1
|
Nica A. Drug-resistant juvenile myoclonic epilepsy: A literature review. Rev Neurol (Paris) 2024; 180:271-289. [PMID: 38461125 DOI: 10.1016/j.neurol.2024.02.385] [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: 11/18/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/11/2024]
Abstract
The ILAE's Task Force on Nosology and Definitions revised in 2022 its definition of juvenile myoclonic epilepsy (JME), the most common idiopathic generalized epilepsy disorder, but this definition may well change again in the future. Although good drug response could almost be a diagnostic criterion for JME, drug resistance (DR) is observed in up to a third of patients. It is important to distinguish this from pseudoresistance, which is often linked to psychosocial problems or psychiatric comorbidities. After summarizing these aspects and the various definitions applied to JME, the present review lists the risk factors for DR-JME that have been identified in numerous studies and meta-analyses. The factors most often cited are absence seizures, young age at onset, and catamenial seizures. By contrast, photosensitivity seems to favor good treatment response, at least in female patients. Current hypotheses on DR mechanisms in JME are based on studies of either simple (e.g., cortical excitability) or more complex (e.g., anatomical and functional connectivity) neurophysiological markers, bearing in mind that JME is regarded as a neural network disease. This research has revealed correlations between the intensity of some markers and DR, and above all shed light on the role of these markers in associated neurocognitive and neuropsychiatric disorders in both patients and their siblings. Studies of neurotransmission have mainly pointed to impaired GABAergic inhibition. Genetic studies have generally been inconclusive. Increasing restrictions have been placed on the use of valproate, the standard antiseizure medication for this syndrome, owing to its teratogenic and developmental risks. Levetiracetam and lamotrigine are prescribed as alternatives, as is vagal nerve stimulation, and there are several other promising antiseizure drugs and neuromodulation methods. The development of better alternative treatments is continuing to take place alongside advances in our knowledge of JME, as we still have much to learn and understand.
Collapse
Affiliation(s)
- A Nica
- Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Clinical Investigation Center 1414, Rennes University Hospital, Rennes, France; Signal and Image Processing Laboratory (LTSI), INSERM, Rennes University, Rennes, France.
| |
Collapse
|
2
|
Jara-Prado A, Guerrero-Camacho JL, Ángeles-López QD, Ochoa-Morales A, Dávila-Ortiz de Montellano DJ, Ramírez-García MÁ, Breda-Yepes M, Durón RM, Delgado-Escueta AV, Barrios-González DA, Martínez-Juárez IE. Association of variants in the ABCB1, CYP2C19 and CYP2C9 genes for Juvenile Myoclonic Epilepsy. Neurol Sci 2024; 45:1635-1643. [PMID: 37875597 DOI: 10.1007/s10072-023-07124-w] [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: 06/15/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
Juvenile myoclonic epilepsy (JME) is the most common of the generalized genetic epilepsies, with multiple causal and susceptibility genes; however, its etiopathogenesis is mainly unknown. The toxic effects caused by xenobiotics in cells occur during their metabolic transformation, mainly by enzymes belonging to cytochrome P450. The elimination of these compounds by transporters of the ABC type protects the central nervous system, but their accumulation causes neuronal damage, resulting in neurological diseases. The present study has sought the association between single nucleotide genetic variants of the CYP2C9, CYP2C19, and ABCB1 genes and the development of JME in patients compared to healthy controls. The CC1236 and GG2677 genotypes of ABCB1 in women; allele G 2677, genotypes GG 2677 and CC 3435 in men; the CYP2C19*2A allele, and the CYP2C19*3G/A genotype in both sexes were found to be risk factors for JME. Furthermore, carriers of the TTGGCC genotype combination of the ABCB1 gene (1236/2677/3435) have a 10.5 times higher risk of developing JME than non-carriers. Using the STRING database, we found an interaction between the proteins encoded by these genes and other possible proteins. These findings indicate that the CYP450 system and ABC transporters could interact with other genes in the JME.
Collapse
Affiliation(s)
- Aurelio Jara-Prado
- Genetics Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | - Adriana Ochoa-Morales
- Genetics Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | - Michelle Breda-Yepes
- National Institute of Neurology and Neurosurgery, Epilepsy Clinic, Mexico City, Mexico
| | - Reyna M Durón
- Universidad Tecnológica Centroamericana (UNITEC), Tegucigalpa, Honduras
| | | | | | | |
Collapse
|
3
|
Zhang T, Zhang Y, Ren J, Zhou H, Yang M, Li L, Lei D, Gong Q, Zhou D, Yang T. Dynamic alterations of striatal-related functional networks in juvenile absence epilepsy. Epilepsy Behav 2023; 149:109506. [PMID: 37925871 DOI: 10.1016/j.yebeh.2023.109506] [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] [Received: 07/03/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To explore the features of dynamic functional connectivity (dFC) variability of striatal-cortical/subcortical networks in juvenile absence epilepsy (JAE). METHODS We collected resting-state functional magnetic imaging data from 18 JAE patients and 28 healthy controls. The striatum was divided into six pairs of regions: the inferior-ventral striatum (VSi), superior-ventral striatum (VSs), dorsal-caudal putamen, dorsal-rostral putamen, dorsal-caudate (DC) and ventral-rostral putamen. We assessed the dFC variability of each subdivision in the whole brain using the sliding-window method, and correlated altered circuit with clinical variables in JAE patients. RESULTS We found altered dFC variability of striatal-cortical/subcortical networks in patients with JAE. The VSs exhibited decreased dFC variability with subcortical regions, and dFC variability between VSs and thalamus was negatively correlated with epilepsy duration. For the striatal-cortical networks, the dFC variability was decreased in VSi-affective network but increased in DC-executive network. The altered dynamics of striatal-cortical networks involved crucial nodes of the default mode network (DMN). CONCLUSION JAE patients exhibit excessive stability in the striatal-subcortical networks. For striatal-cortical networks in JAE, the striatal-affective circuit was more stable, while the striatal-executive circuit was more variable. Furthermore, crucial nodes of DMN were changed in striatal-cortical networks in JAE.
Collapse
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
| | - Huanyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Menghan Yang
- 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.
| |
Collapse
|
4
|
Laskar S, Chaudhry N, Choudhury C, Garg D. Gender differences in quality of life and psychiatric comorbidities among persons with juvenile myoclonic epilepsy: A single-center cross-sectional study. J Neurosci Rural Pract 2023; 14:482-487. [PMID: 37692809 PMCID: PMC10483207 DOI: 10.25259/jnrp_34_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/19/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized/genetic epilepsy syndrome. Gender differences are known in clinical presentation, with a well-identified female predilection. We aimed to study gender-based differences in quality of life (QoL) and psychiatric comorbidities among persons with JME. Materials and Methods This was a cross-sectional study conducted at a teaching hospital in Delhi, India. Persons above 11 years of age with JME diagnosed according to the International League Against Epilepsy criteria established in 2001 were enrolled. QoL assessment was made using Quality of Life in Epilepsy Inventory-Adolescents-48 (QOLIE-AD-48) and Patient-Weighted Quality of Life in Epilepsy Inventory 31 (QOLIE-31-P) for adolescent and adult patients, respectively. For the assessment of psychiatric comorbidities, participants were administered the Mini-International Neuropsychiatric Interview (M.I.N.I). Participants who tested positive for psychiatric comorbidities on M.I.N.I subsequently underwent the Diagnostic and Statistical Manual-5 categorization. Results We enrolled 50 patients with JME. Eighteen (36%) were male and 32 (64%) were female patients. The median age of males at study enrollment was 23.5 (range 15-38) years. The median age of females was 22 (16-48) years. The median QOLIE-31-P score among males was 68.31 (37.13-91.82) and for females was 66.9 (31.7-99.1). The median overall QoL score for males was 65 (25-87.5), which qualified as "fair" QoL. For females, the median overall QoL score was 62.5 (10-87.5) which also qualified as "fair" QoL. No significant difference was noted between genders in QoL (P = 0.723). Among males, 55.5% had psychiatric comorbidity. Of these, two had mild depression and eight had anxiety. Among female patients, 34.4% had comorbid psychiatric issues; 6 had anxiety and 5 had depression. No significant difference was noted between genders (P = 0.9136). Conclusion Persons with JME do not have gender-stratified differences in terms of psychiatric comorbidities and QoL despite differences in exposure to antiseizure medications and other gender-related factors. All persons with JME should be screened for psychiatric comorbidities, specifically anxiety, and depression.
Collapse
Affiliation(s)
- Sanghamitra Laskar
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neera Chaudhry
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Cankatika Choudhury
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| |
Collapse
|
5
|
Rubboli G, Beier CP, Selmer KK, Syvertsen M, Shakeshaft A, Collingwood A, Hall A, Andrade DM, Fong CY, Gesche J, Greenberg DA, Hamandi K, Lim KS, Ng CC, Orsini A, Striano P, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK. Variation in prognosis and treatment outcome in juvenile myoclonic epilepsy: a Biology of Juvenile Myoclonic Epilepsy Consortium proposal for a practical definition and stratified medicine classifications. Brain Commun 2023; 5:fcad182. [PMID: 37361715 PMCID: PMC10288558 DOI: 10.1093/braincomms/fcad182] [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: 10/01/2022] [Revised: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Reliable definitions, classifications and prognostic models are the cornerstones of stratified medicine, but none of the current classifications systems in epilepsy address prognostic or outcome issues. Although heterogeneity is widely acknowledged within epilepsy syndromes, the significance of variation in electroclinical features, comorbidities and treatment response, as they relate to diagnostic and prognostic purposes, has not been explored. In this paper, we aim to provide an evidence-based definition of juvenile myoclonic epilepsy showing that with a predefined and limited set of mandatory features, variation in juvenile myoclonic epilepsy phenotype can be exploited for prognostic purposes. Our study is based on clinical data collected by the Biology of Juvenile Myoclonic Epilepsy Consortium augmented by literature data. We review prognosis research on mortality and seizure remission, predictors of antiseizure medication resistance and selected adverse drug events to valproate, levetiracetam and lamotrigine. Based on our analysis, a simplified set of diagnostic criteria for juvenile myoclonic epilepsy includes the following: (i) myoclonic jerks as mandatory seizure type; (ii) a circadian timing for myoclonia not mandatory for the diagnosis of juvenile myoclonic epilepsy; (iii) age of onset ranging from 6 to 40 years; (iv) generalized EEG abnormalities; and (v) intelligence conforming to population distribution. We find sufficient evidence to propose a predictive model of antiseizure medication resistance that emphasises (i) absence seizures as the strongest stratifying factor with regard to antiseizure medication resistance or seizure freedom for both sexes and (ii) sex as a major stratifying factor, revealing elevated odds of antiseizure medication resistance that correlates to self-report of catamenial and stress-related factors including sleep deprivation. In women, there are reduced odds of antiseizure medication resistance associated with EEG-measured or self-reported photosensitivity. In conclusion, by applying a simplified set of criteria to define phenotypic variations of juvenile myoclonic epilepsy, our paper proposes an evidence-based definition and prognostic stratification of juvenile myoclonic epilepsy. Further studies in existing data sets of individual patient data would be helpful to replicate our findings, and prospective studies in inception cohorts will contribute to validate them in real-world practice for juvenile myoclonic epilepsy management.
Collapse
Affiliation(s)
- Guido Rubboli
- Correspondence may also be addressed to: Guido Rubboli Danish Epilepsy Center, Filadelfia/University of Copenhagen Kolonivej 2A, Dianalund 4293, Denmark E-mail:
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - Kaja K Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo 0372, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo 1337, Norway
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo 3004, Norway
| | - Amy Shakeshaft
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Anna Hall
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Danielle M Andrade
- Adult Epilepsy Genetics Program, Krembil Research Institute, University of Toronto, Toronto M5T 0S8, Canada
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - David A Greenberg
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus 43215, USA
| | - Khalid Hamandi
- Department of Neurology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Ching Ching Ng
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa 56126, Italy
| | | | - Pasquale Striano
- Pediatric Neurology and Muscular Disease Unit, IRCCS Istituto ‘G. Gaslini’, Genova 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova 16132, Italy
| | - Rhys H Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Jana Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
- Motol University Hospital, Prague 150 06, Czech Republic
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto M5G 1X8, Canada
- Departments of Statistical Sciences and Computer Science and Division of Biostatistics, The University of Toronto, Toronto M5G 1Z5, Canada
| | - Deb K Pal
- Correspondence to: Deb K. Pal Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology and Neuroscience, King’s College London 5 Cutcombe Road, London SE5 9RX, UK E-mail:
| |
Collapse
|
6
|
Harvey S, Shahwan A. Typical absence seizures in children: Review with focus on EEG predictors of treatment response and outcome. Seizure 2023; 110:1-10. [PMID: 37295276 DOI: 10.1016/j.seizure.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Typical absence seizures (TAS) occur in idiopathic generalized epilepsy (IGE) syndromes and are a common presentation to paediatric neurologists. Considerable overlap in clinical features of IGE syndromes comprising TAS often complicates prognostication. Clinical and EEG diagnostic features in TAS are well known. However, knowledge of prognostic features for each syndrome, whether clinical or EEG-related, is less clear. Perpetuated impressions in clinical practice regarding the role of EEG when used for prognostication in TAS are known. Assumed prognostic features, particularly those relating to EEG have been rarely studied systematically. Despite rapid expansion in epilepsy genetics, the complex and presumed polygenic inheritance of IGE, means that clinical and EEG features are likely to remain the main guide to management and prognostication of TAS for the foreseeable future. We comprehensively reviewed available literature and hereby summarize current knowledge of clinical and EEG characteristics (ictal and interictal) in children with TAS. The literature focuses predominantly on ictal EEG. Where studied, interictal findings reported relate to focal discharges, polyspike discharges, and occipital intermittent rhythmic delta activity, with generalized interictal discharges not thoroughly studied. Furthermore, reported prognostic implications of EEG findings are often conflicting. Limitations of available literature include inconsistent clinical syndrome and EEG finding definitions, and variable EEG analysis methods, particularly lack of raw EEG data analysis. These conflicting findings coupled with varying study methodologies cause lack of clear information or evidence on features which may influence treatment response, outcome, or natural history of TAS.
Collapse
Affiliation(s)
- Susan Harvey
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Temple Street, Dublin 1, Ireland; School of Medicine, University College Dublin, Dublin Ireland.
| | - Amre Shahwan
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Temple Street, Dublin 1, Ireland; School of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland
| |
Collapse
|
7
|
Cerulli Irelli E, Cocchi E, Ramantani G, Riva A, Caraballo RH, Morano A, Giuliano L, Yilmaz T, Panagiotakaki E, Operto FF, Giraldez BG, Balestrini S, Silvennoinen K, Casciato S, Comajuan M, Fortunato F, Giallonardo AT, Gamirova R, Coppola A, Di Gennaro G, Labate A, Sofia V, Kluger GJ, Gambardella A, Kasteleijn-Nolst Trenite D, Baykan B, Sisodiya SM, Arzimanoglou A, Striano P, Di Bonaventura C. The spectrum of epilepsy with eyelid myoclonia: delineation of disease subtypes from a large multicenter study. Epilepsia 2022; 64:196-207. [PMID: 36307934 DOI: 10.1111/epi.17450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Epilepsy with eyelid myoclonia (EEM) has been associated with marked clinical heterogeneity. Early epilepsy onset has been recently linked to lower chances of achieving sustained remission and to a less favorable neuropsychiatric outcome. However, much work is still needed to better delineate this epilepsy syndrome. METHODS In this multicenter retrospective cohort study, we included 267 EEM patients from 9 countries. Data about electroclinical and demographic features, intellectual functioning, migraine with or without aura, family history of epilepsy and epilepsy syndromes in relatives were collected in each patient. The impact of age at epilepsy onset (AEO) on EEM clinical features was investigated, along with the distinctive clinical characteristics of patients showing sporadic myoclonia over body regions other than eyelids (body-MYO). RESULTS Kernel density estimation revealed a trimodal distribution of AEO and Fisher-Jenks optimization disclosed three EEM subgroups: early-onset (EO-EEM), intermediate-onset (IO-EEM) and late-onset subgroup (LO-EEM). EO-EEM was associated with the highest rate of intellectual disability, antiseizure medication refractoriness and psychiatric comorbidities and with the lowest rate of family history of epilepsy. LO-EEM was associated with the highest proportion of body-MYO and generalized tonic-clonic seizures (GTCS), whereas IO-EEM had the lowest observed rate of additional findings. A family history of EEM was significantly more frequent in IO-EEM and LO-EEM compared with EO-EEM. In the subset of patients with body-MYO (58/267), we observed a significantly higher rate of migraine and GTCS but no relevant differences in other electroclinical features and seizure outcome. SIGNIFICANCE Based on AEO, we identified consistent EEM subtypes characterized by distinct electroclinical and familial features. Our observations shed new light on the spectrum of clinical features of this generalized epilepsy syndrome and may help clinicians towards a more accurate classification and prognostic profiling of EEM patients.
Collapse
Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Roberto H Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina
| | - Alessandra Morano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Tülay Yilmaz
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Eleni Panagiotakaki
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Francesca F Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Beatriz Gonzalez Giraldez
- Epilepsy Unit, Neurology Service, Hospital Universitario and IIS Fundación Jiménez Díaz and CIBERER, Madrid, Spain
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK; Neuroscience Department, Meyer Children's Hospital-University of Florence, Member of the ERN EpiCARE, Florence, Italy
| | - Katri Silvennoinen
- Department of Clinical and Experimental Epilepsy, Partner of the ERN EpiCARE, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | | | - Marion Comajuan
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | | | - Anna T Giallonardo
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | | | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Italy
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Gerhard J Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Clinic Vogtareuth, Vogtareuth, Germany; PMU, Salzburg, Salzburg, Austria
| | | | - Dorothee Kasteleijn-Nolst Trenite
- Department of Neurosurgery and Epilepsy, University Medical Center, Member of the ERN EpiCARE, Utrecht University, Utrecht, The Netherlands; Nesmos Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Betul Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, Partner of the ERN EpiCARE, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Member of the ERN EpiCARE, Genoa, Italy; Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | |
Collapse
|
8
|
Hirsch E, French J, Scheffer IE, Bogacz A, Alsaadi T, Sperling MR, Abdulla F, Zuberi SM, Trinka E, Specchio N, Somerville E, Samia P, Riney K, Nabbout R, Jain S, Wilmshurst JM, Auvin S, Wiebe S, Perucca E, Moshé SL, Tinuper P, Wirrell EC. ILAE definition of the Idiopathic Generalized Epilepsy Syndromes: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1475-1499. [PMID: 35503716 DOI: 10.1111/epi.17236] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022]
Abstract
In 2017, the International League Against Epilepsy (ILAE) Classification of Epilepsies described the "genetic generalized epilepsies" (GGEs), which contained the "idiopathic generalized epilepsies" (IGEs). The goal of this paper is to delineate the four syndromes comprising the IGEs, namely childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone. We provide updated diagnostic criteria for these IGE syndromes determined by the expert consensus opinion of the ILAE's Task Force on Nosology and Definitions (2017-2021) and international external experts outside our Task Force. We incorporate current knowledge from recent advances in genetic, imaging, and electroencephalographic studies, together with current terminology and classification of seizures and epilepsies. Patients that do not fulfill criteria for one of these syndromes, but that have one, or a combination, of the following generalized seizure types: absence, myoclonic, tonic-clonic and myoclonic-tonic-clonic seizures, with 2.5-5.5 Hz generalized spike-wave should be classified as having GGE. Recognizing these four IGE syndromes as a special grouping among the GGEs is helpful, as they carry prognostic and therapeutic implications.
Collapse
Affiliation(s)
- Edouard Hirsch
- Francis Rohmer Neurology Epilepsy Units, National Institute of Health and Medical Research 1258, Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France
| | - Jacqueline French
- New York University Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Bogacz
- Institute of Neurology, Clinical Hospital, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Michael R Sperling
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fatema Abdulla
- Salmaniya Medical Complex-Government Hospital, Manama, Bahrain
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children and Institute of Health & Wellbeing, University of Glasgow, member of EpiCARE, Glasgow, UK
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria.,Department of Public Health, Health Services Research, and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, member of EpiCARE, Rome, Italy
| | - Ernest Somerville
- Prince of Wales Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Pauline Samia
- Department of Pediatrics and Child Health, Aga Khan University, East Africa, Nairobi, Kenya
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Public Hospital Network of Paris, member of EpiCARE, Imagine Institute, National Institute of Health and Medical Research, Mixed Unit of Research 1163, University of Paris, Paris, France
| | | | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Stephane Auvin
- Pediatric Neurology, Public Hospital Network of Paris, Robert Debré Hospital, NeuroDiderot, National Institute of Health and Medical Research, Department Medico-Universitaire, Innovation Robert-Debré, University of Paris, Paris, France.,University Institute of France, Paris, France
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Emilio Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences, Scientific Institute for Research and Health Care, member of EpiCARE, Bologna, Italy
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
9
|
Cerulli Irelli E, Morano A, Orlando B, Salamone EM, Fanella M, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Seizure outcome trajectories in a well-defined cohort of newly diagnosed juvenile myoclonic epilepsy patients. Acta Neurol Scand 2022; 145:314-321. [PMID: 34791656 DOI: 10.1111/ane.13556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the temporal course of medication response and associated prognostic factors in a cohort of juvenile myoclonic epilepsy (JME) patients over a long-term follow-up. MATERIALS AND METHODS Data from 113 JME patients diagnosed according to recently proposed class II criteria were retrospectively reviewed. Early sustained remission was defined as 4-year seizure remission starting within 2 years from the first antiseizure medication (ASM) intake, as opposed to delayed sustained remission. Spontaneous relapse rate (ie, not related to ASM withdrawal) was also investigated, along with factors associated with seizure relapse. RESULTS Four-year seizure remission was obtained by 76/113 (67.3%) subjects. Early sustained remission was achieved by 45/76 (59.2%) patients. Absence seizures were significantly associated with no-remission at multivariable multinomial logistic regression analysis. Catamenial seizures and earlier age at epilepsy onset significantly predicted delayed sustained remission. Spontaneous seizure relapse after 4-year remission occurred in 15.7% of patients with early sustained remission and in 35.5% of those with delayed sustained remission (p = 0.045). The most common concomitant factors for a spontaneous relapse were irregular lifestyle habits and pregnancy-related switch from valproate to another ASM. Patients with a history of catamenial seizures were more likely to experience a spontaneous generalized tonic-clonic seizure relapse after 4-year remission at univariable analysis. SIGNIFICANCE Our data support the prognostic relevance of early medication response in JME patients. Furthermore, the prognostic significance of catamenial seizures and the impact of valproate switch on seizure relapse after a prolonged remission account for the challenging therapeutic management of women with childbearing potential.
Collapse
Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Alessandra Morano
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Biagio Orlando
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Enrico M. Salamone
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Martina Fanella
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Jinane Fattouch
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Mario Manfredi
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Anna T. Giallonardo
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| |
Collapse
|
10
|
Shakeshaft A, Panjwani N, Collingwood A, Crudgington H, Hall A, Andrade DM, Beier CP, Fong CY, Gardella E, Gesche J, Greenberg DA, Hamandi K, Koht J, Lim KS, Møller RS, Ng CC, Orsini A, Rees MI, Rubboli G, Selmer KK, Striano P, Syvertsen M, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK. Sex-specific disease modifiers in juvenile myoclonic epilepsy. Sci Rep 2022; 12:2785. [PMID: 35190554 PMCID: PMC8861057 DOI: 10.1038/s41598-022-06324-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/25/2021] [Indexed: 11/22/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME) is a common idiopathic generalised epilepsy with variable seizure prognosis and sex differences in disease presentation. Here, we investigate the combined epidemiology of sex, seizure types and precipitants, and their influence on prognosis in JME, through cross-sectional data collected by The Biology of Juvenile Myoclonic Epilepsy (BIOJUME) consortium. 765 individuals met strict inclusion criteria for JME (female:male, 1.8:1). 59% of females and 50% of males reported triggered seizures, and in females only, this was associated with experiencing absence seizures (OR = 2.0, p < 0.001). Absence seizures significantly predicted drug resistance in both males (OR = 3.0, p = 0.001) and females (OR = 3.0, p < 0.001) in univariate analysis. In multivariable analysis in females, catamenial seizures (OR = 14.7, p = 0.001), absence seizures (OR = 6.0, p < 0.001) and stress-precipitated seizures (OR = 5.3, p = 0.02) were associated with drug resistance, while a photoparoxysmal response predicted seizure freedom (OR = 0.47, p = 0.03). Females with both absence seizures and stress-related precipitants constitute the prognostic subgroup in JME with the highest prevalence of drug resistance (49%) compared to females with neither (15%) and males (29%), highlighting the unmet need for effective, targeted interventions for this subgroup. We propose a new prognostic stratification for JME and suggest a role for circuit-based risk of seizure control as an avenue for further investigation.
Collapse
Affiliation(s)
- Amy Shakeshaft
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Naim Panjwani
- Program in Genetics and Genome Biology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
| | - Holly Crudgington
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
| | - Anna Hall
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
| | - Danielle M Andrade
- Adult Epilepsy Genetics Program, Krembil Research Institute, University of Toronto, Toronto, Canada
| | | | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | - Jeanette Koht
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rikke S Møller
- Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Ching Ching Ng
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Mark I Rees
- Neurology Research Group, Swansea University Medical School, Swansea, UK
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Kaja K Selmer
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Pasquale Striano
- IRCCS Istituto 'G. Gaslini', Genoa, Italy
- University of Genova, Genoa, Italy
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo, Norway
| | - Rhys H Thomas
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle, UK
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Jana Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- King's College Hospital, London, UK
| | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
- Departments of Statistical Sciences and Computer Science and Division of Biostatistics, The University of Toronto, Toronto, Canada.
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK.
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
- King's College Hospital, London, UK.
- Evelina London Children's Hospital, London, UK.
| |
Collapse
|
11
|
Genetic generalized epilepsies in adults - challenging assumptions and dogmas. Nat Rev Neurol 2022; 18:71-83. [PMID: 34837042 DOI: 10.1038/s41582-021-00583-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/16/2023]
Abstract
Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15-20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizures alone. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Nevertheless, long-term follow-up studies have shown that with advancing age, many patients can discontinue their anti-seizure medication without seizure relapses. Several outcome predictors have been identified, but prognosis across the syndromes is more homogeneous than previously assumed. Overall, overlap in pathophysiology, seizure types, treatment responses and outcomes support the idea that GGEs are not separate nosological entities but represent a neurobiological continuum.
Collapse
|
12
|
Baggio M, Toffoli L, Da Rold M, Duma GM, Mento G, Morao V, Danieli A, Bonanni P. Neuropsychological and behavioral profiles of self-limited epileptic syndromes of childhood: a cross-syndrome comparison. Child Neuropsychol 2022; 28:878-902. [PMID: 35086426 DOI: 10.1080/09297049.2022.2028754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood epilepsy with centro-temporal spikes (CECTS), Childhood absence epilepsy (CAE) and Panayiotopoulos syndrome (PS) are some of the most common pediatric epileptic syndromes. Despite the relatively benign (self-limited) course of epilepsy, current evidence suggests that these conditions are associated with an increased risk of neuropsychological and behavioral comorbidities. This study provides a cross-epileptic syndromes' comparison reporting on the cognitive and behavioral profile of a cohort of 32 children with CECTS (n = 14), CAE (n = 10) and PS (n = 8), aged 6 to 15 years old. Frequent, although often subclinical cognitive difficulties involving attention, executive functions and academic abilities were found in children with CECTS and CAE, and to a lesser extent in PS. Internalizing symptoms (particularly anxiety) were more common in the PS group compared to CECTS and CAE based on parental reports. Correlational analysis revealed a significant correlation between phonemic fluency and seizure-free interval at the time of evaluation, suggesting a beneficial effect of epilepsy remission on this executive function measure in all the three groups. These results add to existing literature providing further detail on neuropsychological and behavioral peculiarities of children with CECTS, CAE, and PS. Moreover, the need for neuropsychological assessment as part of the standard childhood epilepsy evaluation is stressed. The results are discussed in the context of the current literature, highlighting areas of consensus and controversies related to the clinical management of these epileptic syndromes as well as directions for future research.
Collapse
Affiliation(s)
- Martina Baggio
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Lisa Toffoli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Martina Da Rold
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Gian Marco Duma
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Giovanni Mento
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Padova Neuroscience Center (PNC), University of Padova, Italy
| | - Veronica Morao
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| |
Collapse
|
13
|
Ramos-Lizana J, Martínez-Espinosa G, Aguilera-López P, Aguirre-Rodriguez J. Probability of Remission of the Main Epileptic Syndromes in Childhood. J Child Neurol 2022; 37:89-97. [PMID: 34816766 DOI: 10.1177/08830738211056780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM To determine the long-term probability of remission without antiepileptic treatment of common epileptic syndromes and of children without a specific syndromic diagnosis. PATIENTS AND METHODS All children less than 14 years old with 2 or more unprovoked seizures seen at our hospital between June 1, 1994, and March 1, 2011 (n = 680), were included and prospectively followed up until August 15, 2020. Syndromic diagnosis was made retrospectively but blinded to subsequent evolution, employing the data available at 6 months after diagnosis and under predefined operational criteria. RESULTS The Kaplan-Meier estimate of the probability of achieving a remission period of at least 5 years, with neither seizures nor antiepileptic treatment at 14 years was 97% for well-defined childhood epilepsy with centrotemporal spikes, 82% for uncertain childhood epilepsy with centrotemporal spikes, 85% for well-defined Panayiotopoulos syndrome, 88% for uncertain Panayiotopoulos syndrome, 93% for nonfamilial self-limited infantile epilepsy, 100% for familial self-limited infantile epilepsy, 86% for absence epilepsy, 6% for juvenile myoclonic epilepsy, 71% for cryptogenic West syndrome, 72% for patients with no associated neurologic deficits and no specific syndromic diagnosis, 65% for symptomatic West syndrome, and 40% for patients with associated neurologic deficits and no specific syndromic diagnosis. CONCLUSIONS The study results highlight the long-term outcomes of the main epileptic syndromes and also of the patients with no syndromic diagnosis.
Collapse
|
14
|
Al-Otaibi F. Safety and Efficacy of Clonazepam in the Treatment of Juvenile Myoclonic Epilepsy: A Meta-Analysis. J Pharm Bioallied Sci 2022; 14:126-131. [PMID: 36506728 PMCID: PMC9728065 DOI: 10.4103/jpbs.jpbs_298_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Juvenile myoclonic epilepsy (JME) is referred to as one of the most common epileptic syndromes. Several anti-epilepsy drugs (AEDs) have been developed and remain part of clinical intervention with varying safety and efficacy profiles. Comprehensive synthesis of the scientific evidence examining the safety and efficacy of clonazepam toward the treatment of JME was carried out in the study. Methods A detailed scientific literature search was made utilizing the most relevant scientific studies published to date on the intervention of clonazepam in the management of JME. In this study, a detailed search was made in multiple databases, including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scielo databases. Confidence intervals among the studies and continuous measures, proportion, and risk factor analysis were determined using the MedCalC tool (Version 20.110) as per PRISMA guidelines. Results A total of 6 studies out of 70 were found eligible for meta-analysis, where 186 JME patients were subjected to clonazepam intervention with controls. Clonazepam was reported effective in comparative analysis among six studies where P < 0.001. The result also shows a higher prevalence of JME in the female population compared to males (male versus female; 86/110). Efficacy and safety of clonazepam were reported significant as well. Conclusion Clonazepam is effective AEDs for the management of JME. However, more clinical evidence requires for statistical validation of clinical efficacy.
Collapse
Affiliation(s)
- Faisal Al-Otaibi
- Department of Pharmacy Practice, College of Pharmacy, Shaqra University, Al-Dawadmi, Saudi Arabia,Address for correspondence: Dr. Faisal Al-Otaibi, Department of Pharmacy Practice, College of Pharmacy, Shaqra University, Al-Dawadmi, P. O. BOX 33, Saudi Arabia. E-mail:
| |
Collapse
|
15
|
Kamitaki BK, Janmohamed M, Kandula P, Elder C, Mani R, Wong S, Perucca P, O'Brien TJ, Lin H, Heiman GA, Choi H. Clinical and EEG factors associated with antiseizure medication resistance in idiopathic generalized epilepsy. Epilepsia 2021; 63:150-161. [PMID: 34705264 DOI: 10.1111/epi.17104] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/18/2021] [Accepted: 10/08/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We sought to determine which combination of clinical and electroencephalography (EEG) characteristics differentiate between an antiseizure medication (ASM)-resistant vs ASM-responsive outcome for patients with idiopathic generalized epilepsy (IGE). METHODS This was a case-control study of ASM-resistant cases and ASM-responsive controls with IGE treated at five epilepsy centers in the United States and Australia between 2002 and 2018. We recorded clinical characteristics and findings from the first available EEG study for each patient. We then compared characteristics of cases vs controls using multivariable logistic regression to develop a predictive model of ASM-resistant IGE. RESULTS We identified 118 ASM-resistant cases and 114 ASM-responsive controls with IGE. First, we confirmed our recent finding that catamenial epilepsy is associated with ASM-resistant IGE (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.32-10.41, for all study subjects) after covariate adjustment. Other independent factors seen with ASM resistance include certain seizure-type combinations (absence, myoclonic, and generalized tonic-clonic seizures [OR 7.06, 95% CI 2.55-20.96]; absence and generalized tonic-clonic seizures [OR 4.45, 95% CI 1.84-11.34]), as well as EEG markers of increased generalized spike-wave discharges (GSWs) in sleep (OR 3.43, 95% CI 1.12-11.36 for frequent and OR 7.21, 95% CI 1.50-54.07 for abundant discharges in sleep) and the presence of generalized polyspike trains (GPTs; OR 5.49, 95% CI 1.27-38.69). The discriminative ability of our final multivariable model, as measured by area under the receiver-operating characteristic curve, was 0.80. SIGNIFICANCE Multiple clinical and EEG characteristics independently predict ASM resistance in IGE. To improve understanding of a patient's prognosis, clinicians could consider asking about specific seizure-type combinations and track whether they experience catamenial epilepsy. Obtaining prolonged EEG studies to record the burden of GSWs in sleep and assessing for the presence of GPTs may provide additional predictive value.
Collapse
Affiliation(s)
- Brad K Kamitaki
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mubeen Janmohamed
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Padmaja Kandula
- Department of Neurology, Cornell University, New York, NY, USA
| | - Christopher Elder
- Department of Neurology, Columbia University, New York, New York, USA
| | - Ram Mani
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Stephen Wong
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, The University of Melbourne, and Comprehensive Epilepsy Program, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Haiqun Lin
- School of Nursing, Rutgers, the State University of New Jersey, Newark, New Jersey, USA
| | - Gary A Heiman
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Hyunmi Choi
- Department of Neurology, Columbia University, New York, New York, USA
| |
Collapse
|
16
|
Baheti N, Rathore C, Bansal AR, Shah S, Veedu HK, Prakash S, Kanhere K, Jaiswal SK, Jukkarwala A, Murthy JMK, Radhakrishnan K. Treatment outcomes in drug resistant juvenile myoclonic epilepsy: Valproate resistance may not be the end of the road. Seizure 2021; 92:112-117. [PMID: 34496330 DOI: 10.1016/j.seizure.2021.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine treatment responses to various antiseizure medicines (ASMs) in patients with drug resistant juvenile myoclonic epilepsy (DRJME) METHODS: We reviewed records of all JME patients attending epilepsy clinics at 5 centers during a 5-year period. We used International Consensus Criteria to diagnose JME and International League Against Epilepsy Criteria to define drug resistance and sustained seizure freedom. We only used broad spectrum medicines which included valproate, lamotrigine, topiramate, levetiracetam, clobazam, phenobarbitone, clonazepam, and zonisamide. We considered an ASM successful if patient achieved seizure freedom within 3 months of attaining maintenance dose. RESULTS We studied 116 patients (61 males) with DRJME. At terminal followup, 82 (70.7%) patients had achieved sustained seizure freedom with a mean followup of 3.2 ± 1.3 years after last dose change. In patients where valproate failed as first- or second-line ASM (n=70; 60.3%), 49(70%) became seizure-free. In this group, 33(67%) patients became seizure-free after addition of lamotrigine. Success rate of lamotrigine and valproate combination was 69% as compared to 9% with all other combinations (p = 0.001). In patients who were not exposed to valproate as initial therapy (n=46), 33 (71.7%) became seizure-free, 30 (91%) after adding valproate. At last follow-up, 75 (90%) seizure-free patients were receiving valproate including 45 (55%) patients with a combination of valproate and lamotrigine. Only one of 24 patients became seizure-free after failing valproate and lamotrigine combination. CONCLUSION Seizure freedom can be achieved in two-thirds of patients with DRJME. A combination of valproate and lamotrigine is the most effective duotherapy.
Collapse
Affiliation(s)
- Neeraj Baheti
- Department of Neurology, Dr. G. M. Taori Central India Institute of Medical Sciences, Nagpur, India
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, India.
| | - Atma Ram Bansal
- Department of Neurology, Medanta-Medicity Hospital, Gurugram, India
| | - Saumya Shah
- Medical Institute of Central California and Kern Medical Outpatient Clinic, Bakersfield, CA, USA
| | - Hari Kunhi Veedu
- Medical Institute of Central California and Kern Medical Outpatient Clinic, Bakersfield, CA, USA
| | - Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, India
| | - Kalyani Kanhere
- Department of Neurology, Dr. G. M. Taori Central India Institute of Medical Sciences, Nagpur, India
| | | | - Anis Jukkarwala
- Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | | | | |
Collapse
|
17
|
Pietrafusa N, La Neve A, de Palma L, Boero G, Luisi C, Vigevano F, Specchio N. Juvenile myoclonic epilepsy: Long-term prognosis and risk factors. Brain Dev 2021; 43:688-697. [PMID: 33781581 DOI: 10.1016/j.braindev.2021.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our goal was to investigate the long-term clinical course of juvenile myoclonic epilepsy (JME) in a cohort of patients and to identify prognostic factors for refractoriness and seizure relapse after anti-seizure medications (ASMs) withdrawal. A literature review is also presented to consolidate and compare our findings with the previously reported cases. METHODS We retrospectively studied a series of patients diagnosed with JME with 15 years or more of evolution. We collected clinical, neurophysiological and neuroimaging data from patients who met defined inclusion and exclusion criteria. RESULTS Study involved 61 patients (65.5% female) with mean age at study of 37.6 years, and mean age at its outset of 14.8 years. Median follow-up was 31.0 years (mean 28.9, range 15-53). They presented more frequently with a combination of myoclonic and generalized tonic-clonic seizures (GTCS) (65.6%). Sixty-five percent of patients (n = 40) had a 5-year terminal remission with a mean age at last seizure of 27.4 years. Thirty-two percent of seizure-free patients (n = 13) withdrew ASMs: 6 out of 13 had a recurrence of the seizures while 7 remained seizure-free (mean age at ASMs withdrawal 21.0 versus 35.7 years, p < 0.05). In the multivariate model, a high GTCS frequency at onset (p = 0.026) was a prognostic factor of drug resistance. CONCLUSION JME is often regarded as a benign epileptic syndrome, although a quarter of the individuals have refractory epilepsy. The possibility of withdrawing ASMs in patients who have been free of seizures over an extended time seems feasible.
Collapse
Affiliation(s)
- Nicola Pietrafusa
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Luca de Palma
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Giovanni Boero
- Complex Structure of Neurology, SS. Annunziata Hospital, Taranto, Italy
| | | | - Federico Vigevano
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Nicola Specchio
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy.
| |
Collapse
|
18
|
Atalar AÇ, Şirin NG, Bebek N, Baykan B. Predictors of successful valproate withdrawal in women with epilepsy. Epilepsy Behav 2021; 119:107980. [PMID: 33957390 DOI: 10.1016/j.yebeh.2021.107980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Valproate (VPA) use was restricted due to its teratogenic risks in women with epilepsy (WWE). We aimed to assess the outcome and predictors of treatment decisions of withdrawal/switch or continuation of VPA in WWE. METHODS We included 214 consecutive WWE with a follow-up time of 9.57 ± 7.04 years, who have used (n = 142) or are still using VPA (n = 72) during their reproductive ages. The demographic, clinical, and electroencephalography (EEG) properties of WWE who could withdraw (successful withdrawal; n = 142) and could not withdraw VPA (unsuccessful withdrawal; n = 36) were compared statistically. RESULTS The main reasons for still using VPA were high risk of seizure recurrence (63.9%), cognitive impairment (27.8%), and no pregnancy prospect (8.3%). In the successful withdrawal group, 67 (47.1%) patients maintained remission after VPA withdrawal and 26 of them (38.8%) had relapse during the follow-up. The rate of side effects related to the new drugs (levetiracetam and lamotrigine) was 52/142 (36.6%). The unsuccessful withdrawal rate was 13.9% in focal epilepsy whereas it was 86.1% in generalized epilepsy (p = 0.002). Co-occurrence of three types of seizures and anti-seizure medication (ASM)-resistance was related to unsuccessful withdrawal in genetic generalized epilepsy (GGE) (p = 0.02 for both). CONCLUSIONS Although women with focal epilepsies are more ASM-resistant and more likely to have continuing seizures, they do not usually deteriorate after VPA discontinuation, therefore posing them to teratogenic risk is often unnecessary. In GGE, certain predictors such as previous ASM-resistance and the presence of three seizure types must be taken into account, before a withdrawal attempt of VPA treatment.
Collapse
Affiliation(s)
- Arife Çimen Atalar
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinica Neurophysiology, Istanbul, Turkey; Istanbul Education and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Nermin Görkem Şirin
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinica Neurophysiology, Istanbul, Turkey.
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinica Neurophysiology, Istanbul, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinica Neurophysiology, Istanbul, Turkey
| |
Collapse
|
19
|
Rubio C, Luna R, Ibarra-Velasco M, Lee Á. Epilepsy: A bibliometric analysis (1968-2020) of the Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez" in Mexico. Epilepsy Behav 2021; 115:107676. [PMID: 33360176 DOI: 10.1016/j.yebeh.2020.107676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023]
Abstract
The Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" (INNN) is one of the main institutions in Latin America treating epilepsy; and bibliometric analysis has an increasing role in analyzing the literature, acting as a Google Maps of medical research. We tracked the scientific output in Scopus and the impact of the institution from its foundation to July 2020 in the field of epilepsy. We roughly separated this group by clinical and experimental approach, identifying core journals, type of article, increase with time, and number of citations. A total of 228 papers, from a total of 3,034 produced by the INNN in that period, were found. Additionally, we identified that neurocysticercosis, pharmacology, genetics, and proteins involved in epilepsy were the most investigated topics. Also, there is a sustained growth in the number of papers per year since 1985. The number of authors per paper ranges from one to 15, and neuroscience journals are the preferred target of researchers, with a predilection for "Epilepsy and Behavior".
Collapse
Affiliation(s)
- Carmen Rubio
- Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurofisiología, Mexico
| | - Rudy Luna
- Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurofisiología, Mexico
| | | | - Ángel Lee
- Comisión Coordinadora de Institutos Nacionales de Salud, Mexico.
| |
Collapse
|
20
|
Can we predict drug response by functional connectivity in patients with juvenile myoclonic epilepsy? Clin Neurol Neurosurg 2020; 198:106119. [PMID: 32763668 DOI: 10.1016/j.clineuro.2020.106119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We investigated functional connectivity based on EEG using graph theoretical analysis in patients with newly diagnosed juvenile myoclonic epilepsy (JME), and whether it could play a role as a biomarker predicting antiepileptic drug (AED) response. METHODS We consecutively enrolled 38 patients with JME and 40 normal controls. The initial EEG was undertaken at the time of diagnosis of JME in a drug-naïve state. The second EEG was done after at least 12 months from the time of the initial EEG. We classified the patients with JME into two groups according to AED response at the time of taking the second EEG. We investigated functional connectivity based on graph theoretical analysis using connectivity measures of the coherence and phase locking value. RESULTS In the analysis of functional connectivity using coherence as a connectivity measure, the global efficiency and local efficiency in the AED poor responders (N = 4) decreased, whereas the small-worldness index increased. In the analysis of functional connectivity using phase locking value as a connectivity measure, the global efficiency and local efficiency in the AED poor responders decreased. However, in the AED good responders (N = 34), none of the network measures were different from those in healthy controls. CONCLUSIONS We newly found that there were significant differences of functional connectivity based on initial EEG according to AED response in the patients with JME. This suggests that brain connectivity could play a role as a new biomarker predicting AED response in patients with JME.
Collapse
|
21
|
Chen Y, Chen J, Chen X, Wang R, Zeng J, Wang F, Miao J. Predictors of Outcome in Juvenile Myoclonic Epilepsy. Risk Manag Healthc Policy 2020; 13:609-613. [PMID: 32607028 PMCID: PMC7311093 DOI: 10.2147/rmhp.s244725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized epilepsy syndrome, accounting for 10% of all epilepsy. However, there is limited information regarding the predictors of seizure outcome. The aim of this study was to determine the predictors of seizure outcome in JME patients. Methods A population-based retrospective study of JME patients who were treated at the Department of Neurology of affiliated Zhongshan Hospital, Xiamen University from 2008 to 2013. Results Sixty-three patients (30 women and 33 men) were enrolled in this study. The median age at seizure onset was 14 years old, and the average duration of epilepsy was 5 years. The onset of JME at age <16 years was found in 63.5% of patients. The epileptiform runs ≥3 s were observed in 35.8% patients. Febrile seizure was noted in 28.9% of patients. Among 63 patients, 40 patients (63.5%) had remission. Multivariate analysis identified the following factors as significant predictors of seizure outcome: the onset of JME at age <16 years, epileptiform runs ≥3 s runs, and febrile seizure. Conclusion The onset of JME at age <16 years, febrile seizures and epileptiform runs ≥3 s might be associated with poor long-term seizure outcome in patients with JME.
Collapse
Affiliation(s)
- Yiqian Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen 361004, People's Republic of China
| | - Jingzhen Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen 361004, People's Republic of China
| | - Xingyu Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen 361004, People's Republic of China
| | - Ru Wang
- Department of Neurology, Weinan Central Hospital, Weinan 714000, People's Republic of China
| | - Jianqi Zeng
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen 361004, People's Republic of China
| | - Feng Wang
- School of Computer Engineering, Jimei University, Xiamen 361021, People's Republic of China
| | - Jiayin Miao
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen 361004, People's Republic of China
| |
Collapse
|
22
|
McCarthy E, Shakil F, Saint Ange P, Morris Cameron E, Miller J, Pathak S, Greenberg DA, Velíšková J, Velíšek L. Developmental decrease in parvalbumin-positive neurons precedes increase in flurothyl-induced seizure susceptibility in the Brd2 +/- mouse model of juvenile myoclonic epilepsy. Epilepsia 2020; 61:892-902. [PMID: 32301507 DOI: 10.1111/epi.16499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE BRD2 is a human gene repeatedly linked to and associated with juvenile myoclonic epilepsy (JME). Here, we define the developmental stage when increased seizure susceptibility first manifests in heterozygous Brd2+/- mice, an animal model of JME. We wanted to determine (1) whether seizure susceptibility correlates with the proven decrease of γ-aminobutyric acidergic (GABAergic) neuron numbers and (2) whether the seizure phenotype can be affected by sex hormones. METHODS Heterozygous (Brd2+/-) and wild-type (wt) mice of both sexes were tested for flurothyl-induced seizure susceptibility at postnatal day 15 (P15; wt, n = 13; Brd2+/-, n = 20), at P30 (wt, n = 20; Brd2+/-, n = 20), and in adulthood (5-6 months of age; wt, n = 10; Brd2+/-, n = 12). We measured latency to clonic and tonic-clonic seizure onset (flurothyl threshold). We also compared relative density of parvalbumin-positive (PVA+) and GAD67+ GABA neurons in the striatum and primary motor (M1) neocortex of P15 (n = 6-13 mice per subgroup) and P30 (n = 7-10 mice per subgroup) mice. Additional neonatal Brd2+/- mice were injected with testosterone propionate (females) or formestane (males) and challenged with flurothyl at P30. RESULTS P15 Brd2+/- mice showed no difference in seizure susceptibility compared to P15 wt mice. However, even at this early age, Brd2+/- mice showed fewer PVA+ neurons in the striatum and M1 neocortex. Compared to wt, the striatum in Brd2+/- mice showed an increased proportion of immature PVA+ neurons, with smaller cell bodies and limited dendritic arborization. P30 Brd2+/- mice displayed increased susceptibility to flurothyl-induced clonic seizures compared to wt. Both genotype and sex strongly influenced the density of PVA+ neurons in the striatum. Susceptibility to clonic seizures remained increased in adult Brd2+/- mice, and additionally there was increased susceptibility to tonic-clonic seizures. In P30 females, neonatal testosterone reduced the number of flurothyl-induced clonic seizures. SIGNIFICANCE A decrease in striatal PVA+ GABAergic neurons developmentally precedes the onset of increased seizure susceptibility and likely contributes to the expression of the syndrome.
Collapse
Affiliation(s)
- Emily McCarthy
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York
| | - Faariah Shakil
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York
| | - Patrick Saint Ange
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York
| | - Emily Morris Cameron
- Department of Pediatrics, Wexner Medical Center, Ohio State University and Battelle Center for Mathematical Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - James Miller
- Department of Pediatrics, Wexner Medical Center, Ohio State University and Battelle Center for Mathematical Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Shilpa Pathak
- Department of Pediatrics, Wexner Medical Center, Ohio State University and Battelle Center for Mathematical Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - David A Greenberg
- Department of Pediatrics, Wexner Medical Center, Ohio State University and Battelle Center for Mathematical Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Jana Velíšková
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York.,Department of Obstetrics & Gynecology, New York Medical College, Valhalla, New York.,Department of Neurology, New York Medical College, Valhalla, New York
| | - Libor Velíšek
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York.,Department of Neurology, New York Medical College, Valhalla, New York.,Department of Pediatrics, New York Medical College, Valhalla, New York
| |
Collapse
|
23
|
Krämer G. Zur Geschichte des Janz-Syndroms (juvenile myoklonische Epilepsie). ZEITSCHRIFT FÜR EPILEPTOLOGIE 2020. [DOI: 10.1007/s10309-020-00319-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
24
|
Shilkina OS, Shnayder NA, Zobova SN, Dmitrenko DV, Moskaleva PV. Association of the carriage of BRD2 rs206787 and rs516535 and GJD2 rs3743123 polymorphisms with juvenile myoclonic epilepsy in Caucasian patients of Siberia. ACTA ACUST UNITED AC 2019. [DOI: 10.14412/2074-2711-2019-4-61-67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In recent years, the genetics of juvenile myoclonic epilepsy (JME) has been actively studied; the association of JME with the carriage of polymorphic allelic variants of the BRD2 (EJM3 locus) and GJD2 (EJM2 locus) genes has been established. Objective: to establish risk factors for JME in terms of a genetic predisposition; specifically, polymorphic allelic variants rs206787 and rs516535 in the BRD2 gene and rs3743123 in the GJD2 gene. Patients and methods: Examinations were made in 79 patients with JME and in 150 healthy volunteers, who were Caucasian and resided in the Siberian Federal District (SFD) and underwent determination of the carriage of single nucleotide polymorphisms (SNPs) rs206787 and rs516535 in the BRD2 gene and rs3743123 in the GJD2 gene by real-time polymerase chain reaction. Results and discussion. In 2003, American scientists from New York showed that the alleles associated with the development of JME with an autosomal recessive inheritance pattern might be located in the BRD2 gene. Patients with JME are assumed to have an autosomal dominant inheritance pattern of mutations in the BRD2 gene. British scientists revealed that different populations were found to have an association of SNP rs3918149 and no relationship of BRD2 rs206787 to the development of JME in Caucasians, as well as ascertained local linkage disequilibrium in the BRD2 gene. Our investigation has established complete linkage disequilibrium between the loci in patients with JME and in healthy individuals and no association of the carriage of SNPs rs206787 and rs516535 in the BRD2 gene with the development of JME in the patients residing in the SFD (p >0.05). German scientists studied the impact of SNP in the BRD2 gene on a predisposition to a photoparoxysmal response in patients with JME/genetic generalized epilepsy. Our investigation has indicated the association of the carriage of TT/TT haplotype for SNP rs206787 and rs516535 in the BRD2 gene with a photoparoxysmal response in patients with JME (odds ratio (OR), 3.6; 95% confidence interval (CI), 1.37–9.48; p=0.02). We have confirmed that in the studied sample, the carriage of the T allele in the GJD2 gene (rs3743123) in the homozygous form is associated with the development of JME in Caucasian patients residing in the SFD and is a risk factor for JME (OR, 2.66; 95% CI, 1.24–5.74; p=0.04). The clinically significant association of this SNP in the GJD2 gene with the development of JME had been also previously demonstrated in two independent studies conducted in the European populations in the UK and Germany. There is a rise in the proportion of homozygotes in JME patients versus the control group, suggesting that the 588T allele under consideration increases the risk for JME in the homozygous state in the autosomal recessive inheritance pattern. Conclusion. The findings suggest that it is necessary to genotype Caucasian patients with JME, who reside in Siberia, for determination of the carriage of the TT/TT haplotype in terms of the investigated SNPs in the BRD2 gene (EJM 3 locus) and the carriage the T allele (rs3743123) in the GJD2 gene via a personalized approach to predicting the course of JME, as well as for identification of persons at risk for JME in the families having a history of this disease.
Collapse
Affiliation(s)
- O. S. Shilkina
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia
| | - N. A. Shnayder
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia;
V.M. Bekhterev National Medical Research Center of Psychiatry and Neurology, Ministry of Health of Russia
| | - S. N. Zobova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia;
Research Institute of Medical Problems of the North (Separate Subdivision), Federal Research Center «Krasnoyarsk Research Center, Siberian Branch, Russian Academy of Sciences»
| | - D. V. Dmitrenko
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia
| | - P. V. Moskaleva
- V.M. Bekhterev National Medical Research Center of Psychiatry and Neurology, Ministry of Health of Russia
| |
Collapse
|
25
|
Kang SY, Koo CM, Kim SH, Kim HD, Lee JS, Kang HC. Prognostic Factors for Absence Epilepsy in Childhood. ANNALS OF CHILD NEUROLOGY 2019. [DOI: 10.26815/acn.2019.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
26
|
Gilsoul M, Grisar T, Delgado-Escueta AV, de Nijs L, Lakaye B. Subtle Brain Developmental Abnormalities in the Pathogenesis of Juvenile Myoclonic Epilepsy. Front Cell Neurosci 2019; 13:433. [PMID: 31611775 PMCID: PMC6776584 DOI: 10.3389/fncel.2019.00433] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/09/2019] [Indexed: 12/17/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME), a lifelong disorder that starts during adolescence, is the most common of genetic generalized epilepsy syndromes. JME is characterized by awakening myoclonic jerks and myoclonic-tonic-clonic (m-t-c) grand mal convulsions. Unfortunately, one third of JME patients have drug refractory m-t-c convulsions and these recur in 70-80% who attempt to stop antiepileptic drugs (AEDs). Behavioral studies documented impulsivity, but also impairment of executive functions relying on organization and feedback, which points to prefrontal lobe dysfunction. Quantitative voxel-based morphometry (VBM) revealed abnormalities of gray matter (GM) volumes in cortical (frontal and parietal) and subcortical structures (thalamus, putamen, and hippocampus). Proton magnetic resonance spectroscopy (MRS) found evidence of dysfunction of thalamic neurons. White matter (WM) integrity was disrupted in corpus callosum and frontal WM tracts. Magnetic resonance imaging (MRI) further unveiled anomalies in both GM and WM structures that were already present at the time of seizure onset. Aberrant growth trajectories of brain development occurred during the first 2 years of JME diagnosis. Because of genetic origin, disease causing variants were sought, first by positional cloning, and most recently, by next generation sequencing. To date, only six genes harboring pathogenic variants (GABRA1, GABRD, EFHC1, BRD2, CASR, and ICK) with Mendelian and complex inheritance and covering a limited proportion of the world population, are considered as major susceptibility alleles for JME. Evidence on the cellular role, developmental and cell-type expression profiles of these six diverse JME genes, point to their pathogenic variants driving the first steps of brain development when cell division, expansion, axial, and tangential migration of progenitor cells (including interneuron cortical progenitors) sculpture subtle alterations in brain networks and microcircuits during development. These alterations may explain "microdysgenesis" neuropathology, impulsivity, executive dysfunctions, EEG polyspike waves, and awakening m-t-c convulsions observed in JME patients.
Collapse
Affiliation(s)
- Maxime Gilsoul
- GIGA-Stem Cells, University of Liège, Liège, Belgium
- GIGA-Neurosciences, University of Liège, Liège, Belgium
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Thierry Grisar
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Antonio V. Delgado-Escueta
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Epilepsy Genetics/Genomics Lab, Neurology and Research Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Laurence de Nijs
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Bernard Lakaye
- GIGA-Stem Cells, University of Liège, Liège, Belgium
- GIGA-Neurosciences, University of Liège, Liège, Belgium
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
27
|
Silvennoinen K, de Lange N, Zagaglia S, Balestrini S, Androsova G, Wassenaar M, Auce P, Avbersek A, Becker F, Berghuis B, Campbell E, Coppola A, Francis B, Wolking S, Cavalleri GL, Craig J, Delanty N, Johnson MR, Koeleman BPC, Kunz WS, Lerche H, Marson AG, O’Brien TJ, Sander JW, Sills GJ, Striano P, Zara F, van der Palen J, Krause R, Depondt C, Sisodiya SM. Comparative effectiveness of antiepileptic drugs in juvenile myoclonic epilepsy. Epilepsia Open 2019; 4:420-430. [PMID: 31440723 PMCID: PMC6698679 DOI: 10.1002/epi4.12349] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/11/2019] [Accepted: 06/22/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To study the effectiveness and tolerability of antiepileptic drugs (AEDs) commonly used in juvenile myoclonic epilepsy (JME). METHODS People with JME were identified from a large database of individuals with epilepsy, which includes detailed retrospective information on AED use. We assessed secular changes in AED use and calculated rates of response (12-month seizure freedom) and adverse drug reactions (ADRs) for the five most common AEDs. Retention was modeled with a Cox proportional hazards model. We compared valproate use between males and females. RESULTS We included 305 people with 688 AED trials of valproate, lamotrigine, levetiracetam, carbamazepine, and topiramate. Valproate and carbamazepine were most often prescribed as the first AED. The response rate to valproate was highest among the five AEDs (42.7%), and significantly higher than response rates for lamotrigine, carbamazepine, and topiramate; the difference to the response rate to levetiracetam (37.1%) was not significant. The rates of ADRs were highest for topiramate (45.5%) and valproate (37.5%). Commonest ADRs included weight change, lethargy, and tremor. In the Cox proportional hazards model, later start year (1.10 [1.08-1.13], P < 0.001) and female sex (1.41 [1.07-1.85], P = 0.02) were associated with shorter trial duration. Valproate was associated with the longest treatment duration; trials with carbamazepine and topiramate were significantly shorter (HR [CI]: 3.29 [2.15-5.02], P < 0.001 and 1.93 [1.31-2.86], P < 0.001). The relative frequency of valproate trials shows a decreasing trend since 2003 while there is an increasing trend for levetiracetam. Fewer females than males received valproate (76.2% vs 92.6%, P = 0.001). SIGNIFICANCE In people with JME, valproate is an effective AED; levetiracetam emerged as an alternative. Valproate is now contraindicated in women of childbearing potential without special precautions. With appropriate selection and safeguards in place, valproate should remain available as a therapy, including as an alternative for women of childbearing potential whose seizures are resistant to other treatments.
Collapse
Affiliation(s)
- Katri Silvennoinen
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
| | - Nikola de Lange
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgBelvauxLuxembourg
| | - Sara Zagaglia
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
- Department of Experimental and Clinical MedicinePolytechnic University of MarcheAnconaItaly
| | - Simona Balestrini
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
- Department of Experimental and Clinical MedicinePolytechnic University of MarcheAnconaItaly
| | - Ganna Androsova
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgBelvauxLuxembourg
| | - Merel Wassenaar
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Pauls Auce
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
- The Walton Centre NHS Foundation TrustLiverpoolUK
| | - Andreja Avbersek
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Felicitas Becker
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Bianca Berghuis
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | | | - Antonietta Coppola
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
- Department of Neuroscience, Reproductive and Odontostomatological SciencesFederico II UniversityNaplesItaly
| | - Ben Francis
- Department of BiostatisticsUniversity of LiverpoolLiverpoolUK
| | - Stefan Wolking
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | | | - John Craig
- Belfast Health and Social Care TrustBelfastUK
| | - Norman Delanty
- Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
- Department of NeurologyBeaumont HospitalDublinIreland
| | | | | | | | - Holger Lerche
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Anthony G. Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
- The Walton Centre NHS Foundation TrustLiverpoolUK
| | - Terence J. O’Brien
- Departments of Neuroscience and Neurology, Central Clinical SchoolMonash University, The Alfred HospitalMelbourneVic.Australia
| | - Josemir W. Sander
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Graeme J. Sills
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto G. GasliniGenovaItaly
| | - Federico Zara
- Laboratory of Neurogenetics and NeuroscienceIRCCS Istituto G. GasliniGenovaItaly
| | | | - Roland Krause
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgBelvauxLuxembourg
| | - Chantal Depondt
- Department of NeurologyHôpital Erasme, Université Libre de BruxellesBrusselsBelgium
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
| |
Collapse
|
28
|
Outcomes of low-dose valproic acid treatment in patients with juvenile myoclonic epilepsy. Seizure 2019; 70:43-48. [PMID: 31252363 DOI: 10.1016/j.seizure.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE There are conflicting data regarding the drug dose that is sufficient to achieve seizure control as well as the parameters of seizure remission in juvenile myoclonic epilepsy (JME). The present study aimed to identify factors that contribute to seizure control in JME and to evaluate factors associated with JME remission and the efficacy of low-dose valproic acid (VPA) therapy. METHODS This retrospective, cross-sectional study included a total of 215 patients (121 female and 94 male; mean age: 28.03 ± 8.43 [14-59] years) diagnosed with JME. The patients were divided into remission and refractory groups. Remission was defined as a seizure-free (myoclonic, absence, and/or generalized tonic-clonic) period of at least 2 years. Patients in whom remission was achieved with VPA monotherapy were further divided into two groups according to the use of low-dose VPA therapy (VPA ≤ 750 mg/day and >750 mg/day). Potential contributing factors were evaluated in terms of the relationship between the dose and the remission parameters. RESULTS Remission was achieved with VPA monotherapy in 116 patients (87.9%) in the remission group; the VPA dose was ≤750 mg in 77.6% of the patients. The dose of VPA was higher in patients with absence seizure who achieved remission (p = 0.026). Remission was achieved with a lower dose of VPA in females than in males (p = 0.004). CONCLUSIONS Low-dose VPA can be used to achieve remission in JME. However, identification at follow-up visits of the factors that may affect remission may change the planned effective dose of VPA.
Collapse
|
29
|
Zhang Y, Chen J, Ren J, Liu W, Yang T, Zhou D. Clinical features and treatment outcomes of Juvenile myoclonic epilepsy patients. Epilepsia Open 2019; 4:302-308. [PMID: 31168497 PMCID: PMC6546016 DOI: 10.1002/epi4.12321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 03/30/2019] [Accepted: 04/04/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical features and treatment outcomes of patients with juvenile myoclonic epilepsy (JME) in western China. METHOD We continuously reviewed one hundred and five outpatients with JME who were diagnosed and treated at the Epilepsy Registration Center of West China Hospital between October 2012 and July 2014. Seizure control stratified into different seizure types and by antiepileptic drugs (AEDs) was prospectively evaluated every 3-6 months. RESULTS Among 105 patients with JME, eighty-five patients (81%) received monotherapy including valproate (VPA, 47%) and levetiracetam (LEV, 43%) treatment. The rates of seizure freedom 1, 3, and 5 years after the initiation of AED treatment were 64.8% (68/105), 29.5% (31/105), and 14.6% (12/82) in JME patients, respectively. Patients with myoclonic seizure (MS) and absence seizure (AS) were less frequently seizure-free than those with MS and generalized tonic-clonic seizure (GTCS) (P = 0.012). Patients on VPA monotherapy had better control of GTCS than patients on LEV monotherapy (P = 0.036). There is a trend of lower rates of seizure freedom in patients treated with LEV than in those treated with VPA after the first-year treatment period. SIGNIFICANCE Our data suggest that in JME, seizure control is linked to seizure type, possibly allowing a more individualized approach when counseling JME patients.
Collapse
Affiliation(s)
- Yingying Zhang
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| | - Jiani Chen
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| | - Jiechuan Ren
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Wenyu Liu
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| | - Tianhua Yang
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| | - Dong Zhou
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| |
Collapse
|
30
|
Represa A. Why Malformations of Cortical Development Cause Epilepsy. Front Neurosci 2019; 13:250. [PMID: 30983952 PMCID: PMC6450262 DOI: 10.3389/fnins.2019.00250] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
Malformations of cortical development (MCDs), a complex family of rare disorders, result from alterations of one or combined developmental steps, including progenitors proliferation, neuronal migration and differentiation. They are an important cause of childhood epilepsy and frequently associate cognitive deficits and behavioral alterations. Though the physiopathological mechanisms of epilepsy in MCD patients remain poorly elucidated, research during the past decade highlighted the contribution of some factors that will be reviewed in this paper and that include: (i) the genes that caused the malformation, that can be responsible for a significant reduction of inhibitory cells (e.g., ARX gene) or be inducing cell-autonomous epileptogenic changes in affected neurons (e.g., mutations on the mTOR pathway); (ii) the alteration of cortical networks development induced by the malformation that will also involve adjacent or distal cortical areas apparently sane so that the epileptogenic focus might be more extended that the malformation or even localized at distance from it; (iii) the normal developmental processes that would influence and determine the onset of epilepsy in MCD patients, particularly precocious in most of the cases.
Collapse
Affiliation(s)
- Alfonso Represa
- INSERM, Institut de Neurobiologie de la Méditerranée, Aix-Marseille University, Marseille, France
| |
Collapse
|
31
|
Garcia DDS, Polydoro MS, Alvim MKM, Ishikawa A, Moreira JCV, Nogueira MH, Zanão TA, de Campos BM, Betting LEGG, Cendes F, Yasuda CL. Anxiety and depression symptoms disrupt resting state connectivity in patients with genetic generalized epilepsies. Epilepsia 2019; 60:679-688. [PMID: 30854641 DOI: 10.1111/epi.14687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To analyze the lifetime trajectories in genetic generalized epilepsies (GGEs) and investigate the impact of symptoms of anxiety and depression on resting state functional connectivity (FC). METHODS Seventy-four GGE patients were classified according to the pharmacological response as seizure-free (12 patients), pharmacoresistant (PhR; 14 patients), and fluctuating (FL; 48 patients). Fifty-four subjects completed both the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and 38 also underwent 3-T resting state functional magnetic resonance imaging. These 38 patients were subdivided into a positive group (13 patients with concurrent symptoms of depression and anxiety) and a negative group (21 asymptomatic patients and four with mild anxiety or depression symptoms). For FC analysis of resting state networks, we matched 38 healthy asymptomatic volunteers and used the UF2C toolbox running on MATLAB2017/SPM12. RESULTS The PhR group presented shorter duration of epilepsy (P = 0.016) and follow-up (P < 0.001) compared to the FL group. The PhR group showed higher levels (median = 20) on the BAI and BDI. Myoclonic seizures were the most difficult to control, as 50% of subjects persisted with them at last appointment, compared to generalized tonic-clonic seizures and absence seizures (<40%). Patients with concurrent anxiety and depression symptoms were 7.7 times more likely to exhibit pharmacoresistant seizures, although an increase of 1 year of epilepsy duration was associated with a decrease in the odds of presenting pharmacoresistance by a factor of 0.9. Overall, FC was altered between default mode network (DMN) and visuospatial/dorsal attention. However, only the positive group displayed abnormal FC between DMN and left executive control network, and between salience and visuospatial/dorsal attention. SIGNIFICANCE Our findings may help clinicians to have a better understanding of GGE clinical course and increase attention to the potential relationship of psychopathologies and brain connectivity.
Collapse
Affiliation(s)
| | | | - Marina Kutsodontis Machado Alvim
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| | - Akari Ishikawa
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil
| | | | | | | | | | | | - Fernando Cendes
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| | - Clarissa L Yasuda
- Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| |
Collapse
|
32
|
Stevelink R, Koeleman BPC, Sander JW, Jansen FE, Braun KPJ. Refractory juvenile myoclonic epilepsy: a meta-analysis of prevalence and risk factors. Eur J Neurol 2018; 26:856-864. [PMID: 30223294 PMCID: PMC6586162 DOI: 10.1111/ene.13811] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/12/2018] [Indexed: 01/12/2023]
Abstract
Background and purpose Juvenile myoclonic epilepsy (JME) is a common epilepsy syndrome for which treatment response is generally assumed to be good. We aimed to determine the prevalence and prognostic risk factors for refractoriness of JME. Methods We systematically searched PubMed and EMBASE and included 43 eligible studies, reporting seizure outcome after antiepileptic drug (AED) treatment in JME cohorts. We defined refractory JME as persistence of any seizure despite AED treatment and performed a random‐effects meta‐analysis to assess the prevalence of refractory JME and of seizure recurrence after AED withdrawal in individuals with well‐controlled seizures. Studies reporting potential prognostic risk factors in relation to seizure outcome were included for subsequent meta‐analysis of risk factors for refractoriness. Results Overall, 35% (95% confidence interval, 29–41%) of individuals (n = 3311) were refractory. There was marked heterogeneity between studies. Seizures recurred in 78% (95% confidence interval, 52–94%) of individuals who attempted to withdraw from treatment after a period of seizure freedom (n = 246). Seizure outcome by publication year suggested that prognosis did not improve over time. Meta‐analysis suggested six variables as prognostic factors for refractoriness, i.e. having three seizure types, absence seizures, psychiatric comorbidities, earlier age at seizure onset, history of childhood absence epilepsy and praxis‐induced seizures. Conclusion One‐third of people with JME were refractory, which is a higher prevalence than expected. Risk factors were identified and can be used to guide treatment and counselling of people with JME.
Collapse
Affiliation(s)
- R Stevelink
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht.,Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht
| | - B P C Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht
| | - J W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - F E Jansen
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
| | - K P J Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
| |
Collapse
|
33
|
Rzezak P, Moschetta SP, Mendonça M, Paiva MLMN, Coan AC, Guerreiro C, Valente KDR. Higher IQ in juvenile myoclonic epilepsy: Dodging cognitive obstacles and "masking" impairments. Epilepsy Behav 2018; 86:124-130. [PMID: 30017836 DOI: 10.1016/j.yebeh.2018.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022]
Abstract
Executive deficits and impulsiveness are extensively reported in juvenile myoclonic epilepsy (JME). Previous literature suggests that intelligence may mediate these deficits. In this study, we evaluated and compared the performance of adults with JME with high and low intelligence quotient (IQ) and controls on tasks for executive function (EF) and impulsive traits. We investigated the neuropsychological performance of 53 adults with JME and below average IQ (57% women; 26.9 [±7.88] years; mean IQ: 89.8 [±5.1]), 26 adults with JME and average or above average IQ (53.8% women; 28.2 [±9.33] years; mean IQ: 110.7 [±8.3]), 38 controls with below average IQ (55% women; 28.4 [±8.4] years; mean IQ: 90.1 [±5.8]), and 31 controls with average or above average IQ (61.3% women; 32.20 [±11.3] years; mean IQ: 111.6 [±10.5]) with a comprehensive battery of neuropsychological tests that measure executive/attentional function. Impulsive traits were assessed using the Cloninger et al.'s Temperament and Character Inventory (novelty seeking (NS) domain). The group with JME with higher IQ presented worse performance compared with controls with higher IQ on Controlled Oral Word Association (COWA) and Wisconsin Card Sorting Test (WCST) (errors). This group showed worse performance than controls with lower IQ on Stroop Color-Word Test (SCT) 1, Trail Making (TM) A, COWA, and WCST (errors). Patients with lower IQ showed worse performance than controls with higher IQ on Digit Span Forward (DSF), Digit Span Backward (DSB), SCT1, SCT2, SCT3, TM A, COWA, and WCST (errors and failure to maintain set). Patients with lower IQ showed worse performance than controls with lower IQ on DSF, DSB, SCT1, SCT2, SCT3, TM A, TM B, COWA, and WCST (errors and failure to maintain set). Patients from groups with low and high IQ showed higher scores than controls with higher and lower IQ on impulsivity for NS1 and NS2 (except for patients with higher IQ versus controls with lower IQ). Adults with JME and higher IQ show less evidence of EF deficits compared with those with JME and below average IQ, suggesting that a higher degree of intellectual efficiency may act as a compensatory mechanism. However, it does not minimize some aspects of impulsive traits. Patients with JME and higher cognitive reserve may create strategies to dodge their cognitive obstacles. In this context, intelligence may protect and, at the same time, "mask" impairments that could be detected earlier.
Collapse
Affiliation(s)
- Patricia Rzezak
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy-Clinics Hospital, University of São Paulo (USP), Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo (USP), Brazil.
| | - Sylvie Paes Moschetta
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil
| | - Melanie Mendonça
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil
| | - Maria Luisa Maia Nobre Paiva
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil
| | - Ana Carolina Coan
- Department of Neurology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Carlos Guerreiro
- Department of Neurology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Kette Dualibi Ramos Valente
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy-Clinics Hospital, University of São Paulo (USP), Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo (USP), Brazil
| |
Collapse
|
34
|
Relapse after treatment withdrawal of antiepileptic drugs for Juvenile Absence Epilepsy and Juvenile Myoclonic Epilepsy. Seizure 2018; 59:116-122. [DOI: 10.1016/j.seizure.2018.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 05/17/2018] [Accepted: 05/19/2018] [Indexed: 11/23/2022] Open
|
35
|
Cação G, Parra J, Mannan S, Sisodiya SM, Sander JW. Juvenile myoclonic epilepsy refractory to treatment in a tertiary referral center. Epilepsy Behav 2018; 82:81-86. [PMID: 29602081 DOI: 10.1016/j.yebeh.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Juvenile myoclonic epilepsy (JME) is an epileptic syndrome often regarded as one in which seizures are relatively easy to control. Individuals with JME, however, often require lifelong therapy to remain seizure-free, and a few have refractory epilepsy. We ascertained a population with JME and characterized a subgroup with refractory epilepsy. MATERIAL AND METHODS We audited and reviewed clinical records of individuals diagnosed with JME identified via a sample of 6600 individuals in a clinical database from a specialized epilepsy clinic at a tertiary referral center. RESULTS We identified 240 people with a diagnosis of JME (146 females), with a mean age at seizure onset of 14.2years (SD: 4.5), and a mean age at diagnosis of 15.6years (SD: 4.9). Clinical phenotypes seen were classic JME phenotype (88%), childhood absence epilepsy evolving into JME (6%), JME with adolescent absences (4%), and JME with astatic seizures (2%). More than a quarter (28%) had a family history of epilepsy. The most commonly used antiepileptic drug (AED) was sodium valproate in 78% of individuals, followed by levetiracetam (64%) and lamotrigine (55%). In the previous year, 47.5% were seizure-free. Using the International League against Epilepsy (ILAE) definitions and considering National Institute for Health and Care Excellence (NICE)-recommended AEDs for this syndrome, 121 individuals (50.4%) were identified as having refractory epilepsy. DISCUSSION Juvenile myoclonic epilepsy is often regarded as a benign epileptic syndrome, but in this setting, half of the individuals with JME have refractory epilepsy with only about a quarter of those seizure-free in the previous year. Despite some advances in the understanding of this syndrome, there is still much to do before we can offer all the best outcomes.
Collapse
Affiliation(s)
- Gonçalo Cação
- Neurology Department, Centro Hospitalar do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Joana Parra
- Neurology Department, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
| | - Shahidul Mannan
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Sanjay M Sisodiya
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 8ES, UK
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 8ES, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103SW Heemstede, Netherlands
| |
Collapse
|
36
|
Bailey JN, de Nijs L, Bai D, Suzuki T, Miyamoto H, Tanaka M, Patterson C, Lin YC, Medina MT, Alonso ME, Serratosa JM, Durón RM, Nguyen VH, Wight JE, Martínez-Juárez IE, Ochoa A, Jara-Prado A, Guilhoto L, Molina Y, Yacubian EM, López-Ruiz M, Inoue Y, Kaneko S, Hirose S, Osawa M, Oguni H, Fujimoto S, Grisar TM, Stern JM, Yamakawa K, Lakaye B, Delgado-Escueta AV. Variant Intestinal-Cell Kinase in Juvenile Myoclonic Epilepsy. N Engl J Med 2018. [PMID: 29539279 DOI: 10.1056/nejmoa1700175] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In juvenile myoclonic epilepsy, data are limited on the genetic basis of networks promoting convulsions with diffuse polyspikes on electroencephalography (EEG) and the subtle microscopic brain dysplasia called microdysgenesis. METHODS Using Sanger sequencing, we sequenced the exomes of six members of a large family affected with juvenile myoclonic epilepsy and confirmed cosegregation in all 37 family members. We screened an additional 310 patients with this disorder for variants on DNA melting-curve analysis and targeted real-time DNA sequencing of the gene encoding intestinal-cell kinase ( ICK). We calculated Bayesian logarithm of the odds (LOD) scores for cosegregating variants, odds ratios in case-control associations, and allele frequencies in the Genome Aggregation Database. We performed functional tests of the effects of variants on mitosis, apoptosis, and radial neuroblast migration in vitro and conducted video-EEG studies in mice lacking a copy of Ick. RESULTS A variant, K305T (c.914A→C), cosegregated with epilepsy or polyspikes on EEG in 12 members of the family affected with juvenile myoclonic epilepsy. We identified 21 pathogenic ICK variants in 22 of 310 additional patients (7%). Four strongly linked variants (K220E, K305T, A615T, and R632X) impaired mitosis, cell-cycle exit, and radial neuroblast migration while promoting apoptosis. Tonic-clonic convulsions and polyspikes on EEG resembling seizures in human juvenile myoclonic epilepsy occurred more often in knockout heterozygous mice than in wild-type mice (P=0.02) during light sleep with isoflurane anesthesia. CONCLUSIONS Our data provide evidence that heterozygous variants in ICK caused juvenile myoclonic epilepsy in 7% of the patients included in our analysis. Variant ICK affects cell processes that help explain microdysgenesis and polyspike networks observed on EEG in juvenile myoclonic epilepsy. (Funded by the National Institutes of Health and others.).
Collapse
Affiliation(s)
- Julia N Bailey
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Laurence de Nijs
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Dongsheng Bai
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Toshimitsu Suzuki
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Hiroyuki Miyamoto
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Miyabi Tanaka
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Christopher Patterson
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Yu-Chen Lin
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Marco T Medina
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - María E Alonso
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - José M Serratosa
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Reyna M Durón
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Viet H Nguyen
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Jenny E Wight
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Iris E Martínez-Juárez
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Adriana Ochoa
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Aurelio Jara-Prado
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Laura Guilhoto
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Yolly Molina
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Elsa M Yacubian
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Minerva López-Ruiz
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Yushi Inoue
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Sunao Kaneko
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Shinichi Hirose
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Makiko Osawa
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Hirokazu Oguni
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Shinji Fujimoto
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Thierry M Grisar
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - John M Stern
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Kazuhiro Yamakawa
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Bernard Lakaye
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| | - Antonio V Delgado-Escueta
- From the Epilepsy Genetics-Genomics Lab, Neurology and Research Services, Veterans Affairs Greater Los Angeles Healthcare System (J.N.B., D.B., M.T., C.P., Y.-C.L., J.M. Serratosa, R.M.D., V.H.N., J.E.W., A.V.D.-E.), the Department of Neurology, David Geffen School of Medicine at UCLA (D.B., M.T., J.M. Serratosa, J.M. Stern, A.V.D.-E.), and the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (J.N.B.), Los Angeles, and Chapman University, Irvine (V.H.N.) - all in California; Grappe Interdisciplinaire de Génoprotéomique Appliquée Neurosciences, University of Liege, Liege, Belgium (L.N., T.M.G., B.L.); RIKEN Brain Science Institute, Saitama (T.S., H.M., K.Y.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka (Y.I.), Hirosaki University Graduate School of Medicine, Hirosaki (S.K.), Fukuoka University, Fukuoka (S.H.), Tokyo Women's Medical University, Tokyo (M.O., H.O.), Nagoya City University, Nagoya (S.F.), and Tsutsujigaoka Children's Clinic, Aichi (S.F.) - all in Japan; National Autonomous University of Honduras (M.T.M., Y.M.) and Universidad Tecnológica Centroamericana (R.M.D.), Tegucigalpa; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (M.E.A., I.E.M.-J., A.O., A.J.-P.) and General Hospital of Mexico (M.L.-R.), Mexico City; Universidade Federal de São Paulo, São Paulo (L.G., E.M.Y.); and the Instituto de Investigación Sanitaria-Jiménez Díaz Foundation, Autonomous University of Madrid and Biomedical Research Network Center on Rare Diseases, Madrid (J.M. Serratosa)
| |
Collapse
|
37
|
Leite CDC, Valente KDR, Fiore LA, Otaduy MCG. Proton spectroscopy of the thalamus in a homogeneous sample of patients with easy-to-control juvenile myoclonic epilepsy. Radiol Bras 2017; 50:279-284. [PMID: 29085160 PMCID: PMC5656067 DOI: 10.1590/0100-3984.2016.0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Juvenile myoclonic epilepsy (JME) is a subtype of genetically determined
generalized epilepsy that does not present abnormalities on conventional
magnetic resonance imaging. The aim of this study was to identify metabolic
alterations in the thalamus in a clinically homogeneous sample of patients
with easy-to-control JME, using short-echo time proton magnetic resonance
spectroscopy (MRS). Materials and Methods We performed single-voxel (2 cm × 2 cm × 2 cm), short-echo time
(TE = 35 ms) proton MRS of the thalamus in 21 patients with JME and in 14
healthy age-matched controls. We quantified N-acetylaspartate (NAA), total
NAA, creatine (Cr), choline, and myo-inositol (MI), as well as the sum of
glutamate and glutamine signals, all scaled to internal water content, and
we calculated metabolite ratios using Cr as a reference. Values of
p < 0.05 were considered significant. Results The MI level and the MI/Cr ratio were significantly lower in the thalami of
patients diagnosed with JME than in those of the controls. Other metabolites
and their ratios did not differ significantly between the two groups. Conclusion In our sample of 21 JME patients, we identified lower levels of MI in the
thalamus. No significant abnormalities were observed in the concentrations
or ratios of other metabolites.
Collapse
Affiliation(s)
- Claudia da Costa Leite
- PhD, Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Kette Dualibi Ramos Valente
- PhD, Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Lia Arno Fiore
- PhD, Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Maria Concepción García Otaduy
- PhD, Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| |
Collapse
|
38
|
dos Santos BP, Marinho CRM, Marques TEBS, Angelo LKG, Malta MVDS, Duzzioni M, de Castro OW, Leite JP, Barbosa FT, Gitaí DLG. Genetic susceptibility in Juvenile Myoclonic Epilepsy: Systematic review of genetic association studies. PLoS One 2017; 12:e0179629. [PMID: 28636645 PMCID: PMC5479548 DOI: 10.1371/journal.pone.0179629] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 06/01/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Several genetic association investigations have been performed over the last three decades to identify variants underlying Juvenile Myoclonic Epilepsy (JME). Here, we evaluate the accumulating findings and provide an updated perspective of these studies. METHODOLOGY A systematic literature search was conducted using the PubMed, Embase, Scopus, Lilacs, epiGAD, Google Scholar and Sigle up to February 12, 2016. The quality of the included studies was assessed by a score and classified as low and high quality. Beyond outcome measures, information was extracted on the setting for each study, characteristics of population samples and polymorphisms. RESULTS Fifty studies met eligibility criteria and were used for data extraction. With a single exception, all studies used a candidate gene approach, providing data on 229 polymorphisms in or near 55 different genes. Of variants investigating in independent data sets, only rs2029461 SNP in GRM4, rs3743123 in CX36 and rs3918149 in BRD2 showed a significant association with JME in at least two different background populations. The lack of consistent associations might be due to variations in experimental design and/or limitations of the approach. CONCLUSIONS Thus, despite intense research evidence established, specific genetic variants in JME susceptibility remain inconclusive. We discussed several issues that may compromise the quality of the results, including methodological bias, endophenotype and potential involvement of epigenetic factors. PROSPERO REGISTRATION NUMBER CRD42016036063.
Collapse
Affiliation(s)
- Bruna Priscila dos Santos
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil
| | - Chiara Rachel Maciel Marinho
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil
| | | | - Layanne Kelly Gomes Angelo
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil
| | - Maísa Vieira da Silva Malta
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil
| | - Marcelo Duzzioni
- Department of Pharmacology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil
| | - Olagide Wagner de Castro
- Department of Physiology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil
| | - João Pereira Leite
- Division of Neurology, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Daniel Leite Góes Gitaí
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceio, Alagoas, Brazil
| |
Collapse
|
39
|
Baykan B, Wolf P. Juvenile myoclonic epilepsy as a spectrum disorder: A focused review. Seizure 2017; 49:36-41. [PMID: 28544889 DOI: 10.1016/j.seizure.2017.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 01/11/2023] Open
Abstract
In consequence of newer research juvenile myoclonic epilepsy (JME) is no longer seen as a homogeneous disease. The causes of the existing variance are only partially known yet. We discuss to what extent the phenotypical spectrum of this polygenetically determined disorder expresses genetically defined endophenotypes, or is due to mere quantitative differences in the expression of the core phenotype. Of the three common seizure types of JME, myoclonic, generalized tonic-clonic and absences, absences also occur independently and are strong candidates for an endophenotype. Focal features may in some patients be seen in clinical seizures or the EEG but rarely in both. They have no morphological correlates. In a system epilepsy, local manifestations are possible, and some are due to reflex mechanisms. Of the four reflex epileptic traits common in JME, photosensitivity and praxis induction appear related to basic mechanisms of the core syndrome, whereas language-induced orofacial reflex myocloni and eye closure sensitivity are also seen in other clinical contexts and therefore seem to represent endophenotypes. Cognitive abnormalities indicating slight frontal lobe dysfunction seem to be ubiquitous in JME and are also seen in unaffected siblings of patients. Cluster B personality disorder is found in 1/3 of patients, representing a more severe expression of the underlying pathology. Treatment response and prognosis seem to be affected by an interplay of the described factors producing the severest end of the JME spectrum. The spectrum appears to be due to an interaction of stronger or weaker expression of the core phenotype with various endophenotypes.
Collapse
Affiliation(s)
- Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Turkey.
| | - Peter Wolf
- Danish Epilepsy Centre, Kolonivej 1, 4293 Dianalund, Denmark; Programa de Pós-Graduação em Ciências Médicas, Universidad Federal de Santa Catarina, Florianópolis, SC, Brazil.
| |
Collapse
|
40
|
Vorderwülbecke BJ, Kowski AB, Kirschbaum A, Merkle H, Senf P, Janz D, Holtkamp M. Long-term outcome in adolescent-onset generalized genetic epilepsies. Epilepsia 2017; 58:1244-1250. [DOI: 10.1111/epi.13761] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bernd J. Vorderwülbecke
- Department of Neurology; Epilepsy-Center Berlin-Brandenburg; Charité - University Medicine Berlin; Berlin Germany
| | - Alexander B. Kowski
- Department of Neurology; Epilepsy-Center Berlin-Brandenburg; Charité - University Medicine Berlin; Berlin Germany
| | - Andrea Kirschbaum
- Department of Neurology; Epilepsy-Center Berlin-Brandenburg; Charité - University Medicine Berlin; Berlin Germany
| | - Hannah Merkle
- Department of Neurology; Epilepsy-Center Berlin-Brandenburg; Charité - University Medicine Berlin; Berlin Germany
| | - Philine Senf
- Department of Neurology; Epilepsy-Center Berlin-Brandenburg; Charité - University Medicine Berlin; Berlin Germany
| | - Dieter Janz
- Department of Neurology; Epilepsy-Center Berlin-Brandenburg; Charité - University Medicine Berlin; Berlin Germany
| | - Martin Holtkamp
- Department of Neurology; Epilepsy-Center Berlin-Brandenburg; Charité - University Medicine Berlin; Berlin Germany
| |
Collapse
|
41
|
Moura LMVR, Price M, Cole AJ, Hoch DB, Hsu J. Accuracy of claims-based algorithms for epilepsy research: Revealing the unseen performance of claims-based studies. Epilepsia 2017; 58:683-691. [PMID: 28199007 PMCID: PMC6592609 DOI: 10.1111/epi.13691] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate published algorithms for the identification of epilepsy cases in medical claims data using a unique linked dataset with both clinical and claims data. METHODS Using data from a large, regional health delivery system, we identified all patients contributing biologic samples to the health system's Biobank (n = 36K). We identified all subjects with at least one diagnosis potentially consistent with epilepsy, for example, epilepsy, convulsions, syncope, or collapse, between 2014 and 2015, or who were seen at the epilepsy clinic (n = 1,217), plus a random sample of subjects with neither claims nor clinic visits (n = 435); we then performed a medical chart review in a random subsample of 1,377 to assess the epilepsy diagnosis status. Using the chart review as the reference standard, we evaluated the test characteristics of six published algorithms. RESULTS The best-performing algorithm used diagnostic and prescription drug data (sensitivity = 70%, 95% confidence interval [CI] 66-73%; specificity = 77%, 95% CI 73-81%; and area under the curve [AUC] = 0.73, 95%CI 0.71-0.76) when applied to patients age 18 years or older. Restricting the sample to adults aged 18-64 years resulted in a mild improvement in accuracy (AUC = 0.75,95%CI 0.73-0.78). Adding information about current antiepileptic drug use to the algorithm increased test performance (AUC = 0.78, 95%CI 0.76-0.80). Other algorithms varied in their included data types and performed worse. SIGNIFICANCE Current approaches for identifying patients with epilepsy in insurance claims have important limitations when applied to the general population. Approaches incorporating a range of information, for example, diagnoses, treatments, and site of care/specialty of physician, improve the performance of identification and could be useful in epilepsy studies using large datasets.
Collapse
Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Maggie Price
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Andrew J Cole
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel B Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Departments of Health Care Policy and of Medicine, Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
42
|
Poleon S, Szaflarski JP. Photosensitivity in generalized epilepsies. Epilepsy Behav 2017; 68:225-233. [PMID: 28215998 DOI: 10.1016/j.yebeh.2016.10.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/26/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
Abstract
Photosensitivity, which is the hallmark of photosensitive epilepsy (PSE), is described as an abnormal EEG response to visual stimuli known as a photoparoxysmal response (PPR). The PPR is a well-recognized phenomenon, occurring in 2-14% of patients with epilepsy but its pathophysiology is not clearly understood. PPR is electrographically described as 2-5Hz spike, spike-wave, or slow wave complexes with frontal and paracentral prevalence. Diagnosis of PPR is confirmed using intermittent photic stimulation (IPS) as well as video monitoring. The PPR can be elicited by certain types of visual stimuli including flicker, high contrast gratings, moving patterns, and rapidly modulating luminance patterns which may be encountered during e.g., watching television, playing video games, or attending discotheques. Photosensitivity may present in different idiopathic (genetic) epilepsy syndromes e.g. juvenile myoclonic epilepsy (JME) as well as non-IGE syndromes e.g. severe myoclonic epilepsy of infancy. Consequently, PPR is present in patients with diverse seizure types including absence, myoclonic, and generalized tonic-clonic (GTC) seizures. Across syndromes, abnormalities in structural connectivity, functional connectivity, cortical excitability, cortical morphology, and behavioral and neuropsychological function have been reported. Treatment of photosensitivity includes antiepileptic drug administration, and the use of non-pharmacological agents, e.g. tinted or polarizing glasses, as well as occupational measures, e.g. avoidance of certain stimuli.
Collapse
Affiliation(s)
- Shervonne Poleon
- University of Alabama at Birmingham, Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA.
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham, Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA
| |
Collapse
|
43
|
Yacubian EM. Juvenile myoclonic epilepsy: Challenges on its 60th anniversary. Seizure 2017; 44:48-52. [DOI: 10.1016/j.seizure.2016.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/03/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022] Open
|
44
|
The topographical distribution of epileptic spikes in juvenile myoclonic epilepsy with and without photosensitivity. Clin Neurophysiol 2017; 128:176-182. [DOI: 10.1016/j.clinph.2016.10.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/01/2016] [Accepted: 10/08/2016] [Indexed: 11/17/2022]
|
45
|
Risk of seizure relapse after antiepileptic drug withdrawal in adult patients with focal epilepsy. Epilepsy Behav 2016; 64:233-238. [PMID: 27764734 DOI: 10.1016/j.yebeh.2016.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the risk of a seizure relapse and the high-risk period of recurrence after antiepileptic drug (AED) withdrawal and to determine the predictive factors for a seizure relapse in adult patients with focal epilepsy who were seizure-free for more than 2years. METHODS Using the Wenzhou Epilepsy Follow-Up Registry Database, 200 adult patients with focal epilepsy were recruited, who were undergoing follow-up, met the inclusion criteria of this study, were seizure-free for more than 2years, began withdrawing between June 2003 and June 2014, and were followed up prospectively for at least 1year or until a seizure relapse. The risk of recurrence and the time to seizure relapse were analyzed by the Kaplan-Meier method, and the predictive factors were identified by the Cox proportional hazard regression model. RESULT A total of 99 patients had an unprovoked relapse during the follow-up period. The relapse rate was 49.5%, and each year, the recurrence probability of 12, 24, 36, 48, 60, 72, and 84months after AED withdrawal was 24.0%, 20.4%, 8.3%, 2.7%, 4.6%, 0.97%, and 0.98%, respectively. The two independent risk factors for recurrence after withdrawal in adult patients with focal epilepsy were a longer duration of active epilepsy and a shorter seizure-free period before withdrawal. CONCLUSION The high-risk period of a seizure relapse in adult patients with focal epilepsy is the first 2years after withdrawal, and beyond 5years after withdrawal, seizures rarely relapse (relapse rate<1%). A seizure-free period for less than 4years before withdrawal is a predictive factor of risk for seizure recurrence after AED withdrawal in adult patients with focal epilepsy.
Collapse
|
46
|
Ding L, Gallagher MJ. Dynamics of sensorimotor cortex activation during absence and myoclonic seizures in a mouse model of juvenile myoclonic epilepsy. Epilepsia 2016; 57:1568-1580. [PMID: 27573707 DOI: 10.1111/epi.13493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Generalized epilepsy syndromes often confer multiple types of seizures, but it is not known if these seizures activate separate or overlapping brain networks. Recently, we reported that mice with a juvenile myoclonic epilepsy mutation (Gabra1[A322D]) exhibited both absence and myoclonic generalized seizures. Here, we determined the time course of sensorimotor cortex activation and the spatial distribution of spike voltage during these two seizures. METHODS We implanted Gabra1+/A322D mice with multiple electroencephalography (EEG) electrodes over bilateral somatosensory cortex barrel fields (S1) and anterior (aM1) and posterior (pM1) motor cortices and recorded absence seizures/spike-wave discharges (SWDs) and myoclonic seizures. We used nonlinear-association analyses and cross-correlation calculations to determine the strength, leading regions, and time delays of cortical coupling from the preictal to ictal states and within the spike and interspike periods. The distribution of spike voltage was also measured in SWDs and myoclonic seizures. RESULTS EEG connectivity among all electrode pairs increased at the onset of both SWDs and myoclonic seizures. Surprisingly, during spikes of both seizure types, S1 led M1 with similar delay times. Myoclonic seizure spikes started more focally than SWD spikes, with a significant majority appearing first only in S1 electrodes, whereas a substantial fraction of SWD spikes were detected first in S1 and at least one M1 electrode. The absolute voltage of myoclonic seizure spikes was significantly higher than that of SWD spikes, and there was a greater relative voltage over M1 during myoclonic seizure spikes than in the first one to two SWD spikes. SIGNIFICANCE The leading sites in S1 and similar delay times suggest both SWDs and myoclonic seizures activate overlapping networks in sensorimotor cortex and thus, therapeutically targeting of this network could potentially treat both seizures. Spike focality, absolute voltage, and voltage distribution provide insight into neuronal activation during these two seizure types.
Collapse
Affiliation(s)
- Li Ding
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Martin J Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
| |
Collapse
|
47
|
Hernández-Vanegas LE, Jara-Prado A, Ochoa A, Rodríguez NRY, Durón RM, Crail-Meléndez D, Alonso ME, Delgado-Escueta AV, Martínez-Juárez IE. High-dose versus low-dose valproate for the treatment of juvenile myoclonic epilepsy: Going from low to high. Epilepsy Behav 2016; 61:34-40. [PMID: 27300146 PMCID: PMC4985524 DOI: 10.1016/j.yebeh.2016.04.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 01/25/2023]
Abstract
Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy accounting for 3-12% of adult cases of epilepsy. Valproate has proven to be the first-choice drug in JME for controlling the most common seizure types: myoclonic, absence, and generalized tonic-clonic (GTC). In this retrospective study, we analyzed seizure outcome in patients with JME using valproate monotherapy for a minimum period of one year. Low valproate dose was considered to be 1000mg/day or lower, while serum levels were considered to be low if they were at or below 50mcg/dl. One hundred three patients met the inclusion criteria. Fifty-six patients (54.4%) were female. The current average age was 28.4±7.4years, while the age of epilepsy onset was 13.6±2.9years. Most patients corresponded to the subsyndrome of classic JME. Forty-six (44.7%) patients were free from all seizure types, and 76 (73.7%) patients were free from GTC seizures. No significant difference was found in seizure freedom among patients using a low dose of valproate versus a high dose (p=0.535) or among patients with low blood levels versus high blood levels (p=0.69). In patients with JME, it seems appropriate to use low doses of valproate (500mg to 1000mg) for initial treatment and then to determine if freedom from seizures was attained.
Collapse
Affiliation(s)
| | - Aurelio Jara-Prado
- National Institute of Neurology and Neurosurgery of Mexico, Neurogenetics and Molecular Biology Department
| | - Adriana Ochoa
- National Institute of Neurology and Neurosurgery of Mexico, Neurogenetics and Molecular Biology Department
| | | | - Reyna M. Durón
- Universidad Tecnológica Centroamericana (UNITEC), Tegucigalpa, Honduras
| | | | - Ma. Elisa Alonso
- National Institute of Neurology and Neurosurgery of Mexico, Neurogenetics and Molecular Biology Department
| | - Antonio V. Delgado-Escueta
- Epilepsy Genetics/Genomics Laboratories and Epilepsy Center of Excellence, Neurology and Research Services, VA GLAHS and David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Iris E. Martínez-Juárez
- National Institute of Neurology and Neurosurgery, Mexico City, Insurgentes Sur 3877, Col. La Fama, Del. Tlalpan, Mexico City 14269, Mexico. Telephone: +5255-56063822 ext. 2052
| |
Collapse
|
48
|
Stagi S, Lasorella S, Piccorossi A, Iapadre G, Verrotti A. Cessation of epilepsy therapy in children. Expert Rev Neurother 2016; 16:549-59. [DOI: 10.1586/14737175.2016.1168296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
49
|
Park KM, Kim TH, Han YH, Mun CW, Shin KJ, Ha SY, Park JS, Kim SE. Brain morphology in juvenile myoclonic epilepsy and absence seizures. Acta Neurol Scand 2016; 133:111-118. [PMID: 25950250 DOI: 10.1111/ane.12436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We evaluated the differences in brain morphology among patients with juvenile myoclonic epilepsy according to the occurrence of absence seizures. MATERIALS AND METHODS Twenty-one juvenile myoclonic epilepsy patients with (n = 6) and without (n = 15) absence seizures were enrolled. We analyzed whole-brain T1-weighted magnetic resonance imaging using FreeSurfer 5.1. Measures of cortical morphology, such as thickness, surface area, volume, and curvature, and the volumes of subcortical structures, the cerebellum, and cerebrum, were compared between the groups. Moreover, we quantified correlations between clinical variables and each measures of abnormal brain morphology. RESULTS Compared to normal controls, patients without absence seizures demonstrated thinning of the cortical thickness in the right hemisphere, including the post-central, lingual, orbitofrontal, and lateral occipital cortex. Compared to normal controls, patients with absence seizures had more widespread thinning of the cortical thickness, including the right post-central, lingual, orbitofrontal, and lateral occipital cortexes as well as the right inferior temporal cortex. Additionally, the volume of cerebellar white matter in patients without absence seizures was significantly smaller than that in normal controls. Patients with absence seizures had a much smaller cerebellar white matter volume than normal controls or patients without absence seizures. Moreover, there was significantly positive correlation between the age of seizure onset and the volume of cerebellar white matter in patients with juvenile myoclonic epilepsy. CONCLUSIONS We demonstrated that there were significant brain morphology differences in patients with juvenile myoclonic epilepsy according to the presence of absence seizures. These findings support the hypothesis that juvenile myoclonic epilepsy may be a heterogeneous syndrome.
Collapse
Affiliation(s)
- K. M. Park
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - T. H. Kim
- Department of Health Science and Technology; Inje University; Gimhae Korea
| | - Y. H. Han
- Centre for Molecular and Cellular Imaging; Samsung Biomedical Research Institute; Seoul Korea
| | - C. W. Mun
- Department of Health Science and Technology; Inje University; Gimhae Korea
- Department of Biomedical Engineering/u-HARC; Inje University; Gimhae Korea
| | - K. J. Shin
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - S. Y. Ha
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - J. S. Park
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - S. E. Kim
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| |
Collapse
|
50
|
Wight JE, Nguyen VH, Medina MT, Patterson C, Durón RM, Molina Y, Lin YC, Martínez-Juárez IE, Ochoa A, Jara-Prado A, Tanaka M, Bai D, Aftab S, Bailey JN, Delgado-Escueta AV. Chromosome loci vary by juvenile myoclonic epilepsy subsyndromes: linkage and haplotype analysis applied to epilepsy and EEG 3.5-6.0 Hz polyspike waves. Mol Genet Genomic Med 2016; 4:197-210. [PMID: 27066514 PMCID: PMC4799870 DOI: 10.1002/mgg3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME), the most common genetic epilepsy, remains enigmatic because it is considered one disease instead of several diseases. We ascertained three large multigenerational/multiplex JME pedigrees from Honduras with differing JME subsyndromes, including Childhood Absence Epilepsy evolving to JME (CAE/JME; pedigree 1), JME with adolescent onset pyknoleptic absence (JME/pA; pedigree 2), and classic JME (cJME; pedigree 3). All phenotypes were validated, including symptomatic persons with various epilepsies, asymptomatic persons with EEG 3.5-6.0 Hz polyspike waves, and asymptomatic persons with normal EEGs. Two-point parametric linkage analyses were performed with 5185 single-nucleotide polymorphisms on individual pedigrees and pooled pedigrees using four diagnostic models based on epilepsy/EEG diagnoses. Haplotype analyses of the entire genome were also performed for each individual. In pedigree 1, haplotyping identified a 34 cM region in 2q21.2-q31.1 cosegregating with all affected members, an area close to 2q14.3 identified by linkage (Z max = 1.77; pedigree 1). In pedigree 2, linkage and haplotyping identified a 44 cM cosegregating region in 13q13.3-q31.2 (Z max = 3.50 at 13q31.1; pooled pedigrees). In pedigree 3, haplotyping identified a 6 cM cosegregating region in 17q12. Possible cosegregation was also identified in 13q14.2 and 1q32 in pedigree 3, although this could not be definitively confirmed due to the presence of uninformative markers in key individuals. Differing chromosome regions identified in specific JME subsyndromes may contain separate JME disease-causing genes, favoring the concept of JME as several distinct diseases. Whole-exome sequencing will likely identify a CAE/JME gene in 2q21.2-2q31.1, a JME/pA gene in 13q13.3-q31.2, and a cJME gene in 17q12.
Collapse
Affiliation(s)
- Jenny E Wight
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia
| | - Viet-Huong Nguyen
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia
| | - Marco T Medina
- GENESS International ConsortiumLos AngelesCalifornia; National Autonomous University of HondurasTegucigalpaHonduras
| | - Christopher Patterson
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia
| | - Reyna M Durón
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia; National Autonomous University of HondurasTegucigalpaHonduras; Universidad Tecnológica Centroamericana (UNITEC)TegucigalpaHonduras; Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| | - Yolly Molina
- GENESS International ConsortiumLos AngelesCalifornia; National Autonomous University of HondurasTegucigalpaHonduras
| | - Yu-Chen Lin
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia
| | - Iris E Martínez-Juárez
- GENESS International ConsortiumLos AngelesCalifornia; National Institute of Neurology and NeurosurgeryMexico CityMexico
| | - Adriana Ochoa
- GENESS International ConsortiumLos AngelesCalifornia; National Institute of Neurology and NeurosurgeryMexico CityMexico
| | - Aurelio Jara-Prado
- GENESS International ConsortiumLos AngelesCalifornia; National Institute of Neurology and NeurosurgeryMexico CityMexico
| | - Miyabi Tanaka
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia; Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| | - Dongsheng Bai
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia; Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| | - Sumaya Aftab
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia; Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| | - Julia N Bailey
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia; Department of EpidemiologyFielding School of Public Health at UCLALos AngelesCalifornia
| | - Antonio V Delgado-Escueta
- Epilepsy Genetics/Genomics LaboratoriesVA GLAHS - West Los AngelesLos AngelesCalifornia; GENESS International ConsortiumLos AngelesCalifornia; Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| |
Collapse
|