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Grau-López L, Flores-Pina B, Jiménez M, Carbonell J, Ciurans J, Chies E, Fagundez O, Fumanal A, Becerra JL. Epileptiform electroencephalogram discharges increase seizure recurrence risk in patients with acute symptomatic seizure due to a structural brain lesion. Seizure 2024; 117:56-59. [PMID: 38330750 DOI: 10.1016/j.seizure.2024.02.001] [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: 09/25/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE The risk factors for seizure recurrence after acute symptomatic seizure due to a structural brain lesion are not well established. The aim of this study was to analyze possible associations between demographic, clinical, and electroencephalographic variables and epilepsy development in patients with acute symptomatic seizure due to an acute structural brain lesion. METHODS We designed an observational prospective study of patients with acute symptomatic seizure due to an acute structural brain lesion (hemorrhagic stroke, ischemic stroke, traumatic brain injury, or meningoencephalitis) who underwent EEG during their initial admission between January 2015 and January 2020. We analyzed prospectively recorded demographic, clinical, electroencephalographic (EEG), and treatment-related variables. All variables were compared between patients with and without seizure recurrence during 2 years of follow up. RESULTS We included 194 patients (41.2 % women; mean [SD] age, 57.3 [15.8] years) with acute symptomatic seizure due to an acute structural brain lesion. They all underwent EEG during admission and were followed for at least 2 years. The identifiable causes were hemorrhagic stroke (44.8 %), ischemic stroke (19.5 %), traumatic brain injury (18.5 %), and meningoencephalitis (17 %). Fifty-six patients (29 %) experienced a second seizure during follow-up. Seizure recurrence was associated with epileptiform discharges on EEG (52% vs 32 %; OR 2.3 [95 % CI, 1.2-4.3], p = 0.008) and onset with status epilepticus (17% vs 0.05 %, OR 4.03 [95 % CI 1.45-11.2], p = 0.009). CONCLUSIONS Epileptiform discharges on EEG and status epilepticus in patients with acute symptomatic seizure due to an acute structural brain lesion are associated with a higher risk of epilepsy development.
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Affiliation(s)
- Laia Grau-López
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain.
| | - Belén Flores-Pina
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Marta Jiménez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Jaime Carbonell
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Jordi Ciurans
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Eva Chies
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Olga Fagundez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Alejandra Fumanal
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
| | - Juan Luis Becerra
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916, Badalona, Spain
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Hemida M, Rosendahl S, Jokinen TS, Moore R, Vuori KA, Anturaniemi J, Hielm-Björkman A. Assessing the association between supplemented puppyhood dietary fat sources and owner-reported epilepsy in adulthood, among Finnish companion dogs. Front Vet Sci 2023; 10:1227437. [PMID: 37781290 PMCID: PMC10540444 DOI: 10.3389/fvets.2023.1227437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Epilepsy is a serious and common neurological condition in dogs, despite the wide number of antiepileptic drugs available, in approximately one third of the patients, epilepsy remains unsatisfactorily controlled. We aim to analyze whether feeding dietary fat sources during puppyhood was associated with canine epilepsy in adulthood. Methods A nested case-control study was compiled from the validated DogRisk food frequency questionnaire (DogRisk FFQ). DogRisk FFQ collected feeding, disease, and background data about the dog. The study sample consisted of 108 owner-reported epileptic cases and 397 non-epileptic controls. Each case was matched with up to four controls for the key confounding factors of sex, breed, and age. We analyzed associations between feeding as a puppy and owner-reported epilepsy as an adult dog using Cox regression. We tested 55 different food variables. Results We found that feeding fish fat from dietary sources at least once a week during puppyhood was inversely associated with epilepsy in later life in the unadjusted analysis [OR 0.46 (95% CI 0.25-0.83), p=0.01], while when adjusting for keeping conditions and dog characteristics the association was [OR 0.45 (95% CI 0.23-0.88), p=0.02]. When adjusted for keeping conditions, dog characteristics, and other feeding factors, the association was of similar magnitude but not significance [OR 0.56 (95% CI 0.27-1.15), p=0.12]. Discussion The study indicates possible protective associations of feeding the dog with dietary sources of fish fat against epilepsy, although the result could be confounded by other feeding factors. Findings are compatible with current knowledge regarding the role of omega-3 fatty acids and ketogenic diet, a low carbohydrate, high fat diet as supportive treatments of epilepsy. As our findings are based on observations, we suggest the possibility of causality but do not prove it. Dietary intervention studies should now be conducted to confirm our findings.
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Affiliation(s)
- Manal Hemida
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Nutrition and Clinical Nutrition, Faculty of Veterinary Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Sarah Rosendahl
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Tarja S. Jokinen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Robin Moore
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Kristiina A. Vuori
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Anturaniemi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Anna Hielm-Björkman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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3
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Akunal Türel C, Çelik H, Çetinkaya A, Türel İ. Electrophysiologic and anti-inflammatorial effects of cyclooxygenase inhibition in epileptiform activity. Physiol Rep 2023; 11:e15800. [PMID: 37688418 PMCID: PMC10492010 DOI: 10.14814/phy2.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 09/10/2023] Open
Abstract
The aim of our study is to investigate the electrophysiological and anti-inflammatory effects of diclofenac potassium on epileptiform activity, which is the liquid form of diclofenac, and frequently used clinically for inflammatory process by inhibiting cyclooxygenase enzyme (COX). Wistar rats aged 2-4 months were divided into Epilepsy, Diazepam, Diclofenac potassium, and Diazepam+diclofenac potassium groups. Diazepam and diclofenac potassium were administered intraperitoneally 30 min after the epileptiform activity was created with penicillin injected intracortically under anesthesia. After the electrophysiological recording was taken in the cortex for 125 min, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were evaluated by the ELISA in the serums. No change was observed between the groups in serum IL-1β, IL-6, and TNF-α values. It was observed that the co-administration of diclofenac potassium and diazepam at 51-55, 56-60, 61-65, 111-115, and 116-120 min was more effective in reducing spike amplitude than diclofenac potassium alone (p < 0.05). Single-dose diclofenac potassium did not have an anti-inflammatory effect in epileptiform activity but both diazepam and diclofenac potassium reduced the epileptiform activity.
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Affiliation(s)
- Canan Akunal Türel
- Department of NeurologyBolu Abant Izzet Baysal University Medical SchoolBolu Merkez/BoluTurkey
| | - Hümeyra Çelik
- Department of PhysiologyAlanya Alaaddin Keykubat University Medical SchoolAntalyaTurkey
| | - Ayhan Çetinkaya
- Department of PhysiologyBolu Abant Izzet Baysal University Medical SchoolBolu Merkez/BoluTurkey
| | - İdris Türel
- Department of PharmacologyBolu Abant Izzet Baysal University Medical SchoolBolu Merkez/BoluTurkey
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Cappellari AM, Mariani S, Bruschi G. Febrile seizures and convulsions with mild gastroenteritis: age-dependent acute symptomatic seizures. Front Pediatr 2023; 11:1151770. [PMID: 37534200 PMCID: PMC10390780 DOI: 10.3389/fped.2023.1151770] [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: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Background Febrile seizures (FS) and benign convulsions in children with mild gastroenteritis (CwG) are acute symptomatic seizures, transiently occurring in infants and young children, probably related to the immaturity of the brain. Our paper aims to review the literature data on patients with FS and CwG. Methods A review of series of patients with FS and CwG was performed by literature search on PubMed January 1960 to October 2022. Several parameters were considered, including epidemiology, pathophysiology, clinical features, electroencephalographic findings and other diagnostic studies, and treatment. Results FS and CwG share an age-dependent course, but they show significant differences in the pathophysiology, clinical features, diagnostic studies, and treatment. Conclusion Acute symptomatic seizures include seizures that are caused by acute structural brain pathologies, such as stroke, as well as seizures that are provoked by a reversible factor, such as hyponatraemia, although the two groups should be not equated. Furthermore, FS and CwG should be set apart as "age-dependent acute symptomatic seizures", reinforcing the concept of their self-limited course over a certain period.
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Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Mariani
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
| | - Gaia Bruschi
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
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5
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Büyükbayram Z, Aksoy M, Yılmaz R. Difficult lives: A descriptive and relational study on the coping with stress and care burden of caregivers of patients with epilepsy. Epilepsy Behav 2023; 145:109297. [PMID: 37336137 DOI: 10.1016/j.yebeh.2023.109297] [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: 04/06/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
AIM This study was conducted to examine the relationship between coping with stress status and the burden of care of the caregivers of patients with epilepsy. MATERIALS AND METHODS This descriptive correlational study was carried out with a total of 230 voluntary caregivers of patients with epilepsy who visited the neurology clinics and outpatient clinics of a training and research hospital in the southeastern part of Turkiye between March 2022 and February 2023. Study data were collected through the Personal Information Form, the Zarit Caregiver Burden Assessment and the Ways of Coping Scale. Descriptive statistics and multiple regression analysis were used for the evaluation of the data. FINDINGS While the mean score of the caregivers from the Zarit Caregiver Burden Assessment was 41.20 ± 12.44, they had mean scores of 12.12 ± 3.25, 8.93 ± 1.93, 12.24 ± 3.61, 8.77 ± 3.17, and 7.89 ± 1.95, respectively, from the self-confident approach, optimistic approach, helpless approach, submissive approach, and social support-seeking approach sub-dimensions. In the study, a moderate positive statistically significant relationship was found between the caregivers' burden of care and the mean scores of the helpless and submissive approach sub-dimensions(p < 0.05). CONCLUSION The caregivers' burden of care and coping with stress were at moderate levels. The helpless approach, which is one of the ineffective methods of coping with stress, was found to be higher. The helpless and submissive approaches were found to increase in this study as the caregivers' burden of care increased. IMPLICATIONS The use of effective coping skills to reduce the level of personal burden of care would improve the caregiver's physical health and psychological well-being.
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Affiliation(s)
- Zeliha Büyükbayram
- Siirt University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Siirt, Turkey.
| | - Meyreme Aksoy
- Siirt University, Faculty of Health Sciences, Department of Nursing Fundamentals, Siirt, Turkey.
| | - Rıdvan Yılmaz
- Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
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6
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Zhang Z, Li Q, Jiang T, Fang J. Reflex seizures induced by micturition: a case report. ACTA EPILEPTOLOGICA 2023. [DOI: 10.1186/s42494-022-00107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Reflex seizures (RS) induced by micturition are extremely rare, and the clinical and electroencephalogram features of RS are not widely known among clinicians. In particular, the origin of the epileptic area is still unclear.
Case presentation
An 8-year-old girl who had generalized tonic-clonic seizures was diagnosed with RS induced by micturition based on the clinical manifestation and EEG recordings. We also reviewed the clinical and EEG characteristics of RS induced by micturition in literature by searching the databases of PubMed and MEDLINE using keywords “micturition reflex seizure”, “reflex seizure induced by micturition”, and “micturition induced seizure” by January 2022. We speculate that the mechanism of micturition-induced RS may involve excessive neuronal excitation in regions that participate in micturition.
Conclusions
The RS in this patient was considered to be induced by micturition. Awareness should be raised to this rare form of RS among practitioners.
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Salari V, Mengoni F, Del Gallo F, Bertini G, Fabene PF. The Anti-Inflammatory Properties of Mesenchymal Stem Cells in Epilepsy: Possible Treatments and Future Perspectives. Int J Mol Sci 2020; 21:ijms21249683. [PMID: 33353235 PMCID: PMC7765947 DOI: 10.3390/ijms21249683] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
Mesenchymal stem cells (MSCs) are multipotent adult cells with self-renewing capacities. MSCs display specific properties, such as the ability to repair damaged tissues, resulting in optimal candidates for cell therapy against degenerative diseases. In addition to the reparative functions of MSCs, growing evidence shows that these cells have potent immunomodulatory and anti-inflammatory properties. Therefore, MSCs are potential tools for treating inflammation-related neurological diseases, including epilepsy. In this regard, over the last decades, epilepsy has no longer been considered a purely neuronal pathology, since inflammatory events underlying the genesis of epilepsy have been demonstrated. This review assessed current knowledge on the use of MSCs in the treatment of epilepsy. Mostly, attention will be focused on the anti-inflammatory and immunological skills of MSCs. Understanding the mechanisms by which MSCs might modulate the severity of the disease will contribute to the development of new potential alternatives for both prophylaxis and treatment against epilepsy.
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8
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Hobbs SL, Law TH, Volk HA, Younis C, Casey RA, Packer RMA. Impact of canine epilepsy on judgement and attention biases. Sci Rep 2020; 10:17719. [PMID: 33082493 PMCID: PMC7576193 DOI: 10.1038/s41598-020-74777-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
Idiopathic epilepsy (IE) is the most common chronic neurological condition in dogs, characterised by recurrent seizure activity and associated with negative behavioural and cognitive changes. We hypothesised that IE would negatively impact putative affective state, with dogs with IE exhibiting a more pessimistic judgement bias and more negative attention bias than controls. Dogs were tested in a previously-validated spatial judgement bias task, and a novel auditory attention bias task testing attention to sounds with different valence or salience (neutral, novel pre-habituated, threatening). Sixty-eight dogs (IE = 33, Control = 35) were tested, of which n = 37 acquired the spatial discrimination and responses to judgement bias probes were tested (IE = 19, Control = 18), and n = 36 were tested for responses to sounds (IE = 20, Control = 16). Study groups did not significantly differ by age, sex, breed or neuter-status (p > 0.05). Main effects of study group were not significant in judgement bias (F1,102 = 0.20, p = 0.658) or attention bias tasks (F3,102 = 1.64, p = 0.184). In contrast with our hypotheses, there was no evidence that IE altered cognitive biases in this study population; however, dogs with IE were significantly more likely to be unable to learn the spatial discrimination task (p = 0.019), which may reflect IE-related cognitive deficits. Developing methods to test affective state without excluding cognitively impaired individuals is a future challenge for animal welfare science.
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Affiliation(s)
- Sarah L Hobbs
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK
| | - Tsz Hong Law
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK
| | - Holger A Volk
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg, 30559, Hannover, Germany
| | - Chantal Younis
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK
| | - Rachel A Casey
- Dogs Trust, 17 Wakley Street, The Angel, London, EC1V 7RQ, UK
| | - Rowena M A Packer
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK.
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9
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Lum GR, Olson CA, Hsiao EY. Emerging roles for the intestinal microbiome in epilepsy. Neurobiol Dis 2020; 135:104576. [PMID: 31445165 DOI: 10.1016/j.nbd.2019.104576] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/29/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023] Open
Abstract
The gut microbiome is emerging as a key regulator of brain function and behavior and is associated with symptoms of several neurological disorders. There is emerging evidence that alterations in the gut microbiota are seen in epilepsy and in response to seizure interventions. In this review, we highlight recent studies reporting that individuals with refractory epilepsy exhibit altered composition of the gut microbiota. We further discuss antibiotic treatment and infection as microbiome-related factors that influence seizure susceptibility in humans and animal models. In addition, we evaluate how the microbiome may mediate effects of the ketogenic diet, probiotic treatment, and anti-epileptic drugs on reducing both seizure frequency and severity. Finally, we assess the open questions in interrogating roles for the microbiome in epilepsy and address the prospect that continued research may uncover fundamental insights for understanding risk factors for epilepsy, as well as novel approaches for treating refractory epilepsy.
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Affiliation(s)
- Gregory R Lum
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Christine A Olson
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Elaine Y Hsiao
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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10
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Shorvon S, Trinka E. Regulatory aspects of status epilepticus. Epilepsia 2018; 59 Suppl 2:128-134. [DOI: 10.1111/epi.14547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 12/28/2022]
Affiliation(s)
| | - Eugen Trinka
- Department of Neurology; Paracelsus Medical University; Christian Doppler Medical Center; Salzburg Austria
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11
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Autistic traits in epilepsy models: Why, when and how? Epilepsy Res 2018; 144:62-70. [PMID: 29783181 DOI: 10.1016/j.eplepsyres.2018.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/18/2018] [Accepted: 05/14/2018] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a common comorbidity of epilepsy and seizures and/or epileptiform activity are observed in a significant proportion of ASD patients. Current research also implies that autistic traits can be observed to a various degree in mice and rats with seizures. This suggests that there are shared mechanisms in both ASD and epilepsy syndromes. Here, we first review the standard, validated methods used to assess autistic traits in animal models as well as their limitations with regards to epilepsy models. We then discuss two of the potential pathological processes that could be shared between ASD and epilepsy. We first focus on functional implications of neuroinflammation including changes to excitable networks mediated by inflammatory regulators. Finally we examine mechanisms at the cellular and network level involved in neuronal excitability, timing and network coordination that may directly lead to behavioral disturbances present in both epilepsy and ASD. This mini-review summarizes the work first presented at an Investigators Workshop at the 2016 American Epilepsy Society meeting.
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12
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Packer RM, McGreevy PD, Pergande A, Volk HA. Negative effects of epilepsy and antiepileptic drugs on the trainability of dogs with naturally occurring idiopathic epilepsy. Appl Anim Behav Sci 2018. [DOI: 10.1016/j.applanim.2017.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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13
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Physiological reactivity to spontaneously occurring seizure activity in dogs with epilepsy and their carers. Physiol Behav 2017; 177:27-33. [PMID: 28412282 DOI: 10.1016/j.physbeh.2017.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/20/2017] [Accepted: 04/09/2017] [Indexed: 02/01/2023]
Abstract
There is a complex bidirectional relationship between stress and epilepsy. Stressful stimuli and subsequent cortisol release act as a trigger for seizure activity in some individuals with epilepsy, and seizure activity itself may act as a stressor to the affected individual. Epilepsy is the most common chronic neurological condition in domestic dogs and requires chronic management by their human carers, impacting upon the quality of life of both dog and carer. Seizures occur unpredictably and may be stressful for carers to witness and manage. In the present study we investigated the role of seizure activity as a stressor, measuring the effect of spontaneously occurring seizure activity in dogs with epilepsy upon their own cortisol levels and that of their carers. Furthermore, we tested whether individual differences in HPA reactivity were associated with owner personality characteristics and the quality of the dog-carer relationship. Saliva samples were obtained from sixteen dog-carer dyads in the home setting 20 and 40minute post-seizure, and at time-matched points on the following (non-seizure) day. Significant differences in cortisol levels were found in dogs at 40minute post-seizure (265.1% increase), and at 20minute post-seizure in their carers (40.5% increase). No associations were found between cortisol reactivity and the strength of the dog-carer bond. Carers with higher neuroticism scores exhibited higher cortisol levels at both post-seizure sampling points. As there was a gender bias in the carer sample (15/16 were female), and there are known sex differences in cortisol reactivity in response to psychological stress, the conclusions of this study may be limited to female carers. These findings are the first to objectively demonstrate the acutely stressful effects of seizures in dogs with epilepsy and their carers.
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14
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Osborn KE, Shytle RD, Frontera AT, Soble JR, Schoenberg MR. Addressing potential role of magnesium dyshomeostasis to improve treatment efficacy for epilepsy: A reexamination of the literature. J Clin Pharmacol 2015; 56:260-5. [PMID: 26313363 DOI: 10.1002/jcph.626] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/25/2015] [Indexed: 01/08/2023]
Abstract
Magnesium (Mg(2+) ) is an abundant mineral in the body serving many biochemical functions. Magnesium supplementation has been shown to raise seizure threshold in animal and human studies, but the etiological contribution of magnesium deficiency to the onset and maintenance of epilepsy, as well as the degree to which it impacts antiepileptic drug efficacy, remains poorly understood. This may be due, at least in part, to the inherent limitations of commonly used serum levels as a measure of functional magnesium status, as well as insufficient data regarding relative bioavailabilities of various magnesium salts and chelates for use with humans. To date, 1 randomized clinical trial has been conducted assessing Mg(2+) supplementation in epilepsy, and findings yielded promising results. Yet a notable dearth in the literature remains, and more studies are needed. To better understand the potential role of magnesium deficiency as a causal factor in epilepsy, more convenient and accurate measurement methods should to be developed and employed in randomized, controlled trials of oral magnesium supplementation in epilepsy. Findings from such studies have the potential to facilitate far-reaching clinical and economic improvements in epilepsy treatment standards.
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Affiliation(s)
- Katie E Osborn
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - R Douglas Shytle
- Center for Excellence in Aging and Brain Repair, Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Alfred T Frontera
- Department of Neurology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jason R Soble
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Mike R Schoenberg
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Center for Excellence in Aging and Brain Repair, Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Department of Neurology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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15
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Packer RMA, Volk HA. Epilepsy beyond seizures: a review of the impact of epilepsy and its comorbidities on health-related quality of life in dogs. Vet Rec 2015; 177:306-15. [DOI: 10.1136/vr.103360] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rowena M. A. Packer
- Department of Clinical Science and Services; Royal Veterinary College, Hawkshead Lane Hatfield Hertfordshire AL9 7TA UK
| | - Holger A. Volk
- Department of Clinical Science and Services; Royal Veterinary College, Hawkshead Lane Hatfield Hertfordshire AL9 7TA UK
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De Risio L, Bhatti S, Muñana K, Penderis J, Stein V, Tipold A, Berendt M, Farqhuar R, Fischer A, Long S, Mandigers PJJ, Matiasek K, Packer RMA, Pakozdy A, Patterson N, Platt S, Podell M, Potschka H, Batlle MP, Rusbridge C, Volk HA. International veterinary epilepsy task force consensus proposal: diagnostic approach to epilepsy in dogs. BMC Vet Res 2015; 11:148. [PMID: 26316175 PMCID: PMC4552251 DOI: 10.1186/s12917-015-0462-1] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/29/2015] [Indexed: 12/16/2022] Open
Abstract
This article outlines the consensus proposal on diagnosis of epilepsy in dogs by the International Veterinary Epilepsy Task Force. The aim of this consensus proposal is to improve consistency in the diagnosis of epilepsy in the clinical and research settings. The diagnostic approach to the patient presenting with a history of suspected epileptic seizures incorporates two fundamental steps: to establish if the events the animal is demonstrating truly represent epileptic seizures and if so, to identify their underlying cause. Differentiation of epileptic seizures from other non-epileptic episodic paroxysmal events can be challenging. Criteria that can be used to make this differentiation are presented in detail and discussed. Criteria for the diagnosis of idiopathic epilepsy (IE) are described in a three-tier system. Tier I confidence level for the diagnosis of IE is based on a history of two or more unprovoked epileptic seizures occurring at least 24 h apart, age at epileptic seizure onset of between six months and six years, unremarkable inter-ictal physical and neurological examination, and no significant abnormalities on minimum data base blood tests and urinalysis. Tier II confidence level for the diagnosis of IE is based on the factors listed in tier I and unremarkable fasting and post-prandial bile acids, magnetic resonance imaging (MRI) of the brain (based on an epilepsy-specific brain MRI protocol) and cerebrospinal fluid (CSF) analysis. Tier III confidence level for the diagnosis of IE is based on the factors listed in tier I and II and identification of electroencephalographic abnormalities characteristic for seizure disorders. The authors recommend performing MRI of the brain and routine CSF analysis, after exclusion of reactive seizures, in dogs with age at epileptic seizure onset <6 months or >6 years, inter-ictal neurological abnormalities consistent with intracranial neurolocalisation, status epilepticus or cluster seizure at epileptic seizure onset, or a previous presumptive diagnosis of IE and drug-resistance with a single antiepileptic drug titrated to the highest tolerable dose. This consensus article represents the basis for a more standardised diagnostic approach to the seizure patient. These recommendations will evolve over time with advances in neuroimaging, electroencephalography, and molecular genetics of canine epilepsy.
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Affiliation(s)
- Luisa De Risio
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, UK.
| | - Sofie Bhatti
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium.
| | - Karen Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Jacques Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Craig Leith Road, Stirling, FK7 7LE, Stirlingshire, UK.
| | - Veronika Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Mette Berendt
- Department of Veterinary and Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.
| | - Robyn Farqhuar
- Fernside Veterinary Centre, 205 Shenley Road, Borehamwood, SG9 0TH, Hertfordshire, UK.
| | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Sam Long
- University of Melbourne, 250 Princes Highway, Weibee, 3015, VIC, Australia.
| | - Paul J J Mandigers
- Department of Clinical Sciences of Companion Animals, Utrecht University, Yalelaan 108, 3583 CM, Utrecht, The Netherlands.
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Rowena M A Packer
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK.
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Ned Patterson
- University of Minnesota College of Veterinary Medicine, D426 Veterinary Medical Center, 1352 Boyd Avenue, St. Paul, MN, 55108, USA.
| | - Simon Platt
- College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602, USA.
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, 3123 N. Clybourn Avenue, Chicago, IL, 60618, USA.
| | - Heidrun Potschka
- Department of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximillians-University, Königinstr. 16, 80539, Munich, Germany.
| | - Martí Pumarola Batlle
- Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Campus UAB, Bellaterra, 08193, Barcelona, Spain.
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, UK. .,School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7TE, Surrey, UK.
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK.
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Berendt M, Farquhar RG, Mandigers PJJ, Pakozdy A, Bhatti SFM, De Risio L, Fischer A, Long S, Matiasek K, Muñana K, Patterson EE, Penderis J, Platt S, Podell M, Potschka H, Pumarola MB, Rusbridge C, Stein VM, Tipold A, Volk HA. International veterinary epilepsy task force consensus report on epilepsy definition, classification and terminology in companion animals. BMC Vet Res 2015; 11:182. [PMID: 26316133 PMCID: PMC4552272 DOI: 10.1186/s12917-015-0461-2] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/29/2015] [Indexed: 01/30/2023] Open
Abstract
Dogs with epilepsy are among the commonest neurological patients in veterinary practice and therefore have historically attracted much attention with regard to definitions, clinical approach and management. A number of classification proposals for canine epilepsy have been published during the years reflecting always in parts the current proposals coming from the human epilepsy organisation the International League Against Epilepsy (ILAE). It has however not been possible to gain agreed consensus, "a common language", for the classification and terminology used between veterinary and human neurologists and neuroscientists, practitioners, neuropharmacologists and neuropathologists. This has led to an unfortunate situation where different veterinary publications and textbook chapters on epilepsy merely reflect individual author preferences with respect to terminology, which can be confusing to the readers and influence the definition and diagnosis of epilepsy in first line practice and research studies.In this document the International Veterinary Epilepsy Task Force (IVETF) discusses current understanding of canine epilepsy and presents our 2015 proposal for terminology and classification of epilepsy and epileptic seizures. We propose a classification system which reflects new thoughts from the human ILAE but also roots in former well accepted terminology. We think that this classification system can be used by all stakeholders.
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Affiliation(s)
- Mette Berendt
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.
| | - Robyn G Farquhar
- Fernside Veterinary Centre, 205 Shenley Road, Borehamwood, SG9 0TH, Hertfordshire, UK.
| | - Paul J J Mandigers
- Department of Clinical Sciences of Companion Animals, Utrecht University, Yalelaan 108, 3583 CM, Utrecht, The Netherlands.
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Sofie F M Bhatti
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium.
| | - Luisa De Risio
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, UK.
| | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Sam Long
- University of Melbourne, 250 Princes Highway, Weibee, 3015, Victoria, Australia.
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Karen Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Edward E Patterson
- University of Minnesota College of Veterinary Medicine, D426 Veterinary Medical Center, 1352 Boyd Avenue, St. Paul, MN, 55108, USA.
| | - Jacques Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Craig Leith Road, Stirling, FK7 7LE, Stirlingshire, UK.
| | - Simon Platt
- College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602, USA.
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, 3123 N. Clybourn Avenue, Chicago, IL, 60618, USA.
| | - Heidrun Potschka
- Department of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximillians-University, Königinstr. 16, 80539, Munich, Germany.
| | - Martí Batlle Pumarola
- Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Campus UAB, Bellaterra, 08193, Barcelona, Spain.
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, UK.
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7TE, Surrey, UK.
| | - Veronika M Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK.
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International Veterinary Epilepsy Task Force's current understanding of idiopathic epilepsy of genetic or suspected genetic origin in purebred dogs. BMC Vet Res 2015; 11:175. [PMID: 26316206 PMCID: PMC4552344 DOI: 10.1186/s12917-015-0463-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/29/2015] [Indexed: 12/20/2022] Open
Abstract
Canine idiopathic epilepsy is a common neurological disease affecting both purebred and crossbred dogs. Various breed-specific cohort, epidemiological and genetic studies have been conducted to date, which all improved our knowledge and general understanding of canine idiopathic epilepsy, and in particular our knowledge of those breeds studied. However, these studies also frequently revealed differences between the investigated breeds with respect to clinical features, inheritance and prevalence rates. Awareness and observation of breed-specific differences is important for successful management of the dog with epilepsy in everyday clinical practice and furthermore may promote canine epilepsy research. The following manuscript reviews the evidence available for breeds which have been identified as being predisposed to idiopathic epilepsy with a proven or suspected genetic background, and highlights different breed specific clinical features (e.g. age at onset, sex, seizure type), treatment response, prevalence rates and proposed inheritance reported in the literature. In addition, certain breed-specific diseases that may act as potential differentials for idiopathic epilepsy are highlighted.
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Bhatnagar M, Shorvon S. Genetic mutations associated with status epilepticus. Epilepsy Behav 2015; 49:104-10. [PMID: 25982265 DOI: 10.1016/j.yebeh.2015.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 01/28/2023]
Abstract
This paper reports the results of a preliminary search of the literature aimed at identifying the genetic mutations reported to be strongly associated with status epilepticus. Genetic mutations were selected for inclusion if status epilepticus was specifically mentioned as a consequence of the mutation in standard genetic databases or in a case report or review article. Mutations in 122 genes were identified. The genetic mutations identified were found in only rare conditions (sometimes vanishingly rare) and mostly in infants and young children with multiple other handicaps. Most of the genetic mutations can be subdivided into those associated with cortical dysplasias, inborn errors of metabolism, mitochondrial disease, or epileptic encephalopathies and childhood syndromes. There are no identified 'pure status epilepticus genes'. The range of genes underpinning status epilepticus differs in many ways from the range of genes underpinning epilepsy, which suggests that the processes underpinning status epilepticus differ from those underpinning epilepsy. It has been frequently postulated that status epilepticus is the result of a failure of 'seizure termination mechanisms', but the wide variety of genes affecting very diverse biochemical pathways identified in this survey makes any unitary cause unlikely. The genetic influences in status epilepticus are likely to involve a wide range of mechanisms, some related to development, some to cerebral energy production, some to diverse altered biochemical pathways, some to transmitter and membrane function, and some to defects in networks or systems. The fact that many of the identified genes are involved with cerebral development suggests that status epilepticus might often be a system or network phenomenon. To date, there are very few genes identified which are associated with adult-onset status epilepticus (except in those with preexisting neurological damage), and this is disappointing as the cause of many adult-onset status epilepticus cases remains obscure. It has been suggested that idiopathic adult-onset status epilepticus might often have an immunological cause but no gene mutations which relate to immunological mechanisms were identified. Overall, the clinical utility of what is currently known about the genetics of status epilepticus is slight and the findings have had little impact on clinical treatment despite what has been a very large investment in money and time. New genetic technologies may result in the identification of further genes, but if the identified genetic defects confer only minor susceptibility, this is unlikely to influence therapy. It is also important to recognize that genetics has social implications in a way that other areas of science do not. This article is part of a Special Issue entitled "Status Epilepticus".
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Affiliation(s)
- M Bhatnagar
- UCL Institute of Neurology, University College London, UK
| | - S Shorvon
- UCL Institute of Neurology, University College London, UK.
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Irmen F, Wehner T, Lemieux L. Do reflex seizures and spontaneous seizures form a continuum? - triggering factors and possible common mechanisms. Seizure 2014; 25:72-9. [PMID: 25645641 DOI: 10.1016/j.seizure.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/06/2014] [Accepted: 12/14/2014] [Indexed: 11/26/2022] Open
Abstract
Recent changes in the understanding and classification of reflex seizures have fuelled a debate on triggering mechanisms of seizures and their conceptual organization. Previous studies and patient reports have listed extrinsic and intrinsic triggers, albeit their multifactorial and dynamic nature is poorly understood. This paper aims to review literature on extrinsic and intrinsic seizure triggers and to discuss common mechanisms among them. Among self-reported seizure triggers, emotional stress is most frequently named. Reflex seizures are typically associated with extrinsic sensory triggers; however, intrinsic cognitive or proprioceptive triggers have also been assessed. The identification of a trigger underlying a seizure may be more difficult if it is intrinsic and complex, and if triggering mechanisms are multifactorial. Therefore, since observability of triggers varies and triggers are also found in non-reflex seizures, the present concept of reflex seizures may be questioned. We suggest the possibility of a conceptual continuum between reflex and spontaneous seizures rather than a dichotomy and discuss evidence to the notion that to some extent most seizures might be triggered.
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Affiliation(s)
- Friederike Irmen
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Tim Wehner
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom.
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Camfield C, Camfield P. Most adults with childhood-onset epilepsy and their parents have incorrect knowledge of the cause 20-30 years later: a population-based study. Epilepsy Behav 2014; 37:100-3. [PMID: 25005325 DOI: 10.1016/j.yebeh.2014.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022]
Abstract
RATIONALE Understanding the cause of childhood-onset epilepsy should be important for families and the patient as he/she becomes an adult. We studied the accuracy of information about the cause that adults with childhood-onset epilepsy and their parents reported many years after the initial diagnosis. METHODS Patients and parents in the Nova Scotia childhood-onset epilepsy population-based study were contacted. All patients developed epilepsy between 1977 and 1985 with follow-up 20-30 years later with a semistructured telephone interview. Of 600 eligible patients, 373 (62%) answered a question about what they thought had caused the epilepsy. RESULTS We identified a cause in 210 of 373 (56%) patients, and no cause was found in 44%. Surprisingly, only 38% of families knew the correct cause. Nearly all had been followed during childhood by a child neurologist, and all adults had a family physician. Responses were concordant in 40% with our causal diagnoses and not concordant in 60%. Responses were divided into 5 categories: (1) In 26%, the family was sure of the cause when no cause had been identified; (2) In 16%, there was a definite known cause, but families did not recall any cause at all; (3) In 18%, we did not identify a cause and neither did the family; (4) In 20%, we identified a definite cause as did the family, but the causes were completely different; and (5) In 20%, we identified a cause, the same one as the family. Correct information did not vary with broad epilepsy syndrome groupings, the presence or absence of intellectual disability, epilepsy remission, parental education, or family income. Those with intractable epilepsy were more likely to be concordant (p=0.002). None of those with Rolandic epilepsy were correct (n=41). CONCLUSIONS Most adults with childhood-onset epilepsy and their parents have a strikingly poor recall of the cause. We suggest that families receive this information in a written document that is periodically updated, can be preserved, and can be referred to over time.
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Affiliation(s)
- Carol Camfield
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Peter Camfield
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
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Seizure precipitants (triggering factors) in patients with epilepsy. Epilepsy Behav 2014; 33:101-5. [PMID: 24632482 DOI: 10.1016/j.yebeh.2014.02.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/13/2014] [Accepted: 02/16/2014] [Indexed: 11/23/2022]
Abstract
AIM adult epilepsy clinic population: (a) to identify the frequency of seizure precipitants (triggering factors) and their relative frequency in those with psychiatric disorders, and in those in remission or with active epilepsy, differences in frequency with regard to gender, seizure duration, number of drugs taken; (b) to determine which precipitants patients most commonly report; and (c) to identify differences in the distribution of precipitants among generalized, temporal, and extratemporal epilepsies. METHODS Consecutive patients attending a tertiary-care epilepsy clinic were prospectively and an open personal interview to identify and characterize seizure precipitants. Information about the epilepsy and clinical characteristics of patients was collected during the interview and from medical records. RESULTS Of 104 patients, 97% cited at least one precipitant. Stress, sleep deprivation, and fatigue were the most frequently reported precipitants. Patients with psychological comorbidities reported a greater percentage of seizures with seizure precipitants. Patients with idiopathic generalized epilepsy seemed to be more sensitive to seizures during awakening and sleep deprivation, patients with extratemporal epilepsy reported more frequent seizures during sleep. There were no differences in frequency or type of seizure precipitants with regard to gender, seizure duration or frequency, and the number of antiepileptic drugs taken. CONCLUSION The findings may have implications for the better management of epilepsy by increasing a focus on nonpharmacological therapy. The implications of the findings for nosology and causation of epilepsy are also briefly discussed.
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