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Puteikis K, Jasionis A, Mameniškienė R. Epilepsy-related injuries - The role of seizure profile, somatic comorbidities and adverse medication effects. Epilepsy Behav 2024; 157:109907. [PMID: 38905912 DOI: 10.1016/j.yebeh.2024.109907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND While epilepsy-related injuries (ERIs) are frequent in people with epilepsy (PWE), factors associated with hospitalization because of ERIs remain relatively unknown. METHODS We conducted a cross-sectional anonymous survey at a tertiary epilepsy clinic among adult outpatients with epilepsy. Participants indicated their demographic, clinical characteristics, adverse effects of antiseizure medications (ASMs), somatic comorbidities and whether they were hospitalized because of ERIs in the past. For variables with significantly different distributions between participant subgroups (positive vs negative history of past hospitalisation because of ERI), the association with ERI-linked hospitalization was assessed using univariable and multivariable regression models. RESULTS Among 600 PWE (312, 52.0 % female) included, 405 (67.5 %) reported at least one ERI in the past and 104 (25.7 %) had been hospitalised because of at least one of the injuries. Age, seizures in the street, focal unaware seizures and adverse ASM effects were associated with ERI-linked hospitalization only in univariable regression models. Male sex (OR = 1.677, 95 % CI = 1.022-2.753), loss of consciousness during seizures (OR = 2.294, 95 % CI = 1.166-4.513), seizure frequency (OR = 1.264, 95 % CI = 1.024-1.559) and ASM-related loss of coordination (OR = 3.496, 95 % CI = 1.670-7.320) were statistically significant predictors in the multivariable model (Nagelkerke R2 = 0.106). CONCLUSION Our study indicates that, beyond seizure-related factors, adverse effects of ASMs and somatic comorbidities need to be considered when estimating the odds of previous ERI-linked hospitalisations. Alternative determinants of a higher risk of serious ERI, such as lifestyle or occupational variables, should be explored in the future.
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Affiliation(s)
| | - Arminas Jasionis
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Mameniškienė
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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Seizure-related injuries in adults: A prospective case-controlled study on risk factors, seizure severity and quality of life. Epilepsy Behav 2022; 134:108849. [PMID: 35905517 DOI: 10.1016/j.yebeh.2022.108849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The current study was conducted to understand the occurrence of seizure-related injuries in people with epilepsy. The relationship between injuries and clinical variables, the perception of seizure severity and quality of life (QoL) and the practice of risky activities were also assessed. The characteristics of the injuries from the onset of epilepsy and in the previous year were assessed. METHODOLOGY This is a prospective study to assess the occurrence of seizures-related injuries of 72 adult patients with epilepsy. Injury-related data were related to clinical variables and scores of the quality of life in epilepsy inventory (QOLIE-31) and the Seizure Severity Questionnaire (SSQ) with p < 0.05. RESULTS The mean age of the people with epilepsy was 45.8 ± 15.2 years and the mean length of seizure disorder was 24.0 ± 18.7 years. Seizure-related injuries occurred since the onset of epilepsy in 55 (76.4%) cases and in the previous year in 17 (23.6%) cases. Throughout the lifespan, there was a greater occurrence of injuries in younger patients, with younger age at the onset of epilepsy, using various antiseizure medications and with higher SSQ scores (T test; 54.5 ± 27.7 vs 36.1 ± 23.4, p = 0.011). Injuries in the previous year were associated with a high occurrence of previous injuries, lower scores on the QOLIE-31 (56.7 ± 18.6 vs 66.6 ± 16.1; p = 0.048), higher frequency of seizures and the perception of greater severity of seizures. Seizure-related injuries during risky activities occurred in 11 (20%) cases, associated with a longer length of epilepsy disorder (34.9 ± 15.6 years vs 22.1 ± 17.4 years; p = 0.03) and the need for surgical procedures. CONCLUSION The occurrence of seizure-related injuries suffered throughout the lifespan and recurrent injuries in the previous year were high. Injuries were significantly associated with epilepsy variables, the perception of greater severity of seizures and risky activities. Seizure-related injuries in the previous year have compromised QoL but not in individuals who suffered injuries throughout their lifespan.
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Das P, Mishra L, Jena D, Govind S, Panda S, Lapinska B. Oral Health-Related Quality of Life in Children and Adolescents with a Traumatic Injury of Permanent Teeth and the Impact on Their Families: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053087. [PMID: 35270779 PMCID: PMC8910580 DOI: 10.3390/ijerph19053087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
The aim of this systematic review was to evaluate the impact of a traumatic dental injury (TDI) of permanent teeth in children and adolescents on their oral health-related quality of life (OHRQoL) as well as on their families. A bibliographic search in the biomedical databases (PubMed, Cochrane Library, MEDLINE) was limited to studies published between January 2000 and February 2021. The study selection criteria were cross-sectional, case control, or prospective clinical studies, which analyzed TDI before and after the treatment of permanent teeth in healthy children and adolescent, assessed their OHRQoL, and were written in English. The search found 25 eligible articles that were included in the study. The quality assessment of the studies was performed using the quality assessment checklist for survey studies in psychology (Q-SSP). The results indicated that a TDI of permanent teeth strongly influences the OHRQoL of children and adolescents, and the timely-performed dental management of a TDI allows for preventing further biological and socio-psychological impacts. Sociodemographic status, economic status, parent’s education, gender, age group, and type of schooling were determinants of the TDI impact on OHRQoL.
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Affiliation(s)
- Priyankaa Das
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan, Bhubaneswar 751003, Odisha, India; (P.D.); (D.J.); (S.G.)
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan, Bhubaneswar 751003, Odisha, India; (P.D.); (D.J.); (S.G.)
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
| | - Debkant Jena
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan, Bhubaneswar 751003, Odisha, India; (P.D.); (D.J.); (S.G.)
| | - Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan, Bhubaneswar 751003, Odisha, India; (P.D.); (D.J.); (S.G.)
| | - Saurav Panda
- Department of Periodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan, Bhubaneswar 751003, Odisha, India;
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
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Mallela AN, Hect JL, Abou-Al-Shaar H, Akwayena E, Abel TJ. Stereotactic laser interstitial thermal therapy corpus callosotomy for the treatment of pediatric drug-resistant epilepsy. Epilepsia Open 2021; 7:75-84. [PMID: 34758204 PMCID: PMC8886067 DOI: 10.1002/epi4.12559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Corpus callosotomy is a safe and effective procedure for reducing the frequency of drop attacks. MR‐guided laser interstitial thermal therapy (MRgLITT) offers a minimally invasive alternative to conventional open craniotomy for callosotomy. We hypothesized that MRgLITT callosotomy could be safely performed in pediatric patients with similar seizure control. Methods We present an institutional case series of 11 procedures in 10 patients for the treatment of drop attacks in drug‐refractory primary generalized epilepsy. MRgLITT was used for complete callosotomy, anterior two‐thirds, posterior, or ablation of residual callosal fibers following prior callosotomy (open or MRgLITT). We retrospectively reviewed clinical course, operative details, radiographic imaging, clinical outcomes, and complications. Results Operative time ranged from 4‐8 hours, and median hospitalization was 2 days. No complications were encountered. Among the 7 patients with at least 3 months of follow‐up, 71% experienced freedom from drop attacks at longest follow‐up and 57% of cases showed improvement in their other seizure semiologies as well (Engel Class II: 28%, Class III: 28%, Class IV: 43%). Significance MR‐guided LITT callosotomy is safe and effective modality in the management of pediatric patients with medically intractable epilepsy characterized by drop attacks. While this is among the largest pediatric series to date, further studies are required to delineate its safety and efficacy among such patients.
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Affiliation(s)
- Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jasmine L Hect
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emefa Akwayena
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Shu F, Shu J. An eight-camera fall detection system using human fall pattern recognition via machine learning by a low-cost android box. Sci Rep 2021; 11:2471. [PMID: 33510202 PMCID: PMC7844246 DOI: 10.1038/s41598-021-81115-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Falls are a leading cause of unintentional injuries and can result in devastating disabilities and fatalities when left undetected and not treated in time. Current detection methods have one or more of the following problems: frequent battery replacements, wearer discomfort, high costs, complicated setup, furniture occlusion, and intensive computation. In fact, all non-wearable methods fail to detect falls beyond ten meters. Here, we design a house-wide fall detection system capable of detecting stumbling, slipping, fainting, and various other types of falls at 60 m and beyond, including through transparent glasses, screens, and rain. By analyzing the fall pattern using machine learning and crafted rules via a local, low-cost single-board computer, true falls can be differentiated from daily activities and monitored through conventionally available surveillance systems. Either a multi-camera setup in one room or single cameras installed at high altitudes can avoid occlusion. This system’s flexibility enables a wide-coverage set-up, ensuring safety in senior homes, rehab centers, and nursing facilities. It can also be configured into high-precision and high-recall application to capture every single fall in high-risk zones.
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Affiliation(s)
- Francy Shu
- Division of Neuromuscular Medicine, Department of Neurology, Los Angeles Medical Center, University of California, 300 Medical Plaza B200, Los Angeles, CA, 90095, USA.
| | - Jeff Shu
- SpeedyAI, Inc, 19940 Ridge Estate Ct, Walnut, CA, 91789, USA
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Abstract
PURPOSE OF REVIEW We review data on injuries and traffic accidents affecting people with epilepsy with emphasis on the overall risk of injuries, specific types of injuries, and risk factors. RECENT FINDINGS Population-based studies of incident epilepsy cohorts indicate that the risk of physical injuries in people with epilepsy in general is increased only modestly. The risk is higher in selected populations that attend epilepsy clinics or referral centers. Soft tissue injuries, dislocations, and fractures are the most common injures, whereas the greatest increase in risk is reported for more uncommon injuries such as drowning. People with epilepsy are at a two-fold to four-fold increased risk for fatal injuries. Comorbidities contribute to fatal as well as nonfatal injuries. The other major risk factor is poorly controlled major convulsive seizures (generalized as well as focal to bilateral tonic-clonic seizures). Serious transport accidents associated with increased risks for people with epilepsy include pedestrian, bicycle, as well as car accidents. SUMMARY Individualized information on the risk of physical injuries and accidents should be part of counseling of patients with epilepsy. Improved seizure control is likely the most effective way to reduce risks, but work place and home adjustments should also be considered.
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Gutiérrez-Viedma Á, Sanz-Graciani I, Romeral-Jiménez M, Parejo-Carbonell B, Serrano-García I, Cuadrado ML, Aledo-Serrano Á, Gil-Nagel A, Toledano R, Pérez-De-Heredia-Torres M, Santamarina E, García-Morales I. Epidaily, a scale for comprehensive functional assessment of patients with epilepsy. Epilepsy Behav 2021; 114:107570. [PMID: 33234457 DOI: 10.1016/j.yebeh.2020.107570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and validate an epilepsy-specific scale for comprehensive functional assessment of patients with epilepsy, named Epidaily. METHODS The multidisciplinary research group created through brainstorming a list of 47 items to explore the cognitive, social, basic and instrumental functionality of the patient. A group of epilepsy experts independent of the research group evaluated the suitability of all the items, which then were selected and reviewed by the research group to conform the Epidaily scale. On a sample of 102 patients, a reliability analysis was performed, as well as a validation one using as reference scale the score on the Activities of Daily Living Questionnaire (ADLQ), which evaluates basic and instrumental functionality. RESULTS Epidaily consisted of 10 items distributed in four dimensions, with a possible score from 0 to 100 (perfect functionality). Inter-observer reliability was excellent, with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.97-0.99). Criterion validity was demonstrated by the high positive correlation of the Epidaily score with the ADLQ score (Spearman's rho coefficient 0.85, p < 0.001). Significant relation was found between ADLQ and Epidaily in the linear regression analysis (p < 001), which reported that Epidaily explains 85.5% of the variability of ADLQ (R-squared 0.85). Discriminant validity was also proved, as Epidaily allowed to classify epilepsy severity based on Cramer et al epilepsy severity classification. The median time to obtain the Epidaily score was 5 min (interquartile range 4-6). SIGNIFICANCE Epidaily is a brief and versatile scale, with excellent inter-observer reliability, which has been validated for comprehensive functional assessment of patients with epilepsy.
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Affiliation(s)
- Álvaro Gutiérrez-Viedma
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Servicio de Neurología, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.
| | - Isabel Sanz-Graciani
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - María Romeral-Jiménez
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Beatriz Parejo-Carbonell
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Irene Serrano-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Ángel Aledo-Serrano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Antonio Gil-Nagel
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Rafael Toledano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Viejo 100, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Marta Pérez-De-Heredia-Torres
- Unidad de Epilepsia, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Viejo 100, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Estevo Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Vall D́Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Irene García-Morales
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
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Mesraoua B, Deleu D, Hassan AH, Gayane M, Lubna A, Ali MA, Tomson T, Khalil BA, Cross JH, Asadi-Pooya AA. Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality. Curr Med Res Opin 2020; 36:1473-1480. [PMID: 32476500 DOI: 10.1080/03007995.2020.1776234] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Dirk Deleu
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Al Hail Hassan
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Melykian Gayane
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Alsheikh Lubna
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Torbjorn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bassel Abou Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Helen Cross
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
- Epilepsy Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Different modalities of invasive neurostimulation for epilepsy. Neurol Sci 2020; 41:3527-3536. [PMID: 32740896 DOI: 10.1007/s10072-020-04614-z] [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: 04/08/2020] [Accepted: 07/19/2020] [Indexed: 01/12/2023]
Abstract
Epilepsy affects 1% of the general population, about one-third of which is pharmacologically resistant. Uncontrolled seizures are associated with an increased risk of traumatic injury and sudden unexpected death of epilepsy. There is a considerable psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. Epilepsy surgery, when indicated, is the most promising cure for epilepsy. However, when surgery is contraindicated or refused by the patient, neurostimulation is an alternative palliative approach, albeit with a lower chance of entirely curing patients of seizures. There are many options for neurostimulation. The three most commonly used invasive neurostimulation procedures that consistently show evidence of being safe and efficacious are vagal nerve stimulation, responsive neuro stimulation, or anterior thalamic nucleus deep brain stimulation. The goal of this review is to summarize the current evidence supporting the use of these three techniques, which are approved by most regulatory bodies, and discuss different factors that may enable epilepsy surgeons to choose the most appropriate modality for each patient.
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Cainelli E, Di Giacomo DL, Mantegazza G, Vedovelli L, Favaro J, Boniver C. Prognostic role of Mini-Mental State Pediatric Examination (MMSPE) on neuropsychological functioning. Neurol Sci 2020; 41:619-623. [PMID: 31729580 DOI: 10.1007/s10072-019-04141-6] [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: 07/29/2019] [Accepted: 11/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the ability of the Mini-Mental State Pediatric Examinations (MMSPE) in the individuation of neuropsychological impairments. METHOD MMSPE was administered to 60 children attending a primary or lower secondary school suffering from neurological diseases, admitted to our neuropsychology services. All children performed both a MMSPE examination and a neuropsychological evaluation. Results of neuropsychological evaluation and MMSPE were dichotomized. Positive predictive value (PPV), negative predictive value (NPV), and accuracy were also calculated. RESULTS The diagnostic performance of MMSPE showed a good overall accuracy (0.83, CI 95% 0.64-0.91), NPV (0.81, CI 95% 0.73-1.00), PPV (0.87, CI 95% 0.68-0.94), specificity (0.91, CI 95% 0.81-1.00), sensitivity (0.74, CI 95% 0.57-0.90), and odds ratio of 28.5 (CI 95% 6.6-123), p < 0.001. CONCLUSIONS MMSPE has a good prognostic ability in predicting neuropsychological problems in the context of different neurological pediatric diseases. We suggest that this instrument could greatly improve pediatric clinical practice in identifying high-risk children.
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Affiliation(s)
- Elisa Cainelli
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35133, Padua, Italy. .,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy.
| | - Deborah Lidia Di Giacomo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | | | - Luca Vedovelli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Jacopo Favaro
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Clementina Boniver
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
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