1
|
Boureau AS, Guyomarch B, Gourdy P, Allix I, Annweiler C, Cervantes N, Chapelet G, Delabrière I, Guyonnet S, Litke R, Paccalin M, Penfornis A, Saulnier PJ, Wargny M, Hadjadj S, de Decker L, Cariou B. Nocturnal hypoglycemia is underdiagnosed in older people with insulin-treated type 2 diabetes: The HYPOAGE observational study. J Am Geriatr Soc 2023. [PMID: 36965179 DOI: 10.1111/jgs.18341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND There is a lack of real-life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors of hypoglycemia in older patients with insulin-treated T2D. METHODS This prospective multicenter study included 155 insulin-treated T2D patients aged 75 years and older with ≥2 self-monitoring of blood glucose (SMBG) daily controls. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days with FreeStyle Libre Pro® sensor. Study population (n = 141) has >70% CGM active time. Multivariable logistic regressions were used to identify factors associated with SMBG confirmed hypoglycemia (≥70 mg/dL) and with nocturnal level 2 time below range (glucose concentration <54 mg/dL during ≥15 consecutive min between 0.00 and 6.00 am). RESULTS The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA1c was 7.9% ± 1.0%. After geriatric assessment, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy. The primary endpoint (confirmed SMBG <70 mg/dL) occurred in 37.6% patients. In multivariable analysis, the risk of SMBG-confirmed hypoglycemia was positively associated with a longer duration of diabetes (OR (+1 year) =1.04, (1.00-1.08), p = 0.04) and glycemic variability assessed by CGM (CV %) (OR (+1%) = 1.12, [1.05-1.19], p = <0.001). Nighty-two patients (65.2%) experienced nocturnal time in hypoglycemia (i.e., <54 mg/dL during ≥15 consecutive min between midnight and 6 a.m.). In multivariable analyses, cognitive impairment (OR: 9.31 [2.59-33.4]), heart failure (OR: 4.81 [1;48-15.6]), and depressive disorder (OR: 0.19 [0.06-0.53]) were associated with nocturnal time in hypoglycemia. CONCLUSION Nocturnal hypoglycemia is very common and largely underdiagnosed in older patients with insulin-treated T2D. CGM is a promising tool to better identify hypoglycemia and adapt diabetes management in this population.
Collapse
Affiliation(s)
- Anne-Sophie Boureau
- Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, Nantes, F-44000, France
| | - Béatrice Guyomarch
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, F-44000, France
| | - Pierre Gourdy
- CHU de Toulouse & UMR1297/I2MC, Université de Toulouse, Toulouse, France
| | - Ingrid Allix
- Département d'Endocrinologie, Diabétologie, Nutrition, CHU de Angers, Angers, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
- UPRES EA 4638, University of Angers, Angers, France
- Gérontopôle Autonomie Longévité des Pays de la Loire, Nantes, France
- Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada
| | | | - Guillaume Chapelet
- Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, Nantes, F-44000, France
| | | | - Sophie Guyonnet
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Rachel Litke
- CHU Lille, Geriatric Department, Lille, 59000, France
| | - Marc Paccalin
- CHU de Poitiers, Pôle de gériatrie, Poitiers, 86021, France
- Université de Poitiers, INSERM, CHU Poitiers, Centre d'Investigation Clinique CIC 1402, Poitiers, France
| | - Alfred Penfornis
- Centre Hospitalier Sud Francilien, F-91100 Corbeil-Essonnes, Université Paris-Saclay, France
| | - Pierre-Jean Saulnier
- Université de Poitiers, INSERM, CHU Poitiers, Centre d'Investigation Clinique CIC 1402, Poitiers, France
| | - Matthieu Wargny
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, F-44000, France
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, Nantes, F-44000, France
| | - Samy Hadjadj
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, F-44000, France
| | - Laure de Decker
- Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, Nantes, F-44000, France
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, F-44000, France
| |
Collapse
|
2
|
Adenan MH, Khalil M, Loh KS, Kelly L, Shukralla A, Klaus S, Kilbride R, Mullins G, Widdess-Walsh P, Kinney M, Delanty N, El-Naggar H. A retrospective study of the correlation between duration of monitoring in the epilepsy monitoring unit and diagnostic yield. Epilepsy Behav 2022; 136:108919. [PMID: 36166879 DOI: 10.1016/j.yebeh.2022.108919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Long-term video-electroencephalographic (LTVEM) monitoring is a valuable tool in the evaluation of paroxysmal clinical events. However, vEEG itself is costly. Hence, we aimed to establish if longer duration of monitoring (DOM) is associated with higher diagnostic yield. METHOD A retrospective review of patients admitted into the epilepsy monitoring unit (EMU) for the diagnostic evaluation of paroxysmal events was performed. Patients' demographic, clinical characteristics, and vEEG data were analyzed. In the cohort of patients with DOM > 7 days, the reasons for prolonged DOM were identified and the differences in clinical characteristics and vEEG data between conclusive and inconclusive studies were analyzed. RESULT A total of 501 patients were included. Four hundred and thirty-six (87 %) patients had conclusive studies. Of these patients, 67.9 % patients with conclusive studies received diagnosis within the first 7 days of monitoring with the highest on day 7. The likelihood of conclusive studies decreased beyond 7 days. A total of 175 had DOM > 7 days, of which 140 (80 %) had conclusive studies. In the cohort with DOM > 7 days, patients with previous abnormal routine EEG, previous vEEG monitoring, first event recorded before day 5 of admission and ≥1 events recorded during vEEG monitoring were more likely to have conclusive studies. The most common reason for prolonging DOM beyond 7 days was to adequately record multiple semiologically distinctive events (76 %). CONCLUSION Our study supports that longer DOM is associated with an increase in diagnostic yield. More than one-third of our cohort were monitored beyond 7 days with majority (80 %) being conclusive. Our findings may guide clinicians in planning the DOM and predicting the likelihood of conclusive vEEG studies in patients with prolonged DOM based on the clinical characteristics and vEEG data.
Collapse
Affiliation(s)
- Mohammad Hijaz Adenan
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons, Ireland.
| | - Mohamed Khalil
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland
| | - Kai Sheng Loh
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland
| | - Luke Kelly
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland
| | - Arif Shukralla
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland
| | - Stephen Klaus
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland
| | - Ronan Kilbride
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland
| | - Gerard Mullins
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland
| | - Peter Widdess-Walsh
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons, Ireland
| | - Michael Kinney
- Department of Neurology, Royal Victoria Hospital, Belfast, UK; Queen's University, Belfast, UK
| | - Norman Delanty
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons, Ireland; FutureNeuro, Science Foundation Ireland Research Centre, Ireland
| | - Hany El-Naggar
- National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons, Ireland; FutureNeuro, Science Foundation Ireland Research Centre, Ireland
| |
Collapse
|
3
|
Long-Term V-EEG in Epilepsy: Chronological Distribution of Recorded Events Focused on the Differential Diagnosis of Epileptic Seizures and Psychogenic Non-Epileptic Seizures. J Clin Med 2021; 10:jcm10102080. [PMID: 34066156 PMCID: PMC8150823 DOI: 10.3390/jcm10102080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
Differential diagnosis in epilepsy is sometimes challenging. Video-electroencephalography (V-EEG) is an essential tool in the diagnosis and management of epilepsy. The prolonged duration of V-EEG recording increases the diagnostic yield of a conventional V-EEG. The right length of monitoring for different indications is still to be established. We present a retrospective descriptive study with a sample of 50 patients with long-term V-EEG monitoring, with a mean age of 36.1 years, monitored from 2013 to 2019 at the Burgos University Hospital. The mean monitoring time was 3.6 days. Events were obtained in 76% of the patients, corresponding to epileptic seizures (ES) in 57.9% of them, with psychogenic non-epileptic seizures (PNES) in 39.5%, and with episodes of both pathologies in 2.6% of the patients. We found that the first event was highly representative, and it correlated with the rest of the events that would be recorded. Moreover, 92% of the first PNES had been captured at the end of the second day, and 89% of the first ES by the end of the third day. V-EEG for differential diagnosis between ES and PNES can be performed in hospitals without specialized epilepsy surgery units. For this indication, the duration of long-term V-EEG can be adjusted individually depending on the nature of the first event.
Collapse
|
4
|
Chen J, Zhou X, Lu Q, Jin L, Huang Y. Video electroencephalogram combined with electromyography in the diagnosis of hyperkinetic movement disorders with an unknown cause. Neurol Sci 2021; 42:3801-3811. [PMID: 33462635 DOI: 10.1007/s10072-021-05053-0] [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: 02/08/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diagnosis of hyperkinetic movement disorders with an unknown cause is usually challenging. The objective of this study is to learn about video electroencephalogram (VEEG) combined with electromyography (EMG) in the diagnosis of hyperkinetic movement disorders with an unknown cause. METHODS We performed an observational cohort study by recruiting consecutive patients with hyperkinetic movements as the main manifestation with an unknown cause for VEEG combined with EMG evaluations. RESULTS A total of 77 consecutive patients were enrolled for VEEG-EMG examination. Among them, 57 patients changed their diagnosis after VEEG-EMG assessment, with a mean final diagnosis age of 35.4 ± 20.3 years (range, 4-74 years). The mean duration between initial and final diagnosis was 54.8 ± 71.3 months (range 0.5-300 months). The most common misdiagnosed hyperkinetic movement disorders were myoclonus (40.4%), followed by tremors (24.6%), dystonia (15.8%), psychogenic movement disorders (10.5%), and periodic leg movement syndrome (PLMS) (7.0%). Outcomes of therapy were significantly improved after VEEG-EMG examination (p = 0.000). CONCLUSIONS Simultaneous VEEG and EMG are important in the diagnosis of hyperkinetic movement disorders with an unknown cause.
Collapse
Affiliation(s)
- Jianhua Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Xiangqin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Qiang Lu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Liri Jin
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| |
Collapse
|
5
|
Koc G, Morkavuk G, Akkaya E, Karadas O, Leventoglu A, Unay B, Gokcil Z. Latencies to first interictal epileptiform discharges in different seizure types during video-EEG monitoring. Seizure 2019; 69:235-240. [PMID: 31121547 DOI: 10.1016/j.seizure.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Interictal epileptiform discharges (IEDs) have high diagnostic value concerning patients with epilepsy and the instances of obtaining IEDs increase with longer recording times. However, the merit of a single, extended electroencephalography (EEG) recording in detecting IEDs has not been substantiated. We aimed to determine the optimal duration of an EEG required to diagnose epilepsy in different seizure types. METHODS Overall, 84 patients-29 with generalised onset epilepsy and 55 with focal onset epilepsy-were evaluated. Long-term video electroencephalographic monitoring (VEM) was analysed to find the first definite IED besides assessing the first seizure and latency. RESULTS The median latency of the first IED (12 min, ranging from 1 to 440 min vs. 55 min, ranging from 2 to 7500 min; p = 0.014) and the median duration of a VEM recording (2 d, ranging from 1 to 10 d vs. 3 d, ranging from 1 to 10 d; p = 0.012) were found significantly lower in the generalised epilepsy group compared with that in the focal epilepsy group. CONCLUSIONS Generalised onset epilepsy showed a significantly shorter latency to IED and VEM duration compared with focal onset epilepsy. In our data set, all the patients with generalised onset epilepsy had interictal IED within 10 h, but the patients with focal onset epilepsy required monitoring for three days to obtain IED.
Collapse
Affiliation(s)
- Guray Koc
- Department of Neurology, Gulhane Training and Research Hospital, Ankara, Turkey.
| | - Gulin Morkavuk
- Department of Neurology, Ufuk University, Faculty of Medicine, Ankara, Turkey
| | - Efdal Akkaya
- Department of Neurology, Ufuk University, Faculty of Medicine, Ankara, Turkey
| | - Omer Karadas
- Department of Neurology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Alev Leventoglu
- Department of Neurology, Ufuk University, Faculty of Medicine, Ankara, Turkey
| | - Bulent Unay
- Department of Pediatric Neurology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Zeki Gokcil
- Department of Neurology, Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation, Cyprus
| |
Collapse
|
6
|
Chen JH, Zhou XQ, Lu Q, Jin LR, Huang Y. New-Onset Geriatric Epilepsy in China: A Single-Center Study. Chin Med J (Engl) 2018; 131:2915-2920. [PMID: 30539903 PMCID: PMC6302641 DOI: 10.4103/0366-6999.247194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Few studies have been published on new-onset geriatric epilepsy especially in older Chinese people. This study was to have a comprehensive understanding of new-onset geriatric epilepsy and find a more reasonable diagnosis and management of epilepsy in older people. Methods One hundred and three patients with onset age 60 years and older were admitted between January 2008 and December 2016. Electronic medical records were reviewed to collect information. Results There were 103 older patients with new-onset epilepsy. The mean age of the patients was 68.5 ± 6.4 years (range: 60-89 years), and there were 67 (65%) men and 36 (35%) women. The mean onset age was 67.9 ± 6.2 years (range: 60-89 years). The most common identifiable etiology of symptomatic seizures was autoimmune epilepsy in 43 (41.7%) patients. The second most common etiology was stroke in 15 (14.6%) patients. Seven (6.8%) older patients with acute seizures present with status epilepticus and 26 (25.2%) patients experienced clustered seizures (more than three events in 24 h) at seizure onset. Focal seizures (96.1%) were more common than generalized seizures (3.9%). Fifty-three (51.5%) patients had an abnormal brain magnetic resonance imaging (MRI) scan. Among them, video-electroencephalogram findings in 31 (30.1%) patients correlated with MRI abnormalities. Levetiracetam was the most used drugs before admission, in hospital, and during follow-up. Conclusions Autoimmune encephalitis is becoming an increasing risk factor of subsequent epilepsy in older people. Older patients with new epilepsy are more likely to respond to antiepileptic drugs, and drug-resistant epilepsy is uncommon.
Collapse
Affiliation(s)
- Jian-Hua Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiang-Qin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qiang Lu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li-Ri Jin
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
7
|
Cox FME, Visser GH. What is a practical duration time for capturing psychogenic non-epileptic seizures by video-EEG monitoring? Seizure 2018; 56:110. [PMID: 29471257 DOI: 10.1016/j.seizure.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Fieke M E Cox
- Stichting Epilepsie Instellingen Nederland, The Netherlands.
| | | |
Collapse
|