Effect of the modified Atkins diet in adults with drug-resistant epilepsy: A controlled study.

The objective of this study was to be a proof of concept of an analysis strategy to assess the effectiveness of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE). This retrospective cohort study included participants aged >16 years with at least two failed antiseizure medications (ASMs). The variables were self-reported and gathered from medical records or phone calls. Two groups are compared: MAD adjuvant to ASM (diet group) and ASM only (control). To make both groups comparable, diet and control groups were matched (1:2) by predictors of seizure remission (PSR) in adults with DRE. A systematic review of the literature was conducted to establish PSR. A total of 127 patients were eligible. Forty-six participants (36 %) initiated the MAD, but only 28 (22 %) continued the diet after 3 months. The number of past and new ASMs, epilepsy type, and follow-up time were selected as PSR. Twelve patients were included in the diet group and 24 in the control group, matched by PSR. Compared with the control group, the diet group had 4.5 greater odds of achieving ≥50 % seizure frequency reduction at 1-3 months (OR 5.5; 90 % confidence interval 1.1-26.65). Mean seizure frequency and other secondary outcomes did not differ significantly between the groups. In summary, the MAD showed a modest effect over seizure control compared with only ASM. Matching by PSR could be an alternative analysis approach to determine the effectiveness of the ketogenic diet in controlled studies. Additional studies are required to validate the analysis proposed.

Factors associated with initiation of the modified Atkins diet in adults with drug-resistant epilepsy.

Ketogenic diets are promising therapies for drug-resistant epilepsy (DRE). Diet adherence is a major concern in adults, so a less restrictive diet like the modified Atkins diet (MAD) is preferred. The objective of this study was to explore factors associated with MAD initiation in adults with DRE. It is a retrospective cohort study that includes participants aged ≥ 16 years with at least two failing antiseizure medications (ASM). We compared clinical and demographic variables between those patients who initiated the MAD and those who did not. A total of 136 patients were included and 52 participants initiated a MAD. After 3 months, only 28 patients (58%) continued on the MAD. For those who initiated a MAD trial: 1) the average number of current ASMs (3 ±â€¯1 vs 2 ±â€¯1, p < 0.008) and the average lifetime ASMs (6 ±â€¯3 vs 5 ±â€¯2, p < 0.008) was higher, 2) they had an earlier age of epilepsy onset (9 vs 13 years, p < 0.006) and 3) there was a greater proportion of patients with a history of status epilepticus (OR = 3.89, 95% CI = 1.16-13.01). In contrast, temporal lobe epilepsy onset had a negative association with MAD trial initiation (OR = 0.32, 95% CI = 0.12-0.88). In conclusion, five factors are associated with MAD initiation in adults with DRE. Chronic DRE may be the major motivation for MAD initiation. Nonetheless, adults with a history of status epilepticus could be a target population to initiate the MAD early.

Cardiogenic syncope diagnosed as epileptic seizures: the importance of ECG during video-EEG recording.

We describefourpatientswith a previous diagnosis of epilepsy. After reviewing the ECG during the video-EEG recording, cardiogenic syncope, resulting from a cardiac arrhythmia, was identified as the cause of the seizures. Epileptic disorders and cardiogenic syncope may both manifest with convulsions, loss of consciousness, and loss of postural tone, leading to a high level of misdiagnosis. The one-lead ECG during video-EEG monitoring is a key component, which may allow correct diagnosis and treatment.

Failure of antiepileptic drugs in controlling seizures in epilepsy: What do we do next?

Medically intractable epilepsy is a clinical condition of concern that arises when a patient with epilepsy suffers seizures, despite a trial of two or more antiepileptic drugs (AEDs) suitable for the type of epilepsy that are prescribed at maximum tolerated doses, does not achieve control of seizures. This diagnosis could be related to cortical dysplasias. We report the case of a 5-year-old girl with a previous normal neurological development and no family history of epilepsy who presented with focal-type seizures at age 4. She started treatment by taking different AEDs for seizure control. She continued having frequent seizures that sometimes progressed to generalized seizures and status epilepticus. After a focal cortical resection performed in the area where interictal spikes were detected, the pathology confirmed a type IIb cortical dysplasia as the cause of the epilepsy. This article discusses cortical dysplasias as a cause of pharmacoresistant epilepsy and its treatment.

Neuroimágenes funcionales en epilepsia / Functional neuroimaging in epilepsy

El avance en la tecnología biomédica ha permitido una mejoría en la evaluación de los pacientes con epilepsia, no sólo en lo que se refiere a la ubicación del foco epileptogénico, con la intención de resecarlo quirúrgicamente; sino en una mejoría en el entendimiento del proceso fisiológico de muchas lesiones epileptogénicas. A continuación se presneta una revisión de las herramientas de imagen funcional disponibles para la evaluación de pacientes con epilepsia.

Esclerosis Mesial temporal: Clinica, estudios paraclinicos y cirugia / Mesial temporal sclerosis a comprehensive approach

Se realiza una revisión no sistemática de los principales tópicos de la esclerosis mesial temporal. Su clínica en ocasiones precedida en años por crisis febriles, reaparece, en la adolescencia como una epilepsia evolutiva caracterizada por crisis parciales simples y complejas, en muchos casos con pobre respuesta al tratamiento farmacológico, lo cual hace a quien la presenta candidato a una cirugía, procedimiento que reduce (incluso elimina) el uso de antiepilépticos. Se revisan las principales manifestaciones clínicas y su importancia en cuanto a lateralidad y se analizan los principales métodos diagnósticos y se propone una evaluación prequirúrgica sistemática para los candidatos. Finalmente se discute el estudio de Ontario y sus implicaciones en el tratamiento quirúrgico de la epilepsia