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Lorkiewicz SA, Modiano YA, Miller BI, Van Cott AC, Haneef Z, Sullivan-Baca E. The neuropsychological presentation of women with epilepsy: Clinical considerations and future directions. Clin Neuropsychol 2024; 38:1382-1408. [PMID: 37993977 DOI: 10.1080/13854046.2023.2283937] [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: 07/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.
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Affiliation(s)
| | - Yosefa A Modiano
- Neurosciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Brian I Miller
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Anne C Van Cott
- Neurology Division, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zulfi Haneef
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Epilepsy Centers of Excellence, Veteran's Health Administration, USA
| | - Erin Sullivan-Baca
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Chen Y, Sun L, Wang S, Guan B, Pan J, Qi Y, Li Y, Yang N, Lin H, Wang Y, Sun B. Topological regularization of networks in temporal lobe epilepsy: a structural MRI study. Front Neurosci 2024; 18:1423389. [PMID: 39035776 PMCID: PMC11259028 DOI: 10.3389/fnins.2024.1423389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Objective Patients with temporal lobe epilepsy (TLE) often exhibit neurocognitive disorders; however, we still know very little about the pathogenesis of cognitive impairment in patients with TLE. Therefore, our aim is to detect changes in the structural connectivity networks (SCN) of patients with TLE. Methods Thirty-five patients with TLE were compared with 47 normal controls (NC) matched according to age, gender, handedness, and education level. All subjects underwent thin-slice T1WI scanning of the brain using a 3.0 T MRI. Then, a large-scale structural covariance network was constructed based on the gray matter volume extracted from the structural MRI. Graph theory was then used to determine the topological changes in the structural covariance network of TLE patients. Results Although small-world networks were retained, the structural covariance network of TLE patients exhibited topological irregularities in regular architecture as evidenced by an increase in the small world properties (p < 0.001), normalized clustering coefficient (p < 0.001), and a decrease in the transfer coefficient (p < 0.001) compared with the NC group. Locally, TLE patients showed a decrease in nodal betweenness and degree in the left lingual gyrus, right middle occipital gyrus and right thalamus compared with the NC group (p < 0.05, uncorrected). The degree of structural networks in both TLE (Temporal Lobe Epilepsy) and control groups was distributed exponentially in truncated power law. In addition, the stability of random faults in the structural covariance network of TLE patients was stronger (p = 0.01), but its fault tolerance was lower (p = 0.03). Conclusion The objective of this study is to investigate the potential neurobiological mechanisms associated with temporal lobe epilepsy through graph theoretical analysis, and to examine the topological characteristics and robustness of gray matter structural networks at the network level.
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Affiliation(s)
- Yini Chen
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Sun
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Shiyao Wang
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Beiyan Guan
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jingyu Pan
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yiwei Qi
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yufei Li
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Nan Yang
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Hongsen Lin
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Wang
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Bo Sun
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Jiang N, Yang CM, Wang JL, Ye XF, Yang B. The Association Between Sleep Problems and Attentional Network Functions in Patients with Self-Limited Epilepsy with Centrotemporal Spikes. Nat Sci Sleep 2024; 16:751-760. [PMID: 38894978 PMCID: PMC11182751 DOI: 10.2147/nss.s460558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose To investigate sleep problems in children with self-limited epilepsy with central temporal spiking (SeLECTS) and to assess the relationship between sleep problems and attention network dysfunction. Patients and methods 107 children 6-14 years of age with SeLECTS and 90 age- and sex-matched healthy controls were recruited for this study. The sleep status of these participants was evaluated using the Children's Sleep Habits Questionnaire (CSHQ), while attentional network function was assessed with the attention network function test (ANT). Results Together, these analyses revealed that children with SeLECTS exhibited higher total CSHQ scores and sleep disorder incidence relative to healthy controls (P< 0.001). Children with SeLECTS had higher scores in delayed sleep onset, sleep duration, night awakenings, parasomnias, daytime sleepiness and sleep anxiety (P<0.01). Total CSHQ scores were negatively correlated with average ANT correct rates (ρ= -0.253, P<0.01), while they were positively correlated with total reaction time (ρ=0.367, P<0.01) and negatively correlated with the efficiency of the alerting and executive control networks (ρ=-0.344 P<0.01; ρ=-0.418 P<0.01). Conclusion Children with SeLECTS face a higher risk of experiencing sleep disorders relative to age-matched healthy children, while also demonstrating that the magnitude of the impairment of attentional network function in these children is positively correlated with sleep disorder severity. Thus, the prognosis and quality of life of children with SeLECTS can be improved by interventions addressing sleep disorders.
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Affiliation(s)
- Nan Jiang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Chun Mei Yang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Jia Le Wang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao Fei Ye
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Bin Yang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
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Chen KN, Peng QL, Cao DF, Wang ZJ, Zhang K, Zhou XY, Min DY, Zhou BT, Mao XY. Inhibition of lysyl oxidase by pharmacological intervention and genetic manipulation alleviates epilepsy-associated cognitive disorder. Brain Res Bull 2024; 210:110928. [PMID: 38493836 DOI: 10.1016/j.brainresbull.2024.110928] [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: 12/24/2023] [Revised: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Epilepsy-associated cognitive disorder (ECD), a prevalent comorbidity in epilepsy patients, has so far uncharacterized etiological origins. Our prior work revealed that lysyl oxidase (Lox) acted as a novel contributor of ferroptosis, a recently discovered cell death mode in the regulation of brain function. However, the role of Lox-mediated ferroptosis in ECD remains unknown. ECD mouse model was established 2 months later following a single injection of kainic acid (KA) for. After chronic treatment with KA, mice were treated with different doses (30 mg/kg, 100 mg/kg and 300 mg/kg) of Lox inhibitor BAPN. Additionally, hippocampal-specific Lox knockout mice was also constructed and employed to validate the role of Lox in ECD. Cognitive functions were assessed using novel object recognition test (NOR) and Morris water maze test (MWM). Protein expression of phosphorylated cAMP-response element binding (CREB), a well-known molecular marker for evaluation of cognitive performance, was also detected by Western blot. The protein distribution of Lox was analyzed by immunofluorescence. In KA-induced ECD mouse model, ferroptosis process was activated according to upregulation of 4-HNE protein and a previously discovered ferroptosis in our group, namely, Lox was remarkably increased. Pharmacological inhibition of Lox by BAPN at the dose of 100 mg/kg significantly increased the discrimination index following NOR test and decreased escape latency as well as augmented passing times within 60 s following MWM test in ECD mouse model. Additionally, deficiency of Lox in hippocampus also led to pronounced improvement of deficits in ECD model. These findings indicate that the ferroptosis regulatory factor, Lox, is activated in ECD. Ablation of Lox by either pharmacological intervention or genetic manipulation ameliorates the impairment in ECD mouse model, which suggest that Lox serves as a promising therapeutic target for treating ECD in clinic.
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Affiliation(s)
- Kang-Ni Chen
- Key Laboratory of Ministry of Education for TCM Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China; Department of Clinical Pharmacology and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China; Institute of Clinical Pharmacology and Engineering Research Center of Applied Technology of Pharmacogenomics of Ministry of Education, Central South University, Changsha 410078, China
| | - Qi-Lin Peng
- Department of Pharmacy, Xiangya Hospital Central South University, Changsha 410008, China
| | - Dan-Feng Cao
- Academician Workstation and Hunan Provincial University Key Laboratory of the Fundamental and Clinical Research on Functional Nucleic Acid, Changsha Medical University, Changsha 410219, China
| | - Zhao-Jun Wang
- Department of Clinical Pharmacology and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China; Institute of Clinical Pharmacology and Engineering Research Center of Applied Technology of Pharmacogenomics of Ministry of Education, Central South University, Changsha 410078, China
| | - Kai Zhang
- Department of Clinical Pharmacology and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China; Institute of Clinical Pharmacology and Engineering Research Center of Applied Technology of Pharmacogenomics of Ministry of Education, Central South University, Changsha 410078, China
| | - Xin-Yu Zhou
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang 222000, China; Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, China.
| | - Dong-Yu Min
- Key Laboratory of Ministry of Education for TCM Viscera-State Theory and Applications, Liaoning University of Traditional Chinese Medicine, Shenyang 116600, China; Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China.
| | - Bo-Ting Zhou
- Department of Pharmacy, Xiangya Hospital Central South University, Changsha 410008, China.
| | - Xiao-Yuan Mao
- Department of Clinical Pharmacology and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China; Institute of Clinical Pharmacology and Engineering Research Center of Applied Technology of Pharmacogenomics of Ministry of Education, Central South University, Changsha 410078, China.
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Miron G, Müller PM, Hohmann L, Oltmanns F, Holtkamp M, Meisel C, Chien C. Cortical Thickness Patterns of Cognitive Impairment Phenotypes in Drug-Resistant Temporal Lobe Epilepsy. Ann Neurol 2024; 95:984-997. [PMID: 38391006 DOI: 10.1002/ana.26893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE In temporal lobe epilepsy (TLE), a taxonomy classifying patients into 3 cognitive phenotypes has been adopted: minimally, focally, or multidomain cognitively impaired (CI). We examined gray matter (GM) thickness patterns of cognitive phenotypes in drug-resistant TLE and assessed potential use for predicting postsurgical cognitive outcomes. METHODS TLE patients undergoing presurgical evaluation were categorized into cognitive phenotypes. Network edge weights and distances were calculated using type III analysis of variance F-statistics from comparisons of GM regions within each TLE cognitive phenotype and age- and sex-matched healthy participants. In resected patients, logistic regression models (LRMs) based on network analysis results were used for prediction of postsurgical cognitive outcome. RESULTS A total of 124 patients (63 females, mean age ± standard deviation [SD] = 36.0 ± 12.0 years) and 117 healthy controls (63 females, mean age ± SD = 36.1 ± 12.0 years) were analyzed. In the multidomain CI group (n = 66, 53.2%), 28 GM regions were significantly thinner compared to healthy controls. Focally impaired patients (n = 37, 29.8%) showed 13 regions, whereas minimally impaired patients (n = 21, 16.9%) had 2 significantly thinner GM regions. Regions affected in both multidomain and focally impaired patients included the anterior cingulate cortex, medial prefrontal cortex, medial temporal, and lateral temporal regions. In 69 (35 females, mean age ± SD = 33.6 ± 18.0 years) patients who underwent surgery, LRMs based on network-identified GM regions predicted postsurgical verbal memory worsening with a receiver operating curve area under the curve of 0.70 ± 0.15. INTERPRETATION A differential pattern of GM thickness can be found across different cognitive phenotypes in TLE. Including magnetic resonance imaging with clinical measures associated with cognitive profiles has potential in predicting postsurgical cognitive outcomes in drug-resistant TLE. ANN NEUROL 2024;95:984-997.
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Affiliation(s)
- Gadi Miron
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Paul Manuel Müller
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Louisa Hohmann
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Frank Oltmanns
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Christian Meisel
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
| | - Claudia Chien
- Experimental Clinical and Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Neuroscience, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Pugh R, Vaughan DN, Jackson GD, Ponsford J, Tailby C. Cognitive and psychological dysfunction is present after a first seizure, prior to epilepsy diagnosis and treatment at a First Seizure Clinic. Epilepsia Open 2024; 9:717-726. [PMID: 38319041 PMCID: PMC10984291 DOI: 10.1002/epi4.12909] [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: 11/09/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Neuropsychological comorbidities found in chronic epilepsy have also been reported earlier in the disease course. However, recurrent seizures, antiseizure medication (ASM), and adjustment to a chronic diagnosis remain potential confounds of this literature. It thus remains unclear whether these comorbidities are primary or secondary attributes of epilepsy. To capture individuals as close to disease onset as possible, we studied the cognitive and psychological functioning in adults after their first seizure, yet prior to epilepsy diagnosis and treatment. METHODS Using a telehealth-based prospective design, we screened cognition, mood, and anxiety symptoms in adult patients referred to a First Seizure Clinic (FSC), who were over 18 years, English-speaking and not taking ASM. We screened cognition via telephone, and psychological symptoms via online questionnaires, all prior to the patients' diagnostic evaluation. Data were collected on 32 individuals subsequently diagnosed with epilepsy at the FSC, and 30 healthy controls from the community, who were matched to the epilepsy group for age, gender, and education. RESULTS A multivariate analysis of variance revealed that the groups differed significantly on combined cognitive measures with a large effect size (F[1,56] = 5.75, p < 0.001, η2 = 0.45). Post-hoc analyses showed that performances on measures of verbal memory, working memory, and executive functions were significantly worse for the newly diagnosed epilepsy group than controls. The epilepsy group also exhibited higher rates of clinically significant depressive and anxiety symptoms. SIGNIFICANCE Cognitive and psychological dysfunction is prevalent in people with epilepsy as early as the first seizure event, before the influence of diagnosis, ASM and recurrent seizures. Their neuropsychological profile parallels that seen in chronic epilepsy, showing that this dysfunction is already present at the very onset of the disease. The current study demonstrates the viability of telehealth neuropsychological screening for all new epilepsy cases. PLAIN LANGUAGE STATEMENT The results of this study show, using telephone-based cognitive assessment and online questionnaires, that people with newly diagnosed epilepsy can experience problems with their thinking and memory skills, and low mood and anxiety, as early as after their first seizure. These issues are apparent at the very beginning of the disease, before an epilepsy diagnosis is made and before antiseizure medication is commenced, which suggests that they are due to the underlying brain disturbance, rather than the secondary effects of seizures, treatment, or lifestyle changes. Telehealth-screening of thinking skills and mental health for all new epilepsy cases is recommended to promote early management of such problems.
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Affiliation(s)
- Remy Pugh
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
| | - David N. Vaughan
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
| | - Jennie Ponsford
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Epworth Rehabilitation Research CentreEpworth HealthcareMelbourneVictoriaAustralia
| | - Chris Tailby
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of Clinical NeuropsychologyAustin HealthMelbourneVictoriaAustralia
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Helmstaedter C, Tailby C, Witt JA. Neuropsychology of late-onset epilepsies. Seizure 2024:S1059-1311(24)00078-5. [PMID: 38555201 DOI: 10.1016/j.seizure.2024.03.010] [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: 01/18/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024] Open
Abstract
In an increasingly ageing society, patients ageing with epilepsy and those with late-onset epilepsies (LOE) represent a challenge for epilepsy care and treatment. Senescence itself bears risks of pathologies which in the form of acute focal damage (e.g. stroke) or slowly progressive degenerative damage can cause seizures and substantial cognitive impairment. There is converging evidence from studies in LOE that cognitive impairments are present from epilepsy onset before treatment is initiated and may even precede the emergence of seizures. This suggests that these impairments (like the seizures) are expressions of the underlying disease. Indeed, both seizures and cognitive impairments can be early indicators of disease conditions which lead to mental decline. Cognitive decline over time poses the challenge of disentangling the interrelation between seizures, treatment effects and underlying disease. This issue must be considered as some of the etiologies for causing neuropsychological decline can be addressed. Medication and active epilepsy can contribute to impairments and their impact may be reversible. Dementia is rare if seizures are what has brought the person to attention, and if this is not accompanied by other slowly developing features (such as cognitive of psychiatric changes). From a neuropsychological point of view choosing the right screening tools or assessments, obtaining the history and timeline of impairments in relation to epilepsy, and most importantly longitudinally following the patients regardless of whether epilepsy is ultimately controlled or not appear essential.
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Affiliation(s)
- C Helmstaedter
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany.
| | - C Tailby
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, 3084, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria 3010, Australia; Department of Clinical Neuropsychology, Austin Hospital, Heidelberg, Victoria, 3084, Australia
| | - J-A Witt
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
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Shariff S, Nouh HA, Inshutiyimana S, Kachouh C, Abdelwahab MM, Nazir A, Wojtara M, Uwishema O. Advances in understanding the pathogenesis of epilepsy: Unraveling the molecular mechanisms: A cross-sectional study. Health Sci Rep 2024; 7:e1896. [PMID: 38361811 PMCID: PMC10867297 DOI: 10.1002/hsr2.1896] [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: 08/30/2023] [Revised: 11/15/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Epilepsy is characterized by having two or more unprovoked seizures. Understanding the pathogenesis of epilepsy, requires deep investigation into the molecular mechanisms. This helps develop diagnostic techniques, treatments, and pharmacotherapy. It also enhances precision medicine and individualized treatment processes. This article reviews all the molecular mechanisms predisposing to epileptogenesis, presents the current diagnostic techniques and drug therapy, and suggests future perspectives in treating Epilepsy in a more comprehensive and holistic approach. Methodology Four authors searched keywords concerning epilepsy at a molecular level, Epilepsy diagnostic techniques and technologies, and antiepileptic drug therapy and precision medicine. Separate search strategies were conducted for each concern and retrieved articles were reviewed for relevant results. Results The traditional diagnostic techniques for Epilepsy and its pathogenesis are insufficient in highlighting dynamic brain changes. For this, emerging technologies including genetic sequencing and profiling, and functional neuroimaging techniques are prevailing. Concerning treatment, the current approach focuses on managing symptoms and stopping seizures using antiseizure medications. However, their usage is limited by developing resistance to such drugs. Some therapies show promise, although most antiseizure drugs do not prevent epilepsy. Discussion Understanding epileptogenesis at a molecular and genetic level aids in developing new antiepileptic pharmacotherapy. The aim is to develop therapies that could prevent seizures or modify disease course, decreasing the severity and avoiding drug resistance. Gene therapy and precision medicine are promising but applications are limited due to the heterogeneity in studying the Epileptic brain, dynamically. The dynamic investigation of the epileptic brain with its comorbidities works hand-in-hand with precision medicine, in developing personalized treatment plans.
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Affiliation(s)
- Sanobar Shariff
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineYerevan State Medical UniversityYerevanArmenia
| | - Halah A. Nouh
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineLebanese UniversityBeirutLebanon
| | - Samuel Inshutiyimana
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineUnited States International University‐AfricaNairobiKenya
| | - Charbel Kachouh
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineSaint‐Joseph UniversityBeirutLebanon
| | - Maya M. Abdelwahab
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineHelwan UniversityCairoEgypt
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Magda Wojtara
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineClinton Global Initiative UniversityNew YorkNew YorkUSA
- Faculty of MedicineKaradeniz Technical UniversityTrabzonTurkey
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Puteikis K, Wolf P, Mameniškienė R. Longer-term verbal and visual memory patterns in patients with temporal lobe and genetic generalized epilepsies. Epilepsia Open 2023; 8:1279-1287. [PMID: 37381720 PMCID: PMC10690666 DOI: 10.1002/epi4.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/24/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE To compare forgetting patterns between patients with temporal lobe (TLE) and generalized (GGE) epilepsies and to assess whether recall is associated with epileptic activity. METHODS Thirty-three patients with TLE (13 left, 17 right, and 3 nonlateralized TLE), 42 patients with GGE, and 57 healthy controls (HCs) were asked to recall words, verbal story material, and the Rey-Osterrieth complex figure at two delays. Accelerated long-term forgetting (ALF) was defined by group performance comparable to HCs at 30 min and worse recall than HCs after 4 weeks. ALF was assessed by comparing raw test scores in a two-way repeated measures analysis of variance (ANOVA) adjusted for the learning capacity. RESULTS Compared to HCs, patients with R-TLE remembered fewer items of the word list after 30 min as well as after 4 weeks. Patients with L-TLE and GGE had comparable learning-adjusted performance to HCs at the 30 min delay but scored less after 4 weeks (group by delay interaction F(3, 124) = 3.2, P = 0.026,η p 2 = 0.07). The epilepsy group (patients with TLE and GGE combined) performed as well as HCs at 30 min but worse after 4 weeks irrespective of experienced seizures during the 4-week delay or interictal bilateral (TLE) or generalized (GGE) activity before the study. We noted no statistically significant differences between patient and HC verbal story (group by delay interaction F(3, 124) = 0.7, P = 0.570,η p 2 = 0.02) or complex figure (F(3, 124) = 0.8, P = 0.488,η p 2 = 0.02) recall. SIGNIFICANCE Our data support verbal and visual memory impairment in both TLE and GGE with different performances between these groups in the task of word recall. We suggest the presence of ALF in patients with GGE and left TLE after adjusting for learning capacity. We could not confirm the influence of epileptic activity on long-term forgetting patterns. Future studies are required to better define domain-specific differences in memory impairment in TLE and GGE.
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Affiliation(s)
| | - Peter Wolf
- Center for NeurologyVilnius UniversityVilniusLithuania
- Danish Epilepsy Center FiladelfiaDianalundDenmark
- Postgraduation Program of Medical SciencesSanta Catarina Federal UniversityFlorianópolisBrazil
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10
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Puteikis K, Jakonienė A, Jasionis A, Wolf P, Mameniškienė R. Rehabilitation of cognition and psychosocial well-being - a better life with epilepsy (ReCaP-ABLE): a protocol for a randomized waitlist-controlled trial. Front Neurol 2023; 14:1273550. [PMID: 37965169 PMCID: PMC10641769 DOI: 10.3389/fneur.2023.1273550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Despite advances in the understanding of cognitive dysfunction among people with epilepsy (PWE), evidence for cognitive rehabilitation in epilepsy (CoRE) remains scarce. We present the protocol of a randomized waitlist-controlled trial (ClinicalTrials.gov ID NCT05934786) of a psychological-behavioral intervention aiming to ameliorate quality of life as well as cognitive functioning in a mixed PWE sample. The study is set at Vilnius University Hospital Santaros Klinikos and will offer adult PWE six individual and two group sessions led by a certified psychologist and directed toward improving memory, attention, self-regulation, mood and quality of life. The trial is expected to address major gaps in the literature by providing novel evidence on the effectiveness of CoRE in patients with genetic generalized epilepsies, the importance of epilepsy-specific factors for the response to CoRE, the impact of CoRE on long-term memory as well as its maintenance effects.
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Affiliation(s)
| | - Asta Jakonienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arminas Jasionis
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Peter Wolf
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Danish Epilepsy Center Filadelfia, Dianalund, Denmark
- Postgraduation Programme in Clinical Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Rūta Mameniškienė
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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11
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Huang XF, Xu MX, Chen YF, Lin YQ, Lin YX, Wang F. Serum neuronal pentraxin 2 is related to cognitive dysfunction and electroencephalogram slow wave/fast wave frequency ratio in epilepsy. World J Psychiatry 2023; 13:714-723. [PMID: 38058685 PMCID: PMC10696288 DOI: 10.5498/wjp.v13.i10.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Cognitive dysfunction in epileptic patients is a high-incidence complication. Its mechanism is related to nervous system damage during seizures, but there is no effective diagnostic biomarker. Neuronal pentraxin 2 (NPTX2) is thought to play a vital role in neurotransmission and the maintenance of synaptic plasticity. This study explored how serum NPTX2 and electroencephalogram (EEG) slow wave/fast wave frequency ratio relate to cognitive dysfunction in patients with epilepsy. AIM To determine if serum NPTX2 could serve as a potential biomarker for diagnosing cognitive impairment in epilepsy patients. METHODS The participants of this study, conducted from January 2020 to December 2021, comprised 74 epilepsy patients with normal cognitive function (normal group), 37 epilepsy patients with cognitive dysfunction [epilepsy patients with cognitive dysfunction (ECD) group] and 30 healthy people (control group). The mini-mental state examination (MMSE) scale was used to evaluate cognitive function. We determined serum NPTX2 levels using an enzyme-linked immunosorbent kit and calculated the signal value of EEG regions according to the EEG recording. Pearson correlation coefficient was used to analyze the correlation between serum NPTX2 and the MMSE score. RESULTS The serum NPTX2 level in the control group, normal group and ECD group were 240.00 ± 35.06 pg/mL, 235.80 ± 38.01 pg/mL and 193.80 ± 42.72 pg/mL, respectively. The MMSE score was lowest in the ECD group among the three, while no significant difference was observed between the control and normal groups. In epilepsy patients with cognitive dysfunction, NPTX2 level had a positive correlation with the MMSE score (r = 0.367, P = 0.0253) and a negative correlation with epilepsy duration (r = -0.443, P = 0.0061) and the EEG slow wave/fast wave frequency ratio value in the temporal region (r = -0.339, P = 0.039). CONCLUSION Serum NPTX2 was found to be related to cognitive dysfunction and the EEG slow wave/fast wave frequency ratio in patients with epilepsy. It is thus a potential biomarker for the diagnosis of cognitive impairment in patients with epilepsy.
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Affiliation(s)
- Xiao-Fen Huang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Ming-Xia Xu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Yue-Fan Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Yun-Qing Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Feng Wang
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, Fujian Province, China
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12
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Nieoczym D, Banono NS, Stępnik K, Kaczor AA, Szybkowski P, Esguerra CV, Kukula-Koch W, Gawel K. In Silico Analysis, Anticonvulsant Activity, and Toxicity Evaluation of Schisandrin B in Zebrafish Larvae and Mice. Int J Mol Sci 2023; 24:12949. [PMID: 37629132 PMCID: PMC10455331 DOI: 10.3390/ijms241612949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study is to evaluate the anticonvulsant potential of schisandrin B, a main ingredient of Schisandra chinensis extracts. Schisandrin B showed anticonvulsant activity in the zebrafish larva pentylenetetrazole acute seizure assay but did not alter seizure thresholds in the intravenous pentylenetetrazole test in mice. Schisandrin B crosses the blood-brain barrier, which we confirmed in our in silico and in vivo analyses; however, the low level of its unbound fraction in the mouse brain tissue may explain the observed lack of anticonvulsant activity. Molecular docking revealed that the anticonvulsant activity of the compound in larval zebrafish might have been due to its binding to a benzodiazepine site within the GABAA receptor and/or the inhibition of the glutamate NMDA receptor. Although schisandrin B showed a beneficial anticonvulsant effect, toxicological studies revealed that it caused serious developmental impairment in zebrafish larvae, underscoring its teratogenic properties. Further detailed studies are needed to precisely identify the properties, pharmacological effects, and safety of schisandrin B.
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Affiliation(s)
- Dorota Nieoczym
- Department of Animal Physiology and Pharmacology, Institute of Biological Sciences, Faculty of Biology and Biotechnology, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland
| | - Nancy Saana Banono
- Chemical Neuroscience Group, Centre for Molecular Medicine Norway, University of Oslo, Gaustadalleen 21, Forskningsparken, 0349 Oslo, Norway; (N.S.B.); (C.V.E.)
| | - Katarzyna Stępnik
- Department of Physical Chemistry, Institute of Chemical Sciences, Faculty of Chemistry, Maria Curie-Skłodowska University, Pl. M. Curie-Skłodowskiej 3/243, 20-031 Lublin, Poland;
| | - Agnieszka A. Kaczor
- Department of Synthesis and Chemical Technology of Pharmaceutical Substances with Computer Modeling Laboratory, Faculty of Pharmacy, Medical University of Lublin, 4A Chodzki St., 20-093 Lublin, Poland;
| | - Przemysław Szybkowski
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Jaczewskiego St. 8b, 20-090 Lublin, Poland;
- Clinical Provincial Hospital No. 2 St. Jadwiga Krolowej in Rzeszow, Lwowska St. 60, 35-301 Rzeszow, Poland
| | - Camila Vicencio Esguerra
- Chemical Neuroscience Group, Centre for Molecular Medicine Norway, University of Oslo, Gaustadalleen 21, Forskningsparken, 0349 Oslo, Norway; (N.S.B.); (C.V.E.)
| | - Wirginia Kukula-Koch
- Department of Pharmacognosy with Medicinal Plants Garden, Medical University of Lublin, Chodźki St. 1, 20-093 Lublin, Poland;
| | - Kinga Gawel
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Jaczewskiego St. 8b, 20-090 Lublin, Poland;
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13
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Bosco F, Guarnieri L, Rania V, Palma E, Citraro R, Corasaniti MT, Leo A, De Sarro G. Antiseizure Medications in Alzheimer's Disease from Preclinical to Clinical Evidence. Int J Mol Sci 2023; 24:12639. [PMID: 37628821 PMCID: PMC10454935 DOI: 10.3390/ijms241612639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Alzheimer's disease (AD) and epilepsy are common neurological disorders in the elderly. A bi-directional link between these neurological diseases has been reported, with patients with either condition carrying almost a two-fold risk of contracting the other compared to healthy subjects. AD/epilepsy adversely affects patients' quality of life and represents a severe public health problem. Thus, identifying the relationship between epilepsy and AD represents an ongoing challenge and continuing need. Seizures in AD patients are often unrecognized because they are often nonconvulsive and sometimes mimic some behavioral symptoms of AD. Regarding this, it has been hypothesized that epileptogenesis and neurodegeneration share common underlying mechanisms. Targeted treatment to decrease epileptiform activity could represent a valuable strategy for delaying the neurodegenerative process and related cognitive impairment. Several preclinical studies have shown that some antiseizure medications (ASMs) targeting abnormal network hyperexcitability may change the natural progression of AD. However, to date, no guidelines are available for managing seizures in AD patients because of the paucity of randomized clinical trials sufficient for answering the correlated questions. Future AD clinical studies are mandatory to update clinicians about the symptomatic treatment of seizures in AD patients and recognize whether ASM therapy could change the natural progression of the disease, thereby rescuing cognitive performance.
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Affiliation(s)
- Francesca Bosco
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
| | - Lorenza Guarnieri
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
| | - Vincenzo Rania
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
| | - Ernesto Palma
- Department of Health Sciences, School of Pharmacy, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (E.P.); (M.T.C.)
| | - Rita Citraro
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
- System and Applied Pharmacology, University Magna Graecia (FAS@UMG) Research Center, Department of Health Sciences, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Maria Tiziana Corasaniti
- Department of Health Sciences, School of Pharmacy, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (E.P.); (M.T.C.)
| | - Antonio Leo
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
- System and Applied Pharmacology, University Magna Graecia (FAS@UMG) Research Center, Department of Health Sciences, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
- System and Applied Pharmacology, University Magna Graecia (FAS@UMG) Research Center, Department of Health Sciences, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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14
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Hoxhaj P, Habiya SK, Sayabugari R, Balaji R, Xavier R, Ahmad A, Khanam M, Kachhadia MP, Patel T, Abdin ZU, Haider A, Nazir Z. Investigating the Impact of Epilepsy on Cognitive Function: A Narrative Review. Cureus 2023; 15:e41223. [PMID: 37525802 PMCID: PMC10387362 DOI: 10.7759/cureus.41223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/02/2023] Open
Abstract
It has been noted that people who have epilepsy have an increased propensity for cognitive dysfunction. We explored 25 relevant articles on PubMed and Cochrane Library after implementing inclusion criteria. Different factors have been postulated and studied that may cause cognitive dysfunction in these patients; structural brain abnormalities, polypharmacy of antiepileptic medication, and neuropsychiatric disorders are the most common causes. Cognitive assessments such as Montreal Cognitive Assessment (MOCA) and Mini-Mental State Exam (MMSE) are the mainstay tools used to diagnose the degree of cognitive decline, and alterations in EEG (electroencephalogram) parameters have also been noted in people with cognitive decline. The mechanisms and treatments for cognitive decline are still being studied, while attention has also been directed toward preventive and predictive methods. Early detection and treatment of cognitive impairment can help minimize its impact on the patient's quality of life. Regular cognitive assessments are essential for epileptic patients, particularly those on multiple antiepileptic drugs. While proper management of epilepsy and related comorbidities would reduce cognitive decline and improve the overall quality of life for people with epilepsy.
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Affiliation(s)
- Pranvera Hoxhaj
- Medicine, University of Medicine, Tirana, Tirana, ALB
- Obstetrics and Gynaecology, Scher & Kerenyi MDS, New York, USA
| | - Sana K Habiya
- Internal Medicine, Indian Institute of Medical Science and Research, Jalna, IND
- Public Health, Northeastern Illinois University, Chicago, USA
| | | | - Roghan Balaji
- Neurology, Ponjesly Super Speciality Hospital, Nagercoil, IND
- Neurology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, IND
| | - Roshni Xavier
- Internal Medicine, Rajagiri Hospital, Aluva, IND
- Internal Medicine, Carewell Hospital, Malappuram, IND
| | - Arghal Ahmad
- Internal Medicine, Ziauddin University, Karachi, PAK
| | | | | | - Tirath Patel
- Internal Medicine, American University of Antigua, St John, ATG
| | - Zain U Abdin
- Internal Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Ali Haider
- Internal Medicine, Quetta Institute of Medical Sciences, Quetta, PAK
| | - Zahra Nazir
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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15
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Yu Y, Qiu M, Zou W, Zhao Y, Tang Y, Tian J, Chen X, Qiu W. Impaired rich-club connectivity in childhood absence epilepsy. Front Neurol 2023; 14:1135305. [PMID: 37251238 PMCID: PMC10213928 DOI: 10.3389/fneur.2023.1135305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Childhood absence epilepsy (CAE) is a well-known pediatric epilepsy syndrome. Recent evidence has shown the presence of a disrupted structural brain network in CAE. However, little is known about the rich-club topology. This study aimed to explore the rich-club alterations in CAE and their association with clinical characteristics. Methods Diffusion tensor imaging (DTI) datasets were acquired in a sample of 30 CAE patients and 31 healthy controls. A structural network was derived from DTI data for each participant using probabilistic tractography. Then, the rich-club organization was examined, and the network connections were divided into rich-club connections, feeder connections, and local connections. Results Our results confirmed a less dense whole-brain structural network in CAE with lower network strength and global efficiency. In addition, the optimal organization of small-worldness was also damaged. A small number of highly connected and central brain regions were identified to form the rich-club organization in both patients and controls. However, patients exhibited a significantly reduced rich-club connectivity, while the other class of feeder and local connections was relatively spared. Moreover, the lower levels of rich-club connectivity strength were statistically correlated with disease duration. Discussion Our reports suggest that CAE is characterized by abnormal connectivity concentrated to rich-club organizations and might contribute to understanding the pathophysiological mechanism of CAE.
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Affiliation(s)
- Yadong Yu
- Department of Neurology, Lianshui County People's Hospital, Huai'an, China
| | - Mengdi Qiu
- Department of Neurology, The Fifth People's Hospital of Huai'an, Huai'an, China
| | - Wenwei Zou
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Ying Zhao
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Yan Tang
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Jisha Tian
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Xiaoyu Chen
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Wenchao Qiu
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
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16
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Perinelli MG, Riva A, Amadori E, Follo R, Striano P. Learnings in developmental and epileptic encephalopathies: what do we know? Expert Rev Neurother 2023; 23:45-57. [PMID: 36726225 DOI: 10.1080/14737175.2023.2176221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Developmental and Epileptic Encephalopathies (DEEs) encompass a group of neurological disorders caused by either abnormal neuronal development and white matter maturation or even by weak synaptic plasticity. Hitherto, patients commonly have epileptic seizures featuring cognitive dysfunction, such as neurosensory disorders, difficulties in learning, behavioral disturbances, or speech delay. AREAS COVERED This paper provides a comprehensive review of the current knowledge of DEEs and cognition. Medline/Pubmed database was screened for in-English articles published between 1967-2022 dealing with the topic of DEEs and cognitive development. Two authors independently screened the title and abstract of each record and reviewed the selected articles. Reviews, randomized clinical trials, and case reports were selected. EXPERT OPINION Scientific literature has never explicitly dealt with the early neuro-psychomotor rehabilitation and neuropsychological assessment of patients with DEEs. Targeted intervention and environmental stimuli can influence the maturation of neuronal circuits and shape changes in physical and mental development based on neuronal plasticity, particularly if applied in 'critical periods' liable to heightened sensitivity. Thus, 'early neurorehabilitation interventions' are worthy of being more and more applied to clinical practice to improve the quality of life and reduce the psychosocial burden on families and caregivers.
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Affiliation(s)
- Martina Giorgia Perinelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisabetta Amadori
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
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17
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DeFelipe J, DeFelipe-Oroquieta J, Furcila D, Muñoz-Alegre M, Maestú F, Sola RG, Blázquez-Llorca L, Armañanzas R, Kastanaskaute A, Alonso-Nanclares L, Rockland KS, Arellano JI. Neuroanatomical and psychological considerations in temporal lobe epilepsy. Front Neuroanat 2022; 16:995286. [PMID: 36590377 PMCID: PMC9794593 DOI: 10.3389/fnana.2022.995286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/11/2022] [Indexed: 01/03/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy and is associated with a variety of structural and psychological alterations. Recently, there has been renewed interest in using brain tissue resected during epilepsy surgery, in particular 'non-epileptic' brain samples with normal histology that can be found alongside epileptic tissue in the same epileptic patients - with the aim being to study the normal human brain organization using a variety of methods. An important limitation is that different medical characteristics of the patients may modify the brain tissue. Thus, to better determine how 'normal' the resected tissue is, it is fundamental to know certain clinical, anatomical and psychological characteristics of the patients. Unfortunately, this information is frequently not fully available for the patient from which the resected tissue has been obtained - or is not fully appreciated by the neuroscientists analyzing the brain samples, who are not necessarily experts in epilepsy. In order to present the full picture of TLE in a way that would be accessible to multiple communities (e.g., basic researchers in neuroscience, neurologists, neurosurgeons and psychologists), we have reviewed 34 TLE patients, who were selected due to the availability of detailed clinical, anatomical, and psychological information for each of the patients. Our aim was to convey the full complexity of the disorder, its putative anatomical substrates, and the wide range of individual variability, with a view toward: (1) emphasizing the importance of considering critical patient information when using brain samples for basic research and (2) gaining a better understanding of normal and abnormal brain functioning. In agreement with a large number of previous reports, this study (1) reinforces the notion of substantial individual variability among epileptic patients, and (2) highlights the common but overlooked psychopathological alterations that occur even in patients who become "seizure-free" after surgery. The first point is based on pre- and post-surgical comparisons of patients with hippocampal sclerosis and patients with normal-looking hippocampus in neuropsychological evaluations. The second emerges from our extensive battery of personality and projective tests, in a two-way comparison of these two types of patients with regard to pre- and post-surgical performance.
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Affiliation(s)
- Javier DeFelipe
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain,*Correspondence: Javier DeFelipe,
| | - Jesús DeFelipe-Oroquieta
- Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Facultad de Educación, Universidad Camilo José Cela, Madrid, Spain
| | - Diana Furcila
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Mar Muñoz-Alegre
- Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Madrid, Spain
| | - Fernando Maestú
- Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain,Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | - Rafael G. Sola
- Cátedra UAM de “Innovación en Neurocirugía”, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lidia Blázquez-Llorca
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Sección Departamental de Anatomía y Embriología, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén Armañanzas
- Institute of Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain,Tecnun School of Engineering, Universidad de Navarra, Donostia-San Sebastian, Spain
| | - Asta Kastanaskaute
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Lidia Alonso-Nanclares
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Kathleen S. Rockland
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Jon I. Arellano
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States
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18
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On epilepsy perception: Unravelling gaps and issues. Epilepsy Behav 2022; 137:108952. [PMID: 36306590 DOI: 10.1016/j.yebeh.2022.108952] [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: 05/02/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
Epilepsy is one of the most common neurological diseases, but it can sometimes be under-reported or have a time delay in diagnosis. This data is not surprising if we consider that a person often seeks medical attention only after presenting a generalized tonic-clonic seizure. Epilepsy diagnostic delay is caused by several factors: under-reporting by patients, under-diagnosed epileptic manifestations by inexperienced clinicians, and lack of time in the emergency setting. The consequences of this delay are increased accidents, a high rate of premature mortality, and economic expanses for the healthcare system. Moreover, people with epilepsy have a higher probability of comorbidities than the general population, such as mood disorders or cognitive problems. Along with recurrent seizures, these comorbid diseases promote isolation and stigmatization of people with epilepsy, who suffer from discrimination at school, in the workplace, and even in social relationships. Public awareness of epilepsy and its comorbidities is necessary to prevent diagnostic delays and overcome social and professional iniquities for people with epilepsy.
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Leo A, Tallarico M, Sciaccaluga M, Citraro R, Costa C. Epilepsy and Alzheimer's Disease: Current Concepts and Treatment Perspective on Two Closely Related Pathologies. Curr Neuropharmacol 2022; 20:2029-2033. [PMID: 35524669 PMCID: PMC9886839 DOI: 10.2174/1570159x20666220507020635] [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: 10/22/2021] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 11/22/2022] Open
Abstract
The literature on epileptic seizures in Alzheimer's disease has significantly increased over the past decades. Remarkably, several studies suggest a bi-directional link between these two common neurological diseases, with either condition carrying a nearly 2-fold risk of contracting the other in comparison to healthy subjects. In this respect, evidence from both clinical and preclinical studies indicates that epileptogenesis and neurodegeneration possibly share common underlying mechanisms. However, the precise association between epileptogenesis and neurodegeneration still needs to be fully elucidated. Targeted intervention to reduce abnormal network hyperexcitability might constitute a therapeutic strategy to postpone the onset of later neurodegenerative changes and consequent cognitive decline by many years in patients. By virtue of this, an early diagnosis and treatment of seizures in patients with Alzheimer's disease should be pursued. To date, no guidelines are available for treating epileptic activity in this context, largely due to the paucity of studies sufficient to answer the related questions. Accordingly, clinical trials are mandatory, not only to inform clinicians about symptomatic management of seizures in Alzheimer's disease patients but also to detect if treatment with antiseizure medications could have disease-modifying effects. Moreover, it will be fundamental to expand the application of animal models of Alzheimer's disease to comorbid conditions, such as epilepsy both to reveal the mechanisms underlying seizure onset and to better define their role in cognitive decline. Such models could also be useful to identify pharmacological compounds having therapeutically effectiveness as well as reliable early biomarkers for seizures in Alzheimer's disease.
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Affiliation(s)
- Antonio Leo
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy;
| | - Martina Tallarico
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy;
| | - Miriam Sciaccaluga
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Rita Citraro
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy; ,Address correspondence to this author at the Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Viale Europa – Germaneto 88100 Catanzaro, Italy; Tel: +39 0961 3694191; Fax: +39 0961 3694192; E-mail:
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia, Italy
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Mayo J, Panahi S, Roghani A, Van Cott AC, Pugh MJ. Treatment of Epilepsy in the Setting of Cognitive Decline in Older Adults. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Parvizi F, Mehrabi S, Naghizadeh A, Kamalinejad M, Goudarzi S, Farahmandfar M. Comparison of intranasal and intraperitoneal administration of Eugenia caryophyllata (clove) essential oil on spatial memory, anxiety-like behavior and locomotor activity in a pilocarpine-induced status epilepticus rat model. BMC Complement Med Ther 2022. [PMCID: PMC9426212 DOI: 10.1186/s12906-022-03711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epilepsy induces behavioral effects and histological changes in the hippocampus. Eugenol, the main component of clove essential oil, has modulatory effects on seizure. We aimed to investigate the effect of intraperitoneal (IP) and intranasal (IN) clove essential oil on cognitive and histological changes during the chronic phase of temporal lope epilepsy.
Methods
Male Wistar rats were divided into eight groups of seven including control, pilocarpine (PLC), clove oil (IP and IN), sesame oil (IP and IN), phenobarbital (positive control) and saline. Rats were injected with 350 mg/kg PLC to induce status epilepticus (SE). We evaluated the effects of 14 days IP (0.1 ml/kg) and IN (0.02 ml/kg) administration of clove essential oil on locomotor/explorative activity, anxiety-like behavior, spatial recognition memory, and hyperexcitability, as well as hippocampal cell survival in PLC-treated rats.
Results
Our findings indicated that clove oil could effectively ameliorate PLC-induced behavioral deficits, and also alleviate neuronal death in the cornu ammonis 1 (CA1) region of the hippocampus. Behavioral results as in the Y-maze, Open field and elevated plus maze featured significant differences between control and treated groups. Post-seizure behavioral battery (PBSS) results explicated that behavioral hyperexcitability were less in clove oil groups (both IN and IP) compared to PLC-treated rats. Moreover, results of this study demonstrated that IN administration of clove oil was more potent in alleviating behavioral impairment at a lower dosage than by IP route. The results of this study, also demonstrated that intranasal administration of clove oil could reduce duration of recurrent seizures.
Conclusion
In summary, clove oil treatment ameliorated histopathological and behavioral consequences of PLC-induced SE.
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22
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Zhang D, Chen S, Xu S, Wu J, Zhuang Y, Cao W, Chen X, Li X. The clinical correlation between Alzheimer's disease and epilepsy. Front Neurol 2022; 13:922535. [PMID: 35937069 PMCID: PMC9352925 DOI: 10.3389/fneur.2022.922535] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Alzheimer's disease and epilepsy are common nervous system diseases in older adults, and their incidence rates tend to increase with age. Patients with mild cognitive impairment and Alzheimer's disease are more prone to have seizures. In patients older than 65 years, neurodegenerative conditions accounted for ~10% of all late-onset epilepsy cases, most of which are Alzheimer's disease. Epilepsy and seizure can occur in the early and late stages of Alzheimer's disease, leading to functional deterioration and behavioral alterations. Seizures promote amyloid-β and tau deposits, leading to neurodegenerative processes. Thus, there is a bi-directional association between Alzheimer's disease and epilepsy. Epilepsy is a risk factor for Alzheimer's disease and, in turn, Alzheimer's disease is an independent risk factor for developing epilepsy in old age. Many studies have evaluated the shared pathogenesis and clinical relevance of Alzheimer's disease and epilepsy. In this review, we discuss the clinical associations between Alzheimer's disease and epilepsy, including their incidence, clinical features, and electroencephalogram abnormalities. Clinical studies of the two disorders in recent years are summarized, and new antiepileptic drugs used for treating Alzheimer's disease are reviewed.
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Hasegawa N, Annaka H. Cognitive features of adult focal epilepsy with unknown etiology revealed by the trail making test. Epilepsy Behav 2022; 129:108625. [PMID: 35245763 DOI: 10.1016/j.yebeh.2022.108625] [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: 09/17/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether the Trail Making Test (TMT) can clarify cognitive dysfunction in focal epilepsy with unknown etiology. METHODS Trail Making Test data were obtained from patients with focal epilepsy with no structural abnormalities on magnetic resonance imaging, history or coexistence of central nerve system diseases, intellectual disability, psychiatric disorders, or medications that might interfere with cognitive function. We performed multiple regression analyses with TMT scores as dependent variables and clinical features as independent variables. RESULTS We enrolled 125 patients in the study. The statistical analyses revealed that taking fewer antiseizure medications, having a longer duration of education, exhibiting left non-temporal epileptic discharge, and exhibiting right temporal epileptic discharge were associated with shorter time to complete the TMT-A and TMT-B. Older age at the time of last seizure was associated with longer time to complete the TMT-B. In addition, a longer active seizure period was associated with longer time to complete the TMT-A subtracted from time to complete the TMT-B. CONCLUSIONS This study indicated that the TMT can be used for assessing the cumulative effects of seizures and the effects of polypharmacy on cognitive function in patients with focal epilepsy. Furthermore, our results indicated that the visuospatial cognitive ability associated with the TMT may depend on the site of epileptic focus of non-lesional focal epilepsy.
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Affiliation(s)
- Naoya Hasegawa
- Department of Psychiatry, National Hospital Organization, Nishiniigata Chuo Hospital Epilepsy Center, 1-14-1 Masago, Nishi-ku, Niigata 950-2085 Japan.
| | - Hiroki Annaka
- Department of Rehabilitation, National Hospital Organization, Nishiniigata Chuo Hospital Epilepsy Center, 1-14-1 Masago, Nishi-ku, Niigata 950-2085 Japan; Graduate School, Niigata University of Health and Welfare, 1398 Shimami-tyou, Kita-ku, Niigata, Niigata 950-3198 Japan
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Abstract
PURPOSE OF REVIEW This article focuses on the evaluation of children and adults who present with new-onset seizures, with an emphasis on differential diagnosis, classification, evaluation, and management. RECENT FINDINGS New-onset seizures are a common presentation in neurologic practice, affecting approximately 8% to 10% of the population. Accurate diagnosis relies on a careful history to exclude nonepileptic paroxysmal events. A new classification system was accepted in 2017 by the International League Against Epilepsy, which evaluates seizure type(s), epilepsy type, epilepsy syndrome, etiology, and comorbidities. Accurate classification informs the choice of investigations, treatment, and prognosis. Guidelines for neuroimaging and laboratory and genetic testing are summarized. SUMMARY Accurate diagnosis and classification of first seizures and new-onset epilepsy are key to choosing optimal therapy to maximize seizure control and minimize comorbidities.
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Larnyo E, Dai B, Nutakor JA, Ampon-Wireko S, Larnyo A, Appiah R. Examining the impact of socioeconomic status, demographic characteristics, lifestyle and other risk factors on adults' cognitive functioning in developing countries: an analysis of five selected WHO SAGE Wave 1 Countries. Int J Equity Health 2022; 21:31. [PMID: 35216605 PMCID: PMC8876754 DOI: 10.1186/s12939-022-01622-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Though extensive studies have been conducted on assessing the predictors of cognitive functioning among older adults in small community-based samples, very few studies have focused on understanding the impact of socioeconomic status (SES), demographic characteristics and other risk factors such as lifestyle and chronic diseases on the cognitive functioning among adults of all ages in a nationally representative population-based sample across low- and middle-income countries. This study, therefore, seeks to evaluate the impact of SES, demographic characteristics and risk factors on the cognitive functioning of adults across all ages in five selected developing countries. Methods Data from 12,430 observations obtained from the WHO Study on Global AGEing and Adult Health (SAGE) Wave 1; consisting of 2,486 observations each for China, Ghana, India, the Russian Federation, and South Africa, were used for the study. A meta-regression and a five-step hierarchical linear regression were used to analyze the data, with cognitive functioning as the dependent variable. Independent variables used in this study include SES; assessed by household income and education, demographic characteristics, other risk factors such as lifestyle, self-reported memory difficulty and chronic diseases. Results This study found that SES and lifestyle significantly predicted cognitive functioning in all the five selected countries as obtained by the pooled results of the meta-regression analysis. The hierarchical linear regression results also revealed that demographic characteristics such as age, type of residency, and self-reported memory difficulty significantly impact cognitive functioning in China, Ghana, Russia, and South Africa. Conclusion The findings in this study provide new insights for policymakers, caregivers, parents, and individuals, especially those in developing countries, to implement policies and actions targeted at improving SES and eliminating risk factors associated with cognitive decline, as these measures could help improve the cognitive functioning among their populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01622-7.
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Affiliation(s)
- Ebenezer Larnyo
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China. .,Department of Labor and Social Security, School of Public Health, Southeast University, 87# Dingjiaqiao, Nanjing, 210009, Jiangsu province, China.
| | - Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Sabina Ampon-Wireko
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Abigail Larnyo
- School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Ruth Appiah
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
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Martínez-Aguirre C, Cinar R, Rocha L. Targeting Endocannabinoid System in Epilepsy: For Good or for Bad. Neuroscience 2021; 482:172-185. [PMID: 34923038 DOI: 10.1016/j.neuroscience.2021.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023]
Abstract
Epilepsy is a neurological disorder with a high prevalence worldwide. Several studies carried out during the last decades indicate that the administration of cannabinoids as well as the activation of the endocannabinoid system (ECS) represent a therapeutic strategy to control epilepsy. However, there are controversial studies indicating that activation of ECS results in cell damage, inflammation and neurotoxicity, conditions that facilitate the seizure activity. The present review is focused to present findings supporting this issue. According to the current discrepancies, it is relevant to elucidate the different effects induced by the activation of ECS and determine the conditions under which it facilitates the seizure activity.
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Affiliation(s)
| | - Resat Cinar
- Section on Fibrotic Disorders, National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health (NIH), Rockville, USA
| | - Luisa Rocha
- Department of Pharmacobiology, Center for Research and Advanced Studies, Mexico City, Mexico.
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The link between neurology and behavior in veterinary medicine: A review. J Vet Behav 2021. [DOI: 10.1016/j.jveb.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sex differences in factors associated with quality of life in patients with epilepsy in Northeast China. Epilepsy Behav 2021; 121:108076. [PMID: 34082318 DOI: 10.1016/j.yebeh.2021.108076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/10/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to investigate sex differences in factors associated with poor quality of life (QOL) in a cohort of patients with epilepsy (PWE) in Northeast China. METHODS A consecutive cohort of 221 PWE from the First Hospital of Jilin University was recruited. The Chinese versions of the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Quality of Life in Epilepsy Inventory (QOLIE-31) were used to measure depressive symptoms, anxiety symptoms, and the QOL. RESULTS A total of 221 adult PWE participated in this study. In the multivariate regression model, three independent factors were found to be significantly associated with the total QOLIE-31 score in men: epilepsy duration (p = 0.007), the PHQ-9 score (p < 0.001), and the BAI score (p < 0.001). As for the subscale domain of QOL, marital status showed a relationship with cognitive function (p = 0.047), and residence was related with medication effects (p = 0.034). Two independent factors were found to be significantly associated with the total QOLIE-31 score in women: the PHQ-9 score (p < 0.001) and the BAI score (p < 0.001). The education level of women was positively associated with three subdomain scores of QOL, including overall QOL (p < 0.001), emotional well-being (p = 0.028), and energy/fatigue (p = 0.025). CONCLUSION We found that high levels of depressive and anxiety symptoms are strong predictors of a poor QOL in both men and women. Sex differences also occur in several demographic and clinical factors influencing the overall QOL or subscale domain scores such as epilepsy duration, marital status, and educational level. Timely diagnosis and treatment of psychiatric comorbidities might be crucial for improving the QOL in both men and women.
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Duckrow RB, Ceolini E, Zaveri HP, Brooks C, Ghosh A. Artificial neural network trained on smartphone behavior can trace epileptiform activity in epilepsy. iScience 2021; 24:102538. [PMID: 34308281 PMCID: PMC8257969 DOI: 10.1016/j.isci.2021.102538] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022] Open
Abstract
A range of abnormal electrical activity patterns termed epileptiform discharges can occur in the brains of persons with epilepsy. These epileptiform discharges can be monitored and recorded with implanted devices that deliver therapeutic neurostimulation. These continuous recordings provide an opportunity to study the behavioral correlates of epileptiform discharges as the patients go about their daily lives. Here, we captured the smartphone touchscreen interactions in eight patients in conjunction with electrographic recordings (accumulating 35,714 h) and by using an artificial neural network model addressed if the behavior reflected the epileptiform discharges. The personalized model outputs based on smartphone behavioral inputs corresponded well with the observed electrographic data (R: 0.2-0.6, median 0.4). The realistic reconstructions of epileptiform activity based on smartphone use demonstrate how day-to-day digital behavior may be converted to personalized markers of disease activity in epilepsy.
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Affiliation(s)
| | - Enea Ceolini
- QuantActions GmbH, Lausanne, Switzerland
- Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden 2333 AK, The Netherlands
| | | | - Cornell Brooks
- Department of Neurology, Yale University, New Haven, CT, USA
- Amherst College, Amherst, MA, USA
| | - Arko Ghosh
- Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden 2333 AK, The Netherlands
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Associations of individual and structural socioeconomic status with cognition and mental distress in pharmacoresistant focal epilepsy. Epilepsy Behav 2021; 116:107726. [PMID: 33493801 DOI: 10.1016/j.yebeh.2020.107726] [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: 10/04/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Epilepsy is often associated with low socioeconomic status (SES). People with epilepsy (PWE) also suffer from cognitive dysfunction and mental distress. In the general population, these constraints are related to individual and structural SES. However, in PWE, cognitive dysfunction and mental distress have been mainly attributed to biological factors such as brain lesions or pharmacological treatment, whereas comprehensive studies on possible social determinants are missing. Here, we study associations of individual and structural SES with cognition and mental distress in PWE. METHODS We retrospectively studied 340 adult patients with pharmacoresistant focal epilepsy from Berlin treated at a tertiary epilepsy center. Individual SES (education, employment, and income), structural SES (social index of district and neighborhood), and their interactions were examined. Associations between social variables and verbal learning, psychomotor speed, and mental distress were analyzed with multiple regression analyses, controlling for demographic and medical variables and intelligence. RESULTS Our sample had lower educational levels and lived more frequently in low SES neighborhoods compared to the general population of Berlin. Thirty percent showed reduced verbal learning, 31% had deficits in psychomotor speed, and 20% revealed significant mental distress. Lower structural SES was related to lower psychomotor speed (ΔR2 = 0.9%) and higher mental distress (ΔR2 = 1.6%). Employment was related to verbal learning (ΔR2 = 0.7%) and psychomotor speed (ΔR2 = 1.2%). Income and education were linked to mental distress (ΔR2 = 5%). Neighborhood and individual SES covered more than half of the explained variance in mental distress. Furthermore, interactions between individual and structural SES were identified. CONCLUSION We confirm cognitive deficits, significant mental distress, and individual and structural social disadvantage in PWE. Our findings indicate that individual and structural SES are related to cognitive and emotional well-being beyond demographic and medical characteristics. As a clinical implication, individual and structural SES should be considered when interpreting neuropsychological findings.
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