Literature Monitor

Although invasive procedures like cortical stimulation mapping and the Wada test have traditionally been employed to determine the location of motor and language-related areas of the brain prior to ablative epilepsy surgery, a recent review of noninvasive procedures suggests several may have merit. Papanicolaou et al outline the value of magnetoencephalography, functional magnetic resonance imaging, and transcranial magnetic stimulation to accomplish the same purpose and explain the rationale and conditions in which these approaches may be worth considering.

Papanicolaou AC, Rezaie R, Narayana S et al. On the relative merits of invasive and non-invasive pre-surgical brain mapping: New tools in ablative epilepsy surgery [published online ahead of print July 3, 2017]. Epilepsy Res. 2017; doi: 10.1016/j.eplepsyres.2017.07.002.

Although invasive procedures like cortical stimulation mapping and the Wada test have traditionally been employed to determine the location of motor and language-related areas of the brain prior to ablative epilepsy surgery, a recent review of noninvasive procedures suggests several may have merit. Papanicolaou et al outline the value of magnetoencephalography, functional magnetic resonance imaging, and transcranial magnetic stimulation to accomplish the same purpose and explain the rationale and conditions in which these approaches may be worth considering.

Papanicolaou AC, Rezaie R, Narayana S et al. On the relative merits of invasive and non-invasive pre-surgical brain mapping: New tools in ablative epilepsy surgery [published online ahead of print July 3, 2017]. Epilepsy Res. 2017; doi: 10.1016/j.eplepsyres.2017.07.002.

Although invasive procedures like cortical stimulation mapping and the Wada test have traditionally been employed to determine the location of motor and language-related areas of the brain prior to ablative epilepsy surgery, a recent review of noninvasive procedures suggests several may have merit. Papanicolaou et al outline the value of magnetoencephalography, functional magnetic resonance imaging, and transcranial magnetic stimulation to accomplish the same purpose and explain the rationale and conditions in which these approaches may be worth considering.

Papanicolaou AC, Rezaie R, Narayana S et al. On the relative merits of invasive and non-invasive pre-surgical brain mapping: New tools in ablative epilepsy surgery [published online ahead of print July 3, 2017]. Epilepsy Res. 2017; doi: 10.1016/j.eplepsyres.2017.07.002.

Patients who have seizures while asleep are more likely to experience severe and longer episodes of hypoxemia compared with seizures while awake according to an examination of 48 recorded seizures from 20 adults with epilepsy. The analysis also suggested that an increased risk of sudden death may be caused by hypoxemia from nocturnal seizures.

Latreille V, Abdennadher M, Dworetzky BA et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression [published online ahead of print July 17, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13841.

Patients who have seizures while asleep are more likely to experience severe and longer episodes of hypoxemia compared with seizures while awake according to an examination of 48 recorded seizures from 20 adults with epilepsy. The analysis also suggested that an increased risk of sudden death may be caused by hypoxemia from nocturnal seizures.

Latreille V, Abdennadher M, Dworetzky BA et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression [published online ahead of print July 17, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13841.

Patients who have seizures while asleep are more likely to experience severe and longer episodes of hypoxemia compared with seizures while awake according to an examination of 48 recorded seizures from 20 adults with epilepsy. The analysis also suggested that an increased risk of sudden death may be caused by hypoxemia from nocturnal seizures.

Latreille V, Abdennadher M, Dworetzky BA et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression [published online ahead of print July 17, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13841.

A combination of metabolites and genomic indicators hold promise as a noninvasive biomarker for epilepsy suggests a recent study published in Epilepsia. Wu et al found that a metabolomic-genomic signature that included reduced lactate and increased creatine plus phosphocreatine and choline was able to predict the existence of an altered metabolic state in epileptic brain regions, suggesting it may eventually be an alternative to surgically invasive approaches to diagnosis.

Wu HC, Dachet F, Ghoddoussi F, et al. Altered metabolomic-genomic signature: a potential noninvasive biomarker of epilepsy [published online ahead of print July 17, 2017]. Epilepsia. 2017; doi: 10.1111/epi.13848.

A combination of metabolites and genomic indicators hold promise as a noninvasive biomarker for epilepsy suggests a recent study published in Epilepsia. Wu et al found that a metabolomic-genomic signature that included reduced lactate and increased creatine plus phosphocreatine and choline was able to predict the existence of an altered metabolic state in epileptic brain regions, suggesting it may eventually be an alternative to surgically invasive approaches to diagnosis.

Wu HC, Dachet F, Ghoddoussi F, et al. Altered metabolomic-genomic signature: a potential noninvasive biomarker of epilepsy [published online ahead of print July 17, 2017]. Epilepsia. 2017; doi: 10.1111/epi.13848.

A combination of metabolites and genomic indicators hold promise as a noninvasive biomarker for epilepsy suggests a recent study published in Epilepsia. Wu et al found that a metabolomic-genomic signature that included reduced lactate and increased creatine plus phosphocreatine and choline was able to predict the existence of an altered metabolic state in epileptic brain regions, suggesting it may eventually be an alternative to surgically invasive approaches to diagnosis.

Wu HC, Dachet F, Ghoddoussi F, et al. Altered metabolomic-genomic signature: a potential noninvasive biomarker of epilepsy [published online ahead of print July 17, 2017]. Epilepsia. 2017; doi: 10.1111/epi.13848.

Intracranial deep brain stimulation (DBS) may offer some benefit to patients with epilepsy who do not respond to more conservative therapy, but most of the evidence comes from short-term randomized controlled trials, according to a recent review from the Cochrane Library. Experts concluded that anterior thalamic DBS, responsive ictal onset zone stimulation, and hippocampal DBS can reduce the frequency of seizures in patients with refractory epilepsy.

Sprengers M, Vonck K, Carrette E, Marson AG, Boon P. Deep brain and cortical stimulation for epilepsy. Cochrane Database Syst Rev. 2017 Jul 18;7:CD008497.

Intracranial deep brain stimulation (DBS) may offer some benefit to patients with epilepsy who do not respond to more conservative therapy, but most of the evidence comes from short-term randomized controlled trials, according to a recent review from the Cochrane Library. Experts concluded that anterior thalamic DBS, responsive ictal onset zone stimulation, and hippocampal DBS can reduce the frequency of seizures in patients with refractory epilepsy.

Sprengers M, Vonck K, Carrette E, Marson AG, Boon P. Deep brain and cortical stimulation for epilepsy. Cochrane Database Syst Rev. 2017 Jul 18;7:CD008497.

Intracranial deep brain stimulation (DBS) may offer some benefit to patients with epilepsy who do not respond to more conservative therapy, but most of the evidence comes from short-term randomized controlled trials, according to a recent review from the Cochrane Library. Experts concluded that anterior thalamic DBS, responsive ictal onset zone stimulation, and hippocampal DBS can reduce the frequency of seizures in patients with refractory epilepsy.

Sprengers M, Vonck K, Carrette E, Marson AG, Boon P. Deep brain and cortical stimulation for epilepsy. Cochrane Database Syst Rev. 2017 Jul 18;7:CD008497.

A better understanding of the relationship between psychiatric disorders and epilepsy is needed to help clinicians and researchers find the best treatment options, and to avoid the many misconceptions that currently exist. In a recent critical review, Berg et al address the biases in the literature and the diagnostic errors that may occur because of the difficulty in distinguishing psychogenic nonepileptic seizures from epilepsy.

Berg AT, Altalib HH, Devinsky O. Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal. Epilepsia. 2017;58:1123-1130.

A better understanding of the relationship between psychiatric disorders and epilepsy is needed to help clinicians and researchers find the best treatment options, and to avoid the many misconceptions that currently exist. In a recent critical review, Berg et al address the biases in the literature and the diagnostic errors that may occur because of the difficulty in distinguishing psychogenic nonepileptic seizures from epilepsy.

Berg AT, Altalib HH, Devinsky O. Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal. Epilepsia. 2017;58:1123-1130.

A better understanding of the relationship between psychiatric disorders and epilepsy is needed to help clinicians and researchers find the best treatment options, and to avoid the many misconceptions that currently exist. In a recent critical review, Berg et al address the biases in the literature and the diagnostic errors that may occur because of the difficulty in distinguishing psychogenic nonepileptic seizures from epilepsy.

Berg AT, Altalib HH, Devinsky O. Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal. Epilepsia. 2017;58:1123-1130.

Every patient who is initially diagnosed with epilepsy should also be evaluated for coexisting psychiatric problems, according to Andres Kanner with the Department of Neurology, University of Miami School of Medicine. Kanner noted that psychiatric comorbidities often existed in patients before they were diagnosed with a seizure. That, coupled with the fact that drug therapy and surgery for epilepsy often cause psychiatric symptoms, is part of the justification for conducting these evaluations.

Kanner AM. Psychiatric comorbidities in new onset epilepsy: Should they be always investigated? Seizure. 2017;49:79-82.

Every patient who is initially diagnosed with epilepsy should also be evaluated for coexisting psychiatric problems, according to Andres Kanner with the Department of Neurology, University of Miami School of Medicine. Kanner noted that psychiatric comorbidities often existed in patients before they were diagnosed with a seizure. That, coupled with the fact that drug therapy and surgery for epilepsy often cause psychiatric symptoms, is part of the justification for conducting these evaluations.

Kanner AM. Psychiatric comorbidities in new onset epilepsy: Should they be always investigated? Seizure. 2017;49:79-82.

Every patient who is initially diagnosed with epilepsy should also be evaluated for coexisting psychiatric problems, according to Andres Kanner with the Department of Neurology, University of Miami School of Medicine. Kanner noted that psychiatric comorbidities often existed in patients before they were diagnosed with a seizure. That, coupled with the fact that drug therapy and surgery for epilepsy often cause psychiatric symptoms, is part of the justification for conducting these evaluations.

Kanner AM. Psychiatric comorbidities in new onset epilepsy: Should they be always investigated? Seizure. 2017;49:79-82.

Although a recent analysis of adverse effects (AEs) found differences between AEs reported for generic versions compared with brand name versions of the 3 common antiepileptic drugs (AEDs), when approved generic formulations were compared to unapproved generics, reporting odds ratios were similar for authorized generic AEDs and generic AEDs. The researchers concluded that the differences were the result of perception biases. There were differences in drug AE reports of suicide and suicide ideation between authorized generic and brand name drugs that could not be explained by bias.

Rahman MM, Alatawi Y, Cheng N, et al. Comparison of brand versus generic antiepileptic drug adverse event reporting rates in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) [published online June 3, 2017]. Epilepsy Res. doi: http://dx.doi.org/10.1016/j.eplepsyres.2017.06.007

Although a recent analysis of adverse effects (AEs) found differences between AEs reported for generic versions compared with brand name versions of the 3 common antiepileptic drugs (AEDs), when approved generic formulations were compared to unapproved generics, reporting odds ratios were similar for authorized generic AEDs and generic AEDs. The researchers concluded that the differences were the result of perception biases. There were differences in drug AE reports of suicide and suicide ideation between authorized generic and brand name drugs that could not be explained by bias.

Rahman MM, Alatawi Y, Cheng N, et al. Comparison of brand versus generic antiepileptic drug adverse event reporting rates in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) [published online June 3, 2017]. Epilepsy Res. doi: http://dx.doi.org/10.1016/j.eplepsyres.2017.06.007

Although a recent analysis of adverse effects (AEs) found differences between AEs reported for generic versions compared with brand name versions of the 3 common antiepileptic drugs (AEDs), when approved generic formulations were compared to unapproved generics, reporting odds ratios were similar for authorized generic AEDs and generic AEDs. The researchers concluded that the differences were the result of perception biases. There were differences in drug AE reports of suicide and suicide ideation between authorized generic and brand name drugs that could not be explained by bias.

Rahman MM, Alatawi Y, Cheng N, et al. Comparison of brand versus generic antiepileptic drug adverse event reporting rates in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) [published online June 3, 2017]. Epilepsy Res. doi: http://dx.doi.org/10.1016/j.eplepsyres.2017.06.007

The likelihood of experiencing a recurrent seizure is closely linked to a person’s stress level, according to a recent study that looked at 52 individuals with a single unprovoked seizure and 29 with newly diagnosed epilepsy. The researchers, who looked at adult residents in low-income areas of Northern Manhattan and Harlem, New York City, found that generalized anxiety disorder increased the risk of a recurrent seizure threefold. In a second analysis, a mood disorder more than doubled the risk of a recurrent seizure.    

Baldin E, Hauser WS, Pack A, Hesdorffer DC. Stress is associated with an increased risk of recurrent seizures in adults. Epilepsia. 2017;58:1037-1046.

The likelihood of experiencing a recurrent seizure is closely linked to a person’s stress level, according to a recent study that looked at 52 individuals with a single unprovoked seizure and 29 with newly diagnosed epilepsy. The researchers, who looked at adult residents in low-income areas of Northern Manhattan and Harlem, New York City, found that generalized anxiety disorder increased the risk of a recurrent seizure threefold. In a second analysis, a mood disorder more than doubled the risk of a recurrent seizure.    

Baldin E, Hauser WS, Pack A, Hesdorffer DC. Stress is associated with an increased risk of recurrent seizures in adults. Epilepsia. 2017;58:1037-1046.

The likelihood of experiencing a recurrent seizure is closely linked to a person’s stress level, according to a recent study that looked at 52 individuals with a single unprovoked seizure and 29 with newly diagnosed epilepsy. The researchers, who looked at adult residents in low-income areas of Northern Manhattan and Harlem, New York City, found that generalized anxiety disorder increased the risk of a recurrent seizure threefold. In a second analysis, a mood disorder more than doubled the risk of a recurrent seizure.    

Baldin E, Hauser WS, Pack A, Hesdorffer DC. Stress is associated with an increased risk of recurrent seizures in adults. Epilepsia. 2017;58:1037-1046.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

A tiered grading system may help determine which patients with drug-resistant epilepsy are most likely to have resective surgery and become free of seizures. The Epilepsy Surgery Grading Scale used in the study consisted of 3 tiers and included MRI, electroencephalography, concordance between the MRI and EEG, semiology, and IQ. Using the grading system, investigators detected a significant difference between Grade 1 patients, who had a most favorable rating, and Grade 3, who had been classified as least favorable candidates for surgery.

Dugan P, Carlson C, Jette N, et al. Derivation and initial validation of a surgical grading scale for preliminary evaluation of adult patients with drug-resistant focal epilepsy [published online April 4, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13730.

A tiered grading system may help determine which patients with drug-resistant epilepsy are most likely to have resective surgery and become free of seizures. The Epilepsy Surgery Grading Scale used in the study consisted of 3 tiers and included MRI, electroencephalography, concordance between the MRI and EEG, semiology, and IQ. Using the grading system, investigators detected a significant difference between Grade 1 patients, who had a most favorable rating, and Grade 3, who had been classified as least favorable candidates for surgery.

Dugan P, Carlson C, Jette N, et al. Derivation and initial validation of a surgical grading scale for preliminary evaluation of adult patients with drug-resistant focal epilepsy [published online April 4, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13730.

A tiered grading system may help determine which patients with drug-resistant epilepsy are most likely to have resective surgery and become free of seizures. The Epilepsy Surgery Grading Scale used in the study consisted of 3 tiers and included MRI, electroencephalography, concordance between the MRI and EEG, semiology, and IQ. Using the grading system, investigators detected a significant difference between Grade 1 patients, who had a most favorable rating, and Grade 3, who had been classified as least favorable candidates for surgery.

Dugan P, Carlson C, Jette N, et al. Derivation and initial validation of a surgical grading scale for preliminary evaluation of adult patients with drug-resistant focal epilepsy [published online April 4, 2017]. Epilepsia. 2017;doi: 10.1111/epi.13730.