Side Effects Of AEDs Research Articles

Ilae classification of seizures and antiepileptic medications apothegmatic: hereafter advancement and clinical practice

Introduction: The Antiepileptic medications are frequently categorized into divisions such as ‘first-generation’ (i.e., carbamazepine, phenobarbital, phenytoin, primidone, and valproate) and ‘second-generation’ (lamotrigine, levetiracetam, felbamate, gabapentin, topiramate, tiagabine, oxycarbazepine, zonisamide, and pregabalin). Chronic phenytoin ingestion leads to its impact in the cerebral cortex, resulting in atrophy of cerebellum, cause ataxia and nystagmus. Objective: To recapitulate the International league against epilepsy classifications, first treatment for epilepsy based on their classifications, antiepileptic medications adverse drug reaction, Methodology: The author used 74 distinctive published articles for the accomplishment of this review article. Google search engine was used for accessing published articles from databases like Google Scholar, Research Gate, PubMed, NCBI, NDSS, PMID, PMCID, Cochrane Database and CLINMED international library. Findings: Tonic-clonic is characterized by stiffness for loss of consciousness occurred by tonic extension and rhythmic clonic contractions of all considerable muscle groups. Antiepileptic drugs are implicitly an effective treatment for patient with epilepsy. Carbamazepine cause serious and sometimes fatal dermatologic reactions, including toxic epidermal necrolysis and stevens-johnson syndrome, aplastic anemia and agranulocytosis, Suicidal Behavior and Ideation, Stevens johnson syndrome, cholestatic jaundice, ataxia, xerostomia, speech disturbances, feeling sleepy Conclusion: Commonly happening side-effects of AEDs are memory troubles, exhaustion, tremors, gastrointestinal symptoms, osteoporosis, depression, drowsiness, dizziness, weight change, nausea. In generalized seizures, on the other hand, the seizure is generalized from the endeavor (i.e., primary generalized seizures), launching in both hemispheres of the brain contemporaneously

Management of a first unprovoked epileptic seizure in adolescence and adulthood.

An epileptic seizure is one of the causes of so-called "transient neurological events" (TNEs). The differential diagnosis of a TNE relies mainly on history and physical examination. Laboratory markers are less frequently useful. After diagnosing an epileptic seizure, a distinction must be made between an acute symptomatic and an unprovoked seizure, since they have different treatments and prognosis. History, physical examination and other examinations (laboratory and imaging) are paramount in this distinction. After the diagnosis of a first unprovoked seizure, an EEG should be requested which may aid in establishing the diagnosis, evaluating the recurrence risk or ascertaining the self-limited nature of the seizure. 3T-MRI with an epilepsy protocol can be considered when CT has not clarified the aetiology. The decision to treat should be discussed with the patient/relatives, taking into account the risk of recurrence, the clinical characteristics (aetiology, seizure type, age, job, epileptic seizure schedule, comorbidities and polymedication), probability of AED side effects, and stigmatization. Nowadays, the chosen regimen is usually monotherapy with a second-generation AED that better suits the patient's characteristics, comorbidities and concurrent medication. Counselling should include first aid, precipitating factors, sport and physical exercise in order to avoid possible driving restrictions, the need for therapy compliance, and risk of recurrence and SUDEP.

First Attack of Status Epilepticus in Adults: Etiology and Risk Factors

AbstractBackground: Status Epilepticus (SE) is a common life-threatening neurological emergency the etiology of SE varies according to age and prior history of seizures. In people known to be epileptic poor compliance and drug withdrawal are the commonest causes of SE. On the other hand in patients with no prior seizure history strokes, head traumas, CNS infections, cardiac arrests and metabolic disturbances are the most com-mon causes.Aim of Study: Is to study the possible etiologies and outcome of first attack of SE in adults.Patients and Methods: This was a 6-month duration cross sectional study done at Neuropsychiatry Department, Tanta University Hospital, started from July 2016. All patients presented by first attack of SE over the age of 18 years and didn't have previous history of SE, were considered.Results: Of 42 patients included in the study 35 (83.3%) had non refractory SE while 7 (16.7%) had RSE. 37 patients survived (88.1%) and 5 patients died (11.9%). Analysis of statistically significant and most clinically important variables showed that these factors were significantly higher in RSE, cryptogenic etiology (p=0.024), EEG changes (p=0.015). number of AEDs (p=0.001), duration of hospitalization (p= 0.037), complications due to hospitalization (p=0.015), EMSE scores (p=0.001).Conclusion: Most patients presented by SE over the age of 18 has no prior history of epilepsy. CVAs are the leading cause of de novo SE in adults followed by metabolic derange-ments. Refractory Status Epilepticus (RSE) is associated with prolonged duration of hospitalization and higher rates of complications compared to non-refractory SE. Complications due to seizures were the most common followed by side effects of AEDs while complications of prolonged hospitali-zation were the least common. EEG monitoring is an important tool both in managing and predicting the outcome of status epilepticus. STESS and EMSE scoring systems are easy to use bed side tools to help in predicting the outcome of SE.

Short burst Clobazam dosing at discharge from VEEG evaluation reduces re-presentation with seizures

PurposeRecurrent seizures and status epilepticus after medication reduction for inpatient Video Electroencephalograph (VEEG) monitoring is a well-known complication of this investigation. In the literature this is reported to occur at a rate of approximately 3–7%. We review the use of short burst Clobazam dosing on discharge from the Epilepsy monitoring unit (EMU) to determine if this might reduce rates of representation with seizures. MethodsWe performed a retrospective review of all cases admitted to the EMU. Their medication reduction, number of seizures, seizure severity and demographics were collected. Representations to hospital were considered if they occurred within 14 days of discharge from the unit. Results264 cases were included, and 146 patients received 5 days of Clobazam 10 mg PO BD upon discharge after VEEG and 118 did not. There were significantly fewer patients re-presenting to hospital for seizures in the 14 days following discharge in those who were administered short-burst Clobazam compared to those who were not (0% and 4.23% respectively). There was also a trend towards fewer re-admissions for non-seizure indications including mental health issues or non-epileptic seizures and AED side effects. There were no definite adverse reactions to Clobazam recorded. ConclusionShort burst Clobazam appears to be a safe and effective means to reduce representation with seizures after medication reduction during VEEG recording. This obviously benefits patients but it may also be a cost-effective means to reduce unnecessary health expenditure.

Treatment of epilepsy in multiple sclerosis

PurposeThe prevalence of epilepsy is increased in multiple sclerosis (MS), but information on AED treatment and seizure outcome is scarce. We describe epilepsy characteristics including the use of AEDs and proportion of seizure-free patients at two tertiary hospitals in Sweden. MethodWe retrospectively studied electronic medical records of all patients with a diagnosis of MS and seizures at Sahlgrenska university hospital and Uppsala university hospital. Clinical data were reviewed until 2017. ResultsWe identified a total of 62 MS patients with at least one seizure. Median age at the first seizure (before or after MS) was 41 years (range 0–80). The most common MS disease course at the first seizure was secondary progressive MS, the neurological disability was considerable, and most patients had several MRI lesions at their first seizure. The first EEG demonstrated epileptiform discharges in 38% and unspecific pathology in 40%. Current seizure status could be determined for 37 patients. Out of these, 46% had been seizure free for more than one year at last follow-up. The majority of patients (65%) were on monotherapy at last follow-up. Carbamazepine was the most commonly used first AED, with a retention rate of 52%. No individual AED was associated with a particularly high rate of seizure freedom. The most common reason for discontinuation of the first AED was side-effects. ConclusionSeizure freedom rates were low, perhaps indicating a need for higher ambitions in management. Side effects of AEDs may be a particular concern when treating epilepsy in patients with MS.

Psychosocial Impact of Epilepsy in Older Adults.

Objective: The purpose of our study was to describe the quality of life of older adults with seizures or epilepsy and compare its psychosocial impact between those who were new diagnosed and those diagnosed before the age of 65. Methods: In-depth face to face interviews with open ended questions were conducted with two participant groups: Incident group: 42 older adults (>65 years) with new onset or newly diagnosed after age of 65; and Prevalent group: 15 older adults (>65 years) diagnosed before age of 65. Interviews were reviewed and coded using a list of themes and results were compared between the two groups. Eight topics were selected from the participants’ responses to questions about the psychosocial impact of epilepsy and seizures. The topics were then analyzed and compared between the two groups. Results: The topics analyzed were: Emotional and physical impact, significant life changes, co-morbidities, information gathering, stigma, AED side effects, changes in relationships and attitude toward diagnosis. Conclusion: We concluded that the age at onset and duration does seem to have a negative correlation with health related quality of life. However, the perceived health status of older adults with chronic epilepsy was significantly better and reflected in their more positive approach to the diagnosis of seizures or epilepsy probably because they have had a longer opportunity to learn to cope with their diagnosis.

PECULIARITIES OF TREATMENT OF EPILEPSY AT GIRLS AND WOMEN

The epilepsy treatment is to be based on existing general principles and standards of therapy with differential approach to each patient. Besides peculiarities of treatment of different types of seizures and forms of epilepsy there are also differential approaches to special groups of patients. To one of such groups are referred to women of reproductive age. These patients are referred to special group of risk due to the development of certain side effects of antiepileptic drugs (АED). This article focuses in details on peculiarities of treatment of women of reproductive age with epilepsy with accent made on tolerability and safety of the antiepileptic therapy. It is necessary to take into consideration, that at women neuroendocrinal disorders can be caused both by the disease itself – epilepsy (in such case disorders depend on the starting age, form of epilepsy, focal localization, duration of disorder and other factors, referred to the disease), as well as by the undertaken therapy. The article hereunder considers only issues, referred to the treatment, i. e. AED side effects and its input in the decrease of life quality of women with epilepsy. As women’s reproductive function starts forming long ago before childbearing age, it is necessary for this category to comprise not only women and adolescents, but girls as well. Notwithstanding the fact that so called benign forms of epilepsy pass before the pubescence period (idiopathic focal epilepsies, several forms of idiopathic generalized epilepsy), in many cases the epilepsy, which has started in childhood, continues in the adult age as well. In the same time there can be possible remote negative consequences of the antiepileptic therapy, which can show at a woman of a reproductive age. The data, given in the article, witnesses the need of the right AED selection at women of reproductive age, suffering from epilepsy. The AED should be selected not only depending on the form of the epilepsy and on the kind of seizures, but also provided its influence on the neuroen docrinal status of a woman, as well as on its influence on the reproductive system. With that it should be kept in mind that the reproductive function is very important not only from the point of view of woman’s health, but also from the point of view of her family and social status. If possible, women and men of reproductive age (including adolescents) should avoid AED with strong induction of the fermentative system of the liver (all barbiturates, hydantoins, carbamazepine), women should also avoid AED, containing valproic acid. In such cases the priority can be given to new AED, not affecting neuroendocrinal functions and the reproductive system.

O9.10 * ANTI-EPILEPTIC TREATMENT IN GLIOMA, A NORWEGIAN POPULATION-BASED STUDY

INTRODUCTION: Symptomatic epilepsy in glioma is traditionally perceived as difficult to treat and refractory to monotherapy. Older AEDs that induce or inhibit CytP450 enzyme systems (enzyme-inducing AED= EIAED) have previously been preferred. There is an increasing focus on the risk of interaction with other drugs with hepatic metabolism. We wanted to study whether newer AEDs with little or no enzyme effect (non-EIAED) are favored in the current treatment of epilepsy in glioma. MATERIALS AND METHODS: We identified all glioma patients with epilepsy in Norway by linking the Cancer Registry of Norway (CRN) and the Norwegian Prescription Database (NorPD). CRN has since 1952 registered information on all neoplasms diagnosed in Norway, and reporting is mandatory by law for clinicians and pathologists. NorPD was founded in 2004 by the Norwegian Institute of Public Health, and includes information on all prescriptions dispensed from all Norwegian pharmacies. We included all patients with glioma grade II-IV who were registered in NorPD. Epilepsy was defined as being registered as taking AEDs under a relevant epileptic diagnostic code. RESULTS: In 2004-2010, CRN registered 2583 patients with glioma grade II-IV, 1477 men and 1106 women. In low grade glioma, 65% had epilepsy and in high grade glioma, 47% had epilepsy. Low grade gliomas with epilepsy were localized in the frontal lobe in 46%. High grade gliomas with epilepsy were localized in the frontal lobe in 28% and the temporal lobe in 27%. In monotherapy or with other AEDs, carbamazepine was used by 34% and valproate by 36% of the 1104 patients with glioma and epilepsy. Patients aged 20-49 years with astrocytoma, and 40-79 years with glioblastoma multiforme (GBM), used non-EIAEDs more frequently than EIAEDs. Levetiracetam was the preferred AED, used by 39% of the 1104 patients. DISCUSSION: The non-EIAED levetiracetam was the most frequently used AED in glioma patients, especially in GBM. GBM patients often have overall survival <1 year and side effects of AEDs are particularly important. Levetiracetam can give cognitive side effects as mood changes or depression, reducing quality of life. Some studies have indicated an anti-tumor effect of valproate and levetiracetam. In this study, we are investigating whether the usage of different AEDs affect overall survival in GBM patients. CONCLUSION: In the Norwegian population 2004-2010, 65% of patients with low grade gliomas and 47% of patients with high grade gliomas had epilepsy. Levetiracetam was the most frequently used AED, especially in GBM. We further investigate the influence of exposure to the separate AEDs on overall survival in the GBM patients, and these results are to be presented.

Genetic epilepsies. Remarks on the proposed “Organization of the Epilepsies”

SUMMARYIntroduction.Genetic findings in several epilepsy syndromes provide insights into the pathophysiology of specific subtypes of epilepsy and into mechanisms of epileptogenesis, because the genes encoding ion channels, and proteins associated to the vesical synaptic cycle, or involved in energy metabolism, influence neuronal excitability.Aim.The following aspects of genetic epilepsies will be discussed: new proposed “organization of the epilepsies”, genetic and other etiologies, electroclinical syndromes and their genetics and genetic testing in the epilepsies.Methods.The updated review is based on OMIM™ (Online Mendelian Inheritance in Man).Review and remarks.Because of the vast genetic and phenotypic heterogeneity, bridging genotype and phenotype remains a major challenge in epilepsy genetics. The so-called “idiopathic” epilepsies are genetically determined. The new ILAE proposal on the “organization” of the epilepsies takes into account the genetic advances. However, despite proposed changes in the nomenclature, the concept of the electroclinical syndrome, i.e. seizure types, age-dependent onset, electroencephalographic criteria, and concomitant symptoms, such as movement disorders or developmental delay, remain important criteria to group the epilepsies. Although also the differentiation “generalized” versus “focal” is nowadays discussed critically, for practical reasons these categories remain valid. Similarly the categories “benign” syndromes of early childhood, epileptic encephalopathies, and fever-associated syndromes, have their utility.Conclusions.The large number of genetic defects in the epilepsies complicates their analysis. However, it is anticipated that novel genetic methods, that are able to analyze all known genes at a reasonable price, will help identify novel diagnostic and therapeutic avenues, including prognostic and genetic counseling. Today it is already possible to include into genetic testing genes responsible for the side effects of AEDs. In addition, for some epilepsy phenotypes it has became possible to predict the most efficacious antiepileptic drugs for patients based on their genetic makeup. Thus, the development of individualized medicine is expected to greatly improve the management of epilepsy patients.

Impact of the implementation of the AAN epilepsy quality measures on the medical records in a university hospital

BackgroundThe American Academy of Neurology (AAN) suggested eight quality measures to be observed at every patient visit. The aim of this work is to compare the percentage of documentation of each measure before and after the implementation of a new worksheet in a third-level center.MethodsQuasi-experimental study including medical records filled by medical school seniors and junior residents supervised by an epileptologist. The authors surveyed 80 consecutive charts of people with epilepsy who were seen in the outpatient clinic before and after the intervention. McNemar change test was used to compare the percentages of documentation of each quality measure–i.e., seizure type and frequency, etiology, EEG, MRI/CT head scans, AED side effects, surgical therapy referral, safety counseling, preconception counseling–and physical exam. Each quality measure was considered to be fulfilled only if it was assessed and properly recorded.ResultsMean age was 35(±13) years, 55% women, mean epilepsy onset at age 18(±15), 82% presented with partial-onset seizures. The reporting rate improved for all quality measures (previous vs new), reaching statistical significance for: seizure type 80vs94% (p < 0.05), AED side effects 8vs24%, etiology 66vs88% (p < 0.01), safety counseling 5vs64%, preconception counseling 4vs20%, and physical exam 63vs94% (p < 0.001).ConclusionA quality-oriented epilepsy worksheet led to a better practice standardization and documentation of AAN standards for diagnostic and counseling purposes. Further evaluations should be undertaken to assess the impact on medical education and patient care.

Quality Indicators for Epilepsy Care in Zambia: Roadwork for the WHO Mental Health Gap Action Programme (mhGAP) Guidelines (P07.116)

Objective: To develop quality indicators for epilepsy/seizure care before implementation of the World Health Organization9s mhGAP programme. Background mhGAP evidence-based guidelines are aimed at improving care in lower-middle income countries (LMICs). Design/Methods: Healthcare workers with neurologic expertise developed abstraction forms aimed at capturing key aspects of care. Forms were piloted and adapted before evaluation at four sites including one non-general, specialty hospital where epilepsy care is frequently rendered. For ∼2 months, all charts were screened. Those with any seizure-related diagnoses, events or investigations were reviewed for abstraction. Results: 169 outpatient and 95 inpatient charts met criteria for abstraction. Quality of care varied substantially across institutions. Among outpatients, mean age was 27 years (SD 14.9) with male predominance (58.5%, p=0.013). Temperature was documented in 61/169 (36%) and weight in 48/169 (28.4%) with trends toward better documentation in children under 5 (p=0.053 and 0.022, respectively). Among adults based upon standard dosing, AEDs were frequently under-dosed (51/86, 59%). For people with epilepsy, seizure frequency and AED side effects were not routinely noted (present in 20/90, 22%). Folate was prescribed for only 3% of women on AEDs. Among patients prescribed AEDs, 10% received concurrent antipsychotics. Inpatients were younger (mean 18 years, SD 15.4) and 54% male. Temperature documentation remained suboptimal, 67/95(70.5%), though under-5s were more likely to have their temperature recorded (p Conclusions: Quality indicators for epilepsy/seizure care in LMICs offer important insights into areas for improvement within the scope of locally available resources. Further refinement of these indicators will be needed given the heterogeneity of epilepsy care settings and providers in such countries, and to ensure improvement in outcomes based on selected indicators. Supported by: NIH 1R01NS061693 and NIH 1R01NS061693-03S1. Disclosure: Dr. Kvalsund has nothing to disclose. Dr. Mbewe has nothing to disclose. Dr. Mulenga has nothing to disclose. Dr. Atadzhanov has nothing to disclose. Dr. Haworth has nothing to disclose. Dr. Chomba has nothing to disclose. Dr. Birbeck has nothing to disclose.

Psychopathology in Pediatric Epilepsy: Role of Antiepileptic Drugs

Children with epilepsy are usually treated with antiepileptic drugs (AEDS). Some AEDs adversely affect behavior in susceptible children. Since psychiatric comorbidity is prevalent in pediatric epilepsy, this paper attempts to disentangle these AED side effects from the psychopathology associated with this illness. It first outlines the clinical and methodological problems involved in determining if AEDs contribute to the behavior and emotional problems of children with epilepsy. It then presents research evidence for and against the role AEDs play in the psychopathology of children with epilepsy, and outlines how future studies might investigate this problem. A brief description of how to clinically separate out AED effects from the complex illness-related and psychosocial factors that contribute to the behavior difficulties of children with epilepsy concludes the paper.

Treatment of A First Unprovoked Seizure

The Quality Standards Subcommittee of the AAN and Practice Committee of the CNS have reviewed published literature to determine when to begin treatment after a first unprovoked seizure, risk of recurrence, prevention of recurrence, development of chronic epilepsy, and side effects of AEDs.

Rational treatment of refractory epilepsy in childhood.

A multifaceted study on childhood refractory epilepsy disclosed an insufficient classification of epilepsies and epileptic seizures, and inappropriate polypharmacy as the most important factors preventing appropriate therapy. By means of an adjustment of AEDs based on the accurate classification of epilepsies and epileptic seizures, the number of AEDs could be reduced in 37.5% and monotherapy was successful in 13.8% of refractory cases. Most of the latter were those of partial epilepsy and generalized epilepsy with the monoseizure type. The exacerbation of seizures due to AEDs was also mentioned as one of the important side effects of AEDs.