Summary:Purpose: Prospective evaluation of risk factors for posttraumatic epilepsy (PTE) by using clinical, EEG, and brain computed tomography (CT) data in four assessments from the head injury (HI) acute phase to 1 year later; and evaluation of the possible epileptogenic role of hemosiderin as shown by brain magnetic resonance imaging (MRI).Methods: Risk factors for PTE were evaluated by using Kaplan-Meier curves, log-rank test, and the Cox model in 137 consecutively enrolled adult inpatients. Percentage differences of patients with brain hyperintense and/or hemosiderin areas shown by MRI 1 year after HI were statistically evaluated by univariate tests considering two subgroups [e.g., patients with (FTE) and without (WLS) late seizures].Results: The PTE subgroup included 18 patients with at least two seizures between the second and twelfth months. KaplanMeier curves demonstrated that Glasgow Coma Scale low score, early seizures, and single brain CT lesions are PTE risk factors, as is the development of an EEG focus 1 month after HI. No significant percentage difference was found between PTE and WLS patients with hemosiderin spots shown by MRI 1 year after HI.Conclusions: the Cox model indicates that, for HI patients with early seizures and brain CT single temporal or frontal lesions in the acute phase, the PTE risk is 8.58 and 3.43 times higher, respectively, than for those without. An EEG focus 1 month after HI is a risk factor 3.49 times higher than for patients without such EEG changes. One year after HI, a higher percentage of PTE than WLS patients had cortical MRI hyperintense areas including hemosiderin. Key Words: Posttraumatic epilepsy-Clinical-Brain CT-MRI-EEG follow-upHemosiderin.Posttraumatic epilepsy (PTE), known since the time of Hippocrates, is still a puzzle because of the variety of methods used in the different studies and the wide range of their results. Dalmady-Israel and Zasler ( I ) provided a critical analysis of the literature on PTE emphasizing the lack of standardized definitions of both epilepsy and head injury (HI). Differences in inclusion/exclusion criteria and inadequacy in the follow-up of patients generate inconclusive or controversial results on incidence and risk factors.Many of the retrospective studies evaluated outcome when there was no standardized way of managing the

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This paper presents a clinical and electrophysiological analysis of type and duration of seizures recorded by means of long-term video electroencephalogram (EEG) monitoring, a method which enables accurate diagnosis of psychogenic pseudoepileptic seizures occurring with or without epileptic seizures. Analysis is based on 1083 patients, hospitalized at our department between 1990 and 1997, with a preliminary diagnosis of epilepsy. Psychogenic pseudoepileptic seizures were diagnosed in 85 patients (7.8%). In 48 patients, pseudoepileptic seizures alone were diagnosed (group 1), whereas 37 patients had a mixed condition in which pseudoepileptic seizures were accompanied by epileptic seizures (group 2). For comparison of duration of pseudo- and epileptic seizures a control group (group 3), consisting of 55 patients randomly selected from the population of patients suffering from epileptic seizures alone, was parceled out. Long-term video EEG monitoring was performed in 70 patients. In 55 (79%) of these patients 230 seizures (221 pseudoepileptic and nine epileptic) were recorded. In 30 patients (32%), the diagnosis was based on clinical observation of the seizures and on the number of EEG recordings, including activating procedures such as sleep deprivation, photostimulation, hyperventilation and anti-epileptic drug withdrawal. We found that the duration of epileptic seizures was significantly shorter than the duration of psychogenic pseudoepileptic seizures. Our study has exposed the difficulties involved in the diagnosis of psychogenic pseudoepileptic seizures and the negligible value of neuroimaging techniques and interictal EEG recordings in the differential diagnosis of epileptic versus nonepileptic seizures. In this study, psychogenic seizures were significantly more frequent in women than in men; patient history analysis did not confirm the hypothesis that sexual abuse may cause psychogenic seizures.

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Summary:Purpose: To explore the time course of treatmentemergent adverse events (AEs) during topiramate (TPM) adjunctive therapy.Methods: Post hoc analyses were performed by using data from a large (264 subjects) multicenter, double-blind, placebocontrolled trial in which 200 mg/day TPM was added to carbamazepine (CBZ) with or without another antiepileptic drug (AED) in adults with treatment-resistant partial-onset seizures. The daily incidence and mean duration of the most common (≥5% incidence) AEs were calculated for patients completing the 12-week study.Results: The daily incidence of somnolence, headache, loss of appetite, nervousness, fatigue, dizziness, upper respiratory tract infection, and vertigo peaked during titration and declined to rates similar to that of placebo after the target TPM dose had been reached. In contrast, the daily incidence of paresthesia increased during titration and was maintained for the study duration. Relatively few patients had cognitive symptoms (9% with TPM, 5% with placebo), but these were the most common AEs associated with treatment discontinuation. Patient/investigator reports of weight loss increased gradually over the course of the trial, corresponding with the pattern of change in weight measured at study visits.Conclusions: This study demonstrates that most of the more common AEs with TPM adjunctive therapy are transient. Patients can be counseled that most AEs emerging when TPM is initially added to CBZ can be expected to diminish with continued therapy. Key Words: Antiepileptic drug-TopiramateCarbamazepine-Side effects-Time course-Polytherapy.In the medical literature related to antiepileptic drugs (AEDs), adverse event (AE) reporting is typically limited to information about the incidence of the most common AEs, with discontinuation rate(s) serving as a measure of AE severity. Although these data are valuable information for counseling patients, little attention is given to the time course of AEs (i.e., when they emerge and whether they resolve over time). Such information also would be useful in counseling patients.Topiramate (TPM) is a newer AED with a broadspectrum antiseizure effect as adjunctive therapy (1-7) and monotherapy (8,9). Compared with other newer AEDs, TPM has been proved effective over an exceptionally wide dose range (200-1,000 mg/day) as add-on therapy (1-7). In early double-blind, placebo-controlled trials, nearly 80% of patients were assigned to dosages in excess of what are now recognized as the most useful dosages in clinical practice (100-300 mg/day) (10,11). The studies also were Accepted January 13, 2005. Address correspondence and reprint requests to Dr. J.C. Van Oene at Janssen-Cilag, Department Medical Affairs EMEA, P.O. Box 90240, 5000 LT Tilburg, The Netherlands. E-mail: jvoene@jacnl.jnj.com characterized by high starting doses (100 mg/day), rapid dose escalation (100-to 200-mg/day increments at weekly intervals), and combination with multiple AEDs, which further magnified adverse CNS effects. However, they showed that most AEs emer...

Summary: A recent United Kingdom cost minimization analysis (CMA) of four antiepileptic drugs (AEDs) used to treat newly diagnosed adult epilepsy demonstrated that a new drug, lamotrigine (LTG), incurred higher costs than carbamazepine (CBZ), phenytoin (PHT), and valproate (VPA), whose costs were similar. This analysis took account of each drug's sideeffect and tolerability profile. The present analysis investigated the costs of treatment with LTG, CBZ, PHT, and VPA in 12 European countries. Data were derived from published sources and from a panel of locally based experts. When no published data were available, estimates were obtained using expert opinion by a consensus method. These data were incorporated into a treatment pathway model, which considered the treatment of patients during the first 12 months after diagnosis. The primary outcome considered was seizure freedom, Randomized controlled trials demonstrate that the drugs considered are equally effective in terms of their ability to achieve seizure freedom, and thus the most appropriate form of economic evaluation is a CMA. These trials provided data on the incidence of side effects, dosages, and retention rates. The economic perspective taken was that of society as a whole and the analysis was calculated on an "intent-to-treat'' basis. Only direct medical costs were considered. In each country considered, LTG was twofold to threefold more expensive than the other drugs considered. A sensitivity analysis demonstrated that varying each of the assumptions (range defined by expert panels) did not significantly alter the results obtained.

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The results confirm that patients with epilepsy, regardless of age, take commonly CMs. Physicians should be more aware of this practice.