Bertrand Godet

Etiologies of epilepsy: a comprehensive review

Epilepsy is a heterogeneous disorder, the symptoms of which are preventable and controllable to some extent. Significant inter- and intra-country differences in incidence and prevalence exist because multiple etiologic factors are implicated. Many past reviews have addressed sole etiologies. We considered a comprehensive view of all etiologies (genetic/structural/metabolic) to be significant for both the developing and the developed world as well as routine clinical/epidemiology practice. We therefore carried out a comprehensive search for peer-reviewed articles (irrespective of year, region and language; chosen based on novelty and importance) for each etiology. This article was felt to be essential since newer etiologic knowledge has emerged in recent years. Many new genetic links for rarer epilepsy forms have emerged. Epilepsy risk in limbic encephalitis, mechanisms of Alzheimer’s-related epilepsy and the genetic basis of cortical malformations have been detailed. An etiological approach to epilepsy in combination with the conventional classification of epilepsy syndromes is required to gain knowledge.

Malnutrition and epilepsy: A two-way relationship

BACKGROUND & AIMS A link between malnutrition and epilepsy has been suspected for many years. METHODS Different aspects of the question were studied with a review of previous published data. RESULTS Several studies performed on animal models or humans highlight the possible adverse effects of malnutrition in the onset of seizures. Protein-energy, electrolyte, vitamin or trace element deficiencies may be involved. Conversely, several determinants of epilepsy could lead to malnutrition: food taboos and social exclusion in developing countries as well as some adverse effects of antiepileptic treatments. CONCLUSIONS Two different hypotheses exist as a vicious circle: malnutrition predisposing to epilepsy or epilepsy predisposing to malnutrition. A better understanding of these interactions is necessary. In the mean time, malnutrition has to be prevented and treated.

Probable drug-induced liver injury associated with aliskiren: Case report and review of adverse event reports from pharmacovigilance databases

PURPOSE A case of probable drug-induced liver injury (DILI) attributed to use of the antihypertensive agent aliskiren is reported. SUMMARY A 61-year-old woman undergoing routine liver function monitoring in conjunction with long-term antiepileptic therapy was noted to have an asymptomatic acute hepatic cytolysis 1 month after the initiation of concomitant aliskiren therapy (150 mg/day). Liver enzyme testing showed dramatically elevated aspartate transaminase (AST) and alanine transaminase (ALT) concentrations, with substantial rises also noted in γ-glutamyltransferase (GGT) and alkaline phosphatase (ALP) levels. The calculated ALT:ALP value indicated hepatocellular injury. On discontinuation of aliskiren use, rapid biological improvement occurred, including normalization of serum AST and a sharp decline in serum ALT within one week and the return of GGT and ALP levels to baseline a few weeks later; the patients AST and ALT concentrations remained normal during 18 months of subsequent monitoring. Using the algorithm of Naranjo et al. and a DILI-specific causality assessment instrument, it was determined that aliskiren use was the probable cause of the patients liver injury. While this is believed to be the first report of aliskiren-associated DILI in the professional literature, a review of information from several European and North American pharmacovigilance databases (through October 2012) identified 117 reports of suspected aliskiren hepatotoxicity, including 6 reports of liver failure and 12 reports of deaths. CONCLUSION Asymptomatic acute hepatic cytolysis was observed in a 61-year-old woman approximately one month after initiation of aliskerin for treatment of hypertension. Improvement in AST and ALT concentrations was observed shortly after the drug was discontinued.

Arguments for a Relationship Between Malnutrition and Epilepsy

Malnutrition and epilepsy are two major health issues, essentially in developing countries. Malnutrition is responsible for moderate to severe disabilities. Several studies performed on animal models or humans highlight the possible adverse effects of malnutrition on the occurrence of seizures or epilepsy. Low protein diet and certain micronutrient deficiencies as vitamins, trace-elements, or electrolytes are involved. In contrast, a ketogenic diet (high fat and low carbohydrate) can be used in the treatment of severe epilepsy. In developing countries, there are a lot of beliefs around epilepsy (origin, contagiousness of epilepsy, and so on). Sociocultural attitudes as food taboos and social stigma can be responsible for a negative impact on the nutritional status of people with epilepsy. Antiepileptic drugs or traditional treatments can also be responsible for malnutrition.

Épilepsie : analyse du statut nutritionnel et du taux sérique de vitamine D (Vit D)

Introduction.– En France, le nombre de personnes atteintes d’epilepsie est estime a 500 000. Une alteration nutritionnelle pourrait jouer un role dans la reponse au traitement. La vitamine D pourrait etre impliquee dans certaines epilepsies. Objectifs.– Le but principal de l’etude est de decrire le statut nutritionnel des patients epileptiques et d’analyser leur taux serique de vitamine D. Methodes.– Quarante-six patients epileptiques avec ou sans pharmaco-resistance beneficiaient apres consentement d’une evaluation nutritionnelle. Le poids, la taille, l’Indice de Masse Corporelle (IMC), le tour de taille, le pli cutane tricipital (PCT), le perimetre brachial, la masse grasse (MG) et la masse maigre (MM) par impedancemetrie etaient mesures. Le dosage de la vit D serique etait realise avant supplementation (carence < 30 ng/mL). L’analyse statistique utilisait le test t de Student, le Chi2 et l’Anova. Resultats.– Les patients etaient âges de 44,5 ± 14,3 ans, avec un sex-ratio H/F de 1,3 × 60,9 % etaient pharmacoresistants. L’IMC etait de 28,7 ± 7,0 kg/m2, avec 2,2 % de denutris et 30,4 % d’obeses. La concentration en vit D etait de 15,3 ± 9,9 ng/mL avec 87 % de patients carences, et 40 % avec des carences tres severes (< 10 ng/mL). Le PCT etait plus eleve chez les pharmaco-resistants (p = 0,03). Il n’y avait pas de liaison entre pharmaco-resistance et l’etat nutritionnel, la MM, la MG et la concentration en vitamine D. Discussion.– La cohorte etudiee est reduite, mais montre que les patients epileptiques sont tres rarement denutris. Cependant, les etudes sur ce sujet portent surtout sur des populations africaines. En revanche, les patients epileptiques sont plus souvent obeses, peut-etre explique par certains traitements anti-epileptiques. La carence en vitamine D est plus frequente qu’en population generale, avec une prevalence de carence severe beaucoup plus elevee. Conclusion.– L’obesite, frequente chez les epileptiques, meriterait d’etre plus etudiee. La carence en vit D est tres frequente, souvent majeure, mais comme l’etat nutritionnel ne jouerait pas sur la pharmaco-sensibilite de.