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1.
Seizure ; 72: 61-70, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31708349

ABSTRACT

Adverse cutaneous reactions caused by mostly aromatic antiepileptic drugs (AED) affect 50.000 people a year in the United Kingdom (UK; incidence 75.7/100.000). Optimal management of these cases is often difficult, as the patient may report symptoms to a general practitioner, attend Accident & Emergency or inform a specialist over the telephone or via email. When clinical assessment is limited it is thought safest to withdraw offending medication and inform the patient of a new drug allergy. This may unjustifiably restrict future treatment choices, and increase cost. Most frequent offenders are aromatic AEDs: carbamazepine, oxcarbazepine, eslicarbazepine, phenytoin, lamotrigine, phenobarbitone, primidone (recently licensed lacosamide associated with lower risk) and the sulpha-derivative zonisamide. Our study provides a summary of severe delayed allergic reactions and offers a pragmatic management pathway for patients suffering a suspected drug-induced rash. We include UK pretreatment screening guidelines, step by step clinical assessment of rash and associated symptoms aiding early identification of patients at risk of developing severe allergic reactions. At the same time our manuscript reviews published data informing best choice and titration of alternative medication when allergy confirmed. Finally we summarize current knowledge on genetic predisposition and other personalized risks of AED allergies identifying gaps in our current understanding.


Subject(s)
Ambulatory Care/methods , Anticonvulsants/adverse effects , Disease Management , Epilepsy/drug therapy , Stevens-Johnson Syndrome/therapy , Adult , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Drug Hypersensitivity/therapy , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/drug therapy , Drug-Related Side Effects and Adverse Reactions/etiology , Epilepsy/diagnosis , Humans , Risk Factors , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/etiology
2.
Epilepsy Behav ; 90: 129-131, 2019 01.
Article in English | MEDLINE | ID: mdl-30530134

ABSTRACT

This is a case series of 25 patients with drug-resistant epilepsy and psychiatric comorbidities who started on brivaracetam (BRV) at St George's University Hospitals and Frimley Health in London. Median BRV dose was 150 mg for a median follow-up period of 8 months. Twenty had focal epilepsy, four had generalized epilepsies, and one had unclassified epilepsy; 76% had mood disorders (either depression or bipolar disorder), 12% intellectual disabilities with autism spectrum disorder and challenging behavior, and 12% psychoses. Forty percent of patients presented at least 50% seizure reduction, but none of them became seizure-free. A total of 44% of patients discontinued BRV, 20% because of adverse events, 20% because of inefficacy, and 4% because of both. Depression was reported by 8%, aggressive behavior by 8%, while 4% reported both. A total of 91.6% had received levetiracetam (LEV) before, in whom LEV was discontinued because of psychiatric adverse events (PAEs) in half. Seventy-seven percent of patients who developed PAEs with LEV did not do so on BRV suggesting that BRV is better tolerated than LEV in complex patients with psychiatric comorbidities and that the synaptic vesicle glycoprotein 2A (SV2A) protein modulation is unlikely to be implicated in LEV-related PAEs.


Subject(s)
Anticonvulsants/therapeutic use , Drug Resistant Epilepsy/drug therapy , Drug Resistant Epilepsy/psychology , Mental Disorders/drug therapy , Mental Disorders/psychology , Pyrrolidinones/therapeutic use , Adolescent , Adult , Aged , Autism Spectrum Disorder/drug therapy , Autism Spectrum Disorder/epidemiology , Autism Spectrum Disorder/psychology , Comorbidity , Drug Resistant Epilepsy/epidemiology , Female , Follow-Up Studies , Humans , Levetiracetam/therapeutic use , London/epidemiology , Male , Mental Disorders/epidemiology , Middle Aged , Retrospective Studies , Seizures/drug therapy , Seizures/epidemiology , Seizures/psychology , Young Adult
3.
Acta Neurochir (Wien) ; 160(6): 1225-1229, 2018 06.
Article in English | MEDLINE | ID: mdl-29250724

ABSTRACT

We report the case of a 55-year-old woman presenting with progressive memory impairment secondary to a transsphenoidal encephalocele involving her dominant medial temporal lobe. Her clinical deterioration was accompanied by radiological progression in the encephalocele's size and associated encephalomalacia. Through a temporal craniotomy, her encephalocele was resected and the defect closed. Baseline neuropsychological assessment indicated global cognitive impairment, but post-operatively, she reported improved memory and concentration. Standardized assessment reflected an improvement in perceptual skills and an associated improved recall of a complex figure. This is the first case report to date of a patient's memory improving following treatment of a basal encephalocele.


Subject(s)
Cognition , Encephalocele/surgery , Female , Humans , Middle Aged
4.
Epilepsy Behav ; 72: 17-21, 2017 07.
Article in English | MEDLINE | ID: mdl-28570963

ABSTRACT

PURPOSE: To examine the prevalence and clinical correlates of fatigue as an adverse event (AE) of antiepileptic drug (AED) treatment in patients with epilepsy. METHODS: Data from 443 adult outpatients with epilepsy assessed with the Adverse Event Profile (AEP) and the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) were analysed. RESULTS: Fatigue is reported by 36.6% of patients as always a problem during AED treatment. Fatigue is more likely to be reported by females (64.8% vs. 35.2%; Chi-Square=16.762; df=3; p=0.001) and during treatment with levetiracetam (42.3% vs. 33.2%; Chi-Square=11.462; df=3; p=0.009). The associations with the female gender and levetiracetam treatment were not mediated by depression, as identified with the NDDIE, and could not be simply explained by the large number of subjects on levetiracetam treatment, as analogous figures resulted from the analysis of a monotherapy subsample (41.7% vs. 30.3%; Chi-Square=11.547; df=3; p=0.009). CONCLUSIONS: One third of patients with epilepsy reports fatigue as a significant problem during AED treatment. Fatigue is more likely to be reported by females and seems to be specifically associated with LEV treatment. However, fatigue is not mediated by a negative effect of LEV on mood.


Subject(s)
Anticonvulsants/adverse effects , Epilepsy/drug therapy , Fatigue/chemically induced , Piracetam/analogs & derivatives , Adult , Female , Humans , Levetiracetam , Male , Middle Aged , Piracetam/adverse effects
5.
Epilepsy Behav ; 54: 110-4, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26704569

ABSTRACT

PURPOSE: Interpersonal relationships are viewed as important contexts within which psychopathology emerges and persists or desists. Attachment theory describes the dynamics of long-term relationships between humans especially in families and lifelong friendships. The present study was aimed at investigating attachment styles in adult patients with epilepsy as compared to subjects with migraine and their potential correlates with a history of mood disorders. METHODS: A consecutive sample of 219 adult outpatients with epilepsy (117) or migraine (102) was assessed with the Attachment Style Questionnaire (ASQ). RESULTS: Patients with epilepsy and a lifetime history of mood disorders presented elevated scores for Need for approval (p<0.001) and Preoccupation with relationships (p<0.001). Age correlated with the Relationships as secondary (r=0.322; p<0.001) and Need for approval (r=0.217; p=0.019) subscales while age at onset correlated only with Relationships as secondary (r=0.225; p=0.015). Seizure-free patients presented lower scores for Need for approval (p=0.003). Patients with migraine and a lifetime history of mood disorders presented lower scores in Confidence (p=0.002) and higher scores in Discomfort with closeness (p=0.026). CONCLUSIONS: An anxious-preoccupied attachment correlated with mood disorders in epilepsy while it was an avoidant pattern in migraine. Our results bring further data on the role of psychological variables in mood disorders in epilepsy. Further studies will allow early identification of patients at risk and the development of preventive strategies.


Subject(s)
Epilepsy/psychology , Interpersonal Relations , Migraine Disorders/psychology , Mood Disorders/psychology , Object Attachment , Adult , Comorbidity , Epilepsy/diagnosis , Epilepsy/epidemiology , Female , Humans , Male , Middle Aged , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Mood Disorders/diagnosis , Mood Disorders/epidemiology , Surveys and Questionnaires
6.
Epilepsy Behav ; 45: 64-7, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25845494

ABSTRACT

PURPOSE: The purpose of this study was to identify clinical correlates of self-reported aggressiveness (SRA) in patients with epilepsy treated with levetiracetam (LEV) with special reference to the role of depression. METHODS: A consecutive sample of adult outpatients with epilepsy was assessed with the Neurological Disorder Depression Inventory for Epilepsy, the Adverse Event Profile (AEP), and the Emotional Thermometer. RESULTS: From a total sample of 163 consecutive patients treated with LEV, SRA at any level (from rarely a problem to always) was associated with a 7-fold increased risk of being depressed (95% CI: 3.0-17.5; p<0.001). Self-reported aggressiveness was reported as "always" a problem by 9.8% of the patients. In these patients, apart from depression, SRA was associated with high AEP total scores (55.1 vs. 39.3; p<0.001) and polytherapy (43.8% vs. 19.8%; p=0.034). Anxiety scores were not elevated (4.9 vs. 3.6; p=0.183). CONCLUSIONS: Self-reported aggressiveness during treatment with LEV is not an isolated symptom but is associated with depressed mood. Anxiety-mediated mechanisms do not seem to be involved.


Subject(s)
Aggression/psychology , Anticonvulsants/adverse effects , Depressive Disorder, Major/chemically induced , Depressive Disorder, Major/psychology , Piracetam/analogs & derivatives , Self Report , Adult , Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Epilepsy/psychology , Female , Humans , Levetiracetam , Male , Middle Aged , Piracetam/adverse effects , Piracetam/therapeutic use , Treatment Outcome
7.
Pract Neurol ; 12(4): 215-24, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22869763

ABSTRACT

Myoclonus is a brief (less than half a second)contraction involving agonist and antagonist muscles, leading to a sudden jerk. It may be a normal phenomenon,as in the so-called 'sleep starts'. When pathological, myoclonus is a symptom of a broad range of neurological and systemic diseases. Alternatively, it may signal non-organic illness (8% of myoclonus is psychogenic). This review provides pragmatic and systematic guidance to the assessment and differential diagnosis of adult patients presenting with myoclonus.


Subject(s)
Myoclonus/diagnosis , Myoclonus/therapy , Brain/pathology , Diagnosis, Differential , Disease Management , Disease Progression , Humans , Myoclonus/epidemiology , Spinal Cord/pathology
8.
Epilepsia ; 53(2): e21-4, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22050242

ABSTRACT

Sudden unexpected death in epilepsy (SUDEP) has on rare occasions occurred during electroencephalography (EEG) telemetry, and in such cases postictal EEG suppression (PI EEG-SUP) was frequently observed. More recently a retrospective case-control study reported this pattern as a risk factor for SUDEP. We retrospectively audited frequency and electroclinical features of this pattern as well as immediate management following tonic-clonic seizures during telemetry. Forty-eight patients with tonic-clonic seizures were identified from 470 consecutive EEG-videotelemetry reports. Thirteen patients (27%) with PI EEG-SUP (mean duration 38.1 s, range 6-69 s, median 38 s) were compared to 12 randomly selected controls. One seizure was analyzed per individual. Those with PI EEG-SUP were significantly more likely to be motionless after the seizure and have simple nursing interventions performed (suction, oxygen administration, placed in recovery position, vital signs checked). This pattern is relatively common and requires further study as a potential marker for increased mortality in epilepsy.


Subject(s)
Death, Sudden , Electroencephalography , Epilepsy/physiopathology , Seizures/physiopathology , Telemetry , Adolescent , Adult , Case-Control Studies , Child , Death, Sudden/etiology , Epilepsy/complications , Female , Humans , Male , Middle Aged , Retrospective Studies , Seizures/complications , Young Adult
9.
J Neurol ; 257(11): 1946-51, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20872010

ABSTRACT

This short review summarizes epilepsy papers published in the Journal of Neurology in 2009, covering pathophysiology (inflammation; propagation pathways), new treatments (oxcarbazepine in paediatrics; levetiracetam in status epilepticus), and non-seizure outcomes (violence; foetal/pregnancy).


Subject(s)
Epilepsy/drug therapy , Epilepsy/physiopathology , Anticonvulsants/therapeutic use , Epilepsy/psychology , Female , Humans , Pregnancy , Pregnancy Complications , Treatment Outcome , Violence/psychology
10.
Mov Disord ; 19(6): 708-9, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15197714

ABSTRACT

We report on a case of a 25-year-old woman with clusters of myoclonus induced by a single exposure to inhaled cannabis. Investigations excluded a structural abnormality of the spine. Multi-channel surface EMG with parallel frontal EEG recording confirmed the diagnosis of propriospinal myoclonus.


Subject(s)
Marijuana Abuse/complications , Myoclonus/etiology , Myoclonus/physiopathology , Spine/physiopathology , Adult , Electroencephalography , Electromyography , Female , Humans , Magnetic Resonance Imaging , Muscle, Skeletal/pathology , Muscle, Skeletal/physiopathology , Myoclonus/diagnosis , Severity of Illness Index
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