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Zhao Y, Li X, Zhang K, Tong T, Cui R. The Progress of Epilepsy after Stroke. Curr Neuropharmacol 2018; 16:71-78. [PMID: 28606039 PMCID: PMC5771387 DOI: 10.2174/1570159x15666170613083253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/14/2017] [Accepted: 05/02/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Epilepsy is the second most common disease caused by multiple factors and characterized by an excessive discharge of certain neurons in the nervous system. Cerebrovascular disease, including stroke, is viewed as the most common cause of epilepsy in the elderly population, accounting for 30%-50% of the newly diagnosed cases of epilepsy cases in this age group. METHODS Data were collected from Web of Science, Medline, Pubmed, Scopus, through searching of these keywords: "Stroke" and "epilepsy". RESULTS Depending on the underlying cerebrovascular disease, 3%-30% of patients after stroke may develop post-stroke epilepsy (PSE), which has a negative effect on stroke prognosis and the quality of life. CONCLUSION In this review, we summarized new aspects emerging from research into PSE, including definition, epidemiology, risk factors, mechanism, accessory examination and treatment strategies for post-stroke epilepsy, which will enrich our knowledge of this disorder.
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Affiliation(s)
- Yinghao Zhao
- Department of Thoracic Surgery, the Second Hospital of Jilin University; Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Changchun, Jilin, P.R. China
| | - Xiangyan Li
- Center of Chinese Medicine and Bio-Engineering Research and Development, Changchun University of Chinese Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Kun Zhang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, the Second Hospital of Jilin University, 218 Ziqiang Street, Changchun130041, P.R. China
| | - Ti Tong
- Department of Thoracic Surgery, the Second Hospital of Jilin University; Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Changchun, Jilin, P.R. China
| | - Ranji Cui
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, the Second Hospital of Jilin University, 218 Ziqiang Street, Changchun130041, P.R. China
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Kaur S, Garg R, Aggarwal S, Chawla SPS, Pal R. Adult onset seizures: Clinical, etiological, and radiological profile. J Family Med Prim Care 2018; 7:191-197. [PMID: 29915758 PMCID: PMC5958567 DOI: 10.4103/jfmpc.jfmpc_322_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Adult onset seizure disorder is a major public health concern in terms of burden of disease, nature of illness, and its impact on individual, family, and community. This study was done to assess the clinical profile and etiology of adult onset seizures and correlates of clinical and radiological pattern. Materials and Methods: This was a prospective cross-sectional hospital-based study conducted on 100 cases presenting with adult onset seizures. Results: Adult onset seizures were most prevalent in the young and middle-aged adults than elderly; generalized seizures were more common than focal seizures. However, the incidence of generalized seizures showed a falling trend as the age advanced whereas focal seizures increased in incidence with advancing age. Overall, the most common etiology of seizures was stroke, followed by idiopathic and central nervous system infections; yet, most common etiology of adult onset generalized and focal seizures was idiopathic and stroke, respectively. Regarding etiology, among younger adults, idiopathic seizures were predominant, whereas among middle aged and elderly, stroke was the most common etiology. Conclusions: It is mandatory to deal carefully with each case of adult onset seizure with a tailor-made approach. Identification and awareness about the etiological factors and seizure type help in better management of these patients. Primary care physicians play a pivotal role in identifying patients with adult onset seizures and should encourage these patients to undergo neuroimaging so as to arrive at an appropriate etiological diagnosis. In the face of recent advances in neuroimaging techniques, the future prospective management of adult onset seizures appears bright and convincing.
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Affiliation(s)
- Sarabjot Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Simmi Aggarwal
- Department of Radiodiagnosis, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumit Pal Singh Chawla
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ranabir Pal
- Department of Community Medicine, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
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Baftiu A, Feet SA, Larsson PG, Burns ML, Henning O, Sætre E, Molden E, Granas AG, Johannessen SI, Landmark CJ. Utilisation and polypharmacy aspects of antiepileptic drugs in elderly versus younger patients with epilepsy: A pharmacoepidemiological study of CNS-active drugs in Norway, 2004-2015. Epilepsy Res 2018; 139:35-42. [DOI: 10.1016/j.eplepsyres.2017.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/07/2017] [Accepted: 11/09/2017] [Indexed: 12/13/2022]
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Chen J, Zhou X, Huang Y, Lu Q, Jin L, Sun H. How to choose a practicable duration time for capturing paroxysmal events by prolonged video electroencephalogram monitoring in the elderly? Seizure 2017; 53:37-41. [DOI: 10.1016/j.seizure.2017.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
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Doğan EA, Genç E, Genç BO, Erdoğan Ç. Efficacy, tolerability, and retention rates of zonisamide in older adult patients with focal-onset epilepsy: Experiences from two tertiary epilepsy centers. Epilepsy Behav 2017; 76:19-23. [PMID: 28927711 DOI: 10.1016/j.yebeh.2017.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy, tolerability, and retention rates for zonisamide (ZNS) in older adult patients with focal-onset epilepsy. PATIENTS AND METHODS Chart reviews of patients aged 60years and older with focal-onset epilepsy treated with ZNS in two tertiary epilepsy centers were analyzed retrospectively. RESULTS Eighty-five patients (41 males, 44 females) aged over 60years (range: 60-81) with focal-onset epilepsy treated with ZNS were identified; 55.3% of the patients (n=47) were on monotherapy. The median and average doses of ZNS doses were 200mg/day (range: 100-400) and 212.9±84.2mg/day, respectively. With ZNS treatment, 67.1% of the patients (n=57) were seizure-free for a median of 28months (range: 10-56) whereas 20% (n=17) of the patients had seizures that were unresponsive to ZNS treatment. Best seizure control was achieved in patients with poststroke epilepsy; seizure freedom was 80% in this subgroup. Overall retention rate was found to be 83.5%. There was no significant relation between receiving poly- or monotherapy and discontinuation of ZNS (p=0.18). Thirty-two of the patients (37.6%) lost weight. Median weight loss was 8kg (range: 2-16). There was no significant correlation between weight loss and the administered doses of ZNS (r=0.34; p=0.12). CONCLUSION Despite limitations due to the retrospective design of the study, the results show that ZNS is a well-retained drug with high efficacy in older adult patients with epilepsy.
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Affiliation(s)
- Ebru Apaydın Doğan
- Akdeniz University, School of Medicine, Neurology Department, Antalya, Turkey.
| | - Emine Genç
- Necmettin Erbakan University, School of Medicine, Neurology Department, Konya, Turkey
| | - Bülent Oğuz Genç
- Necmettin Erbakan University, School of Medicine, Neurology Department, Konya, Turkey
| | - Çağla Erdoğan
- Akdeniz University, School of Medicine, Neurology Department, Antalya, Turkey
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Risk factors for post-stroke seizure recurrence after the first episode. Seizure 2017; 52:22-26. [PMID: 28957721 DOI: 10.1016/j.seizure.2017.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Seizure is a common complication after stroke. However, the clinical characteristics, treatment, and recurrence rates in patients with the first episode of post-stroke seizure remain unclarified. The aim of this study was to identify the predictors of seizure recurrence in those patients. METHOD We retrospectively identified patients admitted to our hospital between July 2010 and June 2014 and followed-up until June 2015 because of the first episode of post-stroke seizure. We classified post-stroke seizure as early (within one week after stroke) or late (in the second week or later). We compared the baseline clinical characteristics and treatment between the groups and investigated the factors that determined seizure recurrence by Cox proportional hazards model. RESULTS A total of 153 patients (84 men; mean age, 73.7±12.3years; 73 hemorrhagic and 80 ischemic strokes; 63 early and 90 late seizure) were included. Compared with the late seizure group, the early seizure group more frequently manifested with status epilepticus; tended to less often undergo stereotactic aspiration of hematoma; and less frequently used anti-epileptic drugs. During the observation period (median 364days, IQR 124-680days), 40 patients were lost to follow-up; subsequently, 113 patients were included in the analysis. The early seizure group had lower survival and seizure recurrence rates than the late seizure group. The factors significantly associated with seizure recurrence were presence of status epilepticus in the early group (HR 4.75, 95% CI 1.28-17.62) and younger age in the late seizure group (HR 0.95, 95% CI 0.93-0.99). CONCLUSIONS In patients with post-stroke seizure, status epilepticus and younger age were the predictors of recurrence after early and late seizure, respectively.
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Modi AC, Wagner J, Smith AW, Kellermann TS, Michaelis R. Implementation of psychological clinical trials in epilepsy: Review and guide. Epilepsy Behav 2017; 74:104-113. [PMID: 28734195 DOI: 10.1016/j.yebeh.2017.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/11/2017] [Indexed: 01/15/2023]
Abstract
The International League Against Epilepsy (ILAE) Neuropsychiatry commission and United States Institute of Medicine report both identified cognitive and psychological comorbidities as a significant issue for individuals with epilepsy, with rates as high as 60%. However, there is a paucity of evidence-based treatments for many psychological conditions (e.g., learning disorders, cognitive disorders, behavioral disorders). Because of inherent challenges in the implementation of psychological therapy trials and specific considerations for the population with epilepsy, the focus of the current review was to provide guidance and recommendations to conduct psychological trials for individuals with epilepsy. Several key areas will be discussed, including selection of patients, trial design, psychological intervention considerations, outcomes and evaluation of results, publication of trial results, and special issues related to pediatric clinical trials. Rigorously designed psychological therapy trials will set the stage for evidence-based practice in the care of individuals with epilepsy, with the goal of improving seizures, side effects, and HRQOL.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
| | - Janelle Wagner
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA; Comprehensive Epilepsy Program, Medical University of South Carolina, Charleston, SC, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee W Smith
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
| | - Tanja S Kellermann
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rosa Michaelis
- Department of Psychiatry, St. Marien-Hospital, Hamm, Germany; Integrative Curriculum for Anthroposophic Medicine (ICURAM), University Witten/Herdecke, Witten, Germany
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Tanaka T, Ihara M. Post-stroke epilepsy. Neurochem Int 2017; 107:219-228. [PMID: 28202284 DOI: 10.1016/j.neuint.2017.02.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 01/17/2023]
Abstract
Post-stroke epilepsy (PSE) is a common complication after stroke, yet treatment options remain limited. While many physicians prescribe antiepileptic drugs (AED) for secondary prevention of PSE, it is unclear which treatments are most effective in the prevention of recurrence of symptoms, or whether such therapy is needed for primary prevention. This review discusses the current understanding of epidemiology, diagnoses, mechanisms, risk factors, and treatments of PSE.
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Affiliation(s)
- Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
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60
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Abstract
Neurologic diseases are a major cause of death and disability in elderly patients. Due to the physiologic changes and increased comorbidities that occur as people age, neurologic diseases are more common in geriatric patients and a major cause of death and disability in this population. This article discusses the elderly patient presenting to the emergency department with acute ischemic stroke, transient ischemic attack, intracerebral hemorrhage, subarachnoid hemorrhage, chronic subdural hematoma, traumatic brain injury, seizures, and central nervous system infections. This article reviews the subtle presentations, difficult workups, and complicated treatment decisions as they pertain to our older patients."
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Affiliation(s)
- Lauren M Nentwich
- Department of Emergency Medicine, Boston Medical Center, Dowling 1 South, 1 Boston Medical Center Place, Boston, MA 02143, USA.
| | - Benjamin Grimmnitz
- Department of Emergency Medicine, Boston Medical Center, Dowling 1 South, 1 Boston Medical Center Place, Boston, MA 02143, USA
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61
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Is long-term electroencephalogram more appropriate than standard electroencephalogram in the elderly? Clin Neurophysiol 2017; 128:270-274. [DOI: 10.1016/j.clinph.2016.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 10/01/2016] [Accepted: 10/08/2016] [Indexed: 11/22/2022]
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Abstract
Although migraine is less prevalent in older than in younger age groups, the absolute increase in the number of subjects in older age groups may lead to an increase in the total number of migraine patients. Consequently, more elderly migraine patients may seek medical attention. In this review, the epidemiology and clinical aspects of migraine in the age group of ≥60 years are summarized, with special attention to comorbidity. The review will focus on treatment choices in elderly migraine patients. These must be based on knowledge of mechanisms of physiological and pathological ageing.
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Affiliation(s)
- J Haan
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
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63
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Bruscky IS, Leite RAA, Correia CDC, Ferreira MLB. Caracterização da epilepsia com início após os 60 anos de idade. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.150074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: Apesar da elevada incidência, a epilepsia no idoso ainda exibe peculiaridades pouco estudadas. A apresentação clínica na maioria das vezes é atípica e os achados nos exames complementares pouco ajudam no diagnóstico. Existem poucas publicações caracterizando esse grupo de indivíduos. Objetivo: Descrever as características de pacientes com epilepsia iniciada após os 60 anos de idade. Método: Foi desenvolvido estudo descritivo de série de casos, onde foram avaliados, consecutivamente, 50 pacientes com diagnóstico de epilepsia iniciada após os 60 anos de idade, atendidos no ambulatório de epilepsia do Hospital da Restauração (Recife-PE). Resultados: Dos 50 pacientes incluídos no estudo, a idade média foi de 75,3 (±13) anos, sendo que 30 (60,0%) eram do sexo feminino e 20 (40,0%) do sexo masculino. A idade média da primeira crise foi de 72,5 (±11,5) anos. Predominaram as crises epilépticas focais (83,8%). A ocorrência de estado de mal epiléptico foi baixa nesse grupo (4,0%). A epilepsia sintomática foi a mais frequente, tendo como etiologia vascular a causa mais encontrada (43,0%). A medicação mais utilizada foi a carbamazepina, e as crises apresentaram uma boa resposta terapêutica com monoterapia em dose baixa. O eletroencefalograma apresentou resultado normal em número elevado de casos (50,0%) e a neuroimagem na maioria das vezes (83,0%) apresentou achados inespecíficos. Conclusão: A epilepsia no idoso é predominantemente focal e sintomática, apresenta baixa ocorrência de estado de mal epiléptico e boa resposta terapêutica. O eletroencefalograma e a neuroimagem, na maioria das vezes, são inespecíficos.
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Hypertension on admission is associated with a lower risk of early seizures after stroke. Seizure 2016; 36:40-43. [DOI: 10.1016/j.seizure.2016.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 11/18/2022] Open
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Assis TMR, Bacellar A, Costa G, Nascimento OJM. Mortality predictors of epilepsy and epileptic seizures among hospitalized elderly. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 73:510-5. [PMID: 26083887 DOI: 10.1590/0004-282x20150043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/10/2015] [Indexed: 11/22/2022]
Abstract
UNLABELLED Epilepsy and epileptic seizures are common brain disorders in the elderly and are associated with increased mortality that may be ascribed to the underlying disease or epilepsy-related causes. OBJECTIVE To describe mortality predictors of epilepsy and epileptic seizures in elderly inpatients. METHOD Retrospective analysis was performed on hospitalized elderly who had epilepsy or epileptic seizures, from January 2009 to December 2010. One hundred and twenty patients were enrolled. RESULTS The most common etiology was ischemic stroke (37%), followed by neoplasias (13%), hemorrhagic stroke (12%), dementias (11.4%) and metabolic disturbances (5.5%). In a univariate analysis, disease duration (p = 0.04), status epilepticus (p < 0.001) and metabolic etiology (p = 0.005) were associated with mortality. However after adjustment by logistic regression, only status epilepticus remained an independent predictor of death (odds ratio = 13; 95%CI = 2.3 to 72; p = 0.004). CONCLUSION In this study status epilepticus was an independent risk factor for death during hospitalization.
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Affiliation(s)
- Telma M R Assis
- Departamento de Neurologia, Hospital São Rafael, Salvador, BA, Brazil
| | - Aroldo Bacellar
- Departamento de Neurologia, Hospital São Rafael, Salvador, BA, Brazil
| | - Gersonita Costa
- Departamento de Neurologia, Hospital São Rafael, Salvador, BA, Brazil
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Sleeth C, Drake K, Labiner DM, Chong J. Felt and enacted stigma in elderly persons with epilepsy: A qualitative approach. Epilepsy Behav 2016; 55:108-12. [PMID: 26773679 DOI: 10.1016/j.yebeh.2015.12.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022]
Abstract
Stigma is a common psychological consequence of chronic diseases, including epilepsy; however, little research has been done to determine the effect of stigma on persons with epilepsy, especially the elderly. We interviewed 57 older adults with epilepsy to discover the extent and consequences of, and reasons for, epilepsy-related stigma in their lives. Felt stigma was more frequently reported than enacted stigma, with over 70% having experienced this form of stigma. Participants described ignorance and fear of the disease as the foundation of epilepsy-related stigma. The most common response to stigmatizing events was a decrease in epilepsy disclosure to family or friends. Results from this study could inform interventions designed for elderly persons with epilepsy and their support networks, as well as educational campaigns for the general public.
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Affiliation(s)
- Carolyn Sleeth
- Department of Neurology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Kendra Drake
- Department of Neurology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - David M Labiner
- Department of Neurology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | - Jenny Chong
- Department of Neurology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
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El-Tallawy HN, Farghaly WM, Rageh TA, Shehata GA, Metwally NA, Badry R, Sayed MA, Abdelwarith AM, Kandil MR, Hamed MA, Mohamed KO, Tohamy AM. Spectrum of epilepsy - prevalence, impact, and treatment gap: an epidemiological study from Al-Quseir, Egypt. Neuropsychiatr Dis Treat 2016; 12:1111-8. [PMID: 27257380 PMCID: PMC4874633 DOI: 10.2147/ndt.s87765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Epidemiology continues to be an important research tool in the study of epilepsy and related disorders, providing a better understanding of the frequency, causes, and natural history of the disorder. OBJECTIVE To estimate the prevalence of epilepsy in Al-Quseir, Red Sea Governorate, Egypt, and its magnitude of treatment gap. METHODS The study was part of a door-to-door study, including every door, to screen all inhabitants in Al-Quseir (33,818 inhabitants) by three specialists of neurology and 15 female social workers (for demographic data collection) using a standardized screening questionnaire. All suspected cases were subjected to detailed history, clinical examination, and electroencephalogram. Neuroimaging studies and estimation of serum drug level were done in select cases if needed. RESULTS The study revealed that the lifetime prevalence rate of epilepsy in Al-Quseir is 5.5/1,000, with the highest peak during early childhood, while that of active epilepsy is 3.3/1,000 population. The annual incidence rate is 48/100,000, and the age-specific incidence rate has a U-shaped pattern with two peaks of incidence in early infancy and elderly life. Localization-related epilepsy is the most frequently encountered type (58.8%). The treatment gap of epilepsy in Al-Quseir is 83.8%. CONCLUSION The lifetime prevalence of epilepsy in Al-Quseir city, Red Sea Governorate, was 5.5/1000.
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Affiliation(s)
| | | | - Tarek A Rageh
- Department of Neurology, Assiut University, Assiut, Egypt
| | | | - Nabil A Metwally
- Department of Neurology, Faculty of Medicine, Al-Azhar University - Assiut Branch, Assiut, Egypt
| | - Reda Badry
- Department of Neurology, Assiut University, Assiut, Egypt
| | | | - Ahmed M Abdelwarith
- Department of Neurology, Faculty of Medicine, Al-Azhar University - Assiut Branch, Assiut, Egypt
| | | | | | | | - Amal M Tohamy
- Department of Neurology, Assiut University, Assiut, Egypt
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Manacheril R, Faheem U, Labiner D, Drake K, Chong J. Psychosocial Impact of Epilepsy in Older Adults. Healthcare (Basel) 2015; 3:1271-83. [PMID: 27417823 PMCID: PMC4934643 DOI: 10.3390/healthcare3041271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of our study was to describe the quality of life of older adults with seizures or epilepsy and compare its psychosocial impact between those who were new diagnosed and those diagnosed before the age of 65. METHODS In-depth face to face interviews with open ended questions were conducted with two participant groups: Incident group: 42 older adults (>65 years) with new onset or newly diagnosed after age of 65; and Prevalent group: 15 older adults (>65 years) diagnosed before age of 65. Interviews were reviewed and coded using a list of themes and results were compared between the two groups. Eight topics were selected from the participants' responses to questions about the psychosocial impact of epilepsy and seizures. The topics were then analyzed and compared between the two groups. RESULTS The topics analyzed were: Emotional and physical impact, significant life changes, co-morbidities, information gathering, stigma, AED side effects, changes in relationships and attitude toward diagnosis. CONCLUSION We concluded that the age at onset and duration does seem to have a negative correlation with health related quality of life. However, the perceived health status of older adults with chronic epilepsy was significantly better and reflected in their more positive approach to the diagnosis of seizures or epilepsy probably because they have had a longer opportunity to learn to cope with their diagnosis.
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Affiliation(s)
- Rinu Manacheril
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA.
| | - Urooba Faheem
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA.
| | - David Labiner
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA.
| | - Kendra Drake
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA.
| | - Jenny Chong
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA.
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Tanaka T, Yamagami H, Ihara M, Motoyama R, Fukuma K, Miyagi T, Nishimura K, Toyoda K, Nagatsuka K. Seizure Outcomes and Predictors of Recurrent Post-Stroke Seizure: A Retrospective Observational Cohort Study. PLoS One 2015; 10:e0136200. [PMID: 26309124 PMCID: PMC4550357 DOI: 10.1371/journal.pone.0136200] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022] Open
Abstract
Background Seizure is a common complication after stroke (termed “post-stroke seizure,” PSS). Although many studies have assessed outcomes and risk factors of PSS, no reliable predictors are currently available to determine PSS recurrence. We compared baseline clinical characteristics and post-stroke treatment regimens between recurrent and non-recurrent PSS patients to identify factors predictive of recurrence. Methods Consecutive PSS patients admitted to our stroke center between January 2011 and July 2013 were monitored until February 2014 (median 357 days; IQR, 160–552) and retrospectively evaluated for baseline clinical characteristics and PSS recurrence. Cumulative recurrence rates at 90, 180, and 360 days post-stroke were estimated by Kaplan—Meier analysis. Independent predictors of recurrent PSS were identified by Cox proportional-hazards analysis. Results A total of 104 patients (71 men; mean age, 72.1 ± 11.2 years) were analyzed. PSS recurred in 31 patients (30%) during the follow-up. Factors significantly associated with PSS recurrence by log-rank analysis included previous PSS, valproic acid (VPA) monotherapy, polytherapy with antiepileptic drugs (AEDs), frontal cortical lesion, and higher modified Rankin Scale score at discharge (all p < 0.05). Independent predictors of recurrent PSS were age <74 years (HR 2.38, 95% CI 1.02–5.90), VPA monotherapy (HR 3.86, 95% CI 1.30–12.62), and convulsions on admission (HR 3.87, 95% CI 1.35–12.76). Conclusions Approximately one-third of PSS patients experienced seizure recurrence within one year. The predictors of recurrent PSS were younger age, presence of convulsions and VPA monotherapy. Our findings should be interpreted cautiously in countries where monotherapy with second-generation AEDs has been approved because this study was conducted while second-generation AEDs had not been officially approved for monotherapy in Japan.
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Affiliation(s)
- Tomotaka Tanaka
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
- * E-mail:
| | - Hiroshi Yamagami
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rie Motoyama
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuki Fukuma
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tetsuya Miyagi
- Department of Stroke and Cerebrovascular Diseases, Division of Cerebrovascular Medicine, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazutaka Nishimura
- Department of Stroke and Cerebrovascular Diseases, Division of Cerebrovascular Medicine, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Stroke and Cerebrovascular Diseases, Division of Cerebrovascular Medicine, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuyuki Nagatsuka
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
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Huang YH, Chi NF, Kuan YC, Chan L, Hu CJ, Chiou HY, Chien LN. Efficacy of phenytoin, valproic acid, carbamazepine and new antiepileptic drugs on control of late-onset post-stroke epilepsy in Taiwan. Eur J Neurol 2015; 22:1459-68. [DOI: 10.1111/ene.12766] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 05/07/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Y.-H. Huang
- Department of Neurology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
- Department of Neurology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
| | - N.-F. Chi
- Department of Neurology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
- Department of Neurology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
| | - Y.-C. Kuan
- Department of Neurology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
- Department of Neurology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Neurology; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - L. Chan
- Department of Neurology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
- Department of Neurology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
| | - C.-J. Hu
- Department of Neurology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
- Department of Neurology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
| | - H.-Y. Chiou
- School of Public Health; College of Public Health and Nutrition; Taipei Medical University; Taipei Taiwan
| | - L.-N. Chien
- School of Health Care and Administration; College of Public Health and Nutrition; Taipei Medical University; Taipei Taiwan
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Miller WR. Patient-centered outcomes in older adults with epilepsy. Seizure 2014; 23:592-7. [PMID: 24838071 PMCID: PMC4440332 DOI: 10.1016/j.seizure.2014.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/15/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Older adults have the highest incidence of new-onset epilepsy, yet there is a lack of self-management interventions to ensure that this population achieves desirable outcomes. In order to develop patient-centered interventions for older adults with epilepsy, self-management outcomes of importance to these patients must first be explored. The purpose of this study was to describe what outcomes older adults diagnosed with epilepsy late in life hope to achieve in self-managing their condition. METHOD Qualitative description was used. 20 older adults took part in semi-structured interviews. Data were analyzed using conventional content analysis. RESULTS Six themes emerged - Maintaining Normalcy, We Want to be Involved, Well-Equipped, Seizure Freedom, Fitting Epilepsy in with Other Conditions, Incongruence with Provider Goals. CONCLUSION These results add to the extant literature, and provide knowledge on which patient-centered epilepsy self-management interventions can be developed. In addition, these results can inform the development of a patient-centered outcome measure for older adults with epilepsy. Such a measure could be used in conjunction with existing measures related to disease status (seizure frequency, etc.) to ensure that outcomes pertinent to both patients and providers are targeted and measured.
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Affiliation(s)
- Wendy R Miller
- Indiana University School of Nursing, Department of Science of Nursing Care, Sycamore Hall, Room 441, 1033 East 3rd Street, Bloomington, IN 47405, United States.
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Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, Resnick T, Benbadis SR. The consequences of refractory epilepsy and its treatment. Epilepsy Behav 2014; 37:59-70. [PMID: 24980390 DOI: 10.1016/j.yebeh.2014.05.031] [Citation(s) in RCA: 441] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022]
Abstract
Seizures in some 30% to 40% of patients with epilepsy fail to respond to antiepileptic drugs or other treatments. While much has been made of the risks of new drug therapies, not enough attention has been given to the risks of uncontrolled and progressive epilepsy. This critical review summarizes known risks associated with refractory epilepsy, provides practical clinical recommendations, and indicates areas for future research. Eight international epilepsy experts from Europe, the United States, and South America met on May 4, 2013, to present, review, and discuss relevant concepts, data, and literature on the consequences of refractory epilepsy. While patients with refractory epilepsy represent the minority of the population with epilepsy, they require the overwhelming majority of time, effort, and focus from treating physicians. They also represent the greatest economic and psychosocial burdens. Diagnostic procedures and medical/surgical treatments are not without risks. Overlooked, however, is that these risks are usually smaller than the risks of long-term, uncontrolled seizures. Refractory epilepsy may be progressive, carrying risks of structural damage to the brain and nervous system, comorbidities (osteoporosis, fractures), and increased mortality (from suicide, accidents, sudden unexpected death in epilepsy, pneumonia, vascular disease), as well as psychological (depression, anxiety), educational, social (stigma, driving), and vocational consequences. Adding to this burden is neuropsychiatric impairment caused by underlying epileptogenic processes ("essential comorbidities"), which appears to be independent of the effects of ongoing seizures themselves. Tolerating persistent seizures or chronic medicinal adverse effects has risks and consequences that often outweigh risks of seemingly "more aggressive" treatments. Future research should focus not only on controlling seizures but also on preventing these consequences.
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Affiliation(s)
- Kenneth D Laxer
- Sutter Pacific Epilepsy Program, California Pacific Medical Center, San Francisco, CA, USA.
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Lawrence J Hirsch
- Division of Epilepsy and EEG, Department of Neurology, Yale Comprehensive Epilepsy Center, New Haven, CT, USA
| | - Fernando Cendes
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - John Langfitt
- Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA; Department Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA; Strong Epilepsy Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Norman Delanty
- Epilepsy Service and National Epilepsy Surgery Programme, Beaumont Hospital, Dublin, Ireland
| | - Trevor Resnick
- Comprehensive Epilepsy Program, Miami Children's Hospital, Miami, FL, USA
| | - Selim R Benbadis
- Comprehensive Epilepsy Program, University of South Florida, Tampa, FL, USA
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Park KM, Hur Y, Kim HY, Ji KH, Hwang TG, Shin KJ, Ha SY, Park J, Kim SE. Initial response to antiepileptic drugs in patients with newly diagnosed epilepsy. J Clin Neurosci 2014; 21:923-6. [DOI: 10.1016/j.jocn.2013.10.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/14/2013] [Accepted: 10/27/2013] [Indexed: 12/18/2022]
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Abstract
OPINION STATEMENT Elderly people are one of the fastest-growing populations in the United States, and the incidence of epilepsy in older people is much higher than in other population subgroups. This age group is the most vulnerable because of the increased incidence of multiple medical comorbidities, including stroke. The diagnosis of epilepsy is extremely challenging and often delayed in this age group because of an atypical presentation. Seizures are manifest through extremely vague complaints, such as episodes of altered mental status or memory lapses. Once the diagnosis is established by careful history taking and diagnostic testing, anticonvulsants are the mainstay of treatment. The choice of anticonvulsants in elderly patients requires careful evaluation of medical comorbidities, which vary on an individual basis. This subgroup also is more susceptible to adverse effects because of the physiologic changes in the body due to older age, which affect the pharmacokinetics of most anticonvulsants. The ideal drug in this age group should have linear pharmacokinetics, fewer adverse effects, minimal or no drug-drug interactions, no enzyme induction/inhibition, a long half-life, and minimal protein binding, and should be cost-effective. As such, there is no ideal drug for this patient population, although both older- and newer-generation anticonvulsants are used for long-term treatment. Most newer anticonvulsants have the advantage of a favorable pharmacokinetic profile, minimal or no drug-drug interactions, and fewer adverse events, as well as being well tolerated. The older anticonvulsants still are widely used, because the newer anticonvulsants are much more expensive.
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Eslicarbazepine acetate: An update on efficacy and safety in epilepsy. Epilepsy Res 2014; 108:1-10. [DOI: 10.1016/j.eplepsyres.2013.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 09/09/2013] [Accepted: 10/13/2013] [Indexed: 11/23/2022]
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Piskorska B, Miziak B, Czuczwar SJ, Borowicz KK. Safety issues around misuse of antiepileptics. Expert Opin Drug Saf 2013; 12:647-57. [DOI: 10.1517/14740338.2013.796363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Conrad J, Pawlowski M, Dogan M, Kovac S, Ritter MA, Evers S. Seizures after cerebrovascular events: risk factors and clinical features. Seizure 2013; 22:275-82. [PMID: 23410847 DOI: 10.1016/j.seizure.2013.01.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Epileptic seizures are well known sequelae of patients with stroke but only little is known about the different risk factors and about the influence of the different types of stroke including sinus thrombosis and bleedings on developing such seizures. Further, the association of post-stroke seizures and conventional vascular risk factors has not been evaluated to date. METHODS We performed a cohort study on a sample of 593 consecutive patients with different types of cerebrovascular events. In 421 patients, sufficient data were obtained in a personal interview over a mean observation period of 30 months. Data regarding the clinical history were recorded from the patients' charts. RESULTS The total prevalence of epileptic seizures was 11.6%, the total annual risk was 4.6%. We detected the following significant risk factors: younger age at stroke; higher NIH stroke scale score; any coagulopathy. TIA was found significantly less frequent as a cause of seizures as compared to infarction, bleeding, and sinus thrombosis. Patients with bleeding (14.3%) and with sinus thrombosis (16.3%) were significantly more frequent in the seizure group than in the non-seizure group (6.7% and 1.6%, respectively). The location of stroke, including cortical versus subcortical, did not influence the risk of seizures. The majority of patients developed secondary generalized seizures (57.1%). In adjusted analyses, the two major risk factors for post-stroke epilepsy were a higher NIH stroke scale and a sinus thrombosis as the initial cerebrovascular event. Common lifestyle, vascular, and metabolic risk factors of stroke and for dementia were not associated with the development of seizures. CONCLUSIONS In conclusion, our data show that epileptic seizures occur in particular after major strokes and in sinus thrombosis. Interestingly, conventional vascular risk factors were not associated with the occurrence of post-stroke seizures. Considering the risk for seizures after certain types of cerebrovascular events might help to early identify patients for anticonvulsive treatment. In the future, it should be investigated whether these patients might benefit from pre-emptive anticonvulsant treatment.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, University of Münster, Germany
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78
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Antiepileptic drug use in Austrian nursing home residents. Seizure 2012; 22:24-7. [PMID: 23142709 DOI: 10.1016/j.seizure.2012.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Currently around 30% of all newly developed seizures are diagnosed in persons older than 65 years. Five to 17% of nursing home-residents take antiepileptic drugs. The aim of our study was to analyze the type and frequency of prescribed antiepileptic drugs, as well as their indication, co-morbidities and co-medications in institutionalized elderly in Austria. METHODS This was a retrospective, cross-sectional study, which included all residents of the seven public nursing homes in Innsbruck, Austria. The data of 828 probands were extracted from the charts at site and maintained anonymously. The data collection was followed by descriptive statistics. KEY FINDINGS 70 (8.5%; 26 M/44 F) of the 828 (192 M/636 F) residents took at least one antiepileptic medication. In 51.5% the reason for the prescription were epileptic seizures - yielding a minimum prevalence of 4.5%. The most often used antiepileptic drugs were gabapentin (37%), levetiracetam (24%) and valproate (18.5%). The three most common co-morbidities were arterial hypertension (49%), ischemic stroke (36%) and other cerebrovascular diseases (29%). Six to nine co-medications were prescribed in 41%, 26% had more than 10 additional drugs and 91% were treated with proconvulsive co-medications (64/70, median 2, range 0-6). SIGNIFICANCE Austrian nursing home residents receive more frequently newer antiepileptic drugs compared to other countries, but co-prescription of proconvulsive drugs is common.
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Gil-Nagel A, Elger C, Ben-Menachem E, Halász P, Lopes-Lima J, Gabbai AA, Nunes T, Falcão A, Almeida L, Soares-da-Silva P. Efficacy and safety of eslicarbazepine acetate as add-on treatment in patients with focal-onset seizures: Integrated analysis of pooled data from double-blind phase III clinical studies. Epilepsia 2012; 54:98-107. [DOI: 10.1111/j.1528-1167.2012.03605.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Epilepsy is the most common serious neurological disorder in the elderly after stroke and dementia. It may be more important for elderly people because it is intermittent and unpredictable. There is no reliable diagnostic test and so its diagnosis and management requires clinical acumen and experience. The situation is further complicated because the elderly may have many comorbidities and therefore may have many other reasons for losing consciousness. Despite their growing number, there is remarkably little research to underpin the best epilepsy management in the elderly. This article summarizes the scope of epilepsy in elderly people, highlights cerebrovascular and neurodegenerative diseases as the main underlying etiologies, explores the diagnostic challenges in this age group, including the hurdles and processes in their investigation, and examines pertinent clinical management issues.
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Affiliation(s)
- Ann Johnston
- Department of Neurology, Morriston Hospital, Swansea, UK.
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81
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Oteri A, Trifirò G, Gagliostro MS, Tari DU, Moretti S, Bramanti P, Spina E, Caputi AP, Arcoraci V. Prescribing pattern of anti-epileptic drugs in an Italian setting of elderly outpatients: a population-based study during 2004-07. Br J Clin Pharmacol 2011; 70:514-22. [PMID: 20840443 DOI: 10.1111/j.1365-2125.2010.03619.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS The aims of the study were to assess the trend of older and newer anti-epileptic drugs (AEDs) in the elderly population and to analyze the effects of a health-policy intervention with regard to AED use in general practice in a setting in Southern Italy. METHODS Data were extracted from the 'Caserta-1' Local-Health-Unit Arianna database in the years 2004-07. Patients aged over 65 years, receiving at least one AED prescription and registered in the lists of 88 general practitioners, were selected. The use of older and newer AEDs was calculated as 1 year prevalence and incidence of use and defined daily dose (DDD) per 1000 inhabitants day(-1) . Sub-analyses by gender, age and indication of use were performed. RESULTS Most of AED users were treated because of neuropathic pain (64.8%). However, the main indication of use for older AEDs (57.8%) was epilepsy, whereas newer AEDs (79.5%) were used for neuropathic pain. Prevalence and incidence of newer AED use increased until 2006, followed by a reduction in 2007. Newer AEDs, particularly gabapentin and pregabalin, were used in the treatment of more patients than older AEDs. However phenobarbital, accounting for more than 50% of total AED volume, was the most prescribed medication during the entire study period. CONCLUSIONS An increasing use of AEDs has been observed during 2004-07, mostly due to the prescription of newer compounds for neuropathic pain. The fall in the use of newer AEDs during 2007 coincides with revised re-imbursement criteria for gabapentin and pregabalin. The large use of phenobarbital in the elderly should be considered in the light of a risk of adverse drug reactions.
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Affiliation(s)
- Alessandro Oteri
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Via Consolare Valeria, 98125 MESSINA, Italy.
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Affiliation(s)
- Antonio Gambardella
- Institute of Neurological Sciences, National Research Council, Mangone-Cosenza, Italy; Division of Neurology, University Magna Graecia Catanzaro, Catanzaro, Italy.
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Joester J, Vogler CM, Chang K, Hilmer SN. Hypnosedative Use and Predictors of Successful Withdrawal in New Patients Attending a Falls Clinic. Drugs Aging 2010; 27:915-24. [DOI: 10.2165/11584480-000000000-00000] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
PURPOSE OF REVIEW Epilepsy is a clinical disorder of paroxysmal recurring seizures, the diagnosis excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. RECENT FINDINGS New antiepileptic drugs (AEDs) have been a major change in the approach to management of patients with epilepsy. These drugs tend to have fewer significant drug interactions and less severe side effects. Nonetheless, first-generation AEDs are still widely used. Propofol and desflurane have reliable anticonvulsant effects, whereas remifentanil in larger doses and sevoflurane appear to support epileptiform activity, although the clinical significance of these observations is unclear. SUMMARY The primary concerns for providing anesthesia to the patient with epilepsy are the capacity of anesthetics to modulate or potentiate seizure activity and the interaction of anesthetic drugs with AEDs. Proconvulsant and anticonvulsant properties have been reported for virtually every anesthetic such that these properties become elements of the anesthetic plan in the patient with epilepsy. Moreover, AEDs have many physiologic and pharmacologic effects that can have an impact on an anesthetic.
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Affiliation(s)
- W Andrew Kofke
- Departments of Anesthesiology and Critical Care and Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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85
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Tüscher O, Tebartz van Elst L. Management and health implications of epilepsy in older women. Maturitas 2010; 66:242-5. [DOI: 10.1016/j.maturitas.2010.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 02/28/2010] [Indexed: 10/19/2022]
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Strzelczyk A, Haag A, Raupach H, Herrendorf G, Hamer HM, Rosenow F. Prospective evaluation of a post-stroke epilepsy risk scale. J Neurol 2010; 257:1322-6. [DOI: 10.1007/s00415-010-5520-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 02/21/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
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Abstract
Epilepsy affects approximately 50 million people worldwide, with an annual incidence of 50 to 70 cases per 100,000 population. The condition can strike at any time of life, with an immediate impact on everyday activities and routine. Key to optimal management is swift referral to an epilepsy specialist, appropriate investigation, and timely institution of antiepileptic drug therapy. In the past 20 years, the explosion of 13 new agents into the marketplace has greatly increased the potential for therapeutic intervention. This article explores the rationale for treatment selection in adults with epilepsy.
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Affiliation(s)
- Linda J Stephen
- Division of Cardiovascular and Medical Sciences, Epilepsy Unit, Western Infirmary, Glasgow G11 6NT, Scotland, UK
| | - Martin J Brodie
- Division of Cardiovascular and Medical Sciences, Epilepsy Unit, Western Infirmary, Glasgow G11 6NT, Scotland, UK.
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88
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Abstract
Epilepsy is most likely to develop in later life. The burden of this disorder on health-care resources will rise further as the world's population continues to age. Making a secure diagnosis can be challenging because the clinical manifestations of seizures and the differential diagnoses and causes of epilepsy can be different in older individuals compared with younger individuals. Obtaining a reliable account of the events for accurate assessment is particularly important in guiding the appropriate choice and interpretation of investigations to arrive at the correct diagnosis. In older age, unique pharmacokinetic and pharmacodynamic changes occur. The use and selection of antiepileptic drugs is often further complicated by the presence of comorbidities, polypharmacy, and concomitant functional impairment, but there is a paucity of high-level clinical evidence on the effects of these factors as well as on the choice of treatment in the elderly. A comprehensive model of care should combine expertise in the diagnosis and treatment of epilepsy with effective assessment and management of the psychosocial effects to improve the prognosis in this vulnerable and poorly studied group of patients.
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Douglas VC, DeArmond SJ, Aminoff MJ, Miller BL, Rabinovici GD. Seizures in corticobasal degeneration: a case report. Neurocase 2009; 15:352-6. [PMID: 19544144 PMCID: PMC2829102 DOI: 10.1080/13554790902971158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Seizures are relatively common in Alzheimer disease (AD) and other neurodegenerative disorders. To our knowledge, however, there have been no reports of seizures associated with corticobasal degeneration (CBD). We describe a patient with brain biopsy features suggestive of CBD whose course was complicated by complex partial seizures with secondary generalization. Thus, the occurrence of seizures in a patient with dementia should not exclude the diagnosis of CBD.
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Affiliation(s)
- Vanja C Douglas
- University of California Department of Neurology Box 0114 400 Parnassus Ave, 8th Floor Neurology Clinic San Franciso, CA 94143-0114, USA.
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Tebartz van Elst L, Baker G, Kerr M. The psychosocial impact of epilepsy in older people. Epilepsy Behav 2009; 15 Suppl 1:S17-9. [PMID: 19303941 DOI: 10.1016/j.yebeh.2009.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 11/30/2022]
Abstract
Given a prevalence of 0.5-1%, the epilepsies belong to the most common of neuropsychiatric diseases. Many clinicians think of the epilepsies as an entity beginning in early in life. However, the peak incidence of epilepsy in the developed world is now in the age group beyond 60 years. This population has thus an increasing importance; and in this paper we review and summarize the specific aspects of the clinical presentation, etiology, diagnosis, and treatment of older-age patients with epilepsy. In particular, we focus on the specific psychosocial impact that epilepsy has on the life of older people and their carers.
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Affiliation(s)
- Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
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Schreur L, Middeljans-Tijssen CW, Hengstman GJD, Olde Rikkert MGM. [Cognitive impairment and parkinsonism due to use of sodium valproate]. Tijdschr Gerontol Geriatr 2009; 40:29-33. [PMID: 19326700 DOI: 10.1007/bf03088474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Two patients presented with progressive cognitive impairment and parkinsonism related symptoms while being treated with sodium valproate. Both patients suffered from progressive cognitive decline and mobility disorders with an insidious onset over a period of months to years. After discontinuation of sodium valproate both debilitating symptoms resolved nearly completely. There is a growing prevalence and incidence of epilepsy above the age of 60 and a great number of these patients are on sodium valproate treatment. All clinicians treating elderly patients should be aware of the fact that this treatment can cause reversible cognitive decline and parkinsonism probably due to impairment of mitochondrial complex I function. Discontinuation of sodium valproate is strongly recommended in all patients with development of cognitive impairment or parkinsonism or both during sodium valproate treatment.
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Affiliation(s)
- L Schreur
- Klinisch geriater in opleiding, Afdeling geriatrie, Universitair Medisch Centrum St Radboud, Nijmegen
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92
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Santoli F, Crespel A. Recherche étiologique lors d’un état de mal épileptique. Rev Neurol (Paris) 2009; 165:338-43. [DOI: 10.1016/j.neurol.2008.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
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93
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Haut SR, Katz M, Masur J, Lipton RB. Seizures in the elderly: impact on mental status, mood, and sleep. Epilepsy Behav 2009; 14:540-4. [PMID: 19189862 PMCID: PMC2695969 DOI: 10.1016/j.yebeh.2009.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 01/02/2009] [Accepted: 01/10/2009] [Indexed: 11/16/2022]
Abstract
Comorbidities of epilepsy have not been well explored in the elderly. Herein, we examined mental status, mood, and sleep in elderly patients with epilepsy, compared with age- and gender-matched community controls without epilepsy from the Einstein Aging Study. Testing included a mental status test, the Blessed Information Memory and Concentration (BIMC) test; Prime-MD Patient Health Questionnaire (PHQ) Depression and Anxiety Modules; and Medical Outcomes Study Sleep Scale. Persons with epilepsy (n=31) had higher mean BIMC scores than controls (n=31, BIMC 6.3 vs.1.2, P<0.0001). Mean PHQ Depression scores were higher for cases than controls, indicating more depressive symptoms (4.2 vs 0.8, P=0.006); six cases (18%) and no controls met screening criteria for depression. Mean PHQ Anxiety scores were also higher for cases than controls (3.7 vs 0.0, P=0.001). Cases had poorer sleep scores in the categories of somnolence (P=0.009) and shortness of breath/headache (P=0.021). Thus, comorbidities of epilepsy in this elderly population included decreased mental status, a higher prevalence of depression and anxiety, and poorer sleep health when compared with agemates without epilepsy. Mental status impairment was not related to antiepileptic medication or mood disturbance. Further investigation will explore these associations prospectively.
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Affiliation(s)
- Sheryl R. Haut
- Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, Department of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
| | - Mindy Katz
- Department of Epidemiology and Population Health, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
| | - Jonathan Masur
- Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, Department of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
| | - Richard B. Lipton
- Department of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, Department of Epidemiology and Population Health, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
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94
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Abstract
Epilepsy is a chronic neurological disorder that affects one million people in Japan. Medical treatment is highly effective for this disorder. The antiepileptic treatment brings 70% of the patients to seizure freedom. Current guidelines recommend carbamazepine for partial (focal) seizures and valproate for generalized seizures as the first-line drug; however, indivizualized drug selection in accordance to the patients' condition is mandatory. Modern antiepileptic medications have better tolerability and less dug-to-drug interaction, and some of them are waiting to be approved in Japan. Special attention is necessary for the care of woman in child-bearing age, adolescents, and elderly persons. Advances of surgical treatment of the epilepsy brought many medically intractable patients to be seizure free. Early identification of the surgical candidate is an important task for clinicians.
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Affiliation(s)
- Sadatoshi Tsuji
- Department of Neurology, University of Occupational and Environmental Health School of Medicine
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95
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Alves G, Figueiredo I, Castel-Branco M, Lourenço N, Falcão A, Caramona M, Soares-da-Silva P. Disposition of eslicarbazepine acetate in the mouse after oral administration. Fundam Clin Pharmacol 2008; 22:529-36. [DOI: 10.1111/j.1472-8206.2008.00617.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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96
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Stefan H, Hubbertz L, Peglau I, Berrouschot J, Kasper B, Schreiner A, Krimmer J, Schauble B. Epilepsy outcomes in elderly treated with topiramate. Acta Neurol Scand 2008; 118:164-74. [PMID: 18384458 DOI: 10.1111/j.1600-0404.2008.01018.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore effectiveness, tolerability and quality of life in elderly patients with epilepsy treated with topiramate. METHODS One year, open-label, flexible-dosing clinical trial. RESULTS One hundred and seven patients (mean age 69 years, 53% men) were studied during 273 +/- 141 days. The average final dose in monotherapy was 98 mg/day vs 153 mg/day in adjunctive treatment. Mean monthly cumulative seizure frequency decreased from 3.7 +/- 15 to 1.6 +/- 7.7 (n = 101, P < 0.0001), 78% of patients with seizures at baseline (n = 102) achieved at least 50% reduction in seizure frequency, 44% were seizure-free throughout the trial. Total scores on the quality of life in epilepsy inventory (QOLIE-31) improved from 57 +/- 17 to 68 +/- 18 (n = 64, P < 0.0001). The most frequently reported adverse events included convulsions, dizziness and tiredness. CONCLUSIONS Elderly patients treated with topiramate showed marked reductions in seizures, good tolerability and significant improvements in several aspects of quality of life.
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Affiliation(s)
- H Stefan
- Epilepsy Center, University of Erlangen, Germany
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97
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Picot MC, Baldy-Moulinier M, Daurs JP, Dujols P, Crespel A. The prevalence of epilepsy and pharmacoresistant epilepsy in adults: A population-based study in a Western European country. Epilepsia 2008; 49:1230-8. [DOI: 10.1111/j.1528-1167.2008.01579.x] [Citation(s) in RCA: 305] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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98
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Hommet C, Mondon K, Camus V, De Toffol B, Constans T. Epilepsy and dementia in the elderly. Dement Geriatr Cogn Disord 2008; 25:293-300. [PMID: 18311076 DOI: 10.1159/000119103] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2007] [Indexed: 11/19/2022] Open
Abstract
Epilepsy is a frequent condition in the elderly; however, it remains a relatively understudied condition in older adults with dementia. The diagnosis of a seizure is particularly difficult and is most often based on questions to the caregiver. Epilepsy in dementia has significant consequences on the prognosis of the underlying dementia: it can result in a worsening of cognitive performance, particularly in language, as well as a reduction in autonomy, a greater risk of injury and a higher mortality rate. In this review, management strategies are recommended for the clinician. The presence of pre-existing Alzheimer's disease does not exempt the clinician from ruling out other symptomatic causes of seizures. Anti-epileptic drugs (AED) should be started only after the diagnosis has been clearly established, when the risk of recurrence is high, and with monotherapy whenever possible. Although few data are available, the more recent AED offer significant advantages over the older medications in this context.
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Affiliation(s)
- C Hommet
- Geriatric Internal Medicine and Regional Memory Centre, University Hospital, Tours University, Tours, France.
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99
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Oxcarbazepine may induce psychotic symptoms in Parkinson's disease. Epilepsy Behav 2008; 12:492-3. [PMID: 18222110 DOI: 10.1016/j.yebeh.2007.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 12/14/2007] [Accepted: 12/15/2007] [Indexed: 10/22/2022]
Abstract
Although there is a relatively high prevalence of both idiopathic Parkinson's disease (PD) and epilepsy in the elderly population, and PD occurs more frequently in people with epilepsy, there are no studies investigating the efficacy and tolerability of antiepileptic drugs (AEDs) in people with PD. We describe the case of a 71-year-old man with PD who experienced several seizures. The initiation of antiepileptic treatment with oxcarbazepine (OXC) provoked a severe, long-lasting psychotic state. The patient had previously experienced similar psychotic episodes during dopamine agonist therapy. Because recent animal studies have proven that OXC and its active metabolite exert important dopamine- and serotonin-promoting effects in the limbic area, we assumed that in our case the OXC-induced psychosis was mediated by the dopaminergic system. We concluded that OXC should be used with care in cases of a constellation of PD and epilepsy because of its possible psychiatric side effects. The dopaminergic effect of OXC and its active metabolite might also play an ambivalent, but important role in the treatment of alcohol addiction and bipolar disorder; therefore, further studies are required to investigate its psychopharmacological aspects.
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100
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Abstract
A first seizure out of a clear blue sky can be a major life-changing event. Careful history-taking and appropriate investigation together with a clear explanation provided to patient and family are an essential requirement. Although for most patients, pharmacotherapy can be withheld and events awaited, there are circumstances where introduction of antiepileptic drug (AED) therapy should be considered. Medical causes of seizures should also be sought and treated. In addition, a first seizure in HIV-positive patients and in those with underlying neurocysticercosis should usually provoke the introduction of AED therapy. Particular problems can occur in patients with a single episode of provoked status epilepticus, a first tonic-clonic seizure during pregnancy and, particularly, an unprovoked event in older and learning disabled people. Treatment following a first seizure should balance risk factors for recurrence with the informed opinion of the patients and their family.
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Affiliation(s)
- Linda J Stephen
- Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, United Kingdom
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