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

Clinical characteristics of non‐convulsive status epilepticus diagnosed by simplified continuous electroencephalogram monitoring at an emergency intensive care unit The present study aimed to elucidate the clinical characteristics of non-convulsive status epilepticus (NCSE) in patients with altered mental status (AMS).This single-center retrospective study comprised 149 patients who were hospitalized between March 1, 2015 and September 30, 2015 at the emergency intensive care unit (ICU

illness and reduce neurological morbidity and mortality?2. Do antiepileptic drugs used routinely as secondary prophylaxis for all patients who have had at least one seizure due to suspected or proven viral encephalitis reduce the risk of further seizures during the acute illness and reduce neurological morbidity and mortality?For the latest version of this review, we searched the Cochrane Epilepsy Group Specialized Register (11 April 2016), the Cochrane Central Register of Controlled Trials (CENTRAL (...) Antiepileptic drugs for the primary and secondary prevention of seizures in viral encephalitis. Viral encephalitis is characterised by diverse clinical and epidemiological features. Seizures are an important clinical manifestation and are associated with increased mortality and morbidity. Patients may have seizures during the acute illness or they may develop after recovery. There are no recommendations regarding the use of antiepileptic drugs for the primary or secondary prevention of seizures

Recurrent convulsions, hypocalcemia, and hypoparathyroidism related to delayed diagnosis of 22q11.2 deletion syndrome in a middle‐aged man A 49-year-old man had idiopathic epilepsy with recurrent convulsions and history of cleft palate, mental retardation, schizophrenia, and cataract. He had convulsions the day before and on the day of admission. Fosphenytoin was given i.v.; his convulsion stopped, but he lost consciousness 2 h later and was admitted. Glasgow Coma Scale score on arrival was 3 (...) . Cerebral computed tomography showed bilateral calcification in the basal ganglia. Laboratory tests showed decreased serum calcium and albumin and increased creatine kinase. He regained consciousness after i.v. calcium gluconate administration. Additionally, he showed decreased parathyroid hormone and 1,25(OH)2 vitamin D. Suspecting hypoparathyroidism, i.v. calcium gluconate was changed to oral vitamin D. His medical history and physical appearance suggested 22q11.2 deletion syndrome, confirmed

Briviact (brivaracetam) - To treat partial onset seizures in patients age 16 years and older with epilepsy. Drug Approval Package: Briviact (brivaracetam) U.S. Department of Health and Human Services Search FDA Submit search Drug Approval Package: Briviact (brivaracetam) Company: UCB, Inc. Application No.: 205836, 205837 & 205838 Approval Date: February 18, 2016 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. (PDF) (PDF) (PDF) (PDF

interval, 1.9-15.8]; P = .006). No differences were observed in IQs or subsequent epilepsy rates between the 2 groups. Although no difference was observed in the age of FS onset or neurodevelopmental outcomes between the 2 groups, children with FS who received postnatal corticosteroid treatment had a significantly lower mean body temperature during the first FS attack compared with those who did not receive postnatal corticosteroid treatment (38.6 ± 0.4°C vs 39.2 ± 0.6°C; P = .034).Children born very (...) Postnatal Steroids and Febrile Seizure Susceptibility in Preterm Children To investigate risk factors, seizure characteristics, and outcomes of febrile seizure (FS) in children born very preterm.This study used a prospective registry data set of 844 preterm infants (birth weight <1500 g and gestational age <32 weeks) admitted to NICUs from 2001 to 2009 in southern Taiwan. We investigated the prevalence, risks, seizure patterns, and outcomes of FS in children aged 5 years.Among 575 children

Diagnostic value of lumbar puncture among infants and children presenting with fever and convulsions Central nervous system (CNS) infections can be categorized according to the nature of the infectious pathogen into viral, bacterial, protozoan, or fungal. The diagnosis of diffuse CNS infections depends on examination of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP). The aim of this work was to determine the diagnostic value of CSF analysis in infants and children presenting (...) with fever and convulsions.Detailed clinical data of infants and children included in this study were collected with special reference to the course and duration of the illness, description of the convulsions, consciousness level, signs of increased intracranial pressure, and signs of meningeal irritation. Lumbar puncture and chemical and bacteriological analyses of the obtained cerebrospinal fluid were done for all of the children.The total number of children included in the study was 85, they had

Antiepileptic drugs for the primary and secondary prevention of seizures after intracranial venous thrombosis. Intracranial venous thrombosis (ICVT) commonly presents with seizures in the acute period, and some people may develop recurrent seizures in the long term. The prophylactic use of antiepileptic drugs (AEDs) for the management of post-ICVT seizures is controversial, and there is currently no consensus on the optimal management of post-ICVT seizures. This is an updated version (...) of the Cochrane review first published in theCochrane Database of Systematic Reviews 2006, Issue 3.To assess the effects of AEDs for the primary and secondary prevention of seizures related to ICVT.(1) For the question of primary prevention, we aimed to examine whether AEDs reduce the likelihood of seizures in people who have had an ICVT but have not had a seizure.(2) For the question of secondary prevention, we aimed to examine whether AEDs reduce the likelihood of further seizures in people who have had

Contraception for women with epilepsy: counseling, choices, and concerns Approximately 50% of all pregnancies in women with epilepsy (WWE) occur unplanned. This is worrying, given the increased occurrence of obstetrical complications in WWE, including the risk of seizures and their possible consequences for both the mother and the unborn child. Hormonal contraception is usually regarded as highly effective, but it is subject to numerous bidirectional drug interactions with several antiepileptic (...) drugs. These interactions may lead to loss of seizure control or contraceptive failure. Further concerns are loss of bone mineral density and increased seizure activity due to hormonal effects. Many physicians lack sufficient knowledge regarding these issues, and most WWE have never received adequate counseling. Moreover, several studies show that a large proportion of WWE do not take their medicines regularly. This article reviews all of these issues and offers practical recommendations

Neon EEG says the device is much easier and quicker to fit than current methods and does not require a specialist to apply it. Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Electroencephalography; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Monitoring, Physiologic; Neon; Seizures Language Published English Country of organisation England English summary An English language summary is available. Address for correspondence NIHR Horizon Scanning (...) Neon EEG for monitoring neonatal seizures Neon EEG for monitoring neonatal seizures Neon EEG for monitoring neonatal seizures NIHR HSRIC Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation NIHR HSRIC. Neon EEG for monitoring neonatal seizures. Birmingham: NIHR Horizon Scanning Research&Intelligence Centre. Horizon Scanning Review. 2016 Authors' objectives The Neon

. The applicant applied for the following indication: Zonisamide Mylan is indicated as: • monotherapy in the treatment of partial seizures, with or without secondary generalisation, in adults with newly diagnosed epilepsy • adjunctive therapy in the treatment of partial seizures, with or without secondary generalisation, in adults, adolescents, and children aged 6 years and above The legal basis for this application refers to: Generic application (Article 10(1) of Directive No 2001/83/EC) The application (...) is thought to disrupt synchronised neuronal firing, thereby reducing the spread of seizure discharges and disrupting subsequent epileptic activity. Some studies also showed a modulatory effect on Gamma-aminobutyric acid (GABA)-mediated neuronal inhibition as well as a variety of other effects, which may contribute to the pharmacological effects. Furthermore, zonisamide exerts weak carbonic anhydrase activity in-vitro. Zonegran is indicated as: • monotherapy in the treatment of partial seizures