Epilepsy & behavior : E&B
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Epilepsy & behavior : E&B · Oct 2009
Case ReportsGelastic epilepsy and dysprosodia in a case of late-onset right frontal seizures.
Gelastic epilepsy (GE) is an uncommon type of seizure disorder characterized by stereotyped, unprovoked, inappropriate ictal laughter. GE is most frequently associated with hypothalamic hamartoma, with onset almost invariably occurring during childhood. GE also occurs occasionally with temporal and frontal cortical seizure foci. ⋯ In addition to laughter, dysprosodia was a clinical feature. Clinical and electroencephalographic evidence of seizure activity ceased on levetiracetam, and the patient showed concurrent improvement in cognitive function. We review the evidence for the cerebral representation of laughter and prosody, and discuss issues bearing on the differential diagnosis and management of GE.
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Epilepsy & behavior : E&B · Aug 2009
Editorial Biography Historical ArticleIn memoriam: Susan S. Spencer, MD.
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Epilepsy & behavior : E&B · Aug 2009
Two years of experience in the treatment of status epilepticus with intravenous levetiracetam.
Since its introduction in 2006, 43 patients with various forms of status epilepticus (SE) have been treated with the intravenous formulation of levetiracetam (LEV) in our clinic. After ineffective treatment with benzodiazepines, intravenous LEV was administered as a short infusion (nonconvulsive and subtle SE) at a dose of 1000 or 2000 mg. In cases of convulsive SE, a fractionated injection of 1000 or 2000 mg was used. ⋯ No severe adverse reactions were observed. As a result of this investigation, intravenous LEV in moderate doses may represent an efficacious and well-tolerated alternative for the treatment of focal (simple and complex focal) and myoclonic SE. Further investigations are needed to confirm this assumption as the patient numbers are quite low.
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Epilepsy & behavior : E&B · May 2009
ReviewThe differential diagnosis of epilepsy: a critical review.
The wrong diagnosis of epilepsy is common. At referral epilepsy centers, psychogenic non-epileptic attacks are by far the most common condition found to have been misdiagnosed as epilepsy, with an average delay of 7-10 years. There are many "red flags" that can raise the suspicion of psychogenic non-epileptic attacks. ⋯ Other conditions more rarely misdiagnosed as epilepsy include hypoglycemia, panic attacks, paroxysmal movement disorders, paroxysmal sleep disorders, TIAs, migraines, and TGA. Conditions specific to children include nonepileptic staring spells, breath-holding spells, and shudder attacks. At all ages, the over-interpretation of EEGs plays an important part in the misdiagnosis of epilepsy.
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Status epilepticus (SE) is a major neurological emergency with an incidence of about 20/100,000 and a mortality between 3 and 40% depending on etiology, age, status type, and status duration. Generalized tonic-clonic SE, in particular, requires immediate, aggressive, and effective treatment to stop seizure activity, and to prevent neuronal damage and systemic complications and death. Benzodiazepines and phenytoin/fosphenytoin are traditionally used as first-line drugs and are effective in about 60% of all episodes. ⋯ Therefore, there is a need for more effective first-line treatment options. Recently, valproic acid was approved for the treatment of status epilepticus in some European countries, and two of the newer antiepileptic drugs have become available for intravenous use: Levetiracetam (LEV) and lacosamide (LCM) should be evaluated in prospective controlled trials as possible treatment options. Standardized protocols for the management of SE are useful to improve immediate care.