Alertness and Incidence of Seizures in Patients with Lennox‐Gastaut Syndrome

Papini, Massimo; Pasquinelli, A; Armellini, M.; Orlandi, Diego

doi:10.1111/j.1528-1157.1984.tb04172.x

Cited by 31 publications

(12 citation statements)

References 16 publications

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“…In addition, in severe forms there is a generic risk that seizure exacerbation may be triggered by aspecific minor factors (57). Pharmacologic manipulation could act as an aspecific factor, e.g., by modifying the level of alertness (39). Furthermore, some of these syndromes are not merely the sum of the accompanying seizure types but.…”

Section: Childhood Epileptic Encephalopathies With Multiple Seizure Tmentioning

confidence: 99%

Antiepileptic Drug‐Induced Worsening of Seizures in Children

Guerrini

Belmonte

Genton³

1998

Epilepsia

164

126

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Summary: Antiepileptic drugs (AEDs) may aggravate preexisting seizures and trigger new seizure types. However, the extent and mechanisms of this problem are unclear, for several reasons. AED trials are not designed to detect worsening of seizures, severe childhood epilepsies may fluctuate in severity, and worsening of seizures may be over-hastily ascribed to the introduction of a new AED. Moreover, the seizure and the epilepsy type may have been incorrectly diagnosed. The problem is identification of true aggravation of epilepsy in the absence of overdosage or toxicity. This is a common and clinically important problem that concerns both established and newer AEDs, but the biologic mechanisms involved are unknown. An increase in seizure frequency due to overdosage has been reported with phenytoin but is rare with other AEDs. Paradoxical reaction has been reported with carbamazepine (CBZ), benzodiazepines, and vigabatrin (VGB). Exacerbation of seizures may also occur during AED-induced encephalopathy or hepatopathy. An inappropriate choice of the AED (i.e., a purely pharmacodynamic mechanism) can induce worsening when CBZ or VGB is used in absence and myoclonic seizures. Further research should determine whether seizure exacerbation is associated with the type of epilepsy or with the type of EEG abnormality. Recent evidence indicates that lamotrigine i8 inappropriate in severe myoclonic epilepsy. Some childhood epileptic encephalopathies have been affected by certain seizure-worsening mechanisms. Whether this is due to a predisposition in specific syndromes or to an increased risk for adverse effects in patients undergoing multiple AED manipulations is unclear. Furthermore, some syndromes are not the sum of accompanying seizure types but have unique neurobiology.

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Section: Childhood Epileptic Encephalopathies With Multiple Seizure Tmentioning

confidence: 99%

Antiepileptic Drug‐Induced Worsening of Seizures in Children

Guerrini

Belmonte

Genton³

1998

Epilepsia

164

126

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“…benzodiazepines (BDZs) or phenobarbitone. 2,3 Experience suggests that such a response is more likely in patients on polytherapy; this is probably the main mechanism by which polytherapy can make seizures (and other adverse effects) worse.…”

mentioning

confidence: 99%

Aggravation of epilepsy by anti‐epileptic drugs

Gayatri

Livingston

2006

Develop Med Child Neuro

102

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The possibility that so‐called anti‐epileptic drugs (AEDs) may aggravate epilepsy must always be borne in mind by the clinician. Many reports of such aggravation of seizures have been published. Most such reports are anecdotal and speculative, and suggest that many such reactions are idiosyncratic. However, for some there is a sufficient body of evidence to suggest that some AEDs used in certain epilepsies may consistently cause worsening of seizures. Seizure aggravation may include increase in the frequency or severity of existing seizures, emergence of new types of seizure, or the occurrence of status epilepticus. The pathophysiology of seizure aggravation is poorly understood including nonspecific effects such as those associated with sedation, druginduced encephalopathy, and paradoxical or inverse pharmacodynamic effects. For some epilepsies the choice of AEDs may be inappropriate, and although the mechanism of seizure aggravation is not clear, its occurrence may be fairly predictable. This is best documented for the use of carbamazepine in idiopathic generalized and myoclonic epilepsies. Most other AEDs have been reported occasionally to cause seizure aggravation. The lowest risk of seizure aggravation appears to be with valproate. Risk factors for worsening of seizures are epileptic encephalopathy, polytherapy, high frequency of seizures, and cognitive impairment. Advances in pharmacogenomics may in the future enable such adverse effects to be predicted for individual patients. Meanwhile, a systematic approach to reporting AED‐induced seizure aggravation should be developed.

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“…[18][19][20][21][22] Benzodiazepinler GABA-A reseptörleri üzerinden etki ederler, GABA-B reseptörleri üzerinden etkileri yoktur o yüzden benzodiazepinlere bağlı LGS'de tonik status epileptikusun ortaya çıkması, yukarıda tartışılan talamik mekanizmalarla tam olarak açıklanamamaktadır. [4] Altta yatan ciddi beyin patolojisi [4] veya benzodiazepinlere bağlı somnolansın [23] artmış nöbet aktivitesine yol açtığı düşünülmektedir. Bu hastaların çoğu daha önce benzodiazepin almasına rağmen tonik nöbetler tetiklenmemiştir.…”

Section: Discussionunclassified

A Case of Lennox-Gastaut Syndrome Who Developed Tonic Status Epilepticus Induced by Intravenous Diazepam

Atmaca¹,

Baykan²,

Bebek³

et al. 2012

Epilepsi

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ÖzetLennox-Gastaut sendromu (LGS) çok sayıda nöbet tipinin birlikte görüldüğü, özel EEG paternlerine sahip, kognitif etkilenmenin de olduğu, tedaviye dirençli ve kötü prognozlu bir epileptik ensefalopatidir. Bazı antiepileptik ilaçların (AEİ), özellikle çocukluk çağının jeneralize epilepsilerinde, bazı nöbet tiplerini kötüleştirici etkisi iyi bilinen bir fenomendir; ancak bunun altında yatan patogenetik mekanizmalar tam olarak anlaşılmış değildir. Bu yazıda, LGS tanısı ile izlenen, intravenöz diazepam ile tonik status epileptikusa giren bir olgu bildirilmiş, LGS ve AEİ'lere bağlı nöbet kötüleşmesi konusu tartışılmıştır.Anahtar sözcükler: Diazepam; Lennox-Gastaut sendromu; nöbet kötüleşmesi. SummaryLennox-Gastaut syndrome (LGS) is an epileptic encephalopathy characterized by several types of seizures, special EEG patterns, and cognitive deterioration with resistance to therapy and poor prognosis. It is a well known phenomenon that some antiepileptic drugs (AED) have a worsening effect on some seizure types, especially in the generalized epilepsies of childhood. However, its underlying pathogenetic mechanisms are not fully understood. In this paper, a case with LGS who developed tonic status epilepticus induced by diazepame given intravenously is reported and the topic of seizure aggravation caused by AED and LGS is discussed.

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Alertness and Incidence of Seizures in Patients with Lennox‐Gastaut Syndrome

Cited by 31 publications

References 16 publications

Antiepileptic Drug‐Induced Worsening of Seizures in Children

Antiepileptic Drug‐Induced Worsening of Seizures in Children

Aggravation of epilepsy by anti‐epileptic drugs

A Case of Lennox-Gastaut Syndrome Who Developed Tonic Status Epilepticus Induced by Intravenous Diazepam

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