Sirichai Chayasirisobhon

Sepulveda Epilepsy Education: The Efficacy of a Psychoeducational Treatment Program in Treating Medical and Psychosocial Aspects of Epilepsy

Summary: The present study evaluated the efficacy of the Sepulveda Epilepsy Education program (SEE), using a controlled outcome design. SEE is a 2‐day psychoeducational treatment program designed to provide medical education and psychosocial therapy. Thirty‐eight outpatients, matched according to seizure type and frequency, were randomly assigned to treatment (n = 20) or waiting‐list control (n = 18) groups. The major outcome measures used were a 50‐item true‐false test specifically designed to evaluate the SEE program, the Washington Psychosocial Seizure Inventory, the Beck Depression Inventory, Lu‐bins Depression Adjective Checklist, the State‐Trait Anxiety Inventory, the Acceptance of Disability Scale, and Sherers Self‐Efficacy Scale. Significant differences between the two groups were found on the three major subscales of the 50‐item true‐false test. The treatment group demonstrated a significant increase in overall understanding of epilepsy, a significant decrease in fear of seizures, and a significant decrease in hazardous medical self‐management practices. In addition, an objective measure of blood levels of antiepileptic drugs (AEDs) showed the treatment group to have a significant increase in medication compliance.

Recording of brainstem evoked potentials and their association with gentamicin in neonates.

Brainstem auditory evoked potential (BAEP) recording was used to screen presymptomatically the hearing of 200 neonates treated with ampicillin (100 mg/kg daily) and gentamicin sulfate (5 mg/kg daily). The study included 130 male and 70 female neonates; post-conceptional age ranged from 34 to 57 weeks (mean 42.36 weeks). We divided neonates into 2 groups according to duration of antibiotic treatment; group 1 consisted of 179 patients who were treated with antibiotic agents for < or = 7 days. Although 15 (8.4%) in this group initially manifested abnormal BAEP recordings, only 8 of these brain-damaged neonates (4.5%) (6 with peripheral and 2 with central dysfunction) later manifested abnormal recordings. Group 2 consisted of 21 neonates who were treated for 10 to 30 days; BAEP recordings were abnormal in 7 patients (33.3%) (4 with peripheral and 3 with central dysfunction). We conclude that BAEP is indicated only for neonates treated with gentamicin sulfate for > 10 days. In this group, infants so treated usually have underlying disease or severe infection, including birth asphyxia, hypoxia, sepsis, and meningoencephalitis, all of which are clinically significant indicators of high risk for auditory pathway dysfunction.

Screening of EEG Referrals by Neurologists Leads to Improved Healthcare Resource Utilization

The objective of this study was to determine if screening by a neurologist of all non-neurologist electroencephalogram (EEG) referrals prior to approval reduces the number of inappropriate requests. This retrospective survey included 600 consecutive EEG requisitions referred to the Anaheim Kaiser Permanente Neurodiagnostic Laboratory to rule out epilepsy. Patients with established epilepsy referred for a repeat EEG for management issues were excluded. Three groups of EEG referrals were analyzed. Each group consisted of 200 EEGs (100 pediatric and 100 adult EEGs). The first group was referred directly by non-neurologists, the second group was referred by non-neurologists with scrutiny by a neurologist, and the third group was referred by a neurologist directly. In the pediatric group, the ratio of abnormal EEG vs normal EEG was 1: 3.35 in the first group, 1: 0.69 in the second group and 1: 0.33 in the third group. In the adult group, the ratio of abnormal EEGs vs normal EEGs was 1: 2.23 in the first group, 1: 0.82 in the second group and 1: 0.45 in the third group. In the combined pediatric and adult groups, the ratio of abnormal EEG vs normal EEG was 1: 2.70 in the first group, 1: 0.75 in the second group and 1: 0.39 in the third group. There was a significant difference between the results of the EEGs ordered by non-neurologists directly versus non-neurologists with scrutiny (p=.334, chi-square test). Scrutiny by a neurologist of EEG referrals from non-neurologists led to a reduction in the number of normal EEG results. This suggests that inappropriate EEG requests for non-epileptic patients that yield normal EEG results are significantly reduced with scrutiny. This can help reduce the indiscriminate overuse of EEGs by non-neurologists thereby leading to better utilization of healthcare resources.

Efficacy of Neuromodulation Therapy with Vagus Nerve Stimulator in Patientswith Drug-Resistant Epilepsy on Unchanged Antiepileptic Medication Regimenfor 24 Months Following the Implant

To establish efficacy of vagus nerve stimulation (VNS) therapy in the treatment of intractable epilepsy, we compared outcome data from the baseline period to the maintenance period (7 to 24 months post-implant) by calculating the mean seizure frequency at 6-month intervals (7 to 12 months - first study period, 13 to 18 months - second study period, and 19 to 24 months - third study period), in 39 consecutive patients on unchanged antiepilepsy drug (AED) regimen for 24 months following the VNS implant. Of the 39 patients24 (61.5%) at first study period, 25 (64.1 %) at second study period and 25 (64.1 %) at third study period were responders (≥50% reduction in seizures). Twenty one (53.9 %) patients were responders in all three study periods. Incremental seizure control was seen in 15 of these 21 patients. Although 3 (7.7%), 4 (10.3 %) and 8 (20.5%) patients had a total (100%) seizure control at first, second and third study periods respectively, no patient remained seizure-free through all 3 study periods. Seven (17.9%) patients were partial responders (≥ 50% seizure reduction in two or less study periods). Eleven patients (28.2%) were non-responders (< 50% seizure reduction in all 3 study periods). Twenty three patients (59%) had partial epilepsy with and without secondarily generalization and 16 patients (41%) had primary generalized epilepsy. Eleven (47.8%) of the 23 patients with partial epilepsy and 10 (62.5%) of the 16 patients with generalized epilepsy were responders in all three study periods. We conclude that: 1) More than 60 % of patients on unchanged AED regimen continued to be responders at 24 months following the VNS implant. 2) A trend towards increasing responder rate with increasing duration of VNS therapy was observed.3) No major complications or side effects requiring discontinuation of VNS therapy were noted.

Scalp-Recorded Auditory P300 Event-Related Potentials in New-Onset Untreated Temporal Lobe Epilepsy

We studied scalp-recorded auditory event-related potentials (ERPs) of 30 untreated patients with new-onset temporal lobe epilepsy and 30 age-and sex-matched normal controls. This study was designed to eliminate the effects of intractability of seizures and chronic use of antiepileptic drugs on P300 auditory ERPs. There were no statistically significant differences in both latency and amplitude of P300 between the two groups. Similar methods were also used to analyze component latencies and amplitudes of ERPs of 9 patients who had hippocampal sclerosis with comparison to control subjects. There were no statistically significant differences between these two groups as well. Our study evidently does not support temporal lobe sources of P300 scalp-recorded auditory ERPs. We also conclude that the scalp-recorded auditory ERPs procedure is not a useful tool to evaluate temporal lobe epilepsy.

Acute levetiracetam overdose presented with mild adverse events.

PURPOSE Overdose of levetiracetam may produce neurotoxicity. CASE REPORT We reported a patient with epilepsy who took an overdose of 63 grams of levetiracetam with mild adverse events. The patient presented mild blurred vision and mild ataxia that rapidly subsided within one day with supportive care. The laboratory tests showed mild leucopenia and mild thrombocytopenia that gradually returned to normal within 2 months. CONCLUSION The pharmacokinetics, tolerability and adaptation of levetiracetam might play a role in the mild adverse events of levetiracetam overdose in our patient.

Neuromodulation Therapy with Vagus Nerve Stimulation for Intractable Epilepsy: A 2-Year Efficacy Analysis Study in Patients under 12 Years of Age

To study the efficacy of vagus nerve stimulation (VNS) therapy as an adjunctive treatment for intractable epilepsy in patients under 12 years of age, we analyzed 2-year postimplant data of 35 consecutive patients. Of the 35 patients, 18 (51.4%) at 6 months, 18 (51.4%) at 12 months, and 21 (60.1%) at 24 months showed ≥50% reduction in seizure frequency (responders). Although incremental seizure freedom was noted, no patient remained seizure-free throughout the 3 study periods. Partial response (≥50% seizure reduction in 2 or less study periods) was seen in 8 (22.9%) patients. Twelve patients (34.3%) were nonresponders. Out of 29 patients with primary generalized epilepsy, 20 (68.9%) and, out of 6 patients with focal epilepsy, 3 (50%) had ≥50% seizure control in at least one study period. No major complications or side effects requiring discontinuation of VNS therapy were encountered. We conclude that (1) patients with intractable primary generalized epilepsy respond better to VNS therapy, (2) cumulative effect of neuromodulation with improving responder rate to seizure freedom with continuation of VNS therapy is noted, and (3) VNS therapy is safe and is well tolerated in children receiving implant under 12 years of age.

Evaluation of Maturation and Function of Visual Pathways in Neonates Role of Flash Visual-Evoked Potentials Revisited

The purpose of our study was to establish the guidelines for interpreting neonatal flash visual-evoked potentials (FVEPs) by examining the correlation between maturation of the waveforms and conceptual age (CA). We retrospectively analyzed 220 consecutive neonatal FVEPs performed on premature and full-term infants. The CA of the participants ranged from 28 to 52 weeks. The FVEPs were categorized into 6 groups according to CA: 28 to 31+ weeks, 32 to 35+ weeks, 36 to 39+ weeks, 40 to 43+ weeks, 44 to 47+weeks, and 48 to 52 weeks. The data were analyzed in each group and compared among these 6 groups. The waveforms changed from 28 weeks to 52 weeks of CA. In the CA age range 28 to 31+ weeks N3 was well visualized, followed by P3. The morphology of P2 including both latency and amplitude became prominent starting from CA age range 32 to 35+ weeks. The triphasic waveform with clear negative-positive-negative components (N2-P2-N3) presented after 32 weeks. Mean P2 latencies decreased steadily with increasing age. Mean amplitudes of all waveforms (P2-N3 and N3-P3) varied except that of N2-P2 which increased steadily with CA. We conclude that FVEPs can be useful in the evaluation of maturation and function of the visual pathway in neonates. The FVEP is abnormal when the waveforms N3 and P3 are nondetectable in neonates at 28 weeks of CA or older; and when the waveform P2 is non-detectable, or has low amplitude or prolonged latency, in neonates at 36 weeks of CA or older.