Influence on Ictal Seizure Semiology of Rapid Withdrawal of Carbamazepine and Valproate in Monotherapy

Zhou, Dong; Wang, Ying; Hopp, Peter; Kerling, Frank; Kirchner, A.; Pauli, E.; Stefan, Hermann

doi:10.1046/j.1528-1157.2002.45201.x

Cited by 36 publications

(32 citation statements)

References 24 publications

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“…Even though we were extremely cautious about confirming the habituality of the seizures, there still remains the possibility that the patients' usual seizures are different from what we videotaped and analyzed. The occurrence of nonhabitual seizures is frequent in the Epilepsy Monitoring Unit because of the discontinuation of some AEDs [15][16][17] and because of the effects of previous seizures. If these passed unnoticed, the result could have been distorted.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Semiology Description

Heo¹,

Kim²,

Lee³

et al. 2008

The Neurologist

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Section: Discussionmentioning

confidence: 99%

Reliability of Semiology Description

Heo¹,

Kim²,

Lee³

et al. 2008

The Neurologist

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“…Available evidence indicates that seizures precipitated by antiepileptic drug withdrawal appear to be the same as habitual seizures (So and Fisch, 1997). Antiepileptic drug withdrawal can increase the duration and intensity of seizures and also the likelihood of secondary generalization (Zhou et al, 2002). However, seizureonset characteristics are not substantially altered.…”

Section: Limitations Of Seizure Semiologymentioning

confidence: 99%

Value and Limitations of Seizure Semiology in Localizing Seizure Onset

2006

Journal of Clinical Neurophysiology

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Seizure semiology has been the foundation of clinical diagnosis of seizure disorders. This article discusses the value and the limitations of behavioral features of seizure episodes in localizing seizure onset. Studies have shown that some semiologic features of seizures are highly accurate in the hemispheric lateralization and lobar localization of seizures. There is good agreement between blinded reviewers in lateralizing video-recorded seizures in temporal lobe and extratemporal lobe epilepsies. However, seizure semiology alone should not be used to determine the site of seizure onset. Each semiologic feature may falsely localize seizure onset. Seizure semiology in some patients may signify the site of seizure propagation rather than origination. Moreover, seizure semiology may not be as reliable in multifocal epilepsies as it is in unifocal epilepsies. Many semiologic features of seizures of adults are often missing in seizures of children. Seizure semiology should be analyzed and integrated with EEG and neuroimaging data to localize the seizure focus. A sample of the recorded seizures should be shown to the patient's relatives or friends to verify that it is representative of habitual seizures.

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“…, 2000, 2001; Wang et al. , 2001, 2002; Zhou et al. , 2000, 2002) was used for a better interpretation of the rapid withdrawal effects.…”

Section: Introductionmentioning

confidence: 99%

Changes of seizures activity during rapid withdrawal of lamotrigine

Wang-Tilz

Tilz

Wang

et al. 2005

Euro J of Neurology

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Quantitatively evaluating the rapid withdrawal effects of lamotrigine (LTG) and carbamazepine (CBZ) on seizure activity during pre-surgical evaluation in patients with pharmacoresistant complex partial epilepsy. The duration and frequency of seizure activities and electrographic seizure onset of 41 patients totally withdrawing from CBZ monotherapy (n = 20), LTG monotherapy (n = 10) and CBZ + LTG combined therapy (n = 11) were intensively studied by therapeutic intensive seizure analysis (TISA) method. Study phases ran from the baseline phase to the antiepileptic drug (AED) withdrawal phase until the AED free phase, 3 days for each phase. Seizure duration and frequency obviously increased during the withdrawal process in each group (P < 0.05). The duration of secondarily generalized clonic signs markedly increased with the tapering of each drug; tonic signs, however, only in the AED free phase (P < 0.05). The frequency of secondary tonic and clonic signs only increased in the CBZ and CBZ + LTG group. Intergroup comparisons of all variables were insignificant (P > 0.05). There was no change of ictal EEG localization during all withdrawal protocols. All patients experienced more severe seizures during the withdrawal processes. An earlier aggravation of the clonic signs than the tonic signs was observed in each group. Difference between the withdrawal effects of LTG and CBZ monotherapy and LTG + CBZ polytherapy was mainly in the frequency change of ictal signs. The withdrawal process did not influence the ictal EEG localization. This study justified the withdrawal in pre-surgical localization, rationalized precautions for possible accompanying risks, and also aroused attentions in clinical anticonvulsant trials and substitutions involving withdrawal process.

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Influence on Ictal Seizure Semiology of Rapid Withdrawal of Carbamazepine and Valproate in Monotherapy

Cited by 36 publications

References 24 publications

Reliability of Semiology Description

Reliability of Semiology Description

Value and Limitations of Seizure Semiology in Localizing Seizure Onset

Changes of seizures activity during rapid withdrawal of lamotrigine

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