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Background: Regarding treatment of women of childbearing potential with epilepsy, several aspects of family planning and desire to have children have to be taken into account. Objective: Overview of current data on mutual implications of epileptic seizures, antiseizure medication (ASM), pregnancy and child development. Method: Review of the current literature, discussion and presentation of resulting treatment recommendations. Results: Many ASMs bear the potential for clinically relevant interactions with both contraceptives and altered concentrations of sexual hormones and modified pharmacokinetics during pregnancy. All ASMs show an increased risk for congenital malformations; however, due to seizure-related risks for the mother and child effective ASM treatment during pregnancy is crucial. Conclusion: When considering the special aspects of consultation and treatment of women of childbearing potential with epilepsy most pregnancies are uncomplicated. [ABSTRACT FROM AUTHOR]

The purpose of this study was to ascertain whether a correlation exists between glaucoma-associated alteration of ocular vascular haemodynamics and endothelin-1 (ET-1) levels exist. Eyes of patients with cataract (n = 30) or glaucoma (n = 68) were examined with optical coherence tomography (OCT) and OCT-angiography (OCT-A; AngioVue™-RTVue-XR; Optovue, Fremont, California, USA). The peripapillary and the macular vessel density (VD) values were measured. Inferior and superior retinal nerve fibre layer (RNFL) thickness loss was used for further OCT staging. Aqueous humour of the examined eye and plasma were sampled during cataract or glaucoma surgery and analysed by means of ELISA to determine their ET-1 level. Glaucoma eyes are characterised by reductions in RNFL thickness and VD that correlate significantly with the OCT GSS score. Peripheral and ocular ET-1 level were significantly elevated in patients with glaucoma and correlate positively with the OCT-GSS score of the entire study population. Peripapillary and macula VD of glaucoma patients correlates negatively with plasma ET-1 levels. Multivariable analysis showed a subordinate role of intraocular pressure predictive factor for impaired retinal blood flow compared with plasma ET-1 level in glaucoma. Peripheral ET-1 level serves as risk factor for detection of ocular blood flow changes in the optic nerve head region of glaucomatous eyes. [ABSTRACT FROM AUTHOR]

While two thirds of patients with epilepsy become seizure-free with antiseizure medications, 30% remain drug-resistant. In drug-resistant focal epilepsy, epilepsy surgery offers an approximately 65% chance of becoming seizure-free; however, for a successful outcome of surgery a seizure focus must be precisely located, for which imaging techniques are essential. In recent years, the proportion of patients with apparently inconspicuous findings in magnetic resonance imaging (MRI) in the presurgical evaluation has increased. The sensitivity of MRI can be increased using special MRI sequences and MRI postprocessing techniques. Ictal and interictal source localization based on electroencephalography (EEG) and magnetencephalography (MEG) aim at determining the onset of interictal discharges and seizures. Nuclear medicine imaging techniques such as interictal positron emission tomography (PET) and ictal single photon emission computed tomography (SPECT) can detect chronic or acute seizure-related changes in brain metabolism and can indicate an epileptogenic focus even if MRI is inconspicuous. The results of these techniques are used to plan invasive EEG recordings and subsequently surgery. Concordant findings are associated with better surgical outcomes and show significantly higher rates of seizure freedom in the long-term seizure outcome. [ABSTRACT FROM AUTHOR]

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lthough orthostatic dizziness (OD) is a common complaint, its prevalence and medical impact in the general population are unknown. The study aims to assess prevalence, medical sequelae and healthcare and social impact of OD in the general population. Participants of the representative German National Health Interview Survey 2003 ( n = 4077, age 18-89 years, response rate 52%) were screened for moderate or severe dizziness or vertigo. As part of a larger study on the epidemiology of dizziness and vertigo, a consecutive subsample of screen-positive participants ( n = 825) underwent a structured medical interview for OD based on the criteria: (1) non-vestibular dizziness (i.e. diffuse non-rotational dizziness, light headedness, feeling of impeding faint), (2) provocation by sudden postural change (i.e. standing up from supine or sitting), (3) duration of seconds to several minutes, (4) absence of vestibular vertigo according to a validated neurotologic interview. The 12-month prevalence of OD was 10.9% (women 13.1%, men 8.2%), lifetime prevalence was 12.5% (women 15.0%, men 9.6%). OD accounted for 42% of all participants with dizziness/vertigo and for 55% of non-vestibular dizziness diagnoses. The prevalence of OD was highest in young people, although the proportion with severe OD steadily increased with age. OD led to syncope in 19%, falls in 17% and traumatic injury in 5% of affected subjects. Almost half of the individuals with OD (45%) had consulted a physician and 4% had been treated in hospital. OD is a frequent cause of non-vestibular dizziness for which patients often seek medical advice. It carries a considerable risk of syncope, falls and traumatic injury. [ABSTRACT FROM AUTHOR]

Children with congenital heart disease (CHD) remain at risk for neurodevelopmental impairment despite improved perioperative care. Our prospective cohort study aimed to determine the relationship between perioperative brain volumes and neurodevelopmental outcome in neonates with severe CHD. Pre- and postoperative cerebral MRI was acquired in term born neonates with CHD undergoing neonatal cardiopulmonary bypass surgery. Brain volumes were measured using an atlas prior-based automated method. One-year neurodevelopmental outcome was assessed with the Bayley-III. CHD infants (n = 77) had lower pre- and postoperative total and regional brain volumes compared to controls (n = 44, all p < 0.01). CHD infants had poorer cognitive and motor outcome (p ≤ 0.0001) and a trend towards lower language composite score compared to controls (p = 0.06). Larger total and selected regional postoperative brain volumes were found to be associated with better cognitive and language outcomes (all p < 0.04) at one year. This association was independent of length of intensive care unit stay for total, cortical, temporal, frontal and cerebellar volumes. Therefore, reduced cerebral volume in CHD neonates undergoing bypass surgery may serve as a biomarker for impaired outcome. [ABSTRACT FROM AUTHOR]