Epilepsia
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Responses among patients to antiepileptic drugs (AEDs) may be highly variable, with respect to both drug efficacy and safety. Pharmacogenetics addresses the genetic component of such patient variability. Differential response to phenytoin, for example, is related to interindividual genetic differences in the metabolic enzyme CYP2C9, and to a lesser extent, CYP2C19. ⋯ Further understanding of the role of genes in AED response will depend on clinical investigations coupled with new information and technologies derived from the Human Genome Project. Once the DNA sequences involved in specific AED responses are understood, they can be used as the basis of clinical assays to predict the most likely response in each individual patient. The combination of clinical investigations, genomics, and emerging testing methodologies should lead to new tools for the effective management of epilepsy.
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There is no brief, global instrument available that specifically measures the psychosocial impact of pediatric epilepsy on the family. An 11-item scale was created for parents' use to evaluate the influence of epilepsy on the major aspects of their family and child's life. This will be a helpful tool both in the clinical setting and as an outcome measure for research studies. ⋯ The IPES is an accurate, acceptable, and quick measurement tool that reflects the way in which childhood epilepsy has an impact on the child and on family life. It may be helpful in routine clinical care and may be useful in the research setting to find ways to improve the lives of children with epilepsy.
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To examine the frequency of psychiatric disorders before and after surgery for epilepsy and the postoperative changes. ⋯ One third of the surgical patients had psychiatric disorders before and/or after surgery. Preexisting psychiatric problems disappeared after surgery in one third of the patients, but persisted after surgery in the remaining patients, with aggravation in a few. Transient affective disorders appeared in some patients immediately after surgery, and chronic psychiatric disorders appeared after surgery in a minority of patients. The patients having aggravated psychiatric conditions after surgery tended to be young and to have deviated personality traits. The social situation of the patients having psychiatric disorders after surgery was not good.
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We sought to investigate mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. ⋯ There is increased mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. This increase is found in symptomatic patients, young patients, and during the first 2 years after the diagnosis.