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Matricardi S, Operto FF, Farello G, Coppola G, Verrotti A. Withdrawal seizures: possible risk factors. Expert Rev Neurother 2020; 20:667-672. [DOI: 10.1080/14737175.2020.1780917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sara Matricardi
- Department of Child Neuropsychiatry, Children’s Hospital “G. Salesi”, Ospedali Riuniti Ancona, Ancona, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry, Department of Medicine, Surgery, and Odontoiatry, University of Salerno, Salerno, Italy
| | - Giovanni Farello
- Pediatric Clinic, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Giangennaro Coppola
- Pediatric Clinic, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
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102
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Affiliation(s)
| | - Herm J. Lamberink
- Brain Center Rudolf Magnus, Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kees P. J. Braun
- Brain Center Rudolf Magnus, Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
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103
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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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Noninvasive electromagnetic source imaging of spatiotemporally distributed epileptogenic brain sources. Nat Commun 2020; 11:1946. [PMID: 32327635 PMCID: PMC7181775 DOI: 10.1038/s41467-020-15781-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
Brain networks are spatiotemporal phenomena that dynamically vary over time. Functional imaging approaches strive to noninvasively estimate these underlying processes. Here, we propose a novel source imaging approach that uses high-density EEG recordings to map brain networks. This approach objectively addresses the long-standing limitations of conventional source imaging techniques, namely, difficulty in objectively estimating the spatial extent, as well as the temporal evolution of underlying brain sources. We validate our approach by directly comparing source imaging results with the intracranial EEG (iEEG) findings and surgical resection outcomes in a cohort of 36 patients with focal epilepsy. To this end, we analyzed a total of 1,027 spikes and 86 seizures. We demonstrate the capability of our approach in imaging both the location and spatial extent of brain networks from noninvasive electrophysiological measurements, specifically for ictal and interictal brain networks. Our approach is a powerful tool for noninvasively investigating large-scale dynamic brain networks. Noninvasive electromagnetic measurements are utilized effectively to estimate large scale dynamic brain networks. Sohrabpour et al. propose a novel electrophysiological source imaging approach to estimate the location and size of epileptogenic tissues in patients with epilepsy.
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105
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Nie H, Hu Y, Tang Z. Efficacy and safety of percutaneous patent foramen ovale closure devices for recurrent stroke: A systemic review and network metaanalysis. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Randomized controlled trials (RCTs) that directly compare the efficacy and safety of percutaneous patent foramen ovale (PFO) closure devices have not been conducted. Thus, we performed a network meta-analysis to identify the efficacy and safety of occluder devices. Methods: From 1st January, 2000 to 1st May, 2018, we searched Embase, PubMed, and Cochrane Library for RCTs about percutaneous closure devices (such as STARFlex, GORE, and Amplatzer) and medical therapy for cryptogenic cerebral ischemic patients with PFO. The occurrence rate of recurrent stroke, atrial fibrillation (AF), major vascular complication (MVC), headache, transient ischemic attack, and bleeding were compared with the frequentist and Bayesian methods using R statistics. Results: We included 3747 patients from six RCTs. The GORE and Amplatzer occluders were found to be significantly associated with a decreased risk of recurrent stroke [relative risk (RR): 0.37 and 0.49; 95% confidence interval (CI): 0.17–0.81, 0.29–0.83, respectively]. Moreover, STARFlex was correlated to an increased risk of postoperative AF and MVCs (RR: 11.66 and 7.63; 95% CI: 4.87–21.91, 2.34–24.88). Conclusions: Among the three devices, the GORE and Amplatzer occluders are found to be the most effective in preventing secondary stroke in patients with PFO. Meanwhile, STARFlex is the least recommended device because it cannot decrease the risk of recurrent stroke and is the most likely to cause adverse events.
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Affiliation(s)
- Hao Nie
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yang Hu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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106
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Punia V, Chandan P, Fesler J, Newey CR, Hantus S. Post-acute symptomatic seizure (PASS) clinic: A continuity of care model for patients impacted by continuous EEG monitoring. Epilepsia Open 2020; 5:255-262. [PMID: 32524051 PMCID: PMC7278542 DOI: 10.1002/epi4.12393] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 12/31/2022] Open
Abstract
Objective We present a model for the outpatient care of patients undergoing continuous electroencephalography (cEEG) monitoring during a hospitalization, named the post‐acute symptomatic seizure (PASS) clinic. We investigated whether establishing this clinic led to improved access to epileptologist care. Methods As part of the PASS clinic initiative, electronic health record (EHR) provides an automated alert to the inpatient care team discharging adults on first time antiepileptic drug (AED) after undergoing cEEG monitoring. The alert explains the rationale and facilitates scheduling for a PASS clinic appointment, three‐month after discharge, along with a same‐day extended (75 minutes) EEG. We compared the initial epilepsy clinic visits by patients undergoing cEEG in 2017, before (“Pre‐PASS” period and cohort) and after (“PASS” period and cohort) the alert went live in the EHR. Results Of the 170 patients included, 68 (40%) suffered a seizure during the mean follow‐up of 20.9 ± 10 months. AEDs were stopped or reduced in 66 out of 148 (44.6%) patients discharged on AEDs. Pre‐PASS cohort included 45 patients compared to 145 patients in the PASS cohort, accounting for 5.8% and 9.9% of patients, respectively, who underwent cEEG during the corresponding periods (odds ratio [OR] = 1.8, 95% CI = 1.26‐2.54, P = .001). The two cohorts did not differ in terms of electrographic or clinical seizures. The PASS cohort was significantly more likely to be followed up within 1‐6 months of discharge (OR = 4.6, 95% CI = 2.1‐10.1, P < .001) and have a pre‐clinic EEG (51.2% vs 11.1%; OR = 8.39, 95% CI = 3.1‐22.67, P < .001). Significance PASS clinic, a unique outpatient transition of care model for managing patients at risk of acute symptomatic seizure led to an almost twofold increase in access to an epileptologist. Future research should address the wide knowledge gap about the best post‐hospital discharge management practices for these patients.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Pradeep Chandan
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Jessica Fesler
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Christopher R Newey
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA.,Cerebrovascular Center Neurological Institute Cleveland Clinic Cleveland OH USA.,Center for Clinical Artificial Intelligence Cleveland Clinic Cleveland OH USA
| | - Stephen Hantus
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
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Abstract
BACKGROUND Febrile seizures can be classified as simple or complex. Complex febrile seizures are associated with fever that lasts longer than 15 minutes, occur more than once within 24 hours, and are confined to one side of the child's body. It is common in some countries for doctors to recommend an electroencephalograph (EEG) for children with complex febrile seizures. A limited evidence base is available to support the use of EEG and its timing after complex febrile seizures among children. OBJECTIVES To assess the use of EEG and its timing after complex febrile seizures in children younger than five years of age. SEARCH METHODS For the latest update of this review, we searched the following databases on 12 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (Ovid, 1946 to 11 March 2019); and ClinicalTrials.gov. We applied no language restrictions. SELECTION CRITERIA All randomised controlled trials (RCTs) that examined the utility of an EEG and its timing after complex febrile seizures in children. DATA COLLECTION AND ANALYSIS The review authors selected and retrieved the articles and independently assessed which articles should be included. Any disagreements were resolved by discussion and by consultation with the Cochrane Epilepsy Group. We applied standard methodological procedures expected by Cochrane. MAIN RESULTS Of 48 potentially eligible studies, no RCTs met the inclusion criteria. AUTHORS' CONCLUSIONS We found no RCTs as evidence to support or refute the use of EEG and its timing after complex febrile seizures among children under the age of five. An RCT can be planned in such a way that participants are randomly assigned to the EEG group and to the non-EEG group with sufficient sample size. Since the last version of this review, we have found no new studies.
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Affiliation(s)
- Pankaj B Shah
- Sri Ramachandra Institute of Higher Education & Research (SRIHER)Department of Community MedicineRamachandra NagarPorurChennaiTamil NaduIndia600116
| | - Saji James
- Sri Ramachandra Institute of Higher Education & Research (SRIHER)Department of Paediatric MedicineRamachandra NagarPorurChennaiTamil NaduIndia60116
| | - Sivaprakasam Elayaraja
- Sri Ramachandra Institute of Higher Education & Research (SRIHER)Department of Paediatric MedicineRamachandra NagarPorurChennaiTamil NaduIndia60116
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108
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Expert opinion: use of valproate in girls and women of childbearing potential with epilepsy: recommendations and alternatives based on a review of the literature and clinical experience-a European perspective. J Neurol 2020; 268:2735-2748. [PMID: 32239268 DOI: 10.1007/s00415-020-09809-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Valproate is a broad-spectrum antiepileptic drug (AED) of particular interest in pediatric epilepsy syndromes and idiopathic generalized epilepsy, as it is relatively more effective in these syndromes than other AEDs. In 2018, the European Medicines Agency introduced new restrictions on the use of valproate in girls and women of childbearing potential to avoid exposure during pregnancy. The strengthening of existing restrictions sparked controversy and debate among patients and the medical community. The high prevalence of epilepsy syndromes amenable to valproate treatment in women of childbearing age and the little information available on the teratogenic potential of alternative treatments have created uncertainty on how to manage these patients. In this consensus statement, based on a review of the literature and the clinical experience of a panel of European epilepsy experts, we present general recommendations for the optimal clinical management of AED treatment in girls, women of childbearing potential, and pregnant women across the different epilepsy syndromes.
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109
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Yang G, Zhou Y, He H, Pan X, Li X, Chai X. A nomogram for predicting in-hospital mortality in acute type A aortic dissection patients. J Thorac Dis 2020; 12:264-275. [PMID: 32274093 PMCID: PMC7139052 DOI: 10.21037/jtd.2020.01.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Although there are several biomarkers for identifying in-hospital mortality in acute type A aortic dissection (AAD), timely as well as perfect prediction in-hospital mortality is still not attained. Herein, we intend to develop as well to validate an in-hospital mortality risk independent predictive nomogram for AAD patients. Methods From January 2014 to December 2018, 703 individuals with AAD were involved in this study. They were indiscriminately categorized into training (n=520) and validation (n=183) sets. The univariate and multivariate analyses were used to screen in-hospital mortality predictors from the entire training set data. The predictors were used to establish a nomogram which was confirmed via internal as well as external authentication. This validation included discriminative capacity defined by the receiver operating characteristic (ROC) curve area under the curve (AUC) and the predictive precision via calibration curves. Results There was 33.43% in-hospital mortality overall incidence. The uric acid, D-dimer, C-reactive protein and management were individually related to in-hospital mortality as per multivariate logistic regression. On the basis of four variables with internal of AUC 0.901 and external validation of AUC 0.903, a nomogram was established. Calibration plots showed that the predicted and actual in-hospital mortality probabilities were fitted well on both internal and external validation. Conclusions This recommended nomogram can calculate the specific possibility of in-hospital mortality with good precision, high discrimination, and probable clinical application in AAD patients.
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Affiliation(s)
- Guifang Yang
- Department of Emergency Medicine, the Second Xiangya Hospital, Central South University, Changsha 410011, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha 410011, China
| | - Yang Zhou
- Department of Emergency Medicine, the Second Xiangya Hospital, Central South University, Changsha 410011, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha 410011, China
| | - Huaping He
- Department of Emergency Medicine, the Second Xiangya Hospital, Central South University, Changsha 410011, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha 410011, China
| | - Xiaogao Pan
- Department of Emergency Medicine, the Second Xiangya Hospital, Central South University, Changsha 410011, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha 410011, China
| | - Xizhao Li
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xiangping Chai
- Department of Emergency Medicine, the Second Xiangya Hospital, Central South University, Changsha 410011, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha 410011, China
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Cvetkovska E, Babunovska M, Kuzmanovski I, Boskovski B, Sazdova-Burneska S, Aleksovski V, Isjanovska R. Patients' attitude toward AED withdrawal: A survey among individuals who had been seizure-free for over 2 years. Epilepsy Behav 2020; 104:106881. [PMID: 31931459 DOI: 10.1016/j.yebeh.2019.106881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The study aimed to evaluate the attitudes of seizure-free patients toward the antiepileptic drug (AED) withdrawal and to highlight the factors that affect their perspectives. METHODS The study participants were recruited among the individuals attending the epilepsy outpatient clinic of a university hospital in Skopje between January 2018 and April 2019. Patients with epilepsy who had been seizure-free for at least 2 years on stable monotherapy were included. RESULTS Among the 90 participants, 43 were female, and the mean age was 36.3 years. The mean duration of active epilepsy before remission was 7.9 years, and the length of the seizure-free period at the time of evaluation was 2-20 years. Forty-four percent of participants aimed to taper their antiseizure medications because of concerns about the potential long-term side effects and teratogenicity, the burden of taking medication daily, stigma, as well as the impression of no longer having a chronic disease after withdrawal. The majority of them preferred slow versus rapid withdrawal. On the other side, 55% of patients choose to continue AED treatment, mainly feeling well-adjusted to it and being concern about possible seizure recurrence after withdrawal and subsequent loss of driving license or even their jobs. Previous unsuccessful attempts to discontinue AED together with previously uncontrolled seizures were additional motives against withdrawal. The patients' views toward stopping or withholding AED were significantly associated with their gender and marital status (male patients as well as single ones favored medication withdrawal). Patients' age to some extent, though not significantly, affected their viewpoints (younger participants tended to question the further necessity of AEDs and were more concerned about the potential adverse consequences). No other demographic or epilepsy-related data considerably predisposed the decisions. CONCLUSIONS More than half of the patients with epilepsy preferred to continue their AED after 2 years of seizure freedom. Male gender, being single, and somewhat younger age were associated preferences to withdraw AED.
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Affiliation(s)
- Emilija Cvetkovska
- University Clinic of Neurology, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000 Skopje, Macedonia.
| | - Marija Babunovska
- University Clinic of Neurology, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000 Skopje, Macedonia
| | - Igor Kuzmanovski
- University Clinic of Neurology, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000 Skopje, Macedonia
| | - Bojan Boskovski
- University Clinic of Neurology, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000 Skopje, Macedonia
| | - Slobodanka Sazdova-Burneska
- University Clinic of Neurology, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000 Skopje, Macedonia
| | - Vasko Aleksovski
- University Clinic of Neurology, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000 Skopje, Macedonia
| | - Rozalinda Isjanovska
- Institute of Epidemiology, Ss Cyril and Methodius University, Vodnjanska str. 17, MK-1000 Skopje, Macedonia
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Josephson CB, Engbers JDT, Jette N, Patten SB, Singh S, Sajobi TT, Marshall D, Agha-Khani Y, Federico P, Mackie A, Macrodimitris S, McLane B, Pillay N, Sharma R, Wiebe S. Prediction Tools for Psychiatric Adverse Effects After Levetiracetam Prescription. JAMA Neurol 2020; 76:440-446. [PMID: 30688969 DOI: 10.1001/jamaneurol.2018.4561] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance Levetiracetam is a commonly used antiepileptic drug, yet psychiatric adverse effects are common and may lead to treatment discontinuation. Objective To derive prediction models to estimate the risk of psychiatric adverse effects from levetiracetam use. Design, Setting, and Participants Retrospective open cohort study. All patients meeting the case definition for epilepsy after the Acceptable Mortality Reporting date in The Health Improvement Network (THIN) database based in the United Kingdom (inclusive January 1, 2000, to May 31, 2012) who received a first-ever prescription for levetiracetam were included. Of 11 194 182 patients registered in THIN, this study identified 7400 presumed incident cases (66.1 cases per 100 000 persons) over a maximum of 12 years' follow-up. The index date was when patients received their first prescription code for levetiracetam, and follow-up lasted 2 years or until an event, loss to follow-up, or censoring. The analyses were performed on April 22, 2018. Exposure A presumed first-ever prescription for levetiracetam. Main Outcomes and Measures The outcome of interest was a Read code for any psychiatric sign, symptom, or disorder as reached through consensus by 2 authors. This study used regression techniques to derive 2 prediction models, one for the overall population and one for those without a history of a psychiatric sign, symptom, or disorder during the study period. Results Among 1173 patients with epilepsy receiving levetiracetam, the overall median age was 39 (interquartile range, 25-56) years, and 590 (50.3%) were female. A total of 14.1% (165 of 1173) experienced a psychiatric symptom or disorder within 2 years of index prescription. The odds of reporting a psychiatric symptom were significantly elevated for women (odds ratio [OR], 1.41; 95% CI, 0.99-2.01; P = .05) and those with a preexposure history of higher social deprivation (OR, 1.15; 95% CI, 1.01-1.31; P = .03), depression (OR, 2.20; 95% CI, 1.49-3.24; P < .001), anxiety (OR, 1.74; 95% CI, 1.11-2.72; P = .02), or recreational drug use (OR, 2.02; 95% CI, 1.20-3.37; P = .008). The model performed well after stratified k = 5-fold cross-validation (area under the curve [AUC], 0.68; 95% CI, 0.58-0.79). There was a gradient in risk, with probabilities increasing from 8% for 0 risk factors to 11% to 17% for 1, 17% to 31% for 2, 30% to 42% for 3, and 49% when all risk factors were present. For those free of a preexposure psychiatric code, a second model performed comparably well after k = 5-fold cross-validation (AUC, 0.72; 95% CI, 0.54-0.90). Specificity was maximized using threshold cutoffs of 0.10 (full model) and 0.14 (second model); a score below these thresholds indicates safety of prescription. Conclusions and Relevance This study derived 2 simple models that predict the risk of a psychiatric adverse effect from levetiracetam. These algorithms can be used to guide prescription in clinical practice.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Nathalie Jette
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Shaily Singh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Yahya Agha-Khani
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Aaron Mackie
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Sophie Macrodimitris
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Brienne McLane
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Neelan Pillay
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruby Sharma
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kaczmarska A, José-López R, Czopowicz M, Lazzerini K, Leblond G, Stalin C, Gutierrez-Quintana R. Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long-term outcome. J Vet Intern Med 2020; 34:808-820. [PMID: 31990104 PMCID: PMC7096646 DOI: 10.1111/jvim.15687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/10/2019] [Indexed: 12/27/2022] Open
Abstract
Background Although the presence of seizures in dogs with meningoencephalitis of unknown origin (MUO) has been associated with shorter survival times, data regarding the prevalence and risk factors for postencephalitic epilepsy (PEE) is lacking. Objectives To describe the clinical features, prevalence, risk factors, and long‐term outcome of PEE in dogs with MUO. Animals Sixty‐one dogs with presumptive diagnosis of MUO based on the clinicopathological and diagnostic imaging findings. Methods Retrospective study. Cases were identified by search of hospital medical records for dogs with suspected or confirmed MUO. Medical records of dogs meeting inclusion criteria were reviewed. Signalment, seizure history, clinicopathologic, and magnetic resonance imaging (MRI) findings were recorded. Results Among 61 dogs at risk of PEE, 14 (23%) dogs developed PEE. Three of 14 dogs with PEE (21%) developed drug‐resistant epilepsy. Dogs with PEE were younger (P = .03; ORadjusted = 0.75; 95% confidence interval [CI], 0.58‐0.98) and had significantly shorter survival times (log‐rank test P = .04) when compared to dogs that did not develop epilepsy. The risk factors associated with the development of PEE were the presence of acute symptomatic seizures (ASS; P = .04; ORadjusted = 4.76; 95% CI, 1.11‐20.4) and MRI lesions in the hippocampus (P = .04; ORadjusted = 4.75; 95% CI, 1.07‐21.0). Conclusions and Clinical Importance Dogs with MUO and seizures at the early stage of the disease (ASS) seem to be at a higher risk of developing PEE.
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Affiliation(s)
- Adriana Kaczmarska
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Roberto José-López
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Michał Czopowicz
- Laboratory of Veterinary Epidemiology and Economics, Faculty of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Kali Lazzerini
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Guillaume Leblond
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Catherine Stalin
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
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Kim KT, Kim DW, Yang KI, Lee ST, Byun JI, Seo JG, No YJ, Kang KW, Kim D, Cho YW. Refining General Principles of Antiepileptic Drug Treatments for Epilepsy. J Clin Neurol 2020; 16:383-389. [PMID: 32657058 PMCID: PMC7354982 DOI: 10.3988/jcn.2020.16.3.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 12/20/2022] Open
Abstract
Antiepileptic drugs (AEDs) are the primary treatment strategy for epilepsy. As the use of AEDs has become more widespread and diverse over the past century, it has become necessary to refine the associated prescription strategies. This prompted the Drug Committee of the Korean Epilepsy Society to perform a systemic review of both international and domestic guidelines as well as literature related to medical treatment of epilepsy, and prepared a series of reviews to provide practical guidelines for clinicians to follow. This article is the first in a series on AED treatments for epilepsy in South Korea.
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Affiliation(s)
- Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ick Byun
- Department of Neurology, Kyunghee University Hospital at Gangdong, Seoul, Korea
| | - Jong Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Joo No
- Department of Neurology, Samsung Noble County, Yongin, Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.
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Abstract
PURPOSE OF REVIEW Drug-resistant epilepsy is a potentially life-threatening condition affecting one-third of people living with epilepsy. Despite existing evidence of improved outcomes in patients who received surgical treatment compared to continued medical treatment, epilepsy surgery remains underused in patients with drug-resistant epilepsy. This article discusses the gap between evidence and practice and common misconceptions about epilepsy surgery and reviews the current diagnostic and therapeutic surgical options. RECENT FINDINGS Three randomized controlled trials comparing the medical versus surgical treatment for patients with drug-resistant epilepsy have shown the superiority of surgery in controlling seizures and improving patients' quality of life. In addition to resective surgery, neuromodulation through devices such as responsive neurostimulation and vagal nerve stimulation have also shown efficacy in seizure control that increases over time. Diagnostic and therapeutic surgical tools are tailored to the needs of each patient. SUMMARY Appropriate patients with drug-resistant epilepsy benefit more from epilepsy surgery than from continuing medical treatment. These patients should be referred to comprehensive epilepsy centers where a thorough presurgical workup and surgical options can be provided. The gap between evidence and practice can be bridged by education, community outreach, and providers' earnest efforts to improve the quality of life of patients with epilepsy.
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Lin J, Ding S, Li X, Hua Y, Wang X, He R, Du Y, Xia N, Chen Y, Zhu Z, Zheng R, Xu H. External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients. Epilepsia 2019; 61:115-124. [PMID: 31792957 DOI: 10.1111/epi.16402] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Jiahe Lin
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Siqi Ding
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Xueying Li
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Yingjie Hua
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Xinshi Wang
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Ruqian He
- Department of Neurology Ruian People's Hospital (Third Affiliated Hospital of Wenzhou Medical University) Wenzhou China
| | - Yanru Du
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Niange Xia
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Yanyan Chen
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Zhenguo Zhu
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Rongyuan Zheng
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Huiqin Xu
- Department of Neurology First Affiliated Hospital of Wenzhou Medical University Wenzhou China
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Wang J, Huang P, Song Z. Comparison of the relapse rates in seizure-free patients in whom antiepileptic therapy was discontinued and those in whom the therapy was continued: A meta-analysis. Epilepsy Behav 2019; 101:106577. [PMID: 31706169 DOI: 10.1016/j.yebeh.2019.106577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
About 70% of patients with epilepsy can be seizure-free with an appropriate treatment. When the seizures are under control, discontinuation of the antiepileptic drugs (AEDs) can help avoid their side effects; however, it may increase the risk of relapse. Some studies have compared the relapse rates between patients in whom AEDs have been continued and those in whom AEDs have been discontinued. However, it is not clear whether AED discontinuation causes a higher seizure recurrence rate. This meta-analysis aimed mainly to determine whether the seizure recurrence rate was different between seizure-free patients in whom AEDs were continued and those in whom AEDs were discontinued. The I2 value was used for assessing the heterogeneity; the Mantel-Haenszel test was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs). Seven cohort studies and randomized controlled trials (RCTs) met the inclusion criteria. The study quality evaluation was performed respectively using the Newcastle-Ottawa Scale and the Jadad scale. A total of 1253 patients were included. The relapse rate was higher in patients in whom AEDs were discontinued than in those in whom the AED treatment was continued. Furthermore, we also compared the epilepsy recurrence rates after AED discontinuation between seizure-free patients who were on monotherapy with different AEDs (carbamazepine, phenytoin, sodium valproate, and phenobarbitone/primidone). Four studies and 625 patients were included in this analysis. The epilepsy recurrence rates did not significantly differ between the patients on different AED treatment.
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Affiliation(s)
- Jingjing Wang
- Department of Neurology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Pin Huang
- Department of Cardiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhi Song
- Department of Neurology, Third Xiangya Hospital of Central South University, Changsha, China.
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Hayden JA, Wilson MN, Riley RD, Iles R, Pincus T, Ogilvie R. Individual recovery expectations and prognosis of outcomes in non-specific low back pain: prognostic factor review. Cochrane Database Syst Rev 2019; 2019:CD011284. [PMID: 31765487 PMCID: PMC6877336 DOI: 10.1002/14651858.cd011284.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Low back pain is costly and disabling. Prognostic factor evidence can help healthcare providers and patients understand likely prognosis, inform the development of prediction models to identify subgroups, and may inform new treatment strategies. Recent studies have suggested that people who have poor expectations for recovery experience more back pain disability, but study results have differed. OBJECTIVES To synthesise evidence on the association between recovery expectations and disability outcomes in adults with low back pain, and explore sources of heterogeneity. SEARCH METHODS The search strategy included broad and focused electronic searches of MEDLINE, Embase, CINAHL, and PsycINFO to 12 March 2019, reference list searches of relevant reviews and included studies, and citation searches of relevant expectation measurement tools. SELECTION CRITERIA We included low back pain prognosis studies from any setting assessing general, self-efficacy, and treatment expectations (measured dichotomously and continuously on a 0 - 10 scale), and their association with work participation, clinically important recovery, functional limitations, or pain intensity outcomes at short (3 months), medium (6 months), long (12 months), and very long (> 16 months) follow-up. DATA COLLECTION AND ANALYSIS We extracted study characteristics and all reported estimates of unadjusted and adjusted associations between expectations and related outcomes. Two review authors independently assessed risks of bias using the Quality in Prognosis Studies (QUIPS) tool. We conducted narrative syntheses and meta-analyses when appropriate unadjusted or adjusted estimates were available. Two review authors independently graded and reported the overall quality of evidence. MAIN RESULTS We screened 4635 unique citations to include 60 studies (30,530 participants). Thirty-five studies were conducted in Europe, 21 in North America, and four in Australia. Study populations were mostly chronic (37%), from healthcare (62%) or occupational settings (26%). General expectation was the most common type of recovery expectation measured (70%); 16 studies measured more than one type of expectation. Usable data for syntheses were available for 52 studies (87% of studies; 28,885 participants). We found moderate-quality evidence that positive recovery expectations are strongly associated with better work participation (narrative synthesis: 21 studies; meta-analysis: 12 studies, 4777 participants: odds ratio (OR) 2.43, 95% confidence interval (CI) 1.64 to 3.62), and low-quality evidence for clinically important recovery outcomes (narrative synthesis: 12 studies; meta-analysis: 5 studies, 1820 participants: OR 1.89, 95% CI 1.49 to 2.41), both at follow-up times closest to 12 months, using adjusted data. The association of recovery expectations with other outcomes of interest, including functional limitations (narrative synthesis: 10 studies; meta-analysis: 3 studies, 1435 participants: OR 1.40, 95% CI 0.85 to 2.31) and pain intensity (narrative synthesis: 9 studies; meta-analysis: 3 studies, 1555 participants: OR 1.15, 95% CI 1.08 to 1.23) outcomes at follow-up times closest to 12 months using adjusted data, is less certain, achieving very low- and low-quality evidence, respectively. No studies reported statistically significant or clinically important negative associations between recovery expectations and any low back pain outcome. AUTHORS' CONCLUSIONS We found that individual recovery expectations are probably strongly associated with future work participation (moderate-quality evidence) and may be associated with clinically important recovery outcomes (low-quality evidence). The association of recovery expectations with other outcomes of interest is less certain. Our findings suggest that recovery expectations should be considered in future studies, to improve prognosis and management of low back pain.
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Affiliation(s)
- Jill A Hayden
- Dalhousie UniversityDepartment of Community Health & Epidemiology5790 University AvenueRoom 403HalifaxNSCanadaB3H 1V7
| | - Maria N Wilson
- Dalhousie UniversityDepartment of Community Health and EpidemiologyHalifaxNova ScotiaCanada
| | - Richard D Riley
- Keele UniversitySchool of Primary, Community and Social CareDavid Weatherall Building, Keele University CampusKeeleStaffordshireUKST5 5BG
| | - Ross Iles
- Monash UniversityDepartment of Physiotherapy, Faculty of Medicine, Nursing and Health SciencesPeninsula CampusFrankstonVictoriaAustralia3199
| | - Tamar Pincus
- Royal Holloway University of LondonDepartment of PsychologyEghamSurreyUKTW20 0EX
| | - Rachel Ogilvie
- Dalhousie UniversityCommunity Health & Epidemiology5760 University AvenueHalifaxCanadaB3H 1V7
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Quantitative analysis of phenotypic elements augments traditional electroclinical classification of common familial epilepsies. Epilepsia 2019; 60:2194-2203. [PMID: 31625138 PMCID: PMC7145322 DOI: 10.1111/epi.16354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Classification of epilepsy into types and subtypes is important for both clinical care and research into underlying disease mechanisms. A quantitative, data-driven approach may augment traditional electroclinical classification and shed new light on existing classification frameworks. METHODS We used latent class analysis, a statistical method that assigns subjects into groups called latent classes based on phenotypic elements, to classify individuals with common familial epilepsies from the Epi4K Multiplex Families study. Phenotypic elements included seizure types, seizure symptoms, and other elements of the medical history. We compared class assignments to traditional electroclinical classifications and assessed familial aggregation of latent classes. RESULTS A total of 1120 subjects with epilepsy were assigned to five latent classes. Classes 1 and 2 contained subjects with generalized epilepsy, largely reflecting the distinction between absence epilepsies and younger onset (class 1) versus myoclonic epilepsies and older onset (class 2). Classes 3 and 4 contained subjects with focal epilepsies, and in contrast to classes 1 and 2, these did not adhere as closely to clinically defined focal epilepsy subtypes. Class 5 contained nearly all subjects with febrile seizures plus or unknown epilepsy type, as well as a few subjects with generalized epilepsy and a few with focal epilepsy. Family concordance of latent classes was similar to or greater than concordance of clinically defined epilepsy types. SIGNIFICANCE Quantitative classification of epilepsy has the potential to augment traditional electroclinical classification by (1) combining some syndromes into a single class, (2) splitting some syndromes into different classes, (3) helping to classify subjects who could not be classified clinically, and (4) defining the boundaries of clinically defined classifications. This approach can guide future research, including molecular genetic studies, by identifying homogeneous sets of individuals that may share underlying disease mechanisms.
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Relative Seizure Relapse Risks Associated with Antiepileptic Drug Withdrawal After Different Seizure-Free Periods in Adults with Focal Epilepsy: A Prospective, Controlled Follow-Up Study. CNS Drugs 2019; 33:1121-1132. [PMID: 31686405 DOI: 10.1007/s40263-019-00679-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Approximately two-thirds of patients with newly diagnosed epilepsy become seizure-free after antiepileptic drug (AED) treatment. A crucial issue for these patients and their families, especially after a long period of seizure freedom, is when to stop their medications. OBJECTIVE The aim of this study was to identify the optimal timing of AED withdrawal in adults with focal epilepsy who had been seizure-free for ≥ 2 years. METHODS Adults with focal epilepsy who had been seizure-free for ≥ 2 years were recruited. Based on their decision to discontinue (withdrawal) or continue (non-withdrawal) AED treatment, patients were assigned to withdrawal or non-withdrawal subgroups according to the length of remission (2 to < 3 years, 3 to < 4 years, 4 to < 5 years and ≥ 5 years). The relapse risks of the withdrawal and corresponding non-withdrawal subgroups were compared, and the relative relapse risks were assessed in a Cox proportional hazard regression model. RESULTS A total of 213 eligible patients began to withdraw from AED treatment; 70 had been seizure-free for 2 to < 3 years, 62 had been seizure-free for 3 to < 4 years, 37 had been seizure-free for 4 to < 5 years and 44 had been seizure-free for ≥ 5 years. The figures for the corresponding non-withdrawal subgroups were 463, 334, 251 and 182, respectively. There was a significantly higher risk of seizure relapse in patients withdrawing from AEDs after 2 to < 5 years of seizure freedom than in the corresponding non-withdrawal controls, and the relative relapse risk was 3.052 (95% confidence interval [CI] 2.126-4.381; p < 0.001) for the seizure-free period of 2 to < 3 years, 3.617 (95% CI 2.384-5.488; p < 0.001) for 3 to < 4 years and 2.644 (95% CI 1.456-4.799; p = 0.001) for 4 to < 5 years. However, for patients who were seizure-free for ≥ 5 years, AED withdrawal did not significantly increase the risk of seizure relapse compared with that of patients continuing treatment (hazard ratio [HR] 1.362, 95% CI 0.634-2.926, p = 0.428). Compared with a seizure-free period of 2 to < 3 years, the relative relapse risk after AED withdrawal was significantly reduced only after being seizure-free for ≥ 5 years (HR 0.441, 95% CI 0.233-0.834; p = 0.012). CONCLUSION Overall, for adults with focal epilepsy, withdrawal from AEDs significantly increased the risk of seizure relapse after being seizure-free for 2 to < 5 years, but might not increase the risk if the seizure-free period was ≥ 5 years.
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Vorderwülbecke BJ, Kirschbaum A, Merkle H, Senf P, Holtkamp M. Discontinuing antiepileptic drugs in long-standing idiopathic generalised epilepsy. J Neurol 2019; 266:2554-2559. [DOI: 10.1007/s00415-019-09457-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW The goal of this review is to survey the current literature on education in epilepsy and provide the most up-to-date information for physicians involved in the training of future doctors on this topic. We intended to review what opportunities exist to enhance our current teaching practices that may not be well-known or widely used, but may be adapted to a broader audience. RECENT FINDINGS Many new techniques adopting principles of education (e.g., retrieval practice and spaced learning) or new technologies (e.g., pre-recorded lectures, computer-enhanced modules, and simulation practice) have been trialled to enhance medical education in epilepsy with some success. Many of these techniques are currently adaptable to a wider audience or may soon be available. The use of these opportunities more broadly may allow expansion of educational research opportunities as well as enhancing our ability to pass on information. As the knowledge base in epilepsy continues to dramatically expand, we need to keep evaluating our teaching techniques to ensure we are able to pass along this knowledge to our future providers.
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Affiliation(s)
- Daniel J Weber
- Department of Neurology, St. Louis University, 1438 S Grand Boulevard, St. Louis, MO, 63110, USA.
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Inhibition and oscillations in the human brain tissue in vitro. Neurobiol Dis 2019; 125:198-210. [DOI: 10.1016/j.nbd.2019.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/22/2018] [Accepted: 02/07/2019] [Indexed: 01/22/2023] Open
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Allotey J, Fernandez-Felix BM, Zamora J, Moss N, Bagary M, Kelso A, Khan R, van der Post JAM, Mol BW, Pirie AM, McCorry D, Khan KS, Thangaratinam S. Predicting seizures in pregnant women with epilepsy: Development and external validation of a prognostic model. PLoS Med 2019; 16:e1002802. [PMID: 31083654 PMCID: PMC6513048 DOI: 10.1371/journal.pmed.1002802] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Seizures are the main cause of maternal death in women with epilepsy, but there are no tools for predicting seizures in pregnancy. We set out to develop and validate a prognostic model, using information collected during the antenatal booking visit, to predict seizure risk at any time in pregnancy and until 6 weeks postpartum in women with epilepsy on antiepileptic drugs. METHODS AND FINDINGS We used datasets of a prospective cohort study (EMPiRE) of 527 pregnant women with epilepsy on medication recruited from 50 hospitals in the UK (4 November 2011-17 August 2014). The model development cohort comprised 399 women whose antiepileptic drug doses were adjusted based on clinical features only; the validation cohort comprised 128 women whose drug dose adjustments were informed by serum drug levels. The outcome was epileptic (non-eclamptic) seizure captured using diary records. We fitted the model using LASSO (least absolute shrinkage and selection operator) regression, and reported the performance using C-statistic (scale 0-1, values > 0.5 show discrimination) and calibration slope (scale 0-1, values near 1 show accuracy) with 95% confidence intervals (CIs). We determined the net benefit (a weighted sum of true positive and false positive classifications) of using the model, with various probability thresholds, to aid clinicians in making individualised decisions regarding, for example, referral to tertiary care, frequency and intensity of monitoring, and changes in antiepileptic medication. Seizures occurred in 183 women (46%, 183/399) in the model development cohort and in 57 women (45%, 57/128) in the validation cohort. The model included age at first seizure, baseline seizure classification, history of mental health disorder or learning difficulty, occurrence of tonic-clonic and non-tonic-clonic seizures in the 3 months before pregnancy, previous admission to hospital for seizures during pregnancy, and baseline dose of lamotrigine and levetiracetam. The C-statistic was 0.79 (95% CI 0.75, 0.84). On external validation, the model showed good performance (C-statistic 0.76, 95% CI 0.66, 0.85; calibration slope 0.93, 95% CI 0.44, 1.41) but with imprecise estimates. The EMPiRE model showed the highest net proportional benefit for predicted probability thresholds between 12% and 99%. Limitations of this study include the varied gestational ages of women at recruitment, retrospective patient recall of seizure history, potential variations in seizure classification, the small number of events in the validation cohort, and the clinical utility restricted to decision-making thresholds above 12%. The model findings may not be generalisable to low- and middle-income countries, or when information on all predictors is not available. CONCLUSIONS The EMPiRE model showed good performance in predicting the risk of seizures in pregnant women with epilepsy who are prescribed antiepileptic drugs. Integration of the tool within the antenatal booking visit, deployed as a simple nomogram, can help to optimise care in women with epilepsy.
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Affiliation(s)
- John Allotey
- Barts Research Centre for Women’s Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, United Kingdom
| | - Borja M. Fernandez-Felix
- CIBER Epidemiology and Public Health, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - Javier Zamora
- Barts Research Centre for Women’s Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- CIBER Epidemiology and Public Health, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
- * E-mail:
| | - Ngawai Moss
- Patient and Public Involvement, Katie’s Team, Katherine Twining Network, Queen Mary University of London, London, United Kingdom
| | - Manny Bagary
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Kelso
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rehan Khan
- Department of Obstetrics and Gynaecology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Joris A. M. van der Post
- Department of Obstetrics and Gynaecology, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ben W. Mol
- Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | | | - Dougall McCorry
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Khalid S. Khan
- Barts Research Centre for Women’s Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, United Kingdom
| | - Shakila Thangaratinam
- Barts Research Centre for Women’s Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, United Kingdom
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Yang SJ, He GN, Han X, Wang N, Chen Y, Zhu XR, Ma BQ, Li MM, Zhao P, Chen YN, Zhao T, Ma H. A scale for prediction of response to AEDs in patients with MRI-negative epilepsy. Epilepsy Behav 2019; 94:41-46. [PMID: 30884406 DOI: 10.1016/j.yebeh.2019.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Antiepileptic drugs (AEDs) are the first choice in magnetic resonance imaging (MRI)-negative patients with epilepsy, although the responses to AEDs are diverse. Preoperative evaluation and postoperative prognosis in MRI-negative epilepsy have been reported. However, there are few tools for predicting the response to AEDs. Herein, we developed an AED response scale based on clinical factors and video-electroencephalography (VEEG) in MRI-negative patients with epilepsy. METHODS A total of 132 consecutive patients with MRI-negative epilepsy at the Epilepsy Center of Henan Provincial People's Hospital between August 2016 and August 2018 were included. Patients were further divided into drug-responsive epilepsy ([DSE-MRI (-)]; n = 101) and drug-resistant epilepsy ([DRE-MRI (-)]; n = 31) groups. The clinical and VEEG factors were evaluated in univariate analyses and multivariate logistic regression analyses. A scale was derived and the scores categorized into 3 risk levels of DRE-MRI (-). RESULTS A scale was established based on 4 independent risk factors for DRE-MRI (-). The scale had a sensitivity of 83.87%, specificity of 80.20%, positive likelihood ratio of 4.24, negative likelihood ratio of 0.20, and showed good discrimination with the area under the curve (AUC) of 0.886 (0.826-0.946). The categorization of the risk score based on this scale was: low risk (0-3 points), medium risk (3-5 points), and high risk (>5 points). CONCLUSION We established a DRE-MRI (-) scale with a good sensitivity and specificity, which may be useful for clinicians when making medical decisions in patients with MRI-negative epilepsy.
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Affiliation(s)
- Shi-Jun Yang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Gui-Nv He
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Yi Chen
- Clinical research service center, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Xue-Rui Zhu
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Bing-Qian Ma
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Ming-Min Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ya-Nan Chen
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Huan Ma
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
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Yao J, Wang H, Xiao Z. Correlation between EEG during AED withdrawal and epilepsy recurrence: a meta-analysis. Neurol Sci 2019; 40:1637-1644. [PMID: 31011931 DOI: 10.1007/s10072-019-03855-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
To assess the risk of epilepsy recurrence after withdrawal from antiepileptic drugs (AEDs), researchers extensively studied recurrence-related risk factors, including electroencephalogram (EEG) during AED withdrawal. The relationship between EEG and epilepsy recurrence is controversial. We used meta-analysis to determine the correlation between EEG during AED withdrawal and epilepsy recurrence. A total of seven studies met the criteria for inclusion. The Newcastle-Ottawa Scale was used to conduct the research quality evaluation. Seven hundred three patients were included in meta-analysis. Patients with abnormal EEGs during withdrawal had a higher recurrence rate than patients with normal EEGs. Abnormal EEGs during withdrawal were a risk factor for recurrence.
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Affiliation(s)
- Juan Yao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hao Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Britton JW, Dalmau J. Recognizing autoimmune encephalitis as a cause of seizures: Treating cause and not effect. Neurology 2019; 92:877-878. [PMID: 30979858 DOI: 10.1212/wnl.0000000000007444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jeffrey W Britton
- From the Division of Epilepsy (J.W.B.) and ICREA and Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic (J.D.), Universitat de Barcelona, Spain; and Department of Neurology(J.D.), University of Pennsylvania, Philadelphia.
| | - Josep Dalmau
- From the Division of Epilepsy (J.W.B.) and ICREA and Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic (J.D.), Universitat de Barcelona, Spain; and Department of Neurology(J.D.), University of Pennsylvania, Philadelphia
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127
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Chakraborty T, Hocker S. Weaning from antiseizure drugs after new onset status epilepticus. Epilepsia 2019; 60:979-985. [PMID: 30963565 DOI: 10.1111/epi.14730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/04/2019] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In patients with status epilepticus (SE) without prior epilepsy, there are limited data on the safety of discontinuing antiseizure drugs (ASDs) after seizure control. We aimed to describe seizure recurrence when weaning from ASDs following new onset SE (NOSE). METHODS Retrospective review of adult patients with NOSE admitted to Mayo Clinic, Rochester, Minnesota between January 1, 1990 and December 31, 2015 was performed. Weaning was defined as a discontinuation of ASDs following discharge. Patient demographics, SE characteristics, timing of ASD withdrawal, and seizure recurrence were collected. RESULTS One hundred seventy-seven patients with mean age 63 ± 18 years were identified; 96 (54.2%) patients had refractory SE (RSE), and 81 (45.8%) had nonrefractory SE. Mean follow-up was 3.8 ± 3.2 years for those successfully weaned off ASDs. One hundred thirty (73.4%) with outpatient follow-up were included in the analysis; 128 (98.5%) patients were discharged on an ASD; 44 of 128 (34.4%) patients underwent weaning from at least 1 ASD following discharge, including 27 of 128 (21.1%) who were completely weaned off of all ASDs. Younger patients (P = 0.009) and those with RSE (P = 0.048, odds ratio = 2.12, 95% confidence interval = 1.00-4.48) tended to undergo weaning. Six of 44 (13.6%) patients had seizure recurrence when weaned off of any ASD, and two of 27 (7.4%) patients completely weaned off all ASDs had seizure recurrence. Two of seven (28.6%) patients who underwent attempted barbiturate weaning experienced seizure recurrence. SIGNIFICANCE We found a rate of 13.6% for late seizure recurrence after weaning from at least one ASD in patients with NOSE; seizure recurrence was more likely in patients with RSE treated with barbiturates. Systematic collection of longitudinal data in patients requiring multiple ASDs for NOSE control will provide more conclusive guidance on weaning from ASDs.
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Affiliation(s)
| | - Sara Hocker
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Abstract
PURPOSE OF REVIEW As the number of patients diagnosed with epilepsy continues to rise and the pharmacological and device-based treatment options for epilepsy increase, determining when to stop antiepileptic drug (AED) treatment continues to be an important issue for patient management and counseling. RECENT FINDINGS This review focuses on outcomes following AED withdrawal in seizure-free adults with epilepsy. Practical considerations are also discussed because, despite the importance of this topic, relatively little progress has been made in the past year regarding the identification of patients whose risk for recurrent seizures after AED withdrawal is no higher than that of the general population. SUMMARY Although articles in the past year have updated the debates about whether and when to discontinue AEDs in seizure-free adults and have suggested potential utility for electroencephalograms as a prognostic tool for AED reduction as well as for an AED withdrawal risk calculator, decisions about AED withdrawal should still be based on the known risks and consequences of seizure recurrence and be made following well documented discussions between doctor and patient/carer.
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Thijs RD, Surges R, O'Brien TJ, Sander JW. Epilepsy in adults. Lancet 2019; 393:689-701. [PMID: 30686584 DOI: 10.1016/s0140-6736(18)32596-0] [Citation(s) in RCA: 973] [Impact Index Per Article: 194.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/08/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Its incidence has a bimodal distribution with the highest risk in infants and older age groups. Progress in genomic technology is exposing the complex genetic architecture of the common types of epilepsy, and is driving a paradigm shift. Epilepsy is a symptom complex with multiple risk factors and a strong genetic predisposition rather than a condition with a single expression and cause. These advances have resulted in the new classification of epileptic seizures and epilepsies. A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances in brain imaging are helping to identify the structural and functional causes and consequences of the epilepsies. Comorbidities are increasingly recognised as important aetiological and prognostic markers. Antiseizure medication might suppress seizures in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy surgery is the most effective way to achieve long-term seizure freedom in selected individuals with drug-resistant focal epilepsy, but it is probably not used enough. With improved understanding of the gradual development of epilepsy, epigenetic determinants, and pharmacogenomics comes the hope for better, disease-modifying, or even curative, pharmacological and non-pharmacological treatment strategies. Other developments are clinical implementation of seizure detection devices and new neuromodulation techniques, including responsive neural stimulation.
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Affiliation(s)
- Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Rainer Surges
- Section of Epileptology, Department of Neurology, University Hospital RWTH Aachen, Germany
| | - Terence J O'Brien
- Melbourne Brain Centre, Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, VIC, Australia; Departments of Neuroscience and Neurology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, VIC, Australia
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
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130
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Ou S, Xia L, Li R, Wang L, Xia L, Zhou Q, Pan S. Long-term outcome of seizure-free patients and risk factors of relapse following antiepileptic drug withdrawal. Epilepsy Behav 2018; 88:295-300. [PMID: 30340125 DOI: 10.1016/j.yebeh.2018.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to investigate the long-term outcome in seizure-free patients and to explore the risk factors of seizure relapse following antiepileptic drug (AED) withdrawal. METHODS This study included 161 patients who had been seizure-free for at least 2 years. These patients were monitored over a follow-up period of at least 3 years or until seizure relapse after AED withdrawal. Patients were grouped into a seizure-free group and a relapse group. Risk factors of seizure relapse were analyzed. RESULTS During the follow-up period, 72 patients (44.7%) relapsed while 89 patients (55.3%) did not. The average time of relapse was 19.12 ± 27.17 months after the initiation of AED withdrawal, and majority of cases occurred within the first 24 months of AED withdrawal (73.6%). Univariate analysis showed that the likelihood of relapse was higher in patients with uncontrolled seizures beyond the first 6 months of AED therapy initiation, patients with a history of perinatal injury, patients with multiple seizure types, and patients who had been treated with a combination of AEDs. Multiple logistic regression analysis revealed that uncontrolled seizures beyond the first 6 months of AED treatment and a history of perinatal injury were independent risk factors of seizure relapse. CONCLUSION In the majority of cases, epilepsy relapse occurred within the first two years after the initiation of AED withdrawal. The independent risk factors of seizure relapse were uncontrolled seizures beyond the first 6 months of AED therapy and cases with a history of perinatal injury.
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Affiliation(s)
- Shuchun Ou
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Lu Xia
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Rong Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Li Wang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Li Xia
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qin Zhou
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Songqing Pan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
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Abstract
The current paradigm for treatment of epilepsy begins with trials of antiepileptic drugs, followed by evaluation for resective brain surgery in drug-resistant patients. If surgery is not possible or fails to control seizures, some patients benefit from implanted neurostimulation devices. In addition to their therapeutic benefit, some of these devices have diagnostic capability enabling recordings of brain activity with unprecedented chronicity. Two recent studies using different devices for chronic EEG (i.e., over months to years) yielded convergent findings of daily and multiday cycles of brain activity that help explain seizure timing. Knowledge of these patient-specific cycles can be leveraged to gauge and forecast seizure risk, empowering patients to adopt risk-stratified treatment strategies and behavioral modifications. We review evidence that epilepsy is a cyclical disorder, and we argue that implanted monitoring devices should be offered earlier in the treatment paradigm. Chronic EEG would allow pharmacologic treatments tailored to days of high seizure risk-here termed chronotherapy-and would help characterize long timescale seizure dynamics to improve subsequent surgical planning. Coupled with neuromodulation, the proposed approach could improve quality of life for patients and decrease the number ultimately requiring resective surgery. We outline challenges for chronic monitoring and seizure forecasting that demand close collaboration among engineers, neurosurgeons, and neurologists.
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Affiliation(s)
- Maxime O Baud
- From the Sleep-Wake-Epilepsy Center and Center for Experimental Neurology, Department of Neurology (M.O.B.), Inselspital, Bern University Hospital, University of Bern; Wyss Center for Bio- and Neuro-engineering (M.O.B.), Geneva, Switzerland; and Department of Neurology and Weill Institute for Neurosciences (V.R.R.), University of California, San Francisco.
| | - Vikram R Rao
- From the Sleep-Wake-Epilepsy Center and Center for Experimental Neurology, Department of Neurology (M.O.B.), Inselspital, Bern University Hospital, University of Bern; Wyss Center for Bio- and Neuro-engineering (M.O.B.), Geneva, Switzerland; and Department of Neurology and Weill Institute for Neurosciences (V.R.R.), University of California, San Francisco
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Stevelink R, Koeleman BPC, Sander JW, Jansen FE, Braun KPJ. Refractory juvenile myoclonic epilepsy: a meta-analysis of prevalence and risk factors. Eur J Neurol 2018; 26:856-864. [PMID: 30223294 PMCID: PMC6586162 DOI: 10.1111/ene.13811] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/12/2018] [Indexed: 01/12/2023]
Abstract
Background and purpose Juvenile myoclonic epilepsy (JME) is a common epilepsy syndrome for which treatment response is generally assumed to be good. We aimed to determine the prevalence and prognostic risk factors for refractoriness of JME. Methods We systematically searched PubMed and EMBASE and included 43 eligible studies, reporting seizure outcome after antiepileptic drug (AED) treatment in JME cohorts. We defined refractory JME as persistence of any seizure despite AED treatment and performed a random‐effects meta‐analysis to assess the prevalence of refractory JME and of seizure recurrence after AED withdrawal in individuals with well‐controlled seizures. Studies reporting potential prognostic risk factors in relation to seizure outcome were included for subsequent meta‐analysis of risk factors for refractoriness. Results Overall, 35% (95% confidence interval, 29–41%) of individuals (n = 3311) were refractory. There was marked heterogeneity between studies. Seizures recurred in 78% (95% confidence interval, 52–94%) of individuals who attempted to withdraw from treatment after a period of seizure freedom (n = 246). Seizure outcome by publication year suggested that prognosis did not improve over time. Meta‐analysis suggested six variables as prognostic factors for refractoriness, i.e. having three seizure types, absence seizures, psychiatric comorbidities, earlier age at seizure onset, history of childhood absence epilepsy and praxis‐induced seizures. Conclusion One‐third of people with JME were refractory, which is a higher prevalence than expected. Risk factors were identified and can be used to guide treatment and counselling of people with JME.
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Affiliation(s)
- R Stevelink
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht.,Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht
| | - B P C Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht
| | - J W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - F E Jansen
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
| | - K P J Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
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Zhang JH, Han X, Zhao HW, Zhao D, Wang N, Zhao T, He GN, Zhu XR, Zhang Y, Han JY, Huang DL. Personalized prediction model for seizure-free epilepsy with levetiracetam therapy: a retrospective data analysis using support vector machine. Br J Clin Pharmacol 2018; 84:2615-2624. [PMID: 30043454 DOI: 10.1111/bcp.13720] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 07/08/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS To predict the probability of a seizure-free (SF) state in patients with epilepsy (PWEs) after treatment with levetiracetam and to identify the clinical and electroencephalographic (EEG) factors that affect outcomes. METHODS Retrospective analysis of PWEs treated with levetiracetam for 3 years identified 22 patients who were SF and 24 who were not. Before starting levetiracetam, 11 clinical factors and four EEG features (sample entropy of α, β, θ, δ) were identified. Overall, 80% of each the two groups were chosen to establish a support vector machine (SVM) model with 5-fold cross-validation, hold-out validation and jack-knife validation. The other 20% were used to predict the efficacy of levetiracetam. The mean impact value (MIV) algorithm was used to rank the relativity between factors and outcomes. RESULTS Compared with SF patients, not SF patients displayed a specific decrease in EEG sample entropy in α band from the F4 channel, β band from Fp2 and F8 channels, θ band from C3 channel (P < 0.05). The SVM model based on the clinical and EEG features yielded 72.2% accuracy of 5-fold cross-validation, 75.0% accuracy of jack-knife validation, 67.7% accuracy of hold-out validation in the training set and had a high prediction accuracy of 90% in test set (sensitivity was 100%, area under the receiver operating characteristic curve was 0.96). The feature of β band from Fp2 weighs heavily in the prediction model according to the mean impact value algorithm. CONCLUSIONS The efficacy of levetiracetam on newly diagnosed PWEs could be predicted using an SVM model, which could guide antiepileptic drug selection.
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Affiliation(s)
- Jia-Hui Zhang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Xiong Han
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Hong-Wei Zhao
- Department of Pharmacy, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Di Zhao
- Department of Computer Network Information Center, Chinese Academy of Sciences, Beijing, China
| | - Na Wang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Ting Zhao
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Gui-Nv He
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Xue-Rui Zhu
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Ying Zhang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Province, China
| | - Jiu-Yan Han
- Department of Clinical Medicine, Zhengzhou University, Henan Province, China
| | - Dian-Ling Huang
- Department of Computer Network Information Center, Chinese Academy of Sciences, Beijing, China
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Łączkowski KZ, Konklewska N, Biernasiuk A, Malm A, Sałat K, Furgała A, Dzitko K, Bekier A, Baranowska-Łączkowska A, Paneth A. Thiazoles with cyclopropyl fragment as antifungal, anticonvulsant, and anti- Toxoplasma gondii agents: synthesis, toxicity evaluation, and molecular docking study. Med Chem Res 2018; 27:2125-2140. [PMID: 30220831 PMCID: PMC6133161 DOI: 10.1007/s00044-018-2221-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/07/2018] [Indexed: 01/05/2023]
Abstract
Synthesis and investigation of antifungal, anticonvulsant and anti-Toxoplasma gondii activities of ten novel (2-(cyclopropylmethylidene)hydrazinyl)thiazole 3a-3j are presented. Among the derivatives, compounds 3a-3d and 3f-3j possess very high activity against Candida spp. ATCC with MIC = 0.015-7.81 µg/ml. Compounds 3a-3d and 3f-3j possess also very high activity towards most of strains of Candida spp. isolated from clinical materials with MIC = 0.015-7.81 µg/ml. The activity of these compounds is similar and even higher than the activity of nystatin used as positive control. Additionally, compounds 3c and 3e showed interesting anticonvulsant activities in the MES test, whereas compounds 3f and 3i demonstrated the anticonvulsant activity in PTZ-induced seizures. Noteworthy, none of these compounds impaired animals' motor skills in the rotarod test. Moreover, thiazoles 3a, 3h, and 3j showed significant anti-Toxoplasma gondii activity, with IC50 values 31-52 times lower than those observed for sulfadiazine. The results of the cytotoxicity evaluation, anti-Candida spp. and anti-Toxoplasma gondii activity studies showed that Candida spp. and Toxoplasma gondii growth was inhibited at non-cytotoxic concentrations for the mouse L929 fibroblast and the African green monkey kidney (VERO) cells. Molecular docking studies indicated secreted aspartic proteinase (SAP) as possible antifungal target.
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Affiliation(s)
- Krzysztof Z. Łączkowski
- Department of Chemical Technology and Pharmaceuticals, Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Natalia Konklewska
- Department of Chemical Technology and Pharmaceuticals, Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Anna Biernasiuk
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Medical University, Chodźki 1, 20-093 Lublin, Poland
| | - Anna Malm
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Medical University, Chodźki 1, 20-093 Lublin, Poland
| | - Kinga Sałat
- Chair of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University, Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Anna Furgała
- Chair of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University, Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Katarzyna Dzitko
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | - Adrian Bekier
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | | | - Agata Paneth
- Department of Organic Chemistry, Faculty of Pharmacy, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
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Bartolini L, Majidi S, Koubeissi MZ. Uncertainties from a worldwide survey on antiepileptic drug withdrawal after seizure remission. Neurol Clin Pract 2018; 8:108-115. [PMID: 29708173 DOI: 10.1212/cpj.0000000000000441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/05/2017] [Indexed: 11/15/2022]
Abstract
Background We sought to determine differences in practice for discontinuation of antiepileptic drugs (AEDs) after seizure remission and stimulate the planning and conduction of withdrawal trials. Methods We utilized a worldwide electronic survey that included questions about AED discontinuation for 3 paradigmatic cases in remission: (1) focal epilepsy of unknown etiology, (2) temporal lobe epilepsy after surgery, and (3) juvenile myoclonic epilepsy. We analyzed 466 complete questionnaires from 53 countries, including the United States. Statistical analysis included χ2 and multivariate logistic regression. Results Case 1: responders in practice for <10 years were less likely to taper AEDs: odds ratio (OR) (95% confidence interval [CI]) 0.52 (0.32-0.85), p = 0.02. The likelihood of stopping AEDs was higher among doctors treating children: OR (95% CI): 11.41 (2.51-40.13), p = 0.002. Doctors treating children were also more likely to stop after 2 years or less of remission: OR (95% CI): 6.91 (2.62-19.31), p = 0.002, and the same was observed for US physicians: OR (95% CI): 1.61 (1.01-2.57), p = 0.0049. Case 2: responders treating children were more likely to taper after 1 year or less of postoperative remission, with the goal of discontinuing all medications: OR (95% CI): 1.91 (1.09-3.12), p = 0.015, and so were US-based responders: OR (95% CI): 1.73 (1.21-2.41), p = 0.003. Case 3: epileptologists were less likely to withdraw the medication: OR (95% CI): 0.56 (0.39-0.82), p = 0.003, and so were those in practice for 10 or more years: OR (95% CI): 0.54 (0.31-0.95), p = 0.025. Conclusions We observed several differences in practice for AED withdrawal after seizure remission that highlight global uncertainty. Trials of AED discontinuation are needed to provide evidence-based guidance.
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Affiliation(s)
- Luca Bartolini
- Clinical Epilepsy Section (LB) and Stroke Diagnostics and Therapeutics Section (SM), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Center for Neuroscience (LB), George Washington University, Children's National Health System; and Department of Neurology (SM, MZK), George Washington University Hospital, Washington, DC
| | - Shahram Majidi
- Clinical Epilepsy Section (LB) and Stroke Diagnostics and Therapeutics Section (SM), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Center for Neuroscience (LB), George Washington University, Children's National Health System; and Department of Neurology (SM, MZK), George Washington University Hospital, Washington, DC
| | - Mohamad Z Koubeissi
- Clinical Epilepsy Section (LB) and Stroke Diagnostics and Therapeutics Section (SM), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Center for Neuroscience (LB), George Washington University, Children's National Health System; and Department of Neurology (SM, MZK), George Washington University Hospital, Washington, DC
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136
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Diallo A, Jacobi H, Cook A, Labrum R, Durr A, Brice A, Charles P, Marelli C, Mariotti C, Nanetti L, Panzeri M, Rakowicz M, Sobanska A, Sulek A, Schmitz-Hübsch T, Schöls L, Hengel H, Melegh B, Filla A, Antenora A, Infante J, Berciano J, van de Warrenburg BP, Timmann D, Boesch S, Pandolfo M, Schulz JB, Bauer P, Giunti P, Kang JS, Klockgether T, Tezenas du Montcel S. Survival in patients with spinocerebellar ataxia types 1, 2, 3, and 6 (EUROSCA): a longitudinal cohort study. Lancet Neurol 2018; 17:327-334. [PMID: 29553382 DOI: 10.1016/s1474-4422(18)30042-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/03/2018] [Accepted: 01/26/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Spinocerebellar ataxias are dominantly inherited progressive ataxia disorders that can lead to premature death. We aimed to study the overall survival of patients with the most common spinocerebellar ataxias (SCA1, SCA2, SCA3, and SCA6) and to identify the strongest contributing predictors that affect survival. METHODS In this longitudinal cohort study (EUROSCA), we enrolled men and women, aged 18 years or older, from 17 ataxia referral centres in ten European countries; participants had positive genetic test results for SCA1, SCA2, SCA3, or SCA6 and progressive, otherwise unexplained, ataxias. Survival was defined as the time from enrolment to death for any reason. We used the Cox regression model adjusted for age at baseline to analyse survival. We used prognostic factors with a p value less than 0·05 from a multivariate model to build nomograms and assessed their performance based on discrimination and calibration. The EUROSCA study is registered with ClinicalTrials.gov, number NCT02440763. FINDINGS Between July 1, 2005, and Aug 31, 2006, 525 patients with SCA1 (n=117), SCA2 (n=162), SCA3 (n=139), or SCA6 (n=107) were enrolled and followed up. The 10-year survival rate was 57% (95% CI 47-69) for SCA1, 74% (67-81) for SCA2, 73% (65-82) for SCA3, and 87% (80-94) for SCA6. Factors associated with shorter survival were: dysphagia (hazard ratio 4·52, 95% CI 1·83-11·15) and a higher value for the Scale for the Assessment and Rating of Ataxia (SARA) score (1·26, 1·19-1·33) for patients with SCA1; older age at inclusion (1·04, 1·01-1·08), longer CAG repeat length (1·16, 1·03-1·31), and higher SARA score (1·15, 1·10-1·20) for patients with SCA2; older age at inclusion (1·44, 1·20-1·74), dystonia (2·65, 1·21-5·53), higher SARA score (1·26, 1·17-1·35), and negative interaction between CAG and age at inclusion (0·994, 0·991-0·997) for patients with SCA3; and higher SARA score (1·17, 1·08-1·27) for patients with SCA6. The nomogram-predicted probability of 10-year survival showed good discrimination (c index 0·905 [SD 0·027] for SCA1, 0·822 [0·032] for SCA2, 0·891 [0·021] for SCA3, and 0·825 [0·054] for SCA6). INTERPRETATION Our study provides quantitative data on the survival of patients with the most common spinocerebellar ataxias, based on a long follow-up period. These results have implications for the design of future interventional studies of spinocerebellar ataxias; for example, the prognostic survival nomogram could be useful for selection and stratification of patients. Our findings need validation in an external population before they can be used to counsel patients and their families. FUNDING European Union 6th Framework programme, German Ministry of Education and Research, Polish Ministry of Scientific Research and Information Technology, European Union 7th Framework programme, and Fondation pour la Recherche Médicale.
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Affiliation(s)
- Alhassane Diallo
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Sorbonne Université, INSERM, Paris, France
| | - Heike Jacobi
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Arron Cook
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Robyn Labrum
- Neurogenetics Laboratory, National Hospital of Neurology and Neurosurgery, University College London, London, UK
| | - Alexandra Durr
- Institut du cerveau et la moelle épinière (ICM), Sorbonne Université, INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris AP-HP, Pitié-Salpêtrière University Hospital Paris, Paris, France
| | - Alexis Brice
- Institut du cerveau et la moelle épinière (ICM), Sorbonne Université, INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris AP-HP, Pitié-Salpêtrière University Hospital Paris, Paris, France
| | - Perrine Charles
- Genetics Department, Pitié-Salpêtrière University Hospital Paris, Paris, France
| | - Cecilia Marelli
- Service de Neurologie-CMRR, CHRU Gui de Chauliac, Montpellier, France
| | - Caterina Mariotti
- SOSD Genetics of Neurodegenerative and Metabolic Diseases, Fondazione-IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Nanetti
- SOSD Genetics of Neurodegenerative and Metabolic Diseases, Fondazione-IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marta Panzeri
- SOSD Genetics of Neurodegenerative and Metabolic Diseases, Fondazione-IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Rakowicz
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Sobanska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Sulek
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tanja Schmitz-Hübsch
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Charité-Universitätsmedizin Berlin, NeuroCure Clinical Research Center, Clinical Neuroimmunology Group, Berlin, Germany
| | - Ludger Schöls
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany; Department of Neurology, University Hospital of Bonn, Bonn, Germany
| | - Holger Hengel
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany; Department of Neurology, University Hospital of Bonn, Bonn, Germany
| | - Bela Melegh
- Department of Medical Genetics, and Szentagothai Research Center, University of Pécs, Pécs, Hungary; Department of Neurology, Zala County Hospital, Zalaegerszeg, Hungary
| | - Alessandro Filla
- Department of Neuroscience, and Reproductive and Odontostomatological Sciences, Federico II University Naples, Italy
| | - Antonella Antenora
- Department of Neuroscience, and Reproductive and Odontostomatological Sciences, Federico II University Naples, Italy
| | - Jon Infante
- Service of Neurology, University Hospital Marqués de Valdecilla (IDIVAL), University of Cantabria (UC), Santander, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | - José Berciano
- Service of Neurology, University Hospital Marqués de Valdecilla (IDIVAL), University of Cantabria (UC), Santander, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Sylvia Boesch
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Massimo Pandolfo
- Université Libre de Bruxelles (ULB), Neurology Service, ULB Hôpital Erasme, ULB Laboratory of Experimental Neurology, Brussels, Belgium
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany; JARA-Translational Brain Medicine, Aachen-Jülich, Aachen, Germany
| | - Peter Bauer
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Paola Giunti
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Jun-Suk Kang
- Department of Neurology, University of Frankfurt, Frankfurt, Germany
| | - Thomas Klockgether
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Neurology, University Hospital of Bonn, Bonn, Germany
| | - Sophie Tezenas du Montcel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Sorbonne Université, INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris AP-HP, Pitié-Salpêtrière University Hospital Paris, Paris, France.
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Lamberink HJ, Boshuisen K, Otte WM, Geleijns K, Braun KPJ. Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. Epilepsia 2018; 59:e28-e33. [DOI: 10.1111/epi.14020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Herm J. Lamberink
- Department of Child Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Kim Boshuisen
- Department of Child Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Willem M. Otte
- Department of Child Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- Biomedical MR Imaging and Spectroscopy Group; Center for Image Sciences; University Medical Center Utrecht; Utrecht The Netherlands
- Stichting Epilepsie Instellingen Nederland-SEIN; Heemstede The Netherlands
| | - Karin Geleijns
- Department of Child Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Kees P. J. Braun
- Department of Child Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
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138
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Stee K, Martlé V, Broeckx B, Royaux E, Van Ham L, Bhatti S. Imepitoin withdrawal in dogs with idiopathic epilepsy well-controlled with imepitoin and phenobarbital and/or potassium bromide does not increase seizure frequency. Vet J 2017; 230:1-5. [DOI: 10.1016/j.tvjl.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/16/2022]
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139
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Brigo F. Antiepileptic drug withdrawal risk calculator. Pract Neurol 2017; 17:332-333. [DOI: 10.1136/practneurol-2017-001715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 11/04/2022]
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140
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French JA. Withdrawal of antiepileptic drugs: an individualised approach. Lancet Neurol 2017; 16:493-494. [DOI: 10.1016/s1474-4422(17)30136-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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Affiliation(s)
- Marco Leyton
- Correspondence to: M. Leyton, Department of Psychiatry, McGill University, 1033 Pine Ave West, Montreal, QC H3A 1A1;
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