Epilepsy Research Journal
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Altered GABA receptor expression in brainstem nuclei and SUDEP in mice associated with epileptic encephalopathy
Sudden unexpected death in epilepsy (SUDEP) is the leading cause for death in individuals with epilepsy. The frequency of SUDEP correlates with the severity of epilepsies and lack of response to antiepileptic drug treatment, but the underlying mechanisms of SUDEP have not been elucidated fully. GABRG2(Q390X) is a mutation associated with the epileptic encephalopathy Dravet syndrome (DS) and with genetic epilepsy with febrile seizures plus (GEFS+) in patients. The Gabrg2+/Q390X knockin (KI) mouse phenocopies the major features of DS and GEFS+ and has SUDEP throughout life.
Seizures are more specific to cerebral vein and sinus thrombosis (CVST) than to other types of stroke (Conrad et al., 2013). About 12–31.9% of patients with CVST have seizures as the presenting feature of the disease. Among them, 44.3% of patients have seizures in the early stage of the disease (Ferro et al., 2003; Masuhr et al., 2006). The rate of mortality is three times higher in CVST patients with seizures than those without seizures (Masuhr et al., 2006). Seizures in CVST can occur during different periods of the disease's course and can be categorized as either “early/acute seizures”, which take place before the diagnosis or during the first 2 weeks afterward, or as “late/remote seizures”, which occur in the years following CVST development (Ferro et al., 2004).
Approximately 30% of adults complain of symptoms of insomnia, and 10% experience insomnia chronically (Morin and Benca, 2010; Morin et al., 2006). Insomnia is associated with impaired mood, poorer quality of life, and more health care utilization (Morin and Benca, 2010; Morin et al., 2006). Insomnia is costly with direct medical costs of insomnia in the US estimated at $13 billion/year in physician visits, prescriptions and procedures (Walsh and Engelhardt, 1995). People with insomnia spend $1,200 more in direct health care expenses than patients without insomnia (Ozminkowski et al., 2007).
Intrapatient variation in antiepileptic drug plasma concentration after generic substitution stable brand-name drug regimens
Generic substitution of antiepileptic drugs (AEDs) in the treatment of epilepsy is still controversial due to the lack of consensus and clear guidance for clinicians (Privitera, 2013; Shaw and Hartman, 2010). Retrospective studies and anecdotal reports suggested a potential relationship between brand-name vs generic AED switching and adverse effects, especially loss of seizure control, raising concerns among clinicians and patients about the use of generic formulations. A few prospective randomized studies did not confirm the safety risks shown in observational studies, but they must be considered cautiously due to methodological flaws, including small patient samples, short follow-ups and recall bias from subjective reports (Kesselheim et al., 2010; Steinhoff et al., 2009; Talati et al., 2012; Yamada and Welty, 2011).
Concentrations of carbamazepine and carbamazepine-10,11-epoxide in maternal and umbilical cord blood at birth: influence of co-administration of valproic acid or enzyme-inducing antiepileptic drugs
Carbamazepine (CBZ) is an important option for women with focal epilepsy during their childbearing years. It is presently one of the three most frequently prescribed antiepileptic drugs (AEDs) in pregnancy, together with lamotrigine and valproic acid followed by levetiracetam and oxcarbazepine (Kacirova et al., 2010a; EURAP, 2015). The risk of teratogenic effects of CBZ appears to be dose dependent (Tomson et al., 2011); nevertheless, the mechanism by which CBZ exerts its teratogenicity remains largely unknown (Wlodarczyk et al., 2012).
Although pediatric epilepsy surgery offers a potential for cure for drug-resistant epilepsy, long-term seizure freedom is seen in only 41 to 70% of patients in temporal lobe epilepsy and 30 to 67% in extratemporal epilepsy.(Jeha et al., 2007; Liang et al., 2012; Lopez-Gonzalez et al., 2012) It is theorized that at least the early failures, with return of seizures within 6 months of surgery, are the result of incomplete resection of the epileptogenic zone rather than de novo epileptogenesis.(Najm et al., 2013) The epileptogenic zone is defined as the region of brain that is indispensable for the generation of epileptic seizures, and therefore necessary and sufficient to remove or disconnect to render the patient seizure free long-term.(Rosenow and Luders, 2001) A test that determines remaining critical epileptogenic tissue immediately after brain surgery for epilepsy is a very valuable tool.
Imaging increased glutamate in children with Sturge-Weber syndrome: Association with epilepsy severity
Sturge-Weber syndrome (SWS) is strongly associated with epilepsy. Brain tissue studies have suggested that epileptic activity in SWS is driven by glutamatergic synaptic activity. Here, we used proton magnetic resonance spectroscopic imaging (MRSI) to test if glutamate (GLU) concentrations are increased in the affected hemisphere and if such increases are associated with severity of epilepsy in children with SWS. We also studied the metabolic correlates of MRSI abnormalities, using glucose positron emission tomography (PET) imaging.