Carbamazepine (CBZ) is used for treatment of epilepsy, mood disorders, schizophrenia and trigeminal neuralgia. Hearing impairment (tinnitus, hypersensitivity, hearing loss, pitch perception shift) is a rare adverse effect of CBZ. We present two cases of reversible auditory disturbance caused by CBZ-induced pitch perception shift.

We then reviewed the literature, excluding duplicate cases, and added our two cases, bringing the total to 27 cases (7-42years). Our analysis revealed as following. Sex: Female 18 (66.7%), A half tone lowered pitch perception within 2 weeks: 23 (85.2%), Musical background: digital instrument 14 (51.9%), non-digital instrument 4 (14.8%), Absolute pitch perception: 10 (37.0%), suspected to have absolute pitch 3 (11.1%).

Hearing impairment caused by CBZ is mainly a decline in pitch perception after soon medication and recovers quickly when medication is discontinued. However, recovery has also occurred in our case 2 with long term administration.

There have also been cases where hearing impairment has improved with continued medication in patients who have gradually reduced the dosage and who had low levels from the beginning. Hearing impairment caused by CBZ is thought to be a functional disorder of neural network. Players of digital instruments and those with perfect pitch are more likely to notice changes in pitch.

Metabolic epilepsy is epilepsy caused by metabolic abnormalities, often with a genetic component. Metabolic abnormalities result in impaired energy supply to the central nervous system, accumulation of toxic substances and abnormal neurotransmitters, which trigger seizures. Symptoms other than epileptic seizures (e.g. hypoglycaemia, inactivity, recurrent physical deterioration) are important for diagnosis. Diagnosis is based on blood tests, metabolic screening, MRI of the head and genetic analysis, with genetic analysis improving the accuracy of diagnosis. Treatment consists of correction of metabolic abnormalities and management of seizures. Treatment of metabolic disorders includes nutritional therapy and enzyme replacement. Antiseizure medication and ketone diet therapy are used to treat epileptic seizures. Although metabolic epilepsy is rare, it should be differentiated to avoid overlooking a condition for which there is a specific treatment.

The varied symptoms and historical context of epilepsy frequently lead to misinterpretation, resulting in enduring stigma that diminishes sufferers' quality of life (QOL). Recent initiatives by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) have enhanced public awareness. In Japan and other regions of Asia, cultural stigma persists, obstructing social engagement for sufferers. To address this issue, we developed "EpiloBot," an AI chatbot that provides unbiased access to crucial information. The intervention made patients better at understanding and thinking about jobs, which shows that natural language processing (NLP) can be used to help people in a variety of situations. Nonetheless, obstacles persist in mitigating self-stigma, underscoring the necessity for the evaluation of long-term interventions. Future projects should look into how well different types of psychosocial interventions work, such as technology that is run by AI, and they should do research all over the country to create an environment where people with epilepsy and their supporters can interact with others without being judged.

This review aims to support physicians in preparing medical certificates for epilepsy patients utilizing welfare services, particularly those related to mental disorders. Although epilepsy is medically classified as a neurological disorder, Japan's welfare system often treats it as a mental disorder, requiring physicians to complete documents such as disability pension certificates, mental disability certificates, and self-support medical care applications. This discrepancy may cause confusion among physicians, making it essential to understand the current system and respond appropriately. For disability pensions, seizure frequency and type significantly impact classification, with more emphasis on episodes involving loss of consciousness or falls. If seizures are controlled, patients may lose eligibility for support, necessitating consideration of comorbidities such as cognitive impairment or depression. Descriptions of daily living and work abilities must be precise and fair. Mental disability certificates provide financial and employment support, while self-support medical care applications reduce medical expenses. Physician statements under the Comprehensive Support for Persons with Disabilities Act influence eligibility assessments, emphasizing the need for detailed descriptions of necessary support.

The insula, located deep within the Sylvian fissure, had long been inaccessible to the direct exploration of its functional roles and ictal involvement. During the era of intra-operative electrocorticography in the 1950s, Penfield and pioneering neurosurgeons identified residual spikes within the insula following temporal lobectomy and visceral as well as somatosensory symptoms upon direct electrical stimulation. However, it was not until the advent of modern stereo-electroencephalography (SEEG) technique that the intracranial electrodes could be safely and chronically implanted within the insula, thereby enabling anatomo-electro-clinical correlations during insular seizures. Since the first report of SEEG-recorded insular seizures in the late 1990s, the semiological knowledge of insular lobe epilepsy (ILE) has rapidly expanded. ILE has diverse clinical presentations due to the multifaceted functions of the insula and its rich anatomo-functional connections. They include somatosensory symptoms involving a large/bilateral cutaneous territory and/or taking on thermal/painful character, cervico-laryngeal discomfort ranging from slight dyspnea to laryngeal constriction, epigastric discomfort/nausea, hypersalivation, auditory, vestibular, gustatory, and aphasic symptoms. Importantly, these symptoms are mostly subjective and often masked by more overt symptoms of extra-insular seizure propagation, such as hyperkinetic behaviors due to frontal propagation. Therefore, a possible insular origin of seizures should be considered in non-lesional frontal/temporal/parietal epilepsies.

Status epilepticus is defined as a seizure that persists above a threshold length of time or is repeated frequently without recovery of consciousness between attacks. At present, seizures lasting 5-15 min are considered early status epilepticus according to the revised definition by the International League Against Epilepsy. Emergency treatment for these seizures is also started at the same time. Although treatment strategies for the early, established, and refractory stages of status epilepticus are well described in the Japanese clinical practice guidelines for epilepsy, recent results of clinical studies and recommendations in Western clinical practice guidelines suggest a need for more rapid treatment for seizures with a high risk of progressing to status epilepticus. In this paper, we summarize the results and recommendations of current Western guidelines. We also propose a treatment strategy based on our assessment of these summarizations. Herein, our recommended treatment strategy is referred to as "First Aid for Seizure Termination (FAST)." FAST targets the onset of 1) seizure clusters, and 2) prolonged seizures.

In 1968, I began clinical practice and research on epilepsy among children as part of pediatric neurology. My research primarily focused on neonatal seizures, as well as West syndrome, Lennox-Gastaut syndrome, and benign epilepsy of children with centrotemporal foci. Additionally, I studied the natural history of pediatric epilepsy, intractable epilepsy, the epidemiology of epileptic discharges in general population, behavioral disorders in children with epilepsy and compliance in epilepsy.

In 1995, I served as the president of the 19^th Annual Meeting of the Japan Epilepsy Society (Beppu City, Oita Prefecture, Japan). After retiring from the national hospital in 2000, I worked at a rehabilitation hospital for epilepsy associated with developmental disorders where I interpreted the electroencephalogram of older adults as well until 2020.

Most of these research were conducted as part of group projects for the Ministry of Health, Labor, and Welfare or as symposium themes for the Japan Epilepsy Society.