Role of Anticonvulsants in the Management of AIDS Related Seizures

Seventy percent of the AIDS patients have neurological complications. Seizures are one of the complications and can occur at any stage. Seizures can be life-threatening and treatment with anticonvulsants is warranted. The therapeutic dilemma occurs in this case because of the interactions between the anticonvulsants, especially the first generation anticonvulsants, with antiretroviral agents resulting in significant side-effects including toxicity. The non-availability of second-generation anticonvulsants and cost constraints further limit the choices for the physicians. In this mini-review, we discuss the management of AIDS related seizures with emphasis on the drug–drug interactions between anticonvulsants and antiretroviral agents. We will also address the future directions and the need for prospective studies with second-generation anticonvulsants

Case Report Sporadic Hemiplegic Migraine with ATP1A2 and Prothrombin Gene Mutations

Background. Hemiplegic migraine is a rare type of migraine that may present in children and adolescents. Both familial and sporadic hemiplegic migraines have similar prevalence and clinical characteristics. Patient. We report an adolescent with sporadic hemiplegic migraine who previously had a similar attack in the past and who was initially evaluated for a possible acute ischemic event. Results. Magnetic resonance angiography showed dilatation of the left middle cerebral artery that resolved in a follow-up study. She was also found to have a ATP1A2 (c.2273 G>C) mutation and a heterozygous prothrombin mutation. Conclusions. We suggest that patients with sporadic hemiplegic migraine be tested for both ATP1A2 mutations which in some cases may be pathogenic, and prothrombin mutations which increase the stroke risk for this patient population

The Role of Levetiracetam in Treatment of Seizures in Brain Tumor Patients

Levetiracetam, trade name Keppra, is a new second generation antiepileptic drug that is being increasingly used in brain tumor patients. In patients suffering with brain tumors, seizures are one of the leading neurologic complications being seen in more than 30% of patients. Unlike other antiepileptic drugs, levetiracetam is proposed to bind to a synaptic vesicle protein inhibiting calcium release. Brain tumor patients are frequently on chemotherapy or other drugs that induce cytochrome P450, causing significant drug interactions. However, levetiracetam does not induce the P450 system and does not exhibit any relevant drug interactions. Intravenous delivery is as bioavailable as the oral medication allowing it to be used in emergency situations. Levetiracetam is an attractive option for brain tumor patients suffering from seizures, but also can be used prophylactically in patients with brain tumors, or patients undergoing neurological surgery. Emerging studies have also demonstrated that levetiracetam can increase the sensitivity of Glioblastoma tumors to the chemotherapy drug temozolomide. Levetiracetam is a safe alternative to conventional antiepileptic drugs and an emerging tool for brain tumor patients combating seizures

Pediatric Stroke: Overview and Recent Updates

Stroke can occur at any age or stage in life. Although it is commonly thought of as a disease amongst the elderly, it is important to highlight the fact that it also affects infants and children. In both populations, strokes have a high rate of morbidity and mortality. Arguably, it is more detrimental in the pediatric population given the occurrence at a younger age and therefore, a longer duration of disability, potentially over the entire lifespan. The high rate of morbidity and mortality in pediatrics is attributed to significant delays in diagnosis, as well as misdiagnosis. Acute stroke management is time dependent. Patients who receive acute treatment with either intravenous (IV) tissue plasminogen activator (tPA) or mechanical thrombectomy, have improved mortality and functional outcomes. Additionally, the earlier treatment is initiated, the higher the likelihood of preserving penumbra, restoring cerebral blood flow and potentially reversing symptoms, thereby limiting disability. Prompt identification is essential as it leads to improved patient care in such a narrow therapeutic window. It enhances the care received during hospitalization and reduces the risk of early stroke recurrence. Despite limited data and lack of large randomized clinical trials in pediatrics, both IV tPA and mechanical thrombectomy have been successfully used. Bridging the gap of acute stroke management in the pediatric population is an essential part of minimizing adverse outcomes. In this review, we discuss the epidemiology of pediatric stroke, the diverse etiologies, presentation as well as both acute and preventative management

Role of Intravenous Levetiracetam in Acute Seizure Management

Intractable epilepsy still remains the main issue despite new advances in medical and surgical treatment of epilepsy. Acute seizure management in a timely manner is crucial to prevent irreversible brain damage. Benzodiazepines still remain the first initial treatment to abort the seizure activity. The approval phenytoin, fosphenytoin, intravenous valproate, and rectal diazepam provided additional options. The approval of intravenous levetiracetam gave another option to physicians if and when the above treatment fails to control the seizure activity. In this Ebook, we have included chapters from renowned researchers in the field of neurology and epilepsy who have covered the various aspects of these agents in detail including the properties, mechanism of action, pharmacology, neurobehavioral effects, and the roles of these agents in special populations including traumatic brain injury and brain tumor related epilepsy. These data further show that intravenous levetiracetam can be used in acute seizure management and in special circumstances

Importance of Video-EEG Monitoring in the Diagnosis of Epilepsy in a Psychiatric Patient

Epilepsy is a chronic medical condition which is disabling to both patients and caregivers. The differential diagnosis of epilepsy includes psychogenic nonepileptic spells or “pseudoseizures.” Epilepsy is due to abnormal electrical activity in the brain, and pseudoseizure is a form of conversion disorder. The brain waves remain normal in pseudoseizures. The problem arises when a patient with significant psychiatric history presents with seizures. Pseudoseizures become high on the differential diagnosis without extensive work up. This is a case of woman with significant psychiatric issues which resulted in a delay in the diagnosis of epilepsy