Biomedical subjects

Blaise F D Bourgeois

Publications and source records attributed to Blaise F D Bourgeois.

5 recordsLinked to original sources

PubMed2003

Chronic management of seizures in the syndromes of idiopathic generalized epilepsy.

As a group, idiopathic generalized epilepsies (IGEs) have the highest rates of complete seizure control with medication. However, there are little evidence-based data to guide drug choice for treatment. Examples of IGE include absence epilepsy, generalized tonic-clonic epilepsy, and juvenile myoclonic epilepsy. Generalized epilepsies seem to be particularly vulnerable to seizure aggravation, and medications that are primarily effective against partial seizures are more commonly involved in seizure aggravation than other medications. A review of current research has shown that only a few medications can control IGE without potentially causing seizure aggravation. Broad-spectrum antiepileptic drugs such as valproate (VPA), lamotrigine, and topiramate are extremely effective at controlling a variety of seizures without causing excessive seizure aggravation. Among these drugs, VPA has the longest clinical experience history and the largest body of published data.

Adult↗

PubMed2002

Prognostic value of neonatal discontinuous EEG.

The burst suppression pattern on the neonatal electroencephalogram (EEG) is associated with a poor outcome. However, this serious abnormality constitutes only a small proportion of discontinuous neonatal EEGs. We sought to establish whether any easily measurable parameters among the broad range of excessively discontinuous neonatal EEGs are predictive of outcome. We retrospectively reviewed the EEGs and medical records of 43 term infants with excessively discontinuous EEGs. We quantitated 10 parameters in the bursts and interburst intervals, among them the predominant interburst interval duration (defined as the duration of more than 50% of all interburst intervals of an EEG). Univariate and multivariate analyses were performed on the 10 EEG variables in relation to neurologic outcome and subsequent epilepsy. Based on multivariate analysis, a single easily measurable EEG parameter related significantly to outcome. A predominant interburst interval duration of more than 30 seconds correlated with the occurrence of both unfavorable neurologic outcome and subsequent epilepsy (P = 0.040 and P = 0.033, respectively). In conclusion, a infant whose EEG contains a predominant interburst interval duration of more than 30 seconds has a 100% probability of experiencing severe neurologic disabilities or death and an 86% chance of developing subsequent epilepsy. This easily quantitated EEG parameter could be valuable for the early estimation of neurologic prognosis.

Brain Diseases↗

PubMed2002

Reducing overtreatment.

Although treatment of epilepsy easily evolves into a situation of overtreatment, reversing the process can be difficult and time consuming. Benefits of reducing overtreatment may include a decrease in side effects, better seizure control, a simplification in the medication regimen, improved compliance, and reduced costs. The risks include seizure exacerbation due to withdrawal or due to loss of protection. Reversal of pharmacokinetic interactions may also lead to seizure aggravation or to drug toxicity. When reducing overtreatment, there are three main challenges: to select the drugs that should be eliminated, to choose an appropriate rate of reduction, and to anticipate reversible pharmacokinetic interactions that can have clinically significant consequences. Overall, there is a lack of published data to properly support recommendations for implementing reduction of overtreatment. This is particularly the case in the pediatric population and for the newer antiepileptic drugs.

Anticonvulsants↗

PubMed2002

Epilepsy surgery: indications, approaches, and results.

The surgical treatment of epilepsy is divided into procedures with curative or palliative goals. Curative procedures are highly effective in rendering the majority of patients seizure free, and palliative procedures often result in marked improvement in seizure frequency, quality of life, or both. This brief overview of epilepsy surgery outlines the goals of surgery, criteria used to determine patient eligibility, the various types of epilepsy surgery, and anticipated outcomes of these approaches. Newer surgical techniques including vagus nerve and deep brain stimulation and gamma knife radiosurgery are also discussed.

Animals↗

PubMed2002

Differential cognitive effects of antiepileptic drugs.

As a group, children and adolescents with epilepsy have a higher prevalence of cognitive and behavioral disorders, although many fall within the normal distribution. For those affected, several causes have been identified, some of which may be interrelated. It has proven to be methodologically sound to isolate the role of specific antiepileptic drugs as a cause of cognitive impairment. The large body of literature that has accumulated on this topic is characterized by a relatively high proportion of inconclusive or contradictory observations. This may be due in part to the many methodological pitfalls in this area of research. The emerging picture is that cognitive effects caused by antiepileptic drugs are neither the rule nor the exception. Although certain drugs appear more likely to be involved, no single drug causes problems in every patient, and no drug can be assumed never to cause any cognitive impairment. The subgroup of patients that are at higher risk cannot be easily defined. Early detection of cognitive effects is based on actively eliciting reports of symptoms. This can be complemented by a screening battery in case of suspicion.

Adolescent↗