Torbjorn Tomson

Summary

Affiliation: Karolinska University Hospital
Country: Sweden

Publications

  1. ncbi request reprint Visual and ocular outcome in children after prenatal exposure to antiepileptic drugs
    K T Fahnehjelm
    Department of Clinical Sciences, Karolinska Institute, Huddinge University Hospital, Sweden
    Acta Ophthalmol Scand 77:530-5. 1999
  2. pmc Epilepsy as a risk factor for cancer
    C Adelöw
    Department of Neurology, Karolinska University Hospital, Solna, Stockholm, Sweden
    J Neurol Neurosurg Psychiatry 77:784-6. 2006
  3. ncbi request reprint No apparent effect of surgery for temporal lobe epilepsy on heart rate variability
    H Persson
    Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
    Epilepsy Res 70:127-32. 2006
  4. ncbi request reprint Role of valproate across the ages. Treatment of epilepsy in adults
    E Ben-Menachem
    Department of Clinical Neuroscience, Sahlgrenska University Hospital at Göteborg University, Göteborg 413 45, Sweden
    Acta Neurol Scand Suppl 184:14-27. 2006
  5. ncbi request reprint Heart rate variability in patients with untreated epilepsy
    Håkan Persson
    Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
    Seizure 16:504-8. 2007
  6. doi request reprint Antiepileptic drug treatment in pregnancy: changes in drug disposition and their clinical implications
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 54:405-14. 2013
  7. doi request reprint Teratogenic effects of antiepileptic drugs
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Lancet Neurol 11:803-13. 2012
  8. ncbi request reprint Teratogenicity of antiepileptic drugs: state of the art
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
    Curr Opin Neurol 18:135-40. 2005
  9. doi request reprint Are lamotrigine kinetics altered in menopause? Observations from a drug monitoring database
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsy Behav 19:86-8. 2010
  10. doi request reprint Pregnancy registries: differences, similarities, and possible harmonization
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 51:909-15. 2010

Detail Information

Publications56

  1. ncbi request reprint Visual and ocular outcome in children after prenatal exposure to antiepileptic drugs
    K T Fahnehjelm
    Department of Clinical Sciences, Karolinska Institute, Huddinge University Hospital, Sweden
    Acta Ophthalmol Scand 77:530-5. 1999
    ....
  2. pmc Epilepsy as a risk factor for cancer
    C Adelöw
    Department of Neurology, Karolinska University Hospital, Solna, Stockholm, Sweden
    J Neurol Neurosurg Psychiatry 77:784-6. 2006
    ..The authors therefore set out to analyse previous diagnosis of epilepsy as a risk factor for certain cancer forms in a case control study...
  3. ncbi request reprint No apparent effect of surgery for temporal lobe epilepsy on heart rate variability
    H Persson
    Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
    Epilepsy Res 70:127-32. 2006
    ..We have now examined the effect of surgery on cardiac autonomic control in the same patients...
  4. ncbi request reprint Role of valproate across the ages. Treatment of epilepsy in adults
    E Ben-Menachem
    Department of Clinical Neuroscience, Sahlgrenska University Hospital at Göteborg University, Göteborg 413 45, Sweden
    Acta Neurol Scand Suppl 184:14-27. 2006
    ..Valproate can be proposed safely to patients with comorbid psychiatric disease or underlying psychiatric vulnerability...
  5. ncbi request reprint Heart rate variability in patients with untreated epilepsy
    Håkan Persson
    Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
    Seizure 16:504-8. 2007
    ..Little information is, however, available on HRV in untreated patients with newly diagnosed epilepsy...
  6. doi request reprint Antiepileptic drug treatment in pregnancy: changes in drug disposition and their clinical implications
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 54:405-14. 2013
    ....
  7. doi request reprint Teratogenic effects of antiepileptic drugs
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Lancet Neurol 11:803-13. 2012
    ....
  8. ncbi request reprint Teratogenicity of antiepileptic drugs: state of the art
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
    Curr Opin Neurol 18:135-40. 2005
    ..This reviews addresses recent reports on the risk for birth defects and impaired postnatal development attributable to prenatal exposure to AEDs...
  9. doi request reprint Are lamotrigine kinetics altered in menopause? Observations from a drug monitoring database
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsy Behav 19:86-8. 2010
    ..05). Our data suggest that there may be a transient decline in clearance of LTG in conjunction with presumed menopause...
  10. doi request reprint Pregnancy registries: differences, similarities, and possible harmonization
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 51:909-15. 2010
    ..Their objectives were to exchange information on their methodologies and to discuss areas where harmonization might be possible. This report summarizes these discussions...
  11. doi request reprint Teratogenic effects of antiepileptic medications
    Torbjorn Tomson
    Department of Clinical Neuroscience Karolinska Institutet, Stockholm, Sweden
    Neurol Clin 27:993-1002. 2009
    ..These conclusions are largely in line with the recently published report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society...
  12. ncbi request reprint Life expectancy in epilepsy
    Torbjorn Tomson
    Department of Clinical Neuroscience, Section of Neurology, Karolinska Institutet, SE 171 76 Stockholm, Sweden
    Lancet 365:557-8. 2005
  13. doi request reprint Sudden unexpected death in epilepsy: current knowledge and future directions
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
    Lancet Neurol 7:1021-31. 2008
    ..Here, we review SUDEP rates, risk factors, triggers, and proposed mechanisms, and critically assess potential preventive strategies. Gaps in knowledge are discussed and ways forward are suggested...
  14. doi request reprint Pregnancy and epilepsy: what should we tell our patients?
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden
    J Neurol 256:856-62. 2009
    ..Withdrawing or changing an AED should generally be avoided during pregnancy. Women with epilepsy on AED treatment should be encouraged to breast-feed...
  15. ncbi request reprint Gender aspects of pharmacokinetics of new and old AEDs: pregnancy and breast-feeding
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Ther Drug Monit 27:718-21. 2005
    ..For most of the new-generation AEDs, there is an urgent need for further kinetic data from pregnancy and breast-feeding...
  16. ncbi request reprint Valproate effects on kinetics of lamotrigine in pregnancy and treatment with oral contraceptives
    T Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Neurology 67:1297-9. 2006
    ..Valproate seems to reduce the induction of lamotrigine metabolism associated with pregnancy or use of contraceptives...
  17. ncbi request reprint Pharmacokinetics and therapeutic drug monitoring of newer antiepileptic drugs during pregnancy and the puerperium
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Clin Pharmacokinet 46:209-19. 2007
    ..Systematic studies of the effects of pregnancy on the pharmacokinetics of the other newer-generation AEDs are urgently needed...
  18. ncbi request reprint Antiepileptic drug exposure and major congenital malformations: the role of pregnancy registries
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsy Behav 11:277-82. 2007
    ..This review provides a critical discussion and comparison of important methodological aspects of AED and pregnancy registries along with a summary of results published so far...
  19. pmc Epilepsy in pregnancy
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, SE 171 76 Stockholm, Sweden
    BMJ 335:769-73. 2007
  20. ncbi request reprint Teratogenic effects of antiepileptic drugs
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Seizure 17:166-71. 2008
    ..Retrospective and a few small prospective studies suggest that exposure to valproate also might be associated with a lower verbal IQ at school age, but further prospective studies are needed to draw firm conclusions...
  21. doi request reprint Antiepileptic treatment in pregnant women: morphological and behavioural effects
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, S 171 76 Stockholm, Sweden
    Handb Exp Pharmacol 205:295-315. 2011
    ..Information on pregnancy outcomes with newer generation AEDs other than lamotrigine are still insufficient...
  22. ncbi request reprint Pharmacokinetics of levetiracetam during pregnancy, delivery, in the neonatal period, and lactation
    Torbjorn Tomson
    Deparatment of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
    Epilepsia 48:1111-6. 2007
    ..To study pharmacokinetics of levetiracetam (LEV) during pregnancy, delivery, lactation, and in the neonatal period...
  23. doi request reprint The impact of background antiepileptic drugs on the efficacy and safety of pregabalin in treating partial-onset seizures: a post hoc analysis of combined clinical trials
    Torbjorn Tomson
    Department of Neurology, Karolinska University Hospital, SE 17176 Stockholm, Sweden
    Epilepsy Res 96:64-73. 2011
    ..In summary, pregabalin provided a consistent improvement in seizure reduction and comparable tolerability in patients with partial-onset epilepsy regardless of the number of concomitant AEDs...
  24. ncbi request reprint Sudden unexpected death in epilepsy: a review of incidence and risk factors
    Torbjorn Tomson
    Department of Clinical Neuroscience, Division of Neurology, Karolinska Institute, Stockholm, Sweden
    Epilepsia 46:54-61. 2005
    ..Further large-scale case-control studies are needed to assess the role of AEDs in order to form a basis for treatment strategies aiming at seizure control and prevention of SUDEP...
  25. ncbi request reprint Pharmacokinetics of gabapentin during delivery, in the neonatal period, and lactation: does a fetal accumulation occur during pregnancy?
    Inger Ohman
    Department of Internal Medicine, Division of Clinical Pharmacology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
    Epilepsia 46:1621-4. 2005
    ..To study the pharmacokinetics of gabapentin (GBP) during delivery, lactation, and in the neonatal period...
  26. doi request reprint Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
    Lancet Neurol 10:609-17. 2011
    ..We aimed to establish the risks of major congenital malformations after monotherapy exposure to four major antiepileptic drugs at different doses...
  27. ncbi request reprint Navigating toward fetal and maternal health: the challenge of treating epilepsy in pregnancy
    Torbjorn Tomson
    Department of Neurology, Karolinska Hospital, Stockholm, Sweden torbjorn tomson kus se
    Epilepsia 45:1171-5. 2004
    ....
  28. doi request reprint Prior hospitalization for stroke, diabetes, myocardial infarction, and subsequent risk of unprovoked seizures
    Cecilia Adelöw
    Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 52:301-7. 2011
    ..To study diabetes, acute myocardial infarction, and stroke as risk factors for unprovoked seizures in a population-based cohort with incident cases of epilepsy...
  29. ncbi request reprint Circadian variation in heart-rate variability in localization-related epilepsy
    Håkan Persson
    Department of Clinical Neuroscience, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
    Epilepsia 48:917-22. 2007
    ..We examined night versus daytime HRV in patients with newly diagnosed and refractory localization-related epilepsy, assessing the effects of drug treatment and epilepsy surgery on the night/daytime HRV ratio...
  30. ncbi request reprint Mortality of epilepsy in developed countries: a review
    Lars Forsgren
    Department of Neurology, Umea University Hospital, Sweden
    Epilepsia 46:18-27. 2005
    ..The most common direct seizure-related cause of death in adolescents and young adults is sudden unexpected death, which is 24 times more common than in the general population...
  31. doi request reprint Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy
    Cecilia Adelöw
    Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
    Neurology 78:396-401. 2012
    ..To study hospitalization for psychiatric disorders before and after onset of unprovoked epileptic seizures/epilepsy...
  32. ncbi request reprint Plasma concentrations of lamotrigine and its 2-N-glucuronide metabolite during pregnancy in women with epilepsy
    Inger Ohman
    Department of Medicine, Clinical Pharmacology Unit, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
    Epilepsia 49:1075-80. 2008
    ..To further characterize pregnancy-induced alterations in the pharmacokinetics of lamotrigine (LTG)...
  33. doi request reprint Increased risk and worse prognosis of myocardial infarction in patients with prior hospitalization for epilepsy--the Stockholm Heart Epidemiology Program
    Imre Janszky
    Department of Public Health Sciences, Karolinska Institutet, Norrbacka, Karolinska University Hospital, Stockholm, Sweden
    Brain 132:2798-804. 2009
    ..Physicians should be aware of the potential cardiovascular implications of epilepsy...
  34. doi request reprint Unprovoked seizures in multiple sclerosis and systemic lupus erythematosus: a population-based case-control study
    Cecilia Adelöw
    Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
    Epilepsy Res 101:284-7. 2012
    ..The odds ratio with 95% confidence interval was 3.7 (CI 1.2-11.0) for MS and 8.0 (2.2-30.0) for SLE, suggesting an increased risk of unprovoked seizures in patients with both these diagnoses...
  35. doi request reprint Pharmacokinetics of topiramate during pregnancy
    Inger Ohman
    Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
    Epilepsy Res 87:124-9. 2009
    ..To study the effects of pregnancy on plasma concentrations of topiramate (TPM)...
  36. doi request reprint Sudden unexpected death in epilepsy in lamotrigine randomized-controlled trials
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 54:135-40. 2013
    ..We evaluated the risk of SUDEP with lamotrigine (LTG) compared to active comparators and placebo in randomized controlled clinical trials conducted by GlaxoSmithKline (GSK) between 1984 and 2009...
  37. doi request reprint Effects of pregnancy and contraception on lamotrigine disposition: new insights through analysis of lamotrigine metabolites
    Inger Ohman
    Department of Medicine, Solna, Clinical Pharmacology Unit, Karolinska Institutet, Stockholm, Sweden
    Seizure 17:199-202. 2008
    ..To investigate possible underlying mechanisms for alterations in lamotrigine (LTG) kinetics by gestation and use of contraceptives...
  38. doi request reprint Hyponatremia and risk of seizures: a retrospective cross-sectional study
    Imad Halawa
    Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
    Epilepsia 52:410-3. 2011
    ..Using 120-124 mM as reference, odds ratios (95% confidence interval) for having seizures at serum sodium levels of 115-119 mM was 3.85 (0.40-37.53), 8.43 (0.859-82.85) at 110-114 mM, and 18.06 (1.96-166.86) at <110 mM...
  39. doi request reprint What is important in rehabilitation for persons with epilepsy? Experiences from focus group interviews with patients and staff
    Ewa Wadhagen Wedlund
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsy Behav 28:347-53. 2013
    ..Encounters between patients were important, as well as the team's attitude in meeting with the patients. Therapeutic working alliance is essential between patients and staff for creating an individual rehabilitation. ..
  40. doi request reprint Newly diagnosed single unprovoked seizures and epilepsy in Stockholm, Sweden: First report from the Stockholm Incidence Registry of Epilepsy (SIRE)
    Cecilia Adelöw
    Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 50:1094-101. 2009
    ....
  41. ncbi request reprint Unbound valproate fraction in plasma and subcutaneous microdialysate in steady state and after a single dose in humans
    Martin Lindberger
    Departments of Neurology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
    Ther Drug Monit 25:378-83. 2003
    ..In addition, subcutaneous microdialysate VPA levels were consistently lower than unbound plasma levels in steady state but not after single dose. The mechanisms underlying this observation need to be studied further...
  42. ncbi request reprint Medical risks in epilepsy: a review with focus on physical injuries, mortality, traffic accidents and their prevention
    Torbjorn Tomson
    Department of Clinical Neuroscience, Karolinska Institute, SE 171 76 Stockholm, Sweden
    Epilepsy Res 60:1-16. 2004
    ..Moreover, the preventive measures in legislation may be ignored by many people with epilepsy...
  43. ncbi request reprint Preoperative heart rate variability in relation to surgery outcome in refractory epilepsy
    H Persson
    Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
    Neurology 65:1021-5. 2005
    ..This risk seems to be reduced after successful surgery but whether this is an effect of surgery or reflects pre-existing differences between good and poor responders is under debate...
  44. ncbi request reprint Serum concentrations and effects of gabapentin and vigabatrin: observations from a dose titration study
    Martin Lindberger
    Department of Neurology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
    Ther Drug Monit 25:457-62. 2003
    ..Hence, with the present study design we were unable to identify specific target ranges of GBP and VGB serum concentrations...
  45. ncbi request reprint Lamotrigine in pregnancy: pharmacokinetics during delivery, in the neonate, and during lactation
    I Ohman
    Departments of Clinical Pharmacology and Clinical Neuroscience, Section of Neurology, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden
    Epilepsia 41:709-13. 2000
    ..To investigate the pharmacokinetics of lamotrigine (LTG) during delivery, during the neonatal period, and lactation...
  46. doi request reprint Unifying the definitions of sudden unexpected death in epilepsy
    Lina Nashef
    Department of Neurology, King s College Hospital, London, United Kingdom
    Epilepsia 53:227-33. 2012
    ..If disagreement exists about which category fits a particular case, we suggest the use of consensus decision by a panel of informed reviewers to adjudicate the classification of the case...
  47. ncbi request reprint Carbamazepine affects autonomic cardiac control in patients with newly diagnosed epilepsy
    Håkan Persson
    Department of Clinical Neuroscience, Karolinska Institute at Department of Neurology, R3 04 Karolinska Hospital, Stockholm SE 171 76, Sweden
    Epilepsy Res 57:69-75. 2003
    ..Our observations demonstrate that CBZ may suppress both parasympathetic and sympathetic functions in newly diagnosed patients with epilepsy. The possible implications of our results for sudden unexpected death in epilepsy are discussed...
  48. ncbi request reprint Distribution of valproate to subdural cerebrospinal fluid, subcutaneous extracellular fluid, and plasma in humans: a microdialysis study
    M Lindberger
    Department of Neurology, Karolinska Institute, Huddinge University Hospital, S 14186 Huddinge, Sweden
    Epilepsia 42:256-61. 2001
    ....
  49. doi request reprint Long-term follow-up after comprehensive rehabilitation of persons with epilepsy, with emphasis on participation in employment or education
    Ewa Wadhagen Wedlund
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsy Behav 25:219-23. 2012
    ..The significance of the associations disappeared in adjusted multivariable analysis. Participation in employment or education was improved for many patients at follow-up...
  50. ncbi request reprint Microdialysis sampling of carbamazepine, phenytoin and phenobarbital in subcutaneous extracellular fluid and subdural cerebrospinal fluid in humans: an in vitro and in vivo study of adsorption to the sampling device
    Martin Lindberger
    Department of Neurology, Karolinska Institute, Huddinge University Hospital, S 14186 Huddinge, Sweden
    Pharmacol Toxicol 91:158-65. 2002
    ..Reliable estimation of unbound phenytoin is not possible at present...
  51. ncbi request reprint [It's possible to influence prescriptions patterns by producer-independent information]
    Sigurd Vitols
    Avdelningen för klinisk farmakologi, Karolinska Universitetssjukhuset Solna, Stockholm, Sweden
    Lakartidningen 101:2573-5. 2004
    ..The finding underlines the need for repeated information when effects on prescription habits are wanted...
  52. ncbi request reprint Risk of extremity fractures in adult outpatients with epilepsy
    Hakan B I Persson
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Epilepsia 43:768-72. 2002
    ..To study the incidence of extremity fractures in a group of adult patients with epilepsy attending an outpatient clinic compared with the incidence of fractures in the general population in the same geographic area...
  53. ncbi request reprint Therapeutic monitoring of the new antiepileptic drugs
    T Tomson
    Department of Clinical Neuroscience, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden
    Eur J Clin Pharmacol 55:697-705. 2000
    ..To discuss the potential value of therapeutic drug monitoring (TDM) of the new antiepileptic drugs gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide...
  54. ncbi request reprint Psychomotor development in preschool children exposed to antiepileptic drugs in utero
    K Wide
    Department of Clinical Sciences, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
    Acta Paediatr 91:409-14. 2002
    ..5-5 y of age in children exposed to phenytoin may indicate a subtle influence on psychomotor development, which may be more obvious at school age: thus, larger studies and further follow-up are warranted...
  55. ncbi request reprint Gabapentin versus vigabatrin as first add-on for patients with partial seizures that failed to respond to monotherapy: a randomized, double-blind, dose titration study. GREAT Study Investigators Group. Gabapentin in Refractory Epilepsy Add-on Treatment
    M Lindberger
    Department of Neurology, Karolinska Institute, Huddinge Hospital, Sweden
    Epilepsia 41:1289-95. 2000
    ..Our objective was to compare the efficacy and safety of gabapentin and vigabatrin as first-line add-on treatment in patients with partial epilepsy...
  56. ncbi request reprint Mortality in epilepsy
    T Tomson
    Department of Clinical Neuroscience, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
    J Neurol 247:15-21. 2000
    ..It appears, however, that the risk of SUD is closely related to seizure frequency, being 40 times higher in patients who continue to have seizures than in those who are seizure-free...