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PubMed2004

Etiologic factors and clinical features of symptomatic epilepsy: focus on pediatric cases.

We discuss the presumptive etiologic factors of symptomatic epilepsy from the clinical standpoint, based on our experience of 383 inpatients with epilepsy, with a focus on children. The main (top three) presumptive etiologic factors in partial epilepsy are intracranial infection, cerebral malformation and perinatal brain damage. In generalized epilepsy, the main presumptive etiologic factors are perinatal brain damage, intracranial infection, and cerebral malformation. As regards presumptive etiologic factors in partial epilepsy, cerebral malformation was most common in frontal lobe epilepsy, initial convulsive status in temporal lobe epilepsy and perinatal brain damage in occipital lobe epilepsy. Electroclinical characteristics of severe myoclonic epilepsy in infancy, the most intractable epilepsy syndrome in infancy, is the focus and recent advances of genetic research are introduced.

Adolescent↗
PubMedDate not supplied

Classification of the epilepsies: an investigation of 945 patients in a developing country.

The present study classified epilepsies in Nigerians and compared them with the profile of epilepsies as found in other countries: India, France, and Denmark. Partial epilepsy formed the largest group (76.6%) in this study and in that in India (80%), but these incidences were higher than that found in France (62%), owing to a higher frequency of birth injury, CNS infections, and childhood febrile convulsions in developing countries. In contrast to our study and that in France, where partial epilepsy with complex symptomatology formed the largest subgroup, partial epilepsy with elementary symptomatology formed the largest subgroup in India. The reason for this is not totally clear, though etiological factors and criteria for categorization are contributory. The incidence of partial epilepsy was lower in children than in adults owing to a relatively lower incidence of partial epilepsy with elementary symptomatology in children in the present series and a lower incidence of complex symptomatology in children in France and Denmark. Nigerian children seem more vulnerable to complex symptomatology owing to a high incidence of febrile illness (e.g., from malaria) and febrile convulsions. The incidence of generalized epilepsies in children was higher than in adults. Grand mal formed the largest subgroup of generalized epilepsies in children in this series and in Denmark, whereas petit mal formed the largest subgroup in France and India. Petit mal was relatively rare in children in our series (2.5%) compared with children in the French study (17.5%). Secondary generalized epilepsy was peculiar to children in all the series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy.

BACKGROUND: After 1 to 4 years, seizure-free children with epilepsy are encouraged to stop daily antiepileptic drug (AED) treatment. Approximately 70% are successful. The authors examined how often intractable epilepsy follows discontinuation of AED treatment in a population-based cohort of children with epilepsy. METHODS: The Nova Scotia population-based epilepsy cohort was used to identify children who discontinued AEDs but subsequently developed intractable epilepsy. All patients studied (ages 1 month to 16 years) developed epilepsy between 1977 and 1985, had epilepsies characterized by partial or convulsive seizures, and had at least 5 years of follow-up evaluation (n = 367). Those with benign rolandic epilepsy were excluded. Intractability was defined as one or more seizures every 3 months during the last year of follow-up review or until successful seizure surgery and failure of three or more AEDs at maximum tolerated doses. RESULTS: Overall, 71% (260/367) of eligible children became free of seizure for 1 to 4 years and discontinued AED treatment. Of this group, 70% remained seizure-free without AED treatment, but 30% had recurrences. Only three children with recurrences later developed intractable epilepsy. Two then underwent a temporal lobectomy, one successful and one only partially successful (20-year follow-up periods). The third patient continued to have intractable epilepsy for 7 years after discontinuing AED treatment but eventually entered remission. CONCLUSION: Approximately 1% of children who became free of seizure and discontinued antiepileptic drug treatment had recurrent seizures that could not be controlled again with medication. The authors were unable to predict this outcome. It remains unclear whether a similar outcome would have occurred if antiepileptic drugs had not been discontinued.

Adolescent↗
PubMed2002

Correlation of sleep macrostructure parameters and idiopathic epilepsies.

Sleep and epilepsy share some common mechanisms. The objective of the present investigation was to study the macrostructure of sleep in patients with idiopathic epilepsies, focal and generalized, comparing these two groups to each other and to a control group of 12 individuals without epilepsy. A total of 35 polysomnographies were performed, 12 of them in the control group, 10 in patients with idiopathic generalized epilepsies, and 13 in patients with idiopathic focal epilepsies. Antiepileptic medications were maintained for ethical reasons. The group with idiopathic focal epilepsy showed an increase in the total recording time (p = 0.04) and the group with idiopathic generalized epilepsy had a reduction of phase 4 NREM sleep. The efficiency of total sleep period and of total sleep time was also lower in the group with idiopathic generalized epilepsy (p = 0.03 in both cases). We concluded that the group with idiopathic generalized epilepsy presents sleep of poorer quality, whereas the group with idiopathic focal epilepsy presents a tendency toward an excessive somnolence.

Adolescent↗
PubMed2003

Excess mortality in remote symptomatic epilepsy.

BACKGROUND: Published estimates of excess mortality associated with epilepsy vary greatly. How much, if any, of the excess is attributable to the seizures themselves as opposed to an underlying condition causing the epilepsy is not clear from the literature. This article offers evidence that epilepsy per se is associated with excess mortality. The excess varies according to severity and frequency of seizures. MATERIALS AND METHODS: The authors studied mortality rates of developmentally disabled persons in California with and without epilepsy. In order to focus on the effect on mortality risk of epilepsy per se, they included only persons with good motor function (able to walk and climb stairs) and at worst moderate mental retardation (MR). The data were 506,204 person-years and 1523 deaths among 80,682 California subjects of age 5 to 65 years during the 1988-1999 study period. Mortality rates for persons with epilepsy were compared to rates for persons with no history of epilepsy. RESULTS: Mortality rates were higher for persons with epilepsy than for those without. Excess death rates (EDRs) varied according to type and frequency of seizures. Combined EDRs were 6 (deaths per 1000 person-years) for persons with recent (< 12 months) history of status epilepticus, 5 for recent history of generalized tonic-clonic (GTC) seizures, 3 for recent history of seizures but no recent GTC seizures, and less than 1 for a history of seizures but no recent events. CONCLUSIONS: The data presented here are evidence that epilepsy per se is associated with increased mortality. The EDRs reported here may be better measures of excess mortality due to epilepsy than previously published estimates.

Adolescent↗
PubMed2003

Hypothalamic hamartoma and epilepsy in children: illustrative cases of possible evolutions.

The progresses of neuroimaging have allowed an earlier detection of hypothalamic hamartoma in children presenting with gelastic or dacrystic seizures. Associated symptoms can include other types of seizures, precocious puberty, and behavioral or cognitive deterioration. Combination of all these features is not constant and, when present, their evolution may be variable. When epilepsy proves intractable, surgery may be a solution but is not without risks. Therefore, it can only be justified on the basis of a considerable degree of certainty on the progressive character of the disorder, both in terms of epilepsy and global development. Even though epilepsy is a major and usually the most important problem, it is not always possible to predict its course and to be able to evaluate its potential effects on development. Available data suggests that deterioration is partly related to the epileptogenic activity. We reviewed data from 16 personal cases and discussed the possible evolutions of the epilepsy syndrome on the basis of 6 illustrative cases and a review of the literature. We point out that seizures may start early in life and evolve either towards a catastrophic encephalopathy or may be transiently severe and will progressively settle down. Intermediate situations also exist as well as cases presenting with a mild epilepsy. In almost all cases cognitive difficulties are present and may be associated with behavioral disturbances. They are of variable severity, usually in relation to the severity of the epilepsy and the evolution of the EEG abnormalities. Some of our cases also illustrate that, in young children whose seizures are limited to "a sensation of a pleasant feeling", "a pressure to laugh" or "smiling", early detection of the hamartoma may still be difficult and the epilepsy pattern may be misdiagnosed as an epilepsy temporal or frontal origin. Detailed analysis of the electro-clinical evolution of representative cases highlights the variable expression of the epilepsy syndrome and renders difficult any dogmatic position on early surgery. However, recent data suggests that a surgical solution must be sought early. Prospective studies are needed to evaluate, not only outcome in terms of control the seizures without unacceptable side effects but also on the evolution of the cognitive and behavioral profile of children with HH and epilepsy are needed.

Adolescent↗
PubMed2004

[Assement of clumsiness in children with partial and generalized epilepsy].

THE AIM OF THE STUDY: Epilepsy in the developmental age is connected in some cases with disorders of gross motor dysfunction, but in the others every day motor activity is not disturbed. Although it does not mean that in children with epilepsy there are not diagnosed any different motor disorders. Aim of the study was to determined the differences between epilepsy with and without gross motor function disorders, the appearance of clumsiness in children with partial epilepsy and primary generalised. MATERIAL: The study was performed on a group of 40 children with idiopathic epilepsy, 23 with idiopathic partial seizures and 17 with generalised. In this group boys predominated (14/23 and 11/17). The average age of both groups was not significant different (12.5 and 13.4). The assessment of gross motor function and intellectual development was normal. METHODS: The assessment of clumsiness was performed by using 10 tests classifying 3 categories of movement: co-ordination, integration, balance. To diagnose the type of epilepsy the common used clinical, electrophisiological and neuroimaging procedures were done. The statistic assessment was performed by using T-test for independent probe. RESULTS: There were no differences between groups of children in 2 test evaluating balance, which were normal. Children with generalised epilepsy had normal results in other 5 test. The lower results were observed in children with partial epilepsy in 8 and with generalised in 3 tests, but this difference was not statistically significant (VAR2/VAR1 = 0.793 and AR3/VAR1 = 0.965). Results of children with partial seizures were lower in 8 tests, but it was not statistically significant(VAR3/ VAR2 = 0.827). The most expressive difference was seen in the test of balance with jumping. CONCLUSION: Children with partial epilepsy are a little more clumsy than children with primary generalised epilepsy.

Adolescent↗
PubMed2005

Clinical experience with levetiracetam in idiopathic generalized epilepsy according to different syndrome subtypes.

Clinical experience in open-label studies and anectodal reports suggest that levetiracetam is effective in generalized epilepsy. In this open-label prospective study, 19 patients (3 men, 16 women) affected by idiopathic generalized epilepsy were followed for at least 6 months following the introduction of levetiracetam. Patients were categorized according to syndrome subtype: juvenile myoclonic epilepsy (8), juvenile absence epilepsy (5), childhood absence epilepsy (4), and eyelid myoclonia with absences (2). Eleven patients received levetiracetam as monotherapy, eight as add-on therapy. Effectiveness was demonstrated in 18 patients: 13 became seizure-free (five juvenile myoclonic epilepsy, five juvenile absence epilepsy, three childhood absence epilepsy), and five achieved significant reductions in seizure frequency (three juvenile myoclonic epilepsy, one childhood absence epilepsy, one eyelid myoclonia with absences). Only one patient experienced no change in seizure frequency (eyelid myoclonia with absences). Clinical improvement was accompanied by EEG abnormality suppression or reduction. Levetiracetam was well tolerated; no patient reported side-effects.

Anticonvulsants↗
PubMed1984

Genetic animal models of epilepsy as a unique resource for the evaluation of anticonvulsant drugs. A review.

Genetic animal models of epilepsy comprise genetically predisposed animal species in which seizures either occur spontaneously or in response to sensory stimulation. The major advantage of these naturally occurring epilepsies in animals as models of human epilepsy is that they simulate the clinical situation more closely than any other experimental epilepsy. Models with idiopathic spontaneous recurrent seizures are epileptic dogs, tottering mice, and rats with spike-wave absence (petit mal) seizures. In dogs, the most common seizure type are generalized tonic-clonic (grand mal) seizures. Recent epidemiological and antiepileptic drug efficacy studies strongly suggest that epileptic dogs offer a valuable model for human grand mal epilepsy. In tottering mice, two types of spontaneous recurrent seizures occur: spike-wave absence seizures and focal motor seizures. Both types differ in sensitivity to common antiepileptic drugs, which closely resembles the absence and focal types of epilepsy in humans. Spontaneously recurrent spike-wave absence seizures in rats can be selectively blocked by drugs effective in petit mal (absence) epilepsy in man, demonstrating the validity of this new petit mal model for anticonvulsant drug screening. Models with reflex seizures comprise photosensitive baboons (Papio papio) and fowl, audiogenic seizure susceptible mice and rats, and gerbils with seizures in response to different sensory stimuli. With respect to seizure types and drug efficacies in these species, rats and chickens may represent suitable models for grand mal epilepsy, whereas baboons offer a useful model of photomyoclonic seizures. Gerbils can be subdivided into animals with minor (myoclonic) and major (mostly generalized tonic-clonic) seizures, which respond differently to antiepileptic drugs and seem to provide interesting models for petit mal and grand mal epilepsy in man. In conclusion, the data summarized in this review emphasize that genetic animal models of epilepsy offer unique approaches to the evaluation of antiepileptic drugs used or usable in man.

Acoustic Stimulation↗
PubMed1993

[Prognosis of epilepsy in psychoneurologically normal children].

Prognosis of 175 psychoneurologically normal children with the onset of epilepsy after 18 months of age were studied. The remission rate of partial epilepsy (81 of 107 cases, 76%) was higher than that of generalized epilepsy (34 of 56 cases, 61%). Prognoses for patients with sleep epilepsy (52 of 62 cases, 84%) were better than those for patients with waking epilepsy (63 of 101 cases, 62%). Most (95%) of the children with sleep epilepsy had partial epilepsy, including benign childhood epilepsy with centrotemporal spike (BECT, 36 cases) and partial epilepsy other than BECT (23 cases). Benign courses were not limited to BECT patients. Generalized waking epilepsy other than absence had the lowest remission rate. Eleven children exhibited mild mental retardation on last examination. Most of them had atypical absence and/or myoclonic seizures with the onset of seizure before 3 years of age. It appeared important to classify the epileptic children with regard to time of seizure occurrence as well as seizure type to determine their prognoses.

Adolescent↗
PubMed1997

Sleep and the epilepsies.

To review the numerous works concerning sleep and epilepsy, this review considers the effects of sleep, firstly on seizures and secondly on paroxysmal interictal EEG activity (PA), in the different types of epilepsy according to the International League against Epilepsy classification. Apart from the exceptions of the definite nocturnal preponderance of seizures in idiopathic rolandic epilepsy and of the mostly nocturnal occurrence of seizures in some types of familial or sporadic frontal-lobe epilepsy, assessing a seizure according to the time of day it occurs is of no diagnostic or predictive value. In generalised idiopathic epilepsy, as in partial symptomatic or cryptogenic epilepsy, only about 20% of the patients had a sleep increase in PA. This percentage is higher (75%) in idiopathic partial epilepsy. Stereoelectroencephalography demonstrates a relative stability of spiking within the focus across the states of vigilance and an increase in transmitted discharges during stages 3 and 4. In the Landau and Kleffner syndrome, as in the syndromes of continuous spike-waves during sleep, there is a huge, unexplained increase in PA during sleep. The neuropsychological consequences of this PA have some relationship with their localisation and the patient's age at the time of occurrence. Sleep PA has also been reported in several groups of non-epileptic subjects. As regards the effect of epilepsy on sleep, sleep may be lighter and abnormally discontinuous in the absence of seizures, particularly in temporal-lobe epilepsy.

Epilepsy↗
PubMed1998

Ictal technetium-99m ethyl cysteinate dimer single-photon emission tomographic findings and propagation of epileptic seizure activity in patients with extratemporal epilepsies.

Although ictal single-photon emission tomography (SPET) with technetium-99m ethyl cysteinate dimer (ECD) has a well-established role in the diagnostic evaluation of patients with temporal lobe epilepsy who are being considered for epilepsy surgery, its use in cases of extratemporal epilepsy is still limited. We investigated the influence of the propagation of extratemporal epileptic seizure activity on the regional increase in cerebral blood flow, which is usually associated with epileptic seizure activity. Forty-two consecutive patients with extratemporal epilepsies were prospectively evaluated. All patients underwent ictal SPET studies with simultaneous electroencephalography (EEG) and video recordings of habitual seizures and imaging studies including cranial magnetic resonance imaging and positron emission tomography with 2-[18F]-fluoro-2 deoxy-d-glucose. Propagation of epilptic seizure activity (PESA) was defined as the absence of hyperperfusion on ictal ECD SPET in the lobe of seizure onset, but its presence in another ipsilateral or contralateral lobe. Observers analysing the SPET images were not informed of the other results. PESA was observed in 8 of the 42 patients (19%) and was ipsilateral to the seizure onset in five (63%) of these eight patients. The time between clinical seizure onset and injection of the ECD tracer ranged from 14 to 61 s (mean 34 s). Seven patients (88%) with PESA had parieto-occipital epilepsy and one patient had a frontal epilepsy. PESA was statistically more frequent in patients with parieto-occipital lobe epilepsies (58%) than in the remaining extratemporal epilepsy syndromes (3%) (P<0.0002). These findings indicate that ictal SPET studies require simultaneous EEG-video recordings in patients with extratemporal epilepsies. PESA should be considered when interpreting ictal SPET studies in these patients. Patients with PESA are more likely to have parieto-occipital lobe epilepsy than seizure onset in other extratemporal regions.

Adolescent↗
PubMed2005

Epilepsy and medication effects on the pattern visual evoked potential.

Visual disruption in patients diagnosed with epilepsy may be attributable to either the disease itself or to the anti-epileptic drugs prescribed to control the seizures. Effects on visual function may be due to perturbations of the GABAergic neurotransmitter system, since deficits in GABAergic cortical interneurons have been hypothesized to underlie some forms of epilepsy, some anti-epileptic medications increase cortical GABA levels, and GABAergic neural circuitry plays an important role in mediating the responses of cells in the visual cortex and retina. This paper characterizes the effects of epilepsy and epilepsy medications on the visual evoked response to patterned stimuli. Steady-state visual evoked potentials (VEP) evoked by onset-offset modulation of high-contrast sine-wave stimuli were measured in 24 control and 54 epileptic patients. Comparisons of VEP spectral amplitude as a function of spatial frequency were made between controls, complex partial, and generalized epilepsy groups. The effects of the GABA-active medication valproate were compared to those of carbamezepine. The amplitude of the fundamental (F1) component of the VEP was found to be sensitive to epilepsy type. Test subjects with generalized epilepsy had F1 spatial frequency-amplitude functions with peaks shifted to lower spatial frequencies relative to controls and test subjects with complex partial epilepsy. This shift may be due to reduced intracortical inhibition in the subjects with generalized epilepsy. The second harmonic component (F2) response was sensitive to medication effects. Complex partial epilepsy patients on VPA therapies showed reduced F2 response amplitude across spatial frequencies, consistent with previous findings that showed the F2 response is sensitive to GABA-ergic effects on transient components of the VEP.

Adult↗
PubMed1990

Decrease in hippocampal [3H]vinylidene kainic acid binding in genetically epilepsy-prone rats.

Specific [3H]vinylidene kainic acid binding to the kainate-sensitive subtype of glutamate receptor was studied in brain of 31-day-old non-epileptic Sprague-Dawley control and two colonies of genetically epilepsy-prone rats using in vitro autoradiographic techniques. At 37.5 nM [3H]vinylidene kainic acid, specific [3H]vinylidene kainic acid binding was reduced significantly by 18 and 22% in dorsal and ventral hippocampal formation stratum lucidum of 31-day-old genetically epilepsy-prone-9 rats compared with non-epileptic controls. Hippocampal [3H]vinylidene kainic acid binding was reduced in genetically epilepsy-prone-3 rats by 15 and 18%, but these reductions were not statistically significant. Saturation of [3H]vinylidene kainic acid binding studies indicated that the total number of ventral hippocampal [3H]vinylidene kainic acid binding sites was decreased by 21% in genetically epilepsy-prone-3 rats and 28% in genetically epilepsy-prone-9 rats. The reduction in ventral hippocampal [3H]vinylidene kainic acid binding in genetically epilepsy-prone rats resembles the reduction in ventral hippocampal [3H]vinylidene kainic acid binding sites observed in perinatal hypothyroid rats. As genetically epilepsy-prone rats are hypothyroid during the neonatal period, the reduction in hippocampal [3H]vinylidene kainic acid binding in the genetically epilepsy-prone rats may be a consequence of a hypothyroid-induced defect in the development or maturation of the hippocampal mossy fiber projection in genetically epilepsy-prone rats. An alternative hypothesis is that the putative occurrence of spontaneous limbic seizures in genetically epilepsy-prone rats may lead secondarily to a reduction in hippocampal [3H]vinylidene kainic acid binding sites.

Animals↗
PubMed2006

The potential of pharmacogenetics in the treatment of epilepsy.

Pharmacogenetics studies how genetic variants influence individual drug responses. Although pharmacogenetics is currently the subject of intensive research in several disease domains, it remains relatively unexplored in the field of epilepsy. Drug treatment of epilepsy is characterized by unpredictability of efficacy, adverse drug reactions and optimal doses in individual patients. Moreover, a substantial fraction of patients develop drug refractory epilepsy despite optimal treatment. Insights in the pathogenesis of epilepsy and the mechanisms of action of antiepileptic drugs (AEDs) have improved our understanding of the genetic determinants of AED response. The first reports in epilepsy pharmacogenetics are becoming available, and large-scale pharmacogenetic studies are now possible thanks to recent advances in genetics and decreasing genotyping costs. It is hoped that ultimately, findings in epilepsy pharmacogenetics will lead to a more efficacious and less harmful treatment of epilepsy, development of more effective AEDs and facilitation of clinical trials of new AEDs. However, although pharmacogenetics will undoubtedly improve our insight into the mechanisms underlying response to AEDs and perhaps into the pathogenesis of drug refractory epilepsy, clinical application of any findings is expected to be a long process, and considerable practical and theoretical hurdles need to be overcome before pharmacogenetic information will prove of any major utility in the clinical setting. This review addresses current knowledge on genetic factors contributing to AED response and discusses the potential of epilepsy pharmacogenetics in the clinical treatment of epilepsy and new AED development.

Anticonvulsants↗
PubMed2004

Role of neurosteroids in catamenial epilepsy.

Catamenial epilepsy is a menstrual cycle-related seizure disorder that affects up to 70% of women with epilepsy. Catamenial epilepsy is characterized by an increase in seizures during particular phases of the menstrual cycle. Three distinct patterns of catamenial epilepsy - perimenstrual, periovulatory, and inadequate luteal phase - have been described. Currently, there is no specific treatment for catamenial epilepsy. The molecular mechanisms involved in the pathophysiology of catamenial epilepsy are not well understood. Recent studies suggest that cyclical changes of ovarian hormones estrogens (proconvulsant) and progesterone (anticonvulsant) appear to play a key role in the genesis of catamenial seizures. Progesterone reduces seizure susceptibility partly through conversion to neurosteroids such as allopregnanolone, which enhances GABA(A) receptor function and thereby inhibits neuronal excitability. In animal models, withdrawal from chronic progesterone and, consequently, of allopregnanolone levels in brain, has been shown to increase seizure susceptibility. Natural progesterone therapy has proven effective in women with epilepsy. Moreover, neurosteroids have been shown to be very effective inhibitors of catamenial seizures in animal models. Thus, synthetic neuroactive steroids, such as ganaxolone, which are orally active and devoid of hormonal side effects, represent a novel treatment strategy for catamenial epilepsy. However, their clinical efficacy in catamenial epilepsy has yet to be explored. A greater understanding of the molecular mechanisms is clearly needed for designing effective treatment and prevention strategies of catamenial epilepsy in women at risk.

Animals↗
PubMed2005

Prosthodontic status and recommended care of patients with epilepsy.

STATEMENT OF PROBLEM: Epilepsy is a chronic disease that can affect oral health and prosthodontic status in different ways. However, epilepsy is a condition of various etiologies and seizure types, and different patients may have differing needs in prosthodontic care. PURPOSE: The purpose of this study was to examine the prosthodontic status of patients with epilepsy to determine if the disease has any effect on prosthodontic treatment and to obtain information regarding the level of prosthodontic care. This information was used to provide recommendations for the prosthodontic treatment of patients with epilepsy. MATERIAL AND METHODS: One hundred one epileptic patients were examined, interviewed, and compared with 101 age-matched control (nonepileptic) subjects of the general population. Epileptic patients were recruited at an epilepsy outpatient clinic. The only exclusion criterion was a mental handicap severe enough to exclude cooperation of the patient during a dental examination. Control subjects were recruited at a community radiographic chest-screening clinic. Epileptic patients were first grouped according to dental risk factors and dental manageability. Dental classification of patients with epilepsy considered the frequency and type of seizures, as seizures may damage the teeth and dental prostheses. The number of missing teeth, the ratio of missing and replaced teeth, and the number of fixed and removable partial dentures and complete dentures, and the characteristics (material, degree of abrasion, and age) of the dentures was determined by dental examination. Finally, the state of oral mucosa and the number of seizure-related injuries was noted. Statistical comparison of the patient and the control group was performed, using the 2-tailed t -test for continuous variables and the chi-squared test or Fisher's exact test for categorical variables (alpha=.05). RESULTS: The number of missing teeth was significantly higher in the epilepsy group than in the control group (P =.021). The ratio of replaced and missing teeth was lower in the epileptic group (P <.01), indicating inadequate prosthodontic care. There was also a significant difference in the age of the fixed prostheses (P =.0016), being lower in the epilepsy group, and in the material of fixed prostheses (P =.033), metal-ceramic being more common in the control group. More epileptic patients were edentulous than control subjects (8 versus 3) and the average age at the time of examination was younger (48 versus 57 years). Seizure-related injuries were reported by 11% of patients, all belonging to the subgroup of patients with frequent generalized tonic-clonic seizures. CONCLUSION: Patients with epilepsy have an increased risk for loosing teeth and, furthermore, the prosthodontic status of epilepsy patients was not as optimal as compared with the control group. Seizure-related injuries to prostheses are also an issue, but only in those suffering from frequent generalized tonic-clonic seizures. Therefore, the large majority of patients can and should receive prosthodontic treatment without restrictions. For a smaller group of patients, however, certain restrictions apply, to prevent potentially dangerous seizure-related complications.

Adult↗
PubMed2006

Epilepsy in adults with intellectual disabilities: prevalence, associations and service implications.

STATEMENT OF THE PROBLEM: The prevalence of epilepsy in people with an intellectual disability (ID) is apparently higher than in the general population. The outlook for individuals with both epilepsy and ID depends on the presence of any associated conditions. However, there have been few epidemiological studies of the prevalence of epilepsy and associated problems within a representative adult ID population to inform the development of policy. METHOD: This was a population-based prevalence study using the Leicestershire Learning Disability Register. Prevalence was estimated from the number of individuals with reported epilepsy identified from structured home interviews with carers. Associations with epilepsy were investigated for a range of defined physical, mental and skill attributes. Logistic regression was done with and without adjustment for age, sex and level of understanding to identify specific and holistic links respectively. RESULTS: The prevalence of epilepsy was 26%. Among those with epilepsy, 68% experienced seizures despite anti-epileptic medication. Epilepsy showed a significant association with low levels of understanding. Specific morbid associations included wetting (adjusted odds ratio 2.7), soiling (2.2), walking (2.5), daily living skills (1.6), poor speech (2.2), lack of empathy (1.5), mood swings (1.5), being uncooperative (1.6), seeking attention (1.7) and disturbing others at night (1.9). Holistic associations included a wider range of physical and mental problems and global skills deficits. CONCLUSIONS: The high prevalence, associated morbidities and global skills deficits make epilepsy care for adults with ID important and complex. Specialist epilepsy services for this population need a multidisciplinary skills mix.

Adult↗