Morten I. Lossius

Consequences of antiepileptic drug withdrawal : A randomized, double-blind study (Akershus Study)

Objective: Despite side effects associated with the use of antiepileptic drugs (AEDs), withdrawal of AEDs remains controversial, even after prolonged seizure freedom. The main objective of this study was to assess the effects of AED withdrawal on cognitive functions, seizure relapse, health‐related quality of life (HRQOL), and EEG results. Additionally, potential predictors for freedom from seizures after AED withdrawal were studied.

Poststroke Epilepsy: Occurrence and Predictors—A Long‐term Prospective Controlled Study (Akershus Stroke Study)

Summary:  Purpose: The aims of the study were to assess the occurrence of poststroke epilepsy (PSE) in patients with ischemic strokes, to identify predictors, and to investigate whether treatment in a stroke unit (SU) influenced the long‐term outcomes of epilepsy.

Influence of Major Antiepileptic Drugs on Attention, Reaction Time, and Speed of Information Processing: Results from a Randomized, Double-blind, Placebo-controlled Withdrawal Study of Seizure-free Epilepsy Patients Receiving Monotherapy

Summary:  Purpose: All major antiepileptic drugs (AEDs) have been reported to be associated with cognitive side effects. Uncertainty exists regarding the degree of cognitive effects, primarily because many studies do not adhere to basic standards of methodology and design. The aim of this study was to assess the effect of discontinuation of AEDs in patients receiving monotherapy on measures of attention, reaction time, and speed of information processing.

Properties of the 15D and EQ-5D utility measures in a community sample of people with epilepsy

To perform economic evaluation studies in epilepsy using utilities, such as cost-utility analyses, it is necessary to have reliable and valid instruments for eliciting peoples preferences. The objective of this study was to assess the reliability and validity of two multiattribute utility measures in a community sample of 397 people with epilepsy. We assessed the test-retest reliability of individual questionnaire items and aggregate scores. Additionally, construct validity was assessed by correlating items of the EQ-5D with items of the 15D health status questionnaire, and discriminant validity was assessed by comparing scores for known groups. The test-retest reliabilities for the individual items of the 15D (weighted kappa 0.59-0.90, except mobility with only 0.28) and the EQ-5D (weighted kappa 0.49-0.86) were acceptable. For the composite utility scores the test-retest reliability was better (intraclass correlation coefficient 0.93 for both 15D and the EQ-5D). Spearmans rank correlations between EQ-5D single item scores and corresponding 15D single item scores were high (rho 0.34-0.79) and generally higher than the associations between non-corresponding items. Some EQ-5D and 15D items discriminated well between patients according to seizure status, psychiatric comorbidity and working status; less well after antiepileptic drug use and neurologic comorbidity. Both the EQ-5D and 15D were reliable instruments and showed properties supporting the construct validity of both measures.

The health-related quality of life of patients with epilepsy compared with angina pectoris, rheumatoid arthritis, asthma and chronic obstructive pulmonary disease

The objective of this study was to compare the health-related quality of life (HRQL) of patients with epilepsy with populations suffering from different chronic diseases, using the short form 36 (SF-36) health profile measure. The populations to be compared were adult patients drawn from hospital based registers, with confirmed epilepsy (n = 397), angina pectoris (n = 785), rheumatoid arthritis (n = 1030), asthma (n = 117) and chronic obstructive pulmonary disease (COPD) (n = 221). Health-related quality of life scores were compared using analysis of covariance (ANCOVA) for predicting mean scores adjusted for age, gender, education and comorbidity. Patients with epilepsy on average scored highest on all scales, reflecting that in our sample the majority had well-controlled epilepsy. Our results indicate that the HRQL of a representative sample of patients with epilepsy is good, when compared with other chronic disorders, although reduced in several dimensions compared with a general reference population. Patients with rheumatoid arthritis (RA) and COPD scored lowest on the physical function scales, while rheumatoid arthritis patients reported most pain.

Reversible Effects of Antiepileptic Drugs on Reproductive Endocrine Function in Men and Women with Epilepsy—A Prospective Randomized Double-blind Withdrawal Study

Summary:  Purpose: Epilepsy, antiepileptic drugs (AEDs), and reproductive endocrine function have complex interactions. In this study, we wanted to investigate the effects of AEDs on reproductive endocrine function after withdrawal of AEDs and look for reversible endocrine effects.

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.

Reliability and Validity of the Canadian Neurological Scale in Retrospective Assessment of Initial Stroke Severity

Background: Stroke severity is an important determinant of outcome, however, quantitative data on the initial neurological status might be lacking in retrospective studies. We wanted to assess the reliability and validity of the retrospective use of the Canadian Neurological Scale (CNS). Methods: In 181 patients with validated stroke, two raters scored the CNS based on medical record review. We assessed interrater reliability and construct validity of the CNS. Predictive validity was assessed by the ability of the CNS to predict 30-day and 1-year mortality. Results: Interrater reliability was high (kappa or weighted kappa 0.76–0.96). Correlations between similar items of prospective Scandinavian Stroke Scale scores and retrospective CNS scores ranged from 0.54 to 0.85. CNS total score was a strong predictor of death within 30 days and 1 year in multivariate models. Conclusions: The retrospective algorithm for the CNS had a high to substantial interrater reliability and predictive validity. Accordingly, in retrospective stroke studies using medical record information, the CNS can be a feasible instrument to adjust for differences in stroke severity.

Incidence and predictors for post-stroke epilepsy : a prospective controlled trial. The Akershus stroke study

The aim of the study was to assess the incidence and identify predictors for post‐stroke epilepsy (PSE), in particular the possible influence of treatment in a stroke unit (SU). Patients with PSE were identified between 4 weeks and 1 year after the stroke. Different parameters were studied as possible predictors. Twelve patients (2.5%) developed PSE during 12 months. Four of the patients (33%) were treated in an SU and eight of the patients (67%) were treated in general medical wards (GMWs) (P=0.50). Mean age in those with PSE was 75 and 76 in those without (P=0.57). Four out of 363 patients (1.1%) with minor stroke [Scandinavian Stroke Scale (SSS)‐score >30] developed PSE. Seven out of 104 patients (6.3%) with severe stroke developed PSE (P=0.004). In the multivariate analysis SSS‐score scores below 30 was a significant predictor for incidence of PSE (odds ratio=6.1, P=0.003). At 12 months the incidence of PSE was 2.5%. SSS‐score below 30 was a significant predictor for PSE, whilst age and treatment in SU versus GMW were not.

Reliability and Validity of a Norwegian Version of the Quality of Life in Epilepsy Inventory (QOLIE-89)

Summary: Purpose: To develop a Norwegian version of the Quality of Life in Epilepsy Inventory (QOLIE‐89) and to confirm its psychometric properties.