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Cavirani B, Spagnoli C, Caraffi SG, Cavalli A, Cesaroni CA, Cutillo G, De Giorgis V, Frattini D, Marchetti GB, Masnada S, Peron A, Rizzi S, Varesio C, Spaccini L, Vignoli A, Canevini MP, Veggiotti P, Garavelli L, Fusco C. Genetic Epilepsies and Developmental Epileptic Encephalopathies with Early Onset: A Multicenter Study. Int J Mol Sci 2024; 25:1248. [PMID: 38279250 PMCID: PMC10816990 DOI: 10.3390/ijms25021248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
The genetic causes of epilepsies and developmental and epileptic encephalopathies (DEE) with onset in early childhood are increasingly recognized. Their outcomes vary from benign to severe disability. In this paper, we wished to retrospectively review the clinical, genetic, EEG, neuroimaging, and outcome data of patients experiencing the onset of epilepsy in the first three years of life, diagnosed and followed up in four Italian epilepsy centres (Epilepsy Centre of San Paolo University Hospital in Milan, Child Neurology and Psychiatry Unit of AUSL-IRCCS di Reggio Emilia, Pediatric Neurology Unit of Vittore Buzzi Children's Hospital, Milan, and Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia). We included 168 patients (104 with monogenic conditions, 45 with copy number variations (CNVs) or chromosomal abnormalities, and 19 with variants of unknown significance), who had been followed up for a mean of 14.75 years. We found a high occurrence of generalized seizures at onset, drug resistance, abnormal neurological examination, global developmental delay and intellectual disability, and behavioural and psychiatric comorbidities. We also documented differing presentations between monogenic issues versus CNVs and chromosomal conditions, as well as atypical/rare phenotypes. Genetic early-childhood-onset epilepsies and DEE show a very wide phenotypic and genotypic spectrum, with a high risk of complex neurological and neuropsychiatric phenotypes.
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Affiliation(s)
- Benedetta Cavirani
- Child Neuropsychiatry Unit, Azienda USL di Parma, 43121 Parma, Italy;
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Carlotta Spagnoli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Stefano Giuseppe Caraffi
- Medical Genetics Unit, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy (L.G.)
| | - Anna Cavalli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Carlo Alberto Cesaroni
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Gianni Cutillo
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
| | - Valentina De Giorgis
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Child Neurology and Psychiatriy, IRCCS Mondino Foundation, ERN-Epicare, 27100 Pavia, Italy
| | - Daniele Frattini
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Giulia Bruna Marchetti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Silvia Masnada
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
| | - Angela Peron
- Medical Genetics, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy;
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Università degli Studi di Firenze, 50121 Florence, Italy
- Medical Genetics, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy
| | - Susanna Rizzi
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Costanza Varesio
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Child Neurology and Psychiatriy, IRCCS Mondino Foundation, ERN-Epicare, 27100 Pavia, Italy
| | - Luigina Spaccini
- Clinical Genetics Unit, Department of Obstetrics and Gynecology, V. Buzzi Children’s Hospital, University of Milan, 20157 Milan, Italy;
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit-Epilepsy Center, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.V.); (M.P.C.)
- Department of Health Sciences, University of Milan, 20157 Milan, Italy
| | - Maria Paola Canevini
- Child Neuropsychiatry Unit-Epilepsy Center, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.V.); (M.P.C.)
- Department of Health Sciences, University of Milan, 20157 Milan, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy (L.G.)
| | - Carlo Fusco
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
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Coryell J, Singh R, Ostendorf AP, Eisner M, Alexander A, Eschbach K, Shrey DW, Olaya J, Ciliberto MA, Karakas C, Karia S, McNamara N, Romanowski EF, Kheder A, Pradeep J, Reddy SB, McCormack MJ, Bolton J, Wolf S, McGoldrick P, Hauptman JS, Samanta D, Tatachar P, Sullivan J, Auguste K, Gonzalez-Giraldo E, Marashly A, Depositario-Cabacar DF, Wong-Kisiel LC, Perry S. Epilepsy surgery in children with genetic etiologies: A prospective evaluation of current practices and outcomes. Seizure 2023; 113:6-12. [PMID: 38189708 DOI: 10.1016/j.seizure.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE This study assesses current practices and outcomes of epilepsy surgery in children with a genetic etiology. It explores the pre-surgical workup, types of surgeries, and post-surgical outcomes in a broad array of disorders. METHODS Patients ≤18 years who completed epilepsy surgery and had a known genetic etiology prior to surgical intervention were extrapolated from the Pediatric Epilepsy Research Consortium (PERC) surgery database, across 18 US centers. Data were assessed univariably by neuroimaging and EEG results, genetic group (structural gene, other gene, chromosomal), and curative intent. Outcomes were based on a modified International League Against Epilepsy (ILAE) outcome score. RESULTS Of 81 children with genetic epilepsy, 72 % had daily seizures when referred for surgery evaluation, which occurred a median of 2.2 years (IQR 0.3, 5.2) after developing drug resistance. Following surgery, 68 % of subjects had >50 % seizure reduction, with 33 % achieving seizure freedom [median follow-up 11 months (IQR 6, 17). Seizure freedom was most common in the monogenic structural group, but significant palliation was present across all groups. Presence of a single EEG focus was associated with a greater likelihood of seizure freedom (p=0.02). SIGNIFICANCE There are meaningful seizure reductions following epilepsy surgery in the majority of children with a genetic etiology, even in the absence of a single structural lesion and across a broad spectrum of genetic causes. These findings highlight the need for expedited referral for epilepsy surgery and support of a broadened view of which children may benefit from epilepsy surgery, even when the intent is palliative.
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Affiliation(s)
- Jason Coryell
- Department of Pediatrics, Oregon Health & Sciences University, CDRC-P, 707 SW Gaines Rd, Portland, OR 97239, USA.
| | - Rani Singh
- Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, NC, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Allyson Alexander
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Krista Eschbach
- Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Joffre Olaya
- Children's Hospital of Orange County, Orange, CA, USA
| | - Michael A Ciliberto
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cemal Karakas
- Department of Neurology, Division of Child Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, USA
| | - Samir Karia
- Department of Neurology, Division of Child Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, USA
| | - Nancy McNamara
- Department of Pediatrics, Section of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erin Fedak Romanowski
- Department of Pediatrics, Section of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ammar Kheder
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Javarayee Pradeep
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shilpa B Reddy
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Michael J McCormack
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Steven Wolf
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
| | - Jason S Hauptman
- Division of Pediatric Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Debopam Samanta
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Priya Tatachar
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Joseph Sullivan
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, CA, USA
| | - Kurtis Auguste
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, CA, USA
| | - Ernesto Gonzalez-Giraldo
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, CA, USA
| | - Ahmad Marashly
- Department of Neurology, Johns Hopkins, Baltimore, MD, USA
| | - Dewi F Depositario-Cabacar
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Lily C Wong-Kisiel
- Department of Neurology, Divisions of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, TX, USA
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Ho ML, Wirrell EC, Petropoulou K, Sakonju A, Chu D, Seratti G, Palasis S. Role of Electroencephalogram (EEG) and Magnetic Resonance Imaging (MRI) Findings in Early Recognition and Diagnosis of Neuronal Ceroid Lipofuscinosis Type 2 Disease. J Child Neurol 2022; 37:984-991. [PMID: 36184928 DOI: 10.1177/08830738221128773] [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] [Indexed: 11/15/2022]
Abstract
Neuronal ceroid lipofuscinosis type 2 (CLN2) disease is a very rare neurodegenerative lysosomal storage disorder. Progression is rapid and irreversible, making early diagnosis crucial for timely treatment. A group of pediatric neurologists and neuroradiologists with expertise in CLN2 convened to discuss early electroencephalogram (EEG) and magnetic resonance imaging (MRI) findings in CLN2 diagnosis. Of 18 CLN2 cases, 16 (88.9%) had background slowing and 16 (88.9%) had epileptiform discharges on initial EEG. Seven of 17 (41.2%) patients who received intermittent low-frequency photic stimulation had a photoparoxysmal response. Initial MRIs showed subtle cerebellar (n = 14, 77.8%) or cerebral (n = 9, 50.0%) atrophy, white matter abnormalities (n = 11, 61.1%), and basal ganglia T2 hypointensity (n = 6, 33.3%), which became more apparent on follow-up MRI. The recognition of even subtle cerebellar atrophy and white matter signal changes in children aged 2-5 years who present with language delay, new-onset seizures, and an EEG with epileptiform discharges and background slowing should prompt investigation for CLN2. Because these early signs are not unique to CLN2, genetic testing is essential early in the diagnostic journey.
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Affiliation(s)
- Mai-Lan Ho
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Ai Sakonju
- 12302SUNY Upstate Medical University, Syracuse, NY, USA
| | - Dorna Chu
- 10926BioMarin Pharmaceutical Inc, Novato, CA, USA
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Cohen NT, Chang P, You X, Zhang A, Havens KA, Oluigbo CO, Whitehead MT, Gholipour T, Gaillard WD. Prevalence and Risk Factors for Pharmacoresistance in Children With Focal Cortical Dysplasia-Related Epilepsy. Neurology 2022; 99:e2006-e2013. [PMID: 35985831 PMCID: PMC9651467 DOI: 10.1212/wnl.0000000000201033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Focal cortical dysplasia (FCD) is the most common cause of surgically remediable epilepsy in children. Little is known about the risk factors for the timing and development of pharmacoresistance in this population. This study sought to evaluate the prevalence and risk factors for pharmacoresistance in pediatric FCD-related epilepsy. METHODS In this retrospective single-center cohort design, patients were identified from search of centralized radiology report database and a central epilepsy surgical database. Inclusion criteria consisted of 3T MRI-confirmed FCD from January, 2011, to January, 2020; ages 0 days to 22 years at MRI; and at least 18 months of documented follow-up after MRI, unless had single seizure or incidentally discovered FCD. Records were excluded if there was dual pathology (except for mesial temporal sclerosis), hemimegalencephaly, or tuberous sclerosis complex present in imaging or history. RESULTS One hundred forty-three patients with confirmed FCD met the inclusion criteria. One hundred twenty-four children had epilepsy (87% of patients with FCD) with median age at seizure onset 2.7 years (IQR 0.75-6 years, range 0-17 years). Twelve children (8.5%) had a single lifetime seizure (provoked or unprovoked) or recurrent provoked seizures. Seven children (4.9%) had incidental FCD. Ninety-two patients (74%) of those with epilepsy met criteria for pharmacoresistance. Of children with epilepsy of all types, 93 children (75%) were seizure-free at the last visit; 82 patients underwent epilepsy surgery, of whom 59 (72%) achieved seizure freedom. Seven percent (9/124) achieved seizure freedom with a second ASM and 5.6% (7/124) with a third or more ASMs. Failure of only 1 antiseizure medication is associated with enormous increased incidence and earlier development of pharmacoresistance (OR 346; 95% CI 19.6-6,100); Cox regression showed FCD lobar location, pathologic subtype, and age at seizure onset are not. DISCUSSION Failure of 1 antiseizure medication is associated with substantial risk of pharmacoresistance. These data support an operational redefinition of pharmacoresistance, for surgical planning, in FCD-related epilepsy to the failure of 1 antiseizure medication and support early, potentially curative surgery to improve outcomes in this patient population.
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Affiliation(s)
- Nathan T Cohen
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C.
| | - Phat Chang
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Xiaozhen You
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Anqing Zhang
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Kathryn A Havens
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Chima O Oluigbo
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Matthew T Whitehead
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Taha Gholipour
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - William D Gaillard
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
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Benini R, Asir N, Yasin A, Mohamedzain AM, Hadid F, Vasudeva DM, Saeed A, Zamel K, Kayyali H, Elestwani S. Landscape of Childhood Epilepsies – A Multi-Ethnic Population-based Study. Epilepsy Res 2022; 183:106936. [DOI: 10.1016/j.eplepsyres.2022.106936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 11/24/2022]
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Chourasia N, Yuskaitis CJ, Libenson MH, Bergin AM, Liu S, Zhang B, Poduri A, Harini C. Infantile spasms: assessing the diagnostic yield of an institutional guideline and the impact of etiology on long-term treatment response. Epilepsia 2022; 63:1164-1176. [PMID: 35211955 DOI: 10.1111/epi.17209] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neuroimaging and genetic testing have been proposed for diagnostic evaluation of infantile spasms (IS), establishing etiology in ~60% of multicenter IS cohorts. A retrospective analysis of the yield of diagnostic etiology following an institutionally established guideline for investigation/treatment of IS was conducted, and the association between etiological subgroups and sustained response to standard treatment was evaluated. METHODS Etiology of IS, neuroimaging, and genetic results were extracted from clinical records. Etiology was categorized as acquired or non-acquired, the latter including syndromic patients, non-syndromic patients with confirmed etiology, and unknown cases. Regression analyses, using clinical variables including subtypes of etiology, were conducted to determine which factors correlated with favorable (spasms freedom at last follow-up after ≤ 2 standard treatments) versus unfavorable treatment outcome (refractory spasms despite two standard treatments or relapse). RESULTS We included 127 IS patients (60% males) with a follow-up of 2.4 years (range 0.6-5 years). All patients had neuroimaging, and 95% of patients in the non-acquired category (103 of 108 patients) had genetic testing. Etiology was identified in 103/127 (81%, CI-0.73-0.86). At last follow-up, 42 (33%) patients had favorable treatment outcome. No difference in treatment response was observed between acquired and non-acquired etiologies. Among patients with non-acquired etiologies, developmental delay prior to spasms onset increased the odds of unfavorable treatment outcome (p=0.014) while a clearly recognizable dysmorphic/syndromic etiology was associated with a lower risk for treatment failure (p=0.034). In non-acquired etiology without a recognizable dysmorphic/syndrome but with a genetic etiology, unfavorable treatment outcome was more likely (p=0.043). SIGNIFICANCE Rigorous evaluation with neuroimaging and genetic testing yields an etiological diagnosis in most patients with IS. Among patients with a non-acquired etiology, those with recognizable dysmorphic/syndromic diagnosis had a higher likelihood of a favorable treatment outcome, while the absence of such a finding, when associated with an identifiable genetic diagnosis, was associated with unfavorable treatment outcomes.
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Affiliation(s)
- Nitish Chourasia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA.,Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children's Hospital (author's current location), Memphis, TN, USA
| | - Christopher J Yuskaitis
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Mark H Libenson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Ann M Bergin
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Shanshan Liu
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Annapurna Poduri
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Chellamani Harini
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
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Pellino G, Faggioli R, Madrassi L, Falsaperla R, Suppiej A. Operational diagnosis of epilepsy in children at undetermined risk: A meta-analysis of prognostic factors for seizure recurrence. Epilepsy Behav 2022; 127:108498. [PMID: 34954509 DOI: 10.1016/j.yebeh.2021.108498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/23/2021] [Accepted: 12/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE According to the operational epilepsy definition adopted by the International League Against Epilepsy (ILAE) in 2014, in patients with one unprovoked seizure, clinicians must stratify the recurrence risk to determine if the criteria for diagnosis of epilepsy have been met and if antiseizure medications (ASM) are required. A remote symptomatic etiology was considered to be one of the best predictors for seizure recurrence, also according to the available prediction tools, but in children with a previously negative history and a normal neurological examination, estimating the probability of seizure relapse remains less obvious. This meta-analysis aimed to fill this gap of knowledge. METHODS The PubMed, Embase, and Scopus databases were searched from January 2000 to December 2020. We selected studies reporting children (1 month-18 years old) presenting a first unprovoked seizure. The absence of a known remote neurological pathology had to be clearly stated in the paper or the idiopathic/cryptogenic group data were used; the finding of epileptogenic structural brain MRI abnormalities during the diagnostic workup at the moment of the first unprovoked seizure was not an exclusion criterion. Factors analyzed, as possible predictors of recurrence, included: age at onset, sex, family history of epilepsy, type of seizure (focal or generalized), epileptiform abnormalities on EEG, and epileptogenic structural brain MRI abnormalities. RESULTS Four studies met the inclusion criteria and the sample size consisted of 741 children. The estimated recurrence rate within 3 years was 50% (95%CI:33.9%-66.0%). Among the predictors of recurrence, focal seizure (OR = 1.52; 95%CI = 1.05-2.19), epileptiform abnormalities on EEG (OR = 1.97; 95%CI = 1.31-2.96), and positive family history for epilepsy (OR = 2.37; 95%CI = 1.56-3.59) were associated with a statistically significant increased risk. CONCLUSION The analysis of data available until now cannot adequately assess the risk of recurrence after a first unprovoked seizure in neurotypical children. Prospective and multicenter cohort studies are expected.
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Affiliation(s)
- Giuditta Pellino
- Pediatric Unit, Azienda USL Ferrara - University Hospital of Ferrara, Ferrara, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
| | - Raffaella Faggioli
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
| | - Laura Madrassi
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, AOU San Marco-Policlinico, University of Catania, Via Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
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8
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Kramer ZJ, Brandt C, Havens K, Pasupuleti A, Gaillard WD, Schreiber JM. Telehealth for patients with rare epilepsies. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221076861. [PMID: 37180417 PMCID: PMC10032469 DOI: 10.1177/26330040221076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/11/2022] [Indexed: 05/16/2023]
Abstract
Recent developments in technology and exigencies of the COVID-19 pandemic have spurred innovations for telehealth in patients with rare epilepsies. This review details the many ways telehealth may be used in the diagnosis and management of rare, pharmacoresistant epilepsy and documents our experience as measured by surveying caregivers of pediatric patients with epilepsy. Most components of the epilepsy evaluation, including history and examination, neuroimaging, and electroencephalogram (EEG) can be performed or reviewed remotely, assuming similar technique and quality of diagnostic studies. Seizure and epilepsy diagnosis is enhanced through the assistance of caregiver smart phone video recordings and 'ambulatory' EEG. Monitoring patient seizure frequency through paper seizure diaries is now increasingly being replaced by electronic diaries in both clinical and research settings. Electronic seizure diaries have numerous advantages such as data durability, increased accessibility, real-time availability, and easier analysis. Telehealth enhances access to specialized epilepsy care, which has been shown to reduce mortality and improve patient compliance and outcomes. Telehealth can also enable evaluation of patients with rare epilepsy in centers of excellence and enhance enrollment in clinical trials. Reducing mortality risk in patients with epilepsy can be accomplished through remote counseling and addressing psychiatric co-morbidities. Findings from surveying caregivers of children with epilepsy treated at Children's National Hospital showed that 54/56 (96.4%) found that not having to commute to the appointment positively contributed to their telemedicine experience. Overall, most respondents had a positive experience with their telemedicine visit. Almost all respondents (98%) were either 'very happy' or 'happy' with their telemedicine visit and their ability to communicate over telemedicine with the provider and either 'very likely' or 'likely' to want to use telemedicine for some future clinic visits. Telehealth in rare epilepsies is feasible and, in many ways, comparable with traditional evaluation and management.
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Affiliation(s)
- Zachary J. Kramer
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Carrin Brandt
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Kathryn Havens
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Archana Pasupuleti
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - William D. Gaillard
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - John M. Schreiber
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC 20010, USA
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9
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Perry MS, Shandley S, Perelman M, Singh RK, Wong-Kisiel L, Sullivan J, Gonzalez-Giraldo E, Romanowski EF, McNamara NA, Marashly A, Ostendorf AP, Alexander A, Eschbach K, Bolton J, Wolf S, McGoldrick P, Depositario-Cabacar DF, Ciliberto MA, Gedela S, Sannagowdara K, Karia S, Shrey DW, Tatachar P, Nangia S, Grinspan Z, Reddy SB, Shital P, Coryell J. Surgical evaluation in children <3 years of age with drug-resistant epilepsy: Patient characteristics, diagnostic utilization, and potential for treatment delays. Epilepsia 2021; 63:96-107. [PMID: 34778945 DOI: 10.1111/epi.17124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/06/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Drug-resistant epilepsy (DRE) occurs at higher rates in children <3 years old. Epilepsy surgery is effective, but rarely utilized in young children despite developmental benefits of early seizure freedom. The present study aims to identify unique patient characteristics and evaluation strategies in children <3 years old who undergo epilepsy surgery evaluation as a means to assess contributors and potential solutions to health care disparities in this group. METHODS The Pediatric Epilepsy Research Consortium Epilepsy Surgery Database, a multicentered, cross-sectional collaboration of 21 US pediatric epilepsy centers, collects prospective data on children <18 years of age referred for epilepsy surgery evaluation. We compared patient characteristics, diagnostic utilization, and surgical treatment between children <3 years old and those older undergoing initial presurgical evaluation. We evaluated patient characteristics leading to delayed referral (>1 year) after DRE diagnosis in the very young. RESULTS The cohort included 437 children, of whom 71 (16%) were <3 years of age at referral. Children evaluated before the age of 3 years more commonly had abnormal neurological examinations (p = .002) and daily seizures (p = .001). At least one ancillary test was used in 44% of evaluations. Fifty-nine percent were seizure-free following surgery (n = 34), with 35% undergoing limited focal resections. Children with delayed referrals more often had focal aware (p < .001) seizures and recommendation for palliative surgeries (p < .001). SIGNIFICANCE There are relatively few studies of epilepsy surgery in the very young. Surgery is effective, but may be disproportionally offered to those with severe presentations. Relatively low utilization of ancillary testing may contribute to reduced surgical therapy for those without evident lesions on magnetic resonance imaging. Despite this, a sizeable portion of patients have favorable outcome after focal epilepsy surgery resections.
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Affiliation(s)
- Michael Scott Perry
- Justin Neuroscience Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Sabrina Shandley
- Justin Neuroscience Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Max Perelman
- Doernbecher Children's Hospital, Oregon Health Science Center, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Rani K Singh
- Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Lily Wong-Kisiel
- Divisions of Child Neurology and Epilepsy, Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joseph Sullivan
- Benioff Children's Hospital, University of California, San Francisco Weill Institute for Neurosciences, San Francisco, California, USA
| | - Ernesto Gonzalez-Giraldo
- Benioff Children's Hospital, University of California, San Francisco Weill Institute for Neurosciences, San Francisco, California, USA
| | - Erin Fedak Romanowski
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nancy A McNamara
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ahmad Marashly
- Division of Pediatric Neurology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Allyson Alexander
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Krista Eschbach
- Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Steven Wolf
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | - Dewi F Depositario-Cabacar
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Michael A Ciliberto
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kumar Sannagowdara
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samir Karia
- Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Daniel W Shrey
- Children's Hospital of Orange County, Orange, California, USA
| | - Priya Tatachar
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | | | | | - Shilpa B Reddy
- Department of Pediatric Neurology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee, USA
| | - Patel Shital
- Department of Pediatric Neurology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason Coryell
- Doernbecher Children's Hospital, Oregon Health Science Center, Oregon Health and Sciences University, Portland, Oregon, USA
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10
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Bidstrup J, Hansen JK. Fragile X Syndrome and Periventricular Heterotopias: A Rare Association. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1721028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractFragile X syndrome (FXS) is the most common hereditary cause of intellectual disability in males, with an estimated prevalence of 1:4000. Epilepsy occurs in 10 to 20% of males with FXS and usually has a favorable prognosis and positive response to antiepileptic medication. Numerous anomalies in the central nervous system have been reported in FXS. Among these, periventricular heterotopia (PH) has been reported in two previous cases. Epilepsy is also a common comorbidity in PH, but in contrast to epilepsy in FXS, the severity may vary markedly. We present a boy with FXS, PH, and epilepsy—a combination not previously reported in the literature. The presented case suggests a necessity to consider PH in cases of refractory epilepsy or status epilepticus in patients with FXS, emphasizes the importance of ruling out FXS in children with intellectual disability even if there are only discreet or no clinical signs of the disorder, and underscores that FXS should be considered in patients with PH if no other cause can be found.
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Affiliation(s)
- Jakob Bidstrup
- Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark
| | - Jonas Kjeldbjerg Hansen
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
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11
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Hourani R, Nasreddine W, Dirani M, Hmaimess G, Sabbagh S, El Tourjuman O, Wazne J, Toufaili H, AlArab N, El Dassouki M, Beydoun A. When Should a Brain MRI Be Performed in Children with New-Onset Seizures? Results of a Large Prospective Trial. AJNR Am J Neuroradiol 2021; 42:1695-1701. [PMID: 34244128 DOI: 10.3174/ajnr.a7193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/05/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is a paucity of data regarding the incidence of structural brain lesions in children with new-onset unprovoked seizures. Our aim was to determine the frequencies and types of epileptogenic lesions detected on a dedicated epilepsy protocol MR imaging according to age group, the presence of developmental delay, and the number and types of seizures. MATERIALS AND METHODS Consecutive children between 6 months and 18 years of age with new-onset unprovoked seizures were included. The frequencies and types of epileptogenic lesions were determined and then stratified according to sex, age groups, the presence of developmental delay, and the number and types of seizures at presentation. Multivariate analysis was used to identify variables significantly associated with the presence of epileptogenic lesions. RESULTS One thousand children were included. An epileptogenic lesion was identified in 26%, with malformations of cortical development being the most common lesion (32%), followed by hypoxic-ischemic injury (20%) and vascular etiologies (16%). Univariate analysis showed a significant increase in the frequency of epileptogenic lesions with decreasing age, the presence of developmental delay, and the number and types of seizures at presentation. The presence of developmental delay and seizure type at presentation remained significant in a multivariate analysis. CONCLUSIONS We documented a relatively high rate of epileptogenic lesions in children with new-onset seizures, with the presence of developmental delay and specific seizure types being associated with a higher likelihood of detecting an epileptogenic lesion on neuroimaging. This study fulfills the requirements of the study design recommended by the Practice Committee of the American Academy of Neurology, and we hope that our results will assist the relevant societies and committees in formulating neuroimaging guidelines for children with new-onset seizures.
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Affiliation(s)
- R Hourani
- Department of Radiology (R.H., N.A.), American University of Beirut Medical Center, Beirut, Lebanon
| | - W Nasreddine
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
| | - M Dirani
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
| | - G Hmaimess
- Department of Pediatrics (G.H.), St George Hospital Medical University Center, University of Balamand, Beirut, Lebanon
| | - S Sabbagh
- Department of Pediatrics (S.S.), Hotel Dieu de France Hospital, Beirut, Lebanon
| | - O El Tourjuman
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - J Wazne
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - H Toufaili
- Labib Medical Center (H.T.), Beirut, Lebanon
| | - N AlArab
- Department of Radiology (R.H., N.A.), American University of Beirut Medical Center, Beirut, Lebanon
| | - M El Dassouki
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - A Beydoun
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
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12
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De Vito A, Mankad K, Pujar S, Chari A, Ippolito D, D’Arco F. Narrative review of epilepsy: getting the most out of your neuroimaging. Transl Pediatr 2021; 10:1078-1099. [PMID: 34012857 PMCID: PMC8107872 DOI: 10.21037/tp-20-261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neuroimaging represents an important step in the evaluation of pediatric epilepsy. The crucial role of brain imaging in the diagnosis, follow-up and presurgical assessment of patients with epilepsy is noted and has to be familiar to all neuroradiologists and trainees approaching pediatric brain imaging. Morphological qualitative imaging shows the majority of cerebral lesions/alterations underlying focal epilepsy and can highlight some features which are useful in the differential diagnosis of the different types of epilepsy. Recent advances in MRI acquisitions including diffusion-weighted imaging (DWI), post-acquisition image processing techniques, and quantification of imaging data are increasing the accuracy of lesion detection during the last decades. Functional MRI (fMRI) can be really useful and helps to identify cortical eloquent areas that are essential for language, motor function, and memory, and diffusion tensor imaging (DTI) can reveal white matter tracts that are vital for these functions, thus reducing the risk of epilepsy surgery causing new morbidities. Also positron emission tomography (PET), single photon emission computed tomography (SPECT), simultaneous electroencephalogram (EEG) and fMRI, and electrical and magnetic source imaging can be used to assess the exact localization of epileptic foci and help in the design of intracranial EEG recording strategies. The main role of these "hybrid" techniques is to obtain quantitative and qualitative informations, a necessary step to evaluate and demonstrate the complex relationship between abnormal structural and functional data and to manage a "patient-tailored" surgical approach in epileptic patients.
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Affiliation(s)
- Andrea De Vito
- Department of Neuroradiology, H. S. Gerardo Monza, Monza, Italy
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Suresh Pujar
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | | | - Felice D’Arco
- Department of Radiology, Great Ormond Street Hospital, London, UK
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13
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Assadsangabi R, Ozturk A, Kantamneni T, Azizi N, Asaikar SM, Hacein-Bey L. Neuroimaging of Childhood Epilepsy: Focal versus Generalized Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0040-1722301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractNeuroimaging plays an increasingly crucial role in delineating the pathophysiology, and guiding the evaluation, management and monitoring of epilepsy. Imaging contributes to adequately categorizing seizure/epilepsy types in complex clinical situations by demonstrating anatomical and functional changes associated with seizure activity. This article reviews the current status of multimodality neuroimaging in the pediatric population, including focal lesions which may result in focal epileptic findings, focal structural abnormalities that may manifest as generalized epileptiform discharges, and generalized epilepsy without evidence of detectable focal abnormalities.
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Affiliation(s)
- Reza Assadsangabi
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Arzu Ozturk
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Trishna Kantamneni
- Department of Neurology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Nazarin Azizi
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Shailesh M. Asaikar
- Child & Adolescent Neurology Consultants, Sacramento, California, United States
| | - Lotfi Hacein-Bey
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
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14
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Abualsaud DA, Jad LA. Infants routine video electroencephalogram findings in a Saudi tertiary hospital. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2021; 25:350-355. [PMID: 33459282 PMCID: PMC8015594 DOI: 10.17712/nsj.2020.5.20200049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: To report the existence and describe the non-epileptic abnormalities, interictal epileptiform discharges, and seizures in routine electroencephalograms (EEGs) of infants in a tertiary hospital out-patient neurophysiology clinics. Methods: This is a non-interventional, retrospective descriptive study that involved the review of 172 infants’ EEGs conducted from July 2018 to June 2019 in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. Results: Total of 172 EEGs were reviewed; 152 routine EEGs for infants and 20 neonatal EEGs. Seventy-six (50%) EEGs were reported to be normal. Among the remaining EEGs, 54 were characterized by generalized slow background abnormalities (31.3 %), seven (4%) by background asymmetry, one (0.5%) by generalized low amplitude, and one (0.5 %) by an alternate trace that was dysmature for age. Interictal epileptiform discharges (IED) were present in 75 (43.6%) EEGs and they were focal in 72 (41.8%) EEGs, and generalized spike wave discharges were seen in only 3 (1.7%) EEGs with focal interictal epileptiform discharges. A diagnosis of hypsarrythmia was made from 15 (8.7%) EEGs. There were seizures in 11 (6.4%) EEGs, of which three were in neonates (15% of neonatal EEGs), and 8 in infants (4.6 % of infant EEGs). Conclusions: Fifty % of routine infants‘ EEGs had abnormalities and hypsarrythmia was the most common abnormal background associated with seizures. Ictal discharges in form of generalized electrodecremental pattern associated clinically with epileptic spasm was the most common type of seizures
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Affiliation(s)
- Dalya A Abualsaud
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail:
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15
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Grinspan ZM, Patel AD, Shellhaas RA, Berg AT, Axeen ET, Bolton J, Clarke DF, Coryell J, Gaillard WD, Goodkin HP, Koh S, Kukla A, Mbwana JS, Morgan LA, Singhal NS, Storey MM, Yozawitz EG, Abend NS, Fitzgerald MP, Fridinger SE, Helbig I, Massey SL, Prelack MS, Buchhalter J. Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system. Epilepsia 2021; 62:198-216. [PMID: 33368200 PMCID: PMC10508354 DOI: 10.1111/epi.16733] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Common data elements (CDEs) are standardized questions and answer choices that allow aggregation, analysis, and comparison of observations from multiple sources. Clinical CDEs are foundational for learning health care systems, a data-driven approach to health care focused on continuous improvement of outcomes. We aimed to create clinical CDEs for pediatric epilepsy. METHODS A multiple stakeholder group (clinicians, researchers, parents, caregivers, advocates, and electronic health record [EHR] vendors) developed clinical CDEs for routine care of children with epilepsy. Initial drafts drew from clinical epilepsy note templates, CDEs created for clinical research, items in existing registries, consensus documents and guidelines, quality metrics, and outcomes needed for demonstration projects. The CDEs were refined through discussion and field testing. We describe the development process, rationale for CDE selection, findings from piloting, and the CDEs themselves. We also describe early implementation, including experience with EHR systems and compatibility with the International League Against Epilepsy classification of seizure types. RESULTS Common data elements were drafted in August 2017 and finalized in January 2020. Prioritized outcomes included seizure control, seizure freedom, American Academy of Neurology quality measures, presence of common comorbidities, and quality of life. The CDEs were piloted at 224 visits at 10 centers. The final CDEs included 36 questions in nine sections (number of questions): diagnosis (1), seizure frequency (9), quality of life (2), epilepsy history (6), etiology (8), comorbidities (2), treatment (2), process measures (5), and longitudinal history notes (1). Seizures are categorized as generalized tonic-clonic (regardless of onset), motor, nonmotor, and epileptic spasms. Focality is collected as epilepsy type rather than seizure type. Seizure frequency is measured in nine levels (all used during piloting). The CDEs were implemented in three vendor systems. Early clinical adoption included 1294 encounters at one center. SIGNIFICANCE We created, piloted, refined, finalized, and implemented a novel set of clinical CDEs for pediatric epilepsy.
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Affiliation(s)
- Zachary M Grinspan
- Departments of Population Health Sciences and Pediatrics, Weill Cornell Medicine, New York, NY
| | - Anup D Patel
- Division of Neurology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Renée A Shellhaas
- Department of Pediatrics (Pediatric Neurology), Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anne T Berg
- Division of Neurology, Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern Feinberg School of Medicine, United States of America
| | - Erika T Axeen
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Jeffrey Bolton
- Harvard Medical School, Boston, MA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
| | - David F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas
| | - Jason Coryell
- Departments of Pediatrics and Neurology, Oregon Health and Sciences University, Portland, Oregon
| | - William D Gaillard
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | - Howard P Goodkin
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Emory Children’s Center, 2015 Uppergate Drive NE, Atlanta, GA
| | | | - Juma S Mbwana
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | | | - Nilika S Singhal
- Departments of Pediatrics and Neurology, Seattle Children’s Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA
| | - Margaret M Storey
- Department of History, College of Liberal Arts & Social Sciences, DePaul University, Chicago, IL
| | - Elissa G Yozawitz
- Saul Korey Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Nicholas S Abend
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Mark P Fitzgerald
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Sara E Fridinger
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Shavonne L Massey
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Marisa S Prelack
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Jeffrey Buchhalter
- Department of Neurology, St Joseph’s Hospital and Medical Center, Phoenix, Arizona
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International consensus recommendations on the diagnostic work-up for malformations of cortical development. Nat Rev Neurol 2020; 16:618-635. [PMID: 32895508 PMCID: PMC7790753 DOI: 10.1038/s41582-020-0395-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
Malformations of cortical development (MCDs) are neurodevelopmental disorders that result from abnormal development of the cerebral cortex in utero. MCDs place a substantial burden on affected individuals, their families and societies worldwide, as these individuals can experience lifelong drug-resistant epilepsy, cerebral palsy, feeding difficulties, intellectual disability and other neurological and behavioural anomalies. The diagnostic pathway for MCDs is complex owing to wide variations in presentation and aetiology, thereby hampering timely and adequate management. In this article, the international MCD network Neuro-MIG provides consensus recommendations to aid both expert and non-expert clinicians in the diagnostic work-up of MCDs with the aim of improving patient management worldwide. We reviewed the literature on clinical presentation, aetiology and diagnostic approaches for the main MCD subtypes and collected data on current practices and recommendations from clinicians and diagnostic laboratories within Neuro-MIG. We reached consensus by 42 professionals from 20 countries, using expert discussions and a Delphi consensus process. We present a diagnostic workflow that can be applied to any individual with MCD and a comprehensive list of MCD-related genes with their associated phenotypes. The workflow is designed to maximize the diagnostic yield and increase the number of patients receiving personalized care and counselling on prognosis and recurrence risk.
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17
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Shaikh Z, Torres A, Takeoka M. Neuroimaging in Pediatric Epilepsy. Brain Sci 2019; 9:E190. [PMID: 31394851 PMCID: PMC6721420 DOI: 10.3390/brainsci9080190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022] Open
Abstract
Pediatric epilepsy presents with various diagnostic challenges. Recent advances in neuroimaging play an important role in the diagnosis, management and in guiding the treatment of pediatric epilepsy. Structural neuroimaging techniques such as CT and MRI can identify underlying structural abnormalities associated with epileptic focus. Functional neuroimaging provides further information and may show abnormalities even in cases where MRI was normal, thus further helping in the localization of the epileptogenic foci and guiding the possible surgical management of intractable/refractory epilepsy when indicated. A multi-modal imaging approach helps in the diagnosis of refractory epilepsy. In this review, we will discuss various imaging techniques, as well as aspects of structural and functional neuroimaging and their application in the management of pediatric epilepsy.
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Affiliation(s)
- Zakir Shaikh
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Alcy Torres
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Masanori Takeoka
- Department of Pediatric Neurology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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18
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Berg AT, Wusthoff C, Shellhaas RA, Loddenkemper T, Grinspan ZM, Saneto RP, Knupp KG, Patel A, Sullivan JE, Kossoff EH, Chu CJ, Massey S, Valencia I, Keator C, Wirrell EC, Coryell J, Millichap JJ, Gaillard WD. Immediate outcomes in early life epilepsy: A contemporary account. Epilepsy Behav 2019; 97:44-50. [PMID: 31181428 PMCID: PMC8107814 DOI: 10.1016/j.yebeh.2019.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 01/31/2023]
Abstract
RATIONALE Early-life epilepsies (ELEs) include some of the most challenging forms of epilepsy to manage. Given recent diagnostic and therapeutic advances, a contemporary assessment of the immediate short-term outcomes can provide a valuable framework for identifying priorities and benchmarks for evaluating quality improvement efforts. METHODS Children with newly diagnosed epilepsy and onset <3 years were prospectively recruited through 17 US hospitals, from 2012 to 2015 and followed for 1 year after diagnosis. Short-term outcome included mortality, drug resistance, evolution of nonsyndromic epilepsy to infantile spasms (IS) and from IS to other epilepsies, and developmental decline. Multivariable analyses assessed the risk of each outcome. RESULTS Seven hundred seventy-five children were recruited, including 408 (53%) boys. Median age at onset was 7.5 months (interquartile range (IQR): 4.2-16.5), and 509 (66%) had onset in the first year of life. Of 22 deaths that occurred within one year of epilepsy diagnosis, 21 were children with epilepsy onset in infancy (<12 months). Of 680 children followed ≥6 months, 239 (35%) developed drug-resistant seizures; 34/227 (15%) infants with nonsyndromic epilepsy developed IS, and 48/210 (23%) initially presenting with IS developed additional seizure types. One hundred of 435 (23%) with initially typical development or only mild/equivocal delays at seizure onset, had clear developmental impairment within one year after initial diagnosis. Each outcome had a different set of predictors; however, younger age and impaired development at seizure onset were broadly indicative of poorer outcomes. Type of epilepsy and early identification of underlying cause were not reliable predictors of these outcomes. CONCLUSION Early-life epilepsies carry a high risk of poor outcome which is evident shortly after epilepsy diagnosis. Onset in infancy and developmental delay is associated with an especially high risk, regardless of epilepsy type. The likelihood of poor outcomes is worrisome regardless of specific clinical profiles.
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Affiliation(s)
- Anne T. Berg
- Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America,Corresponding author at: Ann & Robert H. Lurie Children’s Hospital of Chicago, Neurology – Epilepsy Division, 225 East Chicago Ave, Box 29, Chicago, IL 60611-2605, United States of America. (A.T. Berg)
| | - Courtney Wusthoff
- Division of Child Neurology, Stanford University, Palo Alto, CA, United States of America
| | - Renée A. Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Zachary M. Grinspan
- Weill Cornell Medicine, New York Presbyterian Hospital, Health Information Technology Evaluation Collaborative, New York, NY, United States of America
| | - Russell P. Saneto
- Division of Pediatric Neurology, Seattle Children’s Hospital, Department of Neurology, University of Washington, Seattle, WA, United States of America
| | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Anup Patel
- Department of Pediatrics, The Ohio State University; Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Joseph E. Sullivan
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Eric H. Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, MD, United States of America
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Shavonne Massey
- Departments of Neurology and Pediatrics, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ignacio Valencia
- Section of Neurology, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Cynthia Keator
- Cook Children’s Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, TX, United States of America
| | - Elaine C. Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Jason Coryell
- Departments of Pediatrics & Neurology, Oregon Health & Sciences University, Portland, OR, United States of America
| | - John J. Millichap
- Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC, United States of America
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