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Goenka A, Reyes I, Fonseca LD, George MC, Stolfi A, Kumar G. Staring Spells: An Age-based Approach Toward Differential Diagnosis. J Child Neurol 2022; 38:64-77. [PMID: 36373696 DOI: 10.1177/08830738221134552] [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] [Indexed: 11/15/2022]
Abstract
Evaluations to rule out epileptic vs nonepileptic staring spells may entail unnecessary evaluations that can be costly and time consuming. Our study aims to identify common etiologies for staring spells across 3 different pediatric age groups and to propose an age-based clinical guidance to help determine which patients warrant further workup. Methods: This was a single-center retrospective chart analysis of 1496 patients aged 0.0-17.9 years presenting with confirmed staring spell diagnosis from January 2011 to January 2021. The patients were divided into 3 groups based on their age: 0.0-2.9, 3.0-12.9, and 13.0-17.9 years. Patient information collected included demographics, clinical presentation, comorbidities, and final diagnosis. Multilevel likelihood ratios and a receiver operating characteristic curve were determined using 8 of the 11 clinical variables. A total of 1142 patients who met the inclusion criteria were included for the final analysis. The most common final diagnosis was attention-deficit hyperactivity disorder (ADHD) (35%), followed by normal behavior (33%). Generalized and focal epilepsy were diagnosed in 8% and 4% of the patients, respectively. In the 0.0-2.9-year age group, normal behavior was the final diagnosis in 72% patients. In the 3.0-12.9-year and 13.0-17.9-year age groups, ADHD was the most frequent final diagnosis in 46% and 60%, respectively. Overall, ADHD and normal behaviors remain the most common final diagnoses. Multilevel likelihood ratios can be used to develop an age-based guidance to differentiate between epileptic and nonepileptic staring spell diagnoses.
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Affiliation(s)
- Ajay Goenka
- Department of Neurology, 2828Dayton Children's Hospital, Dayton, OH, USA.,Department of Pediatrics, 2829Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Irma Reyes
- Department of Neurology, 2828Dayton Children's Hospital, Dayton, OH, USA
| | - Laura D Fonseca
- Department of Neurology, 2828Dayton Children's Hospital, Dayton, OH, USA
| | - Monica C George
- Department of Pediatrics, 2829Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Adrienne Stolfi
- Department of Pediatrics, 2829Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Gogi Kumar
- Department of Neurology, 2828Dayton Children's Hospital, Dayton, OH, USA.,Department of Pediatrics, 2829Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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2
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Stödberg T, Tomson T, Anderlid BM, Andersson T, Henry O, Åmark P, Wedell A. Outcome at age 7 of epilepsy presenting in the first 2 years of life. A population-based study. Epilepsia 2022; 63:2096-2107. [PMID: 35652437 PMCID: PMC9544859 DOI: 10.1111/epi.17314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Objective Existing data suggest that epilepsy presenting in the first few years of life carries a worse prognosis than later onset. However, studies are few and methods differ, making interpretations of data uncertain. This study analyzes outcome at age 7 and potential prognostic factors in a well‐characterized population‐based cohort with epilepsy onset during the first 2 years of life. Methods An incidence cohort of 116 prospectively identified cases of epilepsy with seizure onset before age 2 years was described in Stödberg et al. (2020). Cases were originally retrieved from the Stockholm Incidence Registry of Epilepsy (SIRE), which registered all cases with a first unprovoked epileptic seizure from September 1, 2001, in Northern Stockholm. Data on treatment and outcome at age 7 years were collected from electronic medical records and through interviews with parents. Outcome and potential prognostic factors were analyzed with descriptive statistics and multivariable log binomial regression analysis. Results Eleven children (9.5%) died before age 7. Polytherapy was common. Epilepsy surgery was performed in two children. At age 7 years, 61 of 116 children (53%) had been seizure‐free for the last 2 years or longer. Intellectual disability was diagnosed in 57 of 116 children (49%), autism spectrum disorder in 13 (11%), and cerebral palsy in 28 (24%). West syndrome had a similar seizure remission rate but a worse cognitive outcome. There was no difference in outcome between first and second year onset. Six predictors, including etiology, remained associated with two or more outcome variables after regression analysis. Significance About half of children with infantile‐onset epilepsy will become seizure‐free and half of them will have intellectual disability. Etiology was confirmed as a major independent predictor of outcome. Our study contributes to a more firm knowledge base when counseling parents of infants diagnosed with epilepsy.
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Affiliation(s)
- Tommy Stödberg
- Department of Women's and Children`s Health, Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Britt-Marie Anderlid
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Andersson
- Institute of Environmental Medicine, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm Regional Council
| | - Olivia Henry
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per Åmark
- Department of Women's and Children`s Health, Karolinska Institute, Stockholm, Sweden
| | - Anna Wedell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
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3
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What are the Risk Factor for Epilepsy Among Patients With Craniosynostosis? J Oral Maxillofac Surg 2022; 80:1191-1197. [DOI: 10.1016/j.joms.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 01/22/2023]
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Idris A, Alabdaljabar MS, Almiro A, Alsuraimi A, Dawalibi A, Abduljawad S, AlKhateeb M. Prevalence, incidence, and risk factors of epilepsy in arab countries: A systematic review. Seizure 2021; 92:40-50. [PMID: 34418747 DOI: 10.1016/j.seizure.2021.07.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/03/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the prevalence, incidence, and risk factors of epilepsy in Arab countries. METHODS In this systematic review, electronic databases including PubMed, ProQuest Public Health and Cochrane Library were searched to identify relevant English articles published until April 2020. The search was conducted to cover all 22 Arab countries. Studies were eligible for inclusion if they assessed any of these epidemiological parameters of epilepsy: prevalence, incidence, and/or risk factors and focused on at least one of the Arab countries. The quality of the studies was evaluated using standardized quality assessment tools. RESULTS Twenty-nine articles met the inclusion criteria. Out of the 22 Arab countries, only 11 were found to have published studies reporting on the epidemiology of epilepsy. The median lifetime prevalence of epilepsy in Arab countries was found to be 6.9 per 1000. The median incidence is 89.5 per 100000. The most frequently identified risk factors were parental consanguinity, family history of epilepsy, and a history of perinatal infections/insults. CONCLUSION The prevalence and incidence of epilepsy varies in Arab countries. The most frequently reported risk factor is parental consanguinity. The lack of epidemiological studies on epilepsy in half of the Arab countries calls for more studies on this aspect to identify the burden and risk factors of epilepsy in this region.
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Affiliation(s)
- Anas Idris
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Alyaman Almiro
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Anas Alsuraimi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmad Dawalibi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Mashael AlKhateeb
- Department of Neurosciences, King Faisal Specialty Hospital, and Research Center, Riyadh, Saudi Arabia.
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Al Habbal A, AlSharif A, Almubark A, Fattouh H, Hamzeh G, Kakaje A. Risk factors associated with epilepsy in children and adolescents: A case-control study from Syria. Epilepsy Behav 2021; 114:107596. [PMID: 33246894 DOI: 10.1016/j.yebeh.2020.107596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Epilepsy is a major public health concern in low-income countries (LIC) as they contain 80% of total cases worldwide. Syria has been in war since 2011 which made it difficult to prevent epilepsy risk factors which made this the first study on that matter. METHODS This is a case-control study from 3 medical centers in Damascus, Syria. Data were collected using questionnaires introduced by trained doctors. The control group included patients from a general practice clinic while the cases were taken from the three pediatric neurology clinics. RESULTS The sample consisted of 334 patients with 167 cases and 167 controls. Multivariable analysis confirmed the association between positive family history (FH) in 1st degree (OR, 3.37, 95%CI 1.2-9.47) and 2nd degree relatives (OR, 3.98, 95%CI 1.84-8.62), febrile seizures whether they were simple (OR, 15.08, 95%CI 3.27-69.5) or complex (OR, 13.32, 95%CI 1.58-112.32), developmental delay/regression (OR, 14.31, 95%CI 6.3-32.49), and central nervous system (CNS) infection (OR, 34.05, 95%CI 2.02-573.92). Head trauma, parental factors, consanguinity, asphyxia parameters, and other risk factors were not found to be significantly associated with epilepsy (P > 0.05). CONCLUSION While some results were similar to other studies, others were not. Efforts should be made to facilitate healthcare access and proper diagnosis.
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Affiliation(s)
| | | | - Amjad Almubark
- Neurology Department, Children's University Hospital, Damascus, Syria
| | | | - Ghassan Hamzeh
- Neurology Department, Al Assad University Hospital, Damascus, Syria
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Clinico-etiological Profile and Developmental Status of Infants Aged 1-24 months with Epilepsy. Indian J Pediatr 2019; 86:681-685. [PMID: 30976964 DOI: 10.1007/s12098-019-02943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To study the clinico-etiological profile of epilepsy in children aged 1-24 mo attending a tertiary-care public hospital. METHODS All infants aged 1-24 mo with epilepsy (as per International League Against Epilepsy, 2014) presenting between April 2016 and March 2017 were enrolled. Detailed history and examination were done in all children, and developmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Electroencephalography and neuroimaging (CT/MRI) were done for all subjects. RESULTS Sixty children (39 males) were consecutively enrolled after informed written consent. The mean (SD) age at seizure onset was 4.3 (4.14) mo. Perinatal asphyxia (45%) and malformations of cortical development (18.3%) were the commonest etiologies. Neurological examination was abnormal in 68.3%, and a neuroimaging abnormality was present in 76% of children. Fifteen patients (25%) had West syndrome, which was symptomatic in the majority (73.3%). Developmental delay (DQ < 70) was the commonest co-morbidity (81.7%); 28.3% had profound delay. Odds of having developmental delay were 13-times higher in those with an abnormal neurological examination [OR 13.5 (2.82-64.67), P = 0.001], and nearly 9-times higher with abnormal neuroimaging [OR 8.9 (2.11-37.9), P = 0.003]. CONCLUSIONS Epilepsy in children <2 y is symptomatic in the majority, with sequelae of birth asphyxia as the commonest etiology. High prevalence of co-morbid developmental delay underscores the need for routine evaluation and early intervention in all high-risk infants.
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Walsh S, Donnan J, Fortin Y, Sikora L, Morrissey A, Collins K, MacDonald D. A systematic review of the risks factors associated with the onset and natural progression of epilepsy. Neurotoxicology 2017; 61:64-77. [DOI: 10.1016/j.neuro.2016.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 01/08/2023]
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Wilmshurst JM, Gaillard WD, Vinayan KP, Tsuchida TN, Plouin P, Van Bogaert P, Carrizosa J, Elia M, Craiu D, Jovic NJ, Nordli D, Hirtz D, Wong V, Glauser T, Mizrahi EM, Cross JH. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia 2015; 56:1185-97. [PMID: 26122601 DOI: 10.1111/epi.13057] [Citation(s) in RCA: 241] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
Evidence-based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or "state of the art" interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video-EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile-onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide, valproate, bromide, and the ketogenic diet are possibly effective; and for Ohtahara syndrome, there is weak evidence that most antiepileptic drugs are poorly effective. For epileptic spasms, clinical suspicion remains central to the diagnosis and is supported by EEG, which ideally is prolonged (level C recommendation). Adrenocorticotropic hormone (ACTH) is preferred for short-term control of epileptic spasms (level B recommendation), oral steroids are probably effective in short-term control of spasms (level C recommendation), and a shorter interval from the onset of spasms to treatment initiation may improve long-term neurodevelopmental outcome (level C recommendation). The ketogenic diet is the treatment of choice for epilepsy related to glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency (expert opinion, level U recommendation). The identification of patients as potential candidates for epilepsy surgery should be part of standard practice at primary and secondary level care. Tertiary care facilities with experience in epilepsy surgery should undertake the screening for epilepsy surgical candidates (level U recommendation). There is insufficient evidence to conclude if there is benefit from vagus nerve stimulation (level U recommendation). The key recommendations are summarized into an executive summary. The full report is available as Supporting Information. This report provides a comprehensive foundation of an approach to infants with seizures, while identifying where there are inadequate data to support recommended practice, and where further data collection is needed to address these deficits.
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Affiliation(s)
- Jo M Wilmshurst
- Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - William D Gaillard
- Pediatrics and Neurology, Division Epilepsy and Neurophysiology, Comprehensive Pediatric Epilepsy Program, George Washington University, Washington, District of Columbia, U.S.A
| | | | - Tammy N Tsuchida
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia, U.S.A
| | - Perrine Plouin
- Clinical Neurophysiology Department, INSERM U663, Hospital for Sick Children, Paris, France
| | - Patrick Van Bogaert
- Paediatric Neurology, Department of Pediatrics, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jaime Carrizosa
- Pediatric Department Child Neurology Service, University of Antioquia, Medellín, Colombia
| | - Maurizio Elia
- Unit of Neurology and Clinical Neurophysiopathology, IRCCS Italy Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, EN, Italy
| | - Dana Craiu
- Department of Neurology, Pediatric Neurology, Psychiatry, Neurosurgery, "Carol Davila" University of Medicine Bucharest, Bucharest, Romania.,"Alexandru Obregia" Clinical Hospital, Bucharest, Romania
| | - Nebojsa J Jovic
- Neurology, Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Doug Nordli
- Epilepsy Center, Children's Memorial Hospital, Chicago, Illinois, U.S.A
| | - Deborah Hirtz
- Office of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, Maryland, U.S.A
| | - Virginia Wong
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,Division of Paediatric Neurology/Developmental Behavioural Paediatrics/NeuroHabilitation, Duchess of Kent Children Hospital, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Tracy Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Eli M Mizrahi
- Peter Kellaway Section of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, Texas, U.S.A.,Section of Pediatric Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, U.S.A
| | - J Helen Cross
- Childhood Epilepsy, Paediatric Neurology, UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, NHS Foundation Trust, London, United Kingdom
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Wilmshurst JM, Burman R, Gaillard WD, Cross JH. Treatment of infants with epilepsy: Common practices around the world. Epilepsia 2015; 56:1033-46. [DOI: 10.1111/epi.13003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 01/25/2023]
Affiliation(s)
- Jo M. Wilmshurst
- Department of Pediatric Neurology; Red Cross War Memorial Children's Hospital; University of Cape Town; Cape Town South Africa
| | - Richard Burman
- Department of Pediatric Neurology; Red Cross War Memorial Children's Hospital; University of Cape Town; Cape Town South Africa
| | - William D. Gaillard
- Center for Neuroscience, Children's National Medical Center; George Washington University; Washington District of Columbia U.S.A
| | - J. Helen Cross
- UCL-Institute of Child Health; Great Ormond Street Hospital for Children NHS Foundation Trust; London United Kingdom
- Young Epilepsy; Lingfield United Kingdom
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Bhalla D, Tchalla AE, Marin B, Ngoungou EB, Tan CT, Preux PM. Epilepsy: Asia versus Africa. Epilepsia 2014; 55:1317-21. [PMID: 25092379 DOI: 10.1111/epi.12629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2014] [Indexed: 11/27/2022]
Abstract
Is epilepsy truly an "African ailment"? We aimed to determine this, since international health agencies often refer to epilepsy as an African disease and the scientific literature has spoken the same tone. Various published materials, mainly reports, articles, were used to gather Asian and African evidence on various aspects of epilepsy and many of its risk and associated factors. Our results suggest that in no way can epilepsy be considered as an African ailment and such characterization is most likely based on popular beliefs rather than scientific evidence. In comparison to Africa, Asia has a 5.0% greater burden from all diseases, and is 17.0% more affected from neuropsychiatric disorders (that include epilepsy). Given that more countries in Asia are transitioning, there may be large demographic and lifestyle changes in the near future. However these changes are nowhere close to those expected in Africa. Moreover, 23 million Asians have epilepsy in comparison to 3.3 million Africans and 1.2 million sub-Saharan Africans. In comparison to Africa, Asia has more untreated patients, 55.0% more additional epilepsy cases every year, because of its larger population, with greater treatment cost and possibly higher premature mortality. Of several associated factors discussed herein, many have more importance for Asia than Africa. The current state of epilepsy in Asia is far less than ideal and there is an urgent need to recognize and accept the importance of epilepsy in Asia. In no way can epilepsy be considered as an African ailment. This is most likely based on popular beliefs rather than scientific evidence. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Affiliation(s)
- Devender Bhalla
- Tropical Neuroepidemiology, INSERM UMR1094, Limoges, France; School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, CNRS FR 3503 GEIST, Limoges, France; Dupuytren Hospital, Unit of Geriatry and Home-Based Care, University Hospital Center of Limoges, Limoges, France
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Benjamin T, Hines KA, Khozaim K, Schubert FP. Recurrent fetal seizures diagnosed in the offspring of consanguineous parents. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2014-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Fetal seizures are relatively rare and most often associated with anomalies or adverse neonatal outcome. We describe a patient who presented in both her G1 and G2 pregnancies with fetal seizures. The second pregnancy was a twin gestation in which only one twin was affected. The fetal seizures were noted by the patient as “extreme rhythmic movement” and were observed on ultrasound. Both neonates were diagnosed with a seizure disorder within 1 day of life. Currently, the seizures are controlled by medication; however, both children have some developmental delay. Additionally, the patient and her partner are consanguineous, suggesting a likely genetic etiology. In utero diagnosis of fetal seizures warrants a multidisciplinary approach to attempt to further define prognosis and provide appropriate treatment and counseling.
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Affiliation(s)
- Tara Benjamin
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Obstetrics and Gynecology, Indiana University Hospital, 550 North University Blvd, Suite 2405, Indianapolis, IN 46202, USA
| | - Karrie A. Hines
- Maternal Fetal Medicine, Indiana University Health, Indianapolis, IN, USA
| | - Kareem Khozaim
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frank P. Schubert
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
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Masri A, Hamamy H. Clinical and inheritance profile of familial childhood epilepsy in Jordan. Seizure 2013; 22:443-51. [PMID: 23522625 DOI: 10.1016/j.seizure.2013.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/18/2013] [Accepted: 02/27/2013] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To present the clinical profiles and inheritance patterns of familial childhood epilepsy in the highly consanguineous population of Jordan. METHODS This retrospective study examined children diagnosed with epilepsy and having at least one epileptic parent or sibling. The epilepsy type was classified according to the criteria of the International League Against Epilepsy. Patients were monitored for a period of 6 months to 5 years. RESULTS The study population included 39 children belonging to 31 families; 21 boys (53.8%) and 18 girls (46.2%). The age at onset ranged from one month to 16 years. Generalized seizures were observed in 23 patients (58.9%), partial seizures in 14 patients (35.8%); and generalized and partial seizures in two patients (5.1%). Seizure control was achieved in 33 patients (84.6%), and 13 patients (33.3%) were seizure-free for at least two years. Withdrawal of antiepileptic medication was successful in five of these 13 patients (38.5%), while seizures recurred in the other eight (61.5%) on withdrawal. The consanguinity rate among parents of affected children was 61.3%. Pedigree analysis suggested probable autosomal dominant (AD) inheritance with or without reduced penetrance in 13 families (41.9%), probable autosomal recessive (AR) inheritance in 6 families (19.4%), and an X-linked recessive inheritance (XR) in one family. CONCLUSIONS This is the first report on familial epilepsy involving first degree relatives in Jordan. Genetic testing including exome sequencing could help in reaching the accurate diagnosis and may also reveal novel autosomal recessive genes associated with pediatric idiopathic epilepsy.
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Affiliation(s)
- Amira Masri
- Child Neurology, Department of Pediatrics, Division of Child Neurology, Faculty of Medicine, The University of Jordan, Amman, Jordan, P.O. Box 1612, Code 11941 Amman, Jordan.
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Kleefstra T, de Leeuw N, Wolf R, Nillesen WM, Schobers G, Mieloo H, Willemsen M, Perrotta CS, Poddighe PJ, Feenstra I, Draaisma J, van Ravenswaaij-Arts CM. Phenotypic spectrum of 20 novel patients with molecularly defined supernumerary marker chromosomes 15 and a review of the literature. Am J Med Genet A 2010; 152A:2221-9. [DOI: 10.1002/ajmg.a.33529] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Zelnik N, Konopnicki M, Bennett-Back O, Castel-Deutsch T, Tirosh E. Risk factors for epilepsy in children with cerebral palsy. Eur J Paediatr Neurol 2010; 14:67-72. [PMID: 19576827 DOI: 10.1016/j.ejpn.2009.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 05/29/2009] [Accepted: 06/02/2009] [Indexed: 11/24/2022]
Abstract
The purpose of the study was to identify predictive risk factors for epilepsy among children with cerebral palsy. We conducted a retrospective study of the clinical characteristics of children with cerebral palsy and epilepsy in comparison to those of children with cerebral palsy without epilepsy. The examined parameters included: the prevalence and the age of onset of the seizures, the clinical subgroup of cerebral palsy and subtype of epileptic seizures. We looked for possible risk factors including the presence of neonatal seizures, the imaging findings, the gestational age at delivery, the adjusted birth weight, the mode of delivery, the Apgar scores, and the head size as well as the presence of consanguinity. Epilepsy occurred in 33% of the studied children. Almost 50% of the epileptic children had their first seizure within the first 12 months of life. Neonatal seizures were strong predictors for epilepsy (p<0.001). Presence of at least one abnormal structural finding (particularly brain atrophy) was also a significant predictor of epilepsy (p<0.003). Low Apgar score at 5 min after birth and birth at term were also found more frequently among patients with epilepsy, although when adjusted with other risk factors, Apgar score did not reach statistical significance. The mode of delivery, head circumference, adjusted birth weight, gender and ethnic group, consanguineous marriage and prematurity were not found to be risk factors for the occurrence of epilepsy in these children.
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Affiliation(s)
- Nathanel Zelnik
- Department of Pediatrics and the Child Development Center, Carmel Medical Center, Rappaport Faculty of Medicine, 7 Michal Street, 34383 Technion, Haifa, Israel.
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