Forskere kaster lys over årsaker til epilepsi (reuters.com 24.11.2008) (Health Tip)

Researchers: Epilepsy Cause Identified (washingtonpost.com 30.3.2006)

90 000 mennesker blir hvert år feilaktig diagnostisert med epilepsi i England og Wales (British Epilepsy Association (2006))

Behandling av epilepsi (Tidsskr Nor Lægeforen 2003; 123: 1864-8 (26. juni 2003))

Drug allergy: Watching for unexpected reactions to medications (mayoclinic.com 16.11.2007)

...epilepsies in children (Lancet Neurology 2008; 7:57-69 (January))

Gendefekter gir færre epileptiske anfall (vg.no 6.11.2007)

Independent trial guides doctors through epilepsy treatments (BMJ 2007;334:660-661 (31 March))

Pakningsvedlegg USA (FDA)

Depacon (valproate sodium) injection [Abbott Laboratories] (FDA: DrugLabel) (FDA: DrugLabel) (Norge Valproat; Orfiril etc.)

Norsk Epilepsiforbund Hva er egentlig epilepsi? (epilepsi.no (2007))

Lamictal (lamotrigine) Tablets (Advarsler) (fda.gov/medwatch)

- Epilepsi og fysisk aktivitet

Epilepsi og fysisk aktivitet
nhi.no 3.12.2012
Å ha epilepsi trenger ikke bety at du ikke kan trene. Tvert i mot, for mange kan trening redusere hyppigheten av epileptiske anfall - i tillegg til alle de andre positive effektene trening gir.

Ifølge en artikkel i Tidsskrift for Den Norske Legeforening fra 2000, er mange med epilepsi i dårlig fysisk form. Overbeskyttelse og understimulering av barn med epilepsi er ikke uvanlig, med negativ selvfølelse og isolasjonstendens til følge. For enkelte kan sederende virkning av epilepsimedisin, transportproblemer på grunn av mangel på førerkort, og frykt for å dumme seg ut eller for å få utløst et epileptisk anfall, være en barriere mot et mer aktivt liv.

Forskning viser at regelmessig trening kan redusere hyppigheten av epileptiske anfall, i tillegg til å gi bedre hjertekar og psykisk helse, hos personer med epilepsi. De fleste typer fysisk aktivitet eller idrett er trygt å drive med for personer med epilepsi, dersom du vier ekstra oppmerksomhet til anfallskontroll, følger medisineringen du har blitt foreskrevet nøye, og informerer eller involverer trener, familie eller venner. (...)

(Anm: Karl O. Nakken, Morten I. Lossius Spesialsykehuset for epilepsi (SSE), Oslo universitetssykehus.  Epilepsi må avmystifiseres. Opp mot 70 prosent av dem med epilepsi blir anfallsfrie med moderne behandling. Med moderne behandling blir opp mot 70 prosent anfallsfrie. (aftenposten.no 23.11.2015).)

(Anm: Fysisk trening (aktivitet / løping / jogging). (mintankesmie.no).)

(Anm: Epilepsy Symptoms, Causes and Treatment (medicinenet.com 11.5.2017).)

(Anm: Editorials Avoiding premature death in epilepsy. BMJ 2015;350:h718 (Published 10 February 2015).)

(Anm: Soving på magen "kan øke risikoen for plutselig død ved epilepsi" (Sleeping on stomach 'may raise risk of sudden death in epilepsy') (medicalnewstoday.com 24.1.2015).)

- Alvorlig epilepsi og sirkadisk rytmeprotein linket. Nye funn kan åpne døren til nye behandlinger av epilepsi.

(Anm: Severe epilepsy and circadian rhythm protein linked. New findings may open the door to novel epilepsy treatments. Researchers probing the brain tissue of people with severe forms of epilepsy make a surprising breakthrough: a protein involved in circadian rhythms, called CLOCK, may play a role. Epilepsy is a relatively common brain disorder that causes seizures. It affects around 1.2 percent of people in the United States, and to date, it is not curable. There are drugs available to treat the condition, but side effects can be significant and not all cases of epilepsy respond well. Although certain genetic mutations have been identified that are responsible for inherited forms of epilepsy, these only account for a minority of cases. In most cases, the exact causes are unknown. (medicalnewstoday.com 12.10.2017).)

- Stor betydning for helsen Forskning tyder på at en dårlig koordinert indre tidtagning øker risikoen for sykdom, for eksempel ved langvarig skiftarbeid.

(Anm: Får nobelpris for oppdagelsen av døgnrytmen. De amerikanske forskerne Jeffrey C. Hall, Michael Rosbash og Michael W. Young tildeles årets nobelpris i medisin eller fysiologi for oppdagelsen av den biologiske klokka. (…) Et selvregulerende urverk i kroppen Årets nobelprisvinnere begynte med å studere et gen som krevdes for bananfluens normale døgnrytme. De viste at genet kodet for et protein som økte om natten men brøt ned til lave nivåer om dagen. De identifiserte flere proteiner og kunne dermed beskrive et selvregulerende urverk i våre celler. Klokken har siden vist seg å fungere med samme prinsipp i andre flercellede organismer, også i menneske. (…) Stor betydning for helsen Forskning tyder på at en dårlig koordinert indre tidtagning øker risikoen for sykdom, for eksempel ved langvarig skiftarbeid. Etter nobelprisvinnernes oppdagelser har cirkadisk biologi utviklet seg til et dynamisk og raskt voksende forskningsfelt, med stor betydning for helsen vår. (nrk.no 2.10.2017).)

(Anm: Interview about the 2017 Nobel Prize in Physiology or Medicine (8 minutes) (nobelprize.org 2017).)

- Konklusjon: Epileptiske anfall er ofte utløst av en kombinasjon av ulike kliniske faktorer, men søvnmangel skiller seg ut som en selvstendig anfallstrigger. (- Hvordan stress øker anfallfrekvensen hos pasienter med epilepsi.)

Effekt av søvnmangel på epileptiske anfall
helse-bergen.no 31.10.2016
I denne prospektive overkryssningsstudien ble det undersøkt om søvnmangel kan være en utløsende faktor for epileptiske anfall. Totalt ble 152 voksne personer intervjuet ved akutt innleggelse for epileptisk anfall og ved oppfølging. Studien er utført av forskere fra St. Olavs hospital og Norges teknisk-naturvitenskapelige universitet.

Studien er publisert i Epilepsy Research - The impact of sleep loss on the facilitation of seizures: A prospective case-crossover study 

PURPOSE: The relationship between sleep and seizures is intricate. The aim of this study was to assess whether sleep loss is an independent seizure precipitant in a clinical setting. (…)

Konklusjon: Epileptiske anfall er ofte utløst av en kombinasjon av ulike kliniske faktorer, men søvnmangel skiller seg ut som en selvstendig anfallstrigger. CONCLUSION: Epileptic seizures are often precipitated by a combination of various clinical factors, but sleep loss stands out as an independent seizure trigger. (…)

(Anm: Epilepsi - symptomer og behandling (lommelegen.no 19.9.2016).)

(Anm: How stress increases seizures for patients with epilepsy. It is well known that stress can increase the frequency and severity of seizures for patients with epilepsy. Now, researchers have shed light on why this is, and they may have even found a way to stop it. Published in the journal Science Signaling, the researchers reveal how epilepsy alters the way brain reacts to stress to cause seizures. (medicalnewstoday.com 15.6.2016).)

- Effekter av antiepileptiske legemidler (antiepileptika) på mitokondrielle funksjoner, morfologi, kinetikk, biogenese og overlevelse.

(Anm: Effects of antiepileptic drugs on mitochondrial functions, morphology, kinetics, biogenesis, and survival. Abstract OBJECTIVES: Antiepileptic drugs (AEDs) exhibit adverse and beneficial effects on mitochondria, which have a strong impact on the treatment of patients with a mitochondrial disorder (MID) with epilepsy (mitochondrial epilepsy). This review aims at summarizing and discussing recent findings concerning the effect of AEDs on mitochondrial functions and the clinical consequences with regard to therapy of mitochondrial epilepsy and of MIDs in general. (…) CONCLUSIONS: Mitochondrial epilepsy might be initially treated with AEDs with low mitochondrial toxic potential. Only in case mitochondrial epilepsy is refractory to these AEDs, AEDs with higher mitochondrial toxic potential might be tried. In patients carrying POLG1 mutations AEDs with high mitochondrial toxic potential are contraindicated. Epilepsy Res. 2017 Jul 13;136:5-11.)

(Anm: Mitokondriell dysfunksjon (mitokondriedysfunksjon) indusert av sertraline (Zoloft), et antidepressiva (Mitochondrial dysfunction induced by sertraline, an antidepressant agent) Toxicol Sci. 2012 Jun;127(2):582-91. Epub 2012 Mar 2.)

(Anm: Kan Lupus øke risikoen for demens? Could lupus raise dementia risk? People living with lupus may be at significantly greater risk of developing dementia than those without the autoimmune disease, a new study suggests. (…) Study co-author Daniela Amital, of the Sackler Faculty of Medicine at Tel Aviv University in Israel, and colleagues recently reported their results in the International Journal of Geriatric Psychiatry. (medicalnewstoday.com 9.11.2017).)

(Anm: Antidepressiva ökar risken för benbrott hos äldre. (…) Den förhöjda risken för höftfraktur gällde alla de vanliga antidepressiva läkemedlen, SSRI-preparat, mirtazapin och SNRI-preparat (selektiva serotonin- och noradrenalinåterupptagshämmare. Sambandet gällde även då det kontrollerats för andra faktorer som ålder, annan medicinering som ökar fallrisken, benskörhet, socioekonomisk status, kroniska sjukdomar och psykiatriska diagnoser.) (lakemedelsvarlden.se 12.1.2017).)

(Anm: Links between autism and epilepsy deepen. Over recent years, medical research has uncovered a number of links between autism and epilepsy. The latest study investigating this relationship demonstrates that having a relative with epilepsy is a risk factor for autism. (…) Family links between autism and epilepsy. The new study, published this week in Neurology, investigates whether having a relative with epilepsy might increase the risk of an autism diagnosis. (medicalnewstoday.com 16.6.2016).)

- Metabolic and Homeostatic Changes in Seizures and Acquired Epilepsy-Mitochondria, Calcium Dynamics and Reactive Oxygen Species.

(Anm: Metabolic and Homeostatic Changes in Seizures and Acquired Epilepsy-Mitochondria, Calcium Dynamics and Reactive Oxygen Species. Abstract Acquired epilepsies can arise as a consequence of brain injury and result in unprovoked seizures that emerge after a latent period of epileptogenesis. These epilepsies pose a major challenge to clinicians as they are present in the majority of patients seen in a common outpatient epilepsy clinic and are prone to pharmacoresistance, highlighting an unmet need for new treatment strategies. Metabolic and homeostatic changes are closely linked to seizures and epilepsy, although, surprisingly, no potential treatment targets to date have been translated into clinical practice. We summarize here the current knowledge about metabolic and homeostatic changes in seizures and acquired epilepsy, maintaining a particular focus on mitochondria, calcium dynamics, reactive oxygen species and key regulators of cellular metabolism such as the Nrf2 pathway. Finally, we highlight research gaps that will need to be addressed in the future which may help to translate these findings into clinical practice. Int J Mol Sci. 2017 Sep 8;18(9). pii: E1935.)

- New method identifies brain regions most likely to cause epilepsy seizures.

(Anm: New method identifies brain regions most likely to cause epilepsy seizures. Mathematical approach could pinpoint which brain tissue should be removed during surgical treatment. Scientists have developed a new way to detect which areas of the brain contribute most greatly to epilepsy seizures, according to a PLOS Computational Biology study. The strategy, devised by Marinho Lopes of the University of Exeter and colleagues, could help surgeons select specific brain areas for removal to stop seizures. (medicalnewstoday.com 17.8.2017).)

(Anm: New guidelines provide practical information on sudden unexpected death in epilepsy. There is an uncommon risk of death that people with epilepsy and their loved ones may not know about. The risk is called sudden unexpected death in epilepsy, or SUDEP. Now the American Academy of Neurology (AAN) and the American Epilepsy Society have co-developed a new guideline on SUDEP, published in the April 24, 2017, online issue of Neurology, the medical journal of the American Academy of Neurology, and presented at the 69th AAN Annual Meeting in Boston, April 22 to 28, 2017. The guideline is endorsed by the International Child Neurology Association. (news-medical.net 25.4.2017).)

(Anm: New research on functional brain networks offers insights into causes and symptoms of epilepsy. Epilepsy is a complex neurological disorder that afflicts approximately 50 million people worldwide. Although this disease has been known to exist for centuries, the exact mechanism of its cardinal symptom, the epileptic seizure, remains poorly understood. In fact, roughly 25 percent of epileptic seizures can't be controlled by any of the therapies available today. (news-medical.net 27.4.2017).)

- Vanlig parasitt linket til epilepsi og andre hjernelidelser.

(Anm: Common parasite linked to epilepsy and other brain disorders. Toxoplasma gondii (T. gondii) is a very common parasite that is often associated with cats and is thought to cause very few symptoms and no serious effects in humans. However, research led by the University of Chicago has now shown that it might, in fact, play a role in the development of epilepsy and other brain disorders. The findings are published in the journal Scientific Reports. T. gondii is able to live in the brain cells of nearly all warm-blooded animals. Evidence shows that 30-50% of the world population is infected with T. gondii, but most people aren’t aware of it. Occasionally, however, it causes a condition called toxoplasmosis, and if a woman is infected before or during pregnancy, the parasite can, in rare cases, seriously harm the brain and eyes of the developing child. (…) The latest study, which involved 32 scientists across 16 institutions, used a database containing information about 246 people who had become infected with T. gondii in the womb. The team searched for parasite-generated signs (known as biomarkers) that were not present in an unaffected group of people and examined their probable impact on health. (…) In addition, the researchers found evidence that T.gondii proteins can disrupt GABA signalling, thus disturbing the balance between excitation and inhibition in the brain and increasing the risk of epileptic seizures. (…) You can read about the harmful effects of T. gondii in other animals here. Click here for more epilepsy news. (epilepsyresearch.org.uk 15.9.2017).)

- Epilepsi og barn: - Feildiagnostisering kan skje begge veier ved at man får epilepsi uten å ha det, eller motsatt. (- Forskerne som jobbet med denne studien brukte data fra 114 500 barn fra den norske mor og barn-undersøkelsen. Kilden for å finne barn med epilepsi var Norsk pasientregister. Etter at diagnosene var kvalitetssikret, fant forskerne ut at en tredel av barna ikke oppfylte kriteriene for en epilepsidiagnose.)

Epilepsi og barn: - Feildiagnostisering kan skje begge veier ved at man får epilepsi uten å ha det, eller motsatt
kk.no 3.5.2017
Mange barn har epilepsi, en sykdom det kan være vanskelig å diagnostisere. Feildiagnostisering kan gi uheldige konsekvenser.

Blant 1000 norske barn vil fire-fem ha epilepsi, som er den mest vanlige kroniske nevrologiske sykdommen hos barn. Men ifølge en ny studie fra Folkehelseinstituttet, har mange blitt feildiagnostisert. (Psst: Infeksjon hos gravide kan gi økt risiko for epilepsi)

Forskerne som jobbet med denne studien brukte data fra 114 500 barn fra den norske mor og barn-undersøkelsen. Kilden for å finne barn med epilepsi var Norsk pasientregister. Etter at diagnosene var kvalitetssikret, fant forskerne ut at en tredel av barna ikke oppfylte kriteriene for en epilepsidiagnose.

 Alle barna som var registrert med epilepsidiagnoser uten å fylle kriteriene for epilepsi hadde vært til utredning med mistanke om epilepsi. Men det var få av disse, kun én av seks, som ble gitt en epilepsidiagnose av en barnelege, sier Kari Modalsli Aaberg, spesialist i barnesykdommer og rådgiver i FHI.

I Norsk pasientregister registreres alle diagnoser som settes i spesialhelsetjenesten – disse rapporteres fortløpende, og endres ikke i ettertid, selv om den kliniske diagnosen endres. Ved enhver kontakt med spesialisthelsetjenesten må det settes en diagnose som så rapporteres inn.
– Dette betyr at de fleste av disse barna og foreldrene ikke fikk beskjed av legen om at barnet hadde epilepsi, men at barnet ble utredet med mistanke om epilepsi.

LES OGSÅ: Emily (6) er født med alvorlig epilepsi (…)

- Epileptikere har vært en neglisjert pasientgruppe. Når du som pasient sier til folk at du har epilepsi, så eksisterer det fortsatt mange myter.

Epilepsi og epilepsikirurgi - «Den største nyheten i moderne epilepsihistorie». Mammaen til Luna håper ingen må kjempe samme kamp
dagbladet.no 16.2.2017
- Nå kan pasientene slå i bordet.  (Dagbladet): - Epileptikere har vært en neglisjert pasientgruppe. Når du som pasient sier til folk at du har epilepsi, så eksisterer det fortsatt mange myter.

Det sier nevrolog Karl O. Nakken ved Spesialsykehuset for Epilepsi til Dagbladet. Han har - på Den internasjonale epilepsidagen mandag - nettopp presentert en ny retningslinje for behandling, oppfølging og kirurgi av pasienter med epilepsi.

Den gjør at omlag 45 000 epilepsirammede nordmenn vil kunne slå i bordet med ei liste over hva slags behandling de har krav på, dersom de opplever liten oppfølging fra sykehusene. (…)

- Har vært smertelig klar
Et av hovedpunktene er at pasienter som har forsøkt to, tre medisiner mot sin epilepsiform uten effekt, nå skal umiddelbart sendes videre til Spesialsykehuset for epilepsi (SSE) for kirurgivurdering.

(Anm: Infantile spasmer, også kalt Wests syndrom, er en karakteristisk epileptisk tilstand. Den debuterer i første leveår mellom 3 og 12 måneders alder. (nhi.no 13.2.2017).)

(Anm: Moren filmet datteren - avslørte alvorlig sykdom. Deler hjerteskjærende. video for å advare. (…) Ved første øyekast kan det se ut som at lille Olivia fra Ryhl i Wales pludrer som babyer flest. Men hver gang hun tar hendene over hodet, får hun et alvorlig epileptisk anfall. Det vet ikke moren som filmer henne. (vg.no 13.2.2017).)

(Anm: How stress increases seizures for patients with epilepsy. It is well known that stress can increase the frequency and severity of seizures for patients with epilepsy. Now, researchers have shed light on why this is, and they may have even found a way to stop it. Published in the journal Science Signaling, the researchers reveal how epilepsy alters the way brain reacts to stress to cause seizures. (medicalnewstoday.com 15.6.2016).)

- Ökad risk för autism bland epileptiker. Personer med epilepsi löper högre risk att utveckla autism – särskilt kvinnor och dem som haft epilepsi under barndomen. – Att risk för autism ökar vid epilepsi under barndomen beror förmodligen på att epilepsier som debuterar under barndomen oftare är en del av en neurologisk utvecklingsstörning som många gånger är associerad med autism.

(Anm: Ökad risk för autism bland epileptiker. Personer med epilepsi löper högre risk att utveckla autism – särskilt kvinnor och dem som haft epilepsi under barndomen. – Att risk för autism ökar vid epilepsi under barndomen beror förmodligen på att epilepsier som debuterar under barndomen oftare är en del av en neurologisk utvecklingsstörning som många gånger är associerad med autism, säger Heléne Sundelin, barnneurolog och doktorand vid Institutionen för medicinska vetenskaper vid Örebro universitet. Resultaten i hennes avhandling tyder också på ett tvåvägssamband mellan epilepsi och autism. – Studien visar att autism och epilepsi har ett överlappande arv. Det innebär att det förmodligen är samma sjukdomsmekanismer som ligger bakom att en person kan utveckla autism, epilepsi eller både och, säger hon. Syftet med avhandlingen är att visa att sjukdomar i hjärnan kan dela bakomliggande orsaker och få konsekvenser vid graviditet och ge ökad risk för skador i trafiken. (netdoktor.se 6.9.2017).)

(Anm: 'Sudden Adult Death' May Have Mitochondrial Origin. —Some cases of unexplained sudden death can be traced to a common mitochondrial defect. (medpagetoday.com 22.4.2015).)

(Anm: Mitochondria (mitokondrie) (mitokondriesykdommer) (mitokondrielle sykdommer). (mintankesmie.no).)

(Anm: Linking telomere loss and mitochondrial dysfunction in chronic disease. (…) Drawing a mechanistic connection between telomere function and mitochondria biology will provide a broader perspective for understanding the pathophysiology of diseases and their relation to the aging process, and may provide opportunities for new possible treatments. Front Biosci (Landmark Ed). 2017 Jan 1;22:117-127.)

(Anm: Extreme short and long telomeres linked to increased cancer risk (news-medical.net 5.4.2017).)

(Anm: Scientists discover master regulator of cellular aging. (…) "Telomeres represent the clock of a cell," said TSRI Associate Professor Eros Lazzerini Denchi, corresponding author of the new study, published online in the journal Science. "You are born with telomeres of a certain length, and every time a cell divides, it loses a little bit of the telomere. Once the telomere is too short, the cell cannot divide anymore." (medicalnewstoday.com 13.1.2017).)

(Anm: Betennelser endrer mitokondrier til giftige fabrikker. Å lære hvordan å kontrollere betennelser kan ha store implikasjoner for behandlingen av mange sykdommer. Banebrytende forskning oppdager hvordan makrofager endrer mitokondriene til giftige kjemisk-produserende betennelsespromotører. (Inflammation turns mitochondria into toxic factories. Learning how to control inflammation could have huge implications for the treatment of many diseases. Breaking research discovers how macrophages turn mitochondria into toxic chemical-producing inflammation-promoters.) (medicalnewstoday.com 25.9.2016).)

(Anm: Research may show new ways to repress inflammation at outset. (…) Professor Alexander Weber of the Interfaculty Institute of Cell Biology says the enzyme - Bruton's tyrosine kinase or BTK - is switched on when an inflammation occurs in the body, playing a key role in the inflammation's subsequent development. (medicinenet.com 21.2.2017).)

(Anm: Ørsmå mitokondrier spiller en svært stor rolle mht. menneskets evolusjon og sykdom (Tiny mitochondria play outsized role in human evolution and disease.) (medicalnewstoday.com 25.9.2015).)

(Anm: Mitochondrial dysfunction and seizures: the neuronal energy crisis. (…) An understanding of the reciprocal relation between mitochondrial dysfunction and epilepsy is crucial to select appropriate anticonvulsant treatment and has the potential to open up new therapeutic approaches in the subset of epileptic disorders caused by mitochondrial dysfunction. Lancet Neurol. 2015 Sep;14(9):956-66.)

(Anm: Researchers discover an epilepsy switch. (medicalnewstoday.com 27.10.2015).)

(Anm: Running prevents postnatal side effects of epilepsy drugs in mice. The simple act of running may be sufficient to prevent long-term cognitive impairments caused by prenatal exposure to antiepileptic drugs, according to a study published November 19th in Stem Cell Reports, the journal of the International Society for Stem Cell Research. The findings revealed that prenatal exposure to a commonly used antiepileptic drug called valproic acid (VPA) inhibited the birth of new neurons in the brains of adult mice and impaired their performance on learning and memory tasks. Remarkably, these postnatal side effects were largely prevented when the mice were given access to a running wheel at a young age. (medicalnewstoday.com 20.11.2015).)

(Anm: Animal study shows how exercise may energize brain cell function (medicalnewstoday.com 20.11.2015).)

(Anm: No change in epilepsy incidence in younger patients; increase among elderly. (medicalnewstoday.com 15.2.2016).)

(Anm: ITU og Riget udvikler øresnegl til epileptikere. IT-Universitet og Rigshospitalet er gået sammen om at udvikle en øresnegl, der kan nedsætte antallet af anfald og kraftigheden i anfaldene hos epileptikere. Projektet har hentet knap en halv mio. kr. til et testprojekt på Rigshospitalet. (medwatch.dk 8.6.2016).)

(Anm: New technique could revolutionize surgical treatment of epilepsy. Scientists at the University of Exeter have developed a pioneering new technique that could revolutionise the surgical treatment of epilepsy. (…) The research is published in leading scientific journal, Scientific Reports.  (medicalnewstoday.com 8.7.2016).)

- Fordommer og myter om epilepsi

Utestenges fra arbeidslivet på grunn av fordommer
nrk.no 8.4.2013
Halvparten av alle epileptikere mottar uføretrygd eller annen støndad. Svært mange av de som har epilepsi ønsker seg ut i jobb, men utestenges på grunn av fordommer. (...)

Fordommer og myter om epilepsi
AV: Karl Otto Nakken, Morten I. Lossius
aftenposten.no 2.4.2013
Kunnskapsløshet gir ofte grobunn for fordommer og myter. Mange vegrer seg for å stå frem med epilepsidiagnosen i frykt for å bli stigmatiserte.Fortsatt er det lite kunnskap om epilepsi i befolkningen. Enkelte pasienter forteller at anfallene kan de leve med, men folks reaksjoner på at de har epilepsi er derimot verre. (...)

(Anm: People with epilepsy fear discrimination according to national charity poll (medicalnewstoday.com 29.3.2016).)

(Anm: Epilepsy deaths: 'we have done far too little for far too long' (medicalnewstoday.com 17.12.2015).)

(Anm: Why epilepsy may account for more lost years of life than other brain disorders. Recent studies conclude that people with epilepsy have a 27-fold greater risk of sudden death than people without the disorder. However, many of these deaths could be prevented through greater identification of epilepsy as a cause of death, and in educating the public more effectively about the disease's life-threatening dangers. (medicalnewstoday.com 17.12.2015).)

(Anm: Children with epilepsy are at increased risk of dying early (medicalnewstoday.com 22.12.2015).)

(Anm: Some Psychotic Disorders May Be Induced by Drugs Designed to Combat Effects of Epilepsy. OXFORD, United Kingdom -- August 8, 2016 -- Antiepileptic drugs may induce psychotic disorders in some patients, according to a study published in the journal Brain. People with epilepsy have increased vulnerability to psychiatric problems. However, it is also possible that the drugs used by patients to control their seizures may increase the risk of psychotic symptoms in certain people. (dgnews.docguide.com 8.8.2016).)

- Kan epilepsi kontrolleres metabolsk? (- Can anti-inflammatory therapies be effective against epilepsy?)

Kan epilepsi kontrolleres metabolsk?
Tidsskr Nor Legeforen 2015; 135:1123 (30.6.2015)
Epileptiske anfall hos mus kan kuperes med laktatdehydrogenasehemmere.

Antiepileptika virker på nevronenes ionekanaler eller på reseptorer for nevrotransmittere, men har dårlig effekt hos om lag en tredel av pasientene. Det er vist at for noen kan en ketogen diett hjelpe. Dette har vært bakgrunnen for å undersøke om epilepsianfall kan reduseres ved å hemme enzymet laktatdehydrogenase (LDH) hos mus (1). (…)

– Dette er en spennende studie, sier Karl Otto Nakken, som er overlege ved Spesialsykehuset for epilepsi i Sandvika. – Man har lenge spekulert på om terapiresistent epilepsi blant annet kan skyldes metabolske forstyrrelser i en nevronpopulasjon. Ved vårt sykehus tilbyr vi en ketogen eller modifisert ketogen diett til både barn og voksne med vanskelig kontrollerbar epilepsi. Særlig god effekt av slik diett har pasientgrupper med kjente metabolske encefalopatier, nemlig dem med glukosetransportprotein 1-mangel (GLUT1-deficiency syndrome) og pyruvatdehydrogenasemangel (PDHD), sier han.

– Jeg var ikke kjent med at stiripentol virket anfallsdempende via LDH-hemming. Stiripentol er et «smalt» antiepileptikum som særlig benyttes hos barn med en sjelden og svært terapiresistent myoklonusepilepsi (Dravets syndrom). Kanskje bør derivatet isosafrol bli gjenstand for kliniske utprøvninger, sier Nakken. (…)

(Anm: Can anti-inflammatory therapies be effective against epilepsy? In epileptic patients, seizures lead to an increased level of inflammation-related proteins called chemokines in the brain, and systemic inflammation likely helps trigger and promote the recurrence of seizures, making inflammation a promising new target for anticonvulsant therapy. The latest evidence on one particular chemokine of interest, CCL2, and its potential role in human epilepsy are the focus of an article in DNA and Cell Biology, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free for download on the DNA and Cell Biology website until August 6, 2016. (medicalnewstoday.com 6.7.2016).)

(Anm: PYRUVATE (webmd).)

(Anm: Pyruvat dehydrogenase mangel (Pyruvate Dehydrogenase Deficiency) (rarelink.no).)

(Anm: UiB-forskning: ME-syke har defekt i stoffskiftet. Forskere ved Universitetet i Bergen er ett skritt nærmere forklaring på ME-gåten. (…) Cellene våre benytter normalt karbohydrater, fett og protein (aminosyrer) som energikilder. Dette forbrennes i mitokondriene, som kalles cellenes kraftverk. Når vi trener hardt, får ikke mitokondriene i musklene nok oksygen og det dannes melkesyre. Et spesielt enzym spiller en viktig rolle for cellenes evne til å forbrenne karbohydrater. Akkurat dette enzymet, som heter pyruvat dehydrogenase (PDH), er hemmet i ME-pasienter, noe som kan forklare både energimangel og økt melkesyreproduksjon. Når PDH-enzymet ikke fungerer optimalt, går kroppen løs på andre energikilder i stedet for sukker. Nivået av aminosyrer i cellene blir derfor lavere. Cellene blir også dårligere til å justere forbrenningen ut fra energibehov. (bt.no 1.1.2017).)

- Legemidler indisert for mitokondriell dysfunksjon som behandlinger for akutt encefalopati med utbrudd av feberkramper/ febril status epileptikus.

Drugs indicated for mitochondrial dysfunction as treatments for acute encephalopathy with onset of febrile convulsive status epileptics.
J Neurol Sci. 2016 Jan 15;360:57-60. doi: 10.1016/j.jns.2015.11.043. Epub 2015 Nov 24.
Abstract We studied the efficacy of drugs indicated for mitochondrial dysfunction in the treatment of 21 patients with acute encephalopathy with onset of febrile convulsive status epilepticus at our hospital from January 2006 to December 2014. Among them, 11 patients had been treated with a mitochondrial drug cocktail consisting of vitamin B1, vitamin C, biotin, vitamin E, coenzyme Q10, and l-carnitine (prescription group) and 10 patients were not treated with the cocktail (non-prescription group). We retrospectively reviewed age, trigger, clinical form, treatment start time, and sequelae. Clinical form was classified into a biphasic group presenting acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and a monophasic group. Sequelae were classified as (A) no sequelae group or (B) sequelae group, and differences in the interval between diagnosis and treatment were also evaluated. The sequelae were not different between the mitochondrial drug cocktail prescription and non-prescription groups, but significantly better in the group administered the mitochondrial drug cocktail within 24h (P=0.035). We expect that early treatment with a mitochondrial drug cocktail could prevent sequelae in acute encephalopathy with onset of febrile convulsive status epilepticus. (…)

- Fungerer biotin for hårvekst? Dosering og bivirkninger. Biotin, eller B7, er et essensielt B-vitamin som hjelper kroppen til å få energi og næringsstoffer fra karbohydrater, proteiner og fettstoffer.

(Anm: Does biotin for hair growth work? Dosage and side effects. Biotin, or B7, is an essential B vitamin that helps the body get energy and nutrients from carbohydrates, proteins, and fats. Gastrointestinal bacteria usually produce enough biotin to meet bodily needs. Many foods also contain small amounts of biotin, including whole wheat, egg yolks, nuts, and legumes. (medicalnewstoday.com 16.9.2017).)

- Vitamin B-3-mangel: Symptomer, årsaker og behandling. Vitamin B-3 mangel kan forstyrre dusinvis av prosesser i kroppen og kan føre til en sykdom kalt pellagra.

(Anm: Vitamin B-3 deficiency: Symptoms, causes, and treatment. Vitamin B-3 deficiency can disrupt dozens of processes in the body and can lead to a disease called pellagra. Vitamin B-3, also known as niacin, plays a key role in skin, digestive, and mental health, and supports the functions of more than 200 enzymes in the body. Vitamin B-3 is a combination of two chemicals: nicotinic acid and nicotinamide. The body breaks these chemicals down to produce two additional chemicals: NAD and NADP. NAD and NADP play a role in a variety of chemical reactions inside the body and also support cell metabolism. So, people who don't get enough vitamin B-3 can experience a range of health problems and symptoms, ranging from minor to life-threatening. (medicalnewstoday.com 16.9.2017).)

(Anm: Pellagra er en sjelden mangelsykdom, forårsaket av mangel på niacin (Vitamin B3) i kroppen. Dette kan skyldes redusert inntak av niacin eller aminosyrene tryptofan og leucin. Sykdommen kan ses blant annet ved ensidig kosthold med mais, og ved langvarig alkoholisme. (no.wikipedia.org).)

(Anm: Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice. Abstract Glaucomas are neurodegenerative diseases that cause vision loss, especially in the elderly. The mechanisms initiating glaucoma and driving neuronal vulnerability during normal aging are unknown. Studying glaucoma-prone mice, we show that mitochondrial abnormalities are an early driver of neuronal dysfunction, occurring before detectable degeneration. Retinal levels of nicotinamide adenine dinucleotide (NAD+, a key molecule in energy and redox metabolism) decrease with age and render aging neurons vulnerable to disease-related insults. Oral administration of the NAD+ precursor nicotinamide (vitamin B3), and/or gene therapy (driving expression of Nmnat1, a key NAD+-producing enzyme), was protective both prophylactically and as an intervention. At the highest dose tested, 93% of eyes did not develop glaucoma. This supports therapeutic use of vitamin B3 in glaucoma and potentially other age-related neurodegenerations. Science. 2017 Feb 17;355(6326):756-760.)

(Anm: Forsker: Hjerneceller kan påvirke hinanden uden at have kontakt. Nerveceller kan sende bølger af aktivitet gennem hjernen via elektriske felter uden at være forbundne, viser ny forskning. Det kan åbne op for en ny forståelse af sygdomme som epilepsi, vurderer forskere. (…) Det er en vigtig opdagelse, da det giver os en mere komplet forståelse af, hvordan hjerneceller kommunikerer og påvirker hinanden, konkluderer forskerne bag undersøgelsen. (videnskab.dk 23.2.2016).)

(Anm: Can Neural Activity Propagate by Endogenous Electrical Field? J Neurosci. 2015 Dec 2;35(48):15800-11.)

(Anm: Vitamin C can target and kill cancer stem cells, study shows. Cancer is currently one of the top killers worldwide, and the number of cancer cases is only expected to rise. Although there are a number of therapies available, most of them are toxic and cause serious side effects. New research examines the impact of the natural vitamin C on cancer cell growth. (…) New research, published in the journal Oncotarget, examines the effectiveness of three natural substances, three experimental drugs, and one clinical drug in stopping the growth of these cancer stem cells (CSCs.) (…) Vitamin C up to 10 times more effective than experimental drugs. (…) "We have been looking at how to target cancer stem cells with a range of natural substances including silibinin (milk thistle) and CAPE, a honey-bee derivative, but by far the most exciting are the results with vitamin C. Vitamin C is cheap, natural, nontoxic and readily available so to have it as a potential weapon in the fight against cancer would be a significant step." (medicalnewstoday.com 13.3.2017).)

(Anm: Vitamin C modulates the immunotoxic effect of 17 alpha-methyltestosterone in Nile tilapia. Abstract. The synthetic androgen, 17 alpha-methyltestosterone (MT), is profusely used and practically needed in the production of all-male Nile tilapia fry; however, such androgenic hormones badly disrupt the immune system. This study aimed to alleviate or counteract the immunotoxic effect of MT using vitamin C (ascorbic acid, vit C). Biochemistry. 2017 Mar 21.)

(Anm: How does broccoli help prevent cancer? Study sheds light. Researchers from Oregon State University (OSU) found that sulforaphane reduced the expression of long noncoding RNAs (lncRNAs) in prostate cancer cells, which disrupted the cells' ability to form colonies - a hallmark of metastatic cancer. Previously believed to be "junk DNA" with no significant function, lncRNAs have increasingly emerged as key players in the development of numerous cancers, including prostate, breast, stomach, and lung cancers. (medicalnewstoday.com 18.3.2017).)

- Valproat (Orfiril) og forverring av mitokondrielle sykdommer

5. Valproat og relaterede stoffer – Mitokondriel toksicitet (EPITT nr. 17956)
ema.europa.eu (22. januar 2015 EMA/PRAC/63323/2015 Udvalget for Risikovurdering inden for Lægemiddelovervågning)
PRAC's anbefalinger om signaler til ajourføring af produktinformationen Vedtaget den 6.-9. januar 2015, PRAC

På baggrund af data fra indehaverne af markedsføringstilladelse og rådgivning fra arbejdsgruppen vedrørende farmakogenomik konkluderede PRAC, at der er tilstrækkelig evidens for en årsagssammenhæng mellem valproat og forværring af underliggende mitokondrielle sygdomme, herunder risikoen for hepatotoksicitet, der hovedsagelig forekommer hos patienter med mutationer af POLG (polymerase gamma).  (…)

4.3.Kontraindikationer
Valproat er kontraindiceret hos patienter med mitokondrielle sygdomme forårsaget af mutationer i det kernegen, der koder for det mitokondrielle enzym polymerase γ (POLG), f.eks. Alpers-Huttenlocher syndrom, og hos børn under 2 år, som formodes at have en POLG-relateret sygdom (se pkt. 4.4).

5. Valproat og relaterede stoffer – Mitokondriel toksicitet (EPITT nr. 17956)

På baggrund af data fra indehaverne af markedsføringstilladelse og rådgivning fra arbejdsgruppen vedrørende farmakogenomik konkluderede PRAC, at der er tilstrækkelig evidens for en årsagssammenhæng mellem valproat og forværring af underliggende mitokondrielle sygdomme, herunder risikoen for hepatotoksicitet, der hovedsagelig forekommer hos patienter med mutationer af POLG (polymerase gamma).

Indehaverne af markedsføringstilladelse for lægemidler indeholdende valproat (og relaterede stoffer) skal inden 2 måneder indsende en ansøgning om ændring af produktinformationen som beskrevet i det følgende (ny tekst er understreget). (…)

(Anm: Mitochondria (mitokondrie) (mitokondriesykdommer) (mitokondrielle sykdommer). (mintankesmie.no).)

(Anm: Ny granskning av valproatanvändning under graviditet och hos kvinnor i fertil ålder. Den europeiska läkemedelsmyndigheten (EMA) har inlett en granskning av användningen av läkemedel som innehåller valproat för behandling av flickor och kvinnor som är eller kan bli gravida. Dessa läkemedel är godkända nationellt inom EU för behandling av epilepsi, bipolär sjukdom och i vissa länder migrän, och har tidigare granskats av EMA. (lakemedelsverket.se 13.3.2017).)

(Anm: Tusindvis af franske børn fik fosterskader af epilepsimedicin. Nye undersøgelser viser nu, at op til 4100 børn har fået svære fosterskader, siden medicinen første gang blev bragt på markedet i 1967. (...) Gravide kvinder har taget Sanofi-middel trods risiko for fosterskader (...) Medicinalfirmaerne Sanofi-Aventis, Orion Pharma og Desitin Pharma udsendte allerede for halvandet år siden skærpede advarsler om lægemidler, der indeholder Valproat. Det gælder for eksempel Deprakine og Delepsine. (medwatch 20.4.2017).

(Anm: Thalidomide (Thalidomid) informasjon vs kunnskap og visdom - hvem visste hva? (mintankesmie.no).)

(Anm: Linking telomere loss and mitochondrial dysfunction in chronic disease. (…) Drawing a mechanistic connection between telomere function and mitochondria biology will provide a broader perspective for understanding the pathophysiology of diseases and their relation to the aging process, and may provide opportunities for new possible treatments. Front Biosci (Landmark Ed). 2017 Jan 1;22:117-127.)

(Anm: Extreme short and long telomeres linked to increased cancer risk (news-medical.net 5.4.2017).)

(Anm: Scientists discover master regulator of cellular aging. (…) "Telomeres represent the clock of a cell," said TSRI Associate Professor Eros Lazzerini Denchi, corresponding author of the new study, published online in the journal Science. "You are born with telomeres of a certain length, and every time a cell divides, it loses a little bit of the telomere. Once the telomere is too short, the cell cannot divide anymore." (medicalnewstoday.com 13.1.2017).)

(Anm: Betennelser endrer mitokondrier til giftige fabrikker. Å lære hvordan å kontrollere betennelser kan ha store implikasjoner for behandlingen av mange sykdommer. Banebrytende forskning oppdager hvordan makrofager endrer mitokondriene til giftige kjemisk-produserende betennelsespromotører. (Inflammation turns mitochondria into toxic factories. Learning how to control inflammation could have huge implications for the treatment of many diseases. Breaking research discovers how macrophages turn mitochondria into toxic chemical-producing inflammation-promoters.) (medicalnewstoday.com 25.9.2016).)

(Anm: Research may show new ways to repress inflammation at outset. (…) Professor Alexander Weber of the Interfaculty Institute of Cell Biology says the enzyme - Bruton's tyrosine kinase or BTK - is switched on when an inflammation occurs in the body, playing a key role in the inflammation's subsequent development. (medicinenet.com 21.2.2017).)

(Anm: Ørsmå mitokondrier spiller en svært stor rolle mht. menneskets evolusjon og sykdom (Tiny mitochondria play outsized role in human evolution and disease.) (medicalnewstoday.com 25.9.2015).)

(Anm: Valproat og hyperammonemi Hyperammonemi er en kjent og potensielt alvorlig bivirkning av valproatbehandling. I 2014 ble det mottatt tre meldinger om dette hos barn. (legemiddelverket.no 5.5.2015).)

(Anm: New findings reveal the interplay between epilepsy and aging (medicalnewstoday.com 8.12.2015).)

(Anm: Valproic acid after five decades of use in epilepsy: time to reconsider the indications of a time-honoured drug. (…) However, during the past few years increasing evidence has accumulated that intake of valproic acid during pregnancy is associated with a significant risk of dose-dependent teratogenic effects and impaired postnatal cognitive development in children. Because of these risks, valproic acid should not be used as a first-line drug in women of childbearing potential whenever equally or more effective alternative drugs are available—as in the case of focal epilepsy. Lancet Neurology 2016;15(2):210–218 (February 2016).)

(Anm: Prevensjon for kvinner som bruker antiepileptika. De fleste kvinner i fertil alder vil ha sikker prevensjon. Dette er særlig viktig hos kvinner med epilepsi, fordi noen antiepileptiske legemidler kan ha fosterskadelige effekter. Når man kombinerer hormonell antikonsepsjon med antiepileptiske midler, må man kjenne til at noen antiepileptika kan redusere effekten av hormonelle prevensjonsmidler – og omvendt, noe som kan resultere i nedsatt effekt av begge legemidlene. Ikke-hormonell prevensjon, som kobberspiral og barrieremetoder, kan imidlertid trygt brukes i denne pasientgruppen.Tidsskr Nor Legeforen 2016; 136:32 – 4 (12.1.2016).)

- Toksisitet av valproic acid (Valproate; Orfiril) på mitokondrier i isolerte rottlever

Toxicity of valproic acid in isolated rat liver mitochondria (Toksisitet av valproic acid (Valproate; Orfiril) på mitokondrier i isolerte rottlever)
Toxicol Mech Methods. 2013 Jul 2. [Epub ahead of print]
Abstract Valporic acid (VPA), an anticonvulsant and mood-stabilizing drug, is widely used for treatment of different types of seizures and myoclonic epilepsy. Several mechanisms have been suggested for VPA hepatotoxicity and most of them are associated with oxidative stress. It seems that oxidative stress by VPA treatment has been associated with mitochondrial dysfunction. Therefore, the present study investigated the mitochondrial toxicity mechanisms of VPA on freshly isolated rat mitochondria for better understanding pathogenesis of VPA in mitochondrial toxicity. Rat liver mitochondria were obtained by differential ultracentrifugation and were then incubated with different concentrations of VPA (25-200 µM). Our results showed that VPA could induce oxidative stress via rising in mitochondrial ROS formation, lipid peroxidation, mitochondrial membrane potential collapse, mitochondrial swelling and finally release of cytochrome c. These effects were well inhibited by pretreatment of isolated mitochondria with Cyclosporin A (CsA) and Butylatedhydroxytoluene (BHT). Based on these results, it is clear that VPA exerts mitochondrial toxicity by impairing mitochondrial functions leading to oxidative stress and cytochrome c expulsion which start cell death signaling. (...)

(Anm: Valproat og hyperammonemi Hyperammonemi er en kjent og potensielt alvorlig bivirkning av valproatbehandling. I 2014 ble det mottatt tre meldinger om dette hos barn. (legemiddelverket.no 5.5.2015).)

- Tusenvis av kvinner tok Sanofis legemiddel mot epilepsi til tross for risikoen for fosterskader: media

Thousands of women took Sanofi epilepsy drug despite risk to fetuses: media
reuters.com 9.8.2016
Mer enn 10 000 gravide kvinner i Frankrike tok Sanofi legemiddel Depakine (Orfiril; valproat; valproate) mot epilepsi mellom 2007 og 2014 selv om risikoen for fostermisdannelser var kjent, ifølge en studie sitert av det ukentlige franske satiriske Le Canard Enchaine. (More than 10,000 pregnant women in France took Sanofi's anti-epilepsy drug Depakine between 2007 and 2014 although the risk of fetus malformation was known, according to a study quoted by French satirical weekly Le Canard Enchaine.)

Ukebladet rapporterte at det franske helsedepartementet hadde forsinket offentliggjøring av studien, hvilket departement benekter. (The weekly reported that the French health ministry had delayed publication of the study, which the ministry denied.)

Departementet bekreftet i en uttalelse at en studie ble utført av den nasjonale legemiddelkontrollen ANSM og helseforsikringsbyrået CNAMTS, men la til at den ikke hadde blitt skjult for familier og at første del av studien ville bli presentert den 24. august. (The ministry confirmed in a statement that a study was done by national drug agency ANSM and health insurance agency CNAMTS but added that it had not been hidden from families and that a first part of the study would be presented on August 24.)

Departementet sa det ville vurdere hvilke tiltak som trenges og at hele studien og en handlingsplan basert på dette ville bli offentliggjort i september. (The ministry said it would study measures that needed to be taken and that the full study and an action plan based on it would be made public in September.)

Sanofi sier firmaet ikke var oppmerksom på dataene i studien, og ikke kunne kommentere dem. (Sanofi said the company was not aware of the data in the study and could not comment on it.)

En talskvinne for Sanofi fortalte nyhetsbyrået Reuters at firmaet var blitt klar over risikoen for fostermisdannelser i 1980, og at disse hadde blitt detaljert redegjort for i legemidlets dokumentasjon. A (Sanofi spokeswoman told Reuters that the firm had become aware of the risk of fetus malformation in the 1980s and that these had been spelled out in the drug's documentation.) (…)

(Anm: Gravida fick läkemedel trots risker. Trots att risken för biverkningar i form av fosterskador var kända fick över 14 000 gravida kvinnor i Frankrike ett läkemedel mot epilepsi under åren 2007-2014, enligt en studie som gjorts av franska staten. (...) Läkemedlet Depakine har tillverkats av Sanofi och innehåller den aktiva substansen valproinsyra, som kan öka risken för autism, utvecklingsstörningar och deformerade ansiktsdrag. (dagensmedicin.se 25.8.2016).)

- Fransk läkemedelsskandal berör hela Europa

Fransk läkemedelsskandal berör hela Europa
lakemedelsvarlden.se 30.8.2016
Tiotusentals gravida fransyskor har fått läkemedel innehållande valproinsyra, trots risken för fosterskador. Nu förbereder offren en stämning mot tillverkaren Sanofi. (…)

Däremot anges inte hur många barn som kan ha fötts med missbildningar på grund av medicineringen. Siffror från det franska Läkemedelsverket anger dock att 10 procent av de utsatta fostren kan födas med missbildningar och att mellan 30 och 40 procent kan drabbas av utvecklingsstörningar, som autism. (...)

– Den historien berörde framförallt Frankrike. Nu står vi inför ett problem som berör Europa. Och världen, säger Dominique Martin till Europe 1.

När det gäller valproinsyra är Frankrike inte det enda landet som tycks ha reagerat långsamt. Inte förrän i slutet av 2014 beslutade EUs medlemsländer om särskilda regler vid förskrivning av substansen. (…)

(Anm: Valproat eller valproinsyre er en fettsyre som brukes som et antiepileptikum. I tillegg til anfallsforebyggende behandlnig ved epilepsi, brukes legemiddelet ved bipolar lidelse (også behandling av akutt mani) og migrene. Valproat markedsføres i Norge under merkenavnene Orfiril (Desitin Arzneimittel GmbH) og Deprakine (Sanofi-Aventis). (no.wikipedia.org).)

(Anm: Valproate (VPA), and its valproic acid, sodium valproate, and divalproex sodium forms, are medications primarily used to treat epilepsy and bipolar disorder and to prevent migraine headaches.[2] It is useful for the prevention of seizures in those with absence seizures, partial seizures, and generalized seizures. It can be given intravenously or by mouth. Long acting formulations exist.[2] (...) In much of Europe, Depakine and Depakine Chrono (tablets) are equivalent to Epilim and Epilim Chrono above. (en.wikipedia.org).)

(Anm: TEST UTVIKLET FOR Å OPPDAGE FARLIGE BIVIRKNINGER SLIK AT FÆRRE PASIENTER GIS UTRYGGE LEGEMIDLER (Test aims to detect dangerous side effects so that fewer patients are given unsafe drugs) (medicalnewstoday.com 19.12.2014).)

(Anm: Statlig legemiddelkontroll (Statens legemiddelverk etc.) (mintankesmie.no).)

(Anm: Statlig hvitvasking av legemiddelinformasjon (Tidsskr Nor Legeforen 2010; 130:368 (25.2.2010).)

(Anm: Forskning bliver farlig, når de negative resultater glemmes. (…) Nyt dansk studie viser problemet. (...) For få negative resultater leder til falske konklusioner. (…) Manglende negative resultater har kostet liv. (…) Vores model viser, at vi er nødt til at få publiceret mindst 20 procent af de negative resultater, der produceres inden for hvert forskningsfelt, hvis vi skal undgå at lave falske antagelser om videnskabelig fakta. (videnskab.dk 5.1.2017).)

(Anm: Legemiddelindustriens fortjeneste var nesten det dobbelte av utgifter til forskning og utvikling (FoU-utgifter) i 2013, 2014 og 2015. (Pharmaceutical Industry Profits Are Nearly Double R&D Costs in 2013, 2014 and 2015) (…) En primær unnskyldning som legemiddelindustrien bruker for «prisøkning» er de høye kostnadene for forskning og utvikling (FoU) som disse firmaene betaler for å få nye legemidler på markedet. (citizen.org 27.3.2017).)

- Dette skjoldet av patenter beskytter verdens bestselgende legemiddel.

(Anm: Dette skjoldet av patenter beskytter verdens bestselgende legemiddel. (- Produktet med 16 milliarder dollar i årsomsetning. (...) - Det har dessuten vært tilgjengelig i nærmere 15 år. (…) Den virkelige utfordringen var den tilsynelatende ugjennomtrengelige festningen av patenter som AbbVie metodisk har bygget rundt sin verdsatte pengemaskin. (…) Humira, som står for mer enn 60 prosent av AbbVies inntekter har en listepris på mer enn 50 000 dollar per pasient. (bloomberg.com 7.9.2017).)

(Anm: Myten om mediers åpenhet. Hvorfor er virkelig fordomsfri og frisinnet debatt uvanlig? Hvorfor så få nye, uavhengige meningsytrere? Hvorfor møter mediene dem dels med motstand, dels med taushet? (aftenposten.no 7.9.2006).)

(Anm: Er det en reproduserbarhetskrise i vitenskapelig forskning? (Is there a reproducibility crisis in science?) (…) Nyere studier, som undersøkte en rekke publiserte legemiddelstudier, klarte å gjenskape resultatene for mindre enn 25 % av dem - og tilsvarende resultater er blitt funnet i andre vitenskapelige disipliner. Hvordan bekjemper vi denne krisen for vitenskapelig ikke-reproduserbarhet? (ed.ted.com).)

(Anm: Spinn i randomiserte kontrollerte studier (RCT) på angstlegemidler (antidepressiva) med et positivt opprinnelig resultat: en sammenligning av bekymringer uttrykt av den amerikanske legemiddelkontrollen FDA og den publiserte litteratur. (Spin in RCTs of anxiety medication with a positive primary outcome: a comparison of concerns expressed by the US FDA and in the published literature.) BMJ Open. 2017 Mar 29;7(3):e012886.)

(Anm: LEGEMIDDELPENGER – FDA er avhengig av industrifinansiering; penger kommer «festet med strikk» (DRUG MONEY. FDA Depends on Industry Funding; Money Comes with “Strings Attached”) (pogo.org 1.12.2016).)

(Anm: LEGEMIDDELPENGER - I FDA-møter er "pasientstemmene" ofte finansiert av legemiddelfirmaer (DRUG MONEY - In FDA Meetings, "Voice" of the Patient Often Funded by Drug Companies) (pogo.org 3.12.2016).)

(Anm: Recommendations to improve adverse event reporting in clinical trial publications: a joint pharmaceutical industry/journal editor perspective. BMJ 2016;355:i5078 (Published 03 October 2016).)

(Anm: - Hadde medisinerne på et tidligere tidspunkt hatt et evolusjonært perspektiv på sin medisinering, ville vi ikke vært i den kritiske situasjon vi er kommet i med hensyn til resistens. (aftenposten.no 22.8.2016).)

(Anm: Antibiotika kan gi flere kroniske sykdommer. (…) Folkehelseinstituttet: – Faren er underkommunisert. – Advarslene er høyst betimelige, sier lege og seniorforsker Merete Eggesbø ved Folkehelseinstituttet. (…) Ifølge Blaser viser ny forskning at det er en sammenheng mellom endringen av den naturlige tarmfloraen vår og utvikling av nye sykdommer som fedme, diabetes, astma,(...) Advarslene er høyst betimelige, sier lege og seniorforsker Merete Eggesbø ved Folkehelseinstituttet. (…) Ifølge Blaser viser ny forskning at det er en sammenheng mellom endringen av den naturlige tarmfloraen vår og utvikling av nye sykdommer som fedme, diabetes, astma, allergi, autisme og mageinfeksjoner. (nrk.no 30.10.2016).)

(Anm: Researchers explore link between gut microbiome and nutrition in autism spectrum disorder. (…) Sharon Donovan, a professor of nutrition at the University of Illinois explains that researchers have started to look at more specific disease states and the microbiome. "We are starting to see links with autism, obesity, diabetes, cardiovascular disease, and almost every disease that is looked at. (news-medical.net 28.4.2017).)

(Anm: Researchers discover new mechanism that causes chronic intestinal inflammation. Researchers at the University Medical Center of Johannes Gutenberg University Mainz and the German Research Center for Environmental Health, Helmholtz Zentrum München have discovered that too much of the oncogene Bcl-3 leads to chronic intestinal diseases. They describe in Nature Communications exactly how it throws the immune system off-balance. Chronic intestinal disorders such as ulcerative colitis and Crohn's disease are caused by the body's own immune defense system. (news-medical.net 28.5.2017).)

(Anm: Forsiktighet kreves ved samtidig forskrivning av antibiotika med psykofarmaka hos eldre pasienter. (…) Antibiotika har flere legemiddelinteraksjoner med psykofarmaka som kan føre til bivirkninger eller behandlingssvikt og betydelig øke kostnadene for behandlinger. (dgnews.docguide.com 3.4.2017).)

(Anm: Antibiotika associeras med högre risk för tarmcancer. (…) Det här är första studien som visar på sambandet mellan antibiotikaanvändning och utveckling av adenom i tjock- och ändtarmen. Studien publiceras i den vetenskapliga tidskriften Gut. (…) Resultatet visade att långvarig antibiotikaanvändning tidigare i livet, i åldern 20 till 59 år, hade samband med diagnostiserade adenom. (lakemedelsvarlden.se 5.4.2017.)

(Anm: For mange retningslinjer for behandlinger er skrevet av eksperter med finansielle konflikter, viser studien. (statnews.com 22.8.2016).)

- Abbvie taber sag om fødselsdefekter. Amerikanske Abbvie må endnu engang til lommerne i en sag om et af selskabets lægemidler. (- Depakote er godkendt mod epilepsi, bipolar lidelse og forebyggelse af migræne.)

(Anm: Abbvie taber sag om fødselsdefekter. Amerikanske Abbvie må endnu engang til lommerne i en sag om et af selskabets lægemidler, der blandt andet bruges til behandling af bipolar lidelse. Denne gang anklages lægemidlet for at medføre fødselsdefekter. Anklagerne fortsætter med at klæbe til Abbvies lægemiddel Depakote, der blandt andet bruges til behandling af bipolar lidelse.Denne gang har selskabet tabt en sag om fødselsdefekter, skriver Reuters.Derfor er Abbvie nu blevet dømt til at betale 15 mio. dollars, knap 100 mio. kr., til 10-årige Stevie Gonzales. Hans mor tog Depakote mod bipolar lidelse under sin gravidtet. Steve Gonzales blev født med spina bifida (rygmarksbrok). Moderen hævder, at hun ikke var advaret tilstrækkeligt om risikoen ved fødselsdefekter ved at indtage Depakote, mens hun var gravid.Søgsmålet var egentlig rettet mod Abbott Laboratories, men Abbvie blev spundet ud af Abbott i 2013, hvor Abbvie overtog alle rettighederne til lægemidlet. I øjeblikket er der 695 søgsmål rettet mod Depakote, oplyser Abbvie.Tilbage i 2012 indgik Abbott et historisk højt forlig på 1,6 mia. dollars med anklager om, at Depakote var blevet markedsført i indikationer, som lægemidlet ikke er godkendt til blandt andet demens. Depakote er godkendt mod epilepsi, bipolar lidelse og forebyggelse af migræne. (medwatch.dk 12.6.2017).)

- Soving på magen «kan øke risikoen for plutselig død ved epilepsi» (- In SIDS patients, impaired arousal secondaryto serotonin deficiency can suppress auto-resuscitation mechanisms and prevent them from lifting or turning their heads when their airway is obstructed by soft bedding in a prone position)

Sleeping on stomach 'may raise risk of sudden death in epilepsy' (Soving på magen "kan øke risikoen for plutselig død ved epilepsi»)
medicalnewstoday.com 25.1.2015
- People with epilepsy who sleep on their stomach may be at much higher risk of sudden unexpected death than those with the disorder who do not sleep in this position. This is according to a new study published in the journal Neurology.

Epilepsy is one of the most common neurological disorders in the US, affecting around 2.3 million adults and 450,000 children. Though epilepsy can occur at any age, onset is most common in young children and older adults.

The condition is characterized by seizures, caused by disturbances to electrical activity in the brain. An individual is usually diagnosed with epilepsy if they experience two or more seizures that are not triggered by an underlying medical condition.

There is currently no cure for epilepsy, but seizures can be managed with medication. However, some people do not respond to such treatment and continue to experience seizures. This is known as chronic uncontrolled epilepsy.

"Sudden unexpected death is the main cause of death in uncontrolled epilepsy and usually occurs unwitnessed during sleep," notes study author Dr. James Tao, of the University of Chicago.

For their research, Dr. Tao and colleagues set out to determine whether sleeping position may affect the risk of sudden unexpected death in epilepsy (SUDEP). (…)

Interventions for SIDS may also be effective for SUDEP

The team adds that their findings suggest the mechanisms behind SUDEP may be similar to those involved in sudden infant death syndrome (SIDS).

Fast facts about epilepsy
Around 1 in 26 people in the US will be diagnosed with epilepsy at some point in their lives

Causes of epilepsy include stroke, brain tumor, traumatic brain injury and central nervous system infections, though in many cases the cause is unclear

Each year, the indirect and direct costs of epilepsy in the US total around $15.5 billion.Learn more about epilepsy

"In SIDS patients, impaired arousal secondary to serotonin deficiency can suppress auto-resuscitation mechanisms and prevent them from lifting or turning their heads when their airway is obstructed by soft bedding in a prone position ," the researchers explain. "As such, positioning susceptible children on their backs at bedtime, as in the 'Back-to-Sleep' campaign, has been highly successful for the prevention of SIDS."

Dr. Tao says adopting a similar strategy may be effective in reducing the risk sudden death in patients with epilepsy. "Our findings highlight an important strategy for preventing sudden unexpected death in epilepsy - that 'back is best,'" he notes. "Using wrist watches and bed alarms designed to detect seizures during sleep may also help prevent these deaths." (…)

(Anm: Serotonin i hjerne og blod (mintankesmie.no).)

(Anm: Serotonin syndrom (SS), kramper, parkinsonisme osv. (forhøyet kroppstemperatur) (mintankesmie.no).)

(Anm: Vitenskapens psykedelika-pushere. Stadig mer penger blir gitt til forskning på LSD, ecstasy og fleinsopp. (…) Forskningen har derfor flyttet bort fra dansegulvet og inn i laboratorier og terapirom. Nye forskningsgrupper etableres, sist ved Yale University, og i Norge har det det siste året dukket opp to studentforeninger i regi av interesseorganisasjonen Emmasofia, på Universitetet i Oslo og ved NTNU. (forskning.no 6.4.2016).)

(Anm: Soving på magen "kan øke risikoen for plutselig død ved epilepsi" (Sleeping on stomach 'may raise risk of sudden death in epilepsy') (medicalnewstoday.com 24.1.2015).)

(Anm: Recovery from brain injury and better sleep go hand in hand. After a traumatic brain injury (TBI), people also experience major sleep problems, including changes in their sleep-wake cycle. A new study shows that recovering from these two conditions occurs in parallel. The study is published in Neurology®, the medical journal of the American Academy of Neurology. (medicalnewstoday.com 23.12.2016).)

(Anm: Plutselig, uventet epilepsirelatert død. Anfallsrelaterte dødsfall ved epilepsi inntreffer ofte plutselig og uventet. Det er særlig unge voksne med lang sykdomsvarighet og hyppige anfall som rammes. Ofte inntreffer dødsfallene i relasjon til et nattlig generalisert tonisk-klonisk krampeanfall. I Norge antas at rundt 30 personer rammes hvert år. Optimalisering av epilepsibehandlingen vil trolig kunne forebygge noen av dødsfallene. Tidsskr Nor Legeforen 2016; 136:131 – 5 (26.1.2016).)

(Anm: 'Sudden Adult Death' May Have Mitochondrial Origin. —Some cases of unexplained sudden death can be traced to a common mitochondrial defect. (medpagetoday.com 22.4.2015).)

(Anm: Mitochondria (mitokondrie) (mitokondriesykdommer) (mitokondrielle sykdommer). (mintankesmie.no).)

(Anm: Linking telomere loss and mitochondrial dysfunction in chronic disease. (…) Drawing a mechanistic connection between telomere function and mitochondria biology will provide a broader perspective for understanding the pathophysiology of diseases and their relation to the aging process, and may provide opportunities for new possible treatments. Front Biosci (Landmark Ed). 2017 Jan 1;22:117-127.)

(Anm: Extreme short and long telomeres linked to increased cancer risk (news-medical.net 5.4.2017).)

(Anm: Scientists discover master regulator of cellular aging. (…) "Telomeres represent the clock of a cell," said TSRI Associate Professor Eros Lazzerini Denchi, corresponding author of the new study, published online in the journal Science. "You are born with telomeres of a certain length, and every time a cell divides, it loses a little bit of the telomere. Once the telomere is too short, the cell cannot divide anymore." (medicalnewstoday.com 13.1.2017).)

(Anm: Betennelser endrer mitokondrier til giftige fabrikker. Å lære hvordan å kontrollere betennelser kan ha store implikasjoner for behandlingen av mange sykdommer. Banebrytende forskning oppdager hvordan makrofager endrer mitokondriene til giftige kjemisk-produserende betennelsespromotører. (Inflammation turns mitochondria into toxic factories. Learning how to control inflammation could have huge implications for the treatment of many diseases. Breaking research discovers how macrophages turn mitochondria into toxic chemical-producing inflammation-promoters.) (medicalnewstoday.com 25.9.2016).)

(Anm: Research may show new ways to repress inflammation at outset. (…) Professor Alexander Weber of the Interfaculty Institute of Cell Biology says the enzyme - Bruton's tyrosine kinase or BTK - is switched on when an inflammation occurs in the body, playing a key role in the inflammation's subsequent development. (medicinenet.com 21.2.2017).)

- Legemiddelbehandling av epilepsi hos voksne

State of the Art
Drug treatment of epilepsy in adults

BMJ 2014;348:g254 (Published 28 February 2014)
Abstract Epilepsy is a serious, potentially life shortening brain disorder, the symptoms of which can be successfully treated in most patients with one or more antiepileptic drug. About two in three adults with new onset epilepsy will achieve lasting seizure remission on or off these drugs, although around half will experience mild to moderately severe adverse effects. Patients with epilepsy, especially the 20-30% whose seizures are not fully controlled with available drugs (drug resistant epilepsy), have a significantly increased risk of death, as well as psychiatric and somatic comorbidities, and adverse effects from antiepileptic drugs. Newer drugs have brought more treatment options, and some such as levetiracetam cause fewer drug interactions and less hypersensitivity than older ones. However, they do not reduce the prevalence of drug resistant epilepsy or prevent the development of epilepsy in patients at high risk, such as those with a traumatic brain injury. The development of antiepileptic drugs urgently needs to be revitalized so that we can discover more effective antiseizure drugs for the treatment of drug resistant epilepsy, including catastrophic forms. Antiepileptogenic agents to prevent epilepsy before the first seizure in at risk patients and disease modifying agents to control ongoing severe epilepsy associated with progressive underlying disease are also needed. (...)

(Anm: Adverse Effects of Antipsychotics and Mood Stabilizers. (psychiatrictimes.com 31.12.2007).)

(Anm: [Adverse events of psychotropic drugs].Seishin Shinkeigaku Zasshi. 2014;116(4):323-31).)

(Anm: Gov't Commits $6 Million to Research on Epilepsy Deaths medpagetoday.com 18.12.2014.)

(Anm: Researchers find potential anti-cancer use for anti-epilepsy drug (medicalnewstoday.com 29.1.2015).)

(Anm: Polycystisk ovariesyndrom (PCOS). PCOS er en tilstand som kjennetegnes av økt nivå av mannlige kjønnshormoner, mange små blærer (cyster) på eggstokkene og sjeldne, uregelmessige menstruasjoner. Mange sliter med overvekt, økt behåring, kviser og nedsatt fruktbarhet. (nhi.no 22.2.2016).)

(Anm: A gut check for PCOS-related obesity. In a mouse model of polycystic ovary syndrome, researchers find links between changes to gut bacteria and obesity, diabetes. (medicalnewstoday.com 9.3.2016).)

(Anm: PCOS kopplas till ökad risk för psykisk sjukdom. Forskare kopplar polycystiskt ovariesyndrom, PCOS, till förhöjd psykisk sjuklighet i en ny studie. Även hos syskon till kvinnor med sjukdomen sågs en liten ökad risk. (dagensmedicin.se 2.9.2016).)

(Anm: Irritabel tarm – fra psykisk til fysisk. (- Dermed er det kanskje ikke så rart at mange fagfolk har sett i psyken for å finne årsakene til lidelsen.) (forskning.no 27.6.2016).)

(Anm: Status Epilepticus in Critically Ill Patients. Abstract Status epilepticus (SE) is a common diagnosis in critically ill patients that may bear significant morbidity and mortality. Nowadays it is defined as continuous seizure activity lasting for more than 5 mins and requiring a specific treatment. A generalised convulsive state is a medical emergency burdened by high mortality, especially in the elderly, because repeated seizures swiftly induce significant metabolic and cardiocirculatory derangement. Two different kinds of SE are commonly recognised, depending on the presence of convulsion: convulsive SE and non-convulsive SE, which have different electroencephalographic patterns and require different therapies. In this review we provide an overview of this intriguing issue, focussing on critically ill patients. EMJ Neurol. 2015;3[1]:96-106.)

(Anm: Unge med epilepsi utsatt for spiseforstyrrelser. Tenåringsjenter og -gutter med epilepsi har oppsøkt hjelp for spiseforstyrrelser i større grad enn jevngamle uten epilepsi. (dagensmedisin.no 1.4.2016).)

– Effekten av p-pillen kan dempes av medisiner og tilskudd

– Effekten av p-pillen kan dempes av medisiner og tilskudd
nrk.no 26.3.2015
Du kan bli gravid selv om du går på p-piller – hvis du går på visse medisiner og kosttilskudd.
– Når man ber om p-piller, får man lite informasjon. Man får vite om bivirkningene man kan få av p-piller, men ikke hva andre legemidler kan gjøre med virkningen av dem, sier Nadja Aarestrup. (…)

Epileptikere utsatt
– Vi har sett flere eksempler på kvinner som har blitt gravide, til tross for at de har brukt p-piller, sier overlege Karl Otto Nakken ved Spesialsykehuset for epilepsi.

Han mener at kunnskapen om å bruke epilepsimedisiner sammen med p-piller må bli bedre. (…)

- Epilepsimedisiner gir sprø knokler

Epilepsimedisiner gir sprø knokler
aftenposten.no 15.3.2006
Pasienter som bruker epilepsimedisiner, er mer skjøre i knoklene enn pasienter som ikke tar slike medisiner. Det viser en ny norsk undersøkelse. (...)

Undersøkelsen
26 kvinner i alderen 55 til 80 år som har epilepsi og som tar medisiner mot sykdommen, er med i undersøkelsen. Kvinnene har brukt samme medikament i minst seks år.

I tillegg har de tatt med seg hver sin venninne som fungerer som kontrollgruppe. Det sikrer at de som får medisin og de som ikke får, er sammenlignbare når det gjelder alder og sosioøkonomisk status.

Alle fylte ut ett spørreskjema, det ble tatt blodprøver og bentettheten ble målt.

alderen 55 til 80 år som har epilepsi og som tar medisiner mot sykdommen, er med i undersøkelsen. Kvinnene har brukt samme medikament i minst seks år.

I tillegg har de tatt med seg hver sin venninne som fungerer som kontrollgruppe. Det sikrer at de som får medisin og de som ikke får, er sammenlignbare når det gjelder alder og sosioøkonomisk status.

Alle fylte ut ett spørreskjema, det ble tatt blodprøver og bentettheten ble målt. (...)

Som i andre land.
- Våre funn er i tråd med undersøkelser gjort i andre land. Kvinner etter overgangsalder som bruker epilepsimedisiner, er en gruppe som har økt risiko for benskjørhet, sier professor Erik Taubøll ved nevrologisk avdeling, nevroklinikken på Rikshospitalet-Radiumhospialet.

Han understreker at resultatene fra den aktuelle undersøkelsen må tolkes med forsiktighet fordi antall kvinner som er med, er lavt, men legger til at siden funnene støttes av internasjonal forskning, er det grunn til å legge vekt på dette.

- De første rapportene om sammenhengen mellom epilepsimedisiner og skjøre ben kom allerede i 1968. Senere har dette vært undersøkt og diskutert i internasjonale fagmiljøer med jevne mellomrom. I undersøkelsen ved Rikshospitalet har de fleste kvinnene brukt en av de mest vanlige medisiner mot epilepsi, Tegretol.

- Mange andre medikamenter ville antagelig gitt samme resultat, så dette gjelder ikke bare en spesifikk medisin, sier Taubøll. Han legger til at pasienter med epilepsi ikke må slutte med medisinene.

- Det vi må diskutere, er hva vi eventuelt skal gjøre for å forebygge dette, sier Taubøll.

Vil finne årsak.
Hvorfor disse medisinene gir økt risiko for benskjørhet og brudd, har forskerne ingen sikker forklaring på.

Vår bensubstans bygges opp og brytes ned hele tiden. Når pasienter tar epilepsimedisiner, går hele denne prosessen raskere. Nedbrytingen blir raskere enn oppbyggingen. Da utvikles benskjørhet.

Nå vil forskerne på Rikshospitalet finne ut mer om dette.

- Vi har startet dyreforsøk hvor vi vil forsøke å finne ut hvilke mekanismer som ligger bak. Finner vi svar, blir det lettere å vite hva vi kan gjøre for å forhindre at dette skjer, sier Taubøll.

Eva Johnsen er på vegne av landets mellom 30 000 og 40 000 epilepsipasienter glad for denne forskningen. Hun har vært generalsekretær i Norsk epilepsiforbund i en årrekke. Nå jobber hun der som rådgiver.

- Jeg har møtt mange både kvinner og menn med epilepsi som er rammet av benskjørhet. Det er flott at det settes søkelys på dette. Mange leger vet ikke mye om dette. Vi må jo informeres om hvordan vi selv kan bidra til å forebygge dette, sier Johnsen. (...)

- Fetal valproate syndrome (FVS)

A male with fetal valproate syndrome and autism
Dev Med Child Neurol. 1997 Sep;39(9):632-4
Fetal valproate syndrome (FVS) is characterized by minor craniofacial anomalies, major organ malformations, and developmental delay. We report on a patient who has a clinical phenotype compatible with both FVS and autism. The presence of an autistic disorder in a previously reported case of FVS and similar findings in our patient suggest that a relation between this known teratogen and autism may exist. (...)

- Man kan ha epilepsilignende kramper uten å ha epilepsi!

Andre årsaker
Sidsel Reimers
aftenposten.no 4.4.2013
Nevrologene Lossius og Nakken gir god informasjon om epilepsi i sin kronikk 2. april. Men jeg savner ett poeng: Man kan ha epilepsilignende kramper uten å ha epilepsi!

Det var bare hell (eller min stahet) at jeg ikke fikk epilepsimiddelet fenytoin og merkelappen epileptiker etter tre ukers undersøkelser på Ullevål sykehus.

Kardiologene påviste rytmeforstyrrelse i hjertet som årsak til krampene. Det reddet mitt liv! Jeg ble satt på hjertebeskyttende medikament, og har levd godt med det i 40 år.

Krampeanfall kan ha andre årsaker enn svikt i sentralnervesystemet. Dette burde Lossius og Nakken tatt med i sin ellers utmerkede formidling av kunnskap om epilepsi. (...)

(Anm: New research links anxiety to seizures (medicalnewstoday.com 2.8.2014).)

(Anm: Camilla trodde hun hadde angst – det var epilepsi. Kjennetegn. Selv om denne typen epilepsi er vanskelig å oppdage, finnes det tegn du kan se etter. (…) – Noen kan se ting som ikke er der, begynne å fikle med ting, svelge, smatte eller vandre rundt i ørska. Etter anfallet bruker personene ofte tid før de er seg selv igjen, og som oftest husker de lite eller ingenting fra anfallet, sier Karl Otto Nakken. Han er overlege ved Spesialsykehuset for epilepsi ved Oslo universitetssykehus. – Noen ganger kan det forveksles med dagdrømming, legger han til. (nrk.no 28.1.2017).)

- Er EEG en nyttig undersøkelse i voksenpsykiatrien?

Er EEG en nyttig undersøkelse i voksenpsykiatrien?
Tidsskr Nor Legeforen 2013; 133:1200 – 4 (11.6.2013)
BAKGRUNN Vi presenterer en kortfattet oversikt over bruk av EEG i psykiatrien, spesielt med vekt på differensialdiagnostisk utredning ved akutte psykiatriske tilstander.

KUNNSKAPSGRUNNLAG Artikkelen er basert på litteratursøk i PubMed og forfatternes egne artikkelsamlinger og erfaringer.

RESULTATER Epilepsi, encefalitt eller annen hjernesykdom kan debutere med psykiatriske og kognitive symptomer. Langsom EEG-aktivitet kan være et uspesifikt tegn på hjernesykdom. Psykiatriske pasienter har også økt risiko for å få epilepsi. Ved anfallssymptomer som kramper eller tilstander med hurtige endringer i affekt, er epileptiform aktivitet på EEG et spesifikt tegn på epileptisk etiologi eller komorbidetet. Kvantitativ frekvensanalyse (QEEG) er nyttig i forskning og unntaksvis som et supplement i klinisk virksomhet. Ingen QEEG-metoder er så langt blitt akseptert som pålitelig selvstendige markører for psykiatrisk sykdom eller behandlingsrespons.

FORTOLKNING EEG bør tas ved nyoppståtte psykoser og ved tilstander med fluktuerende eller progredierende tap av kognitiv funksjon. Voksenpsykiatriske pasienter med anfallssymptomer og tilstander med hurtige endringer i affekt bør også henvises til EEG. (…)

Psykiatriske tilstander øker risikoen for epilepsi
Pasienter med psykotiske og affektive tilstander vil ha en økt risiko for å utvikle epilepsi (5, 6). Årsakssammenhengen er kompleks og inkluderer antakelig nevrobiologiske, psykososiale og/eller iatrogene mekanismer (2). En undergruppe med tilbakevendende, kortvarige ustabile depresjoner har ofte et unormalt EEG (fig 2), og har hyppigere komorbid epilepsi enn pasienter med klassiske depressive eller bipolare lidelser (22, 23). (…)

(Anm: Research unlocks revolutionary new procedure for epilepsy diagnosis (medicalnewstoday.com 16.12.2014).)

(Anm: Psykose. Alle mennesker kan utvikle psykose. - Balansegangen mellom opplevd stress og ballast til å stå imot, er avgjørende, forteller psykiater. (…) - Stress er et sentralt tema. For eksempel har vi forskjellige måter å takle en belastende hendelse på jobb på. (…) - Man kan kalle det en forvirringstilstand, selv om heller ikke det er helt dekkende. (…) Symptomer ved psykose. Tidlige tegn kan være at man: (…) - Det er en kjempebelastning å ha en psykose. Mange blir redde og opplever ting de ikke forstår. Man vet at noen mennesker kan få tanker og impulser om å ta sitt eget liv, legger hun til. (lommelegen.no 13.6.2016).)

(Anm: Samtaleterapi styrker hjernens forbindelser for behandling av psykose. (Talk therapy strengthens brain connections to treat psychosis. Cognitive behavior therapy is used to help treat a number of mental health conditions, including anxiety, depression, and post-traumatic stress disorder. For the first time, researchers have shown how this type of therapy triggers brain changes to produce long-term benefits for patients with psycosis. Researchers have found evidence to suggest that talk therapy can alter the brain in a way that leads to long-term recovery from psychosis. Lead study author Dr. Liam Mason, of King's College London in the United Kingdom, and colleagues report their findings in the journal Translational Psychiatry.) (medicalnewstoday.com 22.1.2017).)

(Anm: Forskningen på schizofreni og psykose er i dyp krise | Paul Møller, dr. med. og spesialist i psykiatri. Hjernen kan måles, veies og avbildes eksakt og detaljert. Psyken er derimot subjektiv, flytende, flyktig og abstrakt, og derfor langt mer krevende å forske på. (aftenposten.no 26.1.2017).)

(Anm: Fem myter om schizofreni | Bjørn Rishovd Rund, professor, Psykologisk institutt, Universitetet i Oslo Fem myter om schizofreni. Begrepet schizofreni er sterkt belastet. Det skyldes til dels noen myter som er vanskelige å knekke. Bjørn Rishovd Rund professor, Psykologisk institutt, Universitetet i Oslo (aftenposten.no 5.2.2017).)

(Anm: Det vakreste mennesket jeg kjenner, har diagnosen schizofreni. Likevel kaller du ham gal | Karoline Kongshaug (aftenposten.no 29.6.2017).)

(Anm: Probiotics may help treat yeast infections, bowel problems in men with schizophrenia. The findings, published in the May 1 issue of Brain, Behavior, and Immunity, support growing evidence of close links between the mind and the gut. (…) The commercially available probiotic contained over 1 billion colony-forming units of Lactobacillus rhamnosus and Bifidobacterium animalis in each pill. PANSS scores were reassessed every two weeks, and the participants self-reported on the ease of their bowel movements weekly on a scale of 0 to 4. At the end of the study, the researchers collected another blood sample. Using the blood samples, the researchers measured antibody levels to yeast Saccharomyces cerevisiae, known as brewer's yeast, and Candida albicans, known to cause yeast infections, before and after the probiotic treatment. Both types of yeast are elevated in people with schizophrenia. (news-medical.net 5.4.2017).)

(Anm: Psychosis: Link to brain inflammation antibodies raises new treatment hope. For the first time, researchers reveal that some people presenting with a first episode of psychosis have specific antibodies in their blood. The antibodies are the same ones known to cause encephalitis or brain inflammation. The discovery raises the question of whether the removal of these antibodies could be an effective treatment for psychosis as it is for encephalitis. The researchers - led by Belinda R. Lennox, a professor in the department of psychiatry at the University of Oxford in the United Kingdom - report their findings in The Lancet Psychiatry. (…) Previous studies have already fueled discussion about the role antibodies targeting neural proteins may play in psychosis. For example, a study reported in 2015 of children experiencing their first episode of psychosis, also found links to an antibody response to NMDAR. (medicalnewstoday.com 9.12.2016).)

(Anm: Psykose som målestokk for tvungent psykisk helsevern. Sammendrag Abstract  Denne artikkelen handlar om vilkåra for tvungent psykisk helsevern. Det er særleg fokusert på ei drøfting omkring det såkalla hovudvilkåret etter lov om psykisk helsevern (phvl.) § 3-3 (1) nr. 3. I artikkelen vert det drøfta om dagens rettsregel og dei vurderingstema den set opp, gjer ei god avgrensing sett i høve til føremåla med tvungent psykisk helsevern. Det vert òg skissert ei betre løysing for tolking av vilkåret. Kritisk juss03 / 2016 (Volum 2) Side: 217-237DOI: 10.18261/issn.2387-4546-2016-03-03.)

(Anm: Psykose forbundet med lave nivåer av fysisk aktivitet. (Psychosis associated with low levels of physical activity. A large international study of more than 200,000 people in nearly 50 countries has revealed that people with psychosis engage in low levels of physical activity, and men with psychosis are over two times more likely to miss global activity targets compared to people without the illness.) (medicalnewstoday.com 26.8.2016).)

(Anm: Antidepressiva (nytteverdi) (mintankesmie.no).)

(Anm: Ny forskning: Lykkepiller gør mere skade end gavn. Folk med depression får intet ud af at tage antidepressivet SSRI, bedre kendt som lykkepiller, viser nyt dansk studie. (jyllands-posten.dk 13.2.2017).)

(Anm: Forskere finner link mellom bruk av antidepressiva, medfødte misdannelser eller dødfødsler. (Researchers Find Link Between Antidepressant Use, Congenital Anomalies or Stillbirths) (…) "Mens denne ekstra risikoen kan virke liten er resultatene etter mitt syn så alvorlig som de kan være." (“While this extra risk may seem small, in my view, the outcomes are as serious as they can be.”) (dgnews.docguide.com 5.12.2016).)

(Anm: Eksponering av foster for antidepressiva kan endre Corpus Callosums mikrostruktur: Presentert ved PAS / ASPN. (…) Fordi "den neonate (nyfødtes) corpus callosum mikrostruktur er assosiert med utero (livmor) SSRI-eksponering og prenatal (før fødsel) mødredepresjon, er tidlige modningsprosesser i denne regionen følsomme for endret 5-hydroksytryptamin (5-HT) signalering under tiden i utero (livmor)," bemerket Campbell. "Disse resultatene - sammen med forstyrret hvit substans’ mikrostruktur i genu hos premature spedbarn - tyder dette på at utviklingen av [corpus callosum] kan være følsom for tidlige uheldige påvirkninger. (Fetal Exposure to Antidepressants May Alter Corpus Callosum Microstructure.) (dgnews.docguide.com 10.5.2017).)

(Anm: Unormal sæd med SSRI antidepressiva. Flere studier har funnet endrede sædparametere etter eksponering for SSRI-antidepressiva. Selv om SSRIs rolle er usikker, er det berettiget å ta hensyn til de observerte effektene på sædkvalitet og informere eksponerte pasienter. (Semen abnormalities with SSRI antidepressants. Several studies have found altered semen parameters after exposure to SSRI antidepressants. Although the role of SSRIs is uncertain, it is justified to take into account the observed effects on sperm quality and to inform exposed patients.) Prescrire Int 2015; 24 (156): 16-17.)

(Anm: Gravide kvinner som tar antidepressiva er mer sannsynlig å få barn med autisme, ifølge studie. Pregnant women who take antidepressants more likely to have a child with autism, study finds. Research data published in the BMJ reveal that antidepressant use during pregnancy increases the risk of autism in children, as reported The Independent Thursday. (firstwordpharma.com 20.7.2017).)

(Anm: - Nye data viser økt risiko for misdannelser når antidepressiva brukes under graviditet. (…) En studie publisert i British Medical Journal (BMJ) avslører at antidepressiva forskrevet til gravide kan øke sjansen for å få en baby med misdannelser.) (New Data Show Heightened Risk of Birth Defects When Antidepressants Are Used During Pregnancy.) (dgnews.docguide.com 19.1.2017).)

(Anm: - Utviklingen av et potensielt livstruende serotonergt syndrom eller nevroleptisk malignt syndrom (NMS)-lignende reaksjoner er rapportert for SNRI-er og SSRI-er alene, inkludert Celexa-behandling, men spesielt ved samtidig bruk av serotonerge legemidler (inklusive triptaner) og legemidler som svekker metabolisme av serotonin (inklusive MAO-hemmere), eller med antipsykotika eller andre dopaminantagonister (fda.gov 6.3.2009).)

(Anm: Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. (…) Conclusions Antidepressants with effects on serotonin reuptake during embryogenesis increased the risk of some organ-specific malformations in a cohort of pregnant women with depression. BMJ Open 2017;7:e013372.)

(Anm: Bruk av antipsykotika er assosiert med en 60 % økt risiko for dødelighet hos pasienter med Alzheimers sykdom. (…) Bruk av to eller flere antipsykotika samtidig ble knyttet til nesten doblet dødsrisiko (200 %) enn ved monoterapi.) (Antipsychotic Drug Use Increases Risk of Mortality Among Patients With Alzheimer’s Disease. JOENSUU, Finland -- December 12, 2016 -- Antipsychotic drug use is associated with a 60% increased risk of mortality among patients with Alzheimer's disease, according to a study published in the Journal of Alzheimer’s Disease. The risk was highest at the beginning of drug use and remained increased in long-term use. Use of 2 or more antipsychotic drugs concomitantly was associated with almost 2 times higher risk of mortality than monotherapy.) (dgnews.docguide.com 12.12.2016).)

(Anm: Antipsykotika dobler dødsrisiko allerede etter 180 dagers bruk. Greater Mortality Risk With Antipsychotics in Parkinson's (Større dødsrisiko med antipsykotika ved Parkinsons) (medicalnewstoday.com 21.6.2015).)

(Anm: (...) For ytterligere å illustrere problemet kan nevnes at antipsykotika forårsaker parkinsonisme (5), og en studie fant at mennesker med Parkinsons sykdom og psykose hadde fire ganger større sannsynlighet for å dø etter tre til seks måneders behandling enn de som ikke fikk antipsykotika. (6) De var også mer utsatt for kognitiv svikt, forverring av parkinsonsymptomer, hjerneslag, infeksjoner og fall. RE: Psykisk syke lever kortere. Tidsskr Nor Legeforen 10.11.2015.)

(Anm: Legemidler som kan gi delirium hos eldre. Delirium ses særlig hos eldre ved akutte sykdommer og skader eller som følge av toksisk eller farmakologisk påvirkning. Eldre personer har mange sykdommer og bruken av legemidler er høy. Mange legemidler, og særlig de med antikolinerg eller dopaminerg effekt, kan gi delirium. Kjennskap til legemidler og kombinasjoner av legemidler som kan gi delirium, er viktig for å kunne forebygge og behandle tilstanden. Tidsskr Nor Legeforen 2005; 125:2366-7 (8.9.2005).)

(Anm: Delirium in hospitalized patients: Risks and benefits of antipsychotics. ABSTRACT Consensus panel guidelines advocate for the judicious use of antipsychotic drugs to manage delirium in hospitalized patients when nonpharmacologic measures fail and the patient is in significant distress from symptoms, poses a safety risk to self or others, or is impeding essential aspects of his or her medical care. Here, we review the use of haloperidol, olanzapine, quetiapine, risperidone, and aripiprazole for this purpose. Cleveland Clinic Journal of Medicine. 2017 August;84(8):616-622.)

(Anm: Post injektionssyndrom. (…) De fleste af disse patienter udviklede symptomer på sedation (fra mild sedation til koma) og/eller delirium (herunder forvirring, desorientering, ophidselse/ uro, angst og anden kognitiv svækkelse). Andre symptomer inkluderede ekstrapyramidale symptomer, dysartri, ataksi, aggression, svimmelhed, svaghed, hypertension eller krampe.) (sundhedsstyrelsen.dk 29.6.2014).)

(Anm: Mødre til børn med misdannelser har øget dødelighed. (…) Bivirkninger har ført til to dødsfald. Den største del af bivirkningerne (42 procent) af de 429 blev indberettet for såkaldte psykostimulerende lægemidler - eksempelvis til behandling af ADHD - efterfulgt af 31 procent for antidepressiver og 24 procent for antipsykotiske lægemidler. (videnskab.dk 20.12.2016).)

(Anm: Antikolinerge effekter av vanlige legemidler knyttet til økt dødelighet hos mennesker over 65. De kombinerte antikolinerge effektene av mange vanlige legemidler øker risikoen for kognitiv svekkelse og død hos personer over 65 år, ifølge resultater fra en storskala studie på den langsiktige helseeffekten av legemidler.(Anticholinergic effects of common drugs are associated with increased mortality in over 65s. The combined anticholinergic effects of many common drugs increase the risk of cognitive impairment and death in people aged over 65, a large scale study of the long term effect of drugs on health has found.) BMJ 2011; 342:d4037 (28 June).)

(Anm: Men experience greater cognitive impairment and increased risk of death following hip surgery. In a study of hip fracture patients, men displayed greater levels of cognitive impairment within the first 22 days of fracture than women, and cognitive limitations increased the risk of dying within six months in both men and women. "While men make up only about 25 percent of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture," said Dr. Ann Gruber-Baldini, lead author of the Journal of the American Geriatrics Society study. (medicalnewstoday.com 10.2.2017).)

(Anm: Det autonome nervesystemet. Det autonome nervesystemets hovedoppgave er å bidra til likevekt i kroppens basale funksjoner. Det vil blant annet si kroppstemperatur, blodtrykk, åndedrett og fordøyelse. (nhi.no 4.3.2015).)

(Anm: Ulike selektive serotonin reopptakshemmeres (SSRI-er) cytotoksisitet mot kreftceller. (Cytotoxicity of different selective serotonin reuptake inhibitors (SSRIs) against cancer cells.) (…) Vi har funnet at paroxetine (paroksetin; Seroxat; Paxil etc.) har cytotoksisk aktivitet mot tumorceller. J Exp Ther Oncol. 2006;6(1):23-9.)

(Anm: Could antidepressants stop prostate cancer from spreading? In almost all cases where prostate cancer spreads to other areas of the body, the disease spreads to the bone first. In a new study, researchers reveal the discovery of an enzyme that helps prostate cancer cells to invade bone. Furthermore, certain antidepressant medications may have the potential to block this enzyme. Study co-author Jason Wu, of Washington State University-Spokane, and colleagues recently reported their findings in the journal Cancer Cell. (medicalnewstoday.com 13.3.2017).)

(Anm: Classic cytotoxic drugs: a narrow path for regulatory approval. Several classic cytotoxic drugs have shown encouraging activity in the treatment of metastatic breast cancer.1–3 However, only a few have received an overwhelming welcome from regulatory authorities and succeeded in obtaining widespread regulatory approval for routine use. For example eribulin was approved for treatment of metastatic breast cancer in several countries including Japan, USA, and Europe, based on data that showed longer overall survival in patients treated with eribulin compared with patients treated with physician's choice of treatment. In contrast ixabcpilone with capecitabine gained approval from the US Food and Drug Agency based on data showing longer progression-free survival compared with capccitabine alone, but did not obtain rcgulatory authorisation in Europc because it is associated with a high incidence of nevropathy.5 Lancet Oncol. 2017 Feb 10. pii: S1470-2045(17)30089-X. [Epub ahead of print].)

(Anm: Ødelagt cellulær "klokke" linket til hjerneskade (Broken Cellular 'Clock' Linked to Brain Damage) (sciencedaily.com 25.11.2013).)

(Anm: Signaling Pathways Linked to Serotonin-Induced Superoxide Anion Production: A Physiological Role for Mitochondria in Pulmonary Arteries. Abstract. Serotonin (5-HT) is a potent vasoconstrictor agonist and contributes to several vascular diseases including systemic or pulmonary hypertension and atherosclerosis. Although superoxide anion ([Formula: see text]) is commonly associated to cellular damages due to [Formula: see text] overproduction, we previously demonstrated that, in physiological conditions, [Formula: see text] also participates to the 5-HT contraction in intrapulmonary arteries (IPA). Front Physiol. 2017 Feb 9;8:76. eCollection 2017.)

(Anm: Bruk av antidepressiva ble assosiert med et betydelig eldre utseende og forskere fant også ut at vekten spilte en viktig faktor. I de sett med tvillinger som var yngre enn 40 år ble tyngre tvillinger oppfattet som eldre. (…) I tillegg mistenker forskerne at den vedvarende avslapping av ansiktsmuskler som antidepressiva forårsaker kan forklare årsaken til at ansiktet faller sammen (henger). (mintankesmie.no).)

(Anm: Minislag (ministroke: transient ischemic attack (TIA)) linket til lavere forventet levetid. (- Minislag kan forårsake demens.) (- Enkelte psykofarmaka kan øke risiko for minislag / demens.) (mintankesmie.no).)

(Anm: Stumme infarkt rammer oftere folk med høy smertetoleranse. Stumme hjerteinfarkt gir ikke de klassiske brystsmertene som ved vanlige infarkt. - Denne pasientgruppen tar enten ikke kontakt med lege, eller de har ikke fått riktig diagnose, sier lege og forsker Andrea Milde Øhrn. (…) Det er vanlig å tenke sterke brystsmerter og akutt behandling når det er snakk om hjerteinfarkt. Det mange kanskje ikke vet, er at man kan ha hatt et hjerteinfarkt uten å vite det. Dette kalles et stumt infarkt, et hjerteinfarkt med få eller ingen symptomer. - Et stumt hjerteinfarkt er et hjerteinfarkt som ikke er erkjent. (nhi.no 3.2.2017).)

(Anm: Sannsynlig karotidyni forårsaket av fluoxetine (Prozac; SSRI-er). (Probable fluoxetine-induced carotidynia.)  Karotidyni er en fokal nakkesmerte (bestemt, avgrenset område), som involverer anatomiske områder til den berørte arteria carotis, og stråler ofte ut i den ipsilateral side (samme side) av ansiktet eller øret. På grunnlag av medisinsk historie og alder har karotidyni konvensjonelt vært klassifisert i klassisk (ikke-migrenøs), migrenøs, og vaskulære varianter. The Lancet 2009;374(9695):1061-1062 (26 September).)

(Anm: Nakkesmerter sætter forskerne skakmat. Kroniske nakkesmerter koster samfundet milliarder og er en af de hyppigste årsager til, at danskere melder sig syge fra job. Forskerne er i vildrede: Ingen behandling er effektiv. (videnskab.dk 22.12.2016).)

(Anm: Antidepressiva linket til hjerterisiko: tvillingstudie. (Antidepressants linked to heart risk: twins study) - Middelaldrende menn som bruker antidepressiva er mer sannsynlig å ha en innsnevring av blodårer, noe som øker risikoen for hjerteinfarkt og slag, enn de som ikke bruker legemidlene, ifølge en studie presentert på lørdag. (Reuters) - Middle-age men who use antidepressants are more likely to have a narrowing of blood vessels, increasing the risk of heart attacks and strokes, than those who do not use the medications, according to a study presented on Saturday.) (reuters.com 2.4.2011).)

(Anm: - Pfizers Zyvoxid (Zyvox) og antidepressiva kan være en dødelig kombinasjon. (- Det antas at når linezolid gis til pasienter, som behandles med serotonerge psykofarmaka, kan forhøyede nivåer av serotonin bygge seg opp i hjernen og forårsake toksisitet (giftighet). Dette er referert til som Serotonin syndrom - tegn og symptomer inkluderer mentale endringer (forvirring, hyperaktivitet, minneproblemer), muskelrykninger, overdreven svetting, skjelving eller risting, diaré, problemer med koordinasjon og / eller feber.) (fda.gov 21.10.2011).)

(Anm: Hva er det forskrivere og pasienter ikke vet om bivirkninger av antidepressiva? (What do prescribers and patients not know about the side effects of antidepressant drugs?) (medicalnewstoday.com 15.9.2016).)

(Anm: Forskere: Alvorlige bivirkninger, når antidepressiver droppes. Angst, depression og selvmordstanker er nogle af de bivirkninger, som tit forekommer, når man holder op med at tage antidepressiv medicin. Bivirkningerne kan i nogle tilfælde være langvarige og kroniske, viser et nyt studie. (videnskab.dk 16.3.2015).)

(Anm: Bruk av visse smertestillende midler (og antidepressiva (+ 31 %)) forbundet med økt risiko for drap (Use of certain painkillers linked with increased risk of homicide) Enkelte legemidler som påvirker sentralnervesystemet - som smertestillende og beroligende benzodiazepiner - er assosiert med økt risiko for å begå et drap, finner en ny studie publisert i tidsskriftet World Psychiatry. (medicalnewstoday.com 1.6.2015).)

(Anm: Psykiatriske patienter ender i private botilbud. Drab og vold har de seneste år fyldt debatten om de danske bosteder for patienter med psykiske problemer. (…) Psykiatriske patienter ender i private botilbud. (…) Mens Folketinget kæmper for en løsning på problemet med vold på offentlige bosteder, vælger flere kommuner at sende tunge patienter til private tilbud. (politiken.dk 18.3.2017.)

(Anm: Aggresjon knyttet til økt risiko for substansmisbruk. Aggression disorder linked to greater risk of substance abuse. (…) In the study, published in the Journal of Clinical Psychiatry, Emil Coccaro, MD, and colleagues analyzed data from more than 9,200 subjects in the National Comorbidity Survey, a national survey of mental health in the United States. They found that as the severity of aggressive behavior increased, so did levels of daily and weekly substance use. The findings suggest that a history of frequent, aggressive behavior is a risk factor for later substance abuse, and effective treatment of aggression could delay or even prevent substance abuse in young people. (medicalnewstoday.com 2.3.2017).)

(Anm: Halvparten av norske drap begått av rusede. (…) I 125 av drapene – eller 54 prosent – er det beskrevet i dommen at gjerningspersonen var påvirket av rusmidler under drapet. (nrk.no 13.12.2016).)

- En pasient på UNN døde av blodforgiftning som følge av et legemiddel mot psykiske lidelser, opplyser Statens helsetilsyn.

(Anm: En pasient på UNN døde av blodforgiftning som følge av et legemiddel mot psykiske lidelser, opplyser Statens helsetilsyn. (- Pasienten døde etter kort tid, og dødsårsaken var nøytropen sepsis (blodforgiftning), heter det i tilsynets rapport. (nrk.no 12.10.2016).)

(Anm: Systemic inflammatory response syndrome (SIRS) is an inflammatory state affecting the whole body, frequently a response of the immune system to infection. (en.wikipedia.org).)

(Anm: Sepsis. Definisjon: SIRS + påvist/mistenkt infeksjon (f. eks. positiv blodkultur). SIRS- kriteriene er: - Feber > 38 ºC eller hypotermi < 36 ºC - Puls > 90/minutt - Respirasjonsfrekvens > 20/minutt eller hypokapni med pCO2 < 4,3 kPa i blodgass - Leukocytose ≥ 12 × 109/l eller leukopeni < 4 × 109/l eller > 10 % umodne leukocytter. (helsebiblioteket.no - Metodebok for indremedisinere, 2012).)

(Anm: Rollen til mitokondriell dysfunksjon (mitokondriedysfunksjon) ved sepsis (blodforgiftning)-indusert multiorgansvikt. (The role of mitochondrial dysfunction in sepsis-induced multi-organ failure). (Virulence. 2013 Nov 1;5(1).)

- Diagnostisering av sepsis. Sepsis, også kjent som blodforgiftning, er kroppens hyperaktive respons på en infeksjon som kan føre til betennelse, vevskader, organsvikt etc.

(Anm: Diagnosing Sepsis. Sepsis, also known as blood poisoning, is the body’s hyperactive response to an infection that can lead to inflammation, tissue damage, organ failure etc. It is a very dangerous state in which the immune system stops fighting with the invading agents  and turns to itself. Around one-third of patients who are affected with sepsis die every year. (news-medical.net 7.9.2017).)

- Å anerkjenne sepsis som en global helseprioritet - En WHO- resolusjon.

(Anm: Å anerkjenne sepsis som en global helseprioritet - En WHO- resolusjon. Recognizing Sepsis as a Global Health Priority — A WHO Resolution. “Some very important clinical issues, some of them affecting life and death, stay largely in a backwater which is inhabited by academics and professionals and enthusiasts, dealt with very well at the clinical and scientific level but not visible to the public, political leaders, leaders of healthcare systems... The public and political space is the space in which [sepsis] needs to be in order for things to change.” NEJM (June 28, 2017).)

(Anm: Sepsis – den dödliga sjukdomen som glöms bort. Trots att infektionssjukdomen sepsis förekommer oftare än de vanligaste formerna av cancer och att upp emot hälften som drabbas av den allvarligaste formen dör, så har många knappt hört talas om sjukdomen. Sepsis som är den medicinska termen på blodförgiftning, drabbar omkring 40 000 svenskar varje år. (netdoktor.se 7.6.2017).)

- Hurtigtest finner tegn på sepsis i en enkelt dråpe blod.

(Anm: Hurtigtest finner tegn på sepsis i en enkelt dråpe blod. (- Sepsis, en potensielt livstruende komplikasjon av en infeksjon, har den høyeste byrde mht. død og medisinske utgifter på sykehus over hele verden.) (- Quick test finds signs of sepsis in a single drop of blood. (…) Sepsis, a potentially life-threatening complication of an infection, has the highest burden of death and medical expenses in hospitals worldwide. (medicalnewstoday.com 5.7.2017).)

(Anm: Nye sepsiskriterier kan føre til forsinket behandling. (…) Sepsis er en svært alvorlig tilstand med høy morbiditet og mortalitet (2). Den totale insidensen er ukjent, men man regner med at sepsis er en av de viktigste årsakene til alvorlig, akutt sykdom på verdensbasis (1). (…) Sepsis har inntil nylig vært definert som mistenkt infeksjon med samtidig tilstedeværelse av to eller flere SIRS-kriterier (1). Endringer i hjertefrekvens, kroppstemperatur, respirasjonsfrekvens og leukocytter er kroppens tegn på inflammasjon, og de indikerer ikke nødvendigvis en livstruende, dysregulert vertsrespons på infeksjon. Tidsskr Nor Legeforen 2017; :609-10 (20.4.2017).)

(Anm: LEGENE FORSTO IKKE AT HAN VAR DØDSSYK: Stian (19) døde etter 18 timer på sykehus uten legetilsyn. (…) Helsetilsynet konkluderer med at sykehusets behandling var uforsvarlig. (…) Fikk ikke beskjed. (…) Fastlegen sendte med dem papirer som foreldrene leverte på Akuttmottaket ved Ahus, der sto det; «Diagnose: Obs sepsis».  (tv2.no 29.4.2017).)

(Anm: Svikt i behandlingen av akutt syk ung mann i akuttmottaket – brudd på helselovgivningen. (…) Pasienten ble lagt på observasjonsposten (Akutt 24) ved akuttmottaket frem til neste morgen. I løpet av tiden på observasjonsposten ble han ikke tilsett av lege. På morgenen var han betydelig verre og han fikk tegn på fullt utviklet blodforgiftning. Behandling med antibiotika ble iverksatt, men han døde kort tid etter som følge av meningokokksepsis og hjerneødem. (helsetilsynet.no 2.5.2017).)

(Anm: Sepsis; grunnleggende kliniske observasjoner. Sepsis= En systemisk inflammatorisk respons (SIRS) pga. en infeksjon Tre alvorlighetsgrader: 1) Sepsis (to eller flere symptomer på SIRS som følge av infeksjon) 2) Alvorlig sepsis (sepsis med akutt organdysfunksjon, hypoperfusjon eller hypotensjon) 3) Septisk sjokk (hypotensjon til tross for adekvat væsketerapi, samt forekomst av perfusjonsforstyrrelser og organdysfunksjon) (hnt.no 5.11.2013).)

- Alle bryt lova i behandling av blodforgifting. Pasientar med alvorleg blodforgifting (sepsis) blir undersøkt av lege for seint.

(Anm: Alle bryt lova i behandling av blodforgifting. Pasientar med alvorleg blodforgifting blir undersøkt av lege for seint. Helsetilsynet fann brot ved 24 akuttmottak over heile landet. – Svært alvorleg. – Dette er svært alvorleg, for det dreier seg om ein alvorleg infeksjonssjukdom som i verste fall kan medføra død dersom behandlinga ikkje blir igangsett til riktig tid, seier avdelingsdirektør i Helsetilsynet, Ragnar Hermstad. OVER EIN TIME: Pasientar som kjem inn med teikn på alvorleg infeksjonssjukdom som blodforgifting skal ifølge nasjonale retningslinjer få anitibiotikabehandling innan maks ein time. Alle dei 24 akuttmottaka hadde svikt på dette området. (nrk.no 16.6.2017).)

(Anm: Lege sier improvisert «kur» for sepsis har hatt bemerkelsesverdige resultater. (…) Spesialist i intensivbehandling Paul Marik sier at enkel behandling med infusjon av vitamin C og steroider har bemerkelsesverdig effekt på pasienter med potensielt dødelig tilstand. (independent.co.uk 24.3.2017).)

(Anm: Bivirkninger underrapporteres i videnskabelige tidsskrifter. (...) Mellem 43 og 100 procent af de bivirkninger, der, ifølge det ikke-publicerede materiale, er fundet ved de testede lægemidler, er ikke lagt frem i de videnskabelige artikler, viser Yoon Loke og kollegernes gennemgang. (videnskab.dk 5.10.2016).)

(Anm: Dødsfall på grunn av nøytropen sepsis (blodforgiftning) etter behandling med legemiddelet klozapin – uforsvarlig oppfølging – mangelfull samhandling og informasjon. (…)  Manglende informasjon fra spesialisthelsetjenesten og mangelfull samhandling mellom kommunehelsetjenesten, fastlegen, pasienten og pårørende bidro til hendelsen. Helseforetaket skal gjennomgå hendelsen for å redusere risikoen ved lignende tilfeller. (helsetilsynet.no 12.10.2016).)

(Anm: Eksplosjon av antidepressiva til unge jenter. De ønsker psykologhjelp. I stedet blir de fôret med piller fra fastlegen. Unge jenter har aldri brukt mer antidepressiver. (vg.no 10.9.2016).)

(Anm: Flere barn og unge akuttinnlegges for psykisk sykdom. I fjor utgjorde andelen øyeblikkelig hjelp innleggelser 61 prosent av alle innleggelser. Det er en økning fra 47 prosent i 2012. (dagensmedisin.no 19.9.2016).)

(Anm: Eksplosjon av antidepressiva til unge jenter: Lykkepillegenerasjonen. «Lykkepillen» gjorde Sandra så dårlig at hun ble innlagt på psykiatrisk avdeling. På ti år har bruken av antidepressiver blant unge jenter økt med 83 prosent. Mange får pillene uten en gang å ha snakket med psykolog.  (vg.no 10.9.2016).)

(Anm: Helseminister Bent Høie reagerer på «lykkepille»-praksis: – Veldig urovekkende. ** Kraftig økning i antidepressiva til unge jenter. Helseminister Bent Høie reagerer på den sterke økningen i lykkepillebruk blant unge jenter. Han mener manglende ressurser og fastlegers holdninger er årsaker. Lørdag dokumenterte VG Helg og VG+ konsekvensene av den økende lykkepille-bruken blant unge jenter. (vg.no 10.9.2016).)

(Anm: LO advarer mot trygdebombe. En stadig større del av nordmenn i arbeidsfør alder er uten jobb. LO mener dette er en potensiell trygdebombe. (…) Det trengs 180.000 nye jobber for å få yrkesdeltakelsen opp på samme nivå som i 2008, viser en rapport fra samfunnsøkonomene i LO. I 2008 var 70 prosent av befolkningen mellom 15 og 74 år i jobb. Nå er yrkesdeltakelsen nede i 67,3 prosent., og det er nedgang i alle fylker. (hegnar.no 6.10.2016).)

(Anm: Rekordmange søger akut psykisk hjælp. (- Mens kun 12.099 danskere i 1995 besøgte de psykiatriske akutmodtagelser og skadestuer, er det steget til hele 33.333 i 2015, viser opgørelse fra Sundhedsdatastyrelsen og Danske Regioner, der for kort tid siden blev sendt til Folketinget. (politiken.dk 9.7.2016).)

(Anm: Har vi blitt psykisk sykere? (- Vi vet også at stadig flere får uførepensjon på grunn av psykiske lidelser og at sykefraværet på grunn av psykiske plager og lidelser har økt. Vi tror alle disse forholdene bidrar til vår oppfatning om at stadig flere får en psykisk lidelse eller plage.) (Folkehelseinstituttet fhi.no 10.10.2013).)

(Anm: Høyt fravær på grunn av ME. Minst 270 elever var borte fra skolen i fjor fordi de hadde ME. (aftenposten.no 6.2.2017).)

(Anm: Psykisk ohälsa fortsätter att öka. Antalet svenskar som sjukskrivs på grund av psykisk ohälsa ökar kontinuerligt sedan 2010. Den vanligaste diagnosen är stressrelaterad psykisk ohälsa som till mångt och mycket är arbetsrelaterad. Då evidensbaserad behandling saknas står förebyggande arbete i fokus. (netdoktor.se 14.9.2016).)

(Anm: Psykiatriske skadestuer kan ikke klare presset. Psykiske lidelser hører til nogle af de største sygdomsbyrder, som hvert år koster samfundet et svimlende milliardbeløb i tabt arbejdsfortjeneste og sociale ydelser. (politiken.dk 11.7.2016).)

(Anm: - 9 ting som skjer i hjernen og kroppen på MDMA (Ecstasy). (- 9 Things That Happen in the Brain and Body on MDMA.) (- Derfor, når substansen avsluttes, sitter mennesker igjen med mindre serotonin enn vanlig, noe som kan føre til følelser av depresjon, irritabilitet og tretthet.) (- Siden MDMA frigir så mye serotonin, ødelegger kroppen deretter mer serotonin enn vanlig, ifølge AsapSCIENCE.) (thescienceexplorer.com 24.6.2016).)

(Anm: Antipsykotika (psykofarmaka etc.) (mintankesmie.no).)

(Anm: Lægemiddelstyrelsen opfordrer læger til at være opmærksomme på disse alvorlige bivirkninger hos børn og unge i behandling med aripiprazol (Abilify) (…) Gennemgangen viser også, at børn med ASD (autisme) der behandles med aripiprazol, kan udvikle alvorlige psykiatriske bivirkninger såsom svære kroniske søvnproblemer, aggressiv adfærd og hallucinationer. (…) Hårtab, depression og psykose, Vægtøgning, Hypercholesterolemi, Hypercholesterolemi. (LÆGEMIDDELSTYRELSEN - NYT OM BIVIRKNINGER 2016;7(9).)

(Anm: «Psykiatrien i Norge har hatt for svak ledelse. På alle nivåer. I alle år». KRONIKK: Helseminister Bent Høie (H). BENT HØIE, Helseminister. (vg.no 23.11.2016).)

(Anm: - Kan vi stole på forskningen? (...) - Er det ikke så nøye med sannheten fordi det lønner seg økonomisk og er lettvint bare å tro på forenklingene, halvsannhetene og de opplagt bløffene? (...) - Trass i all forskning. Trass i alle milliarder av kroner som var blitt investert, trass i alle gode intensjoner. Men «sannheten om de psykiske sykdommers natur, ubalansen i hjernens kjemi» viste seg etter hvert ikke å være sann. (dagensmedisin.no 2.4.20

(Anm: Dyremodeller åbner døren til ny generation af antipsykotika. (- »Industrien har måttet erkende, at de ‘varer’, der var på hylderne, ikke var brugbare. (dagensmedicin.dk 31.3.2017).)

(Anm: Psykofarmaka dreper mange. (…) I DAGENS MEDISIN 12. februar hevder psykiaterne Rune Andreas Kroken og Erik Johnsen at det ikke er riktig at psykiatrisk behandling tar liv. De påstår til og med at man lever lenger dersom man får antipsykotika. Dette er helt utrolig.) (dagensmedisin.no 10.3.2017).)

(Anm: Få pasienter kjenner til klageordning. (…) Søkere fikk medhold i en firedel av sakene. For dem som klaget på legemiddelskader utløst av antipsykotika, fikk imidlertid kun 9,4% medhold. - Man kan spekulere i om pasienter som ikke er flinke nok til å snakke om sin sak, ikke når frem. (Tidsskr Nor Legeforen 22.1.2013).)

(Anm: Høie om psykiatrien: Har fått leve sitt eget liv. (...) Dette er veldig alvorlig, og bekrefter dessverre det inntrykket jeg har fått om tvangsbruken innen psykisk helse: at den går langt utover det som er hensikten og det juridiske grunnlaget - og at den går utover det som er god faglighet, sier Høie til VG. (vg.no 20.11.2016).)

(Anm: Antipsykotika og fysisk attraktivitet (Antipsychotics and physical attractiveness) (...) Antipsykotika, som gruppe, fører til vektøkning og kan føre til munntørrhet og dårlig ånde, grå stær, hirsutisme (uvanleg sterk eller altfor utbreidd hårvekst (helst hos kvinner)), akne og stemmeendringer; de kan forstyrre symmetri av gangart og øke risikoen for tics og spasmer og inkontinens, og potensielt undergrave en persons attraktivitet. Clin Schizophr Relat Psychoses. 2011 Oct;5(3):142-146.)

(Anm: Medikamentutløst dystoni. (…) Videoen illustrerer ekstrapyramidale bivirkninger med dystoni i tunge og kjeveområdet. Tidsskr Nor Legeforen 2016; 136:1730-1730 (8.11.2016).)

(Anm: Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Conclusions Older people with intellectual disabilities and with mental health conditions were exposed to high anticholinergic burden. This was associated with daytime dozing and constipation. The British Journal of Psychiatry Dec 2016, 209 (6) 504-510.)

(Anm: Bivirkninger av antipsykotika - Related Editorial (Relatert lederartikkel) (…) Bruken av antipsykotika innebærer en vanskelig avveining mellom nytte for å lindre psykotiske symptomer og noen ganger risikoen for problematiske bivirkninger som forkorter levetiden. (…) Alle antipsykotika er forbundet med en økt sannsynlighet for sedasjon, seksuell dysfunksjon, postural hypotensjon, hjertearytmi og plutselig hjertedød. (…) Antikolinerge effekter inkluderer forstoppelse, urinretensjon, tørr munn, uklart syn og, til tider, kognitiv svekkelse. Disse symptomene kan føre til andre problemer som tannforråtnelse, fall eller gastrointestinal obstruksjon. Am Fam Physician. 2010 Mar 1;81(5):617-622).)

(Anm: J&J’s Janssen dømt til å betale 70 millioner dollar i Risperdal-rettssak. (J&J's Janssen hit with $70 mln verdict in Risperdal trial) (…) Juryen i Philadelphia Court of Common Pleas fant at firmaet mislyktes å advare guttens helsepersonell om risikoen for gynecomastia, som er brystvekst hos menn eller gutter forårsaket av en hormonell ubalanse, og at de med vilje forfalsket, og ødela eller skjulte bevis i saken.) Janssen dømt til å betale 70 millioner dollar i Risperdal-rettssak. (finance.yahoo.com 1.7.2016).)

(Anm: J&J's Janssen hit with $70 million verdict in Risperdal trial. Johnson & Johnson and Janssen are facing more than 12,000 claims over Risperdal, according to Johnson & Johnson's most recent quarterly report. (…) In 2013, Johnson & Johnson and Janssen paid more than $2.2 billion to resolve civil and criminal investigations by the U.S. Department of Justice into its marketing of Risperdal and several other drugs. (reuters.com 1.7.2016).)

(Anm: Jury smacks J&J with $70M in damages in latest Risperdal breast case. Johnson & Johnson ($JNJ) is fighting more than 1,500 legal claims that its antipsychotic Risperdal triggered breast development in boys, and the company has landed on the wrong side of a jury verdict in several of them so far. (fiercepharma.com 5.7.2016).)

(Anm: Antipsykotika forårsaker ansiktsgrimasering og andre typer mulige varige hjerneskader (mintankesmie.no).)

(Anm: Derfor bliver man fed af antipsykotisk medicin. (- Derfor blir man feit av antipsykotika.) (videnskab.dk 7.1.2016).)

(Anm: Signaling from dysfunctional mitochondria induces a distinct type of senescence. (Signalering fra dysfunksjonelle mitokondrier induserer en distinkt type tiltagende alderdom.) Finding provides alternative explanation for the free-radical theory of aging and suggests new role for mitochondria in affecting physiology. (medicalnewstoday.com 11.12.2015).)

(Anm: Mitochondrial Dysfunction Meets Senescence. Trends Biochem Sci. 2016 Feb 10. pii: S0968-0004(16)00020-7. [Epub ahead of print].)

(Anm: NTNU-forskere er med i teamet: Har laget «smart» speil som kan avsløre hjerteinfarkt (vg.no 18.11.2015).)

(Anm: Speilet som ser et fremtidig hjerteinfarkt. (…) Det smarte speilet «Wize mirror» ser ut som et vanlig speil, men inneholder 3D-skannere, multispektrale kameraer og gass-sensorer for å vurdere helsen til den står foran det. Speilet gjør dette gjennom å undersøke personens ansikt, vurdere fettvev, blodgjennomstrømning, ansiktsuttrykk og ansiktsfarge. (gemini.no 18.11.2015).)

(Anm: How Smoking Wrecks Your Looks. See how lighting up can add years to your appearance, causing sagging skin, hair loss, and more. (webmd.com 19.11.2015).)

(Anm: What Does Your Face Say About Your Health? (webmd.com 20.3.2017).)

(Anm: Common antidepressant may change brain. (…) A commonly prescribed antidepressant may alter brain structures in depressed and non-depressed individuals in very different ways, according to new research at Wake Forest Baptist Medical Center. (...) MRI images taken at the end of the treatment phase revealed that in depressed subjects the drug significantly increased the volume of one region of the brain, the anterior cingulate cortex, while decreasing the volume of this same region and the hippocampus in non-depressed subjects. Both of these areas are highly interconnected with other areas of the brain; are critical in a wide array of functions including memory, learning, spatial navigation, will, motivation and emotion; and are implicated in major depressive disorder. (medicalnewstoday.com 7.9.2015).)

(Anm: Antipsychotic drugs linked to brain tissue loss in patients with schizophrenia. Antipsychotic medications are the most common treatment for individuals with schizophrenia, helping to relieve some of the debilitating symptoms caused by the disorder. But according to a new study, long-term use of these drugs may also negatively impact brain structure. Researchers say long-term use of antipsychotic medications - particularly first-generation antipsychotics - may lead to gray matter loss in the brain. First author Dr. Antonio Vita, professor of psychiatry at the University of Brescia in Italy, and colleagues publish their findings in the journal Biological Psychiatry. (medicalnewstoday.com 7.9.2015).)

(Anm: Gray Matter Abnormalities in the Inhibitory Circuitry of Young Binge Drinkers: A Voxel-Based Morphometry Study. (…) Binge drinking (BD) is defined as a pattern of high alcohol intake in a short time followed by periods of abstinence. Front. Psychol., 13 September 2017.)

(Anm: Antipsykotika kan krympe hjernevolumet (Antipsychotics May Shrink Brain Volume) (medpagetoday.com 8.2.2011).)

(Anm: Gray matter abnormality predicts neurodevelopmental problems in smaller premature babies (medicalnewstoday.com 8.4.2016).)

(Anm: Hjerneødem etter status epilepticus Tidsskr Nor Legeforen 2015; 135:439 (10.3.2015).)

- En maske, som uden brug af medicin potentielt kan forebygge og afbryde epilepsianfald

Brødrepar jagter penge til epilepsi-opfindelse
medwatch.dk 7.8.2013
To brødre satser på at kunne behandle epilepsi-patienter med en enkel maske i stedet for at fylde dem med bedøvende medicin. Men på trods af en blåstemplende Venture Cup-pris kæmper douen ”bravt for at holde skruen i vandet”.

Troels Johansen håber, at der snart kommer venturepenge på bordet. Han og broren Asger Johansen står med selskabet BalancAir bag opfindelsen, der i juni hev en pris hjem fra årets Venture Cup Startup Competition inden for life science: En maske, som uden brug af medicin potentielt kan forebygge og afbryde epilepsianfald.

”Vi har snakket med forskellige venturefolk. Udfordringen er, at de bliver ved med at sige: ’Vi skal lige se’. Det er også fint nok, men det betyder, at vi kæmper en brav kamp for at holde skruen i vandet,” siger Ph.d.-studerende Troels Johansen fra Institut for Klinisk Medicin på Aarhus Universitet til MedWatch.

Masken virker ved at hæve niveauet af CO2 i indåndingsluften. Ved at gøre det, falder pH-værdien i kroppen, og kropvæsker som blod bliver mere surt.

”Det har en betydning i hjernen for, at man sænker nervesystemets påvirkelighed. Det betyder, at man hurtigt kan stoppe epileptiske anfald, men også at man kan imødegå epileptiske anfald,” siger Troels Johansen med henvisning til, at epileptikere sommetider kan mærke et kommende anfald. (...)

- Epilepsirelaterte psykoser

Epilepsy Drugs in Pregnancy Tied to Risks for Kids
webmd.com 18.7.2013
Large Norwegian study followed offspring for up to 3 years

THURSDAY, July 18 (HealthDay News) -- The children of women who take drugs to treat epilepsy during pregnancy may be at increased risk for physical and mental developmental delays early in life, a large, new study finds.

Epilepsy is fairly common among women of childbearing age, and the use of antiepileptic drugs by pregnant women ranges from 0.2 to 0.5 percent.
In this study, researchers recruited Norwegian mothers at 13 to 17 weeks of pregnancy. For more than 61,000 children, mothers provided details about motor development, language skills, social skills and autistic symptoms at age 18 months. At 36 months, mothers provided that information for more than 44,000 children.

The researchers found that 333 of the children were exposed to antiepileptic drugs in the womb. At 18 months of age, these children were more likely to have motor skills problems and traits of autism. At 36 months of age, these children were more likely to have problems with motor skills and sentence skills, and traits of autism.

The children exposed to antiepileptic drugs also had an increased risk of birth defects, according to the study appearing July 18 in the journal Epilepsia.

No physical or mental development delays were found in children born to women with epilepsy who did not take antiepileptic drugs during pregnancy, and children of fathers with epilepsy generally showed normal early development, according to a journal news release. (...)

Epilepsirelaterte psykoser
Tidsskr Nor Legeforen 2013; 133:1205 – 9 (11.6.2013)
Se også kunnskapsprøve på www.tidsskriftet.no/quiz

BAKGRUNN Epilepsirelaterte psykoser ligger i grenselandet mellom nevrologi og psykiatri. Hensikten med denne artikkelen er å gi en kort oversikt over hva vi i dag vet om slike psykoser samt å gi noen råd om behandlingen.

KUNNSKAPSGRUNNLAG Denne oversikten er basert på et skjønnsmessig utvalg av artikler funnet etter søk i PubMed samt forfatternes egen erfaring med pasientgruppen.

RESULTATER Psykoser ved epilepsi kan opptre under, etter og mellom anfall. I tillegg kan psykoser opptre som bivirkning av antiepileptika og som såkalt alternativ psykose. Den sistnevnte psykoseformen kan oppstå hos pasienter som ved hjelp av behandling (medikamenter eller kirurgi) er blitt helt anfallsfri. Iktale psykoser og majoriteten av postiktale psykoser er ofte av så kort varighet at behandling med antipsykotika er uaktuelt. Å optimalisere den antiepileptiske behandlingen blir i slike tilfeller det viktigste tiltaket. Ved interiktale psykoser og hos noen pasienter med særlig langvarige eller stadig tilbakevendende postiktale psykoser kan behandling med antipsykotika være indisert.

FORTOLKNING De ulike epilepsirelaterte psykoseformene behandles forskjellig, og noen behandles med antipsykotika. Vi anbefaler da å velge medikamenter som i liten grad senker anfallsterskelen, for eksempel risperidon. (...)

(Anm: Antipsykotika (psykofarmaka etc.) (mintankesmie.no).)

(Anm: Lægemiddelstyrelsen opfordrer læger til at være opmærksomme på disse alvorlige bivirkninger hos børn og unge i behandling med aripiprazol (Abilify) (…) Gennemgangen viser også, at børn med ASD (autisme) der behandles med aripiprazol, kan udvikle alvorlige psykiatriske bivirkninger såsom svære kroniske søvnproblemer, aggressiv adfærd og hallucinationer. (…) Hårtab, depression og psykose, Vægtøgning, Hypercholesterolemi, Hypercholesterolemi. (LÆGEMIDDELSTYRELSEN - NYT OM BIVIRKNINGER 2016;7(9).)

(Anm: «Psykiatrien i Norge har hatt for svak ledelse. På alle nivåer. I alle år». KRONIKK: Helseminister Bent Høie (H). BENT HØIE, Helseminister. (vg.no 23.11.2016).)

(Anm: - Kan vi stole på forskningen? (...) - Er det ikke så nøye med sannheten fordi det lønner seg økonomisk og er lettvint bare å tro på forenklingene, halvsannhetene og de opplagt bløffene? (...) - Trass i all forskning. Trass i alle milliarder av kroner som var blitt investert, trass i alle gode intensjoner. Men «sannheten om de psykiske sykdommers natur, ubalansen i hjernens kjemi» viste seg etter hvert ikke å være sann. (dagensmedisin.no 2.4.20

(Anm: Dyremodeller åbner døren til ny generation af antipsykotika. (- »Industrien har måttet erkende, at de ‘varer’, der var på hylderne, ikke var brugbare. (dagensmedicin.dk 31.3.2017).)

(Anm: Psykofarmaka dreper mange. (…) I DAGENS MEDISIN 12. februar hevder psykiaterne Rune Andreas Kroken og Erik Johnsen at det ikke er riktig at psykiatrisk behandling tar liv. De påstår til og med at man lever lenger dersom man får antipsykotika. Dette er helt utrolig.) (dagensmedisin.no 10.3.2017).)

(Anm: Få pasienter kjenner til klageordning. (…) Søkere fikk medhold i en firedel av sakene. For dem som klaget på legemiddelskader utløst av antipsykotika, fikk imidlertid kun 9,4% medhold. - Man kan spekulere i om pasienter som ikke er flinke nok til å snakke om sin sak, ikke når frem. (Tidsskr Nor Legeforen 22.1.2013).)

(Anm: Høie om psykiatrien: Har fått leve sitt eget liv. (...) Dette er veldig alvorlig, og bekrefter dessverre det inntrykket jeg har fått om tvangsbruken innen psykisk helse: at den går langt utover det som er hensikten og det juridiske grunnlaget - og at den går utover det som er god faglighet, sier Høie til VG. (vg.no 20.11.2016).)

(Anm: Antipsykotika og fysisk attraktivitet (Antipsychotics and physical attractiveness) (...) Antipsykotika, som gruppe, fører til vektøkning og kan føre til munntørrhet og dårlig ånde, grå stær, hirsutisme (uvanleg sterk eller altfor utbreidd hårvekst (helst hos kvinner)), akne og stemmeendringer; de kan forstyrre symmetri av gangart og øke risikoen for tics og spasmer og inkontinens, og potensielt undergrave en persons attraktivitet. Clin Schizophr Relat Psychoses. 2011 Oct;5(3):142-146.)

(Anm: Medikamentutløst dystoni. (…) Videoen illustrerer ekstrapyramidale bivirkninger med dystoni i tunge og kjeveområdet. Tidsskr Nor Legeforen 2016; 136:1730-1730 (8.11.2016).)

(Anm: Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Conclusions Older people with intellectual disabilities and with mental health conditions were exposed to high anticholinergic burden. This was associated with daytime dozing and constipation. The British Journal of Psychiatry Dec 2016, 209 (6) 504-510.)

(Anm: Bivirkninger av antipsykotika - Related Editorial (Relatert lederartikkel) (…) Bruken av antipsykotika innebærer en vanskelig avveining mellom nytte for å lindre psykotiske symptomer og noen ganger risikoen for problematiske bivirkninger som forkorter levetiden. (…) Alle antipsykotika er forbundet med en økt sannsynlighet for sedasjon, seksuell dysfunksjon, postural hypotensjon, hjertearytmi og plutselig hjertedød. (…) Antikolinerge effekter inkluderer forstoppelse, urinretensjon, tørr munn, uklart syn og, til tider, kognitiv svekkelse. Disse symptomene kan føre til andre problemer som tannforråtnelse, fall eller gastrointestinal obstruksjon. Am Fam Physician. 2010 Mar 1;81(5):617-622).)

(Anm: J&J’s Janssen dømt til å betale 70 millioner dollar i Risperdal-rettssak. (J&J's Janssen hit with $70 mln verdict in Risperdal trial) (…) Juryen i Philadelphia Court of Common Pleas fant at firmaet mislyktes å advare guttens helsepersonell om risikoen for gynecomastia, som er brystvekst hos menn eller gutter forårsaket av en hormonell ubalanse, og at de med vilje forfalsket, og ødela eller skjulte bevis i saken.) Janssen dømt til å betale 70 millioner dollar i Risperdal-rettssak. (finance.yahoo.com 1.7.2016).)

(Anm: J&J's Janssen hit with $70 million verdict in Risperdal trial. Johnson & Johnson and Janssen are facing more than 12,000 claims over Risperdal, according to Johnson & Johnson's most recent quarterly report. (…) In 2013, Johnson & Johnson and Janssen paid more than $2.2 billion to resolve civil and criminal investigations by the U.S. Department of Justice into its marketing of Risperdal and several other drugs. (reuters.com 1.7.2016).)

(Anm: Jury smacks J&J with $70M in damages in latest Risperdal breast case. Johnson & Johnson ($JNJ) is fighting more than 1,500 legal claims that its antipsychotic Risperdal triggered breast development in boys, and the company has landed on the wrong side of a jury verdict in several of them so far. (fiercepharma.com 5.7.2016).)

(Anm: Antipsykotika forårsaker ansiktsgrimasering og andre typer mulige varige hjerneskader (mintankesmie.no).)

(Anm: Derfor bliver man fed af antipsykotisk medicin. (- Derfor blir man feit av antipsykotika.) (videnskab.dk 7.1.2016).)

(Anm: Psykose. Alle mennesker kan utvikle psykose. - Balansegangen mellom opplevd stress og ballast til å stå imot, er avgjørende, forteller psykiater. (…) - Stress er et sentralt tema. For eksempel har vi forskjellige måter å takle en belastende hendelse på jobb på. (…) - Man kan kalle det en forvirringstilstand, selv om heller ikke det er helt dekkende. (…) Symptomer ved psykose. Tidlige tegn kan være at man: (…) - Det er en kjempebelastning å ha en psykose. Mange blir redde og opplever ting de ikke forstår. Man vet at noen mennesker kan få tanker og impulser om å ta sitt eget liv, legger hun til. (lommelegen.no 13.6.2016).)

(Anm: Psychosis: Link to brain inflammation antibodies raises new treatment hope. For the first time, researchers reveal that some people presenting with a first episode of psychosis have specific antibodies in their blood. The antibodies are the same ones known to cause encephalitis or brain inflammation. The discovery raises the question of whether the removal of these antibodies could be an effective treatment for psychosis as it is for encephalitis. The researchers - led by Belinda R. Lennox, a professor in the department of psychiatry at the University of Oxford in the United Kingdom - report their findings in The Lancet Psychiatry. (…) Previous studies have already fueled discussion about the role antibodies targeting neural proteins may play in psychosis. For example, a study reported in 2015 of children experiencing their first episode of psychosis, also found links to an antibody response to NMDAR. (medicalnewstoday.com 9.12.2016).)

(Anm: Psykose som målestokk for tvungent psykisk helsevern. Sammendrag Abstract  Denne artikkelen handlar om vilkåra for tvungent psykisk helsevern. Det er særleg fokusert på ei drøfting omkring det såkalla hovudvilkåret etter lov om psykisk helsevern (phvl.) § 3-3 (1) nr. 3. I artikkelen vert det drøfta om dagens rettsregel og dei vurderingstema den set opp, gjer ei god avgrensing sett i høve til føremåla med tvungent psykisk helsevern. Det vert òg skissert ei betre løysing for tolking av vilkåret. Kritisk juss03 / 2016 (Volum 2) Side: 217-237DOI: 10.18261/issn.2387-4546-2016-03-03.)

(Anm: Psykose forbundet med lave nivåer av fysisk aktivitet. (Psychosis associated with low levels of physical activity. A large international study of more than 200,000 people in nearly 50 countries has revealed that people with psychosis engage in low levels of physical activity, and men with psychosis are over two times more likely to miss global activity targets compared to people without the illness.) (medicalnewstoday.com 26.8.2016).)

(Anm: Signaling from dysfunctional mitochondria induces a distinct type of senescence. (Signalering fra dysfunksjonelle mitokondrier induserer en distinkt type tiltagende alderdom.) Finding provides alternative explanation for the free-radical theory of aging and suggests new role for mitochondria in affecting physiology. (medicalnewstoday.com 11.12.2015).)

(Anm: Mitochondrial Dysfunction Meets Senescence. Trends Biochem Sci. 2016 Feb 10. pii: S0968-0004(16)00020-7. [Epub ahead of print].)

(Anm: NTNU-forskere er med i teamet: Har laget «smart» speil som kan avsløre hjerteinfarkt (vg.no 18.11.2015).)

(Anm: Speilet som ser et fremtidig hjerteinfarkt. (…) Det smarte speilet «Wize mirror» ser ut som et vanlig speil, men inneholder 3D-skannere, multispektrale kameraer og gass-sensorer for å vurdere helsen til den står foran det. Speilet gjør dette gjennom å undersøke personens ansikt, vurdere fettvev, blodgjennomstrømning, ansiktsuttrykk og ansiktsfarge. (gemini.no 18.11.2015).)

(Anm: How Smoking Wrecks Your Looks. See how lighting up can add years to your appearance, causing sagging skin, hair loss, and more. (webmd.com 19.11.2015).)

(Anm: What Does Your Face Say About Your Health? (webmd.com 20.3.2017).)

(Anm: Common antidepressant may change brain. (…) A commonly prescribed antidepressant may alter brain structures in depressed and non-depressed individuals in very different ways, according to new research at Wake Forest Baptist Medical Center. (...) MRI images taken at the end of the treatment phase revealed that in depressed subjects the drug significantly increased the volume of one region of the brain, the anterior cingulate cortex, while decreasing the volume of this same region and the hippocampus in non-depressed subjects. Both of these areas are highly interconnected with other areas of the brain; are critical in a wide array of functions including memory, learning, spatial navigation, will, motivation and emotion; and are implicated in major depressive disorder. (medicalnewstoday.com 7.9.2015).)

(Anm: Antipsychotic drugs linked to brain tissue loss in patients with schizophrenia. Antipsychotic medications are the most common treatment for individuals with schizophrenia, helping to relieve some of the debilitating symptoms caused by the disorder. But according to a new study, long-term use of these drugs may also negatively impact brain structure. Researchers say long-term use of antipsychotic medications - particularly first-generation antipsychotics - may lead to gray matter loss in the brain. First author Dr. Antonio Vita, professor of psychiatry at the University of Brescia in Italy, and colleagues publish their findings in the journal Biological Psychiatry. (medicalnewstoday.com 7.9.2015).)

(Anm: Gray matter abnormality predicts neurodevelopmental problems in smaller premature babies (medicalnewstoday.com 8.4.2016).)

- Epilepsimedisin kobles til fosterskader hos 450 barn. (- I 2013 viste studier utført av forskere ved Aarhus Universitet at kvinner som tok valporat under graviditeten hadde tre ganger så høy risiko for å få et barn med autisme sammenlignet med mødre som ikke hadde fått i seg stoffet.)

Epilepsimedisin kobles til fosterskader hos 450 barn.
dagbladet.no 24.2.2016
Knyttes til misdannelser og autisme.

Et mye brukt legemiddel til behandling av epilepsi kobles direkte til misdannelser hos omkring 450 nyfødte barn i Frankrike.

Franske helsemyndigheter advarer kvinner om risikoen ved å bruke legemiddelet depakine under graviditeten, skriver nyhetsbyrået AFP.

Ifølge en rapport som ble lagt fram tirsdag ble mellom 425 og 450 barn, som ble født med misdannelser i perioden 2006-2014, eksponert for stoffet valproat i livmoren under graviditeten.

Epilepsimedisinen kommer derfor med en ekstra advarsel om risiko for gravide på pakken fra 1. mars.

 I 2013 viste studier utført av forskere ved Aarhus Universitet at kvinner som tok valporat under graviditeten hadde tre ganger så høy risiko for å få et barn med autisme sammenlignet med mødre som ikke hadde fått i seg stoffet. (NTB)

(Anm: Orfiril (Valproate, Depacon, Depakene etc.) (en.wikipedia.org).)

(Anm: VALPROATE (valproic acid) (dailymed.nlm.nih.gov).)

(Anm: Valproat gir stor risiko for fosterskader. Valproat er fosterskadelig og gir stor risiko for medfødte misdannelser og utviklingsforstyrrelser. Barn av mødre som har brukt valproat i svangerskapet har høy risiko for alvorlige utviklingsforstyrrelser og medfødte misdannelser: - Risikoen for medfødte misdannelser er 10 % - Inntil 40 % opplever forsinket psykomotorisk utvikling - Gjennomsnittlig intelligenskvotient (IQ) reduseres med 7-10 poeng - Økt forekomst av autismelignende tilstander og ADHD  (legemiddelverket.no 26.5.2016 / 15.12.2014).)

Epilepsimedel kopplas till autism
dagensmedicin.se 30.4.2013
Ny dansk forskning tyder på att risken för autismspektrumstörningar ökar om mamman tar läkemedel som innehåller valproat under graviditeten.

Mediciner med substansen valproat är enligt Läkemedelsverket förstahandsval vid generaliserade anfall hos epilepsipatienter. Redan i dag är dock rekommendationen att om möjligt välja andra mediciner hos gravida eftersom valproat tycks kunna öka risken för fosterskador.

Och nu kommer alltså ytterligare stöd för att substansen bör undvikas om det finns andra alternativ.

Forskare vid universitetssjukhuset i Århus har följt upp alla barn som föddes i Danmark under åren 1996-2006, totalt 655 615 stycken. Hos 508 av dem hade mamman hämtat ut recept på valproat under graviditeten.

Exponering för valproat under fostertiden var kopplat till en femfaldigt ökad risk för autism, och trefaldigt ökad risk för autismspektrumstörning, som förutom autism även omfattar bland annat Aspergers syndrom och atypisk autism.

Den absoluta risken var 2,5 procent för autism och 4,4 procent för autismspektrumstörning om mamman tagit valproat under graviditeten.

Studien publiceras i tidskriften Jama, och forskarna skriver att fynden måste balanseras mot nyttan med behandlingen hos kvinnor som behöver valproat för att hålla sin epilepsi under kontroll. (...)

(Anm: Prenatal Valproate Exposure and Risk of Autism Spectrum Disorders and Childhood Autism (Prenatal eksponering for Valproate (Orfiril) og risiko for autismespekterforstyrrelser og barneautisme) JAMA. 2013;309(16):1696-1703 (April 24, 2013).)

Prenatal Valproate Exposure and Risk of Autism Spectrum Disorders and Childhood Autism (Prenatal eksponering for Valproate (Orfiril) og risiko for autismespekterforstyrrelser og barneautisme)
JAMA. 2013;309(16):1696-1703 (April 24, 2013)
Betydning Valproate brukes til behandling av epilepsi og andre nevropsykologiske lidelser, og kan være det eneste behandlingsalternativet for kvinneri fødedyktig alder. Imidlertid kan prenatal eksponering for Valproate øke risikoen for autisme. (Importance Valproate is used for the treatment of epilepsy and other neuropsychological disorders and may be the only treatment option for women of childbearing potential. However, prenatal exposure to valproate may increase the risk of autism.)

Objective To determine whether prenatal exposure to valproate is associated with an increased risk of autism in offspring. (…)

Konklusjoner og relevans Mors bruk av valproate under svangerskapet var assosiert med en betydelig økt risiko for autismespektrumlidelse og barneautisme selv etter justering for mors epilepsi. For kvinner i fødedyktig alder som bruker epilepsilegemidler må disse funnene veies mot nytte av behandling av kvinner som trenger valproate for å kontrollere epilepsi. (…) (Conclusions and Relevance Maternal use of valproate during pregnancy was associated with a significantly increased risk of autism spectrum disorder and childhood autism in the offspring, even after adjusting for maternal epilepsy. For women of childbearing potential who use antiepileptic medications, these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.)

(Anm: Orfiril (Valproate, Depacon, Depakene etc.) (en.wikipedia.org).)

(Anm: VALPROATE (valproic acid) (dailymed.nlm.nih.gov).)

(Anm: Valproat gir stor risiko for fosterskader. Valproat er fosterskadelig og gir stor risiko for medfødte misdannelser og utviklingsforstyrrelser. Barn av mødre som har brukt valproat i svangerskapet har høy risiko for alvorlige utviklingsforstyrrelser og medfødte misdannelser: - Risikoen for medfødte misdannelser er 10 % - Inntil 40 % opplever forsinket psykomotorisk utvikling - Gjennomsnittlig intelligenskvotient (IQ) reduseres med 7-10 poeng - Økt forekomst av autismelignende tilstander og ADHD  (legemiddelverket.no 26.5.2016 / 15.12.2014).)

- Forskning, diagnostisering, behandling, seponering og oppfølging

A case series of patients with lamotrigine toxicity at one center from 2003 to 2012. (En serie tilfeller av pasienter utsatt for toksistet fra lamotrigin (Lamictal) ved et senter fra 2003 til 2012)
Clin Toxicol (Phila). 2013 Aug;51(7):545-9. doi: 10.3109/15563650.2013.818685. Epub 2013 Jul 19.
INTRODUCTION: Lamotrigine is a phenyltriazine compound that inhibits voltage-gated sodium channels, decreasing release of glutamate and aspartate, and inhibits serotonin, norepinephrine and dopamine reuptake. Reports of toxicity in the literature are limited to case reports and primarily involve coingestants. This case series is intended to report the clinical manifestations of lamotrigine toxicity.

METHODS: This retrospective case series from 2003 to 2012 studies the effects of lamotrigine toxicity when not confounded by coingestants. Admission records at an inpatient toxicology center were reviewed for lamotrigine-only exposure based on history with supporting laboratory data when available. After identification, these charts were reviewed again to characterize vital signs, neurological examination findings, specific laboratory and electrocardiography parameters, and complications.

RESULTS: Fifty-seven patients were identified with possible lamotrigine toxicity. Nine patients, including three toddlers, had lamotrigine-only ingestions. Three of these patients had seizures, four were hypertensive, five were tachycardic, and four experienced tachypnea. Mental status was altered in all nine (depressed (n = 4), agitated (n = 5) or both (n = 3)). Five patients were hyperreflexic and experienced intermittent myoclonus, and two had inducible clonus. On electrocardiogram, two patients experienced QRS prolongation (114-116 ms), and four had QTc prolongation (463-586 ms). No patient had life-threatening symptoms or signs. Serum levels of lamotrigine were available in seven patients, and averaged 35.4 mg/L (17-90 mg/L). The therapeutic range for sLTG is 3-14 mg/L.

CONCLUSIONS: Lamotrigine toxicity manifested with minor-moderate neurologic and/or electrocardiographic effects. Toxicity reflects the known pharmacologic actions of lamotrigine: serotonin, norepinephrine and dopamine reuptake inhibition, and sodium channel blockade. (...)

(Anm: Lamotrigine toxicity secondary to sertraline.Seizure. 1998 Apr;7(2):163-5.)

(Anm: Review: Serotonin syndrome in Lamictal (ehealthme.com).)

(Anm: Serotonin syndrom (SS), kramper, parkinsonisme osv. (forhøyet kroppstemperatur) (mintankesmie.no).)

(Anm: Fatal uncoupling in the epileptic brain (medicalnewstoday.com 27.3.2015).)

(Anm: Lamotrigine May Not Cause Orofacial Birth Defects. —But large European registry case-control study suggests link to clubfoot. The antiepileptic drug lamotrigine (Lamictal) may not cause orofacial birth defects, after all, but there's now more evidence it may be tied to clubfoot, a new study shows. In a case-malformed control study funded by Lamictal manufacturer GlaxoSmithKline, use of lamotrigine during pregnancy wasn't significantly associated with orofacial clefts (adjusted OR 1.31, 95% CI 0.73–2.33) or cleft palate (aOR 1.60, 95% CI 0.70–3.65), Helen Dolk, DrPH, of the University of Ulster in Northern Ireland, and colleagues reported online in Neurology. (medpagetoday.com 7.4.2016).)

(Anm: Anti-epileptic drug linked to birth defects when taken with other drugs. (…) The rise in such "polytherapy" malformation rates began around 2005 when levetiracetam and topiramate use began to increase. Malformation rates were similar in polytherapy pregnancies whether or not levetiracetam was included (7.14 percent versus 8.38 percent), but were higher in polytherapy pregnancies involving topiramate (14.94 percent versus 6.55 percent). (medicalnewstoday.com 7.6.2016).)

Use of antiepileptic drugs and risk of hypothyroidism (Bruk av antiepileptika og risiko for hypotyreose)
Pharmacoepidemiol Drug Saf. 2013 Aug 15. [Epub ahead of print]
PURPOSE: This study aimed to investigate the risk of clinically significant hypothyroidism among all the currently available antiepileptic drugs (AED). (...)

CONCLUSION: The results indicated an increased risk of hypothyroidism among patients using AEDs, especially phenytoin, valproate, phenobarbital, carbamazepine, and oxcarbazepine. The findings also provided strong grounds for further investigations on acute thyroid adverse effect induced by phenytoin. (...)

(Anm: IQ at 6 years after in utero exposure to antiepileptic drugs: A controlled cohort study. Neurology. 2014 Dec 24. pii: 10.1212/WNL.0000000000001182. [Epub ahead of print].)

BYTTET UT MEDISIN MED MAT
aftenposten.no 21.9.2013
MAT SOM MEDISIN: Tommine, som går på ekstrem lavkarbokur for å forhindre epileptiske anfall.

Tommine (5) trenger fett for å unngå epileptiske anfall. Hun går ikke på medisiner, hun går på mat.

– Hei, jeg heter Tommine, sier en blid munn og to skøyeraktige øyne.

Den fem år gamle jenta finnes ikke sjenert, hun strutter av liv og ser ikke ut til å mangle noen verdens ting. Lekerommet inneholder alt en liten jente kan ønske seg. Det eneste Tommine mangler er en liten byggestein som frakter sukker til hjernen; Glut 1-proteinet. Veien til et liv uten epileptiske anfall går gjennom fløteboksen. Fet mat gjør Tommine frisk. (...)

ET FETT LIV.
– Ved Glut 1-mangel finnes det ingen medisiner som kan erstatte diett. Det er derfor avgjørende å få stilt riktig diagnose og diett så tidlig som mulig for å unngå at hjernen tar skade av gjentatte epileptiske anfall og for å forhindre bivirkninger av uvirksomme medisiner, sier Haavardsholm.

Man kan ikke begynne med ketogen diett på egen hånd, man må følges tett opp av helsepersonell med kompetanse på dietten. (...)

Outcomes Mixed for Brain Surgery in Epilepsy (Resultater blandet for hjernekirurgi ved epilepsi)
medpagetoday.com 23.8.2013
Long-term follow-up in children undergoing hemispherectomy for refractory epilepsy showed that most were seizure-free and able to walk independently, but deficits in many areas of daily function were common, researchers said.

Among 115 children with a mean of 6.05 years of follow-up, 70 were seizure-free and 96 were able to walk without assistance, according to Ajay Gupta, MD, of the Cleveland Clinic in Ohio, and colleagues.

But two-thirds of the children had at least mildly impaired speech, some 85% either required assistance at a mainstream school or were in a special school, and, among those 6 or older, only 18% had age-appropriate reading ability, the researchers reported online in the journal Epilepsia.

(Anm: Long-term functional outcomes and their predictors after hemispherectomy in 115 children. Epilepsia 2013 (Article first published online: 23 AUG 2013).)

Epilepsy Drug Warnings May Slip Through Cracks
webmd.com 19.8.2013
1 in 5 neurologists unaware of updated safety risks identified by FDA, survey finds

In study, adults with diabetes who didn't grasp

MONDAY, Aug. 19 (HealthDay News) -- One-fifth of U.S. neurologists are unaware of serious safety risks associated with epilepsy drugs and are potentially risking the health of patients who could be treated with safer medications, a new study reveals.

The 505 neurologists who took part in the survey between March and July 2012 were asked if they knew about several epilepsy drugs' safety risks recently identified by the U.S. Food and Drug Administration.

These risks included increased danger of suicidal thoughts or behaviors linked with some newer drugs, a high risk for birth defects and mental impairment in children of mothers taking divalproex (brand name Depakote), and the likelihood of serious hypersensitivity reactions in some Asian patients treated with carbamazepine (Tegretol). (...)

Anxiety associated with structural brain differences in children with epilepsy (Engstelse forbundet med strukturelle hjerneforskjeller hos barn med epilepsi.)
clinicalpsychiatrynews.com 31.7.2013
MONTREAL – The brains of children who have been recently diagnosed with both epilepsy and anxiety are markedly different from those children who have seizures but are anxiety free, a study has shown.

These differences include significantly larger left amygdala, and prefrontal cortices that are thinner in the left medial orbital, right lateral orbital, and right front pole regions – a pattern known to be associated with anxiety and mood disorders in the general population. (...)

Brain Protein May Suggest New Epilepsy Treatment Strategy
JAMA. 2013;310(1):22 (text)
A protein produced within the brain acts like antiepileptic drugs, report researchers from Stanford University School of Medicine in Stanford, California (Christian CA et al. Neuron. doi:10.1016/j.neuron.2013.04.026 [published online May 30, 2013]). In addition to being an intracellular transporter of a metabolite called acyl-CoA, the protein, diazepam binding inhibitor (DBI), binds to receptors on nerve cells that are responsive to the inhibitory neurotransmitter γ-aminobutyric acid type A (GABAA).

Using single nerve cell–recording techniques, the researchers showed that within the brain’s thalamic reticular nucleus, DBI has the same inhibition-boosting effect on GABAA receptors as do benzodiazepines. Diazepam binding inhibitor lost its effect in bioengineered mice with GABAA receptors that had a defective benzodiazepine-binding site, which made the mice seizure-prone. In normal mice, a compound known to block the benzodiazepine-binding site weakened these same receptors’ inhibitory activity in the thalamic reticular nucleus.

Mice lacking the gene for DBI were also seizure-prone and had diminished activity of benzodiazepine-responsive GABAA receptors. When the gene was reintroduced, the strength of GABAA receptor–induced inhibition was restored.

The findings suggest that enhanced DBI signaling could represent a new therapeutic strategy to treat epilepsy and other neurological disorders. (...)

(Anm: Epilepsy has been found to reduce the generation of new neurons (medicalnewstoday.com 17.5.2015).)

Implantat forudsiger epilepsianfald
medwatch.dk 6.5.2013
Et nyt studie har vist, at et implantat i hjernen er i stand til at opfange tidlige faresignaler på potentielle anfald for epilepsipatienter.

Et hjerneimplantat er muligvis i stand til at forudsige epilepsianfald ved at opfange tidlige faresignaler. Det viser et mindre klinisk studie ifølge BBC.

Studiet, som inkluderede 15 testpersoner og netop er blevet udgivet i tidsskriftet Lancet Neurology, viste, at udstyret virkede i nogle af personerne.

Udstyret bruger hjernens elektriske signaler til at fortælle patienterne, om risikoen for et anfald er høj, moderat eller lav. Signalerne bliver opsamlet fra overfladen af hjernen og sendt videre til et andet implantat i brystet. Herfra bliver informationerne sendt videre til et håndholdt apparat, som udregner risikoen for et anfald.

Det kliniske studie fandt sted på tre forskellige australske hospitaler og blev finansieret af udviklerne af udstyret, virksomheden NeuroVista. (...)

(Anm: Brain implant 'predicts' epilepsy seizures (bbc.co.uk 1.5.2013).)

(Anm: Prediction of seizure likelihood with a long-term, implanted seizure advisory system in patients with drug-resistant epilepsy: a first-in-man study. The Lancet Neurology 2013 (May 2).)

Her prøver de å fjerne epileptiske anfall
nrk.no 29.4.2013
Kristine våken under operasjon av hjernen (Foto: Keylly Neal/NRK)

Kristine (20) må være våken mens kirurgene opererer hjernen hennes. I fire timer ligger hun slik. På en skjerm kan hun følge med på hva som skjer inne i sitt eget hode.

Hjernekirurgene på Rikshospitalet kan fjerne de epileptiske anfallene hos Kristine (20). Her er historien om hvordan kirurgene jobber trinn for trinn. (...)

Exploring Unexplained Deaths in Epilepsy
Ivanhoe.com 27.3.2013
(Ivanhoe Newswire) -- Dravet syndrome (DS) is a form of infantile-onset, treatment-resistant epilepsy that is caused by a mutation in the gene encoding a voltage-gated sodium channel, SCN1A. DS patients have a 30-fold increased risk of dying from sudden unexplained death in epilepsy (SUDEP) compared to patients with other forms of pediatric-onset epilepsy.

Franck Kalume and colleagues at the University of Washington characterized SUDEP in a mouse model of DS. Observation using video, electroencephalography, and electrocardiography revealed that a prolonged slowing of the heart beat preceded SUDEP in mice.

Treatment with drugs that reduce activity in the parasympathetic nervous system reduced the incidence of SUDEP, suggesting that mortality results from seizure-related parasympathetic hyperactivity. In a companion Attending Physician, Orrin Devinsky and colleagues discuss how these results could relate to SUDEP in human DS patients.

SOURCE: Journal of Clinical Investigation, March 2013 (...)

Epilepsi hos eldre
Tidsskr Nor Legeforen 2013; 133:528 – 31 (5.3.2013)
BAKGRUNN Både diagnostikk og behandling kan være vanskelig hos personer som får epilepsi etter fylte 65 år. Epilepsi er en av de vanligste nevrologiske tilstandene hos eldre, og forekomsten av nyoppstått epilepsi hos eldre er økende. Hensikten med denne artikkelen er å gi noen råd om håndtering av epilepsi hos denne pasientgruppen.

KUNNSKAPSGRUNNLAG Artikkelen bygger på et skjønnsmessig utvalg originalartikler og oversiktsartikler funnet i PubMed med søkekombinasjon «epilepsy and elderly» samt forfatternes egne erfaringer.

RESULTATER Anfallene, som som oftest er av fokal type, blir ikke sjelden oversett eller mistolket. Cerebrovaskulær sykdom er årsaken hos rundt halvparten. Ved valg av antiepileptikum er det viktig å ta hensyn til fysiologiske aldersforandringer og komorbide tilstander. Fordi det hos eldre er et smalere terapeutisk vindu enn hos yngre og høyere følsomhet for kognitive og andre bivirkninger, er det særlig viktig med lav startdose og langsom doseopptrapping.

FORTOLKNING Man kan ikke ekstrapolere resultater fra studier av yngre epilepsipasienter til de eldre. Det er derfor behov for flere studier rettet spesifikt mot denne pasientgruppen. Vi anbefaler som hovedregel ikke oppstart av enzyminduserende medikamenter, slike som fenytoin, fenobarbital og karbamazepin, blant annet på grunn av deres høye interaksjonspotensial. (...)

Epilepsimedicin kan øge risiko for at føde børn med autisme
dagenspharma.dk 12.2.2013
Neurologiske lidelser ses oftere hos børn, hvis mødrene har taget medicin mod epilepsi under graviditeten. (…)

Epilepsy Drug Linked To Increased Risk Of Autism
medicalnewstoday.com 1.2.2013
Children born to mothers who took the antiepileptic drug sodium valproate during pregnancy are at significantly increased risk of autism and other neruodevelopmental disorders.

The finding came from new research published in the Journal of Neurology, Neurosurgery and Psychiatry (...)

The children whose moms took valproate by itself or with another drug during pregnancy had a considerably higher chance of being diagnosed with a neurodevelopmental condition, compared to those whose mothers took other medications for their disorder. (...)

IQ hos børn kan påvirkes af epilepsimedicin under graviditet
dagenspharma.dk.dk 29.1.2013
Gravides forbrug af valproat kan medføre langsigtet påvirkning af barnets intelligens og indlæringsevne (...)

Study Links Epilepsy Drug in Pregnancy to Lower IQ
bio-medicine.org 23.1.2013
WEDNESDAY, Jan. 23 (HealthDay News) -- Children of mothers who take the antiepileptic drug valproate during pregnancy have lower IQ scores at age 6, a new study says.

And the higher the dose of valproate during pregnancy, the greater the effect on a child's IQ, according to the report published in the Jan. 22 issue of The Lancet Neurology.

For the study, the researchers looked at 305 pregnant women in the United States and United Kingdom who took a single drug to treat the seizure disorder -- either valproate (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal) or phenytoin (Dilantin).

At age 6, the IQ of children whose mothers took valproate during pregnancy was seven to 10 points lower than children whose mothers took another antiepileptic drug. Exposure to valproate was also associated with poorer speaking and memory abilities. (...)

Genetic Link Between Epilepsy and Migraine (Genetisk link mellom epilepsi og migrene)
sciencedaily.com 7.1.2013
Jan. 7, 2013 — New research reveals a shared genetic susceptibility to epilepsy and migraine. Findings published in Epilepsia, a journal of the International League Against Epilepsy (ILAE), indicate that having a strong family history of seizure disorders increases the chance of having migraine with aura (MA). (...)

(Anm: Evidence for a Shared Genetic Susceptibility to Migraine and Epilepsy. Epilepsia 2013 (7 JAN 2013).)

Valproate-induced hyperammonaemia superimposed upon severe neuropsychiatric lupus: a case report and review of the literature
Clin Rheumatol. 2012 Dec 28. [Epub ahead of print]
Abstract This paper presents a case of systemic lupus erythematosus (SLE) with neuropsychiatric features, where the outcome was influenced by the development of hyperammonaemia, probably induced by sodium valproate. A case of severe SLE occurring in a 20-year-old Maori girl is described. Her disease had been characterised by neuropsychiatric features for several years, culminating in persistent seizure activity at the time of her final presentation. Her management with anticonvulsants was complicated by the development of intractable hyperammonaemia which contributed to irreversible clinical deterioration. We have reviewed the English literature for reports of valproate-related hyperammonaemia which has often been described in the setting of seizure and mood disorders. This is the first case where it has been reported, superimposed upon severe neuropsychiatric SLE (NP-SLE). The mechanism by which valproate induces hyperammonaemia remains incompletely understood but is likely to relate to the urea cycle. Under normal metabolic conditions, acyl-CoA is transported into the mitochondria via a carnitine transport system. It is then converted to acetyl-CoA via β-oxidation and eventually to N-acetyl glutamate. This pathway can be interrupted by the introduction of sodium valproate, leading to a reduction of free coenzyme A, acetyl-CoA and carnitine, and resulting in the decreased availability of cofactors necessary for the function of the urea cycle. As this is the primary means of ammonia metabolism, serious elevation in serum ammonia levels may occur in patients on this anticonvulsant medication. In this patient with active NP-SLE, the combined autoimmune and metabolic brain insult contributed to a fatal outcome. (...)

- Oppdagelse kan påvirke forståelse, behandling av autoimmune og inflammatoriske sykdommer.

(Anm: Discovery could impact understanding, treatment of autoimmune and inflammatory diseases. Scientists from the Research Institute of the McGill University Health Centre (RI-MUHC) may have cracked the code to understanding the function of special cells called regulatory T Cells. Treg cells, as they are often known, control and regulate our immune system to prevent excessive reactions. The findings, published in Science Immunology, could have a major impact in our understanding and treatment of all autoimmune diseases and most chronic inflammatory diseases such as arthritis, Crohn's disease as well as broader conditions such as asthma, allergies and cancer. Researchers made this discovery by investigating a rare human mutation in a gene called FOXP3. Although the importance of the FOXP3 gene in the proper function of Treg cells has been well documented, its mechanisms were still not fully understood by scientists. (news-medical.net 5.7.2017).)

(Anm: Surprising finding provides more support for Alzheimer's being an autoimmune disease. Brain levels of the lipid ceramide are high in Alzheimer's disease, and now scientists have found increased levels of an antibody to the lipid in their disease model. (medicalnewstoday.com 10.3.2015).)

(Anm: Relationships Between Mitochondria and Neuroinflammation: Implications for Alzheimer's Disease. Curr Top Med Chem. 2015 Aug 26. [Epub ahead of print].)

(Anm: Problems finding your way around may be earliest sign of Alzheimer's disease (medicalnewstoday.com 22.4.2016).)

(Anm: T cell type that promotes damaging immune response discovered. For the first time, researchers have identified a type of T cell that plays a key role in promoting the damaging autoimmune response that inflames and attacks the joints in rheumatoid arthritis. The discovery - made with technologies that help to analyze just a "handful of cells" - offers vital new clues to the biology of the disease and could lead to more powerful, targeted treatments. The study - led by Brigham and Women's Hospital (BWH), a teaching affiliate of Harvard Medical School in Boston, MA - is published in the journal Nature. (medicalnewstoday.com 2.2.2017).)

(Anm: Systemic lupus erythematosus The Lancet 2014 (Early Online Publication, 30 May 2014).)

(Anm: Sertraline (Zoloft)-indusert systemisk lupus erythematosus (SLE) (Lupus) (Sertraline Induced Systemic Lupus Erythematosus) (The Internet Journal of Internal Medicine 2005;6(1).)

- Dødsrater for Lupus forblir høye i USA.

(Anm: Lupus Death Rates Remain High in U.S. Drop in SLE death rates less than non-lupus mortality. Despite improving trends in mortality, death rates from systemic lupus erythematosus (lupus) remain high compared with those in the general population, and disparities persist between subpopulations and geographic regions, according to a report in the Annals of Internal Medicine. (medpagetoday.com 6.11.2017).)

– Studien viser hvordan vanlig trening, stressreduksjon kan føre til bedre helse hos lupus pasienter.

(Anm: Study shows how regular exercise, stress reduction could lead to better health in lupus patients. Study shows how regular exercise, stress reduction could lead to better health in lupus patients (news-medical.net 19.9.2017).)

(Anm: Lupus Patients at Risk for Stroke. Risks high for women, the young, and during the year after diagnosis. Systemic lupus erythematosus (SLE) patients are more likely to experience ischemic and hemorrhagic stroke than the general population especially in the first year they are diagnosed, according to new research published in Annals of the Rheumatic Diseases. (medpagetoday.com 23.4.2017).)

(Anm: Lupus: Probiotics could help to reduce kidney inflammation. (…) Researchers have found that adding Lactobacillus to the diets of mice with lupus-induced kidney inflammation - also known as lupus nephritis - led to improvements in kidney function and increased their survival, but only in female mice. (…) Study co-author Xin Luo, from the Department of Biomedical Sciences and Pathobiology at Virginia-Maryland College of Veterinary Medicine at Virginia Tech, and colleagues recently reported their results in the journal Microbiome. (medicalnewstoday.com 3.10.2017).)

(Anm: Researchers discover that beneficial bacteria in yogurt may affect severity of lupus (news-medical.net 3.10.2017).)

(Anm: Antifungals and probiotics could play critical role in potential new therapeutic approaches for IBD. (news-medical.net 5.10.2017).)

(Anm: Financial Strain Tied to Depression in Women with SLE. Survey: 40% of those reporting high money pressures developed depression. High financial strain nearly doubles the risk of incident depression in women with systemic lupus erythematosus (SLE). In an analysis of data from the Lupus Outcomes Study, financial strain was the only significant socioeconomic predictor of incident depression, reported Patricia P. Katz, PhD, from the University of California, San Francisco, and colleagues in Arthritis Care & Research. (medpagetoday.com 26.4.2017).)

(Anm: For lupus patients, anti-inflammatory immune cells are maturing Into wrong cell type (medicalnewstoday.com 9.3.2016).)

(Anm: Slideshow: Thyroid Symptoms and Solutions (webmd.com 15.4..2014).)
(Anm: 15 Cancer Symptoms to Know (webmd 28.3.2016).)
(Anm: Slideshow: Causes of Fatigue and Sleepiness and How to Fight Them. (webmd).)
(Anm: Slideshow: A Visual Guide to Fibromyalgia (webmd.com 10.11.2014).)
(Anm: Slideshow: A Visual Guide to Understanding Lupus (webmd.com 2.2.2016).)
(Anm: Gout Pictures Slideshow: Causes, Symptoms, and Treatments of Gout (webmd.com 3.2.2016).)
(Anm: Slideshow: What Your Nails Say About Your Health (webmd.com 8.4.2014).)
(Anm: Sinusitis Slideshow: Symptoms, Diagnosis, Treatment (webmd 8.12.2014).)
(Anm: What Your Skin Says About Your Health Slideshow. (webmd.com 2.2.2016).)
(Anm: Type 2 Diabetes Overview (webmd.com 2.2.2016).)
(Anm: What Eye Problems Look Like (webmed).)

(Anm: Fibromyalgi: Fibromyalgi rammer over 100.000 norske kvinner. - En del tror sykdommen bare er tøys. Også blant leger er det en del som flirer av den, forteller professor. (…)   Når leger blir bedt om å rangere hvilke sykdommer det er mest prestisje å jobbe med, så havner alltid fibromyalgi nederst, forteller hun. Professor Egil Andreas Fors ved Institutt for samfunnsmedisin og allmennmedisinsk forskningsenhet ved NTNU er blant Norges fremste eksperter på sykdommen. Han bekrefter holdningene Slydal beskriver. (…) Sykdommen kjennetegnes gjerne ved at man har kroniske muskelsmerter, andre symptomer kan være utmattelse, hodepine, stivhet i kroppen, svimmelhet, kvalme, indre frost, depresjoner, angst og søvnproblemer. (kk.no 8.3.2016).)

(Anm: Lettere at diagnosticere fibromyalgi. På University of Colorado har forskere opdaget en speciel hjernesignatur, der med 93 pct. sikkerhed kan fastslå, hvorvidt en person lider af fibromyalgi eller ej. (pharmadanmark.anp.se 27.10.2016).)

(Anm: Management of interstitial lung disease associated with connective tissue disease. (…) Shrinking lung syndrome. (…) Systemic lupus erythematosus. BMJ 2016;352:h6819 (Published 24 February 2016).)

(Anm: Suicidal Thoughts Seen as Risk in Lupus. —Common among lupus patients with neuropsychiatric manifestations (medpagetoday.com 24.9.2015).)

(Anm: Ofre i legemiddelstudie får "livsvarig sykdomsutvikling (mintankesmie.no).)

(Anm: Cancer-inflammation 'vicious cycle' detailed in new study (medicalnewstoday.com 22.4.2015).)

(Anm: Misdiagnosis common in rheumatologic diseases like lupus (medicalnewstoday.com 20.8.2014).)

Coenzyme A plays leading role in nitric oxide function so essential to cell metabolism
medicalnewstoday.com 19.1.2015
Case Western Reserve and University Hospitals (UH) Case Medical Center researchers and physicians have discovered that the molecule known as coenzyme A plays a key role in cell metabolism by regulating the actions of nitric oxide. Cell metabolism is the ongoing process of chemical transformations within the body's cells that sustains life, and alterations in metabolism are a common cause of human disease, including cancer and heart disease. Their findings about the mechanisms of action for coenzyme A, as well as discovering a new class of enzymes that regulate coenzyme A-based reactions, appeared in the Proceedings of the National Academy of Sciences (PNAS). (…)

Antipsychotics and seizures: Higher risk with atypicals? (Antipsykotika og anfall: Høyere risiko med atypiske?)
Seizure. 2012 Nov 9. pii: S1059-1311(12)00284-1
(...) PURPOSE: Almost all antipsychotics have been associated with a risk of epileptic seizure provocation. Among the first-generation antipsychotics (FGA) chlorpromazine appears to be associated with the greatest risk of seizures among the second-generation antipsychotics (SGA) clozapine is thought to be most likely to cause convulsions. This information is largely based on studies that are not sufficiently controlled. Besides, information about the seizure risk associated with newer antipsychotics is scarce. (...)

CONCLUSION: Our results show that SGA may pose a higher risk of seizures than FGA, mainly, but not only due to clozapine. This is line with recent studies suggesting that some SGA carried a higher average risk of electroencephalographic abnormalities than many FGA. Nonetheless, It is well known that spontaneous reports do not allow strong inferences about adverse drug effects, because differences in reporting fractions by time, drug or type of event are difficult or even impossible to distinguish from differences in the occurrence rates of adverse events. Still, we consider that the possibility of SGA carrying a higher risk of seizure induction than FGA warrants further research. (...)

(Anm: Clozapine-induced myocarditis, a widely overlooked adverse reaction. Acta Psychiatr Scand. 2015 Apr 11. [Epub ahead of print].)

Infeksjon hos gravide kan gi økt risiko for epilepsi hos barnet
fhi.no 20.3.2012
En studie Folkehelseinstituttet har vært med på antyder økt fare for epilepsi hos barnet dersom mor brukte antibiotika eller var sykehusinnlagt for infeksjon under svangerskapet.

Studien er utført i Danmark ved Avdeling for klinisk epidemiologi ved Århus universitets hospital. Fra Folkehelseinstituttet har professor og overlege Leiv Sigmund Bakketeig deltatt.

Studien antyder en 40 % økt risiko for epilepsi dersom mor brukte antibiotika i svangerskapet eller var sykehusinnlagt for infeksjon. (...)

Partnere til personer med epilepsi får posttraumatisk stress
premium.netdoktor.com 22.2.2012
En ny kandidatafhandling påpeger, at næsten hver anden partner til personer med svær epilepsi har symptomer på posttraumatisk stress. Nu vil Dansk Epilepsiforening have større fokus på de pårørende.

7,7 % havde alle kriterier
I Danmark lider mellem 15.000 og 20.000 af epilepsi i en grad, hvor anfald ikke kan forebygges. Partnerne til disse er ifølge den nye kandidatafhandling i risiko for at udvikle posttraumatisk stresslidelse (PTSD) – hvis de da ikke allerede lider af det.

DERFOR får man posttraumatisk stress

Det viste sig nemlig, at næsten hver anden partner udviste symptomer på PTSD. Herunder fandt man samtlige symptomer for PTSD hos 7,7 procent af partnerne. Og det undrer ikke Dansk Epilepsiforenings formand Lone Nørager Kristensen:

”Det lyder selvfølgelig barskt, når man lige hører begrebet posttraumatisk stress sat i forbindelse med at leve sammen med en person med epilepsi. Men partnere til personer med epilepsi, der har mange anfald, kan føle sig magtesløse over for de voldsomme anfald, de aldrig ved hvornår kommer, og som kan betyde skade og i allerværste tilfælde død for deres livsledsager”, siger hun. (...)

Guidelines
Diagnosis and management of the epilepsies in adults and children: summary of updated NICE guidance

BMJ 2012;344:e281 (26 January)
Epilepsy is a common neurological disorder characterised by recurring epileptic seizures; it is not a single diagnosis but is a symptom with many underlying causes, more accurately termed the epilepsies. Antiepileptic drugs (AEDs) to prevent recurrence of seizures form the mainstay of treatment. Diagnosis can be challenging, making accurate prevalence estimates difficult. (...)

Fetal Exposure to Epilepsy Drug Might Raise Autism Risk: Study
health.yahoo.com 5.12.2011
MONDAY, Dec. 5 (HealthDay News) -- Children exposed to the epilepsy drug valproate have a nearly three times higher risk of having an autism spectrum disorder, new research finds.

Researchers in Denmark used national birth data that included nearly 656,000 children born in that country between 1996 and 2006 to 428,000 women. Using a national prescription drug registry, they identified women who had filled a prescription for valproate (Depakote) shortly before pregnancy through the day of the child's birth.

Using the Danish Psychiatric Register, researchers then identified children who were diagnosed with an autism spectrum disorder, which can include both severe and milder forms of autism, and children with early-onset, more severe autism.

After taking into account certain factors such as maternal age, the child's gender and other factors that influence autism risk, researchers found that children exposed in utero to valproate were 2.6 times more likely to have an autism spectrum disorder and almost five times more likely to have early-onset autism. (...)

Valproate Exposure Associated With Autism, Lower IQ
clinicalpsychiatrynews.com 5.12.2011
BALTIMORE – In utero exposure to valproate appears to increase the risk of significant adverse effects on fetal brain development that persist into childhood.

In two separate studies, children whose mothers took valproate during pregnancy had a higher risk for lower IQ and other cognitive deficiencies, as well as autism and other disorders along the autistic spectrum. "All women with epilepsy of childbearing potential should be informed of the risks. I feel that valproate should not be a first choice antiepileptic drug in women of childbearing potential," Dr. Kimford J. Meador, director of the Emory Epilepsy Center and professor of neurology at Emory University, Atlanta, said in an interview. (...)

Sudden death in epilepsy
BMJ 2011;343 (15 November)
Optimum seizure control and prompt referral to specialist services are essential
People with epilepsy have a higher risk of premature death throughout the course of the condition.1 2 One of the most important causes of mortality is sudden unexpected death in epilepsy (SUDEP), defined as “sudden, unexpected, non-traumatic, and non-drowning death in patients with epilepsy, with or without evidence for a seizure, and excluding documented status epilepticus, in which postmortem examination does not reveal a structural or toxicological cause for death.”3 In practice, all such deaths where an autopsy is performed are classified as definite SUDEP and those in which no autopsy is performed as probable SUDEP. (...)

Antiepileptika – risk för påverkan på bentätheten
lakemedelsverket.se 1.11.2011
Långtidsanvändning av karpamazepin, fenobarbital, fenytoin, primidon, oxkarbazepin, lamotrigin och natriumvalproat kan öka risken för minskad bentäthet som kan leda till osteopeni, osteoporos och frakturer. Produktresuméer och bipacksedlar för läkemedel som innehåller dessa substanser kommer att uppdateras med harmoniserad information. (...)

The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study
Lancet. 2011 Oct 15;378(9800):1388-95.
BACKGROUND: Surgery is increasingly used as treatment for refractory focal epilepsy; however, few rigorous reports of long-term outcome exist. We did this study to identify long-term outcome of epilepsy surgery in adults by establishing patterns of seizure remission and relapse after surgery. (...)

INTERPRETATION: Neurosurgical treatment is appealing for selected people with refractory focal epilepsy. Our data provide realistic expectations and indicate the scope for further improvements in presurgical assessment and surgical treatment of people with chronic epilepsy. (...)

(Anm: Focal epileptic seizures linked to abnormalities in 3 main brain regions. (medicalnewstoday.com 25.11.2015).)

Antiepileptic drug combinations—Have newer agents altered clinical outcomes?
Epilepsy Research 2011 (online 5 October)
Summary In 2000, 332 (20.5%) of 1617 patients registered with the Western Infirmary Epilepsy Unit required antiepileptic drug (AED) polytherapy to remain seizure-free for at least 1 year. The analysis was repeated 10 years later. Of 2379 seizure-free patients, 20.4% (n = 486 – 254 women, 232 men, aged 18–95 years [median age 49 years]) were receiving combination therapy. Two AEDs were taken by 395 (81.3%) patients in 2010, and by 287 (86.4%) in 2000. Sodium valproate with lamotrigine was the commonest of 64 successful pairings. As a combination, mean daily doses of both AEDs were lower (n = 96; sodium valproate 1200 mg, lamotrigine 155 mg) than when sodium valproate was taken with carbamazepine or levetiracetam (n = 42; 1621 mg; p < 0.001), and lamotrigine was combined with topiramate or levetiracetam (n = 33; 430 mg; p < 0.001), suggesting possible synergism. In 2010, a higher percentage of patients (n = 85) remained seizure-free on 3 AEDs (17.5% in 2010, 12.7% in 2000) in 57 separate regimens. Only 0.9% (n = 3) of patients in 2000, and 1.2% (n = 6) in 2010 responded to 4 AEDs. Levetiracetam (n = 109; 10.2%) and topiramate (n = 81; 7.6%) were the newer agents most commonly represented in successful combinations. These data tend to imply that drug substitution rather than addition has largely led to these marginally improved results. In the last decade, when used as adjunctive therapies, newer agents appear not to have impacted substantially on the likelihood of producing seizure freedom. An alternative approach to AED development may be required to change this disappointing scenario. (...)

Non-Epileptic Seizures Misdiagnosed More Often in Veterans
ivanhoe.com 7.9.2011
(Ivanhoe Newswire) – Psychogenic non-epileptic seizures may go undiagnosed longer in veterans than civilians, according to a new study.

"People with psychogenic seizures are often diagnosed with epilepsy and given drugs to treat epilepsy that do not help and can have serious side effects," study author Martin Salinsky, MD, of the Portland VA Medical Center and Oregon Health and Sciences University, and a member of the American Academy of Neurology, was quoted as saying. "The two types of seizures can be similar in appearance and diagnosis can be difficult." (...)

(Anm: Psychogenic nonepileptic seizures in US veterans Neurology September 6, 2011 77:945-950 (September 6).)

Legemidler under særlig overvåking per 08.07.2011
legemiddelverket.no 11.7.2011
Antiepileptika:
Deprakine, Epinat, Lamictal, Lamotrigin Actavis, Orfiril, Orfiril long, Orfiril Retard, Pro-Epanutin, Tegretol, Tegretol Retard og Trimonil Retard
Det er observert Common Variable Immune Deficiency (CVID – også kjent som akvirert hypogammaglobulinemi) hos pasienter som behandles med natriumkanalblokkerende antiepileptika. I Norge er følgende slike antiepileptika på markedet: fenytoin, fosfenytoin, karbamazepin, lamotrigin, natriumvalproat og okskarbazepin. I kasusrapporter er det sett at panhypogammaglobulinemien reverseres når legemidlet seponeres. Forekomst ved behandling med disse virkestoffene er ukjent, men sannsynligvis svært sjelden. Det kan se ut til at legemidlene er utløsende årsak hos 5-10 % av pasienter med CVID. Mekanismen er ukjent og tid fra oppstart av behandling er observert å være fra tre uker til tolv måneder.

Etter råd fra Bivirkningsnemda settes nå legemidler som inneholder virkestoffene fenytoin, fosfenytoin, karbamazepin, lamotrigin, natriumvalproat og okskarbazepin på overvåkningslista.Se referat fra møte i Bivirkningsnemda 19. mai 2011.

Nye og uventede bivirkninger rapporteres til RELIS på bivirkningsskjema. (...)

(Anm: Common Variable Immune Deficiency (CVID) (en.wikipedia.org).)

Risk of Epilepsy Measured, May Be Still Higher (Risiko for registrert epilepsi, muligens fremdeles høyere)
medpagetoday.com 28.12.2010
One in 26 Americans will develop epilepsy at some point in their lifetime, according to a population-based study.

Lifetime risk up to age 50 was 1.6% and rose to 3.0% at age 80, Dale C. Hesdorffer, PhD, of Columbia University School of Public Health in New York City, and colleagues reported in the Jan. 4 issue of Neurology. (...)

(Anm: Estimating risk for developing epilepsy - A population-based study in Rochester, Minnesota. Neurology 2010;76(l):1 23-27 (December 27).)

Intrauterine exposure to carbamazepine and specific congenital malformations: systematic review and case-control study
BMJ 2010; 341:c6581 (2 December)
(...) Conclusion Carbamazepine teratogenicity is relatively specific to spina bifida, though the risk is less than with valproic acid. Despite the large dataset, there was not enough power to detect moderate risks for some rare major congenital malformations. (...)

(Anm: Karbamazepin (Tegretol, Trimonil). (rikshospitalet.no).)

(Anm: spina bifida; Spina bifida er en tilstand hvor det er ufullstendig lukning av ryggmargskanalen. Feilen oppstår i 5.-6. uke i fosterlivet. Rygghvirvlene vokser ikke sammen i bakkant slik at ryggmargskanalen blir åpen baktil. Defekten, og dermed åpningen i ryggmargskanalen, kan være av forskjellig grad/størrelse. Dette er avgjørende for hvilke følger dette skal få. (no.wikipedia.org)).

FDA warns of aseptic meningitis risk with GSK’s Lamictal (FDA advarer mot risiko for aseptisk meningitt (hjernehinnebetennelse) for GSKs Lamictal)
pharmatimes.com 13.8.2010
Regulators in the USA have declared that GlaxoSmithKline’s anticonvulsant Lamictal can cause a rare type of brain inflammation.

The US Food and Drug Administration has warned that Lamictal (lamotrigine), which is approved to treat seizures and bipolar disorder, can cause aseptic meningitis, an inflammation of the protective membranes that cover the brain and spinal cord not caused by bacterial infection. Symptoms can include headache, fever, chills, nausea, vomiting, stiff neck and sensitivity to light. (...)

(Anm: aseptisk meningitt (hjernehinnebetennelse som ikke forårsakes av bakterier). Kilde: Store norske leksikon Store norske leksikon.).)

(Anm: aseptic meningitis, viral meningitis (cdc.com).)

(Anm: hjernehinnebetennelse og hjernebetennelse; hjernehinnebetennelse (meningitt) er infeksjon av hinnene rundt hjernen og ryggmargen. Infeksjonen kan gripe over på hjernebarken (meningoencefalitt), og den kan også ramme nervene som springer ut fra hjerne og ryggmarg. Encefalitt er en infeksjon i selve hjernevevet. (nhi.no).)

(Anm: Lamictal (lamotrigine): Label Change - Risk of Aseptic Meningitis (fda.gov 12.8.2010).)

US warns of brain problem with Glaxo seizure drug
pharmpro.com 12.8.2010
U.S. health regulators are warning doctors and patients that an anti-seizure drug from GlaxoSmithKline PLC can cause rare inflammation of the brain and spinal cord.

The Food and Drug Administration said Thursday it is working with the British drugmaker Glaxo to add new warnings and labeling information to the company's drug Lamictal. (...)

Valproat fortsatt førstevalg
Tidsskr Nor Legeforen 2010; 130:914 (6.5.2010)
Over 40 % av barn med absensepilepsi fortsatte å ha absenser selv om de fikk den beste medikamentelle behandling. Det viser en amerikansk studie.

Absensepilepsi er det vanligste epilepsisyndromet hos barn og utgjør 10–17 % av tilfellene som debuterer i denne alderen. De fleste blir kvitt absensene med medikamentell behandling, men det har lenge vært omdiskutert hvilket medikament som skal være førstevalget. (...)

Epilepsivård är inte rättvis
sr.se 26.1.2010
Unga, rika och högutbildade kvinnor som bor i storstäder har betydligt större chans att få neurologisk specialistvård mot epilepsi än dem som har sämre ställt, visar en studie genomförd av forskare på Akademiska sjukhuset i Uppsala, skriver Dagens Nyheter.

Neurologer är den läkargrupp som har bäst kunskap om epilepsi, men trots det får äldre epileptiker med sämre ekonomi ofta vård av specialistläkare inom andra områden.

26 000 personer ingick i studien, som publiceras i den amerikanska tidskriften Neurology. (...)

(Anm: Sociodemographic differences in antiepileptic drug prescriptions to adult epilepsy patients. NEUROLOGY 2010;74:295-301 (January).)

Ojämn tillgång på epilepsibehandling
lakemedelsvarlden.se 26.1.2010
Tillgången på rekommenderade läkemedel mot epilepsi varierar stort. Det är betydligt svårare för äldre, lågutbildade och för personer som bor på landsbygden att få den vård de behöver. Det visar en ny svensk studie.

För att som epilepsipatient få tillgång till den bästa vården ska man vara kvinna, ung, högutbildad och bo i en storstad. Det är slutsatsen i en studie som gjorts av forskare i Uppsala och Stockholm. Resultaten som publicerats i amerikanska Neurology visar också att äldre och lågutbildade i lägre utsträckning får rätt vård. (...)

Clue to drug-resistant epilepsy
hc2d.co.uk 7.12.2009
Researchers have said they think they know the reason why "stubborn" epilepsy does not react to drug treatment.

A team from Newcastle University tested brain tissue and found that certain types of fit were the result of faults in the electrical connections linking brain cells, rather than chemical problems.

The researchers said this conclusion would explain why some epileptics have to undergo surgery to treat their condition, because drugs do not work.

The study, led by Dr Mark Cunningham, appeared in Proceedings of the National Academy of Sciences. (...)

Psykogene ikke-epileptiske anfall
Tidsskr Nor Legeforen 2009; 129:2348-51 (19.11.2009)
Bakgrunn. Psykogene ikke-epileptiske anfall er epilepsiliknende anfall som antas å ha psykiske årsaker. Mange pasienter med slike anfall får en feilaktig epilepsidiagnose og årelang medisinering med antiepileptika. (...)

Fortolkning. Et vidt spekter av psykiske konflikter eller traumer er vist å kunne ligge til grunn for slike anfall, noe som gjør det nødvendig med individuelle behandlingstiltak. (...)

AASLD: Antibiotics Top Cause of Drug-Induced Liver Failure (AASLD: Antibiotika topper årsaker til legemiddelindusert leversvikt) (AASLD: The American Association for the Study of Liver Diseases)
medpagetoday.com 5.11.2009
BOSTON -- Antimicrobial agents are the most common cause of drug-induced liver failure, with most cases ending in death or transplant, a researcher said here.

A prospective analysis of some 1,200 cases of acute liver failure found that half of those caused by drugs were associated with antituberculosis, antifungal, sulfa drugs, and other antibiotics, according to Adrian Reuben, MBBS, of the Medical University of South Carolina in Charleston.

Herbal supplements, anticonvulsants, and statins also were relatively common causes of drug-induced liver injury (DILI), Reuben told attendees here at the American Association for the Study of Liver Diseases' annual meeting. (...)

Farmakoresistent epilepsi
Tidsskr Nor Legeforen 2009; 129:1986-9 (8.10.2009)
Bakgrunn. Til tross for at vi de siste årene har fått mange nye antiepileptika, har fortsatt ca. en tredel av pasientene med epilepsi farmakoresistente anfall. Vi gir her en oversikt over to hovedhypoteser for mekanismer som antas å ligge til grunn for farmakoresistent epilepsi, og gir forslag til håndtering av denne pasientgruppen. (...)

Flere behandlingsanbefalinger om antiepileptika er tilgjengelige
helsebiblioteket.no 12.8.2009
Giftinformasjonen har utarbeidet behandlingsanbefalinger for en ny gruppe av antiepileptika. Anbefalingene er nå tilgjengelige i Emnebibliotek forgiftninger. (...)

Ved forgiftning dominerer CNS-symptomer, men også gastrointestinale symptomer og en viss hjertepåvirkning er beskrevet. (...)

(Anm: Antiepileptika, andre - behandlingsanbefaling ved forgiftning. Giftinformasjonen 2009.)

Kan ha funnet svar på epilepsigåte
vg.no 5.8.2009
(VG Nett) Et gjennombrudd i forskningen har vist at det er mulig å forhindre arvelig epilepsi gjennom forsøk på mus.

Epilepsi er en vanlig nevrologisk tilstand som er tilstede i gjennomsnittlig én av 200 mennesker, skriver BBC.

Hva det er som forårsaker tilstanden har vært sett på som ukjent, og medisinbehandling er ineffektivt for en tredjedel av tilfellene.

Britiske forskere fra universitetet i Leeds har nå identifisert en feil i et gen ved navn Atp1a3 som en årsak til epilepsi hos mus. Funnet gir håp om å kunne forhindre arvelige epilepsi også hos mennesker. (...)

Studien er publisert i Proceedings of the National Academy of Sciences.

Forsker Steve Clapcote sier til BBC at dette er den første studien som hever over enhver tvil at det er en defekt i dette bestemte genet som er ansvarlig for noen former epilepsi. (...)

Head Injury While Young Ups Epilepsy Risk (Hodeskade i ung alder øker risiko for epilepsi)
healthfinder.gov 23.2.2009
But treatment can prevent the illness from emerging, Danish researchers say. (...)

MONDAY, Feb. 23 (HealthDay News) -- Children and young adults who suffer a traumatic brain injury are at high risk of developing epilepsy for more than 10 years after the injury, Danish researchers report. (...)

"Traumatic brain injury is a significant risk indicator for epilepsy many years after the injury. Drug treatment after brain injury with the aim of preventing post-traumatic epilepsy has been discouraging, but our data suggest a long time interval for potential, preventive treatment of high-risk patients," wrote Dr. Jakob Christensen, of the neurology department at Aarhus University Hospital, and colleagues. (...)

(Anm: Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet 2009;373(9669):1105 - 1110 (28 March).)

(Anm: Risk of epilepsy after head trauma. Lancet 2009;373(9669):1060 - 1061 (28 March).)

Epilepsy Risk Lingers Years After Traumatic Brain Injury
medpagetoday.com 24.2.2009
(...) The finding -- from a large population-based cohort of more than 1.6 million people -- suggests there is a long window of opportunity for preventive measures, Jakob Christensen, M.D., of Aarhus University Hospital, and colleagues reported online in The Lancet.

Although it is known that the risk of epilepsy is increased shortly after brain injury, it remains unclear how long the increased risk lasts, the researchers said.

To clarify the issue, they looked at medical records of brain injury, skull fracture, and epilepsy for 1,605,216 people born in Denmark from 1977 through 2002. (...)

Seizure Meds Can Be Safely Withdrawn From Kids With Epilepsy (Bruken av epilepsilegemidler kan trygt avsluttes hos barn med epilepsi)
healthfinder.gov 7.12.2008
Stuide viser relativt lav risiko for å utvikle lidelse som vanskelig kan behandles. (Study finds relatively low risk of developing intractable disease.)
(SOURCE: Mayo Clinic, news release, Dec. 7, 2008)
MONDAY, Dec. 8 (HealthDay News) -- Det er generelt trygt å stanse medisinering med anti-epileptiske legemidler for barn med epilepsi, som har oppnådd anfallsfrihet mens de er på legemidler, fordi disse barn har lav risiko for senere å utvikle epilepsi som er vanskelig å behandle, viser en studie ved Mayo Clinic. (- It's generally safe to stop giving anti-seizure medication to children with epilepsy who've achieved seizure-freedom while on the medication, because these children aren't at high risk of later developing intractable epilepsy, a Mayo Clinic study finds.)

Epilepsi som er vanskelig å behandle, som påvirker omtrent 10 prosent av barn med epilepsi, er en tilstand hvor legemidler alene ikke kontrollerer anfallene som har en invalidiserende effekt på pasientens livskvalitet. (Intractable epilepsy, which affects about 10 percent of children with epilepsy, is a condition in which medications alone don't control seizures and in which seizures have a disabling effect on the patient's quality of life.)

"Det er ofte anbefalt at barn med epilepsi, som blir anfallsfrie på anti-epilepsi legemidler, stanser inntaket av legemidler for å unngå sideeffekter etter langtidsbruk. Disse potensielle sideeffekter inkluderer redusertt kognitiv funksjon, inkoordinasjon, vektforandringer, tilbakefall i atferd, og leverskade," sa barnenevrolog dr. Katherine Nickels i en pressemelding fra Mayo. "Imidlertid har få studier undersøkt risikoen for epilepsi, som er vanskelig å behandle, etter avslutning av anti-epilepsi legemidler, og de rapporterte risikoer varierte i stor grad." (...) ("It is often recommended that children with epilepsy who become seizure-free on anti-seizure medications be withdrawn from the drugs to avoid side effects of long-term use. Those potential side effects include cognitive slowing, incoordination, weight change, behavioral decline, and liver damage," pediatric neurologist Dr. Katherine Nickels said in a Mayo news release. "However, few previous studies had examined the risk of intractable epilepsy following withdrawal of anti-seizure medication, and the reported risks varied widely.")

Ifølge studien utviklet totalt 5 prosent av de 56 barn epilepsi, som er vanskelig å behandle, hvor inntaket av legemidler ble stanset etter at de var blitt anfallsfrie. (...) (Overall, intractable epilepsy developed in 5 percent of the 56 children who were taken off anti-seizure medication following seizure-freedom, the study found.)

Studien presenteres på årsmøtet til American Epilepsy Society den 7. desember. (...) (The study was to be presented Dec. 7 in Seattle at the annual meeting of the American Epilepsy Society.)

Epilepsi
mpl.dk (September 2008 / 9) (Månedsskrift for praktisk lægegerning)
Anfald med forbigående tab af bevidstheden er hyppige. Hvornår er det epilepsi? Den første af en serie på fem artikler om epilepsi giver en generel introduktion til emnet. En grundig anfaldsanamnese er det vigtigste diagnostiske tiltag. EEG kan ikke benyttes som »screeningsundersøgelse«. De hyppigste differentialdiagnoser er synkoper og psykogene anfald. (...)

Seponering af epilepsimedicin
irf.dk 26.8.2008 (Institut for Rationel Farmakoterapi (IRF))
Epilepsi er en kronisk tilstand med gentagne epileptiske anfald, som ofte kræver langtidsbehandling med et eller flere antiepileptika (AED). Hos ca. 60-70 % af patienterne opnås fuld anfaldskontrol med medicin (1). Mindst 50 % får bivirkninger af AED både somatiske symptomer og kognitive vanskeligheder. Træthed, reduceret psykomotorisk tempo, koncentrations- og hukommelsesproblemer er de hyppigste klager, som påvirker patienternes daglige funktion med tilhørende psykosociale konsekvenser (2;3). Efter seponering af AED ses betydelig bedring i både adfærdsrelaterede og kognitive funktioner (4;5). Selvom patienterne bliver kognitivt bedre, er der ikke evidens for en væsentlig bedre livskvalitet, viser et randomiseret kontrolleret studie hos voksne (N=150) (6).

Epilepsibehandling vil være mest optimal, hvis der opnås anfaldsremission ved brug af udvalgte AED, og at seponering af disse ikke fremprovokerer recidivanfald.

Selv om der er mange fordele ved at komme ud af antiepileptisk behandling som at slippe for ubehagelige bivirkninger eller at slippe for epilepsidiagnosen, vil mange patienter hellere fortsætte med en livslang medicinsk behandling end at risikere recidivanfald, hvilket kan medføre alvorlige medicinske og psykosociale konsekvenser. Patienterne kan nemlig risikere at miste deres job, tilladelse til at køre bil eller at få mindre (frakturer, tandskade) eller en mere alvorlige skade (biluheld, arbejdsskade) (7). (...)

(Anm: seponere; innstille, holde opp med (om medisinsk behandling). Kilde: Store norske leksikon.)

Initial Management of Epilepsy
NEJM 2008;359:166-176 (July 10)
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. (...)

Albumin levels should be measured before administering highly protein-bound drugs such as phenytoin and valproate, since the fraction of unbound (active) drug is higher in patients with hypoalbuminemia. In adolescents and adults with unexplained generalized seizures, screening for substance abuse should be considered. (...)

In the past two decades, nine new antiepileptic drugs have been marketed, making the choice of initial therapy complex. Antiepileptic drugs are classified as being either broad-spectrum or narrow-spectrum drugs with regard to efficacy against different seizure types and epilepsy syndromes. Broad-spectrum antiepileptic drugs are particularly useful because they are reasonable initial choices in most adult patients, regardless of the type of seizure or syndrome. These drugs include valproate, lamotrigine, topiramate, and levetiracetam (the efficacy of which [in generalized seizures] is supported by randomized, controlled trials), and zonisamide (the efficacy of which [in generalized seizures] is based on open studies and clinical experience). In contrast, narrow-spectrum drugs, which include carbamazepine, phenytoin, gabapentin, tiagabine, oxcarbazepine, and pregabalin, should be restricted to patients who have localization-related (focal) epilepsy with partial and secondarily generalized seizures.22 (...)

Antiepileptic drugs, and especially valproate, have been associated with reproductive endocrine disorders, most notably features of polycystic ovary syndrome (e.g., irregular menstrual cycles, weight gain, and hirsutism).30,31 This association appears to be related at least in part to the epilepsy itself,32,32 but in the majority of women, medication seems to play the major role.34,35 Observational studies have shown clinically important associations between the use of valproate, alone or in combination with other drugs, and the development of polycystic ovaries, anovulatory cycles, and hyperandrogenism.34,36,37 (...)

(Anm: Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain etiology, but there is strong evidence that it can to a large degree be classified as a genetic disease. (en.wikipedia.org).)

(Anm: The anovulatory cycle is a menstrual cycle characterized by varying degrees of menstrual intervals and the absence of ovulation and a luteal phase. In the absence of ovulation, there will be infertility. (en.wikipedia.org).)

(Anm: Hyperandrogenism is a medical condition characterized by excessive production and/or secretion of androgens. (en.wikipedia.org).)

(Anm: Hirsutisme; uvanleg sterk eller altfor utbreidd hårvekst (helst hos kvinner); kan finnast ved tilstandar som gir for stor utskiljing av androgene hormon f eks Stein-Leventhals syndrom eller «idiopatisk hirsutisme», i sjeldne tilfelle pga vondarta binyresvulstar; finst også ved visse medfødde tilstandar (enzymfeil m v) eller bruk av medikament (fenytoin, minoxidil, cyklosporin, hormon m v) EN hirsutism ET [lat. hirsutus hårete] Kilde: Norsk medisinsk ordbok.)

(Anm: A randomized, controlled, double-blind, crossover trial of zonisamide in myoclonus-dystonia. Neurology. 2016 Apr 6. pii: 10.1212/WNL.0000000000002631. [Epub ahead of print].)

(Anm: Importance of Early Weight Changes to Predict Long-Term Weight Gain During Psychotropic Drug Treatment. Background: Psychotropic drugs can induce substantial weight gain, particularly during the first 6 months of treatment. (…) Results: Prevalences of metabolic syndrome and obesity were 22% and 17%, respectively, at baseline and 32% and 24% after 1 year. (…) Conclusion: Following prescription of weight gain–inducing psychotropic drugs, a 5% threshold for weight gain after 1 month should raise clinician concerns about weight-controlling strategies. (J Clin Psychiatry 2015;76(11):e1417–e1423).)

(Anm: Metabolic Syndrome Components Are Associated With Symptomatic Polyneuropathy Independent of Glycemic Status. Diabetes Care 2016 (March 10, 2016).)

(Anm: New cause of immune neuropathy discovered. Hope for a better diagnosis. "Our study backs the assumption from previous studies that patients who have antibodies against proteins of Nodes of Ranvier exhibit characteristic features," says Kathrin Doppler. This means: The disease develops rapidly, causes severe paralysis and responds poorly to standard therapy with corticosteroids or immunoglobulins but excellently to Rituximab treatment. The Würzburg neurologists found that strong neuralgia is another typical symptom in patients with Caspr antibodies. Patients with antibodies against the two other proteins, Neurofascin-155 and Contactin-1, in contrast typically exhibit a distinct tremor in targeted movements. (medicalnewstoday.com 9.8.2016).)

(Anm: Auto-antibodies to contactin-associated protein 1 (Caspr) in two patients with painful inflammatory neuropathy. Brain. 2016 Jul 29. pii: aww189. [Epub ahead of print].)

(Anm: Prepsychosis links with elevated metabolic syndrome. MADRID – Untreated people at high risk for developing psychosis also showed an increased prevalence of certain components of metabolic syndrome in data collected from 163 German study participants, a finding that gives new insight into the well-documented but poorly delineated link between schizophrenia and metabolic syndrome. (...) He also suggested prescribing antipsychotic medications that pose the lowest risk for causing further metabolic derangements in patients. (clinicalpsychiatrynews.com.com 2.4.2016).)

(Anm: Joachim Raese, MD. Metabolic syndrome is defined by the aggregation of hypertriglyceridemia, low high-density lipoprotein (HDL) levels, elevated fasting glucose, hypertension, and increased waist circumference. Metabolic syndrome confers an increased risk of developing diabetes and of dying from coronary artery disease. Cardiovascular disease is the leading cause of death among patients with schizophrenia, who have a life expectancy about 20 years shorter than the general population. (…) For a more detailed discussion, I suggest watching a YouTube video that we have prepared. (cmeinstitute.com 27.4.2016).)

(Anm: Video Lecture 8: Metabolic Syndrome Lectures 1 (By Dr. Joachim Raese) (youtube.com).)

(Anm: Women with type 2 diabetes at greater cardiovascular risk than men. While it is well established that individuals with diabetes are at higher risk for cardiovascular disease, a new scientific statement from the American Heart Association claims this risk may be significantly greater for women with the condition. Published in the journal Circulation, the statement also says women with type 2 diabetes may need to take more action than men to lower their risk for heart attack and stroke. (medicalnewstoday.com 8.12.2015).)

(Anm: Type 2 diabetes: blood pressure drugs may be harmful for some patients. For some patients with type 2 diabetes, treatment with intense blood-lowering medication may do more harm than good. This is according to a new study published in The BMJ. (medicalnewstoday.com 26.2.2016).)

(Anm: Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation. 2015; 132(25): 2424-47.)

A Clinical Guide to Epileptic Syndromes and Their Treatment
By C. P. Panayiotopoulos. 2nd ed, 540 pp, $99.25. London, England, Springer-Verlag, 2007. ISBN-13 978-1-8462-8643-8.
JAMA 2008;299(3):348-349
A Clinical Guide to Epileptic Syndromes and Their Treatment is well worth having in your library for its compendious information and significant update since its first edition (2002). The current edition has grown from 278 pages to 551 pages and has increased not only in size but in its usefulness, with many new illustrations and clinical pearls from the author, a pediatric epileptologist. The text has truly become a pragmatic and helpful guide in the treatment of epilepsy. (...)

The book has an interesting structure. As with the first edition, it begins with a typical introduction covering general aspects of epilepsies. Next covered is status epilepticus, a condition in which seizures continue for extended periods, a dilemma and true neurologic emergency for all practitioners and one of the most anxiety-provoking aspects of epilepsy. This chapter is a bit short in its discussion of the treatment of status epilepticus: whereas many other publications contain algorithms of treatment strategies, this type of information was not provided here. Interestingly, the book then moves to what the author describes as "imitators of epilepsy syndromes" (chapter 4). This places the differential diagnosis early in the consideration of epilepsy because, as the author states later, seizures are misdiagnosed in many cases. (...)

Gendefekter gir færre epileptiske anfall
vg.no 6.11.2007
(VG Nett) Epileptikere som er bærere av to eller flere sykdomsgen er mindre utsatt for alvorlige anfall, viser ny studie. (...)

Johnsen viser til at tjue prosent av barna som kommer inn på Spesialsykehuset for epilepsi med epilepsidiagnose, blir utskrevet uten diagnose. Og hver femte nordmann som går på epilepsimedisiner gjør det unødig, som et resultat av for dårlig oppfølging og kontroll. (...)

Voksne med epilepsi er bange og har lav livskvalitet
premium.netdoktor.com/dk 2.7.2007
Den første videnskabelige undersøgelse af levevilkår for voksne med epilepsi viser blandt andet, at mange er bange for at dø. (...)

På side 7 i rapporten findes der et resume af undersøgelsens resultater (...)

Epilepsi og andre anfaldfænomener hos børn
Månedsskrift for praktisk lægegerning 2007(6) (Juni)
Epilepsi er en af de hyppigste neurologiske sygdomme i barnealderen med en prævalens på 0,5%. I artiklen beskrives de hyppigste former for epilepsi og andre anfaldsfænomener, deres diagnose og behandling. Læs og bliv bedre klædt på til at svare på spørgsmål af typen: »Tager vores barns hjerne skade af anfaldene?« (...)

Behandlingsråd ved epilepsi
Tidsskr Nor Lægeforen 2007; 127: 1327 (15.5.2007)
To store studier gir enkle retningslinjer for behandling av epilepsi - kanskje i enkleste laget for norske forhold. (...)

Battling Epilepsy, and Its Stigma
nytimes.com 20.2.2007
(...) Nora has epilepsy, and as with 30 percent of those with the disorder, her seizures are not controlled by existing treatments.

She often has more than one seizure a day, mostly at night. Her seizures, called tonic-clonic (what used to be known as grand mal), cause her to lose consciousness for a full minute while her body convulses. (...)

Små epilepsipasienter med store problemer
Tidsskr Nor Lægeforen 2007; 127: 552 (1. 3.2007)
Barn med epilepsi har, i tillegg til anfallene, store generelle lærevansker, psykososiale problemer og depresjon.(...)

Epilepsi og rehabilitering
Karl O. Nakken Eylert Brodtkorb Jeanette Koht
Tidsskr Nor Lægeforen 2007; 127: 309-12 (1.2.2007)
(...) Bakgrunn. Epilepsi er en samlebetegnelse på en rekke mer eller mindre veldefinerte syndromer som har gjentatte, uprovoserte epileptiske anfall til felles. Med store variasjoner i alvorlighetsgrad og komorbiditet er pasientenes rehabiliteringsbehov svært forskjellige. (...)

Trained Dogs Not Always Detecting Epileptic Seizures
healthfinder.gov 23.1.2007
Sometimes they're picking up on psychological seizures, study claims.

TUESDAY, Jan. 23 (HealthDay News) -- Many dogs that are trained to detect epileptic seizures are actually predicting psychological seizures rather than "true" epileptic attacks, new research suggests.

"It's important to define what kind of seizures these patients have because we use anti-convulsant drugs to treat epilepsy, and we use other therapies for the nonepileptic seizures," explained Dr. Gregory L. Krauss, an associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore. (...)

"Nonepileptic seizures are probably much more common than people recognize," Devinsky said.

"About 10 percent of the patients we see at epilepsy centers don't have epilepsy but have psychogenic seizures," Krauss added. "It's a physical manifestation of an emotional problem, a form of abnormal coping. A lot of them are stress reactions." (...)

(Anm: Jenna Martin, Senior Editor. Research Articles. The Truth about Psychogenic NonEpileptic Seizures. epilepsy.com (8.4.2005).)

Behandling av epilepsi
Tidsskr Nor Lægeforen 2003; 123: 1864-8 (26. juni 2003)
Behandlingen omfatter mange forhold og forutsetter god kunnskap om både epilepsiene og de mange behandlingsalternativene. Riktig diagnose av epilepsitype og eventuelle anfallsutløsende forhold er det beste utgangspunktet for optimal behandling. Det er deretter viktig å vurdere nøye behovet for langvarig medikamentell behandling, med de bivirkninger denne kan medføre. Flere preparater kan være aktuelle når det gjelder effekt, men mulige interaksjoner og bivirkninger kan være avgjørende. (...)

Valg av medikament
Før man setter i gang behandling med antiepileptika, skal det alltid overveies om det er nødvendig å starte en langvarig, forebyggende terapi. Ett enkelt anfall hos en person uten kjente risikofaktorer for nye bør ikke alltid medføre oppstart av behandling. Er det spesifikke anfallsutløsende forhold som enkelt kan påvirkes, bør man vurdere om ikke dette bør være det første og kanskje eneste man gjør. Det må også vurderes om et anfall kan skyldes et fysiologisk eller psykologisk ikke-epileptisk anfall (1).

Hvis det har forekommet to uprovoserte anfall, er risikoen 70 % for at det vil komme et tredje i løpet av fire år (10). Hvis man kommer til at det bør startes opp med en antiepileptisk medikasjon, er det riktig å informere både pasient og ev. familie godt om risikoen ved anfall og fordeler og ulemper med medikamentell behandling. Det ideelle ville være å kunne velge et medikament som var uten alvorlige bivirkninger og som man visste hadde effekt ved den aktuelle type epilepsi. Det er f.eks. klart at valproat har en god effekt på juvenil myoklon epilepsi med de ulike anfallstyper som forekommer ved denne epilepsitypen. Det er et problem at man ofte bare er opptatt av å diagnostisere anfallstypen uten å finne frem til selve epilepsisykdommen. I de fleste studier av effekten av antiepileptika tar man da også utgangspunkt i anfallstypen og ikke epilepsitypen. Et annet problem er de bivirkninger av valproat som særlig kan være av betydning for unge kvinner, dvs. vektøkning og forstyrrelser av kjønnshormonbalansen. Slike forhold gjør at man mange ganger ikke klarer å få til den optimale tilpasning mellom effekt og bivirkninger når det gjelder behandling.

Ut fra kjennskapet til epilepsitype, ev. anfallstype, patofysiologi, virkningsmekanismer, bivirkninger og farmakokinetikk vil man sammen med data fra gode kliniske studier kunne anbefale et behandlingsopplegg. I de aller fleste tilfellene vil det da være ett enkelt preparat i monoterapi. (...)

Epilepsilegemidler og risiko for selvskading og selvmord

Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior (Bruk av legemidler mot epilepsi og risikoen for selvskading og selvmordsatferd)
NEUROLOGY 2010;75:335-340
Background: A recent meta-analysis of randomized trials revealed that antiepileptic drugs (AEDs) as a class increase the risk of suicidal thoughts and behavior. We conducted an observational study with data from the United Kingdom General Practice Research Database to investigate if an increase in risk for different groups of AEDs is also evident in clinical practice. (...)

Conclusions: Newer AEDs with a rather high frequency of depressive symptoms in clinical trials may also increase the risk of self-harm or suicidal behavior in clinical practice. For the most commonly used other groups of AEDs, no increase in risk was observed. (...)

(Anm: Suicide rate is 22% higher among people with epilepsy than the general population. The suicide rate among people with epilepsy is 22 percent higher than the general population, according to a new study released by the Centers for Disease Control and Prevention (CDC), published in Epilepsy & Behavior. (medicalnewstoday.com 13.7.2016).)

Epilepsy Drugs' Link to Suicide Not Seen in All Patients
medpagetoday.com 4.8.2010
Using antiepileptics was not associated with an increased likelihood of attempting -- or completing -- suicide in patients with epilepsy, researchers found.

However, the class of medications was associated with greater odds of attempted or completed suicide in patients with depression and those taking the drugs for indications other than epilepsy, depression, and bipolar disorder, according to Alejandro Arana, MD, of Risk MR Pharmacovigilance Services in Zaragoza, Spain, and colleagues.

The odds ratios for those two groups of patients were 1.65 (95% CI 1.24 to 2.19) and 2.57 (95% CI 1.78 to 3.71), respectively, the researchers reported in the Aug. 5 issue of the New England Journal of Medicine. (...)

Suicide-Related Events in Patients Treated with Antiepileptic Drugs
N Engl J Med 2010; 363:542-551August 5, 2010
A previous meta-analysis of data from clinical trials showed an association between antiepileptic drugs and suicidality (suicidal ideation, behavior, or both). We used observational data to examine the association between the use or nonuse of antiepileptic drugs and suicide-related events (attempted suicides and completed suicides) in patients with epilepsy, depression, or bipolar disorder. (...)

Conclusions The current use of antiepileptic drugs was not associated with an increased risk of suicide-related events among patients with epilepsy, but it was associated with an increased risk of such events among patients with depression and among those who did not have epilepsy, depression, or bipolar disorder. (...)

Four Anticonvulsants' Link to Suicide Supported (Det gis støtte for at fire legemidler mot epilepsi linkes til selvmord)
Clinical Psychiatry News 20110;38(5):2 (May)
The link between anticonvulsant agents and suicidal acts or violent death—first revealed in a Food and Drug Administration meta-analysis in 2008—appears to have been confirmed for four of the drugs: gabapentin, lamotrigine, oxcarbazepine, and tiagabine, according to a report in JAMA. (...)

Antiepileptika kan öka självmordsrisk
lakemedelsvarlden.se 14.4.2010
Vissa antiepileptiska läkemedel kan göra patienterna mer självmordsbenägna enligt en studie i JAMA. Särskilt i början av behandlingen var sambandet extra tydligt.

SAMBAND Det är amerikanska forskare som gjort en kohortstudie över 13 av de vanligaste antiepileptiska läkemedlen. De ville undersöka sambandet mellan dessa och en ökad risk för självmord, självmordsförsök eller våldsam död. Anledningen är en tidigare metaanalys som tytt på ett samband och som ledde till att det amerikanska läkemedelsverket FDA 2008 införde varningstext på antiepileptiska läkemedel. (...)

Bland de 297 600 nyförskrivningar av antiepileptika till patienter över 15 år under en femårsperiod som forskarna identifierade, fann de 26 fullbordade självmord, 801 självmordsförsök och 41 dödsfall med en våldsam orsak. Alla inträffade under behandlingens första fjorton dagar.

Forskarna såg en förhöjd risk med preparat innehållande gabapentin, lamotrigin, oxkarbazepin, tiagabin och valproat när dessa jämfördes med topiramat eller karbamazepin som ofta används som kontroll. Det fanns en skillnad mellan de olika preparaten. För primidon var incidensen för någon av de tre händelserna 6,2 per 1000 personår, för oxkarbazepin 34,3 per 1000 personår. I analysen ingick också preparat med etosuxemid, felbamat, levetiracetam, fenobarbital, fenytoin, pregabalin, zonisamid och primidon. (...)

Anticonvulsant Medications and the Risk of Suicide, Attempted Suicide, or Violent Death
JAMA. 2010;303(14):1401-1409 (April 14)
Context In 2008, the US Food and Drug Administration mandated warning labeling for anticonvulsant medications regarding the increased risk of suicidal thoughts and behaviors. The decision was based on a meta-analysis not sufficiently large to investigate individual drugs. (...)

Conclusion This exploratory analysis suggests that the use of gabapentin, lamotrigine, oxcarbazepine, and tiagabine, compared with the use of topiramate, may be associated with an increased risk of suicidal acts or violent deaths. (...)

FDA Requires Increased Suicidality Warning on Antiepileptic Labels
medpagetoday.com 16.12.2008
ROCKVILLE, Md., Dec. 16 -- The FDA announced today it will require that all 21 antiepileptic drugs carry a label warning of an increased risk of suicidality.

The warning affects all drugs used to treat psychiatric disorders, migraine, and other conditions, in addition to epilepsy.

The agency initially warned physicians of the increased risk of suicidality associated with the drugs last January. (...)

The drugs with new suicidality warning are:

•Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR)
•Clonazepam (Klonopin)
•Clorazepate (Tranxene)
•Divalproex sodium (Depakote, Depakote ER, Depakene)
•Ethosuximide (Zarontin)
•Ethotoin (Peganone)
•Felbamate (Felbatol)
•Gabapentin (Neurontin)
•Lamotrigine (Lamictal)
•Lacosamide (Vimpat)
•Levetiracetam (Keppra)
•Mephenytoin (Mesantoin)
•Methosuximide (Celontin)
•Oxcarbazepine (Trileptal)
•Phenytoin (Dilantin Suspension)
•Pregabalin (Lyrica)
•Primidone (Mysoline)
•Tiagabine (Gabitril)
•Topiramate (Topamax)
•Trimethadione (Tridione)
•Zonisamide (Zonegran)

The FDA will also require the drugs' manufacturers to submit a Risk Evaluation and Mitigation Strategy that includes a medication guide for patients. (...)

(Anm: A randomized, controlled, double-blind, crossover trial of zonisamide in myoclonus-dystonia. Neurology. 2016 Apr 6. pii: 10.1212/WNL.0000000000002631. [Epub ahead of print].)

(Anm: Zonisamide is a sulfonamide anticonvulsant approved for use as an adjunctive therapy in adults with partial-onset seizures; infantile spasm, mixed seizure types of Lennox–Gastaut syndrome, myoclonic, and generalized tonic clonic seizure.[2] (en.wikipedia.org).)

FDA adds suicide warning to epilepsy drugs
forbes.com 16.12.2008 (Associated Press)
Federal health regulators are ordering companies that make epilepsy drugs to add warnings about increased risks of suicide to their products.

The new warnings apply to blockbuster drugs used by millions of patients to control seizures. The drugs include GlaxoSmithKline's Lamictal, Johnson & Johnson's Topamax and Pfizer's Lyrica. (...)

- Abbvie taber sag om fødselsdefekter. (- Anklagerne fortsætter med at klæbe til Abbvies lægemiddel Depakote.)

(Anm: Abbvie taber sag om fødselsdefekter. Amerikanske Abbvie må endnu engang til lommerne i en sag om et af selskabets lægemidler, der blandt andet bruges til behandling af bipolar lidelse. Denne gang anklages lægemidlet for at medføre fødselsdefekter. Anklagerne fortsætter med at klæbe til Abbvies lægemiddel Depakote, der blandt andet bruges til behandling af bipolar lidelse. Denne gang har selskabet tabt en sag om fødselsdefekter, skriver Reuters. Derfor er Abbvie nu blevet dømt til at betale 15 mio. dollars, knap 100 mio. kr., til 10-årige Stevie Gonzales. Hans mor tog Depakote mod bipolar lidelse under sin gravidtet. Steve Gonzales blev født med spina bifida (rygmarksbrok). Moderen hævder, at hun ikke var advaret tilstrækkeligt om risikoen ved fødselsdefekter ved at indtage Depakote, mens hun var gravid. (medwatch.dk 7.7.2017).)

A Drug Safety Warning That Could Harm
abcnews.go.com 10.7.2008
Some Doctors See a Proposed Suicide Black Box Warning as Too Strict (...)

Since the FDA proposed the black box warning on Monday, some advocates and epilepsy specialists voiced concern that the black box warning is an overreaction and could deter epileptic patients from taking their much-needed medication. (...)

Lynn Dann, of Boston, who suffers from epilepsy, has experienced both the benefits and the tolls of epilepsy medications.

"I know because I've been on so many meds that you just have to live through it," said Dann, who has had rashes and problems digesting her medications. Epilepsy has also caused depression along the way. (...)

FDA panellists vote against black box warning for anti-epileptics
pharmatimes.com 11.7.2008
Advisors to the US regulator have declared that epilepsy treatments carry an increased risk of increased suicidal tendencies in patients but those risks are not big enough to warrant a black box warning.

A joint meeting of the peripheral and central nervous system & psychopharmacologic drugs advisory committees have voted unanimously that 11 anti-seizure medications can cause increased risks of suicidal thought. These include Pfizer’s Neurontin (gabapentin) and Lyrica (pregabalin), as well as GlaxoSmithKline’s Lamictal (lamotrigine), UCB’s Keppra (levetiracetam) and Abbott Laboratories’ Depakote (valproate). (...)

The FDA had noted that the effect was rare and more research is required before a link can be confirmed, a view the committees appear to have agreed with. Furthermore, “if we have good drugs that are working, we have to be very careful about scaring patients into not taking them," said Rochelle Caplan, a professor of psychiatry at University of California, Los Angeles and one of the panellists. (...)

FDA urging black box warning for epilepsy drugs
reuters.com 7.7.2008
WASHINGTON (Reuters) - Food and Drug Administration officials are pushing for a "black box" warning about the risk of suicidal thoughts and behavior with epilepsy drugs, just days ahead of a public meeting on the issue. (...)

Last month, an FDA analysis concluded the medicines are associated with a higher risk of suicidal thoughts and behavior. That echoed findings from other data released by the agency earlier this year.

FDA's Walsh said the agency is proposing the black-box warning based on that data, but will seek the panel's input.

According to the FDA, three of the 11 drugs studied showed no clear signal of suicidal problems. (...)

FDA Warns of Adverse Events Linked to Smoking Cessation Drug and Antiepileptics
JAMA. 2008;299(10):1121-1122.
Patients taking the smoking cessation drug varenicline or antiepileptic drugs may be at risk of developing severe neuropsychiatric symptoms, according to recent alerts from the US Food and Drug Administration (FDA). (...)

FDA Warns of Suicide Risk for More Medications
Psychiatr News 2008;43(5):23 (March 7) (American Psychiatric Association)
Antiepileptics and varenicline are linked to the emergence of suicidal thoughts and behaviors in patients without prior mood disorders or warning signs, the FDA warns.

Two classes of drugs have been recently linked to heightened risk for patients to develop suicidal thoughts and behaviors, according to the Food and Drug Administration (FDA). As a result, the FDA has issued warnings on antiepileptic drugs as well as varenicline (Chantix), a drug to aid smoking cessation. (...)

Vanlige legemidler gir selvmordstanker
aftenposten.no 8.2.2008
Legemidler mot epilepsi og bipolare lildelser kan øke risikoen for selvmord. Nå advarer Det amerikanske legemiddelverket mot vanlige medisiner. (...)

En ny studie viser at elleve vanlige medisiner mot epilepsi og bipolare lidelser kan øke risikoen for selvmord og selvmordstanker. (...)

Håper norske leger vet
Morten Ingvar Lossius er overlege ved Statens senter for epilepsi ved Rikshospitalet. Han kjenner til at antiepileptikum kan medføre depresjon og andre psykiske bivirkninger.

- Denne undersøkelsen tilfører likevel nyttig og viktig tilleggsinformasjon. Selv om depresjon står oppført som mulig bivirkning på flere av disse preparatene, burde selvmordstanker og selvmordsforsøk også være nevnt. Vi får bare håpe at alle leger som skriver ut disse preparatene er bevist dette, sier Lossius. (...)

Epilepsimedisin kan gi sjølmordstanker
helserevyen.no 7.2.2008
Epilepsimedisiner kan forårsake sjølmordsrelatert atferd, advarer den amerikanske legemiddelmyndigheten, FDA. (...)

FDA varnar för självmordsrisk med antiepileptika
lakemedelsvarlden.se 1.2.2008
Personer som behandlas med epilepsiläkemedel har fördubblad risk för självmordstankar och suicidalt beteende. Därför uppmanar det amerikanska läkemedelsverket läkare till att vara uppmärksamma på förändringar i beteendet hos sina patienter. (...)

F.D.A. Finds Increase in Suicide Symptoms for Patients Using Seizure Medications
nytimes.com 1.2.2008
Drugs for epilepsy, bipolar illness and mood problems double the risks of suicidal thoughts and behavior, and patients taking them should be watched for sudden behavioral changes, drug regulators have said.

The increased risks, while double in relative terms, are small. The Food and Drug Administration undertook a combined analysis of 199 clinical trials with 43,892 patients and found 4 suicides and 105 reports of suicidal symptoms among the 27,863 patients who were given the drugs compared to no suicides and 35 reports of suicidal symptoms among the 16,029 patients treated with placebos. (...)

Doctors warned about epilepsy drugs' risks
sfgate.com 1.2.2008
The risk of suicide or other suicidal behavior doubles for patients taking any one of 11 drugs prescribed to millions of people for epilepsy, pain, psychiatric illnesses and other disorders, the Food and Drug Administration said in an alert to physicians Thursday. (...)

Increased risk of suicidality with epilepsy drugs – FDA (Ifølge FDA gir epilepsilegemidler økt risiko for selvmord)
pharmatimes.com 1.2.2008
The US Food and Drug Administration has warned doctors about the increased risk of suicidal thoughts and behaviour connected with a number of treatments used to treat epilepsy and psychiatric disorders.

The agency says it has analysed reports of suicidality from clinical studies of 11 antiepileptics, which include Pfizer’s Lyrica (pregabalin) and Neurontin (gabapentin), Johnson & Johnson’s Topamax (topiramate), GlaxoSmithKline’s Lamictal (lamotrigine), Abbott’s Depakote (valproate) and UCB’s Keppra (levetiracetam). (...)

2nd UPDATE: FDA Warns Of Suicide Risk With Epilepsy Drugs
money.cnn.com 31.1.2008
WASHINGTON -(Dow Jones)- The U.S. Food and Drug Administration warned patients and health-care professionals Thursday about an increased risk of suicidal thoughts and behaviors associated with 11 drugs used to treat epilepsy and certain pyschiatric disorders. (...)

The review of suicidality data was similar to an earlier analysis of antidepressants, which resulted in the FDA's toughest black-box warning being placed on those drugs in 2004 to warn about the risks of suidical behaviors and thoughts. (...)

Suicidality and Antiepileptic Drugs (Selvmord og antiepileptiske legemidler)
fda.gov 31.1.2008
(...) FDA ALERT [1/31/2008] - The FDA has analyzed reports of suicidality (suicidal behavior or ideation) from placebo-controlled clinical studies of eleven drugs used to treat epilepsy as well as psychiatric disorders, and other conditions. These drugs are commonly referred to as antiepileptic drugs (see the list below). In the FDA’s analysis, patients receiving antiepileptic drugs had approximately twice the risk of suicidal behavior or ideation (0.43%) compared to patients receiving placebo (0.22%). The increased risk of suicidal behavior and suicidal ideation was observed as early as one week after starting the antiepileptic drug and continued through 24 weeks. The results were generally consistent among the eleven drugs. (...)

Diverse bivirkninger

Äldre epilepsiläkemedel ökar risken för hjärtsjukdomar
lakemedelsvarlden.se 20.3.2009
Fenytoin och karbamazepin ökar kolesterolhalterna i blodet och därmed risken att drabbas av hjärt- och kärlsjukdomar. Det visar en studie som publicerats online i Annals of Neurology. (...)

Epilepsy Drug May Raise Autism Risk in Offspring (Epilepsilegemiddel kan øke risiko for autisme hos avkom)
healthfinder.gov 2.12.2008
Yet another reason pregnant women should avoid this medication, experts say.

WEDNESDAY, Dec. 3 (HealthDay News) -- Women taking the epilepsy drug valproate while pregnant are at increased risk of delivering a child who develops autism. (- Kvinner som tar epilepsilegemidler mens de er gravide har økt risiko for å få barn som utvikler autisme.)

De brtiske resultater publisert Neurology den 2. desember, kommer i tillegg til tidligere forskning som viser at valproate og andre antiepilepsilegemidler kan bidra til fødselsdefekter (spesielt neuralrørsdefekter). (…) (The British findings, appearing in the Dec. 2 issue of Neurology, add to previous research showing that valproate and other anti-epilepsy drugs can contribute to birth defects (particularly neural tube defects).)

Litt over 6,3 prosent av barn eksponert for valproate alene har autisme eller tegn på disse lidelser, en hyppighet som er syv ganger høyere enn i kontrollgruppen. (Just over 6.3 percent of children exposed to valproate alone have autism spectrum disorders or features of these disorders, a number that's seven times higher than that in the control group.)

På grunn av barna i studien fremdeles er unge er der muligheter for at flere av disse etter hvert som tiden går blir diagnostisert med autisme eller relaterte lidelser. (...) (There is a possibility that more children in the study could be diagnosed with autism or related disorders as time progresses, given that most are still young.)

(Anm: AUTISM SPECTRUM DISORDERS FOLLOWING IN UTERO EXPOSURE TO ANTIEPILEPTIC DRUGS. Neurology, Dec 2008; 71: 1923 - 1924.)

(Anm: neuralrørsdefekt; neuralrøyrdefekt; anencefali, spina bifida cystica, encefalomyelocele pga lytesam utvikling av nevralrøyret hos fosteret; ved slike defektar kan acetylkolinesterase leka ut i fostervatnet og ev påvisast etter amniocentese; sjå spina bifida, folinsyre EN neural tube defect BM neuralrørdefekt.)

Drug allergy: Watching for unexpected reactions to medications
mayoclinic.com 16.11.2007
If you have a drug allergy, your immune system mistakes a medication for a disease-causing agent. A reaction to aspirin results in allergy-like symptoms but doesn't involve the immune system. (...)

Signs and symptoms of drug allergies

Many allergic reactions to drugs occur within a few days or as much as three weeks after drug treatment is started. If you're allergic to a drug, you may experience:

  • Raised, red, itchy patches on the skin (hives, or urticaria)
  • Itching sensation (pruritus)
  • Swollen, red, itchy rash (dermatitis)
  • Swelling or welts deep in the skin (angioedema), especially near your eyes and lips
  • Mild or moderate wheezing (...)

(Anm: Aspirin: is it really a 'wonder drug'? (medicalnewstoday.com 29.10.2015).)

(Anm: Aspirin not an effective treatment for atrial fibrillation, study suggests. New research suggests that aspirin may not be as effective as previously believed for treating patients with atrial fibrillation. In fact, for patients who had a catheter ablation to lower their risk of stroke, the risks of using aspirin may outweigh the benefits. (…) In fact, the American College of Cardiologists report that more than 1 in 3 patients with A-fib who have an "intermediate-to-high" risk of stroke are treated with aspirin instead of oral blood thinners, even when medical guidelines advise the use of anticoagulants. (medicalnewstoday.com 15.5.2017).)

- Hvorfor aspirin kan være farlige for eldre mennesker.

(Anm: Why Aspirin May Be More Dangerous for Older People. (…) Studies have shown that low doses of the blood-thinner can significantly lower the risk of heart problems, especially among people who have already had a heart attack or stroke. But in a study published in the Lancet, researchers say that the risks of aspirin haven’t been properly studied in older people. Most of the studies showing the over-the-counter drug’s benefits have included younger people under 65 years. However, most people who are currently taking daily aspirin for their heart are older. (time.com 14.6.2017).)

(Anm: Bleeding Risks With Aspirin Use for Primary Prevention in Adults: A Systematic Review for the U.S. Preventive Services Task Force. (…) Conclusion: Consideration of the safety of primary prevention with aspirin requires an individualized assessment of aspirin's effects on bleeding risks and expected benefits because absolute bleeding risk may vary considerably by patient.Ann Intern Med. 2016 Apr 12. [Epub ahead of print].)

(Anm: Aspirin Therapy Fails to Reduce ARDS. —Rate at 7 days unchanged. (…) SAN FRANCISCO -- Initiating aspirin therapy to emergency room patients at risk of lung injury does not influence the chance that these patients will experience acute respiratory distress syndrome (ARDS), researchers reported here. (medpagetoday.com 17.5.2016).)

(Anm: OTC Antacids Linked to Bleeding Risk: The Pain Medicine News Report. Over-the-counter antacids that contain aspirin may increase the risk of serious bleeding, according to FDA reports. (medpagetoday.com 23.6.2016).)

(Anm: Antacid. An antacid is a substance which neutralizes stomach acidity, which in turn relieves heartburn, indigestion or stomach upset.[1] (en.wikipedia.org).)

Researchers warn of possible risks to children from new epilepsy drugs
BMJ 2007;334:1243 (16 June)
New drugs for epilepsy are increasingly being given to children despite the lack of evidence for their long term safety, warn researchers at a leading UK centre for paediatric pharmacy.

Ian Wong and colleagues at the University of London's Centre for Paediatric Pharmacy reviewed the data on epilepsy drugs prescribed to under-18s between 1993 and 2005 (British Journal of Clinical Pharmacology 2007;63:689-97). The study looked at 7721 patients aged 18 years or under whose details were included in the UK general practice research database, of whom 70% were treated with one antiepilepsy drug each.

Overall prescribing of newer antiepileptic drugs had increased by 19% over that period, whereas prescribing of conventional drugs had declined by 17%. Lamotrigine was the most prescribed drug, accounting for 65% of the prescriptions of newer antiepileptics.

The study comes after a report last September by the European Medicines Agency calling for a review of drugs used to treat children, including drugs for epilepsy (www.emea.europa.eu/pdfs/human/peg/37717406%20.pdf). Most drugs, including those for epilepsy, are not tested in children, so their use is often "off licence"—in other words, at the doctor's discretion. (...)

Fears over child epilepsy drugs
bbc.co.uk 10.6.2007
Urgent safety studies are needed for newer anti-epilepsy drugs that are being increasingly prescribed for children, say UK researchers.

The British Journal of Clinical Pharmacology report says prescriptions have risen five-fold in 13 years.

Yet the drugs' long-term safety has not been established, say the researchers.
Many medicines are not fully tested on children before licensing, meaning consultants have no official guidance on doses to refer to when prescribing. (...)

Side effects of phenobarbital and carbamazepine in childhood epilepsy: randomised controlled trial
BMJ 2007;334:1207 (9 June)
(...) Results 91 children were followed up for 12 months. Six required a change of antiepilepsy drug. Side effects were compared in 85 children. In the last quarter of the 12 month follow-up, 71 children were seizure free after one year's treatment. Thirty two in the phenobarbital group and 39 in the carbamazepine group had no seizures in 74 and 102 days after randomisation, respectively. Ten children had increased behavioural problems, which were unacceptable in four (one in the phenobarbital group and three in the carbamazepine group). Independent t tests, however, showed no difference between the two trial drugs. (...)

Epilepsimedicin riskerar ge barn med lågt IQ
Läkemedelsvärlden 2007(5) (Mai)
Barn till kvinnor som ätit epilepsiläkemedlet valproat under graviditeten löper ökad risk att bli förståndshandikappade. Det konstaterar amerikanska forskare som presenterade sina resultat på American Academy of Neurology:s årsmöte under torsdagen. (...)

Epilepsy Drug Can Increase Risk for Newborns, Study Says
nytimes.com 4.5.2007
Doctors reported yesterday that expectant mothers with epilepsy who took a commonly prescribed drug to control seizures were at increased risk of having a child with mental deficits. (...)

Women Taking Antiepileptics Give Birth to Babies at Risk: Presented at AAN
docguide.com 4.5.2007
(...) The cohort analysis examined 133 pregnancies in 117 women. There were a total of 11 spontaneous abortions and one twin birth, for a total of 123 live infants.

Antiepileptic drugs observed in this study included valproate, lamotrigine, carbamazepine, levetiracetam, phenytoin, oxcarbazepine, gabapentin, and topiramate.

Results demonstrated that high rates of low birth weight (LBW) were found in newborns that were exposed to valproate, carbamazepine, phenytoin or polytherapy in utero. The researchers noted exceptionally high rates of babies who were small for gestational age (>15%). This finding held across all drug groups except lamotrigine and gabapentin. Over 15% of infants exposed to valproate, lamotrigine, carbamazepine and phenytoin required neonatal intensive care unit/special-care nursery admission. (...)

Lower IQ Found in Children of Women Who Took Epilepsy Drug
newswise.com 3.5.2007
VALPROATE, EPILEPSY, DRUGS, CHILDREN, PEDIATRICS, WOMEN WITH EPILEPSY, IQ SCORES, COGNITIVE DEVELOPMENT, NEUROLOGY, AMERICAN ACADEMY OF NEUROLOGY, ANNUAL MEETING (...)

Children of women who took the epilepsy drug valproate during pregnancy appear to be at a greater risk for lower IQ, according to research presented at the American Academy of Neurology’s 59th Annual Meeting in Boston, April 28 – May 5, 2007. (...)

Newswise — Children of women who took the epilepsy drug valproate during pregnancy appear to be at a greater risk for lower IQ, according to research presented at the American Academy of Neurology’s 59th Annual Meeting in Boston, April 28 – May 5, 2007.

The study looked at IQ results for 187 two-year-old children of mothers who took the epilepsy drugs carbamazepine, lamotrigine, phenytoin, or valproate during pregnancy.

According to the study, 24 percent of the children of mothers who took valproate showed an IQ in the mental retardation range, compared to 12 percent for carbamazepine, nine percent for lamotrigine, and 12 percent for phenytoin. On an IQ test, children whose mothers took carbamazepine scored an average of 93 points, compared to 93 for those who took phenytoin, 96 for lamotrigine, and 84 for valproate. The scores were adjusted to account for the mother’s IQ and the drug dosage.

The study also found that children with higher levels of valproate in their blood had lower IQ scores. (...)

April 2007 Big Pharma Litigation Update - Drugs Part II
By Evelyn Pringle
lawyersandsettlements.com 20.4.2007
Washington, DC: The anti-epileptic drug, Depakote (valproate), marketed by Abbott Laboratories, is one of the most heavily prescribed medications for off-label use. Experts say the evidence of harm caused by Depakote is just beginning to emerge.

According to Harrisburg, Pennsylvania psychiatrist, Dr Stefan Kruszewski, a recognized expert on psychotropic drugs, "we can anticipate a continuing series of tragic outcomes from the massive overuse of Depakote, secondary not only to birth defects and death, but also due to anemias, hepatic disease, obesity, diabetes type II, pancreatitis and other serious systemic and neurological dysfunctions." (...)

Bivirkninger av nyere antiepileptika
Tidsskr Nor Lægeforen 2000; 120: 3163-5 utg
I løpet av 1990-årene har vi fått en rekke nye antiepileptika som har gitt oss flere valgmuligheter i behandling av epilepsi. Noen av de nye medikamentene har en enklere farmakokinetikk, færre interaksjoner og en gunstigere bivirkningsprofil enn de gamle, så langt vi vet til nå. Ulempen er at de er vesentlig dyrere og at det foreløpig ikke er dokumentert at de har bedre effekt enn f.eks. karbamazepin, fenytoin og valproat. For mange pasienter med intraktabel epilepsi har de nye antiepileptika vært en skuffelse idet svært få av pasientene (<5 %) er blitt helt anfallsfrie. (...)

The frequency of reversible parkinsonism and cognitive decline associated with valproate treatment: a study of 364 patients with different types of epilepsy
Epilepsia. 2006 Dec;47(12):2183-5
PURPOSE: We report the frequency of parkinsonism and cognitive decline (P/CD) in patients treated with valproate (VPA) after 1 year of treatment and at least 1 year of follow-up. (...)

CONCLUSIONS: Early identification of this type of AE and discontinuation of the drug led to complete recovery in affected patients. (...)

Diagnostikk

Epilepsy is misdiagnosed in 90 000 people a year in England and Wales (90 000 mennesker blir hvert år feilaktig diagnostisert med epilepsi i England og Wales)
News roundup
BMJ 2006;333:824 (21 October)
Each year more than 90 000 people in England and Wales are wrongly given a diagnosis of epilepsy, a new study has estimated. This scale of misdiagnosis may be resulting in unnecessary costs of as much as £138m (€205m; $257m) a year, it says.

The study, which was published ahead of print publication on 29 September in Seizure (www.sciencedirect.com, doi: 10.1016/j.seizure.2006.08.005), says that diagnosing epilepsy is difficult and that misdiagnosis occurs in one in four cases, largely as a result of patients being seen by medical practitioners who are not specialists in epilepsy. (...)

Researchers: Epilepsy Cause Identified
washingtonpost.com 30.3.2006
MESA, Ariz. -- Researchers have identified a genetic cause for epilepsy, which could lead to the development of medicines to treat epilepsy and autism, the Translational Genomics Research Institute announced Thursday.

"This is the first step" in finding a cure for the childhood-onset diseases, said Dr. Dietrich Stephan, director of the neurogenomic division of TGen, the Phoenix-based research group that focuses on treatments and cures for genetically related illnesses.

"It allows us to better understand what causes the diseases," Stephan said of the discovery of a genetic mutation in Old Order Amish children in Pennsylvania.
TGen and the Clinic for Special Children in Strasburg, Pa. made the finding together.

Currently, medications treating epilepsy don't work on about 40 percent of the varying types of the disease, Stephan said. And the only treatment for autism are behavioral therapies _ working with kids extensively on a daily basis to teach them life skills, he said.

Most epileptic symptoms, including recurring seizures, have been traced to abnormalities of the brain structure or chemistry that alter the electrical activity in nerve cells.

Autistic traits also are believed to be caused by disrupted nerve networks. (...)

Zonegran (zonisamid)

Zonegran (zonisamid)
irf.dk 20.3.2006
Konklusion
Zonegran er et nyt antiepileptikum, af en ny klasse, indiceret som supplerende behandling af voksne patienter med partielle anfald med eller uden generalisering.

Effekten er færre epileptiske anfald blandt en stor gruppe patienter, der ikke har tilstrækkelig effekt af anden behandling, givet som enkeltstof – eller flerstofbehandling. Effekten er opgjort i dels reduktionen i antallet af anfald over en periode på maksimalt 18 uger og dels i antallet af patienter, der oplever mere end 50% reduktion i antallet af anfald sammenlignet med placebo. Number needed to treat (NNT) for at opnå 50% reduktion i anfaldshyppighed angives til 6. Der foreligger ikke studier, hvor Zonegran er sammenlignet med andet add-on antiepileptikum.

Bivirkningerne omfatter ataxi, svimmelhed, træthed, døsighed, kvalme, agitation og nedsat appetit og forekommer 2-4 gange hyppigere end under placebobehandling.

Priserne er op til 1½-3 gange dyrere end andre nyere antiepileptika.

Zonegran er markedsført 13. marts 2006. (...)

Norsk Epilepsiforbund

Epilepsi møtes med fordommer
Av Annelise Høegh, generalsekretær i Norsk Epilepsiforbund
aftenposten.no 11.4.2007
TROR DET KAN SMITTE. Mennesker med epilepsi møter fordommer og uvitenhet hos folk flest og diskriminering i lovverket. En undersøkelse for noen år siden viste at 7 % tror epilepsi er smittsomt. (...)

Myndighetene er opptatt av å redusere utgifter til dyre reseptmedisiner. Likevel gir de ikke mennesker med epilepsi rett til oppfølging hos nevrolog etter anfallsfrihet. Det er uklokt både fra et medisinsk og et samfunnsøkonomisk perspektiv. Alle medisiner har sine bivirkninger. Derfor bør anfallsfrie få muligheten til å trappe ned eller avslutte medisineringen.

Mange lever et godt liv med epilepsi. Mange flere kunne gjort det hvis myndighetene var villige til å satse på opplysning og inkludering i stedet for utestenging. (...)

Hva er egentlig epilepsi?
epilepsi.no (2007) (Norsk Epilepsiforbund)
Epilepsi er ikke en sykdom, men symptom på forskjellige tilstander som har det til felles at de leder til en anfallsvis funksjonsforstyrrelse i hjernen. Årsaken til epilepsien varierer fra person til person, og kan være nær sagt alle former for sykdom eller skade av hjernen. I over halvparten av tilfellene klarer en imidlertid ikke å påvise noen sikker årsak. Et epileptisk anfall er uttrykk for en forbigående funksjonsforstyrrelse i hjernen. Denne skyldes en plutselig og ukontrollert forstyrrelse av hjernebarkens elektriske aktivitet. Alle mennesker kan i prinsippet få et epileptisk anfall under spesielle påkjenninger eller ved visse sykdommer. Personer med epilepsi har en lavere anfallsterskel enn andre, og har derfor tendens til gjentatte anfall. De ulike anfallstypene.

Epileptiske anfall deles grovt i to hovedgrupper, kalt generaliserte og partielle, avhengig av hvor i hjernen anfallet starter. Et anfall som ser ut til å starte over hele hjernen samtidig kalles generalisert, men et anfall som starter i ett bestemt område kalles partielt. (...)

Behandling
Behandling av epilepsi kan deles i tre punkter;

1. Anfallsforebyggende tiltak
I mange tilfeller kan opptreden av epileptiske anfall tilbakeføres til spesielle anfallsutløsende forhold som f.eks. søvnmangel, lite mat, stort alkoholforbruk eller psykisk stress. Det er viktig at hver pasient nøye ser om det kan være forhold av betydning for anfallsutløsning nettopp hos ham i det dette kan gi mulighet til anfallsforebygging uten bruk av medisiner.

2. Medikamentell behandling
Valg av medikament vil avhenge av pasientens anfallstype. Ikke sjelden kan det være nødvendig å prøve seg frem over noe tid for å finne det preparatet som har best virkning. Det opptrer meget sjelden alvorlige bivirkninger ved bruk av antiepileptika, og medisinene er ikke vanedannende. Blant de bivirkninger som kan sees er tretthet, allergiske reaksjoner, hudutslett, vektøkning, endret hårvekst og fortykket tannkjøtt. Dette går vanligvis tilbake når en skifter medikament. Epilepsimedisin må tas regelmessig og over flere år. Først etter 3-5 år uten anfall kan en vurdere å slutte med medisinene. Her er det imidlertid nødvendig med en individuell vurdering.

3. Kirurgisk behandling (...)

Case Raises New Concern Over Withdrawal of Drugs (Tilfelle reiser nye bekymringer om abstinenser fra legemiddel.)
New York Times 19.7.2005
I de senere år, er mange antikonvulsive legemidler blitt mye forskrevet ikke bare mot epileptiske lidelser, men til mange forskjellige typer kronisk smerte og flere forskjellige psykiatriske sykdommer, selv om ikke mange er blitt godkjent av Food and Drug Administration til disse formål. (In recent years, many anticonvulsant drugs have been widely prescribed not only for seizure disorders, but for various kinds of chronic pain and for several different psychiatric illnesses, even though few have been approved by the Food and Drug Administration for those purposes.)

Nå innrapporterer forskere et tilfelle av hjerneoppsvulming, eller hjerneødem, etter plutselig opphør i bruken av pregabalin (Lyrica), et nytt antiepileptisk legemiddel som vil være tilgjengelig i høst. Rapporten er offentliggjort online og i augustnummeret av Annals of Neurology. (Now researchers are reporting a case of brain swelling, or cerebral edema, after abrupt withdrawal from pregabalin (Lyrica), a new antiepileptic drug that will be available this fall. The report appears online and in the August issue of Annals of Neurology.)

Pasienten, en 80 år gammel kvinne, deltok i et klinisk forsøk som tester ut legemidlet mot sterk smerte grunnet helvetesild, eller neuralgia postherpetica. Omtrent en dag etter brått opphør i bruken, led hun av kvalme, hodepine og balansetap, som en uke senere utviklet seg til delirium og hallusinasjoner. En MRI-skan (magnetisk resonanstomografi) avdekket oppsvulming i den samme del av hjernen som er affektert hos noen epileptiske pasienter som plutselig stanser bruken av sine legemidler. (The patient, an 80-year-old woman, was in a clinical trial testing the drug for the severe pain of shingles, or neuralgia postherpetica. About a day after abruptly discontinuing it, she suffered nausea, headache and loss of balance, which progressed to delirium and hallucinations a week later. An M.R.I. scan revealed swelling in the same part of the brain that is affected in some epileptic patients who suddenly stop their drugs.)

Dr. Anne Louise Oaklander, førsteforfatteren av arbeidet, erkjenner at et enkelt tilfelle ikke er bevis. ''Kanskje er det helt tilfeldig at hun hadde unormal MRI og en nevrologisk sykdom, og at hun nylig avsluttet bruken av legemidlet,'' sa hun. Men den mest sannsynlige forklaring er at disse ting henger sammen. (...) (''Dr. Anne Louise Oaklander, the lead author on the paper, acknowledged that a single case did not constitute proof. ''Maybe it's completely coincidental that she had M.R.I. abnormalities and a neurological illness, and that she'd recently stopped the drug,'' she said. ''But the more likely explanation is that these things are linked.'')

(Anm: hjerneødem; oppsvelling eller opptrutning av hjernevevet pga auke i innhaldet av væske; kan koma etter hjerneskade, ved hjernesvulst og ymse andre årsaker; hjerneødem kan gi farleg trykkstiging inne i skallen.

neuralgia postherpetica; vedvarande smerter i utbreiingsområdet for ein nerve der det tidlegare har vore herpes zoster.)

delirium; tilstand med sterk uro, øsing, forvirring, synsviller (hallusinasjonar) og andre innbillingar; «dilla»; e.n. hugstorm. Kilde: Norsk medisinsk ordbok.)

lymfadenopati lymphadenopathia, sjukdom i lymfeknutane, oftast brukt om lymfeknutesvulst pga infeksjonar eller andre tilstandar – vondarta eller godarta; ofte brukt om lymfadenitt; jf immunoblastisk lymfadenopati
EN lymphadenopathy ET [lymphaden + pathos sjukdom] (Kilde: Norsk medisinsk ordbok.)

(Anm: Delirium is associated with 5-fold increased mortality in acute cardiac patients. (medicalnewstoday.com 16.3.2017).)

- Epilepsimedisin kan gi hormonforstyrrelser

Epilepsimedisin kan gi hormonforstyrrelser
Tidsskr Nor Lægeforen 2005; 125:1294 (19.5.2008)
Fertilitetsproblemer, menstruasjonsforstyrrelser og hormonforstyrrelser er ikke uvanlig blant mennesker med epilepsi. Skyldes dette sykdommen eller medikamentene?

Dette har Line Sveberg Røste sett nærmere på i doktoravhandlingen Sex hormones and gonadal functions during anti-epileptic drug treatment, som utgår fra Det medisinske fakultet, Universitetet i Oslo. Det er kjent fra før at epilepsi kan forstyrre balansen i hormonsystemet hos pasienten, både hos kvinner og menn. I 1993 viste imidlertid Isojärvi og medarbeideres studie fra New England Journal of Medicine at et epilepsimedikament også kunne forårsake forstyrrelser. - Denne studien var utgangspunktet for min første artikkel, der jeg påviste tydelige forandringer i hormonbalansen og eggstokkene hos hunnrotter som fikk epilepsimedisin uten å ha epilepsi.

Videre tester viste også forandringer i testiklene hos hannrotter etter langtidsbehandling med epilepsimedisin og disse effektene ser ut til å være medikamentspesifikke hos begge kjønn, sier Sveberg Røste. (...)

Epilepsimedisiner har også vist seg effektivt innen smertebehandling og psykiatri, og brukes derfor i økende grad. Sveberg Røste mener det bør vurderes i hvert enkelt tilfelle om pasienten bør redusere dosen eller eventuelt bytte medikament. (...)

Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy
N Engl J Med. 1993 Nov 4;329(19):1383-8
BACKGROUND. Reproductive endocrine disorders are more common among women with epilepsy than among normal women. These disorders have been attributed to epilepsy itself, but could be related to antiepileptic-drug therapy. (...)

RESULTS. Menstrual disturbances were present in 13 of the women receiving valproate alone (45 percent), 3 of the women receiving valproate in combination with carbamazepine (25 percent), 23 of the women receiving carbamazepine (19 percent), and 8 of those receiving other medications (13 percent). Forty-three percent of the women receiving valproate had polycystic ovaries, and 17 percent had elevated serum testosterone concentrations without polycystic ovaries; 50 percent of the women receiving valproate and carbamazepine had polycystic ovaries, and 38 percent had elevated serum testosterone concentrations without polycystic ovaries. Eighty percent of the women treated with valproate before the age of 20 years had polycystic ovaries of hyperandrogenism. CONCLUSIONS. Menstrual disturbances, polycystic ovaries, and hyperandrogenism are often encountered in women taking valproate for epilepsy. (...)

Altered ovarian function and cardiovascular risk factors in valproate-treated women
Am J Med. 2001 Sep;111(4):290-6
(...) RESULTS: The frequency of polycystic ovaries or hyperandrogenism, or both, among valproate-treated women with epilepsy was 70% (26 of 37) compared with 19% (10 of 52) among control subjects (P <0.001). They were found in 79% (11 of 14) of obese and 65% (15 of 23) of lean women on valproate, and in 20% (7 of 35) of carbamazepine-treated women. The obese valproate-treated women with polycystic ovaries or hyperandrogenism, or both, had hyperinsulinemia and associated unfavorable changes in serum lipid levels consistent with insulin resistance. CONCLUSIONS: Polycystic ovaries and related hyperandrogenism are frequently encountered in both obese and lean women taking valproate for epilepsy. The use of valproate is associated with risk factors for cardiovascular disease in obese women. (...)

Nederlands Bijwerkingen Centrum Lareb
Nederlands Bijwerkingen Centrum Lareb (Juni 2007)
Valproic acid and pubertas praecox
Introduction
Valproic acid (Depakine® and generics) is an antiepileptic drug and is indicated for the treatment of primary generalized epilepsy and partial epilepsy, with or without secondary generalization [1]. (...)

Plasma testosterone was higher in valproate-treated girls (0.71±0.51 ng/ml)
than in control girls (0.35±0.15 ng/ml) (p 0.001). This finding was an early adverse effect and independent of valproate dose and treatment duration. No changes in normal pubertal development or physical repercussions were found in epileptic patients [3]. (...)

Initial Management of Epilepsy
NEJM 2008;359:166-176 (July 10)
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. (...)

Albumin levels should be measured before administering highly protein-bound drugs such as phenytoin and valproate, since the fraction of unbound (active) drug is higher in patients with hypoalbuminemia. In adolescents and adults with unexplained generalized seizures, screening for substance abuse should be considered. (...)

In the past two decades, nine new antiepileptic drugs have been marketed, making the choice of initial therapy complex. Antiepileptic drugs are classified as being either broad-spectrum or narrow-spectrum drugs with regard to efficacy against different seizure types and epilepsy syndromes. Broad-spectrum antiepileptic drugs are particularly useful because they are reasonable initial choices in most adult patients, regardless of the type of seizure or syndrome. These drugs include valproate, lamotrigine, topiramate, and levetiracetam (the efficacy of which [in generalized seizures] is supported by randomized, controlled trials), and zonisamide (the efficacy of which [in generalized seizures] is based on open studies and clinical experience). In contrast, narrow-spectrum drugs, which include carbamazepine, phenytoin, gabapentin, tiagabine, oxcarbazepine, and pregabalin, should be restricted to patients who have localization-related (focal) epilepsy with partial and secondarily generalized seizures.22 (...)

Antiepileptic drugs, and especially valproate, have been associated with reproductive endocrine disorders, most notably features of polycystic ovary syndrome (e.g., irregular menstrual cycles, weight gain, and hirsutism).30,31 This association appears to be related at least in part to the epilepsy itself,32,32 but in the majority of women, medication seems to play the major role.34,35 Observational studies have shown clinically important associations between the use of valproate, alone or in combination with other drugs, and the development of polycystic ovaries, anovulatory cycles, and hyperandrogenism.34,36,37 (...)

(Anm: Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain etiology, but there is strong evidence that it can to a large degree be classified as a genetic disease. (en.wikipedia.org).)

(Anm: The anovulatory cycle is a menstrual cycle characterized by varying degrees of menstrual intervals and the absence of ovulation and a luteal phase. In the absence of ovulation, there will be infertility. (en.wikipedia.org).)

(Anm: Hyperandrogenism is a medical condition characterized by excessive production and/or secretion of androgens. (en.wikipedia.org).)

(Anm: Hirsutisme; uvanleg sterk eller altfor utbreidd hårvekst (helst hos kvinner); kan finnast ved tilstandar som gir for stor utskiljing av androgene hormon f eks Stein-Leventhals syndrom eller «idiopatisk hirsutisme», i sjeldne tilfelle pga vondarta binyresvulstar; finst også ved visse medfødde tilstandar (enzymfeil m v) eller bruk av medikament (fenytoin, minoxidil, cyklosporin, hormon m v) EN hirsutism ET [lat. hirsutus hårete] Kilde: Norsk medisinsk ordbok.)

- Antiepileptika og toksisitet overfor mitokondrier

Toxicity of Antiepileptic Drugs to Mitochondria.
Handb Exp Pharmacol. 2016 Sep 3. [Epub ahead of print]
Abstract Some of the side and beneficial effects of antiepileptic drugs (AEDs) are mediated via the influence on mitochondria. This is of particular importance in patients requiring AED treatment for mitochondrial epilepsy. AED treatment in patients with mitochondrial disorders should rely on the known influences of AEDs on these organelles. AEDs may influence various mitochondrial functions or structures in a beneficial or detrimental way. There are AEDs in which the toxic effect outweighs the beneficial effect, such as valproic acid (VPA), carbamazepine (CBZ), phenytoin (PHT), or phenobarbital (PB). There are, however, also AEDs in which the beneficial effect on mitochondria outweighs the mitochondrion-toxic effect, such as gabapentin (GBT), lamotrigine (LTG), levetiracetam (LEV), or zonisamide (ZNS). In the majority of the AEDs, however, information about their influence of mitochondria is lacking. In clinical practice mitochondrial epilepsy should be initially treated with AEDs with low mitochondrion-toxic potential. Only in cases of ineffectivity or severe mitochondrial epilepsy, mitochondrion-toxic AEDs should be given. This applies for AEDs given orally or intravenously. (…)

Diverse artikler

(Anm: Cannabidiol-substans funnet å hjelpe ved tilstand med kraftig epilepsi hos barn. Cannabidiol drug found to aid in devastating childhood epilepsy condition. (pharmafile.com 25.5.2017).)

(Anm: Cannabidiol Changes Serum Levels of Antiepileptic Drugs. The treatment also is associated with abnormal liver function test results in patients taking concomitant valproate. Neurology Reviews. 2017 September;25(9):23 (mdedge.com).)

(Anm: Interactions between cannabidiol and commonly used antiepileptic drugs. Abstract OBJECTIVE: To identify potential pharmacokinetic interactions between the pharmaceutical formulation of cannabidiol (CBD; Epidiolex) and the commonly used antiepileptic drugs (AEDs) through an open-label safety study. Serum levels were monitored to identify interactions between CBD and AEDs (…) SIGNIFICANCE: Significantly changed serum levels of clobazam, rufinamide, topiramate, zonisamide, and eslicarbazepine were seen. Abnormal liver function test results were noted in participants taking concomitant valproate. This study emphasizes the importance of monitoring serum AED levels and LFTs during treatment with CBD. Epilepsia. 2017 Aug 6.)

Possible association between soy formula and seizures in children with autism
medicalnewstoday.com 18.3.2014
A University of Wisconsin-Madison researcher has detected a higher rate of seizures among children with autism who were fed infant formula containing soy protein rather than milk protein.

The study found excess seizures among girls and in the total sample of 1,949 children. The soy-seizure link reached borderline significance among boys, who comprised 87 percent of the children described in the database under study.

Seizures - caused by uncontrolled electrical currents in the brain - occur in many neurological disorders including epilepsy, Alzheimer's disease, Down syndrome and autism.

About 25 percent of infant formula sold in the United States is based on soy protein.

Study author Cara Westmark, a senior scientist in the UW-Madison department of neurology, says her investigation was sparked by mouse studies of a drug that, it was hoped, would inhibit seizures by blocking signals that excite nerve cells. "It was pure serendipity that we happened to look at soy," she says. (...)

Dysfunctional mitochondrial bioenergetics and oxidative stress in Akita(+/Ins2)-derived β-cells.
Am J Physiol Endocrinol Metab. 2013 Sep 1;305(5):E585-99
Abstract Insulin release from pancreatic β-cells plays a critical role in blood glucose homeostasis, and β-cell dysfunction leads to the development of diabetes mellitus. In cases of monogenic type 1 diabetes mellitus (T1DM) that involve mutations in the insulin gene, we hypothesized that misfolding of insulin could result in endoplasmic reticulum (ER) stress, oxidant production, and mitochondrial damage. To address this, we used the Akita(+/Ins2) T1DM model in which misfolding of the insulin 2 gene leads to ER stress-mediated β-cell death and thapsigargin to induce ER stress in two different β-cell lines and in intact mouse islets. Using transformed pancreatic β-cell lines generated from wild-type Ins2(+/+) (WT) and Akita(+/Ins2) mice, we evaluated cellular bioenergetics, oxidative stress, mitochondrial protein levels, and autophagic flux to determine whether changes in these processes contribute to β-cell dysfunction. In addition, we induced ER stress pharmacologically using thapsigargin in WT β-cells, INS-1 cells, and intact mouse islets to examine the effects of ER stress on mitochondrial function. Our data reveal that Akita(+/Ins2)-derived β-cells have increased mitochondrial dysfunction, oxidant production, mtDNA damage, and alterations in mitochondrial protein levels that are not corrected by autophagy. Together, these findings suggest that deterioration in mitochondrial function due to an oxidative environment and ER stress contributes to β-cell dysfunction and could contribute to T1DM in which mutations in insulin occur. (...)

(Anm: Signaling from dysfunctional mitochondria induces a distinct type of senescence. (Signalering fra dysfunksjonelle mitokondrier induserer en distinkt type tiltagende alderdom.) Finding provides alternative explanation for the free-radical theory of aging and suggests new role for mitochondria in affecting physiology. (medicalnewstoday.com 11.12.2015).)

(Anm: Mitochondrial Dysfunction Meets Senescence. Trends Biochem Sci. 2016 Feb 10. pii: S0968-0004(16)00020-7. [Epub ahead of print].)

Epilepsy Plus Mental Ills Linked to Premature Death, Study Says (Epilepsi pluss mentale sykdommer knyttet til for tidlig død, ifølge studien)
philly.com 22.7.2013
MONDAY, July 22 (HealthDay News) -- People with epilepsy are 11 times more likely to die prematurely than people in the general population. And the increased risk of early death is significantly higher among those with mental illnesses, especially depression and alcohol and drug-use disorders, a new study suggests.

"Our results have significant public health implications as around 70 million people worldwide have epilepsy, and emphasize that carefully assessing and treating psychiatric disorders as part as part of standard checks in persons with epilepsy could help reduce the risk of premature death in these patients," said study leader Seena Fazel, from the University of Oxford, in England.

The study included nearly 70,000 epilepsy patients born in Sweden between 1954 and 2009 and followed for up to 41 years. They were compared to more than 660,000 people in the general population and more than 81,000 siblings without epilepsy.

During the study, about 9 percent of people with epilepsy died, compared with 0.7 percent of people in the general population. Deaths from external causes (suicide, vehicular and non-vehicular accidents, and assaults) accounted for nearly 16 percent of all deaths among people with epilepsy, and were the most common causes of death not associated with the underlying disease process.

Of the epilepsy patients who died from external causes, 75 percent also had a diagnosed mental disorder, with substance abuse (56 percent) and depression (23 percent) the most common, according to the study, published July 22 in The Lancet. (...)

Bad medicine: epilepsy
Accurate diagnosis and long term management is problem in epilepsy, not cost of drugs

BMJ 2013;346:f3920 (18 June 2013)
Spence is right that epilepsy is not managed well.1 Rather than focusing on the cost and use of drugs perhaps the problem is with diagnosis and management in general. The recent national audit of seizure management in hospital identified considerable variability.2 The few sites that performed well showed that good care is possible, but, overall, assessment on arrival was inadequate. Routine measurements were not always done (temperature in only 83% of patients), a proper neurological examination with plantar responses recorded was done in 37% (interquartile range 20.0-49.1), an eyewitness description was sought in 58% (43.3-73.3), and electrocardiography was performed in 59% (43.3-75.8). Only 51% of patients with a first seizure were referred for any form of neurology specialist assessment. Many are started on drug treatment by non-neurologists after presenting to hospital. (...)

Dosa kan förvarna epileptiker
dagensmedicin.se 2.5.2013
En metod att förutsäga epilepsianfall visar lovande resultat i de inledande försöken på patienter.

För den som är drabbad av epilepsi är ovissheten om när nästa anfall ska slå till ofta påfrestande. Att ta sig ett bad, till exempel, går inte med mindre än att någon utomstående är där och vaktar. Att ställa en gryta på spisen blir ett riskmoment.

Nu har en australiensisk forskargrupp, sponsrad av företaget Neurovista, utvärderat säkerheten med en ny metod som kan förvarna om ett annalkande anfall. Nio män och sex kvinnor fick elektroder inopererade under skallbenet, beskriver forskarna i Lancet Neurology. Försökspersonerna, som var mellan 20 och 62 år, hade upp till 20 anfall i månaden trots olika antiepileptiska läkemedel. De hade alla så kallad fokal epilepsi, vilket innebär att anfallen alltid startar på samma ställe i ena hjärnhalvan. (...)

(Anm: Prediction of seizure likelihood with a long-term, implanted seizure advisory system in patients with drug-resistant epilepsy: a first-in-man study. Lancet Neurology, 2013 (2 May).)

Role of mitochondrial fission in neuronal injury in pilocarpine-induced epileptic rats
Neuroscience. 2013 Apr 15. pii: S0306-4522(13)00337-0. [Epub ahead of print]
Abstract Mitochondrial fission has been reported to be involved in oxidative stress, apoptosis and many neurological diseases. However, the role of mitochondrial fission in seizures, which could induce oxidative stress and neuronal loss, remains unknown. In this study, we used pilocarpine to elicit seizures in rats. Meanwhile, we used mitochondrial division inhibitor 1 (mdivi-1), a selective inhibitor of mitochondrial fission protein dynamin-related protein1 (Drp1), to suppress mitochondrial fission in epileptic model of rats in vivo. We found that mitochondrial fission was increased after seizures and inhibition of mitochondrial fission by mdivi-1 significantly attenuated the oxidative stress and reduced neuronal loss after seizures, shown by the decreased 8-hydroxy deoxyguanosine (8-oHdG) content, the increased superoxide dismutase SOD activity, the reduced expression of cytochrome c and caspase3 and the increased surviving neurons in hippocampus. These results indicated that mitochondrial fission is up-regulated after seizures and inhibition of mitochondrial fission is protective against neuronal injury in seizures, the underlying mechanism may be through the mitochondria/ROS/cytochrome c pathway. (...)

Study Supports Link Between Stress, Epileptic Seizures (Studien Støtter sammenheng mellom stress, epileptiske anfall)
hon.ch 4.12.2012
Stress activated brain response for some patients in preliminary research

TUESDAY, Dec. 4 (HealthDay News) -- Scientists have long thought that stress plays a role in epileptic seizures, and new evidence suggests that epilepsy patients who believe this is the case experience a different brain response when faced with a nerve-wracking situation.

Researchers from the University of Cincinnati performed functional MRI brain scans during a stressful math exercise on 16 epilepsy patients who pegged stress as a factor in their seizure control and seven patients who did not. While both groups performed similarly on the test, those who perceived stress to have an impact on their epilepsy showed greater brain activation than the others during intimidating parts of the test. (...)

The adverse effects of antiepileptic drugs differ in patients with migraine
Lancet Neurology 2012:935(11):935 (November 2012)
We read with great interest the Review by Perucca and Gilliam1 addressing the adverse effects of antiepileptic drugs associated with the treatment of epilepsy. We agree that adverse effects often stand in the way of an acceptable treatment outcome and that systematic screening for adverse effects improves outcomes for patients, as has now been shown in different settings.2, 3 However, some antiepileptic drugs—eg, topiramate—are more often used for other indications, such as the prophylactic treatment of migraine. It is therefore important to consider the differences in drug tolerance between patients with epilepsy and those with migraine.

After systematically reviewing all published randomised controlled trials of topiramate monotherapy in epilepsy and migraine,4 we concluded that, when treated with the same doses of topiramate, patients with migraine have different adverse effects than do those with epilepsy, and are more likely to drop out from a trial because of these effects. We think that patients with migraine should be considered a population at risk for adverse effects of antiepileptic drugs and that it could be useful to investigate whether recommended strategies to reduce the burden of adverse effects in patients with epilepsy also apply to those with migraine.

Possible explanations for this reduced tolerance in patients with migraine might be increased sensitivity of the brain to central nervous effects of drugs (eg, fatigue or nausea) or poor therapeutic gain with prophylactic drugs. About 70% of patients with epilepsy who use antiepileptic drugs achieve complete remission from seizures, whereas 50% of those with migraine achieve at best a 50% reduction in number of attacks, with only few complete responders.5 Patients with epilepsy are more likely to adhere to antiepileptic drugs and to achieve complete remission without unacceptable adverse effects than those with migraine. (...)

Effect of valproic acid on mitochondrial epigenetics
Eur J Pharmacol. 2012 Jun 20. [Epub ahead of print]
Abstract Valproic acid (valproate), an anticonvulsant and a mood stabilizer, is a potent histone deacetylase inhibitor and a widely utilized pharmacological tool for neuroepigenetic research including DNA methylation. However, only nuclear but not mitochondrial DNA (mtDNA) has been investigated for the effects of valproate on the formation of 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC). Using mouse 3T3-L1 cells, we investigated the effects of short (1 day) and prolonged (3 day) valproate treatment on global mtDNA 5mC content, global and mtDNA sequence-specific 5hmC content, mRNA levels for ten-eleven-translocation (TET) enzymes involved in 5hmC formation, and the mitochondrial content of TET proteins. Only 5hmC but not 5mC content in mtDNA was affected (decreased) by valproate, and only after the prolonged treatment. This action of valproate was mimicked by MS-275, a class I histone deacetylase inhibitor. The prolonged but not the short valproate treatment decreased the expression of Tet1 mRNA and reduced the mitochondrial content of the TET1 protein. Hence, a likely scenario for a valproate-induced 5hmC decrease in mtDNA may involve nuclear histone deacetylase inhibition (mitochondria do not contain histones) causing the initial increase of Tet1 transcription, which is followed by a delayed compensatory decrease of Tet1 expression and a reduced presence of TET1 protein in mitochondria. Further research is needed to elucidate the functional implications of epigenetic modifications of mtDNA. The observed effects of valproate on mitochondrial epigenetics may have implications for a better understanding of both therapeutic and unwanted effects of this drug and possibly other histone deacetylase inhibitors. (...)

New Epilepsy Tactic: Fight Inflammation
nytimes.com 5.6.2012
In November 2008, when he was just 6, William Moller had his first epileptic seizure, during a reading class at school. For about 20 seconds, he simply froze in place, as if someone had pressed a pause button. He could not respond to his teacher.

This is known as an absence seizure, and over the next year William, now 10, who lives with his family in Brooklyn, went from having one or two a day to suffering constant seizures. Not all were absence seizures; others were frightening tonic-clonics, also known as grand mals, during which he lost consciousness and convulsed.

The seizures often came while he was eating. As his body went rigid, William dropped his food and his eyes rolled back into their sockets. If he seized while standing, he suddenly crashed to the ground — in a corridor, in the driveway, on the stairs. (...)

Lundbeck trækkes i retten over bivirkning ved nyt lægemiddel
medwatch.dk.com 19.4.2012
(...) Lundbeck trækkes få måneder efter lanceringen af epilepsimedicinen Onfi i retten i USA på grund af påståede alvorlige bivirkninger ved lægemidlet. Det fremgår af Courthouse News Service.

Onfi bruges til behandling af epilepsiformen Lennox Gastaut-syndrom, og en niårig dreng er angiveligt blevet ramt af alvorlige og sjældne hudreaktioner kaldet Steven Johnson Syndrom, SJS, og Toksisk Epidermal Nekrolyse, TEN. Drengen er efterfølgende blevet blind og alvorligt vansiret. Reaktionen viste sig få uger efter behandlingen med Onfi blev indledt.

Bestemte typer af medicin kan udløse sådanne reaktioner, og det er også en kendt, men meget sjælden bivirkning ved Onfi, oplyser pressemedarbejder i Lundbeck Simon Augustesen til Ritzau Finans. (...)

Lamotrigine-induced toxic epidermal necrolysis in a young epileptic
BMJ Case Reports 2011
Unexpected outcome (positive or negative) including adverse drug reactions

Summary A 20-year-old young female presented with extensive skin rashes with bullae and extensive epidermal necrolysis about 20 days after the addition of lamotrigine (LTG) to her anticonvulsant medication. The patient was managed by stopping LTG and supportive treatment. The seizures were controlled with increase in the doses of carbamazepine. The report emphasises exercising of caution once LTG is added to a regimen containing valproic acid. (...)

(Anm: Lamictal (lamotrigine) Tablets (fda.gov).)

Epilepsi hos mor gir ADHD-risiko
nrk.no 5.4.2012
ØKT RISIKO: Barn av mødre med epilepsi har større risiko for å få ADHD.

Epilepsi hos mor gir økt risiko for ADHD hos barn, viser ny forskning.

Mødre med epilepsi får oftere barn med ADHD enn det som er normalt, fastslår forskning ved Universitetet i Bergen.

Forsker Anne Halmøy ved Institutt for biomedisin la nylig fram sin konklusjon, og artikkelen er publisert i tidsskriftet Biological Psychiatry, skriver Dagens Medisin.

1,7 ganger høyere risiko
Ifølge Halmøy er risikoen for at mødre med epilepsi skal få barn med ADHD 1,7 ganger høyere enn for andre mødre.

Studien viser imidlertid ikke hvordan epilepsi hos mor og ADHD hos barnet henger sammen. (...)

Epilepsy Leads to More Brain Abnormalities Over Time
news.yahoo.com 4.4.2012
TUESDAY, April 3 (HealthDay News) -- Aging accelerates brain-structure abnormalities in people with childhood-onset temporal-lobe epilepsy, a new study says.

Temporal-lobe epilepsy is the most common type of partial epilepsy, with about 60 percent of all epilepsy patients having this form of the disease.

Previous research suggests that people with childhood-onset epilepsy have significant mental and developmental problems that continue into adulthood, particularly in those who don't respond to seizure medications.

Prior studies also have found that patients with temporal-lobe epilepsy have structural abnormalities in many areas of the brain. But there is limited knowledge about how aging affects these abnormalities.

In the study, researchers from the University of Wisconsin-Madison used MRI to examine the brains of 55 patients with chronic temporal-lobe epilepsy and 53 people without epilepsy. The participants were aged 14 to 60.

The brain scans revealed that the epilepsy patients had more brain-structure abnormalities than healthy people, and that these abnormalities were more extensive in older epilepsy patients.

"Patients with epilepsy are burdened with significant neurodevelopmental challenges due to these cumulative brain abnormalities," Bruce Hermann, professor of neuropsychology at the University of Wisconsin-Madison, said in a news release. "The consequences of these anatomical changes for epilepsy patients as they progress into elder years remain unknown, and further study of the adverse effects in those of older chronological age is needed."

The study appears in the journal Epilepsia. (...)

Autoimmune Epilepsy
Arch Neurol. 2012 (Published online March 26, 2012)
Clinical Characteristics and Response to Immunotherapy

Objective To describe clinical characteristics and immunotherapy responses in patients with autoimmune epilepsy.

Design Observational, retrospective case series.

Setting Mayo Clinic Health System.

Patients Thirty-two patients with an exclusive (n = 11) or predominant (n = 21) seizure presentation in whom an autoimmune etiology was suspected (on the basis of neural autoantibody [91%], inflammatory cerebrospinal fluid [31%], or magnetic resonance imaging suggesting inflammation [63%]) were studied. All had partial seizures: 81% had failed treatment with 2 or more antiepileptic drugs and had daily seizures and 38% had seizure semiologies that were multifocal or changed with time. Head magnetic resonance imaging was normal in 15 (47%) at onset. Electroencephalogram abnormalities included interictal epileptiform discharges in 20; electrographic seizures in 15; and focal slowing in 13. Neural autoantibodies included voltage-gated potassium channel complex in 56% (leucine-rich, glioma-inactivated 1 specific, 14; contactin-associated proteinlike 2 specific, 1); glutamic acid decarboxylase 65 in 22%; collapsin response-mediator protein 5 in 6%; and Ma2, N-methyl-D-aspartate receptor, and ganglionic acetylcholine receptor in 1 patient each.
Intervention Immunotherapy with intravenous methylprednisolone; intravenous immune globulin; and combinations of intravenous methylprednisolone, intravenous immune globulin, plasmapheresis, or cyclophosphamide.

Main Outcome Measure Seizure frequency.

Results After a median interval of 17 months (range, 3-72 months), 22 of 27 (81%) reported improvement postimmunotherapy; 18 were seizure free. The median time from seizure onset to initiating immunotherapy was 4 months for responders and 22 months for nonresponders (P < .05). All voltage-gated potassium channel complex antibody–positive patients reported initial or lasting benefit (P < .05). One voltage-gated potassium channel complex antibody–positive patient was seizure free after thyroid cancer resection; another responded to antiepileptic drug change alone.

Conclusion When clinical and serological clues suggest an autoimmune basis for medically intractable epilepsy, early-initiated immunotherapy may improve seizure outcome. (...)

Rått kjøtt kan gi fosteret epilepsi
nrk.no 9.3.2012
Årlig fødes om lag 3 av 10.000 norske barn med toxoplasmose, en parasitt som kan gi livsvarige plager.

Svekket syn, hjerneskade og epilepsi er noen av bivirkningene fosteret kan få, hvis du som gravid spiser upasteuriserte oster eller rått kjøtt. (...)

Mortality after temporal lobe epilepsy surgery
Epilepsia. 2012 Feb;53(2):267-71
Purpose:  To report mortality, after a longer interval, in a cohort of patients with drug-resistant epilepsy treated by temporal lobe surgery between 1975 and 1995. A previous audit of these patients ending December 1, 1997 observed a standardized mortality ratio (SMR) of 4.5. Methods:  We analyzed mortality in a cohort of 306 patients with temporal lobe epilepsy (TLE) who underwent temporal lobe resections between December 1, 1975 and December 1, 1995. Deaths occurring after December 1,1997 and until December 1, 2009 were evaluated. Medical records, death certificates, postmortem examination reports, coroner officer's reports, and coroner's inquest reports were sought, and causes of death were ascertained. Sudden unexpected death in epilepsy (SUDEP) cases were identified. Key Findings:  In 3,569 person-years of follow-up 19 deaths occurred, [SMR 2.00, 95% confidence interval (CI) 1.27-3.13], 14 men (SMR 2.01, 95% CI 1.19-3.39) and 5 women (SMR 1.68, 95% CI 0.70-4.03). On analysis of subgroups, SMRs were significantly elevated in patients with mesial temporal sclerosis (MTS) (SMR 2.50, 95% CI 1.38-4.51), men with MTS (SMR 3.12, 95% CI 1.56-6.25), men with nonspecific lesions (SMR 2.68, 95% CI 1.00-7.09), and right-sided resections in MTS (SMR 3.33, 95% CI 1.39-8.00). During follow-up, six SUDEP cases were observed with a rate of 1/595 person-years. Significance:  In this cohort, the risk for premature death in patients undergoing TLE surgery decreased over time but remained above the standard population. Men had a slightly higher risk than women, as did right-sided resections in MTS, confirming this observation in the original cohort. Although lower, the risk of SUDEP remained. Without up-to-date information on seizure outcome, we were unable to directly relate this to mortality. (...)

Parasitter i hjernen giver epilepsi
videnskab.dk 30.1.2012
Når stadier af svine-tinte-bændelorm havner i menneskets hjerne, kan det give epilepsi, men både parasitten og dens følgesygdom kan bekæmpes.

Æg fra bændelorm findes i menneskers afføring, bl.a. i naturen i Afrika. Via svin havner de i maven hos mennesker og går derfra videre i hjernen, hvor de skaber epilepsi.

Isabel er 21 år og vokset op på landet uden for Maputo i Mozambique. Hun er en køn kvinde, har gået seks år i skole og kommer fra en god familie.

lligevel er hendes chancer for at blive gift og få børn meget små.

Hun har nemlig epilepsi.

Epilepsi stammer fra afføring
Isabels epilepsi skyldes, at hun har spist afføring, der stammer fra familie, naboer eller venner. Det lyder ulækkert, men er sandt.

Hun har fået tinter (cyster) i hjernen, fordi hun har spist æg fra en bændelorm, som en anden person har udskilt med afføringen.

I Isabels landsby er der ingen fine vandskyldende toiletter, og de latriner, der findes, bliver ikke brugt af alle. Isabel og de andre landsbybeboere går bag en busk, når de bliver trængende, mens de arbejder i marken eller er på vej til markedet eller skolen.

Derfor findes bændelormens æg i miljøet parat til at blive spist af et svin eller et menneske. Når bændelormens æg udvikler sig i menneskets eller svinets krop, får de sygdommen cysticercosis. (...)

Måling av lamotriginkonsentrasjon i blod
Tidsskr Nor Legeforen 2011; 131:1732 (20.9.2011)
Bruk av kombinerte p-piller kan føre til at serumkonsentrasjonen av lamotrigin faller. Det samme skjer under svangerskap. Det er stor interindividuell variasjon i farmakokinetikk.

Lamotrigin (LTG) er det mest brukte antiepileptikum i Norge. Midlet brukes også ved behandling av psykiske lidelser. Ved bruk viser lamotrigin betydelig farmakokinetisk variasjon mellom individer. Dette kan skyldes sykdom, interaksjoner med andre legemidler, aldersavhengige forskjeller i metabolsk kapasitet eller hormonell påvirkning. Gjennom en serie kliniske studier og databaseanalyser har Arne Reimers identifisert og beskrevet disse faktorene og hvordan de påvirker farmakokinetikken til lamotrigin.

- Avhandlingen viser at de fleste psykofarmaka trygt kan kombineres med lamotrigin. Men vi ser at etinyløstradiolet i p-piller reduserer lamotriginserumkonsentrasjonen med over 50 %. Dette kan føre til tap av anfallskontroll og behov for å øke lamotrigindosen. P-piller som kun inneholder et progestin, innvirker ikke på lamotriginet. Det er flest kvinner som bruker lamotrigin, derfor er dette så viktig, sier Reimers. (...)

(Anm: lamotrigine (Lamictal) (dailymed.nlm.nih.gov).)

Sudden Death in Epilepsy Plunges With Drug Treatment (Plutselig død ved epilepsi redusert med legemiddelbehandling)
medpagetoday.com 18.9.2011
Epilepsy patients with previously uncontrolled seizures have a much lower rate of sudden death if they are given adjunctive anti-epilepsy drugs, a meta-analysis has found.

In an examination of 112 trials, the odds ratio for sudden unexpected death (SUDEP) in patients randomly assigned to anti-epileptic drugs (AEDs) at efficacious doses versus those assigned to placebo was 0.17 (95% CI 0.05 to 0.57, P=0·0046), Philippe Ryvlin, MD, of Hospices Civils de Lyon in France, and colleagues reported online in The Lancet Neurology. (...)

The authors disclosed that their study had no outside funding. Ryvlin reported financial links with Pfizer, GlaxoSmithKline, UCB Pharma, Eisai, and BIAL. A co-author reported links with Pfizer and UCB Pharma.

Editorialist Hesdorffer reported links with UCB Pharma, GlaxoSmithKline, and Pfizer. Editorialist Tomson reported links with Eisai, GlaxoSmithKline, Janssen-Cilag, Novartis, sanofi-aventis, Pfizer, and UCB Pharma. (...)

NINDS Dravet Syndrome Information Page
ninds.nih.gov (Last updated November 09, 2010)
What is Dravet Syndrome?
Dravet syndrome, also called severe myoclonic epilepsy of infancy (SMEI), is a severe form of epilepsy. It appears during the first year of life with frequent febrile seizures – fever-related seizures that, by definition, are rare beyond age 5. Later, other types of seizures typically arise, including myoclonus (involuntary muscle spasms). Status epilepticus – a state of continuous seizure requiring emergency medical care – also may occur. Children with Dravet syndrome typically experience poor development of language and motor skills, hyperactivity, and difficulty relating to others.

In 30 to 80 percent of cases, Dravet syndrome is caused by defects in a gene required for the proper function of brain cells. Borderline SMEI (SMEB) and another type of infant-onset epilepsy called generalized epilepsy with febrile seizures plus (GEFS+) are caused by defects in the same gene. In GEFS+, febrile seizures may persist beyond age 5. (...)

Valproate Products: Drug Safety Communication - Risk of Impaired Cognitive Development in Children Exposed In Utero (During Pregnancy)
fda.gov 30.6.2011
Including valproate sodium (Depacon), divalproex sodium (Depakote, Depakote CP, and Depakote ER), valproic acid (Depakene and Stavzor), and their generics

ISSUE: FDA notified healthcare professionals that children born to mothers who take the anti-seizure medication valproate sodium or related products (valproic acid and divalproex sodium) during pregnancy have an increased risk of lower cognitive test scores than children exposed to other anti-seizure medications during pregnancy. This conclusion is based on the results of epidemiologic studies that show that children born to mothers who took valproate sodium or related products throughout their pregnancy tend to score lower on cognitive tests (IQ and other tests) than children born to mothers who took other anti-seizure medications during pregnancy. See the Drug Safety Communication for a data summary and additional information. (...)

Fetal Effects of Anticonvulsant Polytherapies
Arch Neurol 2011 (Published online June 13)
Objective To determine the frequency of malformations among infants born to women who had taken lamotrigine or carbamazepine as part of polytherapy during the first trimester of pregnancy. (...)

Conclusions The risk of malformations among infants exposed to lamotrigine and carbamazepine as polytherapy was higher than the corresponding monotherapies only when the polytherapy includes valproate. These findings suggest that counseling for fetal risks from AED polytherapy should be based on the specific drugs included. (...)

Trobalt (retigabin)
irf.dk 29.5.2011 (Institut for Rationel Farmakoterapi (IRF)
Konklusion: Trobalt (retigabin) er et epilepsipræparat med en ny virkningsmekanisme indiceret som tillægsbehandling ved fokale anfald med eller uden sekundær generalisering. Trobalt er godkendt til voksne > 18 år.

I de pivotale studier var der en signifikant dosisafhængig reduktion i antallet af partielle anfald, på henholdsvis 12-18% (600 mg), 24-28% (900 mg) og 33-36% (1200 mg) i forhold til placebo. Alle inkluderede patienter havde haft anfald, der ikke var tilstrækkeligt kontrolleret med 1 til 3 samtidigt administrerede antiepileptika.

Bivirkningerne i CNS er kendte fra andre antiepileptika, er dosisafhængige, og signifikant højere end i placebogruppen ca. 63-81 % mod 48,2% . Herudover har retigabin dosisuafhængig bivirkninger relateret til vandladningen, som urinretention (5 %), hvorfor præparatet skal anvendes med forsigtighed hos patienter med tidligere urinretention. Endvidere bør der udvises forsigtighed ved ordinering af retigabin hos patienter med kendt kardiovaskulærsygdom herunder forlænget QT-interval. Størstedelen af bivirkningerne opstod i de første 8 uger af behandlingen.

Der foreligger kun begrænsede data for sikkerhed og virkning af retigabin hos patienter > 65 år, og det anbefales at reducere start- og vedligeholdelsesdosis hos disse patienter.

IRF vurderer, effekten af Trobalt (retigabin) er sammenlignelig med de øvrige nye antiepileptika godkendt som tillægsbehandling til behandlingsrefraktær epilepsi.

Imidlertid gør omfanget af bivirkninger og især fraværet af en klar sammenhæng mellem dosis og bivirkninger, at Trobalt må ases for mindre gunstigt end de øvrige antiepileptika på markedet. Endvidere er Retigabin ca. 25 % dyrere en den nuværende dyreste tillægsbehandling (Vimpat - lacosamid). Retigabin bør derfor kun anvendes, når andre alternativer ikke har vist tilstrækkelig effekt eller har uacceptable bivirkninger.

Trobalt (retigabin) blev markedsført 16. maj 2011, og der ydes generelt tilskud, udlevering B. (...)

Epilepsy
JAMA. 2011;305(16):1722 (april 27)
The term epilepsy applies to a group of nervous system disorders characterized by recurrent seizures, which are sometimes called convulsions. A seizure occurs when there are abnormal bursts of electrical activity in the brain. Although head trauma, strokes, brain tumors, brain infections, and withdrawal from drugs (including alcohol) can cause seizures, the recurrent seizures of epilepsy are usually idiopathic (of unknown cause). The April 27, 2011, issue of JAMA includes an article about adherence to treatments for epilepsy. This Patient Page is based on one published in the February 4, 2004, issue of JAMA. (...)

Epilepsy Common in Autism
ivanhoe.com 20.4.2011
(Ivanhoe Newswire) -- A new study found that treatment-resistant epilepsy (TRE) is common in idiopathic autism. Early age at the onset of seizures and delayed global development were associated with a higher frequency of resistance to antiepileptic drugs (AEDs).

According to the Centers for Disease Control and Prevention (CDC), autism spectrum disorders (ASDs) are a group of developmental disabilities that can significantly impact social interaction, communication and behavior. The CDC estimates that, on average, 1 in 110 U.S. children has an ASD (which is four-times more likely to develop in boys than in girls). Medical evidence suggests that the prevalence of epilepsy in autism ranges from 7 percent to 46 percent.

Researchers, led by Orrin Devinsky, M.D., Professor of Neurology, Neurosurgery, and Psychiatry at NYU School of Medicine and Director of the NYU Comprehensive Epilepsy Center in New York, reviewed clinical and laboratory data for patients with idiopathic autism who were evaluated at the Center during a 20-year period.

"Treatment-resistant epilepsy is common among patients with autism, and more than one-third of patients in our study group had TRE," Dr. Devinsky was quoted as saying. "Among patients for whom we had complete AED and seizure control data, 55 percent had TRE."

Among the 127 patients with autism and at least one epileptic seizure, 34 percent had TRE and 28 percent were seizure-free. The remaining 39 percent of patients with autism and epilepsy had infrequent seizures or insufficient data to properly categorize them. In patients with TRE, researchers found that seizure onset was at an earlier age than in patients who were seizure-free. TRE patients also had more developmental regression as well as motor and language delays than seizure-free participants. (...)

Seizures May Foreshadow Brain Tumors (Anfall kan varsle om svulster)
ivanhoe.com 11.4.2011
(Ivanhoe Newswire) -- Epileptic seizures may be an indicator of developing brain tumors in the years to come, according to research published online in the Journal of Neurology, Neurosurgery and Psychiatry.

The researchers based their findings off first-time admissions for epilepsy from the Oxford Record Linkage Study (ORLS) from 1963 to 1998 and national Hospital Episode Statistics (HES) data for England from 1999 to 2005.

The data showed the risk for developing a brain tumor from epileptic seizures was greatest among those aged 15 to 44 when first admitted to the hospital. This data was also linked to subsequent diagnoses and deaths from brain tumors.

Those who suffered from epilepsy were also found to be 25-times more likely to develop a cancerous brain tumor and 10-times more likely to develop a non-cancerous tumor over people of the same 15 to 44 age group without epilepsy.

The risk for developing brain tumors persisted for several years following the first admission to the hospital. According to the ORLS data group, the risk was more than six-times as likely up to 14 years later, and within the HES data group, the risk was five-times greater up to seven years later.

However, the researchers note that brain tumors are actually very rare, even among epileptic patients; only occurring, overall, about 1 to 2 percent of the time within 15 to 44 year olds.

“Our study suggests that tumor as an underlying cause for epilepsy may not become apparent for several years after onset and indicates a need for ongoing vigilance,” researchers of the study were quoted as saying. (...)

(Anm: Epilepsy and the subsequent risk of cerebral tumour: record linkage retrospective cohort study. J Neurol Neurosurg Psychiatry 2011 (Published Online First 28 March).)

Epilepsy in autism: features and correlates
The British Journal of Psychiatry (2011) 198: 289-294
Background Epilepsy occurs in a significant minority of individuals with autism, but few long-term follow-up studies have been reported, so the prevalence, features (type of seizures, age at onset and severity, etc.) and correlates (IQ history of regression, family history) have only partially been identified. (...)

Results Epilepsy developed in 22% of participants. In the majority, seizures began after 10 years of age. Generalised tonic–clonic seizures predominated (88%). In over a half (19/33), seizures occurred weekly or less frequently and in the majority of individuals (28/31) they were controlled with the prescription of one to two anticonvulsants. Epilepsy was associated with gender (female), intellectual disability and poorer verbal abilities. Although the presence of epilepsy in the probands was not associated with an increased risk of epilepsy in their relatives, it was associated with the presence of the broader autism phenotype in relatives. This indicates that the familial liability to autism was associated with the risk for epilepsy in the proband.

Conclusions Epilepsy is an important medical complication that develops in individuals with autism. Seizures may first begin in adolescence or adulthood. Putative risk factors for epilepsy in autism were identified and these will require further investigation in future studies. (...)

Epilepsy Increases Risk of Psych Issues in Kids
medpagetoday.com 26.3.2011
Children with epilepsy are more likely than other kids to have psychiatric problems, researchers said, and the risk is greater for girls than boys, researchers found.

In a population-based study, nearly 38% of children with epilepsy had psychiatric symptoms, compared with 17% of those who did not have the condition, according to Kristin Alfstad, MD, of Oslo University Hospital in Oslo, and colleagues.

Girls with epilepsy were more than four times as likely as other girls to have such symptoms, while boys were only twice as likely, they reported online in Epilepsia. (...)

Poor People With Epilepsy More Prone to Uncontrolled Seizures
medicinenet.com 2.3.2011
WEDNESDAY, March 2 (HealthDay News) -- Epilepsy patients who are poor are more likely to have uncontrolled seizures, drug-related side effects, and a lower overall quality of life compared to those with more money, finds a new study.

Poor patients also visit hospital emergency departments more often and have more appointments with a general practitioner, according to lead author Dr. Charles E. Begley, professor of management and health sciences at the University of Texas Health Science Center in Houston, and colleagues. (...)

FDA: Cleft Palate Risk With Seizure Drug in Pregnancy
medpagetoday.com 4.3.2011
Clinicians should be extra cautious about prescribing the epilepsy drug topiramate (Topamax) to women of childbearing age because of a risk of cleft palates and lips in their offspring should they become pregnant, the FDA warned Friday.

"The benefits and the risks of topiramate should be carefully weighed when prescribing this drug for women of childbearing age, particularly when topiramate is considered for a condition not usually associated with permanent injury or death. Appropriate alternative treatment should be considered," the FDA urged.
Topiramate also is approved to prevent migraine headaches, but not to relieve the pain of migraines.

The drug's labeling will be changed to strengthen an existing warning about use during pregnancy. Topiramate had previously been designated as Class C for risk during pregnancy, reflecting a lack of human data.

Based on a new review of clinical information, topiramate will now be labeled as Class D, the FDA said. (...)

Karbamazepin gir moderat økt risiko for ryggmargsbrokk
Tidsskr Nor Legeforen 2011; 131 (4.2.2011)
Eksponering for karbamazepin i første trimester øker risikoen for alvorlige medfødte misdannelser. Nå har en internasjonal forskergruppe undersøkt hvilke spesifikke misdannelser som er assosiert med karbamazepinbruk (BMJ 2010; 341: c6581).

En litteraturgjennomgang ga en prevalens av alvorlig medfødt misdannelse på 3,3 % etter eksponering for karbamazepin i første trimester og identifiserte fem alvorlige medfødte misdannelser. I en pasient-kontroll-studie med over 3,8 millioner fødsler fant forskerne at ryggmargsbrokk var signifikant assosiert med eksponering for karbamazepinmonoterapi, sammenliknet med ingen bruk av antiepileptika. Men risikoen var signifikant lavere enn for valproat. Økt risiko for de andre fire misdannelsene ble ikke bekreftet i datamaterialet. (...)

Epilepsy Drug Dose Dictates Cognitive Effects
medpagetoday.com 12.1.2011
Use of the antiepileptic drug topiramate (Topamax, Topiragen) can impair cognition, and this cognitive impact is dose-dependent, affecting 35% of patients at the highest dose tested, researchers found.

The number needed to treat at the maximum 384-mg dose to see cognitive side effects in one patient was just 3.3.

The number needed to harm was 15.1 at the 64 mg dose, 32.6 at 96 mg, 10.7 at 192 mg, and 3.3 at the 384 mg dose, David W. Loring, PhD, of Emory University in Atlanta, and colleagues reported in the Jan. 11 issue of Neurology. (...)

Quality Of Life In Children With Epilepsy Adversely Affected By Maternal Depression
medicalnewstoday.com 6.1.2011
A study by Canadian researchers examined the prevalence of maternal depression and its impact on children newly diagnosed with epilepsy. Prevalence of depression in mothers ranged from 30%-38% within the first 24 months following a child's epilepsy diagnosis. The mother's depressive symptoms negatively impacted the child's health-related quality of life, but the effects were moderated by the amount of family resources and mediated by how well the family functions and the extent of family demands. Details of this novel study appear online in Epilepsia, a journal published by Wiley-Blackwell on behalf of the International League Against Epilepsy.

A report from the World Health Organization (WHO) estimates that depression affects 121 million people worldwide. One significant source of stress for parents is caring for a child with a chronic illness, such as epilepsy. Prior studies have shown that families of a child with epilepsy experience significantly more stress, anxiety, and restrictions in family life. Mothers, in particular, are at greatest risk for psychological distress or depression in response to their child's epilepsy, as they are often the primary caregivers for their children. (...)

Predicting When Epileptic Seizures Will Happen
ivanhoe.com 31.12.2011
(IVANHOE NEWSWIRE) -- Epileptic seizures continue to leave scientists at a medical stalemate. Although the causes of epileptic seizures are still unknown, scientists have been exploring how changes in the coordinated activity of brain networks, as monitored through electrodes, might help predict impending seizures. (...)

Surprisingly, Kuhnert and her colleagues found much more regularization of brain network activity at night. Previously, such regularization has been seen in healthy individuals, but never in epilepsy patients. "It remains to be investigated whether the increased regularization at night is causally related to epilepsy, whether it requires some treatment, or whether it can be regarded as a seizure-preventing mechanism," Kuhnert concluded.

SOURCE: American Institute of Physics, December 2010 (...)

Dålig långtidsöverlevnad bland barn med epilepsi
dagensmedicin.se 23.12.2010
Personer som drabbas av epilepsi under barndomen har tre gånger ökad risk för förtida död, enligt en ny studie.

Det är forskare som gjort en 40-årig prospektiv uppföljning av finländare som drabbats av epilepsi under barndomen.

Under perioden inträffade totalt 60 dödsfall bland de 245 deltagarna. Denna siffra motsvarade en trefaldigt ökad dödsrisk jämfört med normalbefolkningen.

Den ökade risken för förtida död var särskilt tydlig bland individer som inte blivit kvitt symtomen.

(Anm: Long-Term Mortality in Childhood-Onset Epilepsy. New England Journal of Medicine 2010; 363: 2522–2529.)

FDA wants more data on Valeant-Glaxo epilepsy drug
forbes.com 1.12.2010
NEW YORK -- Valeant Pharmaceuticals International Inc. and GlaxoSmithKline PLC said Wednesday that the Food and Drug Administration did not approve their epilepsy drug candidate ezogabine.

The companies said the FDA cited "non-clinical reasons" in declining to approve ezogabine. They said they are reviewing the FDA's response to their application, and plan to answer the FDA in early 2011. (...)

Unormale hjernefunn etter legemiddelbruk
dagensmedisin.no 30.11.2010
Unormale funn i hjernen og bevegelsesforstyrrelser er rapportert hos små barn etter bruk av epilepsimedisin. (...)

Sabrilex (vigabatrin) brukes i kombinasjonsbehandling ved visse typer epilepsi samt i behandling av infantile spasmer (West syndrom). (...)

Sabrilex og unormale funn ved MR-undersøkelser
legemiddelverket.no 19.11.2010
Det er rapportert tilfeller av unormale funn ved MR-undersøkelse av hjernen, spesielt hos spedbarn behandlet med høye doser Sabrilex (vigabatrin). I enkelte tilfeller er det også sette bevegelsesforstyrrelser i forbindelse med disse unormale MR-funnene. Det er ikke rapportert tilfeller i Norge.

Sabrilex (vigabatrin) brukes i kombinasjonsbehandling ved visse typer epilepsi samt i behandling av infantile spasmer (West syndrom). Det er rapportert om tilfeller av unormale funn ved MR-undersøkelser hos spedbarn med infantile spasmer som har vært behandlet med høye doser vigabatrin. Endringene er sett i grå substans i en liten subgruppe pasienter under 3 år. Generelt har endringene vært forbigående og blitt borte når behandlingen avsluttes. I enkelte tilfeller er det også meldt om forbigående bevegelsesforstyrrelser, slik som dystoni, dyskinesi og/eller hypertoni i tilknytning til MR-endringene. Eventuell sammenheng mellom bruk av vigabatrin, MR-endringer og bevegelsesforstyrrelsene er uklar. (...)

Women Taking Certain Epilepsy Drugs Can Safely Breast-Feed, Study Suggests
news.yahoo.com 24.11.2010
WEDNESDAY, Nov. 24 (HealthDay News) -- There's encouraging news for women with epilepsy who want to nurse their babies. Children whose mothers took certain anti-seizure medications while breast-feeding don't appear to suffer any negative cognitive effects by age 3, a new study finds.

The multi-center study looked at nearly 200 children whose mothers took one of four common antiepileptic drugs, and found no difference in IQ levels at age 3 among those who were breast-fed versus formula-fed. (...)

Trial against epilepsy drug manufacturer collapses after legal aid is withdrawn
BMJ 2010; 341:c6384 (10 November)
A High Court action against the multinational drug company Sanofi-Aventis over birth defects in children whose mothers took its anticonvulsant drug sodium valproate (marketed as Epilim) during pregnancy has collapsed just days before trial after legal aid was withdrawn.

The Legal Services Commission for England and Wales is thought to have spent around £3m (€3.5m; $4.8m) over six years funding the case, brought by around 80 families, but has refused funding for the trial, which was due to start on 15 November at the High Court in London.

David Body, head of medical law at the solicitors firm Irwin Mitchell, which acts for the families, said that the withdrawal of funds was “bitterly disappointing” for them. “Without public funding to support the case against this multinational pharmaceutical company, it seems very likely that this claim will have to be discontinued.” (...)

FDA Warns of Seizure Drug's Serious Side Effect
Psychiatric News 45;18:19 2010 (September 17) (American Psychiatric Association)
Lamotrigine, a medication used to treat seizures and bipolar disorder, may cause the serious condition known as aseptic meningitis, especially in the first six weeks of use.

On August 12, the Food and Drug Administration (FDA) warned that the medication lamotrigine (Lamictal), which has been approved to treat seizures and bipolar disorder, can cause aseptic meningitis.

Aseptic meningitis is an inflammation of the protective membranes that cover the brain and spinal cord. It is known to have a number of causes—among them are viruses, toxic agents, some vaccines, autoimmune diseases, and certain medications, including lamotrigine. (...)

Metabolic acidosis and generalized seizures secondary to citalopram overdose: a case report. (Metabolsk acidose og generaliserte epileptiske anfall sekundært ved overdose av citalopram: en caserapport)
J Clin Pharm Ther. 2010 Aug 1;35(4):479-82.
Selective serotonin re-uptake inhibitors (SSRIs) are widely used in the community for treating many forms of mental illnesses. Citalopram, a newer generation SSRI, is commonly prescribed, but despite its low toxicity profile has a potential to cause seizures and dysarrythmias in overdose. Data on citalopram overdose-induced metabolic acidosis are scarce. There have been only three cases of metabolic acidosis reported in the literature due to citalopram overdose in humans and we are reporting the fourth one. We report a case of citalopram overdose with metabolic acidosis and generalized seizure. To our best knowledge, this is the first case reported in Saudi Arabia. (...)

(Anm: metabolic acidosis; metabolsk acidose; syreopphoping pga sure stoffskifterestar; jf ketoacidose, mjølkesyreacidose; metabolsk acidose er også ein del av uremitilstanden; jf anion gap. EN metabolic acidosis. Kilde: Norsk medisinsk ordbok.)

(Anm: Metabolsk acidose er når syrebase-balansen (pH-nivået) i kroppsvæsken er for surt. Dette fenomenet ses særlig hos diabetikere og personer med nyresvikt. Endringer i bikarbonat-konsentrasjonen (base, alkali) er den primære årsaken til denne forstyrrelsen1,2. Normalt skal kroppsvæskene ha et pH-nivå på ca. 7,4. Ved høyere verdier (f.eks. 7,6) foreligger alkalose og ved lavere verdier (f.eks. 7,2) foreligger acidose. Metabolsk acidose skyldes at ulike kjemiske prosesser i kroppen medfører opphopning av syre. Manglende utlufting av avfallsgassen CO2 via lungene, gir også acidose, men da kalles det respiratorisk acidose, det vil si at årsaken er sviktende lungefunksjon. (nmi.no).)

(Anm: Cipralex (Lexapro) (escitalopram) - Cipramil (Celexa) (cipramil) (citalopram) - H. Lundbeck A/S (mintankesmie.no).)

(Anm: Autophagic Clearance of Mitochondria in the Kidney Copes with Metabolic Acidosis. J Am Soc Nephrol. 2014 Apr 3. [Epub ahead of print].)

(Anm: Mitochondria: a new therapeutic target in chronic kidney disease. Nutr Metab (Lond). 2015 Nov 25;12:49.) (PDF)

(Anm: Chronic kidney disease may cause diabetes. A team from the University of Montreal Hospital Research Centre (CRCHUM) has discovered a novel link between chronic kidney disease and diabetes. When kidneys fail, urea that builds up in the blood can cause diabetes, concludes a study published today in the Journal of Clinical Investigation. (medicalnewstoday.com 16.8.2016).)

Care of epilepsy patients in Europe has serious gaps, says expert report
BMJ 2010; 341:c4756 (1 September)
Epilepsy care in Europe is seriously under-resourced, a new expert report says, and treatment for many of the estimated six million people affected by the neurological disorder should be scaled up urgently. It also concludes that policies to reduce the social stigma and discrimination faced by people with epilepsy need to be implemented.

Up to 40% of people with the condition in Europe may still be untreated, it says, even though effective, low cost treatment is available.

The report, by the World Health Organization, the International Bureau for Epilepsy, and the International League Against Epilepsy, says that if the illness is properly treated up to 70% of people with it could live productive lives free of seizures. (...)

Epilepsy in the WHO European Region: Fostering Epilepsy Care in Europe is at www.ibe-epilepsy.org/news/european-epilepsy-report. (...)

FDA Warns of Meningitis Linked to Lamotrigine (FDA advarer mot at Lamictal (lamotrigine) er linket til hjernehinnebetennelse (meningitis))
medpagetoday.com 12.8.2010
The antiepileptic drug lamotrigine (Lamictal), also approved for maintenance therapy in bipolar disorder, can cause aseptic meningitis, the FDA warned


The agency said it had identified 40 cases in children and adults taking the drug from 1994 to 2009.

It recommended that healthcare professionals consider discontinuing lamotrigine in patients showing signs of meningitis, though patients should first be evaluated for other potential causes.

Symptoms in the 40 cases included headache, fever, nausea, vomiting, nuchal rigidity, rash, photophobia, and myalgias, starting from one to 42 days after initiating lamotrigine therapy (mean 16 days). In 35 cases, the patients had to be hospitalized. (...)

Brain Injury May Raise Soldier's Epilepsy Risk
drugs.com 20.7.2010
TUESDAY, July 20 -- A wartime brain injury may increase a soldier's risk of epilepsy even years later, a new study finds.

"Not only do combat veterans with a penetrating traumatic brain injury have high rates of epilepsy, but the development of epilepsy can occur decades after their lesion," said lead researcher Jordan Grafman, a senior investigator at the U.S. National Institute of Neurological Disorders and Stroke.

And for those whose epilepsy develops soon after their brain injury, the seizures can become more severe as time passes, Grafman said. (...)

Valproic Acid Monotherapy in Pregnancy and Major Congenital Malformations
NEJM 2010;362(23):2185-2193 (June 10)
Background The use of valproic acid in the first trimester of pregnancy is associated with an increased risk of spina bifida, but data on the risks of other congenital malformations are limited. (...)

Conclusions The use of valproic acid monotherapy in the first trimester was associated with significantly increased risks of several congenital malformations, as compared with no use of antiepileptic drugs or with use of other antiepileptic drugs. (...)

Skader etter krampeanfall
Tidsskr Nor Legeforen 2010; 130:1155 (3.6.2010)
Anfallsrelaterte skader er en av epilepsiens mange og kjedelige komplikasjoner. Epileptiske anfall kan gi direkte skader som følge av sterke muskelkontraksjoner under generaliserte toniske eller tonisk-kloniske anfall, eller føre til indirekte skader som følge av fall eller ulykker forårsaket av anfallet.

En europeisk multisenterstudie viste at 25 % av alle uhell hos epilepsipasienter var anfallsrelaterte. De vanligste følgene var hodeskader, sårskader, brudd og hudavskrapninger – i den rekkefølgen (1). Nakken & Lossius rapporterte at 32 % av multifunksjonshemmede pasienter med epilepsi opplevde anfallsrelaterte skader i løpet av 13 måneder (2). (...)

(Anm: Førstegangs generalisert tonisk-klonisk krampeanfall. BAKGRUNN Førstegangs generalisert tonisk-klonisk krampeanfall er en hyppig årsak til akuttinnleggelse. Hensikten med denne artikkelen er å gi en oversikt over epidemiologi, etiologi, utredning og behandling av slike anfall. (…) FORTOLKNING Pasienter med førstegangs generalisert tonisk-klonisk krampeanfall er en heterogen gruppe. Grundig utredning er nødvendig for å kunne skreddersy behandlingen og redegjøre for prognosen.Tidsskr Nor Legeforen 2015; 135:1256 – 8 (11.8.2015).)

(Anm: Serotonin i hjerne og blod (mintankesmie.no).)

(Anm: Serotonin syndrom (SS), kramper, parkinsonisme osv. (forhøyet kroppstemperatur) (mintankesmie.no).)

AAN: Epilepsy a Special Problem in Nursing Homes
medpagetoday.com 17.4.2010
TORONTO -- Blood levels of epilepsy drugs in nursing home residents can fluctuate wildly for no apparent reason, a researcher said here.

Serum concentrations of carbamazepine within individual patients varied from one measurement to the next by as much as 260%, and valproate levels showed swings of up to 460%, according Ilo Leppik, MD, of the University of Minnesota.

He reported the findings of a study of 44 nursing home residents at the American Academy of Neurology annual meeting. (...)

Leppik said that typically just increases the variability.

In the study he reported here, blood levels were measured repeatedly (mean 6.0, SD 3.2 for carbamazepine; 5.4, SD 2.5, for valproate) over a period of at least six months in patients on stable drug doses. (...)

(Anm: Variability of total phenytoin serum concentrations within elderly nursing home residents. Neurology 2003;60:555-559.)

Missing DNA Linked to Wide Range of Epilepsy Disorders
businessweek.com 15.4.2010
THURSDAY, April 15 (HealthDay News) -- People who are missing large chunks of DNA on chromosome 16 have a greatly increased risk for developing epilepsy, researchers say.

"We found that the presence of this genetic variant is one of the strongest risk factors for all forms of epilepsy, possibly accounting for as many as 300,000 cases of epilepsy worldwide," lead researcher Erin Heinzen, an assistant professor at the Center for Human Genome Variation at Duke University Medical Center, said in a news release from the center.

The researchers compared DNA from 3,800 people with epilepsy with DNA from 1,300 healthy people and found that 23 of those with epilepsy had deletions on chromosome 16 at 16p13.11. No such DNA deletions were found in healthy people, according to a report on the research, published online in the American Journal of Human Genetics. (...)

Gene Mutation Ups Risk of Sudden Death in People with Epilepsy
drugs.com 14.4.2010
WEDNESDAY, April 14 -- A mutation in a gene called Kv1.1 appears to be associated with irregular heart beat and sudden death in people with epilepsy, a new study finds.

People with epilepsy who are otherwise healthy are 10 times more likely than normal to die suddenly and unexpectedly. It's long been suspected that the abnormal ion channels in cells that cause epilepsy also increase the risk of sudden death by affecting the heart.

Ion channels are proteins involved in nerve cell communication. In humans, the potassium ion channel Kv1.1 helps regulate electrical signals in the brain. Mutation of the gene for Kv1.1 has been associated with spontaneous seizures, abnormal muscle movement, and problems with motor coordination. This new study found that mutation of the Kv1.1 gene also affects heart function. (...)

The findings, published in the April 14 issue of The Journal of Neuroscience, could lead to better treatments for at-risk patients, the researchers said. (...)

Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy
NEJM 2010;362(9):790-799 (March 4)
Background Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine. The most efficacious and tolerable initial empirical treatment has not been defined. (...)

Conclusions Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects. (ClinicalTrials.gov number, NCT00088452 [ClinicalTrials.gov] .) (...)

Valproate Sodium and Birth Defects
fda.gov 4.3.2010
FDA is reminding healthcare professionals and patients about an increased risk of birth defects in infants whose mothers took valproate sodium and related products during pregnancy. These drugs, which are used to treat epilepsy, bipolar disorder and migraine headaches, include valproate sodium, valproic acid and divalproex sodium. They are marketed as Depacon (valproate sodium injection), Depakene (valproic acid), Stavzor (valproic acid), and Depakote (divalproex sodium).

Valproate has been associated with neural tube defects and craniofacial defects, as well as cardiovascular and other malformations. These kinds of malformations occur almost four times more frequently in babies born to women with epilepsy who took valproate during pregnancy than in babies born to women with epilepsy who used other anti-epileptic drugs. (...)

Seizure risk associated with neuroactive drugs: Data from the WHO adverse drug reactions database.
Seizure. 2009 Dec 23. [Epub ahead of print]
PURPOSE: To explore the association between the use of neuroactive drugs and reports of epileptic seizures. (...)

CONCLUSIONS: Based on the reports in VigiBase, ADR reports relating to antidepressants, antipsychotic and cholinomimetic drugs included seizures more often than other neuroactive drugs. (...)

SSRIs May Prolong Seizure Duration but Shorten Post-Seizure Depression in Patients With Epilepsy: Presented at AES
docguide.com 6.12.2009
BOSTON -- December 6, 2009 -- Use of selective serotonin reuptake inhibitors (SSRIs) appears to be associated with longer seizures in patients with epilepsy, confounding basic science results suggesting SSRIs reduce the frequency of epileptic seizures in animal models, according to a study presented here at the American Epilepsy Society (AES) 63rd Annual Meeting.

"What we found was not necessarily a causal relationship, but an association, between SSRI use and longer seizures," study presenter Eugen Trinka, MD, MSc, Innsbruck Medical University, Innsbruck, Austria. "Based on our study, we cannot conclude that SSRIs prolong seizures." However, "doctors should use caution in using SSRIs in patients with epilepsy," Dr. Trinka added during his poster presentation held on December 5. (...)

Valproate Sodium and related products (valproic acid and divalproex sodium): Risk of Birth Defects
fda.gov 3.12.2009
(...) [Posted 12/03/2009] The FDA notified health care professionals and patients about the increased risk of neural tube defects and other major birth defects, such as craniofacial defects and cardiovascular malformations, in babies exposed to valproate sodium and related products (valproic acid and divalproex sodium) during pregnancy. Healthcare practitioners should inform women of childbearing potential about these risks, and consider alternative therapies, especially if using valproate to treat migraines or other conditions not usually considered life-threatening. (...)

Epilepsianfall var vanligare bland kvinnor som rökte
dagensmedicin.se 17.11.2009
Personer som röker har en ökad risk att få epileptiska anfall. Men alkohol och kaffe verkar inte ha samma effekt.

Det är slutsatserna i en amerikansk studie som publiceras i dag, onsdag, på tidskriften Epilepsias hemsida.

Undersökningen bygger på data om 116 608 kvinnliga sjuksköterskor i åldrarna 25 till 42 år vilka ingår i den så kallade Nurses Health Study 2.

Deltagarna fick besvara enkätfrågor om livsstil och sjukdomshistoria, inklusive förekomsten av epilepsi och epileptiska anfall. (...)

(Anm: A prospective study of smoking, caffeine, and alcohol as risk factors for seizures or epilepsy in young adult women: Data from the Nurses' Health Study II. Epilepsia. 2009 Aug 19. [Epub ahead of print].)

Epilepsimedicin kan bevara neuroner
sr.se 29.10.2009
Läkemedel som idag används mot epilepsi, kan vara effektiva också mot alzheimer och Parkinsons sjukdom. Vid försök i laboratorium överlevde nervceller längre när de fick epilepsiläkemedlen.

Forskare vid Washington University i Missouri i USA har visat att en viss typ av epilepsiläkemedel gör att hjärnans nervceller överlever längre, åtminstone i laboratorieförsök.

Dessa läkemedel påverkar nervcellers halter av calciumjoner. Signalering med hjälp av calciumjoner är avgörande för nervceller, och om balansen av calciumjoner rubbas kan flera typer av problem uppstå.

Idag finns inga effektiva läkemedel mot åldersrelaterade neurodegenerativa sjukdomar som alzheimer och parkinsons, men försöken visar enligt forskarna att redan existerande läkemedel kan bli grunden för nya behandlingar.

(Anm: Neuroprotective effects of blockers for T-type calcium channels. Molecular Neurodegeneration 2009, 4:44doi:10.1186/1750-1326-4-44 (28 October).)

Epilepsy Drug Raises Risk for Schizophrenia? (Epilepsilegemiddel øker risiko for skizofreni?)
ivanhoe.com 21.10.2009
(Ivanhoe Newswire) -- Georgetown University researchers say common drugs used to treat epilepsy patients may lead to schizophrenia. (...)

Results of the study suggest antiepileptic drug (AED) treatments like phenobarbitol may trigger schizophrenia-like behaviors in its users when given during the brain's developmental period. Animal models that received AEDs during critical periods of brain development showed an increase in such behaviors. (...)

SOURCE: Presented at the 39th Annual Meeting of the Society for Neuroscience, 2009 (...)

Epilepsy in later life
The Lancet Neurology 2009;8(11):1019-1030
Epilepsy is most likely to develop in later life. The burden of this disorder on health-care resources will rise further as the world's population continues to age. Making a secure diagnosis can be challenging because the clinical manifestations of seizures and the differential diagnoses and causes of epilepsy can be different in older individuals compared with younger individuals. Obtaining a reliable account of the events for accurate assessment is particularly important in guiding the appropriate choice and interpretation of investigations to arrive at the correct diagnosis. (...)

Anfall av blått og rødt
forskning.no 30.9.2009
Blinkende blått og rødt gir lettere epilepsianfall enn andre farger, og epileptiske hjerner er mer følsomme for kaos, mener forskere.

Forskere har funnet ut at epileptiske hjerner er mer avhengige av at omgivelsene er velorganiserte. De har også funnet ut at visse blinkende farger har større sjanse for å forårsake anfall.

Studien er publisert i det nettbaserte open access-tidsskriftet PLoS ONE. (...)

Seizures during pregnancy up premature baby risk
reuters.com 10.8.2009
NEW YORK (Reuters Health) - The risk of giving birth to a premature or small infant is increased among women who have seizures while pregnant compared with the general population, researchers in Taiwan report. (...)

Catastrophic Epilepsy Caused by Defect in One Gene ("Katastrofal epilepsi" forårsaket av ett enkelt gen)
healthfinder.gov 8.7.2009
Mouse study led to discovery of mutation and could advance treatments.
WEDNESDAY, July 8 (HealthDay News) -- A mutation in a single gene causes catastrophic epilepsy, U.S. scientists say. And that finding, they say, could lead to treatments or a cure for the disorder.

People with catastrophic epilepsy suffer severe muscle spasms, persistent seizures, mental retardation and sometimes autism.

"At present, there is no proven cure to offer children with this specific epilepsy," Dr. Jeffrey Noebels, a professor of neurology, neuroscience and molecular and human genetics at Baylor College of Medicine in Houston, said in a news release from the college. "We now have new clues into the mechanism and have already initiated studies with a new class of drugs not previously explored for this disorder."

Noebels and his team found that a mutation on a gene called Aristaless-related homeobox (ARX) caused catastrophic epilepsy-like symptoms in mice, including muscle spasms, seizures, learning disabilities and reduced social interaction.

When the researchers examined the brains of mice with the mutated gene, they found that interneurons -- a class of cells that inhibit electrical activity in the brain -- had failed to develop in specific areas of the brain.

Mice with the mutation will be "an essential tool to find a cure for the disorder," said Noebels, who is also director of the Blue Bird Circle Developmental Neurogenetics Laboratory at Baylor.

The study is in the July 8 issue of the Journal of Neuroscience. (...)

(Anm: A Triplet Repeat Expansion Genetic Mouse Model of Infantile Spasms Syndrome, Arx(GCG)10+7, with Interneuronopathy, Spasms in Infancy, Persistent Seizures, and Adult Cognitive and Behavioral Impairment. The Journal of Neuroscience 2009;29(27):8752-8763 (July 8).)

Single Gene Mutation Responsible For 'Catastrophic Epilepsy'
sciencedaily.com 8.7.2009
ScienceDaily (July 8, 2009) — Catastrophic epilepsy – characterized by severe muscle spasms, persistent seizures, mental retardation and sometimes autism – results from a mutation in a single gene, said Baylor College of Medicine researchers in a report that appears in the current issue of the Journal of Neuroscience. (...)

"The new model is an essential tool to find a cure for the disorder," said Noebels.

"Mutation of the ARX gene was previously known to affect interneurons, a class of cells that inhibit electrical activity in the brain," said Dr. Maureen Price, the report's lead author and an instructor in neurology at BCM. (...)

(Anm: A Triplet Repeat Expansion Genetic Mouse Model of Infantile Spasms Syndrome, Arx(GCG)10+7, with Interneuronopathy, Spasms in Infancy, Persistent Seizures, and Adult Cognitive and Behavioral Impairment. The Journal of Neuroscience 2009;29(27):8752-8763 (July 8).)

Avoiding Errors with Lamictal Starter Kits
fda.gov (July 2009)
A recent FDA article describes medication errors that occurred with patients using Lamictal starter kits. Lamictal (lamotrigine) is used to treat epilepsy and bipolar disorder.

The starter kits give patients the recommended initial dose and dose escalation regimen for the first five weeks of treatment. There are three different Lamictal starter kits - orange, blue and green. The titration schedules of these kits vary depending on other medications a patient is taking. Patients must use the right starter kit to avoid over or underdosing. Overdosing a patient could result in ataxia, nystagmus, increased seizures, decreased level of consciousness, coma, and intraventricular conduction delay. Patients who are underdosed may get only limited relief from their epilepsy or bipolar disorder.

Some of the reports say that the wrong kit was dispensed to the patient. Others say the patient administered the product incorrectly. The patients experienced adverse events ranging from sensations of fuzziness and buzzing in the head to Stevens-Johnson Syndrome. (...)

(Anm: Therapeutic approaches for the treatment of Friedreich's ataxia. Expert Rev Neurother. 2014 Aug;14(8):949-57.Epub 2014 Jul 18.)

(Anm: Friedreich's ataxia.The particular genetic mutation (expansion of an intronic GAA triplet repeat in the FXN gene) leads to reduced expression of the mitochondrial protein frataxin. (en.wikipedia.org).)

Evaluating the incidence of leukopenia and neutropenia with valproate, quetiapine, or the combination in children and adolescents.
Ann Pharmacother. 2009 May;43(5):822-30. Epub 2009 Apr 28.
(...) RESULTS: A total of 131 patients were included in the study. Analysis of the laboratory data revealed a combined incidence of neutropenia and/or leukopenia of 44%, 26%, and 6% in the combination group, valproate monotherapy group, and quetiapine monotherapy group, respectively. (...)

CONCLUSIONS: Patients treated with valproate or the combination of valproate and quetiapine should be monitored for the occurrence of leukopenia and neutropenia. Controlled studies are warranted to examine possible pharmacokinetic and pharmacodynamic interactions with the combination of valproate and quetiapine to further evaluate the hematologic findings of this study. (...)

Suicidal Behavior and Ideation and Antiepileptic Drugs
fda.gov 5.5.2009
Manufacturers of antiepileptic drugs (AEDs) or anticonvulsant drugs will update product labeling to include a warning about an increased risk of suicidal thoughts or actions and will develop a Medication Guide to help patients understand this risk. These changes affect all approved AEDs except those indicated only for short-term use. (...)

Pregnant Women With Epilepsy Should Avoid Valproate
healthfinder.gov 27.4.2009
(...) MONDAY, April 27 (HealthDay News) -- Despite recent concerns about fetal malformations linked to the anti-seizure medication valproate, most women with epilepsy can expect to have a relatively uneventful pregnancy with careful planning and preparation, say new guidelines from the American Academy of Neurology.

Whenever possible, women should avoid taking valproate (Depakote) while pregnant, the guidelines state, because its use has been associated with fetal malformations and a decline in cognitive abilities in children whose mothers took the drug during pregnancy.

However, "women with well-controlled epilepsy can safely have children," stressed the lead author of the new guidelines, Dr. Cynthia Harden, director of the epilepsy division at the University of Miami Miller School of Medicine. (...)

Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs
NEJM 360:1597-1605 (April 16)
(...) Conclusions In utero exposure to valproate, as compared with other commonly used antiepileptic drugs, is associated with an increased risk of impaired cognitive function at 3 years of age. This finding supports a recommendation that valproate not be used as a first-choice drug in women of childbearing potential. (...)

Which Drug for the Pregnant Woman with Epilepsy?
NEJM 2009;360:1667-1669 (April 16)
Approximately 25,000 children are born in the United States each year to mothers with epilepsy.1 Most of these women need to continue taking medication during pregnancy, since uncontrolled seizures may be harmful to the women as well as to the fetuses.2 The challenge to physicians is to prescribe a treatment that is effective in controlling seizures but has minimal associated risks. (...)

IQ low in toddlers whose mothers took valproate
reuters.com 16.4.2009
BOSTON (Reuters) - Children born to women who took the epilepsy drug valproate while pregnant had lower IQs at least up to age 3 than the children of women who took rival epilepsy drugs, researchers reported on Wednesday.

The findings add to evidence that the pill is harmful to unborn children. It is sold by Sanofi-Aventis as Epilim and as Depakine in the United States by Abbott Laboratories.

"This finding supports a recommendation that valproate not be used as a first-choice drug in women of childbearing potential," Kimford Meador of Emory University in Atlanta and colleagues wrote in the New England Journal of Medicine. (...)

Food as Medicine: Epilepsy Diet
ivanhoe.com 13.4.2009
ROCHESTER, Minn. (Ivanhoe Newswire) -- More than 320,000 children 15 and under have epilepsy. Many suffer from uncontrolled seizures that make daily life a struggle. Some kids are finding relief not from new medication but from food. Changing his diet helped one little boy change his life. (...)

The borderland of epilepsy: clinical and molecular features of phenomena that mimic epileptic seizures
The Lancet Neurology, Volume 8, Issue 4, Pages 370 - 381, April 2009
Summary
Paroxysmal losses of consciousness and other episodic neurological symptoms have many causes. Distinguishing epileptic from non-epileptic disorders is fundamental to diagnosis, but even this basic dichotomy is often challenging and is certainly not new. In 1907, the British neurologist William Richard Gowers published his book The Border-land of Epilepsy in which he discussed paroxysmal conditions “in the border-land of epilepsy—near it, but not of it” and their clinical differentiation from epilepsy itself. Now, a century later, we revisit the epilepsy borderland, focusing on syncope, migraine, vertigo, parasomnias, and some rarer paroxysmal disorders. For each condition, we review the clinical distinction from epileptic seizures. We then integrate current understanding of the molecular pathophysiology of these disorders into this clinical framework. This analysis shows that, although the clinical manifestations of paroxysmal disorders are highly heterogeneous, striking similarities in molecular pathophysiology are seen among many epileptic and non-epileptic paroxysmal phenomena. (...)

FDA Cites Acid Imbalance With Epilepsy Drug
pharmpro.com 25.2.2009
WASHINGTON (AP) — Federal health officials warned doctors Monday that a drug used in epilepsy patients can cause chemical imbalances in the blood, leading to heart problems and other serious complications.

The Food and Drug Administration said recent data show patients taking the antiseizure pill Zonegran face higher risk of metabolic acidosis, which causes dangerously high levels of acid to accumulate in the blood. The imbalance can cause breathing difficulties, irregular heart rhythms and fatigue.

Left untreated, the condition can do long-term damage to the kidneys and bones and slow growth in children.

FDA advised physicians to monitor patient's blood serum levels while they are taking Zonegran, even if they don't have symptoms. The agency said it will work with drugmakers to add new warning information labels to the drug. (...)

FDA utfärdar varning för epilepsimedel
lakemedelsvarlden.se 24.2.2009
Epilepsiläkemedelet Zonegran kan orsaka metabolisk acidos hos visa patienter. Det skriver det amerikanska läkemedelsverket FDA i ett pressmeddelande.

RISK Det var under måndagen som amerikanska FDA utfärdade en varning för att Zonegran (zonisamid) kan ge upphov till allvarliga metabola biverkningar hos vissa patienter. Varningen kommer efter att FDA gått igenom uppdaterade kliniska data om preparatet. Zonisamid är ett antepileptikum som ges till vuxna som trots annan epilepsibehandling fortfarande får krampanfall. (...)

Information for Healthcare Professionals Zonisamide (marketed as Zonegran, and generics)
fda.gov 23.2.2009
FDA ALERT [February 23, 2009]: Following a review of updated clinical data, the FDA has determined that treatment with zonisamide can cause metabolic acidosis in some patients. Zonisamide is indicated as adjunctive therapy in the treatment of partial seizures in adults with epilepsy.

Metabolic acidosis is a disturbance in the body's acid-base balance that results in excessive acidity of the blood. Metabolic acidosis is diagnosed by laboratory tests measuring the serum bicarbonate level in the blood to determine the presence and severity of metabolic acidosis. (...)

(Anm: metabolic acidosis; metabolsk acidose; syreopphoping pga sure stoffskifterestar; jf ketoacidose, mjølkesyreacidose; metabolsk acidose er også ein del av uremitilstanden; jf anion gap. EN metabolic acidosis. Kilde: Norsk medisinsk ordbok.)

(Anm: Metabolsk acidose er når syrebase-balansen (pH-nivået) i kroppsvæsken er for surt. Dette fenomenet ses særlig hos diabetikere og personer med nyresvikt. Endringer i bikarbonat-konsentrasjonen (base, alkali) er den primære årsaken til denne forstyrrelsen1,2. Normalt skal kroppsvæskene ha et pH-nivå på ca. 7,4. Ved høyere verdier (f.eks. 7,6) foreligger alkalose og ved lavere verdier (f.eks. 7,2) foreligger acidose. Metabolsk acidose skyldes at ulike kjemiske prosesser i kroppen medfører opphopning av syre. Manglende utlufting av avfallsgassen CO2 via lungene, gir også acidose, men da kalles det respiratorisk acidose, det vil si at årsaken er sviktende lungefunksjon. (nmi.no).)

Epilepsikampanje i Kina viser positive resultater
Tidsskr Nor Legeforen 2009; 129:316 (12.2.2009)
Epilepsi er den vanligste alvorlige nevrologiske sykdommen i verden og affiserer rundt 50 millioner mennesker. Inntil 90 % av epileptikere i u-land får ingen eller kun dårlig behandling. En kampanje på landsbygda i Kina for å øke kunnskap om og behandling av epilepsi har vist noen positive resultater. (...)

Pregabalin og misbrukspotensial
Tidsskr Nor Legeforen 2009; 129:186-7 (29.1.2009)
Salget og omsetningen av pregabalin (Lyrica) i Norge har økt betydelig de siste årene. Det har vært spekulert på om dette kan skyldes misbruk. Reflekterer det økte forbruket et medisinsk behov, utvikling av avhengighet blant brukere eller illegalt salg og misbruk blant rusavhengige? Tilgjengelige data på hvorvidt pregabalin har avhengighetsdannende egenskaper er sparsomme og til dels motstridende. (...)

Is it ever safe to stop taking epilepsy drugs?
guardian.co.uk 18.1.2009
New research shows it can be dangerous for people with epilepsy not to take their medicine regularly. But is it ever safe to reduce or stop your medicine, if you have epilepsy? We take a look at the research.

What do we know already?
Medicines work well for most people with epilepsy. But some people get troublesome side effects like drowsiness. If you've been taking drugs for a while and they've stopped your seizures, you might wonder about stopping treatment. It's very important to talk to your doctor before doing this. Stopping or changing dose without help can be dangerous. If you decide you want to stop, a specialist doctor can help you lower your dose gradually over several weeks or months. (...)

Where does the study come from?
The new study was carried out by researchers at the University of Alabama in the US. It was published in the medical journal Neurology, which is owned by the American Academy of Neurology. The study was funded by the company GlaxoSmithKline, which makes some epilepsy medicines. Many drug trials are funded by drug manufacturers. (...)

Scientists identify mutation linked to common form of epilepsy
pharmanews.eu 18.1.2009
A team of EU-funded scientists has discovered that a mutation on chromosome 15 is linked to a common form of epilepsy. The findings, which are published in the journal Nature Genetics, add to our understanding of the underlying causes of epilepsy and could eventually lead to the development of new drugs to treat the condition. (...)

This study focused on idiopathic generalised epilepsy (IGE), which accounts for one third of all epilepsies. The scientists studied the DNA of over 1,000 people with IGE and compared it to the DNA of over 3,500 people without the condition. They found that a small section of chromosome 15 was missing in 1% of the IGE patients. None of the healthy people tested had this deletion. (...)

The deleted section of DNA contains at least seven genes, including one that codes for a protein called CHRNA7 (neuronal nicotinergic acetylcholine receptor). CHRNA7 regulates signalling between nerve cells, and mutations in related genes have been linked to epilepsy in previous research. (...)

The new findings add considerably to our knowledge of the molecular mechanisms involved in both epilepsy and the other disorders linked to this mutation. At the same time, the discovery that the mutation is linked to such a wide range of conditions, but leaves some patients unaffected, means that it would be difficult to use this mutation in a genetic counselling session, for example. (...)

Topiramate can induce hypoadrenalism in patients taking oral corticosteroid replacement
BMJ 2009;338:a1788 (8 January)
A 35 year old woman was taking life long glucocorticoid (dexamethasone) and mineralocorticoid (fludrocortisone, Florinef, Squibb) replacement for congenital adrenal hyperplasia caused by 21-hydroxylase deficiency. She started taking topiramate (Topamax, Janssen-Cilag) in March 2005, and the dose was titrated to 100 mg daily for atypical seizures secondary to mesial temporal sclerosis. (...)

The manufacturer acknowledged the theoretical possibility of a pharmacokinetic interaction between topiramate and corticosteroids but has no other reports. The ability of topiramate to accelerate glucocorticoid and mineralocorticoid clearance to induce hypoadrenalism is not confined to patients with congenital adrenal hyperplasia but is applicable to any patient who is taking a fixed dose of glucocorticoid replacement. Such patients should be warned of the risk of hypoadrenalism. (...)

(Anm: Steroid therapy increases risk of blood clots 5-fold in IBD patients (medicalnewstoday.com 1.2.2015).)

FDA Panel to Vote on Investigational Epilepsy Drug for Kids and Adults
medpagetoday.com 6.1.2009
ROCKVILLE, Jan. 6 -- The FDA's advisory committee on neurology drugs will decide this week whether to recommend approval of an investigational anti-seizure drug known to cause irreversible vision loss in a significant fraction of patients.

Ovation Pharma, the manufacturer of vigabatrin (Sabril), is seeking approval for use of the drug as an adjunctive therapy for treating refractory complex partial seizures in adults and as monotherapy for infantile spasms in children.
Vigabatrin is currently approved for these indications in 50 countries, including Canada, Mexico, and many in Europe.

While three controlled studies have showed the vigabatrin effectively reduces seizures in adults and kids, the drug has not made it to the market in the U.S. over concerns about a bilateral and concentric peripheral visual field defect associated with vigabatrin.

A multinational study of 500 adults and children with refractory partial epilepsy found that vigabatrin induced a peripheral visual field defect in 25% of adults and 15% of children.

Among infants, a vigabatrin-induced retinal abnormality was found in 31%.
Median exposure to vigabatrin at the time the peripheral visual field defects were detected was 4.3 years in children and 4.7 years in adults. (...)

Flerumettede fettsyrer og epilepsi Tidsskr Nor Legeforen 2009; 129:26-8
A Farmen M Lossius K Nakken
Tidsskr Nor Legeforen 2009; 129:26-8 (1.1.2009)
(...) Resultater og fortolkning. Artikler om kliniske forsøk og laboratorieforsøk ble funnet på PubMed, studier vedrørende ketogen diett er hentet fra Cochrane-databasen. Flere dyreforsøk og en klinisk studie har vist at økt inntak av flerumettede fettsyrer gjennom ulike biokjemiske mekanismer kan motvirke tendensen til epileptiske anfall. Men så langt er det ikke sikkert påvist at flerumettede fettsyrer har anfallsreduserende effekt hos mennesker med epilepsi. Om de vil kunne bli et fremtidig behandlingsalternativ, er det for tidlig å si. Mer forskning er nødvendig. (...)

Konklusjon
De få kliniske studiene med flerumettede fettsyrer som hittil er gjennomført, har ikke vist den samme anfallsreduserende effekten som man ville forvente ut fra dyrestudiene.

Videre forskning med forskjellige doser og fettsyresammensetninger, og kanskje med lengre behandlingsperioder, er nødvendig før man kan si noe mer sikkert om den kliniske nytteverdien av flerumettede fettsyrer i behandlingen av personer med epilepsi.

Oppgitte interessekonflikter: Ingen (...)

FDA: Epilepsy Drugs May Carry Skin Risks for Asians
JAMA. 2008;300(24):2845.
Asian patients who receive phenytoin or fosphenytoin (a phenytoin prodrug that is intended for parenteral administration) for epilepsy may be at risk of developing serious skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, warned the US Food and Drug Administration (FDA) in late November.

The warning is based on preliminary data from an ongoing investigation (http://www.fda.gov/cder/drug/infopage/phenytoin_fosphenytoin/default.htm). Previously, the FDA had cautioned that another antiepileptic drug, carbamazepine, posed a similar risk for Asian patients. (...)

Scientists shed light on causes of epilepsy (Forskere kaster lys over årsaker til epilepsi)
reuters.com 24.11.2008
LONDON (Reuters) - A breakdown in a reaction between immune cells and blood vessels in the brain appears to play a key role in epilepsy, Italian researchers said Monday.

The discovery could mean that some modern antibody-based drugs designed to modify the immune system used in other diseases may one day help fight the debilitating disorder.

A study of mice showed how immune cells sticking to blood vessels in the brain caused inflammation that contributed to epileptic seizures, Gabriela Constantin of the University of Verona in Italy and colleagues reported.

The finding could lead to new treatments to prevent the condition that affects about 1 percent of the general population worldwide, said Constantin, who led the study published in the journal Nature Medicine.

"This mechanism was not previously suspected in epilepsy," she said in a telephone interview. (...)

Drug for seizures fatal in some patients: study
reuters.com 28.10.2008
CHICAGO (Reuters) - People treated with a sedative given to stop prolonged epileptic seizures may be at risk of serious complications or death, U.S. researchers said on Tuesday.

Of 31 patients with prolonged seizures who were given the AstraZeneca drug propofol, also called Diprivan, over a 10-year period at the Mayo Clinic in Rochester, Minnesota, three had cardiac arrest and two died.

"There is the potential for serious trouble," said Dr. Vivek Iyer, who presented his findings at a meeting of American College of Chest Physicians in Philadelphia. (...)

Epilepsy Raises Drowning Risk (Epilepsi øker risiko for drukning)
healthfinder.gov 18.8.2008
Seizures could boost the danger in tubs, pools, experts say.

MONDAY, Aug. 18 (HealthDay News) -- Having epilepsy might put you at a significantly higher risk for death by drowning, a new report says.

The study, which looked at information compiled from all over the world, found that epileptics had a 15 to 19 times greater chance of drowning compared with the general population. Epileptics with a learning disability, those in institutional care and those who have had brain surgery were at the greatest risk, according to the study published in the Aug. 19 issue of Neurology. (...)

A Patient’s Journey
Epilepsy
BMJ 2008;337:a799 (1 August 2008)
Sarah Lightbody was 17 when she was diagnosed with epilepsy. This is her account of her experience of the condition during the 14 years since then (...)

Epilepsy Drug May Boost Birth Defect Risk
healthfinder.gov 21.7.2008
Women who take topiramate should discuss preconception planning with their doctor. (...)

MONDAY, July 21 (HealthDay News) -- Pregnant women who use the epilepsy drug topiramate alone or in combination with other epilepsy drugs may be increasing their risk of birth defects, British researchers report.

Topiramate (brand name Topamax) is a common anti-seizure medication used by many with epilepsy. It's also used to treat migraine headaches. Many similar drugs also increase the risk of birth defects, but until this report, the link between birth defects and topiramate had not been well studied. (...)

The report is published in the July 22 issue of the journal Neurology. (...)

Craig's team found that of the 178 babies born, 16 (4.8 percent) suffered from major birth defects. Among the babies with birth defects, three of the mothers were taking topiramate exclusively, while 13 were taking topiramate plus other epilepsy drugs. (...)

Pfizer disputes suicide risks with epilepsy drugs
forbes.com 10.7.2008
WASHINGTON - Pfizer Inc. told government officials Thursday its drug Lyrica should not receive stern warnings about suicide risks that regulators are advocating for all epilepsy drugs.

The world's largest drug maker defended the safety of its blockbuster medication at a Food and Drug Administration meeting to consider whether epilepsy drugs increase suicidal tendencies. The FDA earlier this week said it believes they do and that the drugs should be subject to a black box warning, the most serious type available. (...)

Epilepsy Drug Adherence a Matter of Life and Death
medpagetoday.com 18.6.2008
(...) Irregular medication use was also associated with an 86% increase in hospital admission and 50% more emergency department visits, they reported online in Neurology.

These findings support the long-suspected role of lack of seizure control in the three-fold higher overall mortality in this population compared with the general population, they said. Nonadherence has been estimated at up to 70% for anti-epileptic drugs. (...)

Mom's infection may boost epilepsy risk in offspring
reuters.com 11.5.2008
NEW YORK (Reuters Health) - Exposure to certain maternal infections in the womb increases the odds of epilepsy in childhood, according to an analysis of data from a Danish study. Among the infections cited were cystitis (inflammation of the bladder), pyelonephritis (inflammation of the kidney and upper urinary tract), and vaginal yeast infection.

"If some of these associations are causal, then they could be related to the infection itself or to its consequences, such as change in diet or dehydration, and possibly to its treatment," the research team states.

The study, reported in the May issue of the journal Pediatrics, involved 90,619 infants born between September 1997 and June 2003 and followed through December 2005. (...)

Ketogenic Diet Cuts Kids' Epileptic Seizures
medpagetoday.com 5.5.2008
LONDON, May 5 -- Seizures in children with drug-resistant epilepsy were reduced by the ketogenic diet, which stresses high fat, low carbohydrates, and controlled protein, the first randomized trial of the regimen found. (...)

Diet treatment call for epilepsy
bbc.co.uk 2.5.2008
Seizures are caused by bursts of electrical activity in the brain
A special high-fat diet helps to control fits in children with epilepsy, a UK trial suggests.

The number of seizures fell by a third in children on the "ketogenic" diet, where previously they had suffered fits every day despite medication.

The diet alters the body's metabolism by mimicking the effects of starvation, the researchers reported in the Lancet Neurology. (...)

Antiepileptic Drugs for Brain Tumors
ivanhoe.com 16.4.2008
(Ivanhoe Newswire) -- Patients with brain tumors are often prescribed antiepileptic medications, even if they’ve never had a seizure; but a new review of studies reveals these drugs, which often have serious side effects, may not effectively prevent seizures. (...)

They also found side effects like drowsiness, bruising and unusual bleeding occurred more often in those using the drugs. (...)

“If a physician wants to put a patient on these medications for more than seven days after surgery, then there may be a problem that the patient should bring up with their doctor,” Dr. Tremont-Lukats said. “After a week, there is no evidence that they help and ample evidence of side effects.” Researchers caution that their study only looked at older anticonvulsants, and say newer drugs may be more effective at preventing first seizures. (...)

Prestisjestipend til norsk epilepsiforsker
helserevyen.no 6.2.2008
Legemiddelselskapet UCB har besluttet å gi sitt nye prestisjestipend UCB Nordic Epilepsy Grant til lege og forsker Christian Samsonsen ved St. Olavs hospital i Trondheim. (...)

Sjekker 200 pasienter
Samsonsens forskningsprosjekt tar for seg årsaker som utløser epilepsianfall.
Anfall kan blant annet utløses av søvnmangel, emosjonell stress, lysflimmer, alkoholinntak, eller at pasienten rett og slett har glemt å ta medisinen sin. Kanskje til og med koffein kan være anfallsutløsende.

I studien inngår 200 epilepsipasienter ved St. Olavs hospital i Trondheim. Samsonsens skal kartlegge alt de disse pasientene gjorde i tidsrommet opp til anfallet, før de ble innlagt på sykehuset. (...)

Suicidal-Thoughts Risk Is Linked
To Drugs Used to Treat Epilepsy

wsj.com 1.2.2008
WASHINGTON -- The U.S. Food and Drug Administration warned patients and health-care professionals Thursday about an increased risk of suicidal thoughts and behaviors associated with 11 drugs used to treat epilepsy and certain psychiatric disorders. (...)

Atkins-Like Diet Cuts Epileptic Seizures
healthfinder.gov 31.1.2008
High-fat, low-carb plan may work when other treatments fail, study says. (...)

THURSDAY, Jan. 31 (HealthDay News) -- Adults with epilepsy who have failed other treatments may be able to dramatically reduce their number of seizures by following a modified Atkins-like diet, Johns Hopkins researchers report.

The high-protein, low-carbohydrate diet has already been shown to be valuable in controlling seizures in children, and now results from a small study suggest that the diet also works for adults.

"There are a lot of adults with very bad seizures. There are a lot of adults who have failed medicines and are not candidates for other treatments," said lead researcher Dr. Eric H. Kossoff, an assistant professor of neurology and pediatrics at Johns Hopkins School of Medicine. (...)

The findings are published in the February issue of the journal Epilepsia. (...)

The medical management of the epilepsies in children: conceptual and practical considerations
Lancet Neurology 2008; 7:57-69 (January)
(...) In this Review, we present an overview of the medical management of epilepsy in children and discuss the dilemmas of everyday practice, such as selection of AED, assessment of outcome, monitoring of treatment, and the decision to withdraw medication when the child is free from seizures. Furthermore, we emphasise the need to establish rational goals for treatment, such as aiming for the best possible quality of life rather than freedom from seizures at all costs. (...)

New data provide boost for GSK's Lamictal XR?
pharmatimes.com 15.10.2007
(...) Lamotrigine XR reduced the number of seizures by 46.1% over the entire study, by 28.0% during dose escalation and by 58.0% during maintenance treatment. This compared with 24.2%, 16.3% and 26.7% respectively in the placebo arm. Furthermore, 42.2% and 24.2% of the lamotrigine XR and placebo group respectively experienced at least a 50% reduction in seizure frequency. Patients taking lamotrigine XR also reached a 50% reduction in seizure frequency more rapidly than those taking placebo. Secondarily generalized seizures showed a similar improvement with lamotrigine XR compared with placebo. (...)

Epilepsi kontrollert av «ketogen diett»
Tidsskr Nor Lægeforen 2007;127 (23.8.2007)
Behandlingsresistent epilepsi kan kontrolleres av en diett bestående av lite karbohydrater, men mekanismen har vært ukjent. Denne strenge dietten tvinger kroppen til å bruke fett som energikilde og fører til ketose.

Forskere ved Harvard University har nylig belyst årsaksmekanismene, og deres funn tyder på at dietten regulerer elektriske signaler i et område av hjernen som kontrollerer generaliserte kramper (J Neurosci 2007; 27: 3618 - 25).

Forskerne brukte musehjerner og fant at visse elektriske signaler ble redusert ved ketose. Denne effekten var avhengig av bestemte kaliumkanaler i hjernen, og reduksjonen i elektrisk aktivitet uteble hvis kanalene var eliminert ved genetisk manipulasjon eller medikamentelt. (...)

Many 'believe myths' on epilepsy
bbc.co.uk 25.7.2007
Seizures are caused by bursts of electrical activity in the brain
Many people believe potentially harmful myths about epilepsy, a study from University College London suggests. (...)

The syndrome of transient epileptic amnesia
Ann Neurol. 2007 Jun;61(6):587-98
(...) INTERPRETATION: We propose that transient epileptic amnesia is a distinctive epilepsy syndrome, typically misdiagnosed at presentation and associated with accelerated long-term forgetting and autobiographical amnesia. The syndrome is of clinical and theoretic importance. Ann Neurol 2007. (...)

Gratis epilepsibehandling
helserevyen.no 19.7.2007
Ny forskning viser at karbondioksid (Co2) kan fungere som en ny og helt gratis behandlingsform for å avverge feberrelaterte epileptiske anfall. (...)

Epileptics Have Three Times Greater Suicide Risk, Lancet Says
bloomberg.com 3.7.2007
July 3 (Bloomberg) -- Epileptics are three times more likely to commit suicide than people who don't have the disorder, and are especially susceptible in the six months after they're first diagnosed, a new study by Danish researchers shows.

The greater frequency of suicide among epileptics can't be explained by psychiatric illnesses that often accompany epilepsy, or by a patient's socioeconomic background, according to an article published today in the U.K. journal The Lancet Neurology. (...)

Early seizures: causal events or predisposition to adult epilepsy?
Lancet Neurology 2007; 6:643-651
Summary
Past studies have been unable to confirm whether early seizures predispose to epilepsy in adults. Seizures in infancy were classically thought to cause brain lesions that led to epilepsy in adulthood. (...)

Epilepsi gir lavere IQ
mozon.no 15.6.2007
Voksne menn kan få lavere intelligens dersom mor hadde epilepsi under svangerskapet, ifølge en ny norsk studie. (...)

Long term results of epilepsy surgery are encouraging
Shortcuts from BMJPG journals
BMJ 2007;334:1189 (9 June)
A survey of 70 consecutive adults having surgery for intractable epilepsy in Gothenburg, Sweden, shows that the outcome at two years predicts that at 10 years, with 91% of those in remission at the former time remaining so. (...)

Giver generika af lamotrigin anledning til større svingninger i plasmakoncentrationen?
Ugeskr læger 2007;169(21):2013-2015 (21. MAJ 2007)
Konklusion: Generiske lamotriginpræparater giver ikke anledning
til ændrede plasmakoncentrationer og ej heller større svingninger i
plasmakoncentrationen end original lamotrigin. Der er således
ikke belæg for at hævde, at der er forskel i effekt for original og
generika af lamotrigin. (...)

Epilepsy surgery: Underused but rising
yahoo.com 21.5.2007
WASHINGTON - The research is persuasive: When drugs don't completely control epilepsy, surgery often can — and the sooner it's tried, the better.
Yet while children are going under the knife at younger ages, epilepsy specialists are struggling to get that message to tens of thousands of adult patients. (...)

Up to 30 percent of patients have intractable epilepsy: Medicines don't prevent all their seizures, or they cause intolerable side effects. Many are candidates for surgery, cutting out the abnormal brain tissue that sparks seizures. At leading centers, up to 80 percent of surgery recipients become seizure-free, with few complications. (...)

Bruk av antiepileptika hos sykehjemsbeboere
Tidsskr Nor Lægeforen 2007; 127: 1185-7 (3.5.2007)
Sammendrag
Bakgrunn. Mange personer over 65 år har epilepsi, og behandling av denne pasientgruppen byr på spesielle utfordringer. Målet med denne studien var å undersøke prevalensen av epilepsi og bruken av antiepileptika hos sykehjemsbeboere i Asker og Bærum. (...)

Fortolkning. Medikamentell behandling og oppfølging av sykehjemsbeboere med epilepsi fungerer suboptimalt og kan bedres. (...)

Psykisk helsefare hos ungdom med epilepsi
forskning.no 25.4.2007
(...) Ekstra belastning
Ungdom liker ikke å skille seg ut fra andre ungdommer. Unge med epilepsi, går ofte rundt med angst for å få et epileptisk anfall mens vennene ser det.
Sykdommen blir derfor en ekstra belastning, og redselen for å få anfall gjør at det blir enda verre for dem når det gjelder å fungere godt i hverdagen. (...)

Independent trial guides doctors through epilepsy treatments
BMJ 2007;334:660-661 (31 March)
Shortcuts from other journals
Patients with newly diagnosed epilepsy and their doctors have a bewildering choice of first line drugs. Navigating through them just got slightly easier with the publication of a large trial comparing the main choices head to head. Lamotrigine emerged as the best choice for patients with partial seizures, and valproate had the most favourable profile for patients with generalised or unclassified seizures. (...)

References
Lancet 2007;369:1000-15 Lancet 2007;369:1016-26 Lancet 2007;369:970-1 (...)

Epileptiske syndromer hos barn
Tidsskr Nor Lægeforen 2003; 123:1362-4 (15.5.2003)
Sammendrag
Bakgrunn. For å kunne tilby barn med epilepsi optimal behandling er en korrekt anfalls- og syndromklassifikasjon av avgjørende betydning.

Materiale og metode. På bakgrunn av en litteraturgjennomgang og egne kliniske erfaringer presenteres en kort oversikt over de viktigste epilepsisyndromene i barnealderen.

Resultater og fortolkning. Barn med epilepsi er en svært heterogen pasientgruppe. Noen epilepsisyndromer i barnealderen er så benigne at det ikke er nødvendig å gi behandling. Andre syndromer, kalt katastrofale epilepsier, er så terapiresistente at de etter hvert får en svært negativ innvirkning på barnets utvikling. Selv om mange barn med epilepsi har hatt nytte av den nye generasjonen av antiepileptika, har fortsatt ca. 25% av pasientpopulasjonen en utilfredsstillende anfallssituasjon. Disse refraktære pasientene bør tilbys kirurgi, intermitterende vagusstimulering eller ketogen diett.

Alle barn med farmakoresistente anfall bør få en tverrfaglig multidisiplinær diagnostisk evaluering. Ca. 20% av barn henvist til Spesialsykehuset for epilepsi for «refraktær epilepsi» viser seg å ha en ikke-epileptisk tilstand. (...)

Websidene er designet og tilrettelagt av Hein Tore Tønnesen © 2009