Johannes (Hans) A Carpay

Objective: To evaluate the effect of treatment with anti-calcitonin gene-related peptide (CGRP; receptor) antibodies on visual hypersensitivity in patients with migraine. Background: Increased visual sensitivity can be present both during and outside migraine attacks. CGRP has been demonstrated to play a key role in light-aversive behavior. Met...

Migraine is associated with altered sensory processing, that may be evident as changes in cortical responsivity due to altered excitability, especially in migraine with aura. Cortical excitability can be directly assessed by combining transcranial magnetic stimulation with electroencephalography (TMS-EEG). We measured TMS evoked potential (TEP) amp...

Background and objectives: Increased sensitivity to light and patterns is typically associated with migraine, but has also been anecdotally reported in cluster headache, leading to diagnostic confusion. We wanted to assess whether visual sensitivity is increased ictally and interictally in cluster headache. Methods: We used the validated Leiden...

Background Recently, antimigraine drugs targeting the calcitonin gene-related peptide pathway have been approved for clinical use as preventive migraine medication. Case report We present a case of a 54-year-old male migraine patient, who reported erectile dysfunction as a possible side effect of treatment with galcanezumab, a monoclonal antibody...

Objective Paroxysmal epileptiform abnormalities on electroencephalography (EEG) are the hallmark of epilepsies, but it is uncertain to what extent epilepsy and background EEG oscillations share neurobiological underpinnings. Here, we aimed to assess the genetic correlation between epilepsy and background EEG oscillations. Methods Confounding facto...

Objective Paroxysmal epileptiform abnormalities on electroencephalography (EEG) are the hallmark of epilepsies, but it is uncertain to what extent epilepsy and background EEG oscillations share neurobiological underpinnings. Here, we aimed to assess the genetic correlation between epilepsy and background EEG oscillations. Methods Confounding facto...

Migraine and epilepsy are both characterized by transient attacks of altered brain function with a clinical, pathophysiological, and therapeutic overlap. Furthermore, epilepsy and migraine may mimic each other. In particular, occipital lobe seizures may be easily misinterpreted as migraine with visual aura, although there seems to be several clinic...

Background: Migraine is associated with altered sensory processing and cortical responsivity that may contribute to susceptibility to attacks by changing brain network excitability dynamics. To gain better insight into cortical responsivity changes in migraine we subjected patients to a short series of light inputs over a broad frequency range ("c...

Objective Paroxysmal epileptiform abnormalities on electroencephalography (EEG) are the hallmark of epilepsies, but it is uncertain to what extent epilepsy and background EEG oscillations share neurobiological underpinnings. Here, we aimed to assess the genetic correlation between epilepsy and background EEG oscillations. Methods Confounding facto...

Enhanced sensitivity to light (photophobia) and patterns is common in migraine, and can be regarded as visual allodynia. We aimed to develop and validate a questionnaire to easily quantify sensitivity to light and patterns in large populations, and to assess and compare visual allodynia across different migraine subtypes and states. We developed th...

Clara, een verder volkomen gezond en intelligent meisje van 12 jaar, wordt verwezen naar de neuroloog wegens aanvallen van visuele hallucinaties. De huisarts denkt aan epilepsie, aura’s bij migraine of iets psychisch. De aanvallen bestaan sinds een half jaar en treden een- tot viermaal per maand op, ze duren ongeveer een half uur.

Background: Large administrative databases may prove useful to assess epilepsy-related comorbidity and mortality. Despite their increased use, their validity as data source in epilepsy is yet under-ascertained. Methods: Achmea is a large Dutch health insurance company covering about 25% of the population. We performed a retrospective cohort stud...

Purpose: We describe the effectiveness of lacosamide as adjunctive therapy in patients with epilepsy and an intellectual disability. This information is relevant, as few data exist pertaining to this population with a high prevalence of (intractable) epilepsy. Methods: We performed a retrospective study in three specialised institutions. Inclusi...

Objective: Changes in anti-epileptic drug (AED) regimens may indicate unsatisfactory treatment results such as insufficient seizure control or adverse effects. This inference underlies epilepsy management and research, yet current studies often do not account for AED changes. We assessed AED change patterns and their association with quality of li...

Background: Migraine is often accompanied by sensitivity for light and patterns. This is usually interpreted as manifestation of ‘cortical hyperexcitability’, as is the migraine aura. It is not known if migraineurs with and without aura differ in visual sensitivity. Aim: To quantify ictal and interictal visual sensitivity of migraine patients with...

Epileptic seizures can be provoked by several factors. Better understanding of these factors may improve a patient's sense of control and could reduce seizures. In daily practice, the recognition of seizure precipitants relies heavily on clinical or video-EEG evidence, which can be difficult to obtain. Studies of seizure provocation are largely bas...

Familial hemiplegic migraine (FHM) is a rare monogenic subtype of migraine with aura that includes motor auras. Prophylactic treatment of FHM often has marginal effects and involves a trial-and-error strategy based on therapeutic guidelines for non-hemiplegic migraine and on case reports in FHM. We assessed the response to prophylactic medication i...

Headache and epilepsy often co-occur. Epidemiologic studies conducted in the past few years reinforce the notion of a bi-directional association between migraine and epilepsy. Data on an association between headache (in general) and epilepsy, however, are less clear. Peri-ictal headache often presents with migraine-like symptoms and can be severe....

In the past decade, many new antiepileptic drugs have become available, but their influence on patient outcomes in daily practice is not well known. In a community-based study, we assessed changes in epilepsy treatment and outcomes over a 10-year period. We compared two cross-sectional community-based samples that were obtained from the same Dutch...

Due to the worldwide near-extinction of poliovirus infections an acute presentation of poliomyelitis in the Netherlands has become extremely rare. However, in the differential diagnosis of such a disease presentation other pathogens need to be considered as well. A 44-year-old female presented with fever and a flaccid paresis of the left leg, follo...

Heel veel patiënten bezoeken de huisarts met de klacht: “Ik heb iedere dag hoofdpijn”. Het is belangrijk ten eerste onderscheid te maken tussen de gewone dagelijkse hoofdpijn (tension type headache) en medicatieafhankelijke hoofdpijn. Verder moet u vragen of de hoofdpijn altijd ongeveer hetzelfde is of dat er dagen zijn dat de patiënt echt ziek is...

Migraine bij kinderen kenmerkt zich door een grote verscheidenheid aan klinische symptomen en verschijnselen. Er zijn bij kinderen onder meer verscheidene bijzondere vormen van migraine (varianten), verschillende migraineaanvallen zonder hoofdpijn (equivalenten) en aan migraine gerelateerde aanvallen. In de klinische presentatie van kinderen met mi...

Migraine is – net zoals bijvoorbeeld epilepsie – een ziekte van de hersenen, die zich uit in aanvalsgewijs optredende symptomen. Hoogstwaarschijnlijk spelen genetische factoren een grote rol. In de jaren 80 en 90 van de vorige eeuw is veel ontdekt over het pathofysiologische mechanisme achter de migraineaanval (zie figuur 4 op pagina 24). In feite...

Ongeveer 10–20% van de bevolking heeft last van migraine. Slechts een zeer klein deel van de patiënten zoekt daadwerkelijk hulp voor de migraine. In Nederland zijn naar schatting 2,5 miljoen migrainepatiënten. Een derde van hen heeft drie of meer aanvallen per maand. Ongeveer 55% van de patiënten is tijdens een aanval ernstig beperkt of moet bedrus...

In feite valt behandeling van migraine uiteen in twee verschillende benaderingen.

Dat hormonen een belangrijke rol spelen in het ontstaan of uitlokken van migraine is duidelijk. Vóór de puberteit komt migraine vrijwel even vaak voor bij jongens als bij meisjes. Na de puberteit neemt de frequentie bij vrouwen echter sterk toe, om uiteindelijk een bijna driemaal zo hoge frequentie te bereiken rond het 40e levensjaar. Vervolgens ka...

Migraine is een chronische neurovasculaire polygenetische hersenziekte. Het is niet iets wat je krijgt, maar wat je hebt. Migraine is helaas nog steeds een ondergediagnosticeerde en dus ook onderbehandelde aandoening. Dit boek kan helpen bij het zowel in kwalitatieve als kwantitatieve zin optimalisteren van de behandeling van patiënten met migraine...

Dysgeusia caused by the consumption of pine nuts is not widely reported in the medical literature, although much is written about this condition on the Internet. We present the case of a 46-year-old male who complained of metallic and bitter dysgeusia that started 2 days after the ingestion of approximately 70 grams of pine nuts. A literature searc...

Nervous system adverse drug reactions (NS-ADRs), such as cognitive complaints and paresthesia, are among the most frequent and clinically important ADRs of topiramate. Studying ADR profiles across disorders is clinically relevant because treatment decision-making in neuropsychiatry is highly guided by ADR profiles. We used medline searches (until J...

Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness. Due to this common combination of headache and neck pain, physical treatments of the cervical spine are often considered. The additional value of these treatments to standard medical care or usual care (UC) is insuf...

Complaints about side-effects of antiepileptic drugs (AEDs) may be overlooked in clinical practice. We assessed the value and risks of an active intervention policy for reported complaints in a randomized controlled pragmatic trial. This randomized controlled pragmatic trial included 111 adults treated for epilepsy in seven general hospitals. They...

Epilepsy is very common. The prevalence in the Netherlands is 5:1000 inhabitants. The diagnosis is mostly made on clinical grounds and often incorrectly. If there are doubts about the diagnosis, the patient can be referred to a specialised centre for a seizure registration with an EEG and video recording. The disorder generally responds well to tre...

To compare adverse drug reactions (ADRs) to topiramate in patients with migraine and patients with epilepsy, we systematically reviewed all published randomized controlled trials (RCTs) that compare topiramate monotherapy in epilepsy and migraine. We included four epilepsy RCTs (N = 1,179 patients; vs. active comparators) and six migraine RCTs (N =...

To assess the long-term usefulness of 'new anti-epileptic drugs (AEDs)' (lamotrigine, topiramate, levetiracetam, gabapentin and pregabalin) in institutionalized intellectually disabled patients. Information from RCTs is lacking in this population with severe intellectual and behavioural disabilities. Retrospective study. Data from the medical files...

Case report and clinical discussion. To describe a case of persistent posttraumatic headache associated with the presence of a paracondylar process, and the result of surgical resection of this osseous anomaly. The paracondylar process is one of a group of congenital anomalies of the craniovertebral junction. This heterogenic group is classified in...

Aim of the study was to assess the efficacy and safety of levetiracetam as add-on treatment in patients with partial-onset epilepsy in clinical practice. In this observational, multi-centre study patients were treated with levetiracetam for 16 weeks. From a starting dose of 1000 mg/day, dose levels were adjusted at 2-weekly intervals in 1000-mg ste...

Side-effects of anti-epileptic drugs (AEDs) may be overlooked in patients with epilepsy in everyday clinical practice. The aim of this study was to assess the prevalence and severity of subjective complaints in patients who were considered to be well-controlled and to assess whether these complaints are related to medication, personality traits, or...

Topiramate was assessed in an open-label trial as broad-spectrum antiepileptic monotherapy, independently from the epilepsy type or syndrome. Adults and children aged 2 years and older, who were diagnosed with epilepsy within the last 5 years, treatment-naive or failing prior treatment with one antiepileptic drug (AED), received individually adjust...

Few data exist with respect to the occurrence of chronic side effects due to antiepileptic drugs (AED) in routine clinical practice. To evaluate the prevalence of subjective complaints which patients with epilepsy regard as side effects of their AED treatment in a community-based population. Cross-sectional study. Subjects were identified through t...

Topiramate was assessed in an open-label trial as broad-spectrum anti-epileptic monotherapy, independently from the epilepsy type or syndrome. Adults and children aged 2 years and older, who were diagnosed with epilepsy within the last 5 years, treatment-naive or failing prior treatment with one antiepileptic drug (AED), received individually adjus...

A new oral form of sumatriptan has been developed to facilitate tablet disintegration and drug dispersion and to mitigate the effects of gastric stasis that can accompany migraine. To evaluate the effects on functional ability of the new fast disintegrating/rapid release formulation of sumatriptan. Sumatriptan 50 mg (n = 137), 100 mg (n = 142), or...

Sumatriptan tablets have been developed in a fast-disintegrating, rapid-release formulation designed to facilitate tablet disintegration and drug dispersion and to potentially mitigate the effects of gastric stasis that can accompany migraine. This study was conducted to evaluate the efficacy and tolerability of sumatriptan 50- and 100-mg tablets i...

The antiepileptic drug primidone is to be withdrawn from sale by January 2004. After this date, the drug will still be available for a time, but only on a limited basis. Most primidone users are elderly patients who have been prescribed this drug for many years. Changing to a new drug constitutes a health risk for them. If primidone treatment is di...

We analysed the adverse events of placebo in acute and preventive randomized, double-blind, placebo-controlled studies for migraine treatment. Fifty-seven trials (oral triptans, non-steroidal anti-inflammatory drugs, nasal ergot alkaloids and preventive agents) were included. From 10 to 30% of subjects reported adverse events after placebo. Most co...

To evaluate the effectiveness of sumatriptan 20 mg via nasal spray and 100-mg tablets in treating migrainous headache in patients without a concomitant migraine diagnosis. We prospectively investigated the efficacy of sumatriptan 20 mg via nasal spray and 100-mg tablets in patients with a history of at least 5 moderate to severe headache attacks la...

We used a parent-completed 20-item “side effect scale” quantifying complaints that parents perceive to be caused by antiepileptic drugs (AEDs) in 108 children with active epilepsy. We studied the associations between parent-reported complaints, severity of seizures, and restrictions due to epilepsy, and clinical data including number and AED load....

De behandeling van kinderen met epilepsie is niet eenvoudig. Wanneer moet je wel behandelen en wanneer niet en wat kan worden beschouwd als ‘succesvol’ behandelen. Carpay et al. (1998) beoordeelden bij 494 kinderen uit het Zuid–Hollandse Kinderepilepsie Onderzoek (zhko) de behandelingstrategie en het resultaat.

It is not known how many children with epilepsy may not need treatment with antiepileptic drugs (AEDs), how many respond unsatisfactorily to subsequent treatment regimens, and how many achieve "acceptable control" despite lack of remission. In a prospective multicenter hospital-based study, 494 children with a broad range of seizure types and types...

Coactivation of the ulnar nerve at the wrist can be a source of error in tests for carpal tunnel syndrome (CTS). We compared the effects of coactivation in two tests for CTS: the abductor pollicis brevis-distal motor latency (APB-DML) and lumbrical-interosseus-distal motor latency difference (2LI-DML). We studied 33 hands of 25 consecutive patients...

Parents and doctors impose restrictions on children with epilepsy to avoid seizure-related injuries. We intended to quantify disability due to such restrictions by using a newly developed parent-completed 10-item scale (The Hague Restrictions in Childhood Epilepsy Scale, HARCES). Parents reported disability on at least one item of the HARCES in 83%...

In an open, randomized cross-over study in 124 patients, we compared the efficacy, safety and patient preference of oral and subcutaneous sumatriptan in the acute treatment of migraine. Patients were treated for 3 attacks or 3 months and then crossed over. Primary clinical efficacy was defined as a reduction in headache severity on a four-point sel...

To assess the diagnostic yield of a repeated EEG (REPEEG) after partial sleep deprivation (SD) in children and adolescents with one or more seizures who previously had had a standard EEG (STDEEG) without epileptiform abnormalities (EAs). In the literature, 32-75% of such REPEEGs after SD were reported to show EA. In a prospective, multicentred stud...

We wished to compare a parent-completed scale quantifying seizure severity (SS) in children with various seizure types with the clinicians' impression of SS and other clinical data. The parents of 117 children with recurrent seizures completed a 13-item, subjective scale (The Hague Seizure Severity Scale, HASS). Eight treating neurologists quantifi...

During the past decade, several scales have been developed to improve the assessment of outcome in epilepsy. These scales were developed for adults and their reliability, validity and usefulness have been established. However, there is also a need for alternative measures of outcome in childhood epilepsy, especially a measure of seizure severity (S...

We have developed two outcome measures for childhood epilepsy: a seizure severity (SS) scale and a side-effects (SE) scale. Both scales have been designed for completion by parents. The scales were tested in two pilot phases and the results of this stepwise analysis are described here. The final scales' psychometric properties were assessed in a gr...