Syed Hosain

Topiramate for the Treatment of Infantile Spasms

Topiramate is a new antiepileptic drug with a broad spectrum of efficacy. Reports on the use of topiramate for treatment of infantile spasms are limited. We prospectively followed 15 children with recently diagnosed infantile spasms treated with topiramate for efficacy and tolerability. Twelve patients had symptomatic infantile spasms, and two patients had cryptogenic infantile spasms. Topiramate was started at a dose of 3 mg/kg/day and titrated up to a dose of 27 mg/kg/day in 2 to 3 weeks. The primary efficacy measure was comparison of the seizure rate during the 2-week baseline with the median seizure rate during the first 2 months of treatment with topiramate. We also compared baseline electroencephalograms (EEGs) with post-treatment EEGs. The median seizure rate reduction during the first 2 months of treatment was 41% (P = .002). Three patients became spasm free (20%), five had > 50% reduction, and three had at least 25% reduction. Four patients did not respond. Three of 15 patients had clearing of hypsarrhythmia. Topiramate was generally well tolerated, with irritability being the most common side effect. Topiramate was efficacious and well tolerated; one patient discontinued the medication because of adverse effects. (J Child Neurol 2006;21:17—19).

Felbamate for Refractory Infantile Spasms

etiology of the vasculopathy and an early diagnosis can be achieved with appropriate therapy initiated. The incidence of HIV associated varicella zoster vasculopathy may be greater than recognized. Our patient had a radiologic infarct before the eruption of a rash. Skin manifestations of varicella zoster infection may be absent or occur after the onset of central nervous system disease.2 At present, interventions for varicella zoster central nervous system vasculopathy have limited impact. With an ability to determine the etiologic agent of vasculopathy in pediatric AIDS earlier, more aggressive and novel therapeutic interventions including foscarnet sodium may be explored.

Effects of nitrous oxide on electrocorticography during epilepsy surgery

Interictal spikes on intraoperative electrocorticography during epilepsy are used to tailor resections. There have been a few systematic quantitative studies of anesthetic effects on these interictal discharges, and none on the effects of nitrous oxide (N2O). We calculated spike rates on ECoG on and off N2O in 18 epilepsy surgery patients with subdural strips and grids, analyzing the most active recording contract. In a blinded analyses ten patients had fewer spikes on N2O, while eight patients had more spikes on N2O. The mean spike rates did not differ (41/min on N2O and 40/min off N2O). Spike rate on and off N2O were compared using the non-parametric Wilcoxon matched pairs test. These rates were not significantly different. Our study indicates that N2O in doses employed dose not effect interictal spikes and this agent may be used during epilepsy surgery without concerns about suppression of epileptiform activity.

Apneic Seizures in Infants: Role of Continuous EEG Monitoring

Respiratory compromise is not uncommon in epileptic seizures. However, pure apneic seizures are rare. In this study, we report 10 children who presented with pure apneic seizures. All the children were admitted because of apneic events. Seizures were also considered in the differential diagnosis. Six patients had nonspecific findings consisting of multifocal interictal epileptiform activity with no event correlation. Continuous 24–72 hours electroencephalogram (EEG) was performed in all patients to rule out apneic seizures. Ictal EEG showed high correlation with the apneic episodes, confirming the diagnosis of apneic seizures. Our study suggests that continuous EEG monitoring is essential in the diagnosis and treatment of apneic seizures.

Focal suppression-burst on electrocorticography after temporal lobectomy

Of 40 patients with cortical resections for epilepsy, three had focal suppression-burst (S-B) on postresection intraoperative electrocorticography (ECoG). Eighteen to 24 months later, two patients were seizurefree and one had rare seizures. Follow-up neuropsychological testing and MRI did not reveal unexpected postoperative abnormalities. Follow-up scalp surface EEGs did not show S-B. Although focal S-B on postresection ECoG suggests severe localized cortical damage, this pattern near anterior temporal lobectomy resection margins was not associated with postoperative deficits. NEUROLOGY 1995;45: 2276-2278

Nitrazepam for the treatment oflennox-gastaut syndrome

Lennox-Gastaut syndrome is a severe childhood epileptic syndrome with encephalopathy and multiple seizure types, which are often intractable to treatment. Most of these children will ultimately become mentally retarded and dependent on others for their daily care. Antiepileptic drugs are the mainstay of treatment, however, no particular drug is entirely effective. Apart from the use of antiepileptic drugs, nonpharmacologic treatments are also considered (i.e., callosotomy, ketogenic diet, and vagus nerve stimulation), which have proven to be partially effective. We prospectively studied 14 children (11 months-8 years of age) with medication-resistant Lennox-Gastaut syndrome, being treated with nitrazepam (open-label compassionate protocol). We compared the 1-month baseline seizure frequency with the median seizure rate reduction during the first 12 months of treatment with nitrazepam. The median seizure rate reduction during the first 12 months of treatment with nitrazepam was 41% (P = 0.001), with more than 50% seizure reduction in 60% of patients. Two patients became seizure free, five patients demonstrated at least 50% reduction in seizure rates, six patients had at least 25% seizure rate reduction, and one patient did not respond. No patient had any serious adverse effects. Side effects included sedation in six children (40%) and drooling in nine patients (60%).

Evaluation of Gabapentin in an Outpatient and Office-based Sample of Epilepsy Patients

Abstract A retrospective analysis of charts of patients who received gabapentin (GBP) as adjunctive anticonvulsant therapy in its first year of marketing, between March 1994 and April 1995 was conducted to evaluate patterns of use, side effects, and efficacy in the general epilepsy population. Ninety patients (45 men, 45 women) with an average age of 33.5 years (range: 7 months–78 years) were included. Average GBP dosage was 1700 mg/day; 46 patients took

Reply from the Authors Focal suppression-burst

Reply from the Authors: We were pleased to learn of Cendes et al.s interest in our work and thank them for the additional literature citations. We would like to reply to their question. We systematically reviewed operative findings and postoperative neuroimaging studies in our …