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2 results

  • Four - 1970–1995: Epilepsy in a Globalised World

  • from Section 2 - ‘A Plague upon Your Epileptic Visage’
  • Simon D. Shorvon, Institute of Neurology, University College London
  • Book:
    The Idea of Epilepsy
    Published online:
    13 January 2023
    Print publication:
    02 February 2023, pp 396-497

  • Summary

    The basic science of epilepsy made fundamental advances in this period, with the discovery of GABA as the chief inhibitory transmitter and glutamate as the chief excitatory transmitter involved in epilepsy. This spurred intensive research by the pharmaceutical companies and the introduction of a range of new drug treatments, although none were shown to be of superior efficacy to those already existing. Extraordinary progress was made also in the basic science of genetics, although this did not feed into clinical epilepsy. The major investigational advances were CT and then MRI scanning, which transformed clinical practice in epilepsy, and also EEG technologies allowing prolonged monitoring and video-EEG correlation. The number of clinical researchers in epilepsy greatly increased, stimulated by changing university and hospital priorities and the technological advances of the computing era. Advances were made in many clinical fields in epilepsy, including epidemiology, paediatrics, epilepsy syndromes, febrile convulsions and their relationship to temporal lobe epilepsy, SUDEP and status epilepticus. Aided by therapeutic drug monitoring, antiseizure drug monotherapy became commonplace. New drugs and new surgical techniques were introduced. An attempt was made to federate ILAE and IBE under the umbrella of a new organisation, Epilepsy International, but this failed.

  • Neurophysiological investigations for the diagnosis of non-epileptic attack disorder in neuropsychiatry services: from safety standards to improved effectiveness

  • Andrea E. Cavanna, Stefano Seri
  • Journal:
    Acta Neuropsychiatrica / Volume 28 / Issue 4 / August 2016
    Published online by Cambridge University Press:
    23 March 2016, pp. 185-194
  • Objective

    The discipline of clinical neuropsychiatry currently provides specialised services for a number of conditions that cross the traditional boundaries of neurology and psychiatry, including non-epileptic attack disorder. Neurophysiological investigations have an important role within neuropsychiatry services, with video-electroencephalography (EEG) telemetry being the gold standard investigation for the differential diagnosis between epileptic seizures and non-epileptic attacks. This article reviews existing evidence on best practices for neurophysiology investigations, with focus on safety measures for video-EEG telemetry.

    Methods

    We conducted a systematic literature review using the PubMed database in order to identify the scientific literature on the best practices when using neurophysiological investigations in patients with suspected epileptic seizures or non-epileptic attacks.

    Results

    Specific measures need to be implemented for video-EEG telemetry to be safely and effectively carried out by neuropsychiatry services. A confirmed diagnosis of non-epileptic attack disorder following video-EEG telemetry carried out within neuropsychiatry units has the inherent advantage of allowing diagnosis communication and implementation of treatment strategies in a timely fashion, potentially improving clinical outcomes and cost-effectiveness significantly.

    Conclusion

    The identified recommendations set the stage for the development of standardised guidelines to enable neuropsychiatry services to implement streamlined and evidence-based care pathways.