Lamotrigine is an antiepileptic drug with a broad spectrum. Although the drug is safe, it sometimes has certain side effects that may limit its usage. Here, we present the case of a patient who stopped using lamotrigine due to the hallucination side effect, which is very rare.
Objective: (a) To assess the control of glioblastoma-associated seizure in patients receiving different anti-epileptic drugs and chemotherapies after total resection and its association with O-methylguanine-DNA methyltransferase (MGMT) promotor methylation and the isocitrate dehydrogenase 1 (IDH1) mutation; (b) to determine which anti-epileptic drug exerts the best effective control on glioblastoma-associated epilepsy; (c) to identify the relationship between seizure control and different anti-epileptic drugs and recurrence interval. Methods: This was a retrospective cohort study of patients with postoperative glioblastoma-associated epilepsy in the period between 2014 and 2019. The correlations between the IDH1 mutation and MGMT promotor methylation with anti-epileptic drugs, chemotherapy type, seizure control, and recurrence interval were analyzed using different statistical methods. Results: This study included 53 adult patients with glioblastoma-associated epilepsy. The IDH1 mutation was present in 20 patients, and MGMT promotor methylation was present in 13 patients. Out of 53 patients, 37 cases received chemoradiotherapy while 16 cases receive only radiotherapy. Levetiracetam was the most prescribed anti-epileptic drug (n= 36, 60%), and 36 and 16 patients had controlled and uncontrolled seizures, respectively. The IDH1 mutation and unmethylated MGMT promotor were significantly present in cases with controlled epilepsy (P < 0.05). Among the anti-epileptic drugs, levetiracetam showed significantly better seizure control in cases with the IDH1 mutation and unmethylated MGMT promotor (P < 0.05). Patients did not show significant differences in either seizure control or the tumor recurrence interval (P > 0.05).Conclusion: (a) Glioblastoma-associated epilepsy can be better controlled in patients with the IDH1 mutation and unmethylated MGMT promotor compared with patients with the methylated MGMT promotor, (b) Levetiracetam is considered the first-line anti-epileptic drug for controlling seizures but may not enhance the sensitivity of glioblastomas to chemotherapies, (c) Lack of seizure control in glioblastoma patients may not be related to tumor recurrence despite one-year treatment with anti-epileptic drugs, (d) Better understanding of the risk factors and mechanisms associated with glioma-associated epilepsy are needed to improve patient quality of life.
Objectives: Pneumonia cases that first started in Wuhan were defined as Severe Acute Respiratory Syndrome Coronavirus-2 by The World Health Organization in January 2020.Neurological complications such as epileptic seizures may occur during COVID-19 infection.These seizures may occur for the first time or in the form of acute seizures that can be observed in epilepsy patients during the course of the disease.Methods: Demographic data of the patients, presence of the diagnosis of epilepsy disease, accompanying diseases, number of seizures during hospitalization, follow-up to the intensive care unit, COVID-19 clinical day during seizures, presence of disease that can be detected in the etiology of epilepsy, and discharge status were examined in this retrospectively planned study.Results: Seizure rate was determined to be 0.57% in these patients.18 (58.1%)patients did not have a history of epilepsy, whereas 13 (41.9%)patients had a history of epilepsy.It was found that mortality was higher in the first seizures; there was no difference between age, gender, COVID-19 clinical day, presence of hospitalization in the intensive care unit, and Modified Charlson Comorbidity Index when the data of patients with and without epilepsy were compared.Conclusion: COVID-19 infection can increase the likelihood of seizures like other viral infections, but we do not have strong data that it can trigger seizures in different ways compared to other viral agents with all the data.
Objectives: Pregnancy in women with epilepsy carries a higher risk for fetal development complications, including congenital malformations. In this study, data obtained from pregnant epilepsy patients in a tertiary epilepsy center were presented. Methods: In this study, 128 pregnancies of 110 pregnant women followed up in the epilepsy outpatient clinic between April 2011 and April 2021 were examined. Demographic data of the patients, antiepileptic drugs AEDs used, and pregnancy outcomes were reviewed retrospectively. Results: During pregnancy, 101 patients (78.9%) received monotherapy, and lamotrigine was the most commonly used drug in monotherapy. A two-drug combination was used in 18 patients (14.1%), and a three-drug combination was used in 5 patients (3.9%). Although the frequency of seizures did not increase in most patients, the frequency of seizures increased in 18 patients (14.1%) and decreased in 5 patients (3.9%). In our study, the intrauterine fetal loss occurred in five patients, newborn infants with congenital malformations in three patients, and neonatal death during delivery in one patient. The number of AEDs used in multivariate logistic regression predicted adverse outcomes such as intrauterine fetal loss, neonatal death, and newborns with congenital malformations. Conclusion: Management of pregnant patients with epilepsy is difficult for both mother and fetus. In our study, combination therapy was more associated with adverse outcomes for the fetus and newborn. Pregnancy should be planned, and seizure-free pregnancy should be targeted with low-dose monotherapy.
Objectives: Cytokines are thought to be involved in the pathogenesis of many neurological diseases such as epilepsy. It is predicted that interleukin (IL)-1 beta and IL-6 levels in brain tissue are effective in the initiation and maintenance of epileptic seizures. However, there is no study addressing the inflammatory process in the lung in epileptic conditions. It was aimed to contribute to the mechanism of respiratory pathologies accompanying epilepsy in this study. Methods: The chemical pentylenetetrazol (PTZ) has been used to develop epileptic seizures in rats. To examine the effect of seizures on the formation of inflammation in the lung, the expression levels of IL-1 beta and IL-6 were measured by real-time polymerase chain reaction. Results: We found that the expression levels of IL-6 and IL-1 beta in the lung tissue of rats in the animal model of epilepsy induced by PTZ increased significantly. In addition, we found that both IL-6 and IL-1 beta mRNA expression increased at a higher rate in epileptic females than males. Conclusion: This is the first study evaluating the IL-1 beta and IL-6 expression levels in the lung. Our results support the existence of an inflammatory state in epileptic patients. The significance of our findings will be supported by future studies on pro-inflammatory and anti-inflammatory responses in the lung.
Objectives: Posterior cortex epilepsies (PCE) are characterized by seizures originating from the occipital, parietal, or occipital border of the temporal lobe. It is very important to analyze the patient series and bring them to the literature in the evaluation of the clinical features of this rare seizure type. In our study, the patients with PCE were retrospectively examined and the cognitive functions of the patients were evaluated and the results were compared with those of temporal lobe epilepsy (TLE). Methods: Patients who fulfilled the inclusion criteria among epilepsy patients treated in Cerrahpasa Faculty of Medicine, Department of Neurology were retrospectively screened and included in this study. As a result of the described findings, cases where localization could be made to the posterior or temporal lobe were included in the study and two separate study groups were formed: Group-1; Posterior cortex patients, Group-2; Temporal cortex patients. A control group without any neurological or psychiatric disease was also formed. Detailed neurocognitive tests were applied to all 3 patient groups. Results: There was no significant difference between the demographic data of the control and patient groups. In all the parameters studied, the test results of Group-1 were found to be lower than the control group. The variables that best differentiated the control group from Group-1 and 2 were determined as 'Rey-Osterrieth complex figure test (ROCF),' 'Trail Making Test (TMT) Form A,' 'The Judgment of Line Orientation (JLO) test and California Verbal Learning Test (CVLT) delayed recall' scores. Conclusion: Our findings suggest that both posterior epilepsies and TLE are associated with impairments in visual configuration, verbal skills, and executive functions. From these results, deterioration in visual configuration is an expected result in PCE, whereas deterioration in verbal skills and executive functions is considered an unexpected result in PCE cases since it is typically controlled by the fronto-temporal regions. It was suggested that it would be useful to follow up the patients with a comprehensive cognitive assessment.
Objectives: Epilepsy, according to our current knowledge, does not increase the risk of Coronavirus disease 2019 (COVID-19) infection or the rate of complications related to this infection. However, the COVID-19 pandemic can have adverse effects on patients with epilepsy (PWE) and affect the mental health of the community in general. This study aimed to evaluate the depression and anxiety of epilepsy patients, the effect of the epidemic on the frequency of seizures, and the quality of life of the patients in the past 3 months during the pandemic. Methods: The patients who were referred to an epilepsy outpatient clinic of a tertiary neuropsychiatry center within the past 2 years were retrospectively evaluated. The data regarding the seizures, quality of life, anxiety, and depression were recorded during follow-up or through an online platform. Seizure frequency, frequency change during the pandemic (April 2020 to June 2020), medications, admissions were obtained, and Beck Depression and Anxiety Scale were applied to the patients. The patients' quality of life was evaluated using the "Quality of Life Scale Short Form-36 (SF-36)" form. Results: One hundred sixty-four patients (77 men, 87 women) included in the study were analyzed. The median overall seizure frequency and seizure frequency during pandemic were 0.2 seizures/month (0-1) and 0 seizures/month (0-0.9), respectively. 125(76.2%) of the patients reported that they had no seizures during that period. No significant difference was found between the frequency of seizures reported by the patients before and during the pandemic period (p=0.12). Only one patient had a PCR confirmed COVID-19 diagnosis, and the other six patients were diagnosed clinically and radiologically. No significant relationship was found between COVID-19 diagnosis and seizure frequency (p=0.671). 105(64.02%) patients were considered to have depressive symptoms with ten or more points according to the Beck Depression Scale. 116 patients (70.7%) were considered to have anxiety symptoms with nine or more points from the Beck Anxiety Scale. Conclusion:This study was conducted to evaluate the seizure frequency, psychiatric status, and quality of life of PWE in April, May, and June 2020 during the first peak of the COVID-19 pandemic in our country while the social restrictions were applied at the highest level. We found that there was no significant increase in the seizure frequency of patients during the pandemic period and depressive symptoms were common in this patient group and affected their quality of life.
Objectives: Pneumonia cases that first started in Wuhan were defined as Severe Acute Respiratory Syndrome Coronavirus-2 by The World Health Organization in January 2020. Neurological complications such as epileptic seizures may occur during COVID-19 infection. These seizures may occur for the first time or in the form of acute seizures that can be observed in epilepsy patients during the course of the disease. Methods: Demographic data of the patients, presence of the diagnosis of epilepsy disease, accompanying diseases, number of seizures during hospitalization, follow-up to the intensive care unit, COVID-19 clinical day during seizures, presence of disease that can be detected in the etiology of epilepsy, and discharge status were examined in this retrospectively planned study. Results: Seizure rate was determined to be 0.57% in these patients. 18 (58.1%) patients did not have a history of epilepsy, whereas 13 (41.9%) patients had a history of epilepsy. It was found that mortality was higher in the first seizures; there was no difference between age, gender, COVID-19 clinical day, presence of hospitalization in the intensive care unit, and Modified Charlson Comorbidity Index when the data of patients with and without epilepsy were compared. Conclusion: COVID-19 infection can increase the likelihood of seizures like other viral infections, but we do not have strong data that it can trigger seizures in different ways compared to other viral agents with all the data.
Objectives:The aim of our study was to investigate the presence of increased cardiovascular risk in epileptic children treated with carbamazepine. This study was designed to evaluate the relation of carbamazepine and atherosclerosis by investigating the effect of carbamazepine on antioxidant capacity, lipid profile, oxidized low-density lipoprotein (LDL), and carotid artery intima-media thickness (C-IMT). Methods:Twenty-one children aged between 2 and 16 years with epilepsy who were treated with carbamazepine were included in the study. Triglyceride, total cholesterol, high-density lipoprotein, LDL, lipid hydroperoxide, paraoxonase, arylesterase levels, and C-IMT were measured in all patients before the treatment, at the 3rd and 6th months of the treatment. Results:Thirteen (61.9%) of the patients were male, and 8 (38.1%) were female. The mean age of the patients was 111.48 +/- 44.81 months. There was a significant increase in total cholesterol, arylesterase, and paraoxonase levels at the 6th months of the treatment compared with pre-treatment levels. No significant changes were observed in C-IMT values. Conclusion: Our study is the first study in the literature in which the relation between arylesterase and paraoxonase levels and CIMT in pediatric patients before and after carbamazepine treatment was prospectively investigated. The exact mechanism of carbamazepine on atherosclerosis is not clearly understood. These results demonstrate that these patients could be at increased risk of the development of cardiovascular complications. In light of these findings, future studies in epileptic children should be to plan antioxidant capacity, cholesterol level, and measuring C-IMT with ultrasonography periodically in long term. We think that these findings enhance our understanding of the relationship between oxidative stress and antiepileptic drugs.
Posterior reversible encephalopathy syndrome (PRES) is a syndrome characterized by various neurological findings such as headache, visual disturbances, seizures and altered consciousness, and imaging findings of edema in the posterior cerebral regions. Clinical and radiological findings are often reversible. Etiology may include hypertension, cytotoxic drugs, and autoimmune diseases. It often develops on the background of eclampsia and high blood pressure in the postpartum period. In this article, two cases of PRES, which developed under normal blood pressure values during pregnancy and postpartum period and characterized by seizure, are presented.
Most of the epileptic seizures that begin at an advanced age are focal onset seizures due to an underlying structural lesion. Generalized myoc-lonic seizures, usually seen in adolescence, are very rare in elderly patients without a history of epilepsy. In this study, we present a 60-year-old patient with generalized myoclonic seizures with electrophysiological findings. Because of the late-onset, myoclonic jerks were first evaluated with the diagnosis of non-epileptic psychogenic attack in an external health center. The patient was diagnosed with seizure recordings in Elec-troencephalography-video monitoring. The patient responded well to the antiepileptic treatment and became seizure-free.
Objectives: The coronavirus disease 2019 (COVID-19) pandemic is an extraordinary experience around the world; however, its effect on physical activity, anxiety, and seizure frequency remains unknown among epilepsy patients in the time of the national lockdown. We aimed to investigate whether the physical activity, anxiety, and seizure frequency were affected during the national lockdown of the first 3 months in patients with epilepsy.Methods: Forty-seven epilepsy patients participated in this study. The International Physical Activity Questionnaire-Short Form (IPAQ-SF; metabolic equivalent [MET]-min/week) was used to measure physical activity level. Patients' anxiety was assessed with the Generalized Anxiety Disorder 7-item (GAD-7; score). The patients answered the IPAQ-SF and GAD-7 questions through telephone interviews.Results: The total IPAQ-SF (MET-min/week) scores of patients decreased during the national lockdown compared to pre-lockdown period, while the daily sitting time (min/day) increased (p<0.001). According to the GAD-7 scores, 18 (38.3%) patients had minimal, and only 4 (8.5%) patients had severe anxiety during the lockdown. No changes in seizure frequency were reported by 44 (93.6%) patients.Conclusion: The presence of physical inactivity and anxiety due to the national lockdown in the time of COVID-19 pandemic can have a detrimental effect on the well-being of epilepsy patients. Patients should participate to the home-based physical activity programs to enhance both their mental and physical health.
