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de Toffol B. Epilepsy and psychosis. Rev Neurol (Paris) 2024; 180:298-307. [PMID: 38336524 DOI: 10.1016/j.neurol.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Abstract
Psychotic disorders are eight times more frequent in epilepsy than in the general population. The various clinical syndromes are classified according to their chronology of onset in relation to epileptic seizures: ictal psychoses (during epileptic discharge), post-ictal psychoses (PIP, after a seizure), interictal psychoses (IIP, with no chronological link) and those related to complete seizure control. Antiepileptic drugs can cause psychotic disorders in all these situations. Post-ictal psychoses (PIP) are affective psychoses that occur after a lucid interval lasting 12 to 120hours following a cluster of seizures. They last an average of 10days, with an abrupt beginning and end. PIP are directly linked to epileptic seizures, and disappear when the epilepsy is controlled. Interictal psychoses are schizophrenias. The management of psychotic disorders in epilepsy is neuropsychiatric, and requires close collaboration between epileptologists and psychiatrists. Antipsychotics can be prescribed in persons with epilepsy. Even today, psychotic disorders in epilepsy are poorly understood, under-diagnosed and under-treated.
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Affiliation(s)
- B de Toffol
- Université des Antilles, Neurology Department, Centre Hospitalier de Cayenne, CIC Inserm 1424, rue des Flamboyants, 97300 Cayenne, French Guiana.
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202
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Finsterer J. Whole exome sequencing is the method of choice to determine the etiology of developmental epileptic encephalopathy. Seizure 2024; 117:305-306. [PMID: 38685258 DOI: 10.1016/j.seizure.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Josef Finsterer
- Neurology Department, Neurology & Neurophysiology Center, Postfach 20, 1180, Vienna, Austria.
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203
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Delil MS, Turk BG, Kochan-Kizilkilic E, Abbaszade H, Yeni SN, Ozkara C. The effect of the coronavirus vaccinations on seizures in patients with epilepsy. Heliyon 2024; 10:e28337. [PMID: 38560696 PMCID: PMC10979212 DOI: 10.1016/j.heliyon.2024.e28337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Information on COVID-19 vaccine tolerance and complications in patients with epilepsy is not yet sufficient to provide a recommendation for vaccination guidelines. The aim of this study was to investigate the effect of two types of COVID vaccines currently used in Turkey (mRNA vaccine from Pfizer/BioNTech and inactivated vaccine from Sinovac) on epileptic seizures. Methods We included 318 patients with epilepsy who were admitted to our epilepsy outpatient clinic. Clinical characteristics such as age, gender, age at seizure onset and the duration of epilepsy were noted. Types and the numbers of the anti-seizure drugs were recorded. Patients were evaluated either by face-to-face or by teleconference interviews. The seizure frequency in the first thirty days after any dose of vaccination was questioned. Results A total of 318 patients (149 females, 46.8%) with a confirmed diagnosis of epilepsy were enrolled in the study. An increase in seizure frequency was reported after the COVID-19 vaccine in 19 patients. Of these 19 patients, 2 were vaccinated with Sinovac, while 17 were vaccinated with BioNTech/Pfizer mRNA vaccine. There was no significant relationship between age, age at seizure onset, duration of epilepsy, type of seizures, seizure frequency or seizure induction. Status epilepticus was not reported in any of the participants. Conclusion Physicians need strong scientific evidence to advocate the importance of vaccine for COVID-19, that's why accumulation of knowledge related to this issue is important not only from medical but also from medico-legal point of interest. We aimed to contribute the current literature with our study to strengthen the physicians' hand while recommending COVID vaccines to PWE. Our results show that there is no significant increase in the risk of triggering seizures with COVID-19 vaccines. These data show that vaccination against COVID-19 with both vaccine types in patients with epilepsy is safe and well tolerated.
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Affiliation(s)
- Memet Sakir Delil
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bengi Gul Turk
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Hikmet Abbaszade
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seher Naz Yeni
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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204
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Duan X, Han H, Liu J, Qiu Y, Wang Y, Wu X, Zhang H, Zou Z, Qiu J, Chen C, Xiao F, Tian X. Deferasirox exerts anti-epileptic effects by improving brain iron homeostasis via regulation of ITPRIP. Neurochem Int 2024; 176:105725. [PMID: 38561151 DOI: 10.1016/j.neuint.2024.105725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
Epilepsy constitutes a global health concern, affecting millions of individuals and approximately one-third of patients exhibit drug resistance. Recent investigations have revealed alterations in cerebral iron content in both epilepsy patients and animal models. However, the extant literature lacks a comprehensive exploration into the ramifications of modulating iron homeostasis as an intervention in epilepsy. This study investigated the impact of deferasirox, a iron ion chelator, on epilepsy. This study unequivocally substantiated the antiepileptic efficacy of deferasirox in a kainic acid-induced epilepsy model. Furthermore, deferasirox administration mitigated seizure susceptibility in a pentylenetetrazol-induced kindling model. Conversely, the augmentation of iron levels through supplementation has emerged as a potential exacerbating factor in the precipitating onset of epilepsy. Intriguingly, our investigation revealed a hitherto unreported discovery: ITPRIP was identified as a pivotal modulator of excitatory synaptic transmission, regulating seizures in response to deferasirox treatment. In summary, our findings indicate that deferasirox exerts its antiepileptic effects through the precise targeting of ITPRIP and amelioration of cerebral iron homeostasis, suggesting that deferasirox is a promising and novel therapeutic avenue for interventions in epilepsy.
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Affiliation(s)
- Xinhao Duan
- Department of Health Laboratory Technology, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Huifang Han
- Department of Health Laboratory Technology, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Jing Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, 400016, China; Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, 404100, China
| | - Yu Qiu
- Department of Neurology, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaotian Wu
- Department of Clinical Laboratory, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Hui Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, 400016, China
| | - Zhen Zou
- Molecular Biology Laboratory of Respiratory Diseases, Institute of Life Sciences, Chongqing Medical University, Chongqing, 400016, China
| | - Jingfu Qiu
- Department of Health Laboratory Technology, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Chengzhi Chen
- Department of Occupational and Environmental Health, School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
| | - Fei Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, 400016, China; Key Laboratory of Major Brain Disease and Aging Research(Ministry of Education), Chongqing Medical University, Chongqing, 400016, China.
| | - Xin Tian
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, 400016, China; Key Laboratory of Major Brain Disease and Aging Research(Ministry of Education), Chongqing Medical University, Chongqing, 400016, China.
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205
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Kim MY, Kim JA, Lee Y, Lee SK. Treatment compliance, treatment patterns, and healthcare utilization in epilepsy patients with first add-on antiepileptic drugs: A nationwide cohort study. Heliyon 2024; 10:e27770. [PMID: 38500981 PMCID: PMC10945250 DOI: 10.1016/j.heliyon.2024.e27770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Objective This study aimed to assess the treatment compliance, patterns, healthcare resource utilization (HCRU), and costs of anti-epilepsy drugs (AEDs) as the first add-on therapy in patients with epilepsy. Methods We conducted a retrospective population-based cohort study using Korean National Health Insurance claims data from 2016 to 2020. Patients with epilepsy who newly received AED add-on therapy were identified and followed for up to 12 months to evaluate persistence, adherence, treatment patterns, HCRU, and costs. Results Among 6,746 patients who initiated AED add-on therapy, 65.5% were persistent on their index AED add-on from the index date until the end of the follow-up period, and the mean persistent time on the index add-on was 307.3 ± 92.3 days. A total of 76.8% patients were adherent, with a medication possession ratio (MPR) ≥80%, and the mean MPR was 88.9 ± 25.4%. Persistence and adherence to the index AED add-on were relatively higher among patients prescribed lamotrigine, levetiracetam, oxcarbazepine, and perampanel than those prescribed carbamazepine, topiramate, or valproate. A total of 41.0% of the patients changed their index AED add-on during the follow-up period. The carbamazepine, topiramate, and valproate groups had higher rates of change than the other AED groups. HCRU and costs tended to be lower in the lamotrigine, levetiracetam, oxcarbazepine, and perampanel groups. Furthermore, perampanel showed the lowest HCRU and costs for all-cause cases as well as the lowest length of stay and outpatient visits for epilepsy-related cases. Conclusion In this population-based study, the use of lamotrigine, levetiracetam, oxcarbazepine, or perampanel as the first add-on therapy in patients with epilepsy contributed to better treatment compliance and lower HCRU and costs than that of carbamazepine, topiramate, or valproate.
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Affiliation(s)
- Min Young Kim
- Medical, Eisai Korea Inc, 6 Bongeunsa-ro 86-gil, Gangnam-gu, Seoul, Republic of Korea
| | - Jung-Ae Kim
- Real World Insights, IQVIA Korea, 173 Toegye-ro, Jung-gu, Seoul, Republic of Korea
| | - Youngeun Lee
- Real World Insights, IQVIA Korea, 173 Toegye-ro, Jung-gu, Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
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Ban Y, Yang X, Tan D, Gong C, Gao Y, Yuan J, Chen Y, Wang Y, Xu T. Sorbs2 regulates seizure activity by influencing AMPAR-mediated excitatory synaptic transmission in temporal lobe epilepsy. Neurochem Int 2024; 176:105727. [PMID: 38555055 DOI: 10.1016/j.neuint.2024.105727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Temporal lobe epilepsy (TLE), the most common type of drug-resistant epilepsy, severely affects quality of life. However, the underlying mechanism of TLE remains unclear and deserves further exploration. Sorbs2, a key synaptic regulatory protein, plays an important role in the regulation of synaptic transmission in the mammalian brain. In this study, we aimed to investigate the expression pattern of Sorbs2 in a kainic acid (KA)-induced TLE mouse model and in patients with TLE to further determine whether Sorbs2 is involved in seizure activity and to explore the potential mechanism by which Sorbs2 affects seizures in this TLE mouse model. First, we found that the expression of Sorbs2 was obviously increased in the hippocampus and cortex of a TLE mouse model and in the temporal cortex of TLE patients, indicating an abnormal expression pattern of Sorbs2 in TLE. Importantly, subsequent behavioral analyses and local field potential (LFP) analyses of a TLE mouse model demonstrated that the downregulation of hippocampal Sorbs2 could prolong the latency to spontaneous recurrent seizures (SRSs) and protect against SRSs. We also found that the knockdown of Sorbs2 in the hippocampus could decrease excitatory synaptic transmission in pyramidal neurons (PNs) in the hippocampal CA1 region and reduce the expression levels of the AMPAR subunits GluA1 and GluA2. Thus, we speculated that Sorbs2 may promote epileptogenesis and the development of TLE by affecting AMPAR-mediated excitatory synaptic transmission in PNs in the CA1 region. Therefore, reducing the expression of hippocampal Sorbs2 could restrain epileptogenesis and the development of TLE.
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Affiliation(s)
- Yuenan Ban
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Xiaolan Yang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Dandan Tan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Chen Gong
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Yuan Gao
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Jinxian Yuan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - You Wang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Tao Xu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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207
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Salaria P, Reddy M A. Network Pharmacology Approach to Identify the Calotropis Phytoconstituents' Potential Epileptic Targets and Evaluation of Molecular Docking, MD Simulation, and MM-PBSA Performance. Chem Biodivers 2024:e202400255. [PMID: 38533537 DOI: 10.1002/cbdv.202400255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 03/28/2024]
Abstract
Epilepsy originates from unusual electrical rhythm within brain cells, causes seizures. Calotropis species have been utilized to treat a wide spectrum of ailments since antiquity. Despite chemical and biological investigations, there have been minimal studies on their anticonvulsant activity, and the molecular targets of this plant constituents are unexplored. This study aimed to investigate the plausible epileptic targets of Calotropis phytoconstituents through network pharmacology, and to evaluate their binding strength and stability with the identified targets. In detail, 125 phytoconstituents of the Calotropis plant (C. procera and C. gigantea) were assessed for their drug-likeness (DL), blood-brain-barrier (BBB) permeability and oral bioavailability (OB). Network analysis revealed that targets PTGS2 and PPAR-γ were ranked first and fourth, respectively, among the top ten hub genes significantly linked with antiepileptic drug targets. Additionally, docking, molecular dynamic (MD) simulation, and Molecular Mechanics-Poisson-Boltzmann Surface Area (MM-PBSA) were employed to validate the compound-gene interactions. Docking studies suggested ergost-5-en-3-ol, stigmasterol and β-sitosterol exhibit stronger binding affinity and favorable interactions than co-crystallized ligands with both the targets. Furthermore, both MD simulations and MM-PBSA calculations substantiated the docking results. Combined data revealed that Calotropis phytoconstituents ergost-5-en-3-ol, stigmasterol, and β-sitosterol might be the best inhibitors of both PTGS2 and PPAR-γ.
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Affiliation(s)
- Punam Salaria
- Department of Chemistry, School of Sciences, National Institute of Technology Andhra Pradesh, Tadepalligudem, 534101, Andhra Pradesh, India
| | - Amarendar Reddy M
- Department of Chemistry, School of Sciences, National Institute of Technology Andhra Pradesh, Tadepalligudem, 534101, Andhra Pradesh, India
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208
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Helmstaedter C, Tailby C, Witt JA. Neuropsychology of late-onset epilepsies. Seizure 2024:S1059-1311(24)00078-5. [PMID: 38555201 DOI: 10.1016/j.seizure.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024] Open
Abstract
In an increasingly ageing society, patients ageing with epilepsy and those with late-onset epilepsies (LOE) represent a challenge for epilepsy care and treatment. Senescence itself bears risks of pathologies which in the form of acute focal damage (e.g. stroke) or slowly progressive degenerative damage can cause seizures and substantial cognitive impairment. There is converging evidence from studies in LOE that cognitive impairments are present from epilepsy onset before treatment is initiated and may even precede the emergence of seizures. This suggests that these impairments (like the seizures) are expressions of the underlying disease. Indeed, both seizures and cognitive impairments can be early indicators of disease conditions which lead to mental decline. Cognitive decline over time poses the challenge of disentangling the interrelation between seizures, treatment effects and underlying disease. This issue must be considered as some of the etiologies for causing neuropsychological decline can be addressed. Medication and active epilepsy can contribute to impairments and their impact may be reversible. Dementia is rare if seizures are what has brought the person to attention, and if this is not accompanied by other slowly developing features (such as cognitive of psychiatric changes). From a neuropsychological point of view choosing the right screening tools or assessments, obtaining the history and timeline of impairments in relation to epilepsy, and most importantly longitudinally following the patients regardless of whether epilepsy is ultimately controlled or not appear essential.
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Affiliation(s)
- C Helmstaedter
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany.
| | - C Tailby
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, 3084, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria 3010, Australia; Department of Clinical Neuropsychology, Austin Hospital, Heidelberg, Victoria, 3084, Australia
| | - J-A Witt
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
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209
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Johnson J, Somerfield W, Johnson SR. Lymphangioleiomyomatosis in patients with tuberous sclerosis: a national centre audit. Orphanet J Rare Dis 2024; 19:137. [PMID: 38532450 DOI: 10.1186/s13023-024-03115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/03/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Lymphangioleiomyomatosis (LAM) is common in tuberous sclerosis complex (TSC) yet under recognised with management mostly based upon evidence obtained from patients with sporadic LAM. We performed a prospective audit of patients with TSC-LAM attending a national referral centre to inform management guidelines. METHODS The UK LAM Centre was established in 2011 and conducts a prospective audit of pre-defined quality outcomes for all subjects. Audit data are reported on all patients with TSC-LAM and a comparator population of patients with sporadic LAM. RESULTS Between 2011 and 2022, 73 patients were seen with TSC-LAM. All were women with a mean (SD) age of 39 (12) years. Referral rates were similar over the study period including after the introduction of CT screening. Median age of diagnosis with TSC was 11 years (range 0-70) with one third diagnosed with TSC as adults. Compared with all TSC patients in the 'TOSCA' registry, TSC-LAM patients tended to have been diagnosed with TSC at an older age, had fewer neuro-cognitive manifestations and were more likely to have angiomyolipoma. The most common presentations of TSC-LAM were following workup for angiomyolipoma, pneumothorax or dyspnoea with only one fifth detected after CT screening. Baseline FEV1 and DLCO at first assessment were reduced to 77 and 63% predicted respectively and were similar to patients with sporadic LAM. During follow-up, FEV1 fell by a mean of 81 ml/year and DLCO fell by 0.309 mmol/ml/kPa/year in patients not being treated with an mTOR inhibitor. 55% required treatment with either sirolimus or Everolimus for LAM or angiomyolipoma respectively. For those treated with an mTOR inhibitor, mean FEV1 fell by 3 ml/year and DLCO increased by 0.032 mmol/ml/kPa/year and was similar to sporadic LAM. Risk of death due to LAM or need for lung transplant in patients with TSC-LAM was 0.67%/year. CONCLUSIONS Despite screening recommendations, LAM is often diagnosed in TSC after symptoms develop which may delay treatment. Complications including pneumothorax and loss of lung function are significant and similar to sporadic LAM. Work is needed to implement the recommended CT screening for LAM and improve respiratory care for TSC-LAM.
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Affiliation(s)
- Jan Johnson
- Centre for Respiratory Research, Translational Medical Sciences and Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, UK
| | - Wendy Somerfield
- National Centre for Lymphangioleiomyomatosis, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Simon R Johnson
- Centre for Respiratory Research, Translational Medical Sciences and Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, UK.
- National Centre for Lymphangioleiomyomatosis, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Nottingham NIHR Biomedical Research Centre, Nottingham, UK.
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210
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Lee HY, Lin CH, Wang XA, Tsai JD. Neuropsychiatric comorbidities in tuberous sclerosis complex patients with epilepsy: results of the TAND checklist survey. Acta Neurol Belg 2024:10.1007/s13760-024-02510-3. [PMID: 38523222 DOI: 10.1007/s13760-024-02510-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE In addition to epilepsy, individuals with tuberous sclerosis complex (TSC) experience a wide range of behavioral, psychiatric, intellectual, academic, and psychosocial problems. They usually exert a large psychological burden on individuals with these illnesses. METHODS This cross-sectional study used TSC-associated neuropsychiatric disorders (TAND) checklist interviews conducted at a single medical center. The enrollment of all subjects was > 6 years, and the comorbidities of neurodevelopmental disorders were assessed by clinical psychologists before enrollment. To assess the spectrum of TAND, the TAND checklist was applied as stated in the protocol, and the responses to the TAND checklist were evaluated by clinical psychologists. RESULTS In the behavioral concerns of patients with TSC without epilepsy, those with epilepsy had excessive shyness, language delay, lack of eye contact, rigid behavior, inattentiveness, and restlessness. In psychiatric disorders, autism spectrum disorder and attention-deficit/hyperactivity disorder are significantly correlated with epilepsy history. Diminished academic skills, including reading, writing, and mathematics skills, are significantly associated with epilepsy history. For intellectual ability, TSC patients without epilepsy is associated normal intelligence level. Among neuropsychological skills, deficits in attention, dual tasking/multi-tasking, visuospatial tasking, and executive skills are significantly associated with epilepsy history. CONCLUSIONS Epilepsy in patients with TSC contributes to comorbid neuropsychiatric disorders. In addition to epilepsy evaluation, it is crucial to evaluate the heterogeneous spectrum of neuropsychiatric disorders using a standard checklist during the annual clinical follow-up of patients with TSC.
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Affiliation(s)
- Hom-Yi Lee
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Room of Psychology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Heng Lin
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Paediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Xing-An Wang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Paediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Paediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
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D'Onofrio G, Roberti R, Riva A, Russo E, Verrotti A, Striano P, Belcastro V. Pharmacodynamic rationale for the choice of antiseizure medications in the paediatric population. Neurotherapeutics 2024; 21:e00344. [PMID: 38521667 DOI: 10.1016/j.neurot.2024.e00344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
In the landscape of paediatric epilepsy treatment, over 20 anti-seizure medications (ASMs) have gained approval from Drug Regulatory Agencies, each delineating clear indications. However, the complexity of managing drug-resistant epilepsy often necessitates the concurrent use of multiple medications. This therapeutic challenge highlights a notable gap: the absence of standardized guidelines, compelling clinicians to rely on empirical clinical experience when selecting combination therapies. This comprehensive review aims to explore current evidence elucidating the preferential utilization of specific ASMs or their combinations, with a primary emphasis on pharmacodynamic considerations. The fundamental objective underlying rational polytherapy is the strategic combination of medications, harnessing diverse mechanisms of action to optimize efficacy while mitigating shared side effects. Moreover, the intricate interplay between epilepsy and comorbidities partly may influence the treatment selection process. Despite advancements, unresolved queries persist, notably concerning the mechanisms underpinning drug resistance and the paradoxical exacerbation of seizures. By synthesizing existing evidence and addressing pertinent unresolved issues, this review aims to contribute to the evolving landscape of paediatric epilepsy treatment strategies, paving the way for more informed and efficacious therapeutic interventions.
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Affiliation(s)
- Gianluca D'Onofrio
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Roberta Roberti
- Science of Health Department, Magna Græcia University, Catanzaro, Italy
| | - Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Emilio Russo
- Science of Health Department, Magna Græcia University, Catanzaro, Italy
| | | | - Pasquale Striano
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Via Gerolamo Gaslini 5, 16147 Genoa, Italy
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Barone V, Piastra MC, van Dijk JP, Visser GH, Debeij-van Hall MHJA, van Putten MJAM. Reply to Neurophysiological signatures of visual attention during absence seizures. Clin Neurophysiol 2024:S1388-2457(24)00088-9. [PMID: 38594126 DOI: 10.1016/j.clinph.2024.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Valentina Barone
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, the Netherlands.
| | - Maria Carla Piastra
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, the Netherlands
| | - Johannes P van Dijk
- Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands; Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Gerhard H Visser
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, the Netherlands; Department of Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, the Netherlands
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Xie C, Kessi M, Yin F, Peng J. Roles of KCNA2 in Neurological Diseases: from Physiology to Pathology. Mol Neurobiol 2024:10.1007/s12035-024-04120-9. [PMID: 38517617 DOI: 10.1007/s12035-024-04120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
Potassium voltage-gated channel subfamily a member 2 (Kv1.2, encoded by KCNA2) is highly expressed in the central and peripheral nervous systems. Based on the patch clamp studies, gain-of function (GOF), loss-of-function (LOF), and a mixed type (GOF/LOF) variants can cause different conditions/disorders. KCNA2-related neurological diseases include epilepsy, intellectual disability (ID), attention deficit/hyperactive disorder (ADHD), autism spectrum disorder (ASD), pain as well as autoimmune and movement disorders. Currently, the molecular mechanisms for the reported variants in causing diverse disorders are unknown. Consequently, this review brings up to date the related information regarding the structure and function of Kv1.2 channel, expression patterns, neuronal localizations, and tetramerization as well as important cell and animal models. In addition, it provides updates on human genetic variants, genotype-phenotype correlations especially highlighting the deep insight into clinical prognosis of KCNA2-related developmental and epileptic encephalopathy, mechanisms, and the potential treatment targets for all KCNA2-related neurological disorders.
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Affiliation(s)
- Changning Xie
- Department of Pediatrics, Xiangya Hospital, Central South University, Xiangya Road 87, Hunan, Changsha, 410008, China
| | - Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Xiangya Road 87, Hunan, Changsha, 410008, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Xiangya Road 87, Hunan, Changsha, 410008, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Xiangya Road 87, Hunan, Changsha, 410008, China.
- Hunan Intellectual and Development Disabilities Research Center, Hunan, Changsha, 410008, China.
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Abramson T, Aguero R, Arizpe A, Frank A, Kang S, Mason X. Protocol for a scoping review of factors associated with disparities in clinical provision of deep brain stimulation. BMJ Open 2024; 14:e079601. [PMID: 38514149 PMCID: PMC10961530 DOI: 10.1136/bmjopen-2023-079601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) can be used to treat several neurological and psychiatric conditions such as Parkinson's disease, epilepsy and obsessive-compulsive disorder; however, limited work has been done to assess the disparities in DBS access and implementation. The goal of this scoping review is to identify sources of disparity in the clinical provision of DBS. METHODS AND ANALYSIS A scoping review will be conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews methodology. Relevant studies will be identified from databases including MEDLINE/PubMed, EMBASE and Web of Science, as well as reference lists from retained articles. Initial search dates were in January 2023, with the study still ongoing. An initial screening of the titles and abstracts of potentially eligible studies will be completed, with relevant studies collected for full-text review. The principal investigators and coauthors will then independently review all full-text articles meeting the inclusion criteria. Data will be extracted and collected in table format. Finally, results will be synthesised in a table and narrative report. ETHICS AND DISSEMINATION No institutional board review or approval is necessary for the proposed scoping review. The findings will be submitted for publication to relevant peer-reviewed journals and conferences. SCOPING REVIEW REGISTRATION This protocol has been registered prospectively on the Open Science Framework (https://osf.io/cxvhu).
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Affiliation(s)
- Tiffany Abramson
- Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Rosario Aguero
- University of Southern California, Los Angeles, California, USA
| | - Angel Arizpe
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Adam Frank
- Psychiatry and Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sara Kang
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Xenos Mason
- Neurological Surgery and Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Liu X, Wang FY, Chi S, Liu T, Yang HL, Zhong RJ, Li XY, Gao J. Mitochondria-targeting peptide SS-31 attenuates ferroptosis via inhibition of the p38 MAPK signaling pathway in the hippocampus of epileptic rats. Brain Res 2024; 1836:148882. [PMID: 38521160 DOI: 10.1016/j.brainres.2024.148882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
Ferroptosis is a newly identified form of non-apoptotic regulated cell death (RCD) andplaysanimportantrole in epileptogenesis. The p38 mitogen-activated protein kinase (p38 MAPK) pathway has been confirmed to be involved in ferroptosis. The mitochondria-targeting antioxidant Elamipretide (SS-31) can reduce the generation of lipid peroxidation and the buildup of reactive oxygen species (ROS). Collectively, our present study was to decipher whether SS-31 inhibits ferroptosis via the p38 MAPK signaling pathway in the rat epilepsy model induced by pilocarpine (PILO).Adult male Wistar rats were randomly divided into four groups: control group (CON group), epilepsy group (EP group), SS-31 treatment group (SS group), and p38 MAPK inhibitor (SB203580) treatment group (SB group). Our results demonstrated that the rat hippocampal neurons after epilepsy were followed by accumulated iron and malondialdehyde (MDA) content, upregulated phosphorylated p38 MAPK protein (P-p38) and nuclear factor erythroid 2-related factor 2 (Nrf2) levels, reduced glutathione peroxidase 4 (Gpx4) content, and depleted glutathione (GSH) activity. Morphologically, mitochondrial ultrastructural damage under electron microscopy was manifested by a partial increase in outer membrane density, disappearance of mitochondrial cristae, and mitochondrial shrinkage. SS-31 and SB203580 treatment blocked the initiation and progression of ferroptosis in the hippocampus of epileptic rats via reducing the severity of epileptic seizures, reversing the expression of Gpx4, P-p38 , decreasing the levels of iron and MDA, as well as increasing the activity of GSH and Nrf2. To summarize, our findings proved that ferroptosis was coupled with the pathology of epilepsy, and SS-31 can inhibit PILO-induced seizures by preventing ferroptosis, which may be connected to the inhibition of p38 MAPK phosphorylation, highlighting the potential therapeutic value for targeting ferroptosis process in individuals with seizure-related diseases.
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Affiliation(s)
- Xue Liu
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Fei-Yu Wang
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Song Chi
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Tao Liu
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Hai-Lin Yang
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Ru-Jie Zhong
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Xiao-Yu Li
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Jing Gao
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China.
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Hahn W, Möller L, Menzler K, Poeplau T, Wagner U, Knake S. Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature. Neurol Res Pract 2024; 6:17. [PMID: 38509597 PMCID: PMC10956312 DOI: 10.1186/s42466-024-00312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND An increasing use of newer antiseizure medication (ASM) such as SV2A ligand brivaracetam is observed. However, data on newer antiseizure medication and therapeutic drug monitoring during pregnancy is scarce. METHODS Therapeutic drug monitoring of brivaracetam (BRV) and topiramate (TPM) serum levels were performed during pregnancy, delivery and in the umbilical cord blood at delivery in a 34-year-old female patient with severe drug-resistant epilepsy. RESULTS During pregnancy, the serum levels of brivaracetam and topiramate remained stable. At 39th week of pregnancy, the patient gave birth to a healthy daughter. 1.5 h after the last ASM intake, the penetration rate measured in umbilical cord blood was 45% lower for BRV and 35% lower for TPM. CONCLUSIONS While the pharmacokinetics of topiramate are well known and its use during pregnancy should only be undertaken under special circumstances, there have been few studies on newer ASM in pregnancy such as brivaracetam. Based on our results and other case reports of BRV use during pregnancy, further studies are necessary to confirm its pharmacokinetics and safety during pregnancy.
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Affiliation(s)
- Wiebke Hahn
- Department of Neurology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - Leona Möller
- Department of Neurology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Katja Menzler
- Department of Neurology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Tobias Poeplau
- Department of Gynaecology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Uwe Wagner
- Department of Gynaecology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
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He MF, Liu LH, Luo S, Wang J, Guo JJ, Wang PY, Zhai QX, He SL, Zou DF, Liu XR, Li BM, Ma HY, Qiao JD, Zhou P, He N, Yi YH, Liao WP. ZFHX3 variants cause childhood partial epilepsy and infantile spasms with favourable outcomes. J Med Genet 2024:jmg-2023-109725. [PMID: 38508705 DOI: 10.1136/jmg-2023-109725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The ZFHX3 gene plays vital roles in embryonic development, cell proliferation, neuronal differentiation and neuronal death. This study aims to explore the relationship between ZFHX3 variants and epilepsy. METHODS Whole-exome sequencing was performed in a cohort of 378 patients with partial (focal) epilepsy. A Drosophila Zfh2 knockdown model was used to validate the association between ZFHX3 and epilepsy. RESULTS Compound heterozygous ZFHX3 variants were identified in eight unrelated cases. The burden of ZFHX3 variants was significantly higher in the case cohort, shown by multiple/specific statistical analyses. In Zfh2 knockdown flies, the incidence and duration of seizure-like behaviour were significantly greater than those in the controls. The Zfh2 knockdown flies exhibited more firing in excitatory neurons. All patients presented partial seizures. The five patients with variants in the C-terminus/N-terminus presented mild partial epilepsy. The other three patients included one who experienced frequent non-convulsive status epilepticus and two who had early spasms. These three patients had also neurodevelopmental abnormalities and were diagnosed as developmental epileptic encephalopathy (DEE), but achieved seizure-free after antiepileptic-drug treatment without adrenocorticotropic-hormone/steroids. The analyses of temporal expression (genetic dependent stages) indicated that ZFHX3 orthologous were highly expressed in the embryonic stage and decreased dramatically after birth. CONCLUSION ZFHX3 is a novel causative gene of childhood partial epilepsy and DEE. The patients of infantile spasms achieved seizure-free after treatment without adrenocorticotropic-hormone/steroids implies a significance of genetic diagnosis in precise treatment. The genetic dependent stage provided an insight into the underlying mechanism of the evolutional course of illness.
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Affiliation(s)
- Ming-Feng He
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Li-Hong Liu
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
- Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Sheng Luo
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Juan Wang
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Jia-Jun Guo
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Peng-Yu Wang
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Qiong-Xiang Zhai
- Department of Pediatrics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510120, China
| | - Su-Li He
- Department of Pediatrics, Shantou Chaonan Minsheng Hospital, Shantou 515000, China
| | - Dong-Fang Zou
- Epilepsy Center and Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518029, China
| | - Xiao-Rong Liu
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Bing-Mei Li
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Hai-Yan Ma
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jing-Da Qiao
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Peng Zhou
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Na He
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Yong-Hong Yi
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Wei-Ping Liao
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
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Sultan T, Scorrano G, Panciroli M, Christoforou M, Raza Alvi J, Di Ludovico A, Qureshi S, Efthymiou S, Salpietro V, Houlden H. Clinical and molecular heterogeneity of VPS13D-related neurodevelopmental and movement disorders. Gene 2024; 899:148119. [PMID: 38160741 DOI: 10.1016/j.gene.2023.148119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The VPS13 family of proteins has been implicated in lipid transport and trafficking between endoplasmic reticulum and organelles, to maintain homeostasis of subcellular membranes. Recently, pathogenic variants in each human VPS13S gene, have been linked to distinct human neurodevelopmental or neurodegenerative disorders. Within the VPS13 family of genes, VPS13D is known to be implicated in mitochondria homeostasis and function. METHODS We investigated a Pakistani sibship affected with neurodevelopmental impairment and severe hyperkinetic (choreoathetoid) movements. Whole exome sequencing (WES) and Sanger sequencing were performed to identify potential candidate variants segregating in the family. We described clinical phenotypes and natural history of the disease during a 3-year clinical follow-up and summarized literature data related to previously identified patients with VPS13D-related neurological disorders. RESULTS We identified by WES an homozygous non-synonymous variant in VPS13D (c.5723 T > C; p.Ile1908Thr) as the potential underlying cause of the disease in our family. Two young siblings developed an early-onset neurological impairment characterized by global developmental delay, with impaired speech and motor milestones, associated to hyperkinetic movement disorders as well as progressive and non-progressive neurological abnormalities. CONCLUSION In this study we delineated the heterogeneity of VPS13D-related clinical phenotypes and described a novel VPS13D homozygous variant associated with severe neurological impairment. Further studies will be pivotal to understand the exact VPS13D function and its impact on mitochondria homeostasis, brain development and regulation of movements, to further clarify genotype-phenotype correlations and provide crucial prognostic information and potential therapeutic implications.
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Affiliation(s)
- Tipu Sultan
- Department of Pediatric Neurology, Children Hospital Lahore, Main Boulevard Gulberg, Nishtar Town, Lahore, Punjab 54000, Pakistan
| | | | - Marta Panciroli
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Marilena Christoforou
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Javeria Raza Alvi
- Department of Pediatric Neurology, Children Hospital Lahore, Main Boulevard Gulberg, Nishtar Town, Lahore, Punjab 54000, Pakistan
| | | | - Sameen Qureshi
- Department of Pediatric Neurology, Children Hospital Lahore, Main Boulevard Gulberg, Nishtar Town, Lahore, Punjab 54000, Pakistan
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom.
| | - Henry Houlden
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
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Sarti THM, Akira Watanabe R, Jong-A-Liem GS, Ahumada-Vizcaíno JC, Ramiro Muiños PJ, Magalhães F, Chaddad-Neto F. Microsurgical Resection for Cavernous Malformation of the Uncus: 3D-Operative Video. World Neurosurg 2024; 186:50. [PMID: 38514032 DOI: 10.1016/j.wneu.2024.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
Cavernous malformations (CMs) are rare and often oligosymptomatic vascular lesions. The main symptoms include seizure and focal neurologic deficits.1-3 Depending on the symptomatology, location, size, and risk factors for bleeding, like the presence of a developmental venous anomaly, CMs can be highly morbid. Thus surgical resection may be considered. Deep-seated and eloquent CMs, like those in the uncus, can be challenging.4,5 In Video 1, we present a 23-year-old male adult who developed focal seizures (i.e., oral automatisms) after an episode of sudden intense headache 1 year ago. His neurologic examination was unremarkable. The patient consented to the procedure and publication of his image. Nevertheless, his magnetic resonance images showed an uncal 2-cm Zabramski type I CM. We exposed the insula and its limen through a right pterional craniotomy and transsylvian corridor. During the video, we discuss the surgical nuances to access and resect this CM lesion en bloc while preserving important vascular structures and white matter tracts. Postoperative neuroimaging demonstrated total resection. In postoperative day 1, the patient had 1 episode of generalized seizure and evolved with contralateral hemiparesis. The patient had a good recovery and was discharged on postoperative day 21. At the 6-month follow-up, the patient had no new epileptic events and presented complete weakness improvement. Through this minimally invasive and well-known surgical corridor, we preserve the mesial and lateral portion of the temporal lobe, reducing the risk of lesions to the Meyer loop and limbic association area.
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Affiliation(s)
- Talita Helena Martins Sarti
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Rodrigo Akira Watanabe
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Felipe Magalhães
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
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Singh R, Zamanian C, Bcharah G, Stonnington H, George DD, Bhandarkar AR, Shahrestani S, Brown N, Abraham ME, Mammis A, Bydon M, Gonda D. High-Value Epilepsy Care in the United States: Predictors of Increased Costs and Complications from the National Inpatient Sample Database 2016-2019. World Neurosurg 2024:S1878-8750(24)00446-7. [PMID: 38514037 DOI: 10.1016/j.wneu.2024.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND For patients with medically refractory epilepsy, newer minimally invasive techniques such as laser interstitial thermal therapy (LITT) have been developed in recent years. This study aims to characterize trends in the utilization of surgical resection versus LITT to treat medically refractory epilepsy, characterize complications, and understand the cost of this innovative technique to the public. METHODS The National Inpatient Sample database was queried from 2016 to 2019 for all patients admitted with a diagnosis of medically refractory epilepsy. Patient demographics, hospital length of stay, complications, and costs were tabulated for all patients who underwent LITT or surgical resection within these cohorts. RESULTS A total of 6019 patients were included, 223 underwent LITT procedures, while 5796 underwent resection. Significant predictors of increased patient charges for both cohorts included diabetes (odds ratio: 1.7, confidence interval [CI]: 1.44-2.19), infection (odds ratio: 5.12, CI 2.73-9.58), and hemorrhage (odds ratio: 2.95, CI 2.04-4.12). Procedures performed at nonteaching hospitals had 1.54 greater odds (CI 1.02-2.33) of resulting in a complication compared to teaching hospitals. Insurance status did significantly differ (P = 0.001) between those receiving LITT (23.3% Medicare; 25.6% Medicaid; 44.4% private insurance; 6.7 Other) and those undergoing resection (35.3% Medicare; 22.5% Medicaid; 34.7% private Insurance; 7.5% other). When adjusting for patient demographics, LITT patients had shorter length of stay (2.3 vs. 8.9 days, P < 0.001), lower complication rate (1.9% vs. 3.1%, P = 0.385), and lower mean hospital ($139,412.79 vs. $233,120.99, P < 0.001) and patient ($55,394.34 vs. $37,756.66, P < 0.001) costs. CONCLUSIONS The present study highlights LITT's advantages through its association with lower costs and shorter length of stay. The present study also highlights the associated predictors of LITT versus resection, such as that most LITT cases happen at academic centers for patients with private insurance. As the adoption of LITT continues, more data will become available to further understand these issues.
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Affiliation(s)
- Rohin Singh
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA.
| | - Cameron Zamanian
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - George Bcharah
- Department of Neurosurgery, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Derek D George
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | | | - Shane Shahrestani
- Department of Neurosurgery, Cedars-Sinai Hospital, Los Angeles, California, USA
| | - Nolan Brown
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Mickey E Abraham
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Antonios Mammis
- Departmernt of Neurosurgery, New York University, New York, New York, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David Gonda
- Department of Neurosurgery, University of California, San Diego, California, USA
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Shaw E, Flitcroft I, Bowman R, Baker K. Cerebral visual impairment: genetic diagnoses and phenotypic associations. J Med Genet 2024:jmg-2023-109670. [PMID: 38458753 DOI: 10.1136/jmg-2023-109670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cerebral visual impairment (CVI) is the most common form of paediatric visual impairment in developed countries. CVI can arise from a host of genetic or acquired causes, but there has been limited research to date on CVI in the context of genetic disorders. METHODS We carried out a retrospective analysis of genotypic and phenotypic data for participants with CVI within the DECIPHER database and 100 000 Genomes Project (100KGP). RESULTS 158 individuals with CVI were identified across both cohorts. Within this group, pathogenic or likely pathogenic sequence variants in 173 genes were identified. 25 of these genes already have known associations with CVI, while the remaining 148 are candidate genes for this phenotype. Gene ontology analysis of the CVI gene sets from both DECIPHER and 100KGP suggests that CVI has a similar degree of genetic heterogeneity to other neurodevelopmental phenotypes, and a strong association with genetic variants converging on ion channels and receptor functions. Individuals with a monogenic disorder and CVI have a higher frequency of epilepsies and severe neurodisability than individuals with a monogenic disorder but not CVI. CONCLUSION This study supports the availability of genetic testing for individuals with CVI alongside other neurodevelopmental difficulties. It also supports the availability of ophthalmological screening for individuals with genetic diagnoses linked to CVI. Further studies could elaborate on the links between specific genetic disorders, visual maturation and broader neurodevelopmental characteristics.
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Affiliation(s)
- Emogene Shaw
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Ian Flitcroft
- Children's University Hospital, Temple Street, Dublin, Ireland
- Trinity College, Dublin, Ireland
| | - Richard Bowman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate Baker
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
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Auvin S. A 6-year-old with childhood absence epilepsy and motor hyperactivity. Epilepsy Behav Rep 2024; 26:100660. [PMID: 38532901 PMCID: PMC10963181 DOI: 10.1016/j.ebr.2024.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
A case study of a child with childhood absence epilepsy and hyperactivity introduces the discussion around the psychiatric diagnosis, differential considerations, and pharmacologic treatment options for ADHD/hyperactivity in children with epilepsy. Most of the time, ADHD in children with epilepsy is an inattentive form. The assessment emphasizes the need to differentiate ADHD symptoms from other psychiatric comorbidities. This is also crucial to evaluate when symptoms emerged, their impact on daily life, and if it could be a potential medication side effect. Speaking about hyperactivity signs, differential diagnoses include anxiety disorders, autism spectrum disorders, learning disabilities, and thyroid disorders. Valproate use is associated with an exacerbation of attentional issues in childhood absence epilepsy, but there are also studies suggesting its possible role in hyperactivity symptoms. Regarding pharmacologic treatment, limited studies exist on ADHD management in children with epilepsy. Methylphenidate shows effectiveness without significant risk of epilepsy worsening. Atomoxetine and clonidine, usually use in ADHD, lack sufficient data for efficacy and safety in children with epilepsy and ADHD. Pharmacologic treatment should be a part of a global management plan that involves psychoeducation, environmental adaptations, and collaborative efforts between healthcare providers, caregivers, and schools.
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223
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Baumgartner ME, Qiu L, Philipp LR, Galligan K, Halpern C, Kennedy BC. Technological advances in pediatric epilepsy surgery. Curr Probl Pediatr Adolesc Health Care 2024:101588. [PMID: 38494391 DOI: 10.1016/j.cppeds.2024.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
| | - Liming Qiu
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Lucas R Philipp
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, USA
| | - Kathleen Galligan
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Casey Halpern
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Benjamin C Kennedy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, USA.
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Yüksel MF, Doğulu N, Yıldırım M, Köse E, Bektaş Ö, Eminoğlu FT, Teber S. Metabolic etiologies in children with infantile epileptic spasm syndrome: Experience at a tertiary pediatric neurology center. Brain Dev 2024:S0387-7604(24)00042-1. [PMID: 38493042 DOI: 10.1016/j.braindev.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Infantile epileptic spasm syndrome (IESS), including West syndrome (WS) and infantile spasm (IS), causes a challenging prognosis, particularly when associated with metabolic etiologies. METHODS This study, conducted at a tertiary pediatric neurology center, explored the prevalence and clinical features of inborn errors of metabolism in 112 children with IESS over 10 years. RESULTS Most patients presented with seizures, primarily flexor spasms, and the median age at onset was 5 months. Comprehensive clinical evaluation and neuroimaging revealed structural-acquired causes as the most common etiology. Notably, inborn errors of metabolism were identified in 5.4 % of cases, with six distinct diagnoses including nonketotic hyperglycinemia, pyridoxine-dependent epilepsy, primary coenzyme Q10 deficiency 7, congenital disorder of glycosylation type IIM, 6-pyruvoyl tetrahydrobiopterin synthase deficiency, and argininosuccinate lyase deficiency. The prevalence of inborn errors of metabolism in this cohort was consistent with global variations reported in the literature. Genetic testing, including karyotype analysis and whole exome sequencing, was performed in a subset of cases with no clear diagnosis, revealing abnormalities in approximately 50 % of cases. Adrenocorticotropic hormone emerged as the most frequently prescribed antiseizure medication. CONCLUSION This study provides insight into the diagnostic challenges associated with IESS and highlights the importance of metabolic investigations, especially in cases without a clear etiology. The findings emphasize the need for further genetic and metabolic studies to enhance prognostic accuracy and guide potential treatment options for children with IESS, particularly in populations with high rates of consanguinity.
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Affiliation(s)
- Merve Feyza Yüksel
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Neslihan Doğulu
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Engin Köse
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
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225
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Liang Z, Lou Y, Zheng Z, Guo Q, Liu S. Diet-derived circulating antioxidants and risk of epilepsy: A study combining metabolomics and mendelian randomization. Heliyon 2024; 10:e26813. [PMID: 38463786 PMCID: PMC10920176 DOI: 10.1016/j.heliyon.2024.e26813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Background Previous studies offer inconclusive results on the association between diet-derived circulating antioxidants and epilepsy. Objective This study aims to assess oxidative stress presence in epilepsy patients' circulation and investigate the causal link between diet-derived circulating antioxidants and epilepsy. Methods Untargeted metabolomics analysis was conducted on plasma samples from 62 epileptic patients and 20 healthy individuals to evaluate oxidative stress based on metabolite alterations in epilepsy patients' circulation. Two-sample Mendelian Randomization (MR) analysis examined the causation between diet-derived circulating antioxidants (measured by absolute levels and relative metabolite concentrations) and epilepsy, utilizing the inverse-variance weighted (IVW) method as the primary outcome, with complementary MR analysis methods (MR Egger, weighted median, weighted mode, and simple mode). Results Untargeted metabolomics analysis revealed elevated circulating oxidizing metabolites (palmitic acid, oleic acid, linoleic acid, and myristic acid) and reduced reducing metabolites (glutamine) in epilepsy patients, providing robust evidence of oxidative stress. The IVW analysis indicated significantly reduced epilepsy risk (odds ratio: 0.552; 95% confidence interval: 0.335-0.905, P = 0.018) with genetically determined higher absolute circulating β-carotene. However, other diet-derived circulating antioxidants (lycopene, retinol, ascorbic acid, and selenium) and antioxidant metabolites (α-tocopherol, γ-tocopherol, ascorbic acid, and retinol) did not significantly associate with epilepsy risk. Additional MR analysis methods and heterogeneity assessments confirmed the results' robustness. Conclusion This study provides compelling evidence of oxidative stress in epilepsy patients' circulation. However, the majority of diet-derived circulating antioxidants (lycopene, retinol, ascorbic acid, vitamin E, and selenium) are unlikely to causally associate with reduced epilepsy risk, except for β-carotene.
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Affiliation(s)
- Zhen Liang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yingyue Lou
- Department of Rehabilitation, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhaoshi Zheng
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qi Guo
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Songyan Liu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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226
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Akdag HB, Cevik B, Sumbul O, Aksoy D, Kurt SG. The prevalence of carpal tunnel syndrome in patients with epilepsy. Heliyon 2024; 10:e26834. [PMID: 38434270 PMCID: PMC10907763 DOI: 10.1016/j.heliyon.2024.e26834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Objective Carpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy caused by compression of the median nerve in the carpal tunnel. Epilepsy is characterised by recurrent seizures caused by abnormal neuronal discharges in the brain.This study aimed to investigate whether there is a link between epilepsy and carpal tunnel and, if so, the underlying factors. Materials and methods Two hundred patients with epilepsy were included in this study. The patients' history of epilepsy, seizure type, and seizure frequency were assessed. The Tinel, Phalen, and Flick physical examination tests were performed on patients with complaints that matched those of median nerve neuropathy. Patients with epilepsy and clinically diagnosed carpal tunnel syndrome completed the Boston Carpal Tunnel Syndrome Questionnaire, and nerve conduction studies were performed. The relationship between seizure type and frequency in patients with carpal tunnel syndrome was compared. Results Compared to focal-aware motor-onset seizures, the risk of detecting carpal tunnel syndrome was 88.7 times higher in focal-onset bilateral tonic-clonic seizures. Patients with a seizure frequency of one per month or more had a 0.704 times lower risk of CTS than those with a frequency of one per week or more (p = 0.026). Discussion Patients with epilepsy, especially those experiencing frequent seizures or specific seizure types, may be more susceptible to repetitive wrist flexion-extension postures. Therefore, during clinical follow-up, it is important to inquire about the presence of carpal tunnel syndrome in patients with epilepsy.
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Affiliation(s)
- Hicret Betul Akdag
- Department of Neurology, University of Tokat Gaziosmanpasa, Tokat, Turkey
| | - Betul Cevik
- Department of Neurology, University of Tokat Gaziosmanpasa, Tokat, Turkey
| | - Orhan Sumbul
- Department of Neurology, University of Tokat Gaziosmanpasa, Tokat, Turkey
| | - Durdane Aksoy
- Department of Neurology, University of Tokat Gaziosmanpasa, Tokat, Turkey
| | - Semiha Gulsum Kurt
- Department of Neurology, University of Tokat Gaziosmanpasa, Tokat, Turkey
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227
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Hwang YS, Kang MG, Yeom SW, Jeong CY, Shin BS, Koh J, Kim JS, Kang HG. Increasing incidence of Parkinson's disease in patients with epilepsy: A Nationwide cohort study. J Neurol Sci 2024; 458:122891. [PMID: 38310734 DOI: 10.1016/j.jns.2024.122891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Although epilepsy is an uncommon comorbidity of Parkinson's disease (PD), the exact incidence of PD among the patients with epilepsy is not clarified yet. OBJECTIVES We aimed to estimate the incidence of PD in patients with epilepsy and explore the association between epilepsy and PD. METHODS Epilepsy patients enrolled in the National Health Insurance Service Health Screening Cohort (NHIS-HealS) (2002-2013) between 2003 and 2007 were set up as the experimental group. The major outcome was the occurrence of PD. Non-epilepsy patients were obtained through Propensity Score Matching of 'greedy nearest neighbor' algorithm in 1:1 ratio. The Cox Proportional Hazards model was used to calculate PD incidence and hazard ratio (HR). RESULTS A total of 10,510 patients were finally included in the study, which contained 5255 patients in epilepsy and non-epilepsy groups, respectively. During the follow-up period, 85 patients with Parkinson's disease among 5255 patients with epilepsy and 57 patients with Parkinson's disease among 5255 patients without epilepsy occurred. The 10,000 Person-Year (PY), representing the number of PD patients per 10,000 per year, was 21.38 in the epilepsy group and 11.18 in the non-epilepsy group. When all variables were adjusted, it was found that the epilepsy group had a 2.19 times significantly higher risk of developing Parkinson's disease than the control group (The adjusted HR: 2.19 (95% CI, 1.55-3.12)). CONCLUSION This study indicates an increased risk of PD in patients with epilepsy. However, further research is needed to prove an exact causal relationship between these two brain disorders.
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Affiliation(s)
- Yun Su Hwang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Min Gu Kang
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang Woo Yeom
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Cho Yun Jeong
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jihoon Koh
- Department of Otorhinolaryngology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jong Seung Kim
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea; Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Department of Otorhinolaryngology, Jeonbuk National University Medical School, Jeonju, Republic of Korea.
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
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228
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Wu Y, Zhang Z, Dong X, Liang P, Li L, Zhai X, Zou B. Epilepsy and childhood psychiatric disorders: a two-sample bidirectional Mendelian randomization study. Neurol Sci 2024:10.1007/s10072-024-07447-2. [PMID: 38488928 DOI: 10.1007/s10072-024-07447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Observational studies have indicated that psychiatric disorders are the most common comorbidities in pediatric epilepsy. However, the existence and direction of a causal relationship between the two remains controversial. This study aims to investigate the association between common childhood psychiatric disorders and epilepsy using a two-sample, bidirectional Mendelian randomization (MR) approach. METHODS Genetic instruments were obtained from the most recent and largest genome-wide association studies (GWAS), including datasets for epilepsy (N_case = 29,994, N_control = 52,538), attention deficit hyperactivity disorder (ADHD) (N_case = 38,691, N_control = 186,843), autism spectrum disorder (ASD) (N_case = 18,381, N_control = 27,969), and Tourette syndrome (TS) (N_case = 4,819, N_control = 9488). MR analyses were conducted using the inverse variance weighted (IVW) method, weighted median method, and MR-Egger regression. RESULTS No reliable evidence was found to suggest a causal effect of ADHD, ASD, or TS on epilepsy, nor was there any reliable evidence indicating that epilepsy increases the risk of these three psychiatric disorders. These findings remained consistent across various sensitivity analyses. CONCLUSION Although observational studies have highlighted a high comorbidity rate between pediatric epilepsy and psychiatric disorders like ADHD and ASD, the MR analysis did not confirm a causal relationship between them. This suggests that previous studies might have been influenced by confounding biases or other biases, potentially overestimating the true relationship. A deeper understanding of the mechanisms underlying these comorbidities is crucial for refining the treatment of pediatric epilepsy.
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Affiliation(s)
- YuXin Wu
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - ZaiYu Zhang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Xinyu Dong
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Ping Liang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Lusheng Li
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Xuan Zhai
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Bin Zou
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China.
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China.
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Salpekar J, Ertenu DD. Anxiety and school avoidance in an 8-year-old child with epilepsy. Epilepsy Behav Rep 2024; 26:100659. [PMID: 38532902 PMCID: PMC10963191 DOI: 10.1016/j.ebr.2024.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
Anxiety is ubiquitous in school age children. Co-occurring medical illness adds to the complexity of identifying pathologic anxiety as opposed to that of typical development such as with social interactions or academic pressures. Anxiety may also occur in the context of cognitive difficulties or inattention, both of which may be exacerbated by epilepsy or by anti-seizure medicines themselves. Treatment strategies may require patience and long-term observations to account for the typical range of stressors that may be expected with disease progression or with development through childhood. This section illustrates the challenge of diagnosis and management of anxiety in the context of epilepsy in a school aged child and addresses nuances that neurology clinicians need to consider. Practical strategies for management including stepwise options for pharmacologic treatment will be emphasized.
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Affiliation(s)
- Jay Salpekar
- Neuropsychiatry Center, Kennedy Krieger Institute, Psychiatry and Neurology, Johns Hopkins University School of Medicine, 1741 Ashland Ave., Baltimore, MD 21205, United States
| | - D. Dilara Ertenu
- Neuropsychiatry Center, Kennedy Krieger Institute, Psychiatry and Neurology, Johns Hopkins University School of Medicine, 1741 Ashland Ave., Baltimore, MD 21205, United States
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230
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Wang Y, Ke Z, Li Y, Qiu M, Liu J, Yang Z, Wen S, Liang M, Chen S. De novo variants of IRF2BPL result in developmental epileptic disorder. Orphanet J Rare Dis 2024; 19:121. [PMID: 38481258 PMCID: PMC10938665 DOI: 10.1186/s13023-024-03130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Pathogenic variants of the IRF2BPL gene have been reported to cause neurodevelopmental disorders; however, studies focused on IRF2BPL in zebrafish are limited. RESULTS We reported three probands diagnosed with developmental delay and epilepsy and investigated the role of IRF2BPL in neurodevelopmental disorders in zebrafish. The clinical and genetic characteristics of three patients with neurodevelopmental disorder with regression, abnormal movements, loss of speech and seizures (NEDAMSS) were collected. Three de novo variants (NM_024496.4: c.1171 C > T, p.Arg391Cys; c.1157 C > T, p.Thr386Met; and c.273_307del, p.Ala92Thrfs*29) were detected and classified as pathogenic or likely pathogenic according to ACMG guidelines. Zebrafish crispants with disruption of the ortholog gene irf2bpl demonstrated a reduced body length and spontaneous ictal-like and interictal-like discharges in an electrophysiology study. After their spasms were controlled, they gain some development improvements. CONCLUSION We contribute two new pathogenic variants for IRF2BPL related developmental epileptic disorder which provided evidences for genetic counseling. In zebrafish model, we for the first time confirm that disruption of irf2bpl could introduce spontaneous electrographic seizures which mimics key phenotypes in human patients. Our follow-up results suggest that timely cessation of spasmodic seizures can improve the patient's neurodevelopment.
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Affiliation(s)
- Yong Wang
- Department of Pediatrics, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Gulou District, 350001, Fuzhou, Fujian, China.
| | - Zhongling Ke
- Department of Pediatrics, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Gulou District, 350001, Fuzhou, Fujian, China
| | - Yufen Li
- Department of Pediatrics, Linyi People's Hospital, 276003, Linyi, Shandong, China
| | - Mingqi Qiu
- Department of Pediatrics, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Gulou District, 350001, Fuzhou, Fujian, China
| | - Jing Liu
- Cipher Gene LLC, 100089, Beijing, China
| | | | - Shu Wen
- Cipher Gene LLC, 100089, Beijing, China
| | | | - Shan Chen
- Department of Pediatrics, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Gulou District, 350001, Fuzhou, Fujian, China
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Biset G, Abebaw N, Gebeyehu NA, Estifanos N, Birrie E, Tegegne KD. Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:771. [PMID: 38475724 DOI: 10.1186/s12889-024-18236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Epilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems. OBJECTIVE This study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa. METHODS A comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran's Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger's correlation and Begg's regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals. RESULT In this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children. CONCLUSION Nearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia.
| | - Nigusie Abebaw
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natan Estifanos
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endalk Birrie
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Zhang XY, Sun M, Wang JY, Du FF, Liu XF, Wang LJ, Hou ZD, Cheng YY. Analysis of related factors for neuropsychiatric comorbidities in children with epilepsy. Eur J Med Res 2024; 29:168. [PMID: 38475859 PMCID: PMC10929131 DOI: 10.1186/s40001-024-01751-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To analyze the risk factors affecting psychiatric behavior and study the psychobehavioral conditions of children with epilepsy. METHOD We randomly selected and enrolled 294 children with epilepsy who visited and were hospitalized in the pediatric clinic of Hebei General Hospital between January 2017 and January 2022, as the study participants. We comprehensively assessed their cognitive functions using the Gesell development schedule or Wechsler Intelligence Scales. The participants were divided into the study group (n = 123) with cognitive impairment and the control group (n = 171) with normal cognitive functions, for analysis. RESULTS There were statistically significant differences between the two groups in disease course, frequency of epilepsy, status epilepticus, and the number of antiseizure medications (ASMs) used (P < 0.05), while there were no statistically significant differences in age, gender, age of onset, form of onset, interictal epileptiform discharge, history of febrile convulsion, and the time from onset to initial visit (P > 0.05). Based on multivariate logistic regression analysis, the course of disease, frequency of onset, status epilepticus and number of ASMs used were identified as high-risk factors for cognitive impairment in children with epilepsy. Similarly, early onset, long course of disease, known etiology, and combination of multiple drugs have a negative impact on behavioral problems, school education, and social adaptability. CONCLUSION The course of disease, the frequency of onset, status epilepticus, and the number of ASMs used are high-risk factors for cognitive impairment in children with epilepsy, which can be prevented and controlled early. When selecting ASMs, their advantages and disadvantages should be weighed. Moreover, the availability of alternative treatment options must be considered. With the help of genomic technology, the causes of epilepsy should be identified as early as possible, and precision medicine and gene therapy for children with epilepsy should be actively developed.
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Affiliation(s)
- Xin-Ying Zhang
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Meng Sun
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Jiang-Ya Wang
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Fang-Fang Du
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Xue-Fei Liu
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Ling-Jun Wang
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Zhen-De Hou
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Ya-Ying Cheng
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China.
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Skaria S, Savithriamma SK. Automatic classification of seizure and seizure-free EEG signals based on phase space reconstruction features. J Biol Phys 2024:10.1007/s10867-024-09654-6. [PMID: 38466526 DOI: 10.1007/s10867-024-09654-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/16/2024] [Indexed: 03/13/2024] Open
Abstract
Epilepsy is a type of brain disorder triggered by an abrupt electrical imbalance of neuronal networks. An electroencephalogram (EEG) is a diagnostic tool to capture the underlying brain mechanisms and detect seizure onset in epileptic patients. To detect seizures, neurologists need to manually monitor EEG recordings for long periods, which is challenging and susceptible to errors depending on expertise and experience. Therefore, automatic identification of seizure and seizure-free EEG signals becomes essential. This study introduces a method based on the features extracted from the phase space reconstruction for classifying seizure and seizure-free EEG signals. The computed features are derived from the elliptical area and interquartile range of the Euclidean distance by varying percentage values of data points ranging from 50 to 100%. We consider two public datasets and evaluate these features in each EEG epoch that includes the healthy, interictal, preictal, and ictal stages of epileptic subjects, utilizing the K-nearest neighbor classifier for classification. Results show that the features have higher values during the seizure than the seizure-free EEG signals and healthy subjects. Furthermore, the proposed features can effectively discriminate seizure EEG signals from the seizure-free and normal subjects with 100% accuracy, sensitivity, and specificity in both datasets. Likewise, the classification between the preictal stage and seizure EEG signals attains 98% accuracy. Overall, the reconstructed phase space features significantly enhance the accuracy of detecting epileptic EEG signals compared with existing methods. This advancement holds great potential in assisting neurologists in swiftly and accurately diagnosing epileptic seizures from EEG signals.
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Affiliation(s)
- Shervin Skaria
- Department of Physics, Government College Kottayam, Nattakom, Kerala, India
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234
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Almostafa MM, Mohamed ME, Younis NS. Ameliorative effects of vanillin against pentylenetetrazole-induced epilepsy and associated memory loss in mice: The role of Nrf2/HO-1/NQO1 and HMGB1/RAGE/TLR4/NFκB pathways. Int Immunopharmacol 2024; 129:111657. [PMID: 38335655 DOI: 10.1016/j.intimp.2024.111657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Epilepsy is a severe neurological disorder associated with substantial morbidity and mortality. Vanillin (Van) is a natural phenolic aldehyde with beneficial pharmacological properties. This study investigated the neuroprotective effects of Van in epilepsy and elucidated its mechanism of action. METHODS Swiss albino mice were divided into the following five groups: "normal group", 0.9 % saline; "pentylenetetrazole (PTZ) group", intraperitoneal administration of 35 mg/kg PTZ on alternate days up to 42 days; and "PTZ + Van 20", "PTZ + Van 40", and "PTZ + sodium valproate (Val)" groups received PTZ injections in conjunction withVan 20 mg, Van 40 mg/kg, and Val 300 mg/kg, respectively. Behavioural tests and hippocampal histopathological analysis were performed in all groups. The Nrf2/HO-1/NQO1 and HMGB1/RAGE/TLR4/NFκB pathways, oxidative stress, neuro-inflammation, and apoptotic markers were analysed. Furthermore, brain acetylcholinesterase (AChE) activity and levels of dopamine (DA), gamma-aminobutyric acid GABA, and serotonin 5-HT were assessed. RESULTS Van prolonged seizure manifestations and improved electroencephalogram (EEG)criteriain conjunction with 100 mg/kg PTZ once daily. Van administration increased Nrf2/HO-1/NQO1 levels, with subsequent attenuation of malondialdehyde (MDA) and nitric oxide (NO) levels with elevated glutathione (GSH) levels and intensified superoxide dismutase (SOD) and catalase activities. Van reduced the gene and protein expression of HMGB1/RAGE/TLR4/NFκB and decreased the levels of inflammatory and apoptotic markers. In addition, Van reduced AChE activity, and elevated glial fibrillary acidic proteins (GFAP) increased neurotransmitter and brain-derived neurotrophic factors (BDNF). CONCLUSION By increasing Nrf2/HO-1/NQO1 levels and downregulating the HMGB1/RAGE/TLR4/ NFκB pathway, Van offered protection in PTZ-kindled mice with subsequent attenuation in lipid peroxidation, upregulation in antioxidant enzyme activities, and reduction in inflammation and apoptosis.
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Affiliation(s)
- Mervt M Almostafa
- Department of Chemistry, College of Science, King Faisal University, Al-Ahsa 31982, Saudi Arabia.
| | - Maged E Mohamed
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; Department of Pharmacognosy, College of Pharmacy, Zagazig University, Zagazig 44519, Egypt.
| | - Nancy S Younis
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; Zagazig University Hospitals, Zagazig University, Zagazig 44519, Egypt.
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235
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Li JX, Shi D, Ren SY, Wu GF. Increased Cyclic Adenosine Monophosphate Responsive Element is Closely Associated with the Pathogenesis of Drug-resistant Epilepsy. Curr Neurovasc Res 2024; 21:CNR-EPUB-139056. [PMID: 38468526 DOI: 10.2174/0115672026290996240307072539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/01/1970] [Accepted: 01/22/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Drug-resistant epilepsy (DRE) is a refractory neurological disorder. There is ample evidence that suggest that γ-aminobutyric acid-a (GABAA) receptors could be one of the mechanisms responsible for the development of drug resistance in epilepsy. It is also known that the cAMP response element binding protein (CREB) plays a possible key role in the transcriptional regulation of GABAA. OBJECTIVE This study explores the role of CREB in the development of DRE and the effect of CREB on GABA-related receptors in DRE. METHODS The CREB expression was increased or decreased in the hippocampus of normal rats by lentiviral transfection, who then underwent the lithium-pilocarpine-induced epilepsy model. Phenobarbital (PB) sodium and carbamazepine (CBZ) were used to select a drug-resistant epileptic model. The expression levels of GABAA receptor α1, β2, and γ2 subunits and CREB protein were measured in the rat hippocampus by western blot and fluorescent quantitative PCR. RESULTS The frequency and duration of seizures increased in the overexpression group compared to that in the control group. In addition, the severity, frequency, and duration of seizures decreased in the group with decreased expression. The hippocampus analysis of the expression levels of the CREB protein and CREB mRNA yielded similar findings. Altering the CREB protein expression in the rat hippocampus could negatively regulate the expression and transcript levels of GABAA receptors α1, β2, and γ2, suggesting that CREB may serve as a potential target for the development of treatment protocols and drugs for epilepsy. CONCLUSION Our study shows that enhanced CREB expression promotes the development of DRE and negatively regulates GABAA receptor levels and that the inhibition of CREB expression may reduce the incidence of DRE.
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Affiliation(s)
- Jing-Xuan Li
- Clinical College of Guizhou Medical University, Guiyang, Guizhou, 550001, China
| | - Dai Shi
- Clinical College of Guizhou Medical University, Guiyang, Guizhou, 550001, China
| | - Si-Ying Ren
- Clinical College of Guizhou Medical University, Guiyang, Guizhou, 550001, China
- Affiliated Hospital/Clinical College of Guizhou Medical University, Guiyang, Guizhou, 550001, China
| | - Guo-Feng Wu
- Clinical College of Guizhou Medical University, Guiyang, Guizhou, 550001, China
- Affiliated Hospital/Clinical College of Guizhou Medical University, Guiyang, Guizhou, 550001, China
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236
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Ottaviani MM, Fasinella MR, Di Rienzo A, Gladi M, di Somma LGM, Iacoangeli M, Dobran M. Analysis of prognostic factors and the role of epilepsy in neurosurgical patients with brain metastases. Surg Neurol Int 2024; 15:79. [PMID: 38628515 PMCID: PMC11021078 DOI: 10.25259/sni_735_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/01/2024] [Indexed: 04/19/2024] Open
Abstract
Background Brain metastases (BMs) represent the most frequent brain tumors in adults. The identification of key prognostic factors is essential for choosing the therapeutic strategy tailored to each patient. Epilepsy can precede several months of other clinical presentations of BMs. This work aimed to study the impact of epilepsy and other prognostic factors on BMs patients' survival. Methods This retrospective study included 51 patients diagnosed with BMs and who underwent neurosurgery between 2010 and 2021. The impact of BM features and patient's clinical characteristics on the overall survival (OS) was analyzed through uni- and multivariate analysis. Results The average OS was 25.98 months and differed according to the histology of the primary tumor. The primary tumor localization and the presence of extracranial metastases had a statistically significant impact on the OS, and patients with single BM showed a superior OS to those with multifocal lesions. The localization of BMs in the temporal lobe correlated with the highest OS. The OS was significantly higher in patients who presented seizures in their clinical onset and in those who had better post-surgical Karnofsky performance status, no post-surgical complications, and who underwent post-surgical treatment. Conclusion Our study has highlighted prognostically favorable patient and tumor factors. Among those, a clinical onset with epileptic seizures can help identify brain metastasis hitherto silent. This could lead to immediate diagnostic-therapeutic interventions with more aggressive therapies after appropriate multidisciplinary evaluation.
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237
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Martin BE, Sands T, Bier L, Bergner A, Boehme AK, Lippa N. Comparing the frequency of variants of uncertain significance (VUS) between ancestry groups in a paediatric epilepsy cohort. J Med Genet 2024:jmg-2023-109450. [PMID: 38453479 DOI: 10.1136/jmg-2023-109450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Studies indicate that variants of uncertain significance are more common in non-European populations due to lack of a diversity in population databases. This difference has not been explored in epilepsy, which is increasingly found to be genetic in paediatric populations, and has precision medicine applications. This study examines the differences in the frequency of uncertain next-generation sequencing (NGS) results among a paediatric epilepsy cohort between ancestral groups historically under-represented in biomedical research (UBR) and represented in biomedical research (RBR). METHODS A retrospective chart review of patients with epilepsy seen at Columbia University Irving Medical Center (CUIMC). One hundred seventy-eight cases met the following criteria: (1) visited any provider within the Pediatric Neurology Clinic at CUIMC, (2) had an ICD code indicating a diagnosis of epilepsy, (3) underwent NGS testing after March 2015 and (4) had self-reported ancestry that fit into a single dichotomous category of either historically represented or under-represented in biomedical research. RESULTS UBR cases had significantly higher rates of uncertain results when compared with RBR cases (79.2% UBR, 20.8% RBR; p value=0.002). This finding remained true after controlling for potential confounding factors, including sex, intellectual disability or developmental delay, epilepsy type, age of onset, number of genes tested and year of testing. CONCLUSION Our results add to the literature that individuals who are of ancestries historically under-represented in genetics research are more likely to receive uncertain genetic results than those of represented majority ancestral groups and establishes this finding in an epilepsy cohort.
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Affiliation(s)
- Bree E Martin
- Department of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tristan Sands
- Department of Neurology, Columbia University, New York, New York, USA
- Columbia University Irving Medical Center, New York, New York, USA
| | - Louise Bier
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amanda Bergner
- Genetic Counseling Graduate Program, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Genetics and Development, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Amelia K Boehme
- Department of Neurology, Columbia University, New York, New York, USA
| | - Natalie Lippa
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, USA
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238
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Wu X, Wang K, Wang J, Wei P, Zhang H, Yang Y, Huang Y, Wang Y, Shi W, Shan Y, Zhao G. The Interplay Between Epilepsy and Parkinson's Disease: Gene Expression Profiling and Functional Analysis. Mol Biotechnol 2024:10.1007/s12033-024-01103-y. [PMID: 38453824 DOI: 10.1007/s12033-024-01103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
The results of many epidemiological studies suggest a bidirectional causality may exist between epilepsy and Parkinson's disease (PD). However, the underlying molecular landscape linking these two diseases remains largely unknown. This study aimed to explore this possible bidirectional causality by identifying differentially expressed genes (DEGs) in each disease as well as their intersection based on two respective disease-related datasets. We performed enrichment analyses and explored immune cell infiltration based on an intersection of the DEGs. Identifying a protein-protein interaction (PPI) network between epilepsy and PD, and this network was visualised using Cytoscape software to screen key modules and hub genes. Finally, exploring the diagnostic values of the identified hub genes. NetworkAnalyst 3.0 and Cytoscape software were also used to construct and visualise the transcription factor-micro-RNA regulatory and co-regulatory networks, the gene-microRNA interaction network, as well as gene-disease association. Based on the enrichment results, the intersection of the DEGs mainly revealed enrichment in immunity-, phosphorylation-, metabolism-, and inflammation-related pathways. The boxplots revealed similar trends in infiltration of many immune cells in epilepsy and Parkinson's disease, with greater infiltration in patients than in controls. A complex PPI network comprising 186 nodes and 512 edges were constructed. According to node connection degree, top 15 hub genes were considered the kernel targets of epilepsy and PD. The area under curve values of hub gene expression profiles confirmed their excellent diagnostic values. This study is the first to analyse the molecular landscape underlying the epidemiological link between epilepsy and Parkinson's disease. The two diseases are closely linked through immunity-, inflammation-, and metabolism-related pathways. This information was of great help in understanding the pathogenesis, diagnosis, and treatment of the diseases. The present results may provide guidance for further in-depth analysis about molecular mechanisms of epilepsy and PD and novel potential targets.
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Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Jingjing Wang
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Penghu Wei
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Huaqiang Zhang
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Yanfeng Yang
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Yinchun Huang
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Yihe Wang
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Wenli Shi
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuan Wu Hospital of the Capital Medical University, Beijing, 100053, China.
- International Neuroscience Institute (China-INI), Beijing, China.
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, 100053, China.
- Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, China.
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239
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Lawal M. Managing epilepsy in the community: exploring the perspectives of community epilepsy nurse. Evid Based Nurs 2024:ebnurs-2023-103701. [PMID: 38448206 DOI: 10.1136/ebnurs-2023-103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Muili Lawal
- University of West London - Brentford Site, London, UK
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240
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Dutton C, Mody SK, Nippita S, Dodge LE, Pang T, Pennell PB, Davis A. Depot medroxyprogesterone acetate concentrations in patients with and without the use of antiseizure medications. Contraception 2024:110418. [PMID: 38452921 DOI: 10.1016/j.contraception.2024.110418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To measure plasma concentrations of medroxyprogesterone acetate (MPA) in users with epilepsy treated with antiseizure medications and compare these to MPA concentrations in those without epilepsy. STUDY DESIGN For this multisite cross-sectional study, we obtained a single blood sample from those with epilepsy treated with various antiseizure medications (n = 18) within the week before their next depot medroxyprogesterone injection. Among the participants without epilepsy (n = 20), 10 similarly were scheduled within the week prior to the next injection, and 10 were scheduled at earlier intervals to attempt to balance the time intervals between groups. MPA concentrations were determined by a validated assay. RESULTS MPA concentrations were similar among those with epilepsy and controls and between groups with and without the use of enzyme-inducing medications. The lowest MPA concentrations, under 0.07 ng/mL, were observed among two of eight using enzyme-inducing antiseizure medications, one of 10 using noninducing medications, and one of 19 controls had concentrations below 0.2 ng/mL. CONCLUSIONS In this exploratory study, lower MPA concentrations in some participants using enzyme-inducing antiseizure medications suggest a potential interaction that could reduce depot medroxyprogesterone efficacy.
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Affiliation(s)
- Caryn Dutton
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Sheila K Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, United States
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Laura E Dodge
- Harvard Medical School, Boston, MA, United States; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Trudy Pang
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Page B Pennell
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Anne Davis
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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241
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Özdemir FMA, Çelik H. Evaluation of Sleep Habits and Their Relationship With Quality of Life in Children With Epilepsy. Pediatr Neurol 2024; 155:114-119. [PMID: 38631079 DOI: 10.1016/j.pediatrneurol.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/03/2024] [Accepted: 03/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The aim of this study was to investigate sleep habits, quality of life (QoL), and the relationship between them in children with epilepsy. METHODS In this cross-sectional study, children aged two to 18 years being followed up for epilepsy were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and the Pediatric Quality of Life Inventory (PedsQL). Pearson or Spearman correlation analysis was performed to examine the relationship between normally distributed and non-normally distributed variables, respectively. Linear regression analysis was used to examine independent variables associated with PedsQL total scale score. Level of significance was accepted as P < 0.05. RESULTS The study included 112 children with a mean age of 10.5 ± 4.4 years (51.8% female). The frequency of poor sleep habits was 96.4%. There was a good level of agreement between children's and parents' PedsQL total, physical health, and psychosocial health scores (P < 0.001). Correlation analysis between QoL and sleep parameters revealed negative correlations between total sleep score and self-assessed PedsQL total scale, physical health, and psychosocial health scores (P < 0.05) and parent-assessed PedsQL total scale and psychosocial health scores (P < 0.05). The results of linear regression analysis indicated that the factors most significantly associated with lower QoL were high CSHQ total sleep score and exclusively daytime seizures (P < 0.001). CONCLUSIONS It was found that children with epilepsy had poor sleep habits and low QoL and that poor sleep habits have a negative impact on QoL.
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Affiliation(s)
- Fatih Mehmet Akif Özdemir
- Department of Pediatric Neurology, Dr. Ali Kemal Belviranli Hospital for Obstetrics and Pediatrics, Horozluhan Osb/Selçuklu/Konya, Turkey.
| | - Halil Çelik
- Department of Pediatric Neurology, Konya City Hospital, Karatay/Konya, Turkey
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242
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Xiao W, Li P, Kong F, Kong J, Pan A, Long L, Yan X, Xiao B, Gong J, Wan L. Unraveling the Neural Circuits: Techniques, Opportunities and Challenges in Epilepsy Research. Cell Mol Neurobiol 2024; 44:27. [PMID: 38443733 PMCID: PMC10914928 DOI: 10.1007/s10571-024-01458-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024]
Abstract
Epilepsy, a prevalent neurological disorder characterized by high morbidity, frequent recurrence, and potential drug resistance, profoundly affects millions of people globally. Understanding the microscopic mechanisms underlying seizures is crucial for effective epilepsy treatment, and a thorough understanding of the intricate neural circuits underlying epilepsy is vital for the development of targeted therapies and the enhancement of clinical outcomes. This review begins with an exploration of the historical evolution of techniques used in studying neural circuits related to epilepsy. It then provides an extensive overview of diverse techniques employed in this domain, discussing their fundamental principles, strengths, limitations, as well as their application. Additionally, the synthesis of multiple techniques to unveil the complexity of neural circuits is summarized. Finally, this review also presents targeted drug therapies associated with epileptic neural circuits. By providing a critical assessment of methodologies used in the study of epileptic neural circuits, this review seeks to enhance the understanding of these techniques, stimulate innovative approaches for unraveling epilepsy's complexities, and ultimately facilitate improved treatment and clinical translation for epilepsy.
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Affiliation(s)
- Wenjie Xiao
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Peile Li
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Fujiao Kong
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jingyi Kong
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Aihua Pan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxin Yan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaoe Gong
- Department of Neurology, Hunan Children's Hospital, Changsha, Hunan Province, China.
| | - Lily Wan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China.
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López de Mota Sánchez D, Maure Blesa L, Nyström Hernández AL, Olivié García L, Herranz Bárcenas A. Lettre to editor: Case report of an ictal asystole as debut in new onset epilepsy. Neurol Sci 2024:10.1007/s10072-024-07440-9. [PMID: 38446262 DOI: 10.1007/s10072-024-07440-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/01/2024] [Indexed: 03/07/2024]
Abstract
The case report describes a 65-year-old man with arterial hypertension and a metallic aortic valve who presented to the emergency room for a loss of consciousness event and memory impairment. The electroencephalographic recording showed right temporal epileptiform activity followed by a 9 s asystole with quick consciousness recovery. The patient was diagnosed with right temporal epilepsy with asystole and was prescribed levetiracetam to prevent new events. A pacemaker was indicated in the follow-up for the long duration of the asystole, preventing major morbidity. Ictal asystole (IA) is a rare phenomenon of epilepsy that leads to syncope. It is observed in focal epilepsy, especially in left temporal epilepsy. Underlying cardiac pathology may facilitate IA, especially when the onset of the epilepsy is new. Knowledge of focal temporal semiology is key, concerning our case report, the memory impairment points to temporal pathology, and ictal vomiting in the non-dominant hemisphere. Anti-seizures drugs must be initiated in all patients, and there is a recommendation to avoid those with negative inotropic and arrhythmogenic effects (such as phenytoin, carbamazepine, and lacosamide). There is a discussion about pacemaker indication, however, it is highly recommended in non-controlled epilepsy and in ictal asystoles that last for more than 6 s to reduce morbidity.
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Affiliation(s)
| | - Lucía Maure Blesa
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Laura Olivié García
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Chen J, Ngo A, Rodríguez-Cruces R, Royer J, Caligiuri ME, Gambardella A, Concha L, Keller SS, Cendes F, Yasuda CL, Alvim MKM, Bonilha L, Gleichgerrcht E, Focke NK, Kreilkamp B, Domin M, von Podewils F, Langner S, Rummel C, Wiest R, Martin P, Kotikalapudi R, Bender B, O’Brien TJ, Sinclair B, Vivash L, Kwan P, Desmond PM, Lui E, Duma GM, Bonanni P, Ballerini A, Vaudano AE, Meletti S, Tondelli M, Alhusaini S, Doherty CP, Cavalleri GL, Delanty N, Kälviäinen R, Jackson GD, Kowalczyk M, Mascalchi M, Semmelroch M, Thomas RH, Soltanian-Zadeh H, Davoodi-Bojd E, Zhang J, Lenge M, Guerrini R, Bartolini E, Hamandi K, Foley S, Rüber T, Bauer T, Weber B, Caldairou B, Depondt C, Absil J, Carr SJA, Abela E, Richardson MP, Devinsky O, Pardoe H, Severino M, Striano P, Tortora D, Kaestner E, Hatton SN, Arienzo D, Vos SB, Ryten M, Taylor PN, Duncan JS, Whelan CD, Galovic M, Winston GP, Thomopoulos SI, Thompson PM, Sisodiya SM, Labate A, McDonald CR, Caciagli L, Bernasconi N, Bernasconi A, Larivière S, Schrader D, Bernhardt BC. A WORLDWIDE ENIGMA STUDY ON EPILEPSY-RELATED GRAY AND WHITE MATTER COMPROMISE ACROSS THE ADULT LIFESPAN. bioRxiv 2024:2024.03.02.583073. [PMID: 38496668 PMCID: PMC10942350 DOI: 10.1101/2024.03.02.583073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Objectives Temporal lobe epilepsy (TLE) is commonly associated with mesiotemporal pathology and widespread alterations of grey and white matter structures. Evidence supports a progressive condition although the temporal evolution of TLE is poorly defined. This ENIGMA-Epilepsy study utilized multimodal magnetic resonance imaging (MRI) data to investigate structural alterations in TLE patients across the adult lifespan. We charted both grey and white matter changes and explored the covariance of age-related alterations in both compartments. Methods We studied 769 TLE patients and 885 healthy controls across an age range of 17-73 years, from multiple international sites. To assess potentially non-linear lifespan changes in TLE, we harmonized data and combined median split assessments with cross-sectional sliding window analyses of grey and white matter age-related changes. Covariance analyses examined the coupling of grey and white matter lifespan curves. Results In TLE, age was associated with a robust grey matter thickness/volume decline across a broad cortico-subcortical territory, extending beyond the mesiotemporal disease epicentre. White matter changes were also widespread across multiple tracts with peak effects in temporo-limbic fibers. While changes spanned the adult time window, changes accelerated in cortical thickness, subcortical volume, and fractional anisotropy (all decreased), and mean diffusivity (increased) after age 55 years. Covariance analyses revealed strong limbic associations between white matter tracts and subcortical structures with cortical regions. Conclusions This study highlights the profound impact of TLE on lifespan changes in grey and white matter structures, with an acceleration of aging-related processes in later decades of life. Our findings motivate future longitudinal studies across the lifespan and emphasize the importance of prompt diagnosis as well as intervention in patients.
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Affiliation(s)
- Judy Chen
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Alexander Ngo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Raúl Rodríguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | | | - Antonio Gambardella
- Neuroscience Research Center, University Magna Græcia, Catanzaro, CZ, Italy
- Institute of Neurology, University Magna Græcia, Catanzaro, CZ, Italy
| | - Luis Concha
- Institute of Neurobiology, Universidad Nacional Autónoma de México, Querétaro, México
| | - Simon S. Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Fernando Cendes
- Department of Neurology, University of Campinas-–UNICAMP, Campinas, São Paulo, Brazil
| | - Clarissa L. Yasuda
- Department of Neurology, University of Campinas-–UNICAMP, Campinas, São Paulo, Brazil
| | - Marina K. M. Alvim
- Department of Neurology, University of Campinas-–UNICAMP, Campinas, São Paulo, Brazil
| | | | | | - Niels K. Focke
- Department of Neurology, University of Medicine Göttingen, Göttingen, Germany
| | - Barbara Kreilkamp
- Department of Neurology, University of Medicine Göttingen, Göttingen, Germany
| | - Martin Domin
- Institute of Diagnostic Radiology and Neuroradiology, Functional Imaging Unit, University Medicine Greifswald, Greifswald, Germany
| | - Felix von Podewils
- Department of Neurology, University Medicine Greifswald, Epilepsy Center, Greifswald, Germany
| | - Soenke Langner
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Raviteja Kotikalapudi
- Department of Neurology, University of Medicine Göttingen, Göttingen, Germany
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Germany
| | - Terence J. O’Brien
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Sinclair
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M. Desmond
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Elaine Lui
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Gian Marco Duma
- Scientific Institute IRCCS E.Medea, Epilepsy Unit, Conegliano (TV), Italy
| | - Paolo Bonanni
- Scientific Institute IRCCS E.Medea, Epilepsy Unit, Conegliano (TV), Italy
| | - Alice Ballerini
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Manuela Tondelli
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
- Primary Care Department, Azienda Sanitaria Locale di Modena, Modena, Italy
| | - Saud Alhusaini
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Colin P. Doherty
- Department of Neurology, St James’ Hospital, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Gianpiero L. Cavalleri
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Norman Delanty
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Reetta Kälviäinen
- Epilepsy Center, Neuro Center, Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010, Australia
| | - Magdalena Kowalczyk
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010, Australia
| | - Mario Mascalchi
- Neuroradiology Research Program, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | - Mira Semmelroch
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010, Australia
| | - Rhys H. Thomas
- Transitional and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hamid Soltanian-Zadeh
- Contol and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
- Departments of Research Administration and Radiology, Henry Ford Health System, Detroit, MI, USA
| | | | - Junsong Zhang
- Cognitive Science Department, Xiamen University, Xiamen, China
| | - Matteo Lenge
- Child Neurology Unit and Laboratories, Neuroscience Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Renzo Guerrini
- Child Neurology Unit and Laboratories, Neuroscience Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | | | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre (CUBRIC), College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre (CUBRIC), College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Theodor Rüber
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Benoit Caldairou
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah J. A. Carr
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Eugenio Abela
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Orrin Devinsky
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Heath Pardoe
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Domenico Tortora
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Erik Kaestner
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Sean N. Hatton
- Department of Neurosciences, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Donatello Arienzo
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Sjoerd B. Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Mina Ryten
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Bucks, UK
| | - Peter N. Taylor
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- CNNP Lab, ICOS group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Christopher D. Whelan
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zürich, Zürich, Switzerland
| | - Gavin P. Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, ON, Canada
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paul M. Thompson
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, Regional Epilepsy Center, University of Messina, Italy
| | - Carrie R. McDonald
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Bucks, UK
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
| | - Dewi Schrader
- BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Boris C. Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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Moretz K, Wheless J, Santos C, Segal E, Lancman M, Patten A, Malhotra M. Phase IV PROVE study: Perampanel in real-world clinical care of pediatric patients with epilepsy. Eur J Paediatr Neurol 2024; 50:23-30. [PMID: 38569352 DOI: 10.1016/j.ejpn.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 01/10/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The non-interventional Phase IV PROVE study (NCT03208660) assessed retention, efficacy, safety and tolerability, and perampanel dosing in patients with epilepsy during routine clinical care. This analysis evaluated final data from patients aged <4 years and 4-<12 years. METHODS Data were obtained retrospectively from medical/pharmacy records of patients in the United States initiating perampanel after January 1, 2014, according to treating clinician recommendations. Retention rate was the primary endpoint. Secondary assessments included median percent changes in seizure frequency, seizure-freedom rates, investigator impression of seizure effect, and safety and tolerability. RESULTS The Safety Analysis Set (SAS) included 41 patients (<4 years; mean maximum dose, 3.5 mg/day) and 203 patients (4-<12 years; mean maximum dose, 5.3 mg/day); 24-month retention rates were 35.7% (n = 5/14) and 42.0% (n = 47/112), respectively. In the Full Analysis Set, during Months 1-3, median percent reductions in seizure frequency were 33.3% (n = 8 [<4 years]) and 26.0% (n = 32 [4-<12 years]), and seizure-freedom rates were 12.5% in both groups (n = 1/8 and n = 4/32); patient numbers were low at later time points. Most patients showed improvements in seizure control (45.9% [<4 years] versus 52.4% [4-<12 years]) or no change (45.9% versus 34.5%) (SAS). Treatment-emergent adverse events (TEAEs) were reported in 12 (<4 years: 29.3%; most common, irritability [7.3%]) and 64 patients (4-<12 years: 31.5%; most common, aggression [6.9%]). CONCLUSIONS Perampanel was generally well tolerated with <21% of TEAEs leading to withdrawal at 24 months, had favorable retention rates (≥50% and >35% at 12 and 24 months, respectively), and sustained efficacy in pediatric patients during routine clinical care.
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Affiliation(s)
- Katherine Moretz
- Meridian Clinical Research, LLC, 6602 Waters Avenue, Building C, Savannah, GA, 31406, USA
| | - James Wheless
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, 49 N Dunlap Street, Memphis, TN, 38105, USA.
| | - Cesar Santos
- Valley Children's Hospital, 9300 Valley Children's Place Madera, CA, 93636, USA.
| | - Eric Segal
- Northeast Regional Epilepsy Group, Hackensack University Medical Center, Hackensack Meridian School of Medicine, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Marcelo Lancman
- Northeast Regional Epilepsy Group, Hackensack University Medical Center, Hackensack Meridian School of Medicine, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Anna Patten
- Eisai Europe Ltd., European Knowledge Centre, Mosquito Way, Hatfield, Hertfordshire, AL10 9SN, UK.
| | - Manoj Malhotra
- Formerly: Eisai Inc., 200 Metro Blvd., Nutley, NJ, 07110, USA.
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Tsereteli A, Okujava N, Malashkhia N, Liluashvili K, de Weerd A. The ENCEVIS algorithm in the EMU and the factors affecting its performance: Our experience. Epilepsy Behav Rep 2024; 26:100656. [PMID: 38495403 PMCID: PMC10937301 DOI: 10.1016/j.ebr.2024.100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024] Open
Abstract
The study's purpose was to assess the seizure detection performance of ENCEVIS 1.7, identify factors that may influence algorithm performance, and explore its potential for implementation and application in long-term video EEG monitoring units. The study included video-EEG recordings containing at least one epileptic seizure. Forty-three recordings, encompassing 112 seizures, were included in the analysis. True positive, false negative, and false positive seizure detections were defined. Factors that may influence algorithm performance were studied. ENCEVIS demonstrated an overall sensitivity of 71.2%, significantly higher (75.1%) in focal compared to generalized seizures (62%). Ictal patterns rhythmicity (rhythmic 59.4 %, arrhythmic 41.7 %), seizure duration (<10 sec 6.3 %, >60 sec. 63.9 % (p < 0.05)) and patient age (<18 years 39.5 %, >18 years 58.1 % (P < 0.05)) influenced ENCEVIS sensitivity. The coexistence of extracerebral signal changes did not influence sensitivity. ENCEVIS with 79.1% accuracy annotates at least one seizure in those recordings containing epileptic seizures. ENCEVIS seizure detection performance was reasonable for generalized/focal to bilateral tonic-clonic seizures and seizures with temporal lobe onset. Rhythmic ictal patterns, longer seizure duration, and adult age positively influenced algorithm performance. ENCEVIS can be a valuable tool for identifying recordings containing seizures and can potentially reduce the workload of neurophysiologists.
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Affiliation(s)
- Aleksandre Tsereteli
- Epilepsy and Sleep Centre, S. Khechinashvili University Hospital (SKUH), Georgia
| | - Natela Okujava
- Epilepsy and Sleep Centre, S. Khechinashvili University Hospital (SKUH), Georgia
- Department of Clinical Neurology, Tbilisi State Medical University (TSMU), Georgia
| | - Nikoloz Malashkhia
- Epilepsy and Sleep Centre, S. Khechinashvili University Hospital (SKUH), Georgia
| | | | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, Netherland
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Stephanie B, Michael C, Sreenath TG. Safety and tolerance of the ketogenic diet in patients with Zellweger Syndrome. Epilepsy Behav Rep 2024; 26:100655. [PMID: 38501062 PMCID: PMC10945160 DOI: 10.1016/j.ebr.2024.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
Zellweger Syndrome is a peroxisomal disorder that can lead to elevation of long chain fatty acids and epilepsy, which can be drug resistant. The treatment of drug resistant epilepsy can include the ketogenic diet in appropriately chosen patients. Typically, the ketogenic diet is contraindicated in individuals with defects in fatty acid metabolism because of the diet's reliance on medium and long chain fatty acids. To our knowledge this is the first publication outlining the use of the ketogenic diet in patients with defects in beta oxidation of very long chain fatty acids. We present two patients with Zellweger Syndrome who were placed on a ketogenic diet for drug resistant epilepsy. Safety and tolerance of the ketogenic diet in patients with Zellweger Syndrome.
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Affiliation(s)
- Borst Stephanie
- The University of Iowa, 225 S Grand Ave Iowa City, Iowa 52242, United States
| | - Ciliberto Michael
- The University of Iowa Stead Family Children’s Hospital, 200 Hawkins Drive Iowa City, Iowa 52242, United States
| | - Thati Ganganna Sreenath
- The University of Iowa Stead Family Children’s Hospital, 200 Hawkins Drive Iowa City, Iowa 52242, United States
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Luna-Munguia H, Gasca-Martinez D, Garay-Cortes A, Coutiño D, Regalado M, de Los Rios E, Villaseñor P, Hidalgo-Flores F, Flores-Guapo K, Benito BY, Concha L. Selective Medial Septum Lesions in Healthy Rats Induce Longitudinal Changes in Microstructure of Limbic Regions, Behavioral Alterations, and Increased Susceptibility to Status Epilepticus. Mol Neurobiol 2024:10.1007/s12035-024-04069-9. [PMID: 38443731 DOI: 10.1007/s12035-024-04069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
Septo-hippocampal pathway, crucial for physiological functions and involved in epilepsy. Clinical monitoring during epileptogenesis is complicated. We aim to evaluate tissue changes after lesioning the medial septum (MS) of normal rats and assess how the depletion of specific neuronal populations alters the animals' behavior and susceptibility to establishing a pilocarpine-induced status epilepticus. Male Sprague-Dawley rats were injected into the MS with vehicle or saporins (to deplete GABAergic or cholinergic neurons; n = 16 per group). Thirty-two animals were used for diffusion tensor imaging (DTI); scanned before surgery and 14 and 49 days post-injection. Fractional anisotropy and apparent diffusion coefficient were evaluated in the fimbria, dorsal hippocampus, ventral hippocampus, dorso-medial thalamus, and amygdala. Between scans 2 and 3, animals were submitted to diverse behavioral tasks. Stainings were used to analyze tissue alterations. Twenty-four different animals received pilocarpine to evaluate the latency and severity of the status epilepticus 2 weeks after surgery. Additionally, eight different animals were only used to evaluate the neuronal damage inflicted on the MS 1 week after the molecular surgery. Progressive changes in DTI parameters in both white and gray matter structures of the four evaluated groups were observed. Behaviorally, the GAT1-saporin injection impacted spatial memory formation, while 192-IgG-saporin triggered anxiety-like behaviors. Histologically, the GABAergic toxin also induced aberrant mossy fiber sprouting, tissue damage, and neuronal death. Regarding the pilocarpine-induced status epilepticus, this agent provoked an increased mortality rate. Selective septo-hippocampal modulation impacts the integrity of limbic regions crucial for certain behavioral skills and could represent a precursor for epilepsy development.
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Affiliation(s)
- Hiram Luna-Munguia
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico.
| | - Deisy Gasca-Martinez
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
- Unidad de Analisis Conductual, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Alejandra Garay-Cortes
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Daniela Coutiño
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Mirelta Regalado
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Ericka de Los Rios
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
- Unidad de Microscopia, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Paulina Villaseñor
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Fernando Hidalgo-Flores
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Karen Flores-Guapo
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Brandon Yair Benito
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
| | - Luis Concha
- Departamento de Neurobiologia Conductual y Cognitiva, Instituto de Neurobiologia, Universidad Nacional Autonoma de Mexico, Campus UNAM-Juriquilla, 76230, Queretaro, Mexico
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Zheng Y, She Y, Su Z, Huang K, Chen S, Zhou L. A novel pathogenic variant in TDP2 causes spinocerebellar ataxia autosomal recessive 23 accompanied by pituitary tumor and hyperhidrosis: a case report. Neurol Sci 2024:10.1007/s10072-024-07397-9. [PMID: 38433132 DOI: 10.1007/s10072-024-07397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
TDP2 gene encodes tyrosyl DNA phosphodiesterase 2, an enzyme required for effective repair of the DNA double-strand breaks (DSBs). Spinocerebellar ataxia autosomal recessive 23 (SCAR23) is a rare disease caused by the pathogenic mutation of TDP2 gene and characterized by intellectual disability, progressive ataxia and refractory epilepsy. Thus far, merely nine patients harboring five different variants (c.425 + 1G > A; c.413_414delinsAA, p. Ser138*; c.400C > T, p. Arg134*; c.636 + 3_ 636 + 6 del; c.4G > T, p. Glu2*) in TDP2 gene have been reported. Here, we describe the tenth patient with a novel variant (c.650del, p. Gly217GlufsTer7) and new phenotype (pituitary tumor and hyperhidrosis).
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Affiliation(s)
- Yuqiu Zheng
- Department of Neurology, the Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China
| | - Yingfang She
- Department of Neurology, the Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China
| | - Zhengwei Su
- Department of Neurology, the Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China
| | - Kanghui Huang
- Department of Neurology, the Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China
| | - Shuda Chen
- Department of Neurology, the Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China.
| | - Liemin Zhou
- Department of Neurology, the Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China.
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250
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Kang Y, Kim S, Jung Y, Ko DS, Kim HW, Yoon JP, Cho S, Song TJ, Kim K, Son E, Kim YH. Exploring the Smoking- Epilepsy Nexus: a systematic review and meta-analysis of observational studies : Smoking and epilepsy. BMC Med 2024; 22:91. [PMID: 38433201 PMCID: PMC10910761 DOI: 10.1186/s12916-024-03307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Epilepsy, characterized by recurrent unprovoked seizures, poses significant challenges to affected individuals globally. While several established risk factors for epilepsy exist, the association with cigarette smoking remains debated. This study aims to conduct systematic review and meta-analysis to elucidate the potential association between smoking and the likelihood of epilepsy. METHODS The search was performed on March 31st, 2023, using the Medline, Embase, Web of Science, Scopus, and ScienceDirect. We included cohort, cross-sectional, and case-control studies in our meta-analysis, conducting subgroup analyses based on smoking history, sex, and epilepsy type to yield specific insights. RESULTS We identified 2550 studies, of which 17 studies were finally included in this study. The pooled odds ratio of epilepsy was 1.14 (0.96-1.36) in smokers compared to non-smokers. In current smokers compared to non-smokers, the odds ratio was 1.46 (1.13-1.89), while, in former smokers compared to non-smokers, the odds ratio was 1.14 (0.83-1.56). CONCLUSIONS While the overall association between smoking and epilepsy did not reach statistical significance, a notable association was found among current smokers. The study emphasizes the importance of smoking cessation as a potential preventive measure against epilepsy, especially given the proconvulsive effects of nicotine. Future research should address limitations and explore specific clinical scenarios to enhance our understanding of the complex relationship between cigarette use and epilepsy. SYSTEMATIC REVIEW REGISTRATION CRD42022342510.
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Affiliation(s)
- Yerin Kang
- School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Sieun Kim
- School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Yunah Jung
- School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Dai Sik Ko
- Division of Vascular Surgery, Department of General Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sunghwan Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Kihun Kim
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
| | - Eunjeong Son
- Division of Respiratory and Allergy, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
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