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Godau J, Bharad K, Rösche J, Nagy G, Kästner S, Weber K, Bösel J. Automated Pupillometry for Assessment of Treatment Success in Nonconvulsive Status Epilepticus. Neurocrit Care 2021; 36:148-156. [PMID: 34331202 DOI: 10.1007/s12028-021-01273-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Altered pupillary function may reflect nonconvulsive status epilepticus (NCSE). Neurological pupil index (NPi) assessed by automated pupillometry is a surrogate marker of global pupillary function. We aimed to assess NPi changes in relation to NCSE treatment response. METHODS In this prospective observational study, serial automated pupillometry was performed in 68 NCSE episodes. In accordance with local standards, patients were treated with clonazepam (1-2 mg), levetiracetam (40 mg/kg), and lacosamide (5 mg/kg) in a stepwise approach under continuous electroencephalography monitoring until NCSE was terminated. Patients with refractory NCSE received individualized regimens. NPi was assessed bilaterally before and after each treatment step. For statistical analysis, the lower NPi of both sides (minNPi) was used. Nonparametric testing for matched samples and Cohen's d to estimate effect size were performed. Principal component analysis was applied to assess the contribution of baseline minNPi, age, sex, and NCSE duration to treatment outcome. RESULTS In 97.1% of 68 episodes, NCSE could be terminated; in 16.2%, NCSE was refractory. In 85.3% of episodes, an abnormal baseline minNPi ≤ 4.0 was obtained. After NCSE termination, minNPi increased significantly (p < 0.001). Cohen's d showed a strong effect size of 1.24 (95% confidence interval 0.88-1.61). Baseline minNPi was higher in clonazepam nonresponders vs. responders (p = 0.008), minNPi increased in responders (p < 0.001) but not in nonresponders. NCSE refractivity was associated with normal baseline minNPi (principal component analysis, component 1, 32.6% of variance, r = 0.78), male sex, and longer NCSE duration (component 2, 27.1% of variance, r = 0.62 and r = 0.78, respectively). CONCLUSIONS Automated pupillometry may be a helpful noninvasive neuromonitoring tool for the assessment of patients with NCSE and response to treatment.
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Affiliation(s)
- Jana Godau
- Department of Neurology, Klinikum Kassel, Kassel, Germany. .,Emergency Department, Klinikum Kassel, Kassel, Germany.
| | - Kaushal Bharad
- Department of Neurology, Klinikum Kassel, Kassel, Germany.,Emergency Department, Klinikum Kassel, Kassel, Germany
| | - Johannes Rösche
- Department of Neurology, Klinikum Kassel, Kassel, Germany.,Department of Neurology, University of Rostock, Rostock, Germany
| | - Gabor Nagy
- Department of Neurology, Klinikum Kassel, Kassel, Germany.,Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | | | - Klaus Weber
- Emergency Department, Klinikum Kassel, Kassel, Germany
| | - Julian Bösel
- Department of Neurology, Klinikum Kassel, Kassel, Germany
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Rösche J, Schade B. Levetiracetam as second-line treatment of status epilepticus – which dose should be applied? Journal of Epileptology 2021. [DOI: 10.21307/jepil-2021-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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3
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Rösche J, Dudek MIR, Kohnen O. [Self-induced epileptic seizures: Prevalence, Causes and Treatment]. Fortschr Neurol Psychiatr 2021; 90:147-162. [PMID: 34198356 DOI: 10.1055/a-1484-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-induced seizures were first described in 1827. A majority of authors found that in unselected patients with epilepsy, the prevalence rate of these seizures was 1%. In patients with photosensitive epilepsy, there was roughly a 25% prevalence. Apart from visual stimulation, many other mechanisms of self-induction have been described. A feeling of pleasure or relaxation during seizures may be a reason for self-inductive behaviour. But often the procedure of self-induction is experienced as involuntary. Treatment is always difficult. Behavioral therapy has been proven effective in some patients. In patients with photosensitive epilepsy, sunglasses are recommended. Fenfluramine, clonazepam and valproate seem to be a bit more effective than other drugs. After all, the treatment effect depends on the motivation of the patient to change the condition.
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Affiliation(s)
- Johannes Rösche
- Klinik, Hephata Diakonie, Schwalmstadt-Treysa, Germany.,Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Germany
| | - Maria Iracema Rocha Dudek
- Klinik für Psychiatrie und Psychotherapie/Ludwig-Noll-Krankenhaus Klinikum Kassel GmbH, Kassel, Germany
| | - Oona Kohnen
- Schweizerische Epilepsieklinik, Klinik Lengg AG, Zürich, Switzerland
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Maier S, Godau J, Bösel J, Rösche J. Recognition and treatment of status epilepticus in the prehospital setting. Seizure 2021; 86:1-5. [DOI: 10.1016/j.seizure.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/28/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022] Open
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Cuhls M, Bösel J, Rösche J. Treatment with lacosamide or levetiracetam in patients with renal replacement therapy. What is really known? Journal of Epileptology 2020. [DOI: 10.21307/jepil-2020-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rösche J, Dudek M, Teleki A, Godau J, Bösel J. [Levetiracetam for treatment of status epilepticus - an update]. Fortschr Neurol Psychiatr 2019; 87:357-363. [PMID: 31261415 DOI: 10.1055/a-0832-8652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since 2004 several reports on the treatment of status epilepticus with levetiracetam have been published. In this review, the results of a PubMed-based search of publications December 12, 2011 - July 6, 2018 are summarized and compared to those of earlier publications. In total, 28 treatment episodes in case reports, each on one or two cases of treatment episodes, and 412 treatment episodes in case series and prospective studies were analyzed. Case series and prospective studies reported an average success rate for termination of status probably of 55,0 %-59,4 %. Since preclinical data suggest a delayed effect of levetiracetam, its use in the treatment of generalized convulsive status epilepticus appears still questionable. A loading dose of 30 mg / kg seems to be reasonable.
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Affiliation(s)
- Johannes Rösche
- Klinikum Kassel GmbH, Klinik für Neurologie; Universität Rostock, Klinik und Poliklinik für Neurologie
| | | | | | - Jana Godau
- Klinikum Kassel GmbH, Klinik für Neurologie
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Rösche J, Rühle N, Pohley I, Kampf C. Cognitive deficits and recurrence of seizures. Swiss Arch Neurol Psychiatr Psychother 2018. [DOI: 10.4414/sanp.2018.00616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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8
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Dierking C, Porschen T, Walter U, Rösche J. Pregnancy-related knowledge of women with epilepsy - An internet-based survey in German-speaking countries. Epilepsy Behav 2018; 79:17-22. [PMID: 29223932 DOI: 10.1016/j.yebeh.2017.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 10/28/2017] [Accepted: 11/12/2017] [Indexed: 10/18/2022]
Abstract
There are several issues, which have to be acknowledged, when treating women with epilepsy (WWE). The need for counseling WWE in Germany with epilepsy on pregnancy-related matters was stressed in several papers and medical guidelines. Physicians treating WWE in Germany therefore should be aware of the information needs of their patients. We aimed to determine the level of pregnancy-related knowledge of WWE and their informational needs concerning pregnancy and childbirth issues in German-speaking countries by an internet-based survey. The questionnaire consisted of 18 questions addressing the characteristics of the epilepsy syndromes, the patients' experience with pregnancy, and the sources of their pregnancy-related knowledge. Another 20 items addressed the level of pregnancy-related knowledge. One hundred ninety-two women (179 patients, 13 relatives; age: 30.5±10.8years) participated. Most of the women got information and advice on the treatment of epilepsy from a neurologist (81%). Most of the women had obtained information concerning driving license (72%) followed by information about pregnancy and delivery (60%). The women, who remembered being counseled about pregnancy-related matters gave more correct answers to the pregnancy-related questions than the others (51±17% vs. 38±24%, p<0.011). Thirty-eight percent of WWE taking enzyme inducing antiepileptic drugs (AEDs) were unaware of the interaction with oral contraception. Forty-one percent of WWE taking valproate were unaware of its high teratogenicity, and 89% of WWE had not been counseled about potentially reduced bone mineral density. Forty-six percent of participants did not believe that the majority of WWE have healthy children. The findings of this survey reveal considerable information needs of WWE concerning pregnancy-related matters in German-speaking countries.
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Affiliation(s)
| | - Thomas Porschen
- Association for Epilepsy Self-Help North Rhine-Westphalia, Association for People with Epilepsy, Cologne, Germany
| | - Uwe Walter
- Department of Neurology, University of Rostock, Germany
| | - Johannes Rösche
- Department of Neurology, University of Rostock, Germany; Swiss Epilepsy Centre, Klinik Lengg, Zürich, Switzerland.
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9
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Abstract
ZusammenfassungIn den neuen Leitlinien der Deutschen Gesellschaft für Neurologie wird als Medikament der weiteren Wahl zur Behandlung des fokalen konvulsiven und des non-konvulsiven Status epilepticus (SE) unter anderem auch Topiramat (TPM) vorgeschlagen. Ziel dieser Übersichtsarbeit ist es, die vorliegenden Daten zur Verwendung von TPM bei der Behandlung des SE zu sichten. Auf Einzelfallebene wurden 13 Behandlungsepisoden mit einer Erfolgsrate von 30,8% publiziert. In 12 Fallserien wurden zusammen 147 Behandlungsepisoden mit TPM beim SE beschrieben. TPM wurde in Dosen zwischen 50 mg und 1000 mg/Tag bereits zu Beginn der Behandlung angewandt. Dabei ergab sich auf der Basis der von den jeweiligen Autoren als sicheren Behandlungserfolg eingeschätzten Episoden ein Mittelwert der Erfolgsraten von 36,78%. Obwohl theoretisch gut begründet kann der Einsatz von Topiramat beim therapierefraktären Status epilepticus nur empfohlen werden, wenn etabliertere Substanzen entweder nicht zum Erfolg führten oder kontraindiziert sind.
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Wittstock M, Buchmann J, Walter U, Rösche J. Vagus Nerve Stimulation and External Defibrillation during Resuscitation; a Letter to Editor. Emerg (Tehran) 2018; 6:e27. [PMID: 30009229 PMCID: PMC6036521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | - Johannes Buchmann
- Department of Child and Adolescence Psychiatry and Neurology, University Medicine Rostock, Rostock, Germany
| | - Uwe Walter
- Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Johannes Rösche
- Department of Neurology, University Medicine Rostock, Rostock, Germany.,Department of Neurology, Klinikum Kassel, GNH Holding AG, Kassel, Germany
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11
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Wittstock M, Walter U, Schirrmeister D, Kurtieiev K, Klinke J, Grossmann A, Rösche J. The diagnostic dilemma of non-convulsive status epilepticus in sporadic Creutzfeldt-Jakob disease. Journal of Epileptology 2017. [DOI: 10.1515/joepi-2017-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SummaryIntroduction.The differentiation between the clinical and electroencephalographic changes in nonconvulsive status epilepticus (NCSE) and those in sporadic Creutzfeldt-Jakob disease (sCJD) is a crucial question.Case report.A 77-year old woman was admitted because of fluctuating behavioural chancaseges, adynamia and apraxia since several months for diagnostic. The diagnosis of sCJD was suggested. Subsequently, she had a generalized tonic clonic seizure (GTCS) and the EEG revealed periodic lateralized epileptiform discharges and NCSE was considered.Discussion.The presented case illustrates the dilemma in the differential diagnosis of sCJD and (symptomatic) NCSE in the light of the recently published new Salzburg consensus criteria and unified EEG terminology. Concerning these criteria, the patient showed after an initial generalized seizure and substantial clinical improvement after administration of antiepileptic drugs, persisting epileptic discharges and only subtle clinical ictal phenomena during the EEG patterns with typical spatiotemporal evolution as a correlate of a symptomatic NCSE. During the further course of the disease in the presented patient the picture changed into an encephalopathic pattern.Conclusion.EEG criteria for the diagnosis of NCSE are complex. In our case the EEG resembled the pattern of NCSE in the postictal phase of a GTCS according to a classification of NCSE in use at this time. After initial responsiveness to antiepileptic medication the patient lost responsiveness to therapy displaying the typical encephalopathic EEG findings in sCJD. These findings may support the hypothesis of initial NCSE and transformation into prion protein induced encephalopathic EEG and demonstrated clinical usefulness of the Salzburg consensus criteria for NCSE.
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12
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Redecker J, Wittstock M, Rösche J. The efficacy of different kinds of intravenously applied antiepileptic drugs in the treatment of status epilepticus. How can it be determined? Epilepsy Behav 2017; 71:35-38. [PMID: 28460320 DOI: 10.1016/j.yebeh.2017.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/18/2022]
Abstract
We explored the influence of four different efficacy criteria on the results of observational studies concerning the treatment of status epilepticus (SE) and its subtypes. We compared and contrasted the results of four different efficacy criteria for the effectiveness of phenytoin, valproate, levetiracetam, and lacosamide. Criterion 1=the last antiepileptic drug (AED) administered before SE termination. Criterion 2=the last drug introduced into the antiepileptic therapy within 72h before the cessation of SE and without changes in dosage or number of the co-medication. Criterion 3=the last drug introduced into the antiepileptic therapy or increased in dose within 24h before termination of the SE without changes in the co-medication. Criterion 4=the last drug introduced into the antiepileptic therapy within 72h before the cessation of SE even allowing changes in the co-medication. We used two-tailed χ2-tests with the Yates adjustment for small samples to evaluate statistical differences between efficacy rates of different AEDs in the entire group and in subgroups of SE according to the second level of subdivisions in axis 1 and according to axis 2 of the new ILAE classification. A total of 145 treatment episodes in 124 patients (47 male, 77 female) were evaluated. There were 23 significant differences in efficacy according to the different criteria. Only criteria 1 and 3 led to significant results in our analysis. When incorporating theoretical considerations and the results of this study, criterion 3 seems to be the most appropriate measure for the evaluation of efficacy of an AED in the treatment of SE, because it seems to be more reasonable than criterion 1.
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Affiliation(s)
| | | | - Johannes Rösche
- Department of Neurology, University of Rostock, Germany; Swiss Epilepsy-center, Zurich, Switzerland.
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13
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Rösche J. The role of the hepatic metabolisation for the interaction between valproic acid and carbapenem antibiotics. Journal of Epileptology 2016. [DOI: 10.1515/joepi-2016-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Paschen I, Walter U, Kamm C, Rösche J. Case report: absence-status as late reexacerbation of genetic epilepsy of adolescence. Acta Neurol Belg 2016; 116:675-676. [PMID: 26830647 DOI: 10.1007/s13760-016-0603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 01/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Inga Paschen
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Uwe Walter
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Christoph Kamm
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Johannes Rösche
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany. .,Klinik Lengg AG, Bleulerstr. 60, 8008, Zurich, Switzerland.
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Prasse T, Rösche J. [Efficacy of Epileptological Consultation After Initially Unsuccessful Antiepileptic Medication]. Fortschr Neurol Psychiatr 2016; 84:568-72. [PMID: 27607070 DOI: 10.1055/s-0042-108439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE At least 25 % of patients with epilepsy do not achieve seizure freedom with their first antiepileptic medication. The aim of this study is to make a contribution to discussions on the efficacy of further antiepileptic medications in achieving seizure freedom for at least one year or reduction of seizure frequency of more than 50 % for more than one year. METHODS All patients who presented between January 1, 2009 and July 1, 2013 to the epileptological outpatient consulting service of the University of Rostock with at least one seizure in the previous year despite taking at least one antiepileptic medication were evaluated. Outcome was assessed according to the data available on July 1, 2014. RESULTS 70 patients (35 f/35 m) aged 43.6 years on average (SD 16.7) with active epilepsy, who had taken 3.7 antiepileptic drugs on average (SD 2.8) before the first presentation to our service, were counseled on further antiepileptic treatment options. On average, 1.96 (SD 1.8) antiepileptic drugs were introduced in the therapy. At the last visit to our service, 15.7 % of the patients were seizure free for more than one year and 45,6 % of the patients had a reduction of seizure frequency of at least more than 50 %. CONCLUSION With specialized epileptological counseling, substantial improvement in seizure frequency can be achieved in about 60 % of patients with epilepsy after failure of the initial antiepileptic drug.
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Affiliation(s)
- T Prasse
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - J Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock
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Abstract
SummaryBackground. The lifetime risk of patients with brain tumors to have focal epileptic seizures is 10-100%; the risk depends on different histology. Specific guidelines for drug treatment of brain tumor-related seizures have not yet been established.Aim. This review addresses the special aspects of antiepileptic drug (AED) therapy in brain tumor-related epilepsy.Methods. We analyzed the literature up to December 2015.Results. Based on current evidence the management of tumor-related seizures does not differ substantially from that applied to epilepsies from other etiologies. Therefore, the choice of an AED is based, above all, on tolerability and pharmacokinetic interactions with chemotherapeutic drugs. Levetiracetam is recommended by many authors as first-line therapy in brain tumor-related epilepsy. Due to the possibility of interactions, the combination of enzyme-inducing AEDs and chemotherapeutic drugs, is usually not recommended as a first choice. Currently there is no evidence that prophylactic prescription of long-term AEDs in brain tumor-patients who did not present with seizures is justified. Because of the high risk of recurrence, however, AED treatment should be strongly considered after a single brain tumor-related seizure. The decision to withdraw AEDs must carefully consider the risk of seizure recurrence.Conclusion. At present levetiracetam is the preferred drug in brain tumor-related epilepsy, especially when drug interactions need to be avoided. In the future we hope to acquire more targeted drugs against this disorder by uncovering its pathogenesis.
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Göde K, Grossmann A, Rösche J. Successful treatment of epilepsia partialis continua due to Rassmussen encephalitis with perampanel. Journal of Epileptology 2016. [DOI: 10.1515/joepi-2016-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Background. Epilepsia partialis continua (EPC) is a difficult to treat condition, which tends to be refractory to antiepileptic drugs (AEDs). We previously published two other treatment episodes of EPC due to stroke and vascular dementia with a possible effect of perampanel (PER).
Aim. With the publication of a third treatment episode of EPC terminated by the administration of PER we would like to suggest that PER may be an effective treatment option in this condition.
Material and Methods. We present a case where PER was the last AED introduced in the treatment of a patient with EPC and individual seizures due to Rasmussen encephalitis before his seizure frequency could be reduced significantly.
Results. A 44 years old male patient, who had been on a combination therapy of at least 4 AEDs since the age of 24, was admitted to our hospital presenting with an EPC. After the introduction of PER in the therapy EPC stopped and he remained seizure free for more than a year. Two of his other AEDs could be tapered of.
Conclusion. PER might be especially effective in EPC.
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Kampf C, Walter U, Rösche J. The impact of anxiety, seizure severity, executive dysfunction, subjectively perceived psychological deficits, and depression on social function in patients with epilepsy. Epilepsy Behav 2016; 57:5-8. [PMID: 26900773 DOI: 10.1016/j.yebeh.2015.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/28/2015] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Abstract
The impact of anxiety, seizure severity, executive dysfunction, subjectively perceived psychological deficits, and depression on social function in patients with epilepsy (PWE) was analyzed. A brief cognitive screening test (EpiTrack) and an estimation of the last 6 months' cumulative seizure severity (Chalfont seizure severity scale) were performed, and questionnaires on subjectively perceived cognitive deficits (c.I.-Skala), anxiety (State-Trait Anxiety Inventory, STAIX1 and STAIX2), depression (Self Rating Depression Scale, SDS), and social function (Soziale Aktivität Selbstbeurteilungsskala, SASS) were completed. Forty PWE (aged 41.8 years, SD 16; 24 female, 16 male) were analyzed. Thirty-eight point 5 percent had a score signifying depression in the SDS; 20% had a pathological result in at least one of the anxiety scores. The ANOVA revealed that only anxiety as a trait symptom (STAIX2) had a significant influence on social function apart from the other factors (p<0.004). Additionally there was a trend for a significant influence of depressive symptoms (SDS) on social functioning (p=0.093). Symptoms of anxiety impair the social function of patients with epilepsy apart from depression, cognitive function, and seizure severity. They should be taken into account in the treatment of patients with epilepsy.
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Affiliation(s)
- Christina Kampf
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimerstr. 20, 18147 Rostock, Germany.
| | - Uwe Walter
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimerstr. 20, 18147 Rostock, Germany.
| | - Johannes Rösche
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimerstr. 20, 18147 Rostock, Germany; Klinik Lengg, Bleulerstr. 60, 8008 Zürich, Switzerland.
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Rösche J, Sieveking C, Kampf C, Benecke R. Creutzfeldt-Jakob-Like Syndrome due to Hypercalcemic Encephalopathy. Clin EEG Neurosci 2015; 46:327-30. [PMID: 24973231 DOI: 10.1177/1550059414529764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 03/05/2014] [Indexed: 11/15/2022]
Abstract
Hypercalcemia can cause a subacute syndrome of progressive dementia and marked changes in the electroencephalogram (EEG). We report a case of iatrogenic hypercalcemia with a close correlation between the clinical course and the EEG changes. A 73-year-old woman presented with a subacute syndrome of progressive dementia and bursts of 1.5 to 2 Hz intermittent rhythmic delta activity superimposed on a low-voltage background activity in the EEG. Clinical and EEG abnormalities rapidly resolved after normalization of serum calcium levels. As part of the diagnostic workup of a subacute progressive dementia, a serum calcium level and an EEG should be obtained to detect a Creutzfeldt-Jakob like syndrome in hypercalcemia. Unlike in Creutzfeldt-Jakob disease, and Creutzfeldt-Jakob-like syndrome induced by lithium intoxication, there are rarely myoclonic jerks and periodic discharges in hypercalcemic encephalopathy.
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Affiliation(s)
- Johannes Rösche
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Germany
| | - Catharina Sieveking
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Christina Kampf
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Germany
| | - Reiner Benecke
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Germany
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Walter U, Müller JU, Rösche J, Kirsch M, Grossmann A, Benecke R, Wittstock M, Wolters A. Magnetic resonance-transcranial ultrasound fusion imaging: A novel tool for brain electrode location. Mov Disord 2015; 31:302-9. [PMID: 26362398 DOI: 10.1002/mds.26425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/07/2015] [Accepted: 08/09/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A combination of preoperative magnetic resonance imaging (MRI) with real-time transcranial ultrasound, known as fusion imaging, may improve postoperative control of deep brain stimulation (DBS) electrode location. Fusion imaging, however, employs a weak magnetic field for tracking the position of the ultrasound transducer and the patient's head. Here we assessed its feasibility, safety, and clinical relevance in patients with DBS. METHODS Eighteen imaging sessions were conducted in 15 patients (7 women; aged 52.4 ± 14.4 y) with DBS of subthalamic nucleus (n = 6), globus pallidus interna (n = 5), ventro-intermediate (n = 3), or anterior (n = 1) thalamic nucleus and clinically suspected lead displacement. Minimum distance between DBS generator and magnetic field transmitter was kept at 65 cm. The pre-implantation MRI dataset was loaded into the ultrasound system for the fusion imaging examination. The DBS lead position was rated using validated criteria. Generator DBS parameters and neurological state of patients were monitored. RESULTS Magnetic resonance-ultrasound fusion imaging and volume navigation were feasible in all cases and provided with real-time imaging capabilities of DBS lead and its location within the superimposed magnetic resonance images. Of 35 assessed lead locations, 30 were rated optimal, three suboptimal, and two displaced. In two cases, electrodes were re-implanted after confirming their inappropriate location on computed tomography (CT) scan. No influence of fusion imaging on clinical state of patients, or on DBS implantable pulse generator function, was found. CONCLUSIONS Magnetic resonance-ultrasound real-time fusion imaging of DBS electrodes is safe with distinct precautions and improves assessment of electrode location. It may lower the need for repeated CT or MRI scans in DBS patients.
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Affiliation(s)
- Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jan-Uwe Müller
- Department of Neurosurgery, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Johannes Rösche
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Michael Kirsch
- Institute of Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Annette Grossmann
- Institute of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
| | - Reiner Benecke
- Department of Neurology, University of Rostock, Rostock, Germany
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Redecker J, Wittstock M, Benecke R, Rösche J. Comparison of the effectiveness of four antiepileptic drugs in the treatment of status epilepticus according to four different efficacy criteria. Epilepsy Behav 2015; 49:351-3. [PMID: 25960425 DOI: 10.1016/j.yebeh.2015.04.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/08/2015] [Accepted: 04/19/2015] [Indexed: 11/20/2022]
Abstract
The preliminary data presented here shall give an impression on how different criteria for the identification of an antiepileptic drug (AED) with a possible or certain treatment effect can have an influence on the results of retrospective case series. We present a data subset from a large retrospective study which, when completed, will cover all treatment episodes of status epilepticus (SE) at the neurological department of the Universitätsmedizin Rostock from January 2010 to June 2013. We compare and contrast the results of four different efficacy criteria for the effectiveness of phenytoin (PHT), valproate (VPA), levetiracetam (LEV), and lacosamide (LCM): criterion 1 = the last AED administered before SE termination; criterion 2 = the last drug introduced into the antiepileptic therapy within 72 h before SE termination and without changes in the comedication; criterion 3 = the last drug introduced into the antiepileptic therapy or increased in dose within 24h before SE termination without changes in the comedication; and criterion 4 = the last drug introduced into the antiepileptic therapy within 72 h before SE termination, even allowing changes in the comedication. Thirty-seven treatment episodes in 32 patients (13 male and 19 female, mean age at first episode: 68 years, SD: 17) could be analyzed. In 31 episodes, at least one AED was given intravenously. Efficacy rates in the whole case series according to all four criteria were not significantly different between the four AEDs, but there was a considerable difference in the efficacy rates of each AED when evaluating them with the different efficacy criteria. Our data show that statistically significant results concerning the efficacy of different AEDs in different subtypes of SE may depend on the outcome criteria. Therefore, efficacy criteria for the effectiveness of AEDs in the treatment of SE should be standardized. This article is part of a Special Issue entitled Status Epilepticus.
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Affiliation(s)
- Juliane Redecker
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Matthias Wittstock
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Reiner Benecke
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Johannes Rösche
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
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Rösche J, Rantsch K, Walter U, Wittstock M, Benecke R. Elektroenzephalografische Befunde bei unterschiedlichen Formen des Status epilepticus – Assoziation mit einzelnen Syndromen und prognostische Bedeutung. KLIN NEUROPHYSIOL 2015. [DOI: 10.1055/s-0035-1549890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - K. Rantsch
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - U. Walter
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - M. Wittstock
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - R. Benecke
- Klinik und Poliklinik für Neurologie, Universität Rostock
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Rösche J, Piek J, Hildebrandt G, Grossmann A, Kirschstein T, Benecke R. [Perampanel in the treatment of a patient with glioblastoma multiforme without IDH1 mutation and without MGMT promotor methylation]. Fortschr Neurol Psychiatr 2015; 83:286-9. [PMID: 26018396 DOI: 10.1055/s-0034-1399459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Malignant gliomas like glioblastoma multiforme (GBM) release glutamate which causes excitotoxic death to surrounding neurons, thereby vacating room for tumor expansion. We report the case of a patient with GBM treated with the AMPA receptor blocker Perampanel (PER) in combination therapy for partial seizures. Histological work-up of a biopsy showed the tissue of a GBM without mutation of the isocitrate dehydrogenase 1 (IDH1) and without promotor methylation of the O6-methylguanine-DNA methyltransferase (MGMT). In a group of patients with IDH 1 wild type and non-methylated MGMT a median survival of 199 days after surgery (i. e. 6.5 months) was described. Our patient lived about one year longer. PER rendered our patient seizure-free for at least the last seven months of his life. It was well tolerated and did not increase the toxicity of temozolomide. When choosing an antiepileptic drug (AED) for the treatment of seizures in patients with malignant brain tumors, the efficacy, the tolerability and perhaps possible effects on tumor progression of the AED should be taken into account.
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Affiliation(s)
- J Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - J Piek
- Chirurgische Klinik und Poliklinik, Abteilung für Neurochirurgie, Universitätsmedizin Rostock
| | - G Hildebrandt
- Klinik und Poliklinik für Strahlentherapie, Universitätsmedizin Rostock
| | - A Grossmann
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Rostock
| | - T Kirschstein
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - R Benecke
- Klinik und Poliklinik für Neurologie, Universität Rostock
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Redecker J, Wittstock M, Benecke R, Rösche J. Efficacy of perampanel in refractory nonconvulsive status epilepticus and simple partial status epilepticus. Epilepsy Behav 2015; 45:176-9. [PMID: 25819947 DOI: 10.1016/j.yebeh.2015.01.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 12/24/2022]
Abstract
We provide some evidence concerning the efficacy of perampanel (PER) in refractory status epilepticus (SE). We retroactively identified patients with SE treated in our department by searching for the term "status epilepticus" in the electronic archive of medical records. We present and analyze in this paper the subset of data of the patients treated with PER. We analyzed ten episodes of SE in nine patients. At the first administration, PER was given in a dosage of 6mg to most of our patients (7 of 10). On average, PER was administered as the 6th antiepileptic drug (AED) (range: 2-10). Depending on the criterion for efficacy, PER appears effective for the termination of SE in 2 to 6 (of 10) episodes. Unfortunately, safety data for the administration of PER with loading doses needed for the treatment of SE are lacking. Because of this, PER should be used very carefully in refractory SE and only after first-line treatment options have failed.
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Affiliation(s)
- Juliane Redecker
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Matthias Wittstock
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Reiner Benecke
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Johannes Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
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Fröscher W, Kirschstein T, Rösche J. Antiepileptikabehandlung bei Hirntumor-bedingten epileptischen Anfällen. Fortschr Neurol Psychiatr 2014; 82:678-90. [DOI: 10.1055/s-0034-1385475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- W. Fröscher
- Zentrum für Psychiatrie Südwürttemberg, Epilepsie-Zentrum Bodensee, Ravensburg-Weißenau
| | - T. Kirschstein
- Oscar-Langendorff-Institut für Physiologie, Universitätsmedizin Rostock
| | - J. Rösche
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
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Rösche J, Kampf C, Benecke R. Possible effect of perampanel on focal status epilepticus after generalized tonic-clonic status epilepticus. Acta Neurol Belg 2014; 114:243-4. [PMID: 23801431 DOI: 10.1007/s13760-013-0225-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Johannes Rösche
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimerstr. 20, 18147, Rostock, Germany,
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Rösche J, Pohley I, Jung SU, Benecke R. Meropenem und Valproinsäure – Eine Kombination mit schwerwiegendem Interaktionspotenzial. Akt Neurol 2014. [DOI: 10.1055/s-0034-1370964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. Rösche
- Klinik für Neurologie und Poliklinik, Universitätsmedizin Rostock
| | - I. Pohley
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Sana Hanse-Klinikum Wismar
| | - S.-U. Jung
- Klinik für Neurologie und Poliklinik, Universitätsmedizin Rostock
| | - R. Benecke
- Klinik für Neurologie und Poliklinik, Universitätsmedizin Rostock
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Rühle N, Schley A, Pohley I, Kampf C, Benecke R, Rösche J. Neuropsychological deficits after a first unprovoked seizure and depressive symptoms in the week before. Epilepsy Behav 2014; 31:334-8. [PMID: 24262784 DOI: 10.1016/j.yebeh.2013.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/17/2022]
Abstract
This prospective study was performed to investigate whether verbal memory deficits are present in patients with a first unprovoked seizure irrespective of significant lesions in the brain and whether symptoms of depression were experienced by those patients in the week before the seizure. After having given informed consent, patients who presented with a first unprovoked seizure were investigated with a psychometric battery consisting of a verbal memory test, a figural memory test, a test following the Stroop paradigm, and a self-rating scale for depression in addition to the routine diagnostic work-up with EEG and MRI. The data of 53 patients aged 45years on average (33 males and 20 females) were available. Verbal memory deficits were present in 60% of the patients, and 21% of the patients delivered a self-rating that was suggestive of at least minor depression in the week before the seizure. Neither verbal memory deficits nor symptoms of depression were associated with a significant lesion of the brain. There was a significant negative correlation between immediate recall in the verbal memory test and the score in the self-rating scale for depression. Our data suggest that even at the time of the first unprovoked seizure, there is an epileptic condition of the brain, which facilitates the occurrence of verbal memory deficits and depression in the presence of an epileptogenic focus irrespective of its localization.
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Affiliation(s)
- Nicol Rühle
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Annett Schley
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Inga Pohley
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Sana Hanse-Klinikum Wismar, Störtebekerstraße 6, 23966 Wismar, Germany
| | - Christina Kampf
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Reiner Benecke
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Johannes Rösche
- Universitätsmedizin Rostock, Klinik und Poliklinik für Neurologie, Gehlsheimer Str. 20, 18147 Rostock, Germany.
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Rantsch K, Walter U, Wittstock M, Benecke R, Rösche J. Treatment and course of different subtypes of status epilepticus. Epilepsy Res 2013; 107:156-62. [DOI: 10.1016/j.eplepsyres.2013.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/25/2013] [Accepted: 08/03/2013] [Indexed: 11/29/2022]
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Abstract
The breach rhythm is sometimes considered the consequence of reduced resistance between the cortex and the scalp electrode in the region of a skull defect. On the other hand, the electroencephalographic (EEG) changes after craniotomy were attributed to an activation of EEG activity by meningocortical adhesions with admixed gliosis. We report changes of the breach rhythm in a patient with astrocytoma, which give further evidence that the breach rhythm is not merely the result of physical changes in the area of a skull defect. In our patient, the breach rhythm was no longer detectable before a new tumor progression took place, showed up again, and at the end changed into localized slowing before the deterioration of the patient's general medical condition. This case suggests that in patients with brain tumors, the loss or attenuation in frequency of an established breach rhythm might be considered as an indication of a new tumor progression.
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Affiliation(s)
- Christina Kampf
- Klinik und Poliklinik für Neurologie Universität Rostock, Rostock, Germany
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Hensler K, Uhlmann C, Porschen T, Benecke R, Rösche J. Generic substitution of antiepileptic drugs--a survey of patients' perspectives in Germany and other German-speaking countries. Epilepsy Behav 2013; 27:135-9. [PMID: 23416284 DOI: 10.1016/j.yebeh.2012.12.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/03/2012] [Accepted: 12/28/2012] [Indexed: 11/28/2022]
Abstract
In this study, we sought to determine the patients' attitudes towards generic substitution of antiepileptic drugs (AEDs) and their experiences with the usage of generic antiepileptic drugs in Germany and other German-speaking countries. A questionnaire was designed for a cross-sectional study. Two thousand copies of the questionnaire were delivered with a magazine edited by a patients' organization. Additionally, the questionnaire was placed on the internet platform of another patients' organization. Thirty-two percent of the patients who already experienced a switch to generic AEDs complained of problems with the switch. Patients who answered the magazine survey worried significantly more about generic substitution of AEDs than patients who answered the internet version. Patients who had never switched were more concerned about generic substitution than those who had already switched. Moreover, patients' beliefs differed between the use of generic drugs in acute medical conditions such as pain and infections and the use of generic AEDs in epilepsy.
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Affiliation(s)
- Katrin Hensler
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Germany
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Rösche J, Pohley I, Rantsch K, Walter U, Benecke R. [Experience with levetiracetam in the treatment of status epilepticus]. Fortschr Neurol Psychiatr 2012; 81:21-7. [PMID: 22890440 DOI: 10.1055/s-0032-1312951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Non-convulsive status epilepticus and epilepsia partialis continua are common epileptic conditions for which straightforward recommendations based on controlled randomised trials for treatment of therapy refractory courses are lacking. Therefore in these conditions sometimes antiepileptic drugs that are not approved by governmental authorities for the treatment of status epilepticus (SE) are used. Here we review all case reports and case series concerning the treatment of SE with levetiracetam (LEV), that had been listed in pub-med up to December 12th 2011. Additionally we analysed abstracts and papers in peer reviewed journals, that were listed in the references of the primarily reviewed papers. Furthermore we looked for LEV treatments in papers on the use of lacosamide (LCM) in SE. LEV was given in dosages ranging from 500 mg to 9000 mg per day. Side effects were especially sedation and irritability. Estimated on the basis of the case series the overall success-rate of LEV in terminating status epilepticus may be set in a range between 53.7% and 58.1%. Therefore LEV may be a useful alternative for the treatment of SE when the approved drugs are contraindicated or when these drugs have been taken without success.
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Affiliation(s)
- J Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock.
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Abstract
Objective: In this retrospective study, we tested the hypothesis that patients with epilepsy (PWE) with moderate to major depression have more severe memory deficits than PWE with mild depression or no depression.Methods: Hundred and thirty-nine patients with chronic epilepsy were studied with the Self-Rating Depression Scale (SDS) and a neuropsychological-screening battery the day after admission on a specialised ward for PWE. For this study the data from the Memo-test for verbal memory and from the Benton-test for non-verbal memory were taken into account. For testing of the hypothesis of independence of memory deficits and grade of depression we performed a statistical analysis.Results: Eighty-three patients (59.7%) had a pathological score in the SDS, but only 36 (25.9%) scored in the range of a moderate to major depression. When all 83 patients with a pathological score in the SDS were taken into account, these patients did not differ on any cognitive measure from those without pathological score in SDS. The only significant association in our study was found between pathological results in immediate verbal recall and a score in the SDS for moderate to major depression (p = 0.038).Conclusion: Minor depressive symptoms may be a response to chronic illness without any impact on cognitive functioning. Nevertheless, a verbal memory deficit associated with major depression was observed in our study even in the presence of many confounding factors. This may be a hint for an association of severe depressive symptoms with left temporal dysfunction in PWE.
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Affiliation(s)
- Johannes Rösche
- Epilepsiezentrum Bodensee, 88214 Ravensburg-Weissenau, Germany
| | - Günther Kundt
- Institut für Biostatistik und Informatik in Medizin und Alternsforschung, Universität Rostock, 18057 Rostock, Germany
| | - Raimund Weber
- Epilepsiezentrum Bodensee, 88214 Ravensburg-Weissenau, Germany
| | - Walter Fröscher
- Epilepsiezentrum Bodensee, 88214 Ravensburg-Weissenau, Germany
| | - Carmen Uhlmann
- Epilepsiezentrum Bodensee, 88214 Ravensburg-Weissenau, Germany
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Abstract
Use of Monotherapy is acknowledged as the standard anticonvulsant therapy although no more than about 65% of patients become seizure-free with a single antiepileptic drug. Therefore, up to 50% of patients with epilepsy are treated at least intermittently with more than one antiepileptic drug. The percentage of patients achieving complete seizure control with combination therapy after ineffective monotherapy is small. Monotherapy and combination therapy are not always contrary to each other; many anticonvulsants have different modes of action and are effectively a combination therapy in one drug. Combinations of anticonvulsants with differing mechanisms of action are called "rational polypharmacy". A superior efficacy of these combinations over combinations of anticonvulsants with identical or similar mechanisms of action have not been proved by randomised trials. Add-on trials with lacosamide and the combination of lamotrigine and valproic acid, however, suggest a superior tolerability and/or efficacy of combinations with differing mechanisms of action. Treatment with drug combinations should take into account, above all, efficacy and safety, interactions, and costs of each antiepileptic drug as well as comorbidity.
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Affiliation(s)
- W Fröscher
- Epilepsiezentrum Bodensee, Zentrum für Psychiatrie Südwürttemberg, Ravensburg-Weissenau.
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Kampf C, Benecke R, Rösche J. Veränderungen des Narbenrhythmus (Breach Rhythm, BR) im Krankheitsverlauf eines Patienten mit Astrozytom. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rantsch K, Walter U, Wittstock M, Benecke R, Rösche J. Efficacy of intravenous lacosamide in refractory nonconvulsive status epilepticus and simple partial status epilepticus. Seizure 2011; 20:529-32. [DOI: 10.1016/j.seizure.2011.03.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/12/2011] [Accepted: 03/18/2011] [Indexed: 11/16/2022] Open
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Rösche J, Kundt G, Weber R, Fröscher W, Uhlmann C. The impact of antiepileptic polytherapy on mood and cognitive function. Acta Neurol Belg 2011; 111:29-32. [PMID: 21510230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This retrospective study was performed to reevaluate the effect of polytherapy on mood and cognitive function. 139 patients with refractory epilepsy were screened with a neuropsychological test battery and a depression score. Our regression model with age at admission, duration of the disorder and number of antiepileptic drugs as independent variables had a significant influence on 10 out of 11 neuropsychological parameters but not on depression. Looking at the significance of each predictor variable the number of antiepileptic drugs had a significant effect only on the estimation of the fluid intelligence. A significant effect on five neuropsychological parameters was found for the predictor variable duration of the disorder. Therefore our data do not support the commonly reported hypothesis that antiepileptic polytherapy itself is a substantial risk factor for cognitive deficits or depression in patients with refractory epilepsy. But there may be an influence of accumulative drug load during the course of the disorder as reflected by the effect of the duration of the disorder on five neuropsychological parameters.
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Rösche J, Schley A, Schwesinger A, Grossmann A, Mach H, Benecke R, Walter U. Recurrent aphasic status epilepticus after prolonged generalized tonic-clonic seizures versus a special feature of Todd's paralysis. Epilepsy Behav 2011; 20:132-7. [PMID: 21131238 DOI: 10.1016/j.yebeh.2010.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 10/30/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Abstract
Postictal aphasia may be a feature of Todd's paralysis or the presentation of aphasic nonconvulsive status epilepticus (NCSE). We describe a 74-year-old woman with three episodes of aphasic status epilepticus after prolonged generalized tonic-clonic seizures. In the first episode, the NCSE was not definitively diagnosed, but an increase in the epileptic medication led to resolution of the epileptic activity within 2 weeks. During the second episode, NCSE was terminated within 7 days under intensified antiepileptic treatment. In the third episode, phenytoin treatment led to intoxication and resulted in further treatment on an intensive care unit. The patient required several months to recover from this episode. NCSE in the elderly is difficult to recognize, especially when it presents as a prolonged postictal deficit like aphasia. Once diagnosed it has to be treated carefully, because in the elderly, aggressive treatment strategies may be associated with a high risk of adverse events.
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Affiliation(s)
- J Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock, Rostock, Germany.
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Rösche J, Schwesinger A, Greim B, Benecke R. Temporale intermittierende Delta-Aktivität (TIRDA) und neuropsychologische Defizite bei familiärer mesialer Temporallappen-Epilepsie (FMTLE). KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1249088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rösche J, Uhlmann C, Fröscher W. Kognitive Defizite und psychiatrische Störungen in Frühstadien epileptischer Erkrankungen. Fortschr Neurol Psychiatr 2010; 78:18-26. [DOI: 10.1055/s-0028-1109887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rösche J. [Research and quality control at a neuropsychiatric epilepsy clinic]. Fortschr Neurol Psychiatr 2009; 77 Suppl 1:S58-S60. [PMID: 19685396 DOI: 10.1055/s-0028-1109603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Quality management in German health care services is demanded by law. If a monitoring of treatment results using scientifically established scores is performed as a part of quality management, the data may also be used for research on the course and the outcome of chronic disease and even for basic research. Using a multimodal therapy monitoring on a neuropsychiatric ward for patients with refractory epilepsy it could be shown that comprehensive treatment strategies were able to enhance cognitive abilities, mood and coping-strategies. The introduction of selective serotonin reuptake inhibitors (e. g. citalopram, sertraline) did not result in an increased burden of seizures. Interesting for understanding the multiple causes of depression was the finding that folic acid serum levels in the lower normal range or below were associated with a higher risk of depressive mood.
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Affiliation(s)
- J Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Strasse 20, Rostock.
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Fröscher W, Raape J, Rösche J. Reversibler GGT-Anstieg bei einer Levetiracetam-Kombinationstherapie. Akt Neurol 2005. [DOI: 10.1055/s-2005-866928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fröscher W, Schier KR, Hoffmann M, Meyer A, May TW, Rambeck B, Rösche J. Topiramate: a prospective study on the relationship between concentration, dosage and adverse events in epileptic patients on combination therapy. Epileptic Disord 2005; 7:237-48. [PMID: 16162434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 02/14/2005] [Indexed: 05/04/2023]
Abstract
RATIONALE The relationship between topiramate (TPM) concentration, dosage and adverse events in patients with epilepsy is still controversial. We therefore performed a prospective study in patients with poorly controlled epilepsy treated with TPM, predominantly in combination with other antiepileptic drugs. The goal of the study was to investigate the relationship between the occurrence of adverse events due to TPM and its serum concentration or dosage, respectively. METHODS The relationship between the occurrence of adverse events and TPM serum concentration or dosage, respectively, was examined in a group of 42 young adult and adult patients with poorly controlled epilepsy. Within 22 months, all patients treated with TPM had been included in the study. The 8 adverse events occurring most frequently (difference > or = 10%) in TPM-treated patients in 5, double-blind, placebo-controlled, parallel group studies, were checked regularly. This side effect profile has been presented by Reife et al. (1995a). Other possible or probable adverse events were also documented. RESULTS The difference in TPM serum concentrations and TPM dosages (mg/kg) for patients without an adverse event, and patients with a given adverse event was statistically significant for "abnormal thinking, impaired concentration, weight loss, dizziness, speech problems, somnolence, ataxia, increased seizure frequency and paresthesia". To avoid adverse events, we recommend an initial "maintenance serum concentration" of below 4 microg/mL. As regards the TPM dosage, our results suggest initial maintenance dosages of 100 TPM or lower, 1.5 mg/kg or lower, respectively. These conclusions are limited by the relatively small number of patients.
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Affiliation(s)
- Walter Fröscher
- Department of Neurology and Epileptology, the Epilepsy Center Bodensee, Die Weissenau, Germany.
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Rösche J, Uhlmann C, Fröscher W. [On the value of neuropsychological short tests in epileptology]. Nervenarzt 2004; 75:1204-8. [PMID: 15349735 DOI: 10.1007/s00115-004-1777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Cognitive deficits are common in patients with epilepsy refractive to therapy and have considerable influence on the quality of life in this group of patients. Therefore, neuropsychological investigations should play an important role in the comprehensive evaluation of patients with chronic epilepsy. The aim of this study was to examine whether a reliable screening for cognitive deficits in these patients may be reduced to the assessment of two bedside tests. In a prospective study we analyzed the results of 40 patients with epilepsy refractive to therapy subjected to a 45-min neuropsychological screening battery and compared them with the results of a short battery consisting of two bedside tests. Using the screening battery as the gold standard, the short battery had a sensitivity of 50% and a specificity of 100%. Changing the criteria for pathological results in the short battery, sensitivity could be raised to 81.25% but specificity fell to 50%. Therefore, bedside tests instead of longer neuropsychological testing cannot be recommended as a screening method for cognitive deficits in patients with chronic epilepsy.
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Affiliation(s)
- J Rösche
- Abteilung für Neurologie und Epileptologie, DIE WEISSENAU, Zentrum für Psychiatrie, Ravensburg
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Rösche J, Uhlmann C, Weber R. [Changes of coping strategies in patients with therapy refractory epilepsy in the course of a ward based treatment with a holistic therapeutic approach]. Psychother Psychosom Med Psychol 2004; 54:4-8. [PMID: 14722833 DOI: 10.1055/s-2003-812588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In this study we examined whether individual coping strategies improve in the course of a ward based treatment with a holistic therapeutic approach. An increase in problem-focussed coping and a decrease in emotion-focussed coping or avoidance-oriented coping were considered as improvement. As a part of a comprehensive therapy monitoring 65 patients with therapy refractory epilepsy were studied with the Freiburg Questionnaire of coping with Illness (FKV) on the day after admittance to a specialized epilepsy ward. A second investigation with the FKV was performed on the day before discharge. A decrease in depressive coping and cognitive avoidance and an increase in problem focussed coping could be documented. These changes could not be interpreted as an effect of better seizure control or antidepressive drugs. This may be a hint for the efficacy of a holistic treatment approach to increase the patient's resources for a successful psychosocial adjustment to therapy refractory epilepsy.
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Affiliation(s)
- Johannes Rösche
- Abteilung Neurologie und Epileptologie, Zentrum für Psychiatrie, Die Weissenau (Abt. Psychiatrie I der Universität Ulm)/Epilepsiezentrum Bodensee, Ravensburg-Weissenau
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Rösche J, Uhlmann C, Weber R. Der Einfluss von Erkrankungsalter, Lebensalter und Krankheitsdauer auf die kognitiven Leistungen bei Patienten mit therapierefraktärer Epilepsie. Fortschr Neurol Psychiatr 2003; 71:595-9. [PMID: 14608511 DOI: 10.1055/s-2003-43466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This retrospective study was performed as part of the controversial discussion whether increasing cognitive deficits in patients with refractory epilepsy are mainly an effect of normal aging or caused by epilepsy related noxious events during the course of an intractable epilepsy. Neuropsychological data and information about the course of the disease from 146 patients with refractory epilepsy were available. There were significant correlations between the age at onset and premorbid intelligence, duration of disease and fluid intelligence and age and difference between premorbid intelligence and fluid intelligence as a measure of cognitive deterioration. Discussing these results we conclude that beneath a clear effect of normal aging on cognitive deterioration there is probably a small effect of the refractory course of the epilepsy, which might be mediated by the number of seizures. Additionally we would like to encourage early cognitive screening and rehabilitation programmes for patients with epilepsy to minimize the effect of the age of onset on the level of education or premorbid intelligence.
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Affiliation(s)
- J Rösche
- Abteilung Neurologie und Epileptologie, Zentrum für Psychiatrie, DIE WEISSENAU/Epilepsiezentrum Bodensee, Ravensburg-Weissenau
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Abstract
This study takes into consideration whether low serum folate levels may contribute to depressive mood in patients with chronic epilepsy. The serum folate levels and the score on the Self-Rating Depression Scale (SDS) were examined in 46 patients with chronic epilepsy. Patients with a score indicating at least minor depression on the SDS had a significantly lower serum folate level than patients with a normal score on SDS. There was a significant negative correlation between the serum folate levels and the SDS score. A serum folate level below 7.5 ng/ml was significantly associated with a pathological score on SDS. Because a serum folate level of 7.5 ng/ml is in the normal range for many laboratories, further studies using total plasma homocysteine as a sensitive measure of functional folate deficiency are required to elucidate the impact of folate metabolism on depressive mood in patients with chronic epilepsy.
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Affiliation(s)
- Johannes Rösche
- Department of Neurology and Epileptology, University of Ulm, Ravensburg, Germany
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Rösche J, Uhlmann C, Weber R, Fröscher W. The influence of folate serum levels on depressive mood and mental processing in patients with epilepsy treated with enzyme-inducing anti-epileptic drugs. Acta Neuropsychiatr 2003; 15:63-7. [PMID: 26984794 DOI: 10.1034/j.1601-5215.2003.00009.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Folate deficiency is common in patients with epilepsy and also occurs in patients with depression or cognitive deficits. OBJECTIVE This study investigates whether low serum folate levels may contribute to depressive mood and difficulties in mental processing in patients with epilepsy treated with anti-epileptic drugs inducing the cytochrome P450. METHODS We analysed the serum folate levels, the score in the Self Rating Depression Scale (SDS) and the results of a bedside test in mental processing in 54 patients with epilepsy. RESULTS There was a significant negative correlation between the serum folate levels and the score in SDS and significant positive correlations between the score in SDS and the time needed to process an interference task or a letter-reading task. CONCLUSIONS Low serum folate levels may contribute to depressive mood and therefore to difficulties in mental processing. Further studies utilizing total plasma homocysteine as a sensitive measure of functional folate deficiency and more elaborate tests of mental processing are required to elucidate the impact of folate metabolism on depressive mood and cognitive function in patients with epilepsy.
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Affiliation(s)
- J Rösche
- 1Department of Neurology and Epileptology (Department of Psychiatry I, University of Ulm), Die Weissenau, Ravensburg, Germany
| | - C Uhlmann
- 1Department of Neurology and Epileptology (Department of Psychiatry I, University of Ulm), Die Weissenau, Ravensburg, Germany
| | - R Weber
- 1Department of Neurology and Epileptology (Department of Psychiatry I, University of Ulm), Die Weissenau, Ravensburg, Germany
| | - W Fröscher
- 1Department of Neurology and Epileptology (Department of Psychiatry I, University of Ulm), Die Weissenau, Ravensburg, Germany
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