Improving Epilepsy for Life
Emilio Perucca, Alexis Arzimanoglou
35th anniversary ofthe first launch ofDepakine ® (sodium valproate). Neurologists, epileptologists, and neuropaediatricians, attended the meeting from over 35 countries including eminent experts who covered current practices and highlighted the latest research discoveries in epilepsy.
Renzo Guerrini, Alexis Arzimanoglou, Oebele Brouwer
types of epilepsy can be classified into categories that are conceptually meaningful. It is likewise logical to set treatment targets and to estimate the risks according to the main syndromic groups, as they share common, electroclinical presentations and long-term prognosis. Treatment should then be adjusted to each patient’s clinical characteristics. Treatment should be started soon, whenever there is indication that delay would harm the child. However, if seizures are not disabling, treatment may be delayed, in order to acquire more knowledge about the spontaneous expression of the disorder and the plan thoughtfully explained to the parents. In children presenting with partial symptomatic or cryptogenic epilepsy, it is important to assess the patient’s response to several different drugs. However, in patients regarded as having refractory epilepsy, possibilities for a surgical solution must be evaluated early in the course of the disease. In severe epileptic encephalopathies, complete seizure control is impossible and, ideally, treatment should provide as much integration and autonomy, with alleviation of frequent seizures. Again, this should be carefully explained to the parents. In children with severe epileptiform EEG abnormalities coexisting with brain dysfunction (diffuse or specific), the extent of EEG-related neurological dysfunction should be determined, and vigorous treatment should be started to abate its effects. Finally, seizures could be worsened by inappropriate drugs, paradoxical reaction or intoxication. Severe childhood epilepsies are particularly at risk and mild idiopathic epilepsies may be transformed into severe disorders, priming a vicious circle of heavy treatment, whereby the original disorder is no longer recognizable.
Barbara Tettenborn, Pierre Genton, David Polson
social and cultural issues, age, relationships, diagnosis and characterization, female specific syndromes, the influence of female hormones, hormonal contraceptives and hormonal replacement therapy, the cosmetic side effects of epilepsy treatment, fertility, pregnancy and child care. Regarding the issue of reproduction, there are several misconceptions in relation to fertility in women with epilepsy. In general, women with epilepsy do not have a markedly reduced fertility compared with those without. Standard AEDs in common use have been associated with an increased risk of foetal malformations and with newer AEDs there is very little information regarding teratogenicity. The incidence of congenital malformations is also known to increase with the number of AEDs. Before planning a pregnancy it is imperative that the best possible seizure control is achieved at the lowest possible AED dose, preferably in monotherapy. With this in mind, the importance of effective pre-pregnancy counselling should be stressed and along with appropriate patient management and folic acid supplementation, effective patient education, most women with epilepsy can lead normal lives and deliver healthy children. This report will provide an update on these important considerations for women with epilepsy from both a social and medical perspective.
Ray Tallis, Paul Boon, Emilio Perucca, Linda Stephen
As the proportion of older people in the population grows, the management of epilepsy in this population will become increasingly important. Elderly people are especially susceptible to the consequences of seizures, particularly loss of self-confidence, decreased independence, and "falls" resulting in physical injury. Establishing the diagnosis of epilepsy in old age can be more difficult than in younger patients due to the extensive range of differential diagnoses and a far higher prevalence of concomitant disease. Treatment strategies are demanding; they must allow for the complexities of co-morbidity, co-medication, alterations in drug handling, and drug effects on an aging body. Together with a growing array of antiepileptic medication from which to choose, these factors make the management of epilepsy in elderly people particularly challenging.
Felix Rosenow, Alexis Arzimanoglou, Michel Baulac
decisions. The purpose of this review is to give an overview of the incidence and classification of SEand to summarise the recent developments in the treatment of generalized tonic clonic status epilepticus (GTCSE). These consist in two prospective randomised studies indicating that SEshould be treated as soon as possible, even out-ofhospital, by intravenous (IV) benzodiazepine [1, 2]. Lorazepam is probably the best choice for the initial therapy. However, the differences in efficacy as compared to diazepam [1, 3], diazepam associated to phenytoin or phenobarbital  were not significant. There is no Class I evidence to help us choose which drug to give in SEthat is not responsive to the initial lorazepam. Traditionally, based on a long clinical experience, IV phenytoin is given as the second drug. Recently, phenytoin is being increasingly substituted by fosphenytoin, even though no formal, comparative tolerability studies have been performed to study this compound in GTCSE. Starting in the 1980’s, the use of injectable valproic acid (IV VPA) has been reported in an increasing number of uncontrolled case series initiated by doctors, indicating relative easy use, relative good tolerability and suggesting that it may be efficacious. Finally, we have very little data concerning the treatment of SErefractory to a benzodiazepine and phenytoin. Despite this lack of data many centres today use midazolam or propofol rather than phenobarbital or pentobarbital in this setting because these compounds have short half-lives and are, therefore, easier to handle.