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Seizure-free Period (seizure-free + period)
Selected AbstractsInfantile spasms and cytomegalovirus infection: antiviral and antiepileptic treatmentDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2007Dorota Dunin-Wasowicz MD PhD From 1 January 1995 to 31 December 2004, 22 patients (13 males, nine females; age range 2-12mo) with infantile spasms and cytomegalovirus (CMV) infection were treated with intravenous ganciclovir (GCV) and antiepileptic drugs. GCV was given for 3 to 12 weeks with a 1-month interval (one, two, or three courses). Epileptic spasms occurred before (group A: eight patients), simultaneously (group B: eight patients), and after (group C: six patients) a diagnosis of human CMV (HCMV) infection and antiviral treatment. In 11 patients, DNA HCMV was found in cerebrospinal fluid by nested-polymerase chain reaction method (neuroinfection). All infants excreted CMV in urine. DNA HCMV and specific immunoglobulin M and immunoglobulin G antibodies were present in blood. Ten patients, including four with neuroinfection, have been seizure-free for at least the past 18 months. In two patients with neuroinfection, vigabatrin monotherapy was withdrawn after a 2 year 6 month seizure-free period. Eighteen patients required antiepileptic drugs polytherapy, four of whom required additional adrenocorticotropic hormone (ACTH). Six patients on polytherapy were seizure-free on follow-up, two of whom were treated with ACTH, but no patient with hypsarrhythmia who required ACTH treatment was seizure-free on follow-up. In five patients, psychomotor development was normal, 16 had tetraplegia (Gross Motor Function Classification System [GMFCS] Level V), and one had diplegia (GMFCS Level III). Early antiviral and antiepileptic therapy could result in the long-term cessation of seizures. [source] Hemiconvulsion,hemiplegia syndrome in a patient with severe myoclonic epilepsy in infancyEPILEPSIA, Issue 9 2009Takafumi Sakakibara Summary We report a 2-year-old girl who had repeated febrile or afebrile seizures since infancy. Prolonged left/right hemiconvulsions and myoclonus of the eyelids/extremities with generalization to tonic,clonic seizures, were refractory to antiepileptic agents. At age 1 year and 4 months, she contracted rotavirus infection, and developed status epilepticus with persistent right hemiclonic seizures. Left unilateral brain edema with subsequent emergence of cortical laminar necrosis and white matter lesions, and progressive atrophy of the left cerebral hemisphere were noted during this period. She showed residual right hemiparesis and mild intellectual disability, and had generalized/eyelid myoclonia and hot water epilepsy after a 5-month seizure-free period. Analysis for SCN1A, the gene encoding the neuronal voltage-gated Na+ channel ,1 subunit revealed a nonsense mutation, R1892X. These indicate the potential risk in patients with severe myoclonic epilepsy in infancy (SMEI) to develop hemiconvulsion,hemiplegia (HH) syndrome. SCN1A mutations may need to be further explored in patients with HH syndrome without features of SMEI. [source] Computerized Tremor Analysis of Valproate-induced Tremor: A Comparative Study of Controlled-release versus Conventional ValproateEPILEPSIA, Issue 2 2005Martina Rinnerthaler Summary:,Purpose: Valproate (VPA) induces postural tremor in 6,45% of patients. The characteristics of VPA-induced tremor have not yet been quantitatively assessed, and it is not known whether tremor prevalence or severity is affected by VPA formulation (controlled-release CR-VPA vs. conventional VPA). The aim of this study was quantitatively to assess tremor in epilepsy patients receiving VPA and to compare the effects of two VPA formulations (CR-VPA vs. VPA) on tremor severity. Methods: In a prospective study, 18 consecutive patients with newly diagnosed focal or generalized epilepsy were assigned to receive alternately either VPA (n = 10) or CR-VPA (n = 8) monotherapy. Computerized tremor analysis was performed at baseline 1 day before initiating VPA treatment and repeated after a seizure-free period of ,8 weeks, during which VPA doses had remained stable. Rest and postural tremor were recorded by accelerometry, and surface electromyograms (EMGs) were recorded from the wrist flexors and extensors. Results: At baseline, the two groups had similar postural tremor amplitudes. At follow-up, the CR-VPA group had remained at the same level, whereas VPA subjects exhibited a significant increase in tremor amplitudes (p < 0.05) despite comparable VPA doses and comparable plasma VPA concentrations at the time of tremor testing. Conclusions: This is the first study to assess quantitatively VPA-induced tremor by standardized tremor analysis. These results suggest that CR-VPA may cause less tremorigenic activity as compared with standard VPA. The mechanisms underlying this difference are unclear but may include greater peak,trough variation with VPA than with CR-VPA. [source] Serum S-100 Protein Is Not a Suitable Seizure Marker in Temporal Lobe EpilepsyEPILEPSIA, Issue 10 2002Fritz Leutmezer Summary: ,Purpose: S-100 protein is a sensitive marker of various brain diseases; however, its role in epilepsy is controversially discussed in the literature. We therefore studied the temporal profile of serial concentrations of S-100 protein in serum after secondarily generalized tonic,clonic seizures during video-EEG monitoring. Methods: Ten patients with mesial temporal lobe epilepsy were prospectively studied. Serum S-100 protein was measured after a seizure-free period of ,24 h (baseline) and 30 min, 3, 6, 12, and 24 h after a secondarily generalized tonic,clonic seizure of temporal lobe origin in nine and a convulsive status epilepticus in one patient. Results: All S-100 levels were within the normal range, except for those of one patient at baseline. Mean values were 0.045 ,g/L (range, 0.003,0.13 ,g/L) at baseline, 0.038 ,g/L (range, 0.003,0.09 ,g/L) at 30 min, 0.036 ,g/L (range, 0.003,0.08 ,g/L) at 3 h, 0.034 ,g/L (range, 0.003,0.07 ,g/L) at 6 h, 0.034 ,g/L (range, 0.003,0.08 ,g/L) at 12 h, and 0.035 ,g/L (range, 0.003,0.09 ,g/L) at 24 h after seizure offset. There were no significant differences between mean concentrations at any interval postictally. Conclusions: We could not detect any significant alterations in serum S-100 protein concentration either after a single secondarily generalized tonic,clonic seizure or after convulsive status epilepticus in patients with temporal lobe epilepsy. Our data do not confirm previous work, which suggested serum S-100 protein to be a suitable marker for epileptic seizures. [source] Defining success in clinical trials , profiling pregabalin, the newest AEDEUROPEAN JOURNAL OF NEUROLOGY, Issue 2005P. Ryvlin The efficacy and safety of pregabalin as adjunctive therapy for patients with partial epilepsy with or without secondary generalization has been established by four randomized, 12-week, double-blind, placebo-controlled trials (n = 1396) and four long-term open-label studies (n = 1480). Patients in the three fixed-dose trials were ,12 years of age, had ,6 partial seizures and no 4-week seizure-free period during the 8-week baseline period. Seventy-three per cent of patients were taking ,2 concomitant antiepileptic drugs. Responder rates across the effective doses (150,600 mg/day) ranged from 14% to 51% and demonstrated a significant dose,response relationship. The most common adverse events were central nervous system related, generally mild or moderate, transient, and tended to be dose related. The fourth placebo-controlled trial compared a fixed dose of pregabalin 600 mg/day with a flexible-dose regimen (150,600 mg/day). Responder rates were greater for both the fixed dose (45.3%, P < 0.001) and flexible dose (31.3%, P < 0.001) when compared with placebo (11.0%). Compared with the fixed-dose group, the flexible-dose patients had a lower incidence of adverse events and study discontinuations. In long-term open-label trials, the efficacy of pregabalin was maintained with respect to 50% responder rates suggesting no obvious tolerance developing over 2 years. Seizure-free rates were 8.9% and 5.8% for the last 6 months and 1 year of pregabalin treatment, respectively. Long-term open-label pregabalin treatment was well tolerated. [source] International Regulations for Automobile Driving and EpilepsyJOURNAL OF TRAVEL MEDICINE, Issue 1 2000Winnie W. Ooi Background: Many patients with epilepsy travel abroad and drive automobiles with the assumption that policies, rules, and regulations on epilepsy and driving are similar to those of their home countries. This paper investigates the driving restrictions and other pertinent information on this issue in foreign countries. Methods: A questionnaire was sent to 231 neurologists (chosen from American neurological and epilepsy societies) from 84 countries and to 230 official (embassies and consulates) representatives of 134 countries asking for the local rules and regulations and their comments on driving and epilepsy. Results: One hundred and sixty-six responses were received from 96 of 134 (72%) countries. One hundred and six neurologists (of 231 queried [46%]) responded. In 16 countries, persons with epilepsy are not permitted to drive. In the remaining countries, these patients must have a seizure-free period of 6 to 36 months. This period varies according to the type of seizure. In five countries, physicians must report the names of these patients to their local authorities. In many countries, the rules and regulations are being reevaluated and changed. Conclusions: Patients with epilepsy who plan to drive overseas are advised to contact local embassies and consulates, well before their trips (and keep records of the communications) to obtain the latest information on the rules and regulations governing the driving of automobiles in those countries. [source] An infantile-onset, severe, yet sporadic seizure pattern is common in Sturge-Weber syndromeEPILEPSIA, Issue 9 2009Eric H. Kossoff Summary The young age of onset and frequently intractable nature of seizures associated with Sturge-Weber syndrome (SWS) have been well-reported in large studies. However, many clinicians also anecdotally describe prolonged but sporadic seizure clusters. Over a 5-year period, 77 children and adults with SWS and at least one reported seizure were referred to and evaluated at the Hunter Nelson Sturge-Weber Center at the Kennedy Krieger Institute. The median age of seizure onset was 6 months with 43 (56%) presenting <1 year of age. Age at seizure onset ,6 months was associated with increased hemiparesis, but not seizures. A characteristic pattern of clustering, intense seizures followed by prolonged seizure-free periods was reported in 30 (39%), but was not associated with worse prognosis. This seizure pattern appears to be common with SWS and leads to difficult treatment decisions, especially in regard to the timing of potential surgical resection. [source] | ||||||||||