- Email: [email protected]
Efficacy of chronic stimulation of nucleus accumbens (NAC) and anterior thalamus (ANT) in patients with pharmacoresistant focal epilepsy
e50
Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
Abstract — WCN 2013 No: 2549 Topic: 1 — Epilepsy Surgical palliative care in Lennox–Gastaut syndrome
Conclusion: Prenatal exposure to antiepileptic drugs was associated with lower birth weight, reduced gestational age, decrease in head circumference, and increased risk of preterm birth and being small for gestational age.
E. Hentati, N. Ben Ali, M. Kchaou, S. Belal. Service de Neurologie, Hopital Charles Nicolle, Tunis, Tunisia
doi:10.1016/j.jns.2013.07.179
Aims: To retrospectively review the efficacy of vagus nerve stimulation in three pediatric patients with Lennox–Gastaut syndrome and examine the seizure-frequency, intensity and duration outcomes. Methods: It is a retrospective study of 3 patients followed in the Department of Neurology of the Charles Nicolle Hospital to which had been implanted a vagus nerve stimulation. The standard initial parameters were: A stimulation for 30 s followed by a stimulation-free period of 5 min. Results: The population included 3 children: two girls and a boy. The mean age was 9.33 years and the mean age at implantation was 8 years. The mean of the follow-up duration was 18 months. The median seizure-frequency reduction was 23%. We have noticed a reduction of duration of seizures. The Status epilepticus disappeared in one patient. Conclusion: The efficiency of vagus nerve stimulation was partial. Indeed, the number and the duration of the seizures decreased but any of our patients presented a complete cure. However the efficiency of this technique would be superior to the isolated medicinal treatment. doi:10.1016/j.jns.2013.07.178
Abstract — WCN 2013 No: 2558 Topic: 1 — Epilepsy Adverse birth outcomes after prenatal exposure to antiepileptic drugs D. Kilica, H. Pedersenb, M.I.S. Kjaersgaardc, E.T. Parnerc, M. Vestergaardd, M.J. Sørensene, J. Olsenf. aDepartment of Neurology, Aarhus University Hospital, Denmark; bResearch Unit for General Practice, Denmark; c Department of Public Health, Section for Biostatistics, Aarhus University, Denmark; dDepartment of Public Health, Section for General Medical Practice, Aarhus University, Denmark; eRegional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark; f Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark Background: There is limited knowledge of the effects of prenatal exposure to antiepileptic drugs and birth outcome. Objective: To study birth outcome in newborn children after prenatal exposure to antiepileptic drugs. Patients and methods: From Danish registers, we identified all children born from 1997 to 2008 and linked this with information on the mother's prescriptions for antiepileptic drugs during pregnancy. We used linear regression to study birth weight, gestational age and head circumference at birth, and binominal regression to study preterm birth (b37 weeks) and “small for gestational age” (b10%). Estimates were adjusted for potential confounding factors. Furthermore, head circumference and birth weight were adjusted for gestational age, and gestational age was adjusted for birth weight. Results: We identified 679,762 newborn singletons. After adjustment for confounders, antiepileptic drug exposure (n = 2928) was associated with reduced gestational age; −0.92 days (95% confidence interval (CI): −1.40 to −0.44), lower birth weight; −31.96 g (95% CI: −51.74 to −12.18) and smaller head circumference −0.07 cm (95% CI: −0.14 to −0.004) compared to non-exposed. There was a higher risk of being born preterm (b37 weeks) (adjusted Risk Ratio (aRR): 1.51 (95% CI: 1.32–1.72)) and a higher risk of being small for gestational age (aRR: 1.21 (95% CI: 1.10–1.34).
Abstract — WCN 2013 No: 2495 Topic: 1 — Epilepsy Efficacy of chronic stimulation of nucleus accumbens (NAC) and anterior thalamus (ANT) in patients with pharmacoresistant focal epilepsy F.C. Schmitta, J. Vogesb, L. Buentjenb, T. Zaehlea, K. Bohlmannc, H. Stefand, F. Oltmannse, H.-J. Heinzea, M. Holtkampe,f, A. Kowskif. aDepartment of Neurology, University of Magdeburg, Medical Faculty, Magdeburg, Germany; b Department of Stereotactic Neurosurgery, University of Magdeburg, Medical Faculty, Magdeburg, Germany; cEpilepsy Hospital Tabor, Epilepsy Center Berlin-Brandenburg, Bernau, Germany; dDepartment of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany; eKoenigin-ElisabethHerzberge Hospital, Epilepsy Center Berlin-Brandenburg, Germany; f Department of Neurology, Charité University Medicine, Berlin, Germany Background: The SANTE study proved efficacy of ANT stimulation in pharmacoresistant epilepsy. The nucleus accumbens has a relay function for the frontal lobe and for the Papez circuit. It therefore could also be an effective target to suppress ictal activity in these areas. Objective: This observational study summarizes clinical outcome of DBS in the NAC and compares results to subsequent ANT stimulation. Patients and methods: Four patients had stimulation of the NAC and subsequently of the ANT over 6 months. Stimulation parameters and stimulated contacts for each target, as well as concomitant AEDs remained unchanged. Clinical parameters such as seizure frequency, the Liverpool-Seizure-Severity-Scale (LSSS) and Beck's depression inventory were assessed. Due to pronounced interindividual heterogeneity in baseline period, clinical variables were related to the individual baseline values after each stimulation period and expressed as fraction of 1. Results: Compared to the baseline period the LSSS score significantly reduced to 0.81 (+/− 0.11; p = 0.014) and the relative number of disabling seizures (i.e. complex-partial plus generalized seizures) to 0.66 (+/− 0.34; p = 0.091) in the four patients studied. In one subject, reduction of disabling seizures of more than 50% (21%) was observed. The number of non-disabling seizures and other clinical variables remained unchanged. Results of ANT stimulation are in progress and will be presented at the conference. Conclusion: Six months of NAC stimulation significantly reduced the seizure severity score. A larger cohort may show a significant reduction in seizure frequency and reveal specific responders for ANT and NAC stimulation. doi:10.1016/j.jns.2013.07.180
Abstract — WCN 2013 No: 2151 Topic: 1 — Epilepsy Lack of potassium current in novel mutations of KCNQ2 and KCNQ3 identified in benign familial neonatal epilepsy (BFNE) Y. Sugiuraa, Y. Iharab, A. Ishiib, Y. Ugawaa, S. Hiroseb. aDepartment of Neurology, Fukushima Medical University School of Medicine, Fukushima, Japan; bDepartment of Pediatrics, Fukuoka University School of Medicine, Fukuoka, Japan
Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
Abstract — WCN 2013 No: 2549 Topic: 1 — Epilepsy Surgical palliative care in Lennox–Gastaut syndrome
Conclusion: Prenatal exposure to antiepileptic drugs was associated with lower birth weight, reduced gestational age, decrease in head circumference, and increased risk of preterm birth and being small for gestational age.
E. Hentati, N. Ben Ali, M. Kchaou, S. Belal. Service de Neurologie, Hopital Charles Nicolle, Tunis, Tunisia
doi:10.1016/j.jns.2013.07.179
Aims: To retrospectively review the efficacy of vagus nerve stimulation in three pediatric patients with Lennox–Gastaut syndrome and examine the seizure-frequency, intensity and duration outcomes. Methods: It is a retrospective study of 3 patients followed in the Department of Neurology of the Charles Nicolle Hospital to which had been implanted a vagus nerve stimulation. The standard initial parameters were: A stimulation for 30 s followed by a stimulation-free period of 5 min. Results: The population included 3 children: two girls and a boy. The mean age was 9.33 years and the mean age at implantation was 8 years. The mean of the follow-up duration was 18 months. The median seizure-frequency reduction was 23%. We have noticed a reduction of duration of seizures. The Status epilepticus disappeared in one patient. Conclusion: The efficiency of vagus nerve stimulation was partial. Indeed, the number and the duration of the seizures decreased but any of our patients presented a complete cure. However the efficiency of this technique would be superior to the isolated medicinal treatment. doi:10.1016/j.jns.2013.07.178
Abstract — WCN 2013 No: 2558 Topic: 1 — Epilepsy Adverse birth outcomes after prenatal exposure to antiepileptic drugs D. Kilica, H. Pedersenb, M.I.S. Kjaersgaardc, E.T. Parnerc, M. Vestergaardd, M.J. Sørensene, J. Olsenf. aDepartment of Neurology, Aarhus University Hospital, Denmark; bResearch Unit for General Practice, Denmark; c Department of Public Health, Section for Biostatistics, Aarhus University, Denmark; dDepartment of Public Health, Section for General Medical Practice, Aarhus University, Denmark; eRegional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark; f Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark Background: There is limited knowledge of the effects of prenatal exposure to antiepileptic drugs and birth outcome. Objective: To study birth outcome in newborn children after prenatal exposure to antiepileptic drugs. Patients and methods: From Danish registers, we identified all children born from 1997 to 2008 and linked this with information on the mother's prescriptions for antiepileptic drugs during pregnancy. We used linear regression to study birth weight, gestational age and head circumference at birth, and binominal regression to study preterm birth (b37 weeks) and “small for gestational age” (b10%). Estimates were adjusted for potential confounding factors. Furthermore, head circumference and birth weight were adjusted for gestational age, and gestational age was adjusted for birth weight. Results: We identified 679,762 newborn singletons. After adjustment for confounders, antiepileptic drug exposure (n = 2928) was associated with reduced gestational age; −0.92 days (95% confidence interval (CI): −1.40 to −0.44), lower birth weight; −31.96 g (95% CI: −51.74 to −12.18) and smaller head circumference −0.07 cm (95% CI: −0.14 to −0.004) compared to non-exposed. There was a higher risk of being born preterm (b37 weeks) (adjusted Risk Ratio (aRR): 1.51 (95% CI: 1.32–1.72)) and a higher risk of being small for gestational age (aRR: 1.21 (95% CI: 1.10–1.34).
Abstract — WCN 2013 No: 2495 Topic: 1 — Epilepsy Efficacy of chronic stimulation of nucleus accumbens (NAC) and anterior thalamus (ANT) in patients with pharmacoresistant focal epilepsy F.C. Schmitta, J. Vogesb, L. Buentjenb, T. Zaehlea, K. Bohlmannc, H. Stefand, F. Oltmannse, H.-J. Heinzea, M. Holtkampe,f, A. Kowskif. aDepartment of Neurology, University of Magdeburg, Medical Faculty, Magdeburg, Germany; b Department of Stereotactic Neurosurgery, University of Magdeburg, Medical Faculty, Magdeburg, Germany; cEpilepsy Hospital Tabor, Epilepsy Center Berlin-Brandenburg, Bernau, Germany; dDepartment of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany; eKoenigin-ElisabethHerzberge Hospital, Epilepsy Center Berlin-Brandenburg, Germany; f Department of Neurology, Charité University Medicine, Berlin, Germany Background: The SANTE study proved efficacy of ANT stimulation in pharmacoresistant epilepsy. The nucleus accumbens has a relay function for the frontal lobe and for the Papez circuit. It therefore could also be an effective target to suppress ictal activity in these areas. Objective: This observational study summarizes clinical outcome of DBS in the NAC and compares results to subsequent ANT stimulation. Patients and methods: Four patients had stimulation of the NAC and subsequently of the ANT over 6 months. Stimulation parameters and stimulated contacts for each target, as well as concomitant AEDs remained unchanged. Clinical parameters such as seizure frequency, the Liverpool-Seizure-Severity-Scale (LSSS) and Beck's depression inventory were assessed. Due to pronounced interindividual heterogeneity in baseline period, clinical variables were related to the individual baseline values after each stimulation period and expressed as fraction of 1. Results: Compared to the baseline period the LSSS score significantly reduced to 0.81 (+/− 0.11; p = 0.014) and the relative number of disabling seizures (i.e. complex-partial plus generalized seizures) to 0.66 (+/− 0.34; p = 0.091) in the four patients studied. In one subject, reduction of disabling seizures of more than 50% (21%) was observed. The number of non-disabling seizures and other clinical variables remained unchanged. Results of ANT stimulation are in progress and will be presented at the conference. Conclusion: Six months of NAC stimulation significantly reduced the seizure severity score. A larger cohort may show a significant reduction in seizure frequency and reveal specific responders for ANT and NAC stimulation. doi:10.1016/j.jns.2013.07.180
Abstract — WCN 2013 No: 2151 Topic: 1 — Epilepsy Lack of potassium current in novel mutations of KCNQ2 and KCNQ3 identified in benign familial neonatal epilepsy (BFNE) Y. Sugiuraa, Y. Iharab, A. Ishiib, Y. Ugawaa, S. Hiroseb. aDepartment of Neurology, Fukushima Medical University School of Medicine, Fukushima, Japan; bDepartment of Pediatrics, Fukuoka University School of Medicine, Fukuoka, Japan