rss_2.0Journal of Epileptology FeedSciendo RSS Feed for Journal of Epileptology of Epileptology 's Cover patient with Beta-Propeller Protein-Associated Neurodegeneration: a new missense mutation of the gene<abstract> <title style='display:none'>Summary</title> <sec id="j_joepi-2022-0001_s_001"> <title style='display:none'>Introduction</title> <p>Beta-propeller protein-associated neurodegeneration (BPAN) is a neurodegenerative disorder; its estimated prevalence is 2 to 3 per million individuals. All published cases of BPAN have been sporadic, with a clear female predominance and mutations in various exons of the <italic>WDR45</italic> gene.</p> </sec> <sec id="j_joepi-2022-0001_s_002"> <title style='display:none'>Case presentation</title> <p>The study aimed to confirm the diagnosis of BPAN in a 9-year-old girl with a developmental delay since early childhood complicated with intellectual disability, lack of speech and febrile and non-febrile tonic-clonic seizures. The patient also had autistic symptoms as well as some Rett-like symptoms: stereotypical movements of the hands–twisting objects, putting hands in the mouth.</p> </sec> <sec id="j_joepi-2022-0001_s_003"> <title style='display:none'>Discussion</title> <p>Clinical exome analysis and Sanger sequencing of the proband have been performed to confirm the diagnosis. The novel heterozygous missense mutation c.755T&gt;C of the <italic>WDR45</italic> «autophagy» gene was revealed. Sanger sequencing of the trio (proband and parents) proved the <italic>de novo</italic> nature of mutation; its clinical significance has been defined as probably pathogenic. Thus, we report a new missense variant of the <italic>WDR45</italic> gene in a girl with a clinical picture of BPAN. The use of NGS made it possible to get a correct diagnosis during rather a short period before the second debilitating phase of the disease started so that the physicians and the family would have time to prepare and hopefully choose the way to resist.</p> </sec> </abstract>ARTICLE2022-07-01T00:00:00.000+00:00Speeding up disease diagnosis: a reliable option for the epileptologist? of plant polyphenols on seizures – animal studies<abstract> <title style='display:none'>Summary</title> <sec id="j_joepi-2015-0007_s_001"> <title style='display:none'>Introduction</title> <p>Flavonoids are a large group of natural compounds that have been considered to be beneficial in ameliorating some age-dependent disorders. However, a potential use of these compounds in epilepsy treatment has not been systematically reviewed.</p> </sec> <sec id="j_joepi-2015-0007_s_002"> <title style='display:none'>Aim</title> <p>This review describes the pharmacological activity of some polyphenols (flavonoids) in different animal models of seizures e.g. pentylenetetrazole-induced seizures, kainate-induced seizures and pentylenetetrazole kindling in rats.</p> </sec> <sec id="j_joepi-2015-0007_s_003"> <title style='display:none'>Method and Discussion</title> <p>A literature review was conducted using PubMed from 1963 to October 2013 relating effects of flavonoids on experimentally-induced seizures in rodents. Articles chosen for references were queried with the following prompts: “flavonoids and epilepsy”, “flavonoids and seizures”, “plant polyphenols and epilepsy”, and “plant polyphenols and seizures”. Out of 84 reports 32 pharmacological studies with chemically well-defined flavonoids and using widely accepted animal models of seizures have been taken into account in this review. No clinical data on the antiepileptic effect of flavonoids have been reported so far.</p> </sec> <sec id="j_joepi-2015-0007_s_004"> <title style='display:none'>Conclusion</title> <p>The reviewed data suggest the possible benefits of some chemically well-defined polyphenolic compounds of plant origin in antiepileptic treatment. Among flavonoids, resveratrol, baicalein, quercetin and rutin showed significant antiseizure activity. The ability of flavonoids to prevent brain excitability and to protect the brain against oxidative stress-induced damage suggests a potential use of some flavonoids at least as adjunctive therapy for the treatment of epilepsy.</p> </sec> </abstract>ARTICLE2013-12-04T00:00:00.000+00:00The lateralizing and localizing value of peri-ictal cough in epileptic seizures<abstract> <title style='display:none'>Summary</title> <sec id="j_joepi-2015-0006_s_001"> <title style='display:none'>Introduction</title> <p>Coughing may be observed as an epiphenomenon during or after epileptic seizures.</p> </sec> <sec id="j_joepi-2015-0006_s_002"> <title style='display:none'>Aim</title> <p>In this paper we discuss the lateralization and localization value of cough as an epileptic peri/post ictal semiological phenomenon.</p> </sec> <sec id="j_joepi-2015-0006_s_003"> <title style='display:none'>Material and Methods</title> <p>Seven patients presenting cough as a part of their symptomatology are presented. We will discuss cough in the context of these seven patients.</p> </sec> <sec id="j_joepi-2015-0006_s_004"> <title style='display:none'>Results</title> <p>Six out of these seven patients were multidrug resistant temporal lobe epilepsy patients, all were right handed. They were all examined for possible epilepsy surgery and four underwent surgery with complete seizure freedom. We do not have certain evidence for lateralization in one patient with hot water epilepsy though déjà vu as an initial symptom in this patient implies a temporal lobe onset. The seven other patients had temporal lobe epilepsy. Among the patients who had surgery, three had left sided and one had right sided temporal lobe surgery with consequent seizure freedom.</p> </sec> <sec id="j_joepi-2015-0006_s_005"> <title style='display:none'>Conclusion</title> <p> Referring to the argument in the literature, with our small patient sample, we might conclude that cough has significant value in localizing seizures to the temporal lobe but overall these limited data do not suggest a lateralizing value.</p> </sec> </abstract>ARTICLE2013-12-19T00:00:00.000+00:00Corpus callosum and epilepsies<abstract> <title style='display:none'>SUMMARY</title> <sec id="j_joepi-2015-0008_s_001"> <title style='display:none'>Introduction</title> <p>Corpus callosum (CC) is the largest forebrain commissure. Structural anomalies and accompanying clinical symptoms are not in the focus of neurologists, epileptologists or neurosurgeons.</p> </sec> <sec id="j_joepi-2015-0008_s_002"> <title style='display:none'>Aim and method</title> <p>Anatomy, embryological development, normal functions, structural abnormalities, additional malformations, clinical symptoms and seizure disorders with CC anomalies are reviewed from the literature.</p> </sec> <sec id="j_joepi-2015-0008_s_003"> <title style='display:none'>Review</title> <p>The detection of callosal anomalies increased rapidly with widespread use of brain imaging methods. Agenesis or dysgenesis of corpus callosum (AgCC) might be considered an accidental finding. Epileptic seizures occur in up to 89% of patients with AgCC. The causal relationship correctly is questioned. However, additional causative malformations of midline and/or telencephalic structures can be demonstrated in most seizure patients. The interruption of bilateral spread of seizure activities acts as the concept for callosotomy as epilepsy surgery. Indications are drug-resistant generalized, diffuse, or multifocal epilepsies. A resectable seizure onset zone should be excluded. Most treated patients are diagnosed as Lennox-Gastaut or Lennox-like syndrome.</p> </sec> <sec id="j_joepi-2015-0008_s_004"> <title style='display:none'>Conclusions</title> <p>In cases with callosal abnormalities and clinical symptoms additional malformations are frequently observed, especially with seizure disorders. Callosotomy is the most effective option against drop attacks. The method probably is underused. After callosotomy a circumscript seizure focus might be unveiled and a second step of resective epilepsy surgery can be successful.</p> </sec> </abstract>ARTICLE2013-12-06T00:00:00.000+00:00Burns from foul play? No – previously unsuspected epilepsy<abstract> <title style='display:none'>SUMMARY</title> <sec id="j_joepi-2013-0009_s_001"> <title style='display:none'>Introduction</title> <p>Injuries such as burns may occur from unwitnessed and unsuspected new onset epilepsy with forensic implications.</p> </sec> <sec id="j_joepi-2013-0009_s_002"> <title style='display:none'>Case report</title> <p>A young woman was found with &gt;25% 2nd and 3rd degree body burns after an unwitnessed morning event in a shower.</p> </sec> <sec id="j_joepi-2013-0009_s_003"> <title style='display:none'>Discussion</title> <p>The onset of tonic-clonic seizures and limb jerks in adolescence with a typical EEG recording of 3–4/second spike/polyspike-and-waves are diagnostic of Juvenile Myoclonic Epilepsy (JME). Worldwide there is a significant morbidity and mortality in epilepsy from burns. The treatment of JME and of burns was discussed.</p> </sec> </abstract>ARTICLE2013-12-05T00:00:00.000+00:00The role of the hepatic metabolisation for the interaction between valproic acid and carbapenem antibiotics interrelationship between clinical and immunity variables in epilepsy<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0015_s_001"><title style='display:none'>Introduction</title><p>The role of cellular immunity in the pathogenesis of epilepsy, as an interaction between immunity and clinical and neurobiological variables is not properly understood.</p></sec><sec id="j_joepi-2016-0015_s_002"><title style='display:none'>Aim</title><p>The aim of the current study was to investigate the possible relationship between epilepsy forms, gender, focus localization, lateralization, handedness and cellular immunity with seizures frequency, their severity and length of therapeutic remission in partial forms of epilepsy.</p></sec><sec id="j_joepi-2016-0015_s_003"><title style='display:none'>Material and methods</title><p>Ninety two patients (38 men and 54 women) were included in the study. Symptomatic epilepsy was diagnosed in 40 patients and the cryptogenic form was diagnosed in 52 patients. The amount of different lymphocyte clusters were evaluated and they were transformed into nominal variables for MANOVA analysis. MANOVA was used for the analysis of the interrelationship between nominal fixed factors (epilepsy forms, gender, handedness, and focus laterality, and immunity variables) and dependent variables (remission and seizure frequency and their severity).</p></sec><sec id="j_joepi-2016-0015_s_004"><title style='display:none'>Results</title><p>Simple partial seizure (SPS) and complex partial seizure (CPS) frequencies were under the influence of interaction between immune and neurobiological variables. SPS, and in particular sensory SPS, were associated with CD4/CD8 ratio, gender, left temporal focus and handedness. The highest frequencies of SPS were revealed in cases of low CD4/CD8 ratio combined with left temporal focus, female gender and left-handedness. The maximal CPS frequency was observed in patients with a left frontal focus combined with a high B-lymphocyte level. The more severe seizures were revealed in left-handers with low CD8 and high CD4/CD8 ratio and in frontal left focus and a high T-lymphocyte level. There was a correlation between CD4 cell level and length of remission.</p></sec><sec id="j_joepi-2016-0015_s_005"><title style='display:none'>Conclusion</title><p>The complex multifarious connections between neurobiological, immune and clinical variables in patients with partial forms of epilepsy really exist.</p></sec></abstract>ARTICLE2016-12-22T00:00:00.000+00:00The epileptic multifactorial patient’s burden. Review of the topic<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0009_s_001"><title style='display:none'>Background</title><p>Approximately 26% of the burden of neurologic diseases is due to epilepsy. Its negative impact reflects mainly on people with epilepsy (PWE) themselves.</p></sec><sec id="j_joepi-2016-0009_s_002"><title style='display:none'>Aims</title><p>To highlight the negative impacts of epilepsy on the lives of PEW’s so as to identify a realistic approach to their individual needs.</p></sec><sec id="j_joepi-2016-0009_s_003"><title style='display:none'>Methods</title><p>For recently published papers PubMed and MEDLINE databases were used. In addition relevant references mentioned in the searched articles were also considered.</p></sec><sec id="j_joepi-2016-0009_s_004"><title style='display:none'>Review and discussion</title><p>Generalized tonic-clonic seizures and refractory epilepsy are the most important factors burdening PWE’s, resulting in increased injuries and mortality, including Sudden Unexpected Death in Epilepsy (SUDEP). The need of chronic intake of antiepileptic drugs (AEDs) and of epilepsy surgery are also important with regards to potential for side effects, drug interactions, and different surgery risks. PWE harbour more medical and psychiatric comorbidities than the general population and results in a decreased quality of life. Decreased self-esteem and major stigma are also frequent, linked to social, economic and personal negative consequences.</p><p>Age also plays a role, younger people being more stigmatized given the interdiction to drive or difficulty in getting a job. In the elderly, seizures may have an impact on mental status, mood and sleep. Gender may also contribute, particularly involving women in childbearing age, linked to the fear or depression due to the possibility of AED-induced fertility disturbances, foetal malformations, or breast feeding side-effects.</p></sec><sec><title style='display:none'>Conclusions</title><p>The burden that PWE face must be considered by all people involved in the management of their epilepsy. The causes may be multifactorial, all interconnected and each one influencing the others.</p></sec></abstract>ARTICLE2016-09-30T00:00:00.000+00:00Biofeedback as complementary treatment in patients with epilepsy – an underestimated therapeutic option? Review, results, discussion<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0013_s_001"><title style='display:none'>Background</title><p>Biofeedback methods represent side effect free complementary options in the treatment of epilepsy. In this paper we review the current status of these methods in terms of clinical study results and their evaluation by systematic review papers. Possible mechanisms of action in biofeedback methods are discussed.</p></sec><sec id="j_joepi-2016-0013_s_002"><title style='display:none'>Aim</title><p>To present the current status of biofeedback methods applied to patients with epilepsy.</p></sec><sec id="j_joepi-2016-0013_s_003"><title style='display:none'>Material and Methods</title><p>With a literature search up to 10/2016 we screened publications containing the search terms “biofeedback”, “neurofeedback” or “neurotherapy” and “epilepsy” or “seizure” for intervention and population search terms respectively.</p></sec><sec id="j_joepi-2016-0013_s_004"><title style='display:none'>Results</title><p>Four different techniques of biofeedback were used to improve seizure frequency in patients with epilepsy. Three of these techniques, measuring EEG (slow cortical potentials and sensory motor rhythm) or electrodermal activity (galvanic skin response, GSR) seem to be promising methods for successful seizure control. Nevertheless, methodological standards in the conducted trials were too low for assured empirical evidence in their efficacy.</p></sec><sec id="j_joepi-2016-0013_s_005"><title style='display:none'>Conclusions</title><p>Biofeedback methods could be applied to patients to a greater extent. Probably due to the missing empirical evidence of efficacy and the high demand on patients’ and therapists’ time and commitment and therefore low cost effectiveness, these methods are hardly offered. Especially the relatively new approach of GSR biofeedback represents a promising option here.</p></sec></abstract>ARTICLE2016-12-17T00:00:00.000+00:00The quality of life of children with epilepsy in Poland – the opinion of children and their parents<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0012_s_001"><title style='display:none'>Background</title><p>Every chronic illness, including epilepsy, has a negative effect on both the quality of life of the sufferer as well as on their relationship with their surroundings.</p></sec><sec id="j_joepi-2016-0012_s_002"><title style='display:none'>Aims</title><p>To investigate the quality of life of children suffering from epilepsy and analyse how they assessed and scored their experiences compared to their parents.</p></sec><sec id="j_joepi-2016-0012_s_003"><title style='display:none'>Materials and methods</title><p>The study included 209 children with epilepsy and their parents. The research tool was a questionnaire for gathering demographic and clinical data as well as the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™ 4.0) questionnaire in two versions, one for 8–12 year olds and one for 13–18 year olds and their parents.</p></sec><sec id="j_joepi-2016-0012_s_004"><title style='display:none'>Results</title><p>Cronbach’s alpha coefficient for the entire PedsQL™ 4.0 questionnaire was 0.91 and 0.93 for children with epilepsy and their parents respectively. Children rated their Total Scale Score higher (67.5 points) than their parents (62.5 points). Whilst analyzing children’s functioning in different areas it was observed that girls’ assessments were higher than boys’, except for Emotional Functioning. Both parents and children scored School Functioning the lowest. The greatest agreement of responses was observed in the domain of Physical Functioning, the smallest in the domain of Emotional Functioning.</p></sec><sec id="j_joepi-2016-0012_s_005"><title style='display:none'>Conclusions</title><p>Quality of life was rated higher by both age groups of children suffering from epilepsy than by their parents. A statistically significant difference was found when comparing the assessment scores of children and parents in light of the following variables; child age, gender, illness duration, seizure frequency and treatment effectiveness.</p></sec></abstract>ARTICLE2016-12-19T00:00:00.000+00:00The relationship of medial temporal lobe epilepsy with the declarative memory system<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0011_s_001"><title style='display:none'>Introduction</title><p>Medial temporal lobe of epilepsy (MTLE) is considered as local/regional epilepsy. However, as was discussed in Part I of this review (Halász, 2016a) there is more evidence regarding the involvement of both temporal lobes so as to consider MTLE as one of the typical bilateral system epilepsies.</p></sec><sec id="j_joepi-2016-0011_s_002"><title style='display:none'>Aim</title><p>To provide contemporary review of MTLE in relation to the declarative memory system and the newly recognized hippocampo-frontal memory consolidation during slow wave sleep.</p></sec><sec id="j_joepi-2016-0011_s_003"><title style='display:none'>Methods</title><p>A review of the available literature on experimental and clinical data and also the authors own studies in MTLE patients.</p></sec><sec id="j_joepi-2016-0011_s_004"><title style='display:none'>Review, discussion and results</title><p>New experimental and clinical neurophysiological data have shown that MTLE is closely linked to the hippocampal memory system. It is likely that hippocampal spiking is the epileptic variations of the normal sharp wave ripple events mediating the encoding and consolidation of memory engrams by a hippocampo-frontal dialogue during slow wave sleep.</p></sec><sec id="j_joepi-2016-0011_s_005"><title style='display:none'>Conclusions</title><p>The source of memory impairment in MTLE patients is not merely the cell loss and synaptic transformation of the hippocampal structure, but the every night interference with memory consolidation due to interictal spiking.</p></sec></abstract>ARTICLE2016-11-22T00:00:00.000+00:00Additive interactions between retigabine and oxcarbazepine in the chimney test and the model of generalized tonic-clonic seizures in mice<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0016_s_001"><title style='display:none'>Introduction</title><p>Patients with pharmacoresistant epilepsy are usually treated with two or more antiepileptic drugs (AEDs). The search for therapeutically efficacious AED combinations is still a challenging issue for clinicians and epileptologists throughout the world.</p></sec><sec id="j_joepi-2016-0016_s_002"><title style='display:none'>Aim</title><p>To determine the interaction profile for the combination of retigabine (RTG) and oxcarbazepine (OXC) in both, the model of tonic-clonic seizures, the maximal electroshock (MES)-induced seizure model and chimney test (motor performance) in adult male albino Swiss mice.</p></sec><sec id="j_joepi-2016-0016_s_003"><title style='display:none'>Methods</title><p>Isobolographic analysis (type I) was applied to characterize interactions for the combination of RTG with OXC with respect to its anticonvulsant and acute side (neurotoxic) effects, as determined in the MES and chimney tests, respectively.</p></sec><sec id="j_joepi-2016-0016_s_004"><title style='display:none'>Results</title><p>The combination of RTG with OXC at the fixed-ratios of 1:3, 1:1 and 3:1 produced additive interactions in the MES test in mice. Similarly, the combination of RTG with OXC at the fixed-ratio of 1:1 produced additive interaction with a tendency towards sub-additivity in the chimney test in mice. Measurement of total brain concentrations of both AEDs revealed that RTG did not affect total brain concentrations of OXC and inversely, OXC had no impact on RTG’s total brain concentrations, confirming pharmacodynamic interaction between the drugs.</p></sec><sec id="j_joepi-2016-0016_s_005"><title style='display:none'>Conclusions</title><p>The additive pharmacodynamic interactions in both the MES and chimney tests in mice were observed for the combination of RTG with OXC.</p></sec></abstract>ARTICLE2016-12-22T00:00:00.000+00:00Presurgical diagnosis of epilepsies – concepts and diagnostic tools<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0014_s_001"><title style='display:none'>Introduction</title><p>Numerous reviews of the currently established concepts, strategies and diagnostic tools used in epilepsy surgery have been published. The focus concept which was initially developed by Forster, Penfield and Jasper and popularised and enriched by Lüders, is still fundamental for epilepsy surgery.</p></sec><sec id="j_joepi-2016-0014_s_002"><title style='display:none'>Aim</title><p>To present different conceptual views of the focus concept and to discuss more recent network hypothesis, emphasizing so-called “critical modes of an epileptogenic circuit”.</p></sec><sec id="j_joepi-2016-0014_s_003"><title style='display:none'>Method</title><p>A literature search was conducted using keywords: presurgical evaluation, epileptic focus concepts, cortical zones, diagnostic tools.</p></sec><sec id="j_joepi-2016-0014_s_004"><title style='display:none'>Review and remarks</title><p>The theoretical concepts of the epileptic focus are opposed to the network hypothesis. The definitions of the various cortical zones have been conceptualized in the presurgical evaluation of candidates for epilepsy surgery: the seizure onset zone versus the epileptogenic zone, the symptomatogenic zone, the irritative and functional deficit zones are characterized. The epileptogenic lesion, the “eloquent cortex” and secondary epileptogenesis (mirror focus) are dealt with. The current diagnostic techniques used in the definition of these cortical zones, such as video-EEG monitoring, non-invasive and invasive EEG recording techniques, magnetic resonance imaging, ictal single photon emission computed tomography, and positron emission tomography, are discussed and illustrated. Potential modern surrogate markers of epileptogenicity, such as <italic>High frequency oscillations, Ictal slow waves/DC shifts, Magnetic resonance spectroscopy, Functional MRI,</italic> the use of <italic>Magnetized nanoparticles</italic> in MRI, <italic>Transcranial magnetic stimulation, Optical intrinsic signal</italic> imaging, and <italic>Seizure prediction</italic> are discussed. Particular emphasis is put on the EEG: Scalp EEG, semi-invasive and invasive EEG (Stereoelectroencephalography) and intraoperative electrocorticography are illustrated. Ictal SPECT and <sup>18</sup>F-FDG PET are very helpful and several other procedures, such as dipole source localization and spike-triggered functional MRI are already widely used. The most important lateralizing and localizing ictal signs and symptoms are summarized. It is anticipated that the other clinically valid surrogate markers of epileptogenesis and epileptogenicity will be further developed in the near future. Until then the concordance of the results of seizure semiology, localization of epileptogenicity by EEG and MRI remains the most important prerequisite for successful epilepsy surgery.</p></sec><sec id="j_joepi-2016-0014_s_005"><title style='display:none'>Conclusions and future perspectives</title><p>Resective epilepsy surgery is a widely accepted and successful therapeutic approach, rendering up to 80% of selected patients seizure free. Although other therapies, such as radiosurgery, and responsive neurostimulation will increasingly play a role in patients with an unresectable lesion, it is unlikely that they will replace selective resective surgery. The hope is that new diagnostic techniques will be developed that permit more direct definition and measurement of the epileptogenic zone.</p></sec></abstract>ARTICLE2016-12-22T00:00:00.000+00:00The medial temporal lobe epilepsy is a bilateral disease – novel aspects<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0010_s_001"><title style='display:none'>Introduction</title><p>Medial temporal lobe epilepsy (MTLE) is the most frequent form of epilepsy in adulthood. It is classified as local/regional epilepsy. However, there is increasing evidence of the involvement of both temporal lobes and this provides abundant arguments to question this view, and consider MTLE as one of the typical bilateral system epilepsies.</p></sec><sec id="j_joepi-2016-0010_s_002"><title style='display:none'>Aim</title><p>To provide a contemporary review of medial temporal lobe epilepsy, discussing the bilateral aspects, with reference to epilepsy surgery.</p></sec><sec id="j_joepi-2016-0010_s_003"><title style='display:none'>Methods</title><p>A literature review and a resume of the author’s own experiences with MTLE patients.</p></sec><sec id="j_joepi-2016-0010_s_004"><title style='display:none'>Results</title><p>Recent electrophysiological and neuroimaging data provide convincing data supporting that MTLE is a bilateral disease. The uni-and bilateral features form a continuum and the participation rate of the two temporal lobes determine course and surgical perspective of the individual patient.</p></sec><sec id="j_joepi-2016-0010_s_005"><title style='display:none'>Conclusions</title><p>The contradictory data of invasive presurgical evaluations of MTLE patients suggest that there need to identify further indicatory markers of bilaterality and thus change the presurgical evaluation from the non-invasive towards the invasive ways. The mechanisms of the interrelationship between the two temporal lobes in MTLE warrants further research.</p></sec></abstract>ARTICLE2016-11-22T00:00:00.000+00:00Depression and anxiety in people with epilepsy: Why should we identify?<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0005_s_001"><title style='display:none'>Introduction</title><p>People with epilepsy (PWE) have a higher risk of developing depression and anxiety than people without epilepsy. However, understanding and management of that issue remain under-recognized.</p></sec><sec id="j_joepi-2016-0005_s_002"><title style='display:none'>Aim</title><p>To emphesize: a) the relationship between depression, anxiety, and epilepsy, and b) to suggest practical strategies for their identification by clinicians.</p></sec><sec id="j_joepi-2016-0005_s_003"><title style='display:none'>Methods</title><p>The current literatures was reviewed investigating the impact of depression and anxiety in PWE and those examining the validity of simple screening tools for the detection of depression and anxiety.</p></sec><sec id="j_joepi-2016-0005_s_004"><title style='display:none'>Review</title><p>Approximately one quarter of PWE have been known to be suffered from depression. The frequency of depression and anxiety was closely related to poor seizure control. Depression and anxiety have been reported to have a bidirectional relationship with epilepsy. The higher degree of depression and anxiety was more likely to elicit the suicidal ideation and attempt, adverse events and poor compliance of antiepileptic drugs, poor surgical outcome, and eventually, poor quality of life. Furthermore, depression and anxiety were closely associated with perceived stigma, obsessive-compulsive symptom, aggression, fatigue, and perceived stress.</p></sec><sec id="j_joepi-2016-0005_s_005"><title style='display:none'>Conclusions</title><p>Clinicians who take care of PWE in a busy clinical setting should identify their psychiatric problems by brief screening tools and treat them instantly to minimize their negative impacts.</p></sec></abstract>ARTICLE2016-06-07T00:00:00.000+00:00Natural course of treated epilepsy and medico-social outcomes. Turku studies. Part II<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0001_s_001"><title style='display:none'>Introduction</title><p>Population-based data on the prognosis of childhood-onset epilepsy were almost nonexistent in the 1960s. This prompted me to start an epidemiological prospective study on children with epilepsy.</p></sec><sec id="j_joepi-2016-0001_s_002"><title style='display:none'>Aim</title><p>To study the medical and social outcome of children with epilepsy.</p></sec><sec id="j_joepi-2016-0001_s_003"><title style='display:none'>Methods</title><p>The most important personal data on the natural course and outcome were reviewed and compared with the relevant data of other investigators.</p></sec><sec id="j_joepi-2016-0001_s_004"><title style='display:none'>Results and discussion</title><p>The natural course of treated epilepsy is remitting, uninterrupted by relapse (in 48%); a remitting-relapsing course (interrupted by relapses, in terminal remission) (19%); worsening course (early or late remission followed by drug-resistant epilepsy) (14%); and never in ?5-year remission (drug resistance) (19%) The medical and social outcomes based on my unique, five decades followed cohort show that most subjects are in 10-year remission without medications, which is the definition of resolved epilepsy. Normal or subnormal IQ, non-symptomatic etiology, and low seizure frequency both in the first year of AED treatment and prior to medication appear to be clinical predictors of cure in childhood-onset epilepsy. Subjects with 1-year remission during the first five years form onset of treatment have more than 10-fold chance for entering 5-year terminal remission vs those who have no 1-year remission during the first five years. Even about one fourth of difficult-to-treat subjects become seizure free on medication and more than half of them enter one or more 5-year remissions. Epilepsy has a substantial impact on quality of life even in those who are seizure free off medication for many years and particularly those not in remission or in remission but still on medication.</p></sec><sec id="j_joepi-2016-0001_s_005"><title style='display:none'>Conclusions</title><p>The prognosis is excellent for medical and social outcome. The successful outcome is confirmed by several longitudinal studies from recent decades. Good response to early drug therapy does not necessarily guarantee a favorable seizure outcome, and even a late good response may still predict a successful prognosis. Our life-cycle study is being continued and targets to answer the question whether or not childhood-onset epilepsy is a risk factor for premature and/or increased incidence of mental impairment and dementia.</p></sec></abstract>ARTICLE2016-01-25T00:00:00.000+00:00Successful treatment of epilepsia partialis continua due to Rassmussen encephalitis with perampanel<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0003_s_001"><title style='display:none'>Background</title><p>Epilepsia partialis continua (EPC) is a difficult to treat condition, which tends to be refractory to antiepileptic drugs (AEDs). We previously published two other treatment episodes of EPC due to stroke and vascular dementia with a possible effect of perampanel (PER).</p></sec><sec id="j_joepi-2016-0003_s_002"><title style='display:none'>Aim</title><p>With the publication of a third treatment episode of EPC terminated by the administration of PER we would like to suggest that PER may be an effective treatment option in this condition.</p></sec><sec id="j_joepi-2016-0003_s_003"><title style='display:none'>Material and Methods</title><p>We present a case where PER was the last AED introduced in the treatment of a patient with EPC and individual seizures due to Rasmussen encephalitis before his seizure frequency could be reduced significantly.</p></sec><sec id="j_joepi-2016-0003_s_004"><title style='display:none'>Results</title><p>A 44 years old male patient, who had been on a combination therapy of at least 4 AEDs since the age of 24, was admitted to our hospital presenting with an EPC. After the introduction of PER in the therapy EPC stopped and he remained seizure free for more than a year. Two of his other AEDs could be tapered of.</p></sec><sec id="j_joepi-2016-0003_s_005"><title style='display:none'>Conclusion</title><p>PER might be especially effective in EPC.</p></sec></abstract>ARTICLE2016-03-31T00:00:00.000+00:00Lateralized periodic discharges associated with status epilepticus in the first year after stroke<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0001_s_001"><title style='display:none'>Backgrand</title><p>Lateralized periodic discharges (LPDs) are infrequent electroencephalograph (EEG) findings, and may present in ictal or interictal form. They are regarded as potential electrophysiologic signs of convulsive or nonconvulsive status epilepticus (NCSE). We report four patients who presented with NCSE and one who presented with convulsive status epilepticus in the postictal period, characterized by LPDs in EEG recordings in the first year after stroke.</p></sec><sec id="j_joepi-2016-0001_s_002"><title style='display:none'>Material and methods</title><p>We prospectively evaluated patients who clinically presented with status epilepticus associated LPDs between March 2014 and March 2015. We investigated patients that presented with a new stroke occurrence. We excluded the other LPD etiologies.</p><p>EEG studies of five patients (two men) who were admitted to our emergency unit with confusion, three of whom had visual symptoms; four were treated for NCSE as diagnosed with LPDs. The fifth patient had convulsive status epilepticus with LPD in the postictal period.</p></sec><sec id="j_joepi-2016-0001_s_003"><title style='display:none'>Results and Discussion</title><p>None of the five patients, who were aged between 68 and 92 years, showed any etiologic factor other than a history of cerebrovascular disease (CVD). Magnetic resonance imaging studies of the patients revealed old infarcts and transitional diffusion restrictions. The clinical and EEG findings decreased substantially upon antiepileptic drug treatment. Herein, we illustrate the first patient who had confusion, visual hallucinations, and ictal and interictal LPD in her consecutive EEGs.</p></sec><sec id="j_joepi-2016-0001_s_004"><title style='display:none'>Conclusions</title><p>CVDs may pave the way for LPDs in patients with a history of stroke because CVDs cause structural brain damage. Patients who present with a similar clinical profile and imaging signs of stroke should be checked for NCSE, particularly in the presence of LPDs in EEGs.</p></sec></abstract>ARTICLE2016-03-17T00:00:00.000+00:00Anticonvulsant therapy in brain-tumor related epilepsy<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0004_s_001"><title style='display:none'>Background</title><p>The lifetime risk of patients with brain tumors to have focal epileptic seizures is 10–100%; the risk depends on different histology. Specific guidelines for drug treatment of brain tumor-related seizures have not yet been established.</p></sec><sec id="j_joepi-2016-0004_s_002"><title style='display:none'>Aim</title><p>This review addresses the special aspects of antiepileptic drug (AED) therapy in brain tumor-related epilepsy.</p></sec><sec id="j_joepi-2016-0004_s_003"><title style='display:none'>Methods</title><p>We analyzed the literature up to December 2015.</p></sec><sec id="j_joepi-2016-0004_s_004"><title style='display:none'>Results</title><p>Based on current evidence the management of tumor-related seizures does not differ substantially from that applied to epilepsies from other etiologies. Therefore, the choice of an AED is based, above all, on tolerability and pharmacokinetic interactions with chemotherapeutic drugs. Levetiracetam is recommended by many authors as first-line therapy in brain tumor-related epilepsy. Due to the possibility of interactions, the combination of enzyme-inducing AEDs and chemotherapeutic drugs, is usually not recommended as a first choice. Currently there is no evidence that prophylactic prescription of long-term AEDs in brain tumor-patients who did not present with seizures is justified. Because of the high risk of recurrence, however, AED treatment should be strongly considered after a single brain tumor-related seizure. The decision to withdraw AEDs must carefully consider the risk of seizure recurrence.</p></sec><sec id="j_joepi-2016-0004_s_005"><title style='display:none'>Conclusion</title><p>At present levetiracetam is the preferred drug in brain tumor-related epilepsy, especially when drug interactions need to be avoided. In the future we hope to acquire more targeted drugs against this disorder by uncovering its pathogenesis.</p></sec></abstract>ARTICLE2016-04-06T00:00:00.000+00:00en-us-1