossa, with sharp delimitation at the midline. Blood gas analysis was congruent with respiratory acidosis. Clinically, the patient remained awake without developing any new symptoms. He gradually recovered over the following 3 h and, against our medical recommendation, discharged himself from the hospital.ConclusionsTo the authors’ knowledge, this is the first report of an early postictal state describing sharply delimited uni-hemispheric hyperperfusion and hemispheric alteration of the cerebellum with an equally split rhombencephalon. Surprisingly, these changes were not associated with any focal neurological signs. To prevent misdiagnosis of perfusion alterations in seizures, radiologists and neurologists should be aware of the limitations of CT perfusion maps and software reconstructions. Novel use of CT perfusion reconstruction using peak enhancement helped in identifying the cerebral pathology.

Phenobarbitone versus phenytoin monotherapy for epilepsy: an individual participant data review.

Phenobarbitone versus phenytoin monotherapy for epilepsy: an individual participant data review.

Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review.

Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review.

Heartbreakers-Cardiac Stress After Uncomplicated Generalized Convulsive Seizures.

Adult patients with refractory epilepsy who underwent video-electroencephalography monitoring along with simultaneous one-lead electrocardiography recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitivity troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Peri-ictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals (QTc). Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than 2-fold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 (10%) of 30 patients and 6 (26%) of 23 patients, respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient. The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. Soluble urokinase plasminogen activator receptor may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS but specificity needs to be tested.

Topiramate versus carbamazepine monotherapy for epilepsy: an individual participant data review.

Topiramate versus carbamazepine monotherapy for epilepsy: an individual participant data review.

Blood markers of cardiac stress after generalized convulsive seizures.

Generalized convulsive seizures (GCS) are associated with high demands on the cardiovascular system, thereby facilitating cardiac complications. To investigate occurrence, influencing factors, and extent of cardiac stress or injury, the alterations and time course of the latest generation of cardiac blood markers were investigated after documented GCS. Adult patients with refractory epilepsy who underwent video-electroencephalography (EEG) monitoring along with simultaneous one-lead electrocardiography (ECG) recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitive troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide [NT-proBNP]; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Periictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals(QTc). Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than twofold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 of 30 patients (10%) and 6 of 23 patients (26%), respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient. The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. SuPAR may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS, but specificity needs to be tested.

Perampanel as monotherapy and adjunctive therapy for focal onset seizures, focal to bilateral tonic-clonic seizures and as adjunctive therapy of generalized onset tonic-clonic seizures

ABSTRACTIntroduction: Perampanel is an antiepileptic drug approved in the USA and Europe as monotherapy and adjunctive therapy for focal onset seizures and as adjunctive therapy for generalized tonic-clonic seizures.Areas covered: This an overview of animal data, pharmacokinetics, and clinical data published on Perampanel indexed in PubMed.Expert opinion: Pharmacological studies suggest that perampanel acts via noncompetitive antagonism of the ionotropic AMPA receptor of glutamate. The efficacy of perampanel has been shown in animal models of epilepsy and Phase II/III clinical trials. Efficacy and safety have been evaluated in the phase III trials of adjunctive treatment of focal epilepsy with median focal onset seizure reduction rates of 23% for 4 mg/d, 26–31% for 8 mg/day, and 18–35% for 12 mg/day. Fifty percent responder rates were 29% for 4 mg/day, 33–38% for 8 mg/day, and 34–36% for 12 mg/day. A pivotal Phase III trial in generalized onset tonic-clonic seizures showed a median seizure reduction by 76.5% (8 mg) versus 38.4% placebo and 50% seizure responder rate of 64.2% versus 30.9% placebo. Perampanel showed good safety and tolerability profile across 2–12 mg doses. Perampanel as a broad-spectrum antiepileptic drug has a potential to be an alternative treatment of multiple types of epileptic seizures.

Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review.

Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review.

How does phenytoin compare with sodium valproate in people with focal-onset or generalized-onset tonic-clonic seizures?

How does phenytoin compare with sodium valproate in people with focal-onset or generalized-onset tonic-clonic seizures?

Sodium valproate versus phenytoin monotherapy for epilepsy: an individual participant data review.

Sodium valproate versus phenytoin monotherapy for epilepsy: an individual participant data review.

Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review.

Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.

Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review.

Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review.