Epilepsia
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Current standard treatment of established status epilepticus after failure of benzodiazepines is intravenous phenytoin/fosphenytoin, phenobarbital, or valproate. Since 2006 two new antiseizure drugs have become available as intravenous formulation: levetiracetam (2006) and lacosamide (2008). ⋯ Future randomized controlled trials are needed to inform clinicians better about the best choice of treatment in established status epilepticus. The experimental evidence as well as the current clinical experience with levetiracetam and lacosamide are summarized in this review.
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Patients with status epilepticus that proves refractory to anesthetic agents represent a daunting challenge for treating clinicians. Animal data support the neuroprotective action of brain hypothermia, and its efficacy in status epilepticus models. ⋯ Conversely, mild hypothermia has a high-evidence level and is increasingly used in postanoxic encephalopathy, both in newborns and adults. Due to the paucity of available clinical data, prospective studies are needed to assess the value of hypothermia in status epilepticus.
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To investigate the characteristics of intracranial ictal high-frequency oscillations (HFOs). ⋯ Our study demonstrates the widespread occurrence of ictal HFOs at seizure onset, outlines a practical method to localize the SOZ based on their restricted pattern of evolution, and highlights the differences between the SOZs defined by HFOs and CFA. We show that smaller resections, restricted mainly to the HFOs channels with evolution, can lead to favorable seizure outcome. Our findings support the notion of widespread epileptic networks underlying neocortical epilepsy.
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We propose a patient-specific algorithm for seizure prediction using multiple features of spectral power from electroencephalogram (EEG) and support vector machine (SVM) classification. ⋯ High sensitivity and specificity are achieved by nonlinear classification of linear features of spectral power. Power changes in certain frequency bands already demonstrated their possibilities for seizure prediction indicators, but we have demonstrated that combining those spectral power features and classifying them in a multivariate approach led to much higher prediction rates. Employing only linear features is advantageous, especially when it comes to an implantable device, because they can be computed rapidly with low power consumption.
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Case Reports
Lacosamide-induced second-degree atrioventricular block in a patient with partial epilepsy.
Dose-dependent PR interval prolongation has been reported in preclinical studies of lacosamide (LCM), a recently U. S. ⋯ The patient recovered completely after withdrawal of LCM. This case demonstrates the need for caution and interval cardiac testing when adding LCM to other AEDs known to prolong the PR interval.