ABSTRACT
Sixty-one refractory epileptic patients (46 with partial epilepsy) were treated with intravenous immunoglobulins in a controlled double-blind/dose finding clinical trial; 18 (7 females, mean age 18.5 years) received placebo, while 14 (3 females, mean age 26.2 years, 2 excluded), 14 (4 females, mean age 24.6 years, 1 excluded) and 15 (5 females, mean age 24.4 years) patients received 100, 250 and 400 mg/kg per infusion of intravenous immunoglobulins, respectively. Seven perfusions were scheduled, four the 1st week, and thereafter one during the 2nd, 3rd and 6th week. The patients were followed for 6 months. An optional infusion was given at the end of the study. A comparison of the mean number of seizures per day was made between the baseline (4 weeks before the first infusion) and the 6th month after the first infusion. Patients were considered responders if they had a decrease of at least 50% in daily seizure frequency at the end of the study compared with the baseline. We did not find severe adverse events. One patient had to stop infusions for possible related side effects (vomiting). When all patients were analyzed together, we found a positive trend in favor of intravenous immunoglobulin treatment, but this was not significant (P = 0.095). There was no relationship between dose and efficacy (P = 0.31). When the largest group with partial epilepsy was analyzed separately, we noted 19 responders in the test group, compared with 2 in the placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Epilepsy/drug therapy , Immunoglobulins, Intravenous/therapeutic use , Adolescent , Adult , Child , Child, Preschool , Dose-Response Relationship, Drug , Double-Blind Method , Female , Humans , Male , Middle Aged , Prognosis , Prospective StudiesABSTRACT
About 20% of patients with intractable epilepsy do not have epileptic seizures. The exact diagnosis is in fact difficult because most of the time, the seizures are not directly visualized. In case of uncertainty, prolonged EEG/Video monitoring and clinical observation are necessary to avoid escalated drug therapy and behavioural problems. We describe two such cases. The diagnosis of non epileptic attacks was told to the patients, the antiepileptic drugs were progressively withdrawn and an intensive psychotherapy was started. The seizures decreased in number and severity. In both cases, sexual abuse in childhood was discovered.
Subject(s)
Conversion Disorder/diagnosis , Epilepsy/diagnosis , Seizures/psychology , Adult , Child Abuse, Sexual , Child, Preschool , Conversion Disorder/therapy , Diagnosis, Differential , Electroencephalography/methods , Female , Humans , Incest , Psychotherapy/methods , Seizures/diagnosis , Self Mutilation , Video RecordingABSTRACT
Sixteen Huntington patients (HD) (mean age 43.7 years) were studied and compared to 12 risk people for Huntington disease (HR) (mean age 31.2 years) and 25 normal people (mean age 33.2 years). A simple auditory or somatosensory paradigm was used requiring counting of the rare target stimulus. For the normal subjects, most of the recordings showed a slightly earlier latency for the P3 component of the ERPs with the auditory paradigm (P3A). For the HD, a clear P3 was observed in both modalities in 8 patients, in 5 cases no P3 for both stimuli and in 3 cases no P3 for the somatosensory paradigm (P3S) only. The mean value of the P3A latencies was increased compared to the normal control group and after the age effect correction. The mean value of the P3S is significantly more increased compared to the normal group and the "expected" value, according the P3A latencies. This dissociation is constant in all HD when the P3S is recorded and could be due to the fact that the endogenous component is also related to the stimulus modality (increased difficulty and/or subclinical abnormality in the somatosensory modality).
Subject(s)
Evoked Potentials, Auditory/physiology , Evoked Potentials, Somatosensory/physiology , Huntington Disease/physiopathology , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
Antiepileptic drugs as well epilepsy itself are known to induce some cognitive impairment. Thirty-six epileptic patients under unchanged and reduced therapy conditions were followed from a clinical (seizures' evaluation, reaction times [RTs], memory tests) and neurophysiological (EEG, BAEPs, ERPs) point of view, weekly as inpatients (mean stay 8.9 weeks) and after 1 and 3 months as outpatients. This study showed on one hand no clear correlation between RTs and ERPs components, and on the other hand an improvement of the most complex RT after reduction of polytherapy or stabilization of seizures by the introduction of carbamazepine-CR in newly treated patients. These data suggest that in epileptic patients there exists a slowing of cognitive processes between the stimulus evaluation time and the motor response and that this step is improved when a reduced but efficient therapy is given.
Subject(s)
Anticonvulsants/adverse effects , Cognition/drug effects , Epilepsy/drug therapy , Adolescent , Adult , Brain Stem/physiopathology , Electroencephalography , Epilepsy/psychology , Evoked Potentials, Auditory/drug effects , Female , Humans , Longitudinal Studies , Male , Memory/drug effects , Middle Aged , Reaction TimeSubject(s)
Epilepsy/drug therapy , Midazolam/therapeutic use , Adult , Aged , Electroencephalography , Evoked Potentials/drug effects , Female , Humans , Male , Middle AgedABSTRACT
A total of 7 patients (3-21 years old) suffering from an intractable "primary" Lennox-Gastaut syndrome (LGS) were treated with i.v. high doses of polyvalent human immunoglobulins. Of these patients 6 improved following such treatment with a decrease in fits and an improvement in the EEG. Hypotheses about the contribution of the treatment and immunopathological factors in some cases of idiopathic LGS are discussed.
