Higher Number Of Seizures Research Articles

Discontinuation of antiseizure medication in patients with epilepsy

Approximately two thirds of patients with epilepsy become seizure-free with antiseizure medication (ASM). Acentral question is whether and when ASM can be discontinued. To present an overview of the current knowledge about risks and benefits of discontinuation of ASM. Review of the current literature, discussion of data on and recommendations for discontinuation of ASM. The risk of seizure recurrence after discontinuation of ASM is approximately 40-50% and thus twice as high as continuing with ASM. Guidelines recommend considering discontinuation of ASM at earliest after aseizure-free period of 2years. Predictive variables for seizure recurrence after stopping ASM include longer duration of epilepsy and higher number of seizures until remission, ashorter seizure-free interval until stopping ASM, older age at epilepsy onset, developmental delay or IQ < 70, febrile seizures in childhood, absence of aself-limiting epilepsy syndrome, and evidence of epileptiform activity in the electroencephalograph (EEG). The individual risk of seizure recurrence after stopping ASM can be estimated using an online prediction tool. Discontinuation of ASM should be discussed with patients at the earliest after 2years of seizure freedom in ashared decision-making process weighing up the risks and benefits. The risk of aseizure recurrence depends on anumber of clinical variables. Psychosocial aspects, such as impact on driving and occupational issues must be taken into consideration as well as individual fears and concerns of patients about seizure recurrence or the long-term use of ASM.

Physical fitness in Indian women with epilepsy on anti-seizure medications and its association with reproductive status, quality of life and stigma: A cross-sectional study

PurposeTo determine the status of physical fitness, reproductive abnormalities, QOL and epilepsy associated stigma in women with epilepsy (WWE) and their association with ASM therapy and seizure frequency. MethodsThis cross-sectional study included WWE of reproductive age (18–50 years) on antiseizure medications (ASMs) for at least three months before enrolment. Physical fitness was assessed using International Physical Activity Questionnaires (IPAQ) and Body composition analysis. Subjects were interviewed for menstrual abnormalities [menstrual disturbance or Polycystic Ovary Syndrome (PCOS)/hirsutism]. Validated questionnaires were used for assessment of, QOL (QOLIE-10) and Stigma in epilepsy (Epilepsy Stigma Scale). Sub-group analysis was done to compare the above parameters on the basis of a) type of therapy (mono or polytherapy), b) type of ASMs treatment (conventional, newer, or conventional + newer ASMs), and c) seizure type and (d) seizure frequency. Correlation and regression analysis were done to find out the association among different variables with physical fitness. ResultsThe overall prevalence of poor physical fitness, reproductive abnormalities, worsened QOL and stigma in the enrolled WWE (n = 203) were 21.18 %, 20.19 %, 52.7 %, and 21.67 %, respectively. Sub-group analysis revealed that WWE on monotherapy (n = 99) had higher median IPAQ score (p = 0.002), comparatively less reproductive abnormalities (24.03 %, p = 0.008), and higher stigma (24.03 %, p = 0.04) than polytherapy group. WWE on conventional ASMs had significantly higher IPAQ scores compared to newer and conventional + newer ASMs groups (p = 0.02). The prevalence of poor physical fitness and stigma was significantly higher in WWE with higher number of seizures (p = 0.007, <0.001, respectively). No significant difference in QOL was observed on the basis of ASM type and therapy; however, WWE with generalized onset seizures had worsened QOL compared to those with focal onset seizures (p = 0.04). A significant negative correlation was found among seizure frequency and IPAQ score in WWE (p = 0.04). ConclusionWWE on polytherapy were physically less active, higher occurrence of reproductive abnormalities, and stigma compared to the monotherapy group. WWE with higher seizure frequency had poor physical fitness, and higher stigma compared to those with lesser number of seizures. These findings may aid value in optimization of ASM treatment in WWE of reproductive age.

High number of seizures and unconsciousness in patients with SARS-CoV-2 omicron variants: a retrospective study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variants are now a pandemic. There are differences in clinical features in SARS-CoV-2 variants and we conducted this study to assess the clinical features of coronavirus disease (COVID-19) in children with SARS-CoV-2 omicron variants. The study included children with COVID-19 arrivedto Tokyo Metropolitan Toshima Hospital between January 2020 and October 2022. The clinical features of 214 children with SARS-CoV-2 non-omicron variants and 557 children with omicron variants were compared. In the SARS-CoV-2 omicron variant group, more patients had fever, sore throat, nausea and/or vomiting, and seizures and/or disorders of consciousness. In SARS-CoV-2 non-omicron variants, there was only one patient with seizure and/or unconsciousness whereas there were 92 children in omicron variants. Among these 92 patients, 46 (49%) were diagnosed with simple febrile seizures; 23 (25%), with complex febrile seizures; 10 (11%) with status epilepticus; and two (2%) with encephalopathy. Their mean age was 4.0 ± 3.0 years-a wider age distribution than that in other febrile seizures but similar to that in febrile seizures in patients with influenza. SARS-CoV-2 omicron variants are likely to cause seizures and unconsciousness in children and their age distribution was wider than other febrile seizures patients but similar to those in influenza patients. In clinical practice in patients with COVID-19 and influenza, clinicians should be aware of these features.

Efficacy of single dose of phenytoin/fosphenytoin in benign convulsions with mild gastroenteritis.

This study evaluated the efficacy of a single dose of phenytoin/fosphenytoin (PHT) to control repetitive seizures in children with benign convulsions with mild gastroenteritis (CwG). Children aged between 3 months and 5 years with CwG were retrospectively enrolled. Convulsions with mild gastroenteritis were defined as (a) seizures with acute gastroenteritis without fever or dehydration; (b) normal blood laboratory results; and (c) normal electroencephalography and brain imaging findings. Patients were divided into two groups according to whether or not intravenous PHT (10 mg/kg of phenytoin or phenytoin equivalents) was administered. Clinical manifestations and treatment efficacy were evaluated and compared. Ten of 41 children eligible for inclusion received PHT. Compared to children in the non-PHT group, those in the PHT group had a higher number of seizures (5.2 ± 2.3 vs. 1.6 ± 1.0, P < 0.001) and a lower serum sodium level (133.5 ± 3.2 mmol/L vs. 137.2 ± 2.6 mmol/L, P = 0.001). Initial serum sodium levels were negatively correlated with seizure frequency (r = -0.438, P = 0.004). In all patients, seizures were completely resolved with a single dose of PHT. There were no significant adverse effects from PHT. A single dose of PHT can effectively treat CwG with repetitive seizures. The serum sodium channel may play a role in seizure severity.

A DESCRIPTIVE STUDY OF EPILEPTIC PATIENTS IN HERAT CITY OF AFGHANISTAN

Epilepsy is one of the most common and serious neurological disorders which is characterized by recurrent unprovoked seizures. Its prevalence ranges from 0.5% to 1% of the population in developed countries, and even higher in developing countries. Around 70 million people worldwide have epilepsy.This research aims to perform a descriptive study on epileptic children 7-18 years old in Herat city of Afghanistan.This descriptive study was performed on 7-18 years old children with epilepsy, which was conducted from in 2021 in Herat city of Afghanistan. The study included 100 patients with epileptic disorders, in this study Encephalography, Magnetic resonance imaging, Computed tomography, and Sociodemographic information were used to describe the patients.The main group of this study included 100 epileptic children. The age of study participants ranged from 7- 18 years and the mean age was 9.21 ± 2.64 years.&nbsp;46 (51.1%) were males and 44 (48.9%) were females. More often Epilepsy cases were observed in patients with focal seizures. Hereditary predisposition was found as a risk factor and it was statistically significant, the p-value was less than 0.0007. Having status epilepsy was also found a risk factor for epilepsy and the p-value was 0.001. Also, prognostic factors for refractory epilepsy were determined in this study.The risk factors that were found in epileptic patients, were high and comparable with other studies in the world literature. More often epilepsy cases were determined in patients with focal seizures, hereditary predisposition, and having status epilepsy also found as prevalent risk factors for refractory epilepsy. Also, prognostic factors for epilepsy were identified. Negative factors were a high number of seizures, abnormal electroencephalography findings, and early onset of seizures in epileptic patients.

Risk of seizure relapse and long-term outcomes after discontinuation of antiseizure medication in children with epilepsy

ObjectivesThe aims of this study were to evaluate the demographic and clinical characteristics of children with epilepsy who discontinued their antiseizure medication (ASM), to determine potential predictors of seizure relapse, to calculate the rate of seizure relapse, and to detect long-term seizure outcomes. MethodsA total of 269 seizure-free children with epilepsy who were decided to discontinue their ASM and were followed up for at least 18 months after ASM withdrawal were retrospectively evaluated. ResultsThe enrolled children had been followed up for a median of 46 months (range 18–126 months; IQR: 29–61) after ASM withdrawal and 90 (33.5%) of their seizures relapsed. The median time to seizure relapse was 8 months (range 0.23–117 months; IQR: 2–25). Seizure relapse occurred in 16.7% of the 90 children at 1 month, 45.6% at 6 months, 62.2% at 1 year, 74.4% at 2 years, and 94.4% at 5 years. Univariate logistic regression analyses revealed six predictors significantly related to relapse: age at first seizure, age at diagnosis of epilepsy, intellectual disability, EEG findings after ASM withdrawal, ASM tapering time, and number of seizures on ASM. In multivariate logistic regression analyses, age at first seizure, intellectual disability, and ASM tapering time were not significantly associated anymore. The other three remained independently predictive. Pharmacological control of seizures with monotherapy was restored in 93.3% of the children with seizure relapse. ConclusionThis study evaluated potential predictors of seizure relapse, some of which have rarely been evaluated in previous studies. Adolescent age at diagnosis, abnormal EEG findings after ASM withdrawal, and high number of seizures on ASM were associated with a higher risk of seizure relapse. Abnormal MRI findings such as malformations of cortical development and hydrocephalus may be potential biomarkers for the risk of seizure relapse.

Does diagnostic delay impact on the outcome of epilepsy?

Seizure recurrence in epilepsy poses the patient at risk of self-harm and can have a negative impact on his/her personal and social life. For this reason, the disease, when suspected, should be promptly diagnosed and treated. Unfortunately, this is not the case for several patients. Diagnostic delay in people with epilepsy has been the object of a number of studies that, even with differing results, showed that the disease might go undiagnosed for several years.1-4 A delay in the diagnosis of epilepsy may occur preferably when the first seizures are focal or, if generalized, they present with inhibitory features or only mild motor signs. In those cases, the patient might seek medical advice even after several years.2 Along with seizure type, diagnostic delay can be explained by other factors, including patient's own poor awareness of the nature of his/her symptoms, doctor's misdiagnosis, and, not least, the rarity of some events and their modest impact on patient's daily life. However, seizure recurrence with strong impact on one's health and quality of life cannot be excluded even after mild events, particularly in untreated patients, and one cannot exclude that future seizures have a greater impact on patient's and public safety. For these reasons, Laura Parviainen and co-workers5 are commended for having addressed this issue in the intent to verify the impact of diagnostic delay on seizure outcome in patients with newly diagnosed focal epilepsy. The authors examined 176 adult patients who were eligible for inclusion in randomized trials of antiseizure medications. The choice of that sample was motivated by the accuracy of the medical records with specific reference to the history of seizures while untreated. Patients were followed for five years, and seizure recurrence was noted and classified in three categories: (1) Complete seizure freedom after treatment start; (2) Seizure freedom achieved after treatment changes; (3) No seizure freedom despite medication changes. The authors found that diagnostic delay alone did not correlate with treatment response at five years. However, seizure outcome was worse in patients with a higher number of seizures before diagnosis. The results of this study confirm previous reports6 in showing that diagnostic delay per se does not affect treatment outcome. However, the association between the number of seizures while untreated and treatment response during follow-up is at variance with previous studies that showed that the long-term prognosis of epilepsy (in terms of prolonged seizure remission during follow-up) is not affected by early treatment of seizures (in those studies, treatment of the first seizure).7 The differences might be explained by the differing populations at risk (patients seen at the first seizure vs. patients with two or more seizures, the latter perhaps with more severe disease varieties) and by the length of follow-up (as poor treatment response proves to be a dynamic process when long-term follow-up is considered).8, 9 Then, having several seizures before treatment might be not only the result of diagnostic delay but also of an intrinsic greater severity of the disease at first manifestation. This study brings to our attention another important problem, that is, if epilepsy should be diagnosed only after seizure relapse or even after the first seizure. The International League Against Epilepsy addressed this issue and concluded that in specific circumstances epilepsy can be diagnosed at the first seizure.10 This definition helps reducing the diagnostic gap but requires that a comprehensive evaluation of the patient is performed and, for this reason, the diagnosis of epilepsy should be made by specialists who are well aware of the risk factors for seizure recurrence in a patient with a first seizure. As the diagnosis of epilepsy is mostly based on an accurate history taken from the patient and, where present, from a witness, the diagnostic process is not easy and requires patient's awareness of the nature of his/her symptoms and skillness of the caring physician. We agree with the authors that public and healthcare workers should be made aware of the diversity of seizure types and the negative reflections of the recurrence of undiagnosed seizures. Ettore Beghi reports grants from Italian Ministry of Health, grants from Swedish Orphan Biovitrum, personal fees from Arvelle Therapeutics, and grants from American ALS Association, outside the submitted work. The author confirms that he has read the Journal's position on issues involved in ethical publication and affirms that this editorial is consistent with those guidelines. Read the winning article - https://onlinelibrary.wiley.com/doi/10.1002/epi4.12443

Peri-ictal electrocardiographic alterations in paediatric epilepsy patients. A prospective study

Epileptic seizures can be associated with peri-ictal heart rhythm disorders and even sudden death (SUDEP). Few paediatric studies have been conducted on the subject. To determine heart rhythm disorders in paediatric patients with epilepsy who were studied with video-electroencephalogram (video-EEG). Prospective, observational study in patients under 18 years of age admitted for video-EEG at the Hospital Clinico Red de Salud UC-Christus, Santiago, Chile. A neurological and cardiological evaluation and electrocardiogram (ECG) were performed, in addition to a Holter ECG simultaneously with the video-EEG. Twenty-five patients were studied, 12 with refractory epilepsies, 23/25 focal and 20 on polytherapy. Altogether 768 hours of video-EEG were recorded, including 281 seizures in 15 patients: 157 clinical and 103 generalised. There were no serious arrhythmias, only non-specific or probably benign disorders, mainly incomplete right bundle branch block in 11 patients, which were more frequent in refractory epilepsies (p<0.036). Heart rate variation occurred mainly in seizures >30 seconds. No patient presented SUDEP. This is the first prospective study, with a new technique, using video-EEG and Holter ECG simultaneously in paediatrics. Despite the high number of seizures and refractory patients, we found no serious heart rhythm disorders, consistent with the clinical evaluation. Right bundle branch block is considered a non-pathological cardiological finding, but was highly prevalent in our sample compared to the normal population, especially in refractory epilepsy. Given that this is a serious event in epilepsy, it is important to further investigate such studies to assess preventive measures.

Evaluation of performance-enhancing drugs seized by Israeli enforcement agencies 2012\u20132017: implications for policy and regulatory change

BackgroundIllicit performance-enhancing substances are used mostly by athletes to enhance performance in sports, and by bodybuilders to gain muscle and body mass. Among performance-enhancing substances, the most common and known substances are anabolic-androgenic steroids, which are associated with a range of short and long-term adverse medical and psychiatric effects.While the sale and distribution of performance-enhancing substances are considered criminal offenses per the Israeli local pharmacy ordinance, the use and personal possession of these substances are not. Presently, the Division of Enforcement and Inspection of the Israel Ministry of Health cooperates with police and customs agents in performance-enhancing substance-related enforcement activities, which chiefly include seizures carried out at suspicious sites. Moreover, the Division of Enforcement and Inspection provides professional guidance, lab analysis services, and expert opinions on the toxicological and pharmaceutical nature of products seized.This paper presents a contemporary sub-analysis of registered seizures of performance-enhancing substances carried-out by Israel enforcement agencies. The main aim of this analysis is to characterize current patterns of performance-enhancing substances, thus providing the possibility of better assessment of current enforcement and health policy.MethodsA sub-analysis of 712 seizures of performance-enhancing substances seized by Israeli enforcement authorities during a six-year period ranging from January 2012 to December 2017.ResultsThis study demonstrates that Israel faces a challenge regarding the importation and distribution of illicit performance-enhancing substances. The most common substances seized were anabolic androgenic steroids (N = 539). Most seizures were carried out in the central mail processing sites, (38.4%), followed by seizures in private premises such as homes and warehouses (29.6%). Significant differences were found between anabolic-androgenic steroids and other substances, relating to place and year of seizure. Among seizures with known sources (N = 355), the most frequent geographic region given as the source of substances was Eastern Europe (47.6%), followed by East Asia (24.8%), West Asia (19.4%), and Western Europe (5.9%). Bulgaria was the country with the highest frequency of seizures (N = 71) followed by Jordan (N = 45), Thailand (N = 37) and Moldova (N = 36). Significant regional differences were found based on the variables of gender, place of seizure, and type of substance. The most frequent month of seizures was August (N = 129), followed by July (N = 119), and June (N = 118).ConclusionsWhile data analysis focused on the supply side of the performance-enhancing substances market, the high number of seizures of performance-enhancing substances in Israel represents evidence of the existence of a high demand and a large consumer base for these products. Consequently, there is a need for developing further enforcement, treatment, and prevention policies that do not currently exist in Israel. Policymakers should consider prioritizing law enforcement action and incentivizing intelligence sharing to monitor suspected shipment sources and specific points of entry. Additionally, the results demonstrate that there is a need in reforming the penal law to discourage the use of performance-enhancing substances. Similar measures have already been applied in countries like Spain, Italy, and Belgium. Furthermore, policy-makers should consider enhancing health ministry agencies with a higher enforcement capacity by giving them further investigative and inquiry authority. Due to the troubling magnitude of the phenomenon, policymakers should also prioritize educational and prevention strategies.

Evaluation of the Quality of Life in Epileptic Children of Shiraz, Southern Iran.

People suffering from chronic diseases like epilepsy are highly prone to debilitating changes in factors that affect the quality of life (QOL) such as physical capacity, self-esteem, relationships with others and fulfillment of their daily life activities. This study attempted to evaluate QOL in children with epilepsy in Shiraz, Southern Iran. Epileptic patients admitted at the epilepsy clinic of Shiraz University of Medical Sciences with no first time episode of seizures in the previous six months and no febrile-seizure were included in the study. The patients were evaluated using the standard KIDSCREEN-27 questionnaire. Data were analyzed using the statistical software SPSS 21 along with Man Whitney and Chi-square tests, and were reported in terms of descriptive statistics. The significance level was considered less than 0.05. In this case-control study, 229 children with epilepsy were compared with a control group of 400 normal individuals. The mean age was 12.44±3.16 and 12.10±2.69 years in the case and control groups, respectively. The tonic-clonic seizure had the highest prevalence. Moreover, male gender, older age and more seizures per year were associated with lower QOL. Overall, epileptic children had significantly lower QOL compared to the controls. Epileptic children have an overall lower QOL while factors such as old age, male gender, and high number of seizures per year reduce QOL in epileptic patients.

Prediction of antiepileptic drug treatment outcomes of patients with newly diagnosed epilepsy by machine learning

ObjectiveThe objective of this study was to build a supervised machine learning-based classifier, which can accurately predict the outcomes of antiepileptic drug (AED) treatment of patients with newly diagnosed epilepsy. MethodsWe collected information from 287 patients with newly diagnosed epilepsy between 2009 and 2017 at the Second Affiliated Hospital of Zhejiang University. Patients were prospectively followed up for at least 3 years. A number of features, including demographic features, medical history, and auxiliary examinations (electroencephalogram [EEG] and magnetic resonance imaging [MRI]) are selected to distinguish patients with different remission outcomes. Seizure outcomes classified as remission and never remission. In addition, remission is further divided into early remission and late remission. Five classical machine learning algorithms, i.e., Decision Tree, Random Forest, Support Vector Machine, XGBoost, and Logistic Regression, are selected and trained by our dataset to get classification models. ResultsOur study shows that 1) compared with the other four algorithms, the XGBoost algorithm based machine learning model achieves the best prediction performance of the AED treatment outcomes between remission and never remission patients with an F1 score of 0.947 and an area under the curve (AUC) value of 0.979; 2) The best discriminative factor for remission and never remission patients is higher number of seizures before treatment (>3); 3) XGBoost-based machine learning model also offers the best prediction between early remission and later remission patients, with an F1 score of 0.836 and an AUC value of 0.918; 4) multiple seizure type has the highest dependence to the categories of early and late remission patients. SignificancesOur XGBoost-based machine learning classifier accurately predicts the most probable AED treatment outcome of a patient after he/she finishes all the standard examinations for the epilepsy disease. The classifier's prediction result could help disease guide counseling and eventually improve treatment strategies.

Repeated low-dose kainate administration in C57BL/6J mice produces temporal lobe epilepsy pathology but infrequent spontaneous seizures

More efficient or translationally relevant approaches are needed to model acquired temporal lobe epilepsy (TLE) in genetically tractable mice. The high costs associated with breeding and maintaining transgenic, knock-in, or knock-out lines place a high value on the efficiency of induction and animal survivability. Herein, we describe our approaches to model acquired epilepsy in C57BL/6J mice using repeated, low-dose kainate (KA) administration paradigms. Four paradigms (i.p.) were tested for their ability to induce status epilepticus (SE), temporal lobe pathology, and the development of epilepsy. All four paradigms reliably induce behavioral and/or electrographic SE without mortality over a 7d period. Two of the four paradigms investigated produce features indicative of TLE pathology, including hippocampal cell death, widespread astrogliosis, and astrocyte expression of mGluR5, a feature commonly reported in TLE models. Three of the investigated paradigms were able to produce aberrant electrographic features, such as interictal spiking in cortex. However, only one paradigm, previously published by others, produces spontaneous recurrent seizures over an eight week period. Presentation of spontaneous seizures is rare (N=2/14), with epilepsy preferentially developing in animals having a high number of seizures during SE. Overall, repeated, low-dose KA administration improves the efficiency and pathological relevance of a systemic KA insult, but does not produce a robust epilepsy phenotype under the experimental paradigms described herein.

Clinical profile of patients with recurrent seizure in tertiary care hospital in Nepal.

Epilepsy is a common and diverse disorder with many different causes. Outcomes are varied with 60-70% of newly diagnosed people rapidly entering remission after starting treatment and 20-30% developing a drug-resistant epilepsy with consequent clinical and psychosocial distress. About one third of patients with a first unprovoked seizure will have further seizures within five years, and about three quarters of those with two or three unprovoked seizures have further seizures within four years. The aim of the study was to find out those factors which were associated with recurrence of seizure in Nepalese population. It is a Descriptive Cross-sectional study which was conducted in Tribhuvan University Teaching Hospital from January 2013 to January 2014. A total of 150 patients participated in the study. Neuroimaging was normal in 65(43.3%) patients. 48(32%) patients had neurocystercosis in their brain imaging, neuroinfection in 12(8%) of cases, cerebral infarction in 12(8%), Cerebral atrophy in 5(3.3%) patients, brain tumor in 4(2.7%), Mesial temporal sclerosis in 2(1.3%), tuberous sclerosis in 1(0.7%) and hypoxic brain injury in 1 (0.7%) patient. 14(9.3%) patients reported having a family history of epilepsy in first degree relative. There was statistically significant association between higher number of seizures before starting medication and increased frequency of seizure after starting medication (p<0.001). Most of the patients with recurrent seizure had identifiable cause. Neurocysticercosis was the most common cause. Higher number of seizure before starting medication was associated with increased frequency of seizure after starting medication.

Psychiatric Morbidity, Seizure Frequency and Quality of Life in Refractory Epilepsy.

There are high rates of psychiatric morbidity associated with refractory epilepsy. It is unclear whether seizure frequency or comorbid psychiatric illness impacts more upon patients’ quality of life in epilepsy. The objective of this study was to establish which of these two factors impacted more upon patients. Patients with medically refractory epilepsy who were admitted to the National Neurological Centre in Beaumont Hospital were recruited to the study. Structural Clinical Interview for DSM IV (Axis I) (SCID I) and SCID II (Axis II) were the objective measures and HADS, and QOLIE-89 were the subjective measures utilized. A total of 138 patients had SCIDs conducted over the four year study. 75 patients (54.4%) had an Axis I disorder. Of these 30 patients (21.7%) had a mood disorder, 18 patients (13%) had an anxiety disorder and 49 patients (35.5%) were diagnosed with a psychotic disorder. There was no relationship between patient seizure frequency and HADS (p=0.94) or QOLIE-89 (p=0.93) scores. Patients having a high number of seizures were not more likely to have a SCID Axis I diagnosis than patients with a low number of seizures (p=0.246). Patients with a mood disorder were more likely to have a lower QOLIE-89 score than patients without a mood disorder (p=0.0001). Patients with medically refractory epilepsy have high rates of psychopathology. Seizure frequency is not correlated with the presence, severity of psychiatric symptoms or quality of life. The presence of a psychiatric disorder and its severity is strongly correlated with quality of life.

Effects of ketogenic diets on the occurrence of pilocarpine-induced status epilepticus of rats.

Two sources of medium-chain triglycerides--triheptanoin with anaplerotic properties and coconut oil with antioxidant features--have emerged as promising therapeutic options for the management of pharmacoresistant epilepsy. We investigated the effects of ketogenic diets (KDs) containing coconut oil, triheptanoin, or soybean oil on pilocarpine-induced status epilepticus (SE) in rats. Twenty-four adult male Wistar rats were divided into 4 groups and fed a control diet (7% lipids) or a KD containing soybean oil, coconut oil, or triheptanoin (69.8% lipids). The ketogenic and control diets had a lipid:carbohydrate + protein ratio of 1:11.8 and 3.5:1, respectively. SE was induced in all rats 20 days after initiation of the dietary treatment, through the administration of pilocarpine (340 mg/kg; i.p.). The latency, frequency, duration, and severity of seizures before and during SE were observed with a camcorder. SE was aborted after 3 h with the application of diazepam (5 mg/kg; i.p.). The rats in the triheptanoin-based KD group needed to undergo a higher number of seizures to develop SE, as compared to the control group (P < 0.05). Total weight gain, intake, energy intake, and feed efficiency coefficient, prior to induction of SE, differed between groups (P < 0.05), where the triheptanoin-based KD group showed less weight gain than all other groups, less energy intake than the Control group and intermediate values of feed efficiency coefficient between Control and other KDs groups. Triheptanoin-based KD may have a neuroprotective effect on the establishment of SE in Wistar rats.

Is "benign Childhood Epilepsy with Centrotemporal Spikes" Always Benign?

To determine the prevalence of associated behavioral problems and prognosis with Benign Childhood Epilepsy with CentroTemporal Spikes (BCECTS). Descriptive, Cross Sectional study that was conducted from October 2009 to April 2013 in the Department of Pediatric Neurology, the Children's Hospital Taif, KSA. This study was conducted after approval from the Ethics Committee of the Children's Hospital Taif, Saudi Arabia. Thirty-two patients from the age of 3 to 10 years old were recruited from the pediatric neurology clinic over a period of 4 years. All the patients were selected based on history, EEGs, and neuropsychological and neurological examinations. EEGs were performed for all the patients while in awake and sleep states. Those who had centrotemporal discharges were included in the study. All the patients also underwent a brain MRI. Only two patients had mild cortical atrophy but developmentally they were normal. In our study, prevalence of BRE is 32/430 (7.44%). Among the 32 cases, 24 were male and eight were female. Six cases out of 32 indicated a family history of BRE. Twenty-eight cases had unilateral right sided centrotemporal discharges and four had bilateral discharges. It is possible that for BECTS, a high number of seizures might play an important role in the development of mild cognitive impairment and/or behavior disturbances.

New-onset status epilepticus and cluster seizures in the elderly

We evaluated the frequency, therapeutic response and predictors of status epilepticus (SE) and cluster seizures among elderly people. Patients over 60years old with epilepsy (n=201; age, 68.0±7.5years) were prospectively recruited. Among them, 64 patients (32%) who presented with new-onset cluster attacks and/or SE formed the study group. All underwent evaluation with electroencephalography (EEG) and CT scans. The mean duration of SE and cluster seizures at admission was 14.9±53.7hours. Cluster seizures were observed in 53 (26.4%) and SE in 34 (17%) elderly patients with seizures (n=201). The types of SE were: generalized convulsive (23 patients), epilepsia partialis continua (eight patients), non-convulsive (two patients) and myoclonic (one patient). The types of epilepsy syndrome included were: acute symptomatic (37 patients; 57.8%), cryptogenic (15 patients; 23.4%) and remote symptomatic (12 patients; 18.8%). Interictal EEG was abnormal in 79.7% of patients with critical presentation compared to 53.3% of patients without critical presentation. Epileptiform activity was observed in 46.9% of patients with SE and/or cluster seizures compared to 27.0% without SE and/or cluster seizures (p=0.001). The neuroimaging differences between the two groups were the absence of white-matter changes on CT scan in those with, compared to those without, SE and/or cluster seizures (28.1% compared to 41.6%, p=0.06). The risk factors for SE and/or cluster seizures were: acute symptomatic seizures, simple partial seizures, a higher number of seizures, lower Glasgow coma scale (GCS) score and an absence of white-matter changes on CT scan. After multivariate analysis, lower GCS score (p=0.01; odds ratio [OR]=0.82) and a higher number of seizures (p=0.03; OR=1.03) significantly predicted the occurrence of SE and/or cluster seizures. Seizures were controlled with two antiepileptic drugs in 70.6%. To conclude, SE and/or cluster seizures are common (32%) among elderly patients with epilepsy. Early and aggressive treatment is effective in the majority.

Long‐term outcome of phenobarbital treatment for epilepsy in rural China: A prospective cohort study

To evaluate the long-term outcome of phenobarbital treatment for convulsive epilepsy in rural China, and to explore factors associated with overall seizure outcomes. We carried out follow-up assessments of people who took part in an epilepsy community management program conducted in rural counties of six provinces in China. People with convulsive epilepsy who were previously untreated (or on irregular treatment) were commenced on regular treatment with phenobarbital. Information was collected using a standardized questionnaire by face-to-face interviews of the individuals (and their families where necessary). Information collected included treatment status, medication change, seizure frequency, and mortality. Among the 2,455 people who participated in the original program, outcomes were successfully ascertained during the follow-up assessment in 1986. Among them, 206 had died. Information on treatment response was obtained in 1,780 (56% male; mean age 33.9 years, range 3-84; mean duration of follow-up 6.4 years). Among them, 939 (53%) were still taking phenobarbital. The most common reasons for stopping phenobarbital were seizure freedom or substantial seizure reduction, socioeconomic reasons, and personal preference. Four hundred fifty-three individuals (25%) became seizure-free for at least 1 year while taking phenobarbital, 88% of whom did so at daily doses of 120 mg or below. Four hundred six (23%) reported adverse events, which led to withdrawal of phenobarbital in <1%. The most common adverse effects were malaise/somnolence (7.4%), dizziness (3%), and lethargy (2.6%). At the follow-up assessment, 688 (39%) individuals had been seizure free for at least the previous year. People with persistent seizures had significantly longer duration of epilepsy and higher number of seizures in the 12 months before treatment. People who were taking AED treatment irregularly at recruitment were less likely to become seizure-free. We observed long-term benefits of regular treatment with phenobarbital for convulsive epilepsy in rural China. One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy.

Epilepsy is related to theta band brain connectivity and network topology in brain tumor patients

BackgroundBoth epilepsy patients and brain tumor patients show altered functional connectivity and less optimal brain network topology when compared to healthy controls, particularly in the theta band. Furthermore, the duration and characteristics of epilepsy may also influence functional interactions in brain networks. However, the specific features of connectivity and networks in tumor-related epilepsy have not been investigated yet. We hypothesize that epilepsy characteristics are related to (theta band) connectivity and network architecture in operated glioma patients suffering from epileptic seizures. Included patients participated in a clinical study investigating the effect of levetiracetam monotherapy on seizure frequency in glioma patients, and were assessed at two time points: directly after neurosurgery (t1), and six months later (t2). At these time points, magnetoencephalography (MEG) was recorded and information regarding clinical status and epilepsy history was collected. Functional connectivity was calculated in six frequency bands, as were a number of network measures such as normalized clustering coefficient and path length.ResultsAt the two time points, MEG registrations were performed in respectively 17 and 12 patients. No changes in connectivity or network topology occurred over time. Increased theta band connectivity at t1 and t2 was related to a higher total number of seizures. Furthermore, higher number of seizures was related to a less optimal, more random brain network topology. Other factors were not significantly related to functional connectivity or network topology.ConclusionsThese results indicate that (pathologically) increased theta band connectivity is related to a higher number of epileptic seizures in brain tumor patients, suggesting that theta band connectivity changes are a hallmark of tumor-related epilepsy. Furthermore, a more random brain network topology is related to greater vulnerability to seizures. Thus, functional connectivity and brain network architecture may prove to be important parameters of tumor-related epilepsy.

Therapeutic plasma levels of phenytoin, phenobarbital, and carbamazepine: individual variation in relation to seizure frequency and type.

The range and clinical features that influence the individual variation of the therapeutic plasma concentration of phenytoin, phenobarbital, and carbamazepine were studied in 84 epileptic patients on single-drug therapy. Complete cessation of seizures was observed at plasma concentrations of 17.9 (3 to 50) micrograms/ml phenytoin, 24.5 (3 to 43) micrograms/ml phenobarbital, and 6.5 (4.8 to 9.7) micrograms/ml carbamazepine. Fifty-one percent of the 53 patients receiving phenytoin were completely controlled at either below or above the 10 to 20 micrograms/ml range, suggesting that individual dosage adjustment is preferably based on clinical judgment rather than numerical limits of published therapeutic ranges. Fifty patients with therapeutic plasma concentrations of or above 15 micrograms/ml phenytoin, 25 micrograms/ml plasma concentrations of or above 15 micrograms/ml phenytoin, 25 micrograms/ml phenobarbital, or 6 micrograms/ml carbamazepine more often had partial epilepsies, complex partial seizures and, most markedly, a higher number of seizures in the first year of epilepsy and during the year prior to the present drug therapy, when compared with 34 patients with lower therapeutic plasma concentrations. The variation in therapeutic plasma concentration is primarily related to the type and to the severity of the individual epilepsy, as indicated by the seizure frequency at the onset of the epilepsy or prior to the treatment.