Last update 01 Nov 2024

Epilepsy, Complex Partial

Last update 01 Nov 2024

Basic Info

Synonyms

Complex Partial Epilepsy, Complex Partial Seizure Disorder, Complex partial epilepsy

+ [57]

Introduction

A disorder characterized by recurrent partial seizures marked by impairment of cognition. During the seizure the individual may experience a wide variety of psychic phenomenon including formed hallucinations, illusions, deja vu, intense emotional feelings, confusion, and spatial disorientation. Focal motor activity, sensory alterations and AUTOMATISM may also occur. Complex partial seizures often originate from foci in one or both temporal lobes. The etiology may be idiopathic (cryptogenic partial complex epilepsy) or occur as a secondary manifestation of a focal cortical lesion (symptomatic partial complex epilepsy). (From Adams et al., Principles of Neurology, 6th ed, pp317-8)

Drugs associated with Epilepsy, Complex Partial

Ganaxolone

Target

GABAA receptor

Mechanism

GABAA receptor positive allosteric modulators

Active Org.

Tenacia Biotechnology (Shanghai) Co. Ltd. [+1]

Originator Org.

Purdue Pharma LP

Active Indication

Seizures [+7]

Inactive Indication

Arthropathy, Progressive Pseudorheumatoid, of Childhood [+10]

Drug Highest PhaseApproved

First Approval Ctry. / Loc.

First Approval Date18 Mar 2022

Pregabalin

Target

CACNA2D1 x CACNA2D2

Mechanism

CACNA2D1 blockers [+1]

Active Org.

Huizhi Pharmaceutical (Dalian) Co., Ltd. [+14]

Originator Org.

The Upjohn Co.

Active Indication

Fibromyalgia [+9]

Inactive Indication

Acute herpes zoster neuropathy [+32]

Drug Highest PhaseApproved

First Approval Ctry. / Loc.

EU [+3]

First Approval Date05 Jul 2004

Huperzine A

Target

AChE x NMDA receptor

Mechanism

AChE inhibitors [+1]

Active Org.

Wanbangde Pharmaceutical Holding Group Co., Ltd. [+9]

Originator Org.

Mayo Clinic

Active Indication

Alzheimer Disease [+8]

Inactive Indication

Brain Injuries, Traumatic [+2]

Drug Highest PhaseApproved

First Approval Ctry. / Loc.

First Approval Date01 Jan 1994

Clinical Trials associated with Epilepsy, Complex Partial

CTRI/2022/09/045152 / RecruitingPhase 2/3IIT

A comparison of modulating effect of cTBS and low frequency rTMS on cortical excitability in children and adolescents aged 5-14 years with Lesional Drug refractory Epilepsy (Focal epilepsy orelectrical status epilepticus in sleep): An open label randomized non-inferiority crossover study

Start Date20 Sep 2022

Sponsor / Collaborator

All India Institute of Medical Sciences

CTRI/2020/12/029538 / Not yet recruitingNot ApplicableIIT

Validation of indigenously developed, biocompatibility and safety proven Electrocorticography electrodesâ??

Start Date07 Dec 2020

Sponsor / Collaborator-

IRCT20200111046082N2 / SuspendedNot ApplicableIIT

The Efficacy of High Definition anodal transcranial direct current stimulation in shortening of duration of hospitalization in Epilepsy Monitoring Unit of patients with drug-resistant epilepsy

Start Date20 Jun 2020

Sponsor / Collaborator

Kerman Medical University

100 Clinical Results associated with Epilepsy, Complex Partial

100 Translational Medicine associated with Epilepsy, Complex Partial

0 Patents (Medical) associated with Epilepsy, Complex Partial

907

Literatures (Medical) associated with Epilepsy, Complex Partial

01 Nov 2023·Journal of Vascular Surgery: Venous and Lymphatic Disorders

Transabdominal ultrasound accurately identifies a significant iliac vein area-reducing lesion in patients with pelvic venous insufficiency

Article

Author: Kennedy, Richard ; Christophi, Costas ; Pappas, Peter J ; Sulakvelidze, Levan ; Lakhanpal, Sanjiv ; Lakhanpal, Gaurav ; Calcagno, Tess

BACKGROUNDIn patients with pelvic venous disorders secondary to pelvic venous insufficiency (PVI), the optimal imaging modality is ill-defined. Transabdominal ultrasound (TAU) is widely used to identify the presence of iliac vein stenosis. The purpose of the present investigation is to determine the accuracy of TAU for determining the presence of an iliac vein area-reducing lesion compared with intravascular ultrasound (IVUS).METHODSFrom January to December 2020, a retrospective review of prospectively collected data from 96 patients treated for symptomatic PVI at the Center for Vascular Medicine was performed. All patients had complete history and physical examination findings, demographics, CEAP (clinical, etiologic, anatomic, pathophysiologic), revised venous clinical severity score, and TAU, diagnostic venography, and IVUS measurements recorded in our electronic medical record system. All TAU measurements were performed by the same ultrasound technician with the patient in the supine position. Iliac vein diameters of the common femoral, external iliac, and common iliac veins and the inferior vena cava were obtained. Differences in body habitus were normalized by dividing the minimum diameter measurement of the stenotic vessel with that of the ipsilateral common femoral vein, subtracting this number from 1 and multiplying by 100 (stenosis = [1 - minimal diameter/common femoral diameter] × 100). The normalized stenoses were then compared with the IVUS-derived area reducing measurements. A receiver operating characteristic curve was created, and logistic regression analysis for the probability of predicting an area-reducing lesion of >50% and >60% with TAU was performed. The sensitivity, specificity, and positive and negative predictive values were calculated.RESULTSThe average age of the entire cohort was 49.8 ± 13.5 years, with 69 women and 27 men. The CEAP distribution was as follows: C0, 5%; C1, 5%; C2, 10%; C3, 40%; C4a,b, 30%; C5, 7%; and C6, 3%. The average revised venous clinical severity score was 6.2 ± 2.6. The indications for intervention were leg symptoms alone in 43%, pelvic symptoms alone in 3%, and combined leg and pelvic symptoms in 54%. TAU identified a stenosis of ≥50% in 92 of the 96 patients (96%). For a ≥50% stenosis, a normalized diameter of ≤3 mm demonstrated a sensitivity, specificity, and positive and negative predictive value of 75%, 75%, 98%, and 12%, respectively. Logistic regression analysis indicated that TAU was significant in predicting the presence of a ≥60% area-reducing lesion (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P = .009). The area under the receiver operating characteristic curve (c-statistic) was 68.6%. The sensitivity, specificity, and positive and negative predictive values were 66.7%, 66.7%, 81.5%, and 47.6%, respectively, for a normalized diameter of ≥4 mm.CONCLUSIONSThe ability of TAU to identify an iliac vein stenosis of ≥50% is 96%. The positive predictive value for TAU to identify a ≥60% iliac vein area-reducing lesion is high, with moderate sensitivity and specificity. For patients with symptoms consistent with pelvic venous disorders secondary to PVI, TAU is a good preintervention screening modality for properly trained vascular imaging specialists with findings that correlate well with IVUS measurements.

01 Nov 2023·Journal of Vascular Surgery

Outcomes of symptomatic penetrating aortic ulcer and intramural hematoma in the endovascular era

Article

Author: Kim, Young ; Lella, Srihari K ; Png, C Y Maximilian ; Pendleton, A Alaska ; Khoury, Mitri K ; Dua, Anahita ; Zacharias, Nikolaos ; Majumdar, Monica ; DeCarlo, Charles ; Bellomo, Tiffany R

BACKGROUNDAlthough endovascular technology has resulted in a paradigm shift in treatment, medical management remains the standard of care for penetrating aortic ulcer (PAU) and intramural hematoma (IMH). This study aimed to detail the short- and long-term outcomes of symptomatic PAU/IMH.METHODSInstitutional data on symptomatic PAU/IMH were gathered (2005-2020). The primary outcome was the composite of recurrent symptoms, radiographic progression, intervention, rupture, and death from related or unknown cause. Factors associated with the primary outcome were determined using a Fine-Gray model with death from an unrelated cause as a competing risk.RESULTSA total of 83 symptomatic patients treated with medical management aside from ruptures and type A dissections: 21 isolated PAU, 30 isolated IMH, and 32 IMH and PAU. Adverse outcomes included symptom recurrence in 14 (16.9%), radiographic progression to dissection or saccular aneurysm in 17 (20.5%), surgery in 20 (24.1%) (17 thoracic endovascular aortic repair, 1 endovascular aortic repair, 1 frozen elephant trunk, and 1 open repair), and rupture in 4 (4.8%). Twenty-seven patients (32.5%) died during follow-up: 6 from IMH treatment complications, 8 from an unknown cause, and 13 from other causes. The 30-day, 1-year, and 5-year cumulative incidences of the primary outcome was 26.5% (95% confidence interval [CI], 16.9%-37.0%), 44.9% (95% CI, 32.8%-56.2%), and 57.5% (95% CI, 42.4%-69.9%), respectively. IMH with PAU was associated with a significantly higher risk of the primary outcome compared with isolated IMH (subdistribution hazard ratio, 2.21; 95% CI, 1.09-4.50; P = .027) and isolated PAU (subdistribution hazard ratio, 3.58; 95% CI, 1.44-8.88; P = .006).CONCLUSIONSComplications from symptomatic PAU and IMH are frequent, with intervention, recurrent symptoms, radiographic progression, rupture, or death affecting 25% of patients at 30 days after diagnosis and almost one-half of patients 1 year after diagnosis. Given the high rate of adverse events in this population, investigation into a more aggressive interventional strategy may warranted, especially in patients with a combined IMH and PAU.

07 Aug 2023·Journal of Neurosurgery: Case Lessons

Deep brain stimulation in a pediatric dystonia patient with cochlear implants and mitochondrial disorder: novel application of a frameless stereotactic system and navigating the anesthesia choice and neurosurgical complexities. Illustrative case

Article

Author: Sahgal, Suneet ; Schenk, Mallory ; Conner, Andrew K. ; Shi, Helen H. ; Grossen, Audrey ; Desai, Virendra R. ; Ramsey, Justin ; Stocco, Amber

BACKGROUNDThis report presents a case of medically refractory dystonia in a pediatric patient successfully treated with bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) while under general anesthesia by using microelectrode recordings (MERs) with intraoperative computed tomography (CT).OBSERVATIONSThe patient was an 18-year-old female with primary dystonia secondary to mitochondrial Leigh syndrome. Her past medical history was significant for complex partial epilepsy and hearing loss treated with cochlear implants. Her cochlear implants precluded anatomical targeting via magnetic resonance imaging. Additionally, the patient could not tolerate awake surgery with MER. The decision was made to proceed with bilateral STN DBS with intraoperative CT with the patient under general anesthesia. The patient’s cochlear implants made standard frame placement difficult, so navigation was performed with the Nexframe system. Recordings were obtained with the patient under general anesthesia with ketamine, dexmedetomidine, and remifentanil. At the 3- and 6-month follow-ups, the patient demonstrated marked improvement in dystonia without neurological complications.LESSONSThis is the first case of dystonia secondary to Leigh syndrome treated with DBS. Additionally, the authors describe the novel use of the Nexframe for DBS lead placement in a pediatric patient. This demonstrates that STN DBS with the use of MER and intraoperative CT can be a safe and effective method of treating dystonia in certain pediatric patients.

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