Epilepsy has high incidence and complex etiologies,and its treatment remains challenging.For around 70% of people with epilepsy,seizures can be controlled after proper antiepileptic treatment.The availability of some new antiepileptic drugs in recent years has offered new options for epileptic patients.A solid knowledge on the pharmacokinetics,efficacy,and tolerability profiles of these new antiepileptic drugs will help to provide safe,proper,reasonable,and standardized treatment for patients.
Anticonvulsants ; therapeutic use ; Epilepsy ; drug therapy ; Humans ; Seizures ; drug therapy

Management of drug resistant epilepsy (DRE) requires a systematic approach consisting of (1) investigation of potential causes of DRE, (2) determination of the degree of DRE on the basis of previous drug therapy, (3) rational pharmacotherapy consisting of both monotherapy and combination therapy, and (4) referral to surgery or other alternative therapy. The scheme of rational pharmacotherapy consists of (1) first drug monotherapy (2) second drug monotherapy, (3) two drug combination therapy, (4) triple drug combination therapy, and (5) addition of second-line drug. With the introduction of many new antiepileptic drugs (AEDs) having different mechanisms of action, the combination therapy has become more effective and safer, which made the use of triple drug combination therapy feasible in practice if it includes at least one new AED. It should be acknowleged that the rational combination therapy may achieve a seizure free outcome in a significant proportion of patients with less severe DRE. For patients with surgically remediable epileptic syndromes, a systematic trial of two to three drugs may suffice an earlier referral to surgery.
Anticonvulsants ; Drug Therapy ; Epilepsy* ; Humans ; Referral and Consultation ; Seizures

OBJECTIVES: To study the factors influencing the short-term (28 days) efficacy of initial adrenocorticotropic hormone (ACTH) therapy for infantile epileptic spasms syndrome (IESS), as well as the factors influencing recurrence and prognosis. METHODS: The clinical data were collected from the children with IESS who received ACTH therapy for the first time in the Department of Pediatric Neurology, Xiangya Hospital of Central South University, from April 2008 to January 2018 and were followed up for ≥2 years. The multivariate logistic regression analysis was used to evaluate the factors influencing the short-term efficacy of ACTH therapy, recurrence, and long-term prognosis. RESULTS: ACTH therapy achieved a control rate of seizures of 55.5% (111/200) on day 28 of treatment. Of the 111 children, 75 (67.6%) had no recurrence of seizures within 12 months of follow-up. The possibility of seizure control on day 28 of ACTH therapy in the children without focal seizures was 2.463 times that in those with focal seizures (P<0.05). The possibility of seizure control on day 28 of ACTH therapy in the children without hypsarrhythmia on electroencephalography on day 14 of ACTH therapy was 2.415 times that in those with hypsarrhythmia (P<0.05). The possibility of recurrence within 12 months after treatment was increased by 11.8% for every 1-month increase in the course of the disease (P<0.05). The possibility of moderate or severe developmental retardation or death in the children without seizure control after 28 days of ACTH therapy was 8.314 times that in those with seizure control (P<0.05). The possibility of moderate or severe developmental retardation or death in the children with structural etiology was 14.448 times that in those with unknown etiology (P<0.05). CONCLUSIONS Presence or absence of focal seizures and whether hypsarrhythmia disappears after 14 days of treatment can be used as predictors for the short-term efficacy of ACTH therapy, while the course of disease before treatment can be used as the predictor for recurrence after seizure control by ACTH therapy. The prognosis of IESS children is associated with etiology, and early control of seizures after ACTH therapy can improve long-term prognosis.
Child ; Humans ; Infant ; Adrenocorticotropic Hormone/therapeutic use* ; Spasms, Infantile/drug therapy* ; Treatment Outcome ; Seizures ; Electroencephalography/adverse effects* ; Spasm/drug therapy*

The authors report a case of left parietal glioblastoma developed five years after surgical removal of the frontal cavernous malformation. A 36-year-old woman presented with history of seizure for 13 years and left frontal parasagittal mass on MRI. The mass was removed uneventfully, and the histopathologic examination revealed a cavernous malformation. Her seizure disappeared after the surgery. Five years later, the patient developed new symptoms of right leg weakness and paresthesia. Imaging studies followed by pathological study revealed left parietal, parasagittal glioblastoma, which was located posterior to the previous surgical field. Following surgery, she is now on regular follow up with radiation therapy and chemotherapy. The authors report this rare occurence of the glioblastoma following surgical removal of cavernous malformation with review of pertinent literatures.
Adult ; Drug Therapy ; Female ; Follow-Up Studies ; Glioblastoma* ; Humans ; Leg ; Magnetic Resonance Imaging ; Paresthesia ; Rabeprazole ; Seizures

We aimed to construct web sites providing information on epilepsy and to evaluate its practical use. To estimate the demand for such information, a questionnaire was administrated to 106 patients, their 54 families, and 78 nurses, who consented to be interviewed. After using the data collected from the survey to build a epilepsy information web site, data on the level of satisfaction for the website were collected by e-mails and direct surveys from subjects who used this web site; the collected data were analyzed. The results of this study were as follows: The educational level demanded by nurses was slightly higher than those of patients and their families. Patients, their families, and nurses wanted more information on how to handle patients during seizures, especially, and. families wanted to know about drug therapy. The content of the web site was configured based on the educational level of perceived users. Photoshop 6.0, Flash MX and FrontPage 2000 were used to build the web site. Images available on the internet that are shared served as the source of images. The program's URL is www.multimoon.com/black. Regarding user satisfaction with the web site, users found that the Information on the Prognosis of Epilepsy, the Pharmacological Treatment of Epilepsy, Occupation and Marriage Status in Daily Life, and the How to Manage Epileptic Attacks sections were quite helpful. Generally, the reactions to the website were positive. To construct an effective web site to provide information about epilepsy to patients, their families and nurses, educational data and information that meet the demands of users should be added. Its contents should be continuously updated, and its environment should be kept user-friendly so that the information can be accessed with ease.
Drug Therapy ; Electronic Mail ; Epilepsy* ; Humans ; Internet ; Marriage ; Occupations ; Prognosis ; Surveys and Questionnaires ; Seizures

The previous studies had shown that our society had stigma about epilepsy. These studies were not enough to establish practical and concrete educational program for the general population. This study was carried out to evaluate the knowledge of and attitude toward epilepsy in general population. The subjects consist of the population of 1722 apparently healthy persons who reside in Taegu city and Kyungpook province. The questionnaire consists of 39 items concerning knowledge of epilepsy and 20 items of attitude toward epilepsy and epileptic patients. Seventy percent of respondents answered that epileptics have grand mal seizure as their unique type of seizure. Sixty-eight percent were not confident of drug therapy for epilepsy, and 53% considered that epilepsy is a genetic disorder. The score of negative attitude toward car driving and marriage in epileptics was high. The score of knowledge of epilepsy and of attitude toward epilepsy and epileptics show a significant correlation with age and level of education. Although the group of public servant, teacher and professor had relatively high score in knowledge of epilepsy, they had much more negative attitude toward driving and marriage of epileptics. The group of nurse-teacher had higher knowledge and much more affirmative attitude. It is suggested that an educational program to epilepsy should have special emphasis on the etiology, type of epilepsy and efficacy of medical treatment in epilepsy.
Daegu ; Surveys and Questionnaires ; Drug Therapy ; Education ; Epilepsy* ; Gyeongsangbuk-do ; Humans ; Marriage ; Seizures

Primary leptomeningeal melanoma is a rare and aggressive tumor that originates from pial melanin-bearing cells typically along the cerebral conveidties or at the. Base of the brain. It has been hypothesized that malignant transformation Of the preexisting precursor cells leads to diffuse infiltration of the meninges by tumor and the onset of neurological symptoms and signs . The typical neurological symptoms and signs include psychiatric disturbances, seizures, and symptoros and signs of raised intracranial pressure secondary to hydrocephalus. Blindness has been reported as a late feature. Radiotherapy and chemotherapy has been using, but prognosis is poor We d be our experience with 24-years-woman in which the diagnosis of primary leptomeningea1 melanoma without melanotic pigmentation of variable areas of the skm was made.
Blindness ; Brain ; Diagnosis ; Drug Therapy ; Hydrocephalus ; Intracranial Pressure ; Melanoma* ; Meninges ; Pigmentation ; Prognosis ; Radiotherapy ; Seizures

OBJECTIVE: This study is performed in order to compare the outcomes of surgical management and to define the role of adjunctive therapy in the management of optic pathway glioma in children. METHODS: Sixteen children with optic pathway glioma had been managed in various treatment methods during the last 8 years. The patients aged from 5 months to 14 years. The patients presented with progressive visual loss, increased ICP symptoms, endocrine dysfunction, seizure, and motor weakness. Optic pathway glioma associated with neurofibromatosis was excluded. Tumor involved chiasmatico-hypothalamus(12 patients), optic chiasm(3), and optic nerve(1). The extent of surgical resection were radical(3 patients), subtotal(12), and partial(1). RESULTS: Three patients treated with radical resection showed no evidence of tumor recurrence. Among 12 patients treated with subtotal resection and without adjunctive therapy, 6 patients(50%) developed recurrence in the postoperative period of average 20.5 months. Those patients with recurrence were managed by reoperation(3 patients), irradiation therapy(2), and chemotherapy(1). However three patients with residual tumors after subtotal(2), or partial(1) resection were treated with adjunctive chemotherapy in the postoperative period showed no evidence of recurrence. CONCLUSION: Although radical resection of optic pathway glioma might offer long-term control of tumor, adjunctive chemotherapy could be effective to prevent tumor recurrence in children with subtotally or partially resected optic pathway glioma. More experience is necessary to determine the optimal method of treatment of optic pathway gliomas in children.
Child* ; Drug Therapy ; Glioma* ; Humans ; Neoplasm, Residual ; Neurofibromatoses ; Postoperative Period ; Radiotherapy ; Recurrence ; Seizures

OBJECTIVETo investigate the pathogenesis, clinical characteristics and treatment of benign infantile convulsions with mild gastroenteritis (BICG).

METHODSThe clinical manifestations and laboratory findings were observed in 40 children with BICG. The antigen and antibodies of rotavirus and calicivirus in stool and cerebral spinal fluid (CSF) were tested by the golden standard method and ELISA. The neurological outcome was evaluated by a follow-up of six months or more.

RESULTSAll of the 40 children had mild gastroenteritis with or without minor dehydration. Cluster convulsions were observed in these children. There were normal findings in blood biochemistry (Na+, K+, Ca2+, Cl-, HCO3-, glucose) and cerebral CT or MRI examinations. The interictal EEG showed sprinkle central or frontal epileptiform discharges in 8 children; clear central and parietal epileptiform discharges in 1 child; and no abnormal findings were observed in the other 31 children. Positive rotavirus antigen was detected in 11 children and positive calicivirus antigen in stool samples in 4 children. Positive antibodies of rotavirus and calicivirus in CSF were not seen. Seizures recurred in 22 of 28 children who received prophylactic injections of phenobarbital(5-10 mg/kg). In a 6 months follow-up, one child developed epilepsy and the other 39 children had no seizures and neurological sequelae.

CONCLUSIONSThe digestive system manifestations are mild in children with BICG. Convulsions are always clustered in these children. The mechanism underlying convulsions is not clear. Conventional dose of phenobarbital is not effective for prevention of seizures. Most of children with BICG have a good prognosis.

Child, Preschool ; Female ; Follow-Up Studies ; Gastroenteritis ; complications ; Humans ; Infant ; Male ; Seizures ; drug therapy ; etiology

Adult ; Female ; Humans ; Hypoparathyroidism ; complications ; congenital ; drug therapy ; Recurrence ; Seizures ; etiology