Jurkevičienė, Giedrė

Introduction Seizures cause excessive excitatory neurotransmitter release and intense neuronal firing, which increases metabolic demand and blood flow. If this demand is unmet, cellular stress, edema, and transient postictal MRI changes may occur, potentially mimicking acute structural pathology [1,2]. Studies suggest that MRI signal abnormalities after a single seizure are rare but occur more frequently in status epilepticus [1,3,4]. Case Presentation Patient A.B. was involved in a traffic accident. She showed disoriented behavior prior to the event. Emergency personnel observed leftward versive head turning with left-sided clonic movements, suggesting a seizure, and administered diazepam. In the Kaunas Clinics’ emergency department, neurological examination and CT scan showed no acute abnormalities. During hospitalization, EEG monitoring recorded a possible subclinical seizure with right temporal focus (T4, F8) lasting up to 40 seconds. Carbamazepine therapy was started. Laboratory tests, including infectious and autoimmune panels, were normal. Brain MRI showed a T2-weighted FLAIR hyperintense signal with mild diffusion restriction in the right medial hippocampal region and adjacent white matter, suggestive of postictal changes. Lumbar puncture and sleep EEG, cardiology and rheumatology specialist evaluations were unremarkable. 1-month follow-up MRI showed regression of the hyperintense signal in the right hippocampus and the parahippocampal region. Follow-up MRI at 4.5 months revealed hippocampal atrophy, consistent with hippocampal sclerosis. Since the initial seizure, the patient has been seizure-free and all EEGs were normal. Discussion Postictal brain MRI changes are typically detected within the first day after a seizure, most commonly involve the cortex and hippocampus [1,2,4,5]. They resolve within days or weeks without long-term consequences [5]. After regression of post-seizure changes (particularly after status epilepticus), in rare cases, hippocampal sclerosis, cortical atrophy or necrosis may develop; early seizure termination is associated with improved prognosis [2]. Conclusions Postictal brain MRI changes are rare and often transient, posing diagnostic challenges. No specific treatment is required, the changes regress spontaneously. Good seizure control is essential to prevent long-term structural changes.

Background and Objectives: People with epilepsy frequently complain of poor sleep quality, excessive daytime sleepiness (EDS), and insomnia. Therefore, this study aimed to evaluate differences in anxiety and depression symptoms, as well as clinical characteristics, across groups defined by sleep quality in patients with epilepsy. Materials and Methods: Seventy-eight adults with epilepsy were assessed using standardized questionnaires for sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), insomnia severity (Insomnia Severity Index, ISI), and psychiatric symptoms (PHQ-9, GAD-7, and HADS). Demographic data (age and sex), seizure frequency and characteristics, use of antiepileptic drugs (AEDs), and EEG findings were collected. Patients were divided into groups based on sleep quality scores, and comparisons were made regarding anxiety, depression, and selected clinical variables. Associations were analyzed using t-tests, chi-squared tests, and Spearman correlation coefficients. Results: Poor sleep quality (PSQI > 5) was present in 70.9% of patients and was significantly associated with insomnia, daytime sleepiness, depression, and anxiety symptoms (p < 0.001 for all comparisons). Patients who had experienced generalized tonic–clonic seizures (GTCS) in the past year had significantly worse sleep quality compared to those without GTCS (p = 0.025). Clinical insomnia (ISI ≥ 15) was observed in 23.1% of cases and was significantly associated with the presence of seizures (p = 0.015). EDS was present in 19% of cases and was associated with depressive symptoms (p = 0.019). A higher concentration of levetiracetam was associated with better sleep quality, whereas a higher concentration of lamotrigine was associated with worse sleep quality (p = 0.024 for both). EEG abnormalities, seizure frequency, and duration of epilepsy were not associated with sleep quality. Conclusions: Poor sleep quality was reported in 70% of the study patients and was associated with increased insomnia severity, EDS, and psychiatric comorbidities. People with EDS were more likely to have higher levels of depression and anxiety. Patients who experienced GTCS within the past year were significantly more likely to report poor sleep quality. Insomnia was associated with older age and female sex. Seizure-free patients had less insomnia. Nevertheless, no associations were found between sleep evaluation scores and other demographic or clinical epilepsy characteristics.

Objectives The aim of this study was to assess the adherence to epilepsy treatment and to evaluate the associations between demographic and clinical factors, as well as psychological distress, and the level of adherence in adult epilepsy patients. Materials and Methods This cross-sectional study was conducted at the Neurology Clinic of the Lithuanian University of Health Sciences Hospital, Kaunas Clinics in 2024. Adult patients with epilepsy who were receiving antiepileptic drugs (AEDs) were interviewed after they consented. Socio-demographic and clinical data were analysed. Treatment adherence was assessed using eight yes/no questions related to medication use. The ten-item Kessler Psychological Distress Scale (K10) was applied to evaluate symptoms of depression and anxiety. Statistical analyses were performed using Microsoft Excel 2016 and IBM SPSS Statistics version 29.0. Study was approved by Bioethics Committee of Lithuanian University of Health Sciences (2024 - BEC2 – 204). Results Sixty patients (31 women and 29 men), aged 18–80 years, participated in the study. Most (65.0%; n = 39) were diagnosed with epilepsy before the age of 18 years, and 60.0% (n = 36) had been using antiepileptic drugs (AEDs) for more than 10 years. Half of the participants used AED monotherapy (n = 30; 50.0%). The most common AED regimen was twice-daily dosing (n = 54; 90.0%). Seizure remission during the past six months was reported by 51.7% (n = 31). Psychological distress symptoms were experienced by 56.7% (n = 34) of patients, and 23.3% (n = 14) experienced high-level psychological distress. High adherence to AED regimen was observed in 45.0% (n = 27), moderate in 18.3% (n = 11), and low in 36.7% (n = 22) of participants. Forgetfulness was the most frequently reported reason for non-adherence (50.0%; n = 30). Participants most commonly missed the morning dose (38.3%, n = 23). Only a few participants reported other reasons for non-adherence, including poor tolerance to medication (6.7%, n = 4), improved well-being (5%, n = 3), reluctance to take medication (5%, n = 3), and an inconvenient medication schedule (5%, n = 3). Most participants (70.0%; n = 42) did not use any reminder strategies. Higher adherence was more common among men and participants aged >50 years, but these differences were not statistically significant (p > 0.05). Low adherence was more frequent in patients diagnosed before age 18 years, treated with AEDs for more than 10 years, with EEG abnormalities, or experiencing AED-related adverse effects; however, no statistically significant associations were found between adherence level and clinical characteristics of epilepsy or psychological distress (p > 0.05). Conclusions Fewer than half of adult patients with epilepsy reported high adherence to medical treatment, while one-third reported low adherence. Adherence levels were not associated with demographic factors (age, gender, education, employment, area of residence), clinical characteristics of epilepsy (age at onset, duration, seizure type, remission, EEG findings), or psychological distress (anxiety and depression symptoms). Forgetfulness was the most commonly reported reason for non-adherence, with the morning dose most frequently missed. education on the importance of treatment regularity, along with the use of reminder strategies, may help improve adherence to antiepileptic medication.

Objectives Sleep and epilepsy share a reciprocal relationship, with a myriad of factors contributing to both sleep disruption and poor seizure control. Idiopathic generalized epilepsies (IGE) are a group of homogeneous epilepsy syndromes that are especially prone to an increased risk of seizures upon sleep deprivation. Currently, very few studies have explored the relationship between sleep fragmentation and epilepsy-related factors, such as interictal activity, and even fewer have done so in the context of IGE. In this study, we investigated whether sleep fragmentation is related to clinical and electroencephalography (EEG) characteristics in a small sample of patients with IGE. Materials and Methods We conducted a prospective, cross-sectional study of people with IGE. We collected data regarding patient age, epilepsy syndrome, and seizures. Participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. We then performed overnight polysomnography (PSG) and 24-hour EEG with additional oculography and chin muscle electrodes to distinguish sleep stages. The spike index (SI) during sleep was calculated as the sum of the durations of all epileptic discharges divided by the total sleep time. The duration of an epileptic discharge was measured from the start of the spike/polyspike to the end of the final wave. The arousal index (AI) was extracted from the PSG data according to the American Academy of Sleep Medicine guidelines. Data were analyzed using SPSS version 30. Spearman's rank correlation coefficient was used to evaluate the correlation between SI and AI, as well as between AI and PSQI. The Mann-Whitney U test was used to compare median values between independent groups. Results We enrolled a total of 16 patients (11 female) with a mean age of 14.7 years (±1.9). The IGE syndromes included juvenile myoclonic epilepsy (JME, n=7), juvenile absence epilepsy (JAE, n=5), and epilepsy with generalized tonic-clonic seizures alone (GTCA, n=4). The median PSQI score was 5 (IQR 2.25-9.50), with 8 of 16 patients (50%) reporting scores ≥5, indicating poor subjective sleep quality. The median SI was 0.0001 (IQR 0-0.009) and the median AI was 11.1 (IQR 9.25-20.3). A moderate positive correlation was found between the SI and AI (ρ=0.527, p=0.036). No significant correlation was observed between the AI and PSQI scores (p=0.834). Five of the 16 patients experienced daily seizures (absences, myoclonic seizures, or both); this subgroup had a median SI of 0.01 (IQR 0.006-0.02) and a median AI of 15.6 (IQR 10.1-22.4). The difference in AI between patients with and without daily seizures was not statistically significant (p=0.364). Conclusions In this study of a small sample of IGE patients, we found that interictal epileptic discharges may contribute to sleep fragmentation, as indicated by the moderate positive correlation between the spike and arousal indices. This relationship appeared to be independent of daily seizure occurrence or subjective sleep quality, highlighting that subclinical interictal activity itself may be a driver of poor sleep architecture in this population. The finding that half of our patients reported poor subjective sleep quality emphasizes the importance of screening for sleep problems in individuals with IGE. Further studies with larger sample sizes are needed to draw more reliable conclusions.

Su febrilia infekcija susijęs epilepsijos sindromas (FIRES) yra retas neaiškios etiologijos epilepsijos sindromas, kurio metu po karščiavimo epizodo pasireiškia dažni epilepsijos priepuoliai. Aprašomas 6 metų paciento, sergančio FIRES, klinikinis atvejis. Pacientui skirtas kompleksinis gydymas imunoterapija, vaistais nuo epilepsijos ir pradėta taikyti ketogeninė dieta. Dėl FIRES retumo trūksta geros kokybės tyrimų, kuriais vadovaujantis būtų galima užtikrinti tinkamą šių pacientų priežiūrą. Pristatydami šį klinikinį atvejį ir literatūros apžvalgą, aptariame savo patirtį, gydant FIRES sergantį pacientą. Gydymas ketogenine dieta, tocilizumabu ir anestetiku propofoliu buvo sietinas su dislipidemija ir pankreatitu. Nors dabartinėse FIRES gydymo gairėse kol kas trūksta duomenų apie kanabidiolio naudą, mūsų paciento atveju gydant kanabidioliu stebėtas reikšmingas epilepsijos priepuolių sumažėjimas. Dėl FIRES retumo ir sudėtingumo, tikslinga didinti budrumą dėl vaistų šalutinio poveikio bei aprašyti veiksmingus gydymo būdus.

Pastaraisiais dešimtmečiais priešlaikinių gimdymų pasaulyje daugėja, gerėja ir labai neišnešiotų mažesnio nei 28 sav. gestacinio amžiaus naujagimių išgyvenamumas. Tačiau, nustatyta, kad labai mažo gimimo svorio naujagimiams vis dar gresia didelė raidos sutrikimų rizika. Svarbu anksti nustatyti šiuos sutriki¬mus ir pritaikyti intervencines programas. Amplitudinė elektroencefalogramos (aEEG) kreivės pirmosios atspindi bet kokius naujagimio galvos smegenų ar bendrosios būklės pokyčius. Pasaulyje atliekami nauji tyrimai, kuriuose nagrinėjama dar viena aEEG panaudojimo sritis – remiantis pirmosiomis gyvenimo valandomis, paromis, savaitėmis neišnešiotiems nau¬ja¬gimiams registruotų aEEG rezultatais, galima prognozuoti raidos sutrikimo laipsnį kūdikystėje. Šio tyrimo tikslas - nustatyti amplitudine elektroencefalografija registruoto bioelektrinio smegenų aktyvumo prognozinę vertę numatant labai neišnešiotų naujagimių (< 32 sav. gestacinio amžiaus) neurologinę raidą sukakus 12 mėn. koreguo¬tam amžiui (KA). Visiems tiriamiesiems buvo užrašytos aEEG ir atliktos neurosonogramos iki vieno mėnesio amžiaus. Neurologinė raida vertinta kūdikiams sulaukus 12 mėn. KA. Tyrimo rezultatai parodė, kad pirmosios savaitės po gimimo bioelektrinis smegenų aktyvumas turėjo prognozinę vertę numatant 12 mėn. KA kūdikių motorinę raidą, o protinė raida nebuvo susijusi su bioelektriniu smegenų aktyvumu, bet nustatyta sąsaja su atviru arteriniu lataku.

The importance of sleep has been reported for decades. Epilepsy is a heterogeneous disorder comprising multiple elements that might influence sleep and wakefulness. Notably, animal studies show disruptions of the circadian molecular system in different models of epilepsy, along with altered rest–activity and other circadian rhythms. So far, studies of molecular circadian systems in people with epilepsy are lacking, prompting further research. Seizures—the primary and most debilitating symptom of epilepsy—and interictal activity disrupt regular sleep and sleep–wake rhythms. Alterations in one’s sleep structure are seen in both drug-naïve and drug-resistant patients with epilepsy. In particular, low sleep efficiency, a reduction in total sleep time, and changes in sleep stages were found in both homogenous and mixed samples of epilepsy patients. Both ictal and interictal activity were also shown to be associated with changes in peripheral circadian phase biomarkers such as melatonin and cortisol. Moreover, epilepsy comorbidities, antiseizure medications, and a variety of syndromes can be a cause of sleep problems or even sleep disorders. Sleep disorders vary depending on various comorbidities and syndromes, and encompass all major groups of sleep disorders defined in the International Classification of Sleep Disorders. Controversial findings on the effects of various antiseizure medications were found in the literature. However, medications such as benzodiazepines, gabapentinoids, and barbiturates are particularly associated with excessive daytime sleepiness. Overall, a sleep evaluation must be included in the management of every patient with epilepsy.

Introduction Determining the concentration of antiepileptic drugs is one of the most important factors in assessing the effectiveness of epilepsy treatment. Even small changes in drug concentration, around 20%, are associated with the frequency of seizures. Drug concentrations can fluctuate due to altered pharmacokinetics. Pregnancy is one such condition, as fluid balance and hormonal concentration in the body changes. Case Presentation A woman, aged 28, experienced an epileptic seizure in the 13th week of pregnancy. The patient has been diagnosed with epilepsy since the age of 14, and recently takes lamotrigine at 250 mg per day. The seizure-free period lasted 4,5 years. Serum lamotrigine concentration was measured at 4,29 mcg/ml, which had decreased compared to the result 3 months earlier. It was decided to increase the dosage to 300 mg per day. During pregnancy, 3 more epileptic seizures occurred. Testing revealed lamotrigine concentrations diminishing as low as 2,08 mcg/ml. The dosage was increased to 450 mg per day, which determined successful delivery. 2 months after delivery, the lamotrigine concentration was measured at 10,32 mcg/ml. It was decided to reduce the dosage to 400 mg per day. Subsequent testing showed a concentration of 8,75 mcg/ml, and a stable balance was achieved. Discussion Blood plasma volume increases throughout pregnancy, with the most significant changes occurring in the second trimester. In response to the increased blood volume, the glomerular filtration rate physiologically rises, potentially leading to increased excretion of substances, including drugs, in the urine. It is estimated that for many women (77%) taking lamotrigine, drug excretion increases by 220%. On the other hand, estradiol concentrations rise during pregnancy, which stimulates an increase in the UGT1A4 enzyme. This accelerates the metabolism of lamotrigine into an inactive metabolite. Conclusions Due to physiological changes in pregnancy, especially, during the second trimester, the concentration of lamotrigine decreased by more than 50%, resulting in the occurrence of epileptic seizures. After each seizure drug dosage was increased, which leads to safe delivery. Therefore, patients taking lamotrigine, particularly during pregnancy, must be closely monitored for potential insufficient concentrations, which could trigger epileptic seizures.

Šiame dokumente pateikiamos atnaujintos klinikinės praktikos rekomendacijos, apimančios suaugusiųjų ir vaikų obstrukcinės miego apnėjos diagnostiką ir gydymą.

Background and Objectives: Ketogenic diet therapy (KDT) has been used as a non-pharmacological treatment for childhood refractory epilepsy. Its efficacy and safety have been described in numerous studies and reviews. However, there have been fewer studies evaluating the challenges experienced by patients and their family members when starting KDT. When implementing a new treatment method, challenges arise for both the healthcare professionals and patients, making it important to summarize the initial results and compare them with the experiences of other centers. To analyze and evaluate the efficacy and safety of KDT in children with epilepsy, as well as to consider the challenges faced by their parents/caregivers. Materials and Methods: A retrospective analysis of patients’ data (N = 30) and an analysis of the completed questionnaires of the parents/caregivers (N = 22) occurred. Results: In the study group, 66.7% of the patients had a >50% decrease in seizure frequency, and 2/3 of them had a >90% decrease in seizure frequency or were seizure-free, which enabled reducing the anti-seizure medications in 36.4% of the patients, as well as reducing the hospital visits. Cognitive improvement and better alertness were subjectively reported by 59.1% of the parents/caregivers. No dangerous long-term adverse effects of KDT have been observed in the study group. The patients with generalized epilepsy experienced significantly more adverse events. Most of the adverse effects of KDT were related to the digestive system, but usually they were temporary and controllable. The challenges of the parents/caregivers were mostly related to social life issues and financial difficulties; the medical-related challenges were minimal. Conclusions: KDT is an effective and safe treatment option for children with drug-resistant epilepsy, and the challenges faced by families are resolvable. In order to ensure effective KDT, a multidisciplinary team is required. This would ensure smooth and comprehensive care and the timely resolution of emerging problems. The cooperation of the families undergoing KDT is also important, enabling them to share their experiences.