rss_2.0Journal of Epileptology FeedSciendo RSS Feed for Journal of Epileptology of Epileptology Feed use of ibuprofen as an anti-seizure medication: a systematic review<abstract><title style='display:none'>Summary</title> <sec><title style='display:none'>Background</title> <p>Epileptic seizure is a transient period of signs and symptoms resulting from the abnormal excessive and synchronous neuronal activity in the brain, resulting in brain damage. To prevent complications, the antiseizure medication is needed. Several agents have a potency of anti-seizure effect, including ibuprofen. Unfortunately, there are few studies regarding the anti-seizure effect of ibuprofen.</p> </sec> <sec><title style='display:none'>Aim</title> <p>To determine the anti-seizure effect of ibuprofen to reduce the symptoms of epileptic seizures.</p> </sec> <sec><title style='display:none'>Materials and Methods</title> <p>A systematic review using the databases ScienceDirect, SpringerLink, Nature, and Pubmed. The article was obtained using the keywords “ibuprofen” and (“epilepsy” or “anticonvulsant” or “antiseizure” or “epileptic” or “neuroinflammation”) in the period 2012 to 2022 and screened with inclusion and exclusion criteria. Out of the 1376 articles screened, there are three studies included in this review. The SYRCLE Risk of Bias Tool was used to assess the risk of bias, and the data was synthesised using SWiM guidelines.</p> </sec> <sec><title style='display:none'>Results</title> <p>Ibuprofen affects seizures by reducing the number, grade, and duration of seizure intensity in the PTZ-induced rats. Despite the risk of bias assessment revealing some potential bias in the studies, our study shows that ibuprofen has potency as an additional agent for epileptic seizures among febrile convulsive patients.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>In animal models of seizures, ibuprofen has an antiseizure effect by reducing the number, grade, and duration of seizures.</p> </sec> </abstract>ARTICLEtrue in the management of focal-onset epilepsy in adults – practical considerations for daily practice<abstract> <title style='display:none'>SUMMARY</title> <sec> <title style='display:none'>Introduction</title> <p>Cenobamate (CNB) is a newly approved antiseizure medication in Europe. It is used as an add-on treatment for focal-onset seizures in adult patients with epilepsy that is not responding to other medications.</p> </sec> <sec> <title style='display:none'>Aim</title> <p>This report discusses the practical aspects of using cenobamate to treat adult patients with epilepsy based on current experiences.</p> </sec> <sec> <title style='display:none'>Discussion and conclusions</title> <p>Studies have shown that cenobamate is effective in reducing seizure frequency in adult patients with drug-resistant focal onset epilepsy when used as add-on therapy. It also has a high seizure freedom rate, a good treatment retention rate, and a favorable safety profile. The aspects discussed include using cenobamate in special populations and potential interactions with other drugs, management strategies to mitigate the risk of adverse reactions illustrated by a specific clinical case. Further studies involving larger patient groups are necessary to assess the drug’s efficacy and safety profile, particularly in special populations and patients with other types of epileptic seizures.</p> </sec> </abstract>ARTICLEtrue related to possible autoimmune etiology in patients with drug-resistant epilepsy<abstract> <title style='display:none'>SUMMARY</title> <sec> <title style='display:none'>Background</title> <p>Between 14% and 20% of cases of drug-resistant epilepsy may be attributed to an impaired cellular or humoral immune response.</p> </sec> <sec> <title style='display:none'>Aim</title> <p>Our study aimed to assess disorders of the immune response of the humoral or cellular type and their impact on the course of the disease, factors suggesting the diagnosis of an autoimmune etiology. We wanted to analyse these factors, looking for correlations with a history of status epilepticus.</p> </sec> <sec> <title style='display:none'>Materials and methods</title> <p>This study prospectively analysed 30 patients who were diagnosed with drug-resistant epilepsy. The patients were divided into two groups: those who had previously experienced status epilepticus and those who had not. The study collected and analysed detailed information about the patient’s medical history, routine blood laboratory tests, albumin and immunoglobulin (IgG) levels, neuropsychological evaluations, electroencephalography tests (EEG), general cerebrospinal fluid (CSF) examinations, tests for the presence of oligoclonal bands, IgG index determination, MRZ-reaction (MRZR), chitotriosidase activity, and the presence of anti-herpes type 1 (anti-HSV-1) antibodies and neural autoantibodies. Each patient underwent magnetic resonance imaging (MRI) of the head with intravenous contrast administration using the epileptic protocol.</p> </sec> <sec> <title style='display:none'>Results</title> <p>There was no statistically significant difference in age, gender, onset and disease duration up to the time of our study. None of the patients showed the presence of the tested antibodies against neuronal surface antigens and oligoclonal bands in the CSF.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Lack of antibodies against neuronal antigens does not necessarily rule out autoimmune epilepsy. The exact diagnostic criteria are still a subject of debate. A history of SE increases the risk of autoimmune epilepsy.</p> </sec> </abstract>ARTICLEtrue can we distinguish postictal Todd’s Paralysis from acute ischemic stroke in the prehospital and early hospital setting?<abstract> <title style='display:none'>Summary</title> <sec id="j_joepi-2022-0002_s_001"> <title style='display:none'>Introduction</title> <p>Acute Ischemic Stroke (AIS) is a medical emergency with focal neurological deficits. Todd’s paralysis (TP) is defined as a transient loss of motor ability and weakness that lasts hours to days and typically occurs after a focal seizure. Given the high prevalence of stroke and the rising availability of reperfusion therapies, timely detection of eligible patients is critical. Pre- and early-hospital differential diagnosis of various conditions with comparable clinical presentations is still difficult.</p> </sec> <sec id="j_joepi-2022-0002_s_002"> <title style='display:none'>Aim</title> <p>This review discusses Todd’s post-epileptic paralysis, one of the most common stroke mimics (SM), in pre- and early-hospital settings.</p> </sec> <sec id="j_joepi-2022-0002_s_003"> <title style='display:none'>Discussion and Conclusions</title> <p>The review covers the most critical findings on the TP and its emergency care as a common stroke mimic. Because TP is an excluding diagnosis, the most severe and curable illnesses must be recognised. Since thrombolysis is safe in SM, delaying or withholding medication may be improper when the advantages of treating a stroke mimic outweigh the dangers of treating a stroke mimic.</p> </sec> </abstract>ARTICLEtrue 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>ARTICLEtrue semialdehyde dehydrogenase deficiency (SSADH-D) in an eleven-month-old infant with marked hypotonia and staring episodes: a case report<abstract> <title style='display:none'>Summary</title> <sec id="j_joepi-2022-0003_s_001"> <title style='display:none'>Introduction</title> <p>Succinic semialdehyde dehydrogenase deficiency (SSADH), also known as 4-hydroxybutyric aciduria (OMIM #271980, 610045), is an ultra-rare neurometabolic disorder inherited in an autosomal recessive pattern. It is usually characterised by a relatively nonprogressive encephalopathy in the first two years of life with hypotonia and developmental delay, associated with mild ataxia and hyporeflexia, as well as delays in language and speech development.</p> </sec> <sec id="j_joepi-2022-0003_s_002"> <title style='display:none'>Case report</title> <p>We report on a case of a four-year-old girl with SSADH deficiency who presented, at the age of 11 months old, with marked hypotonia, global neurodevelopmental delay and epilepsy. The diagnosis of “Succinic semialdehyde dehydrogenase deficiency” was indicated as there was a marked elevation of the levels of 4-hydroxy-butyric and 3,4-dihydroxybutyric acid caused by mutation at the gene ALDH5A1 in the homozygous state, identified with WES technique. Currently, she is four years old and has a severe global psychomotor delay, excessive hypotonia, hyperextensibility, and ataxia and is free of seizures.</p> </sec> <sec id="j_joepi-2022-0003_s_003"> <title style='display:none'>Conclusion</title> <p>At the early stage of clinical presentation, the condition is difficult to differentiate from other encephalopathies. This case report suggests that analysis of urinary organic acids should be performed in all patients at risk to allow early diagnosis. DNA analysis with the WES technique can confirm the diagnosis.</p> </sec> </abstract>ARTICLEtrue and autism: How does age at seizure onset factor in?<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2021-002_s_001"><title style='display:none'>Introduction.</title><p>Three neuropathological conditions and two neurosurgical situations have been reported to present significantly earlier seizure onset in cases with autism than without. These are tuberous sclerosis, Angelman syndrome, the <italic>PCDH19</italic> mutation, vagal nerve stimulation and epilepsy surgery.</p></sec><sec id="j_joepi-2021-002_s_002"><title style='display:none'>Method.</title><p>We reviewed the case-report literature to determine the extension of this <italic>autism-specific early seizure onset</italic> effect across all relevant neuropathological conditions. Published clinical cases were collected fulfilling two inclusion criteria: age at seizure onset stated and presence (N = 1885 cases) or absence (N=4907 cases) of autism. We also documented the type and tractability/intractability of the epilepsy, genetic abnormality, neurologic syndrome, structural brain imaging findings and presence of intellectual disability when available.</p></sec><sec id="j_joepi-2021-002_s_003"><title style='display:none'>Results.</title><p>Cases with autism presented significantly earlier seizure onset than cases without autism in 38 neuropathological conditions out of 162, including the previously established five. These 38 neuropathological conditions typically involved intractable epilepsy caused by focal cortical dysplasia located in the social brain, with the ictal or interictal electrical focus also located in the social brain. Within these 38 neuropathological conditions, in the cases with autism, the median seizure onset occurred between 50 days and 24 months after birth.</p></sec><sec id="j_joepi-2021-002_s_004"><title style='display:none'>Conclusion.</title><p>Onset of severe seizure disorder during an early critical post-natal interval, caused by brain damage specifically located in the social brain, strongly associates with subsequent autism.</p></sec></abstract>ARTICLEtrue knowledge, attitudes, behaviors, and associated factors among primary, post-primary, and secondary school teachers in Ouagadougou (Burkina Faso)<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2021-003_s_001"><title style='display:none'>Background.</title><p>Epilepsy is one of the most common pediatric neurological disorders. The knowledge and attitude of teachers toward epileptic students can be crucial.</p></sec><sec id="j_joepi-2021-003_s_002"><title style='display:none'>Patients and methods.</title><p>This cross-sectional study was carried on schoolteachers in the city of Ouagadougou during the period from March 02 to July 20, 2020. The schools were chosen randomly among a list of recognized public or private establishments.</p></sec><sec id="j_joepi-2021-003_s_003"><title style='display:none'>Results.</title><p>Two hundred and twenty teachers were included in the study. Among them, 35.45% were post-primary teachers. Most of them had already heard of epilepsy (98.6%). For the majority of school teachers, epilepsy was not a contagious disease (74%). Regarding the causes of epilepsy, the majority of participants had listed brain disease (65%) and genetic disorders (18.20%). The majority of schoolteachers (70.9%) believed that students with epilepsy usually had associated mental retardation. For the majority of teachers (73.20%), epilepsy was a stigmatizing disease, and students with epilepsy should benefit from personalized supervision (65%). The majority of schoolteachers (75.9%) had a good knowledge of epilepsy, and 43.6% had good attitudes toward epilepsy. The factor associated with teachers’ knowledge was having witnessed an epileptic seizure (p &lt; 0.05). The factors related to schoolteacher practice was gender (p &lt; 0.05) and having already witnessed an epileptic seizure (p &lt; 0.05)</p></sec><sec id="j_joepi-2021-003_s_004"><title style='display:none'>Conclusion.</title><p>Our study found that teachers had a good knowledge of epilepsy, but attitudes and practices were inadequate.</p></sec></abstract>ARTICLEtrue as second-line treatment of status epilepticus – which dose should be applied?<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2021-001_s_001"><title style='display:none'>Introduction</title><p>Since 2004 many treatment episodes in different stages of status epilepticus (SE) have been reported. Nowadays the use of levetiracetam (LEV) is recommended as a second-line treatment of SE, when the use of a benzodiazepine was not successful.</p></sec><sec id="j_joepi-2021-001_s_002"><title style='display:none'>Aim</title><p>The evidence based on randomized controlled trials for the application of a particular weight-based dose of LEV as a second-line treatment in benzodiazepine refractory SE is investigated.</p></sec><sec id="j_joepi-2021-001_s_003"><title style='display:none'>Methods</title><p>Pubmedsearches were undertaken using the terms “Levetiracetam-status-epilepticus-trials” and “Levetiracetam-status-randomized” on May 8<sup>th</sup> 2021. We identified 17 studies reporting treatment with LEV as second line treatment and reporting dosages in mg/kg body weight. We grouped the studies according to the reported dosages (i.e. 20–25 mg/kg; 30 mg/kg; 40 mg/kg, 60 mg/kg). For each group we calculated the mean efficacy rate and the standard deviation of the efficacy rate weighted for the number of cases in the different studies. Twelve studies compared LEV with 20 mg/kg phenytoin (PHT). In these studies, we analysed the relative efficacy rate in comparison to PHT with the same procedure.</p></sec><sec id="j_joepi-2021-001_s_004"><title style='display:none'>Results</title><p>Seven studies used LEV 20–25 mg/kg, two studies 30 mg/kg, six studies 40 mg/kg and one study 60 mg/kg. Efficacy rate was highest in the group given 30 mg/kg (95% CI 87.5–90.1%). The relative efficacy rate with this weight-based dose was 1.12. This is just above the upper range of the 95% CI of the relative efficacy rate in studies using 40 mg/kg LEV (i.e. 1.11). The relative efficacy rates in the two other groups were considerably lower.</p></sec><sec id="j_joepi-2021-001_s_005"><title style='display:none'>Conclusion</title><p>According to the randomized controlled trials published so far a weight-based dose of 30–40 mg/kg LEV may be appropriate for the treatment of benzodiazepine-refractory SE.</p></sec></abstract>ARTICLEtrue with lacosamide or levetiracetam in patients with renal replacement therapy. What is really known?<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2020-004_s_001"><title style='display:none'>Background</title><p>Lacosamide and levetiracetam are commonly used in critically ill patients, who need an antiepileptic treatment in addition to several other medications. Since both drugs are eliminated via the kidneys, dosage has to be adapted to renal function especially in renal replacement therapy (RRT). In 2016 recommendations of dosage in this condition were based on three case reports only.</p></sec><sec id="j_joepi-2020-004_s_002"><title style='display:none'>Aim</title><p>To elucidate the current data basis for recommendations on the dosage of Lacosamide and levetiracetam in patients on renal replacement therapy.</p></sec><sec id="j_joepi-2020-004_s_003"><title style='display:none'>Material and methods</title><p>A search in MEDLINE and Web of Science with several core terms was performed. Papers reporting on doses and concentrations of lacosamide or levetiracetam in patients with renal replacement therapy were analysed.</p></sec><sec id="j_joepi-2020-004_s_004"><title style='display:none'>Results and discussion</title><p>One phase-I study and three case reports concerning lacosamide and one case series with 22 patients and nine case reports concerning levetiracetam were identified. Whether 200 mg Lacosamide twice/day results in trough concentrations at least in the lower therapeutic range depends on the replacement rate used in continuous venovenous haemofiltration. Peritoneal dialysis seems to remove only a small portion of levetiracetam. Levetiracetam (1000 mg) every 12 hours may generate a trough concentration in the lower therapeutic range in continuous venovenous haemofiltration.</p></sec><sec id="j_joepi-2020-004_s_005"><title style='display:none'>Conclusion</title><p>Due to the sparse and low quality data, current recommendations on dosing lacosamide or levetiracetam in patients undergoing renal replacement therapy have to be considered with caution and therapeutic drug monitoring may be useful in guiding patient management.</p></sec></abstract>ARTICLEtrue of professionally active adults towards patients with epilepsy. Pilot study<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2020-008_s_001"><title style='display:none'>Background.</title><p>Attitudes are formed throughout the course of our lives, and they result from our knowledge, experience or belonging to a particular group of people. Stereotypes, prejudice, or discrimination are often the consequence of uncritical copying the behaviour of others and the lack of knowledge.</p></sec><sec id="j_joepi-2020-008_s_002"><title style='display:none'>Aim.</title><p>The aim of the study was to answer the following question: What attitudes towards patients with epilepsy are declared by adults undertaking professional activity?</p></sec><sec id="j_joepi-2020-008_s_003"><title style='display:none'>Materials and Methods.</title><p>Included in the study were professionally active persons aged between 35 and 60 years. The research tool was our own questionnaire. The questions referred to the three components of the attitude: knowledge, emotions, behaviours.</p></sec><sec id="j_joepi-2020-008_s_004"><title style='display:none'>Results.</title><p>The study group comprised 58 (58.59%) women and 41 (41.41%) men. The average age was 46.3 ± 10.2 years. Most respondents completed full tertiary education (n = 68, 68.69%). The average score obtained by the studied group from the entire questionnaire was 20.3 out of 27 points, which suggests that the investigated group represented positive attitudes. The highest score was obtained by the respondents in the affective component of attitudes, whereas the lowest was recorded in the behavioural component.</p></sec><sec id="j_joepi-2020-008_s_005"><title style='display:none'>Conclusion.</title><p>Majority of people participating in the study showed a positive attitude. In the study group, the most difficult questions were those about first aid and direct relations with the patients. Women, respondents with higher education, single and those who do intellectual work have a better perception of people suffering from epilepsy. White-collar workers and women would be more willing to employ and collaborate with a person with epilepsy.</p></sec></abstract>ARTICLEtrue and non-pharmacological approaches to life threatening conditions in epilepsy<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2020-002_s_001"><title style='display:none'>Background</title><p>A higher degree of mortality may be attributed to patients with epilepsy. There are several main reasons responsible – sudden unexpected death in epilepsy (SUDEP), status epilepticus (SE) and central nervous system damage. Also, epilepsy associated accidents and suicidal attempts have to be highlighted.</p></sec><sec id="j_joepi-2020-002_s_002"><title style='display:none'>Aim</title><p>Epidemiology and therapeutic or preventive (pharmacological or non-pharmacological strategies) of the conditions increasing mortality have been reviewed so as to minimize the mortality rate in patients with epilepsy.</p></sec><sec id="j_joepi-2020-002_s_003"><title style='display:none'>Discussion and Conclusions</title><p>Generally, the treatment of convulsive SE entails the need to achieve rapid stabilization of a patient and an appropriate choice of antiepileptic drugs (AEDs) so as to stop seizure activity. In the event of no response the treatment has to be continued under general anaesthesia. For minimizing the risk of SUDEP in young adults or patients with childhood epilepsy, adequate treatments with AEDs must be initiated or possible surgery considered. Patients with uncontrolled epilepsy require AED optimization. Although a possible link between taking AEDs and increased suicidality is questionable, patients with epilepsy are advised to be evaluated for possible symptoms of depression or anxiety. Surgical treatment of epilepsy may increase the risk of depression development, so a careful psychiatric examination is recommended prior to surgery.</p></sec></abstract>ARTICLEtrue characteristics of forced normalization and alternative psychosis with special consideration of the new anticonvulsants<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2020-001_s_001"><title style='display:none'>Background</title><p>In the case of an alternative psychosis (AP) or forced normalization (FN), the patient alternates between periods of clinically manifest seizures and normal behavior, and other periods of seizure freedom or significant seizure reduction accompanied by psychosis or behavioral disturbances. In clinical practice and in the literature, the terms AP and FN are mostly used synonymously despite small differences. FN of the EEG is not only common to interictal mental disturbances but may also occur in the case of pre-ictal and postictal mental disturbances.</p></sec><sec id="j_joepi-2020-001_s_002"><title style='display:none'>Aim</title><p>To update the 2007 review on “Alternative Psychoses of Epilepsy” in this journal with special consideration of the new anticonvulsants.</p></sec><sec id="j_joepi-2020-001_s_003"><title style='display:none'>Material and Methods</title><p>We conducted a literature research from 1987 (in this year a psychosis, triggered by the first “new “anticonvulsant vigabatrin in a patient with epilepsy was reported for the first time) up to September 2019.</p></sec><sec id="j_joepi-2020-001_s_004"><title style='display:none'>Discussion</title><p>AP/FN are rare events; only 10% of epileptic psychosis are AP/FN. AP/FN respectively occur with both generalized and focal epilepsy; in recent years, patients with focal epilepsy predominate. AP/FN generally present with behavioral disturbances of acute or subacute onset associated with thought disorder, delusions, hallucinations, significant mood change, or anxiety with depersonalization and derealization symptoms. The reports on EEG findings in patients with AP are inconsistent. In the case of FN, the EEG is by definition normal or substantially improved. The most prominent risk factor for the development of an AP/FN is the anticonvulsant medication. The following anticonvulsants have not been observed until now as triggers of an AP/FN in the literature reviewed by us: Acetazolamide and sulthiame (“old” anticonvulsants) and the “new” anticonvulsants brivaracetam, eslicarbazepine, pregabalin, retigabine, rufinamide, stiripentol. The treatment is based on 3 strategies: Reduction or complete cessation of anticonvulsants, change of anticonvulsants and administration of antipsychotic drugs.</p></sec><sec id="j_joepi-2020-001_s_005"><title style='display:none'>Conclusion</title><p>The risk of an AP/FN is probably different for the individual dugs. At the current level of experience, gabapentin, pregabalin, oxcarbazepine or eslicarbazepine can be the first alternative if an AP/FN was triggered by another anticonvulsant in a patient with focal epilepsy. In generalized epilepsy, especially in patients with absences, valproic acid remains the first alternative.</p></sec></abstract>ARTICLEtrue epilepsy associated with mutations in the KCNB1 and RELN genes. A case report<abstract><title style='display:none'>SUMMARY</title><p><bold>Introduction.</bold> Epilepsy is one of the most common neurological disorders worldwide. In most cases, epilepsy can be well managed. However, there is a number of patients who do not respond well enough to common medical treatments; a situation known as pharmacoresistant epilepsy. It can be caused by mechanisms that may involve environmental and genetic factors, as well as disease or drug related factors. <bold>Case presentation.</bold> Herein we present a case report of a six-year-old girl who has been diagnosed with pharmacoresistant epilepsy, characterized by generalized and focal seizures while she was on two antiepileptic drugs. Molecular testing, with Next Generation Sequencing (NGS) technique, revealed mutations at KCNB1 and RELN genes.</p></abstract>ARTICLEtrue brief update on psychogenic non-epileptic seizures: a challenge to overcome<abstract><title style='display:none'>SUMMARY</title><p>Psychogenic Non-Epileptic Seizures (PNES) are defined by their semiological resemblance to Epileptic Seizures (ES), not associated with specific epileptic discharges in an ictal EEG. PNES are, in fact, a feature of an underlying psychiatric disorder even if these patients are currently in the realm of epileptologists and for these reasons there is a large degree of confusion underlying the diagnosis (with an average delay of 3 years) and management of PNES. Documented PNES diagnosis would require the attack captured on video EEG (vEEG), but often it is not possible. The video registration of a seizure seen by an expert would make PNES “probable”. Conversational analysis has been demonstrated to be a very useful tool in the differential diagnosis between PNES and ES with a good rate of reliability. From a psychological point of view, PNES could be the same phenotype of different underlying mechanisms and, also for this reason, should consider these underlying processes and treatment could be sometimes seriously deficient. Many psychological approaches are anecdotally reported, but controlled studies are still lacking, and interventions still rely on clinicians’ experience. Moreover, pharmacological treatment may be recommended in adults or elderly with concomitant anxiety or depression. In conclusion, many symptoms and signs are valid but none is pathognomonic, the symptoms should be reported correctly and psychiatrists should be necessarily involved for the correct diagnosis and management of PNES.</p></abstract>ARTICLEtrue position paper on breastfeeding by women with epilepsy – working group report<abstract><title style='display:none'>SUMMARY</title><p><bold>Introduction.</bold> On the initiative of the General Board of the Polish Society of Epileptology a Working Group was established to develop an expert position on breastfeeding by women with epilepsy in Poland.</p><p><bold>Aim.</bold> To facilitate a unified and rational approach to breastfeeding for women with epilepsy.</p><p><bold>Methods.</bold> An ad hoc system was developed to classify available published evidence and expert opinions, which was used to evaluate recommendations on various aspects related to counselling, risk and safety of breastfeeding.</p><p><bold>Discussion and conclusions.</bold> This position paper provides an educational, practical and organizational aspects. It will allow for the introduction of a uniform protocol of conduct in Poland, which in turn will improve the safety of the mother and her child.</p></abstract>ARTICLEtrue tools in the management of epilepsy<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2020-007_s_001"><title style='display:none'>Introduction.</title><p>Epilepsy is a persistent neurological condition characterized by frequent seizures that are not triggered by an environmental or reversible stimulus. Although not yet widely used, mobile health (mHealth) innovations have enhanced epilepsy care and prevention and are expected to play an increasing role in the ownership of smartphones, wearable devices and innovation in medical technology.</p></sec><sec id="j_joepi-2020-007_s_002"><title style='display:none'>Aim.</title><p>The present review paper aims to summarize the current state of knowledge regarding the use of mHealth tools in epilepsy management.</p></sec><sec id="j_joepi-2020-007_s_003"><title style='display:none'>Discussion and Conclusions.</title><p>In this paper, we review available mHealth tools that influence key epilepsy management elements. These components include patient education, self-management directly affecting seizure control, diagnosis and therapy, and managing medical data. mHealth solutions are a promising approach to epilepsy self-management; further work is needed to explore their effectiveness.</p></sec></abstract>ARTICLEtrue of the Polish Society of Epileptology for the treatment of epileptic seizure in adult patients in Poland: an update<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2019-002_s_001"><title style='display:none'>Introduction</title><p>In 2014, a group of Polish epilepsy experts published recommendations for antiepileptic drug (AED) use in adults with epilepsy. Selection of AEDs was based on the registration and reimbursement status in Poland, evidence of efficacy, and the personal views and experiences of the epilepsy practitioners.</p></sec><sec id="j_joepi-2019-002_s_002"><title style='display:none'>Method</title><p>In 2018 previous recommendations were reviewed by the ad hoc group consisting of the authors of the original paper and additional epilepsy experts. As a result of joint work and reaching a consensus, an updated version of these recommendations has been prepared.</p></sec><sec id="j_joepi-2019-002_s_003"><title style='display:none'>Discussion and recommendations</title><p>This update focuses on the epileptic seizure type treatment recommendations for initial monotherapy and add-on treatment in adult patients. Some new relevant aspects of treatment with AEDs are addressed, including information on the safety of valproic acid (VPA) in women of childbearing potential.</p></sec></abstract>ARTICLEtrue influence of clinical and immune variables on psychopathological syndromes in partial epilepsies in relation to handedness<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2019-005_s_001"><title style='display:none'>Background.</title><p>The role of neurobiological and immunity variables in the genesis of psychopathological syndromes in patients with partial epilepsy is not properly understood. It concerns also the role of handedness.</p></sec><sec id="j_joepi-2019-005_s_002"><title style='display:none'>Aim</title><p>The study was carried out in order to find the influence of clinical (neurobiological) and immune variables on co-morbid psychopathological syndromes in patients with epilepsy separately for right-handers and left-handers.</p></sec><sec id="j_joepi-2019-005_s_003"><title style='display:none'>Material and Methods.</title><p>Ninety two (92) patients with epilepsy were recruited into the study. Among the studied patients were 85 right-handers and 7 left-handers. The data on frequency of each seizure semiotics, the assessment of seizures severity and the length of remission were used as main basic clinical variables. Assessment of psychopathological status of patients has been performed by using of Symptom Check List-90 (SCL-90). The amounts of different lymphocytes clusters also were calculated. The product moment correlation analysis was used to find the possible relationships separately for right-handers and left-handers.</p></sec><sec id="j_joepi-2019-005_s_004"><title style='display:none'>Results.</title><p>In the right-handers group only significant correlation between the focal motor seizure frequency and value of Hostility construct of SCL-90 scale (r = 0.284, p = 0.045), and between the total count of T-lymphocytes and expression of Psychoticism, SCL-90 (r =−0.271, p = 0.049). In the left-handers group stochastically significant correlations between focal seizures with impaired awareness (FSIA), focal to bilateral tonic-clonic seizures (FBTCS) and National Hospital Seizure Severity Scale (NHS3) score with 5 SCL-90 constructs were revealed. The regulatory index (CD4/CD8 ratio) correlates positively with Obsessions (r = 0.780, p = 0.039); Interpersonal sensitivity (r = 0.80, p = 0.031); Depression (r = 0.834, p = 0.02); Aggression (r = 0.926, p = 0.003); Paranoid ideations (r = 0.873, p = 0.01) and Psychoticism (r = 0.913, p = 0.004).</p></sec><sec id="j_joepi-2019-005_s_005"><title style='display:none'>Conclusion.</title><p>Neurobiological and immune variables determine the psychopathological constructs strictly in left-handers.</p></sec></abstract>ARTICLEtrue polytherapy: Myth or reality?<abstract><title style='display:none'>SUMMARY</title><sec id="j_joepi-2019-003_s_001"><title style='display:none'>Background.</title><p>The concept of rational polytherapy implies using a combination of antiepileptic drugs with synergistic effect, which in turn, may result in additive or reduced toxicity. This concept is not consensually accepted.</p></sec><sec id="j_joepi-2019-003_s_002"><title style='display:none'>Aim.</title><p>To present evidence in favour and against rational polytherapy.</p></sec><sec id="j_joepi-2019-003_s_003"><title style='display:none'>Methods.</title><p>Narrative literature review on PubMed and Medline databases using the following terms: epilepsy treatment, rational therapy/polytherapy, supraadditive treatment, drug-resistant epilepsy treatment. Cited references within selected articles were also evaluated.</p></sec><sec id="j_joepi-2019-003_s_004"><title style='display:none'>Results.</title><p>Against rational therapy is the evidence of clinical efficacy of the use of antiepileptic drugs with the same mechanism of action and without increased side-effects. Rational therapy may fail because while the addition of one antiepileptic drug to others with the same or different mechanisms of action leads to additive therapeutic efficacy, it also leads to more side effects. The evidence for the robust, unique, true synergism found between valproate and lamotrigine is questionable because the two drugs together may lead to complex pharmacokinetic interactions jeopardizing a consistent interpretation of the data. Data from studies with antiepileptic drugs with multiple mechanisms of action may be questionable because the same mechanism of action might not be responsible for drug efficacy or toxicity in different patients. Favouring rational therapy is the evidence that genetic animal models of seizures and drug-related neurotoxicity are ideal to evaluate the efficacy and toxicity of drug combinations, and that the most successful experimental combination of two antiepileptic drugs would be the one with a single mechanism of action and the other with a multiple mechanism of action.</p></sec><sec id="j_joepi-2019-003_s_005"><title style='display:none'>Conclusion.</title><p>Rational therapy is a sub-optimal, but worth being attempted strategy for the use of antiepileptic drugs in combination.</p></sec></abstract>ARTICLEtrue