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Hereditary and Metabolic Diseases of the Central Nervous System in Adults
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Late findings include: Dysarthria and ataxia.Prominent visual hallucinations.Agitation.Increasing dementia leading to vegetative state.Intractable epilepsy.Nonepileptic myoclonus.
The effects of epilepsy and its treatments on affect and emotion
Published in Howard J. Rosen, Robert W. Levenson, Neurocase, 2020
John D. Hixson, Heidi E. Kirsch
The largest determinant of quality of life in intractable epilepsy is emotional health. Unfortunately, this is one of the most complex and least understood topics in epilepsy care. It is frequently neglected in the clinic, where physicians focus on seizure burden and medication side effects. We have seen that intractable epilepsy itself can cause specific difficulties with mood, emotion processing, and social behavior.
Brain stimulation and epilepsy: basic overview and novel approaches
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Jürgen Lüders, Imad Najm, Hans O Lüders
Centro-median thalamic nucleus. In 1987, Marcos and Francisco Velasco reported a marked reduction in seizures with stimulation of the centro-median (CM) thalamic nucleus in humans.38 This was an uncontrolled study of five patients with intractable epilepsy. In 1989, Chkhenkeli and Sramka reported that stimulation of the CM thalamic nucleus prevents cortical epileptiform discharges.39 Based on these promising results, Fisher performed a placebo-controlled pilot study to determine the efficacy of CM thalamic stimulation in patients with intractable seizures.40 Seven patients were stimulated and showed a 30% reduction in seizure frequency. This reduction in seizure frequency was not statistically significant.
Efficacy of supplemental MCT oil on seizure reduction of adult drug-resistant epilepsy – a single-center open-label pilot study
Published in Nutritional Neuroscience, 2023
Emmaline Rasmussen, Vimal Patel, Samuel Tideman, Robert Frech, Roberta Frigerio, Jaishree Narayanan
Epilepsy is a major public health problem that affects 0.6–1% of the general population [1]. Most efforts are targeted to the development of increasing numbers of anti-epileptic drugs (AEDs) – more than 20 AEDs are used clinically today. However, despite the availability, 30–40% of patients do not respond to pharmacotherapy and continue to have ‘uncontrolled’ or ‘intractable’ seizures – a condition termed drug-resistant epilepsy [2]. Uncontrolled seizures pose a significant risk to quality of life [3]. In addition, uncontrolled seizures are likely to be one of the strongest risk factors of sudden death in epilepsy [4]. Therefore, it is important not to rely on pharmacological interventions alone when treating intractable epilepsy and further evidence for complementary and alternative interventions must be developed.
Can we predict response to vagus nerve stimulation in intractable epilepsy
Published in International Journal of Neuroscience, 2020
Jinbiao Xiong, Yiyao Cao, Weidong Yang, Zhijuan Chen, Qing Yu
Mentality is one of the most important factors affecting the quality of life. The seizures, the side effects of anti-epileptic drugs and the epilepsy syndrome exert bad effects on the mentality of patients with intractable epilepsy. Thus, the mental ability of epileptic patients varies. Some reports show no statistically significant difference in effect of VNS therapy between patients without or with mental retardation [27]. However, after undergoing VNS, Wheeler et al. [18] found 24% of 117 individuals experiencing normal mental function (Intelligence Quotient (IQ)≥70) attained a better outcome compared with 11% of 72 individuals with mental impairment (IQ < 70) (p = 0.029; Chi square test). This indicated that the VNS therapy was more suitable for patients with normal mental function, which may be the reason that the patients with a better mental ability are less refractory compared with patients with impaired intelligence. In addition, the level of mental functioning tends to associate with age when seizure appearing and course of epilepsy, and thus, the factors that affect the effect of VNS seem to affect each other. Therefore, when considering VNS therapy for patients with pharmaco-resistant epilepsy, the demographics should be comprehensively evaluated for the sake of patients getting the best effect of the VNS.
Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality
Published in Current Medical Research and Opinion, 2020
Boulenouar Mesraoua, Dirk Deleu, Al Hail Hassan, Melykian Gayane, Alsheikh Lubna, Musab Abdalhalim Ali, Torbjorn Tomson, Bassel Abou Khalil, J. Helen Cross, Ali A. Asadi-Pooya
The risk of injuries in PWE clearly varies between different parts of the world for many different reasons including geographical, economic, and social circumstances, availability of effective treatments, workplace conditions and individual life styles. Some general epilepsy-related risk factors have, however, been identified. The most consistent findings regarding risk factors for injuries are occurrence of generalized convulsive seizures (focal to bilateral or generalized tonic-clonic seizures)21,22,30,33, but atonic seizures and ictal falls have also been associated with increased risks21,33,34. Intractable epilepsy, uncontrolled seizures, or high seizure frequency are also consistent risk factors for seizure-related injuries21–23,31,35. Polytherapy with AEDs was reported to be associated with increased risk in a few studies21,31,34 although it is not clear if polytherapy is a risk factor as such or just a reflection of a more difficult to treat epilepsy with poor seizure control. Some studies have identified comorbidities as another risk factor for injuries21,26,30,33.