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Epilepsy
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Donald C. Barr, Andres M. Kanner
In a joint collaboration, the AAN, AES, and American Association of Neurological Surgeons (AANS) have developed formal practice guideline for epilepsy surgery.69 Unfortunately, despite these guidelines, less than 1% of patients with drug-resistant epilepsy are referred to a comprehensive epilepsy center constituted by multidisciplinary teams of epileptologists, neuropsychologists, neuroradiologists, and neurosurgeons whose mission is to perform an evaluation to establish if any of the above-cited therapeutic options are available to these patients.70
Absence seizures in the GAERS model: subthalamic nucleus stimulation
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Alim-Louis Benabid, Laurent Vercueil, Karine Bressand, Maurice Dematteis, Abdelhamid Benazzouz, Lorella Minotti, Philippe Kahane
Epilepsy is a term derived from the Greek word ‘epilepsia,’ which means ‘to seize.’ In current usage, epilepsy refers to a variety of neurological disorders characterized by recurrent seizures. It is a common neurological disorder having a prevalence of 0.5–1%. It can affect people of any age, sex, or race. It is estimated that nearly 2.5 million people in the United States have epilepsy. Approximately 50% of seizures are of the partial type and the majority of these arise in the temporal lobe. In patients with intractable temporal lobe epilepsy, magnetic resonance imaging (MRI) can frequently identify hippocampal sclerosis, and surgery can render 60–70% of these cases seizure-free. Surgery is an invasive procedure associated with complications, such as quad-rantanopia. However, a significant proportion of patients with drug-resistant epilepsy are not candidates for epilepsy surgery. Therefore, other therapeutic approaches must be found. Clinical and experimental observations suggest that seizures can be controlled by neuronal structures, particularly those involved in motor control. The nigro-striatal system seems to be particularly important as a network capable of controlling seizures.
Evaluation and management of syncope and related disorders in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Andrea Ungar, Martina Rafanelli, Michele Brignole
Syncope is the most frequent cause of a false diagnosis of epilepsy (67) as it is frequently associated with abnormal movements such as myoclonic jerks, oral automatism, head turning, and more rarely urinary incontinence, thus mimicking the clinical presentation of epileptic seizures (68–70). Syncope and seizures may coexist in a patient, either by pure chance or by pathophysiologic mechanism (71–73). In this clinical context, the application of a standardized and guidelines-based protocol, comprising a careful evaluation and TT, is useful for the differential diagnosis. This observation has been recently confirmed in a group of highly selected patients who presented recurrent TLoC of unknown cause, when evaluated by neurologists (74). Patients with a diagnosis of possible or drug-resistant epilepsy were enrolled and referred to the syncope units. Isolated syncope was diagnosed in 42% of all cases, being more frequent among patients affected by possible epilepsy (≈70%). Syncope and epilepsy coexisted in ≈40% of patients. In follow-up, TLoC recurrence was ≈50%. In patients with possible epilepsy taking antiepileptic drugs before enrollment (≈50%) these drugs were discontinued, and started again only after epilepsy diagnosis confirmation (74).
Morphine ameliorates pentylenetetrazole-induced locomotor pattern in zebrafish embryos; mechanism involving regulation of opioid receptors, suppression of oxidative stress, and inflammation in epileptogenesis
Published in Toxicology Mechanisms and Methods, 2023
Fümet Duygu Üstündağ, İsmail Ünal, Ünsal Veli Üstündağ, Derya Cansız, Merih Beler, A. Ata Alturfan, Pınar Mega Tiber, Ebru Emekli-Alturfan
Anticonvulsive drugs fail to work for a large percentage of epileptic patients. Drug-resistant epilepsy occurs when an epileptic patient fails to maintain seizure-free status after trying two anti-epileptic medicines (Sturgeon et al. 2021). Results of our study show that morphine treatment was as effective as VPA in ameliorating the locomotor pattern induced by PTZ in zebrafish embryos. Opioid receptors play a complicated role in seizures. Our findings support the view that morphine has an anticonvulsant effect at low dosages, but has the opposite effect at high ones (Saboory et al. 2007; Sturgeon et al. 2021). On the other hand, it should be noted that opioids have been known to exacerbate absence-like seizures, while antagonists prevent them. Moreover, opioids enhanced the spontaneous seizure activity in a dose-dependent manner in hippocampus in vitro (Saboory et al. 2007). Neuroexcitation is one of the most intriguing and harmful side effects of opioids and myoclonus and seizures have been recorded due to high dosages of morphine administration (Woodward et al. 2017). The mechanism of opioid-related neuroexcitation, and consequently its therapy, is unknown. Morphine's proconvulsant effect may be mediated by the 3-glucuronide morphine metabolite or NO generated by constitutive nonspecific NO synthase, according to previous animal studies (Hemstapat et al. 2003; Saboory et al. 2007).
A critical evaluation of fenfluramine hydrochloride for the treatment of Dravet syndrome
Published in Expert Review of Neurotherapeutics, 2022
An-Sofie Schoonjans, Berten Ceulemans
Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy with onset in infancy. Children present in the first year of life, often with prolonged, generalized or hemiclonic seizures triggered by fever, usually followed by the appearance of other seizure types, including myoclonic, focal impaired awareness and atypical absence seizures. The majority develop drug-resistant epilepsy. Development prior to the seizure onset seems normal, but a slowing, stagnation or even regression is seen around the age of 2 years. All children develop, in variable degrees, an intellectual disability. In addition, other comorbidities, like behavioral problems, motor problems and sleep problems are usually seen which have a major impact on the quality of life of the patients and their families [1,2]. Additionally, patients with DS have an elevated mortality risk due to status epilepticus and SUDEP (Sudden Unexpected Death in People with Epilepsy) [3,4]. DS is rare with an incidence ranging from one in 15,500 to one in 40,000 live births [5–7].
Glucocorticoid receptors participate in epilepsy in FCDII patients and MP model rats: A potential therapeutic target for epilepsy in patients with focal cortical dysplasia II (FCDII)
Published in Expert Opinion on Therapeutic Targets, 2022
Xiaoqing Zhang, Xiaolin Yang, Bing Chen, Kaifeng Shen, Guolong Liu, Zhongke Wang, Kaixuan Huang, Gang Zhu, Tingting Wang, Shengqing Lv, Chunqing Zhang, Hui Yang, Zhi Hou, Shiyong Liu
The samples used in this study were obtained from the Neurosurgery Department of the Second Affiliated Hospital of Army Medical University. All procedures were reviewed by the Ethics Committee before being performed. The human tissues were used strictly in accordance with the Helsinki declaration, and no brain tissues were resected for research purposes. All patients provided informed consent. The inclusion criteria were as follows: 1) patients that met the diagnostic criteria of drug-resistant epilepsy, 2) patients with FCDII according to ILAE classification, and 3) patients in which the epileptogenic zone was identified after comprehensive presurgical evaluation. Semiological analysis, electroencephalography (EEG), MRI, and PET were performed separately by two independent neurosurgeons and radiologists. Controls were collected from autopsies without a history of epilepsy, stress, or other nervous system diseases at autopsy. Importantly, none of the patients had agonal status before death, all of the patients died relatively quickly, and all of the brain tissues were saved within 24 hours after being reviewed by two neuropathologists. Brain tissues with normal gross and microscopic morphology were included. Detailed information about the specimens is listed in Table 1.