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Badawi GA, Shokr MM, Elshazly SM, Zaki HF, Mohamed AF. "Sigma-1 receptor modulation by clemastine highlights its repurposing as neuroprotective agent against seizures and cognitive deficits in PTZ-kindled rats". Eur J Pharmacol 2024; 980:176851. [PMID: 39084454 DOI: 10.1016/j.ejphar.2024.176851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
Epilepsy is a neurological disorder characterized by recurrent spontaneous seizures alongside other neurological comorbidities. Cognitive impairment is the most frequent comorbidity secondary to progressive neurologic changes in epilepsy. Sigma 1 receptors (σ1 receptors) are involved in the neuroprotection and pathophysiology of both conditions and targeting these receptors may have the potential to modulate both seizures and comorbidities. The current research demonstrated the effect of clemastine (10 mg/kg, P.O.), a non-selective σ1 receptor agonist, on pentylenetetrazol (PTZ) (35 mg/kg, i.p., every 48 h for 14 doses)-kindling rats by acting on σ1 receptors through its anti-inflammatory/antioxidant capacity. Clemastine and phenytoin (30 mg/kg, P.O.) or their combination were given once daily. Clemastine treatment showed a significant effect on neurochemical, behavioural, and histopathological analyses through modulation of σ1 receptors. It protected the kindling animals from seizures and attenuated their cognitive impairment in the Morris water maze test by reversing the PTZ hippocampal neuroinflammation/oxidative stress state through a significant increase in inositol-requiring enzyme 1 (IRE1), x-box binding protein 1 (XBP1), along with a reduction of total reactive oxygen species (TROS) and amyloid beta protein (Aβ). The involvement of σ1 receptors in the protective effects of clemastine was confirmed by their abrogation when utilizing NE-100, a selective σ1 receptor antagonist. In light of our findings, modulating σ1 receptors emerges as a compelling therapeutic strategy for epilepsy and its associated cognitive impairments. The significant neuroprotective effects observed with clemastine underscore the potential of σ1 receptor-targeted treatments to address both the primary symptoms and comorbidities of neurological disorders.
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Affiliation(s)
- Ghada A Badawi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Sinai University- Arish Branch, Arish, 45511, Egypt
| | - Mustafa M Shokr
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Sinai University- Arish Branch, Arish, 45511, Egypt.
| | - Shimaa M Elshazly
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Hala F Zaki
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Ahmed F Mohamed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; Faculty of Pharmacy, King Salman International University (KSIU), South Sinai, 46612, Egypt
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Wu Y, Zhang Z, Dong X, Liang P, Li L, Zhai X, Zou B. Epilepsy and childhood psychiatric disorders: a two-sample bidirectional Mendelian randomization study. Neurol Sci 2024; 45:3971-3978. [PMID: 38488928 DOI: 10.1007/s10072-024-07447-2] [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: 01/08/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Observational studies have indicated that psychiatric disorders are the most common comorbidities in pediatric epilepsy. However, the existence and direction of a causal relationship between the two remains controversial. This study aims to investigate the association between common childhood psychiatric disorders and epilepsy using a two-sample, bidirectional Mendelian randomization (MR) approach. METHODS Genetic instruments were obtained from the most recent and largest genome-wide association studies (GWAS), including datasets for epilepsy (N_case = 29,994, N_control = 52,538), attention deficit hyperactivity disorder (ADHD) (N_case = 38,691, N_control = 186,843), autism spectrum disorder (ASD) (N_case = 18,381, N_control = 27,969), and Tourette syndrome (TS) (N_case = 4,819, N_control = 9488). MR analyses were conducted using the inverse variance weighted (IVW) method, weighted median method, and MR-Egger regression. RESULTS No reliable evidence was found to suggest a causal effect of ADHD, ASD, or TS on epilepsy, nor was there any reliable evidence indicating that epilepsy increases the risk of these three psychiatric disorders. These findings remained consistent across various sensitivity analyses. CONCLUSION Although observational studies have highlighted a high comorbidity rate between pediatric epilepsy and psychiatric disorders like ADHD and ASD, the MR analysis did not confirm a causal relationship between them. This suggests that previous studies might have been influenced by confounding biases or other biases, potentially overestimating the true relationship. A deeper understanding of the mechanisms underlying these comorbidities is crucial for refining the treatment of pediatric epilepsy.
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Affiliation(s)
- YuXin Wu
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - ZaiYu Zhang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Xinyu Dong
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Ping Liang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Lusheng Li
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Xuan Zhai
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Bin Zou
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China.
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China.
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Liu S, Cao Z, He Z, Shi W, Li J. Social support and the burden of physical and psychiatric comorbidities in the patients with late-onset epilepsy in China: A cross-sectional study. Epilepsy Behav 2024; 155:109775. [PMID: 38640724 DOI: 10.1016/j.yebeh.2024.109775] [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: 01/06/2024] [Revised: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Epilepsy is the third most common neurological disorder in elderly people. Patients with epilepsy (PWEs) are more likely to have comorbidities. Social support is very important for PWEs. However, there are many gaps in the research on social support in older PWEs, especially the correlation between social support and comorbidities. METHODS A cross-sectional study was conducted in three hospitals in China. Social support was assessed using the Social Support Rate Scale. The burden of physical comorbidities was assessed using the CCI, and global disability was assessed using the mRS. The NDDIE was used to assess depression, the GAD7 was used for anxiety, the CDR was used for cognitive status, and the NPI was used for psychotic symptoms. RESULTS A total of 154 older PWEs participated in the study. There were 97 patients with at least one physical comorbidities. The burden of physical comorbidities was negatively correlated with overall social support (Adj. r = -0.35, P < 0.001) and global disability (Adj. r = -0.45, P < 0.001). In terms of psychiatric comorbidities, anxiety, depression, and cognitive status were not correlated with overall social support (Adj. r = -0.03, -0.02, and -0.11, P > 0.05). Psychotic symptoms were correlated with overall social support (Adj. r = -0.20, P < 0.05). The overall burden of psychiatric comorbidities was associated with overall social support (r = 0.30, P < 0.01). DISCUSSION Neurologists and social workers should consider more personalized biopsychosocial care to improve the quality of life of older PWEs.
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Affiliation(s)
- Shengyi Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhen Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Geriatrics, The Second People's Hospital of Yibin, Yibin, China.
| | - Zihua He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China.
| | - Wenyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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Cerulli Irelli E, Borioni MS, Morano A, Mazzeo A, Moro P, Orlando B, Salamone EM, Giordano L, Petrungaro A, Toccaceli Blasi M, Giallonardo AT, Canevelli M, Di Bonaventura C. Frailty as a comprehensive health measure beyond seizure control in patients with epilepsy: A cross-sectional study. Epilepsia 2024; 65:1658-1667. [PMID: 38536086 DOI: 10.1111/epi.17964] [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: 12/28/2023] [Revised: 02/12/2024] [Accepted: 03/11/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Due to the high clinical heterogeneity of epilepsy, there is a critical need for novel metrics aimed at capturing its biological and phenotypic complexity. Frailty is increasingly recognized in various medical disciplines as a useful construct to understand differences in susceptibility to adverse outcomes. Here, we develop a frailty index (FI) for patients with epilepsy (PwE) and explore its association with demographic and clinical features. METHODS In this cross-sectional study, we consecutively enrolled 153 PwE from an outpatient epilepsy clinic. Participants were assessed for various health deficits to calculate the FI. Associations between FI and demographic/clinical features, antiseizure medications (ASMs), and patient-reported outcomes were analyzed using general linear models and Spearman correlation. RESULTS The median age at the time of study visit was 47 years (interquartile range = 33-60), and 89 (58.2%) patients were females. Multiple linear regression revealed that the developed 33-item FI showed an independent association with age, female sex, higher body mass index, family history of epilepsy, intellectual disability, and the number of ASMs used. A robust analysis of covariance showed higher FI levels in patients using cytochrome P450 3A4-inducer ASMs. We found a moderate positive correlation between FI and psychological distress, lower quality of life, and physical frailty, measured by the Hospital Anxiety and Depression Scale, Quality of Life in Epilepsy Inventory-10, and handgrip strength, respectively. Finally, a weak association was observed between higher FI scores and an increased number of epileptic falls. SIGNIFICANCE This study highlights the significance of frailty as a comprehensive health measure in epilepsy. It suggests that frailty in this specific population is not only a manifestation of aging but is inherently linked to epilepsy and treatment-related factors. Future research is warranted to validate and refine the FI in diverse epilepsy populations and investigate its impact on specific adverse outcomes in longitudinal studies.
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Affiliation(s)
| | - Maria S Borioni
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Adolfo Mazzeo
- Institute of Research and Medical Care Neuromed, Pozzilli, Italy
| | | | - Biagio Orlando
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Luca Giordano
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Alessio Petrungaro
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Neurorehabilitation Unit, IRCCS Santa Maria Nascente, Don Carlo Gnocchi Foundation, Milan, Italy
| | | | | | - Marco Canevelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Policlinico Umberto I, Rome, Italy
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Häussler U, Neres J, Vandenplas C, Eykens C, Kadiu I, Schramm C, Fleurance R, Stanley P, Godard P, de Mot L, van Eyll J, Knobeloch KP, Haas CA, Dedeurwaerdere S. Downregulation of Ubiquitin-Specific Protease 15 (USP15) Does Not Provide Therapeutic Benefit in Experimental Mesial Temporal Lobe Epilepsy. Mol Neurobiol 2024; 61:2367-2389. [PMID: 37874479 PMCID: PMC10973041 DOI: 10.1007/s12035-023-03692-2] [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: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
Structural epilepsies display complex immune activation signatures. However, it is unclear which neuroinflammatory pathways drive pathobiology. Transcriptome studies of brain resections from mesial temporal lobe epilepsy (mTLE) patients revealed a dysregulation of transforming growth factor β, interferon α/β, and nuclear factor erythroid 2-related factor 2 pathways. Since these pathways are regulated by ubiquitin-specific proteases (USP), in particular USP15, we hypothesized that USP15 blockade may provide therapeutic relief in treatment-resistant epilepsies. For validation, transgenic mice which either constitutively or inducibly lack Usp15 gene expression underwent intrahippocampal kainate injections to induce mTLE. We show that the severity of status epilepticus is unaltered in mice constitutively lacking Usp15 compared to wild types. Cell death, reactive gliosis, and changes in the inflammatory transcriptome were pronounced at 4 days after kainate injection. However, these brain inflammation signatures did not differ between genotypes. Likewise, induced deletion of Usp15 in chronic epilepsy did not affect seizure generation, cell death, gliosis, or the transcriptome. Concordantly, siRNA-mediated knockdown of Usp15 in a microglial cell line did not impact inflammatory responses in the form of cytokine release. Our data show that a lack of USP15 is insufficient to modulate the expression of relevant neuroinflammatory pathways in an mTLE mouse model and do not support targeting USP15 as a therapeutic approach for pharmacoresistant epilepsy.
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Affiliation(s)
- Ute Häussler
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
- BrainLinks-BrainTools Center, University of Freiburg, Georges-Koehler-Allee 201, 79110, Freiburg, Germany.
| | - João Neres
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Catherine Vandenplas
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Caroline Eykens
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Irena Kadiu
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Carolin Schramm
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Renaud Fleurance
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Phil Stanley
- Early Development Statistics, UCB Celltech, 208 Bath Road, Slough, Berkshire, SL1 3WE, UK
| | - Patrice Godard
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Laurane de Mot
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Jonathan van Eyll
- Early Solutions, UCB Biopharma SRL, Chemin du Foriest, 1420, Braine L'Alleud, Belgium
| | - Klaus-Peter Knobeloch
- Institute for Neuropathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
- CIBSS - Centre for Integrative Biological Signalling Studies, Freiburg, Germany.
| | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Georges-Koehler-Allee 201, 79110, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Bernstein Center Freiburg, University of Freiburg, Hansastr. 9a, 79104, Freiburg, Germany
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Carpio A, Salgado C, DiCapua D, Fleury A, Suastegui R, Giagante B, Aguilera L, Quijada A, Nuñez L, Villanueva M, Plascencia‐Alvarez N, Hamamoto Filho PT, Piedra LM, Silva‐Rosas C, Kelvin EA. Causes and prognosis of adults experiencing a first seizure in adulthood: A pilot cohort study conducted in five countries in Latin America. Epilepsia Open 2024; 9:776-784. [PMID: 38366910 PMCID: PMC10984322 DOI: 10.1002/epi4.12900] [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: 10/31/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024] Open
Abstract
There are limited data on first seizure (FS) among adults in low and middle-income countries. We describe findings from a prospective cohort study involving 180 adults presenting with seizures in emergency departments in five Latin American countries. Overall, 102 participants (56.7%) had acute symptomatic seizures (ASyS) while 78 (43.3%) had unprovoked seizures (UPS). Among patients with ASyS, 55 (53.9%) had structural causes, with stroke (n = 24, 23.5%), tumor (n = 10, 9.8%), and trauma (n = 3, 3%) being the most frequent. Nineteen patients (18.6%) had infectious causes, including four (4%) with meningoencephalitis, three (3%) neurocysticercosis, and two (2%) bacterial meningoencephalitis. Twenty patients (19.6%) had metabolic/toxic evidence, including four (4%) with uremic encephalopathy, two (2%) hyponatremia, and three (3%) acute alcohol intoxication. Immune dysfunction was present in seven (7%) patients and neurodegenerative in two (2%). Among participants with UPS, 45 (57.7%) had unknown etiology, 24 (30.7%) had evidence of structural disorders (remote symptomatic), four (5%) were related to infectious etiology (>7 days before the seizure), and five (6.4%) had genetic causes. During the 3- and 6-month follow-up, 29.8% and 14% of patients with UPS, respectively, experienced seizure recurrence, while 23.9% and 24.5% of patients with ASyS had seizure recurrence. Longer follow-up is necessary to assess seizure recurrence for patients with ASyS after the acute cause is resolved and to determine the 10-year risk of recurrence, which is part of the definition of epilepsy. PLAIN LANGUAGE SUMMARY: We monitored 180 adults who presented with their first seizure in emergency departments across five Latin American countries. Among these patients, 57% had acute symptomatic seizures, with structural causes such as stroke (23%), infection (17%), or tumor (10%) being more prevalent. Among the 43% with unprovoked seizures, 58% showed no identifiable acute cause, while 6.4% were due to genetics. Within 3 months after their initial seizure, 26.6% of individuals experienced a second seizure, with 11.9% continuing to have seizures in Months 3-6. Between Months 3 and 6, an additional 20% of patients encountered a second seizure. Research is needed to better understand the cause and prognosis of these patients to improve outcomes.
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Affiliation(s)
- Arturo Carpio
- School of MedicineUniversity of CuencaCuencaEcuador
- Hospital Santa InésCuencaEcuador
| | - Carla Salgado
- Facultad de MedicinaUniversidad de AzuayCuencaEcuador
| | - Daniela DiCapua
- Hospital Eugenio EspejoMinisterio de Salud PúblicaQuitoEcuador
- Universidad San Francisco de QuitoQuitoEcuador
| | - Agnes Fleury
- Departamento de Medicina Genómica y Toxicología AmbientalInstituto de Investigación Biomédicas, Universidad Nacional Autónoma de MéxicoCiudad de MexicoMexico
- Instituto Nacional de Neurología y Neurocirugia deCiudad de MexicoMexico
| | - Roberto Suastegui
- Instituto Nacional de Neurología y Neurocirugia deCiudad de MexicoMexico
| | - Brenda Giagante
- Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi de La PlataLa PlataArgentina
- Hospital de Alta Complejidad El Cruce “Néstor Kirchner”, ENyS, CONICETFlorencio VarelaArgentina
| | - Ledda Aguilera
- Hospital Clínico de la Universidad de ChileSantiago deChile
| | - Alonso Quijada
- Hospital Clínico de la Universidad de ChileSantiago deChile
| | - Lilia Nuñez
- Hospital 20 de NoviembreCiudad de MexicoMexico
| | - Manuela Villanueva
- Hospital de Alta Complejidad El Cruce “Néstor Kirchner”, ENyS, CONICETFlorencio VarelaArgentina
| | | | | | - Luis M. Piedra
- Hospital “José Carrasco” Instituto Ecuatoriano de Seguridad Social de CuencaCuencaEcuador
| | | | - Elizabeth A. Kelvin
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNew YorkUSA
- Department of Occupational HealthEpidemiology & Prevention Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell HealthHempsteadNew YorkUSA
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Zhang XY, Sun M, Wang JY, Du FF, Liu XF, Wang LJ, Hou ZD, Cheng YY. Analysis of related factors for neuropsychiatric comorbidities in children with epilepsy. Eur J Med Res 2024; 29:168. [PMID: 38475859 PMCID: PMC10929131 DOI: 10.1186/s40001-024-01751-5] [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: 01/03/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To analyze the risk factors affecting psychiatric behavior and study the psychobehavioral conditions of children with epilepsy. METHOD We randomly selected and enrolled 294 children with epilepsy who visited and were hospitalized in the pediatric clinic of Hebei General Hospital between January 2017 and January 2022, as the study participants. We comprehensively assessed their cognitive functions using the Gesell development schedule or Wechsler Intelligence Scales. The participants were divided into the study group (n = 123) with cognitive impairment and the control group (n = 171) with normal cognitive functions, for analysis. RESULTS There were statistically significant differences between the two groups in disease course, frequency of epilepsy, status epilepticus, and the number of antiseizure medications (ASMs) used (P < 0.05), while there were no statistically significant differences in age, gender, age of onset, form of onset, interictal epileptiform discharge, history of febrile convulsion, and the time from onset to initial visit (P > 0.05). Based on multivariate logistic regression analysis, the course of disease, frequency of onset, status epilepticus and number of ASMs used were identified as high-risk factors for cognitive impairment in children with epilepsy. Similarly, early onset, long course of disease, known etiology, and combination of multiple drugs have a negative impact on behavioral problems, school education, and social adaptability. CONCLUSION The course of disease, the frequency of onset, status epilepticus, and the number of ASMs used are high-risk factors for cognitive impairment in children with epilepsy, which can be prevented and controlled early. When selecting ASMs, their advantages and disadvantages should be weighed. Moreover, the availability of alternative treatment options must be considered. With the help of genomic technology, the causes of epilepsy should be identified as early as possible, and precision medicine and gene therapy for children with epilepsy should be actively developed.
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Affiliation(s)
- Xin-Ying Zhang
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Meng Sun
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Jiang-Ya Wang
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Fang-Fang Du
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Xue-Fei Liu
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Ling-Jun Wang
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Zhen-De Hou
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China
| | - Ya-Ying Cheng
- Department of Pediatrics, HeBei General Hospital, No.348 of Heping West Road, Xinhua District, Shijiazhuang, 050051, China.
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Babunovska M, Jovanovski A, Boskovski B, Foteva M, Kuzmanovski I, Trencevska GK, Cvetkovska E. Fractures in people with epilepsy: A nationwide population-based cohort study. Epilepsia Open 2023; 8:1028-1037. [PMID: 37335272 PMCID: PMC10472370 DOI: 10.1002/epi4.12776] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the age, gender, and site-specific prevalence of fractures in people with epilepsy (PWE) and matched general population comparators in a nationwide study in North Macedonia between 2015 and 2018. METHODS PWE and matched controls were selected through a systematic search of the electronic National Health System (eNHS). We determined the period prevalence (PP) of all site-specific fractures. We also calculated gender and age-specific incidence rate ratios (IRR) for various fractures. Odds ratios (ORs) and risk ratios (RR) were estimated for the number and type of ASM as well as comorbid conditions. RESULTS Out of 13 818 prevalent epilepsy cases, 6383 (46.2%) were females, and 7435 (53.8%) were males. 109 PWE out of 1000 had at least one fracture during the study period and ~8 people out of 1000 in the general population. The most frequent sites in terms of PP both in PWE and controls, were fractures of the lower arm, hip and femur, and lower leg. Significant differences in PP for all fracture locations were observed between PWE and controls (P < 0.001). The noticeable differences of ∼100 times higher PP were observed for fractures of the skull and jaw in PWE. IRR of any fracture in PWE was 272.84/10 000 person-years; higher in the older age groups and among people who received >2 ASM. Fracture risk was increased with the use of >2 ASM (OR: 1.56; 95% CI: 1.32-1.84 and RR: RR: 1.32). The presence of comorbidities also increased fractures risk (OR: 1.24; 95% CI: 1.10-1.38). SIGNIFICANCE This population-based study depicts a higher fracture prevalence in PWE compared to the general population. A higher number of ASM and the presence of comorbidities increase the risk of fractures and targeted prevention might be needed in those subgroups of PWE.
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Affiliation(s)
- Marija Babunovska
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Aleksandar Jovanovski
- Clinic for Neurology, Early Rehabilitation and Complex Neurological TreatmentEvangelical ClinicsGelsenkirchenGermany
| | - Bojan Boskovski
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Marta Foteva
- University Clinic for Orthopedic SurgerySs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Igor Kuzmanovski
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Gordana Kiteva Trencevska
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
| | - Emilija Cvetkovska
- University Clinic for Neurology, Faculty of MedicineSs. Cyril and Methodius UniversitySkopjeNorth Macedonia
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9
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Miguel Sanz C, Martinez Navarro M, Caballero Diaz D, Sanchez-Elexpuru G, Di Donato V. Toward the use of novel alternative methods in epilepsy modeling and drug discovery. Front Neurol 2023; 14:1213969. [PMID: 37719765 PMCID: PMC10501616 DOI: 10.3389/fneur.2023.1213969] [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: 05/04/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Epilepsy is a chronic brain disease and, considering the amount of people affected of all ages worldwide, one of the most common neurological disorders. Over 20 novel antiseizure medications (ASMs) have been released since 1993, yet despite substantial advancements in our understanding of the molecular mechanisms behind epileptogenesis, over one-third of patients continue to be resistant to available therapies. This is partially explained by the fact that the majority of existing medicines only address seizure suppression rather than underlying processes. Understanding the origin of this neurological illness requires conducting human neurological and genetic studies. However, the limitation of sample sizes, ethical concerns, and the requirement for appropriate controls (many patients have already had anti-epileptic medication exposure) in human clinical trials underscore the requirement for supplemental models. So far, mammalian models of epilepsy have helped to shed light on the underlying causes of the condition, but the high costs related to breeding of the animals, low throughput, and regulatory restrictions on their research limit their usefulness in drug screening. Here, we present an overview of the state of art in epilepsy modeling describing gold standard animal models used up to date and review the possible alternatives for this research field. Our focus will be mainly on ex vivo, in vitro, and in vivo larval zebrafish models contributing to the 3R in epilepsy modeling and drug screening. We provide a description of pharmacological and genetic methods currently available but also on the possibilities offered by the continued development in gene editing methodologies, especially CRISPR/Cas9-based, for high-throughput disease modeling and anti-epileptic drugs testing.
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10
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Dorji T, Yangchen, Wangmo S, Tenzin K, Jamtsho S, Pema D, Chhetri B, Nirola DK, Dhakal GP. Challenges in epilepsy diagnosis and management in a low-resource setting: An experience from Bhutan. Epilepsy Res 2023; 192:107126. [PMID: 36965308 DOI: 10.1016/j.eplepsyres.2023.107126] [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: 01/03/2023] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
Epilepsy is an important cause of morbidity and mortality especially in low- and middle-income countries. People with epilepsy (PWE) face difficulties in access to healthcare, appropriate diagnostic tests and anti-seizure medications (ASM). Bhutan is one such country in the Himalayas that has reported doubling of the prevalence of epilepsy from 155.7 per 100,000 population in 2017 to 312.4 in 2021. The country has one centre for electroencephalography and magnetic resonance imaging for a population of 0.7 million and does not have any neurologists as of 2023. There are 16 ASMs registered in the country but only selected medications are available at the primary level hospitals (phenobarbital, phenytoin and diazepam). There are challenges in the availability of these medicines all time round the year in all levels of hospitals. Neurosurgical treatment options are limited by the lack of adequate pre-surgical evaluation facilities and lack of trained human resources. The majority of PWE have reported facing societal stigma with significant impact on the overall quality of life. It is important to screen for psychiatric comorbidities and provide psychological support wherever possible. There is a need for a comprehensive national guideline that will cater to the needs of PWE and their caregivers within the resources available in the country. A special focus on the institutional and human resource capacity development for the study and care of epilepsy is recommended.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelegphu, Bhutan.
| | - Yangchen
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Karma Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sonam Jamtsho
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dechen Pema
- Department of Radiodiagnosis and Imaging, Central Regional Referral Hospital, Gelegphu, Bhutan
| | - Bikram Chhetri
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Damber Kumar Nirola
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Guru Prasad Dhakal
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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11
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Li G, Wang M, Zheng M, Liu X, Yu T, Ren J, Wang Q. Causal effect of psychiatric disorders on epilepsy: A two-sample Mendelian randomization study. Brain Behav 2023; 13:e2939. [PMID: 36860142 PMCID: PMC10097067 DOI: 10.1002/brb3.2939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND This study aims to explore the relationship between psychiatric disorders and the risk of epilepsy using Mendelian randomization (MR) analysis. METHODS We collected summary statistics of seven psychiatric traits from recent largest genome-wide association study (GWAS), including major depressive disorder (MDD), anxiety disorder, autism spectrum disorder (ASD), bipolar disorder (BIP), attention deficit hyperactivity disorder (ADHD), schizophrenia (SCZ), and insomnia. Then, MR analysis estimates were performed based on International League Against Epilepsy (ILAE) consortium data (ncase = 15,212 and ncontrol = 29,677), the results of which were subsequently validated in FinnGen consortium (ncase = 6260 and ncontrol = 176,107). Finally, a meta-analysis was conducted based on the ILAE and FinnGen data. RESULTS We found significant causal effects of MDD and ADHD on epilepsy in the meta-analysis of the ILAE and FinnGen, with corresponding odds ratios (OR) of 1.20 (95% CI 1.08-1.34, p = .001) and 1.08 (95% CI 1.01-1.16, p = .020) by the inverse-variance weighted (IVW) method respectively. MDD increases the risk of focal epilepsy while ADHD has a risk effect on generalized epilepsy. No reliable evidence regarding causal effects of other psychiatric traits on epilepsy was identified. CONCLUSIONS This study suggests that major depressive disorder and attention deficit hyperactivity disorder may causally increase the risk of epilepsy.
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Affiliation(s)
- Gongfei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Minghui Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meiqi Zheng
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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12
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Gaitatzis A, Majeed A. Multimorbidity in People with Epilepsy. Seizure 2023; 107:136-145. [PMID: 37023627 DOI: 10.1016/j.seizure.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Multimorbidity is an emerging priority in healthcare due to associations with the ageing population, frailty, polypharmacy, health and social care demands. It affects 60-70% of adults and 80% of children with epilepsy. Neurodevelopmental conditions are commonly seen in children with epilepsy, while cancer, cardiovascular and neurodegenerative conditions often afflict older people with epilepsy. Mental health problems are common across the lifespan. Genetic, environmental, social and lifestyle factors contribute to multimorbidity and its consequences. Multimorbid people with epilepsy (PWE) are at higher risk of depression and suicide, premature death, suffer lower health-related quality of life, and require more hospital admissions and health care costs. The best management of multimorbid PWE requires a paradigm shift from the traditional single disease-single comorbidity approach and a refocus on a person-centred approach. Improvements in health care must be informed by assessing the burden of multimorbidity associated with epilepsy, delineating disease clusters, and measuring the effects on health outcomes.
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13
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Babu Y, Sheleme T, Sefera B, Bekele F, Olika W. Magnitude of uncontrolled seizures and associated factors among people with epilepsy. Data from a major teaching hospital in Southwest Ethiopia. Epilepsy Behav 2023; 140:109089. [PMID: 36696732 DOI: 10.1016/j.yebeh.2023.109089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Epilepsy is a major public health problem affecting 70 million people worldwide. 90% of global people with epilepsy were living in developing regions like Ethiopia. Due to the lack of clear guidelines for treatment selection and the difficulty of individualizing care in resource-poor settings, achieving seizure control can be challenging. Seizure control status among epileptic patients is affected by different factors. Accordingly, this study aimed to assess the magnitude of uncontrolled seizures and associated factors among people with epilepsy attending the outpatient clinic of Jimma Medical Center, Southwest Ethiopia. METHODS A hospital-based retrospective chart review and a respective patient interview conducted among people with epilepsy from October 2020 to June 2021. Sociodemographic, behavioral-related factors, medication adherence, and medication belief were obtained through patient interviews. Seizure control status in the last two years before the study period was retrospectively evaluated and recorded from the charts. Data were entered into Epi Data manager version 4.6 and then exported to SPSS version 23.0 for analysis. A backward logistic regression analysis was done to identify factors associated with uncontrolled seizures. RESULTS From a total of 314 medical charts reviewed, 149(47.5 %) of patients were with uncontrolled seizures. 28.7 %,12.8 %, and 6 % of the patients experienced 1-5,6-10, and >10 seizure episodes during the last two years respectively. Comorbidity [adjusted odds ratio [(AOR): 2.13, 95 % confidence interval (CI):1.26-3.58], nonadherence [AOR: 2.41, 95 %CI: 1.46-3.9], possible adverse drug reaction (ADR) [AOR:1.79, 95 %CI: 1.107-3.01], and drug interaction [AOR: 3.06, 95 %CI: 1.24-7.57] were associated with an uncontrolled seizure. CONCLUSION AND RECOMMENDATION Our study showed that a substantial proportion of the patients were with uncontrolled seizures. Epileptic patients with comorbidities, nonadherence, adverse drug reactions, and drug interactions were more prone to have uncontrolled seizures. Hence, to overcome these problems, strategies like community-based education, treatment intensification, and routine assessment of adverse drug reactions and drug interaction may help to improve seizure control status.
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Affiliation(s)
- Yadeta Babu
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia.
| | - Tadesse Sheleme
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
| | - Birbirsa Sefera
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
| | - Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
| | - Wayessa Olika
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
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14
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Tan M, Pearce N, Tobias A, Cook MJ, D'Souza WJ. Influence of comorbidity on mortality in patients with epilepsy and psychogenic nonepileptic seizures. Epilepsia 2023; 64:1035-1045. [PMID: 36740578 DOI: 10.1111/epi.17532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aims to determine the contribution of comorbidities to excess psychogenic nonepileptic seizures (PNES) mortality. METHODS A retrospective cohort study was conducted of tertiary epilepsy outpatients from St. Vincent's Hospital Melbourne, Australia with an 8:1 comparison cohort, matched by age, sex, and socioeconomic status (SES) to national administrative databases between 2007 and 2017. Privacy-preserving data linkage was undertaken with the national prescription, National Death Index, and National Coronial Information System. Forty-five comorbid disease classes were derived by applying the Australian validated RxRisk-V to all dispensed prescriptions. We fitted Cox proportional hazard models controlling for age, sex, SES, comorbidity, disease duration, and number of concomitant antiseizure medications, as a marker of disease severity. We also performed a parallel forward-selection change in estimate strategy to explore which specific comorbidities contributed to the largest changes in the hazard ratio. RESULTS A total of 13 488 participants were followed for a median 3.2 years (interquartile range = 2.4-4.0 years), including 1628 tertiary epilepsy outpatients, 1384 patients with epilepsy, 176 with PNES, and 59 with both. Eighty-two percent of epileptic seizures and 92% of typical PNES events were captured in an epilepsy monitoring unit. The age-/sex-/SES-adjusted hazard ratio was elevated for epilepsy (4.74, 95% confidence interval [CI] = 3.36-6.68) and PNES (3.46, 95% CI = 1.38-8.68) and remained elevated for epilepsy (3.21, 95% CI = 2.22-4.63) but not PNES (2.15, 95% CI = .77-6.04) after comorbidity adjustment. PNES had more pre-existing comorbidities (p = .0007), with a three times greater median weighted Rx-RiskV score. Psychotic illness, opioid analgesia, malignancies, and nonopioid analgesia had the greatest influence on PNES comorbid risk. SIGNIFICANCE Higher comorbidity appears to explain the excess PNES mortality and may represent either a wider underrecognized somatoform disorder or a psychological response to physical illness. Better understanding and management of the bidirectional relationship of these wider somatic treatments in PNES could potentially reduce the risk of death.
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Affiliation(s)
- Michael Tan
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Mark J Cook
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
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15
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Epilepsy: A Multifaced Spectrum Disorder. Behav Sci (Basel) 2023; 13:bs13020097. [PMID: 36829326 PMCID: PMC9952399 DOI: 10.3390/bs13020097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Epilepsy is one of the most widespread chronic conditions, affecting about 50 million people worldwide [...].
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16
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McIntosh AM, Carney PW, Tan KM, Hakami TM, Perucca P, Kwan P, O'Brien TJ, Berkovic SF. Comorbidities in newly diagnosed epilepsy: Pre-existing health conditions are common and complex across age groups. Epilepsy Behav 2023; 138:108960. [PMID: 36427450 DOI: 10.1016/j.yebeh.2022.108960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES People with epilepsy have a higher prevalence of medical and psychiatric comorbidities compared to the general population. Comorbidities are associated with poor epilepsy outcomes, and there have been recommendations for screening and early identification to improve clinical management. Data from 'First Seizure Clinics' (FSCs) with expert epileptological review can inform about disorders already present at the point of diagnosis of epilepsy or unprovoked seizures. Here, we aimed to describe pre-existing conditions with a focus on psychiatric, substance use, cardiac, neurological, and cancer health domains. METHODS We included 1383 adults who received a new diagnosis of epilepsy or unprovoked seizures at Austin Hospital (AH) or Royal Melbourne Hospital (RMH) (Australia) FSCs from 2000 to 2010. Data were audited from FSC records, primarily detailed interviews undertaken by epileptologists. Logistic regression examined age distribution and other risk factors. RESULTS The median age at FSC presentation was 37 years (IQR 26-53, range 18-94). Pre-existing conditions were reported by 40 %; from 32 % in the youngest group (18-30 years) to 53 % in the oldest (65+ years). Psychiatric (18 %) and substance use (16 %) disorders were most common, with higher prevalence among patients 18 to 65 years of age compared to those older than 65 years (p < 0.001). Cardiac, neurological, or cancer conditions were reported by 3-6 %, most often amongst those older than 65 years (p < 0.01). Eight percent (n = 112) reported disorders in >1 health domain. The commonest combination was a psychiatric condition with substance use disorder. Of the sixty-two patients reporting this combination, 61 were ≤65 years of age. CONCLUSIONS Pre-existing health conditions are present in a substantial proportion of patients diagnosed with epilepsy or unprovoked seizures. Disorders are highest amongst elders, but one-third of younger adults also reported positive histories. These are predominantly psychiatric and/or substance use disorders, conditions strongly associated with poor outcomes in the general population. These findings inform post-diagnosis planning and management, as well as research examining post-diagnostic outcomes and associations between comorbidities and epilepsy.
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Affiliation(s)
- Anne M McIntosh
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia; The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia; The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia.
| | - Patrick W Carney
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia; Florey Institute of Neuroscience and Mental Health, Australia; Department of Medicine, Monash University, Australia; Eastern Health, Australia.
| | - K Meng Tan
- The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia; The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Gold Coast University Medical Centre, QLD, Australia.
| | - Tahir M Hakami
- The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia; The Faculty of Medicine, Jazan University, Saudi Arabia
| | - Piero Perucca
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia; The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia; The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia; Department of Neurology, Alfred Health, Melbourne Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia.
| | - Patrick Kwan
- The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia; The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia.
| | - Terence J O'Brien
- The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia; The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia.
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia.
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17
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Xin Y, Lin G, Hua T, Liang J, Sun T, Wu X. The altered expression of cytoskeletal and synaptic remodeling proteins during epilepsy. Open Life Sci 2023; 18:20220595. [PMID: 37070078 PMCID: PMC10105555 DOI: 10.1515/biol-2022-0595] [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: 10/15/2022] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 04/19/2023] Open
Abstract
The cytoskeleton plays an important role in epilepsy; however, the mechanism is unknown. Therefore, this study aimed to reveal the mechanism of cytoskeletal proteins in epilepsy by investigating the expression of cytoskeletal proteins and synaptophysin (SYP) in mice at 0, 3, 6, and 24 h, 3 days, and 7 days in a kainic acid (KA)-induced epileptic model. Our results demonstrated that the expression of F-actin decreased significantly between 3 and 6 h, 6 and 24 h, and 24 h and 3 days (P < 0.05). Meanwhile, the expression of the neurofilament light chain, neurofilament medium chain, and neurofilament heavy chain subunits was significantly decreased (P < 0.001) at 3 h after the KA injection compared to the KA 0 h group, followed by an elevation at 6 h and a further decrease at 24 h compared to at 6 h. SYP expression was significantly decreased between 0 and 3 h as well as between 3 and 6 h (P < 0.05). At 24 h, the level was increased compared to at 6 h and continued to increase at 3 days after the KA injection. Thus, we propose that cytoskeletal proteins may be involved in the pathogenesis of epilepsy.
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Affiliation(s)
- Yanbao Xin
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Institute of Immunology, The First Hospital of Jilin University, Changchun 130021, China
| | - Guojiao Lin
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Institute of Immunology, The First Hospital of Jilin University, Changchun 130021, China
| | - Tianbao Hua
- The First Hospital and International Center of Future Science, Jilin University, Changchun 130015, China
| | - Jianmin Liang
- Department of Pediatric Neurology, The First Hospital of Jilin University, 1 Xinmin Street, Changchun 130000, Jilin Province, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun 130021, China
| | - Tianmeng Sun
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Institute of Immunology, The First Hospital of Jilin University, Changchun 130021, China
- The First Hospital and International Center of Future Science, Jilin University, Changchun 130015, China
| | - Xuemei Wu
- Department of Pediatric Neurology, The First Hospital of Jilin University, 1 Xinmin Street, Changchun 130000, Jilin Province, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun 130021, China
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18
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Zinchuk M, Kustov G, Pashnin E, Gersamia A, Rider F, Voinova N, Popova S, Sviatskaia E, Yakovlev A, Guekht A. Not always that EASI: Validating the Russian version of the epilepsy anxiety survey instrument and its brief counterpart. Epilepsy Behav 2022; 133:108801. [PMID: 35753109 DOI: 10.1016/j.yebeh.2022.108801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop a Russian version of The Epilepsy Anxiety Survey Instrument (EASI) and assess its psychometric properties in a Russian sample of patients with epilepsy (PWE). To compare the brief version of EASI with the General Anxiety Disorder-7 (GAD-7) - the most common tool for a rapid anxiety screening. METHODS The study sample consisted of 181 consecutive Russian-speaking PWE. The Mini-International Neuropsychiatric Interview was used as a gold standard for diagnosing anxiety disorders. All patients completed the set of questionnaires - the Russian version of the GAD-7, The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and the EASI. Internal reliability of the EASI and brEASI, convergent and divergent validity of the brEASI with the GAD-7 and the NDDI-E, and factor structure assessment were performed. RESULTS Among 33.7% of patients with epilepsy diagnosed with any anxiety disorder, 16% had panic disorder, 10.5% had agoraphobia, 8.3% had social anxiety disorder, 21.0% had generalized anxiety disorder, and 13.3% had several comorbid anxiety disorders. The EASI factor structure differed from the original, revealing an additional factor with two items. Nevertheless, the brief version (brEASI) showed excellent screening properties - the AUC to detect any anxiety disorder was 0.916 with the optimal cutoff point > 7 points. CONCLUSION The brEASI performed better than the GAD-7 in our sample and, therefore, may be considered a first-line screening tool for anxiety disorders in PWE.
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Affiliation(s)
- Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation.
| | - Georgii Kustov
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Evgenii Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Anna Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Flora Rider
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Nadezhda Voinova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Sophia Popova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Ekaterina Sviatskaia
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Alexander Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova ul., 5A, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Ostrovitianova ul., 1, Moscow, Russian Federation
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19
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Servilha-Menezes G, Garcia-Cairasco N. A complex systems view on the current hypotheses of epilepsy pharmacoresistance. Epilepsia Open 2022; 7 Suppl 1:S8-S22. [PMID: 35253410 PMCID: PMC9340300 DOI: 10.1002/epi4.12588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/11/2022] Open
Abstract
Drug-resistant epilepsy remains to this day as a highly prevalent condition affecting around one-third of patients with epilepsy, despite all the research and the development of several new antiseizure medications (ASMs) over the last decades. Epilepsies are multifactorial complex diseases, commonly associated with psychiatric, neurological, and somatic comorbidities. Thus, to solve the puzzling problem of pharmacoresistance, the diagnosis and modeling of epilepsy and comorbidities need to change toward a complex system approach. In this review, we have summarized the sequence of events for the definition of epilepsies and comorbidities, the search for mechanisms, and the major hypotheses of pharmacoresistance, drawing attention to some of the many converging aspects between the proposed mechanisms, their supporting evidence, and comorbidities-related alterations. The use of systems biology applied to epileptology may lead to the discovery of new targets and the development of new ASMs, as may advance our understanding of the epilepsies and their comorbidities, providing much deeper insight on multidrug pharmacoresistance.
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Affiliation(s)
- Gabriel Servilha-Menezes
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo (FMRP-SP), Ribeirão Preto, São Paulo, Brazil
| | - Norberto Garcia-Cairasco
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo (FMRP-SP), Ribeirão Preto, São Paulo, Brazil.,Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (FMRP-SP), Ribeirão Preto, São Paulo, Brazil
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20
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Vederhus J, Husebye ESN, Eid K, Gilhus NE, Bjørk MH. Prevalence of self-reported emotional, physical, and sexual abuse and association with fear of childbirth in pregnant women with epilepsy: The Norwegian Mother, Father, and Child Cohort Study. Epilepsia 2022; 63:1822-1834. [PMID: 35352343 PMCID: PMC9541758 DOI: 10.1111/epi.17242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/03/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE This study was undertaken to examine the prevalence of self-reported experiences with abuse in pregnant women with epilepsy and the association between having experienced abuse and childbirth expectations, particularly the fear of childbirth. METHODS We performed a cross-sectional study of women with and without epilepsy enrolled in the Norwegian Mother, Father, and Child Cohort Study 1999-2008. Data on epilepsy diagnosis; antiseizure medication (ASM) use; emotional, physical, and sexual abuse; and childbirth expectations were collected from questionnaires completed during gestational Weeks 17-19 and 30. RESULTS Our study population included 295 women with ASM-treated epilepsy, 318 women with ASM-untreated epilepsy, and 93 949 women without epilepsy. A total of 115 women (47%) with ASM-treated and 132 women (57%) with ASM-untreated epilepsy reported any emotional, physical, or sexual abuse, compared to 25 100 women (32%) without epilepsy. The adjusted odds ratios (aORs) for having experienced any abuse were 1.8 (95% confidence interval [CI] = 1.4-2.3) and 1.8 (95% CI = 1.4-2.2) for ASM-treated and ASM-untreated epilepsy, respectively. A total of 29 women (11%) with ASM-treated and 34 women (11%) with ASM-untreated epilepsy reported having been raped, compared to 3088 women (4%) without epilepsy (aORs = 2.8 [95% CI = 1.8-4.1] and 2.9 [95% CI = 2.0-4.2], respectively). In nulliparous women with ASM-untreated epilepsy, having experienced abuse was associated with fear of childbirth; 22 women (31%) with abuse experiences reported fear of childbirth compared to five women (7%) with no experience of abuse (aOR = 5.4 [95% CI = 1.7-17.2]). This association was not seen in multiparous women or in women with ASM-treated epilepsy. SIGNIFICANCE More women with epilepsy reported emotional, physical, and sexual abuse than women without epilepsy. Such experiences may be associated with childbirth expectations.
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Affiliation(s)
- Johannes Vederhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
| | - Elisabeth Synnøve Nilsen Husebye
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Karine Eid
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Marte Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
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Nobili L, Frauscher B, Eriksson S, Gibbs SA, Halasz P, Lambert I, Manni R, Peter-Derex L, Proserpio P, Provini F, de Weerd A, Parrino L. Sleep and epilepsy: A snapshot of knowledge and future research lines. J Sleep Res 2022; 31:e13622. [PMID: 35487880 PMCID: PMC9540671 DOI: 10.1111/jsr.13622] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Sleep and epilepsy have a reciprocal relationship, and have been recognized as bedfellows since antiquity. However, research on this topic has made a big step forward only in recent years. In this narrative review we summarize the most stimulating discoveries and insights reached by the "European school." In particular, different aspects concerning the sleep-epilepsy interactions are analysed: (a) the effects of sleep on epilepsy; (b) the effects of epilepsy on sleep structure; (c) the relationship between epilepsy, sleep and epileptogenesis; (d) the impact of epileptic activity during sleep on cognition; (e) the relationship between epilepsy and the circadian rhythm; (f) the history and features of sleep hypermotor epilepsy and its differential diagnosis; (g) the relationship between epilepsy and sleep disorders.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatric Unit, Istituto G. Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sofia Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Steve Alex Gibbs
- Department of Neurosciences, Center for Advanced Research in Sleep Medicine, Sacred Heart Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Isabelle Lambert
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.,APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, CNRS UMR 5292/INSERM U1028, Lyon, France
| | - Paola Proserpio
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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22
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Abstract
PURPOSE OF REVIEW Comorbidities are a common feature in epilepsy, but neither the entire spectrum nor the significance of such comorbidities has been fully explored. We review comorbidities associated with epilepsy and their associated burden, provide an overview of relationships, and discuss a new conceptualization of the comorbidities. RECENT FINDINGS The epidemiology of the comorbidities of epilepsy and effects on health outcomes, healthcare use, and healthcare expenditures have been partly delineated. Distinct mechanisms of the associations have been suggested but not entirely ascertained. Movement from conceptualizing epilepsy as a condition to a symptom-complex has occurred. SUMMARY Comorbidities are common among people with epilepsy and are associated with poorer clinical outcomes and quality of life, greater use of health resources, and increased expenditure. Becoming aware of the associated mechanisms and their uncertainty is central to understanding the relationships between epilepsy and comorbid health conditions, which have implications for diagnosis and screening, medical management, and surgical management. Conceptualizing comorbidities of epilepsy as precipitating factors and epilepsy as the symptom will improve the understanding of epilepsy and catalyze research and improvements in clinical practice.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW, The Netherlands
- Neurology Department, West of China Hospital, Sichuan University, Chengdu, China
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