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Biomedical subjects

K O Nakken

Publications and source records attributed to K O Nakken.

At least 19 recordsLinked to original sources
PubMed2005

Coeliac disease, unilateral occipital calcifications, and drug-resistant epilepsy: successful lesionectomy.

PURPOSE: To draw attention to the triad of coeliac disease (CD), occipital calcifications, and drug-resistant epilepsy, with focus on the outcome of epilepsy surgery. METHODS: We describe a male patient who despite a diagnosis of CD from the age of 9 did not comply with the gluten-free diet. At the age of 11 he developed simple and complex partial seizures with visual symptoms, anxiety, and ambulatory automatisms. His epilepsy appeared to be drug resistant, and after having tried nine antiepileptic drugs (AEDs), alone or in combinations, he underwent a presurgical evaluation at the age of 30. Interictal standard electroencephalograms (EEGs) disclosed frequent biparieto-occipital epileptiform discharges. Computed tomography showed cortical-subcortical punctate calcifications in the right parieto-occipital region, where his seizures seemed to start, according to ictal EEG registrations from intracranial strip electrodes. RESULTS: At the age of 31 he underwent epilepsy surgery. A 5 x 6 cm large area of the right parieto-occipital region was resected, including the area with calcifications. Except for a few short-lasting episodes of anxiety (simple partial seizures?) he has now been seizure-free for 12 years. AEDs were withdrawn 5 years ago. Postoperatively he was left with an upper left-sided quadrant anopsia, which is not bothering him. CONCLUSIONS: In patients with CD, unilateral occipital calcifications, and drug-resistant epilepsy, epilepsy surgery should be considered, as a lesionectomy might be very successful.

Adult↗
PubMed2003

The ideal characteristics of antiepileptic therapy: an overview of old and new AEDs.

New and improved anti-epileptic drugs (AEDs) have made the concept of choice, according to the individual prognosis and probable response to specific regimens, increasingly feasible. Inter-individual variability in syndrome severity and complexity make individualization necessary. We propose three categories of disorder control according to the individual objectives of the patient: (1) seizure control, (2) epilepsy control and ultimately, (3) "epilepsy cure"; the latter remaining a largely idealistic target today. An AED is likely to be successful if it exhibits "optimal" characteristics, such as drug efficacy, tolerability, pharmacokinetics, interactions and cost-effectiveness. This review discusses the "optimal" characteristics of add-on AEDs, which, in addition to seizure control, will contribute to the achievement of epilepsy control and therefore address the currently unmet clinical needs of epilepsy treatment.

Anticonvulsants↗
PubMed2001

[Chronic intermittent vagal nerve stimulation--a new therapeutic approach in epilepsy].

BACKGROUND: Vagal nerve stimulation is a new non-pharmacological therapy for patients with refractory epilepsy. Introduced in USA in 1988, the treatment is based on animal experiments demonstrating that intermittent stimulation of the vagal nerve could prevent or reduce the frequency and/or duration of seizures. MATERIAL AND METHODS: At the National Hospital in Norway, 47 therapy-resistant patients have had a vagal nerve stimulator implanted since June 1993. We have used the Neuro-Cybernetic Prosthesis system from Cyberonics, consisting of a programmable pulse generator, a bipolar vagal nerve stimulator lead, a programming wand with accompanying software, and a hand-held magnet. The mean age of the population was 34.4 years (12-70 years). All had a long-standing epilepsy with frequent seizures, 36 (77%) had seizures every day. The majority (89%) had localization-related epilepsy. Mean follow-up time was 2.7 years (0.4-6.5 years). RESULTS: 16 patients (34%) responded to the treatment with > 50% reduction in seizure frequency. No one, however, became seizure free. 20 patients (43%) had no seizure reduction. 24 of the patients (51%) benefited from extra stimulation triggered by the magnet. The stimulation affected several types of seizures; most often a reduction in frequency of secondary generalised tonic-clonic seizures was noted. Hoarseness, coughing and a tingling sensation in the throat were the most frequently reported side effects occurring during stimulation. The patients tended to habituate to these side effects. In 14 patients (30%), the device has been explanted, mostly due to lack of efficacy. INTERPRETATION: Considering the fact that this patient group belongs to the most refractory part of the epilepsy population, the results are regarded as promising and they are in keeping with results from other studies. However, the role of vagal nerve stimulation in the future treatment of epilepsy is still not settled. Several questions remain unanswered, e.g. what are the exact mechanisms of action behind the seizure reducing effect, and which patients are most suitable for this treatment?

Adolescent↗
PubMed2000

[Should people with epilepsy exercise?].

Many people with epilepsy, especially those with uncontrolled seizures, live a sedentary life and have low physical fitness. Regular physical exercise may have a moderate seizure preventive effect in 30-40% of the patient population, while in about 10%, strenuous exercise may provoke seizures. Among those prone to exercise-induced seizures there is a preponderance of patients with very poor physical fitness and symptomatic epilepsy. The underlying mechanisms of interaction between epilepsy and physical exercise are mainly unknown. As a general rule, people with epilepsy should be stimulated to participate in recreational and athletic activities. However, as this patient group is highly heterogeneous, counselling on this topic should be individualised and take into account both seizure type and frequency. A distinction may be drawn between three categories: activities with no restrictions, activities with some restrictions, and activities that are not advisable.

Epilepsy↗
PubMed2000

[Hidden motor dysfunctions in children with epilepsy].

BACKGROUND: At the National Center for Epilepsy, many years of clinical experience with children with difficult-to treat epilepsy has left the impression that many of these children may have motor difficulties in addition to their seizures. The aim of this prospective, uncontrolled study was to investigate if this impression could be confirmed. MATERIAL AND METHODS: In 41 children with "epilepsy only", i.e. without mental retardation or cerebral palsy, their motor performance was evaluated by means of the ABC test (Movement Assessment Battery for Children). RESULTS: More than half of the children had test results consistent with motor difficulties. The motor problems were most pronounced among those with MRI-detectable brain lesions and symptomatic localisation-related epilepsy. Gender, type and number of antiepileptic drugs or seizure frequency did not influence the test results. INTERPRETATION: Hidden motor dysfunctions, which may be caused by the aetiology of the epilepsy, the epilepsy itself, or the epilepsy treatment may easily be overlooked and may represent an extra burden for the children both at school and in their leisure time. We recommend that motor function should be tested in children with severe epilepsy as part of a comprehensive multiprofessional evaluation. Those with poor motor performance should be offered sensory motor stimulation.

Adolescent↗
PubMed2000

[Topiramate--a new antiepileptic agents].

BACKGROUND: Topiramate is a novel antiepileptic drug that was licensed in Norway in 1997 as adjunctive treatment for patients with partial seizures. Metaanalysis of randomized controlled studies suggest that topiramate may be the most potent of the new antiepileptic drugs and have a favourable pharmacokinetic profile. At the National Center for Epilepsy we have used topiramate since 1990. We present our clinical experience with the drug. MATERIAL AND METHODS: We have, retrospectively, assessed 114 adult patients, mainly with intractable partial seizures, who received topiramate as add-on treatment. Average follow-up was 2.3 years. RESULTS: Four patients (3.5%) became seizure free. The overall seizure frequency was reduced by > 50% in 56 patients (49%). Adverse effects were observed in 82 patients (72%); in 54 patients (47%) the drug had to be withdrawn due to unacceptable side effects and/or lack of clinical effect. The most frequent side effects were weight loss, fatigue, behavioural and cognitive problems. INTERPRETATION: Our results corroborate an impression of topiramate being an effective drug used as adjuntive therapy in patients with refractory epilepsy. Side effects can be a problem, but a low starting dose, a slow dose escalation, and topiramate used alone may reduce this problem.

Adolescent↗
PubMed2000

Acupuncture in intractable epilepsy: lack of effect on health-related quality of life.

The objective of this study was to assess the effect on health-related quality of life of acupuncture and sham acupuncture as adjunctive treatment in intractable epilepsy. We performed a randomized controlled trail with two parallel treatment arms at The National Center for Epilepsy in Norway, a comprehensive epilepsy center. Thirty-four patients with long-standing drug resistant epilepsy completed the study. The intervention consisted of 20 acupuncture treatments (bilateral needling of three acupoints plus one or two individually chosen points) or sham acupuncture (bilateral needling with smaller needles of three points outside the traditional meridians) over 8 weeks. The main outcome measures were changes in mean health-related quality of life scores for the two groups after 8 weeks, using the 89-item Quality of Life in Epilepsy (QOLIE-89) questionnaire. We found no difference between the acupuncture and sham acupuncture groups in score changes in any dimension of the QOLIE-89 questionnaire, despite testing a large number of dimensions. We also found no change in QOLIE-89 scores between baseline and 8 weeks in either groups. In conclusion, we could not demonstrate a significant effect of traditional acupuncture or sham acupuncture on the health-related quality of life of patients with intractable epilepsy.

Acupuncture Therapy↗
PubMed1999

[Epilepsy and pregnancy].

Based on recent international consensus conferences and a literature search, a brief summary is given of current knowledge about epilepsy in pregnancy. We suggest new Norwegian guidelines based on international recommendations for handling pregnant women with epilepsy. There is a slightly increased risk for malformations in children born of women with epilepsy. The main reason is probably teratogenic effects of antiepileptic drugs. Nevertheless, the overall chance of giving birth to a healthy child is 92-96%, compared to about 98% in the general population. Counselling all fertile women with epilepsy is important in order to reduce the risk of malformations. Before a planned pregnancy, medication should be re-evaluated, and the lowest dose of the drug most likely to give satisfactory seizure control is preferable. The women should have regular neurological follow-up throughout the pregnancy, and they should be given extra vitamin D, K, and folate. Women using carbamazepine, valproate or the new generation of antiepileptic drugs should be offered amniocentesis and comprehensive ultrasound examination in the 14th and 17th week, respectively. The newly approved drugs should be prescribed only if they provide a considerable better seizure control and/or fewer side effects than the traditional antiepileptic drugs.

Abnormalities, Drug-Induced↗
PubMed1999

[Epilepsy in adolescence. Need for multi-professional diagnosis and treatment].

Epilepsy is one of the most common neurological disorders in adolescence. In a period of life which can be a trying time for anyone, unpredictable and stigmatizing seizures may create considerable additional problems for vulnerable teenagers. In recognition of the many problems young people with epilepsy may be facing, a special ward for teenagers at the National Center for Epilepsy was established. At this ward the patients are offered a broadspectered, multidisciplinary diagnostic and therapeutic programme. Patients with psychogenic seizures represent a particular challenge and are discussed in more detail. During the stay, patients attend an "epilepsy school" with instruction and discussions on topics related to epilepsy. This teenager ward has so far been a success and may serve as a transition clinic from child to adult care.

Adolescent↗
PubMed1999

The effect of acupuncture in chronic intractable epilepsy.

We examined the effect of acupuncture on epileptic seizures in humans in a controlled clinical setting. Treatment was administered by two Chinese professors of acupuncture. Effect was measured by change in seizure frequency. Twenty-nine patients with chronic intractable epilepsy completed the study. They were randomized in two groups; 15 were given classical acupuncture and 14 were given sham acupuncture. There was a reduction in seizure frequency in both groups, which did not reach a level of statistical significance. There was also an increase in the number of seizure-free weeks in both groups, which reached a level of significance in the sham group. Thus, we have not been able to prove a beneficial effect of acupuncture in chronic intractable epilepsy.

Acupuncture Points↗
PubMed1999

Autosomal dominant nocturnal frontal lobe epilepsy: an electroclinical study of a Norwegian family with ten affected members.

PURPOSE: The aim of the study was to describe in detail the electroclinical findings associated with a mutation in the acetylcholine receptor in a Norwegian family with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). Furthermore, we compared the clinical features associated with this mutation with those of an Australian family with a different mutation at the same locus, as well as with those of eight Italian families with ADNFLE and without a verified mutation in this gene. METHODS: We obtained medical records from all of the 10 known affected members of the Norwegian family. A personal interview and a clinical neurologic examination were carried out in six of them. Interictal and ictal scalp EEG recordings were obtained in eight and three, respectively, computed tomography/magnetic resonance imaging (CT/MRI) in five, and blood samples for genetic analysis in seven individuals. The clinical features after an insertion of a leucine residue in the alpha4 subunit of the neuronal nicotinic acetylcholine receptor are examined. Furthermore, the clinical features that accompany this insertion and the clinical features associated with a missense mutation (Ser248Phe) in the same gene were compared. RESULTS: All the affected individuals had a seizure semiology consistent with frontal lobe seizures. Their seizures started in childhood (mean age, 8 years) and were often misinterpreted as benign nocturnal parasomnias, nocturnal paroxysmal dystonia, or a psychiatric disorder. The affected family members were of normal intellect and showed no abnormalities at neurologic and neuroradiologic examinations. Interictal scalp EEG registrations were mostly normal, ictal scalp EEG registrations in three individuals revealed left frontal low-voltage epileptiform discharges in two, and only shallow arousal preceding the attack in one. Although the seizure susceptibility varied among the affected individuals, the epilepsy course was mostly benign. CONCLUSIONS: Patients with ADNFLE, either with the 776ins3 mutation or the Ser248Phe mutation, and those without any recognized mutation in the acetylcholine receptor, have strikingly homogeneous phenotypes, and it seems difficult to separate them on clinical grounds.

Adolescent↗
PubMed1999

Physical exercise in outpatients with epilepsy.

PURPOSE: To compare the exercise habits in a sample of adult outpatients with epilepsy with those of a general population of the same age and sex and furthermore to study physical exercise as a seizure precipitant and the risk of sustaining seizure-related injuries while exercising. METHODS: Two hundred four adult outpatients with active epilepsy responded to two questionnaires. The first one, addressing exercise habits, was a selected part of a broad self-assessing screening used every second year by a marketing and media research institute to reveal changes in the average Norwegian's lifestyle. The exercise habits of the epilepsy population were compared with those of the average population. The other questionnaire, addressing seizures and injuries related to physical exercise, consisted of eight sections and was developed at the National Center for Epilepsy in Norway. RESULTS: The portion of those never exercising was significantly higher among the patient group compared with the average population. Otherwise, the exercise patterns were very similar in the two populations. However, the patients exercised more often in fitness centers and together with friends, whereas individual activities like skiing and swimming were more often preferred by the average Norwegian. Of the 204 patients, 53 and 63% had never experienced seizures during or immediately after exercise, respectively. About 10% of the patients claimed that they had seizures quite often in connection with exercise. However, only 2% had genuine exercise-induced seizures, here arbitrarily defined as having seizures in >50% of the training sessions. Among those prone to have exercise-related seizures, there was a predominance of patients with symptomatic localization-related epilepsy (i.e., with an underlying structural brain lesion). Most exercise-related seizures occurred during strenuous activity. About 38% of the patients claimed to have personal experience regarding whether regular physical exercise influenced their seizure disorder; of these, 53% claimed there was no influence, 36% claimed there was a positive influence, and 10% reported a negative influence. Thirty-six percent of the patients had experienced injuries in connection with physical exercise, but in only 10% were these injuries associated with seizures. The injuries were mostly mild. CONCLUSIONS: The surveyed sample of epilepsy outpatients was more active than expected, and their exercise pattern closely resembled that of the average Norwegian population. In the majority of the patients, physical exercise had no adverse effects, and a considerable proportion (36%) claimed that regular exercise contributed to better seizure control. However, in approximately 10% of the patients, exercise appeared to be a seizure precipitant, and this applied particularly to those with symptomatic partial epilepsy. The risk of sustaining serious seizure-related injuries exercising seemed modest.

Adolescent↗
PubMed1998

[Gabapentin--a new antiepileptic agent].

Gabapentin is a new antiepileptic drug. Its mechanism of action is not clearly understood, but it seems to differ from that of other antiepileptic drugs. The favourable pharmacokinetic properties of gabapentin make it simple to use. Our preliminary clinical observations with gabapentin at the National Center for Epilepsy are presented. 58 adult patients (mean age 28.9 years), mainly with refractory partial seizures, had gabapentin added to their existing medication. The follow-up period was 6.9 months on average. Only one patient experienced a reduction in seizures of more than 50%, while 25 patients experienced a moderate reduction in seizures (10-50%). The clinical effect was most favourable in patients with secondary generalized tonic-clonic seizures. Gabapentin was well tolerated, and no clinically significant interactions were encountered. Recent observations show that the doses of gabapentin used in our study may have been too low.

Acetates↗
PubMed1998

[Autosomal dominant nocturnal frontal lobe epilepsy. An electroclinical and genetic description of a Norwegian family with ten affected members].

We describe a Norwegian family with clusters of brief nocturnal motor seizures with hyperkinetic or tonic manifestations. Seizures started in childhood. Neurological examination and neuroimaging were normal. Interictal EEG registrations were mostly normal, ictal EEG registrations disclosed left frontal epileptiform discharges in two of three patients examined and just shallow arousal preceding the attack in one of the three patients. Segregation analysis indicated an autosomal dominant inheritance pattern, and the patients were subsequently diagnosed as having autosomal dominant nocturnal frontal lobe epilepsy, a disorder first described in 1995. A missense mutation in the gene for the alpha-4 subunit of the neuronal nicotinergic acetylcholine receptor was recently described in an Australian family with this disorder. Our Norwegian family proved to have a novel insertion mutation (776ins3) in the same gene. This mutation affects the second transmembrane domain (M2) which forms the critical section of the ion channel. This is the first case of idiopathic partial epilepsy where the underlying molecular defect has been found. The fact that a dysfunction of the nicotinergic acetylcholine receptor may give rise to frontal epileptic seizures was surprising and may shed new light on the basic mechanisms of epileptogenesis. Manipulations of the cholinergic system may open up a new therapeutic approach.

Adolescent↗
PubMed1998

Do males 30-50 years of age with chronic epilepsy and on long-term anticonvulsant medication have lower-than-expected risk of developing coronary heart disease?

PURPOSE: It has been claimed that long-term use of antiepileptic drugs (AEDs) brings about changes in the lipid profile which might resist development of cardiovascular disease. The aim of this study was to test the following hypothesis: Do males with chronic epilepsy and on long-term treatment with AEDs have a lower than expected risk of developing coronary heart disease? METHODS: The coronary risk profile in 40 male patients with chronic epilepsy, aged 30-50 years, was explored, using an American individual coronary risk factor test program (the Cooper test). We made a survey of the patients' risk factors: total cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, glucose, blood pressure, body fat percentage, physical fitness, hereditary factors, smoking habits, and degree of stress. Each factor was given a score, and the sum of scores constituted the total coronary risk profile. Eighty men in the same age group, casually selected from an industrial medical service, served as controls. RESULTS: There was no statistically significant difference in the total coronary risk profile between the epilepsy patients and the controls. Nor were there any significant differences among the individual risk factors except for physical fitness level, which was significantly lower among the epilepsy group than among the controls. In the epilepsy group, however, there was a trend toward higher levels of total cholesterol, higher levels of HDL-cholesterol, lower levels of total cholesterol/HDL-cholesterol ratio, increased body fat percentage, greater heredity and somewhat greater coronary risk score as compared with the healthy controls, but the differences did not reach statistical significance. The protective effect against coronary heart disease exercised by the enzyme-inducing AEDs seems to be counteracted by other factors, like reduced physical fitness and increased body fat percentage. CONCLUSIONS: Our hypothesis was not confirmed, because we found that the 40 patients with chronic epilepsy tested had about the same risk of developing coronary heart disease as did the control group.

Adipose Tissue↗
PubMed1997

[Organization of epilepsy care for people with mental retardation. A situational analysis after the care reform].

The special care services for the mentally retarded in Norway were closed down by law on 1 January 1991. This implied the termination of centralized care, and integration of these individuals into the local communities. To map the epilepsy service facilities for mentally retarded patients after the care reform, questionnaires were sent to all officially responsible community physicians and to all Departments of Neurology at Norwegian hospitals. 20% of the community physicians expressed the view that mentally retarded patients did not receive adequate specialist service for their epilepsy. There were wide variations within the country. 37% of the responders stated that the community care was inadequately equipped to attend to the special needs of these patients. Firstly, there seems to be a lack of professionals able to transfer their competence concerning epilepsy. Many of the neurological departments felt that the number of referrals of patients with epilepsy and mental retardation had increased since the care reform. 50% of the responders had no opinion about whether the quality of the epilepsy service was not the same for the mentally retarded as for other patients. Many did not realize the need for special measures to provide adequate medical follow-up of this group. It is concluded that education and guidance to personnel and carers should receive high priority in the further development of a comprehensive epilepsy service. The development of multiprofessional epilepsy units at all university hospitals should be facilitated, and the appointment of specially assigned epilepsy nurses at all neurological departments is recommended.

Community Mental Health Services↗