Cognitive deterioration and electrical status epilepticus during slow sleep.

The results of long-term follow-up of 10 children with global or specific cognitive deterioration and, on the electroencephalogram, electrical status epilepticus during sleep (ESES) are described. They were referred because of cognitive deterioration and underwent repeated neurological and neuropsychological examinations and all-night electroencephalography. A previous cognitive level was known or could be estimated in all. Seven children had a continuous spikes and waves during sleep (CSWS) syndrome, with global cognitive deterioration in four and more specific cognitive decline in three, and another three children had Landau-Kleffner syndrome (LKS). Of the last three, two children never had seizures, while the other had localization-related epilepsy. No children experienced aggravation of clinical seizures. However, therapy was disappointing. Cognitive dysfunction did not respond to valproate and/or benzodiazepines in 9 of the 10 children. A frontal epileptic focus was found in 5 of 7 children with CSWS, and a left temporal focus in 2 of 3 children with LKS. The ESES persisted in CSWS for 5-9 years and in LKS for 1-5 years, and disappeared at puberty. Good cognitive recovery after disappearance of ESES occurred in only one child, and partial recovery in four. An unfavorable prognosis of cognitive deterioration seems to be related to long-duration ESES and/or early onset epileptic activity. The authors are of the opinion that cognitive deterioration in children, with or without manifest epileptic seizures, should mandate electroencephalographic investigation during sleep.

Peri-marketing surveillance of lamotrigine in The Netherlands: doctors' and patients' viewpoints.

PURPOSE: Evaluation of daily clinical practice in prescribing lamotrigine in refractory epilepsy patients. METHODS: A collaborative, retrospective, peri-marketing study was performed in in- and out-patients attending one of the three Dutch epilepsy centres. Analysis of both patients' and doctors' information was performed in 520 patients using questionnaires and medical files. RESULTS: After one year of treatment 76% of patients maintained LTG treatment, an intention-to-treat analysis showed > = 50% seizure reduction in 23% of patients; 20-50% seizure reduction in 23% of patients. Six percent of patients became at least three months seizure free. In about 20% of patients seizures became less severe and shorter of duration, while in 6% an increase was found. After three months a significant decrease in number of concomitant antiepileptic drugs was found (change from mean 1.8 to 1.5 AEDs) (p = < 0.01). After twelve months the mean number of AEDs was 1.4 per patient. Overall percentage of side effects appeared to be significantly higher if patients' questionnaire data were used. Epilepsy patients considered side effects as an important factor in the choice of medication and in withdrawal of medication. Future developments of new AEDs should take this into account. CONCLUSION: This perimarketing study gives insight information about long-term daily use of lamotrigine, with emphasis on effectiveness. Patients complained in the questionnaires much more about side-effects, than was known according to the medical file. Therefore, it seems necessary to perform perimarketing studies more systematically.

Status epilepticus in children.

Aetiology and outcome of status epilepticus in children are different in comparison with adult patients. The main characteristics of status epilepticus in 112 children (age 6 months-15 years) are presented, with special attention to age, duration of status epilepticus, causes, medical complications and therapy. The greater part of these children was known to have had prior epilepsy, a considerable number with mental retardation. Outcome in convulsive status epilepticus is influenced by cause, duration, age, the occurrence of medical complications and quality of treatment. Outcome in nonconvulsive status epilepticus is good and does not seem to be influenced by the treatment strategy. The use of a therapy protocol may prevent unnecessary delay and contribute to a better outcome.

Simple partial status epilepticus: causes, treatment, and outcome in 47 patients.

A retrospective case note review was conducted of 47 patients of 15 years and older who had sustained simple partial status epilepticus (SPSE) in The Netherlands between 1980 and 1987. In 46 patients the type of SPSE was somatomotor (in four adversive), and in one aphasic with visual and auditory hallucinations. SPSE was more common over the age of 50. Six of 27 patients with previous epilepsy had an acute symptomatic cause. In 20 patients without previous epilepsy stroke was the most frequent cause (75%). Outcome was determined by the underlying cause. In one patient the continuing epileptic activity may have caused neuronal damage.

Non-convulsive status epilepticus: causes, treatment, and outcome in 65 patients.

The incidence of non-convulsive status epilepticus (NCSE) in The Netherlands is not known. Files of admissions in the years 1980-7 were studied from 40 adult patients (older than 15 years) with complex partial status epilepticus (CPSE) and 25 with absence status epilepticus (ASE). The clinical presentation sometimes made distinction between CPSE and ASE possible. Focal clinical signs were more frequent in CPSE; a fluctuating level of consciousness was more often present in ASE. All patients, but one, with ASE and most patients with CPSE (28) were known to have had previous epilepsy. Outcome in ASE was good in all. Outcome in CPSE depended on the underlying cause and quality of treatment. In three patients inadequate treatment probably contributed to morbidity.

Generalized convulsive status epilepticus: causes, therapy, and outcome in 346 patients.

We report data from 346 admissions for generalized tonic-clonic convulsive status epilepticus (GC-SE); 68% had had epilepsy previously. Outcome was determined by underlying cause, SE duration of > 4 h, the presence of more than one medical complication, and the quality of therapy and management. Clonazepam (CZP), diazepam (DZP), and phenytoin (PHT) were most frequently used for treatment.

Generalized convulsive status epilepticus: pathophysiology and treatment.

The treatment of generalized convulsive status epilepticus according to a protocol, including a time schedule, prevents unnecessary delay and improves outcome. Based on a literature study and our own clinical experiences a treatment protocol is discussed with special emphasis on medical complications, choice of antiepileptic drugs, route of administration and a proper time schedule.