Old Remedies for Epilepsy: Avicenna\u27s Medicine.

BACKGROUND: The history of epilepsy and its treatments dates back to at least 4 millennia. Avicenna, c. 980 AD in Bukhara, Khorasan-1037 in Hamedan was a Persian-speaking Iranian physician, who has many recommendations and suggested various therapies for epilepsy in his book, The Canon of Medicine. METHODS: We first reviewed the most important ancient treatments for epilepsy mentioned by Avicenna and considered those as the key words for our next step. Then, we made a literature search (medline and scopus) with those key words to find out new scientific findings in modern medicine about the Avicenna\u27s suggestions. RESULTS: Among the Avicenna\u27s recommended therapies for epilepsy, only Rue has been tested for anticonvulsant activities in modern medicine. Interestingly, it had a dose dependent anticonvulsant effect. CONCLUSION: It is worthwhile to consider the Avicenna\u27s recommended therapies for epilepsy and to design future scientific studies based on his suggestions

Depression and Anxiety in Patients with Epilepsy, With or Without Other Chronic Disorders

BACKGROUND: Most people with epilepsy lead a normal emotional and cognitive life, however neurobehavioral problems can be found in a large number of patients. This study evaluates the prevalence of depression and anxiety among patients with epilepsy and determines whether having other chronic somatic illnesses increases the prevalence. METHODS: Adults with epilepsy were recruited in either the inpatient epilepsy monitoring unit or the Outpatient Epilepsy Clinic at Thomas Jefferson University in 2006. Patients anonymously filled out a questionnaire, included data about age, sex, education, having other chronic illnesses, and degree of seizure control. The Hospital Anxiety and Depression scale was used to define the presence or absence of anxiety and depression. RESULTS: Two hundreds patients participated, with a mean age of 40.3±16 years. Nineteen (9.5%) patients had depression and 49 (24.5%) had anxiety. Age, seizure control, and having other chronic illnesses did not have a significant relationship with either depression or anxiety. Gender was significantly related to anxiety, with females displaying greater frequency of anxiety than males. Depression was inversely related to education. CONCLUSIONS: It is probable that people with higher education use more effective ways to psychologically and physically adapt to their illness

Comparison of temporal lobe epilepsy with hippocampal sclerosis and temporal lobe epilepsies due to other etiologies.

BACKGROUND: This study compares the clinical characteristics of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) with those who have temporal lobe epilepsy (TLE) due to other etiologies. METHODS: In this retrospective study all patients with a clinical diagnosis of TLE were recruited in a referral outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 to May 2013. We classified the patients with TLE as having mesial temporal sclerosis if they had clear signs of mesial temporal sclerosis and/or atrophy in their MRI and others who had any other MRI abnormality. RESULTS: A total of 174 patients were studied (including 105 patients with mTLE-HS and 69 patients with TLE due to other etiologies). Frequency of seizure types was not significantly different between these two groups. Earlier age at epilepsy onset (p= 0.005), a past history of febrile seizures (p= 0.010) and presence of affective auras (p= 0.008) were commonly seen in patients with mTLEHS, while auditory auras (p= 0.020) were more frequent in those with TLE due to other etiologies. CONCLUSION: The mainstay for making a correct diagnosis, when evaluating a patient with seizure, is having a standardized approach, particularly with regard to taking a detailed clinical history. One may find important clues in the clinical history (e.g., age at disease onset, detailed seizure description and past history) to make a correct diagnosis

Psychogenic non-epileptic seizures in Iran

AbstractPurposeWe investigated the demographic and clinical characteristics of psychogenic non-epileptic seizures (PNES) in patients in Iran.MethodsIn this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2013. The epileptologist interviewed all the patients. We investigated the demographic and clinical characteristics of PNES.ResultsTwo hundred and forty-nine patients were diagnosed as having PNES. Two hundred and eleven patients had video-EEG recordings available and included in the study. One hundred and forty-one (66.8%) were female and 70 (33.2%) were male. There were no significant differences between our patients and previous reports regarding the clinical and semiological characteristics of PNES.ConclusionPsychogenic non-epileptic seizures are relatively common at epilepsy clinics. It appears that an Islamic lifestyle (in Iran) has little influence on the clinical characteristics and manifestations of PNES, as we observed similar results as in most previous studies from other cultures

Generalized Spike-Waves in Idiopathic Generalized Epilepsies: Does Their Frequency Matter?

OBJECTIVES: We hypothesized that the frequency (in Hertz) of generalized spike-waves (GSWs) in patients with idiopathic generalized epilepsy (IGE) has associations with the syndromic diagnosis as well as with the prognosis of patients (their response to medical treatment). METHODS: This was a retrospective study of a prospectively developed database. All patients with a diagnosis of IGE were studied at the epilepsy center at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2022. Patients were classified into four IGE syndromes: childhood absence epilepsy; juvenile absence epilepsy; juvenile myoclonic epilepsy; and generalized tonic-clonic seizures alone. RESULTS: Five hundred and eighty-three patients were studied. GSWs were commonly observed in all four syndromes of IGE. Frequency of GSW (in Hertz) did not have a significant association with the syndromic diagnosis of the patients (p = .179). The presence of GSW did not have a significant association with the seizure outcome (becoming seizure free or not) of the patients (p = .416). Frequency of GSW did not have a significant association with the seizure outcome of the patients either (p = .574). CONCLUSION: GSWs are the hallmark electroencephalographic footprints of idiopathic generalized epilepsies; however, neither their presence nor their frequency has practical associations with the syndromic diagnosis of IGEs or their outcome (response to treatment)

Terminology for psychogenic nonepileptic seizures:Making the case for "functional seizures"

PURPOSE: The purpose of the study was to review the literature on the terminologies for psychogenic nonepileptic seizures (PNES) and make a proposal on the terminology of this condition. This proposal reflects the authors' own opinions.METHODS: We systematically searched MEDLINE (accessed from PubMed) and EMBASE from inception to October 10, 2019 for articles written in English with a main focus on PNES (with or without discussion of other functional neurological disorders) and which either proposed or discussed the accuracy or appropriateness of PNES terminologies.RESULTS: The search strategy reported above yielded 757 articles; 30 articles were eventually included, which were generally of low quality. "Functional seizures" (FS) appeared to be an acceptable terminology to name this condition from the perspective of patients. In addition, FS is a term that is relatively popular with clinicians.CONCLUSION: From the available evidence, FS meets more of the criteria proposed for an acceptable label than other popular terms in the field. While the term FS is neutral with regard to etiology and pathology (particularly regarding whether psychological or not), other terms such as "dissociative", "conversion", or "psychogenic" seizures are not. In addition, FS can potentially facilitate multidisciplinary (physical and psychological) management more than other terms. Adopting a universally accepted terminology to describe this disorder could standardize our approach to the illness and facilitate communication between healthcare professionals, patients, their families, carers, and the wider public.</p

Epilepsy management during difficult times

Major disruption in the delivery of healthcare services can occur in exceptional situations such as natural disasters, conflicts, periods of severe economic hardship, and epidemics. These disruptions typically affect to the greatest extent the most vulnerable segments of the population, including people with epilepsy. Inability to access healthcare services can lead to failure to undergo necessary diagnostic investigations, or to receive needed therapeutic interventions, including epilepsy surgery. Stress and other factors associated with the nature or the cause of the disruption can adversely affect seizure control status, or precipitate the occurrence of psychiatric disorders and other comorbid conditions. Failure to access antiseizure medications is a common occurrence in these situations and can result in loss of seizure control, withdrawal seizures, and status epilepticus. In this article, we provide examples of recent disruptions in healthcare and their implications for people with epilepsy. We discuss the consequences of natural disasters, conflicts, economic sanctions, and focus in greater detail on lessons learnt during the COVID-19 pandemic. We also discuss possible mitigation procedures, focusing in particular on the application of telemedicine to epilepsy care. Finally, we underline the need for governments, healthcare authorities, and international organizations to improve their preparedness to deal with exceptional situations that may arise in the future

Effect of the COVID-19 Pandemic on Seizure Control Status in Patients With Epilepsy

Background: Previous studies have shown that patients with epilepsy (PWE) perceived significant disruption in the quality and provision of care due to the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to investigate the effect of this pandemic on seizure control status and changes in seizure frequency in PWE. Methods:A consecutive sample of adult PWE registered in the database of Shiraz Epilepsy Center (Shiraz, Iran) was included in the study. In July 2021, phone interviews were conducted with all selected patients. Information such as age, sex, last seizure, seizure type, and frequency during the 12 months before the study, and history of COVID-19 contraction was extracted. The seizure control status of the patients in 2019 (pre-pandemic) was compared with that during the COVID-19 pandemic. Data were analyzed using SPSS software with the Fisher’s exact test and Pearson’s Chi squared test. P Results: A total of 158 patients were included in the study, out of which 62 (39.2%) patients had a stable seizure control status, 47 (29.7%) had fewer seizures, and 50 (31.6%) had more seizures. Breakthrough seizures were reported by 32 (34.4%) patients. Seizure frequency increased in 18 (27.7%) and decreased in 46 (70.7%) patients. Conclusion: Overall, the COVID-19 pandemic has not been a major precipitating factor nor has it affected the seizure control status of PWE. In treated epilepsy, a fluctuating course with periods of seizure freedom followed by relapses is part of its natural history

Efficacy and tolerability of adjunctive brivaracetam in patients with prior antiepileptic drug exposure: A post-hoc study.

Brivaracetam (BRV), a selective, high-affinity ligand for synaptic vesicle protein 2A, is a new antiepileptic drug (AED) for adjunctive treatment of focal (partial-onset) seizures in adults with epilepsy. This post-hoc analysis was conducted to explore the efficacy of adjunctive BRV in patients with prior levetiracetam (LEV) exposure and whether changes in efficacy were related to the similar mechanism of action of these two drugs. Data were pooled from three Phase III studies (NCT00490035; NCT00464269; NCT01261325) of adults with focal seizures taking 1-2 AEDs who received placebo or BRV 50-200mg/day without titration over a 12-week treatment period. Patients taking concomitant LEV at enrollment were excluded from this analysis. Patients were categorized by their status of prior exposure to LEV, carbamazepine (CBZ), topiramate (TPM), or lamotrigine (LTG), to investigate any consistent trend towards reduced response in AED-exposed subgroups compared to AED-naïve subgroups, regardless of the mechanism of action. Study completion rates, percent reduction from baseline in focal seizure frequency over placebo, ≥50% responder rates, and tolerability were evaluated for each subgroup. A total of 1160 patients were investigated. Study completion rates were similar in the AED-exposed subgroups and AED-naïve subgroups. In subgroups with (531 patients) or without (629 patients) prior LEV exposure, ≥50% responder rates for each dose of BRV compared with placebo were generally higher among the LEV-naïve subgroups than the previously LEV-exposed subgroups. LEV-exposed subgroups receiving BRV doses ≥50mg/day showed greater ≥50% responder rates than those receiving placebo. Similar results were observed for CBZ, TPM, and LTG. Previous treatment failure with commonly prescribed AEDs (LEV, CBZ, TPM, or LTG) is associated with a reduced response to BRV irrespective of the mechanism of action. Hence, this post-hoc analysis indicates that previous treatment failure with LEV does not preclude the use of BRV in patients with epilepsy