Valproic acid (VPA) is one of the most commonly used antiepileptic drug, but has many drug-drug interactions. A 58-year-old male under the vegetative state has been well controlled with valproic acid (VPA) monotherapy without seizure attacks during the last 6 months. Pneumonia developed and panipenem-betamipron (PAPM-BP) for acinetobacter baumannii was administered. Seizure attacks recurred after 12 days of initiating PAPM-BP. During the maintenance period of PAPM-BP, serum level of VPA was decreased. After the cessation of PAPM-BP, serum level of VPA increased to the previous level without further seizure attacks. PAPM-BP should be cautiously used together with VPA because of possible drug-drug interaction.
Acinetobacter baumannii ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; Pneumonia ; Recurrence* ; Seizures* ; Valproic Acid*

Posthypoxic myoclonus is poorly controlled with current treatments. Based on clinical experience, valproate and benzodiazepines have been used to treat myoclonic seizures. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Although lamotrigine is controversial for treatment in myoclonic seizures, we experience a case of posthypoxic myoclonus improved with lamotrigine add-on therapy.
Anticonvulsants ; Benzodiazepines ; Myoclonus* ; Seizures ; Valproic Acid

Reversible splenial edema has been often reported in epilepsy patients. Clinical presentation is reported to be silent in general. We experienced a patient with splenial lesion and cognitive dysfunction. A 21-year-old man underwent video-EEG monitoring for preoperative evaluation. He had suffered from viral encephalitis eight years ago and developed chronic drug-resistant epilepsy. After antiepileptic drugs withdrawal, he developed eight episodes of secondarily generalized tonic-clonic seizures for several hours and some seizures were repeated without recovery of consciousness. Majority of ictal EEG onset presumed to originate from the left frontal region. After seizures he had shown disorientation and irritability with gradual recovery. Brain MRI demonstrated a splenial lesion. Though splenial lesion disappeared on follow-up MRI, neuropsychological test demonstrated frontal lobe dysfunction 6 months later compared with that performed just before the video-EEG monitoring. We report a patient with isolated reversible splenial lesion associated with long term dysfunction of frontal lobe.
Anticonvulsants ; Brain ; Consciousness ; Edema ; Electroencephalography ; Encephalitis, Viral ; Epilepsy ; Follow-Up Studies ; Frontal Lobe* ; Humans ; Magnetic Resonance Imaging ; Neuropsychological Tests ; Seizures ; Status Epilepticus* ; Young Adult

BACKGROUND: Clozapine is an "atypical" neuroleptic drug with low affinity at most dopamine receptors, and interact at several other classes of receptors. Although it has less adverse effects, clozapine has profound impact on EEG, and may cause seizures. We retrospectively reviewed medical records and EEGs in patients with clozapine to evaluate the prevalence and risk factors of EEG abnormalities and seizures. METHODS: 163 EEGs of 44 patients and their medical records were reviewed from Jan. 2000 to Jul. 2006. EEG was graded as follows: (0: Normal, 1: Less than 50% of theta waves, 2: More than 50% of theta or less than 50% of delta waves or grade 0/1 plus epileptic discharge, 3: More than 50% of delta waves or grade 2 plus epileptic discharge, and 4: Electroclinical seizure or marked low amplitude EEGs). Relation between the dosage of clozapine and EEG abnormalities, effect of anticonvulsant on seizure prevention were reviewed. RESULTS: Dosage of clozapine and EEG abnormality was closely related (P<.001). 82% (23/28) of the EEGs with less than 100 mg of clozapine were grade 0, whereas 8/83 (9.7%) EEGs were grade 0 with more than 400 mg of clozapine. Epileptic discharges were frequently found when clozapine dosage was 200 mg or more [27/130 EEGs (21%)]. Valproate administration did not prevent EEG deterioration in 4/13 patients as long as clozapine was increased. Although preventive treatment with valproate was done in 11 patients, seizures occurred in 2 patients. CONCLUSIONS: Abnormal EEGs were significantly correlated with dosage of clozapine. Efficacy of valproate can not be determined in the prevention of seizure induced by clozapine.
Clozapine* ; Electroencephalography* ; Humans ; Medical Records ; Prevalence ; Receptors, Dopamine ; Retrospective Studies ; Risk Factors ; Seizures ; Valproic Acid

PURPOSE: This study was aimed to investigate the psychiatric manifestations in children with epilepsy and the associations with seizure-related variables. METHODS: The Korean version of the Child Behavior Checklist (K-CBCL) and the ADHD Rating Scale (K-ARS) were used to assess the psychopathology of 78 children with epilepsy (39 boys, mean age: 9.8+/-3.26 years-old) and 78 healthy comparisons matched for age and sex. RESULTS: Compared with healthy comparisons, children with epilepsy showed differences in the social, school, total competence scale, withdrawn, somatic complaints, social problems, thought, attention problems, aggressive behavior, internalizing and externalizing problem, and total behavior problem scores in the K-CBCL. Significant differences in the social, school, total competence scale, withdrawn, social problems, attention, and total behavior problem scales were found between groups in clinical spectrum and nonclinical spectrum. The inattentive, hyperactive/impulsive, and total scores of the K-ARS between groups were significantly different. In addition, the total scores of the K-ARS between subjects in clinical spectrum and nonclinical spectrum were different. The more the number of antiepileptic drugs, the higher significance of the score for aggressive behavior, sex problem, somatic complaints in the K-CBCL, and the inattentive scales in the K-ARS. In addition, the withdrawn, anxious/depressed and somatic complaints in the K-CBCL were correlated with sex, onset age and seizure type, respectively. CONCLUSIONS: Children with epilepsy may experience more various and serious psychiatric problems than healthy children. Responsiveness to antiepileptic drugs and seizure itself can be risk factors of psychiatric manifestations in epileptic children.
Age of Onset ; Anticonvulsants ; Checklist ; Child Behavior ; Child* ; Epilepsy* ; Humans ; Mental Competency ; Psychopathology ; Risk Factors* ; Seizures* ; Sexual Behavior ; Social Problems ; Weights and Measures

BACKGROUND: Folic acid has been frequently used for hyperhomocyesteinemia in various diseases and decreases the level of homocysteine. OBJECTIVES: To assess the effect of folic acid in the level of homocysteine in epilepsy patients, and to analyze factors affecting its responsiveness and the difference of its efficacy according to methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism. METHODS: Total 75 epilepsy patients with antiepileptic drugs (AEDs) therapy were included. 41 patients had normal level of homocysteine and 34 patients with hyperhomocysteinemia (> or =12 micro mol/ ) were supplemented with folic acid for 1 year. Thirty-four patients with hyperhomocyteinemia were divided into two groups according to the responsiveness of homocysteine to folic acid; decrease group (DG) and non-decrease group (NDG). RESULTS: The level of homocysteine in patients with hyperhomocysteinemia was significantly decreased after administration of folic acid, comparing with patients with normal level. DG was younger and had more male gender, shorter duration of seizure, and initial higher homocysteine level, compared to NDG (p<0.05). Patients with mutant type of MTHFR (CT+TT) had more decreased homocysteine level after supplement of folic acid, but had more increased homocysteine level without supplement of folic acid. Comparing between MTHFR genotypes, TT type had the most decreased homocysteine level than others, but there was no significance. CONCLUSION: Folic acid is useful treatment of hyperhomocysteinemia in epilepsy patients and the supplement of folic acid might be considered in patients with mutant type of MTHFR regardless of homocysteine level. The effect of folic acid supplement is greater in younger age, male sex, shorter duration of seizure, and initial higher homocysteine level.
Anticonvulsants ; Epilepsy* ; Folic Acid* ; Genotype ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; Seizures

PURPOSE: This prospective, open-label study evaluated the efficacy and safety of adjunctive levetiracetam (LEV) in Korean adults with uncontrolled partial epilepsy. METHODS: A total of 100 patients whose partial seizures were inadequately controlled on their current antiepileptic drugs were enrolled and received LEV (1000-3000 mg/day). Seizure count and adverse events (AEs) were recorded by patients. Global evaluation scale (GES) and quality of life (QOLIE-31) were also evaluated. Additionally effectiveness over 1-year follow-up was investigated. RESULTS: Ninety-two patients completed the short-term 16-week trial. The median percent reduction in weekly seizure frequency over the treatment period was 43.2%. The > or =50% and > or =75% responder rates were 45.4% and 36.1%, respectively. Seizure freedom was observed in 17 patients throughout the initial 16-week treatment period. On investigator's GES, 81 patients were considered improved, with 41 patients showing marked improvement. Most QOLIE-31 scales improved significantly. At the end of the trial, 79 chose to continue follow-up treatment with LEV. At the follow-up visit (ranging 60 to 81 weeks), 64 patients were still taking LEV; during the last 16 weeks, 65.6% of patients had > or =50% reduction, 50.0% had > or =75% reduction, and 35.9% had a 100% reduction. Seven patients showed continuous seizure freedom from the initiation of LEV treatment. During the entire treatment period, LEV was withdrawn in 36 patients; due to lack of efficacy in 22, AEs in six, both in three, other reasons in five. CONCLUSION: Adjunctive LEV therapy in patients with refractory partial epilepsy was effective and well-tolerated, as evidenced by the high seizure freedom and retention rates in both the short-term trial and the long-term follow-up.
Adult ; Anticonvulsants ; Epilepsies, Partial* ; Epilepsy ; Follow-Up Studies* ; Freedom ; Humans ; Prospective Studies ; Quality of Life ; Seizures ; Weights and Measures

Parkinsonism is a very rare complication of phenytoin. The authors experienced a 71-year-old man who presented progressive cognitive decline, postural tremor, bradykinesia and gait disturbance. Laboratory test and brain imaging revealed no abnormality that commonly causes parkinsonism. The only abnormal finding was elevation of serum phenytoin above the therapeutic level. The patient showed marked improvement of symptoms by reduction of phenytoin dosage. Here we report a case of phenytoin induced parkinsonism.
Aged ; Gait ; Humans ; Hypokinesia ; Neuroimaging ; Parkinsonian Disorders ; Phenytoin ; Tremor

Peripheral neuropathy is rarely caused by antiepileptic drugs andmost cases were reported about phenytoin. Here we report carbamazepine- induced peripheral neuropathy, which is a very rare condition and the pathogenesis is not well understood. A 19-year-old man presented with a several-year history of bilateral foot pain and pes planus. He had craniopharyngioma and underwent neurosurgery in 1997 and 2007. He had been prescribed by the general dose (600 mg/day) of carbamazepine since 1998 for the treatment of postoperative epilepsy. His muscle power was normal in all limbs and there were no abnormal sensory symptom and sign. Findings of electrodiagnostic studies were compatible with sensorimotor polyneuropathy with mixed axonotmesis and demyelination. His family history and genetic diagnosis excluded the possibility of hereditary neuropathy. After dose reduction of carbamazepine, his bilateral foot pain has been improved slowly. We report a case of carbamazepine-induced peripheral neuropathy.
Anticonvulsants ; Carbamazepine ; Craniopharyngioma ; Demyelinating Diseases ; Epilepsy ; Extremities ; Flatfoot ; Foot ; Humans ; Muscles ; Neurosurgery ; Peripheral Nervous System Diseases ; Phenytoin ; Polyneuropathies ; Young Adult

Localization of epileptogenic zone in central epilepsy is difficult because of extent and rapidity of ictal spread. Epilepsy surgery in central region is challenging because of the risk of sensorimotor deficitsrelated to excision of eloquent areas. We present a case of 27- year-old woman with a successful surgical treatment for intractable epilepsy from the central region.
Epilepsy ; Female ; Humans