Effects of antiepileptic drugs on interictal epileptiform discharges in focal epilepsies: an update on current evidence

Guida, Melania; Iudice, Alfonso; Bonanni, Enrica; Giorgi, Filippo Sean

doi:10.1586/14737175.2015.1065180

Cited by 21 publications

(16 citation statements)

References 69 publications

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“…[6][7][8][9][10][11][12][13][14][15][16] More specifically, the confounding factors that influence the diag- with AEEG. [27][28][29] Three dogs in our population received 4 to 6 ASD (1 dog received These data support further questions about the potential use of AEEG as a monitoring tool for epileptic patients. However, levetiracetam previously has been shown to decrease ictal epileptiform discharges in a Rhodesian ridgebacks with juvenile myoclonic epilepsy and absence seizures.…”

Section: Discussionsupporting

confidence: 70%

Effect of prior general anesthesia or sedation and antiseizure drugs on the diagnostic utility of wireless video electroencephalography in dogs

Parmentier

Monteith

Cortez

et al. 2020

Veterinary Internal Medicne

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Background: Ambulatory wireless video electroencephalography (AEEG) is the method of choice to discriminate epileptic seizures from other nonepileptic episodes. However, the influence of prior general anesthesia (GA), sedation, or antiseizure drug (ASD) on the diagnostic ability of AEEG is unknown. Hypothesis/Objectives: The use of sedation/GA or ASD treatment before AEEG recording may affect the diagnostic ability of AEEG and the time to first abnormality on AEEG. Animals: A total of 108 client-owned dogs undergoing ambulatory AEEG for paroxysmal episodes. Methods: Retrospective cohort study. Proportions of diagnostic AEEG and time to first abnormality were compared between dogs that received sedation/GA or neither for instrumentation as well as dogs receiving at least 1 ASD and untreated dogs. Results: Ambulatory EEG was diagnostic in 60.2% of all dogs including 49% of the sedation/GA dogs and 68% of dogs that received neither (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.02-5.00; P = .05). The AEEG was diagnostic in 51% of dogs receiving at least 1 ASD and 66% of untreated dogs (OR, 1.95; 95% CI, 0.9-4.3; P = .11). No difference was found in time to first abnormality between sedation/GA or neither or ASD-treated or untreated dogs (P = .1 and P = .3 respectively). Ninetyfive percent of dogs had at least 1 abnormality within 277 minutes. Conclusion and Clinical Importance: Sedation/GA and concurrent ASD administration were not identified as confounding factors for decreasing AEEG diagnostic capability nor did they delay the time to first abnormality. A 4-hour minimal recording period is recommended.

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Section: Discussionsupporting

confidence: 70%

Effect of prior general anesthesia or sedation and antiseizure drugs on the diagnostic utility of wireless video electroencephalography in dogs

Parmentier

Monteith

Cortez

et al. 2020

Veterinary Internal Medicne

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“…48,49 Recently, Guida et al published a review of past studies that sought to determine the effects of AEDs (alone or in combination) on focal IEDs and concluded that the data is scarce or conflicting for classical AEDs and absent or limited for newer AEDs. 50 In any case, they considered their findings consistent with the prevailing view that focal IEDs are not influenced by chronic AED therapy in patients with focal epilepsy. There are few reports of successful control of PLEDs using carbamazepine, midazolam, pentobarbital, sodium valproate, and felbamate, 22 but these studies must be replicated.…”

Section: Discussionmentioning

confidence: 59%

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

et al. 2017

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Drug-induced burst suppression (DIBS) is bihemispheric and bisymmetric in adults and older children. However, asymmetric DIBS may occur if a pathological process is affecting one hemisphere only or both hemispheres disproportionately. The usual suspect is a destructive lesion; an irritative or epileptogenic lesion is usually not invoked to explain DIBS asymmetry. We report the case of a 66-year-old woman with new-onset seizures who was found to have a hemorrhagic cavernoma and periodic lateralized epileptiform discharges (PLEDs) in the right temporal region. After levetiracetam and before anesthetic antiepileptic drugs (AEDs) were administered, the electroencephalogram (EEG) showed continuous PLEDs over the right hemisphere with maximum voltage in the posterior temporal region. Focal electrographic seizures also occurred occasionally in the same location. Propofol resulted in bihemispheric, but not in bisymmetric, DIBS. Remnants or fragments of PLEDs that survived anesthesia increased the amplitude and complexity of the bursts in the right hemisphere leading to asymmetric DIBS. Phenytoin, lacosamide, ketamine, midazolam, and topiramate were administered at various times in the course of EEG monitoring, resulting in suppression of seizures but not of PLEDs. Ketamine and midazolam reduced the rate, amplitude, and complexity of PLEDs but only after producing substantial attenuation of all burst components. When all anesthetics were discontinued, the EEG reverted to the original preanesthesia pattern with continuous non-fragmented PLEDs. The fact that PLEDs can survive anesthesia and affect DIBS symmetry is a testament to the robustness of the neurodynamic processes underlying PLEDs.

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“…Future work is also needed to more fully characterize the behavior during GEDs using automatic real‐time detection algorithms, which might succeed in attaining faster and more consistent rates of stimulus presentation than we achieved with human visual review. Another factor that could be investigated with a larger sample size is potential effects of antiseizure medications, which are known to influence epileptiform discharges and might also affect behavior …”

Section: Discussionmentioning

confidence: 99%

Realistic driving simulation during generalized epileptiform discharges to identify electroencephalographic features related to motor vehicle safety: Feasibility and pilot study

et al. 2019

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Objective: Generalized epileptiform discharges (GEDs) can occur during seizures or without obvious clinical accompaniment. Motor vehicle driving risk during apparently subclinical GEDs is uncertain. Our goals were to develop a feasible, realistic test to evaluate driving safety during GEDs, and to begin evaluating electroencephalographic (EEG) features in relation to driving safety. Methods: Subjects were aged ≥15 years with generalized epilepsy, GEDs on EEG, and no clinical seizures. Using a high-fidelity driving simulator (miniSim) with simultaneous EEG, a red oval visual stimulus was presented every 5 minutes for baseline testing, and with each GED. Participants were instructed to pull over as quickly and safely as possible with each stimulus. We analyzed driving and EEG signals during GEDs.Results: Nine subjects were tested, and five experienced 88 GEDs total with mean duration 2.31 ± 1.89 (SD) seconds. Of these five subjects, three responded appropriately to all stimuli, one failed to respond to 75% of stimuli, and one stopped driving immediately during GEDs. GEDs with no response to stimuli were significantly longer than those with appropriate responses (8.47 ± 3.10 vs 1.85 ± 0.69 seconds, P < .001). Reaction times to stimuli during GEDs were significantly correlated with GED duration (r = 0.30, P = .04). In addition, EEG amplitude was greater for GEDs with no response to stimuli than GEDs with responses, both for overall root mean square voltage amplitude (66.14 μV vs 52.99 μV, P = .02) and for fractional power changes in the frequency range of waves (P < .05) and spikes (P < .001). Significance: High-fidelity driving simulation is feasible for investigating driving behavior during GEDs. GEDs with longer duration and greater EEG amplitude showed more driving impairment. Future work with a large sample size may ultimately enable classification of GED EEG features to predict individual driving risk. K E Y W O R D Sabsence seizures, consciousness, driving, EEG, epilepsy, spike-wave discharges 20 | COHEN Et al.

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Effects of antiepileptic drugs on interictal epileptiform discharges in focal epilepsies: an update on current evidence

Cited by 21 publications

References 69 publications

Effect of prior general anesthesia or sedation and antiseizure drugs on the diagnostic utility of wireless video electroencephalography in dogs

Effect of prior general anesthesia or sedation and antiseizure drugs on the diagnostic utility of wireless video electroencephalography in dogs

Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

Realistic driving simulation during generalized epileptiform discharges to identify electroencephalographic features related to motor vehicle safety: Feasibility and pilot study

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