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Giugno A, Fortunato F, Sammarra I, Sturniolo M, Fratto E, Martino I, Nisticò R, Gambardella A. Tremor as an intrinsic feature of juvenile myoclonic epilepsy. Epilepsia 2025; 66:e47-e53. [PMID: 39817325 PMCID: PMC11908659 DOI: 10.1111/epi.18268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/03/2025] [Accepted: 01/06/2025] [Indexed: 01/18/2025]
Abstract
We aim to understand whether tremor may be an intrinsic feature of juvenile myoclonic epilepsy (JME) and whether individuals with JME plus tremor experience a different disease course. Thirty-one individuals with JME plus tremor (17 females, mean age = 33.9 ± 13.8 years) and 30 age of onset- and gender-matched subjects with JME (21 females, mean age = 26.8 ± 11.2 years) prospectively underwent clinical and neurophysiologic assessment, including tremor assessment and somatosensory evoked potentials (SEPs). All JME plus tremor subjects experienced postural and action tremor affecting bilateral upper limbs. Nine of 31 individuals (29%) with tremor were never exposed to valproate (VPA), and 14 of 31 (45.2%) were not using VPA at the time of clinical evaluation. Twelve of 31 (38.7%) patients with JME plus tremor were drug-resistant compared to four of 30 (13.3%) with JME (p = .024). The JME plus tremor subjects had higher numbers of previous childhood absence epilepsy (n = 6/31 [19.4%]), interictal epileptiform discharges (n = 30/31 [96.8%]), photosensitivity (n = 8/31 [25.8%]), and psychiatric comorbidities (n = 12/31 [38.7%]). Six of 31 (19.4%) individuals with JME plus tremor had giant SEPs (1/30, 3.3% with JME; p = .05, chi-squared test). The clinical features and decreased sensorimotor inhibition in the JME plus tremor group suggest that tremor might be a marker of disease severity rather than an epiphenomenon of VPA exposure.
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Affiliation(s)
- Alessia Giugno
- Department of Medical Sciences, Institute of NeurologyMagna Græcia UniversityCatanzaroItaly
| | - Francesco Fortunato
- Department of Medical Sciences, Institute of NeurologyMagna Græcia UniversityCatanzaroItaly
| | - Ilaria Sammarra
- Department of Medical Sciences, Institute of NeurologyMagna Græcia UniversityCatanzaroItaly
| | - Miriam Sturniolo
- Department of Medical Sciences, Institute of NeurologyMagna Græcia UniversityCatanzaroItaly
| | - Enrico Fratto
- Department of Medical Sciences, Institute of NeurologyMagna Græcia UniversityCatanzaroItaly
| | - Iolanda Martino
- Department of Medical Sciences, Institute of NeurologyMagna Græcia UniversityCatanzaroItaly
| | - Rita Nisticò
- Department of Medical and Surgical Sciences, Neuroscience Research CenterMagna Græcia UniversityCatanzaroItaly
| | - Antonio Gambardella
- Department of Medical Sciences, Institute of NeurologyMagna Græcia UniversityCatanzaroItaly
- Department of Medical and Surgical Sciences, Neuroscience Research CenterMagna Græcia UniversityCatanzaroItaly
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Peña-Ceballos J, Moloney PB, Choekyi T, Naggar HE, Widdess-Walsh P, Delanty N. The clinical profile of adult-onset idiopathic generalised epilepsy. Seizure 2025; 126:24-31. [PMID: 39919538 DOI: 10.1016/j.seizure.2025.01.024] [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: 11/15/2024] [Revised: 01/13/2025] [Accepted: 01/25/2025] [Indexed: 02/09/2025] Open
Abstract
OBJECTIVE Idiopathic generalised epilepsies (IGE) tend to begin in childhood or adolescence, whereas adult-onset presentations are less frequently observed. In this study, we describe the disease course of a cohort of patients with adult-onset IGE. METHODS In this retrospective observational study, we evaluated clinical features, seizure outcomes, and antiseizure medication (ASM) prescribing trends in a cohort of IGE patients with seizure onset aged 18 years or older. RESULTS In a cohort of 425 IGE patients, we identified 55 with adult-onset IGE (12.9 %). Forty-nine patients (89.1 %) experienced seizure onset between ages 18 and 30 years, while the remaining six patients (10.9 %) had onset after the age of 30 years. Eleven patients were initially diagnosed with focal epilepsy (20 %). Most patients (98.2 %) initially presented with generalised tonic-clonic seizures (GTCS). Epilepsy with generalised tonic-clonic seizures alone (GTCA) was the most common syndrome (65.4 %). Thirty-five patients (63.6 %) were treated with ASM monotherapy, 17 (30.9 %) with polytherapy, and three (5.4 %) were not taking any ASM. Lamotrigine, levetiracetam (38.2 %), and valproate (27.3 %) were the most prescribed ASMs. At last clinical review, 40 patients (72.7 %) were seizure-free (no seizures for ≥12 months), including those with absence seizures and myoclonic seizures, and 46 were free of GTCS for a mean duration of 6.2 years (range 1-21 years). Eight patients (14.5 %) had drug-resistant epilepsy (DRE). Eight patients attempted ASM withdrawal, with seizure recurrence occurring in six (75 %), with the period off ASM ranging from one week to 26 years. SIGNIFICANCE IGE should be considered as a possible diagnosis in people who first present with convulsive seizures in adulthood, particularly those aged between 18 and 30 years with normal neuroimaging. Adult-onset IGE has a good prognosis overall, with most people becoming seizure-free, although the risk of seizure recurrence appears to be high after ASM withdrawal. A minority develop DRE and require polytherapy with ≥2 ASMs.
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Affiliation(s)
| | - Patrick B Moloney
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Tenzin Choekyi
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Hany El Naggar
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | | | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland.
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Gavnholt L, Gesche J, Cerulli Irelli E, Krøigård T, Mangaard SB, Di Bonaventura C, Rubboli G, Röttger R, Beier CP. Unsupervised clustering of a deeply phenotyped cohort of adults with idiopathic generalized epilepsy. Epilepsia 2025; 66:700-711. [PMID: 39724391 DOI: 10.1111/epi.18225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 11/26/2024] [Accepted: 12/02/2024] [Indexed: 12/28/2024]
Abstract
OBJECTIVE Idiopathic generalized epilepsy (IGE) in adults comprise juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and epilepsy with generalized tonic-clonic seizures alone (EGTCS), which are defined by their seizure types but also cover a broad endophenotype of symptoms. Controversy exists on whether adult IGE is a group of distinct diseases or a clinical spectrum of one disease. Here, we used a deeply phenotyped cohort to test the hypothesis that IGE comprises three distinct clinical entities. METHODS Patients (>18 years old) with IGE were recruited between 2016 and 2020 at Odense University Hospital and the Danish Epilepsy Center. Complete data were available for basic demographics, imaging, social status, and treatment response. Subjects were offered neuropsychological screening (including symptoms of psychiatric disease). Electroencephalograms (EEGs) were reanalyzed, and missing data were imputed. After selecting the features and normalizing the data, the dataset and an identical randomized dataset were subjected to k-means cluster analysis. RESULTS The dataset comprised 502 patients and 22 distinct nonoverlapping clinical features. Elbow and gap analyses revealed an optimal number of clusters of 1; the features with the highest eigenvalues were age at diagnosis and self-reported executive dysfunction. Applying k-means clustering yielded three low-quality clusters as assessed by silhouette score (mean = .400 ± .01). The corresponding mean silhouette score for the randomized control dataset was .390 (±.002). Age at diagnosis was associated with the epileptic discharges on EEG and treatment response. Self-reported executive dysfunction showed associations with psychiatric symptoms and impulsivity. JME, JAE, and EGTCS were loosely associated with the clusters (k = .088, p = .002) but showed a specific distribution within a matrix defined by age at diagnosis and self-reported executive dysfunction. SIGNIFICANCE IGE in adults is best described as a continuum of symptoms, where age at diagnosis and executive dysfunction are two main factors explaining most of its clinical variability. The seizure-defined syndromes cover different patient groups within the clinical spectrum.
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Affiliation(s)
- Line Gavnholt
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Thomas Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Neurophysiology, Odense University Hospital, Odense, Denmark
| | | | | | - Guido Rubboli
- Danish Epilepsy Center, member of European Reference Network EpiCARE, Dianalund, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Richard Röttger
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
| | - Christoph Patrick Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Brain Research-Interdisciplinary Guided Excellence, Odense University Hospital, Odense, Denmark
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Curti DG, Bellini A, Cursi M, Lanzone J, Minicucci F, Fanelli GF, Agosta F, Filippi M. Seizure freedom and therapy discontinuation in patients with idiopathic generalized epilepsy: retrospective cohort study from a tertiary epilepsy outpatient service. J Neurol 2025; 272:218. [PMID: 39985574 DOI: 10.1007/s00415-025-12890-y] [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: 10/23/2024] [Revised: 12/04/2024] [Accepted: 12/28/2024] [Indexed: 02/24/2025]
Abstract
BACKGROUND Idiopathic generalized epilepsy (IGE) affects young individuals and is typically successfully managed with anti-seizure medications (ASMs). Discontinuing therapy in IGE patients is a critical decision due to the risk of seizure recurrence. This study aims to identify factors influencing seizure freedom (SF) or relapse after ASM discontinuation. METHODS We retrospectively reviewed the medical records of patients seen at our clinic between 2002 and 2024. Collected data included demographics, disease history, seizure types, ASMs used, EEG findings, outcomes related to SF and ASM withdrawal. RESULTS We identified 322 records, with a mean age of 30 ± 12.4 years and an age at onset of 16 ± 5.9 years. On average, patients tried 1.9 ASMs, 23% on polytherapy. The main seizure types were generalized tonic-clonic seizures (GTCS) in 53.1%, myoclonic seizures in 31.7%, absences in 15.2%. SF was achieved by 76.6%. Patients with GTCS as main seizure type or presenting with GTCS in the first year of disease experienced a delayed achievement of SF. ASM discontinuation was attempted in 64 patients. Predictors of relapse after discontinuation were myoclonic and generalized seizures as principal seizure type and higher seizure frequency. Early SF and lower seizure frequency were associated with successful discontinuation. EEG predictors of discontinuation failure included worsening during treatment tapering and specific abnormalities, such as spike waves, photosensitivity, and hyperpnoea sensitivity. CONCLUSIONS This study provides long-term follow-up data on IGE patients, highlighting key predictors of seizure control, including GTCS or myoclonic seizures and a rapid initial ASM response. EEG emerges as a valuable tool for the longitudinal monitoring of patients undergoing ASM discontinuation.
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Affiliation(s)
- Davide G Curti
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Bellini
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Cursi
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jacopo Lanzone
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Minicucci
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna F Fanelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy.
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Byrnes M, Alzahrany M, Punia V. Management and outcomes among older adults with generalized epilepsy in routine clinical practice. Epilepsia Open 2025; 10:355-360. [PMID: 39728914 PMCID: PMC11803296 DOI: 10.1002/epi4.13123] [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: 07/08/2024] [Revised: 12/17/2024] [Accepted: 12/18/2024] [Indexed: 12/28/2024] Open
Abstract
Generalized epilepsy is classically thought of as a disease of the young and adolescent, with rarely reported cases among older adults. We aimed to analyze management and outcomes in a population sparsely described in the literature through a retrospective single-center cohort design. After excluding individuals without follow-up, we identified 151 people ≥50 years at the time of electrographically confirmed generalized epilepsy. Just over a quarter were late-onset (≥26 years), and 77% were diagnosed with genetic generalized epilepsy (GGE). Active seizures (in the last year of follow-up) were present in 57% of individuals, despite most of them having experienced prolonged seizure remission periods (median 7 years) in the past. Only five people were off antiseizure medication (ASM) at their last appointment, with most on an average of 2 ASMs. The odds of active epilepsy at the last follow-up were significantly higher among those with polyspikes (odds ratio [OR] = 2.42; 95% confidence interval [CI] = 1.01-6.01), myoclonic seizure history (OR = 2.88, 1.23-6.96), and developmental delay (OR = 4.75, 1.45-19.3). The odds were 60% lower in older adults with family history (OR = 0.4, 0.17-5.68). Our findings suggest that most older adults with generalized epilepsy achieve years of seizure remission, but the likelihood of epilepsy resolution is low. PLAIN LANGUAGE SUMMARY: Generalized epilepsy is seldom seen in older adults. We looked at 151 patients diagnosed with generalized epilepsy over the age of 50 to see how they are managed and what influences their outcomes. We found that although these patients can control their seizures with medication, the chance that their epilepsy resolves is low. Patients with certain characteristics classically seen in an epilepsy called "Juvenile Myoclonic Epilepsy" (JME) may have a more intractable course.
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Affiliation(s)
- MarieElena Byrnes
- Epilepsy Center, Neurological InstituteCleveland ClinicClevelandOhioUSA
| | - Majed Alzahrany
- Department of NeurologyKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Vineet Punia
- Epilepsy Center, Neurological InstituteCleveland ClinicClevelandOhioUSA
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Ilyas-Feldmann M, Graf L, Hüsing T, Dörrfuß J, Holtkamp M. [Discontinuation of antiseizure medication in patients with epilepsy]. DER NERVENARZT 2024; 95:1139-1144. [PMID: 39023550 PMCID: PMC11611991 DOI: 10.1007/s00115-024-01708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Approximately two thirds of patients with epilepsy become seizure-free with antiseizure medication (ASM). A central question is whether and when ASM can be discontinued. OBJECTIVE To present an overview of the current knowledge about risks and benefits of discontinuation of ASM. MATERIAL AND METHODS Review of the current literature, discussion of data on and recommendations for discontinuation of ASM. RESULTS The risk of seizure recurrence after discontinuation of ASM is approximately 40-50% and thus twice as high as continuing with ASM. Guidelines recommend considering discontinuation of ASM at earliest after a seizure-free period of 2 years. Predictive variables for seizure recurrence after stopping ASM include longer duration of epilepsy and higher number of seizures until remission, a shorter seizure-free interval until stopping ASM, older age at epilepsy onset, developmental delay or IQ < 70, febrile seizures in childhood, absence of a self-limiting epilepsy syndrome, and evidence of epileptiform activity in the electroencephalograph (EEG). The individual risk of seizure recurrence after stopping ASM can be estimated using an online prediction tool. CONCLUSION Discontinuation of ASM should be discussed with patients at the earliest after 2 years of seizure freedom in a shared decision-making process weighing up the risks and benefits. The risk of a seizure recurrence depends on a number of clinical variables. Psychosocial aspects, such as impact on driving and occupational issues must be taken into consideration as well as individual fears and concerns of patients about seizure recurrence or the long-term use of ASM.
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Affiliation(s)
- Maria Ilyas-Feldmann
- Epilepsie-Zentrum Berlin-Brandenburg, Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Luise Graf
- Epilepsie-Zentrum Berlin-Brandenburg, Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Thea Hüsing
- Epilepsie-Zentrum Berlin-Brandenburg, Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Jakob Dörrfuß
- Epilepsie-Zentrum Berlin-Brandenburg, Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Martin Holtkamp
- Epilepsie-Zentrum Berlin-Brandenburg, Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Robbins-Welty GA, Riordan PA, Shalev D, Chammas D, Noufi P, Brenner KO, Briscoe J, Rosa WE, Webb JA. Top Ten Tips Palliative Care Clinicians Should Know About the Psychiatric Manifestations of Nonpsychiatric Serious Illness and Treatments. J Palliat Med 2024; 27:1657-1665. [PMID: 38727571 PMCID: PMC11971598 DOI: 10.1089/jpm.2024.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 12/12/2024] Open
Abstract
Mental health issues are widespread and significant among individuals with serious illness. Among patients receiving palliative care (PC), psychiatric comorbidities are common and impact patient quality of life. Despite their prevalence, PC clinicians face challenges in effectively addressing the intricate relationship between medical and psychiatric disorders due to their complex, intertwined and bidirectionally influential nature. This article, created collaboratively with a team of psychiatric-palliative care experts, is the second in a two-part series examining the bidirectional relationship between medical and psychiatric illness in PC. This article explores 10 prevalent psychiatric manifestations associated with severe illness and its treatment. Building upon the first article, which focused on 10 common physical manifestations of psychiatric illness among patients receiving PC, these two articles advocate for an integrated approach to PC that prioritizes mental and emotional wellbeing across the continuum of serious illness.
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Affiliation(s)
- Gregg A. Robbins-Welty
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Paul A. Riordan
- Department of Veterans Affairs, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Danielle Chammas
- Department of Medicine, Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry, Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul Noufi
- Department of Medicine, Division of Palliative Medicine, School of Medicine, MedStar Health, Georgetown University, Baltimore, Maryland, USA
| | - Keri O. Brenner
- Section of Palliative Care, Department of Medicine, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Joshua Briscoe
- Department of Veterans Affairs, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jason A. Webb
- Section of Palliative Care, Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
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Crespo Pimentel B, Kuchukhidze G, Xiao F, Caciagli L, Hoefler J, Rainer L, Kronbichler M, Vollmar C, Duncan JS, Trinka E, Koepp MJ, Wandschneider B. Quantitative MRI Measures and Cognitive Function in People With Drug-Resistant Juvenile Myoclonic Epilepsy. Neurology 2024; 103:e209802. [PMID: 39303180 PMCID: PMC11446167 DOI: 10.1212/wnl.0000000000209802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuroimaging studies have so far identified structural changes in individuals with juvenile myoclonic epilepsy (JME) when compared with controls. However, the underlying mechanisms of drug-resistant JME remain unknown. In this study, we aimed at characterizing the structural underpinnings of drug-resistant JME using MRI-derived cortical morphologic markers. METHODS In this prospective cross-sectional 2-center study, T1-weighted MRI and neuropsychological measures of verbal memory and executive function were obtained in individuals with drug-resistant and drug-responsive JME recruited from epilepsy outpatient clinics and healthy controls. We performed vertexwise measurements of cortical thickness, surface area, and local gyrification index (LGI). Vertexwise group comparisons were corrected for multiple comparisons at a familywise error (FWE) of 0.05. The neuropsychological profile of disease subgroups was analyzed through principal component analysis. RESULTS We studied 42 individuals with drug-resistant JME (mean age 29 ± 11 years, 50% female), 37 with drug-responsive JME (mean age 34 ± 10, years, 59% female), and 71 healthy controls (mean age 21 ± 9 years, 61% female). Surface area was increased in participants with drug-resistant JME in the left temporal lobe (Cohen d = 0.82 [-0.52 to -1.12], pFWE < 0.05) when compared with the drug-responsive group. Although no cortical thickness changes were observed between disease subgroups, drug-resistant and drug-sensitive participants showed discrete cortical thinning against controls (Cohen d = -0.42 [-0.83 to -0.01], pFWE < 0.05; Cohen d = -0.57 [-1.03 to -0.11], pFWE < 0.05, respectively). LGI was increased in the left temporal and occipital lobes in drug-resistant participants (Cohen d = 0.60 [0.34-0.86], pFWE < 0.05) when contrasting against drug-sensitive participants, but not controls. The composite executive function score was reduced in drug-resistant individuals compared with controls and drug-sensitive individuals (-1.74 [-2.58 to -0.90], p < 0.001 and -1.29 [-2.25 to -0.33], p < 0.01, respectively). Significant correlations were observed between executive function impairment and increased surface area in the precuneus and medial prefrontal regions (r = -0.79, pFWE < 0.05) in participants with drug-resistant JME. DISCUSSION We identified a developmental phenotype in individuals with drug-resistant JME characterized by changes in cortical surface area and folding complexity, the extent of which correlates with executive dysfunction. No association was observed between cortical thickness and disease severity. Our findings support a neurodevelopmental basis for drug resistance and cognitive impairment in JME.
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Affiliation(s)
- Bernardo Crespo Pimentel
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Giorgi Kuchukhidze
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Fenglai Xiao
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Lorenzo Caciagli
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Julia Hoefler
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Lucas Rainer
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Martin Kronbichler
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Christian Vollmar
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - John S Duncan
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Eugen Trinka
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Matthias J Koepp
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Britta Wandschneider
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
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Ayoub D, Jaafar F, Al-Hajje A, Salameh P, Jost J, Hmaimess G, Wazne J, Ismail-Fawaz Z, Sabbagh S, Boumediene F, Beydoun A. Predictors of drug-resistant epilepsy in childhood epilepsy syndromes: A subgroup analysis from a prospective cohort study. Epilepsia 2024; 65:2995-3009. [PMID: 39150742 DOI: 10.1111/epi.18100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/05/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Previous studies assessing factors associated with drug-resistant epilepsy (DRE) were constrained by their amalgamation of all epilepsy syndromes in their analyses and the absence of uniform criteria for defining DRE. Our objective was to identify predictors of DRE among the four primary childhood epilepsy syndrome groups within a cohort of children with new onset seizures, using the International League Against Epilepsy (ILAE) definition of DRE and the recent classification of epilepsies. METHODS This is a prospective study of 676 children with new onset seizures initiated on antiseizure medication. Patients were monitored for the occurrence of DRE according to the ILAE criteria and were categorized into one of four epilepsy groups: self-limited focal epilepsies (SeLFEs), genetic generalized epilepsies (GGEs), developmental epileptic encephalopathies (DEEs), and focal epilepsies. Cox regression analysis was performed to identify predictors of DRE within each epilepsy group. RESULTS Overall, 29.3% of children were classified as having DRE, with the highest incidence observed among children diagnosed with DEEs (77.7%), followed by focal epilepsies (31.5%). Across the entire cohort, predictors of DRE included the presence of an epileptogenic lesion, a higher pretreatment number of seizures, experiencing multiple seizure types, presence and severity of intellectual and developmental delay, myoclonus, and younger age at epilepsy onset. Within the GGEs, only a younger age at seizure onset and experiencing multiple seizure types predicted DRE. Among focal epilepsies, predictors of DRE included the presence of an epileptogenic lesion, experiencing multiple seizure types, and having a greater number of pretreatment seizures. Within the DEEs, predictors of DRE were the occurrence of tonic seizures. Predictors of DRE within SeLFEs could not be identified. SIGNIFICANCE This study indicates that different epilepsy syndromes are associated with distinct predictors of drug resistance. Anticipation of drug resistance within various groups is feasible using accessible clinical variables throughout the disease course.
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Affiliation(s)
- Dana Ayoub
- National Institute of Health and Medical Research, Unit 1094, Research Institute for Development, Unit 270, Université de Limoges, University Hospital Center of Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Fatima Jaafar
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
| | - Pascale Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Jeremy Jost
- National Institute of Health and Medical Research, Unit 1094, Research Institute for Development, Unit 270, Université de Limoges, University Hospital Center of Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Ghassan Hmaimess
- Department of Pediatrics, St. George Hospital Medical University Center, University of Balamand, Beirut, Lebanon
| | - Jaafar Wazne
- Rafic Hariri University Hospital, Beirut, Lebanon
| | - Zein Ismail-Fawaz
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sandra Sabbagh
- Department of Pediatrics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Farid Boumediene
- National Institute of Health and Medical Research, Unit 1094, Research Institute for Development, Unit 270, Université de Limoges, University Hospital Center of Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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Kim KM, Choi BK, Ha WS, Cho S, Chu MK, Heo K, Kim WJ. Development and Validation of Artificial Intelligence Models for Prognosis Prediction of Juvenile Myoclonic Epilepsy with Clinical and Radiological Features. J Clin Med 2024; 13:5080. [PMID: 39274294 PMCID: PMC11396353 DOI: 10.3390/jcm13175080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/18/2024] [Accepted: 08/26/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Juvenile myoclonic epilepsy (JME) is a common adolescent epilepsy characterized by myoclonic, generalized tonic-clonic, and sometimes absence seizures. Prognosis varies, with many patients experiencing relapse despite pharmacological treatment. Recent advances in imaging and artificial intelligence suggest that combining microstructural brain changes with traditional clinical variables can enhance potential prognostic biomarkers identification. Methods: A retrospective study was conducted on patients with JME at the Severance Hospital, analyzing clinical variables and magnetic resonance imaging (MRI) data. Machine learning models were developed to predict prognosis using clinical and radiological features. Results: The study utilized six machine learning models, with the XGBoost model demonstrating the highest predictive accuracy (AUROC 0.700). Combining clinical and MRI data outperformed models using either type of data alone. The key features identified through a Shapley additive explanation analysis included the volumes of the left cerebellum white matter, right thalamus, and left globus pallidus. Conclusions: This study demonstrated that integrating clinical and radiological data enhances the predictive accuracy of JME prognosis. Combining these neuroanatomical features with clinical variables provided a robust prediction of JME prognosis, highlighting the importance of integrating multimodal data for accurate prognosis.
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Affiliation(s)
- Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Bo Kyu Choi
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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11
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Vaneva I, Kuzmanova R, Stambolieva K. The Most Frequent Psychiatric Comorbidities in Bulgarian Patients With Epilepsy: Their Connection With the Main Clinical Characteristics and Quality of Life. Cureus 2024; 16:e66149. [PMID: 39233990 PMCID: PMC11372338 DOI: 10.7759/cureus.66149] [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] [Accepted: 08/04/2024] [Indexed: 09/06/2024] Open
Abstract
AIM The objective of this study is to determine and compare the relationship of the most common psychiatric comorbidities in Bulgarian patients with epilepsy with the main clinical characteristics, as well as to evaluate their impact on certain aspects of the quality of life. CLINICAL RATIONALE Psychiatric comorbidities occur in about one-third of people with epilepsy throughout their lifetime, and their incidence is much greater in high-risk groups such as patients with treatment-resistant epilepsy. MATERIAL AND METHODS The study group consisted of 129 participants, of whom 104 were divided into four groups according to the presence of one of the most frequently diagnosed psychiatric comorbidities in our patients with epilepsy: personality and behavioral disorder (PBD) (n=25), mild to moderate depressive disorder (n=26), anxiety disorder (n=32), and dissociative and conversion disorders (n=21). A control group was also formed with a similar number of participants with epilepsy (n=25) without psychiatric comorbidity. Some sociodemographic and clinical characteristics of epilepsy were analyzed in all patients. All patients filled out two questionnaires: the Bulgarian version of quality of life in epilepsy - 89 (QOLIE-89) and the Bulgarian version of SIDAED (assessing SIDe effects in antiepileptic drugs (AED) treatment). RESULTS The analysis revealed a negative influence of psychiatric comorbidity on the presence of epileptic seizures, unwanted drug effects, and lower scores for all aspects of the quality of life of patients with epilepsy. CONCLUSION AND CLINICAL IMPLICATIONS The main conclusion of our study is the presence of an interaction between psychiatric comorbidity, the clinical course of the disease, and the deteriorated quality of life (QOL) in patients with epilepsy. Further attention, comprehensive care, and targeted research are needed to analyze individual psychiatric comorbidities in patients with epilepsy for early detection and treatment.
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Affiliation(s)
- Irina Vaneva
- Department of Epilepsy, Multiprofile Hospital for Active Treatment in Neurology and Psychiatry "St. Naum", Sofia, BGR
- Department of Neurology, Medical University, Akad, Sofia, BGR
| | - Rumyana Kuzmanova
- Department of Epilepsy, Multiprofile Hospital for Active Treatment in Neurology and Psychiatry "St. Naum", Sofia, BGR
- Department of Neurology, Medical University, Akad, Sofia, BGR
| | - Katerina Stambolieva
- Department of Cognitive Psychophysiology, Bulgarian Academy of Science, Institute of Neurobiology, Sofia, BGR
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12
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Elshetihy A, Nergiz L, Cloppenborg T, Woermann FG, Müffelmann B, Bien CG. A complex case with generalized epilepsy, probable focal seizures, and functional seizures. Epilepsy Behav Rep 2024; 27:100684. [PMID: 38953098 PMCID: PMC11215947 DOI: 10.1016/j.ebr.2024.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
In this patient, now 42 years old, genetic generalized epilepsy (juvenile myoclonic epilepsy) manifested itself at the age of 13. At the age of 39, she experienced a status episode with prolonged ICU treatment. She was left with a left-sided hippocampal sclerosis and probably focal seizures. In addition, since the age of 24, the patient also experiences functional seizures on the background of a borderline personality disorder. While generalized epileptic seizures could be controlled with antiseizure medication (ASM), the patient was multiple times admitted to Emergency Departments for her functional seizures with subsequent intensive care treatments, including intubation. As a complication, the patient developed critical illness polyneuropathy and myopathy, resulting in wheelchair dependence. Additionally, she acquired a complex regional pain syndrome after extravasation of ASM. The report demonstrates the uncommon development of hippocampal sclerosis after a generalized tonic-clonic status epilepticus and the poor treatability of functional seizures as compared to generalized and focal seizures.
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Affiliation(s)
- Ahmed Elshetihy
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Lema Nergiz
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Thomas Cloppenborg
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Friedrich G. Woermann
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany
| | - Birgitt Müffelmann
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Christian G. Bien
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
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13
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Fayad C, Saad K, Kahwagi GJ, Hallit S, Griffin D, Abou-Khalil R, El-Hayek E. A systematic review and meta-analysis of factors related to first line drugs refractoriness in patients with juvenile myoclonic epilepsy (JME). PLoS One 2024; 19:e0300930. [PMID: 38593118 PMCID: PMC11003615 DOI: 10.1371/journal.pone.0300930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Juvenile Myoclonic Epilepsy (JME) is a prevalent form of epileptic disorder, specifically categorized within the realm of Genetic Generalized Epilepsy (GGE). Its hallmark features encompass unprovoked bilateral myoclonus and tonic-clonic seizures that manifest during adolescence. While most JME patients respond favorably to anti-seizure medication (ASM), a subset experiences refractory JME, a condition where seizures persist despite rigorous ASM treatment, often termed "Drug-Resistant Epilepsy" (DRE). This systematic review and meta-analysis aims to determine the prevalence of refractory JME, and further to identify socio-demographic, electrophysiological and clinical risk factors associated with its occurrence. Pinpointing these factors is crucial as it offers the potential to predict ASM responsiveness, enabling early interventions and tailored care strategies for patients. MATERIAL AND METHODS The systematic review and meta-analysis followed the Cochrane Handbook and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study evaluated outcomes post ASM treatment in JME cohorts by searching papers published up to September 2023 in PubMed/MEDLINE, Scopus, and Google Scholar databases. Predefined inclusion criteria were met by 25 eligible studies, forming the basis for analysis. RESULTS A total of 22 potential risk factors for refractory JME were documented. Notably, robust risk factors for treatment resistance included Psychiatric Disorder (Odds Ratio (OR), 3.42 [2.54, 4.61] (95% Confidence Inverval (Cl)), Febrile Seizures (OR, 1.83 [1.14, 2.96] (95% Cl)), Alcohol Consumption (OR, 16.86 [1.94, 146.88] (95%Cl)), Aura (OR, 2.15 [1.04, 4.47] (95%Cl)), childhood absence epilepsy (CAE) evolving into JME (OR, 4.54 [1.61, 12.78] (95%CI)), occurrence of three seizure types (OR, 2.96 [1.96, 4.46] (95%CI)), and Focal EEG abnormalities (OR, 1.85 [1.13, 3.01] (95%Cl)). In addition, there were some non-significant risk factors for DRE because of noticeable heterogeneity. CONCLUSION In aggregate, over 36% of JME patients demonstrated drug resistance, with seven significant risk factors closely linked to this refractoriness. The interplay between these factors and whether they denote treatment non-response or heightened disease burden remains an open question and more studies would be required to fully examine their influence.
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Affiliation(s)
- Claire Fayad
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Kely Saad
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Georges-Junior Kahwagi
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Darren Griffin
- School of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Rony Abou-Khalil
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Elissar El-Hayek
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
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Lallana S, Fonseca E, Quintana M, Abraira L, Campos-Fernández D, López-Maza S, Santamarina E, Toledo M, Salas-Puig J. Antiseizure medication withdrawal in adult patients with idiopathic generalized epilepsy: Performance of two seizure recurrence prediction models. Epilepsy Behav 2024; 153:109718. [PMID: 38428177 DOI: 10.1016/j.yebeh.2024.109718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Currently, there is a limited availability of tools to predict seizure recurrence after discontinuation of antiseizure medications (ASMs). This study aimed to establish the seizure recurrence rate following ASM cessation in adult patients with idiopathic generalized epilepsy (IGE) and to assess the predictive performance of the Lamberink and the Stevelink prediction models using real-world data. METHODS Retrospective longitudinal study in IGE patients who underwent ASM withdrawal in a tertiary epilepsy clinic since June 2011, with the latest follow up in January 2024. The minimum follow-up period was 12 months. Clinical and demographic variables were collected, and the seizure recurrence prediction models proposed by Lamberink and Stevelink were applied and evaluated. RESULTS Forty-seven patients (mean age 33.15 ± 8 [20-55] years; 72.35 % women) were included. During the follow-up period, seizures recurred in 25 patients (53.2 %). Median time to recurrence was 8 months [IQR 3-13.5 months], and 17 patients (68 %) relapsed within the first year. None of the relapsing patients developed drug-resistant epilepsy. The only significant risk factor associated with recurrence was a seizure-free period of less than 2 years before discontinuing medication (91.7 % vs 40 %, p =.005). The Stevelink prediction model at both 2 (p =.015) and 5 years (p =.020) achieved statistical significance, with an AUC of 0.72 (95 % CI 0.56-0.88), while the Lamberink model showed inadequate prognostic capability. CONCLUSION In our real-world cohort, a seizure-free period of at least 2 years was the only factor significantly associated with epilepsy remission after ASM withdrawal. Larger studies are needed to accurately predict seizure recurrence in IGE patients.
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Affiliation(s)
- Sofía Lallana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samuel López-Maza
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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15
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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.
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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.
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Daquin G, Bonini F. The landscape of drug resistant absence seizures in adolescents and adults: Pathophysiology, electroclinical spectrum and treatment options. Rev Neurol (Paris) 2024; 180:256-270. [PMID: 38413268 DOI: 10.1016/j.neurol.2023.11.010] [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: 10/02/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024]
Abstract
The persistence of typical absence seizures (AS) in adolescence and adulthood may reduce the quality of life of patients with genetic generalized epilepsies (GGEs). The prevalence of drug resistant AS is probably underestimated in this patient population, and treatment options are relatively scarce. Similarly, atypical absence seizures in developmental and epileptic encephalopathies (DEEs) may be unrecognized, and often persist into adulthood despite improvement of more severe seizures. These two seemingly distant conditions, represented by typical AS in GGE and atypical AS in DEE, share at least partially overlapping pathophysiological and genetic mechanisms, which may be the target of drug and neurostimulation therapies. In addition, some patients with drug-resistant typical AS may present electroclinical features that lie in between the two extremes represented by these generalized forms of epilepsy.
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Affiliation(s)
- G Daquin
- Epileptology and Cerebral Rythmology, AP-HM, Timone hospital, Marseille, France
| | - F Bonini
- Epileptology and Cerebral Rythmology, AP-HM, Timone hospital, Marseille, France; Aix Marseille Univ, Inserm, INS, Inst Neurosci Syst, Marseille, France.
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Peña-Ceballos J, Moloney PB, Valentin A, O'Donnell C, Colleran N, Liggan B, Staunton-Grufferty B, Ennis P, Grogan R, Mullins G, Costello DJ, Doherty CP, Sweeney KJ, El Naggar H, Kilbride RD, Widdess-Walsh P, O'Brien D, Delanty N. Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study. Seizure 2023; 112:98-105. [PMID: 37778300 DOI: 10.1016/j.seizure.2023.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE. METHODS We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort. RESULTS Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy. SIGNIFICANCE Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.
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Affiliation(s)
| | - Patrick B Moloney
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Cara O'Donnell
- Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Niamh Colleran
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Brenda Liggan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | | | - Patricia Ennis
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Roger Grogan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Gerard Mullins
- Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Daniel J Costello
- FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland; Department of Neurology, Cork University Hospital, Cork, Ireland
| | - Colin P Doherty
- FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland; Department of Neurology, St. James's Hospital, Dublin, Ireland; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Hany El Naggar
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Ronan D Kilbride
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Peter Widdess-Walsh
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Donncha O'Brien
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland.
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Ghosh S, Sinha JK, Ghosh S, Sharma H, Bhaskar R, Narayanan KB. A Comprehensive Review of Emerging Trends and Innovative Therapies in Epilepsy Management. Brain Sci 2023; 13:1305. [PMID: 37759906 PMCID: PMC10527076 DOI: 10.3390/brainsci13091305] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Epilepsy is a complex neurological disorder affecting millions worldwide, with a substantial number of patients facing drug-resistant epilepsy. This comprehensive review explores innovative therapies for epilepsy management, focusing on their principles, clinical evidence, and potential applications. Traditional antiseizure medications (ASMs) form the cornerstone of epilepsy treatment, but their limitations necessitate alternative approaches. The review delves into cutting-edge therapies such as responsive neurostimulation (RNS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), highlighting their mechanisms of action and promising clinical outcomes. Additionally, the potential of gene therapies and optogenetics in epilepsy research is discussed, revealing groundbreaking findings that shed light on seizure mechanisms. Insights into cannabidiol (CBD) and the ketogenic diet as adjunctive therapies further broaden the spectrum of epilepsy management. Challenges in achieving seizure control with traditional therapies, including treatment resistance and individual variability, are addressed. The importance of staying updated with emerging trends in epilepsy management is emphasized, along with the hope for improved therapeutic options. Future research directions, such as combining therapies, AI applications, and non-invasive optogenetics, hold promise for personalized and effective epilepsy treatment. As the field advances, collaboration among researchers of natural and synthetic biochemistry, clinicians from different streams and various forms of medicine, and patients will drive progress toward better seizure control and a higher quality of life for individuals living with epilepsy.
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Affiliation(s)
- Shampa Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
- ICMR—National Institute of Nutrition, Tarnaka, Hyderabad 500007, India
| | | | - Soumya Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
| | | | - Rakesh Bhaskar
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Kannan Badri Narayanan
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
- Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
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Jiang T, Zhang X, Zhang M, Liu M, Zhu H, Sun Y. Drug-resistant idiopathic generalized epilepsy: A meta-analysis of prevalence and risk factors. Epilepsy Behav 2023; 146:109364. [PMID: 37523796 DOI: 10.1016/j.yebeh.2023.109364] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Idiopathic generalized epilepsy (IGE) is a common epilepsy syndrome with early age onset and generally good seizure outcomes. This study aims to determine the incidence and predictive risk factors for drug-resistant IGE. METHODS We systematically searched three databases (PubMed, Embase, and Cochrane Library) in November 2022 and included 12 eligible studies which reported long-term outcomes (mean = 14.05) after antiseizure medications (ASMs) from 2001 to 2020. We defined drug resistance as the persistence of any seizure despite ASMs treatment (whether as monotherapies or in combination) given the criteria of drug resistance varied in original studies. A random-effects model was used to evaluate the prevalence of refractory IGE. Studies reporting potential poor prognostic factors were included for subsequent subgroup meta-analysis. RESULTS The pooled prevalence of drug resistance in IGE cohorts was 27% (95% CI: 0.19-0.36). Subgroup analysis of the risk factors revealed that the psychiatric comorbidities (odds ratio (OR): 4.87, 95% confidence interval (CI): 2.97-7.98), combined three seizure types (absences, myoclonic jerks, and generalized tonic-clonic seizures) (OR: 5.37, 95% CI: 3.16-9.13), the presence of absence seizure (OR: 4.38, 95% CI: 2.64-7.28), generalized polyspike trains (GPT) (OR: 4.83, 95% CI: 2.42-9.64), sex/catamenial epilepsy (OR: 3.25, 95% CI: 1.97-5.37), and status epilepticus (OR: 5.94, 95% CI: 2.23-15.85) increased the risk of poor prognosis. Other factors, including age onset, family history, and side effects of ASMs, were insignificantly associated with a higher incidence of refractory IGE. CONCLUSION Drug resistance is a severe complication of IGE. Further standardized research about clinical and electroencephalography factors is warranted.
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Affiliation(s)
- Tong Jiang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Xiaohan Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Mengwen Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Min Liu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Haifang Zhu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Yanping Sun
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
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Mula M. Impact of psychiatric comorbidities on the treatment of epilepsies in adults. Expert Rev Neurother 2023; 23:895-904. [PMID: 37671683 DOI: 10.1080/14737175.2023.2250558] [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: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Epilepsy is often accompanied by psychiatric comorbidities and the management of epilepsy in these patients presents unique challenges due to the interplay between the underlying neurological condition and the psychiatric symptoms and the combined use of multiple medications. AREAS COVERED This paper aims to explore the complexities associated with managing epilepsy in the presence of psychiatric comorbidities, focusing on the impact of psychiatric disorders on epilepsy treatment strategies and the challenges posed by the simultaneous administration of multiple medications. EXPERT OPINION Patients with epilepsy and psychiatric comorbidities seem to present with a more severe form of epilepsy that is resistant to drug treatments and burdened by an increased morbidity and mortality. Whether prompt treatment of psychiatric disorders can influence the long-term prognosis of the epilepsy is still unclear as well as the role of specific treatment strategies, such as neuromodulation, in this group of patients. Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.
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Affiliation(s)
- Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK of Great Britain and Northern Ireland
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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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.
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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
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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, BIOJUME Consortium
StrugLisaPanjwaniNaimLinFanAndradeDanielleZarubovaJanaŠobíškováZuzanaCechovazPracovisteKajsovaMichaelaRubboliGuidoMøllerRikke SGardellaElenaBeierChristoph PGescheJoannaMirandaMariaTalvikIngaStrianoPasqualeOrsiniAlessandroFongChoong YiNgChing ChingLimKheng SeangSelmerKaja KSyvertsenMarteBalaPronabKitchingAmyIrwinKateWaldingLornaAdamsLynseyJegathasanUmaSwinglerRachelWaneRachelAramJuliaSudarsanNikilMullanDeeRamsayRebeccaRichmondVivienSargentMarkFrattaroliPaulTaylorMatthewHomeMarieUkaSalKilroySusanNortcliffeTonichaSalimHalimaHolroydKellyHamandiKhalidMcQueenAlisonMcaleerDympnaJayachandranDinaEggintonDawnMacDonaldBridgetChangMichaelDeekolluDavidGauravAlokHamiltonCarolineTakonJaya Natarajan InyanCottaJanetMoranNickBlandJeremyBelderbosRosemaryCollierHeatherHenryJoanneMilnerMatthewWhiteSamKoutroumanidisMichalisSternWilliamRichardsonMark PQuirkJenniferCeballosJavier PeñaAnastasiaPapathanasiouStavropoulosIoannisLozsadiDoraSwainAndrewQuaminaCharlotteCrooksJenniferMajeedTahirRajSoniaPatelShakeelahYoungMichaelMaguireMelissaRayMunniPeaceyCarolineMakawaLinettyChhibdaAsyahSacreEveBegumShanazO’MalleyMartinYeungLapHollidayClaireWoodheadLouiseRhodesKarenThomasRhysEllawelaShanGlentonJoanneCalderVerityDavisJohnMcAlindenPaulFrancisSarahRobsonLisaLanyonKarenMackayGrahamStephenElmaThowColeenConnonMargaretKirkpatrickMartinMacFarlaneSusanMacleodAnneRiceDebbieKumarSivaCampbellCarolynCollinsVickyWhitehouseWilliamGiavasiChristinaPetrovaBoyankaBrownThomasPictonCatieO’DonoghueMichaelWestCharlotteNavarraHelenSlaghtSeán JEdwardsCatherineGribbinAndrewNelsonLizWarrinerStephenAngus-LeppanHeatherEhioroboLovethCamaraBintouSamakomvaTinasheMohanrajRajivParkerVickyPandeyRajeshCharlesLisaCotterCatherineDesurkarArchanaHydeAlisonHarrisonRachelReuberMarkusCleggRosieSidebottomJoRectoMayethEastonPatrickWaiteCharlotteHowellAliceSmithJacquelineCleggRosieMariguddiShyamHaslamZenaGaliziaElizabethCockHannahMenciasMarkTruscottSamanthaDalyDeirdreMhanduHildaSaidNooriaReesMarkChungSeo-KyungPickrellOwenFonferko-ShadrachBeataBakerMarkWhitingAmySwainLouiseO’BrienKirstyScottFraserGhausNaveedCastleGailBartholomewJacquiNeedleAnnBallJulieCloughAndreaSastryShashikiranAgrawalCharlotte Busby AmitDickersonDebbieDuranAlmuKhanMuhammadThrasyvoulouLauraIrvineEveTittensorSarahDaglishJacquelineKumarSumantBackhouseClaireMewiesClaireAramJuliaSudarsanNikilMullanDeeRamsayRebeccaRichmondVivienSkinnerDeniseSargentMarkBharatRahulSharmanSarah-JaneSaraswatulaArunCockerillHelenGreenbergDavid 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: 3] [Impact Index Per Article: 1.5] [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.
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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:
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23
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Lindquist BE, Timbie C, Voskobiynyk Y, Paz JT. Thalamocortical circuits in generalized epilepsy: Pathophysiologic mechanisms and therapeutic targets. Neurobiol Dis 2023; 181:106094. [PMID: 36990364 PMCID: PMC10192143 DOI: 10.1016/j.nbd.2023.106094] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/02/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
Generalized epilepsy affects 24 million people globally; at least 25% of cases remain medically refractory. The thalamus, with widespread connections throughout the brain, plays a critical role in generalized epilepsy. The intrinsic properties of thalamic neurons and the synaptic connections between populations of neurons in the nucleus reticularis thalami and thalamocortical relay nuclei help generate different firing patterns that influence brain states. In particular, transitions from tonic firing to highly synchronized burst firing mode in thalamic neurons can cause seizures that rapidly generalize and cause altered awareness and unconsciousness. Here, we review the most recent advances in our understanding of how thalamic activity is regulated and discuss the gaps in our understanding of the mechanisms of generalized epilepsy syndromes. Elucidating the role of the thalamus in generalized epilepsy syndromes may lead to new opportunities to better treat pharmaco-resistant generalized epilepsy by thalamic modulation and dietary therapy.
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Affiliation(s)
- Britta E Lindquist
- UCSF Department of Neurology, Division of Neurocritical Care, United States of America; UCSF Department of Neurology, Division of Pediatric Epilepsy, United States of America; UCSF Department of Neurology, United States of America
| | - Clare Timbie
- Gladstone Institute of Neurological Disease, United States of America; UCSF Department of Neurology, Division of Pediatric Epilepsy, United States of America; UCSF Department of Neurology, United States of America
| | - Yuliya Voskobiynyk
- Gladstone Institute of Neurological Disease, United States of America; UCSF Department of Neurology, United States of America
| | - Jeanne T Paz
- Gladstone Institute of Neurological Disease, United States of America; UCSF Department of Neurology, United States of America; Kavli Institute for Fundamental Neuroscience, UCSF, United States of America.
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24
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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.
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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
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25
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Lim SN, Wu T, Tseng WEJ, Chang CW, Hsieh HY, Cheng MY, Chiang HI, Lee CH, Lin WR, Liu CJ. Juvenile Myoclonic Epilepsy: Seizure and Social Outcomes in Taiwan. Healthcare (Basel) 2023; 11:1197. [PMID: 37108031 PMCID: PMC10138449 DOI: 10.3390/healthcare11081197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Patients with juvenile myoclonic epilepsy (JME) may not achieve seizure freedom despite optimal treatment with antiseizure medications (ASMs). The aim of this study was to investigate the clinical and social features of patients with JME, and to determine the factors associated with outcomes. We retrospectively identified 49 patients with JME (25 females, mean age 27.6 ± 8.9 years) who were assessed at the Epilepsy Centre of Linkou Chang Gung Memorial Hospital in Taiwan. The patients were divided into two groups, those who were seizure-free and those with ongoing seizures according to their seizure outcome at the last follow-up for one year. Clinical features and social status were compared between these two groups. Twenty-four (49%) of the JME patients were seizure-free for at least one year, while 51% continued to experience seizures despite being treated with multiple ASMs. The presence of epileptiform discharges in the last electroencephalogram and seizures during sleep were significantly associated with worse seizure outcomes (p < 0.05). The patients who were seizure-free had a higher employment rate compared to those who continued to experience seizures (75% vs. 32%, p = 0.004). Despite receiving ASM treatment, a considerable proportion of the patients with JME continued to have seizures. Moreover, poor seizure control was associated with a lower employment rate, which may lead to negative socioeconomic consequences related to JME.
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Affiliation(s)
- Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Hong Lee
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wey-Ran Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
| | - Chun-Jing Liu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan (C.-J.L.)
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26
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Marques VD, Hackbart BA, Guilhoto LM, Duarte JTC, Peixoto-Santos JE, Yacubian EMT, Bittar Guaranha MS. Minimum effective sodium valproate dose in genetic generalized epilepsies. Seizure 2023; 108:53-59. [PMID: 37088055 DOI: 10.1016/j.seizure.2023.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Sodium valproate (VPA) is the most effective antiseizure medication (ASM) in genetic generalized epilepsies (GGEs). However, the frequent adverse effects and the high risk inflicted on the exposed offspring make it imperative to search for the lowest daily VPA dose able to control seizures for most patients. In the current published series, the VPA value of <1000 mg was the most adopted. OBJECTIVE This study aims to provide a cutoff VPA value below which a given daily dose can be considered a low dose in patients with GGEs. METHODS This retrospective, observational cohort study included patients with clinical and electroencephalographic diagnoses of GGEs based on the ILAE criteria. Patients were followed up for at least two years using VPA in mono- or polytherapy. Clinical data, VPA dose, and associated ASMs were analyzed. Adverse effects were also evaluated. We related seizure control to VPA doses through uni- and multivariate statistical analyses. RESULTS From 225 patients, 169 (75%) had good seizure control, with most (60%) receiving monotherapy. The cutoff daily VPA dose capable of distinguishing these patients from those without seizure control was up to 1000 mg (p = 0.006) in univariate analyses and up to 700 mg in multivariate analyses. For patients in polytherapy, the cutoff was up to 1750 mg and 1800 mg in uni- and multivariate analyses, respectively. CONCLUSIONS The lowest daily VPA dose in monotherapy able to control seizures for most GGE patients was up to 700 mg, a value that can be used as a low dose criterion in studies assessing the therapeutic VPA ranges. Patients using higher VPA doses or in polytherapy present a lower probability of seizure control.
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Affiliation(s)
- Vanessa Dinis Marques
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Bárbara Amorim Hackbart
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laura Maria Guilhoto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
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27
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[Idiopathic generalized epilepsies: Analysis of 101 patients]. Med Clin (Barc) 2023; 160:193-198. [PMID: 36030098 DOI: 10.1016/j.medcli.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Idiopathic generalized epilepsies (IGI) are an electroclinical syndrome that includes four subsyndromes according to the ILAE 2017 classification. The long-term prognosis of these syndromes is uncertain due to the scarcity and heterogeneity of the studies. The objective of this study is to analyze the long-term prognosis of these syndromes, pharmacological treatment and the seizure recurrence. METHOD Observational and retrospective study of a serie of patients diagnosed with EGI. Epidemiological variables, pharmacological treatment, freedom of seizures and recurrence after withdrawal of treatment were collected. RESULTS We included 101 patients, the majority women (56.4%), with a median evolution of epilepsy of 17 years (interquartile range: 7-31). The most frequent syndrome was juvenile myoclonic epilepsy (46.5%), followed by epilepsy with generalized tonic-clonic seizures alone (25.7%), juvenile absence epilepsy (13.9%) and childhood absence epilepsy (13.9%). The 71.29% were on monotherapy and 20.79% on polytherapy, with significant differences between the different syndromes (P=.001). The most widely used drug was valproic acid. 39.6% presented seizure remission at 5 years, but we did not observe significant differences between the different syndromes (P=.982). The recurrence rate was 71.4% after withdrawal of treatment. CONCLUSION Juvenile myoclonic epilepsy was the most frequent subtype of IGE. We observed significant differences in terms of polytherapy in the different syndromes, although not in the rates of remission of seizures at one year and at five years. The majority of patients with treatment withdrawal relapsed.
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28
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Oldrati V, Minghetti S, Zanotta N, Bardoni A, Zucca C. Etiology and duration of the disease in the assessment of intellectual functioning of pediatric patients with epilepsy: An observational study. Heliyon 2023; 9:e14085. [PMID: 36915569 PMCID: PMC10006677 DOI: 10.1016/j.heliyon.2023.e14085] [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] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Childhood epilepsy can be frequently associated with impaired cognitive functioning. Previous research has suggested an increased risk of cognitive impairment that may be related to the etiology, the electro-clinical pattern and the load of anti-seizure medications (ASMs). The aim of this study was to evaluate the impact of different clinical features on the global intellectual functioning in a cohort of children and adolescents with epilepsy. We studied eighty patients diagnosed and followed in a tertiary care center. These factors were examined: 1. Etiology of epileptic syndrome; 2. Type of seizure; 3. Number of ASMs; 4. Seizure frequency; 5. Age at seizure onset; 6. Total duration of epilepsy; and 7. Active duration of epilepsy. Multiple regression analysis showed that the etiology and the total duration of epilepsy were the best indicators of intellectual functioning. The present data indicate that children with symptomatic epilepsy (SE) have lower IQ scores (M = 63.5), while children with self-limited focal epilepsy and generalized idiopathic epilepsy, i.e. age-related epileptic syndromes (ARES), have a higher IQ (M = 100.0; p < 0.01). Children with epilepsy of unknown etiology (UEE) (M = 75.1; p < 0.05) are positioned at an intermediate level between the SE and the ARES group (p < 0.01). Increased duration of epilepsy was associated with decreased intellectual functioning. In conclusion, knowledge about the risks associated with etiologic factors and the duration of the disease may guide the definition of optimal neuropsychological rehabilitation strategies.
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Affiliation(s)
- Viola Oldrati
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Sara Minghetti
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Nicoletta Zanotta
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Alessandra Bardoni
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Claudio Zucca
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
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29
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Asadi-Pooya AA, Farazdaghi M. Cluster analysis of a large dataset of patients with juvenile myoclonic epilepsy: Predicting response to treatment. Seizure 2023; 105:10-13. [PMID: 36640450 DOI: 10.1016/j.seizure.2023.01.006] [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: 10/24/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The purpose of the current study was to apply Two-step cluster analysis on a large dataset of patients with juvenile myoclonic epilepsy (JME). We hypothesized that there are distinct subgroups of patients with similar clinical characteristics. We also hypothesized that the seizure outcome is different between these clusters. METHODS This was a retrospective study of a prospectively developed database. All patients with a diagnosis of JME were studied at the epilepsy center at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2022. The Two-Step cluster analysis (Schwarz's Bayesian Criterion) was applied to the whole dataset. In the next step, the seizure outcome was compared between the clusters of patients. RESULTS Two hundred and ninety-five patients were included. Two-Step cluster analysis showed that there were two distinct clusters of homogeneous subgroups of patients with JME, presenting with more or less similar clinical characteristics, with a fair (0.4) silhouette measure of cohesion and separation. One hundred and eighty-one patients had a follow up duration of 12 months or longer at our center. Response to treatment at 12 months of follow-up was different between the clusters (as a trend): 43 patients (39.1%) from cluster 1 and 18 people (25.4%) from cluster 2 were free of all seizure types (p = 0.076). CONCLUSION The Two-Step cluster analysis identified two distinct clusters of patients with JME. Individuals with JME, who also have absence seizures, are less likely to enjoy a seizure free state with ASMs.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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30
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Gesche J, Beier CP. Drug resistance in idiopathic generalized epilepsies: Evidence and concepts. Epilepsia 2022; 63:3007-3019. [PMID: 36102351 PMCID: PMC10092586 DOI: 10.1111/epi.17410] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
Although approximately 10%-15% of patients with idiopathic generalized epilepsy (IGE)/genetic generalized epilepsy remain drug-resistant, there is no consensus or established concept regarding the underlying mechanisms and prevalence. This review summarizes the recent data and the current hypotheses on mechanisms that may contribute to drug-resistant IGE. A literature search was conducted in PubMed and Embase for studies on mechanisms of drug resistance published since 1980. The literature shows neither consensus on the definition nor a widely accepted model to explain drug resistance in IGE or one of its subsyndromes. Large-scale genetic studies have failed to identify distinct genetic causes or affected genes involved in pharmacokinetics. We found clinical and experimental evidence in support of four hypotheses: (1) "network hypothesis"-the degree of drug resistance in IGE reflects the severity of cortical network alterations, (2) "minor focal lesion in a predisposed brain hypothesis"-minor cortical lesions are important for drug resistance, (3) "interneuron hypothesis"-impaired functioning of γ-aminobutyric acidergic interneurons contributes to drug resistance, and (4) "changes in drug kinetics"-genetically impaired kinetics of antiseizure medication (ASM) reduce the effectiveness of available ASMs. In summary, the exact definition and cause of drug resistance in IGE is unknown. However, published evidence suggests four different mechanisms that may warrant further investigation.
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Affiliation(s)
- Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Stevelink R, Al-Toma D, Jansen FE, Lamberink HJ, Asadi-Pooya AA, Farazdaghi M, Cação G, Jayalakshmi S, Patil A, Özkara Ç, Aydın Ş, Gesche J, Beier CP, Stephen LJ, Brodie MJ, Unnithan G, Radhakrishnan A, Höfler J, Trinka E, Krause R, EpiPGX Consortium, Irelli EC, Di Bonaventura C, Szaflarski JP, Hernández-Vanegas LE, Moya-Alfaro ML, Zhang Y, Zhou D, Pietrafusa N, Specchio N, Japaridze G, Beniczky S, Janmohamed M, Kwan P, Syvertsen M, Selmer KK, Vorderwülbecke BJ, Holtkamp M, Viswanathan LG, Sinha S, Baykan B, Altindag E, von Podewils F, Schulz J, Seneviratne U, Viloria-Alebesque A, Karakis I, D'Souza WJ, Sander JW, Koeleman BP, Otte WM, Braun KP. Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis. EClinicalMedicine 2022; 53:101732. [PMID: 36467455 PMCID: PMC9716332 DOI: 10.1016/j.eclinm.2022.101732] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). Interpretation We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding MING fonds.
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Affiliation(s)
- Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Dania Al-Toma
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Floor E. Jansen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Herm J. Lamberink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
- Department of Neurology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
| | - Gonçalo Cação
- Department of Neurology, Unidade Local de Saude do Alto Minho, Estrada de Santa Luzia, Viana do Castelo, 4904-858, Portugal
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa caddesi, Istanbul, 34098, Turkey
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, Belgrat Kapı yolu, Istanbul, 34020, Turkey
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Linda J. Stephen
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin J. Brodie
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Gopeekrishnan Unnithan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Julia Höfler
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Hellbrunner Straße 34, Salzburg, 3100, Austria
- Department of Public Health, University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria
| | - Roland Krause
- Bioinformatics Core Facility, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6 Ave du Swing, Belvaux, 4367, Luxembourg
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurosurgery, and Neurobiology, UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35294, USA
| | - Laura E. Hernández-Vanegas
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Monica L. Moya-Alfaro
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Nicola Pietrafusa
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Nicola Specchio
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Giorgi Japaridze
- Department of Clinical Neurophysiology, Institute of Neurology and Neuropsychology, 83/11 Vazha-Pshavela Ave., Tbilisi, 186, Georgia
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Filadelfia, Visby Allé 5, Dianalund, 4293, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus, 8200, Denmark
| | - Mubeen Janmohamed
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Marte Syvertsen
- Department of Neurology, Vestre Viken Hospital Trust, Dronninggata 28, Drammen, 3004, Norway
| | - Kaja K. Selmer
- National Centre for Epilepsy & Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, G. F. Henriksens vei 29, Sandvika, 1337, Norway
| | - Bernd J. Vorderwülbecke
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Istanbul, 34390, Turkey
| | - Ebru Altindag
- Department of Neurology, Istanbul Florence Nightingale Hospital, Abide-i Hürriyet Cad, Istanbul, 34381, Turkey
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
- Department of Medicine, The School of Clinical Sciences at Monash Health, Monash University, Clayton Road, Melbourne, Victoria, 3168, Australia
| | - Alejandro Viloria-Alebesque
- Department of Neurology, Hospital General de la Defensa, Vía Ibérica 1, Zaragoza, 50009, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avda. San Juan Bosco 13, Zaragoza, 50009, Spain
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Office 335, Atlanta, GA, 30303, USA
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
| | - Josemir W. Sander
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 7, Heemstede, Netherlands
- UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bobby P.C. Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Kees P.J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
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Conrad EC, Chugh N, Ganguly TM, Gugger JJ, Tizazu EF, Shinohara RT, Raghupathi R, Becker DA, Gelfand MA, Omole AT, Decker BM, Pathmanathan JS, Davis KA, Ellis CA. Using Generalized Polyspike Train to Predict Drug-Resistant Idiopathic Generalized Epilepsy. J Clin Neurophysiol 2022; 39:459-465. [PMID: 33298682 PMCID: PMC8184865 DOI: 10.1097/wnp.0000000000000803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The authors tested the hypothesis that the EEG feature generalized polyspike train (GPT) is associated with drug-resistant idiopathic generalized epilepsy (IGE). METHODS The authors conducted a single-center case-control study of patients with IGE who had outpatient EEGs performed between 2016 and 2020. The authors classified patients as drug-resistant or drug-responsive based on clinical review and in a masked manner reviewed EEG data for the presence and timing of GPT (a burst of generalized rhythmic spikes lasting less than 1 second) and other EEG features. A relationship between GPT and drug resistance was tested before and after controlling for EEG duration. The EEG duration needed to observe GPT was also calculated. RESULTS One hundred three patients were included (70% drug-responsive and 30% drug-resistant patients). Generalized polyspike train was more prevalent in drug-resistant IGE (odds ratio, 3.8; 95% confidence interval, 1.3-11.4; P = 0.02). This finding persisted when controlling for EEG duration both with stratification and with survival analysis. A median of 6.5 hours (interquartile range, 0.5-12.7 hours) of EEG recording was required to capture the first occurrence of GPT. CONCLUSIONS The findings support the hypothesis that GPT is associated with drug-resistant IGE. Prolonged EEG recording is required to identify this feature. Thus, >24-hour EEG recording early in the evaluation of patients with IGE may facilitate prognostication.
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Affiliation(s)
- Erin C. Conrad
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nanak Chugh
- Department of Community Physicians, John Hopkins Medicine, Baltimore, Maryland, U.S.A
| | - Taneeta M. Ganguly
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - James J. Gugger
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Etsegenet F. Tizazu
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ramya Raghupathi
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Danielle A. Becker
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Michael A. Gelfand
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Armina T. Omole
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Barbara M. Decker
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jay S. Pathmanathan
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Kathryn A. Davis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Colin A. Ellis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Sánchez-Zapata P, Zapata-Berruecos JF, Peláez-Sánchez RG. [Structural changes to the brain in drug-resistant juvenile myoclonic epilepsy]. Rev Neurol 2022; 75:23-30. [PMID: 35822568 PMCID: PMC10186721 DOI: 10.33588/rn.7502.2022066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION The aim of this research is to determine the changes in brain structures, both cortical and subcortical, in patients with drug-resistant juvenile myoclonic epilepsy (JME), in order to contribute to the understanding of the characteristics of the drug-resistant syndrome and to offer possible answers and hypotheses for further studies and more adequate treatments. SUBJECTS AND METHODS Observational case-control study. A convenience sample size of four cases and 16 healthy controls was defined to ensure the feasibility of the project (ratio of 4:1). The data collected for patients with drug-resistant JME came from 1.5T MRI equipment. FreeSurfer software was used to determine cortical and subcortical areas in both drug-resistant JME patients and healthy controls. RESULTS A total of 20 participants were included in the study, of whom four (20%) were drug-resistant JME patients and 16% (80%) were healthy controls. The clusters with statistically significant differences in cortical thickness are located in the precentral gyrus, superior temporal gyrus, transverse temporal gyrus, medial temporal gyrus and supramarginal gyrus, predominantly in the left hemisphere. CONCLUSIONS Structural brain changes are observed in patients with drug-resistant JME that may go undetected by the conventional processing techniques used in magnetic resonance imaging.
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Affiliation(s)
| | - J F Zapata-Berruecos
- Instituto Neurológico de Colombia, Medellín, Colombia
- Universidad CES, Medellín, Colombia
| | - R G Peláez-Sánchez
- Universidad de Antioquia, Medellín, Colombia
- Universidad CES, Medellín, Colombia
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Shakeshaft A, Laiou P, Abela E, Stavropoulos I, Richardson MP, Pal DK, BIOJUME Consortium
OrsiniAlessandroHowellAliceHydeAlisonMcQueenAlisonDuranAlmuGauravAlokCollingwoodAmberKitchingAmyShakeshaftAmyPapathanasiouAnastasiaCloughAndreaGribbinAndrewSwainAndrewNeedleAnnHallAnnaSmithAnnaMacleodAnneChhibdaAsyahFonferko-ShadrachBeataCamaraBintouPetrovaBoyankaStuartCarmelHamiltonCarolinePeaceyCarolineCampbellCarolynCotterCatherineEdwardsCatherinePictonCatieBusbyCharlotteQuaminaCharlotteWaiteCharlotteWestCharlotteNgChing ChingGiavasiChristinaBackhouseClaireHollidayClaireMewiesClaireThowColeenEggintonDawnDickersonDebbieRiceDebbieMullanDeeDalyDeirdreMcaleerDympnaGardellaElenaStephenElmaIrvineEveSacreEveLinFanCastleGailMackayGrahamSalimHalimaCockHannahCollierHeatherCockerillHelenNavarraHelenMhanduHildaCrudgingtonHollyHayesImogenStavropoulosIoannisDaglishJacquelineSmithJacquelineBartholomewJacquiCottaJanetCeballosJavier PeñaNatarajanJayaCrooksJenniferQuirkJenniferBlandJeremySidebottomJoGescheJoannaGlentonJoanneHenryJoanneDavisJohnBallJulieSelmerKaja KRhodesKarenHolroydKellyLimKheng SeangO’BrienKirstyThrasyvoulouLauraMakawaLinettyCharlesLisaRichardsonLisaNelsonLizWaldingLornaWoodheadLouiseEhioroboLovethHawkinsLynnAdamsLynseyConnonMargaretHomeMarieBakerMarkMenciasMarkRichardsonMark PSargentMarkSyvertsenMarteMilnerMatthewRectoMayethChangMichaelO'DonoghueMichaelYoungMichaelRayMunniPanjwaniNaimGhausNaveedSudarsanNikilSaidNooriaPickrellOwenEastonPatrickFrattaroliPaulMcAlindenPaulHarrisonRachelSwinglerRachelWaneRachelRamsayRebeccaMøllerRikke SMcDowallRobertCleggRosieUkaSalWhiteSamTruscottSamanthaFrancisSarahTittensorSarahSharmanSarah-JaneChungSeo-KyungPatelShakeelahEllawelaShanBegumShanazKempsonSharonRajSoniaBayleySophieWarrinerStephenKilroySusanMacFarlaneSusanBrownThomasSamakomvaTinasheNortcliffeTonichaCalderVerityCollinsVickyParkerVickyRichmondVivienSternWilliamHaslamZenaŠobíškováZuzanaAgrawalAmitWhitingAmyPraticoAndreaDesurkarArchanaSaraswatulaArunMacDonaldBridgetFongChoong YiBeierChristoph PAndradeDaniellePauldhasDarwinGreenbergDavid ADeekolluDavidPalDeb KJayachandranDinaLozsadiDoraGaliziaElizabethScottFraserRubboliGuidoAngus-LeppanHeatherTalvikIngaTakonInyanZarubovaJanaKohtJeanetteAramJuliaLanyonKarenIrwinKateHamandiKhalidYeungLapStrugLisa JReesMarkReuberMarkusKirkpatrickMartinTaylorMatthewMaguireMelissaKoutroumanidisMichalisKhanMuhammadMoranNickStrianoPasqualeBalaPronabBharatRahulPandeyRajeshMohanrajRajivThomasRhysBelderbosRosemarySlaghtSeán JDelamontShaneSastryShashikiranMariguddiShyamKumarSivaKumarSumantMajeedTahirJegathasanUmaWhitehouseWilliam, Howell A, Hyde A, McQueen A, Duran A, Gaurav A, Collingwood A, Kitching A, Shakeshaft A, Papathanasiou A, Clough A, Gribbin A, Swain A, Needle A, Hall A, Smith A, Macleod A, Chhibda A, Fonferko-Shadrach B, Camara B, Petrova B, Stuart C, Hamilton C, Peacey C, Campbell C, Cotter C, Edwards C, Picton C, Busby C, Quamina C, Waite C, West C, Ng CC, Giavasi C, Backhouse C, Holliday C, Mewies C, Thow C, Egginton D, Dickerson D, Rice D, Mullan D, Daly D, Mcaleer D, Gardella E, Stephen E, Irvine E, Sacre E, Lin F, Castle G, Mackay G, Salim H, Cock H, Collier H, Cockerill H, Navarra H, Mhandu H, Crudgington H, Hayes I, Stavropoulos I, Daglish J, Smith J, Bartholomew J, Cotta J, Ceballos JP, Natarajan J, Crooks J, Quirk J, Bland J, Sidebottom J, Gesche J, Glenton J, Henry J, Davis J, Ball J, Selmer KK, Rhodes K, Holroyd K, Lim KS, O’Brien K, Thrasyvoulou L, Makawa L, Charles L, Richardson L, Nelson L, Walding L, Woodhead L, Ehiorobo L, Hawkins L, Adams L, Connon M, Home M, Baker M, Mencias M, et alShakeshaft A, Laiou P, Abela E, Stavropoulos I, Richardson MP, Pal DK, BIOJUME Consortium
OrsiniAlessandroHowellAliceHydeAlisonMcQueenAlisonDuranAlmuGauravAlokCollingwoodAmberKitchingAmyShakeshaftAmyPapathanasiouAnastasiaCloughAndreaGribbinAndrewSwainAndrewNeedleAnnHallAnnaSmithAnnaMacleodAnneChhibdaAsyahFonferko-ShadrachBeataCamaraBintouPetrovaBoyankaStuartCarmelHamiltonCarolinePeaceyCarolineCampbellCarolynCotterCatherineEdwardsCatherinePictonCatieBusbyCharlotteQuaminaCharlotteWaiteCharlotteWestCharlotteNgChing ChingGiavasiChristinaBackhouseClaireHollidayClaireMewiesClaireThowColeenEggintonDawnDickersonDebbieRiceDebbieMullanDeeDalyDeirdreMcaleerDympnaGardellaElenaStephenElmaIrvineEveSacreEveLinFanCastleGailMackayGrahamSalimHalimaCockHannahCollierHeatherCockerillHelenNavarraHelenMhanduHildaCrudgingtonHollyHayesImogenStavropoulosIoannisDaglishJacquelineSmithJacquelineBartholomewJacquiCottaJanetCeballosJavier PeñaNatarajanJayaCrooksJenniferQuirkJenniferBlandJeremySidebottomJoGescheJoannaGlentonJoanneHenryJoanneDavisJohnBallJulieSelmerKaja KRhodesKarenHolroydKellyLimKheng SeangO’BrienKirstyThrasyvoulouLauraMakawaLinettyCharlesLisaRichardsonLisaNelsonLizWaldingLornaWoodheadLouiseEhioroboLovethHawkinsLynnAdamsLynseyConnonMargaretHomeMarieBakerMarkMenciasMarkRichardsonMark PSargentMarkSyvertsenMarteMilnerMatthewRectoMayethChangMichaelO'DonoghueMichaelYoungMichaelRayMunniPanjwaniNaimGhausNaveedSudarsanNikilSaidNooriaPickrellOwenEastonPatrickFrattaroliPaulMcAlindenPaulHarrisonRachelSwinglerRachelWaneRachelRamsayRebeccaMøllerRikke SMcDowallRobertCleggRosieUkaSalWhiteSamTruscottSamanthaFrancisSarahTittensorSarahSharmanSarah-JaneChungSeo-KyungPatelShakeelahEllawelaShanBegumShanazKempsonSharonRajSoniaBayleySophieWarrinerStephenKilroySusanMacFarlaneSusanBrownThomasSamakomvaTinasheNortcliffeTonichaCalderVerityCollinsVickyParkerVickyRichmondVivienSternWilliamHaslamZenaŠobíškováZuzanaAgrawalAmitWhitingAmyPraticoAndreaDesurkarArchanaSaraswatulaArunMacDonaldBridgetFongChoong YiBeierChristoph PAndradeDaniellePauldhasDarwinGreenbergDavid ADeekolluDavidPalDeb KJayachandranDinaLozsadiDoraGaliziaElizabethScottFraserRubboliGuidoAngus-LeppanHeatherTalvikIngaTakonInyanZarubovaJanaKohtJeanetteAramJuliaLanyonKarenIrwinKateHamandiKhalidYeungLapStrugLisa JReesMarkReuberMarkusKirkpatrickMartinTaylorMatthewMaguireMelissaKoutroumanidisMichalisKhanMuhammadMoranNickStrianoPasqualeBalaPronabBharatRahulPandeyRajeshMohanrajRajivThomasRhysBelderbosRosemarySlaghtSeán JDelamontShaneSastryShashikiranMariguddiShyamKumarSivaKumarSumantMajeedTahirJegathasanUmaWhitehouseWilliam, Howell A, Hyde A, McQueen A, Duran A, Gaurav A, Collingwood A, Kitching A, Shakeshaft A, Papathanasiou A, Clough A, Gribbin A, Swain A, Needle A, Hall A, Smith A, Macleod A, Chhibda A, Fonferko-Shadrach B, Camara B, Petrova B, Stuart C, Hamilton C, Peacey C, Campbell C, Cotter C, Edwards C, Picton C, Busby C, Quamina C, Waite C, West C, Ng CC, Giavasi C, Backhouse C, Holliday C, Mewies C, Thow C, Egginton D, Dickerson D, Rice D, Mullan D, Daly D, Mcaleer D, Gardella E, Stephen E, Irvine E, Sacre E, Lin F, Castle G, Mackay G, Salim H, Cock H, Collier H, Cockerill H, Navarra H, Mhandu H, Crudgington H, Hayes I, Stavropoulos I, Daglish J, Smith J, Bartholomew J, Cotta J, Ceballos JP, Natarajan J, Crooks J, Quirk J, Bland J, Sidebottom J, Gesche J, Glenton J, Henry J, Davis J, Ball J, Selmer KK, Rhodes K, Holroyd K, Lim KS, O’Brien K, Thrasyvoulou L, Makawa L, Charles L, Richardson L, Nelson L, Walding L, Woodhead L, Ehiorobo L, Hawkins L, Adams L, Connon M, Home M, Baker M, Mencias M, Richardson MP, Sargent M, Syvertsen M, Milner M, Recto M, Chang M, O'Donoghue M, Young M, Ray M, Panjwani N, Ghaus N, Sudarsan N, Said N, Pickrell O, Easton P, Frattaroli P, McAlinden P, Harrison R, Swingler R, Wane R, Ramsay R, Møller RS, McDowall R, Clegg R, Uka S, White S, Truscott S, Francis S, Tittensor S, Sharman SJ, Chung SK, Patel S, Ellawela S, Begum S, Kempson S, Raj S, Bayley S, Warriner S, Kilroy S, MacFarlane S, Brown T, Samakomva T, Nortcliffe T, Calder V, Collins V, Parker V, Richmond V, Stern W, Haslam Z, Šobíšková Z, Agrawal A, Whiting A, Pratico A, Desurkar A, Saraswatula A, MacDonald B, Fong CY, Beier CP, Andrade D, Pauldhas D, Greenberg DA, Deekollu D, Pal DK, Jayachandran D, Lozsadi D, Galizia E, Scott F, Rubboli G, Angus-Leppan H, Talvik I, Takon I, Zarubova J, Koht J, Aram J, Lanyon K, Irwin K, Hamandi K, Yeung L, Strug LJ, Rees M, Reuber M, Kirkpatrick M, Taylor M, Maguire M, Koutroumanidis M, Khan M, Moran N, Striano P, Bala P, Bharat R, Pandey R, Mohanraj R, Thomas R, Belderbos R, Slaght SJ, Delamont S, Sastry S, Mariguddi S, Kumar S, Kumar S, Majeed T, Jegathasan U, Whitehouse W, BIOJUME Consortium. Heterogeneity of resting-state EEG features in juvenile myoclonic epilepsy and controls. Brain Commun 2022; 4:fcac180. [PMID: 35873918 PMCID: PMC9301584 DOI: 10.1093/braincomms/fcac180] [Show More Authors] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
Abnormal EEG features are a hallmark of epilepsy, and abnormal frequency and network features are apparent in EEGs from people with idiopathic generalized epilepsy in both ictal and interictal states. Here, we characterize differences in the resting-state EEG of individuals with juvenile myoclonic epilepsy and assess factors influencing the heterogeneity of EEG features. We collected EEG data from 147 participants with juvenile myoclonic epilepsy through the Biology of Juvenile Myoclonic Epilepsy study. Ninety-five control EEGs were acquired from two independent studies [Chowdhury et al. (2014) and EU-AIMS Longitudinal European Autism Project]. We extracted frequency and functional network-based features from 10 to 20 s epochs of resting-state EEG, including relative power spectral density, peak alpha frequency, network topology measures and brain network ictogenicity: a computational measure of the propensity of networks to generate seizure dynamics. We tested for differences between epilepsy and control EEGs using univariate, multivariable and receiver operating curve analysis. In addition, we explored the heterogeneity of EEG features within and between cohorts by testing for associations with potentially influential factors such as age, sex, epoch length and time, as well as testing for associations with clinical phenotypes including anti-seizure medication, and seizure characteristics in the epilepsy cohort. P-values were corrected for multiple comparisons. Univariate analysis showed significant differences in power spectral density in delta (2-5 Hz) (P = 0.0007, hedges' g = 0.55) and low-alpha (6-9 Hz) (P = 2.9 × 10-8, g = 0.80) frequency bands, peak alpha frequency (P = 0.000007, g = 0.66), functional network mean degree (P = 0.0006, g = 0.48) and brain network ictogenicity (P = 0.00006, g = 0.56) between epilepsy and controls. Since age (P = 0.009) and epoch length (P = 1.7 × 10-8) differed between the two groups and were potential confounders, we controlled for these covariates in multivariable analysis where disparities in EEG features between epilepsy and controls remained. Receiver operating curve analysis showed low-alpha power spectral density was optimal at distinguishing epilepsy from controls, with an area under the curve of 0.72. Lower average normalized clustering coefficient and shorter average normalized path length were associated with poorer seizure control in epilepsy patients. To conclude, individuals with juvenile myoclonic epilepsy have increased power of neural oscillatory activity at low-alpha frequencies, and increased brain network ictogenicity compared with controls, supporting evidence from studies in other epilepsies with considerable external validity. In addition, the impact of confounders on different frequency-based and network-based EEG features observed in this study highlights the need for careful consideration and control of these factors in future EEG research in idiopathic generalized epilepsy particularly for their use as biomarkers.
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Affiliation(s)
- Amy Shakeshaft
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Petroula Laiou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Eugenio Abela
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Mark P Richardson
- Correspondence may also be addressed to: Professor Mark P Richardson Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology & Neuroscience King’s College London, 5 Cutcombe Road, London SE5 9RX, UK E-mail:
| | - Deb K Pal
- Correspondence to: Professor Deb K Pal Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology & Neuroscience King’s College London 5 Cutcombe Road, London SE5 9RX, UK E-mail:
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Bartolini E, Ferrari AR, Lattanzi S, Pradella S, Zaccara G. Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology. Epilepsy Behav 2022; 132:108739. [PMID: 35636351 DOI: 10.1016/j.yebeh.2022.108739] [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: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
The incidence of epilepsy is highest at the extreme age ranges: childhood and elderly age. The most common syndromes in these demographics - self-limited epilepsies of childhood and idiopathic generalized epilepsies in pediatric age, focal epilepsy with structural etiology in older people - are expected to be drug responsive. In this work, we focus on such epilepsy types, overviewing the complex clinical background of unexpected drug-resistance. For self-limited epilepsies of childhood and idiopathic generalized epilepsies, we illustrate drug-resistance resulting from syndrome misinterpretation, reason on possible unexpected courses of epilepsy, and explicate the influence of inappropriate treatments. For elderly-onset epilepsy, we show the challenges in differential diagnosis possibly leading to pseudoresistance and analyze how drug-resistant epilepsy can arise in stroke, neurocognitive disorders, brain tumors, and autoimmune encephalitis. In children and senior people, drug-resistance can be regarded as a hint to review the diagnosis or explore alternative therapeutic strategies. Refractory seizures are not only a therapeutic challenge, but also a cardinal sign not to be overlooked in syndromes commonly deemed to be drug-responsive.
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Affiliation(s)
- Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Pradella
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy.
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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: 218] [Impact Index Per Article: 72.7] [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.
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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
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Abstract
PURPOSE OF REVIEW This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy. RECENT FINDINGS One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual disability and dementia are common and can complicate the diagnostic process when cognitive and/or behavioral features resemble seizures. SUMMARY Comorbidities require consideration from the first point of contact with a patient because they can determine the presentation of symptoms, responsiveness to treatment, and the patient's day-to-day functioning and quality of life. In epilepsy, psychiatric and cognitive comorbidities may prove a greater source of disability for the patient and family than the seizures themselves, and in the case of essential comorbidities, they are regarded as core to the disorder in terms of etiology, diagnosis, and treatment.
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Asadi-Pooya AA, Rostamihosseinkhani M, Farazdaghi M. Seizure and social outcomes in patients with juvenile myoclonic epilepsy (JME). Seizure 2022; 97:15-19. [DOI: 10.1016/j.seizure.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022] Open
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Richardson RM. Closed-Loop Brain Stimulation and Paradigm Shifts in Epilepsy Surgery. Neurol Clin 2022; 40:355-373. [PMID: 35465880 PMCID: PMC9271409 DOI: 10.1016/j.ncl.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in device technology have created greater flexibility in treating seizures as emergent properties of networks that exist on a local to global continuum. All patients with drug-resistant epilepsy are potential surgical candidates, given that intracranial neuromodulation through deep brain stimulation and responsive neurostimulation can reduce seizures and improve quality of life, even in multifocal and generalized epilepsies. To achieve this goal, indications and strategies for diagnostic epilepsy surgery are evolving. This article describes the state-of-the-art in epilepsy surgery and related changes in how we define indications for diagnostic and therapeutic surgical intervention.
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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: 12] [Impact Index Per Article: 4.0] [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.
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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
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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: 23] [Impact Index Per Article: 7.7] [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.
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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.
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Vorderwülbecke BJ, Wandschneider B, Weber Y, Holtkamp M. 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: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [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.
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Affiliation(s)
- Bernd J Vorderwülbecke
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Yvonne Weber
- Department of Epileptology and Neurology, University of Aachen, Aachen, Germany
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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ATALAR AÇ, BAYKAN B. Different Prognostic Patterns in Epilepsies and Considerations About the Denotations of Atypical Patterns. Noro Psikiyatr Ars 2022; 59:68-76. [PMID: 35317501 PMCID: PMC8895800 DOI: 10.29399/npa.27976] [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: 07/10/2021] [Accepted: 08/12/2021] [Indexed: 06/14/2023] Open
Abstract
Epilepsy is a dynamic and heterogeneous neurological disease, and in long-term studies on prognosis, classically 5 basic patterns (early remission, late remission, relapsing-remitting, worsening, and non-remitting) have been identified. The most frequent pattern was relapsing-remitting course, and factors such as the presence of genetic etiology, rare seizures at the beginning of epilepsy and the absence of psychiatric comorbid diseases were found to be related with this pattern as well as reaching 5 years of remission in the follow-ups. Anti-seizure drug resistance (ASD-R) and factors affecting the presence of this resistance (such as symptomatic etiology, abnormal electroencephalographic findings, having multiple seizure types together, status epilepticus and febrile seizure history) decrease the chance of remission, while idiopathic/genetic etiology, generalized epilepsy, and absence of comorbid diseases seem to be associated with achieving long-term remission. Apart from these basic course patterns, there are some patients with an "atypical prognosis" such as drug-resistant juvenile myoclonic epilepsy (JME), benign hippocampal sclerosis-related mesial temporal lobe epilepsy (HS-MTLE), and severe childhood epilepsy with centro-temporal spikes (CESTS), in which the pathophysiological mechanisms underlying these patterns have not been clarified despite the suggestions of various hypotheses. The presence of comorbid diseases such as hormonal factors (as in catamenial epilepsy), autoimmune processes, thyroid disorders and metabolic and psychiatric diseases may also cause an atypical prognostic pattern by affecting the course of the disease. In this review, our aim is to provide the clinician with an up-to-date and questioning perspective on the prognostic markers of epilepsy, by examining in detail some specific epilepsy syndromes that may show atypical prognosis as well as the general prognostic features of epilepsy.
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Affiliation(s)
- Arife Çimen ATALAR
- University of Health Sciences, Istanbul Education and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Betül BAYKAN
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey
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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.
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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:
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45
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High rates of early remission pattern in adult-onset compared with earlier-onset idiopathic generalized epilepsy: A long-term follow-up study. Seizure 2021; 94:52-56. [PMID: 34864252 DOI: 10.1016/j.seizure.2021.11.019] [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: 06/04/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate electroclinical characteristics and prognostic patterns of adult-onset vs. younger-onset idiopathic generalized epilepsy (IGE) patients during long-term follow-up. METHODS In this single-center retrospective cohort comparative study, adult-onset IGE was defined as onset after 20 years of age. Patients with a follow-up duration between 10 and 30 years from epilepsy diagnosis were enrolled. Maximum follow-up duration was limited to 30 years to ensure a better comparison of prognostic data between adult-onset and younger-onset patients. The Benjamini-Hochberg false discovery rate (FDR) method was applied to obtain FDR-adjusted p-values. RESULTS A total of 177 IGE patients were recruited and 27 adult-onset IGE patients were identified (15.3%). Follow-up duration was similar between younger- and adult-onset IGE patients and 74% of subjects performed at least one 24-hour EEG recording. Of adult-onset IGE patients, 8/27 were diagnosed with juvenile myoclonic epilepsy, while 19/27 were diagnosed with generalized tonic-clonic seizures (GTCS) only. EEG photosensitivity and absence seizures were significantly less frequent among adult-onset IGE patients as compared with younger subjects. When considering prognostic patterns, an early remission pattern was significantly higher among adult-onset IGE patients as compared with younger-onset IGE patients (55.6% vs. 24%, adjusted p value = 0.007). Antiseizure medication withdrawal was attempted in 3/27 adult-onset patients, and all had GTCS relapses. CONCLUSION Our study contributes to better defining the electroclinical characteristics and long-term follow-up of adult-onset IGE patients. A favorable long-term seizure outcome was found in adult-onset IGE patients, as evidenced by the high rates of early remission pattern when compared with younger onset patients.
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46
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Li N, Li J, Chen Y, Chu C, Lin W. Treatment Outcome and Risk Factors of Adult Newly Diagnosed Epilepsy: A Prospective Hospital-Based Study in Northeast China. Front Neurol 2021; 12:747958. [PMID: 34777218 PMCID: PMC8581653 DOI: 10.3389/fneur.2021.747958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: The study was conducted to summarize the treatment outcomes of newly diagnosed epilepsy (NDE) and analyse the risk factors for refractory epilepsy (RE) in Northeast China. Methods: A total of 466 adult patients with NDE were consecutively enrolled in this programme. Clinical data were collected at baseline and each follow-up. Several scales concerning recognition and mood were also completed at the first visit. Results: Seizure-free status was achieved by 52% (n = 244) of the patients; however, 15% (n = 68) manifested RE. A total of 286 (61%) patients continued with the first ASM as monotherapy, among which 186 (40%) patients became seizure-free. Fifteen (22%) patients with RE became seizure-free following ASM adjustment and 34 patients (14%) had breakthrough seizures after being classified as seizure-free. One patient developed RE after attaining seizure-free status. Breakthrough seizures during the first expected interictal interval [Odds ratio (OR) = 5.81, 95% CI: 2.70–12.50], high seizure frequency at baseline (OR = 1.24, 95% CI: 1.04–1.49), younger age of onset (OR = 1.42, 95% CI: 1.12–1.79), and male sex (OR = 2.64, 95% CI: 1.26–5.53) were risk factors for RE. Significance: Treatment outcomes of the majority of NDE cases are good. New risk factors could help physicians more promptly and accurately identify patients who are likely to develop RE. Seizure-free state is not long enough to commence the withdrawal of ASMs. RE is not permanent and seizure-free may be achieved subsequently by appropriate drug adjustment.
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Affiliation(s)
- Nan Li
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jing Li
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanyan Chen
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neuroelectrophysiology, Changchun Six Hospital, Changchun, China
| | - Chaojia Chu
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
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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: 28] [Impact Index Per Article: 7.0] [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.
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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
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48
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Forthoffer N, Tarrada A, Brissart H, Maillard L, Hingray C. Anxiety and Depression in Newly Diagnosed Epilepsy: A Matter of Psychological History? Front Neurol 2021; 12:744377. [PMID: 34675875 PMCID: PMC8525707 DOI: 10.3389/fneur.2021.744377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: Anxiety and depression are highly prevalent in patients with epilepsy (PWE), and these symptoms can even precede the onset of the pathology. We aimed to define the prevalence of anxiety and depressive symptoms at the time of the epilepsy diagnosis and the factors related to their presence in newly diagnosed adult patients. Methods: One hundred and twelve newly diagnosed patients were assessed, usually in the week after diagnosis. Patients were untreated at this time. We used the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off ≥15) and the Generalized Anxiety Disorder 7-Item scale (GAD-7, cut-off >7). A semi-structured interview was conducted to collect sociodemographic and epilepsy data and patients' psychiatric history. We first compared patients with and without anxiety symptoms, then patients with and without depressive symptoms. Results: According to the GAD-7 scale, the prevalence of anxiety symptoms at the time of diagnosis was 35%. Patients with anxiety symptoms had significantly more psychiatric history (26%, p = 0.001) and more history of psychological trauma (51%, p = 0.003) than patients with no anxiety symptoms. According to the NDDI-E scores, the prevalence of depressive symptoms at the time of the diagnosis was 11%. Patients with depressive symptoms had significantly more psychiatric history (43%, p < 0.001) and more history of psychological trauma (65%, p = 0.007) than patients with no depressive symptoms. No difference between groups was found for other sociodemographic variables (age and gender), epilepsy characteristics (number of seizures prior to diagnosis, time from first seizure to diagnosis, type of epilepsy, and localization in focal epilepsy), or neurological comorbidities. Conclusions: Anxiety symptoms are common whereas depressive symptoms are less prevalent at the time of diagnosis. It appears essential to be aware of anxiety and depression in newly diagnosed epileptic patients. They should be screened and routinely monitored, especially those patients with a history of psychological trauma and/or psychiatric disorders. Longitudinal follow-up is required to identify whether these factors and anxiety and depression themselves have an impact on the future course of care.
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Affiliation(s)
- Natacha Forthoffer
- Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg, Strasbourg, France.,Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Alexis Tarrada
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Unité de Formation et de Recherche (UFR) Médecine Paris Centre, Université de Paris, Paris, France
| | - Hélène Brissart
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
| | - Louis Maillard
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
| | - Coraline Hingray
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
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Mangaard S, Gesche J, Delcomyn L, Beier CP. The burden of disease of idiopathic/genetic generalized epilepsy - A nationwide online survey. Epilepsy Behav 2021; 123:108232. [PMID: 34416520 DOI: 10.1016/j.yebeh.2021.108232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
The aim of the study was to assess the self-reported burden of disease in people with idiopathic/genetic generalized epilepsy and risk factors associated with high disease burden. We performed a nationwide online survey on epilepsy characteristics/treatment, quality of life/daily living followed by Standardized Assessment of Personality-Abbreviated Scale, Major Depression Inventory, Barratt Impulsiveness Scale (brief) and the brief Epilepsy Anxiety Survey Instrument. The survey was sent to 275 representative patients with IGE ('Funen cohort') and later publicly distributed via the Danish Epilepsy Association. The characteristics of the responders of the 'Funen cohort' (n = 119) did not differ from non-responders and previously assessed data. Out of 753 persons accessing the public survey, 167 had probable IGE. As compared to the 'Funen cohort', patients from the public survey reported similar age, time since last seizure, years with disease, seizure types, and IGE syndromes but more current and previously tried anti-seizure medications (ASMs). In both cohorts, patients had higher scores for depression, impulsivity, and personality disorders as compared to Danish normal values irrespective of seizure control or medication. Higher depression and anxiety scores but neither impulsivity nor personality disorders were associated with ongoing seizures. Overall health condition was estimated as bad by 28%. In the last four weeks, 20.4% reported limitations of activities of daily living due to epilepsy; 27.8% felt fed up because of their epilepsy. Patients with high subjective disease burden had more current ASMs, shorter time since last seizure and increased scores for depression, anxiety, impulsivity, and personality disorders. In conclusion, having IGE was associated with higher scores for impulsivity, depression, and personality disorders irrespective of seizure control and current treatment. High subjective disease burden was common and associated with ongoing seizures, absence/myoclonic seizures and high scores for impulsivity, depression, anxiety, and personality disorders.
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Affiliation(s)
- Sofie Mangaard
- Department of Neurology, Odense University Hospital, Denmark
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark
| | - Line Delcomyn
- Department of Neurology, Odense University Hospital, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
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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: 6] [Impact Index Per Article: 1.5] [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.
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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
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