Epilepsy & behavior : E&B
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Epilepsy & behavior : E&B · Feb 2011
ReviewSelecting patients for epilepsy surgery: identifying a structural lesion.
One of the most important components of presurgical evaluation of patients with epilepsy is structural imaging, predominantly using magnetic resonance imaging. This study is now part of the basic assessment of patients with epilepsy and is as important as the electroencephalogram. ⋯ To understand the basis of the epileptic disorder, interpretation of these investigations relies on knowledge of the clinical details and features of the seizures, the functional abnormality in the brain as shown on the electroencephalogram, and structural assessment of the brain with a magnetic resonance imaging study optimized for epilepsy. This review considers the essential elements of this issue and gives a broad overview of what imaging options are available for the investigation of the patient with epilepsy from the perspective of the practicing epileptologist.
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Epilepsy & behavior : E&B · Feb 2011
The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?
Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. ⋯ Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.
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Epilepsy & behavior : E&B · Jan 2011
Lacosamide in the treatment of acute recurrent seizures and periodic epileptiform patterns in critically ill patients.
We investigated the safety, tolerability, and effectiveness of lacosamide (LCM) in patients with acute recurrent seizures or with periodic epileptiform activity captured during continuous EEG monitoring. A total of 17 patients received LCM; 12 patients received LCM as a second or third antiepileptic drug (AED), one patient as a fourth AED, and one patient as a fifth AED. No additional AEDs were introduced after LCM in 15 patients. ⋯ No adverse effects, including symptomatic bradycardia and allergic reactions, were seen for intravenous infusion dosages up to 300 mg. Eleven patients were eventually discharged on LCM. LCM is an important new AED in the add-on treatment of acute recurrent seizures and periodic epileptiform activity in critically ill patients.
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Epilepsy & behavior : E&B · Jan 2011
Lacosamide neurotoxicity associated with concomitant use of sodium channel-blocking antiepileptic drugs: a pharmacodynamic interaction?
Lacosamide is a new antiepileptic drug (AED) apparently devoid of major pharmacokinetic interactions. Data from a small postmarketing assessment suggest people who had lacosamide co-prescribed with a voltage-gated sodium channel (VGSC)-blocking AED seemed more likely to discontinue lacosamide because of tolerability problems. ⋯ Slow-inactivated VGSCs targeted by lacosamide might be more sensitive to the effects of conventional VGSC-blocking AEDs. Advising people to reduce concomitantly the conventional VGSC-blocking AEDs during lacosamide uptitration in cases of neurotoxicity might improve the tolerability of combination treatment.
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Epilepsy & behavior : E&B · Jan 2011
Case ReportsTranscranial direct current stimulation in adolescent and adult Rasmussen's encephalitis.
Rasmussen's encephalitis is a rare, progressive inflammatory disease that typically affects one cerebral hemisphere and causes intractable partial-onset seizures. Currently, the only effective therapy is hemispherectomy; however, this procedure is associated with irreversible neurological deficits. Novel therapeutic approaches to this condition are therefore necessary. ⋯ At follow-up evaluations 6 and 12 months later, one patient had a significant reduction in seizure frequency and one was seizure free. Additionally, both patients had improved levels of alertness and language. This is the first time that cTDCS has been applied in serial sessions to treat Rasmussen's encephalitis to avoid or delay surgical treatment.