PubMed Health⌕ Search

Biomedical subjects

Eylert Brodtkorb

Publications and source records attributed to Eylert Brodtkorb.

At least 19 recordsLinked to original sources
PubMed2006

Optimizing therapy of seizures in adult patients with psychiatric comorbidity.

This article provides an overview of appropriate antiepileptic treatment in adult patients with chronic epilepsy and concomitant psychiatric disorders. It highlights the influence of various treatment options for epilepsy on psychiatric symptoms. Six specific topics are discussed: psychosocial aspects and treatment compliance; positive and negative psychotropic effects of antiepileptic drugs (AEDs); pharmacokinetic and pharmacodynamic interactions between AEDs and psychoactive drugs; risks and benefits of resective surgery; the effect of vagal nerve stimulation; and recommended strategies for optimizing epilepsy therapy in patients with psychiatric disorders. Given the multitude of epilepsy treatment options with various CNS effects, it is crucial to select treatments according to the clinical profile of each individual patient.

Adult↗
PubMed2006

[Epilepsy and pregnancy--drug use, seizure control, and complications].

BACKGROUND: There is insufficient knowledge about the effect of epilepsy and epilepsy treatment on pregnancy, and vice versa. The European Registry of Antiepileptic drugs and Pregnancy (EURAP) was therefore established in 1999. We here present the results from the Norwegian part of the study, with emphasis on attack control, use of antiepileptics and folate, presence of status epilepticus, attacks in connection with birth and complications in the pregnancy. MATERIAL AND METHOD: The study is prospective and observational. The women are offered 5 consultations, 3 during pregnancy and 2 after birth. RESULTS: As of September 2005, 296 pregnancies in 263 Norwegian women were included. In 220 pregnancies (74 %), the women were treated with a single antiepileptic drug, most often carbamazepine. In 187 pregnancies (63 %), the women were seizure free. In those with seizures, 17 % had an increase in seizure frequency during pregnancy and 15 % had a decrease. Convulsive status epilepticus associated with delivery occurred in 1 % of the women and seizures associated with the delivery in 2.7 %. The consequences for the mother and the child were not as serious as previously reported. The frequency of complications during pregnancy and the sectio rate did not differ significantly from the average population. INTERPRETATION: Most women with epilepsy go through pregnancy and delivery without complications. Specialists should only follow up those with a suboptimal seizure control. The slightly increased teratogenic risk can be reduced by giving these women extra folate before the conception.

Adolescent↗
PubMed2006

Tobacco habits modulate autosomal dominant nocturnal frontal lobe epilepsy.

Mutations in neuronal nicotinic acetylcholine receptors have been demonstrated in autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). The beneficial effect of nicotine administration was previously reported in one single case. We investigated the influence of the tobacco habits of 22 subjects from two pedigrees with alpha4 mutations (776ins3 and S248F). Subjects were interviewed with respect to pattern of nicotine intake and seizures. Seizure freedom was significantly associated with tobacco use (P=0.024). All seven nonsmokers with manifest ADNFLE had persistent seizures. Seizure fluctuations, including long remissions, corresponded to changes in tobacco habits in several patients. One patient who recently had begun treatment with transdermal nicotine experienced improvement. We conclude that tobacco appears to be an environmental factor that influences seizure susceptibility in ADNFLE. Inactivation by desensitization of the mutant receptors by nicotine may explain the beneficial effect. The efficacy and safety of transdermal nicotine in ADNFLE should be further explored.

Administration, Cutaneous↗
PubMed2006

[Autoimmune epilepsy].

Explore the source record for details and available documents.

Autoimmune Diseases of the Nervous System↗
PubMed2005

A structured, nurse-led intervention program improves quality of life in patients with epilepsy: a randomized, controlled trial.

We tested the hypothesis that structured epilepsy nursing improves quality of life (QOL). One hundred fourteen adult patients with uncontrolled epilepsy were randomly assigned to either an intervention group or a control group. The intervention group was offered an interactive, 1-day group education program followed by extended nurse follow-up and counseling. The nurse was present at as many outpatient consultations as possible and performed repeated consultations by telephone. All patients completed the QOLIE-89 before randomization and after 2 years. QOL was significantly improved from inclusion to completion of study in the intervention group (P=0.019), mainly in the subitems for Health Discouragement (P=0.01), Medication Effects (P=0.035), and Physical Role Limitations (P=0.05). To our knowledge, this is the first study to demonstrate a significant effect of a structured nurse-led intervention program in QOL of patients with epilepsy.

Adolescent↗
PubMed2005

Asymmetry of long-latency auditory evoked potentials in LGI1-related autosomal dominant lateral temporal lobe epilepsy.

PURPOSE: To investigate auditory processing with cortical long-latency auditory evoked potentials (AEPs) in patients with autosomal dominant lateral temporal lobe epilepsy (ADTLE). METHODS: Eight patients with LGI1-related ADTLE belonging to a family with predominantly aphasic seizures were studied. Sixty-five individuals without epilepsy served as controls. AEPs (N1-P2 amplitudes) to binaural tones were recorded over the left and the right hemispheres. Brainstem auditory evoked potentials (BAEPs) to monaural rarefaction clicks also were analyzed. Group differences were statistically assessed with Student's t test and repeated-measures analysis of variance. RESULTS: Left N1-P2 AEP amplitudes were moderately reduced in ADTLE patients (p = 0.005). No group differences in BAEP were found, indicating unaffected cochlear system and auditory brainstem pathways. CONCLUSIONS: A moderate, but highly significant reduction in N1-P2 AEP amplitudes over the left hemisphere was demonstrated in patients with ADTLE. This finding corresponds to the cardinal symptom of aphasia in this family, and also to the generally prevailing left-sided EEG abnormalities in this condition. The background for this electrophysiologic lateralization in LGI1-related epilepsy is unknown. It may be related to a specific function of LGI1 in the dominant hemisphere.

Acoustic Stimulation↗
PubMed2005

Ethinyl estradiol, not progestogens, reduces lamotrigine serum concentrations.

PURPOSE: To study the interaction between lamotrigine (LTG) and hormonal contraception. METHODS: LTG serum concentrations of female patients using either no hormonal contraception (n=18), an ethinyl estradiol (EE)-containing (n=11), or a progestogen (PG)-only-containing compound (n=16) were analyzed. Patients were recruited prospectively, and blood samples were drawn during drug fasting and at steady-state conditions. Comedication with enzyme inducers, valproate, topiramate, or sertraline was not allowed. Some patients changed groups and thus served as their own controls. Samples were analyzed by a gas chromatography/ mass spectroscopy method. The Mann-Whitney U test was used for statistical comparison of the groups. RESULTS: The LTG serum concentration-to-dose ratio (CDR), expressed as (mg/L)/(mg/d) was significantly lower in women using EE than in the control group (mean+/-SD, 0.010+/-0.004 vs. 0.017+/-0.006; p=0.003). The CDR in women using PG was 0.02+/-0.007, which was not statistically different from controls. No difference was found in CDR between women using either oral, topical, or parenteral PG. Five women switched from the control to the EE group and experienced a considerable reduction in CDR. An increase of the CDR toward control level was seen in the two women who changed from EE to PG. CONCLUSIONS: It is the EE component of oral contraceptives that interacts with LTG. The PG-only compounds did not alter LTG serum concentrations in this study. These findings should be considered when counselling women with epilepsy in the childbearing ages.

Anticonvulsants↗
PubMed2005

Speech-induced aphasic seizures in epilepsy caused by LGI1 mutation.

PURPOSE: Patients with autosomal dominant lateral temporal lobe epilepsy (ADTLE) may have seizures precipitated by sound or speech. We have examined a patient with speech-induced seizures caused by an LGI1 mutation (C46R). METHODS: A clinical study and a video-EEG recording using interrogative speech as the activation procedure was performed in a 23-year-old man. RESULTS: He had experienced short episodes of sensory aphasia in situations in which he was suddenly verbally addressed. Voices became distorted, and he could not comprehend despite hearing words. The day after a late party, his girlfriend unexpectedly spoke to him. Her speech became unintelligible to him. He did not reply and had a generalized tonic-clonic (GTC) seizure. During an EEG, he was suddenly asked for the names of his siblings. He answered, but lost understanding of the further conversation and described how syllables floated together with an echoing character. With a versive movement to the right, another GTC occurred. In the EEG, rhythmic 6-Hz activity built up in the frontotemporal areas starting on the left side with bilateral and posterior spreading. Postictal slowing was symmetrical, and no aphasia was noted on awakening. CONCLUSIONS: To our knowledge, this is the first video-EEG recorded seizure in LGI1-caused ADTLE. This peculiar seizure semiology and precipitating effect of speech may serve as a marker for identifying further individuals with this particular phenotype and genotype and may indicate that the LGI1 gene may have a physiologic function connected to the human capacity for speech and language.

Acoustic Stimulation↗
PubMed2005

Levetiracetam concentrations in serum and in breast milk at birth and during lactation.

PURPOSE: To study the pharmacokinetics of levetiracetam (LEV) at birth, during lactation, and in the nursed infant. METHODS: Eight consecutive breast-feeding women with epilepsy treated with LEV twice daily and their infants were studied. RESULTS: The mean umbilical cord serum/maternal serum ratio was 1.14 (range, 0.97-1.45) (n = 4). The mean milk/maternal serum concentration ratio was 1.00 (range, 0.76-1.33) at 3 to 5 days after delivery (n = 7). At sampling 2 weeks to 10 months after delivery (n = 5), it was similar (range, 0.85-1.38). At 3 to 5 days after delivery, the infants had very low LEV serum concentrations (<10-15 microM), a finding that persisted during continued breast-feeding. No malformations were detected, and in none of the infants did signs of adverse effects develop. CONCLUSIONS: Our data indicate an extensive transfer of LEV from mother to fetus and into breast milk. However, breast-fed infants had very low LEV serum concentrations, suggesting a rapid elimination of LEV.

Anticonvulsants↗
PubMed2004

[Disagreement about epilepsy and driving].

BACKGROUND: To find out how current regulations concerning epilepsy and driving licence are applied in clinical practice in Norway. MATERIAL AND METHODS: A questionnaire was sent to all 344 members of the Norwegian Neurological Association. RESULTS: 56% responded within 3 months, most of them (152) working in the field of clinical neurology. The majority (73%) did not see reporting a "situation-related" seizure to the authorities as obligatory, but almost all of these respondents (94%) would temporarily disallow driving. 60% did not consider it obligatory to report the exclusive occurrence of simple partial seizures with retained consciousness and motor control. A surprisingly large number (36%) would never recommend dispensation from the rule instituting a one-year driving ban. 39% generally used EEG in the assessment of driving fitness, whereas 17 % rarely did so. Only 50% instructed their patients not to drive during antiepileptic drug withdrawal. 45% did not consider seizure recurrence resulting from consented withdrawal to activate the obligation to report. CONCLUSION: There is poor consensus among neurologists on many aspects of driving and epilepsy, particularly on the assessment of risk when drugs are withdrawn. These issues should be focused on in graduate and postgraduate education in clinical neurology.

Anticonvulsants↗
PubMed2004

Levetiracetam in adult patients with and without learning disability: focus on behavioral adverse effects.

Optimal antiepileptic drug treatment in patients with learning disability (LD) represents a particular challenge. These patients are often unable to report toxicity, and side effects may manifest as behavioral problems. The aim of this open study was to compare efficacy and tolerability of levetiracetam (LEV) in patients with LD and those without LD. One hundred eighty-four consecutive adult patients who received LEV were followed for an average of 8.1 months. Fifty-six patients (30%) had LD. Thirty-nine percent of patients with refractory epilepsy (37% with and 40% without LD) had > 50% seizure reduction. Significantly more behavioral side effects (23% vs 10%) and a tendency toward less reported somatic central nervous side effects were found in the LD group. We conclude that LEV is equally effective and well tolerated in both patients with LD and patients without LD. However, behavioral problems are more frequent in patients with LD, whereas the tendency toward seizure increase is not enhanced.

Adolescent↗
PubMed2003

[Levetiracetam in the treatment of epilepsy].

BACKGROUND: A proportion of patients with epilepsy are still without seizure control. This open study aims to evaluate the effect and tolerability in consecutive patients treated with the new antiepileptic drug levetiracetam. MATERIALS AND METHODS: 184 adult patients were followed up for an average period of 8.1 months. 166 patients (90%) had refractory epilepsy, defined as having seizures more than once a month despite having tried at least two antiepileptic drugs. RESULTS: 64 (39%) of the patients with refractory epilepsy had at least a 50% reduction of seizure frequency. Of these, 16 (10%) became seizure free. 24 (15%) had at least a 25% increase in seizure frequency. The overall effect was not significantly different for patients with and without learning disability. Levetiracetam also had promising effects in patients with juvenile myoclonic epilepsy and Lennox-Gastaut syndrome. Side effects were reported by 88 (44%) of all patients. Only 10 (5%) discontinued levetiracetam because of side effects. Behavioural effects were more frequent in patients with learning disability. INTERPRETATION: Levetiracetam was well tolerated and effective as add-on treatment in partial and generalised seizures. Some patients experienced an increase in seizure. A possible favourable pharmacodynamic interaction between levetiracetam and carbamazepine should be further explored.

Adolescent↗
PubMed2003

No evidence for a seriously increased malignancy risk in LGI1-caused epilepsy.

The Leucine-rich Glioma Inactivated-1 (LGI1) gene is supposed to be a tumor suppressor gene involved in glial tumors. Mutations in this gene were recently found to cause autosomal dominant lateral temporal lobe epilepsy (ADLTE). We have now analysed the comorbidity in a large Norwegian ADLTE family. No evidence was found that LGI1 is a high-penetrance tumor suppressor gene associated with a serious risk for malignancies in ADLTE families.

Adult↗
PubMed2003

Partial epilepsy with "ecstatic" seizures.

Reports focusing on auras of ecstasy or pleasure have been limited largely to single case descriptions. We examined 11 consecutive patients with such ictal symptoms. Eight had sensory hallucinations, four had erotic sensations, five described "a religious/spiritual experience," and several had symptoms that were felt to have no counterpart in human experience. Ictal EEG recordings were performed in four patients; two had seizure onset in the right temporal lobe and two in the left. In seven the onset could not be definitely localized. The diagnosis of epilepsy was often delayed. Eight patients wished to experience seizures; self-induction was possible in five and four showed treatment noncompliance. In patients with insufficient drug intake, in whom good compliance should be expected, it is relevant to consider seizures with pleasant symptomatology. According to the literature, experiential and ecstatic seizures seem to have had a substantial impact on our cultural and religious history.

Adult↗
PubMed2003

An easily performed group education programme for patients with uncontrolled epilepsy--a pilot study.

The factual knowledge of epilepsy is often insufficient among patients with this disorder. Compliance problems due to ignorance are common, and counselling is extremely important. We have developed a simple 1-day, low-cost group education programme for patients with epilepsy, intended to be suitable in routine care. The programme aims to help patients to achieve an improved understanding of the disorder and was carried out for a total of 54 consecutive patients with at least one seizure during the last year. This hospital-based 6-hour interactive course is organised by an epilepsy nurse and contains the following elements: basic knowledge about epilepsy, living with epilepsy, visit to the EEG lab, social security system and medical treatment. It was evaluated by means of a semi-structured interview and was found generally useful by all the participants. Sixty-five percent considered the sharing of experience with other patients to be the most valuable element. The ideal group size was found to be six to eight. Heterogeneity concerning age, sex and competence seemed to increase the interaction within the groups. This pilot study indicates that group education may be a useful approach in the clinic.

Adolescent↗
PubMed2003

Schizophrenia, psychotic illness and other psychiatric symptoms in families with autosomal dominant nocturnal frontal lobe epilepsy caused by different mutations.

OBJECTIVES: Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is characterized by a strong family history of epileptic seizures, which predominantly occur during sleep. ADNFLE has been associated with mutations in two genes coding for the nicotinic acetylcholine receptor (CHRNA4 and CHRNB2). Thus far, three different mutations have been detected in the CHRNA4 gene, and two in the CHRNB2 gene. The aim of this study was to compare the frequency of psychiatric disorders in two ADNFLE families with different CHRNA4 mutations (776ins3 and Ser248Phe). METHODS: Information was gathered from hospital charts and therapists, and the family members were assessed by clinical interviews and structured clinical interviews. RESULTS: Of the 10 individuals diagnosed with epilepsy in the CHRNA4-776ins3 family, at least four had been in contact with psychiatric services. One individual had schizophrenia, while another family member had experienced at least two severe psychotic episodes, and had been taking antipsychotic medications for years. The third family member had been hospitalized at least three times for psychiatric problems. The fourth family member needs help with activities of daily living due to incapacitating apathy, although she does not have a psychiatric diagnosis. Such accumulation of psychiatric problems was not seen in the family with the Ser248Phe mutation. CONCLUSION: These findings suggest that there may be an association between the 776ins3 mutation and the psychiatric symptoms, a hypothesis that needs further testing.

Epilepsy, Frontal Lobe↗