About three cases that presented the psychotic symptoms (Postictal psychosis, Alternative psychosis, Chronic psychosis) associated with epilepsy, we tried interpretation based on Neojacksonism. The psychotic symptoms of the patients usually start more than ten years after the onset of the epileptic seizures. During this period, we assume that a repeated seizure may make higher brain function lead to instability and gradually weaken. Under this condition, in case the higher brain function heavily collapses, the brain function located in low layers are released and activated psychodynamically. However, the manifestation releasing from the lower brain function may give a misleading result.
The effects of enzyme inducing antiepileptic drugs (EIAED) on laboratory test values were studied in 277 patients with epilepsy treated with antiepileptic drugs (AED). The patients were divided into an EIAED group and a non-EIAED group. Total cholesterol (TC) and alkaline phosphatase (ALP) were significantly higher (p<0.001 for both) and white blood cell count was significantly lower (p<0.01) in the EIAED group than in the non-EIAED group. In all subjects, ALP was significantly higher in males (p<0.05), and ALP increased with age in females. Especially, ALP was significantly higher in the EIAED group than in the non-EIAED group irrespective of gender (males: p<0.001, females: p<0.001). The proportion of patients with abnormal level of bone-specific isoform of ALP (bALP) was significantly high in the EIAED group than in the non-EIAED group (12% versus 3%, p=0.015). These findings suggest that the enzyme-inducing effects of EIAED may impact on both lipid and bone metabolism. Therefore, regular monitoring and dose adjustment have to be considered.
Hemimegalencephaly is characterized by severe psychomotor impairment and intractable epilepsy, which is often requires a hemispherotomy. After hemispherotomy, epileptic discharges may sometimes occur in the non-affected hemisphere even when clinical seizures do not recur for a long time. We evaluated six cases of hemimegalencephaly after hemispherotomy with a seizure-free period lasting at least 36 months, which we could track using video-electroencephalography. Developmental age (DA) and developmental quotient (DQ) were evaluated using the developmental check- list (Kinder Infant Developmental Scale). We found the DQ declined and the total DA increased in all cases. To study the correlation between DA and epileptic discharges in the non-affected hemisphere, we measured the paroxysmal-index (PI) the number of one-second bins containing one or more epileptic discharges in the non-affected hemisphere, divided by the total number of seconds. The PI and DA data were collected at the same time during every regularly-scheduled evaluation. We calculated the rate of change of PI and DA. Interestingly, expressive language development and PI were negatively correlated when the PI increased at a rate above average. The receptive language DA and PI was not correlated. This finding suggests the expressive language development delay may worsen when epileptic discharges of non-affected side increase.
Tokyo medical examiner's office conducts postmortem examination and determine cause and manner of death for all cases of sudden and unexpected death and unnatural death within the central part of Tokyo. If the cause of death cannot be determined by the external examination, we perform an autopsy examination. We report the statistical trends of unexpected epileptic deaths for 20 years, from 1995 to 2015. The total number of unexpected epileptic deaths was 364 cases (0.15% of the total inspection number), including 201 cases (55.2%) of autopsy examinations. The acute death which is comparable to SUDEP was ranked first (52.5%, 191/364). Males were two-and-a-half times large number than females (135 males, 56 females) and more than half of the cases occurred while asleep. The second was death by drowning (29.1%, 106/364). The drowning occurred with nearly equal frequency in both sexes (52 males, 54 females). We found that the characteristic body position of epileptic death was "legs up" as if they slid down the back of the bathtub under the water.
To assess the effect of amendment of driving license regulations and introduction of the new law in 2014, we performed a questionnaire survey to the driving authorities (DA) and physicians of the Japan Epilepsy Society as a successor of serial investigations since 2002. Prominent increase was noted in the number of recognition of people with epilepsy (PWE) by DA and the number of reception of medical certificate between 2010 and 2013. The number of rejected application of drivers' license was increased prominently between 2013 and 2015. A limited number of physicians reported of PWE to DA. Less than half physicians supported the seizure-free period of 1 year for qualification of driver's license.
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