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Daker LI, Sayed SS, Abdelghaffar M, Hamed AH, Aboelnor MI, El-Khatib MES. Could thalamic biochemical changes correlate to cognitive impairment in idiopathic generalized epilepsy? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00638-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Background
The thalamus is crucial in the development of idiopathic generalized epilepsy (IGE), which could lead to cognitive dysfunctions, according to data from neuropsychology and advanced neuroimaging investigations. This research aimed to measure the metabolic changes in the thalamus and to assess if could be contributed to cognitive impairment in IGE patients. Thirty IGE patients and thirty healthy volunteers with matched ages, genders, and educational levels participated in this cross-sectional case–control research. The IGE patients and controls were evaluated neuropsychologically using Intelligence Quotient (IQ) to assess general cognitive ability, Digit span for attention, Wechsler memory scale (WMS) for verbal memory, cube drawing test for visuospatial memory, Trail making test for executive functions, and Controlled Oral Word Association test (COWAT) for verbal fluency and quantitative multi-voxel MR spectroscopy (MRS) measurements of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), NAA/Cr, NAA/Cho and Cho/Cr ratios at 1.5 T scanner. The voxels were located over the right and left thalamus.
Results
The IGE patients showed worse cognitive performance in IQ, attention, executive function, and verbal and visuospatial memory domains compared to the controls. The IGE patients exhibited a significantly decrease NAA in the right thalamus (p = 0.004) and a lower NAA/Cr ratio in the left thalamus (p = 0.01). the mean thalamus NAA level exhibited a positive correlation with CDT (r = 0.45, p = P = 0.01), and WMS-R (r = 0.39, p = 0.03) and a negative correlation with trail-making A test (r = 0.42, P = 0.01).
Conclusions
it was concluded that IGE patients exhibited poor cognition which could be attributed to thalamic neurometabolic changes due to impaired thalamic cortical circuits.
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Meschede C, Witt J, Brömling S, Moskau‐Hartmann S, Rademacher M, Surges R, Wrede R, Helmstaedter C. Changes in cognition after introduction or withdrawal of zonisamide versus topiramate in epilepsy patients: A retrospective study using Bayes statistics. Epilepsia 2020; 61:1481-1490. [DOI: 10.1111/epi.16576] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Carolin Meschede
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | | | - Sarah Brömling
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | | | | | - Rainer Surges
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | - Randi Wrede
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
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Fonseca E, Guzmán L, Quintana M, Abraira L, Santamarina E, Salas-Puig X, Toledo M. Efficacy, retention, and safety of brivaracetam in adult patients with genetic generalized epilepsy. Epilepsy Behav 2020; 102:106657. [PMID: 31731108 DOI: 10.1016/j.yebeh.2019.106657] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy, tolerability, and retention of brivaracetam (BRV) in genetic generalized epilepsy (GGE) in real-life practice. METHODS This is a retrospective cohort study of adult patients with GGE in whom BRV was started between 2016 and 2018, completing a follow-up period of ≥6 months. Clinical and electroencephalogram (EEG) characteristics were analyzed at baseline and at follow-up as outcome measures. RESULTS Brivaracetam was started in 37 patients (mean age: 29.9 ± 12.3 years; 73% women). Juvenile myoclonic epilepsy was the most common syndrome (43.2%). The primary indications for starting BRV were lack of efficacy (51.4%) and adverse events (AEs) (27%) of other antiepileptic drugs (AEDs). In total, 32.4% of patients received BRV monotherapy. Retention rate at 6 months was 81.1%; 83.8% of patients were considered responders, and 62.2% achieved seizure freedom. The primary reasons for withdrawal were treatment-emergent adverse events (TEAEs, 57.1%) and lack of efficacy (42.9%). The higher number of prior AED use was a risk factor for a lack of response [median = 4 (interquartile range (IQR): 3-4) vs 2 (IQR: 1-3); p < 0.05]. Patients with a previous response to valproic acid tended to have a higher response rate to BRV (86.7% vs 50%, p = 0.169). Eighty-three point eight percent (83.8%) of previous levetiracetam (LEV) responders also showed a good response to BRV. In terms of patients who presented LEV-related AEs, AE resolution was observed in 79.8%, particularly with regard to psychiatric AEs. Follow-up EEGs were compared with baseline EEGs in 25 patients (67.6%) during follow-up. Most patients showed a reduction (52%) or no change (36%) in interictal epileptiform discharge (IED) frequency. SIGNIFICANCE Brivaracetam shows good responder and retention rates in GGE and is generally well tolerated. It is an appropriate alternative treatment for GGE, especially in refractory epilepsy and when other AEDs are not tolerated.
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Affiliation(s)
- Elena Fonseca
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Lorena Guzmán
- Neurophysiology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Xavier Salas-Puig
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
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