Andrew L. Reeves

An Assessment of Epilepsy Patients' Knowledge of Their Disorder

Summary: Purpose: Patient education is an effective component of comprehensive care. Studies assessing patients knowledge of their epilepsy are scarce. We report the first objective study evaluating knowledge of epilepsy patients referred to an American tertiary care center.

Time-frequency mapping of R-R interval during complex partial seizures of temporal lobe origin.

BACKGROUND Activation of autonomic nervous system is common with seizures. No reliable biological markers of impending seizures have been found. Evaluation of autonomic changes might help elucidate the transition from interictal to ictal states. METHODS We studied twelve patients (eight females, four males), from 19 to 62 years old with temporal lobe complex partial seizures (CPS). Dynamics of autonomic functions from oscillations in R-R interval (RRI) using time-frequency mapping based upon a Wigner distribution during pre-ictal, ictal and post-ictal periods. Oscillations in RRI at respiratory frequencies (RF) (> 0.1 Hz) are parasympathetically mediated and at nonrespiratory frequencies (NONRF) (0.01-0.09 Hz) are under combined sympathetic and parasympathetic influence. RESULTS CPS evoked marked autonomic imbalance and tachycardia. Spectral powers at both RF_RRI and NONRF_RRI increased over the pre-ictal period. RF_RRI power then fell rapidly over the 30 s before seizure onset and remained markedly reduced during seizure (P < 0.004). NONRF_RRI power reached a maximum at seizure onset and declined to a minimum before the seizure cessation (P < 0.05). CONCLUSION Time-frequency analysis revealed that autonomic activation hallmarks clinical seizure onset for several minutes. After combined parasympathetic and sympathetic activation, rapid parasympathetic withdrawal occurred approximately 30 s before the seizure, and sympathetic activation peaks at seizure onset. Therefore, the transition from interictal to ictal states is relatively long and associated with subclinical autonomic changes.

A Prospective Evaluation of the Effects of a 12-Week Outpatient Exercise Program on Clinical and Behavioral Outcomes in Patients with Epilepsy

Purpose. We hypothesized that patients randomized to an exercise program would demonstrate a measurable improvement in behavioral outcomes with no adverse clinical outcomes, as compared with control patients.Methods. This randomized, prospective, parallel, and controlled study spanned 12 weeks. Twenty-eight patients were randomized either to participate in a supervised exercise program (Exercise) or to continue their current level of activity with no planned intervention (Control). The Exercise group worked with an exercise physiologist three times per week. At specific intervals, behavioral (QOLIE-89, POMS, PSDQ, Self-Esteem) and clinical (seizure activity, antiepileptic drug (AED) concentrations) outcomes were measured.Results. Twenty-three patients completed the study (Exercise n = 14, Control n = 9). Of the four patients in the Exercise group with active seizures, two had no change, one had an increase, and one had a decrease in seizure activity. Of the three patients in the Control group with active seizures, one had no change, one had an increase, and one had a decrease in seizure activity. In all patients, there was <26% coefficient of variation in AED concentrations over the 12-week study, suggesting little or no impact of the exercise intervention. The overall quality of life and two domain scores improved from baseline to Week 12 in the Exercise group (P = 0.031), while the Control group score did not change (P = 0.943). In the Exercise group, there were several measures of physical self-concept and vigor that improved and total mood disturbance decreased from the beginning to the end of the program.Conclusion. This is the first randomized, controlled study of exercise in patients with epilepsy. Behavioral outcomes are positively influenced by moderate exercise and there is no impact on seizure frequency. This suggests that exercise should not be discouraged in the care of epilepsy patients. The ability to offer an exercise program adds a health promotion component to the current plan of care provided by our comprehensive epilepsy program.

Alternative medicine use by patients with epilepsy.

Purpose. The objectives of this study were, first, to determine the prevalence, characteristics, and demographic patterns of alternative medicine (AM) use in patients with epilepsy, and second, to ascertain the extent to which these patients inform the neurologist of AM use. Methods. Surveys were distributed randomly to patients attending a tertiary care epilepsy clinic. The survey assessed use of specific herbal medicine/dietary supplements, along with other forms of AM. Results. Of 150 surveys distributed, 92 were used for analysis. Twenty-two patients with epilepsy (24%) used AM, and only 31% of AM users reported such to their neurologists. Massage and herbs/supplements were used the most, and only two patients used AM specifically for treatment related to epilepsy. Conclusions. A sizable minority of patients with epilepsy who visit our tertiary care clinic use AM. Health professionals should actively monitor therapies to ensure safety and effectiveness with combined traditional medicine and AM use.

Hormone Replacement Therapy in a Postmenopausal Woman with Epilepsy

OBJECTIVE: To prospectively evaluate the effects of hormone replacement therapy (HRT) on seizure activity in a postmenopausal woman with epilepsy. BACKGROUND: Postmenopausal women are at an increased risk for cardiovascular disease and osteoporosis secondary to a lack of estrogens protective effects. As a result, women without known contraindications often take HRT to counteract this risk. Postmenopausal women with epilepsy are at a greater risk for osteoporosis because of the negative effects that certain antiepileptic drugs have on bone density. Clinical studies and experience have shown that hormonal variances across a womans lifetime play a significant role in seizure activity, but the effects of HRT in postmenopausal women with epilepsy are unknown. CASE SUMMARY: We report the case of a 51-year-old postmenopausal white woman with epilepsy who presented with frequent vasomotor flushing. To determine individual effects of HRT on seizure activity, therapy was initiated in two three-month phases, with monthly evaluation. A weekly transdermal patch of estradiol 0.1 mg/d was initiated for the first three months. During the second three months, the regimen was expanded to include oral medroxyprogesterone acetate 2.5 mg once daily. Antiepileptic medications and their dosages remained constant. HRT was associated with a decreased incidence of seizures, cessation of vasomotor flushing, improved sleep, and a positive impact on the lipid profile. CONCLUSIONS: This case report describing the prospective addition of HRT in a postmenopausal woman with epilepsy suggests that HRT can be initiated in certain women to achieve therapeutic benefits without adversely affecting seizure activity.

Medication use, self-reported drug allergies, and estimated medication cost in patients with epileptic versus nonepileptic seizures

Abstract The decision to take medication may say as much about a patients self-perception as it does about his or her diagnosis. Patient-reported drug allergies often cannot be verified by physicians, and may be a self-perception not always grounded in medical reality. We retrospectively studied medication use and self-reported drug allergies in 346 sequential epilepsy monitoring unit (EMU) inpatients from 1994–96. Because financial concerns play an increasing role in patient care, we also estimated minimum antiepileptic drug (AED) costs. A clear diagnosis was reached in 226/346 (65%) cases. Seventy-four cases were nonepileptic seizures (NES) (33%) and 152 were epileptic seizures (ES) (67%). The NES patients were significantly more likely to be women (76%) than were ES patients (60%) ( p p > 0.05). The ES patients took more AEDs than NES patients [1.9 and 1.3, respectively ( p p p

Autonomic activity in epilepsy: Diagnostic considerations and implications

Abstract Autonomic function is usually disrupted to some degree during epileptic seizures. This loss of control has multiple clinical expressions. Some autonomic changes that accompany seizures are subtle and of little importance, while other changes may be life-threatening. In some cases, the autonomic accompaniments of epilepsy overshadow the cerebral effects of the seizures. In doing so, they tend to hamper correct diagnosis and treatment. In this article I will review some of the autonomic changes that accompany seizures. I will focus primarily upon those changes that affect the neurocardiac axis and the neurorespiratory axis. Other autonomic accompaniments affecting the gastrointestinal tract, urinary bladder, and skin are also discussed.

THE PRACTICAL ASPECTS OF EPILEPSY : CRITICAL COMPONENTS OF COMPREHENSIVE PATIENT CARE

&NA; Patients with epilepsy are often exposed to difficult social dilemmas, some of which may be more challenging than the actual seizure. Although all patients with chronic conditions experience social hardships, the epileptic patient may be at greater risk for social difficulties. Due to unjust restrictions and an overall lack of emphasis on psychosocial matters, patients with epilepsy may be wrongfully denied participation in routine activities. These patients may also lack an understanding of appropriate prevention measures related to self injury. Appropriate restrictions for patients with epilepsy include driving and selected extra‐curricular activities. The home environment is particularly dangerous for epilepsy patients. Other social issues for epilepsy patients include suicide attempts, employment and alcohol consumption.