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- Kennebäck, G, et al.
(författare)
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Changes in arrhythmia profile and heart rate variability during abrupt withdrawal of antiepileptic drugs. Implications for sudden death.
- 1997
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Ingår i: Seizure. - 1059-1311 .- 1532-2688. ; 6:5, s. 369-75
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Tidskriftsartikel (refereegranskat)abstract
- Sudden unexpected death (SUD) has been associated with low or undetectable concentrations of antiepileptic drugs in patients with epilepsy suggesting that a sudden fall in plasma levels of these drugs might be a critical factor for the occurrence of SUD. We studied the changes in arrhythmia profile and heart-rate variability, during abrupt withdrawal of carbamazepine and phenytoin treatment in 10 patients with side effects on these drugs. Continuous ECG recording and daily measurements of drug plasma concentrations were performed from the last day of steady-state treatment and the following 4 days. Three patients had a 10-fold increase in ventricular premature beats. In addition, there was a significant reduction in heart-rate variability, assessed over 24 hours, in both the time (SDNN index, P = 0.03) and frequency domains from days 1-5. In the frequency domain analysis there was a significant reduction in total power (P = 0.01), very-low-frequency power (P = 0.004) and in low-frequency (LF) power (P = 0.01). Similar reductions in heart-rate variability and increases in ventricular automaticity have been associated with increased mortality in other patient groups. Two factors that might contribute to the increased rate of SUD in patients with epilepsy have thus been identified.
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- Landtblom, Anne-Marie, 1953-
(författare)
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Did St Birgitta suffer from epilepsy? A neuropathography
- 2004
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Ingår i: Seizure. - 1059-1311 .- 1532-2688. ; 13:3, s. 161-167
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Tidskriftsartikel (refereegranskat)abstract
- Several famous religious personalities have been discussed as possibly having had epilepsy. Partial epileptic fits can be accompanied by religious experiences. The Swedish St Birgitta of Vadstena is focused on from this perspective as the exterior of the skull thought to belong to her has a prominent tuberculum with a corresponding interior indentation possibly indicating the previous existence of a meningioma, a well known cause of epilepsy. This article scrutinises arguments for and against the possibility of epileptic features in the revelations of the saint, as well as in her life story.
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- Räty, Lena, et al.
(författare)
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Seizures and therapy in adolescents with uncomplicated epilepsy
- 2003
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Ingår i: Seizure. - 1059-1311 .- 1532-2688. ; 12:4, s. 229-236
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to describe seizures and their therapy among Swedish adolescents, aged 13–22, with active but uncomplicated epilepsy.Method: The adolescents answered questionnaires (158/193). Data were also obtained from medical records.Results: Epileptic seizure types could be specified in 92.1% of the cases. Predominant types were Primary Generalised Tonic–Clonic Seizures and Partial Complex Seizures with Secondary Generalisation. Clinical diagnoses by physicians were unspecified in 25.8%. Ninety percent were on antiepileptic drugs (AEDs), most commonly valproate and carbamazepine. New AEDs were used in 9.3% of the cases and polytherapy in 13.9%. More than 40% of the respondents had seizures despite AED treatment. Side effects of AEDs were experienced by 61%, most commonly tiredness, concentration difficulties and headache. Patients on polytherapy experienced significantly more side effects. The choice of a new AED over a traditional one was not related to seizure type or seizure control.Conclusions: Many adolescents had persistent seizures despite treatment at a specialist regional epilepsy centre. This, plus the high reported rate of side effects of AED treatment, suggests that treatment is not optimal for the group studied. As traditional AEDs strongly dominated treatment possibly newly marketed AEDs are underused in this group.
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- Almgren, Malin, et al.
(författare)
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Population-based study of antiepileptic drug exposure in utero-Influence on head circumference in newborns
- 2009
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Ingår i: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 18:10, s. 672-675
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To study the effect of AED exposure on head circumference in the newborn. Methods: Data on all Swedish singletons births between 1995 and 2005, over 900,000 births, were obtained from the Swedish Medical Birth Registry. The effects of AEDs on birth-weight-adjusted mean head circumference (bw-adj-HC) were estimated by comparison with data from all births in an analysis which was adjusted for year of birth, maternal age, parity, maternal smoking, and maternal body mass index. Results: A significant reduction of mean bw-adj-HC was seen after both carbamazepine (CBZ) (standard deviation scores (SDS) = 0.15, p < 0.001) and valproic acid (VPA) (SDS = 0.10, p = 0.04) in monotherapy. No effect on mean bw-adj-HC was seen for phenytoin, clonazepam, lamotrigine and gabapentin. There was a significant increase in the occurrence of microcephaly (bw-adj-HC smaller than 2 SD below the mean) after any AED polytherapy (OR = 2.85, 95% CI: 1.74-4.78) but not after AED monotherapy or monotherapy with CBZ or VPA. CBZ OF VPA was taken by 71% of the pregnant mothers on AED, and the usage increased over time. Conclusions: CBZ and VPA in monotherapy during pregnancy reduce mean bw-adj-HC. AED polytherapy increases the rate of microcephaly but no significant effect is seen of AED monotherapy. The possible significance for the further development of the child is uncertain but should be explored. (C) 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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- Andersson, Klara, et al.
(författare)
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Socioeconomic outcome and access to care in adults with epilepsy in Sweden: A nationwide cohort study.
- 2020
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Ingår i: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 74, s. 71-76
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Tidskriftsartikel (refereegranskat)abstract
- Epilepsy has well-documented associations with low income and low education levels, but the impact of a patient's socioeconomic standing (SES) on the effects of epilepsy have been less studied.We performed a register-based cross-sectional study and asked if SES was associated with more severe epilepsy or limited access to care in Sweden, where health care is universal, and if socioeconomic outcomes (employment and income) differed for persons with epilepsy (PWE) with different levels of educational attainment. The study cohort consisted of all adult patients with an epilepsy diagnosis in the Swedish patient register in 2000-2015 (n = 126,406) and controls (n = 379,131) matched for age, gender, and place of birth.Somatic and psychiatric comorbidities were more common in PWE, while education and income levels were lower. Among PWE, hospitalizations were more common in persons with lower income or education. Having at least one prescription written by a neurologist in the study period was more common in the high-income and high-education groups. Finally, although low educational attainment was associated with low levels of income and inversely associated with employment in both persons with epilepsy and controls, regression analyses demonstrated that these associations were much more noticeable in cases than controls.We conclude that both the severity and consequences of epilepsy are greater in persons of low SES, even in a country with universal health care. This indicates that universal access may not be sufficient to mitigate socioeconomic inequity in epilepsy.
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- Axelson, Hans W., et al.
(författare)
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Successful localization of the Broca area with short-train pulses instead of "Penfield" stimulation.
- 2009
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Ingår i: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 18:5, s. 374-375
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Tidskriftsartikel (refereegranskat)abstract
- Direct electrical stimulation of functional cortical areas is a standard procedure in epilepsy and glioma surgery. Many previous studies support that stimulation of the motor cortex with short-train pulses is a less epileptogenic alternative to the 50–60 Hz ‘Penfield’ technique. However, whether the short-train stimulation is useful also in mapping of speech areas is unclear. In this case report we present a patient with oligodendroglioma near the Broca area. Extraoperative electrical stimulation via a subdural grid electrode was primarily performed to locate the speech area. The cortex was stimulated with short-train pulses (5 pulses, 0.5 pulse duration and 3 ms interpulse interval) in addition to 1–3 s 50 Hz stimulation.The patient had speech arrest from both types of stimulation techniques during a naming task. It was however critical that the short (14.5 ms) train stimulation was synchronized with the presentation of the naming objects. If not, there was no speech arrest. Despite this possible pitfall, this case has encouraged us to further try short-train stimulation in attempts to reduce stimulus-triggered seizures during mapping of eloquent areas.
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- Beckung, Eva, 1950, et al.
(författare)
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Motor and sensory dysfunctions in children with mental retardation and epilepsy.
- 1997
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Ingår i: Seizure : the journal of the British Epilepsy Association. - 1059-1311. ; 6:1, s. 43-50
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess motor and sensory functions in a population-based series of 88 mentally retarded children with epilepsy. A new standardized physiotherapy protocol was developed for the heterogeneous population of children with epilepsy; the Cailler-Azusa scale was also found to be useful. For children with cerebral palsy, the gross motor function measure was used. Sensorimotor impairments, resulting in disabilities and handicap, were found to be very common but often overlooked and neglected. Sensorimotor dysfunctions need to be identified in order to provide rational training, understanding and care to children with epilepsy and mental retardation.
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