Epilepsia - Editor's Choice

February 2012 articles from Editor-in-Chief Phil Schwartzkroin

Unifying the Definitions of SUDEP

Nashef L, So, EL, Ryvlin P, Tomson T.
Volume 53, Issue 2, pp 227-233, February, 2012

Sudden unexpected death in epilepsy (SUDEP) is a category of deaths in people with epilepsy occurring in the absence of a known structural cause of death and is most likely heterogeneous with regard to mechanisms and circumstances. SUDEP is particularly difficult to investigate in research studies for several reasons, including its relatively low incidence, its unpredictable occurrence often in unwitnessed settings, and its low rate of complete autopsy examinations. In this paper, the authors describe scenarios that demonstrate the basis for various SUDEP categories, and propose a unified SUDEP definition and classification to resolve current ambiguities and to retrieve cases that would not have been further studied if the previous definitions were used.

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The electroencephalogram of idiopathic generalized epilepsy.

Seneviratne U, Cook M, D’Souza W
Volume 53, Issue 2, pp 234-248, February, 2012

Idiopathic generalized epilepsy (IGE) is classified into several sub-syndromes based on clinical and electroencephalographic (EEG) features. The electrographic signature of IGE is bisynchronous, symmetric and generalized spike-wave complex - although focal, irregular and so called ‘fragments’ of discharges are not uncommon. Other characteristic EEG features include polyspikes, polyspike-wave discharges, occipital intermittent rhythmic delta activity and photoparoxysmal response. Both human and animal data suggest involvement of the thalamus and the cortex in the generation of spike-wave discharges in IGE. Circadian variations of generalized epileptiform discharges are well described which can be useful in diagnostic confirmation. Activation procedures such as hyperventilation, intermittent photic stimulation, eye closure and fixation-off are useful techniques to increase the yield of both interictal and ictal EEG abnormalities. Variations of electrographic abnormalities are evident between different electroclinical syndromes. The EEG is also affected by certain external as well as internal factors, which should be borne in mind when interpreting the EEG in IGE.

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Mortality after temporal lobe epilepsy (TLE) surgery.

Seymour N, Granbichler CA, Polkey CE, Nashef L
Volume 53, Issue 2, pp 267-271, February, 2012

This study reports mortality, after a longer interval, in a cohort (306 patients) with drug-resistant epilepsy treated by temporal lobe surgery between 1975 and 1995. Deaths occurring after December 1st 1997 and until 1st December 2009 were evaluated. In 3569 person-years (py) of follow-up, 19 deaths occurred. In this cohort, the risk for premature death in patients undergoing TLE surgery decreased over time but remained above the standard population. Men suffered a slightly higher risk than women, as did right-sided resections in mesial temporal sclerosis. Though lower, the risk of SUDEP remained.

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January 2012 articles from Editor-in-Chief Phil Schwartzkroin

Overexpression of ADK in human astrocytic tumors and peritumoral tissue is related to tumor-associated epilepsy

de Groot M, Iyer A, Zurolo E, Anink J, Heimans JJ, Boison D, Reijneveld JC, Aronica E. Volume 53, Issue 1, pages 58–66, January 2012

Adenosine kinase (ADK), a largely astrocyte-based metabolic enzyme, regulates adenosine homeostasis in the brain. Overexpression of ADK decreases extracellular adenosine and consequently leads to seizures. Using immunohistochemistry and western blot, we examined ADK expression and cellular distribution in surgically removed tumor tissue and peritumoral cortex of patients with glial and glioneuronal tumors. ADK immunoreactivity was significantly stronger in tumor and peritumoral tissue compared to normal white matter and normal cortex (from autopsy controls). Further, there was a significantly higher expression of ADK in the peritumoral infiltrated tissue of patients with epilepsy than in patients without epilepsy. These results suggest a dysregulation of ADK in astrocytic brain tumors, and are consistent with a role of this enzyme in tumor-associated epilepsy.

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Effects of long-term antiepileptic drug monotherapy on vascular risk factors and atherosclerosis

Chuang Y-C, Chuang H-Y, Lin T-K, Chang C-C, Lu C-H, Chang W-N, Chen S-D, Tan T-Y, Huang C-R, Chan SHH. Volume 53, Issue 1, pages 120-128, January 2012

Long-term therapy with antiepileptic drugs (AEDs) has been associated with metabolic consequences that lead to an increase in risk of atherosclerosis in patients with epilepsy. We compared the long-term effects of monotherapy using different categories of AEDs on markers of vascular risk and the atherosclerotic process. Patients who were under long-term monotherapy with carbamazepine (CBZ), phenytoin (PHT) or valproic acid (VPA) exhibited altered circulatory markers of vascular risk that may contribute to the acceleration of the atherosclerotic process, which is significantly associated the duration of AED monotherapy. No significant alterations in the markers of vascular risk were observed in patients who received long-term lamotrigine (LTG) monotherapy. This information offers guidance in the choice of drug in patients with epilepsy who require long-term AED therapy, particularly in aged and high-risk individuals.

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A once-per-day drug-in-food protocol for prolonged administration of antiepileptic drugs in animal models

Ali A, Dua Y, Constance JE, Franklin MR, Dudek FE Volume 53, Issue 1, pages 199-206, January 2012

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