Study N165 was previously conducted double blind, placebo controlled study in Japanese patients with refractory partial onset seizures, in which efficacy and safety of levetiracetam (LEV) as an add-on therapy was evaluated (J. Jpn. Epil. Soc. 2010; 28: 3-16). Following N165 trial, the current study was further conducted as a multicenter, open-labeled, follow-up trial to evaluate the long-term efficacy and safety of LEV. Patients who completed the N165 entered the long term follow up trial. Starting with a daily dose of 3,000mg of LEV, patients could be treated at individualized dosages ranging from 1,000 to 3,000mg/day. Among 151 patients included in this study, the median percentage reduction from baseline in partial onset seizure frequency per week changed in a range from 34.4 to 48.9% over the course of the study (>36 months), suggesting that efficacy was maintained with long-term treatment of LEV. Three (3) patients (2.0%) were seizure-free for more than a year. The most common adverse events were nasopharyngitis, headache, somnolence, diarrhea and dizziness with all events reported as mild to moderate in intensity. In conclusion, LEV demonstrated its long-term efficacy and safety in Japanese epilepsy patients with partial onset seizures, with a daily dose of up to 3,000mg as an add-on therapy.

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We evaluated the effects of treatment with anti-epileptic drugs (AEDs) in patients with post-stroke seizures. Of 690 stroke patients, we retrospectively examined 63 (9.1%) who received AEDs, most (74.6%) of whom had already begun AED administration at another clinic. The AEDs used as first-line monotherapy were sodium valproate (VPA) (n=39, 61.9%), carbamazepine (CBZ) (n=10, 15.9%), and zonisamide (ZNS) (n=6, 9.5%), with others given to 8 (12.7%). Thirty-nine of the 63 patients (61.9%) were received AEDs after the initial attack, and twenty-four of the 63 patients (38.1%) were administered an AED as a prophylactic. The Japanese guidelines for treatment of epilepsy recommend that monotherapy should be started with CBZ for localization-related epileptic seizures. Post-stroke seizures are more likely to be partial seizures, thus CBZ should also be used for seizures after stroke. However, because of frequent and severe side effects, the use of CBZ might be avoided more often. Our sample size is small, and additional studies are needed to examine the use of AEDs after stroke to clarify guidelines for their administration, as well as their prophylactic use.

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This study was undertaken to investigate the prognosis of posttraumatic epilepsy (PTE) in 142 children who had completed in-patient rehabilitation in our hospital after traumatic brain injury (TBI). Thirty-seven cases developed epilepsy and 105 cases did not. The risk factors for PTE were abuse, acute subdural hematomas, severe and long consciousness loss, and complications such as poor mobility and mental deterioration. The incidence of PTE was low in the traffic accident and diffuse axonal injury groups.
The onset of PTE was within 2 years after TBI in 81.1% cases. The seizure types were partial seizures in 43 cases and generalized seizures in 13 cases. The average numbers of prescribed antiepileptic drugs (AEDs) were 2.1 in the total cases, 2.9 AEDs in the high seizure frequency (more than once a week) group, and 1.6 AEDs in the low frequency (less than once a month) group. The main AEDs were carbamazepine and valproate, followed by phenytoin, phenobarbital and clonazepam.

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Lamotrigine (LTG) is one of the new anti-epileptic drug, which is only approved for Lennox-Gastaut syndrome (LGS) in JAPAN.
We report the efficacy of LTG in 2 patients with LGS.
[Case1] 24-year-old man. The brain tumor and hydrocephalus was founded at 4-months of age, and tumor resection was done at 6-months of age. LGS developed at 3 years of age. Seizures were intractable against the many antiepileptic drugs. LTG was added to sodium valproate (VPA) and zonisamide (ZNS), because the seizures became worse at 22-years of age. Seizures were dramatically improved following LTG therapy. Cessation of ZNS was possible because the patient was seizure free for 2-years.
[Case2] 22-year-old man. LGS developed after acute encephalitis at 1 year of age. Seizures were intractable against the medication with VPA, clonazepam, phenitoin and ZNS, so LTG was added at 20 years of age. After LTG therapy, seizures were decreased remarkably, but about six months after LTG therapy, seizures have increased.
LGS is extremely intractable epilepsy and its causes are greatly various. We suggest that the different efficacy of LTG therapy for LGS may be influenced by the underlying disease causing LGS.

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We report a 15 year-old-male experiencing actualized epileptic seizures after mild traumatic brain injury. Since age 13 years, he had occasionally had an uncomfortable feeling similar to blepharoptosis. At 15 years of age, he was punched in the head during a fight. Three days after the incident, a tonic seizure occurred involving his right arm after the uncomfortable feeling in his eyelids. This seizure progressed to a secondary generalized seizure. There were no abnormal findings on head MRI. At first, the seizures were regarded as non-epileptic convulsions due to acute stress disorder caused by the fight. However, long-term video EEG monitoring revealed that all seizures corresponded to abnormal epileptic activities. The mild head injury without abnormal findings on head CT/MRI is often regarded as non-serious brain trauma not warranting medical intervention. However, this case suggests that some epileptic activities can be induced by very mild traumatic brain injury. In patients with post-traumatic complaints, it is important to conduct not only head CT/MRI examinations but also EEG.

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Startle epilepsy was observed in a seven-year-old girl with hypomyelination of the right frontal area. Since five years of age, massive myoclonic, atonic, and tonic seizures were triggered in her by unexpected auditory stimuli. Interictal electroencephalogram (EEG) depicted spontaneous multifocal spikes, and ictal EEG depicted a diffuse electrodecremental pattern. Magnetic resonance imaging revealed hypomyelination of the right frontal area. Single photon emission computed tomography demonstrated diffuse low perfusion in the right cerebral hemisphere. In addition, we used near-infrared spectroscopy (NIRS) to detect the focal epileptic region. A two-wavelength 24-channel frequency-domain NIRS was applied to monitor brain tissue oxygenation and hemodynamics. NIRS showed that convulsive seizures were associated with an increase in cerebral blood volume of the right frontal area, especially the right premotor area. It is useful for diagnosis of startle epilepsy by exploring the epileptogenic foci and pathophysiological mechanisms.

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A 34-year-old woman had suffered from refractory temporal lobe epilepsy since childhood, and had experienced episodes of complex partial seizures more than several times a week. She had owned a dog for 10 years; over the past 4 years, the dog had learned to recognize when the patient was having a seizure based on her facial expressions. When she was having a seizure, the dog barked at her and alerted her family members. In the event of seizures, the dog's recognition of and response to seizures may be effective in helping this patient to obtain assistance more quickly. As dogs have been shown to be able to recognize smiling human faces, it is likely that dogs are also able to detect changes in a patient's facial expressions during seizures. In Europe and the US, service dogs are used to provide assistance to individuals with epilepsy. These dogs help to improve patients' quality of life, including participation in society. I hope that service dogs that are able to assist patients with epilepsy can be introduced in Japan as well, and discussed various problems associated with the dissemination of these service dogs in Japan.

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