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Fulltext Epilepsy with myoclonic absences

Manonmani V, Wallace SJ

Arch Dis Child, 1994 Apr;70(4):288-90.
PMID: 8185360

The cases are described of eight children, five of them girls, who had epilepsy with myoclonic absences. The mean age of onset was 4.9 years. Brief episodes of loss of awareness with bilateral clonic jerking of the upper limbs were associated with rhythmic 3 cycles/second spike-wave discharges on electroencephalogram. Generalised tonic-clonic or astatic seizures, or both, also occurred in seven patients. All now have learning difficulties, and seven have behavioural problems. Conventional treatment for absences was effective in only two children. Of six patients treated with lamotrigine, five have improved substantially, but only one is in sustained complete remission. One recently diagnosed patient continues to have frequent myoclonic absences. As the response to treatment and long term outcome are much poorer, it is important to differentiate myoclonic absences from typical childhood absence epilepsy.

Matched MeSH terms: Epilepsy, Absence/diagnosis*; Epilepsy, Absence/drug therapy; Epilepsy, Absence/psychology
Medication self-management among parents of children with epilepsy at a tertiary care center in Malaysia

Tan JW, Khoo TB, Burharudin NF, Mohamed Shah N

Epilepsy Behav, 2020 10;111:107317.
PMID: 32693382 DOI: 10.1016/j.yebeh.2020.107317

PURPOSE: Self-management is crucial in the management of chronic diseases. However, information is limited on medication self-management among parents of children with epilepsy. This study aimed to assess medication self-management among parents of children with epilepsy and its association with sociodemographic data, clinical characteristics, antiepileptic drug (AED) regimen complexity, and parent self-reported AED adherence.
METHOD: A cross-sectional survey was conducted at a tertiary care center in Malaysia from February 2019 to June 2019. Parents of children with epilepsy who were on AED for at least 3 months and aged ≤18 years old were recruited. Medication self-management was assessed using a validated Pediatric Epilepsy Medication Self-Management Questionnaire (PEMSQ). A higher total score reflects better medication self-management.
RESULTS: A total of 166 patients were recruited. The mean ± standard deviation (SD) age of patients was 8.20 ± 5.21 years, and 51.8% and 36.7% of patients have generalized seizure and focal seizure, respectively. The mean ± SD PEMSQ score was 116.2 ± 11.28 from a total score of 135. Among the four domains of PEMSQ, the barriers to treatment contributed to the lowest mean scores. Univariate analysis showed that the following were significantly associated with poorer medication self-management: differences in ethnicity, religion; higher number of medications; presence of comorbidities; inability to swallow tablets; and a more complex AED regimen. Other variables were not significant. Multivariate analysis showed that only ethnicity and presence of comorbidity remained independently significant (R2 = 0.14; F [4, 161] = 6.28; p 

Matched MeSH terms: Epilepsy/drug therapy*; Epilepsy/epidemiology*; Epilepsy/psychology
Potential anti-epileptic phytoconstituents: An updated review

Kaur J, Famta P, Famta M, Mehta M, Satija S, Sharma N, et al.

J Ethnopharmacol, 2021 Mar 25;268:113565.
PMID: 33166627 DOI: 10.1016/j.jep.2020.113565

ETHNOPHARMACOLOGICAL RELEVANCE: Epilepsy is one of the most commonly occurring non-communicable neurological disorder that affects people of all age groups. Around 50 million people globally are epileptic, with 80% cases in developing countries due to lack of access to treatments determined by high cost and poor availability or it can be defined by the fraction of active epileptic patients who are not appropriately being treated. The availability of antiepileptic drugs and their adjuvant therapy in such countries is less than 50% and these are highly susceptible to drug interactions and severe adverse effects. As a result, the use of herbal medicine is increasingly becoming popular.
AIM OF THE STUDY: To provide pharmacological information on the active constituents evaluated in the preclinical study to treat epilepsy with potential to be used as an alternative therapeutic option in future. It also provides affirmation for the development of novel antiepileptic drugs derived from medicinal plants.
MATERIALS AND METHODS: Relevant information on the antiepileptic potential of phytoconstituents in the preclinical study (in-vitro, in-vivo) is provided based on their effect on screening parameters. Besides, relevant information on pharmacology of phytoconstituents, the traditional use of their medicinal plants related to epilepsy and status of phytoconstituents in the clinical study were derived from online databases, including PubMed, Clinicaltrial. gov, The Plant List (TPL, www.theplantlist.org), Science Direct. Articles identified using preset searching syntax and inclusion criteria are presented.
RESULTS: More than 70% of the phytoconstituents reviewed in this paper justified the traditional use of their medicinal plant related to epilepsy by primarily acting on the GABAergic system. Amongst the phytoconstituents, only cannabidiol and tetrahydrocannabinol have been explored for clinical application in epilepsy.
CONCLUSION: The preclinical and clinical data of the phytoconstituents to treat epilepsy and its associated comorbidities provides evidence for the discovery and development of novel antiepileptic drugs from medicinal plants. In terms of efficacy and safety, further randomized and controlled clinical studies are required to understand the complete pharmacodynamic and pharmacokinetic picture of phytoconstituents. Also, specific botanical source evaluation is needed.

Matched MeSH terms: Epilepsy/diagnosis; Epilepsy/drug therapy*; Epilepsy/metabolism
Fulltext The treatment of epileptic seizures: the potential of Malaysian medicinal plants

Choo, Brandon Kar Meng, Kumari, Yatinesh, Mun, Hue-Seow, Shaikh, Mohd. Farooq

Neuroscience Research Notes, 2018;1(3):35-53.
MyJurnal

Epileptic seizures result from excessive brain activity and may affect sensory, motor and autonomic function; as well as, emotional state, memory, cognition or behaviour. Effective anti-epileptic drugs (AEDs) are available but have tolerability issues due to their side effects. Medicinal plants are potential candidates for novel AEDs, as many are traditional epilepsy remedies. Malaysia is a megadiverse country, with many endemic plants serving as a large pool of potential candidates for the development of local herbal products. The large variety of flora makesMalaysia a prime location for the discovery of medicinal plants with anti-convulsive potential. This review lists 23 Malaysian medicinal plants, of which four are used traditionally to treat epilepsy, without any scientific evidence. A further eight plants have no known traditional anti-epileptic usebut have scientific evidence of its anti-epileptic activity. The remaining 11 plants possess both traditional use and scientific evidence. Thus, this review identified several potential candidates for the development of novel AEDs or enhancing current ones; as well as identified an imbalance between traditional use and scientific evidence. In addition, this review also identified several limitations in the reviewed studies and provided additional information to facilitate the design of future studies.

Matched MeSH terms: Epilepsy
48-hour video-EEG monitoring for epilepsy presurgical evaluation is cost-effective and safe in resource-limited setting

Lim KS, Fong SL, Thuy Le MA, Ahmad Bazir S, Narayanan V, Ismail N, et al.

Epilepsy Res, 2020 05;162:106298.
PMID: 32172144 DOI: 10.1016/j.eplepsyres.2020.106298

INTRODUCTION: Video-EEG monitoring is one of the key investigations in epilepsy pre-surgical evaluation but limited by cost. This study aimed to determine the efficacy and safety of a 48-hour (3-day) video EEG monitoring, with rapid pre-monitoring antiepileptic drugs withdrawal.
MATERIAL AND METHODS: This is a retrospective study of epilepsy cases with VEM performed in University Malaya Medical Center (UMMC), Kuala Lumpur, from January 2012 till August 2016.
RESULTS: A total of 137 cases were included. The mean age was 34.5 years old (range 15-62) and 76 (55.8 %) were male. On the first 24 -h of recording (D1), 81 cases (59.1 %) had seizure occurrence, and 109 (79.6 %) by day 2 (D2). One-hundred and nine VEMs (79.6 %) were diagnostic, in guiding surgical decision or further investigations. Of these, 21 had less than 2 seizures recorded in the first 48 h but were considered as diagnostic because of concordant interictal ± ictal activities, or a diagnosis such as psychogenic non-epileptic seizure was made. Twenty-eight patients had extension of VEM for another 24-48 h, and 11 developed seizures during the extension period. Extra-temporal lobe epilepsy and seizure frequency were significant predictors for diagnostic 48 -h VEM. Three patients developed complications, including status epilepticus required anaesthetic agents (1), seizure clusters (2) with postictal psychosis or dysphasia, and all recovered subsequently.
CONCLUSIONS: 48-h video EEG monitoring is cost-effective in resource limited setting.

Matched MeSH terms: Epilepsy/drug therapy; Epilepsy/physiopathology; Epilepsy/surgery*
Fulltext Anti-epileptic drugs: Is terminology appropriate? A change might be needed

Bhalla, Devender, Ros, Sina, Lotfalinezhad, Elham, Kapoor, Saloni, Ly, Kheng Heng, Raingsey, Prak-Piseth, et al.

Neurology Asia, 2015;20(2):117-117.
MyJurnal

The term “anti-epileptic drug” refers to the currently available medical treatment against epilepsy. A discussion amongst the authors was sought to critically examine the term and identify possible issues. Translations in other languages were retrieved from literature and the usage confirmed by correspondence with native users of the language working in the medical field. The aim of this article is to initiate a debate by highlighting some negative undertones attached to this terminology.

Matched MeSH terms: Epilepsy
Fulltext EpiNet as a way of involving more physicians and patients in epilepsy research: Validation study and accreditation process

Bergin PS, Beghi E, Sadleir LG, Brockington A, Tripathi M, Richardson MP, et al.

Epilepsia Open, 2017 Mar;2(1):20-31.
PMID: 29750210 DOI: 10.1002/epi4.12033

Objective: EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator-led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet-First trials.

Methods: Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet-First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false-positive errors and could make only one error regarding seizure classification.

Results: Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet-First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70.

Significance: We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet-accredited and to participate in these investigator-led clinical trials.

Matched MeSH terms: Epilepsy
Fulltext The Gut-Brain-Axis on the Manifestation of Depressive Symptoms in Epilepsy: An Evidence-Driven Hypothesis

Shaikh MF, Lee CY, Chen WN, Shaikh FA

Front Pharmacol, 2020;11:465.
PMID: 32322213 DOI: 10.3389/fphar.2020.00465

Epilepsy is a severe neurological disorder involving 70 million people around the globe. Epilepsy-related neuropsychiatric comorbidities such as depression, which is the most common, is an additional factor that negatively impacts the living quality of epilepsy patients. There are many theories and complexities associated with both epilepsy and associated comorbidities, one of which is the gut-brain-axis influence. The gut microbiome is hypothesized to be linked with many neurological disorders; however, little conclusive evidence is available in this area. Thus, highlighting the role will create interest in researchers to conduct detailed research in comprehending the influence of gut-brain-axis in the manifestation of depressive symptoms in epilepsy. The hypothesis which is explored in this review is that the gut-brain-axis do play an important role in the genesis of epilepsy and associated depression. The correction of this dysbiosis might be beneficial in treating both epilepsy and related depression. This hypothesis is illustrated through extensive literature discussion, proposed experimental models, and its applicability in the field. There is indirect evidence which revealed some specific bacterial strains that might cause depression in epilepsy.

Matched MeSH terms: Epilepsy
Clinical predictors of intractable childhood epilepsy

Gururaj A, Sztriha L, Hertecant J, Eapen V

J Psychosom Res, 2006 Sep;61(3):343-7.
PMID: 16938512

This study aimed to determine the clinical, electroencephalographic, and radiological factors associated with medically intractable seizures in children in the Al Ain Medical District in the United Arab Emirates.

Matched MeSH terms: Epilepsy/diagnosis*; Epilepsy/epidemiology; Epilepsy/physiopathology*
Fulltext Severe Developmental Delay, Epilepsy and Neonatal Diabetes (DEND) Syndrome: A Case Report

Helmi MAM, Hussain S

J ASEAN Fed Endocr Soc, 2020;35(1):125-128.
PMID: 33442181 DOI: 10.15605/jafes.035.01.22

Developmental delay, Epilepsy and Neonatal Diabetes (DEND) syndrome is the most severe form of Permanent Neonatal Diabetes with KCNJ11 gene mutation which accounts for most of the cases. We report the first DEND syndrome in Malaysia with heterozygous missense mutation Q52R at KCNJ11 (Kir6.2) gene with delayed presentation beyond 6 months of age and failure to transition to glibenclamide. This report signifies the phenotypical variability among patients with the same genetic mutation and the different response to treatment.

Matched MeSH terms: Epilepsy
Fulltext Age-dependent Electroencephalographic Differences in the Genetic Absence Epilepsy Rats from Strasbourg (GAERS) Model of Absence Epilepsy

Islam MR, Abdullah JM

Malays J Med Sci, 2014 Dec;21(Spec Issue):34-40.
PMID: 25941461 MyJurnal

Genetic Absence Epilepsy Rats from Strasbourg (GAERS) are a prognostic genetic model of absence epilepsy. This model displays the electro-clinical, behavioural, and pharmacological features of absence seizures. Although GAERS share typical characteristics, including spike-and-wave discharges (SWDs) in the electroencephalography (EEG), age-dependent studies with these animals have not yet been reported. The aim of the present study is to perform a systematic comparison contrasting the SWDs of young and older GAERS, in terms of the number, duration, frequency, and waveform morphology of the discharges, as well as the pre-SWD EEG characteristics, using identical measurement and analysis techniques. The number, cumulative total duration and mean duration of SWDs were significantly higher in young GAERS (4 to 6 months) compared to older GAERS (12 to 14 months). Furthermore, the SWD spectra and average SWD waveforms indicated that a single cycle of the SWD contains more energy in faster components, such as increased spikes and higher power, in the SWDs of the young GAERS. Additionally, older GAERS showed weak amplitude spikes in SWDs and higher power pre-SWDs. These clear morphological differences in the EEGs of young and older GAERS rats should be further examined in future studies that explore new dimensions of genetic absence epilepsy.

Matched MeSH terms: Epilepsy, Absence
Fulltext Risk Factors and Phenytoin Prophylaxis for Early Post-Traumatic Seizures among Patients with Traumatic Brain Injury

Chan KH, Tharakan J, Pal HK, Khan N, Tan YC

Malays J Med Sci, 2010 Oct;17(4):36-43.
PMID: 22135559

Post-traumatic seizure is a well-known and serious complication of traumatic brain injury (TBI). The incidence and risk factors vary among study populations. Very little data have been published concerning this in the Malaysian population. The aim of this study was to ascertain the risk factors for the development of early post-traumatic seizures among patients with TBI.

Matched MeSH terms: Epilepsy, Post-Traumatic
Telemetric EEG and the rat: a guide for neuroscientists

Abdullah JM, Rafiqul Islam M

Malays J Med Sci, 2012 Oct;19(4):1-5.
PMID: 23613643

Telemetric EEG in the rat's brain has been used for experiments which tests the effects of an antiepileptic compound on it's antiseizures activity. A simple classification correlating epileptiform discharge and Racine's behavioral activity is discussed.

Matched MeSH terms: Epilepsy
Fulltext A signal processing based analysis and prediction of seizure onset in patients with epilepsy

Namazi H, Kulish VV, Hussaini J, Hussaini J, Delaviz A, Delaviz F, et al.

Oncotarget, 2016 Jan 5;7(1):342-50.
PMID: 26586477 DOI: 10.18632/oncotarget.6341

One of the main areas of behavioural neuroscience is forecasting the human behaviour. Epilepsy is a central nervous system disorder in which nerve cell activity in the brain becomes disrupted, causing seizures or periods of unusual behaviour, sensations and sometimes loss of consciousness. An estimated 5% of the world population has epileptic seizure but there is not any method to cure it. More than 30% of people with epilepsy cannot control seizure. Epileptic seizure prediction, refers to forecasting the occurrence of epileptic seizures, is one of the most important but challenging problems in biomedical sciences, across the world. In this research we propose a new methodology which is based on studying the EEG signals using two measures, the Hurst exponent and fractal dimension. In order to validate the proposed method, it is applied to epileptic EEG signals of patients by computing the Hurst exponent and fractal dimension, and then the results are validated versus the reference data. The results of these analyses show that we are able to forecast the onset of a seizure on average of 25.76 seconds before the time of occurrence.

Matched MeSH terms: Epilepsy/diagnosis; Epilepsy/physiopathology*
Fulltext Variable outcome for epilepsy after neonatal hypoglycaemia

Fong CY, Harvey AS

Dev Med Child Neurol, 2014 Nov;56(11):1093-9.
PMID: 24861161 DOI: 10.1111/dmcn.12496

To evaluate the electroclinical features of epilepsy secondary to neonatal hypoglycaemia.

Matched MeSH terms: Epilepsy, Generalized/etiology*; Epilepsy, Generalized/physiopathology
Fulltext Patient-reported side effects of lamotrigine during routine clinic visits

Daud NA, Ab-Rahman A

Neurosciences (Riyadh), 2012 Jul;17(3):269-70.
PMID: 22772938
Matched MeSH terms: Epilepsy/drug therapy*; Epilepsy/psychology*
A study on discrete wavelet-based noise removal from EEG signals

Asaduzzaman K, Reaz MB, Mohd-Yasin F, Sim KS, Hussain MS

Adv Exp Med Biol, 2010;680:593-9.
PMID: 20865544 DOI: 10.1007/978-1-4419-5913-3_65

Electroencephalogram (EEG) serves as an extremely valuable tool for clinicians and researchers to study the activity of the brain in a non-invasive manner. It has long been used for the diagnosis of various central nervous system disorders like seizures, epilepsy, and brain damage and for categorizing sleep stages in patients. The artifacts caused by various factors such as Electrooculogram (EOG), eye blink, and Electromyogram (EMG) in EEG signal increases the difficulty in analyzing them. Discrete wavelet transform has been applied in this research for removing noise from the EEG signal. The effectiveness of the noise removal is quantitatively measured using Root Mean Square (RMS) Difference. This paper reports on the effectiveness of wavelet transform applied to the EEG signal as a means of removing noise to retrieve important information related to both healthy and epileptic patients. Wavelet-based noise removal on the EEG signal of both healthy and epileptic subjects was performed using four discrete wavelet functions. With the appropriate choice of the wavelet function (WF), it is possible to remove noise effectively to analyze EEG significantly. Result of this study shows that WF Daubechies 8 (db8) provides the best noise removal from the raw EEG signal of healthy patients, while WF orthogonal Meyer does the same for epileptic patients. This algorithm is intended for FPGA implementation of portable biomedical equipments to detect different brain state in different circumstances.

Matched MeSH terms: Epilepsy/diagnosis; Epilepsy/physiopathology
Association between ABCB1 polymorphism and response to sodium valproate treatment in Malaysian epilepsy patients

Haerian BS, Lim KS, Tan HJ, Mohamed EH, Tan CT, Raymond AA, et al.

Epileptic Disord, 2011 Mar;13(1):65-75.
PMID: 21388909 DOI: 10.1684/epd.2011.0419

Over-expression of P-glycoprotein, encoded by the ABCB1 gene, is proposed to be involved in resistance to antiepileptic drugs in about 30% of patients with epilepsy. Here, we investigated the possible association between ABCB1 polymorphisms and sodium valproate (VPA) treatment in Malaysian epilepsy patients. Genotypes were assessed in 249 drug-resistant and 256 drug-responsive Malaysian patients for C1236T, G2677T/A, and C 5T polymorphisms in the ABCB1 gene. No genotypes, alleles, or haplotypes were associated with the response to VPA in either the overall group or Chinese, Indian, and Malay subgroups. Our data suggest that C1236T, G2677T/A, and C3435T polymorphisms in the ABCB1 gene do not contribute to the response to VPA in patients with epilepsy.

Matched MeSH terms: Epilepsy/drug therapy*; Epilepsy/genetics*
Fulltext ABCB1 C3435T polymorphism and the risk of resistance to antiepileptic drugs in epilepsy: a systematic review and meta-analysis

Haerian BS, Roslan H, Raymond AA, Tan CT, Lim KS, Zulkifli SZ, et al.

Seizure, 2010 Jul;19(6):339-46.
PMID: 20605481 DOI: 10.1016/j.seizure.2010.05.004

The C3435T, a major allelic variant of the ABCB1 gene, is proposed to play a crucial role in drug-resistance in epilepsy. The C/C genotype carriers reportedly are at higher risk of pharmacoresistance to AEDs, but only in some studies. The hypothesis of the C-variant associated risk and resistance to antiepileptic drugs (AEDs) has been hampered by conflicting results from inadequate power in case-control studies. To assess the role of C3435T polymorphism in drug-resistance in epilepsy, a systematic review and meta-analysis was conducted.

Matched MeSH terms: Epilepsy/drug therapy*; Epilepsy/genetics*
Fulltext Ethical issues related to epilepsy care in the developing world

Tan CT, Avanzini G

Epilepsia, 2009 May;50(5):975-7.
PMID: 19170738 DOI: 10.1111/j.1528-1167.2008.01934.x

There are three major issues of ethical concern related to epilepsy care in the developing world. First, is it ethical for a developing country to channel its limited resources from direct epilepsy care to research? The main considerations in addressing this question are the particular research questions to be addressed and whether such research will bring direct benefits to the local community. Second, in a country with limited resources, when does ignoring the high treatment gap become an ethical issue? This question is of particular concern when the community has enough resources to afford treatment for its poor, yet is not providing such care because of gross wastage and misallocation of the national resources. Third, do countries with plentiful resources have an ethical responsibility to help relieve the high epilepsy treatment gap of poor countries? Indeed, we believe that reasonable health care is a basic human right, and that human rights transcend national boundaries. Although health care is usually the responsibility of the nation-state, many modern states in the developing world are arbitrary creations of colonization. There is often a long process from the establishment of a political-legal state to a mature functional nation. During the long process of nation building, help from neighboring countries is often required.

Matched MeSH terms: Epilepsy/epidemiology; Epilepsy/therapy*

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