seizure activity from genetic or acquired brain disorder general prevalence of epilepsy is 3% in population 10% of population will have a seizure at some point Seizure categorization: 1) Cause: Primary or Secondary (provoked) 2) Effect on mentation: Generalized (tonic-clonic, absence, atonic, myoclonic) or focal 3) Motor activity: convulsive or non-convulsive There are 6 factors that define an ictal event: 1. abrupt onset 2. brief duration 3. loss of consciousness 4. purposeless activity 5. unprovoked (...) CRACKCast E018 – Seizures CRACKCast E018 - Seizures - CanadiEM CRACKCast E018 – Seizures In , , by Adam Thomas December 15, 2016 This episode of CRACKCast covers Rosen’s Chapter 18, Seizures. This topic covers the basics of seizures, and the management of status epilepticus. PDF Show Notes – Rosen’s in Perspective: seizures are a pathologic excess of neuronal activity that disrupt normal cortical or deep limbic system functioning the term epilepsy refers specifically to recurrent unprovoked

Pulmonary edema following tonic–clonic seizure 29123866 2018 11 13 2052-8817 4 2 2017 04 Acute medicine & surgery Acute Med Surg Pulmonary edema following tonic-clonic seizure. 221-222 10.1002/ams2.251 Izumida Hiroaki H Department of Emergency and Critical Care Medicine School of Medicine Keio University Shinjuku-ku Tokyo Japan. Homma Koichiro K Department of Emergency and Critical Care Medicine School of Medicine Keio University Shinjuku-ku Tokyo Japan. Sasaki Junichi J Department (...) ;127(3):e9-10 24269657 Seizure. 2015 Apr;27:19-24 25844030 Neurology. 1994 May;44(5):815-20 8190280

, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López A, Rey-Ares L. Cannabinoids for refractory epilepsy treatment. Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS). Informe de Respuesta Rapida No. 499. 2016 Authors' conclusions There is scarce and low quality evidence on cannabinoids (specifically cannabidiol) potential in reducing the frequency of seizures in patients with refractory epilepsy. The Clinical Practice Guidelines and health sponsors consulted do (...) Cannabinoids for refractory epilepsy treatment Cannabinoids for refractory epilepsy treatment Cannabinoids for refractory epilepsy treatment Soto N, Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López A, Rey-Ares L Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Soto N, Pichon-Riviere A, Augustovski F

Relationship between Bone Density and Biochemical Markers of Bone among Two Groups Taking Carbamazepine and Sodium Valproate for Epilepsy in Comparison with Healthy Individuals in Yazd Chronic antiepileptic therapy has been associated with metabolic bone diseases including osteomalacia and osteoporosis. The aim of this study was to determine frequency of changes in biochemical and bone mineral density (BMD) in adults receiving valproaic acid (VPA) & carbamazepine (CBZ).In a cross sectional (...) study evaluating adults (age 20-50 y) epileptic patients receiving valproic acid or carbamazepine for at least 2 years. This study was conducted from May 2014 to May 2015 in Shahid Sadoughi Hospital of Yazd University of Medical Science, Yazd, Iran. Bone metabolism was evaluated by measurement of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) and parathormone hormone (PTH), BMD at lumbar and femoral measured by dual energy X ray absorptiometry (DXA). SPSS software (version 18

WITHDRAWN: Oxcarbazepine add-on for drug-resistant partial epilepsy. Most people with epilepsy have a good prognosis and their seizures can be well controlled with the use of a single antiepileptic drug, but up to 30% develop refractory epilepsy, especially those with partial seizures. In this review we summarize the current evidence regarding oxcarbazepine when used as an add-on treatment for drug-resistant partial epilepsy.To evaluate the effects of oxcarbazepine when used as an add (...) -on treatment for drug-resistant partial epilepsy.We searched the Cochrane Epilepsy Group's Specialized Register (28 March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies. We also contacted Novartis (manufacturers of oxcarbazepine) and experts in the field.Randomized, placebo-controlled

Treatment of epilepsy for people with Alzheimer's disease. Any type of seizure can be observed in Alzheimer's disease (AD). Antiepileptic drugs seem to prevent the recurrence of epileptic seizures in most people with AD. There are pharmacological and non-pharmacological treatments for epilepsy in people with AD. There are no current systematic reviews to evaluate the efficacy and tolerability of the treatment. This review aims to review those different modalities.To assess the efficacy (...) conference proceedings, and contacted authors and pharmaceutical companies.We included randomised and quasi-randomised controlled trials investigating treatment for epilepsy in people with AD, with the outcomes of proportion of seizure freedom or experiencing adverse events.Two review authors independently screened the titles and abstracts of identified records, selected studies for inclusion, extracted data, cross-checked the data for accuracy and assessed the methodological quality. We performed

Switching generic antiepileptic drug manufacturer not linked to seizures: A case-crossover study With more antiepileptic drugs (AED) becoming available in generic form, we estimated the risk of seizure-related events associated with refilling generic AEDs and the effect of switching between different manufacturers of the same generic drug.We designed a population-based case-crossover study using the Medicaid Analytic eXtract and a US commercial health insurance database. We identified 83,001 (...) generic AED users who experienced a seizure-related hospital admission or emergency room visit between 2000 and 2013 and assessed whether they received a refill of the same AED from the same manufacturer or a different manufacturer. Patients served as their own controls and conditional logistic regression was used to compare exposure to a refill during the hazard period, defined as days 2-36 preceding the seizure-related event, to exposure during the control period, defined as days 51-85 preceding

Sialanar (glycopyrronium) - for treating severe drooling of saliva in children and adolescents (aged 3 years and above) with conditions affecting the nervous system, such as cerebral palsy, epilepsy and neurodegenerative diseases 30 Churchill Place ? Canary Wharf ? London E14 5EU ? United Kingdom An agency of the European Union Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5520 Send a question via our website www.ema.europa.eu/contact 21 July 2016 EMA/555265/2016 Committee (...) ) regardless the route of dosing. These included mydriasis (all species), tremors, decreased motor activity, clonic and tonic convulsions, respiration failure and death. In rats and mice, absorption of a lethal quantity was not readily accomplished via the oral route. The LD50 values for all species after i.v. dosing was found to be in the range 15-30 mg/kg. Repeat dose toxicity The Applicant only refers to one chronic, oral repeat dose toxicity study in dogs (Dollery, 1998). The applicant summarizes

raise questions that are potentially important to consider in future comparative efficacy trials.NCT00537940.This study provides Class II evidence that for patients with partial seizures enrolled in this study, pregabalin is not superior to gabapentin in reducing seizure frequency. Because of the atypical response rates, the results of this study are poorly generalizable to other epilepsy populations.© 2016 American Academy of Neurology. (...) Adjunctive pregabalin vs gabapentin for focal seizures: Interpretation of comparative outcomes To evaluate the comparative safety and adjunctive efficacy of pregabalin and gabapentin in reducing seizure frequency in patients with partial-onset seizures based on prestudy modeling showing superior efficacy for pregabalin.The design of this comparative efficacy and safety study of pregabalin and gabapentin as adjunctive treatment in adults with refractory partial-onset seizures was randomized

Adjunctive everolimus therapy for treatment-resistant focal-onset seizures associated with tuberous sclerosis (EXIST-3): a phase 3, randomised, double-blind, placebo-controlled study. Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been used for various benign tumours associated with tuberous sclerosis complex. We assessed the efficacy and safety of two trough exposure concentrations of everolimus, 3-7 ng/mL (low exposure) and 9-15 ng/mL (high exposure), compared with placebo (...) as adjunctive therapy for treatment-resistant focal-onset seizures in tuberous sclerosis complex.In this phase 3, randomised, double-blind, placebo-controlled study, eligible patients aged 2-65 years with tuberous sclerosis complex and treatment-resistant seizures (≥16 in an 8-week baseline phase) receiving one to three concomitant antiepileptic drugs were recruited from 99 centres across 25 countries. Participants were randomly assigned (1:1:1), via permuted-block randomisation (block size of six

Sirolimus for epilepsy in children with tuberous sclerosis complex: A randomized controlled trial To investigate whether mammalian target of rapamycin complex 1 (mTORC1) inhibitors could reduce seizure frequency in children with tuberous sclerosis complex (TSC).Due to slow inclusion rate, target inclusion of 30 children was not reached. Twenty-three children with TSC and intractable epilepsy (age 1.8-10.9 years) were randomly assigned (1:1) to open-label, add-on sirolimus treatment immediately (...) % (95% CI -86% to +6%; p = 0.06). Cognitive development did not change. All children had adverse events. Five children discontinued sirolimus prematurely.We describe a randomized controlled trial for a non-antiepileptic drug that directly targets a presumed causal mechanism of epileptogenesis in a genetic disorder. Although seizure frequency decreased, especially in children reaching target trough levels, we could not show a significant benefit. Larger trials or meta-analyses are needed

Catamenial epilepsy: A missed cause of refractory seizure in young women Catamenial epilepsy refers to changes in the frequency of seizures over the course of the menstrual cycle. A thorough history and detailed review of the patient's seizure diary are imperative to classify the seizures accurately and select the most appropriate antiepileptic treatment. As catamenial epilepsy rarely responds to antiepileptic medications, the physician should regularly revise the treatment plan of the women (...) with epilepsy that is refractory to the current treatment. We describe the case of a 34-year-old single woman who presented with refractory seizures.

Psychosocial aspects of epilepsy: a wider approach Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy. We discuss psychosocial issues in epilepsy with special focus on the relationship between stigma (...) and psychiatric comorbidities. Social barriers to optimal care and health outcomes for people with epilepsy result in huge disparities, and the public health system needs to invest in awareness programmes to increase public knowledge and reduce stigma in order to minimise such disparities.J.W.S. receives research support from the Dr Marvin Weil Epilepsy Research Fund, Eisai, GlaxoSmithKline, the World Health Organization and the EU's FP7 programme, and has been consulted by, and has received fees for lectures

Melatonin as add-on treatment for epilepsy. This is an updated version of the original Cochrane review published in Issue 6, 2012.Epilepsy is one of the most common chronic neurological disorders. Despite the plethora of antiepileptic drugs (AEDs) currently available, 30% of people continue having seizures. This group of people requires a more aggressive treatment, since monotherapy, the first choice scheme, fails to control seizures. Nevertheless, polytherapy often results in a number (...) study systematically evaluated quality of life, showing no statistically significant improvement in quality of life in the add-on melatonin group.Included studies were of poor methodological quality, and did not systematically evaluate seizure frequency and adverse events, so that it was impossible to summarize data in a meta-analysis. It is not possible to draw any conclusion about the role of melatonin in reducing seizure frequency or improving quality of life in people with epilepsy.

Transcranial magnetic stimulation for the treatment of epilepsy. Epilepsy is a highly prevalent neurological condition characterized by repeated unprovoked seizures with various etiologies. Although antiepileptic medications produce clinical improvement in most individuals, nearly a third of individuals have drug-resistant epilepsy that carries significant morbidity and mortality. There remains a need for non-invasive and more effective therapies for this population. Transcranial magnetic (...) stimulation (TMS) uses electromagnetic coils to excite or inhibit neurons, with repetitive pulses at low-frequency producing an inhibitory effect that could conceivably reduce cortical excitability associated with epilepsy.To assess the evidence for the use of TMS in individuals with drug-resistant epilepsy compared with other available treatments in reducing seizure frequency, improving quality of life, reducing epileptiform discharges, antiepileptic medication use, and side-effects.We searched

Treatments for the prevention of Sudden Unexpected Death in Epilepsy (SUDEP). Sudden Unexpected Death in Epilepsy (SUDEP) is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic or non-drowning death of people with epilepsy, with or without evidence of a seizure, excluding documented status epilepticus and in whom postmortem examination does not reveal a structural or toxicological cause for death. SUDEP has a reported incidence of 1 to 2 per 1000 patient years and represents (...) the most common epilepsy-related cause of death. The presence and frequency of generalised tonic-clonic seizures (GTCS), male sex, early age of seizure onset, duration of epilepsy, and polytherapy are all predictors of risk of SUDEP. The exact pathophysiology of SUDEP is currently unknown, although GTCS-induced cardiac, respiratory, and brainstem dysfunction appears likely. Appropriately chosen antiepileptic drug treatment can render around 70% of patients free of all seizures. However, around one

breakpoint. Three of the reported patients shared many features with our proband but the other had some clinical features of the Prader-Willi syndrome. It was suggested that ATRX overexpression could be involved in the major clinical features of patients with partial Xq duplications. We propose that this gene could also be involved with the obesity of the patient with the Prader-Willi-like phenotype. Additionally, we suggest that the PCDH11X gene could be a candidate for our patient's recurrent seizures (...) Inherited Xq13.2-q21.31 duplication in a boy with recurrent seizures and pubertal gynecomastia: Clinical, chromosomal and aCGH characterization We report on a 16-year-old boy with a maternally inherited ~ 18.3 Mb Xq13.2-q21.31 duplication delimited by aCGH. As previously described in patients with similar duplications, his clinical features included intellectual disability, developmental delay, speech delay, generalized hypotonia, infantile feeding difficulties, self-injurious behavior, short

Laser interstitial thermal therapy for treating intracranial lesions and epilepsy: a health technology assessment and policy analysis Laser interstitial thermal therapy for treating intracranial lesions and epilepsy: a health technology assessment and policy analysis Laser interstitial thermal therapy for treating intracranial lesions and epilepsy: a health technology assessment and policy analysis Leggett LE, Coward S, Weaver C, Sevick LK, Zhang D, Mackean G, Lorenzetti D, Clement F Record (...) Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Leggett LE, Coward S, Weaver C, Sevick LK, Zhang D, Mackean G, Lorenzetti D, Clement F . Laser interstitial thermal therapy for treating intracranial lesions and epilepsy: a health technology assessment and policy analysis. Calgary: HTA Unit, University of Calgary 2016 Authors' conclusions Two studies

Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG).We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks' postmenstrual age with clinically suspected seizures and/or electrographic seizures. Subjects were assessed between January 2013 and April 2015 at 7 US tertiary care pediatric (...) centers following the guidelines of the American Clinical Neurophysiology Society for cEEG for at-risk neonates. Seizure etiology, burden, management, and outcome were determined by chart review by the use of a case report form designed at study onset.The most common seizure etiologies were hypoxic-ischemic encephalopathy (38%), ischemic stroke (18%), and intracranial hemorrhage (11%). Seizure burden was high, with 59% having ≥7 electrographic seizures and 16% having status epilepticus; 52% received

neonatal period, defined as 28 days of life) by survival analyses, and measured epilepsy severity in those with active epilepsy (≥1 remote seizure and maintenance anticonvulsant treatment) at last follow-up.Among 87 children with perinatal stroke, 40 (46%) had a seizure in the neonatal period. During a median follow-up of 7.1 years (interquartile range 3.2-10.5), 37 children had ≥1 remote seizure. Remote seizure risk was highest during the first year of life, with a 20% (95% confidence interval [CI] 13 (...) %-30%) cumulative incidence by 1 year of age, 46% (CI 35%-58%) by 5 years, and 54% (CI 41%-67%) by 10 years. Neonatal seizures increased the risk of a remote seizure (hazard ratio 2.8, CI 1.3-5.8). Children with neonatal seizures had a 69% (CI 48%-87%) cumulative incidence of remote seizure by age 10 years. Among the 24 children with active epilepsy at last follow-up, 8 (33%) were having monthly seizures despite an anticonvulsant and 7 (29%) were on more than one anticonvulsant.Remote seizures