Preexisting Seizure Disorder Research Articles

Collegiate Athletes With Diabetes: Baseline Medical Comorbidities and Preseason Concussion Testing Performance.

People with diabetes mellitus (DM) are at increased risk for adverse health events and complications throughout their lifetime. Whether DM significantly affects collegiate athletes' concussion baseline testing performance remains unclear. To (1) describe the prevalence of DM and associated comorbidities and (2) compare concussion baseline testing performance between student-athletes with DM and student-athletes without DM (NoDM). Retrospective, cross-sectional study. University. Using the Concussion, Assessment, Research and Education (CARE) Consortium research database, we matched athletes with self-reported DM (N = 229) by institution, sex, age, sport, position, testing year, and concussion history to athletes with NoDM (N = 229; total sample mean age = 19.6 ± 1.4 years, women = 42%). Descriptive statistics and χ2 tests of independence with subsequent odds ratios were calculated. Independent-samples t tests compared baseline symptoms, neurocognitive testing, and balance performance between athletes with DM and athletes with NoDM. Effect sizes were determined for significant group differences. At baseline, athletes with DM had higher rates of self-reported pre-existing balance disorders, sleep disorders, seizure disorders, motion sickness, learning disorders, vision and hearing problems, psychiatric disorders, depression, bipolar disorder, nonmigraine headaches, and meningitis than athletes with NoDM (P values < .05). We found balance differences between groups (P = .032, Cohen d = 0.17) such that, on average, athletes with DM had 1 additional error on the Balance Error Scoring System (DM = 13.4 ± 6.5; NoDM = 12.1 ± 5.9). No other comparisons yielded significant results. Although athletes with DM had high rates of self-reported balance disorders, sleep disorders, seizures, and meningitis, their baseline neurocognitive testing results were largely identical to those of athletes with NoDM. Our findings suggested that nonclinically meaningful differences were present in concussion baseline balance testing but no significant differences were noted in cognitive testing; however, the effect of DM on concussion recovery remains unknown.

Seizures in Neurosarcoidosis (P9-5.011)

<h3>Objective:</h3> To determine how seizures impact the management of neurosarcoidosis and affect long-term outcomes. <h3>Background:</h3> Though neurosarcoidosis can injure the cerebral cortex via several mechanisms, seizures are uncommonly reported as a clinical manifestation of the disease (4–15%) and have been previously associated with a more severe course. <h3>Design/Methods:</h3> Patients with a diagnosis of neurosarcoidosis were included in this retrospective cohort analysis if seizures were a clinical manifestation of their disease. <h3>Results:</h3> Seizures were present in 26/216 (12.0%) patients and were an initial manifestation of neurosarcoidosis in 11/26 (42.3%). None had a pre-existing seizure disorder. Semiologies were reported in 23: generalized in 12/23 (52.2%), focal in 9/23 (39.1%), and both in 2/23 (8.7%). Status epilepticus occurred in 6/26 (23.1%); 2 (7.7%) were intubated. MRIs were obtained in 25 with cerebral parenchymal lesions (18/25, 72.0%) being the most common radiographic accompaniment, followed by leptomeningitis (13/25, 52.0%) and pachymeningitis (10/25, 40.0%). EEGs showed focal slowing in 12/19 (63.1%), focal epileptiform discharges in 5/19 (26.3%), no abnormalities in 4/19 (21.1%), generalized slowing in 2/19 (10.5%), and epileptiform discharges of unclear distribution in 1/19 (5.3%). No patients had generalized epileptiform discharges. Seizures were controlled in 22/26 (84.6%) compliant with antiseizure medicines (ASMs). Most (18/26, 69.2%) required only 1 medicine for control with levetiracetam being beneficial in 22/22 (100%) trialed. 17/25 (68.0%) had 6 or fewer lifetime seizures. 2/26 (7.7%) were ultimately weaned off ASMs. 13/26 (50.0%) required two or more lines of immunosuppression, all of whom received biologic treatments. The average last mRS was 2.0. No patients died as a result of seizures. Median follow-up of 68.4 months. <h3>Conclusions:</h3> Seizures in neurosarcoidosis occur most commonly with cerebral parenchymal lesions and are relatively easy to control with ASMs, but the accompanying neuroinflammation is often challenging to treat with a high reliance on biologic therapies for management. <b>Disclosure:</b> Dr. Ngo has nothing to disclose. Dr. Hutto has nothing to disclose.

Neurocysticercosis Complicating Pregnancy.

Infection with the pork tapeworm can result in neurocysticercosis caused by infestation of central nervous system tissues by the parasite cysts. Parenchymal brain infection can cause symptoms from mass effect that include headache, seizures, confusion, and even coma. Our objective was to describe the clinical course of neurocysticercosis infections in pregnant women. This was a case series that described clinical findings and pregnancy outcomes of women diagnosed with neurocysticercosis from 1994 through 2016 at a single institution. Their medical records were reviewed, cranial computed tomography and magnetic resonance imaging scans were assessed, and the infections were classified according to the criteria of the 2018 Infectious Diseases Society of America and the American Society of Tropical Medicine and Hygiene. Overall, 37 pregnant women with neurocysticercosis were identified. Of the 37 women, 32 were symptomatic, and 16 each had severe headaches or new-onset seizures or other neurologic sequelae. Some of these women had multiple symptoms. Others were diagnosed when neuroimaging was done for a history of neurocysticercosis or evaluation of a preexisting seizure disorder. The most common treatment was with anthelmintics-albendazole, praziquantel, or both-usually given with anticonvulsants and corticosteroids to decrease inflammation. There were eight women in whom invasive neurosurgical procedures were performed, usually for hydrocephaly. Overall, 32 healthy neonates were born at term, and there was one preterm delivery at 34 weeks of gestation. The four pregnancy losses included two molar pregnancies, one anembryonic miscarriage, and a 23-week stillbirth of a pregnancy complicated by preeclampsia with severe features. Neurocysticercosis in pregnant women may be asymptomatic or result in headaches, seizures, confusion, nausea and vomiting, altered mental status, or obtundation. Anthelmintic treatment is usually successful, but in some women neurosurgical procedures are necessary to relieve obstructive hydrocephaly.

Continuous Electroencephalogram and Antiseizure Medication Use in an International Pediatric Traumatic Brain Injury Population.

Electrographic seizures are frequent and associated with worse outcomes following traumatic brain injury (TBI). Despite this, the use of continuous electroencephalogram (cEEG) remains low. Our study describes cEEG usage and treatment dosing antiseizure medications (ASMs) in an international pediatric TBI population, hypothesizing that children monitored with cEEG have an increased rate of treatment ASMs because of electrographic seizure detection, compared with children who are not monitored with cEEG. This subanalysis of the TBI cohort of the international PANGEA study included children, 7days to 17years of age, with acute neurological insults admitted to pediatric intensive care units. We analyzed demographics, injury severity, and therapies including prophylactic or treatment ASMs. We evaluated the relationships between cEEG use, seizure frequency, and receipt of treatment ASMs. [Formula: see text] or Fisher's exact test was used to analyze categorical variables, and the Kruskal-Wallis or Mann-Whitney U-test was used for continuous variables. Multivariable analysis for treatment ASM use was performed using logistic regression. One hundred-twenty-three of 174 patients with TBI were included. Twenty-seven patients (21.9%) underwent cEEG at any point during pediatric intensive care unit admission. Preexisting seizure disorder (18.2% vs. 2.3%, p = 0.014) and neuromuscular blockade use (52.4% vs. 24.1%, p = 0.011) were more frequently observed in the group monitored on cEEG when compared with those that were not. Presenting median Glasgow Coma Scale score was worse in the cEEG group (7 vs. 9, p = 0.044). There was no significant difference in age, use of intracranial pressure monitoring, or hyperosmolar therapy between the cEEG monitored and nonmonitored groups. Patients who were monitored on cEEG were more likely to receive a treatment dose ASM than those without cEEG monitoring (66.7% vs. 28.1%, p = 0.0002). When compared with those without treatment ASM, the treatment ASM group had more electrographic seizures on their first electroencephalogram following injury (51.6% vs. 4%, p = 0.0001) and more clinical seizures (55.8% vs. 0%, p < 0.0001). Children monitored with cEEG after TBI have an increased prescription of treatment ASMs and clinical and electrographic seizures. The increased rate of treatment ASMs in the cEEG group may indicate increased recognition of electrographic seizures.

Characterization and Outcomes of Hospitalized Children With Coronavirus Disease 2019: A Report From a Multicenter, Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) Registry.

Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. Retrospective study. Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. None. The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.

Infliximab\u2010induced seizures in a patient with Crohn\u2019s disease: a case report

BackgroundInfliximab-induced seizures in patients with Crohn’s disease are extremely rare and the mechanism of infliximab-induced seizures is unclear.Case presentationA 60-year-old woman with Crohn’s disease experienced infliximab-induced seizures, diagnosed on normal magnetic resonance imaging of the brain. Moreover, the rechallenge with infliximab was positive.ConclusionsNeurological assessment and tight clinical monitoring before and during therapy with infliximab should be performed in patients with pre-existing seizure disorders.

Contraindications to Magnesium Sulfate and Alternative Seizure Prophylaxis for Severe Preeclampsia [09L

INTRODUCTION: Intravenous magnesium sulfate is considered first-line seizure prophylaxis for preeclampsia, reducing the risk of eclampsia by half. Absolute or relative contraindications to this medication include myasthenia gravis, severe renal failure, cardiac ischemia, heart block and pulmonary edema. Levetiracetam, an alternative antiepileptic drug considered safe in pregnancy, has been suggested in such cases though its efficacy remains uncertain. Our objective was to determine how frequently alternative anticonvulsant medications are administered for seizure prophylaxis in severe preeclampsia and to identify the documented indications in such cases. METHODS: IRB approved, retrospective cohort study of women with a diagnosis of preeclampsia at 34 weeks of gestation or greater who received seizure prophylaxis at a tertiary university hospital from 2014-2017. Demographics, clinical characteristics and contraindications to magnesium sulfate, if present, were evaluated. Patients were excluded if they had a pre-existing seizure disorders or incomplete medical records. RESULTS: A total of 1,370 patients were included; 3.2% (n=44) received levetiracetam for seizure prophylaxis. Most of the levetiracetam group (79.5%) initially received magnesium. The most commonly documented contraindication was pulmonary edema (n=14) which was confirmed by imaging (either ultrasound or chest x-ray) in less than half of cases; other reasons included changes in laboratory data (n=11; increasing serum creatinine, serum magnesium &gt;7 mg/dL), development of additional signs/symptoms (n=11; hypotension, headache, vision changes, decreased urine output) and patient refusal (n=3). Five cases did not document any contraindication. CONCLUSION: The use of alternative anticonvulsant medications in preeclampsia, which may be less efficacious, must be reserved for true contraindications to magnesium sulfate.

The Effect of Pre-existing Seizure Disorders on Mortality and Hospital Length of Stay Following Burn Injury.

Patients with a seizure disorder have a higher incidence of burn injury; however, there are limited studies that examine the association between pre-existing seizure disorders (PSD) and burn outcomes. This is a retrospective study of admitted burn patients. Variables analyzed include patient demographics, clinical characteristics, associated PSD, hospital length of stay (LOS), and mortality. Multivariate logistic regression was performed to analyze the impact of PSD on burn mortality and LOS. Seven thousand six hundred and forty patients met the inclusion criteria and 1.31% (n = 100) patients had a PSD. There was no difference in mortality rate between patients with or without PSD (odds ratio [OR] = 2.28, 95% confidence interval [CI] = 0.87 to 5.93). Multivariate logistic regression showed that patients with PSD had significantly increased odds of longer hospital LOS (OR = 2.85, 95% CI = 1.73 to 4.67). Seizure disorder management is mandatory in reducing burn injury and decreasing the costs associated with increased hospital LOS.

461 The Effect of Pre-Existing Seizure Disorders on Mortality, Intensive Care Unit and Hospital Length of Stay Following Burn Injury

461 The Effect of Pre-Existing Seizure Disorders on Mortality, Intensive Care Unit and Hospital Length of Stay Following Burn Injury

The Effect of Pre-existing Seizure Disorders on Mortality and Hospital Length of Stay Following Burn Injury

The Effect of Pre-existing Seizure Disorders on Mortality and Hospital Length of Stay Following Burn Injury

Reader response: Behavioral interventions as a treatment for epilepsy: A multicenter randomized controlled trial.

I read with interest the Haut et al.1 study on neurobehavioral interventions as a treatment for medication-resistant epilepsy. The complex relationship between stress and seizures is unclear. While stress is not thought to cause epilepsy, it is presumed that it makes preexisting seizure disorder worse and this forms the basis for advising stress reduction techniques to epilepsy patients. Patients commonly report more seizures when they are passing through a stressful period but there is no evidence that stress causes more seizures or makes preexisting seizure disorder worse. Until we have solid evidence to prove causality of stress as a seizure precipitant, the study only proves that with neurobehavioral interventions designed to reduce stress, patients report fewer seizures. It would be useful if portable (ambulatory) EEG recording systems were utilized instead of patient e-diaries to quantify seizure frequency change after neurobehavioral interventions.

Psychiatric Evaluation during Epilepsy Monitoring Unit Admission Identifies Undiagnosed Psychiatric Co-Morbidities in Epilepsy Patients

Rationale: Epilepsy patients are known to have multiple comorbidities. Comorbid psychiatric diagnosis contributes to the poor outcome, especially undiagnosed psychiatric conditions. The goal of the study is to properly identify specific psychiatric diagnosis in this patient population, providing targeted treatment recommendation. Methods: All patients admitted to Epilepsy Monitoring Unit (EMU) from October 2016 to May 2017 are included in this analysis. Psychiatric evaluation was completed from all ninety-seven patients except one due to family refusal (N = 96). All patients have pre-existing epilepsy diagnosis or suspicion of epilepsy. Psychiatric evaluation includes patient interview, family interview, chart review, and discussion with neurology team. Results: Ninety-seven patients were admitted to the EMU between October 2016-November 2017; 96 of those patients received psychiatric intervention. There were 53 (55%) female participants and 43 (45%) male participants; mean age was 43 years old. Of ninety-six epilepsy and epilepsy suspect patients, 61 (64%) reported history of psychiatric illness; 34 (56%) of these patients were treated by their neurologist or primary care doctor for depression or anxiety. Four patients (4.2%) reported pre-existing Post-Trauma Stress Disorder (PTSD) with history of severe trauma. Four patients (4.2%) had autistic spectrum disorder diagnosed at young age; all related to early-onset epilepsy. Five patients (5.2%) had documented, pre-existing Psychogenic Non-Epileptic Seizure (PNES) or conversion disorder evidenced by negative EEG. A few other psychiatric diagnoses were unrelated to epilepsy. Thirty-five patients (36%) who reported no pre-existing psychiatric diagnosis had never had a psychiatric evaluation. After formal psychiatric screening at EMU, 56 out of 96 (58%) of patients’ psychiatric diagnosis has changed. Ten out of 41 (24%) of the patients with pre-existing diagnosis of depression or anxiety were found to have different types of somatic symptoms. With EEG correlation, 13 (14%) patients were confirmed to have PNES or conversion disorder with mixed symptoms during EMU admission from 5 (5%) diagnosed PNES cases before EMU admission. Nine patients met the criteria of somatic symptom disorder with chronic, non-neurological symptoms. Seven (7%) patients received a new diagnosis of adjustment disorder; four of them were due to uncontrolled epilepsy. Five patients received a new diagnosis of PTSD with severe early life trauma; among them, three patients also received another new diagnosis of chronic somatic symptom disorder. Conclusions: Proper diagnosis of psychiatric comorbidities is the first step in treatment. Inpatient psychiatric evaluation during EMU admission identifies more specific psychiatric diagnoses, leading to more targeted treatment recommendations. We strongly recommend integrated psychiatric evaluation for all EMU admissions. Psychiatric consultation with daily inpatient follow-up during EMU admission identified PNES, conversion disorder with mixed symptoms, other somatic symptom disorders and adjustment disorder related to epilepsy, which led to more targeted treatment recommendations. Unrecognized and untreated conversion patients are just as disabled as patients with epilepsy. The misdiagnosis of PNES leads to inappropriate treatment of presumed epilepsy, with significant risk of iatrogenic injury, morbidity and increased cost to patient and to the health care system.

Efficacy and safety of voretigene neparvovec (AAV2-hRPE65v2) in patients with RPE65-mediated inherited retinal dystrophy: a randomised, controlled, open-label, phase 3 trial

Phase 1 studies have shown potential benefit of gene replacement in RPE65-mediated inherited retinal dystrophy. This phase 3 study assessed the efficacy and safety of voretigene neparvovec in participants whose inherited retinal dystrophy would otherwise progress to complete blindness. In this open-label, randomised, controlled phase 3 trial done at two sites in the USA, individuals aged 3 years or older with, in each eye, best corrected visual acuity of 20/60 or worse, or visual field less than 20 degrees in any meridian, or both, with confirmed genetic diagnosis of biallelic RPE65 mutations, sufficient viable retina, and ability to perform standardised multi-luminance mobility testing (MLMT) within the luminance range evaluated, were eligible. Participants were randomly assigned (2:1) to intervention or control using a permuted block design, stratified by age (<10 years and ≥10 years) and baseline mobility testing passing level (pass at ≥125 lux vs <125 lux). Graders assessing primary outcome were masked to treatment group. Intervention was bilateral, subretinal injection of 1·5 × 1011 vector genomes of voretigene neparvovec in 0·3 mL total volume. The primary efficacy endpoint was 1-year change in MLMT performance, measuring functional vision at specified light levels. The intention-to-treat (ITT) and modified ITT populations were included in primary and safety analyses. This trial is registered with ClinicalTrials.gov, number NCT00999609, and enrolment is complete. Between Nov 15, 2012, and Nov 21, 2013, 31 individuals were enrolled and randomly assigned to intervention (n=21) or control (n=10). One participant from each group withdrew after consent, before intervention, leaving an mITT population of 20 intervention and nine control participants. At 1 year, mean bilateral MLMT change score was 1·8 (SD 1·1) light levels in the intervention group versus 0·2 (1·0) in the control group (difference of 1·6, 95% CI 0·72-2·41, p=0·0013). 13 (65%) of 20 intervention participants, but no control participants, passed MLMT at the lowest luminance level tested (1 lux), demonstrating maximum possible improvement. No product-related serious adverse events or deleterious immune responses occurred. Two intervention participants, one with a pre-existing complex seizure disorder and another who experienced oral surgery complications, had serious adverse events unrelated to study participation. Most ocular events were mild in severity. Voretigene neparvovec gene replacement improved functional vision in RPE65-mediated inherited retinal dystrophy previously medically untreatable. Spark Therapeutics.

Seizures in the peripartum period: Epidemiology, diagnosis and management

The occurrence of seizures in the peripartum period is a rare but particularly challenging situation. Seizures in the peripartum period could result from three categories of conditions: first and most frequent is the exacerbation of a known pre-existing seizure disorder, mainly epilepsy. A therapeutic evaluation is needed; second is the new onset of seizures due to a non-pregnancy-related problem. An accurate diagnosis and a specific treatment are required; third is range of pregnancy-related conditions. The present review focuses on this third category, with a special attention to disorders occurring in the peripartum period. It is structured in two sections. The first section is a focus on eclampsia since, based on ICU admission data, it appears to be the leading cause of pregnancy-related seizures. Its epidemiology, pathophysiology, clinical diagnosis, neuro-imaging features and recommended management are reviewed. The efficacy and safety of the recommended regimens of MgSO4 therapy are discussed, as well as controversies on the alteration of these regimens and the use of MgSO4 in women with mild preeclampsia. In the second section, the other causes of pregnancy-related new onset seizures are summarized. These include posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis, thrombotic thrombocytopenic purpura, amniotic fluid embolism, and air embolism. Noteworthy is the fact that most of these pregnancy-related seizure conditions overlap with each other, mainly in terms of clinical presentations and neuro-imaging. Therefore, the diagnosis and the treatment options should be considered on a multidisciplinary basis.

P.033 Novel presentation of NMDA receptor encephalitis

Background: NMDA receptor encephalitis (NMDARE) is associated with pre-existing psychiatric symptoms and seizure disorders. It is not typically associated with elevated ICP. Diagnostically, EEG findings in NMDARE are characteristic as are the pathological features of ovarian teratomas associated with this disease. We report a patient who tested positive for NMDARE however presented with features not known to be associated with the disease including elevated ICP, atypical EEG findings and grossly atypical features on pathological section. Results: A 26 year old woman presented with psychiatric symptoms and status epilepticus. On examination, she was found to have papilledema and eleveated ICP on measurement. Her imaging and EEG demonstrated atypical findings, not consistent with NMDARE. CT scan of the abdomen demonstrated an adnexal mass. CSF studies eventually tested positive for NMDARE and following removal of her ovarian teratoma, the pathology demonstrated atypical findings for lesions associated with NMDARE classically. Conclusions: NMDARE is a new entity, which has historically shown a typical clinical course. Our case demonstrates a previously undescribed presentation of NMDARE with elevated ICP, atypical EEG findings and unique pathology of the associated ovarian teratoma.

Phenytoin versus Levetiracetam for Prevention of Early Posttraumatic Seizures: A Prospective Comparative Study

Background Antiepileptic drugs are routinely given for the prevention of early posttraumatic seizures (EPTS) occurring within the first 7 days after traumatic brain injury. The objective of this study was to compare phenytoin with levetiracetam in their effectiveness for prophylaxis for EPTS. Method This single-blinded, prospective randomized study included 100 consecutive admitted patients at our center during a 3-month period from February 1, 2014, to April 30, 2014. Patients with preexisting seizure disorders and pathological brain conditions were excluded from the study. The patients were alternately assigned to a group receiving phenytoin (group P) or a group receiving levetiracetam (group L). Group P patients received phenytoin intravenously at 18 mg/kg as a loading dose followed by a maintenance dose of 5 mg/kg with phenytoin level monitoring. Group L patients received levetiracetam at a dose of 20 mg/kg loading dose and 20 mg/kg/d maintenance dose. A comparative study was done for the occurrence of EPTS and adverse effects in the two groups. Results One patient in group L ( n = 50) and four patients in group P ( n = 50) developed EPTS after initiating treatment, but this was not statistically significant ( p = 0.362 with odds ratio, OR = 0.24 [95% confidence interval, CI: 0.03–2.17]). There was no statistically significant difference between the two groups in the incidence of drug adverse effects ( p = 0.617 with OR = 0.32 [95% CI: 0.03–3.18]). Adverse effects such as poor glycemic control, ataxia, nystagmus, or giddiness were seen in three patients in group P. One patient in group L had sinus bradycardia. Toxic serum drug levels (> 20 µg/mL) were observed in 6 of 50 (12%) patients of group P. Conclusion There was no significant difference in the occurrence of their adverse effects, but the adverse effects because of the phenytoin were more troublesome. Levetiracetam had a better safety profile than phenytoin and it was equally efficacious for the prevention of EPTS.

Seizures: awareness and observation in the ward environment.

The preconceived 'foaming' and 'violent' seizure stereotypes are misrepresentations, particularly by non-specialist health professionals. Thus the vast semiology (signs and symptoms) of seizures and their subtle signs too easily go unrecognised by the untrained eye. Nevertheless, a significant proportion of adult patients admitted to the ward for treatment of their current illness will have a pre-existing seizure disorder (epilepsy). Furthermore, such hospitalised patients are more likely to suffer a seizure within the ward environment as triggering factors are unavoidably present. Thus, it is essential that nurses are prepared to encounter seizures, irrespective of the reason for admission. This article discusses the clinical semiology of the various seizure types in association with the underpinning neuropathophysiology, as well as the potential seizure triggers. It thereby enhances nurses' awareness and observations of seizure activity in patients in the ward environment.

Development of Mania With Carbamazepine for Treatment of Seizure Disorder in a 7-Year-Old Boy

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. Previous reports of acute behavioral changes with carbamazepine are few. Most reports describe the use of carbamazepine in the context of mood stabilization in patients without seizure disorder. There is 1 previously reported case of carbamazepine-induced mania in an adult with seizure disorder and another1 in a boy with preexisting aggression, mood symptoms, and seizure disorder treated with carbamazepine

Outcome of status epilepticus. What do we learn from animal data?

Status Epilepticus (SE) is a life-threatening neurologic disorder defined as 5 minutes or more of a continuous seizure. SE can represent an exacerbation of a preexisting seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder. In humans, there are several differences between SE that occurs in adults and children. In adult patients, the mortality is high but the incidence is lower than in childhood. Experimental studies have been essential in helping clinicians describe SE, and since these early initial studies, further experimental studies have helped us to better understand the consequences of SE. Animal models of SE support the notion that SE induces brain damage and contribute to epileptogenesis. Laboratory models of SE in developing animals demonstrate age- and model-dependent propensity for brain injury and for epileptogenesis. The use of models with a double hit including a clinical relevant component to seizures provides data that allows us to further understand the contribution of early-life events in the future development of epilepsy. Using this approach, it has been shown that inflammation or a preexisting brain lesion enhance epileptogenesis in the developing brain. The use of models of SE also permits to establish that treatment to stop the seizure and/or the duration of the SE results in a decrease of SE induced cell injury. Preventing epileptogenesis remains an important goal to modify the development of comorbidities, and it still represents an area of research in need of much progress.

Risk of severe and repetitive traumatic brain injury in persons with epilepsy: A population-based case–control study

BackgroundWhile traumatic brain injury (TBI) can lead to epilepsy, individuals with preexisting epilepsy or seizure disorder (ESD), depending on the type of epilepsy and the degree of seizure control, may have a greater risk of TBI from seizure activity or medication side effects. The joint occurrence of ESD and TBI can complicate recovery as signs and symptoms of TBI may be mistaken for postictal effects. Those with ESD are predicted to experience more deleterious outcomes either because of having a more severe TBI or because of the cumulative effects of repetitive TBI. MethodsWe conducted a case–control study of all emergency department visits and hospital discharges for TBI from 1998 through 2011 in a statewide population. The severity of TBI, repetitive TBI, and other demographic and clinical characteristics were compared between persons with TBI with preexisting ESD (cases) and those without (controls). Significant differences in proportions were evaluated with confidence intervals. Logistic regression was used to examine the association of the independent variables with ESD. ResultsDuring the study period, 236,164 individuals sustained TBI, 5646 (2.4%) of which had preexisting ESD. After adjustment for demographic and clinical characteristics, cases were more likely to have sustained a severe TBI (OR=1.49; 95% CI=1.38–1.60) and have had repetitive TBI (OR=1.54; 95% CI=1.41–1.69). ConclusionThe consequences of TBI may be greater in individuals with ESD owing to the potential for a more severe or repetitive TBI. Seizure control is paramount, and aggressive management of comorbid conditions among persons with ESD and increased awareness of the hazard of repetitive TBI is warranted. Furthermore, future studies are needed to examine the long-term outcomes of cases in comparison with controls to determine if the higher risk of severe or repetitive TBI translates into permanent deficits.