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1
Gupta, Vineet Bhushan. "Difficult to Control Epilepsy." Apollo Medicine 4, no. 2 (2007): 135–39. http://dx.doi.org/10.1016/s0976-0016(11)60122-1.
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Kelso, Andrew. "The challenge of managing difficult-to-control epilepsy." Prescriber 21, no. 10 (2010): 17–22. http://dx.doi.org/10.1002/psb.630.
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Alves Gusmão, Walter Leonardo, and Antonio Marcos da Silva Catharino. "Tuberous Sclerosis as a cause of difficult-to-control Epilepsy - Case report." Gazette of Medical Sciences 1, no. 5 (2020): 73–77. http://dx.doi.org/10.46766/thegms.neuro.20102304.
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Tuberous Sclerosis Complex or Bourneville’s disease is an autosomal dominant disease with high penetrance and variability characterized by multisystem involvement by benign lesions, originally defined by the classic triad of Vogt: sebaceous adenoma, epilepsy and mental retardation. The involvement of the brain is responsible for a significant proportion of the morbidity and mortality of this disease and skin lesions are the most common manifestations. The authors report 31-year-old patient case referred to the service by intractable epilepsy with definitive clinical criteria for tuberous sclerosis.
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Sion, Gisele N. M., Aline C. Moraes, Barbara M. R. Sousa, et al. "A case of choreiform movement presentation in a difficult to control epilepsy." Neurophysiologie Clinique 48, no. 3 (2018): 138. http://dx.doi.org/10.1016/j.neucli.2018.05.029.
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Smith, Nicola, and Divya Tiwari. "Epilepsy in older people." Reviews in Clinical Gerontology 25, no. 1 (2015): 53–59. http://dx.doi.org/10.1017/s0959259815000052.
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SummaryEpilepsy is the third most common neurological disorder of older adults, with huge functional and psychological implications. It is often difficult to diagnose in the presence of cognitive impairment and lack of a witness account. The most common identifiable causes of epilepsy in old age are cerebrovascular disease and dementia. New guidelines recommend starting treatment after first unprovoked seizure. If there is any doubt about the diagnosis, electroencephalography (EEG) should be considered, or ‘wait and watch’. The aim of treatment should be to fully control seizure activity with the most effective monotherapy and fewest possible side-effects. Drug compliance is often difficult to achieve in older adults.
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Kerrigan, John F. "New Medications for Epilepsy." CNS Spectrums 2, no. 7 (1997): 43–58. http://dx.doi.org/10.1017/s1092852900010944.
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AbstractThe last 4 years have seen a rapid burst of development of medications used to treat epileptic seizures. While none of these medications has replaced the “standards” in the field, they collectively offer additional treatment options for patients, particularly for those with difficult-to-control seizures. As experience with these novel medications grows, each will occupy its own niche in the treatment strategy for patients with epilepsy.
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Pratesi, R., I. C. Modelli, R. C. Martins, P. L. Almeida, and L. Gandolfi. "Celiac disease and epilepsy: favorable outcome in a child with difficult to control seizures." Acta Neurologica Scandinavica 108, no. 4 (2003): 290–93. http://dx.doi.org/10.1034/j.1600-0404.2003.00082.x.
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Morrell, Martha J., Kerry L. Flynn, Cairn G. Seale, et al. "Reproductive Dysfunction in Women With Epilepsy: Antiepileptic Drug Effects on Sex-Steroid Hormones." CNS Spectrums 6, no. 9 (2001): 771–86. http://dx.doi.org/10.1017/s1092852900001528.
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ABSTRACTWomen with epilepsy are at risk for reproductive health dysfunction. Sex-steroid hormone abnormalities have been reported in women with epilepsy, but it has been difficult to determine whether these abnormalities are due to epilepsy-related hypothalamic-pituitary axis dysfunction, or to pharmacokinetic actions of antiepileptic drugs (AEDs). Sex-steroid hormones were evaluated in 84 reproductive-aged women with epilepsy receiving an AED in monotherapy, and in 20 nonepileptic controls. Estrone, free testosterone, and androstenedione were significantly lower in subjects receiving enzyme-inducing AEDs than in nonepileptic controls. Free testosterone was significantly elevated in subjects receiving valproate compared to nonepileptic controls. Subjects with epilepsy receiving gabapentin or lamotrigine were no different from the nonepileptic controls in any of the endocrine variables. Subjects with epilepsy who are receiving AEDs that alter cytochrome P450 enzymes are at risk for significant abnormalities in sex-steroid hormones. In contrast, subjects receiving AEDs that do not alter cytochrome P450 enzymes show no differences in sex-steroid hormones compared with nonepileptic controls. With new AEDs available that do not alter cytochrome P450 enzymes, physician selection of therapy should consider not only seizure control, but also potential effects on reproductive physiology.
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Subakti, Charles, Madarina Julia, and Agung Triono. "Duration of active epilepsy as a predictor of seizure control after relapse in child epilepsy." Paediatrica Indonesiana 60, no. 4 (2020): 202–7. http://dx.doi.org/10.14238/pi60.4.2020.202-7.
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Background Epilepsy is a chronic illness that may affect childhood growth and development. Some epilepsy cases are easy to control, either with monotherapy or politherapy antiepilepticdrugs, but many cases are difficult to control. Several factors influence the risk of relapse, but information is limited on factors predictive of seizure control after relapse. Our study investigate patient with epilepsy relaps and see whether the duration of active epilepsy prior to initial remission can be use as a predictor of seizure control after relaps.
 Objective To assess whether duration of active epilepsy was predictive of seizure control after relapse.
 Methods This retrospective cohort study was performed in Dr Sardjito Hospital, Yogyakarta, on epileptic relapse patients aged 2 to 18 years , who had achieved remission for at least a 2-year seizure-free interval, and relapsed after antiepileptic drud (AED) discontinuation. We excluded patients with progressive neurological diseases, inborn errors of metabolism, febrile seizures, and those who could not be followed up for at least 2 years, or those with incomplete medical records. Subjects were divided into those who had a duration of active epilepsy prior to initial remission within 6 months and ≥6 months. Time to seizure control after relapse was analysed by Kaplan-Meier survival analysis.
 Results A total of 80 patients were included in the study. Overall median for seizure control after relapse was 3.6 (95%CI 1.1 to 6.0) months. Median for seizure control after relapse for those who had a duration of active epilepsy prior to initial remission within 6 months and ≥ 6 months were 3 (95%CI 0.1 to 5.8) months and 12 (95%CI 4.4 to 19.5) months, respectively. Log-rank test revealed no significant difference between groups (P=0.12).
 Conclusion Duration of active epilepsy prior to initial remission was not a predictor for seizure control after relapse.
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Walker, Matthew C., and Sofia H. Eriksson. "Epilepsy and Sleep Disorders." US Neurology 07, no. 01 (2011): 60. http://dx.doi.org/10.17925/usn.2011.07.01.60.
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There is a close association between sleep and epilepsy. In some epilepsy syndromes, seizures occur predominantly (or even exclusively) during sleep or on awakening. Excessive daytime sleepiness is common in patients with epilepsy and may be due not only to medication but also to nocturnal seizures or concomitant sleep disorders. Sleep disorders such as obstructive sleep apnea can worsen epilepsy, with improvement of seizure control following appropriate treatment of the sleep disorder. Conversely, epilepsy and antiepileptic medication can worsen sleep disorders. Nocturnal epileptic seizures may be difficult to differentiate from parasomnias, in particular non-rapid eye movement parasomnias such as night terrors, sleepwalking and confusional arousals, on history alone since there are semiologic similarities between the two disorders. Schemes have been developed to facilitate differential diagnosis, although this remains a challenge even using the gold standard, video-electroencephalography telemetry.
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Walker, Matthew C., and Sofia H. Eriksson. "Epilepsy and Sleep Disorders." European Neurological Review 6, no. 1 (2011): 60. http://dx.doi.org/10.17925/enr.2011.06.01.60.
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There is a close association between sleep and epilepsy. In some epilepsy syndromes, seizures occur predominantly (or even exclusively) during sleep or on awakening. Excessive daytime sleepiness is common in patients with epilepsy and may be due not only to medication but also to nocturnal seizures or concomitant sleep disorders. Sleep disorders such as obstructive sleep apnoea can worsen epilepsy, with improvement of seizure control following appropriate treatment of the sleep disorder. Conversely, epilepsy and antiepileptic medication can worsen sleep disorders. Nocturnal epileptic seizures may be difficult to differentiate from parasomnias, in particular non-rapid eye movement parasomnias such as night terrors, sleepwalking and confusional arousals, on history alone since there are semiological similarities between the two disorders. Schemes have been developed to facilitate differential diagnosis, although this remains a challenge even using the gold standard, video-electroencephalography telemetry.
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Ebere, Ikenna, Ekkehart FA Staufenberg, and Ketan K. Dhatariya. "The endocrine management of intractable masturbation after epilepsy surgery: a case report and literature review." JRSM Open 10, no. 11 (2019): 205427041987838. http://dx.doi.org/10.1177/2054270419878386.
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Lesson Intractable masturbation has been reported after epilepsy surgery and can be difficult to control, we present a case treated with cyproterone acetate and haloperidol to achieve an endocrine based resolution of symptoms.
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Islam, Farooqul, Shafi Ahmed, BH Nazma Yasmeen, et al. "Recent advances in the management of epilepsy." Northern International Medical College Journal 5, no. 2 (2015): 353–56. http://dx.doi.org/10.3329/nimcj.v5i2.23137.
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Epilepsy is a complex disorder affecting brain function having a variety of contributing factors. The genetic predisposition plays a key role in the genesis of epilepsy. Antiepileptic drugs (AEDs) provide effective control in majority of patients with different seizure types. But some refractory cases and those who cannot tolerate the conventional AEDs, it is difficult to control the seizures adequately. On the basis of different mechanisms of action and considering the side effects of drugs, various newer approaches have been evolved during the recent years in the rational management of epilepsy. A brief account of these newer treatment modalities has been focused and incorporated in this review in order to enlighten the readers with the possible beneficial effect of this regimen and their limitations as well.Northern International Medical College Journal Vol.5(2) 2014: 353-356
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Ikeda, KM, SM Mirsattari, AR Khan, I. Johnsrude, JG Burneo, and TM Peters. "GP.04 Network connectivity following a single unprovoked seizure using 7 Tesla resting-state fMRI." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, S2 (2017): S8. http://dx.doi.org/10.1017/cjn.2017.63.
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Background: Predicting epilepsy following a first seizure is difficult. Network abnormalities are observed in patients with epilepsy using resting-state functional MRI (rs-fMRI), which worsen with duration of epilepsy. We use rs-fMRI to identify network abnormalities in patients after a first seizure that can be used as a biomarker to predict development of epilepsy. Methods: Patients after a single, unprovoked seizure and age/sex matched healthy controls underwent 7 Tesla structural and resting-state functional MRI. Data were analyzed using graph theory measures. Patients were followed for development of epilepsy. Results: Nine patients and nine control subjects were analyzed. There were no differences in baseline characteristics. No patients developed epilepsy (average follow-up 3 months). No differences between groups occurred on a whole-brain network level. At a 20% threshold, significant differences occurred in the default mode network (DMN). Patients demonstrated an increased local efficiency (p=0.02) and clustering coefficient (p=0.04), and decreased path length (p=0.02) and betweenness centrality (p=0.02). Conclusions: No whole-brain network changes occur after a single unprovoked seizure. No patient has developed epilepsy suggesting this group does not have network alterations after a single seizure. In the DMN, the alterations noted indicate increased segregation of network function.
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Osuch, Bartosz, and Piotr Maciejak. "Non-pharmacological treatment of epilepsy." Pharmacotherapy in Psychiatry and Neurology 36, no. 4 (2021): 313–26. http://dx.doi.org/10.33450/fpn.2020.11.002.
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Objectives. This paper aims to summarise the existing knowledge regarding the available non-pharmacological methods of epilepsy treatment. The accurate diagnosis of patients with drug-resistant epilepsy is vital for optimising further treatment. Literature review. In case of failure to achieve permanent seizure control with two appropriately selected and applied antiepileptic pharmacological regimens, it is recommended to consider surgical treatment. The possibility of removing the epileptic focus without causing functional deficits is evaluated (resection surgery). If the resection operation is not possible, alternative methods of treatment are palliative surgery (disconnection procedures) and neurostimulation systems. Some patients may also benefit from a ketogenic diet. Conclusions. While a satisfactory therapeutic effect with only one of the aforementioned methods is difficult to achieve, the combined therapy is to be taken into consideration.
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Berberian, Ana, Christiane Hopker, Ingrid Mazzarotto, et al. "Aspects of Oral Language, Speech, and Written Language in Subjects with Temporal Lobe Epilepsy of Difficult Control." International Archives of Otorhinolaryngology 19, no. 04 (2015): 302–8. http://dx.doi.org/10.1055/s-0035-1547524.
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Jovanovic, Svetlana, Ivanka Gajic, and Vlada Radivojevic. "Risk factors for oral changes in children with epilepsy: Informative article." Serbian Dental Journal 56, no. 1 (2009): 33–39. http://dx.doi.org/10.2298/sgs0901033j.
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Epilepsy is the most common neurological disorder in people of all ages. Based on the data regarding the prevalence of epilepsy in other countries, about 12,000 individuals under the age of 18 are estimated to suffer from active epilepsy. Children with epilepsy are a high risk group for oral diseases primarily due to psychiatric and psycho-social consequences of the primary disorder as well as the adverse effects of anti-epileptic therapy. Due to the primary disorder, children with epilepsy have reduced motivation for a number of activities, reduced mental and physical abilities, neglected social contacts, more difficult adoption of knowledge, skills, positive attitudes and behavior as well as general and oral healthcare. In children with epilepsy, there is an additional risk for oral diseases due to the adverse effects of anti-epileptic therapy such as gingival hyperplasia. Studies in other countries and in Serbia showed higher prevalence and frequency of oral diseases compared to the control group of healthy children of the same age. This paper emphasizes the need for dental educational work with children with epilepsy and their parents as well as doctors who treat the primary disorder.
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Shahani, Lokesh, and Gregory Cervenka. "Impact of surgical intervention on seizure and psychiatric symptoms in patients with temporal lobe epilepsy." BMJ Case Reports 12, no. 7 (2019): e229242. http://dx.doi.org/10.1136/bcr-2019-229242.
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Temporal lobe epilepsy (TLE), a common form of localisation-related epilepsy, is characterised by focal seizures and accompanied by variety of neuropsychiatric symptoms. This form of epilepsy proves difficult to manage as many anticonvulsant and psychotropic medications have little to no effect on controlling the seizure and neuropsychiatric symptoms respectively. The authors, report a patient with TLE and recurrent seizures that were refractory to multiple classes of antiepileptic therapy. Additionally, she exhibited psychosis, depression and irritability that required antipsychotic medication. After several years of poorly controlled seizure disorder, the patient underwent anterior temporal lobectomy and amygdalohippocampectomy, which proved beneficial for seizure control, as well as her neuropsychiatric symptoms. While it is common to treat refractory temporal lobe epilepsy with surgical interventions, there is little literature about it also treating the neuropsychiatric symptoms. This case underscores both the neurological and psychiatric benefits following surgical intervention for patients with TLE.
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Bollo, Robert J., Stephen P. Kalhorn, Chad Carlson, Veronique Haegeli, Orrin Devinsky, and Howard L. Weiner. "Epilepsy surgery and tuberous sclerosis complex: special considerations." Neurosurgical Focus 25, no. 3 (2008): E13. http://dx.doi.org/10.3171/foc/2008/25/9/e13.
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Epilepsy surgery for medically refractory seizures among patients with tuberous sclerosis complex (TSC) is a well-accepted treatment option. Many epilepsy centers around the world have published their experience over the past several years, supporting the idea that the best seizure control is obtained when a single tuber and associated epileptogenic zone is documented and targeted surgically. Recent advances in imaging and physiological techniques that reveal the epileptogenic zone have been used successfully in children with TSC who are being evaluated for surgery. As a result, a number of different surgical strategies have emerged, each reflecting the experience, strengths, and referral biases of the individual treating teams. Experience suggests that some patients with TSC who present with seizures that are difficult to localize and do not meet the classic selection criteria for epilepsy surgery may, nevertheless, benefit from sugery. Tuberectomy alone is often not sufficient for obtaining seizure control. Intracranial electrode recordings performed in a large number of children with TSC undergoing epilepsy surgery have raised new questions about the relationship of the cortical tuber to the epileptogenic zone in TSC. A careful assessment of the risks and benefits of any surgical strategy, compared with those associated with continued refractory epilepsy, should be considered by the treating team in conjunction with the patient's family. Epilepsy surgery has not only benefited many children with TSC, but it also facilitates the understanding of epileptogenesis in TSC.
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Rana, Mandeep, Alcy R. Torres, Kam Lun Hon, Alexander K. C. Leung, and Rinat Jonas. "Febrile Infection-Related Epilepsy Syndrome." Journal of Pediatric Epilepsy 08, no. 03 (2019): 083–92. http://dx.doi.org/10.1055/s-0039-1701035.
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AbstractFebrile infection-related epilepsy syndrome (FIRES) is a subset or variant of new-onset refractory status epilepticus in children. FIRES is characterized by the occurrence of a febrile episode between 24 hours and 2 weeks before the onset of refractory status epilepticus. A infectious cause is rarely identified in FIRES and an inflammatory or autoimmune etiology is implied. Seizures in FIRES are very difficult to control, and treatments include antiepileptic drugs, ketogenic diet, intravenous immunoglobulin, plasmapheresis, and corticosteroid therapy. The prognosis for patients with FIRES is poor, and most children are left with refractory epilepsy and cognitive impairment. The new consensus guidelines on the terminology of FIRES and recent interest in new treatment approaches have been welcome developments for clinicians who face the challenge of diagnosing and managing status epilepticus in a previously healthy child that occurs following a minor febrile episode. This review aims to provide clinicians with an update on the current hypotheses for the etiology, pathogenesis, clinical evaluation, management, and future directions in the diagnosis and treatment of FIRES.
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Pereira, Cristiana Borges, Carlos Otto Heise, and Arthur Cukiert. "High doses of carbamazepine for refractory partial epilepsy." Arquivos de Neuro-Psiquiatria 54, no. 1 (1996): 42–46. http://dx.doi.org/10.1590/s0004-282x1996000100007.
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Forty-eight patients with partial seizures were analysed during treatment with 1200 mg/d or more of carbamazepine (CBZ). Thirty-three were on monotherapy and fifteen on polytherapy. The other drugs were kept unchanged in the patients on polytherapy. The dose of CBZ was increased if no control was observed and the patient had no side effects. The doses used ranged between 1200 and 1900 mg/day (1200 mg/day, n=18; 1300mg/day, n=1; 1400 mg/day, n=7; 1600 mg/day, n=9; 1700 mg/day, n=4; 1800 mg/day, n=8; 1900 mg/day, n=1). Anticonvulsant plasma levels were taken to confirm patient compliance. The average plasma level was 9.6 ug/mL. The period of follow up varied from 3 to 96 months (M=25.6). Seizure's control was observed in 7 (14.48%) patients taking 1200 mg/day and in 2 (4.16%) patients taking 1400 mg/day of CBZ. Thirty-nine patients did not show any control (81.21%). Ten patients (20.81%) had signs of intoxication. When patients have no improvement with 1400 mg/day, it is difficult to obtain any control despite the use of higher doses of CBZ, which frequently expose the patient to significant side effects.
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Collacott, R. A., A. Dignon, A. Hauck, and J. W. Ward. "Clinical and Therapeutic Monitoring of Epilepsy in a Mental Handicap Unit." British Journal of Psychiatry 155, no. 4 (1989): 522–25. http://dx.doi.org/10.1192/bjp.155.4.522.
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Within a group of hospitals for the mentally handicapped serving the Leicestershire district, a cohort of 215 epileptic patients was identified, who were followed up for four years. The anticonvulsant medication of each patient was reviewed regularly until an optimal balance between seizure control, absence of medication side-effects, and reduction of polypharmacy was attained. After four years 172 patients remained in the study. A significant reduction in polypharmacy was attained overall. Some groups of patients showed a significant reduction in the frequency of seizures, while a small group of patients with frequent seizures remained difficult to control.
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Ziółkowski, H., J. J. Jaroszewski, N. Ziółkowska, and A. Jasiecka. "Characteristics of selected second-generation antiepileptic drugs used in dogs." Polish Journal of Veterinary Sciences 15, no. 3 (2012): 571–82. http://dx.doi.org/10.2478/v10181-012-0088-1.
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Abstract A significant number of cases of clinical canine epilepsy remain difficult to control in spite of the applied treatment. At the same time, the range of antiepileptic drugs is increasingly wide, which allows efficient treatment. In the present paper we describe the pharmacodynamics and pharmacokinetics of the newer antiepileptic drugs which were licensed after 1990 but are still not widely used in veterinary medicine. The pharmacokinetic profiles of six of these drugs were tested on dogs. The results of experimental studies suggest that second generation antiepileptic drugs may be applied in mono- as well as in poli- treatment of canine epilepsy because of the larger safety margin and more advantageous pharmacokinetic parameters. Knowledge of the drugs’ pharmacokinetics allows its proper clinical appliance, which, in turn, gives the chance to improve the efficiency of pharmacotherapy of canine epilepsy.
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Dolton, Emily, and Ansar Choudry. "Perampanel and Challenging Behaviour in Intellectual Disability and Epilepsy: A Management Dilemma." Case Reports in Psychiatry 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/409209.
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We describe a case of a patient with a diagnosis of moderate learning disability with challenging behaviour and treatment refractory epilepsy. Antiepileptics can increase challenging behaviour; however, antipsychotics can provoke seizures. This results in a difficult balance for patient care. Due to worsening seizures, the patient was prescribed perampanel. This increased her aggression and agitation resulting in admission. We trialled four antipsychotic drugs to reduce her challenging behaviour, two of which worsened her seizures. It was necessary to continue antiepileptic medication to maintain adequate seizure control. However, the resulting uncontrolled challenging behaviour persisted, meaning she was unable to return to her family home on discharge. This case emphasises the difficult scenario clinician’s encounter when balancing the use of antipsychotics and antiepileptics. The case demonstrates the significant functional loss due to challenging behaviour, balanced against controlling life threatening seizures.
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Egorova, E. V., D. V. Dmitrenko, A. A. Usoltseva, A. M. Iptyshev, N. A. Shnayder, and R. F. Nasyrova. "Modeling of chronic epilepsy in animals through chemical methods." Bulletin of Siberian Medicine 18, no. 4 (2020): 185–96. http://dx.doi.org/10.20538/1682-0363-2019-4-185-196.
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According to the World Health Organization, the prevalence of epilepsy in the world is high, at about 0.5–1% of the world’s population. In 20–40% of cases, according to various sources, it is not possible with standard treatment methods to achieve control over attacks, which significantly impairs the patient’s quality of life, increases economic costs, and poses a difficult task for the doctor to select the optimal treatment to reduce the frequency of attacks. This explains the urgency of creating new and modifying classical antiepileptic drugs (AEDs), as well as finding optimal and safe ways of administering and delivering the drugs. To study the mechanisms of AEDs’ effect on various pathways of epileptogenesis, simulation of convulsive seizures and chronic epilepsy in animals is used; for this purpose, mechanical, physical, chemical, and genetic models of epilepsy are used. The present review discusses chemical models of chronic epilepsy, which are most often used in experimental neuroscience today. It also describes the characteristics, advantages and disadvantages of each of them, the specificity of the study where they can be used and the assessment scales for epileptic seizures in animals.
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Feki, Fatma, Chahnez Triki, and Nesrine Amara. "Drug-Resistant Myoclonic Epilepsy Revealing Juvenile Huntington's Disease: A Case Report." Journal of Pediatric Epilepsy 07, no. 01 (2018): 021–23. http://dx.doi.org/10.1055/s-0038-1641727.
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AbstractJuvenile Huntington's disease (JHD) shares many general clinical features with the adult form. One important difference is that JHD patients experience more epileptic manifestations, sometimes difficult to control. We describe an atypical clinical picture of a genetically confirmed JHD patient diagnosed during evaluation for a progressive myoclonic epilepsy. A female patient with a family history of psychiatric disorders developed recurrent drug-resistant myoclonic seizures at the age of 6 years, followed by extrapyramidal symptoms (rigidity and dystonia). Cognitive impairment, akinetic rigidity syndrome, and dystonia were noticed at the age of 10 years. Epileptiform abnormalities were noted in ictal electroencephalography. Magnetic resonance imaging showed brain atrophy. Genetic testing for HD confirmed the diagnosis. JHD can initially manifest as myoclonic epilepsy. A DNA testing should be performed if clinical history is suggestive.
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Kramer, Mark A., Lauren M. Ostrowski, Daniel Y. Song, et al. "Scalp recorded spike ripples predict seizure risk in childhood epilepsy better than spikes." Brain 142, no. 5 (2019): 1296–309. http://dx.doi.org/10.1093/brain/awz059.
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Abstract In the past decade, brief bursts of fast oscillations in the ripple range have been identified in the scalp EEG as a promising non-invasive biomarker for epilepsy. However, investigation and clinical application of this biomarker have been limited because standard approaches to identify these brief, low amplitude events are difficult, time consuming, and subjective. Recent studies have demonstrated that ripples co-occurring with epileptiform discharges (‘spike ripple events’) are easier to detect than ripples alone and have greater pathological significance. Here, we used objective techniques to quantify spike ripples and test whether this biomarker predicts seizure risk in childhood epilepsy. We evaluated spike ripples in scalp EEG recordings from a prospective cohort of children with a self-limited epilepsy syndrome, benign epilepsy with centrotemporal spikes, and healthy control children. We compared the rate of spike ripples between children with epilepsy and healthy controls, and between children with epilepsy during periods of active disease (active, within 1 year of seizure) and after a period of sustained seizure-freedom (seizure-free, >1 year without seizure), using semi-automated and automated detection techniques. Spike ripple rate was higher in subjects with active epilepsy compared to healthy controls (P = 0.0018) or subjects with epilepsy who were seizure-free ON or OFF medication (P = 0.0018). Among epilepsy subjects with spike ripples, each month seizure-free decreased the odds of a spike ripple by a factor of 0.66 [95% confidence interval (0.47, 0.91), P = 0.021]. Comparing the diagnostic accuracy of the presence of at least one spike ripple versus a classic spike event to identify group, we found comparable sensitivity and negative predictive value, but greater specificity and positive predictive value of spike ripples compared to spikes (P = 0.016 and P = 0.006, respectively). We found qualitatively consistent results using a fully automated spike ripple detector, including comparison with an automated spike detector. We conclude that scalp spike ripple events identify disease and track with seizure risk in this epilepsy population, using both semi-automated and fully automated detection methods, and that this biomarker outperforms analysis of spikes alone in categorizing seizure risk. These data provide evidence that spike ripples are a specific non-invasive biomarker for seizure risk in benign epilepsy with centrotemporal spikes and support future work to evaluate the utility of this biomarker to guide medication trials and tapers in these children and predict seizure risk in other at-risk populations.
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Dutta, Manaswita, Laura L. Murray, Wendy Miller, Isaiah Innis, and Sharlene Newman. "Cognitive–Linguistic Functions in Adults With Epilepsy: Preliminary Electrophysiological and Behavioral Findings." Journal of Speech, Language, and Hearing Research 63, no. 7 (2020): 2403–17. http://dx.doi.org/10.1044/2020_jslhr-19-00351.
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Purpose Cognition and language difficulties are frequently reported in both children and adults with epilepsy. The majority of the existing research has focused on pediatric epilepsy, documenting impairments in learning, academics, and social–emotional functioning. In comparison, language deficits in younger and older adults with epilepsy have received less empirical attention. Given recently identified limitations in the extant literature regarding assessing epilepsy-related language problems in adults ( Dutta et al., 2018 ), the current exploratory study described in this research note investigated the cognitive–linguistic abilities of adults with focal or generalized types of epilepsy. Method Twelve participants with epilepsy and 11 age- and education-matched healthy controls completed a cognitive–linguistic test battery. Event-related potential (ERP) procedures were also employed to assess the integrity of neural activity supporting psycholinguistic processing in both groups using a lexical decision task. Results No significant performance differences between epilepsy and healthy control groups were noted on basic language tasks; however, group differences were evident on the more complex language measures, including spoken discourse. Even though both groups performed the lexical decision task similarly in terms of accuracy, individuals with epilepsy demonstrated longer reaction times and some atypical ERP characteristics compared to controls. Conclusion The cognitive–linguistic assessment and ERP findings suggested that, compared to neurotypical adults, individuals with epilepsy demonstrate slower processing times and greater difficulty with high-level language and spoken discourse production, despite performing within typical limits on basic language tests. Preliminary results from this research are significant in providing new knowledge about language functioning in adults with epilepsy.
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Badv, Reza Shervin, Azin Ghamari, Mahmoud Reza Ashrafi, Mahmoud Mohammadi, Reza Azizi Malamiri, and Morteza Heidari. "Managing Status Epilepticus in a Child with Dravet Syndrome: How Difficult It Could Be?" Journal of Pediatric Epilepsy 10, no. 03 (2021): 128–34. http://dx.doi.org/10.1055/s-0041-1723951.
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AbstractPreviously known as severe myoclonic epilepsy of infancy, Dravet syndrome is characterized by febrile or afebrile prolonged hemiconvulsive seizures or generalized status epilepticus in an infant with previously normal development. Immediate management of status epilepticus is critical in these patients. Early control of status epilepticus prevents further brain damage; however, there is no consensus regarding the management of status epilepticus in children with Dravet syndrome, as many conventional antiseizure medications that are recommended in the management of status epilepticus worsen the seizures in these patients. A 2.5-year-old girl child patient was referred due to status epilepticus which was refractory to antiseizure medications. Sodium valproate, nitrazepam, ketogenic diet, intravenous phenytoin, and midazolam continuous infusion were administered. After controlling status epilepticus, the probable diagnosis of Dravet syndrome was proposed and confirmed by a mutation in SCN1A. As previously stated in numerous case reports, phenytoin worsens seizures in patients with Dravet syndrome. Therefore, it seems logical that in every infant with status epilepticus and probable Dravet syndrome, the practicing physician considers administering intravenous valproate or even midazolam continuous infusion instead of intravenous phenytoin.
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Sakkalis, Vangelis, Tracey Cassar, Michalis Zervakis, et al. "Parametric and Nonparametric EEG Analysis for the Evaluation of EEG Activity in Young Children with Controlled Epilepsy." Computational Intelligence and Neuroscience 2008 (2008): 1–15. http://dx.doi.org/10.1155/2008/462593.
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There is an important evidence of differences in the EEG frequency spectrum of control subjects as compared to epileptic subjects. In particular, the study of children presents difficulties due to the early stages of brain development and the various forms of epilepsy indications. In this study, we consider children that developed epileptic crises in the past but without any other clinical, psychological, or visible neurophysiological findings. The aim of the paper is to develop reliable techniques for testing if such controlled epilepsy induces related spectral differences in the EEG. Spectral features extracted by using nonparametric, signal representation techniques (Fourier and wavelet transform) and a parametric, signal modeling technique (ARMA) are compared and their effect on the classification of the two groups is analyzed. The subjects performed two different tasks: a control (rest) task and a relatively difficult math task. The results show that spectral features extracted by modeling the EEG signals recorded from individual channels by an ARMA model give a higher discrimination between the two subject groups for the control task, where classification scores of up to 100% were obtained with a linear discriminant classifier.
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Banu, Selina Husna, and Mashaya Zaman Koli. "Progressive Myoclonic Epilepsy: Review Article with A Case Report of Lafora Disease." Bangladesh Journal of Child Health 42, no. 3 (2018): 138–47. http://dx.doi.org/10.3329/bjch.v42i3.39269.
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Progressive myoclonic epilepsy (PME) is an autosomal recessive, apparently a rare complex epilepsy syndrome. Among different types of PME, lafora body disease is more quickly progressive usually fatal within 2nd and 3rd decade. They are characterized by childhood or adolescent onset difficult to control multiple type seizures including myoclonous, generalized tonic clonic, absences, psychomotor regression with ataxia, dementia, dysarthria, visual hallucinations, and other general features. Early suspicion is important that leads to the rational diagnostic workout. The electro-clinical criteria would help a lot to exclude the benign epilepsy syndrome such as juvenile myoclonic epilepsy (JME) and suspect PME at the early stage of the complex epilepsy syndrome. Diagnosis is further clarified and confirmed by finding lafora body in skin and genetic study. Genetic mutation found in more than 87% cases in EPM2A gene or the EPM2B also known as NHLRC1 gene and are inherited in an autosomal recessive manner. EMP2A gene is located on chromosome 6q24. They are reported from Mediterranean basin, central Asia, India, Pakistan, northern Africa and Middle East where consanguineous marriage is common. We report a diagnosed case for the first time in Bangladesh. With the detail clinical history, rational use of the available investigation tools and clinical suspicion, diagnosis of the disorder at its early stage is possible. The rapid progress in genetic therapy would be a great hope in near future.
 Bangladesh J Child Health 2018; VOL 42 (3) :138-147
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Ng, Beng-Yeong. "Psychiatric Aspects of Self-Induced Epileptic Seizures." Australian & New Zealand Journal of Psychiatry 36, no. 4 (2002): 534–43. http://dx.doi.org/10.1046/j.1440-1614.2002.01050.x.
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Objective: To review the literature on self-induced epileptic seizures and apply psychiatric knowledge to define possible causes and treatment recommendations. Methods: A review of MEDLINE literature on self-induced epileptic seizures was conducted, followed by cross-referencing with the relevant neurologic, psychiatric and paediatric books and journals. Results: The reported prevalence of self-induction varies depending on the setting. In most instances, self-inducers are people affected by photosensitive primary generalized epilepsy, in whom self-induction is by intermittent photic stimulation or, more rarely, pattern stimulation or eye closure. Self-induced seizures are most commonly absences with spike-wave, though eyelid myoclonia and generalized myoclonic jerks occur. Earlier studies indicate that the majority of self-inducers were of subnormal intelligence but more recent ones indicate that as a group they could not be considered mentally retarded. Monitoring in a well-lit environment is indicated in any therapy-resistant photosensitive patient to determine whether or not selfinduction occurs. Self-induced epilepsy is notoriously resistant to therapy and reasons for this resistance are discussed. An explanatory model for the initiation and maintenance of selfinduction behaviour is also included. Conclusions: It is difficult to determine from published papers just what level of clinical difficulty self-induction of seizures actually posed to the patients and clinicians. In some cases there is contradictory evidence as to the degree of willfulness or self-induction. Self-induced epileptic seizures may be an important aspect of poor seizure control in a subgroup of epilepsy sufferers. These seizures might be modifiable by psychiatric intervention or behavioural modification.
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Khambhati, Ankit N., Ari E. Kahn, Julia Costantini, et al. "Functional control of electrophysiological network architecture using direct neurostimulation in humans." Network Neuroscience 3, no. 3 (2019): 848–77. http://dx.doi.org/10.1162/netn_a_00089.
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Chronically implantable neurostimulation devices are becoming a clinically viable option for treating patients with neurological disease and psychiatric disorders. Neurostimulation offers the ability to probe and manipulate distributed networks of interacting brain areas in dysfunctional circuits. Here, we use tools from network control theory to examine the dynamic reconfiguration of functionally interacting neuronal ensembles during targeted neurostimulation of cortical and subcortical brain structures. By integrating multimodal intracranial recordings and diffusion-weighted imaging from patients with drug-resistant epilepsy, we test hypothesized structural and functional rules that predict altered patterns of synchronized local field potentials. We demonstrate the ability to predictably reconfigure functional interactions depending on stimulation strength and location. Stimulation of areas with structurally weak connections largely modulates the functional hubness of downstream areas and concurrently propels the brain towards more difficult-to-reach dynamical states. By using focal perturbations to bridge large-scale structure, function, and markers of behavior, our findings suggest that stimulation may be tuned to influence different scales of network interactions driving cognition.
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BATISTA, MARCUS SABRY AZAR, CRISTINA FUNATSU COELHO, MÁRCIA MARQUES DE LIMA, and DÉLRIO FAÇANHA SILVA. "Wicket spikes: a case-control study of a benign eletroencephalografic variant pattern." Arquivos de Neuro-Psiquiatria 57, no. 3A (1999): 561–65. http://dx.doi.org/10.1590/s0004-282x1999000400004.
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Wicket spikes (WS) are a benign eletroencephalogram (EEG) variant, seen mainly in adults, during somnolence, in the temporal regions, in many clinical situations. WS can appear in trains or isolatedly, sometimes being difficult to differentiate from epileptiform activity. We reviewed 2,000 EEG's, found 65 with WS (3.25%) and compared them with 65 normal EEG without WS. There was statistically significant (SS) association between WS and age over 33; adolescent age was correlated to absence of WS and age over 65, to the presence of WS; there was an inverse correlation between WS and epilepsy, related to differences in age; a SS association with cerebrovascular disorders disappeared after controlling for age; a SS correlation with headache was also related to age; female predominance was not SS. There was a great variety of clinical situation associated with WS. We conclude that WS are a inespecific normal variant of the EEG that is age-related.
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Hu, Bing, Zhizhi Wang, Minbo Xu, Luyao Zhu, and Dingjiang Wang. "The therapeutic mechanism of epilepsy seizures in different target areas: Research on a theoretical model." Technology and Health Care 29 (March 25, 2021): 455–61. http://dx.doi.org/10.3233/thc-218043.
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BACKGROUND: The selection of optimal target areas in the surgical treatment of epilepsy is always a difficult problem in medicine. OBJECTIVE: We employed a theoretical calculation model to explore the control mechanism of seizures by an external voltage stimulus acting in different nerve nuclei. METHODS: Theoretical analysis and numerical simulation were combined. RESULTS: The globus pallidus, excitatory pyramidal neurons, striatal D1 neurons, thalamic reticular nucleus and specific relay nuclei were selected, we analyzed that the electrical stimulation has different effects in these target areas. CONCLUSIONS: The data selected were reasonable in study, the results may give a theoretical support for similar studies in clinical.
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Antebi, D., and J. Bird. "The Facilitation and Evocation of Seizures." British Journal of Psychiatry 162, no. 6 (1993): 759–64. http://dx.doi.org/10.1192/bjp.162.6.759.
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The finding that seizures can be precipitated in some epileptic patients by stimuli which originate from outside the central nervous system is not new. The influence of psychological changes on seizure frequency has, however, been much more difficult to determine. Patients who become aware of such associations may gain some control over their seizures. One hundred randomly selected out-patients with epilepsy were asked about their awareness of such associations and whether, as a consequence, they believed they had any control of their seizures. Ninety-two reported associations between seizures and facilitators or precipitants. The group who had made associations between independent states or stimuli and their seizures were more likely to have poorly controlled seizures and to be taking more anticonvulsants. Many had used this knowledge to control their seizures.
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Habib, R., R. Islam, A. Rahman, NB Bhowmik, and A. Haque. "Managing Epilepsy in Women of Reproductive Age: A Review." BIRDEM Medical Journal 4, no. 1 (2014): 38–42. http://dx.doi.org/10.3329/birdem.v4i1.18552.
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Despite all of our advances, women with epilepsy face obstacles when it comes to pregnancy and childbearing. Many of these obstacles are social, based on incorrect and inappropriate attitudes of the public towards persons with epilepsy. Most women with epilepsy can conceive and bear healthy children. They have higher probabilities of infertility but this is often amenable to treatment. Complications of pregnancy are higher and revolve primarily around the increased risk of maternal seizures. Careful monitoring of the clinical condition of the patient and the free anticonvulsant levels will obviate much of this difficulty. Maternal seizures themselves can pose hazards for women with epilepsy and their offspring and generalized convulsive seizures are clearly to be avoided. Adverse pregnancy outcomes tend to be seen more often in particular: congenital malformations, dysmorphic features, neonatal hemorrhage and fetal death. Neonatal and infant mortality is increased to two to threefold over the general population; and an uncertain risk of developmental delay particularly in the area of language acquisition. Risks can be reduced by ensuring good seizure control, monotherapy, preconceptual use of multivitamins with folate. The plethora of new anticonvulsants offers us new opportunities for improving the function and control of persons with epilepsy. All of the risks aside, the majority of women with epilepsy can and will have healthy children. DOI: http://dx.doi.org/10.3329/birdem.v4i1.18552 Birdem Med J 2014; 4(1): 38-42
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van Schalkwijk, Frank J., Walter R. Gruber, Laurie A. Miller, Eugen Trinka, and Yvonne Höller. "Investigating the Effects of Seizures on Procedural Memory Performance in Patients with Epilepsy." Brain Sciences 11, no. 2 (2021): 261. http://dx.doi.org/10.3390/brainsci11020261.
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Memory complaints are frequently reported by patients with epilepsy and are associated with seizure occurrence. Yet, the direct effects of seizures on memory retention are difficult to assess given their unpredictability. Furthermore, previous investigations have predominantly assessed declarative memory. This study evaluated within-subject effects of seizure occurrence on retention and consolidation of a procedural motor sequence learning task in patients with epilepsy undergoing continuous monitoring for five consecutive days. Of the total sample of patients considered for analyses (N = 53, Mage = 32.92 ± 13.80 y, range = 18–66 y; 43% male), 15 patients experienced seizures and were used for within-patient analyses. Within-patient contrasts showed general improvements over seizure-free (day + night) and seizure-affected retention periods. Yet, exploratory within-subject contrasts for patients diagnosed with temporal lobe epilepsy (n = 10) showed that only seizure-free retention periods resulted in significant improvements, as no performance changes were observed following seizure-affected retention. These results indicate general performance improvements and offline consolidation of procedural memory during the day and night. Furthermore, these results suggest the relevance of healthy temporal lobe functioning for successful consolidation of procedural information, as well as the importance of seizure control for effective retention and consolidation of procedural memory.
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Dooley, J. M., P. R. Camfield, E. Smith, P. Langevin, and G. Ronen. "Topiramate in Intractable Childhood Onset Epilepsy - A Cautionary Note." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 26, no. 4 (1999): 271–73. http://dx.doi.org/10.1017/s0317167100000366.
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Objectives:To study the effectiveness and safety of topiramate in clinical practice, for a group of patients with childhood onset epilepsy.Methods:All patients treated with topiramate at the three study centers between November 1995 and December 31, 1997 were analyzed retrospectively, using a standardized study protocol. Data were gathered on demographic features, seizure response and medication related adverse events.Results:Eighty-seven patients were treated with topiramate. Over 90% seizure reduction was achieved in 8 (9%) patients, 50%-90% in 21 (24%), <50% in 54 (62%) patients. Four patients (5%) had a deterioration in seizure control. Adverse events required topiramate discontinuation in 36 (41%). Of these 27 (31%) complained of unacceptable cognitive dulling. The rate of dose escalation and final dose in mg/kg were similar in those who remained on topiramate and those who were intolerant because of cognitive side effects.Conclusion:Although topiramate resulted in >50% seizure reduction in 29 (33%) of this group of patients with difficult epilepsy, its usefulness was limited by a high incidence of adverse effects. Adverse events prevented ongoing therapy for 36 (41%) and cognitive dulling resulted in topiramate discontinuation by 27 (31%) of the group.
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Vachhrajani, Shobhan, Sandrine de Ribaupierre, Hiroshi Otsubo, et al. "Neurosurgical management of frontal lobe epilepsy in children." Journal of Neurosurgery: Pediatrics 10, no. 3 (2012): 206–16. http://dx.doi.org/10.3171/2012.6.peds11125.
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Object Pediatric frontal lobe epilepsy (FLE) remains a challenging condition for neurosurgeons and epileptologists to manage. Postoperative seizure outcomes remain far inferior to those observed in temporal lobe epilepsies, possibly due to inherent difficulties in delineating and subsequently completely resecting responsible epileptogenic regions. In this study, the authors review their institutional experience with the surgical management of FLE and attempt to find predictors that may help to improve seizure outcome in this population. Methods All surgically treated cases of intractable FLE from 1990 to 2008 were reviewed. Demographic information, preoperative and intraoperative imaging and electrophysiological investigations, and follow-up seizure outcome were assessed. Inferential statistics were performed to look for potential predictors of seizure outcome. Results Forty patients (20 male, 20 female) underwent surgical management of FLE during the study period. Patients were an average of 5.6 years old at the time of FLE onset and 11.7 years at the time of surgery; patients were followed for a mean of 40.25 months. Most patients displayed typical FLE semiology. Twenty-eight patients had discrete lesions identified on MRI. Eight patients underwent 2 operations. Cortical dysplasia was the most common pathological diagnosis. Engel Class I outcome was obtained in 25 patients (62.5%), while Engel Class II outcome was observed in 5 patients (12.5%). No statistically significant predictors of outcome were found. Conclusions Control of FLE remains a challenging problem. Favorable seizure outcome, obtained in 62% of patients in this series, is still not as easily obtained in FLE as it is in temporal lobe epilepsy. While no statistically significant predictors of seizure outcome were revealed in this study, patients with FLE continue to require extensive workup and investigation to arrive at a logical and comprehensive neurosurgical treatment plan. Future studies with improved neuroimaging and advanced invasive monitoring strategies may well help define factors for success in this form of epilepsy that is difficult to control.
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Mikula, Anthony L., Karim ReFaey, Sanjeet S. Grewal, Jeffrey W. Britton, and Jamie J. Van Gompel. "Medial Temporal Encephalocele and Medically Intractable Epilepsy: A Tailored Inferior Temporal Lobectomy and Case Report." Operative Neurosurgery 18, no. 1 (2019): E19—E22. http://dx.doi.org/10.1093/ons/opz098.
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AbstractBACKGROUND AND IMPORTANCETemporal lobe encephaloceles are increasingly recognized as a potential cause of medically refractory epilepsy and surgical treatment has proven effective. Resection of the encephalocele and associated cortex is often sufficient to provide seizure control. However, it is difficult to determine the extent of adjacent temporal lobe that should be resected. We present a case report and our technique of a tailored inferior temporal pole resection.CLINICAL PRESENTATIONA 32-yr-old man with an 11-yr history of medically refractory epilepsy. Prolonged electroencephalography (EEG) revealed frequent left and rare right frontotemporal sharp waves. Numerous seizures were captured with EEG, all of which originated from the left temporal region. Statistical parametric mapping (SPM) subtraction ictal–interictal SPECT coregistered with magnetic resonance imaging (MRI) (SISCOM) demonstrated ictal hyperperfusion in the anterior left temporal lobe. MRI showed 2 encephaloceles in the left anterior temporal lobe with the accompanying bony defects in the floor of the middle cranial fossa apparent on the computed tomography scan. The patient underwent left temporal craniotomy with intraoperative electrocorticography, resection of the encephaloceles, and a tailored inferior temporal lobectomy (IFTL) and repair of the middle fossa defects. At 7 mo follow up he reported seizure-freedom since surgery.CONCLUSIONResection of temporal encephalocele and adjacent cortex is safe and effective procedure for select patients with medically refractory epilepsy. This video demonstrates our technique which provides a more standardized approach to the resection.
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AlGhamdi, Afnan, Muhammad Talal Alrifai, Abdullah I. Al Hammad, et al. "Epilepsy in Propionic Acidemia: Case Series of 14 Saudi Patients." Journal of Child Neurology 33, no. 11 (2018): 713–17. http://dx.doi.org/10.1177/0883073818786157.
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Propionic acidemia is an inborn error of metabolism that is inherited in an autosomal recessive manner. It is characterized by a deficient propionyl-CoA carboxylase due to mutations in either of its beta or alpha subunits. In the literature, there is a clear association between propionic acidemia and epilepsy. In this cohort, we retrospectively reviewed the data of 14 propionic acidemia patients in Saudi Arabia and compared the findings to those of former studies. Six of the 14 (43%) patients developed epileptic seizure, mainly focal seizures. All patients were responsive to conventional antiepileptic drugs as their seizures are controlled. The predominant electroencephalographic (EEG) findings were diffuse slowing in 43% and multifocal epileptiform discharges in 14% of the patients. In 1 patient, burst suppression pattern was detected, a pattern never before reported in patients with propionic acidemia. Brain magnetic resonance imaging (MRI) findings mainly consisted of signal changes of the basal ganglia (36%), generalized brain atrophy (43%), and delayed myelination (43%).The most common genotype in our series is the homozygous missense mutation in the PCCA gene (c.425G>A; p. Gly142Asp). However, there is no clear genotype–seizure correlation. We conclude that seizure is not an uncommon finding in patients with propionic acidemia and not difficult to control. Additional studies are needed to further elaborate on genotype–seizure correlation.
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Hong, Seung-Chyul, Kwan-Soo Kang, Dae Won Seo, et al. "Surgical treatment of intractable epilepsy accompanying cortical dysplasia." Journal of Neurosurgery 93, no. 5 (2000): 766–73. http://dx.doi.org/10.3171/jns.2000.93.5.0766.
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Object. Surgical treatment of cortical dysplasia (CD) together with intractable seizures is challenging because both visualization and localization of the lesion are difficult, correlation with seizure foci requires comprehensive study, and the surgical outcomes reported thus far are unsatisfactory. The authors report their experience in the surgical treatment of CD classified according to a surgical point of view.Methods. The definition of CD used in this study was a dysplastic lesion visible on magnetic resonance (MR) images or a lesion that, although not visible on MR images, was diagnosed as moderate-to-severe dysplasia by using pathological analysis. During the last 4.5 years, the authors treated 36 patients with intractable epilepsy accompanied by CD. They divided the 36 cases of CD into four characteristic groups: Group A, diffuse bilateral hemispheric dysplasia; Group B, diffuse lobar dysplasia; Group C, focal dysplasia; and Group D, a moderate to severe degree of CD with a normal appearance on MR images. All but one patient in Group C were monitored in the epilepsy monitoring unit by using subdural electrodes for seizure localization and functional mapping.The incidence of CD among a cohort of 291 patients who had undergone epilepsy surgery at the authors' center during the study period was 12.4%. The mean age of the 36 patients was 21.3 years and the mean age at seizure onset was 8.5 years. The mean follow-up period was 26 months. Twenty-six patients (72.2%) belonged to Engel Class I or II (20 and six, respectively). There were five cases in Group A, nine in Group B, nine in Group C, and 13 in Group D. Patients in Groups A and B were significantly younger at seizure onset and had significantly poorer surgical outcomes compared with patients in Groups C and D (p < 0.05). If outcome is compared on the basis of the extent of removal of CD, patients in whom CD was completely removed had significantly better outcomes than those in whom CD was only partially removed (p < 0.001).Conclusions. The authors conclude that intractable epilepsy accompanied by CD can be treated surgically using comprehensive preoperative approaches. Deliberate resective procedures aimed at complete removal of dysplastic tissue ensure excellent seizure control without permanent neurological deficit.
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Mader, Edward C., Bruce J. Fisch, Nicole R. Villemarette-Pittman, Piotr W. Olejniczak, and Michael E. Carey. "Botulinum Toxin Injections for Simple Partial Motor Seizures Associated with Pain." Case Reports in Medicine 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/295251.
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Intractable epilepsy with painful partial motor seizures is a relatively rare and difficult disorder to treat. We evaluated the usefulness of botulinum toxin to reduce ictal pain. Two patients received two or four botulinum toxin (BTX) injections at one-to-two-month intervals. Patient 1 had painful seizures of the right arm and hand. Patient 2 had painful seizures involving the left foot and leg. Injections were discontinued after improved seizure control following resective surgery. Both patients received significant pain relief from the injections with analgesia lasting at least two months. Seizure severity was reduced, but seizure frequency and duration were unaffected. For these patients, BTX was effective in temporarily relieving pain associated with muscle contraction in simple partial motor seizures. Our findings do not support the hypothesis that modulation of motor end-organ feedback affects focal seizure generation. BTX is a safe and reversible treatment that should be considered as part of adjunctive therapy after failure to achieve control of painful partial motor seizures.
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Kiminejad Malaie, Parisa, Mehdi Asadi, Faezeh Sadat Hosseini, Mahmood Biglar, and Massoud Amanlou. "Synthesis, in Vivo and in Silico Studies of N-Aryl-4-(1,3-Dioxoisoindolin-2-Yl)Benzamides as an Anticonvulsant Agent." Pharmaceutical Sciences 26, no. 1 (2020): 38–44. http://dx.doi.org/10.34172/ps.2019.54.
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Background: These days epilepsy is a common neurological disorder, which can affect on quality of life by unpredictable seizure. Thalidomide is one of the drugs to control the epilepsy but side effects such as teratogenicity, made it difficult to use. Methods: Six new analogues of N-aryl-4-(1,3-dioxoisoindolin-2-yl)benzamides were synthesized and tested for anti-seizure activity. To evaluate the anti-seizure activity of these new derivatives, 40 mice in 8 groups were received 10 mg/Kg of each new derivatives 30 min before the injection of pentylenetetrazole (PTZ, 70 mg/kg) to induced seizures. Latency time to first symptom of seizure was measured and compared to vehicle and standard groups. Docking methodology was applied to study on mode of interaction between GABAA receptor and synthetized compounds. Results: Structures of the all synthesized compounds were confirmed by NMR and mass spectroscopy. The latency time and mortality rate were individually measured for an hour after injection of pentylenetetrazole. Docking study revealed that synthesized compounds and thalidomide interact in similar conformation with GABAA receptor. Conclusion: The experimental and docking results were found in good correlation and demonstrated that the most active compound (5a), with 3,4-dimethylphenyl residue increased the duration of seizure inhibition threshold in comparison with thalidomide.
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Reuter-Lorenz, Patricia A., Troy M. Herter, and Daniel Guitton. "Control of Reflexive Saccades following Hemispherectomy." Journal of Cognitive Neuroscience 23, no. 6 (2011): 1368–78. http://dx.doi.org/10.1162/jocn.2010.21537.
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Individuals who have undergone hemispherectomy for treatment of intractable epilepsy offer a rare and valuable opportunity to examine the ability of a single cortical hemisphere to control oculomotor performance. We used peripheral auditory events to trigger saccades, thereby circumventing dense postsurgical hemianopia. In an antisaccade task, patients generated numerous unintended short-latency saccades toward contralesional auditory events, indicating pronounced limitations in the ability of a single hemicortex to exert normal inhibitory control over ipsilateral (i.e., contralesional) reflexive saccade generation. Despite reflexive errors, patients retained an ability to generate correct antisaccades in both directions. The prosaccade task revealed numerous contralesional express saccades, a robust contralesional gap effect, but the absence of both effects for ipsilesional saccades. These results indicate limits to the saccadic control capabilities following hemispherectomy: A single hemicortex can mediate antisaccades in both directions, but plasticity does not extend fully to the bilateral inhibition of reflexive saccades. We posit that these effects are due to altered control dynamics that reduce the responsivity of the superior colliculus on the intact side and facilitate the release of an auditory-evoked ocular grasp reflex into the blind hemifield that the intact hemicortex has difficulty suppressing.
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Smyth, Matthew D., R. Shane Tubbs, E. Martina Bebin, Paul A. Grabb, and Jeffrey P. Blount. "Complications of chronic vagus nerve stimulation for epilepsy in children." Journal of Neurosurgery 99, no. 3 (2003): 500–503. http://dx.doi.org/10.3171/jns.2003.99.3.0500.
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Object. The aim of this study was to define better the incidence of surgical complications and untoward side effects of chronic vagus nerve stimulation (VNS) in a population of children with medically refractory epilepsy. Methods. The authors retrospectively reviewed the cases of 74 consecutive patients (41 male and 33 female) 18 years of age or younger (mean age 8.8 years, range 11 months–18 years) who had undergone implantation of a vagal stimulator between 1998 and 2001 with a minimum follow up of 1 year (mean 2.2 years). Of the 74 patients treated, seven (9.4%) had a complication ultimately resulting in removal of the stimulator. The rate of deep infections necessitating device removal was 3.5% (three of 74 patients who had undergone 85 implantation and/or revision procedures). An additional three superficial infections occurred in patients in whom the stimulators were not removed: one was treated with superficial operative debridement and antibiotic agents and the other two with oral antibiotics only. Another four stimulators (5.4%) were removed because of the absence of clinical benefit and device intolerance. Two devices were revised because of lead fracture (2.7%). Among the cohort, 11 battery changes have been performed thus far, although none less than 33 months after initial implantation. Several patients experienced stimulation-induced symptoms (hoarseness, cough, drooling, outbursts of laughter, shoulder abduction, dysphagia, or urinary retention) that did not require device removal. Ipsilateral vocal cord paralysis was identified in one patient. One patient died of aspiration pneumonia more than 30 days after device implantation. Conclusions. Vagus nerve stimulation remains a viable option for improving seizure control in difficult to treat pediatric patients with epilepsy. Surgical complications such as hardware failure (2.7%) or deep infection (3.5%) occurred, resulting in device removal or revision. Occasional stimulation-induced symptoms such as hoarseness, dysphagia, or torticollis may be expected (5.4%).
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Triglia Pinto, Julia Teles, Ana Carolina Tomasella Auad, Gabrielle Menegucci, et al. "Herpetic Meningoencephalitis by Vertical Transmission: A Case Report and Systematic Review." MedNEXT Journal of Medical and Health Sciences 2, no. 1 (2021): 35–41. http://dx.doi.org/10.34256/mdnt2117.
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Objective: To report a case of vertical herpetic meningoencephalitis. Results: The involvement of the central nervous system (CNS) in infection by HSV (herpes simplex virus), HSV-1 or HSV-2, causes an acute inflammatory process in the brain parenchyma, leading to herpetic encephalitis. It is a feared form of the disease due to its severity and its high rate of morbidity and mortality. Its rapid fatal progression can be prevented from early suspicion and treatment, which is essential when taking into account their neurological sequelae since survivors have motor sequelae, behavioral disorders, or epilepsy. The present work reports the case of a newborn male with spontaneous vaginal delivery who, at 19 days of age, started to experience fever, irritability, difficulty in eating, spasms, tremors of the upper limbs, deviation of the eyes, and seizures of difficult to control, together with CFE and serological changes, in addition to imaging tests compatible with herpetic meningoencephalitis, progressing with a very serious evolution despite the institution of specific treatment for CNS herpetic infection, evolving with important neurological sequelae. Conclusion: The sequels resulting from herpetic encephalitis not properly diagnosed, or even late, leads from severe neurological damage to death. Therefore, it is extremely important to start empirical treatment with antiviral drugs to reduce the sequelae mentioned above.
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Gloor, P. "Epilepsy: Relationships Between Electrophysiology and Intracellular Mechanisms Involving Second Messengers and Gene Expression." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 16, no. 1 (1989): 8–21. http://dx.doi.org/10.1017/s0317167100028468.
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ABSTRACT:It is well known that pure absence epilepsy is a benign form of seizure disorder, while most others, particularly partial and convulsive seizures may have transient or permanent deleterious consequences and are more difficult to bring under therapeutic control by anticonvulsants. The hypothesis is proposed that the preservation of GABA-ergic inhibition in absence attacks and its breakdown in most other seizures may explain these differences. Breakdown of GABA-ergic inhibition allows NMDA receptors to become active. This opens the way for Ca2+ to enter the cell. Such Ca2+ entry is a long-lasting phenomenon. It is likely to be massive during most seizures except during absence attacks, and may therefore damage the neuron transiently or permanently. It may even destroy it. Ca2+ entry is also a crucial factor in the activation of the second messenger cascade which involves cytosolic as well as nuclear (genomic) components. Activation of this cascade converts short-lived electrophysiological processes occurring at the membrane into much longer-lasting intracellular processes. These may include plastic changes at the synaptic and receptor level and may account for kindling and the increasing therapy-resistance of long-standing seizure disorders. Changes resulting from massive Ca2+ entry into the neuron may explain why most seizures, except absence attacks, may have deleterious consequences of various kinds, some short-lived, some of longer duration, and some even permanent.
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Roy, UK, M. Pal, S. Datta, and S. Harlalka. "Has Oxidative Stress any Role on Mechanisms of Aminophylline – Induced Seizures? An Animal Study." Kathmandu University Medical Journal 12, no. 4 (2015): 269–74. http://dx.doi.org/10.3126/kumj.v12i4.13733.
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Background Aminophylline can trigger seizures in patients without known underlying epilepsy or added risk factor for seizure exacerbation in epilepsy. Most of these seizures are difficult to control and are underappreciated compared to other drug toxicities. Despite a long clinical history of aminophylline-induced seizures, relatively little is known about the underlying molecular mechanisms that contribute to methylxanthine-induced seizure generation.Objective The present study evaluated the possible involvement of free radicals in aminophylline induced seizures in rat.Method The rats were divided into two groups. The first group graded single doses of aminophylline from 100 to 300 mg/kg were administered intraperitoneally. On the basis of the results Aminophylline, a dose (300 mg/kg) producing tonic-clonic seizures and mortality in 100% animals was selected as control in the study. The second group were subjected to single antioxidant (Vitamin E or Vitamin C) or in combination for 45 days then single doses of aminophylline 300 mg/kg administered intraperitoneally to rats.Result Aminophylline induced convulsions in rats in a dose-dependent manner, and both incidence of seizure and mortality were maximum at 300 mg/kg and there was significant increase of free radical generation. But though pre-treatment with antioxidants showed differential attenuating effects on aminophylline induced free radical generation as we all known but they were very much ineffective in antagonizing aminophylline induced seizures and post-seizure mortality by any appreciable extent.Conclusion Though Aminophylline induces oxidative stress the results are suggestive that at least free radicals is not only cause of convulsiogenic effects and post-seizure mortality of aminophylline.Kathmandu University Medical Journal Vol.12(4) 2014; 269-274