BACKGROUND AND AIMS: The relationship between anti-epileptic usage and oxidative damage has not yet been clearly understood. In this study, researchers investigated oxidative stress parameters, carnitine levels, liver function tests (LFT) and their relationship in epileptic children treated with valproic acid or levetiracetam.

METHOD: LFTs, serum free carnitine and oxidative damage markers and their relations with each other were determined in patients who are on valproic acid or levetiracetam treatment at least for 6 months. 25 patients on therapeutic doses of valproic acid, 26 patients on therapeutic doses of levetiracetam and 26 healthy volunteers as controls were included. LFTs, ammonia, carnitine, lipid peroxidation biomarker malondialdehyde (MDA) and a sensitive marker of DNA damage, 8-hydroxy-2-deoxyguanosine (8-OHdG) levels were measured. Results of patients are compared to healthy controls. The data is evaluated with IBM SPSS Statistics 22.0.

RESULTS: Ammonia and MDA levels were elevated in patients using levetiracetam; 8-OHdG levels were elevated in both patient groups. Carnitine levels were significantly low in patients under valproic acid therapy, however they were not found to be correlated with MDA, 8-OHdG or LFTs. MDA showed positive correlation with ammonia and 8-OHdG in the levetiracetam group.

CONCLUSION: The researchers did not observe hepatotoxicity in patients under therapeutic doses of valproic acid. However, epileptic children under therapeutic doses of levetiracetam showed significantly elevated levels of MDA and 8-OHdG, which is supportive for oxidative damage under levetiracetam therapy. This result was observed for the first time in childhood epilepsies and further studies are needed to understand its mechanism.

In this prospective study of children with Lennox-Gastaut syndrome receiving clobazam as adjunctive therapy, researchers tested medication efficacy as it relates to seizure reduction as well as improvement in the behavior and quality of life (QOL) reported by parents.

In this 6-week, 4 phase study, they involved 10 patients with Lennox-Gastaut syndrome (aged 3-11 years). Patients exhibited improvement on indices of QOL, including physical activities, well-being, cognition, social activities, behavior, general health, and overall QOL.

The Quality of Life in Childhood Epilepsy (QOLCE) questionnaire showed significant improvement in cognition, social activities, behavior, and overall QOL. An improvement was observed in all patients with documented baseline seizures (8/10), with 5 showing significant improvement (95%-100% reduction) and 3 showing minor improvement (7%-23% reduction). In patients with clobazam, an overall trend towards positive well-being was seen as an adjunct therapy in children for Lennox-Gastaut syndrome.

PURPOSE: To systematically evaluate the duration of focal onset seizures under medication withdrawal as a function of drug half-life.

METHODS: Adults with drug resistant focal epilepsy and invasive electroencephalographic (iEEG) recording between 01/2006 and 06/2016 (n = 128) were identified. Patients with multifocal or unknown epileptic foci were excluded, as well as subclinical seizures, isolated auras, or status epileptic. Antiepileptic drugs (AEDs) were withdrawn upon admission. The seizure duration was determined based on the invasive EEG data, and the latency since start of the monitoring was noted in hours. A negative binomial mixed model was used to compare the seizure durations before and after a cut-off, which was set at 2.5 half-lives of the individual anticonvulsive medication as this is thought to separate therapeutic and ineffective drug levels.

RESULTS: In total, 70 patients were included in the study and the duration of 672 seizures analyzed. On average, the patients were treated with 2.36 ± 0.78 AEDs. The individual cut-off of 2.5 half-lives was on average reached after 95.02 ± 80.18 h. The seizure frequency (321 vs. 351) and the rate of generalization (15.6% vs. 16.8%) was comparable before and after the individual cut-off point. The mean seizure duration was not statistically significantly prolonged after 2.5 half-lives by a factor of 1.168 for focal onset seizures (p = 0.090) and a factor of 1.091 for secondary generalized seizures (p = 0.545).

CONCLUSIONS: Although AED withdrawal increases the likelihood for epileptic seizures, it did not prolong the seizure duration, nor did it increase the rate of secondary generalization in this study.

Children with drug-resistant focal epilepsy and focal cortical dysplasia who undergo complete resection of Morphometric Analysis Program (MAP)-positive regions are more likely to experience seizure-free outcomes compared with children who receive no or partial resection, according to a study published in the European Journal of Neurology.

Using a 2002 to 2015 surgical database, researchers included a consecutive cohort of pediatric patients with drug-resistant focal epilepsy and focal cortical dysplasia who underwent epilepsy surgery before 21 years of age, had a preoperative 1.5T or 3T MRI, had a negative presurgical MRI, and had 12 or more months of postsurgical follow-up data (n=78).

MAP on T1-weighted volumetric MRI was used to perform MRI postprocessing, and the researchers compared these data with an age-specific normal pediatric population (n=370). Surgical outcome and pathology data were also used to confirm the pertinence of MAP-positive areas.

Approximately 56% of patients (n=44) demonstrated positive MAP regions. In the 3- to 5-year, 5- to 10-year, 10- to 15-year, and 15- to 21-year-old age groups, the MAP-positive rates were 100% (2 of 2), 77% (13 of 17), 63% (15 of 24), and 40% (14 of 35), respectively. Approximately 45% of patients with temporal resection and 63% of patients with extratemporal resection had MAP-positive rates. Compared with patients with no or partial resection of the MAP-positive regions, patients who received complete resection of MAP-positive regions were more likely to experience a seizure-free outcome (P <.001).

A Grayling-area man is the first in Michigan with a complete Deep Brain Stimulation (DBS) system surgically implanted for the treatment of epilepsy. Neurosurgeon Jason Schwalb, MD, with help from the team at the Henry Ford Comprehensive Epilepsy Center, implanted targeted electrodes in 32-year-old Steven Rennie’s brain on Feb. 12, and a pacemaker-like device known as an internal pulse generator in his chest on Feb. 28.  

The electrodes are attached to the internal pulse generator, their power source, via thin extension cords below the skin. Together, these components make a complete DBS system – something that provides hope for Rennie, who has not seen a significant reduction in symptoms from other epilepsy treatments.

Objective: Depression and anxiety are highly prevalent among people with epilepsy (PwE) but often remain unrecognized and treated inadequately. Effective psychosocial treatments such as cognitive behavioral therapy (CBT) are rarely available to most PwE, which is one reason electronically delivered CBT (eCBT) is regarded as promising. This study examined an eCBT intervention, termed Emyna, that was tailored to suit the needs of PwE. It includes CBT?related content on depression, stress and anxiety, seizure triggers and auras, and lifestyle habits. The trial examined the efficacy of Emyna in reducing symptoms of depression (primary outcome) and anxiety as well as improving quality of life.

Methods: Participants (N = 200) with epilepsy, a diagnosis of a depressive disorder, and at least moderate depressive symptoms were randomized to Emyna or care as usual. At baseline and after 3, 6, and 9 months, participants were invited to complete online questionnaires. The primary outcome was improvement of depressive symptoms at 3 months.

Results: Relative to the control group, intervention group participants experienced significantly greater improvements in depression, anxiety, stress, social?occupational impairment, and epilepsy?related quality of life, in both intention?to?treat (ITT) and per?protocol analyses. In ITT analyses, effects of medium magnitude were observed, as measured by the Patient Health Questionnaire–9 items (Cohen d = 0.54, 95% confidence interval [CI] = 0.25-0.82, P < 0.001) and the Neurological Disorders Depression Inventory for Epilepsy (d = 0.51, 95% CI = 0.23?0.79, P < 0.01). At 3 months, intervention group participants also reported fewer illness?related days off work and fewer days hospitalized over the preceding months, compared to control group participants, whereas no such differences were present at baseline (P > 0.30).

Significance: These findings showed that Emyna, used adjunctively to usual care, could help improve mental health, social?occupational functioning, and quality of life among people with epilepsy. The program provides an additional treatment option that could produce clinically relevant symptom reductions and reduce key cost drivers (ie, hospitalization rates and illness?related inability to work).