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There is a limited understanding of the complex relationship between poverty and epilepsy. To address the complex interaction of environmental and psychosocial factors in epilepsy a 'social determinants of health' model is presented where individual factors are influenced through three pathways (social environment, work and material factors). In the 2005 California Health Interview Survey, 246 of 604 (41%) persons with a history of epilepsy were in poverty, defined as <200% Federal Poverty Level (FPL). Multivariable logistic regression analyses revealed persons in poverty are not more likely to report a history of epilepsy compared to those not in poverty. However, persons with a history of epilepsy in poverty were significantly less likely than those not in poverty to report taking medication for epilepsy (OR 0.5) once material factors (annual income and living situation) and healthcare access were controlled for in the final sequential model. Healthcare practitioners must continue to recognize that connection to social services and the cost of medications are significant barriers to optimal care in persons with epilepsy. Improved connection to patient advocacy organizations and medication assistance programs may help close these gaps.

Objective: To describe a patient in whom we used adjunctive verapamil therapy was used for its P-glycoprotein inhibitory effects., Case Summary: Verapamil was added to the antiepileptic drug regimen of a 24-year-old woman with intractable epilepsy. The average time interval between hospitalizations for complex partial status doubled. The addition of verapamil greatly improved overall seizure control and subjective quality of life in this pharmacoresistant patient., Discussion: The overexpression of P-glycoprotein in the central nervous system may be one mechanism of pharmacoresistance in patients with epilepsy. The calcium-channel blocker verapamil is a known inhibitor of P-glycoprotein and may function to block P-glycoprotein-modulated efflux of antiepileptic drugs in the brain, thereby raising the intracellular concentration of antiepileptic drugs and ultimately decreasing seizure burden in patients with refractory epilepsy., Conclusions: Verapamil may offer pharmacoresistant patients hope of improved seizure control due to its potential P-glycoprotein inhibitory effects.

Objective: To provide a review of recent developments in the pharmacotherapy of epilepsy., Data Sources: A MEDLINE search was performed to identify pertinent literature (1966-June 2001). Selected articles emphasized those published from 1997 to 2001. Bibliographies of identified articles were also evaluated., Study Selection and Data Extraction: All identifiable sources written in English., Data Synthesis: Epilepsy is a common neurologic disorder, and antiepileptic drugs (AEDs) are the mainstays of therapy. The focus of this article is on the 3 latest AEDs--levetiracetam, oxcarbazepine, and zonisamide. We discuss human data published as both original studies and reviews from the last 4 years, except where noted. We apply a general template for all 3 drugs and provide information on clinical trials, adverse effects, pharmacokinetics, drug interactions, and clinical use., Conclusions: Levetiracetam, oxcarbazepine, and zonisamide are reasonable options for many patients whose seizures are not yet controlled or who suffer from intolerable adverse effects. All 3 agents are approved for adjunctive use in patients with partial seizures. Oxcarbazepine also has approval for monotherapy in partial seizures. All 3 drugs are well tolerated by most patients and have characteristics that potentially make them easier to use with medications other than the older AEDs. Further clinical experience is needed before specific recommendations can be given for their place among older and newer AEDs.

A healthy brain requires balancing of waking and sleeping states. The normal changes in waking and sleeping states result in neurophysiological conditions that either increase or decrease the tendency of seizures and interictal discharges to occur. This article reviews the manifold and complex relationships between sleep and epilepsy and discusses treatment of the sleep-related epilepsies. Several forms of epilepsy predominantly or exclusively manifest during sleep and seizures tend to arise especially from light NREM sleep. Diagnostic interictal epileptiform discharges on the electroencephalogram are also most likely to be activated during deep NREM sleep stage N3. Epileptiform discharges and antiepileptic medications may in turn detrimentally impact sleep. Co-morbid sleep disorders also have the potential to worsen seizure control. Sleep has an important key association with sudden unexpected death in epilepsy (SUDEP). Further research is necessary to understand the complex relationships between sleep and epileptic disorders and their treatments. [ABSTRACT FROM AUTHOR]

Purpose. To determine if methylphenidate (MPH) therapy can improve cognition in adult epilepsy patients on multiple antiepileptic drugs (AEDs), we assessed the impact of MPH on seizure activity, quality of life, cognition, and fatigue in patients with a primary diagnosis of localization-related epilepsy.Methods. This was an open-label, nonrandomized 3-month study. MPH (Ritalin) was added to patients'' current antiepileptic drug regimens. Outcome measures included seizure activity, select AED serum concentrations, quality of life (via Quality of Life in Epilepsy—89 questions (QOLIE-89)), cognition (via Microcog), and fatigue (via a visual analog scale) at baseline and at monthly intervals for the treatment phase.Results. Eleven patients were enrolled and eight completed this pilot study. Of the eight completing the study, five were seizure-free at baseline and throughout the study. One patient had an increase, one a decrease, and one no change in seizure activity. No serious adverse events were observed. On average, serum AED concentrations changed <10% from baseline to the end of the study. Mean overall QOLIE-89 scores and select domains improved significantly from baseline. All Microcog domains improved from baseline. Fatigue also improved significantly.Conclusions. Adult epilepsy patients received relief from sedation with MPH and showed an improved quality of life, without significant alteration of seizure control. [Copyright &y& Elsevier]