Diagnosis and management of epilepsy.

Department of Clinical Neurological Sciences, Epilepsy and Clinical Neurophysiology, London Health Sciences Centre - University Campus, London, ON.
Canadian Medical Association Journal (Impact Factor: 5.81). 03/2003; 168(4):441-8.
Source: PubMed

ABSTRACT This article concisely describes the more common epilepsy conditions and will enable physicians to efficiently evaluate and manage these disorders. Salient aspects of the history and examination, together with electroencephalography, will usually determine the epilepsy syndrome (category), forming the basis for any further investigation and possible antiepileptic therapy. Imaging may be required in some circumstances.

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    ABSTRACT: Background: The diagnosis of epilepsy should be made as early as possible to give a child the best chance for treatment success and also to decrease complications such as learning difficulties and social and behavioral problems. In this study, we aimed to assess the ability of magnetic resonance spectroscopy (MRS) in detecting the lateralization side in patients with Temporal lobe epilepsy (TLE) in correlation with EEG and MRI findings Methods: This was a case-control study including 40 patients diagnosed (clinically and by EEG ) as having temporal lobe epilepsy aged 8 to 14 years (mean, 10.4 years) and 20 healthy children with comparable age and gender as the control group. All patients were subjected to clinical examination, interictal electroencephalography and magnetic resonance imaging (MRI). Proton magnetic resonance spectroscopic examination (MRS) was performed to the patients and the controls. Results: According to the findings of electroencephalography, our patients were classified to three groups: Group 1 included 20 patients with unitemporal (lateralized) epileptic focus, group 2 included 12 patients with bitemporal (non-lateralized) epileptic focus and group 3 included 8 patients with normal electroencephalography. Magnetic resonance spectroscopy could lateralize the epileptic focus in 19 patients in group 1, nine patients in group2 and five patients in group 3 with overall lateralization of (82.5%), while electroencephalography was able to lateralize the focus in (50%) of patients and magnetic resonance imaging detected lateralization of mesial temporal sclerosis in (57.5%) of patients. Conclusion: Magnetic resonance spectroscopy is a promising tool in evaluating patients with epilepsy and offers increased sensitivity to detect temporal pathology that is not obvious on structural MRI imaging.
    Italian Journal of Pediatrics 04/2015; 41(32). DOI:10.1186/s13052-015-0138-2
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    ABSTRACT: The primary purpose of this study was to evaluate the utilization pattern and seizure out-come of newer and older antiepileptic drugs in pediatric clinical practice in a tertiary care hospital setting. The study was a retrospective observational study carried out, among pedi-atric epilepsy patients who were diagnosed according to the classification of the Interna-tional League Against Epilepsy and the information was gathered with the help of a vali-dated data collection form. There was a relative male preponderance (56%) seen among epi-leptic patients. Of the total 210 patients analyzed, 110 (52.4%) were having partial seizure and 100 (47.6%) had generalized seizures. Out of 210 patients 134 (63.8%) were on mono-therapy and 76 patients (36.2%) were on polytherapy. Mean daily doses of carbamazepine were 492.69±51.8 and 320.97±42.09 in polytherapy and monotherapy respectively. The number of patients on newer anticonvulsants was much smaller. The serum levels were mo-nitored for commonly used antiepileptics like phenytoin, carbamazepine, phenobarbitone and Valproate in 43 (20.5%) patients. Among 210 patients, antiepileptic drugs were changed for 96 (45.71%) and the reasons for changing prescriptions were uncontrolled seizures (67.7%), recurrence (22.9%) and adverse effects (9.3%). A nationally based study and guidelines may bring a more rational approach for antiepileptic drug. Though most of the cases can be effectively managed with conventional antiepileptics, an increase in experience with the use of newer medications can offer an additional advantage to patients.
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    ABSTRACT: In children with temporal lobe epilepsy (TLE), memory deficit is not so well understood as it is in adults. The aim of this study was to identify and describe memory deficits in children with symptomatic TLE, and to verify the influence of epilepsy variables on memory. We evaluated 25 children with TLE diagnosed on clinical, EEG and MRI findings. Twenty-five normal children were compared with the patients. All children underwent a neuropsychological assessment to estimate intellectual level, attention, visual perception, handedness, and memory processes (verbal and visual: short-term memory, learning, and delayed recall). The results allowed us to conclude: besides memory deficits, other neuropsychological disturbances may be found in children with TLE such as attention, even in the absence of overall cognitive deficit; the earlier onset of epilepsy, the worse verbal stimuli storage; mesial lesions correlate with impairment in memory storage stage while neocortical temporal lesions correlate with retrieval deficits.
    Arquivos de neuro-psiquiatria 03/2014; 72(3):184-9. DOI:10.1590/0004-282X20130223 · 1.01 Impact Factor


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