Poster Sessions

2011 Epilepsia  
Purpose: To conduct a pan-European survey amongst people with epilepsy to define issues of importance in their daily lives, correlated with duration of epilepsy, age, as well as other characteristics. Questions allowed challenges to traditional assumptions of therapy goals. Method: We collaborated with The International Bureau for Epilepsy (IBE) to develop an easy-to-complete Web-based survey, distributed through the IBE's country chapter websites and by e-mail. The predominantly
more » ... questionnaire was available in 12 different languages. Questions primarily focused on personal experiences of the specific impact of epilepsy, individual management, and on which aspects actually mattered most to them. Issues raised provided opportunities for patients to consider their personal needs and goals in contrast to traditional assumptions of therapeutic goals (doctor's point of view). All survey responses were deidentified and collated on a central database for analysis. The scope of the survey allowed for multiple sub-analyses including demographical stratifications. Results: Preliminary results of the first round of the survey will be presented. Conclusion: The survey findings will provide an insight to the real needs and challenges of people with epilepsy and may play a part in shaping future management strategies. Philippines Purpose: The study aims to characterize the demographics of status epilepticus (SE) patients, determine prognostic factors for survival, and identify predictive factors for developing refractory convulsive SE (RCSE). Method: This is a retrospective study, involving 67 patients admitted for SE at our institution from January 2003 to September 2010. Clinical profiles, presentation and laboratory results were obtained from chart reviews. Prognostic factors for survival were determined using logistic regression. Predictive factors for developing RCSE were identified using stepwise regression analysis. Results: About 52.2% of the patients had first-onset seizures progressing into SE. Half of the events (50.7%, N = 34) were caused by primary seizure disorder. Mortality rate of SE is 19.4%. About 16% (N = 11) of the patients with SE were classified as RCSE. Six RCSE cases were diagnosed with viral CNS infections. Two variables were associated with RCSE (p < 0.05), first onset seizures (p = 0.017), and abnormal cranial imaging (p = 0.006). Sensitivity of first onset seizures and abnormal cranial imaging, as predictive factors for developing RCSE is 81.82%, and specificity of both variables is 5229TH IEC PROCEEDINGS 23 88.91% probability of RCSE occurrence was noted if first-onset seizures and abnormal cranial imaging are both present. Conclusion: This study identified two predictive factors for developing RCSE, abnormal cranial imaging and first-onset seizures. Presence of both variables can predict occurrence of RCSE with a relatively high sensitivity rate. It is important to identify patients who are at risk for developing SE to reduce the probability of progression into RSE, and prevent long-term deleterious complications. Introduction: Status epilepticus (SE) is a life-threatening neurological emergency with patients presenting in a protracted epileptic crisis. Suboptimal management is associated with high morbidity and mortality. Continuous EEG monitoring is regarded as essential by NICE in the management of refractory status epilepticus (RSE). Purpose and Methods: We conducted a national audit to determine current clinical practice in the management of RSE amongst adults in Intensive Care Units (ICU) in 55 randomly selected UK NHS Trusts and a literature review of the management of RSE. Purpose: The beneficial effect of nicotine administration was reported in patients with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) with mutation of neuronal nicotinic acetylcoline receptor (nAChR). Our study aimed to verify whether there is a higher frequency of tobacco use among NFLE patients and their relatives compared to a healthy control group Method: The following groups have been included: NFLE patients with video-EEG recording of at least one hypermotor/asymmetric tonic 24 seizure or two paroxysmal arousals; relatives of patients with NFLE: at least seven members of the proband family; control subjects: matched with probands for age, sex, education and geographic origin; relatives of control subjects: at least seven members of the control family. Results: We interviewed 434 individuals with a questionnaire regarding tobacco use. Thirty-three patients with NFLE, 182 relatives of probands, 31 healthy controls and 188 relatives of controls. The frequency of tobacco use did not differ in the two groups: NFLE group (48.8%) vs control group (43.4%)(p = 0.289). Conclusion: We didn't find a significant difference in the distribution of tobacco use among NFLE patients and their relatives respect to the control group. Our finding could be due to the fact that none of our patients have any of the known mutation of nAChR. Alternatively the genetic model of ADNFLE is not representative of the whole NFLE population. Genetic and environmental mechanisms other than the known mutations may be implicated in the pathogenesis of NFLE in most cases making NFLE a multifactorial polygenic disease. Purpose: Epilepsy has many signs, symptoms, and impacts which are best assessed by the patient. Patient reported outcome (PRO) epilepsy instruments traditionally capture distal concepts of the seizure experience, such as health-related quality of life. The goals of this work were to: (1) identify aspects of seizure severity; (2) evaluate existing PRO epilepsy instruments. Methods: Literature review, qualitative interviews with 25 patients with epilepsy to capture patients' seizure experience, interviews with four epilepsy experts elucidating clinical perspective, and available PRO instrument evaluation. Results: Seizure severity was not consistently defined or applied. Literature, patients, and experts identified seizure severity as a complex concept best assessed from the patient's perspective. Three aspects of seizure severity were identified and supported by literature, experts, and patients: symptoms, seizure duration, and frequency. Symptoms included loss of consciousness, injury/bodily harm, muscle/body pain, exhaustion, headache, confusion, awareness, memory loss/impairment. Duration was characterized as part of seizure severity, and defined as the total time from onset of a seizure to recovery. Frequency included seizure number, pattern, and timing. The PRO epilepsy instruments were evaluated according to expectations in the FDA PRO guidance; existing instruments did not capture all specific aspects of seizure severity as defined by the patients, and lacked documentation of content validity or definition of measurement concept. Conclusions: There is a need for PRO epilepsy instruments that capture the patients' experience and are developed according to regulatory expectations. This work is a starting point for development of a new PRO instrument measuring seizure duration (UCB Sponsored). Purpose: Managing nonconvulsive status epilepticus (NCSE) poses many challenges that would benefit from reliable, early measures to predict patient outcomes. Here we evaluate clinical and electroencephalographic (EEG) responses to an acute antiepileptic drug (AED) trial for predicting outcomes in patients presenting with suspected NCSE. Method: We analyzed all patients referred to our Neurology Service with suspected NCSE assessed by a standard acute intravenous (IV) benzodiazepine (BDZ) protocol. We correlated patients' clinical and EEG responses to the BDZ trial with their subsequent outcomes, including survival, recovery of consciousness, and functional status at hospital discharge. Results: With an acute IV BDZ protocol trial. A favorable clinical response with improvement in consciousness was observed in 22 patients (35%), while 40 (65%) were clinical nonresponders. All of the positive clinical responders (100%) survived, recovered consciousness, and exhibited good functional outcomes. In contrast, outcomes were significantly poorer (p < 0.001) for the clinical nonresponders; only 14 (35%) recovered consciousness and 22 (55%) survived, with 59% of those survivors demonstrating poor functional outcomes. EEG improvement with BDZs also predicted better outcome, but it was less robust than the clinical response, with better subsequent recovery of consciousness (p < 0.05), but not functional outcome or survival. Conclusion: This study demonstrates that a clinical and, to a lesser degree, EEG response to an acute trial of IV BDZs are predictive of subsequent outcome in patients with suspected NCSE, and warrant further consideration and investigation for assessing and managing such patients. p064 VITAMIN D STATUS IN AN OUT-CLINIC PATIENT POPULATION OF A TERTIARY REFERRAL EPILEPSY-CENTER Augustijn P, van Iterson L S.E.I.N., Hoofddorp, The Netherlands Purpose: People with epilepsy (PWE) have a two to sixfold increased risk for bone fracture. About 40% of fractures are osteoporosis-related. Vitamin D plays a major role in bone homeostasis. Vitamin D deficiency not only leads to fragility fractures but is also associated with fatigue, muscle-weakness and bone-pain. In a prospective study we investigated hypovitaminosis-D and its risk factors. Method: 25-hydroxyvitaminD 3 (vit-D), calcium, phosphorus, alkalinephosphatase serum-concentrations were measured in 150 consecutive out-clinic patients, who underwent vena-puncture for therapeutic-drugmonitoring. This selection is characterized by: Age 6-72 years, mean 19, 55% under 18 years; 78 males, 72 females; 24% of non-Dutch origin. AED-use: 1-4 (mean 1.9). Seizure-free >6 months: 42%; 37% had serious developmental, psychomotor or psychiatric disorders. Definitions: vitamin D-deficiency: vit-D < 30 nM; Insufficiency ‡30 and <50 nM. Hypocalcemia: children <2.10 and adults <2.14 mM. Results: No differences were seen for age or sex. Vit-D levels were clearly lowered in nonnative compared to native PWE (30.7 versus 53.9 nM). In nonnatives, vit-D deficiency was established in 58%, insufficiency in 25%, in natives 16% and 34% respectively. Vit-D deficiency was not strongly related to the use of enzyme-inducing AEDs (30.3% vs. 20.6% for noninducing AEDs). A higher risk for vit-D deficiencies was seen in patients with persisting seizures and/or developmental and psychiatric disorders. Two patients had vit-D deficiency and hypocalcemia. Conclusion: Vitamin D-deficiency/insufficiency is very common in patients with chronic epilepsy in all age groups. Nonnative patients and PWE with developmental/motor/psychiatric problems and/or intractability are especially at risk. Enzyme-inducing AED use was no significant risk factor. Purpose: Neurocysticercosis (NCC) is one of the common causes of seizures in India. CT brain scan shows cysts in different stages and most of them respond well to antiepileptic drugs (AED), albendazole and steroids. The exact duration of antiepileptic drug treatment is not known. We have seen some patients who respond well to antiepileptic drugs and their AED tapering becomes difficult if they have calcified lesions on their CT brain scan. Method: In the last 3 years we have seen eight patients at our out patient clinic with seizures and calcified granulomas on their CTS can brain. Five patients were woman three were men. Age varied from 17 to 55 years, their seizures were controlled well with antiepileptic drugs. EEGs were normal. Routine blood and urine examinations were normal.
doi:10.1111/j.1528-1167.2011.03207.x fatcat:77ayxa5tcbannis7zksyeo57ju