Epilepsy & behavior : E&B
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Epilepsy & behavior : E&B · Mar 2013
ReviewUnraveling the genetics of common epilepsies: approaches, platforms, and caveats.
With no known intervention to prevent or cure epilepsy, treatment is primarily symptomatic and requires long-term administration of medications to suppress seizure occurrence. Current antiepileptic drugs (AEDs) are ineffective in one-third of patients (Kwan and Brodie, 2000). Such therapeutic inadequacy is largely due to our insufficient understanding of the basic molecular pathophysiological processes that underlie epileptogenesis. ⋯ We review the approaches that have been taken to identify genetic risk markers of the common epilepsy syndromes, the experimental platforms, and their caveats. We discuss current technologies and analytical frameworks that might expedite the discovery of these variants by leveraging advances in microarray-based, high-throughput, genotyping technology, and complementary interdisciplinary expertise of study teams including the need for meta-analyses under global collaborative frameworks. We briefly discuss the analytical options made available through rapid advances in sequencing and other genomic technologies.
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The relationship between headache and seizures is a complicated one, since these two conditions are related in numerous ways. Although the nature of this association is unclear, several plausible explanations exist: the two disorders coexist by chance; headache is part (or even the sole ictal phenomenon) of seizures or the post-ictal state; both disorders share a common underlying etiology; and epilepsy mimics the symptoms of migraine (as in benign childhood epilepsy). Seizures and headaches as well as their respective primary syndromes (epilepsy and headache/migraine) share several pathophysiological mechanisms. ⋯ Both experimental and clinical measures are required to better understand this relationship. The development of animal models, molecular studies defining more precise genotype/phenotype correlations, and multicenter clinical studies with revision of clinical criteria for headache/epilepsy-related disorders represent the start for planning future translational research. In this paper, we review the relationship between migraine and epilepsy in terms of epidemiology and pathophysiology with regard to translational research and clinical correlations and classification.
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Epilepsy & behavior : E&B · Feb 2013
Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery.
In order to identify the current practices of antiepileptic drug (AED) withdrawal after epilepsy surgery, a survey was administered to 204 adult and pediatric epileptologists. The responses from 58 epileptologists revealed wide variations regarding the time course and extent of AED withdrawal after successful epilepsy surgery. For most of the epileptologists, the likelihood of the surgery being successful is an important factor in determining whether or not AEDs are tapered. ⋯ The majority of the epileptologists were able to stop all AEDs completely in a substantial number of patients. The most important factors considered when deciding to taper AEDs were the presence of ongoing auras and the occurrence of postoperative seizures prior to seizure remission. In the absence of data from well-designed prospective trials, such survey results can inform practice and, hopefully, aid in the design of future trials.
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Epilepsy & behavior : E&B · Jan 2013
Generic substitution in the treatment of epilepsy: patient attitudes and perceptions.
There have been considerable debates about bioequivalence and generic substitution of certain critical care drugs. We aimed to understand patient attitudes and perceptions about generic substitution in the treatment of epilepsy. In this pilot study, a self-administered anonymous survey was completed by 47 patients with epilepsy. ⋯ About 87% of the patients thought that their antiepileptic drug should only be substituted with a generic with their consent, and 64% of the patients believed that substitution should only take place with the consent of their doctor. Considerable concern exists among patients about generic substitution in the treatment of epilepsy. More data regarding whether generic antiepileptic drugs are bioequivalent in clinical situations would help to address patient concerns.