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PubMed1986

Role of inhibitory mechanisms in staring spells.

Phenomena of a negative nature--a motionless stare with arrest of mental activity--characterize absence seizures and some complex partial seizures. In agreement with this clinical observation, it has been found that the slow waves of the spike-wave complex are associated with inhibitory postsynaptic potentials and cessation of neuron firing in both humans and experimental animals. Gamma-aminobutyric acid (GABA) concentration is increased in the cerebral cortex in some experimental models of spike-wave discharge, and GABA agonists exacerbate spike-wave discharges in a variety of experimental models. GABAergic neurons and terminals are also increased in the hippocampus of seizure-sensitive gerbils, and kindling of the hippocampus and amygdala appears to enhance GABAergic inhibitory mechanisms. Antiabsence drugs selectively depress inhibitory pathways in the central nervous system, providing further evidence in support of the hypothesis that absences represent inhibitory paroxysms. Antiabsence drugs also appear to be useful adjunctive drugs in the treatment of complex partial seizures associated with spike-wave discharges, suggesting that here too inhibitory mechanisms may play a prominent role. All these clinical, physiological, and pharmacological observations would indicate that staring spells represent inhibitory seizures, occurring primarily in absences and secondarily in some complex partial seizures.

Anticonvulsants↗
PubMed1987

[Total or partial withdrawal of antiepileptic drugs].

Total withdrawal of antiepileptic drugs leads to a mean relapse rate of approximately 50 p. 100 in adults and 25 p. 100 in children. The relapse rates are lowest in patients with benign epilepsies of childhood and epilepsies with absence seizures only and those with a short duration of epilepsy. Relapse rates are higher in patients with complex partial seizures, absences with generalized tonic-clonic seizures, juvenile myoclonic epilepsy, patients with several types of seizures, high seizure frequency prior to control, in patients with neurological, psychiatric or social handicaps and in those with emotional ambivalence towards the reduction. Guidelines for slow and safe withdrawal are given. Reduction should be actively encouraged only in patients with absence seizures or benign focal epilepsy and those with epilepsy of short duration. Slow partial withdrawal is recommended in uncontrolled epilepsy because in 80 p. 100 of the patients it results in a decrease in seizure frequency and side effects or both.

Anticonvulsants↗
PubMed1994

Nonconvulsive status epilepticus as a cause of confusion in later life: a report of 5 cases.

Five patients (4 women, 1 man) presented with an acute confusional episode for the first time between the ages of 53 and 76. Their EEGs showed generalized paroxysmal activity indicating a diagnosis of nonconvulsive generalized status epilepticus (absence status). Two patients had tonic-clonic seizures just before the onset of the status, but none had a history of chronic epilepsy. Three patients had long-standing psychiatric disorders. Treatment with psychotropic drugs and medical illness (vascular disease, metabolic derangement) may have acted as precipitating factors for the status epilepticus in all patients. The diagnosis was never made on admission, since psychiatric history and ictal behavioral manifestations often raised intriguing problems of differential diagnosis. In all cases, only icta; EEG could provide a correct diagnostic assessment.

Aged↗
PubMed1988

Neurological morbidity of severe epilepsy.

The "severity" of a disease is a relative expression and its definition will vary depending on the perspective of the observer. The patient's subjective perception of the disease, the way it is regarded socially by the community, and the doctor's objective assessment rarely coincide. In fact, they are frequently diametrically opposed. As far as the patient's personal perception of epilepsy is concerned, there has apparently been no satisfactory attempt thus far at a systematic grading of the subjective handicap, despite the growth of interest in psychological matters and the self-help movement. Similarly, social ability or disability cannot be adequately assessed on the basis of medical criteria such as frequency and type of seizures. We present a grading system which will serve as an example of an appropriate method of assessing social abilities, and which will permit the patient's occupational potential to be estimated in relation to the risk of accidents resulting from seizures. From the medical point of view, the impairment of a patient's abilities due to epilepsy is a function of the patient's responsiveness to treatment. We present a critical review of the factors which have an effect on the therapeutic prognosis: the causes of epilepsy, underlying structural lesions, the incidence of convulsive status epilepticus, various types of attacks, and the different epileptic syndromes. Taking two examples--epilepsy presenting in the form of absence and epilepsy with complex focal seizures--we show that ultimately the "severity of epilepsy" can only be defined from the medical standpoint on the basis of several factors whose value is of a predictive nature.

Brain↗