Karl O. Nakken

Which seizure-precipitating factors do patients with epilepsy most frequently report?

When treating patients with epilepsy, dealing with seizure-precipitating factors is a partly neglected and underestimated supplement to more traditional therapies. The aim of this study was to investigate the incidence of seizure precipitants in a large epilepsy population and to determine which precipitants patients most often reported. Study participants included twins and their family members ascertained from the Norwegian Twin Panel (NTP), the Danish Twin Registry (DTR), and the Mid-Atlantic Twin Registry (MATR). One thousand six hundred seventy-seven patients with epilepsy were identified and were asked about seizure precipitants using a closed-ended questionnaire. Fifty-three percent reported at least one seizure-precipitating factor, while 30% claimed to have experienced two or more such factors. Emotional stress, sleep deprivation, and tiredness were the three most frequently reported precipitants. Patients with generalized seizures seemed to be more sensitive to sleep deprivation and flickering light than those with partial seizures, while women with partial seizures appeared to be more prone to seizures during menstruation than women with generalized seizures. Knowledge of seizure precipitants has practical implications, not only in patient treatment and counseling, but also for diagnosis, in that it may be helpful in facilitating the appearance of interictal epileptiform discharges in EEG and ictal EEG recordings.

Physical exercise in outpatients with epilepsy.

Summary: Purpose: To compare the exercise habits in a sample of adult outpatients with epilepsy with those of a general population of the same age and sex and furthermore to study physical exercise as a seizure precipitant and the risk of sustaining seizure‐related injuries while exercising.

Physical Exercise in Women with Intractable Epilepsy

Summary: Fifteen women with pharmacologically intractable epilepsy were given physical exercise (aerobic dancing with strength training and stretching) for 60 min, twice weekly, for 15 weeks. Seizure frequency was recorded by the patients for 3–7 months before the intervention, during the intervention period, and for 3 months after the intervention. Medication and other known seizure‐influencing factors were kept as constant as possible. Self‐reported seizure frequency was significantly reduced during the intervention period. The exercise also led to reduced level‐of subjective health complaints, such as muscle pains, sleep problems, and fatigue. The exercise reduced plasma cholesterol ratio and increased maximum O2 uptake. Because most of the patients were unable to continue the exercise on their own after the intervention period, the exercise effects were not maintained during the follow‐up period. The patients were not unwilling to continue the exercise, but it was not sufficient to offer them the possibility of continuing similar types of exercise. We believe that 15 weeks is too short a time to establish a life‐style change and that continued physical exercise for these patients requires a well‐organized and supportive program, requiring experienced and dedicated instructors.

Familial Temporal Lobe Epilepsy with Aphasic Seizures and Linkage to Chromosome 10q22-q24

Summary:  Purpose: To describe the phenotypic expression of a new family with familial lateral temporal lobe epilepsy with aphasic seizures, and to compare the findings with the clinical features of previously reported families linked to chromosome 10q22‐q24.

Analyzing the etiology of benign rolandic epilepsy : A multicenter twin collaboration

Summary:  Purpose: Benign rolandic epilepsy (BRE) is considered a genetically determined idiopathic partial epilepsy. We analyzed a large sample of twins from four international twin registers to probe the genetics of BRE. We also aim to synthesize the apparently conflicting family and twin data into a model of BRE etiology.

Serum concentration/dose ratio of levetiracetam before, during and after pregnancy

PURPOSE To investigate changes in levetiracetam (LEV) serum concentration/dose ratio (C/D-ratio) in relation to pregnancy. METHODS Altogether 21 consecutive pregnancies in 20 women with epilepsy receiving LEV during gestation were studied retrospectively. The main target variable was the C/D-ratio before and during pregnancy, and in the post partum period. Secondary target variables were changes in LEV dose, concomitant use of other antiepileptic drugs and seizure frequency. Students paired t-test and two-sample t-test for independent samples were used to test for statistically significant changes in C/D-ratio means. RESULTS Mean C/D-ratio in the third trimester was 50% of the mean C/D-ratio at baseline (p<0.001, n=11). Baseline levels were reached within the first weeks after pregnancy. The interindividual variability was pronounced. CONCLUSIONS Serum concentrations of LEV declined significantly in the third trimester of pregnancy and increased rapidly after delivery.

Bone loss associated with use of antiepileptic drugs

Importance of the field: Epilepsy is a neurological disorder associated with several comorbidities, one of them being reduced bone health. As the bone loss most often is insidious and asymptomatic, they are usually not recognized, and thus untreated. The key message of this paper is to make clinicians aware of the problem. Areas covered in this review: This article reviews data from basic and clinical studies of bone loss associated with usage of antiepileptic drugs (AEDs) within the last 4 decades. What the reader will gain: The reader will learn that there is accumulating evidence of biochemical abnormalities indicating a disturbed bone metabolism, a decreased bone density and a 2 – 6 times increased risk of fractures among those with epilepsy compared to the general population. These findings most likely have many causes, both internal and external, but long-term use of AEDs seems to play an important role. Enzyme-inducing drugs, such as phenytoin, phenobarbital and carbamazepine, but also the enzyme inhibitor valproate, appear to have bone-depleting properties. Reduced bone density may be detected during the first 1 – 5 years of treatment. Although many theories have been launched, the exact mechanisms by which the the drugs affect bone architecture are not fully understood. Take home message: We recommend clinicians to promote osteoprotective behavior among their epilepsy patients; that is, sunlight exposure and weight-bearing exercise as well as avoidance of risk factors such as bone-depleting drugs other than AEDs, smoking and heavy alcohol consumption. Enzyme inducing drugs should be avoided, if possible. Bone mineral density screening should be assessed on an individual basis, taking risk factors for bone loss into account. All patients taking AEDs on long-term basis ought to have adequate amounts of dietary calcium and vitamin D, and those who have developed bone loss should in addition be given specific antiosteoporotic treatment.

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy : An Electroclinical Study of a Norwegian Family with Ten Affected Members

Summary: Purpose: The aim of the study was to describe in detail the electroclinical findings associated with a mutation in the acetylcholine receptor in a Norwegian family with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). Furthermore, we compared the clinical features associated with this mutation with those of an Australian family with a different mutation at the same locus, as well as with those of eight Italian families with ADNFLE and without a verified mutation in this gene.

Does physical exercise influence the occurrence of epileptiform EEG discharges in children

Summary: Purpose: To determine if, and how, epileptiform EEG discharges in children were influenced by physical exercise.

Buccal midazolam or rectal diazepam for treatment of residential adult patients with serial seizures or status epilepticus

Nakken KO, Lossius MI. Buccal midazolam or rectal diazepam for treatment of residential adult patients with serial seizure or status epilepticus. 
Acta Neurol Scand: 2011: 124: 99–103.
© 2011 John Wiley & Sons A/S.