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Rao CK, Kuperman R. A Review of Hyperventilation Activation in Diagnosis and Management of Childhood Absence Epilepsy. J Child Neurol 2024:8830738241273347. [PMID: 39175400 DOI: 10.1177/08830738241273347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Childhood absence epilepsy is one of the most prevalent pediatric epilepsy syndromes, but diagnostic delay is common and consequential. Childhood absence epilepsy is diagnosed by history and physical examination including hyperventilation with electroencephalography (EEG) used to confirm the diagnosis. Hyperventilation produces generalized spike-wave discharges on EEG in >90% of patients with childhood absence epilepsy and provokes clinical absence seizures consisting of brief loss of consciousness typically within 90 seconds. Child neurologists report a high volume of referrals for children with "staring spells" that strain already limited health care resources. Resources are further strained by the use of EEG for monitoring antiseizure medication effectiveness with unclear benefit. In this review, we examine the safety and efficacy of hyperventilation activation as a tool for the diagnosis and management of childhood absence seizures.
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Affiliation(s)
- Chethan K Rao
- Division of Pediatric Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Pediatric Epilepsy, Stanford University School of Medicine, Palo Alto, CA, USA
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Tsai ML, Wang CC, Wang AYD, Lee FC, Chang H, Liu YL, Wong TT, Peng SJ. Antiseizure Medications Normalize Electroencephalographic Functional Connectivity and Power in Children With Benign Epilepsy With Centrotemporal Spikes. Pediatr Neurol 2024; 156:41-50. [PMID: 38729071 DOI: 10.1016/j.pediatrneurol.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 02/12/2024] [Accepted: 03/17/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The decision to treat children with benign epilepsy with centrotemporal spikes (BECTS) using antiseizure medications (ASM) is controversial. Our goal is to compare the effect of ASM treatment on the alteration of electroencephalographic (EEG) functional connectivity and power across four frequency bands in children with BECTS. METHODS Children with BECTS with two-year follow-up were retrospectively divided into ASM versus non-ASM groups. The network properties of the EEGs as based on network-based statistic and graph theory were evaluated by the following indices: global efficiency, clustering coefficient, betweenness centrality, and nodal strength in four frequency bands (delta, theta, alpha, and beta). EEG power including absolute power (AP) and relative power (RP) was analyzed in four frequency bands. RESULTS In children with BECTS with ASM treatment, there was no significant change in EEG connectivity across all bands before and after two years of ASM. In children with BECTS without ASM treatment, there was a significant increase of global efficiency, clustering coefficient, and nodal strength but not the betweenness centrality in the delta band after two years of follow-up. A decrease in AP in the delta and theta bands and a decrease in RP in the theta band were found in the ASM group after two years of treatment. CONCLUSIONS Our results suggest that ASM may play a role in modulating the development of increasing overall brain connectivity and in downregulating overt synaptic activity, but not intrinsic focal connectivity, in the early years of BECTS. The changes in the EEG power indicate that ASM significantly normalized slow-wave band power.
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Affiliation(s)
- Min-Lan Tsai
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuang-Chin Wang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Andy Yu-Der Wang
- Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Feng-Chin Lee
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Lin Liu
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tai-Tong Wong
- Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
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Dharan AL, Bowden SC, Peterson A, Lai A, Seneviratne U, Dabscheck G, Nurse E, Loughman A, Parsons N, D'Souza WJ. A cross-sectional investigation of cognition and epileptiform discharges in juvenile absence epilepsy. Epilepsia 2023; 64:742-753. [PMID: 36625418 DOI: 10.1111/epi.17505] [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: 09/25/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Despite the prevalence of cognitive symptoms in the idiopathic generalized epilepsies (IGEs), cognitive dysfunction in juvenile absence epilepsy (JAE), a common yet understudied IGE subtype, remains poorly understood. This descriptive study provides a novel, comprehensive characterization of cognitive functioning in a JAE sample and examines the relationship between cognition and 24-h epileptiform discharge load. METHOD Forty-four individuals diagnosed with JAE underwent cognitive assessment using Woodcock Johnson III Test of Cognitive Abilities with concurrent 24-h ambulatory EEG monitoring. Generalized epileptiform discharges of any length, and prolonged generalized discharges ≥3 s were quantified across wakefulness and sleep. The relationship between standardized cognitive scores and epileptiform discharges was assessed through regression models. RESULTS Cognitive performances in overall intellectual ability, acquired comprehension-knowledge, processing speed, long-term memory storage and retrieval, and executive processes were 0.63-1.07 standard deviation (SD) units lower in the JAE group compared to the population reference mean, adjusted for educational attainment. Prolonged discharges (≥3 s) were recorded in 20 patients (47.6%) from 42 available electroencephalography (EEG) studies and were largely unreported. Duration and number of prolonged discharges were associated with reduced processing speed and long-term memory storage and retrieval. SIGNIFICANCE Cognitive dysfunction is seen in patients with JAE across various cognitive abilities, including those representing more stable processes like general intellect. During 24-h EEG, prolonged epileptiform discharges are common yet underreported in JAE despite treatment, and they show moderate effects on cognitive abilities. If epileptiform burden is a modifiable predictor of cognitive dysfunction, therapeutic interventions should consider quantitative 24-h EEG with routine neuropsychological screening. The growing recognition of the spectrum of neuropsychological comorbidities of IGE highlights the value of multidisciplinary approaches to explore the causes and consequences of cognitive deficits in epilepsy.
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Affiliation(s)
- Anita L Dharan
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andre Peterson
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash Medical Centre Clayton, Melbourne, Victoria, Australia
| | - Gabriel Dabscheck
- Department of Neurology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neurosciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ewan Nurse
- Seer Medical Inc Research, Melbourne, Victoria, Australia
| | - Amy Loughman
- Food & Mood Centre, Institute of Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Nicholas Parsons
- Deakin University, Cognitive Neuroscience Unit, School of Psychology, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
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Seneviratne U, Cook M, D'Souza W. Brainwaves beyond diagnosis: Wider applications of electroencephalography in idiopathic generalized epilepsy. Epilepsia 2021; 63:22-41. [PMID: 34755907 DOI: 10.1111/epi.17119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
Electroencephalography (EEG) has long been used as a versatile and noninvasive diagnostic tool in epilepsy. With the advent of digital EEG, more advanced applications of EEG have emerged. Compared with technologically advanced practice in focal epilepsies, the utilization of EEG in idiopathic generalized epilepsy (IGE) has been lagging, often restricted to a simple diagnostic tool. In this narrative review, we provide an overview of broader applications of EEG beyond this narrow scope, discussing how the current clinical and research applications of EEG may potentially be extended to IGE. The current literature, although limited, suggests that EEG can be used in syndromic classification, guiding antiseizure medication therapy, predicting prognosis, unraveling biorhythms, and investigating functional brain connectivity of IGE. We emphasize the need for longer recordings, particularly 24-h ambulatory EEG, to capture discharges reflecting circadian and sleep-wake cycle-associated variations for wider EEG applications in IGE. Finally, we highlight the challenges and limitations of the current body of literature and suggest future directions to encourage and enhance more extensive applications of this potent tool.
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Affiliation(s)
- Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Mark Cook
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Wendyl D'Souza
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Niu K, Li Y, Zhang T, Sun J, Sun Y, Shu M, Wang P, Zhang K, Chen Q, Wang X. Impact of Antiepileptic Drugs on Cognition and Neuromagnetic Activity in Childhood Epilepsy With Centrotemporal Spikes: A Magnetoencephalography Study. Front Hum Neurosci 2021; 15:720596. [PMID: 34566605 PMCID: PMC8461317 DOI: 10.3389/fnhum.2021.720596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: Childhood epilepsy with centrotemporal spikes (CECTS), the most common childhood epilepsy, still lacks longitudinal imaging studies involving antiepileptic drugs (AEDs). In order to examine the effect of AEDs on cognition and brain activity. We investigated the neuromagnetic activities and cognitive profile in children with CECTS before and after 1 year of treatment. Methods: Fifteen children with CECTS aged 6–12 years underwent high-sampling magnetoencephalography (MEG) recordings before treatment and at 1 year after treatment, and 12 completed the cognitive assessment (The Wechsler Intelligence Scale for Children). Next, magnetic source location and functional connectivity (FC) were investigated in order to characterize interictal neuromagnetic activity in the seven frequency sub-bands, including: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), gamma (30–80 Hz), ripple (80–250 Hz), and fast ripple (250–500 Hz). Results: After 1 year of treatment, children with CECTS had increased scores on full-scale intelligence quotient, verbal comprehension index (VCI) and perceptual reasoning index (PRI). Alterations of neural activity occurred in specific frequency bands. Source location, in the 30–80 Hz frequency band, was significantly increased in the posterior cingulate cortex (PCC) after treatment. Moreover, FC analysis demonstrated that after treatment, the connectivity between the PCC and the medial frontal cortex (MFC) was enhanced in the 8–12 Hz frequency band. Additionally, the whole-brain network distribution was more dispersed in the 80–250 Hz frequency band. Conclusion: Intrinsic neural activity has frequency-dependent characteristic. AEDs have impact on regional activity and FC of the default mode network (DMN). Normalization of aberrant DMN in children with CECTS after treatment is likely the reason for improvement of cognitive function.
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Affiliation(s)
- Kai Niu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Tingting Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Mingzhu Shu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ke Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- MEG Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Zhang T, Zhang Y, Ren J, Yang C, Zhou H, Li L, Lei D, Gong Q, Zhou D, Yang T. Aberrant basal ganglia-thalamo-cortical network topology in juvenile absence epilepsy: A resting-state EEG-fMRI study. Seizure 2020; 84:78-83. [PMID: 33307464 DOI: 10.1016/j.seizure.2020.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/22/2020] [Accepted: 11/28/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The underlying pathophysiology of juvenile absence epilepsy (JAE) is unclear. Since cortical and subcortical brain regions are thought to be altered in genetic generalized epilepsy, the present study examined the resting-state functional network topology of the same regions in JAE. METHODS Electroencephalography and functional magnetic resonance imaging (EEG-fMRI) were performed on 18 JAE patients and 28 healthy controls (HCs). The topology of functional networks was analyzed using the graph-theoretic method. Both global and nodal network parameters were calculated, and parameters differing significantly between the two groups were correlated with clinical variables. RESULTS Both JAE patients and HCs had small-world functional network topological architectures. However, JAE patients showed higher values for the global parameters of clustering coefficient (Cp) and normalized characteristic path length (Lambda). At the nodal level, patients exhibited greater centrality at widespread cortices, including the left superior parietal gyrus, right superior temporal gyrus, right orbital part of middle frontal gyrus and bilateral supplementary motor area. Conversely, patients showed decreased nodal centrality predominantly in the limbic network, left thalamus and right caudate nucleus. Degree centrality in the right hippocampus and betweenness centrality in the right caudate nucleus positively correlated with epilepsy duration. CONCLUSION The global functional network of JAE shows small-world properties, but tends to be regular with higher segregation and lower integration. Regions in the basal ganglia-thalamo-cortical network have aberrant nodal centrality. The hippocampus and caudate nucleus may reorganize as epilepsy progresses. Our findings indicate the pathogenesis and compensatory mechanisms to seizure attacks and cognitive deficits of JAE.
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Affiliation(s)
- Tianyu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cheng Yang
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huanyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Du Lei
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Tianhua Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Barone V, van Putten MJAM, Visser GH. Absence epilepsy: Characteristics, pathophysiology, attention impairments, and the related risk of accidents. A narrative review. Epilepsy Behav 2020; 112:107342. [PMID: 32861896 DOI: 10.1016/j.yebeh.2020.107342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Absence epilepsy (AE) is related to both cognitive and physical impairments. In this narrative review, we critically discuss the pathophysiology of AE and the impairment of attention in children and adolescents with AE. In particular, we contextualize the attentive dysfunctions of AE with the associated risks, such as accidental injuries. DATA SOURCE An extensive literature search on attention deficits and the rate of accidental injuries in AE was run. The search was conducted on Scopus, Pubmed, and the online libraries of the University of Twente and Maastricht University. Relevant references of the included articles were added. Retrospective and prospective studies, case reports, meta-analysis, and narrative reviews were included. Only studies written in English were considered. Date of last search is February 2020. The keywords used were "absence epilepsy" AND "attention"/"awareness", "absence epilepsy" AND "accidental injuries"/"accident*"/"injuries". RESULTS Ten retrospective and two prospective studies on cognition and AE were fully screened. Seventeen papers explicitly referring to attention in AE were reviewed. Just one paper was found to specifically focus on accidental injuries and AE, while twelve studies generally referring to epilepsy syndromes - among which AE - and related accidents were included. CONCLUSION Absence epilepsy and attention deficits show some patterns of pathophysiological association. This relation may account for dysfunctions in everyday activities in the pediatric population. Particular metrics, such as the risk related to biking in children with AE, should be used in future studies to address the problem in a novel way and to impact clinical indications.
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Affiliation(s)
- Valentina Barone
- Twente Medical System International B.V. (TMSi), Zutphenstraat 57, 7575EJ Oldenzaal, the Netherlands; Clinical Neurophysiology (CNPH), Technohal Univeristy of Twente, Hallenweg 5, 7522 NH, the Netherlands.
| | - Michel J A M van Putten
- Clinical Neurophysiology (CNPH), Technohal Univeristy of Twente, Hallenweg 5, 7522 NH, the Netherlands; Department of Clinical Neurophysiology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, the Netherlands..
| | - Gerhard H Visser
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 2, 2103 SW Heemstede, the Netherlands.
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Germanò E, Gagliano A, Arena C, Cedro C, Vetri L, Operto FF, Pastorino GMG, Marotta R, Roccella M. Reading-writing disorder in children with idiopathic epilepsy. Epilepsy Behav 2020; 111:107118. [PMID: 32563891 DOI: 10.1016/j.yebeh.2020.107118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 11/17/2022]
Abstract
Several studies have documented learning disabilities (LDs) in subjects with epilepsy, who have been shown to be at greater risk of mild neuropsychological damage, with the consequent risk of academic failure. This retrospective study aimed to investigate the peculiarities of reading and writing disorders in subjects with idiopathic epilepsy. The reading and writing performance of 35 children affected by reading and writing disorders and idiopathic epilepsy (R/WD + E group) has been compared with the performance of 37 children with only reading and writing disorders (R/WD group). A comparison group of 22 typical developing healthy children (TDC group) was also included in the study. As expected, the TDC group reached better performances in the reading and writing tests administered. Between R/WD + E and R/WD groups, there was a substantial analogy in reading and writing disabilities. The differences between the two clinical groups concern writing ability in sentences dictation and verbal and visuospatial short-term memory in digit span and memory-for-location (MFL) tests.
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Affiliation(s)
- Eva Germanò
- Child Neuropsychiatry Unit, Department of Adulthood and Developmental Age Human Pathology "G.Barresi", University of Messina, Italy
| | - Antonella Gagliano
- Child & Adolescent Neuropsychiatry, Department of Biomedical Sciences, University of Cagliari & "G. Brotzu" Hospital Trust, Cagliari, Italy
| | - Claudia Arena
- Child Neuropsychiatry Unit, Department of Adulthood and Developmental Age Human Pathology "G.Barresi", University of Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Luigi Vetri
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Italy; Sleep Lab for Developmental Age, , Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Rosa Marotta
- Department of Medical and Surgical Science, University "Magna Graecia", Catanzaro, Italy
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy; Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents, Italy
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Fonseca Wald ELA, Hendriksen JGM, Drenthen GS, Kuijk SMJV, Aldenkamp AP, Vles JSH, Vermeulen RJ, Debeij-van Hall MHJA, Klinkenberg S. Towards a Better Understanding of Cognitive Deficits in Absence Epilepsy: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2019; 29:421-449. [PMID: 31776780 PMCID: PMC6892766 DOI: 10.1007/s11065-019-09419-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
Cognition in absence epilepsy (AE) is generally considered undisturbed. However, reports on cognitive deficits in AE in recent years have suggested otherwise. This review systematically assesses current literature on cognitive performance in children with AE. A systematic literature search was performed in Pubmed, Embase, Cochrane and Web of Science. All studies reporting on cognitive performance in children with AE were considered. In total 33 studies were eligible for inclusion. Neuropsychological tests were classified into the following domains: intelligence; executive function; attention; language; motor & sensory-perceptual examinations; visuoperceptual/visuospatial/visuoconstructional function; memory and learning; achievement. Random-effect meta-analyses were conducted by estimating the pooled mean and/or pooling the mean difference in case-control studies. Full-scale IQ in children with AE was estimated at 96.78 (95%CI:94.46–99.10) across all available studies and in case-control studies IQ was on average 8.03 (95%CI:-10.45- -5.61) lower. Verbal IQ was estimated at 97.98 (95%CI:95.80–100.16) for all studies and 9.01 (95%CI:12.11- -5.90) points lower in case-control studies. Performance IQ was estimated at 97.23 (93.24–101.22) for all available studies and 5.32 (95%CI:-8.27–2.36) points lower in case-control studies. Lower performance was most often reported in executive function (cognitive flexibility, planning, and verbal fluency) and attention (sustained, selective and divided attention). Reports on school difficulties, neurodevelopmental problems, and attentional problems were high. In conclusion, in contrast to common beliefs, lower than average neurocognitive performance was noted in multiple cognitive domains, which may influence academic and psychosocial development.
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Affiliation(s)
- Eric L A Fonseca Wald
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands. .,Epilepsy Center Kempenhaeghe, Heeze, The Netherlands. .,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Jos G M Hendriksen
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Gerald S Drenthen
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sander M J V Kuijk
- Department of KEMTA, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Albert P Aldenkamp
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands. .,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
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10
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Gunawan C, Seneviratne U, D'Souza W. The effect of antiepileptic drugs on epileptiform discharges in genetic generalized epilepsy: A systematic review. Epilepsy Behav 2019; 96:175-182. [PMID: 31150997 DOI: 10.1016/j.yebeh.2019.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/02/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the current evidence regarding the effect of antiepileptic drugs (AEDs) on epileptiform discharge (ED) burden in genetic generalized epilepsy (GGE). METHODS We conducted a comprehensive literature search of PubMed, Embase, PsycINFO, and the Web of Science Core Collection databases using the keywords 'genetic generalized epilepsy', 'antiepileptic drugs' and 'epileptiform discharge'. Primary human studies published in English that reported the effect of AEDs on EDs captured on electroencephalogram (EEG) recordings of at least 24 h in duration in patients with GGE were included. RESULTS Six studies published between 1984 and 2017, which reported the effect of AEDs on EDs, involving a total of 116 patients with GGE, were analyzed. Our systematic review found a tendency for AEDs to reduce ED density, frequency, cumulative duration, and burst duration in GGE. Furthermore, we found evidence that the AED-mediated reduction in ED burden was associated with improved seizure control and cognitive outcomes. CONCLUSIONS Antiepileptic drugs tend to reduce ED burden in GGE, but the significance of this association remains uncertain.
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Affiliation(s)
- Claire Gunawan
- St Vincent's Clinical School, The University of Melbourne, Melbourne, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Wendyl D'Souza
- St Vincent's Clinical School, The University of Melbourne, Melbourne, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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11
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Fonseca Wald ELA, Klinkenberg S, Voncken TPC, Ebus SCM, Aldenkamp AP, Vles JSH, Vermeulen RJ, Hendriksen JGM, Debeij-Van Hall MHJA. Cognitive development in absence epilepsy during long-term follow-up. Child Neuropsychol 2019; 25:1003-1021. [PMID: 31145023 DOI: 10.1080/09297049.2019.1614156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Absence epilepsy (AE) has been associated with lower than average cognitive functioning, which are clinically relevant in some and may predispose to problems later in life. This study aimed to assess cognitive development during long-term follow-up in children with AE. Thirty-one children with AE, who had undergone two neuropsychological assessments between 2010 and 2017 were analyzed retrospectively. Cognitive measurements were 1.7 ± 0.95 years apart. The difference in neurocognitive test scores was assessed on a group level and on an individual level using reliable change methodology. Results show that sustained attention was lower at the first measurement compared to the normative mean. Sustained attention improved during follow-up and 7 out of 14 children showed improvement after correction for practice effects. Receptive vocabulary showed a decline over time, but did not differ from the normative mean. Significant lower mean group scores were present for performance IQ, perceptual organization, processing speed, simple reaction times, and visual motor integration, while being stable over time in the majority of children. Cognitive development was not associated with seizure freedom. Mild-to-severe academic underachievement was present in 65% and comorbidities that might affect learning in 38%. This study in children with AE showed improvement in sustained attention during long-term follow-up while other cognitive weaknesses persisted over time, regardless of seizure freedom.
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Affiliation(s)
- Eric L A Fonseca Wald
- a Department of Neurology, Maastricht University Medical Center+ , Maastricht , The Netherlands.,b Department of Epileptology, Epilepsy Center Kempenhaeghe , Heeze , The Netherlands.,e Department of School for Mental Health and Neuroscience, Maastricht University , Maastricht , The Netherlands
| | - Sylvia Klinkenberg
- a Department of Neurology, Maastricht University Medical Center+ , Maastricht , The Netherlands.,e Department of School for Mental Health and Neuroscience, Maastricht University , Maastricht , The Netherlands
| | - Twan P C Voncken
- a Department of Neurology, Maastricht University Medical Center+ , Maastricht , The Netherlands
| | - Saskia C M Ebus
- c Department of Clinical Neurophysiology, Epilepsy Center Kempenhaeghe , Heeze , The Netherlands
| | - Albert P Aldenkamp
- a Department of Neurology, Maastricht University Medical Center+ , Maastricht , The Netherlands.,d Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe , Heeze , The Netherlands.,e Department of School for Mental Health and Neuroscience, Maastricht University , Maastricht , The Netherlands.,f Department of Electrical Engineering, Eindhoven University of Technology , The Netherlands
| | - Johan S H Vles
- a Department of Neurology, Maastricht University Medical Center+ , Maastricht , The Netherlands.,e Department of School for Mental Health and Neuroscience, Maastricht University , Maastricht , The Netherlands
| | - R Jeroen Vermeulen
- a Department of Neurology, Maastricht University Medical Center+ , Maastricht , The Netherlands.,e Department of School for Mental Health and Neuroscience, Maastricht University , Maastricht , The Netherlands
| | - Jos G M Hendriksen
- a Department of Neurology, Maastricht University Medical Center+ , Maastricht , The Netherlands.,d Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe , Heeze , The Netherlands
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12
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Marks WN, Zabder NK, Greba Q, Cain SM, Snutch TP, Howland JG. The T‐type calcium channel blocker Z944 reduces conditioned fear in Genetic Absence Epilepsy Rats from Strasbourg and the non‐epileptic control strain. Eur J Neurosci 2019; 50:3046-3059. [DOI: 10.1111/ejn.14406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/01/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Wendie N. Marks
- Department of Anatomy, Physiology, and Pharmacology University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Nadine K. Zabder
- Department of Anatomy, Physiology, and Pharmacology University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Quentin Greba
- Department of Anatomy, Physiology, and Pharmacology University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Stuart M. Cain
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health University of British Columbia Vancouver British Columbia Canada
| | - Terrance P. Snutch
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health University of British Columbia Vancouver British Columbia Canada
| | - John G. Howland
- Department of Anatomy, Physiology, and Pharmacology University of Saskatchewan Saskatoon Saskatchewan Canada
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Nolan D, Lester SG, Rau SM, Shellhaas RA. Clinical Use and Efficacy of Levetiracetam for Absence Epilepsies. J Child Neurol 2019; 34:94-98. [PMID: 30458657 DOI: 10.1177/0883073818811511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Levetiracetam is prescribed for a broad spectrum of seizure types but does not have a specific indication for absence epilepsy. We hypothesized that levetiracetam is commonly prescribed for children with absence epilepsies and evaluated the efficacy of this medication for absence epilepsy treatment in clinical practice. We also hypothesized that electroencephalographic (EEG) findings could help predict levetiracetam efficacy. METHODS We reviewed the charts of all patients treated for new-onset absence epilepsies at our pediatric neurology clinic between January 2011 and January 2016. Among 158 children diagnosed with absence epilepsies, 72 were treated with levetiracetam. RESULTS Levetiracetam was discontinued in 74% (n = 53/72) because of incomplete seizure control (59%, n = 35/72) and/or intolerable side effects (41%, n = 24/72) after a median 8.5 months (interquartile range 2, 17 months). Among patients for whom levetiracetam was effective, 44% (n = 8/18) had polyspikes on their initial EEG, versus 27% (n = 14/52) of patients for whom levetiracetam was discontinued ( P = .17). The maximal prescribed dose was lower for children in whom levetiracetam was effective (29 ± 13 mg/kg/d) than those for whom levetiracetam failed (42 ± 20 mg/kg/d; P = .005). CONCLUSION In routine clinical practice, levetiracetam is often chosen for patients with absence seizures. However, only about one-quarter of children with absence epilepsy in this study became seizure free with levetiracetam. When effective, levetiracetam can control absence epilepsy at a relatively low dose. Lack of seizure control requiring continued dose escalation should prompt early consideration of a therapeutic medication transition.
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Affiliation(s)
- Danielle Nolan
- 1 Division of Epilepsy, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Shannon G Lester
- 2 Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie M Rau
- 2 Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Reneé A Shellhaas
- 2 Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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14
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Dynamic functional disturbances of brain network in seizure-related cognitive outcomes. Epilepsy Res 2018; 140:15-21. [DOI: 10.1016/j.eplepsyres.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/13/2017] [Accepted: 12/02/2017] [Indexed: 11/23/2022]
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15
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Ekinci O, Okuyaz Ç, Erdoğan S, Gunes S, Ekinci N, Kalınlı M, Teke H, Direk MÇ. Attention-Deficit Hyperactivity Disorder (ADHD) in Epilepsy and Primary ADHD: Differences in Symptom Dimensions and Quality of Life. J Child Neurol 2017; 32:1083-1091. [PMID: 29129152 DOI: 10.1177/0883073817737445] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to (1) compare quality of life (QOL) among children with epilepsy, epilepsy and attention-deficit hyperactivity disorder (ADHD), and primary ADHD and (2) compare ADHD symptom dimensions and subtypes between children with epilepsy-ADHD and primary ADHD. METHODS A total of 140 children; 53 with epilepsy, 35 with epilepsy-ADHD, and 52 with primary ADHD were included. KINDL-R (quality of life measure), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Parent Rating Scale (CPRS) were completed. Neurology clinic charts were reviewed for epilepsy-related variables. RESULTS Children with epilepsy-ADHD had the lowest (poorest) KINDL-R total scores. Epilepsy-ADHD group had more inattentiveness symptoms, whereas primary ADHD group had more hyperactivity/impulsivity symptoms. The frequencies of ADHD combined and inattentiveness subtypes were 60% and 40% in children with epilepsy-ADHD and 80.7% and 19.3% in children with primary ADHD, respectively ( P = .034). CONCLUSION ADHD in epilepsy is associated with a significantly poor quality of life and predominantly inattentiveness symptoms.
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Affiliation(s)
- Ozalp Ekinci
- 1 Department of Child and Adolescent Psychiatry, University of Health Sciences Medical Faculty, Istanbul, Turkey
| | - Çetin Okuyaz
- 2 Department of Pediatric Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Semra Erdoğan
- 3 Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey
| | - Serkan Gunes
- 4 Department of Child and Adolescent Psychiatry, Hatay State Hospital, Hatay, Turkey
| | - Nuran Ekinci
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | - Merve Kalınlı
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | - Halenur Teke
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
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16
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Epilepsy beyond seizures: Predicting enduring cognitive dysfunction in genetic generalized epilepsies. Epilepsy Behav 2016; 62:297-303. [PMID: 27544704 DOI: 10.1016/j.yebeh.2016.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022]
Abstract
Reduced cognitive functioning has been documented in the genetic generalized epilepsies (GGE). Among a number of hypothesized causal mechanisms, some evidence from other epilepsy syndromes suggests the impact of epileptiform discharges. This study investigates the relationship between cognitive function in GGE and burden of epileptiform discharges within a 24-hour EEG recording, controlling for variables relevant to cognitive function in epilepsy. As part of a larger prospective cohort study, 69 patients with EEG-confirmed GGE (11-58years) underwent 24-hour EEG and detailed neuropsychological assessment using the Woodcock Johnson III Tests. Ten-second pages of the EEG were marked manually page-by-page on longitudinal bipolar montage with 0.5 to 70Hz bandwidth by an experienced EEG reader. Multiple regression analyses were conducted. Epileptiform discharges were detected in 90% of patients. Less than 0.01% of electrophysiological events of two or more seconds were recognized by patients. Regression analysis demonstrated that the cumulative duration of epileptiform discharges over a 24-hour period predicted overall cognitive ability and memory function, accounting for 9.6% and 11.8% of adjusted variance, respectively. None of the epilepsy covariates included in multiple regression analysis added significantly to the model. Duration of epileptiform discharges negatively predicts overall cognitive ability and memory function, even after accounting for other known determinants of cognition. Prolonged epileptiform discharges are common and remain unreported by patients, raising important questions regarding the management of GGE syndromes and their associated comorbidities. Further research is required to investigate causal mechanisms if we are to improve cognitive outcomes in this common group of epilepsies.
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Marks WN, Cain SM, Snutch TP, Howland JG. The T-type calcium channel antagonist Z944 rescues impairments in crossmodal and visual recognition memory in Genetic Absence Epilepsy Rats from Strasbourg. Neurobiol Dis 2016; 94:106-15. [PMID: 27282256 DOI: 10.1016/j.nbd.2016.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/27/2016] [Accepted: 06/04/2016] [Indexed: 12/11/2022] Open
Abstract
Childhood absence epilepsy (CAE) is often comorbid with behavioral and cognitive symptoms, including impaired visual memory. Genetic Absence Epilepsy Rats from Strasbourg (GAERS) is an animal model closely resembling CAE; however, cognition in GAERS is poorly understood. Crossmodal object recognition (CMOR) is a recently developed memory task that examines not only purely visual and tactile memory, but also requires rodents to integrate sensory information about objects gained from tactile exploration to enable visual recognition. Both the visual and crossmodal variations of the CMOR task rely on the perirhinal cortex, an area with dense expression of T-type calcium channels. GAERS express a gain-in-function missense mutation in the Cav3.2 T-type calcium channel gene. Therefore, we tested whether the T-type calcium channel blocker Z944 dose dependently (1, 3, 10mg/kg; i.p.) altered CMOR memory in GAERS compared to the non-epileptic control (NEC) strain. GAERS demonstrated recognition memory deficits in the visual and crossmodal variations of the CMOR task that were reversed by the highest dose of Z944. Electroencephalogram recordings determined that deficits in CMOR memory in GAERS were not the result of seizures during task performance. In contrast, NEC showed a decrease in CMOR memory following Z944 treatment. These findings suggest that T-type calcium channels mediate CMOR in both the GAERS and NEC strains. Future research into the therapeutic potential of T-type calcium channel regulation may be particularly fruitful for the treatment of CAE and other disorders characterized by visual memory deficits.
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Affiliation(s)
- Wendie N Marks
- Department of Physiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Stuart M Cain
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Terrance P Snutch
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - John G Howland
- Department of Physiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
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18
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Neuropsychological impairment in childhood absence epilepsy: Review of the literature. J Neurol Sci 2015; 359:59-66. [DOI: 10.1016/j.jns.2015.10.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022]
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19
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Learning skills and academic performance in children and adolescents with absence epilepsy. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Menlove L, Reilly C. Memory in children with epilepsy: a systematic review. Seizure 2014; 25:126-35. [PMID: 25457449 DOI: 10.1016/j.seizure.2014.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/28/2014] [Accepted: 10/04/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Research suggests an increased risk for cognitive impairment in childhood epilepsy with memory being one area of cognition most likely to be affected. Understanding the prevalence and predictors of memory difficulties may help improve awareness of the difficulties and allow efficacious supports to be put in place. METHOD A systematic review was carried out using the search terms 'memory', 'children' and 'epilepsy' in the database PUBMED. Eighty-eight studies met inclusion criteria. The review focuses on comparisons of memory scores of children with epilepsy and controls, and comparison of memory scores of children with epilepsy to normative scores. Predictors of memory impairment and the effect of surgery on memory functioning are also reviewed. RESULTS The majority (78%) of studies reviewed revealed that children with epilepsy scored lower than controls and normative scores on measures of memory. Post-surgery, memory scores were reported to improve in 50% of studies. Predictors of memory impairment included a greater number of AEDs used, younger age of onset, increased seizure frequency and longer duration of epilepsy. CONCLUSION Children with epilepsy have a high frequency of memory impairments. However, the exact prevalence of difficulties is not clear due to the lack of population-based data. Most studies have not controlled for IQ and thus it is unclear if difficulties are always related to global cognitive difficulties. There is need for future population-based studies and studies focussing on the neurobiology of memory problems in children with epilepsy.
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Affiliation(s)
- Leanne Menlove
- Research Department, Young Epilepsy, St. Piers Lane, Lingfield, Surrey RH7 6PW, United Kingdom.
| | - Colin Reilly
- Research Department, Young Epilepsy, St. Piers Lane, Lingfield, Surrey RH7 6PW, United Kingdom.
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Talero-Gutiérrez C, Sánchez-Torres JM, Velez-van-Meerbeke A. Learning skills and academic performance in children and adolescents with absence epilepsy. Neurologia 2013; 30:71-6. [PMID: 24332773 DOI: 10.1016/j.nrl.2013.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/20/2013] [Accepted: 10/13/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Although cognitive and learning disorders have been described in patients with epilepsy, very few studies focus on specific disorders such as absence epilepsy. The aim of this study was to evaluate learning skills and academic performance in children and adolescents with absence epilepsy. METHODS Observational case-control study. Cases were chosen from the Central League against Epilepsy's clinic in Bogotá, Colombia. Controls were selected from a private school and matched with cases by age, school year, and sex. Medical history, seizure frequency, antiepileptic treatment, and academic performance were assessed. Academic abilities were tested with Batería de Aptitudes Diferenciales y Generales (BADyG) (a Spanish-language test of differential and general aptitudes). Data were analysed using Student t-test. RESULTS The sample consisted of 19 cases and 19 controls aged between 7 and 16. In 15 patients, seizures were controlled; all patients had received antiepileptic medication at some point and 78.9% were actively being treated. Although cases had higher rates of academic failure, a greater incidence of grade retention, and more therapeutic interventions than controls, these differences were not significant. Similarly, there were no significant differences on the BADyG test, except for the immediate memory subcategory on which cases scored higher than controls (P=.0006). CONCLUSION Children treated pharmacologically for absence epilepsy, whose seizures are controlled, have normal academic abilities and skills for their age.
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Affiliation(s)
- C Talero-Gutiérrez
- Grupo de Investigación en Neurociencias NeURos, Facultad de Medicina y Ciencias de la salud, Universidad del Rosario, Bogotá, Colombia.
| | - J M Sánchez-Torres
- Facultad de Pedagogía, Universidad Distrital Francisco José de Caldas, Bogotá, Colombia
| | - A Velez-van-Meerbeke
- Grupo de Investigación en Neurociencias NeURos, Facultad de Medicina y Ciencias de la salud, Universidad del Rosario, Bogotá, Colombia
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22
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Lv Y, Wang Z, Cui L, Ma D, Meng H. Cognitive correlates of interictal epileptiform discharges in adult patients with epilepsy in China. Epilepsy Behav 2013; 29:205-10. [PMID: 23994830 DOI: 10.1016/j.yebeh.2013.07.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Learning difficulties or cognitive impairment has been observed in many patients with epilepsy. Evidence from neurophysiologic and functional neuroimaging suggests that epileptic seizures and/or epileptiform activity can be the dominant factors inhibiting specific brain areas. However, most previous studies were focused on cognitive performance in children. In this study, we analyzed a new cohort of adult patients with frequent interictal epileptiform discharges (IEDs). METHODS Data from 67 adult patients with epilepsy were reviewed. Electroencephalography (EEG)-video recording and cognitive testing were performed, and the IED index was estimated as a percentage assigned to one of four categories (<1%, 1-10%, 10-50%, and >50%) during either wakefulness or sleep. Correlations of cognitive test results and clinical characteristics of IED categories were analyzed. The effects of the frequency, duration, location, and sleep-wake cycles of IEDs on cognition (intelligence and memory capacity) were analyzed. RESULTS Patients with an IED index >10% showed impaired performance on the Chinese Wechsler Adult Intelligence Scale (WAIS-RC) and the Chinese Wechsler Memory Scale (WMS). This effect was detected independently from other IED frequencies and other IED-related variables, such as duration, distribution, and location. The impact of waking or sleeping IEDs was of equal importance in contributing to impaired WAIS-RC and WMS performance. CONCLUSION An IED frequency of more than 10% in both waking and sleeping EEGs is associated with impaired cognitive performance in adult patients. However, whether patients with a high IED frequency but low seizure frequency will benefit from antiepileptic treatment should be examined in future studies.
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Affiliation(s)
- Yudan Lv
- Department of Neurology, The First Affiliated Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, PR China
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23
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Cerminara C, D'Agati E, Casarelli L, Kaunzinger I, Lange KW, Pitzianti M, Parisi P, Tucha O, Curatolo P. Attention impairment in childhood absence epilepsy: an impulsivity problem? Epilepsy Behav 2013; 27:337-41. [PMID: 23537619 DOI: 10.1016/j.yebeh.2013.02.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 11/16/2022]
Abstract
Although attention problems have often been described in children with childhood absence epilepsy (CAE), the use of different methodological approaches, neuropsychological tests, and heterogeneous experimental groups has prevented identification of the selective areas of attention deficit in this population. In this study, we investigated several components of attention in children with CAE using a unique computerized test battery for attention performance. Participants included 24 patients with CAE and 24 controls matched for age and sex. They were tested with a computerized test battery, which included the following tasks: selective attention, impulsivity, focused attention, divided attention, alertness, and vigilance. Compared with healthy controls, patients with CAE made more commission errors in the Go/No-Go task and more omission errors in the divided attention task. Childhood absence epilepsy patients also showed decreased reaction times in measures of selective attention and a great variability of reaction times in alertness and Go/No-Go tasks. Our findings suggest that patients with CAE were impaired in tonic and phasic alertness, divided attention, selective attention, and impulsivity.
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Affiliation(s)
- Caterina Cerminara
- Unit of Child Neurology and Psychiatry, Department of Neuroscience, University of Rome Tor Vergata, Italy.
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24
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D'Agati E, Cerminara C, Casarelli L, Pitzianti M, Curatolo P. Attention and executive functions profile in childhood absence epilepsy. Brain Dev 2012; 34:812-7. [PMID: 22459253 DOI: 10.1016/j.braindev.2012.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/29/2012] [Accepted: 03/01/2012] [Indexed: 01/10/2023]
Abstract
Childhood absence epilepsy (CAE) has been associated with executive functions and attention deficits. To clarify the issue of neurocognitive impairments in CAE, we investigated whether specific executive functions and attention deficit patterns were present in a well-defined group of children with CAE who were taking valproic acid. Participants included 15 children with CAE and 15 healthy controls aged 8-15 years and matched for sex, age and IQ. We compared the performances of the two groups in the following neuropsychological domains: planning and problem solving (TOL), verbal fluency (FAS and CAT), verbal short-term memory (DSF), verbal working memory (DSB), visuospatial memory (Corsi Block Tapping Test) and sustained and divided attention (TMT-A and TMT-B). No differences were found between the two groups on measures of intellectual functioning, verbal short-term memory and visuospatial memory. By contrast, significant differences were found in total time of planning task, phonological and category fluency and sustained and divided attention. Future studies that systematically examine different aspects of attention and executive functions are needed to outline a clear and specific neuropsychological profile in CAE.
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Affiliation(s)
- Elisa D'Agati
- Department of Neuroscience, Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy.
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25
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Badawy RAB, Johnson KA, Cook MJ, Harvey AS. A mechanistic appraisal of cognitive dysfunction in epilepsy. Neurosci Biobehav Rev 2012; 36:1885-96. [PMID: 22617705 DOI: 10.1016/j.neubiorev.2012.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/24/2012] [Accepted: 05/13/2012] [Indexed: 12/14/2022]
Abstract
A strong relationship between the clinical characteristics of epilepsy and the nature of cognitive impairments associated with the condition has been found, but the nature of this relationship appears to be quite complex and not well understood. This review presents a summary of the research on the interaction between cognition and epilepsy, surveyed from a mechanistic perspective with the aim of clarifying factors that contribute to the co-existence of both disorders. The physiological basis underpinning cognitive processing is first reviewed. The physiology of epilepsy is reviewed, with emphasis placed on interictal discharges and seizures. The nature of the impact of epilepsy on cognition is described, with transient and prolonged effects distinguished. Finally, the complexity of the co-morbidity between cognitive dysfunction and epilepsy is discussed in relation to childhood and adult-onset epilepsy syndromes and severe epileptic encephalopathies. Structural and functional abnormalities exist in patients with epilepsy that may underpin both the cognitive dysfunction and epilepsy, highlighting the complexity of the association. Research, possibly of a longitudinal nature, is needed to elucidate this multifactorial relationship between cognitive dysfunction and epilepsy.
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Affiliation(s)
- Radwa A B Badawy
- Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Victoria, Australia; Department of Medicine, Melbourne, Victoria, Australia; Electrical and Electronic Engineering, Melbourne, Victoria, Australia. ,
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Nicolai J, Ebus S, Biemans DPLJJG, Arends J, Hendriksen J, Vles JSH, Aldenkamp AP. The cognitive effects of interictal epileptiform EEG discharges and short nonconvulsive epileptic seizures. Epilepsia 2012; 53:1051-9. [PMID: 22554146 DOI: 10.1111/j.1528-1167.2012.03491.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Educational difficulties or even severe cognitive deterioration is seen in many childhood epilepsy syndromes. Many of those cognitive deficits are related directly to the brain disorder underlying the epilepsy syndrome. However, in other types of epilepsy, the epileptic seizures and/or epileptiform activity can be the dominant factor. This is especially unknown for the more "subtle" short nonconvulsive seizure types. For this reason, we analyzed a new cohort of children. METHODS A cross-sectional study of 188 children with epilepsy. Electroencephalography (EEG)-video recordings and cognitive testing were performed simultaneously. The results of children with short nonconvulsive seizures during a 2-h testing session were compared with all children with epilepsy without seizures during the 2-h cognitive testing session and with controls without epilepsy. In a second analysis the cognitive effects of frequency of epileptiform EEG discharges were analyzed. KEY FINDINGS The cognitive effects of short nonconvulsive seizures were large, ranging from 0.5 to 1 standard deviation and concerned global cognitive function, speed of central information processing, and memory function. In children without seizures during cognitive testing, the occurrence of frequent epileptiform discharges showed more subtle effects. These effects were independent from the occurrence of short nonconvulsive seizures. SIGNIFICANCE We concluded that although the effect is less pronounced in number of areas involved and magnitude, the type of association between frequent epileptiform activity (>1% of the time) and cognitive function in children with epilepsy is comparable to the association between short nonconvulsive seizures and cognitive function.
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Affiliation(s)
- Joost Nicolai
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Lee Y, Kim D, Kim YH, Lee H, Lee CJ. Improvement of pentylenetetrazol-induced learning deficits by valproic acid in the adult zebrafish. Eur J Pharmacol 2010; 643:225-31. [PMID: 20599908 DOI: 10.1016/j.ejphar.2010.06.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 06/03/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022]
Abstract
Pentylenetetrazol (PTZ) has been shown to induce seizure-like behavior, learning deficits in passive avoidance response test, and an increase in hsp70 (heat shock protein 70) mRNA expression in the adult zebrafish; PTZ has been increasingly appreciated as an excellent model system for the study of seizures. In this study, we demonstrate that valproic acid (VPA), an antiepileptic drug, suppresses seizure-like behavior and improves learning ability in adult zebrafish treated with PTZ. Pretreatment with VPA significantly reduces rapid involuntary movement and abrupt changes in moving direction in the PTZ-treated zebrafish. PTZ-induced learning impairments were also improved in the zebrafish pretreated with 200 or 500 microM VPA. However, the scopolamine-induced impairments of learning ability were not improved by VPA pretreatment. It is worth noting that while the zebrafish treated with 500 microM VPA for 1-3 weeks learned the passive avoidance response, those treated with 1 or 2mM VPA for 3h didn't. Furthermore, the increased level of hsp70 expression induced by PTZ, a stress marker protein, was significantly reduced in the VPA-pretreated zebrafish brains. Collectively, our data show the antiepileptic effects of VPA in the adult zebrafish, which coincides with reduced hsp70 mRNA expression, rescued learning impairment under PTZ-treated conditions.
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Affiliation(s)
- Yunkyoung Lee
- Department of Biological Sciences, Institute of Molecular and Cellular Biology, Inha University, Incheon, Republic of Korea
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Pandina GJ, Ness S, Polverejan E, Yuen E, Eerdekens M, Bilder RM, Ford L. Cognitive effects of topiramate in migraine patients aged 12 through 17 years. Pediatr Neurol 2010; 42:187-95. [PMID: 20159428 DOI: 10.1016/j.pediatrneurol.2009.10.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 07/30/2009] [Accepted: 10/12/2009] [Indexed: 11/29/2022]
Abstract
Neuropsychologic data are presented from a randomized, double-blind, placebo-controlled, multicenter study with placebo, topiramate 50 mg/day, and topiramate 100 mg/day. The Cambridge Neuropsychological Test Automated Battery (CANTAB) and cognitive adverse events were used to evaluate neurocognitive effects of topiramate. Topiramate 100 mg/day vs placebo was associated with slight statistically significant score increases, indicating slowing, from baseline vs placebo in three CANTAB measures: five-choice reaction time (P = 0.028), pattern recognition memory mean correct latency (P = 0.027), and rapid visual information processing mean latency (P = 0.040). No other patterns related to topiramate treatment were observed in measurements of learning, memory, and visual information processing, except for potential improvement with topiramate 100 mg/day vs placebo in spatial span total errors (accuracy test) (P = 0.040). The most common cognitive and neuropsychiatric adverse events with a higher incidence in the topiramate 50 and 100 mg/day groups vs placebo were anorexia (9% and 11% vs 3%), insomnia (9% and 3% vs 3%), fatigue (6% and 9% vs 6%), and dizziness (6% and 9% vs 0%). Thus, topiramate 100 mg/day was associated with modest increases in psychomotor reaction times. Learning, memory, and executive function were unchanged. The tolerability profile, including cognitive adverse events, appeared to be acceptable.
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Affiliation(s)
- Gahan J Pandina
- Psychiatry, Johnson & Johnson Pharmaceutical Research & Development L.L.C, Titusville, New Jersey 08560, USA.
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Hughes JR. Absence seizures: a review of recent reports with new concepts. Epilepsy Behav 2009; 15:404-12. [PMID: 19632158 DOI: 10.1016/j.yebeh.2009.06.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/02/2009] [Accepted: 06/07/2009] [Indexed: 02/01/2023]
Abstract
Absence seizures with bilateral spike-wave (SW) complexes at 3Hz are divided into the childhood form, with onset at around 6 years of age, and the juvenile form, with onset usually at 12 years of age. These seizures typically last 9-12s and, at times, are activated by hyperventilation and occasionally by photic stimulation. Generalized tonic-clonic (GTC) seizures may also occur, especially in the juvenile form. There may be cognitive changes, in addition to linguistic and behavioral problems. Possible mechanisms for epileptogenesis may involve GABAergic systems, but especially T-calcium channels. The thalamus, especially the reticular nucleus, plays a major role, as does the frontal cortex, mainly the dorsolateral and orbital frontal areas, to the extent that some investigators have concluded that absence seizures are not truly generalized, but rather have selective cortical networks, mainly ventromesial frontal areas and the somatosensory cortex. The latter network is a departure from the more popular concept of a generalized epilepsy. Between the "centrencephalic" and "corticoreticular" theories, a "unified" theory is presented. Proposed genes include T-calcium channel gene CACNA1H, likely a susceptible gene in the Chinese Han population and a contributory gene in Caucasians. Electroencephalography has revealed an interictal increase in prefrontal activity, essential for the buildup of the ictal SW complexes maximal in that region. Infraslow activity can also be seen during ictal SW complexes. For treatment, counter to common belief, ethosuximide may not increase GTC seizures, as it reduces low-threshold T-calcium currents in thalamic neurons. Valproic acid and lamotrigine are also first-line medications. In addition, zonisamide and levetiracetam can be very helpful in absence epilepsy.
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Affiliation(s)
- John R Hughes
- Department of Neurology, University of Illinois Medical Center (M/C 796), 912 South Wood Street, Chicago, IL 60612, USA.
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Schmalzl L, Palermo R, Harris IM, Coltheart M. Face inversion superiority in a case of prosopagnosia following congenital brain abnormalities: What can it tell us about the specificity and origin of face-processing mechanisms? Cogn Neuropsychol 2009; 26:286-306. [DOI: 10.1080/02643290903086904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hamed SA. The aspects and mechanisms of cognitive alterations in epilepsy: the role of antiepileptic medications. CNS Neurosci Ther 2009; 15:134-56. [PMID: 19254331 PMCID: PMC6494068 DOI: 10.1111/j.1755-5949.2008.00062.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Epilepsy is a major health problem. Several studies suggest a significant influence of epilepsy and its treatment on dynamic and functional properties of brain activity. Epilepsy can adversely affect mental development, cognition, and behavior. Epileptic patients may experience reduced intelligence, attention, and problems in memory, language, and frontal executive functions. Neuropsychological, functional, and quantitative neuroimaging studies revealed that epilepsy affect the brain as a whole. Mechanisms of epilepsy-related cognitive dysfunction are poorly delineated. Cognitive deficits with epilepsy may be transient, persistent, or progressive. Transient disruption of cognitive encoding processes may occur with paroxysmal focal or generalized epileptic discharges, whereas epileptogenesis-related neuronal plasticity, reorganization, sprouting, and impairment of cellular metabolism are fundamental determinants for progressive cognitive deterioration. Also antiepileptic drugs (AEDs) have differential, reversible, and sometimes cumulative cognitive adverse consequences. AEDs not only reduce neuronal irritability but also may impair neuronal excitability, neurotransmitter release, enzymes, and factors critical for information processing and memory. The present article serves as an overview of recent studies in adult and childhood epilepsy literatures present in PubMed that highlighted cognitive evaluation in epilepsy field (publications till 2008 were checked). We also checked the reference lists of the retrieved studies for additional reports of relevant studies, in addition to our experience in this field. Our search revealed that although the aspects of cognitive dysfunction, risk factors, and consequences have been explored in many studies; however, the mechanisms of contribution of epilepsy-related variables, including AEDs, to patients' cognition are largely unexplored. In this review, we discussed the differential effect of AEDs in mature and immature brains and the known mechanisms underlying epilepsy and AEDs adverse effects on cognition. The nature, timing, course, and mechanisms of cognitive alteration with epilepsy and its medications are of considerable clinical and research implications.
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Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
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Verrotti A, Cerminara C, Domizio S, Mohn A, Franzoni E, Coppola G, Zamponi N, Parisi P, Iannetti P, Curatolo P. Levetiracetam in absence epilepsy. Dev Med Child Neurol 2008; 50:850-3. [PMID: 18808424 DOI: 10.1111/j.1469-8749.2008.03099.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of the study was to assess the efficacy, tolerability, and safety of levetiracetam therapy in children and adolescents with absence epilepsy. Twenty-one participants (11 male, 10 female) with typical absence seizures were enrolled in this prospective study from seven centres in Italy. The mean age and age range at time of enrollment into the study were 8 years 9 months (SD 0.9) and 5 years 1 month to 13 years respectively. All patients were carefully evaluated at 6 months from baseline, and 12 patients were also re-evaluated at 12 months after the beginning of therapy with levetiracetam. At the 6-month evaluation, out of 21 patients studied, 11 were seizure free and one showed 'decreased' seizures (more than 50% reduction in seizures). A less than 50% reduction in seizures was observed in nine patients. At the 12-month evaluation, 10 patients were completely seizure free and two were seizure free with some anomalies in electroencephalograms. Two patients who had shown no improvement at 6 months had decreased seizures at the second follow-up. Our results suggest that monotherapy with levetiracetam could be effective and well tolerated in patients with childhood absence epilepsy and juvenile absence epilepsy. Prospective, large, long-term double-blind studies are needed to confirm these findings.
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Abstract
Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.
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MacAllister WS, Schaffer SG. Neuropsychological deficits in childhood epilepsy syndromes. Neuropsychol Rev 2007; 17:427-44. [PMID: 17963043 DOI: 10.1007/s11065-007-9048-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 10/04/2007] [Indexed: 11/24/2022]
Abstract
Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.
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Affiliation(s)
- William S MacAllister
- New York University Comprehensive Epilepsy Center, 403 East 34th Street, 4th floor, New York, NY, 10016, USA.
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