Curvature analysis of perisylvian epilepsy.

Purpose: We assess whether alterations in the convolutional anatomy of the deep perisylvian area (DPSA) might indicate focal epileptogenicity.

Materials And Methods: The DPSA of each hemisphere was segmented on MRI and a 3D gray-white matter interface (GWMI) geometrical model was constructed. Comparative visual and quantitative assessment of the convolutional anatomy of both the left and right DPSA models was performed.

Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review.

Purpose: To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV.

Methods: A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of these BAEs and the rates of discontinuation due to each were categorized by ASM, and where possible, weighted means were calculated but not statistically assessed.

Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy.

Objective: To prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adults with medically intractable focal onset seizures (FOS) over 9 years.

Methods: Adults treated with brain-responsive neurostimulation in 2-year feasibility or randomized controlled trials were enrolled in a long-term prospective open label trial (LTT) to assess safety, efficacy, and quality of life (QOL) over an additional 7 years. Safety was assessed as adverse events (AEs), efficacy as median percent change in seizure frequency and responder rate, and QOL with the Quality of Life in Epilepsy (QOLIE-89) inventory.

Stroke code simulation benefits advanced practice providers similar to neurology residents.

Background: Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke code similar to neurology residents.

Neurologist-patient communication about epilepsy in the United States, Spain, and Germany.

Background: Effective communication between patients and their health care providers is recognized as critically important to improve the quality of health services for individuals with epilepsy. We aimed to describe in-office neurologist-patient conversations about epilepsy and focus on disease identification, shared decision-making, and care planning.

Methods: Transcripts and audio recordings of conversations between patients and neurologists in the United States, Spain, and Germany were analyzed linguistically in the topic areas of epilepsy identification and diagnosis, disease education, treatments, and care planning.

A Therapeutic Approach to Psychogenic Nonepileptic Seizures.

The diagnosis of psychogenic nonepileptic seizures (PNES) is usually made in the seizure monitoring unit (SMU; also commonly named the epilepsy monitoring unit) after PNES are recorded on video-EEG. The diagnosis should be discussed with the patient thoroughly. The discussion should focus on how the diagnosis was reached and that the diagnosis is real and treatable.

Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy.

Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2-5 years postsurgery and a few up to 10 years. Our study aimed to assess long-term (up to 15 years) postsurgical seizure and psychosocial outcomes at our epilepsy center.

Closing the Major Gap in PNES Research: Finding a Home for a Borderland Disorder.

Psychogenic nonepileptic seizures (PNES) are events commonly encountered by primary care physicians, neurologists, pediatricians, and emergency medicine physicians in their practices, yet there continues to be significant variability in the way they are evaluated, diagnosed, and treated. Lack of understanding this condition and limited data on long-term outcome from current treatment paradigms have resulted in an environment with iatrogenic injury, morbidity, and significant costs to the patient and healthcare system. This article will review the current state of research addressing PNES treatment both in the adult and pediatric populations.

Influence of age and location of ictal onset on postoperative outcome in patients with localization-related epilepsy.

Introduction: Localization-related epilepsy is a significant concern for the middle-aged and older population given the lesser cognitive reserve and the greater likelihood of adverse systemic antiepileptic drug effects. Epilepsy surgery for this age group has the potential for greater postoperative morbidity and mortality, a protracted rehabilitation with its associated economic burden, progressive cognitive and memory decline and a lesser chance of becoming seizure-free after the procedure.

Methods: A retrospective institutional archival review of 120 patients with medically refractory partial epilepsy of both temporal and extratemporal epilepsy was performed.

Diagnosis, costs, and utilization for psychogenic non-epileptic seizures in a US health care setting.

Background: Psychogenic non-epileptic seizures (PNES) pose a substantial burden to patients and the health care system, due to long diagnostic and treatment delays.

Methods: This study used medical chart notes from 103 patients to shed light on the diagnostic process. Electronic medical records and cost data from a US health system were also used to investigate costs and utilization for the 12-months before and after PNES diagnosis.

Analysis of scalp EEG and quantitative MRI in cases of temporal lobe epilepsy requiring intracranial electrographic monitoring.

Abstract Purpose. Contradictory scalp electroencephalographic (sEEG) and discordant imaging features are common in temporal lobe epilepsy (TLE). We assessed the relative importance of sEEG features and their relation to quantitative magnetic resonance (MR) imaging measures in regard to surgical outcome.

Ictal barking as a manifestation of temporal lobe epilepsy.

Ictal nonspeech vocalizations have been described as manifestations of either frontal or temporal epileptogenicity originating mainly from the dominant hemisphere. Ictal barking, particularly, has been considered a manifestation of mesial frontal epilepsy. A 42-year-old right-handed male with posttraumatic drug-resistant complex partial epilepsy manifested ictal barking near electrographic onset.

The burden of epilepsy to patients and payers.

The extraordinary burden of epilepsy on quality of life (QOL) is well known, as is the very high economic burden associated with the disease. Epilepsy is associated not only with seizures, but also a variety of serious comorbidities, including respiratory, cardiovascular, and neurologic dysfunctions. Psychiatric conditions are very prevalent in the epilepsy population, and may have pathological mechanisms in common with epilepsy.

An assessment of MEG coherence imaging in the study of temporal lobe epilepsy.

Purpose: This study examines whether magnetoencephalographic (MEG) coherence imaging is more sensitive than the standard single equivalent dipole (ECD) model in lateralizing the site of epileptogenicity in patients with drug-resistant temporal lobe epilepsy (TLE).

Methods: An archival review of ECD MEG analyses of 30 presurgical patients with TLE was undertaken with data extracted subsequently for coherence analysis by a blinded reviewer for comparison of accuracy of lateralization. Postoperative outcome was assessed by Engel classification.

Management of epilepsy in drug-resistant patients.

Epilepsy affects > 2 million people in the United States, making it one of the most common neurobiological conditions. Typically, epilepsy is treated with one of several available antiepileptic drugs and patients are able to experience freedom from seizures with minimal side effects. However, there are some patients who do not respond to treatment and require the use of multiple drug combinations or surgical intervention.

Concerns with AED conversion: comparison of patient and physician perspectives.

When discussing AED conversion in the clinic, both the patient and physician perspectives on the goals and risks of this change are important to consider. To identify patient-reported and clinician-perceived concerns, a panel of epilepsy specialists was questioned about the topics discussed with patients and the clinician's perspective of patient concerns. Findings of a literature review of articles that report patient-expressed concerns regarding their epilepsy and treatment were also reviewed.

Direct medical costs for patients seeking emergency care for losses of epilepsy control in a U.S. managed care setting.

The objective of this retrospective claims database study was to compare the costs of care from a U.S. payer perspective before and after epilepsy treatment in emergent care settings and, secondarily, to describe the frequency of toxic effects and physical injuries occurring on the date of the emergent care.

FLAIR signal and texture analysis for lateralizing mesial temporal lobe epilepsy.

Standard magnetic resonance (MR) imaging analysis in several cases of mesial temporal lobe epilepsy (mTLE) either fail to show an identifiable hippocampal asymmetry or provide only subtle distinguishing features that remain inconclusive. A retrospective analysis of hippocampal fluid-attenuated inversion recovery (FLAIR) MR images was performed in cases of mTLE addressing, particularly, the mean and standard deviation of the signal and its texture. Preoperative T1-weighted and FLAIR MR images of 25 nonepileptic control subjects and 36 mTLE patients with Engel class Ia outcomes were analyzed.

Case-control analysis of ambulance, emergency room, or inpatient hospital events for epilepsy and antiepileptic drug formulation changes.

Purpose: Although antiepileptic drugs (AEDs) with multisource generic alternatives are becoming more prevalent, no case-control studies have been published examining multisource medication use and epilepsy-related outcomes. This study evaluated the association between inpatient/emergency epilepsy care and the occurrence of a recent switch in AED formulation.

Methods: A case-control analysis was conducted utilizing the Ingenix LabRx Database.

A survey of neurologists' views on epilepsy surgery and medically refractory epilepsy.

There is a 20-year delay between the diagnosis of epilepsy and surgical treatment. The aim of this study was to describe the different views held by neurologists regarding refractory epilepsy that may contribute to the delay in referring patients for epilepsy surgery. Neurologists in Michigan were mailed a 10-item survey inquiring about their definition of medically refractory epilepsy and their decision-making process in referring patients for epilepsy surgery.

Conversions between monotherapies in epilepsy: expert consensus.

To develop expert consensus for conversion between antiepileptic drug (AED) monotherapies, an 11-member panel used the Delphi Technique over three rounds to: (1) identify relevant issues, (2) vote on the issues, and (3) develop consensus. The panel agreed on the basic principle to taper the existing AED only after a presumably efficacious dose of the planned AED was reached. Application is modified by adverse effects possibly attributable to the existing drug, in which case earlier or more rapid tapering of the existing drug should be considered.

A retrospective analysis of the effect of general anesthetics on the successful detection of interictal epileptiform activity in magnetoencephalography.

Background: A magnetoencephalography (MEG) study requires the patient to lie still for a prolonged period of time. In children and uncooperative adults with epilepsy, general anesthesia or sedation may be required to insure a good quality study. As general anesthetics have anticonvulsant and proconvulsant properties, we investigated whether the use of anesthesia reduced the successful detection of interictal epilepsy activity.

Long-term electrical stimulation-induced inhibition of partial epilepsy. Case report.

The aim of this study was to determine the effects of long-term continuous cerebrocortical electrical stimulation in the treatment of partial epilepsy. The authors review the case of a 44-year-old man with medically intractable postencephalitic localization-related epilepsy with ictal onset in the primary motor cortex. For 5 years he was treated using patterned subthreshold electrical stimulation of the ictal site.

Vasovagal syncope misdiagnosed as epilepsy for 17 years: prime importance of clinical history.

Distinguishing epilepsy from syncope often can be challenging. We report a case of a 20-year-old patient with presumed refractory epilepsy since the age of 3 years. Although the clinical suspicion of syncope was raised at the age of 9 years, key historic features were not identified, cardiac work-up was not pursued and despite lack of electrographic evidence of epilepsy, he received anticonvulsant treatment.

Use of phenytoin for the long-term treatment of partial seizures: Results of a survey conducted during the 2004 meeting of the American Academy of Neurology.

Background: Epilepsy is a chronic disorder that typically requires lifelongpharmacologic treatment. The choice of an antiepileptic drug (AED), therefore, requires careful consideration of efficacy and tolerability. However, the majority of patients with new-onset seizures are initially treated by physicians in the emergency department (ED) or by non-ED physicians (primary care physicians or internists), with phenytoin being the most common AED prescribed for initial therapy, and the long-term adverse effects of AEDs are often overlooked.