Epilepsy & Behavior (Epilepsy Behav)

Publications in this journal

• Article: Depression in patients with newly diagnosed epilepsy predicts lamotrigine-induced rash: A short-term observational study.

  Sung-Pa Park
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  ABSTRACT: Lamotrigine (LTG) has a good efficacy and tolerability as initial monotherapy for patients with newly diagnosed epilepsy (NDE). However, the occurrence of skin rash is one of the main reasons to discontinue LTG. On the basis of a high frequency of adverse effects associated with antiepileptic drugs in depressed patients, this study investigated whether depression is a likely predictor of LTG-induced rash in patients with NDE. Eligible patients received LTG monotherapy and were observed for 12weeks. Twenty (27%) of 74 enrolled patients had depression. Ten patients (13.5%) developed a skin rash within 5weeks. Depression was a sole predictor of LTG-induced rash (OR=9.154, 95% CI 2.077-40.344, p=0.003).
  Epilepsy & Behavior 05/2013; 28(1):88-90.
• Article: Psychosocial status 10years after temporal lobe resection for epilepsy, a longitudinal controlled study.

  Lena Andersson-Roswall, Elisabeth Engman, Hans Samuelsson, Kristina Malmgren
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  ABSTRACT: Knowledge about long-term psychosocial outcome of temporal lobe resection (TLR) for epilepsy is limited. The aims of this study were to describe vocational outcome 10years after TLR and to analyze the effect on the vocational situation by seizures, laterality of resection, verbal memory, and mood. Fifty-one patients were prospectively followed 10years after TLR. Psychosocial and neuropsychological data were ascertained at baseline and 10years after surgery and at corresponding time points for 23 controls. Fewer patients worked 10years post-operatively compared with controls (TLR patients: 61% and controls: 96%). However, seizure-free patients were more likely to retain employment (71%) than patients who had seizures (41%). The odds of working full-time were 9.5 times higher for patients with seizure freedom than for those with continuing seizures. There were no associations between working at 10years and side of resection or mood, and impairment of verbal memory did not have an influence on vocational outcome.
  Epilepsy & Behavior 05/2013;
• Article: Longitudinal assessment of skill development in children with first febrile seizure.

  Emily B Leaffer, Veronica J Hinton, Dale C Hesdorffer
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  ABSTRACT: To determine whether first febrile seizure (FS) has detrimental effects on development, 159 children (aged 6months to 5years) with FS were compared to 142 controls on measures of cognition, motor ability, and adaptive behavior. Participants were identified through the emergency department in an urban, low-income community. Children were evaluated within one month of the ED visit and one year later, and difference in performance over one year was examined. Performance did not differ between cases and controls on measures of cognition (baseline: p=0.5, one year: p=0.2, change over time: p=0.1) or motor skills (baseline: p=0.9, one year: p=0.7, change over time, p=0.6). The adaptive behavior composite score did not differ by FS case status at baseline (p=0.2) or one year later (p=0.6); however, between-group differences over time approached significance (p=0.05). Findings support the idea that first FS does not pose developmental or behavioral consequences in a low socioeconomic environment.
  Epilepsy & Behavior 05/2013; 28(1):83-87.
• Article: Effects of age, sex, and sertraline administration on seizure-induced respiratory arrest in the DBA/1 mouse model of sudden unexpected death in epilepsy (SUDEP).

  Carl L Faingold, Marcus Randall
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  ABSTRACT: DBA/1 mice are susceptible to audiogenic seizure-induced respiratory arrest (S-IRA), leading to death, which is a model of human sudden unexpected death in epilepsy (SUDEP). Female DBA/1 mice exhibited 71% susceptibility to S-IRA on the third daily test when seizure testing began at postnatal day (PND) 24-30, which was slightly (>10%) but not significantly lower than males. When initial seizure testing was delayed (to >7weeks of age), DBA/1 mice of both sexes exhibited significantly reduced S-IRA susceptibility, as compared to mice tested initially at PND 24-30. These sex and age issues had not been previously evaluated and may be important for the future use of this SUDEP model. We also observed that 30min after administering a selective serotonin reuptake inhibitor (SSRI), sertraline (40, 50, or 75mg/kg i.p.), a significantly reduced S-IRA incidence in DBA/1 mice occurred without blocking seizures, which may be relevant to SUDEP prevention.
  Epilepsy & Behavior 05/2013; 28(1):78-82.
• Article: Flashbulb memories in patients with temporal lobe epilepsy.

  B Metternich, K Wagner, A Schulze-Bonhage, F Buschmann, R A McCarthy
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  ABSTRACT: PURPOSE: Flashbulb memories (FMs) are vivid and stable autobiographical memories associated with learning surprising news of high emotional impact. Patients with temporal lobe epilepsy (TLE) can have autobiographical memory deficits. This is the first investigation of FMs in TLE applying a consistency measure of FM quality controlling for confabulation. METHOD: A sample of 12 patients with TLE and a matched group of 15 healthy controls (HCs) were tested on an FM test including a retest procedure. Scores of FM consistency were obtained by comparing answers across both testing occasions. RESULTS: In patients with TLE, FM consistency scores were significantly lower than in HCs. Exploratory subgroup analyses revealed FM deficits in both patients with left TLE and patients with right TLE compared with HCs. CONCLUSION: The present study indicates that the FMs of patients with TLE are less consistent than those of healthy control subjects. Future investigations with larger samples are desirable, especially regarding separate analyses of patients with left TLE and patients with right TLE.
  Epilepsy & Behavior 05/2013; 28(1):71-77.
• Article: Efficacy of the histamine 3 receptor (H3R) antagonist pitolisant (formerly known as tiprolisant; BF2.649) in epilepsy: Dose-dependent effects in the human photosensitivity model.

  Dorothée Kasteleijn-Nolst Trenité, Dominique Parain, Pierre Genton, Pascal Masnou, Jean-Charles Schwartz, Edouard Hirsch
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  ABSTRACT: A new class of drugs, the nonimidazole histamine 3 receptor (H3R) antagonists, has been developed in the past decade for treatment of various brain diseases. Pitolisant is such a drug. We studied the pharmacodynamic effect of pitolisant in patients with epilepsy in early Phase II, using the photosensitivity proof of concept model. A total of 14 adult patients (11 females and 3 males; 5 drug naïve) were studied for three days to evaluate the effect of a single oral dose of pitolisant on EEG photosensitivity ranges. All patients showed repeatedly a generalized photoparoxysmal response (PPR) prior to drug administration on placebo Day 1. A statistically significant suppressive effect (standardized photosensitive response [SPR] reduction as measured with paired t-tests) for 20-, 40-, or 60-mg doses of pitolisant was seen in 9/14 (64%) patients of whom 6/14 (43%) showed abolition of the response to intermittent photic stimulation (IPS). Patients on the highest dosage (60mg) showed the strongest effect with an effect lasting up to 28h. Thus, full-scale Phase II studies with this novel H3R antagonist, pitolisant, in patients with epilepsy are warranted.
  Epilepsy & Behavior 05/2013; 28(1):66-70.
• Article: Patient perceptions and barriers to epilepsy surgery: Evaluation in a large health region.

  Chantelle Hrazdil, Jodie I Roberts, Samuel Wiebe, Khara Sauro, Michelle Vautour, Alexandra Hanson, William Murphy, Neelan Pillay, Paolo Federico, Nathalie Jetté
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  ABSTRACT: PURPOSE: Despite evidence that carefully selected patients with refractory focal epilepsy benefit from epilepsy surgery, significant delays remain. We examined patient knowledge and perceptions regarding epilepsy surgery. METHODS: A 5-minute questionnaire was administered to consecutive adults with focal epilepsy seen in the epilepsy clinic in a large Canadian health region. Survey items assessed the following: (1) knowledge of surgical options, (2) perceptions about the risks of surgery vs. ongoing seizures, (3) disease disability, (4) treatment goals, and (5) demographic and socioeconomic variables. Patient responses were compiled to calculate a "Barriers to Epilepsy Surgery Composite" (BESC) score. RESULTS: Of 129 eligible patients, 107 completed the questionnaire (response rate: 83%). The average BESC score was 60/100. Apprehension about epilepsy surgery was less likely among patients who had previously undergone epilepsy surgery and those born in Canada. DISCUSSION: People with epilepsy often have hindering perceptions that can contribute to delays in surgical care.
  Epilepsy & Behavior 05/2013; 28(1):52-65.
• Article: Treatments for patients with comorbid epilepsy and depression: A systematic literature review.

  Prachi Mehndiratta, Martha Sajatovic
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  ABSTRACT: Depression is recognized as a serious comorbidity of epilepsy, but treatment of depression and anxiety in people with epilepsy is challenging. The aim of this article was to review published controlled clinical treatment studies of depression and anxiety in patients with epilepsy. The PubMed, Cochrane and PsycINFO databases were searched for controlled clinical trials, or controlled psychosocial or behavioral trials published in English before June 2012. Search terms were: seizures, epilepsy, depression, psychotherapy, cognitive therapy/treatment, behavioral therapy/treatment and nonpharmacologic therapy/treatment, education and stress management. Seven studies were included in this review. Interventions included antidepressant medications, antiepileptic medications, and cognitive behavioral therapy. Despite the methodological limitations in the studies identified by this review, both medications and psychotherapy improved depression and anxiety in patients with epilepsy. However, further research is needed in the form of randomized controlled clinical trials to establish appropriate pharmacological and psychosocial co-management of depression and epilepsy.
  Epilepsy & Behavior 05/2013; 28(1):36-40.
• Article: Hyperactive behavior in a family with autosomal dominant lateral temporal lobe epilepsy caused by a mutation in the LGI1/epitempin gene.

  B Berghuis, E H Brilstra, D Lindhout, S Baulac, G J de Haan, M van Kempen
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  ABSTRACT: Autosomal dominant lateral temporal lobe epilepsy (ADLTE) is characterized by focal seizures with auditory features or aphasia. Mutations in the leucine-rich glioma-inactivated 1 (LGI1) gene have been reported in up to 50% of families with ADLTE. Attention-deficit/hyperactivity disorder (ADHD) symptoms have not yet been reported in these families. Clinical data were collected from a family with five affected members. Leucine-rich glioma-inactivated 1 exons and boundaries were sequenced by standard methods. Attention-deficit/hyperactivity disorder symptoms were scored based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Affected members had seizures with auditory features and psychic auras, and some experienced nightmares. A heterozygous c.431+1G>A substitution in LGI1 was detected in all members. Significantly more hyperactivity symptoms were found in family members carrying the LGI1 mutation. This study expands the phenotypic spectrum associated with ADLTE due to LGI1 mutation and underlines the need for more systematic evaluation of ADHD and related symptoms.
  Epilepsy & Behavior 05/2013; 28(1):41-46.
• Article: Association between leisure time, physical activity, and mood disorder levels in individuals with epilepsy.

  Cristiano de Lima, Claudio Andre Barbosa de Lira, Ricardo Mario Arida, Monica Levy Andersen, Gabriela Matos, Laura Maria de Figueiredo Ferreira Guilhoto, Elza Márcia Targas Yacubian, Marly de Albuquerque, Sergio Tufik, Marília Dos Santos Andrade, Rodrigo Luiz Vancini
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  ABSTRACT: The aim of this study was to investigate the association between physical activity levels (occupational, sports, and leisure time activities), depression, anxiety, and epilepsy. The behavioral outcomes of individuals with epilepsy (E) were also compared with healthy control subjects (C). The sample included 31 individuals with epilepsy (12 with idiopathic generalized epilepsy and 19 with partial epilepsy) and 31 control subjects. Self-rating questionnaires were used to assess mood (State-Trait Anxiety Inventory and Beck Depression Inventory), anxiety, and depression as well as habitual physical activity. Patients with epilepsy were more severely impaired compared to control subjects in both mood questionnaires and presented higher levels of depression (35%), state anxiety (18%), and trait anxiety (12.6%) when compared to the C group. Although physical activity level did not differ significantly between groups, linear regression analyses showed that the physical activity leisure level predicted 31% of depression levels and 26% of anxiety levels in the E group. These data suggest that low levels of physical activity may be considered a risk factor for the development of depression and anxiety and can play an important role in the quality of life of individuals with epilepsy.
  Epilepsy & Behavior 05/2013; 28(1):47-51.
• Article: Impaired language function in generalized epilepsy: Inadequate suppression of the default mode network.

  Helena Gauffin, Helene van Ettinger-Veenstra, Anne-Marie Landtblom, Daniel Ulrici, Anita McAllister, Thomas Karlsson, Maria Engström
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  ABSTRACT: We aimed to study the effect of a potential default mode network (DMN) dysfunction on language performance in epilepsy. Language dysfunction in focal epilepsy has previously been connected to brain damage in language-associated cortical areas. In this work, we studied generalized epilepsy (GE) without focal brain damage to see if the language function was impaired. We used functional magnetic resonance imaging (fMRI) to investigate if the DMN was involved. Eleven persons with GE and 28 healthy controls were examined with fMRI during a sentence-reading task. We demonstrated impaired language function, reduced suppression of DMN, and, specifically, an inadequate suppression of activation in the left anterior temporal lobe and the posterior cingulate cortex, as well as an aberrant activation in the right hippocampal formation. Our results highlight the presence of language decline in people with epilepsy of not only focal but also generalized origin.
  Epilepsy & Behavior 05/2013; 28(1):26-35.
• Article: Trans-middle temporal gyrus selective amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy in adults: Seizure response rates, complications, and neuropsychological outcomes.

  S Kathleen Bandt, Nicole Werner, Jennifer Dines, Samiya Rashid, Lawrence N Eisenman, R Edward Hogan, Eric C Leuthardt, Joshua Dowling
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  ABSTRACT: OBJECTIVE: Selective amygdalohippocampectomy (AHC) has evolved to encompass a variety of techniques to resect the mesial temporal lobe. To date, there have been few large-scale evaluations of trans-middle temporal gyrus selective AHC. The authors examine a large series of patients who have undergone the trans-middle temporal gyrus AHC and assess its clinical and neuropsychological impact. METHODS: A series of 76 adult patients underwent selective AHC via the trans-middle temporal gyrus approach over a 10-year period, 19 of whom underwent pre- and postoperative neuropsychological evaluations. RESULTS: Favorable seizure response rates were achieved (92% Engel class I or II), with very low surgical morbidity and no mortality. Postoperative neuropsychological assessment revealed a decline in verbal memory for the left AHC group. No postoperative memory decline was identified for the right AHC group, but rather some improvements were noted within this group. CONCLUSIONS: The trans-middle temporal gyrus selective AHC is a safe and effective choice for management of medically refractory epilepsy in adults.
  Epilepsy & Behavior 05/2013; 28(1):17-21.
• Article: A more realistic approach, using dynamic stimuli, to test facial emotion recognition impairment in temporal lobe epilepsy.

  Akihiro Tanaka, Naoki Akamatsu, Mitsuhiko Yamano, Masanori Nakagawa, Mitsuru Kawamura, Sadatoshi Tsuji
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  ABSTRACT: To explore potentially impaired social functioning in patients with mesial temporal lobe epilepsy (MTLE), we evaluated facial emotion recognition (FER) using dynamic facial stimuli. We evaluated FER in 88 patients with MTLE, including 25 posttemporal lobectomy (PTL) patients, when they watched videos of actors expressing the six basic emotions of happiness, sadness, anger, fear, surprise, and disgust. Thirty-two healthy subjects were examined as controls. The relationships between task, performance, and neurophysiological and radiological variables potentially affecting the ability to recognize moving facial emotions were examined by multivariate analysis. Both the patients with MTLE and the PTL subset demonstrated significantly impaired FER compared with healthy controls. Of the six emotions, they showed impaired recognition of sadness, fear, and disgust. Facial emotion recognition was impaired in patients with chronic MTLE, particularly those with bilateral damage. Failure to recognize emotional expressions, particularly fear, disgust, and sadness, may contribute to difficulties in social functioning and relationship building.
  Epilepsy & Behavior 05/2013; 28(1):12-16.
• Article: Network analysis reveals patterns of antiepileptic drug use in children with medically intractable epilepsy.

  George M Ibrahim, James T Rutka, O Carter Snead
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  ABSTRACT: Network analysis is an emerging tool for the study of complex systems. Antiepileptic drug (AED) polytherapy in children with medically intractable epilepsy may be considered a complex system, given the heterogeneity of drug combinations that are frequently modified according to clinical indications. The current article presents a concise review of network theory and its application to the characterization of AED use in children with refractory epilepsy. Current and previous AEDs prescribed to 27 children with refractory, localization-related epilepsy were recorded, and network theory was applied to identify patterns of drug administration. Of the fifteen unique AEDs prescribed, levetiracetam possessed the highest betweenness centrality within the network. Furthermore, first generation AEDs were often discontinued, while lacosamide and topiramate were most likely to be initiated. We also identified three subnetworks of AEDs that were commonly coadministered. We conclude that network analysis is an effective method to characterize the complexity of AED administration patterns in children with epilepsy with many promising future applications.
  Epilepsy & Behavior 05/2013; 28(1):22-25.
• Article: Doctors, have you ever heard about sleep disturbance, erectile dysfunction, and epilepsy?

  Gabriela Matos, Fulvio A Scorza, Esper A Cavalheiro, Sergio Tufik, Monica L Andersen
  Epilepsy & Behavior 05/2013; 28(1):8-9.
• Article: Lovastatin and sudden unexpected death in epilepsy: A matter for debate.

  Mariana B Nejm, Telma L Gouveia, Maria da Graça Naffah-Mazacoratti, Carla A Scorza, Esper A Cavalheiro, Fulvio A Scorza
  Epilepsy & Behavior 05/2013; 28(1):10-11.
• Article: The role of potassium BK channels in anticonvulsant effect of cannabidiol in pentylenetetrazole and maximal electroshock models of seizure in mice.

  Zahra Shirazi-Zand, Leila Ahmad-Molaei, Fereshteh Motamedi, Nima Naderi
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  ABSTRACT: Cannabidiol is a nonpsychoactive member of phytocannabinoids that produces various pharmacological effects that are not mediated through putative CB1/CB2 cannabinoid receptors and their related effectors. In this study, we examined the effect of the i.c.v. administration of potassium BK channel blocker paxilline alone and in combination with cannabidiol in protection against pentylenetetrazol (PTZ)- and maximal electroshock (MES)-induced seizure in mice. In the PTZ-induced seizure model, i.c.v. administration of cannabidiol caused a significant increase in seizure threshold compared with the control group. Moreover, while i.c.v. administration of various doses of paxilline did not produce significant change in the PTZ-induced seizure threshold in mice, coadministration of cannabidiol and paxilline attenuated the antiseizure effect of cannabidiol in PTZ-induced tonic seizures. In the MES model of seizure, both cannabidiol and paxilline per se produced significant increase in percent protection against electroshock-induced seizure. However, coadministration of cannabidiol and paxilline did not produce significant interaction in their antiseizure effect in the MES test. The results of the present study showed a protective effect of cannabidiol in both PTZ and MES models of seizure. These results suggested a BK channel-mediated antiseizure action of cannabidiol in PTZ model of seizure. However, such an interaction might not exist in MES-induced convulsion.
  Epilepsy & Behavior 05/2013; 28(1):1-7.
• Article: Physical exercise: Potential candidate as coping strategy for people with epilepsy.

  Rodrigo Luiz Vancini, Claudio Andre Barbosa de Lira, Ricardo Mario Arida
  Epilepsy & Behavior 05/2013;
• Article: Health-related quality of life before and after pediatric epilepsy surgery: The influence of seizure outcome on changes in physical functioning and social functioning.

  Jeffrey B Titus, Amy Lee, Aimen Kasasbeh, Liu Lin Thio, Jennifer Stephenson, Karen Steger-May, David D Limbrick, Matthew D Smyth
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  ABSTRACT: Health-related quality of life (HRQOL) is an important outcome in pediatric epilepsy surgery, but there are few studies that utilize presurgical ratings to assess the effect of surgery on HRQOL. We collected parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 28 children who participated in neuropsychological assessment before and after epilepsy surgery. Our results revealed significant improvements in overall HRQOL after surgery, especially in physical and social activities. These changes were apparent despite generally unchanged intellectual and psychological functioning. Children with better seizure outcome had more improvement in HRQOL; however, improvements were not statistically different among children with Engel class I, II, and III outcomes. Our results suggest that children can experience significant improvements in HRQOL following epilepsy surgery even when neuropsychological functioning remains unchanged. Moreover, improvements in HRQOL appear evident in children who experience any worthwhile improvement in seizure control (Engel class III or better).
  Epilepsy & Behavior 04/2013; 27(3):477-483.
• Article: "Simple febrile seizures plus (SFS+)": More than one febrile seizure within 24hours is usually okay.

  Marie F Grill, Yu-Tze Ng
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  ABSTRACT: This study aimed to investigate whether children with recurrent febrile seizures within a 24-hour period need to be worked up differently from children with simple febrile seizures. Inclusion criteria included the following: (i) children with first seizure cluster between 4months and 3years of age, (ii) children who had more than one febrile seizure within 24hours, and (iii) children who returned to baseline between and after each event. Thirty-two patients met the inclusion criteria over a 3-year period. All patients underwent brain CT and/or MRI and EEG. All head CTs were normal. Two children had abnormal MRI findings - both benign: one is thought to represent postictal changes, and the other one is an incidental arachnoid cyst. Of the 4 abnormal EEGs, one showed epileptiform discharges, while the others showed generalized ictal or postictal features. We propose the term "simple febrile seizures plus (SFS+)" to describe children who have more than one seizure within 24hours but who are otherwise not different in presentation from children with SFS.
  Epilepsy & Behavior 04/2013; 27(3):472-476.