In this literature review, we describe the epidemiology, mechanism of development, and medical or surgical treatment of brain tumor-related epilepsy. We found that 70-90% of patients with low-grade glioma presented with epilepsy, which disappeared postoperatively in 75% of patients. Prognostic factors for postoperative seizure control included preoperative medical control, the duration of seizure (≤1 year), and gross total resection (GTR) of the tumor. For temporal lobe tumors, GTR with hippocampectomy and/or corticectomy was more effective than GTR alone. Patients should undergo surgery within 3 years after the onset of epilepsy. Levetiracetam (LEV) or gabapentin is recommended as an add-on to conventional anti-epileptic agents for refractory seizures. A combination of LEV and valproic acid was reported to be more effective than LEV monotherapy and serves as an alternative to phenytoin as postsurgical medication. LEV monotherapy was proven to be effective for seizures and to improve patient quality of life. Expression synaptic vesicle 2 A protein, which is a LEV-binding protein, was reported to predict patient response to LEV.

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In recent years, there have been sporadic incidents of traffic accidents caused by epilepsy. We investigated the real state of these cases and the criminal liability of drivers. We study twenty-two cases dating from 1966 to 2011. Though the Traffic Road Law, which was changed in 2002, enabled epileptics to obtain a driver's license, none of the drivers declared their pre-existing epileptic condition. Seventeen drivers (77.3%) were prosecuted, and five drivers (22.7%) were not prosecuted. Fourteen (82.4%) of the seventeen cases that were handed down a sentence resulted in convictions. The sentencing appears to have become more severe as the years pass. The majority of the drivers continued driving, although they were advised to refrain from doing so by doctors. We think that it is necessary to establish a system to evaluate driving skills. Moreover, it is important to enlighten doctors so that they are better able to advise patients whether it is safe to drive.

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We evaluated the efficacy, safety and pharmacokinetics of topiramate (TPM) as adjunctive therapy in 59 Japanese children with symptomatic or cryptogenic localization-related epilepsy aged between 2 and 15 years. The median percent reduction in partial seizure rate during the treatment period was 34.0%, and the 95% confidence interval (CI) was 16.3% to 50.3%. Since the lower limit of the 95% CI was greater than the prespecified reference rate of 10%, we confirmed the efficacy of the TPM adjunctive therapy. A multivariate analysis revealed that the efficacy against cryptogenic localization-related epilepsy was siginificantly higher than that against symptomatic localization-related epilepsy. The major adverse reactions (ADRs) were decreased blood bicarbonate (20.3%), somnolence (15.3%), hypohidrosis (10.2%) and decreased appetite (5.1%). The incidences of decreased blood bicarbonate and hypohidrosis were higher than those in the previous study of TPM adjunctive therapy in adult patients. As a serious ADR, status epilepticus occurred in 1 patient, which was recovered by discontinuation of TPM and other treatments. Four patients were withdrawn from the TPM treatment due to non-serious ADRs, which were recovered after discontinuation of TPM treatment. We conclude that TPM adjunctive therapy is safe and useful for the treatment of partial seizures in Japanese children with symptomatic or cryptogenic localization-related epilepsy.

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We conducted questionnaire surveys on members of the Japanese Society of Child Neurology (JSCN) and Societas Neurologica Japonica (SNJ) regarding carryover of epilepsy patients. While 95% of JSCN members knew the term "carryover", only 46% of SNJ members did, showing a remarkable difference. Sixty-nine% of JSCN members compared with 78% of SNJ members felt difficulties with epilepsy care. The reasons common to both groups were psychiatric/psychological complications and laws/regulations on epilepsy, while JSCN members also responded no adult inpatient facilities, and SNJ members also responded not familiar with epilepsy diagnosis and interpretation of EEG. The factor hindering transition given by JSCN members was no specialist in adult epilepsy nearby, and those given by SNJ members were difficult to have full picture of the disease course from childhood and not familiar with childhood-specific epilepsy syndromes. From the above findings, we propose that cooperation not only between pediatric neurologists and adult neurologists but also with other disciplines such as psychiatrists, collaboration among relevant societies, as well as national education are necessary to achieve better transition from pediatric to adult care for epilepsy patients.

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This report describes a female patient with subcortical band heterotopias (SBH) who had Lennox-Gastaut syndrome and was observed by day-long video recording and electroencephalography (EEG). Ictal EEG during atonic seizures showed sharp waves that appeared predominantly over the bilateral frontal area at the beginning of the seizures. Subsequently, a generalized slow wave appeared, coincident with the sudden interruption of electromyography (EMG) activity, followed by a generalized spike burst. During the motion arrest that followed, with the low-amplitude EMG, intermittent runs of rhythmic high-voltage slow waves appeared synchronously over the bilateral frontal regions. A total callosotomy was performed, and the atonic seizures disappeared. The ictal EEG findings and post-surgical clinical course suggested that the atonic seizures in this patient were caused by bilateral synchronous epileptiform discharges occurring from the frontal lobe. Atonic seizures in SBH patients may differ from those related to the generalized discharges on ictal EEG.

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The number of patients with epilepsy receiving chronic hemodialysis is expected to increase, as the population continues to age in Japan. We report a patient with frontal lobe epilepsy receiving chronic hemodialysis and formerly treated with valproate and phenytoin, in whom post-dialysis seizures were controlled by additional zonisamide. The patient was a 50-year-old woman. Intermittent hemodialysis was initiated when she was 43 years of age due to aggravation of interstitial nephritis. At 49 years of age, she began to experience convulsive seizures. Symptomatic localization-related epilepsy caused by old cerebral infarction in right frontal lobe was diagnosed, and treatment with valproate 1,400mg/day and phenytoin 175mg/day was started. However, seizures continued to occur during post-dialysis period. She was referred to our hospital. Slight increases of the valproate and phenytoin dosages achieved seizure control. She was seizure-free for 3 years, until 53 years of age, when post-dialysis seizure reappeared. Addition of zonisamide 500mg/day was effective in stopping her seizures. Mean elimination rates of the antiepileptic drugs by hemodialysis were 46% for valproate, 33% for phenytoin, and 18% for zonisamide. During treatment of patients with epilepsy receiving chronic hemodialysis, monitoring pre- and post-dialysis blood concentrations and adjusting the doses of antiepileptic drugs are essential to achieve optimal pharmacotherapy.

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Brain perfusion SPECT, ¹⁸F-FDG PET and ¹²³I-iomazenil SPECT are used to detect epileptic foci in candidates with partial seizures for epileptic surgery. Interictal ¹⁸F-FDG PET detects decreased glucose metabolism in epileptic focus and its surrounding area. It has high detectability of epileptic focus in temporal lobe epilepsy, but low detectability in extratemporal lobe epilepsy. ¹²³I-iomazenil SPECT that is partial agonist to central type benzodiazepine receptor detects a focus as more localized decreased accumulation than ¹⁸F-FDG PET or brain perfusion SPECT. Although interictal brain perfusion SPECT detects decreased perfusion in epileptic focus and its surrounding area, it has low detectability as compared to ¹⁸F-FDG PET. In contrast ictal SPECT has high detectability of a focus as increased perfusion. Statistical image analysis is useful for detection of epileptic focus. This statistical approach is also applicable to detection of focal cortical dysplasia as an epileptic focus in voxel-based morphometry using structural MRI.

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Gelastic seizure (GS) is a cardinal symptom of patients with hypothalamic hamartoma (HH). It is always non-mirthful rather than mirthful GS with temporal lobe epilepsy. There were also several case reports of frontal lobe epilepsy or parietal lobe epilepsy associated with non-mirthful GS. We elucidated the pathophysiological network of GS based on the series of 80 patients with HH. We disclosed that ictogenesis resided within the interface zone of HH itself and propagation network as symptomatogenesis was implicated in mediodorsal (MD) nucleus of the thalamus, facial nuclei of pons, and cerebellum on study of ictal single-photon emission computed tomography. Amygdala is implicated in the center of emotion and MD nucleus of the thalamus is implicated in the center of laughing motion. Only unidirectional connection between amygdala to MD nucleus affects GS without mirth. Hemifacial hyper-expression on GS is likely to be one of the lateralizing sign. Furthermore, MD nucleus of the thalamus is also implicated in memory and behavior because this nucleus is chronically bombarded with epileptic propagation. This is main reason why epileptic encephalopathy associated with HH is treatable after surgery.

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The number of adult epilepsy patients is several times larger than that of pediatric epilepsy patients. In Japan, since there are few specialists who care for adult epilepsy patients, pediatricians not only care for children but also a proportion of adult patients. Although it is anticipated that the number of neurologists who specialize in epilepsy will increase and will be responsible for the care of most of the adult epilepsy patients, treatment for epilepsy patients with psychiatric symptoms require collaboration between psychiatrist and neurologist.
The number of elderly onset epilepsy continues to increase accompanying aging of the Japanese population. The symptoms and treatment of epilepsy in the elderly differ in some aspects from those of epilepsy in younger patients. Onset of epilepsy in the elderly may be misdiagnosed as dementia, and this aspect requires attention.
Epilepsy patients with psychiatric symptoms often take a combination of antiepileptic and antipsychotic drugs. Since these drugs interact with each other to affect the pharmacological actions and blood concentrations, these interactions should be considered during combined use of these agents.

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