Intractable seizures in pregnancy

Smith, Philip E. M.; Saunders, John; Dawson, Andrew; Kerr, Michael Patrick

doi:10.1016/s0140-6736(99)09164-3

Cited by 13 publications

(9 citation statements)

References 2 publications

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“…One fourth of patients with PNESs seen at an epilepsy centre had been taken to an intensive care unit to control their seizures (8). This means that PNES patients are at high risk of iatrogenic harm or even death from inappropriate or inadvertent medication administration (9–12).…”

Section: Overview Of Studies Examining Outcome Of Pnes In Adultsmentioning

confidence: 99%

Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant Is Seizure Remission?

et al. 2005

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Summary: Purpose: To examine whether seizure remission is a comprehensive marker of outcome in psychogenic nonepileptic seizures (PNESs). Methods: A postal questionnaire was returned by 147 patients with PNESs a mean of 4.2 years after diagnosis (mean age at follow‐up, 38.1 years). The proportion of patients who were “unproductive” (receiving health‐related state benefits) at follow‐up was determined, with a comparison of markers of ongoing psychopathology (Global Severity Index, anxiety and depression scores of the Symptom Checklist 90, Somatization Index DSM of the SOMS‐2) in three outcome groups: group 1, continuing seizures; group 2, seizures stopped but patients “unproductive;” and group 3, seizures stopped, patients “productive.” Results: Of the patients, 71.4% continued to have seizures, and 28.6% had achieved seizure remission; 60.0% of patients with continuing seizures and 42.7% of patients in remission were “unproductive” (difference, NS). Ongoing psychopathology was related to the factor “group membership” with higher values in groups 2 and 3 than in group 1 (GSI, p < 0.001; anxiety, p = 0.01; depression, p = 0.02; Somatization Index DSM, p < 0.001). Across all patients and in the subgroup with PNESs and additional epilepsy, differences were significant only between groups 2 and 3, not between groups 1 and 2. In patients with PNESs alone, differences were significant only between groups 1 and 2. Conclusions: Seizure remission is not a comprehensive measure of good medical or psychosocial outcome in PNESs. Nearly half the patients who become seizure free remain unproductive. Many of these patients continue to report symptoms of psychopathology. Seizure control should not be the only focus of treatment in clinical practice or outcome observation in research studies.

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Section: Overview Of Studies Examining Outcome Of Pnes In Adultsmentioning

confidence: 99%

Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant Is Seizure Remission?

et al. 2005

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“…In the present study, only male rats were subjected to pilocarpine injections, since female rats are resistant to pilocarpine (Persinger et al, 1988 ; Mejías-Aponte et al, 2002 ; Scharfman and MacLusky, 2014 ). The variation of sex hormones is a source of variability as testoterone and estradiol modulate seizure activity in both animal models and human patients (Edwards et al, 1999 ; Smith et al, 1999 , 2002 ; Valente et al, 2002 ; Galanopoulou et al, 2003 ; Scharfman et al, 2005 ; Scharfman and MacLusky, 2006 ; Giorgi et al, 2014 ; D’Amour et al, 2015 ) as well as behavioral cognitive functions in mice model of TLE (Oliveira et al, 2015 ). Moreover, few studies have reported that KCC2 expression is sexually dimorphic and controlled by estrogen levels (Galanopoulou and Moshé, 2003 ; Nakamura et al, 2004 ; Perrot-Sinal et al, 2007 ; Galanopoulou, 2008 ; Giorgi et al, 2014 ) and that ovarian cycle induces changes in GABA A -receptor subunits and subsequent inhibition (Stell et al, 2003 ; Maguire et al, 2005 ; Maguire and Mody, 2007 ).…”

Section: Methodsmentioning

confidence: 99%

Detrimental effect of post Status Epilepticus treatment with ROCK inhibitor Y-27632 in a pilocarpine model of temporal lobe epilepsy

Kourdougli

Varpula

Chazal

et al. 2015

Front. Cell. Neurosci.

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Temporal lobe epilepsy (TLE) is the most common type of epilepsy in adults where 20–30% of the patients are refractory to currently available anti-epileptic drugs. The RhoA/Rho-kinase signaling pathway activation has been involved in inflammatory responses, neurite outgrowth and neuronal death under pathological conditions such as epileptic insults. Acute preventive administration of ROCK inhibitor has been reported to have beneficial outcomes in Status Epilepticus (SE) epilepsy. In the present study, we evaluate the effect of chronic post SE treatment with the ROCK inhibitor Y-27632 in a rat pilocarpine model of TLE. We used chronic i.p. injections of Y-27632 for 5 days in 6 week old control rats or rats subjected to pilocarpine treatment as a model of TLE. Surprisingly, our findings demonstrate that a systemic administration of Y-27632 in pilocarpine-treated rats increases neuronal death in the CA3 region and ectopic recurrent mossy fiber sprouting (rMFS) in the dentate gyrus of the hippocampal formation. Interestingly, we found that chronic treatment with Y-27632 exacerbates the down-regulation and pathological distribution of the K+-Cl− cotransporter KCC2, thus providing a putative mechanism for post SE induced neuronal death. The involvement of astrogliosis in this mechanism appears to be intricate as ROCK inhibition reduces reactive astrogliosis in pilocarpine rats. Conversely, in control rats, chronic Y-27632 treatment increases astrogliosis. Together, our findings suggest that Y-27632 has a detrimental effect when chronically used post SE in a rat pilocarpine model of TLE.

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“…The misdiagnosis of non-epileptic seizures as epilepsy is particularly dangerous-severe iatrogenic injury, pregnancy loss, and death have been reported. [59][60][61] Physicians who fail to identify medically unexplained disorders may be faced with litigation. 62 This does not mean that neurologists should rush into calling a symptom functional.…”

Section: How Certain Can We Be That a Symptom Is Functional?mentioning

confidence: 99%