Posts Tagged AED

[Abstract] Post-stroke epilepsy

Highlights

Post-stroke epilepsy (PSE) is a major complication after stroke.

It is unclear which treatments are most effective in the prevention of recurrence of symptoms, or whether such therapy is needed for primary prevention.

The current understanding of epidemiology, diagnoses, mechanisms, risk factors, and treatments of PSE are covered in this review.

Abstract

Post-stroke epilepsy (PSE) is a common complication after stroke, yet treatment options remain limited. While many physicians prescribe antiepileptic drugs (AED) for secondary prevention of PSE, it is unclear which treatments are most effective in the prevention of recurrence of symptoms, or whether such therapy is needed for primary prevention. This review discusses the current understanding of epidemiology, diagnoses, mechanisms, risk factors, and treatments of PSE.

Source: Post-stroke epilepsy

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[ARTICLE] Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy – Full Text

Abstract

BACKGROUND: Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response.

OBJECTIVE: To elucidate rates and predictors of seizure freedom with VNS.

METHODS: We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies.

RESULTS: Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom.

CONCLUSION: Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients.

 

Approximately 1% of the population has epilepsy, and seizures are refractory to antiepileptic drugs (AEDs) in approximately 30% of these individuals.1 Many patients with drug-resistant temporal or extratemporal lobe epilepsy can become seizure-free with surgical resection or ablation, but other patients with epilepsy are not candidates for resection given the presence of primary generalized seizures, nonlocalizable or multifocal seizure onset, or seizure onset from an eloquent brain region.2-5 Treatments based on neuromodulation, such as vagus nerve stimulation (VNS), have, therefore, become an increasingly important part of multimodal epilepsy treatment. VNS therapy was approved by the US Food and Drug Administration in 1997 as an adjunctive therapy for reducing seizures in patients with medically refractory epilepsy, and more than 80 000 patients have received treatment with VNS.6-8 The efficacy of VNS therapy has been evaluated by randomized controlled trials,9,10 retrospective case series,11,12 meta-analysis,13 and registry-based studies.14 These studies show that about 50% to 60% of patients achieve ≥50% reduction in seizure frequency after 2 years of treatment, and response rates increase over time, likely related to neuromodulatory effects with ongoing stimulation.13 Complete seizure freedom, however, is less common with VNS therapy and other neuromodulation treatment modalities.

Given that a minority of patients achieve seizure freedom with VNS, rates and predictors of seizure freedom have not been well studied and remain poorly understood. The vast majority of studies that evaluate VNS therapy focus on rate of response over time (defined as ≥50% reduction in seizures) and predictors of response; there has never been a large-scale evaluation of seizure freedom as a primary end point in patients treated with VNS. However, seizure freedom is the single best predictor of quality of life in patients with epilepsy,15,16 and therefore a better understanding of seizure freedom rates and predictors in patients treated with VNS therapy is critically needed. Importantly, this information may lead to improved patient selection and counseling in the treatment of drug-resistant epilepsy.

Here, we provide the first large-scale study of VNS therapy with a primary goal of defining seizure freedom rates and predictors, and comparing predictors of seizure freedom with those of overall response to treatment. Our study includes univariate and multivariate analyses of registry data including 5554 patients treated with VNS, and also includes a systematic review of the literature including 2869 patients across 78 studies, to help confirm registry-based results.

Continue —> Rates and Predictors of Seizure Freedom With Vagus Nerve Sti… : Neurosurgery

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[Abstract] The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma.

Abstract

Introduction: The withdrawal of antiepileptic drugs (AEDs) in World Health Organization (WHO) grade II-III glioma patients with epilepsy is controversial, as the presence of a symptomatic lesion is often related to an increased risk of seizure relapse. However, some glioma patients may achieve long-term seizure freedom after antitumor treatment, raising questions about the necessity to continue AEDs, particularly when patients experience serious drug side effects.
Areas covered: In this review, we show the evidence in the literature from 1990-2016 for AED withdrawal in glioma patients. We put this issue into the context of risk factors for developing seizures in glioma, adverse effects of AEDs, seizure outcome after antitumor treatment, and outcome after AED withdrawal in patients with non-brain tumor related epilepsy.
Expert commentary: There is currently scarce evidence of the feasibility of AED withdrawal in glioma patients. AED withdrawal could be considered in patients with grade II-III glioma with a favorable prognosis, who have achieved stable disease and long-term seizure freedom. The potential benefits of AED withdrawal need to be carefully weighed against the presumed risk of seizure recurrence in a shared decision-making process by both the clinical physician and the patient.

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Source: The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma – Expert Review of Neurotherapeutics –

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[WEB SITE] Seizure Decisions: After an unprovoked seizure, patients are often left wondering what’s next. A new guideline from a panel of epilepsy experts tries to answer that question.

Last September, Anthony Bonadio, 26, flew from New York to San Diego for a friend’s wedding. The morning after the wedding, he turned on the water for a shower—and the next thing he remembers is waking up in an ambulance. His friend, who was sharing the hotel room, says he heard a heavy thump followed by several more. He rushed to the bathroom and found Bonadio convulsing on the floor.

In October, after a long, stressful day playing piano in auditions for a Broadway musical, Nick Day, 23, went to bed and fell asleep. When he woke up, his girlfriend told him he’d had a seizure and an ambulance was on the way.

Both young men were examined by emergency department doctors, observed for a few hours, and sent home with orders to take it easy. Both were told that unprovoked seizures were quite common and that theirs may have been brought on by exhaustion.

AN UNCERTAIN FUTURE

Each year, an estimated 150,000 Americans experience unprovoked seizures—seizures without an obvious trigger like a blow to the head, a high fever, low blood sugar, or alcohol withdrawal. More than 50 percent of the time, patients will never have a second seizure, even though the cause of the first remains a mystery.

Neither Bonadio nor Day knew whether the seizure was an isolated incident or signaled the onset of epilepsy. Should they take antiepileptic drugs (AEDs) to reduce the risk of having a second seizure, or do nothing and hope they were among the percentage of patients who never have another seizure?

With such uncertainty common in medical practice, the American Academy of Neurology (AAN) and the American Epilepsy Society convened a panel of experts to review the available evidence and draft a guideline, published in the journal Neurology, to help patients and doctors decide what to do in the case of a first unprovoked seizure. The experts set out to answer three questions: If you have an unprovoked seizure, what is your risk of a second one? If you take an AED immediately after your first seizure, will this help you remain free of seizures in the long term? And are there any adverse side effects of AEDs that patients need to know about?

RISK OF A SECOND SEIZURE

The panel found that the overall risk of experiencing a second seizure within five years of a first unprovoked seizure ranged from 21 to 46 percent in different studies. Significantly, the greatest risk was within the first two years, so if patients hadn’t had a seizure after two years their risk dropped substantially. The panel also found that certain clinical factors doubled the risk of a subsequent seizure: a preexisting lesion or injury to the brain; an electroencephalogram (EEG) showing abnormal spikes or electrical discharges, called epileptiform signals; a significant abnormality on a magnetic resonance imaging (MRI) scan; or a nocturnal seizure.“

Between 20 and 50 percent of patients will have another seizure. That means 50 to 80 percent will not,” says Gary S. Gronseth, MD, a co-author of the guideline, a professor of neurology at the University of Kansas School of Medicine, a Fellow of the AAN, and a member of the Neurology Now editorial advisory board. “So, the patient has to make a decision: ‘Should I take medication every single day to help reduce my risk of another seizure?’”

DIFFERENT OUTCOMES

Day didn’t have to calculate his risk. He had a second seizure soon after the first, followed by four more. He was diagnosed with epilepsy and prescribed AEDs. He has been free of seizures since.

Bonadio, on the other hand, hasn’t had another seizure. However, his neurologist saw epileptiform signals on his first EEG, so Bonadio knows his risk of a second seizure and therefore of having epilepsy is higher than it would be for someone whose tests are normal. He’s still undecided about what to do.

Dr. Gronseth understands his dilemma. He suggests that patients crunch the numbers. “A good rule of thumb is that AEDs will reduce your risk of a seizure by half. So if your risk is 20 percent, drugs would make it 10 percent. If it’s 50 percent, taking AEDs would make it 25 percent.”

SIDE EFFECT CONSIDERATIONS

Another concern for Bonadio is the side effects of AEDs. Will they slow him down and make him less competitive in his high-stakes finance job?

Continue —>  Seizure Decisions: After an unprovoked seizure, patients are… : Neurology Now

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[ARTICLE] Epilepsy in patients with gliomas: Incidence and control of seizures

Abstract

Brain tumor-related epilepsy (BTRE) is a unique condition that is distinct from primary epilepsy. The aim of this retrospective study was to clarify the epidemiology and results of treatment of BTRE in a single institution.

From a database of 121 consecutive patients with supratentorial gliomas treated at Chiba Cancer Center from 2006–2012, the incidence and control of seizures before and after surgery were retrospectively evaluated.Epilepsy occurred in 33.9% of patients before surgery. All patients received prophylactic anti-epileptic drugs (AED) during surgery; however, seizures occurred in 9.1% of patients within the first postoperative week.

During follow-up, seizures occurred in 48.3% of patients. The overall incidence of seizures was

  • 73.7% in patients with World Health Organization Grade II gliomas,
  • 66.7% in those with Grade III and
  • 56.8% in those with Grade IV gliomas.

Levetiracetam was very well tolerated. However, carbamazepine and phenytoin were poorly tolerated because of adverse effects. AED were discontinued in 56 patients. Fifteen of these patients (26.8%) had further seizures, half occurring within 3 months and 80% within 6 months of AED withdrawal. No clinical factors that indicated it was safe to discontinue AED were identified. The unpredictable epileptogenesis associated with gliomas and their excision requires prolonged administration of AED. To maintain quality of life and to safely and effectively control the tumor, it is necessary to select AED that do not adversely affect cognitive function or interact with other drugs, including anti-cancer agents.

via Epilepsy in patients with gliomas: Incidence and control of seizures.

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WEB SITE: More Fetal Risks Linked to Epilepsy Drugs

More Fetal Risks Linked to Epilepsy Drugs.

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More Fetal Risks Linked to Epilepsy Drugs

…Fetal exposure to anti-epileptic drugs (AEDs) appears to carry risks beyond those congenital defects currently listed on the products’ labels, a researcher said here…

μέσω More Fetal Risks Linked to Epilepsy Drugs.

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[ARTICLE] Post-traumatic epilepsy: current and emerging treatment options – Full Text PDF or HTML

…Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence…

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μέσω Post-traumatic epilepsy: current and emerging treatment options | NDT.

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[WEB SITE] Seizures and Traumatic Brain Injury

Seizures and Traumatic Brain InjuryOne of the problems that can occur after a traumatic brain injury (TBI) is seizures. Although most people who have a brain injury will never have a seizure, it is good to understand what a seizure is and what to do if you have one. Most seizures happen in the first several days or weeks after a brain injury. Some may occur months or years after the injury. About 70-80% of people who have seizures are helped by medications and can return to most activities. Rarely, seizures can make you much worse or even cause death.

What are seizures?

Seizures happen in 1 of every 10 people who have a TBI that required hospitalization. The seizure usually happens where there is a scar in the brain as a consequence of the injury.

During a seizure there is a sudden abnormal electrical disturbance in the brain that results in one or more of the following symptoms:

  • Strange movement of your head, body, arms, legs, or eyes, such as stiffening or shaking.
  • Unresponsiveness and staring.
  • Chewing, lip smacking, or fumbling movements.
  • Strange smell, sound, feeling, taste, or visual images.
  • Sudden tiredness or dizziness.
  • Not being able to speak or understand others.

Symptoms of a seizure happen suddenly, and you are unable to control them. Seizures usually last only a few seconds or minutes, but sometimes continue for 5 to 10 minutes. You may have a bladder or bowel accident or bite your tongue or the inside of your mouth during a seizure. After the seizure, you may be drowsy, weak, confused or have a hard time talking to or understanding others. After a severe seizure, one that lasts longer than 2 minutes, it may be harder for you to stand, walk or take care of yourself for a few days or even longer.

Conditions that could increase the risk of having a seizure include:

  • High fever.
  • Loss of sleep and extreme fatigue.
  • Drug and alcohol use.
  • Chemical changes in the body such as low sodium or magnesium, or high calcium.

Seizures and TBI

  • Early post-traumatic seizures: A seizure in the first week after a brain injury is called an early post-traumatic seizure. About 25% of people who have an early post-traumatic seizure will have another seizure months or years later.
  • Late post-traumatic seizures: A seizure more than seven days after a brain injury is called a late post-traumatic seizure. About 80% of people who have a late post-traumatic seizure will have another seizure (epilepsy).
  • Epilepsy: Having more than one seizure is called epilepsy. More than half the people with epilepsy will have this problem for their whole lives.

The cause of your brain injury can help doctors figure out how likely you are to have seizures.

  • 65% of people with brain injuries caused by bullet wounds have seizures.
  • 20% of people with ‘closed head injuries’ that cause bleeding between the brain and the skull experience seizures. A ‘closed head injury’ means the skull and brain contents were not penetrated in the injury.
  • Over 35% of people who need 2 or more brain surgeries after a brain injury experience late post-traumatic seizures.

Medications to treat seizures

Medications that are used to control seizures are called antiepileptic drugs (AEDs). These drugs may be used for other problems, such as chronic pain, restlessness, or mood instability. You and your doctor will decide on which drug to use based on your type of seizures, your age, how healthy you are, and if you get any side effects from the medications. Side effects of AEDs usually improve after you’ve been taking the medication for 3-5 days.

Some common side effects of AEDs are:

  • Sleepiness or fatigue.
  • Worsening of balance.
  • Lightheadedness or dizziness.
  • Trembling.
  • Double vision.
  • Confusion.

Blood tests may be needed to make sure you are getting enough of the medication and to make sure the drug isn’t causing other problems. Although these drugs rarely cause birth defects in newborns, tell your doctor if you are pregnant or may become pregnant.

Sometimes your doctor will prescribe two or more of these medications to stop your seizures. Some common AEDs are:

  • Carbamazepine (also known as Tegretol).
  • Lamotrigine (also known as Lamictal).
  • Levitiracetam (also known as Keppra).
  • Gabapentin (also known as Neurontin).
  • Oxcarbazepine (also known as Trileptal).
  • Phenobarbital.
  • Phenytoin/ fosphenytoin (also known as Dilantin).
  • Pregabalain (also known as Lyrica).
  • Topiramate (also known as Topamax).
  • Valproic acid or valproate (also known as Depakene or Depakote).
  • Zonisamide (also known as Zonegran).

What if the medications do not work?

If your seizures continue even after trying medications, your doctor may refer you to a comprehensive Epilepsy Center for more tests and to be seen by special seizure doctors called epileptologists or neurologists specializing in epilepsy. At the comprehensive Epilepsy Center the doctors may do brain wave tests and take a video of you during one of your seizures to help figure out what is causing the problems. This may help your doctor decide what drug will work best, and to see if other types of treatment will help with the problems you are having.

The websites of the Epilepsy Foundation of America (www.efa.org)or the American Epilepsy Society (www.aesnet.org) can tell you about the nearest comprehensive Epilepsy Center.

Safety issues

In most states, if you have had a seizure you cannot drive and you must notify the department of motor vehicles (DMV). Usually you won’t be able to return to driving for a period of time, or until your seizures have been completely stopped. Laws vary from state to state regarding how long after a seizure you must not drive.

Other things you should do to stay safe if your seizures have not stopped:

  • Always have someone with you if you are in water (pool, lake, ocean, bath tub).
  • Don’t climb on ladders, trees, roofs or other tall objects.
  • Let people you eat with know what to do in case you have a seizure and start choking.

What your caregiver should do if you are having a seizure

Family members or caregivers should watch closely to see what happens during a seizure so they can explain it to medical professionals. They should make a diary describing the date, time of day, length of time, and description of each seizure. Your doctor will need this information about your seizures and the drugs you are taking to control them.

The majority of seizures are short and do not result in significant injuries. However, it is important for your caregivers to know what to do to keep you from hurting yourself.

What to do for someone having a seizure:

  • Loosen tight clothing, especially around the neck.
  • Make sure the person does not fall. Hold the person steady if he or she is in a chair, couch or bed. If the person is standing, get him or her to the ground safely.
  • Turn the person and his or her head to the side so that anything in the mouth, even spit, does not block the throat.
  • It can be dangerous to put anything in the mouth as you can get bitten.
  • If you know CPR, check the heart beat in the neck. Start CPR if there is no pulse. Call 911.
  • Listen for breathing at the mouth and extend the neck if breathing is difficult. If there is no breathing, start CPR by sealing your lips over the person’s mouth and breathing 2 quick breaths. Continue breathing every 5 seconds unless the person starts breathing without help. Call 911.
  • If this is the first seizure after TBI, call the person’s doctor for advice.
  • If the seizure does not stop after 3 minutes, call 911.
  • If the seizure stops within 3 minutes, call the person’s doctor.
  • If the person does not return to normal within 20 minutes after the seizure, call 911.

For More Information

The Epilepsy Foundation of America
Phone: 1-800-332-1000
Web: www.efa.org

Brain Injury Association of America
Phone: 1-800-444-6443
Web: www.biausa.org

References

  1. Diaz-Arrastia R, Agostini MA, Frol AB et al, Neurophysiologic and neuradiologic features of intractable epilepsy after traumatic brain injury in adults. Arch Neurol 2000; 57:1611-6.
  2. Englander J, Bushnik T, Duong TT et al, Analyzing risk factors for late posttraumtic seizures: a prospective, mulitcenter investigation. Arch Phys Med Rehabil 2003; 84: 365-373.
  3. Yablon SA, Dostrow VG. Post-traumatic seizures and epilepsy in Zasler ND, Katz DI, Zafonte RD, Brain Injury Medicine: Priciples and Practice. Demos, New York, 2007.
  4. Brain Trauma Foundation and American Association of Neurological Surgeons: Management and prognosis of severe traumatic brain injury 2000; pp 159-165.

 

Continue –> Seizures and Traumatic Brain Injury.

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[WEB SITE] UTHSC Researchers Find Link Between Incidence Of Epilepsy And Traumatic Brain Injury

…A new study by researchers at The University of Texas Health Science Center at San Antonio that reviewed the medical records of Afghanistan and Iraq war veterans who sustained traumatic brain injuries (TBIs), has revealed that subjects with mild TBIs (85 percent of veterans with such injuries) are approximately 28 percent more likely to develop epilepsy than individuals without TBIs…

μέσω UTHSC Researchers Find Link Between Incidence Of Epilepsy And Traumatic Brain Injury.

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