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Epilepsy Center (epilepsy + center)
Selected AbstractsPhotosensitivity in Relation to Epileptic Syndromes: A Survey from an Epilepsy Center in JapanEPILEPSIA, Issue 3 2001Hideaki Shiraishi Summary: ,Purpose: We examined the incidence and distribution of photosensitivity among the different age groups and different types of epilepsies and epileptic syndromes. Furthermore, we considered the influence of ethnic and geographic factors on the incidence of photoparoxysmal response (PPR) in epilepsy patients. Methods: We analyzed the responses to intermittent photic stimulation (IPS) by using a Grass PS22 or PS33 photic stimulator for in 2,187 unselected patients with epilepsy who were treated in our center. Results: The classic PPR was elicited in 37 (1.7%) patients. The mean age of these 37 patients was 17.0 years. The subpopulation of patients having PPR included 2.0% of all patients with symptomatic generalized epilepsy, 5.6% (p < 0.01) of those with idiopathic generalized epilepsy, 0.7% of those with symptomatic localization-related epilepsy, and 2.9% of those with undetermined epilepsy. PPR accounted for 17.4 % (p < 0.01) of the patients with juvenile myoclonic epilepsy, 7.6% (p < 0.01) of those with grand mal on awakening, and 6.1% (p < 0.01) of those with symptomatic occipital lobe epilepsy. The incidence of PPR increased in patients up to age 15 years, and suddenly decreased after age 20 years. Conclusion: The present study presents the first report from eastern Asia, analyzing the incidence of PPR with a restricted definition comparable to the other studies, and the rate of PPR was relatively low compared with the studies performed in the European countries. We could confirm the clear relation between age and positive PPR. [source] Specific Epileptic Syndromes Are Rare Even in Tertiary Epilepsy Centers: A Patient-oriented Approach to Epilepsy ClassificationEPILEPSIA, Issue 3 2004Christoph Kellinghaus Summary: Purpose: To assess the practicability and reliability of a five-dimensional patient-oriented epilepsy classification and to compare it with the International League Against Epilepsy (ILAE) classification of epilepsy and epileptic syndromes. The dimensions consist of the epileptogenic zone, semiologic seizure type(s), etiology, related medical conditions, and seizure frequency. Methods: The 185 epilepsy patients (94 adults, 91 children, aged 18 years or younger) were randomly selected from the database of a tertiary epilepsy center and the general neurological department of a metropolitan hospital (28 adults). The charts were reviewed independently by two investigators and classified according to both the ILAE and the patient-oriented classification. Interrater reliability was assessed, and a final consensus among all investigators was established. Results: Only four (4%) adults and 19 (21%) children were diagnosed with a specific epilepsy syndrome of the ILAE classification. All other patients were in unspecific categories. The patient-oriented classification revealed that 64 adults and 56 children had focal epilepsy. In an additional 34 adults and 45 children, the epileptogenic zone could be localized to a certain brain region, and in 14 adults and five children, the epileptogenic zone could be lateralized. Fourteen adults and 21 children had generalized epilepsy. In 16 adults and 14 children, it remained unclear whether the epilepsy was focal or generalized. Generalized simple motor seizures were found in 66 adults and 52 children, representing the most frequent seizure type. Etiology could be determined in 40 adults and 45 children. Hippocampal sclerosis was the most frequent etiology in adults (10%), and cortical dysplasia (9%), in children. Seven adults and 31 children had at least daily seizures. Seventeen adults and 26 children had rare or no seizures at their last documented contact. The most frequent related medical conditions were psychiatric disorders and mental retardation. Interrater agreement was high (kappa values of 0.8 to 0.9) for both the patient-oriented and the ILAE classification. Conclusions: Specific epilepsy syndromes included in the current ILAE classification are rare even in a tertiary epilepsy center. Most patients are included in unspecific categories that provide only incomplete information. In contrast, all of the patients could be classified by the five-dimensional patient-oriented classification, providing all essential information for the management of the patients with a high degree of interrater reliability. [source] Guidelines for Essential Services, Personnel, and Facilities in Specialized Epilepsy Centers in the United StatesEPILEPSIA, Issue 6 2001The National Association of Epilepsy Centers First page of article [source] Understanding herb and dietary supplement use in patients with epilepsyEPILEPSIA, Issue 8 2009Kitti Kaiboriboon Summary Objective:, To determine the prevalence of herb and dietary supplement use and to provide a comprehensive analysis of factors influencing the use of these products in patients with epilepsy. Methods:, We performed a cross-sectional study using self-administered questionnaires in a selected group of patients who were receiving care at a tertiary epilepsy center. Logistic regression was used to measure the association between the demographic variables and herb and dietary supplement use. In addition, we performed a MEDLINE search for each of the herb and dietary products used by our patients to determine the effect of these products on seizures and on their potential for interactions with other drugs metabolized by the liver. Results:, One hundred eighty-seven patients completed the survey. Fifty-six percent of this group of patients with epilepsy used herbs and dietary supplements at the time of the survey. A considerable portion (71%) of these patients reported the use of these products to their physician, and most of them relied on their physicians as the primary source of information. Most of the patients used dietary supplement for health promotion rather than to specifically benefit their epilepsy condition. Approximately one-third of patients used herb or dietary supplements that had the potential to increase seizures (16%) or to interact with hepatically metabolized drugs (19%). The most powerful independent predictors of herb and dietary supplement use were partial epilepsy [odds ratio (OR) 3.36; 95% confidence interval (CI) 1.27,8.88] and Caucasian race (OR 3.55; 95% CI 1.11,11.34). Conclusion:, Patients with epilepsy commonly used dietary supplements along with their antiepileptic medications. The majority of these patients used herb and dietary supplements for health promotion rather than because of dissatisfaction with conventional treatment. It is important that physicians involved in the care of patients with epilepsy routinely inquire about the use of dietary supplements and that they make use of reliable resources to assess the safety of these products with regard to modification of seizure risk and the potential for interactions with antiepileptic drugs. [source] High-resolution MRI Enhances Identification of Lesions Amenable to Surgical Therapy in Children with Intractable EpilepsyEPILEPSIA, Issue 8 2004Monisha Goyal Summary:,Purpose: Many children with refractory epilepsy can achieve better seizure control with surgical therapy. An abnormality on magnetic resonance imaging (MRI), along with corroborating localization by other modalities, markedly increases chances of successful surgical outcome. We studied the impact of high-resolution MRI on the surgical outcome of intractable epilepsy. Methods: High-resolution MRI using four-coil phased surface array was obtained as part of the comprehensive presurgical protocol for children with focal onset intractable seizures evaluated by our epilepsy center during the first half of 2002. Results: Thirteen consecutive children, ages 5 to 18 years, entered this prospective study. For four patients with a lesion on a recent MRI examination with a standard head coil, management did not change with high-resolution MRI. Standard MRI in the other nine patients did not identify a lesion. However, high-resolution MRI with the phased-array surface coil found previously undiagnosed focal abnormalities in five of nine patients. These abnormalities included hippocampal dysplasia, hippocampal atrophy, and dual pathology with frontal cortical dysplasia. In four of nine patients, no identifiable lesion was identified on the high-resolution MRI. All patients underwent invasive monitoring. In three of five patients, newly diagnosed lesions correlated with EEG abnormalities, and resection was performed. Conclusions: In our center, high-resolution MRI identified lesions not detected by standard MRI in more than half the children (56%). Technical advances such as four-coil phased surface array MRI can help identify and better delineate lesions, improving the diagnosis of patients who are candidates for surgical treatment of refractory epilepsy. [source] Specific Epileptic Syndromes Are Rare Even in Tertiary Epilepsy Centers: A Patient-oriented Approach to Epilepsy ClassificationEPILEPSIA, Issue 3 2004Christoph Kellinghaus Summary: Purpose: To assess the practicability and reliability of a five-dimensional patient-oriented epilepsy classification and to compare it with the International League Against Epilepsy (ILAE) classification of epilepsy and epileptic syndromes. The dimensions consist of the epileptogenic zone, semiologic seizure type(s), etiology, related medical conditions, and seizure frequency. Methods: The 185 epilepsy patients (94 adults, 91 children, aged 18 years or younger) were randomly selected from the database of a tertiary epilepsy center and the general neurological department of a metropolitan hospital (28 adults). The charts were reviewed independently by two investigators and classified according to both the ILAE and the patient-oriented classification. Interrater reliability was assessed, and a final consensus among all investigators was established. Results: Only four (4%) adults and 19 (21%) children were diagnosed with a specific epilepsy syndrome of the ILAE classification. All other patients were in unspecific categories. The patient-oriented classification revealed that 64 adults and 56 children had focal epilepsy. In an additional 34 adults and 45 children, the epileptogenic zone could be localized to a certain brain region, and in 14 adults and five children, the epileptogenic zone could be lateralized. Fourteen adults and 21 children had generalized epilepsy. In 16 adults and 14 children, it remained unclear whether the epilepsy was focal or generalized. Generalized simple motor seizures were found in 66 adults and 52 children, representing the most frequent seizure type. Etiology could be determined in 40 adults and 45 children. Hippocampal sclerosis was the most frequent etiology in adults (10%), and cortical dysplasia (9%), in children. Seven adults and 31 children had at least daily seizures. Seventeen adults and 26 children had rare or no seizures at their last documented contact. The most frequent related medical conditions were psychiatric disorders and mental retardation. Interrater agreement was high (kappa values of 0.8 to 0.9) for both the patient-oriented and the ILAE classification. Conclusions: Specific epilepsy syndromes included in the current ILAE classification are rare even in a tertiary epilepsy center. Most patients are included in unspecific categories that provide only incomplete information. In contrast, all of the patients could be classified by the five-dimensional patient-oriented classification, providing all essential information for the management of the patients with a high degree of interrater reliability. [source] Does Neuroticism Influence Cognitive Self-Assessment After Epilepsy Surgery?EPILEPSIA, Issue 10 2000S. Cañizares Summary Purpose: To examine how cognitive, personality, and seizure outcome variables influence the subjective cognitive functioning of patients with refractory temporal lobe seizures after epilepsy surgery. Methods: Thirty-three consecutive patients with drug-resistant partial epilepsy who underwent surgical treatment at a tertiary referral university epilepsy center were tested before surgery and 1 year after surgery. Objective cognitive and subjective cognitive functioning tests were used, and personality was assessed. Seizure control was operationalized as a dichoto-mous variable. Results: A significant inverse relationship was found between neuroticism and subjective cognitive functioning. None of the other pre- and postoperative cognitive and surgery outcome variables were significant predictors of subjective cognitive functioning, even after controlling for the effect of neuroticism. Conclusions: Subjective and objective memory functioning are independent in patients with epilepsy after surgical treatment. Subjective memory functioning appears to be related not to seizure relief but to neuroticism. These data suggest that psychological factors such as personality traits predisposing to emotional distress should be taken into consideration in the clinical management and counseling of patients undergoing epilepsy surgery. [source] Psychiatric comorbidity and use of psychotropic drugs in epilepsy patientsACTA NEUROLOGICA SCANDINAVICA, Issue 2010O. J. Henning Henning OJ, Nakken KO. Psychiatric comorbidity and use of psychotropic drugs in epilepsy patients. Acta Neurol Scand: 2010: 122 (Suppl. 190): 18,22. © 2010 John Wiley & Sons A/S. Objectives,,, Although epilepsy is associated with a high rate of psychiatric comorbidity, clinicians may withhold treatment with psychotropic drugs for fear of worsening seizures. We have assessed the occurrence of psychiatric disorders in a cohort of epilepsy patients and used the results to discuss this important topic. Material and methods,,, Based on a questionnaire we made a survey of psychiatric symptoms in 167 adult patients referred to a tertial epilepsy center. The mean age was 42 years, and 72% had active epilepsy. Results,,, Forty three patients (26%) had a psychiatric disorder, and 22 patients (13%) used psychotropic drugs. The most frequent diagnoses were mood disorders and anxiety. Conclusions,,, Compared with the general population, people with epilepsy have an increased risk of developing psychiatric disorders. Patients with uncontrolled seizures are most vulnerable. These disorders appear to be under-diagnosed and under-treated, and the fear that psychotropic drugs can cause seizure exacerbation is probably overstated. [source] Long-term assessment of oxcarbazepine in a naturalistic setting: a retrospective studyACTA NEUROLOGICA SCANDINAVICA, Issue 5 2008U. Seneviratne Background,,, New antiepileptics seem to be better tolerated by patients. The retention rate of an antiepileptic would be a useful indicator of its practical usefulness. Aims,,, To assess the long-term outcome of oxcarbazepine (OXC) in a naturalistic setting by determining the retention rate. Methods,,, This is a retrospective study. All epilepsy patients treated with OXC at a tertiary care epilepsy center during a period of 3.5 years were included in this study. Retention rates of OXC at 1 and 3 years were estimated for each cohort group using Kaplan,Meier estimates and corresponding 95% confidence intervals. Results,,, A total of 98 patients were studied. OXC was used as monotherapy in 14 (14.3%) and as add-on therapy in 84 (85.7%). The mean daily dose was 947 ± 492 mg and 60% received ,900 mg/day. Using the Kaplan,Meier survival analysis, the retention rates of OXC at 1 and 3 years were estimated to be 0.853 (0.749,0.956) and 0.737 (0.570,0.904), respectively. Conclusions,,, OXC is well tolerated by patients as both monotherapy and add-on therapy. [source] Differential effects of temporal pole resection with amygdalohippocampectomy versus selective amygdalohippocampectomy on material-specific memory in patients with mesial temporal lobe epilepsyEPILEPSIA, Issue 1 2008Christoph Helmstaedter Summary Purpose: In the surgical treatment of mesial temporal lobe epilepsy, there is converging evidence that individually tailored or selective approaches have a favorable cognitive outcome compared to standard resections. There is, however, also evidence that due to collateral damage, selective surgery can be less selective than suggested. As part of a prospective transregional research project the present study evaluated the outcome in memory and nonmemory functions, following two selective approaches: a combined temporal pole resection with amygdalohippocampectomy (TPR+) and transsylvian selective amygdalohippocampectomy (SAH). Methods: One year after surgery, cognitive outcomes of postoperatively seizure-free patients with mesial TLE and hippocampal sclerosis, who underwent either TPR+ (N = 35) or SAH (N = 62) in two German epilepsy centers (Bonn/Berlin), were compared. Results: Repeated measurement MANOVA and separate post hoc testing indicated a double dissociation of verbal/figural memory outcome as dependent on side and type of surgery. Verbal memory outcome was worse after left-sided operation, but especially for SAH, whereas figural memory outcome was worse after right-sided operation, preferentially for TPR+. Attention improved independent of side or type of surgery, and language functions showed some improvement after right-sided surgeries. Discussion: The results indicate a differential effect of left/right SAH versus TPR+ on material-specific memory insofar as transsylvian SAH appears to be favorable in right and TPR+ in left MTLE. The different outcomes are discussed in terms of a different surgical affection of the temporal pole and stem, and different roles of these structures for verbal and figural memory. [source] Combined Ketogenic Diet and Vagus Nerve Stimulation: Rational Polytherapy?EPILEPSIA, Issue 1 2007Eric H. Kossoff Summary:,Objective: The concept of "rational polypharmacy" has been associated with anticonvulsant management for decades, but the term has not been applied to nonpharmacologic therapies. Methods: We conducted a multicenter, retrospective study of children who received concurrent diet (ketogenic or modified Atkins) and vagus nerve stimulation (VNS) treatment for medically intractable epilepsy. Results: Thirty children in total from six epilepsy centers were treated over a 6-yr period. The median age at the initiation of combination therapy was 10 yr (range, 4,24 yr). Sixteen (53%) received dietary therapy followed by VNS; no differences were noted between centers. After 3 months, 21 (70%) had seizure reduced by >50% over the previous single nonpharmacologic treatment, of whom 13 (62%) had improvement within the first month. A 5-min VNS off-time correlated with >90% seizure reduction (p = 0.02). The median duration of nonpharmacologic polytherapy was 12 months (range, 0.5,96 months); 17 (57%) remain on dual therapy at this time. No side effects were noted. Most patients who discontinued combination therapy did so because of a lack of efficacy rather than restrictiveness. Conclusions: In this small group, the combined use of diet and VNS appeared synergistic and yielded rapid benefits. It may be more effective with longer VNS off-times. Further prospective studies of this combination in refractory pediatric epilepsy are needed to help guide optimal use. [source] Direct Cost of Medical Management of Epilepsy among Adults in Italy: A Prospective Cost-of-Illness Study (EPICOS)EPILEPSIA, Issue 2 2004Ettore Beghi Summary: Purpose: To investigate the costs of epilepsy from a nationwide survey comparing adult patients included in different prognostic categories. Methods: A 12-month prospective observational study was conducted in 15 epilepsy centers from Northern, Central, and Southern Italy. The study population included a random sample of individuals aged 18 years and older with newly diagnosed (ND) epilepsy, seizure remission (R), occasional seizures (OS), active non,drug-resistant (NDR) seizures, drug-resistant (DR) seizures, or surgical candidates (SC). Estimates of the direct costs of care of epilepsy were based on the use of diagnostic examinations, laboratory tests, specialist consultations, hospital admissions, day-hospital days, and drugs, taking the Italian National Health Service perspective. Results: The sample included 631 patients (ND 62, R 158, OS 155, NDR 114, DR 128, and SC 14). The SC group had the highest total cost per patient (,3,619) followed by DR (,2,190), ND (,976), NDR (,894), OS (,830), and R (,561). For each epilepsy group, the main components of the total cost were drugs and hospital admissions. Drug costs increased from the R group to the DR group. The new antiepileptic drugs (AEDs) were the largest part of the cost of treatment. Conclusions: The costs of epilepsy in referral patients vary significantly according to the time course of the disease and the response to treatment. Hospital admissions and drugs are the major sources of expenditure. [source] Benign Partial Epilepsies of Adolescence: A Report of 37 New CasesEPILEPSIA, Issue 12 2001G. Capovilla Summary: ,Purpose: To delineate the electroclinical features of patients with partial seizures in adolescence with a benign outcome. Methods: Patients were recruited in five different Italian epilepsy centers. Patients were selected among those with partial seizures between ages 11 and 17 years. We excluded benign childhood epilepsies, those with neurologic or mental deficits, and those with neuroradiologically documented lesions. We also excluded patients with less than 3 years' follow-up or who were still receiving antiepileptic therapy. Results: There were 37 (22 male, 15 female) patients. Seizures started at the mean age of 14.5 years (range, 11,16.11). Two main electroclinical patterns emerged: 16 of 37 patients had somatomotor seizures frequently associated with focal theta discharges involving the centroparietal regions. Ten of 37 patients showed versive seizures and interictal spiking involving the posterior regions. A third group had clinical characteristics resembling the cases described by Loiseau. All had a favorable outcome. Conclusions: This relevant multicenter study further confirms the existence of benign partial epilepsies with onset during adolescence. [source] | ||||||||||