The importance of semiological information based on epileptic seizure history.

Semiology is the backbone of any correct categorization of seizures, as epileptic or not, focal or bilateral, and is fundamental to elucidating how they are anatomically generated in the brain. An anatomical hypothesis derived from seizure history is the precondition for optimally designed ancillary studies. Without understanding seizure semiology, no rational therapy is possible. This article describes the semiological approach using patient history based on full use of patients' self-reports as well as descriptions by witnesses. Auras represent the subjective aspects of seizures and provide important semiological clues as observable signs, sometimes including rather precise direct anatomical information. Methods of extracting, facilitating and analysing self-reports including linguistic conversation analysis are presented in detail. It is highlighted that prodromes, seizure triggers and reflex epileptic mechanisms can provide crucial information for diagnostics and therapy. Special issues considering seizure semiology in children are discussed in a separate section. Other sections are dedicated to the two most important issues of differential diagnosis: how to distinguish (1) focal from "generalized" epilepsies, particularly when focal seizure phenomena appear in a bilateral epilepsy; and (2) epileptic from a series of non-epileptic events.

Managing Antiepileptic Medication in Dialysis Patients.

PURPOSE OF REVIEW: The purpose of this review is to summarize and discuss available information on the management of epilepsy patients on renal replacement therapy. Older and newer antiepileptic drugs (AEDs) pharmacology will be reviewed, as well as the need to supplement dosages during or after hemodialysis, peritoneal dialysis, and continuous renal replacement treatment. RECENT FINDINGS: The great majority of anticonvulsants have been studied in patients with renal failure. Many of them have also been assessed during renal replacement therapy. For some, data are scant, and choice of management must be decided through information on pharmacology. Trials have been conducted in patients with hemodialysis and results have been extrapolated to other types of dialysis. Furthermore, decision on dose supplementation for some of the newer AEDs involves a combination of analysis of the clinical situation and physician expertise. In this paper, we discuss the basis of renal failure and renal replacement therapy as well as antiepileptic pharmacology and the options for dosage replacement during dialysis. Based on pharmacology of each AED, a dosage supplementation is required in cases where there is sufficient clearance of the drug by the method of dialysis chosen. This depends greatly on physicochemical characteristics of the drug: lipophilicity, volume of distribution, protein binding, and molecular weight; and on characteristics of dialysis membrane, mechanism of clearance and blood or dialysate flow. There are studies done for most AEDs in hemodialysis, but more trials are needed in peritoneal dialysis and continuous replacement therapies. There is insufficient information for the newest AEDs, and for some, the recommendation is to simply avoid them in renal failure and dialysis. More studies are necessary in the topic.