101
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Employability in people with epilepsy: A systematic review. Epilepsy Res 2015; 116:67-78. [DOI: 10.1016/j.eplepsyres.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/12/2015] [Accepted: 06/23/2015] [Indexed: 11/20/2022]
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102
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Developing from child to adult: Risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. Epilepsy Behav 2015; 51:182-90. [PMID: 26291772 DOI: 10.1016/j.yebeh.2015.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/16/2015] [Accepted: 07/28/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Childhood-onset epilepsy during the years of transition to adulthood may affect normal social, physical, and mental development, frequently leading to psychosocial and health-related problems in the long term. OBJECTIVE This study aimed to describe the main characteristics of patients in transition and to identify risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. METHODS Patients with epilepsy, 15-25years of age, who visited the Kempenhaeghe Epilepsy Transition Clinic from March 2012 to December 2014 were included (n=138). Predefined risk scores for medical, educational/occupational status, and independence/separation/identity were obtained, along with individual risk profile scores for poor psychosocial outcome. Multivariate linear regression analysis and discriminant analysis were used to identify variables associated with an increased risk of poor long-term psychosocial outcome. RESULTS Demographic, epilepsy-related, and psychosocial variables associated with a high risk of poor long-term outcome were lower intelligence, higher seizure frequency, ongoing seizures, and an unsupportive and unstable family environment. Using the aforementioned factors in combination, we were able to correctly classify the majority (55.1%) of the patients regarding their risk of poor psychosocial outcome. CONCLUSION Our analysis may allow early identification of patients at high risk of prevention, preferably at pretransition age. The combination of a chronic refractory epilepsy and an unstable family environment constitutes a higher risk of transition problems and poor outcome in adulthood. As a consequence, early interventions should be put into place to protect youth at risk of poor transition outcome.
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103
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Baldin E, Hesdorffer DC, Caplan R, Berg AT. Psychiatric disorders and suicidal behavior in neurotypical young adults with childhood-onset epilepsy. Epilepsia 2015; 56:1623-8. [PMID: 26387857 DOI: 10.1111/epi.13123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We examined the associations of lifetime and current histories of psychiatric disorders and of suicidal thoughts and behaviors with childhood-onset epilepsies in a community-based cohort of young adults. METHODS Cases were neurotypical (normal neurologic, cognitive, and imaging examinations and no evidence of a brain insult responsible for the epilepsy) young adults with childhood-onset epilepsy followed since the onset of their epilepsy approximately 15 years earlier and recruited as part of a community-based study. They were compared to two different control groups: siblings and external controls from the National Comorbidity Survey-Replication (NCS-R). The Diagnostic Interview Survey assessed lifetime and current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnoses of mood disorders and anxiety disorders. Suicidal thoughts and suicide attempt were assessed using the Diagnostic Interview Survey for Children-IV and the Diagnostic Interview Survey (DIS-IV). RESULTS Two hundred fifty-seven cases and 134 sibling controls participated in the DIS-IV portion of the young adult assessment. Comparing cases both to their sibling controls and to the controls drawn from the NCS-R, we did not find any evidence to suggest a higher prevalence of lifetime and current mood or anxiety disorders, suicidal thoughts, and suicide attempt in young adults with childhood-onset epilepsies. SIGNIFICANCE Our findings from a community-based sample of neurotypical young adults do not suggest a substantial or lasting association between childhood epilepsy and psychiatric disorders and suicidal behavior.
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Affiliation(s)
- Elisa Baldin
- GH Sergievsky Center and Department of Epidemiology, Columbia University, New York, New York, U.S.A
| | - Dale C Hesdorffer
- GH Sergievsky Center and Department of Epidemiology, Columbia University, New York, New York, U.S.A
| | - Rochelle Caplan
- David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, U.S.A
| | - Anne T Berg
- Department of Pediatrics, Epilepsy Center, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Mankinen K, Ipatti P, Harila M, Nikkinen J, Paakki JJ, Rytky S, Starck T, Remes J, Tokariev M, Carlson S, Tervonen O, Rantala H, Kiviniemi V. Reading, listening and memory-related brain activity in children with early-stage temporal lobe epilepsy of unknown cause-an fMRI study. Eur J Paediatr Neurol 2015; 19:561-71. [PMID: 26026490 DOI: 10.1016/j.ejpn.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/25/2015] [Accepted: 05/05/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The changes in functional brain organization associated with paediatric epilepsy are largely unknown. Since children with epilepsy are at risk of developing learning difficulties even before or shortly after the onset of epilepsy, we assessed the functional organization of memory and language in paediatric patients with temporal lobe epilepsy (TLE) at an early stage in epilepsy. METHODS Functional magnetic resonance imaging was used to measure the blood oxygenation level-dependent (BOLD) response to four cognitive tasks measuring reading, story listening, memory encoding and retrieval in a population-based group of children with TLE of unknown cause (n = 21) and of normal intelligence and a healthy age and gender-matched control group (n = 21). RESULTS Significant BOLD response differences were found only in one of the four tasks. In the story listening task, significant differences were found in the right hemispheric temporal structures, thalamus and basal ganglia. Both activation and deactivation differed significantly between the groups, activation being increased and deactivation decreased in the TLE group. Furthermore, the patients with abnormal electroencephalograms (EEGs) showed significantly increased activation bilaterally in the temporal structures, basal ganglia and thalamus relative to those with normal EEGs. The patients with normal interictal EEGs had a significantly stronger deactivation than those with abnormal EEGs or the controls, the differences being located outside the temporal structures. CONCLUSIONS Our results suggest that TLE entails a widespread disruption of brain networks. This needs to be taken into consideration when evaluating learning abilities in patients with TLE. The thalamus seems to play an active role in TLE. The changes in deactivation may reflect neuronal inhibition.
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Affiliation(s)
- Katariina Mankinen
- Department of Paediatrics, Oulu University Hospital, PB 29, 90014 Oulu, Finland.
| | - Pieta Ipatti
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Marika Harila
- Department of Neurology, Oulu University Hospital, Finland
| | - Juha Nikkinen
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | | | - Seppo Rytky
- Department of Clinical Neurophysiology, Oulu University Hospital, Finland
| | - Tuomo Starck
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Jukka Remes
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Maksym Tokariev
- Brain Research Unit, O.V. Lounasmaa Laboratory, Aalto University School of Science, P.B. 15100, 00076 Aalto, Finland; Neuroscience Unit, Institute of Biomedicine/Physiology, University of Helsinki, P.B. 63, 00014 University of Helsinki, Finland
| | - Synnöve Carlson
- Brain Research Unit, O.V. Lounasmaa Laboratory, Aalto University School of Science, P.B. 15100, 00076 Aalto, Finland; Neuroscience Unit, Institute of Biomedicine/Physiology, University of Helsinki, P.B. 63, 00014 University of Helsinki, Finland
| | - Osmo Tervonen
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Heikki Rantala
- Department of Paediatrics, Oulu University Hospital, PB 29, 90014 Oulu, Finland
| | - Vesa Kiviniemi
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
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Abstract
Epilepsy, a disorder of unprovoked seizures is a multifaceted disease affecting individuals of all ages with a particular predilection for the very young and old. In addition to seizures, many patients often report cognitive and psychiatric problems associated with both the seizures themselves and its therapy. Epilepsy has numerous etiologies both idiopathic and acquired with a wide range of therapeutic responses. Despite numerous treatments available to control repetitive seizures including medications, diets, immunotherapy, surgery, and neuromodulatory devices, a large percentage of patients continue to suffer the consequences of uncontrolled seizures, which include psychosocial stigma and death.
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Affiliation(s)
- Joseph I Sirven
- Department of Neurology, Mayo Clinic in Arizona, Phoenix, Arizona 85054
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106
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Pakozdy A, Patzl M, Zimmermann L, Jokinen TS, Glantschnigg U, Kelemen A, Hasegawa D. LGI Proteins and Epilepsy in Human and Animals. J Vet Intern Med 2015; 29:997-1005. [PMID: 26032921 PMCID: PMC4895363 DOI: 10.1111/jvim.12610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/23/2015] [Accepted: 04/11/2015] [Indexed: 12/16/2022] Open
Abstract
Leucine‐rich glioma‐inactivated (LGI) protein was first thought to have a suppressor effect in the formation of some cancers. Developments in physiology and medicine made it possible to characterize the function of the LGI protein family and its crucial role in different conditions more precisely. These proteins play an important role in synaptic transmission, and dysfunction may cause hyperexcitability. Genetic mutation of LGI1was confirmed to be the cause of autosomal dominant lateral temporal lobe epilepsy in humans. The LGI2 mutation was identified in benign familial juvenile epilepsy in Lagotto Romagnolo (LR) dogs. Cats with familial spontaneous temporal lobe epilepsy have been reported, and the etiology might be associated with LGI protein family dysfunction. In addition, an autoimmune reaction against LGI1 was detected in humans and cats with limbic encephalitis. These advances prompted a review of LGI protein function and its role in different seizure disorders.
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Affiliation(s)
- A Pakozdy
- University Clinic of Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - M Patzl
- Institute of Immunology, University of Veterinary Medicine, Vienna, Austria
| | - L Zimmermann
- Unit of Physiology and Biophysics, University of Veterinary Medicine, Vienna, Austria
| | - T S Jokinen
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - U Glantschnigg
- University Clinic of Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - A Kelemen
- Epilepsy Center, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - D Hasegawa
- Department of Clinical Veterinary Medicine, Nippon Veterinary and Life Science University, Musashinoshi, Tokyo, Japan
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107
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Jokinen TS, Tiira K, Metsähonkala L, Seppälä EH, Hielm-Björkman A, Lohi H, Laitinen-Vapaavuori O. Behavioral Abnormalities in Lagotto Romagnolo Dogs with a History of Benign Familial Juvenile Epilepsy: A Long-Term Follow-Up Study. J Vet Intern Med 2015; 29:1081-7. [PMID: 25945683 PMCID: PMC4895370 DOI: 10.1111/jvim.12611] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/25/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022] Open
Abstract
Background Lagotto Romagnolo (LR) dogs with benign juvenile epilepsy syndrome often experience spontaneous remission of seizures. The long‐term outcome in these dogs currently is unknown. In humans, behavioral and psychiatric comorbidities have been reported in pediatric and adult‐onset epilepsies. Hypothesis/Objectives The objectives of this study were to investigate possible neurobehavioral comorbidities in LR with a history of benign familial juvenile epilepsy (BFJE) and to assess the occurrence of seizures after the remission of seizures in puppyhood. Animals A total of 25 LR with a history of BFJE and 91 control dogs of the same breed. Methods Owners of the LR dogs in the BFJE and control groups completed an online questionnaire about each dog's activity, impulsivity, and inattention. Principal component analysis (PCA) served to extract behavioral factors from the data. We then compared the scores of these factors between the 2 groups in a retrospective case–control study. We also interviewed all dog owners in the BFJE group by telephone to inquire specifically about possible seizures or other neurological problems after remission of seizures as a puppy. Results Lagotto Romagnolo dogs with BFJE showed significantly higher scores on the factors Inattention and Excitability/Impulsivity than did the control group (P = .003; P = .021, respectively). Only 1 of the 25 BFJE LR exhibited seizures after remission of epilepsy in puppyhood. Conclusions and Clinical Importance Although the long‐term seizure outcome in BFJE LR seems to be good, the dogs exhibit behavioral abnormalities resembling attention deficit hyperactivity disorder (ADHD) in humans, thus suggesting neurobehavioral comorbidities with epilepsy.
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Affiliation(s)
- T S Jokinen
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - K Tiira
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland.,Department of Molecular Genetics, Folkhälsan Institute of Genetics, Helsinki, Finland
| | - L Metsähonkala
- Epilepsy Unit, Hospital for Children and Adolescents, Helsinki, Finland
| | - E H Seppälä
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland.,Department of Molecular Genetics, Folkhälsan Institute of Genetics, Helsinki, Finland
| | - A Hielm-Björkman
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - H Lohi
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland.,Department of Molecular Genetics, Folkhälsan Institute of Genetics, Helsinki, Finland
| | - O Laitinen-Vapaavuori
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
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108
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Ünver O, Keskin SP, Uysal S, Ünver A. The epidemiology of epilepsy in children: a report from a Turkish pediatric neurology clinic. J Child Neurol 2015; 30:698-702. [PMID: 25038132 DOI: 10.1177/0883073814539559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/14/2014] [Indexed: 01/09/2023]
Abstract
This retrospective cohort study aims to assess the distribution of seizure types and epileptic syndromes in children with epilepsy who were followed up in a tertiary outpatient pediatric neurology clinic between January 2004 and December 2009. The findings of 533 children aged between 2 months and 16 years were evaluated. The International League Against Epilepsy criteria (of 1981 and 1989) were used for diagnosis and classification. The rate of partial seizures (56.5%) was higher than that of generalized seizures (43.5%). Partial seizures were more common during late childhood (P < .001). Localization-related epilepsies (53.3%) were more frequent than generalized epilepsies (37.1%). Generalized epilepsies were more frequent during the first year of life, whereas localization-related epilepsies were more common at later ages (P < .001). The majority had a symptomatic etiology (47.1%). The increased frequency of symptomatic etiologies attributed to perinatal insults suggests that intractable epilepsies during childhood represent an important health issue for developing countries.
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Affiliation(s)
- Olcay Ünver
- Division of Child Neurology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical School, Istanbul, Turkey
| | - Sabiha Paktuna Keskin
- Division of Child Neurology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical School, Istanbul, Turkey
| | - Serap Uysal
- Division of Child Neurology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical School, Istanbul, Turkey
| | - Afşin Ünver
- Department of Pediatrics, Private Göztepe Hospital, Istanbul, Turkey
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109
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Early hypoactivity of hippocampal rhythms during epileptogenesis after prolonged febrile seizures in freely-moving rats. Neurosci Bull 2015; 31:297-306. [PMID: 25913039 DOI: 10.1007/s12264-014-1524-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022] Open
Abstract
Prospective and experimental studies have shown that individuals with early-life complex/prolonged febrile seizures (FSs) have a high incidence of temporal lobe epilepsy during adulthood, revealing a close relationship between FSs and epilepsy. However, little is known about how epileptogenesis develops after FSs. The present study was designed to investigate acquired seizure susceptibility and analyze local field potentials during the latent period after FSs. We found that the seizure susceptibility decreased in 35-day-old (P35) FS rats but increased in P60 FS rats. Consistently, hippocampal electroencephalogram (EEG) power in every band was decreased at P35 but increased at P60 in FS rats. Our results provide direct evidence for hypoactivity but not hyperactivity during the early phase of the latent period, displaying a broad decrease in hippocampal rhythms. These characteristic EEG changes can be a useful biomarker for the early diagnosis of epileptogenesis induced by FSs.
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110
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Goodwin SW, Lambrinos AI, Ferro MA, Sabaz M, Speechley KN. Development and assessment of a shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Epilepsia 2015; 56:864-72. [PMID: 25912151 DOI: 10.1111/epi.13000] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and validate a shortened version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). A secondary aim was to compare baseline risk factors predicting health-related quality of life (HRQoL) in children newly diagnosed with epilepsy, as identified using the original and shortened version. METHODS Data came from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES, N = 373), a multicenter prospective cohort study. Principal component analysis reduced the number of items from the original QOLCE, and factor analysis was used to assess the factor structure of the shortened version. Convergent and divergent validity was assessed by correlating the Child Health Questionnaire (CHQ) with the shortened QOLCE. Multiple regression identified risk factors at diagnosis for HRQoL at 24 months. RESULTS A four-factor, higher-order, 55-item solution was obtained. A total of 21 items were removed. The final model represents functioning in four dimensions of HRQoL: Cognitive, Emotional, Social, and Physical. The shortened QOLCE demonstrated acceptable fit: Bentler's Comparative Fit Index = 0.944; Tucker-Lewis Index = 0.942; root mean square approximation = 0.058 (90% CI: 0.056-0.061); weighted root mean square residuals (WRMR) = 1.582, and excellent internal consistency (α = 0.96, subscales α > 0.80). Factor loadings were good (first-order: λ = 0.66-0.93; higher-order λ = 0.66-0.85; p < 0.001 for all). The shortened QOLCE scores correlated strongly with similar subscales of the Child Health Questionnaire (ρ = 0.38-0.70) while correlating weakly with dissimilar subscales (ρ = 0.30-0.31). While controlling for HRQoL at diagnosis, predictors for better HRQoL at 24 months were the following: no cognitive problems reported (p = 0.001), better family functioning (p = 0.014), fewer family demands (p = 0.008), with an interaction between baseline HRQoL and cognitive problems (p = 0.011). SIGNIFICANCE Results offer initial evidence regarding reliability and validity of the proposed 55-item shortened version of the QOLCE (QOLCE-55). The QOLCE-55 produced results on risk factors consistent with those found using the original measure. Given the fewer items, QOLCE-55 may be a viable option reducing respondent burden when assessing HRQoL in children with epilepsy.
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Affiliation(s)
- Shane W Goodwin
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Anastasia I Lambrinos
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Mark A Ferro
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Sabaz
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kathy N Speechley
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada
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111
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Tedrus GMAS, Fonseca LC, Pereira RB. Marital status of patients with epilepsy: factors and quality of life. Seizure 2015; 27:66-70. [PMID: 25891930 DOI: 10.1016/j.seizure.2015.02.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/19/2015] [Accepted: 02/24/2015] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The study investigated how marital status relates to clinical aspects and quality of life (QOL) in patients with epilepsy (PWE). METHOD The clinical data and Quality of Life in Epilepsy Inventory (QOLIE-31) scores of 252 PWE were regressed against their marital status with a significance level of 5% (p < 0.05). RESULTS Logistic regression for single and married PWE revealed that singles had more abnormalities in the neurological examination (p = 0.029) and earlier seizure onset (p < 0.001), while for married and divorced PWE revealed the latter more psychiatric comorbidities (p = 0.002) and longer disease duration (p = 0.011). Regarding QOL score, linear regression showed that psychiatric comorbidity was the only factor (p < 0.001). CONCLUSION The marital status of PWE is negatively associated with clinical aspects of epilepsy.
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112
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Almane D, Jones JE, Jackson DC, Seidenberg M, Koehn M, Hsu DA, Hermann BP. Brief clinical screening for academic underachievement in new-onset childhood epilepsy: utility and longitudinal results. Epilepsy Behav 2015; 43:117-21. [PMID: 25601585 PMCID: PMC4355245 DOI: 10.1016/j.yebeh.2014.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/31/2014] [Accepted: 12/04/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was conducted to determine the lifetime rate and distribution of supportive academic and educational services provided to children with new- or recent-onset epilepsy and typically developing controls, the relationship of this history to objective academic test performance, and the course of performance over serial evaluations (baseline and 2 and 5years later). METHODS Research participants were 91 children aged 8-18 at study entry, including 50 youth with recent-onset epilepsy (28 focal [FE] and 22 generalized [GE] epilepsy) and healthy first-degree cousin controls (n=41). The sample with epilepsy included children with uncomplicated epilepsy and normal imaging and development. Lifetime history of a diversity of supportive educational services was determined via a structured interview with parents at the baseline study visit. Associations were examined between these support services and participants' academic performance in reading, spelling, and arithmetic (Wide Range Achievement Test-Revision 3 [WRAT3] [12]) during three serial study visits including baseline and 2 and 5years later. RESULTS Children with epilepsy had a higher lifetime rate of provision of diverse academic supportive services compared to controls at the baseline visit (52% vs. 18%). These services antedated epilepsy diagnosis in the majority (80.8%) of the children with epilepsy. Among children with epilepsy, children who presented with academic services had significantly lower WRAT3 reading, spelling, and arithmetic performance at baseline and at 2- and 5-year follow-ups. CONCLUSION A brief structured clinical interview conducted with parents identifies children with epilepsy who are at academic risk at the time of diagnosis, with that risk persisting up to 5years later.
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Affiliation(s)
- Dace Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago, IL, USA
| | - Monica Koehn
- Marshfield Clinic Neurosciences, Marshfield Clinic, Marshfield, WI, USA
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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113
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Social competence among well-functioning adolescents with epilepsy. Epilepsy Behav 2015; 42:54-60. [PMID: 25499164 DOI: 10.1016/j.yebeh.2014.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/20/2014] [Accepted: 11/08/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE The aims of the study were to measure the social competence of well-functioning adolescents with epilepsy and compare it with that of their healthy peers as well as to analyze the effects of epilepsy-related variables on the social competence. METHODS Ninety well-functioning adolescents with epilepsy 12-19years of age were compared with healthy controls using the Achenbach Youth Self-Report Questionnaire measures of social competence. Within the group with epilepsy, the impact of duration of epilepsy, etiology, seizure frequency, seizure type, and antiepileptic drugs (AEDs) (monotherapy or polytherapy) on the above measures was also determined. RESULTS Twenty-five (27.8%) adolescents with epilepsy obtained Total Competence T scores in the clinical range, as opposed to only two (3.3%) of the healthy adolescents. There were statistically significant differences in the Activity and Social subscales and Total Competence T score between the group with epilepsy and the control group (p<0.05). Comparing T scores for epilepsy-related variables in the group with epilepsy, we found that there were statistically significant differences in all the social competence subscales regarding the seizure control and seizure types. No significant differences were obtained for other epilepsy-related variables: duration of epilepsy, onset of epilepsy, etiology, and AEDs. CONCLUSION Our results indicate that adolescents with epilepsy are less active in clubs, socialize less with their friends, and have a poorer school performance compared with their healthy peers. This study shows that adolescents with epilepsy are at an increased risk of having difficulties in social competence.
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114
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Roberts JI, Hrazdil C, Wiebe S, Sauro K, Vautour M, Wiebe N, Jetté N. Neurologists' knowledge of and attitudes toward epilepsy surgery: a national survey. Neurology 2014; 84:159-66. [PMID: 25503624 DOI: 10.1212/wnl.0000000000001127] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In the current study, we aim to assess potential neurologist-related barriers to epilepsy surgery among Canadian neurologists. METHODS A 29-item, pilot-tested questionnaire was mailed to all neurologists registered to practice in Canada. Survey items included the following: (1) type of medical practice, (2) perceptions of surgical risks and benefits, (3) knowledge of existing practice guidelines, and (4) barriers to surgery for patients with epilepsy. Neurologists who did not complete the questionnaire after the initial mailing were contacted a second time by e-mail, fax, or telephone. After this reminder, the survey was mailed a second time to any remaining nonresponders. RESULTS In total, 425 of 796 neurologists returned the questionnaire (response rate 53.5%). Respondents included 327 neurologists who followed patients with epilepsy in their practice. More than half (56.6%) of neurologists required patients to be drug-resistant and to have at least one seizure per year before considering surgery, and nearly half (48.6%) failed to correctly define drug-resistant epilepsy. More than 75% of neurologists identified inadequate health care resources as the greatest barrier to surgery for patients with epilepsy. CONCLUSIONS A substantial proportion of Canadian neurologists are unaware of recommended standards of practice for epilepsy surgery. Access also appears to be a significant barrier to epilepsy surgery and surgical evaluation. As a result, we are concerned that patients with epilepsy are receiving inadequate care. A greater emphasis must be placed on knowledge dissemination and ensuring that the infrastructure and personnel are in place to allow patients to have timely access to this evidence-based treatment.
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Affiliation(s)
- Jodie I Roberts
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Chantelle Hrazdil
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Samuel Wiebe
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Khara Sauro
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Michelle Vautour
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Natalie Wiebe
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Nathalie Jetté
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada.
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Berg AT, Rychlik K. The course of childhood-onset epilepsy over the first two decades: a prospective, longitudinal study. Epilepsia 2014; 56:40-8. [PMID: 25431231 DOI: 10.1111/epi.12862] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Determine frequency of remissions, relapses, and pharmacoresistance over two decades. Develop a composite measure of seizure control over that time. METHODS Community-based cohort of children with newly diagnosed epilepsy prospectively followed for up to 21 years with frequent calls and periodic medical record review. Multiple periods of 1-, 2-, 3-, and 5-year remission with subsequent relapses were recorded. Other outcomes included pharmacoresistance (failure of two adequately used drugs), early remission and early pharmacoresistance by 2 years, and complete remission at last contact (CR-LC, 5 years both seizure- and drug-free at last contact). A composite summary of seizure course was created with eight categories ranging from early sustained remission and CR-LC (best) to never achieving a 1-year remission (worst). RESULTS Five hundred sixteen of 613 participants were followed ≥10 years. An initial 1- 2-, 3-, and 5-year remission occurred, respectively, in 95%, 92%, 89%, and 81%. Relapses followed in 52%, 41%, 29%, and 15%, respectively. Repeated remission after relapse was common. Up to seven 1-year, five 2-year and 3-year, and two 5-year remissions were recorded per participant. Pharmacoresistance at any time, early pharmacoresistance (<2 years), early remission, and CR-LC occurred in 118 (22.9%), 70 (13.6%), 283 (54.8%), and 311 (60.3%). Composite outcomes were early sustained remission with CR-LC (N=172, 33%); later but then sustained remission with CR-LC (N=51, 10%); one (N=61, 12%) or more (N=27, 5%) remission-relapse episodes but then CR-LC; various non-CR-LC outcomes (N=179, 35%); and never achieved 1-year remission (N=26, 5%). These patterns varied across groups defined by epilepsy type and presence of brain insults or neurodisability (p<0.0001). SIGNIFICANCE The seizure prognosis of pediatric epilepsies is highly variable. Most patients follow complex courses not easily summarized by remission status at the end of a period of follow-up. These complexities may facilitate efforts to understand the impact epilepsy has on young people entering adulthood.
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Affiliation(s)
- Anne T Berg
- Department of Pediatrics, Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A; Department of Pediatrics, Northwestern Memorial Feinberg School of Medi-cine, Chicago, Illinois, U.S.A
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Berg AT, Rychlik K, Levy SR, Testa FM. Complete remission of childhood-onset epilepsy: stability and prediction over two decades. Brain 2014; 137:3213-22. [PMID: 25338950 DOI: 10.1093/brain/awu294] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ultimate seizure outcome of childhood epilepsy is complete resolution of all seizures without further treatment. How often this happens and how well it can be predicted early in the course of epilepsy could be valuable in helping families understand the nature of childhood epilepsy and what to expect over time. In the Connecticut study of epilepsy, a prospective cohort of 613 children with newly-diagnosed epilepsy (onset age 0-15 years), complete remission, ≥5 years both seizure-free and medication-free, was examined as a proxy of complete seizure resolution. Predictors at initial diagnosis were tested. Information about seizure outcomes within 2 years and from 2-5 years after diagnosis was sequentially added in a proportional hazards model. The predictive value of the models was determined with logistic regression. Five hundred and sixteen subjects were followed ≥10 years. Three hundred and twenty-eight (63%) achieved complete remission; 23 relapsed. The relapse rate was 8.2 per 1000 person-years and decreased over time: 10.7, 6.7, and 0 during first 5 years, the next 5 years, and then >10 years after complete remission (P=0.06 for trend). Six participants regained complete remission; 311 (60%) were in complete remission at last contact. Baseline factors predicting against complete remission at last contact included onset age≥10 years (hazard ratio=0.55, P=0.0009) and early school or developmental problems (hazard ratio=0.74, P=0.01). Factors predicting for complete remission were uncomplicated epilepsy presentation (hazard ratio=2.23, P<0.0001), focal self-limited epilepsy syndrome (hazard ratio=2.13, P<0.0001), and uncharacterized epilepsy (hazard ratio=1.61, P=0.04). Remission (hazard ratio=1.95, P<0.0001) and pharmaco-resistance (hazard ratio=0.33, P<0.0001) by 2 years respectfully predicted in favour and against complete remission. From 2 to 5 years after diagnosis, relapse (hazard ratio=0.21, P<0.0001) and late pharmaco-resistance (hazard ratio=0.21, P=0.008) decreased and late remission (hazard ratio=2.40, P<0.0001) increased chances of entering complete remission. The overall accuracy of the models increased from 72% (baseline information only), to 77% and 85% with addition of 2-year and 5-year outcomes. Relapses after complete remission are rare making this an acceptable proxy for complete seizure resolution. Complete remission after nearly 20 years is reasonably well predicted within 5 years of initial diagnosis.
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Affiliation(s)
- Anne T Berg
- 1 Ann and Robert H. Lurie Children's Hospital of Chicago, Epilepsy Centre, Department of Paediatrics, Chicago, IL, 60611, USA 2 Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Memorial Feinberg School of Medicine, Department of Paediatrics, Chicago, IL, 60611, USA
| | - Karen Rychlik
- 3 Ann and Robert H. Lurie Children's Hospital of Chicago, Biostatistics Research Core, Stanley Manne Children's Research Institute, Chicago, IL, 60611, USA
| | - Susan R Levy
- 4 Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA 5 Department of Paediatrics, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Francine M Testa
- 4 Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA 5 Department of Paediatrics, Yale School of Medicine, New Haven, CT, 06510, USA
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117
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Carbone L, Plegue M, Barnes A, Shellhaas R. Improving the mental health of adolescents with epilepsy through a group cognitive behavioral therapy program. Epilepsy Behav 2014; 39:130-4. [PMID: 25240125 DOI: 10.1016/j.yebeh.2014.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
The threat of unpredictable seizures makes epilepsy unique among childhood chronic illnesses. One consequence is that people who have childhood-onset epilepsy often have poor social adjustment and competence in adulthood. Better emotional and social functioning could improve long-term outcomes. Thirty-four adolescents with epilepsy participated in a group cognitive behavioral therapy program designed to enhance their level of psychosocial functioning. Baseline Strength and Difficulty Questionnaire scores suggested that many participants had difficulties with emotions, concentration, and social functioning, with parent-reported Impact scores significantly worse than adolescent-reported scores (p=0.005). Four months after the intervention, adolescent-reported Prosocial Behavior scores significantly improved (p=0.03). Parent-reported scores improved significantly at follow-up, compared with baseline, in Peer Problems (p=0.04), Impact (p=0.001), and Prosocial Behavior (p=0.004) scores. Adolescents with lower socioeconomic status reported the greatest improvements (p=0.01). A brief CBT intervention was effective and resulted in improved mental health indices and social functioning for adolescents with epilepsy.
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Affiliation(s)
- Loretta Carbone
- Department of Social Work, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Melissa Plegue
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Barnes
- Pediatrics & Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA
| | - Renée Shellhaas
- Pediatrics & Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA
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118
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Shinnar S. Whatever happened to the primary generalized epilepsies of childhood and adolescence? Ann Neurol 2014; 76:658-9. [DOI: 10.1002/ana.24277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Shlomo Shinnar
- Departments of Neurology, Pediatrics, and Epidemiology and Population Health Montefiore Medical Center; Albert Einstein College of Medicine Bronx; NY
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119
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Biopsychosocial predictors of psychogenic non-epileptic seizures. Epilepsy Res 2014; 108:1543-53. [PMID: 25262500 DOI: 10.1016/j.eplepsyres.2014.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/22/2014] [Accepted: 09/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies have identified numerous biological, psychological and social characteristics of persons with psychogenic non-epileptic seizures (PNES) however the strength of many of these factors have not been evaluated to determine which are predictive of the diagnosis compared to those that may only be stereotypes with limited clinical utility. METHOD A retrospective chart review of persons admitted to our epilepsy monitoring unit over a 6-year period was conducted to examine predictors of a video-EEG confirmed PNES diagnosis. RESULTS A total of 689 patients had events leading to a diagnosis, 47% (n=324) with PNES only, 12% (n=84) with PNES & Epilepsy and 41% (n=281) with Epilepsy only. Five biological predictors of a PNES only diagnosis were found; number of years with events (OR=1.10), history of head injury (OR=1.91), asthma (OR=2.94), gastro-esophageal reflux disease (OR=1.72) and pain (OR=2.25). One psychological predictor; anxiety (OR=1.72) and two social predictors; being married (OR=1.81) and history of physical/sexual abuse (OR=3.35). Two significant biological predictors of a PNES & Epilepsy diagnosis were found; migraine (OR=1.83) and gastro-esophageal reflux disease (OR=2.17). CONCLUSIONS Our findings support the importance of considering the biopsychosocial model for the diagnosis and treatment of PNES or PNES with concomitant epilepsy.
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120
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Camfield CS, Berg A, Stephani U, Wirrell EC. Transition issues for benign epilepsy with centrotemporal spikes, nonlesional focal epilepsy in otherwise normal children, childhood absence epilepsy, and juvenile myoclonic epilepsy. Epilepsia 2014; 55 Suppl 3:16-20. [DOI: 10.1111/epi.12706] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Carol S. Camfield
- Department of Pediatrics; Dalhousie University; Halifax Nova Scotia Canada
- Department of Pediatrics; IWK Health Centre; Halifax Nova Scotia Canada
| | - Anne Berg
- Epilepsy Center; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois U.S.A
| | | | - Elaine C. Wirrell
- Department of Neurology; Child and Adolescent Neurology; Mayo Clinic; Rochester Minnesota U.S.A
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121
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Liu J, Liu Z, Chen T, Xu R. Treatment of epilepsy in China: Formal or informal. Neural Regen Res 2014; 8:3316-24. [PMID: 25206653 PMCID: PMC4145945 DOI: 10.3969/j.issn.1673-5374.2013.35.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 09/02/2013] [Indexed: 11/18/2022] Open
Abstract
Antiepileptic drugs are the preferred treatment approach for epileptic patients. However, informal treatment is important for intractable epilepsy. In this study, 500 epileptic patients were recruited from the General Hospital of Beijing Military Area Command of Chinese PLA during the period of October 2009 to January 2012. These involved patients that had been medically treated for at least 1 year. Information on the initial treatment and changes to treatment regimens for each patient was collected through questionnaires. The survey results showed that 52.3% of the epileptic patients searched for treatment after the first seizure, and the mean numbers of seizures was 12.8; 59.8% of the epileptic patients were diagnosed at the first visit, and the mean onset time was 17 months after the first seizure. After diagnosis, patients were treated for an average of 20 days, and the median time was 1 day. Formal anti-epileptic drugs were selected as the first treatment regimen by 67.8% of patients, and 77.5% of these drugs were monotherapies. The mean and median numbers of seizure were respectively 36.9 and 3.0 times before the first regimen was changed. The regimen was changed within the first 6 months by 46.6% of patients, and after the first and second years of treatment, the proportions increased to 54.0% and 71.8%, respectively. In total, 78.5% of the regimens were changed to informal treatments. The informal treatment of epilepsy in China is common, being initiated by either patients or physicians. Enhancing epileptic treatment services in hospital, improving physicians’ professional quality, and strengthening health propaganda may promote the normalization of drug treatment of epilepsy in China.
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Affiliation(s)
- Jianming Liu
- Bayi Brain Hospital, Affiliated to General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China
| | - Zhiliang Liu
- Bayi Brain Hospital, Affiliated to General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China
| | - Tao Chen
- Laser Institute of Engineering, Beijing University of Technology, Beijing 100080, China
| | - Ruxiang Xu
- Bayi Brain Hospital, Affiliated to General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China
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von Podewils F, Lapp S, Wang ZI, Hartmann U, Herzer R, Kessler C, Runge U. Natural course and predictors of spontaneous seizure remission in idiopathic generalized epilepsy: 7–27 years of follow-up. Epilepsy Res 2014; 108:1221-7. [DOI: 10.1016/j.eplepsyres.2014.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/05/2014] [Accepted: 04/27/2014] [Indexed: 11/16/2022]
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123
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Feng B, Tang YS, Chen B, Dai YJ, Xu CL, Xu ZH, Zhang XN, Zhang SH, Hu WW, Chen Z. Dysfunction of thermoregulation contributes to the generation of hyperthermia-induced seizures. Neurosci Lett 2014; 581:129-34. [PMID: 25172570 DOI: 10.1016/j.neulet.2014.08.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/31/2014] [Accepted: 08/19/2014] [Indexed: 12/13/2022]
Abstract
Febrile seizures (FS) are generally defined as seizures taking place during fever. Long-term prognosis, including development of epilepsy and malformation of cognitive function, has been demonstrated after infantile FS. However, the mechanism that triggers seizures in hyperthermic environment is still unclear. We here found that the body temperature of rat pups that experienced experimental FS was markedly decreased (∼28°C) after they were removed from the hyperthermic environment. Both the seizure generation and the temperature drop after seizure attack were abolished by either pre-treatment with chlorpromazine (CPZ), which impairs the thermoregulation, or by an electrolytic lesion of the preoptic area and anterior hypothalamus (PO/AH). However, the non-steroidal anti-inflammatory drug celecoxib did not affect the seizure incidence and the decrease in body temperature after seizure attack. In addition, pentobarbital prevented the generation of seizures, but did not reverse the decrease of body temperature after FS. Therefore, our work indicates that an over-regulation of body temperature occurs during hyperthermic environment, and that the dysfunction of thermoregulation in the PO/AH following hyperthermia contributes to the generation of FS.
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Affiliation(s)
- Bo Feng
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yang-Shun Tang
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Bin Chen
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yun-Jian Dai
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Ceng-Lin Xu
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Zheng-Hao Xu
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Xiang-Nan Zhang
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Shi-Hong Zhang
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Wei-Wei Hu
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China.
| | - Zhong Chen
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
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124
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Sillanpää M, Saarinen M, Schmidt D. Clinical conditions of long-term cure in childhood-onset epilepsy: a 45-year follow-up study. Epilepsy Behav 2014; 37:49-53. [PMID: 24975821 DOI: 10.1016/j.yebeh.2014.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
Clinical conditions of long-term cure in childhood-onset epilepsy, defined as sustained remission off antiepileptic drug (AED) treatment, are not well known. To address that clinically important question, we determined clinical factors predictive of long-term seizure cure in a population-based cohort of 133 patients followed up since their first seizure before the age of 16 years. At the end of the 45-year follow-up (mean=39.8, median=44, range=11-47), 81 (61%) of the 133 patients had entered at least 5-year remission off AEDs, meeting our definition of cure. The 81 patients were seizure-free off AEDs for a mean of 34.4 (median=38, range=6-46) years and 59 (73%) of the 81 patients following the first standard medication until the end of follow-up (mean=36.5, median=39, range=14-46 years). Four independent factors were found to be associated with cure compared with having seizures while on AEDs: seizure frequency less than weekly during the first 12 months of AED treatment (p=0.002), pretreatment seizure frequency less than weekly (p=0.002), higher IQ (>70; p=0.021), and idiopathic or cryptogenic vs. symptomatic etiology (p=0.042). Patients with seizure frequency of less than once a week during early treatment and idiopathic etiology had a ninefold chance to of being cured since the onset of the first adequate antiepileptic therapy until the end of follow-up compared with patients who a symptomatic etiology had at least weekly seizures while on AEDs (RR=8.7, 95% CI=2.0-37.0; p<0.001). In conclusion, IQ, etiology, and seizure frequencies both in the first year of AED treatment and prior to medication appear to be clinical predictors of cure in childhood-onset epilepsy.
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Affiliation(s)
- Matti Sillanpää
- Departments of Public Health and Child Neurology, University of Turku, Turku, Finland
| | - Maiju Saarinen
- Departments of Public Health and Child Neurology, University of Turku, Turku, Finland
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125
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Gupta PK, Sayed N, Ding K, Agostini MA, Van Ness PC, Yablon S, Madden C, Mickey B, D'Ambrosio R, Diaz-Arrastia R. Subtypes of post-traumatic epilepsy: clinical, electrophysiological, and imaging features. J Neurotrauma 2014; 31:1439-43. [PMID: 24693960 DOI: 10.1089/neu.2013.3221] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-traumatic epilepsy (PTE) is a consequence of traumatic brain injury (TBI), occurring in 10-25% of patients with moderate to severe injuries. The development of animal models for testing antiepileptogenic therapies and validation of biomarkers to follow epileptogenesis in humans necessitates sophisticated understanding of the subtypes of PTE, which is the objective of this study. In this study, retrospective review was performed of patients with moderate to severe TBI with subsequent development of medically refractory epilepsy referred for video-electroencephalography (EEG) monitoring at a single center over a 10-year period. Information regarding details of injury, neuroimaging studies, seizures, video-EEG, and surgery outcomes were collected and analyzed. There were 123 patients with PTE identified, representing 4.3% of all patients evaluated in the epilepsy monitoring unit. Most of them had localization-related epilepsy, of which 57% had temporal lobe epilepsy (TLE), 35% had frontal lobe epilepsy (FLE), and 3% each had parietal and occipital lobe epilepsy. Of patients with TLE, 44% had mesial temporal sclerosis (MTS), 26% had temporal neocortical lesions, and 30% were nonlesional. There was no difference in age at injury between the different PTE subtypes. Twenty-two patients, 13 of whom had MTS, proceeded to surgical resection. At a mean follow-up of 2.5 years, Engel Class I outcomes were seen in 69% of those with TLE and 33% of those with FLE. Our findings suggest PTE is a heterogeneous condition, and careful evaluation with video-EEG monitoring and high resolution MRI can identify distinct syndromes. These results have implications for the design of clinical trials of antiepileptogenic therapies for PTE.
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Affiliation(s)
- Puneet K Gupta
- 1 Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center , Dallas, Texas
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Camfield PR, Camfield CS. What happens to children with epilepsy when they become adults? Some facts and opinions. Pediatr Neurol 2014; 51:17-23. [PMID: 24830766 DOI: 10.1016/j.pediatrneurol.2014.02.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The adult outcome after childhood onset epilepsy is a complex subject because seizure types and severity are diverse, comorbidities are common, and additional factors influence social outcome. We review selected data about seizure remission or persistence and social outcome in adulthood. METHODS Information came from published literature, especially population-based studies. RESULTS In general, approximately 50-60% of children with epilepsy eventually have complete seizure remission (i.e., seizure free and off antiepileptic drug treatment): with longer follow-up, the remission rate improves. Predicting remission, persistent or intractable epilepsy is often inaccurate for an individual patient. A tiny proportion of children with epilepsy die as the result of seizures or sudden unexpected death in epilepsy patients; however, an otherwise normal child has the same risk of death as the reference population. When uncontrolled epilepsy persists into adulthood, the rate of sudden unexpected death in epilepsy patients possibly increases. Reports about social outcome in adulthood are increasing. For those with intellectual disability, a lifetime of dependency is to be expected. For those with normal intelligence, adult life is often unsatisfactory with high rates of incomplete education, unemployment, poverty, social isolation, inadvertent pregnancy, and psychiatric disorders. Seizure remission does not ensure good adult social outcome. CONCLUSIONS Although seizure control in childhood is important, anticipating poor social outcome in adulthood may allow earlier interventions. A well-orchestrated transition from pediatric to adult health care may be beneficial for the 40-50% with persistent seizures and for the majority who are at risk for adult social difficulties.
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Affiliation(s)
- Peter R Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Carol S Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
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127
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Rathouz PJ, Zhao Q, Jones JE, Jackson DC, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. Cognitive development in children with new onset epilepsy. Dev Med Child Neurol 2014; 56:635-41. [PMID: 24650092 PMCID: PMC4057956 DOI: 10.1111/dmcn.12432] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2013] [Indexed: 11/28/2022]
Abstract
AIM To characterize the prospective trajectory of cognitive development in children with new or recent onset epilepsy from baseline to 5 to 6 years after diagnosis. METHOD Sixty-nine children (40 males, 29 females; age 8-18y), with new or recent onset epilepsies underwent neuropsychological assessment shortly after diagnosis (Wave 1), 2 years (Wave 2), and 5 to 6 years after diagnosis (Wave 3). Intelligence, academic achievement, language, executive function, and psychomotor speed were evaluated. Sixty-two children (28 males, 34 females; age 8-18) with typical development served as a comparison group at each time point. The cognitive data were examined by syndrome (localization-related epilepsy [LRE]; idiopathic generalized epilepsy [IGE]; comparison group). Mixed effect regression models compared trajectories among groups with respect to time since diagnosis. RESULTS Cognitive abnormalities exhibited by children with epilepsy in arithmetic computation, response inhibition, attention, fine motor dexterity, and psychomotor speed (all p values <0.001), are detectable at or near the time of diagnosis and largely remain stable over the ensuing 5 to 6 years without evidence of progressive worsening or recovery. This course is evident across both LRE and IGE groups, with the LRE group performing better for some outcomes (arithmetic, response inhibition, psychomotor speed) and never worse than the IGE group. INTERPRETATION Cognitive development in children with LRE and IGE is not characterized by progressive deterioration or lack of age-appropriate development; rather, development lags behind that of children with typical development. Cognitive abnormalities, when detected, are present near the time of diagnosis, persist over time, and require early intervention.
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Affiliation(s)
- Paul J Rathouz
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health
| | - Qianqian Zhao
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dave A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carl E Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University, North Chicago, IL, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Compromised maturation of GABAergic inhibition underlies abnormal network activity in the hippocampus of epileptic Ca2+ channel mutant mice, tottering. Pflugers Arch 2014; 467:737-52. [DOI: 10.1007/s00424-014-1555-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
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Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci 2014; 343:23-9. [PMID: 24929650 DOI: 10.1016/j.jns.2014.05.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/08/2014] [Accepted: 05/19/2014] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders seem to be more frequent in patients with epilepsy (PWE) than the general population. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. According to this, psychiatric diseases are often underdiagnosed and undertreated in PWE with further decrease of the quality of life of patients. The aim of the review was to examine the most frequent psychiatric comorbidities in adults with epilepsy (AWE) and the main psychiatric comorbidities in children with epilepsy (CWE) in order to better understand the relationship between epilepsy and the development of psychiatric disorders.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy.
| | - Danilo Carrozzino
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Maddalena Milioni
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy
| | - Maria Minna
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Mario Fulcheri
- Department of Psychological, Humanistic and Territorial Sciences, University "G. D'Annunzio" of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
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130
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Park KM, Hur Y, Kim HY, Ji KH, Hwang TG, Shin KJ, Ha SY, Park J, Kim SE. Initial response to antiepileptic drugs in patients with newly diagnosed epilepsy. J Clin Neurosci 2014; 21:923-6. [DOI: 10.1016/j.jocn.2013.10.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/14/2013] [Accepted: 10/27/2013] [Indexed: 12/18/2022]
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131
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Krauss GL, Perucca E, Ben-Menachem E, Kwan P, Shih JJ, Clément JF, Wang X, Bagul M, Gee M, Zhu J, Squillacote D. Long-term safety of perampanel and seizure outcomes in refractory partial-onset seizures and secondarily generalized seizures: results from phase III extension study 307. Epilepsia 2014; 55:1058-68. [PMID: 24867391 PMCID: PMC4283992 DOI: 10.1111/epi.12643] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate safety, tolerability, seizure frequency, and regional variations in treatment responses with the AMPA antagonist, perampanel, in a large extension study during up to 3 years of treatment. METHODS Patients ≥ 12 years old with partial-onset seizures despite treatment with 1-3 antiepileptic drugs at baseline completed a perampanel phase III trial and entered extension study 307 (NCT00735397). Patients were titrated to 12 mg/day (or their individual maximum tolerated dose) during the blinded conversion period, followed by open-label maintenance. Exposure, safety (adverse events [AEs], vital signs, weight, electrocardiography [ECG], laboratory values) and seizure outcomes were analyzed; key measures were assessed by geographic regions. RESULTS Among 1,216 patients, median exposure was 1.5 years (range 1 week to 3.3 years), with >300 patients treated for >2 years. Treatment retention was 58.5% at cutoff. AEs reported in ≥ 10% of patients were dizziness, somnolence, headache, fatigue, irritability, and weight increase. Only dizziness and irritability caused discontinuation in >1% of patients (3.9% and 1.3%, respectively). The only serious AEs reported in >1% of patients were epilepsy-related (convulsion, 3.0%; status epilepticus, 1.1%). No clinically relevant changes in vital signs, ECG or laboratory parameters were seen. After titration/conversion, responder rate and median percentage change from baseline in seizure frequency were stable: 46% for both measures at 9 months (in 980 patients with ≥ 9 months' exposure) and 58% and 60%, respectively, at 2 years (in the 337 patients with 2 years' exposure). Median percentage reduction in frequency of secondarily generalized (SG) seizures ranged from 77% at 9 months (N = 422) to 90% at 2 years (N = 141). Among the 694 patients with maintenance data ≥ 1 year, 5.3% were seizure-free for the entire year. SIGNIFICANCE No new safety signals emerged during up to 3 years of perampanel exposure in 39 countries. Seizure responses remained stable, with marked reductions, particularly in SG seizures.
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Krishna V, Lozano AM. Brain stimulation for intractable epilepsy: Anterior thalamus and responsive stimulation. Ann Indian Acad Neurol 2014; 17:S95-8. [PMID: 24791096 PMCID: PMC4001217 DOI: 10.4103/0972-2327.128671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 11/18/2022] Open
Abstract
Despite medications, resective surgery, and vagal nerve stimulation, some patients with epilepsy continue to have seizures. In these patients, other approaches are urgently needed. The biological basis of stimulation of anterior thalamic nucleus and epileptogenic focus is presented. Results from two large randomized controlled trials Stimulation of Anterior Nucleus of Thalamus for Epilepsy (SANTE) and Neuropace pivotal trial are discussed. Neuromodulation provides effective treatment for a select group of refractory epilepsy patients. Future investigations into the mechanism underlying ‘response’ to brain stimulation are desired.
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Affiliation(s)
- Vibhor Krishna
- Department of Surgery, Division of Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Surgery, Division of Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Jonsson P, Jonsson B, Eeg-Olofsson O. Psychological and social outcome of epilepsy in well-functioning children and adolescents. A 10-year follow-up study. Eur J Paediatr Neurol 2014; 18:381-90. [PMID: 24565749 DOI: 10.1016/j.ejpn.2014.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 12/17/2013] [Accepted: 01/26/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND From a population based study of epilepsy in Swedish children a subgroup designated well-functioning with an epilepsy diagnosis in 1997 was worked up from a medical point of view 10 years later. AIM To describe the psychological and social outcome in this subgroup. METHODS Thirty-one patients aged 11-22 years and their parents/partners responded to a questionnaire according to Achenbach System of Empirically Based Assessment (ASEBA) to evaluate behavioural and emotional problems, and social competence. RESULTS Active epilepsy, diagnosed in 32%, was related to attention problems, somatic complaints, and school problems. Polytherapy, used in 16%, was related to attention problems and aggressive behaviour. School problems were found in six of seven children younger than 18 years. Internalizing, externalizing, and 'other' syndromes were found in 29% of the individuals, but a grouping of these syndromes in the clinical range only in two (6.5%), a girl with generalized tonic-clonic seizures alone, and a boy with structural focal epilepsy. Both had active epilepsy and were treated with polytherapy. All ten individuals with Rolandic epilepsy were classified as normal. The answers to the ASEBA questionnaire of individuals and parents/partners were inconsistent, and parents generally stated more problems than the individuals. SUMMARY This 10-year follow-up study of psychological and social outcome in well-functioning children and adolescents with childhood onset epilepsy shows some emotional, behavioural, and social problems. Thus, early information to increase knowledge about epilepsy and associated psychological co-morbidities in order to decrease risk of low self-esteem, social anxiety, and depression later in life is of importance.
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Affiliation(s)
- Pysse Jonsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden.
| | - Björn Jonsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden
| | - Orvar Eeg-Olofsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden
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Thomson L, Fayed N, Sedarous F, Ronen GM. Life quality and health in adolescents and emerging adults with epilepsy during the years of transition: a scoping review. Dev Med Child Neurol 2014; 56:421-33. [PMID: 24237329 DOI: 10.1111/dmcn.12335] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Abstract
AIMS The aims of this study were to (1) search the literature in order to identify the challenges facing adolescents and emerging adults with epilepsy; and (2) categorize these issues within both the framework of the International Classification of Functioning, Disability and Health (ICF) and an empirical model of quality of life (QOL) in childhood epilepsy. METHOD We systematically searched PsycINFO, Ovid MEDLINE and Web of Science for studies reporting on QOL and health identified in people with epilepsy aged 12 to 29 years. Studies were limited to those that were published in the last 20 years in English, presenting the patient perspective. Data were extracted and charted using a descriptive analytical method. Identified issues were classified according to the ICF and QOL frameworks. RESULTS Fifty four studies were identified. Another 62 studies with potentially useful information were included as an addendum. The studies highlight a range of psychosocial issues emphasizing peer acceptance, social isolation, and feelings of anxiety, fear, and sadness. INTERPRETATION The ICF and QOL constructs represent useful starting points in the analytical classification of the potential challenges faced by adolescents with epilepsy. Progress is needed on fully classifying issues not included under these frameworks. We propose to expand these frameworks to include comorbidities, impending medical interventions, and concerns for future education, employment, marriage, dignity, and autonomy.
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Affiliation(s)
- Lauren Thomson
- Undergraduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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136
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Sillanpää M, Schmidt D. Neonatal eating epilepsy: 50-year follow-up. Seizure 2014; 23:487-9. [PMID: 24726506 DOI: 10.1016/j.seizure.2014.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/11/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE We present a case of neonatal eating epilepsy. METHOD Case report. RESULTS An otherwise healthy female newborn started having epileptic seizures lasting up to 5 minutes induced by breastfeeding at age of 2 weeks. The convulsive seizure started with crying and coughing followed by opisthotonus, flexion of upper extremities, extension of lower extremities, and generalized jerks in extremities. The patient had fairly often postictal vomitings which could not be relieved by upright positioning. At baseline clinical examination, no abnormal symptoms or signs were found except for a postictal hoarseness. On the day of admission to the tertiary care hospital, during 1.5 hours, she had 10 attacks. Though some attacks were spontaneous and during sleep, most were induced by feeding or--less often and inconsistently--by manipulating the pharynx. Phenobarbital 15 mg four times a day stopped the attacks. The last seizure was documented 14 days after admission and phenobarbital was eventually withdrawn. The patient remained seizure free off AEDs during a prospective follow-up for over 50 years until 2013. CONCLUSIONS Neonatal eating epilepsy may be a suitable diagnosis if convulsive seizures are precipitated by feeding or eating. Polygraphic recording will help ascertain the diagnosis. Antiepileptic therapy is likely to abolish seizures.
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Affiliation(s)
- M Sillanpää
- Departments of Public Health and Child Neurology, University of Turku, Turku, Finland
| | - D Schmidt
- Epilepsy Research Group, Berlin, Germany.
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137
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Adaptive skills and somatization in children with epilepsy. EPILEPSY RESEARCH AND TREATMENT 2014; 2014:856735. [PMID: 24592331 PMCID: PMC3922016 DOI: 10.1155/2014/856735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/20/2013] [Indexed: 11/17/2022]
Abstract
Objective. Children with epilepsy are at risk for less than optimum long-term outcomes. The type and severity of their epilepsy may contribute to educational, psychological, and social outcomes. The objective of this study was to determine the relation between somatization and adaptive skills based on seizure type that could impact on those outcomes. Methods. This study examined adaptive functioning and somatization in 87 children with epilepsy using archival data from a tertiary care facility. Results. No significant differences in adaptive skills emerged between groups of children diagnosed with complex partial (CP) as compared to CP-secondary generalized (SG) seizures; however, deficits in adaptive behavior were found for both groups. The number of medications, possibly reflecting the severity of the epilepsy, was highly correlated to adaptive function. Conclusions. Identification of deficits in adaptive behavior may represent an opportunity for tailored prevention and intervention programming for children with epilepsy. Addressing functional deficits may lead to improved outcomes for these children.
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138
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Helmstaedter C, Aldenkamp AP, Baker GA, Mazarati A, Ryvlin P, Sankar R. Disentangling the relationship between epilepsy and its behavioral comorbidities - the need for prospective studies in new-onset epilepsies. Epilepsy Behav 2014; 31:43-7. [PMID: 24333577 DOI: 10.1016/j.yebeh.2013.11.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/04/2013] [Accepted: 11/09/2013] [Indexed: 12/20/2022]
Abstract
It has been long recognized that there is more to epilepsy than seizures. The prevalence of such neurobehavioral abnormalities as cognitive and mood disorders, autism spectrum disorder, and attention deficit and hyperactivity disorder (ADHD) is significantly higher among patients with epilepsy than in the general population. A long-held view that comorbidities of epilepsy represent mere epiphenomena of seizures has undergone substantial transformation during the past decade, as emerging clinical evidence and experimental evidence suggest the involvement of specific neurobiological mechanisms in the evolution of neurobehavioral deficits in patients with epilepsy. Developmental aspects of both epilepsy and its comorbidities, as well as the frequently reported reciprocal connection between these disorders, both add other dimensions to the already complex problem. In light of progress in effective seizure management in many patients with epilepsy, the importance of neurobehavioral comorbidities has become acute, as the latter are frequently more detrimental to patients' quality of life compared with seizures. This calls for a serious increase in efforts to effectively predict, manage, and ideally cure these comorbidities. Coordinated multicenter clinical, translational, and basic research studies focusing on epidemiology, neuropsychology, neurophysiology, imaging, genetics, epigenetics, and pharmacology of neurobehavioral comorbidities of epilepsy are absolutely instrumental for ensuring tangible progress in the field. Clinical research should focus more on new-onset epilepsy and put particular emphasis on longitudinal studies in large cohorts of patients and groups at risk, while translational research should primarily focus on the development of valid preclinical systems which would allow investigating the fundamental mechanism of epilepsy comorbidities. The final goal of the described research efforts would lie in producing an armamentarium of evidence-based diagnostic tools and therapeutic interventions which would at minimum mitigate and at maximum prevent or abolish neurobehavioral comorbidities of epilepsy and, thus, improve the quality of life of those patients with epilepsy who suffer from the said comorbidities.
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Affiliation(s)
| | - A P Aldenkamp
- Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Dept of Neurology Maastricht University Medical Centre, Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| | - G A Baker
- Division of Neurosciences, University of Liverpool, Liverpool, UK
| | - A Mazarati
- Department of Pediatrics, Neurology Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752, USA
| | - Ph Ryvlin
- Department of Functional Neurology and Epileptology, Neurological Hospital, CTRS-INSERM IDEE, Institut Des Epilepsies de l'Enfant et de l'adolescent, Hospices Civils de Lyon, INSERM U821, Universite Claude Bernard Lyon 1, Lyon, France
| | - R Sankar
- Department of Pediatrics, Neurology Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752, USA
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139
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Byars AW, deGrauw TJ, Johnson CS, Perkins SM, Fastenau PS, Dunn DW, Austin JK. Language and social functioning in children and adolescents with epilepsy. Epilepsy Behav 2014; 31:167-71. [PMID: 24434307 PMCID: PMC4527048 DOI: 10.1016/j.yebeh.2013.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/01/2013] [Accepted: 11/09/2013] [Indexed: 10/25/2022]
Abstract
Individuals with epilepsy have difficulties with social function that are not adequately accounted for by seizure severity or frequency. This study examined the relationship between language ability and social functioning in 193 children with epilepsy over a period of 36months following their first recognized seizure. The findings show that children with persistent seizures have poorer language function, even at the onset of their seizures, than do their healthy siblings, children with no recurrent seizures, and children with recurrent but not persistent seizures. They continue to demonstrate poorer language function 36months later. This poor language function is associated with declining social competence. Intervention aimed at improving social competence should include consideration of potential language deficits that accompany epilepsy and social difficulty.
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Affiliation(s)
- Anna W. Byars
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, USA,Corresponding author at: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2015, Cincinnati, Ohio 45229, USA. Fax: +1 513 636 1888. (A.W. Byars)
| | - Ton J. deGrauw
- Children's Health Care of Atlanta, Emory University School of Medicine, USA
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Ngugi AK, Bottomley C, Fegan G, Chengo E, Odhiambo R, Bauni E, Neville B, Kleinschmidt I, Sander JW, Newton CR. Premature mortality in active convulsive epilepsy in rural Kenya: causes and associated factors. Neurology 2014; 82:582-9. [PMID: 24443454 PMCID: PMC3963418 DOI: 10.1212/wnl.0000000000000123] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya. Methods: In this prospective population-based study, people with ACE were identified in a cross-sectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors. Results: There were 61 deaths among 754 people with ACE, yielding a rate of 33.3/1,000 persons/year. Overall standardized mortality ratio was 6.5. Mortality was higher across all ACE age groups. Nonadherence to antiepileptic drugs (adjusted rate ratio [aRR] 3.37), cognitive impairment (aRR 4.55), and age (50+ years) (rate ratio 4.56) were risk factors for premature mortality. Most deaths (56%) were directly related to epilepsy, with prolonged seizures/possible status epilepticus (38%) most frequently associated with death; some of these may have been due to sudden unexpected death in epilepsy (SUDEP). Possible SUDEP was the likely cause in another 7%. Conclusion: Mortality in people with ACE was more than 6-fold greater than expected. This may be reduced by improving treatment adherence and prompt management of prolonged seizures and supporting those with cognitive impairment.
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Affiliation(s)
- Anthony K Ngugi
- From the KEMRI/Wellcome Trust Research Programme (A.K.N., G.F., E.C., R.O., E.B., C.R.N.), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health (A.K.N., C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.N., E.B., C.R.N.), Accra, Ghana; Research Support Unit, Faculty of Health Sciences (A.K.N.), Aga Khan University (East Africa), Nairobi, Kenya; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health (C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Nuffield Department of Medicine (G.F.), Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, United Kingdom; Neurosciences Unit (B.N., C.R.N.), UCL Institute of Child Health, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy (J.W.S.), UCL Institute of Neurology, London, United Kingdom; Epilepsy Society (J.W.S.), Chalfont St Peter, United Kingdom; SEIN - Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, the Netherlands; Clinical Research Unit (C.R.N.), London School of Hygiene and Tropical Medicine, United Kingdom; and Department of Psychiatry (C.R.N.), University of Oxford, United Kingdom
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Neuropsychological performance in children with temporal lobe epilepsy having normal MRI findings. Eur J Paediatr Neurol 2014; 18:60-5. [PMID: 24103143 DOI: 10.1016/j.ejpn.2013.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 08/16/2013] [Accepted: 08/22/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Most information on the neuropsychological performance of pediatric patients with temporal lobe epilepsy (TLE) is derived from selected surgical series. Non-lesional pediatric TLE patients were studied here at the population level in order to investigate the extent to which neuropsychological deficits predisposing to learning difficulties exist in this more common group. METHODS Language, memory and executive functions were measured in children aged 8-15 years with non-lesional TLE and of normal intelligence (n = 21), and their performance was compared with that of healthy age and gender-matched children (n = 21). The effects of clinical epilepsy variables on performance were examined. RESULTS Although neuropsychological performance did not differ between the TLE patients and the healthy controls, female gender, early onset, longer duration and abnormal interictal EEG had a negative effect on neuropsychological performance. CONCLUSIONS Children with early-onset epilepsy should be assessed carefully for neuropsychological impairment using sufficiently broad batteries of tests in order to detect even slight deficits. Our sample size was small and these findings should be interpreted as preliminary results and need to be confirmed in larger studies.
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143
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Dragoumi P, Tzetzi O, Vargiami E, Pavlou E, Krikonis K, Kontopoulos E, Zafeiriou DI. Clinical course and seizure outcome of idiopathic childhood epilepsy: determinants of early and long-term prognosis. BMC Neurol 2013; 13:206. [PMID: 24350775 PMCID: PMC3878358 DOI: 10.1186/1471-2377-13-206] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/07/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Idiopathic epilepsies and epileptic syndromes predominate childhood and adolescence epilepsy. The aim of the present study was to investigate the clinical course and outcome of idiopathic childhood epilepsy and identify variables determining both early and long-term prognosis. METHODS We followed 303 children with newly diagnosed idiopathic epilepsy aged 1-14 years old, both prospectively and retrospectively. Outcome was defined at one, 2 and 4 years of follow-up, as well as at the end of the study period for all patients. Based on the data collected, patients were classified in four patterns of clinical course: "excellent", "improving", "relapsing" and "poor". Variables defined at intake and after the initial year of treatment were analyzed for their prognostic relevance towards the clinical course and outcome of the patients. RESULTS The mean age at seizure onset was 6.7 years and the mean duration of follow-up was 8.3 years (range 2,0-22,0,SD 4,24). During the initial year of treatment, 70,3% of patients were seizure-free. The course of epilepsy was "excellent" in 53,1% of the subjects, "improving" in 22,8%, "relapsing" in 22,1% whereas only 6 children with idiopathic epilepsy (2%) had a "poor" clinical course exhibiting drug-resistance. After multivariate analysis, variables predictive of a poor initial response to therapy were early seizure onset, multiple seizure types and history of status epilepticus. At the end of follow-up, early response to treatment was of significant positive predictive value, while the presence of multiple seizure types and the history of migraine had a negative impact on prognosis. CONCLUSIONS In the vast majority of children, the long-term prognosis of idiopathic epilepsy is favorable. More than half of the patients attain seizure freedom immediately and their clinical course is considered "excellent". About one fifth exhibit either an improving or a fluctuating course. Early seizure onset, multiple seizure types and status epilepticus are predictive of an initial poor response to treatment in children with idiopathic epilepsy. Initial non-response to treatment, multiple seizure types and history of migraine are determinants of a less favorable final outcome after long-term follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Dimitrios I Zafeiriou
- Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
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Perry MS, Duchowny M. Surgical versus medical treatment for refractory epilepsy: Outcomes beyond seizure control. Epilepsia 2013; 54:2060-70. [DOI: 10.1111/epi.12427] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. Scott Perry
- Comprehensive Epilepsy Program; Jane and John Justin Neuroscience Center; Cook Children's Medical Center; Fort Worth Texas U.S.A
| | - Michael Duchowny
- Department of Neurology and Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
- Department of Neurology; University of Miami Leonard Miller School of Medicine; Miami Florida U.S.A
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145
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Whiteus C, Freitas C, Grutzendler J. Perturbed neural activity disrupts cerebral angiogenesis during a postnatal critical period. Nature 2013; 505:407-11. [PMID: 24305053 PMCID: PMC3947100 DOI: 10.1038/nature12821] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 10/29/2013] [Indexed: 11/09/2022]
Abstract
During the neonatal period, activity-dependent neural-circuit remodelling coincides with growth and refinement of the cerebral microvasculature. Whether neural activity also influences the patterning of the vascular bed is not known. Here we show in neonatal mice, that neither reduction of sensory input through whisker trimming nor moderately increased activity by environmental enrichment affects cortical microvascular development. Unexpectedly, chronic stimulation by repetitive sounds, whisker deflection or motor activity led to a near arrest of angiogenesis in barrel, auditory and motor cortices, respectively. Chemically induced seizures also caused robust reductions in microvascular density. However, altering neural activity in adult mice did not affect the vasculature. Histological analysis and time-lapse in vivo two-photon microscopy revealed that hyperactivity did not lead to cell death or pruning of existing vessels but rather to reduced endothelial proliferation and vessel sprouting. This anti-angiogenic effect was prevented by administration of the nitric oxide synthase (NOS) inhibitor L-NAME and in mice with neuronal and inducible NOS deficiency, suggesting that excessive nitric oxide released from hyperactive interneurons and glia inhibited vessel growth. Vascular deficits persisted long after cessation of hyperstimulation, providing evidence for a critical period after which proper microvascular patterning cannot be re-established. Reduced microvascular density diminished the ability of the brain to compensate for hypoxic challenges, leading to dendritic spine loss in regions distant from capillaries. Therefore, excessive sensorimotor stimulation and repetitive neural activation during early childhood may cause lifelong deficits in microvascular reserve, which could have important consequences for brain development, function and pathology.
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Affiliation(s)
- Christina Whiteus
- 1] Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06511, USA [2] Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Catarina Freitas
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06511, USA
| | - Jaime Grutzendler
- 1] Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06511, USA [2] Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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146
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Bulacio JC, González-Martínez JA. Candidatos a cirugía de la epilepsia: quiénes y cómo. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70256-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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147
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Abimbola S, Martiniuk ALC, Hackett ML, Glozier N, Mohamed A, Anderson CS. Early predictors of remission in newly diagnosed epilepsy: a systematic approach to reviewing prognostic factor studies. Neurol Res 2013; 36:1-12. [PMID: 24070226 DOI: 10.1179/1743132813y.0000000257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND It is necessary to select a range of consistently identified prognostic factors from exploratory studies to include in multivariate models of confirmatory studies. We illustrate a systematic approach to selecting consistently identified prognostic factors using the example of predictors of remission in newly diagnosed epilepsy. METHODS Medline and Embase were searched for reports of cohort studies enrolling at least 100 people with epilepsy within 1 year of diagnosis, and followed up for at least 1 year. We included studies that identified predictors of remission after adjusting for confounders using multivariate regression analysis. To identify consistent predictors a chart was designed to list the variables considered for inclusion in each model and those retained in more than one model from different cohorts were deemed to be consistent. RESULTS Remission off medication was less likely if there was more than one seizure between 6 and 12 months on medication and if there was comorbid intellectual disability in childhood onset epilepsy. The likelihood of remission on or off medication reduces with mixed seizure types at onset, intellectual disability, symptomatic aetiology, and also with increasing number of seizures before diagnosis or in the first 6 months after diagnosis. CONCLUSION A greater number of seizures before diagnosis and early in treatment, intellectual disability, and symptomatic aetiology are consistent predictors of less likelihood of remission. This suggests that early identification, diagnosis of epilepsy, and seizure control should be the primary aim of medical intervention, and that these predictors should be included in future confirmatory studies of prognostic factors of remission in newly diagnosed epilepsy.
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148
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Kasasbeh AS, Smyth MD, Steger-May K, Jalilian L, Bertrand M, Limbrick DD. Outcomes After Anterior or Complete Corpus Callosotomy in Children. Neurosurgery 2013; 74:17-28; discussion 28. [DOI: 10.1227/neu.0000000000000197] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Corpus callosotomy (CC) is a valuable palliative surgical option for children with medically refractory epilepsy due to generalized or multifocal cortical seizure onset.
OBJECTIVE:
To investigate the extent of CC resulting in optimal seizure control in a pediatric patient population and to evaluate the modification of seizure profile after various CC approaches.
METHODS:
The records of 58 children (3–22 years of age at the time of surgery) with medically refractory epilepsy who underwent CC between 1995 and 2011 were retrospectively reviewed.
RESULTS:
Anterior two thirds callosotomy resulted in resolution of absence (P = .03) and astatic (P = .03) seizures, whereas anterior two thirds callosotomy followed by second-stage completion resulted in resolution of generalized tonic-clonic (GTC) (P = .03), astatic (P = .005), and myoclonic (P = .03) seizures in addition to a trend toward resolution of absence seizures (P = .08). Single-stage upfront complete callosotomy resulted in resolution of absence (P = .002), astatic (P < .0001), myoclonic (P = .007), and complex partial (P = .008) seizures in addition to a trend toward resolution of GTC (P = .06). In comparing a composite of subjects who underwent anterior two thirds callosotomy alone or 2-stage complete callosotomy before the second stage to complete the callosotomy with subjects who underwent upfront complete CC, a more favorable outcome was found in those with the upfront complete CC (P = .02).
CONCLUSION:
Single-stage upfront complete callosotomy is effective in relieving a broader spectrum of seizure types than anterior two thirds callosotomy or 2-stage complete callosotomy in children. The advantages of single-stage complete callosotomy must be weighed against the potentially higher risk of neurological and operative complications.
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Affiliation(s)
| | | | - Karen Steger-May
- Department of Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Laleh Jalilian
- Department of Neurology, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, Missouri
| | - Mary Bertrand
- Department of Neurology, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, Missouri
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Shorvon SD, Goodridge DMG. Longitudinal cohort studies of the prognosis of epilepsy: contribution of the National General Practice Study of Epilepsy and other studies. Brain 2013; 136:3497-510. [DOI: 10.1093/brain/awt223] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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150
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Sillanpää M, Shinnar S. SUDEP and other causes of mortality in childhood-onset epilepsy. Epilepsy Behav 2013; 28:249-55. [PMID: 23746924 DOI: 10.1016/j.yebeh.2013.04.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND There are few prospective studies on the causes of mortality in well-characterized cohorts with epilepsy and even fewer that have autopsy data that allow for reliable determination of SUDEP. We report causes of mortality and mortality rates in the Finnish cohort with childhood-onset epilepsy. METHODS A population-based cohort of 245 children with epilepsy in 1964 has been prospectively followed for almost 40 years. Seizure outcomes and mortality were assessed. Autopsy data were available in 70% of the cases. Sudden unexpected death in epilepsy (SUDEP) rates were assessed, and SUDEP was confirmed by autopsy. RESULTS During the follow-up, 60 subjects died. The major risk factor for mortality was lack of terminal remission (p < 0.0001). Remote symptomatic etiology also increased the risk for death (p < 0.0001) but did not remain significant on multivariate analysis after adjusting for effect of remission. Of the deaths, 33/60 (55%) were epilepsy-related including SUDEP in 23/60 (38%) using the Nashef criteria, status epilepticus in 4/60 (7%), and accidental drowning in 6/60 (10%). The nonepilepsy-related deaths occurred primarily in the remote symptomatic group and were often related to the underlying disorder or to medical comorbidities that developed after the onset of the epilepsy. Risk factors for SUDEP on multivariable analysis included lack of 5-year terminal remission and not having a localization-related epilepsy. In cryptogenic/idiopathic cases, SUDEP did not occur in childhood but begins only in adolescence. CONCLUSION Childhood-onset epilepsy is associated with a substantial risk of epilepsy-related mortality, primarily SUDEP. In otherwise neurologically normal individuals, the increased SUDEP risk begins in adolescence. The higher mortality rates reported in this cohort are related to duration of follow-up as most of the mortality occurs many years after the onset of the epilepsy.
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Affiliation(s)
- Matti Sillanpää
- Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland.
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