LEVETIRACETAM AND CUTANEOUS ADVERSE REACTIONS: A SYSTEMATIC REVIEW OF DESCRIPTIVE STUDIES

Levetiracetam (LEV) was approved in 1999 by the US Food and Drug Administration (FDA) for the treatment of seizure disorders. It is a second-generation antiepileptic drug (AED) with a unique mechanism – it acts by binding to specific sites on the nerve cell surfaces [1]. It inhibits the burst firing without affecting the normal neuronal excitability, suggesting that it selectively prevents the hyper synchronisation of epileptiform burst firing and propagation of seizure activity [2]. The FDA-labelled indications of LEV include ...

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Outcome of status epilepticus and the predictive value of the EMSE and STESS scores: a prospective study

Status epilepticus (SE) is an abnormally prolonged seizure state with a high risk of mortality and functional decline. The short-term case fatality rate is 7.6–33% across all seizure types (1). At hospital discharge, 23–58% of survivors have increased need for help in daily living (2–4). Of intensive care patients with refractory SE, less than half recover to baseline function, 20% die and 30% show new functional deficits (5). Aggressive treatment should be aimed at patients who are at a high ...

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The Exploration of the Spectrum of Motor Manifestations of Anti-LGI1 Encephalitis beyond FBDS

Anti-leucine-rich glioma-inactivated protein 1 (anti-LGI1) encephalitis is a type of autoimmune encephalitis with an antibody targeting neuronal surface antigens [1]. LGI1, which is primarily expressed in the hippocampus and temporal cortex, serves as a component of voltage-gated potassium channel (VGKC) complexes by acting as the ligand for two epilepsy-related proteins, ADAM22 and ADAM23 [2,3], thus epileptic seizures are common symptoms [4–9]. Other paroxysmal events, especially motor events, such as faciobrachial dystonic seizures (FBDS), bizarre behaviors, sleep disorders and so on, ...

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Intubation for Psychogenic Non-Epileptic Attacks: Frequency, Risk Factors, and Impact on Outcome

Psychogenic non-epileptic attacks (PNEA) are defined as paroxysmal movements or abnormal behaviors that resemble epileptic seizures, are not accompanied by epileptiform activity, and are often associated with psychogenic factors. [1,2]. Documented clinical signs of PNEA without accompanying epileptiform activity on video electroencephalography (vEEG) is typically required to definitively confirm the diagnosis of PNEA. [1–3] Approximately 30% of hospitalized patients who undergo elective vEEG monitoring in epilepsy referral centers are diagnosed with PNEA.[4,5] We used the term “psychogenic nonepileptic attacks (PNEA)” ...

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Drug withdrawal in the Epilepsy monitoring unit – The Patsalos Table

Admissions to epilepsy monitoring units (EMUs) are a necessary part of the diagnostic and investigative process of most modern epilepsy centres. Video Telemetry (VT) utilises simultaneous video and EEG to capture episodic events for a variety of indications, including the diagnosis of transient episodes of uncertain nature (especially to distinguish epileptic from non-epileptic attack disorder); the classification of epilepsy syndrome; and pre-surgical evaluation in patients with medically refractory epilepsy [1].

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Safety, tolerability and effectiveness of transition to eslicarbazepine acetate from carbamazepine or oxcarbazepine in clinical practice

Eslicarbazepine acetate (ESL) is a once-daily antiepileptic drug (AED) that is approved for the treatment of focal-onset seizures as monotherapy or adjunctive therapy [1,2]. The efficacy and safety/tolerability of ESL as adjunctive therapy for focal-onset seizures in adults have been established in a series of randomised, double-blind, placebo-controlled, Phase III trials [3–6] and long-term extension studies [7–9]. The efficacy and safety/tolerability of ESL in the monotherapy setting have been established in a randomised, double-blind, active-controlled, Phase III trial, conducted in ...

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The efficacy of perampanel in young children with drug-resistant epilepsy

Epilepsy is the most common neurological disorder in children. The prevalence of epilepsy ranges from 3 to 5 per 1000 children in developed countries, and the incidence is about 41 to 187/100,000 person-years [1]. Previous studies have shown the incidence of epilepsy to be highest in the first year of life, ranging from 81 to 130/100,000 [1]. Of those with epilepsy, about 10% of children have drug-resistant epilepsy [2]. The common etiologies of drug-resistant epilepsy can be very diverse, including ...

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Epilepsy and autoimmune diseases: comorbidity in a national patient cohort

Epilepsy is one of the most common chronic brain disorders, and globally 50 million people are affected [1]. Epilepsy prevalence varies between 0.5 and 1 % [2]. Common for all epileptic conditions are recurrent unprovoked seizures. Epilepsy can have severe consequences for the patient, and treatment with antiepileptic drugs is strongly recommanded for most patients. There is a wide range of antiepileptic drugs, and they can be used in combination as their mode of action varies. One third of the ...

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Deep Brain Thalamic Stimulation in the Simultaneous Treatment of Generalised Epilepsy and Dystonic Tremord

Deep brain stimulation (DBS) in the treatment of dystonic tremor is well established with targets including the venterointermediate nucleus (VIM), globus pallidus interna (GPi). More recently the subthalmic nucleus (STN) and zona incerta (ZI) have emerged as promising targets [1]. DBS targeting the centromedian nucleus (CMN) has been found to be a safe and effective treatment for refractory generalised epilepsy. [2]. There is no body of evidence in the literature where dystonic tremor and refractory generalised epilepsy have been managed ...

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Focal EEG abnormalities and focal ictal semiology in generalized epilepsy

In clinical practice, the dichotomy of focal vs generalized epilepsy dictates the choice of antiepileptic drugs (AEDs) for treatment and subsequent management of epileptic patients. In general, patients with focal epilepsy are good candidates for excisional epilepsy surgery, whereas those with generalized epilepsy are not. In most cases, the diagnosis of focal vs generalized epilepsy is clear after a careful consideration of the seizure semiology and results from diagnostic testing, namely video electroencephalography (VEEG), neuroimaging, and genetic testing.

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