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Pregabalin in the management of partial epilepsy
Amir M Arain
Neuropsychiatric Disease and Treatment , 2009,
Abstract: Amir M ArainVanderbilt University Medical Center, Department of Neurology, Nashville, TN, USAAbstract: Pregabalin is a new antiepileptic medication that works by binding to alpha 2 delta subunit of the voltage-dependent calcium channels present in presynaptic neurons. Its pharmacokinetic advantages include rapid and almost complete absorption, lack of protein binding, linear kinetics, absence of enzyme induction, and absence of interactions with other drugs. Pregabalin was found effective as adjunctive therapy for refractory partial-onset seizures, with up to 51% responder at a dose of 600 mg/day. The lowest effective dose was 150 mg/day. Pregabalin is also approved for treatment of painful diabetic polyneuropathy, postherpetic neuralgia and pain with fibromyalgia. Studies also suggest a beneficial effect on sleep and generalized anxiety disorders. Its main adverse effects in randomized adjunctive trials in adults have been mild to moderate. Most common side effects were dizziness, ataxia, somnolence and diplopia. Weight gain was not prominent in pivotal pregabalin trials, but was more problematic in long-term postmarketing analyses in epilepsy patients. Pregabalin, with its potent antiseizure effect, favorable pharmacokinetic profile, and effectiveness in common co-morbidities is an important addition to the treatment of epilepsy.Keywords: epilepsy, seizures, pregabalin, pharmacology, antiepileptic drugs, tolerability
Pregabalin in the management of partial epilepsy
Amir M Arain
Neuropsychiatric Disease and Treatment , 2009, DOI: http://dx.doi.org/10.2147/NDT.S3850
Abstract: egabalin in the management of partial epilepsy Review (4953) Total Article Views Authors: Amir M Arain Published Date July 2009 Volume 2009:5 Pages 407 - 413 DOI: http://dx.doi.org/10.2147/NDT.S3850 Amir M Arain Vanderbilt University Medical Center, Department of Neurology, Nashville, TN, USA Abstract: Pregabalin is a new antiepileptic medication that works by binding to alpha 2 delta subunit of the voltage-dependent calcium channels present in presynaptic neurons. Its pharmacokinetic advantages include rapid and almost complete absorption, lack of protein binding, linear kinetics, absence of enzyme induction, and absence of interactions with other drugs. Pregabalin was found effective as adjunctive therapy for refractory partial-onset seizures, with up to 51% responder at a dose of 600 mg/day. The lowest effective dose was 150 mg/day. Pregabalin is also approved for treatment of painful diabetic polyneuropathy, postherpetic neuralgia and pain with fibromyalgia. Studies also suggest a beneficial effect on sleep and generalized anxiety disorders. Its main adverse effects in randomized adjunctive trials in adults have been mild to moderate. Most common side effects were dizziness, ataxia, somnolence and diplopia. Weight gain was not prominent in pivotal pregabalin trials, but was more problematic in long-term postmarketing analyses in epilepsy patients. Pregabalin, with its potent antiseizure effect, favorable pharmacokinetic profile, and effectiveness in common co-morbidities is an important addition to the treatment of epilepsy.
The Relationship between Sleep and Epilepsy
Nilda TURGUT
Trakya Universitesi Tip Fakultesi Dergisi , 2004,
Abstract: Sleep is an important factor influencing the activation of seizures and interictal discharges. Sleep may contribute to the activation of many seizures, increase the frequency of epileptiform discharges, altering their morphology and distribution. On the other hand, seizures may influence sleep, leading to sleep abnormalities in epileptic patients. This review summarizes the interactions between sleep and epilepsy, the influence of sleep on seizure disorders, and seizure-induced changes in sleep patterns.
Epilepsia y sue o Epilepsy and sleep  [cached]
C. Viteri
Anales del Sistema Sanitario de Navarra , 2007,
Abstract: La relación entre epilepsia y sue o se conoce desde hace más de un siglo. Al final del siglo XIX se observó una relación entre la aparición de las crisis epilépticas y el ciclo vigilia-sue o. Con la aparición de la electroencefalografía se comprobó cual era el efecto del sue o y de la privación del mismo sobre las descargas epileptiformes interictales y las crisis epilépticas. Existen una serie de síndromes epilépticos parciales y generalizados que se asocian con el sue o y que es importante reconocer para poder hacer un buen diagnóstico diferencial de los pacientes con trastornos motores y de comportamiento durante el sue o. En este artículo se revisan todos estos aspectos de la relación entre epilepsia y sue o. The relationship between sleep and epilepsy is known from more than a century ago. At the end of the XIXth century a temporal relationship between the onset of epileptic seizures and the wake-sleep cycle was observed. The introduction of the electroencephalogram allowed establishing the effect of sleep and sleeping deprivation on epileptiform interictal discharges and on epileptic seizures. The recognition of the variety of generalized and partial epileptic syndromes associated to sleep is important to make a correct differential diagnosis of patients presenting with motor and behavioural disturbances of sleep. This article reviews the different aspects of the relationship between epilepsy and sleep.
Sleep board review question: epilepsy or parasomnia?  [cached]
Budhiraja R
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated after first page. Which of the following is the most helpful in differentiating nocturnal frontal lobe epilepsy (NFLE) from non-rapid eye movement (NREM) arousal parasomnias? 1. Onset during rapid eye movement (REM) sleep. 2. Arousal preceding the event. 3. Stereotypy. 4. Concomitant presence of sleep apnea.
Probable causal link between epilepsy and sleep apnea: case report
Dominici, Michele;Pompeu Filho, Fernando;Gomes, Marleide da Mota;
Arquivos de Neuro-Psiquiatria , 2007, DOI: 10.1590/S0004-282X2007000100034
Abstract: patients with epilepsy were reported to have concomitant sleep apnea, but it has been rarely linked to the epilepsy itself. we present a case of a 28-year-old, obese man with secondary medically resistant partial complex epilepsy due to a brain trauma, with progressive snoring, and sleep agitation, apneas, and important daytime somnolence. it was noticed in the polysomnographic study that he had several sleep respiratory events, probably due both to the epileptic seizures and the sleep apnea syndrome as a co-morbidity. apnea and epilepsy will be discussed. a careful video-eeg-polysomnography study is important in evaluating refractory epileptic patients and/or epileptic patients with snoring.
Correlation of sleep macrostructure parameters and idiopathic epilepsies
Barreto, José Roberto Santiago;Fernandes, Regina Maria Fran?a;Sakamoto, Américo Ceiki;
Arquivos de Neuro-Psiquiatria , 2002, DOI: 10.1590/S0004-282X2002000300002
Abstract: sleep and epilepsy share some common mechanisms. the objective of the present investigation was to study the macrostructure of sleep in patients with idiopathic epilepsies, focal and generalized, comparing these two groups to each other and to a control group of 12 individuals without epilepsy. a total of 35 polysomnographies were performed, 12 of them in the control group, 10 in patients with idiopathic generalized epilepsies, and 13 in patients with idiopathic focal epilepsies. antiepileptic medications were maintained for ethical reasons. the group with idiopathic focal epilepsy showed an increase in the total recording time (p = 0.04) and the group with idiopathic generalized epilepsy had a reduction of phase 4 nrem sleep. the efficiency of total sleep period and of total sleep time was also lower in the group with idiopathic generalized epilepsy (p = 0.03 in both cases). we concluded that the group with idiopathic generalized epilepsy presents sleep of poorer quality, whereas the group with idiopathic focal epilepsy presents a tendency toward an excessive somnolence.
Correlation of sleep macrostructure parameters and idiopathic epilepsies
Barreto José Roberto Santiago,Fernandes Regina Maria Fran?a,Sakamoto Américo Ceiki
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: Sleep and epilepsy share some common mechanisms. The objective of the present investigation was to study the macrostructure of sleep in patients with idiopathic epilepsies, focal and generalized, comparing these two groups to each other and to a control group of 12 individuals without epilepsy. A total of 35 polysomnographies were performed, 12 of them in the control group, 10 in patients with idiopathic generalized epilepsies, and 13 in patients with idiopathic focal epilepsies. Antiepileptic medications were maintained for ethical reasons. The group with idiopathic focal epilepsy showed an increase in the total recording time (p = 0.04) and the group with idiopathic generalized epilepsy had a reduction of phase 4 NREM sleep. The efficiency of total sleep period and of total sleep time was also lower in the group with idiopathic generalized epilepsy (p = 0.03 in both cases). We concluded that the group with idiopathic generalized epilepsy presents sleep of poorer quality, whereas the group with idiopathic focal epilepsy presents a tendency toward an excessive somnolence.
EEG recording after sleep deprivation in a series of patients with juvenile myoclonic epilepsy
Sousa, Nise Alessandra de Carvalho;Sousa, Patrícia da Silva;Garzon, Eliana;Sakamoto, Américo C.;Braga, Nádia I.O.;Yacubian, Elza Márcia Targas;
Arquivos de Neuro-Psiquiatria , 2005, DOI: 10.1590/S0004-282X2005000300003
Abstract: seizures in juvenile myoclonic epilepsy (jme) are dependent on the sleep-wake cycle and precipitant factors, among which sleep deprivation (sd) is one of the most important. still an under diagnosed syndrome, misinterpretation of the eegs contributes to diagnostic delay. despite this, a quantitative eeg investigation of sd effects has not been performed. we investigated the effect of sd on eegs in 41 patients, aged 16-50 yr. (mean 25.4), who had not yet had syndromic diagnosis after a mean delay of 8.2 yr. two eeg recordings separated by a 48-hour interval were taken at 7 a.m. preceded by a period of 6 hours of sleep (routine eeg) and after sd (sleep-deprived eeg). the same protocol was followed and included a rest wakefulness recording, photic stimulation, hyperventilation and a post-hyperventilation period. the eegs were analyzed as to the effect of sd on the number, duration, morphology, localization and predominance of abnormalities in the different stages. a discharge index (di) was calculated. out of the 41 patients, 4 presented both normal eeg recordings. in 37 (90.2%) there were epileptiform discharges (ed). the number of patients with ed ascended from 26 (70.3%) in the routine eeg to 32 (86.5%) in the sleep-deprived exam. the presence of generalized spike-wave and multispike-wave increased from 20 (54.1%) and 13 (35.1%) in the first eeg to 29 (78.4%) and 19 (51.4%) in the second, respectively (p<0.05 and p<0.01). as to localization, the number of generalized, bilateral and synchronous ed increased from 21 (56.8%) to 30 (81.1%) (p<0.01). the di also increased; while 8 patients (21.6%) presented greater rate in the routine eeg, 25 (67.6%) did so in the sleep-deprived eeg mainly during somnolence and sleep (p<0.01). moreover, the paroxysms were also longer in the sleep-deprived eeg. sleep-deprived eeg is a powerful tool in jme and can contribute significantly to the syndromic characterization of this syndrome.
Does sleep deprivation alter functional EEG networks in children with focal epilepsy?  [PDF]
Eric van Diessen,Willem M. Otte,Cornelis J. Stam
Frontiers in Systems Neuroscience , 2014, DOI: 10.3389/fnsys.2014.00067
Abstract: Electroencephalography (EEG) recordings after sleep deprivation increase the diagnostic yield in patients suspected of epilepsy if the routine EEG remains inconclusive. Sleep deprivation is associated with increased interictal EEG abnormalities in patients with epilepsy, but the exact mechanism is unknown. In this feasibility study, we used a network analytical approach to provide novel insights into this clinical observation. The aim was to characterize the effect of sleep deprivation on the interictal functional network organization using a unique dataset of paired routine and sleep deprivation recordings in patients and controls. We included 21 children referred to the first seizure clinic of our center with suspected new onset focal epilepsy in whom a routine interictal and a sleep deprivation EEG (SD-EEG) were performed. Seventeen children, in whom the diagnosis of epilepsy was excluded, served as controls. For both time points weighted functional networks were constructed based on interictal artifact free time-series. Routine and sleep deprivation networks were characterized at different frequency bands using minimum spanning tree (MST) measures (leaf number and diameter) and classical measures of integration (path length) and segregation (clustering coefficient). A significant interaction was found for leaf number and diameter between patients and controls after sleep deprivation: patients showed a shift toward a more path-like MST network whereas controls showed a shift toward a more star-like MST network. This shift in network organization after sleep deprivation in patients is in accordance with previous studies showing a more regular network organization in the ictal state and might relate to the increased epileptiform abnormalities found in patients after sleep deprivation. Larger studies are needed to verify these results. Finally, MST measures were more sensitive in detecting network changes as compared to the classical measures of integration and segregation.
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