| 1. |
- Bialek, Fatima, et al.
(författare)
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Outcomes after resective epilepsy surgery in patients over 50 years of age in Sweden 1990-2009-A prospective longitudinal study
- 2014
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Ingår i: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 23:8, s. 641-645
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Most epilepsy surgery candidates are young adults. Outcome reports after epilepsy surgery in patients >= 50 years are few and varying. The aim of this study was to describe patient characteristics of older compared to younger adults and analyse seizure, complication and vocational outcomes in a large population-based series. Methods: We analysed data from the Swedish National Epilepsy Surgery Register for 1990-2009 for patients >= 19 years at resective surgery who had completed two-year follow-up. Variables studied were seizure outcome, histo-pathological diagnoses, complications and vocational outcome. Data from patients >= 50 years and 19-49 years at surgery were compared. Results: 558 Adults underwent resective epilepsy surgery 1990-2009 and had two-year follow-up. 12% of the adults (67 patients) were >= 50 years at surgery. Patients >= 50 had longer epilepsy duration, more often had mesial sclerosis and less often had neurodevelopmental tumours and cortical malformations. The proportion of seizure-free patients at two-year follow-up did not differ between those >= 50 and 1949 years (61% versus 61% seizure-free last year, 48% versus 43% completely seizure-free since surgery), neither did the occurrence of major complications (3% in both groups). The vocational situation was mainly stable between baseline and two-year follow-up in both groups, although older patients were less often employed than younger. Conclusion: 12% of adults in the Swedish series were >= 50 years at epilepsy surgery. Seizure outcome was as good for older as for younger adults, and there was no difference in the occurrence of major complications. This constitutes important information in the presurgical counselling process.
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| 2. |
- Forsgren, Lars, et al.
(författare)
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On the experience of stigma by persons with epilepsy in Sweden and Iran : a comparative study
- 2013
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Ingår i: Seizure. - : Saunders Elsevier. - 1059-1311 .- 1532-2688. ; 22:9, s. 748-751
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this paper is to compare the experience of stigma by persons with epilepsy in Sweden and Iran.METHOD: An adapted version of the Internalized Stigma of Mental Illness Scale was completed by 130 persons with epilepsy in Tehran and 93 patients at a neurology clinic in Sweden.RESULTS: The Swedish subjects reported a significantly lower level of experienced stigmatization than the Iranian patients, which we think is an effect of a more individualized medical treatment and a longer experience of health education in the Swedish society.CONCLUSION: Improved seizure control, legislative measures and health education are major contributory factors for stigma reduction in a society as regards epilepsy and probably also other medical conditions.
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| 3. |
- Kahlow, Hannes, et al.
(författare)
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Complications of vagal nerve stimulation for drug-resistant epilepsy : A single center longitudinal study of 143 patients
- 2013
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Ingår i: Seizure. - : Saunders Elsevier. - 1059-1311 .- 1532-2688. ; 22:10, s. 827-833
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To longitudinally study surgical and hardware complications to vagal nerve stimulation (VNS) treatment in patients with drug-resistant epilepsy. Methods: In a longitudinal retrospective study, we analyzed surgical and hardware complications in 143 patients (81 men and 62 women) who between 1994 and 2010 underwent implantation of a VHS-device for drug-resistant epilepsy. The mean follow-up time was 62 +/- 46 months and the total number of patient years 738. Results: 251 procedures were performed on 143 patients. 16.8% of the patients were afflicted by complications related to surgery and 16.8% suffered from hardware malfunctions. Surgical complications were: superficial infection in 3.5%, deep infection needing explantation in 3.5%, vocal cord palsy in 5.6%, which persisted in at least 0.7% for over one year, and other complications in 5.6%. Hardware-related complications were: lead fracture in 11.9% of patients, disconnection in 2.8%, spontaneous turn-off in 1.4% and stimulator malfunction in 1.4%. We noted a tendency to different survival times between the two most commonly used lead models as well as a tendency to increased infection rate with increasing number of stimulator replacements. Conclusion: In this series we report on surgical and hardware complications from our 16 years of experience with VNS treatment. Infection following insertion of the VNS device and vocal cord palsy due to damage to the vagus nerve are the most serious complications related to the surgery. Avoiding unnecessary reoperations in order to reduce the appearances of these complications are of great importance. It is therefore essential to minimize technical malfunctions that will lead to additional surgery. Further studies are needed to evaluate the possible superiority of the modified leads.
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| 4. |
- Kumlien, Eva, et al.
(författare)
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Attitudes towards epilepsy surgery : A nationwide survey among Swedish neurologists
- 2010
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Ingår i: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 19:4, s. 253-255
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Epilepsy surgery is safe and effective for epilepsy that is refractory to medical treatment. However, only a minority of candidates for epilepsy surgery are referred for surgical evaluation. We investigated Swedish neurologists' views on and criteria for referral for epilepsy surgery. Materials and methods: A survey was sent out to neurologists who treat patients with epilepsy. We received responses from 81% of referring hospitals and 57% of private practices. Results: Sixty-one percent of respondents considered that epilepsy surgery reduced seizure frequency and 53% that it improved quality of life. Surgical treatment was thought to be cost-effective by 90% of respondents. Referral for surgery was considered if three or more antiepileptic drugs had failed. Seizure frequency and severity and, the patient's own wishes were regarded as the most important criteria for surgical referral. MRI and EEG findings were also important whereas duration of illness was considered less important. Age below 65 years and lack of mental retardation were important for considering referral. Conclusion: In general Swedish neurologists have a cautious but positive attitude towards epilepsy surgery. Uncertainties about eligibility criteria among referring clinicians may contribute to the underutilization of epilepsy surgery.
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| 5. |
- Kumlien, Eva, et al.
(författare)
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Seizure risk associated with neuroactive drugs : Data from the WHO adverse drug reactions database
- 2010
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Ingår i: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 19:2, s. 69-73
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore the association between the use of neuroactive drugs and reports of epileptic seizures. MATERIAL: Using the WHO adverse drug reactions (ADR) database, VigiBase, we surveyed reports of suspected seizures from 1968 until February 2006. Case reports of ADRs, that were classified as convulsions were collected and compared to the total number of ADRs reported. RESULTS: The total number of ADRs was 7,375,325. The number of convulsive events was 71,471. The ratio of convulsive ADRs to the total number of ADRs reported for each drug was evaluated and expressed as a percentage. The 10 drugs most frequently associated with convulsive ADRs were maprotilene (14.42%), escitaloprame (9.78%), buproprione (9.49%), clozapine (9.0%), chlorprothiexene (8.89%), amoxapine (8.74%), donepezil (8.40%), rivastigmine (6.41%), quetiapine (5.90%) and trimipramine (5.69%). CONCLUSIONS: Based on the reports in VigiBase, ADR reports relating to antidepressants, antipsychotic and cholinomimetic drugs included seizures more often than other neuroactive drugs.
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| 6. |
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| 7. |
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| 8. |
- Zelano, Johan, et al.
(författare)
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Infections in status epilepticus : A retrospective 5-year cohort study
- 2014
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Ingår i: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 23:8, s. 603-606
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Status epilepticus (SE) has attracted renewed interest lately, and efforts are made to optimize every treatment stage. For refractory SE, optimal supporting care involves mechanical ventilation and intensive care unit (ICU) admission. Infections often complicate SE and recently a single-centre observational study demonstrated an association between infections and poor short-term outcome of SE in a cohort of severely ill patients. We have here attempted to replicate those findings in a different cohort. Method: We performed a retrospective observational study and included all patients with a diagnosis of SE during 2008-2012 at a Swedish tertiary referral centre. Results: The cohort consisted of 103 patients (53% female, 47% male, median age 62 years, range 19-87 years). In house mortality was less than 2 and 70% of the patients' were discharged home. The most common aetiologies of SE were uncontrolled epilepsy (37%) and brain tumours (16%). A total of 39 patients suffered infections during their stay. Presence of infection was associated with mechanical ventilation (OR 3.344, 95% Cl 1.44-7.79) as well as not being discharged home (OR2.705, 95% Cl 1.14-6.44), and duration of SE was significantly longer in patients with infection (median 1 day vs. 2.5 days, p < 0.001). Conclusion: We conclude that the previously described association between infections, a longer SE duration, and an unfavourable outcome of SE seems valid also in SE of less severe aetiology.
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| 9. |
- Zelano, Johan, et al.
(författare)
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Levetiracetam as alternative stage two antiepileptic drug in status epilepticus : A systematic review
- 2012
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Ingår i: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 21:4, s. 233-236
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Forskningsöversikt (refereegranskat)abstract
- Background: The role of new antiepileptic drugs (AED) in the treatment of status epilepticus (SE) is of interest, especially in benzodiazepine-resistant status epilepticus where phenytoin is deemed inappropriate due to allergy or comorbidity. Levetiracetam (LEV) is a new AED with few side effects. It is easy to administer. Reports exist of its use in SE in adults. Aims: To clarify the evidence for use of LEV as an alternative stage two AED in treatment of SE by a systematic review of the literature. Method: An online MEDLINE search identified 118 articles. The abstracts were screened for studies written in English, in which (1) at least two adults had been treated, and (2) LEV had been administered intravenously as the first AED, on its own or together with benzodiazepines. Ten studies were included. Results: Out of the ten studies, seven were retrospective observational, two prospective observational, and one prospective randomized. The studies described a total of 334 patients. The most common reason for administrating LEV was that standard treatment was deemed inappropriate. The efficacy ranged from 44% to 94%, with higher efficacy reported in the retrospective studies. Conclusions: The evidence for use of LEV as an alternative stage two AED in SE is limited. The higher efficacy reported in retrospective studies indicates possible publication bias, and caution is advised when the results of these retrospective studies are considered in clinical decision-making.
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