Epilepsy & behavior : E&B
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Epilepsy & behavior : E&B · Aug 2012
Case ReportsComplementary effect of surgical resection and responsive brain stimulation in the treatment of bitemporal lobe epilepsy: a case report.
We report a 39-year-old man with bilateral mesial temporal lobe epilepsy. He was implanted with a responsive brain stimulator (RNS System) with two depth electrodes placed in the bimesial temporal structures. After the implantation, his seizure frequency decreased by up to 50%. ⋯ After the RNS System was restarted 107 days after the temporal lobectomy, he has been seizure free for more than 1.5 years. However, the implanted device continued to record residual ictal activities at the posterior aspect of the right hippocampus and delivered electrical stimuli to suppress the seizure activities. Our report indicates the importance of electrocorticographic recordings by the RNS System to modify the treatment strategy and the complementary effect of surgical resection and brain stimulation in the treatment of epilepsy.
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Epilepsy & behavior : E&B · Jul 2012
ReviewSeizure diaries for clinical research and practice: limitations and future prospects.
An NINDS-sponsored conference in April of 2011 reviewed issues in epilepsy clinical trials. One goal was to clarify new electronic methods for recording seizure information and other data in clinical trials. ⋯ Recommendations from the conference included: further studies of validity of epilepsy diaries and how they can be used to improve adherence; use and further development of core data sets, such as the one recently developed by NINDS; encouraging links of diaries to electronic sensors; development of diary privacy and legal policies; examination of special pediatric diary issues; development of principles for observational research from diaries; and work with the FDA to make electronic diaries more useful in industry-sponsored clinical trials.
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Epilepsy & behavior : E&B · Jul 2012
Acceptance of epilepsy surgery among adults with epilepsy--what do patients think?
Physician inertia is usually blamed for the underutilization of epilepsy surgery (ES) at the cost of increased patient disability and risk of mortality. Investigations on selected groups of patients with intractable TLE and minorities suggested that patient beliefs may also limit access to ES. To assess acceptance of ES among "mainstream" patients, we distributed an ad hoc questionnaire to 228 adults attending epilepsy clinics and found widespread fears and misconceptions leading to unfavorable perception of ES, irrespective of diagnosis, seizure type, and degree of intractability. ⋯ Attitude changes correlated with patient's social profile. Neurologists are responsible for providing all pertinent information to potential surgical candidates as soon as indicated. Therefore, an untimely or inadequate intervention of the treating physician constitutes an additional barrier to optimal utilization of ES.
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Epilepsy & behavior : E&B · Jun 2012
ReviewDepression and epilepsy, pain and psychogenic non-epileptic seizures: clinical and therapeutic perspectives.
The clinical manifestations of depression in people with epilepsy (PWE) are pleomorphic, often associated with anxiety symptoms and anxiety disorders. The ongoing debate of whether the clinical presentation of depression in PWE is unique to this neurologic disorder is reviewed. Comorbid depression can impact the recruitment of PWE for pharmacologic trials with antiepileptic drugs (AEDs). ⋯ Scarce data are available on the treatment of depression in PWE. Thus, clinicians have had to adopt data from patients with primary depressive disorders. We outline a consensus strategy on the identification and treatment of depressive disorders in adult and pediatric patients with epilepsy.