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The prognostic value of interictal scalp EEG to surgical outcome in patients with hippocampal sclerosis; influence of antiepileptic drugs
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Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
Objective: We report unusual brain MRI findings in a child with epileptic seizures. Patients and methods: We present a previously healthy 8-year-old Caucasian boy with clear personal and family history with repeated epileptic seizures and brain demyelinating-like lesions. Results: Postictal neurological status was normal. Visual Evoked Potentials showed bilateral optic nerve central afferent dysfunction. Lumbar puncture was performed with no significant findings. There was no presence of oligoclonal bands either in cerebrospinal fluid or in blood serum. Postictal electroencephalogram showed slow background activity with groups of delta and theta waves over anterior regions; whereas control EEG was with better organized background activity, with groups of slow and sharp wave discharges. A head CT scan showed relative narrowing of subarachnoid space on brain convexity with suspected discrete brain edema. Brain MRI showed multifocal, supratentorial and subcortical demyelinating-like lesions. Demyelinatinglike lesions were asymmetrical with cortical and cortical–subcortical border line distribution in both hemispheres. There was no significant association of deep white matter. Conclusion: Full diagnostic assessment should be obtained for all patients with epileptic seizures. Considering the available references, we found such MRI findings unusual in a child with epileptic seizures. doi:10.1016/j.jns.2013.07.099
Abstract — WCN 2013 No: 1438 Topic: 1 — Epilepsy The prognostic value of interictal scalp EEG to surgical outcome in patients with hippocampal sclerosis; influence of antiepileptic drugs I. Dolezalovaa,b, M. Brázdila,b, M. Hermanováb,c, E. Janoušovád, R. Kubaa,b. a Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Czech Republic; b Central European Institute of Technology (CEITEC), Masaryk University, Czech Republic; cFirst Department of Pathological Anatomy, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Czech Republic; dInstitute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic Objective: We performed this retrospective study to determine if there are differences in interictal EEG's prognostic value during gradual reduction of antiepileptic drugs (AEDs) in relation to surgical outcome, defined by Engel's classification, in patients with refractory TLE with hippocampal sclerosis (HS). Patients and methods: In a total number of 55 patients, we analyzed laterality and absolute number of IED's as an average value for the total time of monitoring (TT), and in three different periods of interest defined by the level of AEDs' reduction — full medication period (FMP), reduced medication period (RMP), and withdrawal medication period (WMP). Laterality was defined as unitemporal (≥90% of IEDs on the side of HS) and bitemporal (b90% of IEDs on the side with HS). Results: The laterality of IED's during TT (p = 0.047) and during FMP (p = 0.005) was a statistically significant predictor factor for surgical outcome. There were no statistically significant differences of laterality during RMP (0.074) and WMP (0.131) in relation to outcome. The absolute number of IED's on the side of HS was not predictive for the surgery either as an average value (p = 0.502), or during FMP (p = 0.706), RMP (p = 0.709) or WMP (p = 0.719). The absolute number of IED's on the contralateral side to HS was a predictive factor for surgery during TT (p = 0.083) and during FMP (p = 0.01). There were no statistically significant differences during RMP (p = 0.081) and WMP (p = 0.083).
Significance: The prognostic value to the surgical outcome has the laterality and the absolute number of IED's both during TT and FMP. doi:10.1016/j.jns.2013.07.100
Abstract — WCN 2013 No: 1463 Topic: 1 — Epilepsy Retigabine as adjunctive treatment in adults with refractory partial onset epilepsy. Own experience at least a half-year follow-up V. Donatha, L. Lipovskyb, S. Mehesovab. aNeurology, Slovak Medical University, F.D. Roosevelt Teaching Hospital, Banska Bystrica, Slovak Republic; bNeurology, Slovak Medical University, University Hospital, Bratislava, Slovak Republic Background: Retigabine (RTG) exhibits a novel mechanism of action opening neuronal KCNQ/Kv7 potassium channels leading to hyperpolarization of membrane potential and decreased neuronal excitability. RTG has been available in Slovakia since October 1, 2011. Objective: Objective of the study was to monitor pharmacotherapyresistant patients focusing on RTG efficiency and safety. Patients and methods/material and methods: In the survey we monitored demographic data, etiology of epilepsy, response to therapy, co-mediation, and adverse side-effects of RTG treatment. Mean followup time period was 11.7 months. Results: 33 men and 28 women of median age 39.4 years (range: 20–61) and a median duration of epilepsy of 26 years (range: 2–51) were included. Median seizure frequency one month before RTG treatment was 8 (range 2 to 50). Median RTG final dose was 600 mg/day (range 150 to 1150 mg/day). Most frequent co-medication: levetiracetam, carbamazepine, lamotrigine, valproate. Most frequent etiology: 32.8% perinatal injury, 24.6% cryptogenic, 14.7% trauma, 8.2% cerebral infection. Responder rate: 14.7% seizure free; 41.0% responders reporting 50to-99% reduction of seizures; 19.7% reported seizure reduction below 50%; 16.4% reported no change; 3.3% reported deterioration; 21.3% of patients discontinued their treatment. Side-effects were observed in 34.4% of patients — most frequently fatigue, drowsiness, vertigo and tremor. Conclusion: RTG in our study demonstrated the efficiency and tolerability profile comparable to that in pivotal trials. RTG treatment was efficient and well tolerated in a highly therapy resistant population of partial-onset epilepsy patients. doi:10.1016/j.jns.2013.07.101
Abstract — WCN 2013 No: 1477 Topic: 1 — Epilepsy Midazolam plasma levels after the administration of a galenic nasal spray formulation in healthy volunteers O.A. Martineza,b, M.S. Pachaa, J.P. Escaliera, E. Otamendic, A. Lazarowskic, F. Buontempoc, E. Bernabeuc, M. Morettonc, D. Chiappettac, G. Bramugliac. a Neurology, Hospital de Clinicas de Buenos Aires, Argentina; bNeurology, Hospital Britanico de Buenos Aires, Argentina; cPharmacology, Universidad de Buenos Aires, Buenos Aires, Argentina Background: The initial treatment of seizures is intravenous or rectal benzodiazepines. However, intravenous access during a seizure is difficult. Rectal administration is safer, but can be considered socially
Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
Objective: We report unusual brain MRI findings in a child with epileptic seizures. Patients and methods: We present a previously healthy 8-year-old Caucasian boy with clear personal and family history with repeated epileptic seizures and brain demyelinating-like lesions. Results: Postictal neurological status was normal. Visual Evoked Potentials showed bilateral optic nerve central afferent dysfunction. Lumbar puncture was performed with no significant findings. There was no presence of oligoclonal bands either in cerebrospinal fluid or in blood serum. Postictal electroencephalogram showed slow background activity with groups of delta and theta waves over anterior regions; whereas control EEG was with better organized background activity, with groups of slow and sharp wave discharges. A head CT scan showed relative narrowing of subarachnoid space on brain convexity with suspected discrete brain edema. Brain MRI showed multifocal, supratentorial and subcortical demyelinating-like lesions. Demyelinatinglike lesions were asymmetrical with cortical and cortical–subcortical border line distribution in both hemispheres. There was no significant association of deep white matter. Conclusion: Full diagnostic assessment should be obtained for all patients with epileptic seizures. Considering the available references, we found such MRI findings unusual in a child with epileptic seizures. doi:10.1016/j.jns.2013.07.099
Abstract — WCN 2013 No: 1438 Topic: 1 — Epilepsy The prognostic value of interictal scalp EEG to surgical outcome in patients with hippocampal sclerosis; influence of antiepileptic drugs I. Dolezalovaa,b, M. Brázdila,b, M. Hermanováb,c, E. Janoušovád, R. Kubaa,b. a Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Czech Republic; b Central European Institute of Technology (CEITEC), Masaryk University, Czech Republic; cFirst Department of Pathological Anatomy, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Czech Republic; dInstitute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic Objective: We performed this retrospective study to determine if there are differences in interictal EEG's prognostic value during gradual reduction of antiepileptic drugs (AEDs) in relation to surgical outcome, defined by Engel's classification, in patients with refractory TLE with hippocampal sclerosis (HS). Patients and methods: In a total number of 55 patients, we analyzed laterality and absolute number of IED's as an average value for the total time of monitoring (TT), and in three different periods of interest defined by the level of AEDs' reduction — full medication period (FMP), reduced medication period (RMP), and withdrawal medication period (WMP). Laterality was defined as unitemporal (≥90% of IEDs on the side of HS) and bitemporal (b90% of IEDs on the side with HS). Results: The laterality of IED's during TT (p = 0.047) and during FMP (p = 0.005) was a statistically significant predictor factor for surgical outcome. There were no statistically significant differences of laterality during RMP (0.074) and WMP (0.131) in relation to outcome. The absolute number of IED's on the side of HS was not predictive for the surgery either as an average value (p = 0.502), or during FMP (p = 0.706), RMP (p = 0.709) or WMP (p = 0.719). The absolute number of IED's on the contralateral side to HS was a predictive factor for surgery during TT (p = 0.083) and during FMP (p = 0.01). There were no statistically significant differences during RMP (p = 0.081) and WMP (p = 0.083).
Significance: The prognostic value to the surgical outcome has the laterality and the absolute number of IED's both during TT and FMP. doi:10.1016/j.jns.2013.07.100
Abstract — WCN 2013 No: 1463 Topic: 1 — Epilepsy Retigabine as adjunctive treatment in adults with refractory partial onset epilepsy. Own experience at least a half-year follow-up V. Donatha, L. Lipovskyb, S. Mehesovab. aNeurology, Slovak Medical University, F.D. Roosevelt Teaching Hospital, Banska Bystrica, Slovak Republic; bNeurology, Slovak Medical University, University Hospital, Bratislava, Slovak Republic Background: Retigabine (RTG) exhibits a novel mechanism of action opening neuronal KCNQ/Kv7 potassium channels leading to hyperpolarization of membrane potential and decreased neuronal excitability. RTG has been available in Slovakia since October 1, 2011. Objective: Objective of the study was to monitor pharmacotherapyresistant patients focusing on RTG efficiency and safety. Patients and methods/material and methods: In the survey we monitored demographic data, etiology of epilepsy, response to therapy, co-mediation, and adverse side-effects of RTG treatment. Mean followup time period was 11.7 months. Results: 33 men and 28 women of median age 39.4 years (range: 20–61) and a median duration of epilepsy of 26 years (range: 2–51) were included. Median seizure frequency one month before RTG treatment was 8 (range 2 to 50). Median RTG final dose was 600 mg/day (range 150 to 1150 mg/day). Most frequent co-medication: levetiracetam, carbamazepine, lamotrigine, valproate. Most frequent etiology: 32.8% perinatal injury, 24.6% cryptogenic, 14.7% trauma, 8.2% cerebral infection. Responder rate: 14.7% seizure free; 41.0% responders reporting 50to-99% reduction of seizures; 19.7% reported seizure reduction below 50%; 16.4% reported no change; 3.3% reported deterioration; 21.3% of patients discontinued their treatment. Side-effects were observed in 34.4% of patients — most frequently fatigue, drowsiness, vertigo and tremor. Conclusion: RTG in our study demonstrated the efficiency and tolerability profile comparable to that in pivotal trials. RTG treatment was efficient and well tolerated in a highly therapy resistant population of partial-onset epilepsy patients. doi:10.1016/j.jns.2013.07.101
Abstract — WCN 2013 No: 1477 Topic: 1 — Epilepsy Midazolam plasma levels after the administration of a galenic nasal spray formulation in healthy volunteers O.A. Martineza,b, M.S. Pachaa, J.P. Escaliera, E. Otamendic, A. Lazarowskic, F. Buontempoc, E. Bernabeuc, M. Morettonc, D. Chiappettac, G. Bramugliac. a Neurology, Hospital de Clinicas de Buenos Aires, Argentina; bNeurology, Hospital Britanico de Buenos Aires, Argentina; cPharmacology, Universidad de Buenos Aires, Buenos Aires, Argentina Background: The initial treatment of seizures is intravenous or rectal benzodiazepines. However, intravenous access during a seizure is difficult. Rectal administration is safer, but can be considered socially