Epilepsy and destructive brain insults in early life: a topographical classification on the basis of MRI findings

Magnetic resonance imaging findings in Kenyans and South Africans with active convulsive epilepsy: An observational study

OBJECTIVE

Focal epilepsy is common in low- and middle-income countries. The frequency and nature of possible underlying structural brain abnormalities have, however, not been fully assessed.

METHODS

We evaluated the possible structural causes of epilepsy in 331 people with epilepsy (240 from Kenya and 91 from South Africa) identified from community surveys of active convulsive epilepsy. Magnetic resonance imaging (MRI) scans were acquired on 1.5-Tesla scanners to determine the frequency and nature of any underlying lesions. We estimated the prevalence of these abnormalities using Bayesian priors (from an earlier pilot study) and observed data (from this study). We used a mixed-effect modified Poisson regression approach with the site as a random effect to determine the clinical features associated with neuropathology.

RESULTS

MRI abnormalities were found in 140 of 240 (modeled prevalence = 59%, 95% confidence interval [CI]: 53%-64%) of people with epilepsy in Kenya, and in 62 of 91 (modeled prevalence = 65%, 95% CI: 57%-73%) in South Africa, with a pooled modeled prevalence of 61% (95% CI: 56%-66%). Abnormalities were common in those with a history of adverse perinatal events (15/23 [65%, 95% CI: 43%-84%]), exposure to parasitic infections (83/120 [69%, 95% CI: 60%-77%]) and focal electroencephalographic features (97/142 [68%, 95% CI: 60%-76%]), but less frequent in individuals with generalized electroencephalographic features (44/99 [44%, 95% CI: 34%-55%]). Most abnormalities were potentially epileptogenic (167/202, 82%), of which mesial temporal sclerosis (43%) and gliosis (34%) were the most frequent. Abnormalities were associated with co-occurrence of generalized non-convulsive seizures (relative risk [RR] = 1.12, 95% CI: 1.04-1.25), lack of family history of seizures (RR = 0.91, 0.86-0.96), convulsive status epilepticus (RR = 1.14, 1.08-1.21), frequent seizures (RR = 1.12, 1.04-1.20), and reported use of anti-seizure medication (RR = 1.22, 1.18-1.26).

SIGNIFICANCE

MRI identified pathologies are common in people with epilepsy in Kenya and South Africa. Mesial temporal sclerosis, the most common abnormality, may be amenable to surgical correction. MRI may have a diagnostic value in rural Africa, but future longitudinal studies should examine the prognostic role.

Hemiconvulsion-hemiplegia-epilepsy syndrome in Niger: A retrospective case series

OBJECTIVE

To report the demographic, clinical and paraclinical characteristics as well as the outcomes during follow-up visits of HHE syndrome in Niger.

PATIENTS AND METHODS

It was a retrospective study conducted at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) between May 2003 and May 2018.

RESULTS

During the period of study, 882 patients with epilepsy aged 20 years or less were seen in consultation among whom we collected 22 cases of HHE syndrome with a hospital prevalence of 2.5%. They were 14 men and 8 women (sex ratio = 1.75) with a mean age of 3.76 years (range: 1 and 20 years). At the time of diagnosis, 81.8% of patients were aged under 6 years. The antecedent of febrile convulsions in childhood was found in only 31.8% of cases. The mean age of onset of hemiplegia was 1.9 years (range: 9 months and 5 years). The mean age of onset of epileptic seizures was 2.94 years (range: 1 and 8 years). The mean interval between the onset of hemiplegia and onset of epileptic seizures was 9 months (range: 1 month and 4 years). 31.8% of patients had a delay of acquisitions at the time of diagnosis. 95.5% of patients had drug-resistant epilepsy.

CONCLUSION

HHE syndrome is still seen in the countries of Sub-Saharan Africa. The high morbidity and mortality in children with HHE syndrome highlight the need to improve emergency care for febrile clonic seizures in childhood and the early and adequate management of infectious diseases in the child.

Identifying and Analyzing Novel Epilepsy-Related Genes Using Random Walk with Restart Algorithm

As a pathological condition, epilepsy is caused by abnormal neuronal discharge in brain which will temporarily disrupt the cerebral functions. Epilepsy is a chronic disease which occurs in all ages and would seriously affect patients' personal lives. Thus, it is highly required to develop effective medicines or instruments to treat the disease. Identifying epilepsy-related genes is essential in order to understand and treat the disease because the corresponding proteins encoded by the epilepsy-related genes are candidates of the potential drug targets. In this study, a pioneering computational workflow was proposed to predict novel epilepsy-related genes using the random walk with restart (RWR) algorithm. As reported in the literature RWR algorithm often produces a number of false positive genes, and in this study a permutation test and functional association tests were implemented to filter the genes identified by RWR algorithm, which greatly reduce the number of suspected genes and result in only thirty-three novel epilepsy genes. Finally, these novel genes were analyzed based upon some recently published literatures. Our findings implicate that all novel genes were closely related to epilepsy. It is believed that the proposed workflow can also be applied to identify genes related to other diseases and deepen our understanding of the mechanisms of these diseases.

Early destructive lesions in the developing brain: clinical and electrographic correlates

OBJECTIVE

Early brain insults can cause cavitary lesions including porencephaly (POR) and multicystic encephalopathy (MCE). The objective of this study was to investigate clinical and electrographic correlates associated to these types of destructive brain lesions.

METHOD

Patients with POR and MCE were selected and submitted to clinical and Video-EEG monitoring. The following variables were analyzed: demographic data, type of lesion, presence of gliosis, perinatal complications, epilepsy, brain atrophy, and presence and frequency of epileptiform discharges.

RESULTS

Twenty patients were included, 65% males, 35% females, ages ranging from 1 to 40 years, 14 with MCE and 6 with POR. Eighteen patients had hemiparesis, 19 had epilepsy (current or in the past), seven of them had refractory seizures, and 16 had epileptiform discharges. All patients with MCE had gliosis while only 2 with POR had it.

CONCLUSIONS

No correlation was observed between type of lesion and clinical and electrographical outcome. However, a positive correlation was observed between frequency of discharges and presence of brain atrophy, and between MCE and gliosis.