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PubMed1992

Knowledge of epilepsy among relatives of the epilepsy sufferer.

A 23-item questionnaire was constructed to assess awareness of basic facts about epilepsy. Close family members of the epilepsy sufferer achieved significantly higher scores on the questionnaire than individuals from families without experience of the condition. The questionnaire may be useful in the identification of family members of the epilepsy sufferer whose knowledge of the condition is low and who may require appropriate counselling.

Adult↗
PubMed2005

Electric cortical stimulation suppresses epileptic and background activities in neocortical epilepsy and mesial temporal lobe epilepsy.

OBJECTIVE: To evaluate the suppressive effect of electric cortical stimulation upon the seizure onset zone and the non-epileptic cortex covered by subdural electrodes in patients with neocortical epilepsy and mesial temporal lobe epilepsy (MTLE). METHODS: Four patients with medically intractable focal epilepsy had implanted subdural electrodes for preoperative evaluation. Cortical functional mapping was performed by intermittently repeating bursts of electric stimulation, which consisted of 50 Hz alternating square pulse of 0.3 ms duration, 1-15 mA, within 5 s. The effect of this stimulation on the seizure onset zones and on the non-epileptic areas was evaluated by comparing spike frequency and electrocorticogram (ECoG) power spectra before and after stimulation. A similar comparison was performed in stimulation of 0.9 Hz of the seizure onset zones for 15 min. RESULTS: When the seizure onset zone was stimulated with high frequency, spike frequency decreased by 24.7%. Logarithmic ECoG power spectra recorded at stimulated electrode significantly decreased in 10-32 Hz band by high frequency stimulation of the seizure onset zone, and in 14-32 Hz band by high frequency stimulation of the non-epileptic area. Low frequency stimulation of the seizure onset zone produced 18.5% spike reduction and slight power decrease in 12-14 Hz. CONCLUSIONS: Both high and low frequency electric cortical stimulation of the seizure onset zone have a suppressive effect on epileptogenicity. Reduction of ECoG fast activities after electric cortical stimulation suggests the augmentation of inhibitory mechanisms in human cortex.

Adult↗
PubMed2006

Multiple independent spike foci and epilepsy, with special reference to a new epileptic syndrome of "severe epilepsy with multiple independent spike foci".

BACKGROUND: Markand and Blume first realized the specificity of the EEG pattern of multiple independent spike foci (MISF) in the late 1970s; its close relation with hypsarrhythmia and slow spike-waves, extensive bilateral brain lesion, and intractable seizures. But they did not recognize it as an epileptic syndrome. On the other hand, the authors had been taken notice of severe epilepsy with MISF (SE-MISF) as a peculiar clinico-electrical entity showing "generalized seizures", and pointed out its close relation to Lennox-Gastaut syndrome (LGS) from the long-term follow-up of LGS. SUMMARY POINTS: SE-MISF is characterized by (1) interictal EEG showing multiple independent spike foci (three or more foci in both hemisphere, i.e. at least one in each hemisphere) and diffuse slowing of the background activity. Diffuse epileptic discharges are rare. (2) The main seizure type is frequent generalized minor seizures, often tonic spasms. (3) Mutual transition is often observed between the age-dependent epileptic encephalopathies, i.e. Ohtahara syndrome, West syndrome and LGS. (4) The age at epilepsy onset is early, but the onset of SE-MISF is variable. (5) It is often associated with mental retardation and neurological abnormalities, usually severe. (6) Etiology is variable and largely nonspecific, including prenatal, perinatal, and postnatal cerebral pathologies. (7) Prognoses for seizures and psychomotor development are poor. Seizures are very intractable and may cause psychomotor deterioration. CONCLUSION: SE-MISF may be classified into symptomatic generalized epilepsy, namely a diffuse encephalopathy with mutual transition between other age-dependent epileptic encephalopathies. This characteristic entity may be acknowledged as a new epileptic syndrome.

Age of Onset↗
PubMed2004

Topiramate in clinical practice: long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center.

For the treatment of patients with chronic refractory epilepsies, information about the long-term efficacy and safety profile of any new antiepileptic drug is crucial. Topiramate has been proven to be effective in patients with refractory chronic partial epilepsies in short-term controlled clinical trials, but the long-term retention, long-term efficacy, and long-term side-effect profile have not been sufficiently investigated. We analyzed all patients who had been treated with topiramate in the Epilepsy Centre Kempenhaeghe from the introduction of the drug in the spring of 1993 up to a final assessment point in mid-2002. In total, 470 patients were identified. The data show that the clinical dose achieved was about 200mg/day, reached after approximately 6 months of treatment. Further dose escalation in the survivors was slow, with a mean dose of about 300 mg/day after 24 months of treatment. Mean titration dose is 25mg/week, but titration strategy is mostly individual and responds to patient complaints. With respect to seizure frequency, 10-15% of the patients were seizure-free at the 6-month evaluation; 4 patients achieved a 2-year remission. Retention rate was 53% after 1 year, 45% after 2 years, 38% after 3 years, and 30% after 4 years. At 4 years, almost 70% of the patients had discontinued topiramate. The main reason was adverse events, which accounted for about 65% of the discontinuations. Behavioral side effects were dominant, with mental slowing (27.6%), dysphasia (16.0%), and mood problems (agitation: 11.9%) being the most frequently reported side effects. In about 10% of the patients side effects led to discontinuation despite the obvious favorable effects on seizure frequency. Comparisons between the patients who discontinued topiramate treatment and those who continued topiramate showed that discontinuation was associated with comedication (vigabatrin and lamotrigine). Our conclusion is that TPM is associated with a high incidence of side effects in clinical practice, affecting long-term retention. Meaningful prognostic factors that may help us in clinical decision making, i.e., to prevent the side effects or to help us identify those at risk, have not been found.

Adolescent↗
PubMed2004

Epilepsy and insurance in the UK: an exploratory survey of the experiences of people with epilepsy.

We investigated problems in obtaining insurance as reported by people with epilepsy who were members of a major United Kingdom patient organisation. Information was collected via questionnaires mailed to a random sample of the membership, 347 of whom replied. Overall, 62% of respondents reported experiencing a problem obtaining insurance coverage (increased premiums, restricted coverage, or outright refusal). Thirty-six percent of respondents reported having been refused one or more types of insurance on the grounds of their epilepsy. Although the low response rate to the study represents an important source of bias, extrapolation from our figures suggests a problem prevalence rate of at least 10%. Adoption of an evidence-based and standardised approach to informing assessments of risk is vital if insurance companies are to provide fair and reasonable terms for insurance coverage to their clients with epilepsy.

Adult↗
PubMed2006

Further validation and reliability testing of the Attitudes and Beliefs about Living with Epilepsy (ABLE) components of the CDC Epilepsy Program Instrument on Stigma.

The aim of this study was to conduct additional validation and reliability testing of the Attitudes and Beliefs about Living with Epilepsy (ABLE) components of the CDC Epilepsy Program Instrument on Stigma. Thirteen items were tested using a representative sample of U.S. adults (n=4345). Confirmatory factor analyses confirmed two underlying constructs as hypothesized that accounted for 61% of the variance in the factor analysis: Negative Stereotypes (alpha=0.86) and Risk and Safety Concerns (alpha=0.88). As expected, participants differed on scale scores by demographic characteristics. Test-retest reliability was acceptable. The results of these analyses extend those from our previous study suggesting that the negative stereotypes and risk and safety concern scales demonstrate acceptable validity and reliability, and can be used to measure attitudes toward epilepsy related to these two domains.

Adolescent↗
PubMed1983

[Benign partial epilepsies: 11 cases of frontal partial epilepsy with favorable prognosis].

The authors report a retrospective study of 11 observations of partial frontal epilepsy. Cases have been selected on the basis of a complete lack of any associated neurological or psychiatric sign and a disappearance of seizures with normalization of the EEG trace for more than 5 years. This peculiar type of focal epilepsy characterized by an EEG frontal spike focus is first shown to share clinical and electroencephalographic signs with other forms of benign epilepsy of childhood and adolescence. Then the predictive value of some electro-clinical criteria to indicate a favourable outcome is examined.

Adolescent↗
PubMed1997

Neuroimaging in the evaluation of children and adolescents with intractable epilepsy: I. Magnetic resonance imaging and the substrates of epilepsy.

Recent advances in neuroimaging, particularly the magnetic resonance imaging (MRI) scan, have greatly enhanced our ability to visualize intraparenchymal anatomy. With the linkage between intracranial pathology and epilepsy now clearly established, the MRI data provides detailed information for the clinician treating patients with epilepsy. This article supplies the reader with an overview of the new techniques in MRI brain imaging that allow us to identify intracranial abnormalities, and a survey of some of the MRI-identified substrates of epilepsy.

Adolescent↗
PubMed2000

[Photosensitive epilepsy and television epilepsy].

Photosensitivity is defined by the appearance of occipital or more diffuse electroencephalographic spikes and waves induced by intermittent light stimulation (ILS), particular patterns, TV-watching, and video games. Photosensitivity is a genetic characteristic. Only the diffuse spikes and waves induced by ILS are correlated with epilepsy. Pure photogenic epilepsy is characterized by seizures which are only visually induced, usually by watching TV. Video games sometimes add a trigger effect due to slowly moving patterns or intense brightness. Several epileptic syndromes are associated with a photosensitivity with or without visually-induced seizures, mainly generalized idiopathic epilepsy.

Adolescent↗
PubMed2003

A study of anticonvulsant medication on ovarian function in a group of women with epilepsy who have only ever taken one anticonvulsant compared with a group of women without epilepsy.

A group of 105 women (54 of whom were, and had only ever been, taking valproate for at least a year, and 51 who had only ever taken either lamotrigine or carbamazepine, for at least a year) were compared with a group of 50 women who did not have epilepsy: any oral contraceptive taken at the time of testing was recorded and blood levels of follicle stimulating hormone (FSH), luteinising hormone (LH), testosterone and prolactin were estimated from days 2 to 6 of the menstrual cycle (day 1 being the first day of bleeding) and an MRI scan made of their pelvis. Women with epilepsy in general were significantly more likely to exhibit evidence on MRI scanning, of polycystic ovaries (PCO): women taking valproate but not an oral contraceptive were significantly more likely to have clinical biochemical evidence of the polycystic ovarian syndrome (PCOS) with raised LH and/or testosterone levels between days 2 and 6 of their menstrual cycle than women who did not have epilepsy: this was not so for women taking lamotrigine or carbamazepine. Since the polycystic ovary syndrome has potentially serious consequences it is suggested that, where possible, valproate is avoided in women of child bearing potential.

Anticonvulsants↗
PubMed2002

Is epilepsy a progressive disorder? Prospects for new therapeutic approaches in temporal-lobe epilepsy.

During the past decade, it has become apparent that neural circuits undergo activity-dependent reorganisation. In pathological disorders with recurring episodes of excessive neural activity, such as temporal-lobe epilepsy, brain circuits can undergo continual remodelling. For clinical practice, seizure-induced remodelling implies that after a diagnosis of epilepsy, recurring seizures can cause continuing neural reorganisation and potentially contribute to progressive severity of the epilepsy and to cognitive and behavioural consequences. The alterations induced by seizures include neuronal death and birth, axonal and dendritic sprouting, gliosis, molecular reorganisation of membrane and extracellular-matrix proteins, and intermediates involved in cellular homoeostasis. These changes are influenced by genetic background and seizure type, thus identification of genetic risk factors should be a priority. Therapeutic modification of seizure-induced molecular and cellular responses offers new opportunities for intervention beyond seizure suppression.

Animals↗
PubMed2003

Epilepsy self-management: a comparison of self-efficacy and outcome expectancy for medication adherence and lifestyle behaviors among people with epilepsy.

The purpose of this study was to describe self-efficacy beliefs and outcome expectancies toward medication, seizure, and lifestyle management behaviors among 108 adults with epilepsy. Participants responded to an adapted version of the Epilepsy Self-Efficacy and Epilepsy Outcome Expectancy scales. Modifiable behavioral risk factors such as confidence for following medication dosing schedule, planning for medication refills, coping with adverse effects of medication, getting sufficient sleep, avoiding alcohol, and obtaining social support were identified. A larger proportion of persons reported higher self-efficacy for medication management behaviors than for healthful lifestyle behaviors. Findings from this study extend previous research on chronic disease that showed that individuals may be adherent with medication therapy, but not with healthful lifestyle behaviors necessary for the prevention and treatment of chronic disease. Individuals with low self-efficacy would benefit from interventions that increase efficacy beliefs to enhance their ability to adopt and maintain good self-management practices.

Adult↗
PubMed2002

Interrater reliability among epilepsy centers: multicenter study of epilepsy surgery.

PURPOSE: To measure the interrater reliability of presurgical testing and surgical decisions among epilepsy centers. METHODS: Seven centers participating in an ongoing, prospective multicenter study of resective epilepsy surgery agreed to conform to a detailed protocol regarding presurgical evaluation and surgery. To assess quality assurance, each center independently reviewed 21 randomly selected surgical cases for preoperative study lateralization and localization, and surgical decisions. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), validated for use with multiple raters, and calculated in a two-way random model based on absolute agreement. RESULTS: Agreement for ICC values: > or = 0.75, excellent; 0.60-0.74, good; 0.40-0.59, fair; < or = 0.39, poor. One center was excluded for missing data. Agreement was excellent for extracranial EEG lateralization (0.8039), magnetic resonance imaging (MRI) lateralization (0.9521) and localization (0.9130), Wada lateralization (0.9453), and intracranial EEG localization (0.7905). Agreement was good for extracranial EEG localization (0.7384) and neuropsychological testing lateralization (0.7178) and localization (0.6891). Consensus about the decision to perform intracranial monitoring was fair (0.5397), in part reflecting one center's tendency toward intracranial monitoring. Overall agreements on whether to perform surgery (0.8311) and specific surgery recommended (0.8164) were excellent. CONCLUSIONS: High interrater reliability among six epilepsy centers was present for interpretation of most components of presurgical testing. Although consensus for the decision to perform intracranial monitoring was only fair, agreements for the ultimate decision about resective surgery and specific choice of resection were excellent. We believe that this study demonstrates the feasibility of implementing multicenter protocols for neurologic management, especially those involving localization, as well as protocols combining study results with clinical decision making.

Electroencephalography↗
PubMed2000

The contributing factors to medical cost of epilepsy: an estimation based on a French prospective cohort study of patients with newly diagnosed epileptic seizures (the CAROLE study). Active Coordination of the Longitudinal Observational Network in Epilepsy.

Epilepsy is a common neurological condition with significant resource implications. An estimation was performed in France of the direct medical cost of patients presented with newly diagnosed seizures and followed during the first two years after diagnosis. This estimation was based on the service utilization data collected from French prospective cohort study (CAROLE: 1942 patients enrolled). Costs were estimated in a societal perspective in 1998 value. The impact on the costs of different factors like age, aetiologic categorization and severity of seizures (type and number of seizures), and treatment by anti-epileptic drugs (AEDs) was analysed. The mean annual direct epilepsy-related costs per patient were estimated to be 14 305 F and 3766 F for the first and the second year of follow-up respectively, 68% and 40% of the costs were devoted to inpatient care. Costs during the first year were highly sensitive to aetiologic categorization of seizures at inclusion and to other clinical parameters. Second-year costs had a much lower variance and were sensitive to frequency of seizures and the fact of being treated or not by AEDs. Our data emphasize the importance of seizure control as means of reducing the costs of epilepsy especially during the first year of follow-up.

Adolescent↗
PubMed1993

Learning needs of persons with epilepsy: a comparison of perceptions of persons with epilepsy, nurses and physicians.

The purpose of this study was to describe and compare patients', nurses' and physicians' perceptions of learning needs of persons with epilepsy. The study is based on adult learning theory which states that learning needs dictate receptivity to information and knowledge of learning needs can help structure teaching sessions. Study participants were recruited from patients attending epilepsy clinics, neuroscience nurses employed at study hospitals or working with neurologists or neurosurgeons and neurologists or neurosurgeons practicing in the state. The sample sizes were: 59 patients, 85 nurses and 38 physicians. Data were analyzed using frequencies, percent and analysis of variance. Data analysis revealed that patients, nurses and physicians similarly ranked major areas of learning needs. However, differences in the ranking of individual learning needs were noted between patients and health care providers. An understanding of the differences and similarities among the groups provides useful information for educational programs for epilepsy patients.

Adult↗
PubMed2006

Development of a measure to assess the impact of epilepsy on people with an intellectual disability: the Glasgow Epilepsy Outcome Scale - Client version (GEOS-C).

BACKGROUND: Epilepsy is common in people with intellectual disability, yet clinicians and researchers seldom obtain information directly from the client. The development and preliminary validation of a novel measure for use with people with mild to moderate intellectual disabilities is described. METHODS: Focus group methods (6 groups; 24 participants) identified issues of concern, and qualitative analysis (NUD*IST) was applied to derive items and themes for a draft scale. Psychometric scale development techniques were then used in a pilot study and subsequent field-testing to investigate validity and reliability (n = 46). RESULTS: A total of 148 issues of concern was reduced initially to 52 and then to 42 items using these methods. The derived scale comprised sub-scales reflecting (1) concerns about having seizures; (2) about injury; (3) about issues during; and (4) after seizures; (5) about medication; (6) about what people think; and (7) about daily life. Cronbach alpha for the Glasgow Epilepsy Outcome Scale - Client version (GEOS-C) was 0.92, and ranged from 0.64-0.81 for the sub-scales. Relatively weak associations (r <or= 0.40), between client and family carer, staff carer or clinician views, suggests that proxy reports are not good predictors of how people with epilepsy themselves are feeling. Preliminary validation suggests that the GEOS-C can discriminate on variables of clinical importance. CONCLUSIONS: The GEOS-C complements existing GEOS measures, can be completed in 5-15 min depending upon the level of support required, and may provide a valuable clinical and research tool. Further validational work and appraisal of sensitivity are required.

Activities of Daily Living↗
PubMed1992

Status of follow-up among patients with epilepsy in epilepsy clinic.

Out of 238 consecutive patients entering our epilepsy clinic from October 1988 till March 1990, the status of follow-up was evaluated in October 1990. One hundred patients (42%) could adhere to the follow-up appointment and 33 patients (14%) visited the clinic irregularly. A total of 105 patients (44%) failed to return for the follow-up at least for 2 months dated backward from October 1990. Seventy-five percent of the patients lost the follow-up within 6 months. The main reasons of the dropout were poor seizure control, seizure free, denial of epilepsy, receiving operation in other hospitals. The appropriate strategies to aid in adherence to medical care among patients with epilepsy should be formulated through the analysis of factors contributing to the dropout, which might be strongly influenced by different medical and sociocultural backgrounds all over the world.

Adolescent↗
PubMed1981

Natural history and prognosis of epilepsy: report of a multi-institutional study in Japan. The group for the study of prognosis of epilepsy in Japan.

A multi-institutional study on the prognosis of patients with epilepsy was performed in Japan from 1975 to 1977, including 20 institutions. The outcome of epileptic seizures and social adjustment 10, 5, and 3 years after the onset of the illness was studied in three different groups of epileptic patients, respectively. The number of successfully followed-up cases was 1,868 in total, follow-up rate being 42%. The data were analyzed statistically by use of analysis of variance. The rate of remission of seizures in all was 58.3% and the rate of normal social adjustment 62.6%. The remission rate showed no significant difference among the 10-, 5-, and 3-year outcome groups. The study on the outcome of seizure control indicated that the prognosis of seizure control is more favorable (a) in idiopathic than in residual or symptomatic epileptics; (b) in patients with onset before 10 years of age than in those with onset after 10 years; (c) in patients with less frequent seizures; (d) in sleep epilepsy than in waking and diffuse epilepsies; (e) in patients who started treatment within 1 year of onset of seizure; (f) in patients with single-type partial seizures than in those with partial seizures combined with tonic-clonic seizures; (g) in patients without high grade EEG background abnormality; and (h) in patients without neurological symptoms, intellectual deficits, personality disturbances, or psychotic symptoms. Factors that determine the prognosis of social adjustment were almost similar to those for remission of seizures. There was a close correlation between the outcome of seizure control and that of social adjustment. Correlation coefficient between follow-up rate and remission rate in 15 of the 20 collaborated institutions was 0.55 (p less than 0.05), showing a tendency that the remission rate becomes higher as the follow-up rate is raised.

Adolescent↗