Efficacy, Tolerability and Serum Phenytoin Levels after Intravenous Fosphenytoin Loading Dose in Children with Status Epilepticus

Objective: To evaluate the efficacy and tolerability of intravenousfosphenytoin in children with status epilepticus, and resultingserum total phenytoin levels.Methods: In this prospective study, 51 children aged less than 18years received intravenous loading dose of fosphenytoin (18-20mg/kg). Serum total phenytoin levels were estimated at 90 -100minutes. Outcomes studied were (i) seizure control and local and/or systemic adverse effects in next 24 hours and (ii) phenytoinlevels and its correlation with dose received, seizure control andadverse effects.Results: The actual dose of fosphenytoin received varied from15.1 to 25 mg/kg. Seizures were controlled in 45 (88%) childrenand, two required additional dose of 10 mg/kg. None of thechildren showed any local or systemic adverse effects. Serumtotal phenytoin levels were in the therapeutic range (10-20 μg/mL)in 12 (23.5%), sub-therapeutic in 16 (31.3%) and supra-therapeutic in 25 (49%) children. There was weak correlation ofthe phenytoin levels with dose of fosphenytoin received, seizurecontrol, or adverse effects.Conclusion: Intravenous fosphenytoin loading dose of 20 mg/kgis effective in controlling seizures in 88% of children with statusepilepticus, with a good safety profile. Seizure control and adverseeffects appear to be independent of serum total phenytoin levelsachieved.

Factors in Determining Seizure Control in Pediatric Patients On Antiepileptic Medication: A Review of the Literature

@#Introduction Pediatric epilepsy is one of the common illness in children. Pediatric epilepsy has significant impact not only to the patient, but also to the care takers. Furthermore, the disease could potentially cause strain in the limited resources of the healthcare system which is preventable. Methods A search was conducted to review relevant published studies on factors affecting seizure control using PubMed/MEDLINE, Google Scholar and also Science Direct searching engines databases using keywords: paediatric seizure, seizure control, side effects, antiepileptic, adherence and quality of life. Results In this review, we found that many factors contribute to the pediatric epilepsy, namely; compliance, genetic, age, socioeconomic factors, parental health literacy and numbers and side effects of the medications. Furthermore, there is certain factors that need to be explored in the future, such as unaddressed parental concern on treatment/medication, denial of disease and drug-drug interactions. Conclusions Factors that had been identified can be used in the prevention and control programs, while factors which is less studied should be further studied in the future.

Clinical outcomes after medial temporal lobe epilepsy surgery: Anterior temporal lobectomy versus selective amygdalohippocampectomy / 中南大学学报(医学版)

Objective:To compare the anterior temporal lobectomy (ATL) with transsylvian selective amygdalohippocampectomy (SeAH) in 72 patients with medial temporal lobe epilepsy (MTLE) regarding the seizure control and neuropsychological outcomes.Methods:Clinical data and follow-up data were collected and retrospectively analyzed.SeAH and ATL were used in 39 and 33 patients,respectively.All eligible patients were followed up at least one year.Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised were used to test the patients' neuropsychology before and after the surgery for one year.Results:Fifty-nine patients (81.9％) achieved satisfactory seizure control (62.5％ Engel Class Ⅰ and 19.4％ Class Ⅱ).ATL obtained 84.8％ satisfactory seizure control (28 patients),and the success rate was 79.5％ (31 patients) for SeAH.There was no significant difference in seizure control between SeAH and ATL (P=0.760).The postoperative verbal IQ of SeAH group increased significantly in both side surgery (P＜0.05),while the increase was not significant in the group of ATL of both side surgery (P＞0.05).Regarding left-side surgery,postoperative verbal memory and total memory were increased significantly in the group of SeAH (P＜0.05),while the increases were not significant in the group ofATL (P＞0.05).In the right-side surgery,postoperative verbal memory and total memory were increased significantly in the two surgery strategy groups (P＜0.05),while no significant increases were seen in non-verbal memory of the two surgery strategy groups (P＞0.05).Conclusion:Microsurgery for the treatment of refractory MTLE is successful and safe,and should be encouraged.The seizure outcome is not different between ATL and SeAH,while regarding as verbal IQ and verbal memory outcomes,SeAH may be superior to ATL in dominant hemisphere surgery.

In adolescents with epilepsy, high scores of anxiety and depression are associated with occurrence of seizures in public places / Em adolescentes com epilepsia, altos escores de ansiedade e depressão foram associados com ocorrência de crises em lugares públicos

Objective To assess depression and anxiety symptoms of adolescents with epilepsy compared with adolescents without epilepsy. Method The study sample consisted of: case participants (50 subjects) attending the pediatric epilepsy clinic of a tertiary hospital and control participants (51 subjects) from public schools. The instruments utilized were: identification card with demographic and epilepsy data, Beck Depression Inventory and State-Trait Anxiety Inventory. Results No significant differences were founded between the groups regarding scores for depression and anxiety symptoms but both groups presented moderate scores of anxiety. A correlation was found between low scores anxiety and not frequent seizures, low scores anxiety and perception of seizure control, high scores of anxiety and depression and occurrence of seizures in public places. Conclusion Low scores of anxiety are associated with not frequent seizures; high scores of anxiety and depression are associated with occurrence of seizures in public places. .

Objetivo O presente estudo teve como objetivo avaliar os sintomas de ansiedade e depressão de adolescentes com epilepsia comparados com adolescentes sem epilepsia. Método A amostra consistiu: grupo caso (50 indivíduos) atendidos no ambulatório de epilepsia infantil do Hospital Universitário e grupo controle (51 indivíduos) de escolas públicas. Os instrumentos utilizados foram: cartão com dados demográficos e de epilepsia, Beck Depression Inventory e State-Trait Anxiety Inventory. Resultados Os resultados não mostraram diferenças significativas entre os grupos em relação à depressão e ansiedade, mas ambos os grupos apresentaram escores moderados de ansiedade. Foi encontrada correlação entre baixa pontuação de ansiedade e crises não frequentes e percepção de controle de crises; altas pontuações de ansiedade e depressão e ocorrência de crises em lugares públicos. Conclusão Variáveis psicossociais e da doença são contingências importantes no comportamento adaptativo e controle do humor em uma doença crônica como a epilepsia. .

The effects of epileptic seizures upon quality of life / Efeito das crises epilépticas na qualidade de vida

OBJECTIVE: understand the psychological considerations of the relationship between the effect of seizures upon the patients' perception of seizure control, depression, anxiety and quality of life (QoL). METHODS: 151 adult patients with epilepsy diagnosed for over two years were interviewed and responded the 31-Item Quality of Life in Epilepsy (QOLIE-31), the Trait Form of the State/Trait Anxiety Inventory (STAI II) and the Beck Depression Inventory (BDI). RESULTS: 45 patients were depressed (29.8 percent) and 29 (19.2 percent) had anxiety. Depression scores ranged from 0 to 49 (M=7.4; SD=8.9) and anxiety scores ranged from 19 to 69 (M=41.5, SD=11.9). Total QoL score was correlated to seizure control (p<0.001), perception of epilepsy control (p<0.001), anxiety (p<0.001), and depression (p=0.003). The perception of epilepsy control was correlated to seizure control (p<0.001), seizure frequency (p=0.001), anxiety (p<0.001) and depression (p<0.001). Seizure control was associated to anxiety (p=0.033) and depression (p<0.001). There was co-morbidity between anxiety and depression (p<0.001). CONCLUSION: This study highlights the importance of the seizure frequency and control to the evaluation of perception of epilepsy control and shows that anxiety and depression in epilepsy are predicted by seizure-related (seizure frequency and control) and psychosocial aspects (perception of control and QoL) together.

OBJETIVO: Explicarmos a relação entre o efeito das crises epilépticas na percepção subjetiva de controle do paciente, e nos sintomas de depressão, ansiedade e qualidade de vida (QV). MÉTODOS: 151 adultos com epilepsia foram entrevistados e responderam o questionário de qualidade de vida (QOLIE-31), o STAI-II (Traço de Ansiedade) e o inventário de depressão de Beck (BDI). RESULTADOS: 45 pacientes (29.8 por cento) apresentaram sintomas de depressão e 29 (19.2 por cento), traço de ansiedade. O escore de depressão variou de 0 a 49 (M=7.4; SD=8.9) e o de ansiedade de 19 a 69 (M=41.5, SD=11.9).O escore total de QV foi associado ao controle de crises (p<0.001), percepção de controle da epilepsia (p<0.001), ansiedade (p<0.001) e depressão (p=0.003). A percepção de controle foi associada ao real controle de crises (p<0.001), frequência de crises (p<0.001), ansiedade (p<0.001) e depressão (p<0.001). O controle de crises foi associado à ansiedade (p=0.033) e depressão (p<0.001). Ansiedade e depressão foram correlacionadas (p<0.001). CONCLUSÃO: Este estudo aponta a importância da redução da frequência de crises, assim como o seu controle, na avaliação da percepção de controle da epilepsia e mostra que ansiedade e depressão são resultado de fatores associados ao controle à frequência de crises, assim como à percepção de controle e à QV.

Surgical Treatment of the Occipital Lobe Epilepsy

PURPOSE: Although occipital lobe epilepsy may be operable, localization of the epileptogenic zone can be difficult and there is a high risk of postoperative visual loss. METHODS: Thirteen patients with intractable occipital lobe epilepsy underwent resective surgery. Preoperatively, all underwent video-EEG monitoring using extracranial electrodes and MRI; Nine had PET scans; In ten, who were cortically stimulated with subdural grid electrodes, invasive recordings were made. Foramen ovale electrodes had been previously used in two, and bitemporal depth electrodes in one; Nitemporal and occipital electrodes had been used in one, and a unilateral temporal depth electrode in one. Nine underwent partial occipital resection, which had spared the nonepileptogenic primary visual cortex, and two underwent a total unilateral occipital lobectomy: A temporal lobectomy was performed in two. RESULTS: Twelve patients experienced visual aura prior to complex partial seizure, and five had quadrantanopsia. In no patient was noninvasive monitoring reliable in localizing the epileptogenic zone, and in eleven patients, this was localized by invasive recordings. Electrocortical stimulation with subdural grid electrodes evoked simple and complex visual phenomena in nine patients, reproduced the same auras in four, induced a typical seizure in two, and provided language mapping in five. Histopathologic findings revealed cortical dysplasia in five; Tuberous sclerosis was combined in one, hamartoma and ganglioglioma, each in two, and infarction and nonspecific change in the occipital lobe each in one, neuronal loss in the hippocampus and neuronal heterotopia in mesial temporal structures were reported in two patients who underwent temporal lobectomy. Ten were seizure-free during follow-up between six and 46(mean 22.3) months. Seizures recurred in two and were unchanged in one. Only two patients with preoperative quadrantanopsia developed homonymous hemianopsia. CONCLUSION: This study suggests that in the surgical treatment of the occipital lobe epilepsy, the use of intracranial EEG and functional mapping with subdural grid electrodes, can achieve a good outcome, including the preservation of vision.

Postoperativ Seizure Outcome in Patients with Cerebral arteriovenous Malformations

This study was intended to investigate the pre-and postoperative profile of seizures in the patients with cerebral arteriovenous malformatins(AVM's), and to evaluate various preoperative factors to predict the postoperative occurrence of seizures. The patients consisted of 46 consecutive cases with supratentorial AVM's operated on from May 1987 to May 1993. Their mean follow-up duration was 40 months. The pre- and postoperative seizure profiles were similar to each other. The overall incidence of patients experiencing seizure were 50% preoperatively and 52% postoperatively, and the incidence of intractable seizure was 15%, which was the same in both the pre-and postoperatively period. The presence of preoperative seizure and large size of AVM were significant indicators of high incidence of postoperative seizures(P<0.05), while other factors such as preoperative intracerebral hemorrhage or embolization showed no significant influence on the occurrence of postoperative seizures. About 70% of the patients with preoperative seizures also had postoperative seizures, while those without preoperative seizures developed new ones only in 35% of the cases postoperatively. The mean size of the AVM's in the group, with postoperative seizures was larger than that of the group without postoperative seizures(4.56 vs. 3.02 cm). Regarding postoperative intractable seizures, 57% of the group with preoperative intractable seizures remained intractable postoperatively and groups with preoperatively controlled and groups without seizures demonstrated postoperative intractablity only in 13% and 4% respectively. In conclusion, surgery of AVM's did not change the overall incidence of seizures, both controlled and intractable, and patients with preoperative and large sized AVM's and significantly higher possibility of postoperative seizures. Patients with preoperative intractable seizures resulted in control of seizures in 43% after removal of AVM, while 57% remained intractable. Extirpation of epileptic focl, after localization with preoperative study, seems to be needed to improve the outcome of the postoperative seizures.

Intravenous Sodium Valproate(Depakine(R)):Antiepileptic Effect and Safety Assessment During the Postoperative Seven Days in Neurosurgical Patients

Diphenylhydantoin(DPH) has been used intravenously as a drug of choice in conditions which seizure patients are incapable of oral feeding or in a state of status epilepticus. However, its clinical use has limitations because of its serious side effects of cardiac depression or systemic hypotension. In Western countries, the recently developed intravenous sodium valproate has been reported as safe and effective for seizure control in such patients. To assess the safety and effectiveness in seizure control, we investigated the serum levels of the drug at 24 hours, 48 hours, and 7 days after intravenous administration of sodium valproate(Depakine(R)), occurrence of seizures in the perioperative period, and the side effects of the drugs in 30 neurosurgical patients older than 3 years of age. The mean serum concentrations of valproic acid after bolus injection of 15mg/kg followed by continuous infusion with the rate of 0.5mg/kg/hour, were over 45.0 microgram/ml;45.0+/-16.3 microgram/ml at 24 hours, 50.4+/-21.0 microgram/ml at 48 hours, and 58.9+/-20.7 microgram/ml at 7 days after the start of the administration. All the patients whose serum valproic acid level was within the therapeutic range(40-100 microgram/ml), had never experienced an episode of seizure attack during the perioperative days. There was no evidence of elevated liver enzyme activity, but there were evidence of some tendency of decreased platelet count in the peripheral blood at 2 days after the administration of intravenous valproic acid. Four patients experienced episodes of mild nausea and/or vomiting. In conclusion, perioperative intravenous administration of valproic acids in neurosurgical patients was safe and effective in seizure control. However, it must be used precauciously in the patients with compromised coagulation system.