Epilepsy
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Epilepsy
NIH - Medical Encyclopedia Epilepsy
"Some seizures are idiopathic, which means the cause can not be identified. Such seizures usually being between age 5 and 20, but can occur at any age. People with this condition have no other neurological problems, but often have a family history of seizures or epilepsy. Disorders affecting the blood vessels, such as stroke and TIA, are the most common cause of seizures after age 60. Degenerative disorders such as senile dementia Alzheimer type can also lead to seizures.
Some of the more common causes of seizures include:
Developmental problems, genetic conditions present at birth, or injuries near birth (seizures usually begin in infancy or early childhood)
Metabolic abnormalities may affect people of any age and may be a result of:
o Diabetes complications o Electrolyte imbalances o Kidney failure, uremia (toxic accumulation of wastes) o Nutritional deficiencies o Phenylketonuria (PKU) -- can cause seizures in infants o Other metabolic diseases, such as inborn error of metabolism o Use of cocaine, amphetamines, alcohol, or certain other recreational drugs o Withdrawal from alcohol o Withdrawal from drugs, particularly barbiturates and benzodiazepines
Brain injury o Most common in young adults o Seizures usually begin within 2 years after the injury o Early seizures (within 2 weeks of injury) do not necessarily mean that chronic (ongoing) seizures (epilepsy) will develop
Tumors and brain lesions (such as hematomas) o May affect any age but are more common after age 30 o Partial (focal) seizures most common to start with o May lead to generalized tonic-clonic seizures
Infections o May affect people of all ages o May be a reversible cause of seizures o Brain infections like meningitis and encephalitis can produce seizures o Brain abscess o Acute severe infections of any part of the body o Chronic infections (such as neurosyphilis) o Complications of AIDS or other immune disorders.
Seizure disorders affect about 0.5% of the population. Approximately 1.5-5.0% of the population may have a seizure in their lifetime. Epilepsy can affect people of any age."
Highlighted Article
Refractory Epilepsy: Clinical Overview (Epilepsia 2007)
"The incidence of refractory epilepsy remains high despite the influx of many new antiepileptic drugs (AEDs) over the past 10 years. Epidemiological data indicate that 2040% of the patients with newly diagnosed epilepsy will become refractory to treatment. Factors that may be used to predict whether or not a patient will respond favorably to AED therapy include the type of epilepsy, underlying syndrome, etiology, and the patient's history of seizure frequency, density, and clustering. Environmental factors, such as trauma and prior drug exposure, and genetic factors that predetermine the rate of absorption, metabolism, and uptake of a drug by target tissue may also uniquely impact an individual and influence their response to AED therapy."
Featured Internet Site
NIH - Medical Encyclopedia Seizures
"What to expect at your health care provider's office: The doctor will perform a physical examination and ask questions to help understand the cause of the seizures, such as: Did it occur or start on one side of the body? Was there movement of the muscles and if so, what was the pattern? Are there any risk factors (such as recent head injury)? Was consciousness maintained during the seizure? How long did the seizure last? What are the frequency of the seizures? Was there any warning (aura) of the seizures? Were there any other symptoms present (visual changes, abnormal smells)? The following diagnostic tests may be performed: CT scan of the head or MRI of the head EEG Lumbar puncture Blood tests"
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Notes
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Epilepsy
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Teratogenic effects of antiepileptic drugs. (Seizure. 2007) The use of older generation antiepileptic drugs (AEDs) during pregnancy is known to be associated with a two- to threefold increased risk of birth defects in the offspring and possible also other adverse outcomes in the exposed infant. Much less has been known about newer generation AEDs in this respect. Recent studies based on national registries as well as specific epilepsy and pregnancy registries are beginning to provide information on comparative teratogenic effects of different AEDs.
Cognitive/behavioral teratogenetic effects of antiepileptic drugs (Epilepsy & Behavior 2007)
Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy (Acta Neurologica Scandinavica 2007) "Conclusion In conclusion, although uncommon, a possible induction of non-convulsive status epilepticus by valproate-induced hyperammonemic encephalopathy should be taken into account and properly managed by discontinuation of the drug."
Hyperconnectivity of Local Neocortical Microcircuitry Induced by Prenatal Exposure to Valproic Acid. (Cereb Cortex. 2007)
Negative effects of antiepileptic drugs on mood in patients with epilepsy. (Drug Saf. 2007) "Antiepileptic drugs can negatively affect mood and behaviour by different mechanisms: potentiation of GABA neurotransmission, folate deficiency, pharmacodynamic interactions with other antiepileptic drugs in polytherapy regimens, forced normalisation. Individuals with a personal or family history of depression should be carefully followed after initiation of therapy with a new antiepileptic drug, especially if structural brain abnormalities such as hippocampal sclerosis are present."
[AED-induced osteopathy. Subtypes, pathogenesis, prevention, early diagnosis and treatment] (Dtsch Med Wochenschr. 2007)
Antiepileptic drugs and visual function. (Pediatr Neurol. 2007)
Metabolic and Hormonal Disturbances in Women with Epilepsy on Antiepileptic Drug Monotherapy. (Epilepsia. 2007)
General Practitioners and Women Still Not Getting Valproate Message "In utero exposure to the anticonvulsant drug valproate increases the risk for poor cognitive outcomes and anatomical malformations compared with the 3 other most commonly used anticonvulsant medications. However, with a 28% rise in US sales last year, it appears general practitioners (GPs) and women of childbearing potential still are not getting the message, a leading neurologist says."
Development of psychosis in patients with epilepsy treated with lamotrigine: Report of six cases and review of the literature. (Epilepsy Behav. 2007)
The adverse effects of antiepileptic drugs in children. (Expert Opin Drug Saf. 2007)
Epilepsy Drug Can Increase Risk for Newborns, Study Says "Toddlers who had been exposed in the womb to the drug Depakote, from Abbott Laboratories, scored seven to eight points lower on I.Q. tests at age 2 than those whose mothers had been taking other epilepsy drugs while pregnant, the study found. They were twice as likely to score in the range associated with mental retardation, according to the authors, who presented the findings at the annual meeting of the American Academy of Neurology in Boston."
Is valproate encephalopathy under-recognised in older people? A case series (Age and Ageing 2007) "Conclusions: older people may be at particular risk of VE because of co-morbid pathology, age-related metabolic changes and co-medication."
Valproate, weight gain and carbohydrate craving: A gender study (Seizure 2007)
A 6-month longitudinal study of bone mineral density with antiepileptic drug monotherapy (Epilepsy & Behavior 2007)
Teratogenesis of sodium valproate. (Curr Opin Neurol. 2007) "SUMMARY: There is undoubtedly a phamacogenetic component to sodium valproate's teratogenic and neurodevelopmental effects."
Valproic acid-induced pancreatitis: 16 new cases and a review of the literature. (J Gastroenterol. 2007)
Psychiatric and behavioral side effects of the newer antiepileptic drugs in adults with epilepsy (Epilepsy & Behavior 2007) "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."
Second-generation antiepileptic drugs' impact on balance: a meta-analysis. (Mayo Clin Proc. 2007) "CONCLUSION: Second-generation AEDs at standard dosages, except for gabapentin and levetiracetam, increase the imbalance risk, and evidence exists for a dose-response effect. The mechanisms, risk factors, and consequences of this risk for individual AEDs warrant further study."
Homocysteine and bone loss in epilepsy (Seizure 2007) "Epidemiological studies reveal fracture incidence in epilepsy is twice that of the normal population. Much interest has been focused on Vitamin D, however, considering mixed results on non-enzyme inducing anti-epileptic drugs (AEDs) and bone mineral density (BMD) additional metabolic effects may be to blame. AEDs increase serum homocysteine (s-Hcy) by lowering blood folate levels. An association between elevated homocysteine, BMD and increased fracture incidence has been found in non-epilepsy populations."
Valproic Acid Aggravates Epilepsy due to MELAS in a Patient with an A3243G Mutation of Mitochondrial DNA. (etab Brain Dis. 2007) " Our experience suggests that valproic acid should be avoided for the treatment of epilepsy in individuals with mitochondrial disease."
Valproate, weight gain and carbohydrate craving: A gender study. (eizure. 2007) "CONCLUSION: Women are more prone to gain weight during VPA therapy though higher frequency of diet and sociopsychological burden than men, which might possibly be related to leptin-resitance and a higher frequency of carbohydrate craving."
The effects of valproate exposure in utero on behavior and the need for educational support in school-aged children (Epilepsy & Behavior 2007)
Valproic Acid: second generation. (Neurother. 2007) "Valproic acid is one of the four most widely prescribed antiepileptic drugs (AEDs) and is effective (and regularly approved) in migraine prophylaxis and in the treatment of bipolar disorders. Valproic acid is also currently undergoing clinical trials in cancer patients. Valproic acid is the least potent of the established AEDs and its use is limited by two rare but potentially life-threatening side effects, teratogenicity and hepatotoxicity. Because AEDs treat the symptoms (seizure) and not the cause of epilepsy, epileptic patients need to take AEDs for a long period of time. Consequently, there is a substantial need to develop better and safer AEDs."
The Effects of Carbamazepine, Valproic Acid and Phenobarbital on the Oxidative and Antioxidative Balance in Epileptic Children (European Neurology 2007) "Conclusion: Epileptic children exposed to oxidative stress and conventional antiepileptic drugs change the oxidative/antioxidative balance. The serum oxidant and antioxidant status of epileptic children with valproic acid monotherapy are better regulated compared with children with carbamazepine and phenobarbital monotherapy."
Drugs
Topiramate in the treatment of partial and generalized epilepsy (Neuropsychiatric Disease and Treatment 2007) Although it is usually safe and well-tolerated, adverse effects limit use in about 25% of patients. The most salient of these is cognitive dysfunction, especially problems with expressive speech and verbal memory. Weight loss, renal stones, paresthesias and other central nervous system side effects may occur. Tolerability is improved by low initial doses and slow titration to effect.
Topiramate: a review of its use in the treatment of epilepsy. (Drugs. 2007)
Pharmacotherapy of epilepsy: New armamentarium, new issues (Journal of Clinical Neuroscience 2007)
Use of the newer antiepileptic drugs in pediatric epilepsies. (Curr Treat Options Neurol. 2007)
Seizure-Free Outcome in Randomized Add-on Trials of the New Antiepileptic Drugs. (Epilepsia. 2007)
Clinical use of antiepileptic drugs at a referral centre for epilepsy. (Seizure. 2007)
Valproate is an effective, well-tolerated drug for treatment of status epilepticus/serial attacks in adults (Acta Neurol Scand 2007) "VPA seems to be a safe, effective treatment of SE/SA, but efficacy is dependent on time lapse between symptoms and VPA treatment, and administration of a sufficiently high loading dose."
The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. (Lancet. 2007) "INTERPRETATION: Lamotrigine is clinically better than carbamazepine, the standard drug treatment, for time to treatment failure outcomes and is therefore a cost-effective alternative for patients diagnosed with partial onset seizures."
The anaesthetic and intensive care of status epilepticus. (Curr Opin Neurol. 2007)
Slight improvement in mood and irritability after antiepileptic drug withdrawal: A controlled study in patients on monotherapy. (Epilepsy Behav. 2007) "CONCLUSION: The results suggest that seizure-free patients with epilepsy on monotherapy can obtain a slight improvement in symptoms characteristic of depression and irritability if they discontinue treatment with AEDs. The described changes are limited, and the functional impact is of uncertain significance."
The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial (The Lancet 2007) "Valproate is better tolerated than topiramate and more efficacious than lamotrigine, and should remain the drug of first choice for many patients with generalised and unclassified epilepsies. However, because of known potential adverse effects of valproate during pregnancy, the benefits for seizure control in women of childbearing years should be considered."
Treatment of convulsive status epilepticus in infants and young children in Japan (Acta Neurologica Scandinavica 2007)
[Newer antiepileptic drugs] (No To Shinkei. 2007)
Therapeutic monitoring of antiepileptic drugs for epilepsy. (ochrane Database Syst Rev. 2007) " AUTHORS' CONCLUSIONS: We found no clear evidence to support routine antiepileptic drug serum concentration measurement with the aim of reaching predefined target ranges for the optimisation of treatment of patients with newly-diagnosed epilepsy with antiepileptic drug monotherapy. However, this does not exclude the possible usefulness of therapeutic drug monitoring of specific antiepileptic drugs during polytherapy, in special situations or in selected patients, although evidence is lacking."
Corticosteroids including ACTH for childhood epilepsy other than epileptic spasms. (ochrane Database Syst Rev. 2007) " AUTHORS' CONCLUSIONS: No evidence was found for the efficacy or safety of corticosteroids in treating childhood epilepsies. Clinicians using steroids in childhood epilepsies, other than for epileptic spasms, should take this into account before using these agents."
Topiramate in frontal lobe epilepsy. (cta Neurol Scand. 2007)
Exercise
General Information
Which patients become seizure free with antiepileptic drugs? An observational study in 821 patients with epilepsy. (Acta Neurol Scand. 2007)
Treatment of nonconvulsive status epilepticus. (Int Rev Neurobiol. 2007)
Mechanisms of action of antiepileptic drugs. (Int Rev Neurobiol. 2007)
First, do no harm: the risks of overtreating children with epilepsy. (Arq Neuropsiquiatr. 2007)
How reliable is early treatment response in predicting long-term seizure outcome? (Epilepsy Behav. 2007) "The main conclusion is that response at 6 months is an excellent predictor of response at 12 months."
Management of epilepsy in children with autism (Current Paediatrics 2007)
[Epilepsy and rehabilitation] (Tidsskr Nor Laegeforen. 2007)
Opinion of Belgian neurologists on antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET). (cta Neurol Scand. 2007) "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."
Guidelines
Treatment of status epilepticus in adults: guidelines of the italian league against epilepsy. (Epilepsia. 2006)
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
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 - Vitamin and Mineral Supplement Fact Sheets
Nutrition
When do seizures usually improve with the ketogenic diet? (Epilepsia 2007) "Discussion: The KD works quickly when effective, typically within the first 12 weeks. Starting the KD after a fasting period may lead to a more rapid, but equivalent long-term seizure reduction, confirming prior reports. If the KD has not led to seizure reduction after 2 months, it can probably be discontinued."
A Prospective Study of the Modified Atkins Diet for Intractable Epilepsy in Adults (Epilepsia 2007)
[The role of the ketogenic diet in the management of epilepsy] (Rocz Panstw Zakl Hig. 2007)
Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children. (Arq Neuropsiquiatr. 2007)
[Therapeutic approach to epilepsy from the nutritional view: current status of dietary treatment.] (Neurologia. 2007)
Kidney stones and the ketogenic diet: risk factors and prevention. (J Child Neurol. 2007) "Kidney stones continue to occur in approximately 1 in 20 children on the ketogenic diet, and no statistically significant risk factors were identified in this cohort. As oral potassium citrate was preventative, prospective studies using this medication empirically are warranted."
A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet (Epilepsy & Behavior 2007)
The neuropharmacology of the ketogenic diet. (Pediatr Neurol. 2007)
Anticonvulsant mechanisms of the ketogenic diet. (Epilepsia. 2007)
Clinical aspects of the ketogenic diet. (Epilepsia. 2007)
Use of a modified atkins diet in intractable childhood epilepsy. (Epilepsia. 2007)
Ketogenic Diet Improves Sleep Quality in Children with Therapy-resistant Epilepsy. (Epilepsia. 2007) "Conclusion: KD decreases sleep and improves sleep quality in children with therapy-resistant epilepsy. The improvement in sleep quality, with increased REM sleep, seems to contribute to the improvement in QOL."
Anticonvulsant Mechanisms of the Ketogenic Diet (Epilepsia 2007)
Vitamin D Status in Children with Intractable Epilepsy, and Impact of the Ketogenic Diet (Epilepsia 2007)
Discontinuing the Ketogenic Diet in Seizure-Free Children: Recurrence and Risk Factors (Epilepsia 2007) "About 10% of children become seizure-free after initiation of the ketogenic diet, and typically stop the diet after 2 yr. A retrospective chart review was performed of all children who became seizure-free on the ketogenic diet at our institution since 1993 and then discontinued the diet. Thirteen (20%) had recurrence of their seizures at a median of 2.4 yr (range: 05.5 yr) after the diet was stopped. Seven (58%) became seizure-free a second time, four with anticonvulsant therapy. Four patients (6%) continue to have daily seizures despite both medication and dietary therapies."
Other
Other Treatments
Brain stimulation for epilepsy. (Acta Neurochir Suppl. 2007)
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Pattern and frequency of use of complementary and alternative medicine among patients with epilepsy in the midwestern United States (Epilepsy & Behavior 2007)
Carnitine as an antidote for acute valproate toxicity in children. (Curr Opin Pediatr. 2007)
Pattern and frequency of use of complementary and alternative medicine among patients with epilepsy in the midwestern United States. (Epilepsy Behav. 2007) "Thirty-nine percent reported using CAM; 25% reported using CAM specifically for their epilepsy. Prayer/spirituality was the most commonly used form of CAM (46%), followed by "mega" vitamins (25%), chiropractic care (24%), and stress management (16%). CAM use is common among midwestern patients with epilepsy, although the pattern of use may be slightly different than in other regions of the United States and elsewhere."
Natural approaches to epilepsy. (Altern Med Rev. 2007) "In most cases, nutritional therapy is not a substitute for anticonvulsant medications. However, in selected cases, depending on the effectiveness of the interventions, dosage reductions or discontinuation of medications may be possible."
Surgery
Life 12 years after temporal lobe epilepsy surgery: A long-term, prospective clinical study. (Seizure. 2007)
Surgery Insight: Surgical Management of Epilepsy (Nat Clin Pract Neurol. 2007)
Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy. (Seizure 2007)
Epilepsy Surgery in Children: Results and Predictors of Outcome on Seizures. (Epilepsia. 2007)
Surgical treatment for acute symptomatic refractory status epilepticus: a case report. (J Child Neurol. 2007)
Worsening of quality of life after epilepsy surgery (NEUROLOGY 2007) "Conclusions: After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery."
Stopping antiepileptic drugs after epilepsy surgery: A survey of U.S. epilepsy center neurologists (Epilepsy & Behavior 2007)
Role of Surgery in Pediatric Epilepsy (Indian Pediatrics 2007)
Corpus Callosotomy for Treatment of Pediatric Epilepsy in the Modern Era (Pediatric Neurosurgery 2007)
Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients (Child's Nervous System 2007)
Refractory occipital lobe epilepsy treated by surgery in a child with chronic encephalitis. (Pediatr Neurosurg. 2007)
Hemispherectomy for intractable epilepsy in adults: The first reported series. (Ann Neurol. 2007)
Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects (Brain 2007)
Stopping antiepileptic drugs after epilepsy surgery: A survey of U.S. epilepsy center neurologists. (Epilepsy Behav. 2007)
The seizure outcome after amygdalohippocampectomy and temporal lobectomy (European Journal of Neurology 2007)
Psychiatric disorders in temporal lobe epilepsy patients over the first year after surgical treatment. (Seizure. 2007) "CONCLUSIONS: Surgery in TLE patients does not worsen the global psychopathological status. Presurgical psychiatric morbidity was found to be related to the presence of psychiatric disorders after surgery. Specific psychiatric assessment should be made before and after surgery."
Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. (Brain. 2007) "These data underscore the importance of appropriate selection of potential surgical candidates."
Transplantation
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