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Biomedical subjects

Carl W Bazil

Publications and source records attributed to Carl W Bazil.

At least 19 recordsLinked to original sources
PubMed2006

Improved quality of life in patients with partial seizures after conversion to oxcarbazepine monotherapy.

OBJECTIVE: Quality of life (QOL) was assessed in patients who switched to oxcarbazepine monotherapy because of the lack of efficacy or poor tolerability of their current antiepileptic drug (AED). METHOD: This open-label, single-arm study consisted of patients aged 12 >or= years with partial onset seizures. Oxcarbazepine (8-10mg/kg/day for children, 600 mg/day for adults) was titrated up over 4 weeks while the existing AED was tapered off. QOL was evaluated at baseline and end of study (Week 16) using the validated-in-epilepsy QOLIE-31 questionnaire. RESULTS: For all patients who completed the QOLIE-31 at baseline and completion, a statistically significant improvement was noted for both the composite and multi-item subscale QOL scores (P<0.05 vs baseline). Statistically significant mean percentage improvements of >or=10% from baseline (range=10.8-50.1%) were also noted. Significant improvements were seen in health-related QOL for patients who experienced seizure freedom or >or=50% reductions in seizure frequency with oxcarbazepine monotherapy. CONCLUSIONS: Patients with partial seizures who switched to oxcarbazepine monotherapy showed statistically significant, clinically relevant improvements in QOL.

Adolescent↗
PubMed2006

Sleep disturbances reported by refractory partial-onset epilepsy patients receiving polytherapy.

PURPOSE: Although sleep disturbances are common in epilepsy, few studies examined the prevalence and impact of sleep disturbance in epilepsy patients. This study investigates these in a cross-sectional survey. METHODS: We surveyed 201 adult partial-onset epilepsy patients taking stable regimens of two or more antiepileptic medications. Community-based U.S. neurologists recorded patient demographic and clinical information. Patients completed the Medical Outcomes Study (MOS) Sleep Scale, the Quality of Life in Epilepsy-10 instrument (QOLIE-10), and the EuroQol-5D (EQ-5D). We evaluated the associations of sleep with health-related quality of life and clinical and demographic characteristics by using correlation coefficients and analysis of variance. RESULTS: Mean (SD) age was 44.2 (12.5); 34% of patients had diagnosed sleep disturbances; 10% received prescription sleep medications. Patients with sleep disturbance reported poorer mean QOLIE-10 (55.2 vs. 63.7; p = 0.006) and EQ-5D (0.49 vs. 0.71; p < 0.001) scores relative to those without sleep disturbances. The mean (SD) MOS Sleep Problems Index score was 36.2 (20.8), worse than the general population mean of 26. Patients with physician-reported anxiety or depression had more sleep problems than did those without these comorbidities. Higher Sleep Problems Index scores were significantly (p < 0.001) correlated with poorer QOLIE-10 (r=-0.49) and EQ-5D (r=-0.56) scores. Patients experiencing a seizure within the past week reported higher MOS Sleep Problems Index scores than did those with a less-recent seizure (41.5 vs. 32.8; p = 0.003). CONCLUSIONS: Diagnosed and self-reported sleep disturbances in patients with partial-onset epilepsy are frequently overlooked, but are negatively associated with everyday functioning and well-being, and therefore contribute significantly to the burden of epilepsy.

Adult↗
PubMed2005

Effects of levetiracetam on sleep in normal volunteers.

BACKGROUND: Epilepsy patients commonly suffer from sleep disturbances, and these can exacerbate memory dysfunction and seizures. Sleep can be affected by seizures, independent sleep disorders, or anticonvulsant drugs. Levetiracetam is a novel anticonvulsant effective for the treatment of partial seizures. We studied the effects of levetiracetam (LEV) on sleep using polysomnography in normal subjects. METHODS: Subjects (aged 18-40) were screened for freedom from sleep disorders, excessive daytime sleepiness, and depression. Screening overnight polysomnography was performed, followed by baseline polysomnography. Subjects were randomized to placebo or LEV, titrated to 1000 mg twice daily over 9 days. Polysomnography was repeated on Treatment Day 28. Differences between baseline and treatment in the drug and placebo groups were compared using single-factor ANOVA. RESULTS: Seventeen subjects were enrolled; 14 completed the study (8 placebo, 6 LEV). All subjects who remained on LEV were able to tolerate the target dose. There were no significant differences between the placebo and drug groups with respect to baseline sleep characteristics. When baseline polysomnography was compared with treatment polysomnography, there were no differences in the change in sleep efficiency, sleep latency, total sleep time, REM latency, or percentages of REM, stage 1, stage 2, or slow wave sleep. There was an increase in the number of awakenings in the drug group that was significant compared with placebo. CONCLUSION: These results suggest that LEV does not have major effects on sleep structure.

Adolescent↗
PubMed2005

Epilepsy and common comorbidities: improving the outpatient epilepsy encounter.

Epilepsy is a chronic disorder that has been associated with other specific health problems. Evidence from recent clinical and basic investigations indicates that aspects of cerebral dysfunction associated with a lowered seizure threshold may also predispose toward other disorders such as depression, cognitive impairment, sleep disorders, and migraine. Similarly, certain types of brain injury may also increase the risk of adverse antiepileptic drug (AED) effects. For example, a history of febrile seizures is associated with a three fold increase in the occurrence of negative psychiatric effects of two newer AEDs. Poor fitness and obesity are also reported at higher rates in epilepsy. Some comorbid conditions in epilepsy, such a depression and anxiety, may have a greater influence on subjective health status than does seizure rate. Management strategies employed in the outpatient clinic to maximize overall health outcomes should include screening and treatment for the commonly coexistent conditions in persons with epilepsy.

Comorbidity↗
PubMed2004

Nocturnal seizures.

As a subset of epilepsy, nocturnal seizures amplify one of the major problems of epilepsy in general: episodes are less likely to be directly witnessed than daytime seizures, and therefore diagnosis and characterization are more difficult. As a sleep problem, nocturnal seizures are not benign, and the resulting sleep disruption can cause daytime somnolence and concentration difficulty. This article outlines three major topics in nocturnal seizures: differential diagnosis (distinguishing between seizures and parasomnias), the effects of nocturnal seizures on sleep structure, and specific syndromes of primarily or exclusively nocturnal seizures.

Diagnosis, Differential↗
PubMed2004

Comprehensive care of the epilepsy patient--control, comorbidity, and cost.

Traditionally, control of seizures in patients with epilepsy is viewed as the most important clinical outcome. Yet, current antiepileptic drugs (AEDs) do not always achieve this. Around 30-40% of patients remain uncontrolled despite pharmacological intervention. Poor tolerability of AEDs is a large part of the problem and contributes as much to the overall effectiveness of therapy as efficacy. Comorbid conditions are present in many patients, and appropriate management of these can further improve seizure control and quality of life. Patients with epilepsy often experience--among other disorders--neuropsychological effects, migraines, and psychological problems (especially anxiety and depression). Sleep disturbances are also common and have been shown to contribute to the intractability of seizures in some patients. Many anticonvulsant treatments have the potential to improve--or in some cases worsen--these concurrent conditions, and these properties should therefore be considered in the total care of the patient. Finally, the costs of uncontrolled epilepsy are measured not only in terms of direct healthcare-related costs, but also in terms of lost productivity and opportunity. The indirect costs of epilepsy are substantial and account for 70-85% of total disease-related costs. Patients with uncontrolled seizures contribute disproportionately to healthcare costs, reinforcing the need for the development of newer AEDs with improved profiles of efficacy and tolerability, but with minimal adverse effects on behavior, cognition, and sleep.

Anticonvulsants↗
PubMed2003

Sleep-related epilepsy.

Sleep is important for the general health of all, but is particularly essential for individuals with epilepsy. In these patients, a complex relationship exists between seizures and sleep, and both must be considered for optimal care. In this review, recent advances in the field of epilepsy and sleep are considered. These include sleep disorders with a specific relationship to epilepsy, the influences of sleep and sleep deprivation on interictal epileptiform discharges, detrimental effects of seizures on sleep, and the effects (good and bad) of epilepsy treatments on sleep.

Anticonvulsants↗
PubMed2003

Epilepsy and sleep disturbance.

Sleep disturbance is common in epilepsy, the nature of sleep disturbances in epilepsy is diverse, and the etiologies are complex. Evidence suggests that having epilepsy and the occurrence of seizures, as well as some AEDs, are associated with significant sleep disruption. The occurrence of seizures can have profound effects on sleep architecture lasting much longer than the postictal period. Persistent daytime drowsiness in patients with epilepsy is not always due to the side effects of some AEDs and may be independently linked with sleep fragmentation. Significant sleep disruption in epilepsy has been associated with impaired quality of life and impaired seizure control. All aspects of sleep medicine are important in the management of epilepsy and are confounded by the occurrence of seizures, the location of seizures, and the beneficial and detrimental effects of AEDs. Sleep should be proactively evaluated, and sleep disturbances should be treated as part of the total care of patients with epilepsy.

Anticonvulsants↗
PubMed2003

Effects of antiepileptic drugs on sleep architecture: a pilot study.

OBJECTIVES: The effects of antiepileptic drugs (AEDs) on sleep architecture are not well understood, especially in patients with localization-related epilepsy, in whom seizures themselves can disrupt sleep. To clarify the effects of AEDs on sleep architecture, we performed a prospective study, looking at sleep architecture in patients with epilepsy admitted for video-EEG monitoring. METHODS: Adult patients with localization-related epilepsy treated with a single AED and admitted between 10/1997 and 04/2001 were included. Control patients on no AEDs were also included. Both groups were withdrawn from other AEDs. Overnight polysomnography was recorded and was scored according to the standard method. Adult patients with localization-related epilepsy on no medication were also recorded and served as controls. Patients with no seizure during the recording and no seizure in the 24 h preceding the recording were analyzed in this paper. Patients with a seizure in the 24 h preceding the recording and patients with a seizure during the recording were analyzed separately. RESULTS: A total of 72 nights were recorded in 39 patients, and patients taking each AED were compared to controls. We did not find any statistically significant effect of carbamazepine (CBZ). Phenytoin (PHT) disrupted sleep by increasing stage 1 sleep (PHT: 13.2+/-7.3%; control: 7.7+/-4.8%; P=0.008), and decreasing slow wave sleep (SWS) (PHT: 7.9+/-4.2%; control: 11.3+/-4.4%; P=0.03) and REM sleep (PHT: 13.9+/-6.2; control: 18.8+/-5.1; P=0.01). Valproic acid (VPA) disrupted sleep by increasing stage 1 sleep (VPA: 16.8+/-9.8%; control: 7.7+/-4.8%; P=0.007). Gabapentin (GBP) improved sleep by increasing SWS (GBP: 19.4+/-4.2%; control: 11.3+/-4.4%; P=0.0009). PHT and VPA disrupt sleep in the absence of seizures, while CBZ and lamotrigine have no significant effects. GBP improves sleep by increasing SWS. CONCLUSIONS: AEDs have differing effects on sleep structure, which can be beneficial or detrimental. Consideration of these potential effects is important in maintaining optimal sleep in patients with epilepsy.

Adult↗
PubMed2003

Sleep structure in patients with psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures (PNES) are a significant public health problem, occurring in perhaps 25% of patients admitted to epilepsy monitoring units. Additional distinguishing characteristics for these patients would be helpful from both a clinical and a scientific standpoint. This study examines sleep structure by polysomnography in patients with PNES compared with patients with epileptic seizures (ES). ES and PNES were verified by video-EEG monitoring. All patients with PNES were evaluated by a psychiatrist. Eight female patients with PNES were compared with 10 female ES patients in the same age group. Percentage REM sleep was significantly greater for women with PNES (23+/-1%) than for those with ES (18+/-1%). There were no differences in other sleep stages, total sleep time, or sleep efficiency. REM latency was less in PNES patients although not significantly. The study suggests that patients with PNES have a sleep architecture similar to that found in major depression, known to be associated with increased REM sleep.

Adolescent↗
PubMed2003

The multicenter study of epilepsy surgery: recruitment and selection for surgery.

PURPOSE: Multiple studies have examined predictors of seizure outcomes after epilepsy surgery. Most are single-center series with limited sample size. Little information is available about the selection process for surgery and, in particular, the proportion of patients who ultimately have surgery and the characteristics that identify those who do versus those who do not. Such information is necessary for providing the epidemiologic and clinical context in which epilepsy surgery is currently performed in the United States and in other developed countries. METHODS: An observational cohort of 565 surgical candidates was prospectively recruited from June 1996 through January 2001 at six Northeastern and one Midwestern surgical centers. Standardized eligibility criteria and protocol for presurgical evaluations were used at all seven sites. RESULTS: Three hundred ninety-six (70%) study subjects had resective surgery. Clinical factors such as a well-localized magnetic resonance imaging (MRI) abnormality and consistently localized EEG findings were most strongly associated with having surgery. Of those who underwent intracranial monitoring (189, 34%), 85% went on to have surgery. Race/ethnicity and marital status were marginally associated with having surgery. Age, education, and employment status were not. Demographic factors had little influence over the surgical decision. More than half of the patients had intractable epilepsy for >/=10 years and five or more drugs had failed by the time they initiated their surgical evaluation. During the recruitment period, eight new antiepileptic drugs were approved by the Food and Drug Administration for use in the United States and came into increasing use in this study's surgical candidates. Despite the increased availability of new therapeutic options, the proportion that had surgery each year did not fluctuate significantly from year to year. This suggests that, in this group of patients, the new drugs did not provide a substantial therapeutic benefit. CONCLUSIONS: Up to 30% of patients who undergo presurgical evaluations for resective epilepsy surgery ultimately do not have this form of surgery. This is a group whose needs are not currently met by available therapies and procedures. Lack of clear localizing evidence appears to be the main reason for not having surgery. To the extent that these data can address the question, they suggest that repeated attempts to control intractable epilepsy with new drugs will not result in sustained seizure control, and eligible patients will proceed to surgery eventually. This is consistent with recent arguments to consider surgery earlier rather than later in the course of epilepsy. Postsurgical follow-up of this group will permit a detailed analysis of presurgical factors that predict the best and worst seizure outcomes.

Adolescent↗
PubMed2003

Effects of antiepileptic drugs on sleep structure : are all drugs equal?

Good-quality sleep is an important and frequently overlooked component of general health, but it is particularly essential to patients with epilepsy. Their sleep can be affected by seizures, concurrent sleep disorders and seizure treatment. Worsening sleep can result not only in poor daytime functioning but also potentially in worsening epilepsy. The effects of antiepileptic drugs (AEDs) on sleep are of particular concern. Some agents have detrimental effects on sleep, particularly benzodiazepines and barbiturates but also phenytoin and, possibly, carbamazepine. Others, especially gabapentin, seem to actually improve sleep quality. Much research in this area is confounded by the effects of seizures and concurrent conditions on sleep, making it difficult to isolate the direct effects of AEDs on sleep. But because AEDs have independent effects on sleep quality, the choice of an appropriate agent not only determines whether seizures are completely controlled but also whether the patient performs optimally on a daily basis.

Anticonvulsants↗
PubMed2002

Levetiracetam may be more effective for late-onset partial epilepsy.

BACKGROUND: Many agents are available for treating epilepsy; however, population studies have failed to show overall differences in efficacy for a given seizure type. Clinical experience suggests that certain individuals will respond to a given agent while others with the same seizure type will not. OBJECTIVES: To examine a population of patients who received one of the newer antiepileptic drugs, levetiracetam, and to identify those who had either a dramatic improvement or a significant worsening of seizures. METHODS: Retrospective medical record review of patients with refractory epilepsy. RESULTS: Patients who responded well to levetiracetam therapy were older at the onset of epileptic seizure than those who did not (mean [SD] age, 51 [5] vs 27 [3] years; P<.05). This was also true of the subset of patients who had localization-related epilepsy. Patients with temporal lobe onset were likely to do well whereas patients with frontal lobe onset were not. CONCLUSIONS: These results suggest that certain subpopulations may be particularly likely to respond to levetiracetam therapy. These need to be confirmed in a larger prospective trial; however, looking for specific characteristics of patients who respond to certain drugs may lead to useful guidelines for drug choices in treating epilepsy.

Adult↗
PubMed2002

Interrater reliability among epilepsy centers: multicenter study of epilepsy surgery.

PURPOSE: To measure the interrater reliability of presurgical testing and surgical decisions among epilepsy centers. METHODS: Seven centers participating in an ongoing, prospective multicenter study of resective epilepsy surgery agreed to conform to a detailed protocol regarding presurgical evaluation and surgery. To assess quality assurance, each center independently reviewed 21 randomly selected surgical cases for preoperative study lateralization and localization, and surgical decisions. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), validated for use with multiple raters, and calculated in a two-way random model based on absolute agreement. RESULTS: Agreement for ICC values: > or = 0.75, excellent; 0.60-0.74, good; 0.40-0.59, fair; < or = 0.39, poor. One center was excluded for missing data. Agreement was excellent for extracranial EEG lateralization (0.8039), magnetic resonance imaging (MRI) lateralization (0.9521) and localization (0.9130), Wada lateralization (0.9453), and intracranial EEG localization (0.7905). Agreement was good for extracranial EEG localization (0.7384) and neuropsychological testing lateralization (0.7178) and localization (0.6891). Consensus about the decision to perform intracranial monitoring was fair (0.5397), in part reflecting one center's tendency toward intracranial monitoring. Overall agreements on whether to perform surgery (0.8311) and specific surgery recommended (0.8164) were excellent. CONCLUSIONS: High interrater reliability among six epilepsy centers was present for interpretation of most components of presurgical testing. Although consensus for the decision to perform intracranial monitoring was only fair, agreements for the ultimate decision about resective surgery and specific choice of resection were excellent. We believe that this study demonstrates the feasibility of implementing multicenter protocols for neurologic management, especially those involving localization, as well as protocols combining study results with clinical decision making.

Electroencephalography↗