Caffeinated drinks, fruit juices, and epilepsy: A systematic review.

The aim of this systematic review was to provide the required information regarding different aspects of the relationship between epilepsy/antiseizure medications and non-alcoholic drinks. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. MEDLINE and Scopus from the inception until 7 August 2021 were systematically searched. These key words were used: "epilepsy" OR "seizure" OR "antiepileptic" OR "antiseizure" OR "anticonvulsant" AND "coffee" OR "tea" OR "soda" OR "juice" OR "drink" OR "cola" OR "diet" (35 key word combinations). The primary search yielded 21 458 publications (PubMed, n = 4778; Scopus, n = 16 680). Only 50 studies met all the inclusion criteria and were included in the current systematic review. In total, 17 articles investigated various non-alcoholic drinks in human studies, 11 studies were case reports/series, and 22 articles were animal/in vitro studies. None of the studies provided a class 1 of evidence. There is limited evidence suggesting that certain drinks (eg, caffeinated energy drinks) might trigger seizures. Patients with epilepsy should avoid excessive consumption of certain fruit juices (eg, grapefruit, lime, pomegranate, kinnow, and star fruit) and caffeinated drinks. However, daily coffee and tea intake can be part of a healthy balanced diet, and their consumption does not need to be stopped in patients with epilepsy. Coffee/tea consumption is not harmful if consumed at levels of 200 mg (caffeine) in one sitting (about 2½ cups of coffee) or 400 mg daily (about five cups of coffee).

The effect of 2-amino-3-carboxymuconate-6-semialdehyde decarboxylase gene overexpression in the kynurenine pathway on the expression levels of indoleamine 2,3-dioxygenase 1 and interferon-γ in inflammatory conditions: an in vitro study.

BACKGROUND: The kynurenine pathway (KP) can be involved in the pathogenesis of neurodegenerative diseases and excessive neurotoxic metabolite production. This study aimed to evaluate the effects of overexpression of murine 2-amino-3-carboxymuconate-6-semialdehyde decarboxylase (Acmsd) gene in inflammatory conditions in RAW 264.7 cell line to present more information about the effect of this gene on inflammatory conditions and the KP cycle. METHODS AND RESULTS: The coding sequence of the Acmsd gene was cloned into pCMV6-AC-IRES-GFP expression vector with a green fluorescent protein (GFP) marker. To simulate inflammatory conditions, RAW 264.7 macrophage cells were stimulated by Lipopolysaccharide (LPS) 24 h before transfection, and transfected by Polyethyleneimine (PEI) with constructed plasmids expressing the Acmsd gene. The effect of Acmsd gene expression level on murine Interferon-gamma (Ifn-γ) and murine Indoleamine 2,3-dioxygenase 1 (Ido1) gene expression level was investigated by Real-Time PCR. According to the results of this study, good transfection efficiency was observed 72 h after transfection, and Acmsd expression level increased 29-fold (P < 0.001) in transfected LPS-stimulated cells compared to the control group (LPS-stimulated cells that were not transfected). Additionally, increased Acmsd expression level significantly down-regulated Ifn-γ (P < 0.001) and Ido1 (P < 0.01) expression level in transfected LPS-stimulated cells compared to LPS-stimulated cells. CONCLUSIONS: Acmsd gene overexpression in inflammatory conditions can reduce the expression levels of the Ido1 gene, and its regulator, Ifn-γ. Consequently, it may be considered as a novel regulatory factor in the KP balance.

Smart devices/mobile phone in patients with epilepsy? A systematic review.

We systematically reviewed the existing literature on the safety of the use of smartphone, mobile phone/Internet, and Wi-Fi by people with epilepsy (PWE), according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE, and Google Scholar from the inception to April 9, 2021 were searched. These key words were used "epilepsy" OR "seizure" AND "Mobile Phone" OR "Cell Phone" OR "Smartphone" OR "Wi-Fi" OR "Electromagnetic" OR "Radiation." The primary search yielded 7766 studies; 33 studies were related. In total, 19 manuscripts were based on animal/computational studies and 14 articles reported human investigations. Among animal studies, 10 articles suggested detrimental effects by electromagnetic fields (EMFs) on brain function/seizure activity, while nine studies negated this hypothesis. Among human studies, seven studies suggested detrimental effects by EMFs on brain function/seizure activity, while seven studies negated this hypothesis. None of the studies provided a good level of evidence. In one human study, all seven patients with epilepsy and abnormal EEG during the sham exposure, had an increase in the number of epileptic events with exposure to mobile phone radiation. In another study of the detrimental effects of smart technology device overuse among school students, an association was found between reporting seizures and the hours of smart technology device use. While high-quality evidence on the safety of the use of smartphone, mobile phone/Internet, and Wi-Fi in PWE is lacking, prudent use of these technologies, including using wired hand-free sets or other exposure-reducing measures is recommended.

Cosmetic adverse effects of antiseizure medications; A systematic review.

BACKGROUND: We systematically reviewed the existing literature on the cosmetic adverse effects of antiseizure medications (ASMs) in order to depict a clear picture of these unwanted side effects of ASMs with a particular attention to hair loss, hirsutism, acne, and gingival hyperplasia. METHODS: This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE, and Google Scholar from the inception to 25 March, 2021 were systematically searched. These key words (title/abstract) were used: "hair loss" OR "hirsutism" OR "acne" OR "gingival hyperplasia" AND "seizure" OR "epilepsy" OR "anriseizure" OR "antiepileptic". The exclusion criteria included: non-original studies, articles not in English, and animal studies. RESULTS: The primary search yielded 3938 studies; 127 studies were related to the topic and were included in the current systematic review. The most robust evidence on cosmetic adverse effects of ASMs were related to phenytoin (causing gingival hyperplasia, hirsutism, and acne) and valproate (causing hair loss and hirsutism); however, many other ASMs were also implicated in causing these cosmetic adverse effects. CONCLUSION: Antiseizure medications may be associated with various cosmetic adverse effects. Phenytoin and valproate are the most notorious ASMs in this regard; but, other ASMs have also been implicated in causing hair loss, hirsutism, acne, and gingival hyperplasia. Physicians should pay more attention to these significant adverse effects that may affect a patient's facial attractiveness, quality of life, and emotional state.

Treatment of postictal headache: a systematic review and future directions.

BACKGROUND: Postictal headache (PIH) is a common complaint among patients with epilepsy. The prevalence of PIH is 43%. In the current endeavor, we systematically reviewed the existing treatment options for PIH in order to depict the state of the field and also to propose a research agenda to advance this topic. METHODS: MEDLINE, Scopus, and Embase from the inception to 4 February, 2021 were systematically searched for related published articles. In all electronic databases, the following search strategy was implemented and these key words (in all fields) were used: "post-ictal" AND "Headache" AND "Treatment". RESULTS: The primary search yielded 626 studies; only five studies were related to the topic and were included in the current systematic review. None of these studies provided a good class of evidence. These studies suggested that flunarizine and sumatriptan may help patients with PIH. CONCLUSION: While PIH is a common and disabling condition, its treatment is overlooked by the epilepsy society. Flunarizine and sumatriptan can be good candidates to be used in future clinical trials of the treatment of PIH. To obtain the desired evidence on the efficacy of either flunarizine or sumatriptan in treating PIH in patients with epilepsy, we need well-designed, randomized controlled trials.

Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up.

The aim of this study was to evaluate the efficacy of eye movement desensitization and reprocessing (EMDR) on the phantom limb pain (PLP) of patients with amputations within a 24-month follow-up. This study was a randomized-controlled trial. A total of 60 patients with amputations were selected by a purposive sampling and patients were divided randomly into two experimental and control groups. Samples were assigned through randomized allocation. EMDR therapy was administered individually to the experimental group participants in 12 one-hour sessions over a 1-month period In each session, the patient completed the Subjective Units of Distress Scale and a pain-rating scale before and after the intervention. Follow-up measures were obtained 24 months later for the experimental group. The participants in the control group were measured on the two scales at an initial session and again after 1- and 24-month follow-up. The mean PLP decreased in the experimental group between the first and last sessions and remained so at a 24-month follow-up. No decrease occurred for the control group over the 1- and 24-month period. The differences were statistically significant (P<0.001) according to a repeated-measures analysis of variance. EMDR therapy proved to be a successful treatment for PLP. Because of its efficacy and the fact that the positive effects were maintained at the 24-month follow-up, this therapy is recommended for the treatment of PLP.