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γ‐Aminobutyric acid (GABA) mediates both fast synaptic inhibition and a tonic form of signaling that depends on high‐affinity, extrasynaptic GABAA receptors. Tonic inhibition may contribute to the generation of spike‐wave discharges. Because they have a profound effect on circuit excitability, tonically active GABAA receptors represent an important therapeutic target. For an expanded treatment of...
Drug resistance remains one of the major challenges in epilepsy therapy. Identification of factors that contribute to therapeutic failure is crucial for future development of novel drugs and therapeutic strategies for difficult‐to treat epilepsies. For an expanded treatment of this topic see Jasper’s basic mechanisms of the epilepsies. 4th ed. (Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado‐Escueta...
Voltage‐gated Na+ (NaV) channels are key mediators of neuronal function and essential for neuronal excitability. Their abnormal activity is implicated in the generation of seizures, both in acquired and genetic epilepsy. Several of the most widely used antiepileptic drugs inhibit NaV activity by binding to a common receptor site. For an expanded treatment of this topic see Jasper’s Basic Mechanisms of the Epilepsies, Fourth Edition...
Purpose: To compare relative N‐acetylaspartate (NAA) measurements in temporal lobe epilepsy (TLE) patients with good response to the first trial of antiepileptic drugs (AEDs) (an important prognostic factor) to TLE patients who failed the first AED monotherapy and required further AED trials with monotherapy or polytherapy.
Methods: We studied 25 consecutive TLE patients who responded to first AED...
The best prognostic factors in early‐onset epilepsies are the response to the first antiepileptic drug (AED) trial, age at seizure onset, number of seizures prior to treatment, and the presence of a lesion or abnormal neurologic examination. However, early and adequate response to AED is most likely an epiphenomenon reflecting the nature of underlying epileptogenicity, which may be defined as a complex...
Neuroimaging techniques in epilepsy are used widely for definition of the epileptogenic lesion and surgical decision. However, its applications extend to the knowledge of epileptic mechanisms and include the identification of prognostic features that can help our decisions on the appropriate type of treatment on an individual basis. Structural neuroimaging may be able to identify patients more likely...
A significant number of patients with epilepsy fail to respond to currently available antiepileptic drugs. This suggests a need for alternative approaches to reduce the occurrence of seizures in these patients. Recent data have shown that in addition to well‐known neuronal mechanism, seizures may be a consequence of misguided inflammatory response and blood–brain barrier disruption. Both peripheral...
Between 30% and 50% of patients with brain tumors first present with a seizure, and up to 30% more will develop seizures later. Therefore, optimal management of these patients requires a rational approach to the use of antiseizure medications. Based on current evidence, prophylactic prescription of long‐term antiepileptic drugs (AEDs) in patients with brain tumors in patients who did not present with...
PurposeTo analyze seizure control, dose adjustments, and other changes of antiepileptic drug (AED) treatment during pregnancy in a large cohort of women with epilepsy entering pregnancy on monotherapy with carbamazepine, lamotrigine, phenobarbital, or valproate.
MethodsSeizure control and AED treatment were recorded prospectively in 3,806 pregnancies of 3,451 women with epilepsy taking part in European...
PurposeBrain drug bioavailability is regulated by the blood–brain barrier (BBB). It was recently suggested that cytochrome P450 (CYP) enzymes could act in concert with multidrug transporter proteins to regulate drug penetration and distribution into the diseased brain. The possibility that phase II metabolic enzymes could be expressed in the epileptic brain has been not evaluated. Phase II enzymes...
ObjectiveA NaVβ1(C121W) mouse model of human genetic epilepsy has enhanced neuronal excitability and temperature sensitivity attributed to a decreased threshold for action potential firing in the axon initial segment. To investigate the network consequences of this neuronal dysfunction and to establish a genetic disease state model we developed an in vitro assay to investigate CA1 network properties...
ObjectiveCurrent literature does not allow an evidence‐based approach to the treatment of continuous spikes and waves during sleep (CSWS). The aim of this study was to describe treatment choices made by clinicians caring for patients with CSWS in North America.
MethodsA 24‐question survey on treatment choices for CSWS was distributed to the members of the American Epilepsy Society (AES). The survey...
ObjectivesTo assess the effectiveness of the newer antiepileptic drugs (AEDs)—in particular lamotrigine, topiramate, and levetiracetam—in controlling epileptic seizures in pregnant women.
MethodsAnalysis of data in the Australian Register of Antiepileptic Drugs in Pregnancy concerning seizure control in 1,534 pregnancies in women with AED‐treated epilepsies.
ResultsIn AED monotherapy (1,111 pregnancies),...
This open‐label, multicenter, randomized phase IV trial (NCT01498822) of noninferiority design compared the long‐term effectiveness, safety, and tolerability of levetiracetam (LEV) monotherapy with those of oxcarbazepine (OXC) monotherapy in adults with newly diagnosed focal epilepsy. Korean patients (16–80 years), with ≥2 unprovoked focal seizures in the year preceding the trial, who had not taken...
Objective
Approximately 25 million individuals older than age 15 identify as transgender, representing about 0.3–0.9% of the world's population. The aim of this paper is to identify and describe important medical and social considerations facing transgender persons with epilepsy.
Methods
We performed literature searches on the following terms: transgender AND epilepsy, transgender AND neurology,...
Objective
To evaluate the long‐term seizure outcome and potential factors associated with seizure outcome in patients with anti‐N‐methyl‐d‐aspartate receptor (anti‐NMDAR) encephalitis.
Methods
In the setting of a prospective, single‐center, longitudinal cohort study, 109 patients were evaluated with ongoing follow‐up. Patients underwent clinical evaluation every 3 months. Seizure outcomes and the...
Objective
To determine the frequency of older Americans with epilepsy receiving concomitant prescriptions for antiepileptic drugs (AEDs) and non‐epilepsy drugs (NEDs) which could result in significant pharmacokinetic (PK) interaction, and to assess the contributions of racial/ethnic, socioeconomic, and demographic factors.
Methods
Retrospective analyses of 2008‐2010 Medicare claims for a 5% random...
This article reviews the burden of epilepsy in Asia, the challenges faced by people with epilepsy, and the management of epilepsy. Comparison is made with other parts of the world. For this narrative review, data were collected using specified search criteria. Articles investigating the epidemiology of epilepsy, diagnosis, comorbidities and associated mortality, stigmatization, and treatment were...
Objective
In patients with status epilepticus (SE) without prior epilepsy, there are limited data on the safety of discontinuing antiseizure drugs (ASDs) after seizure control. We aimed to describe seizure recurrence when weaning from ASDs following new onset SE (NOSE).
Methods
Retrospective review of adult patients with NOSE admitted to Mayo Clinic, Rochester, Minnesota between January 1, 1990...
Objective
Intracranial (intrahippocampal or intra‐amygdala) administration of kainate in rodents leads to spatially restricted brain injury and development of focal epilepsy with characteristics that resemble mesial temporal lobe epilepsy. Such rodent models are used both in the search for more effective antiseizure drugs (ASDs) and in the development of antiepileptogenic strategies. However, it...
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