Changes of serum concentration of lamotrigine (LTG) and seizure frequency during pregnancy were investigated in 16 pregnancies of 13 patients with epilepsy. 15 of 16 cases gave birth. There was no case with major fetal malformation. One patient died of drowning by seizure during bathing at 27 weeks of pregnancy. The average LTG doses before pregnancy were 216.7±60.6 mg in monotherapy group (6 cases) and 270.0±126.8 mg in polytherapy group (10 cases). The median blood concentration before pregnancy was 7.8 μg/ml, and the median rate of decrease of blood concentration during pregnancy was 62.35%. The LTG dose was increased during pregnancy in 43.75% and other antiepileptic drugs were added in 18.75% of cases. Generalized tonic-clonic seizures worsened in 4 cases and complex partial seizure appeared more often in 5 cases as compared to pre-pregnancy period. 25% of cases required LTG dose higher than that indicated in the package insert. Our data indicates a need of careful management of LTG in pregnant women with epilepsy to avoid aggravation of seizures.
It is known that in general, there is social stigma toward epilepsy. Explicit attitudes, often measured via self-report questionnaires, are consciously accessible and controllable. The implicit association test (IAT) was developed to assess implicit attitudes that are not consciously controllable. The present study used IAT to investigate implicit stigma toward epilepsy in lay people (n=21) and in medical students (n=42). Participants completed a set of IAT word sorting tasks. We used "epilepsy" and "diabetes" as "target categories," and "bad" and "good" as "attribute categories". In addition, participants answered questionnaires covering knowledge of epilepsy and presenting images of epilepsy that may affect stigma, such as epilepsy being familiar, threatening, or having out-group status. The results showed an IAT effect in which lay people showed a stronger connection between "epilepsy" and "bad" than medical students. This indicated that medical students had less stigma toward epilepsy compared with lay people. Participants with less knowledge about epilepsy had a stronger threatening image of epilepsy, and participants with a stronger threatening image of epilepsy had more stigma about epilepsy. Our findings suggest that adequate knowledge about epilepsy resulted in a decrease in implicit stigma toward epilepsy.
The aim of this study is to clarify an effectiveness of rehabilitation for the cognitive dysfunction in patients with epilepsy, and to extract clinical and medical factors related to the cognitive dysfunction of patients with epilepsy. Medical records of 51 patients with symptomatic partial epilepsy were investigated. The cognitive functions were evaluated by Hamamatsu Higher Brain Function Scale (HHBFS). The comparison of the scores in HHBFS between the first evaluation and re-evaluation, the comparison of changes in the scores between the patients with and without the intervention of occupational therapy were made. Multiple regression analysis was performed to extract the factors related to the improvement of the scores in HHBFS. As a result, an improvement of cognitive function in patients with epilepsy was revealed between the first evaluation and re-evaluation, and the more significant improvement was seen in patients with the intervention of occupational therapy than those without in some subscales of HHBFS. Moreover, multiple regression analysis revealed that the factors related to the improvement of cognitive function were discontinuation of the specific antiepileptic drugs and intervention of occupational therapy.
We report a 20-year-old female, right handed, with occipital lobe epilepsy (OLE), psychogenic non-epileptic seizure (PNES), and developmental dyslexia (DD). At the age of 16, she experienced her first seizure, accompanied by loss of consciousness, and then repeated seizures. She was hospitalized for diagnosis of epilepsy and control of seizures. She spoke fluently, but complained of various language problems such as difficulty learning Kanji (Chinese characters), reading aloud, etc. We therefore assessed whether she had any neuropsychological or language deficits. Results revealed no visual recognition problems but she did have DD. The influence of OLE on language problems was not clearly explained. She suffered from various learning difficulties and, owing to the late diagnosis of DD, had been misunderstood as indolent. In addition to reading and writing difficulties, DD is known to cause secondary problems such as learning and psychogenic problems. It was supposed that the conflict between learning disabilities due to DD and the desire to meet family expectation was a cause of the patient's PNES. To detect language and neuropsychological problems as early as possible, we need to construct new systems, such as placing specialists at schools a in certain intervals to support children by identifying DD for the first time. Since epilepsy occurs with developmental problems, including learning disabilities, we need to screen language and cognitive problems at the beginning of epilepsy diagnosis to follow up on problems, to analyze anti-epileptic drug side effects, and to provide necessary support.
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