Epilepsy in adults

Research hotspots and frontiers of alcohol and epilepsy: A bibliometric analysis

PURPOSE

Alcohol is implicated in epileptogenesis and seizures attack. An increasing number of studies about alcohol and epilepsy have been published. We aimed to assess research trends and hot spots in the field of alcohol and epilepsy.

PATIENTS AND METHODS

Literature concerning alcohol and epilepsy was systemically searched through the Web of Science database. Collaborative maps were quantitatively analyzed by using the VOSviewer and CiteSpace tools.

RESULTS

A total of 1578 papers about the field of alcohol and epilepsy were taken into analysis, which was written by 6840 authors from 2153 institutions in 85 countries, published in 676 journals, and cited 79 667 references from 10 750 journals. The United States was the leading country and had close ties with others. The University of Toronto was the most productive institution. Alcoholism-clinical and experimental research was the fastest-growing journal. Richard J. Bodnar was the author contributing the most literature. Analysis of keywords showed epilepsy, alcohol, seizures, alcohol withdrawal, and management were common themes.

CONCLUSION

The presented study conducted the first bibliometric analysis of the field of alcohol and epilepsy, which will provide insights into the latest progress, evolution paths, frontier research hot spots, and future research trends in the field.

Targeted Reducing of Tauopathy Alleviates Epileptic Seizures and Spatial Memory Impairment in an Optogenetically Inducible Mouse Model of Epilepsy

Intracellular deposition of hyperphosphorylated tau has been reported in the brain of epilepsy patients, but its contribution to epileptic seizures and the association with spatial cognitive functions remain unclear. Here, we found that repeated optogenetic stimulation of the excitatory neurons in ventral hippocampal CA1 subset could induce a controllable epileptic seizure in mice. Simultaneously, the mice showed spatial learning and memory deficits with a prominently elevated total tau and phospho-tau levels in the brain. Importantly, selective facilitating tau degradation by using a novel designed proteolysis-targeting chimera named C4 could effectively ameliorate the epileptic seizures with remarkable restoration of neuronal firing activities and improvement of spatial learning and memory functions. These results confirm that abnormal tau accumulation plays a pivotal role in the epileptic seizures and the epilepsy-associated spatial memory impairments, which provides new molecular target for the therapeutics.

The Perceived Social Stigma of People with Epilepsy with regard to the Question of Employability

Objective

To evaluate the perceived social stigma of people with epilepsy with regard to the question of employability.

Methods

A structured questionnaire was given to two groups of people with chronic diseases: those with epilepsy (study group) and those with heart disease (control group). The questions concerned employability.

Results

Having epilepsy was more strongly associated with higher unemployment rates (p < 0.0001); job layoffs (p = 0.001); being unfit to work (p < 0.0001); feeling shame for having the disease (p = 0.014); absence of partners (p = 0.026); and depression (p = 0.004). The tendency to hide their disease from their employers was similar for the two groups.

Conclusion

The age discrepancy between groups was an important limiting factor of this study. However, despite the limited number of participants and the age difference between the groups, there is no impediment in stating that people with epilepsy show high rates of unemployment, depression, and stigma.

Employment in people with epilepsy from the perspectives of patients, neurologists, and the general population

OBJECTIVE

Finding and continuing employment are among the most important issues for patients with epilepsy (PWE). Earlier studies indicated overrepresentation of PWE in manual unskilled or semiskilled positions.

METHODS

The questionnaire-based study was carried out throughout Poland between February and March 2009. 995 PWE (18-65 yrs), 179 neurologists, and a representative sample of the Polish population over 15 yrs of age (1042) were included.

RESULTS

49% of PWE were employed. Patients with epilepsy most commonly work as service and sales workers, office workers, professionals, and technicians. 56% of Poles, 25% of patients, and 28% of neurologists believed that all PWE could work.

CONCLUSIONS

Almost 3/4 of PWE held non-manual positions. This contradicts the stereotype of unskilled professions being more suitable for PWE. Generally, Poles have a positive attitude towards employment of PWE, but the lack of knowledge about the condition makes them less prudent than neurologists and the PWE themselves.

SIMULTANEOUS ACQUISITION OF SIGNALS AND IMAGES: APPLICATIONS IN SPORTS MEDICINE AND NEUROLOGY

In some medical applications, the simultaneous acquisition of signals corresponding to physiological parameters and video recording allows a more accurate analysis of the problem and a more complete diagnosis. In rehabilitation, the correlation between parameters of interest (angles, speed, power, EMG) and images of the patient's movements is important to devise an adequate training protocol. In neurology, some pathologies need to be investigated by a comparison of images and EEG signals. Nowadays, commonly used systems are made up of two different apparatuses: one for signals acquisition and one for video recording. They are separate pieces of equipment, and the integration between data and video is possible only to the detriment of information and the possibility to make quantitative analysis. This paper describes a new digital system for the concomitant acquisition of signals and video. It is a low cost instrumentation, PC based and easy-to-use. Data and video are recorded in standard formats and can be analyzed in a post-acquisition stage. The time resolution of the system is given by the video frame rate (25 fps), although an A/D conversion system allows frequencies up to 8000 Hz. The prototype was tested to verify synchronism between data and frames, and differences smaller than the resolution (40 ms) were found. The feasibility of the system was checked in two different applications: rehabilitation training with an isotonic Leg Extension and a daily EEG examination of one patient at the Neurological Institute of Bologna University. Both the applications gave good results in terms of time resolution, synchronism and user-friendliness.

Factors associated with employment in epilepsy patients

OBJECTIVE

The aim of the study described here was to determine those variables associated with employment in patients followed at a level 4 epilepsy center.

METHOD

A survey was sent to patients seen at the University of Florida Health Science Center/Jacksonville Comprehensive Epilepsy Program.

RESULTS

Two hundred sixty-two eligible subjects constituted the study population. By univariate analysis, variables that distinguished employed patients included: younger age, Caucasian race, higher education and household income, not receiving disability benefits, currently studying, fewer seizure medications, having no other medical conditions that interfere with work, previous work experience, perceived importance of work for personal and financial reasons, and decreased fears of workplace discrimination. By logistic regression, higher annual family income, perceived importance of work for personal reasons, and decreased fears of workplace discrimination were the only variables independently associated with employment.

CONCLUSION

Psychosocial factors such as a high self-perceived importance of work and decreased fears of workplace discrimination are significantly associated with employment in epilepsy patients.

Reaction to epilepsy in the workplace

PURPOSE

The purpose of this study was to determine the characteristics of epilepsy that produce avoidant behavior in the workplace and therefore contribute to the actual stigma that persons with epilepsy are subjected to on the job.

METHODS

We developed a survey consisting three vignettes briefly describing a coworker with either depression, multiple sclerosis, or epilepsy. Each vignette was followed by eight identical questions addressing the level of comfort during interactions with the vignette subject. The epilepsy vignette did not describe a seizure. The surveys were hand-distributed in two companies in New York City and returned anonymously by mail. The results of the responses to each illness were compared by chi2, and the responses were correlated with demographic information by using Pearson's correlation.

RESULTS

Seventy-four of 200 distributed questionnaires were returned. Respondents reported more anxiety at the thought of interacting with a coworker with epilepsy than with depression or multiple sclerosis, but this difference did not reach significance. Worry about sudden, unpredictable behavior for the coworker with epilepsy was significantly greater than that with multiple sclerosis (p = 0.014). The level of comfort regarding providing first aid for the coworker with epilepsy was significantly less (p = 0.018) than that for depression and multiple sclerosis. Lower job level and lower income level correlated with more social discomfort for all three illnesses.

CONCLUSIONS

The idea of a having a coworker with epilepsy may produce some social avoidance. However, the worry about a sudden, unpredictable event and the discomfort regarding providing first aid for a coworker with epilepsy is significant when compared with that with depression or multiple sclerosis. These findings suggest that education about first aid for epilepsy will reduce the worry and discomfort surrounding persons with epilepsy in the workplace.

Psychosocial reactions to the epilepsy in an unselected group of patients with epilepsy under treatment in general hospitals

OBJECTIVE

This study aimed at exploring the psychosocial reactions to epilepsy in a group of patients with uncomplicated well-controlled epilepsy.

METHOD

One hundred and ninety-eight patients, referred by neurologists in a general hospital completed a questionnaire, consisting of simple open questions about the epilepsy and the drug treatment. Additionally, the patients were asked to complete the QOLIE-10-scale as well as a short questionnaire with questions about attitudes towards epilepsy and the treatment.

RESULTS

The overall psychosocial outcome was favourable in our study sample. About 50% of the patients have a paid job, have an average educational level and the majority (almost 70%) of the patients have a partner. This is not different from findings in the general population. In line with these social findings, the patients report in majority that the epilepsy is well integrated: as a rule the family and friend are informed and they feel that the epilepsy is accepted in society. Restrictions are limited to activities such as swimming. Consequently, quality of life (QOL) is high for the majority of the patients, with only 6% of the patients reporting a low QOL.

DISCUSSION

It is often claimed that people with epilepsy, as a group, have more psychosocial problems than control populations of healthy subjects. As this may be true for the average comparisons between patients with epilepsy and controls, we must take into account during clinical practice that these problems occur predominantly in the minority of patients with refractory epilepsy. Patients with well-controlled epilepsy do not show worrying reactions to the epilepsy.

Sociomedical aspects of epileptic patients: their employment and marital status

We examined the employment and marital status of adult patients with epilepsy who did not have mental retardation and who had been treated at Hirosaki University Hospital, Hirosaki, Japan, for more than 5 years. The present study included 278 patients (142 males and 136 females) ranging from 20 to 60 years of age. We investigated the occupational status of the subjects and found that 168 had permanent jobs, but 41 patients were unemployed at the time of this survey. The proportion of the patients whose seizures were controlled at the time of this survey was 68% (114/168) in the group having permanent jobs, and 22% (9/41) in the unemployed group. Forty cases answered that they had resigned from their jobs due to occurrence of epileptic seizures. Of these patients, 13 were dismissed and 27 resigned voluntarily due to the potential for seizures. As to relationship between jobs and neuropsychiatric complications, the incidence of a past history of psychotic states in the unemployed group was significantly higher than that in the employed group. As to marital status, 13 males and 16 females (n = 29) had experienced divorce. Seven cases (two males and five females) had answered that epilepsy had been the reason for their divorce. We conclude that epilepsy or epileptic seizures have various negative effects on the patient's social life.

Antiepileptic drug therapy and sexual function in men with epilepsy

PURPOSE

To study the effects of antiepileptic drugs (AEDs) on sex hormone levels and sexual activity in a group of men attending a hospital-based epilepsy clinic.

METHODS

One hundred eighteen men being treated with AED therapy, 32 with epilepsy but not receiving AEDs, and 34 controls were recruited. All subjects were aged 18-65 years. Blood (20 ml) was removed for hormone assays, after which each subject completed a validated questionnaire [Sexuality Experience Scores (Frenken and Vennix, 1981)] aimed at exploring the individuals' sexual activity and attitudes to sexual morality.

RESULTS

Men taking carbamazepine (CBZ) only had significantly higher mean sex hormone-binding globulin (SHBG) levels than the control group. The CBZ group also had a significantly lower mean DHEAS concentration than the control, untreated, and sodium valproate (VPA) monotherapy groups. The phenytoin monotherapy group (PHT) had a significantly higher mean SHBG than both the control and untreated groups, and had a significantly higher mean total testosterone (TT) value than the control untreated, CBZ, and VPA groups, and a significantly lower mean DHEAS than the controls, untreated, and VPA groups. Men receiving more than one AED had significantly higher mean SHBG concentrations compared with control, untreated, and VPA groups. In addition, the polytherapy group's mean TT was significantly higher than the control and VPA groups, although its mean DHEAS concentration was lower than the control, untreated, and VPA groups. There were no significant differences between the study groups in mean FT, Budrostenedione (AND), or estradiol levels. But the CBZ, PHT, and polytherapy groups had significantly lower mean free and rogen index (FAI) than the controls. The CBZ group had a lower mean FAI than the VPA group. The polytherapy group had a lower FAI than the untreated group. Sexuality Experience Scores (SES) showed that those men receiving AEDs embraced a stricter sexual morality than the controls and untreated, and expressed greater satisfaction with their marriages than the control and untreated groups.

CONCLUSIONS

Seizure type did not affect SES scores. Multiple regression showed men who had received further education were less accepting of strict sexual morality.

Congenital porencephaly and hippocampal sclerosis. Clinical features and epileptic spectrum

We studied clinical features and seizure localization in 14 patients with porencephaly and intractable seizures. Perinatal complications were present in nine patients, childhood febrile convulsions in two, congenital hemiparesis in 12, and intellectual impairment in seven. Ten patients had psychoparetic complex partial seizures (CPS), three had sensorimotor simple partial seizures, and one had generalized tonic-clonic seizures. Surface EEG showed temporal onset in nine patients (one bitemporal) and extratemporal onset in four. MRI showed porencephaly in the distribution of the middle cerebral artery in eight patients, posterior cerebral in three, internal carotid in one, and multiple vessels in two. MR-based volumetry revealed hippocampal formation atrophy in 13 patients (eight unilateral and five bilateral) and amygdalar atrophy in 10 patients (nine unilateral and one bilateral). Hippocampal formation atrophy was concordant with CPS semiology in 10 patients (71%) and with EEG temporal localization in nine patients. Two patients had pathologic confirmation of mesial temporal sclerosis and were seizure free after temporal lobectomy. We conclude that mesial temporal sclerosis often coexists with porencephaly and is the likely seizure focus in the presence of concordant electroclinical data. This recognition implies that effective surgical intervention can be offered to certain patients with porencephaly-related seizure disorders. The dual pathology and association with perinatal cerebral vascular occlusion suggest a common ischemic pathogenesis.

Epilepsy and employment--employers' attitudes

The aim of this study was to examine the possible causes of employment difficulties amongst people with epilepsy by interviewing employers. It was hoped that the outcome of the study would complement the research already carried out in this field by concentrating on the attitudes and policies of employers. Due to the time limit it was decided that a small number (five) of local employers should be approached requesting an interview. The employers were randomly selected but were all large companies within varying industries. All employers approached agreed to participate in the study and interviews were arranged with welfare recruitment staff. The interviews were limited to 45 minutes and concentrated on three main issues for discussion: disclosure, unemployment and improved relationship between employers and people with epilepsy. The outcome of the interviews was that the employers appeared to be rather unaware of the employment problems faced by people with epilepsy. As epilepsy is generally not a registered disability employers are unable to monitor their company's recruitment and promotion methods. It seems that line managers are left to decide on the employment of people with epilepsy often without even general awareness training on equal opportunities. Consequently their need to meet targets and their personal attitude to epilepsy determine the employment chances for people with epilepsy. Only with legislations protecting the interests of people with epilepsy can the unemployment figures be brought in line with the general population.

Familial hemiplegic migraine versus migraine with prolonged aura: an uncertain diagnosis in a family report

Four of five members of a family complained of repeated attacks of hemiplegic migraine, migraine with aura of different types, or migraine without aura. The hemiplegia always outlasted the headache and was often accompanied by altered consciousness, aphasia, and, in one patient, coma; in this latter patient, the ictal EEG, recorded during two attacks, showed delta activity in the hemisphere contralateral to the hemiplegia. At least 2 months after their latest attacks, three patients showed dyscalculia, attentional disturbances, and impaired long-term verbal memory on neuropsychologic assessment. There were no cognitive disturbances in the unaffected relative. The severity of cognitive impairment appears to be correlated with migraine history. We attempt to classify these cases according to the criteria of the International Headache Society.

Update on epilepsy

Increasing knowledge of prognostic factors and of treatment outcomes has led to major changes in the treatment of epileptic seizures. The management of first seizures can now be individualized, based on the probability of seizure recurrence and its expected repercussions. When a decision is made to treat initial or recurrent seizures, monotherapy with nonsedating AEDs is recommended. Therapy should also be optimized to achieve seizure control as early as possible. During AED therapy, clinical monitoring of drug reaction symptoms is preferred over routine laboratory testing. Laboratory monitoring is not cost-effective, and there is no proof that it can forecast drug reactions. The risk of congenital malformations in newborns prenatally exposed to AEDs is around 5%, which is 2 to 2.5 times that of the general population. Valproate and carbamazepine have recently been associated with a 1% risk of spina bifida. There are measures that can be used to reduce the risk of teratogenicity, the most important of which is using the least amount of AEDs necessary to control seizures during pregnancy. Although AEDs to reduce the efficacy of oral contraceptives, oral contraceptives are still reliable with certain precautions. For patients with intractable epilepsy, surgery should be considered to improve seizure control. Proper selection of candidates increases the probability of an excellent outcome in these patients, who otherwise have no hope of leading a normal life. Postsurgical outcome largely depends on the location, the extent, and the pathology of the epileptogenic tissues in the brain.

Emergency department approach to managing seizures in pregnancy

Seizures in pregnancy pose risks for both the mother and the fetus and must be managed aggressively. Antiepileptic drugs have some teratogenic potential, but the risks are not as profound as reported in earlier literature. There is definitely less risk to the fetus from anticonvulsant exposure than from uncontrolled seizures. The evaluation of a pregnant woman with new-onset seizures is the same as for the nonpregnant patient, including head computed tomography with appropriate abdominal shielding. Status epilepticus management is based on IV benzodiazepines, phenytoin, or phenobarbital. Good fetal outcome is dependent on rapid seizure control. Management of eclampsia is controversial. There is little evidence that magnesium sulfate has anticonvulsant properties, and its use as such will probably decline steadily in the future. At present, it is reasonable to manage eclamptic seizures in the same way that status epilepticus is managed.

[Clinical treatment of resistant epilepsy]

The authors analysed 34 cases of resistant epilepsy (20 males and 14 females, mean age 23 years), treated clinically between February/1984 and May/1986. The patients underwent neurological, neuropsychological, psychological, psychiatric, cerebrospinal fluid, electroencephalographic, tomographic and/or angiographic examination. Most of the patients had complex partial seizures. The etiology was unknown in 19 patients (55.8%), probable neurocysticercosis in 6, perinatal hypoxia in 5, delivery trauma in 3 and probable sequelae of encephalitis in 2 patients. There was a clear past history of infantile febrile convulsion in 2 patients. Most patients received carbamazepine (mean dose 24.5 mg/kg/day), phenytoin (5 mg/kg and valproic acid (28 mg/kg) as monotherapy or in association. Twenty-two patients (64.7%) had more than 80% decrease of the seizure frequency. Nine resistant epilepsy cases (24.5%) were evaluated as candidates for surgical therapy. The authors concluded that the resistant epilepsy is best managed by a specialised, multidisciplinary team, and pointed out the need of a correct diagnosis of the seizure type, an adequate drug therapy and a good engagement of the patient and his family in the treatment.

Psychosocial dimensions of epilepsy: a review of the literature

The literature on psychosocial dimensions of epilepsy has been reviewed utilizing the framework developed by Dodrill et al. (Epilepsia 1980; 21:123-35). Factors considered were family background, emotional adjustment, interpersonal adjustment, vocational adjustment, financial status, adjustment to seizures, and medicine and medical management. The published studies highlighted a number of issues and sometimes rendered varying and contradictory conclusions. In general, epilepsy fosters certain reactions in family members. If negative, these reactions may be detrimental to the person with epilepsy. The association between specific emotional adjustment factors and epilepsy is not conclusive. Studies have been published which support as well as refute this association. Studies indicate that persons with epilepsy experience lower rates of marriage and more sexual difficulties than do nonepileptic persons. Studies report greater unemployment and underemployment in epileptic persons than in the population at large. Studies suggest that some persons with epilepsy manifest an attitude of nonacceptance of self. Some are reluctant to disclose their disability to others. The studies also indicate the presence of a discriminatory attitude by some nonepileptic persons toward epileptic persons. Several factors are associated with successful medical management of epilepsy. The emphasis in research studies with regard to psychosocial aspects of epilepsy focuses predominantly on individual deficiencies rather than on strengths and abilities.

A fatal overdose of carbamazepine: case report and review of literature

Carbamazepine is a drug of choice for partial epilepsies, certain affective disorders and neuralgic pain syndromes. It has an excellent safety record; however, overdose can be dangerous. This article reports one of the very few fatalities from carbamazepine overdosage, in an individual with a peak carbamazepine level of 54 mg/L. Manifestations of this and other major carbamazepine overdoses reviewed from the literature were similar to those of tricyclic - anticholinergic overdose, with coma, hypotension, respiratory depression, cardiac arrhythmias, abnormal movements and seizures. Fatality from cardiovascular causes occurred despite decline of serum carbamazepine levels to the putatively non-toxic range, emphasizing the potential for delayed consequences of carbamazepine overdosage. Management should consist of vigorous gastric lavage and installation of activated charcoal, full supportive care in a monitored setting and consideration of early charcoal hemoperfusion, before the patient becomes hypotensive.

CT brain scan and EEG in the diagnosis of adult onset seizures

Incidence of CT abnormalities and their correlation with clinical and EEG features were evaluated in a consecutive series of 202 adult patients with newly diagnosed epileptic seizures. Abnormal CT findings were found in 36% of these patients; the abnormalities consisted of brain tumors (17%), atrophic lesions (11%) and other organic findings (8%) such as arteriovenous malformations. Focal features of seizures, in neurological examination and/or in EEG, correlated significantly with CT abnormalities. The absence of these findings did, however, not exclude the possibility of brain lesions, which in many cases were treatable by surgery.

Partial complex seizures in children: an analysis of 69 seizures in 24 patients using EEG FM radiotelemetry and videotape recording

The electroencephalographic and clinical manifestations of 69 partial complex seizures in 24 pediatric patients recorded during EEG-FM radiotelemetry and videotape monitoring were reviewed. The seizure could be divided into 3 electro-clinical types. Type I attacks were characterized by an initial motionless stare often followed by automatisms and associated with initial lateralized EEG changes. Type II attacks began with automatic behavior and had bilateral, diffuse changes on the EEG initially. Type II attacks began with a loss of body tone followed by automatisms and with bilateral EEG changes initially. This study demonstrates that both the clinical and electroencephalographic aspects of partial complex seizures in children are similar to those reported in adults. This similarity may be secondary to the early maturation of the limbic structures.

Diagnosis of epilepsy

Essential in the diagnosis of epilepsy are repeated seizures due to discharge of electrical activity in the brain neurons, occurring without massive provocation. It is important to differentiate between epileptic seizures from syncopal reactions, cardiac dysrhythmias, vascular causes, metabolic disturbances, and psychogenic seizures. The type of seizure should always be established. It is of utmost importance to find the primary etiology of the seizure and to clarify the role of predisposing factors and the risk for seizure recurrence. Numerous important technical advances in the last few years have been of great benefit in the examination of patients with suspected epilepsy. It is worth keeping in mind, however, that the diagnosis of epilepsy is a clinical diagnosis, and it is not proper to speak of epilepsy until the patient has had two or more epileptic seizures within a relatively short interval and without massive provocation.

The role of computed cranial tomography (CT) in epilepsy

To evaluate the usefulness of CT in detecting unexpected brain lesions in epileptics, scan results were analyzed in a consecutive series of 196 adult epileptics in whom there was no known etiology for their seizures nor any abnormality on neurological examination. Nineteen additional epileptics, selected on the basis of an unexpected positive CT were also included for analysis. In the consecutive series, the overall incidence of abnormal scans was 16% with the highest yield (44%) found in patients with partial elementary seizures. Partial seizures secondarily generalized were correlated with a significantly higher CT positivity than purely partial seizures. Patients with seizures for less than six months more frequently showed CT abnormalities than patients with a longer history. In 25 of 51 cases with abnormal scans a specific lesion amenable to therapy was detected, including 16 neoplasms and 5 arteriovenous malformations. Other lesions included generalized or focal atrophy, infarcts, calcified lesions of tuberous sclerosis, unexplained calcifications and focal low-density or enhancing lesions.