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

Over the last three decades, a greater understanding of the phenomenology and etiology of illness has fostered progress in psychopharmacology. While research has yielded important new psychopharmacologic compounds, the field continues to benefit from the discovery of innovative clinical applications of established agents. For instance, benzodiazepines--among the most commonly used medications in the pharmacopoeia--have demonstrated their efficacy in the treatment of a wide variety of syndromes. Recently, much attention has focused on the use of high-potency benzodiazepines (for example, clonazepam, alprazolam, lorazepam) in the treatment of panic disorder and mania. This paper presents the uses of benzodiazepines to treat other conditions, including psychotic and agitated states, social phobia, obsessive-compulsive disorder, pain syndromes, seizures, drug withdrawal and side-effects induced by antidepressants and neuroleptics.
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PMID:Innovative uses of benzodiazepines in psychiatry. 790 81

We tapered antiepileptic drugs in 40 patients with epilepsy due to neurocysticercosis who had been free of seizures for 2 years. All patients previously received a course of albendazole that resulted in complete destruction of brain cysts. We followed the patients prospectively from the time of diagnosis until 12 months after antiepileptic drug withdrawal. We evaluated the following prognostic factors for seizure recurrence: sex, number of seizures before control, type of seizures, number of parenchymal brain cysts before albendazole therapy, EEG findings, and CT findings after albendazole therapy. In the univariate analysis of prognostic factors for seizure recurrence, the development of brain calcifications caused by albendazole was the only factor associated with a significantly higher rate of relapse (p = 0.004). The multivariate analysis showed that patients who had both recurrent seizures and multiple brain cysts also had a higher risk of relapse than those with single seizures or single cysts (p = 0.05). This study suggests that the prognosis of epilepsy due to neurocysticercosis is not as benign as previously thought. Patients with residual calcifications and those with both recurrent seizures and multiple cysts before albendazole therapy have the highest rate of relapse after withdrawal of antiepileptic drugs.
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PMID:Prognostic factors for seizure recurrence after withdrawal of antiepileptic drugs in patients with neurocysticercosis. 793 1

This paper reviews the concept of "benign" childhood epilepsies on the basis of the literature review and our own published work. The practical diagnostic, prognostic and therapeutic implications of this concept and its limits are discussed and the main syndromes reported as "benign" are reviewed. The recognition of some childhood epileptic syndromes whose prognosis can be established from the onset of the disorder has proven very useful, but does not apply, by far, to all epileptic children. Other important informations on the natural history of various epilepsies, the knowledge of general favorable prognostic factors and the low relapse rate after drug withdrawal in many successfully treated cases has greatly helped the clinical management of many situations. There are numerous myths surrounding the diagnosis "epilepsy" which can have deleterious psychological consequences and which are important to recognize and fight. A globally "benign" final prognosis will depend as much on these factors as on the absolute number of seizures, the duration of the disease and the need for medical treatment.
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PMID:[So-called benign epilepsies in children]. 797 98

Forty five patients with refractory partial seizures were studied in a prospective, randomised, placebo controlled, add on, parallel group, double blind trial of the new antiepileptic drug vigabatrin (1.5 g twice daily) followed by open treatment. Seizure frequency was monitored throughout an eight week baseline, 20 weeks double blind, and up to 18 months of open vigabatrin treatment. Cognitive function, including measures of memory and concentration, mood, and behaviour were assessed at baseline and again during the 20th week of treatment. Vigabatrin was associated with a significant reduction in a measure of motor speed and overall score on a design learning test in the first 20 weeks of treatment. In comparison with the baseline period, vigabatrin treatment was associated with a significant reduction in median complex partial seizure frequency four to 12 and 12 to 20 weeks after commencing vigabatrin (-66% and -69% in the vigabatrin group, +50% and +25% in the placebo group). Ten of 20 patients on vigabatrin and four of 23 on placebo showed a > 50% reduction in complex partial seizure frequency in the last eight weeks of double blind treatment. At least 60% of responders had maintained the response to vigabatrin when assessed during the open phase of the trial at 44 weeks. Two patients discontinued vigabatrin because of depression, which resolved on drug withdrawal.
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PMID:Effects of vigabatrin on partial seizures and cognitive function. 808 68

The role of the inter-ictal EEG in predicting seizure relapse after antiepileptic drug withdrawal (AED-W) is unclear. A prospective study on AED-W is in progress. This trial includes routine and sleep EEG recordings every 3 and 6 months, respectively, at each step of the drug discontinuation and periodically during follow-up. Data obtained for 136 patients (mean age 23.2 years; 63 with Idiopathic Generalized Epilepsy IGE, 73 with Partial Cryptogenic or Symptomatic Epilepsy PE; without associated neuropsychiatric handicap; with at least 1 year of follow-up after AED-W) were analysed. EEG recordings from seizure onset were available for all patients. Data were analysed separately in IGE and PE patients. The presence of inter-ictal epileptiform abnormalities (IEAs) at the seizure onset and just before AED-W does not seem to predict the AED-W outcome. However, results indicate an association between persisting and increased IEAs during AED-W and a higher relapse rate in both groups, which was statistically significant in the IGE patients.
Seizure 1993 Sep
PMID:Drug withdrawal in patients with epilepsy: prognostic value of the EEG. 816 85

We present 100 children diagnosed with epilepsy who were seizure-free for more than 1 year and still on monotherapy of antiepileptic drugs (AEDs). We matched each child with a healthy classmate and performed neuropsychological testing and EEG before and after complete withdrawal of the AEDs. The withdrawal phase lasted 3 months, but the dose decrease was individualized for each patient. Three to 4 months after complete withdrawal of the drug all patients were reassessed. Patients with seizure relapse are excluded from the study. Seventeen patients are regarded as dropout, 11 because of seizure relapse and six because of protocol violation. The remaining 83 patients were treated with carbamazepine (n = 56), valproic acid (n = 17), or phenytoin (n = 10). Serum concentrations of the AEDs were measured using peak plasma levels that were taken immediately before or after psychological testing. We used neuropsychological tests to assess psychomotor function and "central" cognitive processing such as information processing or memory function. We found significant improvement attributable to drug withdrawal on only one of the cognitive tests, namely, psychomotor speed, suggesting that the impact of AED treatment on higher-order cognitive function is rather limited. In addition, we found group differences between the epilepsy group and the control group at baseline that persisted after drug withdrawal. Subsequent analysis showed some factors that may have contributed to these group differences. First, patients with a former diagnosis of absence seizures show lower scores both at baseline and after drug withdrawal. We may assume that the seizure propensity has not disappeared completely in these patients. Some evidence is found that phenytoin may have a different cognitive profile than carbamazepine, with more impairment on tests that measure motor and mental speed. Again, this impairment persists after drug withdrawal.
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PMID:Withdrawal of antiepileptic medication in children--effects on cognitive function: The Multicenter Holmfrid Study. 841 57

We evaluated the prognostic value of the EEG in 120 seizure-free epileptic patients (49 with complex partial seizures with or without episodic secondarily generalization [CPS], 20 with simple partial seizures with or without episodic secondarily generalization [SPS], 51 with only secondarily generalized seizures [PSG] during and after antiepileptic drug withdrawal. All patients had EEG examination before; during; and 3, 12, 24, and 36 months after drug withdrawal. Relapse rates were 45% in CPS, 100% in SPS, and 65% in PSG. Before reduction, 36 patients had epileptiform EEG and 69% relapsed; in the group with normal EEG, 60% relapsed. EEG worsened in 36 patients, 83% relapsed, whereas only 54% of patients with unchanged EEG relapsed. EEG during but not at the start of drug withdrawal has a prognostic value in partial epilepsy.
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PMID:The prognostic value of the electroencephalogram in antiepileptic drug withdrawal in partial epilepsies. 959 37

This review shows that hyponatremia is the most common cause of burn seizures in children, followed by a history of epilepsy, hypoxia, sepsis with high fever, unknown aetiology and drug toxicity or sudden drug withdrawal. This study also shows that burn seizure is most common in younger children and is related to size and degree of burn. We recommend close monitoring of metabolism, haemodynamics, arterial blood gases, wound and blood cultures, and levels of abnormalities in serum, electrolytes, glucose, Ca, P and Mg. Prompt corrections of any problems in these areas can be vital. Invasive procedures for the diagnosis of seizures, including lumbar puncture and EEG, should be reserved for infrequent non-responding cases.
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PMID:Seizure disorders in burned children: a retrospective review. 878 29

Three new antiepileptic drugs (AEDs) are finding increasing use in medical practice. To examine their efficacy and side-effect profile, 483 patients with epilepsy attending either a specialized epilepsy clinic or general neurology clinic under the care of a single consultant neurologist were reviewed. Of these patients 127 had received lamotrigine, 100 vigabatrin and 27 gabapentin. In all but three patients the indication had been epilepsy refractory to other treatments. Efficacy was confirmed if patients achieved a > 50% reduction in seizure frequency or became seizure free. By this criteria 36.3% of patients receiving lamotrigine, 29% receiving vigabatrin and 15% receiving gabapentin benefited significantly. Lack of efficacy was the major reason for discontinuing vigabatrin (27%) and gabapentin (33.3%) whereas an adverse event was the main reason in patients receiving lamotrigine (28.3%). A spectrum of adverse events were noted. Behavioural/psychological effects in particular occurred with all of the drugs and frequently necessitated drug withdrawal. There was also a suggestion of a pharmacodynamic interaction between lamotrigine and both carbamazepine and sodium valproate resulting in toxicity of these latter drugs in a few patients. Drug tolerance was suspected in 12% of patients receiving vigabatrin, less frequently in those on gabapentin and only rarely with lamotrigine.
Seizure 1996 Jun
PMID:An audit of the new antiepileptic drugs in clinical neurological practice. 879 28

Epilepsy is a clinical paroxysmal disorder of recurring seizures, excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. Seizures have been and are thought to arise as a result of abnormalities in (a) neural circuits, (b) excitation/inhibition balance, (c) potassium, and (d) genetic abnormalities. Therapy for epilepsy is either medical, entailing the use of a variety of antiepileptic drugs, or surgical. An urgent approach to seizure control is indicated when status epilepticus occurs. When all standard therapy fails, general anesthesia can be used to control status epilepticus. Surgery is an option in the treatment of epilepsy and requires extensive preoperative evaluation. The primary concerns for the neuroanesthesiologist anesthetizing the patient with epilepsy are the capacity of anesthetics to modulate or potentiate seizure activity and the interaction of anesthetic drugs with antiepileptic drugs. Proconvulsant and anticonvulsant properties have been reported for nearly every anesthetic. If seizure spikes are to be evoked during seizure surgery, then light anesthesia with a proconvulsant anesthetic is used. Conscious analgesia can be used for awake seizure surgery. However, if electrocorticography is not planned, then a general anticonvulsant anesthetic maintenance regimen is used. The latter technique also may be useful in patients whose anesthetic management is complicated by an incidental history of epilepsy.
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PMID:Anesthetic implications of epilepsy, status epilepticus, and epilepsy surgery. 933 9


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