Knowledge attitudes and practice toward epilepsy among adults in BaVi, Vietnam: first report from the population-based EPIBAVI study.

Purpose: We conducted a survey to assess knowledge, attitudes, and practice toward epilepsy in a population-based study in a rural district of Vietnam.

Methods: We utilized an established knowledge-attitudes-practice questionnaire. This was applied by trained surveyors in face-to-face interviews of 2005 randomly selected adult residents (19-71 years of age) of the BaVi district, 60 km west of Hanoi.

Heart rate variability in patients with untreated epilepsy.

Background: Several studies have reported reduced heart rate variability (HRV) in patients with chronic epilepsy under treatment with antiepileptic drugs. This impairment in cardiac autonomic control might be of relevance in relation to the risk of sudden unexpected death in patients with chronic refractory epilepsy. Little information is, however, available on HRV in untreated patients with newly diagnosed epilepsy.

Pharmacokinetics of levetiracetam during pregnancy, delivery, in the neonatal period, and lactation.

Purpose: To study pharmacokinetics of levetiracetam (LEV) during pregnancy, delivery, lactation, and in the neonatal period.

Methods: Fourteen women with epilepsy receiving LEV treatment during pregnancy and lactation contributed with 15 pregnancies to this prospective study in which LEV concentrations in plasma and breast milk were determined. Trough maternal plasma samples were collected each trimester, and at baseline after delivery.

Oral contraceptives induce lamotrigine metabolism: evidence from a double-blind, placebo-controlled trial.

Purpose: This study evaluates the effect of oral contraceptives on lamotrigine (LTG) plasma concentrations and urine excretion of LTG metabolites in a double-blind, placebo-controlled, crossover study in patients with epilepsy.

Methods: Women with epilepsy, treated with LTG in monotherapy and taking combination-type oral contraceptives, were randomized to treatment with placebo or a standard combination-type contraceptive pill. The dose-corrected trough plasma concentration of LTG and the ratio of N-2-glucuronide/unchanged LTG on urine after 21 days of concomitant placebo treatment was analyzed versus those after 21 days of concomitant treatment with the oral contraceptive pill.

Pharmacokinetics and therapeutic drug monitoring of newer antiepileptic drugs during pregnancy and the puerperium.

The treatment of epilepsy in pregnancy is particularly challenging in that the fetal and maternal risks associated with maternal seizures need to be balanced against the potential teratogenic effects of antiepileptic drugs (AEDs). Pregnancy is known to affect the pharmacokinetics of older-generation AEDs. Understanding such alterations is important in the effort to optimise drug therapy since they may affect seizure control as well as fetal drug exposure.

Circadian variation in heart-rate variability in localization-related epilepsy.

Purpose: Case-control studies of sudden unexpected death in epilepsy (SUDEP) have reported that SUDEP is more likely to occur during sleep and thus presumably during night hours. The circadian variation of heart-rate variability (HRV) might be of relevance to this risk. We examined night versus daytime HRV in patients with newly diagnosed and refractory localization-related epilepsy, assessing the effects of drug treatment and epilepsy surgery on the night/daytime HRV ratio.

Therapeutic monitoring of antiepileptic drugs for epilepsy.

Background: The aim of drug treatment for epilepsy is to prevent seizures without causing adverse effects. To achieve this, drug dosages need to be individualised. Measuring antiepileptic drug levels in body fluids (therapeutic drug monitoring) is frequently used to optimise drug dosage for individual patients.

Optimizing treatment of epilepsy during pregnancy.

Freedom from seizures is the ultimate goal in treatment of patients with epilepsy. At the same time, the side effects of antiepileptic drugs (AEDs) should not outweigh the benefits of treatment. This is particularly important in women with epilepsy who wish to become pregnant.

Progress report on new antiepileptic drugs: a summary of the Eigth Eilat Conference (EILAT VIII).

The Eigth Eilat Conference on New Antiepileptic Drugs (AEDs)-EILAT VII, took place in Sitges, Barcelona from the 10th to 14th September, 2006. Basic scientists, clinical pharmacologists and neurologists from 24 countries attended the conference, whose main themes included a focus on status epilepticus (epidemiology, current and future treatments), evidence-based treatment guidelines and the potential of neurostimulation in refractory epilepsy. Consistent with previous formats of this conference, the central part of the conference was devoted to a review of AEDs in development, as well as updates on marketed AEDs introduced since 1989.

Pharmacokinetic variability of newer antiepileptic drugs: when is monitoring needed?

A new generation of antiepileptic drugs (AEDs) has reached the market in recent years with ten new compounds: felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, tiagabine, topiramate, vigabatrin and zonisamide. The newer AEDs in general have more predictable pharmacokinetics than older AEDs such as phenytoin, carbamazepine and valproic acid (valproate sodium), which have a pronounced inter-individual variability in their pharmacokinetics and a narrow therapeutic range. For these older drugs it has been common practice to adjust the dosage to achieve a serum drug concentration within a predefined 'therapeutic range', representing an interval where most patients are expected to show an optimal response.

Valproate effects on kinetics of lamotrigine in pregnancy and treatment with oral contraceptives.

In eight women treated with lamotrigine monotherapy, the lamotrigine dose/plasma concentration (D/C) ratio increased by 295% from baseline outside pregnancy to midgestation, whereas in six women treated with lamotrigine in combination with valproate, the increase was only 60%. No difference in lamotrigine D/C ratio was found between users and nonusers of oral contraceptives comedicated with valproate. Valproate seems to reduce the induction of lamotrigine metabolism associated with pregnancy or use of contraceptives.

ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.

Purpose: To assess which antiepileptic medications (AEDs) have the best evidence for long-term efficacy or effectiveness as initial monotherapy for patients with newly diagnosed or untreated epilepsy.

Methods: A 10-member subcommission of the Commission on Therapeutic Strategies of The International League Against Epilepsy (ILAE), including adult and pediatric epileptologists, clinical pharmacologists, clinical trialists, and a statistician evaluated available evidence found through a structured literature review including MEDLINE, Current Contents and the Cochrane Library for all applicable articles from 1940 until July 2005. Articles dealing with different seizure types (for different age groups) and two epilepsy syndromes were assessed for quality of evidence (four classes) based on predefined criteria.

Role of valproate across the ages. Treatment of epilepsy in adults.

A workshop was held in Göteborg in June 2005 to discuss the place of valproate in treating adult epilepsies. Consensus positions were developed on the epilepsy types for which the drug is most suitable and the use of valproate in women of child-bearing age, in men and in patients with psychiatric comorbidity. Valproate was considered to be effective across a broad variety of epilepsy syndromes and seizure types and should be considered a suitable choice for first-line monotherapy of juvenile myoclonic epilepsy and other idiopathic generalized epilepsies.

No apparent effect of surgery for temporal lobe epilepsy on heart rate variability.

Background: Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy (SUDEP). Clinical observations indicate that successful epilepsy surgery is associated with a reduced risk of SUDEP. However, in a previous study we found impaired cardiac control pre-surgically in patients with poor outcome of surgery, indicating an a priori lower risk in responders to epilepsy surgery.

Epilepsy as a risk factor for cancer.

Aim: Epilepsy and long term use of antiepileptic drugs have been suggested to be associated with an increased risk of cancer. The authors therefore set out to analyse previous diagnosis of epilepsy as a risk factor for certain cancer forms in a case control study.

Methods: Incident cases of leukaemia, lymphoma, myeloma, and pancreatic cancer were identified from the Swedish Cancer Registry 1987-99, a total of 52 861 cases.

Gender aspects of pharmacokinetics of new and old AEDs: pregnancy and breast-feeding.

Alterations in drug disposition in pregnancy and drug transfer into breast milk during lactation are the most important gender-related aspects of the pharmacokinetics of antiepileptic drugs(AEDs). The effect of pregnancy on drug disposition has been fairly well characterized for the old AEDs. Total and unbound plasma concentrations of phenobarbital decline up to 50%.

Sudden unexpected death in epilepsy: a review of incidence and risk factors.

Sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. However, SUDEP is rare in patients with new onset epilepsy and in patients in remission. Incidence is about 0.

Mortality of epilepsy in developed countries: a review.

Mortality in people with epilepsy has been studied in many different populations. In population-based incidence cohorts of epilepsy with 7-29 years follow-up, there was up to a threefold increase in mortality, compared to the general population (standardized mortality ratios [SMR] ranged from 1.6 to 3.

Symptoms in smokers trying to quit.

Aims: To describe the prevalence and intensity of different symptoms in relation to tobacco abstinence. To explore latent dimensions between symptoms in smokers trying to quit.

Design: A cross sectional study using a questionnaire to retrospectively assess symptoms over a period of 12 months.

Preoperative heart rate variability in relation to surgery outcome in refractory epilepsy.

Background: Epilepsy patients may have an impaired autonomic cardiac control, which has been associated with an increased incidence of sudden unexpected death among people with epilepsy (SUDEP). The risk of SUDEP is particularly high among epilepsy surgery candidates with refractory epilepsy. This risk seems to be reduced after successful surgery but whether this is an effect of surgery or reflects pre-existing differences between good and poor responders is under debate.

Pharmacokinetics of gabapentin during delivery, in the neonatal period, and lactation: does a fetal accumulation occur during pregnancy?

Purpose: To study the pharmacokinetics of gabapentin (GBP) during delivery, lactation, and in the neonatal period.

Methods: GBP concentrations in plasma and breast milk were determined with high-performance liquid chromatography in samples from six women treated with GBP and in their offspring. Blood samples were obtained at delivery from mothers, from the umbilical cord, and from the newborns on three occasions during 2 days after delivery.