1
|
Ren T, Li Y, Burgess M, Sharma S, Rychkova M, Dunne J, Lee J, Laloyaux C, Lawn N, Kwan P, Chen Z. Long-term physical and psychiatric morbidities and mortality of untreated, deferred, and immediately treated epilepsy. Epilepsia 2024; 65:148-164. [PMID: 38014587 DOI: 10.1111/epi.17819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE In Australia, 30% of newly diagnosed epilepsy patients were not immediately treated at diagnosis. We explored health outcomes between patients receiving immediate, deferred, or no treatment, and compared them to the general population. METHODS Adults with newly diagnosed epilepsy in Western Australia between 1999 and 2016 were linked with statewide health care data collections. Health care utilization, comorbidity, and mortality at up to 10 years postdiagnosis were compared between patients receiving immediate, deferred, and no treatment, as well as with age- and sex-matched population controls. RESULTS Of 603 epilepsy patients (61% male, median age = 40 years) were included, 422 (70%) were treated immediately at diagnosis, 110 (18%) received deferred treatment, and 71 (12%) were untreated at the end of follow-up (median = 6.8 years). Immediately treated patients had a higher 10-year rate of all-cause admissions or emergency department presentations than the untreated (incidence rate ratio [IRR] = 2.0, 95% confidence interval [CI] = 1.4-2.9) and deferred treatment groups (IRR = 1.7, 95% CI = 1.0-2.8). They had similar 10-year risks of mortality and developing new physical and psychiatric comorbidities compared with the deferred and untreated groups. Compared to population controls, epilepsy patients had higher 10-year mortality (hazard ratio = 2.6, 95% CI = 2.1-3.3), hospital admissions (IRR = 2.3, 95% CI = 1.6-3.3), and psychiatric outpatient visits (IRR = 3.2, 95% CI = 1.6-6.3). Patients with epilepsy were also 2.5 (95% CI = 2.1-3.1) and 3.9 (95% CI = 2.6-5.8) times more likely to develop a new physical and psychiatric comorbidity, respectively. SIGNIFICANCE Newly diagnosed epilepsy patients with deferred or no treatment did not have worse outcomes than those immediately treated. Instead, immediately treated patients had greater health care utilization, likely reflecting more severe underlying epilepsy etiology. Our findings emphasize the importance of individualizing epilepsy treatment and recognition and management of the significant comorbidities, particularly psychiatric, that ensue following a diagnosis of epilepsy.
Collapse
Affiliation(s)
- Tianrui Ren
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yingtong Li
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael Burgess
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sameer Sharma
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Maria Rychkova
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Dunne
- Discipline of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Judy Lee
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | | | - Nicholas Lawn
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Sun F, Wang Y, Li Y, Li Y, Wang S, Xu F, Wang X. Variation in functional networks between clinical and subclinical discharges in childhood absence epilepsy: A multi-frequency MEG study. Seizure 2023; 111:109-121. [PMID: 37598560 DOI: 10.1016/j.seizure.2023.08.005] [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: 04/24/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE Two types of spike-and-wave discharges (SWDs) exist in childhood absence epilepsy (CAE): clinical discharges are prolonged and manifest primarily as impaired consciousness, whereas subclinical discharges are brief with few objectively visible symptoms. This study aimed to compare neural functional network and default mode network (DMN) activity between clinical and subclinical discharges to better understand the underlying mechanism of CAE. METHODS Using magnetoencephalography (MEG) data from 21 patients, we obtained 25 segments each of clinical discharges and subclinical discharges. Amplitude envelope correlation analysis was used to construct functional networks and graph theory was used to calculate network topological data. We then compared differences in functional connectivity within the DMN between clinical and subclinical discharges. All statistical comparisons were performed using paired-sample tests. RESULTS Compared to subclinical discharges, the functional network of clinical discharges exhibited higher synchronization - particularly in the parahippocampal gyrus - as early as 10 s before the seizure. Additionally, the functional network of clinical SWDs presented an anterior shift of key nodes in the alpha frequency band. Regarding clinical discharge progression, there were gradual increases in the parameter node strengths (S), clustering coefficients (C), and global efficiency (E) of the functional networks, while the path lengths (L) decreased. These changes were most prominent at the onset of discharges and followed by some recovery in the high-frequency bands, but no significant change in the low-frequency bands. Furthermore, connections within the DMN during the discharge period were significantly stronger for clinical discharge compared to subclinical discharges. CONCLUSIONS These findings suggest that a more regular network before abnormal discharges in clinical discharges contributes to SWD explosion and that the parahippocampal gyrus plays an important role in maintaining oscillations. An absence seizure is a gradual process and the emergence of SWDs may be accompanied by initiation of inhibitory mechanisms. Enhanced functional connectivity among DMN brain regions may indicate that patients have entered a state of introspection, and functional abnormalities in the parahippocampal gyrus may be associated with patients' transient memory loss.
Collapse
Affiliation(s)
- Fangling Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- 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
| | - Yanzhang Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Siyi Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Fengyuan Xu
- Department of Neurology, 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.
| |
Collapse
|
3
|
Ono H, Sonoda M, Sakakura K, Kitazawa Y, Mitsuhashi T, Firestone E, Jeong JW, Luat AF, Marupudi NI, Sood S, Asano E. Dynamic cortical and tractography atlases of proactive and reactive alpha and high-gamma activities. Brain Commun 2023; 5:fcad111. [PMID: 37228850 PMCID: PMC10204271 DOI: 10.1093/braincomms/fcad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/15/2022] [Accepted: 04/03/2023] [Indexed: 05/27/2023] Open
Abstract
Alpha waves-posterior dominant rhythms at 8-12 Hz reactive to eye opening and closure-are among the most fundamental EEG findings in clinical practice and research since Hans Berger first documented them in the early 20th century. Yet, the exact network dynamics of alpha waves in regard to eye movements remains unknown. High-gamma activity at 70-110 Hz is also reactive to eye movements and a summary measure of local cortical activation supporting sensorimotor or cognitive function. We aimed to build the first-ever brain atlases directly visualizing the network dynamics of eye movement-related alpha and high-gamma modulations, at cortical and white matter levels. We studied 28 patients (age: 5-20 years) who underwent intracranial EEG and electro-oculography recordings. We measured alpha and high-gamma modulations at 2167 electrode sites outside the seizure onset zone, interictal spike-generating areas and MRI-visible structural lesions. Dynamic tractography animated white matter streamlines modulated significantly and simultaneously beyond chance, on a millisecond scale. Before eye-closure onset, significant alpha augmentation occurred at the occipital and frontal cortices. After eye-closure onset, alpha-based functional connectivity was strengthened, while high gamma-based connectivity was weakened extensively in both intra-hemispheric and inter-hemispheric pathways involving the central visual areas. The inferior fronto-occipital fasciculus supported the strengthened alpha co-augmentation-based functional connectivity between occipital and frontal lobe regions, whereas the posterior corpus callosum supported the inter-hemispheric functional connectivity between the occipital lobes. After eye-opening offset, significant high-gamma augmentation and alpha attenuation occurred at occipital, fusiform and inferior parietal cortices. High gamma co-augmentation-based functional connectivity was strengthened, whereas alpha-based connectivity was weakened in the posterior inter-hemispheric and intra-hemispheric white matter pathways involving central and peripheral visual areas. Our results do not support the notion that eye closure-related alpha augmentation uniformly reflects feedforward or feedback rhythms propagating from lower to higher order visual cortex, or vice versa. Rather, proactive and reactive alpha waves involve extensive, distinct white matter networks that include the frontal lobe cortices, along with low- and high-order visual areas. High-gamma co-attenuation coupled to alpha co-augmentation in shared brain circuitry after eye closure supports the notion of an idling role for alpha waves during eye closure. These normative dynamic tractography atlases may improve understanding of the significance of EEG alpha waves in assessing the functional integrity of brain networks in clinical practice; they also may help elucidate the effects of eye movements on task-related brain network measures observed in cognitive neuroscience research.
Collapse
Affiliation(s)
- Hiroya Ono
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Pediatric Neurology, National Center of Neurology and Psychiatry, Joint Graduate School of Tohoku University, Tokyo 1878551, Japan
- Department of Pediatrics, UCLA Mattel Children’s Hospital, David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Masaki Sonoda
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama 2360004, Japan
| | - Kazuki Sakakura
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Neurosurgery, University of Tsukuba, Tsukuba 3058575, Japan
| | - Yu Kitazawa
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, Kanagawa 2360004, Japan
| | - Takumi Mitsuhashi
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Neurosurgery, Juntendo University, School of Medicine, Tokyo 1138421, Japan
| | - Ethan Firestone
- Department of Physiology, Wayne State University, Detroit, MI 48201, USA
| | - Jeong-Won Jeong
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
| | - Aimee F Luat
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Pediatrics, Central Michigan University, Mount Pleasant, MI 48858, USA
| | - Neena I Marupudi
- Department of Neurosurgery, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
| | - Sandeep Sood
- Department of Neurosurgery, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
| | - Eishi Asano
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
- Department of Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA
| |
Collapse
|
4
|
Janmohamed M, Nhu D, Kuhlmann L, Gilligan A, Tan CW, Perucca P, O’Brien TJ, Kwan P. Moving the field forward: detection of epileptiform abnormalities on scalp electroencephalography using deep learning—clinical application perspectives. Brain Commun 2022; 4:fcac218. [PMID: 36092304 PMCID: PMC9453433 DOI: 10.1093/braincomms/fcac218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/25/2022] [Accepted: 08/25/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
The application of deep learning approaches for the detection of interictal epileptiform discharges is a nascent field, with most studies published in the past 5 years. Although many recent models have been published demonstrating promising results, deficiencies in descriptions of data sets, unstandardized methods, variation in performance evaluation and lack of demonstrable generalizability have made it difficult for these algorithms to be compared and progress to clinical validity. A few recent publications have provided a detailed breakdown of data sets and relevant performance metrics to exemplify the potential of deep learning in epileptiform discharge detection. This review provides an overview of the field and equips computer and data scientists with a synopsis of EEG data sets, background and epileptiform variation, model evaluation parameters and an awareness of the performance metrics of high impact and interest to the trained clinical and neuroscientist EEG end user. The gold standard and inter-rater disagreements in defining epileptiform abnormalities remain a challenge in the field, and a hierarchical proposal for epileptiform discharge labelling options is recommended. Standardized descriptions of data sets and reporting metrics are a priority. Source code-sharing and accessibility to public EEG data sets will increase the rigour, quality and progress in the field and allow validation and real-world clinical translation.
Collapse
Affiliation(s)
- Mubeen Janmohamed
- Department of Neuroscience, Central Clinical School, Monash University , Melbourne, VIC 3004 , Australia
- Department of Neurology, Alfred Health , Melbourne, VIC 3004 , Australia
- Department of Neurology, The Royal Melbourne Hospital , Melbourne, VIC 3050 , Australia
| | - Duong Nhu
- Department of Data Science and AI, Faculty of IT, Monash University , Clayton, VIC 3800 , Australia
| | - Levin Kuhlmann
- Department of Data Science and AI, Faculty of IT, Monash University , Clayton, VIC 3800 , Australia
| | - Amanda Gilligan
- Neurosciences Clinical Institute, Epworth Healthcare Hospital , Melbourne, VIC 3121 , Australia
| | - Chang Wei Tan
- Department of Data Science and AI, Faculty of IT, Monash University , Clayton, VIC 3800 , Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University , Melbourne, VIC 3004 , Australia
- Department of Neurology, Alfred Health , Melbourne, VIC 3004 , Australia
- Department of Medicine, Austin Health, The University of Melbourne , Melbourne, VIC 3084 , Australia
- Comprehensive Epilepsy Program, Department of Neurology, Austin Health , Melbourne, VIC 3084 , Australia
| | - Terence J O’Brien
- Department of Neuroscience, Central Clinical School, Monash University , Melbourne, VIC 3004 , Australia
- Department of Neurology, Alfred Health , Melbourne, VIC 3004 , Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University , Melbourne, VIC 3004 , Australia
- Department of Neurology, Alfred Health , Melbourne, VIC 3004 , Australia
| |
Collapse
|
5
|
Sharma S, Chen Z, Rychkova M, Dunne J, Lee J, Lawn N, Kwan P. Risk factors and consequences of self-discontinuation of treatment by patients with newly diagnosed epilepsy. Epilepsy Behav 2022; 131:108664. [PMID: 35483203 DOI: 10.1016/j.yebeh.2022.108664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patients with epilepsy not uncommonly self-discontinue treatment with antiseizure medications (ASM). The rate, reasons for this, and consequences have not been well studied. METHODS We analyzed self-discontinuation of ASM treatment in patients with recently diagnosed epilepsy via review of clinic letters and hospital correspondence in a prospective cohort of first seizure patients. RESULTS We studied 489 patients with newly diagnosed and treated epilepsy (median age 41, range 14-88, 62% male), followed up for a median duration of 3.0 years (interquartile range [IQR]: 1.2-6.0). Seventy eight (16.0%) self-discontinued ASM therapy after a median treatment duration of 1.4 years (IQR: 0.4-2.9), and after a median duration of seizure freedom of 11.8 months (IQR: 4.6-31.8). Patients commonly self-discontinued treatment due to adverse effects (41%), perception that treatment was no longer required (35%), and planned or current pregnancy (12%). Patients who self-discontinued were less likely to have epileptogenic lesions on neuroimaging (hazard ratio [HR] = 0.44, 95% confidence interval [CI]: 0.23-0.83), presentation with seizure clusters (HR = 0.32, 95% CI: 0.14-0.69) and presentation with tonic-clonic seizures (HR = 0.36, 95% CI: 0.19-0.70). Patients with shorter interval since the last seizure (HR = 0.76, 95% CI: 0.66-0.86) were more likely to self-discontinue treatment. Sleep deprivation prior to seizures before diagnosis (HR = 1.80, 95% CI: 1.05-3.09) and significant alcohol or illicit drug use (HR = 2.35, 95% CI: 1.20-4.59) were also associated with higher rates of discontinuation. After discontinuation, 51 patients (65%) experienced seizure recurrence, and 43 (84%) restarted treatment. Twenty two patients (28%) experienced a seizure-related injury after treatment discontinuation. SIGNIFICANCE Self-initiated discontinuation of ASM treatment was not uncommon in patients with newly treated epilepsy. Reasons for discontinuation highlight areas for improved discussion with patients, including the chronicity of epilepsy and management strategies for current or potential adverse effects.
Collapse
Affiliation(s)
- Sameer Sharma
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne 3004, Australia
| | - Zhibin Chen
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne 3004, Australia; Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne 3050, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia
| | - Maria Rychkova
- Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne 3050, Australia
| | - John Dunne
- School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Victoria Square, Perth 6000, Australia; WA Adult Epilepsy Service, Hospital Avenue, Nedlands, Western Australia 6009, Australia
| | - Judy Lee
- WA Adult Epilepsy Service, Hospital Avenue, Nedlands, Western Australia 6009, Australia
| | - Nicholas Lawn
- WA Adult Epilepsy Service, Hospital Avenue, Nedlands, Western Australia 6009, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne 3004, Australia; Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne 3050, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia.
| |
Collapse
|
6
|
Smith EH, Liou JY, Merricks EM, Davis T, Thomson K, Greger B, House P, Emerson RG, Goodman R, McKhann GM, Sheth S, Schevon C, Rolston JD. Human interictal epileptiform discharges are bidirectional traveling waves echoing ictal discharges. eLife 2022; 11:73541. [PMID: 35050851 PMCID: PMC8813051 DOI: 10.7554/elife.73541] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Interictal epileptiform discharges (IEDs), also known as interictal spikes, are large intermittent electrophysiological events observed between seizures in patients with epilepsy. Although they occur far more often than seizures, IEDs are less studied, and their relationship to seizures remains unclear. To better understand this relationship, we examined multi-day recordings of microelectrode arrays implanted in human epilepsy patients, allowing us to precisely observe the spatiotemporal propagation of IEDs, spontaneous seizures, and how they relate. These recordings showed that the majority of IEDs are traveling waves, traversing the same path as ictal discharges during seizures, and with a fixed direction relative to seizure propagation. Moreover, the majority of IEDs, like ictal discharges, were bidirectional, with one predominant and a second, less frequent antipodal direction. These results reveal a fundamental spatiotemporal similarity between IEDs and ictal discharges. These results also imply that most IEDs arise in brain tissue outside the site of seizure onset and propagate toward it, indicating that the propagation of IEDs provides useful information for localizing the seizure focus.
Collapse
Affiliation(s)
- Elliot H Smith
- Department of Neurolosurgery, University of Utah, Salt Lake City, United States
| | - Jyun-You Liou
- Department of Anesthesiology, Weill Cornell Medicine, New York, United States
| | - Edward M Merricks
- Department of Neurology, Columbia University Medical Center, New York CIty, United States
| | - Tyler Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, United States
| | - Kyle Thomson
- Departments of Neurosurgery, University of Utah, Salt Lake City, United States
| | - Bradley Greger
- Department of Bioengineering, Arizona State University, Tempe, United States
| | - Paul House
- Neurosurgical Associates, LLC, Murray, United States
| | | | | | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, United States
| | - Sameer Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, United States
| | - Catherine Schevon
- Department of Neurology, Columbia University, New York, United States
| | - John D Rolston
- Departments of Neurosurgery, University of Utah, Salt Lake City, United States
| |
Collapse
|
7
|
Rohilla S, Duhan A, Bala K, Kaushik JS. Brain Perfusion, Hippocampal Volumetric, and Diffusion-weighted Imaging Findings in Children with Prolonged Febrile Seizures and Focal Febrile Seizures. J Pediatr Neurosci 2021; 16:137-142. [PMID: 35018182 PMCID: PMC8706595 DOI: 10.4103/jpn.jpn_87_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/06/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background: The current study was conducted to describe the findings of brain perfusion, hippocampal volumetric, and diffusion-weighted imaging (DWI) in children aged six months to seven years with febrile status epilepticus (FSE) and focal febrile seizures (FFS) when compared with age and gender-matched controls. Materials and Methods: This cross-sectional study was conducted among children aged six months to seven years presenting with FSE or FFS within 72 h of the seizure. Cases were subjected to magnetic resonance imaging (MRI) brain and sleep-deprived electroencephalography. Age and gender-matched children who were subjected to MRI brain for nonepileptic indications served as their control. Hippocampal volumes, T2 values, cerebral blood flow, and diffusion characteristics were compared between the cases and controls and also between those with FSE and FFS. Results: A total of 31 cases (FFS = 20, FSE = 11) and 30 controls were enrolled. There was no significant difference between right and left hippocampal volumes and T2 relaxometry values between cases and controls and also between children with FSE and FFS. Similarly, the cerebral blood flow was also comparable in cases and controls. There was a single case of FSE with hippocampal malrotation; one child showed diffusion restriction in the hippocampus after prolonged (>60 min) FSE. Conclusion: Children with FSE and FFS had comparable hippocampal volume and brain perfusion to healthy children. However, one child with FSE had hippocampal malrotation and another had diffusion restriction. The study findings need to be interpreted in the context of small sample size, and lack of follow-up neuroimaging.
Collapse
Affiliation(s)
- Seema Rohilla
- Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Aditya Duhan
- Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kiran Bala
- Department of Neurology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Jaya Shankar Kaushik
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| |
Collapse
|
8
|
Sharma S, Chen Z, Rychkova M, Dunne J, Lee J, Lawn N, Kwan P. Short- and long-term outcomes of immediate and delayed treatment in epilepsy diagnosed after one or multiple seizures. Epilepsy Behav 2021; 117:107880. [PMID: 33711683 DOI: 10.1016/j.yebeh.2021.107880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/06/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare the outcomes between immediate and deferred treatments in patients diagnosed after one or multiple (two or more) seizures. METHODS Our observational study investigated seizure recurrence and 12-month seizure remission in patients with newly diagnosed epilepsy, comparing immediate to deferred treatment in patients diagnosed after one seizure or after two or more seizures. RESULTS Of 598 patients (62% male, median age 39 years), 347 (58%) were treated at diagnosis and 251 (42%) received deferred or no treatment. Seizure recurrence was higher with deferred treatment both in patients diagnosed after two or more seizures (n = 363; adjusted hazard ratio [aHR] = 2.38, 95% confidence interval [CI]: 1.79-3.14, p < 0.001) and after one seizure (n = 235; aHR = 1.41, 95% CI: 0.995-1.99, p = 0.05). Cumulative seizure recurrence rates at two years in patients diagnosed after two or more seizures were 73% with deferred treatment and 49% with immediate treatment (risk-factor-corrected number-needed-to-treat [NNT] = 4), and in those diagnosed after one seizure the rates were 60% and 51% (NNT = 8). Of 380 patients with eligible follow-up (median 4.3 years), 287 (76%) had been in seizure remission for at least one year and 211 (56%) remained in remission at last follow-up. Long-term remission rates were similar between immediate and deferred treatments, and between patients diagnosed after one seizure and those with two or more seizures. SIGNIFICANCE Immediate rather than deferred treatment was less likely to influence seizure recurrence in patients diagnosed with epilepsy after a single seizure than in those diagnosed after two or more seizures, and showed no differences in long-term seizure freedom.
Collapse
Affiliation(s)
- Sameer Sharma
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Zhibin Chen
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, VIC 3004, Australia.
| | - Maria Rychkova
- Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia.
| | - John Dunne
- School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Victoria Square, Perth, WA 6000, Australia; WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Judy Lee
- WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Nicholas Lawn
- WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, VIC 3004, Australia.
| |
Collapse
|
9
|
Sharma S, Chen Z, Rychkova M, Dunne J, Lee J, Kalilani L, Lawn N, Kwan P. Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study. Epilepsia 2020; 61:445-454. [DOI: 10.1111/epi.16439] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Sameer Sharma
- Department of Neurosciences Central Clinical School Alfred Hospital Monash University Melbourne Victoria Australia
| | - Zhibin Chen
- Department of Neurosciences Central Clinical School Alfred Hospital Monash University Melbourne Victoria Australia
- Department of Medicine Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Maria Rychkova
- Department of Medicine Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia
| | - John Dunne
- School of Medicine Royal Perth Hospital Unit University of Western Australia Perth Western Australia Australia
- WA Adult Epilepsy Service Perth Western Australia Australia
| | - Judy Lee
- WA Adult Epilepsy Service Perth Western Australia Australia
| | | | - Nicholas Lawn
- WA Adult Epilepsy Service Perth Western Australia Australia
| | - Patrick Kwan
- Department of Neurosciences Central Clinical School Alfred Hospital Monash University Melbourne Victoria Australia
- Department of Medicine Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| |
Collapse
|
10
|
Han JY, Choi SA, Chung YG, Shim YK, Kim WJ, Kim SY, Kim H, Lim BC, Hwang H, Chae JH, Choi J, Kim KJ. Change of centrotemporal spikes from onset to remission in self-limited epilepsy with centrotemporal spikes (SLECTS). Brain Dev 2020; 42:270-276. [PMID: 31813543 DOI: 10.1016/j.braindev.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To reveal the changes of centrotemporal spikes that occur during the disease course of self-limited epilepsy with centrotemporal spikes (SLECTS). METHOD We retrospectively reviewed the serial EEGs of 63 patients with SLECTS from initial diagnosis to remission. There were 32 patients who did not undergo treatment and 31 patients who underwent treatment with oxcarbazepine (OXC). The change of occurrence or abundance, voltage, and location of centrotemporal spikes of serial EEGs were analyzed and compared between the two groups. Clinical seizure evidenced and reported was counted. The time gap between seizure remission and EEG remission was measured in the two groups. RESULT Changes of occurrence or abundance of the centrotemporal spikes were either abrupt (sudden disappearance of the frequent spikes on following EEG) or gradual (decline in number over 2 or more serial EEGs). Pattern of spike disappearance was not significantly different between the medication naïve group and OXC treated group. The spike voltage or the location of centrotemporal spikes did not change during the disease course in most cases. Delay between seizure remission and EEG normalization was 3.34 ± 1.75 (mean ± standard deviation, range: 0.77-7.97) years in untreated patients and 3.03 ± 1.41 (0.95-6.61) years in OXC-treated group. CONCLUSION Pattern of spike disappearance in SLECTS was either abrupt or gradual. Treatment with OXC had no effect in the disappearance pattern. Precise data regarding the pattern of disappearance and delay between seizure remission and EEG normalization can help to understand the evolution of spike in SLECTS and to predict the timing of normalization of EEG after seizure remission.
Collapse
Affiliation(s)
- Ji Yeon Han
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea; Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
| | - Yoon Gi Chung
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Young Kyu Shim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Woo Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jieun Choi
- Department of Pediatrics, SMG-SNU Boramae Hospital, Seoul, South Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| |
Collapse
|
11
|
Gottshall JL, Adams ZM, Forgacs PB, Schiff ND. Daytime Central Thalamic Deep Brain Stimulation Modulates Sleep Dynamics in the Severely Injured Brain: Mechanistic Insights and a Novel Framework for Alpha-Delta Sleep Generation. Front Neurol 2019; 10:20. [PMID: 30778326 PMCID: PMC6369150 DOI: 10.3389/fneur.2019.00020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/08/2019] [Indexed: 12/17/2022] Open
Abstract
Loss of organized sleep electrophysiology is a characteristic finding following severe brain injury. The return of structured elements of sleep architecture has been associated with positive prognosis across injury etiologies, suggesting a role for sleep dynamics as biomarkers of wakeful neuronal circuit function. In a continuing study of one minimally conscious state patient studied over the course of ~8½ years, we sought to investigate whether changes in daytime brain activation induced by central thalamic deep brain stimulation (CT-DBS) influenced sleep electrophysiology. In this patient subject, we previously reported significant improvements in sleep electrophysiology during 5½ years of CT-DBS treatment, including increased sleep spindle frequency and SWS delta power. We now present novel findings that many of these improvements in sleep electrophysiology regress following CT-DBS discontinuation; these regressions in sleep features correlate with a significant decrease in behavioral responsiveness. We also observe the re-emergence of alpha-delta sleep, which had been previously suppressed by daytime CT-DBS in this patient subject. Importantly, CT-DBS was only active during the daytime and has been proposed to mediate recovery of consciousness by driving synaptic activity across frontostriatal systems through the enhancement of thalamocortical output. Accordingly, the improvement of sleep dynamics during daytime CT-DBS and their subsequent regression following CT-DBS discontinuation implicates wakeful synaptic activity as a robust modulator of sleep electrophysiology. We interpret these findings in the context of the “synaptic homeostasis hypothesis,” whereby we propose that daytime upregulation of thalamocortical output in the severely injured brain may facilitate organized frontocortical circuit activation and yield net synaptic potentiation during wakefulness, providing a homeostatic drive that reconstitutes sleep dynamics over time. Furthermore, we consider common large-scale network dynamics across several neuropsychiatric disorders in which alpha-delta sleep has been documented, allowing us to formulate a novel mechanistic framework for alpha-delta sleep generation. We conclude that the bi-directional modulation of sleep electrophysiology by daytime thalamocortical activity in the severely injured brain: (1) emphasizes the cyclical carry-over effects of state-dependent circuit activation on large-scale brain dynamics, and (2) further implicates sleep electrophysiology as a sensitive indicator of wakeful brain activation and covert functional recovery in the severely injured brain.
Collapse
Affiliation(s)
- Jackie L Gottshall
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Zoe M Adams
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Peter B Forgacs
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States.,Department of Neurology, Weill Cornell Medicine, New York, NY, United States.,Rockefeller University Hospital, New York, NY, United States
| | - Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States.,Department of Neurology, Weill Cornell Medicine, New York, NY, United States.,Rockefeller University Hospital, New York, NY, United States
| |
Collapse
|