Perceived self-control of seizures in patients with uncontrolled partial epilepsy

SummaryMany patients with epilepsy have warning symptoms prior to seizure onset, and some of these individuals report the ability to abort or prevent these seizures. We investigated the clinical characteristics of perceived self-control of seizures in 174 patients with uncontrolled partial epilepsy. The warning symptoms were categorized as premonitory (prodrome) and as initial symptoms of simple partial seizure onset, depending on the relationship between the warning events and the ensuing seizures. About 50% of the patients with simple partial seizure onset and about 70% of those with prodrome or premonitory symptoms reported that they could abort or prevent their seizures by various self-developed techniques. Patients who attempted to abort or prevent their seizures reported success rates as high as 80%. The proportion of patients with secondary generalized seizures was significantly lower in patients who tried to abort their seizures than in those who did not (p<0.05). The ability to prevent seizures was significantly higher in patients with brain lesions on MRI than in those without lesions (p<0.05). These results suggest that spontaneously developed methods are helpful in controlling seizures in some patients with uncontrolled partial epilepsy and that the potential success of self-control methods may be influenced by structural abnormalities on brain MRI

Contribution of the family environment to depression in Korean adults with epilepsy

AbstractPurposeDepression is common in adults with epilepsy and an important factor that affects quality of life in these individuals. However, there are few studies on the interactions between epilepsy and family factors in adults and we here investigate this association.MethodsThis cross-sectional, multicenter study collected data on 391 adults with epilepsy and their caregivers recruited from 27 hospitals throughout Korea. The Beck Depression Inventory (BDI), Stigma Scale, and Caregiver Burden Inventory (CBI) were used to evaluate the study population. Multivariate analysis was conducted using hierarchical linear regression. The Sobel test and structural equation modeling were used to examine interrelationships among the potential factors.ResultsThe mean patient BDI score was 16.3 (SD=11.1). Depressive symptoms (BDI≥10) were in 68.3% and 57.0% in patients and their caregivers, respectively. Hierarchical linear regression analysis only identified caregiver BDI (β=0.219; p<0.001) as an independent factor related to patient BDI. The mediational model suggested that caregiver BDI mediated the effects of other family factors on patient BDI: caregiver's educational level (p=0.002), caregiver's CBI score (p<0.001), caregiver's Stigma Scale score (p<0.001), and family APGAR score (p<0.001). In addition, structural equation modeling showed that the relation between caregiver and patient BDI was unidirectional.ConclusionCaregiver depression is the most important contributor to depression in adults with epilepsy. The other family factors such as caregiver's perception of burden and the level of family function are indirectly correlated with patient depression via the mediating effects of caregiver depression

Cortical Laminar Necrosis associated with Osmotic Demyelination Syndrome

Cortical laminar necrosis has been rarely observed in osmotic demyelination syndrome. We report a 32-year-old female patient who became comatose after the rapid correction of hyponatremia. There were high signal intensities in the pons and bilateral deep gray nuclei on T2-weighted MRI images, and linear hyperintensities along the cerebral cortices on T1-weighted images with a diffuse gyriform enhancement. MR spectroscopic findings showed a decrease of the N-acetyl aspartate peak and an increase in those of the lipid and lactate complex. The case demonstrates that a severe form of osmotic demyelination syndrome accompanying cortical laminar necrosis can result from the rapid correction of hyponatremia

Cognitive and behavioral effects of lamotrigine and carbamazepine monotherapy in patients with newly diagnosed or untreated partial epilepsy

AbstractPurposeIn this prospective study, we compared the long-term cognitive and behavioral effects of lamotrigine (LTG) and carbamazepine (CBZ) in patients with newly diagnosed or untreated partial epilepsy.MethodsThis was a multicenter, open-label, randomized study that compared monotherapy with LTG and CBZ in newly diagnosed or untreated patients with partial epilepsy. We employed an 8-week titration period and a 40-week maintenance period. Neuropsychological tests, Symptom Check List-90, and QOLIE-31 were assessed at baseline, 16 weeks, and 48 weeks after drug treatment. A group-by-time interaction was the primary outcome measure and was analyzed by use of the linear mixed model.ResultsA total of 110 patients were eligible and 73 completed the 48-week study (LTG, n=39; CBZ, n=34). Among the cognitive tests, significant group-by-time interaction was identified only in phonemic fluency of Controlled Oral Word Association Task (p=0.0032) and Stroop Color–Word Interference (p=0.0283), with a significant better performance for LTG group. All other neuropsychological tests included did not show significant group-by-time interactions. Among the subscales of Symptom Check List-90, significant group-by-time interactions were identified in Obsessive-Compulsive (p=0.0005), Paranoid Ideation (p=0.0454), Global Severity Index (p=0.0194), and Positive Symptom Total (p=0.0197), with a significant improvement for CBZ group. QOLIE-31 did not show significant group-by-time interactions.ConclusionOur data suggest that epilepsy patients on LTG have better performance on phonemic fluency and the task of Stroop Color–Word Interference than do patients on CBZ, whereas patients on CBZ had more favorable behavioral effects on two subscales and two global scores of Symptom Check List-90 than did patients on LTG

Does Rapid Eye Movement Sleep Aggravate Obstructive Sleep Apnea?

Objectives. To investigate the apnea-hypopnea index (AHI) according to the sleep stage in more detail after control of posture. Methods. Patients who underwent nocturnal polysomnography between December 2007 and July 2018 were retrospectively evaluated. Inclusion criteria were as follows: age >18 years, sleep efficacy >80%, and patients who underwent polysomnography only in the supine position (100% of the time). Patients were classified into different groups according to the methods: the first, rapid eye movement (REM)-dominant group (AHIREM/AHINREM >2), non-rapid eye movement (NREM)-dominant group (AHINREM/AHIREM >2), and non-dominant group; and the second, light sleep group (AHIN1N2>AHISWS) and slow wave sleep (SWS) group (AHISWS>AHIN1N2). Results. A total of 234 patients (mean age, 47.4±13.9 years) were included in the study. There were 108 patients (46.2%) in the REM-dominant group, 88 (37.6%) in the non-dominant group, and 38 (16.2%) in the NREM-dominant group. The AHI was significantly higher in the NREM-dominant group than in the REM-dominant group (32.9±22.9 events/hr vs. 18.3±9.5 events/hr, respectively). There were improvements in the AHI from stage 1 to SWS in NREM sleep with the highest level in REM sleep. A higher AHISWS than AHIN1N2 was found in 16 of 234 patients (6.8%); however, there were no significant predictors of these unexpected results except AHI. Conclusion. Our results demonstrated the highest AHI during REM sleep stage in total participants after control of posture. However, there were 16.2% of patients showed NREM-dominant pattern (AHINREM/AHIREM >2) and 6.8% of patients showed higher AHISWS than AHIN1N2. Therefore, each group might have a different pathophysiology of obstructive sleep apnea (OSA), and we need to consider this point when we treat the patients with OSA

Superficial Vein Thrombosis as the Initial Manifestation of Protein S Deficiency in an Adolescent with Narcolepsy

Protein S (PS) deficiency and narcolepsy have a similar pathomechanism in view of autoimmunity, and they can develop following an infection. However, there is no previous report of a patient with narcolepsy associated with PS deficiency and the relationship between these two diseases has not yet been investigated. PS deficiency may lead to coagulopathies, which can present as superficial or deep vein thrombosis and embolism. Therefore, here we describe a case of an 18-year-old man with narcolepsy who presented with superficial vein thrombosis associated with PS deficiency. Our case suggested that the development of PS deficiency and narcolepsy can be interrelated with each other