Seizure

Epilepsy is a frequent neurological disorder with a prevalence of 6.38 per 1,000 persons [1] and approximately 5 million people have been diagnosed with epilepsy worldwide, according to the World Health Organization (WHO). Patients with epilepsy have a three-fold risk for psychiatric comorbidities compared to the general population [2]. Almost 20-22% of patients with epilepsy suffer from depression [2–7], while its prevalence may reach 60% in patients with temporal lobe epilepsy [8,9].

There are many comorbidities in people with epilepsy (PWE), with depression being the most frequent comorbidity. The lifetime prevalence for depression is around 10% in the general population [1] but is estimated at 30% in PWE [2]. A bidirectional relationship between depression and epilepsy was described more than 2000 years ago [3]. Depression may lower the seizure threshold [4]. Many recent epidemiological studies have found that the presence of primary depressive disorder was associated with a three to seven fold ...

Antiepileptic drugs (AEDs), particularly aromatic ones like Carbamazepine (CBZ), Phenytoin (PHT), Phenobarbitone (PB), and Lamotrigine (LTG), are responsible for various cutaneous adverse drug reactions (cADRs). These vary from minor Maculopapular exanthema (MPE) to severe life-threatening reactions like Drug reaction eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), which may develop within few hours to even several weeks after AED initiation.

Nonconvulsive status epilepticus is an important diagnosis to consider when patients present with altered level of consciousness. NCSE has been documented in approximately 8% of comatose patients admitted to ICU without clinical signs of seizure activity [1]. Delay in the diagnosis of NCSE > 24 hours results in increased mortality from 39% to 75% [2]. An EEG is essential for the diagnosis of NCSE.

Epilepsy is now recognized as a network disorder and this conceptualization is central to the ILAE Classification System [1–4]. In clinical practice this framework requires the clinician to think broadly in terms of the range of deficits that can be associated with focal-onset epilepsies, including temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). Pre-surgical decision-making has traditionally focused on the localization and lateralization of function, which is seemingly juxtaposed to the network approach.

About 30–40% of epilepsy patients whose seizures cannot be controlled with two well-tolerated, appropriately chosen, and used antiepileptic drugs (AEDs) are considered to have drug-resistant epilepsy (DRE) [1]. Even with adequate access to surgical treatment and further AEDs trials, 61.1% of patients with DRE have ongoing seizures [2]. Vagus nerve stimulation (VNS) was approved by the Food and Drug Administration (FDA) as adjunct therapy to reduce the frequency of seizures in adults with DRE [3].

Oral lacerations are widely recognized as potential complications of seizures. These are mostly minor injuries requiring some degree of pain control, but occasionally require repair or result in more serious complications [1,2]. Diagnostic value of ictal tongue biting has been extensively evaluated, demonstrating good positive predictive value of lateralized tongue-biting for epileptic seizure versus paroxysmal non-epileptic seizures [3,4,5].

The need to address key limitations in validation studies is highlighted in order to support future assessments of SDD fitness for ASM clinical trial use. In tandem, a stepwise framework to streamline device testing is put forth. These suggestions provide a starting point for establishing SDD reporting requirements before device integration into ASM clinical trials.

The overall incidence of epilepsy is approximately 37.4 cases per 100,000 population per year and is increasing in older individuals [1,2]. New epilepsy diagnoses in the elderly population have increased by 3.5 cases per 100,000 over the last 25 years, and are now situated at 30 cases per 100,000 per year [2,3].

Tremor is defined as an involuntary, rhythmical, oscillatory movement of a body part produced by either synchronous or alternating contractions of antagonist muscles [1]. As one of the most common neurological symptoms, tremor was frequently seen in patients with epilepsy (PWE). According to the Epilepsy Comorbidities and Health (EPIC) Survey, 9.3% of the respondents with epilepsy reported perceived movement disorder/tremor, more than twice as prevalent as those without epilepsy [2].