Bial, Eisai, GlaxoSmithKline, Janssen-Cilag, Novartis, Pfizer, Sanofi-Aventis, UCB, the Netherlands Epilepsy Foundation, and Stockholm County Council.

A prospective study on seizure-related injuries in Norway's two nursing homes for persons with epilepsy was conducted. Sixty-two multihandicapped patients with mostly difficult-to-treat epilepsy were assessed for 13 months: 6,889 seizures, 2,696 with ensuing falls, resulted in 80 injuries. The seizure-related injury risk was 1.2%. The most frequent injuries were mild soft tissue injuries with and without cuts. Six serious injuries were recorded: two leg fractures, one mandibular fracture, one neck of the femur fracture, one skull fracture, and one subdural hematoma. A 71-year-old woman with subdural hematoma died during operation for the hematoma. Seizure types most often causing injury were atonic and tonic-clonic seizures. Prophylactic measures can be taken. Because the seizure-induced injury risk was slight, we concluded that even persons with refractory epilepsy should be encouraged to lead active lives.

The aim of this prospective, uncontrolled clinical study was to evaluate the tolerability and the efficacy of levetiracetam as add-on treatment in 78 adults and 44 children with intractable epilepsy. The patients' seizure frequency in the 8 weeks baseline period was compared to their seizure frequency after a mean follow-up of 8 months of treatment.A greater than 50% reduction in seizure frequency was achieved in 31 adults (40%) and 9 children (20%), of whom 7 adults (9%) and 3 children (7%) became seizure free. Most often levetiracetam was well tolerated, somnolence being the most frequently reported side effect (18% in adults and 7% in children). However, in 14 adults (18%) and 19 children (43%) levetiracetam was associated with an increase (>25%) in seizure frequency. Such a paradoxical effect, including the development of status epilepticus in three adults and four children, appeared most often in mentally retarded patients during the first 2 months of treatment, and on relatively high doses. Two children developed status epilepticus after 5 and 7 months, respectively. In conclusion, levetiracetam is usually well tolerated as add-on treatment in patients with difficult-to-treat partial onset seizures. By using a lower initial dose and a slower dose escalation than recommended by the manufacturer, a paradoxical effect may perhaps be avoided. In children, doses >20 mgkg(-1) per day should be introduced with caution.

The majority of patients with epilepsy maintain seizure control during pregnancy. The apparently higher risk of seizures among women treated with oxcarbazepine and the more frequent increases in drug load in the oxcarbazepine and lamotrigine cohorts prompts further studies on relationships with pharmacokinetic changes. Risks associated with status epilepticus appear to be lower than previously reported.

The purpose of this open retrospective study was to analyze the efficacy and tolerability of vagal nerve stimulation (VNS) in a Norwegian cohort of referral patients with refractory epileptic seizures. A total of 47 patients have been assessed after a mean follow-up time of 2.7 years. Mean age was 34.4 years, mean duration of epilepsy was 25.3 years. Forty-two patients (89%) had localization-related epilepsy, 36 patients (77%) had daily seizures. The patients had tried on average 9.5 antiepileptic drugs, and 12 patients (26%) had undergone epilepsy surgery. Sixteen patients (34%) had >50% reduction of seizure frequency with VNS, of which one patient became seizure free. The stimulation was generally well tolerated, but three patients requested the device removed because of troublesome side effects. We conclude that VNS is an efficacious and safe mode of treatment that should be offered to patients with medically and surgically refractory seizures.

We examined the effect of acupuncture on epileptic seizures in humans in a controlled clinical setting. Treatment was administered by two Chinese professors of acupuncture. Effect was measured by change in seizure frequency. Twenty-nine patients with chronic intractable epilepsy completed the study. They were randomized in two groups; 15 were given classical acupuncture and 14 were given sham acupuncture. There was a reduction in seizure frequency in both groups, which did not reach a level of statistical significance. There was also an increase in the number of seizure-free weeks in both groups, which reached a level of significance in the sham group. Thus, we have not been able to prove a beneficial effect of acupuncture in chronic intractable epilepsy.

No abstract

Although few neurologists are formally trained in traffic medicine, they are frequently asked to assess whether a patient is medically fit to drive. For patients with epilepsy, the physician must assess the risk of the patient having a seizure while driving, and decide what is an acceptable risk. The legislation on this subject is aiming at finding a reasonable balance between two important considerations: public safety and a patient's individual need to drive. For the neurologist to explain and put into practice the legislation may be a demanding task and a challenge to the doctor-patient alliance. The decision on driving capability should be tailored to the individual patient and based on careful evaluation and informed judgement. In Norway, to qualify for a driver's license, a seizure-free interval of at least 12 months is currently required for group 1 drivers (passenger cars), whereas group 2 drivers (heavy motor vehicles, commercial driving) must have been seizure-free for at least 10 years and not have experienced epileptic seizures from the age of 18 years. Norwegian physicians are obliged to report patients with seizures to driving authorities, although this is an unpopular rule. In reviewing the available literature, it is apparent that despite there being relatively few sound studies, the risks of car accidents among persons with epilepsy may previously have been overestimated.