Biomedical subjects

Karl O Nakken

Publications and source records attributed to Karl O Nakken.

12 recordsLinked to original sources

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

Analyzing the etiology of benign rolandic epilepsy: a multicenter twin collaboration.

PURPOSE: Benign rolandic epilepsy (BRE) is considered a genetically determined idiopathic partial epilepsy. We analyzed a large sample of twins from four international twin registers to probe the genetics of BRE. We also aim to synthesize the apparently conflicting family and twin data into a model of BRE etiology. METHODS: Large population-based twin registries of epilepsies from Odense (Denmark), Richmond, Virginia (United States), and Oslo (Norway) were reviewed for BRE cases and added to our Australian twin data. Diagnosis of classic BRE was based on electroclinical criteria with normal neurologic development. Cases with a compatible electroclinical picture but abnormal neurologic development were termed non-classic BRE. RESULTS: Eighteen twin pairs were identified (10 monozygous; eight dizygous) of whom at least one twin was diagnosed with classic BRE among a total sample of 1,952 twin pairs validated for seizures, and all were discordant for BRE. The estimated monozygous pairwise concordance for BRE in this sample was 0.0 [95% confidence interval (CI), 0.0-0.3). Four twin pairs (one monozygous, three dizygous) had non-classic BRE, and all co-twins had seizures. CONCLUSIONS: The twin data showing an absence of any concordant twin pairs with classic BRE suggest that noninherited factors are of major importance in BRE. Modelling the data shows that the familial occurrence of centrotemporal spikes makes only a minor contribution to the familial aggregation of BRE. Genetic factors are probably more important in non-classic BRE. The etiology and mode(s) of inheritance of BRE are much more complicated than initially conceptualized.

Adult↗

PubMed2005

[Seizure-precipitating factors in epilepsy--what do patients report?].

BACKGROUND: To investigate the occurrence of seizure-precipitating factors in a large epilepsy population and to determine which precipitants patients most often report. MATERIAL AND METHOD: Study participants included Norwegian twins and their family members identified in a multinational twin study. 794 patients with epilepsy were asked about seizure precipitants. RESULTS: Among the respondents, 55% reported at least one seizure-precipitating factor, while 28% claimed to have experienced two or more. Emotional stress, sleep deprivation, and tiredness were the most frequently reported precipitants. Patients with generalised seizures seemed more sensitive to sleep deprivation, tiredness, and flickering light than those with partial seizures. Women with partial seizures appeared to be more prone to seizures during their period than those with generalised seizures. INTERPRETATION: In our opinion, dealing with seizure precipitating factors is a somewhat neglected and underestimated supplement to more traditional epilepsy therapies. Acknowledging and avoiding seizure precipitants may improve seizure control in many patients.

Adolescent↗

PubMed2005

[Epilepsia partialis continua (Kojevnikov's syndrome)].

BACKGROUND: Lesions close to the central sulcus may give rise to focal motor seizures of long duration. This condition is called epilepsia partialis continua (Kojevnikov's syndrome). MATERIAL AND METHODS: Over the last two years, the National Centre for Epilepsy in Norway has treated 12 patients with epilepsia partialis continua. We discuss the occurrence, etiologies, semiology, findings from supplementary investigations, and therapeutic options on the basis of relevant literature and our own experience with these patients. RESULTS AND INTERPRETATION: Morphological lesions were found in 10 out of these 12 patients; cortical dysplasia in 3 patients, brain tumour in 2 patients, cerebral infarction in 2 patients, Rasmussen syndrome in 2 patients, and cerebral haemorrhage from an arteriovenous malformation in 1 patient. 9 patients had intermittent periods of jerking lasting from some hours to several days; the remaining 3 had permanent jerks. One of them had had this condition for 44 years. In 11 patients the jerks were localised to the face and/or the hand. The effect of antiepileptic drugs was disappointing; none became seizure-free. Five patients had undergone surgery. Surgical lesionectomy in this brain area is associated with a high risk of damage to eloquent cortex, but multiple subpial transections may have a seizure-blocking effect. One patient with Rasmussen's syndrome became seizure-free after a functional hemispherotomy.

Adolescent↗

PubMed2005

A patient with a 44-year history of epilepsia partialis continua caused by a perirolandic cortical dysplasia.

Epilepsia partialis continua (EPC), or Kojevnikov's syndrome, is a rare epileptic syndrome arising from a variety of lesions in the perirolandic area. We report herein a 46-year-old woman with drug-resistant EPC due to a cortical dysplasia in the left frontoparietal region. For 44 years she has suffered continuous right-sided jerks, particularly in the right arm and hand, with an average frequency of 10-20 jerks per minute. During EEG recordings her jerks were associated with spikes and sharp waves over the left frontocentroparietal region, sometimes also with bursts of high-voltage generalized spike-wave complexes with a maximum bicentrally, followed by an electrodecrement. Despite the continuous jerks she is independent in daily life activities, and she considers the jerks not severe enough to justify surgery, i.e., multiple subpial transections.

Aspartic Acid↗

PubMed2005

Which seizure-precipitating factors do patients with epilepsy most frequently report?

When treating patients with epilepsy, dealing with seizure-precipitating factors is a partly neglected and underestimated supplement to more traditional therapies. The aim of this study was to investigate the incidence of seizure precipitants in a large epilepsy population and to determine which precipitants patients most often reported. Study participants included twins and their family members ascertained from the Norwegian Twin Panel (NTP), the Danish Twin Registry (DTR), and the Mid-Atlantic Twin Registry (MATR). One thousand six hundred seventy-seven patients with epilepsy were identified and were asked about seizure precipitants using a closed-ended questionnaire. Fifty-three percent reported at least one seizure-precipitating factor, while 30% claimed to have experienced two or more such factors. Emotional stress, sleep deprivation, and tiredness were the three most frequently reported precipitants. Patients with generalized seizures seemed to be more sensitive to sleep deprivation and flickering light than those with partial seizures, while women with partial seizures appeared to be more prone to seizures during menstruation than women with generalized seizures. Knowledge of seizure precipitants has practical implications, not only in patient treatment and counseling, but also for diagnosis, in that it may be helpful in facilitating the appearance of interictal epileptiform discharges in EEG and ictal EEG recordings.

Adult↗

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

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

Vagal nerve stimulation--the Norwegian experience.

The purpose of this open retrospective study was to analyze the efficacy and tolerability of vagal nerve stimulation (VNS) in a Norwegian cohort of referral patients with refractory epileptic seizures. A total of 47 patients have been assessed after a mean follow-up time of 2.7 years. Mean age was 34.4 years, mean duration of epilepsy was 25.3 years. Forty-two patients (89%) had localization-related epilepsy, 36 patients (77%) had daily seizures. The patients had tried on average 9.5 antiepileptic drugs, and 12 patients (26%) had undergone epilepsy surgery. Sixteen patients (34%) had >50% reduction of seizure frequency with VNS, of which one patient became seizure free. The stimulation was generally well tolerated, but three patients requested the device removed because of troublesome side effects. We conclude that VNS is an efficacious and safe mode of treatment that should be offered to patients with medically and surgically refractory seizures.

Adolescent↗

PubMed2003

A paradoxical effect of levetiracetam may be seen in both children and adults with refractory epilepsy.

The aim of this prospective, uncontrolled clinical study was to evaluate the tolerability and the efficacy of levetiracetam as add-on treatment in 78 adults and 44 children with intractable epilepsy. The patients' seizure frequency in the 8 weeks baseline period was compared to their seizure frequency after a mean follow-up of 8 months of treatment.A greater than 50% reduction in seizure frequency was achieved in 31 adults (40%) and 9 children (20%), of whom 7 adults (9%) and 3 children (7%) became seizure free. Most often levetiracetam was well tolerated, somnolence being the most frequently reported side effect (18% in adults and 7% in children). However, in 14 adults (18%) and 19 children (43%) levetiracetam was associated with an increase (>25%) in seizure frequency. Such a paradoxical effect, including the development of status epilepticus in three adults and four children, appeared most often in mentally retarded patients during the first 2 months of treatment, and on relatively high doses. Two children developed status epilepticus after 5 and 7 months, respectively. In conclusion, levetiracetam is usually well tolerated as add-on treatment in patients with difficult-to-treat partial onset seizures. By using a lower initial dose and a slower dose escalation than recommended by the manufacturer, a paradoxical effect may perhaps be avoided. In children, doses >20 mgkg(-1) per day should be introduced with caution.

Adolescent↗

PubMed2002

[Epilepsy and death].

BACKGROUND: The risk of premature death in the epilepsy population is estimated to be two or three times of that in the general population. Premature death is partly a consequence of the aetiology of the epilepsy (tumours, infections, cerebrovascular insults etc.), partly a direct or indirect consequence of a seizure: head trauma, drowning, traffic accident, suicide, status epilepticus, and sudden unexpected death in epilepsy (SUDEP). MATERIAL AND METHODS: On the basis of a review of the current literature on sudden unexpected death in epilepsy, we discuss incidence, risk factors and the assumed pathophysiological mechanisms. RESULTS: Most of these deaths are probably seizure-related. Among patients between 20 and 45, sudden unexpected death is the most frequently occurring epilepsy-related cause of death. In patients with refractory epilepsy, sudden unexpected death comprises about 10% of deaths; the incidence is about 1:200-300 per year. Risk factors are symptomatic epilepsy, tonic-clonic seizures, early onset of the epilepsy, polytherapy, and non-compliance. Ictal central apnoe or ictal fatal cardioarrhythmia are probably the most plausible explanations for these deaths. INTERPRETATION: Some of these deaths may be prevented by better seizure control. Patients and their families should be given balanced information about this potential outcome. Family members should learn first aid and resuscitation.

Adult↗

PubMed2002

Familial temporal lobe epilepsy with aphasic seizures and linkage to chromosome 10q22-q24.

PURPOSE: To describe the phenotypic expression of a new family with familial lateral temporal lobe epilepsy with aphasic seizures, and to compare the findings with the clinical features of previously reported families linked to chromosome 10q22-q24. METHODS: Medical records were collected from 12 living affected members. The patients underwent a personal interview and a clinical neurologic examination. Results from interictal scalp EEGs and neuroimaging examinations were obtained. RESULTS: The cardinal ictal symptom was a brief sensory aphasia in eight of the patients. In four, this was accompanied by auditory symptoms, usually in the form of monotonous unformed sounds. Simple partial seizures with psychic or somatosensory seizures also were present. Visual ictal symptoms and complex partial seizures were absent. All patients had generalized tonic-clonic seizures. Magnetic resonance imaging (MRI) or computed tomography (CT) did not reveal morphologic correlates. Improvement with age seemed to occur in many patients. Significant linkage to chromosome 10q22-q24 was established by testing 17 polymorphic microsatellite markers. CONCLUSIONS: The epilepsy of this family appears to represent a variety of autosomal dominant lateral temporal lobe epilepsy. Aphasic seizures and a peculiar seizure-precipitating effect of the activation of speech (initiation or perception) may serve as markers for identifying further families with this phenotype.

Adolescent↗