Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute psychological disorders (APDs) are more common in epilepsy than in the general population, with estimates varying from 2 to 16% depending on the population of patients sampled. APD has traditionally been classified by seizure activity (ictal), the early post-ictal period (post-ictal) and unrelated to seizure activity (inter-ictal). APD may also occur as a consequence of the use of antiepileptic drugs (AEDs). An ongoing prospective active surveillance system was utilised which surveys all neurologists and associated specialists in the United Kingdom run by the British Neurological Surveillance Unit (BNSU). Incident cases were ascertained, using the BNSU, for a period of 1 year and were defined as patients with epilepsy who developed an acute psychological disorder, whatever the cause, such as a psychosis or depression. Sixty-four cases were ascertained. The ages were between 17 and 69 (mean 36); there were 38 males and 26 females. The majority of patients had location-related epilepsy (52, 81%), either cryptogenic (29, 45%) or secondary to a symptomatic lesion (23, 36%), of which the most common were mesial temporal sclerosis (6, 9%) and trauma (4, 6%). Thirty-one (48%) patients were considered to have APD due to ictal or post-ictal activity. Thirty-three (52%) were inter-ictal. Carbamazepine was the most common AED prescribed (42, 66%), and of the new AEDs lamotrigine was prescribed in 17 patients (27%) and vigabatrin in 16 (25%). The APD in 19 (30%) patients was reported by the referring physician as being secondary to an AED. In 12 patients this was attributed to vigabatrin. However, the relative frequency of APD due to AEDs, or to the different new AEDs, could not accurately be calculated as this was not a true incidence study. In the 19 drug-related APD patients, there was no change in seizure frequency in 8 (42%) and in 7 (37%) the seizure frequency had decreased (in 3 (16%), ceasing altogether prior to the APD). In 4 of the 19 patients (21%) the seizure frequency increased. The overall outcome was good with 17/19 (89%) of the AED attributed cases resolving.
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PMID:Acute psychological disorders in patients with epilepsy: a nation-wide study. 888 70

Clinicians must consider the psychiatric issues relevant to patients undergoing neurosurgical procedures for epilepsy. Obtaining the patient's psychiatric history can facilitate stabilizing the patient's condition before operative intervention. Preoperatively, depressive and anxiety disorders are the most common psychiatric conditions diagnosed in candidates for surgical treatment of epilepsy. Although psychotic disorders occur infrequently, they demand attention because symptoms may interfere with patient compliance with follow-up care. Patients with chronic psychotic symptoms who have ongoing seizures postoperatively and bilateral seizure foci are at higher risk for a poor outcome and postoperative psychosis. When psychiatric disorders are present, surgical management is not contraindicated, but preoperative psychiatric intervention may be warranted. Most patients have a favorable outcome with the elimination of seizures, which simplifies the subsequent treatment of a psychiatric disorder.
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PMID:Psychiatric implications of surgical treatment of epilepsy. 894 96

The objective of this study was to compare the efficacy and tolerability of two new antiepileptic drugs, lamotrigine (LTG) and vigabatrin (GVG) in everyday clinical practice. A comprehensive retrospective survey of a computerized data base and hospital case notes was carried out at the Mersey Regional Epilepsy Clinic (MREC), Liverpool, which services a population of 3 million in the North West of England. The study comprised 333 out-patients with refractory epilepsy exposed to LTG and GVG forming a subset in a total population of 2250 patients with epilepsy held on a comprehensive database. The main outcome measures were duration of treatment with each drug described by a Kaplan-Meier survival curve, seizure control determined by a 50% decrease in seizure frequency and freedom from seizures, and incidence of adverse drug effects leading to discontinuation. The Kaplan-Meier curve indicated a 57% probability of patients continuing to take LTG and 43% GVG after 40 months. A 50% improvement in seizure control followed the addition of LTG in 45% of patients, with 10% seizure free, compared with 32% and 6%, respectively after the addition of GVG. LTG was discontinued because of adverse events (most frequently skin rash) in 15% of patients compared to GVG in 25% (particularly because of personality disturbance and psychiatric disorder). Both LTG and GVG are effective new AEDs in patients with refractory epilepsy, treated in a tertiary referral out-patient setting. LTG has a broader spectrum of antiepileptic efficacy for patients with both partial and idiopathic generalized seizures, whereas GVG should be reserved for patients with partial seizures at low risk of psychiatric disorder.
Seizure 1996 Dec
PMID:A survey comparing lamotrigine and vigabatrin in everyday clinical practice. 895 11

Psychopathology following epilepsy neurosurgery is a significant risk. Treatment modalities have not been addressed in the literature. As disproportionately elevated suicide rates have been reported, it is critical to treat aggressively any psychiatric illness wherein suicidal ideation is a key component. This case reports the safe utilization of electroconvulsive therapy (ECT) for intractable depression following epilepsy neurosurgery (24 references).
Seizure 1996 Dec
PMID:Electroconvulsive therapy (ECT) for intractable depression following epilepsy neurosurgery. 895 18

This article is the eighteenth installment of our annual review of research concerning the opiate system. It includes articles published during 1995 reporting the behavioral effects of the opiate peptides and antagonists, excluding the purely analgesic effects. The specific topics covered this year include stress: tolerance and dependence; eating; drinking; gastrointestinal, renal, and hepatic function; mental illness and mood; learning, memory, and reward; cardiovascular responses; respiration and thermoregulation; seizures and other neurological disorders; electrical-related activity; general activity and locomotion; sex, pregnancy, and development; immunological responses; and other behaviors.
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PMID:Endogenous opiates: 1995. 897 40

Conversion disorders are symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or medical condition. The psychological symptoms associated with the medical condition must be preceded by conflict or other stressors. We present an individual who developed conversion disorder and paraplegia secondary to a sterile epidural abscess near the tip of her surgically implanted, epidural morphine infusion pump. She manifested at varying times both transient bilateral blindness and pseudoseizures consistent with a diagnosis of conversion disorder. Neurological evaluation for seizure activity and meningitis were negative. The etiology of the sterile epidural abscess remained unknown. The essential features of conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, are discussed. Treatment of patients diagnosed with conversion disorder remains primarily supportive, with the focus on consistency and behavioral management. Extreme caution is suggested in regards to further investigations.
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PMID:Conversion disorder presenting in a patient with an implantable morphine pump and an epidural abscess resulting in paraplegia. 904 7

Major advances in understanding the neurobiology of epilepsy have led to more precise diagnosis, early rational treatment with new drugs, useful new neurosurgical techniques, etc. This has led to significant control of seizures, a marked reduction in concurrent psychopathology, improved quality of life of the epileptic patient, the almost complete abolition of old-style institutions for these patients, etc. However in spite of greater scientific knowledge about epilepsy, this has not led to an equally great advance socially. Old-fashioned restrictions and limitations based on mistaken ideas as to the nature of epilepsy still remain. Epilepsy is still considered in the same light as the psychopathological disorders seen in some epileptics, as a result of different variables which are not necessarily related to seizures. Current legal rulings on epilepsy, with or without co-existing mental disorder, are reviewed in relation to their effect on driving motor vehicles, carrying out military service, the condition of minusvalia, the possibility of legal incompetence, and the nullity of marriage and of priesthood. It is concluded that although the limitations maintained by some statutory requirements are reasonable, it would be fairest to abolish restrictions which, in view of present scientific knowledge, are out of date and prevent the return to normal and full social integration which should prevail for people with epilepsy.
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PMID:[Legal aspects of epilepsy and coexisting psychiatric disorders]. 914 83

Electroconvulsive therapy (ECT) is used in adolescent psychiatric practice, yet few studies have been conducted to assess its use for 13-19-year-olds. Efficacy, indications, side effects, technical characteristics, and outcome are uncertain. We retrospectively reviewed the medical records of 21 adolescents treated with bilateral ECT in our department from 1984 through 1995. In our series, ECT was effective in treating both maniac and depressive episodes, with a high rate of relapse at 1 year follow-up (approximately 40%). Clinical improvement was only partial and in schizophrenia and schizoaffective episodes. Seizure threshold was associated with gender, but not with the cumulative number of treatments. Adverse effects were frequent, but were usually transient with only moderate discomfort, even in patients with concomitant medical problems. We conclude that ECT is a safe and effective treatment for adolescents with severe and intractable mental illness, and it has the same indications and effects as in adults.
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PMID:Use of electroconvulsive therapy in adolescents. 915 85

Epilepsy management may need to be modified in certain patient groups. The management of epilepsy in all age-groups, and particularly in children, may be best approached from a disease-based model that recognizes specific epilepsy syndromes. Accurate diagnosis of pediatric epilepsy syndromes allows the physician to improve medication selection, estimate duration of treatment, and counsel patients and family members about aggravating factors and prognosis. Epilepsy management in elderly patients requires knowledge of age-related changes in the metabolism and protein binding of anticonvulsants and how these changes affect use of particular antiepileptic drugs. Concurrent medical illness, especially renal and hepatic disease, may alter drug distribution, metabolism, and excretion in some patients. In addition, a number of medications used to treat coexistent medical or psychiatric illness are associated with seizure provocation. Knowledge of these factors can improve epilepsy management in special patient populations.
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PMID:Seizures in special populations. Children, the elderly, and patients with coexistent medical illness. 922 85

An increased number of adults with mental retardation are living in the community and seeking health care from family physicians. When mentally retarded patients are enrolled in a medical practice, guardianship status should be determined, but these patients should be involved in their own care to as great an extent possible. Since a verbal history may be difficult to obtain, a systematic, thorough physical examination is important. Certain Illnesses, such as hepatitis B, recurrent aspiration syndrome, leukemia and atlantoaxial instability, are much more common in adults with Down syndrome then in adults with mental retardation from other causes. Seizures and mental illness are equally common in all mentally retarded adults. The behavior management and pharmacologic therapy of patients with mental retardation are best handled in close association with caregivers, as well as psychiatrists and neurologists who are familiar with the special needs of this population.
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PMID:Primary care of adults with mental retardation living in the community. 955 40


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