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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After a complete review of the literature the AA. found that the results of the researches about the withdrawal of anticonvulsant therapy in epileptics were discordant. In order to investigate predicting criteria in terms of relapses, four hundred and fifty-seven epileptic children were followed up for a least three years (mean = 4,7 years) after drug withdrawal to determine the frequency of relapses and to discern any prognostic criteria. Each child had at least three separate a febrile seizures before the age of fifteen. Both primary and secondary forms have been considered. Clinical records were analyzed retrospectively to determine which factors were associated with recurrent seizures. The factors evaluated were: 1) types of seizures, 2) age of onset of seizures, 3) kind of therapy, 4) severity of seizure disorder, 5) age of the last seizure, 6) duration of therapy, 7) seizure-free period before drug withdrawal, 8) age of interruption of anticonvulsive therapy, 9) kind of discontinuation and 10) electroencephalography patterns. Statistically significant relationship was found between the type of seizure and the risk of relapse. Relapse rates were lowest in petit-mal epilepsy (2,6%) and in grandmal attacks (13,2%). The highest rate was in children with organic forms (26,2%) and with multiple seizure types (37,5%). A striking relationship was observed between increased risk of recurrence and a short seizure-free period before drug withdrawal and a short duration of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Suspension of antiepilepsy therapy in subjects with epilepsy starting in early childhood]. 682 63

Sedative-hypnotic antiepileptic drugs have potentially toxic effects, but their removal is often thought to be difficult and dangerous. We completely withdrew all barbiturates and benzodiazepines from 78 patients with intractable epilepsy (48 inpatients and 30 outpatients). Initially, 19 patients had plasma levels of sedative drugs above the therapeutic range; 28 were taking more than one of these drugs. Dosages of nonsedative antiepileptic drugs were adjusted to provide optimal seizure control. After 6 months of outpatient follow-up, 69 patients remained on a nonsedative regimen: 35 (51%) showed improvement in both drug toxicity and seizure control, 13 (19%) in toxicity alone, 8 (12%) in seizure control alone; 12 (16%) were unchanged, and 1 was worse. Of 9 patients restarted on sedative antiepileptic drugs by their private physicians, 4 had more toxic symptoms than at discharge, 1 had more frequent seizures, 3 were unchanged, and 1, who had had a temporal lobectomy after drug withdrawal, had less frequent seizures. Sedative drugs are not necessary for optimal seizure control, even in intractable epilepsy, and they may be safely withdrawn.
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PMID:Removal of sedative-hypnotic antiepileptic drugs from the regimens of patients with intractable epilepsy. 684 46

A patient with partial complex seizures evaluated for surgery with chronic depth electrode recordings demonstrated falsely localizing ictal onsets during anticonvulsant drug withdrawal. When phenytoin was being reduced, more seizures appeared to originate from the left temporal lobe than from the right. Right anterior temporal lobectomy, performed on the basis of other findings, revealed a small unsuspected tumor in the resected specimen, and the patient has remained seizure free for 3 years. The seizures that originated from the left temporal lobe were different from the patient's habitual attacks and appeared to be the result of anticonvulsant withdrawal and, perhaps, electrode irritation. Four other patients who received anterior temporal lobectomies at UCLA between 1977 and 1980 had at least one stereotaxic EEG (SEEG)-recorded contralateral seizure onset, and all have benefited from surgery. Although multifocal SEEG-recorded ictal onsets should be considered a poor prognostic sign, distant sites that give rise to atypical seizures during drug withdrawal may not generate spontaneous seizures postoperatively. Consequently, this finding should not be used as a sole criterion against the recommendation of surgical therapy.
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PMID:Falsely localizing ictal onsets with depth EEG telemetry during anticonvulsant withdrawal. 685 66

In a retrospective study of 808 adult epileptic patients undertaken at the Neurological Institute of Montevideo, Uruguay, the rate of remission of seizures (three seizure-free years) was 32%, and that of relapse 39%. Remission occurred mostly during the first years after onset, and relapse during the first years after remission. Patients with generalized or partial seizures alone had a better prognosis than when both types coexisted. Patients with Petit Mal absences persisting after 14 years of age, had the lowest rate of remission. Mental status, abnormal neurological examination and age of onset showed no significant prognosis value. Remission and relapse was similar in cryptogenetic and symptomatic epilepsy. Genetic predisposition did not change the prognosis. Withdrawal of drugs after a minimal seizure-free period of three years produced a higher rate of relapse than when medication was continued. In the first EEG, only the existence of a slow background rhythm had an unfavorable prognosis. These results are compared with those of other series. It is concluded that the differing results can be attributed to a different selection of population and different methods of study. Anyway, several factors showed a similar influence on prognosis in the different series. As to indication for method of drug withdrawal after remission, and its influence on relapse, no definite conclusion can be drawn and a large, multicentric, methodical study on this topic is suggested.
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PMID:Prognosis of epilepsy. Remission of seizures and relapse in 808 adult patients. 696 72

114 epileptic children were followed up after discontinuation of anticonvulsive therapy. Seizures recurred in 35 (30%). The relapse rate was high in psychomotor attacks and in combination of multiple seizure types. Only in psychomotor attacks was seizure frequency in relation to relapse. There also was a relation of relapse to mental and motor retardation, beginning puberty and onset of epilepsy between 3--7 years. The EEG before drug withdrawal was a poor prognostic criterium, worsening of EEG findings after drug withdrawal, however indicated an unfavourable outcome.
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PMID:[Prognosis in childhood epilepsy after discontinuation of therapy (author's transl)]. 709 77

We determined the incidence of seizures due to acute CNS insults for residents of Rochester, Minnesota, U.S.A., from 1935 through 1984. The age-adjusted incidence rates for 1955-1984, the period of most complete case ascertainment, was 39.0/100,000 person-years (United States 1970 population as standard). The age-adjusted incidence was considerably higher in men: 52.0 as compared with 29.5 in women. The 3.6% risk of experiencing an acute symptomatic seizure in an 80-year lifespan approaches that of developing epilepsy. The major causes of acute symptomatic seizures were traumatic brain injury, cerebrovascular disease, drug withdrawal, and CNS infections. Each type of acute symptomatic seizure has age, gender, and time period patterns that reflect the occurrence of the underlying cause.
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PMID:Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984. 760 10

A consecutive series of 170 patients who have been submitted to intracranial depth electrode recordings is reviewed to assess the overall morbidity of the technique. Most patients had bitemporal and frontal electrodes inserted and were monitored for an average period of 18 days. A surgically amenable focus was found in 85% of the cases. There were 4 cases of infection including 2 cerebral abscesses which required surgical evacuation. One patient with frontal lobe atrophy developed an acute subdural hematoma after electrode implantation. There was no death or neurological deficit in the entire series. Morbidity was encountered mainly in the neuropsychological sphere, several patients having developed transient postictal psychosis after repetitive seizures. Our recording technique has been associated with low surgical morbidity. Patients undergoing depth electrode recordings should be closely monitored to minimize the occurrence of psychotic episodes associated with drug withdrawal and increased seizure frequency.
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PMID:Morbidity of chronic recording with intracranial depth electrodes in 170 patients. 762 53

The long-term efficacy and adverse-event profiles of sodium valproate and carbamazepine in children with newly diagnosed primary generalised or partial epilepsy were compared at 63 outpatient clinics. Children with two or more generalised tonic-clonic or partial seizures in the previous six months were randomised to oral sodium valproate (N = 130) or oral carbamazepine (N = 130) and followed for three years as outpatients. Dosages were increased as needed until seizures were controlled or toxicity developed. Sodium valproate and carbamazepine were equally effective in achieving high levels of seizure control in both primary generalised seizures and partial seizures with or without generalisation. Adverse events were mostly mild, few necessitating drug withdrawal. Those particularly associated with valproate were weight increase, alopecia and appetite increase, and with carbamazepine, rashes, somnolence, diplopia and abnormal gait/ataxia.
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PMID:A multicentre comparative trial of sodium valproate and carbamazepine in paediatric epilepsy. The Paediatric EPITEG Collaborative Group. 785 77

During a five year period (1988-1992) 70 cases of seizures were collected by the Adverse Drug Reaction Monitoring Center of Clermont-Ferrand (3.58% of total collected cases). 31 cases (22 M and 9 F) occurred after a drug withdrawal. Benzodiazepines--either alone or in association--were the most often involved. Mean age was 48.8 +/- 2.6 years in this group and additional factors (alcohol abuse and/or association of drugs that lower the seizure threshold) were associated in 26 cases. 39 cases (14 M and 25 F) occurred on the course of various treatments. The most frequently involved drugs were neuropsychiatric, antiinfectious (especially beta-lactam antibiotics, fluorquinolones and isoniazid) and theophylline. Mean age was 56.5 +/- 3.8 years and additional different factors (high dosages, antecedents of epilepsy, underlying diseases) were present in 22 observations.
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PMID:[During the treatment or after... drug-induced convulsive accidents. Apropos of 70 cases]. 785 60

It has been suggested that withdrawal from several subclasses of central nervous system (CNS) depressants involves common underlying mechanisms. For example, mice genetically selected for severe ethanol withdrawal convulsions (Withdrawal Seizure Prone or WSP) have also been found to express severe withdrawal following treatment with barbiturates and benzodiazepines. Corticosteroids appear to modulate severity of withdrawal from CNS depressants. Therefore, it was hypothesized that corticosterone would enhance withdrawal convulsions following acute ethanol, pentobarbital, and diazepam in WSP mice. Corticosterone (20 mg/kg) administered following each of these drugs significantly increased severity of handling-induced convulsions during withdrawal. Corticosterone did not affect pre-withdrawal convulsion scores or handling-induced convulsions of drug-naive mice. These results suggest that withdrawal convulsions following acute ethanol, pentobarbital, and diazepam are sensitive to modulation by corticosterone and they support the hypothesis that stress may increase drug withdrawal severity.
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PMID:Corticosterone increases severity of acute withdrawal from ethanol, pentobarbital, and diazepam in mice. 786 7


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