Epilepsy & behavior : E&B
-
Epilepsy & behavior : E&B · Dec 2011
Quantitative EEG analysis for automated detection of nonconvulsive seizures in intensive care units.
Because of increased awareness of the high prevalence of nonconvulsive seizures in critically ill patients, use of continuous EEG (cEEG) monitoring is rapidly increasing in ICUs. However, cEEG monitoring is labor intensive, and manual review and interpretation of the EEG are impractical in most ICUs. Effective methods to assist in rapid and accurate detection of nonconvulsive seizures would greatly reduce the cost of cEEG monitoring and enhance the quality of patient care. ⋯ These findings suggest that the novel algorithm has potential to be the basis of clinically useful software that can assist ICU staff in timely identification of nonconvulsive seizures. This study also suggests that currently available seizure detection software does not perform sufficiently in detection of nonconvulsive seizures in critically ill patients. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.
-
Epilepsy & behavior : E&B · Nov 2011
Adjunctive lacosamide in clinical practice: sodium blockade with a difference?
Lacosamide (LCM) was licensed in the United Kingdom in 2008 for the adjunctive treatment of partial-onset seizures. It exerts its effect by enhancing sodium channel slow inactivation. This article reports preliminary outcomes with adjunctive LCM in the everyday clinical setting. ⋯ Seizure freedom was more likely when LCM was used as a first add-on compared with a later treatment schedule. Patients also taking sodium valproate were significantly more likely to discontinue LCM compared with those taking other AEDs. These data suggest that the pharmacological effect of LCM differs importantly from that of AEDs that influence fast inactivation of the sodium channel.
-
Epilepsy & behavior : E&B · Oct 2011
Usefulness of verbal selective reminding in distinguishing frontal lobe memory disorders in epilepsy.
Frontal lobe memory disorders are distinguished from hippocampal memory disorders by poor organization of encoding and retrieval, among other things. Because the verbal Selective Reminding Test (SRT) has a metamemory ("remembering-to-remember") component, it may be useful in distinguishing frontal from temporal lobe memory disorders in patients with intractable epilepsy. ⋯ Furthermore, SRT and LM-II were significantly correlated with executive function measures. These findings have both theoretical and practical implications: (1) the memory impairment observed in frontal lobe disorders may be due, in part, to deficits in organizational strategy, monitoring, and remembering-to-remember, and (2) SRT and LM-II may be useful tests to differentiate frontal from temporal lobe memory disorders.
-
Epilepsy & behavior : E&B · Oct 2011
Neurologists' and neurology residents' knowledge of issues related to pregnancy for women with epilepsy.
We aimed to assess physician knowledge for 2009 guidelines established by the American Academy of Neurology and American Epilepsy Society regarding issues related to pregnancy for women with epilepsy. A questionnaire was developed and distributed to all neurologists and neurology residents practicing in a large Canadian health region serving a population of 1.4 million. Descriptive statistics were obtained and percentage of correct responses was calculated. ⋯ Residents were more likely (93.3%) to state that this information was important to their practice than staff physicians (40.0%). Overall knowledge of outcomes associated with specific AEDs was poor; less than half of the physicians correctly indicated which AEDs were associated with adverse outcomes for the majority of drug-related questions. We recommend multifaceted, interactive implementation strategies for increasing knowledge of guideline contents.
-
Epilepsy & behavior : E&B · Oct 2011
Paradoxical effect of noradrenaline-mediated neurotransmission in the antinociceptive phenomenon that accompanies tonic-clonic seizures: role of locus coeruleus neurons and α(2)- and β-noradrenergic receptors.
The postictal state is generally followed by antinociception. It is known that connections between the dorsal raphe nucleus, the periaqueductal gray matter, and the locus coeruleus, an important noradrenergic brainstem nucleus, are involved in the descending control of ascending nociceptive pathways. The aim of the present study was to determine whether noradrenergic mechanisms in the locus coeruleus are involved in postictal antinociception. ⋯ These effects were related to the modulation of noradrenergic activity in the locus coeruleus. Interestingly, microinjections of noradrenaline into the locus coeruleus also decrease the postictal antinociception. The present results suggest that the mechanism underlying postictal antinociception involves both α(2)- and β-noradrenergic receptors in the locus coeruleus, although the action of noradrenaline on these receptors causes a paradoxical effect, depending on the nature of the local neurotransmission.