1,721,008 research outputs found
Withdrawal seizures: possible risk factors.
No full textIntroduction: Most of the patients usually achieve seizure freedom under treatment with antiseizure medications (ASMs). Drug withdrawal in seizure-free patients is still one of the most challenging issues in the management of epilepsy. The decision-making process of whether the treatment should be discontinued must be based on the evaluation of possible long-term side effects of chronic treatment and, on the other hand, the risk of seizure relapse.
Areas covered: This review aims to describe and discuss possible predictors and risk factors for seizure relapse during and after discontinuation, according to the available literature evidence. The most important risk factors for withdrawal failure are the etiology of the epilepsy syndrome and epilepsy-related factors, worsening or persistence of epileptiform abnormalities on EEG recordings at the time of discontinuation or during drug tapering, and brain MRI abnormalities. Each single risk factor should be considered together with possible other concurrent predictors.
Expert opinion: The decision to withdrawal antiseizure medication in seizure-free patients should be carefully planned and based on the evaluation of predictors. A discontinuation program should include tailored discussion with patients and family members and individualized decision, the taper schedule, and plans for monitoring during and after drug tapering
What Are the Challenges With the Pharmacological Management of Epilepsy in Patients With Attention Deficit Hyperactivity Disorder (ADHD)?
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Mozart's music in children with drug-refractory epileptic encephalopathies: Comparison of two protocols
No full textIn this prospective, randomized, open label study, we compared the effect on seizure recurrence and quality-of-life parameters, of two different protocols of music therapy in children and adolescents with refractory epileptic encephalopathies. Nine out of 19 patients (13 males and 6 females, aged between 1 and 24 years) were randomized to listen to Mozart's sonata in D major for two pianos K448 for 2 h/day for 2 weeks; other 10 children were randomized on a set of Mozart's compositions. In group 1 (K448), 2/9 children (22.2%) had a ⥠75% seizure decrease; two patients had less than 50% seizure reduction, and the other five were unchanged. In group 2 (set Mozart), 7/10 patients (70%) had a significant seizure reduction (specifically, ⥠50% in 1/10; ⥠75% in 4/10; 100% in 2/10). An overall more significant behavioral improvement including less irritability and tearfulness, reduced self-/heteroaggression, a better daytime vigilance, and nighttime sleep quality, was also reported in children from group 2. In conclusion, the present study seems to confirm that music therapy may be an additional, nonpharmacological, effective treatment for patients with refractory epileptic seizures in childhood. The Mozart's set of different compositions can be better accepted and effective than the K448
Perampanel tolerability in children and adolescents with focal epilepsy: Effects on behavior and executive functions
No full textObjectives: Perampanel (PER) is a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor antagonist recently approved for focal and generalized epilepsies as an add-on therapy. It is well tolerated and effective as treatment of various pediatric epilepsy syndromes; PER does not seem to negatively affect the cognitive profile of children and adolescents, but its influence on executive functions is still to be assessed.
Methods: Our sample included 37 children aged 12-18 years, with focal pharmacoresistant epilepsy already in therapy with 2 or 3 antiepileptic drug (AED); PER was added with 1 mg/week increments up to a dose of 2-4 mg/day. Changes in executive functions were assessed by the EpiTrack Junior test. Emotional and behavioral aspects were evaluated through the interview for parents Child Behavior Checklist (CBCL). Both tests were performed before taking PER and after 6 and 12 months of treatment.
Results: After 12 months of PER in 22/30 patients, global score of the EpiTrack Junior test remained almost unchanged; in 7/30 patients, this score improved. The CBCL did not show significant changes in emotional or behavioral problems.
Conclusions: Adjunctive treatment with PER did not negatively affect executive functions that could also be improved. No emotional/behavioral negative effects have been reported, and this suggests a good tolerability in the middle/long term
Parental Stress and Parental Ratings of Behavioral Problems of Enuretic Children
Full text linkBackground: Primary monosymptomatic nocturnal enuresis (PMNE) may have a
stressful impact on the everyday life of children and parents, and it may represent a
cumulative stress factor increasing feelings of “learned helplessness.”
Methods: The current study investigated parental stress in a group of parents (n = 330)
of children affected by PMNE, compared to a group of parents (n = 330) of typical
developing children (TDC). In addition, the study evaluated whether parents of PMNE
children experience more emotional, social, and behavioral problems in their children,
compared to parents of TDC. Finally, the study correlated frequency of enuresis with
stress values and Child Behavior Checklist (CBCL) subscales and total stress with CBCL.
Both groups were given The Parental Stress Inventory-Short Form (PSI-SF) and the Child
Behavior Checklist (CBCL).
Results: Parents of PMNE children showed significantly higher stress level than
parents of TDC. Nocturnal enuresis, as a demanding clinical condition difficult to
control, represents a relevant stress factor. Mothers appeared as more vulnerable
to stress than fathers. Parents of PMNE children reported higher behavioral and
emotional problems, compared to reports of parents of TDC. PMNE children appeared
to their parents as having lower competency in social activities, school performance,
and social relationships than TDC. Moreover, they were rated as more withdrawn,
anxious-depressed,more aggressive, inattentive, and withmore somatic complaints than
healthy children. It was always the mother who rated a significantly higher number of
emotional, social, and behavioral problems compared to fathers. Correlational analysis
showed that the higher the frequency of enuresis, the greater the parental stress
level, the lower the social activities, school performance and relational competencies
and the higher the emotional, social and behavioral problems in children, according
to the parents’ evaluations. The greater the parental stress level, the lower the
competencies rated and the higher the behavioral problems detected by parents.
Conclusion: The physicians who deal with PMNE children have taken into account
the stressful role and emotional dimensions of this clinical condition, both for children
and mothers, in order to improve clinical management. Psychological support is needed
for parents, and mothers especially, for a more functional stress management related to
the PMNE
Zonisamide in children and young adults with refractory epilepsy: An open label, multicenter Italian study
No full textPurpose: To report on the first multicenter Italian experience with zonisamide as an add-on drug for refractory generalised or partial epilepsy in children, adolescents and young adults. Methods: The patients were enrolled in a prospective, add-on, open-label treatment study from eight Italian centres for children and adolescent epilepsy care. Eighty-two young patients (45 males, 37 females), aged between 3 and 34 years (mean 13.1 years), all affected by partial (47) or generalised (35) refractory epilepsy, were enrolled in the study.
ZNS was added to the baseline therapy at a starting dose of 1 mg/kg/day twice daily. This dose was increased by 2 mg/kg every 1—2 weeks over a period of up 3 months, according to the patient’s response and tolerability, up to a maximum dose of 12 mg/kg. ZNS was given at the mean daily dose of 5.7/mg/kg/24 h (range 1—12 mg/kg).
Results: After a mean follow-up period of 11.9 months (range 2—64 months), 9 patients (10.9%) were seizure-free. The number of seizures decreased by 50—99% in 31 cases (37.8%), by 25—49% in 5 cases (6.1%), remained the same in 29 cases (35.4%) and increased in 8 cases (9.7%)
Zonisamide in children and young adults with refractory epilepsy: An open label, multicenter Italian study
No full textPurpose: To report on the first multicenter Italian experience with zonisamide as an add-on drug for refractory generalised or partial epilepsy in children, adolescents and young adults. Methods: The patients were enrolled in a prospective, add-on, open-label treatment study from eight Italian centres for children and adolescent epilepsy care. Eighty-two young patients (45 males, 37 females), aged between 3 and 34 years (mean 13.1 years), all affected by partial (47) or generalised (35) refractory epilepsy, were enrolled in the study.
ZNS was added to the baseline therapy at a starting dose of 1 mg/kg/day twice daily. This dose was increased by 2 mg/kg every 1—2 weeks over a period of up 3 months, according to the patient’s response and tolerability, up to a maximum dose of 12 mg/kg. ZNS was given at the mean daily dose of 5.7/mg/kg/24 h (range 1—12 mg/kg).
Results: After a mean follow-up period of 11.9 months (range 2—64 months), 9 patients (10.9%) were seizure-free. The number of seizures decreased by 50—99% in 31 cases (37.8%), by 25—49% in 5 cases (6.1%), remained the same in 29 cases (35.4%) and increased in 8 cases (9.7%)
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