Using personality disorders to distinguish between patients with psychogenic nonepileptic seizures and those with epileptic seizures.

Identifying psychiatric disorders rather than psychiatric symptoms might help to distinguish patients with psychogenic nonepileptic seizures (PNES) from those with epileptic seizures (ES). Patients with PNES (n=35), patients with ES (n=35), and healthy controls (n=37) were compared with respect to the prevalence of psychiatric disorders in this study. We tested the predictive power of having axis I psychiatric disorders, as well as personality disorders, in distinguishing ES from PNES. There was no significant difference between the patient groups in the prevalence of axis I psychiatric disorders. Personality disorders were more prevalent in the PNES group than in the ES group (P<0.05). Having a personality disorder was the only predictor for the PNES group. Having a personality disorder seems to be a more significant predictor for PNES than having an axis I psychiatric disorder. Greater attention should be paid to personality disorders in the differentiation of PNES and ES and the provision of effective treatment.

Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial.

INTRODUCTION: It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks in this randomised, double blind, cross-over, headache-diary based trial on 30 patients diagnosed with migraine without aura. METHODS: Following a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA. Then, the patients were randomised to a 6-week diet either excluding or including specific foods with raised IgG antibodies, individually. Following a 2-week diet-free interval after the first diet period, the same patients were given the opposite 6-week diet (provocation diet following elimination diet or vice versa). Patients and their physicians were blinded to IgG test results and the type of diet (provocation or elimination). Primary parameters were number of headache days and migraine attack count. Of 30 patients, 28 were female and 2 were male, aged 19-52 years (mean, 35 +/- 10 years). RESULTS: The average count of reactions with abnormally high titre was 24 +/- 11 against 266 foods. Compared to baseline, there was a statistically significant reduction in the number of headache days (from 10.5 +/- 4.4 to 7.5 +/- 3.7; P < 0.001) and number of migraine attacks (from 9.0 +/- 4.4 to 6.2 +/- 3.8; P < 0.001) in the elimination diet period. CONCLUSION: This is the first randomised, cross-over study in migraineurs, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.

The efficacy and tolerability of Levetiracetam as an add-on therapy in patients with startle epilepsy.

PURPOSE: To evaluate the efficacy and tolerability of Levetiracetam as an add-on therapy in patients with startle epilepsy (StEp). METHODS: Ten (7 males and 3 females) were enrolled in the study. LEV was started at 500mg bid, escalating over 1-2 weeks to maximal doses of 3000mg daily, based on seizure control and tolerance for 13-28 months. RESULTS: The onset of startle seizures in patients with StEp varied from birth to 11 years. Six in 10 patients gave good responses to the treatment. There were adverse effects in three patients. CONCLUSION: Many AEDs have been used by medically intractable patients with StEp for many years but the results were almost discouraging. It was observed that 60% of the patients gave good response to LEV. Advanced studies are required to indicate the efficiency of LEV which proved to be effective on animals with audiogenic seizures on reflex epilepsies.