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Atacan Yasguclukal M, Gulec B, Deniz Elmali A, Yalcinkaya C, Veysi Demirbilek A. Are the seizures under control or unnoticed? Electroclinical evaluation of epilepsy with eyelid myoclonia. Epilepsy Behav 2024; 157:109895. [PMID: 38905913 DOI: 10.1016/j.yebeh.2024.109895] [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: 03/03/2024] [Revised: 05/12/2024] [Accepted: 06/09/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE In this study, patients with epilepsy with eyelid myoclonia (E-EM) were evaluated according to their EEG findings, seizure outcomes, and their consistency with the final ictal EEG findings. We also investigated the possible prognostic factors. METHODS Patients with E-EM and at least two years of follow-up in our clinic were included in the study. We analyzed the presence of eyelid myoclonia, absence and myoclonic seizures, and generalized tonic-clonic seizures for the prior two years and then verified with the latest ictal EEG features. Video-EEGs were analyzed according to the background activity, the existence of generalized spike-wave discharge or polyspike-wave complexes, focal spike-wave discharge, photoparoxysmal responses, and fast activity. RESULTS 21 patients were involved in this study. In six patients, the seizures were undetected on the first EEGs, whereas they were detected on subsequent ones. The seizures were captured on the first EEGs of six patients; however, they disappeared on subsequent ones. Only one patient had seizures detected on every EEG. The consistency of the seizures was variable in eight patients. At the final follow-up, seizures were reported as being under control for more than two years in 12 patients, according to patients and their parents' reports. However, ictal EEG findings were detected in six of these patients. No electroclinical feature was associated with seizure freedom. CONCLUSION This study provides further evidence that seizure freedom in E-EM patients is overestimated. The patients and their parents may not be aware of the seizures. Therefore, video-EEG monitorization is essential during follow-up.
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Affiliation(s)
- Miray Atacan Yasguclukal
- University of Health Sciences, Hamidiye School of Medicine, Haseki Educational and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Bade Gulec
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Neurology Department, Istanbul, Turkey.
| | - Ayse Deniz Elmali
- Istanbul University, Istanbul Faculty of Medicine, Neurology, Clinical Neurophysiology Department, Istanbul, Turkey
| | - Cengiz Yalcinkaya
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Neurology Department, Istanbul, Turkey
| | - Ahmet Veysi Demirbilek
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Neurology Department, Istanbul, Turkey
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Wessel C, Candan FU, Panah PY, Karia S, Sah J, Mutchnick I, Karakas C. Efficacy of vagus nerve stimulation in managing drug-resistant absence epilepsy syndromes. Seizure 2024; 117:60-66. [PMID: 38330751 DOI: 10.1016/j.seizure.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Around 11% of patients with absence epilepsy develop drug-resistant absence epilepsy (DRAE), and are at increased risk for developing psychiatric and neurologic comorbidities. Current therapeutic options for DRAE are limited. The purpose of this study was to assess the efficacy of vagus nerve stimulation (VNS) in treating DRAE. METHODS Our institution maintains a database of patients who received VNS between 2010 and 2022. We identified DRAE patients who were <18 years of age at seizure onset, were electro-clinically diagnosed with an absence epilepsy syndrome (childhood absence, juvenile absence, or Jeavons Syndrome) by an epileptologist, and had normal brain imaging. The primary outcome measure was post-VNS absence seizure frequency. RESULTS Twenty-six patients (M/F:14/12) were identified. Median age at seizure onset was 7 years (IQR 4-10) and patients experienced seizures for 6 years (IQR 4.3-7.6) before VNS. After VNS, the median absence seizure frequency reduced to 1.5 days (IQR 0.1-3.5) per week from 7 days (IQR 7-7), a 66% reduction seizure frequency. VNS responder rate was 80%, and seven patients achieved seizure freedom. There was no significant effect on VNS efficacy between the time from DRAE diagnosis to VNS placement (p = 0.067) nor the time from first seizure onset to VNS implant (p = 0.80). The median follow-up duration was 4.1 years (IQR 2.4-6.7), without any significant association between follow-up duration and VNS efficacy (r2=0.023) CONCLUSIONS: VNS is effective in managing DRAE. The responder rate was 80%; seizure improvement was independent of age at both seizure onset and latency to VNS after meeting DRAE criteria.
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Affiliation(s)
- Caitlin Wessel
- University of Louisville School of Medicine, Louisville KY 40202, United States
| | - Feride Un Candan
- Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States
| | - Paya Yazdan Panah
- University of Louisville School of Medicine, Louisville KY 40202, United States
| | - Samir Karia
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Jeetendra Sah
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Ian Mutchnick
- University of Louisville School of Medicine, Louisville KY 40202, United States; University of Louisville Department of Neurosurgery, Louisville KY 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Cemal Karakas
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States.
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Ng VHL, Hart F, Kothur K, Buckley M, Harb C, Gill D. Epilepsy with eyelid myoclonia with atonic seizures and generalized paroxysmal fast activity: A novel electroclinical phenotype associated with SETD1B pathogenic variant. Epileptic Disord 2024; 26:250-253. [PMID: 38108116 DOI: 10.1002/epd2.20187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Content available: Video
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Affiliation(s)
- Vanessa Hwee Ling Ng
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Francesca Hart
- NSW Health Pathology Genomics Laboratory, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Kavitha Kothur
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michael Buckley
- NSW Health Pathology Genomics Laboratory, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Clare Harb
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Deepak Gill
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Zawar I, Shreshtha B, Benech D, Burgess RC, Bulacio J, Knight EMP. Electrographic Features of Epilepsy With Eyelid Myoclonia With Photoparoxysmal Responses. J Clin Neurophysiol 2024; 41:83-92. [PMID: 35394968 DOI: 10.1097/wnp.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epilepsy with eyelid myoclonia (EMA) is characterized by eyelid myoclonia, eyelid closure sensitivity, and photosensitivity. EEG may manifest with frontal-predominant (FPEDs) or occipital-predominant epileptiform discharges (OPEDs). Data on clinical and electrographic features of these two subtypes are lacking. The purpose of our research was to look at baseline electroclinical features of EMA subtypes and to study electrographic findings of patients with EMA during intermittent photic stimulation (IPS). METHODS We retrospectively identified all patients who had photoparoxysmal responses on EEGs performed at Cleveland clinic between January 01, 2012, and December 31, 2019. Patients who met diagnostic criteria for EMA were studied further. RESULTS Of the 249 patients with photoparoxysmal responses, 70 (28.1%) had EMA (62 [88.6%] female; the mean age of epilepsy onset: 7.0 ± 7.9 years). Patients with EMA had either FPEDs or OPEDs. Eleven patients with EMA (15.7%) had seizures (4 absence, 5 myoclonic and 2 bilateral tonic-clonic) during IPS. Patients with OPEDs were more likely to have drug-resistant epilepsy; occipital focal IEDs and other focal IEDs (other than frontal/occipital) on baseline EEG; and generalized IEDs with occipital predominance, generalized IEDs with no predominance, or focal IEDs during IPS. Predictors of seizure occurrence during photic stimulation included the presence of focal occipital IEDs on baseline EEG, generalized IEDs with frontal predominance during IPS, and photoparoxysmal response outlasting the stimulus. CONCLUSIONS Our study provides evidence that EMA has two distinct subtypes, which differ in clinical characteristics, baseline EEG, and EEG during photic stimulation. We highlight diagnostic and prognostic implications of these findings. Our study also details EEG characteristics of patients with EMA during IPS.
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Affiliation(s)
- Ifrah Zawar
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
- Department of Neurology, University of Virginia School of Medicine, Virginia, U.S.A
| | - Bijina Shreshtha
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Daniela Benech
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Elia M Pestana Knight
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
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Smith KM, Wirrell EC, Andrade DM, Choi H, Trenité DKN, Jones H, Knupp KG, Mugar J, Nordli DR, Riva A, Stern JM, Striano P, Thiele EA, Zawar I. Clinical presentation and evaluation of epilepsy with eyelid myoclonia: Results of an international expert consensus panel. Epilepsia 2023; 64:2330-2341. [PMID: 37329145 DOI: 10.1111/epi.17683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The objective of this study was to determine areas of consensus among an international panel of experts for the clinical presentation and diagnosis of epilepsy with eyelid myoclonia (EEM; formerly known as Jeavons syndrome) to improve a timely diagnosis. METHODS An international steering committee was convened of physicians and patients/caregivers with expertise in EEM. This committee summarized the current literature and identified an international panel of experts (comprising 25 physicians and five patients/caregivers). This international expert panel participated in a modified Delphi process, including three rounds of surveys to determine areas of consensus for the diagnosis of EEM. RESULTS There was a strong consensus that EEM is a female predominant generalized epilepsy syndrome with onset between 3 and 12 years of age and that eyelid myoclonia must be present to make the diagnosis. There was a strong consensus that eyelid myoclonia may go unrecognized for years prior to an epilepsy diagnosis. There was consensus that generalized tonic-clonic and absence seizures are typically or occasionally seen in patients. There was a consensus that atonic or focal seizures should lead to the consideration of reclassification or alternate diagnoses. There was a strong consensus that electroencephalography is required, whereas magnetic resonance imaging is not required for diagnosis. There was a strong consensus to perform genetic testing (either epilepsy gene panel or whole exome sequencing) when one or a combination of factors was present: family history of epilepsy, intellectual disability, or drug-resistant epilepsy. SIGNIFICANCE This international expert panel identified multiple areas of consensus regarding the presentation and evaluation of EEM. These areas of consensus may be used to inform clinical practice to shorten the time to the appropriate diagnosis.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Danielle M Andrade
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Hyunmi Choi
- Department of Neurology, Columbia University, New York, New York, USA
| | | | | | - Kelly G Knupp
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | | | - Douglas R Nordli
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Antonella Riva
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - John M Stern
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Pasquale Striano
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Elizabeth A Thiele
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ifrah Zawar
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
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Parfyonov M, Ivaniuk A, Parikh S, Pestana-Knight E. Epilepsy with eyelid myoclonia in the setting of de novo pathogenic variant in ATP1A3. Epileptic Disord 2023; 25:545-548. [PMID: 37293976 DOI: 10.1002/epd2.20086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
Mutations in the ATP1A3 gene have been associated with several syndromes, including rapid-onset dystonia-parkinsonism, alternating hemiplegia of childhood, and cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss. In this clinical commentary, we report a 2-year-old female patient with de novo pathogenic variant in the ATP1A3 gene associated with an early-onset form of epilepsy with eyelid myoclonia. The patient had frequent eyelid myoclonia occurring 20-30 times per day, without loss of awareness or other motor manifestations. EEG showed generalized polyspikes and spike-and-wave complexes maximal in the bifrontal regions, with prominent eye closure sensitivity. A sequencing-based epilepsy gene panel revealed a de novo pathogenic heterozygous variant in ATP1A3. The patient showed some response to flunarizine and clonazepam. This case highlights the importance of considering ATP1A3 mutations in the differential diagnosis of early-onset epilepsy with eyelid myoclonia and the potential benefit of flunarizine in improving language and coordination development in patients with ATP1A3-related disorders.
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Affiliation(s)
- Maksim Parfyonov
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alina Ivaniuk
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sumit Parikh
- Neurometabolism & Neurogenetics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elia Pestana-Knight
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Paibool W, Schimpf S, Nordli DR, Phitsanuwong C. Modified Atkins diet in children with epilepsy with eyelid myoclonia (Jeavons syndrome). Epilepsy Behav 2023; 145:109347. [PMID: 37459720 DOI: 10.1016/j.yebeh.2023.109347] [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: 05/08/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Epilepsy with eyelid myoclonia(EEM) or Jeavons syndrome is considered a genetic generalized epilepsy with a typical age of onset in childhood. Many types of seizures can be observed, including eyelid myoclonia, absence, generalized tonic-clonic, and myoclonic seizures. Seizures tend to be difficult to control requiring polypharmacy treatment or become drug-resistant. Dietary therapy, particularly with Modified Atkins Diet (MAD), as a treatment of seizures in this syndrome has rarely been studied. We report efficacy and tolerability of MAD in children with epilepsy with eyelid myoclonia. METHODS We reviewed medical records of children with EEM treated at the University of Chicago Ketogenic Diet program from 2017 to 2022. Patient's demography, seizure characteristics, EEG findings, response to treatment, and adverse effects were reviewed. RESULT Six patients with EEM were identified. Average age of seizure onset was 6 (2-11) years and an average age when the MAD started was 10.7 (6-15) years. All patients were started on MAD and completed at least 6 months on the diet at the time of report. An average of 4 (0-9) anti-seizure medications (ASM) had been tried prior to the MAD. All patients achieved ketosis with an average level of serum beta-hydroxybutyrate of 1.9 (1.03-3.61) mmol/L. At the 6-month follow-up visit, all patients (100%) experienced a greater than 50% seizure reduction, 3/6 patients (50%) had more than 90% seizure reduction, 1/6 patients (17%) became seizure-free. All seizure types demonstrated a greater than 80% reduction in frequency.Absence and myoclonic seizures showed the greatest reduction with 100% seizure reduction. Eyelid myoclonia and generalized tonic-clonic seizures showed more than 80% seizure reduction.Moreover, all patients reported improvement in alertness, mood, and concentration. Initial weight loss and mild gastrointestinal disturbances were reported in 2/6 patients (33%) and corrected with dietary adjustment. CONCLUSION The Modified Atkins Diet has shown to be effective and welltolerated for children with EEM in our study. Cognitive improvement has also been subjectively reported in all patients. Adverse effects are tolerable and correctable. The MAD, therefore, may be considered as a treatment option for patients with epilepsy with eyelid myoclonia.
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Affiliation(s)
- Watuhatai Paibool
- Department of Pediatrics, The University of Chicago, The University of Chicago Medical Center, USA; Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
| | - Stephanie Schimpf
- Department of Pediatrics, The University of Chicago, The University of Chicago Medical Center, USA
| | - Douglas R Nordli
- Department of Pediatrics, The University of Chicago, The University of Chicago Medical Center, USA
| | - Chalongchai Phitsanuwong
- Department of Pediatrics, The University of Chicago, The University of Chicago Medical Center, USA
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Smith KM, Wirrell EC, Andrade DM, Choi H, Trenité DKN, Knupp KG, Nordli DR, Riva A, Stern JM, Striano P, Thiele EA, Zawar I. A comprehensive narrative review of epilepsy with eyelid myoclonia. Epilepsy Res 2023; 193:107147. [PMID: 37121024 DOI: 10.1016/j.eplepsyres.2023.107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
Epilepsy with eyelid myoclonia (EEM) is a generalized epilepsy syndrome with childhood-onset and 2:1 female predominance that consists of: 1. eyelid myoclonia with or without absence seizures, 2. eye closure induced seizures or EEG paroxysms, 3. clinical or EEG photosensitivity. While eyelid myoclonia is the disease hallmark, other seizure types, including absence seizures and generalized tonic-clonic seizures, may be present. It is thought to have a genetic etiology, and around one-third of patients may have a positive family history of epilepsy. Recently, specific genetic mutations have been recognized in a minority patients, including in SYNGAP1, NEXMIF, RORB, and CHD2 genes. There are no randomized controlled trials in EEM, and the management literature is largely restricted to small retrospective studies. Broad-spectrum antiseizure medications such as valproate, levetiracetam, lamotrigine, and benzodiazepines are typically used. Seizures typically persist into adulthood, and drug-resistant epilepsy is reported in over 50%.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.
| | - Elaine C Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Hyunmi Choi
- Department of Neurology, Columbia University, New York, NY, United States
| | | | - Kelly G Knupp
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Douglas R Nordli
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Antonella Riva
- IRCCS Istituto Giannina Gaslini", Genova, Italy and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - John M Stern
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini", Genova, Italy and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Elizabeth A Thiele
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Ifrah Zawar
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
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Wang X, Rao X, Zhang J, Gan J. Genetic mechanisms in generalized epilepsies. ACTA EPILEPTOLOGICA 2023. [DOI: 10.1186/s42494-023-00118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
AbstractThe genetic generalized epilepsies (GGEs) have been proved to generate from genetic impact by twin studies and family studies. The genetic mechanisms of generalized epilepsies are always updating over time. Although the genetics of GGE is complex, there are always new susceptibility genes coming up as well as copy number variations which can lead to important breakthroughs in exploring the problem. At the same time, the development of ClinGen fades out some of the candidate genes. This means we have to figure out what accounts for a reliable gene for GGE, in another word, which gene has sufficient evidence for GGE. This will improve our understanding of the genetic mechanisms of GGE. In this review, important up-to-date genetic mechanisms of GGE were discussed.
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Güleç B, Yasgüçlükal MA, Elmalı AD, Yalçınkaya C, Demirbilek AV. The seizures that wake up with the patient: The effect of sleep deprivation and short sleep on epilepsy with eyelid myoclonia. Neurophysiol Clin 2023; 53:102846. [PMID: 36822149 DOI: 10.1016/j.neucli.2023.102846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE In this study, our aim was to demonstrate the effect of sleep deprivation, short sleep, and awakening on photoparoxysmal responses (PPR) and eyelid myoclonia (EM) in patients with Epilepsy with Eyelid Myoclonia (E-EM). METHODS E-EM patients with at least 1 year of follow-up in our clinic were included in the study. Video EEG(v-EEG) analyses were divided into three periods of wakefulness, sleep, and awakening. The PPR and onset of EMs were investigated. RESULTS 32 patients met the study criteria, of which 56.3% (n = 18) were male. The mean age at disease onset was 7.7 ± 4.1 years. The mean age at EEG recording was 12.4 ± 4.0 years. EM was observed only on awakening in 78.1% of patients (n = 22), of which it was seen only during intermittent photic stimulation (IPS) in 43.7% (n = 14). Eye closure (EC) sensitivity was detected in all patients. The proportion of patients with a PPR was significantly higher on awakening than before sleep (p = 0.01). CONCLUSIONS This study showed that EM is most prominent and sometimes can only be detected in the awakening period in E-EM. In order to detect E-EM, v-EEG recordings including both pre-sleep and post-sleep wakefulness periods should be recorded, with intermittent photic stimulation performed in both periods.
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Affiliation(s)
- Bade Güleç
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Neurology Department, Turkey
| | | | - Ayşe Deniz Elmalı
- Istanbul University, Istanbul Faculty of Medicine, Neurology, Clinical Neurophysiology Department, Turkey; Basaksehir Cam & Sakura City Hospital, Clinical Neurophysiology Department, Turkey
| | - Cengiz Yalçınkaya
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Neurology Department, Turkey
| | - Ahmet Veysi Demirbilek
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Neurology Department, Turkey
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Meritam Larsen P, Wüstenhagen S, Terney D, Gardella E, Aurlien H, Beniczky S. Duration of epileptic seizure types: A data-driven approach. Epilepsia 2023; 64:469-478. [PMID: 36597206 PMCID: PMC10107943 DOI: 10.1111/epi.17492] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the duration of epileptic seizure types in patients who did not undergo withdrawal of antiseizure medication. METHODS From a large, structured database of 11 919 consecutive, routine video-electroencephalograpy (EEG) recordings, labeled using the SCORE (Standardized Computer-Based Organized Reporting of EEG) system, we extracted and analyzed 2742 seizures. For each seizure type we determined median duration and range after removal of outliers (2.5-97.5 percentile). We used surface electromyography (EMG) for accurate measurement of short motor seizures. RESULTS Myoclonic seizures last <150 ms, epileptic spasms 0.4-2 s, tonic seizures 1.5-36 s, atonic seizures 0.1-12,5 s, when measured using surface EMG. Generalized clonic seizures last 1-24 s. Typical absence seizures are rarely longer than 30 s (2.75-26.5 s) and atypical absences last 2-100 s. In our patients, the duration of focal aware (median: 27 s; 1.25-166 s) and impaired awareness seizures (median: 42.5 s; 9.5-271 s) was shorter than reported previously in patients undergoing withdrawal of antiseizure medication. All focal seizures terminated within 10 min. Median duration of generalized tonic-clonic seizures was 79.5 s (57-102 s) and of focal-to-bilateral tonic-clonic seizures was 103.5 (77.5-237 s). All tonic-clonic seizures terminated within 5 min. SIGNIFICANCE This comprehensive list of seizure durations provides important information for characterizing seizures and diagnosing patients with epilepsy. The upper limits of seizure durations are helpful in early recognition of imminent status epilepticus.
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Affiliation(s)
- Pirgit Meritam Larsen
- Department of Clinical Neurophysiology, Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
| | - Stephan Wüstenhagen
- Department of Clinical Neurophysiology, Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
| | - Daniella Terney
- Department of Clinical Neurophysiology, Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
| | - Elena Gardella
- Department of Clinical Neurophysiology, Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
- University of Southern Denmark, Dianalund, Denmark
| | - Harald Aurlien
- Department of Clinical Neurophysiology, Haukeland University Hospital and Holberg EEG AS, Bergen, Norway
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Spurgeon AL, Keaveney SF, Ng YT. Refractory Jeavons Syndrome from Birth Symptomatic to PLCB1 Mutation. Child Neurol Open 2023; 10:2329048X231183524. [PMID: 37441061 PMCID: PMC10334019 DOI: 10.1177/2329048x231183524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 07/15/2023] Open
Abstract
Jeavons syndrome is a common, often misdiagnosed or overlooked epileptic syndrome presenting with a triad of eyelid myoclonia with or without absence seizures, eye closure-induced EEG paroxysms, and photosensitivity. We present a seven-year-old female who presented with eyelid myoclonia evident since birth with absence seizures and migraines with associated photosensitivity. An EEG with photic stimulation confirmed the diagnosis of Jeavons syndrome. Genetic testing showed a heterozygous mutation in the PLCB1 gene which has been linked to early onset epilepsies and encephalopathic epilepsies. This mutation and her clinical presentation identifies another etiology of Jeavons syndrome and confirms it can begin from birth. Its presence highlights the importance of genetic testing in epileptic patients to better understand the links between genetics and epilepsy syndromes so appropriate treatment can be initiated.
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Affiliation(s)
| | | | - Yu-Tze Ng
- Department of Pediatric Neurology, University of Missouri School of Medicine,
Columbia, MO, USA
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13
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Bartolini E, Ferrari AR, Lattanzi S, Pradella S, Zaccara G. Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology. Epilepsy Behav 2022; 132:108739. [PMID: 35636351 DOI: 10.1016/j.yebeh.2022.108739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
The incidence of epilepsy is highest at the extreme age ranges: childhood and elderly age. The most common syndromes in these demographics - self-limited epilepsies of childhood and idiopathic generalized epilepsies in pediatric age, focal epilepsy with structural etiology in older people - are expected to be drug responsive. In this work, we focus on such epilepsy types, overviewing the complex clinical background of unexpected drug-resistance. For self-limited epilepsies of childhood and idiopathic generalized epilepsies, we illustrate drug-resistance resulting from syndrome misinterpretation, reason on possible unexpected courses of epilepsy, and explicate the influence of inappropriate treatments. For elderly-onset epilepsy, we show the challenges in differential diagnosis possibly leading to pseudoresistance and analyze how drug-resistant epilepsy can arise in stroke, neurocognitive disorders, brain tumors, and autoimmune encephalitis. In children and senior people, drug-resistance can be regarded as a hint to review the diagnosis or explore alternative therapeutic strategies. Refractory seizures are not only a therapeutic challenge, but also a cardinal sign not to be overlooked in syndromes commonly deemed to be drug-responsive.
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Affiliation(s)
- Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Pradella
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy.
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