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Intravooth T, Baran H, Wendling AS, Halaby A, Steinhoff BJ. Evaluating the Inheritance Risk: Epilepsy Prevalence among Offspring of Adults with Epilepsy in a Tertiary Referral Epilepsy Center. J Clin Med 2024; 13:2932. [PMID: 38792473 PMCID: PMC11122279 DOI: 10.3390/jcm13102932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
While significant strides have been made in comprehending the pathophysiology and treatment of epilepsy, further investigation is warranted to elucidate the factors impacting its development and transmission, particularly within familial contexts. This study sought to explore the prevalence and risk factors associated with epilepsy in the offspring of patients with epilepsy who were treated at a tertiary epilepsy center. Adult patients with confirmed epilepsy (PWE) receiving outpatient care were consecutively enrolled, starting from January 2021 to January 2023. Data were recorded for various variables, including age, gender, epilepsy pathophysiology, cognitive impairment, and family history of epilepsy. Descriptive statistics, various statistical tests, and multivariate logistic regression analyses were employed to analyze the data. A total of 1456 PWE were included. Among them, 463 patients (31.8%) had children. Twenty-five patients had offspring diagnosed with epilepsy, representing a prevalence of 5.4%. Analysis of the offspring with epilepsy revealed older ages, a higher proportion of parents with idiopathic epilepsy, and a greater prevalence of a positive family history of epilepsy. Multivariate logistic regression analysis demonstrated a significant association between a family history of epilepsy and increased epilepsy risk in offspring. Genetic syndrome-immanent predisposition, advanced age, and a family history of epilepsy were identified as significant risk factors for epilepsy in offspring by means of this mono-center study.
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Affiliation(s)
- Tassanai Intravooth
- Kork Epilepsy Center, Landstr. 1, 77694 Kehl-Kork, Germany; (T.I.); (H.B.); (A.-S.W.); (A.H.)
| | - Hazal Baran
- Kork Epilepsy Center, Landstr. 1, 77694 Kehl-Kork, Germany; (T.I.); (H.B.); (A.-S.W.); (A.H.)
| | - Anne-Sophie Wendling
- Kork Epilepsy Center, Landstr. 1, 77694 Kehl-Kork, Germany; (T.I.); (H.B.); (A.-S.W.); (A.H.)
| | - Amjad Halaby
- Kork Epilepsy Center, Landstr. 1, 77694 Kehl-Kork, Germany; (T.I.); (H.B.); (A.-S.W.); (A.H.)
| | - Bernhard J. Steinhoff
- Kork Epilepsy Center, Landstr. 1, 77694 Kehl-Kork, Germany; (T.I.); (H.B.); (A.-S.W.); (A.H.)
- Medical Faculty, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
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2
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Ratcliffe C, Pradeep V, Marson A, Keller SS, Bonnett LJ. Clinical prediction models for treatment outcomes in newly diagnosed epilepsy: A systematic review. Epilepsia 2024. [PMID: 38687193 DOI: 10.1111/epi.17994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Up to 35% of individuals diagnosed with epilepsy continue to have seizures despite treatment, commonly referred to as drug-resistant epilepsy. Uncontrolled seizures can directly, or indirectly, negatively impact an individual's quality of life. To inform clinical management and life decisions, it is important to be able to predict the likelihood of seizure control. Those likely to achieve seizure control will be able to return sooner to their usual work and leisure activities and require less follow-up, whereas those with a poor prognosis will need more frequent clinical attendance and earlier consideration of epilepsy surgery. This is a systematic review aimed at identifying demographic, clinical, physiological (e.g., electroencephalographic), and imaging (e.g., magnetic resonance imaging) factors that may be predictive of treatment outcomes in patients with newly diagnosed epilepsy (NDE). MEDLINE and Embase were searched for prediction models of treatment outcomes in patients with NDE. Study characteristics were extracted and subjected to assessment of risk of bias (and applicability concerns) using the PROBAST (Prediction Model Risk of Bias Assessment Tool) tool. Baseline variables associated with treatment outcomes are reported as prognostic factors. After screening, 48 models were identified in 32 studies, which generally scored low for concerns of applicability, but universally scored high for susceptibility to bias. Outcomes reported fit broadly into four categories: drug resistance, short-term treatment response, seizure remission, and mortality. Prognostic factors were also heterogenous, but the predictors that were commonly significantly associated with outcomes were those related to seizure characteristics/types, epilepsy history, and age at onset. Antiseizure medication response was often included as a baseline variable, potentially obscuring other factor relationships at baseline. Currently, outcome prediction models for NDE demonstrate a high risk of bias. Model development could be improved with a stronger adherence to recommended TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) practices. Furthermore, we outline actionable changes to common practices that are intended to improve the overall quality of prediction model development in NDE.
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Affiliation(s)
- Corey Ratcliffe
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Vishnav Pradeep
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
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3
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Pellinen J, French J, Knupp KG. Diagnostic Delay in Epilepsy: the Scope of the Problem. Curr Neurol Neurosci Rep 2021; 21:71. [PMID: 34817723 DOI: 10.1007/s11910-021-01161-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Diagnostic delay is an increasingly recognized issue in epilepsy. At the same time, there is a clear disparity between public awareness of epilepsy and that of other public health issues. A contributing factor for this seems to be a lack of studies testing interventions designed to improve seizure recognition. In this review, we summarize the main findings from recent studies investigating diagnostic delay in epilepsy, highlighting causes, consequences, and potential interventions in future research that may improve quality of care in this population. RECENT FINDINGS Building on prior evidence, diagnostic delay in patients with new-onset focal epilepsy has been identified as an important problem for patients with epilepsy. Such delay in diagnosis can lead to delayed treatment and potentially preventable morbidity and mortality including motor vehicle accidents. Nonmotor seizure semiology appears to be a major contributor for delay; such seizures are largely unrecognized when patients present to emergency departments for care. Improving recognition and diagnosis of recurrent nonmotor seizures in emergency departments represents a significant opportunity for improving time to diagnosis, particularly when patients present following a first lifetime motor seizure and meet diagnostic criteria for epilepsy. Diagnostic delay in epilepsy is a significant public health issue and recent studies have highlighted potential areas for intervention.
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Affiliation(s)
- Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jaqueline French
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
| | - Kelly G Knupp
- Departments of Pediatrics and Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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4
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Beghi E. Does diagnostic delay impact on the outcome of epilepsy? Epilepsia Open 2021. [PMCID: PMC8408596 DOI: 10.1002/epi4.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ettore Beghi
- Department of Neuroscience Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy
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Parviainen L, Kälviäinen R, Jutila L. Impact of diagnostic delay on seizure outcome in newly diagnosed focal epilepsy. Epilepsia Open 2020; 5:605-610. [PMID: 33336131 PMCID: PMC7733655 DOI: 10.1002/epi4.12443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE In the current study, we aimed to assess the diagnostic delay and the impact of diagnostic delay on seizure outcome in a cohort of newly diagnosed patients with focal epilepsy. METHODS The study material was compiled from eight clinical antiseizure medication monotherapy trials conducted at Kuopio Epilepsy Center during 1995-2016. We analyzed the time from first seizure to diagnosis, the number of seizures before diagnosis, and the response to treatment at five years. RESULTS Of the 176 patients (age range 15-75 years) in the cohort, 135 (77%) had had more than two seizures before treatment. The majority of these (79 patients, 45%) had had three to ten seizures. Median number of all seizures before diagnosis was 5 (range 2-2000). Focal aware seizures and focal impaired awareness seizures were more frequent than focal to bilateral tonic-clonic seizures; median number 45 (range 2-2000), 11 (range 2-220), and 3 (range 2-30), respectively (P < .001). Median delay was 12 months (range 0-362). Diagnostic delay alone did not correlate with the treatment response at five years. However, an increasing number of seizures before diagnosis indicated a worse seizure outcome (P < .001). SIGNIFICANCE This study shows that patients with focal epilepsy experience significant delays in diagnosis even in developed countries, especially with seizure types other than tonic-clonic seizures. In these cases, a long delay in diagnosis alone might not affect the long-term outcome. However, when accompanied with recurrent seizures misinterpreted by the patient or healthcare providers, the effect of such delay on prognosis can be considerable.
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Affiliation(s)
- Laura Parviainen
- Epilepsy Center, Neuro CenterKuopio University Hospital, Member of the European Reference Network EpiCAREKuopioFinland
| | - Reetta Kälviäinen
- Epilepsy Center, Neuro CenterKuopio University Hospital, Member of the European Reference Network EpiCAREKuopioFinland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Leena Jutila
- Epilepsy Center, Neuro CenterKuopio University Hospital, Member of the European Reference Network EpiCAREKuopioFinland
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Ghiasian M, Daneshyar S, Khanlarzadeh E, Bolouri Novin M. Investigating the relationship of positive family history pattern and the incidence and prognosis of idiopathic epilepsy in epilepsy patients. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:219-222. [PMID: 32509252 PMCID: PMC7265512 DOI: 10.22088/cjim.11.2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Epilepsy is one of the most common neurological disorder. This study aimed to investigating the relationship of family history pattern and prognosis of idiopathic epilepsy. Methods: In this study, 377 patients with epilepsy referring to Imam clinic were investigated. Data were collected by means of a checklist that contained demographic data, age of first seizure attack, response rate to treatment, parental relationship, seizure history, family history and recurrence of seizure. And then the data were analyzed by SPSS Version 23. Results: Among the 337 patients, 199 (52.8 %) individuals were males and 178 (47.2%) individuals were females. The mean age of patients was 28.3±14 years. Approximately 50% of patients had a history of seizure and epilepsy in one of the close first relatives or relatives who had adequate knowledge of their disease. The mean incidence age of epilepsy was lower in patients with a positive family history of disease than those who did not have a family history of epilepsy (p<0.05). Among the 33 patients who did not respond well to treatment, there was a 75% family history of epilepsy (p<0.05). The average age of epilepsy was lower in those with family marriage, but was not statistically significant. Conclusion: According to the findings of the present study, the patients diagnosed with idiopathic epilepsy, the family history of epilepsy and seizure, especially in their first degree relatives is fairly high, that may indicate genetic causes in the etiology of the disease.
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Affiliation(s)
- Masoud Ghiasian
- Department of Neurology, Faculty of Medicine, Hamadan University of Medical Sciences , Hamadan, Iran
| | - Sajjad Daneshyar
- Department of Neurology, Faculty of Medicine, Hamadan University of Medical Sciences , Hamadan, Iran
| | - Elham Khanlarzadeh
- Department of Neurology, Faculty of Medicine, Hamadan University of Medical Sciences , Hamadan, Iran
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Long-term follow-up of a large cohort with focal epilepsy of unknown cause: deciphering their clinical and prognostic characteristics. J Neurol 2019; 267:838-847. [DOI: 10.1007/s00415-019-09656-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
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8
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Hogan RE. Delay of Treatment, After Diagnosis, as a Contributor to the "Treatment Gap" in Epilepsy. Epilepsy Curr 2019; 19:385-386. [PMID: 31530018 PMCID: PMC6891181 DOI: 10.1177/1535759719874793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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9
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Bisulli F, Menghi V, Vignatelli L, Licchetta L, Zenesini C, Stipa C, Morigi F, Gizzi M, Avoni P, Provini F, Mostacci B, d'Orsi G, Pippucci T, Muccioli L, Tinuper P. Epilepsy with auditory features: Long-term outcome and predictors of terminal remission. Epilepsia 2018; 59:834-843. [PMID: 29464704 DOI: 10.1111/epi.14033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the long-term outcome of epilepsy with auditory features (EAF) and to identify the clinical predictors for prognosis. METHODS The study involved consecutive EAF patients with a follow-up of ≥5 years. Terminal remission (TR) was defined as a period of ≥5 consecutive years of seizure freedom at the last follow-up. We used Kaplan-Meier estimate to calculate the cumulative time-dependent probability of conversion to TR. Log-rank test and multivariate Cox regression analyses were performed to study the association between time to TR and prognostic determinants. RESULTS We included 123 EAF patients (male/female = 58/65) with a median follow-up of 11 years (1626.9 person-years). Most were sporadic cases (68.3%), whereas 31.7% reported a family history of epilepsy. At last assessment, 42 patients had achieved TR (34.1%). Of the remaining 81 cases with no TR (65.9%), 37% had been in remission for 1-4 years and 62.9% still had seizures within the past year. The cumulative rates of TR were 26.6%, 35.7%, and 51.6% at 10, 20, and 30 years from inclusion. On multivariate analysis, age at onset > 10 years (hazard ratio [HR] = 3.2, P = .028), auditory aura characterized by distortions only versus simple/complex hallucinations (HR = 2.9, P = .041), and unremarkable scalp electroencephalogram (EEG) versus EEG with focal epileptiform activity (HR = 3.5, P = .041) were associated with TR. SIGNIFICANCE Our data show a wide prognostic spectrum of EAF, ranging from mild forms with spontaneous remission, to severely refractory epilepsy addressed to surgery. The outcome, less favorable than expected from previous studies, appears to be primarily a function of 3 prognostic negative risk factors: age at onset < 10 years, auditory aura characterized by complex auditory hallucinations, and focal epileptiform abnormalities on scalp EEG. These predictors, easy to collect even at the first visit, may inform both clinicians and patients about the long-term prognosis and aid patient management.
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Affiliation(s)
- Francesca Bisulli
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Veronica Menghi
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy
| | - Laura Licchetta
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy
| | - Carlotta Stipa
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Morigi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Matteo Gizzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Patrizia Avoni
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federica Provini
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy
| | - Giuseppe d'Orsi
- Clinic of Nervous System Diseases, Riuniti Hospital, University of Foggia, Foggia, Italy
| | - Tommaso Pippucci
- Medical Genetic Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Lorenzo Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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10
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Licchetta L, Bisulli F, Vignatelli L, Zenesini C, Di Vito L, Mostacci B, Rinaldi C, Trippi I, Naldi I, Plazzi G, Provini F, Tinuper P. Sleep-related hypermotor epilepsy: Long-term outcome in a large cohort. Neurology 2016; 88:70-77. [PMID: 27881627 PMCID: PMC5200852 DOI: 10.1212/wnl.0000000000003459] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/21/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the long-term outcome of sleep-related hypermotor epilepsy (SHE). METHODS We retrospectively reconstructed a representative cohort of patients diagnosed with SHE according to international diagnostic criteria, sleep-related seizures ≥75% and follow-up ≥5 years. Terminal remission (TR) was defined as a period of ≥5 consecutive years of seizure freedom at the last follow-up. We used Kaplan-Meier estimates to calculate the cumulative time-dependent probability of TR and to generate survival curves. Univariate and multivariate Cox regression analyses were performed. RESULTS We included 139 patients with a 16-year median follow-up (2,414 person-years). The mean age at onset was 13 ± 10 years. SHE was sporadic in 86% of cases and familial in 14%; 16% of patients had underlying brain abnormalities. Forty-five percent of patients had at least 1 seizure in wakefulness lifetime and 55% had seizures only in sleep (typical SHE). At the last assessment, 31 patients achieved TR (TR group, 22.3%), while 108 (NTR group, 77.7%) still had seizures or had been in remission for <5 years. The cumulative TR rate was 20.4%, 23.5%, and 28.4% by 10, 20, and 30 years from inclusion. At univariate analysis, any underlying brain disorder (any combination of intellectual disability, perinatal insult, pathologic neurologic examination, and brain structural abnormalities) and seizures in wakefulness were more frequent among the NTR group (p = 0.028; p = 0.043). Absence of any underlying brain disorder (hazard ratio 4.21, 95% confidence interval 1.26-14.05, p = 0.020) and typical SHE (hazard ratio 2.76, 95% confidence interval 1.31-5.85, p = 0.008) were associated with TR. CONCLUSIONS Our data show a poor prognosis of SHE after a long-term follow-up. Its outcome is primarily a function of the underlying etiology.
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Affiliation(s)
- Laura Licchetta
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Francesca Bisulli
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy.
| | - Luca Vignatelli
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Corrado Zenesini
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Lidia Di Vito
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Barbara Mostacci
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Claudia Rinaldi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Irene Trippi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Ilaria Naldi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Giuseppe Plazzi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Federica Provini
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Paolo Tinuper
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
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The Natural History of Epilepsy in 163 Untreated Patients: Looking for "Oligoepilepsy". PLoS One 2016; 11:e0161722. [PMID: 27657542 PMCID: PMC5033474 DOI: 10.1371/journal.pone.0161722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022] Open
Abstract
The clinical evolution of untreated epilepsy has been rarely studied in developed countries, and the existence of a distinct syndrome characterized by rarely repeated seizures (oligoepilepsy) is debated. The aim of this study is to assess the natural history of 163 untreated patients with epilepsy in order to evaluate whether oligoepilepsy retains specific features. We retrospectively evaluated 7344 patients with ≥2 unprovoked seizures. Inclusion criteria: sufficient anamnestic/EEG data, disease duration ≥10 years, follow-up ≥3 years. Exclusion criteria: psychogenic seizures, natural history of disease <5 years. The 163 included subjects were divided into 2 groups according to seizure frequency: oligoepilepsy (≤1/year; 47 subjects) and controls (>1/year; 116 subjects). We also evaluated seizure frequency during the natural history. There were no differences between groups regarding duration of natural history, family history of epilepsy/febrile seizures, interictal EEG. Subjects with oligoepilepsy differed from controls in terms of sex (females 38% vs. 58%, p = 0.03) and drug resistance (6% vs 28%; p = 0.003). Juvenile myoclonic epilepsy was more frequent in controls (9.5% vs 0%, p = 0.04). Patients with oligoepilepsy, differently from controls, had stable seizure frequency. Oligoepilepsy represents a favourable evolution of different epileptic syndromes and keeps a stable seizure frequency over time.
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12
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Bharath RD, Chaitanya G, Panda R, Raghavendra K, Sinha S, Sahoo A, Gohel S, Biswal BB, Satishchandra P. Reduced small world brain connectivity in probands with a family history of epilepsy. Eur J Neurol 2016; 23:1729-1737. [PMID: 27564534 DOI: 10.1111/ene.13104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 06/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The role of inheritance in ascertaining susceptibility to epilepsy is well established, although the pathogenetic mechanisms are still not very clear. Interviewing for a positive family history is a popular epidemiological tool in the understanding of this susceptibility. Our aim was to visualize and localize network abnormalities that could be associated with a positive family history in a group of patients with hot water epilepsy (HWE) using resting-state functional magnetic resonance imaging (rsfMRI). METHODS Graph theory analysis of rsfMRI (clustering coefficient γ; path length λ; small worldness σ) in probands with a positive family history of epilepsy (FHE+, 25) were compared with probands without FHE (FHE-, 33). Whether a closer biological relationship was associated with a higher likelihood of network abnormalities was also ascertained. RESULTS A positive family history of epilepsy had decreased γ, increased λ and decreased σ in bilateral temporofrontal regions compared to FHE- (false discovery rate corrected P ≤ 0.0062). These changes were more pronounced in probands having first degree relatives and siblings with epilepsy. Probands with multiple types of epilepsy in the family showed decreased σ in comparison to only HWE in the family. CONCLUSION Graph theory analysis of the rsfMRI can be used to understand the neurobiology of diseases like genetic susceptibility in HWE. Reduced small worldness, proportional to the degree of relationship, is consistent with the current understanding that disease severity is higher in closer biological relations.
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Affiliation(s)
- R D Bharath
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - G Chaitanya
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.,Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - R Panda
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - K Raghavendra
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - S Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - A Sahoo
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), Newark, NJ, USA
| | - S Gohel
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), Newark, NJ, USA
| | - B B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), Newark, NJ, USA
| | - P Satishchandra
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Kuzmanovski I, Cvetkovska E, Babunovska M, Kiteva Trencevska G, Kuzmanovska B, Boshkovski B, Isjanovska R. Seizure outcome following medical treatment of mesial temporal lobe epilepsy: Clinical phenotypes and prognostic factors. Clin Neurol Neurosurg 2016; 144:91-5. [DOI: 10.1016/j.clineuro.2016.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/20/2016] [Accepted: 03/08/2016] [Indexed: 01/03/2023]
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14
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Factors predictive of late remission in a cohort of Chinese patients with newly diagnosed epilepsy. Seizure 2016; 37:20-4. [PMID: 26921482 DOI: 10.1016/j.seizure.2016.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/05/2016] [Accepted: 02/12/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Limited data have focused on predictive factors of late remission in patients with newly diagnosed epilepsy. We are aiming to identify prognostic predictors of late remission in a prospective cohort of Chinese patients. METHODS Patients with newly diagnosed epilepsy were included from 2009 to September 2012 at a tertiary hospital, with follow-up of at least two years. Early remission was defined by seizure free either immediately or within six months of treatment initiation, late remission was defined by seizure free achieved after more than six months. All analyses were performed with SPSS 13.0 software. RESULTS A total of 223 patients were included, and followed for an average of 43 months. 115 patients (51.6%) achieved early remission and 39 patients (17.5%) achieved late remission. Multivariable logistic regression analysis demonstrated more than 3 seizures prior to treatment (OR=3.12, 95% CI 1.39-7.04, p=0.006) and multiple seizure types (OR=2.49, 95% CI 1.02-6.11, p=0.046) may predict late remission. However, nonadherence was not significantly associated with late remission. CONCLUSION Patients with a high frequency of seizures prior to treatment or multiple seizure types may achieve late remission. Particular consideration should be given to these patients.
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15
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Gasparini S, Ferlazzo E, Beghi E, Sofia V, Mumoli L, Labate A, Cianci V, Fatuzzo D, Bellavia MA, Arcudi L, Russo E, De Sarro G, Gambardella A, Aguglia U. Epilepsy associated with Leukoaraiosis mainly affects temporal lobe: a casual or causal relationship? Epilepsy Res 2015; 109:1-8. [DOI: 10.1016/j.eplepsyres.2014.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/14/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
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16
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Sànchez J, Centanaro M, Solís J, Delgado F, Yépez L. Factors predicting the outcome following medical treatment of mesial temporal epilepsy with hippocampal sclerosis. Seizure 2014; 23:448-53. [PMID: 24680551 DOI: 10.1016/j.seizure.2014.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE There is a lack of information from South America regarding factors that predict the clinical outcomes of patients treated medically for mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This study was conducted to determine which of these factors are the most important. METHODS This study included 110 South American patients with MTLE-HS treated with antiepileptic drugs. The factors considered included age, gender, age of epilepsy onset, interval between the lesion and the first seizure, central nervous system infection, traumatic brain injury, perinatal asphyxia, febrile convulsion, history of status epilepticus, types of seizures, site of hippocampal sclerosis (HS), extrahippocampal pathology, and electroencephalogram (EEG) abnormalities. The patients were divided into two groups based on the response to treatment: Group I, seizure free for at least two years; and Group II, not seizure free. RESULTS On the multivariate analysis, the factors associated with a poor prognosis in terms of seizure frequency and control following treatment included the presence of an early onset of seizure, more than 10 seizures per month before treatment, and EEG abnormalities. CONCLUSION The recognition of risk factors, such as early onset of seizures, more than 10 seizures per month before treatment, and EEG abnormalities, could lead to the identification of risk groups among patients with MTLE-HS and refractory epilepsy, possibly designating these individuals as candidates for early epilepsy surgery.
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Affiliation(s)
- Javier Sànchez
- Brain Research Centre, Institute of Neurosciences, Guayaquil Welfare Board, Guayaquil, Ecuador.
| | - Mirella Centanaro
- Brain Research Centre, Institute of Neurosciences, Guayaquil Welfare Board, Guayaquil, Ecuador
| | - Juanita Solís
- Brain Research Centre, Institute of Neurosciences, Guayaquil Welfare Board, Guayaquil, Ecuador
| | - Fabrizio Delgado
- Brain Research Centre, Institute of Neurosciences, Guayaquil Welfare Board, Guayaquil, Ecuador
| | - Luis Yépez
- Brain Research Centre, Institute of Neurosciences, Guayaquil Welfare Board, Guayaquil, Ecuador
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