The Role of Phenytoin in the Treatment of Localization Related Epilepsy: An International Internet-Based Survey of Neurologists and Epileptologists

Phenytoin (PHT) has been the most widely used medication to treat both partial and generalized seizures. However, over the past twenty years, a variety of new compounds have been released with comparable efficacy, fewer adverse effects, and more predictable pharmacokinetic properties. We surveyed neurologists and epileptologists to determine current practice patterns relating to the use of PHT using an online survey instrument. A total of 200 responses were obtained though response rates for each survey question varied. Of the respondents, 78.1% were epilepsy specialists; 60% were adult practitioners; and the remainder saw either, only children or both adults and children. For new onset partial seizures only 10 respondents said PHT would be their first or second choice, while 45% reported that they would not consider PHT. This study shows that in the era of newer medications, the role of PHT has been placed in the category of a reserve medication in intractable epilepsy

Comparison of artifacts between paste and collodion method of electrode application in pediatric EEG

Objectives: Children pose challenges to obtain quality EEG data due to excessive artifact. Collodion is used in EEG electrodes due to its water resistance and strong adhesive qualities. This study was done to evaluate differences in artifacts between the collodion and paste method. Methods: 115 subjects (children age \u3e 3 years) were randomized into paste and collodion groups and artifacts evaluated at baseline and every hour over 30s increments. Age, sleep state, and number of electrodes with artifact were also documented. T-test was performed to determine differences in the various parameters between the two groups. Results: 61 subjects were in the paste group and 54 in the collodion group. Mean of total seconds of artifact from 0 to 24h were 41.8s in paste group versus 30.3s in collodion group (P=0.02). Children \u3e 11 years old had less artifact than younger children from 0 to 24h (24.3 versus 41.2s, P=0.03), and from 24 to 48h (33.1 versus 43.1s, P=0.03). There was a significant effect of sleep vs. awake state recordings on artifact from 0 to 24h (30.3 versus 50.2s, P=0.01). Conclusion: Electrode problems are common with both collodion and paste in prolonged AEEG monitoring. However, for studies less than 24h, collodion may be a better alternative. Significance: Our study provides evidence that in some cases collodion may be a better alternative to paste in terms of decreased artifacts

Epileptic and nonepileptic paroxysmal events out of sleep in children.

The distinction between epileptic and nonepileptic events out of sleep may represent a significant challenge to the pediatrician. It is known that sleep can facilitate epileptic activity and that seizures in sleep tend to occur during specific sleep stages. Certain epilepsy syndromes have a well-documented and strong association with sleep and these can present with a variety of bizarre behaviors and motor activity. Disorders that may present with nocturnal nonepileptic paroxysmal events may include not only sleep-related disorders per se but also psychiatric/behavioral conditions benign paroxysmal phenomena with unrelated etiology, and nonneurologic disorders. These phenomena, especially when involving complex motor activity, such as that observed in parasomnias, nocturnal panic attacks, and rapid eye movement behavior disorders may be difficult to differentiate from seizures. Moreover, there is increasing awareness that certain sleep disorders, such as sleep-disordered breathing, may coexist with epilepsy. There are several clinical and electrographical features that allow an accurate diagnosis, and diagnostic tools such as video-EEG polysomnography may be essential

Sleep Disorders Associated With Traumatic Brain Injury-A Review

BACKGROUND: Sleep disorders are common are common following traumatic brain injury. METHODS: In this article we review the spectrum and proposed mechanisms of traumatic brain injury associated sleep disorders and discuss the clinical approach to diagnosis and management of these disorders. RESULT: Disordered sleep and wakefulness after traumatic brain injury is common. Sleep disruption contributes to morbidity, such as the development of neurocognitive and neurobehavioral deficits, and prolongs the recovery phase after injury. Early recognition and correction of these problems may limit the secondary effects of traumatic brain injury and improve patient outcomes. CONCLUSION: Evaluating sleep disorders in traumatic brain injury should be an important component of post-traumatic brain injury assessment and management

Gabapentin treatment in a child with delayed-onset hemichorea/hemiballismus

A 13-year, 6-month-old female was evaluated for subacute onset of left-sided hemichorea/hemiballismus, with an old, right parietal, cortical, and subcortical stroke as the presumed cause. Treatment with gabapentin was initiated, with good results at 6-month follow-up. Discussion of the differential diagnosis and evaluation of delayed-onset movement disorders in children and the mechanism of action of gabapentin is included

Sleep Disorders Associated With Mild Traumatic Brain Injury Using Sport Concussion Assessment Tool 3

BACKGROUND: Sleep problems affect 30% to 80% of patients with mild traumatic brain injury. We assessed the prevalence of sleep disorders after mild traumatic brain injury and its correlation with other symptoms. METHODS AND MATERIALS: Individuals with mild traumatic brain injury were assessed at the New York University Concussion Center during 2013-2014 with the Sports Concussion Assessment Tool, third edition, data following mild traumatic brain injury. The relationship between sleep problems (drowsiness, difficulty falling asleep, fatigue or low energy), psychiatric symptoms (sadness, nervousness or anxiousness), headache, and dizziness were analyzed by Spearman correlation and logistic regression using moderate to severe versus none to mild categorization. RESULTS: Ninety-three patients were retrospectively considered. The most common injury causes were falls (34.4%) and motor vehicle accidents (21.5%). There was a positive correlation between dizziness, headache, psychiatric problems (sadness, anxiety, irritability), and sleep problems (fatigue, drowsiness, and difficulty falling asleep) (P \u3c 0.001). Logistic regression showed a significant association between moderate to severe psychiatric symptoms and moderate to severe sleep symptoms (P \u3c 0.05). Sleep symptoms became more severe with increased time interval from mild traumatic brain injury to Sport Concussion Assessment Tool 3 administration (odds ratio = 1.005, 1.006, and 1.008, P \u3c 0.05). There was significant correlation between motor vehicle accident and drowsiness and difficulty falling asleep (P \u3c 0.05). Medications given in the emergency department had a positive correlation with drowsiness (P \u3c 0.05). CONCLUSIONS: Individuals who report moderate to severe headache, dizziness, and psychiatric symptoms have a higher likelihood of reporting moderate to severe sleep disorders following mild traumatic brain injury and should be counseled and initiated with early interventions

A Case of Recurrent Hypersomnia With Autonomic Dysfunction.

We report the case of a 50-year-old man with disabling recurrent hypersomnia with autonomic instability due to catatonia in the setting of atypical bipolar disorder. Treatment with valproic acid for bipolar disorder resulted in complete resolution of symptoms

Prevalence of sleep problems in Smith-Lemli-Opitz syndrome.

Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive genetic disorder, characterized by multiple congenital anomalies, and intellectual disability. It is caused by a genetically inherited deficiency of the enzyme 7-dehydrocholesterol-delta-7-reductase, which results in increased serum levels of 7-dehydrocholesterol (7-DHC), and decreased levels of cholesterol. This study assesses the prevalence of sleep problems in patients with SLOS. The study group comprised 18 subjects with SLOS, ages 2-31 years (median 10.7 ± 8.5 years). Parents completed several questionnaires (Intake Demographic Form; Pediatric Sleep Questionnaire; Pediatric Daytime Sleepiness Scale). The SLOS subjects had symptoms of sleep-disordered breathing (50% snoring; 66.7% mouth breathing), problems with sleep onset [difficulty falling asleep (61.1%) sleep onset time \u3e30 min (62%)], sleep maintenance [wake up screaming (61.1%), waking up more than twice (44.4%), having trouble falling back to sleep (66.7%), waking up early in the morning (61.1%), and restless sleep (50%)]. The subjects with SLOS needed parents in the room to fall asleep (50%), watch TV or listen to music to fall asleep (44.4%), and described bed sharing (33.3%), indicating sleep-anxiety and sleep-associations. Symptoms of excessive-daytime-sleepiness were frequently reported [un-refreshed in the morning (38.9%), daytime sleepiness (44.4%), and daytime naps (55.6%)]. Parents frequently observed difficulty of organizing tasks (66.7%), and easy distractibility (88.9%). Sleep problems such as sleep-disordered breathing, sleep-related anxiety and sleep associations, disturbed sleep patterns at night, and excessive daytime sleepiness are frequent in children with SLOS