1
|
Khateb M, Grinfeld A, Weiler-Sagie M, Herskovitz M. Withdrawal seizures vs on-medication seizures: an intracranial EEG recording case report. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
It has long been an interesting question of whether withdrawal seizures in epileptic patients differ from habitual seizures in terms of semiology and electrophysiology.
Case presentation
Here, we addressed this issue in a 40 year-old woman with drug-resistant focal epilepsy monitored by presurgical intracranial EEG. As a part of this routine pre-operative investigation, anti-seizure medications (ASMs) were halted; as a result, multiple withdrawal seizures were recorded before ASM readministration. During 4 days of invasive monitoring, we noticed three different phases in seizure organization: Acute withdrawal seizure (AWS): The first recorded seizure 10h after the implantation; the stabilized withdrawal seizures (SWS): seven habitual seizures recorded from 24h post implantation to readministration of ASMs; and the Non-withdrawal seizures (NWS): ten seizures recorded 24h after readministration of ASMs. AWS and SWS had the same semiology and same epileptic network, but the propagation time from the temporal pole to the para-hippocampal gyrus (PHG) and hippocampus ranged from no latency in AWS to up to 50 s in SWS. NWS were electrographic seizures, without any apparent clinical manifestation. Seizure onset in this type of seizure, as in the first two types, was in the temporal pole. However, NWS could last up to 3 min without involving the PHG or hippocampus.
Conclusions
We concluded that in acute withdrawal seizures the propagation time of epileptic activity is significantly reduced without affecting ictal organization network or semiology. Furthermore, ASM in this case had a remarkable influence on propagation rather than initiation of epileptic activity.
Collapse
|
2
|
Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-EEG monitoring: A clinical practice guideline of the international league against epilepsy and international federation of clinical neurophysiology. Clin Neurophysiol 2021; 134:111-128. [PMID: 34955428 DOI: 10.1016/j.clinph.2021.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility.
Collapse
Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, France.
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich Switzerland.
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Danish Epilepsy Center, Dianalund, Denmark.
| |
Collapse
|
3
|
Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-electroencephalographic monitoring: A clinical practice guideline of the International League Against Epilepsy and International Federation of Clinical Neurophysiology. Epilepsia 2021; 63:290-315. [PMID: 34897662 DOI: 10.1111/epi.16977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and to establish its clinical utility.
Collapse
Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, Nancy, France
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich,, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Danish Epilepsy Center, Dianalund, Denmark
| |
Collapse
|
4
|
Khateb M, Bosak N, Herskovitz M. The Effect of Anti-seizure Medications on the Propagation of Epileptic Activity: A Review. Front Neurol 2021; 12:674182. [PMID: 34122318 PMCID: PMC8191738 DOI: 10.3389/fneur.2021.674182] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
The propagation of epileptiform events is a highly interesting phenomenon from the pathophysiological point of view, as it involves several mechanisms of recruitment of neural networks. Extensive in vivo and in vitro research has been performed, suggesting that multiple networks as well as cellular candidate mechanisms govern this process, including the co-existence of wave propagation, coupled oscillator dynamics, and more. The clinical importance of seizure propagation stems mainly from the fact that the epileptic manifestations cannot be attributed solely to the activity in the seizure focus itself, but rather to the propagation of epileptic activity to other brain structures. Propagation, especially when causing secondary generalizations, poses a risk to patients due to recurrent falls, traumatic injuries, and poor neurological outcome. Anti-seizure medications (ASMs) affect propagation in diverse ways and with different potencies. Importantly, for drug-resistant patients, targeting seizure propagation may improve the quality of life even without a major reduction in simple focal events. Motivated by the extensive impact of this phenomenon, we sought to review the literature regarding the propagation of epileptic activity and specifically the effect of commonly used ASMs on it. Based on this body of knowledge, we propose a novel classification of ASMs into three main categories: major, minor, and intermediate efficacy in reducing the propagation of epileptiform activity.
Collapse
Affiliation(s)
- Mohamed Khateb
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Noam Bosak
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Moshe Herskovitz
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel.,The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
5
|
Relationship between Delta Rhythm, Seizure Occurrence and Allopregnanolone Hippocampal Levels in Epileptic Rats Exposed to the Rebound Effect. Pharmaceuticals (Basel) 2021; 14:ph14020127. [PMID: 33561937 PMCID: PMC7914513 DOI: 10.3390/ph14020127] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
Abrupt withdrawal from antiepileptic drugs is followed by increased occurrence of epileptic seizures, a phenomenon known as the “rebound effect”. By stopping treatment with levetiracetam (LEV 300 mg/kg/day, n = 15; vs. saline, n = 15), we investigated the rebound effect in adult male Sprague-Dawley rats. LEV was continuously administered using osmotic minipumps, 7 weeks after the intraperitoneal administration of kainic acid (15 mg/kg). The effects of LEV were determined by comparing time intervals, treatments, and interactions between these main factors. Seizures were evaluated by video-electrocorticographic recordings and power band spectrum analysis. Furthermore, we assessed endogenous neurosteroid levels by liquid chromatography-electrospray-tandem mass spectrometry. LEV significantly reduced the percentage of rats experiencing seizures, reduced the seizure duration, and altered cerebral levels of neurosteroids. In the first week of LEV discontinuation, seizures increased abruptly up to 700% (p = 0.002, Tukey’s test). The power of delta band in the seizure postictal component was related to the seizure occurrence after LEV withdrawal (r2 = 0.73, p < 0.001). Notably, allopregnanolone hippocampal levels were positively related to the seizure occurrence (r2 = 0.51, p = 0.02) and to the power of delta band (r2 = 0.67, p = 0.004). These findings suggest a role for the seizure postictal component in the rebound effect, which involves an imbalance of hippocampal neurosteroid levels.
Collapse
|
6
|
Kirby J, Leach VM, Brockington A, Patsalos P, Reuber M, Leach JP. Drug withdrawal in the epilepsy monitoring unit - The patsalos table. Seizure 2019; 75:75-81. [PMID: 31896534 DOI: 10.1016/j.seizure.2019.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/29/2019] [Accepted: 12/12/2019] [Indexed: 01/22/2023] Open
Abstract
Investigation of possible candidates for epilepsy surgery will usually require inpatient EEG to capture seizures and allow full operative planning. Withdrawal of antiepileptic drugs increases the yield of this valuable diagnostic information and the benefits of this should justify any increase in the risk of harm associated with these seizures This paper outlines our opinion on what would constitute proposed best practice for management of antiepileptic drug (AED) dosing when patients are admitted for monitoring of seizures to an epilepsy monitoring unit (EMU). In the vast majority of cases EMU admissions are safe and, even if seizures occur, will pass off without complication. Previous guidance has concentrated on ensuring practice around technical aspects of EEG monitoring itself and staffing within the unit. In this guidance we aim to outline optimally safe ways of ensuring that EMUs ensure the minimisation of risk to the patients admitted under their care. We propose an algorithm for enhancing the safety of AED withdrawal in VT admissions while ensuring adequate seizure yields. Risk minimisation requires planned management of drug dosing (with reduction if appropriate), provision of adequate rescue medication, and adequate supervision to allow rapid response to generalised seizures. This algorithm is accompanied by a table which uses knowledge of the clinical and pharmacological properties of each AED to ensure dose withdrawal and reduction is timely and safe taking into account the severity and frequency of the individual's seizures.
Collapse
Affiliation(s)
- Jack Kirby
- Department of Neurology Institute of Neurosciences, QEUH, Glasgow G51 4TF, United Kingdom
| | - Veronica M Leach
- Department of Clinical Neurophysiology, Institute of Neurosciences, QEUH, Glasgow G51 4TF, United Kingdom
| | - Alice Brockington
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Phillip Patsalos
- Department of Clinical Neurology, Chalfont Centre for Epilepsy, London, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - John Paul Leach
- Department of Neurology Institute of Neurosciences, QEUH, Glasgow G51 4TF, United Kingdom; School of Medicine, University of Glasgow, G12 8QQ, United Kingdom.
| |
Collapse
|
7
|
Hartl E, Seethaler M, Lauseker M, Rémi J, Vollmar C, Noachtar S. Impact of withdrawal of antiepileptic medication on the duration of focal onset seizures. Seizure 2019; 67:40-44. [DOI: 10.1016/j.seizure.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022] Open
|
8
|
Hampel KG, Gómez-Ibáñez A, Garcés-Sánchez M, Hervás-Marín D, Cano-López I, González-Bono E, Conde-Sardón R, Gutiérrez-Martín A, Villanueva V. Antiepileptic drug reduction and increased risk of stimulation-evoked focal to bilateral tonic-clonic seizure during cortical stimulation in patients with focal epilepsy. Epilepsy Behav 2018; 80:104-108. [PMID: 29414538 DOI: 10.1016/j.yebeh.2017.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/23/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Stimulation-evoked focal to bilateral tonic-clonic seizure (FBTCS) can be a stressful and possibly harmful adverse event for patients during cortical stimulation (CS). We evaluated if drug load reduction of antiepileptic drugs (AEDs) during CS increases the risk of stimulation-evoked FBTCS. MATERIAL AND METHODS In this retrospective cohort study, we searched our local database for patients with drug-resistant epilepsy who underwent invasive video-EEG monitoring and CS in the University Hospital la Fe Valencia from January 2006 to November 2016. The AED drug load was calculated with the defined daily dose. We applied a uni- and multivariate logistic regression model to estimate the risk of stimulation-evoked FBTCS and evaluate possible influencing factors. Furthermore, we compared patients whose AEDs were completely withdrawn with those whose AEDs were not. RESULTS Fifty-eight patients met the inclusion criteria and were included in the analysis. Stimulating 3806 electrode contact pairs, 152 seizures were evoked in 28 patients (48.3%). Ten seizures (6.6%) in seven patients (12.1%) evolved to FBTCS. In the univariate and multivariate analysis, a 10% reduction in drug load was associated with an increase of the odds ratio (OR) of stimulation-evoked FBTCS by 1.9 (95%-CI 1.2, 4.0, p-value=0.04) and 1.9 (95%-CI 1.2, 4.6, p-value=0.04), respectively. In patients, whose AEDs were completely withdrawn the OR of FBTCS increased by 9.1 (95%CI 1.7, 69.9, p-value=0.01) compared with patients whose AEDs were not completely withdrawn. No other factor (implantation type, maximum stimulus intensity, number of stimulated contacts, history of FBTCS, age, gender, or epilepsy type) appears to have a significant effect on the risk of stimulation-evoked FBTCS. CONCLUSIONS The overall risk of stimulation-evoked FBTCS during CS is relatively low. However, a stronger reduction and, especially, a complete withdrawal of AEDs are associated with an increased risk of stimulation-evoked FBTCS.
Collapse
Affiliation(s)
- Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain; Department of Psychobiology/IDOCAL, University of Valencia, Avenida Blasco Ibáñez 21, 46010, Valencia, Spain.
| | - Asier Gómez-Ibáñez
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Mercedes Garcés-Sánchez
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - David Hervás-Marín
- Biostatistics Unit, Health Research Institute La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Irene Cano-López
- Department of Psychobiology/IDOCAL, University of Valencia, Avenida Blasco Ibáñez 21, 46010, Valencia, Spain
| | - Esperanza González-Bono
- Department of Psychobiology/IDOCAL, University of Valencia, Avenida Blasco Ibáñez 21, 46010, Valencia, Spain
| | - Rebeca Conde-Sardón
- Refractory Epilepsy Unit, Neurosurgery Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Antonio Gutiérrez-Martín
- Refractory Epilepsy Unit, Neurosurgery Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| |
Collapse
|
9
|
Guld AT, Sabers A, Kjaer TW. Drug taper during long-term video-EEG monitoring: efficiency and safety. Acta Neurol Scand 2017; 135:302-307. [PMID: 27061202 DOI: 10.1111/ane.12596] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Anti-epileptic drugs (AED) are often tapered to reduce the time needed to record a sufficient number of seizure during long-term video-EEG monitoring (LTM). Fast AED reduction is considered less safe, but few studies have examined this. Our goal is to examine whether the rate of AED reduction affects efficiency and safety. MATERIALS & METHODS We performed a retrospective observational study of patients referred for presurgical evaluation. Each patient was categorized by two dichotomous parameters of AED tapering: (i) fast vs slow AED reduction the first 24 h of LTM and (ii) complete vs partial AED discontinuation during LTM. RESULTS Of 79 patients, 51% underwent a fast AED reduction and 58% ended up with AEDs completely discontinued. Complete AED discontinuation was associated with three times increased likelihood of receiving rescue therapy during LTM and double risk of having secondary generalized tonic-clonic seizures (sGTCS) compared to the group partially discontinued. Fast vs slow AED reduction had no effect on the safety of LTM. The fast AED reduction group and the complete AED discontinuation group had a significantly longer time to first seizure and total recording time compared to the slow AED reduction and partial discontinuation groups, respectively. CONCLUSIONS Fast AED reduction was found safe in patients undergoing presurgical video-EEG monitoring. Patients completely discontinued from AEDs had more sGTCS than patients partially discontinued. Further studies are suggested to confirm this finding and to evaluate whether fast reduction is safe and efficient in other subgroups of patients referred for LTM.
Collapse
Affiliation(s)
- A. T. Guld
- Department of Neurology; Rigshospitalet; Copenhagen Denmark
| | - A. Sabers
- Department of Neurology; Rigshospitalet; Copenhagen Denmark
| | - T. W. Kjaer
- Neurophysiology Center; Zealand University Hospital; University of Copenhagen; Denmark
| |
Collapse
|
10
|
Moseley BD, Dewar S, Haneef Z, Eliashiv D, Stern JM. Reasons for prolonged length of stay in the epilepsy monitoring unit. Epilepsy Res 2016; 127:175-178. [PMID: 27608436 DOI: 10.1016/j.eplepsyres.2016.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 05/03/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022]
Abstract
Epilepsy monitoring unit (EMU) admissions are essential for the classification/localization of epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES). However, the duration of admissions is highly variable. Accordingly, we evaluated the duration of 596 EMU admissions and reasons for prolonged (>7 days) lengths of stay (LOS). The average LOS was longer for patients diagnosed with ES (8.0 days, SD 4.1 days) than all others (6.0 days, SD 3.9 days, p<0.001). Of the 596 admissions, 231 (38.8%) had prolonged LOS. The most commonly reported reason for prolonged stay was need to record additional seizures (33%). Other contributors included complications such as seizure clusters (6.9%), status epilepticus (1.6%), test complications (3.7%), psychiatric concerns (4.3%), and medication side effects (1.6%). Our results suggest multiple factors produce prolonged LOS with no factor accounting for the majority. Recording an insufficient number of all habitual seizures was the leading cause, which was over twice the percentage of reported complications (17.6%). However, being able to prolong admissions when necessary resulted in only 14.9% of admissions being inconclusive, potentially justifying the extra expense. Efforts to shorten LOS may be best directed at faster recording of seizures, but this may increase LOS due to complications. Our results may be helpful when assessing whether efforts to shorten LOS are useful in improving the quality and cost of care.
Collapse
Affiliation(s)
- Brian D Moseley
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH, 45267-0525, USA.
| | - Sandra Dewar
- Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Suite 1250, Los Angeles, CA, 90095, USA.
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, One Baylor Plaza, MS: NB302, Houston, TX, 77030, USA.
| | - Dawn Eliashiv
- Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Suite 1250, Los Angeles, CA, 90095, USA.
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Suite 1250, Los Angeles, CA, 90095, USA.
| |
Collapse
|
11
|
Henning O, Baftiu A, Johannessen SI, Landmark CJ. Withdrawal of antiepileptic drugs during presurgical video-EEG monitoring: an observational study for evaluation of current practice at a referral center for epilepsy. Acta Neurol Scand 2014; 129:243-51. [PMID: 23980664 DOI: 10.1111/ane.12179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Withdrawal of antiepileptic drugs (AEDs) before and during video-EEG-monitoring is commonly implemented to reduce time needed to register a sufficient number of seizures during presurgical evaluation. There are, however, few guidelines regarding withdrawal rate and observation time. MATERIAL AND METHODS We performed an observational study including sixty patients admitted to the national Norwegian epilepsy centre and registered tapering of AEDs and their effect on seizure rate and possible complications. RESULTS The mean daily seizure rate before admission to the EMU was 0.4 (range 0.02-4) increasing to 1.1 (range 0-8) at the EMU. 29 patients (48%) followed a slow tapering rate whereas 31 (52%) had an intermediate tapering rate. There was no significant difference between the patients with a daily seizure rate during LTM of more or <0.7 seizures per day, an increase of seizure frequency from habitual to during LTM of more or <3.3 or 6.9 with regard to rate of tapering (slow vs intermediate) etiology or AED monotherapy vs polytherapy. Twenty-six patients (43%) had a sufficient number of seizures registered within 3 days to conclude regarding the presurgical evaluation. Two patients received escape treatment while 25 patients did have 24 h-seizure-clusters. There was no serious event. CONCLUSIONS Less than 50% of the patients got a sufficient number of seizures for a conclusive result within 3 days. An increase in the registration period could increase the number of successful registrations.
Collapse
Affiliation(s)
- O. Henning
- National Centre for Epilepsy; Oslo University Hospital; Oslo Norway
| | - A. Baftiu
- Department of Regulatory Affairs; The Norwegian Medicines Agency; Oslo Norway
| | - S. I. Johannessen
- National Centre for Epilepsy; Oslo University Hospital; Oslo Norway
- Department of Pharmacology; Oslo University Hospital; Oslo Norway
| | - C. Johannessen Landmark
- Department of Pharmacy and Biomedical Science; Faculty of Health Science; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| |
Collapse
|
12
|
Lamberts RJ, Gaitatzis A, Sander JW, Elger CE, Surges R, Thijs RD. Postictal generalized EEG suppression: an inconsistent finding in people with multiple seizures. Neurology 2013; 81:1252-6. [PMID: 23966251 DOI: 10.1212/wnl.0b013e3182a6cbeb] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the consistency and facilitating cofactors of postictal generalized EEG suppression (PGES) of >20 seconds after convulsive seizures (CS), a suggested predictor of sudden unexpected death in epilepsy risk. METHODS We retrospectively reviewed video-EEG data of people with ≥2 recorded CS. Presence and duration of PGES were assessed by 2 independent observers blinded to patient status. Intraindividual consistency of PGES >20 seconds was determined and correlations with clinical characteristics were analyzed after correction for individual effects and the varying number of seizures. RESULTS One hundred fifty-four seizures in 59 people were analyzed. PGES >20 seconds was found in 37 individuals (63%) and 57 (37%) of CS. The proportion of persons in whom PGES occurred consistently (presence or absence of PGES >20 seconds in all CS) was lower in those with more CS. PGES of >20 seconds was more frequent in seizures arising from sleep (odds ratio 3.29, 95% confidence interval 1.21-8.96) and when antiepileptic medication was tapered (odds ratio 4.80, 95% confidence interval 1.27-18.14). CONCLUSION Apparent PGES consistency was less frequent in people with more CS recorded, suggesting that PGES is an inconsistent finding in any one individual. Thus, we believe that PGES >20 seconds is not a reliable predictor of sudden unexpected death in epilepsy. Sleep and antiepileptic drug reduction appear to facilitate the occurrence of PGES.
Collapse
Affiliation(s)
- Robert J Lamberts
- From the SEIN-Stichting Epilepsie Instellingen Nederland (R.J.L., A.G., J.W.S., R.D.T.), Heemstede, the Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London, and Epilepsy Society, Chalfont St. Peter, UK; Department of Epileptology (C.E.E., R.S.), University Hospital Bonn, Germany; and Department of Neurology (R.D.T.), LUMC Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | | | | |
Collapse
|
13
|
Di Gennaro G, Picardi A, Sparano A, Mascia A, Meldolesi GN, Grammaldo LG, Esposito V, Quarato PP. Seizure clusters and adverse events during pre-surgical video-EEG monitoring with a slow anti-epileptic drug (AED) taper. Clin Neurophysiol 2012; 123:486-8. [DOI: 10.1016/j.clinph.2011.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 08/12/2011] [Accepted: 08/16/2011] [Indexed: 11/24/2022]
|
14
|
Devinsky O, Gazzola D, LaFrance WC. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 2011; 7:210-20. [PMID: 21386814 DOI: 10.1038/nrneurol.2011.24] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
15
|
Stefan H, Hopfengärtner R. Epilepsy monitoring for therapy: Challenges and perspectives. Clin Neurophysiol 2009; 120:653-8. [PMID: 19297244 DOI: 10.1016/j.clinph.2009.02.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 01/23/2009] [Accepted: 02/08/2009] [Indexed: 10/21/2022]
|
16
|
Azar NJ, Wang L, Song Y, Abou-Khalil BW. Temporal pattern of oxcarbazepine and phenytoin withdrawal seizures during epilepsy monitoring. Epilepsy Res 2008; 79:78-83. [DOI: 10.1016/j.eplepsyres.2007.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 12/06/2007] [Accepted: 12/29/2007] [Indexed: 10/22/2022]
|