Withdrawal Seizures Research Articles

Preparing Nursing and Social Work Students to Care for Patients in Acute Alcohol Withdrawal.

Alcohol and other drug abuse has become a national crisis with approximately 26% of general medical patients having alcohol-related problems. New nurses and social workers are often not prepared to care for patients with severe alcohol withdrawal symptoms because they lack experience in actual crisis situations. The purpose of this study was to prepare nursing and social work students to care for a patient undergoing an acute alcohol withdrawal process. Nine groups of 8-10 students participated in a 2.5-hour simulation event that included an alcohol withdrawal seizure, team meeting, and discharge of the patient. Students recognized the importance of all the professional roles and how each professional benefits patient care. Before the simulation, students thought they were prepared to care for patients experiencing alcohol withdrawal; however, the crisis of an alcohol seizure decreased the student's ability to perform skills and communicate effectively. These findings suggest that new nurses and social workers may not be prepared to care for the acute alcohol withdrawal patient.

Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review.

Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review.

T60 - Investigating The Role Of One-Carbon Metabolism Pathway In Complicated Alcohol Withdrawal States

Background Complicated withdrawal states in alcohol dependence syndrome (ADS) include alcohol withdrawal seizures (AWS) and delirium tremens (DT) and are associated with significant medical and psychiatric morbidity. Existing evidence suggests that in patients with chronic ADS, the associated deficiency of vitamin B12 and folic acid could lead to hyperhomocysteinemia through the inhibition of methionine synthase (MS) and methylene tetrahydrofolate reductase (MTHFR) enzymes of the one-carbon metabolism pathway. Hyperhomocysteinemia has been found to be associated with complicated alcohol withdrawal especially withdrawal seizures (AWS). The common variant of the MS A2756G gene has been found to be associated with lower plasma homocysteine levels. The homozygote variant of the MTHFR A1298C gene results in partial loss of enzyme activity. Thus, it may be worthwhile to study the above SNPs in patients with complicated alcohol withdrawal states and correlate the findings with plasma homocysteine, vitamin B12 and folate levels. Methods In our study, we aimed to investigate the association of MTR A2756G (responsible for the MS enzyme) and MTHFR A1298C polymorphisms with complicated withdrawal states i.e. AWS and delirium tremens (DT). We also measured levels of plasma homocysteine, vitamin B12 and folate in these patients. The sample consisted of a total of 150 male patients with ADS of which 84 patients had simple withdrawal state (SWS), 30 patients had DT and 36 patients had AWS. Assessments included a general physical examination, biochemistry panel, a complete blood count, assays of plasma homocysteine, vitamin B12 and folate along with genotyping for the MTR A2756G and MTHFR A1298C polymorphisms. Results There was no difference in the mean age at onset of dependence (SWS - 28.2 ± 5.7; DT - 28.2 ± 4.6; AWS - 27.9 ± 5, F = 0.03, p = 0.9). However, there was a significant association between the mean daily units of alcohol consumed and complicated alcohol withdrawal states. (SWS - 13.6 ± 3.7; DT - 19.8 ± 3.9; AWS - 17.1 ± 4.9, F = 27.8, p The study also found no differences in the serum homocysteine levels (SWS – 0.91; DT – 0.91; AWS – 0.88 nmol/ml, t = 0.9, p = 0.6), vitamin B12 levels (SWS – 274; DT – 265; AWS – 230 pg/ml, t = 1.2, p = 0.5), and folate levels (SWS – 99.3; DT – 99.1; AWS – 98.2 pg/ml, t = 2.4, p = 0.1). Although vitamin B12 and folic acid levels fell in the lower end of the normal range, no deficiency states were observed. No association was found between levels of plasma homocysteine, vitamin B12 & folic acid levels and complicated alcohol withdrawal states. No significant differences were found between the groups with respect to haematological and biochemical parameters examined. The two groups did not differ significantly with respect to genotype frequency of the SNPs examined (MTHFR A1298C and MTR A2756G). Discussion Our study finds that it is the quantity of alcohol consumed in a day that is associated with complicated withdrawal states with frequent heavy drinkers more likely to have severe withdrawal. It would be worthwhile to explore this further as no clear genetic risk factors emerged. The study was limited by its sample size, the use of cross-sectional sampling method and the exclusion of female patients from the study. However, it is one of the first studies to examine these SNPs in a south Indian population. The role of the one-carbon metabolism pathway in these states remains an important area of research with numerous possible treatment implications.

Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review.

Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review.

Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review.

Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review.

Prevalence of alcohol use disorders and associated factors among people with epilepsy attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.

IntroductionAlcohol use disorders represent one of the leading causes of preventable death, illness, and injury in many societies throughout the world. Heavy alcohol consumption has multiple negative consequences for people with epilepsy such as precipitation of seizure, exacerbation of seizure, poor seizure control, increased side effects of antiepileptic drugs, noncompliance to antiepileptic drugs, alcohol withdrawal seizures, long-term hospital admission, status epilepticus, sudden unexpected death, and premature mortality.MethodsAn institution-based cross sectional study was conducted from April 15, 2014 to May 15, 2014 with the aim of assessing prevalence of alcohol use disorders and associated factors among people with epilepsy attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. A total of 413 randomly selected epileptic patients were included in this study. Data were structured using the 10-item Alcohol Use Disorders Identification questionnaire. Data were analyzed using SPSS Version 20. Bivariate and multivariate logistic regression analyses were performed to study the association, and variables with P-value <0.05 were considered as having a statistically significant association at 95% confidence interval.ResultsA total of 423 study participants were selected, of whom 413 completely filled the questionnaire making the response rate 97.6%. The mean age of the respondents was 31.9 years with standard deviation of ±10.97, and 248 (60%) were males. The prevalence of alcohol use disorder was 17.4%. Educational status (grade 9–12) (adjusted odds ratio [AOR] =3.25, [1.21, 8.69]), not living with family members (AOR =1.89, [1.06, 3.39]), availability of house (AOR =2.04, [1.10, 3.78]), taking carbamazepine (AOR =2.38, [1.13, 5.01]), and drinking alcohol to find relief from stress (AOR =4.28, [1.89, 9.67]) were significantly associated with alcohol use disorder among people with epilepsy.Conclusion and recommendationThe findings of this study revealed that the prevalence of alcohol use disorder among people with epilepsy was high. Routine screening of epileptic patients with the Alcohol Use Disorders Identification Test is recommended.

Alcohol Withdrawal Increases Protein Kinase A Activity in the Rat Inferior Colliculus.

Cyclic AMP-dependent protein kinase A (PKA) signaling is a key target for the action of alcohol and may therefore play a role in the pathophysiology of alcohol withdrawal seizures (AWSs). Here, we investigated the role of PKA activity with respect to increased seizure susceptibility in rats that were subjected to alcohol withdrawal. Adult male Sprague Dawley rats received 3 daily doses of ethanol (EtOH) (or vehicle) for 4 consecutive days. Rats were then tested for susceptibility to acoustically evoked AWSs 3, 24, and 48hours after the last alcohol dose. In separate experiments, the inferior colliculus (IC) was collected at these same time points from rats subjected to alcohol withdrawal and control rats following alcohol withdrawal. PKA activity, catalytic Cα (PKACα ) protein, regulatory RIIα (PKARIIα ) protein, and RIIβ (PKARIIβ ) protein were measured in the IC. Lastly, insitu pharmacological studies were performed to evaluate whether inhibiting PKA activity in the IC suppressed AWSs. In the EtOH-treated group, AWSs were observed at the 24-hour time point, but not at the 3-hour or 48-hour time points. In the IC, PKA activity was significantly higher both 3hours (i.e., before AWS susceptibility) and 24hours after the last alcohol dose (when AWS susceptibility peaked) than in control rats. Consistent with these findings, protein levels of the PKACα subunit were significantly increased in the IC both 3 and 24hours after the last alcohol dose. Lastly, insitu inhibition of PKA activity within the IC suppressed AWSs. The increase in PKA activity and PKACα protein expression in the IC preceded the occurrence of AWSs, and inhibiting PKA activity within the IC suppressed acoustically evoked AWSs. Together, these findings suggest that altered PKA activity plays a key role in the pathogenesis of AWSs.

Effects of acute alcohol withdrawal on nest building in mice selectively bred for alcohol withdrawal severity

Nest building has been used to assess thermoregulatory behavior and positive motivational states in mice. There are known genetic influences on ethanol withdrawal severity as well as individual/thermoregulatory nest building. Withdrawal Seizure-Prone (WSP-1, WSP-2) and Withdrawal Seizure-Resistant (WSR-1, WSR-2) mice were selectively bred for high vs low handling-induced convulsion (HIC) severity, respectively, during withdrawal from chronic ethanol vapor inhalation. They also differ in HIC severity during withdrawal from an acute, 4g/kg ethanol injection. In our initial study, withdrawal from an acute dose of ethanol dose-dependently impaired nest building over the initial 24h of withdrawal in genetically segregating Withdrawal Seizure Control (WSC) mice. In two further studies, acute ethanol withdrawal suppressed nest building for up to two days in WSP-1 females. Deficits in nest building from ethanol were limited to the initial 10h of withdrawal in WSR-1 females and to the initial 24h of withdrawal in WSP-1 and WSR-1 males. Effects of ethanol on nest building for up to two days were found in WSP-2 and WSR-2 mice of both sexes. Nest building deficits in female mice from the first replicate could not be explained by a general decrease in locomotor behavior. These results suggest that nest building is a novel behavioral phenotype for indexing the severity of acute ethanol withdrawal, and that genes contributing to this trait differ from those affecting acute withdrawal HIC severity.

Meta-Analysis Reveals Significant Association of the 3'-UTR VNTR in SLC6A3 with Alcohol Dependence.

Although many studies have analyzed the association of 3'-untranslated region variable-number tandem repeat (VNTR) polymorphism in SLC6A3 with alcohol dependence (AD), the results remain controversial. This study aimed to determine whether this variant indeed has any genetic effect on AD by integrating 17 reported studies with 5,929 participants included. The A9-dominant genetic model that considers A9-repeat and non-A9 repeat as 2 genotypes and compared their frequencies in alcoholics with that in controls was adopted. Considering the potential influence of ethnicity, differences in diagnostic criteria of AD, and alcoholic subgroups, stratified meta-analyses were conducted. There existed no evidence for the presence of heterogeneity among the studied samples, indicating the results under the fixed-effects model are acceptable. We found a significant association of VNTR A9 genotypes with AD in all ethnic populations (pooled odds ratio [OR] 1.12; 95% confidence interval [CI] 1.00, 1.25; p=0.045) and the Caucasian population (pooled OR 1.15; 95% CI 1.01, 1.31; p=0.036). We also found VNTR A9 genotypes to be significantly associated with alcoholism as defined by the DSM-IV criteria (pooled OR 1.18; 95% CI 1.03, 1.36; p=0.02). Further, we found a significant association between VNTR A9 genotypes and alcoholism associated with alcohol withdrawal seizure or delirium tremens (pooled OR 1.55; 95% CI 1.24, 1.92; p=1.0×10(-4) ). In all these meta-analyses, no evidence of publication bias was detected. We concluded that the VNTR polymorphism has an important role in the etiology of AD, and individuals with at least 1 A9 allele are more likely to be dependent on alcohol than persons carrying the non-A9 allele.

Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study.

BackgroundManaged alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, were investigated in 2013.MethodsStructured interviews were conducted with 18 MAP and 20 control participants assessed as alcohol dependent with most using non-beverage alcohol (NBA). Qualitative interviews were conducted with seven participants and four MAP staff concerning perceptions and experiences of the program. Program alcohol consumption records were obtained for MAP participants, and records of police contacts and use of health services were obtained for participants and controls. Some participants’ liver function test (LFT) results were available for before and after MAP entry.ResultsCompared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time (x2 = 43.84, P < 0.001), 87 % fewer detox admissions (t = −1.68, P = 0.06), and 32 % fewer hospital admissions (t = −2.08, P = 0.03). MAP and control participants shared similar characteristics, indicating the groups were broadly comparable. There were reductions in nearly all available LFT scores after MAP entry. Compared with controls, MAP participants had 43 % fewer police contacts, significantly fewer police contacts (−38 %) that resulted in custody time (x2 = 66.10, P < 0.001), 70 % fewer detox admissions (t = −2.19, P = 0.02), and 47 % fewer emergency room presentations. NBA use was significantly less frequent for MAP participants versus controls (t = −2.34, P < 0.05). Marked but non-significant reductions were observed in the number of participants self-reporting alcohol-related harms in the domains of home life, legal issues, and withdrawal seizures. Qualitative interviews with staff and MAP participants provided additional insight into reductions of non-beverage alcohol use and reductions of police and health-care contacts. It was unclear if overall volume of alcohol consumption was reduced as a result of MAP participation.ConclusionsThe quantitative and qualitative findings of this pilot study suggest that MAP participation was associated with a number of positive outcomes including fewer hospital admissions, detox episodes, and police contacts leading to custody, reduced NBA consumption, and decreases in some alcohol-related harms. These encouraging trends are being investigated in a larger national study.

Electrocardiography Evolution in a Woman Presenting With Alcohol Withdrawal Seizures and Cocaine Use.

Electrocardiography Evolution in a Woman Presenting With Alcohol Withdrawal Seizures and Cocaine Use.

Phenytoin versus valproate monotherapy for partial onset seizures and generalised onset tonic-clonic seizures: an individual participant data review.

Worldwide, phenytoin and valproate are commonly used antiepileptic drugs. It is generally believed that phenytoin is more effective for partial onset seizures, and that valproate is more effective for generalised onset tonic-clonic seizures (with or without other generalised seizure types). This review is one in a series of Cochrane reviews investigating pair-wise monotherapy comparisons. This is the latest updated version of the review first published in 2001 and updated in 2013. To review the time to withdrawal, remission and first seizure of phenytoin compared to valproate when used as monotherapy in people with partial onset seizures or generalised tonic-clonic seizures (with or without other generalised seizure types). We searched the Cochrane Epilepsy Group's Specialised Register (19 May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2015, Issue 4), MEDLINE (1946 to 19 May 2015), SCOPUS (19 February 2013), ClinicalTrials.gov (19 May 2015), and WHO International Clinical Trials Registry Platform ICTRP (19 May 2015). We handsearched relevant journals, contacted pharmaceutical companies, original trial investigators and experts in the field. Randomised controlled trials (RCTs) in children or adults with partial onset seizures or generalised onset tonic-clonic seizures with a comparison of valproate monotherapy versus phenytoin monotherapy. This was an individual participant data (IPD) review. Outcomes were time to: (a) withdrawal of allocated treatment (retention time); (b) achieve 12-month remission (seizure-free period); (c) achieve six-month remission (seizure-free period); and (d) first seizure (post-randomisation). We used Cox proportional hazards regression models to obtain study-specific estimates of hazard ratios (HRs) with 95% confidence intervals (CIs), and the generic inverse variance method to obtain the overall pooled HR and 95% CI. IPD were available for 669 individuals out of 1119 eligible individuals from five out of 11 trials, 60% of the potential data. Results apply to partial onset seizures (simple, complex and secondary generalised tonic-clonic seizures), and generalised tonic-clonic seizures, but not other generalised seizure types (absence or myoclonus seizure types). For remission outcomes: HR > 1 indicates an advantage for phenytoin; and for first seizure and withdrawal outcomes: HR > 1 indicates an advantage for valproate.The main overall results (pooled HR adjusted for seizure type) were time to: (a) withdrawal of allocated treatment 1.09 (95% CI 0.76 to 1.55); (b) achieve 12-month remission 0.98 (95% CI 0.78 to 1.23); (c) achieve six-month remission 0.95 (95% CI 0.78 to 1.15); and (d) first seizure 0.93 (95% CI 0.75 to 1.14). The results suggest no overall difference between the drugs for these outcomes. We did not find any statistical interaction between treatment and seizure type (partial versus generalised). We have not found evidence that a significant difference exists between phenytoin and valproate for the outcomes examined in this review. However misclassification of seizure type may have confounded the results of this review. Results do not apply to absence or myoclonus seizure types. No outright evidence was found to support or refute current treatment policies.

Potential risk factors for dexmedetomidine withdrawal seizures in infants after surgery for congenital heart disease

PurposeFew studies are available on withdrawal seizures about dexmedetomidine (DEX). Thus, we retrospectively evaluated the incidence of withdrawal seizures after discontinuation of DEX and examined potential risk factors in infants after cardiovascular surgery. MethodsThe medical records of 142 infants who had undergone cardiovascular surgery between April 2010 and November 2013 were examined. Clinical characteristics and usage of DEX were analyzed. DEX withdrawal seizures were evaluated using Withdrawal Assessment Tool – version 1 (WAT-1). All the patients and controls were categorized according to DEX discontinuation strategy, which was either gradual or abrupt. ResultsNine patients (6.3%) developed generalized clonic or generalized tonic–clonic seizures accompanied by preceding fever of >38°C approximately four to eight hours following the discontinuation of DEX, and were clinically diagnosed as DEX withdrawal seizures with a median WAT-1 score of 3. Clinical characteristics and operative data were similar, but median cumulative dose and maximum temperature after discontinuation of DEX were significantly higher in infants with withdrawal seizures than in those without (P=0.007 and P<0.001, respectively). Eight of the 9 patients with withdrawal seizures (88.9%) and 20 of the 133 patients (15.0%) with no withdrawal seizures had discontinued DEX abruptly (P<0.001). Cumulative dose and abrupt discontinuation of DEX were significantly associated with DEX withdrawal seizures in infants after cardiovascular surgery (R=0.619, P=0.004). ConclusionsPhysicians should be aware that infants who received DEX after cardiovascular surgery had potential to cause withdrawal seizures accompanied by preceding pyrexia after discontinuation of DEX. Higher cumulative dose and abrupt discontinuation of DEX appears to increase the risk for these withdrawal seizures.

Homocysteine as a biomarker for predicting alcohol withdrawal syndromes: Insight from a retrospective cohort study

BackgroundThe alcohol withdrawal syndrome is a group of symptoms and signs that usually arise within 24 -48 hours of abrupt alcohol cessation or significant reduction in consumption in alcohol dependent individuals. The most severe complication of alcohol withdrawal syndrome is alcohol withdrawal delirium (delirium tremens), which may be preceded or complicated by seizures. In recent years there is a growing interest in the role of serum homocysteine levels in chronic alcohol dependent patients undergoing withdrawal. A number of studies have shown that alcohol dependent patients have elevated serum homocysteine levels and that it can be considered to be a risk factor for severe withdrawal states. The purpose of this study was to evaluate the serum homocysteine levels in alcohol withdrawal syndromes.MethodolgyIt was a retrospective cohort study of alcohol dependent patients (N=49) admitted with a diagnosis of delirium tremens (DT) (n=28) and simple alcohol withdrawal (SW) (n=21) as per the ICD-10 classification. A semi-structured pro-forma was used to gather information from the file records covering both socio-demographic, clinical and biochemical variables. The historical variables included proposed risk factors like amount of daily consumption of alcohol, duration of abstinence and past history of complicated withdrawal. The serum homocysteine, vitamin B12 and folate levels of all patients sent within 24 hours of admission were also collected. Comparisons between clinical and biochemical variables were made between the two groups using Chi-square test and Student’s T test.ResultsThe mean age of patients of DT was 33.07 ± 8.24 years while that of patients with SW was 37.19 ±7.60 years. The mean duration of alcohol use in dependent pattern was 10.00 ±3.00 years in DT compared to 8.66 ±4.76 years in SW. The laboratory investigations revealed a mean serum homocysteine level of 21.09 ± 12.81 in patients presenting with DT as compared with 15.06 ± 6.17 in patients having SW and this difference was statistically significant (p<0.05). The serum folate levels differed significantly in the two groups with patients in DT having a lower mean value of 6.30 ± 3.67 as compared to patients with SW 10.23 ± 7.04. Patients with DT with withdrawal seizures (n=18) had statistically non significant rise in their mean homocysteine levels as compared to patients with DT without withdrawal seizures (n=10) [21.72±13.26 vs 19.96±12.58].ConclusionThe results of this study highlight the potential role of homocysteine as a new biomarker to predict the severity of alcohol withdrawal syndromes. However there is need for further research to prove whether targeting homocysteine levels will be of benefit with respect to alcohol related disorders.

Combination of DAT and DBH gene polymorphisms with a family history of alcohol use disorders increases the risk of withdrawal seizures and delirium tremens during alcohol withdrawal in alcohol-dependent men

To explore the genetic influence of a family history of alcohol use disorders and the dopamine transporter SLC6A3 (DAT1) and dopamine beta-hydroxylase (DBH) gene polymorphisms on the risk of severe complications (withdrawal seizures (AWS) and delirium tremens (DT)) during alcohol withdrawal in alcohol-dependent men. We investigated the effects of 3 previously reported candidate genetic variations: 40-bp variable number tandem repeat (VNTR) polymorphism and C/T exon 15 (rs27072) in the 3' untranslated region (3' UTR) of the SLC6A3(DAT1) gene, and -1021 C/T (rs1611115) of DBH gene in 266 alcohol-dependent Russian male inpatients in two groups by presence (SC group: AWS, DT, AWS+DT, n=130) or absence (n=136) of severe complications diagnosed by ICD-10 during current alcohol withdrawal. Clinically important information and a family history of alcohol use disorders (FH) were obtained by semi-structured interview. Patients in SC group more often have positive FH (54.6% vs. 33%, p=0.001) and their age at first alcohol use (FAU) was lower (16±3.53y.o vs. 17±1.66 y.o, p=0.001). Logistic regression revealed that FH predicts severe complications in total (р=0.001) and DT (р=0.003), FAU independently predicts severe complications in total (р=0.008), AWS (р=0.04), DT (р=0.032), AWS+DT (р=0.048) and every year of delay alcohol use decreases the risk by 18-30%. The gene polymorphisms interact with FAU to decrease the FAU influence on the risk of AWS (T variant of DAT (rs27072), р=0.04), (AWS+DT) and DT (T variant of DBH (rs1611115), р=0.023 and р=0.06). The T variant of DAT (rs27072) is associated with FAU (p=0.007) and increases the risk of (AWS+DT) (р=0.036), but decreases the risk of AWS (р=0.038) and of DT (р=0.021) too, but only in interaction with positive FH. The 9 repeat variant (9R) of DAT VNTR is associated with AWS (p=0.009), but the risk of AWS (р=0.004) and of SC in total (р=0.001) are elevated only in 9R carriers with positive FH. The 9R independently increases the risk of DT (р=0.048) and the effect become more robust in 9R carriers with high density of FH (р=0.014). The gene x gene interaction decreases the risk of DT (р=0.055). According to an analysis of total cohort of patients, the T variant of DBH (rs1611115) is associated with any kind of manifestation of delirium in alcohol-dependent men (p=0.039). This study demonstrate the genetic influence of a family history of alcohol use disorders and DAT and DBH gene polymorphisms on the risk of withdrawal seizures and delirium tremens. The interaction of genetic variations with positive family history provides the most robust effect, the interaction of genetic variations with the age at first alcohol use may «protect» their carriers from negative influence of this «behavioral» risk factor. Replication in large cohorts of patients is necessary to verify these findings for subsequent use in prevention programs.

Occipital lobe epilepsy or migraine headache

Introduction: Occipital lobe epilepsies are rarely met in clinical practice, but when they occur, they can be misdiagnosed as migraine-like headache. Their prevalence ranges from 5%to 10% of all epilepsies. Seizures can occur at any age; etiologically speaking they can be symptomatic, cryptogenic and idiopathic (most often onsetis in childhood). Clinical symptomatology is manifested by partial epileptic seizures in the sense of visual elementary and/or complex manifestations, palinopsia, amaurosis, tonic head deviation, bulbus, nistagmus and headache. Propagation discharge to neighbour areas (temporal, parietal and frontal) is a frequent occurrence appearing with complex partial seizures frequently finishing with secondary generalized tonic-clonic (GTC) seizures. Case report: We are presenting a17-year-old male patient who has suffered from attacks of visual problemswith headache since 10 years of age. All the time it is treated as a migraine headache. During the last attack of headache the patient also had a loss of consciousness, EEG that was performed for the first time evidenced epileptic discharges of the occipital area. The therapy also included treatment with antiepileptic drug pregabalin resulting in seizure withdrawal. Conclusion: The appearance of visual symptoms followed by headache is most frequently qualified as migraine triggered headache. However, when antimigraine therapy does not give favorable results epileptic headache should be suspected, with obligatory performance of EEG recording. Occipital lobe epilepsy often presents diagnostic dilemmas due to clinical manifestations that are similar to that of non-migraine headache.

Mega-dose phenobarbital therapy for super-refractory status epilepticus.

To evaluate the efficacy and safety of mega-dose phenobarbital (MDPB; enteral or parenteral phenobarbital >10 mg/kg/day) for treating super-refractory status epilepticus (SRSE; continuous or recurrent status epilepticus for ≥24 hours after the onset of continuous anaesthetic treatment) in adult patients. Adult patients with SRSE who were treated with MDPB in our institution from March 2005 to September 2014 were reviewed. We collected data on basic demographics, clinical features, functional status, anticonvulsant treatment, and possible adverse events. SRSE outcome was divided into six categories: successful therapy, initial failure, breakthrough seizures, withdrawal seizures, intolerable side effects, and death during treatment. Ten adult patients with SRSE received MDPB. Median age at seizure onset was 38 years (range: 18-59), and half were male. All patients had no history of seizures and had symptoms suggestive of viral encephalitis. Median duration of status epilepticus was 17.5 days (range: 6-60) and anaesthetics were used for a median of 14.0 days (range: 2-54) before MDPB. Successful control of SRSE was achieved in half of the patients, however, only one of ten patients was able to fully recover at discharge. Median duration of the MDPB was 45.5 days and the maximum serum phenobarbital level reached a median of 151.5 μg/ml. Patients with successful MDPB therapy had normal brain imaging (80% vs. 0%; p=0.048) and better functional outcome at discharge and after three months of follow-up. Infection was the most critical complication, along with cardiorespiratory depression. MDPB is a therapeutic option for control of SRSE when other choices are exhausted.

Abstract 17733: Some Epilepsy Patients Die Suddenly Without a Preceding Seizure Episode: What are the Mechanisms?

Introduction: Epilepsy is associated with a significantly increased risk of sudden cardiac arrest (SCA), and we have previously reported that this devastating outcome does not always require a preceding seizure. Based on the hypothesis that the pathophysiology of SCA for epilepsy patients may be heterogeneous, we compared the clinical profile of epilepsy patients with and without seizure activity prior to SCA. Methods: Subjects of all ages with SCA occurring in the setting of prior documented epilepsy were identified from a large, ongoing, population-based study of SCA in the Northwest US (community pop. approx. 1 million). We explored the relationships between baseline demographics, lifetime medical history and SCA circumstances among those who had a witnessed seizure within 24 hours of the SCA event (seizure-dependent) and those who did not (seizure-independent). Data were obtained from multiple sources (first responders, medical practitioners and medical examiner) between 2002 and 2015. Patients with terminal illnesses and non-cardiac causes of arrest were excluded, as well as those with infantile febrile seizures or alcoholic withdrawal seizures. Results: Among 142 subjects with SCA and seizure disorder, 64 (45.1%) were witnessed during the event and, among these, 26 (40.6%) were seizure-dependent while 38 (59.4%) were seizure-independent. The seizure-independent subjects were significantly older (mean age 61.9 years; 95% CI, 43.1 to 80.7 years; vs 47.6 years; 95% CI, 27.0 to 68.2 years; p=0.006). However the younger seizure-dependent group had higher prevalence of cardiac arrest due to pulseless electrical activity (PEA) or asystole (81.0% vs 58.3%; p=0.081). There was no notable difference in the burden of comorbidities (Charlson index 1.92 vs 2.37; p=0.941), periarrest characteristics, ECG and echo parameters. Conclusions: Seizure-independent SCA occurs at an older age, supporting the hypothesis that over time, neuro-cardiac remodeling may lead to cardiac arrest in the absence of hypoxia. In younger, seizure-dependent patients hypoxia may be a pre-requisite, but both hypotheses warrant further detailed investigation.

REMOVED: Prenatal alcohol exposure enhances alcohol withdrawal seizure susceptibility in adulthood

This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our‐business/policies/article‐withdrawal)This meeting abstract has been removed by the Publisher. Due to an administrative error, abstracts that were not presented at the ISDN 2014 meeting were inadvertently published in the meeting's abstract supplement. The Publisher apologizes to the authors and readers for this error.

Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review.

Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review.