Epilepsy evidence

Mikati M, Erba G, Skouteli H, Gadia C. Pharmacokinetic study of allopurinol in resistant epilepsy evidence for significant drug interactions. Neurology (1990) 40 (Suppl 1), 138. 

Cendes, F., Andermann, F., Dubeau, F., Matthews, P.M., and Arnold, D.L. 1997. Normalization of neuronal metabolic dysfunction after surgery for temporal lobe epilepsy. Evidence from proton MR spectroscopic imaging. Neurology 49(6) 1525-1533... 

NTs it is now appropriate to consider what evidence there is for a malfunction of NT activity in epilepsy, particularly in those responsible for primary excitation and inhibition, i.e. the amino acids. Before doing so the epileptogenesis of absence seizures (petit mal) justifies separate consideration. 

Other NTs have been implicated in the aetiology of epilepsy but direct evidence is lacking. They will be considered briefly. 

That the hippocampus is important for memory is generally accepted. This is not because it is a site of major degeneration in AzD, that finding can only be used to account for the memory loss if memory is known to be dependent on the hippocampus, but because lesions of that region are known to impair memory. Case reports in the medical literature are rightly mistrusted but few people have felt inclined to disregard the evidence presented by one 27-year-old male mechanic who underwent bilateral hippocampal removal for intractable epilepsy in Montreal in 1953. While that condition was improved the operation has not been repeated because memory loss was almost total, so while he appeared to behave reasonably normally (and still does), he cannot remember where he lives, what he has just eaten or the person he met a few minutes previously. 

TABLE 27-2. Evidence-Based Guidelines for Initial Monotherapy Treatment of Epilepsy... 

Several other herbs have weaker evidence for CNS depressant effects, but hold potential for further research and evaluation. Certain herbs have also had historical use for treating epilepsy, before the invention of several modern, very effective synthetic antiseizure medications. There is, at present, absolutely no evidence that the CNS depressant herbs will be effective or sufficient in the treatment of epilepsy. Much further research would be needed to support this contention. Further, withdrawal of current antiseizure medications would put an individual at high risk for recurrence or worsening of seizures. 

Molindone (Moban). Molindone is another of the medinm potency antipsychotics. There are two featnres that set it apart. First, it is less prone to cansing weight gain than other antipsychotics. As a result, it is sometimes preferred for obese schizophrenia patients. Second, although typical antipsychotics do not necessarily cause seizures, they may make them more likely to occur in people who are already prone to seizures. There is some evidence to suggest that molindone may be the least likely antipsychotic to increase the vulnerability to seizures. For this reason, molindone is frequently used to treat patients with schizophrenia who also have epilepsy. 

In addition to epilepsy, reduced GABA has been recorded in patients with unipolar depression, following alcohol withdrawal and in hepatic encephalopathy. The finding that the concentration of GABA is reduced in depression is unexpected as there is no evidence that the disorder is associated with an increased cortical excitability. One possibility is that the reduction in GABA is a reflection of a decreased availability in its excitatory amino acid precursor glutamate. 

Epilepsy is a chronic brain disease of diverse etiology it is characterized by recurrent paroxysmal episodes of uncontrolled excitation of brain neurons. Involving larger or smaller parts of the brain, the electrical discharge is evident in the electroencephalogram (EEG) as synchronized rhythmic activity and manifests itself in motor, sensory, psychic, and vegetative (visceral) phenomena Because both the affected brain region and the cause of abnormal excitability may differ, epileptic seizures can take many forms. Erom a pharmaco-therapeutic viewpoint, these may be classified as ... 

Chemical plant workers chronically exposed to 6-12 ppm developed headache, vertigo, nervousness, sleeplessness, nausea, and vomiting. Similar symptoms have occurred in workers repeatedly exposed to 125 ppm in some cases, lower abdominal or back discomfort with urinary frequency was observed without associated evidence of liver or kidney damage. Serious liver and kidney injury has been reported after oral administration of 1.8-2.5ml of pyridine daily for 2 months in the treatment of epilepsy. Skin irritation may result from prolonged or repeated contact with the chemical. 

Hypomania Hypomania has been the most common severe psychiatric side effect reported. This has been largely limited to patients in whom disorders characterized by hyperkinetic symptoms coexist with, but are obscured by, depressive affect. Diabetes There is conflicting evidence as to whether MAOIs affect glucose metabolism or potentiate hypoglycemic agents. Consider this if used in diabetics. Epilepsy The effect of MAOIs on the convulsive threshold may vary. Do not use with metrizamide discontinue MAOl 48 hours or more prior to myelography and resume 24 hours postprocedure. 

An other Cochrane review of nine trials representing 1049 randomized patients concludes Top-iramate has efficacy as an add-on treatment in patients with drug resistant partial epilepsy. However, trials reviewed were of relatively short duration, and provide no evidence for the long term efficacy of top-iramate. Results cannot be extrapolated to monotherapy or patients with other epilepsy types . 

As with several other AEDs, it is difficult to ascribe a single mechanism of action to valproic acid. This compound has broad anticonvulsant activity, both in experimental studies and in the therapeutic management of human epilepsy. Valproic acid has been shown to block voltage-dependent sodium channels at therapeutically relevant concentrations. In several experimental studies, valproate caused an increase in brain GABA the mechanism was unclear. There is evidence that valproate... 

Brodie, M.J. and Yuen, A.W (1997) Lamotrigine substitution study evidence for synergism with sodium valproate 105 Study Group. Epilepsy Res 26 423 32. 

Kastner et al. (1993) evaluated valproic acid in 18 children and adults (mean age, 19.7 years) with self-injury or aggression, irritability, sleep disorder, and evidence of cycling. Fourteen (78%) responded positively as assessed by the CGI in this uncontrolled study. The authors found that 11 subjects with established or suspected epilepsy responded significantly better than participants with no evidence of epilepsy. 

Various religious prophets such as Saint Paul, Ezekiel, and Mohammed may have suffered from epileptic seizures. Recently, several nuns with temporal lobe epilepsy (TLE) have provided evidence that TLE is the root of many mystical religious experiences. For example, one former nun apprehended God in TLE seizures and described the experience ... 

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