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Journal Article 2010; 31(6): 818-822 PubMed PMID: 21196921 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Anticonvulsants:therapeutic use, Diagnosis, Differential, Diagnostic Errors:statistics & numerical data, Drug Resistance, Electroencephalography, Epilepsy:classification, Female, Follow-Up Studies, Humans, Male, Middle Aged.   

OBJECTIVE: There is no universally accepted definition of pseudo-intractable epilepsy. Pseudo-intractability means that the resistance to treatment is, in fact, caused by clinical errors. The purpose of our study was to identify the reasons for intractability and subsequent effective therapeutic management approaches in a group of patients with established pseudo-intractable epilepsy.

METHODS: The study was designed as a retrospective audit of 100 adult patients who, in their past medical history, were diagnosed as having intractable epilepsy but, following adjustments to their medical management, were seizure free for at least 2 years. Patients underwent standard clinical evaluation, including EEG and/or video-EEG monitoring. We re-evaluated past medical, family, seizure and pharmacological history and morphological findings. Epilepsy was re-classified according to the ILAE classification.

RESULTS: We identified possible errors including incorrect diagnosis and/or inappropriate previous epilepsy management in all 100 patients. Incorrect diagnosis (seizure type and/or syndrome) was observed in 47 patients (47%). Thirty two patients (32%) with idiopathic generalized epilepsy were treated for complex focal seizures with inappropriate choice of medication. Therapeutic errors were identified in 48 patients (48%). Issues with medication compliance were found in 20 patients (20%). Potential seizure precipitating factors were detected in 23 patients (23%).

CONCLUSIONS: Our study of 100 patients confirmed that the problem of pseudo-intractability still exists. Every case of pharmacoresistance in epilepsy could potentially be caused by one or more clinical errors....

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Journal Article 2009; 30(5): 599-603 PubMed PMID: 20035264 Citation  Keywords:  Adolescent, Adult, Anticonvulsants:therapeutic use, Child, Circadian Rhythm, Epilepsy:drug therapy, Female, Humans, Male, Middle Aged, Sleep:physiology, Sleep Wake Disorders:physiopathology, Surveys and Questionnaires, Young Adult,.   

OBJECTIVE: The relationship between epilepsy and sleep has been known for many years. Yet is still not well understood because of it's reciprocal and intrinsic influences. Epileptic manifestations during sleep may lead to fragmentation of sleep stages. On the other hand insomnia or other sleep disorders may cause sleep deprivation and increase number of epileptic seizures in patients with epilepsy. The study is designed to compare daytime sleepiness and architecture of sleep in patients with epilepsy and control subjects. We tried to evaluate factors that have influence on sleep architecture of patients with epilepsy.

METHODS: We evaluated the daytime sleepiness through a certain type of questionnaire called Epworth Scale of Sleepiness (ESS). The questionnaire was filled out by patients with epilepsy (83 patients) and a group of healthy controls (80 persons). Furthermore we evaluated the quatity of night sleep in both groups using polysomnograph (electroencephalography - EEG, electrooculography - EOG, electromyography - EMG). Sleep stages were scored according to Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects (Rechtschaffen, Kales, 9). Multiple sleep latency test (MSLT) was performed in the group of patients with epilepsy in order to objectivise daytime sleepiness.

RESULTS: Measuring by Epworth scale of sleepiness we found out that the patients with epilepsy suffered from a significantly higher daytime sleepiness than the healthy controls. Patients with epilepsy also experienced significant changes in sleep architecture, the reduction of NREM S3, S4 and REM stages and the increase of NREM S2 stage. These changes were not related to used antiepileptic medication....

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Journal Article 2009; 30(4): 482-486 PubMed PMID: 20010488 Citation  Keywords:  Adult, Brain Diseases:complications, Child, Cohort Studies, Epilepsy:epidemiology, Hospitalization:statistics & numerical data, Humans, Incidence, Retrospective Studies, Seizures, Febrile:epidemiology, Slovakia:epidemiology, Substance-Related Disorders:co.   

BACKGROUND: Approximately 5% of the general population experiences at least one unprovoked epileptic seizure in the lifetime. This is in contrast to the cumulative incidence of epilepsy (approx. 3-4%) and incidence of acute symptomatic seizures (approx. 4%). Nearly 2% of the population experiences a febrile seizure before the 5 years of age. The aim of this article was evaluation of the distribution of acute symptomatic and unprovoked seizures in our patient cohort after the solitary epileptic seizures, as well as determination of particular etiological factors responsible for the occurrence of solitary epileptic seizure.

MATERIAL AND METHODS: Our patient cohort comprised 116 patients experiencing the solitary epileptic seizure, who were hospitalised at the 1st Department of Neurology, Faculty of Medicine of Comenius University and Faculty Hospital in Bratislava, Slovakia over a period of 10 years (January 1, 1997 - January 1, 2007). It is a retrospective analysis of data from case records and health records; eventually we contacted the patients by phone or by sending a questionnaire.

RESULTS: Of the 116 patients there were 32 cases (37.12%) of an acute symptomatic seizure and 84 cases (62.88%) of an unprovoked seizure. In the group of unprovoked solitary epileptic seizures the etiological conclusions were idiopathic and cryptogenic in 35 cases (41.7%) and late symptomatic in 49 cases (58.3%). The most frequent etiological factor in the group of acute symptomatic seizures was alcohol (40.6%). In the subgroup of late symptomatic seizures the etiology was mostly vascular (17.85%).

CONCLUSION: Data management of etiological factors responsible for the solitary epileptic seizure confirmed a need for a thorough evaluation of the first epileptic seizure....

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Comparative Study 2009; 30(4): 487-490 PubMed PMID: 20010487 Citation  Keywords:  Adult, Binomial Distribution, Child, Electroencephalography:standards, Epilepsy:diagnosis, Humans, Magnetic Resonance Imaging:standards, Reproducibility of Results, Retrospective Studies, Risk Factors, Tomography, X-Ray Computed:standards,.   

BACKGROUND: The occurrence of the first unprovoked epileptic seizure always requires thorough examination. The risk of incorrect diagnosis is high, non-epileptic seizures represent 20-33% of newly diagnosed cases. The aim of the study is to evaluate findings of various modifications of EEG examination in the group of patients who experienced solitary unprovoked epileptic seizure and compare benefits of CT and MRI examination of the brain of these patients.

MATERIAL AND METHODS: The group involved 84 patients hospitalized at the 1st Department of Neurology , Faculty of Medicine, Comenius University in Bratislava between January 1997 and January 2007 after experiencing unprovoked epileptic seizure. It is a retrospective analysis of information from medical records and clinical documentation. For statistic comparing of benefits of various modifications of EEG examination and between CT and MRI examination of the brain binomic test of proportion was used.

RESULTS: Interictal epileptiform EEG graphoelements in native EEG was recorded only in 14.29% of patients. Statistically significantly more epileptiform graphoelements comparing EEG and EEG after sleep deprivation of the patient (SD) with one- hour recording was recorded with 24-hour 8 channels EEG monitoring after SD, EEG after SD with one- hour recording was of no significance comparing to native EEG. MRI examination of the brain was statistically more significant comparing to CT examination.

CONCLUSION: Low catchment of epileptiform EEG graphoelements in patients with solitary unprovoked seizure shows the importance of precise history in diagnostics of these patients. Though EEG is a very important examination it is an auxiliary one. We confirmed that MRI examination in patients who experienced solitary unprovoked epileptic seizure is undoubtedly the first choice method....

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Evaluation Studies 2008; 29(6): 939-948 PubMed PMID: 19112409 Citation  Keywords:  Algorithms, Case-Control Studies, Child, Child, Preschool, Cluster Analysis, Computational Biology, Computer Simulation, Databases as Topic, Diagnosis, Computer-Assisted:instrumentation, Electroencephalography, Epilepsy:complications, Humans, Language Dev.   

: At present, more and more researchers are applying tested mathematical-engineering methods into different domains of life. One of these areas is helping people with different forms of disabilities. Research in this area is focused on searching for the relation between clinical and electrophysiological symptoms of children with developmental dysphasia. Sleep EEG and speech analyses are the primary areas under discussion, while the finding of methods acceptable for improvement of the diagnosis and determination of therapeutic procedures is the research topic. It is possible to reduce fundamentally, or to cure optimally these disorders in advanced diagnosis. Therefore it is important to search for new methods and to combine what has been used separately till now....

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Journal Article 2008; 29(4): 558-570 PubMed PMID: 18766162 Citation  Keywords:  Adolescent, Autistic Disorder:physiopathology, Child, Child, Preschool, Electroencephalography, Epilepsy:complications, Female, Humans, Intellectual Disability:etiology, Intelligence, Male, Retrospective Studies,.   

: We retrospectively evaluated a set of 205 children with autism and compared it to the partial sub-set of 71 (34.6%) children with a history of regression. From 71 children with regression, signs of epileptic processes were present in 43 (60.6%), 28 (65.12%) suffered clinical epileptic seizures, and 15 (34.9%) just had an epileptiform abnormality on the EEG. In our analysis, autistic regression is substantially more associated with epileptic process symptoms than in children with autism and no history of regression. More than 90% of children with a history of regression also show IQ < 70 and reduced functionality. Functionality and IQ further worsens with the occurrence of epileptic seizures (98% of children with regression and epilepsy have IQ < 70). We proved that low IQ and reduced functionality significantly correlate rather with epileptic seizures than just sub-clinical epileptiform abnormality on EEG. Clinical epileptic seizures associated with regression significantly influence the age of regression and its clinical type. The age of regression is higher compared to children with regression without epileptic seizures (in median: 35 months of age in patients with seizures while only 24 months in other patients). Patients with seizures revealed regression after 24th months of age in 68% of cases, while patients without seizures only in 27%. However, coincidence with epilepsy also increased the occurrence of regression before the 18th month of age (23% of patients), while only 4% of patients without epilepsy revealed regression before the 18th month. Epileptic seizures are significantly associated especially with behaviour regression rather than speech regression or regression in both behaviour and speech. Also epileptic seizures diagnosed before correct diagnosis of autism were significantly associated with delayed regression (both behavioural and speech regression)....

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Journal Article 2008; 29(4): 405-409 PubMed PMID: 18766157 Citation  Keywords:  Autistic Disorder:physiopathology, Electroencephalography, Epilepsy:physiopathology, Humans,.   

: Autism is associated with a high frequency of epileptiform EEG abnormalities (prevalence range 10.3-72.4%) and epilepsy (prevalence range 0-44.5%). A significant subgroup of autistic children (20-49%) experience autistic regression. The relationship among EEG abnormalities, epilepsy, and regression in autistic patients is not yet well understood. In this review, the current knowledge of the relationship is summarized. The evidence from clinical studies does not support the view that EEG abnormalities play a role in autistic regression. The majority of studies also failed to find any significant relationship between epilepsy and autistic regression. However, some results indicated that the higher the prevalence of epilepsy in the sample, the greater the probability of there being a significant association between epilepsy and autistic regression. Further research on the topic is needed....

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Journal Article 2008; 29(1): 71-74 PubMed PMID: 18283271 Citation  Keywords:  Adolescent, Aggression:psychology, Anxiety:psychology, Child, Child Abuse:classification, Child, Preschool, Disabled Children:psychology, Epilepsy, Post-Traumatic:classification, Humans, International Classification of Diseases:classification, Panic Disor.   

: This paper studies the contribution of anxiety in origin of functional behavioural disorders of children. The intense sensing of anxiety attributes to the shaping of one's personality. Adaptation and adjustment, accommodation and assimilation to stressful conditions producing anxiety are analyzed. There are diagnosed reactions of organism to the circumstances of the CAN syndrome and trauma. In these circumstances, a primary perception of reality is at stake that consequently leads to sociopathological features. This paper also provides the authors' opinions of psychoanalytical and behavioural schools on origin of personal decompensation and neurotic disorders. Causes of panic disorder and other diseases, in which a stress trauma plays a role, are considered. For these reasons the authors suggest classifying the CAN syndrome as a separate nosologic unit in the future ICD-11....

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