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Russo A, Mazzone S, Landolina L, Colucci R, Baccari F, Fetta A, Boni A, Cordelli DM. Efficacy and Safety of Pulse Intravenous Methylprednisolone in Pediatric Epileptic Encephalopathies: Timing and Networks Consideration. J Clin Med 2024; 13:2497. [PMID: 38731025 PMCID: PMC11084200 DOI: 10.3390/jcm13092497] [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: 03/05/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Epileptic encephalopathies (EE) are characterized by severe drug-resistant seizures, early onset, and unfavorable developmental outcomes. This article discusses the use of intravenous methylprednisolone (IVMP) pulse therapy in pediatric patients with EE to evaluate its efficacy and tolerability. Methods: This is a retrospective study from 2020 to 2023. Inclusion criteria were ≤18 years at the time of IVMP pulse therapy and at least 6 months of follow-up. Efficacy and outcome, defined as seizure reduction > 50% (responder rate), were evaluated at 6 and 9 months of therapy, and 6 months after therapy suspension; quality of life (QoL) was also assessed. Variables predicting positive post-IVMP outcomes were identified using statistical analysis. Results: The study included 21 patients, with a responder rate of 85.7% at 6 and 9 months of therapy, and 80.9% at 6 months after therapy suspension. Variables significantly predicting favorable outcome were etiology (p = 0.0475) and epilepsy type (p = 0.0475), with the best outcome achieved in patients with genetic epilepsy and those with encephalopathy related to electrical status epilepticus during slow-wave sleep (ESES). All patients evidenced improvements in QoL at the last follow-up, with no relevant adverse events reported. Conclusions: Our study confirmed the efficacy and high tolerability of IVMP pulse therapy in pediatric patients with EE. Genetic epilepsy and ESES were positive predictors of a favorable clinical outcome. QOL, EEG tracing, and postural-motor development showed an improving trend as well. IVMP pulse therapy should be considered earlier in patients with EE.
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Affiliation(s)
- Angelo Russo
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Dell’età Pediatrica, 40139 Bologna, Italy; (S.M.); (L.L.); (R.C.); (A.F.); (A.B.); (D.M.C.)
| | - Serena Mazzone
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Dell’età Pediatrica, 40139 Bologna, Italy; (S.M.); (L.L.); (R.C.); (A.F.); (A.B.); (D.M.C.)
| | - Laura Landolina
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Dell’età Pediatrica, 40139 Bologna, Italy; (S.M.); (L.L.); (R.C.); (A.F.); (A.B.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
| | - Roberta Colucci
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Dell’età Pediatrica, 40139 Bologna, Italy; (S.M.); (L.L.); (R.C.); (A.F.); (A.B.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
| | - Flavia Baccari
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOS Epidemiologia e Biostatistica, 40139 Bologna, Italy;
| | - Anna Fetta
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Dell’età Pediatrica, 40139 Bologna, Italy; (S.M.); (L.L.); (R.C.); (A.F.); (A.B.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
| | - Antonella Boni
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Dell’età Pediatrica, 40139 Bologna, Italy; (S.M.); (L.L.); (R.C.); (A.F.); (A.B.); (D.M.C.)
| | - Duccio Maria Cordelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Dell’età Pediatrica, 40139 Bologna, Italy; (S.M.); (L.L.); (R.C.); (A.F.); (A.B.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
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Pu W, Wei S, Qiu M, Chen X, Zou W, Ge Y, Qiu W. Dysfunction of the glymphatic system in childhood absence epilepsy. Front Neurosci 2023; 17:1312676. [PMID: 38144207 PMCID: PMC10749194 DOI: 10.3389/fnins.2023.1312676] [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: 10/10/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Objective This study aimed to evaluate the glymphatic system in childhood absence epilepsy (CAE) using diffusion tensor image analysis along the paravascular space (DTI-ALPS) index. Methods: Forty-two CAE patients and 50 age- and gender-matched healthy controls (HC) were included in this study. All participants underwent scanning using a Siemens 3.0 T magnetic resonance scanner, and the DTI-ALPS index was calculated. The study compared the differences of DTI-ALPS index between CAE patients and the healthy controls. Additionally, this study also assessed the relationship between the DTI-ALPS index and clinical characteristics such as age, seizure frequency, and duration of epilepsy. Results The DTI-ALPS index was lower in CAE patients compared to the healthy controls (1.45 ± 0.36 vs. 1.66 ± 0.30, p < 0.01). The DTI-ALPS index showed a negative correlation with the duration of epilepsy (r = -0.48, p < 0.01) and a positive correlation with age (r = 0.766, p < 0.01) in CAE patients. However, no significant correlation was observed between the DTI-ALPS index and seizure frequency. Conclusion The results of this study indicate that children with CAE exhibit dysfunction in the glymphatic system of the brain, which might contribute to understanding the pathophysiological mechanism of CAE. The DTI-ALPS, as a non-invasive diagnostic marker, can be used to assess the function of the glymphatic system in CAE patients, providing promising applications in the diagnosis and research of CAE.
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Affiliation(s)
- Wanqing Pu
- Department of Neurology, The Fifth People’s Hospital of Huai’an, Huai’an, China
| | - Shanzhen Wei
- Department of Electrophysiology, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Mengdi Qiu
- Department of Neurology, The Fifth People’s Hospital of Huai’an, Huai’an, China
| | - Xiaoyu Chen
- Department of Radiology, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Wenwei Zou
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Yingchao Ge
- Department of Neurology, Qidong People’s Hospital, Nantong, China
| | - Wenchao Qiu
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
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Cutia CA, Christian-Hinman CA. Mechanisms linking neurological disorders with reproductive endocrine dysfunction: Insights from epilepsy research. Front Neuroendocrinol 2023; 71:101084. [PMID: 37506886 PMCID: PMC10818027 DOI: 10.1016/j.yfrne.2023.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
Gonadal hormone actions in the brain can both worsen and alleviate symptoms of neurological disorders. Although neurological conditions and reproductive endocrine function are seemingly disparate, compelling evidence indicates that reciprocal interactions exist between certain disorders and hypothalamic-pituitary-gonadal (HPG) axis irregularities. Epilepsy is a neurological disorder that shows significant reproductive endocrine dysfunction (RED) in clinical populations. Seizures, particularly those arising from temporal lobe structures, can drive HPG axis alterations, and hormones produced in the HPG axis can reciprocally modulate seizure activity. Despite this relationship, mechanistic links between seizures and RED, and vice versa, are still largely unknown. Here, we review clinical evidence alongside recent investigations in preclinical animal models into the contributions of seizures to HPG axis malfunction, describe the effects of HPG axis hormonal feedback on seizure activity, and discuss how epilepsy research can offer insight into mechanisms linking neurological disorders to HPG axis dysfunction, an understudied area of neuroendocrinology.
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Affiliation(s)
- Cathryn A Cutia
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Catherine A Christian-Hinman
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL, USA; Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, IL, USA; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
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de Matos MMF, Batista LA, Thomé U, Sakamoto AC, Santos MV, Machado HR, Wichert-Ana L, Hamad APA. Reduction in anti-seizure medications use in pediatric patients with pharmacoresistant epilepsy submitted to surgical treatment. Childs Nerv Syst 2022; 39:1193-1200. [PMID: 36580119 PMCID: PMC9798357 DOI: 10.1007/s00381-022-05812-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE We aimed to analyze the potential for postoperative (PO) medication suspension and reduction, emphasizing passive withdrawal. METHODS Retrospective study of patients under 18 years old submitted to surgical treatment for pharmacoresistant epilepsy and classified as Engel I during the first year of PO follow-up. Therapeutic management was evaluated through discontinuation or reduction of medications, both in terms of the number of ASM prescribed and in daily maintenance dosages in mg/kg. RESULTS ASM withdrawal started in the first year PO and occurred in 1.2% of cases, with a significant yearly reduction in the number of ASM during follow-up (p < 0.001). A comparison of the most commonly used ASM in daily mg/kg between the preoperative period (preop) and PO showed a reduction of ASM maintenance dosages during PO. Even though recurrence of seizures was observed 5 years after surgery, 125 patients (85%) were still classified as Engel I, albeit a higher number of ASM per patient was observed. Most patients showed no changes in cognitive and adaptive behavior evaluation between preop and PO, even in those who were able to reduce ASM. CONCLUSION Significant reduction observed both in the number and daily maintenance dosages of ASM following each year of PO may be an indirect measure of the effectiveness of epilepsy surgery.
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Affiliation(s)
| | - Larissa Aparecida Batista
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
| | - Ursula Thomé
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
| | - Américo Ceiki Sakamoto
- Department of Neurosciences and Behavioural Sciences, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
| | - Marcelo Volpon Santos
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
- Division of Pediatric Neurosurgery, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Hélio Rubens Machado
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
- Division of Pediatric Neurosurgery, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lauro Wichert-Ana
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil
- Division of Nuclear Medicine, Internal Medicine Department, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Paula Andrade Hamad
- Department of Neurosciences and Behavioural Sciences, Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
- Center for Epilepsy Surgery (CIREP), Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto, São Paulo, CEP, Brazil.
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Auvin S. Paediatric epilepsy and cognition. Dev Med Child Neurol 2022; 64:1444-1452. [PMID: 35801543 DOI: 10.1111/dmcn.15337] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023]
Abstract
Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The cognitive function of children with epilepsy should be appropriately screened, and when there is an impairment, it must be diagnosed and managed. Several factors contribute to the occurrence of this comorbidity. The underlying aetiology and epilepsy syndrome are the major risk factors. Other factors also play a role, such as seizure recurrence, antiseizure medication, and interictal abnormalities. Recent evidence also suggested that cognitive involvement is an ongoing process that interacts with the normal maturation of cognitive function in children with epilepsy. Furthermore, some patients experience rapid cognitive deterioration related to epileptic activity, resulting in epileptic encephalopathy. Further research is needed to better understand how to prevent or modify factors that affect cognitive function in children with epilepsy. WHAT THIS PAPER ADDS: Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The risk factors for cognitive impairment are the underlying aetiology/syndrome, seizure recurrence, antiseizure medication, and interictal abnormalities. Advanced genetic and neuroimaging studies are useful tools to better understand cognitive impairment in children with epilepsy.
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Affiliation(s)
- Stéphane Auvin
- Assistance Publique-Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale NeuroDiderot, Paris, France.,Institut Universitaire de France, Paris, France
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Wu Y, Li Y, Zhu J, Long J. Shared genetics and causality underlying epilepsy and attention-deficit hyperactivity disorder. Psychiatry Res 2022; 316:114794. [PMID: 35994864 DOI: 10.1016/j.psychres.2022.114794] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022]
Abstract
The prevalence of attention deficit hyperactivity disorder (ADHD) in patients with epilepsy was much higher than prevalence in general population, and vice versa. The mechanisms underlying comorbid ADHD and epilepsy remained largely unknown. Here, we systematically analyzed the genetic correlation, causality, shared genetics and specific trait related tissues by using linkage disequilibrium score regression (LDSC), two sample Mendelian randomization (TwoSampleMR), bivariate causal mixture model (MiXeR), conjunctional false discovery rate (conjFDR) and LDSC applied to specifically expressed genes based on genome wide association studies (GWASs) data of ADHD and epilepsy. We found that ADHD had significant positive genetic association with epilepsy. Two-sample Mendelian randomization analysis with genome wide significant single nucleotide polymorphisms (SNPs) as instrument variables suggested a positively causal effect of ADHD on epilepsy. Using MiXeR, which estimates the total amount of shared variants, we observed 1 K causal variants overlapped between ADHD and epilepsy. At conjFDR <0.05, ADHD shared 2 distinct genomic loci with Epilepsy. Further disease-relevant tissues analysis showed that cortex, substantia nigra, amygdala and hippocampus were both associated with ADHD and epilepsy. Our results suggested that ADHD was genetically correlated with epilepsy, which might be due to the fact that they shared common pathogenic sites and tissues origin.
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Affiliation(s)
- Yong Wu
- Research Center for Mental Health and Neuroscience, Wuhan Mental Health Center, Wuhan, Hubei 430012, China
| | - Yichen Li
- Radiology Department, Wuhan Mental Health Center, Wuhan, Hubei 430012, China
| | - Junhong Zhu
- Department of Mental Rehabilitation, Wuhan Mental Health Center, Wuhan, Hubei 430012, China.
| | - Jingyi Long
- Department of Child & Adolescent Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei 430012, China.
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Operto FF, Orsini A, Sica G, Scuoppo C, Padovano C, Vivenzio V, de Simone V, Rinaldi R, Belfiore G, Mazza R, Aiello S, Vetri L, Donadio S, Labate A, Pastorino GMG. Perampanel and childhood absence epilepsy: A real life experience. Front Neurol 2022; 13:952900. [PMID: 36034267 PMCID: PMC9404324 DOI: 10.3389/fneur.2022.952900] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of our study was to evaluate the effectiveness and tolerability of perampanel (PER) as first add-on and as second line monotherapy in subjects with childhood absence epilepsy. Methods Our sample consisted of 20 patients with childhood absence epilepsy, aged between 8 and 10, already in therapy with a first antiseizure medication with incomplete seizure control. PER was added as first add-on in a dose ranging from 3 to 8 mg/die with 1- 2 mg/week increments. The patients that were seizure-free were shifted to a PER monotherapy. All patients underwent a standardized neuropsychological evaluation in order to assess non-verbal intelligence and executive functions before adding PER and after 6 months of drug therapy. All parents completed two questionnaires, in order to assess the emotional-behavioral problems and parental stress. Results 15/20 patients responded to add-on PER and were seizure-free, in 3/20 patients we observed a reduction of seizure frequency <50%, and in the 2 remaining patients the add-on therapy with PER did not lead to a reduction in seizures frequency from baseline. The patients who were seizure-free were switched to PER monotherapy. 9/15 patients remained seizure-free in monotherapy with PER. In the first month of therapy with PER 2/20 patients (10%) reported mild, transient side effects of irritability, headache and dizziness, which did not lead to discontinuation of therapy. Adjunctive treatment with PER did not negatively affect non-verbal intelligence, executive functions, emotional/behavioral symptoms of children and parental stress levels. Significance Our clinical experience in real life showed that PER appears to be effective in the control of absence seizures in childhood absence epilepsy, with a favorable tolerability profile. PER would seem effective on absence seizures even in monotherapy. Further studies with larger samples, longer follow-up and controlled vs. placebo (or other first choice antiseizure medications) are needed to confirm our data.
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Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- *Correspondence: Francesca Felicia Operto
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Chiara Scuoppo
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Chiara Padovano
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Valentina Vivenzio
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Valeria de Simone
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Rosetta Rinaldi
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Gilda Belfiore
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Roberta Mazza
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Salvatore Aiello
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Luigi Vetri
- OASI Research Institute- IRCCS, Troina, Italy
| | - Serena Donadio
- Department of Psychology, Educational and Science and Human Movement, University of Palermo, Palermo, Italy
| | - Angelo Labate
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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Özçelik EU, Çokar Ö, Demirbilek V. Pretreatment electroencephalographic features in patients with childhood absence epilepsy. Neurophysiol Clin 2022; 52:280-289. [PMID: 35953417 DOI: 10.1016/j.neucli.2022.07.003] [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: 03/21/2021] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To analyze the ictal and interictal electroencephalographic (EEG) features in newly diagnosed childhood absence epilepsy (CAE) and determine the association between seizure onset topography, interictal focal spike-wave discharges (FSWDs) and accompanying clinical features of absence seizures. METHODS The authors searched the EEG database for a definite diagnosis of CAE according to ILAE 2017 criteria. Video-EEGs of untreated pediatric patients during sleep and wakefulness were evaluated retrospectively. RESULTS The study included 47 patients (25 males, 22 females). Interictal FSWDs were observed in 49% of patients with CAE during wakefulness and in 85.1% during sleep (p = 0.001). Interictal FSWDs were most frequently observed in the frontal regions (awake: 34%; asleep: 74.5%), followed by the posterior temporoparietooccipital region (awake: 21.2%; asleep: 36.1%), and the centrotemporal region (awake: 6.4%; asleep: 8.5%). Eleven patients (23.4%) had polyspikes during sleep. Both bilateral symmetric and asymmetric seizure onset were noted in 32%, whereas focal seizure onset was observed in 14.9% of the patients. Absence seizures with and without motor components were seen in 72.3% and 61.7% of patients, respectively, and in 33% of patients both occurred. There were no associations between the existence of interictal FSWDs, focal/asymmetric seizure onset, and absence seizures with and/or without motor components. CONCLUSION Asymmetric and/or focal seizure onset, interictal FSWDs, and absence seizures with motor components are commonly observed in drug-naive CAE. This study found no association between seizure onset topography, interictal FSWDs, and semiological features of absence seizures.
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Affiliation(s)
- Emel Ur Özçelik
- Istanbul University, Cerrahpaşa School of Medicine, Departments of Neurology and Childhood Neurology, Istanbul, Türkiye; Istanbul Health and Technology University, Faculty of Health Sciences, Department of Ergotherapy, Istanbul, Türkiye.
| | - Özlem Çokar
- University of Health Sciences, Hamidiye School of Medicine, Haseki Educational and Research Hospital, Department of Neurology, Istanbul, Türkiye
| | - Veysi Demirbilek
- Istanbul University, Cerrahpaşa School of Medicine, Departments of Neurology and Childhood Neurology, Istanbul, Türkiye
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Abstract
PURPOSE OF REVIEW This article reviews the clinical features, typical EEG findings, treatment, prognosis, and underlying molecular etiologies of the more common genetic epilepsy syndromes. Genetic generalized epilepsy, self-limited focal epilepsy of childhood, self-limited neonatal and infantile epilepsy, select developmental and epileptic encephalopathies, progressive myoclonus epilepsies, sleep-related hypermotor epilepsy, photosensitive occipital lobe epilepsy, and focal epilepsy with auditory features are discussed. Also reviewed are two familial epilepsy syndromes: genetic epilepsy with febrile seizures plus and familial focal epilepsy with variable foci. RECENT FINDINGS Recent years have seen considerable advances in our understanding of the genetic factors underlying genetic epilepsy syndromes. New therapies are emerging for some of these conditions; in some cases, these precision medicine approaches may dramatically improve the prognosis. SUMMARY Many recognizable genetic epilepsy syndromes exist, the identification of which is a crucial skill for neurologists, particularly those who work with children. Proper diagnosis of the electroclinical syndrome allows for appropriate treatment choices and counseling regarding prognosis and possible comorbidities.
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Hatami M, Sanjari Moghaddam H, Ranji Burachaloo S, Tafakhori A, Sahebi L, Vaziri S, Panahi P, Seirafianpour F, Yarahmadi M, Aghamollaii V. Psychometric evaluation of Persian version of Seizure Severity Questionnaire. Epilepsy Behav 2022; 128:108506. [PMID: 35104735 DOI: 10.1016/j.yebeh.2021.108506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Seizure severity has been increasingly gaining attention as a complementary assessment to seizure frequency for the measurement of treatment responses. This study aimed to assess the reliability and external validity and of the Persian version of the Seizure Severity Questionnaire (SSQ). METHODS The study sample was recruited from 126 patients with epilepsy who attended the neurology outpatient clinic at Imam Khomeini and Roozbeh hospitals, Tehran, Iran. The Forward-Backward technique was applied to translate the questionnaire. The reliability of SSQ was assessed by Cronbach's alpha coefficient. The external validity of SSQ was assessed by correlating SSQ scores with Quality of Life in Epilepsy Inventory-31 (QOLIE-31) subscales. RESULTS The sample comprised 63 women (50%) and 63 men (50%) aged 13-76 years. The mean scores of SSQ items ranged from 3.46 to 5.48. Distribution was skewed for all component scores, with a tendency for the item scores to concentrate toward the highest scores. Reliability for almost all domains were moderate to good, with Cronbach's alpha ranging from 0.615 to 0.770. Component B to D and total score of SSQ had weak-to-moderate inverse correlation with QOLIE-31 subscale scores. However, the result showed no significant correlation with age, sex, or education. CONCLUSION With some limitations, the Persian version of the SSQ shows relatively good reliability and content validity, supporting its use as a specific measure of seizure severity in epilepsy in Iran.
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Affiliation(s)
- Mahsa Hatami
- Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Abbas Tafakhori
- Tehran University of Medical Sciences, Neurology, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Leyla Sahebi
- Tehran University of Medical Sciences, Statistics, Iran
| | | | - Parsa Panahi
- Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Vajiheh Aghamollaii
- Tehran University of Medical Sciences, Neurology, Roozbeh Hospital, Tehran, Iran.
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Childhood absence epilepsy: Electro-clinical manifestations, treatment options, and outcome in a tertiary educational center. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2021; 9:131-135. [PMID: 35663781 PMCID: PMC9152671 DOI: 10.1016/j.ijpam.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/20/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose and Background To evaluate the electro-clinical manifestations and outcomes of children with absence epilepsy at a tertiary center in Saudi Arabia. Methods This retrospective study reviewed the medical and EEG records of patients who were diagnosed to have CAE as per the International League Against Epilepsy (ILAE) definition for CAE. The study was conducted in the pediatric neurology clinic of King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia, between January 2000 and December 2019. Patients who did not meet (ILAE) criteria, lost follow-up, and those who did not receive treatment at KKUH were excluded. Data regarding the patient's disease, electro-clinical manifestations, anti-seizure medication response, and outcomes were collected. Results A total of 35 patients, with an average age at diagnosis of 7 ± 2.1 y, were included in the study; among them, 51.4% were female and approximately 48.6% presented with a family history of epilepsy. Regarding clinical features, all patients experienced staring and altered awareness, 94.2% had less than 20 spells per day at the time of diagnosis, and 65.7% were provoked by the hyperventilation test. Regarding EEG findings, all patients had bilateral, symmetrical, and synchronous discharges in the form of regular 3 Hz spike-and-wave complexes, and 94.3% had a generalized initial ictal discharge. Also, 22.8% had eye fluttering with electrographic seizures. Ethosuximide (ESM) was used as the drug of choice in 45.7% of the patients. Regarding clinical outcomes, 94.3% had their disease clinically controlled, and 80% had a normalized EEG after few months of starting anti-seizure medication. Finally, 37.2% experienced complete remission of epilepsy after 3–5 y; however, one patient developed juvenile myoclonic epilepsy. Conclusion This study described the electro-clinical manifestations of patients with childhood absence epilepsy and outcomes. Furthermore, early diagnosis and prompt treatment of childhood absence epilepsy improve treatment outcomes.
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Boddu VK, Rebello A, Chandrasekharan SV, Rudrabhatla PK, Chandran A, Ravi S, Unnithan G, Menon RN, Cherian A, Radhakrishnan A. How does "locus of control" affect persons with epilepsy? Epilepsy Behav 2021; 123:108257. [PMID: 34425327 DOI: 10.1016/j.yebeh.2021.108257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Locus of control (LOC) is the degree to which people believe that they have control over the outcome of events in their lives. A person's locus can be internal, external, or chance. A person with internal locus of control believes that one can control one's own life. A person with external locus of control believes that his life is controlled by external factors or people over which he has no influence. A person with chance locus of control believes that fate, chance, or luck controls his own life. The aim of the current study was to determine the health locus of control, anxiety, and depression levels in persons with epilepsy (PWE) and to assess whether locus of control has relation to anxiety, depression, and seizure control. METHODS Patients aged 18 years or older with a history of epilepsy for at least 1 year were recruited from the outpatient epilepsy clinic or from the inpatient epilepsy monitoring unit at SCTIMST, Trivandrum from January 2019 to May 2020. Patients filled the questionnaire form consisting of demographic data, age of onset of seizures, present seizure control, and the current antiepileptic drugs. The Hospital Anxiety and Depression (HAD) scale was used to estimate the level of anxiety and depression in these patients. The Form-C of the Multidimensional Health Locus of Control (MHLC) scale was used to evaluate the health locus of control. Healthy controls aged 18 years or older and free of any chronic disease or psychiatric illness were also recruited. They were asked to fill the questionnaire forms with basic demographic data. HAD scale was used to estimate the level of anxiety and depression and form-C of MHLC was used to evaluate the health locus of control in the healthy controls. The mean scores of anxiety, depression, and locus of control were compared between the two groups. RESULTS A total of 170 participants were recruited which consisted of 100 PWE and 70 healthy controls. The mean anxiety and depression scores were 8.13(SD = 4.23) and 5.85(SD = 3.66) in the PWE group and 6.75(SD = 3.39) and 4.14(SD = 2.96) in the control group, respectively. The mean internal, external, and chance LOC scores were 24.95(SD = 10.92), 26.94(SD = 4.96), and 24.41(SD = 6.46) in the PWE group; and 29.44(SD = 5.62), 26.53(SD = 5.79), and 19.9(SD = 7.13) in the control group, respectively. Persons with epilepsy had higher chance LOC scores and lower internal LOC scores compared to controls (p = 0.00003, p < 0.00001 respectively). There were no differences in the external LOC scores between the two groups (p = 0.620). Persons with epilepsy with some level of anxiety had lower internal LOC scores compared to patients with no anxiety (p = 0.04). PWE with poor seizure control had higher external LOC score and lower internal LOC scores which however did not reach statistical significance. Persons with epilepsy with poor seizure control had higher anxiety and depression scores. CONCLUSIONS Persons with epilepsy had low perceptions of internal and strong perceptions of chance health locus of control. This means that PWE feel that luck plays an important role in their disease control. This information is important in the counseling of persons with epilepsy.
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Affiliation(s)
- Vijay Kumar Boddu
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Alex Rebello
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Soumya V Chandrasekharan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Pavan Kumar Rudrabhatla
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anuvitha Chandran
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Swathy Ravi
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Gopeekrishnan Unnithan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ramshekhar N Menon
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ajith Cherian
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ashalatha Radhakrishnan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Zhu Y, Huang D, Zhao Z, Lu C. Bioinformatic analysis identifies potential key genes of epilepsy. PLoS One 2021; 16:e0254326. [PMID: 34555062 PMCID: PMC8459949 DOI: 10.1371/journal.pone.0254326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022] Open
Abstract
Background Epilepsy is one of the most common brain disorders worldwide. It is usually hard to be identified properly, and a third of patients are drug-resistant. Genes related to the progression and prognosis of epilepsy are particularly needed to be identified. Methods In our study, we downloaded the Gene Expression Omnibus (GEO) microarray expression profiling dataset GSE143272. Differentially expressed genes (DEGs) with a fold change (FC) >1.2 and a P-value <0.05 were identified by GEO2R and grouped in male, female and overlapping DEGs. Functional enrichment analysis and Protein-Protein Interaction (PPI) network analysis were performed. Results In total, 183 DEGs overlapped (77 ups and 106 downs), 302 DEGs (185 ups and 117 downs) in the male dataset, and 750 DEGs (464 ups and 286 downs) in the female dataset were obtained from the GSE143272 dataset. These DEGs were markedly enriched under various Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) terms. 16 following hub genes were identified based on PPI network analysis: ADCY7, C3AR1, DEGS1, CXCL1 in male-specific DEGs, TOLLIP, ORM1, ELANE, QPCT in female-specific DEGs and FCAR, CD3G, CLEC12A, MOSPD2, CD3D, ALDH3B1, GPR97, PLAUR in overlapping DEGs. Conclusion This discovery-driven study may be useful to provide a novel insight into the diagnosis and treatment of epilepsy. However, more experiments are needed in the future to study the functional roles of these genes in epilepsy.
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Affiliation(s)
- Yike Zhu
- Department of Respiratory Medicine, Hainan General Hospital, Haikou, China
| | - Dan Huang
- Department of Neurology, Hainan General Hospital, Haikou, China
| | - Zhongyan Zhao
- Department of Neurology, Hainan General Hospital, Haikou, China
| | - Chuansen Lu
- Department of Neurology, Hainan General Hospital, Haikou, China
- * E-mail:
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Reddy DS. Brain structural and neuroendocrine basis of sex differences in epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 175:223-233. [PMID: 33008527 DOI: 10.1016/b978-0-444-64123-6.00016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This chapter reviews the current information about sex differences in epilepsy and potential mechanisms underlying sex differences in seizure susceptibility and epilepsy. The susceptibility to and occurrence of seizures are generally higher in men than women. There is gender-specific epilepsies such as catamenial epilepsy, a neuroendocrine condition in which seizures are most often clustered around the perimenstrual or periovulatory period in adult women. Structural differences in cerebral morphology, the structural and functional circuits may render men and women differentially vulnerable to seizure disorders and epileptogenic processes. Changes in seizure sensitivity are evident at puberty, pregnancy, and menopause, often attributed to circulating steroid hormones and neurosteroids as well as neuroplasticity in receptor systems. An improved understanding of the sexual dimorphism in neural circuits and the neuroendocrine basis of sex differences or resistance to protective drugs is essential to develop sex-specific therapies for seizure conditions.
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Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX, United States.
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Mastroianni G, Ascoli M, Gasparini S, Brigo F, Cianci V, Neri S, Russo E, Aguglia U, Ferlazzo E. Therapeutic approach to difficult-to-treat typical absences and related epilepsy syndromes. Expert Rev Clin Pharmacol 2021; 14:1427-1433. [PMID: 34289757 DOI: 10.1080/17512433.2021.1959317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: typical absences (TAs), are brief, generalized epileptic seizures of abrupt onset and termination clinically manifesting with impairment of awareness and associated with 3 Hz spike-wave discharges on EEG. TAs may occur in different idiopathic generalized epilepsies (IGE). Despite treatment with adequate anti-seizure medications (ASMs), TAs may persist in ~25% of subjects. This narrative review focuses on the therapeutic approach to difficult-to-treat TAs occurring in the setting of IGE.Areas covered: a literature search was conducted on the topic of treatment of TAs.Expert opinion: ethosuximide (ESX), valproic acid (VPA) and lamotrigine (LTG), alone or in combination, are considered the first-choice drugs. In women of childbearing potential, VPA should be avoided. Alternative therapies (benzodiazepines, levetiracetam, topiramate, or zonisamide) should be considered in subjects unresponsive to monotherapy after the exclusion of pseudo-drug resistance. Newer ASMs such as brivaracetam and perampanel seem to be promising options. Well-conducted clinical trials aimed to evaluate the efficacy of alternative monotherapy (beyond ESX, VPA or LTG) or combination of ASMs on difficult-to-treat TAs, are warranted.
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Affiliation(s)
- Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy
| | - Michele Ascoli
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy
| | - Sabrina Neri
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, Magna Graecia University, Catanzaro, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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Videira G, Gabriel D, Freitas J, Samões R, Chorão R, Lopes J, Ramalheira J, Lemos C, Leal B, da Silva AM, Chaves J. Female preponderance in genetic generalized epilepsies. Seizure 2021; 91:167-171. [PMID: 34171625 DOI: 10.1016/j.seizure.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/26/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Epilepsy is more prevalent in men but Genetic Generalized Epilepsies (GGE) seem to be more common in women. A predominant maternal inheritance has been previously described in GGE. Our objective was to determine sex and inheritance patterns in a GGE population compared to mesial temporal lobe epilepsy with hippocampal sclerosis (MTLEHS). METHODS We performed a prospective observational study including adult GGE and MTLEHS patients followed up at a tertiary epilepsy center from January 2016 to December 2019. Patients' familial history was obtained by a detailed questionnaire. Clinical and demographic data was retrieved from clinical notes. RESULTS A cohort of 641 patients, 403 with GGE and 238 with MTLEHS, was analyzed. GGE was more common in women than MTLEHS (58.8% vs 44.5%, OR=1.63, p = 0.004). Compared to MTLEHS patients, more GGE patients had familial history of epilepsy (45.4% vs 25.2%; p<0.001). The GGE group had a higher percentage of female relatives with epilepsy (55% vs 37%; p = 0.006). The prevalence of maternal inheritance was not different between GGE and MTLEHS groups (62.9% vs 57.7%; p = 0.596). Photosensitivity was more common in females than in males (44.7% vs 34.3%, p = 0.036). CONCLUSION There is a female preponderance in GGE when compared to MTLEHS, as both GGE patients and their affected relatives are more frequently women. The prevalence of maternal inheritance was not higher in GGE than in MTLEHS.
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Affiliation(s)
- Gonçalo Videira
- Neurology Department, Centro Hospitalar Universitário do Porto, Portugal.
| | - Denis Gabriel
- Neurology Department, Centro Hospitalar Universitário do Porto, Portugal
| | - Joel Freitas
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Portugal
| | - Raquel Samões
- Neurology Department, Centro Hospitalar Universitário do Porto, Portugal
| | - Rui Chorão
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Portugal
| | - João Lopes
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Portugal
| | - João Ramalheira
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Portugal
| | - Carolina Lemos
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal; Abel Salazar Biomedical Sciences Institute, University of Porto, Portugal
| | - Bárbara Leal
- Immunogenetics Laboratory, Pathology and Molecular Immunology Department, Abel Salazar Biomedical Sciences Institute, University of Porto, Portugal; Biomedical Investigation Multidisciplinary Unit, Abel Salazar Biomedical Sciences Institute, University of Porto, Portugal
| | - António Martins da Silva
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Portugal; Biomedical Investigation Multidisciplinary Unit, Abel Salazar Biomedical Sciences Institute, University of Porto, Portugal
| | - João Chaves
- Neurology Department, Centro Hospitalar Universitário do Porto, Portugal; Biomedical Investigation Multidisciplinary Unit, Abel Salazar Biomedical Sciences Institute, University of Porto, Portugal
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Li W, Zhao W, Wang J, Zhang X, Qian X, Gu R, He G. Identification of a novel variant p.Ser606Gly in SCN3A associated with childhood absence epilepsy. Epilepsy Res 2021; 175:106682. [PMID: 34102392 DOI: 10.1016/j.eplepsyres.2021.106682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Sodium (Na+) channels are the basis for action potential generation and propagation, which play a key role in the regulation of neuronal excitability. SCN3A is a gene encoding for sodium channel protein type 3 subunit alpha (or known as Nav1.3). This study aimed to explore SCN3A genetic variants in a cohort of childhood absence epilepsy (CAE) via whole exome sequencing. A novel SCN3A missense variant (c.A1816G, p.Ser606Gly) was identified in a patient with CAE. This variant had not been reported in both 1000G and ExAC databases. Bioinformatics analysis revealed that this variant was pathogenic and could transform the protein structure of Nav1.3. The reported phenotypes of SCN3A-related central nerve system disorders included multiple seizure types, polymicrogyria and different degrees of developmental delay/intellectual disability. The patient with p.Ser606Gly variant exhibited typical absence seizures. The MRI and CT scan results were normal, and EEG showed that 3-Hz spike-slow wave discharges. In conclusion, our findings not only broaden the pathogenic spectrum of SCN3A, but also extend the clinical phenotypes of SCN3A-related CAE.
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Affiliation(s)
- Wei Li
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Wenli Zhao
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Jing Wang
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Xiaoli Zhang
- Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xinlai Qian
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China.
| | - Renjun Gu
- Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
| | - Guoyang He
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China.
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Christian CA, Reddy DS, Maguire J, Forcelli PA. Sex Differences in the Epilepsies and Associated Comorbidities: Implications for Use and Development of Pharmacotherapies. Pharmacol Rev 2021; 72:767-800. [PMID: 32817274 DOI: 10.1124/pr.119.017392] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated comorbidities as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated comorbidities, with emphasis on those aspects most informative for the development of new pharmacotherapies. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic comorbidities; catamenial epilepsy in women; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; and cellular mechanisms, including brain-derived neurotrophic factor signaling and neuronal-glial interactions. Further attention placed on potential sex differences in epilepsies, comorbidities, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy. SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various comorbidities. The features of epilepsy and seizure activity as well as comorbid afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.
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Affiliation(s)
- Catherine A Christian
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Doodipala Samba Reddy
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Jamie Maguire
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Patrick A Forcelli
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
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Lee J, Lee C, Ki CS, Lee J. Determining the best candidates for next-generation sequencing-based gene panel for evaluation of early-onset epilepsy. Mol Genet Genomic Med 2020; 8:e1376. [PMID: 32613771 PMCID: PMC7507365 DOI: 10.1002/mgg3.1376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/01/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022] Open
Abstract
Background Genetic testing is an emerging diagnostic approach in early‐onset epilepsy. Identification of the heterogeneous genetic causes of epilepsy may mitigate unnecessary evaluations and allow more accurate diagnosis and therapy. We aimed to uncover genetic causes of early‐onset epilepsy using next‐generation sequencing (NGS) to elucidate the diagnostic candidates and evaluate the diagnostic yield of targeted gene panel testing. Methods We evaluated 116 patients with early‐onset epilepsy developed before 2 years old and normal brain imaging using a NGS‐based targeted gene panel. Variants were classified according to their pathogenicity, and the diagnostic yield of the targeted genes and associated clinical factors were determined. Results We detected 40 disease‐causing variants with diagnostic yield of 34.5% (19 pathogenic, 21 likely pathogenic). Twelve variants were novel. The most commonly detected genes were SCN1A, associated with Dravet syndrome, and PRRT2, associated with benign familial infantile epilepsy. Other variants were identified in ARX, SCN2A, KCNQ2, PCDH19, STXBP1, DEPDC5, and SCN8A. The age of seizure onset and family history were associated with disease‐causing variants. Conclusion Next‐generation sequencing‐based targeted testing is an effective diagnostic test, with 30%–40% comparable diagnostic yield. Patients with earlier seizure onset and family history of epilepsy were the best candidates for testing. For pediatric patients with early‐onset epilepsy, genetic diagnosis is important for accurate prognosis and treatment.
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Affiliation(s)
- Jiwon Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Lee
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | | | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Park J, Koko M, Hedrich UBS, Hermann A, Cremer K, Haberlandt E, Grimmel M, Alhaddad B, Beck‐Woedl S, Harrer M, Karall D, Kingelhoefer L, Tzschach A, Matthies LC, Strom TM, Ringelstein EB, Sturm M, Engels H, Wolff M, Lerche H, Haack TB. KCNC1-related disorders: new de novo variants expand the phenotypic spectrum. Ann Clin Transl Neurol 2019; 6:1319-1326. [PMID: 31353862 PMCID: PMC6649617 DOI: 10.1002/acn3.50799] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/11/2019] [Indexed: 12/30/2022] Open
Abstract
A recurrent de novo missense variant in KCNC1, encoding a voltage-gated potassium channel expressed in inhibitory neurons, causes progressive myoclonus epilepsy and ataxia, and a nonsense variant is associated with intellectual disability. We identified three new de novo missense variants in KCNC1 in five unrelated individuals causing different phenotypes featuring either isolated nonprogressive myoclonus (p.Cys208Tyr), intellectual disability (p.Thr399Met), or epilepsy with myoclonic, absence and generalized tonic-clonic seizures, ataxia, and developmental delay (p.Ala421Val, three patients). Functional analyses demonstrated no measurable currents for all identified variants and dominant-negative effects for p.Thr399Met and p.Ala421Val predicting neuronal disinhibition as the underlying disease mechanism.
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Affiliation(s)
- Joohyun Park
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Mahmoud Koko
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Ulrike B. S. Hedrich
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht‐Kossel”, Department of Neurology and Center for Transdisciplinary Neurosciences Rostock (CTNR)University Medical Center Rostock, University of Rostock18147RostockGermany
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald18147RostockGermany
| | - Kirsten Cremer
- Institute of Human GeneticsUniversity of Bonn, School of Medicine and University Hospital BonnBonnGermany
| | - Edda Haberlandt
- Clinic for PediatricsKrankenhaus Stadt DornbirnDornbirnAustria
| | - Mona Grimmel
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
| | - Bader Alhaddad
- Institute of Human GeneticsTechnische Universität MünchenMunichGermany
- Institute of Human GeneticsHelmholtz Zentrum MünchenNeuherbergGermany
| | - Stefanie Beck‐Woedl
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
| | - Merle Harrer
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Daniela Karall
- Clinic for Pediatrics, Division of Inherited Metabolic DisordersMedical University of InnsbruckInnsbruckAustria
| | - Lisa Kingelhoefer
- Department of NeurologyTechnische Universität Dresden and German Center for Neurodegenerative Diseases, Research Side DresdenDresdenGermany
| | - Andreas Tzschach
- Institute of Clinical GeneticsTechnische Universität DresdenDresdenGermany
| | - Lars C. Matthies
- Institute of Human GeneticsUniversity of Bonn, School of Medicine and University Hospital BonnBonnGermany
| | - Tim M. Strom
- Institute of Human GeneticsTechnische Universität MünchenMunichGermany
- Institute of Human GeneticsHelmholtz Zentrum MünchenNeuherbergGermany
| | - Erich Bernd Ringelstein
- Department of NeurologyUniversity Hospital of MuensterMuensterGermany
- German Neuroscience CenterDubaiUnited Arab Emirates
| | - Marc Sturm
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
| | - Hartmut Engels
- Institute of Human GeneticsUniversity of Bonn, School of Medicine and University Hospital BonnBonnGermany
| | - Markus Wolff
- Department of NeuropediatricsUniversity of TübingenTübingenGermany
| | - Holger Lerche
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Tobias B. Haack
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
- Institute of Human GeneticsTechnische Universität MünchenMunichGermany
- Centre for Rare DiseasesUniversity of TübingenTübingenGermany
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Kishk N, Mourad H, Ibrahim S, Shamloul R, Al-Azazi A, Shalaby N. Sex differences among epileptic patients: a comparison of epilepsy and its impacts on demographic features, clinical characteristics, and management patterns in a tertiary care hospital in Egypt. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0078-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Martínez-Ferrández C, Martínez-Salcedo E, Casas-Fernández C, Alarcón-Martínez H, Ibáñez-Micó S, Domingo-Jiménez R. Long-term prognosis of childhood absence epilepsy. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Childhood absence epilepsy (CAE) is a common pediatric epilepsy syndrome with distinct seizure semiology, electroencephalography (EEG) features, and treatment. A diagnosis of CAE can be obtained during an office visit with a careful history, physical exam including prolonged hyperventilation, and a routine EEG. The treatment of choice for CAE with absence seizures only is ethosuximide. Valproic acid and lamotrigine are also effective treatments for many patients, but when compared to ethosuximide, valproic acid has more adverse effects and lamotrigine is less effective. Attention to predictors of response to treatment, including clinical, electrographic, and genetic factors, is increasing. Refractory CAE occurs in fewer than half of patients, and treatment strategies are available, though efficacy data are lacking. Careful assessment and treatment of psychosocial comorbidities is essential in caring for patients with CAE.
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Affiliation(s)
- Sudha Kilaru Kessler
- Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
| | - Emily McGinnis
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA USA
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Subki AH, Mukhtar AM, Al-Harbi RS, Alotaibi AK, Mosaad FG, Alsallum MS, Jan MMS. The Impact of Pediatric Epilepsy on Children and Families: A Multicenter Cross-Sectional Study. Clin Pract Epidemiol Ment Health 2018; 14:323-333. [PMID: 30972132 PMCID: PMC6407654 DOI: 10.2174/1745017901814010323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/02/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Epilepsy is considered one of the most prevalent causes of morbidity in children. The aim of this study is to determine how epilepsy impacts the lives of children with epilepsy and their families. Methods: A translated version of the “Impact of Pediatric Epilepsy Scale” (IPES) questionnaire was completed by the 80 mothers of children with epilepsy, recruited at three hospitals in Jeddah, Saudi Arabia This is a validated self-administered questionnaire used to assess the impact of epilepsy on the lives of the child and family, as well as the quality of life (QoL) of the child. Results: The mean age of children epilepsy was 6.32 years (SD = 3.22). The mean IPES score was 6.28 (SD = 8.42) and the mean child’s QoL was 2.85 (SD= 0.83). 87.5% of the mothers rated their child’s QoL as low. IPES score was significantly associated with cause of seizure (β=0.259; 95%-CI= 0.263 - 10.334; p = 0.039). Child’s QoL was significantly associated with frequency of seizure (β=0.251; 95%-CI= 0.016 - 0.568; p= 0.039) and child’s nationality (β=-0.270; 95%-CI -0.252, -0.013; p= 0.031). Conclusions: Pediatric epilepsy may have a greater impact on the lives of the child and the family when it is not comorbid with cerebral palsy. Quality of life tends to be lower for non-Saudi children, and children with more frequent seizures. Therefore, these groups may need more support in managing the impact that epilepsy has on their daily functioning and quality of life.
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Affiliation(s)
- Ahmed Hussein Subki
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdel Moniem Mukhtar
- Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan Salah Al-Harbi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Faisal Ghazi Mosaad
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Saad Alsallum
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed M S Jan
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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25
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Farghaly WM, Abd Elhamed MA, Hassan EM, Soliman WT, Yhia MA, Hamdy NA. Prevalence of childhood and adolescence epilepsy in Upper Egypt (desert areas). THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:34. [PMID: 30532513 PMCID: PMC6245138 DOI: 10.1186/s41983-018-0032-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background A high prevalence of epilepsy in children is frequently found in developing countries. Objective This study aimed to determine the prevalence and clinical pattern of childhood and adolescence epilepsy in Upper Egypt. Methods This is a door-to-door study conducted on all inhabitants < 18 years in Al Kharga district and Al Qusier city (36,195 subjects). The study was conducted through two stages; every stage consisted of two phases (screening and diagnostic). Results Lifetime prevalence of childhood and adolescence epilepsy (children < 18 years) in Upper Egypt was 9.7/1000, with higher prevalence among children < 12 years (10.8/1000) than adolescents (7.2/1000). The age-specific prevalence was highest in early childhood (12.01/1000) and least at adolescence (7.2/1000). More than half of the patients (59.4%) had idiopathic epilepsy. The most frequent etiology for structural/metabolic epilepsy was perinatal complications, particularly in infancy, followed by central nervous system (CNS) infections, in childhood, and post-traumatic epilepsy in adolescence. Partial seizures were more frequent in infancy, while generalized seizures were more frequent in late childhood and adolescence. Generalized tonic-clonic seizures (GTCS) were the most frequent type of seizures. Conclusion Prevalence of childhood and adolescence epilepsy in Upper Egypt was not so much different from other developing countries. Idiopathic epilepsy was more prevalent than structural/metabolic cases. Perinatal complications, CNS infections, and head injury were the most frequent etiologies, and generalized tonic-clonic seizures were the most frequent seizure type. Electronic supplementary material The online version of this article (10.1186/s41983-018-0032-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Enas M Hassan
- 2Department of Neurology, Minia University, Minya, Egypt
| | - Wael T Soliman
- 2Department of Neurology, Minia University, Minya, Egypt
| | - Mohamed A Yhia
- 2Department of Neurology, Minia University, Minya, Egypt
| | - Nermin A Hamdy
- 2Department of Neurology, Minia University, Minya, Egypt
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26
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Santos VR, Kobayashi I, Hammack R, Danko G, Forcelli PA. Impact of strain, sex, and estrous cycle on gamma butyrolactone-evoked absence seizures in rats. Epilepsy Res 2018; 147:62-70. [PMID: 30261353 PMCID: PMC6226012 DOI: 10.1016/j.eplepsyres.2018.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/03/2018] [Accepted: 09/15/2018] [Indexed: 12/19/2022]
Abstract
Childhood absence epilepsy (CAE) is the most common pediatric epilepsy syndrome and is characterized by typical absence seizures (AS). AS are non-convulsive epileptic seizures characterized by a sudden loss of awareness and bilaterally generalized synchronous 2.5-4 Hz spike and slow-wave discharges (SWD). Gamma butyrolactone (GBL) is an acute pharmacological model of AS and induces bilaterally synchronous SWDs and behavioral arrest. Despite the long use of this model, little is known about its strain and sex-dependent features. We compared the dose-response profile of GBL-evoked SWDs in three rat strains (Long Evans, Sprague-Dawley, and Wistar), and examined the modulatory effects of estrous cycle on SWDs in female Wistar rats. We evaluated the number of seizures, the cumulative time seizing, and the average seizure duration as a function of dose, strain, and sex/estrous phase. Long Evans rats displayed the greatest sensitivity to GBL, followed by Wistar rats, and then by Sprague-Dawley rats. GBL-evoked SWDs were modulated by estrous cycle in female rats, with the lowest sensitivity to GBL occurring during metestrus. Wistar rats showed the greatest variability as a function of dose, and the least variability within dose; these features make this strain desirable for interventional studies. Moreover, our finding that the SWD response to GBL differs as a function of estrous cycle underscores the importance of cycle monitoring in studies examining female animals using this model. Together, these strain and sex-dependent findings provide guidance for future studies.
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Affiliation(s)
- Victor R Santos
- Department of Pharmacology & Physiology, Georgetown University School of Medicine, United States
| | - Ihori Kobayashi
- Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, United States
| | - Robert Hammack
- Department of Pharmacology & Physiology, Georgetown University School of Medicine, United States
| | - Gregory Danko
- Department of Pharmacology & Physiology, Georgetown University School of Medicine, United States
| | - Patrick A Forcelli
- Department of Pharmacology & Physiology, Georgetown University School of Medicine, United States; Department of Neuroscience, Georgetown University School of Medicine, United States; Interdisciplinary Program in Neuroscience, Georgetown University School of Medicine, United States.
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27
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2018:1-15. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston.,4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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28
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Hilberink SR, van Ool M, van der Stege HA, van Vliet MC, van Heijningen-Tousain HJM, de Louw AJA, van Staa A. Skills for Growing Up-Epilepsy: An exploratory mixed methods study into a communication tool to promote autonomy and empowerment of youth with epilepsy. Epilepsy Behav 2018; 86:116-123. [PMID: 29997037 DOI: 10.1016/j.yebeh.2018.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/15/2018] [Accepted: 05/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The consequences of having epilepsy seriously hamper the development of autonomy for youth with epilepsy (YWE) and limit their social participation. This study was designed to provide insight into the impact of epilepsy on autonomy and empowerment and to evaluate the use of the Skills for Growing Up (SGU-Epilepsy) communication tool in pediatric epileptic care. METHODS A mixed methods design was used to examine the impact of epilepsy on autonomy and empowerment and to evaluate the feasibility and use of the SGU-Epilepsy. Six focus groups with YWE and their parents were organized (N = 27), and the benefits of the SGU-Epilepsy were evaluated (N = 72). RESULTS Youth with epilepsy struggled with social participation. Beliefs of YWE and their parents on managing daily life and taking medication were not always similar. Parents worried about the passive attitude of YWE, but autonomy of YWE seemed to be constrained by parents. The SGU-Epilepsy seemed to be feasible. It facilitated the communication on development and empowerment although it was sometimes confronting for parents. Not all YWE were motivated to use and discuss the tool. In the evaluation, no differences in perceived autonomy and empowerment between YWE who used SGU-Epilepsy and received usual care appeared. CONCLUSION On the short-term, a beneficial effect of using the SGU-Epilepsy on autonomy and empowerment for YWE and their parents was not shown. The SGU-Epilepsy seemed to be a feasible instrument, however, to address nonmedical issues during pediatric consultations.
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Affiliation(s)
- Sander R Hilberink
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands.
| | - Marion van Ool
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+, Heeze, P.O. Box 61, 5590 AB Heeze, The Netherlands
| | - Heleen A van der Stege
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
| | - Michelle C van Vliet
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
| | - Heidi J M van Heijningen-Tousain
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
| | - Anton J A de Louw
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+, Heeze, P.O. Box 61, 5590 AB Heeze, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
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Arzimanoglou A, D'Cruz O, Nordli D, Shinnar S, Holmes GL. A Review of the New Antiepileptic Drugs for Focal-Onset Seizures in Pediatrics: Role of Extrapolation. Paediatr Drugs 2018; 20:249-264. [PMID: 29616471 DOI: 10.1007/s40272-018-0286-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most antiepileptic drugs (AEDs) receive regulatory approval for children years after the drug is available in adults, encouraging off-label use of the drug in children and hindering attempts to obtain quality pediatric data in controlled trials. Extrapolating adult efficacy data to pediatrics can reduce the time between approval in adults and that in children. To extrapolate efficacy from adults to children, several assumptions must be supported, such as (1) a similar disease progression and response to interventions in adults and children, and (2) similar exposure response in adults and children. The Pediatric Epilepsy Academic Consortium for Extrapolation (PEACE) addressed these assumptions in focal-onset seizures (FOS), the most common seizure type in both adults and children. PEACE reviewed the biological and clinical evidence that supported the assumptions that children with FOS have a similar disease progression and response to intervention as adults with FOS. After age 2 years, the pathophysiological underpinnings of FOS and the biological milieu in which seizures are initiated and propagated in children, seizure semiology, electroencephalographic features, etiology and AED response to FOS in children are similar to those in adults with FOS. PEACE concluded that extrapolation of efficacy data in adults to pediatrics in FOS is supported by strong scientific and clinical evidence. However, safety and pharmacokinetic (PK) data cannot be extrapolated from adults to children. Based on extrapolation, eslicarbazepine is now approved for children with FOS, down to age 4 years. Perampanel, lacosamide and brivaracetam are now undergoing PK and safety studies for the purposes of extrapolation down to age 2 or 4 years. When done in conjunction with PK and safety investigations in children, extrapolation of adult data from adults to children can reduce the time delay between approval of effective and safe AEDs in adults and approval in children.
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Affiliation(s)
- Alexis Arzimanoglou
- Department of Clinical Epileptology, Sleep Disorders and Functional Pediatric Neurology, University Hospitals of Lyon (HCL), Lyon, France.,Sección Epilepsia, Sueño y Neurofisiología, Servicio Neurología, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - O'Neill D'Cruz
- Consulting and Neurological Services, Chapel Hill, NC, USA
| | - Douglas Nordli
- Division of Pediatric Neurology, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
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30
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Savic I, Engel J. Reprint of "Structural and functional correlates of epileptogenesis--does gender matter?". Neurobiol Dis 2018; 72 Pt B:131-5. [PMID: 25448763 DOI: 10.1016/j.nbd.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/15/2014] [Accepted: 05/22/2014] [Indexed: 11/30/2022] Open
Abstract
In the majority of neuropsychiatric conditions, marked gender-based differences have been found in the epidemiology,clinical manifestations, and therapy of disease. One possible reason is that sex differences in cerebral morphology, structural and functional connections, render men and women differentially vulnerable to various disease processes. The present review addresses this issue with respect to the functional and structural correlates to some forms of epilepsy.
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31
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Lin JL, Cohen E, Sanders LM. Shared Decision Making among Children with Medical Complexity: Results from a Population-Based Survey. J Pediatr 2018; 192:216-222. [PMID: 29102046 PMCID: PMC5732902 DOI: 10.1016/j.jpeds.2017.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/20/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN). STUDY DESIGN We examined the 2009-2010 National Survey of Children with Special Health Care Needs, a representative survey of 40 242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN screener. We identified 3 subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, and other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed 4 stepwise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, and marital status), behavioral comorbidity, family-centered care, and patient-centered medical home. RESULTS The study population included 39 876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (aOR, 0.76; 95% CI, 0.64-0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR, 0.67; 95% CI, 0.49-0.92) and CMC with other diagnoses (aOR, 0.74; 95% CI, 0.58-0.94), but not CMC with seizures (aOR, 0.95; 95% CI, 0.59-1.51). CONCLUSIONS SDM is less common for CSHCN with complex needs than those without complex needs. Health system interventions targeting future-oriented care planning may improve SDM for CMC.
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Affiliation(s)
- Jody L Lin
- Division of Pediatric Hospital Medicine, Stanford University, Department of Pediatrics, Palo Alto, CA.
| | - Eyal Cohen
- Division of Pediatric Medicine, Hospital for Sick Children, Department of Pediatrics and Institute of Health Policy, Management, and Evaluation, University of Toronto
| | - Lee M Sanders
- Division of General Pediatrics, Stanford University, Department of Pediatrics
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32
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Aaberg KM, Surén P, Søraas CL, Bakken IJ, Lossius MI, Stoltenberg C, Chin R. Seizures, syndromes, and etiologies in childhood epilepsy: The International League Against Epilepsy 1981, 1989, and 2017 classifications used in a population-based cohort. Epilepsia 2017; 58:1880-1891. [PMID: 28949013 DOI: 10.1111/epi.13913] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study provides updated information about the distribution of seizures, epilepsies, and etiologies of epilepsy in the general child population, and compares the old and new classification systems from the International League Against Epilepsy (ILAE). METHODS The study platform was the Norwegian Mother and Child Cohort Study. Cases of epilepsy were identified through registry linkages and sequential parental questionnaires. Epilepsy diagnoses were validated using a standardized protocol, and seizures, epilepsies, and etiologies were classified according to the old (ILAE 1981/1989) and new (ILAE 2017) classifications. Information was collected through medical record reviews and/or parental telephone interviews. RESULTS The study population included 112,744 children aged 3-13 years at the end of follow-up on December 31, 2012. Of these, there were 606 children with epilepsy (CWE). Distribution of seizure types varied by age of onset. Multiple seizure types were common with early onset. Focal epilepsies were the most common, occurring in 317 per 100,000 children in the study population and in 59% of CWE. Generalized epilepsies were found in 190 per 100,000 (35% of CWE). CWE with onset during the first 2 years of life had an even distribution of focal and generalized epilepsies, whereas focal epilepsies became dominant at later ages of onset. A definite cause of epilepsy had been demonstrated in 33% of CWE. The ILAE 1989 classification allowed for a broad syndrome category in 93% of CWE and a defined epileptic syndrome in 37%. With the ILAE 2017 classification, 41% of CWE had a defined epileptic syndrome and 63% had either a defined syndrome or structural-metabolic etiology. SIGNIFICANCE The distribution of seizures and epilepsies is strongly dependent on age of onset. Despite diagnostic advances, the causes of epilepsy are still unknown in two-thirds of CWE. The ILAE 2017 classifications allow for a higher precision of diagnoses, but at the expense of leaving more epilepsies classifiable only at the mode of onset level.
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Affiliation(s)
- Kari Modalsli Aaberg
- National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Surén
- National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Morten I Lossius
- National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Richard Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.,Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Descriptive study of symptomatic epilepsy by age of onset in patients with a 3-year follow-up at the Neuropaediatric Department of a reference centre. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Epileptic encephalopathies account for a large proportion of the intractable early-onset epilepsies and are characterized by frequent seizures and poor developmental outcome. The epileptic encephalopathies can be loosely divided into two related groups of named syndromes. The first comprises epilepsies where continuous EEG changes directly result in cognitive and developmental dysfunction. The second includes patients where cognitive impairment is present at seizure onset and is due to the underlying etiology but the epileptic activity may then worsen the cognitive abilities over time. Recent, large-scale exome studies have begun to establish the genetic architecture of the epileptic encephalopathies, resulting in a re-consideration of the boundaries of these named syndromes. The emergence of this genetic architecture has lead to three main pathophysiological concepts to provide a mechanistic framework for these disorders. In this article, we will review the classic syndromes, the most significant genetic findings, and relate both to the pathophysiological understanding of epileptic encephalopathies.
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Pellock JM, Arzimanoglou A, D'Cruz O, Holmes GL, Nordli D, Shinnar S. Extrapolating evidence of antiepileptic drug efficacy in adults to children ≥2 years of age with focal seizures: The case for disease similarity. Epilepsia 2017; 58:1686-1696. [PMID: 28755452 DOI: 10.1111/epi.13859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 12/18/2022]
Abstract
Expediting pediatric access to new antiseizure drugs is particularly compelling, because epileptic seizures are the most common serious neurological symptom in children. Analysis of antiepileptic drug (AED) efficacy outcomes of randomized controlled trials, conducted during the past 20 years in different populations and a broad range of study sites and countries, has shown considerable consistency for each drug between adult and pediatric populations. Historically, the majority of regulatory approvals for AEDs have been for seizure types and not for specific epilepsy syndromes. Available data, both anatomical and neurophysiological, support a similar pathophysiology of focal seizures in adults and young children, and suggest that by age 2 years the structural and physiological milieu upon which seizures develop is similar. Although the distribution of specific etiologies and epilepsy syndromes is different in children from in adults, this should not impact approvals of efficacy based on seizure type, because the pathophysiology of focal seizures and the drug responsiveness of these seizure types are quite similar. Safety and pharmacokinetics cannot be extrapolated from adults to children. The scientific rationale, clinical consensus, and published data support a future approach accepting efficacy data from adult trials and focusing exclusively on prospective pharmacokinetic, tolerability, and safety studies and long-term follow-up in children. Whereas tolerability studies can be compared easily in children and adults, safety studies require large numbers of patients followed for many years.
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Affiliation(s)
- John M Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Alexis Arzimanoglou
- Department of Clinical Epileptology, Sleep Disorders, and Functional Pediatric Neurology, University Hospitals of Lyon, Lyon, France.,Epilepsy, Sleep, and Neurophysiology Section, Neurology Service, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - O'Neill D'Cruz
- Consulting and Neurological Services, Chapel Hill, North Carolina, U.S.A
| | - Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont, U.S.A
| | - Douglas Nordli
- Division of Pediatric Neurology, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics, and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
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Aaberg KM, Gunnes N, Bakken IJ, Lund Søraas C, Berntsen A, Magnus P, Lossius MI, Stoltenberg C, Chin R, Surén P. Incidence and Prevalence of Childhood Epilepsy: A Nationwide Cohort Study. Pediatrics 2017; 139:peds.2016-3908. [PMID: 28557750 DOI: 10.1542/peds.2016-3908] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy affects 0.5% to 1% of children and is the most frequent chronic neurologic condition in childhood. Incidence rates appear to be declining in high-income countries. The validity of epilepsy diagnoses from different data sources varies, and contemporary population-based incidence studies are needed. METHODS The study was based on the Norwegian Mother and Child Cohort Study. Potential epilepsy cases were identified through registry linkages and parental questionnaires. Cases were validated through medical record reviews and telephone interviews of parents. RESULTS The study population included 112 744 children aged 3 to 13 years (mean 7.4 years) at end of registry follow-up (December 31, 2012). Of these, 896 had registry recordings and/or questionnaire reports of epilepsy. After validation, 587 (66%) met the criteria for an epilepsy diagnosis. The incidence rate of epilepsy was 144 per 100 000 person-years in the first year of life and 58 per 100 000 for ages 1 to 10 years. The cumulative incidence of epilepsy was 0.66% at age 10 years, with 0.62% having active epilepsy. The 309 children (34%) with erroneous reports of epilepsy from the registry and/or the questionnaires had mostly been evaluated for nonepileptic paroxysmal events, or they had undergone electroencephalography examinations because of other developmental or neurocognitive difficulties. CONCLUSIONS Approximately 1 out of 150 children is diagnosed with epilepsy during the first 10 years of life, with the highest incidence rate observed during infancy. Validation of epilepsy diagnoses in administrative data and cohort studies is crucial because reported diagnoses may not meet diagnostic criteria for epilepsy.
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Affiliation(s)
- Kari Modalsli Aaberg
- National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway; .,Norwegian Institute of Public Health, Oslo, Norway
| | - Nina Gunnes
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Morten I Lossius
- National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Richard Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; and.,Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Pål Surén
- National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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Hanaoka Y, Yoshinaga H, Kobayashi K. A ten-year follow-up cohort study of childhood epilepsy: Changes in epilepsy diagnosis with age. Brain Dev 2017; 39:312-320. [PMID: 27847129 DOI: 10.1016/j.braindev.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To elucidate all of the characteristics of childhood epilepsy, we performed a long-term follow-up study on the patients who visited Okayama University Hospital. SUBJECTS AND METHODS We retrospectively investigated the patients who were involved in the previous epidemiological study and visited Okayama University Hospital for a period of 10years after December 31, 1999. RESULTS Overall, there were 350 patients' medical records that were evaluated, and 258 patients with complete clinical information available for a 10-year period were enrolled. Ten patients died and the remaining 82 were lost to follow-up. Of 258 patients with complete information, 153 (59.3%) were seizure-free for at least 5years. One hundred thirty (50.4%) had intellectual disabilities and 77 (29.8%) had motor disabilities, including 75 (29.1%) with both disabilities on December 31, 2009. Thirty-four patients of 350 (9.7%) changed the epilepsy classification during follow-up. With regard to ten patients who died, nine of them had symptomatic epilepsy, particularly those with severe underlying disorders with an onset during the first year of life. CONCLUSION Clinical status considerably changed during the decade-long follow-up period in childhood epilepsy. Changes in the epilepsy diagnosis are especially important and should be taken into account in the long-term care of children with epilepsy.
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Affiliation(s)
- Yoshiyuki Hanaoka
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan.
| | - Harumi Yoshinaga
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
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Martínez-Ferrández C, Martínez-Salcedo E, Casas-Fernández C, Alarcón-Martínez H, Ibáñez-Micó S, Domingo-Jiménez R. Long-term prognosis of childhood absence epilepsy. Neurologia 2017; 34:224-228. [PMID: 28325560 DOI: 10.1016/j.nrl.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Childhood absence epilepsy (CAE) is considered easily manageable with medication provided that a strict patient classification system is employed. It accounts for 10% of all childhood epilepsy cases starting before the age of 15 and it is most frequent in school-aged girls. The aim of this study is to analyse long-term outcomes of patients diagnosed with CAE according to the Loiseau and Panayiotopoulos criteria and treated during childhood. METHODS We conducted a retrospective study including 69 patients with CAE who are currently older than 11; data were gathered from medical histories, EEG records, and telephone questionnaires. RESULTS 52 patients met the Loiseau and Panayiotopoulos criteria. Mean age is now 17.16 years. Female-to-male ratio was 1.65:1; mean age at onset was 6 years and 2 months; mean duration of treatment was 3 years and 9 months. A family history of epilepsy was present in 30.8% of the patients and 7.7% had a personal history of febrile convulsions. Absence seizures were simple in 73.5% of the patients and complex in 26.5%. Response rates to first-line treatment were as follows: valproic acid, 46.3%; and valproic acid plus ethosuximide, 90.9%. The rate of response to second-line therapy (ethosuximide or lamotrigine) was 84.2%; 4% of the patients experienced further seizures after treatment discontinuation, 78.8% achieved seizure remission, and 25% needed psychological and academic support. CONCLUSIONS Our data show that epileptic patients should be classified according to strict diagnostic criteria since patients with true CAE have an excellent prognosis. The relapse rate was very low in our sample. Despite the favourable prognosis, psychological and academic support is usually necessary.
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Affiliation(s)
- C Martínez-Ferrández
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - E Martínez-Salcedo
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - C Casas-Fernández
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - H Alarcón-Martínez
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - S Ibáñez-Micó
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - R Domingo-Jiménez
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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Ochoa-Gómez L, López-Pisón J, Lapresta Moros C, Fuertes Rodrigo C, Fernando Martínez R, Samper-Villagrasa P, Monge-Galindo L, Peña-Segura JL, García-Jiménez MC. A study of epilepsy according to the age at onset and monitored for 3 years in a regional reference paediatric neurology unit. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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40
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Stigma, self-esteem, and depression in adolescent patients with epilepsy. MIDDLE EAST CURRENT PSYCHIATRY 2017. [DOI: 10.1097/01.xme.0000508432.19579.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Syvertsen M, Hellum MK, Hansen G, Edland A, Nakken KO, Selmer KK, Koht J. Prevalence of juvenile myoclonic epilepsy in people <30 years of age-A population-based study in Norway. Epilepsia 2016; 58:105-112. [PMID: 27861775 DOI: 10.1111/epi.13613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Despite juvenile myoclonic epilepsy (JME) being considered one of the most common epilepsies, population-based prevalence studies of JME are lacking. Our aim was to estimate the prevalence of JME in a Norwegian county, using updated diagnostic criteria. METHODS This was a cross-sectional study, based on reviews of the medical records of all patients with a diagnosis of epilepsy at Drammen Hospital in the period 1999-2013. The study population consisted of 98,152 people <30 years of age. Subjects diagnosed with JME, unspecified genetic generalized epilepsy, or absence epilepsy were identified. All of these patients were contacted and asked specifically about myoclonic jerks. Electroencephalography (EEG) recordings and medical records were reevaluated for those who confirmed myoclonic jerks. Information about seizure onset was obtained from the medical records, and annual frequency of new cases was estimated. RESULTS A total of 55 subjects fulfilled the diagnostic criteria for JME. The point prevalence was estimated at 5.6/10,000. JME constituted 9.3% of all epilepsies in the age group we investigated. Of subjects diagnosed with either unspecified genetic generalized epilepsy or absence epilepsy, 21% and 12%, respectively, had JME. We identified 21 subjects with JME (38%) who had not been diagnosed previously. Six subjects (11%) had childhood absence epilepsy evolving into JME. Between 2009 and 2013, the average frequency of JME per 100,000 people of all ages per year was estimated at 1.7. SIGNIFICANCE A substantial portion of people with JME seem to go undiagnosed, as was the case for more than one third of the subjects in this study. By investigating subjects diagnosed with unspecified genetic generalized epilepsy or absence epilepsy, we found a prevalence of JME that was considerably higher than previously reported. We conclude that JME may go undiagnosed due to the underrecognition of myoclonic jerks. To make a correct diagnosis, clinicians need to ask specifically about myoclonic jerks.
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Affiliation(s)
- Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Gunnar Hansen
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Astrid Edland
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Karl Otto Nakken
- Division of Clinical Neuroscience, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Kaja Kristine Selmer
- Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jeanette Koht
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Fietz M, AlSayed M, Burke D, Cohen-Pfeffer J, Cooper JD, Dvořáková L, Giugliani R, Izzo E, Jahnová H, Lukacs Z, Mole SE, Noher de Halac I, Pearce DA, Poupetova H, Schulz A, Specchio N, Xin W, Miller N. Diagnosis of neuronal ceroid lipofuscinosis type 2 (CLN2 disease): Expert recommendations for early detection and laboratory diagnosis. Mol Genet Metab 2016; 119:160-7. [PMID: 27553878 DOI: 10.1016/j.ymgme.2016.07.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/23/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
Neuronal ceroid lipofuscinoses (NCLs) are a heterogeneous group of lysosomal storage disorders. NCLs include the rare autosomal recessive neurodegenerative disorder neuronal ceroid lipofuscinosis type 2 (CLN2) disease, caused by mutations in the tripeptidyl peptidase 1 (TPP1)/CLN2 gene and the resulting TPP1 enzyme deficiency. CLN2 disease most commonly presents with seizures and/or ataxia in the late-infantile period (ages 2-4), often in combination with a history of language delay, followed by progressive childhood dementia, motor and visual deterioration, and early death. Atypical phenotypes are characterized by later onset and, in some instances, longer life expectancies. Early diagnosis is important to optimize clinical care and improve outcomes; however, currently, delays in diagnosis are common due to low disease awareness, nonspecific clinical presentation, and limited access to diagnostic testing in some regions. In May 2015, international experts met to recommend best laboratory practices for early diagnosis of CLN2 disease. When clinical signs suggest an NCL, TPP1 enzyme activity should be among the first tests performed (together with the palmitoyl-protein thioesterase enzyme activity assay to rule out CLN1 disease). However, reaching an initial suspicion of an NCL or CLN2 disease can be challenging; thus, use of an epilepsy gene panel for investigation of unexplained seizures in the late-infantile/childhood ages is encouraged. To confirm clinical suspicion of CLN2 disease, the recommended gold standard for laboratory diagnosis is demonstration of deficient TPP1 enzyme activity (in leukocytes, fibroblasts, or dried blood spots) and the identification of causative mutations in each allele of the TPP1/CLN2 gene. When it is not possible to perform both analyses, either demonstration of a) deficient TPP1 enzyme activity in leukocytes or fibroblasts, or b) detection of two pathogenic mutations in trans is diagnostic for CLN2 disease.
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Affiliation(s)
- Michael Fietz
- Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, Nedlands, Australia
| | - Moeenaldeen AlSayed
- Department of Medical Genetics, Alfaisal University, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Derek Burke
- Chemical Pathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | | | - Jonathan D Cooper
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lenka Dvořáková
- Institute of Inherited Metabolic Disorders, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic
| | - Roberto Giugliani
- Medical Genetics Service, HCPA, Department of Genetics, UFRGS, INAGEMP, Porto Alegre, Brazil
| | | | - Helena Jahnová
- Institute of Inherited Metabolic Disorders, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic
| | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics Unit, Hamburg University Medical Center, Hamburg, Germany
| | - Sara E Mole
- MRC Laboratory for Molecular Cell Biology, UCL Institute of Child Health, University College London, London, UK
| | - Ines Noher de Halac
- Facultad de Ciencias Médicas, Universidad Nacional de Córdoba and National Research Council-CONICET, Córdoba, Argentina
| | - David A Pearce
- Sanford Children's Health Research Center, Sioux Falls, SD, USA
| | - Helena Poupetova
- Institute of Inherited Metabolic Disorders, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic
| | - Angela Schulz
- Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Winnie Xin
- Neurogenetics DNA Diagnostic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Aaberg KM, Bakken IJ, Lossius MI, Lund Søraas C, Håberg SE, Stoltenberg C, Surén P, Chin R. Comorbidity and Childhood Epilepsy: A Nationwide Registry Study. Pediatrics 2016; 138:peds.2016-0921. [PMID: 27482059 DOI: 10.1542/peds.2016-0921] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Children with epilepsy are at increased risk of other disorders and difficulties, preceding, cooccurring with, or after the diagnosis of epilepsy. Risk estimates vary, few studies are population-based, and few provide comprehensive assessments of comorbidities. We used nationwide registry data to describe frequencies of medical, neurologic, developmental, and psychiatric conditions occurring before and after children are diagnosed with childhood epilepsy. METHODS Data were obtained from the Norwegian Patient Registry, which is an administrative database recording International Classification of Diseases, 10th Revision diagnoses from all government-funded specialist health services in Norway (outpatient consultations and hospitalizations). We included data from the years 2008 through 2013 for all children born in Norway between 1996 and 2013 (0-17 years of age at the end of follow-up). Children with epilepsy were compared with the general child population, adjusting for sex and age. We also compared children with complicated epilepsies (ie, epilepsies with additional neurologic and/or developmental disorders) to children with uncomplicated epilepsies. RESULTS The study population included 1 125 161 children. There were 6635 (0.6%) children with epilepsy. Nearly 80% of children with epilepsy had ≥1 comorbid disorder. All types of disorders were more frequent in children with epilepsy, with additional medical disorders recorded in 55%, neurologic disorders in 41%, and developmental/psychiatric disorders in 43%. Children with complicated epilepsies had the highest overall levels of comorbidity, but the risk of medical and psychiatric comorbidities was also substantial among children with uncomplicated epilepsies. CONCLUSIONS The overall frequency of comorbid disease is high in children with epilepsy, including children with presumably uncomplicated epilepsies.
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Affiliation(s)
- Kari Modalsli Aaberg
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway; National Center for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway;
| | | | - Morten I Lossius
- National Center for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Camilla Lund Søraas
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Eldevik Håberg
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Community Care, University of Bergen, Norway; and
| | - Pål Surén
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway; National Center for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Richard Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom
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Ochoa-Gómez L, López-Pisón J, Lapresta Moros C, Fuertes Rodrigo C, Fernando Martínez R, Samper-Villagrasa P, Monge-Galindo L, Peña-Segura JL, García-Jiménez MC. [A study of epilepsy according to the age at onset and monitored for 3 years in a regional reference paediatric neurology unit]. An Pediatr (Barc) 2016; 86:11-19. [PMID: 27291698 DOI: 10.1016/j.anpedi.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/19/2016] [Accepted: 05/05/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE A study of epilepsy, according to the age at onset of the crisis and its causes, monitored by a Paediatric Neurology Unit over a period of three years. PATIENTS AND METHODS Historical cohorts study was conducted by reviewing the Paediatric Neurology medical records data base of epileptic children followed-up from 1 January 2008 to 31 December 2010. RESULTS A total of 4,595 children were attended during the study period. The diagnosis of epilepsy was established in 605 (13.17%): 277 (45.79%) symptomatic, 156 (25.79%) idiopathic, and 172 (28.43%) with cryptogenic epilepsy. Absence epilepsy and benign childhood epilepsy with centro-temporal spikes are the idiopathic epileptic syndromes most prevalent, and the most prevalent symptomatic epilepsies are prenatal encephalopathies. More than one-quarter (26.12%) of epilepsies began in the first year of life, and 67.72% were symptomatic. Refractory epilepsy was observed in 25.29%, 42.46% with cognitive impairment, 26.45% with motor involvement, and 9.92% with an autism spectrum disorder, being more frequent at an earlier age of onset. CONCLUSIONS The absence of a universally accepted classification of epileptic syndromes makes tasks like this difficult, starting with the terminology. A useful classification would be aetiological, with two groups: a large group with established aetiology, or very likely genetic syndromes, and another with no established cause. The age of onset of epilepsy in each aetiological group helps in the prognosis, which is worsened by refractoriness and associated neurodevelopmental disorders, and are generally worse at an earlier onset and in certain aetiologies.
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45
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Sex and Gender Differences in Central Nervous System-Related Disorders. NEUROSCIENCE JOURNAL 2016; 2016:2827090. [PMID: 27314003 PMCID: PMC4904110 DOI: 10.1155/2016/2827090] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/08/2016] [Indexed: 12/12/2022]
Abstract
There are important sex differences in the brain that seem to arise from biology as well as psychosocial influences. Sex differences in several aspects of human behavior and cognition have been reported. Gonadal sex steroids or genes found on sex chromosomes influence sex differences in neuroanatomy, neurochemistry and neuronal structure, and connectivity. There has been some resistance to accept that sex differences in the human brain exist and have biological relevance; however, a few years ago, it has been recommended by the USA National Institute of Mental Health to incorporate sex as a variable in experimental and clinical neurological and psychiatric studies. We here review the clinical literature on sex differences in pain and neurological and psychiatric diseases, with the aim to further stimulate interest in sexual dimorphisms in the brain and brain diseases, possibly encouraging more research in the field of the implications of sex differences for treating these conditions.
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46
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Kim H, Thurman DJ, Durgin T, Faught E, Helmers S. Estimating Epilepsy Incidence and Prevalence in the US Pediatric Population Using Nationwide Health Insurance Claims Data. J Child Neurol 2016; 31:743-9. [PMID: 26719495 DOI: 10.1177/0883073815620676] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/28/2015] [Indexed: 11/17/2022]
Abstract
This study aims to determine prevalence and incidence of epilepsy in the US pediatric population. We analyzed commercial claims and Medicaid insurance claims data between 2008 and 2012. Over 8 million continuously enrolled lives aged 0 to 19 years were included. Our definition of a prevalent case of epilepsy was based on International Classification of Diseases-coded diagnoses of epilepsy or seizures and evidence of prescribed antiepileptic drugs. Incident cases were identified in subjects continuously enrolled for ≥2 years of which the first 2 years had no indication of epilepsy or seizures. The overall prevalence estimate for 2012 was 6.8 per 1,000 children. The overall incidence estimate for 2012 was 104 per 100,000 pediatric population. This study provides estimates of the prevalence and incidence of epilepsy in the US pediatric population, using large claims datasets from multiple US population sectors. The findings appear reasonably representative of the US-insured pediatric population.
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Affiliation(s)
- Hyunmi Kim
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Edward Faught
- Emory University School of Medicine, Atlanta, GA, USA
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Ochoa-Gómez L, López-Pisón J, Fuertes-Rodrigo C, Fernando-Martínez R, Samper-Villagrasa P, Monge-Galindo L, Peña-Segura JL, García-Jiménez MC. Descriptive study of symptomatic epilepsy by age of onset in patients with a 3-year follow-up at the Neuropaediatric Department of a reference centre. Neurologia 2016; 32:455-462. [PMID: 27091679 DOI: 10.1016/j.nrl.2016.02.010] [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: 10/24/2015] [Revised: 02/01/2016] [Accepted: 02/25/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We conducted a descriptive study of symptomatic epilepsy by age at onset in a cohort of patients who were followed up at a neuropaediatric department of a reference hospital over a 3-year period PATIENTS AND METHODS: We included all children with epilepsy who were followed up from January 1, 2008 to December 31, 2010 RESULTS: Of the 4595 children seen during the study period, 605 (13.17%) were diagnosed with epilepsy; 277 (45.79%) of these had symptomatic epilepsy. Symptomatic epilepsy accounted for 67.72% and 61.39% of all epilepsies starting before one year of age, or between the ages of one and 3, respectively. The aetiologies of symptomatic epilepsy in our sample were: prenatal encephalopathies (24.46% of all epileptic patients), perinatal encephalopathies (9.26%), post-natal encephalopathies (3.14%), metabolic and degenerative encephalopathies (1.98%), mesial temporal sclerosis (1.32%), neurocutaneous syndromes (2.64%), vascular malformations (0.17%), cavernomas (0.17%), and intracranial tumours (2.48%). In some aetiologies, seizures begin before the age of one; these include Down syndrome, genetic lissencephaly, congenital cytomegalovirus infection, hypoxic-ischaemic encephalopathy, metabolic encephalopathies, and tuberous sclerosis. CONCLUSIONS The lack of a universally accepted classification of epileptic syndromes makes it difficult to compare series from different studies. We suggest that all epilepsies are symptomatic because they have a cause, whether genetic or acquired. The age of onset may point to specific aetiologies. Classifying epilepsy by aetiology might be a useful approach. We could establish 2 groups: a large group including epileptic syndromes with known aetiologies or associated with genetic syndromes which are very likely to cause epilepsy, and another group including epileptic syndromes with no known cause. Thanks to the advances in neuroimaging and genetics, the latter group is expected to become increasingly smaller.
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Affiliation(s)
- L Ochoa-Gómez
- Unidad de Neuropediatría, Hospital Miguel Servet, Zaragoza, España
| | - J López-Pisón
- Unidad de Neuropediatría, Hospital Miguel Servet, Zaragoza, España.
| | | | | | | | - L Monge-Galindo
- Unidad de Neuropediatría, Hospital Miguel Servet, Zaragoza, España
| | - J L Peña-Segura
- Unidad de Neuropediatría, Hospital Miguel Servet, Zaragoza, España
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Behr C, Goltzene MA, Kosmalski G, Hirsch E, Ryvlin P. Epidemiology of epilepsy. Rev Neurol (Paris) 2016; 172:27-36. [PMID: 26754036 DOI: 10.1016/j.neurol.2015.11.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 12/25/2022]
Abstract
Epilepsy is a burden affecting no fewer than 50 million patients worldwide. It is a heterogeneous group of disorders comprising both common and very rare forms, thus rendering its epidemiological investigations rather difficult. Moreover, making an epilepsy diagnosis per se can be challenging due to an evolving system of classification, and its dependency on local habits and culture. Any attempt at meta-analyses must consider such biases when pooling data from different centers and countries. Differentiating a contextual seizure from chronic epilepsy is every epileptologist's daily mission, yet it is also crucial for achieving a proper estimation of the epidemiology of epilepsy. Our present objective was to provide an overview of the epidemiology of both syndromic and non-syndromic epilepsy. Most epileptic syndromes tend to be rare and, thus, the feasibility of epidemiological quantification in populations is also addressed. Regarding its prevalence and cost, epilepsy deserves greater attention than it generally receives, as it appears to continue to be a condition under persistent taboos.
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Affiliation(s)
- C Behr
- Department of neurology, university hospital of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
| | - M A Goltzene
- Department of neurology, university hospital of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - G Kosmalski
- Department of pharmacology, university hospital of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - E Hirsch
- Department of neurology, university hospital of Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - P Ryvlin
- Department of clinical neurosciences, CHUV, champ de l'Air, 21, rue du Bugnon, 1011 Lausanne, Switzerland
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Kverneland M, Selmer KK, Nakken KO, Iversen PO, Taubøll E. A prospective study of the modified Atkins diet for adults with idiopathic generalized epilepsy. Epilepsy Behav 2015; 53:197-201. [PMID: 26588588 DOI: 10.1016/j.yebeh.2015.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 01/23/2023]
Abstract
For children with pharmacoresistant epilepsy, the ketogenic diet is an established treatment option worldwide. However, for adults, this treatment is less frequently offered, and its efficacy less well-documented. The aim of this study was to examine efficacy and tolerability of such a diet as an adjuvant therapy to antiepileptic drugs for adult patients with pharmacoresistant generalized epilepsy. Thirteen patients (12 women) aged 16-57 years were included prospectively. They were treated with a modified Atkins diet for 12 weeks. Nine of the 13 participants had juvenile myoclonic epilepsy (JME), two had childhood absence epilepsy, one had Jeavons syndrome, and one had generalized epilepsy of unknown type. Six participants, all with JME, completed the 12-week study period. Among these six, four had >50% seizure reduction. Their seizure severity, using the revised Liverpool Seizure Severity Scale, was reduced by 1, 5, 57.5, and 70 points, respectively (scale: 1-100 points). In three of these four responders, quality of life, assessed by QOLIE-89, increased more than 20 points (scale: 0-100 points). Mean reduction of body weight after 12 weeks on diet was 6.5 (range: 4.3-8.1) kg. Lack of motivation, poor compliance, and seizure aggravation were the main reasons for premature termination of the diet. Apart from one patient who developed gallstones when ending the treatment after 10 months, no adverse effects were noted. In conclusion, using a modified Atkins diet for 12 weeks led to a clinically relevant reduction of seizure frequency in four of thirteen adult patients with pharmacoresistant generalized epilepsy. All responders were diagnosed with JME. In three of the four, the benefits of diet were so considerable that they chose to continue the treatment.
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Affiliation(s)
| | - Kaja K Selmer
- Department of Medical Genetics, University of Oslo, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karl O Nakken
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Per O Iversen
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nutrition, University of Oslo, Oslo, Norway
| | - Erik Taubøll
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway
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50
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Benson A, O'Toole S, Lambert V, Gallagher P, Shahwan A, Austin JK. To tell or not to tell: A systematic review of the disclosure practices of children living with epilepsy and their parents. Epilepsy Behav 2015; 51:73-95. [PMID: 26262936 DOI: 10.1016/j.yebeh.2015.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 11/18/2022]
Abstract
Disclosing an epilepsy diagnosis to others is complex due to the condition's largely invisible nature and associated stigma. Despite this, little has been documented in terms of what this process involves for children living with epilepsy (CWE) and their parents. A systematic review was conducted to examine and synthesize evidence pertaining to: (i) the disclosure practices of CWE and their parents, (ii) enablers and barriers for disclosure, (iii) the impact of disclosure practices, and (iv) the relationship between disclosure management and other variables. The electronic databases PsycINFO, PubMed, MEDLINE, CINAHL, Scopus, and Web of Science were searched systematically. Any empirical, peer-reviewed journal articles with findings reported regarding the self- or proxy-reported disclosure practices of children aged 0-18years with any type of epilepsy and/or their parents were deemed eligible for inclusion. Two review authors completed all stages of screening, data extraction, and quality assessment independently with two additional review authors resolving any discrepancies. A total of 32 articles were included in the review. Only one dated study examined disclosure as a primary focus; in the remaining studies, disclosure was a subfocus of larger studies or pertinent qualitative themes/subthemes incidentally emerged. The limited evidence suggests that: 1) CWE and parents adopt varying disclosure management strategies - from concealment to voluntary disclosure; 2) disclosure decisions are challenging for CWE and parents; 3) many barriers to disclosure exist (e.g., fear of stigmatization and rejection); 4) only a limited number of factors that enable disclosure are known (e.g., openness by others to engage with and learn about epilepsy); 5) disclosure management is significantly related to a number of variables (e.g., child/maternal perceived stigma and seizure control); and 6) there are varying outcomes for CWE and/or their parents in accordance with the adoption of specific disclosure management strategies (e.g., disclosure resulting in greater acceptance and the receipt of support or evoking anxiety/fear in others; and concealment resulting in misunderstandings, embarrassment, and stigma-coaching), but the evidence remains inconclusive in terms of which disclosure management strategy is optimal. While some preliminary work has been conducted, disclosure of epilepsy is a topic that has been largely neglected to date. This is despite the fact that disclosure is a significant source of concern for CWE and parent populations. Future studies should focus on elucidating the unique contextual factors that inform disclosure decisions in order to develop a theoretical framework that can explain the epilepsy disclosure decision-making process.
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Affiliation(s)
- A Benson
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - S O'Toole
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - V Lambert
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland.
| | - P Gallagher
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - A Shahwan
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - J K Austin
- Indiana University School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
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