Treatment Of Chronic Epilepsy Research Articles

Tiagabine Incorporated Polymeric Microneedles: Formulation and Characterization Studies

Background: The oral route is the primary route for both acute and chronic treatment of epilepsy. However, lack of oral access during the seizures and high drug resistance limit the antiepileptogenic effects of most antiepileptic drugs. Therefore, alternative routes and novel drug delivery systems are required. In this study, polymeric microneedles were formulated and characterized for possible intranasal administration of Tiagabine (TIA) in order to overcome the blood-brain barrier (BBB). Methods: In our study, carboxymethyl cellulose (CMC) and Eudragit® S 100 (ES100) based polymeric microneedles were formulated by micromolding method. Scanning electron microscopy (SEM), differential scanning calorimetry (DSC), X-ray diffractometry (XRD), fourier transform infrared spectroscopy (FT-IR) and proton nuclear magnetic resonance (1H-NMR), in vitro release, and texture analyses were performed. For the stability analyses, formulations were kept at 25°C ± 2°C (60 ± 5% Relative Humidity; RH), 40°C ± 2°C (75 ± 5% RH) and 5°C ± 3°C for six months. Results: Analysis results revealed that robust microneedles were formulated successfully by micromolding method with adjustable needle lengths. Depending on the polymer type, sustained TIA releases up to 72 hours were achieved. Structural integrities were maintained at all storage conditions during the storage period of six months. Conclusion: TIA-loaded microneedles have the potential with less invasive properties, even with small amounts of TIA, through the unconventional nasal route for effective treatment of epilepsy.

A Case of Anti-GAD 65 Autoimmune Encephalitis Associated with Focal Segmental Stiff-Person Syndrome

Glutamic acid decarboxylase (GAD) antibody-related encephalitis is an autoimmune disease associated with intracellular neuronal antigens. We report on a rare case of GAD antibody-associated encephalitis complicated with focal segmental stiffness-person syndrome (SPS) in a middle-aged woman. The disease course lasted for >10 years, initially presenting with drug-resistant epilepsy, followed by stiffness of the right lower limb, and right upper limb involvement. The patient experienced anxiety and depression symptoms due to long-term illness. During hospitalization, serum and cerebrospinal fluid GAD antibodies were positive and no tumor was found. The symptoms were significantly relieved after corticosteroid therapy and intravenous immunoglobulin immunomodulation therapy. To the best of our knowledge, this case is the first to discuss the early recognition and treatment of chronic epilepsy and focal segmental SPS caused by anti-GAD antibody-related encephalitis.

Acute Administration of Benzodiazepines as Part of Treatment Strategies for Epilepsy

Ad-hoc administration of benzodiazepines (BZD) is well established in status epilepticus, but intermittent BZD use in the treatment of chronic epilepsy is little known beyond catamenial epilepsy. We aim to assess the use of acute drug administration (ADA) in the treatment of 24 patients with epilepsy (9 idiopathic generalized, 14 focal symptomatic/cryptogenic, 1 migraine-epilepsy) receiving ADA for (1) prevention of generalized tonic-clonic seizures (GTCS) after minor seizures, (2) prevention of seizures at perceived risk, (3) prevention of seizure clusters. Standard ADA was 10 mg oral clobazam (CLB); one patient received 10 mg rectal diazepam. Concomitant antiepileptic drugs (AED) remained unchanged whenever possible. Ten patients used ADA always correctly, 7 mostly, 7 sporadically or not. Outcome considering seizure control was positive in 44% of all patients (59% of those who actually used ADA): 5 patients seizure free, 1 free of disabling seizures, 4 with >50% reduction in seizure frequency. Eleven had minor or no improvement, 3 patients could not be rated. Thirteen (of 19 possible) patients attempted prevention of seizures or clusters, 10 with full or >50% success (52.6 resp. 76.9%). Prevention of clusters sometimes required higher or repetitive CLB dosing. Self rating of patients who did use ADA was positive or very positive in 88.2%. Retention rate was 66.7% of all patients, and 88.2% of those using ADA. The best results were obtained in idiopathic generalized epilepsy (IGE) patients with seizures habitually triggered by typical factors (sleep deprival, alcohol) but also some others were successful. The only adverse effect was gait ataxia in a multiple-handicapped patient. ADA is an elegant and often successful but underused treatment option for selected patient groups where it can make the difference between becoming seizure free or not. Depending on the individual case it can be applied as monotherapy or in combination with a basis AED. A controlled investigation should follow.

The treatment of chronic epilepsy: a review of recent studies of clinical efficacy and side effects

There has been a great deal of interest in the treatment of chronic epilepsy in the past 12 months, from both the medical and surgical points of view. The purpose of this article is to provide a review of clinical studies of efficacy and adverse effects which have been published during this period.

Pediatric State of the Art Symposium: Seizures and Epilepsy Complicating Medical Conditions in Childhood 7:30 p.m.–9:30 p.m.

EpilepsiaVolume 46, Issue s8 p. 273-273 Free Access Pediatric State of the Art Symposium: Seizures and Epilepsy Complicating Medical Conditions in Childhood 7:30 p.m.–9:30 p.m. First published: 19 October 2005 https://doi.org/10.1111/j.1528-1167.2005.460801_28.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract 1 Dennis J. Dlugos, 2 Mary L. Zupanc, 1 Robert R. Clancy, 3 Anna Janss, and 4 Benjamin Eidelman ( 1 Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA ; 2 Department of Neurology, Children's Hospital of Wisconsin, Milwaukee, WI ; 3 Department of Neurology, Emory University School of Medicine, Atlanta, GA ; and 4 Department of Neurology, Mayo Clinic, Jacksonville, FL ) This symposium will address advances in clinical management and translational research regarding acute provoked seizures and chronic epilepsy in children with complex medical conditions, such as congenital heart disease, oncological disorders, and organ transplantation. These medical conditions are all complicated by acute provoked seizures and chronic epilepsy, involve treatment with medications with complex interactions with anti-epileptic drugs, and provide opportunities for translational research. The goals of the symposium are: 1) Understand the etiology, pathophysiology and treatment of acute provoked seizures in children with congenital heart disease, CNS and non-CNS neoplasms, and organ transplantation. 2) Understand the etiology, pathophysiology and treatment of chronic epilepsy in these patients, including interactions between anti-epileptic drugs and anti-arrhythmic drugs, chemotherapeutic agents, and immunosuppressive agents. 3) Recognize opportunities for translational research in this area, including neuro-protection, pharmacology and immunology. Volume46, Issues8October 2005Pages 273-273 RelatedInformation

Medical assessment and treatment of chronic epilepsy.

Medical assessment and treatment of chronic epilepsy.