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Kessi M, Yan F, Pan L, Chen B, Olatoutou E, Li D, He F, Rugambwa T, Yang L, Peng J, Yin F. Treatment for the Benign Childhood Epilepsy With Centrotemporal Spikes: A Monocentric Study. Front Neurol 2021; 12:670958. [PMID: 34025572 PMCID: PMC8134665 DOI: 10.3389/fneur.2021.670958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose: To date, there is no specific treatment guideline for the benign childhood epilepsy with centrotemporal spikes (BECTS). Several countries recommend levetiracetam, carbamazepine, sodium valproate, oxcarbazepine, and lamotrigine as first-line drugs. Nevertheless, some of these drugs are associated with cognitive decline. Available studies that investigated the efficacy of levetiracetam and sodium valproate on BECTS involved small sample sizes. This study aimed to evaluate the efficacy of levetiracetam and sodium valproate on cognition, and to investigate the prognostic factors for BECTS as whole. Methods: Clinical data and treatment status of all patients with BECTS at Xiangya Hospital, Central South University followed from 2008 to 2013 were analyzed retrospectively. Since electrical status epilepticus in sleep (ESES) has been confirmed to play a role in cognitive deterioration, in order to evaluate the response to drugs and their cognitive effects, we created two groups of patients according to the levels of spike wave index (SWI): group 1; 0–50% SWI and group 2; >50% SWI at the last follow up. Results: A total of 195 cases were enrolled: 49.7% received monotherapies, 24.1% duotherapies and 27.2% polytherapies. Medications included; levetiracetam plus other drug (s) (75.9%), levetiracetam alone (32.8%), sodium valproate plus other drug (s) (31.3%), and sodium valproate alone (5.1%). After 2 years of treatment and follow up, 71% of the cases had a good seizure outcome, 15.9% had an improvement of SWI, and 91.7% had a normal DQ/IQ. Sodium valproate combined with levetiracetam, and sodium valproate alone correlated with good improvement of SWI, whereas, focal spikes were linked with poor improvement. For both groups (group 1 and group 2): monotherapy, levetiracetam alone, and a normal DQ/IQ at seizure onset correlated with good cognitive outcomes, in contrast, polytherapy, sodium valproate plus other drug (s), levetiracetam plus sodium valproate, an initial SWI of ≥85%, and multifocal spikes were linked to cognitive deterioration. Conclusions: Monotherapy, particularly levetiracetam seems to be a good first-line therapy which can help in normalizing the electroencephalograph and preventing cognitive decline. Polytherapy, mostly the administration of sodium valproate seems to relate with poor cognition, therefore, it is recommended to avoid it.
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Affiliation(s)
- Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fangling Yan
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Langui Pan
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Baiyu Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Eleonore Olatoutou
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Dong Li
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Tibera Rugambwa
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
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A Systematic Review of Seizure-Freedom Rates in Patients With Benign Epilepsy of Childhood With Centrotemporal Spikes Receiving Antiepileptic Drugs. Clin Neuropharmacol 2021; 44:39-46. [PMID: 33605607 DOI: 10.1097/wnf.0000000000000435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate seizure remission rates in patients with benign epilepsy of childhood with centrotemporal spikes (BECTS) receiving antiepileptic drugs. METHODS PubMed and Web of Science were searched for studies on pharmacotherapy in patients with BECTS using free search terms or Medical Subject Headings. Only studies that used seizure-freedom rates as an indicator for pharmaceutical efficacy were considered. Different antiepileptic drugs were compared using the Fisher exact test for seizure-freedom rates. RESULTS A total of 19 studies were included, 6 of them being randomized controlled trials. The randomized controlled trials included a total of 308 patients and covered sulthiame (n = 52), topiramate (n = 45), levetiracetam (n = 43), oxcarbazepine (n = 31), carbamazepine (n = 68), and clobazam (n = 18) as well as placebo (n = 35) and untreated control groups (n = 16). Treatment success rates were significantly higher in those children treated with sulthiame, levetiracetam, and clobazam compared with the children treated with carbamazepine, oxcarbazepine, or topiramate. CONCLUSIONS The available literature suggests the use of sulthiame, levetiracetam, or clobazam as first-line agents for the treatment of BECTS.
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Reduced hippocampal recruitment during response conflict resolution in mesial temporal lobe epilepsy. Neuroimage 2020; 213:116723. [PMID: 32173408 DOI: 10.1016/j.neuroimage.2020.116723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 01/13/2023] Open
Abstract
Recent evidence suggests that the human hippocampus (HC) is not only involved in the processing of motivationally relevant approach-avoidance conflicts but is also engaged in the resolution of more general response conflicts as measured in the Stroop paradigm. Here we investigated whether neural activity in the HC is necessary for successful response conflict resolution. We compared hippocampal recruitment during an auditory Stroop paradigm in 20 patients with mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis and 20 age-matched healthy controls using functional magnetic resonance imaging (fMRI). We analyzed hippocampal activation and behavioral performance in conflict trials relative to non-conflict trials. Moreover, functional connectivity (FC) analyses with left and right HCs as seeds were performed. Subjects' regional gray matter volumes were analyzed based on high-resolution T2-weighted MRI scans. The current study replicated previous results showing increased activation in left HC during the processing of conflict trials in healthy subjects. By contrast, MTLE patients showed higher behavioral costs of response conflict resolution and reduced conflict-related HC activation. In patients with left MTLE, left HC activation was predictive of faster conflict-related response times (RTs). By contrast, right HC activation was related to RT slowing, suggestive of a maladaptive compensation attempt in MTLE patients. Our results provide evidence that left hippocampal activation is required for the successful resolution of response conflicts.
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Cao Y, He X, Zhao L, He Y, Wang S, Zhang T, Jiang J. Efficacy and safety of Levetiracetam as adjunctive treatment in children with focal onset seizures: A systematic review and meta-analysis. Epilepsy Res 2019; 153:40-48. [DOI: 10.1016/j.eplepsyres.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/16/2019] [Accepted: 04/01/2019] [Indexed: 01/20/2023]
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Zhang Q, Yang F, Hu Z, Xu Q, Bernhardt BC, Quan W, Li Q, Zhang Z, Lu G. Antiepileptic Drug of Levetiracetam Decreases Centrotemporal Spike-Associated Activation in Rolandic Epilepsy. Front Neurosci 2018; 12:796. [PMID: 30542255 PMCID: PMC6277790 DOI: 10.3389/fnins.2018.00796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/15/2018] [Indexed: 01/16/2023] Open
Abstract
The objective was to study the modulation effects of levetiracetam on the fMRI activation/deactivation patterns associated with centrotemporal spikes (CTS) in Rolandic epilepsy. Forty patients with Rolandic epilepsy, including levetiracetam-medicated patients (n = 20) and drug-naive patients (n = 20), were studied. Single and sequential hemodynamic response functions-based EEG-fMRI analysis was performed to detect dynamic activation/deactivation associated with CTS. Comparisons of spatiotemporal features of activation/deactivation were performed between the two groups. Both the groups (CTS were detected in 12 cases of levetiracetam-medicated group, and 11 cases of drug-naive group) showed CTS-associated activation in the Rolandic cortex, whereas activation strength, time-to-peak delay, and overall activation were diminished in the levetiracetam-medicated group. Moreover, the drug-naive group showed deactivation in the regions engaged in higher cognition networks compared with the levetiracetam-medicated group. Levetiracetam inhibits CTS-associated activation intensity and alters the temporal pattern of this activation in the epileptogenic regions, and it also affects the brain deactivation related to higher cognition networks. The findings sheds a light on the pharmocological mechanism of levetiracetam therapy on Rolandic epilepsy.
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Affiliation(s)
- Qirui Zhang
- Department of Medical Imaging, Jinling Hospital, Southern Medical University, Nanjing, China.,Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Fang Yang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Boris C Bernhardt
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Wei Quan
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Qian Li
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Southern Medical University, Nanjing, China.,Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Tacke M, Borggraefe I, Gerstl L, Heinen F, Vill K, Bonfert M, Bast T, Neubauer BA, Baumeister F, Baethmann M, Bentele K, Blank C, Blank HM, Bode H, Bosch F, Brandl U, Brockmann K, Dahlem P, Ernst JP, Feldmann E, Fiedler A, Gerigk M, Heß S, Hikel C, Hoffmann HG, Kieslich M, Klepper J, Kluger G, Koch H, Koch W, Korinthenberg R, Krois I, Kühne H, Kurlemann G, Mandl M, Mause U, Navratil P, Opp J, Penzien J, Prietsch V, Quattländer A, Rating D, Schara U, Shamdeen MG, Sprinz A, Wendker-Magrabi H, Stephani U, Muhle H, Straßburg HM, Töpke B, Trollmann R, Tuschen-Hofstätter E, Waltz S, Weber G, Wien FU, Wolff M, Polster T, Freitag H, Sönmez Ö, Reinhardt K, Traus M, Hoovey Z. Effects of Levetiracetam and Sulthiame on EEG in benign epilepsy with centrotemporal spikes: A randomized controlled trial. Seizure 2018; 56:115-120. [PMID: 29475094 DOI: 10.1016/j.seizure.2018.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/19/2017] [Accepted: 01/22/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE BECTS (benign childhood epilepsy with centrotemporal spikes) is associated with characteristic EEG findings. This study examines the influence of anti-convulsive treatment on the EEG. METHODS In a randomized controlled trial including 43 children with BECTS, EEGs were performed prior to treatment with either Sulthiame or Levetiracetam as well as three times under treatment. Using the spike-wave-index, the degree of EEG pathology was quantified. The EEG before and after initiation of treatment was analyzed. Both treatment arms were compared and the EEG of the children that were to develop recurrent seizures was compared with those that were successfully treated. RESULTS Regardless of the treatment agent, the spike-wave-index was reduced significantly under treatment. There were no differences between the two treatment groups. In an additional analysis, the EEG characteristics of the children with recurrent seizures differed statistically significant from those that did not have any further seizures. CONCLUSION Both Sulthiame and Levetiracetam influence the EEG of children with BECTS. Persistent EEG pathologies are associated with treatment failures.
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Affiliation(s)
- Moritz Tacke
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany.
| | - Ingo Borggraefe
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany; Epilepsy Center, University of Munich, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Michaela Bonfert
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Thomas Bast
- Kork Epilepsy Center, Kehl-Kork, Germany; Faculty of Medicine of the University of Freiburg, Germany
| | | | - Bernd Axel Neubauer
- Department of Neuropediatrics, Justus-Liebig-University of Giessen, Germany; Children's Hospital, Rosenheim, Germany
| | | | | | | | | | | | - Harald Bode
- University Children's Hospital, Ulm, Germany
| | | | | | | | | | | | | | | | | | - Soeren Heß
- University Children's Hospital, Halle, Germany
| | | | | | | | | | - Gerhard Kluger
- Epilepsy Center, Vogtareuth, Germany; PMU Salzburg, Austria
| | | | | | | | | | | | | | | | - Ulrike Mause
- Hoechst Children's Hospital, Frankfurt am Main, Germany
| | | | | | | | | | | | - Dietz Rating
- University Children's Hospital, Heidelberg, Germany
| | - Ulrike Schara
- Pediatric Neurology, University of Duisburg Essen, Germany
| | | | - Andreas Sprinz
- Center for Interdisciplinary Pediatric Neurology, Kempten, Germany
| | | | | | | | | | | | | | | | | | | | - Frank U Wien
- University Children's Hospital, Magdeburg, Germany
| | - Markus Wolff
- University Children's Hospital, Tübingen, Germany
| | - Tilman Polster
- Pediatric Epileptology, Mara, Bethel Epilepsy Centre, Bielefeld, Germany
| | - Hedwig Freitag
- Pediatric Epileptology, Mara, Bethel Epilepsy Centre, Bielefeld, Germany
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Vidaurre J, Twanow JDE. Attention Deficit Hyperactivity Disorder and Associated Cognitive Dysfunction in Pediatric Epilepsy. Semin Pediatr Neurol 2017; 24:282-291. [PMID: 29249508 DOI: 10.1016/j.spen.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric comorbidity associated with childhood epilepsy, affecting about a third of children with epilepsy. In contrast, ADHD in the general population occurs in 4%-12% of school-aged children. The cause of this association remains unclear. It is likely that common mechanisms underlie the vulnerability for both executive deficits and epileptogenesis. There are characteristics unique to children with ADHD and epilepsy. The inattentive type of ADHD is more prevalent than the combined presentation in children with epilepsy, while the combined type is more common in the general population. Interestingly, there is an equal sex distribution of ADHD in patients with epilepsy, while in the general population, ADHD is 3-7 times more prevalent in boys. Specific features of ADHD seen in different epilepsy syndromes are frequently associated with executive deficits. Early screening of ADHD symptoms in children with epilepsy is essential, as timely interventions can improve academic and social function and outcomes. The mainstays of therapy include behavioral interventions and pharmacotherapy, with evidence demonstrating that stimulants are both safe and effective in children with ADHD and epilepsy.
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Affiliation(s)
- Jorge Vidaurre
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
| | - Jaime Dawn E Twanow
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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8
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Epilepsy in patients with GRIN2A alterations: Genetics, neurodevelopment, epileptic phenotype and response to anticonvulsive drugs. Eur J Paediatr Neurol 2017; 21:530-541. [PMID: 28109652 DOI: 10.1016/j.ejpn.2017.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/08/2016] [Accepted: 01/02/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To delineate the genetic, neurodevelopmental and epileptic spectrum associated with GRIN2A alterations with emphasis on epilepsy treatment. METHODS Retrospective study of 19 patients (7 females; age: 1-38 years; mean 10.1 years) with epilepsy and GRIN2A alteration. Genetic variants were classified according to the guidelines and recommendations of the American College of Medical Genetics (ACMG). Clinical findings including epilepsy classification, treatment, EEG findings, early childhood development and neurodevelopmental outcome were collected with an electronic questionnaire. RESULTS 7 out of 19 patients fulfilled the ACMG-criteria of carrying "pathogenic" or "likely pathogenic variants", in twelve patients the alterations were classified as variants of unknown significance. The spectrum of pathogenic/likely pathogenic mutations was as follows: nonsense n = 3, missense n = 2, duplications/deletions n = 1 and splice site n = 1. First seizures occurred at a mean age of 2.4 years with heterogeneous seizure types. Patients were treated with a mean of 5.6 AED. 4/5 patients with VPA had an improved seizure frequency (n = 3 with a truncation: n = 1 missense). 3/5 patients with STM reported an improvement of seizures (n = 2 truncation, n = 1 splicing). 3/5 CLB patients showed an improvement (n = 2: truncation; n = 1 splicing). Steroids were reported to have a positive effect on seizure frequency in 3/5 patients (n = 1 each truncation, splicing or deletion). CONCLUSIONS Our data indicate that children with epilepsy due to pathogenic GRIN2A mutations present with different clinical phenotypes and a spectrum of seizure types in the context of a pharmacoresistant epilepsy providing information for clinicians treating children with this form of genetically determined epileptic syndrome.
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Scalp-recorded high-frequency oscillations in atypical benign partial epilepsy. Clin Neurophysiol 2016; 127:3306-13. [DOI: 10.1016/j.clinph.2016.07.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/09/2016] [Accepted: 07/06/2016] [Indexed: 02/04/2023]
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10
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Guida M, Iudice A, Bonanni E, Giorgi FS. Effects of antiepileptic drugs on interictal epileptiform discharges in focal epilepsies: an update on current evidence. Expert Rev Neurother 2015; 15:947-59. [PMID: 26162283 DOI: 10.1586/14737175.2015.1065180] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Interictal epileptiform discharges (IEDs), occurring in the electroencephalograms (EEG) of patients with focal epilepsy, are crucial for diagnosis, while their relationship with seizure severity and recurrence is controversial. The effects of antiepileptic drugs (AEDs) on IEDs are even more debated. In general, it is currently believed by experts in the field that most of the classical AEDs do not significantly affect IEDs occurrence in these patients, and that monitoring their EEG effects during treatment is useless. In this review, we update the existing literature on the effects of classical and newer AEDs on focal IEDs, emphasizing the scarcity of data concerning the latter. We also discuss potential limits of available clinical and experimental data and future perspectives.
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Affiliation(s)
- Melania Guida
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa-Pisa University Hospital, Pisa, Italy
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11
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Vannest J, Tenney JR, Gelineau-Morel R, Maloney T, Glauser TA. Cognitive and behavioral outcomes in benign childhood epilepsy with centrotemporal spikes. Epilepsy Behav 2015; 45:85-91. [PMID: 25775975 DOI: 10.1016/j.yebeh.2015.01.041] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 01/10/2023]
Abstract
We review the evidence that BECTS may be associated with cognitive dysfunction and behavioral problems, the extent to which these problems may be associated with patterns of EEG abnormalities in BECTS, and the impact of antiepileptic medication on cognition and behavior in BECTS. A growing literature examining cognitive and behavioral outcomes suggests that children with BECTS perform below the level of their peers. Consistent with this, neuroimaging studies reveal that BECTS has an impact on structural and functional brain development, but the potential influence of frequency and lateralization of centrotemporal spikes (CTS) on cognition and behavior is not well understood. Treatment with AEDs is an option in BECTS, but existing studies have not clearly shown a clear relationship between elimination of CTS and improved cognitive or behavioral outcomes.
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12
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Shamdeen MG, Jost W, Frohnhöfer M, Gortner L, Meyer S. Effect of sulthiame on EEG pathology, behavior and school performance in children with Rolandic epileptiform discharges. Pediatr Int 2012; 54:798-800. [PMID: 22726228 DOI: 10.1111/j.1442-200x.2012.03688.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rolandic epileptiform discharges (RED) may be associated with behavioral difficulties and low school performance. The aim of this study was to assess whether sulthiame is effective in improving electroencephalogram (EEG) pathology, and whether these changes are paralleled by improved school performance and behavior. METHODS In this single-center study at a university hospital, 38 children with RED (27 boys, 11 girls; mean age, 6 years; range, 3-11 years), but no overt seizures, were included. Sixteen of them were treated with sulthiame (3-10 mg/kg). The observational period was 12 months. In both groups serial EEG was performed, and school performance and behavioral skills were assessed by parents and teachers. RESULTS Children treated with sulthiame showed marked improvement on EEG pathology when compared to the non-treated group (75% vs 44%; P= 0.149). Improvement of EEG pathology was significantly associated with better school performance and normalization of behavioral difficulties (P= 0.016). A significant positive correlation was established between sulthiame treatment and improved intellectual/school performance and behavior (P < 0.05). Side-effects (transient episodes of tachypnea) were rare (four children; 25%). CONCLUSION EEG pathology can be improved with sulthiame in children with RED. The EEG changes were associated with improved clinical outcome parameters. The present findings need to be confirmed in a larger randomized controlled trial.
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Affiliation(s)
- Mohammed Ghiath Shamdeen
- Department of Paediatrics and Neonatology, Section Neuropaediatrics, University Children's Hospital of Saarland, Homburg, Germany
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13
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Khan S, Al Baradie R. Epileptic encephalopathies: an overview. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:403592. [PMID: 23213494 PMCID: PMC3508533 DOI: 10.1155/2012/403592] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 09/12/2012] [Indexed: 11/22/2022]
Abstract
Epileptic encephalopathies are an epileptic condition characterized by epileptiform abnormalities associated with progressive cerebral dysfunction. In the classification of the International League Against Epilepsy eight age-related epileptic encephalopathy syndromes are recognized. These syndromes include early myoclonic encephalopathy and Ohtahara syndrome in the neonatal period, West syndrome and Dravet syndrome in infancy, myoclonic status in nonprogressive encephalopathies, and Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and epilepsy with continuous spike waves during slow wave sleep in childhood and adolescences. Other epileptic syndromes such as migrating partial seizures in infancy and severe epilepsy with multiple independent spike foci may be reasonably added. In this paper, we provide an overview of epileptic encephalopathies including clinical neurophysiological features, cognitive deterioration, and management options especially that these conditions are generally refractory to standard antiepileptic drugs.
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Affiliation(s)
- Sonia Khan
- Department of Clinical Neurosciences, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia
| | - Raidah Al Baradie
- Department of Pediatrics, University of Dammam and King Fahad Specialist Hospital, P.O. Box 2435, Dammam 31451, Saudi Arabia
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Ebus S, Arends J, Hendriksen J, van der Horst E, de la Parra N, Hendriksen R, Santegoeds E, Boon P, Aldenkamp B. Cognitive effects of interictal epileptiform discharges in children. Eur J Paediatr Neurol 2012; 16:697-706. [PMID: 22750349 DOI: 10.1016/j.ejpn.2012.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 04/01/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
Frequent interictal epileptiform discharges (IEDs) may have effects on cognition. We analysed a group of 182 children with different epilepsy syndromes as well as children with IEDs without observed seizures [corrected], with 24-h ambulatory EEG and cognitive tests. The IED index was estimated, in wakefulness and in sleep, as percentage of time in five categories (0%, <1%, 1-10%, ≥10-50% and ≥50%). IEDs were defined as spikes or spike-wave complexes, isolated or occurring serially (in runs) without evident clinical signs of a seizure. The IED categories were correlated to cognitive test results and epilepsy characteristics. The group of patients with diurnal IEDs in ≥10% of the EEG record showed impaired central information processing speed, short-term verbal memory and visual-motor integration. This effect was seen independently from other EEG-related and epilepsy-related characteristics, and independently from epilepsy syndrome diagnosis. The impact of the nocturnal IEDs was of less importance; only contributing partially to the slowing of central information processing speed. We conclude that frequent IEDs (in more than 10% of the record) in the awake EEG can impair cognitive performance in children. Whether children with a high diurnal spike frequency and low seizure frequency can benefit from antiepileptic treatment should be examined in controlled trials.
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Affiliation(s)
- S Ebus
- Epilepsy Centre Kempenhaeghe, Postbus 61, 5590 AB Heeze, The Netherlands.
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Abstract
Effective treatment of epilepsy depends on medication compliance across a lifetime, and studies indicate that drug tolerability is a significant limiting factor in medication maintenance. Available antiepileptic drugs (AEDs) have the potential to exert detrimental effects on cognitive function and therefore compromise patient wellbeing. On the other hand, some agents may serve to enhance cognitive function. In this review paper, we highlight the range of effects on cognition linked to a variety of newer and older AEDs, encompassing key alterations in both specific executive abilities and broader neuropsychological functions. Importantly, the data reviewed suggest that the effects exerted by an AED could vary depending on both patient characteristics and drug-related variables. However, there are considerable difficulties in evaluating the available evidence. Many studies have failed to investigate the influence of patient and treatment variables on cognitive functioning. Other difficulties include variation across studies in relation to design, treatment group and assessment tools, poor reporting of methodology and poor specification of the cognitive abilities assessed. Focused and rigorous experimental designs including a range of cognitive measures assessing more precisely defined abilities are needed to fill the gaps in our knowledge and follow up reported patterns in the literature. Longitudinal studies are needed to improve our understanding of the influence of factors such as age, tolerance and the stability of cognitive effects. Future trials comparing the effects of commonly prescribed agents across patient subgroups will offer critical insight into the role of patient characteristics in determining the cognitive impact of particular AEDs.
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You SJ. Cognitive function of idiopathic childhood epilepsy. KOREAN JOURNAL OF PEDIATRICS 2012; 55:159-63. [PMID: 22670150 PMCID: PMC3362729 DOI: 10.3345/kjp.2012.55.5.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 02/26/2012] [Indexed: 11/27/2022]
Abstract
Most children with epilepsy are of normal intelligence. However, a significant subset will have temporary or permanent cognitive impairment. Factors that affect cognitive function are myriad and include the underlying neuropathology of the epilepsy, seizures, epileptiform discharges, psychosocial problems, age at seizure onset, duration of epilepsy, and side effects associated with antiepileptic drugs. This review article discusses cognitive function in children with idiopathic epilepsy and the effects of antiepileptic drugs on cognitive function in children.
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Affiliation(s)
- Su Jeong You
- Department of Pediatrics, Epilepsy Center, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Bakke KA, Larsson PG, Eriksson AS, Eeg-Olofsson O. Levetiracetam reduces the frequency of interictal epileptiform discharges during NREM sleep in children with ADHD. Eur J Paediatr Neurol 2011; 15:532-8. [PMID: 21683631 DOI: 10.1016/j.ejpn.2011.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 04/13/2011] [Accepted: 04/22/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Symptoms of attention deficit hyperactivity disorder (ADHD) are more common in children with epilepsy than in the general paediatric population. Epileptiform discharges in EEG may be seen in children with ADHD also in those without seizure disorders. Sleep enhances these discharges which may be suppressed by levetiracetam. AIM To assess the effect of levetiracetam on focal epileptiform discharges during sleep in children with ADHD. METHOD In this retrospective study a new semi-automatic quantitative method based on the calculation of spike index in 24-h ambulatory EEG recordings was applied. Thirty-five ADHD children, 17 with focal epilepsy, one with generalised epilepsy, and 17 with no seizure disorder were evaluated. Follow-up 24-h EEG recordings were performed after a median time of four months. RESULTS Mean spike index was 50 prior to levetiracetam treatment and 21 during treatment. Seventeen children had no focal interictal epileptiform discharges in EEG at follow-up. Five children had a more than 50% reduction in spike index. Thus, a more than 50% reduction in spike index was found in 22/35 children (63%). Out of these an improved behaviour was noticed in 13 children (59%). CONCLUSION This study shows that treatment with levetiracetam reduces interictal epileptiform discharges in children with ADHD. There is a complex relationship between epilepsy, ADHD and epileptiform activity, why it is a need for prospective studies in larger sample sizes, also to ascertain clinical benefits.
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Affiliation(s)
- Kristin A Bakke
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway.
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Overvliet GM, Aldenkamp AP, Klinkenberg S, Nicolai J, Vles JSH, Besseling RMH, Backes W, Jansen JFA, Hofman PA, Hendriksen J. Correlation between language impairment and problems in motor development in children with rolandic epilepsy. Epilepsy Behav 2011; 22:527-31. [PMID: 21937281 DOI: 10.1016/j.yebeh.2011.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/11/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE An association between impaired school performance and rolandic epilepsy is frequently reported. Language outcome, in particular, seems to be affected, although rolandic epilepsy originates from the motor-sensory cortex. In this study we tried to find a correlation between locomotion problems and language impairment. METHODS In this noncontrolled, open, clinical cohort study of 48 children with rolandic epilepsy, a 24-hour EEG and a neuropsychological assessment were obtained for all children. RESULTS Children with rolandic epilepsy had a significant delay in reading skills (reading words: mean=6 months, SD=11.9, P<0.002; reading sentences: mean=8.6 months, SD=12.7, P<0.001), compared with the healthy population. There was a significant correlation between problems in motor development and delays in reading skills (reading words: r=-0.426, P=0.006; reading sentences: r=-0.343, P=0.03). CONCLUSION Reading performance is impaired in children with rolandic epilepsy. Reading of sentences is more impaired than reading of words. There is a significant correlation between problems in motor development and language, suggesting their interaction at the level of the cortex.
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A prospective open-labeled trial with levetiracetam in pediatric epilepsy syndromes: Continuous spikes and waves during sleep is definitely a target. Seizure 2011; 20:320-5. [DOI: 10.1016/j.seizure.2010.12.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/17/2010] [Accepted: 12/27/2010] [Indexed: 11/20/2022] Open
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Oguni H. Treatment of benign focal epilepsies in children: when and how should be treated? Brain Dev 2011; 33:207-12. [PMID: 21095081 DOI: 10.1016/j.braindev.2010.10.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 10/27/2010] [Accepted: 10/28/2010] [Indexed: 11/29/2022]
Abstract
Benign focal epilepsies represent almost one-fourth of all childhood epilepsies and are a frequent occurrence in clinical practice. They include benign infantile seizures (BIS), Panayiotopoulos syndrome (PS), and benign childhood epilepsy with centrotemporal spikes (BCECTS) in this order of the onset age. Because the prognosis is always excellent in patients with benign focal epilepsies, we must consider the risks and benefits of chronic antiepileptic drug (AED) administration. AED treatment is usually not recommended for the patients with a first attack, but should be considered for those with a second or third attack. A choice of AED has been based on the expert opinion. Carbamazepine (CBZ) is recommended for both acute and chronic treatment of seizure clusters in patients with BIS. Valproic acid (VPA), CBZ or clobazam (CLB) appears to be a first option of AED for patients with PS. A common first choice for BCECTS is CBZ in the USA and Japan, and VPA in the EU. The treatment period should be as short as possible without waiting for EEG normalization, possibly within 2 years after the initiation of AED. We must remember that some patients with BCECTS may have an "atypical evolution". In conclusion, when and how to treat this benign condition should be determined in an individual manner based on the length and frequency of seizures, circadian rhythm of the attacks, interictal EEG findings, cognitive and behavioral functions in daily life and the attitude of the parents toward seizure recurrences and AED side effects.
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Affiliation(s)
- Hirokazu Oguni
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan.
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Millichap JG. Levetiracetam Add-On Therapy for Rolandic and Other Benign Idiopathic Focal Epilepsies. Pediatr Neurol Briefs 2010. [DOI: 10.15844/pedneurbriefs-24-3-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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