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PubMed1998

Electroconvulsive therapy for epilepsy and major depression.

In this first report of electroconvulsive therapy (ECT) for the simultaneous treatment of seizures and depressive episodes, the authors discuss the use of ECT in the treatment of complex-partial seizures and major depression in a geriatric patients who refused antidepressant and antiepileptic medication. ECT has numerous anticonvulsant effects, including elevated seizure threshold and decreased seizure duration, which make it a useful adjunctive therapy in epilepsy that is refractory or not amenable to treatment with medication.

Aged↗
PubMed1998

Environmental influences on epilepsy gene mapping in EL mice.

The epileptic EL mouse has been studied extensively as a genetic model for idiopathic complex partial seizures in humans. The seizures in EL mice occur during routine handling at approximately 90 days of age, but can be induced at younger ages (50 days) by repeated rhythmic vestibular stimulation, e.g., tossing. Six seizure frequency quantitative trait loci (QTLs), El1-El6, were previously mapped in crosses between EL and non-epileptic strains using mechanical tossing procedures beginning at 30 days of age. The presence of these seizure frequency QTLs depended upon genetic background and the type of cross. Here we confirm Chromosome 2 and 9 QTLs in a backcross to the seizure-resistant ABP/LeJ strain with mice tested beginning at 200 days of age. However, the mapping of epilepsy genes was influenced by the seizure testing procedure, i.e., repeated tossing. The maximum Z-score for El1 (Chromosome 9) was 3.7 after 6 tests, but decreased to 2.4 after 15 tests. In contrast, the maximum Z-score for El2 (Chromosome 2) was 2.0 after 6 tests, but increased to 3.9 after 15 tests. In addition to nonallelic interactions (epistasis), our findings indicate that the genetic complexity of tossing-induced seizure susceptibility in EL mice also arises from genotype-environmental interactions involving the seizure test, seizure history, and age.

Animals↗
PubMed1976

A differential diagnosis of the inspirational spells of Muhammad the Prophet of Islam.

This paper reviews the spells of Muhammad, the Prophet of Islam. During these spells, Muhammad sensed the approach of a figure whom he thought to be the Angel Gabriel. The inspirational message transmitted to Muhammad during these spells helped form the religion of Islam. This is a review of the historical details of these spells and an attempt to reach a medical diagnosis. Although an unequivocal decision is not possible from existing knowledge, psychomotor or complex partial seizures of temporal lobe epilepsy would be the most tenable diagnosis. An examination of Western civilization's views of Muhammad's spells reveals historical and modern misconceptions about epilepsy.

Arabia↗
PubMed2005

Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus.

Diffusion-weighted MRI (DWI) and perfusion MRI (PI) have been mainly applied in acute stroke, but may provide information in the peri-ictal phase in epilepsy patients. Both transient reductions of brain water diffusion, namely a low apparent diffusion coefficient (ADC), and signs of hyperperfusion have been reported in experimental and human epilepsy case studies. We studied 10 patients with complex partial status epilepticus (CPSE) with serial MRI including DWI and PI. All patients showed regional hyperintensity on DWI, and a reduction of the ADC in (i) the hippocampal formation and the pulvinar region of the thalamus (six out of 10 patients), (ii) the pulvinar and cortical regions (two out of 10), (iii) the hippocampal formation only (one out of 10), and (iv) the hippocampal formation, the pulvinar and the cortex (one out of 10). In all patients a close spatial correlation of focal hyperperfusion with areas of ADC/DWI change was present. In two patients hyperperfusion was confirmed in additional SPECT (single photon emission computed tomography) studies. All patients received follow-up MRI examinations showing partial or complete resolution of diffusion and perfusion abnormalities depending on the length of the follow-up interval. The clinical course, EEG and SPECT results all indicate that MRI detected changes related to prolonged epileptic activity. Combined PI and DWI can visualize haemodynamic and tissue changes after CPSE in the hippocampus, thalamus and affected cortical regions.

Adult↗
PubMed2002

Two successful cases of bromide therapy for refractory symptomatic localization-related epilepsy.

Potassium bromide was tried for two children with daily convulsive focal motor seizures with unconsciousness and focal motor seizure status. The treatment resulted in complete cessation of the attacks. It has been reported that bromide is effective for generalized tonic-clonic seizures and not for complex partial seizures, such as convulsive focal motor seizures with unconsciousness. However, our experiences provide evidence that bromide is one of the useful therapeutic agents for intractable symptomatic localization-related epilepsy.

Bromides↗
PubMed1995

Risk factors for subsequent epilepsy after febrile convulsions.

To evaluate the risk of subsequent epilepsy after febrile convulsions and the long-term prognosis of such patients, the risk factors for afebrile seizures following initial febrile convulsions were studied in 154 hospitalized children: 122 with simple febrile convulsions and 32 with complex features of febrile convulsions. The mean follow-up period was 7 years 2 months (range, 4 yr - 11 yr 2 mo). Nineteen patients (12.3%) developed subsequent epilepsy in the follow-up period. The seizure types in patients with subsequent epilepsy following febrile convulsions included generalized seizures in seven patients, complex partial seizures in five patients, partial seizures evolving to secondary generalized seizures in six patients and benign childhood epilepsy with centrotemporal spike in one patient. The occurrence of epilepsy was strongly associated with complex features of febrile convulsions, pre-existing neurodevelopmental abnormalities, family history of epilepsy, and abnormal electroencephalographic findings. However, the number of recurrences of febrile convulsions, sex, family history of febrile convulsions, age of onset and long-term prophylactic use of anticonvulsants for febrile convulsions were not significant factors for subsequent epilepsy. This study demonstrates the importance of identifying the risk factors for subsequent afebrile seizures after febrile convulsions.

Adolescent↗
PubMed1979

Remission of seizures and relapse in patients with epilepsy.

In a longitudinal study of patients with epilepsy in Rochester, Minnesota, we found that the probability of being in remission (at least 5 consecutive years seizure-free, and continuing) at 20 years after diagnosis was 70%. The rates for remission we encountered were generally higher than those previously reported. We believe that the better prognosis in our series results from inclusion of all incidence cases in a defined population, beginning at the initial diagnosis of epilepsy. Prognosis for remission of epilepsy is poor in patients with associated neurologic dysfunction identified from birth. Patients with idiopathic seizures and survivors of postnatally acquired epilepsy have better prospects for eventual remission. The probability of remission is highest in patients with generalized-onset seizures diagnosed before 10 years of age. Prognosis is less favorable for those with partial complex seizures and adult-onset epilepsy.

Adolescent↗
PubMed1991

Risk of epilepsy after febrile convulsions: a national cohort study.

OBJECTIVE: To identify children with febrile convulsions, classify their febrile convulsions into simple and complex, and determine the number and type of subsequent afebrile seizures in those children. DESIGN: National population based study. SETTING: United Kingdom. SUBJECTS: 16,004 neonatal survivors born during one week in April 1970. MAIN OUTCOME MEASURES: Information about febrile and afebrile seizures obtained from questionnaires at 5 and 10 years of age and from hospital records. RESULTS: Information was available for 14,676 of the cohort children. 398 (2.7%) of them had had at least one febrile convulsion. 16 children were known to be neurologically or developmentally abnormal before the first attack. Of the remaining 382 children, 305 had had a simple first febrile convulsion and 77 a complex first febrile convulsion. Thirteen of the 382 had had one or more afebrile seizures, nine of whom had developed epilepsy (recurrent afebrile seizures). A higher proportion of children with complex febrile convulsions (6/95) rather than simple febrile convulsions (3/287) developed epilepsy, the risk being highest for those who had had focal febrile convulsions (5/17; chi 2 = 39.9, p less than 0.001). Three of the 32 children who had prolonged febrile convulsions developed afebrile complex partial seizures. CONCLUSIONS: The risk of epilepsy after febrile convulsions is much less than reported in many hospital studies, and if febrile convulsions cause brain damage that leads to later epilepsy this is a rare occurrence.

Age Factors↗
PubMed2003

VNS in patients with previous unsuccessful resective epilepsy surgery: antiepileptic and psychotropic effects.

OBJECTIVES: To assess the efficacy of vagus nerve stimulation (VNS) in patients with medically and surgically intractable complex partial seizures (CPS). PATIENTS AND METHODS: Sixteen patients with previous temporal [15] and frontal [one] resections were treated with VNS between 1994 and 1999 at King's College Hospital, London, UK. Post-operative video-electroencephalogram telemetry had shown that CPS started from the operated side in 12 patients, contralaterally in three and bilaterally independently in one. RESULTS: Three patients (18.75%) had 50% or more reduction in seizure frequency, but one showed severe worsening of epilepsy, which remitted upon VNS discontinuation. The antiepileptic effect of VNS was not different with respect to the type of operation (anterior temporal lobectomy vs amygdalohippocampectomy), the side of operation, or the side of seizure onset. We observed psychotropic effects in two patients with post-ictal psychosis, in two others with depression, and in a child with severe behavioral disorder. CONCLUSIONS: VNS may have a rather limited antiepileptic role to play in patients with persistent seizures following epilepsy surgery, but may independently possess useful antipsychotic and mood-stabilizing properties.

Adolescent↗
PubMed1994

Psychosis or epilepsy--a diagnostic and management quandary.

MB suffered an episode of status epilepticus of febrile origin at the age of 20 months. This was followed at two years by complex partial seizures of temporal lobe origin and at eight years he had learning difficulties arising from the dominant hemisphere. Subsequent symptoms included auditory, visual and olfactory hallucinations which were not controlled by antipsychotics or antiepileptics. EEG and MRI were unhelpful and alternating diagnoses of schizophrenia and temporal lobe epilepsy were made. Now aged 17 years, he has a diagnosis of schizophreniform psychosis with temporal lobe abnormality from status epilepticus in childhood, and is managed by an adult psychiatrist. His symptoms persist.

Adolescent↗
PubMed2001

Clinical evaluation of Gabitril and Lamictal for drug-resistant epilepsy in adults.

Second generation antiepileptics lamotrigine (LTG) and tiagabine (TGB) were primarily licensed for adjunctive treatment of simple and complex partial seizures with/without secondary generalisation as similarly effective drugs. Reduction of seizures frequency is the most important index of drug efficacy, but overall therapeutic benefit estimated as a quality of life is nowadays the target goal of management. In this study efficacy and tolerability of LTG or TGB as short-term add-on treatment in patients with refractory complex partial seizures were assessed by the use of both physician-rated measures (mean monthly seizure frequency, responders rate, adverse events, clinical biochemistry) and patients perceived change in their own quality of life estimation (descriptive scale and visual analogue scale-VAS). Comparable efficacy of LTG (n-22, 378 mg/day) and TGB (n-26, 43 mg/g) was assessed as 41 and 35% of responders and above half of patients with noticeable improvement. 25% of patients in both groups reported reduction of seizures severity in 4-points descriptive scale. Biochemistry values did not show clinically significant changes after treatment. 13% of patients on LTG reported adverse events (headache, asthenia, irritability, insomnia). This coefficient was greater for TGB-35% (asthenia, headache, sleepiness, vertigo). However, no case of discontinuation as a result of adverse events was reported for either of the tested drugs. Even if efficacy of LTG and TGB was comparable in objective measurements, only patients on LTG reported a significant quality of life improvement in VAS. This might be the consequence of more frequent adverse events and treatment schedule of TGB (triple dosing/day). This trial confirmed that VAS might be used as an easy additional test in evaluation of antiepileptic drug for individual patient in everyday clinical practice.

Adolescent↗
PubMed2002

Partial epilepsy with pericentral spikes: a new familial epilepsy syndrome with evidence for linkage to chromosome 4p15.

The genetic analysis of simple Mendelian epilepsies remains a key strategy in advancing our understanding of epilepsy. In this article, we describe a new family epilepsy syndrome, partial epilepsy with pericentral spikes, which we map to chromosome 4p15. We distinguish it clinically, electrophysiologically, and genetically from previously described Mendelian epilepsies. The family described is a large Brazilian kindred of Portuguese extraction in which affected family members manifest a variety of seizure types, including hemiclonic, hemitonic, generalized tonic-clonic, simple partial (stereotyped episodes of epigastric pain), and complex partial seizures consistent with temporal lobe epilepsy. The syndrome is benign, either requiring no treatment or responding to a single antiepileptic medication. Seizure onset is in the first or second decades of life, with seizures in individuals up to the age of 71 years and documented encephalogram changes up to the age of 30 years. A key feature of partial epilepsy with pericentral spikes is a characteristic encephalogram abnormality of spikes or sharp waves in the pericentral region (centroparietal, centrofrontal, or centrotemporal). This distinctive encephalogram abnormality of pericentral spikes unites these several seizure types into a discrete family epilepsy syndrome. As with other familial epilepsies, the inherited nature of this new syndrome may be overlooked because of the variability in penetrance and seizure types among affected family members.

Adolescent↗
PubMed1996

Epilepsy in children.

Childhood epilepsies comprise a broad range of disorders which vary from benign to progressive and disabling. Accurate diagnosis of epilepsy type and determination of aetiology, when possible, are essential for appropriate treatment. The most common seizure type encountered in children is febrile seizures. These represent a benign condition which is not, in fact, epilepsy and usually does not require antiepileptic medication. When partial seizures occur in childhood, benign syndromes with spontaneous remission, such as rolandic epilepsy, must be distinguished from symptomatic epilepsies which may be refractory to medical management. Complex partial seizures in young children may appear different than in adults. The adverse effect profiles and dosing regimens of antiepileptic drugs in children are also different than in adults, and influence the choice of treatment. Epilepsy surgery should be considered for some children with intractible partial seizures. Generalized epilepsies also have a broader spectrum in children. The idiopathic generalized absence epilepsies are usually easy to control with medication. They range from childhood absence epilepsy which tends to remit in adolescence to juvenile myoclonic epilepsy which is a lifelong condition. In contrast, the seizures of West syndrome and Lennox-Gastaut syndrome are difficult to control, and treatment involves therapeutic modalities rarely used in adults such as ACTH and the ketogenic diet. Many childhood epilepsy syndromes have a familial predisposition, and the genetic bases for several disorders have been described.

Anticonvulsants↗
PubMed2005

Recurrent postictal depression with Cotard delusion.

Depression is a common occurrence among epileptic patients and constitutes, along with anxiety disorders, the most frequent psychiatric condition in these patients. However, little work is done in the area of post-ictal depression especially in children with epilepsy. Here, the authors report an adolescent boy who developed recurrent depression associated with Cotard's delusion following complex partial seizure at the age of 7 years. Trial of antidepressant drug and lithium worsened the clinical picture but ultimately he responded well to carbamazepine. This case is unique in its presentation due to recurrent depression itself is rare at this age and secondly rarity of onset of Cotard delusion in prepubertal phase. This case also showed that post-ictal depression is biological process rather than psychological and social reaction. Prompt identification and management of underlying cause would definitely prevent further complication and would also prevent the child from exposing unnecessary with various pharmacological treatments.

Adolescent↗
PubMed1983

Generalized tonic-clonic seizures in patients with complex-partial seizures: natural history and prognostic relevance.

Clinical course and long-term seizure prognosis were studied in 155 patients with complex-partial seizures during a follow-up of 10.1 +/- 1 (SD) years. In 79% of the patients generalized tonic-clonic seizures were recorded, mostly within the first 3 years of epilepsy but occurring as late as 20 years after the onset of epilepsy. Seizure control was defined as complete absence of all seizures, including auras, for a minimum of 2 years. Seizure control occurred in 20 of 32 patients (63%) with complex-partial seizures only and in 76 of 123 patients (62%) with complex-partial seizures and generalized tonic-clonic seizures. The onset of the epilepsy with generalized tonic-clonic seizures or complex-partial seizures did not influence the therapeutic outcome despite differences in their natural history. A family history of epilepsy and other generalized seizures (e.g., absence) were more frequent in patients with generalized tonic-clonic seizures at the onset of epilepsy. Seizure control was significantly lower (44%) in patients with a history of a maximum frequency of one or more generalized tonic-clonic seizures per month when compared to patients (79%) with a total of less than six generalized tonic-clonic seizures (p less than 0.05). The frequency of generalized tonic-clonic seizures is of predictive value for the seizure prognosis of patients with complex-partial seizures.

Carbamazepine↗
PubMed2006

Treatment with oxcarbazepine during pregnancy.

BACKGROUND: Managing epilepsy during pregnancy is a critical challenge as maternal seizures may have deleterious effects on the fetus. While many patients with epilepsy have been managed successfully with antiepileptic drugs (AEDs), the potential teratogenicity of AEDs is a major concern. First-generation AEDs such as valproate have been associated with at least a 2-fold risk of fetal malformations compared with the general population. However, recent studies suggest that the newer AEDs given as monotherapy may have a lower teratogenic risk. The current case report adds to the growing experience of oxcarbazepine therapy in pregnant women with epilepsy. REVIEW SUMMARY: This case report presents a 23-year-old female with a history of complex partial seizures (CPS) and mild depression. In high school, she had 2 initial tonic-clonic seizures and was placed on phenytoin monotherapy. She was subsequently placed on combination therapy (phenytoin + gabapentin) and was maintained on it for several years. Preceding a planned pregnancy, the patient was switched to oxcarbazepine and tapered off both phenytoin and gabapentin. The patient was maintained on oxcarbazepine monotherapy with a seizure-free pregnancy and delivered a normal, healthy baby girl. The patient breast-fed the infant for 6 months, supplemented with infant formula without any adverse effects. Subsequently, the patient has had a healthy second child while receiving oxcarbazepine during her pregnancy. CONCLUSION: Although there are very limited data in the literature, this case illustrates that a patient with a history of CPS can be treated with oxcarbazepine with no adverse effects during and after pregnancy.

Adult↗
PubMed1998

[Successful induction of tolerance in an epilepsy patient with phenobarbital allergy].

We report on a 32-year-old female patient who had had a history of complex partial seizures since the age of 14. Phenobarbital was the most effective anticonvulsant drug in this patient. However, the drug treatment was complicated by a phenobarbital-induced exanthematous eruption. Reintroduction of the phenobarbital some years later resulted in a skin rash again; therefore, treatment with this substance had to be discontinued a second time. Because of the satisfactory antiepileptic efficacy, phenobarbital was introduced a third time using a desensitization procedure with increased oral doses, starting with a dose of 1 mg. After a daily dose of 90 mg phenobarbital, on day 6 an exanthematous eruption appeared. The exanthem disappeared parallel to a dose reduction of phenobarbital and with a gradually increasing dosage up to a maintenance dose of 200 mg. Tolerance to the allergic effect of phenobarbital was preserved and the seizure frequency was significantly reduced by phenobarbital monotherapy with a daily dose of 200-175 mg.

Adult↗
PubMed1991

Vigabatrin in drug-resistant partial epilepsy: a 5-year follow-up study.

We treated 75 patients with drug-resistant complex partial seizures and secondarily generalized seizures with vigabatrin as additional therapy for 6 months. Twenty-one patients either showed no benefit from vigabatrin treatment or had side effects. The remaining 54 patients entered into the long-term study. The median monthly seizure frequency decreased from 12.5 at baseline to 3.3 at the 3-month visit, and was 3.9 after 5 years of therapy in 28 patients who continued using the drug after the 5-year period. During 5 years of therapy with vigabatrin, 26 patients have withdrawn from the study because of various reasons: loss of efficacy (14), suspected side effects (5), noncompliance (3), administrative reasons (2), pregnancy (1), and epilepsy surgery (1). In all, 19 patients had a greater than 50% seizure frequency reduction at 5 years, representing 35% of the 54 patients who entered the long-term study, or 25% of the 75 patients who were initially recruited into the efficacy study.

Adolescent↗