Epilepsia
-
Randomized Controlled Trial Comparative Study
Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study.
Intravenous lorazepam is considered the drug of first choice for control of acute convulsive seizures. However, resource or personnel constraints necessitate the study of alternative routes and medications. This study compared the efficacy and adverse effects of intranasal versus intravenous lorazepam in children aged 6-14 years who presented with acute seizures. ⋯ Intranasal administration of lorazepam is not found to be inferior to intravenous administration for termination of acute convulsive seizures in children.
-
Editorial Review
Modern antiepileptic drug development has failed to deliver: ways out of the current dilemma.
Despite the development of various new antiepileptic drugs (AEDs) since the early 1990s, the available evidence indicates that the efficacy and tolerability of drug treatment of epilepsy has not substantially improved. What are the reasons for this apparent failure of modern AED development to discover drugs with higher efficacy? One reason is certainly the fact that, with few exceptions, all AEDs have been discovered by the same conventional animal models, particularly the maximal electroshock seizure test (MES) in rodents, which served as a critical gatekeeper. These tests have led to useful new AEDs, but obviously did not help developing AEDs with higher efficacy in as yet AED-resistant patients. ⋯ The failure of AED development has led to increasing disappointment among clinicians, basic scientists, and industry and may halt any further improvement in the treatment of epilepsy unless we find ways out of this dilemma. Therefore, we need new concepts and fresh thinking about how to radically change and improve AED discovery and development. In this respect, the authors of this critical review will discuss several new ideas that may hopefully lead to more efficacious drug treatment of epilepsy in the future.
-
To investigate the feasibility of antiepileptic drug (AED) withdrawal following anterior temporal lobectomy (ATL) and to identify the predictors of post withdrawal seizure recurrence. ⋯ AED withdrawal can be safely attempted following successful ATL. Seizure recurrences are few and can be managed easily.
-
Status epilepticus (SE) is an important neurologic emergency requiring treatment on an intensive care unit (ICU). Although convulsive SE is self-evident, the diagnosis of nonconvulsive SE (NCSE) depends on electroencephalography (EEG) confirmation. Previous work showed that 82% of patients with SE had NCSE in our ICU. We hypothesize that continuous video-EEG monitoring (CVEM) may increase the diagnostic yield in patients with SE, especially NCSE, and leave fewer patients undiagnosed. ⋯ Frequency of NCSE diagnosis increased significantly after implementation of CVEM and was higher than the increment of performed investigations alone. Such an effect may result from the combination of longer observation periods during CVEM, greater and permanent availability of EEG recordings, and heightened awareness of NCSE. Future studies may corroborate improvement of diagnosis and outcomes in patients with disorders of consciousness by CVEM.
-
Randomized Controlled Trial
Population pharmacokinetics of pregabalin in healthy subjects and patients with chronic pain or partial seizures.
Pregabalin, a high-affinity ligand for α2δ subunits of voltage-gated calcium channels, is a novel pharmacotherapy for chronic pain, partial seizures, and other disorders. The present study investigated the population pharmacokinetics of pregabalin following single and multiple doses in healthy volunteers and patient populations. ⋯ Pregabalin CL/F is related to CLcr, and this relationship is similar among healthy volunteers and patients with either partial seizures or chronic pain disorders. The only factor having a clinically significant influence on steady-state plasma pregabalin concentrations is renal function.