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Biomedical subjects

Samden D Lhatoo

Publications and source records attributed to Samden D Lhatoo.

5 recordsLinked to original sources
PubMed2005

Cause-specific mortality in epilepsy.

Epilepsy is associated with a two- to three-fold increase in mortality. Studies of cause-specific mortality show that deaths may be classified into those that are directly or indirectly related to epilepsy, those that are related to the underlying pathology giving rise to epilepsy, and those that are unrelated to both epilepsy and its causes. Overall, direct epilepsy related deaths are infrequent. Pneumonia, especially in the elderly, central nervous system (CNS) and non-CNS neoplasias, and cerebrovascular disease are frequent causes of death. Suicides, accidental deaths, and ischemic heart disease do not appear to be significant contributors to mortality in community-based studies. In hospital/institution-based analyses, epilepsy-related deaths are common and sudden unexpected death in epilepsy (SUDEP) may account for up to 17% of all deaths in epilepsy. A small proportion of these deaths may be witnessed and most such witnessed deaths occur in relation to convulsive seizures. The exact pathogenetic mechanisms are unknown although it is very probable that lack of seizure control is an important risk factor. Patients who continue to suffer seizures appear to have an almost 40 times higher risk of mortality than those in remission.

Accidents↗
PubMed2003

Topiramate and psychiatric adverse events in patients with epilepsy.

PURPOSE: The aim of this study was to determine the prevalence of psychiatric adverse events (PAEs) in patients with epilepsy treated with topiramate (TPM). Classification, relation to TPM dosing, and outcome were evaluated to identify a patient profile at risk of developing PAEs. METHODS: We evaluated the data of the first consecutive and prospectively collected patients in therapy with TPM. RESULTS: Follow-up information was available for 431 patients. PAEs occurred in 103 (23.9%) patients; M/F ratio, 55:48; mean age (+/-SD), 36.5 +/- 11.2. In 46 (10.7%) patients, an affective disorder developed; in 16 (3.7%), a psychotic disorder; in 24 (5.6%), aggressive behavior with or without irritability; in 17 (3.9%), other behavior abnormalities such as agitated behavior, anger/hostility behavior, or anxiety. High starting dose and rapid titration schedule were relevant for the development of PAEs. Family psychiatric history and family history of epilepsy, personal history of febrile convulsions, psychiatric history, and presence of tonic-atonic seizures were found to be significant risk factors. Low seizure frequency before starting TPM and TPM/lamotrigine coadministration had a protective effect for PAEs. CONCLUSIONS: We found that PAEs associated with TPM were related to the titration schedule of the drug and that a unique patient profile is suggested by the clinical history.

Adult↗
PubMed2003

A prospective study of the requirement for and the provision of epilepsy surgery in the United Kingdom.

PURPOSE: Of the 30,000 persons in whom epilepsy develops annually in the United Kingdom, in approximately 6000 (20%), intractability develops. Some of these patients will be appropriate for epilepsy surgery. We aimed to estimate the number of patients who should be considered surgical candidates, by extrapolation from a population-based study of prognosis and the number who are receiving epilepsy surgery, by a survey of U.K. neurosurgeons. METHODS: We identified the number of patients who may eventually require surgery from a prospective cohort of patients with newly diagnosed epilepsy. We identified all U.K. neurosurgeons who had performed any epilepsy surgery in the past year. Each identified surgeon prospectively recorded the number and types of operations carried out for 6 months. RESULTS: Of newly diagnosed patients each year, 450 (1.5%) may eventually require surgery. Thirty-two respondents (22% of all U.K. neurosurgeons) reported that they performed epilepsy surgery. The 211 operations were carried out in the 6 months surveyed (422 operations annually or 13 per surgeon per year). Temporal lobe resection (77%) was the most common procedure. CONCLUSIONS: Based on a prevalence of 5/1,000 persons with epilepsy, < or =4,500 patients in the U.K. require epilepsy surgery. Every year, 450 patients with newly diagnosed epilepsy who may eventually require surgery are added to this "surgical pool." At the current annual rate of operations, a large number of refractory patients remain untreated. This is probably partly because many patients are not referred for specialist care and therefore remain underinvestigated.

Adolescent↗
PubMed2003

Familial idiopathic brain calcification--a new and familial alpha-synucleinopathy?

Familial idiopathic brain calcification (FIBC) is a rare disorder characterised by autosomal dominant transmission, adult onset cerebellar and/or extrapyramidal features and idiopathic calcification of the brain. We present a family with FIBC where pathological studies showed that the proband had alpha-synuclein-immunopositive glial and neuronal cytoplasmic inclusions in oligodendrocytes in the putamen, midbrain and pons. This may represent a new and familial alpha-synuclein disorder causing a predominantly extrapyramidal picture similar to multisystem atrophy.

Adolescent↗