Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction

In 1969, the International League Against Merlis, Dr. D. David Daly of Dallas, Dr. Epilepsy published a scheme for classifica- Dieter Janz of Berlin, Dr. J. Kiftin Penry of tion of epileptic seizures. Professor H. Bethesda, Dr. Carlo Alberto Tassinari of Gastaut, then Secretary-General of ILAE Marseille. In addition, Dr. Rudolph Dreyer and a member of the Commission on Clas- of Bethel. Dr. Antonio V. Escueta of Los sification, related the history of the work Angeles, Dr. K. F. Masuhr of Berlin, Dr. which represents a milestone in efforts at Richard H. Mattson of New Haven, Dr. classifying epileptic seizures and has led to Roger J. Porter of Bethesda. Dr. Dieter world-wide adoption (Gastaut, 1970). Schmidt of Berlin, and Dr. Gregory 0. Since the publication of the 1969 classifi- Walsh of Los Angeles attended as particication, objective and sophisticated methods pants and discussants in this workshop. for studying epileptic seizures have become In 1977, a workshop on generalized seicommonplace. These methods include zures was held in Berlin. The above Comvideo display of epileptic seizures on mag- mission members were present with the adnetic tape, the simultaneous recording of dition of Dr. Toyoji Wada of Shizuoka and the electroencephalogram using hard-wired invited participants who presented vidrecording techniques and radiotelemetry eotape data, including Dr. A. Cirignotta of with split screen display and instant replay Bologna, Dr. Peter Kellaway of Houston, capability. Dr. Cesare Lombroso of Boston, Dr. K. F. Since 1975, two further Commissions on Masuhr of Berlin, and Dr. D. Stefan of Classification and Terminology of the In- Bonn. The results of these workshops comternational League Against Epilepsy have prise the major portions of the version of convened in order to continue to update, the International Classification of Epileptic amend, and improve the classification in Seizures herewith proposed.

Proposal for Revised Clinical and ~lectro~nce~halo ~ra~hic Classification of Epileptic Seizures From the Commission on Classification and Terminology of the International League Against Epilepsy*

Antiepileptic pharmacotherapy can very well have positive effects on cognition and behavior via control of seizures and interictal epileptic discharges, and/or via improvements of mood and psychiat...

https://www.tandfonline.com/doi/pdf/10.1080/14656566.2017.1309025

How can we overcome neuropsychological adverse effects of antiepileptic drugs

Sleep quality and daytime sleepiness in patients treated with adjunctive perampanel for focal seizures.

Effectiveness and safety of perampanel as early add-on treatment in patients with epilepsy and focal seizures in the routine clinical practice: Spain prospective study (PERADON).

Background & objectives: Although the need for a combination of antiepileptic drugs (AEDs) in the treatment of epilepsy is well justified, but an associated increase in adverse effects (AEs) lends a restriction to polytherapy. The aim of this study was to evaluate AEs and drug load (prescribed daily dose/defined daily doses) of AEDs in patients with epilepsy (PWE). Methods: Consecutive PWEs attending Epilepsy clinic in a tertiary care hospital in New Delhi, India, were enrolled in the study. Demographic variables, such as age, gender, diagnosis, age at onset of seizures, frequency of seizures, use of all AEDs and adverse event profile (AEP) score were noted. Routine laboratory tests including lipid profile, fasting blood glucose, haematological parameters and liver and kidney function tests were done. Results: A total of 697 consecutive patients were included in this study. Of them, 64.4 per cent were male; mean age was 29.6 ± 10.6 yr. Generalized seizures and focal seizures were recorded in n=386 (55.4%) and n=311 (44.6%), respectively. Monotherapy and polytherapy with two and greater than or equal to three AEDs were prescribed in 264 (37.9%), 243 (34.9%) and 190 (27.2%) patients, respectively. The average AED load, duration of treatment as well as AEP score were found to be significantly higher in combination of greater than or equal to three AEDs as compared to both monotherapy and combination of two AEDs, whereas no significant difference was observed between monotherapy and combination of two AEDs. Patients on monotherapy were in good control of seizures as compared to polytherapy. There was no significant change in biochemical parameters between the groups. Interpretation & conclusions: Polytherapy with combination of greater than or equal to three AEDs was associated with higher AEs and lower seizure control as compared to both monotherapy and combination of two AEDs. AEs did not correlate with AED load, seizure type, gender and age of the patients but were associated with both numbers of AEDs as well as seizure frequency in PWE.

Adverse effects & drug load of antiepileptic drugs in patients with epilepsy: Monotherapy versus polytherapy.

Purpose The present study was conducted with the aim of evaluating the effects of reducing the number of antiepileptic drugs (AEDs) administered to patients with drug-refractory epilepsy (DRE) during their admission and document any change in seizure frequency in subsequent follow up. Methods A total of 962 patients with DRE who were admitted to the neurology wards waiting for connection to video EEG were recruited for this prospective study. After their admission to the neurology ward, modifications in the number and dosage of AEDs were done with a target of a maximum of three AEDs in every patient. Drug tapering was done using a standardized protocol. The primary outcome was the change in seizure frequency in the follow-up period of 6 months. Secondary outcome measures were the adverse event profile (AEP) and the quality of life (QOL). Results Of the 1134 patients screened, 962 patients gave consent to participate in the study. The mean number of AEDs received by each patient was 4.24. After the tapering following a standardized protocol each patient received a mean of 2.65 AEDs per patient. In 82.70% patients with DRE, there was either a reduction or no change in seizure frequency in the subsequent 6 months follow up. There was a significant reduction in the AEP score after the reduction in the number of AEDs ( P =0. 001). Conclusion Our study proves that optimization of reduction of the number of AED's in patients with DRE leads to reduction or no change in seizure frequency with a significant decrease in adverse effects.

Effect of reduction of antiepileptic drugs in patients with drug-refractory epilepsy §,§§

Background & objectives: The use of clobazam in epilepsy has increased since its introduction in 1975. However, it has not been audited for its overall usefulness in Indian set up. The present study was aimed to evaluate usage pattern, retention rate, effectiveness and tolerability of clobazam during routine practice in an outpatient epilepsy clinic of a tertiary care hospital in New Delhi, India. Methods: This study was performed on the patients prescribed antiepileptic medication who had clobazam as last added drug in their treatment regimen during October 2010 - March 2012. These patients were followed up for two OPD visits. The primary points evaluated were retention rate, percentage of seizure-free patients and reasons for discontinuing clobazam. Results: o0 f the 417 consecutive patients, 132 (31.7%) were on clobazam treatment for more than four years (median 6 yr, range 4-15 yr). No seizure for previous 12 months was considered as seizure free and was observed in 151 (36.2%) patients. There was no improvement in seizure control in 32 (7.7%) patients. A decrease in seizure severity without any change in seizure frequency was observed in 76 (18.2%) patients. Clobazam was discontinued by 15 (3.6%) patients due to complaints like drowsiness (13), fatigue/tiredness (8), headache (6), poor memory (6), irritable behaviour (5), abdominal pain (3) and dizziness (3). Interpretation & conclusions: Our results provide valuable information about the clinical use of clobazam as add-on antiepileptic drug therapy in the management of patients with epilepsy.

Effect of clobazam as add-on antiepileptic drug in patients with epilepsy.

Introduction: Traditionally, Panchagavya Ghrita (PG) has been used for the management of epilepsy, anxiety, fever and jaundice. It consists of five components of cow products namely, cow milk, clarified butter from cow milk, cow urine, curd from cow milk, and cow dung juice. Aim: To evaluate the effect of PG in maximal electroshock (MES) induced seizures model and its pharmacodynamic and pharmacokinetic interaction with phenytoin (PHT) and carbamazepine (CBZ) in rats. Materials and Methods: Male Wistar rats were administered PG 500, 1000, 2000, and 4000 mg/kg orally for 7 days and seizures were induced by MES. For interaction studies, PG (4000 mg/kg) was administered along with a sub-therapeutic dose of PHT (20 mg/kg, p.o.) and CBZ (10 mg/kg, p.o.). Behavioral parameters were assessed. Oxidative stress markers and serum levels of PHT and CBZ were estimated. Results: Tonic hind limb extension, cognitive impairment, and oxidative stress produced by MES were reversed by PG (4000 mg/kg). Co-administration of PG (4000 mg/kg) with a sub-therapeutic dose of PHT and CBZ potentiated antiepileptic effect and ameliorated cognitive impairment as well as oxidative stress. Although, there was a slight increase in serum levels of PHT and CBZ on co-administration with PG, it was statistically insignificant. Conclusion: Co-administration of PG with low doses of PHT and CBZ caused complete seizure protection. This suggests the potential of PG as an adjunct in epilepsy with improved efficacy and tolerability.

Pharmacodynamic and pharmacokinetic interaction of Panchagavya Ghrita with phenytoin and carbamazepine in maximal electroshock induced seizures in rats.

Summary

Purpose

To test the applicability of the new International League Against Epilepsy (ILAE) 2010 classification for epilepsies and to compare it with the ILAE 1989 classification and the ILAE 2001 diagnostic scheme in developing countries with limited resources such as India.



Methods

Prospective data of 500 consecutive patients with epilepsy, presenting in neurology department of All India Institute of Medical Sciences, was collected from January 2011 to June 2012 and analyzed according to the three systems proposed by ILAE in 1989, 2001, and 2010.



Key Findings

All 500 patients could be classified in the ILAE 1989 classification system, but only 413 in the ILAE 2001 diagnostic scheme (in axes 3 and 4) and 420 in the ILAE 2010 classification system. Leading categories were localization-related epilepsies, symptomatic focal epilepsies, perinatal insult, and epilepsies attributed to structural and metabolic cause in ILAE 1989, 2001 axis 3, 2001 axis 4, and 2010 systems, respectively. The ILAE 1989 classification system could categorize significantly greater numbers of patients compared to the 2001 and 2010 systems, whereas the latter two remained similar.



Significance

A large group of patients remained unclassified in the new classification system despite our tremendous gain in knowledge through improved imaging, genomics, and molecular biology, and so on, which could be attributed to lack of availability of facilities in developing countries. Dichotomy of localization-related and generalized epilepsy still makes for a fundamental and pragmatic working diagnosis and guides the physician about the extent of investigations and treatment especially in “epilepsies of unknown cause.”

Rupa Joshi

Papers

Adverse effects & drug load of antiepileptic drugs in patients with epilepsy: Monotherapy versus polytherapy.

Effect of reduction of antiepileptic drugs in patients with drug-refractory epilepsy §,§§

Effect of clobazam as add-on antiepileptic drug in patients with epilepsy.

Pharmacodynamic and pharmacokinetic interaction of Panchagavya Ghrita with phenytoin and carbamazepine in maximal electroshock induced seizures in rats.

Applicability of the new ILAE classification for epilepsies (2010) in persons with epilepsy at a tertiary care center in India.