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Idrish Ali, Arun Gandrathi, Thomas Zheng, Margaret J Morris, Terence J O'Brien, Chris French
OBJECTIVES: Neuropeptide Y (NPY) potently suppresses spike-wave discharges (SWDs) in a genetic rat model of absence epilepsy (GAERS), but the underlying neurophysiologic mechanisms are not clear. We therefore sought to determine the in vivo effects of NPY on neuronal firing in the cortico-thalamo-cortical network activity, known to play a critical role in the generation of SWDs in these rats. METHODS: NPY was administered intracerebroventricularly (ICV) or in separate experiments locally on the neurons of caudal thalamic reticular nucleus (NRT) by use of juxtacellular iontophoresis in triple-barrel electrodes in male GAERS aged 12-15 weeks, in vivo under neuroleptic anesthesia...
June 20, 2018: Epilepsia
Omar Hikmat, Karin Naess, Martin Engvall, Claus Klingenberg, Magnhild Rasmussen, Chantal M E Tallaksen, Eylert Brodtkorb, Torunn Fiskerstrand, Pirjo Isohanni, Johanna Uusimaa, Niklas Darin, Shamima Rahman, Laurence A Bindoff
OBJECTIVE: Epilepsy is common in individuals with mutations in POLG, the gene encoding the catalytic subunit of the mitochondrial DNA polymerase gamma. Early recognition and aggressive seizure management are crucial for patient survival. Disruption of the blood-brain barrier (BBB) is implicated in various neurological disorders including epilepsy. The aim of this study was to assess whether POLG-related disease is associated with BBB dysfunction and what clinical implications this has for patients...
June 19, 2018: Epilepsia
Alain Lekoubou, Kinfe G Bishu, Bruce Ovbiagele
OBJECTIVE: The purpose of this study was to evaluate health care expenditures among elderly patients with epilepsy in the United States. METHODS: We performed an analysis of weighted 37 738 607 US participants aged 65 years to estimate health care expenditures in the elderly with and without epilepsy using the Medical Expenditure Panel Survey Household Component, with 2003-2014 data. Unadjusted health care expenditures were estimated. Independent health care expenditures were estimated, using a 2-part model...
June 19, 2018: Epilepsia
Rosa Michaelis, Venus Tang, Laura H Goldstein, Markus Reuber, William Curt LaFrance, Tobias Lundgren, Avani C Modi, Janelle L Wagner
Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy...
June 19, 2018: Epilepsia
Torbjörn Tomson, Olafur Sveinsson, Sofia Carlsson, Tomas Andersson
Prompted by a recent report on declining incidence of sudden unexpected death in epilepsy (SUDEP) following implantation of a vagus nerve stimulator (VNS), we analyzed SUDEP risk over 6 years in a population-based cohort of 60 952 epilepsy patients in Sweden. All deaths from July 1, 2006 through December 31, 2011, were identified. Those with epilepsy mentioned on the death certificate were adjudicated for SUDEP using medical records and autopsy reports. In all, 292 SUDEP cases were identified. Comparing the first years (2006-2007) with the subsequent 4 years (2008-2011), the crude and standardized (to the US 2000 population) incidence of SUDEP (whether or not possible SUDEP was included) was significantly lower during the second time period; Incidence rate ratios based on standardized rates was estimated at 0...
June 15, 2018: Epilepsia
Magnhild Kverneland, Ellen Molteberg, Per O Iversen, Marit B Veierød, Erik Taubøll, Kaja K Selmer, Karl O Nakken
OBJECTIVE: Ketogenic diets reduce seizures in children with drug-resistant epilepsy. Whether adults benefit from similar treatment has not been clarified. We therefore examined the efficacy of the modified Atkins diet in adults with drug-resistant focal epilepsy. METHODS: We performed a randomized clinical trial (RCT) with patients >16 years who had at least 3 seizures per month despite having tried at least 3 antiepileptic drugs. They were randomized to either 12 weeks on the modified Atkins diet (diet group) or habitual diet (control group)...
June 14, 2018: Epilepsia
Jodi L Pawluski, Mathieu Kuchenbuch, Sarah Hadjadj, Gabriel Dieuset, Nathalie Costet, Laurent Vercueil, Arnaud Biraben, Benoît Martin
Childhood absence epilepsy (CAE) is one of the most frequent epilepsies in infancy. The first-line recommended therapy for CAE is based on the prescription of the narrow-spectrum ethosuximide and the broad-spectrum valproic acid, which have similar efficacy in the first 12 months. Nevertheless, some antiepileptic drugs (AEDs) may worsen seizure duration and type in this syndrome. In line with this, we have encountered a case of identical twins with CAE and early exposure to different antiseizure drugs leading to divergent outcomes...
June 14, 2018: Epilepsia
Arjune Sen, Patricia Dugan, Piero Perucca, Daniel Costello, Hyunmi Choi, Carl Bazil, Rod Radtke, Danielle Andrade, Chantal Depondt, Sinead Heavin, Jane Adcock, W Owen Pickrell, Ronan McGinty, Fábio Nascimento, Philip Smith, Mark I Rees, Patrick Kwan, Terence J O'Brien, David Goldstein, Norman Delanty
OBJECTIVE: There is little detailed phenotypic characterization of bilateral hippocampal sclerosis (HS). We therefore conducted a multicenter review of people with pharmacoresistant epilepsy and bilateral HS to better determine their clinical characteristics. METHODS: Databases from 11 EPIGEN centers were searched. For identified cases, clinicians reviewed the medical notes, imaging, and electroencephalographic (EEG), video-EEG, and neuropsychometric data. Data were irretrievably anonymized, and a single database was populated to capture all phenotypic information...
June 14, 2018: Epilepsia
Manuela Contin, Francesca Bisulli, Margherita Santucci, Roberto Riva, Francesca Tonon, Susan Mohamed, Lorenzo Ferri, Carlotta Stipa, Paolo Tinuper
We prospectively examined the effect of antiepileptic (AED) cotherapy on steady state plasma concentrations of perampanel (PMP) in epileptic patients. We classified AEDs as strong enzyme inducers (carbamazepine, phenobarbital, phenytoin, oxcarbazepine), not strong enzyme inducers/not inhibitors (levetiracetam, lamotrigine, topiramate, rufinamide, lacosamide, zonisamide, clobazam), and enzyme inhibitors (valproic acid [VPA]). The main outcome was the comparison of PMP plasma concentration to weight-adjusted dose ratio (C/D; [μg/mL]/mg kg-1  d-1 ) among comedication subgroups...
June 13, 2018: Epilepsia
Brady S Moffett, Mindl M Weingarten, Marianne Galati, Jennifer L Placencia, Emily A Rodman, James J Riviello, Simon Y Kayyal
OBJECTIVE: Phenobarbital is frequently used in pediatric patients for treatment and prophylaxis of seizures. Pharmacokinetic data for this patient population is lacking and would assist in dosing decisions. METHODS: A retrospective population pharmacokinetic analysis was designed for all pediatric patients <19 years of age initiated on phenobarbital at our institution from January 2011 to June 2017. Patients were included if they were initiated on intravenous or enteral phenobarbital for treatment or prophylaxis of seizures and had a serum phenobarbital concentration monitored while an inpatient...
June 13, 2018: Epilepsia
Jason S Naftulin, Omar J Ahmed, Giovanni Piantoni, Jean-Baptiste Eichenlaub, Louis-Emmanuel Martinet, Mark A Kramer, Sydney S Cash
OBJECTIVE: The treatment of focal epilepsies is largely predicated on the concept that there is a "focus" from which the seizure emanates. Yet, the physiological context that determines if and how ictal activity starts and propagates remains poorly understood. To delineate these phenomena more completely, we studied activity outside the seizure-onset zone prior to and during seizure initiation. METHODS: Stereotactic depth electrodes were implanted in 17 patients with longstanding pharmacoresistant epilepsy for lateralization and localization of the seizure-onset zone...
June 13, 2018: Epilepsia
Fenglai Xiao, Lorenzo Caciagli, Britta Wandschneider, Josemir W Sander, Meneka Sidhu, Gavin Winston, Jane Burdett, Karin Trimmel, Andrea Hill, Christian Vollmar, Sjoerd B Vos, Sebastien Ourselin, Pamela J Thompson, Dong Zhou, John S Duncan, Matthias J Koepp
OBJECTIVE: To investigate the effects of sodium channel-blocking antiepileptic drugs (AEDs) on functional magnetic resonance imaging (fMRI) language network activations in patients with focal epilepsy. METHODS: In a retrospective study, we identified patients who were treated at the time of language fMRI scanning with either carbamazepine (CBZ; n = 42) or lamotrigine (LTG; n = 42), but not another sodium channel-blocking AED. We propensity-matched 42 patients taking levetiracetam (LEV) as "patient-controls" and included further 42 age- and gender-matched healthy controls...
June 13, 2018: Epilepsia
Julie W Dreier, Liselotte Petersen, Carsten B Pedersen, Jakob Christensen
OBJECTIVE: This study aims to examine the association between maternal age, paternal age, and parental age difference at the time of birth and the risk of epilepsy in the offspring. METHODS: We carried out a prospective population-based register study of all singletons born in Denmark between 1981 and 2012. Cox regression was used to estimate hazard ratios (HRs) of epilepsy and their corresponding 95% confidence intervals (CIs), adjusted for relevant confounders...
June 13, 2018: Epilepsia
Martin Holtkamp, William H Theodore
Generic antiepileptic drugs (AED) are significantly cheaper than brand name drugs, and may reduce overall health care expenditures. Regulatory bodies in Europe and North America require bioequivalence between generic and innovator drugs with regard to area under the plasma concentration-time curve (AUC) and peak plasma concentration (Cmax ); strict cutoff values have been defined. The main issue is if bioequivalence ensures therapeutic equivalence. Are switches from brand to generic, or between generic AEDs entirely safe or potentially harmful in patients with epilepsy? We summarized and evaluated the available evidence from bioequivalence, health care utilization, and clinical studies on safety of generic AEDs...
June 12, 2018: Epilepsia
Jeremy Jost, Voa Ratsimbazafy, Thu Trang Nguyen, Thuy Linh Nguyen, Hanh Dufat, Annabelle Dugay, Alassane Ba, Guilhem Sivadier, Yattussia Mafilaza, Cyril Jousse, Mounir Traïkia, Martin Leremboure, Emilie Auditeau, Adeline Raharivelo, Edgard Ngoungou, Symon M Kariuki, Charles R Newton, Pierre-Marie Preux
OBJECTIVE: Epilepsy is a major public health issue in low- and middle-income countries, where the availability and accessibility of quality treatment remain important issues, the severity of which may be aggravated by poor quality antiepileptic drugs (AEDs). The primary objective of this study was to measure the quality of AEDs in rural and urban areas in 3 African countries. METHODS: This cross-sectional study was carried out in Gabon, Kenya, and Madagascar. Both official and unofficial supply chains in urban and rural areas were investigated...
June 12, 2018: Epilepsia
Cristian Donos, Joshua Breier, Elliott Friedman, Patrick Rollo, Jessica Johnson, Lauren Moss, Stephen Thompson, Melissa Thomas, Omotola Hope, Jeremy Slater, Nitin Tandon
OBJECTIVES: Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique for focal epilepsy. A major appeal of LITT is that it may result in fewer cognitive deficits, especially when targeting dominant hemisphere mesial temporal lobe (MTL) epilepsy. To evaluate this, as well as to determine seizure outcomes following LITT, we evaluated the relationships between ablation volumes and surgical or cognitive outcomes in 43 consecutive patients undergoing LITT for MTL epilepsy...
June 12, 2018: Epilepsia
Dongmei Wu, Lang Chen, Fayuan Ji, Yang Si, Hongbin Sun
OBJECTIVE: To investigate the effects of antiepileptic drugs (AEDs; oxcarbazepine [OXC], levetiracetam [LEV], and lamotrigine [LTG]) on semen quality, sexual function, and sex hormones in male adults with epilepsy. METHODS: Individual treatment with OXC, LEV, or LTG was randomly assigned to 38 newly diagnosed male adult patients with epilepsy. Semen quality and sex hormones were measured before treatment and 6 months after taking the medicine. A questionnaire was administered using the International Index of Erectile Function Scale-5 and the Premature Ejaculation Diagnostic Tool Self-Assessment Scale to evaluate sexual function, followed by an analysis of the comparison between the treated patients and healthy volunteers (healthy controls) as well as the changes and differences between the patients themselves before and after treatment...
June 11, 2018: Epilepsia
Arsen S Hunanyan, Ashley R Helseth, Elie Abdelnour, Bassil Kherallah, Monisha Sachdev, Leeyup Chung, Melanie Masoud, Jordan Richardson, Qiang Li, J Victor Nadler, Scott D Moore, Mohamad A Mikati
OBJECTIVE: Na+ /K+ -ATPase dysfunction, primary (mutation) or secondary (energy crisis, neurodegenerative disease) increases neuronal excitability in the brain. To evaluate the mechanisms underlying such increased excitability we studied mice carrying the D801N mutation, the most common mutation causing human disease, specifically alternating hemiplegia of childhood (AHC) including epilepsy. Because the gene is expressed in all neurons, particularly γ-aminobutyric acid (GABA)ergic interneurons, we hypothesized that the pathophysiology would involve both pyramidal cells and interneurons and that fast-spiking interneurons, which have increased firing rates, would be most vulnerable...
June 11, 2018: Epilepsia
Kenneth A Myers, Luis E Bello-Espinosa, Joseph D Symonds, Sameer M Zuberi, Robin Clegg, Lynette G Sadleir, Jeffrey Buchhalter, Ingrid E Scheffer
OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a tragic and devastating event for which the underlying pathophysiology remains poorly understood; this study investigated whether abnormalities in heart rate variability (HRV) are linked to SUDEP in patients with epilepsy due to mutations in sodium channel (SCN) genes. METHODS: We retrospectively evaluated HRV in epilepsy patients using electroencephalographic studies to study the potential contribution of autonomic dysregulation to SUDEP risk...
June 6, 2018: Epilepsia
Ayham M Alkhachroum, Clio Rubinos, Benjamin R Kummer, Neal S Parikh, Monica Chen, Abhinaba Chatterjee, Alexandra Reynolds, Alexander E Merkler, Jan Claassen, Hooman Kamel
OBJECTIVE: Seizures can be provoked by systemic diseases associated with metabolic derangements, but the association between liver disease and seizures remains unclear. METHODS: We performed a retrospective cohort study using inpatient and outpatient claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. The primary exposure variable was cirrhosis, and the secondary exposure was mild, noncirrhotic liver disease. The primary outcome was seizure, and the secondary outcome was status epilepticus...
June 6, 2018: Epilepsia
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