Partial Epilepsies Treatment [tratamento Das Epilepsias Parciais]

Partial epilepsies are the most common form of epilepsy in adult individuals. Antiepileptic drugs (AEDs) continue as the main form of treatment for patients with epilepsy. Regardless of the importance of the medication a high number of patients are under inappropriate or not receiving AEDs. There are several medications available for the treatment of epilepsy. The choice of a particular medication or association among AEDs may be individualized as much as possible. In this article some aspects such as classification, onset of the seizures, age, sex, associated medical conditions, cost and posology of AEDs and medical drug history are reviewed. Details of the available AEDs are also discussed. These points may help to create a profile helping the decision for the appropriate AED. Some practical issues like adverse reaction management, monotherapy and politherapy are also discussed.14SUPPL. 22531Guerreiro, C.A.M., Palmini, A., Tratamento medicamentoso das epilepsias (2002) Epilepsia, pp. 319-337. , Guerreiro CAM, Guerreiro MM, Cendes F, Lopes-Cendes I, eds. São Paulo: Lemos EditorialLi, L.M., Fernandes, P.T., Noronha, A.L., Demonstration Project on Epilepsy in Brazil: Situation assessment (2007) Arq Neuropsiquiatr, 65 (SUPPL. 1), pp. 5-13Proposal for revised classification of epilepsies and epileptic syndromes (1989) Epilepsia, 30, pp. 389-399. , Commission on Classification and Terminology of the International League Against EpilepsyThomas, P., Valton, L., Genton, P., Absence and myoclonic status epilepticus precipitated by antiepileptic drugs in idiopathic generalized epilepsy (2006) Brain, 129, pp. 1281-1292Semah, F., Picot, M.-C., Adam, C., Broglin, D., Arzimanoglou, A., Bazin, B., Cavalcanti, D., Baulac, M., Is the underlying cause of epilepsy a major prognostic factor for recurrence? (1998) Neurology, 51 (5), pp. 1256-1262Betting, L.E., Cendes, F., Crise única (2008) Tratamento Das Doenças Neurológicas, pp. 502-506. , Melo-Souza SE, ed. Rio de Janeiro: Guanabara-KooganHauser, W.A., Rich, S.S., Lee, J.R.J., Annegers, J.F., Anderson, V.E., Risk of recurrence after two unprovoked seizures (1998) N Engl J Med, 338, pp. 429-434Kwan, P., Brodie, M.J., Early identification of refractory epilepsy (2000) N Engl J Med, 342, pp. 314-319Betting, L.E., Kobayashi, E., Montenegro, M.A., Min, L.L., Cendes, F., Guerreiro, M.M., Guerreiro, C.A.M., Treatment of epilepsy: Consensus of the Brazilian specialists (2003) Arquivos de Neuro-Psiquiatria, 61 (4), pp. 1045-1070French, J.A., Kanner, A.M., Bautista, J., Abou-Khalil, B., Browne, T., Harden, C.L., Theodore, W.H., Glauser, T.A., Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new onset epilepsy. Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society (2004) Neurology, 62 (8), pp. 1252-1260Zaccara, G., Franciotta, D., Perucca, E., Idiosyncratic adverse reactions to antiepileptic drugs (2007) Epilepsia, 48 (7), pp. 1223-1244. , DOI 10.1111/j.1528-1167.2007.01041.xBerg, A.T., Shinnar, S., Relapse following discontinuation of antiepileptic drugs: A meta-analysis (1994) Neurology, 44 (4), pp. 601-608Beghi, E., Di Mascio, R., Tognoni, G., Drug treatment of epilepsy. Outlines, criticism and perspectives (1986) Drugs, 31 (3), pp. 249-265Mattson, R.H., Cramer, J.A., Collins, J.F., Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures (1985) N Engl J Med, 313, pp. 145-151Rowan, A.J., Reflections on the treatment of seizures in the elderly population (1998) Neurology, 51, pp. S28-33Ensrud, K.E., Walczak, T.S., Blackwell, T., Ensrud, E.R., Bowman, P.J., Stone, K.L., Antiepileptic drug use increases rates of bone loss in older women: A prospective study (2004) Neurology, 62 (11), pp. 2051-2057Valimaki, M.J., Tiihonen, M., Laitinen, K., Tahtela, R., Karkkainen, M., Lamberg-Allardt, C., Makela, P., Tunninen, R., Bone mineral density measured by dual-energy x-ray absorptiometry and novel markers of bone formation and resorption in patients on antiepileptic drugs (1994) Journal of Bone and Mineral Research, 9 (5), pp. 631-637Farhat, G., Yamout, B., Mikati, M.A., Demirjian, S., Sawaya, R., El-Hajj Fuleihan, G., Effect of antiepileptic drugs on bone density in ambulatory patients (2002) Neurology, 58 (9), pp. 1348-1353Sato, Y., Kondo, I., Ishida, S., Motooka, H., Takayama, K., Tomita, Y., Maeda, H., Satoh, K., Decreased bone mass and increased bone turnover with valproate therapy in adults with epilepsy (2001) Neurology, 57 (3), pp. 445-449Johannessen Landmark, C., Antiepileptic drugs in non-epilepsy disorders: Relations between mechanisms of action and clinical efficacy (2008) CNS Drugs, 22 (1), pp. 27-47Vanotti, A., Osio, M., Mailland, E., Overview on pathophysiology and newer approaches to treatment of peripheral neuropathies (2007) CNS Drugs, 21 (SUPPL. 1), pp. 3-12Perucca, E., Dulac, O., Shorvon, S., Tomson, T., Harnessing the clinical potential of antiepileptic drug therapy: Dosage optimisation (2001) CNS Drugs, 15 (8), pp. 609-621Ruble, J., Matsuo, H., Anticonvulsant-induced cutaneous reactions. Incidence, mechanisms and management (1999) CNS Drugs, 12, pp. 215-236Glauser, T., Ben-Menachem, E., Bourgeois, B., Cnaan, A., Chadwick, D., Guerreiro, C., Kalviainen, R., Tomson, T., ILAE treatment guidelines: Evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes (2006) Epilepsia, 47 (7), pp. 1094-1120. , DOI 10.1111/j.1528-1167.2006.00585.xDichter, M.A., Old and new mechanisms of antiepileptic drug actions (1993) Epilepsy Res, 10 (SUPPL.), pp. 9-17Brodie, M.J., Dichter, M.A., Antiepileptic drugs (1996) N Engl J Med, 334, pp. 168-175Twyman, R.E., Rogers, C.J., Macdonald, R.L., Differential regulation of γ-aminobutyric acid receptor channels by diazepam and phenobarbital (1989) Annals of Neurology, 25 (3), pp. 213-220. , DOI 10.1002/ana.410250302Oxcarbazepine (1989) Lancet, 2, pp. 196-198Dichter, M.A., Brodie, M.J., New antiepileptic drugs (1996) N Engl J Med, 334, pp. 1583-1590Marson, A.G., Al-Kharusi, A.M., Alwaidh, M., Appleton, R., Baker, G.A., Chadwick, D.W., Cramp, C., Williamson, P.R., The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: An unblinded randomised controlled trial (2007) Lancet, 369 (9566), pp. 1000-1015. , DOI 10.1016/S0140-6736(07)60460-7, PII S0140673607604607Panayatopoulos, C.P., Evidence-based Epileptology, Randomized Controlled Trials, and SANAD: A Critical Clinical View (2007) Epilepsia, 48, pp. 1268-1274Cheung, H., Kamp, D., Harris, E., An in vitro investigation of the action of lamotrigine on neuronal voltage-activated sodium channels (1992) Epilepsy Res, 13, pp. 107-112Montenegro, M.A., Ferreira, C.M., Cendes, F., Li, L.M., Guerreiro, C.A.M., Clobazam as add-on therapy for temporal lobe epilepsy and hippocampal sclerosis (2005) Canadian Journal of Neurological Sciences, 32 (1), pp. 93-96Engel Jr., J., Wiebe, S., French, J., Quality Standards Subcommittee of the American Academy of NeurologyAmerican Epilepsy SocietyAmerican Association of Neurological Surgeons. Practice parameter: Temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology (2003) Neurology, 60, pp. 538-547Gilliam, F., Kuzniecky, R., Faught, E., Black, L., Carpenter, G., Schrodt, R., Patient-validated content of epilepsy-specific quality-of-life measurement (1997) Epilepsia, 38 (2), pp. 233-236. , DOI 10.1111/j.1528-1157.1997.tb01102.xLehrner, J., Kalchmayr, R., Serles, W., Olbrich, A., Pataraia, E., Aull, S., Bacher, J., Baumgartner, C., Health-related quality of life (HRQOL), activity of daily living (ADL) and depressive mood disorder in temporal lobe epilepsy patients (1999) Seizure, 8 (2), pp. 88-92. , DOI 10.1053/seiz.1999.0272Perrine, K., Hermann, B.P., Meador, K.J., The relationship of neuropsychological functioning to quality of life in epilepsy (1995) Arch Neurol, 52, pp. 997-1003Boylan, L.S., Flint, L.A., Labovitz, D.L., Jackson, S.C., Starner, K., Devinsky, O., Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy (2004) Neurology, 62 (2), pp. 258-26

Response: Eeg Features In Idiopathic Generalized Epilepsy: Clues To Diagnosis [2]

[No abstract available]47814151416Betting, L.E., Mory, S.B., Lopes-Cendes, I., EEG Features in Idiopathic Generalized Epilepsy: Clues to Diagnosis (2006) Epilepsia, 47, pp. 523-528Scott, R.A., Lhatoo, S.D., Sander, J.W., The treatment of epilepsy in developing countries: Where do we go from here? (2001) Bull World Health Organ, 79 (4), pp. 344-351Mac, T.L., Le, V.T., Vu, A.N., Preux, P.M., Ratsimbazafy, V., AEDs availability and professional practices in delivery outlets in a city center in southern Vietnam (2006) Epilepsia, 47 (2), pp. 330-334Lancman, M.E., Asconape, J.J., Penry, J.K., Clinical and EEG asymmetries in juvenile myoclonic epilepsy (1994) Epilepsia, 35, pp. 302-306Thomas, P., Valton, L., Genton, P., Absence and myoclonic status epilepticus precipitated by antiepileptic drugs in idiopathic generalized epilepsy (2006) Brain, 129, pp. 1281-129

Idiopathic Generalized Epilepsies Treatment [tratamento Das Epilepsias Generalizadas Idiopáticas]

Idiopathic generalized epilepsies (IGEs) correspond to one-third of all epilepsies. Despite of this high frequency, IGEs remains underdiagnosed. Clinical features are the cornerstone to diagnosis. In this group all types of generalized seizures may occur such as generalized tonic-clonic, absences and myoclonic seizures. EEG is very supportive of IGEs diagnosis when it shows the typical generalized symmetrical, spike or polispyke and waves complexes with normal background. According to the main seizure type and the age of onset, IGEs are divided in subsyndromes. The importance of the correct diagnosis is supported by the high rate of seizure free patients under appropriate antiepileptic drug therapy. On the other hand, the use of some antiepileptic drugs such as carbamazepine or phenytoin may exacerbate the seizures or even induce status epilepticus in some subsyndromes. In this article, the main antiepileptic drugs used in the treatment of IGEs are reviewed as well as some practical issues for IGEs subsyndromes treatment.14SUPPL. 22024Panayiotopoulos, C.P., Idiopathic generalized epilepsies (2005) The Epilepsies: Seizures, Syndromes and Management, pp. 271-348. , Panayiotopoulos CP, ed. Oxford: Bladon Medical PublishingProposal for revised classification of epilepsies and epileptic syndromes (1989) Epilepsia, 30, pp. 389-399. , Commission on Classification and Terminology of the International League Against EpilepsyBetting, L.E., Mory, S.B., Lopes-Cendes, I., Li, L.M., Guerreiro, M.M., Guerreiro, C.A.M., Cendes, F., EEG features in idiopathic generalized epilepsy: Clues to diagnosis (2006) Epilepsia, 47 (3), pp. 523-528. , DOI 10.1111/j.1528-1167.2006.00462.xRudolph, U., Crestani, F., Benke, D., Benzodiazepine actions mediated by specific GABAA receptor subtypes (1999) Nature, 401, pp. 796-800Patsalos, P.N., Properties of antiepileptic drugs in the treatment of idiopathic generalized epilepsies (2005) Epilepsia, 46 (SUPPL. 9), pp. 140-148. , DOI 10.1111/j.1528-1167.2005.00326.xBerlin, A., Dahlstrom, H., Pharmacokinetics of the anticonvulsant drug clonazepam evaluated from single oral and intravenous doses and repeated oral administration (1975) Eur J Clin Pharmacol, 9, pp. 155-159Gomora, J.C., Daud, A.N., Weiergraber, M., Block of cloned human T-type calcium channels by succinimide antiepileptic drugs (2001) Mol Pharmacol, 60, pp. 1121-1132Pisani, F., Narbone, M.C., Trunfio, C., Valproic acid - Ethosuximide interaction: A pharmacokinetic study (1984) Epilepsia, 25 (2), pp. 229-233Lees, G., Leach, M.J., Studies on the mechanism of action of the novel anticonvulsant lamotrigine (Lamictal) using primary neuroglial cultures from rat cortex (1993) Brain Research, 612 (1-2), pp. 190-199. , DOI 10.1016/0006-8993(93)91660-KPatsalos, P.N., Perucca, E., Clinically important interactions in epilepsy: General features and interactions between antiepileptic drugs (2003) Lancet Neurol, 6, pp. 347-356Yuen, A.W.C., Land, G., Weatherley, B.C., Sodium valproate inhibits lamotrigine metabolism (1992) Br J Clin Pharmacol, 33, pp. 511-513Sabers, A., Ohman, I., Christensen, J., Tomson, T., Oral contraceptives reduce lamotrigine plasma levels (2003) Neurology, 61 (4), pp. 570-571Patsalos, P.N., The mechanism of action of topiramate (1999) Rev Contemp Pharmacother, 10, pp. 147-153Bialer, M., Doose, D.R., Murthy, B., Pharmacokinetic interactions of topiramate (2004) Clin Pharmacokinet, 43, pp. 763-780Marson, A.G., Al-Kharusi, A.M., Alwaidh, M., Appleton, R., Baker, G.A., Chadwick, D.W., Cramp, C., Williamson, P.R., The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: An unblinded randomised controlled trial (2007) Lancet, 369 (9566), pp. 1016-1026. , DOI 10.1016/S0140-6736(07)60461-9, PII S0140673607604619Benbadis, S.R., Practical management issues for idiopathic generalized epilepsies (2005) Epilepsia, 46 (SUPPL. 9), pp. 125-132. , DOI 10.1111/j.1528-1167.2005.00324.xBuchanan, N., The use of lamotrigine in juvenile myoclonic epilepsy (1996) Seizure, 5 (2), pp. 149-151Obeid, T., Panayiotopoulos, C.P., Clonazepan in juvenile myoclonic epilepsy (1989) Epilepsia, 30, pp. 603-606Janz, D., Durner, M., Juvenile myoclonic epilepsy (1997) Epilepsy: A Comprehensive Textbook, pp. 2389-2400. , Engel JJ, Pedley TA, eds. Philadelphia: Lippincott-RavenJanz, D., Epilepsy with grand mal on awakening and sleep-waking cycle (2000) Clinical Neurophysiology, 111 (SUPPL. 2), pp. S103-S110. , DOI 10.1016/S1388-2457(00)00409-0, PII S1388245700004090Beran, R.G., Berkovic, S.F., Dunagan, F.M., Vajda, F.J.E., Danta, G., Black, A.B., Mackenzie, R., Double-blind, placebo-controlled, crossover study of lamotrigine in treatment-resistant generalised epilepsy (1998) Epilepsia, 39 (12), pp. 1329-1333. , DOI 10.1111/j.1528-1157.1998.tb01332.xBiton, V., Montouris, G.D., Ritter, F., Riviello, J.J., Reife, R., Lim, P., Pledger, G., A randomized, placebo-controlled study of topiramate in primary generalized tonic-clonic seizures (1999) Neurology, 52 (7), pp. 1330-1337Glauser, T., Ben-Menachem, E., Bourgeois, B., Cnaan, A., Chadwick, D., Guerreiro, C., Kalviainen, R., Tomson, T., ILAE treatment guidelines: Evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes (2006) Epilepsia, 47 (7), pp. 1094-1120. , DOI 10.1111/j.1528-1167.2006.00585.xWheless, J.W., Acute management of seizures in the syndromes of idiopathic generalized epilepsies (2003) Epilepsia, 44 (SUPPL. 2), pp. 22-26. , DOI 10.1046/j.1528-1157.44.s.2.5.

Corrigendum To Texture Analysis Of Magnetic Resonance Images Of Patients With Juvenile Myoclonic Epilepsy [epilepsy Behav 27 (1) (2013) 22-28]

[No abstract available]27351

Treatment Of Epilepsy: Consensus Of The Brazilian Specialists [tratamento De Epilepsia: Consenso Dos Especialistas Brasileiros]

Epilepsy is a frequent condition in the world. Recently a study in Brazil showed prevalence of 18/ 1000 inhabitants in São José do Rio Preto, São Paulo State. In the last decade, new therapeutic options were discovered or developed. The main therapeutic decision method is based on randomized clinical trials. This method represents the higher level of evidence. However, even these studies have limitations and in some cases the treatment of choice remains controversial, In these instances, the epilepsy experts' opinions become helpful. In 2001 a similar study had been conducted in USA. The aim of this study is to create guidelines for epilepsy treatment based on the opinion of the Brazilian experts, These guidelines can be used to create manuals and strategies for the treatment of some epileptic syndromes according to Brazilian experts. As compared to the North-American guidelines our study better reflects the resources available in our country.61410451070Proposal for revised classification of epilepsies and epileptic syndromes (1989) Epilepsia, 30, pp. 389-399Kwan, P., Brodie, M.J., Early identification of refractory epilepsy (2000) N Engl J Med, 342, pp. 314-319Goa, K.L., Ross, S.R., Chrisp, P., Lamotrigine: A review of its pharmacological properties and clinical efficacy in epilepsy (1993) Drugs, 46, pp. 152-176Anhut, H., Ashman, P., Feuerstein, T.J., Sauermann, W., Saunders, M., Schmidt, B., Gabapentin (Neurontin) as add-on therapy in patients with partial seizures: A double-blind placebo-controlled study (1994) Epilepsia, 35, pp. 795-801Gabapentin as add-on therapy in refractory epilepsy: A double-blind, placebo-controlled, parallel-group study (1993) Neurology, 43, pp. 2292-2298Gram, L., Oxcarbazepine (1997) Epilepsy: A Comprehensive Textbook, pp. 1541-1546. , Engel J Jr, Pedley TA (eds). Philadelphia: Lippincott-RavenKramer, L.D., Reife, R.A., Topiramate (1997) Epilepsy: A Comprehensive Textbook, pp. 1593-1598. , Engel J Jr, Pedley TA (eds). Philadelphia: Lippincott-RavenSachdeo, R.C., Leroy, R.F., Krauss, G.L., Tiagabine therapy for complex partial seizures: A dose-frequency study (1997) Arch Neurol, 54, pp. 595-601. , The Tiagabine Study GroupTheodore, W.H., Felbamate (1997) Epilepsy: A Comprehensive Textbook, pp. 1509-1514. , Engel J, Jr, Pedley TA (eds). Philadelphia: Lippincott-RavenCereghino, J.J., Biton, V., Abou-Khalil, B., Dreifuss, F., Gauer, L.J., Leppik, I., Levetiracetam for partial seizures: Results of a double-blind randomized clinical trial (2000) Neurology, 55, pp. 236-242White, H.S., Comparative anticonvulsant and mechanistic pro-file of the established and newer antiepileptic drugs (1999) Epilepsia, 40 (SUPPL. 5), pp. S2-S10Wheless, J.W., Venkataraman, V., New formations of drugs in epilepsy (1999) Expert Opin Pharmacother, 1, pp. 49-160Wilder, B.J., Vagal nerve stimulation (1997) Epilepsy: A Comprehensive Textbook, pp. 1353-1358. , Engel J Jr, Pedley TA (eds). Philadelphia: Lippincott-RavenVining, E.P.G., Ketogenic diet (1997) Epilepsy: A Comprehensive Textbook, pp. 1339-1344. , Engel J Jr, Pedley TA (eds). Philadelphia: Lippincott-RavenWiebe, S., Blume, W.T., Girvin, J.P., Eliaziw, M., A randomized controlled trial of surgery for temporal lobe epilepsy (2001) N Engl J Med, 345, pp. 311-318Karceski, S., Morrell, M., Carpenter, D., The expert consensus guidelines series: Treatment of epilepsy (2001) Epilepsy & Behavior, 2 (SUPPL. 2), pp. A1-A50Privitera, M.D., Evidence-based medicine and antiepileptic drugs (1999) Epilepsia, 40 (SUPPL. 5), pp. S47-S56Williamson, P.R., Marson, A.G., Tudur, C., Hutton, J.L., Chadwick, D., Individual patient data meta-analysis of randomized anti-epileptic drug monotherapy trials (2000) J Eval Clin Pract, 6, pp. 205-214Kahn, D.A., Docherty, J.P., Carpenter, D., Frances, A., Consensus methods in practice guideline development: A review and description of a new method (1997) Psychopharmacol Bull, 33, pp. 631-639Dalkey, N.C., (1969) The Delphi Method: An Experimental Study of Group Opinion, , Santa Monica, CA: Rand: Publication RM-58888 PRWoolfe, S.H., Practice guidelines, a new reality in medicine (1992) Arch Intern Med, 152, pp. 946-952Brook, R.H., Chassin, M.R., Fink, A., A method for the detailed assessment of the appropriateness of medical technologies (1986) Int J Technol Assess Health Care, 2, pp. 53-63Kahn, D.A., Carpenter, D., Docherty, J.P., Frances, A., The expert consensus guideline series: Treatment of bipolar disorder (1996) J Clin Psychiatry, 57 (SUPPL. 12A), pp. 1-88Sachs, G.S., Printz, D.J., Kahn, D.A., Carpenter, D., Docherty, J.P., The expert consensus guideline series: Medication treatment of bipolar disorder 2000 (2000) Postgrad Med, pp. 1-104. , AprMcEvoy, J.P., Weiden, P.F., Smith, T.E., Carpenter, D., Kahn, D.A., Frances, A., The expert consensus guideline series: Treatment of schizophrenia (1996) J Clin Psychiatry, 5 (SUPPL. 12B), pp. 1-58McEvoy, J.P., Schiefler, P.L., Frances, A., The expert consensus guideline series: Treatment of schizophrenia 1999 (1999) J Clin Psychiatry, 60 (SUPPL. 11), pp. 1-80March, J.S., Frances, A., Kahn, D.A., Carpenter, D., The expert consensus guideline series: Treatment of obsessive-compulsive disorder (1997) J Clin Psychiatry, 58 (SUPPL. 4), pp. 1-72Alexopoulos, G.S., Silver, J.M., Kahn, D.A., Frances, A., Carpenter, D., The expert consensus guideline series: Treatment of agitation in older persons with dementia (1998) Postgrad Med Spec Rep, pp. 1-88. , AprFoa, E.B., Davidson, J.R.T., Frances, A., The expert consensus guideline series: Treatment of posttraumatic stress disorder (1999) J Clin Psychiatry, 60 (SUPPL. 16), pp. 1-76Rush, A.J., Frances, A., Expert consensus guideline series: Treatment of psychiatric and behavioral problems in mental retardation (2000) Am J Ment Retard, 105, pp. 159-228Conners, C.K., March, J.S., Frances, A., Wells, K.C., Ross, R., Expert consensus guideline series: Treatment of attention-deficit/hyperactivity disorder (2001) Attention Disord, 4 (SUPPL. 1), pp. S1-S128Altschuler, L.L., Cohen, L.S., Moline, M.L., Kahn, D.A., Carpenter, D., Docherty, J.P., The expert consensus guideline series: Treatment of depression in women 2001 (2001) Postgrad Med Spec Rep, pp. 1-115. , MarchAllen, M.H., Currier, G.W., Hughes, D.H., Reyes-Harde, M., Docherty, J.P., The expert consensus guideline series: Treatment of behavioral emergencies (2001) Postgrad Med Spec Rep, pp. 1-88. , MayAlexopoulos, G.S., Katz, I.R., Reynolds III, C.F., Carpenter, D., Docherty, J.P., The expert consensus guideline series: Pharmacotherapy of depressive disorders in older patients (2001) Postgrad Med Spec Rep, pp. 1-88. , OctStefan, H., Snead, C.O., Absence seizures (1997) Epilepsy: A Comprehensive Textbook, pp. 579-590. , Engel J Jr, Pedley TA (eds). Philadelphia: Lippincott-RavenWallace, S.J., Myoclonus and epilepsy in childhood: A review of treatment with valproate, ethosuximide, lamotrigine, and zonisamide (1998) Epilepsy Res, 29, pp. 147-154Guerrini, R., Dravet, C., Genton, P., Belmonte, A., Kaminska, A., Dulac, O., Lamotrigine and seizure aggravation in severe myoclonic epilepsy (1998) Epilepsia, 39, pp. 508-512Mattson, R.H., Comparison of valproate and carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults (1992) N Engl J Med, 327, pp. 765-771Mattson, R.H., Cramer, J.A., Collins, J.F., Comparison of carbamazepine phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures N Engl J Med, 313, pp. 145-151. , 985Deckers, C.L., Czuczwar, S.J., Hekster, Y.A., Selection of antiepileptic drug polytherapy based on mechanisms of action: The evidence reviewed (2000) Epilepsia, 41, pp. 1364-1374Schmidt, D., Modern management of epilepsy: Rational polytherapy (1996) Baillieres Clin Neurol, 5, pp. 757-763Montenegro, M.A.S., Cendes, F., Noronha, A.L.A., Mory, S.B., Carvalho, M.I., Marques, L.H.N., Guerreiro, C.A.M., Efficacy of clobazam as add-on therapy in patients with refractory partial epilepsy (2001) Epilepsia, 42, pp. 539-542Satishchandra, P., Varadarajalu, R., Rajaram, P., Long-term use of clobazam in the management of intractable epilepsy: A prospective study (1998) Neurology (India), 46, pp. 284-287Genton, P., Bauer, J., Duncan, S., On the association between valproate and polycystic ovary syndrome (2001) Epilepsia, 42, pp. 295-394Morrell, M.J., Effects of epilepsy on women's reproductive health (1998) Epilepsia, 39 (SUPPL. 8), pp. S32-S37Isojarvi, J.I., Laatikainen, T.J., Knip, M., Pakarinen, A.J., Juntunen, K.T., Myllyla, V.V., Obesity and endocrine disorders in women taking valproate for epilepsy (1996) Ann Neurol, 39, pp. 579-584Isojarvi, J.I., Rattya, J., Myllyla, V.V., Valproate, lamotrigine, and insulin-mediated risks in women with epilepsy (1998) Ann Neurol, 43, pp. 446-451Sirven, J.I., Acute and chronic seizures in patients older than 60 years (2001) Mayo Clin Proc, 76, pp. 175-183Willmore, L.J., Choice of newer anticonvulsant drugs in older patients (2000) Drugs Aging, 17, pp. 441-452Ramsay, R.E., Pryor, F., Epilepsy in the elderly (2000) Neurology, 55 (SUPPL. 1), pp. S9-S14Meador, K.J., Current discoveries on the cognitive effects of antiepileptic drugs (2000) Pharmacotherapy, 20 S, pp. 185-190Dam, M., Ekberg, E., Loyning, Y., Waltimo, O., Jakobsen, K., A double-blind study comparing oxcarbazepine and carbamazepine in patients with newly diagnosed, previously untreated epilepsy (1989) Epilepsy Res, 3, pp. 70-76Trimble, M.R., Neuropsychiatric consequences of pharmacotherapy (1997) Epilepsy: A Comprehensive Textbook, pp. 2161-2170. , Engel J Jr, Pedley TA (eds). 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Recovery Of White Matter Atrophy After Epilepsy Surgery: Structural Evidences Through Voxel-based Morphometry [regeneração De Atrofia De Substância Branca Após A Cirurgia De Epilesia: Evidências Estruturais Através Da Morfometria Baseada Em Voxel]

Objectives: To study pre and postoperative WMA in MTLE patients. Methods: We performed Voxel-Based Morphometry (VBM) with volume of interest (VOI) in 69 controls (mean age, 34.3±11.1 years) and 67 operated patients (mean age, 34.1±10.4 years) with unilateral MTLE. 34 became seizure-free (SzFree-Group), 23 improved (Engel IB-IIA [Partial recovery-group]) and 10 did not improve (Engel III-IV [Failure-Group]). All had pre and postoperative MRIs (one year minimum). We flipped MRIs of right MTLE patients in order to avoid right-to-left analysis cancelation. VBM was performed on SPM2/MATLAB7.0 with individual masks for surgical lacunae and 1% false-discovery-rate to control for multiple comparisons. We used MARSbar 〈www.marsbar.sourceforge.net〉 routine to select ROIs and t-test for statistical analyses. Results: Mean postoperative follow-up was 60.2 (±SD 30.7) months. On baseline MRI, SzFree-Group showed White Matter Atrophy (WMA) involving temporal lobes [TL], ipsilateral occipital, parietal and frontal regions, with areas of significant recovery of WMA on postoperative MRI. Partial recovery-Group presented a more restricted pattern of WMA, involving ipsilateral temporal lobe, contralateral superior temporal gyrus and few areas in bilateral cingulated and orbitofrontal areas. In this group we also identified areas with relative increase of WM after surgery. By contrast, Failure-Group showed more widespread bi-hemispheric areas of WMA on baseline MRI without postoperative improvement. Conclusions: Although we have identified some differences in baseline WMA, we were unable to correlate a more widespread pattern with a worse prognosis, as SzFree-Group, also presented a bilateral distribution of WMA. 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Mri And Eeg As Long-term Seizure Outcome Predictors In Familial Mesial Temporal Lobe Epilepsy.

To evaluate the natural history and outcome predictors in familial mesial temporal lobe epilepsy (FMTLE). We conducted a longitudinal study of 103 individuals from 17 FMTLE families (mean follow-up: 7.6 years). We divided subjects into 3 groups: FMTLE (n = 53), unclassified seizure (n = 18), and asymptomatics (n = 32). We divided FMTLE patients into 3 subgroups: seizure-free (n = 19), infrequent (n = 17) seizures, and frequent (n = 17) seizures and further reclassified them into favorable and poor outcome. We defined hippocampal atrophy (HA) by visual MRI analysis and performed volumetry in those who had 2 MRIs. FMTLE patients with infrequent seizures evolved to either frequent seizures (17.6%) or seizure freedom (23.5%). In the seizure-free group, most remained seizure-free and 21% developed infrequent seizures. All patients with frequent seizures remained in the same status or underwent surgery. Twelve percent of the asymptomatics and 22% of the unclassified-seizure group evolved to FMTLE with infrequent seizures. Predictive factors of poor outcome were presence of HA (p = 0.0192) and interictal epileptiform discharges (p = 0.0174). The relationship between initial precipitating incidents and clinical outcome was not significant although a tendency was observed (p = 0.055). Use of antiepileptic drugs and secondary generalized seizures during the patient's lifetime did not predict poor outcome. We observed progression of HA only in the group with frequent seizures. Most patients with FMTLE continued in the same clinical status. However, patients with frequent seizures had progression of HA and none improved except those who underwent surgery. Interictal epileptiform discharges and HA predicted poorer outcome in FMTLE, and there was a tendency in favor of initial precipitating incidents as outcome predictors.79242349235