Epilepsy Research and Treatment http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Delays and Factors Related to Cessation of Generalized Convulsive Status Epilepticus Mon, 10 Aug 2015 11:44:59 +0000 http://www.hindawi.com/journals/ert/2015/591279/ Introduction. This study was designed to identify the delays and factors related to and predicting the cessation of generalized convulsive SE (GCSE). Methods. This retrospective study includes 70 consecutive patients (>16 years) diagnosed with GCSE and treated in the emergency department of a tertiary hospital over 2 years. We defined cessation of SE stepwise using clinical seizure freedom, achievement of burst-suppression, and return of consciousness as endpoints and calculated delays for these cessation markers. In addition 10 treatment delay parameters and 7 prognostic and GCSE episode related factors were defined. Multiple statistical analyses were performed on their relation to cessation markers. Results. Onset-to-second-stage-medication (), onset-to-burst-suppression (), and onset-to-clinical-seizure-freedom () delays correlated with the onset-to-consciousness delay. We detected no correlation between age, epilepsy, STESS, prestatus period, type of SE onset, effect of the first medication, and cessation of SE. Conclusion. Our study demonstrates that rapid administration of second-stage medication and early obtainment of clinical seizure freedom and burst-suppression predict early return of consciousness, an unambiguous marker for the end of SE. We propose that delays in treatment chain may be more significant determinants of SE cessation than the previously established outcome predictors. Thus, streamlining the treatment chain is advocated. Leena Kämppi, Jaakko Ritvanen, Harri Mustonen, and Seppo Soinila Copyright © 2015 Leena Kämppi et al. All rights reserved. Semantic Processing Impairment in Patients with Temporal Lobe Epilepsy Thu, 16 Jul 2015 11:03:33 +0000 http://www.hindawi.com/journals/ert/2015/746745/ The impairment in episodic memory system is the best-known cognitive deficit in patients with temporal lobe epilepsy (TLE). Recent studies have shown evidence of semantic disorders, but they have been less studied than episodic memory. The semantic dysfunction in TLE has various cognitive manifestations, such as the presence of language disorders characterized by defects in naming, verbal fluency, or remote semantic information retrieval, which affects the ability of patients to interact with their surroundings. This paper is a review of recent research about the consequences of TLE on semantic processing, considering neuropsychological, electrophysiological, and neuroimaging findings, as well as the functional role of the hippocampus in semantic processing. The evidence from these studies shows disturbance of semantic memory in patients with TLE and supports the theory of declarative memory of the hippocampus. Functional neuroimaging studies show an inefficient compensatory functional reorganization of semantic networks and electrophysiological studies show a lack of N400 effect that could indicate that the deficit in semantic processing in patients with TLE could be due to a failure in the mechanisms of automatic access to lexicon. Amanda G. Jaimes-Bautista, Mario Rodríguez-Camacho, Iris E. Martínez-Juárez, and Yaneth Rodríguez-Agudelo Copyright © 2015 Amanda G. Jaimes-Bautista et al. All rights reserved. Choice of Antiepileptic Drugs in Idiopathic Generalized Epilepsy: UAE Experience Wed, 20 May 2015 13:20:35 +0000 http://www.hindawi.com/journals/ert/2015/184928/ We retrospectively reviewed the electroencephalogram (EEG) reports of patients at our EEG lab from the years 2005–2010 to identify patients referred from the epilepsy clinic, with a confirmed diagnosis of idiopathic generalized epilepsy (IGE) by EEG criteria. We sought to report our experience in UAE of how often patients with IGE are placed on nonspecific antiepileptic drugs (AEDs) before being evaluated at an epilepsy referral clinic. 109 patients with a confirmed diagnosis of IGE based on EEG criteria were identified. When initially seen, 32.11% were taking a broad-spectrum (specific) AED only, 25.69% were taking a narrow-spectrum (nonspecific) AED, and 15.59% were placed on various combinations. Of the total patients who were receiving nonspecific AEDs, 35.71% were seizure-free and 64.28% were poorly controlled accounting for “pseudointractability status.” When converted to broad-spectrum (specific) AEDs, 50% became well controlled. Furthermore, 26.6% of patients, who were previously on no AED prior to the clinic visit, became well controlled once placed on specific AED. Taoufik Alsaadi, Haytham Taha, and Fatema Al Hammadi Copyright © 2015 Taoufik Alsaadi et al. All rights reserved. Episodic and Semantic Autobiographical Memory in Temporal Lobe Epilepsy Mon, 08 Dec 2014 12:11:32 +0000 http://www.hindawi.com/journals/ert/2014/157452/ Autobiographical memory (AM) is understood as the retrieval of personal experiences that occurred in specific time and space. To date, there is no consensus on the role of medial temporal lobe structures in AM. Therefore, we investigated AM in medial temporal lobe epilepsy (TLE) patients. Twenty TLE patients candidates for surgical treatment, 10 right (RTLE) and 10 left (LTLE), and 20 healthy controls were examined with a version of the Autobiographical Interview adapted to Spanish language. Episodic and semantic AM were analyzed during five life periods through two conditions: recall and specific probe. AM scores were compared with clinical and cognitive data. TLE patients showed lower performance in episodic AM than healthy controls, being significantly worst in RTLE group and after specific probe. In relation to semantic AM, LTLE retrieved higher amount of total semantic details compared to controls during recall, but not after specific probe. No significant differences were found between RTLE and LTLE, but a trend towards poorer performance in RTLE group was found. TLE patients obtained lower scores for adolescence period memories after specific probe. Our findings support the idea that the right hippocampus would play a more important role in episodic retrieval than the left, regardless of a temporal gradient. Claudia P. Múnera, Carolina Lomlomdjian, Belen Gori, Verónica Terpiluk, Nancy Medel, Patricia Solís, and Silvia Kochen Copyright © 2014 Claudia P. Múnera et al. All rights reserved. The Perception of Family Function by Adolescents with Epilepsy in a Rural Nigerian Community Tue, 25 Nov 2014 00:00:00 +0000 http://www.hindawi.com/journals/ert/2014/959274/ The family plays a significant role in epilepsy management in sub-Saharan Africa and how this role is perceived by persons with epilepsy could influence epilepsy outcomes. The objective of the study was to assess perception of family function by adolescents with epilepsy (AWE). The sociodemographic and epilepsy characteristics of AWE in a rural Nigerian community were assessed and the Family APGAR tool was used in assessing their perception of satisfaction with family functioning. Adolescents () constituted 26% of the community’s population and 18 (10.5/1000) had epilepsy. The AWE age range was 11–19 years (mean years) with a male preponderance (15, 83.3%). The family was the only source of care. Family dysfunction (Family APGAR Score <7) was indicated by 15 (83.3%) of the AWE. The strongest perception of family function was in adaptability while the weakest was with growth. The indication of family dysfunction was significant () in the older (age 14–19 years) AWE when compared with the younger AWE (11–13 years) in the study. Most of the AWE indicated living in a dysfunctional family setting. The study highlights the need to address the role of the family in the provision of comprehensive epilepsy care. Edwin E. Eseigbe, Folorunsho T. Nuhu, Taiwo L. Sheikh, Sam J. Adama, Patricia Eseigbe, and Okechukwu J. Oguizu Copyright © 2014 Edwin E. Eseigbe et al. All rights reserved. Neurocognitive and Seizure Outcomes of Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy Wed, 01 Oct 2014 07:58:39 +0000 http://www.hindawi.com/journals/ert/2014/306382/ Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student’s -test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted. Alireza Mansouri, Aria Fallah, Mary Pat McAndrews, Melanie Cohn, Diana Mayor, Danielle Andrade, Peter Carlen, Jose M. del Campo, Peter Tai, Richard A. Wennberg, and Taufik A. Valiante Copyright © 2014 Alireza Mansouri et al. All rights reserved. Highights in the History of Epilepsy: The Last 200 Years Sun, 24 Aug 2014 00:00:00 +0000 http://www.hindawi.com/journals/ert/2014/582039/ The purpose of this study was to present the evolution of views on epilepsy as a disease and symptom during the 19th and the 20th century. A thorough study of texts, medical books, and reports along with a review of the available literature in PubMed was undertaken. The 19th century is marked by the works of the French medical school and of John Hughlings Jackson who set the research on epilepsy on a solid scientific basis. During the 20th century, the invention of EEG, the advance in neurosurgery, the discovery of antiepileptic drugs, and the delineation of underlying pathophysiological mechanisms, were the most significant advances in the field of research in epilepsy. Among the most prestigious physicians connected with epilepsy one can pinpoint the work of Henry Gastaut, Wilder Penfield, and Herbert Jasper. The most recent advances in the field of epilepsy include the development of advanced imaging techniques, the development of microsurgery, and the research on the connection between genetic factors and epileptic seizures. Emmanouil Magiorkinis, Aristidis Diamantis, Kalliopi Sidiropoulou, and Christos Panteliadis Copyright © 2014 Emmanouil Magiorkinis et al. All rights reserved. Both Maternal and Pup Genotype Influence Ultrasonic Vocalizations and Early Developmental Milestones in Tsc2+/− Mice Mon, 04 Aug 2014 12:31:20 +0000 http://www.hindawi.com/journals/ert/2014/784137/ Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by tumor growth and neuropsychological symptoms such as autistic behavior, developmental delay, and epilepsy. While research has shed light on the biochemical and genetic etiology of TSC, the pathogenesis of the neurologic and behavioral manifestations remains poorly understood. TSC patients have a greatly increased risk of developmental delay and autism spectrum disorder, rendering the relationship between the two sets of symptoms an extremely pertinent issue for clinicians. We have expanded on previous observations of aberrant vocalizations in Tsc2+/− mice by testing vocalization output and developmental milestones systematically during the early postnatal period. In this study, we have demonstrated that Tsc2 haploinsufficiency in either dams or their pups results in a pattern of developmental delay in sensorimotor milestones and ultrasonic vocalizations. Emily A. Greene-Colozzi, Abbey R. Sadowski, Elyza Chadwick, Peter T. Tsai, and Mustafa Sahin Copyright © 2014 Emily A. Greene-Colozzi et al. All rights reserved. The Peptide Network between Tetanus Toxin and Human Proteins Associated with Epilepsy Sun, 01 Jun 2014 08:09:31 +0000 http://www.hindawi.com/journals/ert/2014/236309/ Sequence matching analyses show that Clostridium tetani neurotoxin shares numerous pentapeptides (68, including multiple occurrences) with 42 human proteins that, when altered, have been associated with epilepsy. Such a peptide sharing is higher than expected, nonstochastic, and involves tetanus toxin-derived epitopes that have been validated as immunopositive in the human host. Of note, an unexpected high level of peptide matching is found in mitogen-activated protein kinase 10 (MK10), a protein selectively expressed in hippocampal areas. On the whole, the data indicate a potential for cross-reactivity between the neurotoxin and specific epilepsy-associated proteins and may help evaluate the potential risk for epilepsy following immune responses induced by tetanus infection. Moreover, this study may contribute to clarifying the etiopathogenesis of the different types of epilepsy. Guglielmo Lucchese, Jean Pierre Spinosa, and Darja Kanduc Copyright © 2014 Guglielmo Lucchese et al. All rights reserved. Caregiver Burden in Epilepsy: Determinants and Impact Tue, 08 Apr 2014 00:00:00 +0000 http://www.hindawi.com/journals/ert/2014/808421/ Aim. Caregiver burden (CB) in epilepsy constitutes an understudied area. Here we attempt to identify the magnitude of this burden, the factors associated with it, and its impact to caregiver quality of life (QOL). Methods. 48 persons with epilepsy (PWE) underwent video-EEG monitoring and their caregivers completed questionnaires providing demographic, disease-related, psychiatric, cognitive, sleep, QOL, and burden information. Results. On regression analysis, higher number of antiepileptic drugs, poorer patient neuropsychological performance, lower patient QOL score, and lower caregiver education level were associated with higher CB. Time allocated to patient care approximated but did not attain statistical significance. A moderate inverse correlation between CB and caregiver QOL physical component summary score and a stronger inverse correlation between CB and caregiver QOL mental component summary score were seen. Conclusion. In a selected cohort of PWE undergoing video-EEG monitoring, we identified modest degree of CB, comparable to that reported in the literature for other chronic neurological conditions. It is associated with specific patient and caregiver characteristics and has a negative effect on caregiver QOL. Ioannis Karakis, Andrew J. Cole, Georgia D. Montouris, Marta San Luciano, Kimford J. Meador, and Charitomeni Piperidou Copyright © 2014 Ioannis Karakis et al. All rights reserved. The Syndrome of Absence Status Epilepsy: Review of the Literature Mon, 10 Feb 2014 10:04:04 +0000 http://www.hindawi.com/journals/ert/2014/624309/ The authors review the literature for cases fulfilling the criteria for the proposed idiopathic generalized epilepsy syndrome (IGE) of absence status epilepsy described by Genton et al. (2008). Difficulties arising in diagnosing such cases are remarked, and possible overlapping with other proposed IGE syndromes is discussed. Leonilda Bilo, Sabina Pappatà, Roberto De Simone, and Roberta Meo Copyright © 2014 Leonilda Bilo et al. All rights reserved. Long-Term Survival and Outcome in Children Admitted to Kilifi District Hospital with Convulsive Status Epilepticus Thu, 30 Jan 2014 13:52:31 +0000 http://www.hindawi.com/journals/ert/2014/643747/ Objectives. The incidence of convulsive status epilepticus (CSE) is high in Africa but the long-term outcome is unknown. We examined the neurocognitive outcome and survival of children treated for CSE in a Kenyan hospital 3 to 4 years after discharge. Methods. The frequency and nature of neurological deficits among this group of children were determined and compared to a control group. The children were screened with the Ten Questions Questionnaire for neurodevelopmental impairment if alive and those that screened positive were invited for further assessment to determine the pattern and extent of their impairment. A verbal autopsy was performed to determine the cause of death in those that died. Results. In the 119 cases followed-up, 9 (8%) died after discharge, with the majority having seizures during their fatal illness. The 110 survivors (median age 5 years) had significantly more neurological impairments on the screening compared to 282 controls (34/110 (30.9%) versus 11/282 (3.9%), OR = 11.0, 95% CI 5.3–22.8). Fifteen percent of the cases had active epilepsy. Conclusions. This study demonstrates the considerable burden of CSE in African children. Strategies to manage children with CSE that are acceptable to the community need to be explored to improve the longer-term outcome. Agnes Prins, Eddie Chengo, Victor Mung'ala Odera, Manish Sadarangani, Claire Seaton, Penny Holding, Greg Fegan, and Charles R. Newton Copyright © 2014 Agnes Prins et al. All rights reserved. The Modified Atkins Diet in Refractory Epilepsy Thu, 30 Jan 2014 10:02:37 +0000 http://www.hindawi.com/journals/ert/2014/404202/ The modified Atkins diet is a less restrictive variation of the ketogenic diet. This diet is started on an outpatient basis without a fast, allows unlimited protein and fat, and does not restrict calories or fluids. Recent studies have shown good efficacy and tolerability of this diet in refractory epilepsy. In this review, we discuss the use of the modified Atkins diet in refractory epilepsy. Suvasini Sharma and Puneet Jain Copyright © 2014 Suvasini Sharma and Puneet Jain. All rights reserved. Epilepsy Surgery Series: A Study of 502 Consecutive Patients from a Developing Country Thu, 30 Jan 2014 08:20:12 +0000 http://www.hindawi.com/journals/ert/2014/286801/ Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC). Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3) at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS) and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp.,) and 3 years (76% and 75%, resp.,). The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%). Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI) brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53%) and (47%) seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47%) and (33%) seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI. Abdulaziz Alsemari, Faisal Al-Otaibi, Salah Baz, Ibrahim Althubaiti, Hisham Aldhalaan, David MacDonald, Tareq Abalkhail, Miguel E. Fiol, Suad Alyamani, Aziza Chedrawi, Frank Leblanc, Andrew Parrent, Donald Maclean, and John Girvin Copyright © 2014 Abdulaziz Alsemari et al. All rights reserved. Adaptive Skills and Somatization in Children with Epilepsy Mon, 27 Jan 2014 06:19:14 +0000 http://www.hindawi.com/journals/ert/2014/856735/ Objective. Children with epilepsy are at risk for less than optimum long-term outcomes. The type and severity of their epilepsy may contribute to educational, psychological, and social outcomes. The objective of this study was to determine the relation between somatization and adaptive skills based on seizure type that could impact on those outcomes. Methods. This study examined adaptive functioning and somatization in 87 children with epilepsy using archival data from a tertiary care facility. Results. No significant differences in adaptive skills emerged between groups of children diagnosed with complex partial (CP) as compared to CP-secondary generalized (SG) seizures; however, deficits in adaptive behavior were found for both groups. The number of medications, possibly reflecting the severity of the epilepsy, was highly correlated to adaptive function. Conclusions. Identification of deficits in adaptive behavior may represent an opportunity for tailored prevention and intervention programming for children with epilepsy. Addressing functional deficits may lead to improved outcomes for these children. Nichole Wicker Villarreal, Cynthia A. Riccio, Morris J. Cohen, and Yong Park Copyright © 2014 Nichole Wicker Villarreal et al. All rights reserved. Excessive Daytime Sleepiness and Epilepsy: A Systematic Review Thu, 31 Oct 2013 15:08:54 +0000 http://www.hindawi.com/journals/ert/2013/629469/ Background. Sleep complaints are common in patients with epilepsy (PWE). Excessive daytime sleepiness (EDS) is one of the most reported complaints and its impact is still a matter of debate. Objective. Evaluate the relationship between EDS and epilepsy, with emphasis on prevalence, assessment, and causes. Methods. A systematic review on PubMed database in the last 10 years (2002 to 2012). The search returned 53 articles and 34 were considered relevant. After citation analysis, 3 more articles were included. Results. Most studies were cross-sectional and questionnaire based. 14 papers addressed EDS as the primary endpoint. 14 adult and 3 children studies used subjective and objective analysis as methodology. The number of studies increased throughout the decade, with 21 in the last 5 years. Adult studies represent almost three times the number of children studies. EDS prevalence in PWE varies from 10 to 47.5%. Prevalence was higher in developing countries. Conclusion. EDS seems to be related more frequently to undiagnosed sleep disorders than to epilepsy-related factors, and although it affects the quality of life of PWE, it can be improved by treating comorbid primary sleep disorders. Andre S. Giorelli, Pâmela Passos, Thiago Carnaval, and Marleide da Mota Gomes Copyright © 2013 Andre S. Giorelli et al. All rights reserved. Temporal Lobe Resective Surgery for Medically Intractable Epilepsy: A Review of Complications and Side Effects Thu, 31 Oct 2013 14:39:02 +0000 http://www.hindawi.com/journals/ert/2013/752195/ Object. It is widely accepted that temporal resective surgery represents an efficacious treatment option for patients with epilepsy of temporal origin. The meticulous knowledge of the potential complications, associated with temporal resective procedures, is of paramount importance. In our current study, we attempt to review the pertinent literature for summating the complications of temporal resective procedures for epilepsy. Method. A PubMed search was performed with the following terms: “behavioral,” “cognitive,” “complication,” “deficit,” “disorder,” “epilepsy,” “hemianopia,” “hemianopsia,” “hemorrhage,” “lobectomy,” “medial,” “memory,” “mesial,” “neurobehavioral,” “neurocognitive,” “neuropsychological,” “psychological,” “psychiatric,” “quadranopia,” “quadranopsia,” “resective,” “side effect,” “surgery,” “temporal,” “temporal lobe,” and “visual field.” Results. There were six pediatric, three mixed-population, and eleven adult surgical series examining the incidence rates of procedure-related complications. The reported mortality rates varied between 0% and 3.5%, although the vast majority of the published series reported no mortality. The cumulative morbidity rates ranged between 3.2% and 88%. Conclusions. Temporal resective surgery for epilepsy is a safe treatment modality. The reported morbidity rates demonstrate a wide variation. Accurate detection and frank reporting of any surgical, neurological, cognitive, and/or psychological complications are of paramount importance for maximizing the safety and improving the patients’ overall outcome. Iordanis Georgiadis, Effie Z. Kapsalaki, and Kostas N. Fountas Copyright © 2013 Iordanis Georgiadis et al. All rights reserved. Surgical Treatment of Pediatric Epileptic Encephalopathies Wed, 30 Oct 2013 13:11:12 +0000 http://www.hindawi.com/journals/ert/2013/720841/ Pediatric epileptiform encephalopathies are a group of neurologically devastating disorders related to uncontrolled ictal and interictal epileptic activity, with a poor prognosis. Despite the number of pharmacological options for treatment of epilepsy, many of these patients are drug resistant. For these patients with uncontrolled epilepsy, motor and/or neuropsychological deterioration is common. To prevent these secondary consequences, surgery is often considered as either a curative or a palliative option. Magnetic resonance imaging to look for epileptic lesions that may be surgically treated is an essential part of the workup for these patients. Many surgical procedures for the treatment of epileptiform encephalopathies have been reported in the literature. In this paper the evidence for these procedures for the treatment of pediatric epileptiform encephalopathies is reviewed. J. Fridley, G. Reddy, D. Curry, and S. Agadi Copyright © 2013 J. Fridley et al. All rights reserved. Sleep and Epilepsy Wed, 23 Oct 2013 08:31:16 +0000 http://www.hindawi.com/journals/ert/2013/483248/ Andrea Romigi, E. Bonanni, and M. Maestri Copyright © 2013 Andrea Romigi et al. All rights reserved. Assessing Systems of Care for US Children with Epilepsy/Seizure Disorder Mon, 21 Oct 2013 09:49:27 +0000 http://www.hindawi.com/journals/ert/2013/825824/ Background. The proportion of US children with special health care needs (CSHCN) with epilepsy/seizure disorder who receive care in high-quality health service systems was examined. Methodology. We analyzed data for 40,242 CSHCN from the 2009-2010 National Survey of CSHCN and compared CSHCN with epilepsy/seizure disorder to CSHCN without epilepsy/seizure disorder. Measures included attainment rates for 6 federal quality indicators with comparisons conducted using chi square and logistic regression methods. In addition, CSHCN with epilepsy/seizure disorder were compared to CSHCN without epilepsy/seizure disorder on the basis of 14 unmet health care needs. Results. Lower attainment rates for receiving comprehensive care in a medical home and easily accessible community-based services were found for CSHCN with epilepsy/seizure disorder versus CSHCN without epilepsy/seizure disorder (medical home: 32% versus 43%; accessible community-based services: 50% versus 66%, resp.) in unadjusted analyses. Lower adjusted odds for these indicators as well as greater unmet need for specialists, dentistry, prescriptions, therapies, and mental health care were also found for CSHCN with epilepsy/seizure disorder. Conclusions. Further efforts are needed to improve attainment of high-quality health care services for CSHCN with epilepsy/seizure disorders. Mary Kay Kenney and Marie Mann Copyright © 2013 Mary Kay Kenney and Marie Mann. All rights reserved. A Clinical-EEG Study of Sleepiness and Psychological Symptoms in Pharmacoresistant Epilepsy Patients Treated with Lacosamide Thu, 19 Sep 2013 09:17:39 +0000 http://www.hindawi.com/journals/ert/2013/593149/ Our aim was to evaluate the EEG and clinical modifications induced by the new antiepileptic drug lacosamide (LCM) in patients with epilepsy. We evaluated 10 patients affected by focal pharmacoresistant epilepsy in which LCM (mean 250 mg/day) was added to the preexisting antiepileptic therapy, which was left unmodified. Morning waking EEG recording was performed before (t0) and at 6 months (t1) after starting LCM. At t0 and t1, patients were also administered questionnaires evaluating mood, anxiety, sleep, sleepiness, and fatigue (Beck Depression Inventory; State-Trait Anxiety Inventory Y1 and Y2; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Fatigue Severity Scale). We performed a quantitative analysis of EEG interictal abnormalities and background EEG power spectrum analysis. LCM as an add-on did not significantly affect anxiety, depression, sleepiness, sleep quality, and fatigue scales. Similarly, adding LCM to preexisting therapy did not modify significantly patient EEGs in terms of absolute power, relative power, mean frequency, and interictal abnormalities occurrence. In conclusion, in this small cohort of patients, we confirmed that LCM as an add-on does not affect subjective parameters which play a role, among others, in therapy tolerability, and our clinical impression was further supported by evaluation of EEG spectral analysis. Filippo S. Giorgi, Chiara Pizzanelli, Veronica Pelliccia, Elisa Di Coscio, Michelangelo Maestri, Melania Guida, Elena Iacopini, Alfonso Iudice, and Enrica Bonanni Copyright © 2013 Filippo S. Giorgi et al. All rights reserved. Epilepsy Surgery: Factors That Affect Patient Decision-Making in Choosing or Deferring a Procedure Mon, 16 Sep 2013 13:32:21 +0000 http://www.hindawi.com/journals/ert/2013/309284/ Surgical resection for well-selected patients with refractory epilepsy provides seizure freedom approximately two-thirds of the time. Despite this, many good candidates for surgery, after a presurgical workup, ultimately do not consent to a procedure. The reasons why patients decline potentially effective surgery are not completely understood. We explored the socio cultural, medical, personal, and psychological differences between candidates who chose (n = 23) and those who declined surgical intervention (n = 9). We created a novel questionnaire addressing a range of possible factors important in patient decision making. We found that patients who declined surgery were less bothered by their epilepsy (despite comparable severity), more anxious about surgery, and less likely to listen to their doctors (and others) and had more comorbid psychiatric disease. Patients who chose surgery were more embarrassed by their seizures, more interested in being “seizure-free”, and less anxious about specific aspects of surgery. Patient attitudes, beliefs, and anxiety serve as barriers to ideal care. These results can provide opportunities for education, treatment, and intervention. Additionally, patients who fit a profile of someone who is likely to defer surgery may not be appropriate for risky and expensive presurgical testing. Christopher Todd Anderson, Eva Noble, Ram Mani, Kathy Lawler, and John R. Pollard Copyright © 2013 Christopher Todd Anderson et al. All rights reserved. How Sleep Activates Epileptic Networks? Thu, 12 Sep 2013 09:43:53 +0000 http://www.hindawi.com/journals/ert/2013/425697/ Background. The relationship between sleep and epilepsy has been long ago studied, and several excellent reviews are available. However, recent development in sleep research, the network concept in epilepsy, and the recognition of high frequency oscillations in epilepsy and more new results may put this matter in a new light. Aim. The review address the multifold interrelationships between sleep and epilepsy networks and with networks of cognitive functions. Material and Methods. The work is a conceptual update of the available clinical data and relevant studies. Results and Conclusions. Studies exploring dynamic microstructure of sleep have found important gating mechanisms for epileptic activation. As a general rule interictal epileptic manifestations seem to be linked to the slow oscillations of sleep and especially to the reactive delta bouts characterized by A1 subtype in the CAP system. Important link between epilepsy and sleep is the interference of epileptiform discharges with the plastic functions in NREM sleep. This is the main reason of cognitive impairment in different forms of early epileptic encephalopathies affecting the brain in a special developmental window. The impairment of cognitive functions via sleep is present especially in epileptic networks involving the thalamocortical system and the hippocampocortical memory encoding system. Peter Halász Copyright © 2013 Peter Halász. All rights reserved. Epileptic Encephalopathies in Children Thu, 22 Aug 2013 12:05:48 +0000 http://www.hindawi.com/journals/ert/2013/505314/ Brahim Tabarki, Giangennaro Coppola, and Elaine Wirrell Copyright © 2013 Brahim Tabarki et al. All rights reserved. Electroencephalogram of Age-Dependent Epileptic Encephalopathies in Infancy and Early Childhood Mon, 19 Aug 2013 11:07:51 +0000 http://www.hindawi.com/journals/ert/2013/743203/ Epileptic encephalopathy syndromes are disorders in which the epileptiform abnormalities are thought to contribute to a progressive cerebral dysfunction. Characteristic electroencephalogram findings have an important diagnostic value in classification of epileptic encephalopathy syndromes. In this paper, we focus on electroencephalogram findings of childhood epileptic encephalopathy syndromes and provide sample illustrations. Lily C. Wong-Kisiel and Katherine Nickels Copyright © 2013 Lily C. Wong-Kisiel and Katherine Nickels. All rights reserved. Epilepsy, Antiseizure Therapy, and Sleep Cycle Parameters Wed, 07 Aug 2013 13:25:02 +0000 http://www.hindawi.com/journals/ert/2013/670682/ A reciprocal relationship exists between sleep and epilepsy. The quality of sleep is affected by the presence and frequency of seizures, type of antiepileptic therapy utilized, and coexisting primary sleep disorders. Daytime somnolence is one of the most common adverse effects of antiepileptic therapy, with specific pharmacologic agents exhibiting a unique influence on components of sleep architecture. The newer generation of antiseizure drugs demonstrates improved sleep efficiency, greater stabilization of sleep architecture, prolongation of REM sleep duration, and increased quality of life measures. The emerging field of chronoepileptology explores the relationship between seizures and circadian rhythms, aiming for targeted use of antiseizure therapies to maximize therapeutic effects and minimize the adverse events experienced by the patients. Vladimir Shvarts and Steve Chung Copyright © 2013 Vladimir Shvarts and Steve Chung. All rights reserved. Continuous Spikes and Waves during Sleep: Electroclinical Presentation and Suggestions for Management Tue, 06 Aug 2013 11:09:20 +0000 http://www.hindawi.com/journals/ert/2013/583531/ Continuous spikes and waves during sleep (CSWS) is an epileptic encephalopathy characterized in most patients by (1) difficult to control seizures, (2) interictal epileptiform activity that becomes prominent during sleep leading to an electroencephalogram (EEG) pattern of electrical status epilepticus in sleep (ESES), and (3) neurocognitive regression. In this paper, we will summarize current epidemiological, clinical, and EEG knowledge on CSWS and will provide suggestions for treatment. CSWS typically presents with seizures around 2–4 years of age. Neurocognitive regression occurs around 5-6 years of age, and it is accompanied by subacute worsening of EEG abnormalities and seizures. At approximately 6–9 years of age, there is a gradual resolution of seizures and EEG abnormalities, but the neurocognitive deficits persist in most patients. The cause of CSWS is unknown, but early developmental lesions play a major role in approximately half of the patients, and genetic associations have recently been described. High-dose benzodiazepines and corticosteroids have been successfully used to treat clinical and electroencephalographic features. Corticosteroids are often reserved for refractory disease because of adverse events. Valproate, ethosuximide, levetiracetam, sulthiame, and lamotrigine have been also used with some success. Epilepsy surgery may be considered in a few selected patients. Iván Sánchez Fernández, Kevin E. Chapman, Jurriaan M. Peters, Chellamani Harini, Alexander Rotenberg, and Tobias Loddenkemper Copyright © 2013 Iván Sánchez Fernández et al. All rights reserved. Vitamin-Responsive Epileptic Encephalopathies in Children Thu, 25 Jul 2013 13:51:25 +0000 http://www.hindawi.com/journals/ert/2013/510529/ Untreated epileptic encephalopathies in children may potentially have disastrous outcomes. Treatment with antiepileptic drugs (AEDs) often may not control the seizures, and even if they do, this measure is only symptomatic and not specific. It is especially valuable to identify potential underlying conditions that have specific treatments. Only a few conditions have definitive treatments that can potentially modify the natural course of disease. In this paper, we discuss the few such conditions that are responsive to vitamin or vitamin derivatives. Satish Agadi, Michael M. Quach, and Zulfi Haneef Copyright © 2013 Satish Agadi et al. All rights reserved. Diagnosis and Management of Epileptic Encephalopathies in Children Mon, 22 Jul 2013 12:14:03 +0000 http://www.hindawi.com/journals/ert/2013/501981/ Epileptic encephalopathies refer to a group of disorders in which the unremitting epileptic activity contributes to severe cognitive and behavioral impairments above and beyond what might be expected from the underlying pathology alone, and these can worsen over time leading to progressive cerebral dysfunction. Several syndromes have been described based on their electroclinical features (age of onset, seizure type, and EEG pattern). This review briefly describes the clinical evaluation and management of commonly encountered epileptic encephalopathies in children. Puneet Jain, Suvasini Sharma, and Manjari Tripathi Copyright © 2013 Puneet Jain et al. All rights reserved. Ketogenic Diet in Epileptic Encephalopathies Wed, 10 Jul 2013 08:05:04 +0000 http://www.hindawi.com/journals/ert/2013/652052/ The ketogenic diet is a medically supervised high-fat, low-carbohydrate diet that has been found useful in patients with refractory epilepsy. It has been shown to be effective in treating multiple seizure types and epilepsy syndromes. In this paper, we review the use of the ketogenic diet in epileptic encephalopathies such as Ohtahara syndrome, West syndrome, Dravet syndrome, epilepsy with myoclonic atonic seizures, and Lennox-Gastaut syndrome. Suvasini Sharma and Manjari Tripathi Copyright © 2013 Suvasini Sharma and Manjari Tripathi. All rights reserved.