Pasquale Parisi

Calcium-channel Blocker Verapamil Administration in Prolonged and Refractory Status Epilepticus

Summary:  We report on an 11‐year healthy boy who presented refractory status epilepticus (SE), which was unresponsive to conventional antiepileptic drugs used in the algorithm of the treatment of SE. Based on evidence that verapamil has anticonvulsant activity in animal models and the fact that the boy had a supraventricular tachycardia (140–160 b/min), i.v. verapamil (0.034 mg/min) was administered on day 37, and after a 3.125 mg cumulative verapamil dose (1.5 hour after initiation of the infusion), the patient regained consciousness was able to breathe spontaneously and the electrical SE promptly disappeared. The apparent dramatic response to i.v. verapamil may be explained by its direct anticonvulsant action on the basis of the potential involvement of calcium channels in epileptic activity and that verapamil, a known Pgp inhibitor in the cerebrovascular endothelium in the epilepticus focus, acted by facilitating the brain penetration of the antiepileptic drugs that our patient was receiving simultaneously.

Neuronal migration disorders: clinical, neuroradiologic and genetics aspects.

Disorders of neuronal migration are a heterogeneous group of disorders of nervous system development.

Bone and calcium metabolism and antiepileptic drugs.

There is increasing evidence suggesting that epilepsy and its treatment can affect bone mineralization and calcium metabolism. Many studies have shown a significant reduction in bone mineral density in patients treated with classic (phenobarbital, carbamazepine, valproate, etc.) and with new (oxcarbazepine, gabapentin) antiepileptic drugs. In spite of data about the possible effects of the antiepileptic drugs on calcium metabolism, the mechanisms of this important side effect remain to be defined. The abnormalities of calcium metabolism were thought to result from the cytochrome P450 enzyme-inducing properties of some antiepileptic drugs and the resultant reduction in vitamin D levels, but the effect of many medications (e.g., valproate) cannot be readily explained by vitamin D metabolism. In this article, the literature related to the effects of classic and new antiepileptic drugs on bone health and calcium metabolism is reviewed.

Autonomic status epilepticus in panayiotopoulos syndrome and other childhood and adult epilepsies: A consensus view

Summary:  Purpose: To discuss and propose a definition of autonomic status epilepticus (SE), describe its clinical and EEG features, and review what is known about its epidemiology, pathophysiology, differential diagnosis, and management.

Attention deficit hyperactivity disorder in children with epilepsy

Attention deficit hyperactivity disorder (ADHD) is more frequent in children with epilepsy than in general pediatric population. Several factors may contribute to this comorbidity, including the underlying brain pathology, the chronic effects of seizures and of the epileptiform EEG discharges, and the effects of antiepileptic drugs. Symptoms of ADHD are more common in some specific types of epilepsies, such as frontal lobe epilepsy, childhood absence epilepsy and Rolandic epilepsy, and may antedate seizure onset in a significant proportion of cases. In epileptic children with symptoms of ADHD, treatment might become a challenge for child neurologists, who are forced to prescribe drugs combinations, to improve the long-term cognitive and behavioral prognosis. Treatment with psychotropic drugs can be initiated safely in most children with epilepsy and ADHD symptoms.

MIGRAINE AND SUICIDAL IDEATION IN ADOLESCENTS AGED 13 TO 15 YEARS

Background: Awareness is growing among clinicians of the importance of suicidal ideation in adolescents. Objectives: To investigate the relationship between migraine and suicidal ideation in a nonreferred sample of adolescents. Methods: This study surveyed migraine and depression in three middle schools in Taitung County, Taiwan. All students completed the questionnaires, including demographics, a validated headache questionnaire, the Adolescent Depression Inventory (ADI), and the Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire. This study used the presence or absence of suicidal ideation as indicated by the ADI for the analysis. Results: A total of 3,963 (2,040 male and 1,923 female; mean age 14.0 ± 0.9 years) adolescents (93% of the target cohort) completed this study. Suicidal ideation was reported in 8.5% of the study group. Compared with nonmigraine subjects (6.2%), subjects with migraine displayed a higher frequency of suicidal ideation (16.1%; odds ratio [OR] = 2.9, 95% confidence interval [CI] 2.3–3.6; p < 0.001), especially those with migraine with aura (23.9%; OR = 4.6 [95% CI 3.0–7.0]; p < 0.001). Suicidal ideation was associated with higher headache frequency and headache-related disability as measured by the PedMIDAS. After controlling for depression score and sociodemographic characteristics, the association remained only for migraine with aura (adjusted OR = 1.79 [95% CI 1.07–2.99]; p = 0.025) and high headache frequency (>7 days/month; adjusted OR = 1.69 [95% CI 1.12–2.56]; p = 0.013) but not for migraine without aura or probable migraine or PedMIDAS score. Conclusions: This study identified a higher frequency of suicidal ideation in younger adolescents with migraine with aura or high headache frequency. These associations were independent of depressive symptoms. ADI = Adolescent Depression Inventory; AOR = adjusted odds ratio; CI = confidence interval; 5-HT = serotonin; ICHD-2 = International Classification of Headache Disorders, Second Edition; MINI-Kid = Mini-International Neuropsychiatric Interview–Kid; OR = odds ratio; PedMIDAS = Pediatric Migraine Disability Assessment.

'Ictal epileptic headache' : Recent concepts for new classifications criteria

Dear Sir, More frequently associated than expected on the basis of coincidence, headache and epilepsy are both characterized by transient paroxysmal episodes of altered brain function with clinical, pathophysiological and therapeutic overlap. Cortical spreading depression (CSD) is probably the connection point between these two conditions. In fact, CSD and an epileptic focus are able to facilitate each other (1–3), and in the central nervous system there is a hierarchical organization based on ‘neuronal networks’ (cortical and subcortical) which may be more or less prone to CSD (migraine) and/or an epileptic focal discharge (i.e. seizures). Hyperexcitation occurs in epilepsy, in migraine hypoexcitation followed by hyperexcitation, as rebound phenomenon (spreading depression) (1–3). Moreover, a disexcitability condition (hyperand hypoexcitation in the same patient at different points in time) has even been demonstrated (1–3). The International Classification of Headache Disorders (ICHD-2) committee recognizes three nosographic entities concerning the relationship between epilepsy and headache (Table 1). The International League Against Epilepsy (ILAE) classification fully

Migralepsy, hemicrania epileptica, post-ictal headache and “ictal epileptic headache”: a proposal for terminology and classification revision

Despite the fact that migraine and epilepsy are among the commoner brain diseases and that comorbidity of these conditions is well known, only few reports of migralepsy and hemicrania epileptica (HE) have been published according to the current ICHD-II criteria. Particularly, ICHD-II describes “migraine-triggered seizure” (i.e., migralepsy) among complications of migraine at “1.5.5” (as a rare event in which a seizure happens during migrainous aura), while hemicrania epileptica (coded at “7.6.1”) and post-ictal headache (coded at “7.6.2”) are described among headaches attributed to epileptic seizure. However, to date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may be the sole ictal epileptic manifestation. Based on the current knowledge, migralepsy is highly unlikely to exist as such. We, therefore, propose to delete this term until clear evidence its existence is provided. Moreover, we herein propose a revision of terminology and classification criteria to properly represent the migraine/headache relationships. We suggest the term “ictal epileptic headache” in cases in which headache/migraine is the sole ictal epileptic manifestation.

Impact of a weight loss program on migraine in obese adolescents

Increased headache frequency and severity have been observed in obese populations, but the real impact of a weight loss treatment on headache has not been studied. We investigated this issue in a sample of obese adolescents.

The relationship between sleep and epilepsy: the effect on cognitive functioning in children

Aim  The purpose of this review was to examine the possible pathophysiological links between epilepsy, cognition, sleep macro‐ and microstructure, and sleep disorders to highlight the contributions and interactions of sleep and epilepsy on cognitive functioning in children with epilepsy.