Electrocardiographic Evaluation in Patients Receiving Lamotrigine Monotherapy/Duotherapy

Objective:Despite its widespread use and safety data, the cardiac safety of lamotrigine was brought into question in October 2020 when the U.S. Food and Drug Administration issued a safety warning about its cardiac side effects. Here, we investigated whether there are differences in electrocardiogram (ECG) findings between epilepsy cases receiving lamotrigine monotherapy and those receiving duotherapy.Methods:Patients older than 16 years who were followed up with a diagnosis of epilepsy and receiving lamotrigine were retrospectively identified. Those receiving only lamotrigine and any second anti-seizure medication (ASM) in addition to lamotrigine were included in the study, and those receiving more than two ASMs were excluded. Eligible patients were asked to apply to any health institution and have an ECG performed. Heart rate, PR distance, QRS duration, QT duration, corrected QT value, and Tp-Tend value were calculated manually, and ST-T changes were evaluated. Comparisons were made between patients receiving monotherapy and dootherapy and those receiving low-dose and high-dose lamotrigine.Results:There were 19 patients receiving monotherapy and 11 receiving duotherapy. The ECG parameters of all other patients were within normal values. When ECG parameters were compared between patients receiving monotherapy and those receiving duotherapy, no significant differences were found in heart rate, PR distance, QRS duration, QT duration, QTc duration, Tp-Tend duration, and presence of ST-T changes. When the patients were divided into low-dose and high-dose lamotrigine groups, there were no significant differences in the ECG parameters between these two groups.Conclusion:The relationship between the use of lamotrigine and cardiac conduction problems in patients with epilepsy has attracted the attention of physicians since its introduction into clinical practice. Although our results did not indicate a significant relationship, there is still a need to determine the risk groups and clarify the pathophysiology of lamotrigine-related arrhythmia through genotype- and phenotype-related studies

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

The Use of Clobazam as Add-on Treatment in Resistant Epilepsy: Our Retrospective Clinical Data

Objective: Patients with drug-resistant focal or generalized epilepsy are important in terms of treatment and polytherapy necessity, adverse effect profiles of drugs, and seizure control difficulties. Clobazam (CLB), which has a lesser sedative effect than other benzodiazepines, is frequently used in different countries. In this study, we aimed to present the results related to the demographic characteristics, adverse effects, and treatment efficacy of patients under CLB treatment

Postictal Syndrome Associated with Epileptic Seizure

Postictal syndrome (PIS) includes clinical, biological, electroencephalography and magnetic resonance imaging findings following the termination of a seizure. All these findings begin immediately after the end of the epileptic seizure and persist for a long time, which allows clinicians to observe this condition. PIS helps clinicians differentiate between epileptic and nonepileptic seizures and determine the type of epileptic seizure

Writing and Reporting of Scalp Electroencephalography

Electroencephalography (EEG) is the gold standard for analyzing electrophysiological processes involved in epilepsy, as well as in several other dysfunctions of the central nervous system. Firstly, to properly interpret the EEG record, one must clearly have in mind the elements of a normal EEG. Secondly, to assist in producing useful information for clinical and research purposes, it is recommended to use standardized terminologies and to follow an orderly EEG reporting approach.The EEG report gives a clinical interpretation in light of the diagnosis and must meet the expectations of the clinician. The EEG terminology should be understandable to other physicians who are not specialized in EEG. The review aims to provide a standardized format for reporting the results of adult routine scalp EEG

Acute Pain Perception in Patients with Psychogenic Non-Epileptic Seizures and its Relationship with Mood Disorders

Objectives: It has been found that pain response is higher in patients with depression and anxiety and also found higher in the patients with psychogenic non-epileptic seizures (PNES). However, these studies are limited in number and they are mainly focused on the chronic pain perception. We aimed to investigate anxiety and depression levels and the perception of acute pain along with childhood traumas among the patients with PNES

The effects of computer-based rehabilitation on the cognitive functions of epilepsy patients

Objective: The aim of this study was to examine the effects of computerized cognitive rehabilitation programs conducted with the purpose of slowing down cognitive losses and developing coping strategies in patients diagnosed with cryptogenic and symptomatic focal epilepsy, with participants' cognitive functions being evaluated through neuropsychological tests prior to and after rehabilitation

Limb Shaking Secondary to Carotid Artery Dissection: Case Report

Limb shaking is involuntary, rhythmical or dysrhythmical, transient, and usually coarse trembling or shaking of upper or lower extremities. Described in this report is a 47-year-old male patient who presented with sudden onset left-sided paresthesias and weakness. He had a similar episode with shaking movements of left arm followed by transient weakness and paresthesias 1 month before presentation. He had multiple acute and subacute infarctions on cranial magnetic resonance imaging (MRI). Cerebral digital subtraction angiography (DSA) revealed calibration changes and irregularity of the right internal carotid artery compatible with dissection and oral anticoagulant therapy was administered. The patient was followed for 6 months under effective oral anticoagulant therapy without appearance of any new symptoms. Limb shaking is a symptom of carotid artery disease (CAD) that can lead to severe cerebral infarction. It is important to recognize this unusual symptom in order to begin appropriate treatment of the ischemic event

The Effects of Computer-Based Rehabilitation on the Cognitive Functions of Epilepsy Patients

Objective: The aim of this study was to examine the effects of computerized cognitive rehabilitation programs conducted with the purpose of slowing down cognitive losses and developing coping strategies in patients diagnosed with cryptogenic and symptomatic focal epilepsy, with participants' cognitive functions being evaluated through neuropsychological tests prior to and after rehabilitation