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Çubukçu D, Güzel O, Arslan N. Effect of Ketogenic Diet on Motor Functions and Daily Living Activities of Children With Multidrug-Resistant Epilepsy: A Prospective Study. J Child Neurol 2018; 33:718-723. [PMID: 30062917 DOI: 10.1177/0883073818786558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To investigate the effect of ketogenic diet on motor function and daily living activities in children with epilepsy. METHODS A total of 62 children (median age 5.0 years) were enrolled. Motor function was assessed using the Gross Motor Function Measure (GMFM), and daily living activities and cognitive functions were assessed using the Functional Independence Measure (WeeFIM) before treatment and 3, 6, and 12 months after ketogenic diet treatment. RESULTS Significant improvement in total GMFM and WeeFIM scores ( P < .001) were found during the 12 months of ketogenic diet treatment. There was a positive correlation between total GMFM scores and WeeFIM scores at baseline (r= 0.792, P = .0001), and at 3 (r= 0.780, P = .0001), 6 (r= 0.744, P = .0001), and 12 months (r= 0.692, P = .0001) of treatment. Both the responder (50 patients, 80.7%) and nonresponder (12 patients, 19.3%) patient groups showed significantly higher GMFM and WeeFIM scores at 12 months of treatment compared to baseline values. A ≥50% reduction in seizure frequency was observed in 77.4%, 72.6%, and 80.7% of the patients after 3, 6, and 12 months of treatment, respectively. CONCLUSION Ketogenic diet treatment improves motor functions and daily living activities in children with epilepsy during the 12 months of treatment.
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Affiliation(s)
- Duygu Çubukçu
- 1 Department of Physical Medicine and Rehabilitation, Behçet Uz Children Hospital, Izmir, Turkey
| | - Orkide Güzel
- 2 Division of Pediatric Neurology, Behçet Uz Children Hospital, Izmir, Turkey.,3 Mediterranean Ketogenic Diet Center, Izmir, Turkey
| | - Nur Arslan
- 4 Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University, Izmir, Turkey.,5 Izmir Biomedicine and Genome Center (iBG-izmir), Dokuz Eylul University, Izmir, Turkey
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Licchetta L, Bisulli F, Vignatelli L, Zenesini C, Di Vito L, Mostacci B, Rinaldi C, Trippi I, Naldi I, Plazzi G, Provini F, Tinuper P. Sleep-related hypermotor epilepsy: Long-term outcome in a large cohort. Neurology 2016; 88:70-77. [PMID: 27881627 PMCID: PMC5200852 DOI: 10.1212/wnl.0000000000003459] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/21/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the long-term outcome of sleep-related hypermotor epilepsy (SHE). METHODS We retrospectively reconstructed a representative cohort of patients diagnosed with SHE according to international diagnostic criteria, sleep-related seizures ≥75% and follow-up ≥5 years. Terminal remission (TR) was defined as a period of ≥5 consecutive years of seizure freedom at the last follow-up. We used Kaplan-Meier estimates to calculate the cumulative time-dependent probability of TR and to generate survival curves. Univariate and multivariate Cox regression analyses were performed. RESULTS We included 139 patients with a 16-year median follow-up (2,414 person-years). The mean age at onset was 13 ± 10 years. SHE was sporadic in 86% of cases and familial in 14%; 16% of patients had underlying brain abnormalities. Forty-five percent of patients had at least 1 seizure in wakefulness lifetime and 55% had seizures only in sleep (typical SHE). At the last assessment, 31 patients achieved TR (TR group, 22.3%), while 108 (NTR group, 77.7%) still had seizures or had been in remission for <5 years. The cumulative TR rate was 20.4%, 23.5%, and 28.4% by 10, 20, and 30 years from inclusion. At univariate analysis, any underlying brain disorder (any combination of intellectual disability, perinatal insult, pathologic neurologic examination, and brain structural abnormalities) and seizures in wakefulness were more frequent among the NTR group (p = 0.028; p = 0.043). Absence of any underlying brain disorder (hazard ratio 4.21, 95% confidence interval 1.26-14.05, p = 0.020) and typical SHE (hazard ratio 2.76, 95% confidence interval 1.31-5.85, p = 0.008) were associated with TR. CONCLUSIONS Our data show a poor prognosis of SHE after a long-term follow-up. Its outcome is primarily a function of the underlying etiology.
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Affiliation(s)
- Laura Licchetta
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Francesca Bisulli
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy.
| | - Luca Vignatelli
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Corrado Zenesini
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Lidia Di Vito
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Barbara Mostacci
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Claudia Rinaldi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Irene Trippi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Ilaria Naldi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Giuseppe Plazzi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Federica Provini
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Paolo Tinuper
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
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Wirrell EC, Grossardt BR, So EL, Nickels KC. A population-based study of long-term outcomes of cryptogenic focal epilepsy in childhood: cryptogenic epilepsy is probably not symptomatic epilepsy. Epilepsia 2011; 52:738-45. [PMID: 21320114 DOI: 10.1111/j.1528-1167.2010.02969.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare long-term outcome in a population-based group of children with cryptogenic versus symptomatic focal epilepsy diagnosed from 1980 to 2004 and to define the course of epilepsy in the cryptogenic group. METHODS We identified all children residing in Olmsted County, MN, 1 month through 17 years, with newly diagnosed, nonidiopathic focal epilepsy from 1980 to 2004. Children with idiopathic partial epilepsy syndromes were excluded. Medical records were reviewed to determine etiology, results of imaging and EEG studies, treatments used, and long-term outcome. Children were defined as having symptomatic epilepsy if they had a known genetic or structural/metabolic etiology, and as cryptogenic if they did not. KEY FINDINGS Of 359 children with newly diagnosed epilepsy, 215 (60%) had nonidiopathic focal epilepsy. Of these, 206 (96%) were followed for > 12 months. Ninety-five children (46%) were classified as symptomatic. Median follow-up from diagnosis was similar in both groups, being 157 months (25%, 75%: 89, 233) in the cryptogenic group versus 134 months (25%, 75%: 78, 220) in the symptomatic group (p = 0.26). Of 111 cryptogenic cases, 66% had normal cognition. Long-term outcome was significantly better in those with cryptogenic versus symptomatic etiology (intractable epilepsy at last follow-up, 7% vs. 40%, p < 0.001; seizure freedom at last follow-up, 81% vs. 55%, p < 0.001). Of those who achieved seizure freedom at final follow-up, 68% of the cryptogenic group versus only 46% of the symptomatic group were off antiepileptic medications (p = 0.01). One-third of the cryptogenic group had a remarkably benign disorder, with no seizures seen after initiation of medication, or in those who were untreated, after the second afebrile seizure. A further 5% had seizures within the first year but remained seizure-free thereafter. With the exception of perinatal complications, which predicted against seizure remission, no other factors were found to significantly predict outcome in the cryptogenic group. SIGNIFICANCE More than half of childhood nonidiopathic localization-related epilepsy is cryptogenic. This group has a significantly better long-term outcome than those with a symptomatic etiology, and should be distinguished from it.
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Affiliation(s)
- Elaine C Wirrell
- Division of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
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