Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (EpIC Project).

BACKGROUND: Strokes are the leading cause of epileptic seizures in adults and account for 50% of seizures in those over the age of 65 years. The use of antiepileptic drugs to prevent recurrent poststroke seizures is recommended. METHODS: One hundred and twenty-eight patients with poststroke seizures were randomly allocated to treatment with either levetiracetam (LEV) or sustained-release carbamazepine (CBZ) in a multicenter randomized open-label study. After a titration study phase (2 weeks), the optimal individual dose of trial medication was determined and treatment was continued for another 52 weeks. The primary endpoint was defined as the proportion of seizure-free patients; the secondary endpoints were: evaluation of time recurrence to the first seizure, EEG tracings, cognitive functions and side effects. RESULTS: Of 128 patients, 22 discontinued the trial prematurely; thus a total of 106 patients (52 treated with LEV and 54 treated with CBZ) were included in the analysis. The results of the study were as follows: no significant difference in number of seizure-free patients between LEV and CBZ (p = 0.08); time to the first recurrence tended to be longer among patients on LEV; there was no correlation between the therapeutic effect and the EEG findings in either treatment group; LEV caused significantly fewer (p = 0.02) side effects than CBZ; attention deficit, frontal executive functions and functional scales (Activities of Daily Living and Instrumental Activities of Daily Living indices) were significantly worse in the CBZ group. CONCLUSIONS: This trial suggests that LEV may be a valid alternative to CBZ in poststroke seizures, particularly in terms of efficacy and safety. In addition, our results show that LEV has significant advantages over CBZ on cognitive functions. This trial also indicates that LEV in monotherapy is a safe and effective therapeutic option in elderly patients who have suffered epileptic seizures following a stroke.

[Compromise of work capacity and quality of life of epileptic subjects]. / Compromissione della capacità lavorativa e qualità della vita nei soggetti epilettici.

The authors test epileptic subjects as far as their professional ability is concerned. An enquiry into patients admitted to the Epilepsy Centre of San martino Hospital in Genova has been performed through a questionnaire about professional performance and quality of life. As far as work related problems are concerned 44.6 per cent of the subjects show the presence of difficulties, while the quality of life is primarily repressed in men relatively to work and in women relatively to social relationship.

[Cryptogenic cerebral atrophy in late-onset epilepsy]. / L'atrofia cerebrale criptogenetica nell'epilessia ad insorgenza tardiva.

174 subjects suffering from late onset epilepsy were examined. The incidence of cerebral atrophy, defined with objective criteria on CT scans by means of a comparative analysis with a matched for age control group was 37.9%. Head traumas, cerebrovascular disorders and alcoholism were the presumed etiological factors in most of the cases while in 25 subjects (20%) the etiology of cerebral atrophy remained unknown ("cryptogenous atrophy"). Clinical profil, psychometric performance and EEG characteristics of these subjects were investigated and compared with the remainder groups of late-onset epileptics. The results obtained show that the subjects with cryptogenous atrophy behave, as regard the features considered, as the late-onset epileptics with normal CT but present an higher familial prevalence for epilepsy. On the contrary they differs in various ways from late-onset epileptics with atrophy of known origin and from epileptics with focal lesions.

Withdrawal seizures in alcoholics. A transverse and longitudinal investigation.

74 heavy drinkers, divided in two groups by positive or negative history for withdrawal seizures, were evaluated on the history, clinical, biochemical, CT, EEG and psychometric investigations. Some of them have been followed up for 20 months. The results suggest the possible role of a constitutional predisposition for withdrawal seizures.

Familial paroxysmal kinesigenic choreoathetosis. Report of a pharmacological trial in 2 cases.

2 cases of familial paroxysmal kinesigenic choreoathetosis are described. The results of a pharmacological trial with phenobarbital, valproic acid, diazepam, iota-Dopa plus carbidopa, and haloperidol are reported. Phenobarbital is the only effective drug. On this basis the pathophysiological mechanisms of this rare disorder are briefly discussed.

Sleep abnormalities in four cases of dyssynergia cerebellaris myoclonica of Ramsay-Hunt.

The nocturnal sleep of four patients with dyssynergia cerebellaris myoclonica (DCM) of Ramsay-Hunt was recorded with a polygraph. The following features were observed: a reduction of spindles, K complexes and vertex spikes; frequent arousals; rare rapid eye movements with a modification of their morphology and pattern; change in sleep stage percentages. In addition, myoclonus and polyspike-and-wave complexes appeared less frequently during sleep than during wakefulness. Three generalized convulsive and sixteen clonic seizures were recorded during stage 3/4 or on arousal. The clinical and physiopathological implications of these data are discussed.

[Parenteral penicillin in rats: an experimental model of periodic EEG activity]. / Penicillina parenterale nei ratti: un modello sperimentale di EEG periodico.

Parenteral G Penicillin has been administered to 10 rats and EEG pattern has been recorded. High voltage spikes appeared on one hemisphere, 12 to 25 minutes after injections. Gradually spike frequency and voltage increased till periodical EEG was observed on both hemispheres. Such activity was synchronous, symmetrical, stereotyped and often accompanied by myoclonias. This pattern lasted from 45 to 100 minutes. The authors underline the analogies with the Ouabain model of epilepsy and with periodical EEG patterns in man.

Gastrointestinal complication of high-dose corticosteroid therapy in acute cerebrovascular patients.

Corticosteroids are commonly used in the treatment of stroke, although their clinical effectiveness has not been established. Side effects, especially gastrointestinal complications, occur in patients with cerebral disease. A necroscopy study of 124 patients investigated the occurrence of gastrointestinal lesions in patients with acute stroke treated with high-dose of corticosteroids compared to untreated patients with stroke and to patients dying from non-vascular neurological diseases. A significant relationship between the use of steroids and gastrointestinal lesion in strokes is demonstrated.