Epilepsia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Vagus nerve stimulation for treatment of partial seizures: 3. Long-term follow-up on first 67 patients exiting a controlled study. First International Vagus Nerve Stimulation Study Group.
Vagus nerve stimulation (VNS) has demonstrated a significant anticonvulsant effect in preclinical studies, in pilot studies in humans, and in the acute phase of a multicenter, double-blinded, randomized study. After completion of a 14-week, blinded, randomized study, with 31 receiving high (therapeutic) VNS and 36 receiving low (less or noneffective) VNS, 67 patients elected to continue in an open extension phase. During the extension phase, all 67 patients received high VNS. ⋯ The previously reported side effects of hoarseness/voice change, coughing, and paresthesia (sensation in neck and jaw) continued to occur during VNS. These side effects were well tolerated. During the follow-up period, 1 patient died of thrombotic thrombocytopenic purpura (TTP) and 5 patients discontinued treatment because of unsatisfactory efficacy.
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Historical Article
Driving and epilepsy: a historical perspective and review of current regulations.
Historically, persons with seizures or epilepsy have been prohibited from driving automobiles or motor vehicles because of concern for public safety. Seizures have a tendency to recur and pose risks of traffic accidents, property damage, and personal injury. In our modern world, however, driving an automobile is such an economic and social necessity that a conflict results between our need to protect public safety and our responsibility to provide reasonable opportunities to drive for persons handicapped by seizures and epilepsy. Currently, there is a trend toward liberalization of driving standards for persons with epilepsy, but there is still considerable controversy regarding the specific driving restrictions necessary for persons with seizures, the way in which such policies should be administered, and the role physicians should have in the process.
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Case Reports
Use of alternative medicine by patients with epilepsy: a survey of 265 epileptic patients in a developing country.
We evaluated the use of alternative treatment methods, in various forms, by epileptic patients who had used these forms of treatment before seeking hospital treatment. Among the 265 epileptic patients, 47.6% used African traditional medicine alone: 24.1% combined traditional medicine with spiritual healing, 20.4% used spiritual healing alone, and 7.5% used other forms of alternative medicine. Patients used the alternative treatments for < 1 year to > 5 years before seeking hospital treatment, presumably when alternative medicine failed to control seizures. ⋯ After initiation of hospital treatment, only 14.6% of patients who had earlier used African traditional medicine continued with such treatment; more than two thirds of the patients who had earlier used spiritual healing continued using such treatment, suggesting that many of these patients perceived some continuing benefits from these alternative treatments. This observation suggests that alternative medicine, especially spiritual healing, cannot be considered irrelevant in management of epilepsy in Africa. Further investigations are required to determine the efficacy, supportive role, and limitation of alternative medicine in management of epilepsy in developing countries.
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Review Comparative Study
A comment on the efficacy of valproate in the treatment of partial seizures.
Discrepancies in the findings of studies sponsored by the Department of Veterans Affairs (VA) in the United States and the Medical Research Council (MRC) in the United Kingdom concerning the efficacy of valproate (VPA) in controlling simple or complex partial seizures, particularly those without secondarily generalized seizures, were reviewed. It was noted that the two studies differed with respect to their subjects' pretreatment seizure frequency. The frequency of complex partial seizures before treatment was obviously greater in the VA study, where carbamazepine (CBZ) provided better seizure control than VPA. Based on other comparative and non-comparative studies as well as the author's over 20 years of experience in the use of VPA in a tertiary epilepsy clinic, it is suggested that although VPA may be effective in controlling both the secondarily generalized seizures of symptomatic localization-related epilepsies and the generalized tonic-clonic seizures of idiopathic and, if not always, symptomatic generalized epilepsies, the efficacy of VPA in controlling simple or complex partial seizures is likely limited to patients with infrequent seizures.
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Vigabatrin, lamotrigine, and oxcarbazepine are three of the many new antiepileptic drugs (AEDs) already registered in several countries that highlight some of the typical problems and prejudices of new AEDs. Both the therapeutic action and the side-effect profiles of new AEDs are only basically known with marketing. ⋯ All three have some effect on focal seizures, but their clinical spectrum probably will turn out to be by no means uniform. These three AEDs are, in general, well tolerated, but it would be premature to compare their safety with traditional AEDs as one must be prepared for rare or delayed untoward effects that may be discovered later, as occurred with some older AEDs.