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5-17-11 Pseudoepileptic seizures in epileptics
Epilepsy 5-l 7-06
Cultural and social aspects of epilepsy Central Africa: 187 patfents
P. Bernet-Bemady, P.M. Preux, M. Druet-Cabanac, M. Dumas. CHU Dupuytren Service De Newofogie, King, Limoges,
in Republic
D. Tabo, Poumale, 2 Avenue
Martin Luther
France
Epilepsy is a serious public health problem in African countries by virtue of its medical, so&-cultural and economic consequences for society. Its frequency is 2 to 5 times higher in devetoping countries compared to industrialized countries. Due to its irrational occurrence, epilepsy has been considered a supernatural phenomenon by civilizations and races through out the ages. These prejudices persist in Africa and the epileptic patient is most often seen by a traditional healer rather than a doctor. This study describes a population of 187 epileptics in the Republic of Central Africa and the so&-cultural aspect of the disease. Diagnosis was based on anamnesis and physical examination of the patients. Epilepsy is strongly believed to be contagious (54% of those questioned believe it is contagious) which results in a familial, educational and professional rejection of the patient. As a consequence of the former two, 46% of epileptics do not attend school and 79.1% are celibate. Most patients consult a healer because epilepsy is considered an incurable disease caused by casting a spelt: 20.9% of patients believe it is supernatural. Different treatments are prescribed ranging from abstinence from certain foods, which most certainly creates vitamin, urential fatty acids and amino acid deficiencies, to baths, drops and scarification. Among the more traditional treatments, 66% drink beverages, 10% receive beverages and ocular drops and 2% scadffcations. Abstinence from certain foodshiff is prescribed in almost 100% of cases. In addition to the psychological sequels following rejection the physical consequences most often present are bums. This is easily explained by proximity of cooking fires and the non assistance to patients in a crisis. The disease remains entrenched in supernatural beliefs, bad genies and traditional therapies including food abstinence and laxative pouders to eliminate “evil”. Epilepsy excludes patients from the family and school but does not preclude a professional activity. Epilepsy in black Africa is a true public health problem and merits particular attention from authorities, doctors and families. Careful accurate education that epilepsy is not contagious, better support of the family and a more appropriate treatment are indispensable.
5-l 7-07 F. Besag, Glaxo
Lamotrigine (LAMICTAL) in the treatment childhood epilepsy R. Sweet,
We//come,
P. Manasco,
Stockfey
J. Gallagher.
of
St Piers LingfTefd, Surrey;
UK,
Park, UK
Data from 285 children (113 yrs) with treatment-resistant epilepsy were pooled from 5 open-label, one year, lamotrigine add-on studies. All studies were conducted under similar protocols. Lamotrigine was effective in all seizure types, in particular typical and atypical absence seizures and atonic seizures, reducing pverall seizure frequency by z 50% in 34% of the children evaluable at week 12 of treatment. One hundred fii-five (155) patients who benefited from add-on lamotrigine therapy during the 12 month study, continued to receive add-on therapy, or monotherapy lamotrigine for up to an additional 3 years. These subjects were monitored every six months. Overall, patients were treated with lamotrigine for l-4.25 years, representing 417 patient-years of experience. The investigator’s global assessment of seizure control compared to the 3-month period before lamotrtgine treatment indicated that seizure control was generally maintained during long-term lamotrigine treatment for up to 4 years. Investigators recorded unsolicited subjective improvements in behavior, alertness, seizure severity, quality of lie, and mobility with lamotrigine treatment. Only 6 patients withdrew from the long-term trial due to an adverse event. Of these, only one (persistent rash) was considered to be related to lamotrigine. There were no deleterious effects on the growth of children with long-term use of lamotrigine. Weconclude that lamotrigine is active in long term-therapy against a number of seizure types and is well tolerated as add-on and monotherapy in children.
5-17-08
Epilepsy in the elderly outpatients. and neuroimaging studies
V. Bettot, M.I. PBrez, 8. Gros, C. Iturriaga, Neurology;
Miguel Servet
Hospital.
Zaragoza,
A. Oliieros.
Electra-clinical Department
of
Espafia
Introduction: In the last years, there has been an increasing appreciation that epileptic seizures and epilepsy are common in elderly people. In this age group a specific etiology can be identified in about 50% of cases and the incidence of partial seizures increases. Methods: The electro-clinical and neuroimaging features in patients aged 60 years or older with active epilepsy has been studied. The study covered the period from May 31, 1994, to January 1, 1997. The medical records of the epileptic older than 60 years that required ambulatory care were reviewed.
s301
Differences in crude proportions were assessed by x2 test for independence by 2 x 2 tables. Reeults and Concfuelon: The age range of the 52 patients studied, 31 men and 21 women was from 60 to 89 years (mean 73 f 7.8). The epilepsy was categorize by etiology as idiopathic in 31 patients or symptomatic in 21, and by seizure type in partial (36) or generafized onset (16). Among the analyzed variables there was statistical difference in the following: only the patients with partial seizures were in politherapy (p = 0.002); b) there was greater proportion of patient seizures free when both initial frequency was lesser one per month (p = 0. 0003) and in symptomatic category (p = 0.04).
5-l 7-09
A case of video game induced
H.-R. Plogsties.
Department
of Neurolog)!
convulsions
Marien-Hospital,
Hamm,
Germany
Cases, in which patients playing video games have epileptic attacks, are rare. Most of these cases concern children. We report the case of a 40-year old male patient, in whom a first grand-mal-attack occurred while playing a video game. As a complication we found an arachnoidal cyst with a slight space occupying effect. There was, however, no indication for a neurosurgical intervention. There has been no further convulsion during a follow-up for more than a year, the patient avoiding playing video games.
5-l 7-10
First unprovoked seizure: An epilepsy clinic perspective
I. Rega, A. Scaramelli, Montevideo,
R. Caseres.
Epilepsy
Section,
institute
outpatient of Neurology.
Uruguay
Relapse rates after a first seizure vary widely according to different authors, mainly depending on patient selection and methodology. The present study retrospectively considered patients seen at the Outpatient Clinic of the Institute of Neurology, Montevideo, through the analysis of computed clinical histories filled at admission and regularly during follow up. Out of 1000 such patients, 46 were identified to have been referred after a first unprovoked seizure and had either relapsed or been followed up for at least 3 years. All of them were older than 14 years, 27 were males and 19 females, the average age at presentation of the seizure being 21.3 years. Twenty three patients (50%) had a second seizure. They were compared with those who did not relapse concerning different variables. The most relevant results were a greater occurrence of generalized tonicclonic seizures during wakefulness, and a higher percentage of treated patients (95.6% vs. 47.1%) among those who did not relapse.
5-l 7-11 I. Rektor,
Pseudoepiieptlc M. Brtidil,
Univ., Hosp.
seizures in epileptics
I. Tyrlikov&
Sv. Anna,
M. SvejdovB. Smo, Czech Republic
Dept. of Neurolog):
Masaryk
Differentiation between intractable epileptic seizures, pseudo-epileptic seizures and psychically evoked epileptic seizures seems to be often difficult. It is even more complicated in patients with atypical seizure phenomenology, psychological finding of possible conversive origin, and a proven structural lesion in their brain. Further complication is possible coincidence of both epileptic and pseudo-epileptic seizures in some subject. The above-mentioned problems of differential diagnosis are presented on patient data, total video-EEG and video-SEEG of surgery candidates in the Epilepsy Centre in Bmo. The phenomenology of pseudo-epileptic seizures is discussed. The pseudo-epileptic seizures are mostly similar to frontal epileptic seizures, less often to temporal seizures. The diagnosis of pseudo-epileptic seizures is probable in patients with atypical seizure phenomenolcgy, positive psychological finding and with beneficial effect of psychotherapy. There is not only one decisive factor that could solve the diagnostic problem. Only the convergence of several methods (k&l video-EEG, psychological and psychiatric, MRI, SPECT, eventually SEEG) can minimize the probability of erroneous diagnosis.
5-l 7-12 P.J. Riekkinen, Virtanen
Hippocampai and amygdalar MRi volumetry and memory scores during vigabatrln monotherapy Sr., R. KiilviBinen,
Institute,
University
M. &ki&, K. Partanen,
T. SalmenperB.
A./.
of Kuopio, Finland
Volumetric magnetic resonance imaging (MRI) and T2 relaxometry provide quantitative means of assessing the degree of f. ex. hippocampal pathology in chronic epilepsy. There are few quantitative MRI-studies of the effects of antiepileptic drug treatment. The objectives of the study were 1) To determine whether changes in prospective volume measurements of the hippocampus and amygdala are associated with efficacy of treatment and the specifii drug used and 2) whether changes in memory scores correlate with quantitative MRI findings.
Cultural and social aspects of epilepsy Central Africa: 187 patfents
P. Bernet-Bemady, P.M. Preux, M. Druet-Cabanac, M. Dumas. CHU Dupuytren Service De Newofogie, King, Limoges,
in Republic
D. Tabo, Poumale, 2 Avenue
Martin Luther
France
Epilepsy is a serious public health problem in African countries by virtue of its medical, so&-cultural and economic consequences for society. Its frequency is 2 to 5 times higher in devetoping countries compared to industrialized countries. Due to its irrational occurrence, epilepsy has been considered a supernatural phenomenon by civilizations and races through out the ages. These prejudices persist in Africa and the epileptic patient is most often seen by a traditional healer rather than a doctor. This study describes a population of 187 epileptics in the Republic of Central Africa and the so&-cultural aspect of the disease. Diagnosis was based on anamnesis and physical examination of the patients. Epilepsy is strongly believed to be contagious (54% of those questioned believe it is contagious) which results in a familial, educational and professional rejection of the patient. As a consequence of the former two, 46% of epileptics do not attend school and 79.1% are celibate. Most patients consult a healer because epilepsy is considered an incurable disease caused by casting a spelt: 20.9% of patients believe it is supernatural. Different treatments are prescribed ranging from abstinence from certain foods, which most certainly creates vitamin, urential fatty acids and amino acid deficiencies, to baths, drops and scarification. Among the more traditional treatments, 66% drink beverages, 10% receive beverages and ocular drops and 2% scadffcations. Abstinence from certain foodshiff is prescribed in almost 100% of cases. In addition to the psychological sequels following rejection the physical consequences most often present are bums. This is easily explained by proximity of cooking fires and the non assistance to patients in a crisis. The disease remains entrenched in supernatural beliefs, bad genies and traditional therapies including food abstinence and laxative pouders to eliminate “evil”. Epilepsy excludes patients from the family and school but does not preclude a professional activity. Epilepsy in black Africa is a true public health problem and merits particular attention from authorities, doctors and families. Careful accurate education that epilepsy is not contagious, better support of the family and a more appropriate treatment are indispensable.
5-l 7-07 F. Besag, Glaxo
Lamotrigine (LAMICTAL) in the treatment childhood epilepsy R. Sweet,
We//come,
P. Manasco,
Stockfey
J. Gallagher.
of
St Piers LingfTefd, Surrey;
UK,
Park, UK
Data from 285 children (113 yrs) with treatment-resistant epilepsy were pooled from 5 open-label, one year, lamotrigine add-on studies. All studies were conducted under similar protocols. Lamotrigine was effective in all seizure types, in particular typical and atypical absence seizures and atonic seizures, reducing pverall seizure frequency by z 50% in 34% of the children evaluable at week 12 of treatment. One hundred fii-five (155) patients who benefited from add-on lamotrigine therapy during the 12 month study, continued to receive add-on therapy, or monotherapy lamotrigine for up to an additional 3 years. These subjects were monitored every six months. Overall, patients were treated with lamotrigine for l-4.25 years, representing 417 patient-years of experience. The investigator’s global assessment of seizure control compared to the 3-month period before lamotrtgine treatment indicated that seizure control was generally maintained during long-term lamotrigine treatment for up to 4 years. Investigators recorded unsolicited subjective improvements in behavior, alertness, seizure severity, quality of lie, and mobility with lamotrigine treatment. Only 6 patients withdrew from the long-term trial due to an adverse event. Of these, only one (persistent rash) was considered to be related to lamotrigine. There were no deleterious effects on the growth of children with long-term use of lamotrigine. Weconclude that lamotrigine is active in long term-therapy against a number of seizure types and is well tolerated as add-on and monotherapy in children.
5-17-08
Epilepsy in the elderly outpatients. and neuroimaging studies
V. Bettot, M.I. PBrez, 8. Gros, C. Iturriaga, Neurology;
Miguel Servet
Hospital.
Zaragoza,
A. Oliieros.
Electra-clinical Department
of
Espafia
Introduction: In the last years, there has been an increasing appreciation that epileptic seizures and epilepsy are common in elderly people. In this age group a specific etiology can be identified in about 50% of cases and the incidence of partial seizures increases. Methods: The electro-clinical and neuroimaging features in patients aged 60 years or older with active epilepsy has been studied. The study covered the period from May 31, 1994, to January 1, 1997. The medical records of the epileptic older than 60 years that required ambulatory care were reviewed.
s301
Differences in crude proportions were assessed by x2 test for independence by 2 x 2 tables. Reeults and Concfuelon: The age range of the 52 patients studied, 31 men and 21 women was from 60 to 89 years (mean 73 f 7.8). The epilepsy was categorize by etiology as idiopathic in 31 patients or symptomatic in 21, and by seizure type in partial (36) or generafized onset (16). Among the analyzed variables there was statistical difference in the following: only the patients with partial seizures were in politherapy (p = 0.002); b) there was greater proportion of patient seizures free when both initial frequency was lesser one per month (p = 0. 0003) and in symptomatic category (p = 0.04).
5-l 7-09
A case of video game induced
H.-R. Plogsties.
Department
of Neurolog)!
convulsions
Marien-Hospital,
Hamm,
Germany
Cases, in which patients playing video games have epileptic attacks, are rare. Most of these cases concern children. We report the case of a 40-year old male patient, in whom a first grand-mal-attack occurred while playing a video game. As a complication we found an arachnoidal cyst with a slight space occupying effect. There was, however, no indication for a neurosurgical intervention. There has been no further convulsion during a follow-up for more than a year, the patient avoiding playing video games.
5-l 7-10
First unprovoked seizure: An epilepsy clinic perspective
I. Rega, A. Scaramelli, Montevideo,
R. Caseres.
Epilepsy
Section,
institute
outpatient of Neurology.
Uruguay
Relapse rates after a first seizure vary widely according to different authors, mainly depending on patient selection and methodology. The present study retrospectively considered patients seen at the Outpatient Clinic of the Institute of Neurology, Montevideo, through the analysis of computed clinical histories filled at admission and regularly during follow up. Out of 1000 such patients, 46 were identified to have been referred after a first unprovoked seizure and had either relapsed or been followed up for at least 3 years. All of them were older than 14 years, 27 were males and 19 females, the average age at presentation of the seizure being 21.3 years. Twenty three patients (50%) had a second seizure. They were compared with those who did not relapse concerning different variables. The most relevant results were a greater occurrence of generalized tonicclonic seizures during wakefulness, and a higher percentage of treated patients (95.6% vs. 47.1%) among those who did not relapse.
5-l 7-11 I. Rektor,
Pseudoepiieptlc M. Brtidil,
Univ., Hosp.
seizures in epileptics
I. Tyrlikov&
Sv. Anna,
M. SvejdovB. Smo, Czech Republic
Dept. of Neurolog):
Masaryk
Differentiation between intractable epileptic seizures, pseudo-epileptic seizures and psychically evoked epileptic seizures seems to be often difficult. It is even more complicated in patients with atypical seizure phenomenology, psychological finding of possible conversive origin, and a proven structural lesion in their brain. Further complication is possible coincidence of both epileptic and pseudo-epileptic seizures in some subject. The above-mentioned problems of differential diagnosis are presented on patient data, total video-EEG and video-SEEG of surgery candidates in the Epilepsy Centre in Bmo. The phenomenology of pseudo-epileptic seizures is discussed. The pseudo-epileptic seizures are mostly similar to frontal epileptic seizures, less often to temporal seizures. The diagnosis of pseudo-epileptic seizures is probable in patients with atypical seizure phenomenolcgy, positive psychological finding and with beneficial effect of psychotherapy. There is not only one decisive factor that could solve the diagnostic problem. Only the convergence of several methods (k&l video-EEG, psychological and psychiatric, MRI, SPECT, eventually SEEG) can minimize the probability of erroneous diagnosis.
5-l 7-12 P.J. Riekkinen, Virtanen
Hippocampai and amygdalar MRi volumetry and memory scores during vigabatrln monotherapy Sr., R. KiilviBinen,
Institute,
University
M. &ki&, K. Partanen,
T. SalmenperB.
A./.
of Kuopio, Finland
Volumetric magnetic resonance imaging (MRI) and T2 relaxometry provide quantitative means of assessing the degree of f. ex. hippocampal pathology in chronic epilepsy. There are few quantitative MRI-studies of the effects of antiepileptic drug treatment. The objectives of the study were 1) To determine whether changes in prospective volume measurements of the hippocampus and amygdala are associated with efficacy of treatment and the specifii drug used and 2) whether changes in memory scores correlate with quantitative MRI findings.