Udo Wieshmann

University of Liverpool

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Simon S. Keller

University of Liverpool

Simon Shorvon

University College London

Gus A. Baker

University of Liverpool

Anthony G Marson

University of Liverpool

Gareth J. Barker

King's College London

Paul Eldridge

Walton Centre

Mark R. Symms

General Electric (United Kingdom)

Kumar Das

University of Liverpool

Barbara A. K. Kreilkamp

University of Göttingen

Neil Roberts

Henry Royce Institute

Cooperative Institutions

Inserm

235

University College London

200

Centre National de la Recherche Scientifique

138

Istituti di Ricovero e Cura a Carattere Scientifico

136

Sorbonne Université

123

National Hospital for Neurology and Neurosurgery

116

Assistance Publique – Hôpitaux de Paris

113

University of Milan

106

Université Paris Cité

University of Liverpool

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PO057 Risks and benefits of chronic antiepileptic drug treatment

Journal of Neurology Neurosurgery & Psychiatry (2017)

Udo Wieshmann Gus A. Baker

Aim

To estimate risk benefit ratios for anti epileptic drugs (AEDs).

Methods

We used the Liverpool adverse event profile (LAEP) as a surrogate marker of risk and the seizure free rate as a marker of benefit in a cohort of 967 epilepsy patients (mono therapy (n=415), poly therapy with 2 AEDs (n=355) and with 3 AEDs (n=197), treatment with Lamotrigine (LTG, n=120), Valproic acid (VPA n=65), Phenytoin (PHT, n=22), Carbamazepine (CBZ, n=97), Levetiracetam (LEV, n=81), Topiramate (TPM, n=12), LTG and VPA (n=18), CBZ and TPM (n=16), CBZ and LEV (n=55), LTG and LEV (n=45), VPA and LEV (n=31), LTG and Clobazam (n=12)). We calculated the risk benefit ratio by dividing the number patients with intoxication (LAEP score >45) with the number of patients who had no seizures in the preceding 4 weeks.

Results

The risk benefit ratio was 0.57 for monotherapy, 1.22 for 2 AEDs and 2.33 for 3 AEDs. The risk benefit ratios were LTG and VPA 0.40, LTG 0.46, VPA 0.49, PHT 0.56, CBZ and TPM 0.57, CBZ 0.63, LEV 0.72, CBZ and LEV 0.91, TPM 1.33, LTG and LEV 1.64, VPA and LEV 1.67, LTG and Clobazam 3.00.

Conclusion

Mono therapy had a better risk benefit ratio than polytherapy. The differences between AEDs need to be confirmed in larger studies.

Clobazam

Levetiracetam

Valproic Acid

10.1136/jnnp-2017-abn.90

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Citations (0)

Predictors of outcome after temporal lobectomy for refractory temporal lobe epilepsy

Acta Neurologica Scandinavica (2008)

Udo Wieshmann Dr James R. Larkin T.R.K. Varma Paul Eldridge

To identify predictors of outcome after epilepsy surgery in patients with temporal lobe epilepsy (TLE).Seventy-six patients with normal magnetic resonance imaging (MRI) or hippocampal sclerosis on MRI who underwent anterior temporal lobe resections were included. Outcome 2 years after surgery was classified as good (Engel I and II) or poor (Engel III and IV). Gender, age at onset and duration of epilepsy, history of febrile convulsions, auras, right- or left-sided TLE, memory ipsilateral to seizure onset (Wada test), hippocampal asymmetry (HA) and T2 relaxation time, amygdala, temporal lobe and hemispheral volume were tested for associations with outcome.Sixty-seven percent had a good outcome. Of all parameters tested, only a history of febrile convulsions and HA on quantitative MRI were significantly associated with a good seizure outcome. The absence of these parameters did not exclude a good outcome, but only five of 18 patients (28%) without HA and without a history of febrile convulsions had a good outcome.Febrile convulsions and HA were predictors of outcome after epilepsy surgery in TLE. Subtle volume loss in amygdala, temporal lobe or hemispheres and the memory ipsilateral to the side of resection were not associated with outcome.

Hippocampal sclerosis

Wada test

Anterior temporal lobectomy

Febrile convulsions

10.1111/j.1600-0404.2008.01043.x

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Citations (50)

Reduced anisotropy of water diffusion in structural cerebral abnormalities demonstrated with diffusion tensor imaging

Magnetic Resonance Imaging (1999)

Udo Wieshmann Chris A. Clark Mark R. Symms Florence Franconi Gareth J. Barker

10.1016/s0730-725x(99)00082-x

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Citations (151)

Development of Hippocampal Atrophy: A Serial Magnetic Resonance Imaging Study in a Patient Who Developed Epilepsy After Generalized Status Epilepticus

Epilepsia (1997)

Udo Wieshmann Friedrich G. Woermann Louis Lemieux S. L. Free Philippa A. Bartlett

Summary: Purpose : To investigate changes in hippocampal volume. Methods : We used serial magnetic resonance imaging (MRI) in a patient who developed chronic epilepsy after having generalized tonic‐clonic status epilepticus (SE). Five MRI investigations were performed during SE and a 58‐month follow‐up period. Hippocampal volumetric measurements and coregistration of scans were performed to detect hippocampal atrophy. Results : During status both mesiotemporal regions returned a high signal on T,‐weighted images. Two months after the onset of SE, bilateral hippocampal atrophy was detected. Further progressive hippocampal atrophy was detected in the subsequent 58 months by both hippocampal volumetric measurements and coregistration of scans. Conclusions : Our findings suggest that hippocampal atrophy is a process that may continue after the end of the SE.

10.1111/j.1528-1157.1997.tb01222.x

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Citations (133)

FC13.01 Severe mental illness and airports — The scope of the problem

European Psychiatry (2000)

B. Lucas Udo Wieshmann Mahmood Anjoyeb

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Scope (computer science)

Content (measure theory)

10.1016/s0924-9338(00)94373-6

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Citations (0)

Combined functional magnetic resonance imaging and diffusion tensor imaging demonstrate widespread modified organisation in malformation of cortical development

Journal of Neurology Neurosurgery & Psychiatry (2001)

Udo Wieshmann Karsten Krakow Mark R. Symms Geoff J.M. Parker CA Clark

A patient with a mild left hemiparesis and a malformation of cortical development in the right hemisphere was investigated with fMRI (functional magnetic resonance imaging) and DTI (diffusion tensor imaging). The motor cortex was studied using a finger tapping fMRI experiment. The fibre orientation was studied by displaying the principal eigenvector of the diffusion tensor in the spatially normalised brain of the patient and of control subjects. In addition, the anisotropy (directionality) of water diffusion of the patient was statistically compared with control subjects. The malformation was located in the right central region in the expected position of the motor cortex. fMRI showed activation anterior and posterior to the malformation. DTI disclosed that fibres with rostrocaudal orientation, presumably representing the pyramidal tract, were deviating from their normal orientation and passing around the malformation. There were widespread regions of reduced anisotropy affecting both hemispheres. In conclusion, fMRI and DTI provided concordant information showing widespread modified functional and structural organisation including regions which appeared normal on standard imaging.

Corticospinal tract

10.1136/jnnp.70.4.521

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Citations (43)

Magnetic resonance imaging in epilepsy with a fast FLAIR sequence.

Journal of Neurology Neurosurgery & Psychiatry (1996)

Udo Wieshmann S. L. Free Alex Everitt Philippa A. Bartlett Gareth J. Barker

To assess the diagnostic value of the fast FLAIR sequence in patients with epilepsy.One hundred and twenty eight patients with epilepsy and 10 control subjects were scanned with the fast FLAIR sequence with 5 mm slices, a coronal gradient echo (GRE) T1 weighted sequence with 1.5 mm slices and spin echo (SE) or fast spin echo (FSE) proton density and T2 weighted sequences with 5 mm slices. All images were compared by an unblinded neuroradiologist and neurologist. Fast FLAIR images of patients with hippocampal sclerosis (HS) and normal control subjects were also evaluated by two blinded independent raters.Fast FLAIR provided a high conspicuity of neocortical damage, hamartomas, dysembryoplastic neuroepithelial tumours, and clear cut hippocampal sclerosis. However, the same information could be obtained from the coronal T1 and T2 weighted images. In three patients fast FLAIR showed a clearly abnormal signal when SE T2 weighted images had not been definitely abnormal. Heterotopia was less conspicuous on fast FLAIR than GRE T1 weighted images. The two blinded raters detected all but one of the patients with clear cut hippocampal sclerosis on fast FLAIR images but missed all borderline cases of hippocampal atrophy and there were two false positives. Clear cut hippocampal sclerosis was more conspicuous on fast FLAIR images than on SE T2 weighted images in most patients, but additional patients were not identified.Fast FLAIR has the advantage of identifying neocortical lesions and definite hippocampal sclerosis with a short scanning time and may also demonstrate lesions when other sequences are normal in a limited number of cases. The technique was not useful, however, for identifying mild hippocampal sclerosis or heterotopia.

Fluid-attenuated inversion recovery

Hippocampal sclerosis

10.1136/jnnp.61.4.357

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Citations (44)

The long-term outcomes of epilepsy surgery

PLoS ONE (2018)

Midhun Mohan Simon S. Keller Andrew Nicolson Shubhabrata Biswas David W. Smith

Despite modern anti-epileptic drug treatment, approximately 30% of epilepsies remain medically refractory and for these patients, epilepsy surgery may be a treatment option. There have been numerous studies demonstrating good outcome of epilepsy surgery in the short to median term however, there are a limited number of studies looking at the long-term outcomes. The aim of this study was to ascertain the long-term outcome of resective epilepsy surgery in a large neurosurgery hospital in the U.K.This a retrospective analysis of prospectively collected data. We used the 2001 International League Against Epilepsy (ILAE) classification system to classify seizure freedom and Kaplan-Meier survival analysis to estimate the probability of seizure freedom.We included 284 patients who underwent epilepsy surgery (178 anterior temporal lobe resections, 37 selective amygdalohippocampectomies, 33 temporal lesionectomies, 36 extratemporal lesionectomies), and had a prospective median follow-up of 5 years (range 1-27). Kaplan-Meier estimates showed that 47% (95% CI 40-58) remained seizure free (apart from simple partial seizures) at 5 years and 38% (95% CI 31-45) at 10 years after surgery. 74% (95% CI 69-80) had a greater than 50% seizure reduction at 5 years and 70% (95% CI 64-77) at 10 years. Patients who had an amygdalohippocampectomy were more likely to have seizure recurrence than patients who had an anterior temporal lobe resection (p = 0.006) and temporal lesionectomy (p = 0.029). There was no significant difference between extra temporal and temporal lesionectomies. Hippocampal sclerosis was associated with a good outcome but declined in relative frequency over the years.The vast majority of patients who were not seizure free experienced at least a substantial and long-lasting reduction in seizure frequency. A positive long-term outcome after epilepsy surgery is possible for many patients and especially those with hippocampal sclerosis or those who had anterior temporal lobe resections.

Hippocampal sclerosis

Anterior temporal lobectomy

10.1371/journal.pone.0196274

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Citations (110)

Nonconvulsive status epilepticus: Epilepsy Research Foundation Workshop Reports

Epileptic Disorders (2005)

Matthew C. Walker J. Helen Cross Shelagh Smith Camilla Young Jean Aicardi

In April 2004, a group of physicians with an interest in nonconvulsive status epilepticus representing a spectrum of opinion met in Oxford, sponsored by the Epilepsy Research Foundation (a charitable organization), to discuss and debate the definition, diagnosis and treatment of nonconvulsive status epilepticus. We felt that such a meeting would be useful, as nonconvulsive status epilepticus is a subject that provokes strong reactions, perhaps largely due to the relative lack of evidence and the surfeit of opinion. The meeting was arranged such that there were formal talks followed by a discussion led by one of the attendees. We present here the extended abstracts of the main talks with the points raised by the discussants. Despite disagreements on certain issues there was much in the way of consensus. First, it was agreed that nonconvulsive status epilepticus is a term that covers a range of disparate conditions with varying prognoses and treatments. The agreed definition was thus suitably vague, A<>. Secondly, it was agreed that even within a specific condition (e.g. complex partial status epilepticus), the prognosis and treatment depends upon the context in which the condition occurs (e.g. in the critically ill, in coma, in the A<> and in people with prior epilepsy). Perhaps, most importantly it was agreed that we lacked good clinical data, and the challenge was to design good studies for a condition that is underrecognised and often difficult to diagnose.

Coma (optics)

10.1684/j.1950-6945.2005.tb00130.x

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Citations (176)

Fast fluid-attenuated inversion-recovery imaging: first experience with a 3D version in epilepsy

Neuroradiology (1998)

Udo Wieshmann Gareth J. Barker Mark R. Symms Philippa A. Bartlett J. Stevens

Fluid-attenuated inversion recovery

Polymicrogyria

Hippocampal sclerosis

Neuroradiology

10.1007/s002340050630

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Citations (19)