1,721,198 research outputs found
Profile of once-daily zonisamide as monotherapy for treatment of partial seizures in adults
Full text linkMarco MulaDivision of Neurology, Trinity Hospital, Borgomanero, ItalyAbstract: Epilepsy is one of the most common neurologic disorders, affecting about 50 million people around the world. It is recognized that around 50% of patients with newly diagnosed epilepsy become seizure-free with the first drug treatment, so the choice of first antiepileptic drug is crucial. This paper provides a comprehensive overview of zonisamide as monotherapy for partial seizures, with special attention to the possibility of a once-daily regimen. The available data suggest that zonisamide is an effective and well tolerated option as monotherapy. Once-daily dosing is indicated, considering the long plasma half-life and linear pharmacokinetics of the drug. Zonisamide 300 mg was shown to be noninferior to carbamazepine 600 mg in terms of efficacy and safety, but even lower doses may be effective. Finally, the broad spectrum of efficacy in different seizure types, the low drug interaction potential, and the possibility of weight loss make zonisamide a preferred option in many epilepsy practices. Further data on monotherapy, especially in special populations, such as women of childbearing potential, are needed.Keywords: epilepsy, zonisamide, monotherap
Suicidal behavior and antiepileptic drugs in epilepsy: analysis of the emerging evidence
Full text linkMarco Mula1, Dale C Hesdorffer21Department of Clinical and Experimental Medicine, Amedeo Avogadro University and Division of Neurology, University Hospital Maggiore della Carità, Novara, Italy; 2Gertrude H Sergievsky Center and Department of Epidemiology, Columbia University, New York, NY, USAAbstract: Two years after the warning issued by the Food and Drug Administration on an increased risk of suicide for people taking antiepileptic drugs (AEDs), a number of pharmacoepidemiologic studies have been published but the scientific community is far from definitive answers. The present paper is aimed at reviewing available evidence on the association between AEDs and suicidal behavior, discussing major variables involved such as the relationship between epilepsy, depression, and suicide and the psychotropic potential of AEDs. All studies published so far show a lack of concordance and are constrained by various methodological limitations. What seems to be established is that mood disorders represent a frequent comorbidity in epilepsy and suicide is a serious complication more frequently encountered in epilepsy rather than in the general population. Moreover, a subgroup of patients appears to be at risk of developing treatment-emergent psychiatric adverse effects of AEDs independently of the specific mechanism of action of the drug. The prior history of suicide attempt, especially preceding the onset of the epilepsy, may represent a key element explaining why what is observed is independent of the specific mechanism of the drug. In general terms, risks associated with stopping, or not even starting, AEDs in epilepsy might well be in excess of the risk of suicide in epilepsy, as deaths due to accident and epilepsy itself may predominate. Clinicians need to pay attention not only to seizure patterns when choosing the appropriate AED but also to a number of different parameters (eg, age, gender, working needs, medical comorbidities, history of psychiatric disorders, and suicidality before epilepsy onset) and not the least the mental state of the patient. Missing severe complications such as suicidal behavior or delaying its treatment may worsen the prognosis of epilepsy.Keywords: antiepileptic drugs, suicide, depression, epilepsy, FD
Consciousness, epilepsy, and emotional qualia
No full textThe last decade has seen a renaissance of consciousness studies, witnessed by the growing number of scientific investigations on this topic. The concept of consciousness is central in epileptology, despite the methodological difficulties concerning its application to the multifaced ictal phenomenology. The authors provide an up-to-date review of the neurological literature on the relationship between epilepsy and consciousness and propose a bidimensional model (level vs contents of consciousness) for the description of seizure-induced alterations of conscious states, according to the findings of recent neuroimaging studies. The neurophysiological correlates of ictal loss and impairment of consciousness are also reviewed. Special attention is paid to the subjective experiential states associated with medial temporal lobe epilepsy. Such ictal phenomenal experiences are suggested as a paradigm for a neuroscientific approach to the apparently elusive philosophical concept of qualia. Epilepsy is confirmed to represent a privileged window over basic neurobiological mechanisms of consciousness. (c) 2005 Elsevier Inc. All rights reserved
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