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6 results

  • Epilepsy and Pregnancy: An Audit of Specialized Care

  • Jimmy Li, Dènahin Hinnoutondji Toffa, Dang Khoa Nguyen
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 49 / Issue 5 / September 2022
    Published online by Cambridge University Press:
    06 August 2021, pp. 678-687
    • Article
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  • Background:

    Caring for women with epilepsy (WWE) during pregnancy poses unique challenges. We conducted an audit of the care our epilepsy clinic provided to pregnant WWE.

    Methods:

    We performed a retrospective study on all pregnancies followed by an epileptologist at a Canadian tertiary care centre’s epilepsy clinic between January 2003 and March 2021. Among 81 pregnancies in 53 patients, 72 pregnancies in 50 patients were analyzed to determine patient-related, follow-up-related, antiseizure-medication-related, and child-related pregnancy characteristics. Univariate analyses were performed to explore if these characteristics were associated with disabling seizure occurrence during pregnancy.

    Results:

    Most pregnancies were intended (72%) and occurred in women who used folic acid pre-pregnancy (76%) and who followed recommended blood tests for antiseizure medication (ASM) levels (71%). In 49% of pregnancies, ASM dosage was modified; 53% of these modifications were made in response to ASM blood levels. Most often used ASMs were lamotrigine (43%), followed by carbamazepine (32%) and levetiracetam (13%). One child was born with a thyroglossal duct cyst; our congenital malformation rate was thus 2%. Disabling seizures occurred in 24% of pregnancies. Exploratory analyses suggested that disabling seizure occurrence during pregnancy was associated with younger patient age (p = 0.018), higher number of ASMs used during pregnancy (p = 0.048), lamotrigine usage in polytherapy (p = 0.008), and disabling seizure occurrence pre-pregnancy (p = 0.027).

    Conclusion:

    This Canadian audit provides an in-depth description of pregnancies benefiting from specialized epilepsy care. Our results suggest an association between disabling seizure occurrence during pregnancy and lamotrigine usage in polytherapy that warrants further evaluation.

  • Chapter 71 - Neurocysticercosis

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 495-500

  • Summary

    Hippocampal sclerosis (HS) has been recognized as the most commonly encountered pathological substrate of mesial temporal lobe epilepsy (MTLE). The pathological condition was initially described by early neuropathologists based on postmortem material. Studies in familial MTLE are also important for better understanding of the pathogenesis of HS. HS identified by magnetic resonance imaging (MRI) has been associated with poor medical control of seizures. Neurologic examination is usually normal except for facial asymmetry and memory deficits, which are material-specific for the side of ictal onset. Interictal electroencephalogram (EEG) findings in patients with MTLE typically include unilateral or bilaterally independent mesial temporal spikes, best seen with basal derivations. Treatment should start with a first-line antiepileptic drug (AED) in monotherapy, the dose of which is increased until seizure freedom or the occurrence of side effects such as tiredness, dizziness, diploplia, or gait disturbance.

  • Chapter 61 - Non-accidental brain injury

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 425-432

  • Summary

    Hemimegalencephaly often presents in early infancy with either cerebral hemisphere affected, and occurs in every ethnic group and both genders. Hemimegalencephaly may be the primary etiology of several epilepsy syndromes. In Ohtahara syndrome, tonic seizures, frequently asymmetric, present early in association with a burst suppression pattern. West syndrome is another frequently encountered epilepsy type with infantile spasms present in up to 50% of patients with hemimegalencephaly. The diagnosis of hemimegalencephaly is made definitively by magnetic resonance imaging (MRI) examination; however, early detection using postnatal cranial ultrasound and computed tomography (CT) is possible. Brain single photon emission computed tomography (SPECT) imaging often reveals hypoperfusion of the malformed hemisphere in the interictal state and hyperperfusion during the ictus. The choice of antiepileptic medication rests largely on the seizure type present in each case. Anatomic or functional hemispherectomy have been employed in patients with hemimegalencephaly and both show similar rates of postoperative seizure-freedom.

  • Chapter 82 - Systemic lupus erythematosus and other collagen vascular diseases

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 579-584

  • Summary

    Gliomas are neoplasms derived from glial cell precursors. Gliomas may present with one or a combination of neurological deficits, symptoms of mass effect and seizures, usually reflecting the anatomical location of the lesion. Seizures in the context of glioma appear to confer a significant prognostic benefit. Epileptic foci are believed to develop within the cortex surrounding tumors, since the lesions themselves have no electroencephalographic (EEG) activity and are not electrically excitable. Diagnosis of a space-occupying lesion as the cause of a seizure is made usually with the aid of cross-sectional imaging. Magnetic resonance imaging (MRI), with and without gadolinium contrast, is the investigation of choice, showing a higher sensitivity and specificity than computed tomography (CT) for detecting glioma. Fractionated focal radiotherapy is a key component of adjuvant treatment, especially in high-grade lesions. Chemotherapy with temozolomide has been shown to be of seizure benefit in approximately 50% of Grade 2 gliomas.

  • Chapter 84 - Psychiatric disorders

  • from Section 3 - Symptomatic epilepsy
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 593-606

  • Summary

    The majority of tumors that present with epilepsy comprise a group of tumors that include dysembryoplastic neuroepithelial tumors (DNT), ganglioglioma, gangliocytoma, and the more recently described angiocentric glioma. This chapter focuses on these tumors and their management is predominantly focused on seizure control. The differential diagnosis includes other low-grade epilepsy-associated tumors, cortical dysplasia, and diffuse gliomas. The chapter discusses the lesions which are distinguished from the dysplastic gangliocytoma of the cerebellum and desmoplastic infantile ganglioglioma. Ganglioglioma accounts for up to 50% of all tumors in patients undergoing surgery for control of epilepsy and is the commonest tumor associated with chronic epilepsy. The goals of management are seizure control, confirmation of the radiological diagnosis, and control of tumor growth and progression. Angiocentric glioma is a low-grade cortical tumor associated with epilepsy. The differential diagnosis includes low-grade glioneuronal tumors, focal cortical dysplasia (FCD), and diffuse glioma.

  • 21 - Neurocognitive outcome in children of mothers with epilepsy

  • from Part V - Family planning, pregnancy, and parenting
    • By Kimford J. Meador, Department of Neurology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington DC 20007, USA
  • Edited by Martha J. Morrell, Columbia University, New York, Kerry L. Flynn, Columbia-Presbyterian Cancer Center, New York
  • Book:
    Women with Epilepsy
    Published online:
    02 November 2009
    Print publication:
    20 March 2003, pp 222-227

  • Summary

    This chapter reviews what one knows about the neurological and cognitive effects of antiepileptic drugs (AEDs) on the developing fetus. The combined effects and interactions of genes and the environment determine neurodevelopment. Thus, a child's neurodevelopment is affected by that child's inheritance, the mother's age at the time of pregnancy, the child's birth order, the mother's health during the pregnancy, drug exposure, obstetric complications, the nutritional status of the mother and child, childhood illnesses, social and economic status of the family, the mother's and father's educational levels, as well as the child's educational opportunities. A variety of factors may contribute to the neurodevelopmental deficits observed in the children of women with epilepsy. Children born to mothers with epilepsy have a slightly higher risk of neurodevelopmental difficulties, which can be reduced by good health practices, good seizure control, and using only as much antiepileptic medication as is necessary for seizure control.