OBJECTIVE: It is assumed that temporal lobe resection in older people is associated with worse seizure outcomes and potential postsurgical memory decline. We studied postsurgical memory development and surgical efficacy in patients over 45 years of age compared with younger patients. METHODS: We studied 88 patients (51 male and 37 female) after temporal lobe surgery, which involved hippocampal resection. The patients were evaluated before surgery and in the first (72 patients) and/or third (57 patients) postsurgical year. The Wechsler Memory Scale III test was performed to evaluate the MQ postsurgical development. Engel's classification was used to evaluate the postsurgical seizure outcome. RESULTS: The presurgical MQ (median 88) in ≥45 years age group was significantly lower than in both younger groups (median MQ = 100 for ≤30 years age group, p = 0.002; median MQ = 107 for 31-44 years age group, p = 0.002). Three years after the surgery, the MQ decreased significantly in ≤30 years age group (p = 0.012), while only non-significant MQ decline was observed in both older groups. We found no significant impact of age on the surgical outcome. CONCLUSION: Higher age at the time of surgery does not significantly increase the risk for postsurgical memory decline; however, older patients are more likely to have lowered presurgical MQ. We did not find significant differences in the impact of surgery on seizure outcome among the age groups. Epilepsy surgery appears to be a safe and effective method in the age over 45 years even though an earlier surgery should be preferred.

• MeSH
• dospělí MeSH
• epilepsie temporálního laloku diagnóza   psychologie   chirurgie   MeSH
• hipokampus chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• neurochirurgické výkony škodlivé účinky   psychologie   trendy   MeSH
• paměť fyziologie   MeSH
• poruchy paměti diagnóza   psychologie   MeSH
• předoperační péče metody   psychologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• spánkový lalok chirurgie   MeSH
• výsledek terapie MeSH
• Wechslerovy škály MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Introduction: Perampanel is an antiepileptic drug approved in the USA and Europe as monotherapy and adjunctive therapy for focal onset seizures and as adjunctive therapy for generalized tonic-clonic seizures. Areas covered: This an overview of animal data, pharmacokinetics, and clinical data published on Perampanel indexed in PubMed. Expert opinion: Pharmacological studies suggest that perampanel acts via noncompetitive antagonism of the ionotropic AMPA receptor of glutamate. The efficacy of perampanel has been shown in animal models of epilepsy and Phase II/III clinical trials. Efficacy and safety have been evaluated in the phase III trials of adjunctive treatment of focal epilepsy with median focal onset seizure reduction rates of 23% for 4 mg/d, 26-31% for 8 mg/day, and 18-35% for 12 mg/day. Fifty percent responder rates were 29% for 4 mg/day, 33-38% for 8 mg/day, and 34-36% for 12 mg/day. A pivotal Phase III trial in generalized onset tonic-clonic seizures showed a median seizure reduction by 76.5% (8 mg) versus 38.4% placebo and 50% seizure responder rate of 64.2% versus 30.9% placebo. Perampanel showed good safety and tolerability profile across 2-12 mg doses. Perampanel as a broad-spectrum antiepileptic drug has a potential to be an alternative treatment of multiple types of epileptic seizures.

• MeSH
• antikonvulziva aplikace a dávkování   farmakologie   MeSH
• epilepsie generalizovaná farmakoterapie   MeSH
• epilepsie parciální farmakoterapie   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• pyridony aplikace a dávkování   farmakologie   MeSH
• záchvaty farmakoterapie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Approximately one third of patients with epilepsy fail to respond to existing medications. Levetiracetam is an effective antiepileptic drug (AED) postulated to act by binding to synaptic vesicle protein 2A. Brivaracetam is a novel high affinity SV2A ligand with approximately 20-fold higher affinity for SV2A protein than levetiracetam. It is at an advanced stage of clinical development for treatment of epilepsy. AREAS COVERED: This article reviews animal data, pharmacokinetics, and phase 1-3 data of Brivaracetam treatment of epilepsy. Brivaracetam has broad-spectrum anticonvulsant activity in animal models. EXPERT OPINION: Phase 1 studies indicated that single oral doses of 5-800 mg and repeated oral doses of up to 600 mg were well tolerated and showed favorable pharmacokinetic profile. Phase 2 studies indicated good safety and tolerability of brivaracetam in the dose range of 5-150 mg/day and provided proof of concept for efficacy in treating refractory partial onset seizures. Efficacy and safety have been evaluated in 4 phase 3 studies with dose range of 5-200 mg which have demonstrated efficacy in the range of 100-200 mg/day dose and, in most studies, also with 50 mg/day dose, and good safety and tolerability profile across 5-200 mg doses in adjunctive treatment of refractory partial onset seizures.

• MeSH
• antikonvulziva farmakologie   terapeutické užití   MeSH
• epilepsie farmakoterapie   MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• pyrrolidinony farmakologie   terapeutické užití   MeSH
• záchvaty farmakoterapie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Ketogenní dieta (KD), která spočívá ve zvýšeném příjmu tuků na úkor bílkovin a cukrů, je efektivní léčbou farmakorezistentní epilepsie. Klasická ketogenní dieta spočívá ve zvýšeném příjmu saturovaných triglyceridů s dlouhými řetězci. Poměr základních živin (tuk) : (protein +cukr) je podle typu diety 3 : 1 nebo 4 : 1, přičemž 87–90 % kalorií je získáváno z tuků. U dětí vede dieta k příznivému ovlivnění frekvence epileptických záchvatů. Výjimkou není ani dlouhodobá bezzáchvatovost. Přes dobré výsledky s léčebným využitím diety u dětí byl efekt doposud jen velmi málo studován u dospělých pacientů. Protizáchvatový efekt nastupuje poměrně rychle během dnů nebo několika týdnů. Efektivita KD je srovnatelná s efektivitou nových antiepileptických léků. V současnosti nejsou známy klinické a biochemické prediktory účinku léčby ketogenní dietou.

Ketogenic diet (KD) is a high fat, low protein, low carbohydrate diet that is an effective treatment of refractory epilepsy in children. The “classic” diet consists of long chain saturated triglycerides with a 3:1 or 4:1 [fat]: [protein + carbohydrate] ratio by weight, with 87–90% of calories derived from fat. In children, the diet may lead to disease modification, with permanent seizure freedom or improvement. In spite of the success of KD treatment of children, KD has been little studied in adults. The anticonvulsant effect occurs quickly within days to a couple of weeks. The efficacy of KD compares favorably with efficacy of new AEDs. At present, there are no clinical or biochemical predictors of treatment responsiveness.

• MeSH
• dítě MeSH
• dospělí MeSH
• epilepsie * dietoterapie   MeSH
• ketogenní dieta * kontraindikace   škodlivé účinky   využití   MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

Spotřeba alkoholu v České republice je vysoká a představuje závažný medicínský problém. Je prokázána souvislost mezi užíváním alkoholu a výskytem epileptických záchvatů. Výskyt epileptických záchvatů je u alkoholiků 3 × vyšší než u zbytku populace. Riziko vzniku epileptických záchvatů u alkoholiků vzrůstá s dávkou užívaného alkoholu. Chronické užívání alkoholu vede k poruše regulace NMDA receptorů (zvýšená regulace) a GABA-A receptorů (snížená regulace). K poruše rovnováhy dojde při náhlém vysazení alkoholu se vznikem epileptických záchvatů známých pod pojmem “withdrawal seizures”. Alkoholová epilepsie je epileptický syndrom se třemi vývojovými stadii (Bartolomei, 2006). Pro první stadium jsou charakteristické záchvaty při náhlém vysazení alkoholu tzv. “withdraval seizures”, v druhém stadiu se vyskytují záchvaty nejenom při abstinenci, ale i mimo abstinenci. Ve třetím stadiu se vyskytují záchvaty, i když pacient plně a dlouhodobě abstinuje. V prvním stadiu není chronická léčba antiepileptiky indikována, ve stadiu druhém a třetím indikována je. Pacienti ve druhém a třetím stadiu onemocnění mají snížený záchvatový práh a jsou ohroženi vznikem opakovaných epileptických záchvatů. Chroničtí alkoholici mohou mít i jinou etiologii epilepsie, která s konzumací alkoholu nesouvisí (CMP, trauma, IGE). Tito nemocní jsou k chronické léčbě antiepileptiky indikováni. Chronický abúzus alkoholu snižuje sérovou hladinu některých antiepileptik (zejm. induktorů jaterních enzymů). U pacientů, kteří chronicky užívají alkohol a jsou léčeni antiepileptickou medikací, je třeba sledovat sérové hladiny u některých antiepileptik.

Alcohol consumption is very high in the Czech Republic and this gives rise to a considerable public health problem. The link between epilepsy and alcohol consumption is definite. Epileptic seizures are three times more frequent in abusers and increase with the amount per day of alcohol consumed. Both intoxication and withdrawal are recorded as the risk factors, but the withdrawal seizures attracts the most of attention. Long-term alcohol abuse impairs regulation of the NMDA and GABA-A receptors. The sudden deficit of alcohol results in alcohol withdrawal seizures. A manifestation of alcoholic epilepsy varies with respect to length of abuse. There are seizures related to withdrawal period at the first stage, seizures appearance in both withdrawal phase and consumption phase at the second stage and finally irreversible third stage of alcoholic epilepsy (Bartolomei, 2006). Epilepsy suffered by alcohol abusers can also have the same kinds of etiology as it has in general population (e.g.post-traumatic, post-stroke etc.) The chronic alcohol abuse influences also the metabolism of an AED that reduces level of the AED within the blood plasma. The repeatedly abstaining abusers (may be for the treatment of abuse) should be observed carefully. Recent studies conclude the antiepileptic treatment of alcohol abusers is necessary. However, the epilepsy and alcohol abuse treatment should be linked together.

• Klíčová slova
• alkoholová epilepsie,
• MeSH
• alkoholismus * komplikace   metabolismus   MeSH
• antikonvulziva krev   metabolismus   terapeutické užití   MeSH
• epilepsie * farmakoterapie   chemicky indukované   komplikace   MeSH
• ethanol metabolismus   škodlivé účinky   MeSH
• interakce mezi potravou a léky MeSH
• lidé MeSH
• pití alkoholu škodlivé účinky   MeSH
• záchvaty při náhlém vysazení alkoholu farmakoterapie   komplikace   MeSH
• záchvaty farmakoterapie   chemicky indukované   komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Syncope is a condition often misdiagnosed as epilepsy. Syncope caused by cardiac disturbance is a life-threatening condition and accurate diagnosis is crucial for patient outcome. We present a case study of a 71-year-old woman who was referred to our epilepsy centre with a diagnosis of refractory epilepsy. We diagnosed convulsive syncope caused by malignant cardiac arrhythmia based on the presence of cardiac asystole lasting for 20-30 seconds, which was caused by sick sinus syndrome combined with third-degree atrioventricular block. The most prominent feature of this syncope was atypical trunk (abdominal or thoracoabdominal) convulsions, which were accompanied by other motor signs (head and eye deviation and brief jerks of the extremities). In the periods between attacks, all investigations, including standard 12-lead ECG and 24-hour ECG monitoring, were normal. This case study highlights the challenge in differential diagnosis of sudden loss of consciousness. [Published with video sequences].

• MeSH
• atrioventrikulární blokáda komplikace   diagnóza   MeSH
• diferenciální diagnóza MeSH
• elektroencefalografie MeSH
• elektrokardiografie MeSH
• epilepsie diagnóza   MeSH
• lidé MeSH
• senioři MeSH
• syndrom chorého sinu komplikace   diagnóza   MeSH
• synkopa diagnóza   etiologie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• audiovizuální média MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

The main purpose of this retrospective analysis was to evaluate the incidence and lateralization value of rhythmic ictal nonclonic hand (RINCH) motions in patients with temporal lobe epilepsy (TLE), who were classified as Engel I at least 2 years after epilepsy surgery. We analyzed the distribution of ictal activity at the time of RINCH appearance in patients in whom RINCH motions were present during invasive EEG monitoring. A group of 120 patients was included in this study. In total, we reviewed 491 seizures: 277 seizures in patients with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (TLE-HS group) and 214 in TLE caused by other lesions (TLE-OTH group). We analyzed 29 patients (79 of the seizures) during invasive EEG monitoring. Fisher's exact test and binomial test were used for the statistical analysis. RINCH motions were observed in 24 out of 120 patients (20%) and in 48 out of 491 seizures (9.8%). There was no significant difference between the occurrence of RINCH motions in patients with TLE-HS and in patients with TLE-OTH, or between gender, right/left-sided TLE, and language dominant/nondominant TLE. RINCH motions were contralateral to the seizure onset in 83.3% of patients and 91.7% of seizures (p=0.0015; p<0.001, respectively). There were no differences in the lateralizing value of RINCH motions in patients with TLE-HS or TLE-OTH. We analyzed RINCH motions in 5 patients/7 seizures during invasive EEG. In all 7 seizures with RINCH motions, we observed the widespread activation of the temporal lobe (mesial and lateral, opercular and polar regions) contralateral to the side of RINCH motions. In all 7 seizures, we observed that at the time of RINCH motion onset, at least 1 explored region of the frontal lobe was affected by the ictal activity. In 3 seizures, we observed time-locked epileptic activation associated with the appearance of RINCH motions, i.e., in the orbitofrontal cortex in 2 seizures and in both the orbitofrontal cortex and anterior cingulate gyrus in 1 seizure. RINCH motions are a relatively frequent ictal sign in patients with TLE. They have a high lateralizing value in these patients, occurring contralateral to the ictal onset. RINCH motions usually occur after the spread of ictal activity beyond the temporal lobe, and their appearance is usually associated with the presence of ictal activity in various regions of the contralateral frontal lobe, mainly the orbitofrontal cortex and anterior cingulate gyrus. This is the first study analysing this phenomenon during invasive EEG recording.

• MeSH
• dítě MeSH
• dospělí MeSH
• elektroencefalografie metody   MeSH
• epilepsie temporálního laloku komplikace   patofyziologie   chirurgie   MeSH
• funkční lateralita fyziologie   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mozek patologie   MeSH
• nádory mozku komplikace   patologie   MeSH
• pohybové poruchy epidemiologie   etiologie   patofyziologie   MeSH
• retrospektivní studie MeSH
• ruka patofyziologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Epilepsy is both a disease of the brain and the mind. Brain diseases, structural and/or functional, underlie the appearance of epilepsy, but the notion of epilepsy is larger and cannot be reduced exclusively to the brain. We can therefore look at epilepsy from two angles. The first perspective is intrinsic: the etiology and pathophysiology, problems of therapy, impact on the brain networks, and the "mind" aspects of brain functions - cognitive, emotional, and affective. The second perspective is extrinsic: the social interactions of the person with epilepsy, the influence of the surrounding environment, and the influences of epilepsy on society. All these aspects reaching far beyond the pure biological nature of epilepsy have been the topics of two International Congresses of Epilepsy, Brain, and Mind that were held in Prague, Czech Republic, in 2010 and 2012 (the third Congress will be held in Brno, Czech Republic on April 3-5, 2014; www.epilepsy-brain-mind2014.eu). Here, we present the first of two papers with extended summaries of selected presentations of the 2012 Congress that focused on epilepsy, behavior, and art.

• MeSH
• chování fyziologie   MeSH
• dějiny 16. století MeSH
• dějiny 17. století MeSH
• dějiny 18. století MeSH
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• dějiny starověku MeSH
• dějiny středověku MeSH
• duševní poruchy komplikace   dějiny   MeSH
• epilepsie * dějiny   patologie   psychologie   MeSH
• lidé MeSH
• mozek patofyziologie   MeSH
• umění * dějiny   MeSH
• Check Tag
• dějiny 16. století MeSH
• dějiny 17. století MeSH
• dějiny 18. století MeSH
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• dějiny starověku MeSH
• dějiny středověku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• historické články MeSH
• přehledy MeSH

OBJECTIVE: We compared the possible contribution (in the detection of seizure onset zone - SOZ) of simple visual assessment of intracerebrally recorded high-frequency oscillations (HFO) with standard automated detection. METHODS: We analyzed stereo-EEG (SEEG) recordings from 20 patients with medically intractable partial seizures (10 temporal/10 extratemporal). Independently using simple visual assessment and automated detection of HFO, we identified the depth electrode contacts with maximum occurrences of ripples (R) and fast ripples (FR). The SOZ was determined by independent visual identification in standard SEEG recordings, and the congruence of results from visual versus automated HFO detection was compared. RESULTS: Automated detection of HFO correctly identified the SOZ in 14 (R)/10 (FR) out of 20 subjects; a simple visual assessment of SEEG recordings in the appropriate frequency ranges correctly identified the SOZ in 13 (R)/9 (FR) subjects. CONCLUSIONS: Simple visual assessment of SEEG traces and standard automated detection of HFO seem to contribute comparably to the identification of the SOZ in patients with focal epilepsies. When using macroelectrodes in neocortical extratemporal epilepsies, the SOZ might be better determined by the ripple range. SIGNIFICANCE: Standard automated detection of HFO enables the evaluation of HFO characteristics in whole data. This detection allows general purpose and objective evaluation, without any bias from the neurophysiologist's experiences and practice.

• MeSH
• dospělí MeSH
• elektrody MeSH
• elektroencefalografie přístrojové vybavení   metody   MeSH
• epilepsie parciální diagnóza   MeSH
• hipokampus MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mozková kůra MeSH
• počítačové zpracování signálu MeSH
• reprodukovatelnost výsledků MeSH
• záchvaty diagnóza   MeSH
• zobrazování dat * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

PURPOSE: To determine whether voxel-based morphometry (VBM) might contribute to the detection of cortical dysplasia within the temporal pole in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE/HS). METHODS: Eighteen patients with intractable MTLE/HS and 30 sex- and age-matched healthy controls were included in the study. All of the patients fulfilled the diagnostic criteria for MTLE/HS and underwent anteromedial temporal resection. VBM without a modulation step was applied to the magnetic resonance (MR) images of the brain. Statistical parametric maps were used to compare structural characteristics such as gray matter concentration (GMC) within the temporal pole among patients and controls separately. The acquired data were then statistically analyzed to determine the congruency between visually inspected MR imaging (MRI) scans and VBM results in the detection of morphologic abnormalities in the temporal pole compared to postoperative histopathologic findings of cortical dysplasia. KEY FINDINGS: Histopathologic examination revealed cortical dysplasia within the temporal pole in 11 patients. In detail, according to Palmini's classification, mild malformations of cortical development (mMCDs) were disclosed in three patients, focal cortical dysplasia (FCD) type Ia in three patients, and FCD type Ib in five patients. Some type of structural temporal pole abnormality was suggested by VBM in 14 patients and by visually inspected MRI scans in 11 patients. The results of VBM were in agreement with the presence/absence of cortical dysplasia in 13 patients (72.2%); this correspondence was significant (p = 0.047). In one case, VBM was false negative and in four cases it was false positive. There was congruence between the results of visual analysis and histologic proof in 55.6% of examined patients, which was not significant. SIGNIFICANCE: We found that VBM made a superior contribution to the detection of temporopolar structural malformations (cortical dysplasia) compared to visual inspection. The agreement with postoperative histopathologic proof was clearly significant for VBM results and nonsignificant for visual inspection.

• MeSH
• analýza rozptylu MeSH
• diplopie diagnóza   etiologie   MeSH
• dospělí MeSH
• epilepsie temporálního laloku komplikace   diagnóza   MeSH
• funkční lateralita MeSH
• hipokampus patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mapování mozku MeSH
• mladý dospělý MeSH
• počítačové zpracování obrazu MeSH
• spánkový lalok patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH