ABSTRACT
AIMS: To determine the proportion of children admitted with difficult to treat paroxysmal events to a tertiary epilepsy centre who did not have epilepsy. METHODS: In an observational retrospective study, all case notes of 223 children admitted in 1997 were examined. The referral was made from the local paediatric department in 51% of cases, other departments in 27%, and from general or specialist practitioners in 22%. Doubt regarding the diagnosis of epilepsy was expressed in the referral note in 17%. On admission, 86% were on antiepileptic drug treatment. During admission all children were subjected to a comprehensive intensive observation and 62% had EEG monitoring. RESULTS: In total, 39% (87/223) were found not to have epilepsy. In 30% of children (55/184) referred without any doubts about the epilepsy diagnosis, the diagnosis was disproved. Of the 159 children admitted for the first time, 75 (47%) were discharged with a diagnosis of non-epileptic seizures. Of 125 children admitted for the first time with no doubts about the diagnosis of epilepsy, 44 (35%) did not have epilepsy. Staring episodes were the most frequently encountered non-epileptic paroxysmal event. Psychogenic non-epileptic seizures were found in 12 children. A total of 34 (15%) had their medication tapered off; a further 22 (10%) had tapered off medication before admission. CONCLUSION: The present study supports the view that misdiagnosis of epilepsy is common. The treating physician should be cautious in diagnosis, especially of staring episodes. A diagnostic re-evaluation should be undertaken in difficult cases with continuing paroxysmal events in order to avoid unnecessary drug treatment and restrictions on the child's lifestyle.
Subject(s)
Diagnostic Errors/statistics & numerical data , Epilepsy/diagnosis , Adolescent , Anticonvulsants/administration & dosage , Child , Child, Preschool , Denmark , Diagnosis, Differential , Electroencephalography , Epilepsy/drug therapy , Female , Hospitalization , Humans , Infant , Male , Referral and Consultation/standards , Retrospective Studies , Seizures/diagnosisABSTRACT
Although it is known that the use of oral contraceptives (OC's) can induce glucuronide conjugating enzymes, currently no data exists as to the potential that the elimination of the glucuronidated drug lamotrigine (LTG) is increased by OC's. We present seven cases in whom the plasma levels of LTG were significantly decreased by OC's (mean 49%, range 41-64%). The interaction was of clinical relevance in most of the patients who either experienced increased seizure frequency/recurrence of seizures after OC's had been added, or adverse effects following withdrawal of OC's.
Subject(s)
Anticonvulsants/blood , Contraceptives, Oral, Hormonal/pharmacokinetics , Triazines/blood , Adolescent , Adult , Anticonvulsants/pharmacokinetics , Drug Interactions/physiology , Epilepsy/blood , Epilepsy/drug therapy , Female , Humans , Lamotrigine , Triazines/pharmacokineticsABSTRACT
Three girls, two aged 12 years and one aged 17 years with refractory localization-related epilepsy were treated on an add-on basis with tiagabine. At dosages 22.5-30 mg/day (0.45-0.57 mg/kg/day) longstanding non-convulsive status epilepticus was noted in all three patients. The events of non-convulsive status epilepticus subsided following reduction in tiagabine dosages. In two cases, tiagabine was withdrawn, whereas it was continued at a lower dosage in one case. This is the first report of non-convulsive status epilepticus provoked by tiagabine in adolescent patients.
Subject(s)
Anticonvulsants/adverse effects , GABA Agonists/adverse effects , Neurotransmitter Uptake Inhibitors/adverse effects , Nipecotic Acids/adverse effects , Status Epilepticus/chemically induced , Adolescent , Anticonvulsants/administration & dosage , Child , Epilepsy/drug therapy , Female , GABA Agonists/administration & dosage , Humans , Nipecotic Acids/administration & dosage , Status Epilepticus/diagnosis , Status Epilepticus/drug therapy , TiagabineABSTRACT
At a tertial referral epilepsy centre 39 children were consecutively enrolled in an open add-on study with topiramate (TPM). All children had intractable epilepsy; the mean seizure frequency was 36 per month, and 31 children were treated with polypharmacy. All but five children were mentally retarded. The initial dose of TPM was 0.5-1 mg/kg daily, slowly titrated with 1-3 mg/kg daily every second week with an estimated target dose of 10 mg/kg daily. At latest follow-up 19 children continued on TPM, three (8%) were seizure-free, eight (21%) had a seizure reduction of more than 50% and eight (21%) improved their general condition. Mean follow-up was 13 months (range 9-36 months). Seizure reduction was seen in focal as well as generalized epilepsies. Adverse effects were reported in 21 cases (54%), weight loss and sedation being most frequent. The mean steady state dose in the children continuing on TPM was at latest follow-up: 14 mg/kg daily (< 5 years), 10 mg/kg daily (5-7 years), 5.8 mg/kg daily (8-17 years). The corresponding plasma level varied from 3 to 45 mumol/litre, and a significant correlation between the daily dose in mg/kg and the plasma level was found. Two patients with progressive myoclonus epilepsy are described separately; one had a dramatic general improvement. It is concluded that TPM seems to be a promising new broad-spectrum anti-epileptic drug, which is efficacious even in epilepsy syndromes, intractable to other new anti-epileptic drugs such as vigabatrin and lamotrigine.
Subject(s)
Anticonvulsants/therapeutic use , Epilepsies, Myoclonic/drug therapy , Epilepsy/drug therapy , Fructose/analogs & derivatives , Adolescent , Anticonvulsants/adverse effects , Anticonvulsants/pharmacokinetics , Body Weight/drug effects , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Fructose/adverse effects , Fructose/pharmacokinetics , Fructose/therapeutic use , Humans , Male , Topiramate , Treatment OutcomeSubject(s)
Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Child , Child, Preschool , Denmark , Guidelines as Topic , Humans , InfantABSTRACT
Previous animal and human studies have suggested an analgesic effect of phenylalanine involving endogenous opioid peptides. Phenylalanine was measured by a HPLC method with electrochemical detection and beta-endorphin by a specific radioimmunoassay in 14 lumbar cerebrospinal fluid samples from 13 patients with phenylketonuria. Cerebrospinal fluid beta-endorphin was also determined in 6 age-matched control subjects. We found a trend towards a higher beta-endorphin level in phenylketonuria (median 26.0 pM, range 13.0-37.8) than in the control subjects (20.6 pM, 12.7-28.0), P = 0.13. Cerebrospinal fluid concentrations of phenylalanine and beta-endorphin were significantly correlated (r = 0.68, P = 0.008). The results support the hypothesis that phenylalanine modifies the central endogenous opioid system.
Subject(s)
Phenylalanine/cerebrospinal fluid , Phenylketonurias/cerebrospinal fluid , beta-Endorphin/cerebrospinal fluid , Adolescent , Adult , Humans , Phenylalanine/bloodABSTRACT
An hypothesis of increased endorphinergic activity has been proposed to account for the characteristic symptoms of Rett syndrome. Cerebrospinal fluid samples from eight girls with Rett syndrome were analysed for beta-endorphin (beta-EP) immunoactivity and compared with samples from a control group of 15 children with acute leukaemia in remission. Severity of symptoms was not found to be related to beta-EP level. A group of early-treated adolescents with phenylketonuria had beta-EP levels similar to the Rett syndrome patients, but no symptoms resembling theirs. Therefore it is unlikely that increased levels of beta-EP are of primary pathogenetic significance. The conflicting findings of many earlier reports may be a result of differences between control groups.
