Biomedical subjects

Sheryl R Haut

Publications and source records attributed to Sheryl R Haut.

8 recordsLinked to original sources

PubMed2006

Nonepileptic uses of antiepileptic drugs in children and adolescents.

Antiepileptic drugs are often prescribed for nonepileptic neurologic and psychiatric conditions. The United States Food and Drug Administration has approved several antiepileptic drugs for the treatment of neuropathic pain, migraine, and mania in adults. For pediatric patients, use of antiepileptic drugs for non-seizure-related purposes is supported mainly by adult studies, open-label trials, and case reports. Summarized here is the published literature for or against the use of antiepileptic drugs for neuropathic pain, migraine, movement disorders, bipolar disorder, aggressive behavior, and pervasive developmental disorders in children and adolescents. Using the American Academy of Neurology's four-tiered classification scheme for a therapeutic article and translation to a recommendation rating, there are no nonepileptic disorders for which antiepileptic drugs have been established as effective for pediatric patients. Valproate and carbamazepine are "possibly effective" in the treatment of Sydenham chorea, and valproate is "probably effective" in decreasing aggressive behavior. Carbamazepine is "probably ineffective" in the treatment of aggression, and lamotrigine is "possibly ineffective" in improving the core symptom of pervasive developmental disorders. Despite the frequent use of antiepileptic drugs in the treatment of juvenile bipolar disorder, migraine, and neuropathic pain, the data are insufficient to make recommendations regarding the efficacy of antiepileptics in these conditions in children and adolescents.

Adolescent↗

PubMed2006

Chronic disorders with episodic manifestations: focus on epilepsy and migraine.

Epilepsy and migraine are chronic neurological disorders with episodic manifestations that are commonly treated in neurological practice and frequently occur together. In this review we examine similarities and contrasts between these disorders, with focus on epidemiology and classification, temporal coincidence, triggers, and mechanistically based therapeutic overlap. This investigation draws attention to unique aspects of both epilepsy and migraine, while identifying areas of crossover in which each specialty could benefit from the experience of the other.

Chronic Disease↗

PubMed2005

Seizure clustering.

Seizure clusters, also known as repetitive or serial seizures, occur commonly in epilepsy. Clustering implies that the occurrence of one seizure may influence the probability of a subsequent seizure; thus, the investigation of the clustering phenomenon yields insights into both specific mechanisms of seizure clustering and more general concepts of seizure occurrence. Seizure clustering has been defined clinically as a number of seizures per unit time and, statistically, as a deviation from a random distribution, or interseizure interval dependence. This review explores the pathophysiology, epidemiology, and clinical implications of clustering, as well as other periodic patterns of seizure occurrence. Risk factors for experiencing clusters and potential precipitants of clustering are also addressed.

Epilepsy↗

PubMed2005

Seizure clustering: risks and outcomes.

PURPOSE: Patients with epilepsy often experience seizures in clusters. In this preliminary study, we examined the prevalence of self-reported clustering and identified potential risk factors and outcomes associated with reported clustering for further analysis in an ongoing prospective diary study. METHODS: Detailed intake questionnaires were administered. Subjects reporting their typical seizure pattern to be three or more seizures within a 24-h period were classified as clusterers. Magnetic resonance imaging (MRI) and EEG data were obtained, and epilepsy was classified by International League Against Epilepsy (ILAE) criteria. All subjects completed Beck Anxiety and Depression Inventories, and Quality of Life in Epilepsy testing. RESULTS: Overall, 29% of subjects reported typical seizure clustering. Extratemporal lobe epilepsy [p = 0.02; OR, 3.0 (1.1-7.8)] was significantly associated with reported seizure clustering. Remote symptomatic epilepsy was associated with clustering [p = 0.03; OR, 2.3 (1.1-4.3)], particularly in association with a history of head trauma with loss of consciousness before epilepsy onset [p = 0.003; OR, 4.2 (1.6-11.1)], although this analysis was limited. Reported clustering was significantly associated with a history of convulsive status epilepticus (SE) [p = 0.029; OR, 3.0 (1.1-8.3)], other seizure-related hospitalization [p = 0.006; OR, 5.3 (1.5-17.6)], and worse seizure control (p = 0.004). Quality-of-life measures were not significantly associated with reported clustering. CONCLUSIONS: These preliminary results identify extratemporal epilepsy and possibly head trauma as potential risk factors for reported seizure clustering and indicate a significant association between reported clustering and convulsive SE. Additionally, seizure clustering appears to be a marker for more intractable epilepsy. The ongoing diary study will refine the definition of seizure clustering and further evaluate specific predictors of poor and favorable outcomes of clustering.

Adult↗

PubMed2004

Susceptibility of immature and adult brains to seizure effects.

The extent that status epilepticus (SE), but also brief seizures, affects neuronal structure and function has been the subject of much clinical and experimental research. There is a reliance on findings from animal research because there have been few prospective clinical studies. This review suggests that the features of seizure-induced injury in the immature brain compared with the adult brain are different and that duration of seizures (SE versus brief), number of seizures, cause of seizures, presence of pre-existing abnormalities, and genetics affect the injury. Increased awareness of age-specific injuries from seizure has promoted research to determine the circumstances under which seizures may produce permanent detrimental effects. Together with recent advances in functional neuroimaging, genomic investigation, and prospective human data, these studies are likely to substantially increase our knowledge of seizure-induced injury, leading to the development of improved algorithms for prevention and treatment of epilepsy.

Age Factors↗

PubMed2003

Stress and epilepsy: a patient perception survey.

A questionnaire was administered to patients in the Montefiore Medical Center outpatient epilepsy department to assess perceptions about stress, seizures, and stress reduction. Eighty-nine patients completed the questionnaire. Overall, 64% of patients reported the belief that stress increased the frequency of their seizures. This belief was not significantly associated with gender, age, location of care, epilepsy classification, or seizure control, but was significantly associated with a shorter duration of epilepsy (P=0.04). Thirty-two percent of subjects had tried stress reduction modalities for epilepsy. Of those who had not, 53% were willing to try, and this willingness was significantly associated with a greater number of seizures in the prior 2 months (P=0.006) and the belief that stress was associated with seizures (P=0.04). Both major and minor stressors were reported with equal frequency. The majority of our study population believe that stress and seizures are related, and are willing to try stress reduction techniques for seizure control. We believe that these findings indicate a need for a prospective study to evaluate the role of stress and stress reduction as an additional potential therapeutic modality for epilepsy.

Adolescent↗

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↗

PubMed2002

Seizure clustering during epilepsy monitoring.

PURPOSE: To identify risk factors associated with seizure clustering during epilepsy monitoring and to assess the effect of clustering on localization of the epileptogenic zone. METHODS: Patients undergoing presurgical epilepsy monitoring at Montefiore Medical Center or Yale-New Haven Hospital were recruited. Seizure clustering was defined as three or more seizures within 24 h. Risk factors for seizure clustering were examined by using regression analysis. The effect of clustering on localization was examined by Student's t test evaluation of mean interseizure interval for consecutive concordant and discordant seizures. RESULTS: Of 91 patients, clustering was present in 56 (61.5%). Variables significantly associated with clustering included a history of seizure clustering at home (p = 0.0003) and the presence of mesial temporal sclerosis (MTS) on magnetic resonance imaging (MRI; p = 0.0172). Clustering was present in nine of 10 patients with more than one seizure-onset zone. Ictal EEG localization was not associated with clustering, nor was rapid medication withdrawal. Mean interseizure intervals were not significantly different for concordant and discordant seizures. CONCLUSIONS: Seizure clustering during epilepsy monitoring is common. Risk factors include history of clustering at home, MTS on MRI, and possibly more than one seizure focus. In this study, seizures that occurred in clusters had as important a role in localization as did nonclustered seizures.

Adult↗