Treated Epilepsy Patients Research Articles

Neurotoxic effects of GABA-transaminase inhibitors in the treatment of epilepsy: ocular perfusion and visual performance.

Vigabatrin is a GABA (gamma-aminobutyric acid) transaminase inhibitor that elicits an antiepileptic effect by enhancing inhibitory neurotransmission in the brain. Vigabatrin has been previously associated with concentric peripheral visual field loss and visual electrophysiological abnormalities. Recently, visual function deficits of the central retina have been identified in a proportion of patients receiving vigabatrin; these include disturbances in colour perception, contrast sensitivity and short-wavelength automated perimetry. Consequently, it is suggested that vigabatrin-associated retinal toxicity is diffuse inducing subtle central visual dysfunction and more severe peripheral visual defects. Reductions in cerebral blood flow and cerebral metabolic rate for glucose occur in epilepsy patients receiving antiepileptic drug therapy. Despite the known cerebral haemodynamic alterations in epilepsy and the visual consequences of vigabatrin therapy, ocular blood flow has only recently been investigated in this group. We present findings from a series of novel investigations that identify compromised retinal microvascular perfusion and pulsatile ocular blood flow (POBF) in epilepsy patients. The reduction in POBF was exacerbated in epilepsy patients treated with vigabatrin compared to conventionally treated epilepsy patients. A number of theories are presented to explain compromised ocular blood flow in vigabatrin treated epilepsy patients, and the possibility of a GABAergic mechanism of toxicity is discussed.

Frontal lobe epilepsy: diagnosis and surgical treatment

Surgical treatment has proven to be a therapeutic option in medically refractory epilepsies. The vast majority of surgically treated epilepsy patients suffer from temporal lobe epilepsy, mainly with seizure origin in the mesiobasal structures. In these patients, epilepsy surgery has yielded seizure-free outcome in 70% to 80% of cases. Conversely, frontal lobe epilepsy used to be more difficult to treat, and the surgical results were not satisfactory. In recent years, however, modern imaging tools such as functional MRI (fMRI), single photon emission computer tomography (SPECT), and improved surgical techniques have resulted in better seizure outcome [1]. In their review, Wetjen et al. present not only the excellent surgical results of one of the leading centers in epilepsy surgery but also the presurgical work-up, which is even more important. Thus, for instance, knowledge of the semiology is a conditio sine qua non for further presurgical evaluation including imaging and invasive EEG. In their review, Wetjen et al. demonstrate that frontal lobe epilepsy can nowadays be surgically treated with results similar to those for epilepsy surgery of the temporal lobe. Thus, this article should help to bring more patients to beneficial surgical treatment of a disease that is often an enormous health and social handicap.

ILAE/IBE/WHO Global Campaign "out of the shadows": global and regional developments.

ILAE/IBE/WHO Global Campaign "out of the shadows": global and regional developments.

Lamotrigine Monotherapy Improves Depressive Symptoms in Epilepsy: A Double-Blind Comparison with Valproate

Depressive symptoms are highly prevalent in patients with epilepsy. The antiepileptic drug lamotrigine has been shown to be an effective treatment for the depressive phase of bipolar disorder and to enhance mood and well-being in epilepsy patients. The effects of lamotrigine monotherapy on depressive symptoms in epilepsy have not been evaluated to date in a controlled clinical trial. A recently completed double-blind epilepsy trial comparing the effects of lamotrigine monotherapy and valproate monotherapy on weight change incorporated a battery of standard mood assessments. Mean screening Beck Depression Inventory scores showed that both lamotrigine and valproate groups suffered from mild depression at baseline. Lamotrigine monotherapy was reliably associated with earlier and larger improvements than valproate in mood assessed with the Beck Depression Inventory, the Cornell Dysthymia Rating Scale, and the Profile of Mood States. Considered in the context of other data showing lamotrigine's antidepressant efficacy in bipolar depression, these results suggest that lamotrigine improves mood in mildly depressed patients with epilepsy. Lamotrigine may be particularly useful in treating epilepsy patients with comorbid depression, the most common psychiatric illness in epilepsy.

Neurological complications during medication of epilepsy patients.

When treating epilepsy patients with an array of drugs, their dosages and distribution in the course of the day depend upon the structures of the epileptic paroxysms, their frequency, and time of beginning. The circle of antiepileptic preparations which produce major therapeutic effects in patients having particular types of seizures grows ever wider. Not rarely, the development of a polymorphism in the paroxysmal manifestiations in the epileptic patient during the progredient of the disease's course leads to a situation such that the therapeutic effect is obtained only by applying a combination of anticonvulsants. Neurological complications have been observed which require timely diagnosis and correction of dosages or changes in the combination of antiepileptic substances [I]. Papers by foreign and domestic authors [2-8] have described individual neurological symptoms which arise during the therapeutic use of diphenine, diphenine in combination with phenobarbital, carbamazepine, and other anticonvulsants. We have examined 48 epileptic patients (28 women and 20 men) hospitalized in the epilepsy clinic of the Moscow Psychiatric Research Institute of the Ministry of Public Health of the RSFSR. Patient ages ranged from 18 to 40 years, the length of illness from 5 to 20 years. In 36 persons, a neurological symptomatology caused by drug therapy was observed upon entry to the clinic; in 12 patients it developed in the hospital. In 17 examinations, the paroxysms had a tonic-clonic, generalized character. In 26 the tonic-clonic seizures were combined with nonconvulsive symptoms (absentia epileptlca, psychomotor, psychosensory, psychopathological, etc.). In five patients only nonconvulsive paroxysms were noted.