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Latest & greatest articles for epilepsy
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, hepatosplenomegaly, and micro or macrocephaly. Drug use or withdrawal. See the CKS topic on for more information. Epilepsy — suspect if there is no compelling history of fever, the seizure was complex, there were post-ictal signs, or there is neurodevelopmental delay. See the CKS topic on for more information. Epilepsysyndromes, such as: Dravet syndrome (severe myoclonic epilepsy of infancy) — a neurodevelopmental disorder characterized by prolonged intractable seizures initially triggered by fever. Typically (...) over time seizures change to become myoclonic and later focal, with developmental delay associated. Genetic epilepsy with febrile seizures plus (GEFS+) — an autosomal dominant disorder where seizures continue beyond 6 years of age, and afebrile seizures may also occur. Other neurological conditions such as cerebral palsy or neurocutaneous syndromes where seizures may form part of the condition: Sturge-Weber syndrome may be suggested by a unilateral port-wine stain over the trigeminal area. Tuberous
a diagnosis of epilepsy. C EEG should be used to support the classification of epilepticseizures and epilepsysyndromes when there is clinical doubt. C EEG should be performed in young people with generalised seizures to aid classification and to detect a photoparoxysmal response. B Short-term video-EEG, preferably with suggestion, should be available for the investigation and diagnosis of suspected epilepsy and non-epilepticattackdisorder. C Inpatient video-EEG monitoring and other specialist (...) investigations (including polysomnography with full EEG montages) should be available for patients who present diagnostic difficulties. Diagnosis and management of epilepsy in adults 2 + 1 - 3 2 + 3 2 + 3 4| 11 ? Access to urgent EEG (within 24 hours of request) should be available in all acute medical units for the diagnosis of suspected non-convulsive status epilepticus. 3.5 HAND-HELD VIDEO There is good evidence that epilepticseizures can be distinguished from non-epilepticattackdisorder based
Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Epilepsy is a common neurological condition with a worldwide prevalence of around 1%. Approximately 60% to 70% of people with epilepsy will achieve a longer-term remission from seizures, and most achieve that remission shortly after starting antiepileptic drug treatment. Most people with epilepsy are treated with a single antiepileptic drug (monotherapy) and current guidelines from the National (...) AEDs (carbamazepine, phenytoin, sodium valproate, phenobarbitone, oxcarbazepine, lamotrigine, gabapentin, topiramate, levetiracetam, zonisamide) currently used as monotherapy in children and adults with partial onset seizures (simple partial, complex partial or secondary generalised) or generalised tonic-clonic seizures with or without other generalised seizure types (absence, myoclonus).We searched the following databases: Cochrane Epilepsy's Specialised Register, CENTRAL, MEDLINE and SCOPUS
Stiripentol (Diacomit) - for use in conjunction with clobazam and valproate as adjunctive therapy of refractory generalized tonic-clonic seizures in patients with severe myoclonic epilepsy in infancy (SMEI, Dravet syndrome) Final Appraisal Recommendation Advice No: 2617 – November 2017 Stiripentol (Diacomit ® ) 250 mg and 500 mg hard capsules; 250 mg and 500 mg powder for oral suspension in sachet Resubmission by Biocodex Additional note(s): • AWMSG considered that stiripentol (Diacomit ® (...) (where available) and the lay member perspective. This recommendation has been ratified by Welsh Government and will be considered for review every three years. Recommendation of AWMSG Stiripentol (Diacomit ® ) is recommended for use within NHS Wales for use in conjunction with clobazam and valproate as adjunctive therapy of refractory generalized tonic-clonic seizures in patients with severe myoclonic epilepsy in infancy (SMEI, Dravet syndrome) whose seizures are not adequately controlled
for unpublished studies.We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQoL was the main outcome measure. For the operational definition of 'psychological treatments', we included a broad range of treatments that used psychological or behavioral techniques designed to improve HRQoL, seizure frequency and severity, and psychiatric comorbidities for adults and children with epilepsy, compared to treatment as usual (TAU) or an active control group.We used standard (...) , and five studies investigated interventions for adolescents and adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from six adult studies, two studies on adolescents and adults, and one on adolescents and young adults (468 participants) for HRQoL, measured with the Quality of Life in Epilepsy-31 (QOLIE-31). We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication
Histopathological Findings in Brain Tissue Obtained during Epilepsy Surgery. Detailed neuropathological information on the structural brain lesions underlying seizures is valuable for understanding drug-resistant focal epilepsy.We report the diagnoses made on the basis of resected brain specimens from 9523 patients who underwent epilepsy surgery for drug-resistant seizures in 36 centers from 12 European countries over 25 years. Histopathological diagnoses were determined through examination (...) of the specimens in local hospitals (41%) or at the German Neuropathology Reference Center for Epilepsy Surgery (59%).The onset of seizures occurred before 18 years of age in 75.9% of patients overall, and 72.5% of the patients underwent surgery as adults. The mean duration of epilepsy before surgical resection was 20.1 years among adults and 5.3 years among children. The temporal lobe was involved in 71.9% of operations. There were 36 histopathological diagnoses in seven major disease categories. The most
Surgery for Drug-Resistant Epilepsy in Children. Neurosurgical treatment may improve seizures in children and adolescents with drug-resistant epilepsy, but additional data are needed from randomized trials.In this single-center trial, we randomly assigned 116 patients who were 18 years of age or younger with drug-resistant epilepsy to undergo brain surgery appropriate to the underlying cause of epilepsy along with appropriate medical therapy (surgery group, 57 patients) or to receive medical (...) ), and on the Vineland Social Maturity Scale (difference, 4.7; 95% CI, 0.4 to 9.1; P=0.03), but not on the Binet-Kamat intelligence quotient (difference, 2.5; 95% CI, -0.1 to 5.1; P=0.06). Serious adverse events occurred in 19 patients (33%) in the surgery group, including hemiparesis in 15 (26%).In this single-center trial, children and adolescents with drug-resistant epilepsy who had undergone epilepsy surgery had a significantly higher rate of freedom from seizures and better scores with respect to behavior
Eslicarbazepine acetate add-on for drug-resistant partial epilepsy. This is an updated version of the Cochrane Review published in the Cochrane Library 2011, Issue 12.The majority of people with epilepsy have a good prognosis, but up to 30% of people continue to have seizures despite several regimens of antiepileptic drugs. In this review, we summarized the current evidence regarding eslicarbazepine acetate (ESL) when used as an add-on treatment for drug-resistant partial epilepsy.To evaluate (...) ). Overall the quality of the evidence was rated as moderate to high.ESL reduces seizure frequency when used as an add-on treatment for people with drug-resistant partial epilepsy. The trials included in this review were of short-term duration and focused on adults. One new trial has been included in this update, but the conclusions are unchanged.
complex febrile seizures among children.To assess the use of EEG and its timing after complex febrile seizures in children younger than five years of age.For the latest update of this review, we searched the Cochrane Epilepsy Group Specialized Register (23 January 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 23 January 2017), MEDLINE (Ovid, 23 January 2017), and ClinicalTrials.gov (23 January 2017). We applied no language (...) restrictions.All randomised controlled trials (RCTs) that examined the utility of an EEG and its timing after complex febrile seizures in children.The review authors selected and retrieved the articles and independently assessed which articles should be included. Any disagreements were resolved by discussion and by consultation with the Cochrane Epilepsy Group. We applied standard methodological procedures expected by Cochrane.Of 41 potentially eligible studies, no RCTs met the inclusion criteria.We found
The role of high-frequency oscillations in epilepsy surgery planning. Epilepsy is a serious brain disorder characterized by recurrent unprovoked seizures. Approximately two-thirds of seizures can be controlled with antiepileptic medications (Kwan 2000). For some of the others, surgery can completely eliminate or significantly reduce the occurrence of disabling seizures. Localization of epileptogenic areas for resective surgery is far from perfect, and new tools are being investigated to more (...) accurately localize the epileptogenic zone (the zone of the brain where the seizures begin) and improve the likelihood of freedom from postsurgical seizures. Recordings of pathological high-frequency oscillations (HFOs) may be one such tool.To assess the ability of HFOs to improve the outcomes of epilepsy surgery by helping to identify more accurately the epileptogenic areas of the brain.For the latest update, we searched the Cochrane Epilepsy Group Specialized Register (25 July 2016), the Cochrane
Yoga for epilepsy. This is an updated version of the original Cochrane Review published in the Cochrane Library, Issue 5, 2015.Yoga may induce relaxation and stress reduction, and influence the electroencephalogram and the autonomic nervous system, thereby controlling seizures. Yoga would be an attractive therapeutic option for epilepsy if proved effective.To assess whether people with epilepsy treated with yoga:(a) have a greater probability of becoming seizure free;(b) have a significant (...) reduction in the frequency or duration of seizures, or both; and(c) have a better quality of life.For this update, we searched the Cochrane Epilepsy Group Specialized Register (3 January 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) in the Cochrane Library (searched 3 January 2017), MEDLINE (Ovid, 1946 to 3 January 2017), SCOPUS (1823 to 3 January 2017), ClinicalTrials.gov (searched 3 January 2017), the World Health Organization (WHO) International Clinical Trials
-onset seizures with or without secondary generalisation in adult and adolescent (16-18 years) patients with epilepsy. The legal basis for this application refers to: Generic application (Article 10(1) of Directive No 2001/83/EC) The application submitted is composed of administrative information, complete quality data and literature from the reference medicinal product Vimpat instead of non-clinical and clinical unless justified otherwise. The chosen reference product is: Medicinal product which (...) membranes. Vimpat was first approved as an adjunctive therapy for the treatment of partial-onset seizures with or without secondary generalization in patients with epilepsy aged 16 years and older. An extension of indication from add-on treatment to monotherapy was approved on 10 November 2016. At the time of this report, Vimpat was indicated as monotherapy and adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adult and adolescent (16-18 years
concluded it is not clear whether cannabinoids reduce the frequency of seizures in epilepsy because the certainty of the evidence is very low, and they probably increase adverse effects. (...) Are cannabinoids effective for epilepsy? Several beneficial effects have been proposed for cannabinoids in different clinical conditions, including epilepsy. However, their clinical role is controversial. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified five systematic reviews including four randomized trials addressing the question of this article. We extracted data and generated a summary of findings following the GRADE approach. We
Clinical features of seizures after cerebral venous sinus thrombosis and its effect on outcome among Chinese Han population Clinical features of epilepticseizures after cerebral venous sinus thrombosis (CVST) among Chinese patients are not known, and it is still controversial whether seizures would affect the outcome of CVST.In a Chinese hospital-based study of consecutive patients with CVST between 2003 and 2015, we described the clinical features of seizures and determined the predictors (...) of seizure onset using multivariable logistic regression analysis. We also compared the in-hospital case-fatality and short-term functional outcome (modified Rankin Scale (mRS) at discharge) in patients with versus without seizures using ordinal regression analysis.Among 151 patients with CVST, 52 (34.4%) presented seizures, of which 42 (80.8%) were generalised seizures. Male gender (OR 6.32, 95% CI 2.06 to 19.35, p=0.001), motor deficits (OR 4.89, 95% CI 1.52 to 15.68, p=0.008), intracerebral
Epilepsy as a health problem among school children in Turaif, Northern Saudi Arabia, 2017 Epilepsy is the most common serious neurological disorder and is one of the world's most prevalent non-communicable diseases. There are no recently published data on the prevalence of epilepsy in school children in Northern Saudi Arabia.This study was conducted to determine the prevalence of epilepsy and to show some of its risk factors in school children and adolescents (6-18 years) in Turaif city (...) test and descriptive statistics.Out of 1,230 children, 66 (5.5%) had epilepsy; 68.2% of them were males and 31.8% females (p=0.000). Consanguinity between parents plays a significant role where 59.1% of cases had parents who were cousins (p=0.000). Family history also had a significant effect as 68.2% of cases had epilepsy cases in their families (p=0.000).Epilepsy prevalence among school children (6-18 years) in Turaif city is higher in males than females. Consanguinity and positive family history
, autonomic, and/or cognitive function.” Convulsion : “refers specifically to the motor manifestations of a seizure” ictal Period : “is the time during which a seizure or seizure-like activity occurs.” Post-ictal period : “A postictal period is an interval of altered mental status immediately following a seizure, generally lasting less than 1 hour.” Epilepsy : “Epilepsy refers to a condition of recurrent unprovoked seizures.” Seizures can be partial (focal) or generalized Partial seizure : “involve (...) will show epileptiform discharges REFRACTORY STATUS EPILEPTICUS = a seizure that does not terminate after treatment with a benzo plus second antiepileptic drug.  List 10 Causes of status epilepticus See Box 92.1 in Rosens 9 th Edition Broken down by: Metabolic Infectious Withdrawal syndromes CNS lesions Intoxication  List the differential diagnosis of ALOC post seizure See Box 92.2 – Differential Diagnosis of AMS in Patient Who Has Seized Post-ictal Period NCSE or subtle convulsive status
surgical strategy in individuals with ECs and seizures is not established. The evaluation of the cause and risk-benefit must be held to choose the appropriate surgical strategy: lesionectomy, lobectomy, or amygdalohippocampectomy. In this case, a lesionectomy was performed due to an absence of evidence of involvement of hippocampus and amygdala. Conclusion Epilepsy secondary to ECs is a rare association. Lesionectomy can be an option with good results without increasing the morbidity. (...) Giant Epidermoid Cyst: A Rare Cause of Temporal Lobe Epilepsy Introduction Epidermoid tumors represent approximately 0.3 to 1.8% of all intracranial brain tumors. Only 1.5% of all intracranial epidermoid cysts (ECs) invade the brain and secondary epilepsy is extremely rare. Since August 2014, a 59-year-old male smoker had been presenting bad smell feelings, totaling four episodes with sudden onset and duration of 2 minutes. On September 2014, after a sense of smell episode, it evolved
Deep brain and cortical stimulation for epilepsy. Despite optimal medical treatment, including epilepsy surgery, many epilepsy patients have uncontrolled seizures. Since the 1970s interest has grown in invasive intracranial neurostimulation as a treatment for these patients. Intracranial stimulation includes both deep brain stimulation (DBS) (stimulation through depth electrodes) and cortical stimulation (subdural electrodes). This is an updated version of a previous Cochrane review published (...) trials without any or a sufficient washout period. Moderate-quality evidence could not demonstrate statistically or clinically significant changes in the proportion of patients who were seizure-free or experienced a 50% or greater reduction in seizure frequency (primary outcome measures) after one to three months of anterior thalamic DBS in (multi)focal epilepsy, responsive ictal onset zone stimulation in (multi)focal epilepsy patients and hippocampal DBS in (medial) temporal lobe epilepsy. However
Felbamate as an add-on therapy for refractory partial epilepsy. This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (Issue 7, 2014) on 'Felbamate as an add-on therapy for refractory epilepsy'. Epilepsy is a chronic and disabling neurologic disorder, affecting approximately 1% of the population. Up to 30% of people with epilepsy have seizures that are resistant to currently available drugs. Felbamate is one of the second-generation (...) antiepileptic drugs and we have assessed its effects as an add-on therapy to standard drugs in this review.To evaluate the efficacy and tolerability of felbamate versus placebo when used as an add-on treatment for people with refractory partial-onset epilepsy.For the latest update we searched the Cochrane Epilepsy Specialized Register, CENTRAL, MEDLINE, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, up to 20 October 2016. There were no language and time restrictions. We
Models and detection of spontaneous recurrent seizures in laboratory rodents Epilepsy, characterized by spontaneous recurrent seizures (SRS), is a serious and common neurological disorder afflicting an estimated 1% of the population worldwide. Animal experiments, especially those utilizing small laboratory rodents, remain essential to understanding the fundamental mechanisms underlying epilepsy and to prevent, diagnose, and treat this disease. While much attention has been focused (...) on epileptogenesis in animal models of epilepsy, there is little discussion on SRS, the hallmark of epilepsy. This is in part due to the technical difficulties of rigorous SRS detection. In this review, we comprehensively summarize both genetic and acquired models of SRS and discuss the methodology used to monitor and detect SRS in mice and rats.