| 1. |
- Harden, C, et al.
(author)
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Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society
- 2017
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In: Epilepsy currents. - : SAGE Publications. - 1535-7597 .- 1535-7511. ; 17:3, s. 180-187
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Journal article (peer-reviewed)abstract
- Objective: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. Methods: Systematic review of evidence; modified Grading Recommendations Assessment, Development and Evaluation process for developing conclusions; recommendations developed by consensus. Results: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0–17 years) is 0.22/1,000 patient-years (95% CI 0.16–0.31) (high confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64–2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). Recommendations: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.
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| 2. |
- Ben-Menachem, Elinor, 1945
(author)
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Is prolactin a clinically useful measure of epilepsy?
- 2006
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 6:3, s. 78-9
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Journal article (peer-reviewed)abstract
- Use of Serum Prolactin in Diagnosing Epileptic Seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Chen DK, So YT, Fisher RS Neurology 2005;65(5):668–675 (Review) The purpose of this article is to review the use of serum prolactin assay in epileptic seizure diagnosis. Methods The authors identified relevant studies in multiple databases and reference lists. Studies that met inclusion criteria were summarized and rated for quality of evidence, and the results were analyzed and pooled where appropriate. Results Most studies used a serum prolactin of at least twice baseline value as abnormal. For the differentiation of epileptic seizures from psychogenic nonepileptic seizures, one Class I and seven Class II studies showed that elevated serum prolactin was highly predictive of either generalized tonic–clonic or complex partial seizures. Pooled sensitivity was higher for generalized tonic–clonic seizures (60.0%) than for complex partial seizures (46.1%), while the pooled specificity was similar for both (approximately 96%). Data were insufficient to establish validity for simple partial seizures. Two Class II studies were consistent in showing prolactin elevation after tilt-test–induced syncope. Inconclusive data exist regarding the value of serum prolactin following status epilepticus, repetitive seizures, and neonatal seizures. Recommendations Elevated serum prolactin assay, when measured in the appropriate clinical setting at 10 to 20 minutes after a suspected event, is a useful adjunct for the differentiation of generalized tonic–clonic or complex partial seizure from psychogenic nonepileptic seizure among adults and older children (Level B). Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B). The use of serum PRL assay has not been established in the evaluation of status epilepticus, repetitive seizures, and neonatal seizures (Level U).
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| 3. |
- Ben-Menachem, Elinor, 1945
(author)
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Is topiramate tops?
- 2008
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 8:3, s. 60-1
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Journal article (peer-reviewed)abstract
- TOPIRAMATE MONOTHERAPY IN NEWLY DIAGNOSED EPILEPSY IN CHILDREN AND ADOLESCENTS: Glauser TA, Dlugos DJ, Dodson WE, Grinspan A, Wang S, Wu SC EPMN-106/INT-28 Investigators. J Child Neurol2007226:693-69917641254 A double-blind, dose-controlled study evaluated topiramate as monotherapy in 470 patients with newly diagnosed (3 months) epilepsy or epilepsy relapse in the absence of therapy. In addition to having at least 2 lifetime-unprovoked seizures, patients had 1 or 2 partial-onset seizures or generalized-onset tonic-clonic seizures during a 3-month retrospective baseline. The trial included a large cohort (N = 151, 32%) of children and adolescents 6 to 15 years of age. Eligible patients were randomized to treatment groups in which topiramate was titrated to target maintenance dosages of either 400 mg/day (n = 77) or 50 mg/day (n = 74). Patients were followed for at least 6 months. Based on Kaplan-Meier analyses, the primary efficacy endpoint of time to first seizure favored the higher topiramate dose in both the overall population and the cohort of children/adolescents. The probability that children/adolescents remaining in the study were seizure free at 6 months was 78% in the 50-mg target dose group and 90% with the higher dose. At 12 months, the probability of being seizure free was 62% and 85%, respectively. The incidence of treatment-limiting adverse events was 4% in the 50-mg target dose group and 14% in the group assigned to 400 mg as a target dose. The most common adverse events, excluding typical childhood illnesses, were headache, appetite decrease, weight loss, somnolence, dizziness, concentration/attention difficulty, and paresthesia. As shown in this subset analysis, topiramate is effective and well tolerated as monotherapy in children and adolescents.
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| 4. |
- Ben-Menachem, Elinor, 1945
(author)
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Retigabine: has the orphan found a home?
- 2007
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 7:6, s. 153-4
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Journal article (peer-reviewed)abstract
- Randomized, Multicenter, Dose-Ranging Trial of Retigabine for Partial-Onset Seizures. Porter RJ, Partiot A, Sachdeo R, Nohria V, Alves WM; 205 Study Group. Neurology 2007;68(15):1197–1204. OBJECTIVE: To evaluate the efficacy and safety of retigabine 600, 900, and 1,200 mg/day administered three times daily as adjunctive therapy in patients with partial-onset seizures. METHODS: A multicenter, randomized, double-blind, placebo-controlled trial was performed. After an 8-week baseline phase, patients were randomized to a 16-week double-blind treatment period (8-week forced titration and 8-week maintenance) followed by either tapering or entry into an open-label extension study. Primary efficacy was the percentage change from baseline in monthly seizure frequency and compared across treatment arms. Secondary efficacy comparisons included the proportion of patients experiencing 50% reduction in seizure frequency (responder rate), emergence of new seizure types, and physician assessment of global clinical improvement. Safety/tolerability assessments included adverse events (AEs), physical and neurologic examinations, and clinical laboratory evaluations. Efficacy analyses were performed on the intent-to-treat population. RESULTS: Of the 399 randomized patients, 279 (69.9%) completed the double-blind treatment period. The median percent change in monthly total partial seizure frequency from baseline was −23% for 600 mg/day, −29% for 900 mg/day, and −35% for 1,200 mg/day vs −13% for placebo ( p < 0.001 for overall difference across all treatment arms). Responder rates for retigabine were 23% for 600 mg/day, 32% for 900 mg/day ( p = 0.021), and 33% for 1,200 mg/day ( p = 0.016), vs 16% for placebo. The most common treatment-emergent AEs were somnolence, dizziness, confusion, speech disorder, vertigo, tremor, amnesia, abnormal thinking, abnormal gait, paresthesia, and diplopia. CONCLUSION: Adjunctive therapy with retigabine is well tolerated and reduces the frequency of partial-onset seizures in a dose-dependent manner.
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| 5. |
- Ben-Menachem, Elinor, 1945
(author)
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Neurostimulation - Past, Present, and Beyond
- 2012
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In: Epilepsy Currents. - : SAGE Publications. - 1535-7597 .- 1535-7511. ; 12:5, s. 188-191
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Journal article (peer-reviewed)abstract
- Neurostimulation as a treatment for epilepsy has been around for almost 20 years in the form of vagus nerve stimulation. Newer types of neurostimulation are being developed and stand on the brink of approval for use. The two newest therapies, not yet approved in the United States, are deep brain stimulation and the Responsive Neurostimulator System . In fact, in Europe, approval has already been given for deep brain stimulation and newer forms of vagus nerve stimulation. Efficacy is similar between these therapies, and side effects are moderate, so what will be the future? The challenge will be to learn how to use these therapies correctly and offer the right treatment for the right patient.
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| 7. |
- Ben-Menachem, Elinor, 1945
(author)
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Eslicarbazepine acetate: a well-kept secret?
- 2010
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In: Epilepsy currents. - : SAGE Publications. - 1535-7511 .- 1535-7597. ; 10:1, s. 7-8
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Journal article (peer-reviewed)abstract
- PURPOSE: To study the efficacy and safety of eslicarbazepine acetate (ESL) as adjunctive therapy for refractory partial seizures in adults with ≥4 partial-onset seizures (simple or complex, with or without secondary generalization) per 4 weeks despite treatment with 1–2 antiepileptic drugs (AEDs). METHODS: This multicenter, parallel-group study had an 8-week, single-blind, placebo baseline phase, after which patients were randomized to placebo (n= 102) or once-daily ESL 400 mg (n= 100), 800 mg (n= 98), or 1,200 mg (n= 102) in the double-blind treatment phase. ESL starting dose was 400 mg; thereafter, ESL was titrated at weekly 400-mg steps to the full maintenance dose (12 weeks). RESULTS: Seizure frequency adjusted per 4 weeks over the maintenance period (primary endpoint) was significantly lower than placebo in the ESL 1,200-mg (p= 0.0003) and 800-mg (p= 0.0028) groups [analysis of covariance (ANCOVA) of log-transformed seizure frequency]. Responder rate was 20% (placebo), 23% (400 mg), 34% (800 mg), and 43% (1,200 mg). Median relative reduction in seizure frequency was 16% (placebo), 26% (400 mg), 36% (800 mg), and 45% (1,200 mg). The most frequent concomitant AEDs were carbamazepine (56–62% of patients), lamotrigine (25–27%), and valproic acid (22–28%). Similar efficacy results were obtained in patients administered ESL with or without carbamazepine as concomitant AED. Discontinuation rates caused by adverse events (AEs) were 3.9% (placebo), 4% (400 mg), 8.2% (800 mg), and 19.6% (1,200 mg). AEs in >10% of any group were dizziness, headache, and diplopia. Most AEs were mild or moderate. DISCUSSION: ESL, 800 and 1,200 mg once-daily, was well tolerated and more effective than placebo in patients who were refractory to treatment with one or two concomitant AEDs.
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| 8. |
- Ben-Menachem, Elinor, 1945
(author)
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Infantile spasms and epilepsy currents.
- 2005
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 5:4, s. 157-8
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Journal article (peer-reviewed)abstract
- The United Kingdom Infantile Spasms Study Comparing Vigabatrin with Prednisolone or Tetracosactide at 14 Days: A Multicentre, Randomised Controlled Trial Lux AL, Edwards SW, Hancock E, Johnson AL, Kennedy CR, Newton RW, O'Callaghan FJ, Verity CM, Osborne JP Lancet 2004;364:1773–1778 Infantile spasms, a severe infantile seizure disorder, have a high morbidity and are difficult to treat. Hormonal treatments (adrenocorticotropic hormone and prednisolone) have been the main therapy for decades, although little evidence supports their use. Vigabatrin has been recorded to have a beneficial effect in this disorder. We aimed to compare the effects of vigabatrin with those of prednisolone and tetracosactide in the treatment of infantile spasms. Methods The United Kingdom Infantile Spasms Study assessed these treatments in a multicenter, randomized controlled trial in 150 hospitals in the United Kingdom. The primary outcome was cessation of spasms on days 13 and 14. Minimum doses were vigabatrin, 100 mg/kg/day; oral prednisolone, 40 mg/day; or intramuscular tetracosactide depot, 0.5 mg (40 IU) on alternate days. Analysis was by intention to treat. Results Of 208 infants screened and assessed, 107 were randomly assigned to vigabatrin ( n = 52) or hormonal treatments (prednisolone, n = 30; tetracosactide, n = 25). None was lost to follow-up. Proportions with no spasms on days 13 and 14 were 40 (73%) of 55 infants assigned hormonal treatments (prednisolone, 21 of 30 [70%]; tetracosactide, 19 of 25 [76%]) and 28 (54%) of 52 infants assigned vigabatrin (difference, 19%; 95% CI, 1%–36%, p = 0.043). Two infants allocated tetracosactide and one allocated vigabatrin received prednisolone. Adverse events were reported in 30 (55%) of 55 infants receiving hormonal treatments and 28 (54%) of 52 infants receiving vigabatrin. No deaths were recorded. Conclusions Cessation of spasms was more likely in infants given hormonal treatments than in those given vigabatrin. Adverse events were common with both treatments.
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| 9. |
- Ben-Menachem, Elinor, 1945
(author)
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Outcomes remain ambivalent for deep brain stimulation and epilepsy.
- 2008
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 8:5, s. 121-3
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Journal article (peer-reviewed)abstract
- DEEP BRAIN STIMULATION IN PATIENTS WITH REFRACTORY TEMPORAL LOBE EPILEPSY: Boon P, Vonck K, De Herdt V, Van Dycke A, Goethals M, Goossens L, Van Zandijcke M, De Smedt T, Dewaele I, Achten R, Wadman W, Dewaele F, Caemaert J, Van Roost D. Epilepsia2007488:1551-156017726798 PURPOSE: This pilot study prospectively evaluated the efficacy of long-term deep brain stimulation (DBS) in medial temporal lobe (MTL) structures in patients with MTL epilepsy. METHODS: Twelve consecutive patients with refractory MTL epilepsy were included in this study. The protocol included invasive video-EEG monitoring for ictal-onset localization and evaluation for subsequent stimulation of the ictal-onset zone. Side effects and changes in seizure frequency were carefully monitored. RESULTS: Ten of 12 patients underwent long-term MTL DBS. Two of 12 patients underwent selective amygdalohippocampectomy. After mean follow-up of 31 months (range, 12-52 months), one of 10 stimulated patients are seizure-free (>1 year), one of 10 patients had a >90% reduction in seizure frequency; five of 10 patients had a seizure-frequency reduction of >/=50%; two of 10 patients had a seizure-frequency reduction of 30-49%; and one of 10 patients was a nonresponder. None of the patients reported side effects. In one patient, MRI showed asymptomatic intracranial hemorrhages along the trajectory of the DBS electrodes. None of the patients showed changes in clinical neurological testing. Patients who underwent selective amygdalohippocampectomy are seizure-free (>1 year), AEDs are unchanged, and no side effects have occurred. CONCLUSIONS: This open pilot study demonstrates the potential efficacy of long-term DBS in MTL structures that should now be further confirmed by multicenter randomized controlled trials.
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| 10. |
- Ben-Menachem, Elinor, 1945
(author)
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Seizure aggravation-evidence that oxcarbazepine requires monitoring.
- 2008
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 8:4, s. 93-5
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Journal article (peer-reviewed)abstract
- AGGRAVATION OF SEIZURES AND/OR EEG FEATURES IN CHILDREN TREATED WITH OXCARBAZEPINE MONOTHERAPY: Vendrame M, Khurana DS, Cruz M, Melvin J, Valencia I, Legido A, Kothare SV Epilepsia20074811:2116-212017645535 Epub 2007 Jul 21. PURPOSE: Exacerbation of epilepsy may occur following initiation of therapy with antiepileptic drugs (AEDs). The aim of this study is to analyze the clinical and EEG characteristics of a group of pediatric patients with worsening of seizures and/or EEG deterioration while on oxcarbazepine (OXC). METHODS: A retrospective analysis of a clinical database was performed to identify patients with epilepsy treated with OXC over the past 3 years. History, neurological examination, and EEG findings were reviewed to identify any who had developed exacerbation of seizures or new abnormalities on EEG. RESULTS: Of 290 patients on OXC, we identified 12 patients with new onset seizures, all with initial normal neurological exam and normal EEG, who developed either worsening of preexisting seizures, new seizure types, and/or EEG deterioration following introduction of OXC monotherapy. EEG changes were primarily characterized by new onset of generalized epileptiform activity not reported on the initial baseline EEG. Following substitution of OXC with a broad spectrum AED, significant improvement of seizure control and improvement in the EEG was observed. CONCLUSIONS: These findings suggest that OXC can aggravate seizures and/or worsen EEG features in children. Following initiation of therapy with OXC, monitoring of patients with follow-up EEGs may be important, especially in patients who do not show adequate response to therapy.
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| 11. |
- Ben-Menachem, Elinor, 1945
(author)
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Some Long Awaited Answers Regarding Seizures during Pregnancy.
- 2009
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 9:1, s. 16-7
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Journal article (other academic/artistic)abstract
- Seizure Control in Antiepileptic Drug-Treated Pregnancy. Vajda FJ, Hitchcock A, Graham J, O'Brien T, Lander C, Eadie M. Epilepsia 2008;49(1):172–176. This brief report covers an analysis of 7 years outcome data from the Australian Register of Antiepileptic Drugs in Pregnancy. In studying the control of antiepileptic drug-treated epileptic seizures during pregnancy, it was found that pregnancy had little influence on antiepileptic drug-treated epileptic seizure disorders. Seizures during pregnancy occurred in 49.7% of 841 antiepileptic drug (AED) treated pregnancies in women with epilepsy. Epilepsies that were active in the year before pregnancy tended to increase the risk of intrapartum and postpartum seizures. The risk of seizures during pregnancy was 50–70% less if the prepregnancy year was seizure-free, and decreased relatively little more with longer periods of prepregnancy seizure control. Once there had been 1 year's freedom from seizures there seemed relatively little further advantage in deferring pregnancy to avoid seizures returning while pregnant.
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| 12. |
- Ben-Menachem, Elinor, 1945
(author)
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Sudden death and epilepsy.
- 2005
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 5:6, s. 223-4
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Journal article (peer-reviewed)abstract
- Case–control Study of SUDEP Langan Y, Nashef L, Sander JW Neurology 2005;64:1131–1133 To examine the influence of various factors on the risk of sudden unexpected death in epilepsy (SUDEP). Methods The authors investigated 154 cases in which a postmortem examination was performed. Each case had four controls with epilepsy from the community, matched for age and geographic location. Backward stepwise conditional logistic regression analysis was performed, and odds ratios for risk and protection were determined. Results The risk of SUDEP was increased with a history of generalized tonic–clonic seizures in the previous 3 months (odds ratio [OR]: 13.8; 95% CI: 6.6 to 29.1). The presence of supervision at night was found to be protective (OR: 0.4; 95% CI: 0.2 to 0.8) when a supervising individual shared the same bedroom or when special precautions such as a listening device were used (OR: 0.1; 95% CI: 0.0 to 0.3). Conclusions This work lends support to the view that SUDEP is a seizure-related phenomenon and that control of tonic–clonic seizures is important in its prevention. Nocturnal supervision seems to protect against SUDEP.
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| 13. |
- Ben-Menachem, Elinor, 1945
(author)
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Treatment of new onset seizures: predicting long-term outcome.
- 2006
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 6:6, s. 184-5
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Journal article (peer-reviewed)abstract
- Prediction of Risk of Seizure Recurrence after a Single Seizure and Early Epilepsy: Further Results from the MESS Trial Kim LG, Johnson TL, Marson AG, Chadwick DW; MRC MESS Study group Lancet Neurol 2006;5:317–322. Erratum in: Lancet Neurol 2006;5:383 The MRC Multicentre trial for Early Epilepsy and Single Seizures (MESS) showed a reduced risk of further seizures in patients, for whom treatment with antiepileptic drugs was uncertain, who were randomly assigned immediate treatment compared with delayed treatment. However, there was no evidence of long-term remission rates. This study was undertaken to assess the role of patient characteristics and treatment in the prediction of seizure recurrence. This will enable decision making on the basis of the perceived risk of treatment compared with the benefit of reducing the risk of further seizures in the initial years after diagnosis. Methods A prognostic model was developed based on individual patient data from MESS to enable identification of patients at low, medium, or high risk of seizure recurrence. A split-sample approach was used in which the model was developed on a subsample of the full data and validated on the remainder of the sample. Distinction of the prognostic groups and predictive accuracy of the model were assessed. Findings Number of seizures of all types at presentation, presence of a neurological disorder, and an abnormal electroencephalogram (EEG) were significant factors in indicating future seizures. Individuals with two or three seizures, a neurological disorder, or an abnormal EEG were identified as the medium-risk group, those with two of these features or more than three seizures as the high-risk group, and those with a single seizure only as the low-risk group. Interpretation The model shows that there is little benefit to immediate treatment in patients at low risk of seizure recurrence, but potentially worthwhile benefits are seen in those at medium and high risk.
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| 14. |
- Ben-Menachem, Elinor, 1945
(author)
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AAN/AES guidelines on use of new AEDS.
- 2005
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 5:1, s. 30-2
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Journal article (peer-reviewed)
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| 15. |
- Ben-Menachem, Elinor, 1945
(author)
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Epilepsy as a warning sign for stroke.
- 2005
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In: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 5:1, s. 42-3
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Journal article (peer-reviewed)
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