Myoclonic epilepsy with ragged red fibers (MERRF) syndrome is a rare mitochondrial disorder marked by myoclonus, ataxia, cognitive impairment, myopathy, and sensorineural hearing loss. Seizures in MERRF syndrome are often resistant to standard antiseizure medication. We present a unique case of an adult patient with MERRF syndrome, caused by the m.8344A > G point mutation, who developed super-refractory status epilepticus (SRSE), successfully managed by the initiation and rapid escalation of vagus nerve stimulation (VNS) therapy. Over a two-year follow-up period, the VNS therapy enabled a long-term control of generalized tonic-clonic seizures. A further status epilepticus has not yet occurred. VNS may therefore be a promising therapeutic option for managing SRSE in patients with mitochondrial epilepsy syndromes.
{"title":"Successful application of vagus nerve stimulation in super refractory status epilepticus associated with MERRF syndrome","authors":"Leyla Baysal , Sabrina Jobi , Simone Zimmermann , Ann-Kristin Helmers , Nils Gerd Margraf","doi":"10.1016/j.ebr.2025.100769","DOIUrl":"10.1016/j.ebr.2025.100769","url":null,"abstract":"<div><div>Myoclonic epilepsy with ragged red fibers (MERRF) syndrome is a rare mitochondrial disorder marked by myoclonus, ataxia, cognitive impairment, myopathy, and sensorineural hearing loss. Seizures in MERRF syndrome are often resistant to standard antiseizure medication. We present a unique case of an adult patient with MERRF syndrome, caused by the m.8344A > G point mutation, who developed super-refractory status epilepticus (SRSE), successfully managed by the initiation and rapid escalation of vagus nerve stimulation (VNS) therapy. Over a two-year follow-up period, the VNS therapy enabled a long-term control of generalized tonic-clonic seizures. A further status epilepticus has not yet occurred. VNS may therefore be a promising therapeutic option for managing SRSE in patients with mitochondrial epilepsy syndromes.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100769"},"PeriodicalIF":1.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-14DOI: 10.1016/j.ebr.2025.100771
Evangeline A. Huis in 't Veld , Olga Braams , Willem M. Otte , Peter van Rijen , Kees P.J. Braun , Renske Schappin
After epilepsy surgery, it varies when children re-enter school. The aim of this study was to identify determinants for this variation. Parents of 21 school-attending children participated in semi-structured interviews during their child’s hospitalization for epilepsy surgery and one year afterward (based on the standard neuropsychological post-surgical follow-up). The mean time to school re-entry was 10.7 weeks (SD = 6.3). One child did not attend school after one year, whilst the fastest child resumed school 2 weeks after surgery. We performed univariable linear regression models with bootstrapped R2 for all variables deemed theoretically or clinically relevant to school re-entry. We found that temporal surgery was significantly related to shorter time to school re-entry; and that longer hospitalization, and presurgical outpatient educational counseling were significantly related to longer time to school re-entry. In multivariable linear regression, these variables together predicted 57% of variance (bootstrapped) in time to school re-entry. In conclusion, our findings indicate that school re-entry varies considerably among children but can partly be explained by surgery related variables and the presence of counseling. Given the importance of school in children’s daily lives, we argue that school attendance should be stimulated by increasing professionals’ awareness of children’s school re-entry process.
{"title":"Exploring determinants of time to school re-entry after pediatric epilepsy surgery","authors":"Evangeline A. Huis in 't Veld , Olga Braams , Willem M. Otte , Peter van Rijen , Kees P.J. Braun , Renske Schappin","doi":"10.1016/j.ebr.2025.100771","DOIUrl":"10.1016/j.ebr.2025.100771","url":null,"abstract":"<div><div>After epilepsy surgery, it varies when children re-enter school. The aim of this study was to identify determinants for this variation. Parents of 21 school-attending children participated in semi-structured interviews during their child’s hospitalization for epilepsy surgery and one year afterward (based on the standard neuropsychological post-surgical follow-up). The mean time to school re-entry was 10.7 weeks (SD = 6.3). One child did not attend school after one year, whilst the fastest child resumed school 2 weeks after surgery. We performed univariable linear regression models with bootstrapped R<sup>2</sup> for all variables deemed theoretically or clinically relevant to school re-entry. We found that temporal surgery was significantly related to shorter time to school re-entry; and that longer hospitalization, and presurgical outpatient educational counseling were significantly related to longer time to school re-entry. In multivariable linear regression, these variables together predicted 57% of variance (bootstrapped) in time to school re-entry. In conclusion, our findings indicate that school re-entry varies considerably among children but can partly be explained by surgery related variables and the presence of counseling. Given the importance of school in children’s daily lives, we argue that school attendance should be stimulated by increasing professionals’ awareness of children’s school re-entry process.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100771"},"PeriodicalIF":1.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-12DOI: 10.1016/j.ebr.2025.100772
Josef Finsterer
{"title":"Before diagnosing stroke-like episodes in OPA1-related mitochondrial disorder, its imaging criteria must be met","authors":"Josef Finsterer","doi":"10.1016/j.ebr.2025.100772","DOIUrl":"10.1016/j.ebr.2025.100772","url":null,"abstract":"","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"31 ","pages":"Article 100772"},"PeriodicalIF":1.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-12DOI: 10.1016/j.ebr.2025.100768
Lucas D'Andrea, Raphael Mosqueira, Alcenor C. Miranda Filho, Renato L. Marchetti
Wilson’s disease (WD) is a rare disorder characterized by abnormal copper metabolism, leading to its accumulation in various tissues, particularly the brain and the liver. Psychiatric and neurological symptoms are common manifestations of WD. We present a case of a 22-year-old woman diagnosed with WD who exhibited neurological symptoms and experienced functional seizures (FS) that were misdiagnosed as epilepsy secondary to WD for almost two years. The patient’s history of childhood trauma and interpersonal difficulties underscored the complex interplay between organic and psychogenic factors contributing to FS development. This case highlights the diagnostic challenges associated with the neuropsychiatric manifestations of Wilson’s disease, as well as the complexities in differentiating functional seizures from epilepsy. It emphasizes the importance of comprehensive assessment and multidisciplinary care in optimizing patient outcomes.
{"title":"A functional seizure case in Wilson’s disease","authors":"Lucas D'Andrea, Raphael Mosqueira, Alcenor C. Miranda Filho, Renato L. Marchetti","doi":"10.1016/j.ebr.2025.100768","DOIUrl":"10.1016/j.ebr.2025.100768","url":null,"abstract":"<div><div>Wilson’s disease (WD) is a rare disorder characterized by abnormal copper metabolism, leading to its accumulation in various tissues, particularly the brain and the liver. Psychiatric and neurological symptoms are common manifestations of WD. We present a case of a 22-year-old woman diagnosed with WD who exhibited neurological symptoms and experienced functional seizures (FS) that were misdiagnosed as epilepsy secondary to WD for almost two years. The patient’s history of childhood trauma and interpersonal difficulties underscored the complex interplay between organic and psychogenic factors contributing to FS development. This case highlights the diagnostic challenges associated with the neuropsychiatric manifestations of Wilson’s disease, as well as the complexities in differentiating functional seizures from epilepsy. It emphasizes the importance of comprehensive assessment and multidisciplinary care in optimizing patient outcomes.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100768"},"PeriodicalIF":1.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-07DOI: 10.1016/j.ebr.2025.100767
Micheline C. Sarbach , Stephan Rüegg , Samuel S. Allemann , Isabelle Arnet
We describe a male patient with symptomatic multifocal epilepsy struggling with medication adherence. He accepted escalating adherence interventions with conventional dosing aids such as pillboxes and medication adherence technologies (MATech) including a smart medication dispensing and adherence device (SMAD). Adherence metrics and drug levels were continuously monitored by electronic monitoring (EM) and therapeutic drug monitoring (TDM). Initially, adherence metrics with pre-filled punch cards supplied by a community pharmacy showed 64% taking adherence, 63% timing adherence, and 47% correctly dosed days, including a five-day medication holiday. Adherence improved with a pharmacy-filled SMAD, reaching 93% taking adherence, 90% timing adherence, 86% correctly dosed days, and no medication holiday. No epileptic seizures were noticed during periods with EM. The patient was satisfied with the SMAD while struggling with other adherence tools. Adherence tended to decrease once adherence reminders were removed. In conclusion, we emphasize the importance of personalized adherence strategies and shared decision-making. This case highlights the positive impact of an interprofessional adherence improvement program, integrating efforts from researchers, neurologists, and community pharmacists.
{"title":"Personalized adherence interventions using medication adherence technologies in polypharmacy management in epilepsy: An interprofessional case report","authors":"Micheline C. Sarbach , Stephan Rüegg , Samuel S. Allemann , Isabelle Arnet","doi":"10.1016/j.ebr.2025.100767","DOIUrl":"10.1016/j.ebr.2025.100767","url":null,"abstract":"<div><div>We describe a male patient with symptomatic multifocal epilepsy struggling with medication adherence. He accepted escalating adherence interventions with conventional dosing aids such as pillboxes and medication adherence technologies (MATech) including a smart medication dispensing and adherence device (SMAD). Adherence metrics and drug levels were continuously monitored by electronic monitoring (EM) and therapeutic drug monitoring (TDM). Initially, adherence metrics with pre-filled punch cards supplied by a community pharmacy showed 64% taking adherence, 63% timing adherence, and 47% correctly dosed days, including a five-day medication holiday. Adherence improved with a pharmacy-filled SMAD, reaching 93% taking adherence, 90% timing adherence, 86% correctly dosed days, and no medication holiday. No epileptic seizures were noticed during periods with EM. The patient was satisfied with the SMAD while struggling with other adherence tools. Adherence tended to decrease once adherence reminders were removed. In conclusion, we emphasize the importance of personalized adherence strategies and shared decision-making. This case highlights the positive impact of an interprofessional adherence improvement program, integrating efforts from researchers, neurologists, and community pharmacists.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100767"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143881715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-06DOI: 10.1016/j.ebr.2025.100766
Po-Yu Lin , Sheng-Hsiang Lin , Pi-Shan Sung
Patients with stroke or epilepsy face an elevated risk of subsequent strokes. This nationwide retrospective cohort study analyzed data from Taiwan’s National Health Insurance Research Database (2012–2020) to compare the risk of future ischemic stroke or transient ischemic attack (IS/TIA) among patients with epilepsy and those with prior IS/TIA. Patients were categorized into four groups: epilepsy with subsequent IS/TIA (E/S), epilepsy without IS/TIA (E), IS/TIA without epilepsy (S), and neither condition (C). Incidence rates and adjusted hazard ratios for IS/TIA and mortality were assessed across groups, which included 5,606, 11,212, 11,212, and 56,060 patients. The corresponding incidence rates of subsequent IS/TIA were 0.67, 0.03, 0.41, and 0.01 per 100 person-years in the E/S, E, S, and C groups, respectively. Compared to the S group, the E/S group had a higher adjusted hazard ratio for IS/TIA (aHR 1.68, 95% CI: 1.30–2.17), whereas the E group had a significantly lower adjusted hazard ratio (aHR 0.08, 95% CI: 0.04–0.14). Mortality risk was significantly elevated in both the E/S group (aHR 1.90, 95% CI: 1.75–2.05) and the E group (aHR 1.21, 95% CI: 1.12–1.30), compared to the S group. These findings suggest that epilepsy increases the risk of subsequent IS/TIA, though to a lesser extent than prior IS/TIA. They underscore the importance of condition-specific prevention strategies and the need for further research into the mechanisms linking epilepsy and stroke risk.
{"title":"Comparing the risk of subsequent ischemic stroke and mortality in patients with epilepsy and patients with ischemic stroke","authors":"Po-Yu Lin , Sheng-Hsiang Lin , Pi-Shan Sung","doi":"10.1016/j.ebr.2025.100766","DOIUrl":"10.1016/j.ebr.2025.100766","url":null,"abstract":"<div><div>Patients with stroke or epilepsy face an elevated risk of subsequent strokes. This nationwide retrospective cohort study analyzed data from Taiwan’s National Health Insurance Research Database (2012–2020) to compare the risk of future ischemic stroke or transient ischemic attack (IS/TIA) among patients with epilepsy and those with prior IS/TIA. Patients were categorized into four groups: epilepsy with subsequent IS/TIA (E/S), epilepsy without IS/TIA (E), IS/TIA without epilepsy (S), and neither condition (C). Incidence rates and adjusted hazard ratios for IS/TIA and mortality were assessed across groups, which included 5,606, 11,212, 11,212, and 56,060 patients. The corresponding incidence rates of subsequent IS/TIA were 0.67, 0.03, 0.41, and 0.01 per 100 person-years in the E/S, E, S, and C groups, respectively. Compared to the S group, the E/S group had a higher adjusted hazard ratio for IS/TIA (aHR 1.68, 95% CI: 1.30–2.17), whereas the E group had a significantly lower adjusted hazard ratio (aHR 0.08, 95% CI: 0.04–0.14). Mortality risk was significantly elevated in both the E/S group (aHR 1.90, 95% CI: 1.75–2.05) and the E group (aHR 1.21, 95% CI: 1.12–1.30), compared to the S group. These findings suggest that epilepsy increases the risk of subsequent IS/TIA, though to a lesser extent than prior IS/TIA. They underscore the importance of condition-specific prevention strategies and the need for further research into the mechanisms linking epilepsy and stroke risk.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100766"},"PeriodicalIF":1.8,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-03DOI: 10.1016/j.ebr.2025.100764
Vijaya Lakshmi Valaparla , Aabishkar Bhattarai , Patrick J. Karas , Diosely C. Silveira
Charles Bonnet Syndrome (CBS) is a condition characterized by complex visual hallucinations in individuals with visual impairment. We present the case of a patient with bilateral optic atrophy secondary to obstructive hydrocephalus caused by a pineal parenchymal tumor of intermediate differentiation (PPTID) who experienced formed visual hallucinations consistent with CBS. Following a right occipital craniotomy for occipital transtentorial approach and tumor resection, she developed elementary visual hallucinations. A thorough clinical history and systematic diagnostic evaluation led to the identification of coexisting right occipital epilepsy. This case highlights an intriguing overlap of two positive visual phenomena with distinct pathophysiological mechanisms.
{"title":"Coexistence of Charles Bonnet Syndrome and occipital epilepsy: A diagnostic challenge","authors":"Vijaya Lakshmi Valaparla , Aabishkar Bhattarai , Patrick J. Karas , Diosely C. Silveira","doi":"10.1016/j.ebr.2025.100764","DOIUrl":"10.1016/j.ebr.2025.100764","url":null,"abstract":"<div><div>Charles Bonnet Syndrome (CBS) is a condition characterized by complex visual hallucinations in individuals with visual impairment. We present the case of a patient with bilateral optic atrophy secondary to obstructive hydrocephalus caused by a pineal parenchymal tumor of intermediate differentiation (PPTID) who experienced formed visual hallucinations consistent with CBS. Following a right occipital craniotomy for occipital transtentorial approach and tumor resection, she developed elementary visual hallucinations. A thorough clinical history and systematic diagnostic evaluation led to the identification of coexisting right occipital epilepsy. This case highlights an intriguing overlap of two positive visual phenomena with distinct pathophysiological mechanisms.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100764"},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-03DOI: 10.1016/j.ebr.2025.100765
Jie Fu , Qinrui Li , Genfu Zhang , Zhixian Yang , Jiong Qin
Tuberous sclerosis complex (TSC) is an autosomal-dominant genetic disorder frequently accompanied by neuropsychiatric disorders, especially in patients who have drug-resistant epilepsy (DRE). This study aimed to evaluate the distribution of neuropsychiatric disorders in Chinese children with TSC-related epilepsy using the TAND (Tuberous Sclerosis Complex Associated Neuropsychiatric Disorders) checklist, comparing those with DRE to those achieving seizure freedom. A total of 47 children, aged 6 to 18 years, diagnosed with TSC at Peking University People’s Hospital, participated in this cross-sectional study. All participants met the latest diagnostic criteria for TSC. Based on the definition of drug-resistant epilepsy, participants were categorized into DRE group and seizure-free group. Neurodevelopmental disorders were evaluated using the TAND checklist. The study found that 66 % of participants exhibited varying degrees of intellectual disability, with the DRE group demonstrating significantly poorer performance in intelligence, behavior, neuropsychological, and learning skills compared to the seizure-free group. The DRE group also had higher rates of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), alongside greater impairments in psychosocial functioning. This study indicates that DRE is strongly associated with neuropsychiatric development in children with TSC, but also that all children with TSC are at increased risk of TAND. Our findings highlight the importance of regular assessment and intervention to support TAND and improve quality of life in this vulnerable group.
{"title":"Neuropsychiatric disorders in Chinese pediatric tuberous sclerosis complex patients associated with drug-resistant epilepsy: A TAND checklist-based survey","authors":"Jie Fu , Qinrui Li , Genfu Zhang , Zhixian Yang , Jiong Qin","doi":"10.1016/j.ebr.2025.100765","DOIUrl":"10.1016/j.ebr.2025.100765","url":null,"abstract":"<div><div>Tuberous sclerosis complex (TSC) is an autosomal-dominant genetic disorder frequently accompanied by neuropsychiatric disorders, especially in patients who have drug-resistant epilepsy (DRE). This study aimed to evaluate the distribution of neuropsychiatric disorders in Chinese children with TSC-related epilepsy using the TAND (Tuberous Sclerosis Complex Associated Neuropsychiatric Disorders) checklist, comparing those with DRE to those achieving seizure freedom. A total of 47 children, aged 6 to 18 years, diagnosed with TSC at Peking University People’s Hospital, participated in this cross-sectional study.<!--> <!-->All participants met the latest diagnostic criteria for TSC. Based on the definition of drug-resistant epilepsy, participants were categorized into DRE group and seizure-free group. Neurodevelopmental disorders were evaluated using the TAND checklist. The study found that 66 % of participants exhibited varying degrees of intellectual disability, with the DRE group demonstrating significantly poorer performance in intelligence, behavior, neuropsychological, and learning skills compared to the seizure-free group. The DRE group also had higher rates of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), alongside greater impairments in psychosocial functioning. This study indicates that DRE is strongly associated with neuropsychiatric development in children with TSC, but also that all children with TSC are at increased risk of TAND. Our findings highlight the importance of regular assessment and intervention to support TAND and improve quality of life in this vulnerable group.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100765"},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-24DOI: 10.1016/j.ebr.2025.100763
Emma Dolan , Norman Delanty
Tramadol is a common pain medication used in practice across numerous specialties. Increased incidence of tramadol abuse and overdose in recent decades has led to it being classified as a controlled drug in several countries. Tramadol appears to be an increasingly popular drug of abuse, possibly related to ease of access to it on prescription, and its potential euphoric effects.
We identified two cases of seizures directly related to tramadol exposure. We then reviewed recent literature on tramadol and its adverse effects, particularly looking at its effect on seizure risk and the incidence of seizures. We found that there were scarce recent studies on the relationship between tramadol and seizure risk. Of studies found, many were carried out in animal models. Tramadol-induced seizures were studied in humans more commonly in the context of overdose, and studies involving humans tended to have small patient cohorts and suggested further study in the area.
We suggest that tramadol may be useful as part of multi-modal analgesia in moderate to severe pain in specific contexts, but that greater awareness of its potential adverse effects, and particularly its potential to lower seizure threshold, is warranted. We feel that more readily available information specifically about tramadol’s effects on seizure threshold may be of interest to colleagues from any specialty prescribing opioid analgesia on a regular basis, but that colleagues treating patients with seizure disorders should be particularly aware of these potential adverse effects.
{"title":"Tramadol use and risk of seizure: A report of two cases and a review of recent literature","authors":"Emma Dolan , Norman Delanty","doi":"10.1016/j.ebr.2025.100763","DOIUrl":"10.1016/j.ebr.2025.100763","url":null,"abstract":"<div><div>Tramadol is a common pain medication used in practice across numerous specialties. Increased incidence of tramadol abuse and overdose in recent decades has led to it being classified as a controlled drug in several countries. Tramadol appears to be an increasingly popular drug of abuse, possibly related to ease of access to it on prescription, and its potential euphoric effects.</div><div>We identified two cases of seizures directly related to tramadol exposure. We then reviewed recent literature on tramadol and its adverse effects, particularly looking at its effect on seizure risk and the incidence of seizures. We found that there were scarce recent studies on the relationship between tramadol and seizure risk. Of studies found, many were carried out in animal models. Tramadol-induced seizures were studied in humans more commonly in the context of overdose, and studies involving humans tended to have small patient cohorts and suggested further study in the area.</div><div>We suggest that tramadol may be useful as part of multi-modal analgesia in moderate to severe pain in specific contexts, but that greater awareness of its potential adverse effects, and particularly its potential to lower seizure threshold, is warranted. We feel that more readily available information specifically about tramadol’s effects on seizure threshold may be of interest to colleagues from any specialty prescribing opioid analgesia on a regular basis, but that colleagues treating patients with seizure disorders should be particularly aware of these potential adverse effects.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100763"},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-16DOI: 10.1016/j.ebr.2025.100762
Franziska van den Bongard , Catharina Petersen , Claus Reinsberger
People with epilepsy (PWE) are encouraged to participate in exercise and be physically active, but some PWE may report exercise-associated seizures (EAS). However, there is a lack of objective tools to inform individual recommendations for physical activity and exercise participation in PWE. This study investigated the feasibility and safety of exhaustive exercise testing in PWE. 29 patients underwent an objectively and subjectively exhaustive exercise test on a bicycle ergometer and resting state EEG was obtained before and after exercise. One patient with a history of EAS experienced a seizure immediately after exercising. In patients without EAS, an asymptomatic subclinical electrographic seizure was observed in one patient, and two patients revealed interictal epileptiform discharges only after exercise. All EEG changes occurred in the setting of non-REM sleep, while the respective pre-exercise EEG recordings revealed less sleep. No seizures or significant EEG changes after exercise were observed in any other patient. EEG investigations before and after exhaustive exercise were feasible in PWE, but safety protocols need to be established, especially in patients with EAS. Investigation of a higher number of PWE with and without EAS with repeat exercise-associated EEG may provide information about the clinical utility of exercise-associated EEGs when counseling PWE.
{"title":"Safety and feasibility of exhaustive exercise testing for people with epilepsy","authors":"Franziska van den Bongard , Catharina Petersen , Claus Reinsberger","doi":"10.1016/j.ebr.2025.100762","DOIUrl":"10.1016/j.ebr.2025.100762","url":null,"abstract":"<div><div>People with epilepsy (PWE) are encouraged to participate in exercise and be physically active, but some PWE may report exercise-associated seizures (EAS). However, there is a lack of objective tools to inform individual recommendations for physical activity and exercise participation in PWE. This study investigated the feasibility and safety of exhaustive exercise testing in PWE. 29 patients underwent an objectively and subjectively exhaustive exercise test on a bicycle ergometer and resting state EEG was obtained before and after exercise. One patient with a history of EAS experienced a seizure immediately after exercising. In patients without EAS, an asymptomatic subclinical electrographic seizure was observed in one patient, and two patients revealed interictal epileptiform discharges only after exercise. All EEG changes occurred in the setting of non-REM sleep, while the respective pre-exercise EEG recordings revealed less sleep. No seizures or significant EEG changes after exercise were observed in any other patient. EEG investigations before and after exhaustive exercise were feasible in PWE, but safety protocols need to be established, especially in patients with EAS. Investigation of a higher number of PWE with and without EAS with repeat exercise-associated EEG may provide information about the clinical utility of exercise-associated EEGs when counseling PWE.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"30 ","pages":"Article 100762"},"PeriodicalIF":1.8,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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