<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_joepi-2018-001_s_001"><h3>Background.</h3><p>Planned homebirth is an option available to a small minority of expecting mothers. Compared with hospital births, long-term risks of homebirths are poorly known.</p></sec><sec id="j_joepi-2018-001_s_002"><h3>Aim</h3><p>To study very long-term outcome for death, seizure remission, and other neurological long-term comorbidities</p></sec><sec id="j_joepi-2018-001_s_003"><h3>Material and Methods.</h3><p>A cohort of virtually all children (n = 230) in a geographically defined area with onset of epilepsy in or active epilepsy diagnosed prior to 1961–1964, and prospectively followed-up for 50 years.</p></sec><sec id="j_joepi-2018-001_s_004"><h3>Results.</h3><p>The proportion of homebirths was 16% in blue collar families and 2% in white collar families (p = 0.007). No significant differences between homebirths and hospital births were found in the frequencies of either abnormal pregnancy (27% vs 27%, p > 0.99) or abnormal birth (32% vs 35%, p = 0.82). Premature mortality following homebirths was non-significantly higher than that following hospital births (41% vs 27%, p = 0.13). Homebirth did not significantly affect 5-year (38% vs 40%) or 10-year (38% vs 37%) remission. Neither was homebirth alone associated with neurological morbidity (2.1, 0.82–6.1, p = 0.137).</p></sec><sec id="j_joepi-2018-001_s_005"><h3>Conclusion.</h3><p>Homebirth is an observable but non-significant risk factor of offspring mortality and neurological morbidity of an offspring with epilepsy. Blue collar families preferred homebirth to hospital birth for reasons which are not fully understood. Further research is needed in a prospective setting by applying modern standards of early identification of risk pregnancies and deliveries, carefully monitoring the health of expecting mothers, and anticipating referral to specialist services according to medical needs.</p></sec></abstract>

Long-term offspring epilepsy outcomes following planned assisted homebirth versus hospital birth

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_joepi-2018-002_s_001"><h3>Background</h3><p>Effective treatment protocols development for West syndrome (WS) is scientifically and economically significant.</p></sec><sec id="j_joepi-2018-002_s_002"><h3>Aim</h3><p>To evaluate the comparative short term efficacy and tolerability of tetracosactide at a dose of 0.03– 0.05 mg/kg and dexamethasone at a dose of 0.3–0.5 mg/kg both combined with valproate at a dose of 30–40 mg/kg/day for WS therapy. The regimen was: 1 injection daily for 10 days, following with 5 injections every other day, then 5 injections every two days, plus a valproate.</p></sec><sec id="j_joepi-2018-002_s_003"><h3>Material and Methods</h3><p>79 infants (Group 1) received tetracosactide, 18 infants (Group 2) – dexamethasone. The demographic data and the main characteristics of WS were similar in both groups.</p></sec><sec id="j_joepi-2018-002_s_004"><h3>Results</h3><p>The efficacy of tetracosactide exceeded that of dexamethasone: there were more responders to therapy in Group 1: 92.4% vs 72% (p = 0.0017). Tetracosactide produced faster results: 50.5% of patients in Group 1 experienced cessation of infantile spasms within the first 5 days of therapy versus 38.7% of patients in Group 2; infantile spasms ceased in 34% of patients in Group 1 on day 6–10, versus 22.2% of patients in Group 2. 74.6% of patients in Group 1 experienced normalization of EEG on day 10, versus 33.3% of patients in Group 2 (p = 0.04). A higher percentage of patients treated with dexamethasone exhibited multiregional activity on EEG by day 10. Tolerability was similar in both groups. All adverse effects were of mild to moderate severity</p></sec><sec id="j_joepi-2018-002_s_005"><h3>Conclusion</h3><p>Tetracosactide therapy in combination with average therapeutic doses of valproate proved to be more effective in treating WS than the combination of dexamethasone and valproate.</p></sec></abstract>

The short-term efficacy of combined hormone therapy in West syndrome

Heinz Gregor Wieser (1943–2018)

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_joepi-2018-004_s_001"><h3>Introduction.</h3><p>Finding an effective epilepsy treatment has been a challenge in medicine for centuries. It is especially difficult to treat drug-resistant epilepsy, which accounts for 20–30% of epilepsy cases, even after the introduction of numerous new anti-epileptic drugs (AEDs). This gives an incentive to search for therapies other than pharmacotherapy, e.g. the ketogenic diet (KD).</p></sec><sec id="j_joepi-2018-004_s_002"><h3>Aim.</h3><p>The present review paper aims to present the current state of knowledge regarding the effectiveness of the KD, its mechanism of action, indications, method of treatment and potential adverse effects.</p></sec><sec id="j_joepi-2018-004_s_003"><h3>Material and method.</h3><p>The review covers relevant most recent (up to March 2018) papers using PubMed and Medline databases.</p></sec><sec id="j_joepi-2018-004_s_004"><h3>Results and discussion.</h3><p>The history of the KD dates back to ancient times. It was believed to be very promising at the beginning of the last century, but then was temporarily ‘forgotten’ and has been undergoing a second renaissance since around 1990. It is currently recognised in most countries. The KD is administered mainly to children but over the last few years there have been attempts to use it in adults as well. The theoretical basis of the diet consists in the fact that it ‘mimics’ the metabolic state of an organism subject to fasting by replacing the basic source of energy for the brain, that is glucose, with ketone bodies, which are a product of fat breakdown. In spite of scientific progress, the exact mechanism underlying the KD is still not known. Its effectiveness, at first mainly as an add-on therapy, and in some cases as the first-line monotherapy, is rated quite highly (&lt;50% seizure reduction in &lt;50% patients; of which in 20–30% of patients seizures are reduced by &lt;90%). It can be used to treat all types of epileptic seizures after excluding contraindications. The KD, like any medical therapy for serious illnesses, may cause adverse effects. Most of them are mild, can be prevented, and if they occur, can be fairly easily treated</p></sec><sec id="j_joepi-2018-004_s_005"><h3>Conclusion.</h3><p>The KD as add-on therapy or as monotherapy is a medical treatment of epilepsy administered under medical supervision.</p></sec></abstract>

Ketogenic diet in epilepsy: an updated review

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_joepi-2018-005_s_001"><h3>Introduction.</h3><p>Valproic acid is commonly used for the treatment of epilepsy, psychiatric disorders such as bipolar disorders, anxiety and prophylaxis migraine. Long-term use of valproic acid is related with metabolic disorders such as the increase of body weight and changes of lipid profiles which are contributed to cardiovascular events, however, these associations remain unclear, furthermore, the mechanisms of these effects have not been fully elucidated.</p></sec><sec id="j_joepi-2018-005_s_002"><h3>Aim.</h3><p>To summarize and discuss the potential mechanisms of valproic acid-related changes of lipid profiles so as to get a better understanding of the side effects of valproic acid on lipid metabolism.</p></sec><sec id="j_joepi-2018-005_s_003"><h3>Methods.</h3><p>Literature reviews were conducted through the survey of the literature utilizing the Pubmed electronic databases, with the aim to identify all literature regarding the metabolic effects of valproic acid. This review has been written to summarize the latest evidence of valproic acid’s effects on lipid profiles.</p></sec><sec id="j_joepi-2018-005_s_004"><h3>Review and Discussion.</h3><p>The possible mechanisms of valproic acid-related changes of lipid profiles could be through insulin resistance and hyperinsulinemia in several ways, resulting in the alteration of lipogenesis and clearance of triglyceride and lipoproteins.</p></sec><sec id="j_joepi-2018-005_s_005"><h3>Conclusion.</h3><p>The effect of valproic acid on lipid profiles is complex and there is a need for further investigation. Consequently the monitoring and follow up of lipid profiles from patients prescribed valproic acid is recommended.</p></sec></abstract>

The potential mechanisms of effect of valproic acid on lipid profiles: an updated review

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_joepi-2018-006_s_001"><h3>Background.</h3><p>Video-EEG (VEEG) monitoring is a vital diagnostic tool, but there are no guidelines for withdrawal of antiepileptic drugs (AEDs).</p></sec><sec id="j_joepi-2018-006_s_002"><h3>Aim.</h3><p>The main objectives of this study were to understand the different withdrawal strategies used in the EMU, how strategies are chosen, and the efficacy and safety of different withdrawal strategies in producing seizures.</p></sec><sec id="j_joepi-2018-006_s_003"><h3>Materials and methods.</h3><p>We retrospectively analyzed 95 consecutive patients and measured time to first seizure, incidence of status epilepticus, and need for rescue medications.</p></sec><sec id="j_joepi-2018-006_s_004"><h3>Results.</h3><p>We found that AED withdrawal strategies can be divided into four categories based on level of aggressiveness. The main factors which impacted choice of strategy was number of AEDs on admission and frequency of pre-admission seizures. Abrupt cessation of medications was correlated with longer time to first seizure compared to other methods (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.20–0.65, p = 0.0007). Patients remaining on medications had shorter time to first seizure (HR 2.98, 95% CI 1.22–7.24, p = 0.016). Withdrawal technique was not correlated with need for rescue medications (OR 5.0, 95% CI 0.77–43, p = 0.20). No patients had status epilepticus in the study.</p></sec><sec id="j_joepi-2018-006_s_005"><h3>Conclusions.</h3><p>Pre-admission seizure frequency and number of AEDs are the main factors which drive choice of withdrawal strategy on the epilepsy monitoring unit (EMU). Counterintuitively, least aggressive strategy is associated with highest risk of seizures. Results of this analysis suggest that disease factors, not choice of withdrawal strategy, determine seizure frequency on the EMU.</p></sec></abstract>

Determinants of medication withdrawal strategy in the epilepsy monitoring unit

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_joepi-2018-007_s_001"><h3>Introduction.</h3><p>Depressive symptoms are very frequent in the population of patients with epilepsy. Comorbidity between depression and epilepsy is estimated in the range of 9–62%. There are no epidemiological studies in Poland thus far in that area and there is no translated and validated screening tool for depression dedicated for persons with epilepsy (PWEs). In this study we intended to validate the Polish version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), which is a short and accurate scale used in many countries for assessment of depressive symptoms in PWEs.</p></sec><sec id="j_joepi-2018-007_s_002"><h3>Aim.</h3><p>The purpose of the study was to validate the Polish version of NDDI-E scale in the sample of PWEs.</p></sec><sec id="j_joepi-2018-007_s_003"><h3>Material and methods.</h3><p>The consecutive 257 patients with epilepsy (PWEs) who met inclusion and exclusion criteria, were recruited by neurologists-epileptologists during their routine outpatient visits in the period from November 2016 to February 2017. The respondents completed the Polish translated version of NDDI-E scale and were assessed with the MINI-International Neuropsychiatric Interview (MINI, depression module).</p></sec><sec id="j_joepi-2018-007_s_004"><h3>Results.</h3><p>After excluding assessments with missing data, we analyzed data of 253 subjects. Sixty-four patients (25.1%) had current major depressive disorder (MDD) according to the MINI criteria. The Cronbach’s coefficient for the NDDI-E was 0.822. Receiver operating characteristic analyses showed an area under the curve of 0.882 (p &lt; 0.001; asymptotic 95% confidence intervals ranged from 0.832 to 0.932). The cut-off point of 9 corresponded to sensitivity of 0.766 and specificity of 0.858.</p></sec><sec id="j_joepi-2018-007_s_005"><h3>Conclusion.</h3><p>The Polish version of NDDI-E scale after validation with a cut-off 9 points may be a useful tool for diagnosing depression in a Polish population of PWEs.</p></sec></abstract>

Validation of the Polish version of the Neurological Disorders Depression Inventory for Epilepsy (P-NDDI-E)

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Journal of Epileptology

 The Journal of Epileptology – published since 2013 - is an international, open access peer reviewed scientific journal that publishes articles of clinical and experimental epilepsy.   The following categories of epilepsy related topics are accepted for publications: medical hypotheses, basic research, clinical research, reviews and special reports, product investigation, diagnostic and medical technology, case reports, letters to Editor, reports from international and local activities.   The aim of the journal is to widen the international community of readers, research and clinicians interested in various aspects of epilepsy and disseminate interdisciplinary knowledge in all fields related to epilepsy.   The Journal of Epileptology is owned by the Foundation of Epileptology which was established in 1993 by Professor Jerzy Majkowski. The Foundation of Epileptology is the first non-governmental organization in Poland whose priority is to improve the quality of life of persons with epilepsy by improving the diagnostic and therapeutic skills of doctors and by shaping a positive attitude to epilepsy among the public. The Foundation, led by this idea, brings together physicians, psychologists, scientists and academics, social activists and other people who wish to contribute to the development of epileptology and thus provide medical assistance to persons with epilepsy.     About Society   The Foundation of Epileptology was established in 1993 by Professor Jerzy Majkowski who also founded the Department of Neurology and Epileptology at the Medical Centre for Postgraduate Education (CMKP) in 1988. The Foundation of Epileptology is the first non-governmental organisation in Poland to have as its priority the improvement of quality of life of epileptic patients by means of furthering doctors' diagnostic and therapeutic mastery and developing a positive approach to epilepsy among the general public. The Foundation, led by this idea, attracts physicians, psychologists, researchers and academics, social activists and other persons who wish to contribute to the development of epileptology and thereby bring medical assistance to people suffering from epilepsy. The Foundation of Epileptology was registered in the Foundation Register of the District Court for the Municipality of Warsaw on 16 March 1993 and thereby acquired legal status. The Founder appointed the Foundation Council and the Foundation Executive Committee.   The Foundation of Epileptology co-operates with the Polish Society of Epileptology, the Warsaw-based Society for Victims of Epilepsy and their Friends "Calm Head" (Spokojna Głowa) and other domestic and foreign organisations with similar goals. The Foundation of Epileptology is a member of the European Epilepsy Academy (EUREPA) and Professor Majkowski is co-organiser and member of the first Executive Committee and is now a member of the EUREPA Research Advisory Committee. The Executive Committee of the Polish Society of Epileptology shares its headquarters with the Epilepsy Foundationv   Archiving   The archiving of issues published from 2013 to 2017 will occur, and thus all issues published in the current form of the Journal will become available on-line. However, the issues published quarterly under the journal’s earlier name of Epileptologia during 1993 to 2012 will be successively attached and published on journal’s website www.journal-epileptology.com.   Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.   Plagiarism Policy   The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 