Value of video EEG and MRI in the diagnosis of intractable epilepsy / 中国生化药物杂志

Objective To study the value of video EEG combined with MRI in the diagnosis of intractable epilepsy.Methods40 patients with intractable epilepsy treated in our hospital from 2013 to 2015 were selected as the subjects.In 40 patients, 26 patients with hippocampal sclerosis, 2 cases of patients with temporal lobe atrophy with cerebral dysplasia, 4 cases of patients with cerebral gray matter and macrogyria, 3 cases of vascular malformation, 1 cases of patients with intracerebral cyst, 2 cases of patients with glioma, 2 cases of patients with traumatic epilepsy.Retrospective of The clinical data of the selected patients were analyzed and the manifestations of epileptic foci were reflected by MRI, The use of video EEG was used to detect the status and source of EEG during epileptic seizure and epilepsy Analysis, combined with MRI scan and video EEG results, control surgery pathological changes, analysis of the results, draw conclusions.ResultsThere were 21 cases of the accurate location of interictal EEG.The accuracy was 52.5%, and the accuracy of the location of epileptogenic foci was about 40, and the accuracy was about 100%.The accuracy of MRI in the diagnosis of epileptic foci and related lesions was 35 cases, the accuracy rate was 87.5%, and the number of lesions was qualitative and accurate in the case of 30 cases, with an accuracy rate of 75%.ConclusionVideo EEG combined with MRI examination for drug refractory epilepsy diagnosis has important clinical value, can make a more accurate diagnosis of patients with epileptogenic foci, provide information for surgical treatment of intractable epilepsy patients, with further clinical promotion and application significance.

Callosotomía: técnicas, resultados y complicaciones: revisión de la literatura / Callosotomy: techniques, results and complications: literature review

Background: Patients with intractable seizures who are not candidates for focal resective surgery are indicated for a palliative surgical procedure, the callosotomy. This procedure is based on the hypothesis that the corpus callosum is an important pathway for interhemispheric spread of epileptic activity and, for drug resistant epilepsy. It presents relatively low permanent morbidity and an efficacy in the control of seizures. Based on literature, the corpus callosotomy improves the quality of life of patients that has the indication to perform this procedure because it allows reducing the frequency of seizures, whether tonic or atonic, tonic-clonic, absence or frontal lobe complex partial seizures. Aim: The aim of this literature review is discuss the technical details, modalities, risks, complications, results as well de prognosis of callosotomy based on critical literature review and the authors experience. Casuistry and Methods: It was performed bibliographical consultation, using the databases MEDLINE, LILACS, SciELO, utilizing language as selection criteria, choosing preferably recent articles in Portuguese, Spanish or English, with publication year higher than 2000. Conclusion: According to author’s experience and references, callosotomy is a safe procedure when indicated to selected cases and the success rate is proportional to the extent of callosal resection. A greater resection can reduce the seizure frequency, however the morbidity may also be larger. There is no important study comparing VNS versus Callosotomy versus VNS plus callososotomy, what would be for future necessary for an important source of data about this topic.

Introducción: Los pacientes con convulsiones intratables que no son candidatos para la cirugía de resección focal están indicados para un procedimiento quirúrgico paliativo, la callosotomía. Este procedimiento se basa en la hipótesis de que el cuerpo calloso es una importante vía para la propagación interhemisférica de la actividad epiléptica y, para la epilepsia resistente a fármacos. Presenta relativamente baja morbilidad permanente y una eficacia en el control de las convulsiones. Sobre la base de la literatura, la callostomía mejora la calidad de vida de los pacientes que tiene la indicación para realizar este procedimiento, ya que permite reducir la frecuencia de las crisis, ya sean tónica o átona, tónico-clónicas, ausencia o lóbulo frontal crisis parciales complejas. Objetivo: El objetivo de esta revisión de la literatura es discutir los detalles técnicos, modalidades, riesgos, complicaciones, resultados y de pronóstico de callosotomía basado en la revisión crítica de la literatura y la experiencia de los autores. Casuística y Métodos: Se realizó la consulta bibliográfica, utilizando la base de datos MEDLINE, LILACS, SciELO, que utiliza el lenguaje como criterios de selección, la elección de los artículos recientes preferiblemente en portugués, español o Inglés, con el año de publicación superior a 2000. Conclusión: De acuerdo con la experiencia y las referencias del autor, callosotomía es un procedimiento seguro cuando indicado para casos seleccionados y la tasa de éxito es proporcional a la extensión de la resección del cuerpo calloso. A mayor resección puede reducir la frecuencia de las crisis, sin embargo, la morbilidad puede ser también mayor. No hay ningún estudio que compara la estimulación del nervio vago frente a frente callosotomía VNS más callososotomy, lo que sería la futura necesaria para una importante fuente de datos sobre este tema.

Possible role of CYP2C9 & CYP2C19 single nucleotide polymorphisms in drug refractory epilepsy.

Background & objectives Multiple drug resistance in epilepsy is a common problem and one third of epilepsy patients remain non responsive to antiepileptic drug (AED) therapy. In this study we aimed to investigate the relationship between the genetic polymorphism of cytochrome P450 genes, namely CYP2C9 and CYP2C19 with multiple drug resistance in epilepsy patients. Methods: A total of 402 patients with epilepsy were enrolled in this study; 128 were drug resistant and 274 were drug responsive. The peripheral blood samples of the patients with epilepsy were collected. Drug compliance was confirmed in 20 per cent patient population using HPLC. Genotyping of CYP2C9 (*2 and *3), and CYP2C19 (*2 and *3) was carried out by PCR-RFLP. Results: The genotype frequencies of CYP2C9 430 C>T (*2 variant) and CYP2C9 1075 A>C (*3 variant) did not differ significantly in drug resistant versus responsive patients. After combining CYP2C9 *2 and CYP2C9 *3, the frequency of CYP2C9*1/*3 was significantly lower in drug resistant as compared to drug responsive epilepsy patients (P=0.03, OR=0.53, 95%CI=0.30-0.95). Similarly, combined frequency of all the slow and poor metabolizer variants (2C9 *1/*2, *1/*3 and *2/*3) was also lower as compared to drug resistant group (P=0.03, OR=0.60, 95% CI 0.38-0.96). There was no significant differences in genotypic or allelic distribution of CYP2C19*2 while CYP2C19*3 was monomorphic in northern Indian population. Interpretation & conclusions: Our results demonstrated significant involvement of CYP2C9 genetic variants in the modulation of epilepsy pharmacotherapy confirming the important role of CYP2C9 mutants preventing epilepsy patients from developing drug resistance.

Psychiatric Symptoms and Quality of Life in Patients with Drug-Refractory Epilepsy Receiving Adjunctive Levetiracetam Therapy

BACKGROUND AND PURPOSE: Levetiracetam (LEV) is a new antiepileptic drug that has been found to be effective as an adjunctive therapy for uncontrolled partial seizures. However, the results of several studies suggested that LEV has negative psychotropic effects, including irritability, aggressiveness, suicidality, and mood disorders. We investigated the impact of adjunctive LEV on psychiatric symptoms and quality of life (QOL) in patients with drug-refractory epilepsy (DRE) and determined the risk factors provoking psychiatric adverse events. METHODS: A 24-week, prospective, open-label study was conducted. At enrollment, we interviewed patients and reviewed their medical charts to collect demographic and clinical information. They were asked to complete self-report health questionnaires designed to measure various psychiatric symptoms and QOL at enrollment and 24 weeks later. RESULTS: Seventy-one patients were included in the study, 12 patients (16.9%) of whom discontinued LEV therapy due to serious adverse events including suicidality. The risk factor for premature withdrawal was a previous history of psychiatric diseases (odds ratio 4.59; 95% confidence interval, 1.22-17.32). LEV intake resulted in significant improvements in Beck Anxiety Inventory score (p<0.01) and some domains of the Symptom Checklist-90-Revised, such as somatization (p<0.05), obsessive-compulsiveness (p<0.05), depression (p<0.05), and anxiety (p<0.05). These improvements were not related to the occurrence of seizure freedom. The Quality of Life in Epilepsy Inventory-31 overall score and subscale scores, such as seizure worry (p<0.01), overall QOL (p<0.05), emotional well-being (p<0.05), energy-fatigue (p<0.05), and social function (p<0.05), also improved. CONCLUSIONS: Adjunctive LEV in patients with DRE is likely to improve psychiatric symptoms and QOL. Clinicians should be well aware of the psychiatric histories of patients to prevent them from developing serious adverse events related to LEV.

Stigma in Patients with Drug Refractory Epilepsy: the Risk Factor, Psychiatric Comorbidities, and Quality of Life / 대한간질학회지

PURPOSE: Stigma is more likely to be reported by people with epilepsy with frequent seizures and associated with various physical and psychosocial factors. We determined risk factors associated with stigma, and investigated the impact of felt stigma on psychiatric comorbidities and quality of life (QOL) in patients with drug refractory epilepsy (DRE). METHODS: Patients with DRE of partial onset, who experienced a failure of at least two antiepileptic drugs (AEDs) and at least 1/month of seizure attack for recent 6 months, were enrolled in the study. We divided patients into two groups according to the presence of stigma. We compared demographic and clinical variables, mood, anxiety, psychiatric symptoms, and QOL between two groups. RESULTS: Among 75 patients with DRE of partial onset, 34 patients (45%) had stigma. Risk factors associated with stigma were age, history of psychiatric disease, duration of epilepsy, and duration of AEDs intake. However, seizure frequency was not associated with the occurrence of stigma. Mood, anxiety, and psychiatric symptoms were significantly higher in patients with stigma than those without stigma. QOL was significantly lower in patients with stigma than those without stigma. CONCLUSIONS: A longer duration of epilepsy with previous history of psychiatric diseases may be indispensable for the occurrence of stigma in patients with DRE. Early detection and appropriate treatment of psychiatric comorbidities can lessen the degree of stigma and improve QOL.