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Kim KM, Choi BK, Ha WS, Cho S, Chu MK, Heo K, Kim WJ. Development and Validation of Artificial Intelligence Models for Prognosis Prediction of Juvenile Myoclonic Epilepsy with Clinical and Radiological Features. J Clin Med 2024; 13:5080. [PMID: 39274294 PMCID: PMC11396353 DOI: 10.3390/jcm13175080] [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: 08/03/2024] [Revised: 08/18/2024] [Accepted: 08/26/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Juvenile myoclonic epilepsy (JME) is a common adolescent epilepsy characterized by myoclonic, generalized tonic-clonic, and sometimes absence seizures. Prognosis varies, with many patients experiencing relapse despite pharmacological treatment. Recent advances in imaging and artificial intelligence suggest that combining microstructural brain changes with traditional clinical variables can enhance potential prognostic biomarkers identification. Methods: A retrospective study was conducted on patients with JME at the Severance Hospital, analyzing clinical variables and magnetic resonance imaging (MRI) data. Machine learning models were developed to predict prognosis using clinical and radiological features. Results: The study utilized six machine learning models, with the XGBoost model demonstrating the highest predictive accuracy (AUROC 0.700). Combining clinical and MRI data outperformed models using either type of data alone. The key features identified through a Shapley additive explanation analysis included the volumes of the left cerebellum white matter, right thalamus, and left globus pallidus. Conclusions: This study demonstrated that integrating clinical and radiological data enhances the predictive accuracy of JME prognosis. Combining these neuroanatomical features with clinical variables provided a robust prediction of JME prognosis, highlighting the importance of integrating multimodal data for accurate prognosis.
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Affiliation(s)
- Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Bo Kyu Choi
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Nica A. Drug-resistant juvenile myoclonic epilepsy: A literature review. Rev Neurol (Paris) 2024; 180:271-289. [PMID: 38461125 DOI: 10.1016/j.neurol.2024.02.385] [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: 11/18/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/11/2024]
Abstract
The ILAE's Task Force on Nosology and Definitions revised in 2022 its definition of juvenile myoclonic epilepsy (JME), the most common idiopathic generalized epilepsy disorder, but this definition may well change again in the future. Although good drug response could almost be a diagnostic criterion for JME, drug resistance (DR) is observed in up to a third of patients. It is important to distinguish this from pseudoresistance, which is often linked to psychosocial problems or psychiatric comorbidities. After summarizing these aspects and the various definitions applied to JME, the present review lists the risk factors for DR-JME that have been identified in numerous studies and meta-analyses. The factors most often cited are absence seizures, young age at onset, and catamenial seizures. By contrast, photosensitivity seems to favor good treatment response, at least in female patients. Current hypotheses on DR mechanisms in JME are based on studies of either simple (e.g., cortical excitability) or more complex (e.g., anatomical and functional connectivity) neurophysiological markers, bearing in mind that JME is regarded as a neural network disease. This research has revealed correlations between the intensity of some markers and DR, and above all shed light on the role of these markers in associated neurocognitive and neuropsychiatric disorders in both patients and their siblings. Studies of neurotransmission have mainly pointed to impaired GABAergic inhibition. Genetic studies have generally been inconclusive. Increasing restrictions have been placed on the use of valproate, the standard antiseizure medication for this syndrome, owing to its teratogenic and developmental risks. Levetiracetam and lamotrigine are prescribed as alternatives, as is vagal nerve stimulation, and there are several other promising antiseizure drugs and neuromodulation methods. The development of better alternative treatments is continuing to take place alongside advances in our knowledge of JME, as we still have much to learn and understand.
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Affiliation(s)
- A Nica
- Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Clinical Investigation Center 1414, Rennes University Hospital, Rennes, France; Signal and Image Processing Laboratory (LTSI), INSERM, Rennes University, Rennes, France.
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Ke M, Hou L, Liu G. The co-activation patterns of multiple brain regions in Juvenile Myoclonic Epilepsy. Cogn Neurodyn 2024; 18:337-347. [PMID: 38699614 PMCID: PMC11061087 DOI: 10.1007/s11571-022-09838-7] [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: 11/30/2021] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/03/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME) as an idiopathic generalized epilepsy has been studied by many advanced neuroimaging techniques to elucidate its neuroanatomical basis and pathophysiological mechanisms. In this paper, we used co-activation patterns (CAPs) to explore the differences of dynamic brain activity changes in resting state between JME patients and healthy controls. 27 cases JME patients and 27 cases healthy of fMRI data were collected. The structural image data of the subjects were analyzed by voxel-based morphological analysis, and the regions with gray matter volume atrophy and high voxel were selected as the regions of interest. Further, the mean disease duration was used as boundary to divide the patients' data into the below-average time and the above-average time groups, which were defined as patient disease duration groups. And these data were used to construct CAPs and to compare changes in brain dynamics. It was found that the number of patterns occurrences and the possibility of switching between patterns were smaller than those in the healthy control, which indicated patients with damage to brain regions. For the patient time control group, the number of patterns occurrences and the possibility of switching between patterns were similar, while there was linear regression between the three values and disease duration. Collectively, this study provides important evidence for revealing the key brain regions of JME by studying the transformation between CAPs. Future studies could investigate the effects of receiving treatment on patient dynamic brain activity.
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Affiliation(s)
- Ming Ke
- School of Computer and Communication, Lanzhou University of Technology, 730050 Lanzhou, China
| | - Lei Hou
- School of Computer and Communication, Lanzhou University of Technology, 730050 Lanzhou, China
| | - Guangyao Liu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, 730030 Lanzhou, China
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [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: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Cerulli Irelli E, Cocchi E, Morano A, Gesche J, Caraballo RH, Lattanzi S, Strigaro G, Catania C, Ferlazzo E, Pascarella A, Casciato S, Quarato P, Pizzanelli C, Pulitano P, Giuliano L, Viola V, Mostacci B, Fortunato F, Marini C, Di Gennaro G, Gambardella A, Labate A, Operto FF, Giallonardo AT, Baykan B, Beier CP, Di Bonaventura C. Levetiracetam vs Lamotrigine as First-Line Antiseizure Medication in Female Patients With Idiopathic Generalized Epilepsy. JAMA Neurol 2023; 80:1174-1181. [PMID: 37782485 PMCID: PMC10546294 DOI: 10.1001/jamaneurol.2023.3400] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
Importance After the recent limitations to prescribing valproate, many studies have highlighted the challenging management of female patients of reproductive age with idiopathic generalized epilepsy (IGE). However, no study, to the authors' knowledge, has addressed the comparative effectiveness of alternative antiseizure medications (ASMs) in these patients. Objective To compare the effectiveness and safety of levetiracetam and lamotrigine as initial monotherapy in female patients of childbearing age with IGE. Design, Setting, and Participants This was a multicenter, retrospective, comparative effectiveness cohort study analyzing data from patients followed up from 1994 to 2022. Patients were recruited from 22 primary, secondary, and tertiary adult and child epilepsy centers from 4 countries. Eligible patients were female individuals of childbearing age, diagnosed with IGE according to International League Against Epilepsy (2022) criteria and who initiated levetiracetam or lamotrigine as initial monotherapy. Patients were excluded due to insufficient follow-up after ASM prescription. Exposures Levetiracetam or lamotrigine as initial monotherapy. Main Outcomes and Measures Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazards regression was performed to compare treatment failure (TF) among patients who received levetiracetam or lamotrigine as initial monotherapy. Results A total of 543 patients were included in the study, with a median (IQR) age at ASM prescription of 17 (15-21) years and a median (IQR) follow-up of 60 (24-108) months. Of the study population, 312 patients (57.5%) were prescribed levetiracetam, and 231 (42.5%) were prescribed lamotrigine. An IPTW-adjusted Cox model showed that levetiracetam was associated with a reduced risk of treatment failure after adjustment for all baseline variables (IPTW-adjusted hazard ratio [HR], 0.77; 95% CI, 0.59-0.99; P = .04). However, after stratification according to different IGE syndromes, the higher effectiveness of levetiracetam was confirmed only in patients with juvenile myoclonic epilepsy (JME; IPTW-adjusted HR, 0.47; 95% CI, 0.32-0.68; P < .001), whereas no significant differences were found in other syndromes. Patients treated with levetiracetam experienced adverse effects more frequently compared with those treated with lamotrigine (88 of 312 [28.2%] vs 42 of 231 [18.1%]), whereas the 2 ASMs had similar retention rates during follow-up (IPTW-adjusted HR, 0.91; 95% CI, 0.65-1.23; P = .60). Conclusions and Relevance Results of this comparative effectiveness research study suggest the use of levetiracetam as initial alternative monotherapy in female patients with JME. Further studies are needed to identify the most effective ASM alternative in other IGE syndromes.
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Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, New York
| | | | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Roberto H. Caraballo
- Department of Neurology, Hospital de Pediatría “Prof. Dr. Juan P Garrahan”, Buenos Aires, Argentina
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Gionata Strigaro
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria “Maggiore della Carità”, Novara, Italy
| | - Cecilia Catania
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, “Bianchi-Melacrino-Morelli” Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Angelo Pascarella
- Regional Epilepsy Centre, “Bianchi-Melacrino-Morelli” Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Chiara Pizzanelli
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Veronica Viola
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Carla Marini
- Child Neurology and Psychiatric Unit, Pediatric Hospital G. Salesi, United Hospitals of Ancona, Ancona, Italy
| | | | | | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Francesca F. Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Betul Baykan
- Istanbul University Istanbul Faculty of Medicine, Department of Neurology and EMAR Medical Center, Istanbul, Turkey
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Nakamura Y, Sakurai K, Ishikawa S, Horinouchi T, Hashimoto N, Kusumi I. Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy. Epilepsy Behav 2023; 145:109345. [PMID: 37441983 DOI: 10.1016/j.yebeh.2023.109345] [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: 04/11/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients with epilepsy (PWE), especially those with Idiopathic Epilepsy (GE), are at a high risk of disadvantage caused by non-adherence. It has been suggested that medical visit behavior may be a surrogate indicator of medication adherence. We hypothesized that patients with IGE would adhere poorly to visits. METHODS This was a retrospective study of PWE who visited the Department of Psychiatry and Neurology at Hokkaido University Hospital between January 2017 and December 2019. Demographic and clinical information on PWE were extracted from medical records and visit data from the medical information system. Non-attendance of outpatient appointments was defined as "not showing up for the day of an appointment without prior notice." Mixed-effects logistic regression analysis was conducted with non-attendance as the objective variable. RESULTS Of the 9151 total appointments, 413 were non-attendances, with an overall non-attendance rate of 4.5%. IGE was a more frequent non-attendance than Focal Epilepsy (FE) (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.17-3.21; p = 0.010). History of public assistance receipt was associated with higher non-attendance (OR 2.04; 95% CI 1.22-3.43; p = 0.007), while higher education (OR 0.64; 95% CI 0.43-0.93; p = 0.021) and farther distance to a hospital (OR 0.33; 95% CI 0.13-0.88; p = 0.022), and higher frequency of visits (OR 0.18; 95% CI 0.04-0.86; p = 0.031) were associated with fewer non-attendances. In a subgroup analysis of patients with GE, women were associated with fewer non-attendance (OR 0.31; 95% CI 0.14-0.72; p = 0.006). CONCLUSIONS GE was more frequent in the non-attendance group than in the FE group. Among patients with GE, females were found to have non-attendance less frequently; however, there was no clear difference in the odds of non-attendance between Juvenile Myoclonic Epilepsy (JME) and IGE other than JME.
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Affiliation(s)
- Yuichi Nakamura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan.
| | - Kotaro Sakurai
- Department of Neuropsychiatry, Aichi Medical University, 1-1, Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Toru Horinouchi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
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Laskar S, Chaudhry N, Choudhury C, Garg D. Gender differences in quality of life and psychiatric comorbidities among persons with juvenile myoclonic epilepsy: A single-center cross-sectional study. J Neurosci Rural Pract 2023; 14:482-487. [PMID: 37692809 PMCID: PMC10483207 DOI: 10.25259/jnrp_34_2023] [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: 01/16/2023] [Accepted: 05/19/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized/genetic epilepsy syndrome. Gender differences are known in clinical presentation, with a well-identified female predilection. We aimed to study gender-based differences in quality of life (QoL) and psychiatric comorbidities among persons with JME. Materials and Methods This was a cross-sectional study conducted at a teaching hospital in Delhi, India. Persons above 11 years of age with JME diagnosed according to the International League Against Epilepsy criteria established in 2001 were enrolled. QoL assessment was made using Quality of Life in Epilepsy Inventory-Adolescents-48 (QOLIE-AD-48) and Patient-Weighted Quality of Life in Epilepsy Inventory 31 (QOLIE-31-P) for adolescent and adult patients, respectively. For the assessment of psychiatric comorbidities, participants were administered the Mini-International Neuropsychiatric Interview (M.I.N.I). Participants who tested positive for psychiatric comorbidities on M.I.N.I subsequently underwent the Diagnostic and Statistical Manual-5 categorization. Results We enrolled 50 patients with JME. Eighteen (36%) were male and 32 (64%) were female patients. The median age of males at study enrollment was 23.5 (range 15-38) years. The median age of females was 22 (16-48) years. The median QOLIE-31-P score among males was 68.31 (37.13-91.82) and for females was 66.9 (31.7-99.1). The median overall QoL score for males was 65 (25-87.5), which qualified as "fair" QoL. For females, the median overall QoL score was 62.5 (10-87.5) which also qualified as "fair" QoL. No significant difference was noted between genders in QoL (P = 0.723). Among males, 55.5% had psychiatric comorbidity. Of these, two had mild depression and eight had anxiety. Among female patients, 34.4% had comorbid psychiatric issues; 6 had anxiety and 5 had depression. No significant difference was noted between genders (P = 0.9136). Conclusion Persons with JME do not have gender-stratified differences in terms of psychiatric comorbidities and QoL despite differences in exposure to antiseizure medications and other gender-related factors. All persons with JME should be screened for psychiatric comorbidities, specifically anxiety, and depression.
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Affiliation(s)
- Sanghamitra Laskar
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neera Chaudhry
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Cankatika Choudhury
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Rubboli G, Beier CP, Selmer KK, Syvertsen M, Shakeshaft A, Collingwood A, Hall A, Andrade DM, Fong CY, Gesche J, Greenberg DA, Hamandi K, Lim KS, Ng CC, Orsini A, Striano P, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK. Variation in prognosis and treatment outcome in juvenile myoclonic epilepsy: a Biology of Juvenile Myoclonic Epilepsy Consortium proposal for a practical definition and stratified medicine classifications. Brain Commun 2023; 5:fcad182. [PMID: 37361715 PMCID: PMC10288558 DOI: 10.1093/braincomms/fcad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Reliable definitions, classifications and prognostic models are the cornerstones of stratified medicine, but none of the current classifications systems in epilepsy address prognostic or outcome issues. Although heterogeneity is widely acknowledged within epilepsy syndromes, the significance of variation in electroclinical features, comorbidities and treatment response, as they relate to diagnostic and prognostic purposes, has not been explored. In this paper, we aim to provide an evidence-based definition of juvenile myoclonic epilepsy showing that with a predefined and limited set of mandatory features, variation in juvenile myoclonic epilepsy phenotype can be exploited for prognostic purposes. Our study is based on clinical data collected by the Biology of Juvenile Myoclonic Epilepsy Consortium augmented by literature data. We review prognosis research on mortality and seizure remission, predictors of antiseizure medication resistance and selected adverse drug events to valproate, levetiracetam and lamotrigine. Based on our analysis, a simplified set of diagnostic criteria for juvenile myoclonic epilepsy includes the following: (i) myoclonic jerks as mandatory seizure type; (ii) a circadian timing for myoclonia not mandatory for the diagnosis of juvenile myoclonic epilepsy; (iii) age of onset ranging from 6 to 40 years; (iv) generalized EEG abnormalities; and (v) intelligence conforming to population distribution. We find sufficient evidence to propose a predictive model of antiseizure medication resistance that emphasises (i) absence seizures as the strongest stratifying factor with regard to antiseizure medication resistance or seizure freedom for both sexes and (ii) sex as a major stratifying factor, revealing elevated odds of antiseizure medication resistance that correlates to self-report of catamenial and stress-related factors including sleep deprivation. In women, there are reduced odds of antiseizure medication resistance associated with EEG-measured or self-reported photosensitivity. In conclusion, by applying a simplified set of criteria to define phenotypic variations of juvenile myoclonic epilepsy, our paper proposes an evidence-based definition and prognostic stratification of juvenile myoclonic epilepsy. Further studies in existing data sets of individual patient data would be helpful to replicate our findings, and prospective studies in inception cohorts will contribute to validate them in real-world practice for juvenile myoclonic epilepsy management.
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Affiliation(s)
- Guido Rubboli
- Danish Epilepsy Centre, Filadelfia, Dianalund 4293, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - Kaja K Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo 0372, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo 1337, Norway
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo 3004, Norway
| | - Amy Shakeshaft
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Anna Hall
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Danielle M Andrade
- Adult Epilepsy Genetics Program, Krembil Research Institute, University of Toronto, Toronto M5T 0S8, Canada
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - David A Greenberg
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus 43215, USA
| | - Khalid Hamandi
- Department of Neurology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Ching Ching Ng
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa 56126, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Disease Unit, IRCCS Istituto ‘G. Gaslini’, Genova 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova 16132, Italy
| | - Rhys H Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Jana Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
- Motol University Hospital, Prague 150 06, Czech Republic
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto M5G 1X8, Canada
- Departments of Statistical Sciences and Computer Science and Division of Biostatistics, The University of Toronto, Toronto M5G 1Z5, Canada
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
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Cervenka MC. Let’s Talk About Sex and Juvenile Myoclonic Epilepsy. Epilepsy Curr 2022; 22:356-358. [DOI: 10.1177/15357597221120487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
[Box: see text]
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Shakeshaft A, Panjwani N, Collingwood A, Crudgington H, Hall A, Andrade DM, Beier CP, Fong CY, Gardella E, Gesche J, Greenberg DA, Hamandi K, Koht J, Lim KS, Møller RS, Ng CC, Orsini A, Rees MI, Rubboli G, Selmer KK, Striano P, Syvertsen M, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK. Sex-specific disease modifiers in juvenile myoclonic epilepsy. Sci Rep 2022; 12:2785. [PMID: 35190554 PMCID: PMC8861057 DOI: 10.1038/s41598-022-06324-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/25/2021] [Indexed: 11/22/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME) is a common idiopathic generalised epilepsy with variable seizure prognosis and sex differences in disease presentation. Here, we investigate the combined epidemiology of sex, seizure types and precipitants, and their influence on prognosis in JME, through cross-sectional data collected by The Biology of Juvenile Myoclonic Epilepsy (BIOJUME) consortium. 765 individuals met strict inclusion criteria for JME (female:male, 1.8:1). 59% of females and 50% of males reported triggered seizures, and in females only, this was associated with experiencing absence seizures (OR = 2.0, p < 0.001). Absence seizures significantly predicted drug resistance in both males (OR = 3.0, p = 0.001) and females (OR = 3.0, p < 0.001) in univariate analysis. In multivariable analysis in females, catamenial seizures (OR = 14.7, p = 0.001), absence seizures (OR = 6.0, p < 0.001) and stress-precipitated seizures (OR = 5.3, p = 0.02) were associated with drug resistance, while a photoparoxysmal response predicted seizure freedom (OR = 0.47, p = 0.03). Females with both absence seizures and stress-related precipitants constitute the prognostic subgroup in JME with the highest prevalence of drug resistance (49%) compared to females with neither (15%) and males (29%), highlighting the unmet need for effective, targeted interventions for this subgroup. We propose a new prognostic stratification for JME and suggest a role for circuit-based risk of seizure control as an avenue for further investigation.
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Affiliation(s)
- Amy Shakeshaft
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Naim Panjwani
- Program in Genetics and Genome Biology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
| | - Holly Crudgington
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
| | - Anna Hall
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
| | - Danielle M Andrade
- Adult Epilepsy Genetics Program, Krembil Research Institute, University of Toronto, Toronto, Canada
| | | | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | - Jeanette Koht
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rikke S Møller
- Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Ching Ching Ng
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Mark I Rees
- Neurology Research Group, Swansea University Medical School, Swansea, UK
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Kaja K Selmer
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Pasquale Striano
- IRCCS Istituto 'G. Gaslini', Genoa, Italy
- University of Genova, Genoa, Italy
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo, Norway
| | - Rhys H Thomas
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle, UK
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Jana Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- King's College Hospital, London, UK
| | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
- Departments of Statistical Sciences and Computer Science and Division of Biostatistics, The University of Toronto, Toronto, Canada.
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neurosciences Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Road, London, SE5 9RX, UK.
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
- King's College Hospital, London, UK.
- Evelina London Children's Hospital, London, UK.
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Ascoli M, Mastroianni G, Gasparini S, Striano P, Cianci V, Neri S, Bova V, Mammì A, Gambardella A, Labate A, Aguglia U, Ferlazzo E. Diagnostic and therapeutic approach to drug-resistant juvenile myoclonic epilepsy. Expert Rev Neurother 2021; 21:1265-1273. [PMID: 33993822 DOI: 10.1080/14737175.2021.1931126] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Juvenile myoclonic epilepsy (JME), also known as Janz syndrome, is a common form of generalized epilepsy of presumed genetic origin representing up to 10% of all epilepsy cases. Despite adequate anti-seizure medication (ASM) treatment, seizures persist in one-third of JME patients. AREAS COVERED A literature search was conducted using Pubmed search on the topics of drug-resistant JME. EXPERT OPINION About 30% of JME patients are drug-resistant. Valproate (VPA) is considered the first-choice drug. In women of childbearing potential, levetiracetam (LEV) should represent the first-choice treatment. Alternative monotherapy or add-on therapy should be considered in subjects with resistant seizures after the exclusion of pseudo-drug resistance. The choice of the add-on ASM depends on the predominant seizure type. In subjects with persistent bilateral tonic-clonic seizures, LEV or lamotrigine should be firstly considered. In patients with difficult-to-treat myoclonic seizures, clonazepam or LEV are recommended. In case of persistent absences, ethosuximide should be considered. With appropriate selection and safeguards in place, VPA should remain available as an option in women of childbearing potential whose seizures are resistant to other treatments.
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Affiliation(s)
- Michele Ascoli
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Disease Unit, IRCCS Institute "Giannina Gaslini", Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Valentina Bova
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
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Sex as a Prognostic Factor in Systematic Reviews: Challenges and Lessons Learned. J Pers Med 2021; 11:jpm11060441. [PMID: 34063786 PMCID: PMC8223789 DOI: 10.3390/jpm11060441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 02/04/2023] Open
Abstract
Sex is a common baseline factor collected in studies that has the potential to be a prognostic factor (PF) in several clinical areas. In recent years, research on sex as a PF has increased; however, this influx of new studies frequently shows conflicting results across the same treatment or disease state. Thus, systematic reviews (SRs) addressing sex as a PF may help us to better understand diseases and further personalize healthcare. We wrote this article to offer insights into the challenges we encountered when conducting SRs on sex as a PF and suggestions on how to overcome these obstacles, regardless of the clinical domain. When carrying out a PF SR with sex as the index factor, it is important to keep in mind the modifications that must be made in various SR stages, such as modifying the PF section of CHARMS-PF, adjusting certain sections of QUIPS and extracting data on the sex and gender terms used throughout the studies. In this paper, we provide an overview of the lessons learned from carrying out our reviews on sex as a PF in different disciplines and now call on researchers, funding agencies and journals to realize the importance of studying sex as a PF.
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