Seizure

Dear Sir,

In patients with new-onset seizures, autoimmune limbic encephalitis (LE) is an important differential diagnosis. Consensus criteria for definite autoimmune LE require typical clinical symptoms with subacute onset (working memory deficits, seizures, or psychiatric symptoms), bilateral MRI signs of LE, and either cerebrospinal fluid (CSF) pleocytosis or focal EEG findings of the temporal lobes [1]. Detection of a typical neural autoantibody may compensate for the lack of one of these three criteria.

Cenobamate is a new antiseizure medication (ASM) indicated for the treatment of focal onset (partial-onset) seizures in adults [1]. The summary of product characteristics for Europe specifies the use of cenobamate as adjunctive treatment for focal onset seizures in adults whose epilepsy has not been adequately controlled with at least two ASMS [2]. The efficacy and safety of cenobamate were demonstrated in two double-blind, randomized, placebo-controlled, phase 2 clinical studies (NCT01397968; NCT01866111) in patients with uncontrolled focal seizures who were ...

The corpus callosotomy (CC) was first introduced by Van Wagenen and Herren in 1940 as a palliative procedure to control refractory seizures [1]. Their hypothesis was based on the idea that the corpus callosum as the connecting bridge for interhemispheric spread of epileptic activity. Hence, this procedure is typically used to treat atonic seizures (drop attacks), which are highly refractory, but is also used to prevent generalization of other seizure types and syndromes, especially, Lennox-Gastaut Syndrome (LGS) [2].

: Super-refractory status epilepticus (SRSE) is extremely difficult to control and associated with poor outcomes. Ketogenic diet (KD) has been increasingly used for SRSE treatment. Enteral ketosis induction in SRSE is sometimes unfeasible, leading to the use of parenteral KD which has limited data among children.

Ring chromosome 20 [r (20)] syndrome is a rare chromosomal disorder seen in 1 in 30,000 to 60,000. Ring formation can occur due to intra-chromosomal fusions in either the germline or somatic cells. [1] Ring chromosome 20 syndrome is a triad of drug resistant focal epilepsy, non-convulsive status epilepticus and characteristic electroencephalogram findings. [2] These patients are usually resistant to conventionally used anti-seizure medicines (ASM).

Complex interactions have been reported between sleep and epilepsy. Sleep deprivation is associated with increased seizure occurrence, and active seizures may disturb sleep architecture [1, 2]. Subjective sleep disturbances are twice as prevalent in adults with epilepsy than that in healthy controls [3]. A recent meta-analysis indicated that the Pittsburgh Sleep Quality Index was significantly poorer in adults with epilepsy than in healthy controls [4].

Much has been written about the outcome of vagus nerve stimulation (VNS) since it was introduced in the early nineties as an ancillary treatment for ‘drug-resistant epilepsy’ or ‘difficult to treat epilepsy’ [1, 2]. There is general agreement that it is a valid and helpful treatment for these patients. However, this extensive literature, extending back over many years, does not cover two aspects in detail. Although many studies describe outcome this is often at fixed intervals, whereas this audit describes ...

While psychological interventions are considered to be the treatment of choice for adults with dissociative seizures (DS), evidence for such treatments was limited prior to the ‘Cognitive behavioural therapy vs standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES)’ Trial. The CODES trial set out to investigate the effectiveness of standardised medical care (SMC) alone versus DS-specific Cognitive Behavioural Therapy (CBT) plus SMC for adults with DS [1–3]. Before completion of the CODES trial only two pilot randomised controlled ...

The benefits of breastfeeding for both the mother and the child are well established, and unless there are clear contraindications, women are encouraged to breastfeed [1, 2]. Breastfeeding in mothers is associated with a reduced risk for type 2 diabetes, breast cancer, and ovarian cancer. In addition, the child has reduced risks for heart disease, diabetes, obesity, and respiratory tract infections. Moreover, it has positive emotional and psychological effects on both [3]. Despite this knowledge and recommendation of the American ...