Cathodal HD-tDCS and attention: A study on patients with intractable left lateral frontal lobe epilepsy.

OBJECTIVE: Defects in the attentional network in patients with epilepsy are influenced by factors such as the location of epileptic foci. Examining the impact of cathodal high-definition transcranial direct current stimulation (HD-tDCS) on attention components could provide insights into potential attention-related side effects of tDCS. This study aimed to investigate the effect of cathodal HD-tDCS on interictal epileptiform discharges (IEDs), auditory/visual (A/V) attention components, and reaction time (RT) in patients with intractable focal left lateral frontal lobe epilepsy (LFLE). METHODS: To control for variations in individual epilepsy syndrome, 12 adult participants diagnosed with drug-resistant left LFLE with focal cortical IEDs on C3 underwent repeated measurements at pretest, posttest, and follow-up steps. 4 × 1 ring electrodes (cathode on C3 and four anodes on F3, P3, T3, and Cz) delivered 2 mA DC for 20 min per session for 10 consecutive days. The integrated visual and auditory continuous performance test (IVA+) assessed the A/V attention components and RT. One-way repeated-measure ANOVA was used. RESULTS: The findings suggest a significant effect in reducing IEDs. The IVA+ results showed a significant improvement in auditory divided attention and visual selective and focused attention (p < 0.05). In the follow-up, these changes demonstrated lasting efficacy. A/V speed scales increased (p < 0.05), showing a significant decrease in reaction time. CONCLUSIONS: Cathodal HD-tDCS significantly reduced IEDs and improved the components of auditory divided attention, visual focused attention, and visual selective attention, with a reduction in patient reaction time. A significant lasting, side-effect-free positive effect was observed for up to one month after the intervention.

Management of seizures in patients with multiple sclerosis; an Iranian consensus.

PURPOSE: Cooccurrence of a seizure in a patient with multiple sclerosis (MS) may complicate the management process. Questions, which may complicate the management process of a patient with MS and seizure, include "how should we approach to the patient", "how should we treat the patient", "how should we modify the patient's MS treatment strategy", etc. METHODS: We searched the electronic database PubMed on March 30, 2018 for articles in English that included the following search terms: "epilepsy" AND "multiple sclerosis" or "seizure" AND "multiple sclerosis" since 2013, to obtain the best recent relevant scientific evidence on the topic. A working group of 6 epilepsy and 5 MS experts took part in two consensus workshops in Tehran, Iran, in 2018. The final consensus manuscript was prepared and approved by all participants. RESULTS: The search with words "seizure" and "multiple sclerosis" yielded 121 entries; 10 were relevant to the topic. The search with words "epilepsy" and "multiple sclerosis" yielded 400 entries; 7 were relevant to the topic. We reviewed these 17 articles and also some other references, derived from these articles or relevant to the topic, for the purpose of our review. CONCLUSION: Cooccurrence of a seizure in a patient with MS may complicate the management process. In this review, we tried to provide answers to the frequently asked questions, considering the best available scientific evidence and expert opinion.

HD-tDCS in refractory lateral frontal lobe epilepsy patients.

PURPOSE: To evaluate the anticonvulsant effect of the novel high definition transcranial direct current stimulation (HD-tDCS) method on patients with refractory lateral frontal lobe epilepsy. The effects of HD-tDCS on working memory were also examined. METHOD: 10 adult patients with intractable lateral frontal lobe epilepsy were studied. A central cathode electrode was placed on the epileptogenic zone according to LTM, and 20-min sessions of 2mA HD-tDCS were applied for 10 consecutive days. The primary endpoint was to make changes in the epileptiform discharges (EDs) during a 1-h EEG. Moreover, the seizure frequency based on seizure diary and neuropsychiatric parameters was evaluated. RESULTS: All patients tolerated HD-tDCS stimulation course without any adverse reaction. The frequency of EDs increased immediately and one month after the stimulation course by an average of 6.4% and 1.2%, respectively. However, these changes in the EDs frequency were not statistically significant (p-value >0.05). The mean seizure frequency changes showed decrement by an average of 17.9% immediately, and increment by an average of 38.1% one month after the HD-tDCS. These changes were not significant statistically (p-value >0.05). One patient experienced exacerbation of seizures during the stimulations hence dropped out of the study. Attention and working memory improved significantly immediately and one month after the HD-tDCS in all patients. CONCLUSION: Changes of EDs and mean seizure frequency caused by HD-tDCS were not statistically significant for the whole group; however, this method could improve the patients' working memory scores.

Auditory temporal processing in patients with temporal lobe epilepsy.

OBJECTIVE: Auditory temporal processing is the main feature of speech processing ability. Patients with temporal lobe epilepsy, despite their normal hearing sensitivity, may present speech recognition disorders. The present study was carried out to evaluate the auditory temporal processing in patients with unilateral TLE. MATERIALS AND METHODS: The present study was carried out on 25 patients with epilepsy: 11 patients with right temporal lobe epilepsy and 14 with left temporal lobe epilepsy with a mean age of 31.1years and 18 control participants with a mean age of 29.4years. The two experimental and control groups were evaluated via gap-in-noise and duration pattern sequence tests. One-way ANOVA was run to analyze the data. RESULTS: The mean of the threshold of the GIN test in the control group was observed to be better than that in participants with LTLE and RTLE. Also, it was observed that the percentage of correct responses on the DPS test in the control group and in participants with RTLE was better than that in participants with LTLE. CONCLUSION: Patients with TLE have difficulties in temporal processing. Difficulties are more significant in patients with LTLE, likely because the left temporal lobe is specialized for the processing of temporal information.

Peri-ictal urinary dysfunction in patients with epilepsy: a cross-sectional study.

PURPOSE: To evaluate the prevalence of peri-ictal urinary symptoms and their association with seizure type in patients with epilepsy. MATERIALS AND METHODS: A total of 115 patients with epilepsy were recruited consecutively from neurology clinic between January 2006 and January 2008. Peri-ictal period was defined as the period ranging from 2 minutes prior to seizure attack up to 48 hours after it, and post-ictal period was the time up to 48 hours after regaining consciousness. Peri-ictal urinary complaints were gathered with interview and data were analyzed using Pearson's Chi-square, Fisher's Exact test, and independent sample t test. RESULTS: The study population consisted of 57 (49.5%) men and 58 (50.4%) women, with the mean age of 26.83 ± 10.01 years. The frequency of at least one urinary symptom in studied patients was 39.1%. Incontinence, frequency, urgency, retention, and hesitancy were reported by 28 (24.3%), 14 (12.2%), 19 (16.5%), 10 (8.7%), and 8 (7%) patients, respectively. Women expressed more symptoms than men and a higher frequency of peri-ictal retention. Although overall urinary complaints were more frequent in patients with partial seizures, there was a higher frequency of urgency in patients with partial seizure (P = .037). Furthermore, apart from retention, there was no significant correlation between peri-ictal urinary symptoms and the patients' age. CONCLUSION: Our findings suggest that peri-ictal urologic dysfunction is a common problem among patients with epilepsy and post-ictal urinary retention might also be considered as a post-ictal deficit (Todd's deficit).

Perceived impact of epilepsy in teaching hospitals of Tehran University.

BACKGROUND: Epileptic seizures would result in embarrassment in society and have some negative impact on the patients' social activities. The aim of this study was to show the perceived impact of epilepsy by patients on different aspect of their social activities including occupation, marriage and education. METHODS: We studied 179 epileptic patients aged 16 years and over using face to face interview. Nine domains including relation to spouses, relation to family members, social life, general health, interpersonal communications and friendships, feelings about success, hope for future, ordinary life and cope with others were considered. RESULTS: One hundred and seven men and 72 women were studied. Nearly 78% of the patients had generalized tonic-clonic seizures. More than half of the patients believed that epilepsy had affected their social life and activities. General health was negatively affected by this disease more than any other item. This may be due to uncontrolled attacks or taking medications. About 15.5% of married and 39% of the single patients considered epilepsy as an obstacle to marry with their ideal spouses and more than half of the employed persons considered epilepsy as an obstacle for their job promotions. CONCLUSION: Epilepsy frequently impacts on several aspects of life. The disease negatively affects social life and activities, overall health, feelings about self, ability to work in paid employments, relationship with spouses, friends, and other family members, future plans, standards of living and ambitions of epileptic patients. Decreasing such impacts should be considered as an important part of treatment and proper management can certainly increase various aspects of life in these patients.

Lamotrigine and twin pregnancy, incidental event or possible correlation?

Lamotrigine is frequently used to manage epilepsy during pregnancy. However, some major and minor birth defects are reported with lamotrigine monotherapy. This study is a case series report on 20 epileptic women who were receiving lamotrigine in their pregnancy. Apart from the normal pregnancies and births, in our study three patients gave birth to healthy twins, two vanished twin syndromes occurred and one patient had abortion. Twin pregnancy in association with lamotrigine therapy has not been clearly described before. Our observational study raises the idea that lamotrigine may induce twin pregnancy but larger studies need to investigate the presence or absence of such association more decently.

Comparison of valporic acid efficacy in familial versus sporadic cases of juvenile myoclonic epilepsy.

BACKGROUND: Juvenile myoclonic epilepsy is a heterogeneous syndrome, both in genetic and clinical aspects. AIMS: This study was conducted to compare the efficacy of valproic acid in familial versus sporadic cases of this syndrome. SETTINGS AND DESIGN: Seventy patients with JME were identified; 24 patients (34.3%) had positive history of JME in their first degree relatives (group I) and 46 patients (65.7%) were sporadic (group II). MATERIALS AND METHODS: Valproic acid was started for the patients with upward titration. The cases were followed for one year after final titration of the drug with regular blood monitoring. Patients, who had no myoclonic, absence and grand mal seizures within one year, were considered excellent responders. STATISTICAL ANALYSIS: We used Student T-test and Fisher's exact test for quantitative and qualitative variables respectively. Logistic Regression test was used to evaluate the predictive factors for final treatment outcomes. RESULTS: Mean dosage of valproic acid was 800 mg/d in both groups (13 mg/kg and 12.4 mg/kg respectively). Mean therapeutic levels of the drug in group I and II were 74 microg/ml and 78.4 microg/ml respectively. Excellent responders' rate was 66.7% in group I and 76.1% in group II. History of absences and older age at the onset of grand mal seizures decreased excellent responders' rate in both groups. CONCLUSIONS: Considering response to valproic acid, there is no significant difference in familial versus sporadic cases of JME, whereas history of absences and older age at the onset of grandmal seizures, decrease the probability of being excellent responders in this syndrome.