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• Catamenial epilepsy is an increase in seizure frequency during or before menses. • Systematic review of progesterone and its derivatives for catamenial epilepsy. • There is no agreement on dose, duration, and pharmacological formulation. • Efficacy was not demonstrated in randomized controlled trials. • Further research and studies in this field are required. Catamenial epilepsy (CE) is defined as an increase in seizure frequency during specific phases of the menstrual cycle in women with epilepsy. The treatment usually includes a combination of non-hormonal and hormonal therapies. This systematic review summarizes the available data on the efficacy of progesterone and its derivates to treat CE. We performed a systematic search of the literature to identify studies reporting data on the use of progesterone and its derivatives (any type and dose) for the treatment of CE. The main outcome included the efficacy of progesterone and its derivatives on seizure frequency. Nineteen articles (457 patients) were included; four were randomized controlled trials (two comparing progesterone vs placebo and two comparing norethisterone vs placebo). Progesterone was generally administered during the luteal phase (from day 15 to 25) or during perimenstrual exacerbations (from day 23 to 25), with an average dose of 10–30 mg/day to a maximum of 300 mg/day. The therapy, usually well tolerated, was ineffective in the randomized controlled trials; conversely, it was associated with an overall reduction in seizure frequency in case reports and uncontrolled studies. Although data from uncontrolled studies suggest that hormone therapy with progesterone may be useful in the treatment of CE, its efficacy has not been demonstrated in controlled trials. The possible antiseizure effect of progesterone could be mediated by its active metabolite allopregnanolone, making the plasmatic measurement of these hormones mandatory to evaluate efficacy. Further randomized controlled trials should investigate the efficacy of progesterone and its derivatives, addressing these pharmacological issues. [ABSTRACT FROM AUTHOR]

Objective: To determine the best available evidence on the efficacy and tolerability of antiepileptic drugs (AEDs) used to treat poststroke seizures and epilepsy.Methods: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and Opengrey.eu were searched for RCTs of AEDs used to treat post-stroke epilepsy. The following outcomes were considered: seizure freedom; occurrence of adverse effects (AEs); withdrawal for AEs. The methodological quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Adjusted indirect comparisons were made between each AED using controlled-release carbamazepine (CR-CBZ) as common comparator.Results: Only 2 RCTs were included, one comparing levetiracetam (LEV) with CR-CBZ and the other comparing lamotrigine (LTG) with CR-CBZ. No significant difference was found in seizure freedom between either LEV or LTG and CR-CBZ. Occurrence of AEs were lower for LEV and LTG than for CR-CBZ. Indirect comparisons showed no difference between LEV and LTG for seizure freedom (OR 0.86; 95%CI: 0.15-4.89). Occurrence of AEs was higher for LEV than for LTG (OR 6.87; 95%CI: 1.15-41.1). For withdrawal rates due to AEs, we found a large width and asymmetrical distribution of confidence intervals around the obtained OR of 10.8 (95% CI: 0.78-149.71).Conclusions: Direct and indirect comparisons did not find a difference in seizure freedom between the various AEDs, probably because of the small number of patients included. LEV and LTG appears better tolerated than CR-CBZ and LEV seems associated with more AEs than LTG. Further studies are required to provide robust evidence on efficacy and tolerability of AEDs for treating poststroke epilepsy. [ABSTRACT FROM AUTHOR]

Abstract: Fixation-off sensitivity (FOS) is a phenomenon induced by elimination of central vision/fixation, and may either manifest clinically with seizures or only represent an EEG abnormality. FOS is characterized by posterior or generalized epileptiform discharges that consistently occur after closing of the eyes and last as long as the eyes are closed. It is most commonly encountered in patients with idiopathic childhood occipital epilepsies, but may also be observed in cases of symptomatic or cryptogenic focal and generalized epilepsies, as well as in asymptomatic non-epileptic individuals. FOS should be differentiated from pure forms of scotosensitivity, in which EEG discharges or epileptic seizures are elicited by darkness, and from epileptiform discharges triggered by eye closure, which refer to eye closure sensitivity. Although FOS is probably associated with occipital hyperexcitability its intrinsic epileptogenic potential is presumed to be low. [Copyright &y& Elsevier]

The inability to stand without orthostatic hypotension is the typical disabling clinical symptom of both Postural Tachicardia Syndrome (POTS) and Orthostatic Intolerance (OI). The increase of sinus heart rate of 30 beats/min or greater occurring within 10 min of head-up tilt test or standing, or a heart rate while upright of >120 beats/min. discriminates between the two conditions. To verify if others criteria, beside the difference in heart rate increase, can distinguish the two groups, we analyzed the cardiovascular responses during active standing and head – up tilt test. We analyzed 10 patients with POTS and 10 with OI. Power spectral analysis of blood pressure and heart rate variability, in resting condition and during a period of 30 min of head – up tilt test to 60°, was performed. Both clinical conditions were compared with each other and with a control group using the Student t test. During the head – up tilt both groups of patients showed a marked and comparable increase of LF-RRI and LF/HF ratio in the power spectrum of R–R interval compared to the baseline. This could suggest the hypothesis of OI as a condition preceding POTS. [ABSTRACT FROM AUTHOR]

The inability to remain upright without orthostatic hypotension is the typical disabling symptom of Postural Orthostatic Tachycardia Syndrome (POTS), attributed either to the central hyperadrenergic outflow or to the compensatory mechanism after legs and splanchnic blood vessels denervation. To verify this second hypothesis we analyzed the neural autonomic responses to different conditions. 10 patients with POTS and 10 controls were investigated with power spectral analysis of the blood pressure and heart rate variability, in resting condition and during a period of 30min of head – up tilt test to 60°. The difference between the two conditions was tested using the Wilcoxon signed rank test. No evidence of sympathetic cholinergic and adrenergic failure was found. The most significant and common finding of patients with POTS was a marked increase of the LF/HF ratio in the power spectrum of the R–R interval in the head – up tilt compared to the reduced values in supine. We did not find an exaggerated pressure response to the Valsalva manoeuvre, but a redistribution of blood flow, due to regional autonomic denervation, was excluded by the preserved increase of blood pressure response during the same test. [ABSTRACT FROM AUTHOR]

In spinal cord injury both the level and the extension of the lesions have been related to different response to tilting in Low Frequency (LF) and High Frequency (HF) oscillations of heart rate. To understand the role of sympatho–vagal interaction in such patients, we tried to evaluate, using the LF/HF ratio, the residual possibility in maintaining the cardiovascular homeostasis. 9 subjects with different outcome of traumatic (4) and inflammatory (5) spinal cord involvement, with lesion between C6 and T10, were investigated with power spectral analysis of the blood pressure and heart rate variability in resting condition and during a period of head – up tilt test. The difference between the two conditions was tested using the Wilcoxon signed rank test. In patients with complete ASIA A lesion, the relatively preserved LF activity in resting condition did not increase during tilting, with a parallel decrease of LF/HF ratio. In patients with incomplete lesion (ASIA B, C, D), the LF power of R–R interval showed an inverse relation with the level of the lesion. The LF/HF ratio was partially maintained due to the concomitant adapting HF activity permitting an efficient sympatho–vagal balance. [Copyright &y& Elsevier]