			Home About us Contact

Drop Attacks (drop + attack)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Errata: Narcolepsy with Cataplexy Associated with Holoprosencephaly Misdiagnosed as Epileptic Drop Attacks

MOVEMENT DISORDERS, Issue 11 2010
G Plazzi
No abstract is available for this article. [source]

Rufinamide: Clinical pharmacokinetics and concentration,response relationships in patients with epilepsy

EPILEPSIA, Issue 7 2008
Emilio Perucca
Summary Rufinamide is a new, orally active antiepileptic drug (AED), which has been found to be effective in the treatment of partial seizures and drop attacks associated with the Lennox-Gastaut syndrome. When taken with food, rufinamide is relatively well absorbed in the lower dose range, with approximately dose-proportional plasma concentrations up to 1,600 mg/day, but less than dose-proportional plasma concentrations at higher doses due to reduced oral bioavailability. Rufinamide is not extensively bound to plasma proteins. During repeated dosing, steady state is reached within 2 days, consistent with its elimination half-life of 6,10 h. The apparent volume of distribution (Vd/F) and apparent oral clearance (CL/F) are related to body size, the best predictor being body surface area. Rufinamide is not a substrate of cytochrome P450 (CYP450) enzymes and is extensively metabolized via hydrolysis by carboxylesterases to a pharmacologically inactive carboxylic acid derivative, which is excreted in the urine. Rufinamide pharmacokinetics are not affected by impaired renal function. Potential differences in rufinamide pharmacokinetics between children and adults have not been investigated systematically in formal studies. Although population pharmacokinetic modeling suggests that in the absence of interacting comedication rufinamide CL/F may be higher in children than in adults, a meaningful comparison of data across age groups is complicated by age-related differences in doses and in proportion of patients receiving drugs known to increase or to decrease rufinamide CL/F. A study investigating the effect of rufinamide on the pharmacokinetics of the CYP3A4 substrate triazolam and an oral contraceptive interaction study showed that rufinamide has some enzyme-inducing potential in man. Findings from population pharmacokinetic modeling indicate that rufinamide does not modify the CL/F of topiramate or valproic acid, but may slightly increase the CL/F of carbamazepine and lamotrigine and slightly decrease the CL/F of phenobarbital and phenytoin (all predicted changes were <20%). These changes in the pharmacokinetics of associated AEDs are unlikely to make it necessary to change the dosages of these AEDs given concomitantly with rufinamide, with the exception that consideration should be given to reducing the dose of phenytoin. Based on population pharmacokinetic modeling, lamotrigine, topiramate, or benzodiazepines do not affect the pharmacokinetics of rufinamide, but valproic acid may increase plasma rufinamide concentrations, especially in children in whom plasma rufinamide concentrations could be increased substantially. Conversely, comedication with carbamazepine, vigabatrin, phenytoin, phenobarbital, and primidone was associated with a slight-to-moderate decrease in plasma rufinamide concentrations, ranging from a minimum of ,13.7% in female children comedicated with vigabatrin to a maximum of ,46.3% in female adults comedicated with phenytoin, phenobarbital, or primidone. In population modeling using data from placebo-controlled trials, a positive correlation has been identified between reduction in seizure frequency and steady-state plasma rufinamide concentrations. The probability of adverse effects also appears to be concentration-related. [source]

Cortical Resection with Electrocorticography for Intractable Porencephaly-related Partial Epilepsy

EPILEPSIA, Issue 1 2005
Koji Iida
Summary:,Purpose: We evaluated the results of cortical resection of epileptogenic tissue for treatment of intractable porencephaly-related epilepsy. Methods: We examined clinical features, electrophysiological data, surgical findings, and seizure outcomes after cortical resection in eight patients with intractable epilepsy related to porencephalic cysts. Results: All eight patients had hemiparesis. Five retained motor function in the hemiparetic extremities; six retained visual fields. All had partial seizures, six with secondary generalization. Seven patients had simple and three had complex partial seizures (CPSs); two also had drop attacks. Four patients had multiple seizure types. Long-term scalp video-EEG (LVEEG) localized interictal epileptic abnormalities that anatomically corresponded to the cyst location in three patients. LVEEG recorded ictal-onset zones in five; these anatomically corresponded to the cyst location in three of the five. EEG recorded generalized seizures in two patients, hemispheric in one, and multifocal in two. Intraoperative electrocorticography (ECoG) revealed interictal epileptic areas extending beyond the margins of the cyst in seven patients. We resected ECoG-localized interictal epileptic areas completely in five patients and partially in two. Cortical resection was based on seizure semiology and LVEEG in one patient whose ECoG showed no epileptiform discharges. After a minimum follow-up of 1 year, six patients had excellent seizure outcome (Engel class I), and two had a >90% seizure reduction (Engel class III) without complications. Conclusions: Cortical resection guided by ECoG allows preservation of motor function and visual field and provides an effective surgical procedure for treatment of intractable epilepsy secondary to porencephaly. [source]

Neuronal Disconnection for the Surgical Treatment of Pediatric Epilepsy

EPILEPSIA, Issue 2000
Hiroyuki Shimizu
Summary: The surgical methods and results of disconnective surgery for pediatric epilepsy were retrospectively analyzed. The techniques of neuronal disconnection included multiple subpial resection (MST), corpus callosotomy, and functional hemisphercctomy by disconnection. Of 158 total pediatric operations, disconnective techniques were employed in more than 60% of the cases. MST was applied when the epileptic focus was located in unresectable cortices such as speech or motor areas. MST was also instrumental when the epileptogenic zone was extensive and was widely disseminated, as is often observed in cases of neocortical epilepsy. Of 25 patients who underwent MST, surgical outcomes after > 1 year follow-up showed Engel Class I or II in 10 cases, Class III in 12, and Class IV in 3. No mortality or morbidity was encountered during surgery or postoperatively. Corpus callosotomy was applied to cases of disabling generalized seizures and showed a marked effect in alleviating potentially injurious drop attacks. Of 34 patients with drop attacks, 29 became free from this type of seizure, 4 had infrequent attacks, and only 1 showed no beneficial effect. Postoperative improvement of cognition and speech was recognized in 77% of the cases. We developed a new method of functional hemispherectomy by fiber disconnection and applied this less invasive technique to 23 cases of hemispheric lesions. Of the 17 cases with > 1 year follow-up, 13 were in Class I or II, and 3 in Class III, and 2 in Class IV. Development partially normalized in infants with good seizure outcomes. [source]