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Biomedical subjects

B Scheepers

Publications and source records attributed to B Scheepers.

10 recordsLinked to original sources
PubMed2003

Epilepsy: from consensus to daily practice.

Most clinicians would accept that epilepsy treatment should begin with monotherapy, and in the majority of cases this is the preferred drug maintenance option. The clinical choice of one antiepileptic drug (AED) over another should be based on firm evidence of efficacy and tolerability as evaluated in comparative monotherapy studies and pharmacokinetics. This paper presents the findings of evidence-based reviews of AED monotherapy in patients newly diagnosed with epilepsy. The main study was conducted in the United Kingdom and investigated the clinical evidence supporting AEDs used as first-line monotherapy. In this paper the general treatment recommendations will focus on valproate, one of the mainstay drugs used in the fight against epilepsy. Finally, with these recommendations in mind, the principles behind AED drug selection in clinical practice will be discussed. Factors for consideration that impact on AED decision-making include: seizure and syndrome diagnosis, AED tolerability profiles, patient characteristics and pharmacokinetic/pharmacodynamic AED interactions.

Adult↗
PubMed2000

Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause.

OBJECTIVES: We sought to investigate the value of cardiovascular tests to diagnose convulsive syncope in patients with apparent treatment-resistant epilepsy. BACKGROUND: As many as 20% to 30% of epileptics may have been misdiagnosed. Many of these patients may have cardiovascular syncope, with abnormal movements due to cerebral hypoxia, which may be difficult to differentiate from epilepsy on clinical grounds. METHODS: Seventy-four patients (33 men, mean age 38.9 +/- 18 years [range 16 to 77]) who were previously diagnosed with epilepsy were studied. Inclusion criteria included continued attacks despite adequate anticonvulsant drug treatment (n = 36) or uncertainty about the diagnosis of epilepsy, on the basis of the clinical description of the seizures (n = 38). Each patient underwent a head-up tilt test and carotid sinus massage during continuous electrocardiography, electroencephalography and blood pressure monitoring. Ten patients subsequently underwent long-term electrocardiographic (ECG) monitoring with an implantable loop recorder. RESULTS: In total, an alternative diagnosis was found in 31 patients (41.9%), including 13 (36.1%) of 36 patients taking an anticonvulsant medication. Nineteen patients (25.7%) developed profound hypotension or bradycardia during the head-up tilt test, confirming the diagnosis of vasovagal syncope. One other patient had a typical vasovagal reaction during intravenous cannulation. Two patients developed psychogenic symptoms during the head-up tilt test. Seven patients (9.5%) had significant ECG pauses during carotid sinus massage. In two patients, episodes of prolonged bradycardia correlated precisely with seizures according to the insertable ECG recorder. CONCLUSIONS: A simple, noninvasive cardiovascular evaluation may identify an alternative diagnosis in many patients with apparent epilepsy and should be considered early in the management of patients with convulsive blackouts.

Adolescent↗
PubMed2000

Is intranasal midazolam an effective rescue medication in adolescents and adults with severe epilepsy?

The aim of this study was to determine whether intranasal midazolam is a safe and effective rescue medication in adolescent and adult patients with severe epilepsy. This field trial was designed to test the feasibility of the use of intranasal midazolam as an alternative to rectal diazepam in a cohort of patients with severe epilepsy who require rescue medication as part of their treatment. A dose of intranasal midazolam (5 mg if the patient weighed less than 50 kg and 10 mg if the patient weighed over 50 kilograms) was prescribed for those who had previously responded to other rescue medication. Midazolam was prescribed buccally if excessive head movement accompanied seizures. The protocol reverted to the usual rescue medication if there was no response to midazolam within 10 minutes. Vital signs were monitored for half an hour following the administration of the treatment. Twenty-two patients received 84 treatment episodes and 79 of these were considered clinically effective. Five treatment failures were recorded, three due to poor technique in delivering the midazolam. Two patients were successfully retried on midazolam and a third is awaiting a retrial of this drug. The two other treatment failures received the drug buccally. In the first patient the clinical opinion was that this was possibly a psychogenic non-epileptic seizure. The other patient responded initially, but within an hour had another seizure requiring further rescue treatment. No significant adverse effects were reported. Our study shows that intranasal midazolam, when used appropriately, is an effective treatment in those who require rescue treatment. There are clear advantages in the use of midazolam over diazepam in the treatment of acute seizures. These include the favourable pharmacokinetic and pharmacodynamic properties of midazolam as well as the potential of a more acceptable and dignified administration route.

Administration, Intranasal↗
PubMed1999

Head-up tilting is a useful provocative test for psychogenic non-epileptic seizures.

Differentiating psychogenic non-epileptic attack disorder (NEAD) from true epilepsy is difficult. This often results in a misdiagnosis and unnecessary and ineffective treatment. Prolonged EEG/video recording is the most sensitive tool for differentiating NEAD from epilepsy, but is costly and therefore limited in availability. Provocative tests, particularly the use of saline injection, can reduce the length of monitoring but give rise to ethical dilemmas. This study assesses the value of head-up tilt testing as a provocative test for NEAD. Twenty-one patients (17 female, mean age 34.6 +/- 11.5 years) with recurrent seizure-like episodes and a clinical diagnosis of NEAD were studied. Patients were tilted to 80( composite function )on an electric tilt table with footplate support for up to 45 minutes during continuous ECG, EEG and blood pressure monitoring. Seventeen patients (81%) experienced typical symptoms (non-epileptiform limb shaking in 15 patients, absence in one patient, myoclonic jerking in one patient) during head-up tilt without significant EEG abnormalities or haemodynamic changes. The mean time to onset of seizure-like activity was 13.2 +/- 11 minutes (range 0-31 minutes). No patients suffered injury or any other significant side-effect. Provocative testing using suggestion and head-up tilt is a sensitive tool for diagnosing NEAD and represents a safe, simple and inexpensive outpatient technique for investigating patients with suspected NEAD.

Adult↗
PubMed1998

Non-epileptic attack disorder and clinical outcome: a pilot study.

Of the total population admitted over a 12-month period to a tertiary referral epilepsy centre for assessment of their seizure disorder, a high percentage were diagnosed with non-epileptic attack disorder. A retrospective analysis of these patients revealed that although intensive therapy and support was offered during the period of admission, the long-term resources for further management post-discharge were inadequate and in some cases non-existent. The implications for patient satisfaction with the service being offered are discussed and a patient information booklet produced in response to the findings is available by writing to the first author (H.R.).

Adolescent↗
PubMed1998

The misdiagnosis of epilepsy: findings of a population study.

This paper reports the results of a population study designed to assess the standards of epilepsy care within a geographical population in relation to diagnosis, seizure management and quality of life. One of the findings was the unexpectedly high frequency of the misdiagnosis of epilepsy. Forty-nine of 214 patients with a primary diagnosis of epilepsy were subsequently found to have been misdiagnosed following a specialist review and investigations. All except two have been withdrawn from antiepileptic medication. The diagnosis of epilepsy was disputed in a further 26 patients. Of the 49 patients, 20 were found to have cardiovascular or cerebrovascular pathology. Seven had only ever experienced a single seizure and a further 10 were found to have underlying psychopathology. Such observations support the view that epilepsy is frequently misdiagnosed and this paper discusses some of the implications of misdiagnosis.

Adolescent↗
PubMed1998

Midazolam via the intranasal route: an effective rescue medication for severe epilepsy in adults with learning disability.

People with a learning disability are often disadvantaged due to the nature of their disability. Up to a third are likely to have concomitant epilepsy which adds to the health loss experienced by this group. It is important to manage their epilepsy in such a way as to limit the debilitating effects of both the illness and the medication. Rectal diazepam remains the gold standard rescue medication for prolonged, recurrent seizures or seizures associated with hypoxia. Some of the drawbacks are highlighted in this paper and we go on to explore a novel means of treating these seizures. Midazolam, via the intranasal route, has been used extensively in children, mostly as a sedative but also in the treatment of epilepsy. We present two cases, both are adults with a learning disability, who have benefited significantly from the use of intranasal midazolam. Ongoing research into the safe use of this form of treatment, training of staff and carers and the impact on the individual is being conducted.

Administration, Intranasal↗
PubMed1994

Non-epileptic attack disorder: a clinical audit.

The results of an audit of all patients with non-epileptic attack disorder admitted over a 1-year period to a neuropsychiatry tertiary referral centre are presented. The high incidence of: sexual abuse, previous psychiatric history and previous brain injury is noted. Reference is made to the reaction of patients and relatives to disclosure of the diagnosis and the management difficulties which this group of patients pose. The different underlying psychopathological processes are discussed and it is suggested that the diagnosis of NEAD, purely by the exclusion of epilepsy, might carry the risk of treating these patients as a homogenous group. An eclectic approach by an experienced, multi-disciplinary team is probably the most appropriate way of successfully managing the condition.

Counseling↗