Epilepsy

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Epilepsy

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Influence of major antiepileptic drugs on attention, reaction time, and speed of information processing: results from a randomized, double-blind, placebo-controlled withdrawal study of seizure-free epilepsy patients receiving monotherapy. (Epilepsia. 2006) "CONCLUSIONS: The results suggest that seizure-free epilepsy patients receiving monotherapy can obtain improvement in cognitive function if they discontinue AED treatment."

Psychotropic effects of antiepileptic drugs. (Neurology. 2006) "CONCLUSION: Antiepileptic drug selection should consider potential effects on mood and behavior."

In utero antiepileptic drug exposure. (Expert Rev Neurother. 2006) "Information from worldwide pregnancy registries are now reporting results that are alarmingly similar with respect to the increased risk of pregnancies born to women with epilepsy, consistently demonstrating greater degrees of major congenital malformations with the use of valproate, polytherapy and high-dose antiepileptic drugs administered within the first trimester of pregnancy."

Epilepsy and antiepileptic drug use in elderly people as risk factors for dementia (Journal of the Neurological Sciences 2006) "Older adults taking AEDs are at a significantly higher relative risk of developing dementia than those not taking AEDs."

Psychotropic effects of antiepileptic drugs (NEUROLOGY 2006)

Long-term use of the ketogenic diet in the treatment of epilepsy. (Dev Med Child Neurol. 2006)

Effects of Antiepileptic Drugs on Mood and Behavior. (Epilepsia. 2006)

Oxidative stress in children receiving valproic acid. (J Pediatr. 2006) "CONCLUSIONS: These data demonstrate that treatment of children with VPA is associated with higher urinary levels of 15-F(2t)-IsoP, a marker of oxidative stress."

The Effect of Antiepileptic Drugs on Cognition: Patient Perceived Cognitive Problems of Topiramate versus Levetiracetam in Clinical Practice. (Epilepsia. 2006) "Conclusion: cognitive complaints are common in TPM treatment and frequently lead to drug withdrawal. The impact of LEV on cognitive function is only mild. This leads to a much higher (15%) drug discontinuation rate for TPM compared to LEV."

Anti-epileptic medication and bone health. (Osteoporos Int. 2006) "RECOMMENDATIONS: Patients receiving long-term AED should be monitored for indices of bone health, including BMD and vitamin D status. Lifestyle factors should be optimized, vitamin D status maintained, and fall prevention strategies introduced as appropriate. Good seizure control is important. The use of additional, specific osteoporosis therapy is not evidence-based in this setting, but would appear reasonable in patients with clinically significant decreases in BMD, applying current treatment guidelines for osteoporosis."

Psychiatric and behavioral side effects of the newer antiepileptic drugs in adults with epilepsy. (Epilepsy Behav. 2006) "OBJECTIVE: Psychiatric/behavioral side effects (PSEs) are common in patients taking antiepileptic drugs (AEDs). The objective of the study described here was to compare the PSE profiles of the newer AEDs. … CONCLUSIONS: There are significant differences between the newer AEDs in terms of their PSE profiles. Patients taking levetiracetan experience significantly more PSEs than average, and patients taking gabapentin and lamotrigine experience significantly fewer PSEs. Even with the medication with the highest rate of PSEs (levetiracetam), less than 10% of patients discontinued it because of PSEs. A past psychiatric condition is the most significant nondrug predictor of AED-related PSEs."

Epilepsy, Prolonged Phenytoin Usage, and Its Effects on Bone (P&T Journal 2006)

U.S. says Glaxo drug may be linked to birth defect "Taking GlaxoSmithKline Plc's Lamictal epilepsy drug during the first three months of pregnancy may increase the chances of having a baby with a cleft lip or palate, U.S. regulators warned on Friday."

Teratogenicity of antiepileptic drugs

Seizure aggravation by antiepileptic drugs. (Curr Treat Options Neurol. 2006)

Antiepileptic drugs and bone metabolism. (Nutr Metab (Lond). 2006)

Adverse Effects of Antiepileptic Drugs on Bone Mineral Density. (Pediatr Neurol. 2006) "In conclusion, long-term antiepileptic drug treatment either with valproic acid, carbamazepine, or with oxcarbazepine which has unknown effects on skeletal mineralization, induces a state of decreased bone mineral density."

Cognitive effects of lamotrigine compared with topiramate in patients with epilepsy. (Neurology. 2006)

Antiepileptic drug-induced mania in patients with epilepsy: What do we know? (Epilepsy Behav. 2006)

In utero antiepileptic drug exposure: fetal death and malformations. (Neurology. 2006) "CONCLUSIONS: More adverse outcomes were observed in pregnancies with in utero valproate exposure vs the other antiepileptic drugs (AEDs). These results combined with several recent studies provide strong evidence that valproate poses the highest risk to the fetus. For women who fail other AEDs and require valproate, the dose should be limited if possible."

Valproate Should Not Be Used as First-Line Therapy in Women of Childbearing Age "In utero exposure to the antiepileptic drug (AED) valproate poses a much higher risk of fetal death and serious birth defects than the 3 other most commonly used AEDs, a new study has found.

Pharmacovigilance in epileptic patients using antiepileptic drugs. (Arq Neuropsiquiatr. 2006) "CONCLUSION: Our data suggest that adverse events are highly prevalent when a detailed questionnaire is applied and that depression may aggravate the number and intensity of side effects in patients using AEDs."

A cross-sectional study of subjective complaints in patients with epilepsy who seem to be well-controlled with anti-epileptic drugs (Seizure 2006) "Of 173 included patients, 67% reported moderate to severe subjective complaints on the questionnaire. Cognitive complaints were reported most frequently."

New anticonvulsants--new adverse effects. (South Med J. 2006) "We review previous reports of these adverse effects with topiramate and oxcarbazepine, describe the pathophysiology of these metabolic alterations, provide treatment strategies, and make suggestions for monitoring patients during therapy with these anticonvulsant medications."

Catatonia induced by levetiracetam. (Epilepsy Behav. 2006) 'We report here the case of a 43-year-old woman who developed symptoms compatible with catatonia after being exposed to levetiracetam for the treatment of epilepsy. To our knowledge, it is the first reported case of catatonia induced by levetiracetam."

Are there potential problems with generic substitution of antiepileptic drugs? (Seizure 2006)

[The use of lamotrigine in female patients.] (Nervenarzt. 2006) "CONCLUSION: In summary, this observational study confirms the good tolerability of LTG with respect to issues particularly relevant to women. More complete elucidation of the correct LTG dosage, which varies widely according to the accompanying medication, will further improve treatment safety."

Effects of common anti-epileptic drug monotherapy on serum levels of homocysteine, Vitamin B12, folic acid and Vitamin B6 (Seizure 2006) "Our results confirm that common anti-epileptic drugs has disadvantageous effects on homocysteine status."

Clinically relevant drug interactions with antiepileptic drugs (British Journal of Clinical Pharmacology 2006)

Efficacy and Safety of Topiramate in Refractory Epilepsy of Childhood: Long-Term Follow-Up Study (J Child Neurol. 2005)

Practical prescribing and long-term efficacy and safety of zonisamide. (Epilepsy Res. 2006)

Plasma free carnitine in epilepsy children, adolescents and young adults treated with old and new antiepileptic drugs with or without ketogenic diet. (Brain Dev. 2005)

Drugs

Topiramate in frontal lobe epilepsy (Acta Neurologica Scandinavica 2006) "Conclusions – TPM is effective in newly diagnosed patients with FLE; TPM can be considered for the treatment of FLE."

Opinion of Belgian neurologists on antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET) (Acta Neurologica Scandinavica 2006) "Conclusions – Neurologists reached consensus for most questions on epilepsy treatment. In 2003, monotherapy with valproate and carbamazepine was the common treatment strategy in Belgium, whereas lamotrigine and to a lesser extent levetiracetam, topiramate, and oxcarbazepine were predominantly prescribed in second-line. This is in agreement with the recently published UK epilepsy guidelines but not in agreement, however, with the US guidelines, that for new onset epilepsy, new and old drugs are equally effective. Belgian neurologists, except for some special situations still prefer old drugs as first line."

Effect of epilepsy drugs may wane over time

Comparison of the efficacy and tolerability of new antiepileptic drugs: what can we learn from long-term studies? (Acta Neurologica Scandinavica 2006)

Topiramate treatment for nocturnal frontal lobe epilepsy. (Seizure. 2006)

Long-term levetiracetam treatment of epilepsy patients: Clinical audit. (Epilepsy Res. 2006)

Comparison of the efficacy and tolerability of new antiepileptic drugs: what can we learn from long-term studies? (Acta Neurol Scand. 2006)

Treatment of partial seizures with gabapentin: double-blind, placebo-controlled, parallel-group study. (Psychiatry Clin Neurosci. 2006)

Pharmacologic treatment strategies for sexual dysfunction in patients with epilepsy and depression. (CNS Spectr. 2006)

Sodium valproate vs phenytoin in status epilepticus: a pilot study. (Neurology. 2006)

Lamotrigine Adjunctive Therapy Among Children and Adolescents With Primary Generalized Tonic-Clonic Seizures. (Pediatrics. 2006)

Treatment with valproate after status epilepticus: Effect on neuronal damage, epileptogenesis, and behavioral alterations in rats. (Neuropharmacology. 2006) "Epileptogenesis, i.e. the process leading to epilepsy with spontaneous recurrent seizures, can be initiated by a number of brain damaging insults, including traumatic brain injury, status epilepticus (SE), and stroke. Such acquired epilepsy is often associated with memory impairment and behavioral problems. There has been a growing interest in the use of antiepileptic drugs (AEDs) for neuroprotection and prevention or modification of epileptogenesis induced by such brain insults. One promising candidate in this respect is valproic acid (VPA), a widely used AED that has been reported to exert neuroprotective activity in a number of in vitro and in vivo models. . The data demonstrate that, although VPA does not prevent the occurrence of spontaneous seizures after SE, it exerts powerful neuroprotective effects and prevents part of the behavioral alterations, demonstrating that administration of VPA immediately after SE exerts a favorable effect on long-term functional outcome."

Long-term profile of lamotrigine in 119 children with epilepsy. (Eur J Paediatr Neurol. 2006) "Results of earlier reports of a favorable cognitive profile of LTG seem to reach relevance in the long-term treatment of childhood epilepsies, as the neutral to beneficial effects of LTG on cognition and vigilance in long-term treatment is confirmed by physicians' and parents' experience. Our qualitative evaluation is supporting LTG as an anticonvulsive drug with a profile suitable for the use in children."

Withdrawal of antiepileptic drugs in adult patients free of seizures for 4 years: A prospective study. (Epilepsy Behav. 2006) "The age at onset of epilepsy and the duration of active disease were found to affect the risk of relapse. Although drug withdrawal could be considered in adult patients free of seizures for 4 years, the final decision should be tailored to the patient's clinical, emotional, and socio-cultural profile."

Effects of intermittent levetiracetam dosing in a patient with refractory daily seizures (NEUROLOGY 2006)

[Oxcarbazepine in the treatment of epilepsy. A review and update.] (Rev Neurol. 2006)

Lamotrigine versus carbamazepine monotherapy for epilepsy. (Cochrane Database Syst Rev. 2006) "AUTHORS' CONCLUSIONS: Lamotrigine was significantly less likely to be withdrawn than carbamazepine but results for time to first seizure suggested that carbamazepine may be superior in terms of seizure control. Trials were of too short a duration to measure important seizure outcomes such as time to 12 month remission. Further trials are needed in which longer-term outcome is assessed as well as measures such as psychosocial outcome and quality of life."

Evidence for a rapid action of levetiracetam compared to topiramate in refractory partial epilepsy. (Seizure. 2006)

Double-blind, placebo-controlled study of lamotrigine in primary generalized tonic-clonic seizures (NEUROLOGY 2005) "Conclusions: Adjunctive lamotrigine is effective in the treatment of primary generalized tonic-clonic seizures and has a favorable tolerability profile."

Exercise

General Information

Treatment of the first tonic-clonic seizure does not affect long-term remission of epilepsy (NEUROLOGY 2006)

Influence of major antiepileptic drugs on attention, reaction time, and speed of information processing: results from a randomized, double-blind, placebo-controlled withdrawal study of seizure-free epilepsy patients receiving monotherapy. (Epilepsia. 2006) "CONCLUSIONS: The results suggest that seizure-free epilepsy patients receiving monotherapy can obtain improvement in cognitive function if they discontinue AED treatment."

Alternative approaches to conventional antiepileptic drugs in the management of paediatric epilepsy (Archives of Disease in Childhood 2006)

Optimizing therapy of seizures in stroke patients (NEUROLOGY 2006)

Optimizing therapy of seizures in children and adolescents with ADHD (NEUROLOGY 2006)

Vitamin D improves bone loss due to epilepsy drugs "It's well known that, taken for long periods, anti-epilepsy drugs can lead to brittle bones. Now, researchers have shown that high-dose vitamin D therapy significantly improves bone mineral density in this situation."

A Systematic Review of the Use of the Ketogenic Diet in Childhood Epilepsy (Pediatric Neurology ) "The studies indicated that some children report reduction in seizure frequency. The estimated rate for obtaining complete seizure control was 15.6% (95% confidence interval 10.4-20.8%) with 33% (95% confidence interval 24.3-41.8%) reporting greater than 50% reduction in seizures. Adverse events were not frequent; however, 16 cases of death occurring while on the diet were found. No cost/benefit studies were located. There is evidence to support the cautious use of ketogenic diet in children with refractory epilepsy."

Withdrawal of antiepileptic drugs in adult patients free of seizures for 4 years: A prospective study (Epilepsy & Behavior 2006) "In patients discontinuing treatment, the probability of relapse was 21.4% during the tapering period (especially in the last months), 28.6% at 1 month, 14.3% at 3 months, 3.6% at 6 months, 7.1% at 12 months, 17.8% at 24 months, and 7.1% at 36 months. The age at onset of epilepsy and the duration of active disease were found to affect the risk of relapse. Although drug withdrawal could be considered in adult patients free of seizures for 4 years, the final decision should be tailored to the patient's clinical, emotional, and socio-cultural profile."

Rapid versus slow withdrawal of antiepileptic drugs (Cochrane Review) (The Cochrane Library, Issue 2, 2006) "Background: The ideal objective of treating a person with epilepsy is to induce remission by usage of antiepileptic drugs (AEDs) and withdraw the AEDs without causing seizure recurrence. Prolonged usage of AEDs may have long-term side effects. Hence when a person with epilepsy is in remission (free of seizures for some time) it is logical to attempt to discontinue the medication. The timing of withdrawal and the mode of withdrawal arise while contemplating withdrawal of AEDs. . Authors' conclusions: In view of methodological deficiencies and small sample size, in the solitary study identified, we cannot derive any reliable conclusions regarding the optimal rate of tapering of AEDs."

The ketogenic diet in children with epilepsy. (Br J Nutr. 2006)

The ketogenic diet: from molecular mechanisms to clinical effects. (Epilepsy Res. 2006)

[Newly treated epilepsy: a French observational study.] (Rev Neurol (Paris). 2006)

Guidelines

Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy (Epilepsia 2006)

2005 AES Annual Course: Evidence Used to Treat Women with Epilepsy. (Epilepsia. 2006)

Overview of treatment guidelines for epilepsy. (Curr Treat Options Neurol. 2006)

EFNS guideline on the management of status epilepticus (2006)

EFNS guideline on the management of status epilepticus. (Eur J Neurol. 2006)

NGC - Newer drugs for epilepsy in adults. (2004)

NGC - Newer drugs for epilepsy in children. (2004)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Epilepsy and Celiac Disease: Favorable Outcome With a Gluten-Free Diet in a Patient Refractory to Antiepileptic Drugs. (Neurologist. 2006)

Efficacy of the Ketogenic Diet as a Treatment Option for Epilepsy: Meta-analysis (J Child Neurol. 2006) "The ketogenic diet is an alternative treatment for intractable epilepsy, involving a strict regimen of high-fat, low-carbohydrate, and low-protein foods. It is used predominantly in children whose seizures have reached the refractory stage.[1,2] The diet is rigid and requires careful adherence but has been purported to show high success rates. Efficacy studies of the ketogenic diet are all observationally based and are often focused on patients able to remain on the diet for extended periods of time. Success rates primarily reflect outcomes in these individuals. …"

Other

Other Treatments

The benefits of a camp designed for children with epilepsy: Evaluating adaptive behaviors over 3 years. (Epilepsy Behav. 2006) "CONCLUSION: A condition-specific camp designed for children with epilepsy can improve adaptive behaviors and social interactions. Overall net gains appear to increase over time, suggesting additional benefits for return campers."

Alternative approaches to conventional antiepileptic drugs in the management of paediatric epilepsy. (Arch Dis Child. 2006)

Electroconvulsive therapy in patients with epilepsy. (Epilepsy Behav. 2006)

Acupuncture for epilepsy. (Cochrane Database Syst Rev. 2006) "CONCLUSIONS: The current evidence does not support acupuncture as a treatment for epilepsy. Much larger high quality clinical trials employing appropriate controls are needed."

Experimental

Physical training decreases susceptibility to subsequent pilocarpine-induced seizures in the rat. (Epilepsy Res. 2006)

Radiotherapy

Supplements-Vitamins-CAM

Two randomized vitamin D trials in ambulatory patients on anticonvulsants: impact on bone. (Neurology. 2006) "CONCLUSIONS: In ambulatory adults on antiepileptic drugs, high-dose vitamin D therapy substantially increased bone mineral density at several skeletal sites. In children, both doses resulted in comparable increases in bone mass."

Tian ma, an ancient Chinese herb, offers new options for the treatment of epilepsy and other conditions (Epilepsy & Behavior 2006)

Surgery

Depression in temporal lobe epilepsy surgery patients: an FDG-PET study. (Epilepsia. 2006) " CONCLUSIONS: Although this study is methodologically limited, and other explanations merit consideration, orbitofrontal cortex dysfunction, already implicated in the pathophysiology of nonepileptic depression, may also be relevant to the depression of TLE and temporal lobectomy."

Long-term prognosis and psychosocial outcomes after surgery for MTLE. (Epilepsia. 2006) "CONCLUSIONS: The results of this study suggest that temporal lobe surgery has real long-term benefits. Two specific conclusions emerge: (a) the long-term rates of freedom from seizure depend on how seizure freedom is defined, and (b) the psychosocial long-term outcome does not change dramatically over years and does not depend on seizure freedom."

Corpus callosotomy in refractory idiopathic generalized epilepsy. (Seizure. 2006) "CONCLUSION: CC can be effective in reducing GTC, absence and myoclonic seizures in patients with refractory IGE. These findings suggest that interhemispheric communication of the cerebral cortices plays an important role in the generation of seizures in IGE. Anterior CC appears safe while complete callosotomy has a risk of disconnection syndrome."

Epilepsy surgery can lead to memory loss "Severe epilepsy that can't be controlled with anti-seizure medication may require a brain operation, but in such cases there's apparently a trade-off. Surgery, especially on the left temporal lobe, can results in long-term loss of verbal memory, Dutch researchers report."

Role of fMRI in the decision-making process: Epilepsy surgery for children. (J Magn Reson Imaging. 2006) "In our experience, fMRI has significantly contributed to the decision-making process, and improved the counseling and management of young people with intractable epilepsy."

Postoperative seizures after extratemporal resections and hemispherectomy in pediatric epilepsy (NEUROLOGY 2006) "Conclusions: Acute postoperative seizures (APOS) occur in 26% children, and the risk is higher after extratemporal cortical resection than hemispherectomy. APOS predict a poor postoperative seizure outcome at 6, 12, and 24 months. This study is useful for counseling families after epilepsy surgery. It also suggests that APOS may not be discounted as "benign" in research studies that evaluate seizure outcomes after epilepsy surgery."

Outcome and long term follow-up after corpus callosotomy in childhood onset intractable epilepsy. (Childs Nerv Syst. 2006)

Transplantation

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