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Genetic generalized epilepsies in adults - challenging assumptions and dogmas. Nat Rev Neurol 2022; 18:71-83. [PMID: 34837042 DOI: 10.1038/s41582-021-00583-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/16/2023]
Abstract
Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15-20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizures alone. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Nevertheless, long-term follow-up studies have shown that with advancing age, many patients can discontinue their anti-seizure medication without seizure relapses. Several outcome predictors have been identified, but prognosis across the syndromes is more homogeneous than previously assumed. Overall, overlap in pathophysiology, seizure types, treatment responses and outcomes support the idea that GGEs are not separate nosological entities but represent a neurobiological continuum.
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Hermann BP, Struck AF, Busch RM, Reyes A, Kaestner E, McDonald CR. Neurobehavioural comorbidities of epilepsy: towards a network-based precision taxonomy. Nat Rev Neurol 2021; 17:731-746. [PMID: 34552218 PMCID: PMC8900353 DOI: 10.1038/s41582-021-00555-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this 'lesion model' has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.
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Affiliation(s)
- Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,
| | - Aaron F. Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Robyn M. Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anny Reyes
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Erik Kaestner
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R. McDonald
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
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Gesche J, Antonson S, Dreier JW, Christensen J, Beier CP. Social outcome and psychiatric comorbidity of generalized epilepsies - A case-control study. Epilepsia 2021; 62:1158-1169. [PMID: 33734434 DOI: 10.1111/epi.16870] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate social outcome and psychiatric comorbidity of patients with idiopathic/genetic generalized epilepsies (IGEs) and its subtypes (epilepsy with generalized tonic-clonic seizures alone [EGTCS], juvenile absence epilepsy [JAE], and juvenile myoclonic epilepsy [JME]). METHODS A cohort of 402 adult patients with IGE from the Danish island Funen was matched with 4020 randomly selected geography-, age-, and sex-matched controls via the Danish Civil Registration System. Based on register data, we compared social status measured by cohabitant status, educational attainment, income, affiliation to labor market, and psychiatric comorbidity. RESULTS As compared to controls, patients with IGE had similar cohabitant status but fewer children (no children: 59.0% vs 50.9%), and lower educational level (primary school only: 46.0% vs 37.3%), employment rate (outside of workforce: 56.7% vs 46.5%), and income (low income: 32.6% vs 24.9%) (P < 0.001 for all comparisons). Having IGE was associated with higher a proportion of psychiatric comorbidity (IGE, 22.6%; controls, 13.0%) (P < 0.001). Seizure-free patients did not differ from controls; patients with persistent seizures had lower incomes and employment rates. In the IGE subgroup analyses, JME was associated with worse social status in all parameters studied (eg, 65.9% of JME patients were outside the workforce vs 44.5% of matched controls; P < 0.001), whereas no adverse social status was identified in patients with EGTCS and JAE. SIGNIFICANCE Patients with IGE in general and JME in particular have poorer social status and more psychiatric comorbidity than matched population controls without epilepsy. Poor seizure control was associated with social status and may contribute to negative socioeconomic consequences associated with IGE.
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Affiliation(s)
- Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Sussie Antonson
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark.,Center for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Julie Werenberg Dreier
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark.,Center for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoph Patrick Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Abstract
PURPOSE OF REVIEW Psychiatric comorbidities are close to 5-times higher in children and youth with epilepsy (CYE) compared to general population. With epilepsy being one of the most common neurological disorders in children, we provide a timely review of psychiatric issues in CYE. RECENT FINDINGS A meta-analysis found a pooled prevalence of anxiety in 18.9% and depression in 13.5% of CYE. Attention deficit hyperactivity disorder (ADHD) is 2.5 to 5.5 times higher in CYE compared to healthy counterparts. Recent evidence highlights that behavioral adverse effects may lead to discontinuation of anti-epileptic drugs (AEDs) in more than 10% of CYE. Up to 70% CYE shows elevation in baseline psychological symptoms after AED initiation. Identifying psychiatric symptoms can be easily accomplished by the routine use of psychiatric screening instruments in CYE clinics, which is associated with improved health-related quality of life (HRQOL). Psychoeducation is a key component for any visit with CYE. There is some evidence of the effectiveness of behavioral psychological interventions for CYE. There are no therapeutic trials of psychotropics in CYE, but treatment recommendations based on the experience in adults with epilepsy and general population are applicable. Early diagnosis and management of psychiatric comorbidities leads to improvement in HRQOL of CYE. This requires routine screening and a multidisciplinary teamwork.
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Affiliation(s)
- Anjali Dagar
- Department of Psychiatry and Epilepsy, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, P57, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Tatiana Falcone
- Department of Psychiatry and Epilepsy, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, P57, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Nilo A, Gelisse P, Crespel A. Genetic/idiopathic generalized epilepsies: Not so good as that! Rev Neurol (Paris) 2020; 176:427-438. [DOI: 10.1016/j.neurol.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022]
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Gabriel D, Ventura M, Samões R, Freitas J, Lopes J, Ramalheira J, Martins da Silva A, Chaves J. Social impairment and stigma in genetic generalized epilepsies. Epilepsy Behav 2020; 104:106886. [PMID: 31931462 DOI: 10.1016/j.yebeh.2019.106886] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Patients with epilepsy have poor social outcome. Multifactorial factors are usually involved, but among them, stigma features may have an important role. Genetic generalized epilepsies (GGEs) were previously considered "benign" syndromes. The aim of our study was to assess social impairment and stigma in GGE and to evaluate differences between the following GGE subsyndromes: juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and generalized tonic-clonic seizures alone (GTCSA). Additionally, we compared these outcomes with outcomes from a cohort of patients with epilepsy with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), a severe and difficult-to-treat syndrome. Results were compared with social data from the general population. METHODS Adult patients with epilepsy with a previously classified GGE or MTLE-HS were consecutively invited to fill in a sociodemographic and stigma questionnaire in outpatient clinic. Clinical data and psychiatric comorbidities were retrieved from clinical notes. RESULTS Questionnaires from 333 patients were obtained: 226/67% from patients with GGE (JME: 106/31.8%, GTCSA: 74/22.2%, and JAE: 46/13.8%) and 107/32.1% from patients with MTLE-HS. We found that patients with GGE have a good academic achievement but they have increased difficulties in finding a partner, higher rates of divorce, and a reduced number of children per woman and per man when compared with general population. We also observed that patients with GGE have higher rates of unemployment (22.6%) and lower monthly income than general population. Severe problems in housing were only seen in GGEs. Of these, 3 patients (1.3%) were in homeless condition. Over half (52%) of patients with MTLE-HS and over a quarter (28%) of patients with GGE experienced felt stigma. Psychiatric comorbidity was highly prevalent among GGE (34.1%), especially in patients with refractory epilepsy. Mood and anxiety disorders were the most prevalent conditions. No other significant differences were found between GGE subsyndromes. DISCUSSION We found an impairment in every social domain assessed (except in level of education) when compared with general population. Most of the social outcome parameters were unexpectedly close or similar to MTLE-HS or even worse as it was the prevalence of homelessness among GGE. Social impairment is underdiagnosed and might be considered in clinical practice even in syndromes for some time considered benign such as GGE.
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Affiliation(s)
- Denis Gabriel
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Magda Ventura
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Raquel Samões
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Joel Freitas
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - João Lopes
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - João Ramalheira
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - António Martins da Silva
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - João Chaves
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Parsons N, Bowden SC, Vogrin S, D’Souza WJ. Default mode network dysfunction in idiopathic generalised epilepsy. Epilepsy Res 2020; 159:106254. [DOI: 10.1016/j.eplepsyres.2019.106254] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/13/2019] [Accepted: 12/07/2019] [Indexed: 12/14/2022]
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Fonseca Wald ELA, Hendriksen JGM, Drenthen GS, Kuijk SMJV, Aldenkamp AP, Vles JSH, Vermeulen RJ, Debeij-van Hall MHJA, Klinkenberg S. Towards a Better Understanding of Cognitive Deficits in Absence Epilepsy: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2019; 29:421-449. [PMID: 31776780 PMCID: PMC6892766 DOI: 10.1007/s11065-019-09419-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
Cognition in absence epilepsy (AE) is generally considered undisturbed. However, reports on cognitive deficits in AE in recent years have suggested otherwise. This review systematically assesses current literature on cognitive performance in children with AE. A systematic literature search was performed in Pubmed, Embase, Cochrane and Web of Science. All studies reporting on cognitive performance in children with AE were considered. In total 33 studies were eligible for inclusion. Neuropsychological tests were classified into the following domains: intelligence; executive function; attention; language; motor & sensory-perceptual examinations; visuoperceptual/visuospatial/visuoconstructional function; memory and learning; achievement. Random-effect meta-analyses were conducted by estimating the pooled mean and/or pooling the mean difference in case-control studies. Full-scale IQ in children with AE was estimated at 96.78 (95%CI:94.46–99.10) across all available studies and in case-control studies IQ was on average 8.03 (95%CI:-10.45- -5.61) lower. Verbal IQ was estimated at 97.98 (95%CI:95.80–100.16) for all studies and 9.01 (95%CI:12.11- -5.90) points lower in case-control studies. Performance IQ was estimated at 97.23 (93.24–101.22) for all available studies and 5.32 (95%CI:-8.27–2.36) points lower in case-control studies. Lower performance was most often reported in executive function (cognitive flexibility, planning, and verbal fluency) and attention (sustained, selective and divided attention). Reports on school difficulties, neurodevelopmental problems, and attentional problems were high. In conclusion, in contrast to common beliefs, lower than average neurocognitive performance was noted in multiple cognitive domains, which may influence academic and psychosocial development.
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Affiliation(s)
- Eric L A Fonseca Wald
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands. .,Epilepsy Center Kempenhaeghe, Heeze, The Netherlands. .,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Jos G M Hendriksen
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Gerald S Drenthen
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sander M J V Kuijk
- Department of KEMTA, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Albert P Aldenkamp
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center+, 6202, AZ, Maastricht, The Netherlands. .,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
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Huang P, Zheng-Dao D, Sun BM, Pan YX, Zhang J, Wang T, Liu W, Jin HY, Zhan SK. Bilateral anterior capsulotomy enhances medication compliance in patients with epilepsy and psychiatric comorbidities. CNS Neurosci Ther 2019; 25:824-831. [PMID: 30868752 PMCID: PMC6630004 DOI: 10.1111/cns.13118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives Patients with epilepsy and refractory comorbid psychiatric disorders often experience functional impairments and a lower quality of life as well as showing a lack of compliance with anti‐epileptic medication regimens. We reasoned that widespread clinical benefits could be gained if the psychiatric comorbidities among these patients were reduced. In this study, we assessed the utility of anterior capsulotomy in managing medication‐refractory comorbid psychotic symptoms and aggression in patients with epilepsy. Methods In this retrospective case series, we evaluated the clinical outcomes of 13 epilepsy patients with severe psychiatric comorbidities who had received bilateral anterior capsulotomy. Clinical outcome assessments were performed at 1 week, 6 months, 1 year, and several years after surgery focusing on: (a) severity of psychotic symptoms, as assessed by the 18‐item Brief Psychiatric Rating Scale and the Positive and Negative Syndrome Scale; (b) severity of impulsivity and aggression, measured by the Barratt Impulsiveness Scale‐11 and the Buss‐Perry Aggression Scale; and (c) social function and quality of life, assessed by the Social Disability Screening Scale and the Quality of Life in Epilepsy. Results After anterior capsulotomy, patients displayed significant improvements of psychotic symptoms, as well as of impulsivity and aggression, along with improvements of social function and quality of life. The clinical benefits to patients were evident within 6 months after surgery and remained stable or continued to improve at a much slower rate thereafter. Furthermore, after anterior capsulotomy all patients complied with epilepsy interventions that they did not comply with prior to surgery. No significant side effects or complications occurred during the study. Conclusion Anterior capsulotomy seems to be a safe and effective treatment for epilepsy patients with otherwise intractable comorbid psychotic symptoms and aggression. Moreover, this neurosurgical treatment may improve the patients' social function, quality of life, and compliance with anti‐epilepsy medication regimens.
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Affiliation(s)
- Peng Huang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deng Zheng-Dao
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo-Min Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Xin Pan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Liu
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Yan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Kun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang Y, Berglund IS, Uppman M, Li TQ. Juvenile myoclonic epilepsy has hyper dynamic functional connectivity in the dorsolateral frontal cortex. Neuroimage Clin 2018; 21:101604. [PMID: 30527355 PMCID: PMC6412974 DOI: 10.1016/j.nicl.2018.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/20/2018] [Accepted: 11/18/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Characterize the static and dynamic functional connectivity for subjects with juvenile myoclonic epilepsy (JME) using a quantitative data-driven analysis approach. METHODS Whole-brain resting-state functional MRI data were acquired on a 3 T whole-body clinical MRI scanner from 18 subjects clinically diagnosed with JME and 25 healthy control subjects. 2-min sliding-window approach was incorporated in the quantitative data-driven data analysis framework to assess both the dynamic and static functional connectivity in the resting brains. Two-sample t-tests were performed voxel-wise to detect the differences in functional connectivity metrics based on connectivity strength and density. RESULTS The static functional connectivity metrics based on quantitative data-driven analysis of the entire 10-min acquisition window of resting-state functional MRI data revealed significantly enhanced functional connectivity in JME patients in bilateral dorsolateral prefrontal cortex, dorsal striatum, precentral and middle temporal gyri. The dynamic functional connectivity metrics derived by incorporating a 2-min sliding window into quantitative data-driven analysis demonstrated significant hyper dynamic functional connectivity in the dorsolateral prefrontal cortex, middle temporal gyrus and dorsal striatum. Connectivity strength metrics (both static and dynamic) can detect more extensive functional connectivity abnormalities in the resting-state functional networks (RFNs) and depict also larger overlap between static and dynamic functional connectivity results. CONCLUSION Incorporating a 2-min sliding window into quantitative data-driven analysis of resting-state functional MRI data can reveal additional information on the temporally fluctuating RFNs of the human brain, which indicate that RFNs involving dorsolateral prefrontal cortex have temporal varying hyper dynamic characteristics in JME patients. Assessing dynamic along with static functional connectivity may provide further insights into the abnormal function connectivity underlying the pathological brain functioning in JME.
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Affiliation(s)
- Yanlu Wang
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Sweden.
| | - Ivanka Savic Berglund
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Sweden; Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Martin Uppman
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Tie-Qiang Li
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Sweden
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Analysis of fractional anisotropy and mean diffusivity in refractory and non-refractory idiopathic generalized epilepsies. Seizure 2018; 62:33-37. [DOI: 10.1016/j.seizure.2018.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/16/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022] Open
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van der Veen S, Zutt R, Elting JWJ, Becker CE, de Koning TJ, Tijssen MAJ. Progressive myoclonus ataxia: Time for a new definition? Mov Disord 2018; 33:1281-1286. [PMID: 30145808 PMCID: PMC6175171 DOI: 10.1002/mds.27412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/25/2018] [Accepted: 03/29/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clinical demarcation of the syndrome progressive myoclonus ataxia is unclear, leading to a lack of recognition and difficult differentiation from other neurological syndromes. OBJECTIVES The objective of this study was to apply a refined definition of progressive myoclonus ataxia and describe the clinical characteristics in patients with progressive myoclonus ataxia and with isolated cortical myoclonus. METHODS A retro- and prospective analysis was performed in our tertiary referral center between 1994 and 2014. Inclusion criteria for progressive myoclonus ataxia patients were the presence of myoclonus and ataxia with or without infrequent (all types, treatment responsive) epileptic seizures. Inclusion criteria for isolated cortical myoclonus was the presence of isolated cortical myoclonus. Clinical and electrophysiological characteristics data were systematically scored. RESULTS A total of 14 progressive myoclonus ataxia patients (males, 7; females, 7), median age 14.5 years, and 8 isolated cortical myoclonus patients (males, 2; females, 6), median age 23.5 years, were identified. In 93% of the progressive myoclonus ataxia patients, ataxia started first (median 2 years) followed by myoclonus (4 years) and finally infrequent epilepsy (9.3 years), with a progressive course in 93%. In 64% of the progressive myoclonus ataxia patients, a genetic underlying etiology was identified, including 3 not earlier reported causative progressive myoclonus ataxia genes. In isolated cortical myoclonus patients, myoclonus started at (median) 12 years with progression over time in 63% and a single epileptic seizure in 1 patient. No genetic causes were identified. CONCLUSION Using a refined definition, we could create a rather homogenous progressive myoclonus ataxia group. Patients with isolated cortical myoclonus have a different course and do not appear to evolve in progressive myoclonus ataxia. The refined progressive myoclonus ataxia definition is a successful first step toward creating a separate syndrome for both clinical practice and future genetic research. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sterre van der Veen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Rodi Zutt
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.,Haga Ziekenhuis (Haga Hospital), Department of Neurology, The Hague, The Netherlands
| | - Jan Willem J Elting
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Charlotte E Becker
- European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Tom J de Koning
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, The Netherlands
| | - Marina A J Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
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13
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Use of primary healthcare for persons with epilepsy. Epilepsy Behav 2018; 80:285-290. [PMID: 29415870 DOI: 10.1016/j.yebeh.2018.01.014] [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] [Received: 08/24/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In Denmark, care and treatment related to epilepsy primarily takes place at specialized hospital departments (neurology and pediatrics). The general practitioner (GP) in contrast is the primary contact and acts as a gatekeeper to the healthcare system for other disorders. The aim of the present study was to describe the utilization of services provided by the GP for children with epilepsy before and after diagnosis of epilepsy and to compare it with that of children without epilepsy. METHODS All live born children born in Denmark between 1st of January 1996 and 1st of December 2013 were identified in the Danish National Patient Registry. Information about number and type of contact to the general practitioner was obtained from the Health Insurance Service Register. Information about epilepsy was obtained from the Danish National Patient Registry (n=10,062). For each child with epilepsy, we sampled 10 children without an epilepsy diagnosis matched on sex and age at the time of diagnosis (n=100,620). Children were followed up until 31st of December 2013. Multiple negative binomial regression analysis adjusting for relevant confounders was used to estimate the association between epilepsy and the use of GPs both before and after the time of epilepsy diagnosis. RESULTS Children with epilepsy had a higher utilization of services provided by the GP after the diagnosis of epilepsy compared with children without epilepsy (incidence rate ratio (IRR): 1.64 (1.61-1.67)). The IRR for any contacts stayed relatively stable during the follow-up period, whereas the IRR for face-to-face contacts tended to decline and phone contacts tended to increase. The more frequent GP contacts in children with epilepsy were also evident before the time of diagnosis and for both sexes and in all age groups. For the specific services provided, children with epilepsy more often had a blood sample taken and more urine stix and CRP tests performed during the first years following diagnosis. CONCLUSION Children with epilepsy have a higher use of services provided by the GP both before and after the epilepsy diagnosis compared with children without epilepsy. This is likely due to a higher prevalence of comorbid conditions in children with epilepsy as well as consequences of the underlying condition.
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Loughman A, Bowden SC, D'Souza WJ. Self and informant report ratings of psychopathology in genetic generalized epilepsy. Epilepsy Behav 2017; 67:13-19. [PMID: 28086188 DOI: 10.1016/j.yebeh.2016.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/23/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
The psychological sequelae of genetic generalized epilepsies (GGE) is of growing research interest, with up to a third of all adults with GGE experiencing significant psychiatric comorbidity according to a recent systematic review. A number of unexplored questions remain. Firstly, there is insufficient evidence to determine relative prevalence of psychopathology between GGE syndromes. Secondly, the degree to which self-report and informant-report questionnaires accord in adults with epilepsy is unknown. Finally, while epilepsy severity is one likely predictor of worse psychopathology in GGE, evidence regarding other possible contributing factors such as epilepsy duration and antiepileptic drugs (AEDs) has been equivocal. The potential impact of subclinical epileptiform discharges remains unexplored. Self-report psychopathology symptoms across six DSM-Oriented Subscales were prospectively measured in 60 adults with GGE, with informant-report provided for a subset of 47. We assessed the burden of symptoms from both self- and informant-report, and the relationship between clinical epilepsy variables and self-reported symptoms. Results showed elevated symptoms in almost half of the sample overall. Depression and anxiety were the most commonly reported types of symptoms. There was a trend towards greater symptoms endorsement by self-report, and relatively modest interrater agreement. Symptoms of ADHD were significantly positively associated with number of AEDs currently prescribed. Other psychopathology symptoms were not significantly predicted by epilepsy duration, seizure-free duration or total duration of epileptiform discharges over a 24-hour period. The high prevalence of psychological needs suggests that routine screening of psychopathology and provision of psychoeducation may be essential to improving patient care and outcomes. Further investigation is required to better understand predictive and causal factors for psychopathology in GGE.
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Affiliation(s)
- Amy Loughman
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia; School of Health & Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia.
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia; Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
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Loughman A, Bowden SC, D'Souza WJ. A comprehensive assessment of cognitive function in the common genetic generalized epilepsy syndromes. Eur J Neurol 2016; 24:453-460. [DOI: 10.1111/ene.13232] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/24/2016] [Indexed: 11/25/2022]
Affiliation(s)
- A. Loughman
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria
- School of Health and Biomedical Sciences; RMIT University; Bundoora Victoria
| | - S. C. Bowden
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria
- Department of Clinical Neurosciences; St Vincent's Hospital Melbourne; Fitzroy Victoria
| | - W. J. D'Souza
- Department of Medicine; St Vincent's Hospital; The University of Melbourne; Fitzroy Victoria Australia
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A Parallel-Column LC–MS/MS Method for High-Throughput Analysis of Eight Antiepileptic Drugs in Clinical Therapeutic Drug Monitoring. Chromatographia 2016. [DOI: 10.1007/s10337-016-3196-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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