Seizure

Lacosamide, a novel anti-epileptic drug (AED) that enhances the slow inactivation of voltage-gated sodium channels, is widely used to treat seizures associated with focal onset epilepsy. Common adverse effects of lacosamide include dizziness, vertigo, ataxia, and diplopia [1].

Status epilepticus in children is a common and serious condition that requires urgent treatment. A number of significant developments have occurred in the past few years that have changed clinical practice– and the publication of this supplement is very timely. Advances have been made in various research areas and the thirteen articles in this supplement provide a good overview of some of these.

Sudden unexpected death in epilepsy (SUDEP) is the most important directly epilepsy-related cause of death, with an estimated incidence of 1.2 cases per 1,000 adult epilepsy patients per year [1]. Some risk factors were identified including longstanding epilepsy and frequent generalized tonic-clonic seizures [1], but it is still challenging to estimate the individual SUDEP risk. The fatal cascade leading to SUDEP mostly involves primary central apnea following generalized tonic-clonic seizures [2].

The index case is a 3-year old boy with Dravet syndrome (de novo mutation in SCN1A gene; p.Ala889Thr [A889 T] variant) born to a non-consanguineous couple of south Indian origin. After an unremarkable early infancy, he presented with infrequent unprovoked hemi-clonic and generalized tonic-clonic seizures at 5 months of age. These were relatively controlled on oral low dose valproate. He had mild delay but could walk with support and spoke 4-5 words at 18 months of age. At 18 months of ...

Brivaracetam (BRV) is the latest anti-epileptic drug (AED) approved for adjunctive therapy of focal onset seizures and was introduced to the German market in February 2016. Similarly to Levetiracetam (LEV), BRV acts through binding synaptic vesicle protein 2 A which plays a role in synaptic vesicle trafficking and is distributed almost ubiquitously in the central nervous system. Orally administered BRV is resorbed completely and quickly and is metabolized via cytochrome P450-dependent and -independent pathways with its metabolites being eliminated renally.

Convulsive status epilepticus (CSE) is a common neurologic emergency in childhood and one of the most common reasons for admission to the pediatric intensive care unit [1,2]. CSE is defined as a prolonged convulsive seizure or multiple seizures without return to the baseline level of functioning between seizures. The estimated incidence of pediatric CSE is 20 cases per 100,000 children per year with a mortality ranging from 0 to 11 % [3–14]. Mortality is higher (4-22%) with symptomatic than idiopathic ...

Previous surveys have demonstrated that areas with high onchocerciasis transmission are prone to an increased prevalence of epilepsy (1). To describe this epidemiological phenomenon, the term onchocerciasis-associated epilepsy (OAE) was proposed that includes different seizure presentations including nodding syndrome (NS) (2,3). NS was first investigated in 2001–2 in Lui and Amadi in Western Equatoria region, South Sudan, by a team led by the World Health Organization (WHO) (4). Three small case control studies (82 pairs in total) performed during these ...

Psychogenic nonepileptic seizures (PNES) are episodic in nature, and many patients are initially misdiagnosed as having epilepsy. Most patients subsequently diagnosed with PNES in specialized centers are on antiepileptic drugs (AEDs) at the time of their referral. This has cost and added adverse effects of AEDs. Recognition of PNES can be difficult even for physicians. [1] Though certain clues in the semiology could suggest that the seizure is non-epileptic, the gold-standard for its diagnosis is the demonstration of a typical ...

Rolandic epilepsy (RE) usually presents with infrequent seizures and has excellent prognosis presenting with characteristic abnormal discharges on electroencephalogram (EEG), mainly “rolandic discharges (RDs)” [1]. The most striking finding of RD is the significant increase in frequency during drowsiness and through all sleep stages. Several studies have provided the clear evidence that children with RE display a profile of pervasive cognitive difficulties and behavioral disturbances, and thus RE is not always benign disorder [2,3].

Although numerous new antiepileptic drugs (AEDs) have been introduced over the last decades, offering advantages in terms of tolerability and drug interactions, most clinical trials and meta-analyses have failed to demonstrate any significant superiority in terms of efficacy of these newer AEDs as compared to older AEDs. [1–3] Also, it is well established that seizure response rates to add-on AED treatment decrease with subsequent AED trials [4–6]. For these reasons, overall drug response rates in patients with epilepsy have not ...