Hyponatremia and risk of seizures: a retrospective cross-sectional study.
Epilepsia. 2011 Feb;52(2):410-3
Authors: Halawa I, Andersson T, Tomson T
This retrospective cross-sectional study was carried out to study the a…

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Levetiracetam-induced thrombocytopenia among inpatients: a retrospective study.

Epilepsia. 2010 Dec;51(12):2492-5

Authors: Sahaya K, Goyal MK, Sarwal A, Singh NN

Lately, few case reports have brought forth limited cases of levetiracetam (LEV)-induced thrombocytopenia. To estimate the burden of LEV-induced thrombocytopenia, we reviewed medical records of 758 patients aged 18 years or older who received LEV during their stay at the University Hospital from June 2005 to December 2008. In patients identified with thrombocytopenia, records were reviewed to establish a cause of thrombocytopenia and possible causal role of LEV. Of 758 patients, 29 patients were identified with thrombocytopenia while on LEV therapy. For 23 patients, an alternative cause for thrombocytopenia was established; 4 patients had preexisting thrombocytopenia without any appreciable change in platelet count after addition of LEV. One patient had limited data for identifying the cause of thrombocytopenia. A single patient had clear temporal co-relation and association of thrombocytopenia with LEV therapy. LEV-induced thrombocytopenia is a rare but reversible complication of LEV therapy. The mechanism remains unknown.

PMID: 21204814 [PubMed - indexed for MEDLINE]

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Should all patients be told about sudden unexpected death in epilepsy (SUDEP)? Pros and Cons.

Epilepsia. 2008 Dec;49 Suppl 9:99-101

Authors: Brodie MJ, Holmes GL

Despite being a relatively rare event, sudden unexpected death in epilepsy (SUDEP) can tragically cut short a young person’s life, particularly if seizures are not well controlled or when concordance with the antiepileptic drug regimen is less than optimal. Both the Scottish Intercollegiate Guidelines Network (SIGN) and the UK National Institute of Clinical Excellence (NICE) recommend universal discussion of SUDEP and support the view of one of the authors (MJB) and that of the Joint Epilepsy Council of UK charities that patients and their families have the right to know about the risks of epilepsy and the reasons for treatment. However, the risk of SUDEP is not uniform across all patient populations. Most people with newly diagnosed epilepsy will stop having seizures, and SUDEP is very rare among them. The highest risk groups are those with a young age of onset, frequent generalized tonic-clonic seizures, and medical intractability. The mechanisms underlying SUDEP are unclear, and there are no effective preventative therapies. It is the contention of the other author (GLH) that it is not necessary, or advisable, to discuss SUDEP with all patients. Rather, he contends that SUDEP should be discussed only with those patients who are at high risk. In particular, patients who have generalized tonic-clonic seizures and who are non-compliant with antiepileptic drugs should be counseled about their risk-taking behavior. Both authors agree that additional studies into the pathophysiology and prevention of SUDEP are urgently needed.

PMID: 19087124 [PubMed - indexed for MEDLINE]

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An evidence-based approach to the first seizure.

Epilepsia. 2008;49 Suppl 1:50-7

Authors: Wiebe S, Téllez-Zenteno JF, Shapiro M

Evidence-based care (EBC) is an explicit approach to applying the best evidence to the care of individual patients. We outline the basic principles of EBC and apply them to various clinical questions pertaining to a patient presenting with a first seizure, providing a summary of the best available evidence for each question. Depending on the question at hand, the evidence derives from retrospective, prospective, and randomized controlled studies in children and adults. There is solid evidence that early seizure recurrence is reduced by early initiation of AEDs. A meta-analysis of six randomized trials revealed an average absolute risk reduction of 34% (95% CI 15-52) with AED therapy. However, the prognosis for the development of epilepsy is not altered by early intervention. EEG epileptiform abnormalities, family history of epilepsy, imaging lesions, and remote symptomatic seizures increase the risk of recurrence, and impact the risk-benefit ratio of treatment after a single event. In the end, clinicians must evaluate patients with a first unprovoked seizure on a case-by-case basis to determine the appropriateness of treatment with a given AED.

PMID: 18184156 [PubMed - indexed for MEDLINE]

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Management of a first seizure. Special problems: adults and elderly.

Epilepsia. 2008;49 Suppl 1:45-9

Authors: Stephen LJ, Brodie MJ

A first seizure out of a clear blue sky can be a major life-changing event. Careful history-taking and appropriate investigation together with a clear explanation provided to patient and family are an essential requirement. Although for most patients, pharmacotherapy can be withheld and events awaited, there are circumstances where introduction of antiepileptic drug (AED) therapy should be considered. Medical causes of seizures should also be sought and treated. In addition, a first seizure in HIV-positive patients and in those with underlying neurocysticercosis should usually provoke the introduction of AED therapy. Particular problems can occur in patients with a single episode of provoked status epilepticus, a first tonic-clonic seizure during pregnancy and, particularly, an unprovoked event in older and learning disabled people. Treatment following a first seizure should balance risk factors for recurrence with the informed opinion of the patients and their family.

PMID: 18184155 [PubMed - indexed for MEDLINE]

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First seizure: EEG and neuroimaging following an epileptic seizure.

Epilepsia. 2008;49 Suppl 1:19-25

Authors: Pohlmann-Eden B, Newton M

An early EEG (within 48 h) and high-resolution magnetic resonance imaging (hr_MRI) are the methods of choice for an accurate diagnosis after a first seizure presentation. Together with a careful history and examination, they will allow definition of the epilepsy syndrome in two-thirds of patients and help assess the individual risk for seizure recurrence, which is determined by the specific syndrome and is highest with focal epileptiform activity on EEG. Despite the heterogeneity of first seizure studies, EEG and etiology are consistently found to be the best predictors for seizure recurrence and prognosis. The additional yield of sleep-deprived EEG and sleep EEG is uncertain; yet MRI is essential for detecting brain tumors and other structural bases for new epilepsy. The rate occurrence of remote symptomatic seizures increases significantly with age and the most common etiology in the elderly with a first seizure is stroke; however, its exact relevance to epileptogenicity is yet to be defined. There is a striking lack of systematic studies using early EEG and hr_MRI in order to better characterize epileptogenic areas and elucidate the mechanisms of seizure provocation.

PMID: 18184150 [PubMed - indexed for MEDLINE]

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Risk of recurrence after a first unprovoked seizure.

Epilepsia. 2008;49 Suppl 1:13-8

Authors: Berg AT

The risk of recurrence after a first unprovoked seizure has been examined in numerous observational studies and two large, high-quality randomized trials. Overall, in untreated individuals, 40-50% can expect a recurrence within 2 years of the initial seizure. Treatment may reduce this risk by as much as half. Those at the greatest risk of recurrence have either an abnormal EEG or an identifiable neurological condition or symptoms consistent with one (“symptomatic”). Status epilepticus and a history of febrile seizures may be associated with an increased risk of recurrence in individuals with symptomatic seizures. The great majority of people (approximately 90%) who are seen for a first unprovoked seizure attain a one to two year remission within 4 or 5 years of the initial event.

PMID: 18184149 [PubMed - indexed for MEDLINE]

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Is the first seizure truly epileptic?

Epilepsia. 2008;49 Suppl 1:2-7

Authors: Perrig S, Jallon P

Transient loss of consciousness (T-LOC) with abnormal posture or movements reflects a temporary dysfunction of the brain, either primary or secondary. In a period of high technological medical access, patients with T-LOC constitute a challenge to improve the medical “art of listening.” The difficulty in dealing with isolated paroxysmal phenomena is associated with the probability of the occurrence of a second event and therefore the entrance of the patient into a chronic disorder. We present a detailed analysis of symptoms that should help the general practitioner in the differential diagnosis among three main entities in the adult populations: syncope, epileptic seizure, and psychogenic seizure (dissociative convulsion).

PMID: 18184147 [PubMed - indexed for MEDLINE]

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