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Kansal B, Anand A, Garg D, Gupta A, Kumar A, Sharma S. Applicability of the International League Against Epilepsy (ILAE) 2022 diagnostic criteria for epilepsy syndromes in children: A retrospective review of 1550 children with epilepsy. Seizure 2024; 117:288-292. [PMID: 38603939 DOI: 10.1016/j.seizure.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE Recently, the ILAE Nosology and Definitions Task Force defined diagnostic criteria for epilepsy syndromes. There is paucity of data on the use of these new diagnostic criteria in children with epilepsy, and how these criteria may lead to changes from previous practice. METHODS This was a retrospective chart review of data of children attending the epilepsy clinic in a tertiary care children's hospital from January 2011 to January 2023. The clinical details such as age at onset, types of seizures, co-morbidities, and results of EEG, MRI and genetic testing were reviewed. Epilepsy syndrome diagnosis was made as per the ILAE 2022 criteria, and compared with the previous syndrome diagnosis as per records. RESULTS Data from 1550 children (63 % boys) with epilepsy were analysed, and 55.4 % children were classified to have epilepsy syndromes as per the new ILAE 2022 diagnostic criteria. Application of the new 2022 ILAE diagnostic criteria was associated with a change in name alone in 676 (77.8 %) children. Hundred (11.5 %) children were newly classified under an epilepsy syndrome who had previously remained unclassified. Eleven (1.3 %) children who were previously classified into an epilepsy syndrome could not be classified using the new diagnostic criteria. Eight (0.9 %) were shifted to a new syndromic category. Overall, change in diagnosis occurred in 13.7 (11.5 + 1.3 + 0.9)%. No change in epilepsy syndrome classification/nomenclature occurred in 74 (8.5 %) children. SIGNIFICANCE The new diagnostic criteria led to an overall change in diagnosis in 13.7 % of children with epilepsy. These criteria will hopefully lead to uniformity in diagnosis of epilepsy syndromes across diverse settings.
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Affiliation(s)
- Bhavya Kansal
- Department of Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran children's Hospital, New Delhi, India
| | - Aakanksha Anand
- Department of Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran children's Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anshika Gupta
- Department of Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran children's Hospital, New Delhi, India
| | - Ashna Kumar
- Department of Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran children's Hospital, New Delhi, India
| | - Suvasini Sharma
- Department of Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran children's Hospital, New Delhi, India.
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Lu YH, Fu Y, Shu J, Yan LY, Shen HJ. Application of cross-migration theory in limb rehabilitation of stroke patients with hemiplegia. World J Clin Cases 2023; 11:4531-4543. [PMID: 37469730 PMCID: PMC10353507 DOI: 10.12998/wjcc.v11.i19.4531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Stroke is a common cause of neurological dysfunction, often resulting in hemiplegia. Thus, rehabilitation of limb function in stroke patients is an important step towards accelerating recovery and improving quality of life.
AIM To investigate whether unilateral strength training in hemiplegic stroke patients could lead to cross-migration, an increase in bilateral muscle strength, and an improvement in lower limb motor function.
METHODS We randomly divided 120 patients with hemiplegic stroke into two groups: Eexperimental and control groups, with 60 patients in each group. Both groups received routine rehabilitation treatment, while the experimental group additionally received ankle dorsiflexion resistance training on the healthy side for 6 wk. We measured the maximum voluntary contract (MVC), changes in surface electromyography (EMG), and the lower limb motor function using the simplified Fugl Meyer Motor Function Assessment Scale (FMA) before and within 1 wk after training.
RESULTS The FMA score in the experimental group improved significantly compared to both their pre-training score and the control group's post-training score (P < 0.05). The integrated EMG of the anterior tibialis muscle and pulmonary intestine muscle in the experimental group were significantly different after training than before (P < 0.05). Furthermore, the MVC of the anterior tibialis muscle on both the healthy and affected sides and the MVC of the pulmonary intestine muscle on both sides showed significant improvement compared with before training and the control group (P < 0.05).
CONCLUSION Our findings suggest that ankle dorsiflexion resistance training on the healthy side in hemiplegic stroke patients can increase strength in the opposite tibialis anterior muscle and antagonist's muscle, indicating a cross-migration phenomenon of strength training. Furthermore, this type of training can also improve lower limb motor function, providing a new exercise method for improving early ankle dorsiflexion dysfunction.
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Affiliation(s)
- Yan-Hong Lu
- Geriatric Rehabilitation Department, Shanghai Jing'an District Shibei Hospital, Shanghai 200040, China
| | - Yi Fu
- Geriatric Rehabilitation Department, Shanghai Jing'an District Shibei Hospital, Shanghai 200040, China
| | - Jin Shu
- Geriatric Rehabilitation Department, Shanghai Jing'an District Shibei Hospital, Shanghai 200040, China
| | - Li-Yan Yan
- Department of Nursing, Shanghai Jing'an District Shibei Hospital, Shanghai 200040, China
| | - Hai-Jian Shen
- Department of Nursing, Shanghai Jing'an District Shibei Hospital, Shanghai 200040, China
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Kentab AY, Al Bulayhi S, Hamad MH, Al Wadei A, Bashiri FA. Pattern and etiology of early childhood epilepsy: An Experience at a tertiary care University Center. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2022; 27:244-250. [PMID: 36252977 PMCID: PMC9749570 DOI: 10.17712/nsj.2022.4.20220001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/06/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate seizure characteristics, types, and define the etiology of epilepsy in children aged ≤2 years using the 2017 ILAE classification. METHODS A retrospective chart review was conducted at King Khalid University Hospital, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia for children below 2 years of age diagnosed with epilepsy, and on anti-seizure medications from January 2017 - December 2018. The collected data involved detailed information on the patients' seizure, electroclinical, neuroimaging, laboratory evaluations, and underlying etiology. RESULTS One- hundred and fifty patients were included in the study and classified according to etiology into: genetic (43, 28.7%), structural (41, 27.3%), metabolic (10, 6.7%), infectious (8, 5.3%), immune-mediated (1, 0.7%) and unknown (47, 31.3%) groups. The most common seizure types were generalized epilepsy, among which generalized tonic-clonic seizures occurred in 56 (37%) patients, followed by tonic seizures in 31 (21%), infantile spasm in 19 (13%), myoclonic seizures in 4 (2.7%), atonic seizures in 6 (4%), and focal seizures in 33 (22%) patients. Global developmental delay and abnormalities in both neurologic exam and neuroimaging were more common in the structural and genetic groups. Electroencephalography was abnormal in 82 (55%) patients, including the majority of the structural group (26, 63.4%). CONCLUSION The etiology of epilepsy in this cohort remains undetermined (unknown) in a large proportion of cases, followed by genetic and structural causes. This result added to the published international data about epilepsy in the first 2-years of life.
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Affiliation(s)
- Amal Y. Kentab
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia,Address correspondence and reprint request to: Dr. Amal Y. Kentab Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-3627-4973
| | - Shumukh Al Bulayhi
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Muddathir H. Hamad
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ali Al Wadei
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fahad A. Bashiri
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Egesa IJ, Newton CRJC, Kariuki SM. Evaluation of the International League Against Epilepsy 1981, 1989, and 2017 classifications of seizure semiology and etiology in a population-based cohort of children and adults with epilepsy. Epilepsia Open 2021; 7:98-109. [PMID: 34792291 PMCID: PMC8886073 DOI: 10.1002/epi4.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/16/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The International League Against Epilepsy (ILAE) has revised the classification of epilepsies and seizures on several occasions since the original classification published in 1964. It is unclear if these changes have impacted the characterization of epilepsy, including the clinical validity of seizure semiology or epilepsy outcomes in resource‐poor areas. We aim to address this important knowledge gap. Methods We reviewed the clinical seizure semiology and etiological data of 483 persons with epilepsy identified from a population‐based survey in rural Kenya. The seizure semiology and etiological data were classified using the 1981 (for seizures) and 1989 (for epilepsy) ILAE criteria and then reclassified according to the ILAE‐2017 criteria. Logistic regression models adjusted for potential confounders were used to measure the associations between the seizure semiology and different clinical and electroencephalographic features of epilepsy. Results Focal (formerly localization‐related) and generalized epilepsies were lower in ILAE‐2017 (56% and 29%) than that of ILAE‐1989 (61% and 34%), P < .001 and P < .001. Combined focal and generalized epilepsy type in ILAE‐2017 accounted for 11% of epilepsies. Individual seizure types were statistically similar in both ILAE‐1981 and 2017. New classification categories in ILAE‐2017 such as unknown seizures and epilepsies were identified, and the proportions were similar to the unclassified category in ILAE‐1989, 6% and 5%, respectively. The most common causes of epilepsy were symptomatic (76%) in the ILAE‐1989 criteria, with infectious (45%) and structural (36%) causes were highest in the ILAE‐2017 criteria. Significance Our study confirms that the two ILAE classification schemes are broadly consistent, but the introduction of the combined onset seizure category in ILAE‐2017 significantly reduces the proportion of mutually exclusive focal and generalized seizures. The comprehensive classification of etiology categories in ILAE‐2017 will facilitate appropriate treatment and improve prognosis.
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Affiliation(s)
- Isaac J Egesa
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya
| | - Charles R J C Newton
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Symon M Kariuki
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
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Poudel P, Kafle SP, Pokharel R. Clinical profile and treatment outcome of epilepsy syndromes in children: A hospital-based study in Eastern Nepal. Epilepsia Open 2021; 6:206-215. [PMID: 33681663 PMCID: PMC7918298 DOI: 10.1002/epi4.12470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/04/2021] [Accepted: 01/14/2021] [Indexed: 12/11/2022] Open
Abstract
Objective It is often difficult to diagnose epilepsy syndromes in resource-limited settings. This study was aimed to investigate the prospect of ascertaining the diagnosis, clinical profile, and treatment outcomes of epilepsy syndromes (ESs) among children in a resource-limited setting. Methods This was a descriptive study done from 01/07/2009 to 15/06/2017 among children (1-17 years of age) with unprovoked seizures presenting to the pediatric neurology clinic of a university hospital in eastern Nepal. Diagnosis, classification, and treatment of seizures were based upon International League Against Epilepsy guidelines. Results Of 768 children with unprovoked seizures, 120 (15.6%) were diagnosed as ES. The age of onset of seizure was unique for each ES. Developmental delay and cerebral palsy were present in 47.5% and 28.3% children, respectively. Common ESs were West syndrome (WS)-26.7%, generalized tonic-clonic seizures alone (GTCSA)-21.7%, self-limited childhood epilepsy with centrotemporal spikes (SLCECTS)-12.5%, childhood absence epilepsy (CAE)-10.0%, Lennox-Gastaut syndrome (LGS)-10.0%, other developmental and epileptic encephalopathies (DEE)-5.8%, self-limited familial infantile epilepsy (SLFIE)-4.2%, and juvenile myoclonic epilepsy (JME)-3.3%. Among children with known outcomes (87/120), overall response to pharmacotherapy and to monotherapy was observed in 72.4% (63/87) and 57.5% (50/87) children, respectively. All children with GTCSA, SLFIE, genetic epilepsy with febrile seizure plus (GEFS+), CAE, SLCECTS, and JME responded to pharmacotherapy and they had normal computerized tomography scans of the brain. Seizures were largely pharmaco-resistant in progressive myoclonus epilepsy (PME)-100.0%, LGS-73.0%, WS-52.0%, and other DEEs-40%. Significance A reasonable proportion (15.6%) of unprovoked seizures could be classified into specific ES despite limited diagnostic resources. WS was the most common ES. GTCSA, SLCECTS, CAE, and LGS were other common ESs. GTCSA, SLFIE, CAE, SLCECTS, GEFS+, and JME were largely pharmaco-responsive. PME, WS, and LGS were relatively pharmaco-resistant. Electro-clinical diagnosis of certain ES avoids the necessity of neuroimaging.
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Affiliation(s)
- Prakash Poudel
- Department of Pediatrics and Adolescent MedicineB.P. Koirala Institute of Health SciencesDharanNepal
| | - Shyam Prasad Kafle
- Department of Pediatrics and Adolescent MedicineB.P. Koirala Institute of Health SciencesDharanNepal
| | - Rita Pokharel
- Department of Psychiatric NursingCollege of NursingB.P. Koirala Institute of Health SciencesDharanNepal
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