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Driollet B, Buajitti E, Ahmed AM, Hutcheon JA, Rosella L, Yang S. Prevalence and Temporal Trends of Epilepsy in Children: A Retrospective Birth Cohort Study. Neuroepidemiology 2024:1-11. [PMID: 39074467 DOI: 10.1159/000540528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/04/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVE Epilepsy is one of the most common chronic neurologic diseases in children; however, few recent studies examine the prevalence of epilepsy and its evolution over time according to birth or maternal characteristics. The aim of the study was to examine the prevalence of epilepsy in children born between 2002 and 2020 and the temporal trends by year of birth, in Ontario, Canada, overall, and according to maternal and birth characteristics. METHODS We included all in-hospital deliveries between 2002 and 2020 (N = 2,343,482) in Ontario, Canada, using linked administrative health dataset. We estimated the overall prevalence of epilepsy diagnosed before the age of 18 years, by birth and maternal characteristics. For temporal trend analyses, we restricted our population to children born up to 2012 (N = 1,405,271) and examined the prevalence of epilepsy diagnosed by age 8 by their year of birth, using Poisson regression. RESULTS The overall prevalence of epilepsy in our cohort was 8.1 per 1,000 live births (95% CI: 8.0-8.2). Prevalence was higher for boys, for children born preterm, with congenital malformations, from multiple pregnancies, from mothers born in Canada, and for children living in deprived areas. Epilepsy prevalence diagnosed by age 8 increased slightly between 2002 and 2012 cohorts (6.9 [95% CI: 6.2-7.6] to 7.3 [95% CI: 6.6-8.1] per 1,000 live births, respectively). Differences by gestational age as gradient and socioeconomic characteristics were persistent and stable over time, while those by pregnancy plurality and sex decreased. SIGNIFICANCE In a large population-based birth cohort in Canada, we observed a slight increase in epilepsy prevalence over time among children born in 2002 and those born in 2012 and persistent disparities by gestational age, socioeconomic position, and maternal immigration status. This study highlights the need for continued surveillance of rates to see if this increasing trend is persistent, to understand the potential causes behind it, and to understand the persistence of these disparities.
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Affiliation(s)
- Bénédicte Driollet
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Emmalin Buajitti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Asma M Ahmed
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Rosella
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Laboratory Medicine and Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
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LaCoursiere CM, Ullmann JF, Koh HY, Turner L, Baker CM, Robens B, Shao W, Rotenberg A, McGraw CM, Poduri AH. Zebrafish models of candidate human epilepsy-associated genes provide evidence of hyperexcitability. iScience 2024; 27:110172. [PMID: 39021799 PMCID: PMC11253282 DOI: 10.1016/j.isci.2024.110172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/13/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Hundreds of novel candidate human epilepsy-associated genes have been identified thanks to advancements in next-generation sequencing and large genome-wide association studies, but establishing genetic etiology requires functional validation. We generated a list of >2,200 candidate epilepsy-associated genes, of which 48 were developed into stable loss-of-function (LOF) zebrafish models. Of those 48, evidence of seizure-like behavior was present in 5 (arfgef1, kcnd2, kcnv1, ubr5, and wnt8b). Further characterization provided evidence for epileptiform activity via electrophysiology in kcnd2 and wnt8b mutants. Additionally, arfgef1 and wnt8b mutants showed a decrease in the number of inhibitory interneurons in the optic tectum of larval animals. Further, RNA sequencing (RNA-seq) revealed convergent transcriptional abnormalities between mutant lines, consistent with their developmental defects and hyperexcitable phenotypes. These zebrafish models provide strongest experimental evidence supporting the role of ARFGEF1, KCND2, and WNT8B in human epilepsy and further demonstrate the utility of this model system for evaluating candidate human epilepsy genes.
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Affiliation(s)
- Christopher Mark LaCoursiere
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Jeremy F.P. Ullmann
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Hyun Yong Koh
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Departments of Neuroscience and Pediatrics, Division of Neurology and Developmental Neuroscience, BCM, Houston, TX 77030, USA
| | - Laura Turner
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Cristina M. Baker
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Kavli Institute for Systems Neuroscience, Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Barbara Robens
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Wanqing Shao
- Research Computing, Department of Information Technology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Alexander Rotenberg
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Christopher M. McGraw
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Annapurna H. Poduri
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
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Kizek Ö, Yapıcı Z, Topaloğlu P. Epilepsy in dystrophinopathies: A retrospective cohort and review of the literature. Epilepsy Behav 2024; 151:109595. [PMID: 38181535 DOI: 10.1016/j.yebeh.2023.109595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/26/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE This study aimed to assess the prevalence and characteristics of epilepsy in dystrophinopathies within a cohort of 142 patients at a tertiary neuromuscular center in Istanbul, Turkey. METHODS We recorded the age at seizure onset, seizure type, family history, history of febrile seizures, treatment, and EEG results. Epilepsy was classified according to the latest International League Against Epilepsy (ILAE) classification. RESULTS Of the 142 DMD patients, 8 experienced epileptic seizures (5.6 %). The median age of the patients was 11 years (8.0-15.2). The median age for the first DMD symptoms was 24 months (16.5-37.5). All seizures were consistent with generalized tonic-clonic seizures. Three patients are currently on anti-seizure medication. SIGNIFICANCE The prevalence of epilepsy in our study (5.6 %) exceeds that of the general pediatric population (0.5-1 %). However, the frequency of febrile seizures in children with dystrophinopathy is similar to that of the general population.
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Affiliation(s)
- Özgü Kizek
- Department of Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Zuhal Yapıcı
- Department of Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pınar Topaloğlu
- Department of Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Schubert-Bast S, Kaur M, Joeres L, Foskett N, Roebling R, Strzelczyk A. Epidemiology of focal onset seizures in children aged >1 month to 4 years in Europe, United States, and Canada: A literature review. Seizure 2023; 112:88-97. [PMID: 37778299 DOI: 10.1016/j.seizure.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023] Open
Abstract
The present study aims to report the currently available epidemiology of focal onset seizures in children aged >1 month to 4 years with the help of a literature review. The terms 'seizure*' OR 'epilepsy' combined with pediatric and epidemiology terms were used to search Embase, PubMed, and Web of Science up to November 16, 2021. Due to the scarcity of epidemiology data on focal onset seizures, the incidence and prevalence were estimated using the proportion of focal onset seizures in epilepsy patients from the most recently published articles. The estimated annual incidence per 100,000 children of focal onset seizures in children of 0-4 years of age ranged from 25.1 (95 % confidence interval [CI] 18.9-32.7) in the United Kingdom to 111.8 in the United States. The estimated period prevalence of focal onset seizures in children 0-4 years of age ranged from 0.15 % (99 % CI 0.13-0.18) in Canada to 0.61 % in the United States. Neurodevelopmental outcomes and psychiatric disorders were the most commonly reported comorbidities in children with epilepsy of age 0-4 years. Presence of focal onset seizures in children with different epilepsy syndromes needs to be thoroughly considered in the treatment planning of this population of interest.
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Affiliation(s)
- Susanne Schubert-Bast
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Schleusenweg 2-16 (Haus 95), Frankfurt am Main 60528, Germany; Hospital for Children and Adolescents, Department of Neuropediatrics, Epilepsy Center Frankfurt Rhine-Main, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany.
| | - Moninder Kaur
- UCB Pharma, 216 Bath Road, Slough, SL1 3WE, United Kingdom
| | - Lars Joeres
- UCB Biosciences GmbH, Alfred-Nobel-Str. 10, Monheim 40789, Germany
| | - Nadia Foskett
- UCB Pharma, 216 Bath Road, Slough, SL1 3WE, United Kingdom
| | - Robert Roebling
- UCB Biosciences GmbH, Alfred-Nobel-Str. 10, Monheim 40789, Germany
| | - Adam Strzelczyk
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Schleusenweg 2-16 (Haus 95), Frankfurt am Main 60528, Germany
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Kaşak M, Çıtak Kurt AN, Tural Hesapçıoğlu S, Ceylan MF. Psychiatric comorbidity and familial factors in childhood epilepsy: Parental psychopathology, coping strategies, and family functioning. Epilepsy Behav 2023; 148:109444. [PMID: 37748417 DOI: 10.1016/j.yebeh.2023.109444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE This study aimed to examine the psychiatric diagnoses, parenting attitudes, family functioning among children and adolescents with epilepsy, coping styles of their mothers, and psychiatric symptoms of their mothers and fathers. METHODS Forty children and adolescents between the ages of 8 and 18 with epilepsy and 40 healthy controls were included in the study. The clinical interview and other measurements were used to assess psychiatric disorders and familial factors. RESULTS At least one psychiatric disorder was diagnosed in 65% of children and adolescents with epilepsy. It was determined that the mothers and fathers in the epilepsy group had higher anxiety and depression scores than the control group, and the fathers' hostility scores were also higher. The Family Assessment Device (FAD) (problem-solving and affective responsiveness), Coping Strategies Scale (COPE) (mental disengagement and substance use), and Parent Attitude Scale (PAS) (strictness/supervision) subtest scores of the epilepsy group were higher than the control group. CONCLUSION Psychiatric comorbidities, especially depression, anxiety disorders, and attention deficit hyperactivity disorder, are more common in children and adolescents with epilepsy. The mental health of parents, parent-child relationships, family functioning, and parental coping styles were adversely affected in families with children with epilepsy. It is essential to evaluate psychiatric comorbidity and family factors in children with epilepsy and to create a treatment plan for problem areas.
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Affiliation(s)
- Meryem Kaşak
- Department of Child and Adolescent Psychiatry, Ankara City Hospital, Ankara, Turkey.
| | - Ayşegül N Çıtak Kurt
- Department of Pediatric Neurology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Selma Tural Hesapçıoğlu
- Department of Child and Adolescent Psychiatry, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
| | - Mehmet Fatih Ceylan
- Department of Child and Adolescent Psychiatry, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
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Bashiri FA, AlSheikh R, Hamad MH, Alsheikh H, Alsheikh RA, Kentab A, AlTheeb N, Alghamdi M. Genotype-Phenotype Analysis of Children with Epilepsy Referred for Whole-Exome Sequencing at a Tertiary Care University Hospital. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1334. [PMID: 37628333 PMCID: PMC10453392 DOI: 10.3390/children10081334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Despite the high consanguinity rates, data on genetic epilepsy in Saudi Arabia is limited. The objective of the current study was to characterize genetic mutations associated with epilepsy in pediatric patients and describe their phenotypic presentations. METHODS A retrospective chart review was conducted among children presented with epilepsy in one center in Saudi Arabia between 2015 and 2018. Only those who had undergone genetic testing were included. RESULTS A total of 45 patients had positive whole-exome sequencing (WES) genetic testing with 37 mutations. Six mutations (SCN1A, DENND5A, KCNQ2, ACY1, SCN2A, and PCDH19) were repeated in 15 patients, with largely heterogeneous phenotypic presentations in patients with the same mutation. Several mutations are reported for the first time in Saudi Arabia. The median age at epilepsy onset was four months. Consanguineous parents and family history of epilepsy were frequent (31.8% and 33.3%, respectively). Developmental delay (44.4%), cognitive delay (42.2%), language delay (40.0%), behavioral features (28.9%), and microcephaly (20.0%) were frequent presentations. At initial diagnosis, 68.9% of EEG and 48.9% of brain MRI were abnormal. The most currently used antiseizure medications (ASMs) were levetiracetam (48.9%), topiramate (28.9%), and valproic acid (20.0%). Approximately 60% of the patients were controlled with (47.6%) or without (11.9%) ASMs, and three (7.1%) patients died. CONCLUSIONS Multiple mutations among children with epilepsy are reported in one hospital in Saudi Arabia, with the majority reported for the first time. The current findings highlight the importance of doing genetic testing for the evaluation of childhood epilepsy.
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Affiliation(s)
- Fahad A. Bashiri
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.K.); (M.A.)
- Division of Pediatric Neurology, Department of Pediatrics, King Saud University Medical City, Riyadh 11461, Saudi Arabia; (M.H.H.); (H.A.)
| | - Rawan AlSheikh
- Division of Pediatric Neurology, Department of Pediatrics, King Saud Medical City, Riyadh 11461, Saudi Arabia; (R.A.); (R.A.A.)
| | - Muddathir H. Hamad
- Division of Pediatric Neurology, Department of Pediatrics, King Saud University Medical City, Riyadh 11461, Saudi Arabia; (M.H.H.); (H.A.)
| | - Hamad Alsheikh
- Division of Pediatric Neurology, Department of Pediatrics, King Saud University Medical City, Riyadh 11461, Saudi Arabia; (M.H.H.); (H.A.)
| | - Rana Abdullah Alsheikh
- Division of Pediatric Neurology, Department of Pediatrics, King Saud Medical City, Riyadh 11461, Saudi Arabia; (R.A.); (R.A.A.)
| | - Amal Kentab
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.K.); (M.A.)
- Division of Pediatric Neurology, Department of Pediatrics, King Saud University Medical City, Riyadh 11461, Saudi Arabia; (M.H.H.); (H.A.)
| | - Najd AlTheeb
- College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Malak Alghamdi
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.K.); (M.A.)
- Division of Medical Genetics, Department of Pediatrics, King Saud University Medical City, Riyadh 11461, Saudi Arabia
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Ullah S, Ali N, Ahmad S, Sha SWA, Ali S, Almarshad F. The likelihood approach for potential role of "GABRG2 (C588T, C315T) gene polymorphisms" on the poor response to carbamazepine therapy in Pakhtun population of Pakistan. Medicine (Baltimore) 2022; 101:e30948. [PMID: 36221407 PMCID: PMC9542555 DOI: 10.1097/md.0000000000030948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Gamma-aminobutyric acid A receptor, gamma 2 gene (GABRG2) encode the GABAA receptor which is responsible for fast neuronal inhibition. Polymorphisms in GABGR2 gene affect the clinical response of anti-epileptic drugs (AEDs). Therefore, we carried out an updated study to find the association GABRG2 gene polymorphisms with carbamazepine (CBZ) non-responsive therapy in the Pakhtun population. METHODS A clinical prospective cohort study was conducted in 79 CBZ treated patients upon consent after the approval of Khyber Medical University Advanced Study and Research Board. Blood sample were taken at optimal dose of CBZ at base line, third and sixth months of the treatment. Blood level of CBZ was measure through reverse phase high performance liquid chromatography (HPLC). Restriction fragment length polymorphisms techniques were used to genotype GABRG2 gene in these patients. CBZ responses were evaluated on three and six months of study by measuring the decrease in frequency of seizure per week. RESULTS The average maximum dose of CBZ was 455 ± 133 mg/day at baseline, 479 ± 142 mg/day at third month and 495 ± 133 mg/day at sixth month of the treatment. CBZ level was found within therapeutic range (4-12 mg/L) without any significant (P > .5) variations among the CC, CT and TT genotypes of GABRG2 (C588T and C315T) gene. But the poor clinical response during CBZ treatment was linked (P < .05) with CT and TT genotypes of GABRG2 (C588T and C315T) gene in Pakhtun Population. CONCLUSION A poor response to CBZ was found in variant genotypes (CT and TT) of GABRG2 (C588T and C315T) gene in Pakhtun Population.
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Affiliation(s)
- Shakir Ullah
- Department of Pharmacology Institute of Basic Medical Science, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
- * Correspondence: Shakir Ullah, Institute of Basic Medical Sciences/Institute of Pharmaceutical Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan (e-mail: )
| | - Niaz Ali
- Department of Pharmacology Institute of Basic Medical Science, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sajjad Ahmad
- Department of Pharmacology Institute of Basic Medical Science, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Syed Wadood Ali Sha
- Department of Pharmacy (Pharmacology), University of Malakand, Chakdara, Pakistan
| | - Saad Ali
- Department of Neurology, Govt. Lady Reading Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan
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XAI4EEG: spectral and spatio-temporal explanation of deep learning-based seizure detection in EEG time series. Neural Comput Appl 2022. [DOI: 10.1007/s00521-022-07809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractIn clinical practice, algorithmic predictions may seriously jeopardise patients’ health and thus are required to be validated by medical experts before a final clinical decision is met. Towards that aim, there is need to incorporate explainable artificial intelligence techniques into medical research. In the specific field of epileptic seizure detection there are several machine learning algorithms but less methods on explaining them in an interpretable way. Therefore, we introduce XAI4EEG: an application-aware approach for an explainable and hybrid deep learning-based detection of seizures in multivariate EEG time series. In XAI4EEG, we combine deep learning models and domain knowledge on seizure detection, namely (a) frequency bands, (b) location of EEG leads and (c) temporal characteristics. XAI4EEG encompasses EEG data preparation, two deep learning models and our proposed explanation module visualizing feature contributions that are obtained by two SHAP explainers, each explaining the predictions of one of the two models. The resulting visual explanations provide an intuitive identification of decision-relevant regions in the spectral, spatial and temporal EEG dimensions. To evaluate XAI4EEG, we conducted a user study, where users were asked to assess the outputs of XAI4EEG, while working under time constraints, in order to emulate the fact that clinical diagnosis is done - more often than not - under time pressure. We found that the visualizations of our explanation module (1) lead to a substantially lower time for validating the predictions and (2) leverage an increase in interpretability, trust and confidence compared to selected SHAP feature contribution plots.
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Jung SY, Yu SW, Lee KS, Yi YY, Kang JW. Transition from pediatric to adult care among patients with epilepsy: Cross-sectional surveys of experts and patients in Korea. Epilepsia Open 2022; 7:452-461. [PMID: 35766448 PMCID: PMC9436304 DOI: 10.1002/epi4.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Many pediatric patients with epilepsy require treatment beyond the pediatric age. These patients require transition to an adult epilepsy center. Currently, many centers worldwide run epilepsy transition programs. However, a standardized protocol does not exist in Korea. The basic data required to establish a transition program are also unavailable. We aimed to assess the status and perceptions of patients and epilepsy care providers on transition. Methods To assess the status of epilepsy transition, we retrospectively collected data from patients with epilepsy older than 18 years who visited our pediatric epilepsy clinic between March 1990 and July 2019. To assess the perception of transition, we surveyed patients, parents, pediatric neurologists (PN), and adult epileptologists (AE). Results In a retrospective chart review, 39 of 267 (14.6%) patients visited the adult epilepsy clinic after consulting a pediatric neurologist, and three patients returned to the pediatric center. The average patient age at transition was 23.29 ± 5.10 years. A total of 94 patients or their guardians and 100 experts participated in the survey. About half of the patients or guardians (44.7%) did not want to transition and emotional dependence was the commonest reason. Most patients (52.1%) thought that the appropriate age of transition was above 20 years. PNs had greater concerns about patients' compliance than AEs. Regarding the age of transition, AEs believed that a younger age (18 years) was more appropriate than PNs (20 years). Significance This study describes difficulties in the transition from pediatric to adult epilepsy centers without appropriate support. There were differences in perspectives among patients, parents, and adult and pediatric epilepsy care providers. This study can assist in creating a standardized protocol in Korea.
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Affiliation(s)
- Seung Yeon Jung
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Woo Yu
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Keon Su Lee
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Yoon Young Yi
- Department of Pediatrics, Hallym University and Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Joon Won Kang
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea.,Department of Pediatrics and Medical Science, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, Korea
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G J K Prakash Raju, Dwajani S., Kannan Rajendran, Adarsh E.. A study of Rationale use of Sodium valproate and Levetiracetam as monotherapy in pediatric patients with Epilepsy at tertiary care hospital. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i1.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Drug utilization studies helps in the understanding of drug usage among patients, as well as the socioeconomic background and rational use of antiepileptics in children with epilepsy.
Objective: The primary aim of this article is to examine the justification for utilizing sodium valproate and Levetiracetam as monotherapy in pediatric epilepsy patients, as well as drug use and prescribing patterns for various kinds of epilepsy.
Materials & Methods:
Pediatric epilepsy patients under the age of 18 who visited the outpatient department, patients who were on sodium valproate, carbamazepine, or Levetiracetam monotherapy for at least 3 months after starting treatment. Demographic details, disease characteristics like type of epilepsy, onset and duration of episode, details of first attack, last attack, frequency and family history related to epilepsy comorbid conditions. Details on the treatment, such as the drug prescribed, the dose, the duration of the treatment, and the dosage, were noted. Magnetic resonance image (MRI) Brain, CT Brain, Electroencephalogram (EEG) was done in selected patients and noted.
Results:
In this study we have total of 91 patients younger than 18 years of age confirmed with epilepsy receiving Sodium valproate, Levetiracetam as Monotherapy. Among them 70.3% were male and 29.6% were females. As per the recent Kuppuswamy scale 64.8% of the patients were from an urban background, whereas 35.1% were from a rural background. On analyzing socioeconomic status we found that 38.5% belong to upper middle class family. Nearly 26 % of the patients were diagnosed with focal seizures and 25% with GTCS. Lesser percentage observed with Rolandic, myoclonic, complex partial, refractory epilepsy. Majority 53.8 % were on Sodium valproate among older AEDs. Among newer AEDs 29.6% of patients received Levetiracetam as monotherapy.
Key words:
Epilepsy, Sodium valproate, Levetiracetam, Monotherapy, Rational use
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Uttl L, Hložek T, Mareš P, Páleníček T, Kubová H. Anticonvulsive Effects and Pharmacokinetic Profile of Cannabidiol (CBD) in the Pentylenetetrazol (PTZ) or N-Methyl-D-Aspartate (NMDA) Models of Seizures in Infantile Rats. Int J Mol Sci 2021; 23:ijms23010094. [PMID: 35008517 PMCID: PMC8744811 DOI: 10.3390/ijms23010094] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/26/2022] Open
Abstract
In spite of use of cannabidiol (CBD), a non-psychoactive cannabinoid, in pediatric patients with epilepsy, preclinical studies on its effects in immature animals are very limited. In the present study we investigated anti-seizure activity of CBD (10 and 60 mg/kg administered intraperitoneally) in two models of chemically induced seizures in infantile (12-days old) rats. Seizures were induced either with pentylenetetrazol (PTZ) or N-methyl-D-aspartate (NMDA). In parallel, brain and plasma levels of CBD and possible motor adverse effects were assessed in the righting reflex and the bar holding tests. CBD was ineffective against NMDA-induced seizures, but in a dose 60 mg/kg abolished the tonic phase of PTZ-induced generalized seizures. Plasma and brain levels of CBD were determined up to 24 h after administration. Peak CBD levels in the brain (996 ± 128 and 5689 ± 150 ng/g after the 10- and 60-mg/kg doses, respectively) were reached 1–2 h after administration and were still detectable 24 h later (120 ± 12 and 904 ± 63 ng/g, respectively). None of the doses negatively affected motor performance within 1 h after administration, but CBD in both doses blocked improvement in the bar holding test with repeated exposure to this task. Taken together, anti-seizure activity of CBD in infantile animals is dose and model dependent, and at therapeutic doses CBD does not cause motor impairment. The potential risk of CBD for motor learning seen in repeated motor tests has to be further examined.
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Affiliation(s)
- Libor Uttl
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Topolová 748, 250 67 Klecany, Czech Republic;
- Laboratory of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, Vídeňská 1083, 142 20 Prague, Czech Republic;
| | - Tomáš Hložek
- Institute of Forensic Medicine and Toxicology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic;
| | - Pavel Mareš
- Laboratory of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, Vídeňská 1083, 142 20 Prague, Czech Republic;
| | - Tomáš Páleníček
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Topolová 748, 250 67 Klecany, Czech Republic;
- Department of Psychiatry and Medical Psychology 3FM CU and NIMH, 3rd Faculty of Medicine, Charles University in Prague, Ruská 87, 100 00 Prague, Czech Republic
- Correspondence: (T.P.); (H.K.)
| | - Hana Kubová
- Laboratory of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, Vídeňská 1083, 142 20 Prague, Czech Republic;
- Correspondence: (T.P.); (H.K.)
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12
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Is the prevalence of thyroid disease higher in children receiving antiepileptic medication? A systematic review and meta-analysis. Seizure 2021; 94:117-125. [PMID: 34896814 DOI: 10.1016/j.seizure.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Antiseizure medications (ASM) have long been examined for their potential to induce thyroid dysfunction. The aim of this systematic review and meta-analysis was to assess the prevalence of thyroid disease in children up to 16 years receiving monotherapy with valproate (VPA), carbamazepine (CBZ) and levetiracetam (LEV). METHODS PubMed/MEDLINE, Cochrane/CENTRAL databases and the gray literature were searched to identify observational studies providing the prevalence of thyroid dysfunction in the target population under VPA, CBZ, or LEV monotherapy schemes. The results were pooled using a random-effects model, and additional subgroup analyses were performed for the three ASM groups. RESULTS Fifteen and thirteen studies met inclusion criteria for the qualitative and the quantitative analysis, respectively, with a total of 945 pediatric patients with prevalence data. Only VPA and CBZ were associated with thyroid dysfunction. The overall prevalence of thyroid abnormality was higher in children receiving ASM [odds ratio (OR) 6.82, 95% confidence interval (CI) 3.96-11.75]. In the subgroup analysis, the prevalence of biochemical thyroid abnormality with increased TSH was higher in the VPA (OR 9.54, 95%CI 5.25-17.34) and the CBZ group (OR 4.08, 95%CI 1.84-9.04) compared with controls. CONCLUSION This study confirms the higher prevalence of biochemical thyroid abnormality in children under VPA and CBZ monotherapy, whereas no such evidence is present for LEV. In children with a predisposition for thyroid disease, LEV should be considered over VPA and CBZ, if appropriate for seizure type and epilepsy syndrome. More studies are needed to reach a consensus on monitoring and management of thyroid dysfunction in children receiving ASM therapy.
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13
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Rahman MM, Fatema K. Genetic Diagnosis in Children with Epilepsy and Developmental Disorders by Targeted Gene Panel Analysis in a Developing Country. J Epilepsy Res 2021; 11:22-31. [PMID: 34395220 PMCID: PMC8357555 DOI: 10.14581/jer.21004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose In childhood epilepsy, genetic etiology is increasingly recognized in recent years with the advent of next generation sequencing. This has broadened the scope of precision medicine in intractable epilepsy, particularly epileptic encephalopathy (EE). Developmental disorder (DD) is an integral part of childhood uncontrolled epilepsy. This study was performed to investigate the genetic etiology of childhood epilepsy and DD. Methods In this study, 40 children with epilepsy and DD with positive genetic mutation were included retrospectively. It was done in a tertiary care referral hospital of Bangladesh from January 2019 to December 2020. Genetic study was done by next generation sequencing. In all cases electroencephalography, neuroimaging was done and reviewed. Results In total, 40 children were enrolled and the average age was 41.4±35.850 months with a male predominance (67.5%). Generalized seizure was the predominant type of seizure. Regarding the association, intellectual disability and attention deficit hyperactivity disorder was common. Seventeen cases had genetically identified early infantile EE and common mutations observed were SCN1A (3), SCN8A (2), SLC1A2 (2), KCNT1 (2), and etc. Five patients of progressive myoclonic epilepsy were diagnosed and the mutations identified were in KCTD7, MFSD8, and CLN6 genes. Three cases had mitochondrial gene mutation (MT-ND5, MT-CYB). Some rare syndromes like Gibbs syndrome, Kohlschütter-Tönz syndrome, Cockayne syndrome, Pitt-Hopkins syndrome and cerebral creatine deficiency were diagnosed. Conclusions This is the first study from Bangladesh on genetics of epilepsy and DD. This will help to improve the understanding of genetics epilepsy of this region as well as contribute in administering precision medicine in these patients.
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Affiliation(s)
- Md Mizanur Rahman
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kanij Fatema
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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14
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Kaplan Ö, Pekmez M, Akıncı Y, Ataklı HD, Eren F, Dirican AC, Gözübatık Çelik RG, Baştuğ Gül Z, Ur Özçelik E, Gül G, Sarı H, Özkara Ç. The relationship between DIRAS1 gene and idiopathic generalized epilepsy in the Turkish population. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Wen Z, Chen J, Zhu B, Lu Y, Chen L. Effects of SCN1A and SCN2A polymorphisms on responsiveness to valproic acid monotherapy in epileptic children: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25831. [PMID: 34011048 PMCID: PMC8136989 DOI: 10.1097/md.0000000000025831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND : The gene mutation of coding sodium channel is one of the most important mechanisms in the pathogenesis of epilepsy. There exists a large inter-individual variation in the efficacy of valproic acid (VPA) against epilepsy. What are the genetic polymorphism influences of sodium channels on VPA response is still under discussion. In this study, a meta-analysis was used to further explore the effects of SCN1A and SCN2A gene polymorphism on VPA response in children with epilepsy. METHODS : The PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, China Biology Medicine disc, and Wan Fang Database were searched up to April 2021 for appropriate studies regarding the association between SCN1A and SCN2A gene polymorphism on VPA response in children suffering from epilepsy. The meta-analysis was conducted by Review Manager 5.3 software. RESULTS : The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION : This meta-analysis will summarize the effects of SCN1A and SCN2A gene polymorphisms on VPA response in children with epilepsy. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/N2786.
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Affiliation(s)
| | - Jiang Chen
- Department of Pediatrics, Haikou Hospital of the Maternal and Child Health, Haikou, Hainan Province, China
| | - Bin Zhu
- Department of Child Rehabilitation
| | - Yan Lu
- Department of Child Rehabilitation
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16
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Smirnova EY, Sinyak DS, Chizhov AV, Zaitsev AV. Age-Dependent Generation of Epileptiform
Activity
in the 4-Aminopyridine Model with Slices of the Rat Entorhinal Cortex. J EVOL BIOCHEM PHYS+ 2021. [DOI: 10.1134/s0022093021020058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Yates N, Gunn AJ, Bennet L, Dhillon SK, Davidson JO. Preventing Brain Injury in the Preterm Infant-Current Controversies and Potential Therapies. Int J Mol Sci 2021; 22:1671. [PMID: 33562339 PMCID: PMC7915709 DOI: 10.3390/ijms22041671] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Preterm birth is associated with a high risk of morbidity and mortality including brain damage and cerebral palsy. The development of brain injury in the preterm infant may be influenced by many factors including perinatal asphyxia, infection/inflammation, chronic hypoxia and exposure to treatments such as mechanical ventilation and corticosteroids. There are currently very limited treatment options available. In clinical trials, magnesium sulfate has been associated with a small, significant reduction in the risk of cerebral palsy and gross motor dysfunction in early childhood but no effect on the combined outcome of death or disability, and longer-term follow up to date has not shown improved neurological outcomes in school-age children. Recombinant erythropoietin has shown neuroprotective potential in preclinical studies but two large randomized trials, in extremely preterm infants, of treatment started within 24 or 48 h of birth showed no effect on the risk of severe neurodevelopmental impairment or death at 2 years of age. Preclinical studies have highlighted a number of promising neuroprotective treatments, such as therapeutic hypothermia, melatonin, human amnion epithelial cells, umbilical cord blood and vitamin D supplementation, which may be useful at reducing brain damage in preterm infants. Moreover, refinements of clinical care of preterm infants have the potential to influence later neurological outcomes, including the administration of antenatal and postnatal corticosteroids and more accurate identification and targeted treatment of seizures.
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Affiliation(s)
- Nathanael Yates
- The Queensland Brain Institute, University of Queensland, St Lucia, QLD 4072, Australia;
- School of Human Sciences, University of Western Australia, Crawley, WA 6009, Australia
| | - Alistair J. Gunn
- The Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (A.J.G.); (L.B.); (S.K.D.)
| | - Laura Bennet
- The Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (A.J.G.); (L.B.); (S.K.D.)
| | - Simerdeep K. Dhillon
- The Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (A.J.G.); (L.B.); (S.K.D.)
| | - Joanne O. Davidson
- The Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (A.J.G.); (L.B.); (S.K.D.)
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18
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Legare JM, Pauli RM, Hecht JT, Bober MB, Smid CJ, Modaff P, Little ME, Rodriguez-Buritica DF, Serna ME, Alade AY, Liu C, Hoover-Fong JE, Hashmi SS. CLARITY: Co-occurrences in achondroplasia-craniosynostosis, seizures, and decreased risk of diabetes mellitus. Am J Med Genet A 2021; 185:1168-1174. [PMID: 33496070 DOI: 10.1002/ajmg.a.62096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/03/2020] [Accepted: 01/09/2021] [Indexed: 12/12/2022]
Abstract
Achondroplasia is the most common disproportionate short statured skeletal dysplasia with a prevalence of approximately 1:20,000-30,000. We created the largest database to date of a historical cohort of 1374 patients with achondroplasia (CLARITY-aChondropLasia nAtuRal hIsTory studY). This cohort was queried for the presence of unrecognized or under-recognized features associated with achondroplasia. Craniosynostosis was found to co-occur with achondroplasia in 9 (0.65%) patients in this cohort, which is much higher than the general population prevalence of 3.1-7.2 per 10,000. In addition, 27 patients had seizures (2.0%), an apparent excess as compared to the general population. Only two people had diabetes despite a high rate of adult obesity. This report documents for the first time an increased prevalence of craniosynostosis in persons with achondroplasia, and adds support to previous observations of an apparently higher than expected prevalence of seizures and lower prevalence of diabetes mellitus.
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Affiliation(s)
- Janet M Legare
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Richard M Pauli
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jacqueline T Hecht
- Department of Pediatrics, McGovern Medical School at UT Health, Houston, Texas, USA
| | - Michael B Bober
- Department of Pediatrics, A. l. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA
| | - Cory J Smid
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Genetics, Children's Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peggy Modaff
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mary Ellen Little
- Department of Pediatrics, A. l. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA
| | | | - Maria Elena Serna
- Department of Pediatrics, McGovern Medical School at UT Health, Houston, Texas, USA
| | | | - Chengxin Liu
- Greenberg Center for Skeletal Dysplasias, McKusick Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julie E Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, McKusick Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - S Shahrukh Hashmi
- Department of Pediatrics, McGovern Medical School at UT Health, Houston, Texas, USA
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19
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Jeon JY, Lee H, Shin JY, Moon HJ, Lee SY, Kim JM. Increasing Trends in the Incidence and Prevalence of Epilepsy in Korea. J Clin Neurol 2021; 17:393-399. [PMID: 34184447 PMCID: PMC8242311 DOI: 10.3988/jcn.2021.17.3.393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE There have been few reports on recent trends in the occurrence of epilepsy. The aim of this study was to estimate the incidence and prevalence of epilepsy and analyze their annual trends in Korea over the period 2009-2017. METHODS This nationwide population-based study was carried out using the National Health Insurance Service of Korea database. A prevalent case was defined as one of a patient receiving a prescription of anticonvulsants under the diagnostic codes for epilepsy or seizure. An incident case was ascertained by confirming the absence of any epilepsy-related diagnostic codes and anticonvulsant prescription for 2 years or more before the operational definition for a prevalent case was met. Alternative operational definitions for epilepsy were tested. The temporal trends of the incidence and prevalence of epilepsy were analyzed using a Poisson regression model, and are expressed as average annual percentage changes (AAPCs). RESULTS The incidence of epilepsy increased from 28.7/100,000 persons in 2009 to 35.4/100,000 persons in 2017. The prevalence increased gradually from 3.4/1,000 persons in 2009 to 4.8/1,000 persons in 2017. These increasing trends were more evident among elderly subjects aged ≥75 years and in those who had codes for epilepsy or seizure as an additional diagnosis. Age standardization revealed a less prominent but still increasing trend in both incidence (AAPC=0.48%) and prevalence (AAPC=3.11%). CONCLUSIONS There have been increasing trends in both the prevalence and incidence of epilepsy in Korea between 2009 and 2017. This finding appears to be related to societal aging and the high incidence of symptomatic epilepsy in the elderly population.
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Affiliation(s)
- Ji Ye Jeon
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea.,Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hye Jin Moon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Seo Young Lee
- Department of Neurology, College of Medicine, Kangwon National University Chuncheon, Korea.,Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea.
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
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20
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Nevin SM, Wakefield CE, Schilstra CE, McGill BC, Bye A, Palmer EE. The information needs of parents of children with early-onset epilepsy: A systematic review. Epilepsy Behav 2020; 112:107382. [PMID: 32854014 DOI: 10.1016/j.yebeh.2020.107382] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Early-onset epilepsy has broad physical and psychosocial impacts, and parents have a wide variety of information needs. This systematic review set out to assess 1) whether parents of children with early-onset epilepsy have unmet information needs and 2) their preferences regarding information content and style of information delivery. METHODS We searched Medline, Embase, PsychInfo, and CINAHL using keywords relating to information needs, information resources, and preferences for information delivery. We limited the search to parent populations and included all peer-reviewed publications published in English after the year 2005. RESULTS Eleven studies met our inclusion criteria. Parents reported a clear need for understandable, realistic, and focused information, highlighting a particular need for content about comorbidities and emotional support. Parents reported limited availability of detailed information resources on early-onset epilepsy, which compromised their ability to access appropriate healthcare services. Unmet information needs were associated with greater levels of stress, poorer psychosocial outcomes, and lower satisfaction with healthcare services. SIGNIFICANCE The results highlight the importance of detailed epilepsy information for families. Healthcare professionals should be aware of the impact of a lack of epilepsy information on family wellbeing. Multipronged and tailored interventions targeting the information needs of families are warranted.
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Affiliation(s)
- Suzanne M Nevin
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Clarissa E Schilstra
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ann Bye
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Elizabeth E Palmer
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, Australia
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21
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Quilião ME, Venancio FA, Mareto LK, Metzker SDA, do Nascimento AI, Vitorelli-Venancio DC, Santos-Pinto CDB, de Oliveira EF. Neurological Development, Epilepsy, and the Pharmacotherapy Approach in Children with Congenital Zika Syndrome: Results from a Two-Year Follow-up Study. Viruses 2020; 12:v12101083. [PMID: 32992985 PMCID: PMC7601787 DOI: 10.3390/v12101083] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
Clinical outcomes related to congenital Zika syndrome (CZS) include microcephaly accompanied by specific brain injuries. Among several CZS outcomes that have been described, epilepsy and motor impairments are present in most cases. Pharmacological treatment for seizures resulting from epilepsy is performed with anticonvulsant drugs, which in the long term are related to impairments in the child's neuropsychomotor development. Here, we describe the results from a two-year follow-up of a cohort of children diagnosed with CZS related to the growth of the head circumference and some neurological and motor outcomes, including the pharmacological approach, and its results in the treatment of epileptic seizures. This paper is part of a prospective cohort study carried out in the state of Mato Grosso Sul, Brazil, based on a Zika virus (ZIKV)-exposed child population. Our data were focused on the assessment of head circumference growth and some neurological and motor findings, including the description of seizure conditions and pharmacological management in two periods. Among the 11 children evaluated, 8 had severe microcephaly associated with motor impairment and/or epilepsy. Seven children were diagnosed with epilepsy. Of these, 3 had West syndrome. In four children with other forms of epilepsy, there was no pharmacological control.
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Affiliation(s)
- Maria Eulina Quilião
- Centro Especializado em Reabilitação, Associação de Pais e Amigos dos Excepcionais, Campo Grande 79050-140, Brazil;
| | - Fabio Antonio Venancio
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (F.A.V.); (D.C.V.-V.)
| | - Lisany Krug Mareto
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (L.K.M.); (C.D.B.S.-P.)
| | - Sahra de Almeida Metzker
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Ana Isabel do Nascimento
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Daniele Cristina Vitorelli-Venancio
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (F.A.V.); (D.C.V.-V.)
| | - Cláudia Du Bocage Santos-Pinto
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (L.K.M.); (C.D.B.S.-P.)
| | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (F.A.V.); (D.C.V.-V.)
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil; (L.K.M.); (C.D.B.S.-P.)
- Correspondence: ; Tel.: +55-67-3345-7403
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22
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Pan PY, Bölte S, Kaur P, Jamil S, Jonsson U. Neurological disorders in autism: A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:812-830. [PMID: 32907344 DOI: 10.1177/1362361320951370] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
LAY ABSTRACT Neurological disorders, such as epilepsy and cerebral palsy, have been reported to occur among individuals with autism beyond chance and may have an impact on daily living across the lifespan. Although there has been research investigating neurological disorders in autism, the findings are not always conclusive. Previous summaries of existing studies have not evaluated the full range of neurological disorders. This study aimed to comprehensively explore the neurological problems appearing in autism to provide updated information that is needed for better healthcare and support in this population. We looked at already published studies focusing on risk or frequency of neurological disorders in autism. Our results suggest that individuals with autism are more likely than the general population to have a range of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headache, and inborn abnormalities of the nervous system. In order to provide individualized healthcare and support of high quality to individuals diagnosed with autism, health care professionals and other support providers need to be attentive to neurological complications. To further improve our understanding about the link between autism and neurological disorders, future research should follow the neurological health of children who are diagnosed with or are at increased likelihood of autism.
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Affiliation(s)
- Pei-Yin Pan
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden
| | - Sven Bölte
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden.,Curtin University, Australia
| | - Preet Kaur
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden
| | - Sadia Jamil
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden
| | - Ulf Jonsson
- Karolinska Institutet, Sweden.,Region Stockholm, Sweden.,Uppsala University, Sweden
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23
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Eissa MA, Abdulghani KO, Nada MA, Elkhawas HM, Shouman AE, Ahmed NS. Serum zinc and copper levels in a sample of Egyptian epileptic children. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00210-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epilepsy is among the most common disabling neurological disorders among children. Altered serum levels of zinc and copper may facilitate seizure occurrence and repetition, and antiepileptic drugs may disturb their serum levels affecting disease control and outcome.
Objective
To investigate the association between serum levels of zinc and copper and epilepsy and antiepileptic treatment in a group of Egyptian epileptic children.
Methods
Case-control study on 100 epileptic patients, aged from 2 to 16 years, from neurology outpatient clinic and 50 apparently healthy children with matched age and sex. Venous samples were withdrawn from patients and controls then serum levels of zinc and copper were measured with graphite furnace atomic absorption spectrometer-A Analyst 800.
Results
Serum zinc level of patients’ group was significantly lower than that of controls with a mean of 59.1 μ/dL ± 22.7 and 85 μ/dL ± 22.2, respectively (P < 0.01). Serum zinc level of patients with history of febrile seizures was significantly decreased compared to patients without history of febrile seizures with a mean of 41.5 μ/dL ± 20.1 and 67.9 μ/dL ± 19.3, respectively (P < 0.01). Patient on carbamazepine intake showed significantly lower zinc serum level than patients without carbamazepine intake, with a mean of 49.0 μ/dL ± 17 and 61.8 μ/dL ± 23.4, respectively (P < 0.01). A significant negative correlation was noted between the duration of illness of epilepsy and the mean copper serum level (P < 0.05).
Conclusion
Zinc and copper altered homeostasis have mounting evidence about their role in the pathogenesis of epilepsy. Designing treatment plans that selectively restore zinc and copper normal levels may be a beneficial strategy in the future.
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Association of common genetic variants with vitamin D status in Malaysian children with epilepsy. Seizure 2020; 79:103-111. [PMID: 32464532 DOI: 10.1016/j.seizure.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Children with epilepsy (CWE) are at risk of vitamin D deficiency. Single nucleotide polymorphisms (SNPs) affecting the vitamin D pathway are potentially important risk factors for serum 25-hydroxyvitamin D [25(OH)D] concentration. The aims of our study were to evaluate the association of vitamin d-related SNPs to serum 25(OH)D concentrations in Malaysian CWE. METHODS Cross-sectional study of Malaysian ambulant CWE on antiseizure medication for >1 year. Sixteen SNPs in 8 genes (GC, VDR, CYP2R1, CYP24A1, CYP27B1, CYP27A1, CYP3A4, NADSYN1/DHCR7) were genotyped. Linear and logistic regression models and co-variates adjusted analyses were used. SNPs with significant associations were further analysed in a group of ethnically-matched healthy Malaysian children. RESULTS 239 CWE were recruited (52.7% Malay, 24.3% Chinese and 23.0% Indian) with mean serum 25(OH)D of 58.8 nmol/L (SD 25.7). Prevalence of vitamin D deficiency (≤37.5 nmol/L) was 23.0%. Minor allele of GC-rs4588-A was associated with lower serum 25(OH)D in the meta-analysis of both CWE (β -8.11, P = 0.002) and Malaysian healthy children (β -5.08, P < 0.001), while VDR-rs7975232-A was significantly associated with reduced odds of vitamin D deficiency in Malay subgroup of CWE (OR: 0.16; 95% CI: 0.06-0.49; P = 0.001) and this association was not found in the healthy children group. CONCLUSIONS Our results suggest that GC-rs4588 is associated with lower serum 25(OH)D concentration in both Malaysian CWE and healthy children, while VDR-rs7975232A is associated with lower risk of vitamin D deficiency in Malaysian CWE of Malay ethnicity. Our findings may assist in the genetic risk stratification of low vitamin D status among CWE.
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Al-Asmi A, Poothrikovil RP, Nandhagopal R, Al-Zakwani I, Al-Futaisi A, Al-Abri M, Gujjar AR. Clinico-electrographic characteristics and classification of genetic generalized epilepsy in Oman. Epilepsy Res 2020; 166:106380. [PMID: 32590287 DOI: 10.1016/j.eplepsyres.2020.106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of information on the annual incidence of genetic generalized epilepsy (GGE) in the Arab countries, especially Oman. Ascertaining the true burden of illness has crucial implications for health policies and priorities. We aim to study the clinico-electrographic characteristics, classification, and annual incidence of GGE in Oman. METHOD Using the cross-sectional data of EEGs obtained from all patients with GGE who presented to Sultan Qaboos University hospital (major referral center for epilepsy in Oman) from January 2007 to June 2014. Analyses were performed using univariate statistics. RESULTS Approximately 10,423 patients had EEG studies during the study period of which 376 patients (3.6 %) had EEG abnormalities suggestive of GGE. Forty two percent of the 376 GGE patients were male with ages ranging from 3 to 58 years. We were able to classify 273 patients to one of the GGE syndromes. Forty-three percent of 130 patients had a positive family history of epilepsy in their first or second-degree relatives. The generalized tonic-clonic seizure was the most common seizure type observed in 242 patients (64 %; 95 %CI: 59.2 %-68.9 %). Juvenile myoclonic epilepsy was the most common epilepsy syndrome (41 % of the total GGE patients) encountered in our region. A significant female predominance (9.7 % vs 2.5 %; p = 0.016) was observed in juvenile absence epilepsy. Certain interictal focal EEG abnormalities did not exclude a diagnosis of GGE. An average annual GGE incidence of 2.9 % (95 % CI: 2.6 %-3.2 %) was observed during the study period. CONCLUSION This hospital-based study is the first of its kind in the Arabian Gulf region, classifying the different subcategories of GGE. Our results indicate that GGE is a common epilepsy subtype in Oman. A prospective population-based epidemiological study is required to estimate the precise frequency of GGE in Oman.
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Affiliation(s)
- Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | | | - Ramachandiran Nandhagopal
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Amna Al-Futaisi
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Abri
- Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Arunodaya R Gujjar
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Cho SJ, Newton J, Li T, Khandai P, Luta G, Lovinger DM, N'Gouemo P. Prenatal alcohol exposure in the second trimester-equivalent increases the seizure susceptibility in developing rats. Alcohol 2020; 85:153-164. [PMID: 32114257 DOI: 10.1016/j.alcohol.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
We have previously reported that prenatal alcohol exposure (PAE) in the 2nd trimester-equivalent of gestation is associated with increased N-methyl-d-aspartate (NMDA)-induced generalized tonic-clonic seizures (GTCSs) prevalence in postpartum developing rats. Whether the 1st trimester-equivalent of gestation is also a vulnerable period for developing GTCSs following PAE is unknown. Here, we investigated the effects of a single episode of PAE at embryonic day 8 (E8, in the 1st trimester-equivalent) or E18 (in the 2nd trimester-equivalent) on NMDA-induced seizures in developing rats at postnatal day 7 (P7, the equivalent of preterm newborns) and P15 (the equivalent of term infants). Pregnant Sprague-Dawley rats were given a single oral dose of ethanol (5 g/kg body weight) at E8 or E18 and the postpartum rats were tested for the susceptibility to NMDA-induced seizures at either P7 or P15. NMDA-induced seizures consisted of wild running-like behavior (WRLB), flexion seizures (FSs), clonic seizures (CSs), GTCSs, and tonic seizures (TSs); these seizures were observed in both control-treated and PAE-treated, male and female, P7 and P15 rats. Quantification reveals that the overall prevalence of CSs, GTCSs and TSs occurrence were significantly increased in the E18-PAE group compared to E8-PAE group, adjusting for sex and postnatal day. Furthermore, the overall prevalence of FSs and TSs occurrence was significantly increased in PAE-treated males compared to females, adjusting for embryonic stage and postnatal day. The overall prevalence of WRLB and FSs occurrence was also increased in PAE-P7 rats compared to PAE-P15 rats, adjusting for sex and embryonic stage. We conclude that the susceptibility to develop GTCSs was higher when PAE occurred in the 2nd rather than in the 1st trimester-equivalent of gestation.
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Tatarinova TV, Deiss T, Franckle L, Beaven S, Davis J. The Impact of MNRI Therapy on the Levels of Neurotransmitters Associated with Inflammatory Processes. Int J Mol Sci 2020; 21:E1358. [PMID: 32085403 PMCID: PMC7072967 DOI: 10.3390/ijms21041358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/02/2023] Open
Abstract
The neurotransmitter levels of representatives from five different diagnosis groups were tested before and after participation in the MNRI®-Masgutova Neurosensorimotor Reflex Intervention. The purpose of this study was to ascertain neurological impact on (1) Developmental disorders, (2) Anxiety disorders/OCD (Obsessive Compulsive Disorder), PTSD (Post-Traumatic Stress disorder), (3) Palsy/Seizure disorders, (4) ADD/ADHD (Attention Deficit Disorder/Attention Deficit Disorder Hyperactive Disorder), and (5) ASD (Autism Spectrum Disorder) disorders. Each participant had a form of neurological dysregulation and typical symptoms respective to their diagnosis. These diagnoses have a severe negative impact on the quality of life, immunity, stress coping, cognitive skills, and social assimilation. This study showed a trend towards optimization and normalization of neurological and immunological functioning, thus supporting the claim that the MNRI method is an effective non-pharmacological neuromodulation treatment of neurological disorders. The effects of MNRI on inflammation have not yet been assessed. The resulting post-MNRI changes in participants' neurotransmitters show significant adjustments in the regulation of the neurotransmitter resulting in being calmer, a decrease of hypervigilance, an increase in stress resilience, behavioral and emotional regulation improvements, a more positive emotional state, and greater control of cognitive processes. In this paper, we demonstrate that the MNRI approach is an intervention that reduces inflammation. It is also likely to reduce oxidative stress and encourage homeostasis of excitatory neurotransmitters. MNRI may facilitate neurodevelopment, build stress resiliency, neuroplasticity, and optimal learning opportunity. There have been no reported side effects of MNRI treatments.
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Affiliation(s)
- Tatiana V. Tatarinova
- Department of Biology, University of La Verne, La Verne, CA 91750, USA
- Functional Genomics Group, Vavilov Institute for General Genetics, Moscow 119991, Russia
- Forest Genomics Laboratory, Siberian Federal University, Krasnoyarsk 660041, Russia
- Bioinformatics Center, Information Transmission Problems Institute, Moscow 127051, Russia
| | - Trina Deiss
- Research Department, United1Front Foundation, Minneapolis, MN 55111, USA;
| | - Lorri Franckle
- Laser Health Department, Laser Health, Orlando, FL 33709, USA;
| | - Susan Beaven
- Family Medicine, St. Petersburg Free Clinic, St. Petersburg, FL 33701, USA;
| | - Jeffrey Davis
- Family Medicine, Prairie Health and Wellness, Wichita, KS 67206, USA;
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Liu R, Wang J, Liang S, Zhang G, Yang X. Role of NKCC1 and KCC2 in Epilepsy: From Expression to Function. Front Neurol 2020; 10:1407. [PMID: 32010056 PMCID: PMC6978738 DOI: 10.3389/fneur.2019.01407] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/23/2019] [Indexed: 01/21/2023] Open
Abstract
As a main inhibitory neurotransmitter in the central nervous system, γ-aminobutyric acid (GABA) activates chloride-permeable GABAa receptors (GABAa Rs) and induces chloride ion (Cl−) flow, which relies on the intracellular chloride concentration ([Cl−]i) of the postsynaptic neuron. The Na-K-2Cl cotransporter isoform 1 (NKCC1) and the K-Cl cotransporter isoform 2 (KCC2) are two main cation-chloride cotransporters (CCCs) that have been implicated in human epilepsy. NKCC1 and KCC2 reset [Cl−]i by accumulating and extruding Cl−, respectively. Previous studies have shown that the profile of NKCC1 and KCC2 in neonatal neurons may reappear in mature neurons under some pathophysiological conditions, such as epilepsy. Although increasing studies focusing on the expression of NKCC1 and KCC2 have suggested that impaired chloride plasticity may be closely related to epilepsy, additional neuroelectrophysiological research aimed at studying the functions of NKCC1 and KCC2 are needed to understand the exact mechanism by which they induce epileptogenesis. In this review, we aim to briefly summarize the current researches surrounding the expression and function of NKCC1 and KCC2 in epileptogenesis and its implications on the treatment of epilepsy. We will also explore the potential for NKCC1 and KCC2 to be therapeutic targets for the development of novel antiepileptic drugs.
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Affiliation(s)
- Ru Liu
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute of Brain Disorders, Beijing, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Junling Wang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute of Brain Disorders, Beijing, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Shuli Liang
- Department of Functional Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Guojun Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Yang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute of Brain Disorders, Beijing, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
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Abstract
Researchers from the University Medical Centre Schleswig-Holstein, Epilepsy Centre Kork, University of Freiburg, University Children’s Hospital Heidelberg, Goethe University, and University Children’s Hospital Zürich conducted a study to evaluate seizure occurrence and cognitive development following epilepsy surgery in children under 3 years of age.
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Affiliation(s)
- Hannah K Weiss
- Department of Neurological Surgery, Northwestern University, Chicago, IL
| | - S Kathleen Bandt
- Department of Neurological Surgery, Northwestern University, Chicago, IL
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Sharopov S, Winkler P, Uehara R, Lombardi A, Halbhuber L, Okabe A, Luhmann HJ, Kilb W. Allopregnanolone augments epileptiform activity of an in-vitro mouse hippocampal preparation in the first postnatal week. Epilepsy Res 2019; 157:106196. [PMID: 31499340 DOI: 10.1016/j.eplepsyres.2019.106196] [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: 05/14/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023]
Abstract
In the immature brain the neurotransmitter γ-amino butyric acid (GABA) mediates a membrane depolarization and can contribute to both, inhibition and excitation. Therefore the consequences of a positive modulation of GABA(A) receptors by neurosteroids on epileptiform activity are hard to predict. In order to analyze whether neurosteroids attenuate or exaggerate epileptiform activity in the immature brain, we investigated the effect of the neurosteroid allopregnanolone on epileptiform activity in an in-toto hippocampus preparation of early postnatal mice (postnatal days 4-7) using field potential recordings. These in-vitro experiments revealed that 0.5 μmol/L allopregnanolone had no effect on ictal-like epileptiform activity, but increased the occurrence of interictal epileptiform events. The allopregnanolone-induced enhancement of interictal epileptiform activity could be blocked by a selective inhibition of synaptic GABAA receptors. In contrast, allopregnanolone had no effect on interictal epileptiform activity upon enhanced extrasynaptic GABAergic activity. Patch-clamp experiments demonstrated that allopregnanolone prolonged the decay of GABAergic postsynaptic currents, but had no effect on tonic GABAergic currents. We conclude from these results that allopregnanolone can enhance excitability in the immature hippocampus viaprolonged synaptic GABAergic currents. This potential effect of neurosteroids on brain excitability should be considered if they are applied as anticonvulsants to premature or early postnatal babies.
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Affiliation(s)
- Salim Sharopov
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 6, D-55120, Mainz, Germany
| | - Paula Winkler
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 6, D-55120, Mainz, Germany
| | - Rie Uehara
- Department of Molecular Anatomy, School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Aniello Lombardi
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 6, D-55120, Mainz, Germany
| | - Lisa Halbhuber
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 6, D-55120, Mainz, Germany
| | - Akihito Okabe
- Department of Molecular Anatomy, School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan; Department of Nutritional Sciences, Faculty of Health and Welfare, Seinan Jo Gakuin University, 1-3-5 Ibori, Kokurakita-ku, Kitakyushu, Fukuoka, 803-0835, Japan
| | - Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 6, D-55120, Mainz, Germany
| | - Werner Kilb
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 6, D-55120, Mainz, Germany.
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Wändell P, Fredrikson S, Carlsson AC, Li X, Gasevic D, Sundquist J, Sundquist K. Epilepsy in second-generation immigrants: a cohort study of all children up to 18 years of age in Sweden. Eur J Neurol 2019; 27:152-159. [PMID: 31340083 DOI: 10.1111/ene.14049] [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: 03/12/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Our purpose was to study the association between country of birth and incident epilepsy in second-generation immigrants in Sweden. METHODS The study population included all children (n = 4 023 149) aged up to 18 years in Sweden. Epilepsy was defined as at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy, using individuals with Swedish-born parents as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence interval (95% CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and comorbid conditions, also using data from the Total Population Register. RESULTS A total of 26 310 individuals had a registered epilepsy event, i.e. 6.5/1000 (6.6/1000 amongst boys and 6.3/1000 amongst girls). After adjustment, the risk of epilepsy was lower than in children of Swedish-born parents. Amongst girls the significant HR was 0.85 (95% CI 0.81-0.88), but in boys only when adjusting also for comorbidity (HR 0.96, 95% CI 0.92-0.99). Amongst specific immigrant groups, a higher incidence of epilepsy was observed amongst boys with parents from Turkey and Africa, but not when adjusting for comorbidity, and a lower risk was observed in many other groups (boys with parents from Latvia, girls with parents from Finland, Iceland, Southern Europe, countries from the former Yugoslavia, and Asia). CONCLUSION The risk of epilepsy was lower in second-generation immigrant children compared to children with Swedish-born parents, but with substantial differences between different immigrant groups.
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Affiliation(s)
- P Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - S Fredrikson
- Department of Clinical Neuroscience, Division of Neurology, Karolinska Institutet Huddinge, Stockholm, Sweden
| | - A C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - X Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - D Gasevic
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - K Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
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32
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Operto FF, Mazza R, Pastorino GMG, Campanozzi S, Verrotti A, Coppola G. Parental stress in a sample of children with epilepsy. Acta Neurol Scand 2019; 140:87-92. [PMID: 31002402 DOI: 10.1111/ane.13106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess maternal and paternal stress in two groups of children with different types of epilepsy, at the time of diagnosis and after one year of follow-up. METHODS We investigated parental stress in a sample of 85 children aged between 2 and 14 years, divided into two groups based on the diagnosis: Group 1 (50 patients) with childhood absence epilepsy or idiopathic focal epilepsy with rolandic discharges and Group 2 (35 patients) with different forms of drug-resistant epilepsy. Parents independently completed the Parental Stress Index-Short Form at Time 0, when they received the diagnosis and patients started therapy, and at Time 1, after 1 year of follow-up. RESULTS We found high levels of stress in both mothers and fathers at Time 0, without statistically significant differences between the two groups. At Time 1, stress values were unchanged in Group 1 mothers; conversely, the levels of stress in Group 1 fathers reduced, with average values that all fell within the "normal range." In Group 2, stress levels were reduced both in mothers and in fathers at Time 1, compared to Time 0, but equally fell into the "pathological range," for both parents. CONCLUSION In our study, the diagnosis of the epilepsy itself tended to increase parental stress, apparently regardless of the severity of the epilepsy; even after a period of follow-up, when the epilepsy was better controlled, overall parental stress remained high. It might have been related to feelings of parental inadequacy or concerns about issues such as safety or the outcome for the child.
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Affiliation(s)
- Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs University of Bari “Aldo Moro” Bari Italy
| | - Roberta Mazza
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs University of Bari “Aldo Moro” Bari Italy
| | | | - Stella Campanozzi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs University of Bari “Aldo Moro” Bari Italy
| | | | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Medical School University of Salerno Salerno Italy
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33
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Attention deficit hyperactivity disorder (ADHD) in children with epilepsy. Ir J Med Sci 2019; 189:305-313. [DOI: 10.1007/s11845-019-02042-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/24/2019] [Indexed: 01/08/2023]
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34
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Al-Eitan LN, Al-Dalalah IM, Mustafa MM, Alghamdi MA, Elshammari AK, Khreisat WH, Aljamal HA. Effects of MTHFR and ABCC2 gene polymorphisms on antiepileptic drug responsiveness in Jordanian epileptic patients. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:87-95. [PMID: 31354331 PMCID: PMC6572658 DOI: 10.2147/pgpm.s211490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
Background Epilepsy is one of the most common neurological diseases with unclear etiology where its genetic background and treatment regime still need further exploration. Objectives This study designed to evaluate the pharmacogenomics of MTHFR and ABCC2 genes, and their association with epilepsy susceptibility among Jordanian population. Methods A case-control study was conducted on Jordanian cohort of 296 epileptic patients and 299 healthy individuals. Custom platform array was used to genotype the genetic polymorphisms within MTHFR (rs1801133) and ABCC2 (rs717620, rs3740066, rs2273697) genes. Results This study revealed a significant genetic association of MTHFR rs1801133 polymorphism with susceptibility to generalized in general and generalized tonic-clonic epilepsy (GTCE)(p=0.018 and 0.01, respectively). Regarding ABCC2 gene, rs717620 was of linkage with generalized and GTCE subtypes (p=0.045 and 0.048, respectively), while rs717620 was associated with poor responder patients (p=0.036) with no linkage of the ABCC2 haplotypes. Conclusions MTHFR and ABCC2 polymorphisms showed an association with either epilepsy types in general or subtypes and treatment response among Jordanian population. This study also suggested that these gene polymorphisms have an important role in epilepsy development and drug effectiveness and could be of a great impact in the era of epilepsy diagnosis and treatment.
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Affiliation(s)
- Laith N Al-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan.,Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Islam M Al-Dalalah
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamed M Mustafa
- Department of Neuroscience, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Afrah K Elshammari
- Queen Rania Hospital for Children, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Wael H Khreisat
- Queen Rania Hospital for Children, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Hanan A Aljamal
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Goasdoue K, Chand KK, Miller SM, Lee KM, Colditz PB, Wixey JA, Bjorkman ST. Seizures Are Associated with Blood-Brain Barrier Disruption in a Piglet Model of Neonatal Hypoxic-Ischaemic Encephalopathy. Dev Neurosci 2019; 40:1-16. [PMID: 31048585 DOI: 10.1159/000499365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
Seizures in the neonatal period are most often symptomatic of central nervous system (CNS) dysfunction and the most common cause is hypoxic-ischaemic encephalopathy (HIE). Seizures are associated with poor long-term outcomes and increased neuropathology. Blood-brain barrier (BBB) disruption and inflammation may contribute to seizures and increased neuropathology but are incompletely understood in neonatal HIE. The aim of this study was to investigate the impact of seizures on BBB integrity in a preclinical model of neonatal hypoxic-ischaemic (HI) injury. Piglets (age: <24 h) were subjected to a 30-min HI insult followed by recovery to 72 h post-insult. Amplitude-integrated electroencephalography (aEEG) was performed and seizure burden and background aEEG pattern were analysed. BBB disruption was evaluated in the parietal cortex and hippocampus by means of immunohistochemistry and Western blot. mRNA and protein expression of tight-junction proteins (zonula-occludens 1 [ZO1], occludin [OCLN], and claudin-5 [CLDN5]) was assessed using quantitative polymerase chain reaction (qPCR) and Western blot. In addition, mRNA from genes associated with BBB disruption vascular endothelial growth factor (VEGF) and matrix metalloproteinase 2 (MMP2) as well as inflammatory cytokines and chemokines was assessed with qPCR. Piglets that developed seizures following HI (HI-Sz) had significantly greater injury, as demonstrated by poorer aEEG background pattern scores, lower neurobehavioural scores, and greater histopathology. HI-Sz animals had severe IgG extravasation into brain tissue and uptake into neurons as well as significantly greater levels of IgG in both brain regions as assessed by Western blot. IgG protein in both brain regions was significantly associated with seizure burden, aEEG pattern scores, and neurobehavioural scores. There was no difference in mRNA expression of the tight junctions, however a significant loss of ZO1 and OCLN protein was observed in the parietal cortex. The inflammatory genes TGFβ, IL1β, IL8, IL6, and TNFα were significantly upregulated in HI-Sz animals. MMP2 was significantly increased in animals with seizures compared with animals without seizures. Increasing our understanding of neuropathology associated with seizure is vital because of the association between seizure and poor outcomes. Investigating the BBB is a major untapped area of research and a potential avenue for novel treatments.
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Affiliation(s)
- Kate Goasdoue
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Kirat Kishore Chand
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Stephanie Melita Miller
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Kah Meng Lee
- Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul Bernard Colditz
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Julie Anne Wixey
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Stella Tracey Bjorkman
- The University of Queensland Perinatal Research Centre, UQ Centre for Clinical Research, Herston, Queensland, Australia,
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Operto FF, Mazza R, Pastorino GMG, Campanozzi S, Margari L, Coppola G. Parental stress in pediatric epilepsy after therapy withdrawal. Epilepsy Behav 2019; 94:239-242. [PMID: 30978636 DOI: 10.1016/j.yebeh.2019.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to explore stress levels in the parents of children with idiopathic epilepsy at different time points of the disease, specifically, at the time of diagnosis, during follow-up, and 1 and 2 years after discontinuation of antiepileptic drugs. METHODS Our study included 50 patients between 5 and 14 years of age, who were diagnosed with childhood absence epilepsy or idiopathic focal epilepsy with Rolandic paroxysms. Parents of the participants independently completed the Parenting Stress Index-Short Form at the time of initial diagnosis, and when the children started antiepileptic drugs (Time 0), and at 1 year (Time 1) and 2 years (Time 2) after discontinuation of therapy. RESULTS At Time 0, parental stress levels were increased, both in mothers and fathers, with average scores in the "clinical range" of the parental distress (PD), dysfunctional parent-child interaction (P-CDI), and total stress (TS) scales. At Time 1, the scores on these scales remained high. At Time 2, a mild reduction in the stress scores was observed in both parents, despite values remaining in the "clinical range" for all the scales. CONCLUSIONS Results suggested that parents of children with epilepsy were not reassured about the child's condition, even after clinical improvement. Parental stress levels remained higher than expected, even 2 years after the discontinuation of therapy and freedom from seizures. This was probably due to concerns with the reappearance of new seizures or a more severe type of epilepsy with the discontinuation of drug(s), and feelings of inadequacy with their parental role(s).
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Affiliation(s)
- Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy; Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Via Giovanni Paolo II, 132, Fisciano, SA, Italy.
| | - Roberta Mazza
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Via Giovanni Paolo II, 132, Fisciano, SA, Italy; Department of Mental and Physical Health and Preventive Medicine, University of Campania, Naples, Italy
| | - Stella Campanozzi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Via Giovanni Paolo II, 132, Fisciano, SA, Italy
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Winkler P, Luhmann HJ, Kilb W. Taurine potentiates the anticonvulsive effect of the GABA A agonist muscimol and pentobarbital in the immature mouse hippocampus. Epilepsia 2019; 60:464-474. [PMID: 30682212 DOI: 10.1111/epi.14651] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The high incidence of epileptic seizures in neonates and their frequent refractoriness to pharmacologic therapies require identification of new therapeutical options. Therefore, we investigated whether the modulatory effect of taurine on γ-aminobutyric acid (GABA)A receptors can enhance the anticonvulsive potential of the GABAA receptor agonist muscimol and of the barbiturate pentobarbital. METHODS We performed field potential recordings in in toto hippocampus preparations of immature (postnatal days 4-7) C57Bl/6 mouse pups. Spontaneous epileptiform activity was induced by the continuous presence of the potassium channel blocker 4-aminopyridine and the glycinergic antagonist strychnine in Mg2+ -free solutions. RESULTS Bath application of 0.1 μmol/L muscimol increases the occurrence of recurrent epileptiform discharges, whereas they are significantly attenuated in a dose-dependent manner by muscimol in concentrations between 0.5 and 5 μmol/L. Taurine at concentrations between 0.1 and 0.5 mmol/L induces a proconvulsive effect, but upon coapplication, it significantly augments the anticonvulsive effect of moderate muscimol doses (0.5-1 μmol/L). In addition, the anticonvulsive effect of 100 and 200 μmol/L pentobarbital is increased significantly in the presence of 0.5 μmol/L taurine. SIGNIFICANCE These observations demonstrate that taurine can indeed enhance the anticonvulsive effects of muscimol and pentobarbital, suggesting that taurine may act as a positive modulator on GABAA receptors. Thus, interfering with the modulatory taurine binding site of GABAA receptors or the interstitial taurine concentration may provide new therapeutical options for anticonvulsive therapies in neonates.
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Affiliation(s)
- Paula Winkler
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Werner Kilb
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Erdogan MA, Yusuf D, Erdogan A, Erbas O. Levodropropizine suppresses seizure activity in rats with pentylenetetrazol-induced epilepsy. Epilepsy Res 2018; 150:32-37. [PMID: 30610970 DOI: 10.1016/j.eplepsyres.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/03/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Millions of individuals worldwide suffer from epilepsy, and up to 25% of patients have seizures that are resistant to currently available antiepileptic drugs. Hence, there continues to be a need for more seizure medications that are effective yet tolerable. Levodropropizine (LVDP) is an established antitussive drug that, based on preclinical data, may also have antiepileptic activity. METHODS We treated rats with either intraperitoneal (IP) LVDP at two different doses or placebo in randomized fashion and then exposed them to IP pentylenetetrazol (PTZ), a potent seizure-inducing compound. We measured the rats' subsequent seizure activity with electroencephalography (EEG), Racine's convulsion scale (RCS) and time to first myoclonic jerk (TFMJ) to determine whether LVDP has antiepileptic properties in our murine model for epilepsy. RESULTS When compared to placebo, LVDP at both doses significantly suppressed seizure activity. Mean EEG spike wave percentage score decreased from 76.8% (placebo) to 13.1% (lower dose) and 7.6% (higher dose, bothp < 0.0001). RCS decreased from a mean of 5.8 (placebo) to 1.83 (lower dose) and 1.16 (higher dose, both p < 0.05). TFMJ had increased from a mean of 65.1 s (placebo), to 247.3 s (lower dose) and 295.5 s (higher dose, both p < 0.0001). CONCLUSIONS Levodropropizine, a common antitussive drug, suppresses seizure activity in rats with PTZ-induced status epilepticus. Given the ongoing need to find effective therapies for refractory epilepsy, the possibility of using levodropropizine as an antiepilepticshould be further explored.
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Affiliation(s)
- Mumin Alper Erdogan
- Department of Physiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - Dimas Yusuf
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Arife Erdogan
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Oytun Erbas
- Department of Physiology, Faculty of Medicine, Bilim University, Istanbul, Turkey.
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Veri K, Talvik I, Vaher U, Napa A, Ilves P, Uibo O, Õiglane-Shlik E, Laugesaar R, Rein R, Kolk A, Noormets K, Reimand T, Õunap K, Talvik T. Incidence of Childhood Epilepsy in Estonia. J Child Neurol 2018; 33:587-592. [PMID: 29862897 DOI: 10.1177/0883073818776760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this prospective epidemiological study was to establish the incidence rate of childhood epilepsy in Estonia, to describe the clinical spectrum and to identify etiology of childhood epilepsy. The overall incidence rate was 86.3/100 000. The incidence rate was the highest (141.9/100 000) in the age group from 5 to 9 years. Specific electroclinical syndromes were identified in 22.8% of cases. Structural or metabolic etiology was identified in 20.0% of cases, presumed genetic origin was identified in 33.9% of cases, and in 46.1% of cases the cause of epilepsy remained unknown. The incidence rate of childhood epilepsy in Estonia (86.3/100 000) is similar to the other European countries. In comparison with the results of the first epidemiological study of childhood epilepsy in Estonia (incidence rate 45/100 000; Beilmann et al), the incidence rate in this study is almost 2 times higher, what can be explained with better case collection and improved diagnostic modalities in Estonia.
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Affiliation(s)
- Kadi Veri
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,2 Tallinn Children's Hospital, Tallinn, Estonia
| | - Inga Talvik
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,2 Tallinn Children's Hospital, Tallinn, Estonia.,3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ulvi Vaher
- 3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aita Napa
- 3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pilvi Ilves
- 4 Department of Radiology, Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Oivi Uibo
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Eve Õiglane-Shlik
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rael Laugesaar
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Reet Rein
- 3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Anneli Kolk
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Klari Noormets
- 3 Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Tiia Reimand
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,5 Department of Genetics, United Laboratories, Tartu University Hospital, Tartu, Estonia.,6 Institute of Biomedicine and Translational Medicine, Department of Biomedicine, University of Tartu, Tartu, Estonia
| | - Katrin Õunap
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,5 Department of Genetics, United Laboratories, Tartu University Hospital, Tartu, Estonia
| | - Tiina Talvik
- 1 Department of Pediatrics, University of Tartu, Tartu, Estonia.,3 Children's Clinic, Tartu University Hospital, Tartu, Estonia.,7 Clinical Ethics Committee of Tartu University Hospital, Tartu, Estonia
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40
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Pavone P, Corsello G, Ruggieri M, Marino S, Marino S, Falsaperla R. Benign and severe early-life seizures: a round in the first year of life. Ital J Pediatr 2018; 44:54. [PMID: 29764460 PMCID: PMC5952424 DOI: 10.1186/s13052-018-0491-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/18/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND At the onset, differentiation between abnormal non-epileptic movements, and epileptic seizures presenting in early life is difficult as is clinical diagnosis and prognostic evaluation of the various seizure disorders presenting at this age. Seizures starting in the first year of life including the neonatal period might have a favorable course, such as in infants presenting with benign familial neonatal epilepsy, febrile seizures simplex or acute symptomatic seizures. However, in some cases, the onset of seizures at birth or in the first months of life have a dramatic evolution with severe cerebral impairment. Seizure disorders starting in early life include the "epileptic encephalopathies", a group of conditions characterized by drug resistant seizures, delayed developmental skills, and intellective disability. This group of disorders includes early infantile epileptic encephalopathy also known as Ohtahara syndrome, early myoclonic encephalopathy, epilepsy of infancy with migrating focal seizures, infantile spasms syndrome (also known as West syndrome), severe myoclonic epilepsy in infancy (also known as Dravet syndrome) and, myoclonic encephalopathies in non-progressive disorder. Here we report on seizures manifesting in the first year of life including the neonatal period. Conditions with a benign course, and those with severe evolution are presented. At this early age, clinical identification of seizures, distinction of each of these disorders, type of treatment and prognosis is particularly challenging. The aim of this report is to present the clinical manifestations of each of these disorders and provide an updated review of the conditions associated with seizures in the first year of life.
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Affiliation(s)
- Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, A.U.O. Vittorio Emanuele-Policlinico of Catania, Via Santa Sofia 78, 95100, Catania, Italy.
| | - Giovanni Corsello
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, A.U.O. Vittorio Emanuele-Policlinico of Catania, Via Santa Sofia 78, 95100, Catania, Italy
| | - Silvia Marino
- University-Hospital 'Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Simona Marino
- University-Hospital 'Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- University-Hospital 'Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Hendriksen RGF, Vles JSH, Aalbers MW, Chin RFM, Hendriksen JGM. Brain-related comorbidities in boys and men with Duchenne Muscular Dystrophy: A descriptive study. Eur J Paediatr Neurol 2018; 22:488-497. [PMID: 29306518 DOI: 10.1016/j.ejpn.2017.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/20/2017] [Accepted: 12/09/2017] [Indexed: 11/15/2022]
Abstract
AIM Duchenne Muscular Dystrophy (DMD) is more than a muscle disease since there is a higher prevalence of neuropsychological comorbidities. Similarly, the prevalence of epilepsy is increased. Given the nowadays-increasing interest in brain-related comorbidities in DMD, this study aimed to evaluate the relationship between DMD, epilepsy, and associated neurodevelopmental disorders in an international sample of DMD patients. METHOD Using a questionnaire-based study we investigated the occurrence of self/by-proxy reported brain-related comorbidities in a group of 228 DMD patients. We evaluated the presence of epilepsy and other brain-related comorbidities, but also the specific mutation in the dystrophin gene. With respect to epilepsy, all individually reported epilepsy cases as based on the questionnaire results including information provided on epilepsy treatment, EEG abnormalities, and a description of how a typical seizure would look like, were independently and blindly re-assessed by two external paediatric neurologists (Cohen's kappa of 0.85). RESULTS Based on the latter, 18 (7.9%) DMD patients were considered to have epilepsy. In patients with both DMD and epilepsy, certain other brain-related comorbidities (i.e. attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety disorders and sleep disorders) were significantly more prevalent. CONCLUSION This study is supportive of a high occurrence of epilepsy and other brain-related comorbidities in DMD. Furthermore this study shows for the first time that the frequency of some of these disorders appear to be further increased when epilepsy is present next to DMD. As this study is limited by the self/by proxy setup and the lack of response rates, future studies should elucidate the true incidence of the (triangular) cooccurrence between epilepsy, neurodevelopmental deficits, and DMD.
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Affiliation(s)
- Ruben G F Hendriksen
- Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health & Neuroscience (MHeNS), Maastricht University, Universiteitssingel 40, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Marlien W Aalbers
- Department of Neurosurgery, Groningen University Medical Centre, Hanzeplein 1, P.O. Box 30001, 9713 GZ Groningen, The Netherlands.
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, The University of Edinburgh, Sylvan Road 20, EH9 1UW Edinburgh, United Kingdom; Department of Paediatric Neuroscience, Royal Hospital for Sick Children, Sciennes Road 9, EH9 1LF Edinburgh, United Kingdom.
| | - Jos G M Hendriksen
- Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Kempenhaeghe Epilepsy Centre, Centre for Neurological Learning Disabilities, Sterkselseweg 65, 5591 VE Heeze, The Netherlands.
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Lindy AS, Stosser MB, Butler E, Downtain‐Pickersgill C, Shanmugham A, Retterer K, Brandt T, Richard G, McKnight DA. Diagnostic outcomes for genetic testing of 70 genes in 8565 patients with epilepsy and neurodevelopmental disorders. Epilepsia 2018; 59:1062-1071. [DOI: 10.1111/epi.14074] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 12/16/2022]
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Håberg SE, Aaberg KM, Surén P, Trogstad L, Ghaderi S, Stoltenberg C, Magnus P, Bakken IJ. Epilepsy in Children After Pandemic Influenza Vaccination. Pediatrics 2018; 141:peds.2017-0752. [PMID: 29449342 DOI: 10.1542/peds.2017-0752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if pandemic influenza vaccination was associated with an increased risk of epilepsy in children. METHODS Information from Norwegian registries from 2006 through 2014 on all children <18 years living in Norway on October 1, 2009 was used in Cox regression models to estimate hazard ratios for incident epilepsy after vaccination. A self-controlled case series analysis was used to estimate incidence rate ratios in defined risk periods after pandemic vaccination. RESULTS In Norway, the main period of the influenza A subtype H1N1 pandemic was from October 2009 to December 2009. On October 1, 2009, 1 154 113 children <18 years of age were registered as residents in Norway. Of these, 572 875 (50.7%) were vaccinated against pandemic influenza. From October 2009 through 2014 there were 3628 new cases of epilepsy (incidence rate 6.09 per 10 000 person-years). The risk of epilepsy was not increased after vaccination: hazard ratio: 1.07; 95% confidence interval: 0.94-1.23. Results from the self-controlled case series analysis supported the finding of no association between vaccination and subsequent epilepsy. CONCLUSIONS Pandemic influenza vaccination was not associated with increased risk of epilepsy. Concerns about pandemic vaccination causing epilepsy in children seem to be unwarranted.
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Affiliation(s)
| | - Kari M Aaberg
- Norwegian Institute of Public Health, Oslo, Norway.,The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Pål Surén
- Norwegian Institute of Public Health, Oslo, Norway.,The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | | | - Sara Ghaderi
- Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Community Care, University of Bergen, Bergen, Norway; and
| | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
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Bitta M, Kariuki SM, Abubakar A, Newton CR. Burden of neurodevelopmental disorders in low and middle-income countries: A systematic review and meta-analysis. Wellcome Open Res 2018. [DOI: 10.12688/wellcomeopenres.13540.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Childhood mortality from infectious diseases has declined steadily in many low and middle-income (LAMIC) countries, with increased recognition of non-communicable diseases such as neurodevelopmental disorders (NDD). There is lack of data on the burden of NDD in LAMIC. Current global burden of these disorders are largely extrapolated from high-income countries. The main objective of the study was therefore to estimate the burden of NDD in LAMIC using meta-analytic techniques. Methods: We systematically searched online databases including Medline/PubMed, PsychoInfo, and Embase for studies that reported prevalence or incidence of NDD. Pooled prevalence, heterogeneity and risk factors for prevalence were determined using meta-analytic techniques. Results: We identified 4,802 records, but only 51 studies met the eligibility criteria. Most studies were from Asia-Pacific (52.2%) and most were on neurological disorders (63.1%). The median pooled prevalence per 1,000 for any NDD was 7.6 (95%CI 7.5-7.7), being 11.3 (11.7-12.0) for neurological disorders and 3.2 (95%CI 3.1-3.3) for mental conditions such as attention-deficit hyperactivity disorder (ADHD). The type of NDD was significantly associated with the greatest prevalence ratio in the multivariable model (PR=2.6(95%CI 0.6-11.6) (P>0.05). Incidence was only reported for epilepsy (mean of 447.7 (95%CI 415.3-481.9) per 100,000). Perinatal complications were the commonest risk factor for NDD. Conclusion: The burden of NDD in LAMIC is considerable. Epidemiological surveys on NDD should screen all types of NDD to provide reliable estimates.
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Niu M, Han Y, Li Q, Zhang J. Endogenous sulfur dioxide regulates hippocampal neuron apoptosis in developing epileptic rats and is associated with the PERK signaling pathway. Neurosci Lett 2018; 665:22-28. [DOI: 10.1016/j.neulet.2017.11.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 01/15/2023]
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Zheng YM, Chen B, Jiang JD, Zhang JP. Syntaxin 1B Mediates Berberine's Roles in Epilepsy-Like Behavior in a Pentylenetetrazole-Induced Seizure Zebrafish Model. Front Mol Neurosci 2018; 11:378. [PMID: 30534049 PMCID: PMC6275243 DOI: 10.3389/fnmol.2018.00378] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is a neuronal dysfunction syndrome characterized by transient and diffusely abnormal discharges of neurons in the brain. Previous studies have shown that mutations in the syntaxin 1b (stx1b) gene cause a familial, fever-associated epilepsy syndrome. It is unclear as to whether the stx1b gene also correlates with other stimulations such as flashing and/or mediates the effects of antiepileptic drugs. In this study, we found that the expression of stx1b was present mainly in the brain and was negatively correlated with seizures in a pentylenetetrazole (PTZ)-induced seizure zebrafish model. The transcription of stx1b was inhibited by PTZ but rescued by valproate, a broad-spectrum epilepsy treatment drug. In the PTZ-seizure zebrafish model, stx1b knockdown aggravated larvae hyperexcitatory swimming and prompted abnormal trajectory movements, particularly under lighting stimulation; at the same time, the expression levels of the neuronal activity marker gene c-fos increased significantly in the brain. In contrast, stx1b overexpression attenuated seizures and decreased c-fos expression levels following PTZ-induced seizures in larvae. Thus, we speculated that a deficiency of stx1b gene expression may be related with the onset occurrence of clinical seizures, particularly photosensitive seizures. In addition, we found that berberine (BBR) reduced larvae hyperexcitatory locomotion and abnormal movement trajectory in a concentration-dependent manner, slowed down excessive photosensitive seizure-like swimming, and assisted in the recovery of the expression levels of STX1B. Under the downregulation of STX1B, BBR's roles were limited: specifically, it only slightly regulated the levels of the two genes stx1b and c-fos and the hyperexcitatory motion of zebrafish in dark conditions and had no effect on the overexcited swimming behavior seen in conjunction with lighting stimulation. These findings further demonstrate that STX1B protein levels are negatively correlated with a seizure and can decrease the sensitivity of the photosensitive response in a PTZ-induced seizure zebrafish larvae; furthermore, STX1B may partially mediate the anticonvulsant effect of BBR. Additional investigation regarding the relationship between STX1B, BBR, and seizures could provide new cues for the development of novel anticonvulsant drugs.
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Affiliation(s)
- Yang-Min Zheng
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Chen
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian-Dong Jiang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing-Pu Zhang
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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47
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Beghi E, Capovilla G, Franzoni E, Minicucci F, Romeo A, Verrotti A, Vigevano F, Perucca E. Midazolam vs diazepam in prolonged seizures in children: A pharmacoeconomic approach. Acta Neurol Scand 2018; 137:24-28. [PMID: 28875555 DOI: 10.1111/ane.12814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A previous European cost-utility study reported that use of buccal midazolam in the community setting for the treatment of prolonged seizures (ie, seizures lasting ≥5 minutes) in children was associated with an overall €12 507 399 reduction in annual costs charged to the Italian national health service compared with rectal diazepam. We re-evaluated these findings by applying a more conservative approach. METHODS The Italian Delphi panel reconvened to apply a more conservative assessment of available reports. A decision-tree model was used, allowing for different treatment pathways depending on whether or not a caregiver administers treatment, an ambulance is required for transport of the child to hospital, and an inpatient stay is required. Direct medical costs were derived from Italian healthcare system data. Estimates of the annual number of prolonged tonic-clonic seizures expected in the country were based on studies which assessed seizure duration using video-EEG recordings and medical records. RESULTS Although drug acquisition costs were greater for buccal midazolam than for rectal diazepam, the acquisition cost difference was outweighed by larger cost savings resulting mostly from a reduction in hospital admissions. Assuming that 1.2% of tonic and/or clonic seizures occurring in children and adolescents over a 12-month period are prolonged, the annual nationwide reduction in costs from preferring buccal midazolam to rectal diazepam was estimated at €3 577 587.9. CONCLUSIONS In this more conservative revised analysis, the high cost of buccal midazolam is still counteracted by greater cost savings compared with rectal diazepam, but cost reduction was less than previously estimated.
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Affiliation(s)
- E. Beghi
- IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”; Milano Italy
| | | | - E. Franzoni
- Azienda Ospedaliera di Bologna; Bologna Italy
| | | | - A. Romeo
- Pediatric Neurology Unit and Epilepsy Center; “Fatebenefratelli e Oftalmico” Hospital; ASST Fatebenefratelli Sacco; Milan Italy
| | - A. Verrotti
- Department of Pediatrics; University of L'Aquila; L'Aquila Italy
| | - F. Vigevano
- Bambino Gesù Children's Hospital; Rome Italy
| | - E. Perucca
- Department of Internal Medicine and Therapeutics; C. Mondino National Neurological Institute; University of Pavia; Pavia Italy
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Bitta M, Kariuki SM, Abubakar A, Newton CRJC. Burden of neurodevelopmental disorders in low and middle-income countries: A systematic review and meta-analysis. Wellcome Open Res 2017. [PMID: 29881784 DOI: 10.12688/wellcomeopenres.13540.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Childhood mortality from infectious diseases has declined steadily in many low and middle-income (LAMIC) countries, with increased recognition of non-communicable diseases such as neurodevelopmental disorders (NDD). There is lack of data on the burden of NDD in LAMIC. Current global burden of these disorders are largely extrapolated from high-income countries. The main objective of the study was therefore to estimate the burden of NDD in LAMIC using meta-analytic techniques. Methods: We systematically searched online databases including Medline/PubMed, PsychoInfo, and Embase for studies that reported prevalence or incidence of NDD. Pooled prevalence, heterogeneity and risk factors for prevalence were determined using meta-analytic techniques. Results: We identified 4,802 records, but only 51 studies met the eligibility criteria. Most studies were from Asia (52.2%) and most were on neurological disorders (63.1%). The median pooled prevalence per 1,000 for all NDD was 7.6 (95%CI 7.5-7.7), being 11.3 (11.7-12.0) for neurological disorders and 3.2 (95%CI 3.1-3.3) for mental conditions such as attention-deficit hyperactivity disorder (ADHD). The type of NDD was significantly associated with the greatest prevalence ratio in the multivariable model (PR=2.6(95%CI 0.6-11.6) (P>0.05). Incidence was only reported for epilepsy (mean of 447.7 (95%CI 415.3-481.9) per 100,000). Perinatal complications were the commonest risk factor for NDD. Conclusion: The burden of NDD in LAMIC is considerable. Epidemiological surveys on NDD should screen all types of NDD to provide reliable estimates.
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Affiliation(s)
- Mary Bitta
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
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Agarwal AK, Tunison K, Dalal JS, Nagamma SS, Hamra FK, Sankella S, Shao X, Auchus RJ, Garg A. Metabolic, Reproductive, and Neurologic Abnormalities in Agpat1-Null Mice. Endocrinology 2017; 158:3954-3973. [PMID: 28973305 PMCID: PMC5695831 DOI: 10.1210/en.2017-00511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
Defects in the biosynthesis of phospholipids and neutral lipids are associated with cell membrane dysfunction, disrupted energy metabolism, and diseases including lipodystrophy. In these pathways, the 1-acylglycerol-3-phosphate O-acyltransferase (AGPAT) enzymes transfer a fatty acid to the sn-2 carbon of sn-1-acylglycerol-3-phosphate (lysophosphatidic acid) to form sn-1, 2-acylglycerol-3-phosphate [phosphatidic acid (PA)]. PA is a precursor for key phospholipids and diacylglycerol. AGPAT1 and AGPAT2 are highly homologous isoenzymes that are both expressed in adipocytes. Genetic defects in AGPAT2 cause congenital generalized lipodystrophy, indicating that AGPAT1 cannot compensate for loss of AGPAT2 in adipocytes. To further explore the physiology of AGPAT1, we characterized a loss-of-function mouse model (Agpat1-/-). The majority of Agpat1-/- mice died before weaning and had low body weight and low plasma glucose levels, independent of plasma insulin and glucagon levels, with reduced percentage of body fat but not generalized lipodystrophy. These mice also had decreased hepatic messenger RNA expression of Igf-1 and Foxo1, suggesting a decrease in gluconeogenesis. In male mice, sperm development was impaired, with a late meiotic arrest near the onset of round spermatid production, and gonadotropins were elevated. Female mice showed oligoanovulation yet retained responsiveness to gonadotropins. Agpat1-/- mice also demonstrated abnormal hippocampal neuron development and developed audiogenic seizures. In summary, Agpat1-/- mice developed widespread disturbances of metabolism, sperm development, and neurologic function resulting from disrupted phospholipid homeostasis. AGPAT1 appears to serve important functions in the physiology of multiple organ systems. The Agpat1-deficient mouse provides an important model in which to study the contribution of phospholipid and triacylglycerol synthesis to physiology and diseases.
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Affiliation(s)
- Anil K. Agarwal
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Katie Tunison
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Jasbir S. Dalal
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Sneha S. Nagamma
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - F. Kent Hamra
- Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Shireesha Sankella
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Xinli Shao
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Richard J. Auchus
- Department of Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
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Rezaei S, Abdurahman AA, Saghazadeh A, Badv RS, Mahmoudi M. Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: A systematic review and meta-analysis. Nutr Neurosci 2017; 22:317-334. [PMID: 29069983 DOI: 10.1080/1028415x.2017.1387721] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Classical ketogenic diet (KD) and modified Atkins diet (MAD) are two types of KD commonly used for the treatment of intractable epilepsy throughout the world. Studies have shown the efficacy of these diets. However, no systematic review and meta-analysis study has to date compared the efficacy of KD and MAD in a time trend. Therefore, the objectives of the present study were to compare the short-term and long-term efficacy of classical KD and MAD in children and adolescents with epilepsy and to determine the efficacy of classical KD and MAD at multiple time points and in a time trend. METHODS Main electronic literature databases, including MEDLINE/PubMed, Web of Science, Scopus, and EMBASE, were searched in November 2016. Rate difference and random effects model were used to compare the efficacy of the classical KD and MAD. RESULTS Overall, 70 studies were eligible for inclusion. Meta-analysis revealed a non-significant trend toward a higher efficacy of MAD at month-3 and month-6 (P > 0.05). In the classical KD group, the percentage of responder patients achieving ≥50% seizure reduction was 62, 60, 52, 42, and 46% at month-1, 3, 6, 12 and 24 and for the MAD group was 55, 47, 42, and 29% at month-1, 3, 6, and 12, respectively. DISCUSSION Classical KD does not differ substantially from MAD in ≥50% and ≥90% reduction of seizure frequency at month-3 and month-6. Overall, the number of patients achieving seizure freedom increases over time.
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Affiliation(s)
- Shahabeddin Rezaei
- a Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics , Tehran University of Medical Sciences , Tehran , Iran.,b Students' Scientific Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Ahmed Abdulahi Abdurahman
- c Department of Community Nutrition, School of Nutritional Sciences and Dietetics , Tehran University of Medical Sciences International Campus (TUMS-IC) , Tehran , Iran
| | - Amene Saghazadeh
- d Molecular Immunology Research Center, Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,e Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN) , Tehran , Iran
| | - Reza Shervin Badv
- f Paediatrics Centre of Excellence, Department of Paediatric Neurology , Children's Medical Centre, Tehran University of Medical Sciences , Tehran , Iran
| | - Maryam Mahmoudi
- a Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics , Tehran University of Medical Sciences , Tehran , Iran.,g Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran.,h Dietitians and Nutrition Experts Team (DiNET), Universal Scientific Education and Research Network (USERN) , Tehran , Iran
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