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Continuum (Minneapolis, Minn.) Apr 2022Issues pertaining to women with epilepsy have advanced with a better understanding of multidirectional influences among hormones, seizures, and antiseizure medications,... (Review)
Review
PURPOSE OF REVIEW
Issues pertaining to women with epilepsy have advanced with a better understanding of multidirectional influences among hormones, seizures, and antiseizure medications, as well as pregnancy-related concerns around fertility, seizure destabilization, and antiseizure medication-associated teratogenicity. This article highlights important developments in this field and reviews best practices in the management of women with epilepsy.
RECENT FINDINGS
Important external hormonal influences may impact women with epilepsy particularly in the context of gender-affirming medications, hormonal replacement therapy, and fertility therapies. Fertility for women with epilepsy is influenced by multiple variables; however, in the absence of preexisting fertility issues, epilepsy per se is not associated with significantly impaired fertility. Once women with epilepsy are pregnant, the majority have a stable course. Antiseizure medication use in pregnancy is associated with major congenital malformations 2 to 5 times that of the general population and is highest with high-dose (≥1500 mg or greater total daily) valproate. Carefully considered changes in drug choice and dose may mitigate these risks. Therapeutic drug monitoring plays an important role in pregnancy care, and under expert supervision, women with epilepsy in pregnancy have similar seizure risks as women with epilepsy who are not pregnant. As women with epilepsy age, bone health and menopause may further be impacted by seizures and antiseizure medications.
SUMMARY
The care of women with epilepsy is a multifaceted discipline that recognizes the life-long impact of sex and gender influences on epilepsy care.
Topics: Anticonvulsants; Epilepsy; Female; Humans; Menopause; Pregnancy; Pregnancy Complications; Seizures
PubMed: 35393964
DOI: 10.1212/CON.0000000000001126 -
Neurologic Clinics Nov 2022Patients with psychogenic nonepileptic seizures (PNES) represent a distinct, challenging group among those with functional neurologic symptom (conversion) disorders and... (Review)
Review
Patients with psychogenic nonepileptic seizures (PNES) represent a distinct, challenging group among those with functional neurologic symptom (conversion) disorders and involve a complex set of symptoms and comorbidities, best evaluated and treated by a multidisciplinary team of clinicians. Multidisciplinary, collaborative care is becoming more common, using evidence-based treatment. Outpatient neurology clinics at sites not currently treating these patients hold potential for providing such a model of care, with coordination of services. Best practice care should encourage the integration of neurology and mental health professionals to improve communication among clinicians and with patients, allowing for better patient care and symptomatic outcomes.
Topics: Humans; Seizures; Psychogenic Nonepileptic Seizures; Conversion Disorder; Neurology; Comorbidity; Electroencephalography; Psychophysiologic Disorders
PubMed: 36270692
DOI: 10.1016/j.ncl.2022.03.017 -
Current Opinion in Neurology Apr 2024To review recent advances in the field of seizure detection in ambulatory patients with epilepsy. (Review)
Review
PURPOSE OF REVIEW
To review recent advances in the field of seizure detection in ambulatory patients with epilepsy.
RECENT FINDINGS
Recent studies have shown that wrist or arm wearable sensors, using 3D-accelerometry, electrodermal activity or photoplethysmography, in isolation or in combination, can reliably detect focal-to-bilateral and generalized tonic-clonic seizures (GTCS), with a sensitivity over 90%, and false alarm rates varying from 0.1 to 1.2 per day. A headband EEG has also demonstrated a high sensitivity for detecting and help monitoring generalized absence seizures. In contrast, no appropriate solution is yet available to detect focal seizures, though some promising findings were reported using ECG-based heart rate variability biomarkers and subcutaneous EEG.
SUMMARY
Several FDA and/or EU-certified solutions are available to detect GTCS and trigger an alarm with acceptable rates of false alarms. However, data are still missing regarding the impact of such intervention on patients' safety. Noninvasive solutions to reliably detect focal seizures in ambulatory patients, based on either EEG or non-EEG biosignals, remain to be developed. To this end, a number of challenges need to be addressed, including the performance, but also the transparency and interpretability of machine learning algorithms.
Topics: Humans; Electroencephalography; Seizures; Epilepsy; Algorithms; Machine Learning
PubMed: 38328946
DOI: 10.1097/WCO.0000000000001248 -
Cancer Apr 2020Seizures are common in patients with cancer and either result from brain lesions, paraneoplastic syndromes, and complications of cancer treatment or are provoked by... (Review)
Review
Seizures are common in patients with cancer and either result from brain lesions, paraneoplastic syndromes, and complications of cancer treatment or are provoked by systemic illness (metabolic derangements, infections). Evaluation should include a tailored history, neurologic examination, laboratory studies, neuroimaging, and electroencephalogram. In unprovoked seizures, antiepileptic drug (AED) treatment is required, and a nonenzyme-inducing AED is preferred. Treatment of the underlying cancer with surgery, chemotherapy, and radiation therapy also can help reduce seizures. Benzodiazepines are useful in the treatment of both provoked seizures and breakthrough epileptic seizures and as first-line treatment for status epilepticus. Counseling for safety is an important component in the care of a patient with cancer who has seizures. Good seizure management can be challenging but significantly improves the quality of life during all phases of care, including end-of-life care.
Topics: Humans; Neoplasms; Seizures
PubMed: 31967671
DOI: 10.1002/cncr.32708 -
Neurology Oct 2020To test the hypothesis that absence seizures can evolve to generalized tonic-clonic seizures, we documented electroclinical features of this novel seizure type.
OBJECTIVE
To test the hypothesis that absence seizures can evolve to generalized tonic-clonic seizures, we documented electroclinical features of this novel seizure type.
METHODS
In 4 large video-EEG databases, we identified recordings of seizures starting with impaired awareness that, without returning to baseline interictal state, evolved to generalized tonic-clonic seizures. We extracted the detailed semiologic and electrographic characteristics of these seizures, and we documented the clinical background, diagnoses, and therapeutic responses in these patients.
RESULTS
We identified 12 seizures from 12 patients. All seizures started with a period of impaired awareness and bursts of generalized spike or polyspike and slow-wave discharges, the hallmark of absence seizures. Without returning to baseline, the nonmotor (absence) phase was followed by tonic-clonic convulsions. We called this novel generalized seizure type absence-to-bilateral-tonic-clonic seizure. Most patients had idiopathic generalized epilepsies, although with a high incidence of unusual features and poor therapeutic response.
CONCLUSIONS
Absence-to-bilateral-tonic-clonic seizures are a novel generalized seizure type. Clinicians should be aware of this seizure for correctly diagnosing patients. This novel seizure type may further elucidate generalized ictogenesis.
Topics: Adolescent; Adult; Child; Electroencephalography; Female; Humans; Male; Middle Aged; Seizures; Young Adult
PubMed: 32817392
DOI: 10.1212/WNL.0000000000010470 -
Handbook of Clinical Neurology 2024Seizures are a common feature of autoimmune encephalitis and are especially prevalent in patients with the commonest autoantibodies, against LGI1, CASPR2 and the NMDA,... (Review)
Review
Seizures are a common feature of autoimmune encephalitis and are especially prevalent in patients with the commonest autoantibodies, against LGI1, CASPR2 and the NMDA, GABA, and GABA receptors. In this chapter, we discuss the classification, clinical, investigation, and treatment aspects of patients with these, and other autoantibody-mediated and -associated, illnesses. We highlight distinctive and common seizure semiologies which, often alongside other features we outline, can help the clinical diagnosis of an autoantibody-associated syndrome. Next, we classify these syndromes by either focusing on whether they represent underlying causative autoantibodies or T-cell-mediated syndromes and on the distinction between acute symptomatic seizures and a more enduring tendency to autoimmune-associated epilepsy, a practical and valuable distinction for both patients and clinicians which relates to the pathogenesis. We emphasize the more effective immunotherapy response in patients with causative autoantibodies, and discuss the emerging evidence for various first-, second-, and third-line immunotherapies. Finally, we highlight available clinical rating scales which can guide autoantibody testing and immunotherapy in patients with seizures of unknown etiology. Throughout, we relate the clinical and therapeutic observations to the immunobiology and neuroscience which drive these seizures.
Topics: Humans; Seizures; Epilepsy; Encephalitis; Autoantibodies; gamma-Aminobutyric Acid
PubMed: 38494275
DOI: 10.1016/B978-0-12-823912-4.00009-8 -
Epilepsia Aug 2023This study was undertaken to evaluate perampanel (PER) when used under real-world conditions to treat people with idiopathic generalized epilepsy (IGE) included in the... (Clinical Trial)
Clinical Trial
OBJECTIVE
This study was undertaken to evaluate perampanel (PER) when used under real-world conditions to treat people with idiopathic generalized epilepsy (IGE) included in the PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) study.
METHODS
The multinational, retrospective, pooled analysis PERMIT explored the use of PER in people with focal and generalized epilepsy treated in clinical practice across 17 countries. This subgroup analysis included PERMIT participants with IGE. Time points for retention and effectiveness measurements were 3, 6, and 12 months (last observation carried forward, defined as "last visit," was also applied to effectiveness). Effectiveness was evaluated by seizure type (total seizures, generalized tonic-clonic seizures [GTCS], myoclonic seizures, absence seizures) and included ≥50% responder rate and seizure freedom rate (defined as no seizures since at least the previous visit). Safety/tolerability was monitored throughout PER treatment and evaluated by documenting the incidence of adverse events (AEs), including psychiatric AEs and those leading to treatment discontinuation.
RESULTS
The Full Analysis Set included 544 people with IGE (51.9% women, mean age = 33.3 years, mean epilepsy duration = 18.1 years). At 3, 6, and 12 months, 92.4%, 85.5%, and 77.3% of participants were retained on PER treatment, respectively (Retention Population, n = 497). At the last visit, responder and seizure freedom rates were, respectively, 74.2% and 54.6% (total seizures), 81.2% and 61.5% (GTCS), 85.7% and 66.0% (myoclonic seizures), and 90.5% and 81.0% (absence seizures) (Effectiveness Population, n = 467). AEs occurred in 42.9% of patients and included irritability (9.6%), dizziness/vertigo (9.2%), and somnolence (6.3%) (Tolerability Population, n = 520). Treatment discontinuation due to AEs was 12.4% over 12 months.
SIGNIFICANCE
This subgroup analysis of the PERMIT study demonstrated the effectiveness and good tolerability of PER in people with IGE when administered under everyday clinical practice conditions. These findings are in line with clinical trial evidence, supporting PER's use as broad-spectrum antiseizure medication for the treatment of IGE.
Topics: Adult; Female; Humans; Male; Anticonvulsants; Drug Therapy, Combination; Epilepsies, Myoclonic; Epilepsy, Absence; Epilepsy, Generalized; Immunoglobulin E; Pyridones; Retrospective Studies; Seizures; Treatment Outcome
PubMed: 37114853
DOI: 10.1111/epi.17631 -
Pediatric Annals Oct 2023
Topics: Humans; Child; Seizures
PubMed: 37820702
DOI: 10.3928/19382359-20230829-07 -
Seminars in Neurology Dec 2020Seizures are common in the pediatric population; however, most children do not go on to develop epilepsy later in life. Selecting appropriate diagnostic modalities to... (Review)
Review
Seizures are common in the pediatric population; however, most children do not go on to develop epilepsy later in life. Selecting appropriate diagnostic modalities to determine an accurate diagnosis and appropriate treatment as well as with counseling families regarding the etiology and prognosis of seizures, is essential. This article will review updated definitions of seizures, including provoked versus unprovoked, as well as the International League Against Epilepsy operational definition of epilepsy. A variety of specific acute symptomatic seizures requiring special consideration are discussed, along with neonatal seizures and seizure mimics, which are common in pediatric populations.
Topics: Child; Epilepsy; Humans; Infant, Newborn; Seizures
PubMed: 33155186
DOI: 10.1055/s-0040-1718718 -
Brain Connectivity Jun 2022Absence seizures are the prototypic primarily generalized seizures, but there is incomplete understanding regarding their generation and maintenance. A core network for...
Absence seizures are the prototypic primarily generalized seizures, but there is incomplete understanding regarding their generation and maintenance. A core network for absence seizures has been defined, including focal cortical and thalamic regions that have frequency-dependent interactions. The purpose of this study was to investigate within-frequency coupling and cross-frequency coupling (CFC) during human absence seizures, to identify key regions (hubs) within the absence network that contribute to propagation and maintenance. Thirteen children with new-onset and untreated childhood absence epilepsy had over 60 typical absence seizures during both electroencephalography-functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) recordings. The spatial map of the ictal network was defined using fMRI and used as prior information for MEG connectivity. A multilayer network approach was used to investigate within-frequency coupling and CFC for canonical frequency bands. A rigorous null-modeling approach was used to determine connections outside the noise floor. Strong coupling between beta and gamma frequencies, within the left frontal cortex, and between the left frontal and right parietal regions was observed. There was also strong connectivity between left frontal and right parietal nodes within the gamma band. Multilayer versatility analysis identified a cluster of network hubs in the left frontal region. Cortical regions commonly identified as being critical for absence seizure generation (frontal cortex, precuneus) have strong CFC and within-frequency coupling between beta and gamma bands. As nonpharmacologic treatments, such as neuromodulation, become available for generalized epilepsies, detailed mechanistic understanding of how "diffuse" seizures are generated and maintained will be necessary to provide optimal outcomes.
Topics: Brain; Child; Electroencephalography; Epilepsy, Absence; Humans; Magnetic Resonance Imaging; Magnetoencephalography; Seizures
PubMed: 34405685
DOI: 10.1089/brain.2021.0119