Does treatment in an epilepsy clinic affect epilepsy-related admissions?

Background: Epilepsy-related emergency hospitalizations are associated with risks to patients. Neurologist ambulatory care can improve seizure control and decrease the rates of ED visits and emergency hospitalizations.

Aims: To evaluate the etiologies for emergency epilepsy-related admissions in patients with and without prior epilepsy clinic follow-up, and to identify possible factors that may influence admission rates.

Bone Mineral Density Screening in People With Epilepsy and Intellectual Disability.

Vitamin D measurements and dual energy x-ray absorptiometry (DXA) scans are recommended in people with intellectual disability and/or epilepsy in order to prevent bone-linked harm. The prevalence of vitamin D supplementation and bone mineral density screening were evaluated in 68 people with epilepsy and intellectual disability (EID) and 68 matched controls with epilepsy without intellectual disability. DXA scans were not performed in any of the people with EID but were performed in 11.

Primary treatment gap among adults with epilepsy: A cross-sectional analysis.

Objective: Despite recommendations to initiate antiseizure medication treatment once the diagnosis of epilepsy is confirmed, a certain proportion of patients with epilepsy who should receive antiseizure medication treatment remain untreated. We aimed to evaluate the rate of and the reasons for the treatment gap in patients with epilepsy who were referred to their first visit in our epilepsy clinic.

Methods: We retrospectively reviewed the computerized database and the medical records of all the patients with epilepsy who had their first visit in our outpatient epilepsy clinic during a 10-year period (2012-2021).

Guidelines and epilepsy practice: Antiseizure medication initiation following an unprovoked first seizure in adults.

Objectives: Adherence rate to evidence-based clinical practice guidelines is relatively low and the impact of guidelines on clinical practice in epilepsy is variable. The 2015 practice guideline on the management of an unprovoked first seizure in adults specifies clinical variables associated with increased risk of seizure recurrence and the impact of immediate antiseizure medication (ASM) treatment on seizure outcome. We aimed to evaluate the impact of the evidence-based guideline for the management of an unprovoked first seizure in adults on clinical practice in our adult neurology department.

Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs.

Background: For over two decades, a daily folic acid (FA) supplementation has been recommended for women of childbearing age with epilepsy. This recommendation is based on evidence that FA administration before conception and during pregnancy can decrease the risk of fetal malformations in the general population, improve cognitive development, and reduce the risk of autistic traits in children exposed in utero to antiepileptic drugs (AEDs).

Objective: The aim of this study was to evaluate FA supplementation rate in nonpregnant women of childbearing age with epilepsy and its relation to AED type and number.

Reasons for delayed treatment initiation in Guillain-Barre syndrome.

Objective: The goal of this study was to analyze the reasons for delayed diagnosis of Guillain-Barre syndrome (GBS).

Methods: We retrospectively reviewed the records of all adult patients with GBS treated at Shamir Medical Center (SMC) from 2006 to 2018. We divided the patients into two groups: those with early initiation of treatment (within 24 h of arrival to ED), and those with later initiation of treatment (>24 h after arrival).

Therapeutic levetiracetam monitoring during pregnancy: "mind the gap".

Background: Epilepsy is one of the most common chronic neurological conditions and its treatment during pregnancy is challenging. Levetiracetam (LEV) is an antiepileptic medication frequently used during pregnancy. Only a few small studies have been published on LEV monitoring during pregnancy, demonstrating decreased serum LEV levels during the first and second trimester; however, the most significant decrease was observed during the third trimester of pregnancy.

Antiepileptic Drug Treatment in Community-Dwelling Older Patients with Epilepsy: A Retrospective Observational Study of Old- Versus New-Generation Antiepileptic Drugs.

Introduction: The use of antiepileptic drugs (AEDs) in older patients with epilepsy is challenged by polypharmacy and decreased drug elimination. Newer AEDs have a lower potential for drug interactions and are reported to be better tolerated by the elderly than old-generation AEDs.

Objective: The objective of this study was to evaluate AED use and the related adverse event rate in an outpatient cohort of older patients with epilepsy.

The yield of non-elective inpatient video-EEG monitoring in adults.

Background: Inpatient video-EEG monitoring (VEM) can contribute to the diagnosis and treatment in many of the monitored patients. Most admissions to VEM are elective and are scheduled ahead before the monitoring session.

Purpose: To retrospectively evaluate the yield of non-elective VEM sessions.

Tolerability and efficacy of perampanel in children with refractory epilepsy.

Aim: There are few reports on the tolerability and efficacy of perampanel, a new antiepileptic drug with a novel mechanism of action, in children and adolescents. We aimed to describe our experience with perampanel add-on and mono-therapy in children with refractory epilepsy.

Method: Computerized medical records of children treated with perampanel in the paediatric neurology clinic from December 2012 to October 2015 were reviewed.

How valuable is inpatient electroencephalogram for medical decision-making?

Background: The electroencephalogram (EEG) can support the diagnosis of epilepsy, diagnose nonconvulsive status epilepticus and aid in the classification of epileptic seizures. Its contribution to the diagnosis of other medical conditions or to decision-making in other clinical situations was not established. Practically, EEG laboratories frequently encounter EEG referrals that are not based on current recommendations.

Postural stability in patients with different types of head and neck trauma in comparison to healthy subjects.

Objective: Dizziness is a common complaint in patients following mild head or neck trauma, but neurological signs are usually rare or absent. The aim of the study was to compare postural control in patients with different types of head and neck trauma to healthy subjects.

Methods: Balance function was evaluated by computerized dynamic platform posturography (CDPP) in 57 dizzy patients with whiplash injury (n = 11), mild head trauma without loss of consciousness (HTNLC) (n = 23), whiplash injury and mild head trauma without loss of consciousness (WHTNLC) (n = 12) and mild head trauma with loss of consciousness (n = 11) and in 14 healthy subjects.

Posturography in MS patients treated with high dose methylprednisolone.

Objectives: To evaluate the sensitivity of the balance sway index (SI) to drug-induced functional changes during acute relapse in patients with MS.

Methods: Dynamic posturography was used to derive the SI in 11 healthy subjects and 13 MS patients before and after intravenous high dose methylprednisolone (HDMP).

Results: In both groups, SI was lower in the least demanding task and increased with test complexity.

Efficacy and safety of felbamate in children with refractory epilepsy.

Background: Despite the introduction of multiple new antiepileptic drugs in the past two decades, many patients with epilepsy continue to experience uncontrolled seizures or significant side effects.

Aim: To present our experience with felbamate therapy in children with drug-resistant epilepsy.

Methods: We retrospectively reviewed the medical charts and video-EEG recordings of all patients receiving felbamate until May 2012.

Seizure occurrence during pediatric short-term EEG.

Aim: To identify the patients who are more likely to experience a seizure during short-term EEG recording.

Methods: We retrospectively reviewed the EEG recordings and medical records of 294 patients, who were admitted to the Pediatric Departments in Assaf Harofeh Medical Center, and referred for a short-term EEG during a 5-years period following a seizure.

Results: Fifteen (5.

Lamotrigine serum concentration in children with epilepsy.

The correlation between lamotrigine serum concentration, efficacy, and toxicity in children is controversial. The database of the Clinical Pharmacology Laboratory at Assaf Harofeh Medical Center was retrospectively searched to identify lamotrigine serum concentrations in children aged 2-19 years with refractory epilepsy who received lamotrigine as monotherapy or polytherapy from 2007-2010. Data collected included age at epilepsy onset, additional antiepileptic drugs, lamotrigine dose, monthly seizure frequency before and after lamotrigine treatment, and side effects.