Epilepsy

Objectives : Psychiatric symptoms and disorders are commonly reported with epilepsy. This study aimed to determine the prevalence of interictal psychosis (IIP) in adults with epilepsy and its risk predictors. Methods : The study included 710 patients (mean age: 36.40 years; age at onset: 13.58 years; duration of epilepsy: 22.80 years). All underwent neurological and psychiatric interviewing, electroencephalography and brain imaging. Results : IIP was reported in 20.65%, of them 50% had temporal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic, 42...

No abstract text is available yet for this article.

The diagnosis of epilepsy is incorrect in up to 20% of cases so should be revisited if attacks are not responding to treatment. We present a case of long QT syndrome that remained undiagnosed in the epilepsy clinic for 15 years until a near-fatal arrhythmia revealed the diagnosis and allowed effective treatment of her attacks. We hope this near miss raises awareness of long QT syndrome as a potentially fatal, rare but treatable condition that neurologists must consider in people with a label of refractory epilepsy...

OBJECTIVE: To compare the cost-effectiveness of genetic testing strategies in patients with epilepsy of unknown etiology. METHODS: This meta-analysis and cost-effectiveness study compared strategies involving 3 genetic tests: chromosomal microarray (CMA), epilepsy panel (EP) with deletion/duplication testing, and whole-exome sequencing (WES) in a cost-effectiveness model, using "no genetic testing" as a point of comparison. RESULTS: Twenty studies provided information on the diagnostic yield of CMA (8 studies), EP (9 studies), and WES (6 studies)...

OBJECTIVE: To identify people with epilepsy who will not achieve a 12-month seizure remission within 5 years of starting treatment. METHODS: The Standard and New Antiepileptic Drug (SANAD) study is the largest prospective study in patients with epilepsy to date. We applied a recently developed multivariable approach to the SANAD dataset that takes into account not only baseline covariates describing a patient's history before diagnosis but also follow-up data as predictor variables...

The progressive myoclonic epilepsies (PMEs) are a group of symptomatic generalised epilepsies caused by rare disorders, most of which have a genetic component, a debilitating course, and a poor outcome. Challenges with PME arise from difficulty with diagnosis, especially in the early stages of the illness, and further problems of management and drug treatment. Recent advances in molecular genetics have helped achieve better understanding of the different disorders that cause PME. We review the PMEs with emphasis on updated genetics, diagnosis, and therapeutic options...

PURPOSE OF REVIEW: Epilepsy neuroimaging is important for detecting the seizure onset zone, predicting and preventing deficits from surgery and illuminating mechanisms of epileptogenesis. An aspiration is to integrate imaging and genetic biomarkers to enable personalized epilepsy treatments. RECENT FINDINGS: The ability to detect lesions, particularly focal cortical dysplasia and hippocampal sclerosis, is increased using ultra high-field imaging and postprocessing techniques such as automated volumetry, T2 relaxometry, voxel-based morphometry and surface-based techniques...

No abstract text is available yet for this article.

Psychosis in epilepsy can be categorized in relation to seizures in two main categories: interictal psychosis and postictal psychosis. Postictal psychosis (PIP) is a specific syndrome in relation to seizure activity: a clear temporal relation exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures. However, this very specific syndrome is not included as such within the DSM-5, and PIP belongs to the category "Psychotic disorder due to another medical condition"...

Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which potential etiopathogenic mechanisms are believed to be closely related to a seizure disorder. POE can present as interictal psychotic episodes, which may often differ semiologically from primary schizophrenic disorder. They may present as ictal or postictal psychotic episodes and may be the expression of an iatrogenic process to pharmacologic and/or surgical interventions.Epilepsy and POE have a complex and bidirectional relation, as not only are patients with epilepsy at greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy...

The classification of epileptic seizures and the epilepsies has recently been revised by the International League Against Epilepsy (ILAE) and a new classification scheme issued. Areas covered: The new classification scheme has been critically appraised in the light of the previous classifications and subsequent revisions. The purposes of the classification and its potential use have been extensively discussed. Expert commentary: This ILAE classification scheme, the latest of a series of proposals published in the last 30 years, has made progress as it has a multi-level structure (seizure types, epilepsy types, epilepsy syndromes) allowing for differing uses and combines the previously separate seizure types and epilepsies schemes into a single instrument...

The psychoses of epilepsy can be classified according to their temporal relationship with seizures, namely as ictal, postictal and interictal psychosis. Interictal psychosis is the most common and may resemble schizophrenia. They can be challenging to diagnose and to manage, especially given the perception that some antipsychotic drugs may exacerbate seizures, while some antiepileptic medications may worsen psychosis. The current uncertainty around their best management means that some patients may not receive appropriate care...

PURPOSE OF REVIEW: To describe the most important issues a clinician must consider whenever selecting and administering antiepileptic drugs (AEDs). There is no available algorithm that identifies how to individualize selection of AEDs. Proper selection and administration can make an enormous difference in both effectiveness and tolerability. RECENT FINDINGS: Many principles of AED selection remain unchanged. Selection of AEDs must be based on understanding of epilepsy syndrome and seizure type, comorbidities, risk of adverse events, as well as on patient characteristics such as age and sex...

PURPOSE OF REVIEW: This review identifies the diverse and variable clinical presentations associated with epilepsy that may create challenges in diagnosis and treatment. RECENT FINDINGS: Epilepsy has recently been redefined as a disease characterized by one or more seizures with a relatively high recurrence risk (ie, 60% or greater likelihood). The implication of this definition for therapy is that antiepileptic drug therapy may be initiated following a first seizure in certain situations...

PURPOSE OF REVIEW: This review presents recent developments in the clinical features, immunologic basis, and treatment options for autoimmune encephalitis, seizures, and epilepsy. RECENT FINDINGS: In addition to the expansion of our knowledge on classic paraneoplastic limbic encephalitis with onconeural antibodies, recent years have witnessed the development of the category of encephalitis associated with antibodies directed toward neuronal surface antigens. Antibodies against the voltage-gated potassium channel are, in fact, directed toward an array of targets within a large molecular complex...

PURPOSE OF REVIEW: Optimal treatment of a possible first seizure depends on the determination if the paroxysmal event was an epileptic seizure and was on an accurate assessment of the recurrence risk. This review summarizes evidence from the last 5 years addressing the following questions: Is it an epileptic seizure? Is it a first seizure? When does a first seizure indicate epilepsy? RECENT FINDINGS: The acts of taking and interpreting the history from patients and witnesses continue to be the most important tools in the diagnosis of first seizures...

No abstract text is available yet for this article.

Autoimmune encephalitides may account for epilepsies of so far unknown cause. These "autoimmune epilepsies" may respond well to immunotherapy. More than a dozen autoantibodies have been found with this constellation; therefore, broad autoantibody testing of serum-CSF pairs offers the best diagnostic yield. Several particular features raise the suspicion of an autoimmune cause in otherwise unexplained seizure disorders.

BACKGROUND: People with epilepsy who became seizure-free while taking antiepileptic drugs might consider discontinuing their medication, with the possibility of increased quality of life because of the elimination of adverse events. The risk with this action, however, is seizure recurrence. The objectives of our study were to identify predictors of seizure recurrence and long-term seizure outcomes and to produce nomograms for estimation of individualised outcomes. METHODS: We did a systematic review and meta-analysis, and identified eligible articles and candidate predictors, using PubMed and Embase databases with a last update on Nov 6, 2014...

OBJECTIVE: The intravenous formulation of lacosamide (LCM) and its good overall tolerability and safety favor the use in status epilepticus (SE). The aim of this systematic review was to identify and evaluate studies reporting on the use of LCM in SE. METHODS: We performed a systematic literature search of electronic databases using a combined search strategy from 2008 until October 2016. Using a standardized assessment form, information on the study design, methodologic framework, data sources, efficacy, and adverse events attributed to LCM were extracted from each publication and systematically reported...