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Ellis CA, Tu D, Oliver KL, Mefford HC, Hauser WA, Buchhalter J, Epstein MP, Cao Q, Berkovic SF, Ottman R. Familial aggregation of seizure outcomes in four familial epilepsy cohorts. Epilepsia 2024. [PMID: 38738647 DOI: 10.1111/epi.18004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To assess the possible effects of genetics on seizure outcome by estimating the familial aggregation of three outcome measures: seizure remission, history of ≥4 tonic-clonic seizures, and seizure control for individuals taking antiseizure medication. METHODS We analyzed families containing multiple persons with epilepsy in four previously collected retrospective cohorts. Seizure remission was defined as being 5 and 10 years seizure-free at last observation. Total number of tonic-clonic seizures was dichotomized at <4 and ≥4 seizures. Seizure control in patients taking antiseizure medication was defined as no seizures for 1, 2, and 3 years. We used Bayesian generalized linear mixed-effects model (GLMM) to estimate the intraclass correlation coefficient (ICC) of the family-specific random effect, controlling for epilepsy type, age at epilepsy onset, and age at last data collection as fixed effects. We analyzed each cohort separately and performed meta-analysis using GLMMs. RESULTS The combined cohorts included 3644 individuals with epilepsy from 1463 families. A history of ≥4 tonic-clonic seizures showed strong familial aggregation in three separate cohorts and meta-analysis (ICC .28, 95% confidence interval [CI] .21-.35, Bayes factor 8 × 1016). Meta-analyses did not reveal significant familial aggregation of seizure remission (ICC .08, 95% CI .01-.17, Bayes factor 1.46) or seizure control for individuals taking antiseizure medication (ICC .13, 95% CI 0-.35, Bayes factor 0.94), with heterogeneity among cohorts. SIGNIFICANCE A history of ≥4 tonic-clonic seizures aggregated strongly in families, suggesting a genetic influence, whereas seizure remission and seizure control for individuals taking antiseizure medications did not aggregate consistently in families. Different seizure outcomes may have different underlying biology and risk factors. These findings should inform the future molecular genetic studies of seizure outcomes.
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Affiliation(s)
- Colin A Ellis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Danni Tu
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen L Oliver
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Heather C Mefford
- Department of Cell and Molecular Biology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - W Allen Hauser
- Department of Neurology and Epidemiology, and the Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Michael P Epstein
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Quy Cao
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel F Berkovic
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Ruth Ottman
- Department of Neurology and Epidemiology, and the Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
- Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, New York, USA
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Ménétré E, De Stefano P, Megevand P, Sarasin FP, Vargas MI, Kleinschmidt A, Vulliemoz S, Picard F, Seeck M. Antiseizure medication ≤48 hours portends better prognosis in new-onset epilepsy. Eur J Neurol 2024; 31:e16107. [PMID: 37889889 DOI: 10.1111/ene.16107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/28/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Several studies found that patients with new-onset epilepsy (NOE) have higher seizure recurrence rates if they presented already prior seizures. These observations suggest that timing of antiseizure medication (ASM) is crucial and should be offered immediately after the first seizure. Here, we wanted to assess whether immediate ASM is associated with improved outcome. METHODS Single-center study of 1010 patients (≥16 years) who presented with a possible first seizure in the emergency department between 1 March 2010 and 1 March 2017. A comprehensive workup was launched upon arrival, including routine electroencephalography (EEG), brain computed tomography/magnetic resonance imaging, long-term overnight EEG and specialized consultations. We followed patients for 5 years comparing the relapse rate in patients treated within 48 h to those with treatment >48 h. RESULTS A total of 487 patients were diagnosed with NOE. Of the 416 patients (162 female, age: 54.6 ± 21.1 years) for whom the treatment start could be retrieved, 80% (333/416) were treated within 48 h. The recurrence rate after immediate treatment (32%; 107/333) was significantly lower than in patients treated later (56.6%; 47/83; p < 0.001). For patients for whom a complete 5-year-follow-up was available (N = 297, 123 female), those treated ≤48 h (N = 228; 76.8%) had a significantly higher chance of remaining seizure-free compared with patients treated later (N = 69; 23.2%; p < 0.001). CONCLUSIONS In this retrospective study, immediate ASM therapy (i.e., within 48 h) was associated with better prognosis up to 5 years after the index event. Prospective studies are required to determine the value of immediate workup and drug therapy in NOE patients.
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Affiliation(s)
- Eric Ménétré
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Pia De Stefano
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
- Neuro-Critical Care Unit, Department of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Megevand
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - François P Sarasin
- Division of Emergency Medicine, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Maria I Vargas
- Neuroradiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Andreas Kleinschmidt
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Picard
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
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Xie K, Gallagher RS, Shinohara RT, Xie SX, Hill CE, Conrad EC, Davis KA, Roth D, Litt B, Ellis CA. Long-term epilepsy outcome dynamics revealed by natural language processing of clinic notes. Epilepsia 2023; 64:1900-1909. [PMID: 37114472 PMCID: PMC10523917 DOI: 10.1111/epi.17633] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Electronic medical records allow for retrospective clinical research with large patient cohorts. However, epilepsy outcomes are often contained in free text notes that are difficult to mine. We recently developed and validated novel natural language processing (NLP) algorithms to automatically extract key epilepsy outcome measures from clinic notes. In this study, we assessed the feasibility of extracting these measures to study the natural history of epilepsy at our center. METHODS We applied our previously validated NLP algorithms to extract seizure freedom, seizure frequency, and date of most recent seizure from outpatient visits at our epilepsy center from 2010 to 2022. We examined the dynamics of seizure outcomes over time using Markov model-based probability and Kaplan-Meier analyses. RESULTS Performance of our algorithms on classifying seizure freedom was comparable to that of human reviewers (algorithm F1 = .88 vs. human annotatorκ = .86). We extracted seizure outcome data from 55 630 clinic notes from 9510 unique patients written by 53 unique authors. Of these, 30% were classified as seizure-free since the last visit, 48% of non-seizure-free visits contained a quantifiable seizure frequency, and 47% of all visits contained the date of most recent seizure occurrence. Among patients with at least five visits, the probabilities of seizure freedom at the next visit ranged from 12% to 80% in patients having seizures or seizure-free at the prior three visits, respectively. Only 25% of patients who were seizure-free for 6 months remained seizure-free after 10 years. SIGNIFICANCE Our findings demonstrate that epilepsy outcome measures can be extracted accurately from unstructured clinical note text using NLP. At our tertiary center, the disease course often followed a remitting and relapsing pattern. This method represents a powerful new tool for clinical research with many potential uses and extensions to other clinical questions.
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Affiliation(s)
- Kevin Xie
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ryan S. Gallagher
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Russell T. Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Chloe E. Hill
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Erin C. Conrad
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kathryn A. Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dan Roth
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Colin A. Ellis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Perucca E, Perucca P, White HS, Wirrell EC. Drug resistance in epilepsy. Lancet Neurol 2023:S1474-4422(23)00151-5. [PMID: 37352888 DOI: 10.1016/s1474-4422(23)00151-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 06/25/2023]
Abstract
Drug resistance is estimated to affect about a third of individuals with epilepsy, but its prevalence differs in relation to the epilepsy syndrome, the cause of epilepsy, and other factors such as age of seizure onset and presence of associated neurological deficits. Although drug-resistant epilepsy is not synonymous with unresponsiveness to any drug treatment, the probability of achieving seizure freedom on a newly tried medication decreases with increasing number of previously failed treatments. After two appropriately used antiseizure medications have failed to control seizures, individuals should be referred whenever possible to a comprehensive epilepsy centre for diagnostic re-evaluation and targeted management. The feasibility of epilepsy surgery and other treatments, including those targeting the cause of epilepsy, should be considered early after diagnosis. Substantial evidence indicates that a delay in identifying an effective treatment can adversely affect ultimate outcome and carry an increased risk of cognitive disability, other comorbidities, and premature mortality. Research on mechanisms of drug resistance and novel therapeutics is progressing rapidly, and potentially improved treatments, including those targeting disease modification, are on the horizon.
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Affiliation(s)
- Emilio Perucca
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Piero Perucca
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Tabaee Damavandi P, Storti B, Fabin N, Bianchi E, Ferrarese C, DiFrancesco JC. Epilepsy in cerebral amyloid angiopathy: an observational retrospective study of a large population. Epilepsia 2023; 64:500-510. [PMID: 36515439 DOI: 10.1111/epi.17489] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cerebral amyloid angiopathy (CAA) is a major cause of spontaneous intracranial hemorrhage in older adults. Epilepsy represents a possible sequela of the disease. To date, studies on epilepsy in CAA are lacking, and the few data available mainly focus on CAA-related inflammation (CAA-ri), the inflammatory form of the disease. METHODS In this retrospective observational study, we consecutively recruited CAA patients observed over a time span of 10 years, collecting demographic, clinical, and instrumental data. Significant baseline characteristics were evaluated as potential risk factors for the development of epilepsy in the CAA population, and in the subgroups of CAA-ri and CAA without inflammatory reaction (CAA-nri). The effect of potential risk factors for epilepsy was measured as odds ratio with 95% confidence interval. RESULTS Within 96 recruited CAA cases, 33 (34.4%) developed epilepsy during follow-up (median = 13.5 months). The prevalent type of seizure was focal (81.3%); 12.1% of the epileptic patients presented status epilepticus, and 6.1% developed drug-resistant epilepsy. Electroencephalographic traces revealed slow and epileptic discharge activity in the majority of epileptic patients, but also in those without epilepsy. The presence of focal or disseminated cortical superficial siderosis (cSS) was associated with an increased risk of epilepsy in the CAA-nri group, and the association with CAA-ri and epilepsy was present in the overall population. SIGNIFICANCE Epilepsy is a common manifestation during the course of CAA, where CAA-ri and cSS represent predisposing factors for the development of seizures. These data suggest the importance of a deep characterization of CAA patients, to better select those more prone to develop epilepsy.
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Affiliation(s)
- Payam Tabaee Damavandi
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Benedetta Storti
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Natalia Fabin
- Laboratory of Epidemiological and Clinical Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Elisa Bianchi
- Neurological Disorders, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
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Janmohamed M, Hakeem H, Ooi S, Hakami S, Vu L, Perucca P, O'Brien TJ, Antonic-Baker A, Chen Z, Kwan P. Treatment Outcomes of Newly Diagnosed Epilepsy: A Systematic Review and Meta-analysis. CNS Drugs 2023; 37:13-30. [PMID: 36542274 DOI: 10.1007/s40263-022-00979-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding the multi-faceted treatment outcomes of newly diagnosed epilepsy is critical for developing rational therapeutic strategies. A meta-analysis was conducted to derive pooled estimates of a range of seizure outcomes in children and adults with newly diagnosed epilepsy commenced on antiseizure medication treatment, and to identify factors associated with different outcomes. METHODS PubMed/EMBASE were screened for eligible articles between 1 January, 1995 and 1 May, 2021 to include unselected cohort studies with a ≥ 12-month follow-up of seizure outcomes. Proportions of patients seizure free at different follow-up timepoints and their characteristics at the study population level were extracted. The patients were group-wise aggregated using a random-effects model. Primary outcomes were proportions of patients with cumulative 1-year seizure freedom (C1YSF), and 1-year and 5-year terminal seizure freedom (T1YSF and T5YSF). Secondary outcomes included the proportions of patients with early sustained seizure freedom, drug-resistant epilepsy and seizure-free off antiseizure medication at the last follow-up (off antiseizure medications). A separate random-effects meta-analysis was performed for nine predictors of importance. RESULTS In total, 39 cohorts (total n = 21,139) met eligibility criteria. They included 15 predominantly adult cohorts (n = 12,024), 19 children (n = 6569), and 5 of mixed-age groups (n = 2546). The pooled C1YSF was 79% (95% confidence interval [CI] 74-83). T1YSF was 68% (95% CI 63-72) and T5YSF was 69% (95% CI 62-75). Children had higher C1YSF (85% vs 68%, p < 0.001) and T1YSF than adult cohorts (74% vs 61%, p = 0.007). For secondary outcomes, 33% (95% CI 27-39) of patients achieved early sustained seizure freedom, 17% (95% CI 13-21) developed drug resistance, and 39% (95% CI 30-50) were off antiseizure medications at the last follow-up. Studies with a longer follow-up duration correlated with higher C1YSF (p < 0.001) and being off antiseizure medications (p = 0.045). Outcomes were not associated with study design (prospective vs retrospective), cohort size, publication year, or the earliest date of recruitment. Predictors of importance in newly diagnosed epilepsy include etiology, epilepsy type, abnormal diagnostics (neuroimaging, examination, and electroencephalogram findings), number of seizure types, and pre-treatment seizure burden. CONCLUSIONS Seizure freedom is achieved with currently available antiseizure medications in most patients with newly diagnosed epilepsy, yet this is often not immediate, may not be sustainable, and has not improved over recent decades. Symptomatic etiology, abnormal neuro-diagnostics, and increased pre-treatment seizure burden and seizure types are important predictors for unfavorable outcomes in newly diagnosed epilepsy. The study findings may be used as a quantitative benchmark on the efficacy of future antiseizure medication therapy for this patient population.
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Affiliation(s)
- Mubeen Janmohamed
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.
| | - Haris Hakeem
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Suyi Ooi
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Suhailah Hakami
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Lily Vu
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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Holtkamp M, Krämer G. Antiepileptic pharmacotherapy in old age: evidence-based approach versus clinical routine – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Quiroga-Padilla PJ, Briceño C, Mayor LC. Effect of the modified Atkins diet in adults with drug-resistant epilepsy: A controlled study. Epilepsy Behav 2022; 136:108936. [PMID: 36215831 DOI: 10.1016/j.yebeh.2022.108936] [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: 06/28/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 12/14/2022]
Abstract
The objective of this study was to be a proof of concept of an analysis strategy to assess the effectiveness of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE). This retrospective cohort study included participants aged >16 years with at least two failed antiseizure medications (ASMs). The variables were self-reported and gathered from medical records or phone calls. Two groups are compared: MAD adjuvant to ASM (diet group) and ASM only (control). To make both groups comparable, diet and control groups were matched (1:2) by predictors of seizure remission (PSR) in adults with DRE. A systematic review of the literature was conducted to establish PSR. A total of 127 patients were eligible. Forty-six participants (36 %) initiated the MAD, but only 28 (22 %) continued the diet after 3 months. The number of past and new ASMs, epilepsy type, and follow-up time were selected as PSR. Twelve patients were included in the diet group and 24 in the control group, matched by PSR. Compared with the control group, the diet group had 4.5 greater odds of achieving ≥50 % seizure frequency reduction at 1-3 months (OR 5.5; 90 % confidence interval 1.1-26.65). Mean seizure frequency and other secondary outcomes did not differ significantly between the groups. In summary, the MAD showed a modest effect over seizure control compared with only ASM. Matching by PSR could be an alternative analysis approach to determine the effectiveness of the ketogenic diet in controlled studies. Additional studies are required to validate the analysis proposed.
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Affiliation(s)
- Pedro J Quiroga-Padilla
- Diabetes, Lipids and Metabolism Laboratory, Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
| | - Claudia Briceño
- Department of Nutrition, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia
| | - Luis C Mayor
- Epilepsy Clinic, Department of Neurology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia; Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
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Zinchuk M, Kustov G, Pashnin E, Gersamia A, Rider F, Voinova N, Popova S, Sviatskaia E, Yakovlev A, Guekht A. Not always that EASI: Validating the Russian version of the epilepsy anxiety survey instrument and its brief counterpart. Epilepsy Behav 2022; 133:108801. [PMID: 35753109 DOI: 10.1016/j.yebeh.2022.108801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop a Russian version of The Epilepsy Anxiety Survey Instrument (EASI) and assess its psychometric properties in a Russian sample of patients with epilepsy (PWE). To compare the brief version of EASI with the General Anxiety Disorder-7 (GAD-7) - the most common tool for a rapid anxiety screening. METHODS The study sample consisted of 181 consecutive Russian-speaking PWE. The Mini-International Neuropsychiatric Interview was used as a gold standard for diagnosing anxiety disorders. All patients completed the set of questionnaires - the Russian version of the GAD-7, The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and the EASI. Internal reliability of the EASI and brEASI, convergent and divergent validity of the brEASI with the GAD-7 and the NDDI-E, and factor structure assessment were performed. RESULTS Among 33.7% of patients with epilepsy diagnosed with any anxiety disorder, 16% had panic disorder, 10.5% had agoraphobia, 8.3% had social anxiety disorder, 21.0% had generalized anxiety disorder, and 13.3% had several comorbid anxiety disorders. The EASI factor structure differed from the original, revealing an additional factor with two items. Nevertheless, the brief version (brEASI) showed excellent screening properties - the AUC to detect any anxiety disorder was 0.916 with the optimal cutoff point > 7 points. CONCLUSION The brEASI performed better than the GAD-7 in our sample and, therefore, may be considered a first-line screening tool for anxiety disorders in PWE.
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Affiliation(s)
- Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation.
| | - Georgii Kustov
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Evgenii Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Anna Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Flora Rider
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Nadezhda Voinova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Sophia Popova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Ekaterina Sviatskaia
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Alexander Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova ul., 5A, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Ostrovitianova ul., 1, Moscow, Russian Federation
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Cerulli Irelli E, Barone FA, Mari L, Morano A, Orlando B, Salamone EM, Marchi A, Fanella M, Fattouch J, Placidi F, Giallonardo AT, Izzi F, Di Bonaventura C. Generalized Fast Discharges Along the Genetic Generalized Epilepsy Spectrum: Clinical and Prognostic Significance. Front Neurol 2022; 13:844674. [PMID: 35356452 PMCID: PMC8960043 DOI: 10.3389/fneur.2022.844674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the electroclinical characteristics and the prognostic impact of generalized fast discharges in a large cohort of genetic generalized epilepsy (GGE) patients studied with 24-h prolonged ambulatory electroencephalography (paEEG). Methods This retrospective multicenter cohort study included 202 GGE patients. The occurrence of generalized paroxysmal fast activity (GPFA) and generalized polyspike train (GPT) was reviewed. GGE patients were classified as having idiopathic generalized epilepsy (IGE) or another GGE syndrome (namely perioral myoclonia with absences, eyelid myoclonia with absences, epilepsy with myoclonic absences, generalized epilepsy with febrile seizures plus, or GGE without a specific epilepsy syndrome) according to recent classification proposals. Results GPFA/GPT was found in overall 25 (12.4%) patients, though it was significantly less frequent in IGE compared with other GGE syndromes (9.3 vs. 25%, p = 0.007). GPFA/GPT was found independently of seizure type experienced during history, the presence of mild intellectual disability/borderline intellectual functioning, or EEG features. At multivariable analysis, GPFA/GPT was significantly associated with drug resistance (p = 0.04) and with a higher number of antiseizure medications (ASMs) at the time of paEEG (p < 0.001) and at the last medical observation (p < 0.001). Similarly, GPFA/GPT, frequent/abundant generalized spike-wave discharges during sleep, and a higher number of seizure types during history were the only factors independently associated with a lower chance of achieving 2-year seizure remission at the last medical observation. Additionally, a greater number of GPFA/GPT discharges significantly discriminated between patients who achieved 2-year seizure remission at the last medical observation and those who did not (area under the curve = 0.77, 95% confidence interval 0.57–0.97, p = 0.02) Conclusion We found that generalized fast discharges were more common than expected in GGE patients when considering the entire GGE spectrum. In addition, our study highlighted that GPFA/GPT could be found along the entire GGE continuum, though their occurrence was more common in less benign GGE syndromes. Finally, we confirmed that GPFA/GPT was associated with difficult-to-treat GGE, as evidenced by the multivariable analysis and the higher ASM load during history.
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Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | | | - Luisa Mari
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Biagio Orlando
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Enrico Michele Salamone
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Angela Marchi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Jinane Fattouch
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Fabio Placidi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Francesca Izzi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
- *Correspondence: Carlo Di Bonaventura
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Genetic generalized epilepsies in adults - challenging assumptions and dogmas. Nat Rev Neurol 2022; 18:71-83. [PMID: 34837042 DOI: 10.1038/s41582-021-00583-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/16/2023]
Abstract
Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15-20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizures alone. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Nevertheless, long-term follow-up studies have shown that with advancing age, many patients can discontinue their anti-seizure medication without seizure relapses. Several outcome predictors have been identified, but prognosis across the syndromes is more homogeneous than previously assumed. Overall, overlap in pathophysiology, seizure types, treatment responses and outcomes support the idea that GGEs are not separate nosological entities but represent a neurobiological continuum.
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12
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Wang NC, Kaplan J, Lee J, Hodgin J, Udager A, Rao A. Stress Testing Pathology Models with Generated Artifacts. J Pathol Inform 2021; 12:54. [PMID: 35070483 PMCID: PMC8721870 DOI: 10.4103/jpi.jpi_6_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Machine learning models provide significant opportunities for improvement in health care, but their "black-box" nature poses many risks. METHODS We built a custom Python module as part of a framework for generating artifacts that are meant to be tunable and describable to allow for future testing needs. We conducted an analysis of a previously published digital pathology classification model and an internally developed kidney tissue segmentation model, utilizing a variety of generated artifacts including testing their effects. The artifacts simulated were bubbles, tissue folds, uneven illumination, marker lines, uneven sectioning, altered staining, and tissue tears. RESULTS We found that there is some performance degradation on the tiles with artifacts, particularly with altered stains but also with marker lines, tissue folds, and uneven sectioning. We also found that the response of deep learning models to artifacts could be nonlinear. CONCLUSIONS Generated artifacts can provide a useful tool for testing and building trust in machine learning models by understanding where these models might fail.
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Affiliation(s)
- Nicholas Chandler Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy Kaplan
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Joonsang Lee
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Hodgin
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Aaron Udager
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
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High rates of early remission pattern in adult-onset compared with earlier-onset idiopathic generalized epilepsy: A long-term follow-up study. Seizure 2021; 94:52-56. [PMID: 34864252 DOI: 10.1016/j.seizure.2021.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate electroclinical characteristics and prognostic patterns of adult-onset vs. younger-onset idiopathic generalized epilepsy (IGE) patients during long-term follow-up. METHODS In this single-center retrospective cohort comparative study, adult-onset IGE was defined as onset after 20 years of age. Patients with a follow-up duration between 10 and 30 years from epilepsy diagnosis were enrolled. Maximum follow-up duration was limited to 30 years to ensure a better comparison of prognostic data between adult-onset and younger-onset patients. The Benjamini-Hochberg false discovery rate (FDR) method was applied to obtain FDR-adjusted p-values. RESULTS A total of 177 IGE patients were recruited and 27 adult-onset IGE patients were identified (15.3%). Follow-up duration was similar between younger- and adult-onset IGE patients and 74% of subjects performed at least one 24-hour EEG recording. Of adult-onset IGE patients, 8/27 were diagnosed with juvenile myoclonic epilepsy, while 19/27 were diagnosed with generalized tonic-clonic seizures (GTCS) only. EEG photosensitivity and absence seizures were significantly less frequent among adult-onset IGE patients as compared with younger subjects. When considering prognostic patterns, an early remission pattern was significantly higher among adult-onset IGE patients as compared with younger-onset IGE patients (55.6% vs. 24%, adjusted p value = 0.007). Antiseizure medication withdrawal was attempted in 3/27 adult-onset patients, and all had GTCS relapses. CONCLUSION Our study contributes to better defining the electroclinical characteristics and long-term follow-up of adult-onset IGE patients. A favorable long-term seizure outcome was found in adult-onset IGE patients, as evidenced by the high rates of early remission pattern when compared with younger onset patients.
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14
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The long-term prognosis and predictors of epilepsy: a retrospective study in 820 patients. ACTA EPILEPTOLOGICA 2021. [DOI: 10.1186/s42494-021-00060-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To investigate the prognosis and predictors for seizure control in epileptic patients in China.
Methods
Eight hundred and twenty patients with epilepsy who visited Xuanwu Hospital from October 2017 to January 2020, were enrolled. The clinical information of the patients was obtained by retrospectively reviewing medical records. Prognostic measures of seizure control included remission, relapse and occurrence of drug resistance. The relationship of prognosis of seizure control with factors such as demographics, clinical characteristics and initial electroencephalography (EEG) features was investigated.
Results
A total of 503 (61.3%) patients experienced a 1-year remission and 330 (49.3% of 669) had a 2-year remission. Idiopathic type of epilepsy (P < 0.001), normal EEG (P < 0.05), number of antiepileptic drugs (P < 0.05) and seizure frequency of < 1 /month (P < 0.001) at the first arrival predicted a remission independently. Of the 503 patients who achieved a 1-year remission, 184 (36.6%) experienced a relapse, due to external reversible causes (58 patients) or with unknown reversible triggers (126 patients). No factors were found to be associated with a relapse (P > 0.05). At the end of the study, 322 patients (39.3%) developed drug resistance. The development of drug resistance was associated with the following factors: symptomatic aetiology of epilepsy, epileptiform abnormality in EEG, number of antiepileptic drugs and seizure frequency of ≥1 /month at first arrival (P < 0.001). For symptomatic epilepsy, patients with meningitis/encephalitis (P = 0.007) were more likely to develop drug-resistant epilepsy than these with other causes.
Conclusions
Remission is a common process. The type of epilepsy (idiopathic or symptomatic), EEG features, seizure frequency and treatment history at first arrival are related to both remission and terminal drug resistance. Among various causes of symptomatic epilepsy, meningitis/encephalitis is associated with the worst prognosis of epilepsy.
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15
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Giussani G, Bianchi E, Beretta S, Carone D, DiFrancesco JC, Stabile A, Zanchi C, Pirovano M, Trentini C, Padovano G, Colombo M, Cereda D, Tinti L, Scanziani S, Gasparini S, Bogliun G, Ferrarese C, Beghi E. Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome. Epilepsia 2021; 62:2395-2404. [PMID: 34309011 DOI: 10.1111/epi.17022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/22/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome. METHODS This cohort study was performed in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10 years. Two pairs of raters independently reviewed patients' records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing-remitting course, no remission). RESULTS Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsing-remitting course, and 4.8% of patients with sustained remission (p = .016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p = .013); for respiratory diseases were 3.6%, .3%, and .3% (p = .001), and for urogenital diseases were 3.6%, .7%, and 1.6% (p = .048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and clinical variables, with patients with these comorbidities showing a lower probability of achieving remission. SIGNIFICANCE Comorbidities in epilepsy are not uncommon and reflect differing underlying mechanisms. Psychiatric, endocrine/metabolic, and respiratory disorders are associated with a worse long-term epileptological outcome.
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Affiliation(s)
- Giorgia Giussani
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Simone Beretta
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Davide Carone
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Jacopo C DiFrancesco
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Andrea Stabile
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Clara Zanchi
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Marta Pirovano
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Claudia Trentini
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Giada Padovano
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Matteo Colombo
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Diletta Cereda
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Lorenzo Tinti
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Sofia Scanziani
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Sara Gasparini
- Medical and Surgical Sciences Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Graziella Bogliun
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Carlo Ferrarese
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Beghi E. Does diagnostic delay impact on the outcome of epilepsy? Epilepsia Open 2021. [PMCID: PMC8408596 DOI: 10.1002/epi4.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ettore Beghi
- Department of Neuroscience Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy
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17
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Beghi E, Beretta S, Colombo M, Bianchi E, Carone D, Zanchi C, Tinti L, Pirovano M, Trentini C, Padovano G, Cereda D, Scanziani S, Giussani G, Gasparini S, Bogliun G, Ferrarese C. Discontinuation of antiseizure medications in seizure-free patients with long-term follow-up: Patients' profile, seizure recurrence, and risk factors. Epilepsy Behav 2021; 117:107871. [PMID: 33690066 DOI: 10.1016/j.yebeh.2021.107871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare withdrawal of antiseizure medications (ASM) to continued treatment in newly diagnosed individuals achieving seizure freedom, and assess the risk of relapse and factors associated with relapse. METHODS This is a multicenter retrospective cohort study with long-term follow-up. Patients with newly diagnosed epilepsy were identified from the medical records of 13 Italian epilepsy centers and followed up until the most recent visit or death. Seizure-free patients discontinuing treatment were compared to patients who maintained treatment for baseline characteristics. Treatment was stopped upon clinical judgment. The probability of relapse was calculated with the Kaplan-Meier method. Demographic, clinical, and instrumental variables associated with relapse were assessed with Cox proportional hazards models. RESULTS One thousand and six patients aged 1 month to 72 years at diagnosis were enrolled and followed up for 17,892 person-years (median follow-up, 9.9 years). Three hundred and twenty patients (31.8%) underwent one or more treatment discontinuations. Factors associated with ASM withdrawal were younger age at remission and normal psychiatric examination. The probability of relapse after the first withdrawal was 16% at six months, 24% at 12 months, and 36%, 45%, and 53% at three, five, and ten years, respectively. The probability of remission after the first relapse was 59% at one month, 67%, 72, and 76% at three, six, and 12 months, respectively. Variables associated with relapse were age 14+ years, structural etiology, abnormal neuroimaging, ASM initiation after a single seizure, and symptomatic/cryptogenic epilepsy. CONCLUSIONS About one half of seizure-free patients stopping ASM relapse in 10 years. However, the possibility of remission after relapse is high, particularly in children and patients with idiopathic/cryptogenic epilepsy. Treatment deprescription might be encouraged at least in these patients.
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Affiliation(s)
- Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - Simone Beretta
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Matteo Colombo
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Davide Carone
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Clara Zanchi
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Lorenzo Tinti
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Marta Pirovano
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Claudia Trentini
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Giada Padovano
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Diletta Cereda
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Sofia Scanziani
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Giorgia Giussani
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Gasparini
- Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Graziella Bogliun
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | - Carlo Ferrarese
- Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
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Moloney PB, Costello DJ. Unanticipated improvement in seizure control in drug-resistant epilepsy- real world observations. Seizure 2020; 84:60-65. [PMID: 33285361 DOI: 10.1016/j.seizure.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine the clinical features and anti-seizure medication (ASM) strategies associated with an unanticipated substantial improvement in seizure control in patients with drug-resistant epilepsy (DRE). METHODS This retrospective analysis of patients attending a tertiary care epilepsy clinic between 2008 and 2017 identified all patients with active DRE (at least 1 seizure per month for 6 months, despite treatment with 2 different ASMs). All treatment interventions were recorded from when DRE was first identified to the end of the study. The primary end points were seizure freedom or meaningful reduction in seizure frequency (greater than 75 %) sustained for at least 12 months after a treatment intervention. RESULTS Three hundred and twenty-two patients were included in the analysis. Overall, 10 % became seizure free following ASM adjustment and an additional 10 % had a greater than 75 % improvement in seizure control (median follow-up, 4 years). An ASM introduction was ten times more likely than an ASM dose increase to improve seizure control. Combined focal and generalized epilepsy, intellectual disability and prior treatment with more than 5 ASMs were more frequently observed in those with continued pharmacoresistance. ASM responders were more likely to have primary generalized epilepsy. Rational polytherapy (combining ASMs with different mechanisms of action) was almost ubiquitous amongst ASMs responders (95 % taking at least 2 drugs with different mechanistic targets). Of the ASM additions that heralded improved seizure control, 85 % were maintained at submaximal doses. CONCLUSIONS This retrospective analysis of a large number of 'real-world' patients provides evidence to persist with ASM trials in DRE. Early rotation of ASMs if a clinical response is not observed at a substantial dose and rational ASM polytherapy may yield better clinical outcomes in patients with DRE, although a prospective study would need to be conducted to validate these findings.
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Affiliation(s)
| | - Daniel J Costello
- Department of Neurology, Cork University Hospital, Ireland; College of Medicine and Health, University College Cork, Ireland.
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Cerulli Irelli E, Morano A, Barone FA, Fisco G, Fanella M, Orlando B, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Persistent treatment resistance in genetic generalized epilepsy: A long‐term outcome study in a tertiary epilepsy center. Epilepsia 2020; 61:2452-2460. [DOI: 10.1111/epi.16708] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Alessandra Morano
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Francesca A. Barone
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Giacomo Fisco
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Martina Fanella
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Biagio Orlando
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Jinane Fattouch
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Mario Manfredi
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
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Chatterjee A, Nair R, Gandeti R, Puppala GK, Chandran V, Gorthi SP, Radhakrishnan K. Socioeconomic consequences of drug-resistant epilepsy in an adult cohort from southern India. Epilepsy Behav 2020; 110:107173. [PMID: 32619961 DOI: 10.1016/j.yebeh.2020.107173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to describe the socioeconomic consequences of drug-resistant epilepsy (DRE). METHODS This study comprised 132 (equal males and females) consecutive patients aged ≥18 years, who fulfilled the International League Against Epilepsy (ILAE) definition for DRE, prospectively seen in a tertiary care center in South India. We used a structured questionnaire to gather relevant information. RESULTS The mean age was 31 (range 18-70) years. Mean age of onset of epilepsy was 17 years and mean duration of epilepsy 14 years. The most common epilepsy type and etiology were focal epilepsy and gliotic lesions secondary to perinatal insults, respectively. The average out of the pocket expenditure on antiseizure drugs annually amounted to 19% of the gross national product (GNP)/capita, which was borne by family members in more than two-thirds of the subjects. Almost 60% reported epilepsy having affected their education, 40% their employment, and 90% their marital prospects. Female patients were less often employed outside their homes and had more marital problems compared with males. CONCLUSIONS In addition to high seizure burden, DRE adversely affects the pursuit of higher education, employment, and marriage. Besides the direct cost of epilepsy, these issues augment both the patient and the caregiver's liability. Socioeconomic consequences of DRE are widely prevalent in developing countries, and this study highlights the need to address them.
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Affiliation(s)
- Aparajita Chatterjee
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Radhika Nair
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ranjith Gandeti
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Goutham Kumar Puppala
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vijay Chandran
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sankar Prasad Gorthi
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kurupath Radhakrishnan
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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30 years of second-generation antiseizure medications: impact and future perspectives. Lancet Neurol 2020; 19:544-556. [DOI: 10.1016/s1474-4422(20)30035-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/30/2019] [Accepted: 11/28/2019] [Indexed: 01/31/2023]
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22
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Predicting seizure freedom with AED treatment in newly diagnosed patients with MRI-negative epilepsy: A large cohort and multicenter study. Epilepsy Behav 2020; 106:107022. [PMID: 32217419 DOI: 10.1016/j.yebeh.2020.107022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We developed and validated a prediction score for predicting the probability of 6-month and 12-month seizure freedom of antiepileptic drug (AED) treatment in newly diagnosed patients with magnetic resonance imaging (MRI)-negative epilepsy. METHODS The development cohort included 543 consecutive patients from the Epilepsy Center of Henan Provincial People's Hospital, while the validation cohorts included 493 consecutive patients in two independent cohorts. Univariate analysis and a forward and backward elimination of multivariate Cox regression analysis were used to select predictive factors. The performance of the score was evaluated with C-index, calibration plots, and decision curve analysis. The risk stratification was also performed. RESULTS The score included five routinely available predictors including Circadian rhythms, Electroencephalography before AED treatment, Neuropsychiatric disorders, Perinatal brain injury, and History of central nervous system infection (CENPH score). When applied to the external validation cohort, the score showed good discrimination with C-index (development group: 0.83; validation group: 0.78), and calibration plots indicated well calibration, as well as the decision curve analysis showed good predictive accuracy and clinical values in four cohorts. The points of the score were categorized to the following three probability levels for predicting seizure freedom: high probability (0-83.11 points), medium probability (83.11-122.71 points), and low probability (>122.71 points). And online calculator was established to make this score easily applicable in clinical practice. CONCLUSIONS We established a simple, practical, and evidence-based prediction score for predicting seizure freedom with AEDs to aid in the clinical consultation and treatment decision for the newly diagnosed patients with MRI-negative epilepsy.
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Long-term follow-up of a large cohort with focal epilepsy of unknown cause: deciphering their clinical and prognostic characteristics. J Neurol 2019; 267:838-847. [DOI: 10.1007/s00415-019-09656-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
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Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study. Sci Rep 2019; 9:16254. [PMID: 31700030 PMCID: PMC6838070 DOI: 10.1038/s41598-019-52574-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/21/2019] [Indexed: 12/03/2022] Open
Abstract
Epilepsy is a chronic neurological disease with a variable therapeutic response. To design effective treatment strategies for epilepsy, it is important to understand treatment responses and predictive factors. However, limited data are available in Africa, including Ethiopia. The aim of this study was therefore to assess treatment response and identify prognostic predictors among patients with epilepsy at Jimma university medical center, Ethiopia. We conducted a retrospective cohort study of 404 newly diagnosed adult epilepsy patients receiving antiepileptic treatment between May 2010 and May 2015. Demographic, clinical, and outcome data were collected for all patients with a minimum follow-up of two years. Cox proportional hazards model was used to identify predictors of poor seizure remission. Overall, 261 (64.6%) of the patients achieved seizure remission for at least one year. High number of pre-treatment seizures (adjusted hazard ratios (AHR) = 0.64, 95% CI: 0.49–0.83) and poor adherence (AHR = 0.57, 95% CI: 0.44–0.75) were significant predictors of poor seizure remission. In conclusion, our study showed that only about two-thirds of patients had achieved seizure remission. The high number of pre-treatment seizures and non-adherence to antiepileptic medications were predictors of poor seizure remission. Patients with these characteristics should be given special attention.
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