Epilepsia
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Randomized Controlled Trial
Population pharmacokinetics of pregabalin in healthy subjects and patients with chronic pain or partial seizures.
Pregabalin, a high-affinity ligand for α2δ subunits of voltage-gated calcium channels, is a novel pharmacotherapy for chronic pain, partial seizures, and other disorders. The present study investigated the population pharmacokinetics of pregabalin following single and multiple doses in healthy volunteers and patient populations. ⋯ Pregabalin CL/F is related to CLcr, and this relationship is similar among healthy volunteers and patients with either partial seizures or chronic pain disorders. The only factor having a clinically significant influence on steady-state plasma pregabalin concentrations is renal function.
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The aim of the study was to evaluate the outcome of status epilepticus (SE) in children and to define predictors for morbidity, mortality, and SE recurrence. ⋯ Outcome of SE in children is favorable in most of the cases, but mortality and morbidity rates are still high. Etiology and prior neurologic abnormalities were the main predictors of mortality, whereas the main predictor of morbidity was underlying etiology.
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Comparative Study
Further evidence that pathologic high-frequency oscillations are bursts of population spikes derived from recordings of identified cells in dentate gyrus.
To analyze activity of identified dentate gyrus granular cells and interneurons during pathologic high-frequency oscillations (pHFOs). ⋯ Pilocarpine-treated epileptic mice were anesthetized with urethane and ketamine. Their heads were fixed in a stereotaxic frame. Extracellular unit activity was recoded with glass micropipettes, whereas multiunit and local field activity was simultaneously recorded with attached tungsten microelectrodes. After electrophysiologic experiments, recorded cells were labeled by neurobiotin and visualized by immunohistochemical methods. KEY FINDINGS AND SIGNIFICANCES: pHFOs containing more than three waves were recorded in our experiments, but pathologic single-population spikes also occurred. Identified granular cells discharged preferentially in synchrony with pHFOs and single population spikes, whereas interneurons decreased their discharge frequency during this time. These experiments provide additional confirmation that pHFOs in the dentate gyrus represent single or recurrent population spikes, which in turn reflect summated hypersynchronous discharges of principal cells.
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To analyze what conditions mimic seizures in the intensive care unit (ICU) setting, we reviewed all bedside electroencephalography (EEG)-videos obtained in the adult ICU setting over an 18-month period. Only those studies performed for "possible seizures" due to motor phenomena and whose clinical events were captured on video were analyzed. A total of 52 studies were performed. ⋯ Thirty-eight (73%) had nonepileptic events. These consisted of 12 (23%) with tremor-like movements, 7 (13.5%) with multifocal myoclonic jerks without electrographic changes, 7 (13.5%) with slow semipurposeful movements, and 10 with other movements. Therefore, seizure mimics in the ICU setting were diverse and distinct from the usual differential diagnosis of seizures seen in ambulatory patients.
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Randomized Controlled Trial Multicenter Study Comparative Study
Efficacy, tolerability, and safety of rapid initiation of topiramate versus phenytoin in patients with new-onset epilepsy: a randomized double-blind clinical trial.
To evaluate topiramate (TPM) and phenytoin (PHT) monotherapy following rapid oral initiation in new-onset epilepsy. ⋯ This study was inconclusive in establishing noninferiority of TPM 100 mg/day compared to a standard regimen of oral PHT in seizure risk in this population of patients with new-onset epilepsy. Given the superiority of TPM in overall retention and favorable tolerability without titration, it may nonetheless be an appropriate option in some patients with new-onset epilepsy requiring rapid treatment initiation.