1. Generic switch and Compliance in epilepsy, pharmacokinetic and clinical aspects                                 

Intricate relationships between pharmacokinetic, psychological and psychiatric factors may jeopardize seizure control in epilepsy. Several generic leveteracitam preparations have been marketed. Switching patients from branded antiepileptic drug to generic alternative, with the same active ingredient, is often a challenging task. The overall aim is to optimize seizure control, and to enhance vigilance concerning psychiatric co-morbidity, in patients with epilepsy. Safe generic switch in epilepsy with safe follow-up routines will increase substitution numbers and diminish patients and doctors worries.

We work on evidence for adequate clinical follow-up routines during generic switch, and after loss of seizure control, including optimized routines for therapeutic drug monitoring.

If routines for serum concentration drug sampling at emergency visits due to break through seizures become standardized, toxicity from unmotivated and inadequate AED dose escalations will be avoided. Enhanced vigilance concerning psychiatric co-morbidity in epilepsy will ensure adequate anti-depressant treatment is prescribed. Hence, adherence to drug regimens for a larger number of persons with epilepsy will be facilitated. Unnecessary suffering and hospital visits can be avoided, with cost savings as a consequence.

2. Epilepsy, cognition and temporal lobe resection                                                                             

Epilepsy surgery is the only option for cure in pharmaco-resistant epilepsy, an effective treatment with positive health economic consequences. 60-70 % become seizure free from temporal lobe surgery. However, epilepsy surgery is not without risk for the patient. Our results will increase safety and refine selection criteria by identifying patient that gain from surgery without suffering functional memory loss. Our methods include: fMRI, 7 Tesla MRI and psychometric tests. Results can directly be implemented as clinical routines in the Lund epilepsy program

We have shown that pre-surgical memory testing, combined with language lateralization by functional MRI, can predict post-surgical memory outcome. We created a risk assessment score for post-surgical memory deficits which had a specificity of 67 % and a sensitivity of 75%. Significant correlations were found between frontal language indices in fMRI and post-surgical verbal memory for left TLE, and between medial temporal lobe language indices and visuospatial memory as well as verbal memory for right TLE. Atypical fMRI pattern in verbal memory assessment were associated to unexpected verbal memory deficit after surgery.