bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric Syndromes Related to Antiepileptic Drugs
Authors: Schmitz Bettina 
Published: August 2005

Summary:All antiepileptic drugs may provoke positive or negative psychiatric reactions in individual patients. These psy‐chotropic effects are not simply idiosyncratic but depend on the drug's anticonvulsive strength and the person's genetic and biographic psychiatric predisposition. Mechanisms related to psychiatric adverse events are polytherapy and folate deficiency, forced normalization, drug toxicity, and withdrawal. Our knowledge on dose independent, idiosyncratic psycho‐tropic side effects is still limited. With respect to the older antiepileptic drugs there are almost no systematic data, and knowledge is largely empirical and based on anecdotal reports. With respect to the new generation of anticonvulsants there are data on psychiatric side effects from drug trials. However, these data are not always entirely transparent to the interested epileptologist. Moreover, drug trials are designed to test anticonvulsive efficacy and psychiatric adverse events are not systematically reported, thus severity psychopathologic nature of behavioral problems remain obscure. Differences in patients included in trials do not allow comparisons of psychiatric risks of specific drugs, particularly since following the vigabatrin experience, patients with a psychiatric history were often excluded from trials. In this chapter, methodological issues related to data on psychiatric adverse events of AED are discussed followed by an overview on the current knowledge on psychiatric side effect profiles of old and new antiepileptic drugs.
Mental Effort‐Related EEG Modulation During Video‐Game Play: Comparison Between Juvenile Subjects with Epilepsy and Normal Control Subjects
Authors: Pellouchoud Emiliana , Smith Michael E. , McEvoy Linda , Gevins Alan 
Published: August 2005

Summary:Purpose: This study investigated the effects of mental effort exerted during video‐game play on features of the EEG in juvenile subjects diagnosed with seizure disorders and in age‐matched clinically healthy subjects.Methods: EEG was recorded from 14 children (9–15 years old) as they played a video game, watched another person playing a video‐game, and sat quietly with their eyes open. Seven of the subjects had been clinically diagnosed with seizure disorders, three of whom had also exhibited photosensitivity.Results: Three spectral components of the EEG showed cognitive load‐related modulation. The amplitude of a frontal midline theta (6–7 Hz) signal increased with video‐game play relative to the watching and eyes open resting conditions. A posterior alpha band (9–12 Hz) signal was attenuated during the playing and the watching conditions relative to the resting condition. A central mu (10–13 Hz) rhythm was attenuated during the game‐playing condition. No significant differences were found between the patient and control groups for any of these features. Incidence of epileptiform events did not discriminate test conditions in the children with epilepsy.Conclusions: The results from this small sample suggest that video‐game play tends to produce similar responses from children with epilepsy and in healthy control subjects. These responses in the juvenile population are similar to responses elicited by increased mental load in normal adult populations.
OXCARBAZEPINE
Authors: Tecoma Evelyn S. 
Published: August 2005

Summary:The success of carbamazepine (CBZ) as a broad‐spectrum antiepileptic drug (AED) has led to its use as first‐line therapy in children and adults for partial and generalized tonic‐clonic seizures. The limitations of CBZ include toxicity in sensitive individuals, autoinduction, which requires dose adjustment when therapy is initiated, and chronic hepatic induction, producing drug interactions when CBZ is used with AEDs and other drugs that undergo hepatic metabolism. One of two main products of CBZ microsomal metabolism, CBZ‐10, 11‐epoxide (formed by oxidation of the double bond between C‐10 and C‐11), appears to provide antiepileptic efficacy but contributes significantly to clinical toxicity. The most common adverse effects of CBZ are central nervous system (CNS) symptoms, followed by gastrointestinal, hepatic, endocrine disturbances, and teratogenic effects. Oxcarbazepine (OXC) was developed to provide a compound chemically similar enough to CBZ to mimic its efficacy and overall safety while improving its side‐effect profile. Biotransformation of OXC does not involve formation of an epoxide metabolite. Compared with the parent compound, hepatic microsomal enzyme induction and auto‐induction are greatly reduced. The clinical efficacy of OXC compares favorably with CBZ in clinical trials. Clinical development of OXC began in Europe. Results of Phase I trials started to appear in the early 1980s. Controlled clinical trials, reported in the mid‐ to late 1980s, led to approval of OXC in many European countries, and now in over 50 nations around the world. United States multicenter clinical trials have recently been completed, and at this writing the drug is awaiting approval by the FDA. This article reviews the pharmacology, animal data, outcomes of published controlled clinical trials, postmarketing data, adverse experiences, and current recommendations for clinical use of OXC.
Felbamate
Authors: Pellock John M. 
Published: August 2005

Summary:Felbamate (FBM) was the first of the new antiepileptic drugs (AEDs) approved in the United States in 1993 with broad‐spectrum efficacy against partial and generalized seizures of various types, and indicated for use as adjunctive and monotherapy. The identification of idiosyncratic aplastic anemia and hepatotoxicity, however, drastically curtailed its use. To update information concerning FBM and its idiosyncratic effects, case studies and literature reviews were undertaken. Thirty‐four FBM‐associated aplastic anemia patients have been reported, with 13 known fatalities. The overall FBM aplastic anemia risk is estimated at between 27 and 209 per million vs. 2 to 2.5 per million in the general population. Prior AED hypersensitivity, cytopenia, and immune disease significantly increase risk. FBM aplastic anemia has not been reported in children below the age of 13 years. Hepatic failure is much less common, occurring with an overall risk similar to that associated with valproate, but children below the age of 5 years have been affected. The recent identification of a reactive metabolite, atropaldehyde, and HLA studies suggest that high‐risk patients can be identified. The efficacy profile of FBM should encourage further investigations to allow its better use, but at present FBM is not a first‐line AED.
Options After the First Antiepileptic Drug Has Failed
Authors: Elger Christian E. , Fernández Guillén 
Published: August 2005

Summary:Long‐term antiepileptic drug (AED) treatment is the standard therapy for epilepsies. In about 60% of patients, the first AED tried usually leads to seizure control. After failure of the first AED, it is important to achieve seizure control rapidly and without side effects. Combining the first drug with an add‐on drug appears to be more effective than a second monotherapy. However, no scientifically based data are available that favor any particular drug combination. Along with pharmacokinetic considerations, clinical experience is an important determinant in choosing a second AED for use as an add‐on. The time needed to introduce a particular AED is a further consideration. The simultaneous introduction of two add‐on drugs, one requiring slow titration and one permitting rapid introduction, may be a useful strategy. If the quickly introduced drug is effective as an add‐on, introduction of a slowly titrated second add‐on can be obviated. If the quickly introduced drug reduces seizure frequency, the patient's quality of life is improved during titration of the second add‐on. If the second, slowly titrated drug is more effective than the quickly introduced one, the less‐effective drug can be withdrawn. This strategy also allows a direct comparison between two add‐on drugs at the same time.
Risk Factors for Poor Health‐Related Quality of Life in Adolescents with Epilepsy
Authors: Devinsky Orrin , Westbrook Lauren , Cramer Joyce , Glassman Marc , Perrine Kenneth , Camfield Carol 
Published: August 2005

Summary: Purpose: To examine potential risk factors for poor health‐related quality of life (HRQOL) among adolescents with epilepsy by using the newly developed QOLIE‐AD‐48. Risk factors were derived from sociodemographic, social, academic, and epilepsy‐ and health‐related domains. Methods: The QOLIE‐AD‐48 was administered to 197 English‐speaking adolescents (age 11–17 years from >20 sites in the United States and in Canada). The self‐report instrument yields an overall HRQOL score and eight subscale scores. Other data were obtained from family interviews, physician reports, and health records. Multiple regression analyses were conducted to study risk factors for impairment of HRQOL. Results: Older adolescents (age 14–17 years), those with more severe epilepsy and more symptoms of neurotoxicity, and those living in households with lower socioeconomic status were more likely to report poor overall HRQOL. Risk factors in the eight HRQOL domains were found as follows: (a) Epilepsy Impact: older age in adolescence, more severe epilepsy and neurotoxicity, more hospitalizations during the past year, and fewer hours of extracurricular activities; (b) Memory and Concentration: longer duration of epilepsy, special education classes, and history of repeating a grade in school; (c) Attitude Toward Illness: older age, female gender, and more severe epilepsy and neurotoxicity; (d) Social Support: younger age, male gender, and fewer hospitalizations in the last year; (e) Stigma: lower socioeconomic status and special‐education classes; and (f) Health Perceptions: older age, female gender, and lower socioeconomic status. None of the factors examined was significantly associated with HRQOL in (g) Physical Functioning or (h) School Behavior subscales. Conclusions: We identified several risk factors for poor HRQOL outcomes in adolescents with epilepsy. Age, increased seizure severity, and neurotoxicity were most consistently associated with poor HRQOL across domains. Older adolescents, independent of epilepsy severity, reported worse overall HRQOL than did their younger counterparts. Older adolescents also were more likely to perceive a greater negative impact on life and general health, and had more negative attitudes toward epilepsy. Adolescent boys and girls may show different sensitivities to various quality‐of‐life domains.
The Ketogenic Diet for Intractable Epilepsy in Adults: Preliminary Results
Authors: Sirven Joseph , Whedon Barbara , Caplan Deborah , Liporace Joyce , Glosser David , O'Dwyer Joyce , Sperling Michael R. 
Published: August 2005

Summary:Purpose:Little is known concerning the efficacy and adverse effects of the ketogenic diet in adults with refractory epilepsy. This review reports preliminary results in 11 adults prospectively treated with the diet who had previously failed to gain seizure control with two or more medications and/or surgery.Methods:Eleven patients nine women, two men), median age, 32.2 years (range, 19–45 years) were treated with the ketogenic diet with a 4:1 ratio with fluid restriction. Six patients had symptomatic partial epilepsy, and five had symptomatic generalized epilepsy. The diet was administered in addition to antiepileptic medication by a multidisciplinary team geared exclusively to adult patients. Medications were not changed while on the diet. Seizure frequency at 8‐month follow‐up was compared with frequency during a baseline period.Results:At 8 months of follow‐up, three patients had a 90% seizure decrease, three patients had a 50–89% decrease in seizure frequency, one patient had <50% seizure decrease, and four patients discontinued the diet. Of the four patients who discontinued the diet, two had no appreciable change in their seizures despite high ketone levels. Two patients were unable to maintain persistent ketosis at home, despite having done so in the hospital. All seizure types responded to the diet. Common adverse effects included constipation and menstrual irregularities in women. Most patients reported a subjective improvement in concentration. Serum cholesterol and triglycerides increased while on the diet as well as cholesterol high‐density lipoprotein (HDL) ratios.Conclusions:The ketogenic diet shows promise in both adult generalized and partial epilepsy. Persistent ketosis was possible in adults, and the diet was tolerable for most patients. Further study assessing the efficacy of the ketogenic diet, and the cognitive and long‐term effects is ongoing.
Postoperative Seizure Control and Antiepileptic Drug Use in Pediatric Epilepsy Surgery Patients: The UCLA Experience, 1986–1997
Authors: Mathern Gary W. , Giza Christopher C. , Yudovin Sue , Vinters Harry V. , Peacock Warwick J. , Shewmon D. Alan , Shields W. Donald 
Published: August 2005

Summary: Purpose: Young children with refractory symptomatic epilepsy are at risk for developing neurologic and cognitive disabilities. Stopping the seizures may prevent these disabilities, but it is unclear whether resective surgery is associated with adequate long‐term seizure control. Methods: This study determined pre‐ and postsurgery seizure frequency and antiepileptic drug (AED) use (6 months to 10 years) in children with symptomatic seizures from unilateral cortical dysplasia (CD; n = 64) and non‐CD etiologies (i.e., ischemia, infection; n = 71), and compared them with older temporal lobe epilepsy (TLE; n = 31) patients with complex partial seizures. Results: Compared with presurgery, postsurgery seizure frequencies were decreased for CD, non‐CD, and TLE patients (p < 0.002), and there were no differences between the three groups from 6 to 24 months after surgery (p > 0.12). At 5 years after surgery, seizure frequencies were greater in CD compared with TLE cases (p = 0.009). Compared with presurgery, the number of AEDs declined after surgery in all three groups (p < 0.002), and positively correlated with seizure frequencies (p = 0.0001). Conclusions: This study indicates that seizure relief and AED use after resective surgery for symptomatic CD and non‐CD etiologies was comparable with complex partial TLE cases up to 2 years after surgery. Furthermore, at 5 years after surgery, CD patients had outcomes better than those before surgery, but worse than TLE cases. In young children, these findings support the concept that early removal of symptomatic pathologic substrates is associated with seizure control and reduced AED use, similar to that noted in older TLE cases up to 2 years after surgery. Seizure control may reduce the risk of developing the seizure‐related encephalopathy associated with severe symptomatic early‐onset childhood epilepsy.
Comparison of Antiepileptic Drug Levels in Sudden Unexpected Deaths in Epilepsy with Deaths from Other Causes
Authors: Opeskin Ken , Burke M. P. , Cordner S. M. , Berkovic Samuel F. 
Published: August 2005

Summary: Purpose: (a) To compare postmortem antiepileptic drug (AED) levels in patients with sudden unexpected death in epilepsy (SUDEP) with those in a control group of subjects with epilepsy. If SUDEP patients more frequently had undetectable or subtherapeutic AED levels, this would suggest that compliance with AED treatment is poorer in this group and that poor compliance is a risk factor for SUDEP. (b) To determine whether a particular AED was detected more commonly in the SUDEP group, suggesting that this AED is associated with a higher risk of SUDEP. Methods: A retrospective study of coronial cases was performed. Postmortem AED levels in 44 SUDEP cases and 44 control cases were compared. The control group consisted of epileptics who died of causes other than epilepsy, including natural disease (e.g., ischemic heart disease, accidents, and suicide). The AEDs measured included carbamazepine (CBZ), phenytoin, (PHT), valproate (VPA), phenobarbitone (PB), lamotrigine (LTG), clonazepam (CZP), and clobazam (CLB). The number of SUDEP and control cases in which CBZ only was detected were compared, as were the number in which PHT only was detected. Results: Compared with the controls, the SUDEP group showed no difference in the number with no detectable AEDs (13 vs. 11), the number with subtherapeutic AEDs (10 vs. 13), and the number with therapeutic levels (21 in both groups). CBZ only was detected in 11 SUDEPs and 11 controls, and PHT only in five SUDEPs and 10 controls. Conclusions: Our study suggests the SUDEP group were no less compliant with AED treatment than the control group. This study does not support the hypothesis that poor compliance with AED treatment is a risk factor for SUDEP. There was no evidence that PHT or CBZ is associated with a higher risk of SUDEP.
Partial Seizures Manifesting As Apnea Only in an Adult
Authors: Lee Hyang Woon , Hong Seung Bong , Tae Woo Suk , Seo Dae Won , Kim Sang Eun 
Published: August 2005

Summary: Purpose: Although several cases of apneic seizures have been reported in neonates, epileptic seizures presenting as apnea only in adults are very rare. We present a case report of a 19‐year‐old man with viral encephalitis and frequent episodes of apneic seizures. Methods: Prolonged electroencephalograms (EEGs), repiratory monitorings, and imaging including ictal‐interictal subtraction single photon emission computed tomography (SPECT) coregistered with magnetic resonance imaging (MRI) were performed. Results: Ictal EEGs recorded during apneic episodes showed repetitive sharp waves or rhythmic theta activity arising from the left or right independent bitemporal region. Ictal SPECT was performed during one episode of apnea that showed ictal EEG discharges arising from the left posterior temporal area. Ictal‐interictal subtraction SPECT coregistered with MRI revealed that the seizures originated from the left, posterior, midlateral temporal cortex. Conclusions: Previous studies with ictal EEG or brain stimulation suggest that apneic seizures might be mediated through the limbic and associated cortical systems. Our study reports on a very rare case of partial seizures with apnea only in an adult patient and is supported by ictal EEG and ictal‐interictal subtraction SPECT coregistered with MRI.
Familial Epilepsy with Unilateral and Bilateral Malformations of Cortical Development
Authors: Bartolomei Fabrice , Gavaret Martine , Dravet Charlotte , Guerrini Renzo 
Published: August 2005

Summary: Purpose: To describe a family in whom two sisters with epilepsy, mental retardation, and microcephaly had different malformations of cortical development detected by magnetic resonance imaging (MRI). Methods: Clinical investigation of the patients and their family. High‐resolution MRI, cognitive testing, and repeated EEG recording in both patients. Results: In one patient, the malformation was bilateral and diffuse but much more pronounced in the parietal and occipital regions, with MRI characteristics indicating pachygyria‐polymicrogyria. In the other patient, the abnormality involved the right hemisphere, predominating around the perisylvian region, with MRI more clearly indicative of polymicrogyria. A brother also had severe epilepsy, diffuse EEG abnormalities, mental retardation, and microcephaly, but could not be studied neuroradiologically. Conclusions: Lack of MRI studies in the parents and brother does not allow a precise hypothesis on the mode of transmission. However, findings from this family indicate that unilateral malformations of cortical development detected during investigations after seizure onset may be genetically based, suggesting that a single genetic abnormality could be responsible for bilateral or unilateral malformations.
Telephone Validation of the Quality of Life in Epilepsy Inventory‐89 (QOLIE‐89)
Authors: Leidy Nancy Kline , Elixhauser Anne , Rentz Anne M. , Beach Robert , Pellock John , Schachter Steven , Willian Mary Kay 
Published: August 2005

Summary: Purpose: To assess the psychometric properties of the Quality of Life in Epilepsy Inventory‐89 (QOLIE‐89) administered via telephone and to compare these properties with data gathered through self‐administration. Methods: A study of 139 patients with epilepsy was undertaken at three clinical sites in the United States. Patients participated in both telephone interview (T) and self‐administration (S). Order effect was controlled through randomization (T‐S and S‐T). Twenty‐eight S‐T subjects participated in an assessment of the 2‐week reproducibility of telephone interviews. Results: Internal consistency and test‐retest reliability levels of the QOLIE‐89 overall score were very high across method of administration (T = 0.98; S = 0.98; ICC of T = 0.96). Scores were significantly related to mood (Profile of Mood States, r= ‐0.76, for both methods, p > 0.001) and two indicators of epilepsy severity (seizure frequency in the past month, T: r= 0.52, p > 0.0001; S: r= 0.54, p > 0.0001; days since last seizure, T: r= 0.28, p > 0.001; S: r= 0.25, p > 0.01), with no significant differences in coefficients by method of administration. Performance of the measure was consistent for patients with unimpaired and impaired memory, using the River‐mead Behavioural Memory Test, and across level of education. Conclusions: Results of this study indicate telephone interview is a viable option for evaluating HRQL in persons with epilepsy and support the reliability and validity of the QOLIE‐89 regardless of method of administration.
Distribution of Epilepsy Syndromes in a Cohort of Children Prospectively Monitored from the Time of Their First Unprovoked Seizure
Authors: Shinnar Shlomo , O'Dell Christine , Berg Anne T. 
Published: August 2005

Summary: Purpose: To assess the distribution of epilepsy syndromes and their stability in children. Methods: A cohort of 407 children with a first unprovoked seizure was prospectively recruited and followed up for a mean of 9.4 years. Etiology and epilepsy syndromes were classified by using the International League Against Epilepsy (ILAE) guidelines in the 182 children with two or more seizures. Classification was done both at time of second seizure and at last follow‐up. Two‐year terminal remission also was analyzed by etiology and epilepsy syndrome. Results: Etiology of epilepsy syndromes was idiopathic in 45 (25%), cryptogenic in 89 (49%), and remote symptomatic in 48 (26%). In the initial classification, 114 (63%) children had a localization‐based epilepsy syndrome including idiopathic in 26, cryptogenic in 34, and symptomatic based on localization or etiology in 54. Twenty‐one (12%) children had a generalized epilepsy syndrome, including 19 with primary generalized epilepsy. Forty‐seven (26%) cases were in the category of undetermined if focal or generalized. At last follow‐up, there was a change in either etiology (n = 16) or the final epilepsy syndrome classification (n = 33) or both (n = 15) in 34 (19%) cases. At time of last follow‐up, 144 (79%) of the children with epilepsy were in 2‐year terminal remission, and 108 (59%) were in 2‐year terminal remission without medications. Factors associated with a favorable prognosis included an idiopathic or cryptogenic etiology and having a localization‐based idiopathic epilepsy syndrome. Conclusions: After two seizures, childhood‐onset epilepsy can be classified by etiology and epilepsy syndrome. Prognosis is favorable in the majority of cases. However, the apparent syndrome may change with longer follow‐up. The ability to classify these cases early in the clinical course is important if they are to be used for prognostic purposes.