1551
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Meng LP, Dai YY. [A clinical analysis of electrical status epilepticus during sleep in children and a follow-up study of methylprednisolone pulse therapy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:348-353. [PMID: 31014427 PMCID: PMC7389217 DOI: 10.7499/j.issn.1008-8830.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/02/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the clinical features of electrical status epilepticus during sleep (ESES) in children, as well as the clinical effect of methylprednisolone pulse therapy in children with ESES. METHODS A retrospective analysis was performed using the clinical data of 78 children with ESES. Among these children, 56 children who had had the failure of antiepileptic drugs were treated with methylprednisolone pulse therapy at a dose of 15-20 mg/(kg·d) for three courses. Each course of treatment was 3 days, followed by oral prednisone [1-2 mg/(kg·d)] for 3 days. The role of methylprednisolone pulse therapy in eliminating ESES, controlling clinical seizures, and improving intelligence and behaviors was analyzed. RESULTS The mean age of onset of epilepsy in 78 children was 6.8±2.4 years, and the mean age for the first occurrence of ESES was 7.6±2.5 years. Compared with normal children, children with ESES had delayed intelligence development and higher scores of some behavior problems. Methylprednisolone pulse therapy had an overall response rate of 73% (41/56) on clinical seizures, and the overall response rate on electroencephalography (EEG)/spike-wave index was 70% (39/56) after treatment. There were significant improvements in verbal intelligence quotient, performance intelligence quotient and full intelligence quotient, and significant reductions in the scores of learning problems, impulse-hyperactivity and hyperactivity index after treatment (P<0.05). The overall recurrence rate after 1-year follow-up was 29% (11/38). CONCLUSIONS ESES often presents around school age and impairs children's intelligence and behaviors. Methylprednisolone pulse therapy has a marked efficiency in reducing clinical seizures and EEG discharges in children with ESES and can improve intelligence and behavior development, but the recurrence rate remains high.
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Affiliation(s)
- Li-Ping Meng
- Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China.
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1552
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Movement disorders phenomenology in focal motor seizures. Parkinsonism Relat Disord 2019; 61:161-165. [DOI: 10.1016/j.parkreldis.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/30/2018] [Accepted: 10/15/2018] [Indexed: 11/20/2022]
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1553
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Geitona M, Stamuli E, Giannakodimos S, Kimiskidis VK, Kountouris V, Charokopou M, Christou P. Lacosamide as a first-line treatment option in focal epilepsy: a cost-utility analysis for the Greek healthcare system. J Med Econ 2019; 22:359-364. [PMID: 30652931 DOI: 10.1080/13696998.2019.1571499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Epilepsy is the most common serious neurological disorder worldwide. Approximately 40% of patients with focal epileptic seizures remain uncontrolled with antiepileptic drug (AED) monotherapy or polytherapy. Lacosamide has been recently approved by the European Medicines Agency as monotherapy for the treatment of focal seizures. The aim of this study was to estimate the cost-effectiveness of lacosamide compared with zonisamide as first-line treatment of focal epilepsy in patients with epilepsy aged ≥ 16 years to inform clinical decision-making in Greece. METHODS A discrete event simulation model was adapted to reflect treatment pathways and resource use within the Greek national healthcare system, as specified by clinical experts. The model captures time-varying events and patient characteristics. Clinical inputs were sourced from pivotal trials and a network meta-analysis comparing lacosamide with other AEDs. The model predicts disease progression and seizures, relevant and most common adverse events, withdrawal due to lack of efficacy or adverse events, and epilepsy-specific and all-cause mortality over a 2-year time horizon. Unit costs were retrieved from published Greek sources. Health outcomes were measured as quality-adjusted life years (QALYs); secondary outcome was the cost per seizure avoided. Robustness of the results was tested with univariate and probabilistic sensitivity analyses. RESULTS The lacosamide treatment pathway was associated with higher costs (i.e. €1,064) and an additional 0.119 QALYs when compared with zonisamide, resulting in an incremental cost-effectiveness ratio of €8,938 per QALY gained. The sensitivity analyses demonstrated that the results are most sensitive to the efficacy and utility estimates. LIMITATIONS There are a number of limitations which stem from the process of model adaptation and lack of local real-world evidence. CONCLUSIONS Lacosamide is a cost-effective option at a willingness-to-pay threshold of €30,000 per QALY, representing a valuable monotherapy treatment option for patients with focal epileptic seizures in the Greek setting.
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Affiliation(s)
- Mary Geitona
- a School of Social & Political Sciences, Department of Social & Educational Policy , University of Peloponnese , Corinth , Greece
| | - Eugena Stamuli
- b Research Fellow Department of Health Sciences , University of York , York , UK
| | | | - Vasileios K Kimiskidis
- d Laboratory of Clinical Neurophysiology , AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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1554
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Abstract
PURPOSE OF REVIEW Recognizing the cause of a first seizure and identifying the etiology of epilepsy are essential for management. A systematic approach to patients who present with a first seizure helps distinguish between an acute symptomatic seizure, a provoked or unprovoked seizure, and potential mimickers. Routine testing with EEG and MRI may reveal a predisposition for further seizures and help to establish the underlying epilepsy syndrome. An acquired etiology can be identified in 30% of patients with established epilepsy. The remaining 70% of patients have a presumably genetic etiology. Particularly in patients with specific epilepsy syndromes or suspicion for an autosomal dominant inheritance, genetic testing and counseling should be considered. RECENT FINDINGS Neuroimaging, autoimmune antibodies, and genetic testing have revolutionized our ability to investigate the etiology of many epilepsies. The new epilepsy classification distinguishes structural, metabolic, genetic, infectious, and immune-mediated etiologies, which often help determine prognosis and treatment. SUMMARY There is growing acceptance and demystification of the term epilepsy as the most common cause for recurrent seizures. The new classification of epilepsy does not stop with the recognition of particular epilepsy syndromes but aims to determine the underlying etiology. This can lead to earlier recognition of surgical candidates, a better understanding of many of the genetic epilepsies, and medical treatments aimed at the underlying mechanism causing the disease.
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1555
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Riechmann J, Willems LM, Boor R, Kieslich M, Knake S, Langner C, Neubauer BA, Oberman B, Philippi H, Reese JP, Rochel M, Schubert-Bast S, Seeger J, Seipelt P, Stephani U, Rosenow F, Hamer HM, Strzelczyk A. Quality of life and correlating factors in children, adolescents with epilepsy, and their caregivers: A cross-sectional multicenter study from Germany. Seizure 2019; 69:92-98. [PMID: 31004927 DOI: 10.1016/j.seizure.2019.03.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/30/2019] [Accepted: 03/24/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify factors correlating with poorer quality of life (QoL) in children and adolescents with epilepsy and regarding QoL and depression of their caregivers in Germany. METHOD A cross-sectional multicenter study on QoL and depression was performed in two representative German states (Hessen and Schleswig-Holstein). Variance analysis, linear regression, and bivariate correlation were used to identify correlating factors for poorer QoL and symptoms of depression. RESULTS Data from 489 children and adolescents (mean age 10.4 ± 4.2 years, range 0.5-17.8; 54.0% male) and their caregivers were collected. We identified missing seizure freedom (p = 0.046), concomitant diseases (p = 0.007), hospitalization (p = 0.049), recent status epilepticus (p = 0.035), living in a nursing home or with foster parents (p = 0.049), and relevant degree of disability (p = 0.007) to correlate with poorer QoL in children and adolescents with epilepsy. Poorer QoL of caregivers was associated with longer disease duration (p = 0.004), non-idiopathic (mainly structural-metabolic) epilepsy (p = 0.003), ongoing seizures (p = 0.003), concomitant diseases (p = 0.003), relevant disability (p = 0.003), or status epilepticus (p = 0.003) as well as with unemployment of the primary caretaker (p = 0.010). Symptoms of depression of caregivers were associated with non-idiopathic epilepsy (p = 0.003), concomitant diseases (p = 0.003), missing seizure freedom (p = 0.007), status epilepticus (p = 0.004), or a relevant disability (p = 0.004) of their ward. A poorer QoL value of the children and adolescents correlated with a poorer QoL value of the caregivers (p < 0.001). CONCLUSIONS Epilepsy shows a considerable impact on QoL and symptoms of depression. Early and effective therapy should focus on reduction of seizure frequency and the probability for developing status epilepticus. Furthermore, comprehensive care should pay attention at comorbidities, consequences of disability and dependency on others.
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Affiliation(s)
- Janna Riechmann
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Department of Pediatrics, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Rainer Boor
- Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Christian-Albrechts-University, Kiel, Germany
| | - Matthias Kieslich
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Bernd A Neubauer
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bettina Oberman
- Center for Social Pediatrics Frankfurt Höchst, Frankfurt am Main, Germany
| | - Heike Philippi
- Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt am Main, Germany
| | - Jens P Reese
- Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg (Lahn), Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jürgen Seeger
- Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt am Main, Germany
| | - Peter Seipelt
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Department of Pediatrics, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Ulrich Stephani
- Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Christian-Albrechts-University, Kiel, Germany
| | - Felix Rosenow
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Hajo M Hamer
- Epilepsy Center Erlangen, Friedrich-Alexander University, Erlangen, Germany
| | - Adam Strzelczyk
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
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1556
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Lüders H, Akamatsu N, Amina S, Baumgartner C, Benbadis S, Bermeo‐Ovalle A, Bleasel A, Bozorgi A, Carreño M, Devereaux M, Fernandez‐Baca Vaca G, Francione S, García Losarcos N, Hamer H, Holthausen H, Jamal Omidi S, Kalamangalam G, Kanner A, Knake S, Lacuey N, Lhatoo S, Lim S, Mani J, Matsumoto R, Miller J, Noachtar S, Palmini A, Park J, Rosenow F, Shahid A, Schuele S, Steinhoff B, Szabo CÁ, Tandon N, Terada K, Van Emde Boas W, Widdess‐Walsh P, Kahane P. Critique of the 2017 epileptic seizure and epilepsy classifications. Epilepsia 2019; 60:1032-1039. [DOI: 10.1111/epi.14699] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/15/2018] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hans Lüders
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Naoki Akamatsu
- Department of NeurologyInternational University of Health and Welfare School of Medicine Narita Japan
| | - Shahram Amina
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Christoph Baumgartner
- Department of NeurologyRosenhügel Neurological Center, Hietzing General Hospital Vienna Austria
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive NeurologyMedical FacultySigmund Freud University Vienna Austria
| | - Selim Benbadis
- Departments of Neurology and NeurosurgeryUniversity of South Florida Tampa Florida
| | | | - Andrew Bleasel
- Department of NeurologyWestmead HospitalUniversity of Sydney Westmead New South Wales Australia
| | - Alireza Bozorgi
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Mar Carreño
- Epilepsy UnitClinical Hospital Barcelona Spain
| | - Michael Devereaux
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | | | | | | | - Hajo Hamer
- Department of NeurologyUniversity of Erlangen Erlangen Germany
| | - Hans Holthausen
- Neuropediatric Clinic and Clinic for NeurorehabilitationEpilepsy Center for Children and AdolescentsSchoen Clinic Vogtareuth Germany
| | - Shirin Jamal Omidi
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | | | - Andrés Kanner
- Comprehensive Epilepsy CenterMiller School of MedicineUniversity of Miami Miami Florida
| | - Susanne Knake
- Department of NeurologyMarburg University Hospital Marburg Germany
| | - Nuria Lacuey
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Samden Lhatoo
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Shih‐Hui Lim
- Department of NeurologyNational Neuroscience Institute Singapore City Singapore
| | - Jayanthi Mani
- Kokilaben Dhirubhai Ambani Hospital and Research Center Mumbai India
| | - Riki Matsumoto
- Department of NeurologyKyoto University Hospital Kyoto Japan
| | - Jonathan Miller
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Soheyl Noachtar
- Department of NeurologyUniversity of Munich HospitalLudwig Maximilian University Munich Germany
| | - André Palmini
- Neurology Service and Epilepsy Surgery Program, School of MedicinePontifical Catholic University of Rio Grande do Sul Porto Alegre Brazil
| | - Jun Park
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Felix Rosenow
- Neurology and Neurosurgery CenterFrankfurt University HospitalGoethe University Frankfurt am Main Germany
| | - Asim Shahid
- Department of NeurologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Stephan Schuele
- Feinberg School of MedicineNorthwestern University Chicago Illinois
| | | | - Charles Ákos Szabo
- Department of NeurologyHealth Science CenterUniversity of Texas San Antonio Texas
| | - Nitin Tandon
- Department of NeurosurgeryMemorial Hermann Texas Medical Center Houston Texas
| | - Kiyohito Terada
- Shizuoka Institute of Epilepsy and Neurological Disorders Shizuoka Japan
| | - Walter Van Emde Boas
- Department of Clinical NeurophysiologyEpilepsy Institutions Netherlands Foundation Hoofddorp The Netherlands
| | | | - Philippe Kahane
- Neurology Department and Grenoble Institute of Neurosciences, National Institute of Health and Medical Research U‐1216Grenoble Alpes University Hospital Grenoble France
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1557
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Catala A, Grandgeorge M, Schaff JL, Cousillas H, Hausberger M, Cattet J. Dogs demonstrate the existence of an epileptic seizure odour in humans. Sci Rep 2019; 9:4103. [PMID: 30923326 PMCID: PMC6438971 DOI: 10.1038/s41598-019-40721-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/19/2019] [Indexed: 11/09/2022] Open
Abstract
Although different studies have shown that diseases such as breast or lung cancer are associated with specific bodily odours, no study has yet tested the possibility that epileptic seizures may be reflected in an olfactory profile, probably because there is a large variety of seizure types. The question is whether a “seizure-odour”, that would be transversal to individuals and types of seizures, exists. This would be a pre requisite for potential anticipation, either by electronic systems (e.g., e-noses) or trained dogs. The aim of the present study therefore was to test whether trained dogs, as demonstrated for cancer or diabetes, may discriminate a general epileptic seizure odor (different from body odours of the same person in other contexts and common to different persons). The results were very clear: all dogs discriminated the seizure odour. The sensitivity and specificity obtained were amongst the highest shown up to now for discrimination of diseases. This constitutes a first proof that, despite the variety of seizures and individual odours, seizures are associated with olfactory characteristics. These results open a large field of research on the odour signature of seizures. Further studies will aim to look at potential applications in terms of anticipation of seizures.
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Affiliation(s)
- Amélie Catala
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35380 Paimpont, France. .,Association Handi'Chiens, 13 Rue de l'Abbé Groult, Paris, France.
| | - Marine Grandgeorge
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35380 Paimpont, France
| | - Jean-Luc Schaff
- Association Handi'Chiens, 13 Rue de l'Abbé Groult, Paris, France.,Centre d'Observation et de Cure pour Enfants Epileptiques, Ets OHS de Lorraine, 46 rue du doyen J. Parisot, Flavigny-sur-Moselle, France.,Service de Neurologie du CHRU de Nancy, 29, avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - Hugo Cousillas
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35000 Rennes, France
| | - Martine Hausberger
- CNRS, Univ Rennes, Normandie Univ, EthoS (Éthologie animale et humaine) - UMR 6552, F-35380 Paimpont, France
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1558
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Jędrzejczak J, Majkowska-Zwolińska B, Ryglewicz D, Nagańska E, Mazurkiewicz-Bełdzińska M. Recommendations of the Polish Society of Epileptology for the treatment of epileptic seizure in adult patients in Poland: an update. JOURNAL OF EPILEPTOLOGY 2019. [DOI: 10.21307/jepil-2019-002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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1559
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Farrell JS, Nguyen QA, Soltesz I. Resolving the Micro-Macro Disconnect to Address Core Features of Seizure Networks. Neuron 2019; 101:1016-1028. [PMID: 30897354 PMCID: PMC6430140 DOI: 10.1016/j.neuron.2019.01.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/14/2018] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
Abstract
Current drug treatments for epilepsy attempt to broadly restrict excitability to mask a symptom, seizures, with little regard for the heterogeneous mechanisms that underlie disease manifestation across individuals. Here, we discuss the need for a more complete view of epilepsy, outlining how key features at the cellular and microcircuit level can significantly impact disease mechanisms that are not captured by the most common methodology to study epilepsy, electroencephalography (EEG). We highlight how major advances in neuroscience tool development now enable multi-scale investigation of fundamental questions to resolve the currently controversial understanding of seizure networks. These findings will provide essential insight into what has emerged as a disconnect between the different levels of investigation and identify new targets and treatment options.
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Affiliation(s)
- Jordan S Farrell
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
| | - Quynh-Anh Nguyen
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Ivan Soltesz
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
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1560
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Gibbs SA, Proserpio P, Francione S, Mai R, Cardinale F, Sartori I, Castana L, Plazzi G, Tinuper P, Cossu M, Russo GL, Tassi L, Nobili L. Clinical features of sleep‐related hypermotor epilepsy in relation to the seizure‐onset zone: A review of 135 surgically treated cases. Epilepsia 2019; 60:707-717. [DOI: 10.1111/epi.14690] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Steve A. Gibbs
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
- Department of NeurosciencesCenter for Advanced Research in Sleep MedicineHôpital du Sacré‐Cœur de MontréalUniversity of Montreal Montreal Quebec Canada
| | - Paola Proserpio
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Stefano Francione
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Roberto Mai
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Francesco Cardinale
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Ivana Sartori
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Laura Castana
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche Bologna Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM)University of Bologna Bologna , Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche Bologna Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM)University of Bologna Bologna , Italy
| | - Massimo Cossu
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Giorgio Lo Russo
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Laura Tassi
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
| | - Lino Nobili
- Department of NeurosciencesCenter for Epilepsy Surgery “C. Munari,”Hospital Niguarda Milan Italy
- Child Neuropsychiatry UnitIRCCS G. Gaslini InstituteDINOGMI‐Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of Genoa Genova Italy
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1561
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1562
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Vlaskamp DRM, Bassett AS, Sullivan JE, Robblee J, Sadleir LG, Scheffer IE, Andrade DM. Schizophrenia is a later-onset feature of PCDH19
Girls Clustering Epilepsy. Epilepsia 2019; 60:429-440. [DOI: 10.1111/epi.14678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Danique R. M. Vlaskamp
- Department of Medicine; Epilepsy Research Centre; The University of Melbourne; Austin Health; Melbourne Victoria Australia
- Department of Neurology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Genetics; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Anne S. Bassett
- Clinical Genetics Research Program; Campbell Family Mental Health Research Institute; Centre for Addiction and Mental Health; Toronto Ontario Canada
- Department of Psychiatry; University of Toronto; Toronto Ontario Canada
- Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome; Toronto General Research Institute; University Health Network; Toronto Ontario Canada
| | - Joseph E. Sullivan
- Pediatric Epilepsy Center; Benioff Children's Hospital; University of California San Francisco; San Francisco California
| | - Jennifer Robblee
- Division of Neurology; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - Lynette G. Sadleir
- Department of Paediatrics and Child Health; University of Otago; Wellington New Zealand
| | - Ingrid E. Scheffer
- Department of Medicine; Epilepsy Research Centre; The University of Melbourne; Austin Health; Melbourne Victoria Australia
- Department of Paediatrics; Royal Children's Hospital; The University of Melbourne; Victoria Australia
- The Florey Institute of Neurosciences and Mental Health; Melbourne Victoria Australia
| | - Danielle M. Andrade
- Division of Neurology; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
- Epilepsy Genetics Research Program; Krembil Neuroscience Centre; University of Toronto; Toronto Ontario Canada
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1563
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A Preliminary Study Evaluating the Safety and Efficacy of Bumetanide, an NKCC1 Inhibitor, in Patients with Drug-Resistant Epilepsy. CNS Drugs 2019; 33:283-291. [PMID: 30784026 DOI: 10.1007/s40263-019-00607-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dysregulation of cation-chloride cotransporters NKCC1 and KCC2 expression was shown to be related to drug-resistant epilepsy. Previous studies suggested that bumetanide, an inhibitor of NKCC1, might have antiepileptic effects. OBJECTIVE The aim of this study was to investigate the safety and efficacy of bumetanide add-on therapy in patients with drug-resistant epilepsy and its relation to cation-chloride cotransporters NKCC1 and KCC2. METHODS We conducted an open-label, single-arm clinical trial in drug-resistant temporal lobe epilepsy (TLE) patients. This study consisted of three phases: pretreatment (3 months), titration (3 weeks), and active treatment (6 months). During the pretreatment phase, the dose of antiepileptic drugs was stabilized, and bumetanide was then added at an initial dose of 0.5 mg/day, increasing by 0.5 mg/week until a target dose of 2 mg/day was achieved. Bumetanide treatment was then continued for 6 months. Seizure frequency and adverse events were assessed at every monthly visit. Blood samples were collected from patients and 12 healthy controls were used for polymerase chain reaction and Western blot analyses. Primary clinical outcomes were drug safety and change in seizure frequency. Changes in NKCC1 and KCC2 expression were the non-clinical endpoints. RESULTS A total of 30 patients were enrolled, 27 of whom completed the study. The mean duration of epilepsy was 16.5 years. Median seizure frequency per month was 9 [interquartile range (IQR) 7-14.5] at baseline, 3.67 (IQR 1.84-6.17) at the first 3 months, and 2 (IQR 0.84-4.34) at the last 3 months (p < 0.001). Five adverse events were detected in six patients. The reported adverse events were anorexia in four patients, nausea and vomiting in two patients, and agitation, headache and increased seizure frequency in one patient each. The level of NKCC1 and KCC2 gene transcripts and KCC2 protein did not change significantly following treatment (p > 0.05); however, we observed a significant reduction in NKCC1 protein levels (p = 0.042). CONCLUSIONS Bumetanide might be an effective and relatively tolerable drug in patients with drug-resistant TLE. Downregulation of NKCC1 protein following bumetanide treatment may be responsible for its antiepileptic effects. IRANIAN REGISTRY OF CLINICAL TRIALS IDENTIFIER IRCT 201012115368N1.
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1564
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Olivé-Gadea M, Requena M, Fonseca Hernández E, Quintana M, Santamarina E, Abraira Del Fresno L, Álvarez-Sabín J, Salas-Puig X, Toledo M. Etiology, seizure type, and prognosis of epileptic seizures in the emergency department. Epilepsy Behav 2019; 92:327-331. [PMID: 30763767 DOI: 10.1016/j.yebeh.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/25/2018] [Accepted: 12/09/2018] [Indexed: 11/28/2022]
Abstract
UNLABELLED Epileptic seizures are a common reason for emergency department (ED) admittance. We aimed to describe the etiological distribution of epileptic seizures and the relationships between etiology and semiology in patients admitted to the emergency room, and to identify early prognostic factors for recurrence and mortality. METHODS A retrospective observational study was conducted in adult patients consecutively attended in the emergency room with epileptic seizures over a 2-year period. We recorded data on the etiological and syndromic classification of the seizure, and on recurrence and mortality at 1 year of follow-up. RESULTS In total, 289 patients were included. Mean age was 55.9 (±21.9 years). There were 38.6% with a previous diagnosis of epilepsy and 49.8% with new-onset seizures. Among structural epilepsies, a vascular etiology was the most common overall (28.3%) but particularly in elderly (>65 years) patients (50.9%), followed by brain tumors (15.5%). In both etiologies, most patients presented with nonconvulsive seizures. Seizure recurrence during follow-up was reported in 37.1% and was most common in patients with symptomatic remote seizures (50 patients, 41%). Brain tumors (odds ratio (OR): 5.1, confidence interval (CI): 1.7-11.8; p < 0.01), younger age (OR: 0.9, CI: 0.97-0.99; p < 0.05), and a previous diagnosis of epilepsy (OR: 3.5, CI: 1.9-6.3; p < 0.01) were independent predictors of recurrence. Overall mortality was 8.6%. Symptomatic epilepsy was an independent predictor of mortality (hazard ratio (HR): 6.3, CI 1.4-23.4; p < 0.05). CONCLUSIONS The most common etiologies of seizures in patients admitted to the ED are seizures of unknown cause and vascular disorder-related seizures. Seizures are more likely to recur in younger patients with a tumor whereas symptomatic epilepsy is associated with a higher risk of death at a 1-year follow-up.
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Affiliation(s)
- Marta Olivé-Gadea
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Manuel Requena
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Elena Fonseca Hernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Laura Abraira Del Fresno
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Jose Álvarez-Sabín
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Xavier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain.
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1565
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Syed TU, LaFrance WC, Loddenkemper T, Benbadis S, Slater JD, El-Atrache R, AlBunni H, Khan MT, Aziz S, Ali NY, Khan FA, Alnobani A, Hussain FM, Syed AU, Koubeissi MZ. Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort. Seizure 2019; 66:104-111. [DOI: 10.1016/j.seizure.2019.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 12/01/2022] Open
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1566
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Li Q, Chen D, Zhu LN, Wang HJ, Xu D, Tan G, Zhang Y, Liu L. Depression in people with epilepsy in West China: Status, risk factors and treatment gap. Seizure 2019; 66:86-92. [DOI: 10.1016/j.seizure.2019.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/18/2022] Open
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1567
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Vilella L, Lacuey N, Hampson JP, Rani MRS, Loparo K, Sainju RK, Friedman D, Nei M, Strohl K, Allen L, Scott C, Gehlbach BK, Zonjy B, Hupp NJ, Zaremba A, Shafiabadi N, Zhao X, Reick-Mitrisin V, Schuele S, Ogren J, Harper RM, Diehl B, Bateman LM, Devinsky O, Richerson GB, Tanner A, Tatsuoka C, Lhatoo SD. Incidence, Recurrence, and Risk Factors for Peri-ictal Central Apnea and Sudden Unexpected Death in Epilepsy. Front Neurol 2019; 10:166. [PMID: 30890997 PMCID: PMC6413671 DOI: 10.3389/fneur.2019.00166] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/08/2019] [Indexed: 02/01/2023] Open
Abstract
Introduction: Peri-ictal breathing dysfunction was proposed as a potential mechanism for SUDEP. We examined the incidence and risk factors for both ictal (ICA) and post-convulsive central apnea (PCCA) and their relationship with potential seizure severity biomarkers (i. e., post-ictal generalized EEG suppression (PGES) and recurrence. Methods: Prospective, multi-center seizure monitoring study of autonomic, and breathing biomarkers of SUDEP in adults with intractable epilepsy and monitored seizures. Video EEG, thoraco-abdominal excursions, capillary oxygen saturation, and electrocardiography were analyzed. A subgroup analysis determined the incidences of recurrent ICA and PCCA in patients with ≥2 recorded seizures. We excluded status epilepticus and obscured/unavailable video. Central apnea (absence of thoracic-abdominal breathing movements) was defined as ≥1 missed breath, and ≥5 s. ICA referred to apnea preceding or occurring along with non-convulsive seizures (NCS) or apnea before generalized convulsive seizures (GCS). Results: We analyzed 558 seizures in 218 patients (130 female); 321 seizures were NCS and 237 were GCS. ICA occurred in 180/487 (36.9%) seizures in 83/192 (43.2%) patients, all with focal epilepsy. Sleep state was related to presence of ICA [RR 1.33, CI 95% (1.08–1.64), p = 0.008] whereas extratemporal epilepsy was related to lower incidence of ICA [RR 0.58, CI 95% (0.37–0.90), p = 0.015]. ICA recurred in 45/60 (75%) patients. PCCA occurred in 41/228 (18%) of GCS in 30/134 (22.4%) patients, regardless of epilepsy type. Female sex [RR 11.30, CI 95% (4.50–28.34), p < 0.001] and ICA duration [RR 1.14 CI 95% (1.05–1.25), p = 0.001] were related to PCCA presence, whereas absence of PGES was related to absence of PCCA [0.27, CI 95% (0.16–0.47), p < 0.001]. PCCA duration was longer in males [HR 1.84, CI 95% (1.06–3.19), p = 0.003]. In 9/17 (52.9%) patients, PCCA was recurrent. Conclusion: ICA incidence is almost twice the incidence of PCCA and is only seen in focal epilepsies, as opposed to PCCA, suggesting different pathophysiologies. ICA is likely to be a recurrent semiological phenomenon of cortical seizure discharge, whereas PCCA may be a reflection of brainstem dysfunction after GCS. Prolonged ICA or PCCA may, respectively, contribute to SUDEP, as evidenced by two cases we report. Further prospective cohort studies are needed to validate these hypotheses.
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Affiliation(s)
- Laura Vilella
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nuria Lacuey
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Johnson P Hampson
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - M R Sandhya Rani
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Kenneth Loparo
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, United States
| | - Rup K Sainju
- Department of Neurology, University of Iowa School of Medicine, Iowa City, IA, United States
| | | | - Maromi Nei
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kingman Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Medical Center, Cleveland, OH, United States
| | - Luke Allen
- Institute of Neurology, University College London, London, United Kingdom
| | - Catherine Scott
- Institute of Neurology, University College London, London, United Kingdom
| | - Brian K Gehlbach
- Department of Neurology, University of Iowa School of Medicine, Iowa City, IA, United States
| | - Bilal Zonjy
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Norma J Hupp
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Anita Zaremba
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Nassim Shafiabadi
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Xiuhe Zhao
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Victoria Reick-Mitrisin
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Stephan Schuele
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jennifer Ogren
- Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ronald M Harper
- Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Beate Diehl
- Institute of Neurology, University College London, London, United Kingdom
| | - Lisa M Bateman
- Department of Neurology, Columbia University, New York, NY, United States
| | - Orrin Devinsky
- NYU Langone School of Medicine, New York, NY, United States
| | - George B Richerson
- Department of Neurology, University of Iowa School of Medicine, Iowa City, IA, United States
| | - Adriana Tanner
- Mercy Health St. Mary's Campus, Grand Rapids, MI, United States
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, United States
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1568
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Abstract
Epilepsy affects 65 million people worldwide, and is a leading neurologic cause of loss of quality-adjusted life years. The diagnosis of seizures and epilepsy often depends on a careful history, and is supported with electroencephalogram and imaging. First-line treatment of epilepsy includes medical management. Antiepileptic drugs must be chosen with the patient's particular comorbidities in mind. Drug-resistant epilepsy cases should be referred to an epilepsy specialist and may be evaluated for additional medications, epilepsy surgery, neurostimulation, or dietary therapy. When caring for women, providers must take into account needs for contraception or pregnancy safety where applicable.
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Affiliation(s)
- Emily L Johnson
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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1569
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Randhawa J, Hrazdil CT, Hassan I. Affect-induced reflex seizures (AIRS): A case series based on a systematic literature review. Epilepsy Behav 2019; 92:18-25. [PMID: 30599458 DOI: 10.1016/j.yebeh.2018.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 11/26/2022]
Abstract
Seizures are commonly thought to occur in a spontaneous, unpredictable manner. However, it is well-established that a subset of patients with epilepsy can experience reflex seizures that are consistently elicited by a specific stimulus. While various forms of reflex epilepsy have been documented in the literature, acute affective states have not been commonly described as a potential reflex seizure trigger. We performed a systematic literature review to determine if acute emotional states can trigger reflex seizures. We included any case in which reflex seizures repeatedly occurred in response to a patient-specific stimulus that was reported as emotionally relevant by the authors. This yielded our case series of ten patients who have been described to have reflex seizures in response to emotional stimuli. We characterized features of these cases including the following: age, gender, developmental and psychiatric history, seizure semiology and duration, emotional triggers, other reflex triggers, relationship between reflex triggers and seizures, investigations, localization, final diagnosis, treatment, and outcome. Considerable variability was found between cases. A trend toward limbic seizure semiology with psychic aura originating in networks involved in emotional processing was noted, with temporal lobe epilepsy being the most common, although without clear laterality or gender predominance. In addition, the report of a significant life stressor occurring at epilepsy onset in three of ten patients as well as the initial suspicion that reflex epileptic seizures were psychogenic in three cases both emphasize the role of electroencephalography in assessment of such presentations to avoid missing a diagnosis of epilepsy. Findings from these ten cases suggest that a patient-specific affective stimulus may trigger reflex seizures in a subset of patients, and that this could be underrecognized or mislabeled as nonepileptic. We encourage future studies with larger numbers to further characterize this phenomenon. Insights gained may enhance our understanding of seizure localization and bear potential treatment implications.
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Affiliation(s)
- Jason Randhawa
- Division of Neurology, The University of British Columbia, Vancouver, British Columbia, V6T 2B5, Canada
| | - Chantelle T Hrazdil
- Division of Neurology, The University of British Columbia, Vancouver, British Columbia, V6T 2B5, Canada; Vancouver General Hospital Epilepsy Program, Gordon and Leslie Diamond Health Care Centre, 8257 - 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Islam Hassan
- Vancouver General Hospital Epilepsy Program, Gordon and Leslie Diamond Health Care Centre, 8257 - 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada; University of British Columbia Neuropsychiatry Program, Detwiller Pavilion, UBC Hospital, 2255 Wesbrook Mall, Vancouver, British Columbia, V6T 2A1, Canada.
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1570
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Willems LM, Kondziela JM, Knake S, Schulz J, Neif B, Schade B, Gerlinger S, Neubauer BA, Brunst B, Schubert-Bast S, Fuchs S, Staab-Kupke H, Kniess T, Rosenow F, Strzelczyk A. Counseling and social work for people with epilepsy in Germany: A cross-sectional multicenter study on demand, frequent content, patient satisfaction, and burden-of-disease. Epilepsy Behav 2019; 92:114-120. [PMID: 30654230 DOI: 10.1016/j.yebeh.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The diagnosis of epilepsy is accompanied by relevant personal, interpersonal, and professional restrictions for patients and their caregivers. Specialized epilepsy counseling services (ECS) have been introduced to inform, advise, and support patients with disease-related problems. AIM AND SCOPE The objective of this cross-sectional, multicenter study was to determine the demand, typical content, and outcomes of ECS in children, adolescents, and adults in two adjacent German regions of Hessen and Lower Franconia. All ECS sites in these regions participated in 2014 and 2015, offering a total population of 7.5 million inhabitants. RESULTS A total number of 435 patients [323 adults (74.3%), 51.7% female, mean age: 40.3 ± 14.7 years and 112 children/adolescents (25.7%), 52.7% female, mean age: 9.4 ± 4.6 years] were enrolled at six ECS sites. The most common reasons for counseling were general information needs (n = 304; 69.9%), administrative help (n = 208; 47.8%), problems with education or work (n = 176; 40.5%), and recreational activities (n = 119; 27.3%). In addition, 6.2% reported epilepsy-related questions on family planning as a specific reason for desiring counseling. Recommendation by the treating physicians was the most frequent reason for receiving counseling through ECS (62.5%), and most patients preferred to receive a personal consultation (73.1%). Patient satisfaction as measured by the ZUF-8 client satisfaction score was high with a mean of 29.7 points (standard deviation: ±2.7 points, median: 29.9 points), and 83.9% of patients said they would recommend ECS. Disease-related job loss or change in school was avoided in 72% of 82 patients. Suggestions for improvement of ECS included an extension of service hours (58.6%) and a better availability of more sites located nearby (32.8%). CONCLUSION Epilepsy counseling services are necessary, valued, and effective institutions for people with epilepsy complementing outpatient and inpatient care. To improve the care for people with epilepsy, access to and availability of ECS should be improved.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jacqueline M Kondziela
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Juliane Schulz
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Birgit Neif
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Bernd Schade
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Stefan Gerlinger
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd A Neubauer
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernhard Brunst
- Epilepsy Counseling Diakonisches Werk Hochtaunus, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simone Fuchs
- Epilepsy Counseling Unterfranken, Stiftung Juliusspital, Würzburg, Germany
| | | | - Tobias Kniess
- Department of Neurology, Campus Rhön Klinikum AG, Bad Neustadt a.d. Saale, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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1571
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Gong JE, Liao HM, Long HY, Li XM, Long LL, Zhou L, Gu WP, Lu SH, Qu Q, Yang LM, Xiao B, Qu J. SCN1B and SCN2B gene variants analysis in dravet syndrome patients: Analysis of 22 cases. Medicine (Baltimore) 2019; 98:e14974. [PMID: 30921204 PMCID: PMC6455785 DOI: 10.1097/md.0000000000014974] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Previous research identified SCN1B variants in some cases of Dravet syndrome (DS). We investigated whether SCN1B and SCN2B variants are commonly happened in DS patients without SCN1A variants. A total of 22 DS patients without SCN1A variants and 100 healthy controls were enrolled in this genetic study. DNA from DS patients was sequenced by Sanger method in whole exons of SCN1B and SCN2B genes. We identified two exon variants (c.351C>T, p.G117G and c.467C>T, p.T156M), which were present both in 1000 egenomes database and in healthy controls with a frequency of 0.54% and 4%, 0.06% and 0%, respectively. Additionally, eight intron or 3 prime UTR variants showing benign clinical significance have also been identified. Our results suggest that variants of SCN1B and SCN2B may not be common causes of DS according to our data. Further large sample-size cohort studies are needed to confirm our conclusion.
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Affiliation(s)
- Jiao-E. Gong
- Department of Neurology, Hunan Children's Hospital, Changsha 410007
| | - Hong-Mei Liao
- Department of Neurology, Hunan Children's Hospital, Changsha 410007
| | - Hong-Yu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410078
| | - Xiang-Min Li
- Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha 410078
| | - Li-Li Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410078
| | - Luo Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410078
| | - Wen-Ping Gu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410078
| | - Shao-Hua Lu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha 410000
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410078
| | - Li-Min Yang
- Department of Neurology, Hunan Children's Hospital, Changsha 410007
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410078
| | - Jian Qu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha 410011, China
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1572
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Bösel J. SOP: First-ever epileptic seizure in adult patients. Neurol Res Pract 2019; 1:3. [PMID: 33324869 PMCID: PMC7650127 DOI: 10.1186/s42466-019-0006-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background About 5% of all adults will have at least one epileptic seizure in their life. The incidence of all unprovoked seizures ranges from approximately 50 to 70 /100,000. The very first epileptic seizure in an adult can be a very decisive event and demands a great deal of responsibility on the part of the treating clinician. Optimal clinical work-up and systematic decision-making are necessary to ensure adequate treatment as well as to avoid unnecessary treatment, such as life-long application of anticonvulsants that may not be indicated. Aim To present a pragmatic standard operating procedure (SOP) for approaching the first seizure in adults. Method Based on current recommendations and personal suggestions, an SOP in the form of a flow chart accompanied with topical explanations and tables was created. Results Approaching the first seizure should start with obtaining bystander information on the seizure and its clinical features. Then, differential diagnoses should be considered. The diagnostic work-up hast to contain a neurological and physical examination, emergency blood tests and cerebral imaging. This should allow to differentiate an unprovoked from an acute symptomatic seizure, i.e. triggered by current specific and identifiable structural or metabolic cause that should be eliminated if possible. In the case of an unprovoked seizure, estimation of seizure recurrence is necessary for the decision to start treatment with antiepileptic drugs. Conclusion The challenge of diagnostic work-up and treatment decisions after a first epileptic seizure in adults may be facilitated by a systematic, SOP-based approach.
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Affiliation(s)
- Julian Bösel
- Department of Neurology, Klinikum Kassel, Mönchebergstr. 41-43, 34125 Kassel, Germany.,Kassel School of Medicine, University of Southampton, Mönchebergstr. 41-43, 34125 Kassel, Germany
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1573
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Stösser S, Böckler S, Ludolph AC, Kassubek J, Neugebauer H. Juxtacortical lesions are associated with seizures in cerebral small vessel disease. J Neurol 2019; 266:1230-1235. [PMID: 30806767 DOI: 10.1007/s00415-019-09253-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Small vessel cerebrovascular disease (SVCD) can manifest with epileptic seizures and transient ischemic attacks (TIA). This study was designed to test if the extent and spatial distribution of SVCD differs in patients with focal impaired awareness seizures (FIAS) from patients with TIA. METHODS This is a retrospective single-center case-control study of elderly patients at a high cardiovascular risk. 118 patients with FIAS (cases) were compared to a matched control group of 118 patients with TIA. The extent and spatial distribution of white matter hyperintensities (WMH) characteristic for SVCD and medial temporal lobe atrophy were analyzed on magnetic resonance imaging (MRI) obtained at admission. The Fazekas, Wahlund, and Scheltens scales were used for grading. Juxtacortical small lesions were analyzed separately. RESULTS FIAS patients were observed to have more extensive WMH (p < 0.001) and more pronounced medial temporal lobe atrophy (p < 0.001) than TIA patients. WMH in FIAS patients were predominantly localized in supratentorial white matter compared to TIA patients (p < 0.001). Juxtacortical hyperintensities were far more common in FIAS patients than in TIA patients (80.5% vs. 22.0%; p < 0.001). Multivariate analysis revealed juxtacortical small lesions as strong independent predictor (OR, 95% CI 12.8, 6.7-24.3) and medial temporal lobe atrophy as further independent predictor of FIAS (3.1, 1.3-7.1). CONCLUSIONS Juxtacortical small lesions and to a smaller extent medial temporal lobe atrophy are associated with epileptic seizures in elderly patients at a high cardiovascular risk. This observation may provide a structural explanation for epilepsy in SVCD. Juxtacortical small lesions in SVCD should be considered a structural cause for epilepsy and promote anticonvulsive therapy after a first seizure.
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Affiliation(s)
- Sebastian Stösser
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Stefanie Böckler
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hermann Neugebauer
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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1574
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Awake craniotomies for epileptic gliomas: intraoperative and postoperative seizure control and prognostic factors. J Neurooncol 2019; 142:577-586. [DOI: 10.1007/s11060-019-03131-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
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1575
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Baumgartner C, Koren J, Britto-Arias M, Schmidt S, Pirker S. Epidemiology and pathophysiology of autonomic seizures: a systematic review. Clin Auton Res 2019; 29:137-150. [DOI: 10.1007/s10286-019-00596-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/25/2019] [Indexed: 02/07/2023]
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1576
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Thijs RD, Surges R, O'Brien TJ, Sander JW. Epilepsy in adults. Lancet 2019; 393:689-701. [PMID: 30686584 DOI: 10.1016/s0140-6736(18)32596-0] [Citation(s) in RCA: 902] [Impact Index Per Article: 180.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/08/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Its incidence has a bimodal distribution with the highest risk in infants and older age groups. Progress in genomic technology is exposing the complex genetic architecture of the common types of epilepsy, and is driving a paradigm shift. Epilepsy is a symptom complex with multiple risk factors and a strong genetic predisposition rather than a condition with a single expression and cause. These advances have resulted in the new classification of epileptic seizures and epilepsies. A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances in brain imaging are helping to identify the structural and functional causes and consequences of the epilepsies. Comorbidities are increasingly recognised as important aetiological and prognostic markers. Antiseizure medication might suppress seizures in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy surgery is the most effective way to achieve long-term seizure freedom in selected individuals with drug-resistant focal epilepsy, but it is probably not used enough. With improved understanding of the gradual development of epilepsy, epigenetic determinants, and pharmacogenomics comes the hope for better, disease-modifying, or even curative, pharmacological and non-pharmacological treatment strategies. Other developments are clinical implementation of seizure detection devices and new neuromodulation techniques, including responsive neural stimulation.
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Affiliation(s)
- Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Rainer Surges
- Section of Epileptology, Department of Neurology, University Hospital RWTH Aachen, Germany
| | - Terence J O'Brien
- Melbourne Brain Centre, Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, VIC, Australia; Departments of Neuroscience and Neurology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, VIC, Australia
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
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1577
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Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:357-375. [PMID: 30773428 PMCID: PMC6416168 DOI: 10.1016/s1474-4422(18)30454-x] [Citation(s) in RCA: 469] [Impact Index Per Article: 93.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/23/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location using data from the Global Burden of Diseases, Injuries, and Risk Factors Study. METHODS We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability), by age, sex, year, location, and Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). FINDINGS In 2016, there were 45·9 million (95% UI 39·9-54·6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621·5 per 100 000 population; 540·1-737·0). Of these patients, 24·0 million (20·4-27·7) had active idiopathic epilepsy (prevalence 326·7 per 100 000 population; 278·4-378·1). Prevalence of active epilepsy increased with age, with peaks at 5-9 years (374·8 [280·1-490·0]) and at older than 80 years of age (545·1 [444·2-652·0]). Age-standardised prevalence of active idiopathic epilepsy was 329·3 per 100 000 population (280·3-381·2) in men and 318·9 per 100 000 population (271·1-369·4) in women, and was similar among SDI quintiles. Global age-standardised mortality rates of idiopathic epilepsy were 1·74 per 100 000 population (1·64-1·87; 1·40 per 100 000 population [1·23-1·54] for women and 2·09 per 100 000 population [1·96-2·25] for men). Age-standardised DALYs were 182·6 per 100 000 population (149·0-223·5; 163·6 per 100 000 population [130·6-204·3] for women and 201·2 per 100 000 population [166·9-241·4] for men). The higher DALY rates in men were due to higher YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6·0% (-4·0 to 16·7) change in the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates (24·5% [10·8 to 31·8]) and age-standardised DALY rates (19·4% [9·0 to 27·6]). A third of the difference in age-standardised DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income settings, and two-thirds were due to a higher YLL rate in low SDI countries. INTERPRETATION Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of disability and mortality. Standardised collection of data on epilepsy in population representative surveys will strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected from improved access to existing treatments in low-income countries and from the development of new effective drugs worldwide. FUNDING Bill & Melinda Gates Foundation.
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1578
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Moura LMVR, Smith JR, Blacker D, Vogeli C, Schwamm LH, Hsu J. Medicare claims can identify post-stroke epilepsy. Epilepsy Res 2019; 151:40-47. [PMID: 30780120 DOI: 10.1016/j.eplepsyres.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/31/2018] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE There have been no validated Medicare claims-based algorithms available to identify epilepsy by discrete etiology of stroke (e.g., post-stroke epilepsy, PSE) in community-dwelling elderly individuals, despite the increasing availability of large datasets. Our objective was to validate algorithms that detect which patients have true PSE. METHODS We linked electronic health records (EHR) to Medicare claims from a Medicare Pioneer Accountable Care Organization (ACO) to identify PSE. A neurologist reviewed 01/2012-12/2014 EHR data from a stratified sample of Medicare patients aged 65+ years to adjudicate a reference-standard to develop an algorithm for identifying patients with PSE. Patient sampling strata included those with: A) epilepsy-related claims diagnosis (n = 534 [all]); B) no diagnosis but neurologist visit (n = 500 [randomly sampled from 4346]); C) all others (n = 500 [randomly sampled from 16,065]). We reconstructed the full sample using inverse probability sampling weights; then used half to derive algorithms and assess performance, and the remainder to confirm performance. We evaluated predictive performance across several measures, e.g., specificity, sensitivity, negative and positive predictive values (NPV, PPV). We selected our best performing algorithms based on the greatest specificity and sensitivity. RESULTS Of 20,943 patients in the reconstructed sample, 13.6% of patients with epilepsy had reference-standard PSE diagnosis, which represents a 3-year overall prevalence of 0.28% or 28/10,000, and a prevalence within the subpopulation with stroke of 3%. The best algorithm included three conditions: (a) at least one cerebrovascular claim AND one epilepsy-specific anticonvulsant OR (b) at least one cerebrovascular claim AND one electroencephalography claim (specificity 100.0% [95% CI 99.9%-100.0%], NPV 98.8% [98.6%-99.0%], sensitivity 20.6% [95% CI 14.6%-27.9%], PPV 86.5% [95% CI 71.2%-95.5%]). CONCLUSION Medicare claims can identify elderly Medicare beneficiaries with PSE with high accuracy. Future epidemiological surveillance of epilepsy could incorporate similar algorithms to accurately identify epilepsy by varying etiologies.
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Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Department of Neurology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Jason R Smith
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Christine Vogeli
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Neurology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - John Hsu
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA, 02114, USA; Department of Health Care Policy, Harvard Medical School, 677 Huntington Avenue, Boston, MA, 02115, USA.
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1579
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Electroencephalographic features associated with intermittent rhythmic delta activity. Neurophysiol Clin 2019; 49:227-234. [PMID: 30712784 DOI: 10.1016/j.neucli.2019.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/20/2019] [Accepted: 01/20/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the clinical importance of intermittent rhythmic delta activity (IRDA) in terms of accompanying electrophysiological findings on EEG and their association with IRDA. METHODS We retrospectively assessed all EEG studies recorded in our institution from 2011 to 2017. Patients with intermittent rhythmic delta activity (IRDA) in EEGs were included. Clinical data were collected from charts of the patients with IRDA. RESULTS We identified 69 EEGs with IRDA in 58 patients from a total of 18,625 EEG recordings. The most common IRDA type was frontal IRDA (FIRDA; 55%), followed by temporal IRDA (TIRDA; 28.9%). Unilateral (UL) distribution was present in 36.8% of FIRDAs and 95% of TIRDAs. The frequency of focal epileptiform discharges (FED) was 78.5% in UL FIRDA group and 89.4% in UL TIRDA group. Among the EEGs with FEDs, in UL FIRDA group 90.9% and in UL TIRDA group 70.5% of the FEDs were ipsilateral. Concordance of focal structural brain lesions and FEDs with UL TIRDA was 30.7%, and with UL FIRDA was 50%. UL FIRDA had a 71.4% positive predictive value for ipsilateral focal epileptic focus and UL TIRDA had 63.1%. The frequency of focal structural lesions and FEDs were significantly higher in the UL FIRDA group than bilateral FIRDA group (P=0.03; P=0.01). Among the patients with focal structural lesions, ipsilateral FED association is significantly higher in the UL FIRDA group than BL FIRDA group (P=0.03). CONCLUSIONS UL FIRDA is more likely to indicate a focal lesion and a focal epileptic focus compared to bilateral FIRDA, and it had similar characteristics to UL TIRDA. It can be considered that UL FIRDA has as good a lateralizing value for ipsilateral focal epileptic focus and focal lesion as UL TIRDA.
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1580
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Süße M, Hamann L, Flöel A, von Podewils F. Nonlesional late-onset epilepsy: Semiology, EEG, cerebrospinal fluid, and seizure outcome characteristics. Epilepsy Behav 2019; 91:75-80. [PMID: 29941211 DOI: 10.1016/j.yebeh.2018.05.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Incidence and prevalence of epilepsy increase with advancing age. Although the majority of late-onset epilepsies are of lesional origin, a considerable proportion of patients present with unknown etiology. The aim of this study was to evaluate the semiological, electroencephalographic (EEG), and cerebrospinal fluid (CSF) characteristics as well as the 12-month seizure outcome in a cohort of patients with nonlesional late-onset epilepsy (≥55 years). METHOD A total of 54 patients with newly diagnosed nonlesional late-onset epilepsy (NLLOE) were retrospectively evaluated for seizure type using the most recent International League Against Epilepsy (ILAE) classification of seizure types, EEG characteristics, and CSF profile and followed-up for at least 12 months after epilepsy onset. Results were compared with a gender-matched control group of 58 patients with nonlesional early-onset epilepsy (NLEOE). RESULTS The predominant seizure types in NLLOE were focal to bilateral tonic-clonic seizures (30%) as well as focal onset impaired awareness motor seizures (IAMS) (22%) and focal onset impaired awareness nonmotor seizures (IANMS) (22%). The predominant seizure types in NLEOE were focal to bilateral tonic-clonic seizures (43%) as well as focal onset aware nonmotor seizures (ANMS) (31%) and IAMS (31%). Focal onset impaired awareness nonmotor seizures were found to be more characteristic in patients with NLLOE (p = 0.019; α < 0.05; NLLOE: 22.2% vs. NLEOE: 8.6%). Electroencephalography revealed no significant differences between groups. Of interest, three patients with NLLOE (8%) presented with oligoclonal bands (OCB) in CSF albeit absence of antineuronal antibodies. Seizure-free rate was 70%. Adverse effects from medication leading to antiepileptic drug (AED) change were reported in 12 patients (22%), valproate was the best tolerated AED in patients with NLLOE [adverse effects in 9%, compared with 12% (gabapentin) and 26% (levetiracetam)]. CONCLUSIONS Using the most recent classification system, different patterns of semiological characteristics were identified: NLLOE more frequently present with IANMS, whereas patients with NLEOE rather have ANMS. Oligoclonal bands were only detected in patients with NLLOE, indicating that careful exclusion of autoimmune encephalitis in this patient group is warranted. Our findings may help to more accurately identify and characterize patients with NLLOE to improve targeted diagnostics and adequate treatment in this challenging group of patients.
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Affiliation(s)
- Marie Süße
- Department of Neurology, University Medicine Greifswald, Epilepsy Center, Greifswald, Germany.
| | - Laura Hamann
- Department of Neurology, University Medicine Greifswald, Epilepsy Center, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Epilepsy Center, Greifswald, Germany
| | - Felix von Podewils
- Department of Neurology, University Medicine Greifswald, Epilepsy Center, Greifswald, Germany
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1581
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Willems LM, Reif PS, Knake S, Hamer HM, Willems C, Krämer G, Rosenow F, Strzelczyk A. Noncompliance of patients with driving restrictions due to uncontrolled epilepsy. Epilepsy Behav 2019; 91:86-89. [PMID: 29752000 DOI: 10.1016/j.yebeh.2018.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/31/2018] [Accepted: 04/13/2018] [Indexed: 11/26/2022]
Abstract
Epilepsies are a common and chronic neurological disorder characterized by sustained risk of recurrent seizures. Because of paroxysmal and often unpredictable occurrence of seizures, patients with uncontrolled epilepsy are subject to disease-specific restrictions in daily life, such as their career choice or specific work limitations. According to German law and many other European and international guidelines, driving is strictly prohibited in patients with uncontrolled epilepsy so as to increase active and passive safety in public road traffic. Nevertheless, a significant percentage of patients probably do not comply with these legal restrictions and drive on a regular basis. For this study, we analyzed a representative German cohort with 302 patients (mean age: 45.0 years ± 16.4; 48% male) with established epilepsy to identify the number of patients driving without permission. Overall, 58.6% (n = 177) of patients had a driving license, 71.1% (n = 69/97) of patients were in seizure remission, and 52.7% (n = 108/205) of patients had uncontrolled epilepsy. Among patients in seizure remission, 54.6% (n = 53/97) reported regular driving while, among patients with uncontrolled epilepsy, 15.1% (n = 31/205) reported driving on a regular basis. No patient in the cohort stated driving without a valid license. Permanent employment, freelance work, the absence of a relevant disability, and living alone were identified as significant risk factors, which underlines the already existing evidence for the importance of a possible restricted access to the labor market as motive for disregarding legal driving restrictions. In our opinion, specialized and generally available social counseling with a special focus on vocational and career guidance is urgently needed to improve compliance with epilepsy-caused driving restrictions and the underlying reasons for violating these rules. In addition, more effort has to be spent on improving diagnostics and treatment of epilepsy to reduce the number of patients with uncontrolled seizures. Comprehensive introduction of self-driving vehicles may also help to improve mobility of patients with refractory epilepsy.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Hajo M Hamer
- Epilepsy Center Erlangen and Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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1582
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Rüegger AD, Freeman JL, Harvey AS. Lacosamide in children with drug-resistant epilepsy. J Paediatr Child Health 2019; 55:194-198. [PMID: 30051539 DOI: 10.1111/jpc.14156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/20/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
AIM To assess the effectiveness and tolerability of lacosamide in paediatric clinical practice. METHODS A search of our hospital's pharmacy database yielded all children <16 years old dispensed lacosamide for drug-resistant epilepsy between January 2011 and June 2016. Medical records were reviewed for clinical and drug details. Continued treatment for ≥12 months was considered an indicator of effectiveness and tolerability. RESULTS A total of 107 children (61 boys) satisfied inclusion criteria. Median age at lacosamide commencement was 9.9 years (interquartile range 6.7-13.7). Of those children, 57 (53%) children had focal epilepsy, with focal motor or impaired awareness seizures most commonly reported; 50 (47%) children had generalised epilepsy, most with tonic-clonic seizures, tonic seizures or epileptic spasms; 83 (78%) children had an intellectual disability, 24 (22%) had a physical disability and 22 (21%) had an autism spectrum disorder; 69 (65%) children continued lacosamide for ≥12 months. Reasons for discontinuation before 12 months in 38 (35%) children included ineffectiveness in 25 (66%), adverse events in 7 (18%) and worsening of seizures in 2 (5%). The most common adverse events were drowsiness, behavioural changes, unsteadiness, nausea and vomiting. Epilepsy type and comorbidities were not associated with continuation or reasons for discontinuation. CONCLUSIONS Most children continued treatment with lacosamide, suggesting effectiveness and tolerability. Lacosamide may prove to be a useful, 'broad-spectrum' antiepileptic medication in children for focal and generalised epilepsies and in association with comorbidities.
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Affiliation(s)
- Andrea D Rüegger
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jeremy L Freeman
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - A Simon Harvey
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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1583
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Willie JT, Malcolm JG, Stern MA, Lowder LO, Neill SG, Cabaniss BT, Drane DL, Gross RE. Safety and effectiveness of stereotactic laser ablation for epileptogenic cerebral cavernous malformations. Epilepsia 2019; 60:220-232. [PMID: 30653657 PMCID: PMC6365175 DOI: 10.1111/epi.14634] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/08/2018] [Accepted: 12/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Magnetic resonance (MR) thermography-guided laser interstitial thermal therapy, or stereotactic laser ablation (SLA), is a minimally invasive alternative to open surgery for focal epilepsy caused by cerebral cavernous malformations (CCMs). We examined the safety and effectiveness of SLA of epileptogenic CCMs. METHODS We retrospectively analyzed 19 consecutive patients who presented with focal seizures associated with a CCM. Each patient underwent SLA of the CCM and adjacent cortex followed by standard clinical and imaging follow-up. RESULTS All but one patient had chronic medically refractory epilepsy (median duration 8 years, range 0.5-52 years). Lesions were located in the temporal (13), frontal (five), and parietal (one) lobes. CCMs induced magnetic susceptibility artifacts during thermometry, but perilesional cortex was easily visualized. Fourteen of 17 patients (82%) with >12 months of follow-up achieved Engel class I outcomes, of which 10 (59%) were Engel class IA. Two patients who were not seizure-free from SLA alone became so following intracranial electrode-guided open resection. Delayed postsurgical imaging validated CCM involution (median 83% volume reduction) and ablation of surrounding cortex. Histopathologic examination of one previously ablated CCM following open surgery confirmed obliteration. SLA caused no detectable hemorrhages. Two symptomatic neurologic deficits (visual and motor) were predictable, and neither was permanently disabling. SIGNIFICANCE In a consecutive retrospective series, MR thermography-guided SLA was an effective alternative to open surgery for epileptogenic CCM. The approach was free of hemorrhagic complications, and clinically significant neurologic deficits were predictable. SLA presents no barrier to subsequent open surgery when needed.
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Affiliation(s)
- Jon T. Willie
- Department of Neurological Surgery, Emory University School
of Medicine. Atlanta, GA
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
| | - James G. Malcolm
- Department of Neurological Surgery, Emory University School
of Medicine. Atlanta, GA
| | - Matthew A. Stern
- Medical Scientist Training Program, Emory University School
of Medicine. Atlanta, GA
| | - Lindsay O. Lowder
- Department of Pathology, Emory University School of
Medicine. Atlanta, GA
| | - Stewart G. Neill
- Department of Pathology, Emory University School of
Medicine. Atlanta, GA
| | - Brian T. Cabaniss
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
| | - Daniel L. Drane
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
- Department of Pediatrics, Emory University School of
Medicine. Atlanta, GA
- Department of Neurology, University of Washington School of
Medicine, Seattle, WA
| | - Robert E. Gross
- Department of Neurological Surgery, Emory University School
of Medicine. Atlanta, GA
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
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1584
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Spyrantis A, Cattani A, Woebbecke T, Konczalla J, Strzelczyk A, Rosenow F, Wagner M, Seifert V, Kudernatsch M, Freiman TM. Electrode placement accuracy in robot-assisted epilepsy surgery: A comparison of different referencing techniques including frame-based CT versus facial laser scan based on CT or MRI. Epilepsy Behav 2019; 91:38-47. [PMID: 30497893 DOI: 10.1016/j.yebeh.2018.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/16/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Precise robotic or stereotactic implantation of stereoelectroencephalography (sEEG) electrodes relies on the exact referencing of the planning images in order to match the patient's anatomy to the stereotactic device or robot. We compared the accuracy of sEEG electrode implantation with stereotactic frame versus laser scanning of the face based on computed tomography (CT) or magnetic resonance imaging (MRI) datasets for referencing. METHODS The accuracy was determined by calculating the Euclidian distance between the planned trajectory and the postoperative position of the sEEG electrode, defining the entry point error (EPE) and the target point error (TPE). The sEEG electrodes (n = 171) were implanted with the robotic surgery assistant (ROSA) in 19 patients. Preoperative trajectory planning was performed on three-dimensional (3D) MRI datasets. Referencing was accomplished either by performing (A) 1.25-mm slice CT with the patient's head fixed in a Leksell stereotactic frame (CT-frame, n = 49), fused with a 3D-T1-weighted, contrast enhanced- and T2-weighted 1.5 Tesla (T) MRI; (B) 1.25 mm CT (CT-laser, n = 60), fused with 3D-3.0-T MRI; (C) 3.0-T MRI T1-based laser scan (3.0-T MRI-laser, n = 56) or (D) in one single patient, because of a pacemaker, 3D-1.5-T MRI T1-based laser scan (1.5-T MRI-laser, n = 6). RESULTS In (A) CT-frame referencing, the mean EPE amounted to 0.86 mm and the mean TPE amounted to 2.28 mm (n = 49). In (B) CT-laser referencing, the EPE amounted to 1.85 mm and the TPE to 2.41 mm (n = 60). In (C) 3.0-T MRI-laser referencing, the mean EPE amounted to 3.02 mm and the mean TPE to 3.51 mm (n = 56). In (D) 1.5-T MRI, surprisingly the mean EPE amounted only to 0.97 mm and the TPE to 1.71 mm (n = 6). In 3 cases using CT-laser and 1 case using 3.0 T MRI-laser for referencing, small asymptomatic intracerebral hemorrhages were detected. No further complications were observed. CONCLUSION Robot-guided sEEG electrode implantation using CT-frame referencing and CT-laser-based referencing is most accurate and can serve for high precision placement of electrodes. In contrast, 3.0-T MRI-laser-based referencing is less accurate, but saves radiation. Most trajectories can be reached if alternative routes over less vascularized brain areas are used. This article is part of the Special Issue "Individualized Epilepsy Management: Medicines, Surgery and Beyond".
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Affiliation(s)
- Andrea Spyrantis
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany.
| | - Adriano Cattani
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | - Tirza Woebbecke
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany
| | | | - Thomas M Freiman
- Department of Neurosurgery, University Hospital Frankfurt - Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
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1585
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Karlov VA. [Back to Jackson or ahead to Jackson? Who brought a contemporary perspective to Jackson's conception?]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:53-55. [PMID: 30698544 DOI: 10.17116/jnevro201811810253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
One hundred and twenty years ago, J. Jackson summarized the results of his research in his seminal lecture, where he used epilepsy, as a model for the analysis of the structural-functional organization of the central nervous system. He revealed a mechanism of epileptic seizure and showed that any epilepsy, including the 'genuine' one, had focal start. However, a dichotomic conception became firmly established later. In this article, basic stages of further development of the problem are discussed and contribution of the Russian-Soviet-Russian neurological school to the return on the modern level to Jackson's unitary conception of epilepsy and a role of epileptic systems forming different courses of epileptic activity flow from epileptic focus to other cerebral structures are emphasized.
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Affiliation(s)
- V A Karlov
- Evdokimov Moscow State University of Medical Dentisitry, Moscow, Russia
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1586
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Chiosa V, Ciolac D, Groppa S, Koirala N, Pintea B, Vataman A, Winter Y, Gonzalez-Escamilla G, Muthuraman M, Groppa S. Large-scale network architecture and associated structural cortico-subcortical abnormalities in patients with sleep/awake-related seizures. Sleep 2019; 42:5304608. [DOI: 10.1093/sleep/zsz006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vitalie Chiosa
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Moldova
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova
| | - Dumitru Ciolac
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Moldova
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova
| | - Stanislav Groppa
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Moldova
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova
| | - Nabin Koirala
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bogdan Pintea
- Department of Neurosurgery, BG University hospital of Bochum, Bochum, Germany
| | - Anatolie Vataman
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Yaroslav Winter
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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1587
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Kondziela JM, Schulz J, Brunst B, Fuchs S, Gerlinger S, Neif B, Staab-Kupke H, Vasileiadis S, Brodisch P, Knake S, Kniess T, Schade B, Neubauer BA, Rosenow F, Schubert-Bast S, Strzelczyk A, Willems LM. [Acceptance, demand, reasons for consultation and outcome of counseling on epilepsy in Hesse and Lower Franconia]. DER NERVENARZT 2019; 90:832-839. [PMID: 30694366 DOI: 10.1007/s00115-019-0676-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The diagnosis of epilepsy is often accompanied by relevant restrictions for patients, which may result in disease-specific daily problems that need targeted and professional counseling. Specialized epilepsy counseling services (ECS) were introduced in some German states since 1996 to provide an additional and independent service for epilepsy-related problems. The objective of this prospective, multicenter cohort study at six ECS was to determine and analyze the acceptance, demand and frequent reasons for consultation in Hesse and Lower Franconia. RESULTS A total of 435 clients were enrolled during the 12-month observation period (June 2014-May 2015) of which 74.3% were adults (n = 323, mean age 40.3 ± 14.7 years, range 18-76 years, 51.7% female) and 25.7% children and adolescents (n = 112, mean age 9.4 ± 4.8 years, range 1-17 years, 52.7% female). The mean number of outpatient consultations per year was 2.5 (median 2.0, SD ± 2.8, range 1-20), whereby a general counseling on dealing with epilepsy (adults 55.7%, children and adolescents 51.8%), clarification and information about the disease (43.7% and 41.1%, respectively) and assistance in applying for support (39.0% and 46.4%, respectively) were the most frequent issues. The distance from the place of residence to the ECS was significantly shorter in Lower Franconia compared to Hesse (p < 0.002). Client satisfaction was high with a mean patient satisfaction questionnaire (ZUF-8) score of 29.0 (maximum score 32). Overall 96.4% of the clients rated the quality of counseling as good or very good and 96.6% would consider consulting the ECS again in case of new problems. In cases of threatened workplace, training position or situation at school, counseling helped to avoid negative consequences in 72.0% of cases. CONCLUSION The ECS are frequently used, appreciated and effective institutions for adults and children with epilepsy as well as for their caregivers. The ECS complements the existing comprehensive specialized outpatient and inpatient care for epilepsy in Germany; however, in view of their limited numbers and inhomogeneous allocation, the number and the availability of ECS should be expanded on the national level.
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Affiliation(s)
- Jacqueline M Kondziela
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Juliane Schulz
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Bernhard Brunst
- Epilepsieberatung Diakonisches Werk Hochtaunus, Frankfurt am Main, Deutschland
| | - Simone Fuchs
- Epilepsieberatung Unterfranken, Stiftung Juliusspital, Würzburg, Deutschland
| | - Stefan Gerlinger
- Abteilung für Kinderneurologie und Sozialpädiatrie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Birgit Neif
- Klinik für Neurologie, Hephata-Klinik, Schwalmstadt-Treysa, Deutschland
| | - Henrike Staab-Kupke
- Epilepsieberatung Unterfranken, Stiftung Juliusspital, Würzburg, Deutschland
| | - Silke Vasileiadis
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Peter Brodisch
- Epilepsieberatung, Innere Mission München, Diakonie in München und Oberbayern e. V., München, Deutschland
| | - Susanne Knake
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Tobias Kniess
- Klinik für Neurologie, Campus Rhön Klinikum AG, Bad Neustadt a.d. Saale, Deutschland
| | - Bernd Schade
- Klinik für Neurologie, Hephata-Klinik, Schwalmstadt-Treysa, Deutschland
| | - Bernd A Neubauer
- Abteilung für Kinderneurologie und Sozialpädiatrie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland
| | - Susanne Schubert-Bast
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland.,Schwerpunkt Neurologie, Neurometabolik, und Prävention der Klinik für Kinder- und Jugendmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Adam Strzelczyk
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland. .,Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland.
| | - Laurent M Willems
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland
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1588
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Neal A, Moffat BA, Stein JM, Nanga RPR, Desmond P, Shinohara RT, Hariharan H, Glarin R, Drummond K, Morokoff A, Kwan P, Reddy R, O'Brien TJ, Davis KA. Glutamate weighted imaging contrast in gliomas with 7 Tesla magnetic resonance imaging. NEUROIMAGE-CLINICAL 2019; 22:101694. [PMID: 30822716 PMCID: PMC6396013 DOI: 10.1016/j.nicl.2019.101694] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/10/2019] [Accepted: 01/27/2019] [Indexed: 01/04/2023]
Abstract
Introduction Diffuse gliomas are incurable malignancies, which undergo inevitable progression and are associated with seizure in 50–90% of cases. Glutamate has the potential to be an important glioma biomarker of survival and local epileptogenicity if it can be accurately quantified noninvasively. Methods We applied the glutamate-weighted imaging method GluCEST (glutamate chemical exchange saturation transfer) and single voxel MRS (magnetic resonance spectroscopy) at 7 Telsa (7 T) to patients with gliomas. GluCEST contrast and MRS metabolite concentrations were quantified within the tumour region and peritumoural rim. Clinical variables of tumour aggressiveness (prior adjuvant therapy and previous radiological progression) and epilepsy (any prior seizures, seizure in last month and drug refractory epilepsy) were correlated with respective glutamate concentrations. Images were separated into post-hoc determined patterns and clinical variables were compared across patterns. Results Ten adult patients with a histo-molecular (n = 9) or radiological (n = 1) diagnosis of grade II-III diffuse glioma were recruited, 40.3 +/− 12.3 years. Increased tumour GluCEST contrast was associated with prior adjuvant therapy (p = .001), and increased peritumoural GluCEST contrast was associated with both recent seizures (p = .038) and drug refractory epilepsy (p = .029). We distinguished two unique GluCEST contrast patterns with distinct clinical and radiological features. MRS glutamate correlated with GluCEST contrast within the peritumoural voxel (R = 0.89, p = .003) and a positive trend existed in the tumour voxel (R = 0.65, p = .113). Conclusion This study supports the role of glutamate in diffuse glioma biology. It further implicates elevated peritumoural glutamate in epileptogenesis and altered tumour glutamate homeostasis in glioma aggressiveness. Given the ability to non-invasively visualise and quantify glutamate, our findings raise the prospect of 7 T GluCEST selecting patients for individualised therapies directed at the glutamate pathway. Larger studies with prospective follow-up are required. 7 T GluCEST glioma imaging is feasible, producing high quality quantifiable images. Increased peritumoural GluCEST contrast correlates with drug resistant epilepsy. Increased tumour GluCEST contrast is associated with prior adjuvant therapy. Two GluCEST patterns were identified with distinct clinico-radiological features. GluCEST contrast correlates with MRS glutamate in peritumoural regions.
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Affiliation(s)
- Andrew Neal
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia.
| | - Bradford A Moffat
- Melbourne Node of the National Imaging Facility, Department of Radiology, University of Melbourne, Australia
| | - Joel M Stein
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Ravi Prakash Reddy Nanga
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, Australia; Department of Radiology and Medicine, University of Melbourne, Australia
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Hari Hariharan
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Glarin
- Department of Radiology, Royal Melbourne Hospital, Australia; Department of Radiology and Medicine, University of Melbourne, Australia
| | - Katharine Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Australia; Department of Surgery, University of Melbourne, Australia; Melbourne Brain Centre, The Royal Melbourne Hospital, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Australia; Department of Surgery, University of Melbourne, Australia
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Neurology, The Alfred Hospital Monash University, Australia
| | - Ravinder Reddy
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Terence J O'Brien
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Neurology, The Alfred Hospital Monash University, Australia
| | - Kathryn A Davis
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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1589
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Lee SM, Kwon S, Lee YJ. Diagnostic usefulness of arterial spin labeling in MR negative children with new onset seizures. Seizure 2019; 65:151-158. [PMID: 30718217 DOI: 10.1016/j.seizure.2019.01.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/25/2018] [Accepted: 01/25/2019] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Arterial spine labeling (ASL) magnetic resonance imaging (MRI) is the non-invasive measurement of cerebral blood flow that can localize the seizure focus in patients with epilepsy. The aim of this study was to identify its utility for localizing the seizure focus in children with no structural lesion on MRI. METHODS Forty-three consecutive children who underwent electroencephalography (EEG) and structural MRI, along with ASL for evaluation of newly developed seizures, were included. ASL abnormalities were classified as hypo/hyperperfusion, based on visual assessment, and compared with the seizure focus determined by clinical information and EEG. RESULTS Among the 43 patients (M 17: F 26, mean age, 6.3 ± 3.3 years), the seizure type was focal in 36 patients and generalized in seven patients. Twenty-five (58.1%) patients showed perfusion change. Out of 36 patients with focal seizure, 24 (66.7%) showed ASL abnormalities, and 19 (52.8%) showed concordance between ASL and clinical focus. Out of seven patients with generalized seizure, only one patient showed ASL abnormalities. The overall concordance revealed moderate agreement (k = 0.542). ASL acquisition within one day from seizure onset was the only significant associating factor with the concordance between the two (p = 0. 014). CONCLUSION To our knowledge, this is the first study to assess the usefulness of ASL MRI to assist in localizing the seizure focus in MR-negative children with new onset seizures. The combined use of ASL with EEG and structural MRI may play an important role in the evaluation of pediatric epilepsy.
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Affiliation(s)
- So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Soonhak Kwon
- Department of Pediatric, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Yun Jeong Lee
- Department of Pediatric, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
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1590
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Akeret K, Serra C, Rafi O, Staartjes VE, Fierstra J, Bellut D, Maldaner N, Imbach LL, Wolpert F, Poryazova R, Regli L, Krayenbühl N. Anatomical features of primary brain tumors affect seizure risk and semiology. NEUROIMAGE-CLINICAL 2019; 22:101688. [PMID: 30710869 PMCID: PMC6354289 DOI: 10.1016/j.nicl.2019.101688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 11/23/2022]
Abstract
Objective An epileptic seizure is the most common clinical manifestation of a primary brain tumor. Due to modern neuroimaging, detailed anatomical information on a brain tumor is available early in the diagnostic process and therefore carries considerable potential in clinical decision making. The goal of this study was to gain a better understanding of the relevance of anatomical tumor characteristics on seizure prevalence and semiology. Methods We reviewed prospectively collected clinical and imaging data of all patients operated on a supratentorial intraparenchymal primary brain tumor at our department between January 2009 and December 2016. The effect of tumor histology, anatomical location and white matter infiltration on seizure prevalence and semiology were assessed using uni- and multivariate analyses. Results Of 678 included patients, 311 (45.9%) presented with epileptic seizures. Tumor location within the central lobe was associated with higher seizure prevalence (OR 4.67, 95% CI: 1.90–13.3, p = .002), especially within the precentral gyrus or paracentral lobule (100%). Bilateral extension, location within subcortical structures and invasion of deeper white matter sectors were associated with a lower risk (OR 0.45, 95% CI: 0.25–0.78; OR 0.10, 95% CI: 0.04–0.21 and OR 0.39, 95% CI: 0.14–0.96, respectively). Multivariate analysis revealed the impact of a location within the central lobe on seizure risk to be highly significant and more relevant than histopathology (OR: 4.79, 95% CI: 1.82–14.52, p = .003). Seizures due to tumors within the central lobe differed from those of other locations by lower risk of secondary generalization (p < .001). Conclusions Topographical lobar and gyral location, as well as extent of white matter infiltration impact seizure risk and semiology. This finding may have a high therapeutic potential, for example regarding the use of prophylactic antiepileptic therapy. Brain tumor location affects seizure prevalence and semiology. Central lobe location is the strongest independent pro-epileptogenic factor. The precentral gyrus and paracentral lobule are most epileptogenic. Central lobe tumors rarely cause bilateral tonic-clonic seizures. Tumor location and white matter infiltration may guide antiepileptic therapy.
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Affiliation(s)
- Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Omar Rafi
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Bellut
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Wolpert
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Division of Pediatric Neurosurgery, University Children's Hospital, Zurich, Switzerland
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1591
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Tan Z, Long X, Tian F, Huang L, Xie F, Li S. Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings. AJNR Am J Neuroradiol 2019; 40:245-252. [PMID: 30679211 DOI: 10.3174/ajnr.a5944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/01/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel 1H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations. MATERIALS AND METHODS Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel 1H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures (n = 18), primary generalized tonic-clonic seizures (n = 19), and secondary generalized tonic-clonic seizures (n = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed. RESULTS Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios (P < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios (P < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups (P > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus (P < .05). CONCLUSIONS Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.
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Affiliation(s)
- Z Tan
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - X Long
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - F Tian
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - L Huang
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - F Xie
- Radiology (F.X.), Xiangya Hospital, Central South University, Changsha, China
| | - S Li
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
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1592
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Vilella L, Lacuey N, Hampson JP, Rani MRS, Sainju RK, Friedman D, Nei M, Strohl K, Scott C, Gehlbach BK, Zonjy B, Hupp NJ, Zaremba A, Shafiabadi N, Zhao X, Reick-Mitrisin V, Schuele S, Ogren J, Harper RM, Diehl B, Bateman L, Devinsky O, Richerson GB, Ryvlin P, Lhatoo SD. Postconvulsive central apnea as a biomarker for sudden unexpected death in epilepsy (SUDEP). Neurology 2019; 92:e171-e182. [PMID: 30568003 PMCID: PMC6340388 DOI: 10.1212/wnl.0000000000006785] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/29/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To characterize peri-ictal apnea and postictal asystole in generalized convulsive seizures (GCS) of intractable epilepsy. METHODS This was a prospective, multicenter epilepsy monitoring study of autonomic and breathing biomarkers of sudden unexpected death in epilepsy (SUDEP) in patients ≥18 years old with intractable epilepsy and monitored GCS. Video-EEG, thoracoabdominal excursions, nasal airflow, capillary oxygen saturation, and ECG were analyzed. RESULTS We studied 148 GCS in 87 patients. Nineteen patients had generalized epilepsy; 65 had focal epilepsy; 1 had both; and the epileptogenic zone was unknown in 2. Ictal central apnea (ICA) preceded GCS in 49 of 121 (40.4%) seizures in 23 patients, all with focal epilepsy. Postconvulsive central apnea (PCCA) occurred in 31 of 140 (22.1%) seizures in 22 patients, with generalized, focal, or unknown epileptogenic zones. In 2 patients, PCCA occurred concurrently with asystole (near-SUDEP), with an incidence rate of 10.2 per 1,000 patient-years. One patient with PCCA died of probable SUDEP during follow-up, suggesting a SUDEP incidence rate 5.1 per 1,000 patient-years. No cases of laryngospasm were detected. Rhythmic muscle artifact synchronous with breathing was present in 75 of 147 seizures and related to stertorous breathing (odds ratio 3.856, 95% confidence interval 1.395-10.663, p = 0.009). CONCLUSIONS PCCA occurred in both focal and generalized epilepsies, suggesting a different pathophysiology from ICA, which occurred only in focal epilepsy. PCCA was seen in 2 near-SUDEP cases and 1 probable SUDEP case, suggesting that this phenomenon may serve as a clinical biomarker of SUDEP. Larger studies are needed to validate this observation. Rhythmic postictal muscle artifact is suggestive of post-GCS breathing effort rather than a specific biomarker of laryngospasm.
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Affiliation(s)
- Laura Vilella
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Nuria Lacuey
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Johnson P Hampson
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M R Sandhya Rani
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rup K Sainju
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Daniel Friedman
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Maromi Nei
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kingman Strohl
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Catherine Scott
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Brian K Gehlbach
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Bilal Zonjy
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Norma J Hupp
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anita Zaremba
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nassim Shafiabadi
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Xiuhe Zhao
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Victoria Reick-Mitrisin
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Stephan Schuele
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jennifer Ogren
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ronald M Harper
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Beate Diehl
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lisa Bateman
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Orrin Devinsky
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - George B Richerson
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Philippe Ryvlin
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Samden D Lhatoo
- From the NINDS Center for SUDEP Research (L.V., M.R.S.R., R.K.S., D.F., M.N., C.S., B.K.G., B.Z., A.Z., S.S., J.O., R.M.H., B.D., L.B., O.D., G.B.R., P.R., S.D.L.); Epilepsy Center (L.V., N.L., J.P.H., N.J.H., N.S., X.Z., V.R.-M., S.D.L.) and Division of Pulmonary, Critical Care and Sleep Medicine (K.S.), University Hospitals Cleveland Medical Center, OH; University of Iowa School of Medicine (R.K.S., B.K.G., G.B.R.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Institute of Neurology (C.S., B.D.), University College London, UK; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles (UCLA); Department of Neurology (L.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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1593
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Falip M, Rodriguez-Bel L, Castañer S, Sala-Padró J, Miro J, Jaraba S, Casasnovas C, Morandeira F, Berdejo J, Carreño M. Hippocampus and Insula Are Targets in Epileptic Patients With Glutamic Acid Decarboxylase Antibodies. Front Neurol 2019; 9:1143. [PMID: 30687213 PMCID: PMC6334555 DOI: 10.3389/fneur.2018.01143] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Antibodies to glutamic acid decarboxylase (GAD ab) have been found in patients with limbic encephalitis (LE) and chronic pharmacoresistant focal epilepsy (FE). The objectives of the study were to: (1) analyze the clinical and neuroimaging course of patients with FE+GAD ab, (2) compare these characteristics with a control group, and (3) describe the most affected cerebral areas with structural and functional imaging. Methods: Patients with FE + high titers of GAD ab and a follow-up of at least 5 years were selected. Titers of serum GAD ab exceeding 2,000 UI/ml were considered high. Evolutive clinical and radiological characteristics were studied in comparison to two different control groups: patients with bilateral or with unilateral mesial temporal sclerosis (BMTS or UMTS) of a non-autoimmune origin. Results: A group of 13 patients and 17 controls were included (8 BMTS, 9 UMTS). The most frequent focal aware seizures (FAS) reported by patients were psychic (5/13: 33%). Somatosensorial, motor, and visual FAS (4/13:32%) (p: 0.045), musicogenic reflex seizures (MRS), and a previous history of cardiac syncope were reported only patients (2/13:16% each) (p: NS). Comparing EEG characteristics between patients and controls, a more widespread distribution of interictal epileptiform discharges (IED) was observed in FE+ GAD ab patients than in controls (p:0.01). Rhythmic delta activity was observed in all controls in anterior temporal lobes while in patients this was less frequent (p: 0.001). No IED, even in 24 h cVEEG, was seen in 6 patients (46%).First MRI was normal in 4/5 (75%) patients. During the follow-up mesial temporal lobe (MTsL) sclerosis was observed in 5/8 (62%) of patients. All patients had abnormal FDG-PET study. MTL hypometabolism was observed in 10/11 (91%) patients, being bilateral in 7/11 (63%). In controls, this was observed in 16/17 (94%), and it was bilateral in 8/17 (47%) (p: NS). Insular hypometabolism was observed in 5/11 (45%) patients (P:0.002). Conclusions: Clinical, EEG, and FDG-PET findings in FE+GAD ab suggest a widespread disease not restricted to the temporal lobe. Progressive MTL sclerosis may be observed during follow-up. In comparison to what is found in patients with non-autoimmune MTL epilepsy, insular hypometabolism is observed only in patients with GAD ab, so it may be an important diagnostic clue.
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Affiliation(s)
- Mercè Falip
- Epilepsy Unit, Department of Neurology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Rodriguez-Bel
- PET Division, Institute of Diagnostic Imaging (IDI), Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Sara Castañer
- MRI Division, Institute of Diagnostic Imaging (IDI), Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Jacint Sala-Padró
- Epilepsy Unit, Department of Neurology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Júlia Miro
- Epilepsy Unit, Department of Neurology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Sónia Jaraba
- Epilepsy Unit, Department of Neurology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlos Casasnovas
- Neuromuscular Unit, Department of Neurology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Morandeira
- Immunology Unit, Biochemistry Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Berdejo
- Department of Cardiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clinic i Provincial, Barcelona, Spain
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1594
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Daniels D, Knupp K, Benke T, Wolter-Warmerdam K, Moran M, Hickey F. Infantile Spasms in Children With Down Syndrome: Identification and Treatment Response. Glob Pediatr Health 2019; 6:2333794X18821939. [PMID: 30671494 PMCID: PMC6328947 DOI: 10.1177/2333794x18821939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/16/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives. To evaluate infantile spasms in children with Down syndrome including assessment of efficacy of treatments, presence of treatment lag, and to identify risk factors that may predict the occurrence of infantile spasms in this population. Methods. Medical charts, electroencephalograms, and brain magnetic resonance images were evaluated in 37 children treated for infantile spasms at a single institution from 2005 to 2015. Results. Mean age at diagnosis was 9.16 months, with an average 1.38-month lag from spasms onset to start of medication. Prevalence of heart defects and pulmonary hypertension were significantly higher in those with infantile spams compared with those without. Eighty-one percent receiving adrenocorticotropic hormone as initial treatment experienced remission within 2 weeks, 94.1% had remission at 3 months compared with 18.8% at 2 weeks and 35.3% at 3 months for other first-line treatments. Type of treatment was the only predictor of good outcome. Conclusions. Results stress the importance of early recognition and adrenocorticotropic hormone treatment for this seizure disorder in children with Down syndrome.
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Affiliation(s)
- Dee Daniels
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
| | - Kelly Knupp
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
| | - Tim Benke
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
| | | | - Maura Moran
- Children's Hospital Colorado, Aurora, CO, USA
| | - Fran Hickey
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
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1595
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Cengiz O, Atalar AÇ, Tekin B, Bebek N, Baykan B, Gürses C. Impact of seizure-related injuries on quality of life. Neurol Sci 2019; 40:577-583. [DOI: 10.1007/s10072-018-3697-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/31/2018] [Indexed: 11/25/2022]
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1596
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Minardi C, Minacapelli R, Valastro P, Vasile F, Pitino S, Pavone P, Astuto M, Murabito P. Epilepsy in Children: From Diagnosis to Treatment with Focus on Emergency. J Clin Med 2019; 8:jcm8010039. [PMID: 30609770 PMCID: PMC6352402 DOI: 10.3390/jcm8010039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/09/2018] [Accepted: 12/26/2018] [Indexed: 12/13/2022] Open
Abstract
Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. An early diagnosis, treatment, and specific medical support must be performed to prevent Status Epilepticus (SE). Seizure onset, especially in the child population, is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse, and smoking in pregnancy. Early death risk in children without neurological comorbidity is similar to the general population. Diagnosis is generally based on the identification of continuous or recurrent seizures but Electroencephalogram (EEG) evaluation could be useful if SE condition is suspected. The main goal of therapy is to counteract the pathological mechanism which occurs in SE before neural cells are irreversibly damaged. According to the latest International Guidelines and Recommendations of seizure related diseases, a schematic and multi-stage pharmacological and diagnostic approach is proposed especially in the management of SE and its related causes in children. First measures should focus on early and appropriate drugs administration at adequate dosage, airway management, monitoring vital signs, Pediatric Intensive Care Unit (PICU) admission, and management of parent anxiety.
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Affiliation(s)
- Carmelo Minardi
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Roberta Minacapelli
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Pietro Valastro
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Francesco Vasile
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Sofia Pitino
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Piero Pavone
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Marinella Astuto
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Paolo Murabito
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
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1597
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Sartori S, Nosadini M, Tessarin G, Boniver C, Frigo AC, Toldo I, Bressan S, Da Dalt L. First-ever convulsive seizures in children presenting to the emergency department: risk factors for seizure recurrence and diagnosis of epilepsy. Dev Med Child Neurol 2019; 61:82-90. [PMID: 30191957 DOI: 10.1111/dmcn.14015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Abstract
AIM Aetiologies of first-ever convulsive seizures may be diverse, not all leading to recurrence or epilepsy diagnosis. We aimed to describe the epidemiology of first-ever convulsive seizures in children, investigating risk factors for recurrence and epilepsy diagnosis. METHOD This was a retrospective study of children presenting with a first-ever convulsive seizure to a tertiary-care paediatric emergency department (PED) in Italy, in a 12-month period (2011-2012). RESULTS One hundred and eight children (57 males, 51 females) presented to the PED for a first-ever convulsive seizure; 90.7% were 6 months to 6 years old (median age 1y 10mo, mean 2y 7mo, range 0mo-14y 4mo). Seizure duration was less than 5 minutes in 76.8%. Seizures were 'unprovoked' in 19.4% and 'provoked' in 80.6%. At 4-year follow-up, 37.9% of patients experienced recurrence and 13.6% received a diagnosis of epilepsy. Factors significantly associated with recurrence were the 'unprovoked' nature of the first seizure, multiple seizures in the first 24 hours, positive family history of febrile seizures or epilepsy, and pre-existing neurological conditions/problems. Factors significantly associated with a diagnosis of epilepsy were the 'unprovoked' nature of the first seizure, age older than 6 years, pre-existing neurological conditions/problems, and focal onset of first seizure. INTERPRETATION Children presenting to the PED with first-ever convulsive seizures represent a heterogeneous group. The identification of prognostic factors for recurrence and epilepsy diagnosis may help provide tailored counselling and follow-up. WHAT THIS PAPER ADDS Seizures were 'unprovoked' in 19.4% and 'provoked' in 80.6% of children presenting to the emergency department. At 4-year follow-up, 37.9% relapsed, and 13.6% received a diagnosis of epilepsy. 'Unprovoked' first seizure, family history of febrile seizures, and pre-existing neurological conditions were associated with recurrence. 'Unprovoked' first seizure, age younger than 6 years, and pre-existing neurological conditions were associated with epilepsy diagnosis.
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Affiliation(s)
- Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giulio Tessarin
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Clementina Boniver
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Irene Toldo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Bressan
- Emergency Department, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Emergency Department, Department of Women's and Children's Health, University of Padua, Padua, Italy
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1598
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Hintz M, Krenz V, Schulze-Bonhage A. Age-dependent semiology of frontal lobe seizures. Epilepsy Res 2019; 149:83-87. [DOI: 10.1016/j.eplepsyres.2018.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/05/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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1599
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1600
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Abstract
Cingulate epilepsy manifests with a broad range of semiologic features and seizure types. Key clinical features may elucidate ictal involvement of certain subregions of the cingulate gyrus. Ictal and interictal electroencephalogram findings in cingulate epilepsy vary and are often poorly localized, adding to the diagnostic challenge of identifying the seizure onset zone for presurgical cases, particularly in the absence of a lesion on imaging. Recent advances in multimodal imaging techniques may contribute to ictal localization and further our understanding of neural and epileptic pathways involving the cingulate gyrus. Beyond medication and surgical resection, new techniques including stereotactic laser ablation, responsive neurostimulation, and deep brain stimulation offer additional approaches for the treatment of cingulate epilepsy.
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