Epilepsia
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Continuous EEG monitoring (cEEG) of critically ill adults is being used with increasing frequency, and practice guidelines on indications for cEEG monitoring have recently been published. However, data describing the current practice of cEEG in critically ill adults is limited. We aimed to describe the current practice of cEEG monitoring in adults in the United States. ⋯ Although there is general agreement regarding the indications for ICU cEEG, there is substantial interinstitutional variability in how the procedure is performed.
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Kv1.1 potassium channel null mouse (NULL) exhibits spontaneous seizure-related bradycardia, dies following seizure, and has been proposed as a model for vagus-mediated SUDEP. We characterized the cardiac events surrounding sudden unexpected death in epilepsy (SUDEP) in NULL during terminal asystole for comparison to patients with epilepsy who exhibit bradycardia and terminal or nonterminal asystole during/following seizure and explored the contribution of vagal-mediated bradycardia to SUDEP. ⋯ The Kv1.1 null mouse is a potential model for SUDEP in patients who experience ictal and postictal bradycardia. It offers the opportunity for evaluation of the combination of factors, in addition to vagal activation, necessary to produce a terminal asystole following seizure. It is notable that long-term studies that evaluate electroencephalography (EEG) and cardiorespiratory events surrounding nonfatal seizures may provide indices predictive of terminal seizure.
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Depression is a common comorbidity of epilepsy, and its timely identification in persons with epilepsy is essential. The use of screening tools to detect depression is common in epilepsy, but some scales in current use have not been validated using a gold standard in this population. The present study aims to validate three commonly used depression-screening scales and assess new cut points for scoring in those with epilepsy. ⋯ The PHQ-9 at a cut point of 9 and the HADS at a cut point of 7 had the best overall balance of sensitivity and specificity. However, for screening purposes the PHQ-9 algorithm method is ideal (optimizing specificity), whereas for case finding the HADS at a cut point of 6 performed best (optimizing sensitivity). Appropriate scale cut points should be chosen based on the study's goals and available resources. Disease-specific scale cut points are recommended for future studies assessing depression in persons with epilepsy.
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Autosomal dominant lateral temporal epilepsy (ADLTE) is a focal epileptic syndrome characterized by auditory or aphasic auras. Mutations in the LGI1 gene account for <50% of ADLTE families. To identify copy number variants (CNVs) related to ADLTE, we examined a collection of ADLTE families without LGI1 mutations. ⋯ Our results provide clues on genes for susceptibility to ADLTE, particularly in those families where the inheritance pattern is less compatible with autosomal dominance. Some of these genes also confer risk for other epilepsy syndromes.
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Randomized Controlled Trial Multicenter Study Comparative Study
Long-term safety and efficacy of zonisamide versus carbamazepine monotherapy for treatment of partial seizures in adults with newly diagnosed epilepsy: results of a phase III, randomized, double-blind study.
To investigate the long-term safety and maintenance of efficacy of monotherapy with once-daily zonisamide versus twice-daily controlled-release carbamazepine for partial seizures in adults with newly diagnosed epilepsy. ⋯ Once-daily zonisamide monotherapy demonstrated favorable long-term safety and maintenance of efficacy in treating partial seizures in adults with newly diagnosed epilepsy. No new or unexpected safety findings emerged.