Mirjana Spasic

Causal or casual association between lamotrigine and sudden unexpected death in females with epilepsy

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Outcome prediction of initial lamotrigine monotherapy in adult patients with newly diagnosed localization related epilepsies

OBJECTIVE To develop and test model to predict outcome of treatment with initial lamotrigine monotherapy in adult patients with newly diagnosed localization - related epilepsy, using data available at the time of diagnosis. METHODS Prospective longitudinal study included consecutive series of adult patients with newly diagnosed localization - related epilepsy started of lamotrigine monotherapy. Logistic regression analysis using backward procedure was performed with treatment failure as the outcome variable. We evaluated both calibration and discrimination of the model. Internal validation of the model was performed with bootstrapping techniques. RESULTS A total of 159 patients on lamotrigine monotherapy have been included in final analysis. Among them 78 (49.06%) patients had persistent seizures. Finally fitted multivariate model included: 1) age at therapy start, 2) presence of complex partial seizures, 3) aetiology of epilepsy and 4) interaction of age and epilepsy aetiology. Estimated odds ratio for seizure relapse in old patients with symptomatic epilepsy is lower than for the old patients with cryptogenic epilepsy, despite strong positive covariate effect of epilepsy aetiology. The model correctly classified 69.23% patients with seizure relapses and 81.48% of patients with seizure freedom, with estimated c - statistic of 0.80. Testing practical application we observed threefold increase or reduction of odds for the seizure relapse after models positive or negative prediction respectively. CONCLUSION Standard clinical data were modesty adequate to predict response to the initial trial of lamotrigine in adult patients with localization related epilepsy. Better markers of antiepileptic failure are required to guide optimal patient counselling and clinical decisions. Formal interaction analysis of variables improves outcome prediction and may be a key to correct interpretation of data.

New daily persistent headache — rare primary or secondary phenomena caused by carotid-cavernous fistula? A case report

Carotid cavernous fistulas (CCF) are dural arteriovenous fistulas which include pathological communications between the arterial system and the venous cavernous sinus situated at the wall of the cavernous sinus. It can be demonstrated by wide range clinical presentations. The presented case shows a very modest clinical presentation of CCF which was present over a few months only as new daily persistent headache without initial positive findings on performed computer tomography of the head, but rapidly worsened over a period of few days.

Epileptic seizure as the first sign of hypoparathyroidism

BACKGROUND Hypoparathyroidism refers to a group of disorders in which extracellular calcium levels cannot be maintained within the normal range due to relative or absolute deficiency of parathyroid hormone (PTH). The clinical features of hypoparathyroidism are consistent with hypocalcaemia and, predominantly, neuromuscular dysfunction. Although hypocalcaemia-induced seizures are well documented hypoparathyroidism-induced epilepsy is often misdiagnosed as idiopathic epilepsy. CASE REPORT We reported a 57-year-old woman with new-onset seizure due to hypoparathyroidism. At first, diagnosis of epilepsy was established and the antiepileptic therapy was initiated with gradual increase of the dose. Computerized tomography scan of the head revealed bilateral basal ganglia and cerebellar calcification and many punctiform calcifications between cortical and subcortical parts. During hospitalization, laboratory tests showed hypocalcemia, hyperphosphatemia and low PTH level. Once the diagnosis of hypoparathyroidism was established, a proper treatment with calcium and vitamin D was started, and the patient was discharged from hospital with full seizure control. CONCLUSION Standard evaluation of serum calcium levels in patients with new-onset epileptic seizures should be obligatory part of a diagnostic algoritam to avoid misdiagnosis of idiopathic epilepsy.