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Epilepsy
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
i – Sodium valproate. Atonic seizures are generalised seizures characterised by sudden onset of loss of muscle tone. Sodium valproate is usually the first-line treatment; lamotrigine can be given as an adjunct if symptoms are not adequately controlled.
Clonazepam and Nitrazepam
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Atonic seizures are frequently associated with the most difficult forms of childhood epilepsy. Patients suffering from atonic seizures usually have evidence of diffuse brain disease and often manifest a variety of other seizure types such as myoclonus, atypical absence, tonic and tonic-clonic seizures. Atonic seizures are often found in the LennoxGastaut syndrome (see Chapter 15). CZP is indicated in such patients either alone or more preferably as an adjunct to VPA.
Vagal nerve stimulation: effects on seizures
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Thus, taken together, these studies suggest that in children VNS reduces seizure rates by -20% in 3 months and -55% in 1 year. Of note, Patwardhan et al.9 found atonic seizures were reduced significantly more (-80%) than other seizure types, and Helmers et al.10 found the best responses in children with previous coprus callosum section (-79%).
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.
Control of seizures in a clozapine-treated schizophrenia patient, using valproate: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2019
Hamza Ayaydın, Şermin Bilgen Ulgar
Drop attacks occurring with up-titration of clozapine dose was considered as atonic seizures clinically despite a lack of epileptic discharge on EEG in our patient; dramatic response to valproic acid/sodium valproate had a positive effect on therapeutic process and compliance. Atonic seizures manifest as spontaneous drop attacks. However, it may be difficult to recognize such attacks. The drop attacks may be misleadingly interpreted as myoclonic flexion of knee joint or psychogenic. Interestingly, it was reported that drop attack and mypclonus were seen due to clozapine use in a case report [30]. Moreover, drop attack could be misleadingly attributed to hypotension; thus, blood pressure measurement during drop attack is important to clarify drop attacks. However, it should be kept in mind that there may be atonic seizures in patients who have syncope attacks, drop attacks, or who suddenly drop objects from his/her hands during clozapine therapy and atonic seizures should be treated by using an anticonvulsant agent such as valproic acid/sodium valproate, which are considered as potential risk for tonic-clonic seizures [31].
Targeting crosstalk between Nuclear factor (erythroid-derived 2)-like 2 and Nuclear factor kappa beta pathway by Nrf2 activator dimethyl fumarate in epileptogenesis
Published in International Journal of Neuroscience, 2018
Neha Singh, Sheekha Vijayanti, Lekha Saha
Phenytoin (PHT), phenobarbitone (PB), carbamazepine (CBZ), oxcarbazepine (OXC) and valproate (VPA) are usually called ‘conventional’ or ‘first-line drugs’. The other AEDs are called ‘new’ or ‘second-line’ drugs . It is preferable to use a conventional AED as the initial drug since it is less expensive and the side effects with long-term use are well-known. The currently used drugs for the treatment of generalized onset, tonic-clonic seizure, atypical absence, myoclonic and atonic seizures are valproic acid, topiramate and lamotrigine, and to treat focal seizures are lamotrigine, PHT, CBZ and levetiracetam [17]. Although these drugs provide symptomatic relief by inhibiting the seizure generation by targeting the neuronal excitability, they are not able to alter the underlying epileptogenesis process and are ineffective in preventing epilepsy in high-risk individuals. Currently, there is no available treatment to inhibit the process of epileptogenesis [18]. DMF can act as a disease-modifying agent in epilepsy by its antioxidant, anti-inflammatory and immunomodulatory properties by activating the Nrf2 pathway and may provide an additional approach for the prevention of epilepsy in high-risk individuals.