Archive for category Epilepsy

[Abstract] Therapeutic Drug Monitoring of Antiepileptic Drugs in Epilepsy: A 2018 Update



Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment. Since 1989, 18 new AEDs have been licensed for clinical use and there are now 27 licensed AEDs in total for the treatment of patients with epilepsy. Furthermore, several AEDs are also used for the management of other medical conditions, e.g., pain and bipolar disorder. This has led to an increasingly widespread application of therapeutic drug monitoring (TDM) of AEDs, making AEDs among the most common medications for which TDM is performed. The aim of this review is to provide an overview of the indications for AED TDM, to provide key information for each individual AED in terms of the drug’s prescribing indications, key pharmacokinetic characteristics, associated drug-drug pharmacokinetic interactions and the value and the intricacies of TDM for each AED. The concept of the reference range is discussed as well as practical issues such as choice of sample types (total vs free concentrations in blood vs saliva) and sample collection and processing.


The present review is based on published articles and searches in PubMed and Google Scholar, last searched March in 2018, in addition to references from relevant papers.


In total, 171 relevant references were identified and used to prepare this review.


TDM provides a pragmatic approach to epilepsy care in that bespoke dose adjustments are undertaken based on drug concentrations so as to optimize clinical outcome. For the older first generation AEDs (carbamazepine, ethosuximide, phenobarbital, phenytoin, primidone and valproic acid), much data has accumulated in this regard. However, this is occurring increasingly for the new AEDs (brivaracetam, eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, perampanel, piracetam, pregabalin, rufinamide, stiripentol, sulthiame, tiagabine, topiramate, vigabatrin and zonisamide).

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[BOOK Chapter] Epilepsy Imaging -Abstract+References| SpringerLink


Epilepsy is one of the most frequent chronic neurological disorder. The role of neuroimaging is crucial in identifying the causal lesion, as its characterization may play a major role for referring the patients to surgery. This chapter reviews the role of MRI in epilepsy, with a special focus on focal intractable epilepsies. A standard protocol is ineffective for epilepsy imaging. By contrast, an optimized protocol carried out by a neuroradiologist experienced in epilepsy imaging and guided by clinical and electroclinical data on a high field magnet improves the detection of the causal lesion. Advanced sequences such as double inversion recovery, arterial spin labeling, or relaxometry can especially be useful for localizing and characterizing the epileptogenic zone. Hippocampal sclerosis is the most frequent cause of intractable temporal epilepsy, and focal cortical dysplasia is the most frequent extratemporal lesion. Functional MRI and diffusion tensor are crucial when planning a surgical treatment.


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[WEB SITE] Cannabis Oil for Epilepsy – What You Need to Know

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[WEB SITE] Christiana Care Health System opens first Epilepsy Monitoring Unit in Delaware


To increase access to advanced neurological care, Christiana Care Health System has opened the first Epilepsy Monitoring Unit (EMU) in the First State.

Specially outfitted private hospital rooms in the Transition Neuro Unit at Christiana Hospital provide state-of-the-art equipment for video and audio monitoring. In the rooms, brain waves are tracked with electroencephalography (EEG) and electrical activity in the heart is recorded with electrocardiography (EKG), helping clinicians understand what is happening during a seizure. To further enhance safety, nurses assist patients whenever they are out of their bed. And patients wear mobility vests that connect to a stationary lift, a system that allows patients to move around a room – and prevents them from falling if they have a seizure. This is one of the few EMUs in the U.S. that uses a patient lift to prevent falls.

Epilepsy is a central nervous system disorder, in which brain activity becomes abnormal, leading to seizures or periods of unusual behavior, sensations or loss of awareness. The U.S. Centers for Disease Control and Prevention report that there are 3.4 million Americans with epilepsy and there is a growing incidence of the disease among the adult population in Delaware, especially among people 60 and older.

“Our community deserves the very best in neurological care,” said Valerie Dechant, M.D., physician leader, Neuroscience Service Line, and medical director, Neurocritical Care and Acute Neurologic Services. “Our new Epilepsy Monitoring Unit will enable us to serve the complex neurologic needs of our adult patients.”

Christiana Care’s EMU is part of a larger effort to establish an epilepsy center of excellence, so adults of any age can receive the highest quality routine and specialty care for seizure disorders.

“We want to help patients who believe they have been over-diagnosed or under-diagnosed so they can see improvement in their lives,” said Neurologist John R. Pollard, M.D., medical director of the new EMU.

While most patients with epilepsy are successfully treated by a general neurologist or epileptologist, a significant number of patients have persistent fainting or seizure episodes – or they have unwanted side effects from medications. This new facility enables physicians to work more closely with these patients to understand their seizures and determine appropriate treatment.

“Typically, these patients visit an EMU where they may stay for several days so they can be safely taken off medications, inducing seizures that are recorded and studied so a proper diagnosis and treatment can be planned,” said Christy L. Poole, RN, BSN CRNI CCRC, a neurosciences program manager. Visiting an EMU to induce a seizure could be a source of anxiety for patients and their families.

“Our staff works with patients and families to reduce any fear by providing information on what to expect, stressing procedures that enhance patient safety and making the stay as pleasant as possible,” said Susan Craig, MSN, RNIII-BC, epilepsy clinical nurse practice coordinator.

via Christiana Care Health System opens first Epilepsy Monitoring Unit in Delaware

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[Slideshow] Updated Clinical Guidelines on the Ketogenic Diet in Children with Epilepsy

The International Ketogenic Diet Study Group has released new clinical guidelines on the ketogenic diet in children with epilepsy.[1] The updated recommendations are the first change since the original guidelines on the subject were published almost 10 years ago.[2]

The Slideshow —> Updated Clinical Guidelines on the Ketogenic Diet in Children with Epilepsy | Neurology Times

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[WEB SITE] Rates of Pregnancy, Live Births Similar Among Women With and Without Epilepsy

Sexual activity and rates of ovulation were also similar among women with epilepsy and those without the disorder.

Sexual activity and rates of ovulation were also similar among women with epilepsy and those without the disorder.

Women with epilepsy who are seeking to become pregnant and have no known infertility or related disorders have a similar probability of achieving pregnancy, time to pregnancy, and live birth rates as do women without epilepsy, according to the results of the observational Women With Epilepsy Pregnancy Outcomes and Deliveries prospective cohort study ( identifier: NCT01259310), which was published in JAMA Neurology.

The investigators sought to examine whether women with epilepsy with no prior diagnosis of infertility or a related disorder were as likely to become pregnant within 12 months as their peers without epilepsy. A cohort of women with epilepsy and healthy controls who were seeking pregnancy were enrolled at 4 academic medical centers in the United States and were followed for up to 21 months. Participants between 18 and 40 years of age who were seeking pregnancy were enrolled within 6 months of having discontinued contraception. Data were evaluated from November 2015 to June 2017.

The primary study outcome was the proportion of women who attained pregnancy within 12 months after enrollment. Secondary outcomes included time to pregnancy, pregnancy outcomes, sexual activity, rates of ovulation, and analysis of disease-related factors in women with epilepsy.

A total of 197 women were included in the study — 89 with epilepsy and 108 controls. Overall, 72.1% of the participants were white. The mean age of the women was 31.9±3.5 years in those with epilepsy and 31.1±4.2 years in the controls. Among the women with epilepsy, 60.7% (54 of 89) achieved pregnancy compared with 60.2% (65 of 108) of those without epilepsy. The median time to attaining pregnancy did not differ significantly between the groups (women with epilepsy: 6.0 months; 95% CI, 3.8-10.1; controls: 9.0 months; 95% CI, 6.5-11.2; =.30).

Sexual activity and rates of ovulation were also similar among women with epilepsy and those without the disorder. Overall, 81.5% (44 of 54) of pregnancies in women with epilepsy and 81.5% (53 of 65) of pregnancies in women without epilepsy resulted in live births.

The investigators concluded that the results of this study should help reassure and encourage women with epilepsy without a prior diagnosis of infertility or an associated disorder, as well as their clinicians, when planning to become pregnant, based on the similar times to achieving pregnancy and similar pregnancy outcomes reported.


Pennell PB, French JA, Harden CL, et al. Fertility and birth outcomes in women with epilepsy seeking pregnancy [published online April 30, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.0646

via Rates of Pregnancy, Live Births Similar Among Women With and Without Epilepsy

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[WEB SITE] List of Seizures (Convulsions) Medications (60 Compared) –

Medications for Seizures (Convulsions)

Other names: Absence Seizure; Complex Partial Seizure; Fits

About Seizures:  A seizure or convulsion can be a sudden, violent, uncontrollable contraction of a group of muscles. A seizure can also be more subtle, consisting of only a brief “loss of contact” or a few moments of what appears to be daydreaming.


Drugs Used to Treat Seizures

The following list of medications are in some way related to, or used in the treatment of this condition.[…]

For the list of medications, Visit Site —> List of Seizures (Convulsions) Medications (60 Compared) –

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[WEB SITE] Tele-Epilepsy and Remote Seizure Monitoring – Case Study

Case Study

Tele-Epilepsy and Remote Seizure Monitoring using Shimmer Sensors


Shimmer offers a wireless sensor platform along with low power connections and host software to enable researchers, whether clinical, applied or academic, to use wearable sensing technologies in many different applications.

Research Objective

The World Health Organization calls epilepsy a chronic noncommunicable disorder of the brain. It is known to affect more than 50 million people all over the world.

Researchers from the Netherlands are currently studying the role of Tele-Epilepsy and Remote Seizure Monitoring, using the Shimmer platform. The research is a joint project between UMC Utrecht, Kempaenhaeghe-Heeze, and SEIN-Zwolle. The aims of the study are:

Detection and alarm triggering when a major nocturnal epileptic seizure occurs: this is done using an integrated Multi-Sensor Detection Instrument (MSDI) which uses a combination of electrocardiography (ECG) and 3-D accelerometry data. This data is collected with the help of Shimmer sensors, with linkage to audio and automated video frame analysis.

Research Method

The objective of this project is to bring out a new device that uses multiple modes of sensing to detect the occurrence of nocturnal epileptic seizures as well as to set off an alarm so as to alert caregivers in this case. The system uses an MSDI which uses Shimmer sensors, audio signals and video streams, yielding both ECG and 3-D accelerometry data.

A diagnostic trial was first conducted to arrive at the best combinations of patient factors and sensory modalities from among the four used in the MSDI, which could reliably detect a seizure. The groups targeted by the study included children under 16 who were staying at home, adolescents who were mentally challenged, and adults living under care, either at home or in another care environment.

Two Shimmer sensors were used per patient, with the accelerometer worn on the right upper arm and the accelerometer-ECG combination on the left upper arm. The data arriving from the sensors was fed to a PC which integrated the input and sent an alarm if the resulting output went beyond the set threshold. Real-time video and audio streams were set up between the PC and a monitoring device.

Data-Driven Results

The Shimmer sensors were preferred in this study because they were easily adaptable as well as being capable of being set to required configurations. The researchers were able to take advantage of the open platform and its easy interfacing with developer tools such as MATLAB, which was not easily available with other providers at the time of the research at a price which was competitive.

The images below show the MSDI as well as the algorithms that the team developed to analyze the four signal modalities with some examples of acquired data. This was taken from recordings of two patients, the one on the left showing a tonic seizure and that on the right a tonic-clonic seizure.

Concept to Delivery – 90% Efficiency

The choice of the Shimmer platform was based upon the CE certification, among other reasons. This hardware was already classified as a medical device, which made it possible to integrate it into a model used for research on human patients, unlike other research projects.

The MSDI using Shimmer sensors has now been tested in more than 50 patients who were in hospital, in four different centers, comparing the yield against the gold-standard for EEG-video monitoring which is the established method to monitor patients who may potentially develop seizures. This reliance upon EEG-video monitoring is because of the reliability of neural feedback in this type of event.

However, this research was favorably assessed in the hospital setting before being tested on patients who were at home. The latest study also showed excellent results with 90% efficacy in detecting nocturnal seizures as compared to the EEG monitoring technology. More work remains to be done, including refining the software which runs real-time analysis of the data, integrating the sensor data and validating the results in this domestic situation.

Shimmer Research – Sensing Solved

While many solutions compete for place in this niche, Shimmer boasts of advanced technology, supporting software and specialized applications which help to control the type of data that is acquired.

This in turn helps researchers look into how to interpret the data collected by the Shimmer platform, as well as to develop new algorithms to make sense of the kinematic and physiological data that pours in with these tools.

In summary, the benefits of using Shimmer technology include:

  • Shimmer suits most research applications because of its ability to help arrive at the meaning of the raw data, and apply this meaning for the benefit of patients and their caregivers
  • Shimmer solutions reduce the time taken for development of an application and its cost by 80%
  • Shimmer technology yields data that is high-quality, robust and accurate
  • The solution is easy to customize to specific applications
  • It gives the researcher full control over what data is captured, as well as over its interpretation and analysis
  • Shimmer solutions can be leveraged with the range of vital support tools available
  • Shimmer solutions are used by a wide range of researchers, both independent, as well as in collaboration with academic and research institutes

About ShimmerShimmer

Since the Shimmer technology was originally conceived in 2006, to when the company was founded in 2008, we have been pioneering wearable sensor technology and solutions, and currently ship to over 80 countries worldwide.


Shimmer is an ‘end-to-end’ wearable technologies services and sensor manufacture company, that constantly provides best-in-class wearable sensing technology, combined with leading experience and expertise to our customers right across the globe. Our solutions and services range from customization services and volume manufacture to complete wearable sensing solutions of any complexity.

Our Services Include

Shimmer offers full customization of our wearable sensor technology to meet your specific application and end user requirement, with low cost, quick-turn development builds

Consultancy & Systems Integration

Expertise in evaluating, rationalizing and integrating wearable sensing solutions, effectively from initial concept to successful integration with wider systems

Application Development

Our experienced applications Engineers meet the most ambitious and complex requirement from embedded programming, firmware development data processing and display

Custom Design & Manufacture

Hardware evaluation, design and volume manufacture to meet your requirements. Incorporating virtual prototyping and interactive feedback from our ISO accredited production line

Engagement and Development Framework: We offer a range of engagement and pricing models to meet our clients’ diverse needs and stage of business growth. All projects are based upon an agreed and detailed specification of work to ensure the requirements are effectively communicated at all stages of the development cycle.

Sponsored Content Policy: publishes articles and related content that may be derived from sources where we have existing commercial relationships, provided such content adds value to the core editorial ethos of News-Medical.Net which is to educate and inform site visitors interested in medical research, science, medical devices and treatments.

Last updated: Jun 7, 2018 at 8:07 AM

via Tele-Epilepsy and Remote Seizure Monitoring

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[Study] Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study – Full Text

Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants.

Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA.

Results: A total of 292 patients (mean age 40.8 years, range 18–86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL.

Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.


Epilepsy is a common and chronic neurological disorder that affects about 39 million people worldwide (12). People with epilepsy are subject to social and vocational stigma, have only restricted access to the labor market and significantly reduced employment opportunities (3). Moreover, quality of life (QoL) is significantly reduced for themselves and their caregivers (49). Active epilepsy with persisting seizures is associated with loss of consciousness, uncontrolled movements, falls or periictal abnormal behavior may predispose to accidents and injuries such as burns, contusions, lacerations or fractures (1012).

A prospective longitudinal analysis from Finland on 245 children with epilepsy since 1964 showed a significantly increased age- and sex-adjusted mortality. During the 40-year follow up, 60 (24%) subjects died and 33 (55%) of these events were attributed to the underlying epilepsy. Besides sudden unexpected death in epilepsy (SUDEP) and status epilepticus, epilepsy-related injuries and accidents (ERIA), such as peri-ictal drowning, were common causes of death. Within this cohort, pneumonia, cardiovascular diseases and suicide have been reported as most frequent causes of death not related to seizures or epilepsy (1315). ERIA were shown to be a major cost factor for hospitalizations among patients with epilepsy (16). One major problem with ERIA is unreported cases in daily practice. If not investigated in detail, it can be assumed that approximately 50% of ERIA are falsely not documented as seizure-related in medical documentation (17).

The main aim of our study was to assess the frequency and types of ERIA in a cohort of consecutive patients with epilepsy using a validated questionnaire (18) and to search for variables associated with ERIA. Improved screening parameters for ERIA may help in reducing the frequency and severity of ERIA. A second aim was to assess QoL and depression as possible consequences of ERIA.[…]


Continue —>  Frontiers | Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study | Neurology

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[NEWS] New epilepsy target discovered – European Biotechnology

French researchers have found a key driver of chronic epilepsy.

As 30% of patients with epilepsy do not respond to current antiepileptic drugs, finding targets that help suppress the initiation and propagation of seizures in the brain is crucial. Epilepsies are characterized by recurrent seizures, which disrupt normal brain function. Alterations in neuronal excitability and excitation-inhibition balance have been shown to promote seizure generation, yet molecular determinants of such alterations remain to be identified. Results of Elena Dossi and colleagues from INSERM Paris now suggest that inhibiting pannexin channels with drugs already approved for the treatment of gout and malaria could serve as a new therapeutic strategy for non responders to standard therapies.

Pannexin channels are nonselective, large-pore channels mediating extracellular exchange of neuroactive molecules. Recent data suggest that these channels are activated under pathological conditions and regulate neuronal excitability, i.e. in stroke. However, whether pannexin channels sustain or counteract chronic epilepsy in human patients was unknown.

Using brain tissue samples from patients with epilepsy undergoing surgical resection and a mouse model of epilepsy the French researchers showed that the membrane channel pannexin-1 contributes to seizure activity. They analyzed 42 postoperative brain tissue samples obtained from surgical resection of epileptogenic zones in patients suffering from lesional or drug-resistant epilepsy and found that pannexin-1 channels contributed to epileptic activity in the samples. Pannexin-1 channel activation promoted seizure generation and maintenance through adenosine triphosphate signaling via purinergic 2 receptors. Pharmacological inhibition of pannexin-1 channels with probenecid or mefloquine—two medications currently used for treating gout and malaria, respectively—blocked ictal discharges in human cortical brain tissue slices. Furthermore, mice lacking the gene that encodes for pannexin-1 channels were less prone to seizures when exposed to the pro-epileptic compound kainic acid compared to control animals.


via New epilepsy target discovered – European Biotechnology

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