Does Epilepsy Get Worse With Aging?

Re: Does Epilepsy Get Worse With Aging?

Submitted by 3Hours2Live on Wed, 2010-03-24 - 01:50

Hi Tara, I re-read the Juvenile Myoclonic Epilepsy (JME), (aka Janz Syndrome), section in "The Epilepsies" by C. P. Panayiotopoulos (2005), pp. 308-320, and much of the information appears incompatible to 20% exceptional. Firstly, JME is an Idiopathic Generalised Epilepsy (IGE), p. 271, and not a focal epilepsy. "In occipital epilepsy, the deviation of the eyes is usually pursuit-like or tonic, rarely clonic.......Conversely, ictal eye movements of extra-occipital origin are more violent and look unnatural....symptomatic visual seizures more frequently progress to other exta-occipital seizure manifestations and mainly temporal lobe seizures" p. 429. Secondly, "One-fifth of patients describe their jerks as unilateral, but video EEG shows that the jerks affect both sides." p. 309. "All seizures are probably lifelong, though improve after the fourth decade of life." But, "Patients with all three types of seizures (JME, GTCS, absences) are more likely to be resistant to treatment." p. 315. Thirdly, "Zonisamide is also a broad-spectrum AED, but its role in JME is largely unknown and probably weak." p. 320. Klonopin (clonazepam) "is one of the most effective anti-myoclonic drugs, but clonazepam alone may not suppress and may even precipitate GTCS." "Clonazepam should be given in small add-on doses.....when myoclonic jerks persist and are troublesome despite adequate monotherapy with another broad-spectrum AED." "Levetiracetum fulfils all expectations as probably the best new AED in the treatment of JME...." p. 317. Fourthly, "Accepted practice for the management of 'epilepsy' is often inappropriate in JME" (IN BOLD RED) p. 315. "Withdrawing treatment in JME is often an erroneous medical decision. More than 80% of patients will relapse." Migraine, with or without headache, aura of bright floaters, lines, various shapes, are common, while sensory "cross-over" with migrainous olfactory hallucinations are infrequent (about 1% to 13% of clinic patients). "Migraines" by Robert A. Davidoff (2002), p. 53, pp. 68-70. (limited preview on books.google). The general rule-of-thumb is, if it lasts longer than 5 minutes, blame a migraine, if it lasts less than 5 minutes, suspect a seizure. Panayiotopoulos weighs most toward seizures: "The concept of migralepsy and its synonymous intercalated sezures or of an epilepsy-migraine sequence needs re-evaluation based on accurate diagnosis. In most instances, it is seizures imitating migraine." (In red) p. 428, Panayiotopoulos. The Limbic System is the most prone to kindling, and things from high fevers, injuries, GTCS, TLE, etc. can damage and/or further kindle damage in the Limbic System, resulting in larger and larger ranges of neurological impairments (the Limbic System and the Temporal Lobes somewhat over-lap, depending on which schools of neurology are involved). Limbic based depression has the characteristic of being "one-sided," with some seizures resulting in episodes of Limbic based depression, and other seizures eliminating episodes of Limbic based depression (which somewhat mirrors the basis of "old-school" electro-shock therapy to treat severe depression). The book "Behavioral Aspects of Epilepsy" by Schachter, Holmes, and Trenite (2008) has a moderate section on kindling, and one chapter focused on the notion of "Forced Normalization," but the book leans toward psychiatry more than neurology. books.google gives 32 results in the book for "kindling," and it gives 21 results for "Forced Normalization." The book Trimble, M.R. and Schmitz, B. (1998) Forced Normalisation and Alternative Psychoses of Epilepsy, Wrightson Biomedical Publishing: Petersfield is available with limited preview at amazon.com, with the chapter by Robertson, M.M. (1998) Forced normalisation and the aetiology of depression in epilepsy, In: Trimble, M.R. and Schmitz, B. (eds), Forced Normalisation and Alternative Psychoses of Epilepsy, Wrightson Biomedical Publishing: Petersfield, pp. 143167. An "old school" article about "Forced Normalization" is at: http://www.asnp.ch/pdf/1998/1998-06/1998-06-064.PDF A more "new school" article about depression and epilepsy that cites Robertson and Trimble/Schmitz is at: http://tan.sagepub.com/cgi/content/abstract/2/5/337 By exploiting the "handedness" of the Limbic System I can usually eliminate post-seizure depression by "stoking" sensations of intense hatred, which is on the opposite side in the Limbic System than Limbic based depression. Most aspects of Pavlovian Conditioning and Aversive Conditioning is also based in the Limbic System, so there should be a way to exploit them in controlling more aspects of epilepsy too!!! The novel/film "A Clockwork Orange" based "The Ludovico Technique" on a satire version of Aversive Conditioning, but much like a strong PTSD, such conditioning is strong and long lasting (maybe too much so, as I wonder if seizures don't often inadvertantly result in such conditioning, giving the problems of one branch of PNEAs once seizures are in fact otherwise controlled). Tadzio